ObjectiveTo explore the correlation between skeletal muscle mass and metabolic syndrome （MS） disease risk among middle-aged and elderly community residents in Urumqi， and to provide a theoretical basis for understanding the relationship between skeletal muscle mass and MS among middle-aged and elderly community residents in China. MethodsA total of 1 438 community residents ≥ 50 years old were selected as the research subjects from July 2018 to January 2019 in Urumqi. They were selected from a multi-ethnic natural population cohort in Xinjiang. Data were collected through questionnaires， physical examination， bioelectrical impedance analysis （BIA）， laboratory tests， etc. Skeletal muscle mass was evaluated using the limb skeletal muscle mass index （SMI） corrected for body weight； MS was defined as it at least includes three of the following： abdominal obesity， hypertension， hyperglycemia， high triglycerides and low high-density lipoprotein cholesterol. SMI was divided into four quantile arrays of Q₁‒Q₄. Trend χ² test was applied to explore whether there was a correlation between SMI changes and MS. A multivariate logistic regression model was used to analyze whether there is a difference in the risk of MS between the higher SMI group （Q₂， Q₃， Q₄） and the reference group Q₁. ResultA total of 560 MS patients were detected in this study， with a prevalence rate of 38.94%. Among them， the prevalence rate of MS was 39.16% in males and 38.80% in females. The increase in male SMI grading level is not correlated with the prevalence of MS （trend P>0.05）； After adjusting for confounding factors （model 4）， the increase in SMI was still not related to the prevalence of MS （P_trend=0.995）. There was no statistical difference in the risk of MS between the lowest quartile group Q₁ and the highest quartile group Q₄ （OR=1.01， 95%CI： 0.69‒1.78）. The prevalence of MS in women gradually decreased with the increase of SMI grading level （P_trend<0.001）； After adjusting for confounding factors （model 4）， there was still a correlation between the increase of SMI and the prevalence of MS （P_trend=0.005）. With the lowest quartile of SMI Q₁ as the reference group， the risk of MS in Q₂ （OR=0.63， 95%CI： 0.40‒1.00）， Q₃ （OR=0.56， 95%CI： 0.34‒0.94）， Q₄ （OR=0.42， 95%CI： 0.23‒0.76） decreased. ConclusionAn increase in skeletal muscle mass may be beneficial for preventing MS， especially among middle-aged and elderly female residents. Considering the intensification of aging in China and the close relationship between MS and related comorbidities， managing skeletal muscle mass may contribute to potential MS prevention.

Objective The MMV-Net,a deep learning framework based on mammogram multiple views,was constructed to evaluate the classification performance of the model for benign and malignant masses.Methods A retrospective analysis was conduc-ted on a dataset of 1 585 breast X-ray images from Harbin Medical University Cancer Hospital from 2018 to 2020,including 806 be-nign cases and 779 malignant cases.The dataset was divided into the training set(n=1268)and the test set(n=317)according to an 8∶2 ratios,and the training set was stratified according to the 5-fold cross validation.The integrated DDSM dataset and INBreast dataset were used as external test sets(n=1645)to evaluate the model performance.Each case in the input layer contained 4 views.The MMV-Net model was constructed by removing the last two layers of the ResNet22 network structure and adding an average poo-ling layer as the feature extraction layer,as well as fully connection layer and softmax activation function as the decision layers.Bayes-ian hyperparameter optimization was used.The performance of MMV-Net,MFA Net,and ensemble inception V4 models in AUC val-ues,accuracy,precision,recall and F1 scores were compared.Results The AUC values of MMV-Net model for distinguishing benign and malignant masses on the test set were 0.913,0.882 for MFA-Net,and 0.865 for inception V4.The accuracy and precision evalu-ation metrics of the MMV-Net model were also higher than the other two models.Conclusion The deep learning MMV-Net model based on multiple views of mammogram is helpful for the classification of benign and malignant breast masses.

