[Epidemiological investigation of iron deficiency among preschool children in 10 provinces, autonomous regions, or municipalities in China]

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

[Peripheral sterile corneal infiltrates after small incision lenticule extraction]

A 31-year-old female patient with refractive error in both eyes underwent small incision lenticule extraction. On the 4th day after surgery, arc-shaped peripheral corneal infiltrates appeared in the right eye. Tobramycin and dexamethasone eye drops, 0.3% gatifloxacin eye drops, and a corneal bandage lens were applied to the eye. After bacterial infection was ruled out, dexamethasone sodium phosphate was injected subconjunctivally near the corneal lesion. The symptoms improved and the corneal lesion subsided afterwards.

[Association between unhealthy lifestyles and hyperuricemia in occupational population and modification effect of hypertension and dyslipidemia]

Objective: To understand the relationship between unhealthy lifestyle and hyperuricemia, as well as the modification effects of hypertension and dyslipidemia in occupational population and provide a theoretical basis for the prevention of hyperuricemia. Methods: A cross-sectional survey design was adopted, based on baseline data from the Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd., which included the population in 28 prefectures from Sichuan Province and Guizhou Province, and 33 districts (counties) from Chongqing Municipality between October and December 2021. This study collected the information about the demographics characteristics, lifestyles, and prevalence of chronic non-communicable diseases of the study subjects through questionnaire, physical measurement and laboratory biochemical test. The unhealthy lifestyle score was scored based on smoking, alcohol consumption, dietary patterns, physical activity, and low weight or overweight, with higher scores being associated with more unhealthy lifestyles. The multivariate logistic regression model was used to analyze the relationship between unhealthy lifestyle score, smoking, alcohol consumption, other factors and hyperuricemia, and the stratified analysis was used to explore the modification effect of hypertension and other diseases on the relationship between unhealthy lifestyle and hyperuricemia. Results: A total of 11 748 participants were included in this study, the prevalence of hyperuricemia was 34.4%. Multivariate logistic regression model showed that current/previous smoking, current/previous alcohol consumption and BMI abnormality were risk factors for hyperuricemia, and the unhealthy lifestyle score showed a "cumulative" effect on the risk for hyperuricemia, with higher score increasing the risk of hyperuricemia, and the OR increased from 1.64 (95%CI: 1.34-2.00) to 2.89 (95%CI: 2.39-3.50). Stratified analysis showed that unhealthy lifestyles had a greater impact on the risk for hyperuricemia in people with hypertension and dyslipidemia. Conclusions: The coexistence of multiple unhealthy lifestyles might increase the risk of hyperuricemia, and this effect was stronger in participants with hypertension and dyslipidemia. Timely correction of unhealthy lifestyles, and control of hypertension and dyslipidemia might reduce the risk for hyperuricemia.

[Respiratory virus infection and its influence on outcome in children with septic shock]

Objective: To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. Methods: The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results: A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions: The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

[Analysis of ultrasound images features and diagnostic model establishment of alveolar soft part sarcoma and intramuscular capillary-type hemangiomas]

Objective: The ultrasonography features of alveolar soft part sarcoma (ASPS) and intramuscular capillary-type hemangiomas (ICTH) were analyzed, and the diagnostic model of ASPS was established. Methods: A cross-sectional study was carried out. The clinical data of 52 patients [28 males and 24 females, aged (20.7±15.1) years] with pathologically confirmed ASPS and ICTH admitted to People's Hospital of Henan Province from January 2005 to February 2023 were included in the study. According to pathological types, the patients were divided into ASPS group and ICTH group. Clinical data of patients were retrospectively collected, and meaningful indicators in the univariate analysis were included in the regression analysis for screening. After comprehensive consideration of clinical significance and statistical significance, eligible indicators were selected for inclusion in the regression analysis. Binary logistic regression analysis was used to screen the factors that distinguished the pathological types of ASPS and ICTH, and the diagnostic model was established. The area under receiver operating characteristic (ROC) curve (AUC) was used to evaluate the diagnostic effectiveness of the diagnostic model in distinguishing ASPS from ICTH. Results: There were 20 patients in ASPS group, 10 males and 10 females, aged (26.9±13.5) years, and 32 patients in ICTH group, 18 males and 14 females, aged (16.8±15.0) years. The age difference between the ASPS group and the ICTH group was statistically significant (P<0.05), and there were statistically significant differences in the ultrasound imaging features of "clear boundary" "peripheral lobe" "thin blood vessels inside the lesion are straight and out of shape" "intra-lesion liquification" "peripheral thick blood vessels" and "peripheral muscle fiber disruption" between the two groups (all P<0.001).Variables with clinical and statistical significance were selected as independent variables. Binary logistic regression analysis showed that peripheral muscle fiber interruption (OR=97.358, 95%CI:6.833-1 387.249) and internal thin blood vessels were flat and out of shape (OR=0.052, 95%CI:0.003-0.921) was the correlation factor to distinguish the pathological types of ASPS and ICTH. Two ultrasonic image features of "peripheral muscle fiber interruption" and "internal thin blood vessels are straight and out of shape" were used to establish the diagnostic model. The sensitivity of "peripheral muscle fiber interruption" diagnostic model was 81.3%, and the specificity was 95.0%. The AUC was 0.811(95%CI: 0.761-0.954). The sensitivity, specificity and AUC of the diagnosis model of "internal thin vessels with flat misshape" were 90.0%, 96.9% and 0.934(95%CI: 0.830-0.984). The sensitivity, specificity and AUC of the combined diagnosis model of "peripheral muscle fiber interruption" and "internal thin blood vessel straight out of shape" were 96.9%, 90.0% and 0.974(95%CI:0.877-0.999). Conclusion: Ultrasonography can be used to distinguish ASPS from ICTH, and the combined diagnostic model based on the two ultrasonic imaging features of "peripheral muscle fiber interruption" and "internal thin blood vessel straight out of shape" can further improve the diagnostic efficiency.

[Comparison among different flushing media for intracoronary imaging with optical coherence tomography]

Objective: To explore the effects and safety of saline mixed 1∶1 with contrast medium (mixed medium) and pure heparinized saline as alternative media for optimal Optical Coherence Tomography (OCT) guided percutaneous coronary intervention (PCI). Methods: This single-center, prospective cohort study enrolled patients who underwent PCI with OCT guidance for chronic stable angina or acute coronary syndrome at the Department of Cardiology, the Second Hospital of Jilin University from October 2021 to August 2022. The target vessels were examined using OCT with three different flushing media at the same anatomical positions: contrast agent, mixed medium, and pure heparinized saline. An independent observer analyzed all imaging results and evaluated the lumen imaging quality, using the proportion of the clear imaging field (CIF%) as a quantitative measure for analysis. The average luminal diameter was compared among different flushing media. The study also assessed the image quality of the luminal anatomical structures, lesion pathologies, and stents. Results: A total of 105 patients were enrolled in the study, including 110 target vessels. The age of the enrolled patients was (60.5±8.4) years, with 60 male patients (57.1%). OCT examinations were successfully completed using all three media, and no related complications were observed in any groups. The three flushing media presented with the same image quality in terms of depicting the lumen anatomical structures, lesion characteristics, and stent-related features. The mixed medium group achieved a comparable CIF% to the contrast group with both right and left coronary arteries (right coronary 100.0% (100.0%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05; left coronary 100.0% (95.9%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05). While the saline group reached a comparable CIF% to the contrast group with right coronary arteries (100.0% (97.6%, 100.0%) vs. 100.0% (95.9%, 100.0%), P>0.05) but showed a significantly lower CIF% with left coronary arteries (84.9% (75.9%, 93.4%) vs. 100.0% (100.0%, 100.0%), P<0.05). For the average diameter of the coronary lumen, there was no statistically significant difference between the mixed medium group and the saline group compared to the contrast group with both right and left coronary arteries (P>0.05). Conclusions: A 1∶1 heparinized saline and contrast mixture can serve as a substitute flushing medium for OCT examination during PCI procedure. Pure saline can also yield good results in OCT examination of the right coronary artery, and both alternatives are safe for use as flushing medium in OCT imaging.

