Objective To explore the most suitable equation in accessing renal function for the elderly type 2 diabetic patients, and its clinical utility in combination with hypersensitive C-reactive protein (hsCRP). Methods The new Cystatin C-based equations for estimated glomerular filtration rate (Cys-eGFR) and conventional predictive equations were compared with isotopic GFR (iGFR) by linear regression analysis, paired t-test, Bland and Altman procedures and non-parametric receiver operating characteristic (ROC) curves. The new Cys-eGFR equation and hsCRP were also incorporated for detecting renal disease in this population. Results The new Cys-eGFR equation had a better relativity with iGFR (r= 0.767, P＜0.001), a less bias (bias: 0.0007, P＞0.05), a higher conformance (2SD: 21.56), higher sensitivity (90.7%) and specificity (88.6%) for diagnosing moderate decrease in renal function. There was a negative relationship between the new Cys-eGFR and hsCRP (r=-0.655, P＜0.01). When the new Cys-eGFR was 67.06 ml· min-1 ·1.73 m-2 and hsCRP was 5.65 mg/L, the combination of Cys-eGFR and hsCRP was better than the combination of serum creatinine and urine albumin/creatinine ratio in screening stage 3 chronic kidney disease (95%vs.46%). Conclusions The combination of new Cys-eGFR equation and hsCRP may screen an early decrease of moderate GFR.

Objective To investigate the efficacy and safety of different doses of dezocine at different administration time on analgesia after laparoscopic cholecystectomy.Methods 80 patients elected from ASA Ⅰ-Ⅱ grade laparoscopic cholecystectomy were randomly divided into four groups,20 cases in each group.Group Ⅰ was anesthetized by intravenously injected dezocine 0.10mg/kg before the surgery,group Ⅱ was anesthetized by dezocine 0.15mg/kg before the surgery,group Ⅲ was anesthetized by intravenously injected dezocine 0.10mg/kg after stopping anesthetic surgery,and group Ⅳ was anesthetized by intravenously injected dezocine 0.15mg/kg after stopping anesthetic surgery.The postoperative pain scores were observed 1,6,12,24 hours after operation in the four groups by using visual analog scale (VAS),comfort score (BCS),and anesthesia recovery score (modified Aldrete score).Results TheVAS of the four groups 1 hour after surgery:group Ⅰ and group Ⅲ was significantly different(t =2.308,P =0.036),group Ⅰ and group Ⅳ was significantly different (t =2.106,P =0.042),group Ⅱ and group Ⅲ was significantly different (t =2.711,P =0.014),group Ⅱ and group Ⅳ was significantly different (t =2.317,P =0.037).The BCS 1 hour after surgery:group Ⅰ and group Ⅲ was significantly different(t =2.108,P =0.042),group Ⅰ and group Ⅳ was significantly different(t =2.069,P =0.048),group Ⅱ and group Ⅲ was significantly different (t =2.353,P =0.033),group Ⅱ and group Ⅳ was significantly different (t =2.361,P =0.036).The VAS 6 hours after surgery:group Ⅰ and group Ⅲ was significantly different (t =2.084,P =0.045),group Ⅱ and group Ⅲ was significantly different(t =2.309,P =0.038),group Ⅱ and group Ⅳ was significantly different(t =2.303,P =0.040).The BCS 6 hours after surgery:group Ⅰ and group Ⅲ was significantly different (t =2.294,P =0.041),group Ⅱ and group Ⅲ was significantly different(t =2.322,P =0.035),group Ⅱ and group Ⅳ was significantly different (t =2.070,P =0.048).The BCS 12 hours after surgery:group Ⅱ and group Ⅲ was significantly different(t =2.518,P =0.047).VAS and BCS scores at other time points had no significant difference (P ＞ 0.05).Conclusion The analgesic after laparoscopic gallbladder surgery using dezocine 0.10mg/kg-0.15mg/kg,especially 0.15mg/kg administered anesthesia before surgery,can effectively relieve postoperative pain and improve postoperative comfort,reduce postoperative analgesic(pain pump) and has less adverse reactions,which is worthy of promotion.

