ObjectiveTo investigate the awareness and clinical practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. MethodsFrom July 19 to December 31， 2024， a self-designed electronic questionnaire was distributed via the WeChat mini program to collect related data from 1 588 clinicians nationwide， including their awareness and practice based on 18 questions regarding testing and referral， diagnosis and treatment， and follow-up. ResultsAmong all respondents， only 350 clinicians correctly understood all the updated key points of antiviral indications and treatment for special populations in the 2022 edition of guidelines for the prevention and treatment of chronic hepatitis B， with an overall awareness rate of 22.0%. Only 20% ‍—‍ ‍40% of the patients with positive HBV DNA and an age of >30 years receive antiviral therapy， while 80% ‍—‍ ‍100% of the patients with positive HBV DNA and a family history of hepatitis B cirrhosis or hepatocellular carcinoma receive antiviral therapy. The median follow-up rates at 1 year， 3 years， and 5 years were 67.5% 57.5% and 47.5%，respectively， showing a trend of gradual reduction， which might be associated with the influencing factors such as insufficient time for follow-up management by clinicians， insufficient awareness of the disease among patients， and poor adherence to follow-up. ConclusionThere is a gap between the awareness and practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. It is recommended to further strengthen training and focus on the whole process of “detection， diagnosis， treatment， and management” for patients with chronic hepatitis B in healthcare institutions， in order to promote the implementation of the guidelines.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective To investigate the expression of hypoxia-inducible factor-1α(HIF-1α),matrix metalloprotein-ase(MMP)-1 and MMP-2 in the serum of patients with diabetic retinopathy(DR),and to analyze their relationship with the stage of DR and angiogenesis.Methods A total of 280 patients with type 2 diabetes mellitus(T2DM)and no DR who were hospitalized in our hospital from December 2020 to December 2021 were selected as the T2DM group;276 DR patients who were hospitalized in the ophthalmology department of our hospital during the same period were selected as the DR group;another 282 healthy subjects who underwent physical examination in our hospital were selected as the normal group.There were no significant differences in gender and age distribution among the normal group,T2DM group and DR group(both P＞0.05).According to the results of fundus examination and fluorescein angiography,the patients in the DR group were divided into non-proliferative diabetic retinopathy(NPDR)group(129 patients)and proliferative diabetic reti-nopathy(PDR)group(147 patients).The fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c)and serum HIF-1 α,MMP-1,MMP-2 levels of subjects in the normal group,T2DM group and DR group,as well as NPDR group and PDR group were compared.The serum basic fibroblast growth factor(bFGF),angiopoietin-1(Ang-1)and vascular endo-thelial growth factor(VEGF)levels of subjects in the normal group,T2DM group and DR group,as well as NPDR group and PDR group were compared.Pearson correlation analysis was used to analyze the correlation between serum HIF-1α,MMP-1,MMP-2 and bFGF,Ang-1,VEGF levels in DR patients.Results The FPG,HbA1c and serum HIF-1α,MMP-1,MMP-2 levels of the T2DM group and DR group were higher than those of the normal group,and the differences were statis-tically significant(all P＜0.05).The serum HIF-1α,MMP-1 and MMP-2 levels of the DR group were significantly higher than those of the T2DM group(all P＜0.05);there were no significant differences in FPG and HbA1 c between the two groups(both P＞0.05).The serum HIF-1α,MMP-1 and MMP-2 levels of the PDR group were significantly higher than those of the NPDR group(all P＜0.05);there were no significant differences in FPG and HbA1c between the two groups(both P＞0.05).The serum bFGF,Ang-1 and VEGF levels of the T2DM group and DR group were higher than those of the normal group,and the differences were statistically significant(all P＜0.05).The serum bFGF,Ang-1 and VEGF levels of the DR group were significantly higher than those of the T2DM group(all P＜0.05).The serum bFGF,Ang-1 and VEGF levels of the PDR group were significantly higher than those of the NPDR group(all P＜0.05).Pearson correlation analysis showed that HIF-1α,MMP-1 and MMP-2 were positively correlated with bFGF,Ang-1 and VEGF levels in DR patients(all P＜0.05).Conclusion The serum HIF-1α,MMP-1 and MMP-2 levels of DR patients are abnormally elevated,and are closely related to the progression of DR and angiogenesis.These parameters can be used to predict the disease development trend and guide clinical intervention.

