ObjectiveTo clearly identify the difference between rescue injuries and agonal injuries and to avoid duplicate identifications and misidentifications. MethodsBased on the forensic pathological data of 5 923 cases of death cause identification from 2013 to 2022 in Sun Yat-sen University Forensic Identification Center and Guangzhou Tianhe District Branch of Guangzhou Public Security Bureau， this study retrospectively studied the characteristics of rescue injuries and agonal injuries seen in cause of death identification and their influence on cause of death identification. ResultsAmong all the 5 923 cases， 640 cases were found to have rescue injuries or agonal injuries， and 624 cases received treatment， of which 609 cases were found to have rescue injuries （97.60%）， 44 cases were found to have agonal injuries， and 13 cases were found to have both types of injuries. Among the 640 cases， 441 were male and 199 were female. The age of death was discontinuously distributed from 0 to 95 years old. The leading cause of death was disease， followed by mechanical injury and asphyxia. The main manifestations of rescue injuries were rib and sternum fractures， soft tissue injuries in the prechest area or face， and pericardial rupture. The most common injuries in agonal stage were falling after unconsciousness， inhalation of foreign body in respiratory tract or multiple violent injuries. Among the 640 cases， 19 cases were repeatedly identified， including 15 cases of rescue injuries， 6 cases of agonal injuries， and 2 cases of both types of injuries. Compared with the cases where neither type of injuries was detected， the repeated identification rate of treatment injuries and agonal injuries was significantly increased （χ²=4.04， P=0.044； χ²=43.49， P<0.001）. Among the 640 cases， 11 cases （1.72%） were misidentified as the initial injuries in the first identification， and 13 cases had combined rescue injuries or agonal injuries that were involved in death. ConclusionsBy elucidating the epidemiological characteristics of the two types of injuries， this study proved that the two types of injuries were associated with higher rates of repeated identification and misidentification， which provided a reference for reducing repeated identification and misidentification and improving the accuracy of cause of death identification.

Objective To analyze the interaction between voriconazole(VRC)and immunosuppressants such as tacrolimus and cyclosporine and the effect of CYP2C19 gene polymorphism on the interaction and adverse reactions(ADR)based on the results of CYP2C19 gene polymorphism and therapeutic drug monitoring,so as to provide a basis for the development of individualized VRC combined with immunosuppressants.Methods Two-dimensional liquid chromatography and pyrosequencing was used to detect the concentration of VRC and the CYP2C19 gene pol-ymorphism,respectively.And the concentration of immunosuppressants was detected at the same time.The rela-tionship among CYP2C19 gene polymorphism,the concentration of VRC and immunosuppressant and ADR was an-alyzed.Results A total of 61 patients were enrolled in this study,and the mutation rates of CYP2C19*2 and CYP2C19*3 were 54.1％(33/61)and 9.84％(6/61),respectively.The concentrations of VRC in patients with extensive metabolism(EMs),intermediate metabolism(IMs)and poor metabolism(PMs)were(4.44±3.46),(3.62±3.02)and(10.05±1.46)μg/ml(P＜0.05),respectively.The concentration of tacrolimus af-ter combined with VRC significantly increased compared to tacrolimus alone[(13.4±9.2)ng/ml vs(6.5±3.6)ng/ml;P=0.002],and the concentration of tacrolimus increased along with an increasing of VRC concentration.The concentration of VRC in patients combined with tacrolimus was lower than that in patients without immunosup-pressants[(3.81±3.48)μg/ml vs(5.84±3.71)μg/ml;P=0.032].The concentration of VRC inpatients with cyclosporine significantly decreased(P＜0.01),while tacrolimus and mycophenolate mofetil had no signifi-cant effect on the concentration of VRC.45.90％(28/61)of the patients had adverse reactions,the concentration of VRC in patients with ADR was significantly higher than that in patients without ADR[(7.07±3.43)μg/ml vs(3.06±2.90)μg/ml;P＜0.001].And the concentration of VRC in patients with ADR was higher than patients without ADR with based on CYP2C19 genotype.Conclusion CYP2C19 gene polymorphism can significantly affect the concentration and adverse reactions of VRC,and VRC has significant interaction with immunosuppressants such as tacrolimus.CYP2C19 gene polymorphism combined with therapeutic drug monitoring can improve the individual-ized treatment of tacrolimus and voriconazole,and is expected to minimize toxicity and improve treatment effects.

