Objective:To conduct a nationwide physician survey to better understand clinicians’ disease awareness, treatment patterns, and experience of Waldenstr?m macroglobulinemia (WM) in China.Methods:This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews.Results:The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-na?ve and relapsed/refractory patients (94% for all patients, 95% for treatment-na?ve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions:This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors’ and patients’ understanding of WM is one of the most urgent issues that must be addressed right now.

Objective:To investigate the interaction of platelet factor 4(PF4)with tumor necrosis factor-α(TNF-α)in the pathoge-nesis of chronic periodontitis(Ⅲ-C).Methods:22 patients with chronic periodontitis(Ⅲ-C)and 22 subjects with periodontal health were recruited.Before and after periodontal treatment,the concentration of PF4 and TNF-α in gingival crevicular fluid(GCF)and ser-um,the amount of PF4 released by platelets after lipopolysaccharide(LPS)stimulated peripheral blood platelets were measured by ELISA.Flow cytometry was used to calculate the number of platelets in GCF before and after treatment.Results:The concentrations of PF4 and TNF-α in the GCF and serum of the patients were higher than those in the periodontal healthy group(P＜0.05).After treat-ment,the concentrations of PF4 and TNF-α in the GCF were significantly lower than those before treatment(P＜0.05),and the con-centrations of PF4 and TNF-α in the serum were unchanged(P＞0.05).After LPS stimulation of the platelets in blood before and after treatment,the concentration of PF4 released by the platelets was much higher in the patients than that in the healthy controls(P＜0.01),and the concentration was significantly lower after periodontal treatment than before treatment(P＜0.01).The number of CD41/CD61 double positive platelets and CD45 negative cells in GCF before periodontal treatment were 85 times and 87 times higher than those in periodontal healthy subjects,respectively(P＜0.01).Conclusion:PF4 and TNF-α have synergistic effect in the patho-genesis of chronic periodontitis.

Humans ; Stomach Neoplasms/pathology* ; Neoadjuvant Therapy ; Chemotherapy, Adjuvant ; Gastrectomy ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Neoplasm Staging

The record speed at which Chinese scientists identified severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and shared its genomic sequence with the world, has greatly facilitated the development of coronavirus disease (COVID-19) diagnostics, drugs, and vaccines. It is unprecedented in pandemic control history to develop a dozen successful vaccines in the first year and to immunize over half of the global population in the second year, due to the efforts of the scientific community, biopharmaceutical industry, and regulatory agencies worldwide. The challenges are both great and multidimensional due to the rapid emergence of virus variants and waning of vaccine immunity. Vaccination strategies need to adapt to these challenges to keep population immunity above the herd immunity threshold, by increasing vaccine coverage, especially for older adults and young people, and providing timely booster doses with homologous or heterologous vaccine boosts. Further research should be undertaken to develop more effective vaccines against SARS-CoV-2 variants and to understand the best prime-boost vaccine combinations and immunization strategies to provide sufficient and sustainable immune protection against COVID-19.
Adolescent ; Aged ; COVID-19/prevention & control* ; COVID-19 Vaccines ; Humans ; Pandemics/prevention & control* ; SARS-CoV-2 ; Vaccination

