Comparing four immunosuppressive agents for chronic spontaneous urticaria-A network meta-analysis.

BACKGROUND: Immunosuppression is an integral part of treating chronic spontaneous urticaria (CSU), but there is no literature to evaluate the efficacy of multiple immunosuppressive agents. OBJECTIVE: The comparison of the efficacy, safety, and incidence of adverse effects of four immunosuppressive medicines (tripterygium glycosides, methotrexate, cyclosporine A, and azathioprine) in combination with antihistamines in treating CSU provides a clinical reference and evidence-based medicine for treating CSU. METHODS: PUBMED, The Cochrane Library, EMBASE, WANFANG, CNKI, CBM, and clinical trial registration platform were searched to collect relevant randomized controlled trials (RCT) and cohort studies of four immunosuppressive medicines combined with antihistamines for treating CSU. The primary outcomes were the efficacy of weekly urticaria activity score 7 (UAS7) and adverse effects. RESULTS: This study pooled data from seven randomized clinical trials with 410 participants. The standardized mean differences for change in UAS7 were 0.10 (95% confidence interval (CI), 0.01 to 0.68) for cyclosporine A plus antihistamine; 0.03 (95% CI, 0.00 to 0.23) for azathioprine plus antihistamine; 0.52 (95% CI, 0.32 to 0.85) for tripterygium glycosides plus antihistamine; and 1.54 (95% CI, 0.64 to 3.67) for methotrexate plus antihistamine. There were no significant differences in side effects between these medicines in the limited number of trials and clinical samples. CONCLUSION: Our results indicate that cyclosporine A combined with antihistamine resulted in greater improvements regarding the UAS7 in CSU patients and that tripterygium glycosides are also effective in treating CSU.

Construction and application of enhanced recovery after surgery-optimized management system with nurse-led multidisciplinary cooperation.

AIM: To evaluate the effect of enhanced recovery after surgery (ERAS)-optimized management system with nurse-led multidisciplinary cooperation. DESIGN: A quasi-experimental design. METHODS: Nursing department cooperated with medical and clinical department to establish an ERAS-optimized management system. After the system was developed, it was applied in surgical departments of the hospital. Using convenience sampling, 220 selective surgical patients, 82 nurses and 98 doctors from January 1st, 2021 to July 31st, 2021 were selected as the trial group. 220 selective surgical patients, 82 nurses and 98 doctors were selected as the control group from January 1st, 2020 to July 31st, 2020. ERAS observation indicators were compared between the two groups before and 6 months after implementation. The nurse professional identity scores and satisfaction of medical cooperation scores of the two groups at different time points were analysed by repeated analysis of variance. RESULTS: After the implementation, ERAS observation indicators in the trial group were better than the control group (p < 0.05). There were significant differences in the group main effect, time main effect and interaction effect of nurse professional identity scores, satisfaction of medical cooperation scores and scores in all dimensions between the two groups (p < 0.05). The scores of the experimental group at 3 months and 6 months after implementation were better than those of the control group (p < 0.05). CONCLUSIONS: Enhanced recovery after surgery-optimized management system with nurse-led multidisciplinary cooperation was an effective working method. It could promote patients recovery and enhance nurse professional identity.

Improved immune algorithm for sudden cardiac death first aid drones site selection.

AIMS: Out-of-hospital cardiac arrest (OHCA) requires a fast emergency response, while traditional emergency takes too long to meet the demand. Combining a drone with a defibrillator can provide rapid resuscitation of OHCA patients. The aims are to improve survival in OHCA and to minimize the total system cost. METHODS: We developed an integer planning model for sudden cardiac death (SCD) first aid drone siting based on a set covering model with the stability of the siting system as the main constraint, considering the rescue time and total system cost. Using 300 points to simulate potential cardiac arrest locations in the main municipal district of Tianjin, China, the SCD first aid drone siting points are solved using an improved immune algorithm. RESULTS: Based on the actual parameters set by the SCD first aid drone, 25 siting points were solved in the main municipal district of Tianjin, China. These 25 sites were able to cover 300 simulated potential demand points. The average rescue time was 127.18 s and the maximum rescue time was 296.99 s. The total system cost was 136,824.46 Yuan. Comparing the pre- and post-algorithm solutions, the system stability was improved by 42.22%, and the maximum number of siting points corresponding to demand points was reduced by 29.41% and the minimum number was increased by 16.86%, which is closer to the average. CONCLUSIONS: We propose the SCD emergency system and use the improved immune algorithm for example solving. Comparing the solution results using the pre- and post-improvement algorithms, the cost solved by the post-improvement algorithm is less and the system is more stable.

Efficient recall of SARS-CoV-2 variant-reactive B cells and T responses in the elderly upon heterologous mRNA vaccines as boosters.

