Objective: To investigate the mortality, probability of premature death and trends due to malignant tumors, cardio-cerebrovascular diseases, diabetes and chronic respiratory diseases in Xiaoshan District, Hangzhou City from 2015 to 2021, so as to provide the basis for the formulation of chronic diseases prevention and control strategies. Methods: The deaths of the four diseases in Xiaoshan District from 2015 to 2021 were collected from Zhejiang Provincial Chronic Diseases Surveillance Information Management System. The crude mortality, standardized mortality and probability of premature death were calculated. The trends in mortality and probability of premature death were analyzed using average annual percent change (AAPC), and the attainment of probability of premature death due to the four diseases was evaluated using the targets of probability of premature death control in 2025 and 2030. Results: Totally 36 130 deaths due to the four diseases were reported in Xiaoshan District from 2015 to 2021. The crude mortality and standardized mortality were 445.20/105 and 237.81/105, which appeared a tendency towards a decline (AAPC=-1.427% and -4.051%, both P<0.05), and the probability of premature death decreased from 9.99% to 7.82%, (AAPC=-4.123%, P<0.05). The standardized mortality of malignant tumors, cardio-cerebrovascular diseases and chronic respiratory diseases appeared a tendency towards a decline (AAPC=-3.017%, -4.999%, and -6.024%, all P<0.05), while there was no significant trend in the standardized mortality of diabetes (AAPC=-0.847%, P>0.05). The probability of premature death due to malignant tumors appeared a tendency towards a decline (AAPC=-4.167%, P<0.05), while there was no significant trends seen in the probability of premature death due to diabetes, cardio-cerebrovascular diseases and chronic respiratory diseases (AAPC=0.638%, -5.250% and -2.022%, all P>0.05). The average probability of premature death due to the four diseases decreased by 4.00% each year, and decreased by 6.64% in 2025 and 5.42% in 2030 as predicted, which were both lower than the target values of 7.99% and 6.99%. Conclusions The mortality and probability of premature death due to the four diseases appeared a tendency towards a decline in Xiaoshan District from 2015 to 2021, with the probability of premature death of malignant tumors decreased significantly. It is predicted that the probability of premature death of the four diseases can reach the target in 2025 and 2030.

Objective To observe the effect of Lactobacillus casei(L.casei)on the depression-like behaviors of offspring rats induced by maternal separation(MS),and explore the potential action mechanism of probiotics to improve central nervous inflammation in depression-like behaviors.Methods MS stress was used to establish a depressed animal model in offspring.Female SD rats were randomly divided into control group(CON),MS group,and MS+L.casei group,with 8 animals in each group.The female rats and their offspring in the control group did not undergo MS intervention after delivery,while those in the MS group were separated 3 h each day,for 14 consecutive days after normal delivery.The offspring of the MS+L.casei group was given intervention of 8 ×108 CFU/(kg·d)L.casei gavage for 4 weeks.Source preference test(SPT)and forced swimming test(FST)were used to evaluate the changes in depressive behaviors of the offspring rats.ELISA was employed to determine the levels of TNF-α,IL-6,IL-1 β and IL-10 in serum and hippocampus tissue.Real-time fluorescence quantitative PCR was applied to detect the mRNA expression levels of indoleamine 2,3-dioxygenase-1(IDO1)and 5-HT mRNA in hippocampus.Results Compared with the CON group,the offspring in the MS group had significantly reduced percentage of source preference(P＜0.05),prolonged immobility time during forced swimming(P＜0.05),and decreased number of grid crossings in spontaneous activity test(though no statistical difference),indicating that the offspring rats had obvious depression-like behaviors after MS.L.casei treatment improved the behavioral changes of offspring rats caused by MS stress,with significantly increased percentage of source preference(P＜0.05)and shortened immobility time of forced swimming(P＜0.05).Compared with the conditions in the MS group,L.casei reduced the levels of IL-6,IL-1 β and TNF-α(P＜0.01)and increased that of IL-10(P＜0.05)in the hippocampus and peripheral blood,and decreased mRNA level of IDO1 and enhanced 5-HT mRNA level in hippocampus(P＜0.01)in the offspring rats of the MS+L.casei group.Conclusion MS stress induces depression-like behavior in offspring rats.L.casei inhibits the hippocampal expression of IDO1 and enhances that of 5-HT by regulating inflammatory factors in hippocampus and peripheral blood,and thus,improves depression-like behavior.

