Objective To systematically analyze and assess the risk of venous thromboembolism in the patients with rheuma‐toid arthritis(RA) .Methods The related literatures on the venous thromboembolism occurrence in the patients with RA published at home and abroad were performed the electronic retrieval .The obtained data were analyzed by adopting the RevMan5 .1 software . The data unable to merge were analyzed by adopting the descriptive analysis method .Results A total of 10 related papers were in‐cluded .The 3 indicators of venous thromboembolism occurrence rate ,deep vein thrombosis occurrence rate and pulmonary thrombo‐embolism occurrence rate were performed the meta analysis .The RR and 95% CI of the occurrence rates of venous thromboembo‐lism ,deep vein thrombosis and pulmonary thromboembolism were 2 .00(1 .71 ,2 .33) ,2 .31(1 .84 ,2 .90) ,2 .25(2 .23 ,2 .28) respec‐tively .Conclusion The risk degree of venous thromboembolism occurrence in the RA patients is higher than that in the non‐RA pa‐tients .

Objective To explore the correlation between adiponectin/leptin(A/L) ratio and metabolic syndrome diagnosis in elderly men. Methods A total of 256 elderly men (≥60 years) were enrolled and divided into metabolic syndrome group(n= 109) and non metabolic syndrome group (n= 147). Serum levels of adiponectin and leptin were measured by radioimmunoassay (RIA) and the A/L ratio was calculated. Metabolic syndrome diagnosis is based on the definition provided by China Diabetes Society (CDS) in 2004. Results (1) In metabolic syndrome group versus non metabolic syndrome group, the serum levels of leptin and adiponectin were (10. 3±7.0) vs (6.8±4.9)μg/L and(7.8±5.6)g/L vs (9.5±5.9)g/L, and A/L ratio was 0. 94±0. 78 vs 2.15±2.13 respectively. (2) A/L ratio was positively correlated with high density lipoprotein cholesterol (HDL-C) and negatively correlated with body mass index (BMI), triacylglycerol (TG) and serum uric acid(P< 0. 001). (3) The higher value of A/L ratio, the lower possibility of metabolic syndrome. When the A/L ratio was more than 5, the incidence of metabolic syndrome was decreased to O(X2 =34. 891 ,P< 0.001). (4) The more components of metabolic abnormality, the lower value of A/L ratio(F= 10. 876,P<0. 001). Conclusions The A/L ratio may be useful in evaluating the extent of metabolic disorder and diagnosing metabolic syndrome in elderly men.

Objective:To analyze the clinical features and genetic factors of neonatal 17β-hydroxysteroid dehydrogenase type10 (HSD10) deficiency.Methods:The clinical characteristics and genetic test results of a child with HSD10 deficiency coming from Children′s Hospital of Nanjing Medical University in April 2019 were retrospectively analyzed.The keywords" 17β-hydroxysteroid dehydrogenase type 10 deficiency" or " 2-Methyl3-Hydroxybutyryl-CoA dehydrogenase deficiency" or " HSD10" , etc.were searched in various databases, including CNKI, Wanfang, Weipu, Embase and PubMed to review the cases collected from all published data until May 31, 2020.Results:The patient was a newborn male who developed symptoms on the first day after birth.The main signs were metabolic acidosis, increased blood ammonia and lactate, and hypotonia.Trio whole exom sequencing in the patient and his parents identified hemizygous NM001037811: c.650G>A, p.R217Q in the HSD17B10 gene that is inherited from the mother.Since the child died on the third day after birth, no further central nervous system examination was performed.The mother of the child has intellectual disability, the sibling sister is normal and the HSD17B10 locus is wild type.By lite-rature reviewing, 5 newborn cases with clear medical records and genetic test results were listed.All patients were male, and had onset of HSD10 deficiency within 1 week after birth.The main phenotypes include metabolic acidosis (increased blood ammonia and lactate), hypoglycemia, hypotonia, and convulsions.All 6 children died in early infancy.The corresponsive HSD17B10 variants were c. 740A>G/p.N247S, c.677G>A/p.R226Q, c.257A>G/p.D86G and c. 650G>A/p.R217Q, which did not indicate the hot spots of mutation. Conclusions:HSD10 deficiency in the neonatal period is relatively rare.The clinical diagnosis is difficult due to the serious condition and short course of the disease.Severe metabolic acidosis, hypotonia, and convulsions in neonatal patients are the main reasons for the poor prognosis, which can be attributed to the hemizygous variation and heterogeneity of the mutation site in male patients.c.650G>A may be closely associated with severe neonatal HSD10 deficiency, but the molecular biological mechanism needs to be further clarified.HSD10 deficiency has a poor prognosis and lacks effective treatment.