Objective: To screen and identify the mutations in Kawasaki disease by targeted enrichment of genomic region sequencing technique and investigate susceptibility genes associated with coronary artery lesion. Method: This was a case-control study.A total of 114 patients diagnosed as Kawasaki disease treated in Shanghai Children′s Hospital between December 2015 and November 2016 were studied and another 45 healthy children who were physically examined in outpatient department were enrolled as control group. Patients were divided into two groups based on the results of echocardiogram. Peripheral venous blood was obtained from patients and controls. Genomic DNA was extracted. SeqCap EZ Choice libraries were prepared by targeted enrichment of genomic region technology. Then the libraries were sequenced to identify susceptibility genes associated with coronary artery lesion in patients diagnosed as Kawasaki disease.Susceptible genes were identified by Burden test, Pearson chi-square test or Fisher′s exact probability test. Result: There was statistically significant difference in TNFRSF11B(rs2073618)G>C(p.N3K)mutation and GG/GC/CC genotype between Kawasaki disease group and control group(χ²=15.52, P=0.00). There was statistically significant difference in TNFRSF13B(rs34562254)C>T(p.P251L)mutation(χ²=10.40, P=0.01)and LEFTY1(rs360057)T>G(p.D322A)mutation(χ²=8.505, P=0.01)between patients with coronary artery lesions and those without. Conclusion Targeted enrichment of genomic region sequencing technology can be used to do primary screening for the susceptible genes associated with coronary artery lesions in Chinese Kawasaki patients and may provide theoretical basis for larger sample investigation of risk prediction score standard in Kawasaki disease.

Objective:To analyze the clinical features, imaging characteristics, diagnosis and treatment of elderly patients with pulmonary cryptococcosis, and to propose considerations for the early diagnosis and treatment of pulmonary cryptococcosis.Methods:Clinical data of 42 elderly patients with pulmonary cryptococcosis diagnosed at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2015 to September 2020 were retrospectively analyzed.Differences in clinical data were compared between immunocompromised patients and immunocompetent patients by using the SPSS software.Results:The mean age of patients of with pulmonary cryptococcosis was(66.0±5.3)years.Of the cases, 27 were immunocompromised, with common underlying diseases such as autoimmune rheumatic disorders, tumors and chronic kidney disease.Main clinical manifestations were cough, sputum expectoration, fever and chest tightness.Twenty-two cases showed nodules on chest CT scans, most of which contained multiple nodules.Twenty-four cases showed unilateral lesions, mainly in the lower lobe.There was no significant difference in clinical manifestations, lesion types or location distribution between the immunocompromised and immunocompetent groups( P>0.05), while the incidence of air bronchograms was higher in the immunocompetent group than in the immunocompromised group( P<0.05). Seventeen cases were diagnosed by histopathology, and the clinical diagnosis of 25 cases was confirmed by the positive detection of capsular polysaccharide antigens.Nine cases were treated surgically, 1 case underwent clinical observation postoperatively, and 8 cases were treated with fluconazole after surgery.Thirty-three cases were treated with antifungal therapy, 6 of whom were treated with a combination of drugs.Eight cases were lost to follow-up, 29 were cured or improved, 2 progressed, and 3 died. Conclusions:Pulmonary cryptococcosis in the elderly is more common in immunocompromised patients, with atypical clinical symptoms and a high rate of misdiagnosis.Cryptococcal capsular polysaccharide antigen testing is helpful for early diagnosis, and treatment plans need to be chosen and adjusted according to the patient's immune status and specific conditions.

Objective To analyze the genotype-phenotype correlation in 5 families with congenital ectopia lentis (CEL) accompanied with cardiovascular abnormal manifestation.Methods Detailed clinical data of 15 family members in 5 families were collected from August 2017 to March 2018 in Zhongshan Ophthalmic Center,including examination of the condition of lens before and after mydriasis by slit-lamp,evaluation of the cardiovascular system using transthoracic echocardiography,and evaluation of the degree of involvement of the subjects' skeletal system using X-ray images.Genomic DNAs were extracted from whole blood sample of the 5 probands and 10 relatives,and screened for FBN1 mutation by targeted exome sequencing.The possible genotype-phenotype correlation was analyzed by reviewing previous literatures into these mutation sites.The study followed the principles of the Helsinki Declaration and written informed consent was obtained from each subject prior to any examination.Results All of the five probands were diagnosed as CEL accompanied with cardiovascular abnormal manifestation.FBN1 gene mutations were identified in all of the five probands,including four missense mutations (c.2741G＞T,c.2585G＞T,c.1633C＞T,c.4260C＞G) and one splicing mutation (c.2114-1G＞C).It was predicted that all of the 5 mutations would alter the protein structure.Conclusions FBN1 gene has a high degree of clinical heterogeneity,and the early detection of ocular phenotypes combined with genetic screening is of great significance in the diagnosis of cardiovascular abnormalities.