[Effects of cognition-related lifestyles on early cognitive decline in community older adults in China]

Objective: To investigate the distribution characteristics of cognition-related lifestyles of elderly in communities and explore the integrated effects on early cognitive decline. Methods: The participants were from the Project of Prevention and Intervention of Neurodegenerative Disease for Elderly in China. A total of 2 537 older adults aged ≥60 years without dementia in the 2015 baseline survey and the 2017 follow-up survey were included. The information about their cognition-related lifestyles, including physical exercise, social interaction, leisure activity, sleep quality, smoking status, and alcohol consumption, were collected through questionnaire survey and the integrated scores were calculated. Multivariate logistic regression analysis was used to assess the association between integrated cognition-related lifestyle score and early cognitive decline. Results: In the 2 537 older adults surveyed, 28.7% had score of 5-6, while only 4.8% had high scores for all 6 healthy lifestyles. Significant differences in healthy lifestyle factor distributions were observed between men and women. Multivariate logistic regression model showed that the risks for early cognitive decline in the older adults who had lifestyle score of 4 and 5-6 were lower than that in those with lifestyle score of 0-3 (OR=0.683, 95%CI: 0.457-1.019; OR=0.623, 95%CI: 0.398-0.976; trend P=0.030). In the women, the risks for early cognitive decline was lower in groups with score of 4 and 5-6 than in group with score of 0-3 (OR=0.491, 95%CI: 0.297-0.812; OR=0.556, 95%CI: 0.332-0.929; trend P=0.024). Conclusion: Cognition-related healthy lifestyles are associated with significantly lower risk for early cognitive decline in the elderly, especially in women.

[Characteristics and impact factors of SARS-CoV-2 infection in adult patients with relapsed/refractory B-cell non-Hodgkin lymphoma receiving chimeric antigen receptor T-cell therapy]

Objective: To explore the clinical characteristics and treatment of COVID-19 infection in patients with relapsed/refractory B-cell non-Hodgkin lymphoma before and after receiving chimeric antigen receptor T-cell therapy, and study the influencing factors of severe COVID-19 infection in these patients. Methods: The data of 59 patients with relapsed/refractory B-cell non-Hodgkin lymphoma who received chimeric antigen receptor T-cell therapy at the Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University between December 2017 and February 2023, and who were infected with novel coronavirus between December 2022 and February 2023 were retrospectively studied. Patients were divided into light, medium, severe, and critical groups, and the differences between the groups were analyzed using the chi-square test. A univariate logistic regression model was used to evaluate the contribution of each variable and its relationship with severe infection. The chi-square and Fisher's exact tests were used to analyze the differences between the B-cell aplasia and B-cell recovery (BCR) groups. Results: Of the 59 pre- and post-infusion infections, 39 (66.1%) led to mild COVID-19, 9 (15.3%) resulted in moderate COVID-19, 10 (16.9%) resulted in severe COVID-19, and 1 (1.7%) led to critical COVID-19. Moroever, age greater than 55 years, having received autologous hematopoietic stem cell transplantation, progressive disease status, and B-cell aplasia at the time of diagnosis of COVID-19 infection are factors affecting severe infection. Patients with B-cell aplasia had a more severe infection with COVID-19 (P<0.001), a longer duration (P=0.015), a longer antiviral therapy course (P<0.001), and a higher hospitalization rate (P<0.001) than the BCR group. Conclusion: Active prevention and treatment of COVID-19 infection remains a crucial issue requiring urgent attention in managing patients with relapsed/refractory B-cell non-Hodgkin lymphoma treated with chimeric antigen receptor T-cell therapy.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

[Investigation and analysis of occupational hazard factors in different industries in Tongliao City]

Objective: To investigate the occupational hazard factors of different industries in Tongliao City, and to provide scientific basis for the prevention and control of occupational disease in Tongliao City. Methods: In July 2021, the detection data of coal dust, silica dust, cement dust, benzene, noise and other occupational hazard factors, as well as the occupational health examination data of workers in various positions of 104 enterprises in different industries in Tongliao City were cllected and anylazed. χ(2) test was used to analyze the results of chest radiography of workers in different age groups. Results: A total of 104 enterprises were investigated, and the median time-weighted average concentration (C(TWA)) of coal dust, silic a dust, cement dust and benzene in contact with test posts were 0.94, 0.30, 0.70 and 0.95 mg/m(3), respectively. The median 8 h equivalent sound level (L(EX, 8 h)) of noise was 74.1 dB (A) . The over standard rates of silica dust, cement dust and noise contact positions were 10.83% (16/240) , 7.14% (2/28) and 0.48% (3/628) , respectively. The differences of chest X-ray examination of coal dust and silica dust workers in different working ages were statistically significant (χ(2)=218.50, 531.80, P<0.001) . The difference of hearing threshold of noise workers with different working age was statistically significant (χ(2)=1290.00, P<0.001) . The rates of leukopenia and neutropenia were 41.90% (44/105) and 20.95% (22/105) in benzene exposed workers. The positive rate of brucella exposure workers was 1.33% (1/75) for tiger red plate agglutination test and 3.23% (3/93) for tube agglutination test. Conclusion: Silica dust, cement dust and noise exceed the standard in some posts and places in the Tongliao City, and some workers are infected with Brucella. In the future, we can focus on monitoring noise-generating posts, strengthen supervision and implement prevention and control measures to reduce the incidence of occupational diseases.

[Association between cognitive function and probability of prodromal Parkinson's disease in middle aged and elderly people aged 55 years and above in 4 provinces in China]

Objective: To analyze probability of prodromal Parkinson's disease (pPD) and assess the association between global cognitive function and cognitive domain function and probability of pPD in ≥55 years old middle-aged and elderly people in Hebei, Zhejiang, Shaanxi and Hunan Provinces in China. Methods: Data were collected from dataset of the Community-based Cohort Study on Nervous System Disease 2020. We selected 4 634 Alzheimer disease and Parkinson's disease free persons aged ≥55 years with completed information on demographics, disease history, cognitive test, and risk factors of Parkinson's disease for this study. Cognitive function was assessed using Montreal Cognitive Assessment Scale (Chinese version). Calculation of probability of pPD and assessment of possible/probable pPD were performed according to the criteria published by the International Parkinson and Movement Disorder Society. Multivariate linear regression model was used to analyze the association between cognitive function and probability of pPD. Results: The M (Q1,Q3) of global cognitive function and cognitive domains in terms of memory, execution, visuospatial function, language, attention and orientation were 25 (20, 30), 13 (11, 15), 10 (7, 12), 6 (4, 7), 5 (4, 6), 15 (12, 18) and 6 (6, 6) points, respectively. The M(Q1,Q3) of probability of pPD was 0.42% (0.80%, 1.73%), and the proportion of the study subjects with possible/probable pPD was 0.4%. Differences in the distribution of probability of pPD were significant among groups by total cognitive score quartiles (P<0.001), and the difference in proportions of study subjects with possible/probable pPD was significant and showed decline trend (P=0.001). After adjusted for confounders, the results of multivariate linear regression analyses showed that probability of pPD in the Q2, Q3 and Q4 group decreased by 23.4%, 31.2% and 20.1% compared with Q1 group, and corresponding β values were 0.766 (95%CI: 0.702-0.836), 0.688 (95%CI: 0.631-0.751) and 0.799 (95%CI: 0.730-0.875), respectively, the trend was significant (P<0.001). Higher index scores of execution, visuospatial function, language, attention and orientation were highly related to lower probability of pPD (P<0.001). Conclusion: Declines in global cognitive function and cognitive domains of execution, visuospatial function, language, attention and orientation might increase the probability of pPD in middle-aged and elderly people, suggesting the importance of cognitive intervention in early stage for pPD prevention.

[Study on the association between air pollution and respiratory disease of primary school students in Chongqing City]

To analyze the association between exposure to air pollution and respiratory disease of primary school students in Chongqing City. Eight districts and counties were randomly selected based on the air pollution situation in Chongqing City. In each selected district and county, one primary school was randomly selected. A questionnaire survey was conducted on all primary school students in Grades 3-5 by the end of 2019. Air quality data from the nearest environmental monitoring sites were collected. A logistic regression model was used to analyze the impact of the living environment, lifestyle and air pollution on the respiratory disease of surveyed students. This study included 5 918 primary school students, with a prevalence rate of respiratory disease of 21.54%. The prevalence rates of boys and girls were 23.38% and 19.59%, respectively. The average Air quality index (AQI) of the surveyed school was 67, and the rates of exceeding standards of PM10, PM2.5, NO2 and O3 were 1.16%, 6.92%, 0.99% and 5.65%, respectively. The level of SO2 and CO did not exceed the standard. After adjusting for relevant factors, logistic regression analysis showed that primary school students in areas with high exposure to air pollution (OR=2.52), using air pollution related-chemicals at home (OR=1.47), passive smoking (OR=1.27), and keeping pets at home (OR=1.18) had a higher risk of respiratory disease (all P<0.05). In addition, the average annual values of AQI (OR=1.18), PM10 (OR=1.20), PM2.5 (OR=1.35), and NO2 (OR=1.11) increased the risk of respiratory diseases in primary school students (all P<0.05). In conclusion, the respiratory disease of primary school students in Chongqing City is related to the living environment, behavior habits and ambient air quality. The increased exposure concentration of PM10, PM2.5 and NO2 in air pollutants can lead to an increased risk of respiratory disease among primary school students.

