Objective To investigate the clinical features and prognosis of adult dermatomyositis with gastrointestinal bleeding and perforation. Methods The clinical data of a adult dermatomyositis with gastrointestinal bleeding and perforation were retrospectively analyzed. And the clinical characteristics of this patient were analyzed, combined with 7 cases reported in the literature. Results Among the 8 cases, 6 cases were females and 2 cases were males, aged 18 to 63 years. The 5 cases had melena, 3 cases had hematemesis, 3 cases had hematochezia and 1 case had hemoptysis. The main treatment was glucocorticoids, immunosuppressive agent, intravenous immune globulin (IVIG), endoscopic hemostasis and angiographic embolization. Four of the 8 cases died. Conclusions Adult dermatomyositis with gastrointestinal bleeding and perforation is rare, but the condition is dangerous and the mortality is high. Dermatomyositis with early onset of abdominal pain, vomiting, melena should be alert to serious complications such as gastrointestinal bleeding and perforation.

Objective To investigate the possible role of mean platelet volume and its value as a therapeutic effect in acute pancreatitis (AP).Methods Data of 78 cases of AP and 40 cases of negative control were retrospectively analyzed.Mean platelet volume (MPV),platelet counts (PLT),platelet distribution width (PDW),leucocyte count (WBC),C reactive protein (CRP) and serum level of calcium (Ca2+) were measured and analyzed on the admission day,3th,5th and 7th day.Results The MPV values were elevated obviously in AP group on the admission day.Moreover,the MPV values of SAP group were significantly higher than those of MAP group on the admission day.The MPV values were decreased at 5 days and 7 days after admission followed by a increasing at 3 days in SAP group.Furthermore,the MPV value of SAP group at every time point was significantly higher than those of MAP group.The MPV values of AP patients showed a significant reduce after treatment.Conclusion MPV was associated with the severity and the treatment effect of acute pancreatitis.

To discuss the advantages and disadvantages of fibular osteosynthesis and osteotomy in the treatment of tibial fractures. Medical literature was searched for articles concerning “fibular fracture”and“fibular osteotomy”on Medline to have a comprehensive idea of experiences of others. The results of others and of ours were analyzed and interpreted. Fractures of distal tibia and fibula with displaced distal tibial articular fractures were classic indications of fibular osteosynthesis, but distal tibiofibular syndesmosis and stability of ankle joint were seldom affected by the fibular fracture when tibia was fractured. It is not necessary to perform routine osteosynthesis for distal fibula fracture. Fibular osteotomy may be considered as an adjuvant procedure when atrophic nonunion or deformity union of tibia occurs. It is wise in treatment of tibial fractures not to perform fibular osteosynthesis or osteotomy whenever possible.

The treatment of total avulsion of the hand is somewhat difficult and the result usually not satisfactory. Four cases of such patients were treated from 1983 to 1987. After routine debridement, digital nerves and its surrounding adipose tissue were preserved. An "S" shape skin flap was designed an raised in the contralateral upper abdominal quadrant to cover the injured hand like a bag, so that both sides of the hand were covered. The donor area (12cm2) was directly sutured. Nerve endings might grow into the flaps because of the preservation of digital nerves. Three patients were followed-up for 2 to 6 years, the injured hands regained good pain sensation as well as stereognostic and temperatuer sensations. The function of the hand is satisfactory, but the flap looked bulky and multiple plastic operations were necessary to seperate the fingers.

Objective To explore the role of enteral nutrition in the treatment of functional delayed gastric emptying. Methods Among 15 patients with functional delayed gastric emptying after resection of esophageal or gastric cardiac carcinoma, 10 patients were treated with enteral nutrition( EN group),5 patients were treated with parenteral nutrition (PN group). Postoperative hospital stay, gastrointestinal decompression amount, recovering time of postoperative gastric emptying were observed to assess the efficacy of enteral nutrition. Results The average postoperative hospital stay was ( 14. 4 ± 4. 6) days in the EN group, whereas (20. 3 ±6. 6) days in the PN group. The average recovering time of postoperative gastric emptying was (19 ±9)days in the PN group and( 12 ± 4)days in the EN group. Conclusion The method of EN can enhance gastric emptying and is effective for functional delayed gastric emptying after resection of esophageal or gastric cardiac carcinoma

