ObjectiveTo investigate reinfection or the third time infection with SARS-CoV-2 among the people tested for positive from December 2022 to January 2023 and the influencing factors through a follow-up survey on previous novel coronavirus nucleic acid positive individuals between March to May, 2022. MethodsEpidemiological data of 2 583 novel coronavirus nucleic acid test positive cases were analyzed from March to May, 2022, following a follow-up survey at the 8^th and 12^th month after the first nucleic acid test positivity. Pearson chi-square method was used to analyze the differences of reinfection and the third time infection rates among first-positive patients with different characteristics. Kaplan-Meier survival analysis and Cox regression were used to analyze the influencing factors of reinfection. ResultsA total of 2 264 valid questionnaires were collected in the 8^th month after nucleic acid tested positive, with a recovery rate of 87.7% and a reinfection rate of 9.7%. The third time infection was investigated among the individuals infected twice at the 12^th month after the first nucleic acid test positivity, with a third time infection rate of 4.6%. The median interval (P₂₅, P₇₅) between reinfection and the first nucleic acid test positive for the novel coronavirus was 261 (252, 268) days and the interval (P₂₅, P₇₅) between the third time infection and reinfection was 135 (111,157) days. Gender, age, occupation, smoking, drinking and underlying diseases were not statistically associated with the risk of reinfection (P>0.05). However, the the third time infection rate for medical staffs (20.0%) was higher than that for student /teachers (14.3%) and corporate employees (9.5%), with a statistically significant difference in the third infection rate between different occupations (P<0.05). The risk of reinfection in self-employed individual was lower than that in corporate employees (HR=0.52, 95%CI: 0.33‒0.83), and which was still lower after adjustment for gender and age. The risk of reinfection among those with underlying diseases was 1.54 times (95%CI: 1.08‒2.02) higher than those without underlying diseases, but even 1.85 times (95%CI: 1.25‒2.75) higher after adjustment for gender and age. ConclusionDue to the constant mutation and variants of the novel coronavirus, the risk of reinfection and the third time infection is unavoidable. The presence of underlying diseases and occupation are the main factors influencing reinfection or third time infection.

BACKGROUND: The relationship between quality of life at three months after lung cancer surgery and different surgical approaches is remains unclear. This study aimed to compare the quality of life of patients three months after uniportal and multiportal thoracoscopic lobectomy. METHODS: Data from patients who underwent lung surgery at the Department of Thoracic Surgery, Sichuan Cancer Hospital between April 2021 and October 2021 were collected. The European Organization for Research and Treatment of Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Quality of Life Questionnaire-Lung Cancer 29 (EORTC QLQ-LC29) were used to collect quality of life data of the patients. Potential confounding factors in the baseline data were included in a multivariate regression model for adjustment, and the quality of life of the two groups three months postoperatively was compared with traditional clinical outcomes. RESULTS: A total of 130 lung cancer patients were included, with 57 males (43.8%) and 73 females (56.2%), and an average age of (57.1±9.5) yr. In the baseline data of the two groups, there was a statistical difference in the number of chest drainage tubes placed (P<0.001). After adjustment with the regression model, at three months postoperatively, there were no significant differences in all symptoms and functional status scores between the two groups (all P>0.05). The multiportal group had longer surgery time (120.0 min vs 85.0 min, P=0.001), postoperative hospital stay (6.0 d vs 4.0 d, P=0.020), and a higher incidence of early ≥ grade 2 complications (39.0% vs 10.1%, P=0.011) compared to the uniportal group. CONCLUSIONS Patients undergoing uniportal and multiportal thoracoscopic lobectomy have similar quality of life at three months postoperatively. The uniportal group may have certain advantages in terms of traditional clinical outcome indicators such as operation time, postoperative hospital stay, and early postoperative complications.
Male ; Female ; Humans ; Lung Neoplasms/surgery* ; Quality of Life ; Thoracic Surgery, Video-Assisted/adverse effects* ; Pneumonectomy/adverse effects* ; Postoperative Complications/surgery* ; Retrospective Studies