[Status in clinical and molecular characteristics of differentiated thyroid carcinoma in children and adolescents]

The epidemiological, clinical, and molecular characteristics of differentiated thyroid carcinoma (DTC) in children and adolescents are different from those in adults. The incidence of DTC in children and adolescents is very low, with high rates of lymph node metastasis, extra-thyroidal extension and recurrence, but mortality is lower than that in adults. Younger children with DTC tend to show a higher rate of recurrence, more lymph node metastases, and more extra-thyroidal extension. Furthermore, studies on molecular characteristics suggest that the diversity of gene mutations causes the clinical manifestations of DTC in children and adolescents that are different from those in adults. The incidence of gene fusion is significantly higher than in adults, while the incidence of point mutations is lower than in adults, which may be closely related to clinicopathological characteristics such as high tumor aggressiveness and poor prognosis.

[Analysis of clinicopathological characteristics and prognosis of papillary thyroid carcinoma in children and adolescents at different ages]

Objectives: To examine the age cut-off point for poor clinicopathological characteristics and prognosis of differentiated thyroid carcinoma (DTC) in children and adolescents. Methods: The clinicopathological features of 74 patients with DTC aged 18 years and younger who underwent surgery in the Department of Thyroid Surgery, the First Hospital of China Medical University from January 2011 to December 2020 were retrospectively analyzed. There were 20 males and 54 females, aged (M(IQR)) 16 (4) years (range: 8 to 18 years). Firstly, the cut-off point of age affecting prognosis was determined according to the receiver operator characteristic curve, the patients included in the study were grouped according to the age cut-off, and then the univariate and multivariate analysis for prognostic factors were performed using the Cox risk proportional regression model. The Kaplan-Meier survival curve was used to verify the factors affecting the prognosis and analyzed the possible mechanisms by bioinformatics. Results: The cut-off value of age was 15 years. Age ≤15 years was the only prognostic factor for recurrence (HR=4.427, 95%CI: 1.236 to 15.859, P=0.022). The number of metastatic cervical lymph nodes was higher in patients aged ≤15 years, and the 10-year recurrence-free survival rate was much lower than in patients aged >15 years (50.4% vs. 84.1%, P=0.018). Gene enrichment analysis and differential gene identification showed that differential genes between ≤15 years old group and>15 years old group were closely related to the transforming growth factor-β signaling pathway and some metabolism-related signaling pathways. Conclusions: Age ≤15 years is the only prognostic factor for the prognosis of DTC in children and adolescents. Age ≤15 years had more cervical lymph node metastases and a worse prognosis. For younger DTC patients, more active treatment and a stricter postoperative management strategy should be adopted.

[Similarities and differences of myocardial metabolic characteristics between HFpEF and HFrEF mice based on LC-MS/MS metabolomics]

Objective: To reveal the similarities and differences in myocardial metabolic characteristics between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) mice using metabolomics. Methods: The experimental mice were divided into 4 groups, including control, HFpEF, sham and HFrEF groups (10 mice in each group). High fat diet and Nω-nitroarginine methyl ester hydrochloride (L-NAME) were applied to construct a"two-hit"HFpEF mouse model. Transverse aortic constriction (TAC) surgery was used to construct the HFrEF mouse model. The differential expression of metabolites in the myocardium of HFpEF and HFrEF mice was detected by untargeted metabolomics (UHPLC-QE-MS). Variable importance in projection>1 and P<0.05 were used as criteria to screen and classify the differentially expressed metabolites between the mice models. KEGG functional enrichment and pathway impact analysis demonstrated significantly altered metabolic pathways in both HFpEF and HFrEF mice. Results: One hundred and nine differentially expressed metabolites were detected in HFpEF mice, and 270 differentially expressed metabolites were detected in HFrEF mice. Compared with the control group, the most significantly changed metabolite in HFpEF mice was glycerophospholipids, while HFrEF mice presented with the largest proportion of carboxylic acids and their derivatives. KEGG enrichment and pathway impact analysis showed that the differentially expressed metabolites in HFpEF mice were mainly enriched in pathways such as biosynthesis of unsaturated fatty acids, ether lipid metabolism, amino sugar and nucleotide sugar metabolism, glycerophospholipid metabolism, arachidonic acid metabolism and arginine and proline metabolism. The differentially expressed metabolites in HFrEF mice were mainly enriched in arginine and proline metabolism, glycine, serine and threonine metabolism, pantothenate and CoA biosynthesis, glycerophospholipid metabolism, nicotinate and nicotinamide metabolism and arachidonic acid metabolism, etc. Conclusions: HFpEF mice have a significantly different myocardial metabolite expression profile compared with HFrEF mice. In addition, biosynthesis of unsaturated fatty acids, arachidonic acid metabolism, glycerophospholipid metabolism and arginine and proline metabolism are significantly altered in both HFpEF and HFrEF mice, suggesting that these metabolic pathways may play an important role in disease progression in both types of heart failure.

[Summary of best evidence for pulse contour cardiac output monitoring in severe burn patients]

Objective: To summarize the best evidence for pulse contour cardiac output (PiCCO) monitoring in severe burn patients. Methods: A bibliometric approach was used. Foreign language databases including UpToDate, BMJ Best Practice, Joanna Briggs Institute Evidence-Based Practice Database, Cochrane Library, PubMed, Web of Science, Embase, Medline, and Guideline International Network, as well as Chinese databases such as China National Knowledge Infrastructure, Wanfang Database, and VIP Database were systematically retrieved to obtain all the publicly published evidence on PiCCO monitoring in severe burn patients in each database from the establishment of each database to May 2022, including guidelines, expert consensus, evidence summary, systematic review, and original research. The literature was screened and evaluated for the quality, from which the evidences were extracted, evaluated, and classified to summarize the best evidences. Results: Three guidelines, two expert consensuses, one evidence summary (with two systematic reviews being traced), two systematic reviews, three randomized controlled trials, one cohort study, and one case-control study were retrieved and included, with good quality of literature. Totally 37 pieces of best evidences about PiCCO monitoring in severe burn patients were summarized from the aspects of pre-operation evaluation, pipe placement and operation, monitoring system establishment, pipeline maintenance, and supervision and education. Conclusions: Totally 37 pieces of best evidences about PiCCO monitoring in severe burn patients are summarized from 5 aspects, providing a basis for the clinical implementation of scientific and standardized PiCCO monitoring and nursing management.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.

[Response characteristics of tislelizumab combined with chemotherapy in first-line treatment of locally advanced or metastatic non-squamous non-small cell lung cancer]

Objective: To investigate the response characteristics of patients with locally advanced/metastatic non-squamous non-small cell lung cancer (nsq-NSCLC) treated with tislelizumab in combination with chemotherapy in the first line. Methods: Patients with nsq-NSCLC who achieved complete or partial remission after treatment with tislelizumab in combination with chemotherapy or chemotherapy alone in the RATIONALE 304 study, as assessed by an independent review board, were selected to analyze the response characteristics and safety profile of the responders. Time to response (TTR) was defined as the time from randomization to the achievement of first objective response. Depth of response (DpR) was defined as the maximum percentage of tumor shrinkage compared with the sum of the baseline target lesion length diameters. Results: As of January 23, 2020, 128 patients treated with tislelizumab in combination with chemotherapy achieved objective tumor response (responders), representing 57.4%(128/223) of the intention-to-treat population, with a TTR of 5.1 to 33.3 weeks and a median TTR of 7.9 weeks. Of the responders (128), 50.8%(65) achieved first remission at the first efficacy assessment (week 6), 31.3%(40) at the second efficacy assessment (week 12), and 18.0%(23) at the third and subsequent tumor assessments. The percentages of responders who achieved a depth of tumor response of 30% to <50%, 50% to <70% and 70% to 100% were 45.3%(58/128), 28.1%(36/128) and 26.6%(34/128), respectively, with median progression-free survival (PFS) of 9.0 months (95% CI: 7.7 to 9.9 months), 11.5 months (95% CI: 7.7 months to not reached) and not reached (95% CI: 11.8 months to not estimable), respectively. Tislelizumab plus chemotherapy were generally well tolerated in responders with similar safety profile to the overall safety population. Conclusion: Among responders to tislelizumab in combination with chemotherapy for nsq-NSCLC, 82.0%(105/128) achieves response within the first two tumor assessments (12 weeks) and 18.0%(23/128) achieves response at later (18 to 33 weeks) assessments, and there is a trend toward prolonged PFS in responders with deeper tumor response.

