Objective To analyze the factors influencing the early recovery of renal function in patients with sepsis-associated acute kidney injury(SA-AKI).Methods A retrospective analysis was conducted on 86 SA-AKI patients treated in the Intensive Care Unit at Zhongshan Hospital,Fudan University from January 2021 to December 2022,who met both the Sepsis 3.0 diagnostic criteria and the AKI diagnostic standards.Patients were divided into a recovery group and a non-recovery group based on whether their renal function recovered within 7 days after AKI onset.Clinical data and laboratory tests of patients were compared between the two groups.Univariate and multivariate logistic analyses were used to identify risk factors affecting renal function recovery in SA-AKI patients,and ROC curve was utilized to evaluate the predictive value of these factors for early renal function recovery in SA-AKI patients.Results The renal function of 37(43.02％)patients recoveried.Compared with the recovery group,the renal replacement therapy rate,in-hospital mortality and 28-day mortality of patients in the non-recovery group were higher(P＜0.001).The multivariate logistic analysis showed that age,APACHE Ⅱ score,urine output,urine neutrophil gelatinase-associated lipocalin(NGAL),and norepinephrine dose were independent related factors affecting renal function recovery in SA-AKI patients(P＜0.05).The final model logit(P)=-4.091+0.001×urine NGAL-0.001 Xurine volume+0.040 ×age+0.073 × APACHE Ⅱ score+1.906 × norepinephrine dose.The AUC of model predicting early SA-AKI recovery was 0.823,with 73.5％of sensitivity,and 81.1％of specificity.Conclusions In SA-AKI patients,age,APACHE Ⅱ score,urine output,urine NGAL,and the dose of norepinephrine independently affect early renal function recovery,and the combined assessment of these indicators has predictive value for the early renal recovery in these patients.

Objective To investigate the correlation between the glucose time in range(TIR)and left ventricular mass index(LVMI)in the patients with type 2 diabetes mellitus(T2DM)complicating hyperten-sion.Methods A total of 102 inpatients with T2DM in the Mingguang Municipal People's Hospital from January to December 2022 were selected as the study subjects and conducted the continuous dynamic glucose monitoring.They were divided into the group A(TIR≤40％,n=31),group B(TIR＞40％-70％,n=41)and group C(TIR＞70％,n=30)according to the TIR level.The clinical data,laboratory indicators and echo-cardiographic parameters were collected and compared among the three groups.Results Compared with the group A,the age,disease course,systolic blood pressure and the levels of HbA1c,FPG,SCr and TG in the group C were significantly decreased,the HDL-C level was increased,and the differences were statistically sig-nificant(P＜0.05).Compared with the group B,the age and the levels of SCr,TG,HDL-C,HbA1c and FPG in the group C were decreased,and the differences were statistically significant(P＜0.05).Compared with the group A and group B,LAD,LVPW,IVS and LVMI in the group C were reduced with statistical differences(P＜0.05).The multiple linear stepwise regression analysis results showed that TIR was a protective factor for LVMI(OR=0.562,95％CI 0.413-0.673,P＜0.05),and the disease course and systolic blood pressure were the risk factors(OR=1.511,95％CI:1.067-2.947;OR=2.325,95％CI:1.086-5.574,P＜0.05).Conclusion TIR in the patients with T2DM complicating hypertension is correlated with LVMI,and the TIR level may be an influencing factor for early cardiovascular events.

Abstract: Objective　To analyze the epidemiological characteristics and related factors of norovirus in Guangxi from 2015 to 2020, and to provide scientific recommendations for norovirus prevention and control. Methods The foodborne diseases surveillance data were collected from 11 sentinel hospitals through the National Foodborne Disease Monitoring and Reporting System from 2015 to 2020. R software with version 4.0.3 was used for descriptive and statistical analysis, including epidemic curve, chi-square test, and trend chi-square and so on. Logistic regression was used to analyze norovirus-related factors, OR values and 95% confidence intervals were calculated respectively with the statistical test level of P<0.05. Results There were 1 008 norovirus cases detected, with a detection rate of 12.75% (1 008/7 903). Children with age less than 5 years (OR=1.43, 95%CI: 1.13-1.82) and patients at age 20-45 (OR=1.45, 95%CI: 1.13-1.87) were high risk population. The detection rate was higher in autumn (OR=1.29, 95%CI: 1.08-1.53) but lower in summer (OR=0.67, 95%CI: 0.55-0.80). In addition, the tourist area (Guilin City) presented a higher detection rate than other areas (OR=1.41, 95%CI: 1.10-1.80). Aquatic products (OR=1.40, 95%CI: 1.03-1.91), meat and dairy products (OR=1.31, 95%CI: 1.06-1.61) were high-risk foods for norovirus infection. The prevention and control policies of COVID-19 can reduce the possibility of norovirus by 61% (OR=0.39, 95%CI: 0.31-0.49) showed a declining trend (Trend χ2=85.33, P<0.001). In addition, prolonged visit time can lead to 19%-23% decrease in the detection rate of norovirus (OR24-48 hours=0.81, 95%CI: 0.70-0.95; OR>48 hours=0.77, 95%CI: 0.63-0.93). Conclusions　The epidemic of norovirus presented seasonal and regional distribution in Guangxi with a declining detection rate trend in diarrhea patients during recent 6 years. Young children were high-risk population in infection norovirus. The intake of seafood can increase the risk of norovirus infection. The prevention and control policies of COVID-19 can sharply decrease the possibility of infection norovirus. The monitoring of key foods such as seafood should be strengthened, and the early screening of suspected cases should be taken. The norovirus monitoring should be improved to ensure the health of the population.