Waning antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the emergence of variants of concern highlight the need for booster vaccinations. This is particularly important for the elderly population, who are at a higher risk of developing severe coronavirus disease 2019 (COVID-19) disease. While studies have shown increased antibody responses following booster vaccination, understanding the changes in T and B cell compartments induced by a third vaccine dose remains limited. We analyzed the humoral and cellular responses in subjects who received either a homologous messenger RNA(mRNA) booster vaccine (BNT162b2 + BNT162b2 + BNT162b2; ''BBB") or a heterologous mRNA booster vaccine (BNT162b2 + BNT162b2 + mRNA-1273; ''BBM") at Day 0 (prebooster), Day 7, and Day 28 (postbooster). Compared with BBB, elderly individuals (≥60 years old) who received the BBM vaccination regimen display higher levels of neutralizing antibodies against the Wuhan and Delta strains along with a higher boost in immunoglobulin G memory B cells, particularly against the Omicron variant. Circulating T helper type 1(Th1), Th2, Th17, and T follicular helper responses were also increased in elderly individuals given the BBM regimen. While mRNA vaccines increase antibody, T cell, and B cell responses against SARS-CoV-2 1 month after receiving the third dose booster, the efficacy of the booster vaccine strategies may vary depending on age group and regimen combination.

Study on the risk and countermeasure of prescription drugs sold online by drug retail enterprises / 中国药房

OBJECTIVE To analyze the risks of prescription drugs sold online by drug retail enterprises， and to provide countermeasures and suggestions for risk prevention and control of prescription drugs sold online. METHODS The risk hierarchy structure model of prescription drugs sold online by drug retail enterprises was constructed by using analytic hierarchy process. Multiple rounds of risk research and judgment were carried out on 123 pairs of evaluation indicators by using Delphi expert survey method. The normalized weight calculation and consistency test of risk judgment matrix were carried out to perform fuzzy quantitative research. RESULTS The risk of prescription dispensing and review （6.48%）， the risk of drug first and prescription later （5.48%）， the risk of rational drug use guidance （4.99%）， the risk of buying drugs by abnormal channel （4.97%）， the risk of “first diagnosis， non-chronic disease and non-common disease” （4.43%）， and the quality and safety risk of returned drugs （4.34%） and the application risk of regulatory technology （4.06%） were high risks； the overall risk of drug retail enterprises （chain） selling prescription drugs online was 38.67%， and the overall risk of drug retail enterprises （individual） selling prescription drugs online was 61.33%， with a difference of 22.66% between them. CONCLUSIONS There were 7 high-risk indicators for prescription drugs sold online by drug retail enterprises. Among them， the risk of prescription dispensing and review， the risk of drug first and prescription later， and the risk of rational drug use guidance are the top three high-risk points. The risk of prescription drugs sold online by drug retail enterprises （individual） is higher than that of drug retail enterprises （chain）. It is recommended that regulatory authorities focus on and regulate the prescription drugs sold online by drug retail enterprises （individual）， and encourage drug retail enterprises （chain） to establish a systematic online sales process for prescription drugs； for high-risk points of prescription drugs sold online， it is recommended that regulatory authorities and drug retail enterprises focus on it and take effective risk prevention and control measures to ensure the safe use of prescription drugs by the general public.

Substitution mode of rare and endangered Chinese medicinal materials and research strategy of multi-component replacement / 中国中药杂志

Rare and endangered Chinese medicinal materials are the material basis for innovation and development of Chinese medicinal materials and their curative effects are remarkable. However, the resources are in shortage due to various man-made or natural factors such as rising demand, overexploitation and environmental degradation. Therefore, finding alternatives is a feasible and effective solution. This study systematically sorted out the list of rare and endangered Chinese medicinal materials, and combed relevant policies and regulations. According to existing research, the substitution model of rare and endangered Chinese medicinal materials was constructed from the theoretical level. In view of the slow search for substitutes, the failure to follow the basic theory of traditional Chinese medicine in the process of research and development, the difficulty in breaking through technologies and the incomplete guarantee of the clinical efficacy of substitutes, a multi-component replacement was proposed to replace the originals with more effective components from a wide range of sources. This study was expected to promote the study on the substitutes of rare and endangered Chinese medicinal materials to step into a new stage.

Mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion lesion / 中国修复重建外科杂志

OBJECTIVE@#To explore the mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion.@*METHODS@#A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic "mini incision" transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up.@*RESULTS@#All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones ( P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences ( P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation ( P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation ( P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear.@*CONCLUSION@#Arthroscopic "mini incision" transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.

