Rosacea is a chronic recurrent inflammatory skin disease, and correct assessment of clinical symptoms and severity may facilitate treatment options. This review summarizes a range of subjective, semi-subjective and objective methods currently used in the assessment of rosacea severity, in order to provide useful tools for clinical assessment of rosacea severity and give guidance on treatment modification according to the therapeutic effect.

Rosacea is a chronic facial inflammatory skin disease. It has been proved that heredity, immunity, neurovascular disorders, microorganisms, skin barrier damage and ultraviolet rays are closely related to the occurrence of rosacea. However, the exact pathogenesis of rosacea has not been fully elucidated. This review summarizes recent advances in the pathogenesis of rosacea in the past 5 years.

Background and purpose:According to current consensus,adverse high-risk pathological features are only associated with adjuvant therapy for stage Ⅱ colorectal cancer(CRC).As important prognostic factors,we further explored the possibility of identifying patients with potential recurrence and poor prognosis based on these incorporating high-risk pathological features.Methods:This is a cohort study.A retrospective analysis was conducted on clinical data of CRC patients who underwent surgical treatment at the Second Department of Colorectal Surgery,Fudan University Affiliated Shanghai Cancer Center from 2008 to 2018.This study was approved by the Ethics Committee of the Fudan University Shanghai Cancer Center(approval No.:050432-4-2108*),and the study complies with the Declaration of Helsinki.A total of 9875 patients were enrolled,including 5859 males and 4016 females,aged[M(IQR)]60(16)years(range:16 to 94).Median follow-up time was 1779.0 days[95%CI:1750.1-1807.9].We used the Kaplan-Meier method to plot survival curves for different groups.Cox multivariate analysis was used to identify independent risk factors for 5-year overall survival(OS),disease-free survival(DFS)and recurrence-free survival(RFS).Finally,a column chart model was constructed to evaluate and stratify patient prognosis.The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this cohort study.Results:According to the number of incorporating high-risk pathological features,patients were divided into five groups:Hr_0 group(0 incorporating high-risk pathological feature),Hr_1 group(1 incorporating high-risk pathological feature),Hr_2 group(2 incorporating high-risk pathological features),Hr_3 group(3 incorporating high-risk pathological features),and Hr_4 group(4 or more incorporating high-risk pathological features).The Kaplan-Meier survival curve results indicated significant differences in OS,DFS and RFS among different groups(all P<0.001).Subgroup analysis was conducted on stage Ⅱ colorectal cancer,and the survival curves of OS,DFS and RFS in different Hr groups overlapped with each other.Compared to the overall population,the survival differences in different groups were significantly reduced,indicating that stage Ⅱ colon cancer patients with incorporating high-risk pathological features may benefit from adjuvant chemotherapy.The independent prognostic factors for RFS included age,pT stage,pN stage and Hr group.The survival curves of OS,DFS and RFS indicated that the prognosis of Hr_4 group was significantly worse than that of stage Ⅲc patients;5.2%and 14.1%of stage Ⅰ and Ⅱ patients had two or more incorporating high-risk pathological features(Hr group≥2),respectively.Finally,a column chart model was constructed by incorporating the independent prognostic risk factors for CRC mentioned above.The calibration curve showed a good consistency between the actual observations and the predictions made by the nomogram,and the decision curve analysis(DCA)indicated that the model constructed in this study had good efficacy in stratifying recurrence.Conclusion:The number of incorporating high-risk pathological features is an independent prognostic factor for RFS in patients with stage Ⅰ-ⅢCRC.Combining it as a multiclass variable with age,pT and pN stage has good prognostic stratification and recurrence stratification efficacy,which is expected to guide clinical treatment.

Objective To explore the pain catastrophizing (PC) level of pain in patients with multiple fractures and its influencing factors. Methods A convenience sampling method was used to investigate 156 patients with multiple fractures in the orthopedic trauma department of the First Affiliated Hospital of Nanjing Medical University. The questionnaire included a general information survey, a Digital Pain Rating Scale, PC scale, Positive and Negative Emotion Scale, and Social Rating Scale. Results The average PC score of patients with multiple fractures was (23.22±12.05), with 27 patients (17.20%) reaching the PC level. The average score of the Digital Pain Rating Scale was (6.30±1.49), the score of the Positive Emotion Scale was (27.92±6.06), the score of the Negative Emotion Scale was (23.18±7.00), and the total score of the Social Rating Scale was (27.90±4.61). The results of multiple linear regression analysis showed that pain score, negative emotion level, and social support level had predictive effects in PC among patients with multiple fractures. Conclusion The incidence of PC among patients with multiple fractures is at a moderate to high level. Patients with high pain scores, high negative emotion scores, and low social support are more likely to develop PC.