The prevention and control of chronic and non-communicable diseases is an important public health problem in China. The general environment in the northwestern China is unique, and the health and disease status of local population is distinctive. In order to meet the urgent need for in-depth research of the causes, mechanisms and prognosis of chronic and non-communicable diseases in this area, a general population cohort in Shaanxi Province, Gansu Province and Qinghai Province, Ningxia Hui Autonomous Region and Xinjiang Uygur Autonomous Region was established during 2017-2019. A total of 117 644 general individuals aged 35-74 years in the multi-ethnic groups (Han, Hui, Uygur, Kazak and Tibetan) were recruited according to the special ecological environment, population size and ethnic distribution. The baseline information about individual exposure, environment and society were collected. More than 900 000 biological samples, including whole blood, plasma, serum and buffy coat, were collected and stored at -80 ℃ in standardized biobank. The long-term observation has started in forms of routine monitoring and active follow-up. The average age of the cohort members was 52.43 years, and 70 391 cohort members were women (59.8%). There were some differences in socio-economic status and lifestyle among different ethnic groups. Although the cohort members in different ethnic groups had similar health status, different characteristics still existed. The cohort can serve as a platform for in-depth research of the relationship between major chronic and non-communicable diseases and environment, people's lifestyle and genetic factors, and the research results can be used as important epidemiological evidence for clarifying the causes of chronic and non-communicable diseases and long-term health hazards in different ethnic groups in this area and reference for the national chronic and non-communicable disease prevention and control. This paper briefly introduces the design and practice of general population cohort in northwestern China.

The vasoactive substance resistance (VSR) in the end-stage liver disease (ESLD) refers as the reduction of patients' responsiveness to endogenous and exogenous vasoactive substances, cardiac and vascular excitability, peripheral circulatory dysfunction, but induction of related adverse events. VSR is closely related to pathogenesis and treatment-related ESLD complications. However, to date, there are so many unsolved issues, like 1). The cause and underlying mechanism of VSR in ESLD patients; 2). VSR and ESLD multiple organ damages; 3). The preventive and mitigated measurement of VSR; and 4). VSR vasoactive drug use in ESLD patients. This review discussed and summarized the up to date progress in this field of research and clinical VSR in patients with ESLD, i.e., VRS in ESLD patients, disputes of vasoconstrictor drug therapy in ESLD patients, and future research direction of the field.

Objective:To investigate the value of neck circumference (NC) for identifying metabolic syndrome (MS) in patients with type 2 diabetes.Methods:a total of 413 type 2 diabetic patients (188 male and 225 female) in Qinhuangdao Chinese Medicine Hospital from August 2018 to July 2019 were recruited. Waist circumference (WC), NC and metabolic indicators were measured. The association between WC, NC and metabolic indicators was explored. Area under the curve (AUC) was used to evaluate the abilities of NC.Results:The average age of male was (55.35 ± 14.15) years, and the detection rate of MS was 74.47% (140/188). The average age of female was (60.19 ± 10.29) years, and the detection rate of MS was 71.11% (160/225). In male group, WC showed a negative correlation with age and high density lipoprotein-cholesterol (HDL-C) ( P<0.05); NC showed a negative correlation with glycated hemoglobin, total cholesterol (TC) and HDL-C ( P<0.05), and a positive correlation with diastolic blood pressure (DBP) ( P<0.05). In female group, WC showed a positive correlation with fasting plasma glucose (FPG) and systolic blood pressure (SBP), and a negative correlation with HDL-C; NC showed a positive correlation with FPG and SBP. WC and HC were good indexes for identifying metabolic syndrome in type 2 diabetes (WC: AUC male 0.862, female 0.870; NC: AUC male 0.745, female 0.752). After applying the ROC analysis, neck circumferences ≥ 34.5 cm in males and ≥ 31.75 cm in females were determined as the best cutoff values to predict MS in type 2 diabetes. Conclusions:NC is a helpful tool to detect MS in type 2 diabetes.

