Sichuan Provincial Research Articles

The establishment, practicing and future of a 5G-based emergency medical rescue system

The advantages of 5G communication, including large bandwidth, low latency and wide connection, and rapid transmission, have proved to be vital in facilitating emergency medical rescue. On June 17th, 2019, an earthquake occurred in Channing, Yibin, Sichuan Province. Sichuan Provincial People’s Hospital initiated the Emergency Medical Rescue System for the rescue operation in the disastrous area. This was the first use of 5G emergency medical rescue worldwide. Remote consultations, injury assessments and helicopter transfers were carried out for the critical patients. Our rescue system have been effective and efficient in rapid responding, information transmission and the coordination of medical resources, which has led to the best possible medical decisions and treatments. However, there were challenges found in the application of this system: the stability of 5G signal, the optimization of the configuration of 5G ambulances, and the survival rate and self guarantee in the field. In conclusion, this practice of 5G emergency medical system provides a new paradigm and valuable experiences for the improvements in disaster rescue in China and worldwide. Key words: 5G; Emergency Medical Rescue; Earthquake; Disaster Medicine

Application of video education combined with Teach-back in patients with rheumatoid arthritis

Objective To explore the effect of video education combined with Teach-back on the compliance of patients with rheumatoid arthritis (RA) to exercise at home and the condition of disease activity. Methods By convenience sampling, 80 patients with RA who were hospitalized in the Rheumatology and Immunology Department of Sichuan Provincial People's Hospital from March to November 2018 were included in the study. By random number table, the patients were divided into the intervention group and control group, the control group was given routine discharge instruction and the patients were taught about the functional exercise orally; on the basis of that, the intervention group was given the video education combined with Teach-back and assisted to download videos, Family Exercise Compliance Scale and Disease Activity Score in 28 Joints (DAS28) were used to evaluate the patients' compliance in functional exercise at home and disease activity condition before intervention, 1 month and 3 months after intervention. Results Finally, 73 cases (37 cases in the control group, 36 cases in the intervention group) in two groups completed the research plan. One and 3 months after intervention, the compliance with family functional exercise of the intervention group was better than the control group from the same period with statistical significance (P 0.05) . Conclusions Video education combined with Teach-back can effectively improve the compliance of RA patients with home functional exercise, help to cultivate healthy behavior, and hence reduce the number of tender joint, swelling joints, reduce the degree of pain, improve the prognosis of patients. Key words: Rheumatoid arthritis; Family functional exercise; Compliance; Disease activity

Effects of anxiety and depression and early detection and management of emotional distress on length of stay in hospital in non-psychiatric inpatients in China: a hospital-based cohort study

BackgroundEmotional distress, including anxiety and depression, is associated with negative outcomes (such as poorer prognosis of physical diseases, longer hospital stays, and more readmissions) of patients in non-psychiatric settings. We investigated the effects of anxiety and depression, as well as the effects of early detection and management of emotional distress, in non-psychiatric inpatients on length of stay in hospital, with the aim of better informing the provision of medical care to meet the needs of non-psychiatric patients receiving general hospital care. MethodsThis real-world hospital-based cohort study included inpatients (aged ≥15 years) from 20 non-psychiatric departments in West China Hospital. The Huaxi emotional-distress index (HEI), a validated questionnaire for screening depression and anxiety in Chinese non-psychiatric clinical settings, was recommended for use in brief screening of non-psychiatric inpatients on their admission to hospital. Patients with depression or anxiety were provided with a graded psychological service, ranging from brief supportive care (for mild distress [HEI score 9–12]) to treatment by a psychiatrist or psychotherapist (for severe distress [HEI score ≥17]). Patients were grouped on the basis of whether brief screening and graded psychological service was provided (BS-GPS group) or not (non-BS-GPS group). Length of stay was compared between the groups and between patients with and without clinically significant anxiety or depression. FindingsFrom Jan 1, 2015, to Dec 31, 2018, 487 871 patients admitted to 20 non-psychiatric departments were included in the study, of whom 178 883 (36·7%) patients underwent brief screening on admission (BS-GPS group) and 308 988 (63·3%) patients were not screened (non-BS-GPS group). Across all departments, 9590 (5·4%) patients in the BS-GPS group (range 2·6–20·5% across departments) showed clinically significant anxiety or depression (ie, total HEI score ≥11). Mean length of stay differed significantly between patients with (12·7 days [SD 0·12]) and without (9·5 days [0·02], p<0·0001) clinically significant anxiety or depression, and between the BS-GPS group (9·6 days [0·02]) and the non-BS-GPS group (10·8 days [0·02], p<0·0001). These differences remained significant after controlling for sociodemographic factors and categories of physical diseases. InterpretationAnxiety and depression significantly prolonged the length of stay of non-psychiatric inpatients in general hospital. Early detection and management of emotional distress should be promoted and applied to better care for patients with non-psychiatric disorders and to conserve medical resources. Funding1.3.5 Project for Disciplines of Excellence of West China Hospital (Sichuan University), Science and Technology Benefit the People Project of Chengdu Municipal Government (grant numbers 2015-HM01-00011-SF and 2016-HM02-00095-SF), Science and Technology Support Program of Sichuan Provincial Government (grant number 2015SZ0058).