Objective:To investigate the incidence and related risk factors of refeeding syndrome (RFS) in patients with severe stroke.Methods:Patients with severe stroke admitted to the Department of Neurology, the First Affiliated Hospital of Soochow University underwent nutritional treatment again after fasting between December 2017 and October 2022 were included retrospectively. The incidence of RFS in patients with severe stroke was summarized. Multivariate logistic regression models were used to analyze the independent risk factors for RFS. A restricted cubic spline model was used to explore the dose-response relationship between relevant indicators and RFS. Results:A total of 188 patients were included, including 108 males and 80 females, with a median age of 72 years (interquartile range, 63-77 years); 185 patients (98.4%) had ischemic stroke and 3 (1.6%) had cerebral hemorrhage; 59 (31.4%) received enteral nutrition, 36 (19.1%) received gastrointestinal decompression, 30 (16.0%) received mechanical ventilation; and 60 patients (31.9%) developed RFS. Multivariate logistic regression analysis showed that serum creatinine (odds ratio [ OR] 1.011, 95% confidence interval [ CI] 1.001-1.020; P=0.025), serum potassium ( OR 8.349, 95% CI 3.025-23.039; P<0.001), serum phosphorus ( OR 46.578, 95% CI 6.444-336.661; P<0.001) and diabetes ( OR 2.173, 95% CI 1.087-4.345; P=0.028) were the independent risk factors for the occurrence of RFS. The restricted cubic spline model analysis showed that there was a non-linear relationship between serum creatinine and RFS, and the increased risk of RFS showed an "S" shape with the increase of serum creatinine. When serum creatinine exceeded 70.68 μmoI/L, the risk of RFS continued to increase. There was no non-linear relationship between serum phosphorus and serum potassium and RFS. Conclusions:Serum creatinine, serum phosphorus, serum potassium and diabetes are the independent risk factors for RFS in patients with severe stroke. These risk factors should be utilized to identify the high-risk patients with RFS early and the targeted measures should be taken as soon as possible.

Taking lipophagy as the breakthrough point, we explored the mechanism of Zexie Decoction(ZXD) in improving lipid metabolism in the hepatocyte model induced by palmitic acid(PA) and in the animal model induced by high-fat diet(HFD) on the basis of protein kinase B(Akt)/transcription factor EB(TFEB) signaling pathway. Co-localization was carried out for the microtubule-associated protein light chain 3(LC3) plasmid labeled with green fluorescent protein(GFP) and lipid droplets(LDs), and immunofluorescence co-localization for liver LC3 of HFD mice and perilipin 2(PLIN2). The results showed that ZXD up-regulated the expression of LC3, reduced lipid accumulation in hepatocytes, and increased the co-localization of LC3 and LDs, thereby activating lipo-phagy. Western blot results confirmed that ZXD increased autophagy-related protein LC3Ⅱ/LC3Ⅰ transformation ratio and lysosome-associated membrane protein 2(LAMP2) in vivo and in vitro and promoted the degradation of sequestosome-1(SQSTM1/p62)(P<0.05). The results above jointly explained that ZXD regulated lipophagy. Furthermore, ZXD activated TFEB expression(P<0.05) and reversed the PA-and HFD-induced decrease of TFEB nuclear localization in hepatocytes(P<0.05). Meanwhile, ZXD activated liver TFEB to up-regulate the expression of the targets Lamp2, Lc3 B, Bcl2, and Atg5(P<0.05). Additionally, ZXD down-regulated the protein level of p-Akt upstream of TFEB in vivo and in vitro. In conclusion, ZXD may promote lipophagy by regulating the Akt/TFEB pathway.
Animals ; Mice ; Autophagy/drug effects* ; Hepatocytes/metabolism* ; Microtubule-Associated Proteins/metabolism* ; Proto-Oncogene Proteins c-akt/metabolism* ; Signal Transduction ; Drugs, Chinese Herbal/pharmacology*

