Humans ; Aripiprazole/therapeutic use* ; Schizophrenia/drug therapy* ; Antipsychotic Agents/therapeutic use* ; Risperidone ; China ; Treatment Outcome

Purpose/Significance With regional collaboration as the core,the study explores an efficient,convenient and stand-ardized two-way referral service mode,further implements the hierarchical diagnosis and treatment system,and realizes the ration-al allocation of medical resources.Method/Process Combined with the"internet+",a two-way referral cloud platform is built to realize the interconnection and information sharing between the referral business and the hospital business.Result/Conclusion The construction of the two-way referral cloud platform has promoted the standardization and convenience of referral process and im-proved the satisfaction of doctors and patients.The two-way referral service mode based on regional collaboration promotes the in-tegration of medical resources,improves the medical service capacity of medical alliances,and improves the medical experience of referral patients.

Objective:To investigate the value of artificial intelligence (AI) cytomorphologic analysis system in the cytomorphological diagnosis and therapeutic evaluation of acute myeloid leukemia (AML).Methods:Bone marrow smear samples were collected from 150 patients with newly diagnosed and treated acute myeloid leukemia who were inpatients and outpatients at the Department of Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 1, 2021 to July 31, 2022 for retrospective analysis. Among them, there were 50 patients in the newly diagnosed group, including 28 males and 22 females, with the onset age of 43.5(32.3,58.8)years. There were 100 patients in the post-treatment group, including 36 males and 64 females, with the onset age of 34.5(23.0,47.0)years. The results from cytomorphology expert were used as the gold standard and the Python 3.6.7 was used for analysis to evaluate the accuracy, sensitivity, and specificity of the AI cytomorphologic analysis system for blast cell recognition in AML diagnosis and treatment.Results:The proportion of blasts in AI analysis of 50 samples in the newly diagnosed group was≥20%, which met the diagnostic criteria of AML. AI analysis of blasts had an accuracy of 90.3%, sensitivity of 85.5%, and specificity of 98.0%. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.882, P<0.001). Meanwhile, in the post-treatment group, the sensitivity and specificity of AI analysis of blasts were 89.7% and 99.2%, respectively. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.957, P<0.001). According to AI analysis data, there are 8 samples in this group whose AI efficacy evaluation results on AML are inconsistent with expert analysis. Conclusion:AI cytomorphologic analysis system has high accuracy, sensitivity and specificity for blast cell recognition in AML morphological diagnosis and therapeutic evaluation.