Internet addiction severity and risk for psychopathology, serious mental illness, and suicidalities: a cross-sectional study

BackgroundInternet addiction is a major global concern and health burden, compounded by the advances of Internet Plus and artificial intelligence. There is controversy on the question of recognising some types of internet addiction as mental illness, largely because there is no consensus on its link to mental health outcomes. We investigated the associations between internet addiction severity and several mental health outcomes including four psychopathologies, serious mental illness, and suicidalities. MethodsIn this cross-sectional study, all first-year undergraduate students enrolled in Sichuan University (Chengdu, China) during 2015–18 were invited to participate in the study survey. Participants were required to finish the whole questionnaire (online) by Oct 31 of their enrolment year. We excluded participants who did not respond completely, did not complete the questionnaire by the deadline, were not aged 15–23 years, or who provided obviously dishonest information (eg, selecting the same choice for all questions or several users having the same unique ID). The severities of internet addiction were categorised using Young's 20-item internet addiction test (normal 0–30 points, mild 31–49, moderate 50–79, and severe 80–100). The four psychopathologies were defined according to the recommended cutoff points of the 15-item Patient Health Questionnaire (high somatic symptom severity), the 9-item Patient Health Questionnaire (clinically significant depression), and the Symptom Checklist-90 (psychoticism and paranoia). Serious mental illness was screened using the 6-item Kessler Psychological Distress Scale (cutoff 12–13 points), and lifetime suicidal ideation, planning, and attempts were measured with the Suicidal Behaviours Questionnaire-Revised. Prevalence among student demographics or internet addiction severity groups was compared with the χ2 test, adjusted odds ratios (ORs) of mental health outcomes in addiction severity groups were compared using binary logistic regression adjusted for demographic confounders (ie, age, sex, and enrolment year), and interactions between psychopathologies were assessed using a two-tailed alpha of 0·05. Findings37 187 undergraduate students enrolled in the university during the study years. 34 140 (91·8%) of them agreed to participate and accessed the online survey system, and 32 269 (86.8%) responded fully. 12 254 (38·0%) students had mild internet addiction, 2057 (6·4%) had moderate addiction, and 67 (0·2%) had severe addiction. The prevalence and risks of the four psychopathologies and their comorbidities, serious mental illness, and suicidalities increased significantly with internet addiction severity (p values from 0·0003 to <0·0001), and most increments in risk were large (ORs increasing more than four times, except for suicidalities) for students with moderate and severe internet addiction. Prevalence of clinically significant depression, most strongly associated with internet addiction after adjustment for demographics and psychopathologies, increased from 1·0% (95% CI 0·9–1·2) for students with no addiction to 4·9% (4·5–5·3) for those with mild addiction, 24·8% (22·9–26.7) for those with moderate addiction, and to 56·7% (44·5–68·9) for those with severe addiction. Risk for the three addiction groups compared with the no-addiction group increased accordingly (OR 4·2 [95% CI 3·6–5·0] for mild, 18·9 [15·7–22·9] for moderate, and 59·9 [33·5–107·2] for severe addiction). Prevalence of the four psychopathologies increased from 4.1% (3·8–4·4) in students with no addiction to 36.8% (34·7–38·9) in those moderately addicted and to 67.2% (55·6–78·7) for those severely addicted. Similarly, prevalence increased from 25.0% (24·4–25·6) to 67·5% (65·6–69·6) and 71·6% (60·6–82·7) for suicidal ideation, from 2·6% (2·4–2·8) to 16·5% (14·9–18·1) and 32·8% (21·3–44·4) for suicidal plans, and from 0·5% (0·4–0·6) to 3·6% (1·1–1·5) and 11·9% (4·0–20·0) for suicidal attempts. InterpretationOur study format does not allow us to identify possible causal relationships between internet addiction and mental health comorbidities, but allows us to compare the prevalence and risk of these outcomes through our large population size (to our knowledge, the largest to date in such a study) and methodology. Internet addiction was strongly associated with several adverse mental health outcomes, supporting the validity of defining moderate and severe, but not mild, internet addiction as mental illness. FundingNational Scientific and Technical Fund of China (grant 81571305), Department of Science and Technology of Sichuan Provincial Government (grant 2019YFS0153), and 1.3.5 Project for Disciplines of Excellence, West China Hospital.

Inflammation and Endothelial Function Relevant Genetic Polymorphisms and Carotid Plaque in Chinese Population

