In recent years, with the rapid development of organ donation after citizen’s death and transplantation, central and local governments in China have successively released incentive policies. To protect the legitimate rights and interests of organ donors after citizen’s death and their families, current status of incentive policies for organ donation after citizen’s death was illustrated and analyzed from the perspective of ethics. Combining with the principles of justice, respect for autonomy, nonmaleficence and beneficence, the problems existing in the implementation of incentive policies for organ donation after citizen’s death were identified in China, such as lack of continuous psychological intervention in spiritual incentives, the misinterpretation of humanitarian assistance in practice and the impact of indirect economic incentives on individual donation autonomy, etc. Relevant countermeasures and suggestions were proposed at the government, society and individual levels, aiming to provide reference for improving the incentive policies for organ donation after citizen’s death and accelerate the development of organ donation in China.

Objective:To analyze the relationship between CT attenuation value of pulmonary artery thrombi and the efficacy of interventional thrombolysis in patients with acute pulmonary embolism (APE).Methods:This was a single center cross-sectional study. The clinical and imaging data of 89 APE patients who underwent interventional thrombolysis in Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2022, were retrospectively analyzed. All patients underwent CT pulmonary angiography (CTPA) before and after thrombolysis, the CT attenuation value of pulmonary artery thrombi and ratio of CT attenuation value of thrombi to left subscapularis muscle CT value were obtained; and the difference of Qanadli embolism index (ΔQ) before and after thrombolysis was calculated. According to the median ΔQ, patients were classified as good efficacy group (ΔQ>50%) and poor efficacy group (ΔQ≤50%). The clinical characteristics and quantitative parameters of CT were compared between the two groups, and the factors associated with efficacy of thrombolysis were analyzed with univariate and multivariate logistic regression. The correlation between CT attenuation value of pulmonary artery thrombi and ΔQ was analyzed by Spearman correlation analysis.Results:The CT attenuation value of thrombi and ratio of attenuation value of thrombi to left subscapularis muscle CT value showed significant difference between the two groups ( P<0.05). Multivariate analysis showed that compared with CT attenuation value of emboli≤53.47 HU, the value>53.47 HU might be associated with the good efficacy of thrombosysis ( OR=9.175, 95% CI: 0.937-89.846, P=0.057). There was a positive correlation between CT value of pulmonary artery thrombi and ΔQ ( r=0.365, P<0.001). Conclusion:The CT attenuation value of thrombi can predict the efficacy of interventional thrombolysis in APE patients, and patients with higher CT attenuation value would have a better treatment response.

Objective To analyze the clinical application value of cinematic rendering(CR)reconstruction technology in acute aortic dissection(AAD),and to compare the imaging quality between CR and volume rendering(VR)reconstruction.Methods Patients with suspected A AD who underwent aortic computed tomography angiography(CTA)were analyzed retrospectively.All images were uploaded to Siemens Syngo.via post-processing workstation for VR and CR three-dimensional reconstruction,respectively.The optimized view angle,staining and transparency were selected and segmented by a radiologist to display the lesion to the full extent.All subjective evaluations of post-processing images were randomly evaluated on Siemens Syngo.via post-processing workstation by two radiologists.The two radiologists reached a consensus after consultation,and the results without consensus were evaluated by another senior radiologist.The 3-point scale was used in the subjective evaluation of post-processing images.The scores of rupture,endometrium,and true and false cavity were recorded.The diagnostic confidence was also recorded.Results A total of 21 ADD patients were enrolled,11 patients(52.3％)were Debakey Ⅲ type.The scores of rupture in CR and VR reconstruction were 2.952 points and 2.619 points,respectively,which had significant difference(P=0.016).For the endometrium of AAD,the score of all 21 patients in the CR reconstruction was 3 points,while only 7 patients(33.3％)in the VR reconstruction had 3 points,which showed significant difference between the both(P＜0.001).For the true and false cavity of AAD,only 1 patient(4.8％)in the VR reconstruction was 3 points,while all 21 patients in the CR reconstruction had 3 points(P＜0.001).The scores of CR reconstruction on the diagnostic confidence were significantly higher than those of VR reconstruction(P＜0.001).Conclusion CR reconstruction can provide photorealistic anatomical post-processing images,and can improve the display and evaluation of AAD.

