Abstract:Objective To investigate the trends of proportion and in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) over the past 12 years. Methods A retrospective analysis was performed on 4 868 patients, who were hospitalized for acute myocardial infarction (AMI) in the Department of Cardiovasology, Changhai Hospital, Naval Medical University (Second Military Medical University) from Jan. 1, 2007 to Dec. 31, 2018. The annual percentage change (APC) method was used to analyze the changes of the proportion and in-hospital mortality of STEMI and NSTEMI patients. Results Of the 4 868 AMI patients, 3 064 (62.9%) had STEMI and 1 804 (37.1%) had NSTEMI. The proportion of NSTEMI patients significantly increased within the 12 years (APC value 14.0%, P<0.01), from 15.7% in 2007 to 45.2% in 2018; the proportion of STEMI patients showed a significant decline (APC value -5.5%, P<0.01), from 84.3% in 2007 to 54.8% in 2018. The in-hospital mortality of AMI patients showed a significantly downward trend (APC value -6.6%, P<0.05), from 7.0% in 2007 to 4.3% in 2018. The in-hospital mortality of NSTEMI patients also showed a significant decline (APC value -11.9%, P<0.05), from 13.9% in 2007 to 1.9% in 2018, while that of STEMI patients showed no significant change (APC value -3.8%, P=0.225). Conclusion Among AMI patients in our hospital from 2007 to 2018, the proportion of NSTEMI patients showed an increasing trend. The in-hospital mortality of NSTEMI patients decreased within the 12 years, while that of STEMI patients did not.

Abstract:Objective To retrospectively analyze the allergen characteristics and the onset season of allergic rhinitis (AR) patients in Shanghai, China. Methods From Jan. 1, 2015 to Dec. 31, 2017, 1 570 suspected AR patients were selected from the Department of Otolaryngology/Head and Neck Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University). One milliliter of serum was extracted from each patient and the specific immunoglobulin E (IgE) levels of 22 kinds of allergens and total IgE levels were detected using allergen specific IgE antibody detection kit (immunoblotting method). The AR patients were divided into 5-16, 17-39, 40-64 and ≥ 65 years old groups, and the positive rates of allergens were compared. The number of AR patients with one or more positive allergens was recorded every month, and the seasonal distribution of positive allergen was analyzed. Results Of the 1 570 suspected AR patients, 143 (9.1%) had elevated serum total IgE, and 1 182 (75.3%) had one or more positive allergens, including 491 (41.5%) with single positive allergen and 691 (58.5%) with two or more positive allergens. Among the 22 kinds of allergens, dust mites (including Dermatophagoides pteronyssinus and Dermatophagoides farinae) were the most common allergens (715 cases, 60.5%), followed by penicillin (239 cases, 20.2%) and Chinese parasol (167 cases, 14.1%). Among the 1 182 AR patients, 17-39 years old was the highest proportion (61.0%, 721 cases). The positive rate of dust mites in the 5-16 years old group was significantly higher than those in the 17-39, 40-64 and ≥ 65 years old groups (all P<0.05). The prevalence peaks of AR were in Apr., May, Jun., Aug., Sep., Oct. and Nov.; and the numbers of AR patients with one or more positive allergens were 175±21, 156±16, 259±31, 172±15, 176±14, 164±4 and 204±32, respectively, which were significantly higher than the average value (97±42) of 36 months from Jan. 1, 2015 to Dec. 31, 2017 (all P<0.05). The positive detection time of dust mites was mainly in May, Jun., Jul., Aug., Sep. and Nov.; and the numbers of dust mite positive AR patients were 64±11, 113±21, 68±18, 76±15, 70±11 and 89±21, respectively, which were significantly higher than the average value (52±32) of the 36 months (all P<0.05). Conclusion Dust mites are the most common and main allergens of AR patients in Shanghai, China. The proportion is high in AR patients aged 17-39 years old, and the prevalence peaks are from Apr. to Jun. and from Aug. to Nov..

