A 37-year-old female patient with chronic hepatitis B was treated with levonorgestrel dispersible tablets (1.5 mg daily, 21 days of medication and 7 days off in a month) due to menstrual disorder. Three months later, the patient developed nausea, vomiting, poor appetite, and jaundice successively. Laboratory tests showed alanine aminotransferase 93 U/L, aspartate aminotransferase 68 U/L, γ-glutamyltransferase 100 U/L, total bilirubin 206.1 μmol/L, and direct bilirubin 138.9 μmol/L. After excluding chronic hepatitis B reactivation and other hepatotropic virus infections by laboratory indicators, the liver injury was considered to be related to levonorgestrel. Levonorgestrel was stopped, liver protective and symptomatic treatments were given, the patient′s symptoms gradually disappeared, and liver function returned to normal after 2 months. The pathological examination result of liver puncture supported the diagnosis of chronic hepatitis B complicated with acute drug-induced liver injury.

A 37-year-old female patient with chronic hepatitis B was treated with levonorgestrel dispersible tablets (1.5 mg daily, 21 days of medication and 7 days off in a month) due to menstrual disorder. Three months later, the patient developed nausea, vomiting, poor appetite, and jaundice successively. Laboratory tests showed alanine aminotransferase 93 U/L, aspartate aminotransferase 68 U/L, γ-glutamyltransferase 100 U/L, total bilirubin 206.1 μmol/L, and direct bilirubin 138.9 μmol/L. After excluding chronic hepatitis B reactivation and other hepatotropic virus infections by laboratory indicators, the liver injury was considered to be related to levonorgestrel. Levonorgestrel was stopped, liver protective and symptomatic treatments were given, the patient′s symptoms gradually disappeared, and liver function returned to normal after 2 months. The pathological examination result of liver puncture supported the diagnosis of chronic hepatitis B complicated with acute drug-induced liver injury.

Objective:To improve the longevity genetic research study design by applying self-organizing maps to select a control group for longevity study.Methods:This study included the Han population aged 90 years and above or less than 80 years who have died (control group) from the natural population-based cohort formed by the fusion of the Chinese Chronic Diseases and Risk Factors Surveillance in 2013 and the China Death Surveillance System. The subjects who died of injury, infectious diseases, parasitic diseases, and malignant tumors were excluded. The self-organizing maps method, with multiple iterations and self-organizing clustering, was used to select similar factors among the population aged 90 years and above and the control group, including demographic characteristics, diseases, living habits, social behaviors, and mental and psychological factors. The study used PLINK 1.9 software to evaluate the quality of whole genome sequencing and to conduct logistic regression of single nucleotide polymorphisms (SNPs) and longevity on autosomes. Q-Q plots were used to visualize the P value associated with SNPs and longevity. Results:There were 1 019 samples selected from the baseline of 177 099 survey participants for genome sequencing, including 517 in the longevity group and 502 in the control group. The longevity and the control groups are generally similar in smoking, drinking, diet, sleep duration, blood lipid level, and self-assessment oral health status but differ significantly in socio-economic status, physical activity time, BMI, and self-assessment health status. The whole genome sequencing results were controlled, and 4 618 216 SNPs were involved in association analysis. The Q-Q plot of longevity-related SNPs analysis results showed that the enrichment of P value 1e-4 was significantly lower than the expected P value, and significant signals were also detected among P<1e-7 regions. Conclusions:The self-organizing maps can comprehensively consider the influence of socioeconomic and behavioral risk factors and select longevity control samples among samples with actual age and cause of death in a large-scale natural population cohort to improve the efficiency of longevity genome association analysis. This study provides a methodological reference for nested case-control study sample selection from the large-scale natural population cohort.