Objective:To explore the interaction between pediatric sleep-disordered breathing（SDB）, the intestinal microbiota, and pediatric non-alcoholic fatty liver disease（NAFLD）. Methods:A total of 63 non-obese children（47 children with SDB in the experimental group and 16 without SDB in the control group） were enrolled in this study. The liver function and degree of SDB were assessed in both groups. High-throughput 16S rRNA sequencing was conducted to detect the composition and functional variations of the intestinal microbiota in the two groups of children. Results:Compared with children in the experimental group, serum ALT and AST levels were higher in the control group. and the relative proteobacteria abundance of intestinal flora increased, and the relative abundance of Bacteroidetes decreased significantly. Function including membrane transport, carbohydrate metabolism and lipid metabolism, were enriched in the intestinal microbiota of children with SDB. Conclusion:The composition and functional annotation of the pediatric liver functional status and gut microbiota were significantly different between the two groups of children with and without SDB. Changes in SDB-associated intestinal bacterial abundance may be related to the pathogenesis of pediatric NAFLD.
Humans ; Non-alcoholic Fatty Liver Disease/microbiology* ; Gastrointestinal Microbiome ; Child ; Male ; Sleep Apnea Syndromes/microbiology* ; Female ; RNA, Ribosomal, 16S/genetics* ; Bacteroidetes ; Proteobacteria/isolation & purification* ; Lipid Metabolism

Objective:To analyze the satisfaction of referral patients for the medical services provided by the countywide medical community, for reference in further improving its quality and continuity of medical services.Methods:From April to July 2021, a systematic sampling method was adopted to selected the survey subjects from the outpatients from the leading hospitals and three affiliated units of two medical communities, as well as those from two county-level hospitals of non medical communities and five grass-roots medical and health institutions. A total of 660 patients were included in the questionnaire survey. The questionnaire covered key demographic information and 15 satisfaction questions under 4 dimensions. The propensity score matching method was used to reduce confounding factors, factor analysis was used to calculate the satisfaction of referral patients in the medical community group and the non-medical community group, and the systematic dynamics approach was used to analyze the effect of patient satisfaction on referral intention.Results:A total of 641 valid questionnaires were collected. Based on a 1∶2 propensity score matching, 591 patients were finally enrolled, consisting of 102 up-referral cases from the non-community group and 273 such cases from the community group, as well as 76 down-referral cases from the non-community group and 140 such cases from the community group. The overall satisfaction scores by both up and down referral patients were 4.26(1.01)and 4.29(1.14)respectively.The overall satisfaction, medical service satisfaction, technical service quality satisfaction and non-technical service quality satisfaction of up-referral patients, as well as the overall satisfaction, non-technical service quality satisfaction of down-referral patients of the community group were higher than those from the non-community group, with differences statistically significant( P<0.05). The higher satisfaction of patients with their referral in the community, the stronger their referral willingness. Conclusions:The overall satisfaction of refrerral patients in the medical community group is higher than that of the non medical community group. The construction of county medical community has promoted the improvement of satisfaction of referral patients. However, it is still imperative to encourage high-quality medical resources to support primary institutions, to enhance the service level of primary medical and health institutions, to implement differentiated medical insurance reimbursement policies, and to improve the continuity of medical services within the community.

