Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective:To learn about the monitoring indicators and patient management in coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province, and provide a basis for consolidating and improving the prevention and control achievements.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing of the Monitoring Plan for Key Endemic Diseases Such as Kashin-Beck Disease" and "The Monitoring Plan for Endemic Fluorosis and Arsenic Poisoning in Shaanxi Province", a basic situation investigation was conducted in the affected villages of all counties (districts) with coal-burning-borne endemic arsenic poisoning in Shaanxi Province, and on-site visits were conducted to check the management of high arsenic coal mines. Using the simple random sampling method, 30 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors. A survey on arsenic poisoning was carried out among all populations in the affected villages. According to the requirements of the provincial monitoring program, 720 people were randomly selected from 12 affected villages in 3 monitoring counties to measure their urinary arsenic level. The determination was based on the "Guidelines for the Safety of Urinary Arsenic in Population" (WS/T 665-2019). The evaluation for elimination of disease areas was carried out in accordance with the "National Health Commission Issued the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition)".Results:A total of 2 cities, 8 counties (districts), 99 townships, and 1 414 affected villages were monitored. All 53 high arsenic coal mines had stopped mining. The rate of qualified improved stoves was 99.97%; the correct utilization rate of qualified improved stoves, and the correct drying rate of corn and chili peppers provided for human consumption in the affected villages were 100.00%. A total of 2 064 138 people were examined, and 2 682 cases of arsenic poisoning were detected, all of whom were historical patients. There were no new cases of arsenic poisoning or skin cancer. There were currently 2 682 arsenic poisoning patients who had received family doctor contract services and implemented follow-up management. The geometric mean of urinary arsenic was 0.016 7 mg/L, which was lower than the safety guideline value for human urinary arsenic (0.032 mg/L).Conclusions:The monitoring indicators in the coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province have reached the elimination standards. In the future, we should continue to strengthen the management of high arsenic coal mines, implement comprehensive prevention and control measures mainly focused on furnace and stove renovation and health promotion, and do a good job in patient management to continuously consolidate and improve the prevention and control achievements.

Humans ; Glycated Hemoglobin ; Diabetes Mellitus, Type 1 ; Blood Glucose ; Diabetes Mellitus, Type 2

Objective To compare the accuracy of consolidation/tumor ratio(CTR)measured at different CT thresholds for the prediction of invasiveness in small lung cancer with diameter≤2 cm using artificial intelligence-assisted measurements,and to explore the CTR thresholds and the corresponding CT thresholds for predicting lung cancer invasiveness.Methods Clinical data from 59 lung cancer patients(78 lung nodules in total)treated at Wuwei Hospital of Traditional Chinese Medicine from January 2021 to May 2023 were collected to analyze the prediction efficacy of CTR on invasiveness in small lung cancer with diameter≤2 cm measured at CT thresholds of-400,-350,-300,-250,-200,-150 HU.ROC curves were plotted to determine the optimal critical value for invasiveness prediction,followed by the corresponding CT threshold.Results The highest diagnostic efficacy for the invasiveness of lung nodules was achieved at a CT threshold of-250 HU,with an area under the curve of 0.931,sensitivity of 77.5％,specificity of 100％,and an optimal CTR threshold of 0.322.Conclusion For small lung cancers with a maximum diameter≤2 cm,CTR measured at a CT threshold of-250 HU can accurately predict lung cancer invasiveness.At CTR>0.322,the nodule is more likely to be microinvasive or invasive adenocarcinoma.

