Objective:To study the relationship between the dynamic changes of angiopoietin-2 (Ang-2) and surfactant protein D (SP-D) in pediatric acute respiratory distress syndrome (pARDS) and the severity and prognosis of the disease.Methods:Using nested case-control study method, 80 children with pneumonia complicated with pARDS admitted to PICU at Fujian Maternal and Child Health Hospital from June 2018 to May 2021 were selected as pARDS group, and 19 healthy children with corresponding age were selected as control group.According to the oxygenation, the children in pARDS group were divided into three subgroups: mild group (23 cases), moderate group (32 cases) and severe group (25 cases). According to the prognosis at discharge, the children in pARDS group were divided into survival group (67 cases) and death group (13 cases). Ang-2 and SP-D were detected by enzyme-linked immunosorbent assay.The levels of Ang-2 and SP-D in children with pARDS of different severity on the first day were compared; The changes of Ang-2 and SP-D levels on the 1st, 3rd and 8th day of children in survival group and death group were compared, and the receiver operating characteristic (ROC) curve was plotted to compare the predictive value of Ang-2 and SP-D for pARDS prognosis.Results:(1) The levels of Ang-2 and SP-D on the first day in pARDS group were significantly higher than those in control group( P<0.001). (2) The levels of Ang-2 and SP-D on the first day in children with pARDS of different severity levels were significantly different ( P<0.001), and the levels of Ang-2 and SP-D increased gradually with the increase of disease severity.(3) The levels of Ang-2 and SP-D in death group were significantly higher than those in survival group on the 1st, 3rd and 8th day ( P<0.05). (4) Prognostic efficacy of Ang-2 and SP-D levels in pARDS group at different time points: when the areas under the ROC curve predicted by Ang-2 on the 1st, 3rd and 8th day for inpatient mortality in children with pARDS were 0.808, 0.981 and 0.989, respectively; the optimal cut-off values were 6 000 pg/mL, 6 971 pg/mL and 4 171 pg/mL, respectively; the sensitivity was 84.6%, 92.3% and 92.3%, respectively; and the specificity was 76.1%, 97.0% and 98.5%, respectively.The areas under the ROC curve predicted by SP-D on the 1st, 3rd and 8th day for inpatient mortality in children with pARDS were 0.689, 0.993 and 0.983, respectively; the optimal cut-off values were 13544 pg/mL, 16003 pg/mL and 12294 pg/mL, respectively; the sensitivity was 84.6%, 100.0% and 100.0%, respectively; and the specificity was 46.3%, 98.5% and 97.0%, respectively. Conclusion:Serum Ang-2 and SP-D levels in children with pARDS increase with the aggravation of the disease.The dynamic changes of Ang-2 and SP-D in children with pARDS with different prognosis are different during the course of disease, and monitoring serum Ang-2 and SP-D during the course of disease has a certain predictive value for clinical outcome.

In the context of the prevention and control for coronavirus disease (COVID), public health emergency governance has been incorporated into an important part of the national governance system, and the "combination of peacetime and wartime" has become an important principle of public health emergency governance. Based on the experience of public health emergency management in large cities and the theory of collaborative governance, this study analyzed the problems and obstacles of general hospitals in coping with emerging respiratory infectious diseases. It is proposed to select general hospitals above tertiary level in the region to build peacetime and wartime combined emergency hospital, establish standardized conversion procedures and strengthen the construction of key elements of integrated emergency hospitals, so as to provide new ideas for the construction of emergency medical system "combination of peacetime and wartime" mechanism and improve the "combination of civilian and combat" public health emergency governance system.

