Key molecules regulating the blood meals of Rhipicephalus sanguineus (Acari: Ixodidae) revealed by transcriptomics.

Rhipicephalus sanguineus, a repulsive obligate blood feeder, is a three-host tick inflicting tremendous damage. Blood-sucking initiates tick-pathogen-host interactions along with alterations in the expression levels of numerous bioactive ingredients. Key molecules regulating blood meals were identified using the transcriptomic approach. A total number of 744 transcripts showed statistically significantly differential expression including 309 significantly upregulated transcripts and 435 significantly downregulated transcripts in semiengorged female ticks compared to unfed ticks, all collected in 2021. The top 10 differentially upregulated transcripts with explicit functional annotations included turripeptide OL55-like protein, valine tRNA ligase-like protein and ice-structuring glycoprotein-like protein. The top 10 differentially down-regulated transcripts were uncharacterized proteins. Gene Ontology (GO) enrichment analysis revealed four associated terms in the cellular component category and 16 in the molecular function category among the top 20 terms. Differentially expressed genes (DEGs) were enriched in GO terms ID 0000323 (lytic vacuole) and ID 0005773 (vacuole). The top 20 enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways included metabolism, cellular processes, organismal systems and human diseases. The DEGs were enriched in the KEGG term ID: ko-04142 (lysosome pathway) associated with intracellular digestion in the tick midgut epithelium. Molecular markers annotated via comparative transcriptomic profiling were expected to be candidate markers for the purpose of tick control.

Analysis of the influence of teachers' teaching input on teaching effect satisfaction in medical colleges / 中华医学教育探索杂志

Objective:To investigate and analyze the influencing factors of teachers' teaching input status on teaching effect satisfaction in medical colleges.Methods:A total of 782 teachers of basic medicine and clinical medicine in a local medical college in Hebei Province were selected by multi-stage stratified random sampling method. The (mean ± standard deviation) was used to describe the status quo of teachers' teaching input, and the t- or F-test was used for inter-group comparison. The influence of teaching input on teaching satisfaction was analyzed by multiple linear regression. Results:The teaching input of medical college teachers was affected by different demographic characteristics, among which the teaching time input was affected by gender, age, professional title, teaching age, educational background and category (all P<0.05), the emotional input was affected by age,professional title,teaching age,educational background and category (all P<0.05), and the teaching ability development input was affected by age, professional title, teaching age and category (all P<0.05). There was a correlation between the population characteristics of teachers and the teaching input and the satisfaction of teaching effect, and the teaching age of teachers is negatively correlated with the satisfaction of teaching effect ( β=-0.057, P<0.05). There were positive correlations between teaching satisfaction and teaching effect (all P<0.05), including the number of lesson preparation hours, the number of weekly teaching hours, the degree of teaching attention, the degree of medical teaching research balance, the learning and expansion of teaching skills, and the difference of teaching observation reflecting teaching input. The teaching input of basic medicine teachers was significantly higher than that of clinical teachers (all P<0.05). Conclusion:It is suggested that medical colleges and clinical teaching bases should pay attention to the construction of teacher echelon, optimization of policies and measures to balance the relationship between medical education and research, construction of the support system of teachers' teaching work input to improve teachers' professional efficacy, and the building of a professional development community of teachers integrating basic medical teachers and clinical teachers to improve the training quality of medical students.

Body characteristics of adults from 17 minorities of the Tibeto-Burman language group in China / 解剖学报

