Objective To explore the clinical value of the ten-point scale in the early diagnosis of fat embolism syndrome.Methods The data of 129 patients with fat embolism syndrome diagnosed by Gurd criteria admitted from January 1993 to February 2012 were analyzed retrospectively.At the same time,another 97 patients with single or multiple long bone fracture and/or pelvic fracture without fat embolism admitted from July 2005 to February 2012 were enrolled as control group.Patients were excluded if they had any of the following diseases:simple brain trauma,thoracic injury,spine fracture,hemorrhagic shock and the complications of cardiopulmonary cerebral resuscitation (CPCR).The patients of two groups were comparable in respect of clinical setting.The clinical data were analyzed and scored by the ten-point scale.The x2 test were applied to statistical works.Results Among all the clinical characteristics,the incidence of increased D-dimer was the highest (74.1％) in early fat embolism syndrome,followed by the progressive decrease in hemoglobin (63.6％) and hypoxemia (57.4％),and the occurrence of dyspnea was the lowest (17.8％).The percentage of total scores over ten points in patients with fat embolism syndrome group was higher than that in those without fat embolism syndrome (x2 =202.6,P ＜ 0.01).The sensitivity of tenpoint scale was 96.12％ and the specificity was 99.8％.Conclusions Ten-point scale could be used to make early diagnosis of fat embolism syndrome,thereby reducing the occurrence of misdiagnosis and misseddiagnosis.

Objective To study the expression of tumor necrosis factor -α (TNF-a) and correlation with TNF-a in breast cancer. Methods We used SABC method to detect the expression of TNF-a in 112 cases of primary breast cancer, and analysis the relationship between TNF-α with histologic grades and ER. Results The positive expression rate of TNF-α in breast cancer was higher than those of normal tissues and lobular hyperplasia of the breast (X2 =8.573, P =0.014). There was no significant correlation between histologic grades and TNF-α (X2 =1.304, P =0.521). TNF-a had a positive correlation with ER in breast cancer (X2=11.949, P =0.001). Conclusion The positive expression rate of TNF-α in breast cancer was higher than those of normal tissues and lobular hyperplasia of the breast.TNF-α had a positive correlation with ER in breast cancer, but the exact mechanism is unclear.

Objective To determine the expression of Human Epidermal Growth Factor Receptor 2 (HER-2) in breast cancer and its correlation with Tumor Necrosis Factor-α (TNF-α). Methods We used SABC method to detect the expression of HER-2 and TNF-α in 112 cases of primary breast cancer, and analyzed the association of HER-2 expression with clinicopathological features and TNF-α expression. Results The positive expression rate of HER-2 in breast cancer was 35.71% (40/112), of which, the expression rate was 35.05% (34/97) in 97 invasive tubic breast cancer, and 33.33% (2/6) in invasive lobular breast cancer,25.00% (1/4) in mucinous carcinoma, and 50. 00% (2/4) in intraductal carcinoma. There was no significant correlation between HER-2 and any clinicopathological features of primary breast cancer ( P ＞ 0. 05 ). The expression of HER-2 in breast cancer had no signiciant association with TNM stage, age, age of menarche,menopause, gravidity, parity and family history of cancer ( Ps ＞ 0. 05 ), The positive rate of TNF-α was 23.61% (17/72) when HER-2 was negative, whereas the positive rate of TNF-α was 52. 50% (21/40) when HER-2 was positive. The expression of HER-2 was signiciantly positively correlated with the expression of TNF-α (r = 0. 881, P ＜ 0. 05 ). Conclusion HER-2 expression had a positive correlation with TNF-α in breast cancer,but the specific mechanism is still unclear.

Objective To evaluate the effect of duodenal shunt procedures for the treatment of cholangitis caused by peripapi llary duodenal diverticulum. Methods Three types of shunt procedure were adopted i.e. Roux-en-Y gastrojejunost omy (14 cases), Billroth-Ⅱ operation (24 cases), duodenojejunostomy (4 cases). Results There was no severe co mplication nor recurrent cholangitis postoperatively in 42 patients at a follow up of 1～10 years. Four patients suffering from moderate delayed empting wer e relieved by conservative measures.Conclusion Duodenal shunt procedures are effective for the treatment of ch olangitis caused by peripapillary duodenal diverticulam.

Objective To explore the insulin resistance(IR),serum cortisol.level and circadian secretion rhythm in the patients with pituitary adenoma(PA).Methods Sixty-seven patients with PA in this hospital from October 2016 to April 2017 were selected as the observation group,including 23 cases of pituitary Cushing syndrome,15 cases of growth hormone adenoma,16 cases of prolactinoma and 13 cases of non-functioning adenoma.Contemporaneous 49 individuals undergoing healthy physical examination were selected as the control group.The biochemical indexes of fasting plasma glucose(FPG),fasting insulin(FINS) and serum cortisol were measured and the homeostasis model assessment for insulin resistance(HOMA-IR) was determined.The correlation between insulin resistance and serum cortisol was analyzed.Results The incidence rate of cortisol circadian rhythm disorder in the observation group was 58.21％,the level of fasting serum cortisol in abnormal secretion rhythm of PA group was higher than that in normal secretion rhythm of PA group and control group(P＜0.05);the levels of FINS and HOMA-IR in the pituitary Cushing syndrome and growth hormone adenoma group were higher than those in the control group,the correlation analysis showed that HOMA-IR in PA patients was positively correlated with fasting serum cortisol level and FINS level(P＜0.05).Conclusion The IR occurrence exists in pituitary Cushing syndrome and growth hormone adenoma,which may be closely correlated with serum cortisol increase.

