Table of Content

15 October 2021, Volume 24 Issue 29

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Monographic Research

Effect of Acute Sleep Deprivation on Cognition and Emotion：an Updated Review　

MAI Zifeng，XU Hongyan，MA Ning

2021, 24(29):  3653-3659.  DOI: 10.12114/j.issn.1007-9572.2021.01.016

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Acute sleep deprivation（ASD） can induce adverse changes in cognitive and emotional function，including attention，working memory，inhibition control，emotional discrimination，and emotional regulation. A number of neuroimaging studies have found changes in the fronto-parietal network，salience network，default mode network，and thalamus during cognitive tasks，and the changes in the amygdala，medial prefrontal cortex，and salience network during emotional tasks after acute sleep deprivation. Future studies should focus on：（1） the role of salience network between cognitive and emotional functions；（2） application of dynamic functional connectivity to ASD research；（3） the neural mechanisms underlying the effect of ASD on social behavior.
Sleep deprivation；Acute sleep deprivation；Cognitions；Emotion；Neural mechanism；Dynamic functional connectivity；Review


Interpretation of Guideline for the Diagnosis and Treatment of COPD（2021 revision） for General Practitioners　

WANG Fengyan，ZHANG Dongying，LIANG Zhenyu，SU Guansheng，ZHENG Jinping，CHEN Rongchang

2021, 24(29):  3660-3663.  DOI: 10.12114/j.issn.1007-9572.2021.01.304

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According to the Guideline for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease （2021 revision），different levels of medical institutions undertake different tasks in the stratified diagnosis and treatment of chronic obstructive pulmonary disease （hereinafter referred to as COPD）. General practitioners are main force responsible for prevention of COPD. General practitioners use questionnaire surveys and popularize the application of simple lung function to implement early screening of COPD；implement drug treatment for stable maintenance treatment through patient education，supervision and regular follow-up；participate in the overall management of COPD by guiding and verifying the correct use of inhaled drugs，improving compliance，implementing respiratory rehabilitation treatment，etc. With reference to the revised guideline，general practitioners are expectedto participate in the overall management of COPD to improve the medical level of COPD in primary care institutions.


Performance Evaluation of Spirometer PF680，a New Domestically-made Spirometer Based on Differential Pressure Sensing　

ZHONG Liping，WUZhongping，HUANG Ruibo，ZHENG Jinping，GAO Yi

2021, 24(29):  3664-3670.  DOI: 10.12114/j.issn.1007-9572.2021.01.018

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Background　As an appropriate approach facilitating the diagnosis and treatment of respiratory disease，one of the four major diseases in China，pulmonary function test has been included in the national health plan and the long-term plan for the prevention and treatment of chronic diseases. A variety of domestically-made portable spirometers have been widely used in primary healthcare，but their performance needs to be scientifically verified. Objective　To assess the performance of spirometer PF680，a new domestically-made spirometer based on differential pressure sensing. Methods　This study was conducted from September to October 2020. A comparative analysis was performed between spirometer PF680 （produced by e-Link Care Meditech Co.，Ltd.，Zhejiang，China，n=2，experimental group） and Master Screen Pneumo spirometer（produced by Jaeger，Germany，n=2，control group） in terms of performance indicators〔forced vital capacity （FVC），forced expiratory volume in one second （FEV1），peak expiratory flow （PEF），maximal mid-expiratory flow （MMEF），forced expiratory flow at 50% of vital capacity （FEF50%），forced expiratory flow at 75% of vital capacity（FEF75%）〕 generated by the standard flow/volume simulator，which was applied according to 13 standard waveforms （C1-C13） in the ISO 26782：2009. Results　As for accuracy，in the experimental group，except for FVC of the C12 waveform measured by No. 2 spirometer，the errors of the FVC of the other 25 waveforms and the FEV1 of the 26 waveforms measured by two spirometers were all ≤±0.05 L or ±3%. In terms of repeatabilities，the maximal differences between the values of FVC and FEV1measured for three times by the two spirometers in the experimental group were <0.05 L and <3% of the average value. With regard to linearity，in the experimental group，except for the C5 waveform FVC of the No. 2 spirometerand the C5 waveform FVC and FEV1 of the No. 1 spirometer，the waveform linearity errors of the remaining FVC and FEV1 measured by the two spirometers were within a permissible range. The impedance for all respiratory airflow waveforms was <0.15 kPa•L-1•s-1. Compared with the single waveform of the control group，the FVC of C5，C7-C8 and C11-C12 waveforms demonstrated significantly differences between the two groups（P<0.05）. The FEV1 of C3，C5-C6，C8-C9 and C11-C12 waveforms differed significantly between the two groups （P<0.05）. The PEF of C1-C10 waveforms was significantly different between the two groups（P<0.05）. The PEF of C13 waveform was significantly different between the two groups（P<0.05）. The difference of C1-C11 and C13 waveform MMEF between the two groups was statistically significant（P<0.05）. The FEF50% of C1，C3-C11 and C13 waveforms between the two groups showed statistically significant differences （P<0.05）. The difference of C1-C12 waveform FEF75% between the two groups was statistically significant（P<0.05）. There were statistically significant differences in MMEF，FEF50% and FEF75% of the overall 13 waveforms between the two groups （P<0.05）. The Bland-Altman chart showed that FVC，FEV1，PEF，and FEF50% had 12 values （92.31%） and MMEF，and FEF75%had all values（100.00%）within the 95% confidence interval. The maximum absolute error for FVC，FEV1，PEF and FEF50% was 0.193 L，0.108 L，0.364 L/s，and 0.387 L/s，respectively. Conclusion　The spirometer PF680 has proved to be eligible for measuring pulmonary functions，and has good consistency with the German Jaeger spirometer，so it can be used for collectingreliable data clinically.


Summary of the Best Evidence Regarding Perioperative Exercise Improving the Health Outcome in Patients with Non-small Cell Lung Cancer　

WANG Tingting，ZHANG Xinqiong，WANG Aimei，HAN Shiyu，ZHANG Honghui

2021, 24(29):  3671-3677.  DOI: 10.12114/j.issn.1007-9572.2021.01.005

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Background　Appropriate perioperative exercise can effectively improve the health outcome of non-small cell lung cancer （NSCLC） patients，but the related best evidence about the effectiveness of various intervention programs has not been summarized. Objective　To search and evaluate studies about perioperative exercise improving the health outcome of NSCLC patients，then summarize the best evidence. Methods　We searched Up To Date，BMJ Best Practice，Joanna Briggs Institute Evidence-Based Practice Database，China National Guideline Clearinghouse，National Guideline Clearinghouse，The Cochrane Library，PubMed，CNKI and other databases to collect evidence summaries，guidelines，expert consensuses and systematic reviews regarding perioperative exercise improving the health outcome in patients with NSCLC from inception to July 2020. Methodological quality and evidence level were assessed by researchers systematically trained on evidence-based medicine. Results　Totally 22 studies were included，including 1 evidence summary，3 guidelines，1 expert consensus，14 systematic reviews and 3 randomized controlled trials. Their methodological qualities were rated high overall. Finally 22 pieces of best evidence involving 7 dimensions were summarized，namely，necessity of perioperative exercise，population suitable for performing perioperative exercise，pre-exercise health evaluation，preoperative exercise program，postoperative exercise program，precautions and effectiveness evaluation. Conclusion　This summary indicates that clinical healthcare workers should value the exercise management for NSCLC patients，and develop personalized intervention programs（including preoperative and postoperative exercise programs） with the patient's individual features〔such as comprehensive health evaluation（including per-exercise evaluation） and preference〕，precautions and effectiveness evaluation regarding the exercise taken into account.


