Objective:To investigate the relationship between intramuscular adipose tissue index (IATI) calculated from computed tomography images at transverse process of the first lumbar and all-cause mortality in maintenance dialysis patients, and to provide a reference for improving the prognosis in these patients.Methods:It was a multicenter retrospective cohort study. The clinical data of patients who received maintenance hemodialysis or peritoneal dialysis treatment from January 1, 2017 to December 31, 2019 in 4 grade Ⅲ hospitals including Zhongda Hospital Affiliated to Southeast University, Taizhou People's Hospital Affiliated to Nanjing Medical University, Affiliated Hospital of Yangzhou University, and the Third Affiliated Hospital of Soochow University were retrospectively collected. IATI was calculated by low attenuation muscle (LAM) density/skeletal muscle density. The receiver-operating characteristic curve was used to determine the optimal cut-off value of IATI, and the patients were divided into high IATI group and low IATI group according to the optimal cut-off value. The differences of baseline clinical data and measurement parameters of the first lumbar level between the two groups were compared. The follow-up ended on December 23, 2022. The endpoint event was defined as all-cause mortality within 3 years. Kaplan-Meier survival curve and log-rank test were used to analyze the survival rates and the differences between the two groups. Multivariate Cox regression analysis models were used to analyze the association between IATI and the risk of all-cause mortality in maintenance dialysis patients. Multivariate logistic regression analysis model was used to analyze the influencing factors of high IATI.Results:A total of 478 patients were eligibly recruited in this study, with age of (53.55±13.19) years old and 319 (66.7%) males, including 365 (76.4%) hemodialysis patients and 113 (23.6%) peritoneal dialysis patients. There were 376 (78.7%) patients in low IATI (<0.42) group and 102 (21.3%) patients in high IATI (≥0.42) group. The proportion of age ≥ 60 years old ( χ2=24.746, P<0.001), proportion of diabetes mellitus ( χ2=5.570, P=0.018), fasting blood glucose ( t=-2.145, P=0.032), LAM density ( t=-3.735, P<0.001), LAM index ( t=-7.072, P<0.001), and LAM area/skeletal muscle area ratio ( Z=-9.630, P<0.001) in high IATI group were all higher than those in low IATI group, while proportion of males ( χ2=11.116, P<0.001), serum albumin ( Z=2.708, P=0.007) and skeletal muscle density ( t=12.380, P<0.001) were lower than those in low IATI group. Kaplan-Meier survival analysis showed that the 3-years overall survival rate of low IATI group was significantly higher than that in high IATI group (Log-rank χ2=19.188, P<0.001). Multivariate Cox regression analysis showed that IATI<0.42 [<0.42/≥0.42, HR(95% CI): 0.50 (0.31-0.83), P=0.007] was an independent protective factor of all-cause mortality, and age ≥60 years old [ HR (95% CI): 2.61 (1.60-4.23), P<0.001], diabetes mellitus [ HR (95% CI): 1.71 (1.06-2.78), P=0.029] and high blood neutrophil/lymphocyte ratio [ HR (95% CI): 1.04 (1.00-1.07), P=0.049] were the independent risk factors of all-cause mortality in maintenance dialysis patients. Stepwise Cox regression analysis showed that IATI<0.42 was still an independent protective factor of all-cause mortality in maintenance dialysis patients [<0.42/≥0.42, HR (95% CI): 0.45 (0.27-0.76), P=0.003]. Multivariate logistic regression analysis showed that low skeletal muscle density [ OR (95% CI): 0.84 (0.81-0.88), P<0.001] and high serum triglyceride [ OR (95% CI): 1.39 (1.07-1.82), P=0.015] were the independent influencing factors of IATI≥0.42. Conclusion:IATI<0.42 of the first lumbar level is an independent protective factor of all-cause mortality in maintenance dialysis patients. Localized myosteatosis within high-quality skeletal muscle may reduce the risk of all-cause mortality in these patients.

