Objective:To analyze the clinical characteristics and all-cause mortality influencing factors of patients with Keshan disease.Methods:Clinical data of patients with Keshan disease from Keshan disease areas in Sichuan Province and Yunnan Province were collected and retrospectively analyzed for clinical characteristics and survival status during regular follow-up. According to the survival status of patients, the survey subjects were divided into a survival group and a death group. All-cause mortality (referring to the death caused by various reasons throughout the follow-up period) was used as the study endpoint. Kaplan-Meier (K-M) survival curve analysis and log-rank χ 2 test were performed, univariate and multivariate Cox regression analysis were used for all-cause mortality factor analysis. Results:A total of 176 patients with Keshan disease were collected, including 92 cases in Sichuan Province and 84 cases in Yunnan Province. Among all the patients, there were 105 males, accounting for 59.66%, and 71 females, accounting for 40.34%. The age was (53.89 ± 13.19) years old. Thirty-five cases died from all causes, with a mortality rate of 19.89%. There were significant differences in age ( t = 2.09, P = 0.038), New York Heart Association (NYHA) cardiac function grading (χ 2 = 14.62, P < 0.001) and ventricular premature contraction (χ 2 = 6.82, P = 0.009) between the survival group and the death group. K-M survival curve analysis showed that patients with Keshan disease complicated by premature ventricular contraction and high NYHA cardiac function grading (Ⅲ and Ⅳ) had higher all-cause mortality (log-rank χ 2 = 8.72, 22.49, P < 0.05). Univariate Cox regression analysis showed that NYHA cardiac function grading and ventricular premature contraction ( HR = 3.09, 2.71, P < 0.05) were predictive influencing factors for all-cause mortality in patients with Keshan disease. Multivariate Cox regression analysis showed that NYHA cardiac function grading ( HR = 6.57, P = 0.002) and ventricular premature contraction ( HR = 2.98, P = 0.050) were independent factors for all-cause mortality in patients with Keshan disease. Conclusions:Among 176 patients with Keshan disease, the number of patients with poor cardiac function (NYHA cardiac function grading Ⅲ and Ⅳ) and arrhythmia is high. NYHA cardiac function grading and ventricular premature contractions are independent influencing factors for all-cause mortality in patients with Keshan disease.

Objective:To investigate the clinicopathologic characteristics, gene mutation profile and prognostic influencing factors of diffuse large B-cell lymphoma (DLBCL) complicated with follicular lymphoma (FL) (DLBCL/FL).Methods:The clinicopathological data of 50 DLBCL/FL patients admitted to Rui Jin Hospital Affiliated of Shanghai Jiao Tong University School of Medicine from February 2018 to November 2021 were retrospectively analyzed. Targeted sequencing was performed to assess the mutation profile of 55 lymphoma-related genes. The clinicopathological characteristics were summarized to evaluate the short-term therapeutic efficacy of all patients. Kaplan-Meier method was used to analyze the overall survival (OS) and progression-free survival (PFS) of patients. Cox regression risk models were used to assess the factors affecting the OS and PFS.Results:Among 50 DLBCL/FL patients, 23 cases (46%) were male, 22 cases (44%) had an international prognosis index (IPI) score ≥ 2 points, 16 cases (32%) were double-expression lymphoma (DEL) and 4 cases (8%) were double-hit lymphoma (DHL). The complete response (CR) and overall response rates were 68% (34/50) and 78% (39/50), respectively after the first-line therapy. The median follow-up time was 23.3 months (5.1-50.9 months). The 2-year OS rate was 82.1% and 2-year PFS rate was 67.1%; and the median OS and PFS were not reached. Targeted sequencing results showed that the mutation frequencies of KMT2D, MYD88, TP53, BTG2, DTX1, EZH2, CD70, CREBBP, DUSP2, HIST1H1C, HIST1H1E and PRDM1 genes in this cohort were more than 15%. Multivariate Cox regression analysis showed that male ( HR = 4.264, 95% CI 1.144-15.896, P = 0.031) and IPI score ≥ 2 points ( HR = 6.800, 95% CI 1.771-37.741, P = 0.007) were independent risk factors of PFS in newly diagnosed DLBCL/FL patients, and TP53 mutation ( HR = 4.992, 95% CI 1.027-24.258, P = 0.046) was an risk influencing factor of OS. Conclusions:The proportion of male and female DLBCL/FL patients is similar, with a small proportion of DHL. Mutations of KMT2D, MYD88 and TP53 genes are commonly found in DLBCL/FL patients. Generally, DLBCL/FL patients can have a high overall response and good prognosis. Male and IPI score ≥ 2 points are the independent risk factors of PFS, and TP53 mutation is an independent risk factor of OS in DLBCL/FL patients.

