[Investigation on occupational burnout among medical staff of tuberculosis control in Beijing]

Objective: To understand the occupational burnout status of tuberculosis prevention and treatment medical staff in Beijing, and analyze the influencing factors of different degrees of occupational burnout. Methods: From April to May 2021, an anonymous questionnaire survey was conducted among the medical staff of tuberculosis prevention and control in Beijing and 16 districts under its jurisdiction. A total of 313 questionnaires were issued, 311 were recovered, and 311 were valid, with an effective recovery rate of 99.36%. The General Information Questionnaire and Maslach Burnout Inventory Generalized Scale (MBI-GS) were used to collect social demographic data and the occurrence of occupational burnout, analyze the occurrence degree of occupational burnout, and identify the influencing factors of the occurrence degree of occupational burnout by using the orderly multiple logistic regression model. Results: Among 311 tuberculosis prevention and control medical staff, the total detection rate of occupational burnout was 62.70% (195/311), and the detection rates of mild, moderate and severe occupational burnout were 22.19% (69/311), 38.59% (120/311) and 1.93% (6/311), respectively. Orderly multiple logistic regression analysis showed that medical staff in prevention and control positions (OR=1.616, 95% CI: 1.030-2.534, P=0.037) and not meeting expectations for title promotion (OR=2.969, 95%CI: 1.675-5.262, P<0.001), and not getting along well with colleagues (OR=2.177, 95%CI: 1.362-3.480, P=0.001) were the main factors affecting the occurrence and severity of occupational burnout among tuberculosis prevention and treatment medical staff. Conclusion: The main manifestations of tuberculosis prevention and control medical staff in Beijing are mild to moderate occupational burnout. It is suggested to pay attention to the occupational needs of different positions of tuberculosis prevention and control medical staff, cultivate professional achievement, carry out psychological counseling, and reduce the degree of occupational burnout.

[Cross-sectional study of low anterior resection syndrome in patients who have survived more than 5 years after sphincter-preserving surgery for rectal cancer]

Objective: In this study, we aimed to investigate the prevalence of low anterior resection syndrome (LARS) in patients who had survived for more than 5 years after sphincter-preserving surgery for rectal cancer and to analyze its relationship with postoperative time. Methods: This was a single-center, retrospective, cross-sectional study. The study cohort comprised patients who had survived for at least 5 years (60 months) after undergoing sphincter- preserving radical resection of pathologically diagnosed rectal adenocarcinoma within 15 cm of the anal verge in the Department of Gastrointestinal Surgery, Peking University People's Hospital from January 2005 to May 2016. Patients who had undergone local resection, had permanent stomas, recurrent intestinal infection, local recurrence, history of previous anorectal surgery, or long- term preoperative defecation disorders were excluded. A LARS questionnaire was administered by telephone interview, points being allocated for incontinence for flatus (0-7 points), incontinence for liquid stools (0-3 points), frequency of bowel movements (0-5 points), clustering of stools (0-11 points), and urgency (0-16 points). The patients were allocated to three groups based on these scores: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The prevalence of LARS and major LARS in patients who had survived more than 5 years after surgery, correlation between postoperative time and LARS score, and whether postoperative time was a risk factor for major LARS and LARS symptoms were analyzed. Results: The median follow-up time of the 160 patients who completed the telephone interview was 97 (60-193) months; 81 (50.6%) of them had LARS, comprising 34 (21.3%) with minor LARS and 47 (29.4%) with major LARS. Spearman correlation analysis showed no significant correlation between LARS score and postoperative time (correlation coefficient α=-0.016, P=0.832). Multivariate analysis identified anastomotic height (RR=0.850, P=0.022) and radiotherapy (RR=5.760, P<0.001) as independent risk factors for major LARS; whereas the postoperative time was not a significant risk factor (RR=1.003, P=0.598). The postoperative time was also not associated with LARS score rank and frequency of bowel movements, clustering, or urgency (P>0.05). However, the rates of incontinence for flatus (3/31, P=0.003) and incontinence for liquid stools (8/31, P=0.005) were lower in patients who had survived more than 10 years after surgery. Conclusions: Patients with rectal cancer who have survived more than 5 years after sphincter-preserving surgery still have a high prevalence of LARS. We found no evidence of major LARS symptoms resolving over time.