Objective:To investigate the association of Subclinical Carotid AtheroSclerosis (SCAS) and prediabetes or Diabetes Mellitus (DM)in the healthy people.Methods:From September 2018 to June 2019, participants who underwent physical examination in the Health Management Center of Beijing Tiantan Hospitial were enrolled consecutively. The baseline characters were collected prospectively. Carotid Ultrasound was evaluated by radiologists according to the standard operating protocol. Univariable analysis and multivariable logistic analysis were used to estimate the association of prediabetes or DM with SCAS.Results:Totally 401 participants were eligible and enrolled. The mean age was (52.2±10.4) years and 43.7% (252/401) of them were females. The prevalence of DM and SCAS were 16.4% (66/401) and 48.9% (196/401) respectively. In the univariate analysis, elder age (≥60 years old) ( OR=5.93, 95% CI: 3.86-9.09, P<0.001), hypertension ( OR=2.76, 95% CI: 1.84-4.15, P<0.01), prediabetes( OR=1.67, 95% CI: 1.08-2.58, P<0.05) and DM ( OR=3.60, 95% CI: 1.97-6.58, P<0.01), cigarettes smoking ( OR=2.64, 95% CI: 1.82-3.81, P<0.001), lower HDLlevel<1.04 mmol/L ( OR=1.58, 95% CI: 1.04-2.42, P<0.001) and hyperhomocysteinemia (≥15 μmol/L)( OR=1.69, 95% CI: 1.17-4.04, P<0.01) were associated with higher prevalence of SCAS. On the contrary, female sex ( OR=0.53, 95% CI: 0.39-0.74, P<0.001) was associated with lower prevalence of SCAS. In the multivariable logistic analysis, elder age(≥60 years old) ( OR=6.04, 95% CI: 3.13-11.7, P<0.01), hypertension ( OR=2.14, 95% CI: 1.13-3.87, P<0.05), cigarettes smoking ( OR=2.19, 95% CI: 1.21-3.98, P<0.05) and DM ( OR=2.32, 95% CI: 1.16-4.67, P<0.05) were associated with SCAS independently. The association between prediabetes and SCAS was not statistically significant. Conclusions:DM is independently associated with SCAS in neurological healthy people, while prediabetes tended to increase the risk of SCAS.

Objective:To retrospectively analyze the clinical efficacy, safety and the main factors affecting the prognosis of anlotinib hydrochloride in the treatment of advanced primary liver cancer.Methods:Fifty-five cases with advanced primary liver cancer who received anlotinib hydrochloride were enrolled. The baseline data of the patients, such as prothrombin time, total bilirubin, albumin, Child-Pugh score, procalcitonin, alpha fetoprotein, extrahepatic metastasis, cirrhosis, portal hypertension, whether or not combined surgery, pathological staging, etc before treatment were recorded. Hematological and imaging results of the patients were reviewed. Adverse events that appeared in patients at any time until the end of follow-up or loss- to- follow-up or death were recorded. The survival curve was plotted by Kaplan-Meier method, and the difference of survival time between groups was examined by log-rank test. Cox regression model of single and multiple factor were used to analyze the factors affecting the prognosis.Results:As of the last follow-up, 2 patients were lost-to-follow-up, 30 died, and 23 survived. The median survival time was 6.5 months (196 days). Grade 3 or higher adverse events included hypertension (12.73%), leukopenia (3.64%), absolute neutropenia (1.82%), thrombocytopenia (9.09%), fatigue (3.64%), anemia (1.82%), and diarrhea (1.82%). Adverse events were effectively controlled. One case had fatal ruptured esophageal varices, which were not medically related. Multivariate Cox regression analysis showed that total bilirubin ( HR = 0.247, P = 0.003), albumin ( HR = 0.279, P = 0.003) and procalcitonin ( HR = 0.105, P = 0.012) were independent factors affecting the prognosis of advanced HCC. Conclusion:Anlotinib hydrochloride therapy is safe, effective and well tolerated in patients with advanced liver cancer, and total bilirubin, albumin, and procalcitonin are independent factors that affect the prognosis of patients with advanced liver cancer.

