Objectives:To establish a risk prediction model for gastrointestinal bleeding after cardiopulmonary bypass heart surgery,and to verify the prediction efficacy. Methods:A total of 1 002 patients who underwent cardiopulmonary bypass heart surgery in the department of cardiac great vascular surgery of our hospital from January 2019 to November 2023 were collected by convenient sampling method.They were divided into gastrointestinal bleeding group(n=47)and non-gastrointestinal bleeding group(n=955).Logistic regression analysis was used to establish the risk prediction model,and the area under ROC curve test and Hosmer-Lemeshow χ2 test were used to compare the two groups of data Model prediction effect.Bootstrap method was used for internal validation. Results:The risk prediction model of gastrointestinal bleeding after cardiopulmonary bypass heart surgery included four predictors:time of aortic occlusion(OR=1.021,95%CI:1.012-1.030),history of digestive disease(OR=5.710,95%CI:1.697-19.212),use of intra-aortic balloon counterpulsation(OR=22.180,95%CI:5.870-83.808),and continuous kidney replacement therapy(OR=12.159,95%CI:5.066-29.181).Model formula:Logit(P)=-5.821+0.021×time of aortic occlusion+1.742×history of digestive disease+3.099×whether intra-aortic balloon counterpulsation was used+2.498×whether continuous renal replacement therapy was used.The area under ROC curve was 0.812(95%CI:0.746-0.877),sensitivity was 64.6%,specificity was 85.7%,and Youden index was 0.503.After internal validation by Bootstrap method,the consistency index after correction is 0.813. Conclusions:The risk prediction model constructed in this study cohort has a good auxiliary prediction performance for the occurrence of gastrointestinal bleeding after cardiopulmonary bypass surgery,which is helpful for risk stratification for gastrointestinal bleeding after cardiopulmonary bypass surgery and facilitate clinical decision-making in daily clinical work.

Objective:To collect and analyze the quality control data of gastric cancer surgery in Jiangsu Province from 2020 to 2022,and study the role of publishing surgical quality control data in promoting the improvement of gastric cancer surgery of China. Methods:An online questionnaire was created and distributed to the members of Jiangsu Gastric Cancer Union(JSGCU).The questionnaire collected information including the basic situation of hospital,the diagnosis and treatment of early gastric cancer,advanced gastric cancer and metastatic gastric cancer,the digestive tract reconstruction,the surgical safety,the economic indicators,and so on. Results:The quality control data of gastric cancer surgery in Jiangsu Province from 2020 to 2022 were consistently collected and published.The data analysis results show that there was a gradual increase in the percent of patients with stage Ⅰ gastric cancer,reflecting the success efforts of early screening and diagnosis.Laparoscopic surgery showed a steady increase and became the mainstream approach for curative surgery of gastric cancer in Jiangsu Province.The percent of hospital with lymph node dissection≥30 was also increased.Different locations of gastric cancer exhibited specific patterns in the choice of anastomosis methods after curative surgery.The rate of grade 3 or higher complications in laparoscopic gastric cancer surgery was slightly lower than that in open surgery.For patients experiencing complications,their postoperative hospitalization duration and expenditure were significantly higher.Finally,there was a gradual increase in the proportion of hospital choosing to close the mesentery during gastric cancer surgery. Conclusion:The publication of the quality control data of gastric cancer surgery in Jiangsu Province has driven the improvement of gastric cancer surgery standards of China.

Objective:To assess the status quo of uncertainty in illness among patients undergoing daytime ophthalmic surgeries and to identify its influencing factors.Methods:Patients who underwent surgery in the Ophthalmic Daytime Surgery Wards of Beijing Tongren Hospital, Capital Medical University, from January to June 2023, were selected by convenience sampling. Data were collected using a general demographic survey and the Medical Uncertainty Inventory Scale (MUIS/MUIS-A). Multiple linear regression analysis was employed to investigate the factors influencing the uncertainty in illness among these patients.Results:Out of 248 questionnaires distributed, 243 were effectively collected, resulting in a 97.98% response rate. The scores on the MUIS/MUIS-A ranged from 55 to 144, with a median of 102. Multiple linear regression analysis indicated that acceptance of the disease, educational level, and the number of surgeries were significant factors influencing the uncertainty in illness among these patients ( P<0.05) . Conclusions:The uncertainty in illness among patients undergoing daytime ophthalmic surgery is above the medium level. Factors such as acceptance of the disease, educational level, and the number of surgeries significantly influence this uncertainty.

