OBJECTIVES: To compare the clinical effect on Bell's facial palsy in the acute stage between the staging comprehensive treatment with acupuncture-moxibustion and western medication. METHODS: Sixty patients with Bell's facial palsy in the acute stage were randomly divided into an observation group and a control group, with 30 cases in each one. The patients in the control group were administered orally with prednisone acetate tablets and methylcobalamin tablets until the 28th day of illness. In the observation group, the staging comprehensive treatment with acupuncture-moxibustion was adopted. On the affected side, Qianzheng (EX-HN 16), Yifeng (TE 17), Sibai (ST 2), Yangbai (GB 14), Jiache (ST 6), Dicang (ST 4) and Touwei (ST 8), etc. were stimulated. In the acute stage (Day 1 to 7 of illness), the routine acupuncture and the point-toward-point needle insertion were delivered, no any manipulation was exerted at acupoints, and the needles were retained for 30 min. In the subacute stage (Day 8 to 14 of illness), on the base of the treatment as the acute stage, the depth of needle insertion was adjusted at a part of acupoints and the even needling technique was operated by twisting needle. Besides, electroacupuncture (EA) was attached to Qianzheng (EX-HN 16) and Dicang (ST 4), with continuous wave of low intensity and high frequency, 100 Hz, for 20 min. In the recovery stage (Day 15 to 28 of illness), on the base of the treatment as the subacute stage, the heavy stimulation of acupuncture was given, in which, the sticking and lifting needle techniques were delivered after the needles were inserted from Sibai (ST 2) toward Dicang (ST 4), and from Dicang (ST 4) toward Jiache (ST 6), separately; warm needling was operated at Yifeng (TE 17), and EA changed to stimulate the acupoints with the intermittent wave of high intensity and low frequency, 2 Hz, for 30 min. Acupuncture-moxibustion was given once every other day until the end of the 28th day of illness. The level of House-Brackmann facial nerve function rating scale (H-B grade),the score of Sunnybrook facial nerve grading system (Sunnybrook), the score of facial disability index (FDI), the temperature difference in the infrared thermal imaging facial area and electromyogram (EMG) situation of the affected muscle group were observed before and after treatment in the two groups. Using musculoskeletal ultrasound,the facial nerve diameter was detected and the clinical effect was compared between the two groups. RESULTS: After treatment, the level of H-B grade, Sunnybrook score, the scores of physical function and social life function in FDI were improved when compared with those before treatment in the patients of either group (P<0.01, P<0.05), and the results of these evaluations in the observation group were better than those of the control group (P<0.05). After treatment, the temperature difference of the frontal area, the eye area, the zygomatic area and the mouth corner was declined in comparison with that before treatment in the two groups (P<0.05), and the temperature difference in each area in the observation group was lower than that of the control group (P<0.05).The root mean square (RMS) of the frontal muscle group, the zygomatic muscle group and the orbicularis muscle group on the affected side increased in comparison with that before treatment in the two groups (P<0.01), and RMS of the observation group was higher than that of the control group (P<0.05) after treatment. Before treatment, the diameter of the facial nerve on the affected side was larger than that on the healthy side (P<0.01), and after treatment, the diameter on the affected side was reduced when compared with that before treatment in the two groups (P<0.01); the diameter of the facial nerve on the affected side in the observation group was smaller than that of the control group (P<0.05), while, the diameter on the affected side was larger when compared with the healthy side in the control group (P<0.05). The total effective rate of the observation group was 93.3% (28/30), higher than that of the control group (83.3% [25/30], P<0.05). CONCLUSIONS The staging comprehensive treatment with acupuncture-moxibustion is clearly effective on Bell's facial palsy in the acute stage, which affirms the effectiveness of acupuncture-moxibustion for the acute stage of Bell's facial palsy in comparison with conventional western medication.
Humans ; Facial Paralysis/therapy* ; Moxibustion ; Acupuncture Therapy ; Bell Palsy/therapy* ; Face

