Objective:To explore the clinical significance of hepatitis B virus (HBV) DNA detection in screening patients with hepatitis B.Methods:Clinical data of 682 331 hepatitis B patients were retrospectively analyzed. The HBV DNA of these patients was detected in the Fifth Medical Center of the PLA General Hospital from January 2017 to December 2021, there were 481 159 males and 201 172 females in this cohort, the average age was (41.34±16.13) years. Patients were divided into HBV DNA positive group (219 879 cases) and HBV DNA negative group (462 452 cases). Clinical characteristics, data of five serologic markers of hepatitis B and hepatitis B surface antigen quantification (HBsAg-QN), liver function, alpha fetoprotein (AFP) and prothrombin time (PT) results were collected and analyzed and compared between the two groups.Results:The positive rate of HBV DNA was 32.22% (219 879/682 331) in this cohort. Among the different age groups, the positive rate of HBV DNA was the highest (40.34%, 128 038/317 380) in young people aged 18-44 years. The proportion of patients was lower among aged <1, 45-59 and ≥60 years patients in HBV DNA positive group than that in HBV DNA negative group, while the proportion of patients was higher among aged 1-17 and 18-44 years patients in HBV DNA positive group than that in HBV DNA negative group (all P<0.001). Among 2 291 <1-year-old infants tested for HBV DNA, 71 infants were HBV DNA positive. The positive rates of HBV DNA from 2017 to 2021 were 4.86% (27/556), 3.68% (14/380), 3.47% (17/490), 1.55% (6/386) and 1.46% (7/479) respectively, showing a downward trend year by year. The positive rate of HBV DNA in acute hepatitis B (AHB) patients was the highest (49.88%, 208/417) among 680 040 patients with hepatitis B. The proportion of AHB patients (0.09%, 208/219 808) and chronic hepatitis B (80.44%, 176 806/219 808) in HBV DNA positive group was higher than that in HBV DNA negative group [0.05% (209/460 232) and 65.45% (301, 216/460 232)], while the proportion of patients with HBV-related liver cirrhosis (11.28%, 24 793/219 808), HBV-related liver cancer (6.72%, 14 775/219 808), liver cancer surgery (1.39%, 3 055/219 808) and liver transplantation (0.08%, 171/219 808) were lower than that in HBV DNA negative group [22.99% (105 813/460 232), 7.25% (33 385/460 232), 3.50% (16 129/460 232) and 0.76% (3 480/460 232)] (all P<0.001). At the same time, positive rate of hepatitis B surface antigen (HbsAg), HBsAg-QN, hepatitis B e antigen (HbeAg), level of total bilirubin, total bilirubin, AFP and PT were higher in HBV DNA positive group than those in HBV DNA negative group, while the age, male ratio and albumin results in HBV DNA positive group were lower than those in HBV DNA negative group (all P<0.01). The HBV DNA loads were higher in HBsAg positive group, hepatitis B surface antibody positive group and HBeAg positive group than those in respective negative groups, while the HBV DNA loads were lower in hepatitis B e antibody positive group and hepatitis B core antibody positive group than those in respective negative groups (all P<0.001). Conclusions:The mother to child transmission rate of<1-year-old infants decreases year by year. HBV DNA is an important factor for the progression of hepatitis B disease. HBV DNA positive hepatitis B patients with higher HBsAg-QN values are more likely to have abnormal serum markers such as liver dysfunction. HBV DNA detection is therefore of clinical importance in screening patients with hepatitis B.