Objective To observe the effects of ischemic postconditioning (IPTC) on myocardial infarction sizes (IS) and protein kinase Cα (PKCα) expression in aged rats with post-ischemia reperfusion injury,and to explore the mechanism.Methods A total of 120 male Wistar rats were divided into aged group and adult group.The aged group was randomly divided into control group (n=12,30-min ischemia and 3-h reperfusion),5 s,10 s,30 s and 60 s IPTC groups [n= 12,each;after 30 min occlusion of left coronary artery (LCA),three cycles of 5 s,10 s,30 s,60 s reperfusion respectively followed by the same interval LCA re-occlusion were applied at the beginning of reperfusion].The IS was measured with TTC dye,and PKC expression was investigated by immunohistochemistry.Results Different IPTC intervals had different effects on IS and PKC expression,10 s and 30 s IPTC could reduce IS both in aged rats and adult rats [(55.9±6.0)% and (47.4±5.5)%],IS in 10 s IPTC group in aged rats was (48.1±5.3)%,in adult rats was (39.2±5.7) %;IS in 30 s IPTC group in aged rats was (48.8 ± 6.8) %,in adult rats was (40.2 ± 6.1 ) %.PKCα expression increased in aged and adult rats (all P<0.05).5 s IPTC could increase IS [IS in 5 s IPTC group in aged rats was (63.5±5.4)%,and PKCα expression reduced in aged rats (all P<0.05)].Conclusions IPTC has cardio-protective effect in aged rats suffering from acute myocardial injury during reperfusion,the effect of IPTC is related to reperfusion-reocclusion interval.

Background Multimorbidity imposes a heavy burden on individuals, families, and society. There are relatively few studies exploring patterns of multimorbidity among middle-aged adults in China. Objective To explore the current status of multimorbidity, associated risk factors, and multimorbidity patterns among adults aged 45-64 years in China, so as to provide a scientific basis to prevent and control multimorbidity in China. Methods A total of 5494 adults aged 45-64 years from the Chinese Health and Nutrition Survey (CHNS) in 2018 were selected. Of these, 2494 (45.39%) were men and 3000 (54.61%) were women. The nine diseases included were hypertension, diabetes, dyslipidaemia, obesity, mild cognitive impairment (MCI), myocardial infarction, stroke, asthma, and tumor. The prevalence of each disease or multimorbidity was expressed as N (%). Comparisons of multimorbidity prevalence between different groups were performed using the χ² test or Cochran-Armitage trend test. Association rule with the Apriori algorithm was used to explore the pattern of multimorbidity, with parameters set at a minimum conditional support of 3.00%, a minimum rule confidence of 50.00%, and a lift of >1.20. Logistic regression was used to evaluate the associations between selected risk factors and multimorbidity. Results In 2018, 37.44% of participants reported multimorbidity in 15 provinces of China. The prevalence of diseases in descending order was dyslipidaemia (39.99%), hypertension (39.48%), obesity (16.42%), MCI (14.47%), diabetes (14.16%), tumor (1.09%), stroke (1.04%), myocardial infarction (0.71%), and asthma (0.64%). A total of seven multimorbidity patterns were identified in this group. Obesity paired with hypertension, and diabetes paired with dyslipidemia were the two major patterns of multimorbidity in the general population and age or sex subgroups. The multimorbidity patterns of different populations were concentrated in the combination of obesity, hypertension, diabetes, and dyslipidemia. The risk of multimorbidity was lower in females than in males (OR=0.85, 95%CI: 0.75, 0.97). The multimorbidity risk was 1.56 times higher in the 55-64 years group than in the 45-54 years group (OR=1.56, 95%CI: 1.40, 1.75). Drinking in the past year increased the risk of multimorbidity by 25% (OR=1.25, 95%CI: 1.08, 1.45) compared to no alcohol comsumption in the past year. High and medium levels of physical activity were associated with a decreased OR (high: OR=0.74, 95%CI: 0.65, 0.85; medium: OR=0.81, 95%CI: 0.70, 0.93) with low level of physical activity as reference. Conclusion In 2018, there was a high prevalence rate of multimorbidity among middle-aged adults in China. The main multimorbidity patterns were obesity-hypertension and diabetes-dyslipidemia. Surveillance and interventions should be strengthened particularly for men, individuals with alcohol consumption or insufficient physical activity, and those with major multimorbidity patterns.

