Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

In recent years, the spread of clubroot disease caused by Plasmodiophora brassicae infection has seriously affected the yield and quality of Brassica juncea (L.) Czern.. The cascade of mitogen-activated protein kinases (MAPKs), a highly conserved signaling pathway, plays an important role in plant responses to both biotic and abiotic stress conditions. To mine the MAPK genes related to clubroot disease resistance in B. juncea, we conducted a genome-wide analysis on this vegetable, and we analyzed the phylogenetic evolution and gene structure of the MAPK gene family in mustard. The 66 BjuMAPK genes identified by screening the whole genome sequence of B. juncea were unevenly distributed on 17 chromosomes. At the genomic scale, tandem repeats led to an increase in the number of MAPK genes in B. juncea. It was found that members of the same subfamily had similar gene structures, and there were great differences among different subfamilies. These predicted cis-acting elements were related to plant hormones, stress resistance, and plant growth and development. The expression of BjuMAPK02, BjuMAPK15, BjuMAPK17, and BjuMAPK19 were down-regulated or up-regulated in response to P. brassicae infection. The above results lay a theoretical foundation for further studying the functions of BjuMAPK genes in B. juncea in response to the biotic stress caused by clubroot disease.
Mustard Plant/parasitology* ; Plasmodiophorida/pathogenicity* ; Plant Diseases/genetics* ; Mitogen-Activated Protein Kinases/metabolism* ; Phylogeny ; Disease Resistance/genetics* ; Gene Expression Regulation, Plant ; Genome, Plant ; Plant Proteins/genetics*

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

The WUSCHEL related-homeobox (WOX) family is one of the plant-specific transcription factor families, playing important roles in plant growth and development. In this study, 51 WOX gene family members were identified from the genome data of Brassica juncea by searching and screening with HUMMER, Smart and other software. Their protein molecular weight, amino acids numbers, and isoelectric point were analyzed by using Expasy online software. Furthermore, bioinformatics software was used to systematically analyze the evolutionary relationship, conservative region, and gene structure of the WOX gene family. The mustard WOX gene family was divided into three subfamilies: ancient clade, intermediate clade, and WUS clade/modern clade. Structural analysis showed that the type, organization form and gene structure of the conservative domain of WOX transcription factor family members in the same subfamily were highly consistent, while there was a certain diversity among different subfamilies. 51 WOX genes are distributed unevenly on 18 chromosomes of mustard. Most of the promoters of these genes contain cis acting elements related to light, hormone and abiotic stress. Using transcriptome data and real-time fluorescence quantitative PCR (qRT-PCR) analysis, it was found that the expression of mustard WOX gene was spatio-temporal specific, among which BjuWOX25, BjuWOX33, and BjuWOX49 might play an important role in the development of silique, and BjuWOX10, BjuWOX32, and BjuWOX11, BjuWOX23 respectively might play an important role in the response to drought and high temperature stresses. The above results may facilitate the functional study of mustard WOX gene family.
Mustard Plant/genetics* ; Multigene Family/genetics* ; Transcription Factors/metabolism* ; Plants/genetics* ; Promoter Regions, Genetic ; Phylogeny ; Gene Expression Regulation, Plant ; Plant Proteins/metabolism*

Objective:To investigate the clinical characteristics of postpartum pyomyoma.Methods:Clinical data of two patients with postpartum pyomyoma admitted to the Department of Obstetrics and Gynecology, Peking University First Hospital, between 2019 and 2020, were collected. Another 16 postpartum pyomyoma reported in China and foreign areas from 2000 to 2020 were reviewed.Results:Apart from three patients without reported gravidity and parity, 12 out of the remaining 15 patients were primiparous. The median maximum diameter of uterine fibroids in pregnancy was 10 cm (6-25 cm). Of the 18 patients, 12 had a history of intrauterine manipulation, 10 had anemia or severe postpartum hemorrhage, and four had other infections. All patients manifested as fever at first, and most were accompanied by abdominal pain. The onset time of 14 cases was within postpartum two weeks. CT, MRI, and ultrasound detection rate in diagnosing postpartum pyomyoma was 11/13, 3/6, and 1/8, respectively. Pus culture had the highest positive rate, with Escherichia coli as the most common pathogen. No death was reported, but 14 patients developed severe complications, including sepsis, septic shock, disseminated intravascular coagulation, rupture of pyomyoma, peritonitis, and incision infection. As failing in anti-infection medication, all patients received surgical treatment, which controlled infections. Three patients were conceived two years after the operation (16 months to two years). Conclusions:Pyomyoma should be considered once postpartum fever develops in patients complicated by uterine fibroids ≥10 cm in diameter during pregnancy, especially those with anemia, infection, or a history of intrauterine manipulation. Surgical treatment should be performed once pyomyoma is diagnosed.

