OBJECTIVE To establish a ultra-high-performance liquid chromatography-mass spectrum/mass spectrum(UPLC-MS/MS) method for the determination of anlotinib in human plasma and assessment of clinical application. METHODS Zanubrutinib was used as internal standard and the extraction process was performed through protein precipitation method using acetonitrile, followed by separation on an Ultimate XB-C18(100 mm×2.1 mm, 3.0 μm) column using acetonitrile and 10 mmol·L−1 ammonium acetate-0.1% formic acid step-elution gradient. The flow rate was 0.6 mL·min−1 and injection volume was 5 μL. The mass analysis was performed by positive ion electrospray ionization in multiple-reaction monitoring mode, and the mass spectrometer was set at m/z 408.1→339.1 for anlotinib and m/z 472.2→290.1 for internal standard, respectively. The specificity, standard curve and lower limit of quantification, precision and recovery, matrix effect and stability of the method and clinical application were investigated. RESULTS The method was validated over the concentration range of 1.0−100.0 ng·mL−1, with R2=0.998 4. The precision RSD was<9%, the recovery and matrix effect were 104.81%−107.32% and 102.54%−105.26%, respectively, and this method had good stability and was not affected by matrix effect. The method had been used for determined 52 advanced non-small cell lung cancer patients treated with anlotinib. The trough plasma concentration (Ctrough) was measured on day 43 after initiation of anlotinib treatment. Anlotinib Ctrough were higher than lower limit of quantitation (1.0 ng·mL−1) from 52 patients. The plasma concentration of anlotinib Ctrough was (11.38±4.29)ng·mL−1 with 37.66% coefficients of variation, which were shown large inter-patient variability. CONCLUSION This method is high sensitivity, specificity and accurate, and suitable for determination of anlotinib in human plasma.

Objective: To analyze the influencing factors for hospitalization costs among stroke patients with different subtypes, so as to provide the reference for reducing the economic burden of patients. Methods: Data of patients with hemorrhagic or ischemic stroke who were discharged from hospitals in Nanshan District, Shenzhen City from January 1, 2016 to December 31, 2021 were collected through Hospital Information System. Hospitalization costs were analyzed between hemorrhagic and ischemic stroke patients, and factors affecting hospitalization costs among stroke patients with different subtypes were identified using a structural equation model. Results: A total of 10 298 patients with stroke were recruited, including 2 820 patients with hemorrhagic stroke (27.38%) and 7 478 patients with ischemic stroke (72.62%). The patients with hemorrhagic stroke had a median duration of hospital stay of 19.00 (interquartile range, 18.00) d, and a median hospitalization cost of 26 759.48 (interquartile range, 51 000.87) Yuan. The patients with ischemic stroke had a median duration of hospital stay of 12.00 (interquartile range, 10.00) d, and a median hospitalization cost of 12 199.87 (interquartile range, 13 290.20) Yuan. Structural equation model analysis showed that department of hospitalization, discharge status, ways of leaving hospital, surgery and hypertension had direct effects on hospitalization costs and indirect effects on hospitalization costs through duration of hospital stay among hemorrhagic stroke patients, and duration of hospital stay had the highest total effect (0.684), followed by surgery (0.632). Employment status, admission route, department of hospitalization, ways of leaving hospital, payment mode, surgery and dyslipidemia had direct effects on hospitalization costs and indirect effects on hospitalization costs through duration of hospital stay among ischemic stroke patients, and duration of hospital stay (0.746), surgery (0.424) and department of hospitalization (0.151) ranked the top three in total effects. Conclusion The hospitalization cost is relatively high among stroke patients in Nanshan District, and duration of hospital stay and surgery have great influence on hospitalization costs among stroke patients with different subtypes.

Objective: To investigate the trend in incidence of stroke in Nanshan District, Shenzhen City from 2010 to 2021, so as to provide the evidence for formulating the integrated strategy for stroke control. Methods: The data of stroke morbidity in Nanshan District from 2010 to 2021 were collected through Shenzhen Chronic Disease Prevention and Control Management System. The incidence of stroke was calculated, and standardized by the population of the Chinese Sixth National Census in 2010. The trends in stroke incidence were evaluated in Nanshan District from 2010 to 2021 using annual percent change (APC) and average annual percent change (AAPC), and gender-, age- and subtype-specific incidence of stroke was descriptively analyzed. Results: A total of 30 377 cases with stroke were reported in Nanshan District from 2010 to 2021, with a crude incidence rate of 190.45/105 and a standardized incidence rate of 405.65/105. The crude incidence rate of stroke appeared a tendency towards a rise in Nanshan District from 2010 to 2021 (APC=5.38%, t=4.678, P=0.001), and a higher crude incidence rate of stroke was seen among men than among women (227.57/105 vs. 148.40/105; χ2=1 309.580, P<0.001). The incidence of stroke appeared a tendency towards a rise with age (χ2trend =435.717, P<0.001), and there was a tendency towards a rise in stroke incidence among residents under 40 years of age (APC=2.89%, t=2.538, P=0.029). The crude incidence of ischemic stroke was 151.24/105, which was higher than that of hemorrhagic stroke (39.21/105) (χ2=10 521.000, P<0.001). Conclusions The incidence of stroke appeared a tendency towards a rise in Nanshan District from 2010 to 2021, with ischemic stroke as the predominant subtype of stroke. Males and middle-aged and elderly residents should be given a high priority for stroke prevention and treatment.