Objective To screen and prepare a broad-spectrum monoclonal antibody against Strep-tococcus pneumoniae ( S. pneumoniae) surface protein A ( PspA) and to evaluate its potential in clinical prac-tice. Methods Hybridoma cells were screened and inoculated into the abdominal cavities of BALB/c mice to prepare antibodies in ascites. Monoclonal antibodies were obtained by ammonium sulfate precipitation and protein A affinity chromatography and then identified by SDS-PAGE and Western blot. Their specificity, iso-forms and killing activities in vitro were analyzed. Results A broad-spectrum monoclonal antibody that rec-ognized PspA subclasses 2, 3 and 4 was obtained. Its in vitro killing rate against S. pneumoniae reached 40. 3％. Conclusions A broad-spectrum monoclonal antibody that could specifically bind to PspA was suc-cessfully prepared with a strong in vitro killing activity. This study provided reference for clinical diagnosis of S. pneumoniae-related diseases, quality assessment of S. pneumoniae vaccines and further research on mono-clonal antibody therapeutics.

Objective: To investigate the clinical efficacy and safety profile of hyaluronic acid dermal filler(Restylane®) in treating nasolabial folds in Chinese population. Methods: 103 subjects in this study were recruited from five Chinese clinical trial centers between July 2014 and December 2015. Subjects were treated with hyaluronic acid dermal filler in correcting nasolabial folds and an optional re-treatment was performed after 12 months according to the subjects′wishes. The improved of nasolabial folds was evaluated by the change of severity (wrinkle severity rating scale, WSRS) and aesthetic improvement (global aesthetic improvement scale, GAIS). Satisfaction of subjects on treatment was evaluated using subject satisfaction questionnaires (SSQ). Safety indicators such as pain, skin and soft tissue presentation at the injection site were continuously evaluated throughout the whole treatment process. Results: Significant improvement in scores of WSRS and GAIS of all subjects was observed after treatment. Nine months after treatment, the scores of WSRS in 80 subjects (77.7%) and GAIS in 96 subjects (93.2%) were still improved. The 68 subjects (95.8%) received re-treatment after 12 months gained further improvement in nasolabial folds. Most adverse events were mild or moderate (transient/reversible local manifestations) and all resolved before study end, no severe adverse event related to products observed. Conclusions Hyaluronic acid dermal filler is effective and safe in treatment of nasolabial folds in Chinese population and the effect can last up to 12 months.

Objective To observe the change of learning and memory and the expression change of GABAR1 and N-methyl-D-aspartate receptor 2B (NMDAR2B)in right frontal lobe of the brain of the aged rats after the inhalation of sevoflurane.Methods Fifty male SD rats were randomly divided into control group (group C,n=10)and experimental group (group T,n=40).The control group received air at room tempreture.Experimental groups were divided into two groups:group T1 (2 h)and group T2 (4 h)according to the time of inhalation of sevoflurane at 3% concentration.Ev-ery group was equally divided into two groups and Morris water maze was performed on day 1 and day 7 after sevoflurane inhalation.Then the right frontal lobe was gathered and the mRNA transcription and protein expression of GABAR1 and NMDAR2B were detected by Quantitative Real-time PCR and immunofluorescence technique.Results Compared with group C,the escape latency was prolonged in groups T1 and T2 after 1 day of inhalation of sevoflurane (P<0.05),and the times of space explora-tion reduced (P<0.05).mRNA transcriptional and protein content of GABAR1 were significantly upregulated in frontal lobes of groups T1 and T2,mRNA transcriptional and protein content of NMDAR2B were significantly down-regulated (P<0.05).After inhalation of sevoflurane for 7 days, the protein expression of NMDAR2B in the frontal lobe of group T1 was lower than that of group C (P<0.05).In group T2,the escape latency was prolonged (P<0.05),the number of space explo-ration traversals was decreased (P<0.05),the expression of GABAR1 protein in frontal lobe was up-regulated (P<0.05),and the expression of NMDAR2B protein was down-regulated (P<0.05), and the amplitude was higher than that in group T1 (P<0.05).Conclusion Continuous inhalation of sevoflurane can reduce the spatial memory ability of aged rats,and the effect of prolonged inhalation is greater and longer.This effect is related to the expression of neurotransmitter receptors such as GABAR1 and NMDAR2B in the frontal lobe.