Objective To understand the body characteristics of adults from the Tibeto-Burman language group. Methods Totally 14 837 adults (6578 males and 8259 females) from 17 minorities were selected for investigation during 2015 to 2019 and these surveys were carried out in regions including Sichuan, Yunnan, Guizhou, Hubei, Hunan and Tibet Autonomous Region. Eight physical parameters (stature, sitting height, etc.) along with 4 corresponding indexes (stature-sitting index and the like) were carefully analyzed. The body characteristics of the Tibeto-Burman language group were then compared to those of certain minorities as well as Han in both northern and southern part of China based on our collected data. Results Among 17 minorities of the Tibeto-Burman language group, people from Pumi and Tibet were relatively tall and have longer trunk and limbs. The presence of wider trunk and thicker limbs appeared to be common in Tibetan individuals. Subjects from Lahu, Jino and Derung were in possession of shorter stature and limbs while the trunk of Naxi, Lisu and Achang people seemed wider. Compared with other ethnic groups in China, individuals from the Tibeto-Burman language group tended to own shorter stature accompanied by medium trunk width, probably sharing similar physical characteristics with those minorities in southern China, especially She and Li. Conclusion Among ethnic groups dotting in southern China, individuals from the Tibeto-Burman language group generally have medium stature, medium trunk height, and wide trunk whereas those from 3 Mon-Khmer groups, Va, Khmus and Blang, are shorter and smaller in width and height of the trunk.

Nutritional physical indexes, obesity status and their warning effect on hypertension among Blang, Deang and Va ethnic groups in Yunnan / 解剖学报

Objective To analyze the nutritional level, obesity status and the prevalence of frypertension in Blang, Deang and Va ethnic groups in Yunnan, to explore the relationship among nutritional physical index, obesity indicators and blood pressure, and use the cutoff value of related indicators to warn frypertension. Methods This paper was based on a statistical analysis of the 7 nutritional pfrysical indexes, 5 types of obesity status and frypertension status of 766 Blang, 570 Deang and 565 Va. Results We found that the nutritional pfrysique index of man)' items (4 items for men and 4 items for women) of Blang was significantly higher than that of Deang and Va (P Blang > Deang and the difference was statistically significant (P<0. 05). Conclusion Pelidisi' s index, WHR, and PBF all have good early warning effects on frypertension in all three ethnic groups.

Tracking evaluation on the implementation of Survey of oncomelanid snails (WS/T 563—2017) in Sichuan and Anhui provinces / 中国血吸虫病防治杂志

To evaluate the implementation of Survey of oncomelanid snails (WS/T 563—2017) in schistosomiasis-endemic foci, two schistosomiasis-endemic counties were selected from two provinces of Sichuan and Anhui. Professional staff working in province-, city-, county- and township-level disease control and prevention institutions, parasitic disease control institutions or medical institutions were recruited, and the understanding, use and implementation of Survey of oncomelanid snails (WS/T 563—2017) were investigated using questionnaires and interviews. The awareness, use, proportion of propagation and implementation and correct rate of answering questions pertaining to Survey of oncomelanid snails (WS/T 563—2017) were analyzed. A total of 270 questionnaires were allocated, and 269 were recovered, including 254 valid questionnaires. The overall awareness of Survey of oncomelanid snails (WS/T 563—2017) was 84.64% (215/254), and propagation and implementation of Survey of oncomelanid snails (WS/T 563—2017) was not performed in 23.28% (17/73) of the survey institutions following implementation of Survey of oncomelanid snails (WS/T 563—2017), with meeting training and allocation of propagation materials as the main type of propagation and implementation. Among 254 respondents, 77.16% (196/254) were familiar with the standard, 66.14% (168/254) understood the conditions for use of the standard during snail surveys, and 96.85% (246/254) had the approach for identifying snails. In addition, there were 41.73% (106/254), 50.78% (129/254) and 7.48% (19/254) of respondents that considered the operability of Survey of oncomelanid snails (WS/T 563—2017) was very good, good and general, respectively. The findings demonstrate that the issue and implementation of Survey of oncomelanid snails (WS/T 563—2017) has filled the gap for the standardization of snail control techniques, and which plays an importang guiding role in the national schistosomiasis control program.

Application of CRISPR/Cas systems in the nucleic acid detection of pathogens: a review / 中国血吸虫病防治杂志

Rapid, sensitive and specific detection tools are critical for the prevention and control of infectious diseases. The in vitro nucleic acid amplification assays, including polymerase chain reaction and isothermal amplification technology, have been widely used for the detection of pathogens. Recently, nucleic acid detection-based on clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated proteins (Cas) have been developed, which are rapid, highly sensitive, highly specific, and portable. This review describes the classification and principle of CRISPR/Cas systems and their applications in pathogen detection, and discusses the prospects of CRISPR/Cas systems.

