Effect of transanal mucosal flap displacement and transanal intersphincterotomy on the treatment of complex anal fistulas and their influence on the pressure of anorectal canal / 临床外科杂志

Objective To explore the effect of Endoanal advancement flap(ERAF)and transanal opening of interphincteric space(TROPIS)in the treatment of complex anal fistula and their impact on anorectal pressure,so as to provide a reference for clinical selection of surgical methods.Methods Eighty-four patients with complex anal fistula admitted from October 2018 to October 2022 were divided into group E received ERAF treatment(n=48)and group T received TROPIS treatment(n=36).The clinical efficacy,operation,wound surface and anorectal pressure of the two groups were compared.Results The effective rate of treatment in Group T was 97.22％,which was higher than that in Group E(87.50％),with no statistically significant difference(P＞0.05).The surgical time[(31.53 ±7.29)minutes],intraoperative bleeding volume[(29.56±7.37)ml],and wound area[(10.03± 0.96)cm2,(8.76±0.87)cm2,(6.20±0.77)cm2]on the day of surgery,7 and 14 days after surgery in Group T were all smaller than those in Group E[(35.36±8.54)min,(36.86±8.04)ml,(12.09± 1.23)cm2,(10.52±1.09)cm2 and(7.36±0.85)cm2](P＜0.05).After surgery,the VAS score and Wexner incontinence score of Group T were(1.38±0.27)and(0.21±0.08),respectively.Group E was(1.56±0.29)and(0.33±0.09),respectively.In group T,the anorectal systolic pressure at 20 mm and 30 mm and the anorectal resting pressure at 20 mm and 30 mm were(138.18±29.58)mmHg,(136.22±35.41)mmHg,(35.47±6.58)mmHg,and(32.97±8.01)mmHg,respectively.In Group E,the data was(152.78±31.53)mmHg,(156.29±32.74)mmHg,(38.29±7.62)mmHg and(36.41±7.63)mmHg,respectively.Both groups showed a decrease in score and anorectal pressure,and group T was lower than group E(P＜0.05).The incidence of adverse reactions in Group E was 20.83％,which was higher than that in Group T(11.11％),but the difference was not statistically significant(P＞0.05).Conclusion TROPIS has a better effect in the treatment of complex anal fistula,which can shorten the operation time,reduce intraoperative bleeding,reduce postoperative pain,and protect anal function.

Relationship between white matter fiber tract changes and executive function impairment in patients with Alzheimer's disease / 中风与神经疾病杂志

@#Objective To explore the relationship between changes in white matter fiber tracts and executive function impairment in patients with Alzheimer's disease (AD). Methods A total of 118 patients with AD admitted to our hospital from December 2019 to January 2022 were divided into executive dysfunction group(n=46) and normal executive function group(n=72) based on their executive function. General data and the fractional anisotropy (FA) values of white matter fiber tracts in different brain regions were compared between the two groups. Multivariable logistic regression analysis was performed to determine influencing factors for executive dysfunction in patients with AD. Pearson analysis was used to analyze the correlation between the FA values of white matter fiber bundles in various brain regions and the Behavioral Assessment of the Dysexecutive Syndrome (BADS) score. Spearman analysis was used to analyze the correlation between the FA values of white matter fiber bundles in various brain regions and executive dysfunction. A Bayesian network model was constructed and evaluated for its effectiveness. Results Severe dementia and the volume of white matter lesions (WMLs) were independent risk factors for executive dysfunction in patients with AD(P<0.05). BADS score and the mean FA value of white matter fiber bundles were protective factors against executive dysfunction (P<0.05).The FA value of white matter fiber bundles in each region was significantly positively correlated with BADS score(P<0.05) and significantly negatively correlated with executive dysfunction (P<0.05). For the constructed Bayesian network model,the area under the curve was 0.839 (95% confidence interval [CI]:0.822-0.853,P<0.001), indicating high predictive value. Conclusion The FA value of white matter fiber bundles is an independent protective factor against executive dysfunction in patients with AD,which is significantly negatively correlated with executive dysfunction. Measuring white matter fiber bundle changes may be an objective examination method of executive function decline in patients with AD.

Genomic perspectives on the emerging SARS-CoV-2 Omicron variant

A new variant of concern for SARS-CoV-2, Omicron (B.1.1.529), was designated by the World Health Organization on November 26, 2021. This study analyzed the viral genome sequencing data of 108 samples collected from patients infected with Omicron. First, we found that the enrichment efficiency of viral nucleic acids was reduced due to mutations in the region where the primers anneal to. Second, the Omicron variant possesses an excessive number of mutations compared to other variants circulating at the same time (62 vs. 45), especially in the Spike gene. Mutations in the Spike gene confer alterations in 32 amino acid residues, which was more than those observed in other SARS-CoV-2 variants. Moreover, a large number of nonsynonymous mutations occur in the codons for the amino acid residues located on the surface of the Spike protein, which could potentially affect the replication, infectivity, and antigenicity of SARS-CoV-2. Third, there are 53 mutations between the Omicron variant and its closest sequences available in public databases. Many of those mutations were rarely observed in the public database and had a low mutation rate. In addition, the linkage disequilibrium between these mutations were low, with a limited number of mutations (6) concurrently observed in the same genome, suggesting that the Omicron variant would be in a different evolutionary branch from the currently prevalent variants. To improve our ability to detect and track the source of new variants rapidly, it is imperative to further strengthen genomic surveillance and data sharing globally in a timely manner.

