Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To investigate the causes of strong pathogenicity of Bacillus cereus ( B. cereus) in a mouse model of B. cereus endophthalmitis and the factors that might be related to the prognosis of the disease. Methods:C57BL/6J mice aged 6-8 weeks were injected with 1 μl PBS solution containing 100 CFU B. cereus into the vitreous cavity to construct traumatic endophthalmitis model, and a control group was set up by injecting the contralateral eyeball with 1 μl sterile PBS. A mouse model of Staphylococcus epidermidis ( S. epidermidis) endophthalmitis was constructed in the same way as disease control group. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) were used to detect the levels of inflammatory cytokines at different time points. Histology, electroretinogram and transmission electron microscopy were used to detect the progression of endophthalmitis and retinal function at different time points. Results:B. cereus grew significantly faster than S. epidermidis in the eyes of C57BL/6 mice and gradually moved to the cornea 12 h after infection. The results of transmission electron microscopy showed that many more B. cereus were found in the iris with sparse pigment particles, while S. epidermidis could not be detected in the anterior segment after infection. The electroretinogram results showed that the amplitude of A wave and B wave of mice with B. cereus endophthalmitis decreased significantly 6 h after infection, and the B wave could not be detected 12 h after infection. Moreover, the amplitude reduction at different time points was significantly larger than that in the S. epidermidis endophthalmitis group. Histological examination found that compared with the S. epidermidis endophthalmitis group, the mice with B. cereus endophthalmitis had significantly increased inflammatory cells in the anterior chamber and vitreous cavity with a higher degree of infiltration, which was more destructive to the tissue structure. ELISA results showed that the activity of myeloperoxidase (MPO) was significantly stronger in the B. cereus endophthalmitis group than in the S. epidermidis endophthalmitis group, suggesting that a much more severe inflammation was induced. The expression of IL-6, TNF-α and IL-1β at the transcription and protein levels in the mouse model of B. cereus endophthalmitis were significantly higher than those in the mice with S. epidermidis endophthalmitis. Conclusions:B. cereus could induce severe endophthalmitis and tissue destruction in the eye due to its rapid growth and migration ability, which was an important factor leading to vision loss.

Objective: To investigate the influence of intermittent cold stress on collagen content of atherosclerotic plaque in experimental ApoE-/-mice.
Methods: A total of 20 male ApoE-/-mice at 8 weeks of age were divided into 2 groups:Experimental group, the mice had intermittent cold exposure at (4 ± 1)°C from 8am to 12noon and Control group, the mice were living at (24 ± 2) °C. All animals were treated for 12 weeks, n=10 in each group. The collagen content of atherosclerotic plaque at the aortic root in ApoE-/-mice was observed by Masson staining, the protein expressions of aortic MMP-2, MMP-9 and TIMP-1 were examined by Western blot analysis.
Results: Compared with Control group, the Experimental group presented the lower collagen content of atherosclerotic plaque at the aortic root, higher protein expressions of MMP-2, MMP-9 and lower protein expression of TIMI 1.
Conclusion: Intermittent cold stress may disturb the balance of MMP/TIMP and decrease collagen content of atherosclerotic plaque to form vulnerable plaque in experimental ApoE-/-mice which may cause acute coronary syndrome.

Objective To evaluate the impact of low dietary glycemic index on the risk of coronaryheart disease (CHD).Methods We searched the Cochrane Database of Systematic Reviews,JBI Database of Systematic Reviews,MEDLINE,EMbase,CBMdisk,and CNKI to collect cohort studies from 2000 to 2011.The quality of cohort studies was critically appraised and data were extracted by 4 reviewers independently.Meta-analysis were conducted for the eligible cohort studies using RevMan 5.0.Results Five cohort studies were included,and 128 911 samples were researched.The result of meta analysis indicated that low dietary glycemic index was a protective factor of CHD,RR value was 1.25,95％ CI was (1.13,2.15).Further more,the result was only effective to female,RR value was 1.35,95％ CI was (1.16,1.57),but not to male,RR value was 0.96,95％CI was (0.76,1.31).Conclusions Low dietary glycemic index can decrease the risk of CHD,but it is still to be proved whether it is suitable to male.