Objective:To explore the predictive value of pre-biopsy serum inflammatory markers on positive prostate biopsy results, establish a nomogram model based on pre-biopsy inflammatory markers combined with other parameters, and evaluate its predictive ability for prostate biopsy results.Methods:The clinical data of 601 patients undergoing transperineal prostate biopsy who were admitted to the Second Hospital of Tianjin Medical University from August 2019 to August 2021 were retrospectively analyzed. The median age was 68(35, 89)years, and the median tPSA was 9.56(4.01, 19.95)ng/ml. The median fPSA was 1.36(0.88, 2.02)ng/ml, the median PSAD was 0.16(0.11, 0.26)ng/ml 2, and the median platelet-to-lymphocyte ratio(PLR)was 129.90(98.95, 169.89). PI-RADS v2.1 score<3 points in 189 cases(31.45%), 3 points in 174 cases(28.95%), 4 points in 190 cases(31.61%), and 5 points in 48 cases(7.99%). A simple randomization method was used to obtain 421 cases(70.00%)in the modeling group and 180 cases(30%)in the validation group.There was no significant difference in the clinical data between the two groups ( P>0.05). Univariate and multivariate logistic regression analysis were performed in the modeling group to screen independent influencing factors for the prediction of positive prostate biopsy results. A nomogram model was established and internal verification was conducted. External validation of the model was performed in the validation group. Receiver operating characteristic(ROC)curve was used to verify model discrimination, Hosmer-Lemeshow goodness-of-fit test was used to verify model calibration, and decision curve analysis (DCA) was used to evaluate the net benefit and clinical utility of the predictive model. Results:The results of univariate analysis showed that the age( OR=1.060, P<0.01), histological inflammation( OR=0.312, P<0.01), the number of biopsy needles( OR=0.949, P=0.009), f/tPSA( OR=0.954, P=0.003), PV( OR=0.973, P<0.01), PSAD( OR=29.260, P<0.01), PI-RADS v2.1 score(3-point OR=3.766, P=0.001; 4-point OR=11.800, P<0.01; 5-point OR=57.033, P<0.01), lymphocyte count( OR=1.535, P=0.013), NLR( OR=0.848, P=0.044), PLR( OR=0.994, P=0.005)and SII( OR=0.999, P=0.009)were statistically different between the prostate patients and non-prostate cancer patients in the modeling group; Multivariate analysis showed that age( OR=1.094, P<0.001), fPSA( OR=0.605, P=0.002), histological inflammation ( OR=0.241, P<0.001), PSAD ( OR=7.57, P=0.013), PLR ( OR=0.994, P=0.005) and PI-RADS v2.1 Score(3-point OR=2.737, P=0.016; 4-point OR=8.621, P<0.001; 5-point OR=47.65, P<0.001) was an independent influencing factor for prostate cancer at initial biopsy; a nomogram model based on age, fPSA, PSAD, PLR and PI-RADS v2.1 scores was established. The AUC of the modeling group was 0.849(95% CI 0.810-0.888), and the sensitivity was 80.9%, and the specificity was 76.1%; the AUC of the validation group was 0.862(95% CI 0.809-0.915), and the sensitivity was 91.9%, and the specificity was 67.8%, suggesting that the diagnostic prediction model had a good discrimination. The calibration curve showed that the prediction model was well calibrated ( χ2=6.137, P=0.632). The decision curve analysis (DCA) of the modeling and validation groups indicated a larger net benefit of the predictive model. Conclusions:The nomogram model established in this study based on age, fPSA, PSAD, PLR and PI-RADS v2.1 score showed good predictive efficacy for prostate biopsy in patients with PSA between 4-20 ng/ml.