[Adherence to adjuvant with therapy imatinib in patients with gastrointestinal stromal tumor: a national multi-center cross-sectional study]

Objective: To analyze the current adherence to imatinib in patients with gastrointestinal stromal tumors (GIST) in China and its influencing factors. Methods: A cross-sectional survey was conducted. Study period: from October 1, 2020 to November 31, 2020. Study subjects: GIST patients taking imatinib who were diagnosed and treated in public tertiary level A general hospitals or oncology hospitals; those who had not been pathologically diagnosed, those who never received imatinib, or those who had taken imatinib in the past but stopped afterwards were excluded. The Questionnaire Star online surgery platform was used to design a questionnaire about the adherence to adjuvant imatinib therapy of Chinese GIST patients. The link of questionnaire was sent through WeChat. The questionnaire contained basic information of patients, medication status and Morisky Medication Adherence Scale. Results: A total of 2162 questionnaires from 31 provinces, autonomous regions, and municipalities were collected, of which 2005 were valid questionnaires, with an effective rate of 92.7%. The survey subjects included 1104 males and 901 females, with a median age of 56 (22-91) years old. Working status: 609 cases (30.4%) in the work unit, 729 cases (36.4%) of retirement, 667 cases of flexible employment or unemployment (33.3%). Education level: 477 cases (23.8%) with bachelor degree or above, 658 cases (32.8%) of high school, 782 cases (39.0%) of elementary or junior high school, 88 cases (4.4%) without education. Marital status: 1789 cases (89.2%) were married, 179 cases (8.9%) divorced or widowed, 37 cases (1.8%) unmarried. Two hundred and ninety-four patients (14.7%) had metastasis when they were first diagnosed, including 203 liver metastases, 52 peritoneal metastases, and 39 other metastases. One thousand eight hundred and sixty-nine patients underwent surgical treatment, of whom 1642 (81.9%) achieved complete resection. The median time of taking imatinib was 25 (1-200) months. Common adverse reactions of imatinib included 1701 cases (84.8%) of periorbital edema, 1031 cases (51.4%) of leukopenia, 948 cases (47.3%) of fatigue, 781 cases (39.0%) of nausea and vomiting, 709 cases (35.4%) of rash, and 670 cases (33.4%) of lower extremity edema. The score of the Morisky Medication Adherence Scale showed that 392 cases (19.6%) had poor adherence, 1023 cases (51.0%) had moderate adherence, and 590 cases (29.4%) had good adherence. Univariate analysis showed that gender, age, work status, economic income, residence, education level, marriage, the duration of taking medication and adverse reactions were associated with adherence to adjuvant imatinib therapy (all P<0.05). Multivariate analysis showed that female (OR=1.264, P=0.009), non-retirement (OR=1.454, P=0.001), monthly income ≤4000 yuan (OR=1.280, P=0.036), township residents (OR=1.332, P=0.005), unmarried or divorced or widowed (OR=1.362, P=0.026), the duration of imatinib medication >36 months (OR=1.478, P<0.001) and adverse reactions (OR=1.719, P=0.048) were independent risk factors for poor adherence to adjuvant imatinib. Among patients undergoing complete resection, 324 (19.7%) had poor adherence, 836 (50.9%) had moderate adherence, and 482 (29.4%) had good adherence. Meanwhile, 55 patients with good adherence (11.4%) developed recurrence after surgery, 121 patients with moderate adherence (14.5%) developed recurrence, 61 patients with poor adherence (18.8%) developed recurrence, and the difference was statistically significant (P=0.017). Conclusions: The adherence to adjuvant therapy with imatinib in Chinese GIST patients is relatively poor. Females, non-retirement, monthly income ≤4000 yuan, township residents, unmarried or divorced or widowed, the duration of imatinib medication >36 months, and adverse reactions are independently associated with poor adherence of GIST patients. Those with poor adherence have a higher risk of recurrence after surgery. Positive interventions based on the above risk factors are advocated to improve the prognosis of patients with GIST.

[Spatio-temporal distribution of pulmonary tuberculosis and influencing factors in Beijing, 2008-2018]

