This article reports one case of adult COVID-19-associated acute necrotizing encephalopathy(ANEC).The patient developed disturbance of consciousness and seizure on the 12th day after SARS-CoV-2 infection.Imaging showed significant swelling and signal changes in the bilateral thalamus,brainstem,cerebral hemisphere and cerebellar hemisphere,which were consistent with the characteristic images of Acute necrotizing encephalitis(ANE).Although methylprednisolone shock therapy and high-dose human immunoglobulin therapy were given early,the patient died.ANEC often starts quickly and progresses rapidly,unconsciousness and seizure are the main manifestations.Imaging features of thalamic and subtentorial symmetry and multifocal lesions are specific for diagnosis,but the treatment and prognosis still face challenges and need further study.

Objective:To investigate the changing trends in cardiac function following xenogeneic heterotopic heart transplantation of multi-gene edited pig hearts and assess the impact of recipient immune responses on donor heart, laying experimental groundwork for the clinical application of gene editing technology.Methods:On December 16, 2023, xenogeneic heterotopic heart transplantation was performed between pigs and rhesus monkeys. Functional status of the graft under post-transplantation load conditions and recipient immune indicators were observed.Results:The recipient monkeys survived for 40 days with satisfactory functionality of both donor and recipient hearts, and no hyperacute or acute immune rejection reactions were observed.Conclusion:Multi-gene editing technology provides potential for xenotransplantation, yet further exploration is needed for its clinical application.

Literature related to children's adenoid hypertrophy was retrieved to form an expert questionnaire.According to the group standard writing rules of the China Association of Chinese Medicine,the peer consultation,quality evaluation and suitability eval-uation were completed through three rounds of Delphi expert questionnaire surveys and expert discussion meetings,and the Clinical Practice Guidelines for TCM in Children with Adenoidal Hypertrophy was finally formed.The guidelines have been formulated to clarify the scope of application of the guidelines,normative reference documents,terms and definitions,diagnosis,syndrome differentiation,treatment,prevention and care,and to provide an important reference for the clinical practice and diagnosis and treatment norms of tra-ditional Chinese medicine for children with adenoid hypertrophy.

Backgroud Beta-cypermethrin and emamectin benzoate are widely used for the prevention and control of pests in the greenhouse planting industry, and their combined exposure may increase the accumulation of beta-cypermethrin and emamectin benzoate in organisms and affect human health. Objective Based on the changes in reproductive hormone levels in the hypothalamic-pituitary-ovarian (HPO) axis, to investigate the effect of combined exposure to beta-cypermethrin and emamectin benzoate on the estrous cycle of female mice. Methods Twenty-four healthy adult SD rats were randomly divided into a blank control group, a beta-cypermethrin group (Beta-CYP, 53 mg·m⁻³), an emamectin benzoate group (EMB, 8 mg·m⁻³), and a beta-cypermethrin and emamectin benzoate combined exposure group (Beta-CYP+EMB, Beta-CYP 53 mg·m⁻³ + EMB 8 mg·m⁻³). Six rats in each group were exposed to the designed treatment protocol by aerosol inhalation 6 d a week for 13 weeks. The general condition of the rats was observed in real time during the treatment. From the 12th week of exposure, a 10-day reproductive tract smear was performed on the rats to observe the estrous cycle. The rats were neutralized on the second day after the end of the treatment protocol, and the ovarian tissues were stained with HE to observe histopathological changes. Serum levels of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured by ELISA. Experimental results were expressed as mean ± standard deviation (\begin{document}$ \overline{x}\pm s $\end{document}). One-way ANOVA was used for comparison among groups, and LSD test for pairwise comparison between groups. The significance level was α=0.05. Results After four weeks of the treatment protocol, the rats in the Beta-CYP group and the Beta-CYP+EMB group continued to be hyperactive and irritable, while the EMB group showed symptoms of mental disorder, decreased activity, and slow response. On the 90th day of the treatment protocol, the body weight of rats in the control group increased to (314.51±2.44) g, and that in the Beta-CYP+EMB group only increased to (253.47±1.50) g. There was no abnormal cellular morphology in the control group; however, small deeply stained nuclei appeared in the Beta-CYP group, the EMB group, and the Beta-CYP+EMB group, and abnormal morphological development of keratinized epithelial cells in the Beta-CYP+EMB group was found. The estrous cycle of rats in the control group was (97.83±4.17) h, and compared with the control group, the estrous cycles of rats in the Beta-CYP group, the EMB group, and the Beta-CYP+EMB group were prolonged to (134.33±7.53) h, (126.50±5.28) h, and (156.00±6.66) h, respectively. The results of ANOVA showed that the numbers of leukocytes (527.17±15.83), keratinized epithelial cells (35.67±4.32), and non-keratinized epithelial cells (70.50±4.51) in the vaginal smears during diestrus in the Beta-CYP+EMB group were significantly lower than those in the control group (752.50±28.89, 50.50±2.74, 101.33±7.92) (P<0.001). The hormone levels of GnRH and FSH in the control group were (5.13±0.59) and (0.76±0.09) IU·L⁻¹ respectively, while the levels in the Beta-CYP+EMB group were increased to (16.86±0.59) and (3.80±0.19) IU·L⁻¹ respectively (P<0.05). The levels of LH and E2 in the control group were (12.93±0.81) IU·L⁻¹ and (22.23±1.44) pmol·L⁻¹ respectively, and the levels in the Beta-CYP+EMB group were decreased to (5.63±0.41) IU·L⁻¹ and (10.45±0.78) pmol·L⁻¹ respectively (P<0.05). Conclusion The combined exposure to beta-cypermethrin and emamectin benzoate may ultimately affect the estrous cycle of female rats by interfering with the secretion of reproductive hormones involved in the HPO axis.

