Objective To investigate the cognition, self-management and quality of life of osteoporosis in elderly patients, and to provide the basic theory for health education in elderly patients with osteoporosis.Methods 565 elderly patients with osteoporosis in our hospital from May 2012 to Mar.2015 were enrolled.The cognition, health beliefs, self-efficacy and quality of life were investigated by questionnaires and analyzed by Microsoft Office Excel 2007.Results 565 osteoporosis patients, the symptom score was (15.6±2.0), and the score was lower in sporting knowledge (4.3 ± 1.8) than in calcium knowledge (5.7 ± 1.5) (t=2.784, P=0.011).Health beliefs score was (139.0±9.6), containing exercise benefits score of (21.5±3.1), exercise barriers score of (13.8±3.9), susceptible score of (19.4±4.2), serious score of (18.8±4.4), health motivation score of (25.0±3.0), calcium intake benefits score of (20.7±3.5) and calcium intake disorder score of (19.8 ± 4.0).Self efficacy score was (63.7 ± 19.4), containing exercise efficacy score of (58.6 ±18.7) and calcium efficacy score of (69.2± 18.5).Quality of life score included the general health (16.5± 2.9 score), social function (5.8 ± 1.3 score), vitality (14.8 ± 3.2 score), mental health (20.7± 4.2 score), physiological function (20.5 ± 4.1 score), physiological role limit (6.3 ± 1.6 score), emotional role limit (5.1 ± 1.3 score) and body pains (4.3 ± 1.8 score).Conclusions The score in cognitive function is low in elderly osteoporosis patients.It's useful to improve elderly osteoporosis awareness and quality of life by carrying out relative education.

Objective To explore the association of immune suppression with the severity of HBV-related acute-on-chronic liver failure(ACLF) patients.Methods From August 2009 to April 2010 in Shanghai Public Health Clinical Center, the peripheral blood samples and clinical data of 27 HBV-related ACLF patients (ACLF group), 28 patients wit h chronic active hepatitis B (CHB group)and 8 healthy individuals (Control group) were collected.APACHE Ⅲ score and the grade of hepatic encephalopathy were as quantitative index to evaluate the severity degree of the disease.The absolute counts of the subsets of T lymphocytes and human leukocyte antigen (HLA)-DR expression on the surface of monocyte in patients' peripheral blood were examined by flow cytometry, the proinflammatory cytokines and anti-inflammatory cytokines(IFN-γ, TNF-α, IL-2, IL-4, IL-10) in patients' plasma were detected by cytometric bead array (CBA) kit.The data was analyzed with SPSS 16.0 software.Results Compared with CHB group and control group, the level of anti-inflammatory eytokire IL-10 markedly increased ir HBV-related ACLF patients (Z= -4.279 ,U= 124, P＜0.01;Z= - 3.871, U= 9.5, P= 0.0001 ), however the level of pro-inflammatory cytokines IFN-γ、 TFN-α、IL-2 、 IL-4 in plasma were at low limit of detectable value.Meanwhile the expression quantity of HLA-DR on the peripheral blood monocytes significantly down-regulated (Z= -4.714, U= 98, P＜0.01;7= - 4.086, U = 4, P＜ 0.01), and there was negative correlation between HLA-DR expression quantity and APACHE Ⅲ score (R2 =0.2667, P=0.0167).In addition, the absolute counts of CD4+T lymphocytes in adaptive immune cells significantly decreased (Z= -4.411, U= 116, P＜0.01; Z=-3.575, U= 17, P= 0.0004).Conclusions The immune system of HBV-related ACLF patients displays immune dysfunction like monocyte function inhibition; CD4+ T lymphocytes depletion and high level of anti-inflammatory eytokines, the persistent down-regulation of the HLA-DR expression on monocyte is an indicator for the severity of disease.