Objective: To understand the spatiotemporal distribution of pulmonary tuberculosis (TB) and influencing factors in Beijing from 2008 to 2018. Methods: The incidence data of pulmonary TB in Beijing from 2008 to 2018 were from Tuberculosis Information Management System of Chinese Disease Prevention and Control Information System. Software ArcGIS 10.2 was used to visualize the spatiotemporal distribution of pulmonary TB incidence. Getis's G_i^* statistic was applied to analyze the spatial clustering of pulmonary TB incidence at street/township scale. Bayesian spatiotemporal model was applied to analyze factors affecting its spatiotemporal distribution, including urbanization rate, GDP per capita, number of hospital beds per thousand population, permanent migrant population and population density. Results: The reported pulmonary TB incidence showed a downward trend in the past 11 years in Beijing, from 58.64/100 000 to 30.43/100 000. The incidences were higher in Tongzhou, Changping and other newly developed urban districts, with the hot spots concentrated in local areas of these districts. The incidences of pulmonary TB were lower in Dongcheng, Xicheng and other old urban districts-with the cold spots also concentrated in these area. The risk for the incidence of pulmonary TB was associated with the urbanization rate and the permanent migrant population. For every 1% increase in the urbanization rate, the relative risk of pulmonary TB would increase by 1%. For every 10 000 person increase of permanent migrant population, the relative risk of pulmonary TB would increase by 0.6%. Conclusions: In Beijing, the current pulmonary TB prevention and control needs to be focused on the newly developed urban areas. Due to the accelerated process of urbanization, it is necessary to strengthen TB prevention and control in permanent migrant population to reduce the incidence of TB in Beijing.

[Diagnosis and treatment of pneumatosis cystoides intestinalis]

Pneumatosis cystoides intestinalis (PCI) is a rare disease, which is characterized by the accumulation of gas cysts located in the submucosa or subserosa of the gastrointestinal tract. It can occur in the whole or part of the gastrointestinal tract from the esophagus to the rectum, but clinically the main involved sites are the colon and small intestine. PCI can also appear in other sites such as mesentery, the greater omentum and the hepatogastric ligament. In recent years, with the renewal of imaging method, the detection rate of PCI has been on the rise. Most patients with PCI have no obvious symptoms or only non-specific symptoms of the digestive tract like abdominal distension, abdominal pain, diarrhea, hematochezia, etc. The atypical clinical symptoms of PCI can easily lead to missed diagnosis or misdiagnosis. A small amount of patients would have complications like peritonitis and even perforation of the digestive tract. The therapeutic principle for these patients is different from that for patients with acute abdomen. The prognosis of PCI depends on its severity and comorbidities. In this article, a literature review would be conducted on the epidemiological characteristics, etiology and pathogenesis, clinical manifestations, diagnosis and treatment of PCI, which might help clinical doctors with diagnosis and treatment of the disease.

[Procedure for prolapse and hemorrhoids versus stapled transanal rectal resection in the treatment of grade IV hemorrhoids]

Objective: To compare the efficacy and safety of two procedures in the treatment of hemorrhoid: the procedure for prolapse and hemorrhoids (PPH) and stapled transanal rectal resection (STARR). Methods: A retrospective cohort research was conducted. Clinical data of 263 patients undergoing the first elective surgery for grade IV hemorrhoids by the same team of surgeons at our department from January 2015 to December 2016 were analyzed retrospectively, while those had other anorectal diseases, emergency surgery, inflammatory bowel disease, tumor and incomplete clinical data were excluded. PPH was performed in 129 patients and STARR was performed in 134 patients. PPH procedure: a circular purse 2-0 string suture was made at 4 cm above the dentate line; in accordance with the standard protocol, the PPH circular stapling devicewas introduced; the suture was closed, and a pull-through followed; the traction was continued; the stapler was fired; the prolapsed mucosa and submucosa were removed. STARR procedure: 3-5 needles were sutured in the anterior rectal mucosa, protecting the posterior wall mucosa; with the help of a finger the PPH stapler was inserted into the vaginal lumen; the sutures were hooked from both sides of the stapler to maintain traction; according to the disease condition, the suturewas tightened appropriately; stapler was screwed and activated; the anterior wall mucosa was removed; the joint of the both ends of anastomosis was cut; the posterior wall mucosa was removed as well. The short-term efficacy, surgical safety and prognosis of the two groups were compared. Results: There were 67 males (51.9%) in the PPH group and 57 (42.5%) males in the STARR group. The median age of the two groups was 51.0 (22.0, 80.0) years and 49.0 (24.0, 74.0) years, respectively. There were no significant differences in the baseline data between the two groups (all P>0.05). No significant differences in the intraoperative bleeding, length of hospital stay, postoperative analgesic drug use, postoperative bleeding, postoperative infection, etc. were found between two groups (all P>0.05). As compared to PPH group, STAAR group had longer operation time and higher hospitalization cost with significant differences [(44.0±19.3) minutes vs. (26.3±8.5) minutes, t=9.701, P=0.001; (11 047±473) yuan vs. (7674±309) yuan, t=32.826, P=0.001]. One case in STAAR group developed rectovaginal fistula. The median follow-up period of the whole group was 40 (33, 52) months. A total of 108 cases in STARR group and 114 cases in PPH group completed the follow-up. The 3-year disease-relapse rate was 0 in STARR group and 4.2% in PPH group (P=0.042). Conclusion: STARR procedure can improve the prognosis in the treatment of grade IV hemorrhoid, but attention should be paid to the development of complications.