Objective:To explore the thoughts and rules of Ye Tianshi’s medication in the treatment of damp-resistance spleen and stomach disease in the Clinical Guideline Medical Records. Methods:In the spleen and stomach-related diseases and dampness chapters of Clinical Guideline Medical Records, the medical cases selected in the spleen and stomach, disease syndrome ondampness were selected and entered into the Traditional Chinese Medicine Inheritance Assistance Platform System (V 2.5). The software was used to analyze the frequency, tastes, meridian, and for the association rules analysis and complex system entropy cluster analysis of medication. Results:A total of 162 prescriptions were included, involving 155 traditional Chinese medicines. The Poria, Magnoliae Officinalis Cortex, Citri Reticulatae Pericarpium, Atractylodis Macrocephalae Rhizoma, Alismatis Rhizoma, were used frequently. The Qi of medicationwere mainly warm, cold and flat, and the five tastes were mainly bitter, sweet and pungent, mainly belonging to the spleen, stomach and lung meridian. The core drugs in the associated network were Atractylodis Macrocephalae Rhizoma, Alismatis Rhizoma, Polyporus, Poria, Magnoliae Officinalis Cortex, Citri Reticulatae Pericarpium, Ginseng Radix et Rhizoma, Scutellariae Radix and Coptidis Rhizoma. In the analysis of the correlation between drugs, there are 106 combinations of 2 drugs, 19 combinations of 3 drugs, 1 combination of 4 drugs, and 15 drug pairs with a correlation coefficient greater than 0.03, such as " Cimicifugae Rhizoma- Puerariae Lobatae Radix" and " Atractylodis MacrocephalaeRhizoma- Cinnamomi Ramulus" , " Armeniacae Semen Amarum- Gardeniae Fructus" . Based on complex entropy clustering analysis, 5 pairs of core combinations were extracted, such as " Paeoniae Radix Alba- Coptidis Rhizoma- Nelumbinis Semen" and " Scutellariae Radix- Coptidis Rhizoma-Poria" , and 5 new prescription combinations were obtained, which had the effects of clearing heat and drying dampness, promoting Yang and surpassing dampness, regulating qi and removing dampness, warming yang and removing dampness, clearing heat and dampness. Conclusions:In Clinical Guideline Medical Records, Ye Tianshi stressed regulating Qi machine, eliminating and removing discharge in the treatment of spleen and stomach diseases with dampness resistance. He often used the treatment methods of dispersing lung and removing dampness, ascending Yang and surpassing dampness, conducting Qi and guiding dampness, aromatizing dampness, warming yang and removing dampness, relieving dampness with bitterness, reducing dampness, clearing heat and removing dampness.

Establishing fever clinic was an important achievement of the fight against severe acute respiratory syndrome (SARS) in 2003, and played an important role in the subsequent outbreaks of H1N1, H7N9 and Middle East respiratory syndrome (MERS). Fever clinics have significant emergency characteristics, but there are no rescue conditions in the fever clinics. Consequently, the problem of establishment and management of fever clinics is still outstanding. Based on the development of fever clinics, this paper analyzes the operational dilemma of fever clinics, explores the measures of establishment and management of fever clinics, and constructs the operational mechanism of fever clinics in order to provide the basis for the emergency management system of public health emergencies, which is suitable for Chinese health system.

OBJECTIVE:To systematically evaluate therapeutic efficacy and safety of pitavastatin comparison of atorvastatin in the treatment of primary hypedipemia in Chinese adults,and to provide evidence-based reference for clinic.METHODS:Retrieved from The Cochrane Library,PubMed,Chinese Journal Full-text Database,Wanfang database,and manually search Google Scholar,Baidu academic search engine,randomized controlled trials (RCTs) about pitavastatin (trial group) vs.atorvastatin (control group) in the treatment of primary hyperlipemia in Chinese adults were collected.After literature screening,data extraction,quality evaluation of included studies with modified Jadad scale,Meta-analysis of the levels of total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C),response rate and the incidence of ADR was conducted by using Rev Man 5.3 statistical software.RESULTS:A total of 5 RCTs were included,involving 456 patients.Results of Meta-analysis showed that the decrease of TC level [MD=0.09,95％CI(0.01,0.16),P=0.03] in trial group was more better than control group,while the increase of HDL-C level [MD=0.08,95％ CI (0.01,0.14),P=0.03] and the decrease of the TG level [MD=-0.13,95％ CI (-0.20,-0.06),P=0.000 4] in trial group were worse than control group,with statistical significance.There was no statistical difference in the decrease of LDL-C[MD=-0.01,95％ CI (-0.13,0.10),P=0.84],response rate [OR=0.75,95％CI (0.15,3.66),P=0.72] or the incidence of ADR [OR=0.68,95 ％ CI (0.44,1.05),P=0.08] between 2 groups.CONCLUSIONS:Pitavastatin has better therapeutic efficacy in decreasing TC,but its therapeutic efficacy in decreasing LDL-C is similar to that of atorvastatin;its therapeutic efficacy in decreasing TG and increasing HDL-C is worse than that of atorvastatin.The safety of them is equivalent.