Objective:To further investigate the prevalence of tea-drinking-borne endemic fluorosis in Tianzhu Tibetan Autonomous County (referred to as Tianzhu) Gansu Province, to accurately master the information of patients with tea-drinking-borne endemic fluorosis, and to provide scientific basis for popularizing low fluoride brick tea and carrying out patient rescue and treatment.Methods:From 2019 to 2020, according to the "Investigation Plan of Tea-drinking-borne Endemic Fluorosis in Gansu Province in 2019", in the administrative villages with the habit of drinking and selling tea, drinking water samples of local residents were collected to detect the fluorine content of water in Tianzhu, 10 families were randomly selected in each village, basic situation of each family member and the drinking situation of tea were investigated, and tea samples were collected to determine the fluorine content. At the same time, all children aged 8 - 12 in the investigation village were examined for dental fluorosis; clinical examination of bone and joint symptoms and signs was conducted for permanent residents over the age of 25 in the investigation village (excluding 25 years old), X-ray examination of bone and joint was conducted for patients with clear clinical symptoms or signs of skeletal fluorosis, and urine samples were collected to detect urinary fluorine. Ion selective electrode method was used to detect fluorine in water, tea and urine, and dental fluorosis was diagnosed by "Diagnosis of Dental Fluorosis" (WS/T 208-2011), and the "Diagnostic criteria for Endemic Skeletal Fluorosis" (WS 192-2008) was used for the diagnosis of skeletal fluorosis.Results:A total of 161 water samples were collected, and the fluorine content in water was from 0.07 to 0.68 mg/L, which met the domestic drinking water standard ( < 1.0 mg/L). A total of 1 644 side-tea samples were collected, and the annual per capita consumption of side-tea of permanent residents over 16 years old was 1.05 kg. The average fluoride content of tea was 601.99 - 991.38 mg/kg. According to the detection results of tea fluorine, 16 administrative villages with an average daily intake of tea fluorine more than 3.5 mg/d were screened, the lowest intake was 4.91 mg/d in Tuta Village Danma Township, and the highest intake was 18.98 mg/d in Huashan Village Maozang Township. A total of 253 children aged 8 - 12 years old in 14 administrative villages were investigated. There were 3 cases of very mild dental fluorosis, 2 cases of mild dental fluorosis, and 1 case of moderate dental fluorosis. The overall prevalence of dental fluorosis was 4.74% (12/253). The clinical examination of bone and joint symptoms and signs was carried out for 3 100 permanent adults over the age of 25 (excluding the age of 25) in 15 administrative villages. The X-ray examination of bone and joint was carried out for 104 patients with definite clinical symptoms and/or signs of skeletal fluorosis. Six patients with skeletal fluorosis were diagnosed, including 3 mild and 3 severe, aged 56 - 76 years. The average urinary fluorine in the investigated villages was 0.73 - 4.74 mg/L (the number of investigated was 3 100). According to the determination and classification standards of tea-drinking-borne fluorosis area, Tuta Village Danma Township, Xiding Village Dahonggou Township and Daiqian Village Zhuaxixiulong Township were determined to be in the mild area of tea-drinking-borne endemic fluorosis, while Nannigou Village Zhuaxixiulong Township was in the moderate area of tea-drinking-borne endemic fluorosis.Conclusion:Tea-drinking-borne endemic fluorosis is prevalent in Tianzhu, Gansu Province, and targeted prevention methods and control measures need to be taken.

Objective:To evaluate the value of transrectal ultrasound(TRUS)in diagnosing extramural venous invasion(EMVI) of rectal cancer.Methods:Clinical data of 81 rectal cancer patients were retrospectively analyzed in the People′s Hospital of Inner Mongolia Autonomous Region from January 2015 to December 2021. The extramural vascular sonographic features in these patients were summarized. Based on the postoperative pathology and compared with MRI examination, the efficacy of TRUS for the diagnosis of EMVI in rectal cancer was investigated.Results:①According to the sonographic presentation, extramural vessels of rectal cancer can be divided into the following four types: typeⅠshowed that the mass broke through the muscularis propria of the intestinal wall, and no peripheral vascular shadow was observed; typeⅡshowed that the mass broke through the muscularis propria, surrounded by extraneous vessels with normal diameter, running and blood flow; type Ⅲ showed that the mass broke through the intrinsic muscle layer of the intestinal wall and was surrounded by extramural vessels with abnormally thickened diameters, and blood flow filling defects; type Ⅳ showed a mass that broke through the intrinsic muscular layer, with irregularly dilated vessels outside the peritumoral wall and no blood flow signal in the lumen. ②With type Ⅲ and type Ⅳ as positive signs of EMVI, the diagnosis compliance rate of TRUS was 90.1% (Kappa=0.580, P<0.001), sensitivity was 58.3%, specificity was 95.7%, positive predictive value was 70.0%, negative predictive value was 93.0%, and area under the ROC curve(AUC) was 0.770. The diagnosis compliance rate of MRI was 86.4% (Kappa=0.541, P<0.001), sensitivity was 75.0%, specificity was 88.4%, positive predictive value was 52.9%, negative predictive value was 95.3%, and the AUC was 0.817. The differences in sensitivity and specificity between TRUS and MRI for the diagnosis of rectal cancer EMVI were not statistically significant ( P>0.05), and the differences in the AUC were not statistically significant ( Z=0.447, P=0.655). Conclusions:TRUS is valuable in assessing the extramural vascular status of rectal cancer and is expected to be an effective imaging method for preoperative diagnosis of EMVI.