Purpose To investigate the clinicopathological features and prognosis of alpha-fetoprotein-producing colorectal carcinoma(AFPCRC).Methods 42 cases of AFPCRC from 2 012 colorectal carcinomas of preoperative serum AFP detected and surgically resected were identified.The clinicopathological data of AFPCRC and other 42 cases of conventional colorectal carcinoma exactly matched for age,gender,stage were also col-lected.Immunohistochemical EnVision method was performed to detect the expression of HER2,MMR,p53,AFP,Glypican3,and SALL4.Cases presenting HER2 2+were further analyzed by fluorescence in situ hybridization.Elastic staining was per-formed in cases with ambiguous extramural venous invasion.The clinicopathlogical features and prognosis between two groups were compared.Cases with AFPCRC were divided into high-AFP group and low-AFP group.The clinicopathological features and prognosis of the two groups were compared.Results AF-PCRC accounted for 2.1％(42/2 012)of colorectal carcinoma in the same period.The frequency of extramural vascular inva-sion and moderate/high grade of tumor budding of AFPCRC was 35.7％and 61.9％,while that of control group was 14.3％and 40.5％respectively.The 5-year survival rate of AFPCRC and control group was 66.8％and 85.1％respectively.The differ-ence of aforementioned clinicopathological features between 2 groups was significant(P＜0.05).The proportion of tumor in rectum in the high-AFP group was significantly higher than that in the low-AFP group(61.9％vs 23.8％,P＜0.05).Conclu-sion AFPCRC is a rare subset of colorectal carcinoma,which has a propensity for extramural vessel invasion,moderate-or high-grade of tumor budding and poor prognosis.

【Objective】 To explore the correlation between different feeding styles of caregivers and diet quality of children with nutritional problems, in order to provide reference for making effective feeding guidance and intervention strategy. 【Methods】 From January 2022 to August 2023, 2- to 6-year-old children who had been enrolled in kindergartens or nurseries and their caregivers from the combined outpatient department of Child Healthcare and Nutrition in Shanghai Children′s Hospital were selected into this study.The amount of dinner served and consumed was obtained through the three-day dinner intake survey, and the Chinese Healthy Eating Index (CHEI) was calculated.Feeding styles were divided into four groups through the Caregiver Feeding Style Questionnaire.Pearson correlation analysis was used to determine the correlation between served and consumed CHEI score.Chi-square test, t-test and ANOVA were used to compare the differences in CHEI score for dinner consumed in children with different feeding styles. 【Results】 1) Totally 133 parent-child pairs were included in this study.There were 68 boys (51.1%) and 65 girls (48.9%), with an average age of (4.6±0.6) years.2) CHEI scores for dinner served was highly correlated with that for dinner consumed (r=0.90, P<0.05).There was statistically significant difference between the CHEI score for dinner served and consumed by authoritative and authoritarian feeding styles (t=2.538, 1.732, P<0.05).3) After adjusting body shape, children in the authoritative feeding style actually completed a significantly higher diet quality CHEI score than those in the authoritarian feeding style (P<0.05).4)Authoritative and indulgent feeding styles had statistical differences in the distribution of children′s body size (χ²=13.587, P=0.035). 【Conclusions】 Parents with authoritarian feeding style and indulgent feeding style have worse control over their children′s dietary completion.Children with authoritative feeding style have higher dietary quality than those with authoritarian feeding style.Children with indulgent feeding style may have a higher proportion of non-low weight than those with authoritative feeding style.Although feeding style could not reverse the outcome of body shape deviation in children with disease, it may have some positive effects.