[Efficacy of intravenous drug information management system on the improvement of anemia in maintenance hemodialysis patients]

Objective: To investigate the effect of information management of intravenous drugs on anemia in maintenance hemodialysis patients. Methods: The information management of intravenous drugs was a management system developed by the Hemodialysis Center of Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital in April 2020. The parameters six months before and after the use of the information management system were retrospectively collected and compared, including the rate of reaching the standard of hemoglobin, ferritin, transferrin saturation rate and the incidence of cardiovascular events. Specifically, the control stage was from October 2019 to March 2020, which was before the use of information management, and the study stage was from April to September 2020, which was after the use of information management. Results: There were 285 patients (190 males and 95 females) included in the control stage, with an average age of (62.4±13.2) years, while 278 patients (193 males and 85 females) were included in the study stage, with an average age of (62.8±13.2) years. Compared with the control stage, the rate of reaching the standard of hemoglobin [47.8% (797/1 668) vs 40.2% (687/1 710), P<0.001], ferritin [39.0% (217/556) vs 31.2% (178/570), P=0.006], and transferrin saturation [64.7% (360/556) vs 58.6% (334/570), P=0.034] increased in the study stage. The incidence of cardiovascular events in the study stage was 11.2% (31/278), which was significantly lower than that in the control stage [16.5% (47/285)] (P=0.043). Conclusion: The information management of intravenous drugs in the hemodialysis center may help improve the anemia status in maintenance hemodialysis patients.

[Epidemiological characteristics of cardio-metabolic risk factors among children and adolescents aged 7-17 years in 4 provinces of China]

Objective: This study aimed to investigate the epidemiological characteristics of cardio-metabolic risk factors among children and adolescents aged 7-17 years in (Hebei, Zhejiang, Shaanxi, Hunan) 4 provinces of China and the influence of demographic and economic characteristics on them. Methods: A total of 1 747 children and adolescents aged 7-17 from a Community-based Cohort Study on Nervous System Disease in 2018 were selected. High waist circumference, central obesity, elevated TG, elevated TC, elevated LDL-C, decreased HDL-C, elevated blood pressure, elevated blood glucose, and clustering of risk factors was analyzed. χ² test was used for univariate analysis, multivariate logistic regression was used to analyze the correlation between demographic and economic factors and risk factors, and the Cochran-Armitage trend test was used for trend analysis. Results: The detection rates of high waist circumference, decreased HDL-C, elevated blood pressure, elevated TG, elevated blood glucose, central obesity, elevated TC, and elevated LDL-C were 29.08%, 15.28%, 13.17%, 13.05%, 11.79%, 7.33%, 6.53%, and 5.15%, respectively. The rate of clustering of risk factors was 18.37%. Multivariate logistic regression analysis showed that the risk of high waist circumference in girls was higher than that in boys (OR=1.67, 95%CI: 1.26-2.22), and the risk of elevated blood glucose and clustering of risk factors was lower than that in boys (OR=0.69, 95%CI: 0.49-0.99; OR=0.72, 95%CI: 0.53-0.99). The risk of high waist circumference, decreased HDL-C, and clustering of risk factors in 13-17 years old group was higher than that in the 7-year-olds group (OR=2.24, 95%CI: 1.65-3.04; OR=1.59, 95%CI: 1.20-2.11; OR=1.75, 95%CI: 1.26-2.44), but the risk of central obesity was lower (OR=0.54, 95%CI: 0.37-0.78). The risk of elevated TC, elevated TG, and decreased HDL-C in children and adolescents in southern was higher than that in northern parts of China (OR=1.88, 95%CI: 1.25-2.83; OR=1.61, 95%CI: 1.17-2.22; OR=1.55, 95%CI: 1.19-2.04), but the risk of high waist circumference and central obesity was lower than that in northern China (OR=0.57, 95%CI: 0.43-0.75; OR=0.62, 95%CI: 0.42-0.90). The risk of decreased HDL-C in rural children and adolescents was higher than in urban children and adolescents (OR=1.36, 95%CI: 1.02-1.83). The risk of multiple risk factors increased with the increase in average monthly household income per capita and BMI level. Conclusions: High waist circumference, decreased HDL-C and elevated blood pressure were prominent cardio-metabolic risk factors among children and adolescents aged 7-17 years in 4 provinces of China in 2018. The region, average monthly household income per capita, and BMI were the main influencing factors of cardio-metabolic risk factors.

[Depression status of elderly patients with metabolic syndrome in three provinces of China]

Objective: To understand the depression status and its influencing factors in elderly patients with MS in China and to explore the correlation between various components of elderly MS and depression. Methods: This study is based on the "Prevention and Intervention of Key Diseases in Elderly" project. We used a multi-stage stratified cluster random sampling method to complete 16 199 elderly aged 60 years and above in 16 counties (districts) in Liaoning, Henan, and Guangdong Provinces in 2019, excluding 1 001 missing variables. Finally, 15 198 valid samples were included for analysis. The respondents' MS disease was obtained through questionnaires and physical examinations, and the respondents' depression status within the past half month was assessed using the PHQ-9 Depression Screening Scale. The correlation between elderly MS and its components and depression and its influencing factors were analyzed by logistic regression. Results: A total of 15 198 elderly aged 60 years and above were included in this study, with the prevalence of MS at 10.84% and the detection rate of depressive symptoms in MS patients at 25.49%. The detection rates of depressive symptoms in patients with 0, 1, 2, 3, and 4 MS abnormal group scores were 14.56%, 15.17%, 18.01%, 25.21%, and 26.65%, respectively. The number of abnormal components of MS was positively correlated with the detection rate of depressive symptoms, and the difference between groups was statistically significant (P<0.05). The risk of depression symptoms in patients with MS, overweight/obesity, hypertension, diabetes, and dyslipidemia was 1.73 times (OR=1.73, 95%CI:1.51-1.97), 1.13 times (OR=1.13, 95%CI:1.03-1.24), 1.25 times (OR=1.25, 95%CI:1.14-1.38), 1.41 times (OR=1.41, 95%CI:1.24-1.60), 1.81 times (OR=1.81,95%CI:1.61-2.04), respectively, more than those without the disease. Multivariate logistic regression analysis showed that the detection rate of depressive symptoms in patients with sleep disorders was higher than that with normal sleep (OR=4.89, 95%CI: 3.79-6.32). The detection rate of depressive symptoms in patients with cognitive dysfunction was 2.12 times higher than that in the average population (OR=2.12, 95%CI: 1.56-2.89). The detection rate of depressive symptoms in patients with impaired instrumental activities of daily living (IADL) was 2.31 times (OR=2.31, 95%CI: 1.64-3.26) higher than that in the average population. Tea drinking (OR=0.73, 95%CI: 0.54-0.98) and physical exercise (OR=0.67, 95%CI: 0.49-0.90) seemed to be protective factors for depression in elderly MS patients (P<0.05). Conclusions: Older patients with MS and its component abnormalities have a higher risk of depression than the average population. Sleep disorders, cognitive impairment, and IADL impairment are important influencing factors for depression in elderly MS patients, while tea drinking and physical exercise may help to reduce the risk of the disease.

[Diagnosis and treatment of pediatric septic shock in pediatric intensive care units from hospitals of different levels]

Objective: To investigate the differences in clinical characteristics, diagnosis, and treatment of pediatric septic shock in pediatric intensive care unit (PICU) among hospitals of different levels. Methods: This retrospective study enrolled 368 children with septic shock treated in the PICU of Beijing Children's Hospital, Henan Children's Hospital, and Baoding Children's Hospital from January 2018 to December 2021. Their clinical data were collected, including the general information, location of onset (community or hospital-acquired), severity, pathogen positivity, consistence of guideline (the rate of standard attainment at 6 h after resuscitation and the rate of anti-infective drug administration within 1 h after diagnosis), treatment, and in-hospital mortality. The 3 hospitals were national, provincial, and municipal, respectively. Furthermore, the patients were divided into the tumor group and the non-tumor group, and into the in-hospital referral group and the outpatient or emergency admission group. Chi-square test and Mann-Whitney U test were used to analyze the data. Results: The 368 patients aged 32 (11, 98) months, of whom 223 were males and 145 females. There were 215, 107, and 46 patients with septic shock, with males of 141, 51, and 31 cases, from the national, provincial, and municipal hospitals, respectively. The difference in pediatric risk of mortality Ⅲ (PRISM Ⅲ) scores among the national,provincial and municipal group was statistically significant (26(19, 32) vs.19(12, 26) vs. 12(6, 19), Z=60.25,P<0.001). The difference in community acquired septic shock among the national,provincial and municipal group was statistically significant (31.6%(68/215) vs. 84.1%(90/107) vs. 91.3%(42/46), χ²=108.26,P<0.001). There were no significant differences in compliance with guidelines among the 3 groups (P>0.05). The main bacteria detected in the national group were Klebsiella pneumoniae (15.4% (12/78)) and Staphylococcus aureus (15.4% (12/78)); in the provincial group were Staphylococcus aureus (19.0% (12/63)) and Pseudomonas aeruginosa (12.7% (8/63)), and in the municipal group were Streptococcus pneumoniae (40.0% (10/25)) and Enteric bacilli (16.0% (4/25)). The difference in the proportion of virus and the proportion of 3 or more initial antimicrobials used among the national,provincial and municipal group was statistically significant (27.7% (43/155) vs. 14.9% (13/87) vs. 9.1% (3/33), 22.8%(49/215) vs. 11.2%(12/107) vs. 6.5%(3/46), χ²=8.82, 10.99, both P<0.05). There was no difference in the in-hospital mortality among the 3 groups (P>0.05). Regarding the subgroups of tumor and non-tumor, the national group had higher PRISM Ⅲ (31(24, 38) vs. 22 (21, 28) vs.16 (9, 22), 24 (18, 30) vs. 17(8, 24) vs. 10 (5, 16), Z=30.34, 10.45, both P<0.001), and it was the same for the subgroups of in-hospital referral and out-patient or emergency admission (29 (21, 39) vs. 23 (17, 30) vs. 15 (10, 29), 23 (17, 29) vs. 18 (10, 24) vs. 11 (5, 16), Z=20.33, 14.25, both P<0.001) as compared to the provincial and municipal group. There was no significant difference in the in-hospital mortality among the 2 pairs of subgroups (all P>0.05). Conclusion: There are differences in the severity, location of onset, pathogen composition, and initial antibiotics of pediatric septic shock in children's hospitals of different levels, but no differences in compliance with guidelines and in-hospital survival rate.

