Objective To compare the efficacy and safety of erector spinae plane block(ESPB)and thoracic paravertebral block(TPVB)in preventing acute post-surgical pain syndrome(PSP)of breast cancer.Methods The following databases,both domestic and international,including Embase,Cochrane Library,Web of Science,PubMed,CNKI,VIP,Wanfang,and Sinomed,were searched via computer to gather clinical randomized controlled trials(RCTs)on ESPB and TPVB for breast cancer patients.The included literature was evaluated using the Cochrane bias risk assessment tool to assess quality,and meta-analysis was performed using Review Manager 5.4 software and Stata 17.0 software.Results This study comprised 14 RCTs,with a total of 1079 patients,including 540 ESPB patients and 539 TPVB patients.The analysis results indicated that there was a significant difference in pain scores during postoperative rest between ESPB and TPVB during 3-4 h(I2=53%,SMD=0.36,95%CI:0.07-0.65,P=0.020)and 5-6 h(I2=80%,SMD=0.53,95%CI:0.05-1.01,P=0.030),with TPVB being superior to ESPB.However,there was no significant difference in pain scores during postoperative rest between ESPB and TPVB at 1-2 h(I2=75%,SMD=0.28,95%CI:-0.03-0.60,P=0.080),7-8 h(I2=89%,SMD=0.24,95%CI:-0.47-0.94,P=0.510),12 h(I2=90%,SMD=0.1,95%CI:-0.40-0.60,P=0.690),24 h(I2=78%,SMD=0.33,95%CI:-0.04-0.70,P=0.080),and 48 h(I2=85%,SMD=-0.05,95%CI:-0.52-0.42,P=0.830).For the pain score during postoperative exercise,there was a significant difference between ESPB and TPVB during 3-4 h(I2=0,SMD=0.29,95%CI:0.09-0.48,P=0.004),7-8 h(I2=48%,SMD=0.37,95%CI:0.00-0.73,P=0.050),and 48 h(I2=0,SMD=0.21,95%CI:0.03-0.39,P=0.020),with TPVB being su-perior to ESPB.There was no significant difference between ESPB and TPVB at 1-2 h(I2=89%,SMD=0.42,95%CI:-0.19-1.03,P=0.180),5-6 h(I2=90%,SMD=0.29,95%CI:-0.67-1.24,P=0.560),12 h(I2=81%,SMD=0.25,95%CI:-0.22-0.72,P=0.300),and 24 h(I2=83%,SMD=0.39,95%CI:-0.10-0.89,P=0.120).There was a statistical difference in the operation time of nerve blocks between the two methods,with ESPB taking less time than TPVB(P＜0.001).However,there was no statistical difference in opioid consumption within 24 h after surgery,incidence of nausea and vomiting,and the first PCIA press time(all P＞0.05).Conclusions Compared to ESPB,TPVB tends to result in a decreased pain score after breast cancer surgery,but it also took longer to perform.There was no significant difference be-tween the two methods in terms of opioid consumption at 24 h after surgery,incidence of nausea and vomiting and the first PCIA press time.