Background: Inflammation and endothelial function play important roles in the pathogenesis of atherosclerosis. The genetic influence on carotid atherosclerotic plaque is mostly unclear. The aim of current study was to examine the association of carotid plaque with variants in genes involved in inflammation and endothelial function. Methods: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The residents aged ≥ 40 years volunteered to participate in face-to-face survey in 8 communities at random. A total of 2377 subjects with high stroke risk population were enrolled. Carotid plaque and plaque phenotype were assessed by carotid ultrasound. Genotypes of 19 variants in 10 genes related to inflammation and endothelial function were examined. Gene-gene interaction was analyzed by generalized multifactor dimensionality reduction (GMDR). Finding: Carotid plaques were found in 852 (35.8%) subjects, 454 (53.3%) had stable plaques, 398 (46.7%) had vulnerable plaques. PPARA rs4253655, HABP2 rs7923349 and IL1A rs1609682 were associated with the carotid plaque presence, and NOS2A rs2297518 and PPARA rs4253655 were associated with vulnerable plaque in univariate analysis. GMDR analysis observed that there was a significant gene-gene interaction among HABP2 rs7923349, ITGA2 rs1991013, IL1A rs1609682 and NOS2A rs8081248, and the high-risk interactive genotype among the 4 variants was independently associated with a higher risk for carotid vulnerable plaque after adjusting the covariates (OR, 2.86, 95% CI: 1.32-7.13, P = 0.003). Interpretation: Prevalence of carotid plaque was very high in the high risk stroke population in southwestern China. Variants in genes involved in endothelial function and inflammation were associated with the carotid plaque and plaque vulnerability. The high-risk interactive genotype among rs7923349, rs1991013, rs1609682 and rs8081248 was independently associated with a higher risk for vulnerable plaque, and might be potential markers for plaque vulnerability. Funding Statement: This study was supported in part by grants from the Scientific Research Foundation of Sichuan Provincial Health Department (Grant No. 16ZD046), the Sichuan Science and Technology Agency Research Foundation (Grant No.2018JY0164), and Universal Application Program, Health and Family Planning Commission of Sichuan Province in China (Grant No.17PJ084). Declaration of Interests: The authors stated: None. Ethics Approval Statement: The survey protocol was reviewed and approved by the Ethics Committee of the participating hospitals (People’s Hospital of Deyang City, Suining Central Hospital, and the Affiliated Hospital of Southwest Medical University), and informed consent was obtained from all participants during recruitment.

Early warning of nursing risk based on patient electronic medical record information

In order to study the nursing risk warning of patients’ electronic medical record (EMR) information, data of 200 cases of patient from Eastern Medical District of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital is selected. The Logistic regression model and nursing risk warning information system are used to calculate the death probability of the recovered patients 24h before discharge and 24h before the death of the patients. The predictive ability of the system is verified, and incidence of infusion, blood transfusion, surgical patient handover, blood sample collection nursing risk, and corresponding indirect care hours before and after the use of nursing risk warning are compared. The probability of death of the recovered patients within 24h before discharge is less than 0.5, and the death probability of the dead patients before the death of 24h is greater than 0.5. After the nursing risk warning is used, the infusion, surgical patient handover, and incidence of blood sample collection nursing risk are significantly lower than those before using the nursing risk warning and the difference is statistically significant. The indirect nursing hours of infusion, blood transfusion, surgical patient handover, and blood sample collection are significantly lower than those before using the nursing risk warning, and the difference is statistically significant. Therefore, the predictive ability of the patient's EMR information risk warning system has important reference value in clinical nursing, which can significantly reduce the incidence of infusion, surgical patient handover, and blood sample collection and nursing risk, reduce the infusion, blood transfusion, surgical patient handover, and indirect nursing hours for collecting blood samples, and improve the quality and efficiency of hospital diagnosis and treatment.

Analysis of mental state of allergic rhinitis patients in Chengdu city by symptom check list 90 (SCL-90) scale

Objective: To analyse the mental state of patients with allergic rhinitis (AR) in Chengdu. Methods: One thousand five hundred and thirty-six AR patients from Sichuan Provincial Integrated Traditional Chinese and Western Medicine Hospital, West China Hospital of Sichuan University, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan People's Hospital, Sichuan Second Hospital of Traditional Chinese Medicine were selected from July 2013 to January 2018. Eight hundred and twenty-seven patients were screened into study group by inclusion and exclusion standards. The symptom check list 90 (SCL-90) was used to group and score the mental state of these patients according to nine classification criteria: gender, BMI, age, marital status, monthly salary, disease duration, living environment, education level and working environment. Then, the scores were compared within groups. Inter-group comparison was made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, i.e. nasal itching, sneezing, clear discharge and nasal congestion, were scored on the visual analogue scale (VAS). SPSS 19.0 software was used to carry out statistical analysis. Partial correlation analysis was performed between the positive factors and the symptom scores by multiple regression statistical method. Results: The total score of SCL-90 in the study group was 2.64±0.25, which was accorded with mild to moderate mental health impairment. There were 124 (15.0%) without mental health damage, 176 (21.3%) with mild damage, 474 (57.3%) with mild to moderate damage, 41 (5.0%) with moderate to severe damage and 12 (1.4%) with severe damage. The in-group comparison showed that the top three categories of different items were the living environment, gender and working environment. The scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, psychosis, other (sleep, diet) and total average score of urban residents were higher than that of country residents (3.29±0.61 vs 2.65±0.50, 2.81±0.77 vs 2.05±0.38, 3.10±0.19 vs 2.49±0.67, 3.40±0.84 vs 2.49±0.70, 3.04±0.64 vs 2.33±0.51, 3.02±0.55 vs 2.40±0.77, 3.40±0.41 vs 2.52±0.77, 2.91±0.11 vs 2.29±0.40, Z value was 4.88, 5.25, 4.57, 5.91, 5.09, 4.63, 5.55, -4.55, respectively, all P<0.05). Women scored higher than man for somatization, interpersonal sensitivity, depression and others (2.66±0.51 vs 2.00±0.45, 3.37±0.47 vs 2.63±0.51, 3.44±0.57 vs 2.85±0.52, 3.47±0.36 vs 2.76±0.45, Z value was -5.10, -5.51, -4.86, -5.28, respectively, all P<0.05). The scores of somatization, interpersonal sensitivity, psychosis and other (sleep, diet) were higher in the indoor group than those in the outdoor group (3.49±0.64 vs 2.78±0.46, 3.33±0.30 vs 2.56±0.68, 3.28±0.60 vs 2.67±0.31, 3.50±0.85 vs 2.85±0.37, Z value was 5.31, 5.79, 4.89, 5.00, respectively, all P<0.05). The outdoor group scored higher on obsessive-compulsive symptoms, anxiety and hostility (3.44±0.40 vs 2.83±0.35, 3.40±0.50 vs 2.57±0.93, 3.34±0.88 vs 2.69±0.56, Z value was 4.96, 6.22, 5.08, respectively, all P<0.05). The inter-group comparison found that depression, anxiety, psychosis and other (sleep, diet) could be partially correlated with VAS scores as 4 positive factors. The results of partial correlation analysis showed that depression was positively correlated with sneezing and nasal runny discharge, anxiety was positively correlated with nasal itching and nasal obstruction, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with nasal runny discharge and nasal obstruction. Conclusion: AR patients have mild to moderate mental health impairments, which are correlated with AR symptoms.

