Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objective To investigate the clinical characteristics of 16 patients with connective tissue diseases associated interstitial lung disease(CTD-ILD)complicated with lung cancer,and to improve the cognition of the disease.Methods Clinical data of 16 patients diagnosed as CTD-ILD associated with lung cancer,who were admitted to our center,were retrospectively analyzed,including general conditions,clinical characteristics,auxiliary examinations,pathological classification of lung cancer,TNM type,treatment and clinical outcome.Results Among the 16 CTD-ILD patients with lung cancer,there were 12 males and 4 females.The mean age at diagnosis of CTD-ILD was(64.7±9.2)years,and the mean age at diagnosis of lung cancer was(66.6±8.7)years.Lung occupying space on imaging(62.5%)was the most common initial symptom in lung cancer patients,followed by cough and phlegm(12.5%)and chest pain(12.5%).Of patients with lung cancer,adenocarcinoma(8 cases,50.0%)was the most common pathological type,followed by small cell lung cancer(4 cases,25.0%).The diagnosis time of CTD-ILD was earlier than that of lung cancer in 8 cases(50.0%),with a median time of 36.0(11.3,57.0)months,followed by 7 cases(43.8%)of CTD-ILD diagnosed with lung cancer at the same time.The diagnosis time of lung cancer was earlier than that of CTD-ILD in 1 case(6.3%).The most common TNM stage for lung cancer was stage Ⅳ(9 cases,56.25%).Sixteen patients were followed up from 1 to 64 months,with a median of 8.5(1.5,14.3)months.Eleven patients(68.8%)died,including 8 patients(72.7%)died of infection and 3 patients(27.3%)died of end-stage lung cancer.Conclusion For CTD-ILD patients,close follow-up and regular imaging monitoring are necessary to help early detection of lung cancer and improve prognosis.

Objective:To investigate the clinical characteristics and treatment strategies of patients with connective tissue disease (CTD) related lymphatic duct obstruction.Methods:The clinical data, laboratory tests results, imaging data, and treatment of CTD patients associated with lymphatic vessel obstruction were retrospectively collected from January 2008 to December 2020 at Beijing Shijitan Hospital. Lymphatic duct obstruction was confirmed by thoracic duct ultrasound or thoracic duct MRI or lymphoscintigraphy or direct lymphangiography. SLE and RA patients were matched with gender and age in a 1∶2 ratio, and SLE and RA patients without lymphatic reflux disorder admitted at the same time were randomly selected as the control group. When comparing the data between the two groups, t-test or rank sum test was used to test continuous variables, and chi-square test or Fisher′s exact probability method was used to test categorical variables. Results:Forty-four patients with CTD complicated with thoracic duct obstruction were included, with a male-to-female ratio of 7∶37, including 14 cases of rheumatoid arthritis (RA), 21 cases of systemic lupus erythematosus (SLE), 8 cases of primary Sjogren's syndrome (pSS), and 1 case of systemic sclerosis (SSc). The onset age of CTD ranged from 14 to 68 years, the mean age was (37±15) years and the median duration of CTD was 66 (range 1~480) months. The median age at the onset of lymphatic duct obstruction such as limb edema or thoracoabdominal effusion was (42±17) years, and the median duration of lymphatic duct obstruction symptoms was 12 (range 3~480) months. 59%(26/44) of patients were diagnosed with CTD followed by the diagnosis of thoracic duct obstruction, and 41%(18/44) of patients had lymphatic duct obstruction symptoms as the initial presentation of CTD. Thoracic duct-related imaging was performed in 44 patients and showed thoracic duct obstruction (64%, 28/44), thoracic duct malformation or variation (36%, 16/44), limb lymphatic reflux disorder (34%, 15/44), and small bowel lymphatic duct dilatation or intestinal protein loss (18%, 8/44), respectively. Compared with the control group, among these patients, patients with RA complicated with lymphatic involvement had a younger onset age [(34±14)years old vs. (44±13)years old, t=-2.15, P=0.037)] and longer RA course [(17±11)months vs. (7±7)months, t=3.38, P=0.002] and presented with limb swelling (12/14). While compared with the control group, SLE patients complicated with lymphatic duct obstruction presented with celiac multi-plasmatic effusion (20/21), more patients presented with multiple serous cavity effusion [95%(20/21) vs. 62%(25/42), χ2=7.63, P=0.006], but the prevalence of lupus nephritis [(60%(12/21) vs. 86%(36/42), χ2=4.87, P=0.027] and lupus encephalopathy [0%(0/21) vs. 16.7%(17/42), χ2=6.11, P=0.013] was lower. 27% (12/44) of patients improved with aggressive glucocorticoids combined with immunosuppressive therapy, 54%(24/44) of patients were performed with lymphatic duct reconstruction surgery on top of medical treatment, 5 patients were lost of follow-up, and 2 patients deceased. Conclusion:CTD patients may develop lymphatic duct obstruction during the disease course, while lymphatic duct obstruction can also be the initial presentation of CTD. Rheumatologists and surgeons should be alert to this rare situation. Young women with refractory polyserositis or lymphedema should be examined for the possibility of combined CTD. Lymphatic duct obstruction may be associated with long-term chronic inflammation in CTD. Glucocorticoids combined with immunosuppressive agents and surgery can be used to treat lymphatic duct obstruction in patients with CTD.