Association between Admission Serum Sodium and In-hospital Postoperative 30-day Mortality in Acute Aortic Dissection Patients　

WANG Hongyan，ZHAO Yongbo，LIU Xiao，SU Peng，ZHANG Jinjin，MA Shuo，PAN Zhe，SHI Juexin，HOU Fangfang，ZHANG Nana，ZHENG Xiaohui，LIU Nan，ZHANG Ling，MA Dong

2021, 24(29):  3678-3683.  DOI: 10.12114/j.issn.1007-9572.2021.00.589

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Background　Acute aortic dissection（AAD）is a macrovascular disease with acute onset，quick progression and high mortality. Studies indicate that the severity of hypersodium is associated with in-hospital death. However，the relationship between admission serum sodium and in-hospital death of patients with AAD remains little known. Objective　To examine whether in-hospital postoperative mortality associates with admission serum sodium，and its associated risk factors in patients with AAD. Methods　Four hundred and fifteen AAD inpatients from Department of Cardiac Surgery，the Fourth Hospital of Hebei Medical University were enrolled during January 2015 to December 2019. General clinical data，and baseline laboratory results were collected. The endpoint was in-hospital all-cause mortality. The Kaplan-Meier estimate was used to compute the in-hospital postoperative 30-day cumulative survival in quartile groups of admission serum sodium（Q1：≤136 mmol/L，Q2：137-138 mmol/L，Q3：139-140 mmol/L，Q4：≥141 mmol/L）. The Cox proportional-hazards model was used to examine the association of admission serum sodium with in-hospital postoperative mortality，and risk factors associated with in-hospital postoperative mortality. Results　Q1-4 groups（n=114，103，102，96）had statistically significant differences in variables involving mean age，prevalence and mortality of Stanford-A AAD，in-hospital mortality，and mean levels of blood urea nitrogen，serum neutrophil count，monocyte count，and chloride（P<0.05）. In particular，Q4 group had much higher mean neutrophil count and in-hospital mortality than other groups（P<0.05）. The survival of in-hospital postoperative 30-day mortality differed significantly across the four quartile groups（χ2=10.994，P=0.012）. The in-hospital postoperative 30-day cumulative survival in Q1 group was statistically different compared with that of Q3 group and Q4 group（χ2=6.282，P=0.012；χ2=9.632，P=0.002）. Cox regression analysis demonstrated that the risk of death was 2.890〔95%CI（1.264，6.604），P=0.012〕 in Q3 group，and was 3.253〔95%CI（1.447，7.312），P=0.004〕 in Q4 group. After adjusting for age and gender，the risk of death in Q3 and Q4 groups was 2.825〔95%CI（1.228，6.502），P=0.015〕 and 3.241〔95%CI（1.441，7.290），P=0.006〕，respectively. After adjusting for all covariates，the risk of death in Q3 and Q4 groups was 3.086〔95%CI（1.242，7.671），P=0.015〕 and 3.370〔95%CI（1.384，8.204），P=0.007〕，respectively. The risk of death in Q2 group changed insignificantly before and after partial or fully adjusting for the covariates（P<0.05）. Multivariate Cox regression analysis revealed that Stanford-A AAD 〔HR=3.634，95%CI（1.638，8.086），P=0.002〕，plasma glucose 〔HR=1.077，95%CI（1.025，1.132），P=0.002〕，α-HBDH〔HR=1.001，95%CI（1.001，1.002），P<0.001〕 and serum sodium〔HR=1.068，95%CI（1.029，1.109），P=0.001〕 were associated with in-hospital postoperative 30-day mortality in patients with AAD. Conclusion　The in-hospital postoperative 30-day mortality may be associated with the serum sodium at admission in AAD patients，and the risk of the former may increase with the elevation of the latter.


Predictive Value of Lp-PLA2 Concentration and AASI Level for Left Ventricular Function in Patients with Essential Hypertension　

XIN Caifeng，ZHANG Qiang，YANG Lihong，SUN Caihong，YAO Fang，LIU Fangfang，FEI Sijie

2021, 24(29):  3684-3691.  DOI: 10.12114/j.issn.1007-9572.2021.01.209

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Background　Essential hypertension is supposed to be independently associated with increased risk of multiple cardio-cerebrovascular diseases，and increased arterial stiffness in essential hypertension is associated with increased cardiovascular morbidity and mortality. However，there is a lack of adequate indicators to evaluate the cardiac function of essential hypertension patients. Objective　To investigate the predictive value of lipoprotein-associated phospholipase A2（Lp-PLA2）concentration and ambulatory arterial stiffness index（AASI）on left ventricular function in patients with essential hypertension. Methods　A total of 216 inpatients（including 122 with essential hypertension and 94 without）were selected from Cardiovascular Department the Second Affiliated Hospital of Zhengzhou University in 2020. Data were collected，including general information（gender，age，body weight，BMI，history of smoking，drinking，diabetes，and dyslipidemia），and biomarkers〔serum uric acid（SUA），creatinine，fasting plasma glucose，glycosylated hemoglobin，triglyceride，high-density lipoprotein cholesterol，low-density lipoprotein cholesterol，C-reactive protein，NT-proBNP，Lp-PLA2，AASI，and left ventricular ejection fraction（LVEF）〕. The concentrations of Lp-PLA2 and AASI were compared between LVEF≥50% and<50% subgroups to explore the association of them with LVEF，and between NT-proBNP≥514 ng/L and <514 ng/L subgroups（stratified by the median value NT-proBNP）to explore the association of them with NT-proBNP. Multivariate Logistic regression was used to explore risk factors of LVEF，NT-proBNP and hypertension. ROC analysis was conducted to assess the predictive value of Lp-PLA2 and AASI for heart failure. Results　Patients with and without essential hypertension showed significant differences in mean age，and SUA，Lp-PLA2，AASI，SBP，NT-proBNP and LVEF（P<0.05）. Linear regression analysis indicated that LVEF was negatively correlated with Lp-PLA2（r=-0.437，P=0.036），and AASI（r=-0.580，P=0.001），but NT-ProBNP was positively correlated with Lp-PLA2（r=0.309，P=0.038）and AASI（r=0.519，P=0.041）in patients with essential hypertension. However，in those without essential hypertension，LVEF showed no linear correlation with Lp-PLA2（r=0.027，P=0.601）and AASI（r=0.019，P=0.372），and NT-ProBNP also showed no linear correlation with Lp-PLA2（r=0.033，P=0.460），and AASI（r=0.058，P=0.703）. Multivariate Logistic regression analysis revealed that hypertension history，Lp-PLA2 and AASI were associated with LVEF（P<0.05），Lp-PLA2 and AASI were associated with NT-proBNP，and Lp-PLA2，smoking history and AASI were associated with essential hypertension（P<0.05）. The AUC of Lp-PLA2 concentration in predicting heart failure in essential hypertension was 0.637 〔95%CI（0.48，0.80）〕，with the optimal cutoff value of 115.77 μg/L（sensitivity：64%；specificity：70%）. The AUC AASI in predicting heart failure in essential hypertension was 0.861 〔95%CI（0.750，0.973）〕，with the optimal cutoff value of 0.535（sensitivity：82%；specificity：85%）. Conclusion　Essential hypertension may be associated with poorer cardiac function. Lp-PLA2 or AASI may be an effective independent predictor for left ventricular function in essential hypertension.


