Objective:To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer.Methods:This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group ( n=75) and a non-delirium group ( n=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results:The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender ( OR=2.802, P=0.005), perioperative sleep disturbances ( OR=7.104, P<0.001), and moderate-to-severe postoperative pain ( OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions:Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.

Objective:To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer.Methods:This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group ( n=75) and a non-delirium group ( n=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results:The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender ( OR=2.802, P=0.005), perioperative sleep disturbances ( OR=7.104, P<0.001), and moderate-to-severe postoperative pain ( OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions:Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.

Objective:To investigate whether ultra-high dose rate (FLASH) irradiation can reduce radiation-induced intestinal injuries of mice compared to conventional dose rate (CONV) irradiation.Methods:Both FLASH and CONV irradiation were delivered with electron beam, with dose rates of 750 Gy/s and 0.5G y/s, respectively. A total of 105 mice were randomly divided into groups using a simple randomization method. Twenty-one mice were selected for weight observation, 7 mice in each group. After 9 Gy FLASH and CONV irradiation on the abdomen, the weight changes of mice were measured every other day, and compared among three groups. Twenty-four mice were selected for pathological examination including 5 mice in the control group. Three-and-a-half-day days after 12 Gy FLASH ( n=10) and CONV irradiation ( n=9) on the abdomen, the intestines of the mice were taken. Pathological sections were stained with hematoxylin-eosin (HE) to compare the number and percentage of regenerated crypts of the small intestine between two groups. After 12 Gy FLASH ( n=10) and CONV irradiation ( n=10) on the abdomen, the survival of 20 mice was observed. After FLASH using 4.5 Gy×2 times ( n=10) and CONV irradiation at 9 Gy×1 time ( n=10) on the abdomen, the weight changes were observed. After FLASH using 6 Gy×2 times ( n=10) and CONV irradiation at 12 Gy×1 time ( n=10) on the abdomen, the survival of mice was observed. The time interval between two irradiation was 1 min. EBT3 film was employed to monitor the actual exposure dose of the mice. The variables conforming to normal distribution were expressed by Mean±SD. Inter group comparison was performed by independent t-test. The survival of mice among different groups was compared by log-rank test. Results:After 9 Gy of abdominal irradiation, the mean weight of mice in the FLASH group was significantly higher than that in the CONV group. The weight of mice in the FLASH and CONV groups was (19.8±0.8) g and (18.0±1.8)g ( P=0.036) at 7 days after irradiation, (22.0±1.0)g and (21.2±0.5)g ( P=0.075) at 15 days after irradiation, and (24.2±1.4)g and (22.0±1.2)g ( P=0.012) at 25 days after irradiation, respectively. After 12 Gy irradiation, the mean survival of mice in FLASH and CONV groups was 4 days and 4.7 days ( P=0.029). After 12 Gy total abdominal irradiation, the mean number of intestinal regenerative crypts in the FLASH and CONV groups was 2.9/mm and 1.2/mm ( P=0.041), and the percentage of intestinal regenerative crypts was 34.1% and 14.1%, respectively. The survival of mice irradiated by FLASH using 6 Gy×2 times was longer compared with that of mice after CONV irradiation at 12 Gy×1 time. The weight of mice after 4.5 Gy×2 times irradiation was higher than that of mice after CONV irradiation at 9 Gy×1 time. Conclusion:Weight, survival and the number of intestinal regenerative crypts in the FLASH group are higher than those in the CONV group after irradiation, indicating that radiation-induced intestinal injury caused by FLASH irradiation is slighter than that of CONV irradiation.