Objective:To develop and test the reliability and validity of the assessment scale for patients with persistent vegetative state (PVS) or minimally conscious state (MCS) discharge from the anesthesia recovery room after operation.Methods:From September 2018 to October 2020, three dimensions and 17 item pools were determined through literature review and discussion among the project members. Two rounds of expert consultation were conducted to determine the respiratory (R), circulatory (C), oxygenation (O), bispectral index (B) and neuromuscular monitoring (N) scale (RCOBN scale), the reliability and validity were tested. 87 patients with PVS or MCS after operation Affiliated Sichuan Bayi Rehabilitation Center of Chengdu University of Traditional Chinese Medicine were selected to verify the effectiveness.Results:In the first round, 23 questionnaires were distributed. The total score of experts was 50 ± 3, F=9.24, CV were 0.00-0.43. The Cronbach α coefficient of each dimension was 0.782-0.846, and the Cronbach α coefficient of the total scale was 0.813. In the second round, 10 questionnaires were distributed. The item-level content validity index was 0.7-1.0, the probability of random consistency ( Pc) was 0.001-0.117, the adjusted kappa value ( k*) was 0.567-1.000, and the sum of the index scores corresponding to k* > 0.74 was 8. The scale-level content validity index of the overall consistency was 0.87. The ratio of patients transferred out of PACU by two rounds of evaluation method was 100 : 96.55, and the difference was not statistically significant ( χ2=3.05, P>0.05). The time of the first round of assessment was significantly longer than that of the second round, which were (197 ± 52) s and (58 ± 14) s respectively. The difference was statistically significant ( t=26.52, P < 0.01). Conclusions:The RCOBN scale has high reliability and validity. It can be used as an assessment scale for patients with PVS or MCS to transfer out of PACU after surgery, and those with a total score of 8 can be transferred out of PACU.

As d-amino acids play important roles in the physiological metabolism of bacteria, combination of d-amino acids with antibiotics may provide synergistic antibacterial activity. The aim of the study was to evaluate and activity of d-serine alone and in combination with -lactams against methicillin-resistant (MRSA) strains, and to explore the possible sensitization mechanisms. The activity of d-serine, -lactams alone and in combinations was evaluated both by standard MICs, time-kill curves and checkerboard assays, and by murine systemic infection model as well as neutropenic thigh infection model. An synergistic effect was demonstrated with the combination of d-serine and -lactams against MRSA standard and clinical strains. Importantly, the combinations enhanced the therapeutic efficacy in the animal models as compared to -lactam alone groups. Initial mechanism study suggested possible revision of d-alanine-d-alanine residue to d-alanine-d-serine in peptidoglycan by adding of d-alanine in the medium, which may cause decreased affinity to PBPs during transpeptidation. In conclusion, d-serine had synergistic activity in combination with -lactams against MRSA strains both and . Considering the relatively good safety of d-serine alone or in combination with -lactams, d-serine is worth following up as new anti-MRSA infection strategies.

Objective To investigate the implementation status quo of the contracted family doctor system in Wangcheng District of Changsha City. Methods Sixty-three health workers and 185 medical residents were selected from 6 township health centers in Wangcheng district which implementing the contracted family doctor system and performed the questionnaire survey on the implementation status quo of the contracted family doctor system and its influencing factors.. Implementation status of contracted family doctor system and its influencing factors were investigated by using questionnaires. Results The total satisfaction of the residents in Wangcheng District to township hospitals was 49.44%;the satisfaction differences to different institutions were analyzed,the results showed that the medical environment, service attitude and medical equipments had statistical difference among 6 township health center(P<0.05);Logistic regression analysis results showed that queuing time for consultation, medical price, service attitude, explain of disease state,technological level and medical effect were the main influence factors affecting the residents' satisfaction (P<0.05) ;the development prospects,distribution of workload and time, equity and work risk were the influence factors for the medical workers' satisfaction (P<0.05). Conclusion Many problems and influencing factors exist in the implementation process of the contracted family doctor system in Wangcheng District, which can be perfected in the aspects of the job responsibility of family doctors,performance assessment of family doctors and distribution of medical insurance reimbursement ratio.

