Periodical assessment over the actual situation of physician work in a Class One Grade A hospital in Beijing is performed, and some ideas to improve the work are proposed in view of the problems existing in the work.

Objective To evaluate the modified Physical and Operative Severity Score for the Enumera-tion of Mortality and Morbidity (POSSUM) in predicting the postoperative morbidity in patients with fractures of the pelvis and acetabulum. Methods The clinical data of 94 patients with pelvic and acetabular fractures were retrospectively analyzed. Their postoperative prognosis during hospital stay was evaluated with the POSSUM scoring system modified according to the features of orthopedics and pelvic and acetabular fractures. The peritoneum in-fection in the severity index of operation was replaced by operative approach, the several operations at one time by operative duration, and the cancer by the associated injury. The size and type of operation were made into 4 grades with corresponding orthopedic scores. The scores were compared between the complication group and the non-complication group. The receiver operator characteristic (ROC) curve was drawn to describe the coincidence degree, define the cut points, and evaluate its predicting capability. Results The mean preoperative physi-ological score (PS) and operative severity score (OS) in the complication group (38 cases) were significantly higher than those in the noncomptication (56 cases) (17.26 ± 2.84 vs 16.04 ± 2.77; 19.50 ± 5. 14 vs 13.00 ±3.81 ) ( P ＜ 0.05) . In the modified POSSUM, the area under ROC curve was 0. 856, the cut point 43%, sen-sitivity 73.68%, specificity 80. 36%, and coincidence degree 77.66%. Conclusions Since the modified POSSUM scoring system has a high capability of predicting postoperative morbidity for fractures of the pelvis and acetabulum, it can be helpful for surgeons to lower operative risks and ensure safety in operation. When the score is higher than the cut point, the risk is too great for an operation. Therefore, the fracture should be treated non-operatively or mini-invasively until the score is lower than the cut point.

Objective To compare the values of the mangled extremity syndrome index (MESI), the mangled extremity severity score (MESS) and the limb salvage index (LSI) in deciding amputation or salvage in the management of the mangled extremity syndrome (MES). Methods Clinical data of 353 MES patients including 95 with amputation and 258 with salvage admitted in recent eight years were retrospectively evaluated by using MESI, MESS and LSI, the value of which in deciding amputation or salvage was assessed with receiver operating characteristic ( ROC ). Results There was statistical difference in aspect of mean scores of three grading systems between patients with amputation or salvage (P＜0. 01). For MESI, MESS and LSI, the sensitivities was 89.47%, 85.26% and 83.15% respectively, the specificities was 100%, 96.89% and 96.12% respectively, the coincidence was 97.16%,93.76% and 92.63% respectively, the areas under ROC curves was 0. 924, 0905 and 0. 861 respectively and the cut-off points were equal or over 20, 7 and 6 respectively. Conclusions Three scoring systems are all highly capable of predicting early amputation or not in MES management. The MESI is recommended as a quantitative criterion for determining amputation or salvage.

Objective To discuss the value of preoperative digital design of struetund bone graft for acetabular wall defects. Methods The . dieom data from spiral CT scans were imported into Mimics 10.0 to build the 3D solid model of the pelvis of an old female patient with left acetabular wall defects. The 3D solid model of the defect area was built by Mirror and 3D mask editing. A simulated bone graft was conducted on the 3D model by segmentation and trimming according to the data measured on the reconstructed model. Results The reconstructed 3D model of the patient's pelvis could be presented in different colors, transparenees, or combinations of interested tissues. The acetabular wall defects could be visualized very clearly at different angles. The geometric data of the bone graft could be measured to ensure the bone graft would fit the defects accurately. Conclusion Preoperative digital design based on 3D com-puterized reconstruction of acetabular wall defects may provide a valuable aid to clinical treatment, because it is a simple, rapid, and accurate method of increasing the fitness of bone graft and the defects,

Objective:To investigate the expression and its possible role of Oct4B1 subtype of Embryonic stem cell transcription factor Oct4 in colorectal cancer stem cells. Methods: 3D microspheres were cultured by suspension culture to human colorectal cancer cell line SW480 cells. The 3D microspheres and SW480 cells were used as the research objects. Whether 3D microspheres were enriched cancer stem cells,we used the methods of cell differentiation experiments,soft agar cloning experiments,and the expression levels of cancer stem cells markers CD133,CD44 detected by flow cytometry. The expression levels of Oct4B1 mRNA were detected by RT-qPCR. Results:3D microspheres could differentiate into normal cancer cells. Compared with the parental SW480 cells,in vitro colony formation was significantly enhanced(P<0. 01),the percentage of positive cells of CD133 and CD44 were significantly increased ( P < 0. 01 ), the expression levels of Oct4B1 mRNA were obviously higher ( P < 0. 01 ) in 3D microspheres. Conclusion: Oct4B1 subtype of Embryonic stem cell transcription factor Oct4 in 3D microspheres enriched human colorectal cancer stem cells,which may be involved in the regulation of colorectal cancer stem cells.

