OBJECTIVE:To compare the pharmacoeconomic efficacies of 5 drug therapeutic regimens for children pneumonia.METHODS:Using retrospective study and cost-effectiveness analysis to compare the pharmacoeconomic efficacies among the following 5 regimens in treating children pneumonia:amoxicillin sodium/clavulanate potassium(Group A),cefotaxime sodium(Group B),cefoperazone sodium/sulbactam sodium(Group C),cefuroxime sodium(Group D),and azithromycin(Group E).RESULTS:The effective rates of the 5 groups(A,B,C,D and E) were 80.43%,76.09%,65.12%,77.27%,and 91.30%,respectively,and the cost-effectiveness ratios were 1 595.06,1 225.38,1 669.69,1 284.83,and 697.84,respectively.CONCLU-SION:The regimen of azithromycin(group E) is the optimal one among the 5 groups for children pnemonia.

Objective To study the serum small dense low density lipoprotein-cholesterol (sdLDL-C)concentration in patients with clinical and sub-clinical primary hypothyroidism,and to explore the clinical significance of serum sdLDL-C determination in pa-tients with hypothyroidism.Methods 60 patients with clinical hypothyroidism(clinical hypothyroidism group),96 cases with sub-clinical hypothyroidism(sub-clinical hypothyroidism group)and 132 normal subjects (normal group)were enrolled in the study. FT3,FT4,thyroid stimulating hormone (TSH),TG,TC,HDL-C,LDL-C,apolipoprotein AⅠ(ApoAⅠ),apolipoprotein B (ApoB), and sdLDL-C concentrations were measured.Analysis of Variance,Kruskal-Wallis H test and Spearman rank correlation analysis were used for statistical analysis.Results The concentration of sdLDL-C in sub-clinical hypothyroidism group was significantly higher than that in normal group (t=5.78,P <0.01),the concentration of sdLDL-C in clinical hypothyroidism group was signifi-cantly higher than that in sub-clinical hypothyroidism group(t=-2.88,P <0.01)and in normal group (t=6.68,P <0.01).There was statistically significant difference among groups (F =37.66,P <0.01).Correlation analysis showed that sdLDL-C in primary hypothyroidism patients was positively correlated with LgTSH (r =0.203,P =0.011 ),and negatively correlated with FT4 (r =-0.169,P =0.035).Conclusion The high concentration of sdLDL-C is a manifestation of dyslipidemia in primary hypothyroidism patients,and an important risk factor for atherosclerosis in primary hypothyroidism patients.

Objective To investigate the distribution characteristics of serum small dense low density lipoprotein-cholesterol (sdLDL-C) levels in healthy normolipidemia and hyperlipidemia and analyze the correlation between sdLDL-C and other serum lipids.Methods Totally 1012 normolipidemic subjects (18 93 years old,503 male,509 females) were grouped according to gender and age (18 -29,30 -69 and ≥70 years old).And 433 hyperlipidemic subjects (23 -90 years) were divided into the following 3 groups based on fasting triglyceride (TG) and low density lipoprotein-cholesterol (LDL-C)levels:hypertriglyceridemia (n =165 ),high-LDL-C ( n =129) and combined hyperlipidemia ( n =139 ).The sdLDL-C and other serum lipids were measured by Olympus AU2700 automatic analyzer.Analysis of Variance and Kruskal-Wallis H test was used for statistical analysis.Results The distribution of the sdLDL-C levels in normolipidemic subjects was near normal distribution.The sdLDL-C levels had differences in gender and age.In the 18 -29 and 30 -69 years old group,the mean values of sdLDL-C were significantly higher in males than in females [ (0.55 -0.21 ) mmol/L vs (0.47 ±0.22) mmol/L,t =2.212,P =0.028 and (0.66±0.28) mmol/L vs (0.62±0.25) mmol/L,t =2.121,P=0.034].In the ≥70 years old group,the difference of sdLDL-C levels in gender was not statistically significant [ male ( 0.54 ± 0.21 )mmol/L vs female (0.54 ± 0.22 ) mmol/L,t =0.022,P =0.982] ; the mean value was ( 0.54 ± 0.22 ) mmol/L The hyperlipidemic subjects had conspicuous higher levels of sdLDL-C compared with normolipidemia [ ( 1.25 ±0.44) mmol/L vs (0.60 ±0.26) mmol/L,t =29.306,P ＜0.001 ].Among all of groups,the combined hyperlipidemia group had the highest sdLDL-C level [ ( 1.52 ± 0.49) mmol/L,F =525.66,P ＜0.001 ] ; the hypertriglyceridemia group had the highest sdLDL-C/LDL -C level (0.47 ±0.12,F =287.93,P ＜0.001 ) and the high-LDL-C group had the highest level of non-sdLDL-C [LDL-C subtract sdLDL-C,(2.71 ± 0.52) mmol/L.F =336.32,P ＜ 0.001 ].The sdLDL-C showed a good positive correlation with TC,TG,LDL-C,ApoB and BMI ( rs =0.66,0.68,0.65,0.79 and 0.27,P ＜ 0.001 ),and negative correlation with HDL-C and ApoA1 ( rt =- 0.42 and - 0.37,P ＜ 0.001 ).Based on partial correlative analysis,sdLDL-C showed a different correlation with TG,LDL-C and TC ( r =0.42,0.28 and 0.15,P ＜ 0.001 ).Conclusions LDL-C and TG are the important factors influencing the sdLDL-C levels.However,TG has greater effect than LDL-C.The sdLDL-C is an appropriate and good index to evaluate the small dense low density lipoprotein (sdLDL) mass and the overall situation of lipid metabolism.In order to make full use of sdLDL in the clinical treatment and health assessment,it is necessary to establish sdLDL-C reference intervals through the survey of distribution of sdLDL-C levels in different geographic areas.

