Objective:To analyze the epidemiological characteristics of hospitalized patients diagnosed with sepsis in a large class Ⅲ general hospital in Southwest China in a period of 2 years, and to explore the risk factors related to death in patients with sepsis.Methods:A retrospective study was conducted to select patients with sepsis admitted to Sichuan Provincial People's Hospital from September 1, 2021 to August 31, 2023, and general characteristics such as gender, age, discharge diagnosis, discharge department, hospitalization cost, length of stay, and prognosis during hospitalization were collected. The baseline of two groups of patients were compared, and the risk factors of in-hospital cause of death in patients with sepsis were analyzed by multivariate Logistic regression.Results:A total of 3 568 patients with sepsis were included with median age of 58 (35, 74) years old. Of all patients, there were 2 147 males (60.17%). The median length of hospitalization was 13 (8, 24) days, and the median hospitalization cost was 3.98 (1.87, 8.83) ten thousand yuan. The departments with more than 100 cases of sepsis in 2 years were central intensive care unit (ICU), pediatrics department, nephrology department, emergency medicine department, emergency intensive care unit (EICU), infectious department, respiratory medicine department, hematology department, neonatal care unit and emergency surgical department. A total of 1 210 patients (33.91%) admitted to ICU (including central ICU and EICU). The hospitalization cost of ICU patients were higher [6.7 (3.1, 15.5) ten thousand yuan], the hospitalization duration was longer [9 (3, 17) days], and the mortality was higher [35.29% (427/1 210)]. Among 3 568 patients with sepsis, 448 died and 3 120 survived during hospitalization. The age, male proportion and hospitalization cost of patients with sepsis in the death group were significantly higher than those in the survival group [age (years old): 75 (60, 86) vs. 57 (30, 71), male proportion: 67.86% (304/448) vs. 59.07% (1 843/3 120), hospitalization cost (ten thousand yuan): 6.7 (3.0, 16.9) vs. 3.7 (1.8, 8.1)], the ratio of diabetes mellitus was significantly lower than that of survival group [4.91% (22/448) vs. 10.45% (326/3 120)], the length of hospitalization was shorter than that of survival group [days: 10.0 (3.0, 19.0) vs. 13.0 (8.0, 24.0)], the differences were statistically significant (all P < 0.01). Multivariate Logistic regression analysis showed that male [odds ratio ( OR) = 0.75, 95% confidence interval (95% CI) was 0.59-0.96], elder ( OR = 1.04, 95% CI was 1.03-1.05) and diabetes ( OR = 0.32, 95% CI was 0.19-0.54) were independent risk factors for in-hospital death in patients with sepsis (all P < 0.05). Conclusions:Sepsis is a heavy burden in Southwest China, especially for ICU, with high mortality, high hospitalization costs, and heavy economic burden on patients and society. Male, elder and diabetes were independent risk factors for in-hospital death of sepsis patients.

ObjectiveTo explore the mechanism of Buzhong Yiqitang in ameliorating inflammatory injury in autoimmune thyroiditis (AIT) mice based on the Toll-like receptor 4（TLR4）/nuclear transcription factor-kappa B（NF-κB）/absent in melanoma 2（AIM2）inflammasome signaling pathway. MethodThe 120 genetically susceptible 8-week-old NOD.H-2^h4 mice were selected and randomly divided into control group， model group， low， medium and high dose groups of Buzhong Yiqitang （4.78， 9.56， 19.12 g·kg^-1）， and western medicine group （selenium yeast tablets， 3.033×10^-5 g·kg^-1）. The AIT model mice in each group drank ad libitum 0.05% sodium iodide aqueous solution for 8 weeks to establish the AIT model， and the control group drank ad libitum distilled water. Eight weeks later， the mice in each dosing group were divided into groups and gavage. The swelling of thyroid tissue was observed with the naked eye， and the weight of spleen was weighed. The content of serum inflammatory factors interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） was measured by enzyme-linked immunosorbent assay （ELISA）， and Real-time PCR was used to detect the expression of HMGB1， TLR4， AIM2， NF-κB p65，apoptosis-associated speck-like protein（ASC），cysteinyl aspartate-specific protease-1（Caspase-1）， IL-1β mRNA. Western blot was used to detect the expression of high motility group protein 1 （HMGB1）， TLR4， AIM2， NF-κB p65， phosphorylation（p）-NF-κB p65， ASC， Caspase-1， and IL-1β proteins in thyroid tissue， and immunofluorescence staining was used to observe the protein expression of HMGB1， AIM2， and NF-κB p65 in thyroid tissue of mice. ResultCompared with the control group， the thyroid tissue of mice in the model group was significantly swollen， the spleen quality was significantly increased， and the expression of HMGB1， TLR4， NF-κB p65， AIM2， ASC， Caspase-1， IL-1β in thyroid tissue was significantly increased （P<0.01）. Compared with the model group， the swelling of thyroid tissue in mice in each dose group of Buzhong Yiqitang was improved， the quality of spleen was significantly reduced， and the expression of HMGB1， TLR4， AIM2， NF-κB p65， p-NF-κB p65， ASC， Caspase-1， IL-1β in thyroid tissue was significantly reduced （P<0.05， P<0.01）. ConclusionBuzhong Yiqitang can effectively improve the inflammatory injury of AIT， and regulating the abnormal activation of the TLR4/NF-κB/AIM2 inflammasome signal pathway may be one of its intervention mechanisms.

