Objectives:To investigate the relationship between locations of ventricular septal perforation and 30-day prognosis in patients with acute myocardial infarction complicated by ventricular septal perforation.Methods:Clinical data of 150 acute myocardial infarction patients with ventricular septal perforation admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and People's Hospital of Xinjiang Uygur Autonomous Region from January 2009 to October 2023 were retrospectively analyzed.Kaplan-Meier method was used to compare the difference in 30-day survival rate among patients with different sites of ventricular septal perforation.The impact of locations of ventricular septal perforation on 30-day prognosis of acute myocardial infarction patients was evaluated by multivariate Cox regression analysis(forward stepwise).Results:In acute myocardial infarction patients,the occurrence of anterior ventricular septal perforation was higher than that of posterior ventricular septal perforation(79.5%vs.20.5%,P<0.001).In the anterior ventricular septal perforation patients,females were more common(50.0%vs.22.6%,P=0.006),the blood glucose level was higher([10.51±5.99]mmol/L vs.[8.02±2.81]mmol/L,P=0.026),the left ventricular end-diastolic diameter was smaller([50.7±6.1]mm vs.[55.1±5.0]mm,P<0.001),the ventricular septal aperture was also smaller([9.8±4.6]mm vs.[12.6±5.4]mm,P=0.004),30-day mortality was higher(55.8%vs.35.5%,P=0.043)compared with posterior ventricular septal perforation patients.Multivariate Cox regression analysis(forward stepwise)showed that no transthoracic surgery or transcatheter closure(HR=26.344,95%CI:8.261-84.009,P<0.001)and anterior ventricular septal perforation(HR=2.432,95%CI:1.281-4.619,P=0.007)were associated with increased risk of 30-day all-cause mortality in patients with acute myocardial infarction complicated by ventricular septal perforation.Conclusions:In patients with acute myocardial infarction complicated by ventricular septal perforation,the incidence of anterior ventricular septal perforation is higher than posterior ventricular septal perforation and the 30-day all-cause mortality of anterior ventricular septal perforation patients is also higher.No transthoracic surgery or transcatheter closure and anterior ventricular septal perforation are the independent influential factors of 30-day all-cause mortality in patients with acute myocardial infarction and ventricular septal perforation.

Objectives:To investigate the relationship between locations of ventricular septal perforation and 30-day prognosis in patients with acute myocardial infarction complicated by ventricular septal perforation.Methods:Clinical data of 150 acute myocardial infarction patients with ventricular septal perforation admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and People's Hospital of Xinjiang Uygur Autonomous Region from January 2009 to October 2023 were retrospectively analyzed.Kaplan-Meier method was used to compare the difference in 30-day survival rate among patients with different sites of ventricular septal perforation.The impact of locations of ventricular septal perforation on 30-day prognosis of acute myocardial infarction patients was evaluated by multivariate Cox regression analysis(forward stepwise).Results:In acute myocardial infarction patients,the occurrence of anterior ventricular septal perforation was higher than that of posterior ventricular septal perforation(79.5%vs.20.5%,P<0.001).In the anterior ventricular septal perforation patients,females were more common(50.0%vs.22.6%,P=0.006),the blood glucose level was higher([10.51±5.99]mmol/L vs.[8.02±2.81]mmol/L,P=0.026),the left ventricular end-diastolic diameter was smaller([50.7±6.1]mm vs.[55.1±5.0]mm,P<0.001),the ventricular septal aperture was also smaller([9.8±4.6]mm vs.[12.6±5.4]mm,P=0.004),30-day mortality was higher(55.8%vs.35.5%,P=0.043)compared with posterior ventricular septal perforation patients.Multivariate Cox regression analysis(forward stepwise)showed that no transthoracic surgery or transcatheter closure(HR=26.344,95%CI:8.261-84.009,P<0.001)and anterior ventricular septal perforation(HR=2.432,95%CI:1.281-4.619,P=0.007)were associated with increased risk of 30-day all-cause mortality in patients with acute myocardial infarction complicated by ventricular septal perforation.Conclusions:In patients with acute myocardial infarction complicated by ventricular septal perforation,the incidence of anterior ventricular septal perforation is higher than posterior ventricular septal perforation and the 30-day all-cause mortality of anterior ventricular septal perforation patients is also higher.No transthoracic surgery or transcatheter closure and anterior ventricular septal perforation are the independent influential factors of 30-day all-cause mortality in patients with acute myocardial infarction and ventricular septal perforation.

