Objective To explore the short-term efficacy of endovascular isolation treatment for type A aortic intramural hematoma(AIH)with pericardial effusion,and to discuss the endovascular isolation treatment strategy for type A AIH with pericardial effusion.Methods A total of 12 patients with type A AIH complicated by pericardial effusion,who were admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine of China between February 2018 and November 2021,were enrolled in this study.Before surgery,the intima of the ascending aorta was intact in all patients,but a rupture at the proximal intima of the aortic arch or the thoracic descending aorta was detected.All patients received endovascular isolation treatment.Among them,4 patients received endovascular isolation treatment within one week after the onset of disease,and 8 patients received selective operation after receiving conservative treatment for one week.The patients were followed up for one year.Results Among the patients who received endovascular isolation treatment within one week after the onset of disease,one patient recovered smoothly,two patients developed type A dissection within 3 months after surgery,and one died early after surgery.All the 8 patients,who received selective operation after receiving conservative treatment for one week,recovered smoothly.Conclusion For patients with type A AIH complicated by mild to moderate pericardial effusion,selective endovascular isolation treatment after receiving the conservative treatment to alleviate the ascending aortic hematoma can achieve ideal therapeutic effect.

Objective:To analyze the epidemiological characteristics of norovirus (NoV) acute gastroenteritis (AGE) outbreaks caused by GII.17[P17] variant in China, 2022.Methods:Information and specimens of AGE outbreaks between January and December 2022 were collected. NoV RNA was detected in all specimens by real-time RT-PCR. The viral genome of the positive specimens were amplified, sequenced and analyzed.Results:Between January and December 2022, 360 AGE outbreaks were reported cumulatively, of which 266 outbreaks successfully obtained genotype results. GII.17 [P17] was one of the main genotypes and detected in 34 outbreaks (12.78%, 34/266), with the highest number of outbreaks detected in spring (6 outbreaks in March and 7 outbreaks in May), mainly in childcare facilities and primary schools (61.76%, 21/34). According to the result of NoV genotype analysis in different age groups, 14 strains of GII.17 [P17] in this study belonged to Cluster III b and SC III branch of Cluster III (Kawasaki308) in the capsid region and polymerase region, respectively, and both belonged to the same cluster as the variant strain (GZ41621 strain) that caused the NoV AGE outbreaks in China during the 2014/15 season. Compared to reference strains of Cluster I, Cluster II and Cluster III a, Cluster III b was provided with 22 amino acid mutations in VP1. The main amino acid changes in the subgroup of Cluster III b including the virus strains isolated in this study were at T294I and Q299R of antigen epitope A, an insertion mutation occurred at antigen epitope D, H353Q at the site I of the human histo-blood group antigen receptor binding site. The selection pressure analysis detected a large number of negative selection sites, indicating that negative selection plays an important role in the evolution of VP1 genes.Conclusions:GII.17 [P17] was one of the primary genotypes responsible for NoV diarrhea outbreaks in China in 2022. Phylogenetic analysis had revealed that it still belonged to the same cluster as the novel GII.17 [P17] variant (strain GZ41621) that caused NoV epidemics in China during the 2014/15 season, exhibiting minor amino acid variations at the potential epitope.

Frailty is related to the aging of the elderly, characterized by the decline of multi-system physiological functions and the increase of susceptibility. Both frailty and brain function decline are associated with age increase, and brain health can affect the postoperative outcomes and long-term quality of life in elderly patients. This paper provided a review on the relationship between frailty and brain health, specifically elaborating on the relationships of frailty with olfactory function decline, sleep disorders, and cognitive function, and aimed to remind medical staffs to pay attention to the frailty and brain function status of elderly patients, strengthen early evaluation and intervention, and improve the quality of life of elderly patients.

