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There is limited information is known about the composition difference of the gut microbiota in patients with constipation and healthy controls. Here, the faecal 16S rRNA fastq sequence data of microbiota from the publicly available American Gut Project (AGP) were analysed. The tendency score matching (PSM) method was used to match in a 1:1 manner to control for confounding factors age, gender, body mass index (BMI), and country. A total of 524 participants including 262 patients with constipation and 262 healthy controls were included in this analysis. The richness and evenness of the gut microbiota in the constipation group were significantly lower than those in the control group. The dominant genera in the constipation group include Escherichia_Shigella, Pseudomonas, and Citrobacter. The dominant genera in the control group include Faecalibacterium, Prevotella, Roseburia, Clostridium_XlVa, and Blautia. The abundance of three butyrate production-related pathways were significantly higher in the constipation group than in the control groups. There was no significant difference in the diversity and gut microbiota composition in patients with constipation at different ages. In conclusion, patients with constipation showed gut microbiota and butyrate metabolism dysbiosis. This dysbiosis might provide a reference for the diagnosis and clinical therapy of diseases.

This study aimed to evaluate the effect of resistance exercise on peripheral inflammatory biomarkers in healthy adults.Four databases, including PubMed, Web of Science, Cochrane Library, and SPORTDiscus, were searched from inception until April 1st, 2022. A meta-analysis was conducted using a random-effects model, followed by sensitivity analysis, subgroup analysis, meta-regression analysis, and publication bias analysis.15 randomized controlled trials were included in the meta-analysis. The pooled results showed that resistance exercise significantly decreased TNF-α levels (SMD = -0.81, 95% CI: -1.42 to -0.20, p = 0.009) but did not affect IL-6 and CRP levels. Individuals with BMI 18.5-24.9 exhibited significantly decreased IL-6 levels, while moderate strength resistance exercise could significantly decrease TNF-α levels. Finally, age might be a confounding factor influencing the effect of resistance exercise on IL-6.Resistance exercise could reduce TNF-α levels in healthy adults, and resistance exercise with moderate intensity could reduce TNF-α levels more effectively.

The aim of our study was to elucidate the clinical characteristics of alcoholic-hyperlipidemic etiologically complex acute pancreatitis.We reviewed complete data from 233 patients with acute pancreatitis treated in our hospital during the period January 2017-January 2022. They were divided into three groups according to etiology: alcoholic acute pancreatitis (AAP), hyperlipidemic acute pancreatitis (HLAP), and alcoholic-hyperlipidemic acute pancreatitis (AHAP). General clinical data, co-morbidities, laboratory results, imaging data, and disease severity were analyzed and compared between groups.The proportion of male individuals in the AHAP group was significantly higher than that in the HLAP group (p0.001). Age of onset was lower and the number of cases with antibiotic use was higher in the AHAP group than in the AAP group (p0.05). Additionally, the average alcohol intake each time and weekly alcohol intake were also higher in the AHAP group than in the AAP group (p0.05). Comparison of disease severity (moderate and severe acute pancreatitis, severe acute pancreatitis, and modified computed tomography severity index score) revealed the disease condition to be more severe in the AHAP group than in the AAP and HLAP groups (p0.05). Accordingly, patients in the AHAP group had longer hospital stays than those in the other two groups (p0.05). There were no significant differences in alcohol consumption, severity, or length of hospital stay in the AHAP group (p0.05).The clinical characteristics of patients in the AHAP, AAP and HLAP groups were different, and the patients in the AHAP group were more likely to have a moderate to severe disease course, with longer hospital stay. As a new AP classification concept, AHAP would offer high significance for diagnosis, treatment, and prognosis.

伴肠母细胞分化的胃腺癌合并绒毛膜癌成分并肝转移病例比较罕见。患者为65岁女性。胃癌根治标本，胃肿瘤呈腺管状、乳头状结构，细胞质透明，诊断为伴肠母细胞分化的胃腺癌。在淋巴结转移灶和肝转移灶中出现了绒毛膜癌成分。免疫组织化学不同程度表达SALL4、Glypican3、甲胎蛋白、人绒毛膜促性腺激素、CDX2、CD10等抗体。二代测序提示TP53突变、MYC扩增等改变。此肿瘤恶性程度高，预后差，对术前化疗不敏感。患者术后12个月死亡。.

Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the sacroiliac joints, spine and peripheral joints. In China, standardized diagnosis and treatment of AS is still to be popularized. Based on the evidence and guidelines from China and other countries, Chinese Rheumatology Association developed standardization of diagnosis and treatment of AS. The purposes are: (1) to standardize the diagnosis and evaluation of AS; (2) to promote rational use of non-steroidal anti-inflammatory drugs, biological as well as traditional disease modifying anti-rheumatic drugs, so as to improve the patient's quality of life.强直性脊柱炎（AS）是一种主要侵犯骶髂关节、脊柱和外周关节的慢性炎症性疾病。在我国，AS的规范化诊断和治疗仍有待普及。中华医学会风湿病学分会结合我国国情，在借鉴国内外诊治经验和指南的基础上，制定了本规范，旨在规范AS的诊断和病情评估，合理使用非甾体抗炎药、生物和传统合成改善病情抗风湿药，提高患者的生活质量。.

