To analyze inpatient mortality cases in a tertiary general hospital in Beijing based on diagnosis-related groups (DRG), with the aim of providing references for healthcare quality management.

The enterotoxigenic Escherichia coli (ETEC) infection is a major factor restricting the development of animal husbandry. However, the abuse of antibiotics will lead to the antibiotic residues and emergence of antibiotic-resistant bacteria. The existing vaccines face challenges in stimulating intestinal immunity, demonstrating limited prevention effects. Therefore, it is indispensable to develop a new vaccine that is safe and suitable as a feed additive to activate intestinal immunity. This study constructed yeast-cell microcapsules (YCM) carrying the DNA vaccine against ETEC by genetic engineering. Furthermore, animal experiments were carried out to explore the regulatory effects of feeding YCM on the intestinal immune system and intestinal microbiota. Saccharomyces cerevisiae was selected as the oral delivery vehicle (microcapsules) of the DNA vaccine. The codon-optimized nucleic acid sequence of K88, the main antigen of mammal-derived ETEC, was synthesized, and the yeast shuttle vector containing the corresponding DNA vaccine expression cassette was constructed by DNA recombination. The recombinant strain of YCM was prepared by transforming JMY1. Additionally, the characteristics of the YCM strain and its feasibility as an oral vaccine were comprehensively evaluated by the fluorescence reporter assay, gastrointestinal fluid tolerance assay, intestinal epithelial cell adhesion assay, intestinal retention assessment, antiserum detection, and intestinal microbiota detection. The experimental results showed that the DNA vaccine expression cassette was expressed in mammals, and the recombinant strain of YCM could tolerate up to 8 hours of gastrointestinal fluid digestion and had good adhesion to intestinal epithelial cells. The results of mouse feeding experiments indicated that the recombinant strain of YCM could stay in the intestinal tract for at least two weeks, and the DNA vaccine expression cassette carried by YCM entered the intestinal immune system and triggered an immune response to induce the production of specific antibodies. Moreover, feeding YCM recombinant bacteria also improved the abundance of gut microbiota in mice, demonstrating a positive effect in regulating intestinal flora. In summary, we prepared the recombinant strain of YCM carrying the DNA vaccine against ETEC and comprehensively evaluated its characteristics and feasibility as an oral vaccine. Feeding the recombinant YCM could induce specific immune responses and regulate intestinal microbiota. The findings provide a reference for the immunoprevention of ETEC-related animal diseases.
Animals ; Enterotoxigenic Escherichia coli/genetics* ; Saccharomyces cerevisiae/metabolism* ; Vaccines, DNA/genetics* ; Mice ; Escherichia coli Infections/immunology* ; Escherichia coli Vaccines/genetics* ; Capsules ; Mice, Inbred BALB C ; Female

Objective:To explore the cause of inconsistency between the results of trisomy 7 by expanded non-invasive prenatal testing (NIPT-PLUS) and trisomy 18 by prenatal diagnosis.Methods:A pregnant woman who received genetic counseling at Jiaozuo Maternal and Child Health Care Hospital on July 5, 2020 was selected as the study subject. NIPT-PLUS, systematic ultrasound and interventional prenatal testing were carried out. The middle segment and root of umbilical cord, center and edge of the maternal and fatal surface of the placenta were sampled for the validation by copy number variation sequencing (CNV-seq).Results:The result of NIPT-PLUS indicated that the fetus has trisomy 7. Systematic ultrasound has shown multiple malformations including atrioventricular septal defect, horseshoe kidney, and rocker-bottom feet. However, QF-PCR, chromosomal karyotyping analysis, and CNV-seq of amniotic fluid samples all showed that the fetus was trisomy 18. Validation using multiple placental samples confirmed that the middle segment of the umbilical cord contains trisomy 18, the center of the placenta contained trisomy 7, and other placental sites were mosaicism for trisomy 7 and trisomy 18. Notably, the ratio of trisomy 18 became lower further away from the umbilical cord.Conclusion:The false positive results of trisomy 7 and false negative trisomy 18 by NIPT-PLUS was probably due to the existence of placental mosaicism. Strict prenatal diagnosis is required needed aneuploidy is detected by NIPT-PLUS to exclude the influence of placental mosaicisms.

