Objective: To investigate the relationship between long-, short-term systolic blood pressure variability (SBPV) and renal damage in elder population. Methods: Our research was conducted in the 3rd physical examination of healthy population from Kailuan group by cohort study. Cluster sampling was used by 25% ratio in subjects≥60 years of age to monitor their 24-hour ambulatory blood pressure and finally, 2464/3064 participants with inclusion criteria were recruited. SBPV indexes as standard deviation of systolic blood pressure (SSD), variability independent of the mean (VIM), maximum-minimum difference (MMD) and average real variability (ARV) were examined; renal damage indexes as estimated glomerular filtration rate (eGFR) and microalbuminuria (ALBU) were detected. Relationships between different long-term, short-term SBPV indexes and eGFR, ALBU were studied by multi-liner regression analysis. Results:①The mean age of 2464 participants was (67.41 ± 6.05) years including 1667 (67.7%) male and 797 (32.3%) female.②Multi-liner regression analysis indicated that different long-term SBPV indexes were not related to eGFR and ALBU; 24h SBPV in all 4 indexes and day-time SSD, MMD, ARV were negatively related to eGFR; 24h ARV and day-time MMD, ARV were positively related to ALBU; night-time SBPV indexes were not related to eGFR and ALBU.Conclusion: Different short-term SBPV indexes were, at certain point related to eGFR and ALBU

With increasing use of carbapenem antibiotics , carbapenems-resistant gram-negative bacteria are spreading, and carbapenemase-producing is the main mechanism of carbapenems resistance . Rapid and accurate identification of carbapenemase and its type is of great importance to timely and effective treatment and control of infections .Chromogenic /Fluorogenic culture media, modified Hodge test and double disk synergy test are traditional methods for carbapenemase detection , but all are time-consuming. Biochemical method is more time efficient and with high sensitivity and specificity , but cannot be used to identify subtypes.Now matrix-assisted laser desorption ionization -time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully applied in the identification of species , subtypes and detection of drug -resistant genes.And among various carbapenemase gene detection techniques , next generation sequencing (NGS) can also be used for the detection of integrons , transposons and plasmids, which is important in both epidemiology and resistant mechanism studies .This article reviews the advantages and disadvantages of various methods for phenotype and gene detection of carbapenemase .

Objective To explore the risk factors for lower extremity amputation in patients with diabetic foot.Methods The clinical data of 1 771 patients with diabetic foot at the Air Force General Hospital of PLA from November 2001 to April 2015 were retrospectively analyzed.The patients were divided into the non-amputation and amputation groups.Within the amputation group , subjects were further divided into the minor and major amputation subgroups.Binary logistic regression analyses were used to assess the association between risk factors and lower extremity amputation.Results Among 1 771 patients with diabetic foot , 323 of them ( 18.24%) were in the amputation group ( major amputation: 41; minor amputation:282 ) and 1 448 ( 81.76%) in the non-amputation group.Compared with non-amputation patients, those in the amputation group had a longer hospital stay and higher estimated glomerular filtration rate(eGFR)levels.Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-reaction protein (CRP), ESR, ferritin, fibrinogen and WBC levels of the amputation group were higher , while hemoglobin albumin, transferrin, TC, TG, HDL-C and LDL-C were lower than those of the non-amputation group (all P<0.05 ).The proportion of hypertension ( 52.48% vs 59.98%) , peripheral vascular disease ( PAD ) (68.11% vs 25.04%), and coronary heart disease (21.33% vs 28.71%) were different between the amputation and non-amputation groups (all P<0.05).Multivariable logistic regression analyses showed that Wagner′s grade , PAD and CRP were the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot.Conclusion Wagner′s grade, ischemia of lower limbs and infection are closely associated with amputation of diabetic foot patients.

Objective To observe the association between the cardiovascular health score and newonset atrial fibrillation.Methods A total of 95 026 participants who participated the health examination between July 2006 and October 2007 at Kailuan group and without history of atrial fibrillation were selected as the observation cohort.The second,the third and the fourth health examination were performed between July 2008 to October 2009,July 2010 to October 2011,July 2012 to October 2013,respectively.A total of 85 028 participants were included in the final analysis after excluding participants who had new-onset valvular atrial fibrillation and participants lost to follow-up.The participants were divided into 4 subgroups by cardiovascular health score at baseline according to the definition of AHA and cardiovascular health scoring system,namely group of 0-6 points (n =11 103),7-8 points (n=24 487),9-10 points (n =32 556),and 11 14 points (n =16 882).The incidence of atrial fibrillation in each subgroup was observed,and the association between cardiovascular health score and risk of new-onset atrial fibrillation was analyzed using multiple Cox regression analysis.Results A total of 254 participants developed atrial fibrillation during the median of (5.6 ± 1.4) years follow-up.The total incidence of new-onset atrial fibrillation was 0.53/1 000 person-year.The incidence of atrial fibrillation was 0.69/1 000 person-year,0.60/1 000 person-year,0.56/1 000 person-year,and 0.30/1 000 person-year,respectively in 0-6 points,7-8 points,9-10 points,and 11-14 points subgroups,respectively (P ＜ 0.01).After adjustment of age,gender,education level,income,drink,history of myocardial infarction,history of stroke,serum uric acid and C reactive protein level,multiple Cox regression analysis showed that one health score point increase was related to 8％ reduction of new onset atrial fibrillation(HR =0.92,95％ CI 0.86-0.99,P ＜ 0.05).Compared with the group of 0-6 points group,the risk of atrial fibrillation in the group of 11-14 points group was reduced by 49％ (HR =0.51,95 ％ CI 0.31-0.83,P ＜ 0.01).Conclusion The risk of new-onset atrial fibrillation is reduced in proportion to increase of cardiovascular health score.