Objective:To evaluate the diagnostic for classification of newly diagnosed diabetes patients and assess the application of the screening tests recommended by the 2022 Chinese Expert Consensus on Diabetes Classification.Methods:Retrospective case series study. The data from the electronic medical record system of patients with new-onset diabetes mellitus (within 1 year of disease onset) who attending the Diabetes Specialist Outpatient Clinic at the Second Xiangya Hospital of Central South University from January 1, 2018 to December 31, 2021 were collected for the analysis. Based on the consensus, patients were categorized according their age of onset, body mass index (BMI), and suspicion of type 1 diabetes mellitus (T1DM). The chi-square statistic was used to compare key classifier indicators, including C-peptide, islet autoantibodies, and genetic markers, in the subgroups. The diagnosis in suspected T1DM patients was also evaluated. The screening strategy recommended in the consensus was further assessed using a logistic regression model and the area under the receiver-operating curve (AUC).Results:A total of 3 384 patients with new-onset diabetes were included. The average age of disease onset was (46.3±13.9) years, and 61.0% (2 065/3 384) of the patients were male. The proportions of patients who completed C-peptide and glutamic acid decarboxylase antibody (GADA) tests were 36.6% (1 238/3 384) and 37.5% (1 269/3 384), respectively. There were no significant differences in C-peptide test results among the subgroups (all P>0.05). In contrast, the GADA detection rate was higher in patients with young age of onset (<30 years old), in those who were non-obese (BMI<24 kg/m 2), and in those clinically suspected of T1DM (all P<0.05). According to the diagnostic pathway proposed by the consensus, only 57.4% (1 941/3 384) of patients could be subtyped. For a definitive diagnosis, the remaining patients needed completion of C-peptide, islet autoantibody, genetic testing, or follow-up. Furthermore, among patients with clinical features of suspected T1DM, the antibody positivity rate was higher than in non-suspected T1DM patients [24.5% (154/628) vs. 7.1% (46/646), P<0.001]. When the clinical features of suspected T1DM defined in the consensus were taken as independent variables and antibody positivity was considered the outcome variable in the logistic regression model, young onset, non-obese onset, and ketosis onset could enter the model. Based on AUC analysis, the accuracy of the diagnostic model was 0.77 (95% CI 0.73-0.81), suggesting that the clinical features of suspected T1DM in the consensus have good clinical diagnostic value for this patient subgroup. Conclusions:There was a significant discrepancy between the clinical practice of diabetes classification and the process recommended by the consensus, which was specifically reflected in the low proportions of both subtyping indicator testing and definitively subtyped diabetes patients. Attention should be pay to the classification diagnosis process proposed in the consensus and the clinical detection rate of key diabetes subtyping indicators such as C-peptide and islet autoantibodies for diabetes classification should be improved. Noteworthy, the screening strategy for T1DM proposed by the consensus showed good clinical application value.

Massive transfusion protocol (MTP) is a programmatic procedure for massive blood transfusions, which is an important means of patient blood management (PBM) for trauma and massive hemorrhage patients. MTP can be initiated in a variety of modes, including the McLaughlin, ABC and TASH scoring systems and the mode depending on the patient′s hemorheology. After MTP has been activated, blood components should be injected as soon as possible. Generally, red blood cells should be injected first, followed by plasma and platelets injected proportionally. MTP should be based on good damage control measures and good hemostatic treatment, and should try to avoid the waste of blood components.This article reviews the progress of research on MTP in the above aspects.

Objective:To explore the characteristics of working memory ability of female methamphetamine dependent youths, and to analyze the effect of spatial and temporal training task (CODING) on working memory ability of female methamphetamine dependent youths.Methods:Sixty methamphetamine dependent youths from a women's drug rehabilitation center in Sichuan province were selected as the methamphetamine dependent group, while 60 female healthy volunteers from vocational high schools and universities participated as the healthy control group. Visual memory test (VISGED) was used to evaluat the working memory ability of the subjects, and SPSS 21.0 software was used for the nonparametric test of the memory difference between the two groups.The methamphetamine dependent group was divided into treatment group and waiting group based on the baseline matching principle of working memory. The treatment group was trained under the spatio-temporal CODING paradigm for working memory, and the training effect was assessed using the independent sample t-test. Results:(1)The individual parameters(0.06(-1.62, 1.67) vs 1.93 (-0.28, 2.71)) and working program(15.00(14.00 vs 16.00), 17.00(15.00, 20.00)) of working memory in methamphetamine dependent group and normal control group were statistically significant ( Z=-3.83, P<0.05, Z=-3.50; P<0.05). (2) Through memory training, the personal parameters before and after training in the treatment group ((0.08±1.79) vs 1.68 (0.68, 2.25)) had a statistically significant difference ( Z=-3.63, P<0.05). The personal parameters before and after the test in the waiting group ((-0.01±1.86) vs 0.72(-1.54, 1.88)) had no statistically significant difference ( Z=-1.35, P>0.05). Conclusion:Methamphetamine dependence impaire the working memory of female youths regardless of age or education level. Memory training can restore and improve memory ability to a certain extent, help to restore learning ability and living ability, and lay a foundation for a better return to society.

