Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To investigate the risk factors associated with mortality in patients with severe traumatic liver injury (TLI) and to establish and validate an early prediction model for mortality.Methods:A retrospective cohort study was conducted to analyze the clinical data of 273 patients with severe TLI admitted to the ICU from the medical information mart for the intensive care-IV (MIMIC-IV) database. The cohort consisted of 176 males and 97 females, with age ranging from 18 to 83 years [35.6 years(25.7,57.5)years]. The patients were divided into two groups based on in-hospital mortality: the survival group (253 patients, 92.7%) and the death group (20 patients, 7.3%). The two groups were compared with regards to gender, age, cause and type of injury, treatment method, massive blood transfusion, comorbidities as well as vital signs and laboratory tests measured within 24 hours of ICU admission. Univariate analysis was used to screen for risk factors associated with mortality in severe TLI patients. Independent risk factors for mortality were determined using multivariate Logistic regression analysis. Lasso regression was used to screen for predictors of mortality, and a nomogram prognostic model was then established through a multivariate Logistic regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the model, while the Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the model. The model′s clinical applicability was evaluated through decision curve analysis (DCA). Internal validation was performed by the 200 Bootstrap samples, and external validation was performed by using 163 patients with severe TLI from the emergency ICU collaborative research database (eICU-CRD). Finally, the predictive efficacy of the nomogram model was compared to other trauma or severity scores.Results:Univariate analysis showed that the age, cause of injury, massive blood transfusion, chronic liver disease and laboratory tests measured within 24 hours of ICU admission, including temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, shock index, platelets, red blood cell distribution width (RDW), mean red blood cell hemoglobin concentration (MCHC), blood glucose, blood urea nitrogen, creatinine, anion gap, bicarbonate, prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were associated with the mortality of severe TLI patients ( P<0.05 or 0.01). Multivariate Logistic regression analysis revealed that age ( OR=1.08, 95% CI 1.03, 1.12, P<0.01), body temperature <36 ℃ ( OR=8.00, 95% CI 2.17, 29.53, P<0.01), shock index ( OR=9.59, 95% CI 1.76, 52.18, P<0.01) and anion gap ( OR=1.32, 95% CI 1.15, 1.53, P<0.01) were significantly associated with mortality in severe TLI patients. Lasso regression analysis selected 7 predictors, including age, body temperature<36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT. Based on these 7 predictors, a nomogram prediction model was developed. The AUC of the nomogram for predicting mortality was 0.96 (95% CI 0.94, 0.99), and the Hosmer-Lemeshow goodness-of-fit test indicated a good fit ( P>0.05). The calibration curve demonstrated excellent consistency between the predicted and actual probabilities, and DCA demonstrated that the model had good clinical net benefit at all risk threshold probability ranges. Internal validation confirmed the stability of the model ( AUC=0.96, 95% CI 0.92, 0.98), and external validation demonstrated good generalization ability ( AUC=0.95, 95% CI 0.91, 0.98). Moreover, the nomogram exhibited superior predictive efficacy compared with injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS), sequential organ failure score (SOFA), acute physiological score III (APS III), Logistic organ dysfunction score (LODS), Oxford acute severity of illness score (OASIS) and simplified acute physiological score II (SAPS II). Conclusions:Age, body temperature <36 ℃, shock index and anion gap are independent risk factors for mortality in severe TLI patients. A nomogram prognosis model based on 7 predictors, namely age, body temperature <36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT exhibits good predictive efficacy and robustness, and is contributive to accurately assess the risk of mortality in severe TLI patients at an early stage.

【Objective】 To observe the effects of paternal age on the pregnancy outcomes in frozen embryo transfer (FET) cycles. 【Methods】 The clinical data of two groups after propensity score matching (PSM) were retrospectively analyzed, including 738 cycles in the <40 year group and 387 cycles in the 40-60 year group. The differences in general information and pregnancy outcomes were compared between the two groups, and logistic regression analysis of pregnancy outcomes were conducted. 【Results】 There were no statistical differences in age, duration of infertility, female body mass index (BMI), infertility factors, fertilization method, endometrial preparation methods, endometrial thickness on the day of transformation, stage of embryo transfer, number of embryos transferred, and number of high-quality embryos between the two groups after PSM (P>0.05). The clinical pregnancy rate (52.2%vs. 67.2%) and live birth rate (41.1% vs. 57.2%) decreased in the 40-60 year group compared with those in the <40 year group (P<0.001), but there was no statistical difference in abortion rate (19.8% vs. 13.7%) (P>0.05). 【Conclusion】 Advanced paternal age decreases clinical pregnancy rate and live birth rate.

