Objective:To investigate the role of ubiquitin-specific protease 21 (USP21) in enterovirus group A type 71 (EV-A71) infection.Methods:Peripheral blood mononuclear cells (PBMC) were obtained from a cohort of 24 children infected with EV-A71 and 24 healthy children. Expression of USP21 was determined by real-time fluorescence quantitative PCR (qPCR). Additionally, the impact of USP21 overexpression or knockout on EV-A71 replication was evaluated using a combination of qPCR and western blot (WB) analysis. Furthermore, WB was employed to measure the levels of EV-A71 structural protein VP1, phosphorylated interferon regulatory factor 3 (IRF3) and other key molecules in the RIG-I-like receptor (RLR) signaling pathway. Co-immunoprecipitation (Co-IP) was utilized to investigate the effects of USP21 on the ubiquitin levels of EV-A71 nonstructural protein 2A protease (2A pro). Results:In comparison to healthy children, the expression of USP21 mRNA in PBMC of children infected with EV-A71 was notably elevated. The overexpression of USP21 significantly enhanced the cytopathic effects induced by EV-A71, upregulated levels of VP1 mRNA and protein, and facilitated EV-A71 replication, leading to a decrease in cell activity with increasing levels of USP21 transfection. Following the knockout of the USP21 gene, the VP1 mRNA levels were significantly declined in comparison to the control group. Furthermore, the overexpression of USP21 was found to have no impact on the transcriptional activity of EV-A71 2A pro. However, it was observed to enhance the expression of 2A pro protein, reduce the ubiquitination of 2A pro, suppress the protein levels of mitochondrial antiviral signaling protein (MAVS) and melanoma differentiation-associated gene 5 (MDA5), as well as decrease the phosphorylation of IRF3. Additionally, the induction of IFN-β mRNA by EV-A71 infection was downregulated. Conclusions:USP21 has been shown to enhance the replication of EV-A71 through the downregulation of 2A pro ubiquitination, suppression of MAVS and MDA5 protein expression, and inhibition of the interferon signaling pathway.

Objective:To investigate the follow-up colonoscopy of patients after colorectal adenoma (CRA) resection, so as to improve colonoscopy quality and reduce missed CRA diagnosis.Methods:A total of 189 patients after CRA resection who underwent follow-up colonoscopy from October 2020 to October 2021 were consecutively recruited. The effect of bowel preparation was evaluated by the Boston bowel preparation scale (BBPS). The location, the number, and gross morphology of adenomas during CRA resection and two colonoscopies during 1 year follow-up after the resection were recorded, and their correlation with major clinicopathologic features were analyzed, and the missed CRA in follow-up colonoscopy were also analyzed.Results:The BBPS scores of the right colon, transverse colon, left colon and total colon in 189 patients who underwent CRA resection were 1.93±0.42, 2.53±0.52, 2.77±0.45, and 7.22±1.03 points at the 1-year follow-up colonoscopy and 2.08±0.35, 2.70±0.46, 2.81±0.40, and 7.57±0.84 points at the time of CRA resection. Except for the left colon segment ( χ 2=0.98, P>0.05), the differences in other colon segments were significantly different ( P<0.05). At the time of CRA resection, 62, 66, 210 and 338 CRAs were detected in the right colon, transverse colon, left colon and total colon segments, respectively. At the 1-year follow-up colonoscopy, 21, 38, 49 and 108 CRAs were missed in the corresponding colon segments and total colon, respectively. CRA missed diagnosis was related to patient age (≥60 years accounting for 54.2%), gender (males accounting for 81.9%), adenoma location (predominantly in the left colon comprising 36.2%) and gross morphology (flat types representing 72.3%) ( P<0.05), but not related to being vegetarian, history of cholecystectomy or appendectomy, smoking or alcohol consumption, number of adenomas or pathological type ( P>0.05). Conclusion:The missed diagnosis of CRA in patients after CRA resection primarily involves the flat type adenomas, which is associated with the age, gender, adenoma location within the colon and the gross morphology.