Objective To analyze the MRI data of misdiagnosed and missed diagnosed of breast lesions and their histopathological features.Methods Data from 241 breast lesions within 121 patients were recruited in this study.The data included MRI images,uhrasounds and X-ray images were retrospectively interpreted by two radiologist and each lesion was assessed according to the BI-RADS classification.The pathologic features of miss or error diagnosed lesions on MRI were analyzed.Results In 241 breast lesions (malignance 120,bcnign 121),4 lcsions were miss diagnosed on MRI.Thcy were 2 intraductal papillomatosis and 2 fibroadenoma.All was benign.Twenty three lesions were misdiagnosed on MRI.Sixteen were overestimation,including 3 chronic inflammations,3 sclerosing adenosis,2 fibroadenoma,4 fibrocystic changes with or without atypical ductal hyperplasia (ADH),2 intraductal papilloma,1 infiltration of pectoralis major muscle and 1 axillary lymphnode metastasis.Meanwhile,there were 7 lesions were underestimation.These lesions included 2 invasive ductal carcinomas,1 mucinous adenocarcinoma,2 DCIS and 1 blunt duct adenosis with ADH and focal cancerous,1 inflammatory breast cancer underwent chemotherapy.The sensitivity and specificity and accuracy of breast MRI were 95.83 ％ (115/120),72.73 ％ (88/121),84.23 ％ (203/241),respectively.MRI findings had no difference with respect to mammogram or ultrasound was 75.10 ％ (181/241).Conclusion MRI misdiagnosis and missed often occurs in smaller breast lesions,morphologic and hemodynamic malignant manifestation atypical,especially intraductal lesions.MRI diagnosis should be combined with physical examination,X-ray mammogram and ultrasound to improve diagnostic accuracy and reduce missed diagnosis.

Objective To investigate the effective ways of improving medical students' clinical competence during the process of internship. Methods Totally 398 students of clinical medicine from 2006 and 2007 grade in Soochow University were enrolled as research objects. Forty objects distribut-ed to the First Affiliated Hospital were taken as experiment group while 358 objects distributed to other hospital as control group. In experiment group, objective structured clinical examination (OSCE) was introduced during regular internship, innovation was made on test on completion of a course and autonomous learning and clinical practice was advocated and enhanced. Traditional practice and ex-amination method was used in control group. SPSS 19.0 was used to do statistical analysis on the test scores of students. Paired sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.

Objective To estimate the prevalence of sexually transmitted diseases(STDs) among men who have sex with men (MSM) in some cities of Jiangsu province.Methods A cross-sectional questionnaire survey was carried out among MSM attending gay bars in some cities of Jiangsu province.Participants underwent screening for STDs in accordance with their personal wishes.Urethral swabs,first void urine and blood samples were collected at these survey sites and delivered to the STD research laboratory for testing.Univariate analysis and multivariate logistic regression analysis were performed to assess factors associated with STDs.Results A total of 388 subjects completed the questionnaire and underwent physical examination and STD screening.Of these subjects,45.6％ had only homosexual behavior.Examination of urine or urethral swab specimens showed that the prevalence rate was 1.3％ (5/388),9.4％ (36/385),17.2％ (66/384) and 28.1％ (109/388) for Neisseda gonorrhoeae,Chlamydia trachomatis,Mycoplasma genitalium and Ureaplasma urealyticum infection respectively.Serological tests revealed that the positivity rate was 1.0％ (4/388) for anti-human immunodeficiency virus (HIV)antibody,18.8％(73/388) for Treponema pallidum particle agglutination assay (TPPA),12.1％(47/388) for rapid plasma reagin (RPR) test,9.8％ (38/388) for human herpes simplex virus (HSV)-2-IgG,9.8％ (38/388) for hepatitis B surface antigen,1.0％ (4/388) for anti-hepatitis C virus antibody and 2.1％ (8/388) for anti-hepatitis E virus antibody.Multivariate analysis indicated that Chlamydia trachomatis infection was independently and significantly associated with polymorphonuclear leucocyte (PMNL) counts in urethral swab smears (adjusted odds ratio (AOR):5.30,95％ CI:2.04-13.77,P ＜ 0.01),Mycoplasma genitalium infection was significantly associated with age (AOR:2.84,95％ CI:1.17-6.87,P＜ 0.05),PMNL counts in urethral swab smears (AOR:2.37,95％ CI:1.01-557,P＜ 0.05) and urethral discomfort in the past three months (AOR:2.43,95％ CI.1.18-5.02,P＜ 0.05),and syphilis (defined as a positive TPPA and RPR test) was associated with age (AOR:2.46,95％ CI:1.05-5.75,P ＜ 0.05) and seropositivity for anti-HSV-2 antibodies (AOR:3.70,95％ CI:1.62-8.44,P ＜ 0.01).Conclusions There is a high prevalence of STDs among MSM attending gay bars in some cities of Jiangsu province,with Chlamydia trachomatis and Mycoplasma genitalium as the most common pathogens of urethritis.