Objective To compare the efficacy and safety of erector spinae plane block(ESPB)and thoracic paravertebral block(TPVB)in preventing acute post-surgical pain syndrome(PSP)of breast cancer.Methods The following databases,both domestic and international,including Embase,Cochrane Library,Web of Science,PubMed,CNKI,VIP,Wanfang,and Sinomed,were searched via computer to gather clinical randomized controlled trials(RCTs)on ESPB and TPVB for breast cancer patients.The included literature was evaluated using the Cochrane bias risk assessment tool to assess quality,and meta-analysis was performed using Review Manager 5.4 software and Stata 17.0 software.Results This study comprised 14 RCTs,with a total of 1079 patients,including 540 ESPB patients and 539 TPVB patients.The analysis results indicated that there was a significant difference in pain scores during postoperative rest between ESPB and TPVB during 3-4 h(I2=53%,SMD=0.36,95%CI:0.07-0.65,P=0.020)and 5-6 h(I2=80%,SMD=0.53,95%CI:0.05-1.01,P=0.030),with TPVB being superior to ESPB.However,there was no significant difference in pain scores during postoperative rest between ESPB and TPVB at 1-2 h(I2=75%,SMD=0.28,95%CI:-0.03-0.60,P=0.080),7-8 h(I2=89%,SMD=0.24,95%CI:-0.47-0.94,P=0.510),12 h(I2=90%,SMD=0.1,95%CI:-0.40-0.60,P=0.690),24 h(I2=78%,SMD=0.33,95%CI:-0.04-0.70,P=0.080),and 48 h(I2=85%,SMD=-0.05,95%CI:-0.52-0.42,P=0.830).For the pain score during postoperative exercise,there was a significant difference between ESPB and TPVB during 3-4 h(I2=0,SMD=0.29,95%CI:0.09-0.48,P=0.004),7-8 h(I2=48%,SMD=0.37,95%CI:0.00-0.73,P=0.050),and 48 h(I2=0,SMD=0.21,95%CI:0.03-0.39,P=0.020),with TPVB being su-perior to ESPB.There was no significant difference between ESPB and TPVB at 1-2 h(I2=89%,SMD=0.42,95%CI:-0.19-1.03,P=0.180),5-6 h(I2=90%,SMD=0.29,95%CI:-0.67-1.24,P=0.560),12 h(I2=81%,SMD=0.25,95%CI:-0.22-0.72,P=0.300),and 24 h(I2=83%,SMD=0.39,95%CI:-0.10-0.89,P=0.120).There was a statistical difference in the operation time of nerve blocks between the two methods,with ESPB taking less time than TPVB(P＜0.001).However,there was no statistical difference in opioid consumption within 24 h after surgery,incidence of nausea and vomiting,and the first PCIA press time(all P＞0.05).Conclusions Compared to ESPB,TPVB tends to result in a decreased pain score after breast cancer surgery,but it also took longer to perform.There was no significant difference be-tween the two methods in terms of opioid consumption at 24 h after surgery,incidence of nausea and vomiting and the first PCIA press time.

Objective:To analyze the allocation of general practitioners per 10 000 population in China and its influencing factors, so as to provide reference for optimizing the allocation of general practitioners resources in China.Methods:The number of general practitioners per 10 000 population and other relevant data of 31 provinces (except Hong Kong, Macao and Taiwan) in China from 2012 to 2021 were collected from China Statistical Yearbook, China Health Statistics Yearbook, China Health and Family Planning Statistical Yearbook. The geographical area data of 31 provinces (except Hong Kong, Macao and Taiwan) from 2012 to 2021 were retrieved from the website of the Central People ′s Government. The influencing factors of the number of general practitioners per 10 000 population were preset by literature analysis and unstructured interview. Taking the number of general practitioners per 10 000 population as the dependent variable, the correlation between it and the preset influencing factors was analyzed by panel data regression. Results:From 2012 to 2021, the average annual growth rate of the number of general practitioners per 10 000 population in each province of China was greater than 0. The factors affecting the number of general practitioners per 10 000 population included the number of people per square kilometer ( r=3.818, P<0.01), the number of beds in medical and health institutions per capita ( r=2.135, P<0.01), the proportion of the elderly population aged 65 and above ( r=0.180, P<0.01), and the proportion of total expenditure in medical and health institutions to gross domestic product ( r=0.080, P<0.01). Conclusions:The development trend of general practitioners resources allocation in China is good, but the government needs to integrate the population agglomeration and aging trend, the allocation of medical and health resources, the investment support for the development of general practitioners and other influencing factors, optimize the allocation of general practitioners resources according to local conditions, and strengthen policy support for areas and links where the allocation of general practitioners resources is relatively weak.