To explore the clinicopathological characteristics, endoscopic manifestations, and efficacy of endoscopic procedure for early gastroesophageal junction cancer, a retrospective analysis was conducted on the patients who underwent endoscopic submucosal dissection (ESD) and pathologically confirmed early cancer of the gastroesophageal junction at Zhongshan Hospital, Fudan University and Xiamen Branch from November 2014 to October 2021. The pathological and gastroscopic features, as well as short-term efficacy of ESD were analyzed. Among the 401 patients, there were 332 males with the age of 66.02±7.93 years, and 69 females with the age of 66.26±9.31 years. The male-to-female ratio was 4.8∶1. Siewert type Ⅱ accounted for 70.82% (284/401). Lesions involving the lesser curvature accounted for 57.10% (229/401). Endoscopic manifestation of mucosal erythema accounted for 96.26% (386/401). Lesion morphology of 0-Ⅱc type accounted for 38.15% (153/401) and tubular adenocarcinoma accounted for 86.53% (347/401). The en bloc resection rate of ESD was 99.75% (400/401), with a curative resection rate of 72.82% (292/401). It is indicates that early gastroesophageal junction cancer predominantly occurs in middle-aged and elderly males. It is mostly Siewert type Ⅱ, and involves the lesser curvature, and primarily presents as type 0-Ⅱc morphology. The lesions are most commonly manifested as mucosal redness and are predominantly moderately to well-differentiated adenocarcinomas. ESD demonstrates a safe and effective therapeutic approach for early gastroesophageal junction cancer.

Vascular cognitive impairment (VCI), caused by cerebrovascular dysfunction, severely impacts the quality of life in the elderly population, yet effective therapeutic approaches remain limited. Mitophagy, a selective mitochondrial quality-control mechanism, has emerged as a critical focus in neurological disease research. Accumulating evidence indicates that mitophagy modulates oxidative stress, neuroinflammation, and neuronal apoptosis. Key signaling pathways associated with mitophagy—including PINK1/Parkin, BNIP3/Nix, FUNDC1, PI3K/Akt/mTOR, and AMPK—have been identified as potential therapeutic targets for VCI. This review summarizes the mechanistic roles of mitophagy in VCI pathogenesis and explores emerging therapeutic strategies targeting these pathways, aiming to provide novel insights for clinical intervention and advance the development of effective treatments for VCI.

Objective:To explore the diagnostic value of multiparametric magnetic resonance imaging (mp-MRI) combined with computed tomography (CT) for brucellar spondylitis (BS).Methods:From March 2019 to March 2024, patients with suspected BS admitted to Yili Kazakh Autonomous Prefecture Friendship Hospital were selected as study subjects. Their clinical characteristics, laboratory tests, and imaging findings (mp-MRI and CT) were analyzed.Results:A total of 60 suspected BS patients were enrolled, including 43 males and 17 females. Among them, 39 cases (65.00%) were diagnosed with BS, while 21 cases (35.00%) were non-BS. CT examination was performed in 48 patients, mp-MRI in 40 patients, and both examinations in 28 patients. Among CT-examined patients, there were 28 BS cases, 1 case had cervical spine involvement, 3 case had thoracic spine involvement, 3 case had thoracolumbar spine involvement, and 21 case had lumbosacral spine involvement. There were 16 cases involved 2 vertebrae, 3 cases involved 3 vertebrae, and 9 cases involved > 3 vertebrae.There were 15 cases had vertebral osteophyte formation, 28 cases had vertebral bone destruction, 22 cases had intervertebral space stenosis, 25 cases had uneven intervertebral disc density, 28 cases had thickening of soft tissues around the vertebrae, 19 cases had paravertebral abscesses, and 6 cases had spinal canal stenosis. In the mp-MRI examination of patients, there were 30 BS patients, among whom 1 case had cervical spine involvement, 2 case had thoracic spine involvement, 4 case had thoracolumbar spine involvement, and 23 case had lumbosacral spine involvement. There were 16 cases involved 2 vertebrae, 3 cases involved 3 vertebrae, and 11 cases involved > 3 vertebrae, 24 cases had intervertebral space stenosis, 27 cases had intervertebral disc destruction. There were 27 cases had swelling and thickening of soft tissues around the vertebrae, and 21 cases had paravertebral, psoas major muscle, and/or spinal canal abscesses. The BS group showed lower fractional anisotropy value and higher apparent diffusion coefficient value compared to the non-BS group, with statistically significant differences ( t = 5.26, 5.63, P < 0.001). The mp-MRI combined with CT showed higher sensitivity (86.36%, 19/22) and specificity (5/6) for BS diagnosis compared to mp-MRI alone (78.57%, 11/14; 80.77%, 21/26) and CT alone (56.25%, 9/16; 71.88%, 23/32). Conclusions:BS patients present diverse imaging manifestations. The combination of mp-MRI and CT demonstrates better diagnostic efficacy for BS than single examinations alone, showing good diagnostic value.