Objective:To evaluate the feasibility of a novel liver fiducial marker implantation method for internal fixation and removal of rabbit livers, in order to use in Cyberknife tracking therapy.Methods:Experiments were conducted in vivo and in vitro. In the in vivo experiment, three fiducial markers were implanted percutaneously in each liver of ten rabbits under anesthesia, and the fourth fiducial marker with an external catheter and fixed thin wire was implanted ten days later. After the reference group (the first and the second maker), and the casing group (the first and the fourth marker) were respectively registered and tracked with the Cyberknife, the implantation success rate, registration accuracy, and removal safety of fiducial markers were assessed. The tensile test was performed using liver in vitro by measuring the resistance required to dislodge the spring coil fiducial markers and the fiducial markers without spring coil from liver. Results:The intrahepatic catheter implantation and removal of fiducial marker in rabbit liver had a success rate of 100% and no distant migration. The operation-related and postoperative complications were not occurred. All fiducial markers were successfully traced. Compared to the reference group, the casing group had slightly higher translational errors in supero-inferior and antero-posterior directions ( Z=-11.77, -4.57, P<0.05), and lower translational errors in left-right direction ( Z=-2.52, P<0.05). The dislodgement forces for spring coil fiducial markers was (2.23±0.85) N, significantly different with (0.81±0.13) N for fiducial markers without spring coil ( Z=- 2.31, P < 0.05). Conclusions:The spiral coil structure provides superior fixation in the punctured needle channel, the thin line limits the distant displacement of the fiducial marker outside the liver, and the catheter establishes a channel for the removal. The general operation is simple and easy.

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

Objective:To study the factors influencing repeatedly hospitalization in patients with acute pancreatitis (AP), and to analyse the predictive value of triglyceride for repeated hospitalization.Methods:The clinical data of 1 958 patients with AP treated at the First Affiliated Hospital of Anhui University of Science and Technology from January 2012 to April 2022 were analyzed. Of 1 733 AP patients who were enrolled, there were 1 000 males and 733 females, with mean ± s. d age being (49.4±16.4) years. Patients were grouped based on their ID numbers to determine their number(s) of hospitalization. Those who were admitted only once were included in the initial hospitalization group ( n=1 030), and those who were admitted twice or more were included in the repeated hospitalization group ( n=703). The factors influencing repeated hospitalization were analyzed by univariate analysis and multivariate logistic regression analysis. The predictive value of triglyceride for repeated hospitalization was evaluated by receiver operating characteristic (ROC) curve. Results:Multivariate logistic regression analysis showed that hypertriglyceridemia ( OR=1.445, 95% CI: 1.144-1.825, P=0.002) and biliary causes ( OR=3.184, 95% CI: 1.978-5.125, P<0.001) were independent risk factors for repeated hospitalization. When triglyceride <10.9 mmol/L, the prediction of AP patients without repeated hospitalization was 90.6%. The area under the ROC curve was 0.589, and the Yoden index was 0.170. Conclusion:Hypertriglyceridemia was risk factor for repeat hospitalization in AP patients and the efficacy of triglyceride in predicting repeat hospitalization in AP patients was good.

