Objective To develop a practical image acquisition strategy using intermittent breath?hold cone beam computed tomography (CBCT). Methods A breathing phantom was used to simulate the movement of tumor near the diaphragm during free breathing and breath hold and scanned by conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. In the conventional breath?hold CBCT, scan paused and free breathing occurred at the break of breath hold and free breathing was not included in the scan. In the intermittent breath?hold CBCT, one scan covered several breath holds separated by free breathing in a ratio of 3 vs1. Image quality and three?dimensional registration accuracy were quantitatively compared between conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. Comparison of image quality parameters between conventional breath?hold CBCT and intermittent breath?hold CBCT was made by paired t test. Results Motion artifacts arose in type I and Ⅱ intermittent breath?hold CBCT scans. There were no significant differences in the reconstructed pixel value or uniformity between intermittent breath?hold CBCT and conventional breath?hold CBCT ( P>0. 05, and P= 0. 02, 0. 53 ) . Compared with conventional breath?hold CBCT images, the signal?to?noise ratios of type I andⅡintermittent breath?hold CBCT images were reduced by 30% and 60%, respectively ( P<0. 05 ) . The registration error was up to 0 . 4 cm in the anterior?posterior direction and less than 0 . 1 cm in other directions . Conclusions The phantom study shows that intermittent breath?hold CBCT does not significantly reduce image quality or registration accuracy compared with conventional breath?hold CBCT. The feasibility of intermittent breath?hold CBCT in clinical application needs to be further validated among a large number of patients.

Objective:To investigate the prevalence and clinical characteristics of pruritus in adult patients with psoriasis vulgaris, and to evaluate the effect of pruritus on sleep and quality of life.Methods:From January 2020 to December 2020, 291 patients with psoriasis vulgaris were enrolled in Lanzhou University Second Hospital, and characteristics of pruritus as well as quality of sleep and life were evaluated by physicians directly or through a questionnaire. Binary logistic regression analysis was performed to analyze risk factors for pruritus, and multivariate linear regression to analyze factors affecting sleep and quality of life.Results:Among the 291 patients with psoriasis vulgaris, 184 (63.23%) were males and 107 (36.77%) were females, with the age ( M [ Q1, Q3]) being 37.00 (28.00, 50.00) years; 258 (88.64%) had the itching symptom, and the severity of itching was usually moderate. The severity of skin lesions was the main risk factor for pruritus ( OR = 1.252, 95% CI: 1.114-1.407, P < 0.001) . Psoriasis area and severity index was positively correlated with pruritus numerical rating scale (NRS) score ( r = 0.65, P < 0.001) , 5-D′S score ( r = 0.65, P < 0.001) , Pittsburgh sleep quality index (PSQI) score ( r = 0.48, P < 0.001) and dermatology life quality index (DLQI) score ( r = 0.63, P < 0.001) , the pruritus NRS score was positively correlated with the DLQI score ( r = 0.61, P < 0.001) and PSQI score ( r = 0.55, P < 0.001) , and the 5-D′S score was positively correlated with the DLQI score ( r = 0.62, P < 0.001) and PSQI score ( r = 0.64, P < 0.001) . Conclusion:Most adult patients with psoriasis vulgaris have moderate pruritus; the severity of disease markedly affects the severity of pruritus, and pruritus exerts considerable impact on sleep and quality of life.

Diabetes retinopathy (DR) is a blinding ocular complication of diabetes, and its pathological mechanism is complex. The damage to the retinal neurovascular unit (NVU) and the imbalance of its coupling mechanism are important pathological foundations. Autophagy plays an important role in the progression of DR. Oxidative stress, endoplasmic reticulum stress, hypoxia, and competitive endogenous RNA regulatory networks can affect the occurrence of autophagy, and autophagy induced cell death is crucial in NVU dysfunction. Retinal neurocyte are non-renewable cells, and adaptive autophagy targeting neuronal cells may provide a new direction for early vision rescue in patients with DR. It is necessary that exploring the possible autophagy interrelationships between ganglion cells, glial cells, and vascular constituent cells, searching for targeted specific cell autophagy inhibitors or activators, and exploring the impact of autophagy on the NVU complex more comprehensively at the overall level. Adopting different autophagy intervention methods at different stages of DR may be one promising research directions for future DR.