With this meta-analysis we aimed at systematically evaluating the intervention effects of aerobic exercise on inflammatory factors in healthy adults and identifying an optimal aerobic exercise program with anti-inflammatory effects.Four databases, including PubMed, Web of Science, Cochrane Library and SPORTDiscus, were searched from inception until April 30, 2021. Stata version 11.0 was used for data analysis.A total of 15 studies with 1160 participants were included. The pooled estimates showed that aerobic exercise could significantly reduce TNFα levels (SMD=-0.30, 95% CI: -0.58 - -0.03, p=0.032), while the levels of IL-6 (SMD=-0.14, 95% CI: -0.32-0.03, p=0.109) and CRP (SMD=-0.09, 95% CI: -0.34-0.16, p=0.484) were not significantly affected.Aerobic exercise exerts a positive effect by preventing inflammation-related diseases.

With the progress of globalization, the public health emergencies represented by major infectious diseases have become a major challenge for the public health management in China. The article briefly describes the emergency response capability assessment tools in China, and introduces two emergency response assessment tools with complete content structure and wide application in the world. Then the advantages and disadvantages of the tools are compared and discussed in order to provide reference for improvement of the assessment tools for public health emergency response capability in China.随着全球化进程推进，以重大传染病疫情为代表的突发公共卫生事件已成为国家应急管理的一大挑战。文章简述了我国的应急管理能力评估工具，介绍国际上两种内容架构完整且应用范围广泛的应急管理能力评估工具，并比较、讨论不同评估工具的优劣，以期为我国完善突发公共卫生事件应急管理能力评估工具提供参考。.

In order to provide evidence-based recommendations on the management of salivary gland malignancy (SGM), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) formulated and updated SGM clinical practice guidelines respectively in 2021.The two guidelines are interpreted and compared in this article from six perspectives including preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, follow-up evaluations and recurrent-metastatic diseases' management of SGM, which has guiding significance for diagnosis and treatment of SGM in China.为给唾液腺恶性肿瘤（salivary gland malignancy，SGM）的诊疗提供循证建议，2021年美国临床肿瘤学会和美国国家综合癌症网分别制订和更新了SGM临床实践指南。本文从SGM的术前评估、手术治疗、放射治疗、系统性治疗、随访和复发转移性疾病诊疗等角度出发，对两种指南进行解读和比较分析，旨在为我国SGM的诊疗提供临床指导。.

To establish a prediction model of renal calculus for university teachers to help them prevent renal calculus scientifically. This study involves a specific group of university teachers. We collected the physical examination index of 1043 university teachers in the Hubei University of Chinese Medicine in 2018 to build the model. We also used the physical examination data of 968 teachers in 2019 to verify the model.We used Lasso regression to screen the factors and logistic regression analysis to establish the model.The models of this study included sex, age, DBP, TC, HDL. C, CEA, UA, ALT, GGT, HB, pH, RBC, RDW, and CLYMPH. Among these, sex, TC, ALT, HB, and LYMPH present high risks in the model. The result is of great significance related to the research of university teachers suffering from renal calculus. The C-index is 0.715, and the AUC is 0.7064.Based on the results of this study, we suggest that physical examination indicators can predict the risk of renal calculus and the individual probability of prevalence in specific groups. According to the risk of each physical examination index, it is possible to effectively prevent the occurrence of renal calculus in certain high-risk groups through lifestyle changes.

目的 回顾性分析原发中枢神经系统淋巴瘤中弥漫大B细胞淋巴瘤（PCNSL-DLBCL）患者的临床特征及不同治疗方案对患者生存及预后的影响。 方法 回顾性分析天津医科大学总医院自2014年7月至2020年12月收治的49例PCNSL-DLBCL患者的临床资料，根据治疗方案分为MTX组、R-CDOP组、BTKi-R-MTX组和RLZT组，计算各组中位总生存（OS）与无进展生存（PFS）时间，并进行单因素、多因素预后分析，比较各组患者的生存预后。 结果 MTX组、R-CDOP组、BTKi-R-MTX组和RLZT组的中位OS时间分别为16.5个月、4.5个月、42个月和未达到（P

OBJECTIVE: The most common form of urinary bladder cancer is the low and intermediate risk categories of stage Ta. This patient group has a high recurrence rate, but progression is rare. The aim of this study was to investigate recurrence and survival in a large population-based setting, with respect to possible prognostic factors and during different time periods. PATIENTS AND METHODS: BladderBaSe is a database which links information from the Swedish National Register of Urinary Bladder Cancer with national healthcare and demographic registers. Between 1997 and 2014, 16,599 were diagnosed with low and intermediate risk of Ta cancer in Sweden. The times to recurrence and cancer-specific death were analysed concerning the differences in age, gender, grade, region and hospital type. For temporal analysis, we divided the material into 6-year periods. RESULTS: The mean age was 70 years and 75% were males. Low risk according to grade constituted 56%, whilst 44% had intermediate risk. With a median follow-up time of 63 months the recurrence rates were 47% and 59% for the respective categories and overall 52%. The rate was similar between the first two time periods, but became substantially lower in the most recent period. Five percent of patients died of the disease and risk category was the main prognostic variable. CONCLUSIONS: The risk of recurrence decreased in the last time period. Risk category based on grade was the most important prognostic indicator for outcome.