Objectives:This study aims to explore the impact of new-onset heart conduction block post transcatheter aortic valve replacement(TAVR)on the cardiac conduction status during 1-year follow-up.Methods:A total of 130 patients who completed TAVR surgery at Fuwai Central-China Cardiovascular Hospital from July 2019 to October 2022 were screened.Among them,56 cases with postoperative heart conduction block were selected for analysis.According to the degree of heart block,patients were divided into mild block group(n=36),moderate block group(n=9),and severe block group(n=11).The clinical characteristics and cardiac conduction conditions at 1-year follow-up between different groups were compared.Results:During a mean(8.5±4.1)months follow-up period,10(17.9%)patients had long-term atrioventricular conduction block,and 46(82.1%)patients had partial or complete recovery of heart block,with 28(50.0%)patients with completely recovered cardiac conduction.In the mild block group,22(61.1%)cases were completely recovered,9(25.0%)patients partly recovered,and 5(13.9%)cases uncovered.In the moderate block group,2(22.2%)cases were completely recovered,5(55.6%)patients partly recovered,and 2(22.2%)cases uncovered.Difference in long-term atrioventricular conduction block among three groups was statistically significant(P<0.001).The Kaplan-Meier curve shows that patients with moderate to severe heart block have a higher rate of long-term atrioventricular conduction block(86.1%vs.77.8%vs.72.7%,log-rank P=0.03).Cox multivariate analysis exhibited that old age(≥75 years old,HR=1.204,95%CI:1.051-1.525,P=0.041)and severe heart conduction block(HR=1.106,95%CI:1.100-1.616,P=0.031)are the two independent risk factors for long-term atrioventricular conduction block post TAVR.Conclusions:The ratio of complete cardiac conduction recovery post TAVR is 50.0%.Older age(≥75 year)and new-onset severe heart conduction block are independent risk factors for long-term atrioventricular conduction block post TAVR procedure.

Objective:To study the consistency between post-processing bone mineral density(BMD)values of multi-slice spiral computed tomography(MSCT)scan and the BMD value of quantitative computed tomography(QCT)for lumbar vertebra,so as to explore the feasibility of utilizing MSCT scan-based post-processing BMD values for lumbar vertebra in clinical practice.Methods:The MSCT equipment and QCT equipment were respectively adopted to conduct imaging scan for the L2-L4 of lumber vertebra of QRM-ESP145 European Spine Phantom(ESP),and L2-L4 of lumbar vertebra of adult sheep,and L2-L4 of lumbar vertebra of adult volunteer.The L2-L4 of ESP lumber vertebra and L2-L4 of lumbar vertebra of adult sheep were scanned respectively MSCT and QCT for three times,so as to measure BMD values.The L2-L4 of lumbar vertebrae of volunteers were scanned respectively by the two methods for one time according to the standard of clinical examination,which were reconstructed by three times so as to obtain mean of them.The BMD values of QCT scan were set as control group,and the BMD values of MSCT scan were set as experiment group.The experiment group was further divided into experiment 1 group[two dimension(2D)regional volumetric BMD values of the lumbar vertebra]and experiment 2 group[three dimension(3D)global volumetric BMD post-processing of the lumbar vertebra]according to the reliability of experiment.Then,the consistency between the MSCT 3D post-processing BMD values of three groups and QCT-measured BMD values was compared and analyzed.Results:The MSCT 3D post-processing BMD values of L2-L4 of ESP lumbar vertebra of three groups were respectively(120.83±0.97),(199.57±0.54)and(119.19±1.04)mg/cm3,and that of L2-L4 of lumbar vertebra of adult sheep of three groups were respectively(414.89±1.72),(410.50±0.77)and(420.25±2.71)mg/cm3,and that of L2-L4 of lumbar vertebra of volunteer were respectively(141.22±0.09),(137.38±0.37)and(152.03±1.03)mg/cm3.There were not statistically significant differences in BMD values between MSCT examination and QCT examination(P＞0.05).Conclusion:MSCT 3D post-processing BMD values on lumbar vertebra has high consistency with that of QCT measurements,which post-processing technique can replace QCT to conduct BMD examination,and reduce unnecessary radiation exposure and examination costs for patients.