Pre-rheumatoid arthritis （Pre-RA） is the asymptomatic state of rheumatoid arthritis （RA）， and its progression showed complexity， dynamics and significant individual differences. The dynamic prediction model is valuable in identifying individual risks and taking timely preventive and control measures. It is believed that applying the dynamic prediction model to traditional Chinese medicine （TCM） clinical studies of Pre-RA is expected to predict the critical state of Pre-RA to RA， reveal the evolution of Pre-RA， reflect the external authenticity of the TCM clinical studies， and complement the clinical efficacy evaluation method. Accordingly， it is envisioned to construct a dynamic prediction model for Pre-RA progression based on TCM clinical trial data through the dynamic prediction model algorithm， and to apply long-term follow-up cohort data for external validation， thereby providing a basis for scientific warning and clinical decision-making on the evolution of Pre-RA.

Objective:To investigate the effect of low-dose oxytocin receptor antagonist atosiban on the pregnancy outcome of the elective single embryo transfer (eSET).Methods:A retrospective cohort study was performed on the clinical data of patients who got eSET at Department of Reproductive Medicine, Tianjin First Central Hospital from January 2015 to August 2021 and had a first- or second-time embryo transfer. They were divided into fresh cleavage stage embryo cycles, frozen-thawed cleavage stage embryo cycles, and frozen-thawed blastocyst cycles, depending on the days of embryological development and the treatment strategy. Patients were divided into atosiban group and control group according to whether or not they received an intravenous injection of 6.75 mg of atosiban 30 min before implantation. Propensity score matching (PSM) with a ratio of 1∶2 was utilized to match the patients in each group. The differences in the rates of biochemical pregnancy, clinical pregnancy, abortion, ectopic pregnancy, live birth, and birth defects were evaluated.Results:PSM included 243 patients in fresh cleavage stage embryo cycles (81 patients in the atosiban group and 162 patients in control group), 210 patients in frozen-thawed cleavage stage embryo cycles (70 patients in the atosiban group and 140 patients in control group), and 216 patients in frozen-thawed blastocyst cycles (72 patients in the atosiban group and 144 patients in control group). At eSET of fresh cleavage stage embryos, frozen-thawed cleavage stage embryos, or frozen-thawed blastocysts, the biochemical pregnancy rate, the clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate, the live birth rate, and the birth defect rate in atosiban group were not statistically different from those in control group (all P>0.05). Conclusion:Intravenous injection of low dosage of atosiban before eSET failed to significantly improve the pregnancy outcome of infertile patients.