The COVID-19 epidemic has spread to the whole world for three years and has had a serious impact on human life, health and economic activities. China's epidemic prevention and control has gone through the following stages: emergency unconventional stage, emergency normalization stage, and the transitional stage from the emergency normalization to the "Category B infectious disease treated as Category B" normalization, and achieved a major and decisive victory. The designated hospitals for prevention and control of COVID-19 epidemic in Tianjin has successfully completed its tasks in all stages of epidemic prevention and control, and has accumulated valuable experience. This article summarizes the experience of constructing a hospital infection prevention and control system during the "Category B infectious disease treated as Category A" period in designated hospital. The experience is summarized as the "Cluster" hospital infection prevention and control system, namely "three rings" outside, middle and inside, "three districts" of green, orange and red, "three things" before, during and after the event, "two-day pre-purification" and "two-director system", and "one zone" management. In emergency situations, we adopt a simplified version of the cluster hospital infection prevention and control system. In emergency situations, a simplified version of the "Cluster" hospital infection prevention and control system can be adopted. This system has the following characteristics: firstly, the system emphasizes the characteristics of "cluster" and the overall management of key measures to avoid any shortcomings. The second, it emphasizes the transformation of infection control concepts to maximize the safety of medical services through infection control. The third, it emphasizes the optimization of the process. The prevention and control measures should be comprehensive and focused, while also preventing excessive use. The measures emphasize the use of the least resources to achieve the best infection control effect. The fourth, it emphasizes the quality control work of infection control, pays attention to the importance of the process, and advocates the concept of "system slimming, process fattening". Fifthly, it emphasizes that the future development depends on artificial intelligence, in order to improve the quality and efficiency of prevention and control to the greatest extent. Sixth, hospitals need to strengthen continuous training and retraining. We utilize diverse training methods, including artificial intelligence, to ensure that infection control policies and procedures are simple. We have established an evaluation and feedback mechanism to ensure that medical personnel are in an emergency state at all times.

Objective:To explore the application method and effect of online teaching of pediatrics in undergraduate clinical medicine.Methods:From March to August, 2020, two classes of pediatrics were selected as research objects: 67 students from Batch 2016 "5+3" clinical medicine class were taught by providing recorded teaching resources and online communication and answering questions (hereinafter referred to as "recorded courses"); 39 students from Batch 2015 "5+3" clinical medicine class were taught by live courses and online communication and answering questions (hereinafter referred to as "live courses"). Through the questionnaire survey on the two groups of students, the effect of the two online teaching methods were compared and the medical students' views and suggestions on them were collected. SPSS 26.0 was used for statistical analysis.Results:Most of the students in the two groups (98.1%) agreed with the effect of the online teaching of pediatrics and thought it could meet their learning needs. There was no significant difference in the online teaching effect between recorded courses group and live courses group ( P > 0.05). However, they had a poor recognition with the implementation of complete online teaching in the future, while they preferred the combination of online teaching with practical exercises in offline hospitals. Conclusion:Online teaching of pediatrics has been recognized by medical students. The two online teaching methods have their own advantages: recorded courses are more planned and the content is more rigorous; live courses are more interactive and flexible. However, considering that medicine is a highly practical subject, it still needs to be supplemented by offline practice while giving full play to the advantages of online teaching.