Objective:To retrieve and summarize the evidence of indications for extubation in neurosurgical tracheotomy patients, so as to provide reference for promoting timely and safe extubation of neurosurgical tracheotomy patients.Methods:Evidence-based problems were identified according to the population, intervention, professional, outcome, setting, type of evidence (PIPOST) model. According to the "6S" classification model of the evidence-based retrieval database, all evidences of extubation indications of neurosurgical tracheotomy patients in the database, guideline website and professional institution website were systematically retrieved, including clinical guidelines, systematic review, expert consensus, evidence summary and clinical decision-making. The search period was from the establishment of the database to May 31, 2022. Two researchers independently evaluated the quality of the included article and extracted evidence.Results:A total of 12 articles were included, including four guidelines, four systematic reviews, two expert consensuses, one evidence summary, and one clinical decision-making. A total of 18 pieces of best evidence for extubation indications of neurosurgical tracheotomy patients were summarized, including 7 themes: disease condition, consciousness and autonomous activity, respiratory function, cough function, swallowing function, airway condition, multidisciplinary team and equipment support.Conclusions:The extubation of neurosurgical tracheotomy patients should consider many factors. The summary of evidence has a certain degree of scientific and practical significance, which can provide evidence-based basis for medical and nursing staff to apply evidence in a targeted manner.

Objective:To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods:Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern, central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire. Information on occurrence of unintended pregnancy within 2 years after delivery, postpartum contraceptive use, sexual resumption, breastfeeding, and women′s socio-demographic characteristics, and so on, were collected. Life-table analysis, cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results:A total of 18 045 postpartum women were investigated. The cumulative 1- and 2-year unintended pregnancy rates after delivery were 5.3% (95% CI: 4.5%－6.1%) and 13.1% (95% CI: 11.3%－14.8%), respectively. Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women, ethnic minorities, women with abortion history, and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation (all P<0.01). The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth (all P>0.05). Conclusions:In China, the risk of unintended pregnancy within 2 years after delivery is relatively high. Service institutions and service providers should improve the quality of postpartum family planning services, promote the use of high effect contraceptive methods, and educate women to use a method at the time of their sexual resumption or even before.

Objective: To compare the difference of cognitive fusion, empirical avoidance between patients with obsessive-compulsive disorder and healthy control group, and to explore the relationship between obsessive-compulsive score and cognitive fusion, empirical avoidance. Methods: The cognitive fusion questionnaire(CFQ), acceptance and action questionnaire-2nd edition(AAQ-II) and Yale-Brown scale for obsessive-compulsive symptoms (Y-BOCS) were used to investigate 100 subjects with obsessive-compulsive disorder (OCD) and 166 healthy controls.And the differences in cognitive fusion and empirical avoidance scores were compared between the two groups.The relationship of obsessive-compulsive symptoms and cognitive fusion, empirical avoidance was analyzed using multiple linear regression analysis. Results: The scores of cognitive fusion ((49.89±10.62) vs (33.88±11.44), t=-11.345, P<0.01)and empirical avoidance ((29.75±9.53) vs (21.59±7.03), t=-7.995, P<0.01) in obsessive-compulsive disorder group were significantly higher than those in healthy control group.There were significant differences in cognitive fusion and empirical avoidance in age variables (F=8.63, P<0.01). In AAQ-Ⅱ, item 2 (r=0.246, P<0.05), item 6 (r=0.223, P<0.05) and total score (r=0.240, P<0.05) were positively correlated with the total score of Y-BOCS.Item 2 (r=0.311, P<0.01), item 3 (r=0.286, P<0.05), item 6 (r=0.248, P<0.05) and total score (r=0.229, P<0.05) were positively correlated with the scores of obsessive-thinking.In CFQ, item 2 (r=0.231, P<0.0) 5), item 4 (r=0.242, P<0.05), item 7 (r=0.308, P<0.05), item 8 (r=0.277, P<0.05) and item 9 (r=0.249, P<0.05) were positively correlated with the total score of Y-BOCS.Item 8 (r=0.261, P<0.05) was positively correlated with the scores of obsessive-thinking, item 7 (r=0.237, P<0.05) and item 9 (r=0.238, P<0.05) were positively correlated with scores of obsessive-compulsive behavior.When predicting total obsessive-compulsive scores, only CF item 7 of Q (B=1.827, P<0.01), item 3 (B=0.956, P<0.05), and item 6 of AAQ-Ⅱ (B=0.584, P<0.05) entered the equation with a joint explanatory variation of 19%.When predicting the score of obsessive-thinking, only item 2 of AAQ-Ⅱ (B=0.446, P<0.01) entered the equation, explaining the variance was 9.7%.In the prediction of obsessive-compulsive behavior, only item 9 (B=0.815, P<0.05) of CFQ entered the equation, and the explanatory variation was 5.6%. Conclusion Cognitive fusion in the patients with obsessive-compulsive disorder and the high level of empirical avoidance may be an important factor for the maintenance of the symptoms.

