Purpose To explore the cardioprotective effect of cang-ai volatile oil(CAVO)on rats with cardiac function impairment model under low-pressure and low-oxygen environment in Tibet Plateau based on 7.0T cardiovascular magnetic resonance(CMR)imaging.Materials and Methods Forty SD rats were randomly divided into the normal group,the high altitude model group,the CAVO-treated group and the rhodiola rosea-treated group,with 10 rats in each group.Except for the normal group,the rats in other groups were transferred from the plain(500 m above sea level)to the Tibet Plateau(4 250 m above sea level)for two months,and then administered with the corresponding drugs by gavage for 14 d.The left ventricle function was measured by using a 7.0T high-field strength CMR and myocardial strain was analysed by using tissue tracing technique.HE staining was used to observe the morphology of cardiomyocytes,Masson staining to observe interstitial fibrosis,wheat germ agglutinin staining to observe cardiomyocyte hypertrophy,and transmission electron microscopy to observe the morphological changes of mitochondria in each group.Serum levels of creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,cardiac troponin T,superoxide dismutase,malondialdehyde and glutathione peroxidase were detected.Intracellular reactive oxygen species levels were detected using flow cytometry.Results The left ventricular ejection fraction of rats in the CAVO-treated group was higher than that of the high altitude model group[(66.61±1.38)％vs.(60.94±3.21)％;t=3.969,P=0.032];meanwhile,the global circumferential strain of the left ventricle in the CAVO-treated group was higher than that of the high altitude model group(-25.68±1.30 vs.-22.84±1.17;t=3.967,P=0.003).HE,Masson and wheat germ agglutinin staining showed hypertrophy and necrosis as well as interstitial fibrosis and ultrastructural disruption of cardiomyocytes in the high altitude model group,which improved after CAVO treatment.The level of cardiac troponin T in the serum of rats with CAVO treatment group was significantly decreased compared with that of the high altitude model group[(314.03±20.05)pg/ml vs.(518.30±18.13)pg/ml;1=13.090,P=0.001].Conclusion CAVO treatment can reduce cardiac injury caused by low-pressure hypoxia in high altitude,and its effect can be detected dynamically and non-invasively by 7.0T high-field strength CMR.

Objective:To analyze the risk factors for the lateral condyle fracture of the humerus concomitant with fractures of ulna olecranon and coronoid (triple fracture) in children.Methods:A retrospective study was conducted to analyze the data of 584 children who had been hospitalized for lateral condyle fracture of the humerus from January 2012 to December 2022 at Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University. There were 392 males and 192 females with an age of 60.5 (43.0, 86.0) months, and 327 left and 257 right sides affected. There were 546 cases of simple lateral condyle fracture of the humerus (simple group) and 38 cases of triple lateral condyle fracture of the humerus (triple group). The treatment methods for the triple group were recorded, and the elbow function of the children in the triple group was assessed using the Mayo Elbow Performance Score (MEPS) at the last follow-up. First, a univariate analysis was conducted of the gender, side profile, surgical age, height, weight, and distribution of the Jacob and Milch types of the lateral condyle of the humerus in the 2 groups. Next, the P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:All the fractures of the lateral condyle of the humerus were treated by internal fixation with Kirschner wires after closed or open reduction. The 38 patients in the triple group were followed up for 15.0 (13.0, 21.3) months after surgery. There were no such serious complications as bone nonunion, malunion, ischemic necrosis, cubitus valgus, or delayed ulnar nerve paralysis. At the last follow-up, the MEPS score was 97.5 (95.0, 100.0) points. The univariate analysis showed that surgical age ( P=0.087), Jacob type ( P=0.044) and Milch type ( P<0.001) were the risk factors for a triple fracture. The multivariate logistic regression analysis showed that Milch type Ⅰ was an independent risk factor for a triple fracture ( OR=25.764, 95% CI: 11.645 to 57.001, P<0.001). Conclusion:Milch type Ⅰ is an independent risk factor for a triple fracture of lateral condyle fracture of the humerus in children.

