OBJECTIVE To investigate the impact of Netupitant and palonosetron hydrochloride capsules （NEPA） on the pharmacokinetics of Paclitaxel for injection （albumin bound） （i. e. albumin-bound paclitaxel） under different intestinal microenvironment conditions. METHODS Male SD rats were divided into a normal group and a model group （n＝16）. Rats in the model group were intragastrically administered vancomycin solution to establish an intestinal disorder model. The next day after modeling， intestinal microbiota diversity was analyzed， and the mRNA expressions of cytochrome P450 3A1 （CYP3A1） and CYP2C11 in small intestine and liver tissues as well as those protein expressions in liver tissue were measured. Male SD rats were grouped as described above （n＝16）. The normal group was subdivided into the TP chemotherapy group （TP-1 group） and the TP chemotherapy+NEPA group （TP+NEPA-1 group）； the model group was subdivided into the TP chemotherapy group （TP-2 group） and the TP chemotherapy+NEPA group （TP+NEPA-2 group） （n＝8）. Rats in the TP+NEPA-1 and TP+NEPA-2 groups received a single intragastric dose of NEPA suspension （25.8 mg/kg， calculated by netupitant）. One hour later， all four groups received a single tail vein injection of albumin-bound paclitaxel and cisplatin. Blood samples were collected at different time points after the last administration. Using azithromycin as the internal standard， plasma paclitaxel concentrations were determined by liquid chromatography-tandem mass spectrometry. The main pharmacokinetic parameters were calculated using DAS 2.0 software and compared between groups. RESULTS Compared with the normal group， the model group showed significantly decreased Chao1 and Shannon indexes （P＜0.05）， significant alterations in microbiota composition and relative abundance， and significantly downregulated expressions of CYP3A1 mRNA in liver tissue and CYP2C11 mRNA in both small intestine and liver tissues （P＜0.05）. Compared with the TP-1 group， the AUC0－t， AUC0－∞， MRT0－t of paclitaxel in the TP-2 group， the cmax， AUC0－t， AUC0－∞ of paclitaxel in the TP+NEPA-1 group and TP+NEPA-2 group were significantly increased or prolonged； CL of paclitaxel in the TP-2 group， Vd and CL of paclitaxel in the TP+NEPA-1 group and the TP+NEPA-2 group were significantly decreased or shortened （P＜0.05）. Compared with the TP-2 group， cmax of paclitaxel in the TP+NEPA-2 group was significantly increased， and Vd and MRT0－t were significantly decreased or shortened （P＜0.05）. CONCLUSIONS Intestinal microbiota disorder affects the mRNA expressions of CYP3A1 and CYP2C11， leading to decreased clearance and increased systemic exposure of paclitaxel. Concomitant administration of NEPA under normal intestinal microbiota condition increases paclitaxel exposure. However， under conditions of intestinal microbiota disorder， concomitant administration of NEPA has a limited impact on paclitaxel systemic exposure.

Objective To explore imaging manifestations of crossed ectopic fused kidney.Methods Data of 12 patients with crossed ectopic fused kidney were retrospectively analyzed,and the imaging manifestations of crossed ectopic fused kidney were observed.Results L type crossed ectopic fused kidney was detected in 5 cases,while inferior ectopic type(Ii type),S-shaped type and lump type(O type)ectopic fused kidney was found each in 2 cases,respectively,and doughnut or disc type(C-C type)ectopic fused kidney was noticed in 1 case.The ectopic fused kidney presented with empty one side renal cavity,while the morphology and position of the contralateral kidney were generally normal in all 12 cases,which crossed the midline and fused with the contralateral in situ kidney,including right to left crossed ectopic fusion in 8 cases and left to right crossed ectopic fusion in 4 cases.The ureters of the crossing kidney went across the midline,opened into the bladder trigone on the contralateral side in 11 cases or prostate in 1 case.Combined reproductive system abnormalities were found in 3 cases,including unicornous uterus,bicornuate uterus and cryptorchidism each in 1 case.Two cases were found complicated with abnormal inferior vena cava,including 1 case of both side inferior vena cava and 1 case of left inferior vena cava.Conclusion The imaging manifestations of crossed ectopic fused kidney had characteristics.Complete displaying of reveal fused kidney,ureteral course and opening was helpful to accurate diagnosis and classification of crossed ectopic fused kidney.