Pathological myopia, a blinding eye disease, is the most common cause of visual impairment in Asian countries. The most obvious features of pathological myopia are the elongation of the eye axis, the appearance of posterior scleral staphyloma, and even degenerative changes in the retina and choroid, resulting in corresponding complications and ultimately leading to marked visual impairment. Controlling the elongated eye axis is a key factor in preventing the complications of pathological myopia. Posterior scleral reinforcement is the main surgical method to delay the elongation of the eye axis and treat the posterior scleral staphyloma. Although most studies have confirmed that posterior scleral reinforcement is effective in delaying axial elongation and treating myopia, some scholars hold negative views on this surgery. This article summarizes the relevant research results of posterior scleral reinforcement surgery in the treatment of pathological myopia, concerning patients' vision, refractive power, eye axis, and corneal curvature, and discusses the effectiveness of the surgery.病理性近视眼（PM）是一种全球性致盲性眼病，也是亚洲人群最常见的视力损伤原因。PM最明显的特征是眼轴增长，出现后巩膜葡萄肿，甚至视网膜、脉络膜发生退行性改变，出现相应并发症，最终严重影响视力。控制眼轴增长是预防PM并发症的关键因素。后巩膜加固术是延缓眼轴增长、治疗后巩膜葡萄肿的主要手术方法。虽然大部分研究结果证实后巩膜加固术对延缓眼轴增长和近视发展具有效果，但也有学者持不同意见。本文汇总了国内外后巩膜加固术治疗PM的最新研究结果，分析手术对患者视力、屈光度数、眼轴长度、角膜曲率等方面的影响，探讨手术的有效性，以期为临床相关工作提供参考。（

A 52-year-old male presented to Beijing Tongren Hospital with a 5-year history of bilateral dry eyes. He had been diagnosed with Steven-Johnson syndrome due to allergy to cold medication. On examination, the Schirmer I test value was 0 mm, the tear break-up time was 0 s, and corneal fluorescein staining showed corneal epithelial erosion with partial fusion in both eyes. The clinical diagnosis was dry eyes (severe) and Steven-Johnson syndrome. No significant effect was observed after use of artificial tears and anti-inflammatory eye drops and tear punctal embolization. Then an insular infraorbital neurovascular pedicle labial salivary gland transplantation was performed in the right eye. During the 1-year postoperative follow-up, the symptoms and signs were significantly improved in the operated eye, and the surgical results were satisfactory.1例52岁男性患者因双眼干涩5年，就诊于首都医科大学附属北京同仁医院北京同仁眼科中心。既往因感冒药物过敏诊断为Steven-Johnson综合征。眼部检查双眼泪液分泌试验结果为0 mm，泪膜破裂时间为0 s，角膜荧光素染色可见角膜上皮糜烂，部分融合。临床诊断为双眼干眼（重度）；Steven-Johnson综合征。常规人工泪液、抗炎滴眼液及泪小点栓塞治疗无明显效果后，行具有创新性的岛状眶下神经血管蒂唇腺移植术。术后随访1年，患者术眼干眼症状及体征均明显改善，手术效果满意。（

脑膜瘤的血管内同时出现大B细胞淋巴瘤者十分罕见，既往仅检索到1例报道。为加深对此类碰撞瘤临床病理特征的认识，该文报道1例脑膜瘤合并血管内大B细胞淋巴瘤病例。患者为中年女性，因突发晕厥和肢体僵直入院，磁共振成像（MRI）提示右额叶脑膜瘤。镜下在脑膜瘤的血管内见大B细胞淋巴瘤，免疫组织化学示脑膜瘤细胞上皮细胞膜抗原、D2-40阳性；血管内瘤细胞CD20、CD79α阳性。患者术后予以甲氨蝶呤化疗及利妥昔单抗靶向治疗，6个月未见肿瘤复发。.

目的 分析9例遗传性凝血因子Ⅴ（FⅤ）缺乏症患者的临床表现及分子致病机制。 方法 对1999年4月至2019年9月就诊于中国医学科学院血液病医院的9例遗传性FⅤ缺乏症患者进行回顾性分析：应用活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）及FⅤ促凝活性（FⅤ∶C）测定进行表型诊断；使用高通量靶向测序筛查F5基因变异，Sanger测序验证并分析双亲携带情况；Swiss-model进行三维结构分析，ClustalX-2.1软件进行同源保守性分析。 结果 9例患者的FⅤ∶C为0.1～10.6 U/dl，其中8例患者有出血病史，以皮肤/黏膜出血最为多见（3例），其余1例未发生出血事件。所有患者中纯合子5例，复合杂合子4例，共检测到12个致病或疑似致病F5基因突变，其中c.6100C>A/p.Pro2034Thr、c.6575T>C/p.Phe2192Ser、c.1600_1601delinsTG/p.Gln534*、c.4713C>A/p.Tyr1571*和c.952+5G>C为首次报道。 结论 该研究新发现的基因突变丰富了与遗传性FⅤ缺乏症相关F5基因突变谱，高通量测序方法可以有效检测F5基因突变。