Down-regulation of the Smad signaling by circZBTB46 via the Smad2-PDLIM5 axis to inhibit type I collagen expression / 老年心脏病学杂志（英文版）

BACKGROUND@#Abnormal type I collagen (COL1) expression is associated with the development of many cardiovascular diseases. The TGF-beta/Smad signaling pathway and circRNAs have been shown to regulate COL1 gene expression, but the underlying molecular mechanisms are still not fully understood.@*METHODS@#Gain- and loss-of-function experiments were prformed to study the effect of circZBTB46 on the expression of alpha 2 chain of type I collagen (COL1A2). Co-immunoprecipitation assay was performed to observe the interaction between two proteins. RNA immunoprecipitation assay and biotin pull-down assay were performed to observe the interaction of circZBTB46 with PDLIM5.@*RESULTS@#In this study, we investigated the role of circZBTB46 in regulating COL1A2 expression in human vascular smooth muscle cells (VSMCs). We found that circZBTB46 is expressed in VSMCs and that TGF-beta inhibits circZBTB46 formation by downregulating KLF4 expression through activation of the Smad signaling pathway. CircZBTB46 inhibits the expression of COL1A2 induced by TGF-beta. Mechanistically, circZBTB46 mediates the interaction between Smad2 and PDLIM5, resulting in the inhibition of Smad signaling and the subsequent downregulation of COL1A2 expression. Furthermore, we found that the expression of TGF-beta and COL1A2 is decreased, while circZBTB46 expression is increased in human abdominal aortic aneurysm tissues, indicating that circZBTB46-mediated regulation of TGF-beta/Smad signaling and COL1A2 synthesis in VSMCs plays a crucial role in vascular homeostasis and aneurysm development.@*CONCLUSIONS@#CircZBTB46 was identified as a novel inhibitor of COL1 synthesis in VSMCs, highlighting the importance of circZBTB46 and PDLIM5 in regulating TGF-beta/Smad signaling and COL1A2 expression.

Interpretation of Chinese experts consensus on artificial intelligence assisted management for pulmonary nodule (2022 version) / 中国胸心血管外科临床杂志

@#The increasing number of pulmonary nodules being detected by computed tomography scans significantly increase the workload of the radiologists for scan interpretation. Limitations of traditional methods for differential diagnosis of pulmonary nodules have been increasingly prominent. Artificial intelligence (AI) has the potential to increase the efficiency of discrimination and invasiveness classification for pulmonary nodules and lead to effective nodule management. Chinese Experts Consensus on Artificial Intelligence Assisted Management for Pulmonary Nodule (2022 Version) has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future AI-assisted management on the diagnosis and treatment of pulmonary nodules. It is hoped that through our joint efforts, we can promote the standardization of management for pulmonary nodules and strive to improve the long-term survival and postoperative life quality of patients with lung cancer.

Running ahead of evolution - AI based simulation for predicting future high-risk SARS-CoV-2 variants

The never-ending emergence of SARS-CoV-2 variations of concern (VOCs) has challenged the whole world for pandemic control. In order to develop effective drugs and vaccines, one needs to efficiently simulate SARS-CoV-2 spike receptor binding domain (RBD) mutations and identify high-risk variants. We pretrain a large protein language model on approximately 408 million protein sequences and construct a high-throughput screening for the prediction of binding affinity and antibody escape. As the first work on SARS-CoV-2 RBD mutation simulation, we successfully identify mutations in the RBD regions of 5 VOCs and can screen millions of potential variants in seconds. Our workflow scales to 4096 NPUs with 96.5% scalability and 493.9x speedup in mixed precision computing, while achieving a peak performance of 366.8 PFLOPS (reaching 34.9% theoretical peak) on Pengcheng Cloudbrain-II. Our method paves the way for simulating coronavirus evolution in order to prepare for a future pandemic that will inevitably take place. Our models are released at https://github.com/ZhiweiNiepku/SARS-CoV-2_mutation_simulation to facilitate future related work.

