BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and pre-DIC status in sepsis patients. METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation. RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7％,22.0％and 31.5％,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P＜0.05).On day 1,the SIC score with a cut-off value＞3 had a significantly higher sensitivity(72.00％)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00％,SAC status 52.00％;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P＜0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95％confidence interval[95％CI]:0.060-0.783,P=0.018)and SAC(adjusted HR=0.146,95％CI:0.041-0.513,P=0.003). CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.

Objective To analyze the mortality characteristics and trends and the cause-eliminated life expectancy of gastric cancer in Harbin City from 1987 to 2019. Methods Mortality data of residents with gastric cancer from 1987 to 2019 in Harbin was analyzed to describe the mortality characteristics and trends of gastric cancer. Abridged life table and cause-eliminated life table were applied to calculate life expectancy and cause-eliminated life expectancy. Average annual percentage change (AAPC) was calculated with Joinpoint 4.2 software to evaluate the trends of mortality and cause-eliminated life expectancy of gastric cancer. Results From 1987 to 2019, the crude mortality, ASMRC and ASMRW and the truncated rate (35-64) were 14.3/10⁵, 10.9/10⁵, 10.9/10⁵, and 13.5/10⁵, respectively. The ASMRC showed an obvious decreasing trend at an average annual rate of 2.9% from 1987 to 2019 (95%CI: -4.4%--1.4%). Significant decreasing trends were observed for males (AAPC=-3.0%, 95%CI: -4.4%--1.7%) and females (AAPC=-3.1%, 95%CI: -5.3%--0.9%). An obvious decreasing trend in the ASMRW was also observed. The truncated rate (35-64) showed a downward trend (AAPC=-2.8%, 95%CI: -3.1%--2.5%). The average life expectancy of residents from 1987 to 2019 in Harbin were 76.78 years (male: 74.41 years, female: 79.33 years). After eliminating the causes of death of gastric cancer, the life expectancy increased by 0.25 years (male: 0.31 years, female: 0.18 years). Significant decreasing trends were found in the proportion of gastric cancer in all malignant cancer cases (AAPC=-0.18%, 95%CI: -2.0%--1.7%). Conclusion The mortality of gastric cancer decreases gradually from 1987 to 2019 in Harbin. After eliminating the causes of death of gastric cancer, the life expectancy increases by 0.25 years. Therefore, prevention and control should be strengthened.

Objective To explore the rules of acupoint selection and manipulation application of Tuina in the treatment of diabetes peripheral neuropathy(DPN)with data mining technology.Methods The clinical research literature of Tuina for DPN from October 2022 was selected by searching four Chinese databases that CNKI,WanFang,VIP and Chinese Biomedical Literature Database.Using the traditional Chinese medicine inheritance assistance platform software,analyze and summarize the rules of selecting acupoints and applying manipulations in the treatment of DPN with Tuina.Results A total of 110 articles were included,including 65 acupoints and 33 manipulations.The acupoints with the highest frequency are Zusanli(ST 36),Sanyinjiao(SP 6),Taixi(KI 3),Yongquan(KI 1),Taichong(LR 3),Yanglingquan(GB 34),etc.The meridians mainly include Taiyin Spleen Meridian of Foot,Yangming Stomach Meridian of Foot,Taiyang Bladder Meridian of Foot and Shaoyin Kidney Meridian of Foot.Five-shu Points,Lower He-sea Points and Yuan-primary Points are commonly used specific points.The acupoints are mostly distributed in the lower limbs.The categories of Tuina manipulations mainly include squeezing-pressing manipulations,pushing rolling manipulations and composite manipulations.The Tuina manipulations mainly include kneading manipulation,pressing manipulation,point-pressing manipulation,pressing-kneading manipulation and twisting manipulation with both palms.Conclusion The acupoint selection and manipulation application of Tuina in treating DPN have certain rules,and the main treatment principles are to regulate the organs and dredge collaterals,and to replenish qi and promote blood circulation,which can provide objective basis for clinical treatment.