Association of Anemia with Clinicopathological Characteristics and Prognosis in Henoch-Schonlein Purpura Nephritis Patients　

SHENG Xiaoxiao，ZHAI Yaling，CHEN Yazhuo，GAO Jingge，YAO Xingchen，WANG Xinnian，SHEN Ya，ZHANG Wenhui，GAO Ge，CHENG Genyang

2021, 24(29):  3692-3698.  DOI: 10.12114/j.issn.1007-9572.2021.01.021

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Background　Henoch-Schonlein purpura nephritis（HSPN） is a major cause of chronic kidney disease. Anemia is a common presentation of HSPN，which seriously affects the life quality. Objective　To analyze the association of anemia with clinicopathological characteristics and prognosis in HSPN patients. Methods　Participants were 195 HSPN patients with and without anemia recruited from the First Affiliated Hospital of Zhengzhou University from December 2014 to July 2019. Clinical data〔including age，gender，baseline extrarenal manifestations（joints/ abdomen），hypertension，white blood cell count，hemoglobin，serum calcium，serum phosphorus，blood urea nitrogen，serum creatinine，serum uric acid，serum total protein，serum albumin，cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein，estimated glomerular filtration rate （eGFR），24-hour urine protein，urinary RBC count〕 and pathological data（including IgG deposition，IgM deposition，IgA deposition，C3 deposition，renal interstitial fibrosis，renal interstitial inflammation，renal tubule atrophy，arteriolar disease，prevalence of crescent formation，glomerulosclerosis rate，pathological grade） were collected. All of them were followed up as of December 2019. Composite adverse outcomes were also collected. Kaplan-Meier curve was plotted to estimate the renal survival. Log-rank test was used to compare the survival of patients with and without anemia. Multivariate Cox regression analysis was adopted to explore the influence factors for prognosis. Results　Patients with anemia（n=63） had older mean age，higher rate of having extrarenal manifestations at admission，and higher mean levels of blood urea nitrogen，24-hour urine protein，and urinary RBC count than those without（n=132）（P<0.05）. Moreover，patients with anemia demonstrated lower mean levels of hemoglobin，serum calcium，total protein，albumin，high-density lipoprotein，and eGFR（P<0.05）. Furthermore，greater severity of arteriolar disease and higher prevalence of crescent formation were found in those with anemia（P<0.05）. Multivariate Cox regression analysis suggested that older age，24-hour urine protein and glomerulosclerosis were associated with increased risks of poor prognosis of HSPN（P<0.05）. Survival analysis showed that patients with anemia had lower cumulative renal survival rate than those without （χ2=4.675，P=0.031） . Conclusion　HSPN patients with anemia presented more serious clinicopathological features，and a lower renal cumulative survival rate. Older age，24-hour urine protein and glomerulosclerosis may be influence factors for composite adverse outcomes.


Characteristics of ECG Lorenz Scatter Plot of Muscle Sleeve Atrial Arrhythmias　

GENG Yiming，DONG Anqin，NIU Xiangdong，JING Yongming，ZHANG Yehang，MAO Yuhong，NIE Liantao，MA Hanzhang，ZHAO Yang

2021, 24(29):  3698-3703.  DOI: 10.12114/j.issn.1007-9572.2021.01.217

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Background　 The ECG Lorenz scatter plot has been extensively reported to be used for studying the mechanism of qualitative diagnosis of various types of arrhythmia. However，there is no evidence on its use in the diagnosis of muscle sleeve atrial arrhythmias（AAR）. Objective　To analyze the characteristics of ECG Lorenz scatter plot of muscle sleeve AAR，providing evidence for rapid interpretation of this kind of ambulatory ECG. Methods　Participants were outpatients and inpatients retrospectively recruited from the Fifth Affiliated Hospital of Zhengzhou University from August 2016 to August 2020，including 31 with muscle sleeve AAR，and 30 with frequent non-muscle sleeve AAR，suggested by the ambulatory ECG Lorenz scatter plot. The features of the ambulatory ECG Lorenz scatter plot of two groups and inter-group differences were analyzed. Results　The overall features of the ambulatory ECG Lorenz scatter plot of 31 cases of muscle sleeve AAR were like this：（1）sinus rhythm with frequent atrial premature of a short coupling interval（part not delivered to ventricular）；（2） repeatedly paroxysmal atrial tachycardia（irregularly delivered to ventricular）；（3）repeatedly paroxysmal atrial flutter and atrial fibrillation constitute a scatter plot combination，embedding in diffusely scattered peripheral and distal sinus rhythms. The ECG Lorenz scatter plot of non-muscle sleeve AAR cases also had the first three same features of that of muscle sleeve AAR cases，mainly manifested as sinus rhythm combined with at least two other features，with a centralized distribution，instead of embedding in diffusely scattered peripheral and distal sinus rhythms. Conclusion　If an ECG Lorenz scatter plot shows the characteristics of sinus rhythm with multiple types of recurrent atrial arrhythmias embedded in the diffuse scattered background，then muscle sleeve AAR is highly suggested. According to this feature，muscle sleeve AAR could be quickly identified.


Intracranial Failure Analysis in Patients with Brain Metastasis from Lung Adenocarcinoma Harboring Epidermal Growth Factor Receptor Mutation　