BACKGROUND:It has been shown that in a mouse model of acute traumatic brain injury,the transcriptional and translational levels of silent information regulator 1(SIRT1)activated by drugs significantly elevates the expression of SIRT1 in brain tissue,reduces inflammatory and oxidative stress in brain tissue,and improves neurological function. OBJECTIVE:To investigate the mechanism of intraperitoneal injection of SRT1720,an activator of SIRT1,to alleviate acute traumatic brain injury in rats. METHODS:Ninety Sprague-Dawley rats were randomized into three groups(n=30 per group):a sham group(without modeling),a model group and an activator group.Animal models of acute traumatic brain injury were established in the latter two groups.At 6 hours after modeling,the sham,model and activator groups were injected intraperitoneally with dimethyl sulfoxide solution,methylsulfoxide solution and SRT1720 once a day for 28 days,respectively.The time points for sampling were set,and rats'neurological function,brain tissue water content,brain tissue oxidative stress and inflammatory response,brain tissue morphology,apoptosis and angiogenesis,and the protein expression of SIRT1 in brain tissue were detected and measured. RESULTS AND CONCLUSION:Compared with the sham group,the modified neurological deficit score,brain tissue water content and apoptosis rate of rats were increased in the model group at 7,14 and 28 days of injection(P<0.05);compared with the model group,the modified neurological deficit score,brain tissue water content and apoptosis rate of rats were decreased in the activator group(P<0.05).Compared with the sham group,the levels of reactive oxygen radicals and myeloperoxidase in the brain tissue were increased(P<0.05),the levels of malondialdehyde,tumor necrosis factor α and interleukin 6 in the serum were increased(P<0.05),and the levels of superoxide dismutase in the serum were decreased in the model group at 7,14 and 28 days of injection(P<0.05).Compared with the model group,the levels of reactive oxygen radicals and myeloperoxidase in the brain tissue were decreased(P<0.05),the levels of malondialdehyde,tumor necrosis factor α and interleukin 6 in the serum were decreased(P<0.05),and the levels of superoxide dismutase in the serum were increased in the activator group at 7,14 and 28 days of injection(P<0.05).Immunohistochemical staining at 7,14 and 28 days of injection showed that the number of new vessels in the brain tissue was higher in the model group than the sham group(P<0.05)as well as higher in the activator group than the model group(P<0.05).Western blot assay indicated that at 7,14 and 28 days of injection,the expression of SIRT1 protein in the brain tissue was lower in the model group than the sham group(P<0.05)and higher in the activator group than the model group(P<0.05).Hematoxylin-eosin staining showed that at 7,14 and 28 days of injection,the degree of brain injury in the activator group was less than that in the model group.To conclude,intraperitoneal injection of the SIRT1 signal activator SRT1720 can significantly reduce oxidative and inflammatory stress in the brain tissue,inhibit neuronal apoptosis,promote angiogenesis,and alleviate brain injury in rats with acute traumatic brain injury.

Objective:To investigate the application value of Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) in evaluating early postoperative complications for radical gastric cancer surgery.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 484 patients who underwent radical gastric cancer surgery in Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2016 to December 2018 were collected. There were 1 086 males and 398 females, aged (60±17)years. The early complica-tions of patients were classified by the CDC and the CCI was calculated. Measurement data with normal distribution were represented as Mean± SD. Count data are expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was conducted using Logistic regression analysis. Correlation analysis between CDC, CCI and duration of postopera-tive hospital stay, total hospital expenses was performed using the Spearman rank correlation. Multiple linear regression analysis was conducted to compare the correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Results:(1) Distribution of early postoperative complications by CDC and CCI. Among the 1 484 patients, 432 patients developed early postoperative complications, of which 322 cases had a single complication, and 110 cases had multiple complications. Among the 432 patients with complications, the numbers of patients with grades Ⅰ, Ⅱ, Ⅲa, Ⅲb, Ⅳ, and Ⅴ of CDC were 231, 137, 45, 13, 3, and 3 cases, respectively. The CCI in the 432 patients with complications was 17.2±11.7, with peak values of 8.7 and 20.9. (2) Analysis of factors influencing early postoperative complications in patients undergoing radical gastric cancer surgery. Results of multivariate analysis showed that female, age ≥70 years, and preoperative serum albumin <35 g/L were independent risk factors for early postoperative complications in patients undergoing radical gastric cancer surgery ( odds ratios=1.391, 1.535, 1.521, 95% confidence intervals as 1.083-1.786, 1.187-1.985, 1.055-2.192, P<0.05). (3) Correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Among the 432 patients with post-operative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.574, 0.576, P<0.05), and both were positively correlated with total hospital expenses ( r=0.413, 0.438, P<0.05). Among the 110 patients with multiple postoperative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.514, 0.537, P<0.05), and both were positively correlated with total hospital expenses ( r=0.427, 0.474, P<0.05). (4) Regression analysis between CDC, CCI, and duration of postoperative hospital stay, total hospital expenses. Multiple linear regression analysis of duration of postoperative hospital stay showed that CDC ≥grade 3, age ≥70 years, preoperative C-reactive protein ≥10 g/L, and American Society of Anesthesiology (ASA) classification ≥grade 3 were associated with prolonged duration of postopera-tive hospital stay. The higher CCI indicated longer duration of postoperative hospital stay. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.467 versus 0.212). The regression analysis of total hospital expenses showed that CDC ≥grade 3, age ≥70 years, preoperative serum albumin <35 g/L, ASA classification ≥grade 3, and pathological stage Ⅲ-Ⅳ increased total hospital expenses, while gender of female reduced the expenses. The higher CCI indicated higher hospital expenses. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.449 versus 0.061). Conclusions:Both the CDC and CCI can effectively reflect the severity of postoperative complica-tions following radical gastric cancer surgery. Compared to the CDC, the CCI can better predict post-operative hospital stay and total hospital expenses.

