The amyloid plaques (Aβ) hypotheses and Tau propagation hypothesis are still proposed as the most prevailing causes for Alzheimer's disease (AD). Recent compelling evidences have firmly demonstrated that there are tight involvements of dysfunction of the immune system in the pathogenesis and progression of AD. Here, we review the current knowledge on the role of immune system in pathogenesis of AD and discuss the most relevant findings in immunotherapies for AD to help clinician to further consider the possible direction of diagnosis and treatment of AD.

Objective:To analyze the relationship between the expression and prognosis of kinesin family member 4A (KIF4A) in renal clear cell carcinoma and explore its potential mechanism.Methods:Information on the KIF4A gene in renal clear cell carcinoma was retrieved from the UALCAN database, including expression levels, survival analysis, and positive and negative correlation gene data, from which the expression levels, prognostic information, and potential mechanisms of KIF4A in renal clear cell carcinoma were derived.Results:KIF4A is highly expressed in renal clear cell carcinoma, and male patients have a higher expression rate than female patients. The higher the tumor grade and the later the N stage, the more expression ( P<0.05). The survival analysis showed that the expression level and prognosis of KIF4A were negatively correlated ( P<0.05). Cyclin B2 (CCNB2), kinesin family member 23 (KIF23), cell division cycle associated 5 (CDCA5), and KIF4A were significantly positively correlated, whereas DHRS12, crumbs protein homolog 3 (CRB3), β-hydroxybutyrate dehydrogenase 2 (BDH2), and KIF4A were significantly negatively correlated. Conclusions:KIF4A plays an important role in the development of renal clear cell carcinoma and can be used as a potential marker and therapeutic target for the diagnosis and prognosis of renal clear cell carcinoma, including in children.

Objective:To evaluate the day-surgery unit-based training of laparoscopic cholecystectomy (LC).Methods:Perioperative data of 438 patients (187 males and 251 females) with a median age of 54 (aged 17 to 91) years undergoing LC during January 2019 to April 2021 in the day-surgery unit of Chinese PLA General Hospital were retrospectively collected and subdivided according to the training methods of surgeons [Group A( n=260): conventional training vs. Group B ( n=178): protocoled stepwise training]. The protocoled stepwise training consists of the rotation in open biliary surgery unit, the stimulator-based laparoscopic training, and the stepwise procedural tutoring. The conventional training features the traditional surgical practice following senior surgeons. The technical data involving operation time, blood loss, the percentages of intraoperative decision-making by senior surgeons and the handing-over of procedure to senior surgeons, etc. were statistically analyzed. Results:The operation time was shortened in Group B [(55±30) min vs. (61±33) min], with significantly decreased percentages of intraoperative decision-making by senior surgeons [7.9% (14/178)vs. 16.9%(44/260), P<0.05] and the handing-over of procedure to senior surgeons [3.4%(6/178) vs. 11.2%(29/260), P<0.05]. Conclusion:Based on the protocoled stepwise training and the consecutive, high-volumed and standardized procedures, the laparoscopic technical proficiency and competency of the trainee surgeons have been improved.

Objective: The prevalence of HIV/AIDS in people aged ≥50 years is increasing in China, resulting in another focus for AIDS prevention and control. A Meta-analysis was conducted to evaluate the HIV infection, its area and time distributions in people aged ≥50 years in China to provide evidence for the prevention and control of HIV/AIDS. Methods: Information on HIV infection rate in people aged ≥50 years in China were collected from Wanfang digital database, China National Knowledge Infrastructure (CNKI), PubMed and Embase. The R Studio1.1.456 software was used to calculate the pooled infection rate, and assessed the publication bias. Results: A total of 30 studies which covered 13 provinces were selected. From 2010 to 2018, the pooled HIV infection rate in people aged ≥50 years was 1.68% (95%CI:1.00%-2.79%). The HIV infection rate (2.60%) was higher in eastern China than in central and western China (0.16%, 2.13%). Conclusion The overall HIV infection rate in people aged ≥50 years is generally high in China. It is important to control the HIV infection in this population to facilitate the AIDS prevention and control in China.

