Objective:To analyze the risk factors for aspiration pneumonia (AP) among stroke survivors with dysphagia and construct a prediction model.Methods:The records of one hundred and forty-eight stroke survivors with dysphagia admitted since 2021 were retrospectively analyzed. They were divided into an AP group ( n=46) and a non-AP group ( n=102). Univariate and multivariate logistic regressions were evaluated seeking independent risk factors for AP. the receiver-operating characteristic (ROC) curves were used to analyze predictive power. Results:The incidence of AP was 31%. Multivariate logistic regression analysis showed that age, Barthel index, Kubota′s water drinking test grading, nutritional support methods and the neutrophil/lymphocyte ratio (NLR) could be useful independent predictors of AP. The areas under the ROC curves suggested that Kubota grading, nutritional support methods, the NLR and the Barthel index could be used to prepare a prediction nomogram with good sensitivity and specificity.Conclusions:Age, Barthel index, Kubota water drinking test grades, nutritional support methods and NLR are independent predictors of AP for stroke survivors with dysphagia. Combining them in a nomogram gives better predictive power than using the factors alone.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective To learn about the current situation and trends of novel coronavirus diseases 2019 (COVID-2019) in foreign countries. Methods The data on confirmed COVID-2019 cases were collected between January 20, 2020 and February 18, 2020 and by age, sex, nationality, contact history, region, and country were performed stratified analysis and onset time analysis. Results From January 20th to February 18th, the cumulative number of confirmed cases of COVI D-2019 abroad was 804. Excluding the 454 cases on the 'Diamond Princess' cruise ship in Japan, the daily number of new cases fluctuated, showed a trend of rising first and then maintaining a steady trend. The peak date for new cases was on February 1, with the number of cases reaching 26. The confirmed cases were mainly concentrated in Asian countries, but also distributed in Europe, North America, Oceania and Africa. As of February 15, there was no more increase reported in the number of countries where confirmed cases occurred after reaching 25. Among these countries, Singapore, Japan, and Thailand were with the highest number of cases, with 77, 65, and 35 cases, respectively. In accordamce to available information on confirmed cases, the cases with history of exposure to confirmed cases were more than those with history of living or traveling in Hubei. And more cases were non-Chinese nationalities, 40 years old and above, and males . Conclusion The novel coronavirus has transmitted abroad, and produced second-generation cases. Although the incidence is low abroad , its trend fluctuates greatly, so sufficient attention must be paid to the possibility of further transmission.

Neonatal hyperthyroidism is a rare,transient,but serious disease,while it can lead to significant morbidity and mortality if without prompt diagnosis and adequate treatment.Most cases are secondary to maternal autoimmune hyperthyroidism (85％ ～95％ are Graves'disease),caused by transplacental passage of maternal stimulating TAHR anti-bodies (TRAb).Signs and symptoms are multifaceted,nonspecific,and it can be easily confused with sepsis and congenital viral infections.The management of pregnant women with thyroid diseases during pregnancy should be strengthened.It is recommended to monitor thyroid function and TR-Ab levels from the beginning of 20 weeks'gestation.Neonates with symptomatic hyperthyroidism require prompt initiation of therapy and close monitoring of response in consultation with a pediatric endocrinologist.Here we will review the latest research progress in pathogeneses,clinical manifestation,diagnosis and treatment of neonatal hyperthyroidism.

Objective To investigate clinicopathological features of pancreatic carcinoma with or without lymph node metastasis,and to explore the relationship between the lymph node metastasis and the prognosis of pancreatic carcinoma.Methods The clinical and follow up data of 216 patients with pancreatic carcinoma from 2001 to 2015 were retrospectively analyzed.Kaplan-Meier method was used to estimate survival rates and plot survival curves.Results The postoperative survival time was 4-86 months,the median survival time was 19 months,and the postoperative 1,3 and 5 year survival rates were 65.1％,33.8％,20.5％,respectively.Patients with positive lymph node metastasis were with 1,3,5 year survival rates of 36.5％,12.2％,0％,those with no lymph node metastasis were with 1,3,5 year survival rates of 70.3％,38.0％,21.4％ (x2 =15.803,P ＜ 0.001).Conclusions Lymph node metastasis in patients with pancreatic cancer is worse than that without lymph node metastasis.Lymph node metastasis is one of the main prognostic factors in patients after radical resection of the pancreatic cancer.

Objective To compare the safety and efficiency between simultaneous resection and staged resection of synchronous colorectal liver metastases.Methods A systematic literature search was performed in PubMed,Embase,Cochrane Library,OVID,Web of Science,WanFang Data,CBM,VIP and CNKI databases for relevant articles published from January 2000 to July,2017.The meta-analysis was performed by RevMan 5.3.The primary outcomes were peri-operative complications,postoperative mortality,five-year survival rate.Results 25 studies with a total of 5 631 patients were finally included.The results of meta-analysis showed that simultaneous and staged resections were similar in peri-operative complications (OR =0.90,P =0.39),postoperative mortality (OR =1.23,P =0.29) and five-year survival rate (OR =1.03,P =0.68).Conclusions Simultaneous resection is safe and efficient in the treatment of patients with SCLMs.However,the results should be interpreted and applied prudently due to the lower level of evidence and the existence of heterogeneity.