Objective:To investigate the effect of low-dose oxytocin receptor antagonist atosiban on the pregnancy outcome of the elective single embryo transfer (eSET).Methods:A retrospective cohort study was performed on the clinical data of patients who got eSET at Department of Reproductive Medicine, Tianjin First Central Hospital from January 2015 to August 2021 and had a first- or second-time embryo transfer. They were divided into fresh cleavage stage embryo cycles, frozen-thawed cleavage stage embryo cycles, and frozen-thawed blastocyst cycles, depending on the days of embryological development and the treatment strategy. Patients were divided into atosiban group and control group according to whether or not they received an intravenous injection of 6.75 mg of atosiban 30 min before implantation. Propensity score matching (PSM) with a ratio of 1∶2 was utilized to match the patients in each group. The differences in the rates of biochemical pregnancy, clinical pregnancy, abortion, ectopic pregnancy, live birth, and birth defects were evaluated.Results:PSM included 243 patients in fresh cleavage stage embryo cycles (81 patients in the atosiban group and 162 patients in control group), 210 patients in frozen-thawed cleavage stage embryo cycles (70 patients in the atosiban group and 140 patients in control group), and 216 patients in frozen-thawed blastocyst cycles (72 patients in the atosiban group and 144 patients in control group). At eSET of fresh cleavage stage embryos, frozen-thawed cleavage stage embryos, or frozen-thawed blastocysts, the biochemical pregnancy rate, the clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate, the live birth rate, and the birth defect rate in atosiban group were not statistically different from those in control group (all P>0.05). Conclusion:Intravenous injection of low dosage of atosiban before eSET failed to significantly improve the pregnancy outcome of infertile patients.

【Objective】 To evaluate the clinical efficacy and safety of one kind of human prothrombin complex concentrate in treatment of patients with hemophilia B. 【Methods】 The clinical data of 36 patients with hemophilia B treated with human prothrombin complex concentrate produced by Shenzhen Weiguang Biological Products Co. Ltd. from May 2018 to April 2019 were retrospectively analyzed, and its clinical efficacy and safety were analyzed. 【Results】 A total of 35 subjects entered the full analysis set (FAS)and safety set (SS), 33 subjects entered the per protocol Set (PPS). Thirty minutes after the first infusion of FAS subjects, the activity of coagulation factor Ⅸ increased from (3.93±0.975) IU/dL to (25.61±9.337) IU/dL, and the infusion efficiency was (96.43±22.007)%. The increased value of coagulation factor Ⅱ activity was (73.25±14.874) IU/dL. The activity of coagulation factor Ⅶ was (42.79±16.847) IU/dL. The increased value of coagulation factor Ⅹ activity was (65.29±17.042) IU/dL. The increased value of coagulation factor Ⅸ activity was (21.68±9.434%) IU/dL. Twenty-four hours after the first infusion of FAS subjects, the improvement of bleeding symptoms and signs was excellent in 21 cases (60%), improved in 14 cases (40.0%), and the effective rate was 100%. The incidence of adverse reactions was 2.9%(1/35), and there was no antibody to human coagulation factor Ⅸ and new virus infection. 【Conclusion】 Infusion of human prothrombin complex concentrate produced by Shenzhen Weiguang Biological Products Co. Ltd. in the treatment of hemophilia B has significant clinical efficacy and good safety.

Objective:To investigate the clinical effect of Infix combined with hollow screws for the treatment of pelvic injuries with pubic symphysis separation in middle-aged and elderly patients.Methods:Data of 8 middle-aged and elderly patients with pelvic injuries due to pubic symphysis separation undergone treatment from January 2017 to December 2020 were retrospectively analyzed.Results:The average operating time of 8 patients was (46.0±6.2)min(range: 40-62min); the average intraoperative blood loss was (32.0±5.6)ml(range: 25-50 ml); the average length of incisions at the iliac screw was(2.6±0.4)cm(range: 2.0-3.5 cm); the average length of incisions at the hollow screw was (1.1±0.3)cm(range: 0.8-1.5 cm); and the average times of fluoroscopy were (36.0±6.0)times(range: 28-52 times). Postoperative X-ray and CT examinations showed that the reduction of the pubic symphysis was good, the inserted iliac screws and cannulated screws were positioned accurately, and the incision healed well.Based on Matta's criteria, postoperative radiological outcomes were evaluated, with 7 cases rated as excellent and 1 as good, giving an excellent to good rate of 100%(8/8). The average followed up time for all 8 patients was (15.0±4.2)months(range: 6-24 months). Pelvic X-ray and CT examinations at the last follow-up showed that the fractures healed well and the pubic symphysis reduction did not fail.Infix and cannulated screws in the pubic symphysis were removed 10-12 weeks after surgery[average: (10.5±0.5)weeks]. According to the Majeed Pelvic Score, 5 cases were rated as excellent, 2 cases as good and 1 as fair, with an excellent to good rate of 87.5%(7/8). One patient had symptoms related to the lateral femoral cutaneous nerve that disappeared after 3 months.One patient developed deep venous thrombosis after surgery, and the filter was placed and removed 10 weeks later.Conclusions:Using Infix plus cannulated screws for the treatment of pelvic injuries in middle-aged and elderly patients with pubic symphysis separation has the advantages of limited trauma and intraoperative blood loss, good fixation and few complications.

