Objective To investigate the value of afterload-related cardiac performance(ACP)in evaluating cardiac dysfunction and prognosis in patients with septic shock.Methods This prospective observational study included 45 patients with septic shock.The patients were divided into the death(n=21)or survival(n=24)group according to whether they died within 28 days.Baseline and labora-tory data were collected within 24 h.Cardiac function indices were collected and monitored at 0,6,12,18,and 24 h using the pulse index continuous cardiac output.Variables affecting the prognosis were included in the multivariate Cox proportional hazard model.Prognosis was predicted using a receiver operating characteristic(ROC)curve.Results The ACP in the death group was significantly lower than that in the survival group at 0,6,12,18,and 24 h(all P＜0.05).Logistic regression analysis showed that decreased ACP,increased acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,increased sequential organ failure assessment(SOFA)score,increased fluid balance at 24 h,increased vasoactive-inotropic score,increased central venous pressure,and decreased mean arterial pressure were risk factors for poor prognosis.The Cox proportional hazard model showed that ACP,APACHE Ⅱ score,and SOFA score were independent risk factors influencing prognosis.ROC analysis showed that the area under the curve of ACP was the largest at 24 h,which was the best time point for predicting 28-day mortality.The corresponding sensitivity,specificity,and best cutoff values were 76.20％,91.70％,and 75.16％,respectively.Conclusion ACP could be used as a valuable index to evaluate cardiac dysfunction and as an independent risk factor for poor prognosis in patients with septic shock.

Objective:To construct an evaluation indicator system for accessories of patient monitor,so as to provide a basis for clinical management,equipment procurement,and technical improvement for accessories of medical monitor.Methods:The initial selection indicators of corresponding accessories of three types of monitoring of medical monitors,including electrocardiogram(ECG),blood oxygen saturation(SpO2)and non-invasive blood pressure(NIBP),were determined through literature research,expert consultation,and actual investigation.The Delphi method was adopted to conduct two rounds of questionnaire consultation for experts from clinical medicine,biomedical engineering and other fields in medical institutions included Sichuan Provincial People's Hospital,The Affiliated Hospital of Southwest Medical University and Medical Institute of Chengdu Institute of Metrology Verification and Testing.The evaluation indicators were screened and optimized,and the Analytic Hierarchy Process(AHP)was used to calculate the weights of each indicator.The consistency test was conducted to verify the rationality of the evaluation indicator system.Results:The evaluation indicator system for accessories of medical monitor included three first-level indicators:clinical value,cost value,and management value.The number of second-level indicators about ECG,SpO2 and NIBP of evaluation indicator system were respectively 10,9 and 8,and the number of third-level indicators of that were respectively 20,19,and 14.In the first-level indicators,the clinical value had the highest weight,with 72.49%for ECG,70.88%for SpO2 and 70.32%for NIBP.In the second-level indicators,the accuracy(28.70%for ECG,38.13%for SpO2 and 43.03%for NIBP)and safety(27.47%for ECG,26.48%for SpO2 and 23.06%for NIBP)were the core indicators.The weights of cost value and management value were between 14.62%and 17.41%,and between 12.27%and 12.89%,respectively.Conclusion:The evaluation indicator system for accessories of medical monitor integrates multi-dimensional expert opinions and quantitative analysis,highlights the priority principle for clinical performance.It can provide theoretical support for optimizing selection about accessory for medical institutions,and improving quality of monitoring,and promoting standardized management in the industry.

Objective To investigate the value of afterload-related cardiac performance(ACP)in evaluating cardiac dysfunction and prognosis in patients with septic shock.Methods This prospective observational study included 45 patients with septic shock.The patients were divided into the death(n=21)or survival(n=24)group according to whether they died within 28 days.Baseline and labora-tory data were collected within 24 h.Cardiac function indices were collected and monitored at 0,6,12,18,and 24 h using the pulse index continuous cardiac output.Variables affecting the prognosis were included in the multivariate Cox proportional hazard model.Prognosis was predicted using a receiver operating characteristic(ROC)curve.Results The ACP in the death group was significantly lower than that in the survival group at 0,6,12,18,and 24 h(all P＜0.05).Logistic regression analysis showed that decreased ACP,increased acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,increased sequential organ failure assessment(SOFA)score,increased fluid balance at 24 h,increased vasoactive-inotropic score,increased central venous pressure,and decreased mean arterial pressure were risk factors for poor prognosis.The Cox proportional hazard model showed that ACP,APACHE Ⅱ score,and SOFA score were independent risk factors influencing prognosis.ROC analysis showed that the area under the curve of ACP was the largest at 24 h,which was the best time point for predicting 28-day mortality.The corresponding sensitivity,specificity,and best cutoff values were 76.20％,91.70％,and 75.16％,respectively.Conclusion ACP could be used as a valuable index to evaluate cardiac dysfunction and as an independent risk factor for poor prognosis in patients with septic shock.

