Spatial transcriptomic profiling of coronary endothelial cells in SARS-CoV-2 myocarditis

ObjectivesOur objective was to examine coronary endothelial and myocardial programming in patients with severe COVID-19 utilizing digital spatial transcriptomics. BackgroundSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has well-established links to thrombotic and cardiovascular events. Endothelial cell infection was initially proposed to initiate vascular events; however, this paradigm has sparked growing controversy. The significance of myocardial infection also remains unclear. MethodsAutopsy-derived cardiac tissue from control (n = 4) and COVID-19 (n = 8) patients underwent spatial transcriptomic profiling to assess differential expression patterns in myocardial and coronary vascular tissue. Our approach enabled transcriptional profiling in situ with preserved anatomy and unaltered local SARS-CoV-2 expression. In so doing, we examined the paracrine effect of SARS-CoV-2 infection in cardiac tissue. ResultsWe observed heterogeneous myocardial infection that tended to colocalize with CD31 positive cells within coronary capillaries. Despite these differences, COVID-19 patients displayed a uniform and unique myocardial transcriptional profile independent of local viral burden. Segmentation of tissues directly infected with SARS-CoV-2 showed unique, pro-inflammatory expression profiles including upregulated mediators of viral antigen presentation and immune regulation. Infected cell types appeared to primarily be capillary endothelial cells as differentially expressed genes included endothelial cell markers. However, there was limited differential expression within the endothelium of larger coronary vessels. ConclusionsOur results highlight altered myocardial programming during severe COVID-19 that may in part be associated with capillary endothelial cells. However, similar patterns were not observed in larger vessels, diminishing endotheliitis and endothelial activation as key drivers of cardiovascular events during COVID-19. Condensed AbstractSARS-CoV-2 is linked to thrombotic and cardiovascular events; however, the mechanism remains uncertain. Our objective was to examine coronary endothelial and myocardial programming in patients with severe COVID-19 utilizing digital spatial transcriptomics. Autopsy-derived coronary arterial and cardiac tissues from control and COVID-19 patients underwent spatial transcriptomic profiling. Our approach enabled transcriptional profiling in situ with preserved anatomy and unaltered local SARS-CoV-2 expression. We observed unique, pro-inflammatory expression profiles among all COVID-19 patients. While heterogeneous viral expression was noted within the tissue, SARS-CoV-2 tended to colocalize with CD31 positive cells within coronary capillaries and was associated with unique expression profiles. Similar patterns were not observed in larger coronary vessels. Our results highlight altered myocardial programming during severe COVID-19 that may in part be associated with capillary endothelial cells. Such results diminish coronary arterial endotheliitis and endothelial activation as key drivers of cardiovascular events during COVID-19 infection. LIST OF HIGHLIGHTSO_LISARS-CoV-2 has variable expression patterns within the myocardium of COVID-19 patients C_LIO_LISARS-CoV-2 infection induces a unique myocardial transcriptional programming independent of local viral burden C_LIO_LISARS-CoV-2 myocarditis is predominantly associated with capillaritis, and tissues directly infected with SARS-CoV-2 have unique, pro-inflammatory expression profiles C_LIO_LIDiffuse endothelial activation of larger coronary vessels was absent, diminishing large artery endotheliitis as a significant contributor to cardiovascular events during COVID-19 infection. C_LI

Hematological characteristics and current situation of chronic mountain sickness among Tibetan residents in extremely high altitude area of Ali / 西安交通大学学报(医学版)

【Objective】 To clarify the hematological characteristics and current situation of chronic mountain sickness among Tibetan residents in extreme high altitude area (more than 5 000 m above the sea level) of Ali district based on the analysis of physical examination and blood test results. 【Methods】 Totally 250 Tibetan residents were selected by convenient sampling for blood oxygen saturation (SpO2), heart rate, and blood routine examination. Chronic mountain sickness was determined according to the hemoglobin (Hb) level and SpO2. 【Results】 The red blood cell (RBC), Hb and hematocrit (HCT) of the Tibetan residents at 5 200-meter altitude were all higher than the normal physiological reference range of China. Mean red blood cell volume (MCV), mean red blood cell hemoglobin content (MCH), mean red blood cell hemoglobin concentration (MCHC), white blood cell (WBC) and platelet (PLT) were in the upper limit of the reference value. The RBC, Hb, HCT and MCHC of male Tibetan residents were higher than those of females, while PLT was lower than that of females, with significant differences. There were no statistical differences in MCV, MCH or WBC among different genders of Tibetan residents. The SpO2 of the Tibetan residents was about 85% of the normal value, and the males had higher SpO2 than the females in the same age group, and the difference was statistically significant, but the heart rate did not differ significantly. The prevalence rate of chronic mountain sickness in this area was as high as 16.4%, and the prevalence rate of heavy manual workers was significantly higher than that of light manual workers, with significant differences. 【Conclusion】 The high-altitude anoxic environment causes the changes in red blood cells, hemoglobin, and oxygen saturation of local residents, and the prevalence of chronic mountain sickness increases significantly. Labor intensity is one of the risk factors for chronic mountain sickness in high-altitude areas.