Objective:To analyze the evolution of predominant Norovirus strain GⅡ.4 Sydney[P31] from 2017 to 2020 in China.Methods:Universal primers and next-generation sequencing technology were applied to establish Norovirus genogroup Ⅱ genome amplification method . Phylogenetic and key sites were analyzed on GⅡ.4 Sydney[P31] strains.Results:Among the 8 GⅡ.4 Sydney[P31] strains, 6 were successfully amplified and the genome sequences were obtained using the preliminarily established GⅡ genome amplification method . Phylogenetic analysis showed that the 6 strains obtained in this study from 2017-2020 strains grouped with the 2015-2019 GⅡ.4 Sydney[P31] reference strains in one cluster, and the Chinese strain GZ20133135 in 2013 and the 2012-2014 GⅡ.4 Sydney[P31] reference strains grouped into another one. A mutation Asp372Asn was found adjacent to the HBGA binding site Ⅱ. Epitope analysis showed that strains after 2017 have developed several aa mutations in A epitopes (297, 372, and 373), B epitopes (333), E epitopes (414), and H epitopes (309, 310), wherein the 2020 strains 20HN261 and 20HN253 have new changes in the A epitope (368) and G epitope (355) compared with the previous strains.Conclusions:The key mutation sites of the Chinese predominant Norovirus strain GⅡ.4 Sydney[P31] have been determined, which provides a scientific basis for tracking the emergence of new strains, and provides basic data for the development of vaccines against epidemic strains in China.

Noroviruses were discovered in 1972 and have since been recognized as one of the leading causes of acute gastroenteritis epidemics and outbreaks worldwide, becoming a global public health problem. Over the past 50 years, there has been considerable understanding of the clinical, epidemiological, and pathogenic features of norovirus infection, but to date there has been a failure to establish effective in vitro culture and experimental animal models, resulting in limited studies of its infection and pathogenic mechanisms, and no specific vaccines and drugs available. With the global application of rotavirus vaccines, noroviruses become an important public health challenge that is yet to be controlled urgently after rotavirus.

Objective:To clarify the evolutionary characteristics and key site variations of the GII.6[P7] genome of norovirus disease outbreak in China.Methods:Genome amplification and sequencing of 46 GII.6[P7] positive samples monitored from CaliciNet China from 2018 to 2021. Simultaneous integration of all ORF1 (GII. P7) and ORF2 (GII.6) sequences for Bayesian evolutionary analysis. And the use of Simplot for restructuring analysis.Results:According to Bayesian evolution analysis, GII. P7 polymerase has temporal evolutionary characteristics, with an average base replacement rate of 2.067× 10 -3 nucleotide substitution/site/year, and recombination with 4 different VP1 genotypes (GII.6, GII.7, GII.14, GII.20). In the capsid region, GII.6 noroviruses can be further divided into GII.6a, GII.6b and GII.6c subtypes. The 46 strains in this study belong to the GII.6a subtype, which are divided into the same cluster as the virus strain NHBGR59 circulating in China in 2015. Simplot analysis determined that the recombination site of the GII.6[P7] strain in this study was at the ORF1-2 junction. The amino acid site variation of VP1 mainly occurred at the end of P1.1 and the P2 region. Compared with the reference strain of GII.6a subtype, there was no variation in the receptor binding site. Conclusions:The GII.6[P7] recombinant strains of the norovirus outbreak from 2018 to 2021 in China all belong to the GII.6a[P7] subtype.

Objective To study the effect of insulin on phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway in diabetic rats with myocardial ischemia reperfusion injury.Methods Diabetic rats were induced by high-sugar and high-fat diet plus intraperitoneal injection of streptozotocin (40 mg/kg).They were randomly divided into diabetic sham group (group A),diabetes ischemic reperfusion group (group B),diabetes ischemic reperfusion insulin treatment group (group C) and diabetic ischemia reperfusion + insulin Wortmaninn (PI3K inhibitors) group (group D),10 in each group.Myocardial ischemia reperfusion model in diabetic rats:heart was exposed between the third and fourth ribs of the left chest,2 mm from the lower edge of the left atrial ear,and 5-0 sterile suture was used to ligate the anterior descending coronary artery (LAD) and the great cardiac vein for 30 min,and then the perfusion was resumed for 120 min.Wortmannin (15 μg/kg) was given through femoral vein 20 min before ligation in group D,and the same amount of normal saline was given in the other 3 groups.Insulin (2 U/kg) was injected subcutaneously in group C and D 10 min before ligation,and the same amount of normal saline was injected subcutaneously in group A and group B.Plasma creatine kinase MB (CK-MB)and troponin Ⅰ (cTnⅠ) levels were measured in arterial blood after 120 min of reperfusion,and PI3K and Akt expression in myocardial tissue were detected by Western blot.Results Compared with the group A,the plasma levels of cTnI and CK-MB increased and the expressions of PI3K and phosphorylated protein kinase B (p-Akt) in myocardium decreased in the group B (P ＜ 0.05).After insulin treatment,the plasma cTnI [(0.89 ± 0.26) μg/L],CK-MB [(9.24 ±3.16) μg/L] in the myocardial tissue of the group C decreased,while the expression of PI3K (0.341 8 ±0.03 1) and p-Akt (0.673 1 ±0.028) in the myocardial tissue increased (P ＜0.05).After insulin + Wortmaninn administration,the plasma cTnI [(1.16 ±0.29) μg/L] and CK-MB [(12.57 ± 3.01) μg/L] in the group D increased,while the expression of PI3K (0.292 7 ± 0.036) and p-Akt (0.531 4 ± 0.030) in the myocardial tissue decreased,with statistically significant difference (P ＜ 0.05).Conclusions Insulin can reduce serum CK-MB and cTnⅠ levels in diabetic rats with myocardial ischemia reperfusion injury,possibly by activating PI3K/Akt signal transduction pathway,inhibiting myocardial enzyme release,and improving myocardial ischemia reperfusion injury in diabetic rats to play a protective role in myocardial cells.