Objective:To explore the effect of methamphetamine (MA) dependence on the attention of female youth, and to analyze the intervention effect of computer-based cognitive training on the attention of MA-dependent female youth.Method:From May to August 2021, a total of 64 MA-dependent female youths in abstinence period from a women's compulsory isolated drug rehabilitation center in Sichuan Province were selected as the MA group, and 53 ordinary female youths matched with their age and education level were selected as the normal control group.According to the matching principle of age, education level, and attention pre-test scores, the subjects in MA-dependent group were divided into MA-dependent intervention group( n=30)and MA-dependent waiting group( n=34). CogniPlus cognitive training system was used to train the attention of subjects in MA-dependent intervention group( n=30), while the subjects in MA-dependent waiting group( n=34) and normal control group did not receive training.The Vienna Test System was used to collect the attention scores of all subjects.SPSS 20.0 analysis software was used for data processing.Statistical analysis was performed using independent samples t test and paired samples t test. Results:The MA-dependent group had significantly longer endogenous alertness, temporary alertness, and concentration response time ((275.61±47.79)ms, (268.63±51.41)ms, (444.08±134.40)ms) compared with the normal control group ((247.02±34.09)ms, (237.60±46.04)ms, (355.15±44.37)ms) ( t=3.767, 3.405, 4.976; all P<0.05). After attention training, the post-test reaction time of endogenous alertness, temporary alertness, and concentration ((264.10±38.98)ms, (251.67±38.06)ms, (352.03±65.70)ms) in the MA-dependent intervention group were significantly shorter than those in the MA-dependent waiting group ((323.18±83.28)ms, (302.74±82.75)ms, (402.76±74.34)ms) ( t=-3.702, -3.232, -2.876; all P<0.05). The post-test reaction time of temporary alertness and concentration in the MA-dependent intervention group ((251.67±38.06)ms, (352.03±65.70)ms)were shorter than those of the pre-test ((265.70±37.84)ms, (428.67±120.11)ms) ( t=2.179, 3.588; both P<0.05). The MA-dependent waiting group had a longer post-test reaction time of endogenous alertness and temporary alertness(323.18±83.28)ms, (302.74±82.75)ms) compared with the pre-test ((285.35±51.43)ms, (271.21±61.42)ms) ( t=-2.752, -2.664; both P<0.05) and the post-test reaction time of concentration ((402.76±74.34)ms) was shorter than that of the pre-test ((457.68±146.29)ms)( t=2.431, P<0.05). The MA-dependent intervention group had longer endogenous alertness, temporary alertness, and pre-test reaction time of concentration ((264.57±41.41)ms, (265.70±37.84)ms, (428.67±120.11)ms)compared with the normal control group( t=2.083, 2.841, 3.230; all P<0.05). The post-test of endogenous alertness ((264.10±38.98)ms) was longer than that of the normal control group ( t=2.082, P<0.05). Conclusion:The cognitive training based on the CogniPlus system has a certain effect on the attention maintenance or recovery of MA-dependent female youth.It can be used as an intervention measure for cognitive impairment of drug addicts and help them healthy return to society.

Traditional depression research based on electroencephalogram (EEG) regards electrodes as isolated nodes and ignores the correlation between them. So it is difficult to discover abnormal brain topology alters in patients with depression. To resolve this problem, this paper proposes a framework for depression recognition based on brain function network (BFN). To avoid the volume conductor effect, the phase lag index is used to construct BFN. BFN indexes closely related to the characteristics of "small world" and specific brain regions of minimum spanning tree were selected based on the information complementarity of weighted and binary BFN and then potential biomarkers of depression recognition are found based on the progressive index analysis strategy. The resting state EEG data of 48 subjects was used to verify this scheme. The results showed that the synchronization between groups was significantly changed in the left temporal, right parietal occipital and right frontal, the shortest path length and clustering coefficient of weighted BFN, the leaf scores of left temporal and right frontal and the diameter of right parietal occipital of binary BFN were correlated with patient health questionnaire 9-items (PHQ-9), and the highest recognition rate was 94.11%. In addition, the study found that compared with healthy controls, the information processing ability of patients with depression reduced significantly. The results of this study provide a new idea for the construction and analysis of BFN and a new method for exploring the potential markers of depression recognition.
Brain ; Brain Mapping ; Depression/diagnosis* ; Electroencephalography ; Humans ; Recognition, Psychology

OBJECTIVE: To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program. METHODS: A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed. RESULTS: NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035. CONCLUSION NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Aneuploidy ; Cost-Benefit Analysis ; Female ; Humans ; Noninvasive Prenatal Testing ; Pregnancy ; Retrospective Studies ; Trisomy 18 Syndrome/genetics*