Objective To construct a nomogram model for predicting the risk of in-hospital death in CHF patients by using noninvasive hemodynamic monitoring combined with age,DBP,CRP and renal insufficiency(serum creatinine≥ 442 μmol/L).Methods A total of 223 elderly patients with acute onset of CHF admitted in First,Second Medical Centre of Chinese PLA General Hos-pital from September 2022 to March 2023 were recruited in this study.According to their clinical outcomes,they were divided into survival group(196 cases)and death group(27 cases).Based on the in-hospital death and other related indicators,a nomogram model was constructed to predict the risk factors of in-hospital death in CHF.Results Noninvasive hemodynamic mornitoring indi-cated that the death group had significantly higher LVEF and LCWI values but lower LVEDV value than the survival group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that age(OR=1.131,95％CI:1.052-1.213,P=0.001),DBP(OR=0.932,95％CI:0.882-0.982,P=0.011),CRP(OR=1.171,95％CI:1.021-1.352,P=0.024),LVEDV(OR=0.984,95％CI:0.962-0.992,P=0.011)and renal insufficiency(OR=5.863,95％CI:1.351-1.731,P=0.004)were independent risk factors for the short-term prognosis of the elderly CHF patients.The AUC value of the nomogram model was 0.902(95％CI:0.819-0.948,P＜0.05),and calibration curve analysis showed the C-index was 0.902,indicating accurate predictive perform-ance.Conclusion Age,DBP,LVEDV,CRP and renal insufficiency are independent risk factors for the short-term prognosis of the elderly CHF patients.

Soft tissue and organ defects or degeneration,caused by trauma,disease,and aging,lead to a great burden on human health,and soft tissue regeneration technology has shown great promise for addressing these challenges.In recent years,interdisciplinary efforts in the fields of biomechanics,mechanobiology and regenerative medicine have highlighted the critical roles of mechanical cues in microenvironment in regulating soft tissue regeneration.Despite these advances,there is still a lack of comprehensive understanding regarding the mechanical features of soft tissues in clinical practice,and the full potential of such mechanical features for diagnosing and treating soft tissue diseases has not been fully known.In this review,the concept of'mechanomedicine for soft tissue regeneration'is proposed.Subsequently,the possible influence mechanisms of mechanical cues on soft tissue development and regeneration are systematically described from four distinct aspects,i.e.,multi-scale biomechanics of soft tissues,mechanobiology of soft tissue regeneration,mechanomedicine techniques for soft tissue regeneration,and applications of mechanomedicine for soft tissue regeneration.Finally,the potential of mechanomedicine in clinical diagnosis of soft tissue diseases and soft tissue defect repair is discussed,thereby providing a new direction for the development of mechanomedicine for soft tissue regeneration.