Maternal risk factors and neonatal outcomes associated with low birth weight.

This study aims to evaluate the incidence of low birth weight (LBW) and related maternal risk factors (during pregnancy or childbirth) and neonatal outcomes. A retrospective cross-sectional study design was used to select 7,421 pregnant women who gave birth in our hospital from January 2018 to June 2021. The data were analyzed using STATA 14.1, and the dependent variable (LBW) and risk were analyzed by the chi-square test of independence. The association between factors is used to determine the factors related to LBW through bivariate and multivariate logistic regression. The incidence of LBW in this study was 4.77%. Compared with single pregnant women, the probability of newborn LBW in married pregnant women is 40% lower (AOR = 0.60 95%CI: 0.40-0.90, p = 0.013). Compared with gestational age less than 37 weeks, the LBW probability of gestational age 37-42 and 42 weeks or older is 85 and 81% lower respectively (AOR = 0.15 95% CI: 0.10-0.24, p = 0.001; AOR = 0.19 95 %CI: 0.09-38, p = 0.001), compared with normal pregnant women, the probability of neonatal LBW among pregnant women with hypertension is 94% higher [AOR = 1.94 (95% CI: 1.39-2.74, p = 0.001). Compared with neonates with normal birth weight, neonates with LBW are at Apgar 1 min And Apgar 5 min score is lower than 7 (AOR = 0.52 95%CI: 0.37-0.73, p = 0.001, AOR = 0.54 95%CI: 0.38-0.75, p = 0.001) higher risk. In conclusion, women's marital status (single), gestational age (<37 weeks), and combined hypertension are independently associated with LBW, and the higher risk of Apgar 1 min and Apgar 5 min scores <7 is an independent result of LBW.

S373P Mutation of Spike Protein in SARS-CoV-2 Stabilizes Omicron

Recently, a cluster of several newly occurring mutations on Omicron, which is currently the dominant SARS-CoV-2 variant, are found at the (mechanically) stable {beta}-core region of spike proteins receptor-binding domain (RBD), where mutation rarely happened before. Notably, the binding of SARS-CoV-2 to human receptor ACE2 via RBD happens in a dynamic airway environment, where mechanical force caused by coughing or sneezing occurs and applies to the proteins. Thus, we used atomic force microscopy-based single-molecule force spectroscopy (AFM-SMFS) to measure the stability of RBDs and found that the unfolding force of Omicron RBD increased by 20% compared with the wild-type. Molecular dynamics simulations revealed that Omicron RBD showed more hydrogen bonds in the {beta}-core region due to the closing of the -helical motif caused primarily by the S373P mutation, which was further confirmed by the experiment. This work reveals the stabilizing effect of the S373P mutation and suggests mechanical stability becomes another important factor in SARS-CoV-2 mutation selection.

Diagnosis and treatment status of perioperative anemia in patients with gastrointestinal neoplasms: a multi-center study in Hubei Province / 中华外科杂志

Objective: To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. Methods: The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The t test and χ2 test were used for inter-group comparison. Results: The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) vs. 3.05% (140/4 589), χ²=434.555, P<0.01) and the incidence of postoperative complications (17.78% (513/2 885) vs. 14.08% (646/4 589), χ²=18.553, P<0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days vs. (13.3±6.2) days, t=5.202, P<0.01). Conclusions: The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.

