Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[ OR ]=1.51, 95% confidence interval[ CI ]: 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[ SMD ]=1.39, 95% CI : 1.06-1.71, P < 0.01), D-dimer ( SMD =0.44, 95% CI : 0.07-0.81, P =0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[ MD ]=3.51, 95% CI : 1.38-5.64, P < 0.01), alcoholic etiology ( OR =3.57, 95% CI : 2.68-4.75, P < 0.01), and biliary etiology ( OR =0.60, 95% CI : 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex ( OR =1.63, 95% CI : 1.30-2.05, P < 0.01), CRP ( SMD =2.09, 95% CI : 1.12-3.05, P < 0.01), APACHE-Ⅱ score ( MD =4.28, 95% CI : 2.73-5.83, P < 0.01), Ranson score ( MD =2.99, 95% CI : 2.50-3.47, P < 0.01), and organ failure ( OR =10.87, 95% CI : 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age ( MD =2.16, 95% CI : 0.43-3.89, P =0.01), body mass index (BMI)( MD =1.74, 95% CI : 1.23-2.25, P < 0.01), albumin level ( SMD =-0.43, 95% CI : -0.75 to-0.12, P < 0.01), CRP ( SMD =0.58, 95% CI : 0.04-1.11, P =0.03), procalcitonin ( SMD =0.80, 95% CI : 0.56-1.04, P < 0.01), D-dimer ( MD =0.23, 95% CI : 0.15-0.31, P < 0.01), APACHE-Ⅱ score ( MD =2.47, 95% CI : 0.73-4.22, P < 0.01), Ranson score ( MD =1.60, 95% CI : 1.46-1.73, P < 0.01), and extent of necrosis ≥30%( OR =2.52, 95% CI : 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age ( MD =4.07, 95% CI : 1.82-6.31, P < 0.01), APACHE-Ⅱ score ( MD =3.28, 95% CI : 1.39-5.17, P < 0.01), Ranson score ( MD =2.18, 95% CI : 1.75-2.62, P < 0.01), SIRS score ( OR =3.88, 95% CI : 1.58-9.51, P < 0.01), alcoholic etiology ( OR =0.61, 95% CI : 0.42-0.87, P < 0.01), and organ failure ( OR =3.63, 95% CI : 1.11-11.92, P =0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.

Objective:To investigate the predictive value of atherogenic index of plasma (AIP) in the assessment of acute pancreatitis (AP).Methods:598 patients diagnosed with AP admitted to the Affiliated Hospital of Yangzhou University between January 2016 and December 2020 were recruited and divided into severe acute pancreatitis group (SAP group, n=57) and non-severe acute pancreatitis group (non SAP group, n=541) according to the Atlanta Classification (2012 revision). General clinical data and related biochemical indicators of all enrolled patients were collected, and Bedside Index of Acute Pancreatitis Severity (BISAP) score, Ranson score and CT Severity Index (CTSI) score were performed. The risk factors of SAP were analyzed by logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the evaluation value of AIP and various scoring systems on the severity of pancreatitis. Results:The AIP, white blood cell (WBC), neutrophil count (NEUT), fasting blood glucose (FBG), serum total cholesterol (TC) level, proportion of hyperlipidemia, proportion of diabetes, Ranson score, BISAP score, CTSI score of patients in SAP group were higher than those in non SAP group, and the difference was statistically significant (all P<0.05). Multivariate logistic regression analysis showed that AIP was an independent risk factor for SAP ( P<0.05). ROC curve showed that the are under the curve (AUC) of SAP predicted by AIP was 0.706(95% CI: 0.631-0.782, P<0.001). Conclusions:AIP is an independent risk factor for SAP, which helps to assess the severity of AP.