Objective:This study evaluates the performance of chemiluminescence assay, which is designed to detect Hepatitis D Virus (HDV) Immunoglobulin G (IgG) antibodies.Methods:A comparative analysis was conducted among chemiluminescence anti-HDV IgG reagent, the magnetic particle-based domestic reagent A and domestic reagent B, and the Robo Gene HDV RNA kit, using 1909 HBsAg-positive plasma samples. This comparison aimed to delineate clinical specificity and detection accuracy. The anti-HDV IgG reagent precision was assessed at three different concentration levels following the Clinical Laboratory Standards Institute EP5-A2 guidelines. The specificity of the assay was validated using 200 HAV IgM positive, 545 HBsAg-positive but anti-HDV IgG-negative, 350 anti HCV positive plasma samples and 200 healthy human blood samples. Additionally, a concordance study was conducted with 545 HBsAg-positive and 37 anti-HDV IgG-positive plasma samples, comparing the anti-HDV IgG reagent against reagent A.Results:1 909 HBsAg-positive plasma samples were tested using 3 anti HDV IgG reagent and 1 HDV RNA reagent, 19 samples were identified as anti-HDV IgG-positive. The anti-HDV IgG demonstrated superior accuracy and specificity. The assay exhibited excellent precision, with intra-assay coefficient of variation (CV) values ranging from 1.57% to 4.30%, and inter-assay CV values between 1.71% and 4.67% for detecting samples at high, medium, and low concentration levels. Concordance with Reagent A showed consistent results in both positive and negative detections.Conclusion:In this study, the anti-HDV IgG reagent (chemiluminescence method) displayed outstanding specificity in detecting clinical samples and exhibited a high conformity rate with commercialized reagents, making it potentially suitable for screening anti-HDV IgG in HBsAg-positive samples.

Objective:This study aims to evaluate the quality and explore the preliminary clinical applications of a domestically developed hepatitis D virus nucleic acid quantification reagent (abbreviated as"domestic HDV RNA reagent").Methods:The sensitivity and accuracy of the reagent were evaluated in accordance with the WHO HDV RNA international standard, employing the Bio-Rad CFX Opus 96 real-time fluorescence quantitative PCR analysis system. Serial dilutions of pseudo-viruses or cell culture-derived virus were used to determine the linear range of the domestic HDV RNA reagent. Specificity was assessed using positive samples of HAV, HBV, HCV infection, and HEV national reference materials. Precision was evaluated with samples at both high and low concentrations. In a comparative analysis, 30 HDV IgG positive samples were tested using both the domestic HDV RNA reagent and the RoboGene HDV RNA kit based on the ABI 7500 FAST DX system. The Pearson correlation coefficient (r) was used to examine the correlation between the two reagents.Results:The domestic HDV RNA reagent demonstrated a high sensitivity of up to 6 IU/ml, consistent with that of the comparator reagent. The calibration curve for WHO HDV RNA standards had a slope of -3.286, with an amplification efficiency of 101.6%. The linear detection range spanned from 10 to 10 8 IU/ml for eight HDV genotypes. The domestic HDV RNA reagent exhibited exceptional specificity, without cross-reactivity observed with HAV, HBV, HCV, or HEV. Accuracy assessments at five concentration levels met the required standards, with intra-assay precision coefficient of variation ( CV) ranging from 1.20% to 4.20%, and inter-assay precision CV from 1.20% to 7.90%. The detection results for HDV IgG positive samples were highly correlated with the comparator reagent ( r=0.984, P<0.001), achieving a diagnostic accuracy of 100% compared to sequencing results. Conclusion:In this study, the domestic HDV RNA reagent possesses excellent specificity, accuracy, precision, and a broad linear range, attaining a sensitivity level on par with international reagents of the same type.

Objective:To investigate the value of machine learning-based computed tomography (CT) images radiomics analysis in preoperative evaluation of surgical portal vein-superior mesenteric vein (PV-SMV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).Methods:The retrospective study was conducted with 156 consecutive PDAC patients who were underwent surgery at the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2010 and July 2021. There were 95 males and 61 females, with the age of (65.7±8.2) years. Patients were randomly split into training set and validation set by a ratio of 3∶2. Minimum redundancy maximum relevance was used to select radiomic features, which were extracted from contrast-enhanced CT images. Five machine learning classifiers were developed, and those models' area under the curve (AUC) values were compared with the conventional radiologic-feature-based evaluation.Results:Ninety-four and 52 patients were included into the training set and validation set, respectively. Their PV-SMV invasion rates were confirmed by intraoperative exploration with 31.9%(30/94) and 40.3%(25/61), respectively. Five models: LASSO regression, random forest, support vector machine, k-nearest neighbor and Naive Bayesian, were established based on ten features from CT images radiomics, and LASSO regression model achieved the highest AUC value compared with the other four models (all P<0.05). Compared with the conventional radiologic evaluation, the LASSO regression model had higher AUC (0.920 vs. 0.752) and sensitivity (92.0% vs. 86.5%)(both P<0.05). Conclusion:Machine learning-based CT images radiomics analysis can be used to evaluate PV-SMV invasion status preoperatively in PDAC. The LASSO regression model showed better performance than the conventional radiologic evaluation.