Objective To explore the occlusal contact designs in accordance with biomechanical principles in the All-on-4 immediate loading scheme of the edentulous maxilla with four kinds of framework materials.Methods Cone beam CT of an edentulous maxilla was selected.The cone beam CT data,crown,framework,abutment and implant data were used and the titanium,cobalt-chromium al-loy,polyetheretherketone(PEEK)and resin framework materials were specified.The finite element models were divided into 4 groups,according to whether the anterior teeth or the cantilever had occlusal contact(AC group:both the anterior teeth and the cantilever were loaded;ANC group:load on the anterior teeth and no load on the cantilever;NAC group:no load on the anterior teeth and load on the cantilever;NANC group:no load on both the anterior teeth and the cantilever).The stress of cortical bone,implant and framework,the micromotion of implant and the deformation of framework were calculated and statistical analysis was then performed.Results Among the four types of framework materials,in terms of cortical bone peak stress,the NAC group had the highest value and the ANC group had the lowest.There was a statistical difference between the NAC group and the other three groups respectively(P＜0.05).With the four framework materials,in terms of the peak stress of implant,the ANC group had the highest.When the framework material was PEEK or resin,there was a significant difference between the ANC group and the other three groups(P＜0.05).The peak stress value of the framework compared,the NAC group had the highest peak stress and was significantly different from the other three groups(P＜0.05).The ANC group had the lowest peak stress and was significantly differ-ent from the other three groups(P＜0.05)when the framework material was titanium or cobalt-chromium alloy.If the framework material was PEEK or resin,there were no statistical differences between the four occlusal schemes.Comparing the peak micromotion of implant or the peak deformation of framework,the ANC/NAC group was significantly higher than the AC/NANC group(P＜0.05).Among the different framework materials,titanium and cobalt-chromium alloy had higher peak stress of framework compared to PEEK and resin(P＜0.05),with less stress transmitted to the cortical bone and implant(P＜0.05).Conclusion ①In terms of occlusal contact design,when the All-on-4 immediate loading scheme is applied to the edentulous maxilla,the scheme that the anterior teeth loaded and the cantilever unloaded(ANC)is more conducive to the stress distribution of bone-implant interface.②The application of load on both anterior teeth and cantilever(AC)or the absence of load on both anterior teeth and cantilever(NANC)is favourable for reducing the peak micromo-tion of implant and the peak deformation of framework.③Among the four types of framework materials,titanium or cobalt-chromium al-loy framework transmit less stress to the bone-implant interface than PEEK or resin framework.

BACKGROUND: Hepatitis B surface antigen (HBsAg) clearance is vital for a functional cure of hepatitis B virus (HBV) infection. However, the incidence and predictors of HBsAg seroclearance in patients co-infected with HBV and human immunodeficiency virus (HIV) remain largely unknown in Guangdong, China. METHODS: Between 2009 and 2019, patients co-infected with HBV/HIV undergoing antiretroviral therapy (ART) in Guangzhou Eighth People's Hospital affiliated to Guangzhou Medical University were retrospectively reviewed with the endpoint on December 31, 2020. The incidence and risk factors for HBsAg seroclearance were evaluated using Kaplan-Meier and multivariate Cox regression analyses. RESULTS: A total of 1550 HBV/HIV co-infected patients were included in the study, with the median age of 42 years and 86.0% (1333/1550) males. Further, 98.3% (1524/1550) received ART containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC). HBV DNA was examined in 1283 cases at the last follow-up. Over the median 4.7 years of follow-up, 8.1% (126/1550) patients achieved HBsAg seroclearance, among whom 50.8% (64/126) obtained hepatitis B surface antibody, 28.1% (137/488) acquired hepatitis B e antigen seroconversion, and 95.9% (1231/1283) undetectable HBV DNA. Compared with patients who maintained HBsAg positive, cases achieving HBsAg seroclearance showed no differences in age, gender, CD4 + T cell count, alanine aminotransferase (ALT) level, or fibrosis status; however, they presented lower HBV DNA levels, lower HBsAg levels, and higher rates of HBV genotype B at the baseline. Multivariate analysis showed that baseline HBsAg <1500 cutoff index (COI) (adjusted hazard ratio [aHR], 2.74, 95% confidence interval [95% CI]: 1.48-5.09), ALT elevation >2 × upper limit of normal during the first six months after receiving ART (aHR, 2.96, 95% CI: 1.53-5.77), and HBV genotype B (aHR, 3.73, 95% CI: 1.46-9.59) were independent predictors for HBsAg seroclearance (all P <0.01). CONCLUSIONS Long-term TDF-containing ART has high anti-HBV efficacy including relatively high overall HBsAg seroclearance in HBV/HIV co-infected patients. Lower baseline HBsAg levels, HBV genotype B, and elevated ALT levels during the first six months of ART are potential predictors of HBsAg seroclearance.
Male ; Humans ; Adult ; Hepatitis B Surface Antigens ; Hepatitis B virus/genetics* ; HIV Infections/drug therapy* ; HIV ; DNA, Viral ; Incidence ; Coinfection/drug therapy* ; Retrospective Studies ; Tenofovir/therapeutic use* ; Lamivudine/therapeutic use* ; Hepatitis B, Chronic/drug therapy*

