Objective:To explore the cause of death of 2 suspected Yunnan sudden unexplained death (YNSUD) cases in Dayao County, Yunnan Province.Methods:The field epidemiological investigation and autopsy of 2 cases of YNSUD in Dayao County from June 15 to 20, 2020 were conducted; and blood and tissue samples were collected for qualitative analysis of common poisons and drugs.Results:The areas where the two cases were located were all seriously ill villages with a history of YNSUD, and the time of death occurred in the onset season of YNSUD. There was no blood relationship between the 2 cases, no obvious abnormal symptoms before death, no special diet, no history of exposure to pesticides and other toxic chemicals, and the test results of common poisons were all negative. Autopsy pathological examination results showed that case 1 died of acute cardiac dysfunction caused by sudden acute myocardial infarction of coronary heart disease, and case 2 died of central respiratory and circulatory failure caused by spontaneous subarachnoid hemorrhage.Conclusions:The two cases are excluded from YNSUD through autopsy, and the cause of death is determined. It is suggested that emergency response should be taken as soon as possible for YNSUD cases, and autopsy should be actively carried out to clarify the cause of death from a pathological point of view.

Objective : To investigate the effects of one night of sleep deprivation on adults ’cognitive performance and sleepiness. Methods : The study employed a repeated⁃measures design. Participants performed cognitive performance tasks , which included the Continuous Performance Test and Digit Span Test and Karolinska Sleepiness Scale. The data were analyzed using one⁃way repeated⁃measures ANOVA. Results : 48 participants were included in this study. Sleep deprivation during night shift had a adversely affect on sustained attention performance and alertness (P < 0. 05) . Compared with the beginning of night shift work , the correct number decreased , the number of errors , missed number and reaction time increased , and the score of Karolinska sleepiness scale decreased after the night shift work. The sleep deprivation has no significant effect on working memory performance (P > 0. 05) . Conclusion One night of sleep deprivation has significant deleterious effects on cognitive performance and subjec⁃ tive sleepiness. However, no effect on the working memory performances has been found.

Objective:To evaluate the feasibility, safety and effectiveness of the active surveillance as an alternative to surgery in patients with low-risk papillary thyroid microcarcinoma(PTMC); And to explore potential surgical indicators based on characteristics of patients and medical environment.Methods:A prospective cohort study was conducted in patients with low risk PTMC and received active surveillance management( n=98). Patient adherence, non-progression surgery rates were described, cumulative incidence of tumor growth≥3 mm and tumor volume increase≥50% under ultrasonic monitoring, as well as tumor doubling rate(TDR) were evaluated. Results:A total of 98 patients were enrolled in this prospective cohort. The median age was 39(30, 45) years, and the median baseline diameter of the index tumors was 5.0(3.8, 6.8) mm, with 63.3% of tumors being≤5 mm. After a median 22(12, 44) months follow-up, tumor size growth≥3 mm and tumor volume increase≥50% occurred in 11(11.2%) and 50(51.0%) patients, and no new lymph node metastasis, distant metastasis, and death occurred. Five cases(5.1%) required delayed surgery, and other five non-progression patients opted in surgery based on their own preferences. One patient lost to follow-up. The median post-tumor progression TDRs was significantly lower than that of pre-tumor progression TDRs [size growth per year: -0.09(-0.12, 0.48) vs 0.91(0.86, 1.25), P=0.014, n=8; volume increase per year: 0.29(-0.14, 0.70) vs 1.04(0.66, 2.17), P<0.001, n=39]. After tumor size and volume progression, 62.5% and 43.6% of tumors were remained stable or shrank, respectively. Conclusions:Actived surveillance can be considered as one of the management strategies for low-risk PTMC. Given the differences in population and clinical characteristics, it should be taken in to consideration in developing active surveillance management, such as candidate criteria, follow-up strategies, and intervention indications.

