Objective:To investigate the role of survivin in the regulation of leptin expression and its sensitivity.Methods:Survivin was overexpressed in adipocytes via lentivirus, and the RNA-sequencing(RNA-seq) was used to explore the effect of survivin on the regulation of adipocyte secretory proteins. Survivin was overexpressed in the inguinal adipose tissue(iWAT) of mice by targeted injection of adeno-associated virus(AAV). The transcription levels of leptin and adiponectin were detected by realtime quantitative PCR(RT-qPCR), and the secretion levels of leptin and adiponectin in cellular supernatants and mice serum were detected by enzyme-linked immunosorbent assay(ELISA). The protein level of phosphorylated signal transducer and activator of transcription 3(STAT3) in hypothalamus was detected by Western blotting to investigate the effect of survivin on central leptin sensitivity.Results:Survivin overexpression in both 3T3-L1 and primary white adipocyte significantly down-regulated the leptin transcriptional expression without affecting the adipocyte differentiation( P<0.01). Overexpression of survivin significantly decreased leptin level without affecting the adiponectin levels in the cellular supernatant( P<0.001). Overexpression of survivin in iWAT via AAV injection, not only specifically down-regulated leptin transcriptional level in a dose dependent manner in local adipose tissue, but also led to a decrease in serum leptin level( P<0.05). In mice fed short-term high-fat diet, STAT3 phosphorylation level in hypothalamus significantly increased, suggesting improved central leptin sensitivity. Conclusion:Survivin could downregulate leptin expression and improve leptin sensitivity in high-fat diet induced obese mice.

To investigate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Yunnan Province, explore its risk factors, and provide a basis for the prevention and treatment of chronic complications of diabetes mellitus (DM). This is a large cross-sectional study, in all, 1 524 DM patients in 16 communities and villages of Yunnan Province who were registered in health service centers were included in this study from August to November 2019. All patients completed a uniform questionnaire, anthropometric measurements, biochemical measurements, and auxiliary examinations. Logistic regression analysis was used to screen the risk factors of DR. The prevalence rates of DR, mild non-proliferative DR (mild-NPDR), and referable DR (RDR) were 16.0% (244/1 524), 4.5% (69/1 524), and 11.5% (175/1 524), respectively. Glycated hemoglobin A 1c (HbA 1c)≥7.0% was the risk factor of mild-NPDR ( OR=1.872, 95% CI 1.055-3.323) and RDR ( OR=4.821, 95% CI 2.917-7.969). Blood pressure≥130/80 mmHg (1 mmHg=0.133 kPa) was the risk factor of mild-NPDR ( OR=1.933, 95% CI 1.112-3.358) and RDR ( OR=1.505, 95% CI 1.063-2.130). In Yunnan Province, 16.0% DM patients had accompanying DR, wherein about 71.7% of them required an ophthalmology referral, and the high incidence of RDR in DM patients was associated with poor control of blood glucose and blood pressure.

Humans ; Acupuncture Points ; Deglutition Disorders ; Electroacupuncture

ObjectiveTo investigate the role of proinflammatory cytokines tumor necrosis factor alpha （TNFα） and interleukin-1β （IL-1β） in rostral ventromedial medulla （RVM） in chronic postsurgical pain （CPSP） induced by skin/muscle incision and retraction （SMIR）. MethodsSD rats were randomly divided into 5 groups： ① Sham group； ② SMIR group； ③ SMIR+TNFα/IL-1β neutralizing antibody group； ④ SMIR+TNFα/IL-1β group and ⑤ SMIR+vehicle group. 50% paw mechanical withdrawal threshold （MWT） was measured by the up-down method， immunofluroscence was used to detect the TNFα and IL-1β expression and ELISA for the 5-Hydroxytryptamine （5-HT） level. ResultsSMIR elicited persistent nociceptive sensitization， upregulated TNFα and IL-1β expression in RVM neurons and astrocytes. Microinjection of TNFα or IL-1β neutralizing antibody into RVM inhibited the development of nociceptive sensitization and decreased the level of 5-HT in both RVM and spinal dorsal horn. While microinjection of recombinant TNFα or IL-1β into RVM enhanced the development of nociceptive sensitization and increased the level of 5-HT in both RVM and spinal dorsal horn. ConclusionUp-regulation of proinflammatory cytokines in RVM may contribute to SMIR induced CPSP by promoting 5-HT release.