Effect of electroacupuncture on calcium homeostasis in hippocampal neurons of mice with sepsis-associated encephalopathy / 中华麻醉学杂志

Objective:To investigate the effect of electroacupuncture on calcium homeostasis in hippocampal neurons of mice with sepsis-associated encephalopathy (SAE).Methods:Twenty-four healthy male C57BL/6J mice, weighing 18-22 g, were divided into 4 groups ( n=6 each) using a random number table method: sham operation group (Sham group), SAE group, SAE plus electroacupuncture group (SAE+ EA group), and SAE plus sham electroacupuncture group (SAE+ SEA group). The virus carrying calcium ion (Ca 2+ ) fluorescent probes was injected and then an optical fiber was implanted into the hippocampal CA1 area to record the fluorescence signals of Ca 2+ . SAE was induced by cecal ligation and puncture in anesthetized mice at 3 weeks after administration. Starting from 3 days before surgery, Baihui and bilateral Quchi and bilateral Zusanli acupoints were stimulated for 30 min per day for 7 consecutive days in SAE+ EA group. In SAE+ SEA group, electroacupuncture was performed at the points 0.2 mm lateral to the corresponding acupoints without electrical stimulation. Open field tests were conducted at 5 days after surgery to record the number of rearing and changes in related Ca 2+ signals in hippocampal CA1 neurons. Novel object recognition tests were conducted at 6-7 days after surgery to record the recognition time and changes in related Ca 2+ signals in hippocampal CA1 neurons. Mice were sacrificed after the end of behavioral testing on 7 days after surgery, and brain tissues ipsilateral to the optical fiber implant were obtained and the fluorescence intensity of Ca 2+ in the hippocampal CA1 neurons was acquired using a fluorescent microscope. Results:Compared with Sham group, the number of rearing and amplitudes of related Ca 2+ signals in hippocampal CA1 neurons while rearing were significantly decreased in SAE group and SAE+ SEA group ( P<0.05), and no statistically significant changes were found in the parameters mentioned above in SAE+ EA group ( P>0.05), and the recognition index and amplitudes of related Ca 2+ signals while recognizing were significantly deceased, and the fluorescence intensity of Ca 2+ in hippocampal CA1 neurons was increased in SAE, SAE+ EA and SAE+ SEA groups ( P<0.05). Compared with SAE group and SAE+ SEA group, the number of rearing and amplitudes of related Ca 2+ signals in hippocampal CA1 neurons while rearing were significantly increased, the recognition index and amplitudes of related Ca 2+ signals in hippocampal CA1 neurons while recognizing were increased, and the fluorescence intensity of Ca 2+ in hippocampal CA1 neurons was decreased in SAE+ EA group ( P<0.05). There were no statistically significant differences in the parameters mentioned above between SAE group and SAE+ SEA group ( P>0.05). Conclusions:The mechanism by which electroacupuncture alleviates SAE may be related to regulation of Ca 2+ homeostasis in hippocampal neurons of mice.

Clinical observation of electroacupuncture combined with Qingyi Xianxiong Decoction in the treatment of acute respiratory distress syndrome due to severe acute pancreatitis / 中华危重病急救医学