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective:To investigate the various factors that contribute to self-reported hypoglycemia in elderly patients with type 2 diabetes mellitus.Methods:This is a prospective cohort study that included 1, 010 elderly patients with type 2 diabetes mellitus who were hospitalized in Tianjin Medical University Chu Hsien-I Memorial Hospital from April to September 2019.Patients were selected using the convenient sampling method and were between the ages of 60-90(66.7±5.3)years with a disease course of 0.5-40.0 years.Baseline data was collected through questionnaires and patients were followed up for six months.The study observed self-reported hypoglycemia events and analyzed the influencing factors of self-reported hypoglycemia using logistic regression.Results:Out of the 1, 010 patients who participated in the study, 901(89.2%)completed it.Of those who completed the study, 321(35.6%)reported experiencing hypoglycemia.The median frequency of hypoglycemia was found to be 3(2, 4)times.Several factors were found to be influential in self-reported hypoglycemia in elderly patients with type 2 diabetes.These factors included waist circumference, HbA1c, thiazolidinediones combined with insulin therapy, frequency of hypoglycemia in the past year, blood glucose prevention education, and fear of hypoglycemia.All of these factors had a significant impact on self-reported hypoglycemia(all P<0.05). Conclusions:Medical professionals should prioritize patients who are undergoing thiazolidinediones combined with insulin therapy and frequently experience hypoglycemia.They should address the patients' fear of hypoglycemia and provide them with comprehensive education.

Immunothrombosis refers to the innate immune response caused by thrombosis in blood vessels(especially microvessels).Immunothrombosis is related to immune cells and specific thrombosis related molecules,producing intravascular scaffolds that promote pathogen recognition,inhibition,and destruction,thereby protecting the integrity of the host.However,abnormal or uncontrolled activation of immunothrombosis may be harmful to the host and serve as the foundation for various infectious and inflammatory related thrombotic diseases.Therefore,understanding the potential mechanisms of immunothrombosis plays a decisive role in developing more effective therapies for thrombosis treatment and prevention.This review provides an overview of the mechanisms of immunothrombosis in order to understand new treatment strategies for reducing the risk of immunothrombosis.

OBJECTIVE To conduc t qualitative and quantitative analysis for the chemical compounds in 3 species of wild Veratrum（V. nigrum ，V. maackii ，V. dahuricum ）from Inner Mongolia. METHODS HPLC-Q-Exactive-MS/MS technology was used to identify the chemical components of V. nigrum ，V. maackii and V. dahuricum by consulting SciFinder ，ChemSpider database and related literatures and comparing with the reference substance. The contents of polydatin ，oxyresveratrol and resveratrol in 3 species of wild Veratrum were determined by HPLC. RESULTS A total of 31 compounds were identified ，including 13 stilbenes， 11 flavonoids，4 organic acids ，2 glycosides，1 brasilin. Most of the compounds were shared by 2 or 3 species of wild Veratrum， only 2 flavonoids kaempferol and luteolin were owned by V. dahuricum . The total contents of polydatin ，oxyresveratrol and resveratrol in 3 species of wild Veratrum were in the range of 6.618-11.292 mg/g，and the total contents of them in V. nigrum were the highest ，followed by V. maackii and V. dahuricum . The contents of polydatin and resveratrol in V. maackii were the highest ，and the content of oxyresveratrol in V. nigrum was highest. CONCLUSIONS Most of the components of 3 species of wild Veratrum are similar，only kaempferol and luteolin are unique to V. dahuricum . The contents of polydatin ，oxyresveratrol and resveratrol are significantly different among 3 species of wild Veratrum.