【Objective】 To evaluate the efficacy and safety of human coagulation factor Ⅷ developed by Shenzhen Weiguang Biological products Co, Ltd in the treatment of patients with hemophilia A. 【Methods】 A prospective, multi-center, open, single-group clinical study was conducted. A total of 65 subjects with hemophilia A were enrolled, and human coagulation factor Ⅷ(FⅧ) was injected according to the patients’ bleeding severity. The improvement score of bleeding symptoms and signs after the first infusion of the first bleeding event and the transfusion efficiency of FⅧ activity at 10 min and 1 hour after infusion were taken as the main efficacy indexes. The improvement scores of bleeding symptoms and signs after the first infusion and the increase of FⅧ activity at 10 min and 1 hour after infusion were the secondary efficacy indexes. 【Results】 The 65 subjects were enrolled in safety analysis set (SS) and full analysis set (FAS), and 58 of them were enrolled in protocol analysis set (PPS). Ten minutes and one hour after the first infusion, the level of factor Ⅷ activity in the subjects increased significantly, and the FⅧ activity increased by 100% or more in more than 79% of the subjects. The average infusion efficiency of FⅧ activity in all subjects was more than 100%. In 70% of the subjects, the pain was relieved rapidly and /or the bleeding symptoms were significantly improved 8 hours after each bleeding infusion, and the improvement rate of bleeding symptoms and signs reached 100% 72 hours after infusion. 【Conclusion】 After infusion of human coagulation factor Ⅷ, the activity level of factor Ⅷ in patients with hemophilia A significantly increased. The infusion efficiency can reach a optimal level, and the bleeding symptoms can be significantly improved.

Objective:To investigate the clinical effect of using combined lumbar pelvis fixation device in the treatment of old vertical unstable fracture dislocation of posterior pelvic ring.Methods:Data of 7 patients with old vertical unstable fracture dislocation of posterior pelvic ring admitted and followed up from January 2017 to April 2020 were retrospectively analyzed, including 4 males and 3 females with an average age of 42.4 years old (range, 22-73 years old). There were 3 cases of traffic injury, 3 cases of falling injury and 1 case of tumble injury. According to Tile classification for pelvic fractures, there were 5 cases of type C1, 1 case of type C2 and 1 case of type C3. The average time from fracture to surgery was 5.4 weeks (range, 3-10 weeks). Among the 7 patients, 4 patients' posterior ring fractures were fixed by combined lumbar pelvic triangle fixation, and 3 patients' posterior ring fracture were fixed by combined lumbar pelvic fixation. 4 patients' anterior ring injury were not treated, 2 patients' anterior ring injury were treated by closed cannulated screw and internal fixation, and 1 patient's anterior ring injury was fixed by INFIX and cannulated screw. Every patient's operating time, intraoperative blood loss, length of incision and times of X-ray fluoroscopy were recorded. Pelvic X-ray and CT scan were taken postoperatively to observe the condition of reduction and screw position. Postoperative fracture reduction quality was assessed by Matta radiological criteria and Majeed criteria was used at the final follow-ups to evaluate the degree of functional recovery after pelvic fracture.Results:The average operating time of 7 patients was 143 min (range, 96-205 min); the intraoperative average blood loss was 579 ml (range, 300-1 650 ml); the average length of incisions was 12.9 cm (range, 9-15 cm) and the average time of X-ray fluoroscopy was 27 times (range, 15-52 times). Postoperative X-ray and CT scan showed that the displacements of the posterior rings were reset well and all the hollow screws were located accurately and firmly. Postoperative radiation quality was evaluated according to Matta radiological criteria, and there were 4 cases of excellent, 2 cases of good and 1 case of fair, with an excellent and good rate of 85.7% (6/7). Seven patients had good fracture union. The average followed up time for all 7 patients was 12 months (range, 6-16 months). At the last follow-up, imaging examination showed good reduction of the sacroiliac joint, and the reduction of anterior and posterior rings were not lost. The healing time was 14.2 weeks (range, 12-20 weeks). Majeed score: postoperative 4.90±6.64 points (range, 48-58 points), postoperative 3 months 71.40±7.32 points (range, 67-75 points), postoperative 6 months 84.90±8.14 points (range, 68-96 points), the difference was statistically significant ( F=0.614, P=0.004). Majeed score 6 months after operation showed that 5 cases were excellent, 1 case was good and 1 case was fair, and the excellent and good rate was 85.7% (6/7). Conclusion:Using combined lumbar pelvis fixation device in the treatment of old vertical unstable fracture dislocation of posterior pelvic ring has good reduction quality, high fixed strength and good postoperative effect.

