BackgroundThe occurrence rate of dangerous behaviors in patients with severe mental disorders is higher than that of the general population. In China， there is limited research on the prediction of dangerous behaviors in community-dwelling patients with severe mental disorders， particularly in terms of predicting models using data mining techniques other than traditional methods. ObjectiveTo explore the influencing factors of dangerous behaviors in community-dwelling patients with severe mental disorders and testing whether the classification decision tree model is superior to the Logistic regression model. MethodsA total of 11 484 community-dwelling patients with severe mental disorders who had complete follow-up records from 2013 to 2022 were selected on December 2023. The data were divided into a training set （n=9 186） and a testing set （n=2 298） in an 8∶2 ratio. Logistic regression and classification decision trees were separately used to establish predictive models in the training set. Model discrimination and calibration were evaluated in the testing set. ResultsDuring the follow-up period， 1 115 cases （9.71%） exhibited dangerous behaviors. Logistic regression results showed that urban residence， poverty， guardianship， intellectual disability， history of dangerous behaviors， impaired insight and positive symptoms were risk factors for dangerous behaviors （OR=1.778， 1.459， 2.719， 1.483， 3.890， 1.423， 2.528， 2.124， P<0.01）. Being aged ≥60 years， educated， not requiring prescribed medication and having normal social functioning were protective factors for dangerous behaviors （OR=0.594， 0.824， 0.422， 0.719， P<0.05 or 0.01）. The predictive effect in the testing set showed an area under curve （AUC） of 0.729 （95% CI： 0.692~0.766）， accuracy of 70.97%， sensitivity of 59.71%， and specificity of 72.05%. The classification decision tree results showed that past dangerous situations， positive symptoms， overall social functioning score， economic status， insight， household registration， disability status and age were the influencing factors for dangerous behaviors. The predictive effect in the testing set showed an AUC of 0.721 （95% CI： 0.705~0.737）， accuracy of 68.28%， sensitivity of 64.46%， and specificity of 68.60%. ConclusionThe classification decision tree does not have a greater advantage over the logistic regression model in predicting the risk of dangerous behaviors in patients with severe mental disorders in the community. ［Funded by Chengdu Medical Research Project （number， 2020052）］