[The significance of lymph node yield in rectal cancer after neoadjuvant chemotherapy]

Neoadjuvant therapy has become an indispensable part of the treatment in locally advanced mild-low rectal cancer. Neoadjuvant therapy can cause the regression of the tumor body as well as drainage lymph nodes, which may influence the size, number, and metastatic status of the lymph nodes. In clinical practice, the total number of lymph nodes detected in rectal cancer treated with neoadjuvant therapy were significantly decreased, making it difficult to meet the standard of the NCCN guideline that at least 12 regional lymph nodes should be harvested. The optimal detection of yielded lymph nodes in rectal cancer is essential for accurate staging, response assessment, and adjuvant treatment decision. The lymph node diameter is significantly reduced after neoadjuvant therapy in locally advanced rectal cancer. In general, the number of detected lymph nodes is significantly reduced without additional pathological examination. The detected lymph nodes would increase by deliberate pathological examination, improvement of the detection method, or using a lymph node tracer. However, whether the number of detected lymph nodes is still needed to meet the requirements of the NCCN guideline, and the relationship between the number of detected lymph nodes and the prognosis are still controversial. At present, the number of negative lymph nodes, LNR, LODDS, etc. can be also used to predict prognosis in addition to ypN staging. For patients with ypN0 and ypN+ stage, different evaluation methods can be selected. For patients with ypN0, the number of detected lymph nodes still has important clinical significance for the prognosis and treatment decision. This article will introduce the related issues, and provide more evidence-based diagnosis and treatment practice.

[Spatial-temporal analysis on pulmonary tuberculosis in Beijing during 2005-2015]

Objective: To analyze the spatial distribution and identify the high risk areas of pulmonary tuberculosis at the township level in Beijing during 2005-2015. Methods: Data on pulmonary tuberculosis cases was collected from the tuberculosis information management system. Global autocorrelation analysis, local indicators of spatial association and Kulldorff's Scan Statistics were applied to map the spatial distribution and detect the space-time clusters of the pulmonary tuberculosis cases during 2005-2015. Results: Spatial analysis on the incidence of pulmonary tuberculosis at the township level demonstrated that the spatial autocorrelation was positive during the study period. The values of Moran's I ranged from 0.224 3 to 0.291 8 with all the P values less than 0.05. Hotspots were primarily distributed in 8 towns/streets as follows: Junzhuang, Wangping, Yongding and Tanzhesi in Mentougou district, Yancun in Fangshan district, Wangzuo town in Fengtai district, Tianqiao street in Xicheng district and Tianzhu town in Shunyi district. Spatiotemporal clusters across the entire study period were identified by using Kulldorff's spatiotemporal scan statistic. The primary cluster was located in Chaoyang and Shunyi districts, including 17 towns/streets, as follows: Cuigezhuang, Maizidian, Dongfeng, Taiyanggong, Zuojiazhuang, Hepingjie, Xiaoguan, Xiangheyuan, Dongba, Jiangtai, Wangjing, Jinzhan, Jiuxianqiao, Laiguangying, Sunhe towns/streets in Chaoyang district, Houshayu and Tianzhu town in Shunyi district, during January to December 2005. Conclusion: Incidence rates of pulmonary tuberculosis displayed spatial and temporal clusterings at the township level in Beijing during 2005-2015, with high risk areas relatively concentrated in the central and southern parts of Beijing.

MYBA2 gene involved in anthocyanin and flavonol biosynthesis pathways in grapevine

MYBA2 transcription factor (Myb-related gene) affects the coloring in grapevine berry and plays an important role in the biosynthesis of anthocyanin. The MYBA2 gene was cloned from Vitis vinifera L. cv. Cabernet Sauvignon and polyclonal antibodies for VvmybA2 were prepared. The VvmybA2 gene expression patterns were observed in seven tissues (the leaf, stem, flower, bud, root, berry, and tendril) and during the berry development stage at transcriptional and translational levels, respectively. The results indicated that the expression of VvmybA2 was approximately 11-fold higher in the berry than that in the other six tissues, and increased rapidly from 60 days after full bloom reaching a maximum on day 80. Furthermore, both the anthocyanin content and UDP-glucose:flavonoid-3-O-glucosyltransferase (UFGT) gene expression levels increased rapidly 60 days after full bloom. Moreover, correlation analysis indicated that the transcriptional and translational expression levels of the VvmybA2 gene were significantly positively correlated with not only UFGT and DFR genes but also with the anthocyanin content during berry development. These results suggested that VvmybA2 could not only regulate the transcription of both UFGT and DFR but also is involved in the expression of the UFGT gene associated with color determination in grape berries.

