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 evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.

Radiotherapy may be an effective method for the treatment of keloids. After decades of clinical practice, the efficacy of radiotherapy combined with surgery has been comprehensively recognized and reported by the clinicians. At presents, radiotherapy has innovated from superficial X-ray to brachytherapy for the treatment of keloids, while the consensus of optimized radiotherapy strategy has not been defined. Many factors such as radiation interval, dose, fractions, lesion locations and complications may affect the clinical outcome of radiotherapy for keloids. Optimizing radiotherapy strategies can help improve the clinical outcome, as well as patient satisfaction, and reduce the recurrence rate of keloids. This article discussed the radiation dose, interval, and fractions of radiotherapy for keloids after extensive review of the existing literature, which may facilitate clinical decision making.

Radiotherapy may be an effective method for the treatment of keloids. After decades of clinical practice, the efficacy of radiotherapy combined with surgery has been comprehensively recognized and reported by the clinicians. At presents, radiotherapy has innovated from superficial X-ray to brachytherapy for the treatment of keloids, while the consensus of optimized radiotherapy strategy has not been defined. Many factors such as radiation interval, dose, fractions, lesion locations and complications may affect the clinical outcome of radiotherapy for keloids. Optimizing radiotherapy strategies can help improve the clinical outcome, as well as patient satisfaction, and reduce the recurrence rate of keloids. This article discussed the radiation dose, interval, and fractions of radiotherapy for keloids after extensive review of the existing literature, which may facilitate clinical decision making.

In order to ensure the normal teaching order during the prevention and control of the COVID-19 epidemic, the second semester of the 2019-2020 academic year in Central South University was devoted to the online teaching. In response to the school's call, the diagnostics teaching team has applied the Tencent classroom software, WeChat mini programs, analog teaching software and digital curriculum platform to carry out online teaching activities. On the basis of summarizing the previous online teaching experience, we have made a preliminary discussion and reflection on the online teaching, which will provide ideas and directions for the reform of medical education.

Objective:To explore the early application effect of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 102 patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD treated in Shanghai Public Health Clinical Center from June 2018 to December 2019 were selected and divided into the control group and the research group by random digits table method with 51 cases in each group. The control group was given the conventional treatment and nursing measures; and the research group was given the bedside sitting respiratory training. Pulmonary functional and blood -gas analysis parameters, clinical outcome of patients, etc. before and after the intervention between the two groups were compared. Results:After the intervention, the forced expiratory volume in one second (FEV 1), forced vital capacity(FVC), FEV 1/FVC were (1.79±0.22) L, (3.09±0.28) L, (62.16±5.94)% in the research group, and (1.43±0.18) L, (2.66±0.23) L, (53.48±5.31)% in the control group, the differences were statistically significant(t values were 8.36, 8.00, 7.19, P<0.01). Arterial partial pressure of carbon dioxide (PaCO 2) and arterial partial pressure of oxygen (PaO 2) in blood gas analysis were (51.14±3.79) mmHg(1 mmHg=0.133 kPa), (71.07±5.49) mmHg in the research group, and (57.52±3.86) mmHg, (65.62±5.27) mmHg in the control group, the differences were statistically significant ( t values were -7.78, 4.72, P<0.01). The non-invasive positive pressure ventilation time, hospital stays were (7.41±1.76) d, (11.27±2.41) d in the research group, and (9.79±2.11) d, (15.46±3.12) d in the control group, the differences were statistically significant ( t values were -5.71, -6.70, P<0.01). The incidence of adverse events was 3 cases in the research group, 1 case in the control group, the difference was no statistically significant ( P>0.05). Conclusions:The application of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD can effectively improve the pulmonary physiological function, shorten the noninvasive positive pressure ventilation time and hospitalization time, which has clinical application value.

Objective:To analyze the sensitivity and specificity of SARS-CoV-2 nucleic acid testing in 20 348 close contacts of COVID-19 cases in different prevention and control stages in Guangzhou and to provide scientific evidence for optimizing epidemic response strategies.Methods:A total of 20 348 close contacts of COVID-19 cases in Guangzhou were traced between February 21 and September 22,2020. All the close contacts were tested for the nucleic acid of SARS-CoV-2. The sensitivity and specificity of nucleic acid testing and diagnosis in the different prevention and control stages were compared.Results:In 20 348 close contacts, 12 462 were males (61.24%), the median ( P 25, P 75) of age of them was 31.0 years (23.0,43.0), the median number ( P 25, P 75) of nucleic acid testing for them was 2.0 (1.0,3.0), and the median ( P 25, P 75) of their quarantine days was 12.0 (8.0,13.0) days, respectively. A total of 256 COVID-19 cases were confirmed in the close contacts after seven nucleic acid tests. In the 1 st, 2 nd, 3 rd and 7 th nucleic acid testing, the sensitivity and specificity were 69.14% and 99.99% (177 cases confirmed), 89.84% and 99.99% (230 cases confirmed), 97.27% and 99.99% (249 cases confirmed), and 100.00% and 99.98%, respectively. In the three stages of COVID-19 prevention and control in China: domestic case stage, imported case stage, and imported case associated local epidemic stage, the sensitivity of the 1 st nucleic acid testing was 70.68%, 68.00% and 67.35%, and the specificity was 99.98%, 100.00% and 100.00%, respectively. Conclusions:The sensitivity of nucleic acid testing in the close contacts at the different stages were consistent with slight decrease, which might be related to the increased proportion of asymptomatic infections in the late stage of epidemic prevention and control with COVID-19 in Guangzhou. It is suggested to give three nucleic acid tests to improve the sensitivity and reduce false negative risk.