Objective:To assess the association between warm ischemia time (WIT) and renal function in patients undergoing laparoscopic partial nephrectomy.Methods:A total of 344 patients treated with laparoscopic partial nephrectomy in Peking University People’s Hospital were included. There were 240 males (69.8%) and 104 females (30.2%) with a median age of 57 (23-89) years.The median BMI was 25.6 (16.7-36.0) kg/m 2.213 cases (61.9%) were associated with hypertension.There were 66 (19.2%) patients with diabetes mellitus. There were 92 cases (26.7%) with smoking history. The median preoperative creatinine was 73 (32-170) μmol/L. The median preoperative estimated glomerular filtration rate (eGFR) was 95 (33-142) ml/(min·1.73m 2). The maximum diameter of the tumor was 2.5 (7-9) cm.314 (91.3%) patients with renal cancer stage T 1. All patients underwent warm ischemia during the operation. The patients were divided into three groups for analysis. Restricted cubic spline regression analysis was used to assess the association between WIT as a continuous variable and percentage change of eGFR. Analysis of covariance was used to compare postoperative eGFR among the three groups, and to adjust for preoperative eGFR and tumor diameter. Results:There were statistically significant differences in the percentage change of postoperative eGFR ( P=0.009) and tumor diameter ( P<0.001) among the three groups. Restricted cubic spline regression analysis showed that with the prolongation of WIT, the percentage change of postoperative eGFR gradually decreased, and the curve began to stabilize after 30 minutes (R 2=0.044, P=0.015). The results of covariance analysis showed that after adjusting for baseline preoperative eGFR and tumor size, the effect of WIT on postoperative eGFR was significantly different among the three groups ( F=3.864, P=0.022). The postoperative eGFR in the WIT<20 min group was significantly higher than that in 20 min≤WIT<30 min group( P=0.009) and WIT≥30 min group( P=0.017). There was no significant difference in postoperative eGFR between the two groups with longer WIT( P=0.806). Conclusions:In partial nephrectomy, patients with WIT less than 20 minutes had higher postoperative eGFR levels than those with WIT greater than 20 minutes. However, when WIT exceeded 20 minutes, prolonged ischemia time did not lead to further decline in renal function.

Objective:Evaluation of combined inflammatory and coagulation markers for early identification of DIC in septic patients.Methods:This study was a single-center, retrospective, observational study involving 356 patients with sepsis. Sepsis was defined by the diagnostic criteria of Sepsis version 3.0. Definition of DIC was from the International Society on Thrombosis and Hemostasis (ISTH) DIC Score. Inflammatory biomarkers, including tumor necrosis factor (TNF)-α, interleukin (IL)-1β,2R,6,8,10, etc. and biomarkers of coagulation, like platelet (PLT), international normalized ratio (INR), D-dimer, fibrinogen (Fib), etc. were included in this study.Results:Among 356 patients with sepsis, 301 patients did not develop DIC (non-DIC) during hospitalization, 32 patients had DIC on the day of admission (overt-DIC), and 23 patients developed DIC within 1 week of admission (pre-DIC). Compared to non-DIC patients, pre-DIC patients had lower platelet counts and fibrinogen ( P < 0.05), higher levels of INR and D-dimer ( P < 0.05), higher levels of cytokines (TNF-α、IL-1β、IL-2R、IL-8、IL-10) and procalcitonin ( P < 0.05), higher APACHEⅡ and SOFA scores ( P < 0.05). Using receiver operating characteristics (ROC) analysis, we found that some biomarkers of coagulation and inflammation could discriminate pre-DIC from non-DIC patients. The area under the curve (AUC) of INR in the ROC analysis was 0.773 (95% CI: 0.696-0.851), the AUC of IL-2R was 0.700 (95% CI: 0.599-0.798) which is highest among inflammation markers, the highest AUC was obtained from the combination of platelets, INR, Fib, D-dimer and IL-2R (AUC = 0.843; 95% CI: 0.758-0.928). Kaplan-Meier survival curve suggested that high level of IL-2R (> 1064.5 U/mL) was a valuable predictor of 28-day mortality in septic patients. Conclusion:Inflammatory marker, IL-2R, is related to the occurrence of DIC in septic patients and has predictive value for pre-DIC. Combination of coagulation (platelets, INR, Fib, D-dimer) and inflammatory markers (IL-2R) can help to identify pre-DIC state in septic patients.

