Objective:To investigate the Kub stage classification of clinical renal tuberculosis and provide a reference for disease evaluation and management.Methods:A retrospective analysis was conducted on clinical data from 180 patients diagnosed with renal tuberculosis who were admitted to the First Affiliated Hospital of Dali University between January 2011 and December 2022. The 180 cases included 82 males and 98 females. The average age was (44.56±9.62) years. The tuberculosis lesions of 101 cases were on left kidney, while that of 79 cases were on right kidney. Localized/multiple lesions were observed in 118 cases, whereas extensive destruction was found in 62 cases. Moreover, the ureters were involved in 165 cases, and bladder invasion occurred in 139 cases. For patients undergoing renal preservation treatment, a comprehensive approach was employed, including ureteral stricture stenting and regular replacement of double-J stent, percutaneous nephrostomy, excision of tuberculosis lesions or partial nephrectomy, ureter reconstruction, and sigmoidocystoplasty. In cases requiring nephrectomy, either laparoscopic or open surgical approaches are utilized. Based on the results of patient imaging and endoscopy, staging and classification were performed based on the extent of tuberculosis lesions involving the kidneys (K), ureters (u), and bladder (b). The state for each above organ was divided into four stages: K stage (K 1-4), u stage (u 0-u 3), and b stage (b 0-b 3), which were then combined with the actual disease condition for further categorization. The classifications included local intrarenal type(K 1-2u 0b 0), local renal-ureteral involvement type(K 1-2u 1-2b 0-2), multiple renal-ureteral invasion type(K 3u 1-3b 0-2) and extensive destruction type(K 4u 1-3b 1-3). Further analysis was conducted on kidney preservation and subsequent disease progression among patients with different subtypes. Results:Among the 180 patients, 15 cases of local intrarenal type underwent kidney-preserving treatment. Out of these cases, 6 patients (4 patients in stage K 1u 0b 0 and 2 patients in stage K 2bu 0b 0) achieved clinical cure after receiving a pure durative anti-tuberculosis for two years. Additionally, 4 patients in stage K 2au 0b 0 attained clinical cure following anti-tuberculosis drugs combined with partial nephrectomy after two years of follow-up. Furthermore, 5 patients in stage K 2bu 0b 0 underwent ureteroscopy and D-J stent placement for regular stent replacement. The stents were subsequently removed after two years, and the patients remained clinically stable. Among the 47 cases with localized renal-ureteral involvement type, all initially underwent kidney-preserving treatment. Of these, 5 patients in stage K 1u 1b 0-2 achieved clinical remission, while disease progression necessitated nephrectomy for 3 patients in stage K 2au 1-2b 0-2 and 7 patients in stage K 2bu 1-2b 0-2. The remaining patients maintained stable conditions. Among the 56 cases of multiple renal-ureteral invasion type, stable conditions were observed in 9 out of 24 patients with stage K 3u 1-2b 0-2, while disease progression necessitated nephrectomy in 15 cases. Nephrectomy was performed for all 32 patients with stage K 3u 3b 0-2. In instances of extensive destruction type, nephrectomy was conducted for all 62 cases. The progression rates of the local renal-ureteral involvement type and the multiple renal-ureteral invasion type were 21.28% (10/47) and 48.39% (15/31), and the difference was statistically significant ( P<0.05). The kidney preservation rates of the local renal-ureteral involvement type and multiple renal-ureteral invasion type were 78.72% (37/47) and 16.07% (9/56), and the difference was statistically significant ( P<0.001). Conclusions:The Kub stage classification can provide reference to management and monitoring for renal tuberculosis. The patients in the local intrarenal type and local renal-ureteral involvement type are often treated with anti-tuberculosis plus ureteral stent implantation or partial nephrectomy or ureteral reconstruction. The patients in the multiple renal-ureteral invasion type and extensive destruction type are mostly managed by nephrectomy.