BACKGROUND: Excessive proliferation and migration of vascular smooth muscle cells (VSMCs) are the main causes of restenosis (RS) in diabetic lower extremity arterial disease (LEAD). However, the relevant pathogenic mechanisms are poorly understood. METHODS: In this study, we introduced a "two-step injury protocol" rat RS model, which started with the induction of atherosclerosis (AS) and was followed by percutaneous transluminal angioplasty (PTA). Hematoxylin-eosin (HE) staining and immunohistochemistry staining were used to verify the form of RS. Two-step transfection was performed, with the first transfection of Lin28a followed by a second transfection of let-7c and let-7g, to explore the possible mechanism by which Lin28a exerted effects. 5-ethynyl-2΄-deoxyuridine (EdU) and Transwell assay were performed to evaluate the ability of proliferation and migration of VSMCs. Western blotting and quantitative real-time polymerase chain reaction (qRT-PCR) were performed to detect the expression of Lin28a protein and let-7 family members. RESULTS: Using a combination of in vitro and in vivo experiments, we discovered that let-7c, let-7g, and microRNA98 (miR98) were downstream targets of Lin28a. More importantly, decreased expression of let-7c/let-7g increased Lin28a, leading to further inhibition of let-7c/let-7g. We also found an increased level of let-7d in the RS pathological condition, suggesting that it may function as a protective regulator of the Lin28a/let-7 loop by inhibiting the proliferation and migration of VSMCs. CONCLUSION These findings indicated the presence of a double-negative feedback loop consisting of Lin28a and let-7c/let-7g, which may be responsible for the vicious behavior of VSMCs in RS.
Rats ; Animals ; Down-Regulation ; MicroRNAs/metabolism* ; Feedback ; Cell Proliferation/genetics* ; Atherosclerosis

Objective:To explore the tracking accuracy of the surface optically guided tracking system (OGTS) in radiotherapy.Methods:Phantom verification and clinical trial verification were adopted. Specialized equipment was employed for the phantom verification. Specifically, the displacement of the optical markers as they moved from a predetermined position to the target position on the reflector ball platform was captured using the OGTS, and then the obtained displacement was compared with the fixed distance within the phantom to calculate the accuracy and repeatability of the OGTS. For the clinical trial verification, 45 patients treated with radiotherapy, which consisted of 15 cases with head, breast, and rectal tumors each, were selected to investigate the tracking accuracy and repeatability of the OGTS. For each patient, the values derived from the image-guided positioning system (IGPS) and the OGTS before and after image-guided setup error correction during three times of fractionated radiotherapy were randomly obtained. The translational errors of each error correction were also recorded. Before radiotherapy, patients′ setup errors were corrected and relevant data were obtained using the IGPS. The correction result of translation errors obtained using the IGPS served as a gold standard to verify the accuracy of the OGTS in monitoring the translational motion of patients. Finally, the comprehensive translational deviation of both method was calculated.Results:The phantom measurements showed that the comprehensive translational deviation for tracking accuracy and tracking repeatability of the OGTS had a maximum deviation and a standard deviation of 0.18 mm and 0.03 mm, respectively. The clinical trial result indicated that the tracking accuracy of IGPS and OGTS exhibited statistically significant differences only for the head in the z direction ( t = 2.21, P < 0.05). Conversely, no statistically significant differences were observed for the head in the remaining directions or for the breast and rectum in the three translational directions ( P > 0.05). The analysis showed that comprehensive translational deviations for the head, breast, and rectum derived from OGTS and IGPS were (0.91±0.62), (1.64±1.30), and (1.52±1.29) mm, respectively, satisfying the requirement that the deviations should be below 2 mm. Conclusions:The OGTS, featuring easy operation and high tracking accuracy, can assist the IGPS in real-time respiratory monitoring during radiotherapy.

Objective:To evaluate the effects of intensive intervention on negative spouses in sero-discordant couples.Methods:From December 2019 to December 2020, all HIV sero-discordant couples in seven townships in Butuo County of Liangshan were enrolled and divided into intensive intervention group and routine intervention group. Both intensive intervention and routine intervention were conducted for one year. Baseline survey and follow-up were conducted respectively with a questionnaire survey and a serological testing in HIV sero-discordant couples in the two groups at 6 th month before and after the interventions. Multivariable Cox proportional hazards model and difference-in-difference model were used to evaluate the effect of the intensive intervention. Results:A total of 899 sero-discordant couples were enrolled (393 of intensive intervention group and 506 of routine intervention group), in whom 806 completed the follow up survey (349 of intensive intervention group and 457 of routine intervention group). Compared with routine intervention, intensive intervention had no effect to improve the correct answer rate of an AIDS related question in negative spouses ( P>0.05), but could improve their awareness of AIDS related knowledge ( β=1.40, P=0.008). Compared with routine intervention, intensive intervention could reduce the frequency of sex between HIV sero-discordant couples ( β=-0.73, P=0.021), and increase the frequency of condom use ( β=0.19, P=0.007), but had no effect to decrease the positive conversion rate in negative spouses ( β=-0.61, OR=0.55,95% CI:0.18-1.66, P=0.294). Conclusions:The intensive interventions could improve the awareness of AIDS related knowledge in negative spouses in sero-disordant couples and promote their safe sexual behavior, but had no effect to decrease the positive conversion in negative spouses. It is necessary to continue the intensive intervention and follow up to evaluate the effects of the intervention.