Objective:Based on ear cartilage of congenital microtia, we tried to find the different metabolites and variational metabolic pathways on molecular level by gas chromatography time-of-flight mass spectrometry (GC-TOFMS).Methods:Patients with microtia were collected from June 2017 to January 2018. During operation, the ear cartilage tissue was collected and labeled, and the case group was residual ear cartilage tissue of the patients with microtia, with 18 cases. The control group was normal ear cartilage tissue, total 18 cases. After the sample pretreatment, based on the technique of GC-TOFMS and the software of XploreMET, the differential metabolites in the residual ear cartilage of microtia were analyzed by orthogonal partial least square discriminant analysis (OPLS-DA) and its variable importance projection (VIP) and U test statistical method. Compared with the metabolite database, the metabolic pathway enrichment analysis (MPEA) was used to screen the most related metabolic pathways. Results:According to the multidimensional statistical analysis, it is different in the metabolites of ear cartilage between the two groups. According to the verification of single dimensional statistical analysis, 14 specific biomarkers were identified, and their P value was less than 0.05. According to the metabolic pathway enrichment analysis (MPEA), 3 metabolic pathways had statistically significant difference, including arginine metabolism, taurine and the taurine metabolism, pantothenate and CoA metabolism, beta-alanine metabolism, glycerophospholipid metabolism, P <0.05. Conclusions:Arginine, taurine, L-cysteine and pantothenic acid may have an association with microtia, which proved that it is feasible to study the pathogenesis of microtia by metabonomics.

Objective:To investigate the microenvironment associated with tumorimmunity in regenerated lymph nodes treated with VEGF-C, which involves the lymphangiogenesis, chemokine as well as alteration of cell populations.Methods:A total of 10 nude mice were randomized to 2 groups. 5 mice in group A were treated with autologous lymph nodes fragmentary transplantation together with VEGF-C, 5 mice without any intervention in group B were served as control group. 4 weeks after surgeries, MDA-MB-231-Luc-GFP cells (5×10 6 cells/mouse, 100 μl of 40% matrigel solution) were injected subcutaneously in the thoracic flunk of nude mice in group A, the same number cells were implanted into the second mammary fat pad in group B as well. 4 weeks post inoculation, the tumor draining lymph nodes (TDLNs) in both groups were harvested, and the microenvironment was assessed by hematoxylin-eosin (HE) staining and multispectral immunofluorescence staining for LYVE-1, chemokine CCL21, programmed death ligand-1(PD-L1) and F4/80. Results:The specific markers were analyzed based on positive cell percentage between group A and group B. The LYVE-1 and F4/80 expression in the group A was significantly higher than that in group B[LYVE-1: group A 21.44 0(34.675)% vs group B 2.964 (4.160)%, P<0.001; F4/80: group A 5.396 (7.205)% vs group B 3.573 (2.670)%, P=0.020)], and there were no significant differences in the expression of CCL21 and PD-L1 between these two groups [CCL21: group A 21.470((29.145)% vs group B 16.430((29.145)%( P=0.166); PD-L1: group A10.000 (14.430)%vs group B 4.070 (26.740)%, P=0.091]. Additionally, the double positive expression of LYVE-1/CCL21 and LYVE-1/F4/80 had still statistically significant differences[LYVE-1/CCL21: group A 8.637 (13.150)% vs group B 1.571 (1.680)%, P<0.001; LYVE-1/F4/80: group A 6.181 (9.050)% vs group B 1.454 (0.830)%, P<0.001], whereas, the two groups did not differ from each other in the double positive expression of LYVE-1/PD-L1 [group A 3.617 (4.195)% vs group B 2.363 (3.900)%, P=0.266]. Conclusions:The renewed lymph nodes treated with VEGF-C demonstrate some more immune suppressive conditions such as lymphatic endothelial cells hyperplasia, myeloid-derived suppressor cells infiltration, enhanced expression of CCL21 and PD-L1.

Objective:Based on ear cartilage of congenital microtia, we tried to find the different metabolites and variational metabolic pathways on molecular level by gas chromatography time-of-flight mass spectrometry (GC-TOFMS).Methods:Patients with microtia were collected from June 2017 to January 2018. During operation, the ear cartilage tissue was collected and labeled, and the case group was residual ear cartilage tissue of the patients with microtia, with 18 cases. The control group was normal ear cartilage tissue, total 18 cases. After the sample pretreatment, based on the technique of GC-TOFMS and the software of XploreMET, the differential metabolites in the residual ear cartilage of microtia were analyzed by orthogonal partial least square discriminant analysis (OPLS-DA) and its variable importance projection (VIP) and U test statistical method. Compared with the metabolite database, the metabolic pathway enrichment analysis (MPEA) was used to screen the most related metabolic pathways. Results:According to the multidimensional statistical analysis, it is different in the metabolites of ear cartilage between the two groups. According to the verification of single dimensional statistical analysis, 14 specific biomarkers were identified, and their P value was less than 0.05. According to the metabolic pathway enrichment analysis (MPEA), 3 metabolic pathways had statistically significant difference, including arginine metabolism, taurine and the taurine metabolism, pantothenate and CoA metabolism, beta-alanine metabolism, glycerophospholipid metabolism, P <0.05. Conclusions:Arginine, taurine, L-cysteine and pantothenic acid may have an association with microtia, which proved that it is feasible to study the pathogenesis of microtia by metabonomics.