Diabetic neuropathic pain (DNP) is the most common disabling complication of diabetes. Emerging evidence has linked the pathogenesis of DNP to the aberrant sprouting of sensory axons into the epidermal area; however, the underlying molecular events remain poorly understood. Here we found that an axon guidance molecule, Netrin-3 (Ntn-3), was expressed in the sensory neurons of mouse dorsal root ganglia (DRGs), and downregulation of Ntn-3 expression was highly correlated with the severity of DNP in a diabetic mouse model. Genetic ablation of Ntn-3 increased the intra-epidermal sprouting of sensory axons and worsened the DNP in diabetic mice. In contrast, the elevation of Ntn-3 levels in DRGs significantly inhibited the intra-epidermal axon sprouting and alleviated DNP in diabetic mice. In conclusion, our studies identified Ntn-3 as an important regulator of DNP pathogenesis by gating the aberrant sprouting of sensory axons, indicating that Ntn-3 is a potential druggable target for DNP treatment.
Mice ; Animals ; Diabetes Mellitus, Experimental/metabolism* ; Axons/physiology* ; Diabetic Neuropathies ; Sensory Receptor Cells/metabolism* ; Neuralgia/metabolism*

Objective To understand the correlation between atmospheric particulate matter and confirmed cases of influenza in Pudong New Area, Shanghai, and to provide a basis for formulating relevant control measures. Methods The meteorological factors (average temperature, relative humidity, and atmospheric pressure), atmospheric pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) and confirmed cases of influenza of different ages and genders from January 1, 2014 to December 31, 2018 were collected. Data was fitted to a generalized additive model of Poisson distribution to assess the correlation between atmospheric particulate matter (PM_2.5, PM₁₀) and the number of confirmed cases of influenza. Results There was a correlation between atmospheric particulate matter and the number of confirmed cases of influenza in Pudong New Area. For each increase of 10 μg/m³ in the concentration of the two types of particulate matter, the confirmed cases increased by 0.638% (95%CI: 0.413%~0.864%), and 0.520% (95%CI: 0.324%~0.715%), respectively, when the lag was 0-7d (lag07). People of different ages and genders were affected by atmospheric particulate matter differently. After incorporating the effects of SO₂, NO₂, CO, and O₃ in the multi-pollutant model, the effect of atmospheric particulate matter on the number of influenza cases had changed. Conclusion The increase of atmospheric particulate matter (PM_2.5, PM₁₀) concentration increased the number of confirmed cases of influenza in Pudong New Area.

Clostridioides difficile is a key pathogen of antibiotic related diarrhea and hospital associated infection, causing several outbreaks in Europe and North Americans and resulting in severe disease burden. However, the standardized diagnostic principle and detection specifications in C. difficile infection (CDI) survey are limited in China, and the infection rate and disease burden of CDI in China are unclear. Therefore, National Institute for Communicable Disease Control and Prevention,National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, together with another 11 institutions, draft the group standard entitled "Diagnosis of Clostridium difficile infection (T/CPMA 008-2020)" of Chinese Preventive Medicine Association. Based on the principle of "legality, scientificity, advancement, and feasibility", this standard clarifies risk factors, diagnosis principles, diagnoses and differential diagnoses in order to improve the accuracy of CDI diagnosis in clinical practice, guide the surveillance for CDI, and understand the infection rate and disease burden of CDI in China .

Objective:To explore the application effect of traditional Chinese medicine iontophoresis in patients with diabetic peripheral neuropathy (DPN) of Qi deficiency and blood stasis type.Methods:Using the convenient sampling method, a total of 72 patients with DPN of Qi deficiency and blood stasis type who were admitted to Department of Endocrinology of Pudong New Area Hospital of Traditional Chinese Medicine in Shanghai from January to June 2019 were selected as the research objects. According to the random number table method, 72 patients with DPN of Qi deficiency and blood stasis were randomly divided into the experimental group and the control group, with 36 cases in each group. Patients in the control group were given conventional treatment and health education. On this basis, patients in the experimental group were given traditional Chinese medicine iontophoresis at Zusanli and Sanyinjiao points on both sides for 14 days of intervention. Visual Analogue Scale (VAS) , Toronto Clinical Scoring System (TCSS) and Pittsburgh Sleep Quality Index (PSQI) were used to compare the limb pain, neural symptoms and sleep quality of the two groups before and after intervention.Results:Finally, 34 patients in the experimental group and 35 patients in the control group completed the study. After the intervention, VAS scores of the two groups were lower than those before the intervention and that of the experimental group was lower than that of the control group, and the differences were all statistically significant ( P<0.05) . After the intervention, the total scores of TCSS, sensory function scores and neural symptoms scores of the two groups decreased compared with those before the intervention, and those of the experimental group were lower than those of the control group, and the differences were all statistically significant ( P<0.05) . After the intervention, PSQI of the two groups decreased, and that of the experimental group was lower than that of the control group, and the differences were all statistically significant ( P<0.05) . Conclusions:Traditional Chinese medicine iontophoresis can alleviate the limb pain of patients with DPN of Qi deficiency and blood stasis, improve the sensory function, neural symptoms and TCSS score of them and improve sleep problems caused by limb pain.