Background::While type 2 diabetes mellitus (T2DM) is considered a putative causal risk factor for coronary artery disease (CAD), the intrinsic link underlying T2DM and CAD is not fully understood. We aimed to highlight the importance of integrated care targeting both diseases by investigating the phenotypic and genetic relationships between T2DM and CAD.Methods::We evaluated phenotypic associations using data from the United Kingdom Biobank ( N = 472,050). We investigated genetic relationships by leveraging genomic data conducted in European ancestry for T2DM, with and without adjustment for body mass index (BMI) (T2DM: Ncase/ Ncontrol = 74,124/824,006; T2DM adjusted for BMI [T2DM adjBMI]: Ncase/ Ncontrol = 50,409/523,897) and for CAD ( Ncase/ Ncontrol = 181,522/984,168). We performed additional analyses using genomic data conducted in multiancestry individuals for T2DM ( Ncase/ Ncontrol = 180,834/1,159,055). Results::Observational analysis suggested a bidirectional relationship between T2DM and CAD (T2DM→CAD: hazard ratio [HR] = 2.12, 95% confidence interval [CI]: 2.01–2.24; CAD→T2DM: HR = 1.72, 95% CI: 1.63–1.81). A positive overall genetic correlation between T2DM and CAD was observed ( rg = 0.39, P = 1.43 × 10 -75), which was largely independent of BMI (T2DM adjBMI–CAD: rg = 0.31, P = 1.20 × 10 –36). This was corroborated by six local signals, among which 9p21.3 showed the strongest genetic correlation. Cross-trait meta-analysis replicated 101 previously reported loci and discovered six novel pleiotropic loci. Mendelian randomization analysis supported a bidirectional causal relationship (T2DM→CAD: odds ratio [OR] = 1.13, 95% CI: 1.11-1.16; CAD→T2DM: OR = 1.12, 95% CI: 1.07-1.18), which was confirmed in multiancestry individuals (T2DM→CAD: OR = 1.13, 95% CI: 1.10-1.16; CAD→T2DM: OR = 1.08, 95% CI: 1.04-1.13). This bidirectional relationship was significantly mediated by systolic blood pressure and intake of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, with mediation proportions of 54.1% (95% CI: 24.9-83.4%) and 90.4% (95% CI: 29.3-151.5%), respectively. Conclusion::Our observational and genetic analyses demonstrated an intrinsic bidirectional relationship between T2DM and CAD and clarified the biological mechanisms underlying this relationship.

Objective:To analyze the allocation of general practitioners per 10 000 population in China and its influencing factors, so as to provide reference for optimizing the allocation of general practitioners resources in China.Methods:The number of general practitioners per 10 000 population and other relevant data of 31 provinces (except Hong Kong, Macao and Taiwan) in China from 2012 to 2021 were collected from China Statistical Yearbook, China Health Statistics Yearbook, China Health and Family Planning Statistical Yearbook. The geographical area data of 31 provinces (except Hong Kong, Macao and Taiwan) from 2012 to 2021 were retrieved from the website of the Central People ′s Government. The influencing factors of the number of general practitioners per 10 000 population were preset by literature analysis and unstructured interview. Taking the number of general practitioners per 10 000 population as the dependent variable, the correlation between it and the preset influencing factors was analyzed by panel data regression. Results:From 2012 to 2021, the average annual growth rate of the number of general practitioners per 10 000 population in each province of China was greater than 0. The factors affecting the number of general practitioners per 10 000 population included the number of people per square kilometer ( r=3.818, P<0.01), the number of beds in medical and health institutions per capita ( r=2.135, P<0.01), the proportion of the elderly population aged 65 and above ( r=0.180, P<0.01), and the proportion of total expenditure in medical and health institutions to gross domestic product ( r=0.080, P<0.01). Conclusions:The development trend of general practitioners resources allocation in China is good, but the government needs to integrate the population agglomeration and aging trend, the allocation of medical and health resources, the investment support for the development of general practitioners and other influencing factors, optimize the allocation of general practitioners resources according to local conditions, and strengthen policy support for areas and links where the allocation of general practitioners resources is relatively weak.