Abstract:Objective To explore the prevalence and influencing factors of coronary atherosclerotic heart disease (CHD) in rheumatoid arthritis (RA) patients during past 10 years. Methods A total of 5 426 RA patients were selected from Jan. 1, 2009 to Mar. 20, 2019 in the Tianjin First Central Hospital, and 1 483 osteoarthritis (OA) patients were selected as controls. Basic information, laboratory indicators, prevalence of CHD and related complications, and drug use of RA and OA patients were collected and compared. The influencing factors of CHD prevalence in RA patients were analyzed by logistic regression. Results There was no significant difference in the prevalence of CHD between male and female RA patients (32.1%, 321/1 000 vs 32.3%, 323/1 000; χ²=0.02, P=0.90). The prevalence rates of CHD, hyperlipidemia and hypertension in RA patients were significantly increased in the past 10 years (χ²=115.67, 129.41, 193.81, all P<0.01), while the prevalence of diabetes mellitus was significantly decreased after 2014 (χ²=29.99, P<0.01). After propensity score matching of 1:1 by age and gender, there was no significant difference in CHD prevalence between the RA and OA patients (P=0.74). The levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 2 receptor (IL-2R), interleukin 6 (IL-6), high density lipoprotein-cholesterol (HDL-C), rheumatoid factor (RF), anti-cyclic citrullinated peptide (ACCP), D-dimer, fibrinogen (FiB) and creatine kinase-myocardial band (CK-MB), and positive rate of anti-keratin antibody (AKA) were significantly higher in the RA patients than those in the OA patients, while the levels of creatine kinase (CK) and blood glucose were significantly lower than those in the OA patients (all P<0.05). The levels of ESR, CRP, total cholesterol, low density lipoprotein-cholesterol (LDL-C), triglyceride, immunoglobulin G-rheumatoid factor (IgG-RF), ACCP, FiB, blood glucose and uric acid, and the positive rate of AKA were all significantly higher in the RA patients with CHD than those in the RA patients without CHD, while the levels of HDL-C, immunoglobulin G (IgG), immunoglobulin M (IgM) and 25-hydroxyvitamin D were significantly lower than those in the RA patients without CHD (all P<0.05). Logistic regression analysis showed that the prevalence of CHD was negatively correlated with the levels of total cholesterol, ACCP, IgG and 25-hydroxyvitamin D, but positively correlated with the levels of IgG-RF and uric acid in PA patients (all P<0.05). Conclusion In clinical treatment, we should pay more attention to the risk factors of CHD in RA patients so as to select more targeted and effective RA treatment, reducing the risk of CHD and improving the quality of life of patients.

Abstract:Objective To investigate the efficacy of AI-SONIC^TM Thyroid system, a version 2.0 artificial intelligence (AI) automatic detection system, in the preoperative ultrasound diagnosis of thyroid nodules, and to evaluate the application value of AI automatic detection system version 2.0 in the differential diagnosis of benign and malignant thyroid nodules by comparing with the subjective diagnosis conclusions of sonographers with different seniorities. Methods A total of 247 patients (325 thyroid nodules) admitted to the Department of General Surgery in our hospital from Aug. 2019 to Jan. 2020 were selected for this study. All patients underwent routine ultrasound examinations by a senior sonographer with 13 years of experience in thyroid ultrasound diagnosis and a junior sonographer with 4 years of work experience. At the same time, the patients were also examined by another sonographer with 20 years of work experience using AI automatic detection system version 2.0, without knowing the diagnosis conclusions of the above two sonographers. Kappa test was used to evaluate the consistency of the results of routine ultrasound examination of sonographers with different seniorities and AI automatic detection system version 2.0 and the postoperative pathological results. Results The postoperative pathology confirmed 229 malignant nodules and 96 benign nodules. The sensitivity, specificity and accuracy in the diagnosis of benign and malignant thyroid nodules were 85.15% (195/229), 66.67% (64/96) and 79.69% (259/325), 93.45% (214/229), 79.17% (76/96) and 89.23% (290/325), and 92.58% (212/229), 71.88% (69/96) and 86.46% (281/325) for junior sonographer, senior sonographer and AI automatic detection system version 2.0, respectively. The Kappa consistency test results showed that the diagnosis result of senior sonographer was highly consistent with the pathological diagnosis result (Kappa value 0.78, P<0.01), while the diagnosis results of junior sonographer and AI automatic detection system version 2.0 were generally consistent with the pathological diagnosis result (Kappa values 0.55 and 0.74, both P<0.01). Conclusion The sensitivity, accuracy and specificity of the AI automatic detection system version 2.0 AI-SONIC^TM Thyroid in diagnosing benign and malignant thyroid nodules are similar to those of routine ultrasound examination by senior sonographers, and the system might be a reliable auxiliary means for preoperative evaluation of benign and malignant thyroid nodules.

