Objective This study aimed to identify high?risk groups for metabolic syndrome(MS)among Chinese children and adolescents by calculating the cutoff values of adiposity measures and insulin resistance(IR). Methods From December 2010 to January 2011,data from 933 Chinese subjects(492 boys and 436 girls,aged 11?16 years)from Liaoyang City,China,were included. Questionnaires were administered,and da?ta such as anthropometric parameters(height,waist circumference,and hip circumference),blood pressure,fasting blood glucose level,blood lip?id level,serum uric acid level,and fasting insulin level were collected. Receiver?operating characteristic(ROC)curve analysis was used to deter?mine the optimal cutoff waist?to?height ratio(WHtR),waist?to?hip ratio(WHR),homeostasis model assessment?insulin resistance(HOMA?IR) index,triglyceride level,glucose index(TyG index),and serum uric acid(SUA)level for identification of children and adolescents with MS. Results The AUC of WHtR,WHR,TyG index,HOMA?IR index,and SUA level were larger than 0.5,with P values of<0.01. The optimal cutoff WHtR and WHR derived from the ROC analysis were respectively 0.48(87.0%,84.1%)and 0.84(83.3%,70.3%)for boys and 0.46(95.1%, 81.8%)and 0.80(90.5%,71.8%)for girls. Conclusion This study demonstrated that WHtR and WHR are useful predictive markers of MS , while HOMA?IR,TyG index,and SUA level are not. The usefulness of these criteria needs to be verified by further evaluation.

Objective To explore the effects of different doses of sodium fluoride (NaF) on cartilage lesion and expression of interleukin-6 (IL-6) in serum and cartilage tissue of Balb/c mice.Methods Sixty-four 5-week-old male Balb/c mice were divided into 4 groups based on body weight via the random number table method and 16 mice were in each group.The mice in control group were fed with distilled water,and experimental animals in low,middle and high fluoride groups were fed with distilled water containing NaF 25,50 and 100 mg/L,respectively.The mice were weighed once a week and fed for three months to establish the drinking water fluorosis model.The fluoride contents in spine were detected via the fluorin-ion selective electrode method.The pathological changes in articular cartilage and epiphyseal plate cartilage were observed through optical microscope.The levels of serum IL-6 and souble IL-6 receptor (sIL-6R) were detected via the enzyme-linked immunosorbent assay.The expression of IL-6 protein in articular cartilage and epiphyseal plate cartilage was examined by immunohistochemistry.Results From the sixth week of the experiment,compared with other 3 groups,the body weight of high fluoride group decreased significantly (all P ＜ 0.05);from the seventh week,compared with control and low fluoride groups,the body weight of middle fluoride group decreased significantly (all P ＜ 0.05);throughout the experiment,compared with control group,the body weight of low fluoride group had not changed significantly (all P ＞ 0.05).The fluoride contents of bone in control group,low fluoride group,middle fluoride group and high fluoride group were (842.46 ± 89.27),(1 705.05 ± 105.76),(2 614.17 ± 156.10) and (3 444.58 ± 233.69) mg/kg,respectively.The differences between groups were statistically significant (F =309.716,P ＜ 0.05),and fluoride contents of bone increased with increase of fluoride doses (all P ＜ 0.05).Under optical microscope,the cartilage tissue of control group was normal,while articular cartilage and epiphyseal plate cartilage showed different degrees of cartilage ossification in fluorosis mice and the changes increased with the increase of fluoride doses.The levels of serum IL-6 in control group,low fluoride group,middle fluoride group and high fluoride group were (5.98 ± 1.43),(7.54 ± 2.16),(5.25 ± 1.97) and (6.31 ±-1.36) ng/L,respectively.The differences between groups were statistically significant (F =3.840,P ＜ 0.05),low fluoride group was significantly higher than control group (P ＜ 0.05),and middle fluoride group was significantly lower than low fluoride group (P ＜ 0.05).The levels of serum slL-6R in control group,low fluoride group,middle fluoride group and high fluoride group were (0.83 ± 0.20),(0.93 ± 0.23),(0.82 ±0.27) and (0.92 ± 0.28) μg/L,respectively.The differences between groups were not statistically significant (F =0.738,P ＞ 0.05).Immunohistochemical results showed that articular cartilage full-layer cells in each group expressed IL-6 protein especially in the middle layer of chondrocytes,while IL-6 protein only expressed in hypertrophic chondrocytes of epiphyseal plate cartilage.Comparing with other groups,IL-6 positive cells were the most and had the deepest staining in low fluoride group.Conclusions Different doses of NaF could not only cause cartilage lesion,but also change the expression of IL-6 in serum and cartilage tissue of Balb/c mice.The results indicate that IL-6 may be involved in the cartilage lesion caused by fluoride.