Objective To investigate the efficacy of emotional nursing of traditional Chinese medicine (TCM) combined with Ba Duan Jin exercise on chronic pulmonary heart disease. Methods A total of 86 patients with stable chronic pulmonary heart disease were selected and randomly divided into observation group and control group, with 43 patients in each group. The control group received routine nursing care, while the observation group received TCM emotional nursing combined with Ba Duan Jin exercise. After two months, the anxiety and depression emotions, cardiopulmonary function, and quality of life were assessed and compared between the two groups. Results After the intervention, the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) scores, and left ventricular posterior wall diameter (LVPWD) of both groups were lower than before the intervention, with the observation group showed significantly lower scores compared to the control group (P < 0.05). Meanwhile, the left ventricular ejection fraction (LVEF), lung function indicators [forced expiratory volume in one second to forced vital capacity ratio (FEV₁/FVC), FEV₁ as a percentage of the predicted value (FEV₁%)], and various dimensions and total scores of the General Quality of Life Inventory-74 (GQOLI-74) for quality of life of two groups after the intervention were higher than before the intervention, and the observation group showed higher scores than the control group (P < 0.05). Conclusion TCM emotional nursing combined with Ba Duan Jin exercise can effectively alleviate negative emotions, improve cardio pulmonary function, and enhance the quality of life of patients with chronic pulmonary heart disease.

The bacterial ATP-competitive GyrB/ParE subunits of type II topoisomerase are important anti-bacterial targets to treat super drug-resistant bacterial infections. Herein we discovered novel pyrrolamide-type GyrB/ParE inhibitors based on the structural modifications of the candidate AZD5099 that was withdrawn from the clinical trials due to safety liabilities such as mitochondrial toxicity. The hydroxyisopropyl pyridazine compound 28 had a significant inhibitory effect on Gyrase (GyrB, IC₅₀ = 49 nmol/L) and a modest inhibitory effect on Topo IV (ParE, IC₅₀ = 1.513 μmol/L) of Staphylococcus aureus. It also had significant antibacterial activities on susceptible and resistant Gram-positive bacteria with a minimum inhibitory concentration (MIC) of less than 0.03 μg/mL, which showed a time-dependent bactericidal effect and low frequencies of spontaneous resistance against S. aureus. Compound 28 had better protective effects than the positive control drugs such as DS-2969 ( 5) and AZD5099 ( 6) in mouse models of sepsis induced by methicillin-resistant Staphylococcus aureus (MRSA) infection. It also showed better bactericidal activities than clinically used vancomycin in the mouse thigh MRSA infection models. Moreover, compound 28 has much lower mitochondrial toxicity than AZD5099 ( 6) as well as excellent therapeutic indexes and pharmacokinetic properties. At present, compound 28 has been evaluated as a pre-clinical drug candidate for the treatment of drug-resistant Gram-positive bacterial infection. On the other hand, compound 28 also has good inhibitory activities against stubborn Gram-negative bacteria such as Escherichia coli (MIC = 1 μg/mL), which is comparable with the most potent pyrrolamide-type GyrB/ParE inhibitors reported recently. In addition, the structure-activity relationships of the compounds were also studied.