Hepatitis B virus (HBV) infection is a common cause of liver disease in China, and with the continuous progress in the research on antiviral therapy for chronic hepatitis B, the indications for antiviral therapy are constantly expanding. However, there are still controversies over the indications for antiviral therapy in patients with chronic hepatitis B (CHB), especially those with negative HBV. By analyzing the limitations of HBV DNA detection, the risk of HBV reactivation in HBV-negative CHB patients, the risk of disease progression in the DNA-negative population with compensated hepatitis B cirrhosis, antiviral response, and the economic benefits of antiviral therapy, this article proposes the necessity of antiviral therapy for HBV-negative HBsAg-positive patients with compensated hepatitis B cirrhosis.

ObjectiveTo investigate the features of liver injury and related influencing factors in adolescents and adults with infectious mononucleosis (IM). MethodsA retrospective analysis was performed to investigate the features of liver injury in adolescents and adults with IM who were hospitalized in Peking University First Hospital from January 2005 to December 31 2018, and the patients were divided into subgroups based on age, Epstein-Barr virus (EBV) DNA level, and presence or absence of jaundice or infection with cytomegalovirus or hepatitis E virus (HEV). The t-test was used for comparison of continuous data meeting analytical conditions between two groups, and the Mann-Whitney U test was used for comparison of continuous data which did not meet analytical conditions between two groups; the chi-square test was used for comparison of categorical data between two groups, and the Fisher’s exact test was used for comparison of categorical data which did not meet the analytical conditions of the chi-square test. A logistic regression analysis was used for multivariate analysis. ResultsA total of 274 patients were enrolled, with 154 male patients (56.2%) and 120 female patients (43.8%), and the mean age of onset was 22.3±67 years. The incidence rate of liver injury ［defined as alanine aminotransferase (ALT) ＞50 U/L and/or aspartate aminotransferase (AST)＞40 U/L］ was 97.4% (267/274), and that of jaundice was 27.6% (74/268). The patients, aged ≥20 years, tended to have a higher level of gamma-glutamyl transpeptidase (GGT) (Z=2.070, P=0.038). Serum EBV DNA was measured for 167 patients, among whom 90 had positive results and 77 had negative results. The positive serum EBV DNA group had significantly higher levels of GGT (Z=3.005, P=0.003) and lactate dehydrogenase (Z=2.162, P=0.031) than the negative serum EBV DNA group. The patients with cytomegalovirus infection tended to have a higher level of alkaline phosphatase (Z=2.351, P=0.019), and the patients with HEV infection presented with a higher level of GGT (Z=1.988, P=0.047). AST (odds ratio ［OR］=1.006, 95% confidence interval ［CI］: 1.002-1.010, P=0.005) and ALP (OR=1.012, 95%CI: 1.005-1.020, P=0.001) were independent risk factors for jaundice. ConclusionThere is a high incidence rate of liver injury in adolescents and adults with IM, and the patients with an older age or positive serum EBV DNA tend to have more severe liver injury.

Objective:To analyze the effectiveness of antiviral therapy on adolescents and adults with infectious mononucleosis (IM).Methods:The clinical data of patients aged≥16 years old with IM who were hospitalized in Peking University First Hospital from January 1, 2005 to December 31, 2018 were analyzed retrospectively, and the patients were divided into antiviral treatment group and non-antiviral treatment group. The duration of hospitalization day, fever duration, ratio of lymphocytes and duration for normalization of Epstein-Barr virus (EBV) markers were compared between the two groups through single factor and propensity score matching analysis. Statistical analysis was conducted by independent sample t test, Mann-Whitney U test, chi-square test or Fisher exact probability method. Results:A total of 274 cases were enrolled and 176 cases (64.23%) were divided into antiviral treatment group and 98 cases (35.77%) into non-antiviral treatment group. The proportion of male (56.25%(99/176) vs 56.12%(55/98)), age (21.0(18.0, 26.0) years old vs 21.0(18.0, 27.0) years old), the ratio of fever (98.30%(173/176) vs 93.88%(92/98)), sore throat (90.34%(159/176) vs 88.78%(87/98)), lymphocyte ratio (0.648(0.568, 0.707) vs 0.663(0.581, 0.711)), atypical lymphocyte ratio (0.150(0.100, 0.235) vs 0.135(0.060, 0.250)) and serum EBV DNA level (2.71(2.70, 3.47) lg copies/mL vs 2.70(2.70, 3.28) lg copies/mL) were comparable between two groups at admission, and the differences were all not statistically significant(all P>0.05). The durations of hospitalization and fever in antiviral treatment group were 14.0(10.0, 18.0) d and (14.91±7.24) d, respectively, which were both significantly longer than those in non-antiviral treatment group (11.0(7.0, 15.0) d and (9.95±5.67) d, respectively). The differences were both statistically significant ( Z=-3.294 and t=-5.035, respectively, both P<0.01). Twenty-six patients each in the antiviral treatment group and non-antiviral treatment group were included in the propensity score matching assessment. The fever days of the two groups were 15.0(10.0, 18.0) d and 7.5(5.0, 12.5) d, respectively, and the hospitalization days were (15.4±5.5) d and (12.0±5.7) d, respectively. The differences were both statistically significant ( Z=-3.781 and t=-2.187, respectively, both P<0.05). However, there were no significant differences in the time required for the ratio of lymphocytes returning to normal, the time required for the ratio of atypical lymphocytes decreasing to <0.100, and the time required for serum EBV DNA becoming negative(all P>0.05). Conclusion:The antiviral treatment could not improve the prognosis of adolescent and adult IM patients.

