ObjectiveTo investigate the differences in abnormal liver biochemical parameters in pregnant patients during the epidemic or non-epidemic period of coronavirus disease 2019 （COVID-19）. MethodsA retrospective analysis was performed for 539 pregnant women who were discharged from Department of Obstetrics， Peking University First Hospital， from October 2017 to March 2022 and had at least one abnormal liver biochemical parameter among alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， gamma-glutamyl transpeptidase （GGT）， total bilirubin （TBil）， and total bile acid. The patients in the epidemic period of COVID-19 and those in the non-epidemic period of COVID-19 were compared in terms of etiology， coagulation parameters， aminotransferases， bile acid， and renal function. The independent samples t-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. ResultsAmong the patients discharged from Department of Obstetrics during the non-epidemic period of COVID-19， 262 had abnormal liver biochemical parameters， accounting for 1.46%， while 277 patients had abnormal liver biochemical parameters during the epidemic period of COVID-19， accounting for 1.73% among the patients discharged from Department of Obstetrics during the same period of time， and there was a significant difference between these two groups （χ²=3.947， P=0.047）. The etiological analysis of the patients with abnormal liver biochemical parameters during the two periods showed that there was no difference in the proportion of patients with four pregnancy-specific liver diseases （hyperemesis gravidarum， preeclampsia and eclampsia， intrahepatic cholestasis of pregnancy， and acute fatty liver of pregnancy）. As for the patients with abnormal liver biochemical parameters in pregnancy， there was no significant difference in the proportion of patients with normal creatinine and stimated glomerular filtration rate （eGFR） between the epidemic period and the non-epidemic period （86.78% vs 87.90%， χ²=0.141， P=0.708）. The patients with ALT≥5×upper limit of normal accounted for 7.94% in the epidemic period of COVID-19 and 9.54% in the non-epidemic period （χ²=0.433， P=0.511）， and the patients with severe cholestasis accounted for 7.75% in the epidemic period of COVID-19 and 9.27% in the non-epidemic period （χ²=0.392， P=0.531）. The proportion of patients with obstetric bleeding during the epidemic period of COVID-19 was significantly lower than that during the non-epidemic period （14.61% vs 24.19%， χ²=489.334， P<0.001）. ConclusionThere is no difference in the proportion of patients with pregnancy-specific liver diseases among the patients with abnormal liver biochemical parameters in pregnancy between the epidemic period and the non-epidemic period of COVID-19， and there is no change in the proportion of patients with normal creatinine and eGFR among these patients in the epidemic period of COVID-19.

The histopathological growth patterns (HGPs) of colorectal cancer (CRC) liver metastasis reflect the complicated and varied interactions between tumor cells and host microenvironment. Exploring the tumor vascular and immunological features of HGPs, the relationship between HGPs and anti-tumor treatment efficacy, and HGPs prediction methods may have potential clinical aplication value for making optimal treatment strategies, evaluating patients' prognosis, and monitoring disease progression.

Standardized patient (SP) has been widely used for medical teaching and assessment in medical colleges at home and abroad. Pediatric consultations are mostly directed toward parents, so in pediatric education, SP is usually referred to as standardized family (Sfam), which is trained to portray the patient's family members. At present, the development of Sfam in pediatric teaching in China is relatively slow. Based on the characteristics of pediatric teaching, the paper summarizes the necessity of Sfam, the application of different types of Sfam, the integration of Sfam with other clinical teaching methods, and the value of Sfam in pediatric teaching, and also discusses the future direction and prospects of Sfam combined with artificial intelligence in pediatric teaching. After years of development, Sfam has been proved to be an effective teaching model. We hope this paper can help more pediatric clinical educators gain a deeper understanding of the Sfam teaching method, and promote the application of Sfam in pediatric teaching to maximize its role in advancing the development of pediatric education.

