ObjectiveTo explore the relationship of rejection sensitivity,social inhibition and negative affect in army recruits.Methods358 recruits were measured with rejection sensitivity questionnaire,type D personality scale,and positive affect and negative affect scale.Results(1)The score of intimates' rejection sensitivity was highest(9.33±3.88),peers' rejection sensitivity was in the middle(8.59±3.27),teachers' rejection sensitivity was lowest(6.79±2.90),with statistical significance(F(2,355)=53.76,P<0.01).(2)Rejection sensitivity had significantly positive correlation with social inhibition(r=0.346,P<0.01).Negative affect had significantly positive correlation with rejection sensitivity (r=0.233,P<0.01) and social inhibition(r=0.351,P<0.01).(3)Social inhibition partially mediated the relationships between rejection sensitivity and negative affect(the value of mediating effect was 45.7%).ConclusionRejection sensitivity has direct effects on negative affect and indirect effects through social inhibition.

Rivaroxaban is one of the new oral anticoagulants (NOAC) for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation. It has clear pharmacokinetic parameters, stable plasma concentration, less drug-drug interaction and higher compliance of patients. However, the discrepancy of pharmacokinetics between individuals and drug-induced hemorrhage events frequently occur clinically, therefore the association of gene polymorphism with drug metabolism has become a research hotspot. This article reviews the research progress on pharmacokinetic characteristics of rivaroxaban and its relationship with gene polymorphism, to provide a reference for the individualized rational use of rivaroxaban.

Objective To investigate the clinicopathologic features of GIST. Method Fifty-five GIST cases were collected. Immunohistochemical assays of vimentin, CD117, CD34, S-100, SMA, desmin, NF were used to study the specimen. Results 69% (38/55) of the tumors located in the stomach, 18% (10/55) in the small intestine. Tumors varied greatly in size, ranging from 0.4 to 40 cm (average 6.7 cm). Morphologic criteria of malignancy are tumor size≥5 cm, mitotic rates≥5/50 HPF and ulcer formation and there were significant differences between the benign and the malignant. Immunohistochemical staining results: CD117 positive in 39 cases(71%), CD34 in 45 cases (82%), S-100 in 19 cases (35%), SMA in 12 cases (22%), vimentin in 32 cases (58%), desmin in 6 cases(11%),and NF in 2/4 (50%). All 13 benign cases were alive on the latest follow-up. In 42 cases of malignancy and potential malignancy, 4 developed metastasis, 13 died. Conclusion (1) GIST occur predominantly in middle-aged and older persons.(2) The main criteria of malignancy of GIST are tumor size≥5 cm, mitotic rates≥5/50 HPF and ulcer formation. (3)Whereas it is difficult to identify true leiomyomas/leiomyosarcomars and neuogenic tumors from GIST, immunohistochemical staining is capable of doing this.

Objective To investigate the sleep quality of inland military officers and soldiers stationed and trained at plateau and its possible influence factors.Methods A total of 459 military officers and soldiers stationed and trained at plateau were performed the on site psychological assessment by adopting the psychological stress self-evaluation test (PSET),Pittsburgh Sleep Quality Index (PSQI),work related fatigue feelings (WRFFQ) and self compiled general data questionnaire.Results (1) The mean value of overall sleep quality in militaries stationed and trained at plateau was 5.61-±-3.48.40.5 ％ of respondents had good sleep quality,25.3％ had poor sleep quality and 34.2％ had general sleep quality.(2)The fatigue and psychological stress scores in the militaries with poor sleep quality were significantly higher than those in the militaries with good sleep quality (t1 =10.70,t2 =-9.68,P＜0.01).(3)The psychological stress,fatigue degree,confidence level of self-assessment health status had significantly positive correlation(r =0.517,0.488,0.259,0.352,P＜ 0.01).(4) The psychological stress,fatigue degree,confidence level of self-assessment health status entered the PSQI total score regression equation,moreover the predictive variation amount was 36.1％.Conclusion The psychological stress status and fatigue level in the militaries at plateau affect the sleep quality,and the confidence degree and health status assessment of officers and soldiers on exercise also produce the active influence on sleep.