To explore the differentially expressed genes (DEGs) related to biosynthesis of active ingredients in wolfberry fruits of different varieties of Lycium barbarum L. and reveal the molecular mechanism of the differences of active ingredients, we utilized Illumina NovaSeq 6000 high-throughput sequencing technology to conduct transcriptome sequencing on the fruits of 'Ningqi No.1' and 'Ningqi No.7' during the green fruit stage, color turning stage and maturity stage. Subsequently, we compared the profiles of related gene expression in the fruits of the two varieties at different development stages. The results showed that a total of 811 818 178 clean reads were obtained, resulting in 121.76 Gb of valid data. There were 2 827, 2 552 and 2 311 DEGs obtained during the green fruit stage, color turning stage and maturity stage of 'Ningqi No. 1' and 'Ningqi No. 7', respectively, among which 2 153, 2 050 and 1 825 genes were annotated in six databases, including gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG) and clusters of orthologous groups of proteins (KOG). In GO database, 1 307, 865 and 624 DEGs of green fruit stage, color turning stage and maturity stage were found to be enriched in biological processes, cell components and molecular functions, respectively. In the KEGG database, the DEGs at three developmental stages were mainly concentrated in metabolic pathways, biosynthesis of secondary metabolites and plant-pathogen interaction. In KOG database, 1 775, 1 751 and 1 541 DEGs were annotated at three developmental stages, respectively. Searching the annotated genes against the PubMed database revealed 18, 26 and 24 DEGs related to the synthesis of active ingredients were mined at the green fruit stage, color turning stage and maturity stage, respectively. These genes are involved in carotenoid, flavonoid, terpenoid, alkaloid, vitamin metabolic pathways, etc. Seven DEGs were verified by RT-qPCR, which showed consistent results with transcriptome sequencing. This study provides preliminary evidences for the differences in the content of active ingredients in different Lycium barbarum L. varieties from the transcriptional level. These evidences may facilitate further exploring the key genes for active ingredients biosynthesis in Lycium barbarum L. and analyzing their expression regulation mechanism.
Flavonoids/metabolism* ; Fruit/genetics* ; Gene Expression Profiling/methods* ; Gene Expression Regulation, Plant ; Lycium/metabolism* ; Metabolic Networks and Pathways ; Transcriptome

The gastroduodenal artery (GDA) has an important role in pancreatic surgery. Relevant literature was reviewed and sum-marized in this article, along with practical experiences from our center, in order to provide references for surgeons in dealing with anatomical variations of the GDA and postoperative bleeding. GDA has close relationships with the blood supply of surroun-ding organs and is the most common vessel associated with intra-abdominal bleeding after pancreatic surgery. Therefore, the GDA plays a crucial anatomical role that affects the strategies and approaches of pancreatic surgery . Preoperative assessment of GDA variations can be achieved through CT angio-graphy. During surgery, it is important to identify and dissect the GDA properly and protect its remnants. In cases of residual bleeding from the GDA, endovascular treatment or secondary laparo-tomy can be conducted.

Objective:To evaluate the barrier-free level of village clinics of a city in the aging era, for references in improving the barrier-free medical environment for the elderlies.Methods:The village dectors of 156 village clinics in 12 counties of a city were selected as the objects of a questionnaire survey from Dec.2020 to Jan.2021, with 6 evaluation indexes established, each set with 1-10 points. This questionnaires was used to survey the barrier-free construction levels of village clinics. The data were statistically analyzed by rank sum ratio and quadrant graph model.Results:The barrier-free buildings of such clinics scored 32.86 points in average. Among the six indexes, the barrier-free access and doors(7.21 points) scored the highest, and the barrier-free parking space(4.71points) and toilets(3.28 points) scored the lowest. All the counties of the city fell into four categories, including 2 counties with high degree of aging-high level of accessibility, 4 counties with low degree of aging-high level of accessibility, 4 counties with low degree of aging-low level of accessibility, and 2 counties with high degree of aging-low level of accessibility, according to the quadrant graph model built based on the aging degrees and the barrier-free levels of village clinics.Conclusions:The barrier-free level of the village clinics in a city needs to be further improved, and the barrier-free transformation of parking space and toilets should also be strengthened in the future. The government should take different measures in view of conditions of each county to improve the accessibility of village clinics and facilitate the health care-seeking of elderlies.