Objectives:This study aims to investigate the incidence,characteristics and clinical outcomes of vagal response(VR)during pulmonary vein isolation(PVI).Methods:A total of 702 patients with nonvalvular atrial fibrillation(AF)who received the first PVI radiofrequency ablation in Central China Fuwai Hospital from January 2022 to December 2023 were consecutively enrolled.PVI was initiated from right superior pulmonary vein(RSPV),followed by other pulmonary veins(PVs).The VR was defined as atrioventricular block(AVB),asystole or a 50%increase in the RR interval.Results:Among 702 patients with AF,380 patients(54.1%)were paroxysmal AF and 322 patients(45.9%)were persistent AF.77 patients(11.0%)developed 81 VR episodes,which were more common in paroxysmal group than in persistent AF group(19.5%vs.0.9%,P<0.001).VR manifestations included 51 sinus arrest(63.0%),26 sinus bradycardia(32.1%),and 4 atrioventricular block(AVB,4.9%).Most VR episodes were observed in the left superior ganglionated plexi(67[82.7%]).Paroxysmal AF(OR=18.667,95%CI:6.638-52.491,P<0.001),body mass index(BMI)≥28.0 kg/m2(OR=2.361,95%CI:1.376-4.051,P=0.002)and left ventricular ejection fraction(LVEF)≥62.0%(OR=1.964,95%CI:1.119-3.447,P=0.019)were independent risk factors of VR.During a mean of(13.0±7.1)months follow up,among paroxysmal AF patients,6 patients(8.1%)with VR and 33 patients(10.8%)without VR experienced AF recurrence(P=0.496).Kaplan-Meier curves estimated that the AF-free survival rate was similar between VR group and non-VR group among paroxysmal AF patients(log-rank P=0.735).Conclusions:The most common sites of VR when initiating PVI from right RSPV occur in left superior ganglionated plexi.Paroxysmal AF,BMI≥28.0 kg/m2 and LVEF≥62.0%are independent risk factors of VR.VR does not affect AF-free survival.

Objective To explore the correlation between central venous oxygen saturation(ScvO2)-re-lated indexes at different time points and the occurrence of low cardiac output syndrome(LCOS)after con-genital heart disease(CHD)correction surgery.Methods A total of 73 children who underwent CHD correc-tion surgery in this hospital from July 1st,2021 to July 1st,2024 were selected as the research subjects.The clinical data,preoperative conditions,and postoperative conditions of the children were collected.The ScvO2 and arterial lactate(Lac)levels of the children at different time points(the 1st,6th,12th,and 24th hours after surgery)were monitored,and the ScvO2/Lac at different time points and the change rate of ScvO2 in different time periods were calculated.The correlation between ScvO2-related indexes and LCOS after CHD correction surgery was analyzed.Results ScvO2 at the 6th hour after surgery,ScvO2 at the 12th hour after surgery,Sc-vO2/Lac at the 12th hour after surgery,the change rate of ScvO2 from the 1st to the 24th hour after surgery,the change rate of ScvO2 from the 6th to the 12th hour after surgery,and the change rate of ScvO2 from the 12th to the 24th hour after surgery were independent influencing factors of LCOS occurrence after CHD cor-rection surgery(P＜0.05).There was a negative correlation between ScvO2 at the 12th hour after surgery,ScvO2/Lac and LCOS occurrence after CHD correction surgery(r=-0.543,-0.523,P＜0.05).The area under the curve(AUC)of ScvO2 at the 12th hour after surgery for predicting LCOS occurrence after CHD correction surgery was 0.938(95％CI:0.865-1.000);the AUC of ScvO2/Lac at the 12th hour after surgery for predicting LCOS occurrence after CHD correction surgery was 0.922(95％CI:0.851-0.994).Conclusion ScvO2 and ScvO2/Lac at the 12th hour after surgery have good predictive potential for LCOS occurrence af-ter CHD correction surgery.

Objective To explore the short-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of early carcinoma in the remnant stomach. Methods A retrospective study was conducted on 45 patients with early residual gastric cancer underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2014 to April 2024, with a total of 45 lesions. The patients were divided into an anastomotic group (n=15) and a non-anastomotic group (n=30) based on the location of tumor occurrence, and their clinical data, endoscopic diagnosis and treatment, and histopathological conditions were compared between the two groups. Results All 45 patients had lesions with redness and erosion. There were 9 cases of poor lifting of submucosal injection in the anastomotic group and 2 cases in the non-anastomotic group, respectively, and the difference was statistically significant (P<0.05). ESD surgery was performed on 13 lesions in the anastomotic group and 28 lesions in the non-anastomotic group, with surgery times of 80.00 (50.00, 100.00) min and 55.00 (43.75, 80.00) min, respectively. The difference in surgery time between the two groups was statistically significant (P=0.03). Among the 45 patients, ESD surgery achieved curative resection in 35 cases, including 11 cases in the anastomotic group and 24 cases in the non-anastomotic group, with no statistically significant difference. Conclusions Careful preoperative evaluation of early carcinoma in the remnant stomach is essential to prevent oversight. Lesions at anastomotic sites and suture lines present higher technical challenges for complete resection. ESD is safe and effective, with auxiliary traction technique available when necessary.