Objective:To make a new simple respirator and observe the oxygen therapy effect of the respirator on patients with severe and critical coronavirus disease 2019 (COVID-19).Methods:Based on the infectivity and hospital requirements of COVID-19, a new simple respirator was designed by the medical staff of the Department of Anesthesiology of the Second Affiliated Hospital of Nanchang University, which was applied on the 22 patients with severe and critical COVID-19 who needed oxygen therapy admitted to the Cancer Center of Tongji Medical College of Huazhong University of Science and Technology from February 15th to March 15th in 2020. The new simple respirator contained two National Utility Model Patents (a respirator: ZL 2015 2 0410623.6, a fluid switch and oxygen suction device: ZL 2017 2 0873509.6), which was mainly composed of anesthesia mask and filter, L-shaped connecting tube, soft breathing bladder, connecting tube and elastic fixing belt. When in use, the anesthesia mask was fixed to the patient's mouth and nose with elastic straps, the connecting tube was inserted into the oxygen meter interface, the oxygen flow was adjusted to 6-10 L/min, and the L-shaped connecting tube was opened immediately after the soft breathing bag was full. The carbon dioxide and excess oxygen in the body was discharged from exhaust port. The oxygen flow was lowered to 2-3 L/min, the patient's respiratory rate (RR) was observed through the soft breathing bag fluctuations, and the oxygen flow was adjusted at any time. The changes of pulse oxygen saturation (SpO 2), RR and heart rate (HR) before and after application of new simple respirator were observed, and the blood gas test results of part of the patients were collected. Results:Twenty-two patients with severe and critical COVID-19 had significantly higher SpO 2 at 10 minutes after application of the new simple ventilator than before application (0.994±0.007 vs. 0.952±0.017, P < 0.01), and RR was significantly lower than that before application (times/min: 27.59±3.63 vs. 29.64±3.81, P < 0.01); after 1 day of application, each index was further improved. All 13 patients who received blood gas analysis indicated no carbon dioxide accumulation. Conclusions:The new simple respirator can significantly improve the oxygen therapy effect of patients with severe and critical COVID-19. At the same time, 2019 novel coronavirus (2019-nCoV) can be filtered through the filter to reduce the formation of aerosol and protect the medical staff and patients.

Objective:To analyze influence on HIV related fatality of implementation of 'Four Free Services One Care’ policy in China during 1993-2012, and evaluate effectiveness for the policy of HIV/AIDS prevention and treatment.Methods:The data during 1993-2003 (before the implementation of the policy) and during 2005-2012 (after the implementation of the policy) were collected from the national HIV/AIDS Comprehensive Response Information Management System for the analysis on HIV related fatality in Chinese, especially in rural residents. Interrupted time series analysis was used to analyze the trends of HIV related fatality during 1993 and 2012.Results:During the twenty years from 1993 to 2012, the HIV related fatality in China decreased, and the HIV related fatality in rural areas was higher than the overall HIV related fatality. Compared with the period before the implementation of the policy, the overall HIV related fatality decreased by 1.5 % ( P=0.156) and the HIV related fatality in rural residents decreased by 2.6 % in 2004 when the policy was implemented ( P=0.094). As for the change of slope, the overall slope rate after the policy implementation was -0.466 ( P=0.005), indicating a decrease trend of HIV related fatality. The slope rate after the policy implementation in rural residents was-0.592 ( P=0.005), indicating a decrease trend of HIV related fatality. At the same time, the slope rate after the policy implementation in rural residents infected through blood transmission route was-0.766 ( P<0.001), indicating a decrease trend of HIV related fatality. Conclusions:The implementation of the 'Four Free Services One Care’ policy in China has made remarkable progress in free HIV antiviral therapy.

Objective: To understand the AIDS awareness and related factors as well as the demands for AIDS-related health education programs, among first-grade students from three senior high schools in Tianjin. Methods: A cross-sectional study using both stratified cluster and convenient sampling methods was conducted. Anonymous questionnaires including social demographic characteristics, AIDS-related knowledge and needs for AIDS health education were distributed to the first-grade students from two general middle schools and one vocational senior middle school in Tianjin. Results: A total of 1 082 students were responding to the questionnaires. Among them, the overall awareness rates of AIDS-related knowledge were 34.3%(371/1 082), 71.9%(778/1 082) of the students had received knowledge about AIDS and 59.4% (643/1 082) of the students had received knowledge about sexual health in the past, from the three schools. There appeared statistical differences among the two types of schools. 7.0% (76/1 082) of the students reported having had sexual behaviors. Results from the multivariate logistic regression analysis showed that, in vocational senior middle school, the awareness rate of AIDS knowledge was lower (compared with general middle school, OR=0.41, 95%CI: 0.29-0.59) and in the following items, including no need in receiving safe sex health knowledge (compared with needs of safe sex health knowledge, OR=0.62, 95%CI: 0.43-0.91), no interests in reading AIDS-related health education materials (compared with attention to AIDS health education materials, OR=0.41, 95%CI: 0.30-0.56), not aware of safe sex behavior (compared with aware of safe sex behavior, OR=0.55, 95%CI: 0.39-0.77), not aware of correct condom use, compared with aware of correct condom use (OR=0.33, 95%CI: 0.24-0.46). Conclusions The overall awareness rate of AIDS knowledge was low among the first-grade students in Tianjin. Some students reported of already having had insertive sex, sexual health knowledge has a significant impact on AIDS knowledge, suggesting that sexual health education and AIDS health education among high school students be strengthened in Tianjin.