Objective:To analyze the characteristics of patients with chronic rhinosinusitis (CRS) in the South China region based on pathological tissue biomarkers for regional comparison.Methods:The study population consisted of CRS in-patients in the First Affiliated Hospital of Sun Yat-sen University from October 2019 to June 2022. Among all the 181 cases, 123 of them were male and 58 were female, with an average age of 40. Retrospectively collected clinical data included demographic information, preoperative symptom scores, preoperative endoscopic images, preoperative paranasal sinus computed tomography scanning images, and inflammatory serological features. In addition, 52 variables of pathological tissue biomarkers including cytokines, chemokines and remodeling factors were collected for analysis. Cluster analysis was performed on the integrated data of training set through centroid-based clustering algorithm, and the inflammatory characteristics, post-operation control status, and airway diseases comorbidity of each endotype were analyzed. R project (version 4.2.2) was used in statistical analysis.Results:Cluster analysis divided 181 patients with CRS into 4 endotypes. Cluster 1 ( n=101, 55.80%) showed a locally low inflammatory status. Cluster 2 ( n=23, 12.71%) showed a mixed type of inflammation with predominantly neutrophilic inflammation and tissue remodeling. Cluster 3 ( n=11, 6.08%) was characterized by type Ⅱ inflammation without tissue remodeling. Cluster 4 ( n=46, 25.41%) was mainly characterized by type Ⅱ inflammation with tissue remodeling, showing higher comorbidity rate of asthma and allergic rhinitis. This cluster presented more severe symptoms, significant olfactory dysfunction, extensive overall inflammation based on objective examination results, a notable increase in total eosinophil count and proportion in peripheral blood, and the highest uncontrolled rate observed one year post-surgery. In comparison to other regions, the endotype classification of CRS in Southern China was characterized by a predominant pattern of locally low inflammatory status, a moderate level of type Ⅱ inflammation with tissue remodeling, and a lesser presence of neutrophilic inflammation. Conclusion:CRS distribution in Southern China is mainly characterized by low inflammatory endotype and type Ⅱ inflammation with tissue remodeling. The latter shows more severe clinical manifestations and higher uncontrol rate after surgery.

Objective:To construct an evaluation index system for the reform of public hospital salary system and conduct empirical research, for reference in deepening the reform of public hospital salary system.Methods:Based on the building blocks of health systems and the Guiding Opinions on Pilot Work of Public Hospital Salary System Reform (Human Resources and Social Security Ministry 〔2017〕 No. 10), a preliminary index system was constructed. And the expert consultation method was used to determine the evaluation index system for public hospital salary system reform. The authors selected representative hospitals in Chaoyang district of Beijing with reform experiences of such salary system, and applied this index system for empirical research. Objective indexes were extracted from the hospital information system, which were used to evaluate relevant data before the reform (from 2016 to 2017) and after the reform (from 2018 to 2019); a questionnaire was customized based on the subjective indexes in the index system, which was used for a questionnaire survey on hospital staff, outpatient patients, and inpatients. A descriptive analysis was made on such indexes as hospital revenue and expenditure, medical expenses, salary levels, and satisfaction. The comparison of relevant data before and after the reform was conducted using one-way ANOVA. Results:This study constructed a public hospital salary system reform evaluation system, comprising 4 first-level indexes, 8 second-level indexes, and 38 third-level indexes. second-level indexes were salary level and structure, salary governance and information construction, health manpower and service provision, medical products and technology. There were 28 objective indexes and 10 subjective ones. The evaluation results of 4 representative public hospitals showed that the proportion of labor costs, hygiene materials income, treatment income, nursing income, and physician service fees to the total income increased as compared to that before the reform, with statistical significance ( P<0.05); The average medical expenses of discharged patients and the proportion of drug income (excluding traditional Chinese medicine slices) to total income decreased compared to that before the reform, and the difference was statistically significant ( P<0.05); The difference between the average medical expenses per outpatient visit and the proportion of surgical income to total income was not statistically significant ( P>0.05). There was no statistically significant difference in salary levels among employees of different genders, seniority, and educational backgrounds ( P>0.05). On the other hand, there was a statistically significant difference in salary levels among employees of different ages, majors, professional and technical titles, and employment types ( P<0.05). The actual salary of 636 employee was only 56.26% of the expected salary, and their total score of salary satisfaction was (3.33 ± 0.86) points. The scores of public service motivation, medical service quality, and job satisfaction were (3.52 ± 0.78) points, (3.91 ± 0.77) points, and (3.72 ± 0.65) points, respectively. The satisfaction scores of outpatient and inpatient patients were (4.64 ± 0.23) and (4.82 ± 0.45), respectively. Conclusions:The evaluation system for the reform of the salary system in public hospitals constructed in this study can comprehensively evaluate the effectiveness of hospital reform from a multidimensional perspective, combining quantitative and qualitative, subjective and objective aspects. It proves scientific and practical.

