Objective To understand the reliability of caloric test results through the analysis of the pod shape dia-gram types of caloric test and to provide a more accurate and reliable basis for vestibular system function evaluation.Meth-ods The results of caloric test in 528 patients from July 2021 to May 2022 in vertigo diagnosis and treatment center were analyzed.According to pod pattern and unilateral weakness(UW),the patients were divided into five groups:cold and warm test symmetrical group,left and right side asymmetry group,single value significant abnormal group,bilateral hypo-plasia group and pod morphology unable to be classified group.Unreliable data can be identified by comparing,explaining,and summarizing the results of UW of different groups,so as to reduce the interference of unreliable data to clinical diagno-sis and treatment.Results Cold and warm test symmetric group(n=439)included patients with symmetry of bilateral vestibular function(n=273)and decreased vestibular function of one side(n=166).Left and right symmetrical groups in-eluded pationts with bilateral symmetric vestibular function(n=11)and unilateral reduction(n=13).Single value signifi-cant abnormal group showed cases with unilateral vestibular function reduction(n=25)and bilateral symmetric vestibular function(n=11).Bilateral hypolasion group showed cases with bilateral symmetric vestibular function(n=25)and unilat-eral reduction(n=9).Pod morphology unclassified group(n=5)suggested varions interference factors.Conduson When the function of the peripheral vestibular is symmetrical and normal,we should be alert to the existence of temperature effect,and should consider the inspection of the perfusion apparatus and the calibration of the irrigation temperature.When the function of the peripheral vestibular shows unilateral weakness,repeating the irrigation is recommended when the single value of the caloric test significantly increases or decreases.If there is no change,repeating the irrigation at the same tem-perature in the other ear or even repeating the whole caloric test are recommended.The UW value could not truly reflect the state of peripheral vestibular function when the caoric test produces bilateral weakness.Therefore,water irrigation could be used to make a correct judgment based on the medical history and other auxiliary examinations.It is of great significance to judge the effectiveness of caloric test comprehensively by combining the morphology of pod diagram with UW value.

Objective:To compare the results of invasive prenatal diagnosis and preimplantation genetic testing (PGT) and explore the underlying mechanism.Methods:Clinical data of pregnant women undergoing PGT and invasive prenatal diagnosis at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2022 were collected. The results of PGT and invasive prenatal diagnosis were compared, and the outcomes of pregnancies were followed up. This study has been approved by the Medical Ethics Committee of the the Sixth Affiliated Hospital of Sun Yat-sen University (No. 2022SLYEC-491).Results:A total of 172 couples were included in this study, and 26 non-targeted variants were discovered upon prenatal diagnosis, including 10 cases (38.5%) by chromosomal karyotyping, 15 (57.7%) by chromosomal microarray analysis (CMA), and 1 (3.8%) by whole exome sequencing. The 10 karyotypic anomalies had included 6 chromosomal polymorphisms, 2 chromosomal mosaicisms, 1 paternally derived translocation, and 1 missed maternal chromosomal inversion. CMA has identified 15 copy number variations (CNVs), which included 11 microdeletions and microduplications, 3 loss of heterozygosity, and 1 low-level mosaicism of paternal uniparental disomy. One CNV was classified as pathogenic, and another one was likely pathogenic, whilst the remaining 13 were classified as variants of uncertain significance. Therefore, 8.7% of CNVs was detected by invasive prenatal diagnosis after PGT. 92.3% (24/26) of the non-targeted variants have been due to technological limitations of next-generation sequencing (NGS).Conclusion:Invasive prenatal diagnosis after PGT can detect non-targeted variants, which may further reduce the incidence of birth defects.