Objective:To analyze the early diagnostic value of plasma soluble cluster of differentiation 14 subtype (sCD14-ST, Presepsin) in sepsis in a population with suspected sepsis in fever clinic.Methods:A prospective observational study was conducted. The patients admitted to the fever clinic of Beijing Chaoyang Hospital from April to December 2022 were enrolled as the study objects. According to sequential organ failure assessment (SOFA) score, the patients were divided into low SOFA score group (SOFA score ≤3) and high SOFA score group (SOFA score > 3). Venous blood was collected at the time of admission. The level of plasma Presepsin was detected by chemiluminescence enzyme-linked immunoassay. The level of plasma procalcitonin (PCT) was detected by enzyme-linked immunofluorescence method. The level of C-reactive protein (CRP) was detected by scattering turbidimetry. White blood cell count (WBC) and neutrophil count (NEUT) were measured by automatic blood cell analyzer. For patients with fear of cold or chills, venous blood of upper limbs was taken for blood culture at the time of admission. The differences in inflammatory biomarkers were compared between the two groups. Binary multivariate Logistic regression analysis was used to screen the early risk factors of sepsis in fever outpatients with suspected sepsis. Receiver operator characteristic curve (ROC curve) was drawn to investigate the early diagnostic value of Presepsin and other inflammatory markers in sepsis, and to analyze the optimal cut-off value.Results:A total of 149 fever outpatients with suspected sepsis were enrolled, including 92 patients with low SOFA score and 57 patients with high SOFA score. Plasma PCT and Presepsin levels in the high SOFA score group were significantly higher than those in the low SOFA score group [PCT (μg/L): 0.77 (0.18, 2.02) vs. 0.22 (0.09, 0.71), Presepsin (ng/L): 1?129.00 (785.50, 1?766.50) vs. 563.00 (460.50, 772.25), both P < 0.01]. There was no significant difference in WBC, NEUT, CRP or positive rate of blood culture between the high and low SOFA score groups [WBC (×10 9/L): 11.32±5.47 vs. 11.14±5.29, NEUT (×10 9/L): 9.88±4.89 vs. 9.60±5.10, CRP (mg/L): 54.05 (15.95, 128.90) vs. 46.11 (19.60, 104.60), blood culture positivity rate: 42.3% (11/26) vs. 29.4% (10/34), all P > 0.05]. Multivariate Logistic regression analysis showed that Presepsin was an early risk factor for sepsis in suspected sepsis patients in fever clinics [odds ratio ( OR) = 16.96, 95% confidence interval (95% CI) was 6.35-45.29, P = 0.000]. ROC curve analysis showed that the early diagnostic value of Presepsin in sepsis was significantly better than WBC, NEUT, CRP, PCT, and blood culture [the area under the ROC curve (AUC) and 95% CI: 0.832 (0.771-0.899) vs. 0.522 (0.424-0.619), 0.532 (0.435-0.629), 0.533 (0.435-0.632), 0.664 (0.574-0.753), 0.554 (0.458-0.650)]. When the optimal cut-off value of Presepsin was 646.50 ng/L, its sensitivity and positive predictive value were higher than those of WBC, NEUT, CRP, and PCT (sensitivity: 89.5% vs. 38.6%, 68.4%, 38.6%, 57.9%; positive predictive value: 64.6% vs. 44.9%, 44.3%, 47.8%, 55.9%). Conclusion:Plasma PCT and Presepsin have early diagnostic value for sepsis in suspected sepsis patients in fever clinics, and Presepsin is more sensitive than PCT and can be used as a early marker of sepsis.

Objective:To investigate the CT and MRI features of sinonasal lymphoepithelial carcinoma (LEC) and to compare functional MRI index of LEC with olfactory neuroblastoma (ONB) in this area.Methods:The clinical data, CT and MRI conventional findings of 7 patients were retrospectively reviewed . All of the patients, 5 males and 2 females, with age of 35-58 (45±9) years old, were histologically diagnosed as LEC of sinonasal tract at Beijing Tongren Hospital, Capital Medical University from February 2014 to November 2019. The semi-quantitative DCE-MRI parameters and ADC value were measured and compared with 18 cases of ONB which were collected during the same period. Independent sample t test or corrected t test, Fisher′s exact test were performed to compare the differences between the two groups. Results:In all of the 7 LEC patients, 6 lesions were located in naso-ethmoid area, 1 lesion was located in naso-orbital area. Six lesions were on the left side, and another one was sitted on both sides. All tumors manifested irregular soft tissue density with bony destruction, 3 of them showed bony sclerosis. All lesions showed homogeneous density or signal and obvious enhancement in solid portion accompanied with varying degrees of local invasion. Morphologically, two forms were observed: localized soft tissue mass and diffuse infiltration along mucosa. There were polypoid strips ( n=3), spherical masses ( n=3), and diffuse thickening of nasal cavity and turbinate mucosa ( n=1). DCE-MRI examinations were performed in six LEC patients. Maximum contrast enhancement index (CI max) was 1.51±0.46, wash out ratio (WR) was 14.26%±6.24%. Time intensity curve (TIC) showed a plateau pattern (type Ⅱ) in 4 cases and a washout pattern (type Ⅲ) in 2 cases. Time to peak (T peak) were (40.09±4.59)s, showing a rapid peak performance. Diffusion weighted imaging was performed in six LEC patients, and the ADC value was (0.80±0.14)×10 -3 mm 2/s. There were statistical differences in WR and ADC values between sinonasal LEC and ONB ( t=4.873, P=0.020 and t=3.255, P=0.025). Conclusion:The radiological manifestations of LEC have certain characteristics. The characteristics of conventional imaging findings and functional MRI index combined with clinical data are helpful in making differential diagnosis between LEC and other sinonasal malignant tumors.