Objective:To observe the clinical effect of electroacupuncture combined with Qingyi Xianxiong Decoction on the treatment of acute respiratory distress syndrome (ARDS) caused by severe acute pancreatitis (SAP).Methods:From February 2021 to April 2022, 120 patients with ARDS caused by SAP who were admitted to the department of critical care medicine of Tianjin Nankai Hospital and whose syndrome differentiation belonged to the syndrome of knot chest were selected. They were randomly divided into pure traditional Chinese medicine group and acupuncture medicine group, with 60 cases in each group. The pure traditional Chinese medicine group was received Qingyi Xianxiong Decoction on the basis of conventional western medicine treatment, and the acupuncture medicine group was received electric acupuncture treatment on the basis of the pure traditional Chinese medicine group. The two groups continued to be treated for 7 days. The primary outcome was the ventilator-free days within 28 days after admission to the intensive care unit (ICU), and the secondary outcome measures were mechanical ventilation time, the length of ICU stay, total lenth of hospital stay, time of intra-abdominal pressure recovery, scores of organ function, oxygenation index (PaO 2/FiO 2), serum inflammatory factors, blood amylase, urine amylase, etc. Results:Compared with the pure traditional Chinese medicine group, the ventilator-free days in the acupuncture medicine group within 28 days after admission to the ICU were significantly longer [day: 22.10±2.29 vs. 20.97±2.31, P < 0.05, odds ratio ( OR) = 1.24, 95% confidence interval (95% CI) was 1.053-1.460, P < 0.05]. The time of mechanical ventilation, the length of ICU stay, total length of hospital stay, and recovery time of intra-abdominal pressure were significantly shortened [mechanical ventilation time (days): 5.90±2.29 vs. 7.03±2.31, the length of ICU stay (days): 8.07±1.89 vs. 12.08±2.23, total length of hospital stay (days): 19.55±6.82 vs. 22.28±5.19, recovery time of intra-abdominal pressure (days): 6.05±1.81 vs. 8.45±1.76, all P < 0.05]. The Murray score and bedside index for severity in acute pancreatitis (BISAP) score of the two groups after 7 days of treatment were significantly lower than those before treatment, while PaO 2/FiO 2 was significantly higher than those before treatment, and the Murray score of the acupuncture medicine group after 7 days of treatment was significantly lower than that of the pure traditional Chinese medicine group [score: 0.50 (0.33, 0.75) vs. 1.00 (1.00, 1.33), P < 0.05], PaO 2/FiO 2 was significantly higher than that in the pure traditional Chinese medicine group [mmHg (1 mmHg ≈ 0.133 kPa): 390.75±27.73 vs. 330.02±42.34, P < 0.05]. With the prolongation of treatment time, the levels of inflammatory factors such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), serum amylase and urine amylase in both groups after treatment continued to decrease, and the levels of the inflammatory factors in the acupuncture medicine group after 7 days of treatment were significantly lower than those in the pure traditional Chinese medicine group [TNF-α (ng/L): 38.20±10.00 vs. 45.35±5.09, IL-6 (ng/L): 0.95±0.44 vs. 7.42±1.39, CRP (mg/L): 8.55±2.79 vs. 36.20±13.97, all P < 0.05]. Subgroup analysis showed that biliary system disease was a risk factor for the duration of mechanical ventilation ≥ 7 days in the treatment of ARDS with acupuncture and medicine ( OR = 2.728, 95% CI was 1.293-5.754). Conclusion:Compared with the pure traditional Chinese medicine, acupuncture combined can better reduce the clinical symptoms of patients with ARDS caused by SAP, promote the recovery of patients, and reduce systemic inflammatory reaction, which is worthy of clinical promotion.

Study on establishing the reference range of atrial septal excursion index and foramen ovale membrane angle in normal fetuses aged 16-40 weeks / 中华超声影像学杂志

Objective:To establish the normal reference range of atrial septal excursion index (ASEI) and foramen ovale membrane angle in normal fetuses aged 16-40 weeks, and to analyze the correlation between ASEI and foramen ovale membrane angle in normal fetuses.Methods:A total of 378 normal singletons with gestational ages of 16-40 weeks undergoing by fetal echocardiography were selected in the Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, from January to June 2021, and 349 fetuses successfully finished all measurements. After all fetuses completed the systematic fetal echocardiography, fetal foramen ovale diameter and foramen ovale membrane angle were measured on the four chamber view. The maximum distance of foramen ovale valve from the base of atrial septum to the free wall of left atrium and the transverse diameter of left atrium were measured, and ASEI was calculated. The differences of ASEI, foramen ovale membrane angle and foramen ovale diameter of the groups with different gestational weeks were compared. The correlations among ASEI, foramen ovale membrane angle and foramen ovale diameter were analyzed by Pearson correlation analysis.Results:All 349 fetuses were divided into 6 groups according to their gestational weeks, including 17 cases at 16-20 weeks, 46 cases at 21-24 weeks, 114 cases at 25-28 weeks, 105 cases at 29-32 weeks, 31 cases at 33-36 weeks and 36 cases at 37-40 weeks. The ± s of ASEI was 0.492 7±0.059 7, 95% CI was 0.486 4-0.499 0, 95% normal reference value range was 0.375 7-0.609 8. Significant differences were found in ASEI among different groups( P<0.05). The ± s of foramen ovale membrane angle was (44.03±5.48)°, 95% CI was 43.46-44.61°, 95% normal reference value range was 33.29-54.78°. Significant differences were found in the foramen ovale membrane angle among different groups( P<0.05). The ± s of foramen ovale diameter was (4.32±1.30)mm, 95% CI was 4.18-4.45 mm, the differences among different groups were significant( P<0.05) and foramen ovale diameter was found increased with the increase of gestational weeks. There was a significant positive correlation between ASEI and foramen ovale membrane angle ( r=0.558, P<0.05). There was no correlation between foramen ovale diameter and ASEI and foramen ovale membrane angle ( r=-0.166, -0.084; all P>0.05). Conclusions:The normal reference ranges of ASEI and foramen ovale valve angle of normal fetuses aged 16-40 weeks was successfully established. These parameters may be useful for evaluating diastolic cardiac function by assessing foramen ovale.

