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 impact of mandibular retrognathism on brain function in rats and its potential mechanisms． Methods : Male SD rats aged 3 to 4 weeks ( w) were randomly divided into control group ( n = 10) and mandible retrusion ( MR) group ( n = 30) ，with the MR group further divided into three subgroups: 1，2， or 4 weeks，with 10 rats in each subgroup．The MR group used modified metal tubes，which were bonded to the lingual side of the maxillary incisors in rats，forcing the mandible to retract by 2－2. 5 mm，thereby achieving the goal of constructing a mandibular retrognathism model; the control group received no interventions．The effects of mandibular retraction on the spatial learning ability and memory ability of rats were explored by behavioral experi- ments such as Morris water maze，Y maze and new object recognition 1，2，and 4 weeks after modeling，respective- ly．Hematoxylin-eosin ( HE) and Nissl staining were employed to observe the histomorphological changes in CA1， CA3，and DG regions of hippocampal tissues．Immunohistochemistry was employed to detect the protein expression levels of tropomyosin receptor kinase B ( TrkB) in the CA1，CA3，and dentate gyrus ( DG) regions of the hippo- campus．Western blot was used to assess the expression changes in the TrkB / phosphoinositide 3-kinase ( PI3K) / protein kinase B ( AKT) pathway in hippocampal tissue．Quantitative analysis of apoptosis-related proteins in the hippocampus，including Bcl-2-associated X protein ( Bax) ，B-cell lymphoma-2 protein ( Bcl-2) ，and Caspase-3， was conducted using qRT-PCR and Western blot． Results: Behavioral experiments showed that rats in the MR group，especially the MR 4 w group，were significantly weaker in learning and spatial memory than the control group，MR 1 w，and MR 2 w( P＜0. 05) ．HE staining showed that pyramidal cells in the control group were ar- ranged orderly with regular morphology．In contrast，the MR group exhibited a reduction in the number of cells in the hippocampal CA1，CA3，and dentate gyrus ( DG) regions．The cells were sparsely and irregularly arranged， with nuclear condensation and enlarged cellular spaces． Nissl staining further demonstrated damage to the Nissl bodies in the MR group．Meanwhile，the TrkB / PI3K / AKT signaling pathway was activated in the MR group，and the expression of p-TrkB，PI3K，and p-AKT proteins was up-regulated ( P ＜0. 05) ．Western blot and qRT-PCR indicated that MR up-regulated the expression of pro-apoptotic protein Bax，apoptotic effector protein Caspase-3 ( P＜0. 05) ，and inhibited the expression of anti-apoptotic protein Bcl-2 ( P ＜0. 05) ． Conclusion Mandibular retraction impairs brain function and affects cognition and learning memory in rats．This may be achieved by regula- ting the TrkB / PI3K / AKT signaling pathway to induce apoptosis in hippocampal neurons．

Objective To analyze the current status of medical services in secondary and tertiary hospitals in Shandong Province based on DRG,and to provide effective support for the implementation strategies of bidirectional referral.Methods The DRG group was used to analyze 42.348 3 million cases from 75 secondary hospitals and 69 tertiary hospitals in Shandong Province from 2019 to 2023.Experts were organized to establish standards for bidirectional referral of diseases.Results(1)35 high-frequency DRG disease groups with diagnosis,treatment ability and medical resources in secondary hospitals were selected,(2)The medical expenses and medical quality in the high-frequency DRG disease groups within secondary hospitals were lower than those in tertiary hospitals,(3)To develop standardized referral standards and programs with esophageal cancer as an example.Conclusion It is urgent to triage patients gradually and accurately through disease classification management,and formulate disease diagnosis and treatment plans and bidirectional referral standards to improve the medical quality of secondary hospitals.

