Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Immune deficiency of the host caused by allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the initial factor of reactivation of latent human cytomegalovirus (HCMV). The risk factors of reactivation of HCMV in allo-HSCT recipients consist of the serological status of HCMV in donors and recipients, the matching degree of human leukocyte antigen (HLA) and pretreatment patterns, etc. The reactivation of HCMV is associated with the expression of a series of viral cleavage and proliferation proteins induced by the overexpression of major immediate early promoter/enhancer (MIEP) in the viral genome. In this article, the risk factors of reactivation of HCMV after allo-HSCT, the molecular changes related to maintaining latent infection of HCMV, the key role of MIEP overexpression in reactivation of HCMV, and the molecular pathways involved in reactivation of HCMV after allo-HSCT were reviewed and the major molecular events of reactivation of HCMV after allo-HSCT were elucidated, aiming to provide reference for the prevention and treatment of cytomegaloviral disease (CMVD) after allo-HSCT.

COVID -19 poses a major threat to safety and health of human life. Vaccination has become an important means to resist and prevent COVID -19. Under the background of limited global supply of COVID -19 vaccine and its initial application, it is extremely necessary to discuss its ethical principles. Based on the bioethics theory and in accordance with relevant laws and regulations on vaccine use in China, this paper put forward the ethical principles of COVID -19 vaccine use, including safety principle, respect principle, fairness and justice principle, optimization principle and humanitarianism principle, which provided reference for scientifically formulating COVID -19 vaccination strategy and forming a group immune barrier to effectively control the epidemic situation in COVID -19.

Objective:To explore the application of multi-modal digital massive open online courses (MOOCs) mode in the standardized residency training of obstetrics and gynecology.Methods:A total of 40 residents who entered the training program of obstetrics and gynecology from September 2018 to February 2020 were selected as the control group, and 40 residents from March 2020 to August 2020 were selected as the study group. The control group adopted the traditional teaching method, and the study group adopted the multi-modal digital MOOCs teaching method. The scores of theoretical examination and skill operation examination after the standardized training, clinical ability examination before and after the standardized training and teaching satisfaction were compared between the two groups. SPSS 22.0 was performed for t test and chi-square test. Results:After the standardized training, the scores of theoretical knowledge [(88.53±6.04) vs. (79.67±5.52)] and skill operation [(85.52±6.33) vs. (71.15±7.86)] in the study group were significantly higher than those in the control group ( P < 0.05). After the standardized training, the scores of all kinds of clinical ability of the two groups were higher than before ( P < 0.05), and the scores of all items in study group were higher ( P < 0.05). The satisfaction of all aspects of teaching in the study group was higher than that in the control group ( P < 0.05). Conclusion:The application of multi-modal digital MOOCs teaching mode in the standardized residency training of obstetrics and gynecology can strengthen the learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and significantly improve the quality of teaching with high teaching satisfaction.

OBJECTIVE: To investigate the status of anxiety and depression in patients requiring emergency treatment during the epidemic of COVID-19 to identify the patients with acute psychological stress disorder. METHODS: During the COVID-19 epidemic, the medical staff divided the patients visiting the emergency department into suspected group, fever group and control group through interview of the patients at triage. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were distributed to each patient, and a trained medical staff was responsible for assisting the patient to complete the scales. RESULTS: A total of 557 sets of scales were distributed, including 211 in suspected COVID-19 case group, 167 in fever group and 179 in the control group. A total of 516 scales were retrieved, including 197 in suspected case group, 151 in fever group and 168 in control group. In the 3 groups, the incidence rates of anxiety and depression were 57.87% and 58.88%, 48.34% and 43.71%, and 18.31% and 18.99%, respectively, and the rates were significantly higher in suspected group and fever group than in the control group ( < 0.01), and significantly higher in suspected group than in fever group ( < 0.05). The standardized anxiety and depression scale scores in suspected case group, fever group and control group were 57.38±16.25 and 42.58±14.27, 51.23±15.29 and 38.32±15.39, and 32.58±17.8 and 12.25±12.94, respectively. Compared with the control group, both suspected case group and fever group had significantly higher standard scores for anxiety and depression ( < 0.01), and suspected case group had significantly higher standardized scores than fever group ( < 0.01). CONCLUSIONS Among the patients visiting the emergency treatment, the patients with suspected COVID-19 and common fever are more likely to develop anxiety and depressive symptoms.
Anxiety ; epidemiology ; Betacoronavirus ; Coronavirus Infections ; epidemiology ; psychology ; Depression ; epidemiology ; Emergency Service, Hospital ; Humans ; Pandemics ; Pneumonia, Viral ; epidemiology ; psychology