Abstract:Objective To explore the therapeutic effect of endonasal transsphenoidal sellar tumor resection surgery for the treatment of non-functioning pituitary adenoma patients with hyperprolactinemia. Methods A total of 80 non-functioning pituitary adenoma patients with serum prolactin level >25 ng/mL and <200 ng/mL, who underwent endonasal transsphenoidal sellar tumor resection surgery in the Department of Neurosurgery of our hospital from Jan. 1, 2015 to Dec. 31, 2019, were retrospectively included. The clinical characteristics, surgical methods, postoperative complications, and the relief of postoperative hyperprolactinemia and clinical symptoms were analyzed. The predictive factors of postoperative hyperprolactinemia remission were analyzed using logistic regression. Results Out of the 80 patients, 21 were males and 59 were females. The preoperative prolactin level was 51.11 (25.20-136.52) ng/mL, and the tumor volume was 3.99 (0.23-37.11) cm³. Headache was the most common initial symptom (37.5%, 30/80). There was significant difference in the initial symptoms between the male and female patients (P=0.031), and the female patients were more likely to present with hypogonadotropic hypogonadism compared with the male patients (28.8%[17/59] vs 9.5%[2/21]). The male patients were significantly more likely to have two or more hormonal axis dysfunctions (47.6%[10/21] vs 15.3%[9/59], P=0.025). All the 80 patients received the resection surgery and 88.8% (71/80) of them achieved gross or near total resection. Sixty-five (81.2%) patients had remission of hyperprolactinemia within 3 months after surgery, and the prolactin level was 13.44 (1.74-24.19) ng/mL 3 months after surgery; 15 patients had no remission, and the corresponding prolactin level was 32.69 (25.20-115.23) ng/mL. The prolactin levels before and 1 d after surgery were significantly lower in the remission group than those in the non-remission group (preoperative:45.47[25.20-136.52] ng/mL vs 64.82[33.17-130.88] ng/mL, P=0.003; postoperative day 1:13.12[0.60-36.35] ng/mL vs 40.06[26.25-118.01] ng/mL, P<0.01). There were no significant differences in gender, age, tumor volume, surgical methods or extent of tumor resection between the two groups (all P>0.05). Multivariate logistic regression analysis showed that prolactin level ≤ 25 ng/mL on postoperative day 1 was an independent predictor of remission of hyperprolactinemia (odds ratio 13.500, 95% confidence interval 3.623-50.298, P<0.01). The visual defect and headache improvement rates were 87.9% (29/33) and 93.9% (31/33), respectively. Among the 17 female patients with menstrual disorders before surgery, 14 (82.4%) returned to normal menstrual cycles. Conclusion Endonasal transsphenoidal sellar tumor resection surgery is a reliable treatment option for non-functioning pituitary adenoma patients with hyperprolactinemia.

Abstract:Objective To investigate the correlation between serum 1,5-anhydroglucitol (1,5-AG) and mild cognitive impairment (MCI). Methods According to the diagnostic criteria of MCI and the cognitive function test results by Montreal cognitive assessment (MoCA) scale Chinese version, 80 volunteers receiving health check in our hospital from Nov. to Dec., 2019 were divided into MCI group (33 cases) and normal control (NC) group (47 cases). The demographic and clinical data were collected, and the blood glucose-related indexes, including 1,5-AG, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and 2 h-postprandial glucose (2 h-PPG), were measured. Anxiety and depression were assessed by self-rating anxiety scale (SAS) and geriatric depression scale (GDS), respectively. Linear correlation analysis and multiple linear regression analysis were used to study the correlation between the blood glucose-related indexes and MCI. Results There were no significant differences in the demographic data, clinical data, SAS score or GDS score between the two groups (all P> 0.05). Compared with the NC group, the MoCA score and the level of 1,5-AG were significantly lower in the MCI group (P<0.01, P=0.023), and the levels of FPG and 2 h-PPG were significantly higher (P=0.041, 0.027). Linear correlation analysis showed that the MoCA score was negatively correlated with the levels of FPG, 2 h-PPG and HbA1c (all P<0.05), but not with 1,5-AG level (P=0.134); the score of delayed recall, a cognitive domain of MoCA scale, was negatively correlated with the levels of FPG, 2 h-PPG and HbA1c (all P<0.05), and positively correlated with the 1,5-AG level (P=0.027). Multiple linear regression analysis showed that FPG was an independent factor of MoCA score (β=-0.291, P=0.009), and 1,5-AG and FPG were independent factors of delayed recall score (β=0.199 and -0.390, P=0.015 and 0.001). Conclusion 1,5-AG may be a potential biomarker for predicting cognitive impairment, especially for delayed recall; the blood glucose fluctuates greatly in MCI individuals at early stage, and maintaining the stability of blood glucose may be beneficial to the prevention of MCI.