Objective To study the differences of symptoms and pathological features of Wistar and Lewis rat models of collagen-induced rheumatoid arthritis. Methods Wistar and Lewis rats were injected with intermixture of bovine TypeⅡ collage and complete Freund's adjuvant(CFA)for first immunization, then strengthen it after 14 days and observed the incidence of Wistar-RA group and Lewis-RA group. The degree of paws swelling and the titer of serum anti CII antibody were determined. The pathological changes in toe and joint tissues were examined at 12 weeks, and the expressions of VEGF, IL-6, IL-10 and IL-17A in the synovial membrane of ankle joint were detected. Results After collagen induction,the Wistar and Lewis rats showed paw swelling after 10 d and 14 d,and peaked at 21 d and 24 d,the titer of serum anti CII antibody was significantly increased at third week(P< 0.01), and arthritis index(AI)was also significantly increased(P< 0.01). In the Wistar-RA rat group, the rate of molding was 80%, and at fifth weeks, the swelling of the paws subsided and went into a flat level. The molding rate of the Lewis-RA group was 100%,at the seventh week,the swelling of paws subsided and went into a flat level. At 12 weeks,the two model groups showed severe articular cartilage erosion, synovial hyperplasia and inflammatory cell infiltration, neovascularization and pannus formation in the joint synovium,and the bone mineral density of the femur and tibia of the hind limbs was significantly decreased(P<0.01). The expression of VEGF,IL-6 and IL-17A in synovium was significantly increased(P< 0.05,P< 0.01). The expression of IL-10 was obviously decreased(P< 0.01). Compared with the Wistar-RA group,the paw volume and paw thickness were increased for a longer time in the Lewis-RA group,AI was higher than that of the Wistar-RA group,synovial angiogenesis and pannus formation were more distinct, the expression of VEGF in synovium was significantly higher than that of Wistar-RA group(P< 0.05), while the expression of IL-17A was significantly lower than that in the Wistar-RA group(P< 0.05). Conclusions Both the Wistar-RA rat model and Lewis-RA rat model show joint swelling,deformation and decreased activity. AI is increased,the expression of VEGF,IL-6 and IL-17A increased,and the expression of IL-10 decreased,which are consistent with the clinical manifestation. The Wistar-RA rat model has a short duration of swelling, while the Lewis-RA rat model has a longer swelling duration and more severe joint damages. The neovascularization and pannus formation are more obvious. The expression of IL-17A in the Wistar-RA rat model is higher, while the Lewis-RA model has a highly expressed VEGF,which may be related to its pathological characteristics.

A 69-year-old male patient received oral aspirin (100 mg once daily),ticagrelor (45 mg twice daily),amlodipine besylate (5 mg once daily),losartan potassium (50 mg once daily),metoprolol sustained release tablets (47. 5 mg once daily ),and atorvastatin (10 mg once daily )after coronary angiography. After 28 days of treatments,ticagrelor was discontinued for economic reason and changed to clopidogrel (75 mg once daily). The next day,symmetrical erythema and needle-shaped papules appeared on skin of the abdomen and limbs,and gradually throughout the whole body. Then,mung bean-sized blisters and papulo-vesicle appeared and part of them fused into lamella with a small amount of exudation and severe itching. Two weeks later,the skin of the distal extremities thickened and the skin surface was rough and desquamated. The patient had developed 2 episodes of similar symptoms in the past. Six years ago,the similar symptoms occurred for the first time. The patient developed rashes 4 to 5 days after taking aspirin and clopidogrel after PCI. Clopidogrel was discontinued after 10 months and,half a month later,the skin symptoms completely subsided. Fourteen months ago,the similar skin symptoms occurred for the second time. Clopidogrel was given after PCI and rashes appeared 2 days later. The skin rash was relieved after anti-allergic treatments. The patient stopped taking clopidogrel herself 9 months later,the skin symptoms completely subsided half a month later. Clopidogrel-induced eczema-like drug eruption was considered. Clopidogrel was withdrawn and antihistamine,glucocorticoid,and antipruritic were given. Two weeks after drug withdrawal,the papules on the trunk were flattened and became dry,the part of the ruptured vesicles on the abdomen healed,scales of the limbs reduced,itching subsided,and no new skin lesions appeared.