Three-amino acid loop extension (TALE) transcription factors play important roles in plant growth and cell differentiation. There are plenty of studies on TALE transcription factors in several model plants, but not in radish (Raphanus sativas). A genome-wide bioinformatics analysis identified 33 TALE family genes in the Xiang-Ya-Bai (XYB) radish, These genes, are distributed on nine chromosomes and all contain 4-6 exons. The 33 TALE genes in radish showed a co-linearity relationship with the 17 homologous genes in Arabidopsis thaliana. Moreover, a large number of stress response cis-elements were found in the promoter regions of these genes. Expression analysis showed that four genes in the BELL subfamily were highly expressed in roots, and two genes in the KNOX subfamily were highly expressed in shoots of bolting plants and callus. All radish TALE genes contain sequences encoding the conserved HOX domain, except for the gene RSA10037940, which is homologous to Arabidopsis KNATM. The deduced 3D structures of the TALE proteins irrespective of subtypes are highly similar. All the encoded proteins were weakly acidic and hydrophilic. The radish TALE gene family is relatively evolutionarily conserved, which was consistent with results from Arabidopsis, but quite different from that of rice. This study provides important clues for studying the biological functions of TALE transcription factors in radish.
Amino Acids ; Arabidopsis/metabolism* ; Gene Expression Regulation, Plant ; Phylogeny ; Plant Proteins/metabolism* ; Raphanus/metabolism* ; Transcription Factors/metabolism*

Objective:To analyze the serology and molecular typing of Listeriamonocytogenes isolated from patients in Henan, and to explore the epidemic situation of listeriosis, construct the molecular traceability database of patient isolates, so as to provide laboratory basis for listeriosis traceability. Methods:From January 2015 to July 2020, 71 positive Listeriamonocytogenes cases were monitored in 16 sentinel hospitals in Henan. Eighty samples of positive cases were collected for detection, and 71 positive strains were obtained for molecular typing. According to the Entry-exit Inspection and Quarantine Industry Standard of China (SN/T 2521-2010) and the instructions for the use of diagnostic serum of Listeriamonocytogenes, 80 strains of Listeriamonocytogenes were serotyped, and PFGE cluster analysis was performed according to the User Manual of National Foodborne Disease Molecular Traceability Network. Results:A total of 71 positive listeriosis cases were detected, of which 38 cases were perinatal cases and 33 cases were non-perinatal cases. Among the 80 positive cases of listeriosis, 58.75% (47/80) were from perinatal cases, 20.00% (16/80) were from non-perinatal cases with underlying diseases, the proportion of>1 month-≤5 years old,>5-≤60 years old and >60 years old was 7.50% (6/80), 12.50% (10/80) and 1.25% (1/80), respectively, in non-perinatal age group. There were 5 types of specimens, 73.75% (59/80) were blood, 15.00% (12/80) were cerebrospinal fluid, and 3.75% (3/80) were stool, intrauterine swab and sputum. 80 strains of Listeriamonocytogenes were classified into three serotypes, Type 1/2b, Type 1/2a and Type 4b accounted for 61.25% (49/80), 35.00% (28/80) and 3.75% (3/80) respectively. The 71 strains of Listeriamonocytogenes were digested by AscⅠ, and 58 bands were obtained. Each band type included 1-4 strains, and the similarity was 60.8%-100%. GX6A16HA0005, GX6A16HA0011, GX6A16HA0030, GX6A16HA0023, GX6A16HA0029 and GX6A16HA0054 were dominant bands, including 4, 4, 4, 3, 2 and 2 strains respectively. Four strains of GX6A16HA0005 from 2016, 2018 and 2020 were isolated. One strain from 2016 and one strain from 2018 were from Puyang City. Four strains of GX6A16HA0011 were isolated from samples of 2016, 2018 and 2020, including two strains of 2020 from Luoyang City. Four strains of GX6A16HA0030 were isolated from 2018 samples from Luoyang City, Shangqiu City and Zhengzhou City, respectively. Three strains of GX6A16HA0023 were isolated from 2017 and 2018 samples, of which one strain from 2017 and one strain from 2018 were from Luoyang City. Two strains of GX6A16HA0029 were isolated from 2018 samples, from Kaifeng City and Puyang City respectively. Two strains of GX6A16HA0054 were isolated from 2020 from Pingdingshan City and Anyang City, respectively. The PFGE patterns of 4 strains with different serotypes were the same. Conclusion:Listeriosis cases in Henan are mainly found in patients during the perinatal period, and in elderly, new-born, and low immunity population. The infection type is mainly invasive infection; the serotypes of epidemic strains are 1/2a, 1/2b and 4b, and the results of PFGE typing of strains are diverse. There is a consistent phenomenon of cross-year or different regions in the same year, different time zones in the same year and the same region; phenotyping and genotyping or different genotyping techniques should be combined in the traceability analysis.