Objective To construct a model for predicting recidivism in violence in community-based schizophrenia spectrum disorder patients(SSDP)by adopting a joint modeling method.Methods Based on the basic data on severe mental illness in Southwest China between January 2017 and June 2018,4565 community-based SSDP with baseline violent behaviors were selected as the research subjects.We used a growth mixture model(GMM)to identify patterns of medication adherence and social functioning.We then fitted the joint model using a zero-inflated negative binomial regression model and compared it with traditional static models.Finally,we used a 10-fold training-test cross validation framework to evaluate the models'fitting and predictive performance.Results A total of 157 patients(3.44%)experienced recidivism in violence.Medication compliance and social functioning were fitted into four patterns.In the counting model,age,marital status,educational attainment,economic status,historical types of violence,and medication compliance patterns were predictive factors for the frequency of recidivism of violence(P＜0.05).In the zero-inflated model,age,adverse drug reactions,historical types of violence,medication compliance patterns,and social functioning patterns were predictive factors for the recidivism in violence(P＜0.05).For the joint model,the average value of Akaike information criterion(AIC)for the train set was 776.5±9.4,the average value of root mean squared error(RMSE)for the testing set was 0.168±0.013,and the average value of mean absolute error(MAE)for the testing set was 0.131±0.018,which were all lower than those of the traditional static models.Conclusion Joint modeling is an effective statistical strategy for identifying and processing dynamic variables,exhibiting better predictive performance than that of the traditional static models.It can provide new ideas for promoting the construction of comprehensive intervention systems.

Humans ; Skin ; Rosacea ; Patients

Objective To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two.Methods A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018.In addition,based on the outcome-wide analysis strategy,a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients.Results In this 13-year prospective cohort,65 175 patients(31.4％)showed good medication adherence,while 142 394 patients(68.6％)showed poor medication adherence.The incidence rates of various risky behaviors during the follow-up period were as follows,minor nuisances,12.25％,violation of the Law of the People's Republic of China on Penalties for Administration of Public Security(APS law),3.82％,violation of criminal law,0.94％,suicide completed,0.28％,self-harm,1.42％,and attempted suicide,0.82％.Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did,with the associated effects being minor nuisances(hazard ratio[HR]=1.31,95％confidence interval[CI]:1.27-1.35),violation of APS law(HR=1.47,95％CI:1.38-1.56),violation of criminal law(HR=1.17,95％CI:1.05-1.31),and self-harm(HR=1.43,95％CI:1.32-1.56),respectively,while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence(HR=0.56,95％CI:0.47-0.66).There was no statistically significant association between attempted suicide and medication adherence.Conclusion There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.

