Objective:To explore the association between postoperative radiotherapy for bladder cancer and the risk of second primary rectal cancer.Methods:Eligible 75 120 patients with bladder cancer from the Surveillance, Epidemiology, and End Result database (SEER) of the National Cancer Institute (NCI) (1975-2017) were enrolled in this study. The second primary cancers referred to rectal cancers patients suffered after more than five years post-treatment for bladder cancer, and the cumulative incidence was estimated using Fine-Gray competing risk regression. The relative risk (RR) of rectal cancer in patients treated with or without radiotherapy (the RT group or the NRT group) was evaluated using Poisson regression.Results:Among the 75 120 patients, 70 045 (92.4%) were Caucasian, with a median age of 65.8 years (54-74 years). A total of 2 236 (3%) received postoperative radiotherapy, while 72 884 (97%) received surgery alone. The 30-year follow-up revealed a cumulative incidence of rectal cancer of 0.93% in the RT group and 0.43% in the NRT group ( P = 0.004). The competing risk regression analysis identified a significant association between radiotherapy and rectal cancer ( HR: 1.86; 95% CI 1.26-2.74, P < 0.009). Furthermore, the RR of radiotherapy-associated rectal cancer significantly increased as the diagnosis occurred earlier (1975-1985 vs. 1985-1994: RR 2.59; 95% CI 1.20-4.86, P < 0.001), and a lower age at the time of radiotherapy was associated with a higher probability of second primary tumors (≤50-year old vs. > 50 year old : RR 7.89, 95% CI 2.97-21.30, P < 0.001). As calculated using the Poisson distribution, the RR of second rectal tumors was higher in the RT group ( RR: 2.20, 95% CI 1.45-3.18, P < 0.001), even after adjusting the date of diagnosis ( RR: 1.77, 95% CI 1.17-2.57, P = 0.009). Conclusions:An increased risk of rectal cancer following bladder cancer radiotherapy necessitates aggressive follow-ups for the purpose of early detecting second primary rectal cancer associated with bladder cancer radiotherapy.

Objective To develop a self-assessment scale for medication literacy in patients with coronary heart disease comorbidity diabetes and to test its reliability and validity.Methods According to medication literacy theory model,the initial scale was formed through literature review,the qualitative interview and expert inquiry.Cognitive interview was used to optimize the expression of item text.421 patients with coronary heart disease comorbidity diabetes in a tertiary hospital in Zhejiang province from November 2022 to April 2023 were selected to investigate the reliability and validity of the scale by convenience sampling.Results The self-assessment scale of drug literacy for coronary heart disease comorbidity diabetes mellitus included 23 items in 5 dimensions including acquisition,understanding,communication,evaluation and calculation.The total Cronbach's α coefficient of the scale was 0.911;the retest reliability was 0.948;the average content validity index was 0.997;the correlation coefficients between each dimension and total score of the scale and the calibration scale ranged from 0.485 to 0.926.The exploratory factor analysis was employed to extract 5 common factors,and the cumulative variance contribution rate was 73.753％.Confirmatory factor analysis showed that the scale factor structure was stable.Conclusion The scale has good reliability and validity,and it can be used as an effective tool to evaluate the self-rated medication literacy level of patients with coronary heart disease comorbidity diabetes.

Objective To develop a self-assessment scale of home volume management for patients with chronic heart failure(CHF),and to test its reliability and validity.Methods With the self-care theory as the theoretical framework,the initial scale was developed through literature analysis,qualitative interview and expert consultation.A questionnaire survey was conducted on 598 patients with CHF who were treated or reviewed in a tertiary hospital in Hangzhou from September 2022 to January 2023 to test the reliability and validity of the scale.Results The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 61.268％.The results of confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range of the judgment standard.The item-level content validity index ranged from 0.853 to 1.000;the scale-level content validity index/average was 0.951.The Cronbach's a coefficient,half reliability and retest reliability of the overall scale were 0.930,0.723 and 0.867,respectively.Conclusion The self-rating scale of home volume management for CHF patients has good reliability and validity,and it can effectively assess the level of home volume management for CHF patients.

