Objective Taking Chinese college students as the target group,this study detected the distribution of plantar pressure in different gait groups and analyzed the distribution characteristics of plantar pressure in in-toeing gait populations,to provide references for their orthopedic rehabilitation.Methods Ten subjects with typical in-toeing and normal and out-toeing gaits were selected to participate in the plantar pressure testing experiment.The maximum force,pressure,and contact time during natural standing and during one walking gait cycle were measured using a Zebris foot plantar pressure measurement system.Gait parameters,including step length,step width,step speed,step direction angle,gait center line,and force change curves,were collected,and a hazard analysis was conducted.Results During natural standing,the swaying interval area of the center of pressure was 939.0±252.4 mm2 for the in-toeing gait group and 1 120.2±101.6 mm2 for the out-toeing gait group,which was larger than that for the normal group(240.7±130.6 mm2).The in-toeing gait further weakens the human body's ability to maintain stability.The dynamic and static plantar pressures in the three gait groups exhibited different distribution characteristics.During static standing,the pressure center of the in-toeing gait group shifted to the hindfoot,which accounted for 70%of the plantar pressure and was higher than that of the normal group.During dynamic walking,the absolute value of peak pressure in the tripodal area of the foot in the in-toeing gait group was higher than that in the other two groups.Conclusions The in-toeing gait group had poor static maintenance ability,and to a certain extent,the distribution of plantar pressure in the foot tripodal area and plantar zone pressure were different compared with that of the normal gait.This led to poor stability,easy muscle fatigue,and ankle and knee joint injuries in the in-toeing gait group under equal-intensity exercise conditions.

OBJECTIVE To explore the action mechanism of kushenol F （KSCF） in treating ulcerative colitis （UC） in mice. METHODS The potential targets of KSCF intervening in UC were predicted with network pharmacology and molecular docking. C57BL/6J mice were randomly divided by body weight into model group， positive control group （sulfasalazine， 703 mg/kg）， KSCF group （100 mg/kg）， and normal group， with 6 mice per group. The UC model of mice was induced by dextran sulfate sodium solution. During the modeling period， the mice were given relevant medicine intragastrically， once a day， for 7 consecutive days. After the last administration， the disease activity index （DAI） of the mice was scored； the length of the mice’s colon was measured； pathological changes in the colon tissue of mice were observed； the levels of lipopolysaccharide （LPS） in serum， myeloperoxidase （MPO）， nitric oxide （NO） and superoxide dismutase （SOD） in the colon were detected in mice； the expression levels of occludin and ZO-1 in colon tissue of mice were detected； the proportions of CD3+T， CD4+T， and CD8+T lymphocytes in the spleen and the ratio of CD4+/CD8+ were detected； changes in colonic microbiota were analyzed by 16S rDNA sequencing. RESULTS Results of network pharmacology indicated that KSCF may treat UC by regulating signaling pathways such as phosphatidylinositol-3 kinase/protein kinase B （PI3K/AKT） and nuclear factor kappa B （NF- κB）. Molecular docking results showed that KSCF bound most stably with NF-κB p65 protein. Animal experiment results demonstrated that， compared with the model group， the pathological characteristics of colon tissue in mice were improved in KSCF group. DAI scores， serum levels of LPS， the levels of MPO，NF-κB p65 phosphorylation and NLRP3 protein expression in the colon， and the proportion of CD8+T lymphocytes in the spleen were reduced significantly （P＜0.05）. Body weight， SOD levels， expression levels of occludin and ZO-1 in the colon， proportions of CD3+T and CD4+T lymphocytes， and the CD4+/CD8+ ratio in the spleen were significantly increased （P＜0.05）； the abundance of Firmicutes， Actinobacteria， Akkermansia， and Lactobacillus genera were increased， while Proteobacteria decreased； the microbial community structure tended towards that of the normal group. CONCLUSIONS KSCF alleviates UC by restoring intestinal microbial imbalance， enhancing immune response， and inhibiting colonic inflammatory responses， thereby improving intestinal barrier integrity.

