Background::Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis (UC). Here, we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods::We conducted a retrospective cohort study in UC patients, whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People’s Hospital of Tongji University from January 2017 to May 2022. We identified an inflammatory cell enumeration index (ICEI) for assessing histological healing based on the proportions of eosinophils, CD177 + neutrophils, and CD40L + T cells in the colonic lamina propria under high power field (HPF), and the outcomes (risks of symptomatic relapses) of achieving histological remission vs. persistent histological inflammation using Kaplan-Meier curves. Intrareader reliability and inter-reader reliability were evaluated by each reader. The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness. The ICEI was further validated in a new cohort of UC patients from other nine university hospitals. Results::We developed an ICEI for clinical diagnosis of histological healing, i.e., Y = 1.701X 1 + 0.758X 2 + 1.347X 3 - 7.745 (X 1, X 2, and X 3 represent the proportions of CD177 + neutrophils, eosinophils, and CD40L + T cells, respectively, in the colonic lamina propria under HPF). The receiver operating characteristics curve (ROC) analysis revealed that Y <-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve (AUC) was 0.942 (95% confidence interval [CI]: 0.905-0.979) with a sensitivity of 92.5% and a specificity of 83.6% ( P <0.001). The intraclass correlation coefficient (ICC) for the intrareader reliability was 0.855 (95% CI: 0.781-0.909), and ICEI had good inter-reader reliability of 0.832 (95% CI: 0.748-0.894). During an 18-month follow-up, patients with histological healing had a substantially better outcome compared with those with unachieved histological healing ( P <0.001) using ICEI. During a 12-month follow-up from other nine hospitals, patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing. Conclusions::ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy. Therefore, ICEI provides a promising, simplified approach to monitor histological healing and to predict the prognosis of UC.Registration::Chinese Clinical Trial Registry, No. ChiCTR2300077792.

Objective:To analyze the clinical application of different diagnostic methods for heart failure with preserved ejection fraction (HFpEF) in maintenance hemodialysis (MHD) patients.Methods:It was a single-center retrospective cohort study. Uremia patients who underwent hemodialysis at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to June 2021 were enrolled. The demographic characteristics, laboratory indicators, and echocardiography parameters were collected. The 2016 European Society of Cardiology (ESC) criteria, H 2FPEF score [composite score based on weighted scores of heavy (H), hypertensive (H), atrial fibrillation (F), pulmonary hypertension (P), elder (E), and filling pressure (F)], and Heart Failure Association (HFA) -PEFF score [including pre-test assessment (P), echocardiography and natriuretic peptide score (E), functional testing (F) and final aetiology (F)] were used to diagnose HFpEF, respectively, and the difference of three diagnostic methods was compared. The association between HFpEF diagnosed by the three methods and poor outcomes (all-cause death, cardiovascular death) was analyzed. Results:A total of 160 MHD patients were included, whose age was (58.5±13.4) years, median dialysis age was 5.0 (2.3, 9.6) years, median H 2FPEF score was 2 (1, 3), median HFA-PEFF score was 4 (3, 5), and 92 (57.5%) were males. Of these patients, 118 patients (73.8%) met the 2016 ESC criteria for diagnosis of HFpEF, 4 (2.5%) met H 2FPEF score for diagnosis of HFpEF, and 56 (35.0%) met HFA-PEFF score for diagnosis of HFpEF. The consistency of three methods in diagnosing HFpEF was poor with κ values of 0.018 between ESC criteria and H 2FPEF score, 0.322 between ESC criteria and HFA-PEFF score, and 0.056 between H 2FPEF score and HFA-PEFF score. After a median follow-up of 2.6 years, 20 (12.5%) of the 160 MHD patients died. The Kaplan-Meier survival analysis showed a significant difference in mortality between patients diagnosed with HFpEF and those without using the H 2FPEF score (Log-rank test, χ2=6.95, P=0.008). After adjusting for demographic and clinical parameters, multivariate Cox regression analysis showed that HFpEF diagnosed by HFA-PEFF score was associated with all-cause mortality ( HR=2.73, 95% CI 1.07-6.98, P=0.036) and cardiovascular mortality ( HR=4.77, 95% CI 1.31-17.30, P=0.018). Conclusions:The 2016 ESC criteria, H 2FPEF score, and HFA-PEFF score have high heterogeneity and poor consistency in diagnosing HFpEF in MHD patients. Among the three diagnostic methods, only the diagnosis based on HFA-PEFF score is associated with the prognosis of MHD patients. The HFA-PEFF score can be used to assess the risk of HFpEF in MHD patients, and more clinical studies are needed to further verify it in the future.