Objective: To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes, and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound. Methods: Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital, Shanghai Jiao Tong University were included in the study. Ultrasound contrast agent was injected subcutaneously, and axillary lymph nodes were displayed under contrast enhanced ultrasound mode. The longitudinal diameter (anteroposterior diameter), transverse diameter, longitudinal/transverse ratio and the distance from skin surface were measured. Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound: typeⅠ, uniform enhancement; type Ⅱ, ring-shape enhancement; type Ⅲ, ununiform enhancement; type Ⅳ, regional filling defect; type Ⅴ, total filling defect. Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation. Results: The detection rate of sentinel lymph nodes was 95.08% (58/61). Seventy-seven lymph nodes, including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients. The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones (P=0.001, 0.003). When type Ⅳ(regional filling defect) and type Ⅴ(total filling defect) were classified as involved, the sensitivity, specificity, positive-predictive value, negative-predictive value, accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71%, 96.43%, 90.00%, 94.70%, 93.51% and 0.911, respectively. Conclusions Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes. Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound.

The incidence of renal tumors is increasing year by year,especially that of malignant kidney tumors.Quantitative analysis of CEUS plays an important role in the diagnosis of renal tumors and evaluation of therapeutic effect,and contributes to differentiating benign and malignant renal lesions.The application of CEUS quantitative analysis in diagnosis of renal tumors were reviewed in this article.

Objective To investigate the incidence and predictors of cerebral infarction in patients with ruptured ACoA aneurysms, and to provide diagnostic and therapeutic information.Methods A total of 319 patients with ruptured ACoA aneurysms in our hospital from January 2009 to February 2015 were reviewed in this study. The author collected data regarding clinical characteristics, and measured the aneurysm morphologies on CTA images. Age, flow angle, vessel angle were analyzed by independent-samples t tests in patients with or without cerebral infarction. Mann-Whitney U tests were used for aneurysm size, aneurysm height, perpendicular height, neck size, size ratio, aspect ratio, aneurysm angle , World Federation of Neurosurgical Societies (WFNS) grade at admission and Fisher grade. Chi-square tests and Fisher's exact tests were used for sex, histories of hypertension, smoking and stroke, treatment modalities, anterior cerebral A1 segment configuration and angiographic vasospasm on CTA images. The multivariate logistic regression analyses were used to determine the independent risk factors of cerebral infarction using the stepwise regression method. Results Of the 319 patients, there were 253 without and 66 patients with cerebral infarction. Differences of age(53±11 vs 57±12,respectively;t=-2.415, P=0.016), Fisher grade [Ⅰ 23(9.1%), Ⅱ 27(10.7%), Ⅲ 74(29.2%), Ⅳ 129(51.0%) vs Ⅰ 1(1.5%), Ⅱ 7 (10.6% ), Ⅲ 13(19.7% ), Ⅳ 45(68.2% ), respectively;Z=-2.541, P=0.035] and treatment modalities [endovascular coil embolization 155(61.3% ), neurosurgical clipping 98(38.7% ) vs endovascular coil embolization 23(34.8%), neurosurgical clipping 43(65.2%), respectively;χ2=14.810, P<0.001] reached statistical significance. Multivariate analysis showed that Fisher grade Ⅳ(OR=10.36,95%CI 1.34-80.29, P=0.025) and neurosurgical clipping (OR=3.28, 95% CI 1.84-5.86,P<0.001)still had statistical significance. Conclusions Cerebral infarction in patients with ruptured ACoA aneurysms may be associated with Fisher grade and treatment modalities. Although there is difference between the two groups in age, it is not a predictor of the occurrence of cerebral infarction.

