Objective To establish a simultaneous detection approach for 34 emerging contaminants(ECs)in tap water by liquid chromatography-tandem mass spectrometry(HPLC-MS/MS).Human health risk assessment was performed according to the detection results from 43 tap water samples.Methods Tap water samples were concentrated and extracted by solid phase extraction,and then blown to near dry by nitrogen at 40℃.The sample extracts were dissolved in methanol-water solution(95:5,VN)to 0.5 mL for analyzing.Agilent Jet Stream Electrospray Ionization(AJS ESI)and the multiple reaction monitoring(MRM)mode were performed for MS to acquire the data of 34 ECs.A database including precursor ion,product ion and retention times was established accordingly.Results The average linear correlation coefficients(r)of 34 kinds of ECs was 0.995 9.The limits of detection were 0.01～0.60 ng/L and the recoveries were between 60.7％and 119.8％.The intra-group precisions were between 0.05％～9.89％and the intra-day precisions were between 0.20％～14.40％for the spiked samples.The method was applied to analyze 43 tap water samples and a total of 15 ECs were detected.According to the results,the detection rate of caffeine was the highest(84％),and the concentration range was ND～74.42 ng/L.Among all the ECs detected,1,2,3-benzotriazole had the highest concentration(ND～361.15 ng/L),where detection rate was 44％.Humans may be exposed to these ECs by drinking the tap water.The human health risk assessments of 12 kinds of ECs were carried out,however,the estimated risk was negligible(risk quotient＜0.01).Conclusion The method is simple,highly sensitive and selective,and could meet the detection needs of ECs at trace level in tap water.There was no human health risk posed for ECs identified in 43 tap water samples analyzed by this method.

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Objective:To explore the value of adrenocorticotrophic hormone (ACTH) stimulation in adrenal vein sampling (AVS) with its effect on the sampling success rate and lateralization determination.Methods:The clinical data of 54 patients with primary aldosteronism (PA) who underwent AVS in Nanjing Drum Tower Hospital from July 2018 to June 2020 were collected retrospectively. Blood samples from bilateral adrenal veins were collected simultaneously at baseline and after ACTH stimulation. The selectivity index (SI), lateralization index (LI), and relative aldosterone secretion index (RASI) were examined.Results:The concentration of serum cortisol level in left and right adrenal vein and peripheral vein increased significantly after ACTH stimulation ( P<0.001). SI of left adrenal vein increased from 18.00 (2.29, 20.29) to 34.76 (12.10, 46.86) , and the SI of right adrenal vein increased from 26.61(5.24, 31.85) to 28.40 (27.65, 56.05, P<0.001). The bilateral vein sampling success rate increased from 80%(43/54) to 93%(50/54). LI decreased from 2.85(1.78, 6.20) at baseline to 2.45(1.40, 6.10) after ACTH stimulation without significant difference( P>0.05). Eleven patients who identified unilateral secretion at baseline demonstrated bilateral after ACTH stimulation, and the RASI of these patients decreased from 0.50 (0.38, 1.25 ) to 0.37 (0.22, 0.84, P=0.019). Conclusion:ACTH stimulation significantly increased SI and the AVS success rate in patients with PA: ACTH stimulation decreased the relative aldosterone secretion in the dominant side of some patients with aldosterone producing adenoma, thus reduced the proportion of identified unilateral PA.

Objective To compare the corneal biomechanical parameters identified from uniaxial tensile test under fast and slow loading. Methods The stress-strain and stress relaxation data were obtained from uniaxial tensile tests on corneal strips from 15 healthy adult rabbits at average loading rate of 0.16 mm/s and 0.02 mm/s, respectively. A visco-hyperelastic model was applied to analyze the loading and unloading data from the fast tensile tests, where the model parameter set was denoted by Gvh. The first-order Ogden model and second-order Prony series model were used to fit stress-strain and stress relaxation data from the slow tensile tests, respectively, in which the model parameter set was denoted by Gvh. Correlation analysis was used to compare the correlation of parameters between Gvh and GOP. Results All the goodness-of-fits to the three data sets were greater than 0.95. There were significant differences in 5 (μ, A1, A2, τ1, τ2,) of the 6 parameters between Gvh and GOP (P<0.05), and the Ogden model parameters was positively correlated between the two groups. Conclusions There are differences in corneal biomechanical parameters identified by data from uniaxial tensile tests under fast and slow loading. The results provide a preliminary research basis for further exploring the use of clinical data to identify corneal biomechanical properties.