Objective To explore characteristics and significance of the indexes of peripheral white blood cell (WBC) in patient with human brucellosis.Methods People checked by brucellosis physical checkup and routine physical checkup at Qiqihar Center for Disease Control and Prevention from December 2014 to December 2015,including 40 acute brucellosis patients (acute group),35 chronic brucellosis patients (chronic group) and 72 healthy people (control group),were selected.Automatic blood analyzer was used to determine the indexes of WBC,lymphocyte count (LY),lymphocyte percentage (LY％),monocytes count (MONO),monocytes percentage (MONO％),eosinophil count (EO),eosinophil percentage (EO％),basophilic granulocyte count (BASO),basophilic granulocyte percentage (BASO％),neutrophils count (NEUT) and neutrophils percentage (NEUT％).The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of WBC parameters in acute and chronic groups.Results Compared to control group,the levels of WBC,EO,EO％,BASO,BASO％,NEUT and NEUT％ were decreased in acute group [(5.222 0-± 2.551 2) × 109/L vs (6.352 5 ± 1.905 8) × 109/L,(0.030 0 ± 0.006 8) × 109/[,vs (0.083 9 ± 0.039 3) × 109/L,(0.54 ± 0.12)％ vs (2.31 ± 0.14)％,(0.009 0 ± 0.001 1) × 109/L vs (0.019 0 ± 0.002 4) × 109/L,(0.17 ± 0.09)％ vs (0.32 ± 0.20)％,(2.698 7 ± 1.948 4) × 109/L vs (4.012 9 ± 1.579 0) × 109/L,(48.13 ± 14.38)％ vs (62.13 ± 9.00)％,all P ＜ 0.05],and the levels of LY,LY％ and MONO％ were increased in acute group [(2.125 3 ± 0.949 9) × 109/L vs (1.794 4 ± 0.606 6) × 109/L,(43.37 ± 14.52)％ vs (29.10 ± 7.97)％,(7.84 ± 2.23)％ vs (6.55 ± 2.04)％,all P ＜ 0.05].Compared to control group,the level of NEUT％ [(54.63 ± 9.26)％] was decreased in chronic group (P ＜ 0.05),and the levels of LY,LY％ and EO [(2.212 0 ± 0.633 2) × 109/L,(36.41 ± 8.51)％,(0.153 9 ± 0.028 8) × 109/L] were increased in chronic group (all P ＜ 0.05).The levels of LY％ and MONO％ [(6.45 ± 1.58)％] in chronic group were lower than those in acute group (all P ＜ 0.05),and the levels of WBC [(6.175 7 ± 1.469 5) × 109/L],EO,EO％ [(2.32 ± 1.21)％],BASO [(0.021 8 ± 0.001 9) × 109/L],BASO％ [(0.37 ± 0.21)％] and NEUT％ were higher than those in acute group (all P ＜ 0.05).The areas under ROC curve (AUCs) of LY and MONO in acute group were 0.681 and 0.529,they were in 0.5-0.7,and the diagnostic value was low;the AUCs of EO,EO％,LY％,NEUT％,NEUT,BASO,BASO％,MONO％ and WBC in acute group were 0.816,0.816,0.806,0.790,0.766,0.760, 0.721,0.715 and 0.710,they were in ＞ 0.7-0.9,and the diagnostic value was medium.The AUCs of LY,NEUT,BASO,EO,BASO％,EO％,MONO％,MONO and WBC in chronic group were 0.693,0.617,0.586,0.584,0.581,0.541,0.500,0.513 and 0.510,they were in 0.5-0.7,and the diagnostic value was low;the AUCs of LY％ and NEUT％ in chronic group were 0.725 and 0.717,they were in ＞ 0.7-0.9,and the diagnostic value was medium.Conclusion The indexes of peripheral WBC in patient with acute and chronic human brucellosis are changed abnormally,which has a certain reference value in diagnosis of human brucellosis.