The aim of this study was to explore whether LINC00657 can regulate cell proliferation and invasion by regulating the PI3K/AKT pathway and thus participate in the occurrence of colon cancer.Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was applied to detect the expression levels of LINC00657 and E-cad in colon cancer tissues and corresponding adjacent tissues obtained from 80 patients, and the correlation was analyzed between LINC00657 expression and clinical information of patients such as prognosis, tumor size, tumor stage, and distant metastasis. The expression of LINC00657 and E-cad in colon cancer cell lines was also examined, and the effect of LINC00657 on tumor cell proliferation was evaluated by cell counting kit-8 (CCK-8) assay and colony formation experiments. Meanwhile, transwell assay was performed to evaluate the influence of LINC00657 and CAPN7 on cell invasive ability. In addition, the effect of LINC00657 on CAPN7 and PI3K/AKT pathway was detected by Western blot assay.The expression levels of LINC00657 and E-cad in tumor tissues decreased remarkably, especially in patients who occurred distant metastasis. Compared with patients with highly-expressed LINC00657, the patients with lower level of LINC00657 had a worse prognosis and an advanced tumor size and TNM stage. Similarly, LINC00657 and E-cad also showed a decrease in colon cancer cell lines. After overexpression of LINC00657, cell viability and invasive ability decreased remarkably while cell apoptosis rate increased significantly. In addition, high expression of LINC00657 in an in vitro model significantly promoted CAPN7 expression and inhibited activation of PI3K/AKT pathway.LINC00657 had a low expression in colon cancer tissues, which could accelerate cell proliferation and invasion by activating PI3K/AKT pathway and inhibiting CAPN7 expression.

Biliary and hyperlipidemic acute pancreatitis (AP) has become the second most common AP in China. Currently, AP is exclusively diagnosed as biliary or hyperlipidemic AP. However, as suggested by some reports, biliary and hyperlipidemic AP might coexist in a single patient. Moreover, acute lipotoxicity was shown to regulate the severity of biliary AP in the mouse model. Thus, whether these two etiologies coexist in AP patients and potentially worsen the clinical course remains unclear. To elucidate the clinical feature of a new complex type of acute pancreatitis with both biliary and hyperlipidemic etiologies.This retrospective study included AP patients who were admitted into our department within 7 days after the onset of the disease. 267 AP patients were enrolled in this study and were classified as BAP (biliary acute pancreatitis, n=153), HLAP (hyperlipidemic acute pancreatitis, n=65) and BHAP (biliary-hyperlipidemic acute pancreatitis, n=49). All the enrolled patients met the classification criteria of biliary etiology, hyperlipidemic etiology, and both etiologies, respectively. BHAP was compared with BAP and HLAP in terms of general information, inflammatory biomarkers, organ dysfunction, disease severity and clinical outcomes.BHAP (41 vs. 53) patients were younger than BAP patients. Serum procalcitonin of BHAP patients was higher than BAP and HLAP patients. Serum CRP of BHAP patients was higher than BAP patients. BHAP patients had the highest diagnosis rate of severe acute pancreatitis (SAP) (46.9% vs. 17.6% or 21.5%) compared to BAP and HLAP. Prevalences of persistent respiratory, acute renal, and circulatory failure were highest in BHAP patients (44.9%, 28.6%, 12.2%, respectively). Requirements for mechanical ventilation, renal replacement therapy and vasoactive agents were also highest in BHAP patients (36.7%, 34.7%, 12.2%, respectively). Hospital stay was longer in BHAP patients (33 days) compared with BAP patients (24 days).Patients with both biliary and hyperlipidemic etiologies suffer from more severe clinical course of the disease and have worse prognosis than single-etiology BAP or HLAP patients in the early stage of AP (within 7 days). It should be recognized as a new etiological type named biliary-hyperlipidemic acute pancreatitis (BHAP).

I am 20 years old this year, and I am also a patient who is born with atopic dermatitis. Because I want to explore the treatment of atopic dermatitis and further understand this disease, I have searched many related studies, but the studies about how Psychological level of patients are affected by atopic dermatitis are relatively rare. In view of this, I want to write this study to provide some suggestion to medical personnel and other patients.

Cerebral ischemia/reperfusion (CIR) frequently causes serious disabilities and correlates with certain neurological processes. Some studies have shown that microRNAs (miRNAs) exert a neuroprotective effect by modulating the inflammatory process in CIR. However, the biofunction and the mechanism of miR-130b in CIR need to be fully elucidated.An oxygen-glucose deprivation/reperfusion (OGD/R) model was constructed using SH-SY5Y cell line to analyze the function of miR-130b in CIR. Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to examine the expression levels of miR-130b and IRF1. Western blot was performed to detect the protein levels of IRF1, Bax, and Bcl-2. Cell viability was determined using MTT (3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assays. Dual-Luciferase reporter assay was conducted to confirm the target gene of miR-130b.In this study, we found that miR-130b level was prominently decreased after treatment with OGD/R. Through gain and loss assays, we concluded that miR-130b restoration promoted cell proliferation and inhibited cell apoptosis in OGD/R-treated cells. Moreover, we also identified IRF1 as an important target of miR-130b. Additionally, IRF1 knockdown remarkably abrogated the protection mediated by miR-130b against the injuries in OGD/R-treated cells.Taken together, our results suggested that miR-130b facilitated cell viability and suppressed cell apoptosis of CIR via negatively regulating of IRF1.