Objective:To investigate the effect of 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip in small volume benign prostatic hyperplasia (BPH).Methods:The case data of 120 patients diagnosed with small volume BPH in the Yan′an University Affiliated Hospital from June 2020 to June 2022 were retrospectively analyzed, and they were divided into improved group and conventional group according to different treatment methods, with 60 cases in each group. Patients in the improved group were treated with 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip, and patients in the conventional group were treated with 980 nm semiconductor laser vaporization of prostate. The sexual function of the patients was evaluated by the international erectile function index-5(IIEF-5) score, erectile hardness score (EHS) and retrograde ejaculation before surgery and 1, 3, 6, and 12 months after surgery. International prostate symptom scale (IPSS), quality of life (QOL) score, the maximum urine flow rate (Qmax) and postvoid residual urine (PVR) were used to evaluate urinary control function. The incidence of urinary incontinence, bladder neck contracture and other complications were compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups. The count data were expressed as cases and percentage, and Chi-square test was used for comparison between groups. Results:There was no significant difference in PVR, Qmax, IPSS score, QOL score, IIEF-5 score and EHS score between two groups ( P>0.05). In terms of PVR, Qmax, IPSS score, QOL score, IIEF-5 score and EHS score at 1, 3, 6 and 12 months after surgery, all these parameters were significantly improved compared with the preoperative, the differences were statistically significant ( P< 0.05). However, there was no significant difference between the two groups ( P> 0.05). There was no significant difference in IIEF-5 score and EHS score between the two groups during postoperative follow-up and before and after operation ( P> 0.05). The incidence of retrograde ejaculation rate in the improved group was lower than that in the conventional group during the follow-up 1, 3, 6 months after surgery, and the difference was statistically significant ( P<0.05). In the follow-up 1, 3 months after surgery, the incidence of stress urinary incontinence in the improved group was lower than that in the conventional group, the differences were statistically significant ( P< 0.05). At follow-up 6, 12 months after surgery, the rates of stress urinary incontinence were similar between the two groups, and the difference was not statistically significant ( P> 0.05). In the follow-up 12 months after surgery, there were 2 cases (3.33%) of bladder and neck contracture in the improved group, and 8 cases (13.33%) in the conventional group, the difference was statistically significant ( P<0.05). Conclusions:The effect of 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip in small volume BPH patients is similar to that of conventional vaporization, and the operation time is short. At the same time, the proximal 1 cm tissue of the verticulae and the integrity of the bladder neck are preserved, and the internal and external sphincter of the urethra are protected, thus improving the immediate postoperative urinary control rate and the incidence of retrograde ejaculation in small volume BPH patients.

Objective:To develop the Self-Stigma Scale for Drug Addicts(SSSDA),and test its validity and reliability.Methods:On the basis of literature analysis,open questionnaire survey,semi-structured interview and ex-pert consultation,the theoretical structure of the questionnaire was developed,and 943 drug addicts were test-ed.Sample 1(n=483)was used for item analysis and exploratory factor analysis,and sample 2(n=460)was used for confirmatory factor analysis,criterion related validity and internal consistency reliability analysis.Sixty-four drug addicts were retested 4 weeks later for test-retest reliability test.The criterion related validity was tested with the Drug Stereotype Threat Scale.Results:The scale consisted of 6 dimensions and 31 items,including self-negative cognition,stereotype identity,confidentiality,social avoidance,stigma experience,and stigma experience in the process of detoxification(factor loadings were from 0.41 to 0.81),which explained 64.09％of the total vari-ance.The 6-factor structure model fitted the data well(x2/df=2.82,RMSEA=0.06,CFI=0.92,GFI=0.85,TLI=0.91).The total scores and factor scores of the SSSDA were positively correlated with the DSTS scores(ICC=0.10-0.22,Ps＜0.05).The Cronbach α coefficients for the total scale and each dimension were between 0.80 and 0.95,and the test-retest reliability coefficients(ICC)were between 0.82 and 0.94.Conclusion:The Self-stigma Scale for Drug Addicts(SSSDA)initially developed in this study has satisfactory reliability and validity.