【Objective】 To detect the types of human papillomavirus （HPV） infection in exfoliated cervical cells to screen patients with early cervical lesions through HPV infection； analyze the viral load and integration sites of HPV58 positive specimens to explore the relationship of HPV58 viral load and integration status with cervical lesions in the hope of providing a scientific basis for the prevention and treatment of cervical lesions. 【Methods】 The exfoliated cervical cells and their clinicopathological data were collected， and genome DNA and total RNA were extracted from the collected specimen. HPV infections were detected using MY09/11 of HPVL1 region general primers and HPV58 was detected using HPV58 E6 specific primers. The copy numbers of HPV58 E6， E2 and human housekeeper gene β-actin were detected by quantitative fluorescence PCR， and the integration status of HPV58 was determined by the ratio of E2 to E6. At the same time， the position of HPV58 integrated into the host chromosome was analyzed through oncogene transcription amplification. 【Results】 Totally 295 HPV positive cases were detected in 1 269 exfoliated cervical cell samples， with the total infection rate of 23.2%. Among them 34 HPV58 positive were detected， which consisted of 4 samples of pure episome， 8 samples of integration， and 22 cases of mixture （both integration and episome）. Statistical analysis showed no significant correlation of the degree of cervical lesions with the viral load and integration status of HPV58. Eight HPV58 samples were integrated into chromosomes 1， 2， 5， 8， and 17， respectively. 【Conclusion】 HPV positive rate was 23.2% in the exfoliated cervical cells， the HPV infection rate increased with the aggravation of cervical lesions. Patients with early cervical lesions can be screened through high-risk HPV infection.

Circular RNA (circRNA) is a kind of RNA with a circular structure. The unique structure of circRNA endows it with various cell biological functions and characteristics. It has become a research hotspot recently. CircRNA can play a role via mechanisms, such as microRNA (miRNA) sponge, RNA binding protein, peptide translation and regulation of gene transcription. CircRNA was found to be associated with disc degeneration, spinal cord injury, scoliosis, and facet arthritis. Some techniques, including bioinformatics and molecular biology techniques, microarray and high-throughput sequencing, can be used to predict and to discover disease-related circRNA, aiming to evaluate whether circRNA can be used as a molecular biomarker for spinal and spinal cord diseases. Based on the current role of circRNA, the corresponding therapeutic strategies have been carried out in experimental animals, which can provide theoretical basis for gene therapy. At present, the researches in circRNA for spinal and spinal cord diseases are still insufficient compared with those in other fields. Currently, the main direction focuses on the miRNA sponge mechanism of circRNA. Due to the variety of diseases in spinal surgery, the research progress of circRNA is also varied. In addition, the development of microarray and high-throughput sequencing technology have greatly promoted the researches in circRNA. The availability of public database is of great significance in the study. The present review summarized the current researches status of circRNA in spinal and spinal cord diseases, aiming to deepen understanding of circRNA in spinal and spinal cord diseases.

Objective To examine the effect of a Caregiving Self-Management Support (C-SMS) Program on self-efficacy, social support for family caregivers of people with dementia and psychological symptom of patients. Methods Using the convenient sampling method, 41 caregivers of dementia patients were selected as the study objects from September 2016 to September 2017 in the Memory Disorders Outpatient Department of two ClassⅢ Grade A hospitals in Shanghai. They were divided into the experimental group(n=26) and control group(n=15) according to their willingness. Totally 4 participants in each of the two groups dropped out of the study in the middle. In the experimental group, a total of 6 times, once in 2 weeks social support group activities were carried out; in the control group, a total of 3 telephone instruction, once a month was carried out, all participants were distributed with the Caregiver Educational Booklet prepared by the research team and participated 3 education seminars during the follow-up visit. Self-Efficacy Questionnaire for Chinese Family Caregivers(SEQCFC) and Medical Outcome Study Social Support Survey(MOS-SSS) and Revised Memory and Behaviour Problems Checklist(RMBPC) were used to compare the effect of intervention. Results The time effect of the total score of SEQCFC was significant (P＜ 0.01). There was a statistically significance in the interaction on social support score between groups and time (P＜ 0.05). After intervention and follow-up, the self-efficacy scores of family caregivers in the experimental group were higher than the baseline (P＜0.05). There were significant time effect in the total score of behavioral and psychological symptom behavioral symptoms, memory and depression related problems (P＜0.05). The total score of behavioral and psychological symptom, score of the disruptive behaviour dimension after follow-up visit, scores of the depression dimension after intervention and follow-up visit in the experimental group were all lower than the baseline (P＜ 0.05). Conclusions The self-management support project of caregivers can improve the self-efficacy of family caregivers and alleviate the behavioral and psychological symptom of dementia patients.