Objective: To explore the effect of vaccination on viral negative conversion of children with COVID-19. Methods: A retrospective cohort study was conducted. A cohort of 189 children aged 3-14 years with COVID-19 admitted to Renji Hospital (South branch) of Shanghai Jiao Tong University School of Medicine from April 7^th to May 19^th 2022 was enrolled in the study. According to the vaccination status, the infected children were divided into an unvaccinated group and a vaccinated group. Age, gender, severity, clinical manifestations, and laboratory tests, etc. were compared between groups, by rank sum test or chi-square test. The effects of vaccination on viral negative conversion were analyzed by a Cox mixed-effects regression model. Additionally, a questionnaire survey was conducted among the parents of unvaccinated children to analyze the reasons for not being vaccinated. Results: A total of 189 children aged 3-14 years were enrolled, including 95 males (50.3%) and 94 females (49.7%), aged 5.7 (4.1,8.6) years. There were 117 cases (61.9%) in the unvaccinated group and 72 cases (38.1%) in the vaccinated group. The age of the vaccinated group was higher than that of the unvaccinated group (8.8 (6.8, 10.6) vs. 4.5 (3.6, 5.9) years, Z=9.45, P<0.001). No significant differences were found in clinical manifestations, disease severity, and laboratory results between groups (all P>0.05), except for the occurrence rate of cough symptoms, which was significantly higher in the vaccinated group than in the non-vaccinated group (68.1% (49/72) vs. 50.4% (59/117),χ²=5.67, P=0.017). The Kaplan-Meier survival curve and Cox mixed-effects regression model showed that the time to the viral negative conversion was significantly shorter in the vaccinated group compared with the unvaccinated group (8 (7, 10) vs. 11 (9, 12) d, Z=5.20, P<0.001; adjusted HR=2.19 (95%CI 1.62-2.97)). For questionnaire survey on the reasons for not receiving a vaccination, 115 questionnaires were distributed and 112 valid questionnaires (97.4%) were collected. The main reasons for not being vaccinated were that parents thought that their children were not in the range of appropriate age for vaccination (51 cases, 45.5%) and children were in special physical conditions (47 cases, 42.0%). Conclusion: Vaccination can effectively shorten the negative conversion time of children with COVID-19 and targeted programs should be developed to increase eligible children's vaccination rate for SARS-CoV-2 vaccination.
Child ; Female ; Male ; Humans ; COVID-19/prevention & control* ; COVID-19 Vaccines ; Retrospective Studies ; SARS-CoV-2 ; China/epidemiology* ; Vaccines

Objective To analyze the expression of ROCK2 in osteosarcoma tissues and explore its effect on the invasion and migration of osteosarcoma cells and related mechanism. Methods Real-time fluorescent quantitative PCR, Western blot and immunohistochemical staining were used to detect the expression of ROCK2 in osteosarcoma tissues. The migration and invasion of osteosarcoma cells were analyzed by wound-healing and Transwell assays after the knockdown of ROCK2 expression. The effect of reducing ROCK2 expression on metastasis in vivo was tested by tail vein metastasis experiment. We detected the expression of EMT-related proteins in osteosarcoma cells, and added the EMT inducer TGF-β to osteosarcoma cells with down-regulated ROCK2 expression to detect the changes of cell invasion and migration. Results The expression of ROCK2 in osteosarcoma tissues was significantly higher than that in corresponding adjacent tissues (P < 0.05). After down-regulating the expression of ROCK2 in osteosarcoma cells, the invasion and migration abilities in vivo and in vitro were significantly inhibited (P < 0.05). The expression of EMT-related protein E-cadherin decreased, while N-cadherin and Vimentin proteins increased significantly. Inducing EMT could attenuate the inhibitory effect of down-regulating ROCK2 on the invasion and migration of osteosarcoma cells. Conclusion The expression of ROCK2 is increased in osteosarcoma tissues, which promotes the invasion and migration of osteosarcoma cells by inducing EMT. ROCK2 may be a potential biomarker for targeted therapy of osteosarcoma.

