Abstract: Objective To investigate the molecular characteristics of the H9N2 avian influenza virus (AIV) causing human infection in Yunnan Province in 2019, and to provide the scientific basis for the prevention and control of avian influenza in Yunnan Province. Methods Influenza virus typing was performed by real-time RT-PCR in two influenza-like illness samples, and the Illumina Miseq high-throughput sequencer was used to determine the viral genome sequence. HA and NA gene sequence alignment and phylogenetic tree construction were performed using Mega7.0 software. Results Real-time RT-PCR results showed that two influenza-like illness samples were positive for H9N2 subtype. The full length of HA and NA were obtained by genomic sequencing. Sequence system evolution analysis showed that the HA and NA of the two AIVs in Yunnan Province were in the same evolutionary clade as A/Chicken/Zhejiang/HJ/2007 and belonged to the G57 type. The HA nucleotide and amino acid homology of the two AIVs were 93.92% and 95.00%, respectively, and the NA nucleotide and amino acid homology was 93.31% and 82.03%, respectively. The nucleotide (amino acid) homology of HA was 92.29%-96.94% (93.77%-98.43%) and 92.84%-94.92% (94.18%-96.23%), respectively, and NA nucleotide homology (amino acid) were 91.81%-97.60% (77.82%-94.83%), 94.38%-97.22% (85.47%-94.55%), respectively, compared with that of human infected H9N2 epidemic strains obtained in China from 2015 to 2020. Both AIVs HA protein cleavage site sequences were PSRSSR↓GLF, which was in line with the characteristics of low pathogenic influenza. The analysis of HA protein receptor binding site showed that amino acids at positions 109, 161, 163, 191, 202, 203 and 234 were consistent with the reference strains, while amino acids at position 198 were mutated to T. N166D and 168N mutations were also found in HA protein, and both AIVs had 7 potential glycosylation sites. Analysis of the erythrocyte binding site of NA gene found that there were amino acid mutations at positions 369, 402, 403, and 432, and amino acid deletion at positions 63-65 was found in the NA genes. There were 4 and 5 potential glycosylation sites in the two AIVs, respectively, and no drug resistance site mutations were found. Conclusions　The receptor binding sites, erythrocyte binding sites and glycosylation sites of HA and NA genes of H9N2 AIV in Yunnan Province have different degrees of variation, and monitoring and prevention and control should be strengthened.

Objective:To investigate the current status and related factors of psychological distress in tele-phone operators.Methods:Totally 575 telephone operators from sample of a convenient survey in a certain telecom-munication company of Shandong Province were selected.They were assessed with Kessler Psychological Distress Scale (K10),Connor-Davidson Resilience Scale (CD-RISC-10),Perceived Social Support Scale (PSSS)and Sim-plified Coping Style Questionnaire (SCSQ)for the evaluation of psychological distress,resilience,perceived social support and the coping style respectively.Ordinal logistic regression was used to identify the related factors of psy-chological distress.Results:The mean score of K10 was (24.7 ±6.7),91.8% (528 /575)of telephone operators had psychological distress.Specifically,24.5%(141 /575)had mild psychological distress,45.4% (261 /575)had moderate psychological distress,21.9% (126 /575)had severe psychological distress.Ordinal logistic regression a-nalysis indicated that the ones with good economic conditions (OR =1.74,95%CI:1.15 -2.63),higher level of re-silience (OR =1.13,95%CI:1.10 -1.17)and other social support (OR =1.07,95%CI:1.02 -1.12)had milder psychological distress;while with negative coping style (OR =0.29,95%CI:0.20 -0.41)had more severe psycho-logical distress.Conclusion:It suggested that the prevalence rate of psychological distress among telephone opera-tors is high.Poor economic conditions,lower level of resilience and social support,and negative coping style might be the related factors of psychological distress.

