In view of the problem of slow development of intensive care medicine in Xizang, the research team made full use of the national partner assistance to Xizang, gathered resources across all cities in Xizang, and formed a national academic platform for critical care medicine in plateau areas. Adhering to the academic orientation with hemodynamics as the main topic, critical care ultrasound as the bedside dynamic monitoring and evaluation method, and blood flow-oxygen flow resuscitation as the core connotation, we have achieved the goals of improving the critical care talent echelon throughout Xizang, driving the overall progress of intensive care medicine in Xizang, making a figure in China, and focusing on training of top-notch talents.

Objective: To perform an epidemiological survey of the first case with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Pinghu City of Jiaxing City, Zhejiang Province on March 13, 2022, so as to provide insights into the management of coronavirus disease (COVID-19) epidemics. Methods: According to the requirements of the Protocol on Prevention and Control of COVID-19 (8th Edition), epidemiological investigations were performed among 39 cases with SARS-CoV-2 infections in Pinghu City from March 13 to 20, 2022. Cases' demographics, clinical symptoms, history of immunization and exposure were collected, and close contacts were identified. Pharyngeal swabs were sampled from infected cases for detection of SARS-CoV-2 nucleic acid and whole-genome sequencing, and the source of infection and transmission route were investigated. Results: The index case for this COVID-19 epidemic was an imported case from Shanghai Municipality, who infected 6 persons via aerosol transmission when playing in the badminton venue of Pinghu National Fitness Center on March 9; subsequently, one of these infected cases infected another 18 persons when playing in the badminton venue of Jiadian Village Resident's Fitness Center in Zhapu Township on March 12. Sixteen confirmed cases were reported, and all cases were mild; another 23 asymptomatic cases were diagnosed, with no death reported. This epidemic occurred from March 11 to 20, with 3 generations of spread and a median incubation period of 3 days. The SARS-CoV-2 infected cases had a median age of 33.5 (interquartile range, 12.0) years and included 36 cases with a history of COVID-19 vaccination. There were 16 cases with fever, cough, runny nose and sore throat, and 13 cases with imaging features of pneumonia. The effective reproductive number (Rt) of the COVID-19 epidemic was 7.73 at early stage, and was less than 1 since March 21. Whole-genome sequencing identified Omicron BA.2 variant among 33 cases, which had high homology with the index cases. Conclusion This epidemic was a cluster of COVID-19 caused by imported Omicron BA.2 variant infection from Shanghai Municipality, and the COVID-19 transmission was mainly caused by indoor aerosols.

Alstr?m syndrome is a rare multisystem genetic disease caused by mutations in the ALMS1 gene.Both of its clinical diagnosis and treatment are very difficult.In 2020, the Consensus Clinical Management Guidelines for Alstr?m Syndrome, developed with the participation of many countries, was published in the Orphanet Journal of Rare Diseases.A systematic literature review on Alstr?m syndrome of the last 45 years until October 2019 was carried out and then the clinical management guideline for Alstr?m syndrome was proposed.In this report, the contents of the 2020 European guideline for Alstr?m syndrome would be introduced briefly with appropriate interpretation in order to provide reference.

OBJECTIVE: To explore the genetic basis for 7 patients with Alström syndrome. METHODS: DNA was extracted from peripheral blood samples of the patients and their parents. Whole exome sequencing was carried out for the patients. Suspected variant was verified by Sanger sequencing and bioinformatic analysis. RESULTS: Genetic testing revealed 12 variants of the ALMS1 gene among the 7 patients, including 7 nonsense and 5 frameshift variants, which included c.5418delC (p.Tyr1807Thrfs*23), c.10549C>T (p.Gln3517*), c.9145dupC (p.Thr3049Asnfs*12), c.10819C>T (p.Arg3607*), c.5701_5704delGAGA (p.Glu1901Argfs*18), c.9154_9155delCT (p.Cys3053Serfs*9), c.9460delG (p.Val3154*), c.9379C>T (p.Gln3127*), c.12115C>T (p.Gln4039*), c.1468dupA (p.Thr490Asnfs*15), c.10825C>T (p.Arg3609*) and c.3902C>A (p.Ser1301*). Among these, c.9154_ 9155delCT, c.9460delG, c.9379C>T, and c.1468dupA were unreported previously. Based on the standards and guidelines of American College of Medical Genetics and Genomics, the c.9379C>T and c.12115C>T variants of the ALMS1 gene were predicted to be likely pathogenic (PVS1+PM2), whilst the other 10 variants were predicted to be pathogenic (PVS1+ PM2+ PP3+PP4). CONCLUSION ALMS1 variants probably underlay the Alström syndrome in the 7 patients, and genetic testing can provide a basis for the clinical diagnosis of this syndrome. The discovery of four novel variants has expanded the mutational spectrum of Alström syndrome.
Alstrom Syndrome/genetics* ; Cell Cycle Proteins/genetics* ; Humans ; Mutation ; Pedigree ; Whole Exome Sequencing