ObjectiveTo explore the effect of Naoxin'an capsule against mitochondrial dysfunction and oxidative damage in brains of rats with vascular cognitive impairment （VCI） induced by chronic cerebral ischemia. MethodA total of 150 rats were randomized into modeling group （130 rats） and sham-operated group （20 rats） with the random number table method. The two-vessel occlusion （2-VO） was employed to induce VCI in rats， and finally 87 rats developed VCI. The VCI rats were classified into model group， positive drug group （Aricept， 0.5 mg·kg^-1）， and low-， medium- and high-dose Naoxin'an capsule groups （0.18， 0.36， 0.72 g·kg^-1， separately）， with 17-18 rats in each group. The administration lasted 8 weeks. The learning and working memory of VCI rats were assayed by novel object recognition test and Y-maze test. The 8-oxoguanine （8-OxoG） level was measured based on immunofluorescence staining. Spectrophotometry was performed to determine the activity of mitochondrial respiratory chain complexes Ⅰ， Ⅱ， Ⅲ， and Ⅳ， mitochondrial swelling， mitochondrial membrane potential （MMP）， and activity of pyruvate dehydrogenase （PDH） and α-ketoglutarate dehydrogenase （KGDH）. The submicroscopic structure of mitochondria was observed with electron microscope. The phosphorylation of cAMP response element-binding protein （CREB） and the expression of peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）， nuclear respiratory factor 1 （NRF-1）， and mitochondrial transcription factor A （mt-TFA） were determined by Western blot. The mitochondrial status Ⅳ H₂O₂ generation， activity of cerebral superoxide dismutase （SOD） and glutathione peroxidase （GSH-Px）， and malondialdehyde （MDA） content were measured with the photochemical method. ResultCompared with the sham-operated group， model group showed decrease in new object discrimination index （P<0.01） and spontaneous alternation rate in the Y-maze test （P<0.01）， increase in ROS production in the brain （P<0.01）， reduction in MMP and mitochondrial swelling A value （P<0.01）， obvious mitochondrial swelling， vacuoles and cristae fractures in mitochondria， decrease in the level of phosphorylated CREB， expression of PGC-1α， NRF-1 and mt-TFA （P<0.01）， and activity of the respiratory chain complexes Ⅰ， Ⅱ， Ⅲ， and Ⅳ （P<0.01）， PDH and KGDH in the brain （P<0.01）， rise of the production of H₂O₂ at state IV （P<0.01） and the content of MDA （P<0.01）， and reduction in the activity of SOD and GSH-Px （P<0.01）. Compared with the model group， each dose of Naoxin'an capsules can improve the new object discrimination index （P<0.05， P<0.01） and the rate of spontaneous alternation （P<0.05， P<0.01）， decrease ROS production in the brain （P<0.01）， improve the MMP and swelling A value （P<0.05， P<0.01）， alleviate mitochondrial swelling and mitochondrial submicroscopic damage， elevate the phosphorylated CREB level， the expression of PGC-1α， NRF-1 and mt-TFA （P<0.05， P<0.01）， and the activity of mitochondrial respiratory chain complexes Ⅲ， and Ⅳ， PDH and KGDH （P<0.01）， decrease state Ⅳ H₂O₂ generation （P<0.01） and MDA content （P<0.05， P<0.01）， and raise the activity of SOD and GSH-Px （P<0.01）. ConclusionBy activating the CREB/PGC-1α pathway， Naoxin'an capsule can protect the structure and function of mitochondria， enhance the antioxidant capacity， and inhibit the mitochondrial dysfunction and oxidative damage induced by chronic cerebral ischemia， thus improving the VCI.

Objective:To explore the differences of clinical laboratory indicators between Kawasaki disease (KD) and systemic juvenile idiopathic arthritis (SJIA), providing objective evidence for diagnosis and differential diagnosis of these diseases.Methods:A total of 41 children patients with KD (KD group) and 33 children patients with SJIA (SJIA group) who received treatment in Huainan Maternal and Child Health Hospital between September 2017 and January 2022 were retrospectively analyzed. An additional 50 healthy children who concurrently received physical examination in the same hospital were included in the control group. Platelet count (PLT), white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP), serum procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), and serum ferritin (SF) levels were compared among groups before treatment.Results:One-way analysis of variance and pairwise q test were performed to compare laboratory indicators among KD, SJIA and control groups. CRP, ESR, SF and IL-6 levels in the KD group were significantly lower than those in the SJIA group [CRP: (57.80 ± 25.23) mg/L vs. (77.72 ± 45.64) mg/L; ESR: (67.02 ± 28.80) mm/h vs. (83.84 ± 47.64) mm/h; SF: (320.21 ± 182.53) μg/L vs. (945.58 ± 604.65) μg/L; IL-6: (50.35 ± 20.54) ng/L vs. (89.35 ± 45.54) ng/L, q = 4.34, 3.42, 11.51, 8.85, all P < 0.05]. IL-10 level in the KD group was significantly higher than that in the SJIA group [(18.52 ± 16.71) ng/L vs. (10.01 ± 3.24) ng/L, q = -5.25, P < 0.05]. WBC, CRP, ESR, PCT, PLT, IL-6, IL-10 and SF in the KD and SJIA groups were significantly higher than those in the control group (all P < 0.05). Conclusion:Detection of CRP, ESR, SF, IL-6, IL-10 in blood can provide objective evidence for the early diagnosis and differential diagnosis of KD and SJIA, thereby reducing the misjudgment of clinical diagnosis.