Diabetic retinal neurodegeneration is a serious complication of diabetes mellitus, manifested by apoptosis and gliosis, and its pathogenesis is closely related to the oxidative stress induced by high glucose levels. The increase in blood glucose in the body leads to excessive production of reactive oxygen species and the downregulation of antioxidant defense signaling pathways, which leads to oxidative stress in the body, which in turn induces apoptosis, mitochondrial damage and autophagy, resulting in diabetic retinal neurodegeneration. Antioxidant stress therapy with gene therapy, flavonoids, recombinant Ad-β-catenin carriers, and autophagy inducers to exert neuroprotective effects. In the future, more clinical trials are needed to explore the effective dosage and side effects of drugs, and to develop new drugs and treatment strategies for oxidative stress to prevent and treat diabetic retinal neurodegeneration and protect retinal nerve function.

OBJECTIVETo explore the quantitative relationship between the intensity of psychosocial stress and the degree of overall health damages.

METHODSA multi-group case-control study was designed and implemented. The cases included two groups of out-patients (177) and in-patients (214) in a hospital in Jianyang city, and controls (587) were from the follow-up cohort in the same city. Three groups were studied on the following contents: general demographic characteristics, psychosocial factors and the degree of health damages including mental, physical, and social status. Major statistical analyses were as follows: ranks test, ANOVA, cluster analysis, multinomial logistic regression and ordered-logit regression.

RESULTSOrdered-logit regression model showed that the odds ratio of negative life-events on degree of health damages was 1.335 (P < 0.01). This result showed that there was a positive dose-effect relationship between the negative life-events score and overall health damages. The utility of social support to overall health had protective effect (OR = 0.513).

CONCLUSIONNegative life-events were the major risk factors to overall health, and there was a dose-effect relationship between negative events and health damages. Function of social support played a protective factor for health.

Analysis of Variance ; Case-Control Studies ; Cohort Studies ; Educational Status ; Health Status ; Humans ; Marital Status ; Social Class ; Stress, Psychological ; psychology

Conservative endodontic access cavity (CEC) is the first step of minimally invasive endodontics. After that operation, teeth retain the dental hard tissue, such as crest and peri-cervical dentin, to a large extent. It is of great significance to reduce the tissue excision and achieve a favorable prognosis. There are a variety of approaches and corresponding cavities in CEC. The methods to determine the medullary approach include X-ray localization, micro CT/cone beam CT localization and digital guide plate localization. Among them, X-ray film and micro CT/cone beam CT are simple and commonly used in the clinic. For more complex root canal systems, the use of a digital guide plate can establish a more accurate pulp opening pathway and reduce the unnecessary loss of tooth hard tissue. However, the positioning price of a digital guide plate is high, and it has not been widely used in the clinic. The hole types of CEC include minimally invasive medullary hole type, super conservative minimally invasive medullary hole type, "Truss" hole type and cutting end hole type. The stress analysis of CEC and traditional endodontic access (TEC) cavity are mainly based on the loading of teeth by a universal mechanical testing machine in vitro, finite element analysis and clinical observation. Most scholars’ studies have shown that minimally invasive endodontics can improve the fracture resistance of teeth, but the differential capacities of CEC and TEC remain controversial. How does on balance the purpose of pulp treatment and the maximum retention of tooth tissue? Further exploration is still needed.

