Objective To investigate the malnutrition status among the elderly in age care institutions in Shanghai suburb and analyze its potential influential factors.Methods The MiniNutritional Assessment (MNA) was adopted to evaluate the nutritional status of the 190 elderly people in age care institutions.The dietary supply by the institution canteen and the quantity of residual food left by the malnourished elderly people were weighted.Results In the age care institutions,the malnutrition rate reached 23.7％,47.9％ of the elderly people were at the risk of malnutrition,and only 28.4％ of the elderly people were well nourished.Logistic regression analysis showed that the major influential factors for malnutrition in the elderly people were food intake ability,mobile capability,chewing and swallowing ability,ageing and mental Illness.The malnourished elderly people had the most residual meat and vegetables,and insufficiency of nutrient intake was the main cause for the malnutrition in the elderly people.Conclusions The elderly people in age care institutions in Shanghai suburb have the higher risk of malnutrition.The malnutrition occurs under influence of many factors,of which some are unavoidable,however,some factors like dietary factors can be changed to improve the nutritional status of the elderly people in age care institutions.

Objective:To study the experience of frontline medical workers in COVID-19 quarantine points.Methods:Purposive sampling method was employed and 12 frontline medical workers in COVID-19 points of Zhaoyuan City were selected for semi-structured and in-depth interview. Colaizzi′s seven-step analysis method was adopted to analyze and categorize the data.Results:The real experience of frontline medical workers in quarantine points were classified into five themes: professional mission and pride, inadequate initial response in dealing with public health emergencies (shortage of personal protective equipment,inadequate preparation of medical workers and imperfect settings of quarantine points), having some negative emotions (worrying about being infected and feeling fearful for family members), facing complex and diverse working difficulties (repugnance and diversified demands of people quarantined, heavy workload, discomfort from personal protective equipment and occupational exposure), and gaining support and appreciation (getting support from epidemic control and prevention departments as well as medical systems and winning appreciation from people quarantined).Conclusions:The frontline medical workers are lack of experience in dealing with public health emergencies and have some psychological and working pressure. Administrative department should further complete the emergency plan of centralized isolation medical observation, strengthen the contingency management of public health emergencies, attach importance to the mental health of medical workers, optimize management methods and establish flexible work schedules.

Objective To evaluate cytological test of cerebrospinal fluid in the diagnosis of meningeal dissemination of tumor cells.Methods The clinical and imaging features of 85 cases with tumor cells diagnosed by thin-layer centrifugal cytological test of cerebrospinal fluid were retrospectively reviewed.The characteristics of cellular morphology and immunocytochemical staining were analyzed.Results The main presentations of all the patinets was meningeal irritation and neurological dysfunction.The features of the brain MRI were meningeal thicking and enhancement,intracranial abnormal signals and intracranial space occupying lesion in part of the patients.Atypical cells were found in 84 cases (98.8％) with the first sample test and immunocytochemical staining was conducted in 48 cases to identify the tissue origin.Meningeal carcinomatosis was shown to be the majority with lung cancer as the dominated tissue type and adenocarcinoma as the most common histological type.Others were lymphatic hematopoietic system (13 cases),melanomas (5 cases),primitive neuroectodermal tumor (3 cases) and glioma (1 case).In addition,12 cases were only proved to be cancer by cytological test of cerebrospinal fluid.Conclusion The thin-layer centrifugal cytological test of cerebrospinal fluid has a relatively high accuracy for detecting disseminated tumor cells of meninges and could be of great help to identify the source and type of lesion with immunocytochemical staining.

Objective:To investigate the effects of bezafibrate (BF) on the activation,proliferation and differentiation of CD4+T cells from primary biliary cirrhosis ( PBC) patients and to elucidate the mechanisms for the immunosuppressive effects of BF and to further provide experience basis for BF target therapy PBC.Methods:PBMCs were isolated from PBC patients then CD 4+T cells were selected by MACS, and stimulated with anti-CD3, anti-CD28, in the presence of different concentration of BF.The cytokines were measured by ELISA,and the activation,proliferation and differentiation of CD4+T cells were analyzed by flow cytometry.Results:(1) BF could inhibit the activation of CD 4+T cells in PBC patients.(2) BF could inhibit the proliferation of CD 4+T cells in PBC patients in a dose-dependent manner (P<0.05).(3)BF could down-regulation IFN-γand IL-17 production of CD4+T cells in a dose-dependent manner ( P<0.05 ).Conclusion: BF could inhibit immune responses of PBC patients by suppressing CD 4+T cells activation;proliferation and cytokine production.