Objective To investigate the effect of fecal microbiota transplantation (FMT) on a rat model of hypertriglyceridemic acute pancreatitis (HLAP). Methods A total of 72 male Sprague-Dawley rats were randomly divided into sham-operation group, model group, Rheum officinale group, and fecal microbiota group, with 18 rats in each group. After 8 weeks of feeding with high-fat diet, the rats in the sham-operation group were given sham operation, and those in the other three groups were given retrograde pancreaticobiliary injection of 5% sodium taurocholate to induce acute pancreatitis; after modeling, the rats in the Rheum officinale group were given enema with Rheum officinale , and those in the fecal microbiota group were given enema with fresh fecal microbiota solution. Blood, pancreatic, and terminal ileal tissue samples were collected at 6, 24, and 36 hours after surgery. HE staining was used to observe histopathological changes of the pancreas and the intestine; an automatic biochemical analyzer was used to measure the serum levels of amylase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HLD-C); ELISA was used to measure the serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and endotoxin as an index for intestinal permeability. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test or the Tamhane T2 test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Bonferroni method was used for further comparison between two groups. Results Compared with the sham-operation group, the Rheum officinale group and the fecal microbiota group had no significant increase in the pathological score of the terminal ileum at 6 and 24 hours, and there was no significant difference between the fecal microbiota group and the sham-operation group at 36 hours (all P > 0.05). At 36 hours, the Rheum officinale group and the fecal microbiota group had a significantly lower serum level of amylase than the model group (all P < 0.05). Compared with the model group, the Rheum officinale group had a significantly lower serum level of ALT at 36 hours ( P < 0.05) and a significantly lower serum level of AST at 24 hours ( P < 0.05), while the fecal microbiota group had a significantly lower level of ALT at each time point ( P < 0.05) and a significantly lower serum level of AST at 24 and 36 hours (all P < 0.05). The Rheum officinale group and the fecal microbiota group had significant reductions in the serum levels of TC and TG (all P < 0.05); compared with the Rheum officinale group, the fecal microbiota group had a significantly higher serum level of HDL-C at 24 and 36 hours (all P < 0.05), and compared with the model group, the fecal microbiota group had a significantly lower serum level of HDL-C at each time period (all P < 0.05). There were no significant differences in the inflammatory indices IL-6 and TNF-α between the fecal microbiota group and the sham-operation group at each time point (all P > 0.05), and the Rheum officinale group had significantly higher levels than the sham-operation group (all P < 0.05); both the Rheum officinale group and the fecal microbiota group had a significantly lower serum level of endotoxin than the model group (all P < 0.05), and the fecal microbiota group had a significantly lower level of endotoxin than the Rheum officinale group within 6 hours of treatment ( P < 0.05). Conclusion Both Rheum officinale and fecal microbiota transplantation can improve tissue inflammation and intestinal permeability in HLAP rats and can improve lipid metabolism and alleviate the progression of pancreatitis to a certain extent, and fecal microbiota transplantation shows a better clinical effect than Rheum officinale alone, but more randomized controlled trials are needed for further investigation.

Objective:To observe the effect of gaze stabilization exercises on the balance of stroke patients.Methods:Forty stroke patients were randomly divided into an experimental group ( n=20) and a control group ( n=20). Both groups were given conventional rehabilitation therapy, while the experimental group was additionally provided with gaze stabilization exercises, once a day, five days a week, for a total of four weeks. Each session lasted 30 minutes. Before and after the four weeks, both groups were evaluated in terms of their envelope ellipse area and the plantar pressure distribution on the affected side in static standing and using the anterior-posterior center of pressure displacement velocity (AP-COPV). They were also assessed using the Berg Balance Scale (BBS), the timed up-and-go test (TUGT), and the Activities-specific Balance Confidence Scale (ABC). Results:After the gaze stabilization exercises, the average envelope ellipse area, the plantar pressure distribution of the affected side with the eyes open and closed, AP-COPV, BBS score, TUGT time and ABC score of the experimental group were significantly superior to the control group′s averages and to the results four weeks previously.Conclusions:Gaze stabilization exercises can improve balance, weight shifting and one-leg standing after a stroke. That should enhance balance confidence and reduce the risk of falling.

Objective To investigate the development of rehabilitation medical resources in Jiangsu during Thirteenth Five-year Plan.Methods The electronic questionnaire was issued uniformly to the medical and health institutions in 13 prefecture-level cities in Jiangsu Province through the Health Commission system, to survey the rehabilitation medical resources data from 2015 to 2019.Results Compared with those in 2015, the secondary and above general hospitals with rehabilitation medicine departments increased 3.42 percentage points and community-level medical and healthcare institutions providing rehabilitation medical services increased 5.67 percentage points at the end of 2019; while, the authorized beds increased 127 and actual beds increased 142 in the rehabilitation department per million population; the early rehabilitation intervention increased 4 326 person-times per million population; there were 91 more rehabilitation professionals per million population, including 25 rehabilitation physicians, 31 rehabilitation therapists, 29 rehabilitation nurses and six other rehabilitation practitioners; the practitioners with associate senior titles and above increased 1.65 percentage points, and those with master-degree or above increased 1.27 percentage points.Conclusion The allocation of various rehabilitation resources has been improved in Jiangsu province during Thirteenth Five-year Plan.