Implementation of the hierarchical medical system :an analysis based on the Smith policy implementation process model / 中华医院管理杂志

Objective To analyze the problems existing in the implementation of the hierarchical medical system in China under the new situation .Methods The Smith policy implementation process model was used as an analytic framework.By means of literature analysis ,stakeholder analysis and PEST analysis ,the analysis was conducted in terms of such elements as the Smith policy implementation process model ,namely ,the idealized policy ,the implementing organization ,the target group and the environmental factors ,as well as its mechanism of action .Results The literature review found that the main obstacle that hinders the smooth implementation of the hierarchical medical system was the lagging of relevant supporting measures ,which accounted for 16.6％ (161)of the problems.In addition ,defects in policy design(the lack of division and cooperation mechanism etc .)and constraints in existing institutional mechanism (separation of revenue and expenditure ,unclear orientation ,etc .) were suggested to accelerate the introduction of supporting policies ,respectively accounting for 6.0％(58) and 9.3％ (90 ) of the results .Conclusions In the process of policy implementation ,the relationship between the four elements of the ideal policy outcomes ,the implementing organization ,the target group and the environmental factors needs to be coordinated to ensure the effective implementation of the hierarchical medical system .

Literature review on influence of case-based payment on hospitalization costs / 中华医院管理杂志

Objective To systematic review the influence of case-based payment on inpatient costs since China′s new medical reform. Methods Studies about inpatient costs before and after the implementation of case-based payment were collected. The literature collected underwent a meta-analysis by RevMan 5. 0. Results A total of 11 articles in compliance were included in the study. The meta-analysis of random effect model showed the overall effect size (SMD) was -1. 54 with 95% CI being -1. 79, -1. 29, showing a significant difference (P<0. 05). The subgroup analysis showed that the overall effect size (MD) in the low-cost disease group was -585. 57 yuan with 95% CI being -750. 34, -420. 80, showing a significant difference (P < 0. 05). The overall effect size (MD) in the high-cost disease group was-4 172.65 yuan with 95% CI being -5 368. 21, -2 977. 10, showing a significant difference ( P <0.05). The funnel plot was approximately symmetrical, suggesting a publication bias as less likely in the study. Conclusions The implementation of case-based payment has reduced the inpatient costs to some extent thanks to China′s new healthcare reform. And the effect in the high-cost disease group was more obvious than that in the low-cost disease group.

Evaluation study of the current deployment of general practitioners and service usage by residents in China / 中华医院管理杂志

Objective To evaluate the current deployment of general practitioners and residents′utilization of services in China, for reference of their optimal allocation across the country. Methods The methods of HRDI and TOPSIS were used to comprehensively evaluate their deployment and residents′utilization of their services in China. Results General practitioners fall short of demand in general, averaging 0.137 1 GP per 1 000 population in China, with unbalanced regional distribution as well. Utilization of residents of general practitioners service remains at a low level, with unbalanced regional distribution as well. As shown in the comprehensive evaluation results, 87.10% of the regions were found with defective deployment and service utilization, featuring " low resources, low utilization" . Conclusions Sizable gapes are found between the eastern, the central and the western regions, in terms of allocation of resources and service utilization. The government should rationalize deployment of general practitioners and minimize such gaps among different regions, in view of local population, geography and health service needs.