Objective:To investigate the application value of Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) in evaluating early postoperative complications for radical gastric cancer surgery.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 484 patients who underwent radical gastric cancer surgery in Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2016 to December 2018 were collected. There were 1 086 males and 398 females, aged (60±17)years. The early complica-tions of patients were classified by the CDC and the CCI was calculated. Measurement data with normal distribution were represented as Mean± SD. Count data are expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was conducted using Logistic regression analysis. Correlation analysis between CDC, CCI and duration of postopera-tive hospital stay, total hospital expenses was performed using the Spearman rank correlation. Multiple linear regression analysis was conducted to compare the correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Results:(1) Distribution of early postoperative complications by CDC and CCI. Among the 1 484 patients, 432 patients developed early postoperative complications, of which 322 cases had a single complication, and 110 cases had multiple complications. Among the 432 patients with complications, the numbers of patients with grades Ⅰ, Ⅱ, Ⅲa, Ⅲb, Ⅳ, and Ⅴ of CDC were 231, 137, 45, 13, 3, and 3 cases, respectively. The CCI in the 432 patients with complications was 17.2±11.7, with peak values of 8.7 and 20.9. (2) Analysis of factors influencing early postoperative complications in patients undergoing radical gastric cancer surgery. Results of multivariate analysis showed that female, age ≥70 years, and preoperative serum albumin <35 g/L were independent risk factors for early postoperative complications in patients undergoing radical gastric cancer surgery ( odds ratios=1.391, 1.535, 1.521, 95% confidence intervals as 1.083-1.786, 1.187-1.985, 1.055-2.192, P<0.05). (3) Correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Among the 432 patients with post-operative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.574, 0.576, P<0.05), and both were positively correlated with total hospital expenses ( r=0.413, 0.438, P<0.05). Among the 110 patients with multiple postoperative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.514, 0.537, P<0.05), and both were positively correlated with total hospital expenses ( r=0.427, 0.474, P<0.05). (4) Regression analysis between CDC, CCI, and duration of postoperative hospital stay, total hospital expenses. Multiple linear regression analysis of duration of postoperative hospital stay showed that CDC ≥grade 3, age ≥70 years, preoperative C-reactive protein ≥10 g/L, and American Society of Anesthesiology (ASA) classification ≥grade 3 were associated with prolonged duration of postopera-tive hospital stay. The higher CCI indicated longer duration of postoperative hospital stay. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.467 versus 0.212). The regression analysis of total hospital expenses showed that CDC ≥grade 3, age ≥70 years, preoperative serum albumin <35 g/L, ASA classification ≥grade 3, and pathological stage Ⅲ-Ⅳ increased total hospital expenses, while gender of female reduced the expenses. The higher CCI indicated higher hospital expenses. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.449 versus 0.061). Conclusions:Both the CDC and CCI can effectively reflect the severity of postoperative complica-tions following radical gastric cancer surgery. Compared to the CDC, the CCI can better predict post-operative hospital stay and total hospital expenses.

OBJECTIVE: To explore the genetic basis for a patient with Dilated cardiomyopathy. METHODS: A patient admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University in April 2022 was selected as the study subject. Clinical data and family history of the patient was collected. Targeted exome sequencing was carried out. Candidate variant was verified by Sanger sequencing and bioinformatic analysis based on guidelines of the American College of Medical Genetics and Genomics (ACMG). RESULTS: DNA sequencing revealed that the patient has harbored a heterozygous c.5044dupG frameshift variant of the FLNC gene. Based on the ACMG guidelines, the variant was predicted to be likely pathogenic (PVS1+PM2_Supporting+PP4). CONCLUSION The heterozygous c.5044dupG variant of the FLNC gene probably underlay the pathogenesis in this patient, which has provided a basis for the genetic counseling for his family.
Humans ; Cardiomyopathy, Dilated/genetics* ; Genetic Testing ; Genetic Counseling ; Computational Biology ; Frameshift Mutation ; Mutation ; Filamins

Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.