Objective:To construct an evaluation the index system of entrustable professional activities for resident training doctors in psychiatric department,and to provide reference for formulating training strategies and assessment standards.Entrustable professional activities refers to the ability of trainees to perform and complete spe-cific clinical tasks independently after they have been trusted.Methods:Through documental analysis and semi-structured interviews,the item database of entrustable professional activities for psychiatric resident training physi-cians was established.Delphi consultation was conducted among 63 experts in the field of psychiatry from 7 national resident training bases and 3 medical colleges in China.Indicators were comprehensively screened and sorted out,and indicators at all levels and their weights were determined by the analytic hierarchy process.Results:A hierarchi-cal evaluation index system of entrustable professional activities for psychiatric resident training doctors was con-structed,including 4 first-level indicators,17 second-level indicators and 68 third-level indicators.The weights of the first-level,second-level and third-level indicators were determined.Conclusion:The evaluation index system of en-trustable professional activities is comprehensive and systematic,which is suitable for clinical work and convenient for practical application.It could provide quantitative standards for the assessment of psychiatric residents and pro-mote the improvement of training quality.

BACKGROUND: China bears the biggest atrial fibrillation (AF) burden in the world. However, little is known about the incidence and predictors of AF. This study aimed to investigate the current incidence of AF and its electrocardiographic (ECG) predictors in general community individuals aged over 60 years in China. METHODS: This was a prospective cohort study, recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District, Shanghai, China. The subjects were then followed up from 2015 to 2019 annually. Data on sociodemographic characteristics, medical history, and the resting 12-lead ECG were collected. Kaplan-Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF. Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models. RESULTS: This study recruited 18,738 subjects, and 351 (1.87%) developed AF. The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years. Multivariable Cox regression analysis indicated age (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.06-1.09; P < 0.001), male (HR, 1.30; 95% CI: 1.05-1.62; P = 0.018), a history of hypertension (HR, 1.55; 95% CI: 1.23-1.95; P < 0.001), a history of cardiac diseases (HR, 3.23; 95% CI: 2.34-4.45; P < 0.001), atrial premature complex (APC) (HR, 2.82; 95% CI: 2.17-3.68; P < 0.001), atrial flutter (HR, 18.68; 95% CI: 7.37-47.31; P < 0.001), junctional premature complex (JPC) (HR, 3.57; 95% CI: 1.59-8.02; P = 0.002), junctional rhythm (HR, 18.24; 95% CI: 5.83-57.07; P < 0.001), ventricular premature complex (VPC) (HR, 1.76; 95% CI: 1.13-2.75, P = 0.012), short PR interval (HR, 5.49; 95% CI: 1.36-22.19; P = 0.017), right atrial enlargement (HR, 6.22; 95% CI: 1.54-25.14; P = 0.010), and pacing rhythm (HR, 3.99; 95% CI: 1.57-10.14; P = 0.004) were independently associated with the incidence of AF. CONCLUSIONS The present incidence of AF was 5.2/1000 person-years in the studied population aged over 60 years in China. Among various ECG abnormalities, only APC, atrial flutter, JPC, junctional rhythm, short PR interval, VPC, right atrial enlargement, and pacing rhythm were independently associated with AF incidence.
Humans ; Male ; Middle Aged ; Aged ; Atrial Fibrillation/epidemiology* ; Prospective Studies ; Incidence ; Atrial Flutter/complications* ; Risk Factors ; China/epidemiology* ; Electrocardiography