Objective To investigate the involvement of mitogen-activated protein kinase(MAPK)and PI3K(phosphatidylinositol 3 kinase)/ Protein kinase B(Akt) signal transduction pathways in the mechanism of myocardium remodeling in patients with congestive heart failure(CHF).Methods Thirty nine patients of mitral valve disease with CHF were randomly selected and 30 cases of healthy persons were included as controls.Cardiac function parameters were measured by echocardiography.Concentration of AngⅡ in plasma and myocardial tissues was determined by radio immunoassay.Activity of PKC was determined by using competive prote in binding method,activity of MAPK was detected by the methods of immunoprecitipation.Immunoprecitipation was used to assay the protein expression and phosphorylation of PI3K and Akt(Protein kinase B),protein expression of C-FOS and ?-skeletal-actin in myocardial tissues.Results Pathological changes of myocardial tissues in CHF with valvular heart diseaseshowed typical myocardial remodeling.The hypertrophy was dominant at early stagy of CHF,while at end stage the characteristics include disordered alignament of the myocytes,the discontinuity and dissolving of cardiomyofibrills,destroyed subcellular organs,and the hyperplasia of interstitial tissue.AngⅡ concentration in plasm and myocardial tissues in patients with CHF was higher than those in the control group(P

Objective To investigate the involvement of mitogen-activated protein kinase(MAPK)system and hypertrophy related genes in myocardial remodeling mechanism of patients with congestive heart failure(CHF).Methods Thirty-nine patients of mitral valve disease with CHF were randomly selected and 30 cases of healthy persons were included as controls.Cardiac function parameters were measured by echocardiography.Concentration of AngⅡ in plasma and myocardial tissues were determined by radio immunoassay.Immunoprecipitation was used to assay the protein expression and phosphorylation of c-jun NH2-terminal kinase(JNK),extracellular signal regulated kinase(ERK),P 38- mitogen-activated protein kinase(P 38-MAPK)in myocardial tissues;protein expression of c-myc,c-myb,c-jun was also determined by immunoprecipitation.Results Compared to the control group,the phosphorylation of ERK1/2 was obvious in heart function class Ⅱ group(P0.05);phosphorylation of JNK was obvious in CHF groups(P0.05);there was no expression in control group.Conclusion MAPK activated by renin angiotensin system may play an important role by causing the protein expression of c-myc,c-myb,c-jun in myocardial remodeling in patients with CHF.

BACKGROUND: Having breakfast everyday is a behavior promoting health recommended WHO, while it is easy to be ignored.OBJECTIVE: To investigate the breakfast habits of pupils in Beijing and Shanghai so as to provide a scientific basis for further studying the problems in having breakfast among the pupils, drafting and developing "nutritious breakfast program for students".DESIGN: Stratified and cluster sampling and investigation study were used based on the pupils.SETTING: Institute of health for child of two universities.SUBJECTS: A total of 8688 six to eleven years old Beijing and Shanghai pupils were involved from March 2002 to June 2002. Among them 4692 pupils came from Beijing. There were 4637 valid questionnaires, 2386 of which were from male pupils and 2251 from female pupiIs. Among the total subjects, there were 4300 Shanghai pupils, and 4051 questionnaires were valid, of which 2031 were from the male pupils and 2020 from female students.METHODS: A self-administered questionnaire survey was conducted. The content of the questionnaire included the general conditions of the family, dietary preferences, food for breakfast, consumption of the milk food and so on.RESULTS: The results showed that about 25.8% boys and 21.6% girls in Beijing did not eat breakfast regularly; similarly, the percentage was about 11.4% for boys and 13.3% for girls in Shanghai. The reasons for not having breakfast included the following: They had no appetite, or had no enough time for it, or the parents were too busy to prepare in the mornings. For those of them who eat breakfasts, the nutrients of their breakfast usually were not adequate. 55% of the students had their breakfast prepared by their mothers. As for the eating sites, students mainly ate at home; the next was having it on the way to school or eating at the roadside luncheonettes. The cost of breakfast was 2 - 3 yuan. The breakfast behaviors of the pupils were closely related with the behaviors of their mothers( r = 0. 4333, P < 0.01 ).CONCLUSION: It is suggested that quality of breakfast of the pupils need to be improved. The behaviors of the parents influence their children in breakfast habits.