ObjectiveTo investigate the risk factors for survival after transjugular intrahepatic portosystemic shunt （TIPS） in patients with liver cirrhosis and esophagogastric variceal bleeding （EGVB）， and to establish a predictive model for survival after TIPS. MethodsClinical data were collected from 352 patients with liver cirrhosis and EGVB who underwent TIPS in Department of Gastroenterology， Affiliated Drum Tower Hospital of Nanjing University Medical School， from January 2015 to December 2018， and the patients were randomly divided into training group （n=248） and validation group （n=104） at a ratio of 7∶3. The Cox regression analysis was used to identify the independent risk factors for survival after TIPS， and a nomogram predictive model was established. The index of concordance （C-index） and the receiver operating characteristic （ROC） curve were used to assess the discriminatory ability of the model， and the calibration curve was used to assess the predictive value of the model. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier analysis was used to calculate cumulative survival rate. ResultsFor the patients in the training group， the 1-，3-， and 5-year cumulative survival rates were 91.1%，79.5%， and 77.0%， respectively. The multivariate Cox regression analysis showed that age （hazard ratio ［HR］=1.047， 95% confidence interval ［CI］：1.032‍ ‍—‍ ‍1.092，P<0.001）， MELD score （HR=1.127，95%CI：1.003‍ ‍—‍ ‍1.268，P=0.045）， and serum sodium （Na） （HR=0.928，95%CI：0.878‍ ‍—‍ ‍0.981，P=0.008） were independent influencing factors for survival， and a predictive model and a nomogram were established based on these factors. The predictive model had a C-index of 0.760 in the training group and 0.757 in the validation group. In the training group， the nomogram had an area under the ROC curve of 0.807，0.788， and 0.787， respectively， in predicting 1-，3-， and 5-year cumulative survival rates. The calibration curve showed relatively high consistency between the results predicted by the nomogram and the actual results. ConclusionA nomogram model is established based on age， MELD score， and Na for predicting survival after TIPS in patients with liver cirrhosis and EGVB， and this model has good discriminatory ability and accuracy.

AIM: To understand the screening and correction of myopia in children and adolescents from the Gannan region of Gansu Province, and to provide guidance for the prevention and control of myopia.METHODS: A cross-sectional stratified cluster sampling study was conducted to select 2 kindergartens and 12 primary and secondary schools in Hezuo City and Zhouqu County, Gannan region of Gansu Province, two classes were randomly selected from each grade, and the whole class was used as a unit for screening. The screening and correction of myopia in children and adolescents were collected for statistical analysis.RESULTS: A total of 5 072 children and adolescents were selected, and 4 806 valid data were finally included after excluding unqualified records. The overall prevalence of myopia was 45.55%, and the prevalence of myopia showed an increasing trend with the increase of grade(P<0.001). The prevalence of myopia in girls(48.66%)was higher than that in boys(42.18%; P<0.001). The prevalence of myopia increased with age(P<0.001), and the age group of 10-12 years old was the fastest growing for myopia, increasing from 25.62% to 60.57%. Furthermore, moderate myopia and high myopia showed an increasing tread with the increase of the grade(all P<0.001). The overall glasses wearing rate of the Gannan region was 28.55%, with a full correction rate of 50.72%, and the glasses wearing rate showed an increasing trend with the increase of grades(P<0.001). The glasses wearing rate of female students(30.84%)was higher than that of male students(26.69%; P=0.008). The full correction rates of low, moderate and high myopia in junior high were the lowest among the 3 phases of studying. The full correction rate of high myopia was the lowest in all phases of studying.CONCLUSION: The prevalence of myopia in children and adolescents from the Gannan region is lower than the national average, but the myopia of children and adolescents is still a trend of young age and high incidence, and the glasses wearing rate of myopia and full correction rate are low.

Objective:To explore whether transjugular intrahepatic portosystemic shunt (TIPS) can improve the prognosis of esophagogastric variceal bleeding (EGVB) combined with sarcopenia in cirrhotic patients.Methods:A retrospective cohort study was performed. A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected. Regular follow-up was performed for the long-term after treatment. The primary outcome was transplantation-free survival. The secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE). The obtained data were statistically analyzed. The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups. The χ2 test, or Fisher's exact probability test, was used to compare categorical variables between groups. Results:The age of the included patients was 55.27±13.86 years, and 286 cases were male. There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia. The median follow-up period was 43 months. The two groups had no statistically significant difference in follow-up time. There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort ( HR=1.31, 95% CI: 0.97-1.78, P=0.08). The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival (median survival: 47.76 vs. 52.45, χ2=4.09; HR=1.55, 95 CI: 1.01~2.38, P=0.04). There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia ( HR=1.22, 95% CI: 0.78~1.88, P=0.39). Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination (patients without combined sarcopenia: median rebleeding time: 39.48 vs. 53.61, χ2=18.68; R=2.47, 95 CI: 1.67~3.65, P<0.01; patients with sarcopenia: median rebleeding time: 39.91 vs. 50.68, χ2=12.36; HR=2.20, 95 CI: 1.42~3.40, P<0.01). TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group (sarcopenia patients: 6.93% vs. 16.67%, χ2=3.87, P=0.049; patients without sarcopenia combination: 2.19% vs. 9.68%, χ2=8.85, P=0.01). There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups ( P>0.05). Conclusion:TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis. However, its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.