SONG Yuzhi，ZHEN Chanjun，BAI Wenwen，LI Bo，QIAO Xueying，ZHOU Zhiguo

2021, 24(29):  3704-3710.  DOI: 10.12114/j.issn.1007-9572.2021.00.540

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Background　The treatment of patients with brain metastasis（BM） from lung adenocarcinoma（LAC） with epidermal growth factor receptor（EGFR） mutation is a hot and controversial issue，as no standard treatment modality currently exists. Objective　To analyze the clinical factors associated with intracranial failure following BM treatment in BM patients from LAC with EGFR mutation. Methods　In this study，we retrospectively enrolled 282 patients with a confirmed diagnosis of BM from LAC with EGFR mutation from the Fourth Hospital of Hebei Medical University between January 2011 and June 2018. Baseline characteristics were obtained，containing age，gender，smoking history，Karnofsky Performance Status Scale score，extracranial disease control status，number of involved extracranial organs，number and symptoms of BMs，timing of BM development，treatment modality for BMs，treatment strategy for the primary lung tumor，and Lung-molGPA. At four weeks after the end of whole-brain radiation therapy（WBRT） or targeted oral therapy using tyrosine kinase inhibitors（TKIs），we assessed the intracranial response，and delivered a follow-up to patients，during which the overall survival-BM（OS-BM），intracranial progression-free survival（iPFS） and time of intracranial control were recorded. We plotted Kaplan-Meier curves for OS-BM and iPFS. We used multivariate Logistic regression analysis to explore clinical factors associated with intracranial failure and to further investigate the associated factors between two subgroups divided by the median time to intracranial failure〔early failure subgroup（≤10.0 months） and late failure subgroup（>10.0 months）〕. Results　（1） Baseline characteristics：the median follow-up time was 28.4 months（range，3.0 to 94.8 months）. The median OS-BM was 45 months，and the 3-year OS-BM rate was 28.5%. The median iPFS time was 24 months，and the 3-year iPFS rate was 38.4%. （2）Group analysis of intracranial failure：in all，48.9% of the patients developed intracranial failure. BM symptoms and related treatment modality as well as Lung-molGPA were significantly different for those who developed intracranial failure as compared to those who did not in the baseline characteristics（P<0.05）. Other baseline data showed no intergroup differences（P<0.05）. Multivariate Logistic regression analysis showed that BM treatment modality was associated with intracranial failure〔OR=1.992，95%CI（1.308，3.437），P=0.004〕. The patients receiving WBRT combined with TKIs or not had a higher 3-year iPFS rate as compared to those receiving TKIs alone（51.6% vs 26.7%）（χ2=10.769，P=0.001）. （3）Subgroup analysis of intracranial failure：early failure subgroup（n=71） had a lower 3-year OS-BM rate than late failure subgroup（n=67）（5.9% vs 42.1%）（χ2=51.888，P<0.001）. By the multivariable analyses，the number of involved extracranial organs was associated with early intracranial failure〔OR=0.336，95%CI（0.126，0.894），P=0.029〕. The 3-year iPFS rate was 4.2% in patients with ≥4 involved extracranial organs，and 14.0% in those with ≤3（χ2=4.993，P=0.025）. Conclusion　For patients with EGFR-mutated LAC with BM，BM treatment modality was associated with intracranial failure. Compared to the use of TKIs alone，using WBRT in combination with TKIs or not may delay the time to develop intracranial failure with an around 50% reduced risk. In addition，the number of involved extracranial organs was associated with early intracranial failure. The higher the number（≥4），the earlier intracranial failure occurred.


Inflammatory Indicators and Pathogenic Bacteria of Urinary Tract Infections with Convulsion in Children　

YAO Yao，ZHAO Liping，ZHOU Hongxia，GE Tingting，ZHANG Lin，LIU Yuli，ZHU Guoqin，XU Jinwen，LIU Xunwei，WU Qing，CHENG Yun，YANG Lingyun

2021, 24(29):  3711-3715.  DOI: 10.12114/j.issn.1007-9572.2021.01.013

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Background　Urinary tract infections（UTIs） are common in children，mostly caused by Escherichia coli. Some children with UTIs may have convulsion，which aggravates the condition and prolongs the treatment time. However，there have been no studies comparing inflammatory indicators and pathogenic bacteria between UTIs children with and without convulsion. Objective　To perform a comparative analysis of inflammatory indicators，common pathogenic bacteria and antibiotic resistance between UTIs children with and without convulsion，providing evidence for clinical treatment. Methods　We enrolled 181 children with UTIs from Wuxi Children's Hospital during 2010 to 2019，including 81 with convulsion（convulsive group），and 100 without （non-convulsive group） . Data about sex，age，results of routine blood test （WBC，CRP，PCT），urine culture test and sensitivity test of two groups were collected. Results　Convulsive group had higher average PCT level （P<0.05）. Forty species of pathogenic bacteria（49.4%） were isolated from the samples of convulsive cases，47.5% of which（19/40） were gram-negative bacteria，and 52.5%（21/40） were gram-positive bacteria. Twenty-seven species of pathogenic bacteria（27.0%） were isolated from the samples of non-convulsive cases，85.2% of which（23/27） were gram-negative bacteria，and 14.8%（4/27） were gram-positive bacteria. No fungus was isolated from samples of both groups. Escherichia coli was the most common bacterium infected in both groups. The difference in the prevalence of infected Escherichia coli and non-Escherichia coli between the two groups was statistically significant （P < 0.05）. Escherichia coli had a high resistance rate to ampicillin（93.3%），cefazolin（86.7%） and ceftriaxone（73.3%），and a low resistance rate to imipenem（0），cefotetan（0），ertapenem（0）. Enterococcus faecium had a high resistance rate above 80.0% to ampicillin（92.3%），clindamycin（100.0%），erythromycin（84.6%），and penicillin G（92.3%），and a low resistance rate to vancomycin（0），linezolid（0） and nitrofurantoin（23.1%）. Conclusion　For children with UTIs，attentions should be given to the detection of PCT and timely assessment of infection level，to guide clinical treatment of controlling infection，and reducing the risk of convulsion promptly. For those also with convulsion，clinical focus should be given to midstream urine culture and sensitivity test，and appropriate selection of effective antibiotics to control the disease progression in time.


Effects of Exogenous Spermine on Radiation-induced Oxidative Injury of H9c2 Cardiomyocytes　

