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 compare the short-term effect of the arthroscopic reconstruction of anterior cruciate ligament (ACL) by femoral tunnel positioning through the tendon incision (TI) technique and anteromedial (AM) technique.Methods:Between December 2015 and March 2017, 176 patients with ACL injuries underwent arthroscopic ACL reconstruction at the First Affiliated Hospital of USTC were analyzed. According to the method of localization of femoral tunnel, they were divided into two groups: TI group (localization of femoral tunnel by TI for reconstruction of ACL) and AM group (localization of femoral tunnel by AM for reconstruction of ACL). There were 87 patients in the TI group (63 males and 24 females) with an age of 32.8±9.4 years (range, 19-51 years) and a body mass index (BMI) of 24.8±6.3 kg/m 2 (range, 18.1-31.7 kg/m 2), including 9 obese patients (BMI>28 kg/m 2). There were 89 patients in the AM group (59 males and 30 females) with an age of 36.7±13.0 years (range, 17-56 years) and a BMI of 25.7±5.8 kg/m 2 (range, 18.9-31.6 kg/m 2), including 11 obese patients. To evaluate whether the drill was in contact with the articular surface of the medial condyle of the femur, whether the anterior angle of the medial meniscus was damaged, the sagittal and coronal angles of the femoral tunnel and the total length of the femoral tunnel. The anterior drawer test, Lachmann test, pivot shift test, knee flexion angle (KFA), Lysholm score, International Knee Documentation Committee (IKDC) score and the incidence of postoperative complications were compared between the two groups. At the same time, the time of taking out tendon, operation time, hospital stay and recovery time were compared between two groups of obese people. Results:In the TI group, the guide pin could reach all areas of the medial wall of the lateral femoral condyle from the inferior cartilage edge to the top of the intercondylar fossa, the drill bit had no contact with the medial femoral condyle (MFC), and the anterior angle of the medial meniscus was not damaged. In AM Group, 3 cases of MFC and 1 case of anterior horn of medial meniscus were injured in order to get the best position of femoral tunnel. The angle of femoral tunnel in sagittal plane (50.2°±3.2°) and coronal plane (46.1°±5.8°) in experimental group was notably larger than that in control group (45.6°±5.4°, 38.3°±4.7°), the difference was statistically significant ( P<0.05). However, there was no significant difference in the length of femoral tunnel between the two groups (38.2±3.2 mm and 37.7±2.5 mm, P>0.05). All patients were followed up for an average of 8.3±2.1 (range, 3-12) months. The positive rates of anterior drawer test, Lachmann test and pivot shift test were not significantly different between the two groups at 3, 6, 9 and 12 months after operation ( P>0.05). The KFA, Lysholm and IKDC scores in both groups were significantly increased after operation ( P<0.05), but there was no significant difference of above indexes between the two groups ( P>0.05). The overall complication rate in AM group (14.6%, 13/89) was significantly higher than that in TI group (6.9%, 6/87), the difference was statistically significant ( P<0.05). Additionally, the tendon harvesting (15.0±0.2 min vs. 26.0±0.2 min, P<0.05) and operation time (2.0±0.3 h vs. 3.0±0.4 h, P<0.05) were significantly shortened among obese patients in experimental group compared with those in control group. Conclusion:The TI technique demonstrates comparable effectiveness to the AM technique in ACL reconstruction through femoral tunnel positioning, with the added advantage of safer femoral tunnel localization. This approach minimizes the risk of iatrogenic injuries to the articular cartilage of the medial condyle of the femur and the anterior horn of the medial meniscus. Furthermore, the TI technique reduces tendon removal time, particularly beneficial for obese patients.