High-risk non-muscle invasive urinary bladder cancer (NMIBC) presents an increased risk of progression and cancer death. To reduce these risks, two different treatments are recommended - BCG or radical cystectomy (RC). The purpose of this study is to analyze cancer-specific survival of these two initial treatments.BladderBaSe links information from the SNRUBC from 1997 to 2014, with a number of national healthcare and demographic registers. BCG was used for 3,862 patients (399 had delayed RC), while 687 had initial RC. Propensity scores were used to match the patients treated with RC and with relevant variables such as age, gender, and tumor stage with the same number treated with BCG (673 each arm). In a further comparison, an instrumental variable analysis using hospital strategy as the instrument was used.The 5-year cancer-specific survival chance was higher for the BCG group than it was for the initial RC group, 87 vs 71%, respectively. In the population with propensity score matching, 78 died from cancer in the BCG group during follow-up and 162 in the RC group. In the instrumental variable analysis, the multivariate adjusted risk difference of cancer-specific death 2 years after diagnosis was 32 per 100 treated patients, in favor of the BCG group.BCG therapy had better cancer-specific survival than RC also when two different statistic methods were used to try to control for confounding. A prospective randomized trial will be necessary to rule out that selection is a major factor for the outcome.

Central vein catheterizations facilitate the establishment of reliable venous pathways in emergent medical situations. The subclavian is an important vein for central venous catheterizations. But, inadvertent arterial punctures during subclavian vein catheterizations are more dangerous than those during jugular or femoral vein catheterizations, because of the lack of a reliable compression site. We aimed to identify risk factors for the occurrence of inadvertent arterial puncture during subclavian vein catheterizations in crowded emergency rooms.We evaluated 190 patients undergoing bedside subclavian vein catheterizations in our emergency room, from which 62 patients experienced inadvertent arterial punctures. We evaluated possible risk factors from basic physical or laboratory tests that can easily be obtained in the ER, and performed Chi-square test, Kruskal-Wallis ANOVA, non-conditional logistic regression analysis, and receiver-operating characteristic curves to determine the cut-off values of the identified risk factors.We identified age, BMI, and serum pre-albumin level as significant risk factors for inadvertent arterial puncture during subclavian vein catheterization (p0.05) through regression analyses (odds ratios of 1.043, 0.719 and 0.989; and receiver-operating characteristic curves with AUCs of 0.741, 0.818, and 0.717, respectively). The cut-off values for age, BMI and serum pre-albumin level were 66.5 years old, 21.12 and 109.5 mg/L, respectively.We found that patients with poor nutritional status (BMI21.12 and serum pre-albumin109.5 mg/L) or older than 69.5 years tended to experience more accidental arterial punctures during subclavian vein catheterizations, probably due to atrophy or diminished peri-vascular support tissues in patients with poor nutritional statuses that make it difficult to obtain adequate chest extensions.

The aim of this study was to investigate the expression of mediator complex subunit 27 (MED27) in breast cancer (BC) and explore its effects on the proliferation and apoptosis of BC cells.The expression of MED27 in 60 BC tissues and para-cancer tissues was detected. Based on the significantly high expression level of MED27 in tumors, the tumor samples were divided into high-expression group and low-expression group according to the median standard, with 30 samples in each group. Then, the association between MED27 expression and clinicopathological features of patients was analyzed. The correlation between MED27 expression and survival time of patients was estimated using the Kaplan-Meier method. Next, the expression level of MED27 in cells was also measured using qRT-PCR assay. In vitro study, si-MED27 was designed to interfere with the expression of MED27 in MDA-MB-231 cells. To further explore the mechanism of MED27 in BC, the expression level of SP1 in cells was examined after different treatments.In quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay, MED27 was found to be highly expressed in both BC tissues and cells. Then, the relationship between MED27 expression and clinical pathological data was statistically analyzed, and it was found that MED27 expression was correlated with tumor size and grade. In the 60-month follow-up and Kaplan-Meier analysis, patients with high expression of MED27 had a poor prognosis. In in vitro study, MED27 expression in cells was down-regulated by transfection with si-MED27. Western blot (WB) analysis suggested that si-MED27 could effectively reduce the protein expression level of MED27 in cells, and the specificity protein 1 (Sp1) expression was also limited. In CCK-8, clone formation and flow cytometry experiments, the proliferation of cells with low MED27/Sp1 expression was suppressed, while cell apoptosis was promoted.MED27 acted as an oncogene in BC. By affecting Sp1, MED27 could be a new therapeutic target for the treatment of BC.