Objective To evaluate the therapy effect and clinical value of non-invasive positive-pressure ventilation (NPPV) treatment in acute respiratory distress syndrome (ARDS) caused by severe acute pancreatitis. Methods Data of 22 cases of AP with ARDS who were treated with NPPV were retrospectively analyzed. The oxygenation index (OI), PaO2, PaCO2, respiratory rate (RR) and heart rate (HR) were measured and analyzed before and after NPPV treatment. Results All of cases recovered from ARDS. The PaO2, SpO2 and RR decreased 2 h after NPPV treatment [(81.60 ± 12.56) mmHg (1 mmHg=0.133 kPa) vs. (61.50 ± 5.71) mmHg, (95.66 ± 5.13)% vs. (88.52 ± 4.41)% and (24.49 ± 2.01) times/min vs. (33.37 ± 2.96) times/min] (P<0.05). The OI, PaO2, SpO2 and RR further decreased 12 h after NPPV treatment [(367.89 ± 49.58) mmHg vs. (214.64 ± 20.93) mmHg, (105.19 ± 17.60) mmHg vs. (61.50 ± 5.71) mmHg; 0.991 ± 0.026 vs. 0.885 ± 0.044] (P < 0.05). The OI, PaO2, PaCO2 and SpO2 increased significantly, in contrast, RR and HR descended 24 h after NPPV treatment (P < 0.05). Conclusions NPPV treatment can effectively improve oxygenation of patients with ARDS caused by SAP. NPPV has a good value of clinical application and is worth spreading.

OBJECTIVE：To study the mode of regional volume-based proc urement of injection ，design complete and effective volume-based procurement plan of injection ，and to provide decision-making basis for government departments. METHODS ：The official documents of all provinces/provincial-level alliances that carried out injection volume-based procurement were retrieved as of Feb. 8th，2021. Content analysis method was used to sort out and compare volume-based procurement types ，grouping methods ， product selection methods and other information of injection. Combined with the existing information ，the suggestions were put forward for improving volume-based procurement mode and the improved volume-based procurement mode framework. RESULTS & CONCLUSIONS ：By Feb. 8th，2021，a total of 13 provinces/provincial-level alliances have launched volume-based procurement of injections ，mainly involving antibiotics and proton pump inhibitors ；a comprehensive evaluation system was used for evaluation for many provinces/provincial-level alliances. Comprehensive evaluation system involves the price and quality of injection ，and enterprise credit ，etc.，and include a variety of factors other than price into evaluation scope. But the comprehensive evaluation system is still in its preliminary application stage ，and has differences in each province/provincial-level. Its details need to be perfected and it has not yet formed a unified standard. In the future，the way of product quality inspection needs to be refined. On the existing basis ，it has been constructed and improved that comprehensive evaluation system framework include efficacy ，safety，economy and other indicators. It is suggested to promote the comprehensive clinical evaluation of com drugs and apply more re al world data for product review ，so as to further reduce drug price，and promote the hea lthy development of the pharmaceutical industry.

Objective:To investigate the potential correlation between miR-223 level in leukocytes and platelet responses to clopidogrel in patients with coronary artery disease.Methods:A cohort of 188 outpatients,who conducted percutaneous coronary intervention (PCI) and received dual antiplatelet therapy,were recruited.The patient's electronic health data were collected,and their blood samples were obtained for measurement of adenosine diphosphate (ADP)-induced whole-blood platelet aggregation.Extreme cases ofplatelet responses to clopidogrel (ultra-vs.non-responder) were measured with miR-223-3p levels in leukocytes.Results:Both groups had similar miR-223-3p levels in leukocytes.There were no significant differences in other demographic and clinical data except for metrics of ADP-induced whole-blood platelet aggregation between the 2 group.Conclusion:MiR-223-3p in peripheral leukocytes is not associated with the altered platelet responses to clopidogrel in PCI outpatients.