Objective:To improve the understanding of patients with connective tissue diseases(CTD) associated with lung cancer.Methods:The clinical manifestations of in-patients diagnosed as CTD associated with lung cancer in our center from January 2011 to May 2022 were retrospectively analyzed,including demographic information,pathological classification of lung cancer,TNM stage,the time sequence of the diagnosis of CTD and lung cancer, treatment and clinical outcomes. The mean±standard deviation was used for the numeric variables and the number of cases (%) was used in the counting data. Fifty patients were cofirmed to have squamous cell carcinoma, adenocarcinoma and small-cell carcinoma group. Chi-square test was used to compare the differences between groups.Results:Fifty-six patients with CTD were complicated with lung cancer, of whom 27 were male, and 29 were female. The age of CTD at diagnosis was (58±15) years. The age of lung cancer at diagnosis was (69±10) years. Of patients with CTD, rheumatoid arthritis was the most common type of rheumatic disease, followed by polymyositis/dermatomyositis, systemic sclerosis and systemic lupus erythematosus. Of patients with CTD, 24 cases (42.9%) had interstitial pulmonary disease. Of patients with lung cancer, mass ( n=26, 46.4%) was the most common initial presentation, followed by cough and expectoration ( n=19, 33.8%). Non small cell lung cancer, the most common pathological type, was found in 47 cases (83.9%), followed by small cell lung cancer in 6 cases(10.7%). Stage Ⅳ was the most common stage in 36 cases(65.5%) by TNM staging. The diagnosis of CTD was earlier than that of lung cancer in 42 cases (42/56), with an median of 90 (45, 244) months, ranged between 7 months and 50 years. The diagnosis of lung cancer was earlier than that of CTD in 2 cases (2/56), with the interval of 7 and 15 months respecticely. Twelve cases (12/56) were diagnosed with CTD at the same time, and the interval between CTD and lung cancer was within 6 months. Fifty-five patients were followed up with an median of 10 (2, 24) months. In 15 patients (26.8%) with stable conditions, stageⅠ( n=10, 66.7%) cancer was the most common stage, followed by stage Ⅱ( n=2, 13.3%). Thirty-seven patients (66.1%) died of end stage lung cancer ( n=21, 56.8%) or infection ( n=16, 43.2%). The most lethal was stage Ⅳ ( n=32, 86.5%) lung cancer. There were significant differences in sex [male 9 cases (90.0%), 13 cases (38.2%) vs 4 cases (66.7%), χ2=8.88, P=0.012], smoking [8 cases (80.0%), 11 cases (32.4%) vs 4 cases (66.7%), χ2=8.24, P=0.016] and TNM stage [stage I for 0 case (0), 12 cases(35.3%) vs 0 case (0), stage Ⅱ-Ⅲ for 4 cases (40.0%), 3 cases (8.8%) vs 0 cases (0), stage Ⅳ for 6 cases (60.0%), 19 cases (55.9%) vs 6 cases (100%), χ2=13.58, P=0.009] among squamous cell carcinoma, adenocarcinoma and small-cell carcinoma groups. Conclusion:The prognosis of patients with CTD complicated with lung cancer is poor and the mortality rate is high. Therefore, close follow-up and regularly imaging are necessary for CTD patients.