ObjectiveTo investigate the design and mechanical properties of bone cement injectable canulated pedicle screw (CICPS) so as to provide a safe and effective internal fixation for osteoporotic spinal disorder.Methods ( 1 ) Bone cement injection test was performed in vitro,and within osteoporotic cancellous bone models and osteoporotic vertebrae respectively.The distribution of bone cement and screw-bone interface were observed by X-ray films and CT.(2) Ten CICPSs already injected with bone cement and ten conventional pedicle screws were respectively examined by shear strength test.(3) CICPS in the cancellous bone models was augmented with 2-3 ml of bone cement.Then,the maximum axial pull-out strength of the CICPS was measured and were compared with that of conventional screws.ResultsBone cement overflowed from each side hole of the CICPS and distributed only around the front of screws in an even and extensive way.Also,no bone cement leakage was founded.The mean shear load of CICPS and conventional screws was ( 10 600.8 ± 360.1 ) N and ( 15 458.1 ± 31 1.4) N respectively ( P ＜0.05 ).The mean maximum axial force at pull-out was ( 209.3 ± 13.3 ) N for the CICPS and ( 27.0 ± 5.0) N for the conventional screws ( P ＜ 0.05 ).Conclusions By dispersing bone cement uniformly,CICPS reduces the risk of cement leakage and significantly improves the pullout strength of screws in osteoporotic vertebrae.CICPS with good efficacy and safety provides theoretic basis for its clinical application.

Intramyocardial dissecting hematoma (IDH) is an uncommon complication of myocardial infarction that can potentially lead to cardiac rupture.[1] Two distinguishable types of cardiac rupture have been identified: a simple tear, which is the most common case and is characterized by a lineal or tortuous tear along the myocardial wall, and complex hemorrhagic dissection. IDH is generally classified as complex hemorrhagic dissection, in which blood infiltrates into the myocardial wall.[2] IDH is characterized by a serpiginous tract within the myocardium, which is also known as subepicardial aneurysm. The mechanisms of IDH are multifactorial and contribute to the rupture of intramyocardial vessels, diminished tensile strength of the infarcted myocardium, abrupt increases in perfusion pressure during the perfusion phase, or in rare cases, iatrogenesis.[3] Furthermore, the anatomical substrate of IDH is the spiral helical structure of the heart that favors hemorrhage spreading along the spiral myocardial fibers.[4] IDH is often a challenging diagnosis and prone to misdiagnosis because of its rarity and various clinical presentations. Here, we report a patient with IDH.

Objective To detect the single nucleotide polymorphisms (SNPs) in the upstream promoter region of chemokine like factor (CKLF) gene and analyze their possible associations with asthma and asthma-related phenotypes.Methods Direct Sequence of the 1553bp upstream promoter region of CKLF gene was performed in 245 Chinese Han human genomic DNAs (119 asthmatics and 126 controls).The frequencies of alleles, genotypes, and haplotypes were determined and the association of these SNPs with asthmawere further analyzed.Results Fournovel SNPs,SNP88 (T>C),SNPI96 (T>C),SNP568 (C> G) ,and SNP1047 (C > G) were found in the promoter region of CKLF.The frequency of rare allele was 0.168 (SNP88C), 0.168 (SNP196C), 0.352 (SNP568G) and 0.167 (SNP1047G), respectively.Haplotypes,their frequencies and the linkage disequilibrium coefficients between SNPs were constructed.Complete linkage disequilibrium (LDs) were observed between SNP88 and SNP196,SNP88 and SNP1047, as well as SNPI96 and SNP1047 ,respectively (D1 = 1.000,r2 = 1.000).SNP568 was in partial LD with the other three SNPs (r2 = 0.366).No association between asthma and the SNPs was observed.Conclusions Four SNPs in the regulatory region of CKLF in Chinese Han population were firstly identified.Although no significant correlation with asthma was revealed, the SNP and haplotype information is useful for other disease association studies in the future.