Objective:To explore the correlation between abnormal expression of serum 25(OH)D and immune-related fac-tors and subclinical atherosclerosis(AS)in patients with impaired glucose regulation.Methods:A total of 142 patients with im-paired glucose regulation admitted to Zaozhuang Municipal Hospital from December 2019 to April 2021 were selected.The patients with impaired glucose regulation were selected as the control group(n=86)and patients with subclinical atherosclerosis were selected as the observation group(n=56)according to carotid ultrasound examination and bramolecular pulse wave conduction velocity.The serum 25(OH)D and immune factors were compared between the two groups.Carotid ultrasound was used to measure the carotid inti-media thickness,and Pearson method was used to determine the correlation between the intimedia thickness,25(OH)D and immune factors.Baseline data and hematological indicators were collected,univariate and multivariate Logistic regression analysis was per-formed to determine the influencing factors of subclinical atherosclerosis,and ROC curve was used to evaluate the diagnostic efficacy of serum 25(OH)D and immune factors in subclinical atherosclerosis.Results:The serum 25(OH)D[(24.01±4.87)mmol/L vs(30.74±5.01)mmol/L,t=7.909,P=0.000)in the observation group was significantly lower than that of control group.TNF-α[(48.32±8.02)ng/L vs(33.21±9.00)ng/L,t=10.199,P=0.000)and IL-6[(41.22±9.43)ng/L vs(30.21±7.01)ng/L,t=7.492,P=0.000)in ob-servation group were significantly higher than those in control group.Carotid intima-media thickness was negatively correlated with se-rum 25(OH)D(r=-0.428,P<0.001),and was positively correlated with serum TNF-α and IL-6(r=0.574,0.577,P<0.001).Logis-tic regression analysis showed that serum 25(OH)D(OR=0.520,95%CI:0.401～0.675),serum TNF-α(OR=1.667,95%CI:1.131～2.457)and serum IL-6(OR=1.478,95%CI:1.213～1.802)were the influencing factors of subclinical atherosclerosis.ROC curve showed that the optimal cut-off value of serum 25(OH)D was 28.32 mmol/L,and the corresponding sensitivity,specificity and AUC were 69.64%,70.93%and 0.803(95%CI:0.749～0.855),respectively.The critical value of serum TNF-α was 40.56 ng/L,corre-sponding sensitivity was 71.43%,specificity was 72.09%,and AUC was 0.761(95%CI:0.717～0.823).Serum IL-6 cut-off value was 36.13 ng/L,corresponding sensitivity was 60.71%,specificity was 60.47%,and AUC was 0.627(95%CI:0.566～0.702).The sensitivity,specificity and AUC of regression analysis were 85.71%,81.40%and 0.889(95%CI:0.830～0.915).Conclusion:Serum 25(OH)D and immune-related factors alone and in combination can effectively predict the occurrence of subclinical atherosclerosis,which is correlated with carotid intima-media thickness,and serum 25(OH)D and immune-related factors are predictors of subclinical atherosclerosis.

Objective:To investigate the clinical characteristics and prognosis of bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in preterm infants, and to provide basis for early clinical diagnosis and infection control. Methods:The clinical data of infants with CRKP bloodstream infection admitted to the Preterm Infants Ward of Children′s Hospital Affiliated to Zhengzhou University from January 2015 to December 2022 were retrospectively analyzed. The risk factors for death in preterm infants caused by CRKP bloodstream infection were explored through multivariate logistic regression analysis, and the receiver operating characteristic (ROC) curve was used to analyze the clinical value of each factor on evaluating prognosis. The area under curves (AUC) of each factor in different ROC curve were compared by Delong′s test.Results:A total of 96 preterm infants with CRKP bloodstream infection were included, including 70 in the survival group and 26 in the death group. The first onset symptoms of CRKP bloodstream infection in preterm infants were persistent tachycardia (heart rate>180 per minute) (69 cases, 71.9%), fever (61 cases, 63.5%), and apnea (59 cases, 61.5%). There were 88(91.7%) cases of infection combined with septic shock, and 91(94.8%) cases required vasoactive drug support. Multivariate logistic regression analysis showed that the maximum vasoactive-inotropic score (VIS) within 48 hours of onset (odds ratio ( OR)=1.058, 95% confidence interval (95% CI) 1.022 to 1.095, P=0.001), concurrent purulent meningitis ( OR=8.029, 95% CI 1.344 to 47.972, P=0.022), and concurrent necrotizing enterocolitis (NEC) ( OR=10.881, 95% CI 1.566 to 75.580, P=0.016) were independent risk factors for death in preterm infants with CRKP bloodstream infection. The ROC curve showed that the AUCs for evaluating the prognosis of preterm infants with NEC and purulent meningitis were 0.784 and 0.711, respectively. The AUC for evaluating the prognosis of preterm infants with a maximum VIS ≥52.5 points within 48 hours of onset was 0.840, and the AUC for combining the three factors was 0.931. Compared with NEC and purulent meningitis, the AUC for combining factors was higher, the differences were statistically significant ( P=0.002, P<0.001). Conclusions:Preterm infants with CRKP bloodstream infection who have a maximum VIS ≥52.5 points within 48 hours of onset, with NEC and purulent meningitis have a higher risk of death.