Objective:To study the effects of Empagliflozin on left ventricular function and the level of blood glucose and lipid in type 2 diabetes mellitus (T2DM) patients.Methods:A total of 120 patients with T2DM complicated with cardiac function impairment were selected from Chu Hsien-I Memorial Hospital, Tianjin Medical University from December 2020 to May 2021. The diabetic patients were randomly divided into the observation group (60 cases) and control group (60 cases) by random number table method. Patients in the observation group were treated with Empagliflozin, while the control group underwent original hypoglycemic treatment. After the treatment, 6 cases were eliminated and 114 cases were completed, with 57 cases in each group. The changes of echocardiographic left ventricular function related indexes such as E/ e', left atrial volume index (LAVI), tricuspid regurgitation speed, left ventricular ejection fraction (LVEF) and laboratory indexes in the two groups were observed before and after treatment. The laboratory indexes checked include fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL) and how density lipoprotein (HDL). Results:The E/ e', LAVI of the observation groups was significantly lower than that of the control group, and the differences were statistically significant (all P<0.05). There were no significant changes in tricuspid regurgitation speed, LVEF, TG, TC, LDL and HDL levels between the two groups after the treatment (all P>0.05). After the treatment, the levels of FBG and HbA1c in the two groups decreased, but there was no significant difference between the two groups (all P>0.05). Conclusions:Empagliflozin can effectively control the E/ e', LAVI of T2DM patients, and can early significant improvement of left ventricula diastolic function, which is very favorable for the patients. Along with good safety, Empagliflozin is suitable for clinical recommendation.

Objective:To investigate the efficacy and safety of daratumumab in relapsed and refractory multiple myeloma (RRMM).Methods:The efficacy and adverse events (AEs) of daratumumab based regimens were retrospectively analyzed in 37 patients with RRMM from Peking University People′s Hospital, Beijing Hospital and Fu Xing Hospital affiliated to Capital Medical University in China. The deadline for inclusion was December, 2019.Results:Among the 37 patients, 35 patients were available for response evaluation. The overall response rate (ORR) was 68.6%, which was better in patients receiving 16 mg/kg daratumumab than in those with fixed doses of 800 mg daratumumab [ORR: 78.3%(18/23) vs. 40.0%(4/10)]. The percentage of infusion related reactions of daratumumab was 27.0%(10/37). The most common hematological AEs were lymphocytopenia and thrombocytopenia, with the incidences of grade 3 or more severe 59.5%(22/37) and 43.2%(16/37) respectively. Pulmonary infections(37.8%, 14/37) were the most common non-hematological AEs. One patient with positive hepatitis B surface antigen (HBsAg) and two patients dependent on dialysis were safely treated with daratumumab.Conclusion:Daratumumab is highly effective in relapsed and refractory multiple myeloma. Adverse reactions are mild and well tolerable.

Objective To summarize the clinical features of patients with ovarian tumor associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis,and to explore the influence of operation patterns on the prognosis.Methods The clinical data of ovarian tumors with anti-NMDAR encephalitis in the Third Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2018 were collected,and the clinical characteristics,treatment and prognosis were analyzed.Results A total of 110 patients with ovarian tumors and anti-NMDAR encephalitis were collected.All patients were positive for anti-NMDAR antibodies in serum and/or cerebrospinal fluid.The age of onset ranged from 10 to 35 years (24.6 ±5.7).About 60.9％ patients'initial symptom was psychosis.The main clinical features were psychosis (97.3％),seizures (83.6％),conscious disturbance (72.7％),autonomic dysfunction (64.5％),dyskinesia (64.5％),central hypoventilation (54.5％) and impaired memory (31.8％).Most patients'symptoms were relieved after surgery and immunotherapy.Postoperative pathological results revealed that ovarian teratoma accounted for 97.8％ of the ovarian tumor.The prognosis of patients with surgery was better than the patients without surgery,with statistically significant difference (P ＜ 0.05).The prognosis of patients with adnexectomy was better than the patients with ovarian tumor excision,with statistically significant difference (P ＜ 0.05).Conclusions Anti-NMDAR encephalitis,with psycho-neurological symptoms as dominant manifestation,is usually associated with ovarian tumor.For young female patients with psychosis,clinicians should be alert to the possibility of anti-NMDAR encephalitis and screen for tumor.Patients with adnexectomy and immunotherapy can get a better prognosis.