Comparison between logistic regression and machine learning algorithms on survival prediction of traumatic brain injuries

PurposeTo compare twenty-two machine learning (ML) models against logistic regression on survival prediction in severe traumatic brain injury (STBI) patients in a single center study. Materials and methodsData was collected from STBI patients admitted to the Sichuan Provincial People's Hospital between December 2009 and November 2011. Twenty-two machine learning (ML) models were tested, and their predictive performance compared with logistic regression (LR) model. Receiver operating characteristics (ROC), area under curve (AUC), accuracy, F-score, precision, recall and Decision Curve Analysis (DCA) were used as performance metrics. ResultsA total of 117 patients were enrolled. AUC of all ML models ranged from 86.3% to 94%. AUC of LR was 83%, and accuracy was 88%. The AUC of Cubic SVM, Quadratic SVM and Linear SVM were higher than that of LR. The precision ratio of LR was 95% and recall ratio was 91%, both were lower than most ML models. The F-Score of LR was 0.93, which was only slightly better than that of Linear Discriminant and Quadratic Discriminant. ConclusionsThe twenty-two ML models selected have capabilities comparable to classical LR model for outcome prediction in STBI patients. Of these, Cubic SVM, Quadratic SVM, Linear SVM performed significantly better than LR.

Preparation and 1.06 μm Fluorescence Decay of Nd3+-Doped Glass Ceramics Containing NaYF4 Nanocrystallites**Supported by the National Key Research and Development Program of China under Grant No 2017YFB0405302, the Scientific Research Fund of Sichuan Provincial Education Department under Grant No 15ZB0294, the Key Technical Project of Yibin City in 2015, the Scientific Research Project of Yibin University under Grant No 2015PY02,

Considered to be a candidate for large-size bulk materials used in lasers and other fields, Nd3+-doped glass ceramics containing NaYF4 nanocrystallites are prepared. Using x-ray diffraction and transmission electron microscopy, we show that pure cubic NaYF4 is well precipitated in the glass matrix. To obtain the optical property of this material at 1.06 μm, the fluorescence decay of 4F3/2 energy levels is measured and analyzed. It is found that the fluorescence lifetime decreases first and then increases with the increasing dopant concentration due to the existing but finally weakening energy dissipation. As a result, a long radiation lifetime of about 191–444 μs is obtained at 1.06 μm in the prepared material. It is thus revealed that Nd3+-doped glass ceramic containing NaYF4 nanocrystallites is a potential candidate as a near-infrared laser material.

Third investigation and analysis of quality control situation of intensive care unit in traditional Chinese medicine hospitals in Sichuan Province

To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU. Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases. There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6% (5/52), 38.5% (20/52), and 51.9% (27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71:1 and 2.0:1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high; the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62. ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.

Comparison of two radiofrequency ablation devices for atrial fibrillation concomitant with a rheumatic valve procedure.

