Objective:To compare the efficacy of catheter-directed thrombolysis versus catheter-directed thrombectomy for high-risk pulmonary embolism.Methods:The clinical data of 105 patients with high-risk pulmonary embolism from April 2020 to January 2023 in Hebei China Petroleum Central Hospital were retrospectively analyzed. Among them, 52 patients were treated with catheter-directed thrombolysis (thrombolysis group), and 53 patients were treated with catheter-directed thrombectomy (thrombectomy group). The efficacy, symptom relief time, oxygen saturation recovery time, mortality rate, Qanadli embolic index, pulmonary artery pressure and complications were compared between two groups.Results:There were no statistical differences in total effective rate, symptom relief time, oxygen saturation recovery time, mortality rate and total incidence of complications between two groups ( P>0.05). Compared with before treatment, the Qanadli embolic index and pulmonary artery pressure after treatment in thrombolysis group and thrombectomy group were significantly lower, thrombolysis group: 22.08 ± 8.57 vs. 45.18 ± 13.27 and (24.18 ± 5.19) mmHg (1 mmHg = 0.133 kPa) vs. (34.15 ± 6.22) mmHg, thrombectomy group: 23.11 ± 8.62 vs. 44.82 ± 13.14 and (23.66 ± 5.02) mmHg vs. (34.89 ± 6.27) mmHg, and there were statistical differences ( P<0.01); but there was no statistical difference the Qanadli embolic index and pulmonary artery pressure before and after treatment between two groups ( P>0.05). Conclusions:In patients with high-risk pulmonary embolism, both catheter-directed thrombolysis and catheter-directed thrombectomy have good efficacy and can promote the relief of clinical symptoms and the recovery of oxygen saturation, improving the prognosis.

Objective:To investigate the image quality, radiation dose, and diagnostic efficiency of the regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, in the assessment of coronary in-stent restenosis.Methods:A total of 120 patients (with 142 stents) treated with coronary stent implantation at the Beijing Renhe Hospital from August 2020 to August 2022 were enrolled in this study. They were randomly divided into an observation group (60 cases with 70 stents) and a conventional group (60 cases with 72 stents) using the random number table method. Both groups received GE 256-slice Revolution CT examinations. Patients in the conventional group were injected with 70 ml of iopromide as a contrast agent each, while those in the observation group were given individualized doses based on their body mass indices (BMIs). A tube voltage of 120 kV and a tube current of 534 mA were applied to the conventional group, whereas the tube voltage and current for the observation group were adjusted within the ranges of 80-120 kV and 150-534 mAs based on patients’ BMIs. Both groups received coronary angiography 7-14 d after coronary computed tomography angiography (CCTA). Finally, the CT image quality, radiation dose, iodine intake, and diagnostic efficiency were compared between the two groups.Results:Both groups exhibited no significant differences in CT values, contrast-to-noise ratios, blooming artifacts, and stent diameters of the left main coronary artery ( P > 0.05). The conventional group manifested higher CT dose index, CT dose length product, effective dose, and iodine intake compared to the observation group ( t = 10.30, 8.75, 10.27, 4.60, P < 0.05). With coronary angiography result as the gold standard, the observation and conventional groups yielded Kappa values of 0.904 and 0.879, respectively, suggesting high consistency in diagnostic performance. Additionally, the two groups demonstrated nonsignificant differences in sensitivity and specificity ( P > 0.05). Conclusions:The regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, yielding image quality and diagnostic efficiency equivalent to those of the conventional regimen, can effectively reduce radiation dose and iodine intake. Therefore, this regimen merits wide applicability.