Aim To construct and express the eukary-otic expression vector of double-stranded RNA-depend-ent protein kinase (PKR)fusion green fluorescent and analyse its antiviral activity of HBV in vitro.Methods The PKR gene was cloned into an empty expression vector pEGFP-N1 using molecular clone technology. After being confirmed by restriction enzyme digestion and sequencing methods,the recombinant plasmid was named as pEGFP-PKR that was subsequently transfect-ed into HepG2.2.15 cells using LipofectamineTM2000. The expression level of PKR in HepG2.2.15 cells was confirmed by using fluorescent microscopy. Mean-while,HBV DNA and HBsAg/HBeAg were detected by real-time PCR and electrochemiluminescence meth-od,respectively.Results Both restriction enyme di-gestion and sequencing assays showed that the recombi-nant vector pEGFP-PKR was successfully constructed in our study.Fluorescent microscopy observation indi-cated that the fusion protein pEGFP-PKR expressed ef-ficiently in HepG2.2.15 cells.Moreover,compared with the empty vector group,the expression of HBV antigen in supernatants was significantly decreased (P<0.05 ).However,the extracellular HBV DNA ex-pression was not inhibited significantly.Conclusion In vitro,PKR proteion has certain antiviral activity of HBV.

Objective:To investigate the effects of chitin on atopic dermatitis in an OVA induced AD murine model.Methods:Twenty-eight BALB/c mice were randomly divided into three groups:the normal control group (N)(8),the chitin group(E) (10) and the AD model group(M)(10).The murine model of atopic dermatitis was established through intraperitoneal injection of OVA followed by repeated epicutaneous application of OVA on mice back skin( AD model group).During the set up of AD murine model,mice of the chitin group were given intragastric gavage of 3 mg/d for 4 weeks.At the end of the experiment, the mice were sacrificed and skin lesions were biopsied for histological study.HE and O-toluidine stained paraffin sections were observed under microscope.The spleen cells were cultured and challenged with OVA and chitin,respectively,the supernatant was obtained for cytokine determination.Serum levels of total and OVA-specific IgE and total IgG2a were determined with ELISA.Results:Chitin significantly inhibited skin inflammation induced by OVA.Compared with the AD model group,the thickness of the epidermis and dermis in the chitin group were obviously decreased.The numbers of dermal infiltrated inflammatory cells,eosinophils and mast cells were significantly decreased in the chitin group compared with the AD model group ( P<0.05-0.001 ).The serum level of total IgE and OVA-specific IgE were significantly lower in the chitin group than in the AD model group(P<0.05-0.001),while the serum level of IgG2a in the chitin group was significantly higher than that of the AD model group( P<0.001).The cultured spleen cells of the chitin group produced significantly higher levels of IL-12 and IFN-γ,but lower level of IL-4 compared with those of the AD model group after OVA challenge (P<0.05).Conclusion:Chitin can inhibit the inflammation and decease the seum level of IgE in the murine AD model.The antiallergic effect of chitin might be associated with the induced production of Th1 type cytokines by mice spleen cells.

Peking University Third Hospital is one of the first hospitals for experiments in clinical pathway selected by the Ministry of Health,which keeps optimizing the clinical pathway management mechanism and function of information system in its 4-year practice.This article described the combination strategy of clinical pathway management and information system applications,in terms of reasonable design of the management plan,standardized clinical pathway,strengthened execution control and improvement of the quality control.The purpose is to balance the relationship between clinical pathway management norms and user-friendliness of the system,enhance rationality and feasibility,improve efficiency and provide high-quality service to ensure medical safety.

Exploding head syndrome(EHS)is a rare sensory parasomnia and rarely reported in China, leading to serious misdiagnosis, mistreatment, and unnecessary testing. A detailed collection of clinical symptoms and longterm polysomnography-electroencephalography monitoring is very important for diagnosis and differential diagnosis of EHS. We diagnosed a patient with EHS according to the International classification of sleep disorders, third edition diagnostic criteria. The electro-clinical feature of the patient and relevant references were analyzed in order to improve the understanding of EHS, meanwhile to prevent unnecessary testing and avoid misdiagnosis and mistreatment.

