Objective To explore the clinical characteristics and risk factors of death during hospitalization in patients with community-acquired pneumonia(CAP)complicated with diabetes mellitus(DM).Methods A retrospective analysis was performed on 566 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022.The patients were divided into simple CAP group(n=478)and CAP combined with diabetes(CAP+DM)group(n=88)according to whether they had diabetes,and then CAP+DM group(n=88)was divided into survival group(n=69)and death group(n =19)according to whether the patients died during hospitalization.The clinical data and laboratory test indicators of patients in different groups were compared.Cox regression analysis was used to screen the risk factors of death during hospitalization in the CAP+DM group.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of independent risk factors on hospitalization death.Results Compared with the simple CAP group,the CAP+DM group had significant differences in age,concomitant hypertension,coronary heart disease,CURB-65 score,neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),albumin(ALB),prealbumin(PA),glucose(GLU),serum potassium(K),calcium(Ca),phosphorus(P),magnesium(Mg),lactic acid(Lac),non-invasive ventilation time,ICU occupancy rate and mortality rate(P<0.05);Compared with the survival group,there were statistically significant differences in CURB-65 score,NLR,CRP,PCT,GIU,ALB,PA,serum iron(Fe),Ca,non-invasive ventilation time,and ICU admission rate among the death group patients(P<0.05).Cox regression analysis showed that the increase of NLR level and the decrease in PA level were the risk factors for in-hospital death in patients with CAP complicated with diabetes(P<0.05).When the PA cutoff value was 91 mg/L,the AUC,sensitivity,and specificity for predicting in-hospital death of CAP patients with diabetes were 0.849,84.2%and 81.2%,respectively.Conclusion Patients with CAP combined with diabetes are more serious and have worse prognosis than those with CAP alone.PA has a good predictive value for the prognosis of these patients.Early detection and active intervention should be carried out to reduce the in-hospital mortality of patients.

Objective:To explore the effects of internet-based group cognitive-behavioral therapy(IGCBT)on the depressive and anxiety symptoms in patients with major depressive disorder(MDD).Methods:Eighty pa-tients with MDD were recruited and randomly divided into IGCBT combined drug therapy group and control group with drug therapy.Blind assessments were performed using the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)three times at baseline,4 weeks after treatment and 8 weeks after treatment,respectively.Results:The effective rates of HAMD and HAMA at the end of the 4th and 8th week,and the effective rates of HAMA at the end of the 8th week were higher in the combined treatment group than those in the control group(Ps＜0.05).The total scores of HAMD and HAMA in the combined treatment group and the control group were lower at the end of the 4th and 8th week than those at baseline(Ps＜0.001).The total scores of HAMD and HAMA were lower in the combined treatment group than those in the control group at the baseline,4 weeks and 8 weeks after treatment(Ps＜0.01).Conclusion:It suggests that intemet-based group cognitive-behavioral therapy combined with antidepressant medication has a better effect on relieving depressive and anxiety symptoms in patients with ma-jor depressive disorder than drug therapy alone,and especially has a better effect on improving anxiety symptom.

Fibroblast activation protein inhibitors(FAPI)can specifically bind to fibroblast activation protein,which is highly expressed in tumor stroma,and 68Ga-FAPI do not get involved into the procedure of glucose metabolism in tumor cells.68Ga-FAPI PET/CT and PET/MR can be used for displaying malignant tumors at various sites and play a unique role for diagnosis and differential diagnosis.The research progresses of 68 Ga-FAPI-based PET/CT and PET/MR for diagnosing malignant tumors were reviewed in this article.

This paper presents a systematic review of extant research investigating the effectiveness of Internet-based group cognitive behavioral therapy （IGCBT） for depression and anxiety symptoms with an emphasis on the treatment modalities， treatment protocols， efficacy and mechanism， together with a summary of research limitations and suggestions for future research. Cognitive behavioral therapy （CBT） is a structured， short-term and present-oriented psychotherapeutic treatment， its Internet- and group-delivered modalities have led to its wider application， and has proven to be clinically effective in alleviating depression and anxiety symptoms caused by different diseases， whereas some drawbacks have been reported. Thus this paper elaborates the clinical application， therapeutic effect and underlying mechanisms of IGCBT intervention for depression and anxiety symptoms， so as to provide references for its future application. ［Funded by the Natural Science Foundation of the Inner Mongolia Autonomous Region （number， 2019MS03038）