Objective:To explore the clinical characteristic and prognosis of juvenile dermatomyositis (JDM) by retrospectively study of the clinical manifestations, laboratory examinations, treatment and follow-up results. The aim of this study was to improve the diagnosis and treatment of JDM and reduce the complications and mortality.Methods:Medical charts of 612 JDM cases hospitalized to Beijing children's hospital from July 2002 to July 2018. We retrospectively analyze the onset, clinical manifestations, laboratory examinations, treatment and the follow-up, and then summarize the clinical characteristics and assess the therapeutic effect and prognosis.Results:There were 278 male and 334 female. The maleto female ratio was 1∶1.2. Themedian age at symptoms onset was 5.4(2.9-8.4) years old (range 6 months to 14 years). Rash was the most common initial presentation. The main clinical manifestations were rash (100%, 612 cases) and muscles weakness (96.1%, 588 cases). The most commonly involved organs by JDM were lung (57.5%, 352 cases), digestive tract (38.5%, 236 cases) and heart (32.5%, 199 cases). Muscle enzymes elevated in 95.5% (584 cases) of the patients and 89.5%(534 cases) of the patients had typical changes on electromyography. Muscle biopsy was performed in 134 patients and pathologicresults were compatible with JDM. For the treatment, all of the patients were treated by steroids plus therapy combined with immunosuppressive agents. Mostof the patients got good effect and outcome. Twenty-four patients died, and acute respiratory failurewas the most common cause of death. 17.9%(105 cases) of patients had complications. The complications included calcinosis in 70 patients and amyotrophy in 35 patients.Conclusion:JDM is a rare disease of children, andis characterized by muscle weaknessand rash. Severe organ involvement may cause death. Treatments include corticosteroids and immunosuppressive agents, andthe outcome is generally good.

Objective:To investigate the clinical characteristics and follow-up of thrombosis of pediatric patients with systemic lupus erythematosus (SLE).Methods:In this retrospective study, inpatients who were diagnosed in Beijing Children's Hospital with SLE complicated with arterial or venous thrombosis from January 2006 to December 2019 were collected, the clinical characteristics and outcomes were analyzed. Statistical product and Service solutions (SPSS) 25.0 was used for statistical analysis. T test or χ2 test (counting data) was used to compare the differences between groups, and Kaplan-Meier survival curve was used to analyze the time of thrombus endpoint events in lupus children. Results:A total of 1 395 newly diagnosed SLE patients were admitted. Twenty-seven cases were diagnosed with thrombosis, accounting for 1.9% of all the lupus patients. The median course from diagnosis to thrombosis was 20 days (49 days before diagnosis to 1 year after dia-gnosis). Among the 27 patients, 22(81%) cases had renal involvement. The mean SLE disease activity index (SLEDAI) score was (14±6) and (11±4) at the diagnosis of lupus and at onset of thrombosis, respectively ( t=2.547, P=0.017). 30% (8/27) of the patients had no apparent clinical manifestations of thrombosis. The patients received standard anticoagulant therapy after the diagnosis of thrombosis. During follow-up, 6 patients stopped taking medications due to the severity of the primary disease. Twenty-one patients were followed up regularly for 1-3 years. Thrombosis disappeared in 12 cases (44%), thrombolysis time ranged from 16 days to 1 year. Thrombosis were getting smaller in 9 cases (33%). And the disease was stable during follow up. Conclusion:Thrombosis is not rare in pediatric patients with systemic lupus erythematosus patients. Some patients do not have apparent clinical manifestations related to thrombus. Pediatricians should be alert to patients with renal involvement need to be more vigilant for thrombosis. Early detection and active treatment are the keys to improve the prognosis of thrombosis in pediatric SLE patients.