DU Xiao，XU Chao，TU Yu，ZHOU Juying

2021, 24(29):  3716-3723.  DOI: 10.12114/j.issn.1007-9572.2021.01.017

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Background　During radiotherapy，a therapy for increasing number of cancer patients，the normal organ may be injured unavoidably due to exposure to radiation. Spermine is a polyamine with high biological activity. Studies have proved that exogenous spermine has a certain ROS-like function. We attempted to explore the effect of exogenous spermine on cardiomyocytes of the heart，an organ often damaged by radiation in radiotherapy. Objective　To explore the effect of exogenous spermine on radiation-induced oxidative injury of H9c2 cardiomyocytes. Methods　This study was carried out from December 2018 to December 2020. H9c2 cardiomyocytes in the logarithmic growth phase were divided into three spermine groups and a blank group： 100 μmol/L，200 μmol/L，400 μmol/L spermine groups，and a blank group（treated with culture medium alone）. CCK8 assay was used to determine the number of viable cells at 12，24，48 h in each group. Then according to previous screening results，the H9c2 cardiomyocytes cultured in vitro were taken and divided into four groups： blank group（DMEM medium），radiation damage group（X-ray irradiation only），low drug concentration combined radiation group（100 μmol/L spermine-pretreatment，followed by X-ray irradiation）and high drug concentration combined radiation group（200 μmol/L spermine-pretreatment，followed by X-ray irradiation）. Cells in each group were irradiated vertically by a medical linear accelerator，then were cultured for 0，12，24 and 48 hours after processing to X-ray irradiation. Apoptosis was detected by flow cytometry. Fluorescence microscope was used to observe the state of cells after X-ray irradiation. Malondialdehyde（MDA） ELISA Kit was used to measure the MDA of cells. Total superoxide dismutase（T-SOD） kits were used to detect the SOD vitality of cells. Results　The survival rate of cells in 100 μmol/L，200 μmol/L or 400 μmol/L group at 24 h was higher than that at 12 h and 48 h（P<0.05）. At 12 hours after treatment ： the survival rate of blank group was higher than that of three spermine groups（100 μmol/L，200 μmol/L and 400 μmol/L）（P<0.05）. The survival rate of 100 μmol/L or 200 μmol/L group was higher than that of 400 μmol/L group（P<0.05）. At 24 hours after treatment： the survival rate of blank group was higher than that of 100 μmol/L group and 400 μmol/L group（P<0.05）. The survival rate of 100 μmol/L group was lower than that of 200 μmol/L group，but higher than that of 400 μmol/L group（P<0.05）. The survival rate of 200 μmol/L group was higher than that of 400 μmol/L group（P<0.05）. At 48 hours after treatment： the survival rate of blank group was higher than that of 100 μmol/L，200 μmol/L and 400 μmol/L groups（P<0.05）. The survival rate of 100 μmol/L group was lower than that of 200 μmol/L group，but higher than that of 400 μmol/L group（P<0.05）. The survival rate of 200 μmol/L group was higher than that of 400 μmol/L group（P<0.05）. Apoptosis at 0 hour after treatment： the blank group had lower apoptosis rate than radiation+100 μmol/L spermine treatment group，and radiation +200 μmol/L spermine treatment group（P<0.05）. The apoptosis rate of radiation group was lower than that of radiation +100 μmol/L spermine group and radiation +200 μmol/L spermine group（P<0.05）. The apoptosis rate of radiation +200 μmol/L spermine group was lower than that of radiation +100 μmol/L spermine group（P<0.05）. Similar inter-group comparative results of apoptosis were also found at 12，24 and 48 hours after treatment. In terms of comparison for single group，as for the blank group，the apoptosis rate at 0 hour after treatment was lower than that at 12 and 48 hours after treatment（P<0.05），the apoptosis rate at 12 hours after treatment was lower than that at 24 hours after treatment（P<0.05），and the apoptosis rate at 24 hours after treatment was lower than that at 48 hours after treatment（P<0.05）. For the radiation +200 μmol/L spermine group，the apoptosis rate at 24 hours after treatment was lower compared with that at 0，12 and 48 hours after treatment（P<0.05）；the apoptosis rate at 12 hours after treatment was lower compared with that at 0，and 48 hours after treatment（P<0.05）；the apoptosis rate at 24 hours after treatment was lower compared with that at 48 hours after treatment（P<0.05）. For radiation +100 μmol/L spermine group，the apoptosis rate at 24 hours after treatment was lower than that at 0 and 48 hours after treatment（P<0.05）；the apoptosis rate at 12 hours after treatment was lower than that at 0 and 48 hours after treatment（P<0.05）. For the radiation group，the apoptosis rate at 0 hour after treatment was lower than that at 12，24 and 48 hours after treatment（P<0.05），the apoptosis rate at 12 hours after treatment was lower than that at 24 and 48 hours after treatment（P<0.05），and the apoptosis rate at 24 hours after treatment was lower than that at 48 hours after treatment（P<0.05）. At 12 hours after treatment，the blank group had significantly different SOD activity and MDA levels compared to radiation +100 μmol/L spermine group，radiation +200 μmol/L spermine group and radiation group（P<0.05）. The radiation group had higher SOD activity level and lower MDA level than radiation +100 μmol/L spermine group（P<0.05）. The radiation group had higher SOD activity level than radiation +200 μmol/L spermine group（P<0.05）. The radiation +100 μmol/L spermine group had lower SOD activity level and higher MDA level than radiation +200 μmol/L spermine group（P<0.05）. At 24 hours after treatment，the blank group showed significantly different SOD activity and MDA levels compared to radiation +100 μmol/L spermine group，radiation +200 μmol/L spermine group and radiation group（P<0.05）. The SOD activity level in the radiation group was lower than that in radiation +100 μmol/L spermine group and radiation +200 μmol/L spermine group（P<0.05）. The radiation group had higher MDA level than radiation +200 μmol/L spermine group（P<0.05）. The radiation +100 μmol/L spermine group had lower SOD activity level and higher MDA level than radiation +200 μmol/L spermine group（P<0.05）. At 48 hours after treatment，the blank group demonstrated significantly different SOD activity and MDA levels compared to radiation +100 μmol/L spermine group，radiation +200 μmol/L spermine group and radiation group（P<0.05）. The radiation group had lower SOD activity level and higher MDA level than radiation +200 μmol/L spermine group（P<0.05）. Compared with radiation +200 μmol/L spermine group，the SOD activity level was lower and MDA level was higher in radiation +100 μmol/ L spermine group，with statistical difference（P<0.05）. After 24-hour X-ray irradiation，H9c2 cardiomyocytes in the blank group were long spindle-shaped，with complete nucleus and uniform staining. In contrast，H9c2 cardiomyocytes in radiation +100 μmol/L spermine group，radiation +200 μmol/L spermine group and radiation group showed different degrees of changes，such as rounded shape with nuclear breakage，uneven staining，and so on，and the cell morphology of the 200 μmol/L spermine group had the slightest changes，which was most similar to that of blank group. Conclusion　Exogenous spermidine could protect H9c2 cardiomyocytes against radiation-induced oxidative injury，and the protective effect may be dependent on concentration and time. Within a certain concentration range，the protective effect of spermine was stronger when it was at a high concentration. And its protective effect was the strongest when the cells were treated at each concentration for 24 hours.


Methods of Obtaining Epidemiological Data of Hypertensive Elderly People in an Isolated Natural Village：a Comparative Analysis　

HOU Xuliang，FENG Yong'en，YIN Tianlu，CHEN Wei，XU Shaohua，FENG Lijie，LIU Yahua，SUN Xin，SHEN Hong

2021, 24(29):  3724-3728.  DOI: 10.12114/j.issn.1007-9572.2021.01.305

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Background　In China，imperfections in the early detection，real-time monitoring and effective control of chronic diseases make it impossible to accurately obtain the epidemiological characteristics of hypertension and other chronic diseases，negatively influencing chronic disease management and residents' health. Artificial intelligence（AI）technologies significantly improve health records management. Exploring methods that can accurately obtain epidemiological characteristics is conducive to the management of chronic diseases. Objective　To compare the reliability of three methods used for accurately obtaining epidemiological data of hypertensive elderly people in an isolated natural village，providing a reference for bettering the prevention and treatment of hypertension in primary care. Methods　This study was conducted in an isolated natural village with a population of 2 603 as of June 2019 in Menjiazhuang Township，Jizhou District，Hengshui City，Hebei Province. For obtaining the epidemiological data of hypertension in villagers aged over 65 years，three methods were used，with different numbers of participants. The first method was by searching the data stored in the local health information management system，the number of villagers aged over 65 years was determined〔n=516，accounting for 20.76% of the total villagers registered by the village physician since January 2016 （n=2 485，accounting for 95.47% of the total village residents）〕，and the number of diagnosed hypertensive cases registered was also collected，then the hypertension prevalence was estimated. The second method was by use of a household survey（consisting of completing a blood pressure questionnaire and blood pressure measurement） conducted between June and July 2019，the number of respondents was determined as 416〔accounting for 80.62% of the total surveyed villagers aged over 65 years（n=516）〕，and the hypertension prevalence，awareness level，treatment rate and control rate of hypertension in the respondents were obtained according to the survey results. And the third method was searching the health management data in an AI-assisted diagnosis and treatment system，which has been used since December 2017，and had stored 9 856 visits of 2 460 villagers as of June 2019，including 337 villagers aged over 65 years. By analyzing the healthcare-seeking data of older villagers，the hypertension prevalence，awareness level，treatment rate and control rate of hypertension were obtained. The merits and limitations of these three methods were compared. Results　No significant differences were found in the mean age and sex ratio across the three participant groups（P>0.05）. According to the statistics of hypertension registration，the prevalence of hypertension was 43.80%（226/516）. According to the household survey，the prevalence of hypertension was 75.24%（313/416）；260 cases had a history of definite hypertension，and 53 were newly found with hypertension；the awareness rate of hypertension was 83.07%（260/313）；238 received anti-hypertensive medication treatment in the past two weeks，with a treatment rate of 76.04%（238/313）；74 had a blood pressure reading of<140/90 mm Hg（1 mm Hg=0.133 kPa），with a hypertension control rate of 23.64%（74/313）. According to the analysis of the data in the AI-assisted diagnosis and treatment system，the hypertension prevalence was 52.23%（176/337）；172 had a hypertension history；the awareness rate of hypertension was 97.73%（172/176）；168 received anti-hypertensive medication treatment in the past two weeks，with a treatment rate of 96.45%（168/176）；118 had blood pressure measurement records，and 32 of them had a blood pressure reading of<140/90 mm Hg，with a hypertension control rate of 27.12%（32/118）. Conclusion　The use of AI-assisted diagnosis and treatment system and household surveys can both better obtain the prevalence rate，awareness rate，treatment rate and other epidemiological characteristics of hypertension. In particular，using the AI-assisted diagnosis and treatment system can obtain data more comprehensively and dynamically，which facilitates the collection of epidemiological data and chronic disease management.