Pancreatic cancer is a type of highly malignant digestive system tumor, with a 5-year overall survival rate of < 10%. In recent years, a large number of studies have shown that there is a two-way relationship between pancreatic cancer and diabetes; diabetes is not only one of the high-risk factors for pancreatic cancer, but also a paraneoplastic phenomenon caused by pancreatic cancer. Hyperglycemia and hyperinsulinemia in patients with type 2 diabetes are risk factors for pancreatic cancer, and on the contrary, pancreatic cancer cells cause the dysfunction of pancreatic β cells through autocrine or paracrine pathways and thus lead to the onset of pancreatic diabetes. This article reviews the epidemiology and pathogenesis of pancreatic cancer and the two-way relationship between pancreatic cancer and diabetes, so as to provide a reference for clinical practice.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective To analyze the risk factors that affect the early recurrence (recurrence occurring within 3 months after surgical resection) of hepatocellular carcinoma (HCC), and to discuss the risk factors influencing the survival after hepatectomy. Methods The clinical data of 257 HCC patients, who were admitted to authors' hospital during the period from January 1, 2007 to March 31, 2014 to receive cTACE within 3 months after surgical resection of hepatocellular carcinoma, were retrospectively analyzed. According to DSA findings (lipiodol CT scan was performed in part of patients with undetermined diagnosis), the patients were divided into recurrence group and non-recurrence group. By using univariate analysis and multiple logistic regression analysis, the correlation of the clinical and pathological data with the early recurrence was analyzed. The patients were followed up, the survival time was recorded. The relationship between patient's clinical data and postoperative survival was evaluated. Results ① Of the 257 patients, early recurrence was detected in 150 patients (58. 4％, recurrence group) and no recurrence was observed in 107 patients (41. 6％, non-recurrence group). ②The presence of satellite nodules and the integrity of tumor encapsulation were two independent factors associated with the postoperative residual lesions. ③The maximum diameter of the tumor, Edmondson grade and the vascular cancer thrombus were the independent risk factors affecting survival. ④The median survival time of patients in recurrence group was markedly shortened than that of patients in non-recurrence group (39 months vs. 93 months). Conclusion The early recurrence (within 3 months after resection) of hepatocellular carcinoma is associated with the presence of satellite nodules and the integrity of tumor encapsulation. The survival of patients after hepatectomy is related to the maximum diameter of the tumor, Edmondson grade and the vascular cancer thrombus. The median survival time in patients having early recurrence is significantly shortened than that in patients having no early recurrence. (J Intervent Radiol, 2018, 27: 215-222)

OBJECTIVETo investigate the effect of MTHFR gene on schizophrenia and its cognitive function.

METHODSWe recruited 254 schizophrenia patients with stable condition, 339 healthy controls for genetic analysis and 72 healthy controls for cognitive evaluation. The repeatable battery for the assessment of neuropsychological status (RBANS) was used for cognitive measurement. PCR-RFLP technique was carried out to genotype 677C/T polymorphism.

RESULTSThere were no significant differences in genotypic or allelic frequencies of the 677C/T polymorphism between the case and control groups (P> 0.05). In the RBANS, patients had higher scores of immediate memory, visuospatial skill, language, attention, delayed memory and total scores than healthy controls (P< 0.01); Patients with different genotypes of 677C/T polymorphism had significant differences in the scores of immediate memory, attention and total scores (P< 0.05).

CONCLUSIONOur results did not provide evidence for MTHFR gene conferring susceptibility to schizophrenia. However, there was a significant association between the MTHFR gene and cognitive impairment in patients with schizophrenia, especially in immediate memory and attention.

Adolescent ; Adult ; Cognition ; Genotype ; Humans ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Middle Aged ; Polymorphism, Genetic ; Schizophrenia ; genetics ; Schizophrenic Psychology ; Young Adult

Objective To observe the changes of tissue morphology and ultrastructure of kidney in the rat model of acute necrotizing pancreatitis (ANP),and to investigate the protein expression of glycogen synthase kinase-3β(GSK-3β) and phosphorylated GSK-3βin renal tissue.Methods Sixty SPF male SD rats were randomly divided into 5 groups (n =12 for each group) according to random number method,including control group,ANP 3 h,6 h,12 h,24 h groups.ANP model was established by retrograde infusion of 5％ sodium taurocholate solution into the biliopancreatic duct.Rats were sacrificed at corresponding time points to collect pancreatic and left renal tissue.Serum amylase (AMY),lipase (LIPA),creatinine (Cr) and urea nitrogen (BUN) levels were detected.Pancreatic and renal tissues were routinely pathologically examined.Rephrocytes' ultrastructure changes were observed by projection electron microscope.GSK-3β protein expression and phosphorylated GSK-3β(p-GSK-3β) in kidney tissue were quantified by Western-blot.Results Serum AMY,LIPA,Cr,Bun and pathological scores for pancreatic and renal tissues in ANP groups were obviously higher than those in control group,which increased gradually with the progress of pancreatitis.In ANP rats,it was observed that the microvilli on the surface of the epithelial cells of renal tubules were swelling and irregularly arranged,the nucleus was condensed and broken,the nuclear chromatin was condensed and separated from the nuclear membrane,the mitochondria was condensed,swelling and vacuolated.The expression levels of GSK-3β protein in the renal tissue of the control group and ANP 3 h,6 h,12 h,24 h groups were 0.702± 0.044,0.876± 0.017,0.872± 0.034,0.855± 0.035 and 0.852± 0.032,respectively.The expression levels of p-GSK-3β were 0.626 ± 0.029,0.790 ± 0.029,0.616 ± 0.021,0.448 ±0.028 and 0.439 ± 0.017.GSK-3β protein expression was higher in ANP group than in control group,and the difference was statistically significant (all P ＜ 0.05).But there was no statistically significant difference at different time points in ANP group.p-GSK-3β protein expression increased at 3 h after modeling,and then gradually decreased.p-GSK-3β protein expression was higher in ANP 3 h group than control group and other ANP groups,which in ANP 12 h,24 h group was obviously lower than control group and ANP 3 h,6 h group,and the difference was statistically significant (P ＜ 0.05).Conclusions GSK-3β expression in the kidney of ANP rats began to increase at 3 h after modeling and maintain a high level.p-GSK-3β was transiently increased at 3 h after modeling and then gradually decreased to a level obviously lower than control group.It indicated that these changes may play a crucial role in ANP associated kidney injury.