Comparative study on the axial length measurement with A-scan on different postures for difficult measuring eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To provide guidance for more accurate measurement of axial length(AL)of difficult measuring eyes by comparing the differences in the AL of the patient's difficult measuring eye with three methods of the sitting position, supine position A-scan and Lenstar 900(Lenstar, LS900). METHODS: Clinical case-control study. We selected 102 cases(102 eyes)including cataract patients with combined silicone oil filled, vitreous hemorrhage or retinal detachment and patients with dislocation of the lens or IOL in Zhengzhou Second Hospital from May 2019 to September 2020. AL were measured using LS900 and A-scan on sitting position and supine position respectively, and the results of the three methods were statistically analyzed.RESULTS: The detection rates of LS900 and A-scan axial measurement were 83% and 100% respectively. Three methods of A scan in sitting position, supine position and LS900 to measure the overall AL, silicone oil group, lens dislocation group and vitreous hemorrhage group, the differences were statistically significant(P&#x003C;0.001), The mean values of AL measured by overall A-scan, supine positions of silicone oil group, supine position of lens dislocation group and vitreous hemorrhage group were statistically significant differences with LS900 measurement(all P&#x003C;0.05), while there was no statistical difference between the results of the overall sitting position and the difficult measuring eye groups' sitting position compared with the LS900 measurement of AL. The three measurements showed good consistency within the 95% consistency range, but the result of A-scan on sitting position was closer to LS900.CONCLUSION: Changing the conventional decubitus position to the sitting position can improve the accuracy of the measurement results and provide clinicians with more reliable guidance for the treatment of patients with difficult measuring eyes of A-scan axial measurement, especially in diseases with altered ocular structure.

Preliminary experience of neoadjuvant immunochemotherapy in resectable non-small cell lung cancer / 中华胸心血管外科杂志

Objective:The study aimed was to explore the safety and efficacy of neoadjuvant immunochemotherapy for non-small cell lung cancer (NSCLC).Methods:We retrospectively collected data of all patients who received neoadjuvant immunochemotherapy and chemotherapy for NSCLC followed by surgery in our unit between January 2019 to September 2021.Results:Forty-four patients were diagnosed with NSCLC in a stageⅠ(2 cases), ⅡA(7 cases), ⅡB(11 cases), ⅢA (15 cases), ⅢB (1 case). The average age was 63 years old(range 44-71 years old). Squamous cell carcinoma accounted for 65.91% of all patients. Central lung cancer accounted for the vast majority, with 39 patients (88.64%). There were 19 cases in the neoadjuvant immunochemotherapy group and 25 cases in the neoadjuvant chemotherapy group; the average interval between the end of neoadjuvant therapy and the day of operation was 34 days, including( 33.74±10.66 )days in the immunochemotherapy group and (33.88±11.9) days in the chemotherapy group, and there was no significant difference between the two groups. No grade 3 or more adverse events occurred in all patients. There were 13 cases (63.16%) reached PR (partial response)+ CR (complete response) according to the Response Evaluation Criteria in Solid Tumors (RECIST v. 1.1) in the neoadjuvant immunity group and 11 cases (44.00%) in the neoadjuvant chemotherapy group. There was no significant difference between the two groups. In the neoadjuvant immunochemotherapy group, 9 cases (47.37%) achieved down-staging, In the neoadjuvant chemotherapy group, 8 cases (32.00%) achieved down-staging, there was no significant difference between the two groups. Seven patients (36.84%) in neoadjuvant immunochemotherapy group showed pCR (pathologic complete remission), but there were no patients who reached pCR in the neoadjuvant chemotherapy group., the difference was statistically significant ( P=0.001). Four patients (21.05%) in the neoadjuvant immunochemotherapy group reached mPR (major pathologic response), 6 patients (24.00%) in the neoadjuvant chemotherapy group reached mPR, and the difference was no statistically significant( P= 0.817). Conclusion:The safety of neoadjuvant immunochemotherapy was satisfactory; Compared with neoadjuvant chemotherapy, neoadjuvant immunochemotherapy did not increase the preoperative grade 3 adverse events and prolong the waiting time before operation; neoadjuvant immunochemotherapy had obvious advantages in pCR, which provided the possibility for the cure of tumor.

Maternal stress perception in the first or second trimester affects breastfeeding behavior: a prospective cohort study / 中华围产医学杂志