Background:Perioperative and median-term follow-up outcomes have not been compared among procedures using radiofrequency ablation devices for permanent atrial fibrillation with concomitant rheumatic valve disease. We compared the sinus rhythm restoration efficacy of “non-irrigation” ablation forceps and an “irrigation” ablation device in patients with rheumatic valve disease undergoing a modified Cox maze radiofrequency ablation procedure due to permanent atrial fibrillation.Methods:Data of 278 patients with rheumatic valve disease from the Cardiac Surgery Department of Sichuan Provincial People's Hospital who underwent the modified Cox maze radiofrequency ablation procedure between May 2013 and May 2017 were reviewed. The procedure was performed using “non-irrigation” ablation forceps (AtriCure, group A) in 149 patients and an “irrigation” ablation device (Medtronic, group M) in 129 patients. Data were collected prospectively, and follow-up was documented and compared between the groups.Results:The radiofrequency procedure duration was 28.9 ± 3.8 min in group A and 29.5 ± 2.8 min in group M (t = 1.623, P = 0.106). The predicted radiofrequency time to the left atrium diameter was (Ya = 0.4964 X + 0.3762, R2 = 0.74) in group A and (Ym = 0.4331 X + 4.3563, R2 = 0.8435) in group M. The sinus rhythm (SR) conversion rate without use of anti-arrhythmic drugs was similarly good in groups A and M, with 75.2%, 72.5%, and 70.5% vs. 73.6%, 71.3%, and 69.8% at discharge, 6 and 12 months, respectively (F = 0.084, F = 0.046, F = 0.046, P > 0.05, respectively).Conclusion:Two types of radiofrequency ablation devices characteristic of “non-irrigation” and “irrigation” bipolar ablation forceps were similarly efficient at SR restoration.

Association of ABCA1 rare nonsynonymous variants with primary open angle glaucoma

Objective To explore the rare nonsynonymous variants of ABCA1 gene in primary open angle glaucoma (POAG). Methods A prospective cohort study was carried out.Three hundred and ninety-eight POAG patients and 198 healthy controls matched in age and gender were recruited from March 2017 to March 2018 in Eye and Ear Nose Throat (ENT) Hospital of Fudan University.The periphery blood of 2-5 ml from all the subjects was collected for extraction of DNA, and rare variant analysis of the ABCA1 gene was conducted by whole exome sequencing (WES) data of these subjects.The study protocol was approved by Ethic Committee of Eye and Ear Nose Throat Hospital of Fudan University and Sichuan Provincial People's Hospital (No.2016-32-1), and written informed consent was obtained from each subject prior to entering the study cohort. Results A total of 21 rare nonsynonymous variants (minor allele frequency MAF A (p.Thr1437Asn), c.3772G>T(p.Asp1258Tyr), c.775A>G (p.Lys259Glu) and c. 1507_1508insGAGGT (p.Glu503GlyfsX7) were four novel variants.In the 198 healthy controls, five rare nonsynonymous variants were detected in the ABCA1 gene from five subjects respectively, with the detection rate of 2.5%, the detection rate of nonsynonymous in POAG group was higher than that in healthy control group, showing a significant difference (χ2=4.72, P=0.03, OR=2.81). Conclusions Rare nonsynonymous variants in ABCA1 is associated with the pathogenesis of POAG.These variants can enrich the variation spectrum of ABCA1. Key words: Glaucoma, Open angle/genetics; Genetic variation; Sequence analysis, DNA/methods; Nonsynonymous variants; Whole exome sequencing; ABCA1 gene

Combined Exercise and Leucine Supplementation Promotes Skeletal Muscle Protein Deposition in Tumor Bearing Mice

PURPOSE: To investigate the effect of concurrent exercise training and leucine supplementation on skeletal muscle protein deposition in Colon 26 tumor bearing mice. METHODS: Male BALB/c mice were divided into a control group (C, n=8), a C26 tumor bearing group (T, n=8) and a tumor bearing plus exercise and leucine supplementation group (TEL, n=8). Mice in the C and T groups were fed with normal chow diet, while mice in the TEL group were fed with formulated diet contained 5% leucine and received 30-min swimming training 3 days per week (Monday, Wednesday and Friday) and resistance training 3 days per week (Tuesday, Thursday and Saturday) for 2 weeks. At 24 hours after the last training session, blood and gastrocnemius muscle samples were collected under full anesthesia. The contents of TNF-α and IL-6 in gastrocnemius muscle and serum were determined by ELISA. maximal grip strength was measured with a commercial grip strength meter. Two-way ANOVAs and post-hoc tests were used for data analysis. RESULTS: After tumor bearing, cumulative food intake appeared to decrease, whereas body weight (20.7 g vs. 26.1 g), wet gastrocnemius muscle weight (97.3 mg vs. 128.9 mg), total protein content (35.7 mg/g vs. 51.2 mg/g), sarcoplasmic protein content (26.5 mg/g vs. 38.3 mg/g), myofibrillar protein content (28.6 mg/g vs. 43.3 mg/g) and muscle strength (82.7 g vs. 156.5 g) were significantly lower in the T group than in the C group (all p<0.01). TNF-α and IL-6 contents in serum and gastrocnemius were obviously higher in the T group than in the C group (p<0.01). After exercise and leucine supplementation, cumulative food intake and the TNF-α and IL-6 content were significantly lower in the TEL group than in the T group (p<0.05), while body weight (21.8 g), wet gastrocnemius muscle weight (111.1 mg), total protein content (40.3 mg/g), sarcoplasmic protein content (30.7 mg/g), myofibrillar protein content (34.0 mg/g) and muscle strength (112.2 g) were significantly higher in the TEL group than in the T group (p<0.05 to p<0.01). CONCLUSIONS: Combined exercise and leucine supplementation significantly ameliorated skeletal muscular protein deposition in C26 tumor bearing mice, which may be through down-regulating the inflammatory response. (Supported by Research Foundation of Sichuan Provincial Department of Education grant #18ZB0106).