Objective:To investigate the relationship between carotid atherosclerosis(CAS)and subclinical left ventricular(LV)dysfunction in type 2 diabetes mellitus patients with preserved LV ejection fraction(LVEF).Methods:A total of 120 patients with type 2 diabetes mellitus who had LVEF≥50% were selected in the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June 2021 to October 2021. The global longitudinal strain(GLS)was obtained by two-dimensional speckle tracking echocardiography(STE)to assess subclinical LV systolic function. The mitral ratio of peak early to late diastolic filling velocity(E/A), and mitral velocity to early diastolic velocity of the mitral annulus(E/E′)ratio were obtained by pulsed tissue Doppler echocardiography to assess LV diastolic function. Acrroding to bilateral carotid ultrasound examination, the subjects were divided into normal carotid arteries group( n=46) and CAS group( n=74). Demographics and biochemical parameters were compared between two groups. Binary logistic regression and Pearson correlation analysis were used to evaluate the relationship between CAS and subclinical LV dysfunction. Results:The CAS group had a higher proportion of men, older age, and a longer duration of diabetes than the normal carotid arteries group(all P<0.05). There was no difference in LVEF and GLS between the two groups [normal carotid arteries group vs CAS group, LVEF: (60.72±4.73)% vs(60.07±4.28)%; GLS: (18.24±3.72)% vs(17.81±3.47)%, respectively; both P>0.05]. However, compared with normal carotid arteries group, E/A ratio was decreased and E/E′ ratio was significantly increased in CAS group(both P<0.01). Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT; both P>0.05). By contrast, E/E′ ratio was positively correlated with carotid plaque thickness and CIMT(both P<0.05). Binary logistic regression analysis showed that GLS and E/E′ ratio were not associated with CAS( both P>0.05). However, decreased E/A ratio was significantly associated with the existence of CAS( OR=0.09, 95% CI 0.01-0.67, P=0.018). Conclusions:In type 2 diabetes mellitus patients without overt heart failure and with preserved LVEF, the occurrence of CAS is not associated with subclinical LV systolic impairment assessed by GLS, but is significantly associated with LV diastolic dysfunction, and is independent of traditional cardiovascular risk factors.

Since the Global Polio Eradication Initiative was launched by the World Health Assembly in 1988, significant progress has been made in global polio prevention and control. But the occurrence of vaccine-associated paralytic poliomyelitis cases and vaccine-derived poliovirus related cases have become a major challenge during the post-polio era. While coronavirus disease 2019(COVID-19) has brought serious disease burden and economic burden to all countries in the world, prevention and control of vaccine-preventable infectious diseases such as polio should not be neglected under the background of the global common fight against COVID-19. Taking the type Ⅲ VDPV cycle event in Shanghai as an example, the paper discussed how to do a good job of routine inoculation under the prevention and control of COVID-19 to strictly prevent the outbreak of vaccine-preventable infectious diseases.
COVID-19 ; China ; Humans ; Poliovirus ; Poliovirus Vaccine, Oral ; SARS-CoV-2 ; Vaccination

Objective:To explore the practice and preliminary effects of "integrated neurology curriculum" for medical students before internship.Methods:The following 3 aspects were integrated together: teaching content, teaching faculty and teaching methods. Teaching contents are comprised of basic medical theories and extension of clinical knowledge; teaching faculty includes teachers that teach basic theories and many other clinical disciplines; teaching methods were composed of classroom teaching, case discussion and clinical internship. It is a 56-hour curriculum, with 40 hours for studying theories and 16 for clinical internship. 82 students in total had attended the course. Independent sample t-test was used to compare the scores of students in the same grade but had different course structures, and chi-square test was performed with SPSS 22.0 to compare the results of the satisfaction degree from questionnaires.Results:The average score of students was (84.7±9.3) for the courses of 2017-2018 academic year, significantly higher than that of the students who were in the same grade in previous three years. The results of satisfaction degree by the questionnaires showed that 38.6% of the students considered the integrated course to be very helpful in general, 47.7% of the students thought the case analysis part during class was helpful, and 31.8% of the students thought clinical internship was of great help to their medical study.Conclusion:The neurology curriculum based on integrated textbooks has achieved preliminary achievements in preclinical teaching practice, and the teaching group of the curriculum will continue to track the performance of medical students after entering neurology clinical internship, while further improving the quality of integrated courses in terms of teaching and assessment.