Objective To observe the clinical effect of Shumu-Yuntu-Zhike decoction with conventional treatment for the Gastroesophageal Reflux Cough (GERC).Methods A total of 64 patients with GERC were randomly divided into the conventional treatment group and the combined treatment group, 32 in each. The conventional treatment group took the Rabeprazole capsule and Mosapride Citrate Tablets, and the combined treatment group received the traditional prescription of Shumu-Yuntu-Zhike decoction on the basis of the conventional therapy. Two groups were treated for 8 weeks and evaluated the effect with the Visual analogue scale (VAS), Reflux diagnostic questionnaire (RDQ) and Chronic cough impact questionnaire (CCIQ) before and after 4 and 8 weeks' treatment.Results After 4 week treatment, the VAS (4.47 ± 1.32vs. 6.22 ± 1.34;t=-5.859,P<0.01), CCIQ (32.60 ± 5.83vs. 47.32 ± 5.56,t=-11.548,P<0.01) in the combined treatment group decreased significantly than the conventional group, but the RDQ (13.62 ± 2.89vs. 13.67 ± 2.77;t=-0.079, P=0.937) showed no significant difference between the two groups. After 8 weeks' treatment. After 8 week treatment, the VAS (2.57 ± 1.69vs. 4.55 ± 2.06;t=-4.676,P<0.01), CCIQ (12.47 ± 3.41vs. 23.47 ± 3.55;t=-14.126,P<0.01) in the combined treatment group decreased significantly, but the RDQ (9.18 ± 2.77vs. 9.3 ± 2.43,t=-0.202,P=0.841) showed no significant difference between the two groups. After the treatment, the total effective rate of combined treatment group was 90.6% (29/32), while the control group was 68.7% (22/32). There was significant difference between the two groups (χ2=4.730,P=0.030).Conclusions The therapy of Shumu-Yuntu-Zhike decoction combined with conventional therapy can relieve the symptom of gastroesophageal reflux cough.

Objective:To investigate the clinical value of early gastroscopy for patients with hypopharyngeal cancer.Methods:A total of 231 cases of hypopharyngeal cancer diagnosed and treated in the First Affiliated Hospital of Xiamen University from January 2010 to December 2014 were included in the retrospective analysis. The 5-year survival rate of hypopharyngeal cancer and patients accompanied with synchronous esophageal cancer (including early and advanced esophageal cancer), as well as the detection rate of synchronous esophageal cancer by gastroscopy and systemic PET-CT examination were statistically analyzed.Results:The 5-year survival rate of hypopharyngeal cancer was 38.96% (90/231). The 5-year survival rates of 62 patients accompanied with synchronous esophageal cancer and 169 patients without were 27.42% (17/62) and 43.20% (73/169), respectively, with statistic difference ( χ2=4.747, P=0.029). The 5-year survival rate of 49 patients accompanied with synchronous early esophageal cancer was 30.69% (17/49). Among the 13 patients with synchronous progressive esophageal cancer, none had a survival period of 5 years, which was significantly different compared with the patients with synchronous early esophageal cancer ( P=0.013). The detection rates of synchronous esophageal carcinoma by gastroscopy and by systemic PET-CT were 26.84% (62/231) and 14.29% (33/231), respectively, with statistic difference ( χ2=11.14, P<0.01). The detection rates of synchronous early esophageal carcinoma by gastroscopy and by systemic PET-CT were 21.21% (49/231) and 8.66% (20/231), respectively, and the difference was also statistically significant ( χ2=14.328, P<0.01). Conclusion:Hypopharyngeal cancer accompanied with synchronous esophageal cancer is of high risk, which affects the survival rate of patients. Early gastroscopy in hypopharyngeal cancer patients can significantly improve the detection rate of synchronous esophageal cancer, which helps to design individualized regimen to improve the survival rate of patients.