OBJECTIVE：To establish an overall quality evaluation model for Agrimonia pilosa based on extract and characteristic spectrum，and to provide evidence for comprehensive quality evaluation of the medicinal material and screening of high-quality provenance. METHODS ：Referring to different extraction method and solvent condition stated in 2015 edition of Chinese Pharmacopoeia （part Ⅳ），using the content and total peak area of HPLC characteristic chromatogram of extract as indexes，and the extraction technology was optimized by weighted comprehensive score. HPLC characteristic spectrum of 15 batches of A. pilosa was established ，and similarity evaluation and characteristic peak identification were performed. SPSS 25.0 software was used to conduct single factor analysis and Pearson correlation analysis for the extract content and total peak area of A. pilosa from different origins. The quality of medicinal materials from different origins were compared. Entropy weight TOPSIS method was adopted to evaluate comprehensive quality of A. pilosa using the extract content and total peak area of 15 batches of A. pilosa . RESULTS ：The extraction technology of A. pilosa extract，which was extracted with hot dip plating using 50％ ethanol as solvent ，was optimized. The similarity of 15 batches of A. pilosa was higher than 0.92，and 4 characteristic components were identified（ellagic acid ，quercetin，apigenin，kaempferol）. There were significant differences in average extract content and total peak area of characteristic chromatogram of A. pilosa from different origins （P＜0.05 or P＜0.01），and there was a certain positive correlation between them （r＝0.86，P＜0.01）. Results of entropy weight TOPSIS evaluation showed that the average Ci values of A. pilosa in Anhui ，Zhejiang，Sichuan，Henan and Jiangsu provinces were 0.689，0.351，0.218，0.308 and 0.361 respectively. CONCLUSIONS：The quality of A. pilosa from Anhui was the best ，that from Zhejiang and Jiangsu was better ，that from Henan was the second ，and that from Sichuan was poor. Established extraction technology and characteristic spectrum determination method of A. pilosa are stable and feasible. The entropy weight TOPSIS model is objective and quantifiable for comprehensive quality evaluation of A. pilosa ，and can effectively evaluate its quality.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease, affecting about 0.6% of the Chinese population. Many patients are not well controlled by conventional treatments, thus there is need for new treatment regimens. In this study, we assessed the efficacy and safety of secukinumab in Chinese patients with moderate to severe plaque psoriasis. METHODS: This study was a 52-week, multicentre, randomized, double-blind, placebo-controlled, parallel-group, Phase 3 trial. A sub-population of study participants (≥18 years) of Chinese ethnicity were randomized to receive subcutaneous injections of 300 or 150 mg secukinumab, or placebo. The co-primary endpoints were psoriasis area severity index (PASI) 75 and Investigator's Global Assessment (IGA) 0/1 at Week 12. RESULTS: A total of 441 Chinese patients were enrolled in this study. Co-primary outcomes were achieved; 300 and 150 mg secukinumab were superior to placebo as shown in the proportion of patients that achieved PASI 75 (97.7% and 87.2% vs. 3.7%, respectively; P < 0.001), and IGA 0/1 (82.3% and 69.7% vs. 2.7%; P < 0.001) at Week 12. Treatment efficacy was maintained until Week 52. There was no increase in overall adverse events with secukinumab relative to placebo throughout the 52-week period. CONCLUSION: Secukinumab is highly effective and well tolerated in Chinese patients with moderate to severe plaque psoriasis. TRIAL REGISTRATION ClinicalTrials.gov, NCT03066609; https://clinicaltrials.gov/ct2/show/record/NCT03066609.
Antibodies, Monoclonal/therapeutic use* ; Antibodies, Monoclonal, Humanized ; China ; Double-Blind Method ; Humans ; Psoriasis/drug therapy* ; Severity of Illness Index ; Treatment Outcome