STUDY DESIGN: Retrospective cohort study. PURPOSE: The aim of our study is to evaluate the extent of posterior spinal dural shift following spinous process splitting multi-level intervertebral lumbar laminectomies, and determine the relationship between posterior spinal dural shift and preoperative parameters. OVERVIEW OF LITERATURE: There are no existing studies on the posterior spinal dural shift after spinous process-splitting multi-leveled lumbar laminectomies. METHODS: We examined 37 patients who underwent spinous process-splitting laminectomies in at least two intervertebral levels, including at the L5/S level. We defined the distance between the vertebral bodies and the anterior edge of the dural sac in the magnetic resonance images at the L5 vertebral level as the anterior dural space (ADS) and detected the difference (d-ADS) between preoperative ADS (pre-ADS) and postoperative ADS (post-ADS). We assessed the relationship between ADS or d-ADS, and preoperative parameters, including age, sex, lumbar lordosis, focal lordosis (FL), and number of decompression levels. RESULTS: Post-ADS was significantly greater than pre-ADS (p<0.001). Pre-ADS was significantly correlated with FL (p=0.44, p<0.01) and also with post-ADS (p=0.43, p<0.01). d-ADS was negatively correlated with pre-ADS (p=−0.37, p<0.05). A single regression analysis revealed that the relationship between d-ADS and pre-ADS was described as d-ADS=3.67−0.46×pre-ADS. In one of three patients whose d-ADS was above the range of two standard errors, reoperation was performed because of impingement of the nerve root caused by the excessive posterior dural shift. CONCLUSIONS: Posterior dural shifts occur after spinous process-splitting multi-level lumbar laminectomies, including at the L5/S level. FL and pre-ADS are good predictive factors for posterior dural shift. Excessive posterior dural shift may lead to stretching and impingement of nerve roots and thus require attention.

Objective To investigate the influence of inhibited gene expression of fisson 1 (Fis1) gene on the level of Fis1,mitofusin 1 (Mfn1) and mitochondrial membrane potential in SH-SY5Y cells with fluorine,to study the role of mitochondrial dynamic balance in the pathogenesis of chronic fluorosis.Methods SH-SY5Y cells were cultured in vitro,when adherent cells entered the logarithmic phase,using a group design,they were divided into four groups:blank control group (control),fluoride group [2 mmol/L sodium fluoride (NaF)],fluoride negative control group (2 mmol/L NaF + non-specific siRNA) and the gene-silencing group (2 mmol/L NaF + specific siRNA-Fis1).The protein expression levels of Fis1 and Mfn1 were measured by Western blotting;the mRNA expression levels of Fis1 and Mfn1 were measured by Real-time PCR;and the levels of the mitochondrial membrane potential was detected by mitochondrial membrane potential detection kit.Results Compared with control (1.37 ± 0.18,1.00 ± 0.04;1.57 ± 0.19,1.00 ± 0.04;1.00 ± 0.10),the expression levels of Fisl protein (1.72 ± 0.04) and mRNA (1.48 ± 0.13) in fluoride group were increased,the expression levels of Mfn1 protein (0.87 ± 0.02) and mRNA (0.69 ± 0.07) in fluoride group were decreased,the level of mitochondrial membrane potential (0.76 ± 0.13) was decreased (P ＜ 0.05).Compared with control,the expression levels of Fis1 protein (0.79 ± 0.07) and mRNA (0.06 ± 0.03) in gene-silencing group were decreased,the expression levels of Mfn1 protein (1.71 ± 0.04) and mRNA (1.52 ± 0.05) in gene-silencing group were increased (P ＜ 0.05),the level of mitochondrial membrane potential (0.94 ± 0.01) was decreased.Compared with fluoride group,the expression levels of Fis1 protein and mRNA in gene-silencing group were decreased,the expression levels of Mfn1 protein and mRNA in gene-silencing group were increased,the level of mitochondrial membrane potential in gene-silencing group was increased (P ＜ 0.05).Conclusion Gene expression inhibition of Fis1 gene can reduce the mitochondrial division and damage of mitochondrial membrane potential in SH-SY5Y cells induced by fluoride.

Humans ; Neurotoxicity Syndromes ; etiology ; Xylenes ; toxicity

Capital Medical University Pediatrics Online Course which has been set since June 2013 provides students with more personalized and efficient learning platform in line with modern educational concepts.The paper has introduced the application platform,basic framework and usage of the Online Course,analyzing the characteristics of excellent teaching resources,bilingual teaching,students' participation and students' learning more in line with manifestations habits,and finally reflected on the subsequent development of Pediatrics Online Course in the future.