BACKGROUND:Pulmonary pericytes are located at the concavity where pulmonary vessels are interconnected,which is closely related to the formation and stability of pulmonary vascularization.However,there are few studies on how pulmonary pericytes affect the activity of pulmonary vascular endothelial cells in the pathogenesis of broncho-pulmonary dysplasia. OBJECTIVE:To analyze the relationship between the quantity of subgroups of pulmonary pericytes and endothelial cells in different stages of broncho-pulmonary dysplasia and to explore the effects of PDGFR-β+NG2+α-SMA+ pericytes on the early tube-forming activity of pulmonary vascular endothelial cells. METHODS:(1)Animal experiment:Twelve newborn C57BL/6 mice were randomly divided into normoxia and hyperoxia groups within 24 hours of birth,with six mice in each group.Mice in the hyperoxia group were exposed to an 85%O2 environment to build the mouse models of broncho-pulmonary dysplasia,while those in the normoxia group were fed in the same room air.The lung tissues of the mice in the two groups were taken at 7 and 14 days after birth.The pathological changes of the lung tissues were observed by hematoxylin-eosin staining.Three subgroups of pulmonary pericytes were measured by flow cytometry:PDGFR-β+NG2+α-SMA-,PDGFR-β+NG2+α-SMA+,and PDGFR-β+NG2-α-SMA+ cells.(2)Cellular experiment:Passage 3 PDGFR-β+NG2+α-SMA+ pericytes were co-cultured with mouse pulmonary vascular endothelial cells(experimental group)at a ratio of 1:4.Mouse pulmonary vascular endothelial cells cultured alone were used as controls.The tube-forming difference between two groups was analyzed after 15 hours of co-culture. RESULT AND CONCLUSION:(1)Animal experiment:Hematoxylin-eosin staining revealed that on day 7,the lung tissue of mice in the normoxia group had regular structure,obvious alveolar structure,and uniform size,while the number of alveoli in the lung tissue of mice in the hyperoxia group was less and the morphology of alveoli was irregular.On day 14,the alveoli of mice in the normoxia group gradually developed and matured,the alveolar structure gradually became regular and uniform in size,and the alveolar density gradually increased.The lung tissue structure of mice in the hyperoxia group was relatively disordered and the alveolar formation was delayed with the size gradually increasing and the alveolar structure being simplified.Flow cytometry results indicated that the number of PDGFR-β+NG2-α-SMA+ and PDGFR-β+NG2+α-SMA+ pericytes was increased in the hypoxia group compared with the normoxia group(P＜0.01),while the number of PDGFR-β+NG2+α-SMA-pericytes and pulmonary vascular endothelial cells was decreased(P＜0.01,P＜0.04).(2)Cellular experiment:In the control group,the pulmonary vascular endothelial cells arranged in cords and extended around,and lumen-like structures formed in some areas.In the experimental group,PDGFR-β+NG2+α-SMA+ pericytes and their pseudopodia were not observed,the irregular grid structure of pulmonary vascular endothelial cells was significantly less than that of the control group,and the endothelial cells mainly clustered in clumps.To conclude,α-SMA+ pericyte subgroups are predominant in mice with broncho-pulmonary dysplasia.PDGFR-β+NG2+α-SMA+ pericytes can directly inhibit the tube-forming activity of pulmonary vascular endothelial cells,which may be involved in the process of abnormal vascularization in broncho-pulmonary dysplasia.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To investigate the safety and efficacy of FOLFOX (5-fluorouracil + calcium folinate + oxaliplatin) hepatic arterial infusion chemotherapy (FOLFOX-HAIC) combined with immune and targeted therapy as triple combination therapy for patients with single China Liver Cancer Staging (CNLC) Ⅰb hepatocellular carcinoma.Methods:A total of 20 patients with single CNLC Ⅰb hepatocellular carcinoma who received FOLFOX-HAIC combined with immune and targeted therapy as triple combination therapy in the First Affiliated Hospital of Guangxi Medical University from October 2021 to August 2022 were included. The clinical data of all patients was retrospectively analyzed. There were 18 males and 2 females, with the age of (55.1±9.9) years. Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and Modified Response Evaluation Criteria in Solid Tumors (mRECIST) were used to evaluate the efficacy of FOLFOX-HAIC combined with immune and targeted therapy, and the clinical safety of triple combination therapy was evaluated by common terminology criteria for adverse events 4.0.Results:According to RECIST 1.1, objective response rate of 20 patients was 70.0% (14/20) and disease control rate was 100.0% (20/20) after 2 cycles of treatment (one cycle of FOLFOX-HAIC plus programmed death-1 antibody). According to mRECIST, objective response rate was 90.0% (18/20) and the disease control rate was 100.0% (20/20) after 2 cycles of treatment. Following the treatment, 12 patients (60.0%) received liver tumor resection, and all of them achieved R 0 resection, 2 patients (10.0%) received radiotherapy, 3 patients (15.0%) stopped drug treatment for surgery, 2 patients (10.0%) refused surgery, and 1 patient (5.0%) died of multiple organ failure caused by immune hepatitis. According to pathological results, 3 patients (25.0%, 3/12) achieved pathological complete response, and 4 patients (33.3%, 4/12) achieved major pathological response. In the safety evaluation, the overall incidence of adverse events was 100.0% (20/20). Seven patients (35.0%) had grade 3 adverse events and 1 patient (5.0%) died of multiple organ failure due to immune hepatitis (grade 5). Grade 1-3 adverse events could be relieved after symptomatic treatment. Conclusion:The triple combination therapy of FOLFOX-HAIC combined with immune and targeted therapy is safe and has high objective response rate and disease control rate, which could be a new strategy for the neoadjuvant treatment of hepatocellular carcinoma.

