Objective To investigate the value of Charlson comorbidity index (CCI) in predicting the short- and long-term risks of death in patients with acute-on-chronic liver failure (ACLF). Methods A total of 317 patients with ACLF who attended The First Hospital of Lanzhou University from December 1, 2016 to December 1, 2021 were enrolled, and according to their prognosis, they were divided into death group with 169 patients and survival group with 148 patients. The two groups were analyzed in terms of clinical data and follow-up data. The group t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the prognosis of ACLF patients. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison of survival time between patients with different CCI scores. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CCI and other indices in assessing the prognosis of ACLF patients. Results Among the 317 patients, there were 225 (71.0%) male patients. There were significant differences between the death group and the survival group in age, hemoglobin, white blood cell count, total bilirubin, albumin, Model for End-Stage Liver Disease (MELD) score, prothrombin time activity, CCI, age-adjusted Charlson co-morbidity index (ACCI), and follow-up time (all P < 0.05). The multivariate Cox regression analysis showed that the CCI (hazard ratio [ HR ]=1.351, 95% confidence interval [ CI ]: 1.112-1.641, P =0.002), ACCI ( HR =1.200, 95% CI : 1.011-1.423, P =0.037), and MELD score ( HR =1.076, 95% CI : 1.054-1.099, P < 0.001) were independent risk factors for the prognosis of ACLF patients. Based on CCI score, the patients were divided into CCI ≤4 group with 167 patients, CCI=5 group with 64 patients, and CCI ≥6 group with 86 patients, with a 3-year mortality rate of 26.5%, 83.2%, and 96.9%, respectively, and there was a significant difference in survival time between any two groups after 3 years of follow-up and at the time of follow-up till September 2022 (all P < 0.001). CCI, ACCI, and MELD scores had an area under the ROC curve of 0.845, 0.811, and 0.790, respectively, in predicting the prognosis of ACLF patients. Conclusion As commonly used comorbidity assessment indices, CCI and ACCI scores have certain value in evaluating the short- and long-term prognosis of ACLF patients.

Objective:To explore the effect of group painting art therapy on negative symptoms, the cognitive status and social function of patients with schizophrenia during rehabilitation.Methods:A total of 114 patients with schizophrenia recovered from May 2018 to May 2019 in Zhangjiakou Shalingzi Hospital. They were divided into two groups according to the random number table method with 57 case in each group, the control group was given routine nursing, and the observation group received group painting art therapy on the basis of routine nursing. The Positive And Negative Symptoms Scale (PANSS), MATRICS Consensus Cognitive Battery(MCCB), and Social Disability Screening Schedule (SDSS) were used to evaluate the symptoms, cognitive status, and social function improvement of the two groups before and after intervention.Results:There were no significant differences in the negative symptom scores and positive symptom scores of the PANSS between the two groups of patients before the intervention ( P>0.05). After the intervention, the scores of negative symptoms and general psychopathology were (11.83 ± 3.19), (17.30 ± 4.93) points in the observation group and (13.57 ± 2.85), (20.34 ± 5.12) points in the control group, the differences were significant ( t values were 2.789, 2.932, P<0.05). After the intervention, the 7-dimensional MCCB scores of the two groups of patients decreased, and the scores of the observation group were significantly lower than those of the control group ( t values were 2.046-3.238, P<0.05). After the intervention, the score of SDSS was (11.63±2.71) points in the observation group and (13.84 ±3.14) points in the control group, the differences were significant( t value was 3.653, P<0.01). Conclusions:The use of group painting art therapy in patients with schizophrenia during rehabilitation can promote the improvement of negative symptoms and improve the cognitive and social functions of patients.

Objective: To investigate a cluster of coronavirus disease 2019(COVID-19)caused by latent infection in Haikou,so as to provide reference for the prevention and control of COVID-19 clusters. Methods: An epidemiological investigation was conducted according to the COVID-19 Prevention and Control Program(Fourth Edition). The course of diagnosis and treatment,clinical characteristics and field investigation data were collected to analyze the transmission chain and the intergeneration between cases. Results : Among 39 people involved,five confirmed cases and two asymptomatic infections were found,with an attack rate of 17.95%. The cases aged from 40 to 65 years and lived in the dormitories near the farm of Dongshan. The first case(named Case 1)closely contacted with a confirmed case of COVID-19 in Chengmai from January 28 to February 10,was isolated on February 13 and developed symptoms on February 16. The other six cases(Case 2 to Case 7)shared the water source with Case 1 from January 28 to February 13(within the incubation period of Case 1). They needed to open the power switch outside Case 1's room and the water valve in Case 1's washroom before the use of water. They might be infected by contacting the doorknob and the water valve contacted by Case 1,or by the aerosol formed after Case 1 used the washroom,then infected each other when living together. The onset of Case 2 to Case 7 was earlier than Case 1,and they had no travelling history in Hubei Province 14 days before and contacted no confirmed cases except Case 1. Therefore,Case 1 was the source of the cluster during his incubation period of COVID-19. Conclusion This was a cluster of COVID-19 due to latent transmission by living in the same area and touching the same objects indirectly,which indicated that COVID-19 was infectious in the incubation period.