Objective To investigate the effect of labor induction of full-term pregnancy use of oxytocin,and the incidence of adverse reactions of mode of delivery of cervical dilatation balloon with pubeisheng.Methods The clinical data of full-term pregnant women who were delivered in our hospital from October 2014 to November 2015 were retrospectively analyzed,According to the induction of labor is divided into the way of pubeisheng group and cervical dilation balloon group.The differences of delivery mode,oxytocin utilization,maternal and neonatal outcomes and adverse reactions were observed between the two groups.Results Cervical dilatation balloon group vaginal delivery rate was 90.38％,higher than that of pubeisheng group(P<0.05); oxytocin use rate of 11.54％,lower than that of pubeisheng group(P<0.05); Cervical dilatation balloon group first,second and third labor time is shorter pubeisheng group(P<0.001); The cervical dilation balloon group bleeding more than pubeisheng group(P<0.001),two groups of infection,urinary retention complication rate had no significant difference.Two groups of neonatal aspiration pneumonia incidence rate had no significant difference after the birth of 1min Apgar score difference,and cervical dilatation balloon group after the birth of 5min Apgar was higher than that of pubeisheng group(P<0.05).Conclusion The application of cervical dilation balloon in the induction of labor in term pregnancy is better,which can significantly improve the rate of vaginal delivery,reduce the use rate of oxytocin and shorten the labor process,and has the value of clinical application.

Objective To analyze the clinical characteristics and therapy of Nocardia infection, and provide reference for clinical practice.Methods Patients with positive specimen culture of Nocardia from May 2014 to June 2016 were surveyed retrospectively, the body status, clinical features, therapeutic regimen, and prognosis were analyzed.Results A total of 10 cases of Nocardia infection were surveyed, there were 7 males and 3 females;average age was (49.90+13.75) years old.Nocardia infection occurred mostly in population with impaired immune status or underlying diseases, the main infection site was lung, compound sulfamethoxazole was the first choice drug for treatment of infection, amikacin, imipenem/cilastatin and so on were alternative choice according to disease condition, 8 patients all improved after therapy.Conclusion The diagnosis made on the basis of microbiological examination, imaging, and pathological examination, combined with comprehensive judgment according to risk factors of Nocardia infection, patient can be treated timely and rationally, and the prognosis is better.

Background: Stage at diagnosis and molecular subtype are important clinical factors associated with breast cancer patient survival. However, subgroup survival data from a large study sample are limited in China. To estimate the survival differences among patients with different stages and various subtypes of breast cancer, we conducted a hospital-based multi-center study on breast cancer in Beijing, China. Methods: All resident patients diagnosed with primary, invasive breast cancer between January 1, 2006 and Decem-ber 31, 2010 from four selected hospitals in Beijing were included and followed up until December 31, 2015. Hospital-based data of stage at diagnosis, hormone receptor status, and selected clinical characteristics, including body mass index (BMI), menopausal status, histological grade, and histological type, were collected from the medical records of the study subjects. Overall survival (OS) and cancer-specific survival (CSS) were estimated. Cox proportional hazards models were employed to evaluate the associations of stage at diagnosis and molecular subtype with patient survival. Results: The 5-year OS and CSS rates for all patients were 89.4％ and 90.3％. Survival varied by stage and molecu-lar subtype. The 5-year OS rates for patients with stage Ⅰ, Ⅱ, Ⅲ, and IV diseases were 96.5％, 91.6％, 74.8％, and 40.7％, respectively, and the corresponding estimates of 5-year CSS rates were 97.1％, 92.6％, 75.6％, and 42.7％, respectively. The 5-year OS rates for patients with luminal A, luminal B, HER2, and triple-negative subtypes of breast cancer were 92.6％, 88.4％, 83.6％, and 82.9％, respectively, and the corresponding estimates of 5-year CSS rates were 93.2％, 89.1％, 85.4％, and 83.5％, respectively. Multivariate analysis showed that stage at diagnosis and molecular subtype were important prognostic factors for breast cancer. Conclusions: Survival of breast cancer patients varied significantly by stage and molecular subtype. Cancer screen-ing is encouraged for the early detection and early diagnosis of breast cancer. More advanced therapies and health care policies are needed on HER2 and triple-negative subtypes.