Objective:To establish autoverification rules for coagulation tests in multicenter cooperative units, in order to reduce workload for manual review of suspected results and shorten turnaround time (TAT) of test reports, while ensure the accuracy of results.Methods:A total of 14 394 blood samples were collected from fourteen hospitals during December 2019 to March 2020. These samples included: Rules Establishment Group 11 230 cases, including 1 182 cases for Delta check rules; Rules Validation Group 3 164 cases, including 487cases for Delta check; Clinical Application Trial Group 77 269 cases. Samples were analyzed for coagulation tests using Sysmex CS series automatic coagulation analyzers, and the clinical information, instrument parameters, test results, clinical diagnosis, medication history of anticoagulant and other relative results such as HCT, TG, TBIL, DBIL were summarized; on the basis of historical data, the 2.5 and 97.5 percentile of all data arranged from low to high were initially accumulated; on the basis of clinical suggestions, critical values and specific drug use as well as relative guidelines, autoverification rules and limits were established.The rules were then input into middleware, in which Stage I/Stage II validation was done. Positive coincidence, negative coincidence, false negative, false positive, autoverification pass rate, passing accuracy (coincidence of autoverification and manual verification) were calculated. Autoverification rules underwent trial application in coagulation results reports.Results:(1) The autoverification algorisms involve 33 rules regarding PT/INR, APTT, FBG, D-dimer, FDP,Delta check, reaction curve and sample abnormalities; (2)Autoverification Establishment Group showed autoverification pass rate was 68.42% (7 684/11 230), the false negative rate was 0%(0/11230), coincidence of autoverification and manual verification was 98.51%(11 063/11 230), in which positive coincidence and negative coincidence were respectively 30.09% (3 379/11 230) and 68.42%(7 684/11 230); Autoverification Validation Group showed autoverification pass rate was 60.37%(1 910/3 164), the false negative rate was 0%(0/11 230), coincidence of autoverification and manual verification was 97.79%(3 094/3 164), in which positive coincidence and negative coincidence were respectively 37.42%(1 184/3 164) and 60.37%(1 910/3 164); (3) Trialed implementation of these autoverification rules on 77 269 coagulation samples showed that the average TAT shortened by 8.5 min-83.1 min.Conclusions:This study established 33 autoverification rules in coagulation tests. Validation showedthese rules could ensure test quality while shortening TAT and lighten manual workload.

Accurate detection of low frequency mutations from plasma cell-free DNA in blood using targeted next generation sequencing technology has shown promising benefits in clinical settings. Duplex sequencing technology is the most commonly used approach in liquid biopsies. Unique molecular identifiers are attached to each double-stranded DNA template, followed by production of low-error consensus sequences to detect low frequency variants. However, high sequencing costs have hindered application of this approach in clinical practice. Here, we have developed an improved duplex sequencing approach called SinoDuplex, which utilizes a pool of adapters containing pre-defined barcode sequences to generate far fewer barcode combinations than with random sequences, and implemented a novel computational analysis algorithm to generate duplex consensus sequences more precisely. SinoDuplex increased the output of duplex sequencing technology, making it more cost-effective. We evaluated our approach using reference standard samples and cell-free DNA samples from lung cancer patients. Our results showed that SinoDuplex has high sensitivity and specificity in detecting very low allele frequency mutations. The source code for SinoDuplex is freely available at https://github.com/SinOncology/sinoduplex.