Objective:To analyze the clinical characteristics of patients with uremic tumoral calcinosis (UTC).Methods:A total of 10 patients with UTC were enrolled in this study, who were admitted in the Department of Nephrology, China-Japan Friendship Hospital and Beijing Chuiyangliu Hospital from March 2013 to February 2019.Results:The average age of 4 male and 6 female patients on regular hemodialysis was (39.90±8.57) years. The average dialysis duration was(5.90±2.57) years. Three patients presented as single lesion of one joint, the other 7 patients as involvement of multiple large joints. Serum calcium was elevated in 2 patients,both over 2.75 mmol/L. Serum hyperphosphatemia was seen in all patients with average level 2.22 (1.94,2.44) mmol/L. Serum intact parathyroid hormone (iPTH) was remarkably increased in 9 patients with average level 1 348.0(854.8,1 800.0) ng/L, while only 1 patient reported slight elevation (92.4 ng/L).High-sensitivity C-reactive protein increased in all 10 patients with average 35.81 (17.60,74.20) mg/L. The imaging findings before treatment suggested that a large number of irregular masses of calcification shadows deposited in the soft tissue adjacent to the joints. The outlines of calcification were clear without significant bone absorption. Nine patients with severe secondary hyperparathyroidism (SHPT) were treated with parathyroidectomy, resulting in lesions diminishing or even disappearing. A total of 32 parathyroid glands were resected, and pathological results showed that 7 parathyroids were diffuse hyperplasia, 11 as diffuse/nodular hyperplasia, the rest 14 as nodular hyperplasia. At least one hyperplastic parathyroid gland was seen in each patient. Only 1 patient received medical therapy yet no obvious improvement was observed.Conclusion:UTC is a rare complication in patients on regular hemodialysis, which is usually associated with severe SHPT. Parathyroid surgery may improve the clinical outcome.

Objective: To explore the changes of the peripheral invariant natural killer T (iNKT) cells in patients with human immunodeficiency virus (HIV) infection. Methods: A total of 101 patients with HIV infection including 52 asymptomatic patients and 49 acquired immunodeficiency syndrome (AIDS) patients were enrolled in the study from June 2016 to July 2017. Flow cytometry was used to detect iNKT cells, CD4⁺ T cells and CD8⁺ T cells, and the relationship among them and HIV RNA was studied. At same time, 12 healthy persons were enrolled as control group. T test or variance analysis, rank sum test, Chi-square test and Fisher exact test were used for statistical analysis. Results: In HIV infected asymptomatic patients, AIDS patients and healthy controls, iNKT cells were 0.135% (0.066%, 0.228%), 0.058% (0.034%, 0.100%) and 0.385% (0.205%, 0.600%), respectively, and the difference was statistical significant (Z=40.113, P<0.01). CD4⁺ T cell counts in the three groups were (340.82±119.26) cells/μL, (72.73±61.84) cells/μL and (555.17±229.43) cells/μL, respectively, and the difference was statistical significant (t=113.79, P<0.01); CD8⁺ T cell counts in the three groups were (842.29±423.68) cells/μL, (540.43±257.85) cells/μL and (875.92±516.45) cells/μL, respectively, and the difference was statistical significant (t=9.423, P<0.01). Ratios of CD4⁺ /CD8⁺ T cells in the three groups were 0.490 (0.240, 0.695), 0.120 (0.030, 0.210) and 0.600 (0.475, 0.895), respectively, and the difference was statistical significant (Z=53.603, P<0.01). iNKT cell counts in patients with or without hepatitis B virus infection, pneumocystis pneumonia, oral mold infection, treponema pallidum, latent tuberculosis or EB virus infection were not significantly different (Z=0.244, 2.325, 2.393, 0.168, 1.183 and 0.454, respectively, all P>0.05). There were correlations between iNKT cells and CD4⁺ T cells, CD4⁺ /CD8⁺ T cells (r=0.513 and 0.261, respectively, both P<0.05), and no relationship was found between iNKT cells and CD8⁺ T cells (r=0.155, P=0.126). In HIV infected asymptomatic patients and AIDS patients, iNKT cells was not associated with HIV RNA (r=-0.113 and -0.111, respectively, both P>0.05). Conclusions The level of peripheral iNKT cells in HIV infected patients decreases with the disease progression. To certain extent, iNKT cells can reflect the severity of immune damaging in HIV infected patients.