Phosphoprotein Phosphatases ; Kinetics ; Protein Phosphatase 2/metabolism*

Speaking lesson is an effective way and teaching skill to prepare lessons for the teaching of anatomy. Taking the speaking lesson design of lecture teaching of the neck as an example, this article shows the teaching of topographic anatomy for "5+3" integrated clinical medical students. Adhering to the teaching concept of "student-centered", we have launched the theoretical teaching of "problem-centered discussion" and the experimental teaching of "operator responsibility system" in groups, with the "thanksgiving" humanistic education running through the whole process of theoretical and experimental courses. The teaching is a good way to cultivate the students' gratitude consciousness and humanistic quality, self-learning ability, critical thinking ability, communication and expression ability, hands-on operation ability and teamwork spirit, which has laid a solid foundation for training medical professionals in the new era.

Objective To evaluate endoscopic surgical treatment of synchronous esophageal squamous cell carcinoma and adenocarcinonm at the esophagogastric junction.Methods The clinical data of 17 patients with synchronous esophageal squamous cell carcinoma associated with adenocarcinoma of esophagogatric junction between Jan 2010 and Jan 2017 were analyzed retrospectively.Results Among these 17 patients,9 patients underwent thoracoscopy and laparoscopy with partial resection of esophagus and proximal stomach,and gastroesophageal and neck anastomosis.3 patients underwent thoracoscopy and laparoscopy with partial resection of esophagus and proximal stomach,gastroesophageal intrathoracic anastomosis.Laparoscopic radical total gastrectomy combined with radiotherapy for esophageal cancer was performed in 5 cases.There was not perioperative death or serious complications.The cumulative survival rates of 1,3 and 5 years after surgery were 100％,42％ and 24％,respectively.Conclusion Thoracolaparscopic surgery combined with local radiation therapy is a safe and effective treatment for patients with synchronous esophageal squamous cell carcinoma and adenocarcinoma at esophagogastric junction.

Objective To evaluate the value of energy spectrum CT with multimodal quantitative parameters in diagnosis of the metastatic lymph nodes of gastric adenocarcinoma compared with the conventional CT.Methods 37 patients with gastric adenocarcinoma diagnosed by gastroscopy underwent enhanced CT scan with gemstone spectral imaging mode.We positioned and marked the stomach lymph nodes on CT images and compared with postoperative pathologic results one to one.ROC was used to identify the critical quantitative index of energy spectrum CT in distinguishing the metastasis from benign lymph node,and to evaluate the diagnostic effect compared with CT features.Results The 40-80 keV single energy spectrum curve slope (λHU )and normalized iodine concentration (NIC)in metastasis group were lower than those in the benign one in the arterial phase with statistical differences (P <0.05 ),but without statistical differences in venous phase.The combination of arterialλHU and NIC showed significant advantages compared with CT features(P <0.01), with the sensitivity,specificity and accuracy of 84.3% vs 61.4 %,88.4% vs 81.3 % and 86.8% vs 73.6 %.Conclusion The energy spectrum CT can provide quantitative analysis for differential diagnosis of gastric cancer metastasis from benign lymph nodes,and significantly improve the diagnostic accuracy of lymph node metastasis of the cancer.

PurposeTo investigate the correlation between iodine concentration and clinical severity of acute pancreatitis (AP) through the quantitative evaluation with dual-energy spectral computed tomography (DESCT), so as to find out an effective imaging technology in the evaluation of clinical severity of AP.Materials and Methods Sixty patients with AP confirmed clinically (AP group) and 30 patients with normal pancreas (control group) were retrospectively analyzed. All the patients underwent enhanced CT scan in the spectral imaging mode. Iodine concentration and normalized iodine concentration (NIC) were respectively measured during arterial phase and portal phase in the material-decomposition images by using a spectral imaging viewer (GSI Viewer). Results Iodine concentration and NIC were significantly higher in the control group than in the AP group (P<0.05,P<0.001). In the AP group, according to Ranson grading, 24 patients were in the mild grade, 20 patients were moderate, and 16 patients were severe. Iodine concentration and NIC decreased along with the increase of their Ranson grade. There were significant difference in iodine concentration and NIC among the three subgroups (iodine concentration on arterial phase:F=8.776,P<0.01; iodine concentration on portal phase:F=4.019,P<0.05; NIC on arterial phase:F=12.700,P<0.001; NIC on portal phase:F=8.732,P<0.01). Iodine concentration and NIC on arterial and portal phases in the mild grade group were both significantly higher than those in the moderate grade group (P<0.05); however, iodine concentration on arterial and portal phases, and NIC on arterial phase in the severe grade group were significantly lower than those in the moderate grade group (P<0.05).Conclusion DESCT can analyze hemodynamic changes in AP quantitatively, which is of great value in evaluating changes in AP of each grade.