Objective:To investigate the clinical features of the initial phase of acute osteomyelitis in children with skin and soft tissue infection as the main sign.Methods:The clinical data of 154 children with skin and soft tissue infections as the main sign from July 2017 to February 2023 were retrospectively analyzed. According to MRI, 48 children with no signs of osteomyelitis and only simple skin and soft tissue infection were included in the non-osteomyelitis group, including 28 boys and 20 girls, aged 38.50 (12.00, 93.00) months; 106 children with acute osteomyelitis with skin and soft tissue infection as the main sign were included in the osteomyelitis group, including 65 boys and 41 girls, aged 49.50 (17.50, 87.00) months. The disease course, maximum body temperature at onset, inflammatory indicators (including white blood cell count, neutrophil count, C-reactive protein, erythrocyte sedimentation rate) examined within 24 h after admission were compared between the two groups, and receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each index in diagnosing osteomyelitis.Results:The white blood cell counts in the non-osteomyelitis group and osteomyelitis group were 13.72 (10.19, 19.19) ×10 9 /L and 14.74 (10.63, 18.67) ×10 9 /L, and the neutrophil counts were 7.79 (5.62, 11.91) ×10 9 /L and 9.58 (5.77, 13.67) ×10 9 /L, the difference was not statistically significant ( Z=-0.68, P=0.495; Z=-1.24, P=0.216). The course of disease in the non-osteomyelitis group and osteomyelitis group was 5.00 (3.00, 7.00) d and 5.50 (4.00, 9.00) d ( Z=-2.03, P=0.042), and the maximum body temperature at the onset of the disease was 38.50 (36.65, 39.00) ℃ and 39.00 (38.50, 40.00) ℃ ( Z=-3.72, P<0.001), C-reactive protein was 23.26 (8.16, 47.67) mg/L and 69.27 (26.28, 111.03) mg/L ( Z=-4.52, P<0.001), erythrocyte sedimentation rate was 35.00 (24.25, 53.00) mm/1 h and 61.00 (43.00, 78.00) mm/1 h ( Z=-5.06, P<0.001), the differences were statistically significant. The proportion of patients with increased C-reactive protein was 70.8% (34/48) and 92.5% (98/106) in non-osteomyelitis group and osteomyelitis group, the proportion of patients with increased erythrocyte precipitation rate was 81.3% (39/48) and 100% (106/106), and the proportion of patients with fever was 66.7% (32/48) and 100% (106/106), respectively, the difference was statistically significant (χ 2=12.61, P<0.001; χ 2=21.11, P<0.001; χ 2=39.43, P<0.001). The sensitivity, specificity and area under the curve of osteomyelitis were 84.0%, 33.3% and 0.602, respectively. The maximum body temperature at onset was 99.1%, 35.4% and 0.687, and the C-reactive protein was 57.6%, 85.4% and 0.728, respectively. Erythrocyte sedimentation rates were 84.0%, 56.3% and 0.755, respectively. Multivariate logistic regression analysis indicated that the maximum body temperature was >37.6 ℃ [ OR=22.54, 95% CI (2.66, 190.81)] and C-reactive protein was >54.59 mg /L [ OR=4.23, 95% CI (1.63, 11.01)] was an independent risk factor for predicting osteomyelitis with skin and soft tissue infection as the main sign. Conclusion:Compared to simple skin and soft tissue infections, children with osteomyelitis had a higher proportion of fever, elevated C-reactive protein, and elevated erythrocyte sedimentation rate, a longer duration of illness, and higher elevations in temperature, C-reactive protein, and erythrocyte sedimentation rate. Length of onset, maximum body temperature at onset, C-reactive protein and erythrocyte sedimentation rate had certain diagnostic efficacy in determining the tendency of skin soft tissue infection to osteomyelitis. Maximum body temperature >37.6 ℃ and C-reactive protein >54.59 mg/L may independently predict the possibility of skin soft tissue infection as osteomyelitis, and prompt Magnetic Resonance Imaging is recommended for early diagnosis and treatment in such children.

OBJECTIVE: To analyze the clinical and genetic characteristics of a child with mucopolysaccharidoses type I. METHODS: Enzymatic and genetic testing were carried out for the child who was admitted due to contraction of fingers and flexion deformity of lower limbs. The child was subjected to target exome capture sequencing. Candidate variants were verified by Sanger sequencing of the child, her parents and two sisters. RESULTS: The child had featured facial dysmorphism, short stature, round head, short neck, corneal turbidity and skeletal deformity. Enzyme test was positive, and genetic testing revealed that she had harbored c.1049delA (p.N350Mfs*4) and c.1815dupT (p.V606Cfs*53) compound heterozygous variants of the IDUA gene, which were inherited from her mother and father, respectively. Her two sisters had each carried one of above variants. c.1815dupT was known to be pathogenic, whilst c.1049delA was not reported in Human Gene Mutation Database. CONCLUSION The compound heterozygous variants of the IDUA gene probably underlay the disease in this child, among which the c.1049delA (p.N350Mfs*4) is unreported previously.
Child ; Dwarfism ; Female ; Genetic Testing ; Humans ; Iduronidase ; Mucopolysaccharidosis I ; Mutation ; Exome Sequencing