Objective To analyze the causes of early death in elderly patients undergoing maintenance hemodialysis ( MHD) and major risk factors.Methods A retrospective study was conducted.Fourty-three patients who had undergone MHD between January 2005 and December 2015 and died within 3 -12 months after hemodialysis in the Hemodialysis Center of China Aerospace Center Hospital were included in Group A while 106 patients who had undergone hemodialysis in the same period but survived for over 12 months were selected as control group(Group B).Results The main causes of early death of 43 elderly patients with MHD were cardiovascular ( 46.5%) and cerebrovascular diseases ( 25.6%) (CCVD), and infections(14.0%).The age,proportion of patients with diabetes and CVD,and the proportion of patients using the central venous catheter( CVC) as vascular access were higher in Group A,but the level of hemoglobin and serum albumin was lower.Indicators of cardiac structure and function showed that the left ventricular end-diastolic diameter (LVDd),left ventricular posterior wall thickness(LVPWT),and left ventricular myocardial quality index(LVMI)in Group A were well above those in Group B, but EF and E/A ratio were significantly lower(P<0.05 and P<0.01).COX regression analysis indicated that the comorbidity with CVD, a lower level of serum albumin and EF were the main risk factors for early mortality in elderly patients under MHD.Conclusion The main cause of early death in elderly MHD patients is CCVD.The comorbidity of CVD, malnutrition and decreased left ventricular systolic function might be the main risk factors for early mortality in elderly MHD patients.Early and adequate dialysis,active treatment of underlying diseases, and the correction of hypoalbuminemia can decrease complications,prolong life and improve the quality of life.

Objective To investigate the risk factors of hypersensitivity induced by compound sulfamethoxazole (Co-SMZ)in patients with human immunodeficiency virus (HIV)infection.Methods A retrospective study was performed in 111 patients with HIV infection receiving prophylactic Co-SMZ at the Department of Infectious Diseases,the Third People′s Hospital of Nantong City,Jiangsu Province from January 2014 to December 2014.Data including age,gender,interval time from diagnosis of HIV infection to hospitalization,history of drug allergy,and the counts of CD3 + T cell,CD4 + T cell,CD8 + T cell and natural killer (NK)cell on the day when the medicine was administrated for the first time were recorded. All the patients were followed up for two months.Student t test was used in data with normal distribution or approximate normal distribution.Rank sum test was used in data with skew distribution.The count materials were examined byχ2 test.Results Among the 111 patients with HIV infection,there were 107 males and 4 females with average age of (45 .7±11 .1)years old.The interval time from taking Co-SMZ to hypersensitivity was (14.0±7.6)d.There were differences in the counts of CD4 + T cell and NK cell between patients with hypersensitivity and without hypersensitivity (both P <0.05).Multivariate analysis showed that NK cell was a risk factor for inducing hypersensitivity (OR=1 .010,95 %CI :1 .005 -1 .017, P =0.001).The area under of receiver operating characteristic curve predicting hypersensitivity induced by Co-SMZ was 0.748 (95 %CI :0.647-0.850,Z =4.701 ,P =0.001).The best predictor was 109.80/μL with sensitivity of 63.2% and specificity of 84.7%.Conclusion In patients with HIV infection,NK cell might be associated with hypersensitivity induced by Co-SMZ.