[Gasless submental approach endoscopic removal of thyroglossal cyst]

Objective: To explore the safety and feasibility of gasless submental approach endoscopic removal of thyroglossal cyst. Methods: This work prospectively included the clinical data of 13 patients who underwent the gasless submental approach endoscopic removal of thyroglossal cyst at the Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University from August 2021 to February 2022. The operative time, bleeding volumes, postoperative complications, subjective pain levels, satisfaction with incisional scars, neck and facial deformities, and recurrences were prospectively evaluated by visual analogue scale(VAS) score. Results: All of 13 patients were successfully treated using this new technique. The patients had a median age of 38 years, ranging from 24 to 59 years, comprising of 3 males and 10 females. The length of the submental incision was about 3 cm and the median of operation time was 135 minutes. Postoperative complications were minimal. The median volume of blood loss was 10 ml. Surgical site swelling existed in 1 case and dysphagia for more than 1 week occurred in 2 cases. Patients were discharged from the hospital with a median of 3 days after surgery. On a VAS of 0-10 scores, the pain had a median of 2 on the first day after surgery, and the satisfaction with incision scars and neck and facial deformities showed a median of 8 at 6 months after surgery. There were no recurrences during the follow-up period of 9-15 months. Conclusion: Gasless submental approach endoscopic removal of thyroglossal cyst may be a reliable new surgical method that is safe and has cosmetic advantages.

[A deep-learning model for the assessment of coronary heart disease and related risk factors via the evaluation of retinal fundus photographs]

Objective: To develop and validate a deep learning model based on fundus photos for the identification of coronary heart disease (CHD) and associated risk factors. Methods: Subjects aged>18 years with complete clinical examination data from 149 hospitals and medical examination centers in China were included in this retrospective study. Two radiologists, who were not aware of the study design, independently evaluated the coronary angiography images of each subject to make CHD diagnosis. A deep learning model using convolutional neural networks (CNN) was used to label the fundus images according to the presence or absence of CHD, and the model was proportionally divided into training and test sets for model training. The prediction performance of the model was evaluated in the test set using monocular and binocular fundus images respectively. Prediction efficacy of the algorithm for cardiovascular risk factors (e.g., age, systolic blood pressure, gender) and coronary events were evaluated by regression analysis using the area under the receiver operating characteristic curve (AUC) and R² correlation coefficient. Results: The study retrospectively collected 51 765 fundus images from 25 222 subjects, including 10 255 patients with CHD, and there were 14 419 male subjects in this cohort. Of these, 46 603 fundus images from 22 701 subjects were included in the training set and 5 162 fundus images from 2 521 subjects were included in the test set. In the test set, the deep learning model could accurately predict patients' age with an R² value of 0.931 (95%CI 0.929-0.933) for monocular photos and 0.938 (95%CI 0.936-0.940) for binocular photos. The AUC values for sex identification from single eye and binocular retinal fundus images were 0.983 (95%CI 0.982-0.984) and 0.988 (95%CI 0.987-0.989), respectively. The AUC value of the model was 0.876 (95%CI 0.874-0.877) with either monocular fundus photographs and AUC value was 0.885 (95%CI 0.884-0.888) with binocular fundus photographs to predict CHD, the sensitivity of the model was 0.894 and specificity was 0.755 with accuracy of 0.714 using binocular fundus photographs for the prediction of CHD. Conclusion: The deep learning model based on fundus photographs performs well in identifying coronary heart disease and assessing related risk factors such as age and sex.

Constraints on Heavy Decaying Dark Matter from 570 Days of LHAASO Observations

The kilometer square array (KM2A) of the large high altitude air shower observatory (LHAASO) aims at surveying the northern γ-ray sky at energies above 10 TeV with unprecedented sensitivity. γ-ray observations have long been one of the most powerful tools for dark matter searches, as, e.g., high-energy γ rays could be produced by the decays of heavy dark matter particles. In this Letter, we present the first dark matter analysis with LHAASO-KM2A, using the first 340 days of data from 1/2-KM2A and 230 days of data from 3/4-KM2A. Several regions of interest are used to search for a signal and account for the residual cosmic-ray background after γ/hadron separation. We find no excess of dark matter signals, and thus place some of the strongest γ-ray constraints on the lifetime of heavy dark matter particles with mass between 10^{5} and 10^{9}  GeV. Our results with LHAASO are robust, and have important implications for dark matter interpretations of the diffuse astrophysical high-energy neutrino emission.

[Association between fasting plasma glucose and mild cognitive impairment in Chinese 55 and older population from four provinces]

Objective: To analyze the association of fasting plasma glucose (FPG) with mild cognitive impairment (MCI) in the Chinese middle-aged and elderly population from four provinces. Methods: Data were drawn from the baseline data of the Community-based Cohort Study on Nervous System Disease 2018-2019. We selected 3 272 subjects aged 55 and above with completed information on demographics, lifestyle, disease history, cognitive test, psychological assessment, and bio-chemistries measurement, and who were capable of performing basic activities of daily living but without Alzheimer's disease during recruitment. A multivariate logistic regression model was employed to analyze the association between FPG and MCI. Results: Median level of FPG in the study population was 5.5 mmol/L. The prevalence of MCI was 24.8%, and those in groups of the FPG quintile were 19.4%, 22.2%, 29.2%, 26.6%, and 26.1%, respectively, which significantly increased the trend (P=0.002). After adjustment of confounders, multivariate logistic regression analysis found that the MCI risk of subjects in the Q₃,Q₄ and Q₅ groups was 1.641 (95%CI: 1.226-2.131), 1.373 (95%CI: 1.036-1.825), 1.402 (95%CI: 1.054-1.871) times as high as that in the Q₁ group, respectively. Conclusion: High FPG level might serve as a risk factor for MCI in the middle-aged and elderly population, suggesting the importance of monitoring and controlling plasma glucose even without diabetes.

[Association between obesity and the prevalence of type 2 diabetes mellitus among Chinese adults aged 18-65 years in 15 provinces in 2018]

Objective: To analyze the association between different types of obesity, BMI, and waist circumference (WC) and the risk of type 2 diabetes mellitus (T2DM) in Chinese adults. Methods: Based on the China Health and Nutrition Survey data in 2018, different types of obesity were defined across different BMI and WC combinations based on Criteria of weight for adults (WS/T 428-2013), including non-obesity, simple general obesity, simple central obesity, and complex obesity. The associations of different types of obesity, BMI, and WC with T2DM risk were explored using two-level mixed-effects logistic regression and restricted cubic spline models. Results: A total of 7 030 subjects aged 18-65 were included in this study. The prevalence of general obesity and central obesity were 16.29% (502/3 082), 42.28% (1 303/3 082) in males, and 14.41% (569/3 948), 37.87% (1 495/3 948) in females. The prevalence of complex obesity was 14.70% and 12.97% in males and females, respectively. The prevalence of T2DM was 11.28% in participants, and the prevalence in complex obesity (18.98%, 22.07%) was higher than in simple central obesity (16.24%, 15.26%) and non-obesity (9.65%, 5.18%) in males and females, respectively. Multilevel regressions showed that males with simple central obesity and complex obesity had 1.61 (95%CI: 1.24-2.08) and 2.11 (95%CI: 1.56-2.86) times the odds of T2DM, respectively, as compared with the non-obesity; and the odds of T2DM in females were 2.70 (95%CI: 1.16-6.28) times for simple general obesity, 2.62 (95%CI: 2.01-3.40) times for simple central obesity, and 4.47 (95%CI: 3.35-5.98) times for complex obesity. A nearly linear positive association was observed between BMI and T2DM risk. WC was also positively associated with T2DM risk and a non-linearly increased risk in females (P for non-linear=0.024). The risk of T2DM increased when BMI ≥22.5 kg/m² and 23.0 kg/m², WC ≥85.0 cm and 80.0 cm in males and females, respectively. Conclusions: Complex obesity adults are more likely to suffer from T2DM. The risk of T2DM increases significantly when BMI is at the normal high values and waist circumference at the stage of pre-central obesity.