Objective To analyze the incidence, mortality and time trend of lung cancer in Heilongjiang Cancer Registries from 2013 to 2017. Methods We calculated the incidence (mortality) rate and age-standardized incidence (mortality) rate of lung cancer in Heilongjiang Cancer Registries from 2013 to 2017. Chinese population census in 2000 and World Segi's standard population were used for age-standardization. Annual percentage change (APC) was calculated using Joinpoint software. Results The incidence of lung cancer in Heilongjiang Cancer Registries from 2013 to 2017 was 63.44/10⁵ and ASR China was 36.14/10⁵. The incidence of lung cancer in males (78.08/10⁵) was higher than that in females (49.04/10⁵). The incidence of lung cancer in rural areas (65.54/10⁵) was higher than that in urban areas (58.20/10⁵). From 2013 to 2017, the mortality rate of lung cancer in Heilongjiang Cancer Registries was 57.02/10⁵, and ASR China was 32.53/10⁵. The mortality rate of lung cancer in males (69.92/10⁵) was higher than that in females (44.40/10⁵). The mortality rate of lung cancer in rural areas (60.68/10⁵) was higher than that in urban areas (48.02/10⁵). The incidence of lung cancer in the 55-year-old age group showed a downward trend (APC=-5.0%, t=-5.1, P < 0.05), and the mortality rate of lung cancer in the 70-year-old group showed a downward trend (APC=-4.9%, t=-5.0). Conclusion Heilongjiang Province is a high incidence area of lung cancer. The prevention and control of lung cancer should be further strengthened according to the epidemiological characteristics of lung cancer in this province.

Objective:To explore the incidence and mortality of esophageal cancer in the cancer registration areas of Heilongjiang province from 2013 to 2017 and their trends of change over time.Methods:The esophageal cancer incidence, mortality and population data reported by 12 cancer registration areas of Heilongjiang province were collected. Among them, the data of 11 areas met the check standards, including 7 cities above the prefecture level (abbreviated as urban area), 4 counties and county-level cities (abbreviated as rural area). The crude incidence and mortality rates of esophageal cancer in 11 cancer registration areas of Heilongjiang province from 2013 to 2017, and their standardized rates by Chinese population (adjusted according to the standard population composition of the 2000 census of China) and world population (adjusted using Segi world standard population composition), and the cumulative incidence or mortality rate from 0 to 74 years old (abbreviated as cumulative incidence or mortality rate) were calculated. Joinpoint regression was used to calculate the annual percentage change (APC) of the incidence and mortality rates, and the trend analysis was performed.Results:From 2013 to 2017, the crude incidence rate of esophageal cancer in the cancer registration areas of Heilongjiang province was 6.40/100 000, the standardized incidence rate by Chinese population was 3.63/100 000, and the cumulative incidence rate was 0.44%. The crude incidence rate of esophageal cancer in males (11.61/100 000) was higher than that in females (1.27/100 000). The crude incidence rate of esophageal cancer in rural area (6.27/100 000) was lower than that in urban area (6.71/100 000). From 2013 to 2017, the crude mortality rate of esophageal cancer in the cancer registration areas of Heilongjiang province was 5.32/100 000, the standardized mortality rate by Chinese population was 3.01/100 000, and the cumulative mortality rate was 0.35%. The crude mortality rate of esophageal cancer in males (9.56/100 000) was higher than that in females (1.15/100 000). The crude mortality rate of esophageal cancer in rural area (5.13/100 000) was lower than that in urban area (5.39/100 000). Joinpoint regression analysis showed that from 2013 to 2017, the incidence and mortality rates of esophageal cancer in the entire population and males had an increasing trend, but the differences were not statistically significant (all P > 0.05), and the standardized incidence rate by Chinese population in females had a downward trend, and the difference was statistically significant (APC = -7.92, 95% CI -11.52- -4.21, P < 0.01). Conclusions:The incidence and mortality rates of esophageal cancer in Heilongjiang province have been increasing in recent years, and the burden of disease is still heavy. In the male population, the primary prevention, early detection and early treatment of esophageal cancer should be paid more attention.