Objective To investigate the long-term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of primary biliary cholangitis (PBC) with portal hypertension. Methods A retrospective analysis was performed for 102 patients who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to August 2021, and these patients were divided into PBC group with 41 patients and viral hepatitis cirrhosis group with 81 patients. Related indicators were collected, including routine blood test results, liver and renal function, coagulation function, portal vein thrombosis, hepatic encephalopathy, and etiology of TIPS treatment shortly after admission, preoperative portal venous pressure, and stents used in surgery, and Child-Pugh score was calculated. Follow-up data were collected and analyzed, including postoperative upper gastrointestinal rebleeding, stent dysfunction, hepatic encephalopathy, and the data on survival and prognosis. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for survival difference analysis. Results In the PBC group and the viral hepatitis cirrhosis group, the median percentage of reduction in portal venous pressure after surgery was 33.00% and 35.00%, respectively, and there was no significant difference between the two groups ( P > 0.05). At the end of follow-up, there were no significant differences between the PBC group and the viral hepatitis cirrhosis group in stent dysfunction rate (14.63% vs 24.69%, χ 2 =1.642, P > 0.05), upper gastrointestinal rebleeding rate (17.07% vs 24.69%, χ 2 =0.917, P > 0.05), the incidence rate of overt hepatic encephalopathy (12.20% vs 7.41%, χ 2 =0.289, P > 0.05), and disease-specific death rate (14.63% vs 9.88%, χ 2 =0.229, P > 0.05). Conclusion For PBC patients with portal hypertension, TIPS can achieve the same efficacy as the treatment of portal hypertension caused by viral hepatitis cirrhosis and can also effectively reduce portal hypertension without increasing the incidence rate of complications and disease-specific death rate. Therefore, it is a safe and effective treatment method.

Objective:To explore the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of esophago-gastric variceal bleeding (EGVB) complicated with cavernous transformation of portal vein (CTPV).Methods:From January 1, 2015 to December 31, 2018, the clinical data of liver cirrhosis patients with EGVB and complicated with (CTPV group) or without (non-CTPV group) CTPV receiving TIPS at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were retrospectively analyzed. The success rate of operation, stent patency rate, recurrent bleeding rate, incidence and survival rate of hepatic encephalopathy of CTPV group and non-CTPV group were analyzed. Independent samples t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Kaplan-Meier method was used for survival analysis. Results:A total of 37 liver cirrhosis patients with EGVB and CTPV receiving TIPS treatment were screened out, among which 10 patients (27.0%) failed the portal vein puncture during the TIPS and switched to endoscopic treatment, the success rate was 73.0%. A total of 460 liver cirrhosis patients with EGVB and non-CTPV received TIPS treatment, among which TIPS in 18 patients (3.9%) was failed, and the success rate was 96.1%. With 1∶2 ratio propensity matching, 54 patients were enrolled in non-CTPV group. In the CTPV group, after TIPS treatment, the average portal vein pressure decreased from (28.9±5.1) mmHg (1 mmHg=0.133 kPa) to (18.8±4.5) mmHg, and the difference was statistically significant ( t=7.122, P<0.01). The median follow-up time was 33 months(1 to 66 months). There were no significant differences between the CTPV group and the non-CTPV group in one-year of cumulative stent patency rate (75.0% vs. 86.8%), recurrent upper gastrointestinal bleeding rate of hepatic encephalopathy (21.0% vs. 10.0%), the incidence of hepatic encephalopathy (34.8% vs. 22.2%) and the survival rate (80.7% vs. 88.9%)(all P >0.05). Conclusion:TIPS is safe and effective in the treatment of liver cirrhosis patients with EGVB and CTPV, and does not increase the incidence of postoperative complications and long-term mortality.

Invasive fungal infections (IFIs) represent a growing public concern for clinicians to manage in many medical settings, with substantial associated morbidities and mortalities. Among many current therapeutic options for the treatment of IFIs, amphotericin B (AmB) is the most frequently used drug. AmB is considered as a first-line drug in the clinic that has strong antifungal activity and less resistance. In this review, we summarized the most promising research efforts on nanocarriers for AmB delivery and highlighted their efficacy and safety for treating IFIs. We have also discussed the mechanism of actions of AmB, rationale for treating IFIs, and recent advances in formulating AmB for clinical use. Finally, this review discusses some practical considerations and provides recommendations for future studies in applying AmB for combating IFIs.