Objective To explore the effect of paraspinal approach and posterior median approach for one -stage decompression recon-struction in the treatment of thoracolumbar spine fracture and dislocation .Methods From January 2012 to January 2014, 60 patients with thoracolumbar spine fracture and dislocation who were admitted and treated in our hospital were selected as the research objects .All patients received one-stage decompression reconstruction for treatment .According to the methods of approach , the patients were divided into the ob-servation group and the control group .The 30 cases in observation group were treated by paraspinal approach while the other 30 cases in con-trol group were treated by posterior median approach .Visual analogue score ( VAS) was applied .The status of surgery , recovery of centrum height, changes of Cobb angle as well as the occurrence rate of postoperative complications in the two groups were recorded .Results In the observation group, the operative time, time in bed and length of stay were (89.16 ±11.63) min, (39.75 ±8.69) h and (3.96 ±1.04) d respectively, which were shorter than those in the control group .The intraoperative blood loss was (89.64 ±13.62) mL which was lower than that in the control group and the difference was significant (P<0.05).One week after operation, the anterior and posterior height of centrum in the observation group increased significantly while Cobb angle significantly reduced .Compared with those before the treatment , the difference was significant (P<0.05).The maximum coronary diameter and maximum sagittal diameter of paraspinal muscles in the ob -servation group after the treatment were (48.96 ±5.34)mm and (18.16 ±6.74)mm respectively, which were significantly higher than those in the control group and the difference was significant (P<0.05).The incidence of lumbar and back pain in the observation group was 3.33%which was lower than 23.33%in the control group and the difference was statistically significant (P<0.05).Conclusion To carry out decompression reconstruction through paraspinal approach can reduce the the pain degree of patients and the incidence of lumbar and back pain after operation .

The paper described the professional approach of Shanghai Hospital Development Center(SHDC)in developing a professional team of public hospital directors by such means as operation and management-autonomy,fixed tenures system,performance appraisal,part-time job control and income distribution. Recommendations raised include an organic unity of management functions of investors and power of management of the directors to motivate them in their management;building a comprehensive investor management system and strict cadre management mechanism to enhance supervision of the directors.

Objective To investigate the protective effect of hydrogen-rich saline on lung injury associated with severe acute pancreatitis and its impact on P38MAPK and NF-κB expressions.Methods Fifty-four male Wistar rats were randomly (random number) divided into three groups:(1) hydrogen-rich saline treatment group (HRS group,n =18),in which the rats were treated with hydrogen-rich saline (6 mL/kg) administered intravenously via tail vein and HRS (20 mL/kg) administered subcutaneously at 5 min after successful modeling.(2) Severe acute pancreatitis model group (SAP group,n =18),in which rats received equivalent volume of normal saline instead of hydrogen-rich saline both intravenously and subcutaneously as in HRS group.(3) Sham operation group (SO group,n =18),in which rats were treated with sham surgery,and received equivalent volume of normal saline as in SAP group.The model of severe acute pancreatitis (SAP) was made by retrograde injection of 5％ sodium taurocholate (1 mL/kg) into cholepancreatic duct.All rats were sacrificed at 3 h,12 h,and 24 h separately after the operation (n =6 at a time).The levels of serum amylase,lipase were measured.The ratio of wet and dry lung tissues was measured.The histopathological changes of lung tissues were observed under optic microscope.The expressions of P38MAPK,p-P38MAPK and NF-κB were measured by using immunohistochemistry method.Results Compared with SAP group,there were no significant differences in levels of serum amylase [12 h (5306.7±909) vs.(5435.0 ±441.2)] and lipase [12 h (1897.8 ±149.4) vs.(1917.9± 106.8)] in HRS group (P ＞0.05),but there were significant differences in the ratio of wet and dry lung tissues [12 h (3.12 ± 0.58) vs.(1.87 ± 0.25)] and histopathology scores [12 h (2.14 ± 0.38) vs.(3.58 ±0.32)] (P ＜0.05).There was no significant difference in expression of P38MAPK in lung tissues among three groups at 12 h.Compared with SO group,the expressions of p-P38MAPK and NF-κB were significant increased in SAP group at 12 h,however,they were lower significantly in HRS group than those in SAP group.Conclusions Hydrogen-rich saline has a protective effect on lung injury associated with severe acute pancreatitis,and its mechanism may be likely related to the antioxidant effect and inhibiting the activation of P38MAPK and NF-κB.