Objective To describe and analyze the incidence and mortality of malignant tumors in Daoli District of Harbin from 2008 to 2012. Methods The tumor registration data of 2008—2012 reported by the Daoli District Cancer Registry was collect-ed. The crude incidence and mortality,China standardization rate,World standardization rate,cumulative rate and truncated incidence rate of major malignant tumors were calculated and trends of the incidence and mortality of malignant tumors in 5 years were analyzed. Results From 2008 to 2012,there were 10 893 cases of malignant tumors in Daoli District of Harbin,including 5879 males and 5 014 females. The incidence rate increased first and then stabilized. Incidence of malignancy,China standardization rate,world standardiza-tion rate,cumulative rate and truncated incidence rate in men were higher than those in women. The incidence rates were at a low level in the 0~25 age group,rising rapidly in the 25~80 age group,reaching a peak at the age of 80,and then beginning to decline. From 2008 to 2012,there were 6 801 cases of malignant tumor deaths in Daoli District of Harbin,including 4 069 males and 2 732 females. There was no significant change in mortality over five years. Malignancy mortality,China standardization rate,world standardization rate,cumulative rate and truncated incidence rate in men were higher than those in women. The mortality rates were at a low level in the 0~30 age group,rising rapidly in the 30~75 age group,reaching a peak at the age of 75,and then beginning to decline. The high-est incidence of malignant tumors in Daoli District from 2008 to 2012 was lung cancer,followed by liver cancer,colorectal cancer, stomach cancer and breast cancer. The highest mortality rate of malignant tumors was lung cancer,followed by liver cancer,colorectal cancer,stomach cancer and pancreatic cancer. Conclusion The incidence of malignant tumors in Daoli District of Harbin City in-creased first and then stabilized in 2008-2012,and there was no significant change in mortality. Lung cancer,digestive system malig-nant tumors,and female breast cancer are the main cancer types of malignant tumors incidence and death in Daoli District of Harbin.

Objective: To summarize the clinical features of 7 rare cases of hemolytic disease of newborn (HDN), and to improve the understanding of rare HDN. Methods: Data of clinical information, laboratory findings, treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M, two cases due to anti-Kidd, and one case due to anti-Duffy. All of them were admitted to the Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medial University from July 2007 to June 2017. Results: Among the four MN hemolytic babies, two were males and two were females. Jaundice was found in three cases. Two cases had hyperbilirubinemia, one of them had severe hyperbilirubinemia. All the four cases developed anemia, including severe anemia in three cases. Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia, but did not reach the level of severe hyperbilirubinemia and severe anemia. MN hemolytic disease babies got negative results in direct antiglobulin test, whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test. None of the babies had blood transfusion, and they were discharged from the hospital. Conclusions Without maternal and fetal blood group incompatibility (ABO or Rh blood-group system), for early onset of jaundice, severe jaundice or anemia, antiglobulin test to mother and child earlier should be administered, and MN, Kidd, Duffy and other rare hemolytic disease of the newborn should be pay attention to.

Epidermal growth factor (EGF) is a multifunctional growth factor,which is widely expressed in most ocular tissues including cornea,retina and sclera.It may regulate the growth and proliferation of various ocular cells with the interaction of epidermal growth factor receptor in vitro or in vivo.This article reviews the role of EGF in pathological and physiological processes of ocular diseases,including corneal injury,retinal proliferative diseases,myopia,pterygium,glaucoma,cataract,and eye tumors.