Objective:To evaluate direct and indirect costs for schizophrenia,major depressive disorder(MDD)and bipolar disorder,and to compare their differences of cost composition,and to explore the drivers of the total costs.Methods:A total of 3 175 inpatients with schizophrenia,MDD,and bipolar disorder were recruited.In-patient's self-report total direct of medical costs outpatient and inpatient,out-of-pocket costs,and direct non-medical costs were regarded as direct costs.Productivity loss and other loss caused by damaging properties were defined as indirect costs.The perspectives of this study included individual and societal levels.Multivariate regression analysis was applied for detecting the factors influencing disease costs.Results:The total cost of schizophrenia was higher than those of MDD and bipolar disorder at individual and societal levels.The indirect costs of three mental disorders were higher than the direct costs,and the indirect cost ratio of bipolar disorder was higher than those of schizophre-nia and MDD.Age,gender,working condition and marital status(P＜0.05)were the important drivers of total costs.Conclusion:The economic burden of the three mental disorders is relatively heavy.Schizophrenia has heaviest disease burden,and the productivity loss due to mental disorders is the driving force of the soaring disease cost

Objective:To investigate the pathogenic role and possible mechanism of NADPH oxidase 4 (Nox4) in type 1 diabetic keratopathy mouse models.Methods:Forty Nox4 knockout ( Nox4-/-) heterozygous male mice were selected and 120 age- and sex-matched wild-type C57BL/6 ( Nox4+ /+ ) mice were selected as controls. Nox4-/- and Nox4+ /+ mice were randomized into diabetic group (DM group) and non-DM group by random number method.Type 1 DM model was established in DM groups by intraperitoneal injection of streptozotocin.The DM and non-DM groups of Nox4+ /+ mice were randomized into regular feed group and Nox4 inhibitor GKT137831 (GKT) supplementary feed group by random number method.At 16 weeks after modeling, tear secretion of mice in different groups was measured by the phenol red thread test.Corneal epithelial integrity was evaluated by fluorescent staining.Changes in corneal never fiber density were observed by the in vivo laser scanning confocal microscopy.Reactive oxygen species (ROS) products in corneal epithelium were assayed by CellROX staining.The expressions of E-Cadherin and nuclear factor-κB (NF-κB) proteins were detected by immunofluorescence staining.Central corneal nerve fiber density was examined by flatmount staining with TUBB3 antibody.The use and care of laboratory animals complied with ARVO statement.The study protocol was approved by Laboratory Animal Care Committee of Xi'an Jiaotong University (No.XJTULAC201301). Results:In Nox4+ /+ mice, the tear secretion was (2.40±1.18)mm/minute in DM group, which was significantly less than (5.30±1.02)mm/minute in non-DM group ( P<0.01).The tear secretion was (4.19±0.63)mm/minute in DM group of Nox4-/- mice, which was significantly more than that in DM group of Nox4+ /+ mice ( P<0.05).Significant difference was found between (2.23±0.83)mm/minute of regular feed group and (4.02±0.71)mm/minute of GKT supplementary feed group ( P<0.01).In Nox4+ /+ mice, the DM group showed significantly increased corneal staining score, reduced corneal nerve fiber density, increased fluorescence intensity of ROS in corneal epithelium, weakened fluorescence intensity of E-Cadherin protein expression, and enhanced fluorescence of NF-κB protein expression compared with non-DM group.In Nox4-/- mice and mice fed with GKT supplementary feed, the increased fluorescence of ROS and decreased fluorescence of E-Cadherin protein expression were seen in the corneal epithelium of the DM groups compared with non-DM groups.In Nox4-/- mice and mice fed with GKT supplementary feed, NF-κB protein fluorescence was weak in corneal epithelial cells in DM groups, which was similar to that in non-DM groups.Immunofluorescence staining of corneal flatmount showed that the density of TUBB3-stained nerve fibers in DM group of Nox4+ /+ mice was significantly lower than that in non-DM group of Nox4+ /+ mice, and there was no significant reduction of nerve fibers in the corneal stromal layer in DM group of Nox4-/- mice or mice fed with GKT supplementary feed. Conclusions:Nox4 is involved in the pathogenic process of diabetic keratopathy, and its mechanism may be related to oxidative stress-induced aggregation of ROS products and activation of NF-κB-mediated inflammatory responses.

With the rapid development of the nuclear industry, the uranium-exposed population is rapidly expanding. Kidney injury is a major health concern for uranium-exposed population because uranium is initially retained in the kidneys and induces chemical toxicity. However, the commonly used clinical markers of kidney injury usually show significant changes in the late stages of such damage, making it difficult to monitor the occupational health of uranium-exposed population. In recent years, a number of biomarkers that can reflect early kidney injury caused by uranium have been identified and investigated by enzyme-linked immunosorbent assay and protein blotting. This article will review the studies in this area, with the aim of providing a basis for the diagnosis and understanding the development and prognosis of uranium-induced kidney injury.