Objective To investigate the related factors on effects of uterine artery embolization (UAE) in the treatment of dysmenorrhea in patients with adenomyosis, and to construct and validate the efficacy prediction model. Methods A total of 127 cases of adenomyosis patients with symptoms of dysmenorrhea in Guangzhou No.1 People′s Hospital and Nanfang Hospital of Southern Medical University from June 1999 to December 2009 were reviewed. The evaluation standard was to improve the degree of dysmenorrhea, the related factors of efficacy were analysed. Combined with artificial neural network theory, the effect prediction model was constructed, and the effectiveness of the model was evaluated using receiver operating characteristic (ROC) curve, and the effectiveness of the cut-off point was calculated. The model was validated by 68 cases of patients with adenomyosis in the Nanfang Hospital from January 2010 to November 2014. Results (1) In 127 cases of dysmenorrhea patients, UAE treatment was effective in 98 cases, effective rate was 77.2% (98/127). (2) Age was an independent predictor of effective UAE treatment (HR=1.129, P=0.026);in the range of this study, the greater the age, the higher the UAE treatment efficiency. (3) The developing situation of ovary branches of uterine artery was an independent predictor of effective UAE treatment (HR=0.460, P=0.020), the efficiency of patients whose intraoperative bilateral uterine artery ovarian branch did not develop was 89.7%(35/39), the efficiency of patients whose unilateral uterine artery ovarian branch was developing was 84.1% (37/44) and the efficiency of patients whose bilateral uterine artery ovarian branch were developing was 59.1% (26/44). (4) Blood supply of adenomyosisis was an independent predictor of effective UAE treatment (HR=0.313, P=0.001). Type Ⅰ (bilateral predominated) patients, efficiency was 93.5%(43/46);typeⅡ(bilateral balanced) patients, efficiency was 78.0%(39/50);type Ⅲ (unilateral predominated) patients, efficiency was 51.6% (16/31). (5) UAE for the treatment of adenomyosis efficacy of artificial neural network prediction model was constructed, the model′s area under the ROC curve was 0.808, the optimal cut-off point was 0.669 13. Actual verification of the model, sensitivity was 96.5%, specificity was 81.8%, positive predictive value was 96.5%and negative predictive value was 81.8%, the total accuracy was 94.1%. Conclusions (1) Age, the developing situation of ovary branches and blood supply of adenomyosis are the independent predictors of effective UAE treatment. (2) The artificial neural network prediction model is satisfied with the accuracy and the accuracy of prediction.

Objective: To summarize the peri-operative management experience of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A total of 56 CTEPH patients received PEA in our hospital from 2015-01 to 2016-11 were retrospectively analyzed. Our study was focused on the medication in respiratory and circulatory system during ICU stay, peri-operative application of vasoactive drug and target drug to pulmonary hypertension (HP), usage of ventilators, mechanical assisted devices and other management experiences. Results: No peri-operative death occurred. There were 2/56 (3.6%) patients with lung reperfusion, 2 (3.6%) with PH crisis. Compared with pre-operation, the post-operative pulmonary artery hemodynamics parameters were improved as right heart catheter measured pulmonary artery systolic pressure (PASP) decreased from (85.05±22.40) mmHg to (36.83 ±17.21) mmHg and pulmonary vascular resistance decreased from (773.84±342.95) dyn·s·cm-5 to (293.59±214.95) dyn·s·cm-5. Post-operative oxygen saturation was maintained at (95-100) % in all patients. Echocardiography found that PASP from pre-operation (85.03±25.78) mmHg decreased to (39.44±19.24) mmHg at follow-up period, P<0.01.Conclusion: A comprehensive peri-operative management of PEA was helpful to improve pulmonary hemodynamics in CTEPH patients; meanwhile, effective prevention and treatment of severe complication could obviously reduce peri-operative mortality.