Objective To explore the value of the combination of serum hemoglobin A1c(HbA1c),Alarin and Ficolin-3 in predicting adverse pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods From March 2021 to March 2023,129 GDM patients who underwent prenatal examination and hospital delivery in Yantai Yeda Hospital were collected as the GDM group,while 133 pregnant women with normal glucose tolerance test results were regarded as the control group.Fully automated glycated hemoglobin analyzer was applied to detect serum HbA1c level.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum Alarin and Ficolin-3 levels.Pearson method was used to analyze the correlation between serum HbA1c,Alarin,Ficolin-3 levels and 2 hour postprandial glucose(2 h PG),fasting blood glucose(FBG)and homeostasis model assessment method for insulin resistance(HOMA-IR)in GDM patients.Logistic regression was applied to analyze the relationship between HbA1c,Alarin,Ficolin-3 levels and adverse pregnancy outcomes in GDM patients.Receiver operating characteristic(ROC)curve was plotted to analyze the value of serum HbA1c,Alarin and Ficolin-3 levels in predicting adverse pregnancy outcomes in GDM patients.Results The 2 h PG,FBG,HOMA-IR,and serum HbA1c,Alarin,and Ficolin-3 levels were significantly higher in the GDM group than those in the control group(P＜0.05).The serum levels of HbA1c,Alarin and Ficolin-3 were positively correlated with 2 h PG,FBG and HOMA-IR in GDM patients(P＜0.05).The serum HbA1c,Alarin and Ficolin-3 levels were greatly higher in GDM patients with poor blood glucose control than those in GDM patients with good blood glucose control(P＜0.05).The above levels of three indicators in GDM patients with adverse pregnancy outcomes were significantly higher than those in GDM patients without adverse pregnancy outcomes(P＜0.05).Elevated levels of HbA1c,Alarin and Ficolin-3 were independent risk factors for adverse pregnancy outcomes in GDM patients(P＜0.05).The area under the curves of HbA1c,Alarin and Ficolin-3 alone and in combination were 0.840,0.865,0.815 and 0.979,respectively in predicting adverse pregnancy outcomes in GDM patients.Conclusion The serum HbA1c,Alarin and Ficolin-3 levels are abnormally elevated in GDM patients,and the combined detection of the three can improve the value in predicting adverse pregnancy outcomes.

Objective:To investigate the effect of melatonin on the expression of PD-L1 on the surface of ovarian cancer cells.Methods:Ovarian cancer cell line OVCAR3 was treated with melatonin,then flow cytometry was used to detect the expression level of PD-L1 on the surface of ovarian cancer cells.Western blot was used to detect the expressions of PD-L1 and LC-3 in ovarian cancer cells after different treatments.After adding autophagy inhibitor Autophinib,flow cytometry was used to detect the expression of PD-L1 on the surface of ovarian cancer cells,ovarian cancer cells were treated with melatonin or melatonin combined with autophagy inhibi-tors and co-incubated with human T lymphocyte Jurkat.The proportion of ovarian cancer cell apoptosis was detected by flow cytometry.Results:Melatonin treatment significantly reduced expression of PD-L1 on the surface of ovarian cancer cells,promoted autophagy of ovar-ian cancer cells.Autophagy inhibitors reversed down regulation of PD-L1 treated by melatonin,Jurkat cells killed more melatonin treated ovarian cancer cells,and the killing of ovarian cancer cells by Jurkat cells revised by autophagy inhibitors.Conclusion:Mela-tonin can enhance the killing effect of T cells on ovarian cancer cells.

Ziziphi spinosae semen mainly contains contents of saponins,flavonoids,alkaloids and aliphatic acids.Meanwhile,it has a variety of activities such as sedative-hypnotic,anti-anxiety,anti-depression,nerve protection,cardiovascular and cerebrovascular protection,liver protection,and antioxidant,which is widely used in medicine,food,health food and other fields.The chemical constituents,pharmacological action and clinical application of Ziziphi spinosae semen were systematically summarized in this paper by reviewing the literature,in order to provide theoretical guidance for the sustainable development of the resources and the rational use of Ziziphi spinosae semen.

Objective:To summarize and sort out the best evidence for sleep disorders management in children with autism spectrum disorder.Methods:Literatures related to sleep disorders management in children with autism spectrum disorder were systematically retrieved on UpToDate, BMJ Best Practice, National Guidelines Clearinghouse, Registered Nurses' Association of Ontario, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence, Guidelines International Network, World Health Organization website, Medlive, Joanna Briggs Institute evidence-based healthcare center database, Web of Science, Cochrane Library, PubMed, Embase, CINAHL, PsychInfo, China Biology Medicine disc, Wanfang Database, CNKI, VIP, Association for Science in Autism Treatment website, Autism Society website, National Autism Society website and other domestic and foreign databases and websites. Literature types included guidelines, systematic review/Meta-analysis, evidence summary, clinical decision making and expert consensus. The search deadline was from the establishment of the databases to November 30, 2022. Two researchers trained in systematic evidence-based knowledge evaluated literature quality and extracted evidence.Results:A total of 14 literatures were included, including 1 clinical decision, 4 guidelines, 7 expert consensus and 2 systematic reviews. A total of 32 pieces of evidence were formed from 8 aspects, including screening, assessment, sleep planning, treatment goals, intervention, follow-up, caregiver support and team management of children with autism spectrum disorder.Conclusions:This study summarizes and forms the best evidence on the management of sleep disorders in children with autism spectrum disorder, and provides an evidence-based basis for the management of sleep disorders in them.