Objective: To investigate the prevalence of current smoking and smoking cessation, and identify the influencing factors among hypertensive patients in Nanshan District, Shenzhen City, so as to provide insights into smoking control among hypertensive patients. Methods: The demographic features, life style, status of smoking and smoking cessation in hypertensive patients were collected from 69 community health centers in Nanshan District from 2017 to 2019. The gender- and age-specific prevalence of smoking and smoking cessation was estimated among hypertensive patients, and the factors affecting hypertensive patients&#39; smoking and smoking cessation were identified using a multivariable logistic regression model. Results: Totally 4 385 patients with hypertension were enrolled, with a mean age of (58.41±11.19) years, and the participants included 2 265 men (51.65%) and 2 120 women (48.35%). There were 724 current smokers, and the prevalence of current smoking was 16.51%, with 29.71% prevalence in males and 2.41% in females. There were 424 hypertensive patients quitting smoking, and the prevalence of smoking cessation was 36.93%, with 38.20% prevalence in males. Multivariable logistic regression analysis identified male ( OR=12.885, 95%CI: 9.567-17.354 ) and drinking ( OR=2.567, 95%CI: 2.118-3.111 ) as facilitating factors for current smoking among hypertensive patients, and increasing age (OR=0.723, 95%CI: 0.642-0.815) and high exercise frequency (OR=0.881, 95%CI: 0.817-0.950) as barrier factors, while male ( OR=7.309, 95%CI: 3.304-16.165), increasing age ( OR=1.381, 95%CI: 1.120-1.703 ), unmarried ( OR=1.819, 95%CI: 1.329-2.490 ), divorced ( OR=7.837, 95%CI: 1.254-48.975 ), retired ( OR=1.545, 95%CI: 1.095-2.180 ), unemployed (OR=1.801, 95%CI: 1.057-3.066), and high exercise frequency ( OR=1.221, 95%CI: 1.096-1.360 ) were identified as facilitating factors for smoking cessation among hypertensive patients and widowed ( OR=0.285, 95%CI: 0.089-0.906 ), high educational level ( OR=0.766, 95%CI: 0.619-0.949 ), and drinking ( OR=0.488, 95%CI: 0.368-0.647 ) as barrier factors. Conclusions The prevalence of smoking is lower, and the prevalence of smoking cessation is higher among hypertensive patients than among general populations in Nanshan District. Young and middle-aged, employed, widowed men with a high educational level are key populations for tobacco control, and alcohol consumption control and intensified exercises are important measures to reduce the prevalence of smoking and improve the prevalence of smoking cessation.

Objective: To investigate the status and identify the influencing factors of smoking behaviors among residents in Nanshan District, Shenzhen City, so as to provide insights into tobacco control. Methods: Permanent residents at ages of more than 18 years were recruited from 17 communities in Nanshan District, Shenzhen City using the stratified multistage random sampling method from July to November, 2018. Participants&#39; demographic features, smoking, smoking cessation and exposure to secondhand smoke were collected using the Individual Questionnaire for 2018 Chinese Adult Chronic Disease and Nutrition Surveillance. The factors affecting current smoking were identified using a multivariable logistic regression model. Results: Totally 1 700 questionnaires were allocated, and 1 625 valid questionnaires were recovered, with an effective recovery rate of 95.59%. The respondents included 714 men and 911 women, with a male to female ratio of 1∶1.27, and had a mean age of ( 45.13±13.59 ) years. The prevalence of current smoking was 15.51%, with 28.15% prevalence in men and 5.60% in women. The mean age of starting daily smoke was ( 21.00±5.52 ) years, and the mean daily smoking frequency was (13.53±9.15) cigarettes/d. The prevalence of smoking cessation was 6.58%, with 10.64% in men and 3.40% in women, and the prevalence of exposure to secondhand smoke was 41.42%, including 46.63% in men and 37.32% in women. Multivariable logistic regression analysis showed that an educational level of junior high school ( OR=1.683, 95%CI: 1.088-2.602 ), an educational level of high school/technical secondary school/vocational school (OR=1.687, 95%CI: 1.185-2.402), an occupation of farmers ( OR=2.514, 95%CI: 1.404-4.500 ), and an occupation of commercial and service personnel ( OR=1.939, 95%CI: 1.093-3.439 ) were associated with current smoking. Conclusion The prevalence of current smoking is low among residents in Nanshan District, but the prevalence of current smoking in women is higher than the national level. Educational level and occupation are main factors affecting current smoking.