Objective:To explore the effect of maternal stress perception and plasma serotonin level in the first or second trimester on breastfeeding behavior, and to provide evidence for promoting exclusive breastfeeding.Methods:This prospective cohort study recruited pregnant women (≤20 gestational weeks) from Maternal and Child Health Center of Gulou District from April 2019 to March 2020. Stress perception at study enrollment was evaluated using Perceived Stress Scale (PSS) and the maternal plasma serotonin level was detected. Telephone interviews were conducted 42 d after delivery to collect information on childbirth and breastfeeding. Chi-square test, two independent samples t-test, and logistic regression model were used to analyze the risk factors of non-exclusive breastfeeding. Results:A total of 366 pregnant women were enrolled and 353 (96.4%) of them completed telephone interviews, who were divided into the exclusive ( n=194) and non-exclusive breastfeeding group ( n=159). Univariate analysis showed that the PSS scores [(19.4±6.9) vs (21.1±6.9) scores, t=－2.25, P=0.026] and the proportion of high-stress perception [23.7% (46/194) vs 34.0% (54/159), χ 2=4.03, P=0.045] in the exclusive group were all significantly lower than those in non-exclusive group. In the logistic regression analysis, exclusive breastfeeding was set as the dependent variable and the independent variables included factors with P<0.200 in the univariate analysis (PSS scores or PSS rating, plasma serotonin level, age, delivery mode) and potential clinical risk factors (parity, preterm birth). The results showed that when PSS was considered as a continuous variable, total PSS scores in the first or second trimester was an independent risk factor for non-exclusive breastfeeding ( OR=1.043, 95% CI: 1.010-1.077, P=0.011) and so was the high-stress perception when PSS was considered as a categorical variable (PSS rating) ( OR=1.765, 95% CI: 1.097-2.854, P=0.020). Conclusions:Overstress in the first or second trimester will affect breastfeeding patterns. Mental health counseling may help relieve perinatal stress, which will further increase the exclusive breastfeeding rate.

Clinicopathological analysis of lung transplantation in the treatment of end-stage lung disease complicated with neuroendocrine carcinoma / 中华器官移植杂志

Objective:To explore the clinicopathological features of end-stage lung disease complicated with neuroendocrine carcinoma after lung transplantation (LT).Methods:From April 2017 to December 2021, 5 cases of neuroendocrine cancer were diagnosed as end-stage lung disease by hematoxylin-eosin (HE) and immunohistochemical stain.Clinical follow-up data, histological characteristics and immunophenotyping were analyzed retrospectively.Results:The ratio of male-to-female in five recipients was 4: 1 and the average age 64(56-73) years.Three cases were idiopathic pulmonary fibrosis concomitant with small cell carcinoma (including 1 case of combined small cell carcinoma), bronchiectasis plus carcinoid carcinoma (n=1) and connective tissue disease-related fibrosis plus carcinoid carcinoma (n=1). HE stain indicated that morphological spectrum changed from neuroendocrine cell hyperplasia to carcinoid in transplanted lung of bronchiectasis.Immunohistochemical stain indicated that neuroendocrine markers CgA, Syn, CD56 and epithelial markers AE1/AE3, TTF-1 were positive for small cell carcinoma and carcinoid.Ki-67 index of small cell carcinoma (n=2) and combined small cell carcinoma (n=1) was 80% and Ki-67 index of carcinoid (n=2) was ≤1%.Until the last follow-up, 3/5 patients survived and the remaining 2 died of Klebsiella pneumoniae, Corynebacterium striatus and Acinetobacter baumannii infections at Days 33 and 196 post-transplantation.Conclusions:Neuroendocrine carcinoma in transplanted lung is more common in elderly males and end-stage lung disease is mostly idiopathic pulmonary fibrosis.Small cell carcinoma is a major type of neuroendocrine carcinoma.Specific neuroendocrine markers and TTF-1 aid in a definite diagnosis of neuroendocrine carcinoma.Postoperative infection is an important prognostic factor.

Serum uric acid and short term prognosis of acute ischemic stroke in patients received intravenous thrombolysis / 中华内分泌代谢杂志

Objective:To investigate the relationship between serum uric acid (SUA) and 3-month outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis.Methods:A total of 386 patients with acute ischemic stroke received intravenous thrombolysis therapy from 1 January 2017 to 31 December 2019 in the Affiliated Hospital of Lianyungang, Xuzhou Medical University were enrolled prospectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. The functional outcome was evaluated by the modified Rankin Scale at discharge or 3 months after onset. Pearson′s correlation was used to assess the relationship between SUA and NIHSS scores at baseline and discharge. Propensity score matching was used to balance confounding factors. Multivariate logistic regression model was used to identify the correlation between SUA and prognostic outcome after thrombolysis.Results:A total of 386 eligible patients were included. Two hundred and thirty patients (59.6%) had good outcomes in the follow-up after 3 months. The levels of SUA are negatively associated with the NIHSS score at discharge ( r=-0.171, P=0.003). A positive correlation was observed between the levels of SUA and the difference of NIHSS at baseline and discharge ( r=0.118, P=0.032). Patients were divided into three groups according to the quartile of SUA. Multivariate logistic regression analysis showed that high SUA levels were independently associated with good outcome three months after stroke ( OR=0.421, 95% CI 0.327-0.541, P<0.001). Conclusion:In patients with acute ischemic stroke, elevated SUA levels can predict better recovery and short-term outcomes in patients undergoing intravenous thrombolysis.