The clinical data of a case of compound oxidative phosphorylation deficiency type 10 (COXPD10) caused by a new site mutation of MTO1 gene in the Department of Pediatrics, Affiliated Hospital of Southwest Medical University on December 29, 2020 were retrospectively analyzed.The patient was a 2 months and 19 days old boy of Han nationality.The main clinical manifestations were shortness of breath, hyperlactic acidemia, hyperammonemia and brain damage.Cardiac hypertrophy was not obvious.Heterozygous mutations at c. 344delA and c. 1055C>T sites in the MTO1 gene have not been reported in domestic and foreign literature.COXPD10 caused by MTO1 gene mutations may result in diversified clinical manifestations due to inconsistent mutation sites.For hyperlactic acidemia with unknown predisposing factors, early genetic examination should be conducted to confirm the possibility of COXPD10.

Objective:To explore the application effect of case-based learning (CBL) combined with problem-based learning (PBL) teaching model in refresher training of medical imaging technologists.Methods:The study recruited 46 imaging technologists trained in radiology department in the Batch 2017 and Batch 2018 of West China Hospital of Sichuan University. They were divided into 2 groups: experimental group (23 persons) and control group (23 persons). CBL combined with PBL teaching method was used in the experimental group, and traditional lecture-based learning (LBL) method was used in the control group. The results of attitude evaluation, staged exminations, graduation assessment and operational skill tests were compared between the two groups, and the questionnaire survey was performed to test the affirmation of self-worth of the two groups of interns. SPSS 17.0 was used for chi-square test, independent t test, and Mann-Whitney U test. Results:Theoretical examination results at the second stage, the third stage, completion and operational examination results in the experimental group were significantly higher than those in the control group [(91.17±2.59) vs. (85.26±3.03), (92.00±1.86) vs. (87.43±3.23), (92.39±2.08) vs. (87.04±2.93), (85.70±5.48) vs. (80.87±5.57), P<0.05]. The questionnaire survey showed that such 7 aspects as the stimulation of subject interest, the cultivation of exploration spirit, the exercise of self-learning ability, the establishment of clinical ideas, the analysis of difficult problems, the mastering of practical operations, and the affirmation of self-worth in the experimental group were better than those in the control group, with significant difference ( P<0.05), while the consolidation of theoretical knowledge of the experimental group was not statistically different from the control group ( P>0.05). Conclusion:The reasonable application of CBL combined with PBL teaching model in refresher training of medical imaging technologists is helpful to improve their learning enthusiasm, self-learning ability, clinical analysis ability, practical operation ability, and long-term consolidation of theoretical knowledge.

Objective:To explore the application effect of magnetic resonance imaging (MRI) sequence experiment based on virtual simulation software in undergraduate teaching of medical imaging technology.Methods:Fifty-six undergraduate students from the Batch 2015 and Batch 2016 medical imaging technology of West China Clinical Medical College of Sichuan University were recruited in this study. They were divided into 2 groups: experimental group (Batch 2016) and control group (Batch 2015). The experimental group adopted the teaching method based on virtual simulation experiment, and the control group used the teaching method based on traditional small-sized magnetic resonance. The after-class test scores and final exam scores of the two groups of students were compared, and the questionnaire survey on teaching effectiveness was conducted for students in the experimental group SPSS 21.0 was used for ttest and Mann-Whitney Utest. Results:The scores of theoretical knowledge and the final grades in the experimental group were significantly higher than those of the control group [(84.55 ± 6.57) points vs. (79.37 ± 6.13) points; (90.03 ± 4.72) points vs. (80.06 ± 7.29) points, all P< 0.05). The effective recovery rate of the questionnaires was 100%, and the questionnaire survey showed that the experimental group was significantly superior to the control group in such four aspects as increasing subject interest, expanding relevant knowledge, solving clinical work, and promoting teamwork ( P< 0.05). Conclusion:In MRI sequence teaching, the teaching method based on virtual simulation software can increase the students' interests in learning, strengthen their understanding of MRI principles, then effectively improve the teaching effect of medical imaging undergraduate education.