Correlation between SOX2 and Survivin clinical features in patients with salivary adenoid cystic carcinoma

ObjectiveIn this study, expression of cancer stem cells (CSCs)-related factor-Sex-determining region of Y chromosome-related high-mobility-group box 2 (SOX2) and anti-apoptotic specific factor- Survivin in salivary adenoid cystic carcinoma (SACC) was detected to provide important clues for effective SACC prevention and treatment by combining clinical pathological parameters analysis. MethodsParaffin and fresh specimens were collected from SACC patients who underwent surgery at the Oral and Maxillofacial Surgery Department of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital. The experimental group was designed as SACC tissue, and the control group normal paracancerous normal gland tissue. (1) SOX2 and Survivin expression were detected using immunohistochemistry and analyzed by comnining clinical pathological parameter analysis. (2) mRNA and protein expression levels of SOX2 and Survivin were detected using RT-PCR, Western Blot. Results1. Immunohistochemistry: (1) SOX2 was mainly expressed on the nucleus. The SOX2 positive rate was 28.57% in clinical stage I–II, and 76.92% in stage III–IV. (2) Survivin was mainly expressed in the cytoplasm. The Survivin positive rate was 61.90% in clinical stage I–II, and 76.92% in stage III–IV. (3) There was a clear correlation between SOX2 and Survivin. 2. RT-PCR and Western Blot: The mRNA and protein expression levels of SOX2 and Survivin were significantly higher in the experimental group than in the control group (P < 0.01). Conclusion(1) The mRNA and protein expression level of SOX2 and Survivin was significantly higher in SACC tissues than in paracancerous normal salivary gland tissues, indicating that both of the two are tissue-specific and may become SACC oncogenes. (2) SOX2 and Survivin are significantly correlated in expression, which may coorinatively participate in SACC incidence and development.

Early kidney injury in patients with non-alcoholic fatty liver disease: a cross-sectional study

Objective To investigate early kidney injury in the patients with non-alcoholic fatty liver disease (NAFLD) without hypertension, diabetes and history of kidney diseases, as so to provide evidence for preventing early kidney injury in patients with NAFLD. Methods From December 2014 to January 2016, 169 subjects visiting Sichuan Provincial People′s Hospital were recruited. Among them, 104 cases were in NAFLD group, 31 cases were in simple obesity group (overweight or obesity), and 34 subjects were in the healthy control group. The general data, biochemical indexes, metabolic indexes, biochemical indexes of kidney, and early kidney injury makers, including serum β2-microglobulin, urinary albumin and creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), were detected. Least significant difference-t test, chi-square test and Spearman correlation analysis were performed for statistical analysis. Results Compared with simple obesity group, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptadase (GGT), fasting insulin level, homeostasis model assessment-insulin resistance (HOMA-IR), serum creatinine, ACR and β2 microglobulin were higher in NAFLD group ((21.13±8.14) U/L vs. (66.20±44.34) U/L, (24.80±9.57) U/L vs. (49.78±25.41) U/L, (19.26±7.88) U/L vs. (66.53±56.34) U/L, (7.03±1.52) mU/L vs. (9.55±5.41) mU/L, 1.22±0.38 vs. 2.23±2.01, (62.90±10.01) μmol/L vs. (71.75±10.80) μmol/L, (4.41±1.16) μg/mg vs. (13.76±9.56) μg/mg, (1.46±0.26) mg/L vs. (2.01±0.53) mg/L); however the eGFR was lower (112.46±11.90) mL·min-1·(1.73 m2)-1 vs. (101.09±17.17) mL·min-1·(1.73 m2)-1). The differences were statistically significant (t=9.825, 8.250, 8.288, 4.229, 4.121, 4.007, 9.732, 7.792 and -3.443, all P 0.05). Compared with healthy control group, the renal injury indexes serum creatinine, ACR and β2 microglobulin of NAFLD group were higher((58.78±7.77) μmol/L vs. (71.75±10.80) μmol/L, (1.01±0.32) μg/mg vs. (13.76±9.56) μg/mg, (1.12±0.15) mg/L vs. (2.01±0.53) mg/L), and the eGFR was lower ((115.10±12.59) mL·min-1·(1.73 m2)-1 vs. (101.09±17.17) mL·min-1·(1.73 m2)-1). The differences were statistically significant (t=7.621, 13.591, 15.126 and -5.120, all P<0.01). Compared with healthy control group, the renal injury indexes ACR and β2 microglobulin of simple obesity group were higher ((1.01±0.32) μg/mg vs. (4.41±1.16) μg/mg, (1.12±0.15) mg/L vs. (1.46±0.26) mg/L), and the differences were statistically significant (t=9.732 and 7.792, both P<0.01). ACR of NAFLD patients was positively correlated with body mass index, waist circumference, triglyceride level, total cholesterol level, low density lipoprotein level, fasting blood glucose level, two-hour postprandial blood glucose, fasting insulin level and HOMA-IR (r=0.554, 0.327, 0.314, 0.353, 0.176, 0.195, 0.552, 0.364 and 0.987, all P<0.05), and was negatively correlated with high density lipoprotein (r=-0.330, P<0.01). Conclusions NAFLD is closely related with chronic kidney disease at same baseline of gender, age, blood glucose, blood lipids, and blood pressure. Abnormal metabolism of glycolipids, obesity and insulin resistance may be the mechanisms of early kidney injury in NAFLD patients. Combination of ACR and β2 microglobulin are more sensitive than serum creatinine and eGFR in detecting early renal injury in NAFLD patients. Key words: Nonalcoholic fatty liver disease; Obesity; Chronic kidney disease; Early kidney injury