Objective To examine the process of the initial ethical review of drug clinical trials in medical institutions in Shaanxi province,analyze the current situation of initial reviews,and make suggestions to expedite the speed of initial ethical review of drug clinical trial projects.Methods Based on the drug clinical trial institutions in Shaanxi recorded in the"drug and medical device clinical trial institutions for the record management information system".This study involved retrieving information through hospital website,WeChat public accounts,and conducting telephone consultations to usnderstand the process.The analysis focused on the initial review requirements,documents submission,and approval documents.Results A total of 44 drug clinical trial institutions were assessed.63.6% of these institutions had clearly issued ethical review/application guidelines,with some lacking detailed provisions on the initial review submission list,simplified data and seal requirements.31.8% of the institutions had established ethics review management systems.The average time of obtaining ethics approval was from 5.13 to 6 d.Conclusion It is recommended to further improve ethical review guidelines,standardize the initial review process,refine the initial ethical review documents and institutional project approval documents,build an information management platform,reduce the time for initial review of drug clinical trial projects,and improve the speed of clinical trial initiation.

Objective:To improve the prognosis stratification, especially early mortality(EM), of elderly patients with newly diagnosed multiple myeloma(NDMM).Methods:In this retrospective study, univariate and multivariate Cox regression analysis were conducted to identify the independent prognostic factors associated with overall survival(OS)and the chi-square test and multivariate Logistic analysis were used to identify the prognostic factors associated with EM in 223 elderly patients(age≥65 years)with NDMM from three centers in the country.Results:Increased NT-pro-BNP(≥300 pg/ml), ECOG-PS≥2 and stage Ⅲ R-ISS were identified as three independent adverse prognostic factors of OS.The rates of EM3, EM6, EM12 and EM24 were 12.1%, 20.1%, 32.2% and 60%, respectively.The most common cause for EM6(particularly EM3)was disease-related complications resulting from ineligibility for treatment due to poor physical performance, severe organ dysfunction or treatment discontinuation due to treatment intolerance, while the most common cause for EM12(particularly EM24)was disease progression or relapse mainly as a result of inadequate treatment.R-ISS staging failed to predict EM, while decreased eGFR, ECOG-PS≥2, and increased NT-pro-BNP were able to estimate the risk of EM, with increased NT-pro-BNP as a common independent factor for EM12( P=0.03)and EM24( P=0.015). Conclusions:R-ISS staging, which primarily reflects MM biology, cannot predict EM.However, factors such as NT-pro-BNP, eGFR and ECOG-PS associated with frailty and impairment of organ functions can be used to estimate the risk of EM, among which NT-pro-BNP may be the most important independent factor for EM.Therefore, incorporation of these frailty-related biomarkers into R-ISS staging may be able to more precisely estimate the prognosis and particularly early death of elderly patients with NDMM.

Immune checkpoint inhibitors (ICIs) have demonstrated unparalleled clinical responses and revolutionized the paradigm of tumor treatment, while substantial patients remain unresponsive or develop resistance to ICIs as a single agent, which is traceable to cellular metabolic dysfunction. Although dysregulated metabolism has long been adjudged as a hallmark of tumor, it is now increasingly accepted that metabolic reprogramming is not exclusive to tumor cells but is also characteristic of immunocytes. Correspondingly, people used to pay more attention to the effect of tumor cell metabolism on immunocytes, but in practice immunocytes interact intimately with their own metabolic function in a way that has never been realized before during their activation and differentiation, which opens up a whole new frontier called immunometabolism. The metabolic intervention for tumor-infiltrating immunocytes could offer fresh opportunities to break the resistance and ameliorate existing ICI immunotherapy, whose crux might be to ascertain synergistic combinations of metabolic intervention with ICIs to reap synergic benefits and facilitate an adjusted anti-tumor immune response. Herein, we elaborate potential mechanisms underlying immunotherapy resistance from a novel dimension of metabolic reprogramming in diverse tumor-infiltrating immunocytes, and related metabolic intervention in the hope of offering a reference for targeting metabolic vulnerabilities to circumvent immunotherapeutic resistance.
Humans ; Neoplasms/pathology* ; Immunotherapy/methods* ; Immune Checkpoint Inhibitors/therapeutic use*

