Objective To explore the possible risk factors associated with postoperative lower respiratory infections in the elderly patients with lung carcinoma,and to formulate the appropriate preventive strategies according to the results of the study.Methods From January 2014 to April 2015,182 elderly patients with lung carcinoma who were undergoing surgical treatment in Renji Hospital of Shanghai Jiaotong University were collected.All patients were divided into infection group (n =29) and control group (n =153) according to whether occuring postoperative lower respiratory infections or not.The possible risk factors associated with postoperative lower respiratory infections were analyzed by single factor analysis and multivariable Logistic regression model.Results Single factor analysis showed that the postoperative lower respiratory infections of elderly patients with lung carcinoma were associated with age (t =-3.03,P ＜ 0.05),smoking (x2 =5.69,P =0.02),albumin (t =2.40,P =0.02),forced expiratory volume (FEV) 1.0％ (t =5.85,P ＜ 0.05),lung carcinoma stage (x2 =7.06,P =0.01),small cell lung cancer (x2 =5.09,P =0.02),complication with chronic obstructive pulmonary disease (COPD) (x2 =16.28,P ＜0.01) and complication with coronary heart disease (x2 =10.13,P ＜ 0.01).Multivariable Logistic regression analysis showed that age (OR =1.34,95％CI:1.13-1.59,x2 =11.17,P＜0.01),smoking (OR=12.68,95％ CI:2.06-78.04,x2 =7.50,P=0.01),FEV1.0％ (OR =0.90,95％ CI:0.83-0.97,x2 =7.76,P =0.01),squamous-cell carcinoma (OR =6.88,95％ CI:1.41-33.56,x2 =5.70,P =0.02),complication with COPD (OR =12.44,95％ CI:1.41-109.90,x2 =5.15,P =0.02) and complication with coronary heart disease (OR =10.61,95％ CI:2.25-90.50,x2 =7.18,P =0.01) were independent risk factors for postoperative lower respiratory infections in the elderly patients with lung carcinoma.Conclusion Age,smoking,squamous-cell carcinoma,low value of FEV1.0％,complication with COPD or coronary heart disease can increase the risk of postoperative lower respiratory infections in the elderly patients with lung carcinoma.Comprehensive and effective preventive strategies should be performed to reduce the risk of postoperative respiratory infections.

OBJECTIVE To investigate the epidemiological characteristic of lower respiratory infection among the hospitalized patients in Tianlin Community Health Service Center so as to take effective measures to control the infection and reduce the emergence of drug resistant strains.METHODS Totally 6150 cases of patients discharged from our Center during from Jan 2004 to Sept 2006 were collected and among them 141 cases occurred hospital onset of lower respiratory infection and drug resistance was analyzed through contrasting.RESULTS The incidence rate of hospital onset of lower respiratory infection and drug resistance were 2.29% and 58.62%.Among the 141 cases,the incidence rate of ESBLs was 28.36% which mainly produced from Escherichia coli and Klebsiella pneumoniae.CONCLUSIONS Primary affection should actively treated and antibiotics should use rationally according to the drug sensitive cultivation to control the abuse of antibiotics and reduce the emergence of drug resistant strains.