Objective:To improve the understanding of the relationship between lymphedema and retroperitoneal fibrosis (RPF).Methods:Four cases with lymphedema and RPF in Beijing Shijitan Hospital Capital Medical University were reported. The diagnosis and treatment were analyzed and discussed.Results:All four patients had lymphedema onset and imaging showed suspicious RPF. One case of non-Hodgkin's lymphoma was confirmed by lymph node biopsy. The malignant lesions were excluded in the other two cases by pathology or positron emission tomography (PET)/computerized tomography (CT). They were proved to be idiopathic retroperitoneal fibrosis after treatment with glucocorticoid combined immunosuppressive agents. Another case was systemic amyloidosis mimicking retroperitoneal fibrosis.Conclusion:Lymphatic involvement in RPF is relatively rare, and the possibility of RPF should be considered when patients develop lymphedema. Even if the initial diagnosis is RPF, we should be wary of tumors or other diseases. Imaging examination should be performed, and tissue biopsy should be used if necessary, so as to facilitate early diagnosis and treatment and improve the prognosis of patients.

Objective:To understand the positive rate of 2019 novel coronavirus (2019-nCoV) specific IgG antibody induced by Coronavirus Disease 2019 (COVID-19) inactivated vaccine in healthy population in Xizang Autonomous Region, and evaluate the immune effect of the vaccine.Methods:Serum samples were collected from COIVD-19 vaccine immunized health population without history of 2019-nCoV infection from six prefecture-level cities in Xizang Autonomous Region. The IgG antibody against 2019-nCoV were tested by chemiluminescence method. Then, the positive rate of IgG antibody was analyzed for different immunization histories and age groups.Results:A total of 22 255 participants were enrolled in this survey. After full-access (two doses of vaccine) and booster immunization, the overall positive rate of specific IgG antibody against 2019-nCoV was 96.38%. The positive rate of IgG antibody in the booster immunized population was 97.12%, which was much higher than the 88.38% in the full-access immunization population, the difference is statistically significant ( χ2=381.11, P<0.001). There was a significant differences in the positive rates of specific IgG antibodies in different age groups ( χ2=138.28, P<0.001). Especially in the younger age groups, including less than 10 years old and the 11-20 years age group, the positive rate of specific IgG antibody were 93.44% and 89.03% respectively, which were lower than those in other age groups. Except for Naqu city and the age group ≤ 10 years old, the differences in antibody positivity rates were statistically significant between different age groups in the same region and between the different regions in the same age group for the two populations with different immunization histories ( P<0.05). Conclusions:The COVID-19 inactivated vaccine showed a good immune effect in the healthy population in Xizang Autonomous Region, and the booster immunization helps to increase the positive rate of specific IgG antibody in healthy population.

The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.

Objective:To explore how to carry out endoscopic skill training in undergraduate medical education and evaluate the teaching effect of modular skill training using endoscopic simulator.Methods:After completing the basic teaching content of the surgical practice course, we added the learning course of the basic theory and basic operation of endoscopy to the students of Clinical Medicine Department from Nantong University. In the experimental group, 292 students were trained by the modular training using the endoscopic simulator. The control group consisted of 114 students, who were treated with ordinary video teaching and instrument operation exercises. After the same class hours of training, the two groups of students were evaluated with intermittent suture and knotting under endoscope as the skill assessment criteria. The chi-square test was performed using SPSS 19.0.Results:The excellent rate and qualified rate of the medical students after the modular training of the endoscopic simulator were 7.5% and 42.8% respectively, which were significantly higher than 0% and 11.4% of the control group, while the unqualified rate of the experimental group was 49.7%, which was also lower than 88.6% of the control group, with significant differences ( P<0.01). Conclusion:Modular training using endoscopic simulator helps the medical undergraduates to quickly increase the ability of endoscopic operation. And in the stage of undergraduate, medical education implementation of the training can shorten the learning curve of endoscopic skills for medical students after they enter clinical practice.