Objective To explore the working mode of continuous malaria elimination. Methods Judong Village in Congjiang County, Guizhou Province, which had the highest record of malaria incidence in the history of Guizhou Province, was selected as a pilot, a comprehensive prevention and control intervention was carried out aiming at the malaria epidemic, transmission and influencing factors, and the effect was evaluated after the intervention. Results From 2015 to 2016, through those intensive measures of constructing system, improving environment and health education, the people’s awareness of malaria prevention was increased, the people’s enthusiasm and initiatives to participate in the prevention and control of malaria were improved in Judong Village. Meanwhile, the roads were hardened and beautified, the dispose of sewage, feces and garbage was centralized. The awareness rate of malaria prevention knowledge of residents increased to 85% to 95%, and the formation rate of anti-mosquito behavior increased to 89.66%. The density of media Anopheles reduced from 0.56 to 0.07 mosquitoes per hour each mosquito catching platform. Conclusion A long-term mechanism for malaria prevention and control has been almost constructed in Judong Village, which facilitates the consolidation of malaria control achievements, and the progress towards malaria elimination.

OBJECTIVETo analyze the relationship between radiographic parameters and clinical outcomes of patients with distal radius fractures in elderly patients following conservative treatment, and find the important radiographic parameters with distal radius fractures in elderly patients.

METHODSFrom May 2012 to May 2015, a retrospective analysis was performed of 45 elderly patients with distal radius fractures treated by conservative treatment, which including 17 males and 28 females with an average age of 64.49 years old from 60 to 89 years old. The imaging parameters were measured and the clinical efficacy was evaluated. The imaging parameters on the standard wrist joint X-ray picture were measured including metacarpal angle, the radius height, the ulna variation, the ulnar angle, and so on. The clinical effect of wrist joint was evaluated by Dienst score standard. Multiple factor linear regression was used to analyze the relationship between the image parameters and the clinical efficacy.

RESULTSAll patients were followed up for 12 to 24 months with an average of 17.6 months. All fractures of the distal radius were healed. According to the Dienst evaluation, at the final follow-up the result was excellent in 27 cases, good in 10 cases, fair in 6 cases and poor in 2 cases. There was a significant correlation between the height of the radius, the angle of the palmar and the variation of the ulna and the function of the wrist joint in the imaging parameters. When the radius height more than 8.12 mm, the palmar angle more than -1.64 degree and the ulna variant less than 4.05 mm, the result of Dienst function was better.

CONCLUSIONSThe imaging parameters such as the radius height, the palmar angle and the ulna variation are related to the recovery of the clinical efficacy of the distal radius fractures in the elderly. The most important parameter is the radius height, which reminds the surgeon to pay special attention to the reduction of the radius fracture in the elderly.

ObjectiveTo investigate the diagnosis and management of penile fracture.

METHODSFrom June 1993 to May 2017, 46 cases of penile fracture were treated in our hospital, averaging 33.5 (25－42) years of age and 3.45 (1－10) hours in duration, of which 41 occurred during sexual intercourse, 4 during masturbation and 1 during prone sleeping, 4 with hematuria, but none with dysuria or urethral bleeding. Hematoma was confined to the penis. Emergency surgical repair was performed for all the patients, 45 under spinal anesthesia and 1 under local anesthesia, 16 by coronal proximal circular incision and the other 30 by local longitudinal incision according to the rupture location on ultrasonogram. The tunica albuginea ruptures averaged 1.31 (0.5－2.5) cm in length, which were sutured in the "8" pattern for 6 cases and with the 3－0 absorbable thread for 18 cases. The skin graft or negative pressure drainage tube was routinely placed, catheters indwelt, and gauze used for early pressure dressing. In the recent few years, elastic bandages were employed for 3－5 days of pressure dressing and antibiotics administered to prevent infection. The stitches and catheter were removed at 7 days after surgery.

RESULTSShort-term postoperative foreskin edema occurred in 14 of the 16 cases of circular degloving incision, but no postoperative complications were observed in any of the cases of local incision. Twenty-eight of the patients completed a long-term follow-up of 49.4 (10－125) months, which revealed good erectile function, painless erection, and satisfactory sexual intercourse.

CONCLUSIONSFor most penile fractures, local longitudinal incision is sufficient for successful repair of the tunica albuginea, with mild injury, no influence on the blood supply or lymph reflux, and a low rate complications. It therefore is obviously advantageous over circular degloving incision except when the cavernous body of urethra is to be explored, which necessitates circular degloving incision below the coronal groove.

Adult ; Coitus ; Edema ; etiology ; Hematoma ; diagnosis ; etiology ; Humans ; Male ; Masturbation ; complications ; Penile Erection ; Penis ; injuries ; Postoperative Complications ; etiology ; Rupture ; diagnosis ; etiology ; surgery ; Surgical Wound ; Ultrasonography ; Urethra ; surgery