Objective:To detect the expression levels of laboratory of genetics and physiology 2 (LGP2), retinoic acid inducible gene I (RIG-I) and melanoma differentiation associated gene 5 (MDA5) in children with hand, foot and mouth disease (HFMD), and to explore their possible clinical significance in HFMD.Methods:Fifty children with HFMD, who visited Second Affiliated Hospital of Xi′an Jiao Tong University, Xi ′an Children′s Hospital and Xi ′an Central Hospital from May 2020 to May 2021, were selected as the research subjects, and 20 children with physical examination at the same age during the same period were selected as the control group.Children with HFMD were divided into enterovirus 71 (EV-A71) type and coxsackievirus A6 (CV-A6) type according to the results of pathogen detection, and then divided into mild group and severe group according to the severity of the disease.The relative mRNA expression levels of LGP2, RIG-I and MDA5 in each group, and the correlation among the three proteins were compared and analyzed.Results:Among 50 cases of HFMD, 26 cases were EV-A71 type (16 cases were mild and 10 cases were severe) and 24 cases were CV-A6 type (17 cases were mild and 7 cases were severe). There was no significant difference in age and sex between HFMD group and control group ( P>0.05). The relative expression levels of LGP2 mRNA in EV-A71 and CV-A6 HFMD cases were 2.37(1.78, 3.25)% and 1.88 (1.35, 3.13)%, lower than that in control group [2.97(2.61, 3.55)%]. Only the difference between CV-A6 HFMD children and control group was statistically significant ( Z=-2.310, P=0.021). The relative expression levels of RIG-I mRNA in EV-A71 and CV-A6 HFMD cases were 9.95 (7.79, 14.62)% and 9.78(7.04, 15.83)%, lower than that in control group [18.47(13.00, 21.07)%]. The differences were all statistically significant ( P<0.05). The relative expression levels of MDA5 mRNA in EV-A71 and CV-A6 HFMD cases were 4.41(2.82, 5.99)% and 3.98 (2.18, 7.41)%, lower than that in control group [5.10(3.52, 7.71)%], but the differences were not statistically significant.There were no significant differences in the relative expression levels of the three indicators between the mild and severe groups of children with EV-A71 or CV-A6 HFMD.The expression levels of LGP2, RIG-I and MDA5 mRNA were highly correlated( P<0.001). Conclusion:The relative expression levels of LGP2, RIG-I and MDA5 mRNA in children with HFMD are decreased in different degrees than those in normal children.And there is a correlation among them.

Primary liver cancer is one of the common malignant tumors and its mortality ranks third in the world. Because there are no obvious symptoms in the early stage of liver cancer, most patients are diagnosed as advanced stage, without the opportunity of surgical resection. The authors report a case of hepatocellular carcinoma with portal vein tumor thrombus, which reduced significantly after hepatic artery infusion chemotherapy combined with bevacizumab and atezolizumab, showing the safety and efficacy.

The liver is an important metabolic organ in the body. Studies have shown that chronic liver disease is closely associated with glucose and lipid metabolism disorders, and different types of liver diseases often show different characteristics of glucose and lipid metabolism. This article reviews the epidemiological characteristics, disease severity, pathogenesis, and treatment methods of glucose and lipid metabolism disorders in different types of chronic liver diseases, so as to improve the awareness among clinicians.

