Objective To investigate the level 4 surgical safety management in tertiary public hospitals in Sichuan Province.Methods A combination of questionnaires and qualitative interviews was used to investigate the basic situation of four-level surgery performed,the volume of surgery,and the management of surgery in 34 tertiary public hospitals in Sichuan Province.Results Among the 34 tertiary public hospitals surveyed,the percentage of patients discharged with level Ⅳ surgery in 2023 was 18.96％,which was lower than the level of the percentage of patients discharged with level Ⅳ surgery did not establish a leading group for level Ⅳ surgery (17.65％),a system for preoperative multidisciplinary discussion of level Ⅳ surgery(14.71％),and a system for preoperative multidisciplinary discussion of level Ⅳ surgery with various department-related expert pool(41.18％),multidisciplinary joint examination room(23.53％),and the monitoring and evaluation mechanism for the completion of preoperative multidisciplinary discussion for level 4 surgery(20.59％).Conclusion The volume of level Ⅳ surgeries in tertiary public hospitals in Sichuan Province needs to continue to be improved,and the establishment of a standardized management system for level Ⅳ surgeries is imperative.

Objective To investigate the level 4 surgical safety management in tertiary public hospitals in Sichuan Province.Methods A combination of questionnaires and qualitative interviews was used to investigate the basic situation of four-level surgery performed,the volume of surgery,and the management of surgery in 34 tertiary public hospitals in Sichuan Province.Results Among the 34 tertiary public hospitals surveyed,the percentage of patients discharged with level Ⅳ surgery in 2023 was 18.96％,which was lower than the level of the percentage of patients discharged with level Ⅳ surgery did not establish a leading group for level Ⅳ surgery (17.65％),a system for preoperative multidisciplinary discussion of level Ⅳ surgery(14.71％),and a system for preoperative multidisciplinary discussion of level Ⅳ surgery with various department-related expert pool(41.18％),multidisciplinary joint examination room(23.53％),and the monitoring and evaluation mechanism for the completion of preoperative multidisciplinary discussion for level 4 surgery(20.59％).Conclusion The volume of level Ⅳ surgeries in tertiary public hospitals in Sichuan Province needs to continue to be improved,and the establishment of a standardized management system for level Ⅳ surgeries is imperative.

OBJECTIVE: This study aimed to investigate the association between fruit and vegetable intake and arterial stiffness. METHODS: We conducted a cohort-based study comprising 6,628 participants with arterial stiffness information in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project. A semi-quantitative food-frequency questionnaire was used to assess baseline (2007-2008) and recent (2018-2021) fruit and vegetable intake. We assessed changes in fruit and vegetable intake from 2007-2008 to 2018-2021 in 6,481 participants. Arterial stiffness was measured using the arterial velocity-pulse index (AVI) and arterial pressure-volume index (API). Elevated AVI and API values were defined according to diverse age reference ranges. RESULTS: Multivariable-adjusted linear regression models revealed that every 100 g/d increment in fruit and vegetable intake was associated with a 0.11 decrease in AVI ( B= -0.11; 95% confidence interval [ CI]: -0.20, -0.02) on average, rather than API ( B = 0.02; 95% CI: -0.09, 0.13). The risk of elevated AVI (odds ratio [ OR] = 0.82; 95% CI: 0.70, 0.97) is 18% lower in individuals with high intake (≥ 500 g/d) than in those with low intake (< 500 g/d). Furthermore, maintaining a high intake in the past median of 11.5 years of follow-up was associated with an even lower risk of elevated AVI compared with a low intake at both baseline and follow-up ( OR = 0.64; 95% CI: 0.49, 0.83). CONCLUSION Fruit and vegetable intake was negatively associated with arterial stiffness, emphasizing recommendations for adherence to fruit and vegetable intake for the prevention of arterial stiffness.
Humans ; Vascular Stiffness ; Fruit ; Vegetables ; Atherosclerosis ; China