BACKGROUND: Mitogen-activated protein kinases (MAPKs) is a group of protein kinase related with neuronal apoptosis. Sleep derivation can lead to neuronal apoptosis.OBJECTIVE: To observe change and possible significance of MAPKs in rats after sleep deprivation.DESIGN: Prospective study with complete randomization.SETTING:Research Room of Nerve, Department of Physiology, Zhengzhou University.MATERIALS: The experiment was performed at Zhengzhou University from June 2000 to October 2002. Totally 24 adult healthy SD rats were selected.METHODS: A total of 24 rats were randomly assigned into rapid eye movement (REM) sleep deprivation group, REM sleep deprivation control group and normal control group with 8 rats in each group. The rats in the sleep deprivation group received successive sleep deprivationfor 72 hours from 8:00in the morning. The rats in the normal control group were fed in the rearing cage, having normal sleep-awareness cycle. Their morphological change was observed. Another 24 rats were grouped as above and determined with MAPKs. Morphological change of neurons in hippocampus of rats after sleep deprivation was observed with terminal dUTP nick end-labelling (TUNEL)staining. Changes of activity of extracellular signal-regulated kinase (ERK)and expression of c-Jun N-terminal kinase (JNK) were observed.MAIN OUTCOME MEASURES: ①Morphological change of hippocampal neuron in rats after sleep derivation was observed. ②Changes of expressions of ERK and JNK in hippocampal neuron were observed.RESULTS: ①Morphological change of hippocarnpal neuron: A mass of apoptotic positive cells appeared in CA1 and CA3 regions of rats in the REM sleep deprivation group, mainly distributed in pyramidal layer of hippocampus. A few apoptotic cells appeared in CA2 region. Seldom apoptotic cells appeared in the CA4 region. There was no significant positive cell in hippocampal tissue sections of the normal control group and REM sleep deprivation control group. ②Change of ERK activity: It was significantly lower in the REM sleep deprivation group than the REM sleep deprivation control group and normal control group (1 764.00±941.56,6 139.67±2 863.62,566.700±2 763.41 ,t=3.211 1,0.986 3,P ＜ 0.05). ③JNK positive expression: It was markedly higher in the REM sleep deprivation group than the REM sleep deprivation control group and normal control group (87.5%, 25%, 75%, t=3.412 1, P＜0.05).CONCLUSION: The sleep deprivation can cause change of MAPKs activity, which may be related with neuron apoptosis.

ObjectiveTo investigate the effect of direct-acting antiviral (DAA) on the recurrence of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after curative treatment. MethodsPubMed, Web of Science, Cochrane Library, CNKI, CBM, Wanfang Data, and VIP were searched for the clinical studies of DAA and the recurrence of HCV-related HCC published up to April 2020. Stata 14.0 software was used to perform the meta-analysis. The Cochran Q test was used to evaluate heterogeneity between studies; the fixed effects model was used for non-heterogeneous data, and the random effects model was used for heterogeneous data. The Egger regression method or the Begg rank correlation method was used to evaluate the presence or absence of publication bias. ResultsA total of 10 articles (11 studies) were included in our study, among which 8 articles (9 studies) compared the effect of DAA versus the absence of anti-HCV therapy on the recurrence of HCC after curative treatment. There were 991 patients in DAA group and 808 patients in untreated group. The results of the meta-analysis showed that DAA reduced the recurrence rate of HCC after curative treatment in patients with HCV infection (hazard ratio ［HR］=0.42, 95% confidence interval ［CI］: 0.28?0.36, P＜0.001). Three articles compared the effect of DAA versus interferon for the treatment of hepatitis C on the recurrence of HCC after curative treatment, with 267 patients in DAA group and 212 in interferon group, and the results of the meta-analysis showed that DAA and interferon had a similar effect on the recurrence rate of HCV-related HCC (HR=0.85, 95% CI: 0.64-1.15, P=0.298). ConclusionBoth interferon and DAA can significantly reduce the recurrence risk of HCV-related HCC after curative treatment, with no significant difference between them.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Rho-associated kinases (ROCKs) are serine-threonine protein kinases that act downstream of small Rho GTPases to regulate the dynamics of the actin cytoskeleton. Two ROCK isoforms (ROCK1 and ROCK2) are expressed in the mammalian central nervous system. Although ROCK activity has been implicated in synapse formation, whether the distinct ROCK isoforms have different roles in synapse formation and function in vivo is not clear. Here, we used a genetic approach to address this long-standing question. Both Rock1 and Rock2 mice had impaired glutamatergic transmission, reduced spine density, and fewer excitatory synapses in hippocampal CA1 pyramidal neurons. In addition, both Rock1 and Rock2 mice showed deficits in long-term potentiation at hippocampal CA1 synapses and were impaired in spatial learning and memory based on the water maze and contextual fear conditioning tests. However, the spine morphology of CA1 pyramidal neurons was altered only in Rock2 but not Rock1 mice. In this study we compared the roles of ROCK1 and ROCK2 in synapse formation and function in vivo for the first time. Our results provide a better understanding of the functions of distinct ROCK isoforms in synapse formation and function.