【Objective】 To investigate the effect of two different blood transfusion strategies in non-shock stage of sever burn patients, so as to provide reference for clinical rational use of blood. 【Methods】 74 cases of severe burn patients in our hospital from July 2019 to December 2020 were randomly divided into restrictive transfusion group and liberal transfusion group. The differences of blood transfusion volume, red blood cell (RBC) count before and after blood transfusion, Hb value, incidence of transfusion adverse reactions, postoperative infection rate, length of hospital stay, and 30 day mortality between the two groups were retrospectively analyzed. 【Results】 1) The blood transfusion volume of the restricted blood transfusion group [(9.58±7.43)U] was statistically less than that of the liberal blood transfusion group [(22.24±20.08)U] (P<0.05). 2) The increase of Hb per unit of RBC in the restrictive transfusion group [(4.98±3.37)g/L] was higher than that in the liberal transfusion group [(3.28±3.12)g/L], and the difference was statistically significant. (P< 0.05). 3) There were no significant differences in postoperative infection rate, incidence of transfusion adverse reaction, length of stay and 30 day mortality between the two groups (P> 0.05). 【Conclusion】 Limited blood transfusion treatment for severe burn patients in non-shock stage can reduce the frequency and risk of blood transfusion and save blood resources, which is of great significance for rational and safe blood use in clinic.

Objective:To explore the application effect of WeChat-based IIFAR combined with progressive exercise prescription in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) .Methods:Using the convenient sampling method, a total of 90 ACS patients from the First Affiliated Hospital of Air Force Military Medical University were selected as the research objects from June 2017 to June 2019. The patients were divided into the observation group and the control group, with 45 cases in each group by random number method. Patients in the control group adopted conventional nursing methods, while patients in the intervention group used WeChat-based IIFAR combined with progressive exercise prescription intervention. Coronary Self-Management Behavior Scale (CSMS) , 6 min walking test and exercise load test were used to compare the effects of the intervention.Results:A total of 3 cases in the control group and 1 case in the observation group dropped out. None of the patients had any adverse cardiac events during the study period. The scores of daily life management, social emotional management and medical disease management behaviors of the observation group were higher than those of the control group at 3 months after operation, and the differences were statistically significant ( P<0.05) . Three months after the operation, the 6-min walking distance and maximum exercise load of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:WeChat-based IIFAR combined with progressive exercise prescription can improve the exercise load and self-management behavior of ACS patients after PCI.

Objective To evaluate the role of mitochondrial ATP sensitive potassium ( mito-KATP ) channel in dexmedetomidine-induced inhibition of subarachnoid hemorrhage ( SAH )-caused programmed cell death ( PCD) in cardiomyocytes of rats. Methods On hundred and twenty clean-grade healthy male Sprague-Dawley rats, aged 9-10 weeks, weighing 350-400 g, were divided into 5 groups ( n=24 each) using a random number table method: sham operation group ( group Sham ) , SAH group, SAH plus dexmedetomidine group ( group SD) , 5-HD plus SAH and dexmedetomidine group ( group HSD) and 5-HD plus SAH group ( group HS) . The rats were subjected to SAH by intracranial vascular puncture after being anesthetized with pentobarbital sodium. Dexmedetomidine 5 μg∕kg was infused for 10 min via the jugular vein starting from the time point after intracranial vascular puncture, followed by a continuous infusion of 5μg·kg-1 ·h-1 for 1 h in SD and HSD groups. 5-HD 30 mg∕kg was intraperitoneally injected at 1 h before intracranial vascular puncture in HSD and HS groups. Blood samples were collected from the abdominal aor-ta at 24 h after intracranial vascular puncture for determination of serum cardiac troponin I ( cTnI) concen-trations. The animals were then sacrificed, and myocardial specimens were collected for determination of PCD rate ( by TUNEL) , reactive oxygen species ( ROS) activity ( by DCFH-DA assay) , and expression of cleaved caspase-3, cleaved caspase-1 and interleukin-1beta ( IL-1β) ( by Western blot) . Results Com-pared with group Sham, the serum concentrations of cTnI, PCD rate and ROS activity were significantly in-creased, and the expression of cleaved caspase-3, cleaved caspase-1 and IL-1βwas up-regulated in SAH, SD, HSD and HS groups ( P<0. 05) . Compared with group SAH, the serum concentrations of cTnI, PCD rate and ROS activity were significantly decreased, and the expression of cleaved caspase-3, cleaved caspase-1 and IL-1βwas down-regulated in group SD, and the serum concentrations of cTnI, PCD rate and ROS activity were significantly increased, and the expression of cleaved caspase-3, cleaved caspase-1 and IL-1βwas up-regulated in group HS ( P<0. 05) . Compared with group SD, the serum concentrations of cT-nI, PCD rate and ROS activity were significantly increased, and the expression of cleaved caspase-3, cleaved caspase-1 and IL-1β was up-regulated in group HSD ( P<0. 05) . Compared with group HSD, the serum concentrations of cTnI, PCD rate and ROS activity were significantly increased, and the expression of cleaved caspase-3, cleaved caspase-1 and IL-1βwas up-regulated in group HS ( P<0. 05) . Conclusion mito-KATP channel is involved in dexmedetomidine-induced inhibition of PCD in cardiomyocytes of rats with SAH.