OBJECTIVE: To investigate the efficacy and safety of the bladder training in male patients before urinary catheter removal after mid-low rectal cancer surgery. METHODS: This was a prospective, open, randomized controlled study. INCLUSION CRITERIA: male patients; pathologically diagnosed as mid-low rectal adenocarcinoma; distance from tumor lower edge to anal margin ≤10 cm; standard radical surgery for rectal cancer, including intestinal resection and regional lymph node dissection. EXCLUSION CRITERIA: previous history of benign prostatic hyperplasia or history of prostate surgery; bladder dysfunction such as dysuria and urinary retention before surgery; local resection of rectal tumor or extended resection. According to the above criteria, 92 patients who underwent colorectal surgery at the Union Hospital of Fujian Medical University from June to December 2016 were prospectively included. The patients were randomly divided into bladder training group (n=43) and bladder non-training group (n=49) according to the random number table method. The study was approved by the Ethics Committee of the Union Hospital of Fujian Medical University (ethical approval number: 2016KY005) and registered with the China Clinical Trial Registration Center (ChiCTR) (registration No.ChiCTR-IOR-16007995). The implementation of patient's treatment measures, the data collection and analysis were based on the three-blind principle, using envelopes for distribution concealment. In the bladder training group, bladder training was routinely performed from the first day after operation to catheter removal, and in bladder non-training group the catheter was kept open till its removal. The catheter was removed in the early morning at the 5th day after surgery, and the spontaneous urine output was recorded and the residual urine volume of the bladder was measured after the first urination. The international prostate symptom score (IPSS) was applied to evaluate the patient's urinary function before and after surgery. RESULTS: The age of whole group was (58.6±10.9) years old, the body mass index was (22.4±2.7) kg/m , and the distance from tumor lower edge to anal margin was (6.5±1.9) cm. The baseline data, such as age, body mass index, distance from tumor lower edge to anal margin, preoperative IPSS score, preoperative bladder residual urine volume, neoadjuvant radiotherapy and chemotherapy, preventive ileostomy and surgical procedure were not significantly different between two groups (all P>0.05). There was no significant difference in IPSS scores evaluated at the second day (3.6±4.0 vs. 3.5±3.4, t=0.128, P=0.899) and one month (3.7±2.9 vs. 3.0±3.1, t=1.113, P=0.269) after catheter removal between the bladder training group and bladder non-training group. No significant difference in the postoperative residual urine volume of bladder (media 44 ml vs. 24 ml, Z=-1.466, P=0.143), the first spontaneous urination volume (median 200 ml vs. 150 ml, Z=-1.228, P=0.219) after catheter removal, and postoperative hospital stay [(8.2±4.5) days vs. (9.1±5.5) days, t=-0.805, P=0.423] was found. Urinary infection rate was 20.9%(9/43) in the training group, which was even higher than 8.2%(4/49) in the non-training group, but the difference was not significant(χ²=3.077, P=0.079). No patient needed re-catheterization in either group. CONCLUSIONS The routine bladder training after mid-low rectal cancer surgery does not improve the urinary function, and can not reduce the residual urine volume of bladder after catheter removal. This routine clinical practice is not helpful for the bladder function recovery after rectal cancer surgery.
Aged ; China ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Rectal Neoplasms ; surgery ; therapy ; Treatment Outcome ; Urinary Bladder ; surgery ; Urinary Retention ; therapy

Recurrent cerebral infarction (RCI) is very common in clinical practice. Intracranial and extracranial vessels diseases closely associate with the recurrence of cerebral infarction. Hypertension, diabetes, high homocysteine, etc., result in vascular stenosis and more in-farction recurrence by atherosclerosis and arterial plaque formation. Study of the etiology of RCI is important for the secondary prevention of cerebral infarction.

