Objective:To investigate the relationship between body mass index(BMI) and osteoporosis using Mendelian randomization analysis.Methods:The genetic variation strongly related to BMI was selected as the instrumental variables in the collection data set of the genome-wide association study(GWAS). The MR-Egger regression, weighted median estimator(WME), inverse variance weighted(IVW), simple mode and weighted mode were used for Mendelian randomization(MR) analysis. The causal association between BMI and osteoporosis was evaluated by odds ratio and 95% confidence interval. The MR-APSS method was applied to make the causal inference results based on MR more reliable. The Linkage disequilibrium score regression was applied to evaluate the genetic correlation, and the horizontal pleiotropy test, heterogeneity test, and leave-one-out method were used to evaluate whether the results were reliable, The influence of heterogeneity and horizontal pleiotropy were reduced by the MR-PRESSO outlier test.Results:A total of 421 SNPs were included, with inverse variance-weighted method as the main analysis approach. The calculated OR value and 95% CI were 0.994(95% CI 0.992-0.997), indicating a protective effect of BMI on osteoporosis. The MR-APSS method showed that the effect of BMI on osteoporosis was statistically significant. Linkage disequilibrium score regression demonstrated a genetic correlation between BMI and osteoporosis. MR-Egger regression intercept showed no horizontal pleiotropy of instrumental variables, and the funnel plot showed no bias in instrumental variables. Leave-one-out analysis confirmed robust results. Conclusion:There may be a negative causal relationship between BMI and osteoporosis and BMI is a protective factor for osteoporosis.

Objective To explore whether liver cirrhosis markers aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4 index(FIB-4)based on blood biochemical indicators can predict disease free survival(DFS)and overall survival(OS)in patients with hepatocellular carcinoma(HCC)after resection.Methods 300 patients with HCC who underwent radical resection in Zhongshan Hospital,Fudan University from February 2005 to July 2017 were enrolled and the clinicopathological characteristics,recurrence and survival of these patients were retrospectively collected.The relationships between APRI,FIB-4 and postoperative recurrence and survival were evaluated.The ROC curve was used to evaluate the predictive values of APRI,FIB-4.Results The median follow-up of 300 patients was 61 months.Univariate Cox regression analysis showed that APRI,FIB-4,vascular invasion were risk factors affecting postoperative DFS and OS.The multivariate Cox regression analysis showed that vascular invasion was the independent risk factor for postoperative DFS(HR=1.518,95%CI 1.024-2.252,P=0.038)and OS(HR=2.301,95%CI 1.270-4.167,P=0.006).The time dependent ROC(time-ROC)curve showed that AUCs of APRI and FIB-4 predicting 1-year,3-year,and 5-year DFS were 0.555-0.596,which were 0.600-0.679 when predicting 1-year,3-year,and 5-year OS.Conclusions The predictive value of APRI and FIB-4 based on blood biochemical indicators alone for postoperative DFS and OS in HCC patients is limited.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective The aim of this study is to analyze the current situation and influencing factors of specialist nurses'work in 72 tertiary hospitals in Anhui Province which can provide suggestions for the training and use of specialist nurses.Methods Using stratified sampling,a survey of 2,400 specialist nurses in 72 tertiary hospitals across the province were recruited and investigated by a self-administered questionnaire on the current work status and competencies of specialist nurses,from December 2022 to January 2023.The one-way ANOVA and multiple linear regression methods to analyze the influencing factors.Results A total of 2,248 valid questionnaires were returned from specialist nurses,with a validity rate of 93.67%.Specialist nurses scored(19.07±5.11)for their current work status and(17.07±2.84)for their ability to work.The results of multiple linear regression analyses showed that the level and nature of the hospital,title,position,method of obtaining training qualifications,working time in the speciality after training,and the competence of the specialist nurses were the factors influencing the current status of the specialist nurses'work(P<0.05).Conclusion The current status of specialist nurses'work in tertiary hospitals in Anhui Province is relatively satisfactory,and it is influenced by the level and nature of the hospital,the way of training and selection,and factors of the specialist nurses themselves.It is recommended to pay attention to the subsequent use and training of specialist nurses to improve their ability to work and provide high-quality professional care to patients.