Objective:To investigate the clinical effects of a single lateral-rectus approach (LRA) in the Ti-Robot-assisted treatment of acetabular fractures involving the posterior column.Methods:A retrospective study was conducted to analyze the clinical data of 16 patients with acetabular fracture who had been admitted to Department of Trauma Orthopedics, Taihe Hospital from August 2021 to March 2023. There were 13 males and 3 females with a mean age of 51.5 (35.8, 56.8) years. By the Judet-Letournel classification, there were 4 anterior and posterior semi-transverse fractures, 2 T-shaped fractures, and 10 double-column fractures. The time from injury to operation was 6.0 (5.3, 7.8) d. All their acetabular fractures involving the posterior column were treated by a single LRA with the assistance of a Ti-Robot. Operation time, blood loss, complications, quality of fracture reduction, modified Merle d'Aubigné & Postel scores and acetabular recovery at the last follow-up were recorded.Results:In this cohort, the operation time was (4.1±0.6) h and the blood loss 400 (300, 575) mL. By the Matta evaluation, the fracture reduction was excellent in 10 cases, good in 5 cases, and poor in 1 case. The follow-up time was (11.3±3.9) months. Bone union was achieved in all fractures after 3.0 (2.3, 4.0) months. By the modified Merle d'Aubigné & Postel scores at the last follow-up, 9 cases were excellent, 6 cases were good and 1 case was fair. Injury to the lateral femoral cutaneous nerve occurred in 1 patient, and deep venous thrombosis in 6 patients. Follow-ups revealed no iatrogenic vascular injury, loosening or rupture of internal fixation, or incision infection.Conclusion:A single LRA approach can be used in the minimally invasive treatment assisted by a Ti-Robot for acetabular fractures involving the posterior column, demonstrating advantages of minimal invasion, high reduction quality and good functional recovery of the hip joint.

Objective:To explore the risk factors for atrial fibrillation(AF)in elderly Chinese patients with severe valvular heart disease(VHD).Methods:This was a cross-sectional study and consecutively enrolled 978 elderly patients with severe VHD diagnosed in 18 Class A tertiary hospitals across the country from September 2021 to March 2022, including 322(32.9%)patients with concurrent AF.Clinical and echocardiographic data were collected to analyze the risk factors for AF.Results:Among VHD patients, compared with the non-AF group, the AF group was older, had a higher female ratio, higher diastolic blood pressure, higher proportions with cerebrovascular disease and chronic kidney disease, lower serum low density lipoprotein cholesterol and higher serum creatinine, amino-terminal A-type natriuretion peptide and glycosylated hemoglobin.As for echocardiographic parameters, the left atrial diameter was larger, the left ventricular end-diastolic diameter, interventricular septum thickness, and left ventricular posterior wall thickness were smaller in the AF group than in the non-AF group.All of the differences were statistically significant(all P<0.05). The results of multivariate Logistic regression analysis showed that the left atrial anteroposterior diameter increased( OR=1.166, P<0.01), the left ventricular end-diastolic diameter decreased( OR=0.929, P<0.01), and advanced age( OR=1.051, P<0.05)was an independent risk factor for elderly VHD patients with concurrent AF. Conclusions:In elderly patients with severe VHD, advanced age, an increased left atrial anteroposterior diameter, and a decreased left ventricular end-diastolic diameter were independently associated with AF.Therefore, evaluation of cardiac structure and regular follow-up should be performed in elderly patients with severe VHD for early intervention to reduce the incidence of AF.

Objective:To study the correlation between the Rivaroxaban concentration and bleeding events in patients with nonvalvular atrial fibrillation(NVAF).Methods:This was a retrospective study.According to the inclusion and exclusion criteria, 369 patients with NVAF taking Rivaroxaban admitted to Beijing Hospital or Tianjin Medical University General Hospital from January 2018 to June 2019 were enrolled.Clinical data including sex, height, weight, liver and kidney function, drug valley concentrations and peak concentrations, doses, CHADS2 scores and bleeding events after 6 months of medication were recorded.Results:The average drug valley concentration was (44.92±38.39) mg/L, the average drug peak concentration was (226.96±139.34) mg/L, and the average CHADS2 score was (2.8±1.2). Among the 369 patients, 22 had bleeding events.The peak drug concentration and valley drug concentration were similar between those with or without bleeding events( P=0.324 and 0.960, respectively). With the increase of age, the peak drug concentration and valley drug concentration were significantly elevated(all P<0.001). In addition, compared with those without bleeding events, patients with bleeding events had a significantly higher average valley concentration( P=0.009), valley/dose ratio( P=0.001), peak/dose ratio( P=0.028)and similar peak drug concentration( P=0.360). Conclusions:Age affects the peak and valley drug concentration of Rivaroxaban, especially for the elderly, who should be given appropriately reduced doses.Monitoring the peak and valley drug concentration is of great significance for patients at high-risk for bleeding.