Objective:To investigate the correlation of monocyte/lymphocyte ratio (MLR) with the prognosis and adverse event in critically ill patients.Methods:Basic information of patients were extracted from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ), including demographics, blood routine, biochemical indexes, systemic inflammatory response syndrome score (SIRS), sequential organ failure assessment (SOFA) score, and outcome, etc. MLR on the first day of intensive care unit (ICU) admission was calculated. The receiver operating characteristic curve (ROC curve) was applied to evaluate the prognostic value of MLR on the 30-day mortality and its cut-off value. According to the cut-off value, the patients were divided into two groups, and the differences between the groups were compared. Logistic regression model was used to analyze the relationship of MLR with 30-day mortality, continuous renal replacement therapy (CRRT), mechanical ventilation, the length of ICU stay, and total hospitalization time.Results:① A total of 43 174 critically ill patients were included. ROC curve showed that area under ROC curve (AUC) of MLR in predicting 30-day mortality was 0.655 [95% confidence interval (95% CI) was 0.632-0.687]. The cut-off value of MLR calculated according to the maximum Yoden index was 0.5. There were 16 948 patients with MLR ≥ 0.5 (high MLR group) and 26 226 patients with MLR < 0.5 (low MLR group). ② Compared with the low MLR group, the high MLR group had higher age, proportion of male, body mass index (BMI) [age (years old): 66.0 (51.7, 78.4) vs. 57.6 (27.1, 74.6), proportion of male: 57.2% vs. 52.5%, BMI (kg/m 2): 26.5 (22.5, 31.1) vs. 24.7 (14.3, 29.7)]. The high MLR group also had higher incidence of complications (hypertension: 49.2% vs. 44.6%, chronic heart failure: 32.6% vs. 21.7%, diabetes mellitus: 27.0% vs. 23.4%, chronic obstructive pulmonary disease: 21.5% vs. 16.1%, renal insufficiency: 19.3% vs. 13.1%), and higher white blood cell count (WBC), blood glucose, lactate (Lac), serum creatinine (SCr), SIRS score and SOFA score [WBC (×10 9/L): 13.8 (9.6, 19.2) vs. 11.5 (8.4, 15.6), blood glucose (mmol/L): 8.66 (6.88, 11.49) vs. 8.27 (6.55, 10.88), Lac (mmol/L): 2.2 (1.5, 3.7) vs. 2.1 (1.4, 3.3), SCr (μmol/L): 106.1 (70.7, 176.8) vs. 88.4 (70.7, 132.6), SIRS score: 3 (2, 4) vs. 2 (2, 3), SOFA score: 4 (2, 7) vs. 3 (1, 5)]. The 30-day mortality, and the proportion of patients with length of ICU stay > 5 days, total hospitalization time > 14 days, CRRT and mechanical ventilation > 5 days were significantly higher in high MLR group (30-day mortality: 20.0% vs. 8.3%, length of ICU stay > 5 days: 33.2% vs. 20.4%, total hospitalization time > 14 days: 33.7% vs. 16.2%, CRRT: 3.6% vs. 0.7%, mechanical ventilation > 5 days: 18.4% vs. 5.7%), with statistically significant differences (all P < 0.05). ③ After adjusted with the related factors, multivariate Logistic regression analysis showed that elevated MLR was an independent risk factor for increased 30-day mortality [odd ratio ( OR) = 1.54, 95% CI was 1.37-1.72, P < 0.001]. Moreover, the increased MLR was independently associated with the increased risk of usage of CRRT ( OR = 2.77, 95% CI was 2.18-3.51), mechanical ventilation > 5 days ( OR = 2.45, 95% CI was 2.21-2.72), the length of ICU stay > 5 days ( OR = 2.29, 95% CI was 2.10-2.49), and total hospitalization time > 14 days ( OR = 2.28, 95% CI was 2.08-2.49), all P < 0.001. Conclusions:Retrospective analysis of large sample shows that MLR elevation is an independent risk factor for 30-day mortality, usage of CRRT, prolonged mechanical ventilation time, prolonged hospitalization, prolonged length of ICU stay. MLR can be used for risk stratification of severe patients.