With the development of nuclear energy technology and the use of depleted uranium weapons, the uranium exposed population is gradually expanding and the health effects of uranium exposure are of increasing concern. The toxicity of uranium to kidney, a sensitive organ for uranium to enter the body to produce effects, cannot be ignored. As of now, the effects of uranium exposure on the kidney are still not well understood, the threshold of uranium-induced kidney injury has been controversial, and there is a lack of sensitive and specific biomarkers for the diagnosis of early kindey damage, especially in the context of chronic uranium exposure. For these reasons, this paper reviewed the results of research on dose-effect relationships and biomarkers of uranium-induced kidney injury and provided an outlook on future research directions, with the aim of providing a basis for subsequent study on animal experiments and population health effects related to uranium exposure.

Runt-related transcription factor 1 (RUNX1) is an essential regulator of normal hematopoiesis. Its dysfunction, caused by either fusions or mutations, is frequently reported in acute myeloid leukemia (AML). However, RUNX1 mutations have been largely under-explored compared with RUNX1 fusions mainly due to their elusive genetic characteristics. Here, based on 1741 patients with AML, we report a unique expression pattern associated with RUNX1 mutations in AML. This expression pattern was coordinated by target repression and promoter hypermethylation. We first reanalyzed a joint AML cohort that consisted of three public cohorts and found that RUNX1 mutations were mainly distributed in the Runt domain and almost mutually exclusive with NPM1 mutations. Then, based on RNA-seq data from The Cancer Genome Atlas AML cohort, we developed a 300-gene signature that significantly distinguished the patients with RUNX1 mutations from those with other AML subtypes. Furthermore, we explored the mechanisms underlying this signature from the transcriptional and epigenetic levels. Using chromatin immunoprecipitation sequencing data, we found that RUNX1 target genes tended to be repressed in patients with RUNX1 mutations. Through the integration of DNA methylation array data, we illustrated that hypermethylation on the promoter regions of RUNX1-regulated genes also contributed to dysregulation in RUNX1-mutated AML. This study revealed the distinct gene expression pattern of RUNX1 mutations and the underlying mechanisms in AML development.
Core Binding Factor Alpha 2 Subunit/metabolism* ; DNA Methylation ; Gene Expression ; Humans ; Leukemia, Myeloid, Acute/genetics* ; Mutation ; Promoter Regions, Genetic

Objective:To evaluate delayed laparoscopic cholecystectomy (DLC) after percutaneous transhepatic gallbladder drainage (PTGBD) in acute cholecystitis.Methods:Clinical data of 64 patients who were diagnosed moderate (grade Ⅱ) acute cholecystitis by the 2018 Tokyo Guidelines in acute phase and underwent delayed LC at our hospital from Jan 2018 to Jan 2021 were compared between two groups ie PTGBD treatment (21 cases)in acute stage before DLC and DLC without PTGBD group (43 cases). The difficulty score of TG18 was used to evaluated every surgical procedure of the cases by reviewing the operation videos.Results:Patients in DLC after PTGBD group had a longer hospital stay and operation time, more blood lose and higher difficulty score than the DLC without PTGBD group(all P<0.05). There was no statistically significant difference in the conversion rate and morbidity rate between the two groups( P>0.05). Conclusion:This study fails to show there is any if ever benefit of PTGBD before DLC over DLC without PTGBD in the management of Grade Ⅱ acute cholecystitis.

Objective To explore the role of clinical pharmacists in the treatment of drug poisoning by analyzing the clinical pharmacist's participation in the treatment of a patient with sodium valproate poisoning. Methods Clinical pharmacists measured the plasma concentration of sodium valproate to inform the doctor to diagnose illnesses. At the initial stage when the concentration is high, to eliminate the free drug by continuous venous-venous hemodialysis-filtration (CVVHDF). Then, the combined drug was cleared by hemoperfusion (HP). Results The blood concentration dropped by half at the first CVVHDF and decreased obviously after two HPs. After stable observation in five days’ course of disease, the blood concentration was maintained at a low level and the patient was cured and discharged. Conclusion The implementation of the blood purification program under the monitoring of the blood drug concentration with the participation of pharmacists is helpful for the rescue of drug overdose and is worthy of promotion.

Objective To investigate the difference of the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein between primary lesions of breast cancer and its synchronous ipsilateral lymph node metastasis,as well as its clinical implications.Methods Retrospectively analyze invasive breast cancer patients treated in Peking University First Hospital from January 2012 to May 2016.The IHC expressions of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein in both the primary and lymph node metastatic lesions are compared and analyzed statistically.The count data were represented as n(％),and comparsion between groups were evaluated using the McNemar test.Results One hundred and fifty-six patients were included,of which on 2 cases (1.3％),estrogen receptor status of primary lesions is different from that of lymph node metastases(P =0.500);on 10 cases (6.4％),progesterone receptor status of primary lesions is different from that of lymph node metastases (P =0.344);on 28 cases (18.0％),Ki-67 protein status of primary lesions is different from that of lymph node metastases (P =0.000 18);on 3 cases (1.9％),human epidermal growth factor receptor 2 status of primary lesions is different from that of lymph node metastases (P =1.000).Conclusion There may be difference between primary lesions and lymph node metastases in the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein,which can provide a reference for individualized treatment of breast cancer patients.