Objective To investigate the clinical application of recovered autologous blood trans-fusion in cesarean section for puerperas with high risk of hemorrhage.Methods A total of 100 puer-peras with cesarean section were selected,and they were preoperatively diagnosed with high-risk hem-orrhage,including perilous placenta previa,placenta accreta,placental abruption,threatened uterine rupture,and scarred uterus.According to the different blood transfusion methods,50 puerperas re-ceiving autologous blood transfusion were assigned to observation group,and 50 puerperas receiving allogeneic blood transfusion were assigned to control group.Clinical indicators,blood routine tests,coagulation function,inflammatory factors,and postoperative adverse reactions were compared be-tween the two groups.Results The intraoperative blood loss,intraoperative blood transfusion vol-ume,blood costs,total costs,operative duration,and hospitalization time in the observation group were significantly shorter or lower than those in the control group.Immediately after blood transfusion(T1),there were no significant differences in blood routine indicators between the two groups(P＞0.05).At the end of blood transfusion(T2)and 24 hours after surgery(T3),there was no signifi-cant difference in hematocrit(Hct)between the two groups(P＞0.05),while the hemoglobin(Hb)and platelet(Plt)levels in the observation group were significantly higher than those in the control group(P＜0.05).At T1,there were no significant differences in coagulation function indicators between the two groups(P＞0.05).At T2 and T3,there were no significant differences in D-dimer(D-D)between the two groups(P＞0.05),while the prothrombin time(PT),thrombin time(TT),and activated partial thromboplastin time(APTT)in the observation group were significantly shorter than those in the control group,and fibrinogen(Fib)was significantly higher in the observationgroup(P＜0.05).At 48 hours after blood transfusion,the serum procalcitonin(PCT)and interleukin-6(IL-6)levels in the observation group were significantly lower than those in the control group(P＜0.05).The number of cases with allergic reactions,infections,and hypotension in the observation group was significantly lower than that in the control group,but there was no significant difference in the total incidence rate of adverse reactions between the two groups(P＞0.05).Conclusion Clin-ical application of recovered autologous blood transfusion in cesarean section for puerperas with high risk of hemorrhage shows remarkable effects.

Objective:To understand the infection status, epidemiological characteristics and drug resistance of Diarrheagenic Escherichia coli (DEC) in Shanghai and provide evidence for the disease surveillance. Methods:The epidemiological data of diarrhea cases in Shanghai from 2016 to 2022 were collected from Shanghai Diarrhea Comprehensive Surveillance System, and stool samples were collected from the cases for DEC detection. The drug resistance data was obtained from Chinese Pathogen Identification Network. Statistical analysis was conducted by using χ2 and fisher test. Results:In 24 883 diarrhea cases detected during 2016-2022, the DEC positive rate was 9.13% (2 271/24 883), the single DEC positive rate was 8.83% (2 197/24 883) and the mixed DEC positive rate was 0.30% (74/24 883). The main type of DEC was Enterotoxigenic Escherichia coli (ETEC) [4.33% (1 077/24 883)]. The DEC positive rate was highest in people aged ≤5 years 18.48% (22/119). The annual peak of DEC positive rate was observed during July - September [5.91% (1 470/24 883)]. The DEC positive rate were 9.47% (554/5 847) and 9.02% (1 717/19 036) in urban area and in suburbs, respectively, Enteroaggregative Escherichia coli (EAEC) [3.98% (233/5 847)] and ETEC [4.56% (868/19 036)] were mainly detected. From 2016 to 2019, the DEC positive rate was 9.42% (1 821/19 330), while it was 8.10% (450/5 553) from 2020 to 2022, the main DEC types were ETEC (4.87%, 941/19 330) and EAEC (4.70%, 261/5 553). The multi-drug resistance rate was 40.21% (618/1 537). The top three antibiotics with high drug resistance rates were ampicillin [64.74% (995/1 537)], nalidixic acid [58.49% (899/1 537)] and tetracycline [45.09% (693/1 537)]. Conclusions:Compared with 2016- 2019, a decrease in DEC detection rate was observed during 2020-2022, and the main type of DEC detected shifted from ETEC to EAEC. The prevalence of multi-drug resistance was severe. Therefore, it is necessary to further strengthen the surveillance for DEC drug resistance and standardize the use of clinical antibiotics.