Objective To analyze the current status of medical services in secondary and tertiary hospitals in Shandong Province based on DRG,and to provide effective support for the implementation strategies of bidirectional referral.Methods The DRG group was used to analyze 42.348 3 million cases from 75 secondary hospitals and 69 tertiary hospitals in Shandong Province from 2019 to 2023.Experts were organized to establish standards for bidirectional referral of diseases.Results(1)35 high-frequency DRG disease groups with diagnosis,treatment ability and medical resources in secondary hospitals were selected,(2)The medical expenses and medical quality in the high-frequency DRG disease groups within secondary hospitals were lower than those in tertiary hospitals,(3)To develop standardized referral standards and programs with esophageal cancer as an example.Conclusion It is urgent to triage patients gradually and accurately through disease classification management,and formulate disease diagnosis and treatment plans and bidirectional referral standards to improve the medical quality of secondary hospitals.

Objective To explore the clinical efficacy of arthroscopy combined with cubital tunnel expansion and plasty in the treatment of patients with elbow osteoarthritis and cubital tunnel syndrome.Methods A total of 101 patients with elbow osteoarthritis and cubital tunnel syndrome who were admitted to the Department of Orthopedics,Cangzhou Hospital of Integrated TCM-WM Hebei from September 2020 to August 2023 were selected as the research subjects.According to different surgical methods,the patients were divided into an observation group(n=51)and a control group(n=50).The surgical method in the observation group was arthroscopy combined with cubital tunnel expansion and plasty,and the surgical method in the control group was conventional cubital tunnel expansion and plasty.The operation time,intraoperative blood loss,length of hospital stay,and complications were observed and recorded for both groups.The mayo elbow performance score(MEPS)was used to assess elbow function,the activities of daily living(ADL)scale was used to evaluate daily living ability,and the visual analogue scale(VAS)was used to assess pain levels preoperatively and at 6 months postoperatively.Elbow range of motion,including pronation,supination,and flexion-extension,was measured using a goniometer.Nerve recovery was evaluated by measuring compound muscle action potential(CMAP)of the abductor digiti minimi,ulnar nerve conduction velocity(NCV),and motor evoked potential latency(MEPLP)using a Keypoint electromyography device.Results The operation time and length of hospital stay in the observation group were significantly shorter than those in the control group,and the intraoperative blood loss and complications were significantly less than those in the control group(P＜0.05).Before operation,there were no statistically significant differences in MEPS scores,ADL scores and VAS scores between the observation group and the control group(P＞0.05);6 months after operation,the MEPS scores and ADL scores of patients in the observation group were signifi-cantly higher than those in the control group,and the VAS scores were significantly lower than those in the control group(P＜0.05).Before operation,there were no statistically significant differences in pronation,supination and flexion-extension between the observation group and the control group(P＞0.05);6 months after operation,the pronation,supination and flexion-extension of patients in the two groups were significantly higher than those before operation(P＜0.05),but there were no statistically significant differences in pronation,supination and flexion-extension between the observation group and the control group(P＞0.05).Before operation,there were no statistically significant differences in CMAP,NCV and MEPLP between the observation group and the control group(P＞0.05);6 months after operation,the CMAP and NCV of patients in the observation group were significantly higher than those in the control group,and the MEPLP ratio was significantly lower than that in the control group(P＜0.05).Conclusion Conventional cubital tunnel expansion and plasty and arthroscopy combined with cubital tunnel expansion and plasty can improve the range of motion of the elbow in patients with elbow osteoar-thritis and cubital tunnel syndrome,but the latter features less damage and faster recovery,is better in improving elbow function and daily living ability,reducing pain,and adjusting electromyographic examination indicators,and has fewer complications.