Objective To observe the effect of abdominal acupuncture in treating allergic rhinitis(AR).Methods Twenty-seven AR patients who attended Fangshan Hospital,Beijing University of Chinese Medicine from August to October 2022 were selected.They were divided into treatment group(15 cases)and control group(12 cases)according to randomized numerical table method.The treatment group received abdominal acupuncture.The control group at the same point was used one-time sterile cannula acupuncture to simulate acupuncture,but no needle was inserted into the acupoint.Two groups were treated,3 times a week for 4 weeks.The visual analogue scale(VAS),rhinoconjunctivitis quality of life questionnaire(RQLQ),Pittsburgh sleep quality index(PSQI)scores,and the histamine(HIS),leukotriene D4(LTD4),immunoglobulin E(IgE)levels were compared between two groups before and after treatment.Results At each time point after treatment,the VAS,RQLQ,PSQI scores and HIS,LTD4,IgE levels of patients in treatment group were significantly lower than those before treatment(P<0.05).There were no statistically significant differences in VAS,RQLQ,and PSQI scores,the HIS,LTD4,and IgE levels after 2-week treatment in both groups(P>0.05).After 4-week treatment and follow-up 4-week,the VAS,RQLQ,and PSQI scores,the HIS,and LTD4 levels in treatment group were significantly lower than those in control group(P<0.05).Conclusion Abdominal acupuncture has good therapeutic effect on AR and significantly improves life quality of the patients,which can reduce the levels of HIS,LTD4 and IgE.The therapy is worthy of clinical application.

Objective To analyze the epidemiological characteristics of nosocomial Escherichia coli infection and risk factors of ESBLs-producing Escherichia coli infection in children, and to provide scientific basis for better prevention of nosocomial Escherichia coli infection in children. Methods A total of 169 children with nosocomial infection hospitalized in Handan Regional Children's Hospital from January 2020 to December 2020 were selected by random sampling method. After specimen collection, bacteria were identified by VitEK-32 identification system , and drug sensitivity of isolated pure Escherichia coli colony was identified by automatic drug sensitivity analyzer Phoenix 100. Statistical analysis of drug resistance of Escherichia coli. The clinical data of the children were retrieved from the case system by uniformly trained professionals, and the department distribution, underlying diseases, clinical characteristics, antibiotic resistance, length of hospital stay, surgery, invasive exercises and other clinical data of all the children were counted. Factor logistic regression analysis of the risk factors of nosocomial infection of ESBLs Escherichia coli in children in the hospital. Results A among of 39 strains of Escherichia coli were detected in children with nosocomial infection in children's hospital. The main specimens were 22 strains (56.41%) in sputum, 11 strains (28.21%) in urine and 6 strains (15.38%) in blood.Twenty-one strains of ESBLs Escherichia coli were detected, with a positive rate of 53.85%. Fever was the most common first symptom in 37 cases (94.87%). Children with ESBLs (+) Escherichia coli infection were significantly higher than those with ESBLs (-) Escherichia coli in age, length of hospitalization, neonates/recent use of broad-spectrum antibiotics, complicated underlying diseases, and invasive operation (P<0.05). Multivariate logistic regression analysis showed that recent use of antibiotics, combined with underlying diseases, and invasive operation were independent risk factors for ESBLs infection in children in hospital (P<0.05). Conclusion The incidence of nosocomial Escherichia coli infection in children is high, and active intervention should be carried out for children who have recently used antibiotics, complicated with underlying diseases, and invasive operations to reduce the risk of ESBLs Escherichia coli infection.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Humans ; Autistic Disorder ; China/epidemiology* ; Cohort Studies ; Autism Spectrum Disorder/genetics* ; Asian People

In the emergency of the outbreak of COVID-19 in December 2019, Shaanxi Provincial Health Committee mobilized several medical teams from major hospitals in the province, and, by relying on Xi’an Chest Hospital, jointly established an anti COVID-19 consortium to control and eradicate the epidemic in a short time. Information support is an important guarantee for winning this battle. In order to realize the efficient cooperation among multiple medical teams, we have carried out some exploratory and innovative information support services on the basis of the original information system of the chest hospital. In this process, we have gone through some detours. Some compromises were made on some problems that could not be solved in the short term. Finally, in an environment full of uncertainty, a set of information support management system with basically smooth operation was built through rapid trial and error adjustment. The system mainly includes the following aspects: support of the organizational structure and operation process of the anti-epidemic consortium, support for medical collaboration related businesses of multiple medical teams, and support for statistical reports and online meetings. Information support has played a very important role in this action, and this practice has also accumulated experience for us to deal with similar situations in the future.

Radiotherapy is one of the most commonly used and effective method to treat malignant tumors in clinical practice. However, there are still some limitations including high radiotherapy doses, harmful side effects on normal tissues, and radiation resistance of tumor cells. Therefore, seeking safe and effective radiotherapy sensitizers to improve radiation sensitivity of tumor cells has been focused for a long time. Histone deacetylase inhibitors (HDACIs), as a kind of epigenetic modifiers, can regulate the sensitivity of tumor cells to ionizing radiation and ultraviolet radiation in addition to the inherent anticancer characteristics. This article reviewed the molecular mechanisms of HDACIs in enhancing radiation sensitivity and by selectively killing tumor cells.