Objective To explore the characteristics of distribution of TCMsyndrome elements of disease nature between active stage and stationary stage of patients with hepatitis cirrhosis,and to study the corre-lation between the TCMsyndrome elements and serum level of homocysteine (Hcy).Methods By using Information Collection Form ofHepatitis Cirrhosis drafted by our research team,a national multicenter and cross-sectional epidemiological survey was conducted to collect the general condition,symptoms,and blood samples from which the serum Hcy levels were obtained.In accordance with Standard ofHepatitis Cirrhosis Syndrome Elements Differentiation,the TCM syndrome elements of nature of the patients were determined.Then the correlation of the TCMsyndrome elements and the serum levels of Hcy was investi-gated at active stage and stationary stage.Results Altogether 715 patients were included.The frequen-cy of all syndrome elements in patients of active stage were higher than those in patients of stationary phase,in which the element of blood stasis,yin deficiency,qi deficiency,yang deficiency and water re-tention showed statistical differences (P <0.05).The serum level of Hcy in patients of active stage was higher significantly than that of stationary stage (P <0.05).The Hcy level of patients with yin deficiency pattern was lower than that of patients without yin deficiency pattern,the same as element of damp heat, qi stagnation and yang deficiency;however,the situations of element of blood stasis,qi deficiency and water retention were quite the reverse.In the patients of stationary stage,the serum levels of Hcy showed significant difference between qi stagnation group and non qi stagnation group (P <0.05).In the pa-tients of active stage,the levels of Hcy showed difference between yin deficiency group and non yin defi-ciency group,as well as the element of qi deficiency (P <0.05).Conclusion The frequency of TCM syndrome elements and the serum Hcy level in patients of active stage higher than those of patients of sta-tionary stage,reflected the degree of hepatic inflammation and severity of disease.That the correlation between the Hcy level and the TCMsyndrome elements of nature could provide the evidence for pathologi-cal basis and standardization study of TCMsyndrome elements in patients with hepatitis cirrhosis.

Objective To analyze the distribution of diseases with TCMpattern of spleen-stomach damp-ness-heat (SSDHP)and the prescriptions and Chinese herbal medicines involved,so as to guide TCM clinical practice and further research on SSDHP.Methods Taking “SSDHP”(Chinese:脾胃湿热证) as subject term or title /keyword,the databases of China National Knowledge Infrastructure(CNKI),Wan-fang Data Knowledge Service Platform and VIP Information were systematically retrieved,from the begin-ning of the databases to 31 December,2015.The articles related to treatment on SSDHP were collected, and the database was established by using Microsoft Excel 2010,on which data were descriptively statisti-cal analyzed.Results 109 articles were eligible from total 1 681 retrieved ones.The top two diseases with SSDHP were digestive system disorders (86.41%)and dermatoses (5.83%).The common formu-la directed at clearing heat and dampness including Pingwei Powder,Huopu Xialing Decoction,and Sanren Decoction,combined with specific medications for exact symptoms.The common Chinese herbal medications with frequency more than 1 percent were listed as the following:Golden Thread (Huangli-an),Pinellia Tuber(Banxia),Official Magnolia Bark(Houpu),Liquorice Root (Gancao),Dried De-coctionerine Peel (Chenpi),Baical Skullcap Root (Huangqin),Indian Bread (Fuling),Dandelion (Pugongying),Agastache Rugosus (Huoxiang),Atractylodes Rhizome (Cangzhu),Coix Seed (Yiy-iren),Round Cardamon Fruit (Baidoukou),Largehead Atractylodes Rhizome (Baizhu),Orange Fruit (Zhiqiao),Immature Orange Fruit (Zhizi ),Corydalis Rhizoma (Yanhusuo ),White Peony Root (Baishao),Medicinal Evodia Fruit (Wuzhuyu),Dried Ginger (Ganjiang),Bamboo Shavings (Zhu-ru),Virgate Wormwood Herb (Yinchen),Grassleaf Sweetflag Rhizome (Shichangpu),Turmeric Root Tuber (Yujin),Immature Orange Fruit (Zhishi),Chinese Thorowax Root(Chaihu),Common Bletilla Tuber (Baiji),Danshan Root (Danshen),Bitter Apricot Seed (Kuxingren),Villous Amomum Fruit (Sharen),Common Aucklandia Root (Muxiang),Finger Citron (Foshou),Talc (Huashi).Conclu-sion Now,the diseases with SSDHP were most common in digestive system,but also in other systems. And the prescription and Chinese herbal medicines should be applied by holistic conception,combination of disease and pattern and pattern differentiation and treatment.Classic herbal formulas in TCM ancient books are still playing the strictly key roles in clinical practice,but proved formulas of modern outstand-ing senior traditional Chinese practitioners and Hospital Preparations also are paid more attention by re-searchers.