Background::Understanding the characteristics of newly diagnosed primary human deficiency virus-1 (HIV-1) infection in the context of the post-antiretroviral therapy era and HIV drug prophylaxis is essential for achieving the new target of 95-95-95-95 by 2025. This study reported the characteristics of newly diagnosed primary HIV-1 infection in Shenzhen.Methods::This is a real-world retrospective study. Eighty-seven newly diagnosed primary HIV-1-infected patients were recruited from January 2021 to March 2022 at the Third People’s Hospital of Shenzhen. Demographic, epidemiological, diagnostic, drug resistance, and medical data were described and analyzed.Results::Overall, 96.6% (84/87) of the newly identified primary HIV-1-infected patients were male, including 88.5% (77/87) men have sex with men (MSM), with a median age of 29.0 years (Q 1-Q 3: 24.0-34.0 years); of these, 85.1% (74/87) reported high-risk sexual behaviors with casual partners. The rate of condom usage was only 28.7% (25/87). The overall rate of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was 8.0% (7/87, including 4 PrEP and 3 PEP cases) around the potential exposure, although 41.4% of the patients had prior awareness of such interventions. Moreover, only 19.5% (17/87) had previously used PrEP or PEP. Of those, 58.8% (10/17) of the patients obtained drugs from the internet, and only 35.3% (6/17) reported good compliance. A total of 54.0% (47/87) of subjects were diagnosed by the HIV nucleic acid test. Acute retroviral syndrome appeared in 54.0% (47/87) of patients. The prevalence of transmitted drug resistance (TDR) mutation was 33.9% (19/56), including 6 (10.7%) against nucleoside reverse transcriptase inhibitor (NRTI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI), 8 (14.3%) against NNRTI, and 5 (8.9%) against protease inhibitor (PI) only. Conclusions::Owing to the low utilization rate and incorrect usage of PrEP and PEP, massive efforts are needed to promote HIV-preventive strategies in the MSM population. The extremely high prevalence of TDR mutation in this population implies the need for future pretreatment drug resistance surveillance.

Objective:To improve the ability of identification and differential diagnosis of severe systemic lupus erythematosus (SLE).Methods:A severe SLE patient with lupus myocarditis, neuropsychiatric lupus, thrombotic microangiopathy (TMA) and other multiple system involvement was reported and discussed.Results:A young female patient developed albuminuria 5 months ago, edema of both lower limbs 3 months ago, change of consciousness 1 month ago and two convulsions attack 2 days ago. She experienced life threatening manifestations such as neuropsychiatric lupus, myocardial involvement of lupus, and TMA. During the course, her condition was generally improved after glucocorticoid pulse therapy and plasma exchange.Conclusion:Various complicated clinical manifestations related to SLE need to be recognized earlier and intervened as soon as possible.

Objective:To analyze the expressions of minichromosome maintenance protein 4(MCM4) and proliferating cell nuclear antigen (PCNA) in gastric cancer tissues, to explore the relationship between MCM4/PCNA and gastric cancer, and to investigate the possibility of MCM4/PCNA as a potential biomarker for gastric cancer.Methods:Bioinformatics methods were used to analyze the mRNA expressions of MCM4 and PCNA in gastric cancer tissues and adjacent normal tissues. The clinicopathological data of 69 patients with gastric cancer who underwent surgery were retrospectively analyzed. The expression levels of MCM4 and PCNA in gastric cancer tissues and adjacent normal tissues were detected by immunohistochemistry, and their relationship with the clinicopathological characteristics of gastric cancer patients was analyzed.Results:The mRNA levels of MCM4 and PCNA in gastric cancer tissues are significantly higher than those in adjacent normal tissues (all P<0.05). The expression of MCM4 is correlated with the tumor size of gastric cancer ( P=0.037), but there is no significant correlation with gender, age and tumor grade (all P>0.05). Both MCM4 and PCNA proteins are highly expressed in gastric cancer patients. Conclusions:The expression levels of MCM4 and PCNA have a clear correlation with the occurrence of gastric cancer. MCM4 and PCNA are expected to be potential biomarkers for the diagnosis and treatment of gastric cancer.

Objective:To understand the knowledge awareness and service acceptance of HIV non-occupational post-exposure prophylaxis (nPEP) men who have sex with men (MSM) among college students in three cities of China.Methods:Male college students in 10 universities of Beijing, Shenzhen and Kunming aged 18 and above who had sex with men in the last 3 months were recruited as research objects by cluster stratified sampling from March 15, 2019 to April 14, 2019.Basic information, sexual behavior characteristics, knowledge, and service acceptance of nPEP were collected through online questionnaire survey. Multivariate dichotomy and unconditioned logistic regression model was used to explore related factors about knowledge awareness and service acceptance of nPEP.Results:A total of 293 MSM were surveyed. The average age was (21.0±0.2) years old, and 91.1% (267) were undergraduates. In the last 3 months before the survey, 54.3%(159) used condom each time of sex; 4.4%(13) had intercourse with the HIV infected men, and 9.2% (27)suffered STDs in the past 6 months. The 29.4% (86) had not received HIV testing in the past year. The nPEP knowledge awareness rate was 47.8% (140). The 21.2% (62) counseled nPEP services, and 9.9% (29) received nPEP services. After multiple logistic regression analysis, compared with those who not received HIV testing in the past year, OR(95% CI) value of those who received HIV testing for more than twice in the past year to aware the nPEP knowledge was 3.15 (1.01-9.86). Compared with those who not received HIV testing in the past year, OR(95% CI) value of those who received HIV testing for more than twice in the past year to counsel the nPEP services was 5.29 (1.51-18.51). Compared with those who never used rush in the last 3 months, OR(95% CI) value of those who ever used rush in the last 3 months to receive the nPEP services was 3.86 (0.99-14.98). Compared with those who not sexed with HIV infected in the last 3 months, OR (95% CI) value of those who sexed with HIV infected in the last 3 months to receive the nPEP services was 14.30 (3.35-61.03). Conclusion:The proportions of awareness of nPEP knowledge and acceptance of nPEP services are low. MSM among college students need further health education of the nPEP knowledge to improve the accessibility of services.