Objective:To explore clinical features, diagnosis, localization, and therapeutic strategy of migratory pharyngeal and cervical esophageal foreign bodies.Methods:A total 23 cases of pharyngeal and cervical esophageal migratory foreign bodies were admitted between January 2015 and December 2021. There were 14 females and 9 males with the age ranged from 35 to 82 (55.0±12.7)years. In all the cases, esophageal CT was taken to confirm the esophageal foreign body. Multiplanar reconstruction (MPR) was performed to locate the foreign body from the horizontal, coronal and sagittal dimensions as well as the corrected reconstructed MPR. According to the location of the foreign body, appropriate surgical method was selected.The symptoms, complications, types of foreign body, positioning, surgical methods, and relevant information were recorded.Data were analyzed using the descriptive method and SPSS 25.0 software.Results:The clinical symptoms of 23 migrating esophageal foreign bodies included pharyngodynia (20/23), foreign body sensation (6/23), hoarsenss (1/23), difficulty in turning neck(1/23), difficulty in opening mouth (1/23), fever (7/23), poor appetite (1/23), and abdominal pain (1/23). The foreign bodies included 19 fish bones, 2 wires, 1 embroidery needle and 1 chicken bone. There were 9 cases (39.1%) of foreign bodies located in extraluminal cervical esophagus, 2 cases (8.7%) of foreign bodies located in the muscular layer of the cervical esophagus and 12 cases (52.2%) of foreign bodies located in pharynx. Twenty-one cases of foreign bodies were removed by cervical lateral incision, in which 11 were removed by cervical lateral incision directly, 10 by the second lateral cervical incision after the foreign bodies were accurately located by MPR and/or corrected MPR, 1 foreign body was removed by incision of the pharyngeal mucosa under suspension laryngoscope, 1 foreign body was removed by tracheoscopy. Compared with patients with intraluminal foreign bodies ( n=308) treated in the same period, intake of fishbone [19 (19/23) vs. 133 (82.6% (43.2%, 133/308), OR=7.31] and first visit was more than 24 hours [20(87.0%, 20/23) vs. 77(25.0%, 77/308), OR=17.2] were the significant risk factors of migratory esophageal foreign bodies. Conclusions:MPR and the corrected MPR can accurately locate the migrating pharyngeal and cervical esophageal foreign bodies, by providing more intuitive imaging evidence for doctors, which provide imaging basis for formulation of surgical programs. Foreign bodies in pharyngeal and cervical esophagus need to be treated as soon as possible, otherwise they are easy to migrate, leading lead to serious complications.

Postmortem changes on corpses appear immediately after death, and can transform the original structure characteristics of the corpse to different degrees as well as show specific changes on computed tomography （CT） images, sometimes with false positives and false negatives, influencing the identification of injuries or diseases. This paper systematically summarizes the postmortem changes of computed tomography imaging characteristics on corpses, to further expand the application of virtopsy in the practices of forensic pathology identification, and provide reference for the identification of injuries, diseases and changes after normal death.
Autopsy ; Cadaver ; Forensic Pathology/instrumentation* ; Humans ; Postmortem Changes ; Research/trends* ; Tomography, X-Ray Computed

Objective To investigate the inhibitory effect of Glycyrrhizin in MHCC97-H cell line in vitro and explore the relevant mechanism.Methods MHCC97-H cells were cultured in vitro and treated with Glycyrrhizin in different concentrations and then cell viability was assayed at different time points.The concentration and time were selected with 50％ cell viability.MHCC97-H cell plate clone formation assay and invasion-migration experiment were also performed to study the tumor-suppressor efficacy of Glycyrrhizin.Acridine orange staining was used to evaluate the formation of autophagic vacuoles.Meanwhile,3-MA and Atg7-siRNA were both employed to avoid the autophagy activation in MHCC97-H cells and cell viability was reassessed.Western-blot was carried out to study the expression of autophagic proteins of LC3B,p-mTOR and p-ERK1/2.Results It showed Glycyrrhizin significantly inhibited MHCC97-H cell viability and the concentration and time at 50％ cell viability were 2 mmol/L and 48 h respectively.Clone number in Glycyrrhizin group was significantly smaller than that in the control group (176.7 ± 14.5 vs.410.0 ± 32.1).Invasion-migration rate was also lower in Glycyrrhizin group compared with the control group (41.0％ ±3.8％ vs.100％).Autophagic vacuoles was increased in MHCC97-H cells when treated with Glycyrrhizin and expression of LC3B-Ⅱ was enhanced and LC3B-Ⅱ/I Ratio was increased,at the same time degradation of P62 was accelerated.Reduced p-mTOR in concurrence with upregulated p-ERK1/2 could be observed in MHCC97-H cells administered with Glycyrrhi-zin.Cell groups additionally treated with 3-MA or Atg7-siRNA exerted higher cell viability (64.3％ vs.45.9％ and 67.7％ vs.47.1％,respectively).Conclusion Glycyrrhizin can induce excessive autophagy in hepatocellular carcinoma cells to cause autophagic cell death and exhibit great potential in clinical application.