A combined epidemic prediction method based on multi-source data fusion is presented to address the common problems of low accuracy,weak generalization,single structure,poor nonlinear processing ability,and long prediction time in traditional epidemic prediction models.The collected multi-source epidemic data are normalized and subjected to feature selection using principal component analysis.An ARIMA-GM-BPNN model for pandemic prediction is constructed by combining ARIMA model,grey GM model and BPNN.The fitting values of the first two prediction models are used as inputs to BPNN for model training.After sufficiently integrating the data and combining the advantages of different prediction models,the optimal combined model is obtained and used for forecasting the incidence and trend of epidemics.Experimental results show that the combined model exhibits excellent fitting performance,with predicted incidences and trends consistent with the real conditions.The proposed approach improves prediction accuracy and generalization capabilities,and it can provide reliable data support for epidemic prediction and control.

Objective:To study the efficacy of dental floss traction-assisted endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions.Methods:Data of 127 patients with gastric angle mucosal lesions admitted to the endoscopic center of the First Affiliated Hospital of Xiamen University from January 2015 to December 2018 were retrospectively analyzed. According to the surgical methods, patients were divided into the dental floss traction-assisted ESD group (the traction group, n=51) and the traditional ESD group (the traditional group, n=76). The 41 fibrosis cases were further divided into the traction group (n=23) and the traditional group (n=18). The operation time, en block resection rate, curative resection rate and the incidence of adverse events such as bleeding, muscle layer injury and perforation were compared between the two groups.Results:There was no significant difference in age, sex, lesion size or morphology between the traction group and the traditional group ( P > 0.05). The operation time of the traction group was significantly shorter than that of the traditional group (65.4±36.5 min VS 103.5±43.2 min, P=0.012). The en block resection rate was higher in the traction group [100.00% (51/51) VS 90.79% (69/76), P=0.026], and the curative resection rate was higher too [94.12% (48/51) VS 81.58% (62/76), P=0.042]. The incidences of muscular layer damage [5.88% (3/51) VS 25.00% (19/76), P=0.010] and intraoperative bleeding [47.06% (24/51)VS 82.89% (63/76), P=0.010] were lower in the traction group. Perforation occurred in two patients (2.63%) of fibrosis in the traditional group; no perforation occurred in the traction group. There was no significant difference in the perforation incidence ( P=0.243). In the cases of fibrosis, the operation time of the traction group was significantly shorter compared with that of the traditional group (81.4±29.3 min VS 119.3±37.6 min, P=0.010). The en block resection rate and curative resection rate were also higher in the traction group [100.00% (23/23) VS 72.22% (13/18), P=0.007; 95.65% (22/23) VS 72.22% (13/18), P=0.035]. The incidences of muscular layer damage [8.70% (2/23) VS 72.22% (13/18), P=0.001] and intraoperative bleeding [78.26% (18/23) VS 100.00% (18/18), P=0.035] were lower in the traction group. Conclusion:The dental floss traction-assisted ESD is safe and effective for gastric angle mucosal lesions and fibrotic lesions, with shorter operation time, higher curative resection rate and lower incidence of adverse events.

Objective:To explore the influence of chronic rhinitis on depressive symptoms of college freshmen and the mediating effect of avoidant personality.Methods:A cluster sampling method was used to survey 8 079 college freshmen from April 2018 to October 2018 using the Beck depression inventory and the avoidant personality diagnosis questionnaire based on DSM-Ⅳ.SPSS 25.0 software was used for descriptive statistics and Spearman correlation analysis, and the macro program PROCESS version 3.3 was used for the mediating effect.Results:(1) The detection rates of chronic rhinitis, avoidant personality and depressive symptoms were 22.90% (1 850/8 079), 19.22% (1 553/8 079) and 6.28% (507/8 079). The scores for avoidant personality disorder and depressive symptoms were 1.00 (0, 3.00) and 1.00 (0, 4.00), respectively. (2) The chronic rhinitis, avoidant personality and depressive symptoms were positively correlated ( rchronic rhinitis-avoidant personality=0.094, rchronic rhinitis-depressive symptoms=0.095, ravoidant personality-depressive symptoms=0.416, all P<0.001). (3) Chronic rhinitis could positively predict depressive symptoms ( β=1.113, P<0.001). (4) Avoidant personality played a mediating role between chronic rhinitis and depressive symptoms ( β=1.094, P<0.001), and accounted for 44.92%(0.500/1.113) of the total effect. Conclusion:Chronic rhinitis directly affect the depressive symptoms of college freshmen, and indirectly affect the depressive symptoms of college freshmen through the mediating role of avoidant personality.