Application of fetal atrial septal excursion index and comprehensive Z-scores of cardiovascular structures in fetuses with redundancy foramen ovale flap / 中华超声影像学杂志

Objective:To investigate the application of fetal atria septal excursion index (ASEI) combining cardiovascular structure Z-scores in fetuses with redundancy foramen ovale flap (RFOF).Methods:Twenty-two fetuses with RFOF diagnosed by fetal echocardiography in Sir Run Run Shaw Hospital from December 2019 to September 2021 were selected as the RFOF group and 62 normal fetuses as the control group. The movement of the foramen ovale valve was observed in the four chamber view, and the maximum distance of the foramen ovale valve bulging, the total length of the atrial septum, the foramen ovale diameter, the diameters of the aortic valve, the pulmonary valve, the ascending aorta, the aortic isthmus, the descending aorta and the left and right ventricular areas were measured. ASEI, foramen ovale diameter, foramen ovale valve excursion distance, the ratio of foramen ovale diameter to total atrial septum length, aortic valvular annular diameter Z-score(AOV Z-score), pulmonary valvular annular diameter Z-score(PV Z-score), ascending aorta diameter Z-score(AOA Z-score), ascending aorta diameter Z-score (AOA Z-score), aortic isthmus Z-score (AOI Z-score), descending aorta diameter Z-score (AOD Z-score), diastolic right ventricular area Z-score (RV area Z-score) and diastolic left ventricular area Z-score(LV area Z-score) were compared between the two groups. RFOF fetuses were followed up to observe the prognosis.Results:There were significant differences in fetal ASEI, foramen ovale diameter, foramen ovale valve excursion distance, the ratio of foramen ovale diameter to total atrial septum length, AOV Z-score, PV Z-score, AOA Z-score, AOI Z-score, AOD Z-score and LV area Z-score between RFOF group and control group (all P<0.05), but there was no significant difference in RV area Z-score ( P>0.05). Postnatal follow-up outcomes in RFOF group indicated that 17 of 22 cases (77.3%) had live birth, five cases (22.7%) were lost at follow-up. Twelve of 17 live birth cases (70.5%) showed structurally normal heart by postnatal echocardiography, 3 cases (17.6%) showed mild coarctation of the aorta with nonsignificant hemodynamics under clinical follow-up, 2 cases (11.8%) were diagnosed with coarctation of the aorta, pulmonary artery dilation and atrial septal defect, and died after operation, of which one case died of infections pneumonia after operation. Another case was born prematurely at 36 + 4 weeks with a birth weight of 2 650 g, and neotal echocardiography showed ventricular septal defect, atrial septal defect and patent ductus arteriosus. Conclusions:ASEI can quantitatively evaluate the behavior of foramen ovale valve mobility and in combination with Z-scores of cardiovascular structures can be used to assess the morphological changes of fetal hearts. Although some fetuses with RFOF demonstrate left and right ventricular disproportion and coarctation of the aorta in fetal echocardiography, most fetuses have a good prognosis.

Endoscopic posterior nasal neurectomy for the treatment of allergic rhinitis: anatomy and analysis of clinical efficacy / 中华耳鼻咽喉头颈外科杂志

Objective: To propose total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle from anatomy for the treatment of allergic rhinitis, and to explore its clinical application. Methods: Two fresh cadaveric heads (4 sides) were dissected through endoscopic transnasal middle meatus approach at Otorhinolaryngology Anatomy Laboratory of China-Japan Friendship Hospital. The structures of the craniofacial bone related to the surgical approach were observed. Twelve patients with allergic rhinitis who treated in Department of Otorhinolaryngology, China-Japan Friendship Hospital from Feb. 1 2019 to Jun. 10 2021 were selected. All the patients were treated by posterior nasal neurotomy with the technique of complete transection of sphenopalatine neurovascular bundle and followed up for 1 year after sugery. During the follow-up, 2 patients were lost. The other 10 patients included 4 males and 6 females, aging from 29 to 69 years. Visual Analogue Scale (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were used to evaluate the effect of the surgery. SPSS 25.0 software was used for statistical analysis. Results: Important anatomic landmarks of transnasal middle meatus approach were obtained during anatomy, such as ethmoid crest, sphenopalatine foramen/notch, palatine orbital process and sphenopalatine process. The postoperative VAS scores of nose, eye, pharynx, ear and whole body and total VAS scores were significantly lower than those before operation, with statistically significant difference (nose 2.50±1.70 vs 6.47±2.17, eyes 1.15±0.89 vs 3.60±2.57, pharynx 1.30±1.36 vs 4.25±3.64, ear 1.10±1.03 vs 2.67±2.00, whole body 1.08±1.24 vs 3.60±1.17, total 7.13±4.31 vs 20.58±9.05, all P<0.05). The postoperative RQLQ scores of sleep, nose, eyes, practical problems, emotion, activity and the total RQLQ scores of patients were significantly lower than those before operation, with statistically significant difference (sleep 0.80±0.69 vs 2.93±1.33, nose 1.38±1.18 vs 3.93±1.50, eyes 0.58±0.66 vs 1.80±1.25, practical problems 1.10±1.22 vs 3.03±1.84, emotion 1.00±1.81 vs 2.58±2.00, activity 2.77±2.93 vs 6.00±1.85, total 8.99±8.92 vs 22.42±8.69, all P<0.05). There was no significant difference in preoperative and postoperative scores of non-nasal/ocular symptoms (1.37±1.60 vs 2.16±1.12, P=0.166). There was no other complication except 2 cases with short-term postoperative numbness. Conclusions: Total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle is a safe, effective and feasible method for the treatment of intractable allergic rhinitis, and its long-term efficacy needs further observation.