Objective To analyze the miss rates of colorectal adenomas during colonoscopy as well as risk factors influencing the adenoma miss rates and to take corresponding measures. Methods A total of 432 patients who underwent index and follow-up colonoscopy in 18 months were randomized and investigated. The results of two colonoscopies were compared and the missed adenomas were defined as the adenomas de-tected only during the second colonoscopy. Miss rates were calculated according to patient-based methods. Chi-square test was used to analyze the relative factors influencing the adenoma miss rate of per-patient. Then the meaningful factors were chosen into the logistic regression model for multiple factors analysis. Results Of 432 patients,116(26. 9%)had missed adenomas on first colonoscopy. Single factor analysis found that the size of adenoma( χ2 = 89. 686,P = 0. 000),the shape of adenoma( χ2 = 68. 488,P = 0. 000),the location of adenoma(χ2 = 77. 055,P = 0. 000)and adenoma tissue types(χ2 = 417. 000,P = 0. 000)were the risk factors for miss rates of colorectal adenomas. Number of polyps(χ2 = 8. 450,P= 0. 038),the organi-zation type of polyp(χ2 = 10. 718,P= 0. 013)and proficiency of colonoscopists(χ2 = 56. 069,P= 0. 000), the quality of bowel preparation(χ2 = 39. 195,P = 0. 000),insertion time(χ2 = 13. 133,P = 0. 001)were also the risk factors for miss rates of colorectal adenomas. Logistic regression analysis showed that the bigger the adenoma size,the less missed adenomas(OR= 0. 341,95%CI:0. 173-0. 671). Also,the longer insertion time took,the lower the adenoma miss rate(OR = 0. 987,95% CI:0. 981-0. 994). Per-patient miss rates were lower for high-risk adenomas compared with low-risk adenomas(OR = 0. 324,95%CI:0. 154-0. 680). Adenomas happening in multiple parts of bowel easily leads to missing(OR= 3. 791,95%CI:1. 505-9. 546). Conclusion The missed diagnosis of adenomas is not only significantly associated with features of missed adenomas,but also with skills of colonoscopists,insertion time,and bowel preparation. The key is high-quality index colonoscopy to avoid adenomas missing.

Objective To study apoptosis and antigen presentation changes of monocytes in HBV-related acute-on-chronic liver failure (ACLF) patients under immune dysfunction state.Methods Peripheral blood samples of 26 HBV-related ACLF patients (ACLF group),20 active chronic hepatitis B patients (CHB group) and 18 healthy individuals (control group) were collected.The changes of apoptosis and proliferation (Ki67) in monocytes and the expression of surface markers including human leukocyte antigen (HLA)-DR and B7 molecules (CD86) of monocytes were analyzed by flow cytometry. Results The percentage of Annexin V expressed monocytes of ACLF group (64％) was significantly higher than that of CHB group (28％) and control group (20％),and the difference was statistically significant (x2 value was 11.75 and 27.23 ; both P＜0.01),which indicated that monocytes apoptosis increased.The Ki67 expression in monocytes of ACLF group was lower than that of CHB group and control group,and the difference was statistically significant (x2 value was 4.71 and 4.83; both P＜ 0.05),which indicated that activated monocytes reduced. The mean fluorescence intensity (MFI) of HLA-DR and CD86 of monocytes in ACLF group was 22.85 and 11.63,which was significantly lower than that of CHB group and control group,indicating the antigen presentation ability of monocytes injured. The percentage of Annexin Ⅴ positive monocytes in survivals (62 ％ ) was significantly higher than that of dead patients (46 ％ ) in ACLF group.Conclusion In HBV-related ACLF patients under immune dysfunction state,the apoptosis of peripheral blood monocytes increased,and the quantity of activated cells reduced,resulting in the decline of the antigen presentation ability of monocytes.

Spontaneous bacterial peritonitis (SBP) is a common serious complication of end-stage liver disease. Intestinal microecology is closely associated with the development, progression, and prognosis of SBP, and bacterial translocation is the key pathogenesis of SBP. This article summarizes the intestinal microecology in patients with liver cirrhosis and briefly describes the mechanism of action of intestinal flora in the development and progression of SBP, thus providing a theoretical basis for the clinical regulation of intestinal microecology and treatment of SBP.