【Objective:】 To analyze the emotional status and follow-up status of the participants in the drug clinical trials in a hospital during the epidemic prevention and control, with a view to maximizing the protection of participants’ rights and interests under special circumstances. 【Methods:】 The general information, depression screening scale (PHQ-9), anxiety screening scale (GAD-7) and subject compliance assessment scale were completed online by participants with gold data questionnaire. At the same time, the status of drug clinical trials under study and the follow-up status of participants under study were collected from November 1, 2021 to December 8, 2021 and from December 9, 2021 to January 24, 2022. Excel software and SPSS18.0 software were used for data statistics and analysis. 【Results:】 During the epidemic prevention and control, there were 20 drug clinical trial projects under way in the hospital. From December 9, 2021 to January 24, 2022, the planned number of visits was 161, and the actual number of visits to the hospital was 84 (52.2%). Plus 24 participants who mailed drugs, the overall visit rate was 67.1%, among which the visit rates of oral drugs, non-oral drugs, and oral drugs combined with non-oral drugs were 79.3%, 71.9%, and 41.0% respectively. From November 1, 2021 to December 8, 2021, the planned number of visits was 166, the actual number of visits to the hospital was 157 (94.6%), and the number of telephone visits accounted for 1.8% of the total planned number of visits. The number of participants who did not take the drug and those who delayed taking the drug were both 0. The total compliance of participants was as high as 80.0%. A total of 40 valid questionnaires were retrieved, and the detection rates of depression and anxiety were 42.5% and 30.0% respectively. 【Conclusion:】 The epidemic prevention and control has a large short-term impact on the follow-up of the participants under study. The formulation of relevant follow-up measures and the conduction of classification management can not only improve the emotions of the participants to a certain extent, but also protect the rights and interests of participants, providing suggestions for the follow-up of participants under emergencies in the future.

Objective:To carry out a scoping review on feeding decision aids in patients with advanced dementia, clarify the characteristics, functions, and application effects of the tools, so as to provide reference for further clinical research.Methods:The research on feeding decision aids for patients with advanced dementia was systematically searched on China National Knowledge Infrastructure (CNKI) , VIP, WanFang Data, and the China Biomedical Literature Library, PubMed, Web of Science, Embase, and Cochrane Library. The search period was from database establishment to August 2022. Two researchers independently selected literature based on inclusion and exclusion criteria, extracted, summarized and analyzed data from the included literature.Results:A total of 8 decision aids were included. The main types included web-based decision aids, paper text decision support manuals, audio manual form decision aids, and a combination of various forms of decision aids. Decision aids provided dementia feeding related information to patients and surrogate decision-makers, analyzed the advantages and disadvantages of different feeding methods, helped clarify their value preferences, and assisted them in making feeding decisions. The evaluation of application effectiveness mainly included outcome indicators such as knowledge, decision conflict, decision regret, decision satisfaction, frequency of doctor-patient communication, and acceptability and effectiveness of decision aids.Conclusions:Decision aids have played a positive role in selecting feeding methods for dementia patients and surrogate decision-makers. Under the background of "Internet + nursing service", we can learn from the experience of foreign research and make full use of artificial intelligence technology to explore scientific and feasible personalized decision aids, so as to provide demand based decision support for patients and their surrogate decision-makers and improve the quality of decisions.