Objective:To investigate the expression level of transcription factor dimerization partner 2 (TFDP2) in the placentas of women with preeclampsia, and analyze its effect on the apoptosis of trophoblast cells.Methods:Placental tissues from thirty puerperae with preeclampsia who gave birth by cesarean section in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between January 2018 and December 2022 (preeclampsia group) and 30 healthy puerperae undergoing cesarean section during the same period (control group) were retrospectively selected. Immunohistochemistry was used to localize TFDP2 in the placental tissues. Real-time quantitative-polymerase chain reaction (qRT-PCR) and Western blot were used to detect the differences in expression of TFDP2 at mRNA and protein levels in placental tissues between the two groups. Forskolin-exposed BeWo cells were transfected with small interfering RNA (siRNA) to knockdown TFDP2 and the changes in the expression of apoptosis-related indicators, B cell lymphoma 2 (Bcl2) and Bcl2 associated X (Bax), at protein and mRNA levels were analyzed by Western blot and qRT-PCR, respectively. Besides, the change in the apoptosis level of BeWo cells was detected using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining and flow cytometry. Downstream signaling pathways were analyzed to understand the involved molecular mechanisms. Two independent samples t-test, Wilcoxon rank-sum test, and Chi-square test were used for statistical analysis. Results:TFDP2 was mostly localized in the syncytiotrophoblasts and the extravillous trophoblasts in the normal placentas. TFDP2 expression in the syncytiotrophoblasts was lower in the preeclampsia group than in the control group at both mRNA (0.722±0.239 vs. 1.000±0.348, t=3.61, P=0.001) and protein (0.728±0.185 vs. 1.000±0.206, t=2.41, P=0.037) levels. Comparing the group without knockdown of TFDP2, the knockdown of TFDP2 in BeWo cells elevated the Bax/Bcl2 ratio (mRNA: 1.755±0.452 vs. 1.000±0.279, t=3.48, P=0.006; protein: 3.206±0.922 vs. 1.000±0.290, t=3.95, P=0.017), and increased cell apoptosis both in number and ratio (TUNEL staining: 4.556±1.740 vs. 2.444±1.130, t=3.05, P=0.008; flow cytometry: 21.37%±1.66% vs. 12.61%±0.38%, t=8.92, P=0.001). Furthermore, following TFDP2 knockdown, a decrease in the phosphorylation activity of catalytic subunit of protein kinase A (PKAc) at the Thr197 site was observed in the cytoplasm of BeWo cells (0.466±0.035 vs. 1.000±0.075, t=11.19, P<0.001) and a reduction in the expression of β-catenin in the cell nucleus was also detected (0.250±0.093 vs. 1.000±0.269, t=4.57, P=0.010). Conclusion:The expression of TFDP2 decreased significantly in the placentas of patients with preeclampsia, which may promote the apoptosis of syncytiotrophoblasts by inhibiting the PKAc/β-catenin signaling pathway.

Objective To investigate the value of quantitative iodine-based material decomposition images with gemstone spectral CT imaging in the follow-up of patients with hepatocellular carcinoma ( HCC) after transcatheter arterial chemoebolization ( TACE ) . Methods Consecutive 32 HCC patients with previous TACE treatment were included in this study.For the follow-up, arterial phase ( AP) and venous phase ( VP) dual-phase CT scans were performed with a single-source dual-energy CT scanner ( Discovery CT 750HD, GE Healthcare).Iodine concentrations were derived from iodine-based material-decomposition images in the liver parenchyma, tumors and coagulation necrosis ( CN ) areas.The iodine concentration difference (ICD) between the arterial-phase (AP) and venal-phase (VP) were quantitatively evaluated in different tissues.The lesion-to-normal parenchyma iodine concentration ratio ( LNR) was calculated.ROC analysis was performed for the qualitative evaluation, and the area under ROC ( Az ) was calculated to represent the diagnostic ability of ICD and LNR.Results In all the 32 HCC patients, the region of interesting ( ROI ) for iodine concentrations included liver parenchyma ( n =42 ) , tumors ( n =28 ) and coagulation necrosis ( n =24).During the AP the iodine concentration of CNs ( median value 0.088μg/mm3 ) appeared significantly higher than that of the tumors ( 0.064 μg/mm3 , P =0.022 ) and liver parenchyma (0.048μg/mm3 ,P=0.005) .But it showed no significant difference between liver parenchyma and tumors (P=0.454).During the VP the iodine concentration in hepatic parenchyma (median value 0.181 μg/mm3) was significantly higher than that in CNs (0.140 μg/mm3,P=0.042).There was no significant difference between liver parenchyma and tumors, CNs and tumors (both P>0.05).The median value of ICD in CNs was 0.006 μg/mm3 , significantly lower than that of the HCC (0.201 μg/mm3 , P<0.001) and hepatic parenchyma (0.117 μg/mm3, P <0.001).The ICDs in tumors and hepatic parenchyma showed no significant difference (P =0.829).During the AP, the LNR had no significant difference between CNs and tumors ( a median value 1.805 vs.1.310, P=0.389) , and during the VP, the difference was also non-significant (the median value 0.647 vs.0.713, P=0.660).The mean Az value of ICDs for evaluation of surviving tumor tissues was 0.804, whiles LNR measured a disappointing result in both AV images and VP images.Conclusion Quantitative iodine-based material decomposition images with gemstone spectral CT imaging can improve the diagnostic efficacy of CT imaging for HCC patients after TACE treatment.