ObjectiveTo analyze the clinical efficacy of open reduction and internal locking system (PHILOS) in management of three- and four-part proximal humeral fractures in the elderly patients.MethodsA retrospective study was performed on 18 elderly patients (age≥80 years) with proximal humeral fractures who were treated surgically from June 2008 to June 2010 and received complete follow-up.The fractures were Neer three- and four-part fractures and managed with PHILOS.Rehabilitation exercise was performed postoperatively and followed up regularly.ResultsThe patients were followed up for average 15.3 months,which showed sound healing of all fractures.Shoulder joint function was assessed by Constant-Murley score that was 55 to 83 points (mean 72.5 points) at 12 months,with an overall excellence rate of 67％.ConclusionOpen reduction and fixation with PHILOS can attain satisfactory clinical outcome for the elderly patients with three- and four-part proximal humeral fractures.

Objective To investigate the levels of small and dense low-density lipoprotein-cholesterol (sdLDL-C) and the influence of insulin therapy on lipid metabolism in type 2 diabetic patients.Methods The subjects were composed of a normal group (n =400,195 males and 205 females),and a type 2 diabetic patients group (n =193,108 males and 85 females) which was further divided into normal lipid (n =33),hypercholesterolemia (n =21,TC ≥ 5.18 mmol/L),hypertriglyceridemic (n =53,TG ≥ 1.7 mmol/L),combined hyperlipidemia (n =75),and low high-density lipoprotein-cholesterol(n=11,HDL-C＜ 1.04 mmol/L) subgroups.The pre-and post-treatment levels of sdLDL-C and the influence of insulin therapy on lipid metabolism in type 2 diabetic patients (n =122,70 males and 52 females) were compared.Serum concentrations of sdLDL-C (sdLDL-EX SEIKENreagent),triglyceride (TG),total cholesterol (TC),and fasting plasma glucose (FPG) were measured by automatic biochemical analyzer,fasting insulin and C-peptide were determined by chemiluminesence immunoassay,TG/HDL-C,sdLDL-C/ LDL-C,LDL-C/HDL-C,apoB/apoA Ⅰ,and other parameters were calculated.Results Compared with diabetic normal lipid group,the levels of sdLDL-C in hypercholesterolemia,hypertriglyceridemic,and combined hyperlipidemia subgroups were significantly higher(P＜0.05),the levels in combined hyperlipidemia subgroup were the highest.The levels of sdLDL-C in low high density lipoprotein cholesterol group showed no significantly difference (P＞0.05).While compared with normal group,the levels of sdLDL-C,TG,TC,LDL-C,ApoB,sdLDL-C/LDL-C,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,apoB/apoA Ⅰ,CRP,and HOMA-IR in type 2 diabetic patients were significantly higher(P＜0.05).Compared with pre-treatment group,the levels ofTG,TC,LDL-C,sdLDL-C,sdLDL-C/LDL,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,and apoB/apoA Ⅰ in post-treatment group were significantly lower(P ＜ 0.05).Conclusions sdLDL-C is the important indicator of lipid metabolism in type 2 diabetes,particularly in evaluating the changes in LDL particles.Insulin therapy is effective both in blood glucose control and improvement of dyslipidemia.Important information of clinical risk of dyslipidoses in type 2 diabetic patients provided by TG/HDL-C,LDL-C/HDL-C,sdLDL-C/LDL-C,and apoB/apoA Ⅰ ratios should be recognized and implemented in future clinical guidelines.