Objective To explore the effect of interleukin-6 (IL-6) and Interleukin-12(IL-12) on immune response to hepatitis B vaccination in infants of HBsAg-positive mothers.Methods A total of 91 neonates whose mothers were HBsAg-positive were included and followed up for 12 months.HBV DNA and HBV serological markers in the peripheral blood of the neonates and infants were detected with fluorescence quantitative polymerase chain reaction (FQ-PCR) and chemiluminescence immunoassay (CLIA),and the levels of IL-6 and IL-12 in the peripheral blood of the neonates and infants were detected with enzyme-linked immunosorbent assay (ELISA).Results The non-/hypo-response rate to hepatitis B vaccination was 35.16％ (32/91) in the 91 infants.In the neonatal period and infantile period,the level of IL-6 in non-/hypo-response group was lower than that in high-response group,while the level of IL-12 was higher than that in high-response group,and there was significant difference (P＜0.01).From the neonatal period to the infantile period,the level of IL-6 increased,while the level of IL-12 descended in both groups,and there was significant difference (P＜0.01).Furthermore,the level of anti-HBs of infants was positively correlated with the level of IL-6 (rs =0.70,0.79,P＜ 0.01),and was negatively correlated with the level of IL-12 (rs=-0.71,-0.72,P＜0.01) in the neonatal period and the infantile period.From the neonatal period to the infantile period,the increased level of IL-6 was positively associated with the level of anti-HBs (rs =-0.74,P＜0.01),while the decreased level of IL-12 was negatively associated with the level of anti-HBs (rs=-0.42,P＜0.01).The level of IL-6 was negatively correlated with the level of IL-12 in the neonatal period and the infantile period (rs=-0.68,-0.70,P＜0.01).Conclusions IL-6 might promote the immune response to hepatitis B vaccination in infants whose mothers were HBsAg-positive,while IL-12 might inhibit the immune response.IL-6 and IL-12 would affect the immune response to hepatitis B vaccination in infants of HBsAg-positive mothers at the same time.

Objective To explore the safety and short?term efficacy of irreversible electroporation (IRE)ablation which is a novel ablation technology in unresectable hepatic neoplasms. Methods Patients with pathologically diagnosed as liver cancer or liver metastases were prospectively enrolled. The patients were not suitable for surgery with PS score ≤ 2. Exclusion criteria included who was not tolerate general anesthesia, severe liver and kidney dysfunction, and with cardiac pacemaker. A total of 16 patients were included in this study. There was 12 males and 4 females, aged 40 to 86 years with mean age (60 ± 10)y. Ultrasound and CT guided percutaneous IRE ablation was performed. Perioperative hemodynamic changes were reviewed. Liver and kindey function before and 7 d after ablation was compare by t test. The adverse reactions within 30 d after ablation treatment were recorded. CT and MR scans within 1 month were performed and the 30 d curative effect was evaluated by the modified RECIST criteria. Results All patients received IRE treatment successfully, and some patients experienced adverse reactions within 30 days after ablation, including abdominal pain in 7 cases, peritoneal effusion in 5 cases, hydrothorax in 4 cases, fever in 3 cases, cough, nausea and vomiting in 2 cases, biliary tract infection and thrombocytopenia in 1 case. After symptomatic treatment, these symptoms were improved. Severe complications, such as massive haemorrhage and bile leakage didn't occur. At 30 days after ablation, the curative effects were evaluated. Complete response (CR) was achieved in 1 patient , partial response (PR) was achieved in 12 patients, stable disease (SD) was in 2 patients , and progressive disease(PD) was 1 patients . The tumor relief rate (complete response+partial response) was 81.3%. Conclusions IRE ablation in the treatment of unresectable hepatic malignant tumor could have many advantages, including high safety, mild adverse reactions, and short?term efficacy. However, its long?term effect still need further observation.