Objective:To study the real-world outcome of China FDA-approved Sofosbuvir (SOF)/Velpatasvir (VEL) in Northwest China.Methods:In this multicenter, prospective, real-world cohort study, we recruited patients from 10 sites from Northwest China, who were chronically infected with HCV GTs 1-6 from 06/2018 to 09/2019. Patients received SOF (400mg)/VEL (100mg) for 12 weeks, and with ribavirin 900-1200 mg for GT3 cirrhosis and for any genotype decompensated cirrhosis. The primary endpoint was sustained virological response at 12-weeks post-treatment (SVR12) and safety. The secondary endpoint was the change of liver function after the achievement of SVR12.Results:Totally, 143 patients were enrolled in the study, four patients were lost to follow-up and one died during the follow-up, 138 patients were included in per-protocol analysis. Of the 138 patients, the mean age 53 years, 53.6% male, 94.2% Han nationality, 53.6% liver cirrhosis, 10.1% HBsAg +, 6.5% renal dysfunction, 5.1% treatment-experienced, and 16.7% patients received ribavirin treatment. The genotype distribution was as follows: 35.5% GT1, 42.8% GT2, 15.9% GT3, and 5.8% un-typed. The SVR12 rate was 96.5% (138/143, 95% CI: 93.5%-99.6%) for intention-to-treat analysis, and in per-protocol analysis, all 138 patients obtained SVR12 (100%). Compared with baseline, the serum total bilirubin, ALT and AFP levels decreased (all P < 0.05), as well as increased ALB and platelet count (all P < 0.001) at post-treatment 12-weeks. Overall adverse events (AEs) rate is 29.0%, and the most common AEs were anemia (14.5%) and fatigue (8.0%). Severe side effects (edema and fatigue) occurred in 2 patients, one of whom needed a short-term interruption of treatment due to fatigue. Conclusion:In this real-world cohort study, 12-week SOF/VEL regimen with or without ribavirin achieved high SVR12 rates (96.5%-100% overall) with excellent safety profile among patients with HCV GT1/2/3 infection including patients with GT3 and cirrhosis, and led to improvement of liver function.

Objective:To develop bundled and continuous nursing measures for patients during daytime chemotherapy after gastric cancer surgery and explore its effects.Methods:Literature search, expert consultation and field visits were used to understand the needs of patients during daytime chemotherapy after gastric cancer surgery, specify the corresponding measures, and determine the final evidence-based bundled and continuous nursing measures. Totally 62 patients undergoing the first chemotherapy after gastric cancer surgery from May to December 2018 were included into the control group, and 53 patients undergoing the first chemotherapy after gastric cancer surgery from January to July 2019 were included into the intervention group. Patients in the control group received conventional continuous nursing, while patients in the intervention group received evidence-based bundled and continuous nursing. The laboratory tests and chemotherapy compliance during the eight chemotherapy treatments were compared between the two groups of patients, and the quality of life and satisfaction with the medical and nursing staff after the eight chemotherapy treatments of the two groups of patients were observed.Results:After the implementation of evidence-based bundled and continuous nursing measures, the compliance of the intervention group was higher than that of the control group ( P<0.05) . There were statistically significant differences in the quality of life between the two groups, except for cognitive function, sleep and economic status ( P<0.05) . The satisfaction with the medical and nursing staff in the control group was 79.03% (49/62) lower than 92.45% (49/53) in the intervention group, and the difference between the two groups was statistically significant ( P<0.05) . Conclusions:The evidence-based bundled and continuing nursing measures can improve the compliance, quality of life and satisfaction with the medical nursing staff in patients undergoing the first chemotherapy after gastric cancer surgery.

