Taking into consideration the characteristics and current development status of air medical rescue,an analysis is conducted from the perspective of hospitals to examine the focal points and challenges in establishing the capability of hospital air medical rescue.A capability framework comprising five modules,namely planning system,service model,professional teams,hardware platform,and operational procedures,is proposed.The key tasks for each module are sorted out.Furthermore,the ex-ploration and practical experience of The First Affiliated Hospital of Sun Yat-sen University are shared,with the aim of providing a reference for the construction of hospital air medical rescue capabilities in the modern era.

Objective To investigate the relationship between the development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations(ARMs)in order to improve the understanding of rectal ganglion development abnormalities in ARMs patients.Methods A retrospective trial was conducted on the male patients with complex ARMs admitted to our hospital from 2015 to 2021.The terminal rectal specimens were taken from them during anoplasty.According to the findings on development of terminal rectal ganglion after HE staining,the patients were classified into G1 group(ganglion cells observed)and G2 group(no ganglion cells observed).Imaging techniques were used to evaluate whether there were abnormalities in the spinal cord and sacrum,and their correlation with the terminal rectal ganglion development was analyzed.Results A total of 139 patients were enrolled,and their median age at anoplasty was 5.77(4.57,6.97)months.There were no significant differences between the G1(n=80,57.6％)and G2(n=59,42.4％)groups in ARMs pathological type(P=0.706)and age at surgery(P=0.140).Radiological findings showed there were 48 cases(34.5％)of spinal cord anomalies(SCA),25 cases(18.0％)of sacral abnormalities and 18 cases(12.9％)of coccyx abnormalities.No significant differences were observed in the incidences of SCA and sacral abnormalities between the G1 and G2 groups(P＜0.05).Moreover,the differences of fatty filum terminale and syrinx were statistically significant(P＜0.05).In addition,the ratio of sacrum to coccyx between the G1 and G2 groups were 0.72±0.10 vs 0.67±0.12(P＜0.05)of the anteroposterior position and 0.77±0.09 vs 0.72±0.09(P＜0.05)of the lateral position.Multivariate logistic regression analysis showed that sacral abnormalities,fatty filum terminale and syrinx were independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.Conclusion The development of terminal rectal ganglia in male patients with ARMs is closely associated with the abnormalities of spinal cord and sacrum.Sacral abnormalities,fatty filum terminale and syrinx are independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.

Objective To analyze the relationship of lipoprotein(a)[Lp(a)]with poor prognosis in chronic heart failure(CHF)patients aged over 80 years,and explore the influencing factors for poor prognosis in these patients.Methods A total of 135 over-80-year-old patients with acute de-compensated CHF admitted in Tianjin University Chest Hospital from June 2018 to August 2021 were enrolled in this study.With Lp(a)300 mg/L as the cut-off value,they were divided into higher Lp(a)group(73 cases)and lower Lp(a)group(62 cases).Their baseline clinical data and outcomes after 12 months of follow-up were collected.The primary endpoint was composite end-point including re-hospitalization due to CHF and/or all-cause mortality.Kaplan-Meier survival curve were plotted to compare the survival rates between the two groups.Logistic regression anal-ysis was employed to analyze the risk factors of poor prognosis in these patients.Results The higher Lp(a)group had larger proportion of chronic kidney disease and higher levels of homocys-teine,total cholesterol and low-density lipoprotein-cholesterol than the lower Lp(a)group(P＜0.05).Kaplan-Meier survival analysis showed that the lower group obtained significantly longer 1-year survival time without primary endpoint events than the higher group[9.8 months(95％CI:8.884-10.665)vs 8.2 months(95％CI:7.057-9.272),P＜0.05].Multivariate logistic regression analysis revealed that Lp(a)≥300 mg/L(OR=2.841,95％CI:1.133-7.092,P=0.026),female(OR=2.809,95％CI:1.111-7.092,P=0.029)and use of diuretic(OR=4.631,95％CI:1.103-19.443,P=0.036)were independent risk factors for primary endpoint events within 1 year.Con-clusion Lp(a)≥300 mg/L is an independent risk factor for re-hospitalization due to CHF and/or all-cause mortality in elderly CHF patients within 1 year after discharge.