Objective:To estimate and summarize the evidence for the blood pressure in patients with ruptured intracranial aneurysm bleeding, to provide valuable reference for clinical care and improve the prognosis of patients.Methods:BMJ Best Practice, UpToDate, Chinese Guideline Website, Cochrane Library, PubMed, American Stroke Association, Chinese National Knowledge Infrastructure, Wanfang Database and VIP Database were utilized for screening out evidences of blood pressure management strategies for patients with ruptured intracranial aneurysm bleeding from database establishment to December 8, 2020. The source of evidences included guidelines, evidence summarization, information brochure of optimal clinical practice, recommended practice, systematic review and original research. Upon the assessment of the included literature, the evidences meeting the enrollment criterion would be identified and extracted.Results:There were 9 articles involved in this research and 20 evidences possessing clinical applicability were extracted. The evidences involved in clinical assessment, regulation tenets, intervention protocol, and nursing to prevent complications in patients with ruptured intracranial aneurysm bleeding.Conclusions:To summarize, we suggested strongly to evaluate the individual differences in age, underlying diseases and pharmacological tolerance, and to effectivelly control blood pressure in patients with ruptured intracranial aneurysm bleeding through scientific nursing methods, which could improve the nursing qualification.

Objective:This paper briefly reviewed the literature related to skin flaps published in Chinese Journal of Plastic Surgery ( CJPS) and Plastic and Reconstructive Surgery ( PRS) in recent five years (from January 2016 to December 2020) to compare the similarities and differences between these two journals and to direct future research. Methods:In May of 2021, literature with "flap" as the keyword in the titles and abstracts published in CJPS and PRS in recent five years were searched. Related literature published by CJPS were searched by Wanfang Data and CNKI database, and that of PRS were searched by PubMed and Scopus database. After removing the repetitive literature, the titles and abstracts were read to exclude the non-flap studies and non-original articles. By reading the full text and using bibliometrics, the total number of papers published, the number of papers on flap research, the level of evidence-based medicine evidence, the nationality and organization distribution of the authors, the type of flaps, the application of flaps, and new technologies were comprehensively analyzed. Results:The total number of papers published by CJPS in recent five years was 1 116, and 244 were included in this study. The total number of articles published in PRS in the same period was 4 562, and 268 were included in this study. Most of the articles published in PRS are from American authors. The number of articles published by Chinese authors is in the second place. In the past five years, authors from the mainland of China published 21 papers in PRS. Most of the articles published by CJPS are about the pedicle flap, while PRS is about the free flap. CJPS published more articles about the traditional flaps than perforator flaps, and PRS did the opposite. CJPS published articles mainly on the local flap, anterolateral thigh flap, and peroneal artery perforator flap, while PRS focused on the inferior epigastric artery perforator fibula bone or osteocutaneous flap, and anterolateral thigh flap. The indication of flap surgery reported by CJPS is the reconstruction of various defects, while the flaps reported by PRS are mainly used in breast reconstruction and other fields. In addition, computer-aided imaging, indocyanine green angiography, propeller flap, multilobed flap, and other new technologies and concepts have been widely reported in the literature related to skin flaps published in CPJS and PRS. Conclusions:In the recent five years, the flap research in China has been at the leading international level and has certain competitiveness. However, the study in China is limited to reporting clinical experience, and the level of evidence-based medicine is relatively low, so there is still a certain gap with the international frontier research.

Objective:This paper briefly reviewed the literature related to skin flaps published in Chinese Journal of Plastic Surgery ( CJPS) and Plastic and Reconstructive Surgery ( PRS) in recent five years (from January 2016 to December 2020) to compare the similarities and differences between these two journals and to direct future research. Methods:In May of 2021, literature with "flap" as the keyword in the titles and abstracts published in CJPS and PRS in recent five years were searched. Related literature published by CJPS were searched by Wanfang Data and CNKI database, and that of PRS were searched by PubMed and Scopus database. After removing the repetitive literature, the titles and abstracts were read to exclude the non-flap studies and non-original articles. By reading the full text and using bibliometrics, the total number of papers published, the number of papers on flap research, the level of evidence-based medicine evidence, the nationality and organization distribution of the authors, the type of flaps, the application of flaps, and new technologies were comprehensively analyzed. Results:The total number of papers published by CJPS in recent five years was 1 116, and 244 were included in this study. The total number of articles published in PRS in the same period was 4 562, and 268 were included in this study. Most of the articles published in PRS are from American authors. The number of articles published by Chinese authors is in the second place. In the past five years, authors from the mainland of China published 21 papers in PRS. Most of the articles published by CJPS are about the pedicle flap, while PRS is about the free flap. CJPS published more articles about the traditional flaps than perforator flaps, and PRS did the opposite. CJPS published articles mainly on the local flap, anterolateral thigh flap, and peroneal artery perforator flap, while PRS focused on the inferior epigastric artery perforator fibula bone or osteocutaneous flap, and anterolateral thigh flap. The indication of flap surgery reported by CJPS is the reconstruction of various defects, while the flaps reported by PRS are mainly used in breast reconstruction and other fields. In addition, computer-aided imaging, indocyanine green angiography, propeller flap, multilobed flap, and other new technologies and concepts have been widely reported in the literature related to skin flaps published in CPJS and PRS. Conclusions:In the recent five years, the flap research in China has been at the leading international level and has certain competitiveness. However, the study in China is limited to reporting clinical experience, and the level of evidence-based medicine is relatively low, so there is still a certain gap with the international frontier research.