Efficacy analysis of jejunal side anastomosis combined with jejunal nutrition tube in gastric cancer surgery / 中国综合临床

Objective:To investigate the adverse reactions and postoperative inflammatory reactions of Bill-Roth Ⅱ (BⅡ) gastroenterostomy with jejunal anastomosis and jejunal nutrient tube placement using linear cutting and closing device in gastric cancer surgery.Methods:A retrospective case-control study was conducted on 93 patients undergoing gastric cancer surgery in The Affiliated Hospital of North China University of Science and Technology from February 2017 to April 2020. According to 2016 (American Joint Committee on Cancer/Universal Integrated Circuit Card) AJCC/UICC, (Tumor, Node, stage; Tumor lymph node metastasis; Distant metastasis) TNM, there were 11 cases in stage ⅠA, 14 cases in stage ⅠB, 13 cases in stage ⅡA, 15 cases in stage ⅡB, 11 cases in stage ⅢA, 13 cases in stage ⅢB, and 16 cases in stage ⅢC. There were 51 cases of gastric antrum carcinoma, 26 cases of gastric body carcinoma and 16 cases of gastric pylorus carcinoma. There were 27 cases of papillary adenocarcinoma, 26 cases of tubular adenocarcinoma, 22 cases of mucinous adenocarcinoma, 9 cases of signet-ring cell carcinoma, 7 cases of adenosquamous carcinoma, and 2 cases of squamous carcinoma. The patients were divided into experimental group (48 cases) and control group (45 cases) according to whether or not the linear cutting and closing device was added and jejunal anastomosis was performed and jejunal nutrition tube was placed. The gender composition, age, lesion site, pathological type, pathological stage, postoperative hospital stay and postoperative complications were compared between the two groups, and the white blood cell count WBC, C-reactive protein CRP on the 7th day after surgery, erythrocyte Sedimentation rate (ESR), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) inflammation indicators were compared between the two groups.Results:There was no significant difference in gender composition, age, lesion location, pathological type and pathological stage between the two groups (all P>0.05). The incidence of abdominal pain, abdominal distension, nausea, vomiting and pleural effusion in 93 patients were 18.3%(17/93), 21.5%(20/93), 23.7%(22/93), 17.2%(16/93) and 18.3%(17/93), respectively. The complication rates of the above indexes in the two groups were 10.4% (5/48) Compared with 26.7% (12/45), 12.5% (6/48) and 31.1% (14/45), 15.6%(7/48) and 33.3% (15/45), 8.3%(4/48) and 26.7% (12/45), 8.3% (4/48) and 28.9% (13/45) (χ 2 values were 4.11, 4.77, 4.52, 4.27 and 5.27, respectively; P values were 0.043, 0.029, 0.033, 0.039 and 0.022, respectively). There was no significant difference in lower extremity venous thrombosis, anastomotic bleeding, accumulated pneumonia and incision dehiscence between the two groups ( P>0.05). WBC on the 7th day after operation in the experimental group and the control group (7.02±1.83)×10 9/L and (8.39±2.27)×10 9/L ( t=3.22, P=0.002), TNF-α (2.44±0.70) μg/L and (3.56±1.14) μg/L ( t=5.71, P<0.001), IL-6 (235.31±41.72) μg/L and (365.91±73.16) μg/L ( t=10.66, P<0.001) there was significant difference between the two groups. There was no significant difference in CRP and ESR between the two groups on the 7th day after operation ( P>0.05). The postoperative hospital stay between the experimental group and the control group was (13.88±2.81) d and (22.78±2.51) d, the difference was statistically significant ( t=16.07, P<0.001). Conclusion:The application of side-to-side jejunostomy combined with jejunal nutrition tube for enteral nutrition in gastric cancer surgery can reduce the occurrence of adverse reactions such as postoperative abdominal pain, abdominal distension, accumulated pneumonia, nausea, vomiting and pleural effusion, reduce the postoperative hospital stay and reduce the postoperative inflammatory reaction to a certain extent.