Objective:To assess the effectiveness and safety of adalimumab in Crohn′s disease (CD) patients.Methods:We retrospectively reviewed the charts of 41 CD patients who received adalimumab in Zhongda Hospital Southeast University from January 2020 to August 2021. General clinical data, laboratory results, endoscopy and radiologic findings were collected, meanwhile, disease activity and safety events were evaluated at baseline and at 12, 24 and 48 weeks of administration. Adalimumab was given subcutaneously once every 2 weeks in doses of 160 mg for the first time, 80 mg for the second time, and 40 mg for each subsequent time.Results:The clinical remission rates at 12, 24, and 48 weeks of treatment were 43.9% (18/41), 60.6% (20/33), 60.9% (14/23), and the clinical response rates were 75.6% (31/41), 69.7% (23/33), and 56.5%( 13/23), respectively. The proportion of endoscopic remission at 12, 24 and 48 weeks were 4/14, 2/6, 1/4 in patients undergoing endoscopy, and 1/14 patients achieved mucosal healing at 24 weeks. Primary nonresponse rate (PNR) was 17.1% (7/41), loss of response (LOR) rate was 14.6% (6/41). The incidence of adverse reactions was 9.8%(4/41).Conclusion:Adalimumab can effectively relieve the clinical symptoms and intestinal disease activities of Crohn′s disease, and deserves to be popularized clinically. Patients with disease course <2 years, first-line biologics, low baseline HBI score, and longer duration of medication may have better results.

Aortic dissection, especially Stanford type A aortic dissection, is an acutely progressive and highly fatal cardiovascular disease.Early prevention and timely treatment can greatly reduce mortality and reduce the burden on families and society.However, due to the etiological mechanism is still unclear, the clinical treatment is still mainly surgery, and the early prevention and drug application are very limited.And some recent studies have found that ferroptosis may play an important role in the occurrence and development of aortic dissection, revealing the relationship between them may provide ideas for the prevention, treatment and scientific research of the disease.

Objective:To analyze the relations of blood-brain barrier (BBB) integrity with clinical features and their response to immunotherapy in patients with autoimmune encephalitis (AE).Methods:One hundred and forty-seven AE patients confirmed in Department of Neurology, First Affiliated Hospital of Zhengzhou University from August 2015 to December 2021 were chosen; their clinical and laboratory data were collected retrospectively. In accordance with cerebrospinal fluid (CSF) albumin/serum albumin (QAlb) value of 7, patients were classified into normal BBB group ( n=101, QAlb value ≤7.00) and damaged BBB group ( n=46, QAlb value >7.00). Modified Rankin Scale (mRS) and Clinical Assessment Scale for Autoimmune Encephalitis (CASE) were used to evaluate the severity on admission and 30 d after first-line immunotherapy; and good immunotherapy responsiveness was defined as CASE or mRS scores 30 d after first-line immunotherapy lower than those at admission. Differences of general data, clinical manifestations, CSF and peripheral blood biochemical results, and response to immunotherapy between the two groups were compared and analyzed. Results:The damaged BBB group had significantly higher proportions of patients with decreased consciousness level (58.7% vs. 37.6%), increased CSF protein, increased immunoglobulin G (IgG) and increased 24 h intramural IgG synthesis rate, and significantly higher fibrinogen in peripheral blood than normal BBB group ( P<0.05). On 30 th d of treatment, mRS scores of patients in damaged BBB group were significantly higher than those of patients in normal BBB group ( P<0.05), and the differences of CASE scores and mRS scores before and after treatment in damaged BBB group were significantly lower than those in normal BBB group (0.50±0.46 vs. 3.24±2.93, 0.70±0.62 vs. 1.15±1.04, P<0.05). In damaged BBB group, good immunotherapy response rate in patients receiving single immunotherapy was significantly lower than that in patients receiving two or three combinations of first-line immunotherapy ( P<0.05). Conclusion:BBB integrity is closely related to clinical characteristics and response to immunotherapy of AE; combined first-line immunotherapy is recommended for AE patients with BBB injury.