Mapping the allosteric effects that define functional activity of SARS-CoV-2 specific antibodies

Previous studies on the structural relationship between human antibodies and SARS-CoV-2 have focused on generating static snapshots of antibody complexes with the Spike trimer. However, antibody-antigen interactions are dynamic, with significant binding-induced allosteric effects on conformations of antibody and its target antigen. In this study, we employ hydrogen-deuterium exchange mass spectrometry, in vitro assays, and molecular dynamics simulations to investigate the allosteric perturbations linked to binding events between a group of human antibodies with differential functional activities, and the Spike trimer from SARS-CoV-2. Our investigations have revealed key dynamic features that define weakly or moderately neutralizing antibodies versus those with strong neutralizing activity. These results provide mechanistic insights into the functional modes of human antibodies against COVID-19, and provide a rationale for effective antiviral strategies. TeaserDifferent neutralizing antibodies induce site-specific allosteric effects across SARS-CoV-2 Spike protein

Human neutralising antibodies elicited by SARS-CoV-2 non-D614G variants offer cross-protection against the SARS-CoV-2 D614G variant.

OBJECTIVES: The emergence of a SARS-CoV-2 variant with a point mutation in the spike (S) protein, D614G, has taken precedence over the original Wuhan isolate by May 2020. With an increased infection and transmission rate, it is imperative to determine whether antibodies induced against the D614 isolate may cross-neutralise against the G614 variant. METHODS: Antibody profiling against the SARS-CoV-2 S protein of the D614 variant by flow cytometry and assessment of neutralising antibody titres using pseudotyped lentiviruses expressing the SARS-CoV-2 S protein of either the D614 or G614 variant tagged with a luciferase reporter were performed on plasma samples from COVID-19 patients with known D614G status (n = 44 infected with D614, n = 6 infected with G614, n = 7 containing all other clades: O, S, L, V, G, GH or GR). RESULTS: Profiling of the anti-SARS-CoV-2 humoral immunity reveals similar neutralisation profiles against both S protein variants, albeit waning neutralising antibody capacity at the later phase of infection. Of clinical importance, patients infected with either the D614 or G614 clade elicited a similar degree of neutralisation against both pseudoviruses, suggesting that the D614G mutation does not impact the neutralisation capacity of the elicited antibodies. CONCLUSIONS: Cross-reactivity occurs at the functional level of the humoral response on both the S protein variants, which suggests that existing serological assays will be able to detect both D614 and G614 clades of SARS-CoV-2. More importantly, there should be negligible impact towards the efficacy of antibody-based therapies and vaccines that are currently being developed.

The Identification of A Novel HIV-1 Second-Generation Recombinant form (CRF01_AE/CRF07_BC) Among Men Who Have Sex with Men in Jiangsu, China.

BACKGROUND: CRF01_AE and CRF07_BC are the two major HIV-1 virus strains circulating in China. The proportion of dominant subtypes (CRF01_AE and CRF07_BC) among MSM in Jiangsu province was over 80%. A large number of URFs have been found in China in recent years. OBJECTIVE: This study aimed to report on novel HIV-1 recombinants. METHODS: We constructed Phylogenetic trees using the maximum likelihood (ML) method with 1000 bootstrap replicates in IQ-TREE 1.6.8 software and determined recombination breakpoints using SimPlot 3.5.1. RESULTS: We identified a novel, second-generation HIV-1 recombinant (JS020202) between CRF01_ AE and CRF07_BC. The analysis of near full-length genome (NFLG) showed there were at least 8 breakpoints in the virus, which differed from any previously identified CRF and URF around the world. CONCLUSION: Novel diverse CRF01_AE/07_BC suggested the complexity trends of HIV-1 genetics. The emergency situation of diverse recombinant strains should be monitored continuously.