Objective: To analyze the clinical data of children with rheumatic diseases complicated with osteonecrosis and summarize the clinical characteristics, so as to guide clinical work. Methods: The clinical data of 59 children with rheumatic diseases complicated with osteonecrosis from January 2010 to July 2018 were collected and analyzed retrospectively. Results: Among 59 children with rheumatic diseases complicated with bone infarction, 25 cases were systemic lupus erythematosus (SLE), 4 cases were mixed connective tissue disease, 6 cases were juvenile dermatomyositis, 1 case was Takayasu arteritis, 1 case was leukocy to clystic vasculitis, 13 cases were systemic onset juvenile idiopathic arthritis (SJIA), 1 case was polyarthritis, and 8 cases were juvenile ankylosing spondylitis. The median time from the onset of rheumatic diseases to osteonecrosis onset was 18 (7.00, 38.75) months. A total of 115 joints were involved in 59 children, the most common of which were bilateral hips and knees. Twenty-five were single joint involvement and 34 were multiple joints involvement. There were 37 cases (63%) with vasculitis, 9 cases (15%) with oralulcer, 5 cases (8%) with Raynaud's phenomenon, 31 cases (53%) with Cushing's face, 18 cases (31%) with kidney involvement, 25 cases (42%) with hypertension, and 12 cases (24%) with spinal compression frac- tures. According to statistics, 10 children with osteonecrosis occurred without glucocorticoid intake. The longest duration of glucocorticoid therapy was 13 years, and the average duration was about (27±35) months whensymptomatic osteonecrosis occurred. The median cumulative dose of prednisone was 381.9(209.77, 561.19) mg/kg. Conclusion SLE, SJIA and juvenile ankylosing spondylitis are the three most common rheumatic diseases in children with osteonecrosis. The locations of osteonecrosis are mostly the bilateral hips and knees. It is necessary to strengthen joint examination, physical examination and imaging screening for children with rheumatic diseases after 18 months of onset, so early detection, early treatment are the strategy to improve the prognosis of the diseases.

Objective: To construct and implement a calculation model of clinical nursing post classification. Methods: Between October to December 2018, head nurses of the hospital were screened as consultants, and Delphi method was used to determine the indicators, while the weights were assigned from the aspects of nursing workload, work quality, patient satisfaction and number of nursing night shifts. Combined with HIS data, the calculation model of clinical nursing post classification was constructed to classify clinical nursing units into different categories and levels. Results: After two rounds of expert enquiry, 82 nursing work items were identified and the objective weight assignment was determined ranging from 0.80 to16.14. According to the established calculation model and HIS data, nursing posts in clinical departments were classified into 6 levels and 3 categories, and the accurate management of clinical nursing post classification was achieved. Conclusions The construction of a calculation model is scientific and rigorous, which provides a scientific basis for dynamic nurse performance management and rational allocation of human resources. In addition, it provides a useful reference for accurate nursing management.

Objective To explore the gene mutation,clinical phenotype,treatment and prognosis of chronic infantile neurologic,cutaneous,articular (CINCA) syndrome,so as to improve the diagnosis rate,reduce the disability rate and teratogenicity rate of CINCA syndrome.Methods Ten children with CINCA syndrome admitted to our hospital were retrospectively analyzed in terms of the clinical phenotypes,auxiliary examinations,treatment and follow-up.Three ml ethylene diamine tetraacetic acid (EDTA) anticoagul-ation was taken from children and their parents with the consents.Genomic DNA was extracted by QIAamp whole blood Deoxynbonucleic acid (DNA) extraction kit (German Qiagen Company).The whole exons were detected by Agilent liquid phase capture technology (Agilent Company).Finally,Sanger sequencing was used to verify the results.Results In this study,eight mutations of NLRP3 gene were found in children with CINCA syndrome,namely 913G/A (D305N),1057G/T(V353L),1702T/A (F568I),1703T/A (F568Y),1710G/C (K570N),1789A/G (S597G),1991T/C (M664T),2269G/A (G757R).The onset age of most of the cases was less than half a month,and the initial manifestation was mainly urticaria-like rash.Short stature and special face could be seen in all 10 cases.All the patients had fever and urticarial rash in varying degrees during the course of the disease.Nine of them had obvious arthritis.Nine children had central nervous system involvement.There were 8 cases of binaural nervous deafness,7 cases of binocular optic neuritis,and 6 cases of hepato-splenomegaly and/or lymphadenopathy.Amyloid A was significantly increased.Glucocorticoids and immunosup-pressive agents are the basic drugs for the treatment of this disease.If the curative effect was not good,biological agents should be added early to alleviate the disease.Conclusion CINCA syndrome is a rare autosomal dominant hereditary disease,the main clinical manifestations of which are skin,joint and central nervous system involvement,and even amyloidosis of organs.Early diagnosis and active treatment can reduce the involvement of important organs.