Human genetic resources are an indispensable part of national natural science and technology resources,as well as an important strategic resource for safeguarding national security,public health,and social public interests.To promote the effective protection and rational utilization of human genetic resources,as well as improve and optimize the local human genetic resources management system in China,this paper summarized the current situation of administrative approval and supervision of national human genetic resources from 2004 to 2021 by sorting out the national human genetic resources management policies and regulations.Furthermore,the current situation and progress of local human genetic resources management in China were understood from three aspects,including development planning and programs of human genetic resources,administrative licensing and penalties,and the construction of management expert committees.The main problems of local human genetic resources management in China were discussed and analyzed,such as unclear supervision,difficulty in supervision and inspection,and capacity for services.Based on the causes of the problems and the local management work,specific countermeasures and suggestions were put forward from the perspective of clarifying the regulatory policies and procedures for human genetic resources,improving the supervision and inspection mechanisms,and improving the management and service capabilities.

The aim of this study is to investigate the effect of Dahuang Fuzi decoction(DHFZT)on the killing effect of natural killer(NK)cells and the growth of lung cancer xenografts in mice.Lewis lung cancer xenograft model was constructed,and the mice were randomly divided to the normal saline group,low and high concentrations of DHFZT groups.The growth of lung cancer xenografts in mice in the control group,low and high concentration of DHFZT treatment groups was detected.The levels of IFN-y,IL-2 and IL-10 were detected by ELISA.The killing effect of NK cells was detected by calcein release assay.The release of CD107α was detected by flow cytometry.The expression of activated receptors and the tumor cell surface ligands were detected in the con-trol group and DHFZT treatment groups.The results showed that the xenografts of Lewis mice in the DHFZT treatment groups were grown slower than that in the control group in a dose depend-ent manner(P＜0.05).Compared with the control groups,the levels of IL-2 and IFN-y in tumor tissues were increased in DHFZT treatment groups(P＜0.05),but no significant changes in IL-10.Calcein release assay showed that the killing efficiency of NK cells in the DHFZT treatment groups was increased(P＜0.05).The secretion level of IFN-y in the culture supernatant was increased by DHFZT treatment(P＜0.05).DHFZT treatment increased the expression level of CD107α of NK cells.The expression of MIC A/B on the surface of A549 and H1299 cells was up-regulated by DHFZT treatment,but not the expression of inhibitory ligand HLA-ABC.The results showed that DHFZT enhanced the killing effect of NK cells on mouse lung cancer cells by up-reg-ulating the expression of MIC A/B,increasing the secretion of IFN-y and CD107α.Hence,these re-sults indicated that DHFZT suppresses the lung cancer growth potential through regulating the killing effect of NK cells.

【Objective】 To understand the status of COVID-19 vaccination among elderly adults in long-term care facilities and analyze the influencing factors so as to provide scientific basis for improving the policy of COVID-19 vaccination. 【Methods】 The socio-demographic characteristics, disease-related data, disability, and COVID-19 vaccination status of 575 elderly adults who resided in long-term care facilities in Shaanxi Province were collected via Sojumpin in January 2022. Factors that affected non-vaccinated elderly adults were analyzed by using the SPSS 25.0 software. 【Results】 Of the included 575 participants, 199 (34.6%) were not vaccinated against COVID-19. Univariate analysis showed that COVID-19 vaccination was associated with age, room type, length of stay, marital status, number of children, chronic diseases (i.e., diabetes, stroke, dementia), disability degree, and long-term medication use. Logistic regression analysis demonstrated that age of 90 years or above (OR=4.25), triple room (OR=6.17), moderate disability (OR=2.94), severe disability (OR=6.67), long-term medication use (OR=1.81), and stroke (OR=1.74) were independent risk factors for not injecting COVID-19 vaccine. 【Conclusion】 The COVID-19 vaccination coverage rate of elderly adults in long-term care facilities needs to be improved, and more attention should be paid to the high-risk groups (e.g., who are older, and have disability, long-term medication use, or stroke).