Objective:To observe the effects of self-made Qingyuan Shenghua decoction on coagulation dysfunction in patients with sepsis, and to explore its possible mechanism.Methods:Eighty patients with sepsis and coagulation dysfunction admitted to the department of critical care medicine of Chengdu First People's Hospital from March 2018 to April 2020 were enrolled. The patients were divided into control group and observation group according to random number table method, with 40 cases in each group. Patients in both groups received basic treatment for sepsis. On this basis, the observation group was administrated with self-made Qingyuan Shenghua decoction, one dose a day, 100 mL in the morning and 100 mL in the evening; the control group was given the same amount of normal saline. Both groups were treated for 7 days. Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (Fib), D-dimer, platelet count (PLT), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were measured before and after treatment, and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) were calculated. The length of intensive care unit (ICU) stay, the incidence of multiple organ dysfunction syndrome (MODS) and 28-day mortality was recorded.Results:The indexes of coagulation function and inflammation in the two groups were significantly improved after treatment, the improvement of various indexes in the observation group were better than those in the control group [PT (s): 16.01±1.08 vs. 19.21±1.38, APTT (s): 55.33±15.29 vs. 79.41±12.69, INR: 1.30±0.21 vs. 1.65±0.22, Fib (g/L): 2.87±0.89 vs. 5.44±1.13, D-dimer (mg/L): 2.56±1.67 vs. 6.41±2.42, PLT (×10 9/L): 125.79±18.51 vs. 95.46±18.50, WBC (×10 9/L): 7.50±0.78 vs. 12.75±4.09, CRP (mg/L): 21.27±9.32 vs. 65.44±13.40, PCT (μg/L): 1.15±0.58 vs. 6.31±1.29], and the differences were statistically significant (all P < 0.05). After treatment, APACHEⅡ and SOFA scores in the two groups decreased significantly compared with those before treatment, and the decrease in the observation group were more obvious than those in the control group (APACHEⅡ score: 10.29±1.86 vs. 15.35±2.06, SOFA score: 5.51±1.08 vs. 7.65±1.58, both P < 0.05). The length of ICU stay was shortened in the observation group than that in the control group (days: 12.22±9.48 vs. 20.22±15.35, P < 0.05). The incidence of MODS [35.0% (14/40) vs. 47.5% (19/40)] and the 28-day mortality [45.0% (18/40) vs. 47.5% (19/40)] was lower than that of the control group, but there was no statistical difference (both P > 0.05). Conclusion:Self-made Qingyuan Shenghua decoction can effectively improve the prognosis of patients with coagulation dysfunction and sepsis, and its mechanism may be related to inhibition of inflammatory reaction and improvement of coagulation function.

Objective:To explore the clinical value of T 1 mapping/indexed extracellular volume fraction (iECV) quantified with cardiac MR (CMR) parameters, and its correlation with traditional indicators of myocardial dysfunction in aortic insufficiency (AI) patients. Methods:A total of 36 patients clinically and radiologically diagnosed with chronic AI in our hospital between May 2012 and February 2016 were retrospectively selected. All AI patients underwent conventional CMR protocol, native and post T 1 mapping. CMR parameters, such as aortic regurgitant fraction (RF), late gadolinium enhancement (LGE) mass fraction, myocardial extracellular volume fraction (ECV) and iECV. Based on the values of aortic RF, AI patients were divided into mild AI group (9 cases), moderate AI group (14 cases) and severe AI group (13 cases). The clinical characteristics were teased from the patients′ electronic medical records. Univariate analysis of variance was used to compare the measurement data of native T 1 mapping, post-contrast T 1 mapping, ECV, and iECV. LSD test was used for pair wise comparison between the mild AI, moderate AI and severe AI groups. Data about cardiovascular history, New York Heart Association (NYHA) heart function classification, and LGE were compared by chi-square test or Fisher exact test. The correlation between left ventricle ejection fraction (LVEF) and iECV was evaluated by Spearman correlation analysis. Results:There was no difference in age, sex, cardiovascular history among the three groups. Comparison of patients with different severity of AI in the three groups: (1) There was statistically significant difference in the LGE positive rate among the three groups ( P=0.023), while the myocardial replacement of fibrosis increased with the grade of aortic regurgitation. (2) There was no statistically significant difference in the measurement data of native T 1 mapping, post-contrast T 1 mapping, ECV among the three groups ( H=1.815, 0.929, 2.496, all P values>0.05), while the diffuse myocardial fibrosis tended to increase with the degree of aortic regurgitation. There was statistically significant difference in iECV among the three groups ( H=16.725, P<0.001). The measurement data of iECV in the severe AI group was significantly higher than those in the other two groups ( P<0.05). LVEF value was inversely correlated with iECV ( r=-0.649, P<0.001). Conclusions:Quantitative T 1 mapping/iECV can serve as a parameter to noninvasively identify diffuse myocardial fibrosis in AI patients of different severities. It changes with LVEF and can manifest the reversible stage of left ventricular decompensation.