Objective:To analyze the dynamic development of physical, psychological, and cognitive degenerative multimorbidity among middle-aged and older Chinese adults (≥45 years old) while estimating the longitudinal association between socioeconomic status (SES) and the progression of multimorbidity.Methods:Based on data from the China Health and Retirement Longitudinal Study (2011-2020), the Sankey diagram was used to show the dynamic development of physical, psychological, and cognitive degenerative multimorbidity from 2011 to 2020. SES was constructed based on the level of education and total household wealth. Logistic regression was used to estimate OR and 95% CI to evaluate the association between SES and the progression of multimorbidity. Results:Of the 5 393 participants included, 4 484 (83.14%) of them developed new diseases, and the prevalence of physical, psychological, and cognitive degenerative multimorbidity increased from 38.04% to 74.23%. Compared to those with no reported disorders at baseline, participants with psychological disorder (for newly developed physical-cognitive multimorbidity: OR=4.59,95% CI: 2.89-7.29), cognitive disorder (for newly developed physical-psychological multimorbidity: OR=2.24,95% CI: 1.40-3.60), or their multimorbidity at baseline were more likely to progress to physical, psychological, and cognitive degenerative multimorbidity. After adjusting covariates, individuals with low SES were more likely to develop physical diseases ( OR=1.45, 95% CI: 1.11-1.89), cognitive disorder ( OR=1.84, 95% CI: 1.16-2.91), physical-psychological multimorbidity ( OR=1.87, 95% CI: 1.37-2.56), physical-cognitive multimorbidity ( OR=3.58, 95% CI: 2.54-5.06), psychological-cognitive multimorbidity ( OR=5.66, 95% CI: 3.04-10.55), and physical-psychological-cognitive multimorbidity ( OR=3.21, 95% CI: 2.06-5.01) in comparison to those with high SES. There is a dose-response relationship between SES and the multimorbidity progression (all trend P<0.001). Conclusions:The prevalence of physical, psychological, and cognitive degenerative multimorbidity increased significantly among middle-aged and older Chinese adults. Lower SES was associated with multiple patterns of physical, psychological, and cognitive disorders progression.

Objective:To understand the positive rate of 2019 novel coronavirus (2019-nCoV) specific IgG antibody induced by Coronavirus Disease 2019 (COVID-19) inactivated vaccine in healthy population in Xizang Autonomous Region, and evaluate the immune effect of the vaccine.Methods:Serum samples were collected from COIVD-19 vaccine immunized health population without history of 2019-nCoV infection from six prefecture-level cities in Xizang Autonomous Region. The IgG antibody against 2019-nCoV were tested by chemiluminescence method. Then, the positive rate of IgG antibody was analyzed for different immunization histories and age groups.Results:A total of 22 255 participants were enrolled in this survey. After full-access (two doses of vaccine) and booster immunization, the overall positive rate of specific IgG antibody against 2019-nCoV was 96.38%. The positive rate of IgG antibody in the booster immunized population was 97.12%, which was much higher than the 88.38% in the full-access immunization population, the difference is statistically significant ( χ2=381.11, P<0.001). There was a significant differences in the positive rates of specific IgG antibodies in different age groups ( χ2=138.28, P<0.001). Especially in the younger age groups, including less than 10 years old and the 11-20 years age group, the positive rate of specific IgG antibody were 93.44% and 89.03% respectively, which were lower than those in other age groups. Except for Naqu city and the age group ≤ 10 years old, the differences in antibody positivity rates were statistically significant between different age groups in the same region and between the different regions in the same age group for the two populations with different immunization histories ( P<0.05). Conclusions:The COVID-19 inactivated vaccine showed a good immune effect in the healthy population in Xizang Autonomous Region, and the booster immunization helps to increase the positive rate of specific IgG antibody in healthy population.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To investigate epidemic status of avian influenza virus (AIV) in live poultry market (LPM) and evaluate its potential public health threat and develop control measures in Nanchang city.Methods:Forty-seven LPM in 10 counties/districts of Nanchang city were selected as surveillance sites by using cluster random sampling. Poultry swabs and environmental samples were obtained from LPM. Real time RT-PCR was used for AIV typing and subtyping. Excel 2016, SPSS 24.0 and Prism Version 7 (GraphPad) software were used for statistical analysis.Results:Total of 9 248 poultry swabs and environmental samples were collected. 1 525 specimens(16.49%) were positive for AIV. H7 and H9 were the dominant subtypes, and H9 positive rate was highest (17.44%). Sewage (21.46%) and throat swabs (20.46%) had higher positive rates than the other types of samples. Chicken and duck were dominant hosts for AIV, the corresponding positive rates were 22.80% and 13.95%. The positive rates of Honggutan district, Anyi county and Xinjian district were 25.52%, 24.31% and 22.35%, which were higher than that of the other counties/districts. Each county/district had its unique subtype composition of AIV.Conclusions:The coexistence of H7, H9 and other subtypes of AIV in LMP was identified in Nanchang city. Continuing active surveillance and comprehensive control measures should be taken to reduce the potential risk of human infection.