OBJECTIVE： To study the efficacy and economics of cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with multidrug-resistant Acinetobacter baumannii （MDRAB）. METHODS： By prospective study， 150 MDRAB pneumonia patients were selected from Jingmen Second People’s Hospital during Jan. 1st， 2016-Aug. 31st， 2019， and then randomly divided into control group and observation group， with 75 cases in each group. Control group was given Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Tigecycline for injection （first dose 100 mg， maintenance dose 50 mg， q12 h， ivgtt）. Observation group  was give Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Moxifloxacin hydrochloride and sodium chloride injection （400 mg， qd， ivgtt） and Amikacin sulfate injection （0.6 g， qd， ivgtt）. The treatment lasted for 14 days in both groups. The time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal， clinical efficacy， bacterial clearance rate and the occurrence of ADR were compared between 2 groups. Cost-effectiveness analysis was used to evaluate the cost- effectiveness ratio （C/E） and incremental cost-effectiveness ratio （ΔC/ΔE） of 2 groups using antibiotics cost as cost. Sensitivity analysis was performed by reducing drug cost by 15％. RESULTS： There was no statistical significance in the time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal between control group and observation group （P＞0.05）. Clinical response rates of 2 groups were 85.33％ and 81.33％， and bacterial clearance rate were 89.33％ and 82.67％， with statistical significance （P＞0.05）. No serious ADR occurred in either group. The antibacterial cost of control group and observation group were 32 371.49 yuan/person and 9 367.82 yuan/person. C/E of clinical response rate were 379.37 and 115.18， and C/E of bacterial clearance rate were 362.38 and 113.32 in 2 groups， respectively. ΔC/ΔE of clinical response rate and bacterial clearance rate between control group and observation group were 5 750.92 and 3 454.00. Sensitivity analysis supported cost-effectiveness analysis results. CONCLUSIONS： Cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with MDRAB has similar efficacy， but cefoperazone/sulbactam combined with moxifloxacin and amikacin has economic and social benefits.

Objective To explore the possible associations between EBV capsid antigen-immunoglobulin M antibody (EBV-VCA-IgM ) ,serum EBV DNA load and clinical severity ,laboratory results in adolescent and adult patients with infectious mononucleosis (IM ).Methods Clinical data of 250 adolescent and adult IM patients were retrospectively analyzed .Patients were divided into two groups by EBV-VCA-IgM titer (＞160 U/mL or≤160 U/mL) and serum EBV DNA level (＞3 .38 lg copies/mL or ＜3.38 lg copies/mL) ,respectively . Clinical data were compared between the two groups ,respectively .The t test was used for intergroup comparison and the Mann-Whitney U test was used for non-normally distributed data .Results Compared with those with lower VCA-IgM antibody titer (≤160 U/mL) ,sore throat (83.0%[122/147] vs 67.2%[43/64] ,χ2＝ 6.534 ,P＝0 .011) ,pharynx secretion (59 .9%[88/147] vs 40 .6%[26/64] ,χ2＝6.645 , P＝0 .010) ,and swollen tonsils (78 .9%[116/147] vs 59.4%[38/64] ,χ2＝8.631 , P＝0.003) were more common in those with higher VCA-IgM antibody titer (＞160 U/mL).ALT level was higher as well in those with higher VCA-IgM antibody titer (290 .5 [168.0 ,460.5] U/L vs 221 .0[113 .0 ,440.5] U/L ,Z＝ －2.251 ,P＝0.024).The peak body temperature ([39.2 ± 0.7]°C vs [38.7 ± 0 .7]°C ,t＝ －3 .150 ,P＝0.002) ,maximum WBC counts (16 .2 [12 .2 ,20.4]×109/L vs 13.4[11 .1 ,17.3]×109/L ,Z＝ －2 .098 , P＝0.036) ,maximum percentage of lymphocyte ([72.0 ± 7.8]% vs [68.2 ± 7 .0]%,t＝ －2.238 ,P＝0.028) ,and lymphocyte EBV DNA load ([5 .5 ± 0.9] lg copies/mL vs [4 .8 ± 1 .0] lg copies/mL ,t＝ －2 .602 ,P＝0.012)in those with higher serum EBV DNA load ＞3 .38 lg copies/mL were higher than those with serum EBV DNA load ＜3.38 lg copies/mL . Regression analysis showed that serum EBV DNA load was associated with the peak body temperature (regression coefficient 0.368 , P＝0.003) and lymphocyte EBV DNA load (regression coefficient 0.389 , P＝0.002).Conclusions In adolescents and adults ,EBV-VCA-IgM antibody titer and serum EBV DNA load are associated with severity of patients with infectious mononucleosis .