Objective:To report the clinical and genetic characteristics of autosomal dominant cutis laxa type 3 caused by ALDH18A1 mutation, and therefore to further understand this rare disease.Methods:High-precision full-exon sequencing was performed for the patient from the Department of Endocrinology and Genetic Metabolism, Children′s Hospital of Chongqing Medical University and genotype-phenotype correlation was summarized. Relevant literature was also reviewed.Results:A 9-month-old boy was admitted with complaint of " development retardation for 9 months, cough for 3 days" , accompanied by skin laxity, special features, skeletal malformation, tracheal bronchus, inguinal hernia, gastroesophageal reflux, and abnormal creases on palms. The heterozygous variation of ALDH18A1 c. 274C>G(p.Leu92Val) on chromosome 10 was revealed using high-precision full-exon sequencing. Together with imaging and metabolomics results, the diagnosis of cutis laxa type 3 was determined. The clinical presentations of this disease are variable, encompassing skin, bone, joint, and neuromuscular system.Conclusion:For suspected pediatric case, it is very important to evaluate the clinical manifestations and metabolic index at regular intervals, and to identify the molecular basis of the disease with gene sequencing early on.

Objective To investigate the expressions of thymidylate synthase (TS) and methylene tetrahydrofolate reductase (MTHFR) polymorphisms and the therapeutic efficacy of chemotherapy with pemetrexed and platinum in advanced lung adenocarcinoma patients. Methods Fifty-eight patients with advanced lung adenocarcinoma were enrolled in this study. The blood samples from 25 of them were examined for extraction of DNA. The associations of the gene polymorphisms with the chemotherapy efficacy and PFS were analyzed. Results Disease control rate was noted by 38％ and the median time of progression-free survival was 8.1 months among 58 patients.There were 16％, 32％, 52％, and TS genotypes as 2R/2R, 2R/3R and 3R/3R respectively; the difference in the control rate between those with TS gene of 3R/3R and those with TS gene of R/2R+2R/3 R was significant statistically (53.8％ vs. 91.7％, P = 0.046) , but the difference in PFS was statistically insignificant (9.3 vs. 10.4 months, P> 0.05). There were 40％, 52％, 8％, and MTHFR genotypes as CC, CT and TT respectively. The DCR in those with MTHFR CC and C/T + T/T was 70％ and 73.3％, respectively and PFS was 10 months and 9.7 months respectively, showing no significant difference (P> 0.05). Conclusion The TS gene polymorphism is associated with therapeutic effect of pemetrexed for advanced lung adenocarcinoma, but MTHFR is not.

Objective: To study the effect of different proportions of piper chinaroot and rheum palmatum on the dissolution rate of five effective components (aloe emodin, emodin acid, emodin, emodin, emodin methyl ether). Methods: The high performance liquid chromatography (HPLC) method was used to analyz the contents of five effective components of rheum palmatum in the extracts of different combination of piper chinaroot and rheum palmatum. The tests were carried out by Thermo C18 (250 mm×4.6 mm, 5 μm) by gradient elution with methanol and 0.1% phosphoric acid water solution as mobile phase at a flow rate of 1ml/min, the column temperature was 30 ℃ and the detection wavelength was 254 nm. Results: The linear ranges of aloe emodin, emodin acid, emodin, emodin, emodin methyl ether were 0.018 5-0.741 8, 0.017 9-0.717 8, 0.015 9-0.635 5, 0.054 2-2.167 2, 0.016 2-0.646 4 μg, respectively. The average recoveries of aloe emodin, emodin acid, emodin, emodin, emodin methyl ether were 94.35%, 95.50%, 100.61%, 96.27%, 97.39%, and the RSDs were 1.81%, 1.99%, 2.84%, 2.71%, and 1.86%, respectively. Compared with rheum palmatumby single extract, the content of aloe emodin and emodin were increased by 5 proportions (3:1, 2:1, 1:1, 1:2, 1:3), while the content of emodin and emodin methyl ether were decreased. Conclusions The optimal compatibility proportion of piper chinaroot and rheum palmatum is 1:1.