Background Oral exposure to hexavalent chromium [Cr(VI)] can lead to gastrointestinal tumorigenesis in mice, and the mechanism is not yet clear. To predict health risk due to chemical exposure, data mining and computational toxicology analysis has become an important tool in toxicology research, which can help to elucidate mode of action (MOA) and identify key toxicity pathways. Objective This study aims to identify and evaluate key events in the MOA of oral Cr(VI) exposure. Methods Gene sets established from Comparative Toxicogenomics Database (CTD) and Gene Expression Omnibus (GEO) respectively were imported into Ingenuity® Pathway Analysis (IPA) software for pathway enrichment analysis and biological function analysis to identify potential key toxicity pathways of target organs/tissues toxicity of oral exposure to Cr(Ⅵ). Next, the weight of evidence (WOE) of the identified key toxicity pathways in the MOA of oral exposure to Cr(VI) was evaluated based on the modified Bradford Hill principle. Results A total of 54 pieces of literature related to oral Cr(VI) exposure were screened in CTD, among which 18 and 9 were related to liver and intestine with 125 and 272 corresponding genes, respectively. The pathway enrichment and biological function analysis results showed that liver and intestinal perturbation pathways were mainly related to cell stress and injury, cell cycle regulation, and apoptosis, indicating that Nrf2 pathway and AHR pathway might be the key toxicity pathways involved in the cytotoxic-mediated MOA. Meanwhile, the dose (≥170 mg·L⁻¹ sodium dichromate) and the time point (90 d) of the activation of Nrf2 pathway was similar to the emergence of crypt cell proliferation. It was proposed that Nrf2 pathway activation might be a key event for cytotoxic-mediated MOA of small intestinal tumors. The WOE results showed moderate validity of evidence in this hypothesis, with high validity of evidence for biological plausibility and dose-response manner. Conclusion Nrf2 pathway activation might be the key event in the cytotoxic-mediated MOA of small intestinal tumors induced by oral exposure to Cr(VI) via initiating or maintaining crypt cell proliferation.

OBJECTIVE: To analyze the clinical phenotype and pathogenic variant in a child diagnosed with mental retardation and microcephaly with pontine and cerebellar hypoplasia (MICPCH). METHODS: Clinical phenotype of the child was reviewed. Whole exome sequencing was carried out for the child. Candidate variant was verified by Sanger sequencing of the family member. RESULTS: The proband manifested dyskinesia, development delay, cerebellar hypoplasia and bilateral hearing impairment. WES results revealed that the proband has carried a pathogenic c.1641_1644delACAA (p.Thr548Trpfs*69) variant of the CASK gene, which was verified by Sanger sequencing to be a de novo variant. CONCLUSION The c.1641_1644delACAA (p.Thr548Trpfs*69) variant of the CASK gene probably underlay the MICPCH in the proband. Above finding has provided a basis for genetic counseling. WES should be considered for the diagnosis of neurological dysplasia.
Cerebellum/abnormalities* ; Child ; Developmental Disabilities ; Family ; Humans ; Mental Retardation, X-Linked ; Microcephaly/genetics* ; Nervous System Malformations

Objective:To investigate the current status of multi-drug use in elderly inpatients with multiple chronic conditions in internal medicine and its correlation with nursing risk events, and to put forward targeted suggestions to help manage clinical multiple drug use in elderly patients.Methods:Using the convenient sampling method, a total of 2 254 elderly inpatients in Department of Internal Medicine in 4 Class Ⅲ Grade A general hospitals in Sichuan province were selected to conduct a questionnaire survey from March 2020 to January 2021, and their general conditions, multiple chronic conditions and multiple drug use were analyzed. Single factor and binary Logistic regression were used to analyze the current situation of multiple drug use in elderly patients with chronic disease and its influence on nursing risk events.Results:There were statistically significant differences in patients with different ages, weights, education levels, personal income, medical payment methods, whether they were weak or not, and whether patients with multiple chronic conditions took multiple drugs ( P<0.05) . Logistic regression analysis showed that education level and the number of chronic diseases were independent risk factors for multiple drug use ( P<0.05) . There were statistically significant differences in the total number of nursing risk events and the occurrence of pressure injuries, deep vein thrombosis and cardiac arrest in patients with multiple medications ( P<0.05) . In the same state of multimorbidity, the nursing risk events of patients with multiple drug use increased. In patients with the same multiple medications, the incidence of patient nursing risk events with an increase in the number of multimorbidities showed a downward trend. Conclusions:Elderly patients with a high education level, a large number of chronic diseases and aged 65-74 years old should pay special attention to whether they have multiple drug use behaviors. In the future, it is necessary to actively popularize the knowledge of rational drug use, actively prevent the occurrence of chronic diseases, strengthen the cooperation of drug management teams and comprehensively consider treatment options in multiple specialties, so as to fundamentally reduce multiple drug use.