Objective: To compare the diagnostic value of MRI plain scan and DWI for autoimmune pancreatitis(AIP). Methods: From March 2016 to April 2017, 82 AIP patients in the Central Hospital of Taiyuan were selected in the research.And 42 healthy volunteers were selected as the control group.All patients received MRI plain scan and DWI examination.The imaging characteristics of AIP were observed and the diagnostic value of the two methods was compared. Results: Among the 82 AIP patients, 42(51.22%) had diffuse pancreatic enlargement, 21(25.61%) in local pancreas, 72(87.80%) in pancreatic duct stricture, 68(82.93%) in common bile duct strictures, 67(81.71%) in false envelopes, and MRI plain scanning with low T₁ signal, high T₂ signal and delayed enhancement.The lesion was high in DWI, and the ADC was low.The average ADC value [(1.12±0.15)mm²/s] was significantly lower than that of the normal pancreas [(1.87±0.25)mm²/s], and the difference was statistically significant(t=22.295, P<0.05). The positive predictive value of MRI plain scan was 72.36%, the negative predictive value was 81.37%, and the sensitivity was 71.94%.The specificity was 70.52%.The positive predictive value of DWI for diagnosing AIP was 85.48%, the negative predictive value was 89.13%, and the sensitivity was 87.52%.The specificity was 88.49%.At ADC=0.001 13mm²/s, the sensitivity and specificity of DWI for the diagnosis of AIP were 86.9% and 89.2%, respectively, and the AUC was 0.826 (95% CI: 0.686-1.804). Conclusion MRI and DWI manifestations of AIP are characteristic, and the diagnostic efficiency of DWI for AIP is higher than MRI plain scan.

Objective: The aim of the study was to evaluate the changes and outcome of kidney function after catheter ablation in patients with persistent atrial fibrillation (PAF). Methods: A total of 146 patients with PAF underwent primary atrial fibrillation (AF) ablation were enrolled from January 2013 to December 2014 and followed up. The subjects were divided into the AF recurrence and AF non recurrence groups. The estimated glomerular filtration rate (eGFR) was calculated and serum creatinine levels were detected before ablation and during follow-up. Renal failure was defined as ≥ 25% decline in eGFR. Kaplan-Meier survival curves was applied for the incidence of renal failure. Cox proportional hazards models were conducted to assess the relationship between recurrence of AF and renal failure. Results: After (16.3±11.8) months of follow-up, the eGFR in patients with no recurrence of AF was higher than that in patients with recurrence. eGFR and ΔeGFR in patients with no AF recurrence differed significantly from those in patients with recurrence [(114.15±18.24) ml·min^-1·1.73m^-2 vs. (98.64±24.09) ml·min^-1·1.73m^-2, and (7.42±6.36) ml·min^-1·1.73m^-2 vs. (-11.40±10.19) ml·min^-1·1.73m^-2, all P<0.001]. The incidence of the renal failure was significantly lower (4.41% vs. 16.67%, P<0.05) and the survival prognosis was significantly better in patients with no recurrence than those in patients with recurrence (χ²=5.965, log-rank P=0.05). The multivariate Cox regression analysis revealed that age, baseline eGFR, recurrences of AF and diabetes were independent predictors of the renal failure, with the HR 1.152, 1.086, 13.442 and 6.076, respectively. Conclusions PAF patients with no recurrence after ablation had a better renal function than those with recurrence, and the recurrence of AF is associated with the deterioration of kidney function in patients with PAF.

Objective To investigate the influence of laparoscopic radical gastrectomy for gastric cancer or colon cancer on immune indices and micrometastasis.Methods According to the treatment method,80 cases of gastric cancer or colon cancer in the Second Hospital of Shanxi Medical University from May 2016 to May 2017 were divided into observation group and control group,with 40 cases in each group.The observation group was treated with laparoscopic radical gastrectomy for gastric cancer or colon cancer,and the control group was treated with open stomach cancer or colon cancer radical operation.The changes of immune indicators of peripheral blood and micrometastasis of peritoneal lavage fluid were compared between the two groups.Results Compared with the preoperative immune indicators in peripheral blood of the two groups of IgG [(8.1 ±2.6)g/L],IgA[(1.6 ±0.9)g/L],IgM[(0.8 ± 0.2)g/L],C3[(0.7 ±0.3)g/L]and C4[(0.2 ±0.1)g/L]levels were decreased at first and then increased,and at 7d after operation,the levels[(10.5 ±2.3)g/L,(2.4 ±0.5)g/L,(1.3 ±0.6)g/L,(1.2 ±0.4)g/L,(0.5 ± 0.2)g/L]were closed to the preoperative levels.The level of IL-10[(98.8 ±32.4)g/L]increased obviously first,and then gradually decreased.The differences of C3 and IL-10 in the two groups were statistically significant at different time points,between the two groups and between different points(F=3.6786,5.769,4.668,4.625,9.375,5.354,all P<0.05).The other indicators were only statistically different among different time points(F=3.578,4.137,3.966,all P <0.05).At the end of the surgery,the CEA and DDC of the two groups were significantly increased,and the CEA[(1165.2 ±386.5)ng/L vs.(1788.6 ±725.5)ng/L]and DDC[(102.5 ±36.5)ng/L vs.(150.5 ±57.2)ng/L] levels and added value in the observation group were significantly lower than those in the control group,the differences were statistically significant(t=6.543,5.669,5.712,4.935,all P<0.05).Conclusion Laparoscopic radical gastrectomy for gastric cancer or colon cancer can improve the immune indices of the patients and reduce the index of micrometastasis in the peritoneal lavage fluid.