A 69-year-old male patient received oral aspirin (100 mg once daily),ticagrelor (45 mg twice daily),amlodipine besylate (5 mg once daily),losartan potassium (50 mg once daily),metoprolol sustained release tablets (47. 5 mg once daily ),and atorvastatin (10 mg once daily )after coronary angiography. After 28 days of treatments,ticagrelor was discontinued for economic reason and changed to clopidogrel (75 mg once daily). The next day,symmetrical erythema and needle-shaped papules appeared on skin of the abdomen and limbs,and gradually throughout the whole body. Then,mung bean-sized blisters and papulo-vesicle appeared and part of them fused into lamella with a small amount of exudation and severe itching. Two weeks later,the skin of the distal extremities thickened and the skin surface was rough and desquamated. The patient had developed 2 episodes of similar symptoms in the past. Six years ago,the similar symptoms occurred for the first time. The patient developed rashes 4 to 5 days after taking aspirin and clopidogrel after PCI. Clopidogrel was discontinued after 10 months and,half a month later,the skin symptoms completely subsided. Fourteen months ago,the similar skin symptoms occurred for the second time. Clopidogrel was given after PCI and rashes appeared 2 days later. The skin rash was relieved after anti-allergic treatments. The patient stopped taking clopidogrel herself 9 months later,the skin symptoms completely subsided half a month later. Clopidogrel-induced eczema-like drug eruption was considered. Clopidogrel was withdrawn and antihistamine,glucocorticoid,and antipruritic were given. Two weeks after drug withdrawal,the papules on the trunk were flattened and became dry,the part of the ruptured vesicles on the abdomen healed,scales of the limbs reduced,itching subsided,and no new skin lesions appeared.

Objective To investigate the display status of ultrasonography imaging check in central nervous system (CNS) in infants of early pregnancy and the diagnostic value of CNS malformation in infants of early pregnancy.Methods Gestational weeks of 2 751 enrolled subjects were divided according to the ultrasonic measurement of the crown rump length (CRL):11-11 +6 weeks group,12-12+6 weeks group,and 13-13 + 6 weeks group,prenatal ultrasound were performed to examine fetal CNS anatomy in infants of early pregnancy,record the display status in each groups of infants and analyze the relationship between the display situation and gestational age.Results Fourteen cases of fetal CNS malformation (20 malformations) in total were found by prenatal ultrasound,and the incidence of CNS malformation was about 5.09％ (14/2 571).Wherein,12 cases of early pregnancy were diagnosed,and 2 cases of middle pregnancy were diagnosed.The sensitivity of ultrasound of early pregnancy in the diagnosis of fetal CNS malformation was 85.71％.In the group of research,the ultrasound display ratios of 11-11+6 weeks group,12-12+6 weeks group and 13-13+6 weeks group were 96.73％,97.94％,98.06％,respectively.There was no significant difference in early pregnancy fetal CNS display ratio among groups (x2 =1.56,v =2,x2＜ x0.05.2 =5.99,P ＞ 0.05).Conclusions The display rate of CNS structure in infants of early pregnancy (11-13+6 weeks)is higher,and is not affected by gestational weeks.Prenatal ultrasound can effectively diagnose CNS severe malformation in infants of early pregnancy.

Objective To analyze the unreasonable elements in prescriptions from outpatient department through the intervention of unreasonable prescriptions;To provide evidence for reasonable usage of medicine in outpatient department.Methods Prescriptions were examined by senior pharmacists. If they found any unreasonable elements, they would consult doctors, and record all the unreasonable elements in the prescriptions to avoid unreasonable prescriptions. A total of 663 unreasonable prescriptions from Jan. 2011 to May 2013 were analyzed.Results A total of 709 unreasonable elements were found in these prescriptions. The man elements were following three types:overdose of toxic decoction pieces (73.76%), incompatible prescriptions without signature (12.13%), wrong inputting of prescription and decoction (7.76%).Conclusion With early intervention in prescriptions, the quality of prescriptions and the safety and effectiveness of medication can be improved.