Abstract:Objective To analyze the imaging feature and misdiagnosis reason of pancreatic neuroendocrine neoplasm (pNEN) with pancreatic duct obstruction. Methods The data of 25 patients with pNEN accompanied by pancreatic duct obstruction who underwent surgical treatment in our hospital from Jun. 2012 to Oct. 2018 were retrospectively analyzed. The imaging findings and misdiagnosis reason of pNEN were summarized by two senior radiologists. Results A total of 26 lesions in 25 patients were included, including six G1 tumors, 19 G2 tumors and one G3 tumor. The average size of the lesions was (2.5±1.7) cm (range, 0.4-9.1 cm). Of the 26 lesions, the main pancreatic duct was mildly dilated in 12 cases (46.2%), moderately dilated in eight cases (30.8%), and severely dilated in six cases (23.1%). Seventeen (65.4%) lesions were accompanied by severe atrophy of the upstream pancreatic parenchyma, six (23.1%) by moderate atrophy, one (3.8%) by mild atrophy, and two (7.7%) with no atrophy. Before operation, 14 (53.8%) lesions were correctly diagnosed as pNEN; and eight (30.8%) lesions were misdiagnosed as pancreatic cancer, two (7.7%) as solid pseudopapillar tumor, one (3.8%) as intraductal papillary mucinous neoplasm and one (3.8%) as serous cystadenoma. The main reasons of misdiagnosis included atypical lesion manifestations, insufficient understanding of atypical manifestations of the disease, inadequate observation of image details, less consideration of clinical data of the patients, etc. Conclusion It is difficult to differentiate pNEN with pancreatic duct obstruction from other pancreatic tumors. Being familiar with the atypical manifestations of the lesion, observing the image details carefully and understanding clinical data with imaging findings can help to reduce misdiagnosis and improve the accuracy of diagnosis.

Abstract:Objective To explore the application and clinical effect of ropivacaine incision infiltration combined with Wiltse approach in the analgesia of lumbar multi-segment decompression and fusion internal fixation. Methods A total of 120 patients with lumbar spinal stenosis and (or) lumbar disc herniation, who received posterior lumbar multi-segmental (≥ 2) transforaminal lumbar interbody fusion (TLIF) in the Second Affiliated Hospital of Nantong University from Jan. 2016 to Jan. 2019, were randomly assigned to four groups:group A (ropivacaine incision infiltration+Wiltse approach), group B (ropivacaine incision infiltration+posterior median approach), group C (saline incision infiltration+Wiltse approach) and group D (saline incision infiltration+posterior median approach). The operation time, intraoperative blood loss, postoperative drainage volume, postoperative analgesic dosage, the visual analogue scale (VAS) score of low back pain before operation and 6 h, 1 d, 3 d, 7 d, 1 month and 3 months after operation, and the Oswestry disability index (ODI) before operation and 3 d, 7 d, 1 month and 3 months after operation, were compared among the four groups. Results There were no significant differences in gender, age, body weight, operative segments, low back pain VAS score or ODI before operation (all P>0.05). The intraoperative blood loss, postoperative drainage volume and analgesic dosage were significantly lower in the groups A and C than those in the groups B and D (all P<0.05). The VAS scores 6 h after operation were significantly lower in the groups A and B than those in the groups C and D, and the VAS scores 3 and 7 d after operation were significantly lower in the groups A and C than the groups B and D (all P<0.05). The ODI values 3 d and 3 months after operation were significantly lower in the groups A and C than those in the groups B and D (all P<0.05). Conclusion Preemptive analgesia using ropivacaine incision infiltration combined with Wiltse approach in lumbar multi-segment decompression and fusion internal fixation can effectively relieve postoperative pain, with remarkable analgesic effect and rapid functional recovery, benefiting early recovery of patients after operation.