Objective:To investigated the correlation between vascular remodeling pattern and perforator stroke after stenting in patients with symptomatic intracranial vertebrobasilar artery stenosis.Methods:Patients with symptomatic intracranial vertebrobasilar atherosclerotic stenosis underwent stenting and high resolution magnetic resonance imaging (HR-MRI) from January 2017 to August 2020 were enrolled retrospectively. The data of demography, vascular risk factors, plaque characteristics, operation process and postoperative complications were collected. The plaque characteristics were observed by HR-MRI, and the correlation between vascular remodeling pattern and perforator stroke after stenting was analyzed.Results:A total of 41 patients were enrolled in the analysis. Their age was 60.1±8.8 years (range, 49-77 years). There were 31 males (75.6%). Among them, 21 (51.2%) were positive remodeling, 20 (48.8%) were non-positive remodeling, and 5 (12.2%) had perforator stroke after procedure. The incidence of perforator stroke in the positive remodeling group was significantly higher than that in the non-positive remodeling group (23.8% vs. 0%; P=0.048). The positive remodeling rate of the perforator stroke group was significantly higher than that of the non-perforator stroke group (100.0% vs. 44.4%; P=0.048). Conclusions:Patients with intracranial vertebrobasilar atherosclerotic stenosis and positive vascular remodeling were more likely to have perforator stroke after stenting.

OBJECTIVE:To control the risk of off-label drug use,and to provide reference for rational drug use. METHODS:Outpatient prescriptions were selected by stratified equal proportion sampling method from a third grade class A hospital during Jun. 2015-Jun. 2016. According to the latest edition of drug instruction issued by CFDA,the off-label prescriptions were screened and analyzed statistically. According to Micromedex tools and literatures report,guidelines,off-label drug use and related severe ADR were analyzed. RESULTS:Of 3 025 outpatient prescriptions,11.2% of prescriptions(339 pieces)were considered as off-label prescriptions,including without indication(88.7%),over dose(6.0%),beyond route of administration(3.2%)and beyond adapt-to-the-crowd(2.1%). Gastroesophagedal reflux was the main diagosis(16.0%). 1.5% of off-label drug use were supported by FDA-approved labels,83.8% of them were supported by international and national guidelines,12.4% of them were supported by expert consensus,and 2.4% of them were supported by other literature report. Thirteen items of off-label drug use had been included in Micromedex,recommendation grade and evidence intensity of which varied. Eight drugs of off-label drug use were reported to result in serious ADR. CONCLUSIONS:All off-label drug use in outpatient department of this hospital is supported by evidence-based medical evidence. But the quality of evidence varies. In the practice,physicians and pharmacists should balance the benefit and risk of off-labed drug use carefully.

Objective To evaluate the effect and safetyof Yupingfeng Powdercombined with antihistamines for the treatment of patients with chronic urticaria.Methods Searched all randomized controlled trials (RCTs)of Yupingfeng Powder for treatment of chronic urticaria from the databases of CENTRAL,Pubmed,Embase,CNKI,CBM,VIP and Wanfang.Two researchers independently searched the literature and used the Cochrane system evaluation method to evaluate the quality of the study,and used RevMan 5.3 for meta-analysis.Results A total of 10 RCTs involving 964 patients were included in this study.Meta-analysis showed that compared with antihistamines alone,Yupingfeng Powder combined with antihistamines could improve the clinical effective rate (OR=2.83,95 ％ CI:1.89-4.25,P ＜ 0.01),reduce relapse rate (OR =0.13,95 ％ CI:0.07-0.24,P＜0.01) and reduce the incidence of adverse reactions (OR=0.40,95％CI:0.19-0.83,P=0.01).Conclusion Yupingfeng Powder combined with antihistamines has superior clinical effective rate,lower recurrence rate and incidence of adverse reactions.