Objective:To translate and culturally adjust Decisional Fatigue Scale (DFS) , and test its reliability and validity.Methods:The Chinese version of DFS was formed through the method of double translation, back translation and expert consultation. Using the convenient sampling method, 247 medical staffs from 16 departments in 76 wards of Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were selected as the research objects. Content validity, criterion validity and structure validity were used for validity evaluation, and internal consistency reliability, split half reliability and retest reliability were used for reliability evaluation. A total of 247 questionnaires were sent out in this study and 247 were effectively received, with effective recovery of 100.00%.Results:The total Cronbach's α coefficient of Chinese DFS was 0.933, the half-reliability coefficient was 0.849 and the retest reliability coefficient was 0.838 ( P<0.01) . Both the item content validity index and scale content validity index were 1.00, and the correlation coefficient with the total score of SRF-S was 0.729 ( P<0.01) . One common factor was extracted by exploratory factor analysis and 65.64% of the variation was explained cumulatively, which was consistent with the dimensions of the original scale. Confirmatory factor analysis showed that all fitting indexes were up to standard and the fitting degree was good. Conclusions:The reliability and validity of the Chinese version of DFS in medical staffs is good, which can be used to evaluate the degree of decision-making fatigue of Chinese medical staffs.

Corona Virus Disease 2019 (Corona Virus Disease 2019,COVID-19) has become a public health emergency that has attracted global attention because of its large-scale outbreak resulting in numerous human infections and deaths. COVID-19 is a highly contagious respiratory disease caused by novel coronavirus 2019-nCoV. Due to a large number of infections and fast transmission speed, it's significant to diagnose the infected people quickly and detect the asymptomatic infected people as soon as possible. At present, the preliminary screening is judged by the clinical manifestations of the patients, mainly involving the respiratory system, but recent studies have found that the patients infected with COVID-19 have unique oral manifestations, such as taste disturbance, xerostomia, halitosis, inflammation of salivary glands, necrotizing periodontal disease and some of them are earlier than typical symptoms such as dry cough, fever, etc. Paying attention to the oral manifestations of patients can further improve the COVID-19 screening procedure. At present, symptomatic treatment is mainly used for these oral symptoms.

Objective:To examine whether the mixed infection rate in pertussis infants is significantly higher than that in non-pertussis infants with respiratory tract infection, to explore the mixed infection pathogen distribution in pertussis infants, and to provide reference for clinical diagnosis and treatment.Methods:A case-control study was conducted on 118 nasopharyngeal swabs collected from infants who applied for clinical pertussis etiological testing (culture and specific nucleic acid detection of Bordetella pertussis) in Beijing Children′s Hospital, Jiaxing Maternity and Child Health Care Hospital and Wuhu No.1 People′s Hospital from August 2018 to January 2021.According to the pertussis etiological testing results, the patients were divided into the pertussis group (65 cases) and non-pertussis group (53 cases). Thirty-three pairs of cases were matched according to age, onset season and city.All nasopharyngeal swabs were tested for infections of other pathogens using FilmArray RP2, which can detect 21 respiratory infection pathogens.The mixed infection rate was compared between groups by Chi- square test. Results:According to the FilmArray RP2 test results, 56.9%(37/65) cases in pertussis group and 15.1%(8/53) cases in the non-pertussis group were positive for multiple pathogens, and the difference was statistically significant ( χ2=21.651, P<0.001). The top 5 mixed infection pathogens in pertussis infants were human rhinovirus/enterovirus (HRV/EV) (38.5%, 25/65), parainfluenza virus (PIV) (18.5%, 12/65), respiratory syncytial virus (RSV) (10.8%, 7/65), coronavirus (Cov) (10.8%, 7/65), and adenovirus (ADV) (7.7%, 5/65). The mixed infection rates of the pertussis group in spring, summer, autumn and winter were 46.2% (6/13), 58.3%(14/24), 55.6%(5/9), and 63.2%(12/19), respectively.Comparison of matched and unmatched cases achieved similar results. Conclusions:Among clinical suspected pertussis infant specimens, the mixed infection rate in confirmed cases is tremendously higher than that in non-pertussis infants.The main mixed infection pathogens in pertussis infants are HRV/EV, PIV, RSV, Cov, and ADV.Mixed infection in pertussis children commonly occurs in four seasons, with the highest incidence in winter.