Objective:To analyze the etiology and risk factors of Zang nationality cerebral infarction patients of different ages in Xizang Autonomous Region, so as to provide basis for more targeted diagnosis, treatment and prevention of cerebral infarction in this region.Methods:The clinical data of 500 Zang nationality cerebral infarction patients hospitalized in Xizang Autonomous Region People′s Hospital from January 2019 to December 2023 were retrospectively analyzed. According to age, they were divided into young and middle-aged group (18-59 years old) and elderly group (60-75 years old). Baseline data, laboratory data and imaging results of patients in each group were collected and retrospectively analyzed.Results:The proportion of males in the young and middle-aged group ( n=267) [188 (70.41%)] was higher than that in the elderly group ( n=233) [130 (55.79%), χ 2=11.485, P=0.001]. The proportion of smokers [131 (49.06%) vs 74 (31.76%), χ 2=15.401], drinkers [121 (45.32%) vs 84 (36.05%), χ 2=4.417], high altitude polycythemia (HAPC)[ 51 (19.10%) vs 23 (9.87%), χ 2=8.406], hyperuricemia (HUA)[ 61 (28.90%) vs 34 (19.32%), χ 2=4.766], increased hemoglobin [152 (56.93%) vs 97 (41.63%), χ 2=6.677], hypertriglyceridemia [47 (17.60%) vs 18 (7.73%), χ 2=10.734], hypercholesterolemia [12 (4.94%) vs 3 (1.29%), χ 2=4.397], hyperlipidemia [79 (29.59%) vs 43 (18.45%), χ 2=8.360] in the young and middle-aged group was higher than that in the elderly group (all P<0.05). The proportion of hypertension [108 (40.44%) vs 158 (67.81%), χ 2=37.413], atrial fibrillation [5 (1.87%) vs 20 (8.58%), χ 2=11.797], hyperhomocysteinemia (HHcy)[159 (59.55%) vs 168 (72.10%), χ 2=8.664], abnormal creatinine [18 (6.74%) vs 29 (12.45%), χ 2=4.755], atherosclerosis [113 (42.32%) vs 145 (62.23%), χ 2=19.748], heart disease [135 (50.56%) vs 150 (64.38%), χ 2=9.690] in the young and middle-aged group was lower than that in the elderly group (all P<0.05). Multivariate Logistic regression analysis showed that hypertension ( OR=2.865, 95% CI 1.742-4.710) and HHcy ( OR=1.968, 95% CI 1.177-3.290) were risk factors of cerebral infarction in the elderly group. Smoking ( OR=1.848, 95% CI 1.017-3.360), HAPC ( OR=1.993, 95% CI 1.991-4.011), HUA ( OR=1.863, 95% CI 1.015-3.419) and living at the extremely high altitude ( OR=2.405, 95% CI 1.207-4.791) were risk factors of cerebral infarction in the young and middle-aged group. According to the TOAST etiological classification, the causes of stroke of other determined etiology and stroke of other undetermined etiology were complex and diverse, which were more common in the young and middle-aged group, while cardiac embolism was more common in the elderly group. Conclusions:There are significant differences in the risk factors and etiology of cerebral infarction in different age groups in Xizang Autonomous Region. The occurrence of cerebral infarction in elderly patients is significantly related to hypertension and HHcy, while the occurrence of cerebral infarction in young and middle-aged patients is significantly related to smoking, HAPC, HUA, and living in extremely high altitude areas. In clinical practice, diagnosis and treatment of cerebral infarction patients in different age groups should have different focuses.

OBJECTIVE To provide a reference for the standardized treatment of chronic obstructive pulmonary disease （COPD） and the adjustment of therapeutic drugs for COPD in the national essential medicine list. METHODS Relevant clinical experts， pharmaceutical experts and medical insurance experts were invited to sort out the COPD treatment drugs involved in the domestic and foreign COPD clinical guidelines， the national essential medicine list， the WHO standard list of essential medicine， the national medical insurance catalogue， and comparatively analyzed the COPD treatment drugs. RESULTS & CONCLUSIONS Compared with domestic clinical guidelines， foreign clinical guidelines included an additional COPD triple preparation， while involving fewer types of expectorants and antioxidants； there were only 12 kinds of COPD treatment drugs included in the WHO standard list of essential medicine， while there were 18 kinds in the national essential medicine list in China， and more theophylline drugs， expectorants and antioxidants were included. In addition， 15 kinds of COPD treatment drugs were found in both the national clinical guidelines and the national medical insurance catalogue， but not in the national essential medicine list， including terbutaline， levalbuterol hydrochloride， salmeterol， formoterol， indacaterol， beclometasone， mometasone furoate， salbutamol ipratropium， glycopyrronium formoterol， umeclidinium vilanterol， indacaterol glycopyrronium， beclometasone formoterol， budesonide/glycopyrrolate/formoterol fumarate， fluticasone furoate/vilanterol/umeclidinium， and fudosteine， which were mainly long-acting beta 2-agonists and COPD triple preparations. These drugs had certain evidence-based medicine evidence， their efficacy and economy had certain advantages， and their impact on the budget of the medical insurance fund was controllable. Therefore， it is suggested that the aforementioned drugs should be included in the essential medicines list in the subsequent update.