Abstract:Objective To investigate the distribution, drug resistance and molecular biological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in our hospital, so as to provide reference for rational use of antibiotics and prevention and control of nosocomial CRKP infection. Methods Non-repetitive CRKP strains were collected from Jan. to Dec. 2019 in our hospital. VITEK 2 Compact automatic microbial analyzer and Kirby-Bauer test were used for bacterial identification and antimicrobial susceptibility analysis. WHONET 5.6 software was used to analyze CRKP detection rate, sample source and clinical department distribution. Hypermucoviscosity phenotype strains were screened by string test. Carbapenemase resistance genes, capsular serotype and virulence genes were detected by polymerase chain reaction (PCR). Results A total of 532 Klebsiella pneumoniae strains were detected, including 140 (26.3%) CRKP strains. The CRKP strains were mainly isolated from sputum and bronchoalveolar lavage fluid (66 strains, 47.1%), followed by urine (21 strains, 15.0%). The clinical departments of the isolates were mainly cardiovascular surgery intensive care unit (ICU) (47 strains, 33.6%), burn ICU (18 strains, 12.9%) and emergency department (18 strains, 12.9%). The antimicrobial susceptibility test showed that the CRKP strains were susceptible only to tigecycline, with resistance rates being over 50% to other common antibiotics. The resistance rates to the first to fourth generation cephalosporin antibiotics were above 85%, and the resistance rates to carbapenems were up to 100.0%. We also found that out of the 121 CRKP strains, 101 (83.5%) carried Klebsiella pneumoniae carbapenemase 2 (KPC-2) gene, seven (5.8%) with oxacillinase-48 (OXA-48) gene, and two (1.7%) with New Delhi metallo-β-lactmase 1 (NDM-1) gene; while one carried both KPC-2 and NDM-1 genes, and one carried both KPC-2 and OXA-48 genes; and nine carried no target drug-resistance genes. Fifteen (12.4%, 15/121) CRKP strains were positive for string test, with 13 being K64 capsular type and two being K47 capsular type; and 14 strains carried at least one virulence gene. Conclusion The clinical isolation rate of CRKP is high in our hospital, and the CRKP strains (mainly K64 capsular high virulence) are resistant to multiple antibiotics, suggesting that we should further strengthen the monitoring of drug resistance and rational use of antibiotics, so as to prevent the spread and prevalence of drug-resistant and highly virulent strains.

Abstract:Objective To investigate the effects of spinal cannabinoid type 2 receptor (CB₂R) and microglia activation on hyperalgesia in neuropathic pain mice. Methods Male C57/BL mice were randomly divided into six groups:sham, spinal nerve ligation (SNL), SNL+CB₂R agonist AM1241 (SNL+AM1241), SNL+microglia inhibitor minocycline (SNL+ minocycline), SNL+small interfering RNA (siRNA) targeting CB₂R (SNL+siRNA), and SNL+siRNA+minocycline groups. A neuropathic pain mouse model was established by SNL. The expression levels of spinal CB₂R and microglia-specific protein ionized calcium-binding adapter molecule 1 (IBA-1) were determined by Western blotting, mechanical pain thresholds were measured by Von Frey, spinal microglia activation was observed by IBA-1 immunofluorescence, and the expression levels of inflammatory factors in spinal cord dialysate were determined by quantitative real-time polymerase chain reaction (qRT-PCR). Electrophysiology was applied to observe the effect of CB₂R agonist on spontaneous inhibitory postsynaptic current (sIPSC) in the spinal dorsal horn. Results Compared with the sham group, the expression of CB₂R in spinal cord was significantly decreased in the SNL group (P<0.012 5), the pain threshold was significantly reduced (P<0.016 7), the fluorescence quantification and protein expression of IBA-1 were significantly increased (both P<0.008 3), and the mRNA expression levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 were significantly increased (all P<0.008 3). After intrathecal injection of CB₂R agonist AM1241 or microglial inhibitor minocycline, compared with the SNL group, the pain thresholds of mice were significantly increased in the SNL+AM1241 and SNL+minocycline groups (both P<0.008 3), the fluorescence quantification and protein expression of IBA-1 were significantly decreased (both P<0.008 3), and the mRNA expression levels of TNF-α, IL-1β and IL-6 were significantly decreased (all P<0.008 3). After targeted interfering CB₂R expression by siRNA, compared with the SNL group, the pain threshold was significantly decreased in the SNL+siRNA group (P<0.008 3), the fluorescence quantification and protein expression of IBA-1 were significantly increased (both P<0.008 3), and the mRNA expression levels of TNF-α, IL-1β and IL-6 were significantly increased (all P<0.008 3); while intrathecal injection of minocycline significantly reversed the above changes (all P<0.008 3). Intervention in vitro of AM1241 could significantly enhance the frequency and amplitude of sIPSC in the spinal dorsal horn (both P<0.05), while continuous treatment with minocycline inhibited the enhancement effects of AM1241 on sIPSC. Conclusion CB₂R can reduce the neuroinflammatory responses and enhance the inhibitory electrical activity in the spinal cord by inhibiting spinal microglia activation, thereby alleviating hyperalgesia of neuropathic pain in mice.