Objective To compare the incidence of catheter-related venous thrombosis between midline catheters and peripherally inserted central catheters.Methods Randomized controlled trials and cohort studies on the incidence of venous thrombosis associated with midline catheters and PICC catheters were searched from CNKI,Wanfang database,VIP database,Web of Science,PubMed,Embase and Cochrane Library from inception to December 31,2022.Review Manager 5.4 software and Stata 14.0 software were used to analyse and describe the outcome indicators.Results A total of 16 studies were included,including 12 cohort studies and 4 randomized controlled studies,with 21853 subjects.The results of the Meta-analysis showed that the incidence of catheter-related venous thrombosis per thousand catheter days of midline catheters was statistically significant compared with PICC[RR=2.74,95％CI(1.21,6.21),P=0.016].There was no significant difference in the incidence of catheter-related venous thrombosis compared with PICC[RR=0.85,95％CI=(0.70,1.03),P=0.101].In the subgroups,the incidence of superficial vein thrombosis in the midline catheter was significantly different from that in the PICC[RR=2.36,95％C/=(1.56,3.58),P＜0.001].Conclusion The current evidence shows that the incidence rate of catheter-related venous thrombosis per thousand catheter days and superficial vein thrombosis was higher for midline catheters than PICCs.Therefore,in clinical practice,vascular access devices should be selected reasonably,and the occurrence and development of catheter-related superficial venous thrombosis should be paid attention to,and clinical screening should be effectively carried out on the basis of a full evaluation.

Objective:To evaluate the incidence of arrhythmias and electrocardiographic (ECG) characteristics in cancer patients treated with immune checkpoint inhibitors (ICIs).Methods:This was a cohort study conducted in the Fourth Hospital of Hebei Medical University. Cancer patients initiating ICIs treatments from November 2020 to September 2022 were included in this study. Baseline 12-leads ECG before ICIs initiation and post-treatment ECG were analyzed. An abnormal ECG was defined as the presence of any of the following changes: sinus arrhythmias, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia, premature contractions, conduction disorder, and ST-T changes.Results:A total of 87 patients were enrolled, aged 63 (57, 68) years, with 66 (75.9%) males. And 44.8% (39/87) of patients presented with at least one confirmed cardiovascular disease or cardiovascular risk factor at baseline. The incidence of abnormal ECG increased from 31.0% (27/87) at baseline to 65.5% (57/87) after receiving (5.0±2.7) cycles of ICIs treatment ( P<0.001). The incidence of sinus arrhythmias was significantly increased after ICIs treatment (23.0% (20/87) vs. 9.2% (8/87), P=0.023), of which only the incidence of sinus tachycardia was significantly increased (11.5% (10/87) vs. 2.3% (2/87), P=0.039). There was also a significantly increased incidence of ST-T changes after ICIs treatment (31.0% (27/87) vs. 17.2% (15/87), P=0.012), which mainly attributed to the T wave changes (29.9% (26/87) vs. 13.8% (12/87), P=0.001). The incidence of premature contractions was also significantly increased after ICIs treatment (9.2% (8/87) vs. 0, P=0.008). Additionally, compared with baseline, the P wave axis was significantly increased after ICIs treatment ((56.94±21.01)° vs. (52.00±22.69)°, P=0.043). After ICIs treatment, the heart rate was significantly increased ((79.07±15.37) beats/min vs. (75.64±13.37) beats/min, P=0.029). Sokolow-Lyon index ((2.21±0.81)mV vs. (2.33±0.75)mV, P=0.138), QTc interval ((431.44±36.04)ms vs. (428.00±30.05)ms, P=0.415) all showed signs of change after treatment, but did not reach the traditional significant level. Conclusions:The incidence of abnormal ECG is significantly increased after ICIs treatment, especially for sinus tachycardia, premature contractions and T wave changes; the P wave axis and heart rate is also significantly increased after treatment. It is important to perform regular ECG monitoring in patients receiving ICIs treatment.

Pelvic floor dysfunction(PFD)is a common clinical problem that can lead to bladder and bowel dysfunction such as urinary incontinence,urinary retention,fecal incontinence,pelvic organ prolapse,and sexual dysfunction.Pelvic floor rehabilitation aids are essential tools in the treatment of PFD.However,there is limited understanding of the efficacy and mechanisms of these aids,and there is a lack of standardized guidelines for selecting appropriate aids for different types of PFD.To assist patients in choosing suitable pelvic floor rehabilitation aids to their needs,it is necessary to summarize the existing types,mechanisms,and applications of these aids.Based on their mechanisms and target functions,pelvic floor rehabilitation aids can be mainly categorized into 3 main types.The first type includes aids that improve pelvic floor function,such as vaginal dumbbells,vaginal tampons,and vaginal dilators,which aim to strengthen pelvic floor muscles and enhance the contractility of the urethral,vaginal,and anal sphincters,thereby improving incontinence symptoms.The second type consists of aids that mechanically block the outlet,such as pessaries,urethral plugs,incontinence pads,incontinence pants,anal plugs,and vaginal bowel control systems,which directly or indirectly prevent incontinence leakage.The third type includes aids that assist in outlet drainage,such as catheters and anal excreta collection devices,which help patients effectively expel urine,feces,and other waste materials,preventing incontinence leakage.By summarizing the existing pelvic floor rehabilitation aids,personalized guidance can be provided to patients with PFD,helping them select the appropriate aids for their rehabilitation needs.