Objective:To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence.Methods:The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m 2 of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m 2 of PTX at day 1 and day 8, meanwhile 80 mg/m 2 of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results:Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months.Conclusions:Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

Objective:To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence.Methods:The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m 2 of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m 2 of PTX at day 1 and day 8, meanwhile 80 mg/m 2 of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results:Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months.Conclusions:Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

Objective To identify the risk factors of early post-surgical recurrence of hepatocellular carcinoma (HCC) within 2 years.Methods This retrospective study included 178 consecutive patients with HCC who underwent curative resection between January 2009 to December 2012 at Zhongshan Hospital,Fudan University.There were 151 males and 27 females,with a mean age of (58±11) years.The CT features including rim enhancement,satellite nodule,two-trait predictor of venous invasion (TTPVI),and nonsmooth tumor margins were reviewed.After hospital discharge,the patients were followed-up regularly for at least 2 years to detect tumor recurrence.The primary end point was recurrence of HCC.Results On univariate analyses AFP ≥ 200 μg/L,rim enhancement,TTPVI,non-smooth tumor margins and largest diameter ＞5 cm were correlated with early post-surgical recurrence of HCC.On multivariate analyses,AFP≥200 pg/L (HR=2.144,95％CI:1.350～ 3.406),rim enhancement (HR =2.196,95％ CI:1.345 ～ 3.587),TTPVI (HR=1.735,95％CI:1.086～2.772),and non-smooth tumor margins (HR=2.065,95％CI:1.242～3.432) were independent risk factors of early post-surgical recurrence of HCC.Conclusion AFP≥200 μg/L,rim enhancement,TTPVI,and non-smooth tumor margins were independent risk factors of early post-surgical recurrence of HCC.

Objective To explore the clinical characteristics, risk factors of mortality and antimicrobial therapy of carbapenemresistant Klebsiella pneumoniae (CRKP) bloodstream infections. Methods A 5-year retrospective study was conducted for 60 patients with CRKP bloodstream infection, who were treated in Chinese People's Liberation Army (PLA) General Hospital during the period from June 2011 to August 2016. The patients were assigned to death (n=24) or survival (n=36) group according to 28-day survival after bloodstream infection to identify the predictors of mortality. The patients treated with combination antimicrobial therapy (n=32) were compared with those received monotherapy (n=14). Results A total of 60 nonduplicate CRKP blood isolates were identified. The 28-day mortality was 40.0％ (24/60). High APACHE Ⅱ score (OR=1.15, 95％ CI 1.0-1.3, P=0.048) was identified as an independent risk factor for 28-day mortality in patients with CRKP bloodstream infection. The 46 patients receiving antimicrobial therapy showed 28-day mortality of 34.8％. Univariate analysis indicated that the 28-day mortality rate was similar between the patients receiving combination antimicrobial therapy and those receiving monotherapy. Conclusions Bloodstream infection due to CRKP is associated with high mortality. APACHE II score is an independent predictor for mortality in patients with CRKP bloodstream infection.