Objective To explore the effect of Naikan cognitive-music reminiscence therapy on coping style in female patients with chronic schizophrenia.Methods In May, 2020, 72 female patients with chronic schizophrenia from Beijing Huilongguan Hospital were assigned into control group (n = 48) and music group (n = 24) after trait matching. Both groups accepted routine medicine, while the control group accepted Naikan cognitive therapy, and the music group accepted Naikan cognitive therapy combined music reminiscence, for twelve weeks. They were blind assessed with Simplified Coping Style Questionnaire, Self-rating Depression Scale and Self-rating Anxiety Scale before and after intervention.Results There were five cases in the control group removed for erroneous response. The main effects of group were not significant for all the assessments (F < 0.567, P > 0.05). The main effect of time was significant for negative coping style score (F = 6.968, P = 0.01), and the interaction effects were significant for positive coping style score and Self-rating Depression Scale score (F > 4.227, P < 0.05).Conclusion Combining with music reminiscence, Naikan cognitive therapy may be advantageous for the coping style of female patients with chronic schizophrenia.

BACKGROUND: Changes in thyroid hormone levels are commonly recognized characters among the elderly, which were reported to potentially influence incident frailty. Therefore, we examined the cross-sectional associations of thyroid hormones (THs) with frailty as well as the five components characterizing frailty (fatigue, resistance, ambulation, number of illnesses, and loss of weight) among the oldest-old. METHODS: Four hundred and eighty-seven community-dwelling oldest-old from a local community in Haidian District, Beijing, participated in our recruitment campaign between April 2019 and May 2020. The primary outcomes were a definitive diagnosis of frailty according to the FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) and a positive score for each frailty subdomain. Demographic information (age, sex, marital status, and educational status), comorbidities, and details on the participants' lifestyles were recorded. Serum THs including free triiodothyronin (fT3), triiodothyronine (T3), free thyroxine (fT4), and thyroxine (T4) and thyroid stimulating hormone (TSH) levels were also measured at the beginning of our study. Logistic regressions were conducted to screen for potential risk factors for frailty and its subdomains. RESULTS: Among the total 487 subjects at enrollment, 60 (12.23%) of them were diagnosed with subclinical hypothyroidism and 110 (22.59%) of the total population scored positive for frailty. Logistic regression analyses adjusted for all potential confounders, showed that frailty was significantly associated with the serum TSH concentration (odds ratio [OR]: 1.06), fT3 concentration (OR: 0.54), and subclinical hypothyroidism score (OR: 2.18). The association between fT4 and frailty was absent in our observational study. The fT3/fT4 ratio characterizing peripheral hormone conversion was also tested to be correlated with frailty. CONCLUSION Subclinical hypothyroidism, higher TSH level, lower fT3 level, and decreased fT3/fT4 ratio were all associated with frailty assessed by the FRAIL scale among the community-dwelling oldest-old, suggesting a relevant role of thyroid function in aging. Future longitudinal studies are warranted to determine the casual relationship between thyroid dysfunction and frailty in the oldest-old.
Humans ; Aged, 80 and over ; Aged ; Thyroxine ; Cross-Sectional Studies ; Thyrotropin ; Frailty ; Independent Living ; Triiodothyronine ; Thyroid Function Tests ; Thyroid Hormones ; Hypothyroidism ; Fatigue

Objective:To establish an index system of population based SARS-CoV-2 nucleic acid screening, and provide reference to determine the screening coverage appropriately.Methods:The literature review and brain storming sessions were used to develop the basic frame and index system of population based SARS-CoV-2 nucleic acid screening. Based on Delphi method and Analytic Hierarchy Process, 21 domestic experts were selected for two rounds of consultation to determine the index system of population based SARS-CoV-2 nucleic acid screening and its weight.Results:The positive indexes of experts in two rounds of consultations were both 100%. The experts' authority coefficients ( Cr) were 0.88±0.08 and 0.89±0.07, respectively. And the range of coefficient of variation ( CV) were (0.08, 0.24), (0.09, 0.25). The Kendall's W coordination coefficients were 0.34 and 0.22 respectively, which were statistically significant. The index system of population based SARS-CoV-2 nucleic acid screening was established, which had 4 first-level indexes, 11 second-level indexes and 58 third-level indexes. Besides, the weight of each index was determined. Conclusion:The index system of population based SARS-CoV-2 nucleic acid screening has been established, which can provide scientific reference for the health administration to determine the coverage of population based SARS-CoV-2 nucleic acid screening when local COVID-19 epidemic occurs.