Objective:To analyze the value of alpha-fetoprotein(AFP) in predicting survival of patients who underwent salvage surgery after tumor downstaging therapy in patients with advanced hepatocellular carcinoma.Methods:The data of 50 patients with Barcelona Clinic Liver Cancer Staging (BCLC) C hepatocellular carcinoma treated at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from December 2018 to December 2021 were collected. There were 45 males and 5 females, with the age of (53.0±10.5) years. The patients were divided into two groups based on the serum AFP level after tumor downstaging therapy, AFP normal group ( n=27, AFP≤20 μg/L) and the control group ( n=23, AFP>20 μg/L). Patient survival and tumor recurrence were followed up by outpatient review or telephone follow-up. The survival rate was calculated by the Kaplan-Meier method and compared by the log-rank test. The efficacy of combined immunotargeted therapy were compared between the two groups. Univariate and multivariate Cox regression analysis were carried to analyse the factors influcing prognosis. Results:The median survival time was not reached in both groups. The 1-year and 2-year cumulative survival rates were 95.0% and 88.2% in the normal group and 73.4% and 54.1% in the control group, respectively. The median relapse-free survival time of the normal group was not reached, and the median relapse-free survival time of the control group was 11 months. The 1-year recurrence-free survival rate was 78.1% in the normal group and 39.5% in the control group. The cumulative survival rate and relapse-free survival rate in the normal group were significantly higher than those in the control group (χ 2=7.60, 8.83, P=0.006, 0.003). The complete response, partial response and pathological complete response of tumors in the normal group were significant better than those in the control group. Multivariate Cox regression analysis showed that patients with serum AFP >20 μg/L ( HR=2.952, 95% CI: 1.023-8.517, P=0.045) after immunotherapy combined with targeted therapy had an increased risk of postoperative recurrence. Conclusion:The reduction of serum AFP to normal after downstaging therapy could be used as a prognostic indicator of salvage surgical in patients with BCLC C hepatocellular carcinoma, and AFP was related to the efficacy of downstaging therapy in patients.

Virtue ethics and normative ethics are corresponding ethical concepts, and their collision and integration promote the development of ethical system. On the issue of doctor-patient relationship, from virtue to norm is the objective requirement of social transformation and development, and is also the inevitable choice to resolve doctor-patient conflicts and reshape doctor-patient relationships. In the new era, the construction of doctor-patient relationship faces ethical dilemma such as one-sided emphasis on doctors’ virtue cultivation, unclear ethical responsibilities between doctors and patients, and lack of trust and tolerance between doctors and patients. Therefore, it is necessary to strengthen the institutionalization of doctor ethics, clarify the ethical responsibilities of both doctors and patients, optimize the social ethical ecological environment, so as to realize the ethical reconstruction of doctor-patient relationship from virtue to norm.

Objective To investigate the relationship between Cytochrome P-450 1A1 (CYP1A1) gene polymorphism and the ethnic differences to brick-tea fluorosis and the gene-environment interaction.Methods Inhabitants over the age of 16 years old in Inner Mongolia,Qinghai and Xinjiang were investigated.The questionnaire survey included basic information,dietary survey and total fluoride intake,and peripheral venous blood was collected.The CYP1A1 gene single nucleotide polymorphism (SNP) genotyping was determined using mass spectrometry;the diagnosis of skeletal fluorosis was based on the X-ray method;combined genetic factors with environmental factors,the interaction of gene-environment was analyzed.Results In the 1 414 copies of whole blood samples (308 Tibetans,290 Kazakhs,261 Mongolians,425 Han people,130 Russians),CYP1A1 genes rs1048943 sites were typed into AA,AG and GG genotypes,and gene distribution met Hardy-Weinberg equilibrium (P ＞ 0.05).The frequencies of genotypes AA,AG and GG in Tibetans were 55.8％ (172/308),37.3％ (115/308) and 6.8％ (21/308),respectively;the frequencies of the three genotypes in Kazakhs were 69.7％ (202/290),27.6％ (80/290) and 2.8％ (8/290),respectively;the frequencies of the three genotypes in Mongolians were 60.5％ (158/261),36.0％ (94/261) and 3.4％ (9/261),respectively;the frequencies of the three genotypes in Han people were 60.9％ (259/425),33.6％ (143/ 425) and 5.4％ (23/425),respectively;the frequencies of genotypes in Russians were 72.3％ (94/130),26.9％ (35/130) and 0.8％ (1/130),respectively;the differences of the three genotype frequencies between different ethnic groups were statistically significant (x2 =24.757,P ＜ 0.05).The skeletal fluorosis detection rates in different ethnic from high to low were Tibetans (39.94％,123/308),Kazakhs (33.79％,98/290),Mongolians (22.22％,58/261),Han people (13.41％,57/425) and Russians (8.46％,11/130),and the differences were statistically significant (x2 =100.156,P＜ 0.05).Skeletal fluorosis detection rates of different genotypes were AA (24.18％,214/885),AG/GG (25.14％,133/529),the difference was not statistically significant between the groups (x2 =0.165,P ＞ 0.05).After the ethnic stratification,the differences were also not statistically significant (P ＞ 0.05).Only in the group of Tibetans whose urine fluoride level was 1.6-3.2 mg/L and Mongolians under age 45 were found that the G gene was one of the risk factors in skeletal fluorosis [OR =2.035,95％ CI (1.003-4.128);OR =5.602,95％CI (1.461-21.479)];G gene might be a protective factor in the Mongolians aged 45 years and over [OR =0.422,95％CI(0.190-0.938)].Conclusion This study does not find a positive correlation between CYP1A1 gene polymorphism and the ethnic differences to bricktea fluorosis.