【Objective】 To compare the difference in the detection rate of microorganisms in cord blood between BACTEC FX and BacT/ALERT 3D automated blood culture systems, and to compare the influence of incubation time and different types of culture sample on the detection rate of microorganisms in cord blood. 【Methods】 Cord blood samples prepared from April to August 2020 in Sichuan Cord Blood Bank(n=4 358) were selected, and 20 mL of plasma was used as culture samples for microbial detection. In addition, cord blood samples prepared in the same months of 2021(n=4 057) were selected, and 19 mL of plasma plus 1 mL of final product was used as culture samples for microbial detection. The total sample size was 8 415, of which 4 849 samples(2 458 in plasma group and 2 391 in plasma plus final product group) were assigned to the BACTEC FX system, and 3 566 samples(1 900 in the plasma group and 1 666 in the plasma plus final product group) to the BacT/ALERT 3D system. All samples were cultured for 7 days, and culture data were recorded on day 5 and day 7. Positive results were confirmed by Gram staining. 【Results】 The positive rate detected by the BACTEC FX system was higher than that of the BacT/ALERT 3D system(4.08% vs 2.69%), with statistically significant difference(P<0.05). The positive rates of BACTEC FX and BacT / ALERT 3D on day 7 increased by 8% and 4.26% respectively compared with on day 5. When the culture sample types were concerned, the BACTEC FX showed statistically significant difference in positive rate between plasma group and plasma plus final product group(P<0.05), while no significant difference was found in positive rate(P>0.05) detected by the BacT/ALERT 3D system. With quality control strains, there were significant differences in TTP between these two systems for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Clostridium sporogenes, and Bacillus subtilis(P<0.05), but no significant difference for Aspergillus brasiliensis and Candida albicans(P>0.05). 【Conclusion】 This study suggests that the selection of BACTEC FX blood culture system with incubation time of not less than 7 days and plasma plus final product as culture samples may improve the detection rate of microorganisms in cord blood.

Objective:To investigate the application value of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for local resection of rectal neoplasms.Methods:The retros-pective and descriptive study was conducted. The clinicopathological data of 7 rectal neoplasms patients undergoing R-TAMIS in Daping Hospital of Army Medical University from June 2017 to March 2021 were collected. There were 3 males and 4 females, aged (60±7)years. Observation indicators: (1) intraoperative situations; (2) postoperative recovery; (3) postoperative histopatholo-gical examinations; (4) follow-up. Follow-up was conducted using telephone interview or outpatient examination to detect readmission of patients within postoperative 30 days, tumor recurrence and metastasis and survival of patients. Follow-up was performed at postoperative 1, 3, 6 months and once every 6 months thereafter up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All the 7 patients underwent R-TAMIS successfully without conversion to laparotomy or laparoscopic surgery. Of the 7 patients, 2 cases underwent full-thickness rectal resection and 5 cases underwent submucosal dissection of tumor. The rectal wounds were not sutured in 2 cases because of large lesions, and the rectal wounds were sutured with synthetic sutures in 5 cases after resection of lesions. Transanal drainage tube was placed in 2 cases and not in 5 cases. The volume of intra-operative blood loss of the 7 patients was 15(range, 2?50)mL. The total operation time of the 7 patients was (91.4±18.4)minutes, including (19.1±2.3)minutes for transanal platform placement and Da Vinci robotic surgical system installation, and (72.3±16.6)minutes for operation. There was no intraoperative complication such as urethral injury. (2) Postoperative recovery. All the 7 patients started water drinking and out-of-bed activities at postoperative day 1 and liquid food intake at postoperative day 2. The time to postoperative first flatus of the 7 patients was 1(range, 1?3)days. The two cases with transanal drainage underwent removing of transanal drainage at postoperative day 2. There was no postoperative complication and the duration of postoperative hospital stay of the 7 patients was 3(range, 3?9)days. (3) Postoperative histopathological examinations. Of the 7 patients, 3 cases had villous adenoma, 2 cases had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor invasion into submucosa (stage SM1), 1 case had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor localized in the inner mucosa (stage Tis) and 1 case had moderately differentiated adeno-carcinoma with tumor invasion into superficial muscle layer (stage T2). All the 7 patients had negative surgical margins with none of tumor cell remained in the base. (4) Follow-up. All the 7 patients were followed up for 18(range, 1?42)months. One of the 7 patients showed rectal adenocarcinoma with tumor invasion into superficial muscle layer by the postoperative histopathological examina-tion and was recommended for remedial radical surgery. The patient refused further surgery and underwent 3 courses of oral capecitabine chemotherapy. The other 6 patients did not receive postoperative chemotherapy. None of 7 patients underwent readmission within postoperative 30 days, and no patient had tumor local recurrence, distant metastasis or death during the follow-up.Conclusion:R-TAMIS for local resection of rectal neoplasms is safe and feasible for patients with rectal adenoma and early rectal cancer, with reliable short-term efficacy and short-term oncological efficacy.

