Objective:To analyze the effect of long-term care insurance on the incidence of falls in old people with disability, and the modification effect of different living arrangements.Methods:Based on the discharge diagnosis records of the hospitalization in urban residents who applied for long-term care insurance in Chengdu from July 2014 to June 2021, those who received long-term care insurance were selected as the intervention group and those who received no long-term care insurance were selected as the control group, the changes in the incidence of falls before and after the long-term care were analyzed using difference-in-differences method, and the modification effects of different living arrangements were explored using stratified analysis.Results:Long-term care insurance significantly reduced the risk for monthly incidence of falls in older adults [average treatment effects on treated (ATT) = -1.21% (95% CI: -1.82%--0.60%)], and the effect increased over time (ATT=-1.26%, 95% CI: -1.93%--0.59%). Long-term care insurance had a significant effect on reducing the incidence of falls in old people living with spouses/family members (ATT=-0.92%, 95% CI: -1.47%--0.37%) and in nursing facilities/hospitals (ATT=-2.10%, 95% CI: -3.81%--0.40%), but it had no significant effect in those living alone. Conclusions:Long-term care insurance can effectively reduce the incidence of falls in old people with disability, showing a positive effect. Living with family members or in nursing facilities/hospitals has a modification effect of the implementation of long-term care insurance policy. It is necessary to pay attention to key populations in the future and expand the coverage of long-term care insurance.

Cerebral ischemia-reperfusion injury(CIRI)is a serious complication caused by the recovery of blood flow in the affected brain tissue of patients with ischemic stroke.CIRI patients are often accompanied by neurological dysfunction,cognitive impairment,emotional disorders and other symptoms,which have a serious impact on daily life.At present,CIRI is easy to be diagnosed early,but there are relatively few related specific treatments.In this paper,the correlation between cyclic adenylate-activated exchange protein 1/RAS-related protein 1(Epac1/Rap1)signaling pathway and CIRI is reviewed,in order to provide new ideas for clinical treatment of CIRI patients.

Objective To investigate whether VHD prefabricated foot orthoses can reduce the incidence of lower limb overuse injury (LLOI) in naval recruits. Methods Totally 400 recruits who underwent enlistment training were enrolled and randomly assigned to the intervention group (n=200) and control group (n=200). During the enlistment training,the recruits in the intervention group wore VHD prefabricated foot orthoses,while those in the control group did not wear foot orthoses. Questionnaire survey was conducted 1 week later,and the foot orthoses of those recruits with adverse events were remoulded. The health data of recruits were collected again by questionnaire survey and physical examination 12 weeks later.The primary outcome was the incidence of LLOI. The secondary outcomes included the type of LLOI,the lost training time due to LLOI,the comfort score of the foot orthoses,and the adverse events. Results There were no significant differences in the baseline characteristics between the 2 groups (P>0.05). A total of 76 cases of LLOI was recorded,including 24 cases (12％) in the intervention group and 52 cases (26％) in the control group. Plantar fasciitis was the most common type of LLOI. The lost training time of the intervention group and the control group were 51 d (2.12 d for each one) and 123 d (2.37 d for each one),respectively. The comfort scores of the foot orthoses at 1 week and 12 weeks were 3.76±1.87 and 2.03±1.74,respectively. The incidences of adverse events in 1 week and 3 months were 18％ (36/200) and 5％ (10/200),respectively. The most common adverse event was arch pain. Conclusion VHD prefabricated foot orthoses can reduce the incidence of LLOI and lost training time due to LLOI in recruits,with good wearing comfort and less adverse events.

