OBJECTIVE T o explore the prevention and control measures for the hospital-acquired pulmonary mu-cormycosis caused by Cunninghamella bertholletiae.METHODS One case of patient with pulmonary mucormyco-sis caused by Cunninghamella bertholletiae who was treated in pediatric intensive care unit(PICU)of a three-A general hospital was enrolled in the study,the process of clinical diagnosis and treatment was summarized.A ret-rospective survey regarding four aspects including people,machine,materials and environment was conducted.The related factors leading to the hospital-acquired infections in the patient were analyzed.RESULTS The child was diagnosed with severe aplastic anemia and underwent hematopoietic stem cell transplantation,the child was treated with various invasive procedures during the treatment period and was infected with pulmona-ry mucormycosis caused by the rare Cunninghamella bertholletiae.The occurrence of the pulmonary mucormyco-sis was associated with the poor management of medical textile,insufficient environmental cleaning and disinfec-tion and nonstandard invasive procedures.CONCLUSIONS The Cunninghamella bertholletiae infection is less com-mon,but the risk of death is high.It is necessary for the medical institutions to complete the prevention and con-trol measures and intensify the health care workers'capabilities in identification of the pathogenic fungus so as to reduce the incidence of pulmonary mucormycosis caused by the pathogen.

OBJECTIVE T o explore the prevention and control measures for the hospital-acquired pulmonary mu-cormycosis caused by Cunninghamella bertholletiae.METHODS One case of patient with pulmonary mucormyco-sis caused by Cunninghamella bertholletiae who was treated in pediatric intensive care unit(PICU)of a three-A general hospital was enrolled in the study,the process of clinical diagnosis and treatment was summarized.A ret-rospective survey regarding four aspects including people,machine,materials and environment was conducted.The related factors leading to the hospital-acquired infections in the patient were analyzed.RESULTS The child was diagnosed with severe aplastic anemia and underwent hematopoietic stem cell transplantation,the child was treated with various invasive procedures during the treatment period and was infected with pulmona-ry mucormycosis caused by the rare Cunninghamella bertholletiae.The occurrence of the pulmonary mucormyco-sis was associated with the poor management of medical textile,insufficient environmental cleaning and disinfec-tion and nonstandard invasive procedures.CONCLUSIONS The Cunninghamella bertholletiae infection is less com-mon,but the risk of death is high.It is necessary for the medical institutions to complete the prevention and con-trol measures and intensify the health care workers'capabilities in identification of the pathogenic fungus so as to reduce the incidence of pulmonary mucormycosis caused by the pathogen.

Objective To explore the value of vesical imaging reporting and data system(VI-RADS)combined with absolute tumor-wall contact length(ABTCL)and actual tumor-wall contact length(ACTCL)in diagnosing muscle invasive bladder cancer(MIBC).Methods The MRI data of 113 patients with pathologically confirmed bladder cancer(BCa)were analyzed retrospectively.All patients underwent conventional MRI,diffusion weighted imaging(DWI)and dynamic contrast enhanced(DCE)MRI before sur-gery.Two radiologists independently evaluated MRI images based on VI-RADS score,and measured quantitative parameters,inclu-ding ABTCL and ACTCL.The Chi-square test was used to compare the difference of VI-RADS scores between MIBC and non-mus-cle invasive bladder cancer(NMIBC).Quantitative parameters between MIBC and NMIBC were compared by Mann-Whitney U test.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of VI-RADS,quantitative parameters and VI-RADS combined with quantitative parameters in the diagnosis of MIBC.Results VI-RADS,ABTCL and ACTCL had significant differences between MIBC and NMIBC(P＜0.05).The area under the curve(AUC)for VI-RADS,ABTCL and ACTCL in diagno-sing MIBC were 0.89,0.76 and 0.77,respectively.There was no significant difference between the AUC for ABTCL and ACTCL(P＞0.05).The AUC for VI-RADS combined with ABTCL or ACTCL in diagnosing MIBC was 0.93,higher than that of only VI-RADS(P＜0.05).Conclusion The combination of VI-RADS with either ABTCL or ACTCL can effectively improve the diagnostic performance of MIBC.ABTCL obtainedby linear measurement is easier to implement in clinical practice than ACTCL obtained by curved measurement.