Objective: To investigate the social support of medical students during the outbreak of COVID-19 and its mediating effect on the correlation between epidemic exposure and depression with anxiety. Methods: A total of 5 593 medical students were enrolled, and Social Support Rating Scale(SSRS), Patient Health Questionnaire-9 and 7-tiem Generalize Anxiety Disorder Scale were used to measure. Results: The social support score of SSRS of male students was lower than that of female students (t=-4.36, P<0.05) and juniors and seniors scored lower than other grades(F=4.84, P<0.05). Epidemic exposure proportion was positively correlated with both depressive proportionand anxiety proportion(r=0.05, 0.06, P<0.01), while epidemic exposure and depressive proportion and anxiety proportion were negatively correlated with social support score(r=-0.05, -0.25, -0.19, P<0.01). After controlling for gender and grade, the mediating effect of social support in the correlation between epidemic exposure and depression accounted for 26.6% of the total effect, and the mediating effect of subjective support and supportive utilization was 32.3% and 25.7% respectively. After controlling for gender and grade, the mediating effect of social support in the correlation between epidemic exposure and depression accounted for 20.0% of the total effect, and the mediating effect of subjective support and supportive utilization was 15.9% and 12.2% respectively. Conclusion Social support has partially mediating effect in the correlation between epidemic exposure with depression and anxiety.

Objective To investigate the influencing factors of the cognitive deficits in schizophrenic patients with diabetes.Methods 578 inpatients with schizophrenia and 400 healthy adults were collected.578 schizophrenic patients were divided into schizophrenia group with type 2 diabetes (combined group,n=277) and schizophrenia without type 2 diabetes (single disease group,n=301).The cognitive function of all subjects were examined by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).The clinical symptoms of patients with schizophrenia were measured with the Positive and Negative Syndrome Scale (PANSS).Fasting glucose,lipids,hemoglobin A1c (HbA1c) and insulin levels were measured.Results The total score and factor scores of RBANS in the combined group were lower than those in the healthy control group (total score (70.51 ± 14.43) vs (80.04 ± 15.14),immediate memory (62.65 ± 16.81) vs (75.66± 17.33),visual span(83.60±20.81) vs (87.61 ± 15.61),verbal function(85.58± 14.64) vs (93.88± 13.10),attention function (73.66± 17.52) vs (87.42±20.37),delayed memory(75.27± 17.80) vs (86.27± 15.27),all P＜0.05).The total score of RBANS,immediate memory and attention function factor were lower in the combined group than that in the single disease group ((70.51±14.43) vs (75.02±15.25),(62.65±16.81) vs (67.37±19.12),(73.66±17.52) vs (84.17±15.22),all P＜0.05).Multiple linear stepwise regression analysis showed that education,negative symptoms,positive symptoms,BMI,HbAc 1,course of disease and antipsychotic type were the influencing factors of cognitive impairment in schizophrenic patients with diabetes.Conclusion The cognitive impairment of schizophrenic patients with diabetes is more serious and affected by many factors.Targeted early intervention can help reduce cognitive impairment.

OBJECTIVE: The aim of this study was to evaluate the safety and effectiveness of balloon sinuplasty, and to summarize the main points of its use. METHOD: Fifteeen patients (41 sinuses) were offered treatment with a new technique of balloon sinuplasty and followed for 3 to 6 months after surgery, including "balloon-only" patients and "hybrid" patients. Effectiveness was evaluated by endoscopic examination and computed tomographic (CT) scan. The effect of the operation was tested by the Lund-Mackay CT scores, and the patient's subjective symptoms were tested by the sino-nasal outcome test-20 (SNOT-20) to evaluate postoperative condition. RESULT: Fifteeen patients (41 sinuses) were followed after surgery, including 9 "balloon-only" patients and 6 "hybrid" patients. No unanticipated adverse effects were noted in any patients. Endoscopic examination showed the sinus ostium was opening well, and CT scan showed the lesions apparently disappeared. Lund-Mackay CT scores showed that all patients postoperative scores were significantly improved from baseline at 3 months and 6 months. SNOT-20 showed that all patients postoperative scores were significantly improved from baseline at 3 months and 6 months. There was no significant difference between the "balloon-only" patients and "hybrid" patients. Operation curative effect is very confirmed, and subjective symptoms improved significantly. CONCLUSION Balloon sinuplasty can not only open nasal sinus effectively, but also preserve normal tissue structure and mucous membrane of nasal cavity and nasal sinus. Balloon sinuplasty appears to be a safe, effective and minimally invasive treatment option to relieve sinus ostial obstruction. Patients who received balloon catheter sinusotomy in endoscopic sinus surgery had significant improvement after surgery. Balloon sinuplasty can also be combined with the endoscopic sinus surgery to achieve a better therapeutic effect. It is worth of clinical promotion and application.
Airway Obstruction ; Endoscopy ; Humans ; Nasal Surgical Procedures ; methods ; Paranasal Sinus Diseases ; surgery ; Paranasal Sinuses ; surgery ; Postoperative Period ; Tomography, X-Ray Computed ; Treatment Outcome