Humans ; Mpox (monkeypox) ; China

Objective:To analyze the clinical characteristics and prognostic factors of high-risk neuroblastoma (HR-NB) patients with skeletal metastasis.Methods:The clinical features of 336 newly treated HR-NB patients with skeletal metastases admitted to the Department of Medical Oncology of Beijing Children′s Hospital, Capital Medical University from January 2007 to December 2018 were analyzed retrospectively.Kaplan-Meier method was used for the survival analysis, and Log- Rank test was used for univariate prognosis analysis.The Cox model was used to analyze the multifactorial prognostic analysis. Results:A total of 336 HR-NB patients were recruited, involving 188 males and 148 females with the median age of onset of at 43 (4-148) months.Skeletal metastases affected the viscerocranium (89 cases, 26.5%), neurocranium (193 cases, 57.4%), vertebrae (298 cases, 88.7%), sternum and ribs (183 cases, 54.5%), pelvis (270 cases, 80.4%), upper limbs (182 cases, 54.2%) and lower limbs (240 cases, 71.4%). The 5-year event-free survival (EFS) rate and overall survival (OS) rate were (30.4±2.7)% and (41.3±2.9)%, respectively.Univariate analysis showed a significantly lower 5-year OS rate in skeletal metastatic HR-NB patients with poor prognostic classification, the morphology of neuroblastoma (stroma-poor) and ganglioneuroblastoma (intermixed), high index of mitosis-karyorrhexis index, lactate dehydrogenase≥587 U/L, serum ferritin≥92 μg/L, MYCN amplification and 1p loss of heterozygosity, and metastases in the viscerocranium, neurocranium, vertebrae, sternum and ribs, pelvis, upper limbs and lower limbs (all P<0.05). The 5-year OS rate of HR-NB patients with all 7 regions of skeletal metastases was only (14.2±5.9)%, which was significantly lower than that in patients with a single region metastasis or multi-region metastases[(66.0±10.2)% vs.(43.6±3.4)%, χ2=45.722, P<0.05]. Cox multifactorial analysis showed that MYCN amplification ( HR=4.165, 95% CI: 2.356-7.363) and the viscerocranium metastasis ( HR=2.560, 95% CI: 1.519-4.315) were the independent risk factors affecting the prognosis of HR-NB patients with skeletal metastases (all P<0.05). Conclusions:The prognosis is extremely poor in HR-NB patients with multiple skeletal metastases at the initial diagnosis.The amplification of MYCN and the viscerocranium metastasis are the poor prognostic factors for HR-NB patients with skeletal metastases.

Background: and Purpose This study aimed to construct an optimal dynamic nomogram for predicting malignant brain edema (MBE) in acute ischemic stroke (AIS) patients after endovascular thrombectomy (ET). Methods: We enrolled AIS patients after ET from May 2017 to April 2021. MBE was defined as a midline shift of >5 mm at the septum pellucidum or pineal gland based on follow-up computed tomography within 5 days after ET. Multivariate logistic regression and LASSO (least absolute shrinkage and selection operator) regression were used to construct the nomogram. The area under the receiver operating characteristic curve (AUC) and decisioncurve analysis were used to compare our nomogram with two previous risk models for predicting brain edema after ET. Results: MBE developed in 72 (21.9%) of the 329 eligible patients. Our dynamic web-based nomogram (https://successful.shinyapps.io/DynNomapp/) consisted of five parameters: basal cistern effacement, postoperative National Institutes of Health Stroke Scale (NIHSS) score, brain atrophy, hypoattenuation area, and stroke etiology. The nomogram showed good discrimination ability, with a C-index (Harrell’s concordance index) of 0.925 (95% confidence interval=0.890–0.961), and good calibration (Hosmer-Lemeshow test, p=0.386). All variables had variance inflation factors of <1.5 and tolerances of >0.7, suggesting no significant collinearity among them. The AUC of our nomogram (0.925) was superior to those of Xiang-liang Chen and colleagues (0.843) and Ming-yang Du and colleagues (0.728). Conclusions Our web-based dynamic nomogram reliably predicted the risk of MBE in AIS patients after ET, and hence is worthy of further evaluation.

The chemical constituents from the roots of Aconitum kongboense were studied. Twenty-five diterpenoid alkaloids were isolated from the 95% methanol extract of the roots of A. kongboense by silica gel, reverse-phase silica gel and basic alumina column chromatography. They included a new aconitine-type diterpenoid alkaloid, named as kongboensenine(1), and twenty-four known ones(2-25), i.e., acotarine F(2), acotarine G(3), 14-acetyltalatisamine(4), talatisamine(5), indaconitine(6), yunaconitine(7), chasmanine(8), 6-epi-foresticine(9), homochasmanine(10), 8-deacetyl-yunaconitine(11), chasmaconitine(12), ajaconine(13), franchetine(14), ezochasmanine(15), crassicautine(16), 14-O-deacylcrassicausine(17), genicunine A(18), falconeridine(19), sachaconitine(20), liljestrandisine(21), 8-methyl-14-acetyltalatisamine(22), kongboendine(23), 14-benzoylchasmanine(24) and pseudaconine(25). Their structures were elucidated by common spectroscopic methods including high-resolution electrospray ionization mass spectrometry(HR-ESI-MS) and nuclear magnetic resonance(NMR) techniques. Compounds 2-4, 10, 13, 15-19 and 21-22 were isolated from this plant for the first time. Experimental results showed that all compounds did not have a significant inhibitory activity against acetylcholinesterase(AChE).
Acetylcholinesterase ; Aconitum/metabolism* ; Alkaloids ; Diterpenes ; Magnetic Resonance Spectroscopy ; Molecular Structure ; Plant Roots/metabolism*