【Objective】 To explore the protective effects of exogenous hydrogen sulfide （H2S） on oxygen glucose deprivation and re-oxygenation （OGD/R）-induced SH-SY5Y cell injury. 【Methods】 OGD/R model was established in SH-SY5Y cells. Based on interferences， SH-SY5Y cells were divided into control group （no interference）， OGD/R model group， and treatment groups （OGD/R model treated with different concentrations of NaHS （H2S donor）. The cells were cultured in low glucose medium without fetal bovine serum under 37 ℃， 93% N2 and hypoxia （2% O2） for 12 h， then in complete medium under normoxia （5% O2 ） for 24 h. CCK-8 was used to detect cell viability， and flow cytometry was used for assaying the level of cellular apoptosis. Western blot was used to detect the expression levels of endoplasmic reticulum stress-related proteins including glucose regulatory protein 78 （GRP78）， CCAAT/enhancer-binding homologous protein （CHOP）， NF-κB P65 and COX-2. 【Results】 The cell viability was lower in OGD/R model group than in the control group （P<0.05）. NaHS treatment at a concentration of 0-0.5 mmol/L increased cell viability in OGD/R model group in a dose-dependent manner （P<0.05）. In contrast， NaHS （C>0.5 mmol/L） decreased cell viability of OGD/R （P<0.05）. The apoptosis level of early stage in OGD/R model group was significantly higher than that in control group （P<0.05）. NaHS treatment at concentrations of 0.2 and 0.4 mmol/L lowered the apoptosis level of early stage in OGD/R model group （P<0.05）. Western blot showed that the protein expression levels of GRP78， CHOP， NF-κB p65， and COX-2 were significantly higher in OGD/R model group than those in control group （P<0.05）. When compared with OGD/R model group， the expression levels of GRP78， CHOP， NF-κBp65 and COX-2 were decreased by NaHS at concentrations of 0.2， 0.4 and 4 mmol/L （P<0.05）， but there was no statistically significant difference among the treatment groups （P>0.05）. 【Conclusion】 NaHS can rescue cell viability of OGD/R-induced cell injury. It may be achieved by inhibiting the activation of NF-κBp65 and COX-2 proteins induced by endoplasmic reticulum stress to reduce the level of cell apoptosis.

Objective:To understand the infection status of HCV and Treponema pallidum (TP) in HIV/AIDS cases in Yunnan province,and identify the risk factors. Methods:Between January 1 and June 30 in 2020,a cross-sectional survey was conducted in Yunnan. Two enzyme-linked immunosorbent assay (ELISA) kits were used to detect anti-HCV, the positive results of both two kits indicated HCV infection. ELISA and syphilis toluidine red untreated serum test were applied to identify TP infection. Both Excel 2016 and SPSS 22.0 software were used for statistical analysis, and logistic regression model was conducted to identify the relevant factors of HCV and TP infection.Results:A total of 5 922 HIV/AIDS cases were included in this study, the infection rates of HCV and TP were 6.5% (383/5 922) and 5.8% (344/5 922) respectively. The co-infection rate of HCV and TP was 0.4% (22/5 922). The risk for HCV infection in HIV/AIDS cases was higher in younger age groups compared with age group ≥50 years (15-19:a OR=3.53;20-29:a OR=3.02;30-39:a OR=2.91;40-49:a OR=3.61), in males than in females (a OR=2.31), in the married and unmarried than in the divorced or widowed (married:a OR=1.61;unmarried:a OR=1.63), in other ethnic groups than in Han ethnic group (a OR=1.70), in people with lower education level than in people with education level of college and above (primary school degree and below:a OR=4.69;middle school:a OR=3.96), in people living in the central and western Yunnan than in people living in eastern Yunnan (central Yunnan:a OR=2.46; western Yunnan:a OR=7.08), in injection drug users than in MSM (a OR=131.08). The risk of TP infection in HIV/AIDS cases was higher in people with education level of college and primary school than in middle school degree (primary school and below:a OR=1.73;college and above:a OR=1.77), in people with other occupations than in farmers (a OR=1.39), in people living in eastern Yunnan than in people living in western Yunnan (a OR=1.75); in MSM than in people with heterosex (a OR=9.75). Conclusions:A certain proportion of HIV/AIDS cases reported between January and June in 2020 in Yunnan were co-infected with HCV and TP, many factors were associated with the co-infection. It is suggested to strengthen HCV and TP tests in HIV/AIDS cases and conduct active treatment of the co-infection.

Objective:To study the patterns of tocilizumab (TCZ) use, its efficacy and safety in patients with rheumatoid arthritis (RA) in routine clinical practice.Methods:A total of 407 patients with RA were enrolled from 23 centers and treated with TCZ within 8 weeks prior to the enrollment visit, and were followed for 6-month. The patterns of TCZ treatment at 6 months, the effectiveness and safety outcomes were recorded. Statistical analysis was performed using SAS version 9.4.Results:A total of 396 patients were included for analysis, in which 330 (83.3%) patients received TCZ combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 16.7%(66/396) received TCZ monotherapy. At baseline, TCZ was initiated in 56.6%(224/396) and 9.6%(38/396) of patients after failure of DMARDs and other biological agents (bDMARDs) respectively. During the 6-month follow-up period, the mean frequency of TCZ administration was (3.7±1.6), the mean TCZ dosage was (7.4±1.2) mg/kg, and the mean interval between doses was (40±13) days. 120(25.8%) patients were on TCZ treatment at the end of the study. Improvements in disease activity, systemic symptoms and patient report outcomes were observed at the end of the study. 22.7%(90/396) patients experienced at least one treatment related adverse event, and 8 patients experienced at least one serious adverse event.Conclusion:This study demonstrates that TCZ treatment is effective in patients with RA when being treated for 6 months with an acceptable safety profile. The duration of TCZ treatment needs to be extended.