Objective:To explore the establishment of a nomographic chart model based on computed tomography(CT)imaging characteristics and clinical data in predicting the recurrence risk of pleomorphic adenoma(PA)of salivary gland.Methods:Clinical and CT imaging data of 99 PA patients admitted to Cangzhou central hospital from November 2019 to November 2022 were retrospectively analyzed,and they were divided into recurrence group(15 cases)and non-recurrence group(84 cases)according to whether occurred recurrence.The influence factors of PA recurrence were analyzed by univariate analysis and multivariate logistic regression,and the risk prediction model was constructed.The predictive value of the model was analyzed by receiver operating characteristic(ROC)curve.Results:Multivariate Logistic regression analysis showed that the tumor site was at deep lobe,the capsule of tumor was incomplete and the surrounding tissue of tumor existed invasion were respectively independent risk factors for PA recurrence(OR=79.730,67.194,479.801,P<0.05).The area under curve(AUC)of ROC curve of the risk prediction model based on the above three indexes was 0.960,and the sensitivity and specificity were respectively 80.0%and 97.6%,which were higher than each single index in the model.There was no significant difference between this risk predictive model and actual observation value(x2=0.823,P=0.935).Conclusion:The tumor site is deep lobe,the capsule of tumor is incomplete,and the surrounding tissue of tumor exists invasion are independent risk factors of PA recurrence.The risk prediction model based on the above three indexes has higher predictive value for PA recurrence,which can provide theoretical basis for preventing PA recurrence.

Objective:To investigate the clinical characteristics and prognosis of cytomegalovirus-sepsis-like syndrome (CMV-SLS) in premature infants, and to provide the evidence for early clinical identification and treatment.Methods:Premature infants with CMV-SLS admitted to Children′s Hospital Affiliated of Zhengzhou University from January 1, 2019 to December 31, 2022 were selected as the research subjects, and their clinical characteristics, treatment, and prognosis were retrospectively analyzed.Results:A total of seven cases of CMV-SLS were included, with a gestational age of (26.8±1.2) weeks and a birth weight of (890±121) g. The age of disease onset was 55(45, 60) days, and the age of diagnosis was 67(56, 71) days. All the seven cases were exclusively breast feeding after birth, and cytomegalovirus (CMV) DNA was detected positive in their breast milk when diagnosed with CMV-SLS. The common clinical features were fever, abdominal distension, liver function damage, decreased neutrophil and platelet counts. Pneumonia, neonatal necrotizing enterocolitis, hearing loss, and chorioretinitis were common. After the diagnosis was confirmed, all the seven cases were given intravenous treatment of ganciclovir and followed by oral formulations, with a course of treatment ranging from five to seven weeks. Two cases were treated with intravitreal injection of ganciclovir for chorioretinitis. All the seven cases survived. During the follow-up with a corrected gestational age of 12 months, one case had delayed intellectual and motor development, two cases had delayed motor development, and the remaining cases had normal development.Conclusions:CMV-SLS in premature infants mainly occurs in extremely low birth weight infants, with atypical clinical manifestations and may be misdiagnosed easily. If extremely low birth weight infants who receive CMV DNA positive breast feeding show sepsis-like symptoms, the possibility of CMV infection should be considered, and early diagnosis and treatment should be carried out to prevent adverse outcomes.

This article reported a male patient with neonatal onset mental retardation autosomal dominant 35 (MRD35). The boy presented with repeated convulsions, hypotonia, enlarged head circumference, congenital muscular torticollis and feeding difficulties in the neonatal period. Dynamic electroencephalogram showed paroxysmal epileptic discharges in the left central-temporal region. High-throughput whole-exome sequencing revealed a heterozygous mutation of c.139G>A (p.Glu47Lys) in the PPP2R5D gene, which was a de novo mutation not inherited from his parents. The child had significant developmental delay at the age of one year. MRD35 lacks typical clinical manifestations and requires whole-exome sequencing for definitive diagnosis. Currently, there is no specific treatment for MRD35 and symptomatic treatments, including rehabilitation training, language training and seizure control, are mostly adopted.