Objective To investigate the relationship between serum uric acid ( UA) level and brachial?ankle pulse wave velocity ( baPWV) in patients with systemic lupus erythematosus ( SLE) and lupus nephritis (LN)??Methods A total of 110 hospitalized,out?patient and healthy examinees from January 2017 to September 2017 were selected from Kailuan General Hospital??They were divided into three groups:(1)Fifty?five healthy controls were examined at the same time,and those who had no history of hypertension, myocardial infarction and stroke were excluded by physical examination??(2)Thirty?four SLE patients without LN were diagnosed according to the SLE classification standard revised by the American Society of Rheumatology ( ACR) in 1997,excluding those with lupus nephritis??( 3) 21 SLE patients with LN were diagnosed according to the SLE classification standard revised by the American Society of Rheumatology (ACR) in 1997??Pearson correlation coefficient and multivariate linear regression model were used to analyze the related factors affecting baPWV??Results The level of baPWV and the proportion of baPWV (≥1400 cm／s) in SLE without LN group and SLE with LN group were higher than those in healthy control group (all P＜0??05)??In SLE without LN group, baPWV was positively correlated with age, systolic blood pressure (SBP) and total cholesterol ( CHOL) ( r＝ 0??623,0??528,0??402, P＜0??01 or P＜0??05), and negatively correlated with blood uric acid(UA) ( r＝－0??371,P＜0??05),but the correlation was not significant??The correlation between UA and baPWV disappeared after after correction of age,SBP,diastolic blood pressure (DBP) by partial correlation analysis??In SLE with LN group,baPWV was positively correlated with SBP, DBP and serum creatinine ( Cr) ( r＝0??815, 0??725, 0??464, P＜0??01 or P＜0??05)??Multivariate stepwise regression analysis showed that SBP was independently correlated with baPWV in SLE group ( t＝2??54,P＝0??026); UA in SLE group without LN was independently negatively correlated with baPWV(t＝－2??96,P＝0??042); UA(t＝4??24,P＝0??013) and SBP(t＝7??70,P＝0??002) were independently positively correlated with baPWV in SLE group with LN??Logistic regression analysis showed that SLE was a risk factor for baPWV (≥1 400 cm／s),and the OR (95% CI) was 4??31 ( 1??56－11??88),P＝0??005,and there was statistical significance after adjusting for age,SBP,DBP,body mass index ( BMI)??However,UA was not a risk factor for baPWV (≥1 400 cm／s) (P values were 0??163 and 0??519,respectively)??Conclusion The degree of arteriosclerosis in SLE patients is higher than that in normal subjects,and the level of UA in SLE patients may be related to baPWV??

Objective To investigate the correlation between cumulative serum uric acid (cumUA) and brachial-ankle pulse wave velocity (baPWV).Methods Among the workers who participated in the four health check-up of Kailuan Group from 2010 to 2017,subjects who completed one PWV test were selected.The subjects who met the selection criteria were 20 688,subjects who lacked the first three uric acid tests and sex data were excluded.The subjects who had ischemic stroke (excluding lacunar infarction),transient ischemic attack and myocardial infarction were excluded.Decreased subjects were excluded and the extreme value were also excluded,20 295 subjects eventually meet the inclusion criteria and were included for statistical analysis.Stepwise linear regression,multivariate logistic regression and natural spline function were used to analyze the relationship between cumUA and baPWV and the influence of cumUA on baPWV.Results Among 20 295 subjects,the incidence of baPWV ≥ 14 m/s (criteria for judging atherosclerosis) increased with the increase of cumUA.There was significant difference in the incidence of baPWV ≥ 14 m/s (53.07％,54.35％,56.42％,58.41％,61.91％) among different cumUA partition groups (β=0.11,P＜0.01).In stepwise linear regression analysis,after adjusting for other confounding factors,it was found that cumUA was positively correlated with baPWV.In multivariate logistic regression analysis,after adjusting for other confounding factors,the results showed that baPWV ≥aPWVm were all risk factors for the third,fourth and fifth subgroups of cumUA compared with the first subgroup,and the OR05％CI) was 1.35(1.13,1.62) (P=0.01),1.60(1.29,1.97) (P＜0.01) and 2.14(1.64,2.80) (P＜0.01),respectively.Natural spline analysis exhibited a similar J curve relationship between cumUA and increased baPWV.Conclusion CumUA is a risk factor for increased baPWV.