Objective To analyze the cerebroplacental blood flow distribution characteristics in monochorionic‐diamniotic ( MCDA ) twin pregnancies with selective fetal grow th restriction ( sFGR ) ,and investigate the relationship between co‐twin cerebroplacental blood flow discordances and co‐twin birth weight discordances ( BWdisc ) . Methods The cerebroplacental blood flow distribution characteristics and their discordances were analyzed retrospectively in 52 MCDA twin pregnancies with normal grow th ( control group) and 52 with sFGR ( case group) ,including the umbilical artery pulsatility index ( U A‐PI) ,middle cerebral artery peak systolic velocity ( MCA‐PSV ) ,middle cerebral artery pulsatility index ( MCA‐PI ) , cerebroplacental ratio ( CPR ) ,and their discordances ( U A‐PIdisc ,MCA‐PSVdisc ,MCA‐PIdisc and CPRdisc ) . Results Compared to the control group ,UA‐PIdisc ,MCA‐PIdisc and CPRdisc increased significantly ( all P ＜0 .01) . U A‐PIdisc ,MCA‐PIdisc and CPRdisc were related positively to BW disc as show n by correlation analyses ( r＝0 .488 ,0 .414 ,0 .592 ;all P ＜ 0 .001) ,and they had moderate predictive accuracy for sFGR with area under the curves of 0 .743 ,0 .662 and 0 .778 , with sensitivity of 48 .08% ,67 .31% and 71 .15% , and specificity of 92 .31% ,59 .62% and 78 .85% ( all P ＜ 0 .01 ) . M ultivariate Logistic regression analyses showed that only CPRdisc were independently associated with sFGR ( P ＜ 0 .05 ) . Conclusions More cerebroplacental blood flow discordances are observed in MCDA twin pregnancies with sFGR . Co‐twin cerebroplacental blood flow discordance is related to BW disc .

Objective: To analyze the cerebroplacental blood flow distribution characteristics in monochorionic-diamniotic (MCDA) twin pregnancies with selective fetal growth restriction (sFGR), and investigate the relationship between co-twin cerebroplacental blood flow discordances and co-twin birth weight discordances (BW_disc). Methods: The cerebroplacental blood flow distribution characteristics and their discordances were analyzed retrospectively in 52 MCDA twin pregnancies with normal growth (control group) and 52 with sFGR (case group), including the umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR), and their discordances (UA-PI_disc, MCA-PSV_disc, MCA-PI_disc and CPR_disc). Results: Compared to the control group, UA-PI_disc, MCA-PI_disc and CPR_disc increased significantly (all P<0.01). UA-PI_disc, MCA-PI_disc and CPR_disc were related positively to BW_disc as shown by correlation analyses (r=0.488, 0.414, 0.592; all P<0.001), and they had moderate predictive accuracy for sFGR with area under the curves of 0.743, 0.662 and 0.778, with sensitivity of 48.08%, 67.31% and 71.15%, and specificity of 92.31%, 59.62% and 78.85% (all P<0.01). Multivariate Logistic regression analyses showed that only CPR_disc were independently associated with sFGR (P<0.05). Conclusions More cerebroplacental blood flow discordances are observed in MCDA twin pregnancies with sFGR. Co-twin cerebroplacental blood flow discordance is related to BW_disc.

BACKGROUND: In the past few years, many studies have shown that mesenchymal stem cells play roles in tissue repair and regeneration, which is to a large extent by their paracrine effect. As one of the important paracrine factors, exosomes have become an issue of concern for researchers. OBJECTIVE: To explain the components, sources and biological characteristics of exosomes, to summarize the latest research advances of mesenchymal stem cells derived exosomes in tissue repair and regeneration, and to make prospects of its application in the field of oral medicine. METHODS: A computer-based search of the relevant literature in CNKI and PubMed full-text databases of journals from 1983 to 2017 was performed. The keywords were "exosome, MSC-exosomes, tissue repair and regeneration, oral diseases" in Chinese and English, respectively. Totally 61 eligible articles were included in the result analysis. RESULTS AND CONCLUSION: Exosome is a vesicle secreted by cells and contains different proteins and RNAs. It plays an important role in the intercellular communication, and has the functions of inhibiting apoptosis, stimulating proliferation and regulating immunity. Mesenchymal stem cells derived exosomes play an important role in repairing bone injury, skin injury, nerve injury and liver injury, but its mechanism is yet unclear. The application of exosomes in the field of oral medicine is rarely reported, which is certainly worthy of further research and exploration.