【Objective】 To analyze the changes of gut microbes in patients with postpartum depression so as to explore the relationship between postpartum depression and gut microbes. 【Methods】 A total of 60 postpartum subjects were recruited to participate in this study. The depression status of the participants was scored using the Edinburgh Postpartum Depression Scale (EPDS). Those with a score ≥13 were included in the postpartum depression group (PPD group), while those with a score less than 13 were included in the postpartum healthy control group (PPHC group). The feces of these 60 subjects were collected, and the fecal whole genome DNA was extracted for 16S rDNA sequencing. The data of changes in the bacterial diversity between the groups were obtained, and the possible correlation between the changes of intestinal microbes and postpartum depression was analyzed. 【Results】 The number of microorganisms in PPD patients was significantly reduced (P<0.001); the Chao1 index (P<0.001) and ACE index (P<0.001) of α diversity decreased significantly. There were also significant differences in β diversity between the two groups. Analysis of the bacteria in the groups showed that Acetanaerobacterium, Adlercreutzia, Allobaculum, Alloprevotella, Bifidobacterium, Christensenella, Escherichia, Eubacterium, Faecalicatena, Fusobacterium, Haemophilus, Intestinimonas, Lactobacillus, Megamonas, Monoglobumus, Muribaculum, Oscillospira, Paraprevotella, Streptococcus, Raoultibacter, Ruminococcus and Stomatobaculum were significantly enriched in PPHC group. In contrast, Kineothrix, Lachnoclostridium, Acinetobacter, Aquisphaera, Enterococcus, and Mucispirillum were enriched in PPD group. RDA/CCA analysis showed that EPDS was positively correlated with Prevotella, Kineothrix, and Alistipes, but negatively correlated with Lachnospira. 【Conclusion】 This study found that the intestinal flora of patients with postpartum depression was significantly disrupted, and there was a correlation between the intestinal flora and postpartum depression symptom score. Therefore, intestinal microbial markers may contribute to the diagnosis and treatment of patients with postpartum depression.

Objective:To evaluate the success rate and influencing factors of auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube in oldest-old patients.Methods:A case series study was conducted in those elderly hospitalized patients who met the indications for naso intestinal intubation from January 2019 to May 2021 in China-Japan Friendship Hospital. Auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube was implemented. In addition, abdominal X-ray imaging was performed to confirm the location of the catheter tip. The primary indicators included were the success rate and the first attempt success rate of nasojejunal tube placement;, while the secondary indicators included were the number of attempts and the time of insertion. The rate of operational-related adverse events was ustreated as to evaluate the indicator of safety. Logistic regression analysis was used to conduct multi factor analysis.Results:The total success rate and the first-attempt success rate of tube implantation reached were 90.1%(73/81) and 85.2%(69/81), respectively. The mean attempt per individual patient was (1.2 ± 0.2) times for each patient. The median length of operation time was 40.0(27.0, 45.0) minutes, more specifically, among which the median length time of nasogastric and gastrojejunal placement was 20.0(15.0, 25.0) and 18.0(12.5, 20.0) minutes, respectively; while the median lengthtime of nasogastric placement was greaterhigher than that of gastrojejunal placement ( Z = -2.78, P<0.05). As suggested by multivariate analysis, indicated that the conscious conditions of patients had a signific antlyimpact affect on the success rate of for tube implantation ( OR = 19.25, 95% CI 1.24-299.63, P<0.05). In addition, the incidence rate of operational-related adverse events was 37.0%(30/81). By contrast, there were no serious adverse events occurring during the study period. Conclusions:The auscultation-assisted bedside blind placement of the nasojejunal feeding tube technique is effective and safe for early nutrition support in oldest-old patients in terms of early nutritionsupport, the success rate of which is significant largely affected by the patients′ conscious conditions of patients.

Objective: To analyze the trend of percentile changes in body composition among children and adolescents aged 7 to 18 by gender and age, and to provide a scientific basis for reference value. Methods: A stratified cluster random sampling method was used to select 1 585 children and adolescents from September to December 2020. Use the GAMLSS to estimate the P 25 , P 50 and P 75 percentile value of gender, age specific body fat percentage (BF%), fat mass index (FMI) and fat free mass (FFM). Results: In different age groups, body fat percentage of boys with normal nutritional status peaked at around 10-year old, among them, body fat percentage of 10-year old P 25 , P 50 and P 75 were 22.2%, 26.1% and 30.1%, respectively. Body fat percentage of obese boys was at a high level. Among girls, body fat percentage under different nutritional status did not change. With the increase of age, fat mass index plateaued slightly in normal and overweight boys. However, in obese boys, with the increase of age, FMI gradually increased with the increase of percentile, while the value of FMI gradually decreased in girls. Whether in boys or girls, with the increase of age, fat free mass index shows an increasing trend, and boys increase faster. Conclusion Under different nutritional status, there are differences in the percentile value of body fat percentage, fat mass index and fat free mass by gender and age, which can provide a scientific basis for reference value of body composition in children and adolescents.