Risk Factors of Hospital-acquired Pneumonia in Patients with Mental Disorders：a Nested Case-control Study　

HAN Jingjing，WU Yu，WANG Gaohua，WANG Jianmiao

2021, 24(29):  3729-3733.  DOI: 10.12114/j.issn.1007-9572.2021.00.581

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Background　Hospital-acquired pneumonia（HAP）is a high-incidence illness and a major leading cause of death in patients with mental disorders. However，there are few studies on the incidence and risk factors of HAP in these patients. Objective　To explore the incidence and risk factors of HAP in patients with mental disorders，so as to provide a basis for clinical treatment and nosocomial infection prevention and control of this illness. Methods　A nested case-control design was used. Mental disorder patients（n=9 336）who were hospitalized in Mental Health Center，Renmin Hospital of Wuhan University from January 2018 to December 2019 were included in the study cohort，among whom those with HAP were assigned to the case group，and compared to those without HAP（control group）after being matched in a ratio of 1∶3 or less value of ratio based on hospitalization period，ward，age，and duration of observation. The clinical information of all patients was collected，including gender，age，length of stay，routine blood test parameters，combined diseases，use of antipsychotics，combined salivation/swallowing disorder（defined as having obvious dysphagia symptoms or a history of aspiration）. Multivariate Logistic regression analysis was used to explore the risk factors of HAP in patients with mental disorders. Results　Of the participants，124（1.33%）had HAP，and they were compared to 334 controls after matching. The case group had longer mean length of stay，higher prevalence of in-hospital use of clozapine，atypical antipsychotics，and antipsychotics ≥2 types，pneumonia in the past two years，underlying diseases，salivation/dysphagia，hyperglycemia as well as schizophrenia（P<0.05）. Multivariate Logistic regression analysis demonstrated that the longer length of stay〔OR=1.025，95%CI（1.004，1.047）〕，in-hospital use of clozapine 〔OR=3.634，95%CI（1.842，7.171）〕，in-hospital use of two or more types of antipsychotics〔OR=2.653，95%CI（1.380，5.100）〕，prevalence of underlying diseases〔OR=2.268，95%CI（1.167，4.411）〕，prevalence of salivation/swallowing disorder 〔OR=56.726，95%CI（7.534，427.078）〕，and prevalence of hyperglycemia〔OR=4.129，95%CI（1.032，16.520）〕 were risk factors of HAP in patients with mental disorders（P<0.05）. Conclusion　To reduce the incidence of HAP in patients with mental disorders，special attention should be paid to the monitoring，prevention and control of HAP in those using clozapine. The monitoring of HAP should also be strengthened in those with salivation/swallowing disorders，combined use of antipsychotics，having hyperglycemia，underlying diseases and longer hospital stay due to disease conditions.


Efficacy and Safety of Wenyang Lishui Recipes for Heart Failure with Diuretic Resistance：a Meta-analysis　

WANG Mengxi，CAO Peihua，WU Chenjie，CHEN Xiaohu

2021, 24(29):  3734-3741.  DOI: 10.12114/j.issn.1007-9572.2021.01.001

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Background　Diuretics are a cornerstone treatment for heart failure，but some patients will gradually develop reduced sensitivity to diuretics，resulting in weakened or even disappeared diuretic effect after a long-term use of them，which is clinically called diuretic resistance. Diuretic resistance is independently associated with heart failure-related mortality，which cannot be cured by western medicine，but has been proven to be partially improved by Wenyang Lishui Recipes（WLR），a type of Chinese medicine treatment. Objective　To systematically evaluate the efficacy and safety of WLR in treating heart failure with diuretic resistance. Methods　The authors searched the databases of PubMed，Web of Science，The Cochrane Library，EMBase，CNKI，Wanfang，VIP and CBM to screen randomized controlled trials（RCTs） comparing WLR with western medicine treatment against western medicine treatment in heart failure with diuretic resistance patients from inception to January 2020. The major primary outcome indicators included 24-hour urine collection，and left ventricular ejection fraction （LVEF）. Secondary outcome indicators included N-terminal proB-type natriuretic peptide （NT-proBNP），clinical symptom response rate，and cardiac function improvement rate. Safety indicators included serum potassium and creatinine. The “Risk of bias' tool described in Cochrane Handbook （version 5.1.0） and the modified Jadad Scale were used to evaluate the quality of the included RCTs. RevMan 5.3 and Stata 12.0 were used for meta-analysis. Results　Fourteen RCTs were included，involving 932 patients. Meta-analysis revealed that compared with western medicine treatment alone，WLR with western medicine treatment could further increase the 24-hour urine collection〔MD=499.41，95%CI（287.26，711.55），P<0.000 01〕，improve the LVEF〔MD=5.25，95%CI（3.28，7.22），P<0.000 01〕，clinical symptom response rate〔RR=1.26，95%CI（1.16，1.37），P<0.000 01〕，cardiac function improvement rate〔RR=1.25，95%CI（1.14，1.38），P<0.000 01〕，and serum potassium level〔MD=0.19，95%CI（0.14，0.24），P<0.000 01〕，as well as further decrease the NT-proBNP〔MD=-594.14，95%CI（-796.95，-391.33），P<0.000 01〕. Subgroup analysis found that WLR with western medicine treatment showed greater effects on improving LVEF no matter the sample size was greater or less than 80〔MD=2.04，95%CI（0.64，3.44），P=0.004；MD=6.61，95%CI（5.17，8.04），P<0.000 01〕. Conclusion　WLR with western medicine treatment may have better clinical efficacy in patients with heart failure with diuretic resistance with good safety.However，more high-quality clinical studies are still needed to verify this conclusion.