Objective:To investigate the changes of T helper cell (Th), regulatory T-cell (Treg cell) related cytokines in vaginal lavage fluid of patients with high risk-human papilloma virus 16 (HR-HPV16) positive and its predictive effect on the development of cervical neoplasms.Methods:A total of 200 cases of HR-HPV16 positive patients who admitted to Xingtai People's Hospital from January 2022 to December 2022 were selected as the experimental group. According to the results of pathological examination, all patients in the experimental group were divided into non pathological group (78 cases), low grade squamous intraepithelial lesion (LSIL) group (49 cases), high grade squamous intraepithelial lesion (HSIL) group (39 cases) and cervical cancer group (34 cases); and 100 healthy people undergoing the physical examination in the same period were taken as the healthy control group. Enzyme-linked immunosorbent assay (ELISA) double-antibody sandwich method was used to detect the levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12, IL-17, tumor necrosis factor α (TNF-α), interferon γ (IFN-γ) and transforming growth factor β (TGF-β) in vaginal lavage fluid of patients in different groups. Multivariate logistics regression was used to analyze the risk factors of cervical cancer, and a nomogram model was established. The receiver operating characteristics (ROC) curve was drawn with pathological results as the gold standard, and the area under the curve (AUC) was calculated to evaluate the predictive ability of the nomogram model.Results:The levels of IL-6, IL-10, IL-17, TNF-α, TGF-β in vaginal lavage fluid of patients in the experimental group were higher than those in the healthy control group, while the levels of IL-2, IL-12 and IFN-γ in the experimental group were lower than those in the healthy control group, and the differences were statistically significant (all P < 0.05); the difference in IL-4 level of both groups was not statistically significant ( P > 0.05). There were statistically significant differences in IL-6, IL-10, IL-17, TNF-α, TGF-β, IL-2, IL-12 and IFN-γ among non pathological group, LSIL group, HSIL group and cervical cancer group (all P < 0.05); the levels of IL-6, IL-10, IL-17, TNF-α, TGF-β in cervical cancer group were the highest, the levels of IL-2, IL-12 and IFN-γ were the lowest; the level of IL-4 in non pathological group, LSIL group, HSIL group and cervical cancer group had no statistically significant difference ( P > 0.05). Logistics regression analysis showed that low IL-2, high IL-4, high IL-6, high IL-10, low IL-12, high IL-17, high TNF-α, low IFN- γ and low TGF-β expressions in vaginal lavage fluid of patients with HR-HPV16 positive were independent risk factors for the development of cervical cancer (all P < 0.05). The results of nomogram analysis showed that IL-6, IL-10, IL-17, TNF-α, TGF-β in vaginal lavage fluid were the factors predicting the development of cervical cancer in HR-HPV16 positive patients. The ROC curve analysis showed that the AUC of nomogram model in predicting the development of cervical cancer in HR-HPV16 positive patients was 0.945 (95% CI 0.901-0.988), and the predictive efficacy was good. Conclusions:Th and Treg cell related cytokines levels in vaginal lavage fluid of patients with HR-HPV16 positive show pathological changes in cervical cancer patients and the above indicators have a high value in predicting the development of cervical cancer.

Standardized electroencephalography (EEG) electrode positions are essential for both clinical applications and research.The aim of the International Federation of Clinical Neurophysiology (IFCN) guideline is to update and expand the unifying nomenclature and standardized positioning for EEG scalp electrodes.Twenty percent and ten percent standard recordings do not cover the anterior and basal temporal lobes.Here,IFCN proposes a basic array of 25 electrodes including the inferior temporal chain,which should be used for all standard clinical recordings.Contrary to the established belief,the guideline suggests at least as many electrodes in young children as in adults.High-density scalp EEG arrays (64-256 electrodes) allow source imaging with even sub-lobar precision.In the future,nomenclature for high density electrodes arrays beyond the 10-10 system needs to be defined,to allow comparison and standardized recordings across centers.

Objective To assess alternations in left ventricular( LV) torsion parameters in healthy subjects and patients with premature ventricular complexes ( PVCs) from the right ventricular outflow tract (RVOT) .Methods ThirtypatientswithPVCsfromRVOTand31healthysubjectswereincluded.Two-dimensional speckle tracking imaging( 2D-STI) was applied to evaluate LV torsion parameters ,including LV rotational degrees in basal and apical levels respectively ,LV total torsional degrees ,and time to peak rotational and torsional degrees . All values of patients with PVCs were recorded during both sinus beats ( PVC-S) and premature ventricular beats ( PVC-V) . Results No significant difference was observed in left ventricular ejection fraction(LVEF) between PVC-S group and control subjects( P > 0 .05) ,while LV rotational degrees in apical levels[( 8 .47 ± 3 .54)° vs (9 .50 ± 3 .21)° , P = 0 .042] and LV total torsional degrees [ (11 .25 ± 6 .31)° vs (14 .00 ± 4 .07)° , P =0 .046] were significantly reduced in PVC-S group . In addition to the reduction of LV rotational degrees in apical levels[( 3 .93 ± 7 .23)° vs (9 .50 ± 3 .21)° , P =0 .000] and LV total torsional degrees[ ( 4 .35 ± 9 .62)° vs (14 .00 ± 4 .07)° , P =0 .000] ,lower apical levels[ ( -0 .57 ± 4 .44)° vs ( -5 .26 ± 3 .84)° , P =0 .000] and advanced LV rotational degrees [ ( 40 .5 ± 18 .6)％vs (48 .0 ± 9 .1)％ , P =0 .05] in basal levels were observed in PVC-V group in comparison with the control subjects . Compared with the PVC-S group ,PVC-V group showed lower LV rotational degrees in basal levels [ ( -0 .57 ± 4 .44)° vs ( -4 .57 ± 4 .57)° , P = 0 .000] and advanced time to peak rotational degrees [ (40 .5 ± 18 .6)％ vs (48 .1 ± 12 .6)％ , P =0 .018] ,as well as advanced time to peak and lower LV total torsionaldegrees[(39.3±15.4)％ vs(46.7±13.8)％ ,P =0.007 ;(4.35±9.62)°vs(11.25±6.31)°,P=0 .001] .Conclusions As to RVOT-PVC patients ,LV myocardial torsional motion has changed in PVC-S mainly manifested as a decrease of rotation degrees in apical levels even if the LVEF is still in the normal range . During PVC-V the rotation and twist degree is further reduced ,and the time sequence altered , accompanied with significantly decreased LVEF .