Infection Characteristics and Physical Prevention Strategy of Panax notoginseng Round Spot Disease Caused by Mycocentrospora acerina

Panax notoginseng round spot disease (PRSD), caused by Mycocentrospora acerina, is the main leaf disease occurring in cultured P. notoginseng. Aiming to find a safe and efficient control method for PRSD, we studied the disease characteristics of PRSD and the optimal growth conditions of M. acerina and evaluated the efficacy of rain-shelter cultivation in PRSD control. Moreover, we described M. acerina based on morphological characterization and molecular analyses (ITS, ACT, LSU, and TEF-1α). The optimum temperature for M. acerina conidial germination was found to be 14 to 22°C. Furthermore, leaf surface wetness for at least 4 h is required for conidial germination, and conidia can successfully infect P. notoginseng when the leaf wetness lasts for more than 8 h. Additionally, rainwater splashing determines the conidial transfection distance, which is less than 2 m. Finally, our study revealed that rain-shelter cultivation is an effective and simple physical prevention strategy to control PRSD, with an average efficacy of up to 100%.

[C1q or IgA deposition in glomeruli of children with primary membranous nephropathy]

Objective: To assess the correlation of glomerular C1q or IgA deposition with clinical and pathological features of primary membranous nephropathy (PMN) in children. Methods: The clinical and pathological manifestations including (phospholipase A2 receptor, PLA2R) and IgG subclasses staining in renal biopsies, serum anti-PLA2R antibody and therapeutic response of 33 children diagnosed with PMN in Peking University First Hospital from December 2012 to December 2020 were retrospectively summarized and analyzed. According to results of PLA2R test and findings renal pathological, the patients were divided into PLA2R-related group and non-PLA2R-related group, typical MN group and atypical MN group, C1q deposit group and non-C1q deposit group, as well as IgA deposit group and non-IgA deposit group respectively. T-test, Mann-Whitney U test and Fisher's exact probability test were used for comparison between the groups. Results: Among the 33 children with PMN, there were 20 males and 13 females, of that the age of onset was 11 (8, 13) years, and 32 patients had nephrotic level proteinuria. Renal biopsies were performed at 4.6 (2.1, 11.6) months after onset, and 28 patients (85%) received glucocorticoid or immunosuppressive therapy prior to renal biopsy. There were 20 cases (61%) with PLA2R-related MN and 13 cases (39%) with non-PLA2R-related MN. Compared with the non-PLA2R-related group, the PLA2R-related group had an older age of onset (12 (10, 13) vs. 7 (3, 12) years, Z=-2.52, P=0.011), a lower preceding infection rate (45% (9/20) vs. 11/13, P=0.032) and lower spontaneous remission rate (0 vs. 4/13, P=0.017). Renal PLA2R positivity was significantly associated with predominant or co-deposition of IgG4 (13/17 vs. 5/15, P=0.031) and low albumin levels at renal biopsy ((25±6) vs. (29±7) g/L, t=2.14, P=0.041). There were 12 patients with typical PMN and 21 patients with atypical PMN, and no significant difference in clinical and pathological manifestations was found between these 2 groups (all P>0.05). There were 10 cases (32.3%) with glomerular C1q deposition, and their disease course before renal biopsy was significantly shorter than those without C1q deposition (1.8 (0.8, 5.9) vs. 6.0 (2.5, 22.3) months, Z=-2.27, P=0.023). Twelve cases (36.4%) had glomerular IgA deposition, and their course of disease,clinical and pathological manifestations were not significantly different from those without IgA deposition (all P>0.05). Conclusion: Glomerular C1q or IgA deposition may not affect the clinical manifestations, glomerular PLA2R and IgG subclasses staining pattern, or the response to treatment of PMN in children.

[Epidemiological characteristics and trends of cardiometabolic risk factors in residents aged 18-64 years in 15 provinces of China]

Objective: To investigate the epidemiological characteristics and trends of cardiometabolic risk factors in residents aged 18-64 years in 15 provinces (autonomous regions,municipalities) of China, and to analyze the impact of demographic characteristics on cardiometabolic risk factors. Methods: 19 827 adults aged 18-64 from the "China Health and Nutrition Survey" in 2009, 2015 and 2018 were selected as subjects. Using the data of demographic and economic factors, blood biochemical measurements and physical measurements, the trend of detection rates of metabolic risk factors in different years was analyzed by Joinpoint regression model. The association between risk factors and demographic characteristics was analyzed by multinomial logit model. Results: Among all the risk factors, overweight and central obesity had the highest detection rates (36.41% and 39.93%, respectively). In addition, among the three years, the clustering of risk factors was highest in 2015 and decreased slightly in 2018. Joinpoint regression model analysis showed that the detection rates of most metabolic risk factors expressing an overall upward trend from 2009 to 2018 but there was no significantly statistical difference in annual percentage change (APC). Among the risk factors under APC>0, the APC of obesity and diabetes was the largest (APC=5.37%, t=3.26, P=0.190; APC=5.52%, t=7.70, P=0.082), while among the risk factors with APC<0, high hs-CRP appeared as the largest (APC=-6.95%, t=-4.17, P=0.150). Multinomial logit model showed that male had higher risk of developing all metabolic risk factors than female except LDL-C, TC and hs-CRP. The risk of other risk factors except HDL-C in adults aged 45-64 years was higher than that in the younger age group aged 18-44 years, and was more significant in hypertension and elevated HbA1c, which were 4.67 (95%CI:4.07-5.37) times and 3.73 (95%CI:2.91-4.77) times of the younger age group, respectively. Residents living in the eastern areas had the highest risk of obesity, borderline high LDL-C, hypertension, elevated blood glucose and diabetes, and the lowest risk of elevated TG and high hs-CRP. People from the western region had the lowest risk of central obesity, elevated blood pressure and hypertension. Conclusions: In the three years, the detection rate and clustering of most risk factors were the highest in 2015, and there was little change in 2018. Gender, age and geographical distribution were the main influencing factors of cadiometabolic risk factors. It is suggested to adopt targeted prevention strategies and intervention measures to reduce the risk of cardiovascular disease.

[The level distribution of serum AMH in different clinical manifestations of women of childbearing age]

To investigate the distribution and diagnostic value of serum anti-Müllerian hormone (AMH) in healthy women of childbearing age, women with polycystic ovary syndrome (PCOS), ovarian dysfunction (DOR) and premature ovarian failure (POF). This study retrospectively selected female patients of childbearing age who were treated in the affiliated Obstetrics and Gynecology Hospital of Fudan University from January to December 2019. According to different clinical manifestations, they were divided into 133 cases in PCOS group, 120 cases in DOR group and 134 cases in POF group. 125 healthy women in the same period were selected as the control group. The values of serum AMH, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) were measured in the four groups. Single sample Kolmogorov-Smirnov test, one-way ANOVA, independent sample t-test, Kruskal-Wallis H test, Mann-Whitney U test, logistic regression analysis and ROC curve were used for comparative analysis. The serum AMH levels of PCOS group, DOR group, POF group and control group were 9.10 (6.67, 11.49) ng/ml, 0.11 (0.05, 0.29) ng/ml, 0.03 (0.02, 0.06) ng/ml and 2.99 (1.57, 4.98) ng/ml, respectively [M(Q₁,Q₃)], the differences were statistically significant (P<0.001). The basal endocrine levels including E2, FSH, LH and T also had significant differences between groups (P<0.001). The results of multiple comparisons showed that there were significant differences in AMH and LH between DOR, POF and PCOS groups and the control group. The T level of PCOS group was significantly higher than that of the control group, the E2, LH and T levels of DOR group were significantly higher than that of the control group, and the FSH level of POF group was significantly higher than that of the control group (P<0.05). The area under the curve (AUC) of AMH and AMH+LH in the diagnosis of PCOS were 0.905 and 0.922, the sensitivity was 82.7% and 85.0%, and the specificity was 88.0% and 88.8%. The AUC of DOR was 0.861 and 0.971, the sensitivity was 89.0% and 92.5%, and the specificity was 63.0% and 92.0%. The AUC of POF was 0.950 and 0.998, the sensitivity was 98.3% and 99.2%, and the specificity was 75.9% and 97.0%, respectively. The AUC of AMH and AMH+LH combined indexes in the differential diagnosis of DOR and POF were 0.768 and 0.937, the sensitivity was 70.3% and 95.5%, and the specificity was 73.9% and 80.8%.