Nonlinear Cerenkov radiation in nonlinear photonic crystal waveguides

We study nonlinear Cerenkov radiation generated from a nonlinear photonic crystal waveguide where the nonlinear susceptibility tensor is modulated by the ferroelectric domain. Nonlinear polarization driven by an incident light field may emit coherently harmonic waves at new frequencies along the direction of Cerenkov angles. Multiple radiation spots with different azimuth angles are simultaneously exhibited from such a hexagonally poled waveguide. A scattering involved nonlinear Cerenkov arc is also observed for the first time. Cerenkov radiation associated with quasi-phase matching leads to these novel nonlinear phenomena.

High-power red-green-blue laser light source based on intermittent oscillating dual-wavelength Nd:YAG laser with a cascaded LiTaO3 superlattice

We demonstrate a high-power red-green-blue laser source based on the quasi-phase-matching and intermittent oscillating dual-wavelength laser technique. A cascaded LiTaO3 superlattice was used to achieve the generation of red light at 660 nm, green light at 532 nm, and blue light at 440 nm to obtain the output of red-green-blue laser light from a diode-side-pumped Q-switched intermittent oscillating dual-wavelength Nd:YAG laser. The average output power of red-green-blue of 1.01 W was achieved under the total fundamental power of 5.1 W, which corresponds to the conversion efficiency of 20%.

Green-pumped high-power optical parametric oscillator based on periodically poled MgO-doped stoichiometric LiTaO3

A high-power 532 nm-pumped multikilohertz nanosecond optical parametric oscillator using a periodically poled 1.0 mol.% MgO-doped stoichiometric lithium tantalate crystal that could be operated from room temperature to 200 degrees C without damage is reported. A broad continuous tuning range from 855 to 1410 nm was achieved within a single domain period. Efficient operation of high peak power and watt level average power with a power conversion of 62.5% was measured. These results show that a high-resolution high average power visible tunable source can be realized.

[Expression of total RNA and amplification of myocardial troponin gene during monitoring viral cardiomyocyte injury.]

BACKGROUND

To investigate the value of circulating cTnI-mRNA detection for monitoring myocardial injury development and prognosis.

METHODS

Viral myocardial injury models in BALB/c mice were created by intraperitoneal inoculation with Coxsackievirus B3 (CVB3,1x108 TCID50) for inducing myocardial injury. The total RNAs were extracted and cTnI-mRNA in mice cardiac tissues and circulating blood were amplified by RT-PCR during mice myocardial injury.

RESULTS

In virus infected mice, the mRNA abundance for cTnI was up-regulated in heart and circulating blood and associated with salient myocardial histopathologic features, including myocardial swelling, inflammatory cell infiltration, pyknosis, karyorrhexis, karyolysis, denaturalization, necrosis, and calcification. The cTnI-mRNA form infected mice heart and circulating cardiac myocytes were analyzed by RT-PCR, the amplified gene fragments were found in all heart tissues. The incidence of cTnI-mRNA was 0, 0, 0, 16.7%, 40.0%, 71.4%, 83.3% and 87.5% in the controls, the 3rd, 6th, 9th, 12th, 15th, 18th,and 21st day in circulating bloods from the infected mice, respectively.

CONCLUSION

The present data suggest that cTnI-mRNA expression is up-regulated and released into blood on viral myocardial injury, and detection of circulating cTnI-mRNA is a sensitive genetic marker for monitoring myocardial injury development and prognosis.

Efficient periodically poled stoichiometric lithium tantalate optical parametric oscillator for the visible to near-infrared region

A compact, efficient optical parametric oscillator (OPO) for the visible to near-infrared region based on periodically poled stoichiometric lithium tantalate pumped by a frequency-doubled multikilohertz Q-switched Nd:YAG laser is demonstrated. Up to 61% photon conversion with a 71% slope efficiency for photon conversion from 532 nm to the signal radiation was measured. We observed that the efficient conversion diminished the potential for photorefractive damage induced by the 532 nm radiation in the crystal and made sustained operation of the OPO device possible.

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.

METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger’s technique.

RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group.

CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.