Objective:To measure the morphological parameters of distal tibiofibular syndesmosis in healthy adults using multi-slice CT (MSCT) so as to provide a reference for the diagnosis of distal tibiofibular syndesmosis injury.Methods:The ankle MSCT imaging data in 110 normal adults were retrieved from the image report database of Cangzhou People′s Hospital from May 2019 to May 2021, including 56 males and 54 females; aged 18-60 years [(38.2±11.0)years]. There were 51 patients with imaging on the right ankle and 59 on the left ankle. Picture archiving and communication system (PACS) was used to measure parameters at 10 mm above the articular surface of the distal tibia on MSCT, including the anterior tibiofibular space (L1), posterior tibiofibular space (L2), middle tibiofibular space (L3), depth of fibula in notch (L4), distance of anterior tibiofibular edge (L5), distance of posterior tibiofibular edge (L6), anterior tibiofibular syndesmosis angle (A1), and fibular rotation angle (A2), and the measurements were compared by sex, age and side. The positive rate of "tibiofibular line" was observed. The morphological classification of distal tibiofibular syndesmosis was performed.Results:There was no significant difference in L1-L6, A1 and A2 among different age and side (all P>0.05). No significant difference was found in L4, L5, A1 and A2 between males and females ( P>0.05), but L1, L2, L3 and L6 were larger in males than in females ( P<0.05 or 0.01). The positive rate of "tibiofibular line" was 80.4% (45/56) in males compared to 74.1% (40/54) in females ( P>0.05), 77.2% (44/57) in the youth compared to 77.4% (41/53) in the middle-aged, and 78.0% (46/59) in the left ankle compared to 76.5% (39/51) in the right ankle (all P>0.05). Morphological classification of distal tibiofibular syndesmosis was crescent in 61 patients (55.5%), trapezoid in 14 (12.7%), I-shaped in 3 (2.7%), M-shaped in 17 (15.5%), V-shaped in 10 (9.1%), Г-shaped in 5 (4.5%). Conclusions:When L1, L2, L3 and L6 are used as references in the diagnosis of adult distal tibiofibular syndesmosis injury, gender factors rather than age or side factors should be considered. Males have wider distal tibiofibular space than females, with the fibula more forward. The "tibiofibular line" has a high positive rate and is not affected by gender, age or sides, providing a new idea for the diagnosis of distal tibiofibular syndesmosis injury and anatomical reduction. There are many variations in the morphology of distal tibiofibular syndesmosis, so it is easy to be misdiagnosed as the separation of distal tibiofibular syndesmosis on X-ray, which should be noted.

Background: The systemic immune inflammation index (SII) is a reproducible biomarker of inflammatory process. Aims: To explore the predictive value of SII for severe acute pancreatitis (SAP). Methods: A total of 406 patients with acute pancreatitis (AP) from Jan. 2013 to Dec. 2020 at Affiliated Hospital of Yangzhou University were collected, and were divided into SAP group and non SAP group. ROC curve was drawn to evaluate the value of SII, NLR, PLR, CAR for predicting SAP. Results: Compared with non‑SAP group, SII, NLR, PLR, CAR were significantly increased in SAP group (P<0.05). When the best cut‑off value was 1 705.83, AUC of SII for predicting SAP was 0.754, the sensitivity was 75.47%, and the specificity was 69.12%. AUC of SII for predicting SAP was higher than that of PLR, CAR (Z=2.647, P=0.007; Z= 2.616, P=0.008), while no significant difference was found between SII and NLR (P>0.05). And no significant difference in AUC was found between PLR and CAR (P>0.05). Conclusions: SII is a good new hematological index that can be used to predict the severity of AP, its predictive ability is similar to NLR, better than PLR and CAR.

Stage T1 lung cancer refers to the tumor with maximum diameter≤3 cm, surrounded by the pleural membrane of the lung or viscera, and does not exceed the lobar bronchus under the bronchoscope. The prognosis is generally good, but some of them are more invasive, and more aggressive treatments are needed to achieve the best prognosis. This article reviews which T1 lung cancers are susceptible to metastasis and their risk factors. It is hoped that such patients will receive the attention of relevant scholars, and when they are encountered clinically, a more aggressive approach will be taken to extend their life expectancy．