Objective To compare the performance of three deep-learning models （VGG19, Inception-V3 and Inception-ResNet-V2） in automatic bone age assessment based on pelvic X-ray radiographs. Methods A total of 962 pelvic X ray radiographs taken from adolescents （481 males, 481 females） aged from 11.0 to 21.0 years in five provinces and cities of China were collected, preprocessed and used as objects of study. Eighty percent of these X ray radiographs were divided into training set and validation set with random sampling method and used for model fitting and hyper-parameters adjustment. Twenty percent were used as test sets, to evaluate the ability of model generalization. The performances of the three models were assessed by comparing the root mean square error （RMSE）, mean absolute error （MAE） and Bland-Altman plots between the model estimates and the chronological ages. Results The mean RMSE and MAE between bone age estimates of the VGG19 model and the chronological ages were 1.29 and 1.02 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-V3 model and the chronological ages were 1.17 and 0.82 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-ResNet-V2 model and the chronological ages were 1.11 and 0.84 years, respectively. The Bland-Altman plots showed that the mean value of differences between bone age estimates of Inception-ResNet-V2 model and the chronological ages was the lowest. Conclusion In the automatic bone age assessment of adolescent pelvis, the Inception-ResNet-V2 model performs the best while the Inception-V3 model achieves a similar accuracy as VGG19 model.运用3种卷积神经网络模型对青少年骨盆骨龄评估的比较.目的 比较VGG19、Inception-V3、Inception-ResNet-V2 3种深度学习（deep learning，DL）模型基于骨盆X线片图像进行骨龄自动评估的性能。 方法 采集我国5省市11.0~21.0周岁汉族青少年骨盆X线片图像962例（男性481例，女性481例），将上述图像进行预处理作为研究对象。采用随机抽样的方法抽取80%作为训练集、验证集，用于模型拟合和超参数的调整。20%作为测试集，用于评估模型泛化的能力。通过比较模型估计值与生活年龄的均方根误差（root mean square error，RMSE）、平均绝对误差（mean absolute error，MAE）以及绘制Bland-Altman散点图来评估3种模型的性能。 结果 VGG19模型预测年龄与生活年龄的平均RMSE、MAE分别为1.29、1.02岁，Inception-V3模型预测年龄与生活年龄的平均RMSE、MAE分别为1.17、0.82岁，Inception-ResNet-V2模型预测年龄与生活年龄的平均RMSE、MAE分别为1.11、0.84岁。Bland-Altman散点图显示Inception-ResNet-V2模型的差值的均值最小。 结论 在对青少年骨盆的自动骨龄评估中，Inception-ResNet-V2模型性能最优，Inception-V3模型与VGG19模型性能相当。.法医人类学；年龄测定，骨骼；骨盆；图像识别；深度学习；卷积神经网络；汉族；青少年.

One of the characteristics on cohort studies is that exposures may change over time. The full use of information related to time-updated exposures, time-dependent covariates and their relationships to estimate the association between exposures and outcomes has become the hotspot of research. In this paper, the Kailuan cohort is used as an example to explore the association between fasting blood-glucose and hepatocellular carcinoma, based on different Cox regression models. Cox or time-dependent Cox regression models can be used to estimate the impact of exposure at baseline or on the time-updated exposures. When time-dependent confounders exist, marginal structure model is recommended. We also summarize the basic principles, conditions of applications, effect estimates, and results interpretation for each model, in this paper.队列研究的特点之一是暴露因素会随时间而改变，如何充分利用暴露因素及其协变量的变化及其相互关系，从而获得更真实的暴露因素与结局关系是目前的研究热点。本研究以开滦队列为例，探讨基于基线暴露状态、随时间变化的暴露信息以及同时控制依时混杂因素时，如何利用Cox比例风险回归及其拓展模型，包括依时Cox回归及边际结构模型，探讨FPG与肝癌的关系，概述并比较了上述拓展模型的基本原理、应用条件、估计结果及结果解释。.

野生型转甲状腺素蛋白淀粉样变（ATTRwt）是野生型转甲状腺素蛋白错误折叠后沉积于组织器官从而影响其结构和功能导致的疾病。近期研究发现ATTRwt在老年人、射血分数保留的心力衰竭患者中的患病率被低估。ATTRwt在老年男性人群中较为常见，多表现为心力衰竭、心律失常等。近年来骨闪烁显像在转甲状腺素蛋白淀粉样变的诊断中表现出良好的敏感度和特异度。有望抑制ATTRwt进程的治疗方法包括氯苯唑酸、AG10和表没食子儿茶素-3-没食子酸酯等药物治疗以及心脏移植。本文对ATTRwt的临床特征、诊断思路、影像学检查及治疗的最新进展进行了综述，以期为临床诊治提供参考。.