Application status of official micro-blogs run by health and family planning commissions of provincial level / 中华医院管理杂志

Objective To analyze the current situation of the official micro-blogs of the health and family planning commissions of provincial level, and to understand its application approaches.Methods The internet crawler software was used to collect the 102 899 micro-blog posts published by 24 official micro-blogs of health and family planning commissions of provincial level,and analyze the information of crawling by using content analysis method.Results At present, except for a number of provinces in the eastern regions where such micro-blogs were active and interactive,most of these official micro-blogs were found poor in operation management, especially in the spreading capacity; their micro-blog content was focused on science popularization(59.50%).Part of the content lacked scientific basis,and was short of planning in their information release form and content.Conclusions These micro-blogs need optimization in operations management,service positioning,information release specifications,and content audit.Such efforts can help improve their spreading capacity,influence and user viscosity, in order to better serve the public, achieve the goal of a service-oriented government.

Constructing nurse′s ability of scientific research assessment system / 中国实用护理杂志

Objective To construct a scientific and objective assessment to value nurse′s ability of scientific research in order to provide an objective unified standard and operable method to value nurse′s ability of scientific research and provide a standard for medical institutions to select nurses of scientific research. Methods After searching literatures and interviewing 7 experts, Delphi method was used to construct primary variables of nurse′s ability of scientific research. Then a second interview was given to each of 18 experts. The variables were weighted using analytic hierarchy process. Results Variables to assess nurse′s ability of scientific research included 2 first grade indices, 9 second grade indices and 35 third grade indices. Questionnaire return rates for two rounds of interviews were 84.00%(21/25) and 85.71%(18/21), respectively. Degree of authority Cr was 0.938. Scores of variables′importance ranged at 4.06-4.96. Ratios of full scores ranged at 33.33%-94.44%. Variable coefficients ranged at 0.05-0.25. The weight coefficients of 3 first grade indices (scientific research accumulation, explicit ability of scientific research, and intrinsic ability of scientific research) were 0.475 and 0.525, respectively. Conclusions The nurse′s ability of scientific research assessment system based on Delphi method and analytic hierarchy process is scientific and objective. This system combines quantitative and qualitative variables. It thus can calculate the ability of nurse′s scientific research according to the three grade indices. It is operable to be used to assess the ability of nurse′s scientific research.

Fast Structure Confirmation of Daptomycin by Matrix_assisted Laser Desorption Ionization Mass Spectrometry and Electrospray Ionization Mass Spectrometry / 分析化学

Matrix_assisted laser desorption ionization_time of flight tandem mass spectrometry ( MALDI_TOF/TOF MS) and electrospray ionization_quadrupole_time of flight mass spectrometry ( ESI_Q_TOF MS) were used to confirm the structure of cyclic lipopeptide daptomycin fastly. First, the relative molecular weight 1916. 7107 of daptomycin was measured by ESI with error 0. 0007. The sample’s doubly charged peak m/z 809. 848 was selected as precursor ion for ESI_MS/MS analysis, and the exocyclic amino acid sequence C9 H19 CO_Trp_Asn_Asp was successfully matched. Second, the experimental conditions of cleaving daptomycin by lithium hydroxide ( LiOH) were optimized and the ring_opened process was monitored by MALDI_TOF/TOF MS. After obtaining ring_opened product with purity of above 95%, the MS/MS measurements by MALDI and ESI were carried out. The b+and y+of ring_opened product were completely matched, which confirmed the amino acid sequence of daptomycin. Finally, ESI_MS/MS conditions of ring_opened product were further optimized to obtain more low mass fragment ions for analyzing the structure of fatty acid chain and the cleavage pattern of fat chain in mass spectrometry was proposed. The method was fast, convenient, accurate and reliable for identifying cyclic lipopeptide compounds.

Characteristic analysis of highly cited papers in Chinese nursing journals / 中国实用护理杂志

Objective To analyze the distribution and content characteristics of highly cited pa pers in Chinese nursing journals,in order to give a reference for nursing researchers to design their studies and to improve more high quality nursing papers.Methods Nursing papers were searched from database of China Academic Journal Network.Papers cited 100 times or more were collected for statistical analysis.Results There were 266 nursing papers cited 100 times or more.They were found in 9 nursing journals,of which Chinese Nursing Journal was 69.1％.The paper most highly cited was 1 298 times.The contents of highly cited papers covered basic nursing (infusion nursing and air way nursing),health education,nursing management (safety management,nursing laws,and nursing profession protection),humanistic care,psychological nursing care,and pressure of nurses.Conclusions In order to produce high quality of nursing paper,nursing researchers should improve their academic sensitivity,pay more attention to the scientific fronts,emphasize basic nursing research and study persistent.