Objective:To investigate the status of Corona Virus Disease 2019 (COVID-19) health literacy and associated factors in Inner Mongolia Autonomous Region.Methods:Based on the multi-stage stratified sampling method, the questionnaire survey of health literacy of COVID-19 were carried out in 55 599 local residents from12 prefecture-level cities of Inner Mongolia Autonomous Region between March 10 and 15, 2020. The questionnaire in details included not only knowledge, attitude and behavior, but also mental health, their scores were calculated using Decimal method. A ≥80% of the correct answer rate of the survey content was regarded as qualified for health literacy. There were 51 722 (93.0%) valid questionnaires, according to the ratio of medical staff to non-medical staff, 32 529 questionnaires were selected for analysis. The health literacy level was defined according to the proportion of qualified people.The credibility and availability of the questionnaires were evaluated by Cronbach′s α coefficient and KMO test. The associated factors were analyzed by Pearson χ 2 test and logistic regression. Results:In Inner Mongolia Autonomous Region, the whole level of health literacy of COVID-19 was 85.7%, and their scores were (26.30±2.48). Knowledge, attitude, and behavioral literacy levels were 61.6%, 95.6%, and 96.8%, respectively. Compared with the population of 15-25 years old, the health literacy level of 46-65 years old was the highest ( OR=2.00, 95% CI: 1.78-2.24). The health literacy level of medical staff group ( OR=2.54, 95% CI: 1.30-4.95) was far higher than the non-medical staff group; the population with college or above education level ( OR=10.22, 95% CI: 9.19-11.36) was significantly higher than the population with education level below college. The degree of anxiety was negatively correlated with education level. Conclusions:The health literacy level of COVID-19 in residents in Inner Mongolia Autonomous Region is relatively high, but the level of knowledge literacy needs to be improved. The main factors affecting the health literacy of COVID-19 among Inner Mongolia residents are age, occupation and education level.

Structure of biliary system is complex as well as various, making troubles for optimal surgical treatment of biliary disease. Remarkable imaging of biliary system helps surgeon evaluating patients and planning surgeries. There are several methods to obtain accurate anatomical information of biliary system, such as X-ray fluoroscopy, MRI and fluorescence-based imaging. Each has its own advantages and disadvantages. Combination of multi-model imaging technologies may improve visual result of anatomical information of biliary tract. More resolvable, legible, and sequential imaging technology of biliary system remains further study. This article reviews various cholangiography methods widely used in the clinical setting.

OBJECTIVE： To study the mechanism of Prunus persica-Carthamus tinctorius couplet medicine in the treatment of osteonecrosis of the femoral head （ONFH）. METHODS： The network pharmacology was adopted. The active components of P. persica -C. tinctorius couplet medicine and ONFH target were screened through TCM systematic pharmacological analysis platform target （TCMSP）， DRAR-CPI， hnuman gene database （GeneCards） and online medelian inheritance in man （OMIM） using oral availability of compounds （OB）＞30％ and drug like （DL）＞0.18 as standard. Network topology attribute analysis software Cytoscape 3.6.0 was utilized to construct the active components-ONFH targets network. Target protein interaction network was established on the basis of STRING database， and top 5 target proteins in the list of connectivity were screened， and molecular docking server was used to predict the combination activity of active components from P. persica -C. tinctorius couplet medicine. The biological processes of target gene ontology （GO） and metabolic pathways in Kyoto encyclopedia of genes and genomes （KEGG） were enriched and analyzed by DAVID. RESULTS： A total of 44 active components were screened from P. persica -C. tinctorius couplet medicine， including baicalin， quercetin， etc.， and 78 targets related to ONFH including VEGF， VEGI， CRP， etc. Through analysis of molecular docking server， binding activity of active components of P. persica -C. tinctorius couplet medicine to target protein was strong. GO and KEGG pathway enrichment analysis showed that biological process of P. persica -C. tinctorius couplet medicine for ONFH was related with negative regulation of apoptosis process and positive regulation of nuclear factor-κB transcription factor， mainly through regulating secretory glycoprotein signaling pathway， melanogenesis signaling pathway， VEGF signaling pathway， signaling pathway of basal cell carcinoma， adenosine-activated protein kinase signaling pathway. CONCLUSIONS： This study preliminarily validates the major targets and pathways of P. persica -C. tinctorius couplet medicine for ONFH， which lay a foundation for further study on their pharmacological action.