Objective To investigate the expression of programmed death receptor-1 (PD-1) in CD8+ T cells and FoxP3+CD4+ cells in patients with primary biliary cholangitis (PBC).Methods The peripheral blood and clinical data of 69 PBC patients in Peking Union Medical College Hospital and 58 health controls (HC) were collected.They were divided into initial treatment group and follow-up group according to whether they were treated or not.Patients in the treatment group were further divided into the refractory group and stable group according to treatment response.Flow cytometry was used to detect the expression of PD-1 in CDS+T cells and FoxP3+CD4+ cells.T-test and Person correlation analysis were used for data analysis.Results The PD-1 expression in peripheral blood mononuclear cells (PBMCs) of 69 PBC patients (12±9)％ was lower than that of HC (20±12)％ (t=-3.687,P＜0.01).The percentage of PD-1+ in FoxP3+ CD4+T cells was significantly increased in PBC (5.6±3.7)％ than HC (7.4±2.4)％ (t=2.048,P＜0.01).The proportion of CD8+T cells,PD-1 expression in CD8+T cells and the proportion of FoxP3+CD4+ cells weren't correlated with clinical parameters (P＞0.05).There was a negative correlation between the expression of PD-1 cells in FoxP3+CD4+ cells and GLOBE score (r=-0.307,P＜0.05).Conclusion The expression of PD-1 in peripheral CD8+T lymphocytes of PBC patients is lower than that of HC,and decreases more significantly in the refractory group.The expression of PD-1 on FoxP3+CD4+T cells is higher than that in HC,and is negatively correlated with the prognostic GLOBE score.It suggests that PD-1/PD-L1 pathway participates in the immune mechanism of PBC.

Objective To investigate the health related quality of life score [primary biliary cholangitis (PBC)-40] in patients with PBC,and the relationship between PBC-40 and clinical presentations.Methods The PBC-40 score and clinical presentations in PBC patients (n=65) were adapted in this study.Patients were divided into the untreated group and the treated group,and the treated group was further divided into ursodesoxycholic acid (UDCA) response group and UDCA non-response group.PBC-40 scores of different groups were analyzed by t-test and the relationship between PBC-40 and clinical presentations were analyzed with Pearson's test.Results Dimensions of PBC-40 scores of this group of patients were as follows:symptoms were (15.8±4.1) points,itch was (4.9±2.8) points,atigue was (23.8±8.9) points,cognitive dysfunction score was (11.4±4.7) points,social activity score was (17.0±7.5) points,and the emotion score was (6.5±3.1) points.The untreated group had higher emotion scores than the treated group (t=2.024,P=0.045).Compared with the UDCA response group,UDCA non-response group had higher scores in cognitive,social and emotion dimension (t =2.126,2.309,2.062,respectively,P=0.039,0.025,0.045,respectively).Itch score was significantly correlated with total bilirubin (TBil),direct bilirubin (DBil),alkaline phosphatase (ALP) and total bile acid (TBA) (r=0.349,0.345,0.324,0.427,respectively,P＜0.01),while the social scores were correlated with TBil,DBil,aspartate aminotransferase (AST) and TBA (r=0.361,0.383,0.316,0.331,P＜0.01) and emotion scores were associated with ALT,TBil,GGT,ALP,AST and TBA (r=0.332,0.430,0.265,0.326,0.297,0.353,P＜0.05).ConclusionPBC-40 can be used as a health-related quality of life assessment for PBC patients inChinese population.Itch,social and emotion dimensions are correlated with clinical activity indicators.Hyperbilirubin,ALP and TBA can predict low health quality of life in PBC patients.Conclusion PBC-40 can be used as a health-related quality of life assessment for PBC patients in Chinese population.Itch,social and emotion dimensions are correlated with clinical activity indicators.Hyperbilirubin,ALP and TBA can predict low health related quality of life in PBC patients.

Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.
Algorithms ; Clothing ; Electrocardiography ; Equipment Design ; Female ; Humans ; Internet ; Machine Learning ; Maternal Health ; Monitoring, Ambulatory ; instrumentation ; Telemedicine ; instrumentation

Objective To investigate the diagnostic value of apparent diffusion coefficient in the evaluation of sinonasal masses.Methods Sixty-seven sinonasal solid masses over 1 cm in diameter confirmed by pathology were retrospectively analyzed,all patients underwent preoperative routine MRI with DWI,the ADC values were measured in ROI within the solid mass.The patients were divided into benign and malignant groups by the histopathology,according to pathological findings,the patients were further divided into the hematolymphoid tumors,the malignancy of epithelium and mesenchymal tissue,the benign tumors of epithelial and mesenchymal tissue,and vasogenic masses.ANOVA test and t test were used to compare the ADC values of different groups.The receiver operating characteristic curve (ROC) was constructed using various cut points of ADC for different parameters to confirm the diagnostic threshold value and evaluate the diagnostic efficacy.Results All lesions were solitary.There were 22 malignant tumors,of which 6 lesions were hematolymphoid tumors and 16 lesions malignancy from epithelium and mesenchymal tissue.There were 45 benign tumors,of which 22 lesions were benign tumors from epithelium and mesenchymal tissue and 23 lesions vasogenic masses.The mean ADC value of malignant and benign masses was(0.88 ± 0.26) × 10-3 mm2/s and (1.54 ± 0.41) × 10-3 mm2/s respectively.There was statistically significant differences between them (t =6.897,P ＜ 0.01).The mean ADC value was(0.63 ± 0.10) × 10-3 mm2/s in hematolymphoid tumors,(0.97 ±0.24) × 10 3 mm2/s in malignancy from epithelium and mesenchymal tissue,(1.38 ± 0.23) × 10-3 mm2/s in benign tumors from epithelium and mesenchymal tissue,(1.68 ± 0.49) × 10-3 mm2/s in vasogenic masses respectively.There was statistically significant difference among all 4 groups(F =22.788,P ＜ 0.01),and the differences between any 2 groups were still statistically significant(P ＜ 0.05).The area under the ROC calculated was 0.945.Using an ADC value of 1.08 × 10-3 mm2/s as the threshold value for differentiating malignant from benign lesions,the best result obtained had a sensitivity of 81.8％ (18/22),specificity of 97.8％ (44/45),accuracy of 92.5 ％ (62/67).Conclusion The ADC value is a valuable tool in differentiating benign from malignant masses and different kinds of masses in sinus and nasal cavity.

Objective To determine the CT and MRI features of the sinonasal cavity. Methods The CT and MRI of nine patients with histologically proved hemangiopericytoma in the sinonasal cavity were retrospectively reviewed. All nine patients underwent CT and seven of them underwent MRI. In addition, the time-intensity curve (TIC) of dynamic contrast-enhanced (DCE) MRI were analyzed in three patients. Results The lesions were from the nasal cavity in 5 cases, the maxillary sinus in 3 cases, and the sphenoid sinus in one case. The lesions appeared spindle in 4 cases, oval in 3, and irregular in 2. The mean maximum diameter of the lesions was 31 mm (range, 15 to 52 mm). Seven hemangiopericytomas had welldefined margins and 2 had ill-defined margins. On plain CT, the lesions were isodense to gray matter in six (66. 7% ) and slightly hyperdense in three (33. 3% ) patients. Only two patients had post-contrast CT and the tumors showed marked enhancement. The lesions caused adjacent bony compression and absorption in 7 cases and bony destruction in 2. On MR T1WI, hemangiopericytomas appeared hypointense in 3 (42. 8% ) patients and isointense in 4 (57. 2% ) patients. On T2WI, the lesions appeared hyperintense in three (42.8%) patients and isointense in four (57.2%) patients. On T1WI, all the lesions showed relatively homogeneous signal, while 2 lesions revealed heterogeneous signal on T2WI. Hemangiopericytomas showed marked homogeneous contrast enhancement in 4 cases and heterogeneous contrast enhancement in 3.TIC showed a steady enhancement pattern in 3 patients. The lesions involved the orbit in 2 cases and,cavernous sinus, anterior skull base meninge, pterygopalatine fossa and infratemporal fossa in one case. Five patients underwent follow-up for two to eight years after surgery. Two patients were found to have recurrence.Conclusions Marked enhancement and steady enhancement pattern of TIC on MRI are typical manifestations of hemangiopericytoma of the sinonasal cavity. Bone changes may help to identify the nature of the lesion. Imaging can accurately detect the scope of hemangiopericytoma in this region.