As a member of vessel extracellular matrix, pericytes have a close relationship with angiogenesis.Pericytes widely exist on the surface of microvascular all over the body, which are important to the stability of vessels.As a member in development of vascular structure, pericytes are located in the niches between the junction of lung vascular cells, and pericytes definitely play important roles in lung development and lung diseases.Based on the functional characters of pericytes, this article summarizes the relevant researches about the roles of pericytes in the lung development and lung diseases, and further study of pericytes will provide new insights into the mechanism of lung development and lung diseases.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To investigate the status quos of helicobacter pylori infection in people of the area bordering Yunnan,Guizhou and Guangxi so as to provide the basis for the prevention of diseases caused by helico-bacter pylori infection. Methods There were 29547 people including 6644 civil servants,1484 medical staff,5839 factory workers,5542 teachers,10038 students,who took physical examination from January,2012 to Decem-ber,2015 in the Affiliated Hospital of Youjiang Medical University for Nationalities. According to the principle of stratified sampling,3363 people were selected at random from the above groups. Among them there were 756 civil servants,215 medical staff,689 factory workers,654 teachers,1049 students. And there were 1515 Zhuang people, 897 Han people,234 Miao people,282 Yao people ,147 Gelao ,134 Buyi,154 people from other ethnics. Their ages ranged from 7 to 65. ELISA reagent method was adopted to detect helicobacter pylori infection. The relationship between ethnicity,gender,age,occupation,region and infection rate was analyzed. Results The total positive rate of helicobacter pylori was 47.2%in this region. As for different ethnic groups,the positive rate of Zhuang people was as high as 52.7%,and that of Kelao people was the lowest ,only 31.3%. Women′s infection rate was 41.5%,while that of the male was 52.4%. In terms of different age groups,people aged from 50 to 59 got an infection rate as high as 55.3%,while the age group under 18 had the lowest rate,only 19.6%. In the aspect of different professions,civil servants had the highest positive rate 57.9%. Students had the lowest rate 35.9%. Regional distribution analysis showed that Baise had the highest infection rate(51.4%),while Qian xi nan had the lowest rate of 33.9%. There was statistical difference in helicobacter pylori infection between different ethnic groups,genders,ages,occupations and regions(P<0.05). Conclusion The infection of helicobacter pylori in people of the area bordering Yunnan, Guizhou and Guangxi are related to ethnicity,gender,age,occupation and region.

Objective To study the hip angle characteristics in hemiplegic gait.Methods Gait analysis was performed in 20 subjects with hemiplegia and 20 healthy subjects and the hip joint angle of all subjects was analyzed.Results The hip joint angle of affected-side lower limb of hemiplegic gait showed significant differences between 20 subjects with hemiplegia and 20 healthy subjects on hip flextion at heel-contact,maximum extension in stand phase,flextion toe-off,maximum flexion in swing phase and total excursion on sagittal plane.Conclusion The research on the characteristics of hemiplegic gait is helpful to make clinical assessment and treatment planning.

ObjectiveTo investigate the clinical features of 19 patients with opticospinal multiple sclerosis(OSMS).Methods19 cases with OSMS according to Kira Criteria were collected(15 women).Their clinical features were analyzed in combination with the laboratory examination.Results and ConclusionThere was no significant difference in the aspects of age of onset,disease duration,initial symptoms,MRI finding,evoked potential,immunological test of cerebrospinal fluid(CSF),between literatures reported elsewhere and ours. However,in our study,the OSMS patients did not show CSF pleocytosis associated with a decreased protein levels.The proportion of OSMS in all the types of MS seemed to be lower(18.66%).

ObjectiveTo study normal gait characteristics of healthy adults in different age groups.Methods90 healthy adults were divided into three groups according to their ages. It was 20～39 year group, 40～59 year group and 60～70 year group. They received a gait analysis with the gait analysis system based on digital video and image processing which could provide temporal-spatial parameters and kinematic parameters. The gait data of the three groups were compared. Relationships between gait speed and other gait parameters were investigated.ResultsThere were statistically significant differences in some parameters among three groups. Gait speed was significantly correlated with stride time, stride length, stance time (%), cadence, maximum flexion of hip and knee in swing phase.ConclusionThe normal gait patterns of healthy adult established with the gait analysis system based on digital video and image processing can be used as the base line to compare with abnormal gait.