Objective To establish a suitable model for predicting the success of trial of labor after cesarean section (TOLAC) during the pregnancy at term.Methods Data for all deliveries at term with one cesarean delivery history in Shenzhen Maternity and Child healthcare hospital during 1 January 2012 to 31 December 2014 were reviewed.Variables associated with VBAC were identified and used to build a model to predict the outcome of TOLAC with multivariable logistic regression.Godness of fit and accuracy of the model were evaluated by ROC.Results A total of 531 women met inclusion criteria and underwent TOLAC.Of the women who underwent trial of labor, 448 (84.4％) had a successful VBAC, 83 failed, and 2 (0.38％) had uterine rupture.Multivariable logistic regression analysis showed that previous cesarean section (CS) time interval, neonatal birth weight (BW) and premature rupture of membranes (PROM) were independent factors affecting TOLAC outcome, and their Odds Ratios were 2.79, 1.002 and 0.244, respectively.The Logistic regression model was expressed as follows:P =1/[1 + exp (2.4 × neonatal BW + 1.03 × previous CS time interval-1.41 × PROM-10.24)].The Hosmer-lemeshow test showed that the model fitted well (x2 =123.45, P =0.996), and the prediction accuracy of the model was 86.77％.The model performed well with an AUC of 0.794 (P =0.000).Conclusions A predictive model, which contains three variables (previous CS time interval, neonatal BW and PROM), has been developed and its prediction efficiency and accuracy are satisfactory.The larger birth weight, the longer time interval from previous CS, and the absence of PROM are more likely to be failed in TOLAC.

OBJECTIVETo investigate the levels and influencing factors of phthalate internal exposure in pregnant women (gestation age ≤ 16 weeks).

METHODSDuring April to June in 2013, 1 020 pregnant women (gestation age ≤ 16 weeks) who had established the maternal care manual were recruited in maternal and child health hospital of Siming District, Xiamen city. Participators were asked to complete a questionnaire to obtain information on socio-demographic characteristics, lifestyle behaviors, and antenatal examination and to provide a urine sample. Finally, 998 pregnant women who provided a urine sample and completed the questionnaire were enrolled. Adopting systematic sampling method, 100 ones were selected randomly among 998 pregnant women. High performance liquid chromatography-electrospray ionization-tandern mass was used to determine the concentration of five phthalate monoesters in each urine, including mono-n-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), mono-ethylhexyl phthalate (MEHP). Based on the measurements and questionnaire data, multivariate logistic regression was used to analyze the association between the phthalate monoester levels and potential influential factors.