2019年底，武汉出现了由新型冠状病毒（2019-nCoV）引发的新型冠状病毒肺炎（COVID-19）。该疫情在短时间内迅速蔓延，严重威胁着公共卫生安全。目前，COVID-19尚无有效的治疗手段。血管紧张素转化酶2（ACE2）作为受体介导2019-nCoV进入细胞，是目前最有可能防治COVID-19的靶点之一。中老年人是COVID-19的易感人群，多伴有基础疾病，且大部分为心血管疾病，因此这部分人更容易发展为重症和危重症，造成严重的临床后果。ACE2是肾素-血管紧张素系统重要的组成部分，以此系统为靶点的ACE抑制剂和血管紧张素受体阻断剂等药物，是目前临床治疗高血压、心肌重构和心力衰竭等心血管疾病的最主要的药物之一。本文系统地介绍了COVID-19以及肾素-血管紧张素系统相关药物及其临床应用，并且分析了肾素-血管紧张素系统相关药物在COVID-19防治中的价值，以及并发心血管疾病的COVID-19患者用药方面需要注意的问题。.

Objective To develop mathematical models for skeletal age determination with multiple statistic method based on the correlation between age and the growth of the epiphysis of extremitas sternalis of clavicle in Shanxi adolescents. Methods The 562 Shanxi sternoclavicular joint samples （454 cases of modelling, 108 cases of external verification） were scanned by the thin-section computed tomography. After volume rendering was obtained, indicators such as area of epiphysis, area of metaphysis, longest diameter of epiphysis and longest diameter of metaphysis of both extremitas sternalis of clavicle were collected. Indicators such as the ratio of area of epiphysis to area of metaphysis, and the ratio of longest diameter of epiphysis to longest diameter of metaphysis of both sides were calculated. Then multiple linear regression and random forest discriminant models were used to build mathematical models for age determination of adolescents. Results The obtained indicators exhibited a strong correlation with age （山西省青少年锁骨胸骨端骨龄推断数学模型的构建.目的 基于我国山西省青少年锁骨胸骨端骨骺发育情况与年龄的相关性，利用多元统计方法建立骨龄推断的数学模型。 方法 利用薄层计算机体层扫描技术对山西省562例胸锁关节样本（454例建模，108例外部验证）进行扫描，获取容积再现后采集双侧锁骨胸骨端骨骺面积、干骺端面积、锁骨胸骨端骨骺最长径、干骺端最长径，并分别计算双侧骨骺面积与干骺端面积之比、骨骺最长径与干骺端最长径之比等指标，再利用多元回归及随机森林判别构建青少年活体年龄推断的数学模型。 结果 观察指标与年龄均具有较强的相关性（法医人类学；年龄测定，骨骼；锁骨胸骨端；数学模型；青少年；山西.

We conducted a large, retrospective cohort study using data from Taiwan's National Health Insurance Research Database to evaluate whether the risk of developing osteoporosis is associated with sepsis. Our study found that adults younger than 65 years with sepsis had a significantly increased risk of developing osteoporosis.There have been limited studies regarding the osteoporosis risk associated with sepsis. Our purpose is to evaluate whether the risk of developing osteoporosis is associated with sepsis.We conducted a large, retrospective cohort study using data from Taiwan's National Health Insurance Research Database. From the insurance claims data, a total of 13,178 patients diagnosed with sepsis from 2000 to 2012 were included in the sepsis cohort, and a propensity score-matched cohort included 13,178 individuals without sepsis. To calculate the incidence of osteoporosis, both groups were followed until 2013. Cox regression analysis was performed to obtain the hazard ratios (HRs) to assess the risk of developing osteoporosis. The Kaplan-Meier method was used to estimate the cumulative incidence of osteoporosis.The overall incidences of osteoporosis (per 1,000 person-years) in the sepsis and non-sepsis groups were 10.2 and 10.7, respectively. The risk of osteoporosis significantly increased in the presence of sepsis (adjusted HR = 1.17, 95% confidence interval (CI) = 1.04-1.31). The risk of osteoporosis in the sepsis group was significantly higher than that in the non-sepsis group for young patients aged 20-49 years and patients aged 50-64 years (adjusted HR = 1.93, 95% CI = 1.08-3.44; adjusted HR = 2.01, 95% CI = 1.52-2.65, respectively). The Kaplan-Meier curves of cumulative probability also showed a significantly increased risk of osteoporosis in patients aged 20-49 years and aged 50-64 years with sepsis compared with non-sepsis (P = 0.025; P0.001, respectively).Adults younger than 65 years with sepsis had a significantly increased risk of developing osteoporosis.

Aim To establish a predictive nomogram for high-grade prostate cancer (HGPCa) in biopsy-naive patients based on the Prostate Imaging–Reporting and Data System version 2 (PI-RADS v2), magnetic resonance imaging (MRI)-based prostate volume (PV), MRI-based PV-adjusted prostate-specific antigen density (PSAD), and other classical parameters. Material and methods Between August 2014 and August 2015, 158 men who were eligible for analysis were included as the training cohort. A prediction model for HGPCa was built using backward logistic regression and was presented on a nomogram. The prediction model was evaluated by a validation cohort between September 2015 and March 2016 (n=89). Histology of all lesions was obtained with MRI-directed transrectal ultrasound (TRUS)-guided targeted and sectoral biopsy. Results The multivariate analysis revealed that patient age, PI-RADS v2 score, and adjusted PSAD were independent predictors for HGPCa. The most discriminative cut-off value for the logistic regression model was 0.33; the sensitivity, specificity, positive predictive value, and negative predictive value were 83.3%, 87.4%, 88.4%, and 81.2%, respectively. The diagnostic performance measures retained similar values in the validation cohort (AUC=0.83). Conclusion The nomogram for forecasting HGPCa is effective and potentially reducing harm from unnecessary prostate biopsy and over-diagnosis.