Objective To investigate the effect of different radiation doses on the accuracy of iodine quantification and CT value of virtual monochromatic image with a muti-spectral CT iodine phantom using second-generation dual-layer detector spectral CT(DLCT).Methods The second-generation DLCT scan abdominal phantom was used,which consisted of six different concentrations of iodine rods at 4,8 and 12 g/L.The scan parameters were set at 100,120 and 140 kVp tube voltages,and six radiation exposure sequences were scanned at each tube voltage:5,10,15,20,25 and 30 mGy.Measure the iodine concentration value and the CT value at the single level of 50,70 and 100 keV,and calculate the absolute error value of iodine concentration and CT value under different radiation exposure.SPSS 22.0 software single factor analysis of variance was used to compare the difference between the io-dine concentration and the absolute error of CT value under different Radiation exposure,and LSD method was used to compare the two groups.Results The absolute error of CT value of 4 g/L iodine rod with 10～30 mGy scanning at 100 keV energy level was significantly higher than that of 12 g/L and 8 g/L(P＜0.05),and the absolute error of iodine concentration measurement of other iodine rods with different concentrations at different Radiation exposure had no statistical difference.Conclusions The second-generation double-layer detector spectral CT has high meas-urement stability for iodine concentration quantification and CT value accuracy under conditions of radiation dose greater than 5 mGy.

Objective:To study the clinical value of N-terminal pro-B-type natriuretic peptide (NTproBNP) predicting the risk of bronchopulmonary dysplasia (BPD) in very/extremely low birth weight infants (VLBWI/ELBWI).Methods:From June 2017 to December 2019, VLBWI/ELBWI admitted to neonatal department in our hospital were enrolled in this non-interventional prospective study. According to the occurrence of BPD, the infants were assigned into BPD group and non-BPD group. Infants in BPD group were further assigned into mild, moderate and severe BPD groups. Plasma NTproBNP were measured on 14 d, 21 d, 28 d, 35 d, 42 d and 49 d after birth. Repeated-measures ANOVA was used to determine the differences of NTproBNP at different time points in each group.Results:A total of 190 infants were enrolled, including 36 cases in BPD group (18, 13 and 5 cases in mild, moderate and severe BPD group, respectively) and 154 cases in non-BPD group. The gestational age, birth weight and 5-min Apgar score in BPD group were lower than non-BPD group. BPD group had significantly higher incidences of retinopathy of prematurity, patent ductus arteriosus and necrotizing enterocolitis and significantly longer duration of invasive mechanical ventilation and noninvasive ventilation than non-BPD group ( P<0.05).No significant differences existed in NTproBNP levels between BPD group and non-BPD group on 42 d and 49 d ( P>0.05). At other time points, NTproBNP levels in BPD group were significantly higher than non-BPD group ( P<0.05). NTproBNP level in severe BPD group was the highest on 14 d. No significant differences existed in NTproBNP levels between mild and moderate groups on 28 d ( P>0.05). At other time points, NTproBNP in severe BPD group was higher than mild and moderate BPD groups ( P<0.001). The receiver operating characteristic curve analysis showed the best cut-off value of NTproBNP was 982 pg/ml on 14 d (AUC=0.907, 95% CI 0.831~0.983). Conclusions:VLBWI/ELBWI with BPD have higher levels of NTproBNP. And the more severe of BPD, the higher the NTproBNP level. NTproBNP has certain predictive values for BPD in VLBWI/ELBWI.

Obesity and its associated complications are highly related to a current public health crisis around the world. A growing body of evidence has indicated that G-protein coupled bile acid (BA) receptor TGR5 (also known as Gpbar-1) is a potential drug target to treat obesity and associated metabolic disorders. We have identified notoginsenoside Ft1 (Ft1) from