Objective:To investigate the association between ureaplasma urealyticum (UU) colonization in the respiratory tract and bronchopulmonary dysplasia (BPD) in extremely preterm or extremely low birth weight infants.Methods:This was a retrospective study involving preterm infants with gestational age <28 weeks or birth weight <1 000 g who was hospitalized in the Neonatal Intensive Care Unit (NICU) of Chengdu Women's and Children's Central Hospital from June 2019 to March 2022. Respiratory tract secretion was collected for UU DNA detection within 24 h after admission. All the participants were divided into the UU-positive or negative groups based on the detection results. Clinical characteristics of the two groups were analyzed using Mann-Whitney U, t-, or Chi-square tests (Fisher exact test). Results:A total of 82 infants were enrolled, including 31 cases (37.8%) in the UU-positive group and 51 patients (62.2%) in the negative group. Among the 30 cases treated with azithromycin in the positive group, 27 (90.0%, 27/30) turned negative after two courses of treatment. The rates of premature rupture of membranes [51.6% (16/31) vs 17.6% (9/51), χ2=10.50] and prenatal antibiotic exposure [71.0% (22/31) vs 47.1% (24/51), χ2=4.47] in the UU-positive group were both higher than those in the UU-negative group (both P<0.05). Multivariate logistic regression analysis showed that premature rupture of membranes ( OR=5.893, 95% CI: 2.016-17.228) and gestational age ( OR=0.663, 95% CI: 0.441-0.999) were independent risk factors for UU colonization (both P<0.05). UU-positive group had a longer duration of oxygen use [ M ( P25- P75), 1 756 h (1 385-2 088 h) vs 1 357 h (1 128-1 656 h), Z=2.98], a longer length of hospital stay [81 d (70-105 d) vs 68 d (59-84 d), Z=3.05], and higher hospitalization costs [(201 574±70 326) yuan vs (161 288±53 412) yuan, t=－2.74] compared to the UU negative group (all P<0.05). The incidence of BPD [74.2% (23/31) vs 47.1% (24/51), χ2=5.80] and retinopathy of prematurity [93.4% (29/31) vs 74.5% (38/51), χ2=4.68] in the UU positive group was higher than those in the UU-negative group (both P<0.05). No significant correlation was found between UU colonization and the severity of BPD ( P>0.05). Conclusion:UU colonization may increase the incidence of BPD, but there was no clear correlation with the severity of BPD.

Objective:To analyze the efficiency of medical resource utilization in public traditional Chinese medicine (TCM) hospitals in Gansu province from 2016 to 2020, so as to provide decision-making reference.Methods:The number of in-service staff, actual number of open beds, number of diagnosis and treatment, and number of discharge from TCM hospitals in Gansu province from 2016 to 2020 were extracted, and their technical efficiency, pure technical efficiency, scale efficiency, and returns to scale were analyzed by data envelopment analysis.Results:From 2016 to 2020, the average technical efficiency, pure technical efficiency, and scale efficiency of the sample hospitals were 0.647, 0.680, and 0.952, respectively. Among them, 213 hospitals (48.2%) were in a decreasing state of returns to scale, 54 hospitals (12.2%) were in a constant state of returns to scale, and 175 hospitals (39.6%) were in an increasing state of returns to scale; Out of the 45 tertiary hospitals, 42 (93.3%) were in the stage of diminishing returns to scale, while 226 (56.9%) of 397 secondary and lower hospitals were in a state of constant or increasing returns to scale.Conclusions:The utilization efficiency of medical resources in public TCM hospitals in Gansu province is relatively low, and there is a significant gap between different levels of TCM hospitals.

Objective To describe and analyze the disease burden and its changing trend of liver cancer caused by nonalcoholic steatohepatitis (NASH) in China from 1990 to 2019, and to provide reference for reducing the morbidity and mortality of liver cancer in China. Methods Based on data from the Global Burden of Disease (GBD2019) study, different gender and age groups were selected. The morbidity, mortality, and disability adjusted life year (DALY) rate were used to analyze the disease burden of liver cancer caused by NASH in China from 1990 to 2019. The time trend was analyzed by using the Joinpoint regression model, and the annual percent of change (APC) and annual average percentage change (AAPC) of morbidity, mortality and DALY rate were calculated. Results Compared with 1990, the incidence rate, mortality rate and DALY rate of liver cancer caused by NASH in 2019 decreased by 4.05%, 12% and 25.79%, respectively. Age-standardized morbidity, standardized mortality and standardized DALY rates decreased by 49.50%, 54.72% and 58.45%, respectively. In 2019, the incidence rate, mortality data and DALY rate of liver cancer caused by NASH increased with age, and the highest mortality rate was among people over 85 years old. The average annual change percentage (AAPC) of age-standardized incidence rate, standardized mortality rate and standardized DALY rate of liver cancer caused by NASH from 1990 to 2019 were -2.65% ［95% CI（-3.09%，-2.21 %），P<0.001］, -2.86%［95% CI（-3.34%，-2.38 %），P<0.001］, and -2.91%［95% CI（-3.23%，-2.58%），P<0.001］，respectively. The AAPC of all indexes in males was higher than that in females. Conclusion From 1990 to 2019, the disease burden of liver cancer caused by NASH in China showed an overall downward trend. The AAPC of all indexes in males is higher than that in females, and the elderly population is a high-risk group.