Abstract:Objective To investigate the effect of ginkgo diterpene lactones on hypoxia-induced apoptosis and angiogenesis of human umbilical vein endothelial cells (HUVECs) and the related molecular mechanisms. Methods HUVECs were cultured under hypoxia for 24 h, and then treated with ginkgo diterpene lactones (low-dose:6.25 mg/L and high-dose:25.00 mg/L). MTT assay was used to detect the cell activity. Flow cytometry was used to detect the apoptosis of HUVECs. Transwell assay was employed to detect the migration of HUVECs. Quantitative real-time polymerase chain reaction and Western blotting were used to test the expression levels of mRNA and protein of hypoxia-inducible factor 1α (HIF-1α), apoptosis-related genes (B-cell lymphoma 2[Bcl-2] and B-cell lymphoma 2-related X protein[Bax]), and angiogenesis-related genes (vascular endothelial growth factor[VEGF] and transforming growth factor β[TGF-β]). Results Compared with the normal group, the HUVEC activity was significantly decreased after exposed to hypoxia for 24 h (P<0.05), and the apoptosis rate of HUVECs and mRNA and protein expression levels of HIF-1α were significantly higher (all P<0.05). The cell activity and migration ability of HUVECs were significantly higher in the low- and high-dose ginkgo diterpene lactones groups than those in the hypoxia group (all P<0.05), and the apoptosis rates of HUVECs were significantly lower than those in the hypoxia group (both P<0.05). Meanwhile, the cell activity and migration ability were significantly higher in the high-dose group than those in the low-dose group (both P<0.05), and the apoptosis rate was significantly lower than that in the low-dose group (P<0.05). The mRNA and protein expression levels of HIF-1α and Bax were lower in the low- and high-dose ginkgo diterpene lactones groups than those in the hypoxia group, and the mRNA and protein expression levels of Bcl-2, VEGF and TGF-β were higher than those in the hypoxia group; and the expression changes of the above genes were more significant in the high-dose group. Conclusion Ginkgo diterpene lactones can improve hypoxia-induced apoptosis and angiogenesis of HUVECs by regulating the expression levels of HIF-1α and apoptosis- and angiogenesis-related genes, and it might be used as a new agent to treat anoxic vascular diseases.

Abstract:Objective To propose a drug word vector conversion model based on attention mechanism named Drug2vec for generating vectorized representation of drug information, and to compare the vector conversion effect with Word2vec and Med2vec. Methods Using the attention mechanism to capture the roles of medical entities on the central word, we proposed a Drug2vec model to convert medical entities in unstructured electronic medical records into vectors. Using the systemic lupus erythematosus (SLE) dataset of 14 219 patients and 963 drug entities, we tested the effect of the drug vectors generated by Drug2vec and compared it with the widely used language concept space vector conversion models Word2vec and Med2vec. Results In the SLE dataset, the accuracy of drug vectors generated by Drug2vec was higher than those of Word2vec and Med2vec models. The rank results of the similarity of drugs showed that the drug vectors generated by Drug2vec were consistent with the clinician's medication order. Conclusion Drug2vec model can more accurately modify central drug entities using contextual entities, producing more precise drug vectors.