A 58-year-old female was referred to our department with intermittent suffocation for 1.5 years, aggravated for a month. 1.5 years before she developed oral ulcer, raynaud phenomenon, proteinuria, bilateral pleural effusion, ANA and anti-dsDNA positive. This patient was diagnosed with systemic lupus erythematosus (SLE). After given hormones, hydroxychloroquine sulfate (HCQ), her symptom relieved soon. The patient stopped her pills 1 year ago. One month ago, she had chest tightness, increased urine foam, and suffered from oliguria. Her admission medical examination: blood pressure (BP) 130/80 mmHg, conjunctiva pale, and lower lung breath sounds reduced. There was no tenderness, rebound pain and abdominal muscle tension in the abdomen. Liver and spleen rib inferior, mobile dullness negative, and lower extremity edema. Blood routine tests were performed with hemoglobin (HGB) 57 g/L. Urine routine: BLD (3+). 24-hour urinary protein 3.2 g. serum albumin 20.5 g/L, C-reactive protein (CRP) 12.85 mg/L, erythrocyte sedimentation rate (ESR) 140 mm/h. Antinuclear antibody (ANA) (H)1 ∶10 000;, anti-dsDNA antibody 1 ∶3 200;, anti-Smith antibody, anti-U1-snRNP / Sm antibody were positive, blood complement 3(C(3)) 0.43 g/L, complement 4(C(4)) 0.07 g /L. Anticardiolipin antibody (ACL), anti-β2-GP1;, lupus anticoagulant (LA) were negative, HRCT suggested bilateral medial pleural cavity product liquid. Admission diagnosis: SLE lupus nephritis, anemia, pleural effusion, and hypoproteinemia. We treated her with methylprednisolone 1 000 mg×3 d;, late to 48 mg/d and cyclophosphamide 1.0 g, HCQ 0.2 g bid, gamma globulin 10 g×5 d. Day 2 of treatment;, this patient developed acute right upper quadrant pain, not accompanied by nausea, vomiting, blood stool and diarrhea. Antipyretic antispasmodic treatment was invalid, after the morning to ease their own abdominal pain. Day 4 of treatment, daytime blood HGB 77 g/L. Bilateral renal vascular ultrasound: bilateral renal artery blood flow velocity was reduced. The abdominal pain of the above symptoms recurred at night, BP was 120/80 mmHg, and no positive signs were found on abdominal examination. No abnormality was found in the vertical abdominal plain film. Blood routine examination: HGB 53 g/L, Plasma D dimer 2 515 μg/L;, amylase in hematuria was normal, the stool occult blood was negative. Abdominal computed tomography (CT): normal structure of right adrenal gland disappeared, irregular mass shadow could be seen in adrenal region, CT value was about 50 HU. Morphological density of left adrenal gland was not abnormal. The retroperitoneum descended along the inferior vena cava to the right iliac blood vessel and showed a bolus shadow. The density of some segments increased. The lesion involved the right renal periphery and reached the left side of abdominal aorta. Most lesions surrounded the inferior vena cava, the right renal vein and part of the small intestine. The boundary between the upper lesion and the vena cava was unclear. Iodine-containing contrast agent was taken orally. No sign of contrast agent overflowing was found in the abdominal cavity. Hematoma and exudative changes were considered in retroperitoneum. Conclusion of contrast-enhanced ultrasound of blood vessels: The retroperitoneal inferior vena cava (volume 3.5 cm×3.5 cm×1.5 cm) was hypoechoic and had no blood flow lesion. The adrenal gland had a high possibility of origin. Left renal vein thrombosis extended to inferior vena cava. According to the above data;, it was analyzed that the cause of retroperitoneal hematoma of the patient was left adrenal vein thrombosis caused by hypercoagulable state, which led to vascular rupture and hemorrhage caused by increased vascular pressure in adrenal gland. Therefore, on the basis of continuing to actively treat the primary disease, and on the basis of dynamic observation of no active hemorrhage for 3 days, the anticoagulant therapy was continued with 10 mg/d of apixaban. Clinical symptoms were gradually eased, HGB did not decrease. Two weeks later, the ultrasonic examination showed that the irregular cluster hypoechoic range behind the inferior vena cava was significantly smaller than that before (1.8 cm×1.2 cm×0.7 cm). Abdominal CT examination after 1 month showed that there was no abnormal morphological density of bilateral adrenal glands and basic absorption of retroperitoneal exudation. Adrenal hemorrhage is uncommon. SLE with adrenal hemorrhage is rarer. In SLE patients;, especially those complicated with APS, if abdominal pain accompanied by HGB decrease occurs, except after gastrointestinal hemorrhage, the possibility of adrenal hemorrhage should be warned.