Objective:To investigate the value of computational omics biology model (CBM) in treatment of refractory acute myeloid leukemia (AML) patients.Methods:The clinical data of a refractory AML patient who received personalized therapy regimen predicted by Cellworks tumor response index (TRI) test in November 2018 were retrospectively analyzed. The diagnosis, treatment and the therapeutic efficacy were summarized. The literature related to CBM in AML was reviewed.Results:The patient, a 43-year-old female, was diagnosed as AML accompanied with t(6;11)(q27;q23). She failed to respond after 2 courses of induction therapy, and had poor tolerance of chemotherapy. And then the Cellworks TRI test recommended the 3-drug combination regimen of cladribine, trametinib and cytarabine as the optimal chemotherapy regimen. After 1 course of treatment, the patient achieved complete remission and minimal residual disease negative. After remission, the patient successfully underwent haplo-hematopoietic stem cell transplantation. She experienced a prolonged disease-free survival of 19 months and relapsed in November 2020, and passed away in April 2021. The overall survival time was 28.5 months.Conclusions:Cellworks TRI test based on CBM provides a new therapeutic approach for refractory AML patients, and its personalized treatment regimen based on genomics may improve the survival of patients.

Objective:To analyze the current situation of cardiovascular diseases and the exposure as well as control level of their risk factors in the Chinese residents.Methods:Based on the 2017 China Cardiovascular Health Index (hereafter referred to as CHI) study, data on the 29 indicators from three dimensions named as prevalence of cardiovascular disease, exposure to relevant risk factors, and prevention and control of risk factors of the 31 provinces in China (excluding Hong Kong, Macao and Taiwan) were obtained. To make a higher CHI score indicate better cardiovascular health levels, all the reverse metrics were firstly converted into positive metrics. Thenstandard normal conversion were adopted and a percentage score was assigned to each value according to its area proportion under the standard normal conversion distribution curve. Finally the scores of the three dimensions and the total CHI were calculated by weighted sum of these scores. Scores and ranks in each dimension were used to compare the performance in different provinces.Results:Heilongjiang, Tibet, Jilin, Henan, Xinjiang had the lowest scores in the prevalence of cardiovascular disease. Tianjin, Hebei, Liaoning, Shanxi and Beijing had the lowest scores in the exposure to relevant risk factors. Hainan, Guizhou, Yunnan, Shaanxi and Guangxi had the lowest in the prevention and control of risk factors. In terms of behavioral risk factors, smoking rates, rate of insufficient physical activity, obesity rate of adults aged 18 in the 31 provinces in China excluding Hong Kong, Macao, Taiwan were 26.80% (25.15%, 29.25%), 17.80% (11.60%, 19.45%) and 12.00% (8.90%, 17.95%), respectively. The daily per capital salt intake level was 8.6 (8.2, 9.3) g. As for metabolic risk factors, the prevalence of dyslipidemia (33.7%) exceeded hypertension (26.0%) and diabetes (9.7%), while its awareness rate (14.5%), treatment rate (7.9%) and control rate (5.4%) were all below the corresponding levels of hypertension and diabetes.Conclusion:Risk factors of cardiovascular disease in China is relatively severe and the prevention and control of dyslipidemia needs to be further strengthened.

Objective:To analyze the current situation of cardiovascular diseases and the exposure as well as control level of their risk factors in the Chinese residents.Methods:Based on the 2017 China Cardiovascular Health Index (hereafter referred to as CHI) study, data on the 29 indicators from three dimensions named as prevalence of cardiovascular disease, exposure to relevant risk factors, and prevention and control of risk factors of the 31 provinces in China (excluding Hong Kong, Macao and Taiwan) were obtained. To make a higher CHI score indicate better cardiovascular health levels, all the reverse metrics were firstly converted into positive metrics. Thenstandard normal conversion were adopted and a percentage score was assigned to each value according to its area proportion under the standard normal conversion distribution curve. Finally the scores of the three dimensions and the total CHI were calculated by weighted sum of these scores. Scores and ranks in each dimension were used to compare the performance in different provinces.Results:Heilongjiang, Tibet, Jilin, Henan, Xinjiang had the lowest scores in the prevalence of cardiovascular disease. Tianjin, Hebei, Liaoning, Shanxi and Beijing had the lowest scores in the exposure to relevant risk factors. Hainan, Guizhou, Yunnan, Shaanxi and Guangxi had the lowest in the prevention and control of risk factors. In terms of behavioral risk factors, smoking rates, rate of insufficient physical activity, obesity rate of adults aged 18 in the 31 provinces in China excluding Hong Kong, Macao, Taiwan were 26.80% (25.15%, 29.25%), 17.80% (11.60%, 19.45%) and 12.00% (8.90%, 17.95%), respectively. The daily per capital salt intake level was 8.6 (8.2, 9.3) g. As for metabolic risk factors, the prevalence of dyslipidemia (33.7%) exceeded hypertension (26.0%) and diabetes (9.7%), while its awareness rate (14.5%), treatment rate (7.9%) and control rate (5.4%) were all below the corresponding levels of hypertension and diabetes.Conclusion:Risk factors of cardiovascular disease in China is relatively severe and the prevention and control of dyslipidemia needs to be further strengthened.

Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) combined with transcranial electrical stimulation (tDCS) and memantine tablets on cognitive impairment in the patients with moderate to severe craniocerebral injury.Methods Forty-nine patients with moderate or severe cognitive impairment induced by trauma brain injury (TBI) who were admitted into the Rehabilitation Department and Neurosurgery Department of Shanxi University Hospital from May 2017 to May 2018 were enrolled for the study.The patients were divided into the HBO group (or group A,n =16),the HBO + tDCS group (or group B,n =16) and the HBO + tDCS + memantine group (or group C,n =17) in accordance with different treatment methods.The total scores of Montreal Cognitive Assessment Scale (MoCA) and the scores of each item before and 4 weeks after treatment,the Simple Mental State Examination Scale (MMSE) and Barthel Index (BI) were analyzed to determine improvement of cognitive impairment in the TBI patients.Results After 3 courses of treatment,MoCA comprehensive scores and sub-item scores were all significantly higher than those before treatment,with statistical significance (P ＜ 0.01).In sub-items,the comprehensive scores of VS-EF,ATT,LANG,D-MEM and MoCA in group B were significantly higher than those in group A after treatment,also with statistical significance (P ＜ 0.05).Following treatment,the scores of VS-EF,ATT,LANG and D-MEM in group C were all significantly higher than those in group B after treatment,also with statistical significance (P ＜0.05).The comprehensive scores of MMSE and ADL in group B and C after treatment were all significantly higher than those in group A,and statistical significance could be seen when comparisons were made between them (P ＜ 0.01).The comprehensive scores of MMSE (21.23 ± 6.53) and ADL(64.38 ±12.80) in group C were all obviously higher than those in group B(17.61 ±6.35,5.39 ± 10.22),also with statistical significance (P ＜ 0.05).Conclusion Comprehensive treatment with HBO + tDCS + memantine could achieve obvious better therapeutic effects on cognitive impairment of the patients with severe TBI.For this reason,it is worth further clinical application.

Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) combined with transcranial electrical stimulation (tDCS) and memantine tablets on cognitive impairment in the patients with moderate to severe craniocerebral injury.Methods Forty-nine patients with moderate or severe cognitive impairment induced by trauma brain injury (TBI) who were admitted into the Rehabilitation Department and Neurosurgery Department of Shanxi University Hospital from May 2017 to May 2018 were enrolled for the study.The patients were divided into the HBO group (or group A,n =16),the HBO + tDCS group (or group B,n =16) and the HBO + tDCS + memantine group (or group C,n =17) in accordance with different treatment methods.The total scores of Montreal Cognitive Assessment Scale (MoCA) and the scores of each item before and 4 weeks after treatment,the Simple Mental State Examination Scale (MMSE) and Barthel Index (BI) were analyzed to determine improvement of cognitive impairment in the TBI patients.Results After 3 courses of treatment,MoCA comprehensive scores and sub-item scores were all significantly higher than those before treatment,with statistical significance (P ＜ 0.01).In sub-items,the comprehensive scores of VS-EF,ATT,LANG,D-MEM and MoCA in group B were significantly higher than those in group A after treatment,also with statistical significance (P ＜ 0.05).Following treatment,the scores of VS-EF,ATT,LANG and D-MEM in group C were all significantly higher than those in group B after treatment,also with statistical significance (P ＜0.05).The comprehensive scores of MMSE and ADL in group B and C after treatment were all significantly higher than those in group A,and statistical significance could be seen when comparisons were made between them (P ＜ 0.01).The comprehensive scores of MMSE (21.23 ± 6.53) and ADL(64.38 ±12.80) in group C were all obviously higher than those in group B(17.61 ±6.35,5.39 ± 10.22),also with statistical significance (P ＜ 0.05).Conclusion Comprehensive treatment with HBO + tDCS + memantine could achieve obvious better therapeutic effects on cognitive impairment of the patients with severe TBI.For this reason,it is worth further clinical application.