Objective To investigate the protective roles of Epigallocatechin gallate (EGCG) on liver ischemia reperfusion injury (IRI) in rats.Methods 30 healthy male SD rats were selected and equally and randomly divided into 3 groups.Sham group,IRI group and IRI-EGCG group were established to construct 70％ liver IRI rat model.Drinking water with 0.4 mg/ml EGCG was administered for 2 weeks before the experiment in IRI-EGCG group.HE staining was performed to evaluate the injury.Transaminases in serum were investigated to assess liver injury.p-p85 and p-AKT was detected by Western-blot assay.qPCR was carried out to study the mRNA expression of TNF-α,IL-6 and IL-1β in liver tissue.The secretion of TNF-α,IL-6 and IL-1 β in serum was examined with ELISA assay.Results EGCG pretreatment reduced ASTand ALT in serum [AST:(550.0 ±66.5) IU/L vs.(220.0 ±63.5) IU/L;ALT:(376.0 ± 25.7) IU/L vs.(158.0 ± 33.1) IU/L,all P ＜ 0.05] and mitigated liver tissue damage.p-p85 and p-AKT increased due to liver IRI,and IRI-EGCG group showed higher expression of p85 and AKT.The proinflammatory cytokines of TNF-α,IL-6 and IL-1 β exhibited a relatively lower mRNA expression in IRI-EGCG group comparing with IRI group.IRI-EGCG group also revealed a decreased secretion of TNF-α,IL-6 and IL-1β in serum [TNF-α:(398.0±33.4) ng/Lvs.(211.0±23.6) ng/L;IL-6:(341.0±27.3) ng/L vs.(187.0±19.6) ng/L;IL-1β:(486.0±43.7) ng/L vs.(352.0±31.5) ng/L;allP＜0.05].Conclusion EGCG pretreatment can enhance IRI-induced activation of PI3K/AKT signaling and reduce the release of proinflammatory cytokines to exert liver protective effects.

Objective: To investigate the clinical characteristics and treatment options for otogenic intracranial infections. Method: Clinical records of all the patients of otogenic intracranial infections admitted to the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were retrospectively analyzed. Their clinical presentations, radiological findings, culture results, and medical and surgical therapy modalities, as well as treatment outcomes were studied. Results: Sixteen cases were identified. The majority of the otogenic patients had a history of cholesteatoma, other rare events included congenital cerebrospinal fluid otorhinorrhea, Gorham-Stout disease and after radiation therapy for nasopharyngeal carcinoma. Meningitis, cerebral venous thrombosis and brain abscess were the primary intracranial infection. Eight patients had received modified radical mastoidectomy at least one time. Results of routine culture for cerebrospinal and pus samples had high negative rate. All patients received initial empirical broadspectrum intravenous antibiotics therapy. Four cases of brain abscesses were drained or excised at the same time for otologic surgery. The mortality rate was 6.25% (1 case). Conclusions Cholesteatoma is still the most commonly primary disease of otogenic intracranial complications. Diagnosis and treatment of otogenic intracranial infections require multidisciplinary cooperation. Surgical intervention for primary ear lesions and intracranial abscess is still the main option in the treatment of otogenic intracranial infections.