Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To investigate the effects of matrix metalloproteinase 10(MMP10)on the proliferation,migration,invasion,and lymph node metastasis of oral squamous cell carcinoma(OSCC)cells,and to explore the underlying mechanisms.Methods:Gene expression profile data and survival data of head and neck squamous cell carcinoma(HNSCC)tissues and adjacent non-cancerous tissues were downloaded from The Cancer Genome Atlas(TCGA).Protein expression profile data of HNSCC tissues and adjacent non-cancerous tissues were downloaded from the Clinical Proteomic Tumor Analysis Consortium(CPTAC)database,and select the data of OSCC from HNSCC.The data from public database were used to analyze the differences in MMP10 expression at the mRNA and protein level between HNSCC/OSCC tissues and adjacent non-cancerous tissues,and to analyze the impact of MMP10 expression level on the survival rate of HNSCC patients,as well as the impact of human papillomavirus(HPV)on MMP10 gene expression in HNSCC patients.MMP10 expression level in 52 pairs of OSCC tissue samples and adjacent non-cancerous tissue samples(from the First Affiliated Hospital of Fujian Medical University)was measured by real-time quantitative PCR.After silencing MMP10 expression using siRNA(siMMP10-1291 and siMMP10-1336),the effect of MMP10 on the proliferation ability of OSCC cells was detected by CCK-8 assay and colony formation assay.The effects of MMP10 on the migration and invasion abilities of OSCC cells was assessed by wound-healing assay and transwell assay,respectively.To verify the effect of MMP10 knocking down on lymph node metastasis of OSCC cells in vivo,we constructed a nude mouse tongue cancer orthotopic model by shRNA(shMMP10-1291 and shMMP10-1336).Differential expression genes associated with MMP10 were screened from the gene expression profile data of OSCC patients in the TCGA database,and pathway enrichment analysis was performed using the GSEA software to further analyze the correlation between MMP10 and genes from the significantly enriched pathway.Results:Compared with adjacent non-cancerous tissues,the expression level of MMP10 in HNSCC and OSCC tissues was significantly increased(P<0.000 1),and HNSCC patients with high MMP10 expression had a lower survival rate(HR=1.32,P=0.04).HNSCC patients in the HPV-group had higher MMP10 gene expression levels(P<0.000 1),but their survival rate was significantly lower than that of HNSCC patients in the HPV+group(HR=0.48,P=0.004).Downregulating MMP10 expression could inhibit the migration,invasion and lymph node metastasis in vivo of OSCC cells.In OSCC patients,differentially expressed genes associated with MMP10 were significantly enriched in the Wnt signaling pathway(NES=1.505,P=0.029),and multiple genes in the Wnt signaling pathway,including WNT3,WNT3A,WNT5A,and WNT5B,were positively correlated with the expression level of MMP10.Conclusion:MMP10 promotes the invasion,metastasis and lymph node metastasis in vivo of OSCC cells by regulating the Wnt signaling pathway.