Fixed assets management is an important part of hospital operation management. At present, the fixed asset management of public hospitals in China lacks integrity and needs further improvement. In May 2022, a tertiary public hospital in Shanghai explored a fixed asset bubble management mode from an integrated perspective based on a bubble management strategy. The main approach included building a hospital′s fixed asset management organizational structure, equipping it with fixed asset sorting cards, setting up large, medium and small fixed asset bubbles respectively, implementing such management measures as bubble flow management, bubble rupture plans, and bubble internal and external environmental risk control mechanisms.In March 2023, the hospital had constructed 104 fixed asset management bubbles, including 17 large bubbles, 58 medium bubbles and 29 small bubbles. The fixed asset bubble management mode effectively reduced the loss rate of hospital fixed assets and achieved a preliminary success, providing reference for improving the efficiency and quality of fixed asset management in public hospitals in China.

A new definition of metabolic dysfunction-associated fatty liver disease (MAFLD) has recently been proposed. We aim to examine the associations of MAFLD, particularly its discordance from non-alcoholic fatty liver disease (NAFLD), with the progression of elevated brachial-ankle pulse wave velocity (baPWV) and albuminuria in a community-based study sample in Shanghai, China. After 4.3 years of follow-up, 778 participants developed elevated baPWV and 499 developed albuminuria. In comparison with the non-MAFLD group, the multivariable adjusted odds ratio (OR) of MAFLD group for new-onset elevated baPWV was 1.25 (95% confidence interval (CI) 1.01-1.55) and 1.35 (95% CI 1.07-1.70) for albuminuria. Participants without NAFLD but diagnosed according to MAFLD definition were associated with higher risk of incident albuminuria (OR 1.77; 95% CI 1.07-2.94). Patients with MAFLD with high value of hepamet fibrosis score or poor-controlled diabetes had higher risk of elevated baPWV or albuminuria. In conclusion, MAFLD was associated with new-onset elevated baPWV and albuminuria independently of body mass index, waist circumference, and hip circumference. Individuals without NAFLD but diagnosed as MAFLD had high risk of albuminuria, supporting that MAFLD criteria would be practical for the evaluation of long-term risk of subclinical atherosclerosis among fatty liver patients.
Humans ; Pulse Wave Analysis ; Albuminuria ; Ankle Brachial Index ; Non-alcoholic Fatty Liver Disease/diagnosis* ; Vascular Stiffness ; Prospective Studies ; Risk Factors ; China/epidemiology*

Objective:To investigate the effect of conventional coronary CT angiography (CCTA) bolus injection of contrast agent on the diameter and angle of the left main coronary artery (LMA) bifurcation area, and to provide a basis for the application of CCTA to accurately measure the coronary artery.Methods:In Cangzhou Central Hospital of Hebei Province from January to December 2020, the clinical data of 54 patients with suspected coronary heart disease who underwent coronary artery calcification score (CACS) and CCTA with conventional bolus injection of contrast agent were retrospectively analyzed. Two physicians measured middle lumen diameter of LMA (d1), proximal lumen diameter of left anterior descending (LAD) (d2), proximal lumen diameter of left circumflex (LCX) (d3) and bifurcation angle between LAD and LCX (∠1). The consistency of 2 physicians was compared, and the results of CACS and CCTA were compared.Results:The consistency analysis result showed that only d3 measured by CCTA had a moderate consistency (intra-group correlation coefficient = 0.717), and the remaining indexes were in good agreement (intra-group correlation coefficient >0.75). There were no statistical differences in indexes measured results between CACS and CCTA ( P>0.05). According to the degree of left coronary artery stenosis, 54 patients were divided into 2 groups: LMA and branches normal or stenosis degree < 50% group (25 cases) and LMA and branches 1 or more branches stenosis degree≥50% group (29 cases). There were no statistical differences in indexes measured results between CACS and CCTA in patients with different disease severity ( P>0.05). Conclusions:In the CCTA examination, the conventional bolus injection of contrast agent does not affect the diameter and angle of the lumen of the LMA bifurcation area of the coronary artery.