Objective : To analyze the survival of patients with malignant mesothelioma, so as to provide insights into the management of malignant mesothelioma. Methods : Totally 36 patients with malignant mesothelioma admitted to Cixi Third People’s Hospital from October 2012 to January 2021 were enrolled, and the demographic features, exposure to asbestos, and diagnosis and treatment were retrospectively reviewed. The survival rate and median survival time were calculated with the life-table method, and the factors affecting the survival rate of malignant mesothelioma were identified using the Kaplan-Meier estimate and log-rank test. Results : The 36 patients with malignant mesothelioma included 6 men ( 16.67% ) and 30 women ( 83.33% ), and had a median age of 61 ( interquartile range, 14 ) years. There were 30 cases with pleural malignant mesothelioma ( 83.33% ) and 6 cases with peritoneal malignant mesothelioma ( 16.67% ), 32 cases ( 88.89% ) with a history of occupational exposure to asbestos, and 26 cases ( 72.22% ) receiving palliative treatment. The 1-, 2- and 3-year cumulative survival rates were 30%, 15% and 3%, respectively, and the median survival time was 0.71 years. In addition, there were no significant differences in the survival period among patients with malignant mesothelioma in terms of gender, age, route of asbestos exposure, duration of asbestos exposure, pathogenic site and treatment regimens ( P>0.05 ). Conclusion The 36 patients with malignant mesothelioma had a median survival period of 0.71 years, and no association was found between the survival period and asbestos exposure or pathogenic site.

Objective: To investigate the effect of ribosomal DNA (rDNA) copy number variation caused by hexavalent chromium exposure on DNA damage response in different cell lines, so as to provide insights into the involvement of hexavalent chromium-induced rDNA copy number variation in DNA damage responses. : Methods Human lung epithelial BEAS-2B cells and human embryonic lung MRC-5 cells were treated with 2 μmol/L potassium dichromate for 24 hours, and then cells were transferred to fresh media for further incubation, while cells treated with the same volume of phosphate buffer solution served as controls. Cells treated with potassium dichromate for 24 hours, and 3 and 7 days post-detoxification, were harvested, and rDNA copy number was quantified in cells using a quantitative fluorescent real-time PCR assay. Cell cycle, apoptosis and DNA damage were detected using a Muse cell analyzer, and the DNA damage was evaluated with the proportion of ataxia telangiectasia-mutated (ATM) gene activation, proportion of double-strand DNA breaks and the percentage of the H2A.X variant histone phosphorylatio. : Results The 45S and 5S rDNA copy numbers of were significantly higher in MRC-5 cells than in BEAS-2B cells [(1.54±0.26) vs. (1.02±0.18), P<0.05; (6.97±1.07) vs. (3.00±0.15), P<0.05]. The 45S rDNA copy number was lower in MRC-5 cells 3 days post-detoxification (0.80±0.04) than in controls (P<0.05), and was higher in BEAS-2B cells 3 days post-detoxification (1.43±0.07) than in controls (P<0.05) . G0/G1 phase arrest was found in MRC-5 cells 24 hours post-treatment, and the apoptotic rates were significantly higher in MRC-5 cells 3 and 7 days post-detoxification than in controls [(11.53±1.53)%, (18.33±0.70)% vs. (3.53±0.93)%, P<0.05]. The overall apoptotic rates 24 hours post-treatment and 3 days post-detoxification [(2.80±0.17)%, (3.33±0.57)% vs. (1.53±0.61)%, P<0.05], proportion of ATM gene activation 3 days post-detoxification [(3.37±0.67%) vs. (1.18±0.22)%, P<0.05], proportion of double-strand DNA breaks 3 days post-detoxification [(4.45±0.85)% vs. (0.97±0.21)%, P<0.05] and percentage of the H2A.X variant histone phosphorylation 3 days post-detoxification [(1.68±0.56)% vs. (0.29±0.06)%, P<0.05] in BEAS-2B cells were higher than in controls. Conclusions Hexavalent chromium-induced rDNA copy number variation affects DNA damage response in different cell lines. A stronger DNA damage response is found in BEAS-2B cells with a low rDNA copy number, and a relative stable response is observed in MRC-5 cells with a high rDNA copy number.