Circumference characteristics of Tibetan-Burman adults / 解剖学报

Objective To investigate the characteristics of bod)' circumference of Tibetan-Burman adults. Methods Using a human bod)' altimeter and a measuring tape, the height and 9 circumference indicators of 14 722 adults from 17 Tibetan-Bunnan ethnic groups in Sichuan, Yunnan, Guizhou, Hubei, Hu ' nan and Tibet Autonomous Region were measured from 2015 to 2019, 5 circumference indexes were calculated, and the data were statistically analyzed. Results The higher the longitude, the larger the head circumference, thigh circumference, biceps circumference and foreann circumference of Tibetan-Bunnan adults and the female maximum biceps circumference, and the smaller the trunk circumferences and male calf circumference; The higher the latitude, the larger the circumferences (except for female thigh circumference); The higher the altitude, the larger the circumferences; The higher the temperature, the smaller the circumferences. Conclusion Among the 17 ethnic groups of Tibeto-Burman, the Tibetan has a larger circumference, while the Gongshan Nu, Lahu, and Drung have relatively small and close circumferences. With age, the chest and waist circumferences of Tibetan-Bunnan adults increase, and the circumference of the limbs decreases.

Facial changes of Mongolian nationality from youth to old age in China / 解剖学报

Objective To explore the law of changes in the appearance of Chinese Mongolians with age. Methods Totally 24 human indexes of head and face from 4410 cases (1916 males and 2494 females) and 13 Mongolian ethnic groups were measured, and 12 craniofacial indexes were calculated. Correlation analysis was used to study the changes of craniofacial indexes and indexes with age. The method of analysis of variance was used to study whether the differences between the index values and index values of the three age groups were statistically significant. Results With the increase of age, the distance between the two mandibular angles became wider, the mouth widened, the width, height and length of the nose increased, the skin of the upper lip increased, the length and width of the ear increased, the width of the head, forehead, face, mastoid and tragus narrowed, the width of the eyes narrowed, the upper and lower lips thinned, the circumference of the head and the height of the head decreased, and the length of the head did not change significantly. With the increase of age, the Mongolian face becomes narrower and longer, the proportion of the height of the face in the whole head high school increases, the nose becomes wider, and the head appears to be relatively longer, lower and wider. The distance between the left and right frontotemporal points is relatively closer, the mouth cleft appears more slender, and the ratio of length to width of the ear does not change much. Conclusion With the increase of age, the facial features of Mongolian have changed.

Prevention and treatment system design and digital management practice of venous thromboembolism in hospital / 中华医院管理杂志

Venous thromboembolism(VTE)is a high mortality disease involving multiple factors, and public hospitals assume the main responsibility for the diagnosis and treatment of VTE. Based on the concept of taking patients as the center, Zhejiang Provincial People′s Hospital improved the system design and digital level, and carried out digital practices such as patient timeline management, high-risk patient management, VTE special disease bank, and auxiliary decision-making system. The hospital evaluation rate and prevention rate continued to increase, the follow-up effect was good, and the workload of medical staff was reduced and satisfaction rate was improved.

Combination of preoperative CA19-9 levels, cell differentiation, and age predicts survival for patients with gastric cancer before surgery.

ABSTRACT: Gastric cancer (GC) is very common in China, posing a threat to public health, with high morbidity and mortality ranks. Tumor-node-metastasis (TNM) staging system is routinely used to predict prognosis for patients with GC but only available after surgery. Therefore, searching for markers that can predict prognosis of GC patients before surgery is desirable to assist management decisions preoperatively. Among 322 GC patients followed-up for 128 months, the tumor markers alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 15-3 and carbohydrate antigen 72-4 of 168 patients were detected before surgery, and their impact on survival was analyzed. Four major findings were revealed: (1) Preoperative examined CA19-9 levels and cell differentiation using endoscopic biopsies were positively correlated with lymphatic metastases and TNM stages obtained after surgery. (2) Kaplan-Meier analyses demonstrated that poor survival of patients with GC was associated with higher CA19-9 levels, poor cell differentiation, and older age. (3) Cox multi-factorial regression analyses indicated that, in terms of predicting overall survival for GC patients, preoperative CA19-9 level, cell differentiation and age were independent factors, respectively, comparable to postoperative TNM staging system. (4) Using receiver operating characteristic curve analysis, we first revealed that preoperative CA19-9 levels and cell differentiation had the impact weights (IW) on survival comparable to postoperative TNM components. These findings suggest that preoperative CA19-9 levels, cell differentiation and age are useful prognostic related markers for GC patients, superior to postoperative TNM system in terms of timing for management. We propose that, assisted by clinical imaging, a comprehensive utilization of these preoperative survival-predictors may help formulate individualized medical management for GC patients such as surgical strategy, optimal chemotherapy and radiotherapy, and appropriate follow-up intervals after surgery.