Objective:To analyze the clinicopathological characteristics, treatment responses and kidney outcomes of patients with atypical membranous nephropathy (MN), and to provide information for the clinical practice.Methods:The clinical data of patients with atypical MN and synchronous primary MN who were diagnosed, treated and followed up in Peking University First Hospital from January 2008 to June 2020 were retrospectively collected and analyzed. Clinicopathological features, treatment responses and kidney prognosis were compared between the two groups. The expression of phospholipase A2 receptor (PLA2R) in kidney tissues was detected by immunofluorescence. Serum anti-PLA2R antibody was detected by enzyme-linked immunosorbent assay. Clinicopathological indexes were compared between PLA2R-related MN group and non-PLA2R-related MN group. Kaplan-Meier (Log-rank test) survival curve and multivariate Cox regression analysis methods were used to analyze the influencing factors of kidney prognosis in patients with atypical MN. The primary endpoint of renal adverse outcome was renal insufficiency, defined as end-stage renal disease or estimated glomerular filtration rate (eGFR) decline>30% baseline and<60 ml·min -1·(1.73 m 2) -1. Results:A total of 65 atypical MN patients were enrolled in this study. Compared with primary MN ( n=324), patients with atypical MN had younger age ( Z=-4.229, P<0.001), higher proportion of hematuria ( χ2=5.555, P=0.018), higher level of urinary protein ( Z=2.228, P=0.026) and lower level of eGFR ( t=-5.108, P<0.001); the proportion of IgG4 deposition in kidneys was lower ( χ2=8.081, P=0.004), and the proportions of IgA ( χ2=16.969, P<0.001) and IgM ( χ2=9.281, P=0.002) deposition were higher. There was no significant difference on gender, serum albumin, positive proportion of anti-PLA2R antibody, anti-PLA2R antibody level and kidney C3/C1q deposition between the two groups (all P>0.05). The proportions of atypical MN patients receiving renin-angiotensin aldosterone system inhibitors (49.3% vs 57.1%), calcineurin inhibitors (27.7% vs 19.1%) and cyclophosphamide (21.5% vs 23.8%) were comparable to those of primary MN patients (all P>0.05). The rates of clinical remission (80.0% vs 77.2%), partial remission (44.6% vs 44.1%), complete remission (35.4% vs 33.1%), spontaneous remission (36.9% vs 42.6%), response to cyclophosphamide (85.7% vs 81.8%), response to calcineurin inhibitor (88.9% vs 79.0%), and relapse (30.8% vs 26.8%) in atypical MN patients were comparable to those in primary MN patients (all P>0.05). During the follow-up 30.0(21.5, 61.5) months, 15 atypical MN patients (23.1%) had eGFR reduction>30%, among whom 7 patients (10.8%) had eGFR reduction>50% and 3 patients (4.6%) had end-stage kidney disease. There was no significant difference on poor kidney prognosis between the two groups (all P>0.05). Kaplan-Meier survival curve showed that patients with age>39 years old ( χ2=10.092, P=0.001), eGFR≤100 ml·min -1·(1.73 m 2) -1( χ2=5.491, P=0.019), tubular interstitial lesion ( χ2=6.999, P=0.008) and no nephropathy remission ( χ2=22.952, P<0.001) had earlier poor renal prognosis. Multivariate Cox regression analysis showed that no nephropathy remission ( HR=12.604, 95% CI 2.691-59.037, P=0.001) was an independent influencing factor for poor renal prognosis in atypical MN patients. Conclusion:No significant difference is found between atypical MN and primary MN on treatment responses and kidney prognosis, which implies that clinical practice of atypical MN can be performed by referring to the guidelines and experience of primary MN.

Adult ; Cyclosporine ; Glomerulosclerosis, Focal Segmental/drug therapy* ; Humans ; Leflunomide/therapeutic use* ; Nephrosis, Lipoid/drug therapy* ; Nephrotic Syndrome ; Steroids