Bariatric Surgery and Multiple Health-related Outcomes：an Umbrella Review　

XU Mei，ZHANG Mingxuan，ZHANG Qian，ZHANG Guixiang，LIAO Jing，LEI Zhixiang，LAN Ruichao，YAO Shun，ZHAO Yisi,CHEN Yi

2021, 24(29):  3742-3750.  DOI: 10.12114/j.issn.1007-9572.2021.01.213

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Background　The number of bariatric surgeries is increasing rapidly worldwide，which may significantly promote weight loss in obese patients，and help to improve diabetes，hypertension and other diseases，but may also increase the risk of suicide and other adverse events. Therefore，comprehensive and systematic studies are needed to assess the impact of bariatric surgery on multiple health-related outcomes. Objective　To examine the influence of bariatric surgery on various health-related outcomes other than weight loss. Methods　We searched databases of PubMed，Web of Science，EMBase，and The Cochrane Library from the inception to September 20，2020，for systematic reviews/meta-analyses of the associations between bariatric surgery and health-related outcomes. Each study was screenedby two authors separately based on the inclusion and exclusion criteria. The 11-item AMSTAR was used for methodological quality assessment. Results　Twenty-five meta-analyses were included. The median AMSTAR score for the meta-analyses was 10（7，11）. Among the 54 outcomes in these meta-analyses，bariatric surgery was found to be associated with a lower risk of multiple cancers，and decreased cancer mortality，all-cause mortality，and cardiovascular mortality. Besides，bariatric surgery improved health quality and multiple chronic diseases，particularly type 2 diabetes，cardiovascular diseases，urinary incontinence，and nonalcoholic fatty liver disease. Several functional outcomes including sexual function，pulmonary function，renal function，and physical activity were also improved after bariatric surgery. However，bariatric surgery also increased the risk of suicide，self-harm，emotional eating，and adverse perinatal outcomes. Conclusion　The majority of health-related outcomes are improved after bariatric surgery，but it should be cautious that bariatric surgery might increase the risk of adverse mental and perinatal problems. Because the methodological quality of some includ meta-analyses and the evidence quality of some health-related outcomes are comparatively low，more high-quality clinical studies and systematic reviews are still needed in the future.


Efficacy and Safety of Tumor-treating Fields Versus Angiogenesis Inhibitors in Combination with Stupp Protocol for Newly Diagnosed Glioblastoma：a Network Meta-analysis　

SU Dongpo，ZUO Zhengyao，LI Mei，HAN Qian，ZHANG Weihong，FU Aijun，ZHU Jun，CHEN Tong

2021, 24(29):  3751-3756.  DOI: 10.12114/j.issn.1007-9572.2021.01.214

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Background　Tumor-treating fields（TTFields）with Stupp protocol and angiogenesis inhibitors with Stupp protocol have proved to be effective in the treatment of newly diagnosed glioblastoma，but there are few studies directly comparing their efficacies and safety. Objective　To compare the efficacy and safety of TTFields versus angiogenesis inhibitors in combination with Stupp protocol for newly diagnosed glioblastoma. Methods　The databases of PubMed，The Cochrane Library，EMBase and OVID were comprehensively searched from January 1，2004 to January 1，2020 for studies about newly diagnosed glioblastoma treated by TTFields with Stupp protocol compared with those treated by angiogenesis inhibitors with Stupp protocol. The literature information was extracted and stored in the Excel file，including the first author，country of the author，year of publication，number and age of participants，treatment scheme（experimental groups：Stupp protocol in combination with bevacizumab，cilengitide，or TTFields combined with other treatment regimens；control group：Stupp protocol），outcome indicators〔overall survival（OS），progression-free survival（PFS）〕 and adverse events. The quality of the included literatures was evaluated. Revman 5.3 and Stata 13.1 were used for network meta-analysis. Results　Seven studies were included，involving 1 859 cases and 1 566 controls，with a relatively high methodological quality. Seven therapies from studies were included in the network meta-analysis：TTFields with Stupp protocol，bevacizumab with Stupp protocol，bevacizumab with irinotecan，bevacizumab with irinotecan and Stupp protocol，cilengitide（twice a week）with Stupp protocol，cilengitide（five times a week）with Stupp protocol，and Stupp protocol. Through network meta-analysis，the 6-month OS rate of each treatment modality was ranked from high to low：TTFields with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with Stupp protocol > cliengitide（twice a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > bevacizumab with irinotecan > Stupp protocol. The one-year OS rate was ranked from high to low as follows：TTFields with Stupp protocol > bevacizumab with irinotecan> bevacizumab with Stupp protocol> cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > Stupp protocol. The 6-month PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan> bevacizumab with Stupp protocol > TTFields with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > cliengitide（five times a week）with Stupp protocol > cliengitide（twice a week）with Stupp protocol > Stupp protocol. The one-year PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan > bevacizumab with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > TTFields with Stupp protocol > cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > Stupp protocol. In terms of adverse events，Bevacizumab and irinotecan increased the incidence of treatment-related adverse events，but TTFields and cilengitide did not. Conclusion　TTFields with Stupp protocol seems to be safer and more effective，but whether it can be used as an alternative to other six therapies still needs to be verified.


Inventory Survey of Home Bathing and Wound Infection in Patients with Traumatic Wounds and Analysis of the Influencing Factors of Wound Infection：a Multicenter Study　

JIANG Qixia，XU Juan，WANG Yaling，XIE Yijie，ZHENG Meichun，WANG Weiwei，SUN Hongling，FENG Huan，JI Huiming，BAI Yuxuan