Abstract:The risk of cardiovascular diseases is significantly increased in cancer patients receiving chemotherapy or radiotherapy. Recent evidences suggested that cardiac dysfunction and subsequent heart failure are mainly caused by vascular toxicity rather than myocardial toxicity. However, not all of the vascular toxicity of cancer therapies can be explained by obstructive coronary artery disease. In the past few decades, it has been found that myocardial ischemia may be caused by structural or functional disorders of the complex vascular network that cannot be seen by coronary angiography, known as coronary microvascular dysfunction (CMD). There is growing evidences that cancer therapy-related cardiovascular dysfunction (CTRCD) and CMD have many common pathophysiological mechanisms. This paper elucidates the relationship between CTRCD and CMD from the pathophysiological perspective, providing reference for exploring new diagnostic methods and treatment strategies of cardiovascular diseases.

Abstract:Epidemic infectious diseases have become a major threat to public health safety. This paper reviews the previous researches and analyzes the psychological impact of infectious disease outbreak on medical staff, patients and the public, exploring the risk and protective factors of adverse psychological reactions, so as to provide references for future research and counseling after coronavirus disease 2019 outbreak. It is suggested that multi-center and large-scale follow-up investigation is needed, and more attention needs to be paid on influences of stigma and public opinion on internet and the change of positive psychological quality after the epidemic outbreak. Moreover, the research results of risk and protective factors should be fully used in psychological intervention.

Abstract:Objective To investigate the hardiness level of military medical students and to explore its influencing factors. Methods A total of 543 medical students from a military university were investigated with Chinese adult hardiness personality scale, general self-efficacy scale and perceived social support scale. Multiple linear regression model was performed to explore the predictive factors of hardiness of medical students. Results A total of 543 questionnaires were sent out, and 504 valid questionnaires were collected, with an effective recovery rate of 92.8%. The total score of hardiness was 72.91±13.03, and the average score of the items was 2.70±0.48. The average score of resilience items was the highest (2.81±0.56), followed by control (2.70±0.51), commitment (2.69±0.55) and challenge (2.62±0.55). Frequency of extracurricular activities (β=0.121, P=0.002), self-efficacy (β=0.432, P<0.01) and friend support (β=0.170, P<0.01) were predictive factors of hardiness, and they could explain 27.5% variances of hardiness in military medical students. Conclusion The hardiness of military medical students is relatively low and need to be improved. Encouraging the students to participate in extracurricular activities, promoting their self-efficacy and increasing their friend support may help to upgrade the hardiness of military medical students.

Abstract:Analgesia for battlefield war wound is the beginning of the war wound analgesia management system, and effective analgesia for battlefield war wound plays a significant role in keeping the fighting capacity. Special combat is characterized by the complexity and diversity of combat tasks, small scale of combat units, and limited medical service, resulting in a high incidence of war trauma. Therefore, the battlefield war wound analgesia for special combat personnel has prominent demands. In this paper, we analyzed the characteristics and current situation of battlefield war wound analgesia for special combat personnel, and discussed how to effectively carry out battlefield war wound analgesia, so as to provide reference for improving the fighting capacity of special combat personnel.

Abstract:Objective To summarize the clinical symptoms, imaging features and endovascular treatment outcomes of the middle meningeal vein dural arteriovenous fistula (MMV-DAVF). Methods The data of nine MMV-DAVF patients admitted to our hospital from Jan. 1999 to Apr. 2020 were retrospectively collected. A total of 16 Chinese and English articles, including 23 cases of MMV-DAVF, were retrieved from the database between Jan. 1, 1960 and Aug. 30, 2020. The clinical symptoms, imaging features and endovascular treatment outcomes were analyzed. Results Of the nine MMV-DAVF patients in our hospital, seven patients had a clear history of head trauma. Headache (five cases) and intracranial murmur (five cases) were the most common clinical symptoms. Six patients had computed tomography (CT) data, and four of them had skull fracture and five had intracranial hemorrhage. All the nine patients were drained from the middle meningeal vein (MMV) to adjacent venous sinus or venous plexus. The nine patients were treated with Onyx-18 glue endovascular intervention via middle meningeal artery (MMA) approach, and seven patients had complete embolization immediately after operation and two had subtotal embolization. No recurrence or new onset of DAVF was found in four patients having CT data half a year after operation. Among the 32 patients from our hospital and literatures, 26 patients (81.2%) had a clear history of head trauma, 16 patients (50.0%) suffered from headache, and 12 patients (37.5%) suffered from intracranial murmur. Twenty-five patients had CT data, including 21 patients (84.0%) with skull fracture, 16 patients (64.0%) with intracranial hematoma. Twenty patients (62.5%) were treated with endovascular interventional therapy via MMA approach, and 16 patients (80.0%) had complete embolization immediately after operation. Among them, seven cases had imaging follow-up data half a year after operation, and no recurrence or new onset of DAVF was found. Conclusion MMV-DAVF is rare, and many patients have head trauma history combined with skull fracture or intracranial hematoma. Endovascular embolization via MMA approach is safe and effective in treating MMV-DAVF.