Objective:To analyze the epidemiological and etiological characteristics of a dengue fever outbreak in Hunan province in 2018.Methods:Real-time PCR assay was performed for the laboratory diagnosis of 8 suspected dengue fever cases. Etiological surveillance was performed in 186 suspected dengue fever cases and fever cases who had close contacts with dengue fever patients. C6/36 cells was used for the virus isolation from acute phase serum. By sequencing the full length of E genes of 15 dengue virus strains, phylogenetic analysis was performed based on the sequences obtained, including reference sequences from the NCBI GenBank database, the serotypes and gene subtypes of the virus were analyzed to trace the possible source of transmission. An emergency monitoring of vector density and a retrospective survey of sero-epidemiology in healthy population were conducted in the epidemic area.Results:In the serum samples of 8 suspected patients, 6 were dengue virus RNA positive, and 4 were NS1 antigen positive. In 186 suspected patients, 96 were dengue virus nucleic acid, NS1 antigen or antibody positive in etiological test. A total of 64 dengue virus strains were isolated. The phylogenetic analysis showed that all the dengue virus strains belonged to type 2, which might be from Guangdong or Zhejiang provinces. The Bretub index was up to 65, indicating an extremely high risk of transmission. The positive rate of the dengue virus IgG antibody was 0.53%(2/377) in retrospective survey of 377 healthy people.Conclusion:The field epidemiologic and the molecular genetics analyses showed the outbreak of dengue fever in Hunan in 2018 was caused by imported cases and dengue virus 2.

Objective To compare the effects of movable artificial lumbar vertebra implantation and traditional vertebral excision and fusion on the stress of adjacent intervertebral discs,so as to provide reference for the biomechanical safety of new prosthesis implantation.Methods The total lumbar vertebra CT scan data of a healthy adult were imported into the compute r-aided software Mimics 16.0 for three dimensional reconstruction.The reconstructed three dimensional model was smoothed using computer-aided software Geomagic Studio 12.0.Subsequently,meshing,parameter setting and ligaments reconstructing were completed using computer-aided software Hypermesh 13.0 and Solidworks 2013,successfully constructing the finite element model of lumbar vertebral physiology group.On the basis of the finite element model of physiological group,three vertebral bodies and two intervertebral spaces were fused and fixed,and a simplified finite element model of fusion group was constructed.The partitioned prosthesis model was inserted into the established finite element model of physiological group,replacing the L 3 vertebral body and the adjacent two intervertebral discs in the model,constructing the finite element model of non fusion group.Three finite element models were imported into computer-aided software Abaqus/Explict and loaded under six motion modes including anteflexion,dorsiflexion,left and right rotation,and left and right bending.The stress changes of adjacent intervertebral discs were calculated.Results The maximum Mises stress of the adjacent intervertebral disc in the direction of forward flexure,dorsal extension,left and right rotation and left and right lateral bending of the three finite element models was located at the site of loading and increased with the increase of loading.Under the maximum loading,the Mises stress of adjacent intervertebral discs in the above directions in the fusion group (L1-2 respectively were 0.79,0.96,1.26,1.92,1.34,1.57 MPa while L4-5 respectively were 0.52,1.13,1.50,1.74,0.94,0.87 MPa) was significantly higher than that in the physiological group (L1-2 respectively were 0.42,0.53,0.57,0.66,0.64,0.72 MPa while L4-5 respectively were 0.23,0.29,0.68,0.63,0.37,0.34 MPa).The Mises stress of adjacent intervertebral disc in the non-fusion group (L1-2 respectively were 0.38,0.57,0.75,1.02,0.87,0.90 MPa while L4-5 respectively were 0.18,0.26,0.81,0.98,0.30,0.27 MPa) was similar to that in the physiological group,although there was some difference.Conclusion Movable artificial lumbar disc prosthesis implantation can better avoid the stress increase of adjacent intervertebral discs,and its long-term implantation in the human body is expected to reduce the incidence of degeneration of adjacent intervertebral discs.