Objective:To examine the survival rates and clinical characteristics of people with newly discovered non-M 3 acute myeloid leukemia (AML) who carry the ASXL1 gene mutation. Methods:From January 2016 to April 2021, the clinical information of patients with newly diagnosed non-M 3 AML at Shandong University's Qilu Hospital was retrospectively examined, and their clinical characteristics and survival were compared and analyzed. Gene mutation was detected by next-generation sequencing. Results:① The study included 256 AML patients who were initially diagnosed and had complete data, including 47 cases of ASXL1 gene mutation-positive (ASXL1 +) patients and 209 cases of ASXL1 gene mutation-negative (ASXL1 -) patients. All patients were divided into three groups: elderly (≥60 years old, n=92) , middle-aged (45-59 years old, n=92) , and young (≤44 years old, n=72) . ②WBC, and age were higher in patients with ASXL1 mutations compared to ASXL1 - patients, while complete response after the first round of treatment (CR 1) was lower ( P<0.05) . In the elderly group, WBC and the proportion of aberrant cells in nuclear cells in ASXL1 + patients were higher than those in ASXL1 - patients ( P<0.05) . In the young group, the WBC of ASXL1 + patients was higher than that of ASXL1 - patients ( z=-2.314, P=0.021) . ③IDH2 mutation and ASXL1 mutation was related ( P=0.018, r=0.34) . In ASXL1 + patients, the proportion of peripheral blasts in the high VAF group (VAF>40% ) was higher than that in the low VAF group (VAF<20% ) , and the proportion of aberrant nuclear cells was higher in the duplication and replacement mutation patients than in the deletion mutation patients ( P<0.05) . ④The overall survival (OS) and progression-free survival (PFS) of ASXL1 + patients were shorter than those of ASXL1 - patients (median, 10 months vs 20 months, 10 months vs 17 months; P<0.05) . The proportion number of aberrant cells in nuclear cells (≥20% ) , complex karyotypes, and TET2 mutation were all independent risk variables that had an impact on the prognosis of ASXL1 + patients, according to multivariate analysis ( P<0.05) . Conclusion:ASXL1-mutated non-M 3 AML patients have higher WBC in peripheral blood, a higher proportion of aberrant cells in nuclear cells, lower CR 1 rate, and shorter OS and PFS. Additionally, a poor prognosis is linked to higher VAF, duplication, and substitution mutations in the ASXL1 gene, as well as the high proportion of aberrant cells in nuclear cells, complex karyotype, and TET2 mutation.

Combined with the clinical use condition of MR in use in Shanghai Sixth People's Hospital, MR components are divided into scanning type I and scanning type II. At the same time, combined with the main loss force of MR components, the research divides MR components into dynamic components and electric thermal components. In this study, a complete set of MR system reliability indexes and implementation methods are given, including system reliability index determination, system reliability allocation, component reliability index realization, system reliability prediction and system reliability verification. At the same time, this study also gives the methods of reliability prediction and reliability verification, and gives the MTBF calculation method of MR system based on clinical use data statistics.
China ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Reproducibility of Results

Based on the clinical application data of medical X-ray computed tomography (CT) in the Shanghai Sixth People's Hospital, this study transformed it into the product reliability index requirements, and took the mechanical representative component-examination table (hereinafter referred to as "patient table") and the electronic representative component-DCB (data control board) as examples. Based on the relationship between failure characteristics and clinical application data, a complete set of closed-loop implementation methods from reliability index requirements to reliability design and verification are discussed.
China ; Humans ; Reproducibility of Results ; Tomography, X-Ray Computed

Objective: To explore effects of histone deacetylase inhibitor Belinostat on the immunologic function of dendritic cells (DC) and its possible mechanism. Methods: Cultured mouse bone marrow-derived DC from C57BL/6 mouse in vitro. The experiments were divided into 0, 50, 100 nmol/L Belinostat + immature DC (imDC) group, and 0, 50, 100 nmol/L Belinostat mature DC (mDC). The changes of the ultrastructure of DC were observed by transmission electron microscope (TEM). Immunophenotype and CCR7 expression rate were detected by FCM, and the migration rate was observed by chemotaxis assay. The proliferation of lymphocytes stimulated by different DC was detected by mixed lymphocyte culture reaction. The cytokines in the culture supernatant, including TNF-α, IL-12 and IL-10, were examined by ELISA. RQ-PCR was used to examine the relative expression of mRNA in RelB. Results: Successful cultured and identified the qualified imDC and mDC. Belinostat decreased the expression of CCR7 on imDC [(25.82±7.25)% vs (50.44±5.61)% and (18.71±2.00)% vs (50.44±5.61)%], meanwhile increased the rate on mDC [(71.14±1.96)% vs (64.90±1.47)%]. Chemotaxis assay showed that the migration rate of Belinostat+imDC and Belinostat+mDC group were both decreased, but the difference in imDC was not significant. T lymphocyte proliferation rate stimulated by 100 nmol/L Belinostat+imDC group was lower than imDC group in condition irritation cell∶reaction cell=1∶2 [(227.09±13.49)% vs (309.49±53.69)%]. Belinostat significantly suppressed the secretion of cytokines TNF-α, IL-12 and IL-10 (all P<0.01). The relative expression of mRNA in RelB was slightly decreased in Belinostat+imDC and Belinostat+mDC group (all P<0.05). Conclusion Belinostat could effectly suppress DC maturation and regulate immune tolerance of DC, which may be due to the down-regulation of mRNA level of RelB in DC.