[A multi-center, randomized controlled study on the effect of Saccharomyces boulardii combined with triple therapy for the initial eradication of Helicobacter pylori infection]

Objective: To assess the efficacy and safety of Saccharomyces boulardii (S. boulardii) in combination with triple therapy as a first-line regimen for the eradication of Helicobacter pylori (H. pylori) in non-ulcer dyspepsia (NUD) patients. Methods: A total of 497 Helicobacter pylori-positive patients who underwent gastroscopy and diagnosed with NUD were enrolled from June 2018 to January 2020 in 9 medical centers across China. Participants were segmentedly randomly divided into 3 groups. Patients in group A received S. boulardii for 14 days and triple therapy for 10 days, while patients in group B received bismuth quadruple group for 10 days, and patients in group C received triple therapy for 10 days. The H. pylori status was determined by the ¹³C-urea breath test on the 44th day of the treatment. Symptom improvement and adverse reactions were assessed on the 14th and 44th day. Results: There were 229 males and 268 females in all 497 patients enrolled. They were aged 18-69 (46.1±11.8) years and 472 of them (158 cases in group A, 159 cases in group B, and 155 cases in group C) completed the trial. The intention-to-treat (ITT) eradication rates in patients in patients A, B and C were 77.8% (126/162), 80.1% (137/171) and 65.2% (107/164) respectively, and per protocol-based (PP) eradication rates were 79.7% (126/158), 86.2% (137/159) and 69.0% (107/155) respectively. The differences were statistically significant in ITT and PP analysis among 3 groups (ITT: χ²=11.14, P<0.01; PP: χ²=13.86, P<0.01). There was no significant difference between eradication rates of two quadruple therapys(all P>0.05), but both of them were significantly higher than that of standard triple therapy (both P<0.05). Statistics revealed that both quadruple therapys led to significantly higher symptom improvement of belching compared with that of standard triple therapy in day 14 (P<0.05). The relief of abdominal distension and belching symptom scores of group A were significantly higher than those of group C in day 44(all P<0.05). There was no serious adverse event reported. The incidence of diarrhea in group A was significantly lower than those in the other two groups (both P<0.05). Conclusions: The combination of S. boulardii and triple therapy can achieve a better eradication effect on H. pylori infection with NUD, and has advantages in symptom relief and safety.

Heavy metal uptake by bryophytes and vascular plants in a manganese carbonate slag field, China

Slag produced in mining and smelting of manganese carbonate ore potentially pollutes the environment and endangers the health of humans and other living organisms. This study investigates the uptake of six heavy metals, Cu, Pb, Mn, Zn, Cr and Cd, by bryophytes and vascular plants growing on manganese carbonate slag in the Houshangou Slag Field near Zunyi City, Guizhou Province, China. Determination of heavy metal uptake in bryophytes and vascular plants may identify species suitable as biomonitors for bioremediation of polluted lands. Eight bryophyte taxa were identified in the study area; among which, Bryum argenteum and Physcomitrium eurystomum were dominant; life forms of bryophytes were predominantly short turfs. Three monocotyledons, all Poaceae, and five dicotyledons were recorded in four families. The highest heavy metal uptake in bryophytes, Mn content by B. argenteum, was more than 25,000 mg·kg^-1 . Furthermore, determination of heavy metal content in roots, leaves and fruits of six vascular plants demonstrated that each had a unique capacity for heavy metal accumulation: roots, leaves and fruits of similar plant species exhibited varying uptake capacity. Mn content in leaves was recorded in the order: B. davidii > A. tricolor > E. crus-galli > C. argentea > P. acinosa > C. album. In summary, B. argenteum, Echinochloa crus-galli and Phytolacca acinosa have strong enrichment capacity for heavy metals. These species could be used for comprehensive treatment of heavy metal pollution in electrolytic Mn slag fields, and for bioremediation of polluted areas associated with Mn mining and processing.

Exploring Lorentz Invariance Violation from Ultrahigh-Energy γ Rays Observed by LHAASO

Recently, the LHAASO Collaboration published the detection of 12 ultrahigh-energy γ-ray sources above 100 TeV, with the highest energy photon reaching 1.4 PeV. The first detection of PeV γ rays from astrophysical sources may provide a very sensitive probe of the effect of the Lorentz invariance violation (LIV), which results in decay of high-energy γ rays in the superluminal scenario and hence a sharp cutoff of the energy spectrum. Two highest energy sources are studied in this work. No signature of the existence of the LIV is found in their energy spectra, and the lower limits on the LIV energy scale are derived. Our results show that the first-order LIV energy scale should be higher than about 10^{5} times the Planck scale M_{Pl} and that the second-order LIV scale is >10^{-3}M_{Pl}. Both limits improve by at least one order of magnitude the previous results.

[Recommendations of diagnosis and treatment of juvenile idiopathic arthritis in China]

The common clinical subtypes of juvenile idiopathic arthritis (JIA) include systemic onset juvenile idiopathic arthritis (SOJIA), oligoarthritis/polyarthritis juvenile idiopathic arthritis and juvenile spondyloarthritis. Juvenile idiopathic arthritis has no specific diagnostic index, and needs to be differentiated from infectious diseases and malignant diseases. The onset of SOJIA is rapid, the disease progresses rapidly, and it is easy to be complicated with macrophage activation syndrome (MAS) which is life-threatening. The experience of pediatric rheumatologists in dealing with JIA is still insufficient, and the standardized diagnosis and treatment level of this disease needs to be further improved. Based on the experience and guidelines of diagnosis and treatment in China and abroad, we formulated this diagnosis and treatment standard, aiming at standardizing the diagnosis and treatment of the subtypes of JIA and MAS, so as to reduce the incidence of disability and serious complications and improve the prognosis.

[Analysis of the clinical effects and outcome of patients with double-hit high-risk multiple myeloma]

Objective: To compare the clinical features, clinical efficacy, and prognosis of patients with double-hit and non-double-hit high-risk multiple myeloma (MM) and explored the clinical significance of high-risk cell karyotype in MM development. Methods: The clinical data of 73 high-risk MM patients admitted to the Department of Hematology of Fujian Provincial Hospital from January 2011 to February 2019 were retrospectively analyzed. Interphase fluorescence in situ hybridization was used to detect their karyotypes. Based on mSMART 3.0 risk stratification, we divided the patients into a double-hit group (28 cases) and a non-double-hit group (45 cases). Results: Fifteen patients in the double-hit group and 26 in the non-double-hit group received bortezomib-based chemotherapy. The median progression-free survival (PFS) in the double-hit and the non-double-hit groups was 8.0 months and 22.0 months, and the median overall survival (OS) was 10.0 months and not reached, respectively. Ten patients in the double-hit group and 12 in the non-double-hit group received bortezomib combined with lenalidomide (RVD) chemotherapy. The median PFS in the double-hit group and the non-double-hit group was 12.0 months and 24.0 months, and the median OS was 14.0 months and not reached, correspondingly. Both the PFS and OS of the double-hit group were significantly shorter than those of the non-double-hit group (P<0.05). Univariate analysis results indicated that cytogenetic abnormalities, revised-international staging system (R-ISS), β2 microglobulin, and calcium had significant effects on PFS in high-risk MM patients (P<0.05). The cytogenetic abnormalities, R-ISS, and β2 microglobulin were associated with OS in high-risk MM patients (P=0.001). Multivariate Cox regression analysis showed that the cytogenetic grouping was an independent prognostic factor for OS and PFS in high-risk MM patients. The risk of disease progression was 3.160 times (95% CI: 1.364-7.318) and the risk of death was 2.966 times higher (95%CI: 1.205-7.306) in the double-hit group than those in the non-double-hit group. Calcium was an independent risk factor for PFS in the high-risk MM patients. Notably, the risk of disease progression in patients with calcium levels≥ 2.75 mmol/L was 2.667 times higher than that in patients with calcium<2.75 mmol/L (95% CI: 1.209-5.883). Conclusions: Double-hit patients are a highly specific group with worse high-risk MM prognosis. In such patients, the relapse is more common, the disease progression is faster, and the survival time is shorter than those in the non-double-hit patients.