Abstract:Objective To analyze the effectiveness and the best drainage time of transurethral ureteral stent (D-J catheter) placement or percutaneous nephrostomy (PCN) in treating upper urinary tract calculi with infection at different time points after admission. Methods A total of 104 patients with upper urinary tract calculi and infection were enrolled in our hospital from Jan. 2018 to Dec. 2019. They were randomly divided into D-J catheter group and PCN group. According to the time from admission to operation, each group was then further divided into subgroups of ≤ 2 h, >2 h to 12 h and >12 h to 24 h (24, 18 and 10 cases, respectively). The body temperature, blood white blood cell (WBC) count and neutrophil proportion, C-reactive protein (CRP), serum procalcitonin, urine WBC count and the time of body temperature returning to normal were analyzed preoperatively and 1-3 d postoperatively. Results The patients in the two groups successfully received the operation with no change in operation mode. On the first day after the operation, the urine WBC counts were increased significantly in the three subgroups of each group (all P<0.05). The body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were significantly higher in the three subgroups of the D-J catheter group than those in the three subgroups of the PCN group, while the urine WBC count was significantly lower (all P<0.05). In the two groups, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and WBC count were significantly higher in the >12 h to 24 h subgroup than those in the ≤ 2 h and >2 h to 12 h subgroups (all P<0.05). On the second day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and urine WBC count were significantly lower in each subgroup of the PCN group than those in each subgroup of the D-J catheter group (all P<0.05). On the third day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were basically decreased to normals, but the above indexes were significantly higher in the >12 h to 24 h subgroup than those in the ≤ 2 h and >2 h to 12 h subgroups (all P<0.05). The time of body temperature returning to normal was similar between the ≤ 2 h and >2 h to 12 h subgroups of the two groups (all P>0.05), while the time in the >12 h to 24 h subgroup of the D-J catheter group was significantly longer than that of the PCN group (P<0.05). Conclusion Transurethral D-J catheter placement and PCN drainage within 12 h after admission can achieve good efficacy in treating patients with upper urinary tract calculi and infection, and the infection control of PCN is better.

Abstract:Objective To detect the methylation levels of PR domain-containing protein 12 (PRDM12), forkhead box E1 (FOXE1), beta-1,3-glucuronyltransferase 2 (B3GAT2), vimentin (VIM) and secreted frizzled-related protein 2 (SFRP2) genes in colorectal cancer tissues, so as to evaluate their potentials as early screening markers for colorectal cancer. Methods The paraffin specimen samples were collected from 31 colorectal cancer patients receiving surgical resection in Changhai Hospital, Naval Medical University (Second Military Medical University). The methylation levels of PRDM12, FOXE1, B3GAT2, VIM, SFRP2-1 and SFRP2-2 gene promoters in cancer tissues and corresponding paracancerous normal tissues were detected using pyrosequencing method. Results The promoter methylation indexes of PRDM12, FOXE1, B3GAT2, VIM, SFRP2-1 and SFRP2-2 genes were significantly higher in the cancer tissues of the 31 patients than those in the paracancerous tissues (all P<0.01). The positive methylation rates of PRDM12, FOXE1, B3GAT2, VIM, SFRP2-1 and SFRP2-2 gene promoters were 87.1% (27/31), 90.3 (28/31), 80.6% (25/31), 77.4% (24/31), 74.2% (23/31) and 64.5% (20/31), respectively. In the 18 cases of early stage (TNM Ⅰ-Ⅱ) colorectal cancer, the positive methylation rates of PRDM12, FOXE1, B3GAT2, VIM, SFRP2-1 and SFRP2-2 gene promoters were 88.9% (16/18), 94.4% (17/18), 83.3% (15/18), 77.8% (14/18), 83.3% (15/18) and 61.1% (11/18), respectively. Conclusion PRDM12 and FOXE1 genes show abnormal methylation in colorectal cancer tissues, suggesting that they may serve as potential molecular markers for the early diagnosis of colorectal cancer.

Abstract: