Objective To analyze the clinical characteristics of severe fever with thrombocytopenia syndrome (SFTS) so as to improve the recognition of the emerging infectious disease.Methods A retrospective analysis was performed upon clinical manifestations,laboratory test results and prognostic features of 169 patients with SFTS admitted to the 154 Hospital,Chinese People's Liberation Army from October 2010 to May 2011.The patients were divided into moderate disease group and severe disease group according to the prognosis.The differences between two groups were compared to explore the prognostic indicator of severe type.Results All patients with SFTS inhabited in hilly ground with history of field work.The main clinical symptoms were severe fever (98.8％,167/169),headache (52.1％,88/169),muscle soreness (95.9％,162/169),nausea (73.4％,124/169),vomiting (67.5％,114/169),coughing (61.5％,104/169),etc.Superficial lymph node enlargement with haphalgesia was observed in 45.0％(76/169) patients.Petechia or ecchymosis was observed in 36.7％ (62/169) patients.Critical patients were mainly aged ＞ 60 years,associated with nerve and circulatory system syndrome,prominent hemoptysis,dyspnea,and nearly 73.3％ (22/30) of severe thrombocytopenia.Serum levels of aspartate aminotransferase,creatinine and urea nitrogen were significantly higher in severe disease group than those in moderate disease group [235 (47-1750) U/L vs 88 (14-2000) U/L,997 (281-2601) U/L vs 399 (26-2633)U/L,101 (62-291) μmol/L vs 70(26-205) μmol/L,7.0(2.2-20.0) mmol/L vs 4.8(1.4-18.5) mmol/L,all P values ＜0.001].Conclusion Nerves system syndrome,transaminase and urea nitrogen are risk factors of prognosis of severe SFTS to whom deserves paying attention.

Objective To explore Wang Xingkuan’s rules of syndrome and treatment of chest blocking and heartache (Xiongbixintong).Methods Collection of professor Wang Xingkuan’s 267 consilia of patients with Xiongbixintong for outpatients. Chinese medicine terminology was regulated and Excelldatabase was established. Symptom, syndrome element, pathogenesis and treatment were statistically described by using Weka3.6 software, and Apriori algorithm was adopted for the main pathogenesis→treatment analysis of association rules.Results Symptoms include:chest pain, heart palpitations, shortness of breath, pale tongue (dark) red, etc. Syndrome elements include:in liver, and heart, and blood stasis, phlegm, qi stagnation, etc. The key pathogenesis is liver-heart imbalance, including stagnation of liver qi, heart and blood stasis, deficiency of heart qi-ying, disturbing heart-mind, etc. The principle of treatment is liver-heart Tongzhi, so the treatment is of“liver” with Shu gan-mu;treatment of“heart” contains freeing channels, eliminating phlegm and blood stasis, quiet the heart, replenishing qi-ying, etc. The main pathogenesis related credibility→treatment was higher than 0.50;with high reliability, the liver-heart imbalance→liver-heart Tongzhi was 0.71. Medication includes catharsis and tonic,“catharsis” to salvia, allium macrostemon, pseudo-ginseng, bupleurum, etc;“tonic” to white ginseng, ophiopogon japonicus, radix paeoniae alba, poria with hostwood, polygala tenuifolia, etc. Conclusion “Xintongzhigan, liver-heart Tongzhi, catharsis and tonic” is Wang Xingkuan’s thoughts and experience in treating Xiongbixintong.

Objective To evaluate the clinical significance of sentinel lymph nodes biopsy (SLNB) in breast cancer patients after neoadjuvant chemotherapy. Methods SLNB was performed in sixty primary breast cancer patients after neoadjuvant chemotherapy using a combination of 99mTc- Rituximab and patent blue. SLN was examined by routine pathologic examination and immunohistochemistry. Routine axillary lymph node resection was performed after SLNB. Results The successful rate of SLNB was 95% (57/60). Twenty-three cases of SLN (40% ) were metastasis positive, including 18 positive cases detected by HE staining and 5 by immunohistochemistry. SLN was the only metastasis lymph nodes in 14 out of 23 cases. One case was of false negative metastasis by SLN. The sensitivity and accuracy of SLNB were 96% (23/24) and 98% (56/57), respectively. The specificity was 100% (33/33) , the false negative rate was 4. 3% (1/23) with the negative predictive value being 97% (36/37). The positive predictive value was 100% (24/24). Internal mammary sentinel lymph node lymphoscintigraphy were positive in 11 cases but all the cases were negative in metastases by pathologic examination. Conclusion The combination of isotope imaging agent and patent blue is suitable for primary breast carcinoma after neoadjuvant chemotherapy. Internal mammary sentinel lymph node biopsy is less clinically important.

Objective:To discuss the surgical effect of modified cervical cerclage for the treatment of pregnant women with cervical insufficiency.Methods:The clinical data of 225 pregnant women who underwent modified cervical cerclage in Qilu Hospital (Qingdao) were selected for retrospective analysis from April 2014 to June 2020. Surgical success rate, full-term birth rate, preterm birth rate, prolonged pregnancy weeks and newborn birth weight were compared between singleton and twin pregnancies, preventive cerclage and emergency cerclage, surgery before and after 18 weeks, naturally and in vitro fertilization and embryo transfer (IVF-ET) conceived pregnant women respectively.Results:Among the 225 pregnant women, the gestational weeks of surgery were 14-24 +5 weeks, mean gestational weeks of delivery were 38 +2 weeks (35 +5-39 +3 weeks), the number of prolonged gestation were (20.3±5.2) weeks, and the newborn birth weight was (3 065±735) g; the overall surgical success rate was 92.9% (209/225), and the miscarriage rate was 7.1% (16/225); among the surviving newborns, the full-term birth rate was 73.7% (154/209), and the preterm birth rate was 26.3% (55/209). All cases had no intraoperative complications. Among the 225 pregnant women, 202 (89.8%, 202/225) cases were singleton pregnancies, and 23 (10.2%, 23/225) cases were twin pregnancies; 201 (89.3%, 201/225) cases underwent preventive cervical cerclage, and 24 (10.7%, 24/225) cases underwent emergency cervical cerclage; 190 (84.4%, 190/225) cases underwent the surgery before 18 weeks, and 35 (15.6%, 35/225) cases underwent the surgery after 18 weeks; 49 (21.8%, 49/225) cases were conceived by IVF-ET. There was no statistically significant difference in the overall surgical success rate of single and twin group ( P>0.05). The full-term birth rate, newborn birth weight and prolonged pregnancy weeks of single group were higher than those of twin group ( P<0.05). There were no statistical differences between preventive and emergency cerclage in overall surgical success rate, full-term birth rate, preterm birth rate, and newborn birth weight (all P>0.05). The pregnancy prolonged weeks of preventive cerclage was higher than that of emergency cerclage ( P<0.05). There were no statistically significant differences in the overall surgical success rate, full-term birth rate, preterm birth rate and birth weight of newborns at different surgical timings (all P>0.05). The pregnancy prolonged week for those who underwent surgery before 18 weeks was higher than that of surgery after 18 weeks ( P<0.05). The premature birth rate of IVF-ET was higher than that of naturally conceived pregnant women ( P<0.05). Conclusion:The modified cervical cerclage could effectively prolong the gestational weeks of delivery, reduce the rate of preterm birth, and the operation is simple and easy to promote. It could be used as a surgical option for patients with cervical insufficiency.

Objective:To establish a nomogram model for predicting the risk of coronary artery disease in elderly patients with acute myocardial infarction (AMI).Methods:The clinical data of elderly patients with AMI who underwent coronary angiography in the department of cardiology of Cangzhou Central Hospital from July 2015 to March 2020 were analyzed, including age, gender, smoking history, underlying diseases, family history, blood pressure, left ventricular ejection fraction (LVEF), and several biochemical indicators at admission, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein [Lp(a)], apolipoproteins (ApoA, ApoB), ApoA/B ratio, total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil), fasting blood glucose (FBG) and uric acid (UA). Patients were divided into model group (2 484 cases) and validation group (683 cases) according to the ratio of 8∶2. According to Gensini score, the model group and validation group were divided into mild lesion group (0-20 points) and severe lesion group (≥81 points). The differences of each index between different coronary lesion degree groups were compared. Lasso regression and Logistic regression were used to analyze the risk factors of aggravating coronary lesion risk in elderly patients with AMI, and then the nomogram prediction model was established for evaluation and external validation.Results:① In the model group, there were significant differences in the family history of coronary heart disease, FBG and HDL-C between the mild lesion group (411 cases) and the severe lesion group (417 cases) [family history of coronary heart disease: 3.6% vs. 7.7%, FBG (mmol/L): 5.88±1.74 vs. 6.43±2.06, HDL-C (mmol/L): 1.48±0.69 vs. 1.28±0.28, all P < 0.05]. In the validation group, there were significant differences between the mild lesion group (153 cases) and the severe lesion group [132 cases; FBG (mmol/L): 5.58±0.88 vs. 6.85±0.79, HDL-C (mmol/L): 1.59±0.32 vs. 1.16±0.21, both P < 0.05]. ② Lasso regression analysis showed that family history of coronary heart disease, FBG, and HDL-C were risk factors of coronary artery disease in elderly patients with AMI, with coefficients 0.118, 0.767, and -0.558, respectively. Logistic regression analysis showed that FBG [odds ratio ( OR) = 1.479, 95% confidence interval (95% CI) was 1.051-2.082, P = 0.025] and HDL-C ( OR = 0.386, 95% CI was 0.270-0.553, P < 0.001] were independent risk factors of coronary artery disease in elderly patients with AMI. ③ According to the rank score of FBG and HDL-C, the nomogram prediction risk model of aggravating coronary artery disease degree was established for each patient. It was concluded that the risk of coronary artery disease in elderly people with higher FBG level and (or) lower HDL-C level was significantly increased. ④ The nomogram model constructed with the model group data predicted the risk concordance index (C-index) was 0.689, and the C-index of the external validation group was 0.709. Conclusions:FBG and HDL-C are independent risk factors for aggravating coronary artery disease in elderly patients with AMI. The nomogram model of aggravating coronary artery disease in elderly patients with AMI has good predictive ability, which can provide more intuitive research methods and clinical value for preventing the aggravation of coronary artery disease in elderly patients.

OBJECTIVETo investigate the prognosis value of early and interim ¹⁸F-FDG-PET/CT scan in patients with diffuse large B- cell lymphoma （DLBCL） to establish the suitable criteria for evaluating posttherapeutic lesions in scans.

METHODSFifty- six newly diagnosed DLBCL patients were enrolled in the study, and underwent baseline, early and interim ¹⁸F- FDG PET/CT scans. Five- point and % ΔSUVmax criteria were used separately to interpret ¹⁸F- FDG PET/CT images. Interobserver reproducibility was assessed with the kappa test（κ）, and thresholds of %ΔSUVmax were calculated via receiver operating characteristic curve（ROC）. Survival curves were obtained using Kaplan-Meier curves and log-rank test. Cox regression analysis was used for multi-factor analysis.

RESULTSMedian follow-up was 24 months（6 to 42 months）. The kappa value of the five- point scale was above 0.600 with the reference background set in the liver（Score≥4）. The optimal threshold of %ΔSUVmax was 81% for early PET/CT and 74% for interim PET/CT. Survival analysis showed both early and interim PET/CT scans could predict the outcome of 56 patients with DLBCL, and 3-year PFS and OS of PET-negative patients were significantly higher than those of PET-positive ones（P<0.05）. Five-score criteria were more accurate in evaluating 3- year PFS of DLBCL patients in the interim PET/CT scan（76.79%）. %ΔSUVmax criteria were better for interpreting 3-year OS（76.79% and 83.93%）. Multi-factor analysis demonstrated that early and interim PET/CT were solid predicting factors for DLBCL patients.

CONCLUSIONEarly and interim PET/CT scans could predict the outcome of patients with DLBCL, treated with R-CHOP/CHOP. Three-year OS was more accurate in early and interim PET/CT using 66 %ΔSUVmax criteria as an interpretation, while 3-year PFS was more accurate in interim PET/CT by five scores criteria.

Antibodies, Monoclonal, Murine-Derived ; Antineoplastic Combined Chemotherapy Protocols ; Cyclophosphamide ; Doxorubicin ; Fluorodeoxyglucose F18 ; Humans ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; drug therapy ; Positron-Emission Tomography ; Prednisone ; Prognosis ; ROC Curve ; Reproducibility of Results ; Survival Analysis ; Tomography, X-Ray Computed ; Vincristine

OBJECTIVE: To analyze the effect of occupational stress on abnormity of serum total cholesterol and triglyceride in male steel workers. METHODS: A total of 3 957 male steel workers from an iron and steel group company were selected as study objects by judgment sampling method. Occupational stress was measured by the Chinese version of Job Content Questionnaire. The serum total cholesterol and triglyceride levels were measured using fasting venous blood. RESULTS: Among the 3 957 workers,the detection rate of occupational stress was 56. 8%,and 55. 0% of them showed high social support. The abnormal rates of total cholesterol and triglyceride were 21. 8% and 40. 9%,respectively. The multivariate logistic regression analysis showed that workers with high social support had high risk of abnormal total cholesterol and abnormal triglyceride than workers with low social support( P < 0. 05) after adjusting for confounding factors such as age,education level,marital status,body mass index,smoking and drinking alcohol,tea. The odds ratio of abnormal total cholesterol in occupational stress workers was 1. 17 times of that of non-occupational stress workers. No association was found between occupational stress and abnormal triglyceride( P > 0. 05). CONCLUSION: Occupational stress may be associated with abnormity of total cholesterol in male steel workers. Social support is an important influences factor to the abnormity of total cholesterol and triglyceride in male steel workers.