Objective:To investigate the clinical characteristics, drug resistance and serotypes of children′s invasive pneumococcal disease(IPD) in Shenzhen.Methods:Clinical data and drug sensitivity results of IPD children enrolled in Shenzhen Children′s Hospital, from January 2012 to December 2018, were analyzed retrospectively, and serotypes of the retained strains were identified by capsule swelling method or polymerase chain reaction(PCR) method.Results:One hundred and forty-one cases were enrolled, majority of them were less than 2 years old (86 cases, 61.0%). A total of 99 cases(70.2%) had onset in autumn and winter.The clinical manifestation included single bloodstream infection(62 cases, 45.4%), purulent meningitis(30 cases, 21.3%), pneumonia with bacteremia(28 cases, 19.9%), bone and joint infection(12 cases, 8.5%), purulent pleurisy (4 cases, 2.8%), peritonitis (3 cases, 2.1%), and infective endocarditis (2 cases, 1.4%). Underlying diseases were found in 33 cases(23.4%), co-infection in 14 cases (9.9%), complications in 39 cases (27.7%). After active treatment, 5 cases (3.5%) who were all under 2 years old died, and all of the isolates had multi-drug resistance.Four cases (2.8%) were discharged without recovery, and the rest cases were improved.The incidence of Penicillin insensitive Streptococcus pneumoniae (PNSP) with underlying diseases (30.7% vs.15.4%, χ2=3.956), meningitis(32.0% vs.9.2%, χ2=10.722) and multiple drug resistance (86.7% vs.63.1%, χ2=10.538)were higher than those of Penicillin sensitive Streptococcus pneumo- niae(PSSP)(all P<0.05). The serotypes of 97 invasive Streptococcus pneumoniae strains were identified.Types of 14 and 19F (21 strains for each type, 21.6%) were the most common, followed by type 19A (15 strains, 15.5%), type 6B and 23F (13 strains for each type, 13.4%), and type 3 (3 strains, 3.1%). The serotype coverage of 13-valent pneumococcal conjugate vaccine (PCV13) was 92.8% (90/97 strains). Conclusions:Children under 2 years old are prone to IPD and death.The IPD distribution varies in different seasons, and single bloodstream infection is the most common clinical manifestation; PNSP is more likely to occur in children with underlying diseases and meningitis, and the multi-drug resistance of pathogenic strains may be related to poor prognosis.PCV13 can cover most IPD serotypes.

Minimizing the burden on study subjects and assessing the general dietary nutritional status as accurately as possible are the basis of a nutritional epidemiological cohort study in the general population. While introducing the main dietary nutrition assessment methods, this paper manly describes the basic contents and principles for the development of food frequency questionnaire, and briefly illustrates the problems and solutions for the development of area specific food frequency questionnaires by taking the example of Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort study. Finally, discusses preliminarily the necessity and possibility of developing a national food frequency questionnaire.

Objective To explore the hypoglycemia risk prevention self-attitude in diabetes mellitus patients so as to provide a basis for medical staff to participate in hypoglycemia risk prevention. Methods From February 2019 to March 2019, we selected 15 patients with diabetes mellitus at a ClassⅢ Grade A diabetes specialized hospital by purposive sampling to carry out semi-structured interview. Interview data were analyzed with the Colazizzi phenomenology seven-step method. Results After analyzing interview data, a total of four themes were refined including neglect, fluke, contradiction and puzzle as well as unbalanced focus. Conclusions Diabetes mellitus patients puzzle about and are not active in hypoglycemia risk prevention, and they don't implement positive and effective hypoglycemia risk prevention. Medical staff should strengthen hypoglycemia education and help patients develop a positive attitude with hypoglycemia risk to reduce the hypoglycemia risk.

Objective To analyze the clinical diagnosis and treatment data of 20 children with hypophosphatemic rickets (HR) in order to improve the clinical diagnosis and treatment of HR.Methods The retrospective analysis of clinical data of 20 cases with HR who were hospitalized at Children's Hospital of Nanjing Medical University from May,2010 to April,2016 was performed to summarize the clinical characteristics.All patients were analyzed for the phosphate regulating gene with homologies to endopeptidase on the X chromosome(PHEX) gene by direct sequencing.If no mutations were detected,multiplex ligation-dependent probe amplification analysis was performed.Results All of the 20 cases with HR showed different degrees of growth retardation and typical X-ray rickets.After treatment,the clinical features were improved.Height standard deviation score (HSDS) was improved significantly with longer treatment time,and the difference was statistically significant(P =0.027).There was a correlation between the blood phosphorus fluctuation and secondary hyperparathyroidism(P ＜ 0.05).Nineteen cases had PHEX gene mutations.Truncating mutations was the most frequent mutation type,and 4 new mutations were found.Conclusions Clinical characteristics,laboratory test results and X-ray examination are important clinical index for the diagnosis of HR,and PHEX gene test can be used as an important auxiliary diagnostic tool.Early diagnosis and treatment can significantly improve the clinical manifestations of the patients.