Objective: To examine the Longitudinal influence of perceived discrimination on pro social behavior of left alone junior middle school students and to explore the longitudinal mediating role of teacher-student relationship and classmate relationship, so as to provide a reference for improving pro social behavior of left behind junior middle school students. Methods: The Perceived Discrimination Questionnaire, Teacher-Student Relationship Questionnaire, Classmate Relationship Questionnaire and Prosocial Behavior Questionnaire were used to conduct two follow up surveys on 930 left behind junior middle school students in Guizhou Province at two time points, in mid November 2021(T1) and mid May 2022(T2). Deviation corrected Bootstrap method was used to examine the mediating effect of T2 teacher-student relationship and T2 classmate relationship on the impact of T1 discrimination perception on T2 pro social behavior. Results: The perceptions of discrimination, teacher-student relationship, classmate relationship, and pro social behavior scores of the left behind junior high school students were (1.98±0.94) (4.13± 0.77 ) (3.54±0.91) (3.52±0.75) for T1, and (3.98±0.83)(3.42±0.86)(3.48±0.72) for teacher-student relationship, classmate relationships and pro social behavior scrores of T2. After controlling for gender, age and self assessment of family economic status, T1 perceived discrimination negatively predicted T2 pro social behavior ( β =-0.07); and T1 perceived discrimination indirectly influenced T2 pro social behavior through T2 teacher-student relationship, and mediated effect value was -0.02(95% CI = -0.02 to -0.01); and T1 perceived discrimination indirectly influenced T2 pro social behavior through T2 classmate relationship, mediated effect was -0.03(95% CI =-0.05 to -0.02)( P <0.05). Conclusions Perceived discrimination not only directly reduces pro social behavior of left behind junior middle school students, but also indirectly and negatively affects pro social behavior of left alone junior middle school students by reducing teacher-student relationship and classmate relationship.

OBJECTIVE: To observe the effect of Shenbing Decoction Ⅲ for improving renal function and pathology in rats with 5/6 nephrectomy and analyze its therapeutic mechanism for renal fibrosis in chronic kidney disease using network pharmacology combined with molecular docking. METHODS: Forty male SD rats were randomized into two groups to receive two-staged 5/6 nephrectomy (n=30) or sham operation (n=10), and 2 weeks after the final operation, serum creatinine level of the rats was measured. The rats with nephrectomy were further randomized into Shenbing Decoction Ⅲ group, losartan group and model group for daily treatment with the corresponding drugs via gavage starting at 1 week after 5/6 nephrectomy. After 16 weeks of treatment, serum creatinine and urea nitrogen levels of the rats were measured, and HE staining and Western blotting were used to examine the changes in renal pathology and fibrosis-related factors. Network pharmacology combined with molecular docking study was performed to explore the therapeutic mechanism Shenbing Decoction Ⅲ against renal fibrosis in chronic kidney disease, and Western blotting was used to verify the expressions of the core targets. RESULTS: Compared with those in the model group, the rats receiving 5/6 nephrectomy and Shenbing Decoction Ⅲ treatment showed significantly reduced serum creatinine and urea nitrogen levels, lessened renal pathologies, and improvement of the changes in epithelial mesenchymal transition-related proteins. Network pharmacological analysis showed that the main active ingredients of Shenbing Decoction Ⅲ were acacetin, apigenin, eupatilin, quercetin, kaempferol and luteolin, and the key targets included STAT3, SRC, CTNNB1, PIK3R1 and AKT1. Molecular docking study revealed that the active ingredients of Shenbing Decoction Ⅲ had good binding activity to the key targets. Western blotting showed that in rats with 5/6 nephrectomy, treatment with Shenbing Decoction Ⅲ obviously restored the protein expression of STAT3, PI3K, and AKT in renal tissue. CONCLUSION Shenbing Decoction Ⅲ can reduce renal injury induced by 5/6 nephrectomy in rats, and its therapeutic effects are mediated possibly by its main pharmacologically active ingredients that alleviate renal fibrosis via modulating multiple targets including STAT3, PIK3R1, and AKT1.
Male ; Animals ; Rats ; Rats, Sprague-Dawley ; Molecular Docking Simulation ; Network Pharmacology ; Creatinine ; Renal Insufficiency, Chronic/drug therapy* ; Fibrosis ; Urea