Objective     To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods    The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results     A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion     The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult  patients undergoing elective cardiac surgery with cardiopulmonary bypass.

Objective: To investigate the pathogenicity of rare damaging variants from ciliary pathway to human lumbosacral neural tube defects(NTDs). Methods: The coding region sequences of 49 ciliary genes were amplified by AmpliSeq technique and sequenced by PGM sequencing platform for screening the rare damaging variants, and the parents without phenotype were used as controls to evaluate the pathogenicity of variants. Results: The rare de novo mutation of GLI3 gene(c.C580 T,p.H194 Y) was detected in one patient.The rare complex heterozygous mutations of CRB2 gene(c.G1392 C,p.R464 S;c.T3448 C,p.C1150 R) was detected in another patient. Conclusion Rare damaging variants from ciliary pathway may be associated with the occurrence of human lumbosacral NTDs.

Objective To use World Health Organization Family International Classifications (WHO-FICs) to explore the framework and approaches of development and research of guidelines of rehabilitation at levels of policies, community and services.Methods The important documents and tools of rehabilitation at international level, including United Nations Convention on the Rights of Persons with Disabilities, WHO World Report on Disability, Community-based Rehabilitation Guideline, Rehabilitation in Health Service System, and International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Intervention (ICHI) of WHO-FICs, had been discussed.Results The framework, classifications, diagnosis and description of diseases and functioning, coding, intervention and functioning evaluation based on ICD-11, ICF and ICHI-β-2 had been established for development and implementation of rehabilitation guidelines and Cochrane rehabilitation.Conclusion The framework and systematic approaches of ontology, classification, terminology, coding, diagnosis and description of diseases and functioning, interventions and evaluations for the development and implementation of rehabilitation guidelines had been developed.

Objective : To evaluate the effects of transcutaneous electrical nerve stimulation ( TENS ) and waterbirth with Doula services on the outcome of delivery. Methods: From July 2018 to December 2019, 150 primiparas in Hangzhou Women&#39;s Hospital were randomly divided into three groups: TENS, waterbirth and control groups. They were given TENS, waterbirth and conventional midwifery, accompanied by Doula services. The visual analogue scores ( VAS ) , length of labor stages and neonatal asphyxia were compared. Results: It finally included 45 cases in the TENS group, 45 cases in the waterbirth group and 44 cases in the control group. There were no significant differences in gestational weeks, age, height, weight, fetal biparietal diameter and newborn birth weight among the three groups ( P>0.05 ) . The VAS scores of TENS group and waterbirth group were lower than those of the control group ( P<0.05 ) , but there were no significant differences between the two groups ( P>0.05 ) with the cervix open to 2.5-3 cm, 5-7 cm ( 0.5 hours later ) and 10 cm. There was no interaction between the analgesia methods and cervix diameter ( P>0.05 ) . The duration of the first stage of labor in the TENS group and the waterbirth group was less than that in the control group ( P<0.05 ) , and there was no significant difference between the TENS group and the waterbirth group ( P>0.05 ) . The asphyxia rate of neonates in TENS group, waterbirth group and control group were 2.22%, 2.22% and 4.55%, respectively, with no significant difference ( P>0.05 ) . Conclusion Under Doula services, both TENS and waterbirth can effectively relieve the pain of delivery and shorten the first stage of labor, without obvious differences.

Objective To investigate the clinical characteristics of nontraumatic spinal cord injury, including the demographic characteristics,etiology and neurological function. Methods 44 patients with nontraumatic spinal cord injury in the past 4 years were reviewed. Results There were 27 males (61.3%) and 17 females (38.7%) with mean age of 39.85 years (3.5~78). They were followed up for mean of 13.3 (3~23) months. Myelitis (36%) and spinal tumor (including primary and metastatic tumor, 18.1%) were the most common causes, followed by intraspinal tumor (15.9%), vascular disease (13.6%), nontraumatic acute disc herination (6.8%), spinal cord ischemia after non-spinal surgery (4.5%) and hepatic myelopathy (4.5%). Neurological function at the initial admission included tetraplegia in 9 patients, paraplegia in 30 patients, conus medullaris syndrome in 2 patients and cauda equina syndrome in 2 patients. Neurological function of ASIA at the initial admission included A in 14 cases, B in 6, C in 13 and D in 11. 34% patients improved at least one ASIA grade when evaluated at final follow up. Conclusion Nontraumatic etiologies contribute to a significant proportion for spinal cord injury. Patients with nontraumatic spinal cord injury present the clinical characteristics different from traumatic spinal cord injury cases.