Objective:To explore the efficacy of bibliotherapy to improve stigma and social function for patients with schizophrenia in rehabilitation.Methods:From June, 2018 to June, 2020 at Shandong Mental Health Center, a total of 115 patients with schizophrenia in rehabilitation were randomly divided into study group (58 cases) and control group (57 cases). The study group received bibliotherapy and the control group received general rehabilitation nursing based on original antipsychotic treatment and routine nursing. They were assessed with Link Disgrace Scale (LDS) and Inpatient Psychiatric Rehabilitation Outcome Scale (IPROS) before and after intervention.Results:There was no significant difference in the scores of all factors and total scores of LDs and IPROS before intervention between the two groups ( P>0.05). After intervention, the scores of all factors and total scores of LDS in the study group were 29.08±3.25, 63.69 ± 4.09, 12.54 ± 2.15, 105.31 ± 5.22 respectively, which were lower than those in the control group 37.17 ± 3.41, 74.00 ± 4.63,20.17 ± 2.89, 131.33 ± 8.51, there were significant differences between the two groups ( t values were 5.91-9.30, all P<0.05). After intervention, the scores of all factors and total scores of IPROS in the study group were 3.92 ± 1.32, 5.38 ± 1.56, 5.15 ± 1.63, 4.69 ± 1.44, 4.46 ± 1.66, 23.62 ± 3.31 respectively, which were lower than those in the control group 5.58 ± 2.11, 7.33 ± 2.67, 6.83 ± 1.12, 6.75 ± 2.73, 6.42 ± 2.31, 32.92 ± 5.07, there were significant differences between the two groups ( t values were 2.25-5.48, all P<0.05). Conclusions:Bibliotherapy can effectively improve the stigma and social function of patients with schizophrenia in rehabilitation.

Objective:To analyze the cases referred to a higher-level hospital from the Department of Neonatology in a primary hospital, and evaluate the efficiency of clinical works related to the referrals.Methods:Data of neonates admitted to the Department of Neonatology at Maternal and Child Health Hospital of Dabu County from January 2018 to December 2020 and referred to the superior hospital were retrospectively analyzed.Results:A total of 1 670 neonates were included and 128 neonates were referred.The median age of the neonates referred was 0.5 hours(0 hours, 25 days), the median gestational age was 38 + 3(29 + 1, 42 + 4) weeks, the median weight was 3 000(1 250, 4 800) g, and the transport distance was 78 km.Twenty-four cases were assessed as critical cases before the referral, 125 cases were improved and discharged after treatment in the superior hospital, and three cases died.The referral rate in 2018, 2019 and 2020 showed a downward trend year by year (10.3%, 7.6% and 4.0%, respectively), and the difference was statistically significant( χ2=14.362, P=0.001). The proportion of critical cases in referral cases increased year by year (9.4%, 23.9% and 38.9%, respectively), and the difference was statistically significant( χ2=9.289, P=0.010). The incidence of critical case was higher in those whose mothers didn′t have regular prenatal examination during pregnancy( χ2=5.129, P=0.032). Conclusion:The ability of neonatal treatment in primary hospitals has been improved.The neonates need to be referred and critical cases are not rare in primary hospitals.More attention should be paid to the safety and effectiveness of the regional transport network.Also, enhancing the health awareness of residents and improving the primary medical technics are important to maximize the life safety and optimal transition of newborns.

Background/Aims: Achalasia is a rare disease, but the incidence is increasing recently. Peroral esophageal myotomy (POEM) is an effective treatment.Regurgitation is a common symptom before and after POEM. Our aim is to investigate the factors related to preoperative and postoperative reflux symptoms. Methods: Our study was retrospective. The achalasia patients diagnosed by high-resolution manometry and gastroscopy were divided into reflux group and non-reflux group before and after POEM, respectively. General information, symptoms, POEM information, and manometric results were compared. Results: (1) Ninety-six of 130 patients had reflux symptoms before POEM. The lower esophageal sphincter pressure (LESP) in the reflux group was significantly higher than the non-reflux group (P = 0.023), while integrated relaxation pressure (IRP) was similar. The reflux group had longer esophagus than the non-reflux group (P = 0.006). Reflux symptoms were not related to subtypes of achalasia.(2) Twenty-five of 84 patients had reflux symptoms after POEM. Postoperative Eckardt scores, LESP, and 4-second IRP (4sIRP) were significantly lower than the preoperative values (P < 0.001). The preoperative values and POEM information were similar between the postoperative 2 groups and there was no significant difference in the presence of preoperative reflux symptoms between 2 groups.The postoperative LESP and 4sIRP were similar between the 2 groups, however, the postoperative UESP was significantly higher in the reflux group than the non-reflux group (P = 0.042). The non-reflux group had more declines in Eckardt scores and LESP than the reflux group. Conclusions The reflux symptoms of achalasia patients without treatment were mainly due to food retention. The postoperative reflux symptoms were not the sign of the excessive relaxation of lower esophageal sphincter.