Objective To compare the clinical therapeutic effect of radical resection of esophageal carcinoma under combination of thoracoscopy and laparoscopy (RECTL) with traditional radical resection of esophageal carcinoma(TREC).Methods 80 patients receiving RECTL and 80 patients receiving TREC were chosen in our hospital.The general conditions during operation,pathologic data,postoperative complications and recurrence or metastasis rates were compared between two groups.Results Compared with TREC group,RECTL group had longer operation time 、less bleeding、less postoperative chest drainage liquid amount and less postoperative morphine administration (P ＜ 0.05 or P ＜ 0.01).The postoperative hospital stays were not statistically different between the two groups(P ＞0.05).The length of resected esophagus specimen and tumor near end cutting edge length in RECTL group are longer than that in TREC group,but with the former no statistically different(P ＞0.05) and the latter statistically different(P ＜ 0.05).There were no statistical differences about the number of dissected lymph nodes and the incidence of complications and local recurrence by cut plant between the two groups(P ＞ 0.05).The incidence of postoperative reflux gastritis was 7.1％ in RECTL group and 45 ％ in TREC group,with significantly statistical difference(P ＜0.01).The two groups had similar recurrence or metastasis rate(P ＞ 0.05).Conclusion Radical resection of esophageal carcinoma under combination of thoracoscopy and laparoscopy,with small wound and early recovery,has the same effect as traditional operational resection of esophageal carcinoma.

OBJECTIVE To find out the status about detection and drug resistance of Ureaplasma urealyticum(Uu) and Mycoplasma hominis(Mh) of urogenital tract infection in Shaoxing area of Zhejiang Province.METHODS The detections and drug sensitive tests of Uu and Mh adopting the reagent boxes produced by bioMerieux Company in France were made.RESULTS In 2678 samples of suspicious urogenital tract infection patients,980 samples cultured of mycoplasma were positive,and the positive rate was 36.6%.Among these cases,763 samples(28.5%) were Uu positive;116 samples(4.3%) were Mh positive.In the drug sensitive test,Uu and Mh were most sensitive to PRI,JOS,DOX and TET.To CFLX,OFL,ERY,CM and AM,they had the highest level of drug resistance.CONCLUSIONS The clinical therapy of mycoplasma infection ought to choose the appropriate antibiotics based on the results of the drug sensitive test of the laboratory.

Objectives:To investigate the relationship between calcitonin gene-related peptide(CGRP) in rat dental pulp and tooth movement.Methods:The first maxillary molars in 36 SD rats were moved mesially by orthodontic force,18 were examined 3,7 and 14 day after application of the appliance whereas another 18 rats were observed 7,14 and 28 days after removal of the appliance respectively.6 control rats were without treatment.Then,CGRP immunoreactivity was demonstrated by indirect immunoflurescence on frozen sections of dental pulp samples.Results:3,7 and 14 days after application of orthodontic force, the CGRP containing nurve fiber counts in each pulp were 17.57?4.42,24.04?3.55 and 21?4.11 respectively,those in the control pulps were 8.03?4.49. 7,14 and 28 days after removal of the appliance, the counts were 19.23?5.23,18.23?5.08 and 8.12?5.01 respectively.Conclusions:CGRP immunoreactive nerve fibres may take an active part in tissue responses in pulp tissues during experiment tooth movement.