[Absract] Objective To investigate the imaging features of CT and MRI of echinococcosis, and improve the imaging knowledge of the disease. Methods Clinical and radiological findings of echinococcosis of ribs were retrospectively analyzed by reviewing the seventeen cases confirmed by clinical and pathological findings. All patients had CT scan, eight had X?ray plain film and five had MR examination, while 4 patients underwent additional contrast?enhanced CT examination. Results All lesions were unilateral. There were 33 ribs involved, and single involved rib was seen in 7 cases. On CT scans, 10 cases showed cystic, swelling and osteolytic bone destruction, and 7 cases showed moth?eaten osteolytic bone destruction. There were 13 cases of hydatid cyst, 3 cases of a single sac watery density shadow and 10 cases of polycystic separating wheels form. There were 4 cases of fractured ribs, 2 cases of the longitudinal fracture and 2 cases of the transverse fracture. On MRI, there was one case of rib medullary cavity expansion destruction. It was a single cyst with hypointensity on T1WI, hyperintensity on T2WI and hyperintensity on short time inversion recovery (STIR) images. There were one case of rib medullary cavity expansion destruction and 3 cases of hydatid erosion ribs cortex among 4 cases of polycystic type. Polycystic type echinococcosis appeared hypointensity on T1WI, hyperintensity on T2WI and hyperintensity on STIR images. Polycystic type had mother sac and ascus structure, and signal intensity of ascus was higher. STIR sequence showed more clearly polycystic structure. Conclusions CT and MRI can clearly show location of echinococcosis of ribs. There are the imaging features of cystic, swelling and osteolytic bone destruction or complicating cyst of polycystic type which can help the qualitative diagnosis of rib echinococcosis.

BACKGROUND:Different races, genders, heredity, geographical environment can cause different bone ages. Therefore, an assessment of hand-wrist bone age has been done in the Han and Uygur adolescents and children in Xinjiang region.
OBJECTIVE: To investigate the actual conditions of hand-wrist bone age in Han and Uygur adolescents and children in Urumqi.
METHODS: 760 children and adolescents (aged 4.0-4.0 years) of Uighur and Han nationalities were enroled in this study. Two years acted as an age group. The hand-wrist bone age was estimated by hand-wrist X-ray using theChinese Wrist Skeletal Development Standard CHN Method. The correlation between bone age and chronological age was analyzed statisticaly as wel as difference in the bone age and chronological age between two ethnic groups.
RESULTS AND CONCLUSION: (1) A close correlation was found between hand-wrist bone age and chronological age for two ethnic groups (P < 0.05). (2) Thirteen age group showed higher bone ages than chronological ages, including four age groups of Han nationality girls aged 4.0-11.9 years, three age groups of Han nationality boys aged 4.0-9.9 years, three age groups of Uygur girls aged 4.0-9.9 years, and three age groups of Uygur boys aged 4.0-9.9 years. (3) The bone and chronological ages were higher in the Han girls aged 10-11.9 year than the Uygur girls aged 10-11.9 years as wel as in the Han boys aged 12-13.9 years than the Uygur boys aged 12-13.9 years. Results show that the two ethnic groups of children and adolescents exhibit the early mature trend of skeletal development in multiple age groups; and there is a difference in skeletal and chronological age between Han and Uygur adolescents in some age groups.

In order to remove the endotoxin from the blood of endotoxemia patients, we prepared a new adsorbent with heparin space arm and polymyxin B (PMB) ligand. The carrier of chloromethyl polystyrene resin was activated and heparin space arm was grafted, and then PMB ligand was immobilized onto adsorbent with glutaraldehyde. We employed in vitro FITC-lipopolysaccharide (FITC-LPS) static adsorption to characterize the adsorption properties on the adsorbent, and conducted in vitro lipopolysaccharide (LPS) static adsorption to measure quantitavely the adsorption capacity and rate, and then evaluated the blood compatibility. The in vitro static adsorption indicated that the adsorbent had the removal rate of LPS above 70% with the adsorption equilibrium time for 2 hours. Blood compatibility experiment showed that the adsorbent had little negative effects on blood cells and plasma protein, and their adsorption rates were less than 10% for hemocytes and 20% for plasma protein respectively. This adsorbent exhibited high selectivity, high adsorption capacity and good biocompatibility, and presented a promising clinical application in the treatment of endotoxemia.
Adsorption ; Endotoxemia ; therapy ; Endotoxins ; isolation & purification ; Hemofiltration ; instrumentation ; methods ; Heparin ; chemistry ; Humans ; Ion Exchange Resins ; chemistry ; Ligands ; Polymyxin B ; chemistry ; Sorption Detoxification ; methods