Objective:To evaluate the detection accuracy of hepatitis B virus (HBV) serological markers among grassroots medical institutions in the demonstration areas of infectious diseases.Methods:A fixed sampling method was used among the followed-up hepatitis B cohort in general population of six infectious disease demonstration areas nationwide. Blood samples of chosen objects were collected, in which HBsAg and anti-HBs were tested by grassroots medical institutions and were also parallely tested by the third-party platform. The test results were compared between the two groups. Statistical analyses were conducted by SAS 9.4 software.Results:A total of 5 756 and 5 263 samples of HBsAg and anti-HBs were successfully tested, respectively. Comparing the results of HBsAg and anti-HBs from grassroots medical institutions with the results from the third platform, the agreement of HBsAg and anti-HBs was 97.13% and 77.33%, respectively. The Kappa value was 0.56 (95% CI 0.50-0.62) for HBsAg and 0.54 (95% CI 0.52-0.56) for anti-HBs, respectively; and the McNemar tests indicated the difference between the results (all P<0.01). There were also significant differences in agreement of testing results with the third platformin among different regions ( P<0.05 or <0.01). The Kappa values indicated that Jiangsu province and Guangdong province had high accordance rates of HBsAg (0.87 and 0.81, respectively), and Gansu province and Guangdong province had high accordance rates of anti-HBs (Both were 0.74). Regarding the results from the third platform as the standard, the sensitivity of HBsAg testing in grassroots medical institutions was moderate (40.51%) and the specificity was well (99.96%). The sensitivity of anti-HBs testing was substantial (73.18%) and the specificity was well (84.31%). Guangdong province (Youden index: 0.69) and Jiangsu province (Youden index: 0.80) had high identification ability for HBsAg, and for indicator of anti-HBs, Gansu province (Youden index: 0.78) and Guangdong province (Youden index: 0.76) had high identification ability. Conclusion:There are certain differences in results of HBV serological markers tests between the grassroots medical institutions in the demonstration areas of infectious diseases and the third platform. Current testing strategies in grassroots medical institutions are suitable for identifying people without hepatitis B infection, while it is necessary to pay attention to the situation of potential false negative error.

OBJECTIVE: To evaluate the feasibility of the inter-laboratory comparison of microwave radiation measuring instruments which uses cellphone signal shielding device as standard source,and to establish inter-laboratory comparison method of microwave radiation.METHODS: The typical sampling method has been used by selecting twenty-one measuring instruments of microwave radiation from 21 occupational hygiene technical service organizations as study subjects.A cellphone signal shielding device was applied as standard source.Measurement points were measured by surveyors at a distance of 1.0 and 1.5 meter to the standard source,and the measurement results were analyzed by four robust technology and z-score evaluation method.RESULTS: Stability test showed that there was no statistical difference among the power density of standard source which were measurement at three diffluent time [(26.10 ± 0.94) vs(25.78 ± 0.27) vs(25.83 ±0.47) μW/cm~2,P>0.05].The standard source stability can also satisfy the requirement of inter-laboratory comparison.Among the 21 selected equipments,one of the 21 measuring instruments was not calibrated,one calibration certificate of the instruments was expired,and one calibration result of the instruments was unqualified.The z score of inter-laboratory(z_B) of 21 measuring instruments ranged from-1.27 to 4.85,while z score of within-laboratory(z_w) ranged from-1.42 to 2.18.One | z_B| of the instruments was above 3.00,while | z_W| was above 2.00.Comprehensive evaluation of the above results showed that only one instrument was unqualified.CONCLUSION: It is feasible that a cellphone signal shielding device could be applied as standard source.The method developed in this study can be used to understand the performance of microwave radiation instruments.