A Comprehensive Map of Disease Networks and Molecular Drug Discovery for Glaucoma

Background: Glaucoma is the leading cause of irreversible blindness worldwide. The molecular etiology of glaucoma is complex and unclear. At present, there are few drugs available for glaucoma treatment. The aim of the present study was to perform a systematic analysis of glaucoma candidate drugs/chemicals based on glaucoma genes including genetic factors and differentially expressed (DE) genes. Methods and Findings: Online Mendelian Inheritance in Man (OMIM), Genome-wide association study (GWAS) Catalog and Phenolyzer databases were used to identify genetic factors associated with glaucoma. GEO was used to identify glaucomarelated RNA datasets. DE genes were identified using the WGCNA R package. The Database for Annotation, Visualization and Integrated Discovery (DAVID), a functional annotation bioinformatics resource, was used to analyze possible signaling pathways for glaucoma genes. The Phenome-wide Association Studies (PheWAS) database was employed to identify the disease spectrum of glaucoma genes. DGIdb, CLUE, and KEGG databases were used to mine drugs targeting glaucoma genes. In total, 401 genes from the genetic databases and 2,068 genes from the DE gene analysis were included in further analysis. In terms of glaucoma-related genetic factors, 54 pathways were significantly enriched (FDR < 0.05) and 96 pathways for DE genes were significantly enriched (FDR < 0.05). A search of the PheWAS database for diseases associated with glaucoma-related gene returned 1,289 diseases, and a search for diseases associated with DE glaucomarelated genes returned 1,356 diseases. Cardiovascular diseases, neurodegenerative diseases, cancer, and ophthalmic diseases were highly related to glaucoma genes. A search of the DGIdb, KEGG, and CLUE databases revealed a set of drugs/chemicals targeting glaucoma genes. A subsequent analysis of the electronic medical records (EMRs) of 136,128 patients treated in Sichuan Provincial People's Hospital for candidate drug usage and the onset of glaucoma revealed nine candidate drugs. Among these drugs, individuals treated with nicardipine had the lowest incidence of glaucoma. Taken together with the information from the drug databases, 40 most likely candidate drugs for glaucoma treatment were highlighted. Conclusions: Based on the findings, we concluded that the molecular mechanism of glaucoma is complex and it may be a reflection of systemic diseases. A set of ready-for-use candidate drugs targeted glaucoma genes, which may be developed for glaucoma clinical treatment drugs. Our results provide a systematic interpretation of glaucoma genes, interactions with other systemic diseases, and candidate drugs/chemicals. Funding Statement: This research project was supported by: the National Natural Science Foundation of China (81670895 (L.H.) and 81300802 (L.H.); the Department of Science and Technology of Sichuan Province, China (2017JQ0024 (L.H.), 2016HH0072 (L.H.), 2015JQO057 (L.H.) and 2013JY0195 (L.H.) Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: The study was approved by the institutional ethics committee of Sichuan Provincial People’s Hospital and was conducted according to the Declaration of Helsinki principles.

Moderate-to-vigorous intensity physical activity in early pregnancy reduces risk of gestational diabetes mellitus

Objective To investigate the effects of moderate-to-vigorous intensity physical activity (MVPA) in early pregnancy on the onset of gestational diabetes mellitus (GDM) in Sichuan Province. Methods A case-control study was performed on 1 508 gravidas at 8-14 gestational weeks in Sichuan Provincial Hospital for Women and Children from February to July, 2017. Baseline information during early pregnancy was collected through questionnaires. Information on time and intensity of physical activity were collected through pregnancy physical activity questionnaire. The time spent in MVPA was calculated and was categorized as active (≥3.5 h/week) or inactive MVPA (<3.5 h/week). Based on self-reported pre-pregnancy weights collected by questionnaire as well as the measured heights, body mass index (BMI) before pregnancy was calculated. After a 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, all subjects were divided into GDM (n=561) or non-GDM group (n=947), according to the GDM diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China (2014). Mann-Whitney U test and Chi-square test were used for statistical analysis. Multivariate unconditional logistic regression model was used to analyze the association between the time of MVPA in early pregnancy and GDM incidence. Results The median time spent in MVPA [M(P25-P75)] in early pregnancy was 3.00 (0.50-3.12) h/week, and 345 gravidas (22.9%) were classified as active in MVPA. After the control of confounding factors such as age, gravidity and parity history, and pre-pregnancy BMI, the multivariate unconditional logistic regression analysis showed that compared with the inactive group, the risk of GDM of active MVPA gravidas was reduced by 26.1% (OR=0.739, 95%CI: 0.553-0.989, P=0.042). Among primigravidas and primiparae, the risk of GDM in active MVPA gravidas was decreased by 47.6% and 44.3% than the inactive ones, respectively (primigravidas: OR=0.524, 95%CI: 0.297-0.925, P=0.026; primiparae: OR=0.557, 95%CI: 0.357-0.868, P=0.010). Conclusions Insufficient physical activity in early pregnancy is common in gravidas in Sichuan, China. The risk of GDM could be reduced if the frequency of MVPA during early pregnancy is no less than 3.5 h/week, especially in primigravidas and primiparae. Key words: Diabetes, gestational; Exercise; Pregnancy trimester, first

Factors predicting the colorectal adenoma detection rate in colonoscopic screening of a Chinese population: A prospective study.