Objective To explore the relationship between serum tenascin C(TN-C),irisin(Irisin) and the severity and prognosis of patients with acute ischemic stroke(AIS).Methods 203 AIS patients admitted to our hospital(January 2017 to December 2019) were selected as the AIS group.According to the National Institutes of Health Stroke Scale(NIHSS) and Modified Rankin Scale(mRS),they were divided into severe group(n=52),moderate group(n=87),mild group(n=64) good prognosis group(n=125) and poor prognosis group(n=78),another 74 healthy people at the same period were selected as the control group,and the serum TN-C and Irisin level were compared between the groups,Pearson correlation analysis was used to analyze the correlation between serum TN-C and Irisin levels and NIHSS,mRS scores,ROC curve analysis was used to analyze the prognostic value of serum TN-C and Irisin levels in AIS.Results The serum TN-C levels in the AIS group were significantly higher than those in the control group,and the Irisin levels were significantly lower than those in the control group(P<0.05);the serum TN-C levels in the severe group were significantly higher than those in the moderate group,and the Irisin levels were significantly lower than those in the moderate group(P<0.05);the serum TN-C levels in the moderate group were significantly higher than those in the mild group,and the Irisin levels were significantly lower than those in the mild group(P<0.05);the serum TN-C levels in the poor prognosis group were significantly higher than those in the good prognosis group,Irisin levels were significantly lower than those in the good prognosis group(P<0.05);pearson correlation analysis showed that the serum TN-C level in the AIS group was positively correlated with NIHSS and mRS scores (P<0.05);the serum Irisin level was negatively correlated with NIHSS and mRS scores(P<0.05);ROC curve showed that the AUC,sensitivity and specificity of TN-C+Irisin predicting the prognosis of AIS were higher than those predicted by TN-C and Irisin alone.Conclusion Elevated serum TN-C level and decreased irisin level can reflect the severity of AIS and adverse prognosis,the combined determination of the two can improve the predictive value of the prognosis of AIS patients,and can be used as an indicator to evaluate the prognosis.

Objective To explore the value of ultrasound imaging in complications associated with venous catheterization.Methods Patients (n =853) underwent ultrasound imaging examination after venous catheterization.Ultrasonography manifestations of venous catheterization complications and clinical curative effect were analyzed and summarized.Results Phlebitis,thrombus and mechanical complications were found by ultrasound imaging examination.Pneumothorax,hemothorax,arterial puncture and hematoma were among the main mechanical complications.Among the 853 patients,85 cases (9.96％) were found to have complications by ultrasound examination,with 35 cases (4.10％) of phlebitis,26 cases (3.05％) of catheter-related thrombus and 24 cases (2.81％) of mechanical complications.Conclusions In summary,a variety of venous catheterization complications can be diagnosed using ultrasound imaging non-invasively,effectively and efficiently.Real-time ultrasound imaging examination can dynamically monitor the develop ment and evolution of venous catheterization complications and effectively evaluate outcomes.

Objective To investigate correlation between seizures and uric acid level in the hippocampus in a mouse model with acute limbic seizures by pharmacological and genetic method. Methods Normal male C57BL/6 and mutant mice were used in this study,including urate oxidase overexpression (UOx-OE) and urate oxidase knock-out (UOx-KO) ;These mice were divided into the following groups,including the control,KA, All ,OE ,KO group respectively;during the experiment ,behaviors ,latency and duration time were recorded;dialysates were collected by microdialysis technique and uric acid level was detected by FPLC;Uric acid in the hippocampus,seizures status,latency and duration were compared. Results Twenty-four mice in total were enrolled and only 1 death occurred until the end of the study. Seizures state appeared after KA treatment. Compared to the KA group,uric acid and generalized seizures declined by the treatment of KA and All (P< 0.05) . Compared to the KA group,uric acid,latency and generalized seizures elevated in the KO group (P < 0.05). Compared to the KA group,there was no difference of latency,duration,partial and generalized seizures occurring in the OE group (P> 0.05). Conclusions Uric acid level in the hippocampus of mice may have effects on seizures ,in which it suggests that uric acid and its relevant signal pathway could be a potential therapy target in seizures clinically.

Objective To explore the clinical value of CEUS guided biopsy of lymphoma in anterior mediastinum.Methods The data of 36 patients with lymphoma of anterior mediastinum underwent biopsy guided by CEUS and 36 patients by conventional ultrasound retrospectively.The successful rate of biopsy and rate of complication occurence were compared between the CEUS group and conventional ultrasound group.Results The successful rate of biopsy in CEUS group was 100％ (36/36),including 26 non-Hodgkin's lymphoma (NHL),10 Hodgkin's lymphoma (HL).The total times of puncture were 60 in 36 patients.The rate of complication occurrence was 11.11 ％ (4/36).The successful rate in conventional ultrasound group was 88.89％ (32/36),including 22 NHL,14 HL.The times of puncture were 91 in 36 patients.The rate of complication occurrence was 41.67％ (15/36).There were significant differences in successful rate and the rate of complication occurrence between two groups (x2 =4.235,8.651,P=0.040,0.003).Conclusion CEUS can reflect the microcirculation of lymphomas in anterior mediastinum,and can guide targeted biopsy.It can improve the successful rate of biopsy and reduce the complications.