ObjectiveTo investigate the clinical features of acute hepatitis E (AHE) patients with or without severe jaundice and the risk factors for severe jaundice. MethodsA retrospective analysis was performed for the clinical data of 179 AHE patients who were admitted to Shanghai Public Health Clinical Center Affiliated to Fudan University from January 1, 2018 to March 26, 2020. According to whether total bilirubin (TBil) was ＞171 μmol/L, the patients were divided into AHE-mild jaundice (AHE-M) group and AHE-severe jaundice (AHE-S) group, and the two groups were compared in terms of clinical data and laboratory markers. The t test or the Mann-Whitney U test or the chi-squared test was used for comparison, and a binary logistic regression analysis was used to identify independent risk factors. ResultsOf all 179 patients, 101 (56.42%) were found to have severe jaundice. Compared with the AHE-M group, the AHE-S group had a significantly higher proportion of male patients (80.20% vs 61.54%, χ2=7.612, P=0.006), a significantly longer length of hospital stay ［29 (19-45) days vs 18 (14-22) days, Z=-6.035, P＜0.001］, a significantly higher number of patients with liver failure (23 vs 0, χ2=18.373, P＜0.001), and a significantly poorer prognosis (P＜0.001). Compared with the AHE-M group, the AHE-S group had significantly higher baseline anti-HEV-IgM, alpha-fetoprotein, and liver elasticity (Z=-3.534, -3.588, and -4.496, all P＜0.001), significantly lower baseline CD4 (Z=-2.015, P＜0.05), significantly higher peak values of TBil, direct bilirubin, creatinine, prothrombin time, international normalized ratio, and absolute neutrophil count (Z=-11.016, -10.926, -2.726, -4.787, -4.989, and -6.016, all P＜0.01), a significantly lower peak value of gamma-glutamyl transpeptidase (GGT) (Z=-4.55, P＜0001), and significantly lower valley values of albumin, prealbumin (PA), and absolute lymphocyte count (Z=-4.685, -5.087, and -4.818, all P＜0.001). The logistic regression analysis showed that anti-HEV-IgM (odds ratio ［OR］=1.022, 95% confidence interval ［CI］: 1005-1.039, P=0.012), GGT (OR=0.995, 95%CI: 0.993-0.998, P=0.001), PA (OR=0.991, 95%CI: 0.983-0.999, P=0.02), and neutrophils (OR=1.486, 95%CI: 1.169-1.889, P=0.001) were independent risk factors for severe jaundice in AHE patients. ConclusionThere is a relatively high proportion of male patients among the AHE patients with severe jaundice, with a long length of hospital stay, a large number of patients with liver failure, and poor prognosis. Anti-HEV-IgM, GGT, PA, and neutrophils are independent risk factors for severe jaundice in AHE patients.

Objective To investigate the clinical features and prognosis of pregnant women with HBV-related acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of 26 pregnant women with HBV-ACLF who were admitted to Shanghai Public Health Clinical Center from June 2008 to July 2020, including age, gestational weeks at disease onset, parity, initial symptoms, complications on admission, laboratory markers [white blood cell count, hemoglobin, platelet count, alanine aminotransferase, total bilirubin (TBil), albumin, serum creatinine, Model for End-Stage Liver Disease (MELD) score, HBsAg, and HBV DNA], abdominal ultrasound, mode of delivery, fetus conditions, treatment measures, and prognosis. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups. Results Among the 26 patients, 8 died within 28 days after disease onset, and the mortality rate reached 30.8%. There were 22 multiparous patients, accounting for 84.6%, and HBV-ACLF often occurred in the third trimester of pregnancy (20/26, 76.9%), with a mean gestational age of 30.9±5.8 weeks. HBV-ACLF often had atypical clinical manifestations, and initial symptoms included weakness, poor appetite (21/26, 80.8%), and yellow urine (19/26, 73.1%). Compared with the survival group, the death group had significantly higher levels of TBil ( Z =-2.056, P =0.041), prothrombin time ( Z =-2.362, P =0.016), international normalized ratio ( Z =-2.528, P =0.009), and MELD score ( Z =-2.223, P =0.026), a significantly longer time from initial symptom to diagnosis ( Z =-2.468, P =0.021), significantly higher HBV DNA level ( χ 2 =7.571, P =0.021), degree of hepatic encephalopathy ( χ 2 =24.775, P < 0.001), and incidence rate of complications ( χ 2 =5.951, P =0.042), and significantly lower levels of fibrinogen ( Z =-2.667, P =0.006) and prothrombin time activity ( Z =-2.365, P =0.016). Conclusion HBV-ACLF is a serious complication in the third trimester of pregnancy and is often observed in multiparous patients, with an extremely high short-term mortality. It often has atypical clinical manifestations in the early stage, and high MELD score, high viral load, and complications often indicate a poor prognosis.