Objective:To detect genomic aberrations and investigate the expression and clinical significance of TBX2,CHK2, and p53 in malignant peripheral nerve sheath tumor (MPNST) tissues. Methods:We collected 63 cases of MPNST tissue samples, which were re-moved by resection and were confirmed by pathology, from January 1991 to December 2011 in Department of Bone and Sofer Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital. Twelve fresh tumor samples with qualified DNA quality were selected from the above 63 cases of tissue samples. Genome abnormalities of 12 MPNST tissues were detected by next-generation sequencing. The protein expression levels of TBX2, CHK2, and p53 in 63 MPNST tissue samples were assessed by immunohistochemistry staining. Results:One case of TBX2 gene mutation was observed out of the 12 MPNST tissue samples. In 63 MPNST tissue samples, the protein expression rates of TBX2, CHK2, and p53 were 60.3%(38/63), 47.6%(30/63), and 30.2%(19/63), respectively. TBX2 expression was sig-nificantly correlated with AJCC (American Joint Committee on Cancer, AJCC) stage, recurrence, and metastasis (P<0.05). TBX2 expres-sion was directly correlated with that of CHK2 (r=0.254, P=0.045), and CHK2 expression was directly correlated with that of p53 (r=0.343, P=0.006). In terms of the disease-free survival and overall survival time, patients with high expression levels of TBX2, CHK2, and p53 had significantly worse prognosis than patients with low expression levels of TBX2, CHK2, and p53(all P<0.05). TBX2, CHK2, and p53 were independent prognostic factors of MPNST. Conclusion:TBX2 and its associated proteins may play important roles in MPNST development and progression. Detecting TBX2 expression may provide the theoretical basis for estimating the prognosis of patients with MPNST.

Objective To compare the clinical efficacy between pediatric ABO-incompatible liver transplantation (ILT) and ABO-compatible liver transplantation (CLT) by Meta-analysis. Methods Relevant studies published until May 2017 were electronically retrieved from PubMed, Embase, Cochrane library, China national knowledge internet (CNKI),Wanfang and VIP databases. According to the inclusion and exclusion criteria, the publications eligible were screened and clinical data were extracted. Meta-analysis was performed using the random or fixed effect model analyses with Review Manager 5.3 statistical software. Results Eleven retrospective cohort studies in English were selected. Meta-analysis demonstrated that the postoperative 1-year survival rate of the recipients in the ILT group was significantly lower than that in the CLT group [odds ratio (OR)=0.64, 95% confidence interval (CI) 0.49-0.83, P=0.0007)]. In the ILT group, the incidence of postoperative rejection reactions was considerably higher compared with that in the CLT group (OR=1.96,95% CI 1.03-3.72, P=0.04). No statistical significance was observed in the postoperative 3- and 10-year survival rate of the recipients, 1-, 3- and 10-year survival rate of the graft and the incidence of postoperative biliary tract complications between two groups (all P>0.05). Conclusions Compared with their CLT counterparts, the 1-year survival rate of the ILT recipients is lower, whereas the incidence of rejection reactions is higher. However, the long-term survival rate of both the recipient and graft and the incidence of biliary tract complications do not significantly differ between CLT and ILT. ILT is a relatively ideal option for emergent patients or those lacking of liver graft with compatible blood group for a long period of time.

Objective To report the clinical effects of a 3D-printed metal drilling template used in surgery for complex upper cervical disorders.Methods Between August 2015 and June 2017,5 patients with upper cervical disorder complicated with complex cranial cervical junction deformity underwent instrumentation and fusion.They were 4 males and one female,aged from 3 to 36 years.All the patients underwent thin slice CT scan before operation.The CT image data were imported into a computer workstation for three dimensional reconstruction of individualized models of the upper cervical spine on which individualized drilling templates were designed.Guided by each of the individualized metal drilling templates manufactured by 3D printing,surgery via the posterior approach was performed in 2 cases and surgery via the combined anterior and posterior approach in 3 cases.After surgery,the screw trajectory was evaluated by CT scan.Results Surgery succeeded in all the 5 patients.A total of 5 pedicle screws and 5 laminar screws were drilled.Postoperative CT scan showed accurate placement of all the 10 screws.The patients recovered with no neurovascular complications.Conclusion Since an individualized 3D-printed metal drilling template can improve the accuracy and safety of screw placement,it can reduce surgical risks and enhance surgical success in the surgery for complex upper cervical disorders.

Objective To compare the safety and efficiency of nasogastric ( NG ) feeding with nasojejunal (NJ) feeding in treating severe acute pancreatitis ( SAP).Methods The terms NG tube,NJ tube,SAPand enteral nutritionwere used for literature search in PubMed , Embase, Cochrane Library, WanFang and CNKI databases and the publication deadline was June 1, 2016.Random effect model was used for Meta analysis .Results A total of 5 random clinical trials involving 264 patients ( 136 in NG group and 128 in NJ group ) were included .There was no statistical difference on the incidence of adverse events (mortality:RR=0.77, 95%CI 0.42~1.41, P=0.39; infection complications: RR=0.77, 95%CI 0.45~1.30, P=0.39; digestive complications: RR=1.26, 95%CI 0.73~2.16, P=0.41; stopping nasogastric proportion:RR=0.66, 95%CI 0.10~4.10, P=0.65;MODS rate:RR=0.98, 95%CI 0.71~1.35, P=0.90; the percentage of energy balance: RR=1.00, 95%CI 0.97~1.03, P=0.39 and the average length of hospital stay:RR=0.98, 95%CI 0.71~1.35, P=0.90).Conclusions NG feeding was safe and effective , which was comparable with NJ feeding .NG feeding was more convenient with a higher clinical value .