Objective:To observe the effect of theophylline intravenous drip combined with high flow respiratory humidifier on serum pro Calcitonin (PCT) and lactate clearance rate (LCR) in elderly patients with chronic obstructive pulmonary disease (COPD) secondary to type II respiratory failure.Methods:We prospectively selected 120 elderly patients with COPD secondary to type II respiratory failure who were admitted to the Affiliated Hospital of Jining Medical University from March 2020 to March 2022. They were randomly divided into the control group ( n=60) and the observation group ( n=60). The control group was treated with non-invasive positive pressure ventilation combined with theophylline intravenous drip, and the observation group was treated with high flow respiratory humidification therapy apparatus combined with theophylline intravenous drip. The sputum viscosity of the two groups was counted, and the pulmonary function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1), FEV 1/FVC], blood gas analysis, respiratory mechanics, oxygen metabolism, and serum index levels, as well as the difference between acute physiology and chronic health assessment Ⅱ (APACHE Ⅱ) scores after treatment were compared between the two groups. Results:The overall sputum viscosity of the observation group was better than that of the control group ( P<0.05). Before treatment, there was no statistically significant difference in lung function and blood gas analysis indicators between the two groups (all P>0.05); After treatment, the lung function indicators, arterial partial pressure of oxygen (PaO 2), and oxygenation index (PaO 2/FiO 2) of both groups were significantly increased compared to before treatment (all P<0.05), while arterial partial pressure of carbon dioxide (PaCO 2) was significantly decreased compared to before treatment (all P<0.05), and the values of each indicator in the observation group after increasing or decreasing were significantly better than those in the control group (all P<0.05). Before treatment, there was no statistically significant difference in respiratory mechanics and oxygen metabolism indicators between the two groups (all P>0.05); After treatment, the arterial blood oxygen content (CaO 2) in the two groups was significantly higher than that before treatment (all P<0.05), while the oxygen uptake rate (ERO 2) in the two groups and the VO 2 max (VO 2Max), airway peak value, and respiratory resistance in the observation group were significantly lower than those before treatment (all P<0.05), and the values of each index in the observation group after rising or falling were significantly better than those in the control group (all P<0.05). Before treatment, there was no statistically significant difference in serum indicators and APACHE Ⅱ scores between the two groups (all P>0.05); After treatment, LCR and C-reactive protein (CRP) in the observation group were significantly higher than those before treatment ( P<0.05), while the scores of PCT, Interleukin 6 (IL-6), CRP and APACHE Ⅱ were significantly lower than those before treatment (all P<0.05), and the values of each index in the observation group after increase or decrease were significantly better than those in the control group (all P<0.05). Conclusions:Theophylline intravenous drip combined with high flow respiratory humidifier can improve respiratory mechanics, oxygen metabolism, reduce inflammatory reaction, and reduce the impact of disease on life in elderly patients with COPD secondary to type II Respiratory failure.

AIM: To compare the clinical efficacy of conbercept and aflibercept in the treatment of wet age-related macular degeneration(wARMD)based on 4 consecutive intravitreal injections.METHODS: The clinical data of 108 patients(108 eyes)who were diagnosed as wARMD and treated with intravitreal injection at our hospital from January 2019 to January 2021 were retrospectively analyzed. They were divided into conbercept group(54 cases, 54 eyes)and aflibercept group(54 cases, 54 eyes)according to the different injectable drugs. All patients received intravitreal injection once a month, with four consecutive injections. Follow up for 12mo to observe best corrected visual acuity(BCVA), central macular thickness(CMT), complications and recurrence before and after injection.RESULTS: BCVA and CMT of patients in the two groups at 1, 2, 5 and 8mo after injection had no between-group differences(P>0.05), but both were significantly improved compared with those before injection(P<0.05). By the end of follow-up, conjunctival hemorrhage occurred in 2 eyes of the conbercept group at the early stage, and increased intraocular pressure and conjunctival hemorrhage occurred respectively in 2 eyes of the aflibercept group. There were no serious complications related to drug injection such as retinal detachment, complicated cataract, endophthalmitis and retinal pigment epithelial tear in the two groups, and there was no difference in the recurrence rate between the two groups(7% vs. 6%, P=1.000).CONCLUSION: On the basis of continuous 4 times of intravitreal injection, both conbercept and aflibercept are safe and effective in the treatment of wARMD, and the efficacy is even.