Objective To investigate the feasibility and safety of Bean Bag in lateral position placing during pulmonary operations,evaluate its effects by comparing with the routine placing of lateral position by sandbags and side shields, and to provide scientific evidences to solve the existing clinical problems in lateral position placing. Methods One hundred patients with pulmonary surgeries who needed lateral position placing were divided into Bean Bag group and routine method group randomly according to random digit table,50 patients in each group.Bean bag was used in lateral position placing in Bean Bag group,while sandbags and side shields were used in routine lateral position placing in routine method group. The required time for positioning and skin pressing condition, the activity of both upper limbs during postoperative follow-up were recorded.The satisfaction of operating surgeons on this position was acquired by self-designed questionnaire when operation was finished. Results The required time for positioning in Bean Bag group was(178.36±24.27)seconds,and that for positioning in routine method group was (282.06 ± 29.34) seconds, there was statistically significant difference between two groups (t=19.254,P<0.01).There were 14 patients who appeared skin injury and press red in Bean Bag group and 27 patients who appeared skin injury and press red in routine method group, and there was statistically significant difference between two groups(χ2=6.986,P=0.008).In Bean Bag group,the total score of seven items in satisfaction questionnaire of operating surgeons on patient's position was 38.34±1.36,while that in routine method group was 29.34±1.29,there was statistically significant difference between two groups(Z=33.924,all P<0.01). Conclusions Our study indicated that it was feasible and safe to use Bean Bag to place lateral position.The exposure of operating field was good and the stability of position was strong. Compared with routine position placing method, lateral position placing by using Bean Bag could save time, the operating procedures were more simple and convenient, and it could protect the physiological function of all aspects in patient's body more effectively, the satisfaction of surgeons for this method in lateral position placing was higher. It might deserve to popularize this method in the clinical practice in the future.

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli )isolated from patients with bloodstream infection,and provide evidence for rational use of antimicrobial agents in clinical practice.Methods BacT/A-lert automated blood culture system and VITEK 2 automated identification system were used for bacterial culture and identi-fication.Antimicrobial susceptibility testing and detection of extended-spectrum β-lactamases (ESBLs)-producing strains were performed by Kirby-Bauer method.Results From 2009 to 2011 ,a total of 235 strains of E.coli were isolated from patients with bloodstream infection,90 (38.30%)of which were ESBLs positive strains.The resistant rates of ESBLs-producing strains to ampicillin,cefotaxime and ceftriaxone were all 100%,but susceptibility rate to imi-penem/cilastatin and meropenem were all 100%,to cefmetazole and amikacin were >90%.The resistant rate of non-ESBLs-producing strains to ampicillin was the highest (70.63%),susceptibility rate to imipenem/cilastatin and meropenem were both 100%,to amikacin,cefotaxime,and cefmetazole were all >95%.The resistant rate of ES-BLs-producing strains was significantly higher than that of the non-ESBLs-producing strains.Ofβ-lactamase inhibi-tor,only susceptibility rate of ESBLs-producing E.coli to cefoperazone/sulbactam was>90%,susceptibility rates to piperacillin/tazobactam and ticarcillin/clavulanate were both<80%.Conclusion Antimicrobial resistant rate of ESBLs-producing strains causing bloodstream infection is high,individualized treatment strategies should be made according to antimicrobial resistance of bacteria causing infection in patients.