Objective: To explore the screen related sedentary behavior among senior primary school students in Beijing and to analyze the influence of psychosocial determinants and nutrition related knowledge on the behavior. Methods: In January 2020, a total of 1 316 students in grade 4-6 from two primary schools in Beijing were selected. Information on video viewing (watching TV or playing video games), self efficacy, habit strength, nutrition related knowledge, outcome expectation and the capacity to persist toward goal attainment were collected through questionnaires. Disordered multi classification Logistic regression and random forest algorithm were used to analyze the influencing factors. Results: The frequency of screen related sedentary was 5.0 (3.0, 10.5) times/week, and the duration was 37.5(9.6, 97.5) min/d in senior elementary school children. The results of disordered multi classification Logistic regression showed that the capacity to persist toward goal attainment, nutrition related knowledge, habit strength, self efficacy and gender positively correlated with the frequency of screen related sedentary ( OR =1.6, 1.7, 4.9, 4.2, 1.5 ), while the nutrition related knowledge, habit strength, self efficacy, outcome expectations, grade and gender positively correlated with screen time ( OR =1.7, 5.6, 5.7, 1.6, 1.6, 1.7)( P <0.05). Random forest regression tree model showed that the top four influencing factors on screen related sedentary frequency were self efficacy, the capacity to persist toward goal attainment, habit strength and nutrition related knowledge and the top four influencing factors on screen time were self efficacy, outcome expectation, nutrition related knowledge, habit strength. Conclusion Screen related sedentary behavior is prevalent among senior primary school students in Beijing. Health education should be strengthened regarding influencing factors of screen related sedentary behavior.

Objective: The association of self efficacy, habit strength, goal intention and outcome expectation with the consumption of snack in senior primary school students were investigated, providing evidence for the application of psychosocial determinants based on Social Cognitive Theory in children s nutrition education. Methods: A total of 1 353 students, 10-12 years old, participated in this study. Participants completed questionnaires for assessing self efficacy, habit strength, goal intention, outcome expectation and snack consumption in January 2020. Results: Average times of snack consumption among primary school students were 5.0 (3.0, 8.5) times per week, and the snack intake were 4.0(0.9, 22.9)g/d. The outcome expectation score was -1.0(-2.0, -1.0 ) points, while the score of children s snack related selfefficacy was (4.3±0.9) points, habit strength score 1.0(1.0, 3.0) points, and the goal intention (4.2±1.2) points. Students with higher snack intake showed lower scores in outcome expectation, self efficacy and goal intention( t=-9.0, 6.8, 5.2, P <0.01). Logistic regression showed negative association between outcome expectation and self efficacy factors with snacking behavior( OR =0.7, 0.8, respectively), as well as positive association between habit strength and snacking behaviors( OR=1.3, P <0.05). Conclusion The evidence indicated that self efficacy, habit strength, goal intention and outcome expectation are associated with child s snack consumption, and can be used as theoretical foundation for child snack consumption education.

Objective:To explore the effects of secondary pulmonary hypertension(SPH)on postoperative outcomes of lung transplant recipients.Methods:The hospitalization data of 309 patients undergoing lung transplant were retrospectively analyzed. They were divided into normal(mPAP <25 mmHg, 56 cases), low-pressure(mPAP: 25 mmHg≤mPAP<40 mmHg, 155 cases)and high pressure(mPAP ≥40 mmHg, 98 cases)groups.Three groups were compared with regards to general profiles, intraoperative status, postoperative outcomes and survival rates. The postoperative patient survival was plotted by Kaplan-Meier curve and log-rank test performed. Multivariate Cox regression analysis was performed to explore the influencing factors of postoperative survival.Results:The distribution of chronic lung disease(CLD)was statistically different among 3 groups( χ2=30.837, P=0.001). Patients with different levels of pulmonary artery pressure had different decisions supported intraoperatively by extracorporeal membrane oxygenation(ECMO)( χ2=28.205, P<0.001). The 2-year survival rates of normal, low-pressure and high-pressure groups were 58.9 %, 63.9 % and 69.4 % respectively and there were no statistically significant differences( P=0.513). Multivariate Cox regression analysis indicated that preoperative cardiac function was an independent risk factor for postoperative survival. The postoperative risk of mortality was 1.796 (95 %CI: 1.078~2.991)folds higher in patients with cardiac function grade Ⅲ/Ⅳ than those with grade Ⅰ/Ⅱ( P=0.025). Conclusions:Preoperative classification of cardiac function should be emphasized in SPH patients. And surgery during early decompensated stage of cardiac function may confer a better survival.

By analyzing the main problems existing in the current management of medical devices for clinical trials, this study proposes a feasible management model and specific requirements for acceptance, distribution, storage and recovery combining with the characteristics of medical consumable equipment and diagnostic reagent, which provides a favorable guarantee for the authenticity and reliability of clinical trials.
Clinical Trials as Topic ; Equipment and Supplies/standards* ; Indicators and Reagents/standards* ; Reproducibility of Results ; Research Design/standards*

Background: and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. Methods: From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. Results: Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95). Conclusion Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.