ObjectiveTo explore the value of color Doppler ultrasonography (CDU) in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC) in infants.MethodsA total of 54 infants diagnosed with hepatic portal cystic lesion in the First Affiliated Hospital of Sun Yat-sen University from January 2012 to July 2014 who were going to receive surgical treatment were included in this prospective study. Of the 54 cases, 35 were baby boys and 19 were baby girls with a mean of (63±19) d old. According to the results of pathological examination, the patients were divided into the CBA group and the CC group.All guardians of the infants signed the informed consent and the local ethical committee approval had been received. Preoperative TB level and DB level were recorded. CDU was used to observe the incidence of hepatic portal ifbrous mass, intrahepatic bile duct dilation and biliary sludge sedimentation in the cyst. In addition, the length diameter and width diameter of gallbladder and the inner diameter of hepatic artery were measured. The observed parameters of two groups were compared byχ2 test ort test.ResultsThe incidence of hepatic portal ifbrous mass in CBA group was 96% (25/26), which was signiifcantly higher than 0 (0/28) in CC group (P<0.05). The incidence of intrahepatic bile duct dilation and biliary sludge sedimentation in the cyst in CBA group were both 0 (0/26), which were signiifcantly lower than 75% (21/28) and 54% (15/28) in CC group (P<0.05). The width diameter of gallbladder in CBA group was (5±1) mm, which was signiifcantly less than (8±2) mm in CC group (t=-38.68,P<0.05). The inner diameter of hepatic artery in CBA group was (2.4±0.4) mm, which was significantly greater than (1.8±0.3) mm in CC group (t=28.40,P<0.05). ConclusionsThe hepatic portal ifbrous mass, intrahepatic bile duct dilation, biliary sludge sedimentation in the cyst, width diameter of gallbladder and inner diameter of hepatic artery are effective indexes for CDU to differentiate CBA and CC, thus, CDU may be used in the preoperative differential diagnosis.

Objective To research expression changes of COX-2 gene in Barrett′s esophageal mucosa before and after argon plasma coagulation (APC)operation and to explore it′s clinical curative effect and possible mechanism .Methods 66 barrett′s e-sophageal diagnosed with gastroscope and pathology were randomly divided into normal esophageal group (the negative control group ,group A) ,the APC with acid suppression therapy group(group B) ,Acid antimicrobial drug treatment group(group C) .Ob-serve symptom relief condition ,barrett esophagus epithelium ablation under gastroscope before and after treatment ,esophageal mu-cosa tissue samples was detected by real-time fluorescent quantitative PCR technique .Expression of COX-2 gene in barrett′s esoph-ageal mucosa were compared among groups .Results Compared with group A ,both Group B and group C could effectively relieve symptoms (P<0 .05) .Symptom remission rate had no no statistically significant difference in Group B and group C .Barrett esopha-gus epithelium was not significantly narrowed under gastroscope follow-up Group A and group C ,while Barrett esophageal mucosal occurred ablation with pink mucous covered in Group B .The expression of Cox-2 mRNA in group B decreased ,which was similar to group A .The expression of Cox-2 mRNA in group C also decrease ,but there was no significant differences before and after treat-ment .Conclusion APC with acid suppression therapy could effectively relieve symptoms ,melting Barrett esophagus epithelium ,and is of a safe and effective treatment on Barrett′s esophagus .

ObjectiveTo observe the clinical effect of laparoscopic intrafascial supracervical hysterectomy.Methods The complications during and after the operation of laparoscopic intrafascial supracervical hysterectomy of 46 patients were reviewed and summarized retrospectively. Results Laparoscopic intrafascial supracervical hysterectomy of 46 cases had been done well without significant complications,such as injury of intestine,bladder and ureter.Four cases had complications in short term,one was pelvic hematoma,one was pelvic infection,and two were hematocele in cervical canal.There were five cases had complications in long term.Residual cavity periodic hemorrhage in two cases,cervical gland cyst,pelvic parcel effusion and cervical polypoid hyperplasia each in one case.ConclusionsThere are less complications during the laparoscopic intrafascial supracervical hysterectomy,while much more after the surgery.Therefore,the surgical method needs to be improved.