Objective: To analyze the mental health status of the Chinese Medical Team (CMT) members and its influencing factors. Methods: A total of 1 015 members of the CMT were recruited and surveyed by using a self-administered questionnaire and 12-item General Health Questionnaire (GHQ-12) from May 10 to June 10, 2018. Multivariable logistic regression models were used to identify risk factors for mental health problems. Results: A total of 808 subjects completed the questionnaire and an estimated 25.9% of them were suspected to have mental health problems (GHQ-12≥3). Logistic model analysis indicated that family life (OR=1.928, 95%CI: 1.162-3.197), domestic work status (OR=2.069, 95%CI: 1.210-3.538), father’s health status (OR=1.703, 95%CI: 1.060-2.736), disease symptoms (OR=2.087, 95%CI: 1.363-3.194), captain (OR=1.996, 95%CI: 1.128-3.532), cultural differences (OR=2.439, 95%CI: 1.621-3.671) were the risk factors for mental health. Age (OR=0.736, 95%CI: 0.571-0.949), leisure activities (OR=0.654, 95%CI: 0.490-0.872) were the protective factors. Drinking habits (OR=7.439, 95%CI: 1.290- 42.900), loneliness (OR=4.094, 95%CI: 2.438-6.875), and respect from the hospital (OR=0.783, 95%CI: 0.610-1.004) were relative to mental health problems. Conclusion CMT members have certain mental health problems, especially young members and captains. Therefore, interventions should be implemented to improve the mental health of CMT members and to promote the development of foreign aid work.

Objective To analyze the characteristics of antibiotic resistance in group A Streptococ-cus ( GAS) strains isolated from children with scarlet fever in Tianjin in order to provide reference for clinical drug administration. -ethods GAS strains were collected from 2011 to 2016. A total of 276 isolates were analyzed by antibiotic susceptibility test and emm typing. Results All of the isolates were susceptible to penicillin, cefazolin and vancomycin, while 98. 2％ were susceptible to both chloramphenicol and levofloxa-cin. The resistance rates to azithromycin, erythromycin, clarithromycin, clindamycin and tetracycline were 97. 8％, 97. 1％, 94. 2％, 94. 2％ and 79. 3％. The concomitant resistance to erythromycin, azithromycin, clarithromycin, clindamycin and tetracycline was 73. 2％. The resistance rates of GAS strains isolated from different years to tetracycline, clindamycin, clarithromycin, erythromycin and azithromycin were significantly different. A statistically significant difference was found between the percentages of emm12 and emm1 strains resistant to tetracycline (84. 0％ vs 59. 5％, χ2=13. 820, P=0. 000). Conclusions The isolated GAS strains are sensitive toβ-lactams and highly resistant to macrolide antibiotics, clindamycin and tetracycline. Penicillin remains the preferred treatment for GAS infection and cephalosporins may be used as a substitute if the patient is allergic to penicillin.

Objective: To investigate the etiological characteristics of Streptococcus pyogenes that caused scarlet fever from 2012 to 2016 in Tianjin. Methods: The subjects were children diagnosed clinically as scarlet fever in Tianjin scarlet fever monitoring hospital from 2012 to 2016. The exclusion criteria were children with scarlet fever who were unable to cooperate with sampling. A total of 575 cases of children's swabs were collected. Biochemical methods were used to isolate and identify the bacteria of pharynx swab, and the PCR method was used to detect the emm genotyping and superantigen speA and speC, and the resistance of the strains to 10 antibiotics was measured by K-B paper method. We compared the carrying status of superantigen genes by different types of GAS and the resistance of all GAS to different antibiotics. Results: There were 5 emm types (emm1/11/12/22/89). The dominant types were emm12 (52.9%, 100 strains) and emm1 (44.4%, 84 strains). The carrying rates of speA and speC genes were 21.7% (41 strains) and 76.7% (145 strains), respectively. The speA gene carrying rate of emm1 type GAS was 33.3% (28 strains), which were higher than that of emm12 (12% (12 strains)) (χ²=12.21, P<0.001). The speA and speC gene simultaneous carrying rate of emm1 type GAS was 27.4% (23 strains), which was higher than that of emm12 type (12% (12 strains)) (χ²=7.01, P=0.008). The percentages of the strains that were resistant to Azithromycin, Erythromycin, Clarithromycin, Clindamycin, Tetracyclin, Levofloxacin and Chloramphenicol were 96.8% (183 strains), 96.3% (182 strains), 92.1% (174 strains), 92.1% (174 strains), 73.0%(138 strains), 2.1% (4 strains) and 1.6% (3 strains), respectively. All isolates were susceptible to Penicillin, Cefazolin and Vancomycin, and there were statistical significance (χ²=953.28, P<0.001). Conclusion The dominant emm types causing scarlet fever are emm12 and emm1. The frequencies of speA and speC in emm1 and emm12 are different. S.pyrogenes in Tianjin were susceptible to penicillin, cefazolin and vancomycin, but highly resistant to the clindamycin, clarithromycin, erythromycin and azithromycin.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.