Objective:To construct an evaluation indicator system for accessories of patient monitor,so as to provide a basis for clinical management,equipment procurement,and technical improvement for accessories of medical monitor.Methods:The initial selection indicators of corresponding accessories of three types of monitoring of medical monitors,including electrocardiogram(ECG),blood oxygen saturation(SpO2)and non-invasive blood pressure(NIBP),were determined through literature research,expert consultation,and actual investigation.The Delphi method was adopted to conduct two rounds of questionnaire consultation for experts from clinical medicine,biomedical engineering and other fields in medical institutions included Sichuan Provincial People's Hospital,The Affiliated Hospital of Southwest Medical University and Medical Institute of Chengdu Institute of Metrology Verification and Testing.The evaluation indicators were screened and optimized,and the Analytic Hierarchy Process(AHP)was used to calculate the weights of each indicator.The consistency test was conducted to verify the rationality of the evaluation indicator system.Results:The evaluation indicator system for accessories of medical monitor included three first-level indicators:clinical value,cost value,and management value.The number of second-level indicators about ECG,SpO2 and NIBP of evaluation indicator system were respectively 10,9 and 8,and the number of third-level indicators of that were respectively 20,19,and 14.In the first-level indicators,the clinical value had the highest weight,with 72.49%for ECG,70.88%for SpO2 and 70.32%for NIBP.In the second-level indicators,the accuracy(28.70%for ECG,38.13%for SpO2 and 43.03%for NIBP)and safety(27.47%for ECG,26.48%for SpO2 and 23.06%for NIBP)were the core indicators.The weights of cost value and management value were between 14.62%and 17.41%,and between 12.27%and 12.89%,respectively.Conclusion:The evaluation indicator system for accessories of medical monitor integrates multi-dimensional expert opinions and quantitative analysis,highlights the priority principle for clinical performance.It can provide theoretical support for optimizing selection about accessory for medical institutions,and improving quality of monitoring,and promoting standardized management in the industry.

When partial nephrectomy is performed by posterior abdominal approach, the surgical field is poorly exposed, resulting in increased surgical difficulty and risk of injury.In this study, 28 patients with T 1a stage kidney tumors underwent retroperitoneal laparoscopic partial nephrectomy. Intraoperatively, exposure of the surgical field was achieved using the percutaneous puncture of the renal fascia suspension technique. There were no dissatisfactory exposures due to peritoneal damage during the surgery, no additional tubes were inserted, and no conversions to open surgery were needed. The operation time was (76.5±20.3) minutes, blood loss was (92.1±18.7) ml, renal artery clamping time was (19.5±4.3) minutes. Postoperatively, there were no complications such as bleeding, infection, or hematuria.

Fluorosis is an endemic disease caused by prolonged exposure to excessive fluoride and is considered a serious public health problem in many countries. In recent years, the damage of chronic fluorosis to the central nervous system has attracted extensive attention from scholars at home and abroad. The mechanisms of neurotoxicity caused by fluorosis include oxidative stress, inflammatory reaction, autophagy, neurotransmitters and related enzymes, changes in neural signaling pathways, abnormal neuronal energy metabolism of neurons, cell apoptosis, etc., causing permanent damage to human brain structure, impaired learning ability, memory dysfunction and behavioral problems. This article reviews the effects of fluorosis on the nervous system and related mechanisms, and provides a reliable basis for prevention and treatment of fluorosis.

ObjectiveTo study the prevalence of depression and the related influencing factors among the frontline healthcare professionals in the prevention and control of risk of imported COVID-19 cases， so as to provide references for improving their mental health status. MethodsBased on Wenjuanxing platform， a total of 984 frontline healthcare professionals participating in the screening and treatment of imported COVID-19 cases in Beijing Xiaotangshan hospital were assessed using Patients’ Health Questionnaire Depression Scale-9 item（PHQ-9）. ResultsA total of 770 questionnaires were collected with a valid rate of 78.3%， among which 344 cases （44.7%） had depressive symptoms. Logistic regression analysis showed that great changes in work content （OR=2.206， P<0.01）， sleep deprivation （OR=2.359， P<0.01）， six hours or less of sleep （OR=2.032， P<0.05）， focusing on epidemic information more than 1 hour per day （OR=1.095， P<0.05） were risk factors for depression， and regular exercise （OR=0.473， P<0.01） was a protective factor for depression relief. ConclusionThe frontline healthcare professionals in the prevention and control of risk of imported COVID-19 cases suffer a high risk of depression， while measures including scientific shift system， adequate sleep， less attention to the epidemic， and regular exercise may be effective in maintaining their physical and mental health.