Objective:To investigate the prognosis and related factors of ischemic cardiomyopathy.Methods:Clinical data of 271 patients with acute decompensated chronic heart failure admitted to the Cardiac Intensive Care Unit of Tianjin Chest Hospital from December 2019 to June 2022 were enrolled, including 135 cases with ischemic cardiomyopathy (ICM group) and 136 cases with non-ischemic cardiomyopathy (NICM group). Patients were followed up for 48 weeks; and the primary endpoint was all-cause death and/or readmission due to heart failure, the secondary end point was cardiogenic death. Kaplan-Meier survival curve was used to compare the difference in prognosis between the two groups. Univariate and multivariate Cox regression models were used to evaluate the factors influencing the primary and secondary end points of ischemic cardiomyopathy.Results:Compared with the NICM group, ICM group had higher proportion of patients with older age, fast pulse rate, high body mass index, comorbidities of hypertension, diabetes, chronic kidney disease, stroke or peripheral vascular disease; and greater left ventricular end-diastolic diameter, right ventricular end-diastolic anteroposterial diameter, pulmonary artery systolic blood pressure, and left ventricular ejection fraction (all P<0.05). Kaplan-Meier survival analysis showed that survival without primary endpoint (Log-rank P=0.009) and survival without secondary endpoint (Log-rank P=0.037) were lower in the ICM group than in the NICM group. Multivariate Cox regression analysis showed that elevated triglyceride (TG)/high density lipoprotein-cholesterol (HDL-C) ratio and elevated neutrophil percentage were independent risk factors for primary and secondary endpoint events in patients with ischemic cardiomyopathy. Conclusions:Patients with ischemic cardiomyopathy have lower survival rates than those with non-ischemic cardiomyopathy. High levels of TG/HDL-C ratio and neutrophil percentage are independent risk factors for poor prognosis in ischemic cardiomyopathy.

Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.

Objective     To analyze the relationship between preoperative anemia and postoperative infection and death in children with acyanotic congenital heart disease (CHD) after elective cardiac surgery. Methods     Medical records and follow-up data of 3 859 children with acyanotic CHD who underwent elective cardiac surgery in our hospital from 2011 to 2018 were retrospectively collected, including 2 081 males and 1 778 females with a median age of 32.2 (13.7, 61.5) months. The relationship between preoperative anemia and postoperative infection and death within 90 days was analyzed by univariate and multivariate regression analyses. Results     Preoperative anemia was found in 325 (8.4%) patients. There were 716 (18.6%) patients of postoperative infection, including 281 (7.3%) patients of confirmed infection and 435 (11.3%) patients of suspected infection. Forty-six (1.2%) patients died within 90 days after the operation. Univariate analysis showed that age, infection history within 3 months before admission, degree of pulmonary hypertension, the risk adjustment in congenital heart surgery-1 (RACHS-1) score, cardiopulmonary bypass (CPB), disease diagnosis,  chromosome abnormality, preoperative left ventricular ejection fraction (LVEF)<55% and preoperative anemia were associated with postoperative infection. Age, degree of pulmonary hypertension, RACHS-1 score, CPB, disease diagnosis and preoperative LVEF<55% were associated with postoperative death within 90 days. Logistic regression analysis showed that preoperative anemia was significantly associated with confirmed postoperative infection [OR=1.82, 95%CI (1.18, 2.82), P=0.007], suspected infection [OR=1.60, 95%CI (1.11, 2.30), P=0.012] and total infection [OR=1.64, 95%CI (1.20, 2.24), P=0.002]. The results of modified Poisson regression analysis showed that there was no significant association between preoperative anemia and death within 90 days after the surgery [RR=1.59, 95%CI (0.69, 3.69), P=0.276]. Conclusion     Preoperative anemia may be a risk factor for infection after elective cardiac surgery in children with acyanotic congenital heart disease.

Objective    To analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD). Methods    A total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected. Results    (1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative  predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively. Conclusion    Children with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.