BACKGROUND: Bone marrow necrosis has unspecific clinical features, which is often misdiagnosed or missed due to a lack of the knowledge of the disease. OBJECTIVE: To improve the awareness and vigilance to bone marrow necrosis, and to further explore the clinical manifestations, hematological characteristics, pathogenesis and treatment of bone marrow necrosis. METHODS: The bone marrow necrosis, hematologic neoplasms, solid tumor, bone marrow puncture, bone marrow pathology in Chinese and English served as the search terms to search articles related to bone marrow necrosis in PubMed and Wanfang databases, published from 1941 to 2016. Totally 43 articles were selected for review. RESULTS AND CONCLUSION: Bone marrow necrosis is a rare complication caused by various diseases, clinically characterized by bone pain, fever, anemia, and nucleated red cells and immature neutrophilic leukocytes in the blood smear. Bone marrow aspiration and/or bone marrow biopsy show(s) necrotic features. Its pathogenesis is complex, and it is still poorly understood and needs further research. There is no good treatment for bone marrow necrosis, and the prognosis is poor. Early correct diagnosis and etiological treatment are crucial for the prognosis of bone marrow necrosis.With the improvement of disease awareness, bone marrow cytology, genetics, MRI and hematopoietic stem cell transplantation, bone marrow necrosis is expected to get a better prognosis.

BACKGROUND:Currently, modified laminoplasty with C7 spinous process and muscle attachment points reserved and C2, C7 decompressive laminectomy can reconcile both ful decompression and structure stability. With early isometric neck muscle exercise, it can enhance cervical dynamic and static force balance and maintain the stability of the cervical spine.
OBJECTIVE:To investigate the clinical effects of modified cervical laminoplasty with postoperative isometric neck muscle exercise on cervical spondylotic myelopathy patients.
METHODS:114 patients with cervical myelopathy were separately performed traditional cervical laminoplasty (control group), modified cervical laminoplasty (modified group), modified cervical laminoplasty, and neck muscle isometric exercise (combined group). Fol ow-up was conducted for 24 months.
RESULTS AND CONCLUSION:(1) Cervical Japanese Orthopaedic Association score, cervical Neck Disabilitv Index scores and the incidence of axial symptoms:There was no significant difference in the Japanese Orthopaedic Association score of three groups at 6, 12 and 24 months after surgery. At 6, 12 and 24 months after surgery, Neck Disability Index scores and constituent ratio of axial symptoms were better in the modified group than the other groups (P<0.05). (2) Results show that modified cervical laminoplasty with isometric neck muscle exercise can get better clinical results in the treatment of cervical myelopathy.

Objective To evaluate the effect of evidence-based bundle intervention strategy on reducing the inci-dence of central line-associated bloodstream infection (CLABSI).Methods Prospective and multicenter study was adopted,patients admitted to 54 intensive care units (ICUs)of 41 hospitals and with central venous catheters (CVCs)between October 1 ,2013 and September 30,2014 were monitored .Baseline data between October 2013 and March 2014 were collected as pre-intervention data;from April to September 2014,the participated hospitals performed intervention strategy,post-intervention data were compared with pre-intervention data.Results The usage rate of CVCs before and after intervention was significantly different (44.18% vs 44.63%,χ2 =5.526,P =0.019).Incidence of CLABSI before and after intervention was not significantly different(RR ,0.82[95%CI ,0.59-1 .13],P =0.10).Constituent ratio of catheter insertion sites between pre-and post-intervention was significantly different (χ2 =76.264,P <0.001),femoral vein catheterization rate as well as proportion of two and above catheter insertion sites after intervention decreased(17.25% VS 13.72%;2.27% VS 1 .44%,respectively);hand hygiene implementation rate and accuracy rate after intervention were both higher than before intervention (79.73% vs 76.14%,P <0.001 ;91 .47% vs 74.26%,P <0.001 ,respectively);constituent ratio of skin disinfectant applica-tion before and after intervention was significantly different(χ2 =3.861 ,P <0.001 ),proportion of chlorhexidine ethanol increased (29.62% VS 50.56%);except daily assessment and record,compliance to other prevention and control measures before and after intervention were all significantly different(all P <0.001);utilization rate of max-imal sterile barrier,qualified rate of dressing of operators,and port disinfection were all significantly enhanced. Conclusion Bundle intervention in intubation and maintenance are implemented effectively,but intervention effect on CLABSI needs further study.