Objective:To investigate the potential prognostic value of cyclin D1 expression in patients with locally advanced oral squamous cell carcinoma (OSCC) and its relationship with taxol (Docetaxel)/cisplatin plus 5-fluorouracil (TPF) induction chemothera-py. Methods:A total of 256 patients with locally advanced OSCC were selected from Shanghai Ninth People's Hospital of Shanghai Ji-ao Tong University School of Medicine between March 2008 and December 2010 as the objects of study in this prospective randomized clinical trial. The effect of TPF induction chemotherapy was investigated. Immunohistochemical staining against cyclin D1 was per-formed in the pretreatment biopsy specimen of the patients. The relationship between cyclin D1 expression and prognostic data of the TPF induction arm and control arm was analyzed. Results:Cyclin D1 expression was detected in 232 out of the 256 patients. Patients with low cyclin D1 expression showed significantly better overall survival (OS) (P=0.001), disease-free survival (DFS) (P=0.003), lo-coregional recurrence-free survival (LRFS) (P=0.004), and distant metastasis-free survival (DMFS) (P=0.001) than those with high cy-clin D1 expression. No significant differences existed in OS, DFS, LRFS, or DMFS between the patients with TPF induction chemother-apy and the control. Cyclin D1 expression levels were not predictive of the benefit from TPF induction chemotherapy in the overall pop-ulation. However, patients with nodal stage cN2 and high cyclin D1 expression, who were undergoing TPF chemotherapeutic regimen, showed significantly higher OS (P=0.024) and DMFS (P=0.024) than cN2 patients with high cyclin D1 expression but undergoing stan-dard surgical treatment. Conclusion:Cyclin D1 can be used as a prognostic biomarker for patients with locally advanced OSCC. Fur-thermore, cN2 OSCC patients with high cyclin D1 expression can receive long-term benefit from the addition of TPF induction chemo-therapy to standard surgical treatment.

Objective:To evaluate the lung protection of pressure-controlled ventilation volume guaranteed (PCV-VG) in elderly patients undergoing laparoscopic surgery in Trendelenburg position.Methods:Sixty patients of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, aged 65-80 yr, with body mass index of 19-27 kg/m 2, scheduled for elective laparoscopic radical prostatectomy or laparoscopic radical cystectomy, were allocated into 2 groups ( n=30 each) by a random number table method: VCV group (group V) and PCV-VG group (group P). Tracheal intubation was performed after induction of anesthesia.The anesthesia machine was connected to perform mechanical ventilation with tidal volume of 7 ml/kg (corrected body weight), positive end-expiratory pressure at 5 cmH 2O, inspiratory/expiratory ratio 1∶2, fraction of inspired oxygen 50%, fresh gas flow at 2 L/min and respiratory rate 12-15 breaths/min in two groups.Recruitment maneuver was performed with a pressure of 30 cmH 2O, lasting for 30 s, starting from 5 min before the end of administration.The airway peak pressure (P peak), airway plateau pressure (P plat), driving pressure (DP), and dynamic lung compliance (Cdyn) were measured at 5 min after intubation (T 1), 5 min after changing position (T 2), 5, 30, 60, 90 and 120 min of pneumoperitoneum (T 3-7) and 5 min after restoring the supine position and after the end of pneumoperitoneum (T 8). Blood samples were collected from the radial artery for blood gas analysis at T 1, T 4 and T 6 and when modified Aldrete score reached 10 in postanesthesia care unit, and pH value, partial pressure of arterial oxygen (PaO 2), partial pressure of arterial carbon dioxide (PaCO 2), arterial oxygen saturation (SaO 2) and alveolar-arterial oxygen gradient (P A-aO 2) were recorded.Blood samples were collected from the radial artery before induction of anesthesia and at the end of surgery for determination of concentrations of Clara cell protein (CC-16), interleukin-6 (IL-6) and neutrophil elastase (NE) in serum by enzyme-linked immunosorbent assay.The development of pulmonary complications was recorded within 7 days after surgery. Results:Compared with group V, P peak was significantly decreased at T 1-8, P plat and DP were decreased at T 5-7, Cdyn was increased at T 2-7, P A-aO 2 was decreased at T 1, 4, 6, serum CC-16, IL-6 and NE concentrations were decreased at the end of surgery ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after surgery in group P ( P>0.05). Conclusion:PCV-VG can produce lung protection to some extent in elderly patients undergoing laparoscopic surgery in Trendelenburg position.