Objective:To study the use of perfluorobutane contrast-enhanced ultrasound (CEUS) in preoperative detection of microvascular invasion (MVI), and postoperative short-term recurrence of hepatocellular carcinoma (HCC).Methods:Patients who underwent hepatectomy with curative intent at the Chinese PLA General Hospital from January 2021 to April 2021 were prospectively enrolled into this study. Of 42 patients in this study, there were 36 males and 6 females, with age of (56.51±11.95) years old. All patients underwent preoperative perfluorobutane CEUS, and the characteristics of ultrasound, the vascular phase and Kupffer phase of perfluorobutane CEUS were recorded. Based on the pathological results, these patients were divided into the MVI and non-MVI groups. These patients underwent liver MRI once every 3 months postoperatively to diagnose tumor recurrence. According to the recurrence of HCC 6 months after operation, these patients were divided into the non-recurrence and the recurrence groups. Independent risk factors for MVI and short-term recurrence were analyzed by univariate and multivariate analyses.Results:Two patients had two lesions, and the remaining 40 patients had a single lesion. The pathological diagnosis of all the lesions were HCC (14 patients in the MVI group and 28 patients in the non-MVI group). The median follow-up was 6 (3, 6) months, and there were 8 patients in the recurrence group and 34 patients in the non-recurrence group. On logistic analysis, independent risk factors for MVI included the number of vessels detected on color Doppler flow imaging (CDFI) ( OR=5.762, 95% CI: 1.597-20.785, P=0.007), increased tumor size by more than 10% after CEUS arterial enhancement ( OR=10.186, 95% CI: 3.647-28.447, P=0.037), and thickness of corona enhancement at Kupffer phase of greater than 5 mm ( OR=17.340, 95% CI: 6.124-49.095, P=0.040). Cox regression showed the independent risk factors for short-term recurrence to include the number of vessels in CDFI ( RR=7.519, 95% CI: 1.086-52.051, P=0.041) and thickness of corona enhancement at Kupffer phase of greater than 5 mm ( RR=10.623, 95% CI: 1.265-89.218, P=0.030). Conclusion:Preoperative perfluorobutane CEUS had potential values in detecting MVI and in predicting postoperative short-term recurrence of HCC.

【Objective】 To investigate the intrinsic relationship of social support and psychological capital with college students’ volunteer motivation in the post-epidemic era so as to provide theoretical basis for formulating policies and measures to increase college students’ participation in volunteer activities. 【Methods】 In March 2022, 1 120 college students from 15 universities in Henan Province were selected by convenient sampling method. Their general information, social support, psychological capital, and volunteer motivation were investigated, and univariate analysis, correlation analysis and intermediary effect analysis were performed. 【Results】 The differences of scores in six dimensions of volunteer motivation (i.e., values, understanding, enhancement, career, social interaction, and self-protection) were statistically significant (F=124.90, P<0.001). There were significant differences in social support level of college students of different genders (t=-2.40, P<0.05), and the difference in volunteer motivation level among different grades of college students was statistically significant (F=6.72, P<0.001). Social support, psychological capital, and volunteer motivation were positively correlated with one another (r=0.41, r=0.35, r=0.50, P<0.001). Part of the intermediary effect of psychological capital between social support and volunteer motivation was significant (intermediary effect value=0.49, 95% CI: 0.39-0.59). 【Conclusion】 Colleges and universities can take corresponding measures to improve college students’ volunteer motivation level by improving social support and psychological capital level.