Objective To evaluate the role of Toll-like receptor 4 (TLR4)-p38 mitogen-assoliated protein kinase (p38MAPK)-nuclear factor kappa B (NF-κB) signaling pathway in sevoflurane-induced decrease in cognitive function of aged rats.Methods Sixty SPF healthy male Sprague-Dawley rats,aged 20 months,weighing 550-750 g,were divided into 5 groups (n =12 each) using a random number table method:control group (C group),sevoflurane group (S group),TAK242 plus sevoflurane group (TS group),SB202190 plus sevoflurane group (SS group),and PDTC plus sevoflurane group (PS group).All the rats were intubated after anesthesia and connected to an animal ventilator.TAK242,SB202190 and PDTC 10 μl were injected into the lateral cerebral ventricle in TS,SS and PS groups,respectively,and normal saline containing the equal volume of DMSO was given in C and S groups.Starting from 10 min after lateral cerebral ventricle injection,4％ sevoflurane was inhaled for 6 h via the tracheal tube,with the inhaled oxygen concentration 30％ and oxygen flow rate 2 L/min.The mixture of air and oxygen was inhaled in C group.The learning and memory ability was assessed by Morris water maze test at 7 days after the end of sevoflurane anesthesia,and the escape latency and swimming distance were recorded.Animals were sacrificed after the end of Morris water maze test,and brains were removed and hippocampi were isolated for determination of neural apoptosis (by TUNEL),contents of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) in hippocampal tissues (by enzyme-linked immunosorbent assay),and expression of caspase-3,phosphorylated p38MAPK (p-p38MAPK),total p38MAPK (t-p38MAPK) and NF-κB in nucleus (by Western blot).The apoptosis rate and p-p38MAPK/t-p38MAPK ratio were calculated.Results Compared with C group,the escape latency and swimming distance were significantly prolonged at each time point,the apoptosis rate and contents of TNF-oα and IL-1β were increased,the expression of caspase-3,p-p38MAPK and NF-κB was up-regulated,and p-p38MAPK/t-p38MAPK ratio was increased in the other four groups (P＜0.05).Compared with S group,the escape latency and swimming distance were significantly shortened at each time point,the apoptosis rate and contents of TNF-α and IL-1β were decreased,and the expression of caspase-3 was down-regulated in TS,SS and PS groups,the expression of NF-κB was significantly down-regulated in TS and SS groups,and the expression of p-p38MAPK was significantly down-regulated,and p-p38MAPK/t-p38MAPK ratio was decreased in TS group (P＜0.05).Compared with TS group,the escape latency and swimming distance were significantly prolonged at each time point,the apoptosis rate and contents of TNF-α and IL-1β were increased,the expression of caspase-3 and p-p38MAPK was up-regulated,and p-p38MAPK/t-p38MAPK ratio was increased in SS and PS groups,and the expression of NF-κB was significantly up-regulated in PS group (P＜0.05).The expression of NF-κB was significantly up-regulated in PS group when compared with SS group (P＜0.05).Conclusion TLR4-p38MAPKNF-κB signaling pathway is involved in sevoflurane-induced decrease in cognitive function of aged rats.

To explore the clinical significance of C1q tumor necrosis factor-related protein-9 (CTRP9) in patients with cerebral infarction.Our data showed that the serum CTRP9 was significantly lower than that of control group,especially in patients with large artery atherosclerotic cerebral infarction.CTRP9 was first decreased and even lower from day 4 to day 10,then gradually elevated.Logistic regression analysis suggested that high CTRP9 level was a protective factor for cerebral infarction.Thus,CTRP9 could be a factor for further classification of cerebral infarction and provides a potential option for disease prevention and treatment.