Objective: To investigate the prevalence and related factors of obesity and central obesity among 35-75 year-old population in Jiangsu Province. Methods: During 2015-2017,83 530 eligible subjects aged 35-75 years from six study sites of Jiangsu Province were interviewed and examined. The data of demography,lifestyles,disease history,height,weight and waistline were collected. Logistic regression analysis was conducted for the influencing factors for obesity and central obesity. Results: A total of 83 393 residents completed the study,with a response rate of 99.84%. The prevalence of overweight,obesity and central obesity was 43.35%（standardized rate：35.90%）,20.02%（19.48%）and 59.93%（57.03%）. The results of multivariate logistic regression analysis showed that females（OR=0.822,95%CI：0.786-0.859;OR=0.900,95%CI：0.851-0.952;OR=1.130,95%CI：1.083-1.179）,45-75 years old（OR：1.120-1.731,95%CI：1.102-1.881）,graduating from high school or above（OR：0.767-0.902,95%CI：0.721-0.943）,living in urban areas（OR：1.530-2.077,95%CI：1.284-3.007）,smoking（OR：0.724-0.855,95%CI：0.678-0.898）,drinking （OR：1.125-1.179,95%CI：1.076-1.235）,hypertension（OR：1.884-3.461,95%CI：1.821-3.613）,diabetes（OR：1.363-1.758,95%CI：1.305-1.851）, dyslipidemia（OR：1.478-1.870,95%CI：1.429-1.851）were associated with overweight,obesity and central obesity. Conclusion The standardized prevalence rates of overweight,obesity and central obesity among 35-75 year-old population in Jiangsu Province are 35.90%,19.48% and 57.03%,respectively. Gender,age,education,residence,smoking,drinking,hypertension,diabetes and dyslipidemia are related factors.

Objective: During the 2016 winter season, GII.2 norovirus(NoV) suddenly emerged in China. To elucidate its mechanism of epidemic, this study focused on characteristics of binding between the P protein of capsid and histo-blood group antigens (HBGAs). Methods: The research object was GⅡ.2 ZTX strain which had an outbreaks by the end of 2016 in Beijing. Recombinant prokaryotic expression plasmid was constructed, and the expression of virus P protein was determined and purified. The P protein characteristics of binding to HBGAs was studied through saliva and oligosaccharide binding experiments. Results: Soluble P protein was successfully obtained, and combined with type A, B, AB saliva. Conclusions The result illuminate the combination with new outbreaks of NoV and salivary types, which provided a basis for its pathogenic mechanism and prevention and control measures.

Objective: To evaluate of the specificity of a new norovirus (NoV) detection method of in situ capture real-time quantitative reverse transcription polymerase chain reaction (ISC-RT-qPCR) and to apply the method for the detection of NoVs in fresh strawberry. Methods: A panel of stool samples with different NoV genotypes and various inoculums were used for the experiments. Results: We found that all the tested samples of eight genogroup Ⅱ (GⅡ) NoVs could be detected specifically by ISC-RT-qPCR. Moreover, in contrast to the conventional RT-qPCR method , the situation that the Ct value increased as the inoculum of NoV GⅡ decreased was not shown using ISC-RT-qPCR. When we tested NoVs in strawberry samples by ISC-RT-qPCR, the minimum test limit could reach 1.36 genocopy/10 g of fresh strawberry. Conclusions ISC-RT-qPCR is an effective and specific technic and it could be applied for the detection of infectious NoVs from stool samples and fresh strawberry samples.