In order to study genetic variation diversity of porcine circovirus type 2 (PCV2) strains in Shanxi,the genomic sequences of nine PCV2 strains including SXQX,SXCZ,SXTY2,SXJC,SXJX,SXLL,SXPY,SXPG and SXXY recently isolated from some areas of Shanxi from 2013 to 2016,was cloned,sequenced and received by GenBank.The amplified PCV2 genomic sequences,ORF2 sequences and Cap protein amino acid of these nine strains were analysed and compared with those of published 28 PCV2 strains by DNAStar,drawing phylogenetic tree.The results showed that the genomic sequences of SXJX,SXJC and SXXY PCV2 strains were 1 768 bp,and the others were 1 767 bp,which accounted for 33％ and 67％,respectively.The homologies of nucleotide sequences of the nine strains were 94.7％-99.8％,the homologies of nucleotide sequences of the nine strains with the 28 isolates from different regions of the world PCV strain were 93.9％-99.9％,and the homologies of nucleotide sequences of the nine strains with the domestic vaccine strains were 95.1％-99.8％.The phylogenetic analysed that SXJX,SXJC and SXXY belonged to genotype PCV-2D,SXLL,SXPY and SXCZ belonged to genotype PCV-1C,and SXTY14,SXPG and SXQX belonged to genotype PCV-1A/1B.Thus it proved that the epidemic strain of PCV2 was mainly PCV-2b in Shanxi.The homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains were 90.0％-100.0％ and 87.1 ％-100.0％ respectively,the homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains with the 28 isolates from different regions of the world PCV strain were 87.6％-100.0％ and 84.1％-100.0％ respectively,and the homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains with the domestic vaccine strains were 91.0％-100.0％ and 89.3％-100.0％ respectively.The Cap amino acids of SXQX,SXJX,SXTY14,SXPG,SXJC and SXXY PCV2 were 233,ORF2 of SXQX,SXTY14 and SXPG located at 1 033-1 734 bp,ORF2 of SXXY,SXJX and SXJC located at 1 033-1 734 bp,and the Cap amino acids of SXCZ,SXLL and SXPY PCV2 were 234,ORF2 of them located at 1 030-1 734 bp,in addition,the positions of 1 030-1 734 bp were more three bases TCA than other ORF2 genome sequence of 1 767 bp,resulting in increasing a K (Lys) of amino acid sequencein at the 234 position.Also Cap protein of 9 PCV2 strains showed more amino acid variation in addition to the only high-ly conserved glycosylation sites (NYS) (pp.143-145 amino acid).It provided theoretical basis for the PCV2 immune prevention of research in Shanxi,and the data of basic theory of molecular pathogenesis of PCV2.

Objective To compare the short‐term clinical effects of single segment and two segments of Dynesys dynamic in‐ternal fixation system for treating lumbar degenerative disease .Methods 40 cases of degenerative lumbar disease treated by the Dynesys dynamic fixation system combined with posterior approach decompression from 2009 July to March 2012 were selected and performed the evaluation on the clinical effects by the waist and leg pain visual analogue scale (VAS) ,the Oswestry disability index (ODI) and the orthopaedic spinal association of North America (NASS) index .The imaging method was used to observe the mobili‐ty of operative segment and proximal adjacent segment and the degenerative change of intervertebral height .Results All of the 40 cases were followed up .The VAS score and ODI score at postoperative 3 months and last follow‐up were significantly decreased when compared with the pre‐operative scores (P<0 .05);there was no statistically significant differences in the VAS score and ODI score at 3 months and last follow‐up between the single segment group and the 2‐segment group (P> 0 .05) .The NASS index showed no statistically significant difference in the postoperative effect satisfaction between the two groups (P>0 .05);there was no statistically significant difference in the variation of the intervertebral height between before operation and at the last follow‐up (P>0 .05) .There was statistically significant difference in the motility of proximal adjacent segment at the last follow‐up between the two groups (P<0 .05);but comparing the motility of proximal adjacent segment between the last follow‐up and pre‐operation , only the single segment group showed statistically significant difference (P< 0 .05) .Conclusion The Dynesys dynamic fixation system combined with posterior approach decompression operation has good clinical effect in the treatment of lumbar degenerative disease .Meanwhile ,the single segment method has more significant effect on the motility of proximal adjacent segment than the double segments method .