2021, 24(29):  3757-3762.  DOI: 10.12114/j.issn.1007-9572.2021.00.580

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Background　Posttraumatic bathing is an important means to keep skin clean，but how to bathe has always been controversial. Studies have reported that warm water shower after operation does not increase the wound infection rate，and there is still a lack of evidence to support the feasibility of bathing at home. Objective　To investigate the current situation of home bathing and wound infection in patients with traumatic wounds by a multicenter investigation，and analyze the correlation between bathing and wound infection，and the influencing factors of wound infection，so as to provide the basis for the selection of appropriate bathing methods. Methods　From September 1 to September 30 in 2020，wound patients in wound care clinics of 13 hospitals were selected as the research objects. A questionnaire was designed to investigate the current situation of home bathing and wound infection in patients with traumatic wounds，including demographic data，wounds data，post-traumatic bathing and wound infection data. Anonymous filling and submission of online questionnaire were completed voluntarily through star link，QR code. Descriptive analysis and multivariate Logistic regression analysis were used to analyze the current situation and related factors of home bathing and wound infection. Results　A total of 949 questionnaires were received，excluding 2 invalid questionnaires，including 947 valid questionnaires，and the effective rate was 99.8%.（1）Basic data：460 males and 487 females，aging from 18 to 100 years old，the average age was（50.2±17.9）years. The duration of trauma was（42.7±66.7）d.Full thickness injury and partial thickness injury accounted for 55.8%（528/947） and 44.2%（419/947），respectively. The main causes of injury were sharp cutting injury and falling injury accounted for 43.4%（411/947） and 27.8%（263/947）.（2）The status of home bathing after injury：28.0%（265/947）who never bathed at home after injury，72.0%（682/947）who bathed at home with injury. The main bathing method was warm water wiping bath for 76.7%（523/682），warm water shower by wrapping wound and opening wound accounted for 18.3%（125/682）and 5.0%（34/682）. The bathing frequency was once a week the most，accounting for 38.4%（262/682），followed by twice a week，accounting for 37.4%（255/682）and three times a week，accounting for 24.2%（165/682）.（3）Current status of wound infection：the total wound infection rate was 36.0%（341/947），the wound infection rate of injured home bathers was 24.6%（168/682），and 65.3%（173/265）of those who had never bathed after injury，the difference was statistically significant（χ2=136.900，P<0.001）. Among them，the wound infection rate of warm water bathing，warm water shower by wrapping wound and opening wound were 25.8%（135/523），20.0%（25/125） and 23.5%（8/34），the difference was not statistically significant（χ2=1.860，P=0.385）. The wound infection rates of those who took a bath at home once a week，twice a week and 3 times a week were 32.8%（86/262），22.4%（57/255） and 15.2%（25/165），the difference was statistically significant（χ2=18.173，P<0.001）. （4）Analysis of influencing factors of wound infection：a single factor analysis was conducted by grouping whether the wound was infected or not. The results showed that there were significant differences in home bathing，bathing frequency，antibiotic treatment，wound duration，cause of injury，wound depth and wound site ratio between the wound infection group and the non wound infection group（P<0.05）. Multivariate Logistic regression analysis showed that home bathing〔OR=0.30，95%CI（0.20，0.44），P<0.001〕，bathing frequency〔OR=0.60，95%CI（0.39，0.93），P=0.023〕，antibiotic treatment〔OR=1.67，95%CI（1.20，2.33），P=0.002〕，wound duration〔OR=1.64，95%CI（1.19，2.76），P=0.003〕，and wound site〔OR=5.69，95%CI（2.72，11.90），P<0.001〕 were the influencing factor of wound infection. Conclusion　Bathing at home and increasing bathing frequency do not increase the wound infection rate，which is a feasible skin cleaning method. Antibiotic treatment，wound age more than 30 days and wounds on the waist，hips and extremities may increase the risk of wound infection. Patients can choose appropriate bathing methods and frequencies according to their self-care ability，wound pain，wound odor and other factors.


High-risk HPV Infection Analysis in 18 378 Cervical Cancer Screening Participants in Urban Areas of Shihezi，Xinjiang　

WEI Yan，BAI Rui，RUAN Yangyang，SUN Qianyu，DIAO Bowen，YANG Ping

2021, 24(29):  3763-3768.  DOI: 10.12114/j.issn.1007-9572.2021.01.212

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Background　Cervical cancer is a highly prevalent malignancy in women，which can be effectively prevented through standardized screening based on its clarified etiology. However，cytology-based cervical cancer screening programs are unfeasible in Xinjiang Uyghur Autonomous Region，where medical resources are inadequate. So it would be meaningful to understand the status of high-risk human papilloma virus（hrHPV）infection in Shihezi region for optimizing the primary hrHPV screening. Objective　To investigate the hrHPV infection status in cervical cancer screening participants aged 30-65 years from urban areas，Shihezi，Xinjiang Uygur Autonomous Region. Methods　The cervical cancer screening data （results of hrHPV DNA testing，ThinPrep cytologic test，colposcopy and histopathology）of 18 378 women，who underwent primary hrHPV screening at First Affiliated Hospital，School of Medicine，Shihezi University，Shihezi People's Hospital，and Shihezi Maternal and Child Health Hospital during December 2018—May 2019，were retrospectively collected. The prevalence of hrHPV subtypes（hrHPV16 and/or 18 positive versus other hrHPV positive）were comparatively analyzed. The prevalence of hrHPV was compared between four age groups（30-39，40-49，50-59，and 60-65）. Results　Among the participants，the hrHPV prevalence was 15.32%（2 816/18 378），with single infections accounting for 11.38%（2 092/18 378）and multiple infections for 3.94%（724/18 378）. The five most common hrHPV subtypes of single infections were hrHPV52（2.37%），hrHPV16（1.65%），hrHPV53（0.97%），hrHPV51（0.90%），and hrHPV39/68（0.87%），hrHPV18 was ranked 11th（0.36%）. Participants infected with both hrHPV16 and hrHPV18 had higher prevalence of cervical lesions than those infected with only hrHPV18（35.71% vs 8.95%），and so did those infected with hrHPV16（30.86% vs 8.95%）（P<0.05）. Although the hrHPV52 was the most frequent subtype，no precancerous cervical lesion or cervical cancer was detected in the cohort with hrHPV52 infection. Among the people with infections of other hrHPV subtypes and histology ≥LSIL revealed by colposcopic cervical biopsies，hrHPV58，hrHPV56，hrHPV51，hrHPV33，and hrHPV39 were more common than other subtypes. In addition，there was a statistically significant difference in hrHPV infection rates between different age groups（χ2=7.866，P=0.049）. Conclusion　The prevalence of hrHPV infection among women in urban areas，Shihezi is high，and infections with single hrHPV are predominant，where infections of hrHPV16 need to be given special attention.


Ferroptosis Pathway and Process in Cardiovascular Disease　

LYU Mingming，ZHENG Zaiyong，ZHANG Yulong，YUE Rongchuan，HU Houxiang

2021, 24(29):  3769-3773.  DOI: 10.12114/j.issn.1007-9572.2021.01.301

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Ferroptosis is a novel mode of cell death that is neither apoptotic nor necrotic and has characteristics that are distinct from other forms of regulated cell death，such as：iron dependency，redox balance dosorder mediated by glutathione and glutathione peroxidase 4，and lipid peroxidation. Recent studies have found that ferroptosis also plays an important role in cardiovascular disease. This paper reviews the research progress of ferroptosis pathway and its role in cardiovascular disease. It has been found that the molecular regulation of ferroptosis has made rapid progress，but the research on ferroptosis and heart disease has just started. To further explore the mechanism of ferroptosis and its role in cardiovascular disease can provide more scientific basis for targeting ferroptosis as the prevention and treatment of heart disease.


Advances in the Key Oncogene and Tumor-suppressor Gene in Early Lung Adenocarcinoma　

YANG Rong，LIAO Xiaoyang，LEI Yi，YUAN Mengyi

2021, 24(29):  3774-3780.  DOI: 10.12114/j.issn.1007-9572.2021.00.542

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Lung cancer is a malignant tumor with high incidence and mortality rates，causing a heavy socio-economic burden worldwide. Lung adenocarcinoma is the main type of lung cancer with a poor prognosis，but most early lung adenocarcinomas cases may have a high rate of 5-year survival. So it is vital to early evaluate condition and prognosis，and based on this，to choose an appropriate personalized regimen for early lung adenocarcinoma patients. And the research on key oncogenes and tumor-suppressor genes in early lung cancer has become a hot topic. We reviewed five key genes in lung cancer，including four oncogenes （EGFR，ALK，ROS1 and KRAS） and a tumor-suppressor gene（TP53），with a description of clinical features，prognosis evaluation and targeted therapies of early lung adenocarcinoma patients with mutations of the genes，and a summary of other small molecular biomarkers related to the disease，with a view to advancing general practitioners' understanding of key genes related to early lung adenocarcinoma，thereby improving the personalized management of these patients.