Genomic epidemiology of SARS-CoV-2 in Pakistan

Pakistan has been severely affected by the COVID-19 pandemic. To investigate the initial introductions and transmissions of the SARS-CoV-2 in the country, we performed the largest genomic epidemiology study of COVID-19 in Pakistan and generated 150 complete SARS-CoV-2 genome sequences from samples collected before June 1, 2020. We identified a total of 347 variants, 29 of which were over-represented in Pakistan. Meanwhile, we found over one thousand intra-host single-nucleotide variants. Several of them occurred concurrently, indicating possible interactions among them. Some of the hypermutable positions were not observed in the polymorphism data, suggesting strong purifying selections. The genomic epidemiology revealed five distinctive spreading clusters. The largest cluster consisted of 74 viruses which were derived from different geographic locations and formed a deep hierarchical structure, indicating an extensive and persistent nation-wide transmission of the virus that was probably contributed by a signature mutation of this cluster. Twenty-eight putative international introductions were identified, several of which were consistent with the epidemiological investigations. No progenies of any of these 150 viruses have been found outside of Pakistan, most likely due to the nonphmarcological intervention to control the virus. This study has inferred the introductions and transmissions of SARS-CoV-2 in Pakistan, which could provide a guidance for an effective strategy for disease control.

Hybrid capture-based sequencing enables unbiased recovery of SAR-CoV-2 genomes from fecal samples and characterization of the dynamics of intra-host variants

BackgroundIn response to the current COVID-19 pandemic, it is crucial to understand the origin, transmission, and evolution of SARS-CoV-2, which relies on close surveillance of genomic diversity in clinical samples. Although the mutation at the population level had been extensively investigated, how the mutations evolve at the individual level is largely unknown, partly due to the difficulty of obtaining unbiased genome coverage of SARS-CoV-2 directly from clinical samples. MethodsEighteen time series fecal samples were collected from nine COVID-19 patients during the convalescent phase. The nucleic acids of SARS-CoV-2 were enriched by the hybrid capture method with different rounds of hybridization. ResultsBy examining the sequencing depth, genome coverage, and allele frequency change, we demonstrated the impeccable performance of the hybrid capture method in samples with Ct value < 34, as well as significant improvement comparing to direct metatranscriptomic sequencing in samples with lower viral loads. We identified 229 intra-host variants at 182 sites in 18 fecal samples. Among them, nineteen variants presented frequency changes > 0.3 within 1-5 days, reflecting highly dynamic intra-host viral populations. Meanwhile, we also found that the same mutation showed different frequency changes in different individuals, indicating a strong random drift. Moreover, the evolving of the viral genome demonstrated that the virus was still viable in the gastrointestinal tract during the convalescent period. ConclusionsThe hybrid capture method enables reliable analyses of inter- and intra-host variants of SARS-CoV-2 genome, which changed dramatically in the gastrointestinal tract; its clinical relevance warrants further investigation.

Single-cell transcriptional atlas of the Chinese horseshoe bat (Rhinolophus sinicus) provides insight into the cellular mechanisms which enable bats to be viral reservoirs

Bats are a major "viral reservoir" in nature and there is a great interest in not only the cell biology of their innate and adaptive immune systems, but also in the expression patterns of receptors used for cellular entry by viruses with potential cross-species transmission. To address this and other questions, we created a single-cell transcriptomic atlas of the Chinese horseshoe bat (Rhinolophus sinicus) which comprises 82,924 cells from 19 organs and tissues. This atlas provides a molecular characterization of numerous cell types from a variety of anatomical sites, and we used it to identify clusters of transcription features that define cell types across all of the surveyed organs. Analysis of viral entry receptor genes for known zoonotic viruses showed cell distribution patterns similar to that of humans, with higher expression levels in bat intestine epithelial cells. In terms of the immune system, CD8+ T cells are in high proportion with tissue-resident memory T cells, and long-lived effector memory nature killer (NK) T-like cells (KLRG1, GZMA and ITGA4 genes) are broadly distributed across the organs. Isolated lung primary bat pulmonary fibroblast (BPF) cells were used to evaluate innate immunity, and they showed a weak response to interferon {beta} and tumor necrosis factor- compared to their human counterparts, consistent with our transcriptional analysis. This compendium of transcriptome data provides a molecular foundation for understanding the cell identities, functions and cellular receptor characteristics for viral reservoirs and zoonotic transmission.