OBJECTIVES: Long-term treatment of olanzapine, the most widely-prescribed second-generation antipsychotic, remarkably increases the risk of non-alcoholic fatty liver disease (NAFLD), whereas the mechanism for olanzapine-induced NAFLD remains unknown. Excessive hepatic fat accumulation is the basis for the pathogenesis of NAFLD, which results from the disturbance of TG metabolism in the liver. Apolipoprotein A5 (ApoA5) is a key regulator for TG metabolism in vivo that promotes TG accumulation in hepatocytes, thereby resulting in the development of NAFLD. However, there are no data indicating the role of apoA5 in olanzapine-induced NAFLD. Therefore, this study aims to investigate the role of apoA5 in olanzapine-induced NAFLD. METHODS: This study was carried out via animal studies, cell experiment, and ApoA5 gene knockdown experiment. Six-week-old male C57BL/6J mice were randomized into a control group, a low-dose group, and a high-dose group, which were treated by 10% DMSO, 3 mg/(kg·d) olanzapine, and 6 mg/(kg·d) olanzapine, respectively for 8 weeks. The lipid levels in plasma, liver function indexes, and expression levels of ApoA5 were detected. HepG2 cells were treated with 0.1% DMSO (control group), 25 μmol/L olanzapine (low-dose group), 50 μmol/L olanzapine (medium-dose group), and 100 μmol/L olanzapine (high-dose group) for 24 h. HepG2 cells pretreated with 100 μmol/L olanzapine were transfected with siRNA and scrambled siRNA (negative control), respectively. We observed the changes in lipid droplets within liver tissues and cells using oil red O staining and fat deposition in liver tissues using HE staining. The mRNA and protein levels of ApoA5 were determined by real-time PCR and Western blotting, respectively. RESULTS: After intervention with 3 and 6 mg/(kg·d) olanzapine for 8 weeks, there was no significant difference in body weight among the 3 groups (P>0.05). Olanzapine dose-dependently increased the plasma TG, ALT and AST levels, and reduced plasma ApoA5 levels (all P<0.05), whereas there was no significant difference in plasma cholesterol (HDL-C, LDL-C, and TC) levels among the 3 groups (all P>0.05). Olanzapine dose-dependently up-regulated ApoA5 protein levels in liver tissues (all P<0.05), but there was no significant change in ApoA5 mRNA expression among groups (P>0.05). In the control group, the structure of liver tissues was intact, the morphology of liver cells was regular, and only a few scattered lipid droplets were found in the cells. In the olanzapine-treated group, there was a large amount of lipid deposition in hepatocytes, and cells were balloon-like and filled with lipid droplet vacuoles. The nucleus located at the edge of cell, and the number of lipid droplets was increased significantly, especially in the high-dose group. Likewise, when HepG2 cells were treated with olanzapine for 24 h, the number and size of lipid droplets were significantly elevated in a dose-dependent manner. Moreover, olanzapine dose-dependently up-regulated ApoA5 protein levels in HepG2 cells (all P<0.05), but there was no significant difference in ApoA5 mRNA expression among groups (P>0.05). Compared with the HepG2 cells transfected with scrambled siRNA, the number and size of lipid droplets in HepG2 cells transfected with ApoA5 siRNA were significantly reduced. CONCLUSIONS The short-term intervention of olanzapine does not significantly increase body weight of mice, but it can directly induce hypertriglyceridemia and NAFLD in mice. Olanzapine inhibits hepatic apoA5 secretion but does not affect hepatic apoA5 synthesis, resulting in the pathogenesis of NAFLD. Inhibition of apoA5 secretion plays a key role in the development of olanzapine-related NAFLD, which may serve as an intervention target for this disease.
Animals ; Apolipoprotein A-V/genetics* ; Body Weight ; Dimethyl Sulfoxide/metabolism* ; Liver/metabolism* ; Male ; Mice ; Mice, Inbred C57BL ; Non-alcoholic Fatty Liver Disease/chemically induced* ; Olanzapine/metabolism* ; RNA, Messenger/metabolism* ; RNA, Small Interfering ; Triglycerides

OBJECTIVE: To explore the genetic etiology of a child featuring recurrent oral ulcer. METHODS: Clinical data of the child was collected. Whole exome sequencing was carried out for her. Candidate variant was verified by low-coverage massive parallel copy number variation sequencing (CNV-seq) of the family trio. RESULTS: The child, a 6-year-old girl, has featured recurrent fever and ulcers of the oral mucosa, vulvar and perianal regions. No pathogenic variant was found by whole exome sequencing. However, analysis of chromosome copy number variation using the whole exome sequencing data has revealed mosaicism of trisomy 8. CNV-seq assay has verified the variant in the child, with the percentage of mosaicism being 73%. No abnormality was found in neither of her parents. CONCLUSION A case of mosaicism trisomy 8 with recurrent oral ulcer as the first symptom was diagnosed, which has enriched the phenotypic data of trisomy 8 syndrome.
Humans ; Child ; Female ; Trisomy/genetics* ; Chromosomes, Human, Pair 8/genetics* ; DNA Copy Number Variations ; Oral Ulcer ; Mosaicism