Xanthomonas albilineans (Ashby) Downson is a quarantine pest for importing plants to China that causes leaf scald bacterial disease on sugarcane. X. albilineans produces a potent phytotoxin/antibiotic called albicidin. As a pathogenic factor, albicidin causes typical white leaf stripes by inhibiting plastid DNA gyrase and disturbing chloroplast differentiation. Meanwhile, the antibacterial activity of albicidin gives X. albilineans a competitive advantage against rival bacteria during their colonization. Furthermore, albicidin has a rapid bactericidal activity against a variety of Gram-positive and Gram-negative pathogenic bacteria of human species at nanomolar concentrations, making it a potential antimicrobial drug for clinical application. This article reviews the advances of albicidin from the aspects of its molecular structure, traditional extraction methods, mechanism of action, biosynthetic genes and processes, chemical synthesis method and improvement, in order to provide insights into the prevention and treatment of the sugarcane leaf scald disease, and the development of new antibiotics.
Anti-Bacterial Agents/pharmacology* ; China ; Humans ; Organic Chemicals ; Xanthomonas/genetics*

【Objective】 To analyze the RBC products returned by hospitals due to positive direct antiglobulin test (DAT), and explore measures to reduce the discarding rate of blood products and ensure the safety of clinical blood use. 【Methods】 The data of RBC products, which were returned by hospitals due to positive-DAT, in Hebei Blood Center from 2018 to 2020 were retrospectively analyzed. The donation time, hospital, gender of blood donors, donation times and DAT typing results were searched through blood donation code, input into the statistical software SPSS17.0, and analyzed by linear trend χ² and Pearsonχ². 【Results】 1)The discarding rate of RBC products due to positive DAT in 2018, 2019 and 2020 accounted for 0.15‰, 0.32‰ and 0.26‰, respectively, of the overall RBC collection. The total concordance rate was 89.94% by our retest. 2)The concordance rate of returned blood from secondary hospitals and tertiary hospitals was 78.26% and 91.78%, respectively (P<0.05), with the latter higher than the former. 3)No statistical significance was noticed in the DAT-positive blood by months(P>0.05). 4)The DAT-positive rate of female donors was higher than that of male donors, and that of first-time blood donors was higher than that of repeated and regular blood donors with statistical differences (P<0.05). 5)DAT-positive typing results was mainly due to IgG incomplete antibody. 【Conclusion】 In order to reduce the discarding rate of RBC products, it is suggested to strengthen the consultation before blood collection, encourage healthy males to donate blood and increase the proportion of regular blood donors. Meanwhile, the quality management of Transfusion Department in secondary hospitals should be further improved to ensure the safety of clinical blood transfusion.

Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

Objective:To analyze the severity and influencing factors of comorbidities in elderly comorbidity patients and to put forward targeted recommendations to effectively control the development of comorbidities.Methods:A total of 750 elderly comorbidity patients in Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were enrolled using convenience sampling method. General data questionnaire, Modified Cumulative Illness Rating Scale-Geriatric (MCIR-G) , Lubben Social Network Scale 6 (LSNS-6) and Long-Term Care Needs Assessment Questionnaire were collected. Univariate analysis and multiple linear regression analysis were used to explore the influencing factors.Results:The scores of comorbidities, social isolation and long-term care needs of 750 elderly comorbidity patients were (13.85±3.46) , (21.36±4.61) and (140.49±13.69) respectively. Multiple linear regression analysis showed that social isolation and long-term care needs were influencing factors of the severity of comorbidity in elderly patients ( P<0.05) . Conclusions:Medical staff should pay more attention to physical and mental health of elderly comorbidity patients, and develop personalized care programs according to long-term care needs, so as to delay the functional degradation of elderly comorbidity patients and improve their quality of life.

Objective:To evaluate the value of endovascular recanalization and hybrid recanalization for chronic internal carotid artery occlusion(COICA), and to evaluate its feasibility, safety, success rate, and clinical outcomes.Methods:Totally 35 patients who received endovascular recanalization or hybrid recanalization with symptomatic COICA were enrolled from January 2019 to December 2019 in Department of Cerebrovascular Disease,Zhengzhou University People′s Hospital. The clinical characteristics, treatment strategies, success rate, and major events of the patients were analyzed retrospectively.Results:Thirty of 35 patients were successfully recanalized. Among them, hybrid recanalization was performed in 3 cases, carotid endarterectomy was performed in 1 case, and endovascular recanalization was performed in 26 cases, 5 patients failed because they could not reach the distal true cavity. Among the successful patients, 5 patients had operation-related complications, 3 patients had embolism cerebral infarction, 1 patient had hyperperfusion cerebral hemorrhage, 1 patient still had transient ischemic attack after operation. All patients were followed up clinically, 2 patients had reoccurrence of obstruction, 2 patient had restenosis, the remaining patients had no hemodynamic stenosis or reocclusion.Conclusion:In highly-selected cases, intracavitary recanalization for symptomatic COICA is feasible, relatively safe and effective.