The emergence of SARS-CoV-2 variants of concern and repeated outbreaks of coronavirus epidemics in the past two decades emphasize the need for next-generation pan-coronaviral therapeutics. Drugging the multi-functional papain-like protease (PLpro) domain of the viral nsp3 holds promise. However, none of the known coronavirus PLpro inhibitors has been shown to be in vivo active. Herein, we screened a structurally diverse library of 50,080 compounds for potential coronavirus PLpro inhibitors and identified a noncovalent lead inhibitor F0213 that has broad-spectrum anti-coronaviral activity, including against the Sarbecoviruses (SARS-CoV-1 and SARS-CoV-2), Merbecovirus (MERS-CoV), as well as the Alphacoronavirus (hCoV-229E and hCoV-OC43). Importantly, F0213 confers protection in both SARS-CoV-2-infected hamsters and MERS-CoV-infected human DPP4-knockin mice. F0213 possesses a dual therapeutic functionality that suppresses coronavirus replication via blocking viral polyprotein cleavage, as well as promoting antiviral immunity by antagonizing the PLpro deubiquitinase activity. Despite the significant difference of substrate recognition, mode of inhibition studies suggest that F0213 is a competitive inhibitor against SARS2-PLpro via binding with the 157K amino acid residue, whereas an allosteric inhibitor of MERS-PLpro interacting with its 271E position. Our proof-of-concept findings demonstrated that PLpro is a valid target for the development of broad-spectrum anti-coronavirus agents. The orally administered F0213 may serve as a promising lead compound for combating the ongoing COVID-19 pandemic and future coronavirus outbreaks.
Animals ; Coronavirus Papain-Like Proteases/antagonists & inhibitors* ; Cricetinae ; Humans ; Mice ; Pandemics ; SARS-CoV-2/enzymology* ; COVID-19 Drug Treatment

Objective:To investigate the effect of citric acid-induced cough on swallowing function and serum substance P in stroke patients with early tracheotomy.Methods:Forty-nine post-stroke tracheotomy patients admitted to the Department of Neurosurgery at the First Affiliated Hospital of Soochow University from January 2018 to July 2019 were selected as study subjects. They were divided into intervention group ( n=24) and control group ( n=25) using the random digit table. The control group was subjected to routine nursing, while the intervention group was given citric acid to induce cough based on routine care. The intervention time was 1 week. The swallowing function and serum substance P levels were compared between the two groups before and after the intervention. Results:After the intervention, 45.8% (11/24) of the patients in the intervention group were assessed as having "strong" swallowing function, compared to 28.0% (7/25) in the control group, with a statistically significant difference in swallowing function between the two groups ( Z= -2.22, P<0.05), and the level of substance P in the intervention group was (283.40 ± 134.82) ng/L, significantly higher than that of the control group (203.59 ± 126.16) ng/L ( t=2.14, P<0.05). Conclusions:Citric acid-induced cough helped stroke patients with early tracheotomy to produce effective swallowing action and up-regulate substance P in serum to promote recovery of swallowing function.

Objective:To establish a quantitative detection method for the main components of dust mite allergens Der p 1, Der p 2 specific immunoglobulin E (sIgE) by using the nano-magnetic particle chemiluminescence immunoassay.Methods:The performance indexes of the established method were evaluated after setting up and optimizing the chemiluminescence detection system and immune reaction conditions of sIgE for dust mite allergen. Serum sIgE levels of 50 suspected allergic patients with dust mite were determined by this chemiluminescence method. At the same time, this method was compared with the Phadia kit and the consistency was analyzed by Kappa test. Results:The optimal amount of magnetic beads was 25 μg, the optimal reaction buffer (pH=7.4) contained 0.1 mol/L Tris-HCl and 0.25%( W/ W) casein, the optimal coating solution contatined 20 mmol/L phosphate buffer (PB) and 1%( W/ W) bovine serum albumin (BSA), and the luminescence enhancement solution contained 0.05%( V/ V) Triton X-100. The two-step immunoreaction was adopted, and the detection could be completed with 20 μl sample at the optimal reaction temperature of 37℃. The limit of detection (LOD) of the established nano-magnetic particle chemiluminescence system in detecting Der p 1 and Der p 2 sIgE antibodies were both less than 0.01 kU/L, with the linear range of 0.2-100.0 kU/L, the precision of less than 7%, and the cross contamination rate of 0.19% and 0.21%. Compared with the Phadia system, the positive and negative coincidence rate of Der p 1 were 78.0%(32/41) and 9/9 with good consistency ( Kappa=0.65, P=0.008), and the positive and negative coincidence rate of Der P 2 were 93.3%(28/30) and 85.0%(17/20) with good consistency ( Kappa=0.79, P=0.003). Conclusion:The nano-magnetic particle chemiluminescence immunoassay is successfully established for detecting dust mite allergen sIgE, which has good detection performance and good consistency with Phadia system.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.