Currently,the medical technology and service capability in grass-root medical institutions are still at low level.This article emphasizes the need for pilot bases of appropriate medical emergency technologies,introducing our experiences in this respect and the effects.We hope to offer reference for the promotion of appropriate medical emergency technologies.

OBJECTIVETo explore the relationship between abnormal expressions of positive cell cycle control factors and thyroid carcinoma occurrence and progression, and assess the value of these factors in evaluating tumor cell proliferation activity and the prognosis of the patients.

METHODSImmunohistochemical SP method was used to detect the expressions of MCM7, CDK2 and Ki-67 proteins in 50 cases of thyroid carcinoma, 30 cases of thyroid adenoma, 30 cases of nodular goiter and 20 cases of normal thyroid gland tissues.

RESULTSThe positive rates of MCM7, CDK2 and Ki-67 expressions in thyroid carcinoma were 100% (50/50), 80.00% (40/50) and 84.00% (42/50), significantly higher than the rates in thyroid adenoma, nodular goiter and normal thyroid tissue (P<0.01). In thyroid carcinoma tissues, positive correlations were observed between the expressions of MCM7 and CDK2 proteins (r=0.637, P<0.01), MCM7 and Ki-67 proteins (r=0.633, P<0.01), and CDK2 and Ki-67 proteins (r=0.862, P<0.01).

CONCLUSIONThe high expressions of MCM7, CDK2 and Ki-67 protein may contribute to the development of thyroid carcinoma, and their combined examination may serve as useful index for early diagnosis and prognostic evaluation of thyroid carcinoma. MCM7 is superior to Ki-67 in the evaluation of the thyroid tumor cell proliferation activity.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cyclin-Dependent Kinase 2 ; metabolism ; Female ; Humans ; Ki-67 Antigen ; metabolism ; Male ; Middle Aged ; Minichromosome Maintenance Complex Component 7 ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology ; Young Adult

OBJECTIVETo establish the EST-SSR marker system for Cordyceps by using ESTs of C. bassiana and C. militaris.

METHODThe ESTs of Cordyceps were downloaded from the public database of NCBI, and the redundant ESTs with low quality were removed. The EST-SSR primers were designed by Sequece Seiner 1. 2. And the primers were screened through PAGE-Electrophoresis.

RESULTThe 4 556 non-redundant ESTs which from C. bassiana with total length of 2 953 173 bp were selected. 718 EST-SSRs distributed in 616 ESTs were totally screened out, accounting for 15.8% of the non-redundant ESTs. It was discovered that the average distance of EST-SSSR was 1/4 096 bp in EST-SSRs distribution of C. bassiana. Trinucleotide repeats were the most abundant types with 419 repeated sequences. Regarding to C. militaris, totally 1 363 non-redundant ESTs were acquired, from which 1 117 EST-SSRs were screened, and rate of SSR sites in ESTs was 81.95%. The leading motif of SSR was nucleotide A. The 50 pairs of EST-SSR primers were designed according to the ESTs of C. bassiana, and preliminary test showed the 34 pairs of primers amplified clear fragments,accounting for 68% of all primers. Furthermore, the 39 of the 40 pairs of primers from the ESTs of C. militaris were found to be amplified as the clear fragments, accounting for 97.5%. The phylogenetic analysis revealed that different anamorph of Cordyceps spieces were divided into four branches.

CONCLUSIONThe EST-SSR of Cordyceps had comparably higher utility value. The EST-SSR markers developed from ESTs of C. bassiana and C. militaris had well transferability in Cordyceps. And it was suggested that the EST-SSR markers should be an easy and effective way to assay molecular genetic structure of Cordyceps.

China ; Cordyceps ; classification ; genetics ; DNA Primers ; DNA, Fungal ; genetics ; Databases, Nucleic Acid ; Expressed Sequence Tags ; Genetic Markers ; genetics ; Genome, Fungal ; genetics ; Microsatellite Repeats ; genetics ; Phylogeny ; Polymorphism, Genetic ; Repetitive Sequences, Nucleic Acid ; genetics