Objective To indentify the cognitive status of Chinese patients to acne and the influencing factors to theirs' cognitive status,so as to provide solid evidences for the prevention and treatment of acne.Methods A self-designed questionnaire was made to conduct this survey of 16,156 acne patients,who seeked to the treatment in the dermatological departments from 112 hospitals in China.The survey consisted of several parts,including the general status of patients,the patients' cognition of occurrence,development and risk factors of acne,whether the first choice was seeking treatment at the hospital when the patients had acne and the condition of selection of skin care products.The factors were analyzed,which could impact the cognition of the patients' behavior of treatment,how did the patients' cognition to influence their medical behavior and skin care as well as the consistency of assessment of the severity of acne by doctors and patients themselves.Results The acne patients studied had the best knowledge of "acne is a skin disease","it not only occurs in the period of adolescence" and "the disease can be prevented and cured",which accordingly accounted for 80.65％,69.16％ and 65.49％ of the total patients respectively.However,the awareness of acne patients to heredity,high sugar and dairy products as risk factors for acne was insufficient,which accounted for 48.72％,42.40％ and 18.25％ of the total patients,respectively.Gender,age,educational level,occupation and health knowledge were the main factors affecting the cognitive level of patients;the survey also found that men,patient with educational level of junior high or even lower educational condition,occupation of labor workers or farmers and patients were lack of health education with poor knowledge of the genetics and dietary were risk factors for acne;patients with age over 36 years or with mild illness had poor knowledge of dietary risk factors for acne;the difference was statistically significant (P＜0.05).The analysis of the influence of cognitive status on medical treatment behavior and skin care showed that the better the cognition,the higher the probability of patients would choose medical treatment as the first choice as well as choosing functional skin care products;the difference was statistically significant (P＜0.05).The consistency of assessment of the severity of acne by doctors and patients was poor (Kappa value ＜0.4),and the assessment of severity of acne by patients was more serious than doctors' assessment.Conclusions Patient's cognitive status will affect their medical behavior and skin care,and there is also a phenomenon that patients have a more serious assessment of their acne condition.It is suggested that health education for acne patients should be strengthened in clinical medicine so as to improve their knowledge of acne as well as preventing from acne effectively.

Purpose To observe the changes of perineal body morphology and modulus of primiparas with real-time shear wave elastography (SWE) combined with gray-scale ultrasound and to explore the influence of delivery on perineal body tension. Materials and Methods One hundred and sixty primiparas after 42 to 56 days of delivery in the Department of Gynecology and Obstetrics of the First Affiliated Hospital of Nanchang University from December 2016 to August 2017 were enrolled and divided into cesarean section group (n=80) and vaginal delivery group (n=80). Meanwhile, 100 healthy married nulliparous women during the same period were selected as nulliparous group. Perineal body depth, height and Young's modulus were measured by using gray-scale sonography and SWE at resting state and retraction status. Values of each ultrasonic parameter were analyzed. Results Difference of perineal body depth and height contraction amplitude was of statistical significance among subjects in the three groups (P<0.05). The mean Young's modulus of perineal body during resting state and retraction status in nulliparous group was higher than those in the cesarean section group and vaginal delivery group, while that in cesarean section group was higher than that in vaginal delivery group. The differences were statistically significant (P<0.05). Conclusion Different delivery modes have different effects on female perineal body muscle, among which vaginal delivery is of more obvious damage to perineal body.

Objective To investigate the correlation between admission hyperglycemia and clinical prognosis in elderly patients with community-acquired pneumonia.Methods Based on the electrical medical record (EMR),information of the patients with pneumonia was retrospectively collected and the necessary data were prepared and arranged.Based on clinical outcomes,demographic characteristics and clinical indicators were compared between groups in order to screen potential variables affecting clinical outcomes.Then,the random blood glucose level 8.6 mmol/L was considered to be the cutoff point for grouping patients,with clinical outcomes as outcome variables,random blood glucose levels as grouping variables,propensity score value analysis method was applied along with the ratio of 1:1 nearest neighbor matching method to generate paired samples in order to assess the impact of blood glucose level on mortality rate;With hospitalization time serving as time variable,survive analysis method was used to analyze COX proportional model.Results Five hundred and fifty-eight patients were enrolled in the analysis,197 patients of which were recorded dead during hospitalization (the dead group).After the correction of demographic characteristics,past medical history and blood test indexes,white blood cells,C reactive protein,random blood glucose at admission and triglyceride levels were regarded as potential factors for the deaths of patients (P<0.05).However,the propensity score analysis method suggested that there was no significant difference between the blood glucose levels and mortality.The survival analysis showed that the mortality in the high blood glucose group was higher than that in the normal blood glucose group (HR=1.68,95%CI(1.22,2.31)).Conclusion Admission hyperglycemia is an important indicator of adverse prognosis in elderly patients with pneumonia.It may be of significance for screening and identifying high-risk patients.