RESULTSThe detection rates of MMP, MEP, MBP, MBzP and MEHP in 100 pregnant urine samples were 94%, 93%, 87%, 83%, 99%, respectively. And the urinary median uncorrected concentrations of MMP, MEP, MBP, MBzP and MEHP in 100 urine samples were 20.56, 17.62, 10.15, 2.03, and 5.12 ng/ml, respectively. Specific gravity-corrected concentration were 20.81, 20.36, 12.88, 2.58, 5.00 ng/ml, respectively. The results of multivariate logistic regression analysis indicated that: education degree was negatively associated with urinary concentration of MMP, MEP, MBP, MBzP and MEHP, OR (95% CI) were 0.495 (0.253-0.966), 0.380 (0.191-0.755), 0.379 (0.186-0.774), 0.401 (0.196-0.819), 0.373(0.183-0.762), respectively. Participants who had hair permed and dyed during pregnancy had higher urinary level of MBP and MBzP, OR (95% CI) were 12.867 (1.240-133.525), 15.982 (1.367-186.911), respectively; Participants who use cosmetics during pregnancy had higher urinary level of MEP and MBP, OR (95% CI) were 2.977 (1.012-8.757), 4.440 (1.485-13.272), respectively; plastic bottled water consumption was positively associated with urinary concentrations of MEP and MEHP, OR (95% CI) were 3.780 (1.417-10.083), 2.699 (1.039-7.010), respectively; annual household income was negatively associated with urinary concentration of MMP, OR (95% CI) was 0.597 (0.372-0.959); individuals who took medications during pregnancy had higher urinary level of MEHP than non-takers, OR (95% CI) was 4.853 (1.084-21.732).

CONCLUSIONPregnant women whose gestation age was less than 16 weeks are generally exposed to phthalate. Phthalate internal exposure levels are significantly associated with most measured factors and the influencing factors with different phthalates internal exposure levels are different.

Chromatography, High Pressure Liquid ; Dibutyl Phthalate ; urine ; Female ; Humans ; Life Style ; Maternal Exposure ; Phthalic Acids ; urine ; Pregnancy ; Surveys and Questionnaires ; Tandem Mass Spectrometry

Objective To evaluate of impact of thalidomide on CD4 +CD25 +T lymphocytes in patients with acute myeloid leukemia and its clinical curative effect.Methods 71 cases of patients with AML were randomly divided into the control group and the experiment group, and 31 healthy people were selected to be the normal group.The experiment group and the control group patients were treated with the same chemotherapy, the experiment group was treated with thalidomide.The levels of CD4 +CD25 +T lymphocyte, CD3 +T lymphocyte, CD4 +T lymphocyte, CD8 +T lymphocyte, ratio of CD4 +/CD8 +and NK cells were detected at before treatment, 10 to 14d after treatment, complete remission 6 months follow-up.In normal group, the same index was detected before and after chemotherapy, and 10-14 d.The clinical curative effect of the experiment group and the control group were observed.Results The effective rate of the experiment group was higher than of the control group(P<0.05); The levels of CD4 +CD25 +T lymphocyte in the experiment group and control group were significantly higher than in the normal group(P<0.05), the two groups decreased compared with the control group, the level of CD4 +CD25 +T lymphocyte in the experiment group was significantly decreased(P<0.05).And with thalidomide treatment, the experiment group in the CD3 +T lymphocytes, CD4 +T lymphocytes and ratio of CD4 +/CD8 +, NK cells were significantly higher than the control group ( P<0.05 ) .Conclusion Thalidomide can improve both the immunity cell function and the clinical efficiency in patients with AML.The mechanism is related to reduce the level of CD4 +CD25 +T lymphocyte.

OBJECTIVETo provide a rapid, simple, accurate and reproducible identification method from which Cordyceps sinensis can be distinguished from other species.

METHODTo observe the larva and stroma of Cordyceps family with macroscopic identification method, and with powder microscopic identification method.

RESULT AND CONCLUSIONFor macroscopic, only stroma of C. sinensis is mostly non-inflated, and un-obtuse at the tip, the caterpillar annulations of C. sinensis and the C. gracilis is distinct, about 20-30, and feet of above two are 8 pairs, 4 of 8 pairs are relatively distinct. The above appearance shows its unique characteristic. For microscopic identification, only C. sinensis exists microtrichia, the tip is pointed. The arranging order of stubby setae is irregular, the tip is blunt while the basal is gradually broader; the top of some setae bends slightly like a hook.

Cordyceps ; classification ; Microscopy