AIM: To investigate the efficacy and safety of dacryocystorhinostomy(DCR)through nasal endoscope with extended bone window and high ostomy in the treatment of chronic dacryocystitis.METHODS: Retrospective clinical study. A total of 50 patients(59 eyes)diagnosed with chronic dacryocystitis in our hospital from January 2018 to January 2020 were selected. They were divided into two groups according to the operation method, with 23 cases(29 eyes)in the simple stoma group and 27 cases(30 eyes)in the improved group. Patients in the simple stoma group were treated with transnasal endoscopic flat middle turbinate axillary DCR(simple stoma), and patients in the improved group were treated with transnasal endoscopic extended bone window with high-level stoma DCR. The total clinical efficiency, postoperative complication rate and satisfaction of the two groups were compared.RESULTS: The effective rate of the simple stoma group was 79% at 12mo after surgery, while that of the improved group was 97%(P=0.039). The total incidence of complications in the simple stoma group was 28%, while that in the improved group was 7%(P=0.042). The satisfaction rate of the simple stoma group was 65%, while that of the improved group was 93%(P=0.030).CONCLUSION: The treatment of chronic dacryocystitis with transnasal endoscopic extended bone window and high-level ostomy DCR further improved the efficiency of surgery and reduced the incidence of complications.

Humans ; Breast ; Neoplasms, Muscle Tissue/surgery*

Objective:To evaluate the efficacy and safety of total aortic arch replacement in elderly patients with Stanford type A aortic dissection(TAAD).Methods:In this retrospective study, a total of 481 TAAD patients treated with total arch replacement in our hospital from January 2016 to January 2020 were divided into three groups: aged≤59 years, 60-69 years and ≥70 years.The differences between three groups in surgical method, extracorporeal circulation time, blocking time, circulatory time, stopping time, surgical time, ventilator use time, ICU time, hospitalization time, treatment rate of continued renal replacement, fatality rate, and cause of death were statistically analyzed and compared.Results:There were statistically significant differences in the stopping time between any two groups of the three groups(all P<0.05). The older the age, the shorter the circulatory arrest time.The difference of ventilator time and ICU time between ≤59 and 60-69 years was statistically significant( P<0.01). Patients with continuous renal replacement(CRRT)were 19.0%(71/373)in ≤59 years, 23.1%(18/78)in 60~69 years, and 26.7%(8/30)over 70 years.In-hospital mortality was 35/373(9.4%)in the group of ≤59 years old, 11/78(14.1%)in the group of 60~69 years old, and 5/30(16.7%)in the group of ≥70 years old.There was no death in patients undergoing type Ⅱ hybrid surgery. Conclusions:Age is one of the important death factors after total aortic arch replacement in TAAD patients.Total aortic arch replacement is an acceptable surgical method for elderly patients with TAAD.Hybridization may reduce hospitalization death in elderly patients.

Objective:The aim of this study was to explore the associations of muscle size and density with handgrip strength(HGS)and the Timed Up and Go(TUG)test.Methods:Totally 301 participants living in the Xinjiekou community near Beijing Jishuitan Hospital were recruited for CT imaging of the hip and a 1-cm slice of the mid-thigh.The cross-sectional area and density of the gluteus maximus and the mid-thigh muscles were estimated by the Osirix viewer based on CT images.HGS and TUG were also performed in these subjects.Logistic regression analysis was used to evaluate the correlations of muscle density and size with TUG and grip strength.Results:In women, after adjustment for age and BMI, the density of the gluteus maximus was negatively correlated with TUG( P trend=0.0366), while the size of the gluteus maximus and the mid-thigh muscles was not correlated with TUG.In men, the density or size of these muscles was not correlated with TUG.After adjustment for age and BMI, the density of the gluteus maximus was positively correlated with grip strength( P trend=0.0334)and the size of the mid-thigh muscles was also positively correlated with grip strength( P trend=0.0155)in men, but they were not correlated with grip strength in women. Conclusions:There were sex differences in the relationship between muscle size or density and grip strength or timed up and go.The density of the gluteus maximus is associated with muscle strength and physical performance while the size of the mid-thigh muscles is correlated with muscle strength.