Objective:To investigate the clinical efficacy of budesonide formoterol combined with tiotropium bromide in the treatment of asthma chronic obstructive pulmonary disease(COPD) overlap (ACO).Methods:From January 2016 to December 2018, 160 ACO patients who met the inclusion criteria in the Department of Respiratory Medicine, Linxi Hospital, Kailuan General Hospitalwere selected as the observation objects.Prospective cohort study was used for observation and analysis.The patients were divided into study group and control group with 80 cases in each group by random number table.Both groups received conventional treatment, on this basis, control group received budesonide and formoterol powder inhalation, 1 inhalation/time, 2 times/d, study group received tiotropium bromide 1 granule/time, once a day based on the control group.Both groups were treated for 12 months.The clinical efficacy, lung function, blood gas analysis, inflammatory factors and T lymphocyte levels were compared between the two groups.Results:The total control rate in study group was 87.5%(70/80), significantly higher than that in control group (70.0%(56/80)), the difference was statistically significant (χ 2=7.32, P<0.05). After treatment, the asthma control test (ACT) scores in both groups increased significantly, while ACT scores in study group((23.12±3.12) point )was significantly higher than that in control group ((20.45±4.28) point, t=4.51, P<0.05). After treatment, the COPD assessment test (CAT) scores in both groups decreased significantly, while CAT scores in study group ((14.25±3.03) point ) was significantly lower than that in control group ((18.69±3.52) point, t=8.55, P<0.05). After treatment, the forced expiratory volume in 1s (FEV1), FEV1%, FEV1 /Forced vital capacity (FEV1/ FVC) and Inspiratory capacity / total lung capacity (IC/TLC) levels in both groups increased significantly, while FEV1((2.20±0.47)L), FEV1%((68.62±7.89)%), FEV1/ FVC((67.63±7.59)%)and IC/TLC levels(48.84±4.86)%) in study group were significantly higher than those in control group ((1.93±0.49)L, (61.88±7.65)%, (62.88±8.41)%, (43.22±5.15)%)(t value were 3.56, 5.49, 3.75, 7.10, all P<0.05). After treatment, the level of partial pressure of oxygen (PaO 2) in both groups increased significantly, while PaO 2 level in study group((78.12±6.45) mmHg) was significantly higher than that in control group ((72.45±7.52) mmHg)( t=5.12, P<0.05). After treatment, the arterial partial pressure of carbon dioxide (PaCO 2) level in both groups decreased significantly, while PaCO 2 level in study group((46.73±7.13) mmHg) was significantly lower than that in control group((49.81±8.02) mmHg) ( t=2.57, P<0.05). After treatment, the levels of IL-6, hs CRP and TNF-α in the two groups were decreased significantly, while IL-6, hs-CRP and TNF-α levels in study group((15.35±6.72) ng/L, (18.14±7.62) mg/L, (56.84±4.92) ng/L) were significantly lower than those in control group((21.42±5.35) ng/L, (23.35±8.64) mg/L, (69.45±8.51) ng/L) (t value were 6.32, 4.05, 11.47, all P<0.05). After treatment, the levels of CD4 + and CD4 +/CD8 + levels in both groups increased significantly, while CD4 + and CD4 +/CD8 + levels in study group((44.20±6.02)%, (1.82±0.31)) were significantly higher than those in control group((38.52±5.56)%, (1.43±0.29)) ( t=6.20, 8.22, all P<0.05). CD8 + level in both groups decreased significantly, while CD8 + level in study group((23.62±7.89)%) was significantly lower than that in control group((27.42±7.65)%)( t=3.09, P<0.05). Conclusion:Budesonide and formoterol combined with tiotropium bromide in the treatment of ACO has good clinical efficacy, reduce the level of inflammation, relieve the clinical symptoms of COPD and asthma, improve the respiratory function and lung function of patients, and have a good effect on improving the cellular immune function.

OBJECTIVE：To optim ize the ultrafiltration technology of enzymatic hydrolysate from Eucommia ulmoides peel. METHODS：The single factor test was adopted to investigate the effects of molecular weight of ultrafiltration membrane ，liquid temperature，operating pressure ，operating frequency ，membrane filtration time ，liquid concentration and pH on transfer rates of aucubin，geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel. Setting the molecular cut off of fixed ultrafiltration membrane of 100 000，liquid concentration of 7 g/L，and pH value of 7，the ultrafiltration technology was optimized by Box-Behnken design response-surface methodology and validated with liquid temperature ，operating pressure，operating frequency and membrane passing time as factors ，using comprehensive scores calculated from transfer rates of aucubin，geniposide and chlorogenic acid as well as solid removal rate as indexes. RESULTS ：The optimal ultrafiltration technology of enzymatic hydrolysate from E. ulmoides peel was as follows as liquid temperature of 35 ℃，operating pressure of 0.5 MPa，operating frequency of 35 Hz and membrane passing time of 42 min. Results of validation tests showed that the comprehensive scores of the transfer rates of aucubin ，geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel was 78.06％（RSD＝1.43％，n＝3），and its relative error with the predicted value （77.18％） was 1.14％. CONCLUSIONS ：The optimized ultrafiltration technology is stable and reliable ，and can be used for the ultrafiltration purification of enzymatic hydrolysate from E. ulmoides peel.