Objective To investigate the level of vascular endothelial growth factor (VEGF), homocysteine (HCY), fibronectin (Fn) and apolipoprotein E (ApoE) in the serum and cerebrospinal fluid patients with stroke to inquire into patients′endothelial function damage.Methods We chose standard stroke patients in Brain Hospital of Hu′nan Province from August 2015 to August 2016, divided into ischemic stroke (IS) group (52 cases) and hemorrhagic stroke (HS) group (33 cases), and chose patients with the cerebrospinal fluid for diagnosis and treatment and ruled out infections, the nervous system and cardiovascular system diseases as control group (20 cases).The serum VEGF, HCY, Fn, and ApoE levels of the patients on the 1 th, 5 th and14 th day after admission were monitored and compared with those in cerebrospinal fluid expression, NIHSS and Barthel were also performed for assessment of severity and prognosis of HS.Results The serum levels of VEGF, HCY and ApoE in HS group were higher than those in IS group, and the Fn level was lower than that in IS group and control group.At the same time, the Fn levels gradually increased on the 5 th and 14 th day after admission (P＜0.05), close to the control group.Cerebrospinal fluid of VEGF, HCY, Fn, and ApoE levels in HS group were higher than those in the control group, while Fn level was lower, and these indexes were lower in cerebrospinal fluid than those in the serum, and the differences were statistically significant (P＜0.05).In correlation analysis, HCY level of cerebrospinal fluid was positively correlated with ApoE in HS patients (r=0.645, P=0.001), HCY and ApoE levels in HS patients were positively correlated with patients′NIHSS score (r=0.547, P=0.006;r=0.720, P＜0.001), and negatively correlated with Barthel index score (r=-0.703, P＜0.001, r=-0.765, P＜0.001, respectively).Conclusion There were vascular endothelial injury and neuroprotective function decreased in brain tissue of stroke patients.The level of Fn was related to the patient′s prognosis, which was conducive to the differentiation of IS and HS.The cerebrospinal fluid levels of HCY and ApoE can be used to evaluate the prognosis of HS patients.

Aim To investigate the effect that catalpol intervenes macrophage polarization mediated by mouse mesangial cells(MMCs) stimulated by advanced glycation end products(AGEs).Methods RAW264.7 macrophages and MMCs were co-cultured in vitro and divided into model group(100 mg·L-1 AGEs), control group(100 mg·L-1 BSA), catalpol(0.1, 1.0, 10.0 μmol·L-1) group, and aminoguanidine(1.0 μmol·L-1) group which was set as positive control.After being incubated with catalpol for 1 h, MMCs were stimulated by AGEs for 23 h.The proliferation-inhibition rate of MMCs was measured by MTT assay.MCP-1 in supernatant liquid of MMCs was detected by ELISA method.The expression of iNOS, CD16/32, TNF-α, COX-2, CD206 and Arg-1 was detected by Western blot.Simultaneously, the percentage of iNOS and CD206 was also measured by flow cytometry.Results AGEs could increase the level of MCP-1 secreted by MMCs.The expression of iNOS, TNF-α, CD16/32 and COX-2 protein of macrophage was up-regulated after MMCs stimulated by AGEs, while the expression of CD206 and Arg-1 was down-regulated.After being intervened by catalpol, these effects could be reversed.All the changes were concentration-related.Conclusions Catalpol can inhibit macrophages M1-type polarization process and promote M2-type polarization, which may be mediated through MCP-1 secreted by MMCs after AGEs stimulation.Catalpol can ameliorate inflammation and relieve diabetic kidney injury.

Objective To investigate and analyze the clinical application of washed red blood cells in Quzhou in 2014-2015 years,and to provide evidence for the rational and effective use of washed red blood cells in clinical practice.Methods the amount of washed red blood cells,the distribution of diseases and the serological detection before transfusion were analyzed retrospectively in 8 hospitals of grade two and over in Quzhou during the past 2014-2015 years.Results the amount of washed red blood cells in 2015 increased by 39.07％ compared with 2014,an increase of 24.4 times the amount of red blood cells increase,increase mainly in 3 hospitals;Diseases of the blood system,malignant tumors and chronic kidney disease is the main diagnosis of transfusion cases,accounted for 63.49％,19.05％,12.70％.There were different standards for the development of serological testing items before transfusion Conclusion the advantages of washed red blood ceils gradually recognized by clinicians,but also don't rely on experience,hospitals should pay attention to the comprehensive evaluation of clinical blood transfusion and standardize the serological detection of blood transfusion department,which is the key to improve the cost performance of this component.

Objective To discuss the effect of quick freezer equipment and quick freezing time on the preparation of cryoprecipitate.Methods The cryoprecipitate,already prepared,was placed into the MBF21 freezer and minus 30℃ SANYO refrigerator for 30-minute and 50-minute storage.The activity of coagulation factor VⅧ,and the content of fibrinogen in different equipment were detected by automatic coagulation analyzer,in order to make sure whether it met the quality requirements.Results The content of fibrinogen in the cryoprecipitates from both of the equipment after 30-minute storage met the requirement,with the qualification rate of 100％.As to the activity determination of coagulation FⅧ,low temperature refrigerator showed a qualification rate of 62.5％,which was significantly lower than that of quick freezer with a qualification rate of 97.5％ (P＜0.01).The cryoprecipitates from both of the equipment after 50-minute storage,with part of fibrin precipitation,had a qualification rate of fibrinogen content lower than 50％ (P＞0.05).The qualification rate of quick freezer and low temperature refrigerator was 35％ and 12.5％,respectively,with significant difference.Conclusion Quick freezer can make the cryoprecipitate quick-frozen,which can ensure the quality.The coagulation factor VⅧ is unstable,whose activity decreased with the increase of temperature.We should try our best to shorten the time off the cold chain.