ObjectiveTo explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure （HBV-ACLF） at different stages. MethodsClinical information of 1,058 hospitalized HBV-ACLF patients， including 618 in the early stage， 355 in the middle stage， and 85 in the late stage， were collected from 18 clinical centers across 12 regions nationwide from January 1， 2012 to February 28， 2015. The “Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire” were designed to investigate the basic information of the patients， like the four diagnostic information （including symptoms， tongue， pulse） of traditional Chinese medicine （TCM）， and to count the frequency of the appearance of the four diagnostic information. Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome elements and patterns of HBV-ACLF patients at different stages. ResultsThere were 76 four diagnostic information from 1058 HBV-ACLF patients， and 53 four diagnostic information with a frequency of occurrence ≥ 5% were used as factor analysis entries， including 36 symptom information， 12 tongue information， and 5 pulse information. Four types of TCM patterns were identified in HBV-ACLF， which were liver-gallbladder damp-heat pattern， qi deficiency and blood stasis pattern， liver-kidney yin deficiency pattern， and spleen-kidney yang-deficiency pattern. In the early stage， heat （39.4%， 359/912） and dampness （27.5%， 251/912） were most common， and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern （74.6%， 461/618）； in the middle stage， dampness （30.2%， 187/619） and blood stasis （20.7%， 128/619） were most common， and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern （53.2%， 189/355）， and qi deficiency and blood stasis pattern （27.6%， 98/355）； and in the late stage， the pattern of the disease was dominated by qi deficiency （26.3%， 40/152） and yin deficiency （20.4%， 31/152）， and the patterns were dominated by qi deficiency and blood stasis pattern （36.5%， 31/85）， and liver-gallbladder damp-heat pattern （25.9%， 22/85）. ConclusionThere are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF， presenting an overall trend of evolving patterns as "from excess to deficiency， transforming from excess to deficiency"， which is damp-heat → blood stasis → qi-blood yin-yang deficiency.

By removing a part of the structure, the tooth preparation provides restorative space, bonding surface, and finish line for various restorations on abutment. Preparation technique plays critical role in achieving the optimal result of tooth preparation. With successful application of microscope in endodontics for >30 years, there is a full expectation of microscopic dentistry. However, as relatively little progress has been made in the application of microscopic dentistry in prosthodontics, the following assumptions have been proposed: Is it suitable to choose the tooth preparation technique under the naked eye in the microscopic vision? Is there a more accurate preparation technology intended for the microscope? To obtain long-term stable therapeutic effects, is it much easier to achieve maximum tooth preservation and retinal protection and maintain periodontal tissue and oral function health under microscopic vision? Whether the microscopic prosthodontics is a gimmick or a breakthrough in obtaining an ideal tooth preparation should be resolved in microscopic tooth preparation. This article attempts to illustrate the concept, core elements, and indications of microscopic minimally invasive tooth preparation, physiological basis of dental pulp, periodontium and functions involved in tool preparation, position ergonomics and visual basis for dentists, comparison of tooth preparation by naked eyes and a microscope, and comparison of different designs of microscopic minimally invasive tooth preparation techniques. Furthermore, a clinical protocol for microscopic minimally invasive tooth preparation based on target restorative space guide plate has been put forward and new insights on the quantity and shape of microscopic minimally invasive tooth preparation has been provided.