Colorectal cancer has high incidence and mortality. Early diagnosis could increase patient survival, but early diagnosis has been poor in China for the past decades. The purpose of this study is to assess the polyp detection rate (PDR) and adenoma detection rate (ADR) by colonoscopy in a Chinese population, and to determine the risk factors for adenoma.This prospective study at Sichuan Provincial People's Hospital evaluated patients who underwent colonoscopy in September 2017 to February 2018. Basic information, exact insertion and withdrawal times, PDR, and ADR were assessed. Risk factors for colorectal adenoma in the adenoma-positive and adenoma-negative groups (based on pathology) were assessed by multivariable logistic regression analysis.A total of 1058 procedures with 767 polyps were analyzed. The overall PDR and ADR were 36.96% (391/1058) and 24.67% (261/1058), respectively. Occurrence of adenoma was associated with age, gender, body mass index (BMI), family history of colon cancer, personal history of adenoma, diabetes mellitus, and tobacco use. There was a significant association between withdrawal time and ADR (P < .001). In the multivariable analysis, age (OR = 1.041, 95%CI 1.028–1.055; P < .001), insertion time (OR = 0.999, 95%CI 0.998–1.000; P = .009), withdrawal time (OR = 1.009, 95%CI 1.007–1.011; P < .001), personal history of adenoma (OR = 2.572, 95%CI 1.115–5.932; P = .027), and diabetes mellitus (OR = 2.221, 95%CI 1.084–4.549; P = .029) were risk factors for colorectal adenoma detection.In a Chinese population, ADR increases with age, withdrawal time, a personal history of adenoma, and diabetes. Age, insertion and withdrawal times, and a personal history of adenoma may independently predict colorectal adenoma detection.

Design and Preliminary Experience of a Tele-Radiotherapy System for a Medical Alliance in China.

Background: The medical alliance and telemedicine are considered to be important means to solve the imbalance between regions and shortage of professionals and promote the homogenization of medical services. Sichuan Provincial People's Hospital Group (SPPHG) is a network of hospitals with different levels of expertise, and all the members with radiotherapy form a radiotherapy network (RTN). Addressing the inadequacy and imbalance of radiotherapy services of Sichuan Province, China, a tele-radiotherapy system for RTN-SPPHG is designed, which includes the business model and corresponding technical implementation of an information system. Materials and Methods: In the RTN-SPPHG, a distributed remote collaboration business model is explored and a tele-radiotherapy information system is customized for this telemedicine model. Both the business model and tailored information system were evaluated in actual use. Results: Based on the tele-radiotherapy system of RTN-SPPHG, multitype hospitals are linked together and serve as a whole. Through the internet, the experience of experts of Sichuan Provincial People's Hospital is effectively deployed to member hospitals at the grassroot level. Conclusions: A close-knit medical alliance based on a tele-radiotherapy system should be a way to rapidly improve radiotherapy services and promote the homogenization of service in a region.

Long-term outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: Results from a meta-analysis of randomized controlled trials

BackgroundLaparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) are 2 widely used procedures performed in bariatric surgery. However, their long-term weight loss effects have not been well compared. ObjectivesTo evaluate the long-term outcome of 2 procedures for treating morbid obesity. SettingThe gastrointestinal surgery center, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital. MethodsThree electronic databases, PubMed, CNKI, and EMBASE, were searched ending in September 2018. Eligible studies were prospective randomized controlled trials. ResultsOf 15 randomized controlled trials studies, 1381 cases were included, 697 were randomly divided into the laparoscopic sleeve gastrectomy group and 684 to the LRYGB group. A statistically significant percent excess weight loss reduction in weighted mean difference was observed in LRYGB group at 5 years (weighted mean difference = −8.9, 95% confidence interval [CI] = −13.08 to −4.73, P < .0001), and at 3 years (weighted mean difference = −11.96, 95% CI = −17.62 to −6.30, P < .0001). However, there was not any statistically difference between the 2 procedures in <3 years. The total complication of the LSC group were less than that of the LRYGB groups (odds ratio = .52, 95%CI = .35–.76, P = .0007). This meta-analysis showed that the LRYGB procedure could reduce gastrointestinal reflux disease (odds ratio = .26, 95%CI = .11–.61, P = .002); however, no statistically significant differences were found in type 2 diabetes, hypertension, dyslipidemia, and sleep apnea. ConclusionsThis meta-analysis showed that significantly greater in percent excess weight loss after 5 years of LRYGB treatment; however, it seems to have a higher incidence of total complications.