Objective:To explore the feasibility and clinical effects of using free thinned deep inferior epigastric artery perforator flap to repair extensive soft tissue defects in extremities.Methods:From April 2010 to January 2014, 12 patients with extensive soft tissue defect in extremities after trauma, including 10 males and 2 females, aged 21 to 48 years, 6 patients with defect in the back of wrist and 6 patients with defect in ankle were admitted to the Department of Bone Microsurgery of Xi′an Honghui hospital. After debridement, the size of soft tissue defect ranged from 15.0 cm×4.5 cm to 28.0 cm×11.0 cm. The free thinned deep inferior epigastric artery perforator flap was designed, cut and transferred for reconstruction, with size of 15.0 cm×5.0 cm to 29.0 cm×12.0 cm. The flap thickness ranged from 4.0 to 6.5 cm before defatting, and was 0.6 to 0.9 cm after defatting. All the donor sites of flaps were closed directly by suturing. The flap survival and the appearance and function of flap and donor site were observed during follow-up.Results:All the flaps survived smoothly after surgery. During follow-up of 10 to 42 months, the flaps showed no bloat in appearance, no further flap revision or defatting procedures were required, the distance of static 2-point discrimination was 11 to 17 mm (14.5 mm on average). The abdominal function of patients was not affected, and no postoperative abdomen hernia or ulceration was noted.Conclusions:The free thinned deep inferior epigastric artery perforator flap is thin and suitable for repairing extensive soft tissue defects in extremities with very good outcomes.

Objective:To understand the knowledge awareness and service acceptance of HIV non-occupational post-exposure prophylaxis (nPEP) men who have sex with men (MSM) among college students in three cities of China.Methods:Male college students in 10 universities of Beijing, Shenzhen and Kunming aged 18 and above who had sex with men in the last 3 months were recruited as research objects by cluster stratified sampling from March 15, 2019 to April 14, 2019.Basic information, sexual behavior characteristics, knowledge, and service acceptance of nPEP were collected through online questionnaire survey. Multivariate dichotomy and unconditioned logistic regression model was used to explore related factors about knowledge awareness and service acceptance of nPEP.Results:A total of 293 MSM were surveyed. The average age was (21.0±0.2) years old, and 91.1% (267) were undergraduates. In the last 3 months before the survey, 54.3%(159) used condom each time of sex; 4.4%(13) had intercourse with the HIV infected men, and 9.2% (27)suffered STDs in the past 6 months. The 29.4% (86) had not received HIV testing in the past year. The nPEP knowledge awareness rate was 47.8% (140). The 21.2% (62) counseled nPEP services, and 9.9% (29) received nPEP services. After multiple logistic regression analysis, compared with those who not received HIV testing in the past year, OR(95% CI) value of those who received HIV testing for more than twice in the past year to aware the nPEP knowledge was 3.15 (1.01-9.86). Compared with those who not received HIV testing in the past year, OR(95% CI) value of those who received HIV testing for more than twice in the past year to counsel the nPEP services was 5.29 (1.51-18.51). Compared with those who never used rush in the last 3 months, OR(95% CI) value of those who ever used rush in the last 3 months to receive the nPEP services was 3.86 (0.99-14.98). Compared with those who not sexed with HIV infected in the last 3 months, OR (95% CI) value of those who sexed with HIV infected in the last 3 months to receive the nPEP services was 14.30 (3.35-61.03). Conclusion:The proportions of awareness of nPEP knowledge and acceptance of nPEP services are low. MSM among college students need further health education of the nPEP knowledge to improve the accessibility of services.

Objective: To evaluate the nursing workload in surgical departments by decision tree method. Methods: The indexes of nursing workload of 23 surgical departments were analyzed with decision tree method from February 20 to March 26 in 2017. Results: According to decision tree analysis, the number of admitted patients was high-priority variable (F=39.128, P=0.000), and the nursing workload was divided into four grades by number of admitted patients ≤ 1, 17, respectively. The suboptimal variables were number of operations (F=7.578, P=0.046) and number of electrocardiogram monitors used (F=28.306, P=0.000), the nursing workload was further divided into six grades by number of operations ≤ 5, number of operations>5 and number of electrocardiogram monitors use ≤ 5, number of electrocardiogram monitors use > 5, respectively. Conclusions The number of admitted patients, electrocardiogram monitors used and operative patients were significant indexes of nursing workload in surgical departments, which helps the nurse managers evaluate the nurse performance and optimize human resource allocation based on decision tree analysis and clinical practice.