Objective:To establish a disease risk prediction model for the newborn screening system of inherited metabolic diseases by artificial intelligence technology.Methods:This was a retrospectively study. Newborn screening data ( n=5 907 547) from February 2010 to May 2019 from 31 hospitals in China and verified data ( n=3 028) from 34 hospitals of the same period were collected to establish the artificial intelligence model for the prediction of inherited metabolic diseases in neonates. The validity of the artificial intelligence disease risk prediction model was verified by 360 814 newborns ' screening data from January 2018 to September 2018 through a single-blind experiment. The effectiveness of the artificial intelligence disease risk prediction model was verified by comparing the detection rate of clinically confirmed cases, the positive rate of initial screening and the positive predictive value between the clinicians and the artificial intelligence prediction model of inherited metabolic diseases. Results:A total of 3 665 697 newborns ' screening data were collected including 3 019 cases ' positive data to establish the 16 artificial intelligence models for 32 inherited metabolic diseases. The single-blind experiment ( n=360 814) showed that 45 clinically diagnosed infants were detected by both artificial intelligence model and clinicians. A total of 2 684 cases were positive in tandem mass spectrometry screening and 1 694 cases were with high risk in artificial intelligence prediction model of inherited metabolic diseases, with the positive rates of tandem 0.74% (2 684/360 814)and 0.46% (1 694/360 814), respectively. Compared to clinicians, the positive rate of newborns was reduced by 36.89% (990/2 684) after the application of the artificial intelligence model, and the positive predictive values of clinicians and artificial intelligence prediction model of inherited metabolic diseases were 1.68% (45/2 684) and 2.66% (45/1 694) respectively. Conclusion:An accurate, fast, and the lower false positive rate auxiliary diagnosis system for neonatal inherited metabolic diseases by artificial intelligence technology has been established, which may have an important clinical value.

Objective:This study aimed to examine the prevalence of comorbid generalized anxiety disorder (GAD) among adult patients with major depressive disorder (MDD) in China and explore its potential risk factors.Methods:This is a multicenter, cross-sectional study, involving 1 086 patients in 9 clinical settings. The diagnosis of MDD and GAD were confirmed by the MINI. Life events were evaluated by the Life Events Scale (LES), and early life stress was assessed by the Childhood Trauma Questionnaire (CTQ). The severity of depression, social support, coping style and personality traits were assessed by Hamilton Depression Rating Scale-17 item (HAMD 17), Simplified Coping Style Questionnaire (SCSQ), and Eysenck Personality Questionnaire, short scale for China (EPQ-RSC), respectively. Pearson correlation analysis, univariate regression analysis and Logistic regression analysis were used to explore the association of clinical characteristics, life stress, social factors and comorbidity of MDD and GAD. Results:Among 1 086 MDD patients, 276 of them (25.4%) were diagnosed with comorbid GAD. Patients with comorbid GAD were more likely to report adulthood adversity then those without (60.2% （165/276） vs. 39.9%（321/810）, χ2=33.993， P<0.01). However, there was no difference in social support and coping styles between the two groups. Furthermore, patients with comorbid GAD had higher levels of neuroticism, and lower levels of extraversion. After controlling for confounders, logistic regression results showed that adulthood adversity ( OR=1.720, 95% CI 1.262-2.343, P<0.01) and higher neuroticism levels (O R=1.211, 95% CI 1.141-1.286, P<0.01) were significantly associated with comorbid GAD in patients with MDD. Conclusion:Adulthood adversity and high levels of neuroticism were potential risk factors of comorbidity of MDD and GAD. This finding provides empirical evidence for developing targeted interventions for this subgroup population with MDD.