Objective: To investigate the usefulness of loss of CIC expression as the prescreening detection of 1p/19q co-deletion in the diagnosis of oligodendroglial tumors and its prognostic implication. Methods: The retrospective study included 113 oligodendroglial tumors diagnosed in the Department of Pathology, Xuanwu Hospital, Capital Medical University. Expression of CIC protein was detected by immunohistochemistry, and the 1p/19q co-deletion by fluorescence in situ hybridization in all the tumors; and the correlation of the loss of protein and 1p/19q co-deletion with prognosis was assessed. Results: The rate of negative CIC protein expression was 59.3% (67/113) in 113 oligodendroglial tumors. CIC protein expression was differentially lost in various gliomas, 85.7% (42/49) in pure oligodendrogliomas and 39.1% (25/64) in mixed oligodendroglial tumors (P<0.01). The loss of CIC protein expression showed a sensitivity of 76.1% (54/71), specificity 71.1% (27/38), false positive rate of 16.9% (11/65), and a false negative rate of 38.6% (17/44). In 63 cases integrated diagnosis as oligodendroglial tumors with mutant IDH and 1p/19q co-deletion, the loss of CIC protein expression was 81.0% (51/63); the sensitivity and specificity were increased to 81.0% (51/63) and 76.9% (20/26), and the false positive rate and false negative rate decreased to 10.5% (6/57) and 37.5% (12/32), respectively. By using Kaplan-Meier analysis, the CIC negative group showed a trend towards better outcome than the CIC positive group, but there was no statistical difference (overall survival: P=0.218; progression free survival: P=0.249). Conclusions Detection of the lost CIC protein expression can predict the chromosome 1p/19q co-deletion. In oligodendroglial tumors with IDH mutant and 1p/19q co-deletion, there is no relation between prognosis and CIC protein expression.

Objective To study the expression of autophagy-related proteins ( Beclin-1, LC3 and p62) in brain tissue with malformations of cortical development and related molecular pathogenesis. Methods The brain tissue of 18 cases with epileptogenic foci resection, including 6 cases of tuberous sclerosis complex (TSC), 6 cases of focal cortical dysplasia type Ⅱb (FCD Ⅱb) and 6 cases of focal cortical dysplasia type Ⅰ ( FCD Ⅰ) , were retrieved.Immunohistochemical study for Beclin-1, LC3 and p62 proteins was performed.The degree of positivity for Beclin-1 and LC3 proteins was compared.Western blot was used to quantitatively analyze the LC3 protein in focal lesion of each disease groups.Results Immunohistochemical study showed that the three proteins were mainly expressed in the dysmorphic neurons and balloon cells/giant cells of TSC and FCD Ⅱb.The positivity was more intense in the dysmorphic neurons than the other cell types.Immunostaining for Beclin-1 showed granular or diffuse cytoplasmic positivity, in addition to the strong expression in axons.On the other hand, LC3 showed diffuse or perinuclear cytoplasmic expression.The staining for p62 was mainly cytoplasmic or perinuclear and sometimes nuclear.In FCD typeⅠ, only individual cells showed positive expression for the three proteins.The number of Beclin-1 and LC3-positive cells was larger in TSC group, followed by FCDⅡb group and FCDⅠgroup.And there were significant differences between TSC group and FCDⅠgroup, as well as FCDⅡb group and FCDⅠgroup (P<0.05).Quantitative expression of LC3 protein by Western blot showed smaller amount in TSC group, followed by FCD Ⅱb group and FCDⅠ group.Conclusions The dysmorphic neurons and balloon cells/giant cells of TSC and FCD Ⅱb show abnormality in autophagy, resulting in intracytoplasmic protein accumulation.There are differences in molecular pathogenesis in these cell types.

Objective To investigate the clinicopathologic features of intractable epilepsy related encephalitis.Methods The clinical and pathologic findings of 15 cases of intractable epilepsy after functional neurosurgical treatment were reviewed and analyzed retrospectively.Results All patients,including four male and 11 female,had medically intractable epilepsy.The mean age of onset for seizure was 5.3 years (1-15 years) and the disease duration was 4.7 years (0.5-15 years).A definite past history was identified in 11 patients,including viral encephalitis in nine patients,anoxia in utero and head trauma in one patient respectively.The extent and sites of involvement were different,including single cerebral hemisphere diffusely in five cases,multiple lobes in seven cases,and single lobe in three cases.Temporal lobe was involved in 13 cases,frontal lobe in eight,parietal lobe in eight,occipital lobe in seven,and insular lobe in four.Microscopically,all cases were characterized by perivascular inflammatory cells infiltration in the subarachnoid space.The focal cerebral cortex showed obvious atrophy with various degrees of the neuronal loss and glial proliferation,eventually leading to glial scar formation.In addition,microglia nodules,lymphatic cuff and neuronophagia were also observed.Seven cases of focal cortical dysplasia were identified among the 11 cases with adequate perilesional cerebral cortex.Hippocampus sclerosis was found in two cases.Intranuclear inclusions were seen in six cases,and these were immunopositive of cytomegaloviruslate antigen,and three cases also showed muhinucleated giant cells and calcifications.Conclusion Encephalitis is one of the common causes of refractory epilepsy,and may result in refractory epilepsy as a sequel.