Objective: To clarify the status of proliferation and differentiation of RCJ3.1C5.18 cells in chondrogenesis and explore insulin-like growth factor binding proteins (Igfbps) gene expression profile during the process. The results provided a research foundation for understanding the role of Igfbps in chondrogenesis. Methods: Fetal rat derived mesenchymal chondrogenic cell line RCJ3.1C5.18 was used, which progresses spontaneously to differentiated growth plate chondrocytes. The proliferation and differentiation status of cells were determined by cell staining, real-time PCR and Muse™ Cell Analyzer at days 1, 4, 7 and 10 of culture respectively. Igfbps gene expression was assessed by real-time PCR. Results: In the early period (1-4 days), cells proliferated rapidly and the expression of chondrocytes marker genes, such as typeⅡ collagen, SRY-box 9 and aggrecan increased gradually. Igfbp4 and Igfbp6 gene expression paralleled the expression of chondrocytes marker genes. On days 7-10 of culture, cells viability decreased and gradually developed hypertrophic-like and osteogenic-like characteristics, which was confirmed by specific staining and gene expression of alkaline phosphatase, matrix metallopeptidase 13.Igfbp1, Igfbp3 and Igfbp5 mRNA levels were up regulated gradually at this stage. Conclusions The status of proliferation and differentiation of cells are different in the process of chondrogenesis. Changes in Igfbp gene expression are associated with chondrocyte differentiation, suggesting that they have different role during chondrocyte proliferation and differentiation.

Objective To investigate the executive function of preschoolers with attention-deficit/ hyperactivity disorder(ADHD),and comorbid of oppositional defiant disorder (ODD),and analyze the correlation between executive function and ADHD,executive function and ODD symptom.Methods The 234 ADHD preschool children enrolled in this study,aged 4y0m-5y11 m(including 191 children with ADHD and 43 with ADHD+ ODD),met both the clinical diagnosis with DSM-5 criteria and the interview diagnosis by Diagnostic Infant and Preschool Assessment.Total of 115 healthy normal children with the similar age to the ADHD children were as control.Behavior Rating Scale of Executive Function-Preschool Version (BRIEF-P) and Chinese Version of Swanson Nolan and Pelham,Version Ⅳ Scale-parent Form (SNAP-Ⅳ)were used to evaluate executive function,symptoms of ADHD and ODD respectively.Covariance and partial correlation analysis were applied to explore the relation between executive function and symptoms of ADHD and ODD.Results The comorbidity rate of ADHD with ODD among preschoolers in this research was 18.4％ (43/234),no significant difference was found between two genders (18.6％ and 17.5％ in boys and girls respectively,x2=0.03,P＞0.05).There was no significant difference in the age among the three groups.There were significant differences in gender (x2=22.33,P＜0.01)and intelligence quotient (IQ;F=15.87,P＜0.05) among the three groups.After the gender,IQ and scores of inattention and hyperactivity were controlled,domains of BRIEF-P (except for working memory and metacognition index) among ADHD+ODD children were significantly higher than those in ADHD children (all P＜0.01).Besides,partial correlation analysis showed a positive correlation between ODD symptom and executive function (except for working memory;r=0.11-0.49,all P＜0.01).The correlation was still positive between ADHD symptom and executive function when gender,IQ and ODD symptom were statistically controlled (r=0.16-0.70,all P＜0.01).Conclusions Compared with that in normal preschool children,the executive function in children with ADHD only or ADHD combined ODD are damaged.There is a significant positive correlation between executive function and ADHD,ODD symptom in preschool children.

Objective To investigate the executive function of preschoolers with attention-deficit/ hyperactivity disorder(ADHD),and comorbid of oppositional defiant disorder (ODD),and analyze the correlation between executive function and ADHD,executive function and ODD symptom.Methods The 234 ADHD preschool children enrolled in this study,aged 4y0m-5y11 m(including 191 children with ADHD and 43 with ADHD+ ODD),met both the clinical diagnosis with DSM-5 criteria and the interview diagnosis by Diagnostic Infant and Preschool Assessment.Total of 115 healthy normal children with the similar age to the ADHD children were as control.Behavior Rating Scale of Executive Function-Preschool Version (BRIEF-P) and Chinese Version of Swanson Nolan and Pelham,Version Ⅳ Scale-parent Form (SNAP-Ⅳ)were used to evaluate executive function,symptoms of ADHD and ODD respectively.Covariance and partial correlation analysis were applied to explore the relation between executive function and symptoms of ADHD and ODD.Results The comorbidity rate of ADHD with ODD among preschoolers in this research was 18.4％ (43/234),no significant difference was found between two genders (18.6％ and 17.5％ in boys and girls respectively,x2=0.03,P＞0.05).There was no significant difference in the age among the three groups.There were significant differences in gender (x2=22.33,P＜0.01)and intelligence quotient (IQ;F=15.87,P＜0.05) among the three groups.After the gender,IQ and scores of inattention and hyperactivity were controlled,domains of BRIEF-P (except for working memory and metacognition index) among ADHD+ODD children were significantly higher than those in ADHD children (all P＜0.01).Besides,partial correlation analysis showed a positive correlation between ODD symptom and executive function (except for working memory;r=0.11-0.49,all P＜0.01).The correlation was still positive between ADHD symptom and executive function when gender,IQ and ODD symptom were statistically controlled (r=0.16-0.70,all P＜0.01).Conclusions Compared with that in normal preschool children,the executive function in children with ADHD only or ADHD combined ODD are damaged.There is a significant positive correlation between executive function and ADHD,ODD symptom in preschool children.