BACKGROUND:Since the FDA was the first to approve autologous bone marrow stem cel transplantation for treatment of myocardial infarction in 2003, there has a large number of clinical and basic research reports. However, their conclusions are different and stem cel homing is a key point. OBJECTIVE:To explore the homing abilities of different subgroups of mouse bone marrow mesenchymal stem cels in myocardial regeneration. METHODS:After mouse bone marrow mesenchymal stem cels were detected using a mouse cardiac stem cel surface differentiation antigen, four cel subgroups were separated on the basis of CD45 and CD31. The homing abilities of the four subgroups were assayed in a Transwel chamberin vitro. The different cel subgroups were injected into the model mice suffering from myocardial infarction for 48 hours. The mice were sacrificed at 48 hours, 96 hours, and 7 days after injection; the hearts were taken and analyzed through whole-body imaging and fluorescence intensity detection. RESULTS AND CONCLUSION:The SCA-1+/CD45+/CD31+ subgroup exhibited the strongest homing ability. The whole-body imaging indicated that the fluorescence intensity of SCA-1+/CD45+/CD31+ subgroup was higher than that of the other subgroups at 48 hours, 96 hours and 7 days after stem cel injection. The migration rate of SCA-1+/CD45+/CD31+ subgroup was also the highest. These findings indicate that the homing ability of the SCA-1+/CD45+/CD31+ subgroup of mouse bone marrow mesenchymal stem cels exhibit a homing trend to the damaged myocardial tissue.

Objective To compare the dose distribution of reserved planned tangential beam IMRT(2-field IMRT) with multifields beams IMRT(6-field IMRT) of the bulk-recurrent chest wall in postmastectomy breast cancer patients.Methods For 8 patients with chest wall in postmastectomy breast cancer bulk-recurrence,2-field IMRT and 6-field IMRT plans were generated on PTV in Pinnacle Planning System.The prescribed dose of PTV was 50 Gy in 25 fractions and GTV was 66-70 Gy which irradiated incrementally by subsequent plan in 8-10 fractions.The conformal index (CI) and homogeneity index (HI) of 95％ of prescribed dose over PTV were compared,while the dose distribution on ipsilateral lung and heart were evaluated.Results The CI of PTV by 6-field IMRT (0.66 ± 0.08) was higher than that of the2-field IMRT (0.53±0.10)(t=7.99,P＜0.05).The HI ofPTV by6-field IMRT (1.36±0.08)waslower than that of 2-field IMRT (2.19 ±0.78) (t =9.04,P ＜0.05).There was no statistical difference in V5,V10,V20 and V35 for ipsilateral lung and in D V35 and D for heart between two plans.Conclusions Compared with 2-field IMRT,6-field IMRT might have a better dose distribution on planning target volume(PTV) for chest wall in postmastectomy breast cancer bulk-recurrence patients,butthere is no significant difference in dose-volume of ipsilateral lung and heart between two plans.

Objective To evaluate the role of inositol triphosphate receptor (IP3 R) in the fractalkine-induced activation of p38MAPK signaling pathway in BV-2 microglial cells.Methods BV-2 microglial cells were seeded in 3.5 cm diameter dishes (5 ml/dish),50 ml culture flasks (8 ml/flask) or 24-well plates (1 ml/hole) with a density of 1 × 105/ml and randomly divided into 5 groups (n =25 each) ∶ control group (group C),fractalkinegroup (group F),CX3C chemokine receptor 1 (CX3CR1) antibody anti-CX3CR1 + fractalkine group (group CF),IP3R antagonist 2-APB + fractalkine group (group AF) and p38 mitogen-activated protease (p38MAPK) inhibitor SB203580 + fractalkine group (group SF).Fractalkine 10 nmol/L was added to the culture medium in groups F,CF,AF and SF.The anti-CX3CR1 15 μmol/L,2-APB 50 μmol/L and SB203580 10 μmol/L were added to the culture medium in groups CF,AF and SF,respectively,1 h before addition of fractalkine.The cells were then cultured for 24 h.The intracellular Ca2+ concentration ([Ca2+]i) was measured during the 10 min incubation with fractalkine.The phosphorylation of p38MAPK was measured at 0,30,60,120 and 240 min of incubation with fractalkine.The concentrations of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in theculture medium were determined at 24 h of incubation with fractalkine.Results Compared with group C,[Ca2+]i,and the phosphorylation of p38MAPK and concentrations of IL-1β and TNF-α were significantly increased in groups F,CF,AF and SF (P ＜ 0.05).[Ca2+]i was significant lower in groups AF and CF and phosphorylation of p38MAPK and concentrations of IL-1β and TNF-α were significantly lower in groups CF,AF and SF than in group F (P ＜ 0.05).Conclusion IP3 R is involve in the fractalkine-induced activation of p38MAPK signaling pathway in BV-2 microglial cells.