Objective To determine the effects of delayed umbilical cord clamping on the postpartum hemorrhage,instant and long-term newborn anemia,newborn jaundice.Methods In total,303 infants were selected during October 2016 to June 2017 in three hospitals in Beijing.They were randomly allocated into two groups receiving instant clamping of umbilical cord (less than 60s after delivery,n=158) and delayed clamping of umbilical cord(after cord pulsation ceased,n=145).Relevant indicators of maternal and neonatal outcomes are compared.Results There were significant differences between two groups in instant hemoglobin concentration and in 5～7 days (P＜0.05).There were no differences between two groups in transcutaneous bilirubin,the risk of anemia in three months,the risk of jaundice in 5～7 days and the need of blue-light therapy (P＞0.05).There were no differences between two groups of women in postpartum hemorrhage,the length of third stage of labor and the rate of breast feeding (P＞0.05).Conclusion Clamping the umbilical cord when cord pulsation has ceased does not have negative effects on delivery process and postpartum hemorrhage,but it increases the instant hemoglobin concentration and hemoglobin concentration after delivery in 5～7 days.Still it is unclear whether it will affect the risk of jaundice.

Objective To study the impact of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) for patients with cardiac arrest (CA). Methods A prospective study was conducted. A total of 122 CA patients admitted to Department of Emergency of Shandong Provincial Mining Industry Group Company Central Hospital from July 2013 to December 2017 were enrolled. They were divided into standard cardiopulmonary resuscitation (S-CPR) group (n = 62) and IAPP-CPR group (n = 60) according to order of admission. The patients in S-CPR group received external cardiac compression, open airway, endotracheal intubation, mechanical ventilation, routine drug rescue, and defibrillation when ventricular fibrillation was found. And the patients in IAPP-CPR group received the IAPP-CPR on the basis of the routine chest compression. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100 times/min, and the time ratio of lifting to compressing was 1:1. The data of demographics and clinical signs of patients were collected. The markers of respiratory and circulatory performance of all patients after CPR were determined. The rates of restoration of spontaneous circulation (ROSC), successful resuscitation, and the prognosis were recorded. With the success of CRP as the dependent variable, the factors with statistical significance showed by univariate analysis were used as the independent variable to carry out two classification Logistic regression analysis for screening the influence factors of CPR success. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of various factors on the success of CPR. Results 122 patients were enrolled in the analysis. Compared with the S-CPR group, heart rate (HR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO2), and end-tidal carbon dioxide partial pressure (PETCO2) were significantly increased at 30 minutes after CPR in IAPP-CPR group [HR (bpm): 66.3±11.5 vs. 53.1±12.6, MAP (mmHg, 1 mmHg = 0.133 kPa): 65.4±6.5 vs. 53.2±5.4, PaO2(mmHg): 77.7±11.8 vs. 61.8±14.3, PETCO2(mmHg):45.5±9.6 vs. 31.8±8.2, all P < 0.05], and arterial partial pressure of carbon dioxide (PaCO2) and lactic acid (Lac) were significantly lowered [PaCO2(mmHg): 46.7±6.2 vs. 57.9±9.5, Lac (mmol/L): 2.1±1.5 vs. 4.4±2.2, both P < 0.05]. The time of CA to ROSC in IAPP-CPR group was significantly shorter than that in S-CPR group (minutes: 6.3±1.8 vs. 11.2±1.4, P < 0.05), the ROSC rate and CPR success rate were significantly higher than those in S-CPR group [ROSC rate: 61.7% (37/60) vs. 43.5% (27/62), CPR success rate: 40.0% (24/60) vs. 21.0% (13/62), both P < 0.05], and 24-hour survival rate and survival and discharge rate of patients were significantly higher than those in the S-CPR group [24-hour survival rate: 46.7% (28/60) vs. 29.0% (18/62), survival and discharge rate: 20.0% (12/60) vs. 11.3% (7/62), both P < 0.05]. Logistic regression analysis showed that PaO2, PaCO2 and PETCO2 were the factors that affect the success of CPR [PaO2: β= -3.76, odds ratio (OR) = 0.23, 95% confidence interval (95%CI) = 0.12-0.86, P = 0.031; PaCO2:β=1.41,OR=4.09,95%CI=1.70-9.82,P=0.002,PETCO2:β=0.78,OR=2.18,95%CI=1.42-3.35,P=0.000]. ROC curve analysis showed that the above three factors had good predictive value for the success of CPR. The predictive value of PaCO2 and PETCO2 were better, the area under ROC curve (AUC) was 0.93 and 0.92, respectively, when the cut-off values was 46.7 mmHg and 48.8 mmHg, the sensitivity was 92.0%, 88.0%, respectively, and the specificity was both 94.3%. Conclusions PaO2, PaCO2 and PETCO2 are the factors that influence the success of CPR. PaCO2 and PETCO2 have great value in predicting the success of CPR. Compared with the S-CPR group, IAPP-CPR group results in better hemodynamic and pulmonary ventilation effects, and remarkably improve ROSC and successful resuscitation. IAPP-CPR has obvious clinical value for CA patients.