Study on spore release of Polytrichum commune Hedw. var. commune by synergetic effects of sub-hygroscopic movement and wind

The effect of humidity change on spore release of the Nematodontae Polytrichaceae has never been tested experimentally. Similarly, the impact of humidity alterations on structure of the peristome have never been studied. Polytrichum commune Hedw. var. commune from Guizhou Province, China, was selected as the research object to examine effects of simulated wind in the laboratory. By controlling humidity and wind, the mechanism of spore dispersal was revealed. When humidity increased, the size of the peristome and epiphragm enlarged significantly (the peristome has no obvious spatial displacement, unlike the hygroscopic movement of Arthrodontae mosses. Thus, we named it 'sub-hygroscopic movement'), then recovered to normal size when humidity decreased. When humidity was controlled and wind applied, the scattering of spores gradually decreased as the capsule dried out and finally reached a very low level; when the capsule was wetted or rewetted, the amount of spores released rose and returned to the initial state. Through comparison of moist and dry capsules, only enhanced humidity of the sporophytes led to increases in spore release. The results show that the dispersal of spores was significantly improved in windy conditions and the sub-hygroscopic movement of the capsule peristome, which ensure the continuity and effectiveness of P. commune reproduction.

[Investigation of occupational hazard of 750 kV extra high voltage substations]

Objective: To understand the current status of major occupational hazards in 750 kV extra high voltage (EHV) substations. Methods: In July 2019, through investigating and detecting the sulfur hexafluoride, power frequency electric field and noise occupational hazards of 750 kV EHV substations in substation 1, substation 2, substation 3, substation 4, substation 5, substation 6 and substation 7, the exposure intensity of the sulfur hexafluoride, power frequency electric field and noise intensity that the operators are exposed to during the inspection process were analyzed. Results: The qualified rate of 358 sulfur hexafluoride test results was 100.0% of the seven 750 kV EHV substations. The qualified rate of 8 h time-weighted average of the power frequency electric field of those 750 kV EHV substations contacted by operators was 100.0%. Among the 847 power frequency electric field detection points, the exceeding standard rate of power frequency electric field was 64.3%, and the differences in the power frequency electric field detection exceeding standard rates of different substations and inspection areas were statistically significant (χ²=87.52, 50.86, P<0.01) . The highest exceeding standard rate of power frequency electric field was the circuit breaker inspection area (94.4%, 34/36) . The noise intensity test results of the seven EHV substations were 41.1-79.7 dB (A) , and the qualified rate was 100.0%. Conclusion: The sulfur hexafluoride, power frequency electric field and noise that the operators contacted in 750 kV EHV substations meet the requirements of occupational exposure limits. The inspection areas of main transformers, capacitors, reactors, bus bars and switches have high power frequency electric field radiation, should be select equipment iand give priority to robot inspection, and reasonably adjust the inspection time to reduce the intensity level of substation operators' exposure to power frequency electric field.

[Summary of research methods of stroke disease burden in big data era]

Stroke has high disability rate and high mortality rate, resulting in huge disease burden to society and individuals. In the context of highly informationization of global health system, countries have built and improved various public health information platform to provide support for health decision-making through public health information collection, classification, extraction, analysis and sharing in the research of disease burden of stroke. Based on the retrieval of domestic and foreign literatures, this paper summarizes the research methods of stroke-caused disease burden and its public health information sources in China, evaluates the significance of public health as well as the limitations of each research method of disease burden and describes the application and development of stroke-caused disease burden big data platform in the world, and provide suggestions for establishing a more modern and information-based stroke-caused disease burden evaluation system in China by analyzing the limitations of the existing stroke-caused disease burden evaluation system.

[Anatomical study and clinical application of in situ reduction and fixation of anterior medial fenestration approach of femoral head fracture]

Objectives: To explore the feasibility of anterior medial fenestration approach in situ reduction and fixation in the treatment of PipkinⅠ and Ⅱ femoral head fractures,and to explore the clinical effect of this operation. Methods: Hips of two anti-corrosion adult specimens treated with formalin were dissected, then anatomical structures and directional characteristics of anterior medial main muscles,ligaments,blood vessels and nerves were observed.The anterior medial fenestration approach was performed on bilateral hips of four fresh frozen specimens to determine pulling direction of stripped muscles and ligaments required during operation,and to observe and analyze vascular and nerve traction protection directions exposed in the approach.Determine extent of exposure to the approach and assess feasibility of this approach.The clinical data of 12 patients with Pipkin Ⅰ and Ⅱ femoral head fractures who underwent in situ reduction and fixation of anterior medial fenestration at Department of Orthopaedics,Affiliated Hospital of Chengdu University from February 2016 to April 2018 were retrospectively analyzed.There were 3 males and 9 females with an age of 48.5 years(range:37 to 59 years).There were 8 cases of Pipkin type Ⅰ and 4 cases of Pipkin type Ⅱ.The operation time,blood loss,fracture healing time,last Thompson-Epstein evaluation and Harris score were observed. Results: Anterior medial fenestration approach to expose the femoral head in 4 bilateral hips with a total of 8 sides of fresh frozen specimens.The upper boundary of observation fenestration was pubic body (anterior acetabulum),and the outer upper boundary was iliacus and psoas muscle.The lateral boundary is rectus femoris and femoral vessels,the lower boundary was transverse branch of the medial femoral circumflex artery and vein.The medial boundary was pubis muscle,short adductor muscle and long adductor muscle.Pubofemoral and iliofemoral ligament were seen in fenestration. Four quadrants in front of femoral head in fenestration can be seen after cutting switch capsule active hip joint. In 12 patients with femoral head fracture,the operation time was 107.5 minutes(range:90 to 135 minutes),and the intraoperative bleeding volume was 115.0 ml(range:85 to 150 ml).The patients were followed up for 18.6 months(range:12 to 28 months).The fracture healing time of 12 patients was 144.2 days(range:120 to 180 days).The curative effect was evaluated according to Thompson-Epstein standard at the last follow-up:excellent in 6 cases,good in 4 cases and fair in 2 cases.At the last follow-up,the Harris score of hip joints was 85.1(range:75 to 93). Conclusions: Anterior medial fenestration in situ reduction and fixation surgery is feasible for the treatment of Pipkin Ⅰ and Ⅱ femoral head fractures. The short and midterm follow-up reveal satisfactory effect.

[Investigation on population dynamics and Echinococcus infections in small rodents around human settlement in Yushu City, Qinghai Province]

OBJECTIVE

To investigate the population dynamics and Echinococcus infections in small rodents around human settlement in Yushu City, Qinghai Province.

METHODS

Rodents were captured using the mouse trap method in pastures from Batang Township and Longbao Township of Yushu City, Qinghai Province on May, August and October, 2018. The body weight and snout-vent length of all captured rodents were measured, and the species was identified according to the rodent morphology. Genomic DNA was extracted from rodent liver specimens and lesion specimens, and the mitochondrial cox1 gene of Echinococcus was amplified using PCR assay for identification of parasite species. In addition, the tissue specimens positive for PCR assay were sampled for pathological examinations. The prevalence of Echinococcus infections was estimated in rodents, and a phylogenetic tree was created based on Echinococcus cox1 gene sequences.

RESULTS

A total of 285 small rodents were captured, including 143 Ochotona curzoniae (50.2%), 141 Lasiopodomys fuscus (49.5%), and 1 Neodon irene (0.3%), and there was a remarkable variation in habitat selection among these three rodent species. The number of L. fuscus correlated positively with vegetation coverage (r = 0.350, P = 0.264), with the greatest number seen in August, and the number of O. curzoniae negatively with vegetation coverage (r = -0.371, P = 0.235), with the highest number seen in August and the lowest number in May. The female/male ratios of O. curzoniae and voles were 1:0.96 and 0.82:1, respectively. The body weight (r = 0.519, P < 0.01) and snout-vent length (r = 0.578, P < 0.01) of O. curzoniae showed a tendency towards a rise with month, while the body weight (r = -0.401, P < 0.01) and snout-vent length (r = -0.570, P < 0.01) of voles presented a tendency towards a reduction with month. No Echinococcus infection was detected in voles, while 2.1% prevalence of E. shiquicus infection was seen in O. curzoniae. Phylogenetic analysis revealed consistent sequences of cox1 gene from E. shiquicus in Yushu City of Qinghai Province and Shiqu County, Ganzi Tibetan Autonomous Prefecture of Sichuan Province.

CONCLUSIONS

The small rodents around the human settlement in Yushu City of Qinghai Province mainly include O. curzoniae and L. fuscus, with the greatest numbers seen in May and August, respectively. Following the concerted efforts for echinococcosis control, the prevalence of Echinococcus infections is low in small rodents around the human settlement in Yushu City; however, there is still a risk of echinococcosis transmission.