Objective:To explore the influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai,and to explore the relevant policy for reasonable control of hospitalization costs.Methods:A total of 10 065 patients with malignant tumors were enrolled in this study.The multiple linear regression analysis was used to seek the determinants for hospitalization cost of malignant tumor patients during the final phase.Results:The median length of hospital stay was 43 days for the patients,with an average age of (70.73±12.87) years.Among them 61.66％ of hospitalized patients were male and the median hospitalization cost of malignancy was 55 447.84 yuan.Hospitalization cost showed the linear regression relationship with type of health care,hospital level,hospital types,tumor types,length of hospital stay,surgery,age,gender,and time from hospital admission to death.Conclusion:Proximity to death in malignant tumor patients is an important factor for the hospitalization cost.Medical resources should be allocated rationally,and the comprehensive measures should be taken to control the cost reasonably.

Objective To detect the expression of dead box 1(DDX1)gene in tumor tissue and pericarcino-matous tissue of clinical neuroblastoma(NB)samples,and explore the relationship between DDX1 and NB. Methods Five cases of pathological specimens in children with NB were chosen from Department of Pathology,the First Affi-liated Hospital of Xinxiang Medical University between January 2012 and December 2014. In the 5 cases,3 cases were male,2 cases were female,the age of 1 - 5 years old,average age(2. 1 ± 1. 6)years. The NB tissue and pericarcino-matous tissue(pericarcinomatous tissue was normal tissue which was at least 2 cm from the tumor tissue)of 5 children were collected and fixed in 40 g/ L formaldehyde solution. Then with the conventional dehydration,embedding,sectio-ning, dewaxing, hydration, antigen repair, add primary antibodies, secondary antibodies, diaminobenzine chromogenic. The expressions of DDX1 in tumor tissue and pericarcinomatous were observed with light microscopy and with semi - quantitative analysis.(1)Staining degree:no staining with 0 score;light staining with 1 score;medium staining with 2 scores;deeply staining with 3 scores.(2)Positive cells proportion:positive cells proportion ﹤ 10% with 0 score;positive cells proportion within 10% - 30% with 1 score;positive cells proportion within 31% - 60% with 2 scores;positive cells proportion ﹥ 61% with 3 scores. Final scores were a half of the sum of staining degree score and positive cells proportion score,final score within 0 -1. 0 with - ,1. 1 -2. 0 with + ,2. 1 - 3. 0 with + + ,3. 1 -5. 0 with + + + . Results DDX1 were expressed in NB and pericarcinomatous tissues,but visible DDX1 positive staining number more and deeper in NB,DDX1 positive staining number less and light in pericarcinomatous tissues. Five cases of pericarcinomatous tissues immunohistochemical semi - quantitative score were negative and final scores were 1. 0 score or less,the mean value was 0. 5 score. NB immunohistochemical semi - quantitative score were+or + +and final scores were 1. 5 score or higher,the mean value was 1. 8 scores,the expressions of DDX1 were sig-nificantly higher in NB than the pericarcinomatous tissues. Conclusions DDX1 is highly expressed in NB,which may contribute to the development of NB. This suggest DDX1 may serve as an oncogene and play a catalytic role in the de-velopment of NB,which provides a clinical evidence for the follow - up study.