Objective To investigate the therapeutic effect of stereotactic surgical treatment and postoperative cognitive functions in patients with treat-resistant obsessive compulsive disorder(TRO). Methods Twelve patients with TRO receiving MRI stereotactic bilateral anterior capsulotomy was retrospectively studied. The evaluation was conducted using the Yale-Brown obsessive compulsive rating scale (Y-BOCS),Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC),Wechsler Memory Scale-Revised in China(WMS-R), Modified Version of Wisconsin Card Sorting Tests (M-WCST) before and 6 months after the operation. Results The scores of Y-BOCS was 5.00(1.00,12.25) and 25.00 (20.25,32.00) after and before surgery, respectively. The scores of Y-BOCS were significantly lower after surgery than before (P<0.05). Most of cognitive function tests were not significantly different in TRO between pre-operation and 6 month post-operation (P>0.05).There were significant improvements in several cognitive tests after surgery including im-mediately logical memory 20.00(12.50,24.00),delayed logical memory16.50(11.50,21.75),immediately visual reproduc- tion 12.00(11.00,14.00),delayed visual reproduction11.00(8.50,14.00) and block design test scores 36.50(29.75,46.75), immediately logical memory14.00(13.00,18.75),delayed logical memory 14.50 (8.75,17.00),immediately visual reproduc-tion 11.00(6.50,11.75),delayed visual reproduction 8.50(6.25,10.00) and block design test scores 30.50(21.00,41.50) (P<0.05). Conclusions MRI-guided bilateral anterior internal capsulotomy is effective and safe treatment for patients with TRO and can improve their cognitive function.

Objective To construct eukaryotic enhanced green fluorescent protein (EGFP) expressing recombinant plasmid, pEGFP-C1-hnRNP A1, which contains coding sequence of human hnRNP A1 (heterogeneous nuclear ribonucleo-protein A1), and to perform cellular localization analysis of EGFP tagged hnRNP A1 under stress. Methods Total RNA was isolated from HeLa cell used for synthesis of first-strand cDNAs using reverse primers that are specific for the 3′-un-translated region of hnRNP A1. hnRNP A1 gene fragments were then amplified by touch-down PCR from those cDNAs and inserted into pEGFP-C1 fluorescent bearing vector through EcoRⅠ/BamHⅡdouble enzyme digestion and T4 DNA Ligase connection. The recombinant pEGFP-C1-hnRNP A1 plasmid was transfected into HeLa cells and green fluorescent tagged fusion proteins was examined by Western blot and confocal fluorescence microscopy. Co-localization of EGFP-hnRNP A 1 with poly (A)+mRNA (the marker of the stress granules), or DCP1a (the marker of processome) were detected by RNA fluores-cence in situ hybridization and immunofluorescence. Results The pEGFP-C1-hnRNP A1 was sequenced and digested cor-rectly by restriction single/double enzyme. The green fluorescent fusion protein was also detected in transfected HeLa cell by Western blot and confocal fluorescence microscopy. EGFP-hnRNP A1 co-localizes with poly(A)+mRNA, but not DCP1a. Conclusion Recombinant eukaryotic plasmid of pEGFP-C1-hnRNP A1 was constructed successfully and expressed effec-tively. EGFP tagged hnRNP A1 takes part in forming stress granules.