Objective:To evaluate the clinical value of blastocysts derived from poor-quality embryos after day 3 (D3) transplantation and frozen, to investigate the best embryo strategies of frozen-thawed blastocysts.Methods:A retrospective cohort study was conducted on 362 frozen-thawed blastocyst transfer cycles were retrospectively analyzed in the Department of Reproductive Medicine, Tianjin First Central Hospital from July 2015 to March 2020. According to the days of culture, they were divided into day 5 (D5) and day 6 (D6) blastocyst transplantation group; according to the number of embryos transferred, they were divided into single blastocyst transplantation group and double blastocyst transplantation group; according to the embryo quality, single blastocyst transplantation group was divided into single high-quality embryo group and single poor-quality embryo group. The double blastocyst transplantation group was divided into double high-quality blastocyst group, a high-quality embryo matching a poor-quality blastocyst transplantation group and the double poor-quality blastocyst group. Clinical pregnancy rate, implantation rate and multiple pregnancy rate were compared in each group.Results:The clinical pregnancy rate and the implantation rate of D5 blastocyst transplantation group in thawing cycles were higher than those of D6 blastocyst transplantation group [62.96% (102/162) vs. 42.50%(85/200), 53.98% (122/226) vs. 35.86% (104/290)](all P<0.001), and there was no statistically significant difference of early abortion rate and multiple pregnancy rate between the D5 and D6 groups ( P>0.05). There was no statistically significant difference in the clinical pregnancy rate and the early abortion rate of D5 single blastocyst groups and double blastocyst pregnancy ( P>0.05), the implantation rate of single blastocyst group was higher than that of the double blastocyst group [62.24% (61/98) vs. 47.66% (61/128)] while the multiple pregnancy rate of single blastocyst group was lower than that of the double blastocyst group [3.28% (2/61) vs. 46.34% (19/41)] ( P=0.029, P<0.001). The clinical pregnancy rate and the multiple pregnancy rate of D6 single blastocyst group were lower than those of D6 double blastocyst pregnancy group [35.45% (39/110) vs. 51.11% (46/90), 5.13% (2/39) vs. 26.09% (12/46)] ( P=0.026, P=0.009), there were no statistically significant differences in implantation rate and early abortion rate (all P>0.05). There were no statistically significant differences in clinical pregnancy rate, implantation rate, early abortion rate and multiple pregnancy rate between single high-quality embryo and poor-quality embryo group in D5 and D6 single blastocyst transplantation group (all P>0.05). There were no statistically significant differences in clinical pregnancy rate, implantation rate, early abortion rate, and multiple pregnancy rate of the double high-quality blastocyst transplantation group, a high-quality embryo matching a poor-quality blastocyst transplantation group and the double poor-quality blastocyst group in D5 ( P>0.05). The implantation rate of D6 double poor-quality embryo group [26.67% (24/90)] was lower than that of the double high-quality embryo group [47.62% (20/42)] and a high-quality embryo matching a poor-quality embryo group [43.75% (7/16)]( P=0.029), while there were no statistically significant differences in clinical pregnancy rate, early abortion rate, and multiple pregnancy rate (all P>0.05). Conclusion:After the high-quality D3 embryo transfer and freezing, the remaining poor-quality embryos can be cultured to form blastocyst, better clinical pregnancy rate was obtained for transfer the frozen-thawed blastocysts, it increases the value of embryos and reduces the cost of treatment. The quality of D5 blastocyst is better than that of D6 blastocyst. The single blastocyst transplantation of D5 is preferred to reduce the rate of multiple pregnancy without affecting the clinical pregnancy rate.