Objective: To investigate the level of preschool children’s weekend screen time in Zhejiang Province, and to explore family related factors. Methods: A total of 6 829 preschool children were selected from 25 kindergartens in Zhejiang Province from March to April 2019. Through a questionnaire survey among their caregivers, relevant data and information such as children’s screen time and family related factors were obtained. Result: The report rate of children in different age groups whose average screen time per day on weekends ≥2 h/d: boys were higher than girls( P <0.05); and the difference between boys and girls in the age groups of 3, 3.5, 4 and 6 was statistically significant( P <0.05). At the age of 3, the lowest rate of video time ≥2 h/d report was 9.57% and 6.03% for boys and girls, while at the age of 5.5, the highest rate was 18.49% and 17.37% for boys and girls. Logistic regression analysis showed that age, boy( OR =1.33), caregiver( OR =1.42), father’s high school( OR =1.36), father’s junior high school and below( OR =1.37), and parents’ no exercise habit ( OR =1.47) were associated with high screen time during weekend( P <0.05). Conclusion Family related factors can affect children’s screen time. Parents should pay attention to children’s screen time in the process of children’s growth.

Objective: To explore sleep duration and associated factors among children aged 3-6 years old in Zhejiang Province. Methods: A total of 7 034 children aged 3-6 years from 24 kindergartens in Zhejiang province were selected through clustered sampling method. Through parental questionnaire, child sleep duration and associated factors were colleted. Possible influencing factors of sleep insufficiency were analyzed by logistic regression model. Results: The rate of insufficient sleep was 56.1%, with 57.1% for boys and 55.1% for girls in Zhejiang Province. The rate of insufficient sleep increased with the increase of age, which was 46.7%, 49.8%, 50.2%, 55.2%, 64.0%, 65.8% and 68.1% for 3.0, 3.5, 4.0, 4.5, 5.0, 5.5 and 6.0 years old group (χ 2=45.71, P<0.01), respectively. The rate of insufficient sleep was 59.9%, 54.7% and 45.6% for children with <1 h/d, 1-2 h/d and ≥2 h/d outdoor physical activity (χ 2=67.10, P<0.01). Multivariate Logistic regression model showed that children older than 4.5 years old, whose caregiver was other than parents, outdoor activity time< 1 h/d and 1-2 h/d, maternal education below junior middle school and senior high school were positiviely associated with sleep insufficiency [OR(95%CI) was 1.29(1.07-1.54), 1.97(1.64-2.37), 2.04(1.69-2.46), 2.35(1.82-3.03), 1.21(1.08-1.35), 1.73(1.49-2.01), 1.47(1.26-1.72), 1.35(1.15-1.59), 1.16(1.01-1.32), P<0.05]. Conclusion Sleep insufficiency among preschool children is associated with multiple factors, increase of age, insufficient outdoor activity and overdose screen time in particular. The finding calls for outdoor physical activity promotion among preschool children, especially for those whose caregivers are those other than parents.

U1 trastuctrural changes of myocardium and lungs from 6 cases died of cranioce-rebral penerating gunshot wound 2 hours after injury is reportcd.In all cases theelectron microscopy of the myocardial and lung tissue samples showed the similar ultrastructural morphological changes of the cells and interstitial tissues.The mostpr-ominent ultrastructural changes of myocardium were disorderly arrangement of the Zband.focal dissociation of the myofibrills,mitochondrial swelling with decreasing ofmatrix density and disruption of cristae,and interstial edema.The changes of theung tissue were increasing of width of alveolar septa with decreasing of the electron density.Aggregation of neutrophils in the capillaries of alveolar septa and some alveolar space was observed.The significance and the pathogenesis of the mainpathological changes were discussed.It is suggested that the pulmonary interstitialedema was neurogenic.The pulmonary edema may be manifested as interstitial edemaor intra-lveolar edema depending upon the time elapsed after the gunshot injury.