Objective:To investigate the effects of matrix metalloproteinase 10(MMP10)on the proliferation,migration,invasion,and lymph node metastasis of oral squamous cell carcinoma(OSCC)cells,and to explore the underlying mechanisms.Methods:Gene expression profile data and survival data of head and neck squamous cell carcinoma(HNSCC)tissues and adjacent non-cancerous tissues were downloaded from The Cancer Genome Atlas(TCGA).Protein expression profile data of HNSCC tissues and adjacent non-cancerous tissues were downloaded from the Clinical Proteomic Tumor Analysis Consortium(CPTAC)database,and select the data of OSCC from HNSCC.The data from public database were used to analyze the differences in MMP10 expression at the mRNA and protein level between HNSCC/OSCC tissues and adjacent non-cancerous tissues,and to analyze the impact of MMP10 expression level on the survival rate of HNSCC patients,as well as the impact of human papillomavirus(HPV)on MMP10 gene expression in HNSCC patients.MMP10 expression level in 52 pairs of OSCC tissue samples and adjacent non-cancerous tissue samples(from the First Affiliated Hospital of Fujian Medical University)was measured by real-time quantitative PCR.After silencing MMP10 expression using siRNA(siMMP10-1291 and siMMP10-1336),the effect of MMP10 on the proliferation ability of OSCC cells was detected by CCK-8 assay and colony formation assay.The effects of MMP10 on the migration and invasion abilities of OSCC cells was assessed by wound-healing assay and transwell assay,respectively.To verify the effect of MMP10 knocking down on lymph node metastasis of OSCC cells in vivo,we constructed a nude mouse tongue cancer orthotopic model by shRNA(shMMP10-1291 and shMMP10-1336).Differential expression genes associated with MMP10 were screened from the gene expression profile data of OSCC patients in the TCGA database,and pathway enrichment analysis was performed using the GSEA software to further analyze the correlation between MMP10 and genes from the significantly enriched pathway.Results:Compared with adjacent non-cancerous tissues,the expression level of MMP10 in HNSCC and OSCC tissues was significantly increased(P<0.000 1),and HNSCC patients with high MMP10 expression had a lower survival rate(HR=1.32,P=0.04).HNSCC patients in the HPV-group had higher MMP10 gene expression levels(P<0.000 1),but their survival rate was significantly lower than that of HNSCC patients in the HPV+group(HR=0.48,P=0.004).Downregulating MMP10 expression could inhibit the migration,invasion and lymph node metastasis in vivo of OSCC cells.In OSCC patients,differentially expressed genes associated with MMP10 were significantly enriched in the Wnt signaling pathway(NES=1.505,P=0.029),and multiple genes in the Wnt signaling pathway,including WNT3,WNT3A,WNT5A,and WNT5B,were positively correlated with the expression level of MMP10.Conclusion:MMP10 promotes the invasion,metastasis and lymph node metastasis in vivo of OSCC cells by regulating the Wnt signaling pathway.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Plasmids remain important microbial components mediating the horizontal gene transfer (HGT) and dissemination of antimicrobial resistance. To systematically explore the relationship between mobile genetic elements (MGEs) and antimicrobial resistance genes (ARGs), a novel strat-egy using single-molecule real-time (SMRT) sequencing was developed. This approach was applied to pooled conjugative plasmids from clinically isolated multidrug-resistant (MDR) Klebsiella pneu-moniae from a tertiary referral hospital over a 9-month period. The conjugative plasmid pool was obtained from transconjugants that acquired antimicrobial resistance after plasmid conjugation with 53 clinical isolates. The plasmid pool was then subjected to SMRT sequencing, and 82 assem-bled plasmid fragments were obtained. In total, 124 ARGs (responsible for resistance toβ-lactam, fluoroquinolone, and aminoglycoside, among others) and 317 MGEs [including transposons (Tns), insertion sequences (ISs), and integrons] were derived from these fragments. Most of these ARGs were linked to MGEs, allowing for the establishment of a relationship network between MGEs and/or ARGs that can be used to describe the dissemination of resistance by mobile elements. Key elements involved in resistance transposition were identified, including IS26, Tn3, IS903B, ISEcp1, and ISKpn19. As the most predominant IS in the network, a typical IS26-mediated multi-copy composite transposition event was illustrated by tracing its flanking 8-bp target site duplica-tions (TSDs). The landscape of the pooled plasmid sequences highlights the diversity and complex-ity of the relationship between MGEs and ARGs, underpinning the clinical value of dominant HGT profiles.

Objective To identify the diagnostic value of ADC combined with DWI in benign lesions and malignant lesions of testis. Methods 35 patients with testicular lesions confirmed by operation and pathological examination in our hospital were analyzed retrospectively, including 18 benign lesions and 17 malignant lesions.The mean ADC values of normal tissue and parenchyma of testicular lesions were measured and statistically analyzed by K ruskal-W allis test,and receiver operating characteristic(ROC)curve was delineated. The optimum ADC value for differential diagnosis of malignant testicular lesions was analyzed and determined.Results In 33 cases of normal testicular tissue DWI showed homogeneous high signal,and mean ADC was(1.137 ± 0.119)×10-3mm2/s.18 cases of benign lesions mostly showed unrestricted diffusion,and mean ADC was(1.104 ± 0.463)×10-3mm2/s.In 17 cases of malignant lesions DWI showed high signal,and mean ADC was(0.778 ± 0.198)×10-3mm2/s.The comparison of ADC mean values between malignant testicular lesions and normal tissue as well as benign lesions of testis showed significant difference(P<0.05).The optimum ADC to distinguish malignant testicular lesions from benign testicular lesions was 0.911×10 -3mm2/s(82.4% sensitivity and 82.4% specificity). Conclusion DWI combined with ADC value is beneficial to the preoperative diagnosis and differential diagnosis between malignant testicular lesions and benign lesions of testis.

Objective:To investigate the clinical effect of botulinumtoxin type A (Botox-A) combined with electromyographic biofeedback therapy on the upper limb muscle spasm after stroke.Methods:86 cases of patients with upper limb muscle spasm after stroke in our hospital from January 2016 to January 2017 were selected and divided into the observation group and the control group,with 43 cases in each group.Patients in the control group were treated with electromyographic biofeedback therapy,and the observation group was treated with Botox-A based on the basis of control group.The improvement of upper limb muscle spasm,Upper limb movement function,the active range of wrist joint and life skills before and after treatment were compared between two groups.Results:After treatment,the total effective rate of improvement of upper limb muscle spasm of observation group were significantly higher than that of the control group (P＜0.05);At 2 weeks and 4 weeks after treatment,the Fugl-Meyer scores,Wrist joint activities,modified Barthel index (MBI) of two groups were significantly higher than those before treatment (P＜0.05),which were significantly higher in the observation group than those of the control group (P＜0.05).Conclusion:Botox-Acombined with electromyographic biofeedback therapy had remarkable clinical effect on the upper limb muscle spasm after stroke,which could effectively reduce the upper limb spasticity,improve the arm and wrist movement ability and the ability of daily life.

Objective To explore the related factors of the influence of persistent pulmonary hypertension( PPH) after neonatal resuscitation. Methods Tow hundred and fifty?six cases asphyxia patients who were treated in the Maternal and Child Care Service Center of Shangluo from March 2012 to March 2015 were retrospectively analyzed. One hundred and thirty?six newborns asphyxia of persistent pulmonary hypertension were selected as the observation group. One hundred and twenty newborns asphyxia without persistent pulmonary hypertension were selected as the control group. Medical records of children of two groups were retrospectively analyzed. Apgar scores of all observed objects. Before resuscitation blood pressure, blood glucose, body temperature,blood pH value of children in the two groups were recorded. Results In admission, the systolic blood pressure,diastolic blood pressure,body temperature,blood sugar,blood pH value in the observation group ((49. 27±8. 08) mmHg,(22. 25±5. 17) mmHg,(34. 40±0. 41)℃,(2. 78±0. 65) mmol/L,(7. 11±0. 79)) were lower than that in the control group((51. 23±4. 17) mmHg,(23. 87±2. 18) mmHg,(36. 80±0. 85)℃, (3. 55±0. 33) mmol/L,(7. 33±0. 17)),the differences were statistically significant(t=2. 480,3. 334,28. 169, 12. 155,3. 166;P<0. 05) . Hypoglycemia,hypothermia,low systolic blood pressure,low diastolic blood pressure were identified as the impact factors that can cause neonatal resuscitation after persistent pulmonary hypertension ( OR=3. 660,1. 930,8. 903,4. 543;95%CI=1. 061-12. 631,1. 399-2. 661,1. 166-67. 962,1. 636-12. 613;P<0. 05). Conclusion Hypoglycemia,hypothermia,low systolic blood pressure and low diastolic blood pressure are impact factors can cause neonatal resuscitation after persistent pulmonary hypertension.