Detecting Task Difficulty of Learners in Colonoscopy: Evidence from Eye-Tracking.

Eye-tracking can help decode the intricate control mechanism in human performance. In healthcare, physicians-in-training require extensive practice to improve their healthcare skills. When a trainee encounters any difficulty in the practice, they will need feedback from experts to improve their performance. Personal feedback is time-consuming and subjected to bias. In this study, we tracked the eye movements of trainees during their colonoscopic performance in simulation. We examined changes in eye movement behavior during the moments of navigation loss (MNL), a signature sign for task difficulty during colonoscopy, and tested whether deep learning algorithms can detect the MNL by feeding data from eye-tracking. Human eye gaze and pupil characteristics were learned and verified by the deep convolutional generative adversarial networks (DCGANs); the generated data were fed to the Long Short-Term Memory (LSTM) networks with three different data feeding strategies to classify MNLs from the entire colonoscopic procedure. Outputs from deep learning were compared to the expert's judgment on the MNLs based on colonoscopic videos. The best classification outcome was achieved when we fed human eye data with 1000 synthesized eye data, where accuracy (91.80%), sensitivity (90.91%), and specificity (94.12%) were optimized. This study built an important foundation for our work of developing an education system for training healthcare skills using simulation.

Mutation N501Y in RBD of Spike Protein Strengthens the Interaction between COVID-19 and its Receptor ACE2

SARS-CoV-2 is spreading around the world for the past year. Enormous efforts have been taken to understand its mechanism of transmission. It is well established now that the receptor-binding domain (RBD) of the spike protein binds to the human angiotensin-converting enzyme 2 (ACE2) as its first step of entry. Being a single-stranded RNA virus, SARS-CoV-2 is evolving rapidly. Recently, several variants such as B.1.1.7, B.1.351, and P.1, with a key mutation N501Y on the RBD, appear to be more infectious to humans. To understand its mechanism, we combined cell surface binding assay, kinetics study, single-molecule technique, and computational method to investigate the interaction between these RBD (mutations) and ACE2. Remarkably, RBD with the N501Y mutation exhibited a considerably stronger interaction characterized from all these methodologies, while the other two mutations from B.1.351 contributed to a less effect. Fluorescence-activated cell scan (FACS) assays found that RBD N501Y mutations are of higher binding affinity to ACE2 than the wild type. Surface plasmon resonance further indicated that N501Y mutation had a faster association rate and slower dissociation rate. Consistent with the kinetics study, atomic force microscopy-based single-molecule force microscopy quantify their strength on living cells, showing a higher binding probability and unbinding force for the mutation. Finally, Steered Molecular Dynamics (SMD) simulations on the dissociation of RBD-ACE2 complexes revealed that the N501Y introduced additional {pi}-{pi} and {pi}-cation interaction for the higher force/interaction. Taken together, we suggested that the reinforced interaction from N501Y mutation in RBD should play an essential role in the higher transmission of COVID-19 variants.

Practice of applying multimedia technology in doctor-patient communication before diagnosis and treatment / 中华医院管理杂志

The existing doctor-patient communication pattern often falls prey to insufficient informed consent and even medical disputes. In the patient centered perspective, Zhejiang Provincial People′s Hospital explored a new communication mode centering on patients. Based on diagnosis-related groups catalogues and high-frequency surgeries catalogues of the departments, multimedia technology was called into play to produce dubbed PPTs and videos that were easy to understand, standardized and homogeneous, which were embedded into medical records system. Following observation of the PPT or video, patients could directly sign an informed consent on the computer. This practice not only deepens patient′s understanding and achieves homogeneous level of the communication, but also elevates doctor′s work efficiency, contributing to building a harmonious doctor-patient relationship.