Objective:To construct a multi-dimensional surgical equipment management and control platform based on artificial intelligence and Internet of Things(AIoT)to assist with the refinement and intelligent management medical equipment in hospital operating rooms.Methods:A multi-dimensional surgical equipment control platform based on AIoT was established by integrating the Internet of Things(IoT),big data analysis,indoor positioning technology,artificial intelligence(AI)technology and other technologies to collect real-time process data of surgical equipment such as endoscopy and electrosurgical,and to open up the relationships among information systems relating to surgical equipment,such as hospital information system(HIS),laboratory information system(LIS),radiology information system(RIS)and operation anesthesia management system(OAMS),so as to provide technical support for efficiency analysis,benefit analysis and assets management of surgical equipment.The platform was composed of 3 layers:data extraction layer,data engine layer and AI data analysis layer,including 4 functional modules:automatic data acquisition,deep data fusion,data mining and analysis and data visualization.Results:This platform was launched in Shanghai Municipal Hospital of Traditional Chinese Medicine in June 2022,and had realized achieving intelligent daily management such as indoor positioning of operating room equipment,one click inventory.A set of performance analysis method based on IoT and integrated with information systems was established to automatically count the utilization efficiency and cost-effectiveness of key surgical equipment to realize intelligent service,intelligent management,and digital operation.Conclusion:The construction and application of this platform improved the efficiency of medical equipment in operating rooms,reduced the cost and increased the efficiency,assisted in the refinement and intelligent management of hospital surgical equipment,and provided data support for scientific decision-making of hospital managers.

Pseudorabies virus(PRV)is the etiological agent of pseudorabies in pigs,which is char-acterized by dyspnea,reproductive disorders,and neurological diseases,and it spreads widely a-round the world.Since 2011,the newly emerged PRV variants have resulted in poor immunity pro-tection of traditional vaccine strains,and the original method of vaccine strain preparation is time-consuming and labor-intensive.Therefore,it is urgently needed to develop an efficient screening method of the vaccine strain at present.Using CRISPR/Cas9 gene editing technology in this study,two single guide RNAs(sgRNA)were designed targeting the virulence gene TK of PRV variant strain CH/JX/2016,and then the enhanced green fluorescent protein the reporter(EGFP)gene was inserted at the TK locus by a homologous repair plasmid.After multiple rounds of plaque puri-fication,the rPRV-ΔTK/EGFP strain was obtained.The results showed the cleavage efficiency of the two sgRNAs was extremely high.The preparation of rPRV-ΔTK/EGFP strain was succeed af-ter only three rounds of purification,and the EGFP expressed normally.The CRISPR/Cas9 system can edit the PRV gene simply,rapidly,and efficiently,and exhibits great potential in the construction of vaccine candidate strains.Meanwhile,the rescued rPRV-ΔTK/EGFP strain not only could be used as a tracer strain in PRV variant infection progresses,but also for subsequent antivi-ral drug screening.

Objective:Pediatric chronic sinusitis （CRS） is a common disease within the field of otolaryngology-head and neck surgery. Due to the immaturity of sinus development and immune competence in children, its etiology and pathophysiology are complex, and its clinical features and outcomes differ significantly from those in adult patients. Currently, there are issues in the diagnosis and treatment of pediatric CRS, particularly in areas such as antibiotic use and surgical interventions, owing to a lack of sufficient attention. In recognition of this, the Chinese Rhinopathy Research Cooperation Group developed this expert consensus based on a systematic review of the latest literatures from both domestic and international sources, with reference to the latest evidence-based medical evidence worldwide, and in combination with their own clinical experience. The consensus covers various aspects including epidemiology, predisposing factors, pathophysiology, diagnosis and differential diagnosis, as well as treatment strategies such as medical therapy and surgical intervention. It aims to standardize the clinical diagnosis and treatment of pediatric CRS, improve clinical efficacy and patient satisfaction, reduce clinical expenditures, and decrease the occurrence of adverse reactions.
Humans ; Sinusitis/therapy* ; Chronic Disease ; Child ; Consensus ; Anti-Bacterial Agents/therapeutic use*

Objective:To establish a real-time fluorescent quantitative TaqMan reverse transcription polymerase chain reaction (Real-time RT-PCR) detection method for Wuxiang virus (WUXV).Methods:All gene sequences of WUXV were downloaded from GenBank, and multi-sequence alignment analysis was performed using Mega-X. Primers and probes designed for the highly conservative region of S-segment genes were selected to evaluate the specificity, sensitivity and stability of detection reactions.Results:The established method can specifically detect WUXV and does not cross-react with various arboviruses. The lowest detection limit was 1 pfu/ml. The inter-batch variation coefficients of repeated detection cycle threshold ( Ct) of the same sample were all less than 1.00%. TaqMan RT-PCR was used to detect 30 batches of sandflies nucleic acid samples, and 7 of them showed positive amplification curve of WUXV. Conclusions:TaqMan RT-PCR with high sensitivity, specificity and repeatability has been successfully established, which can be used to screen large quantities of samples of WUXV.

Objective:To investigate the molecular mechanism of rabbit ear cartilage remodeling induced by 1064 nm Nd∶YAG laser irradiation.Methods:Thirty-three rabbits were divided into 6 groups according to a random number table, and were used in the following experiments respectively: screening the optimal laser energy (6 rabbits), observing the changes of ear cartilage tissue immediately (6 rabbits), 1 week (6 rabbits), 3 weeks (6 rabbits), and 6 weeks after irridiation (6 rabbits), as well as transcriptome sequencing and verification (3 rabbits). The left ears of rabbits were used as untreated self-controls, while the right ears were irradiated. (1) Laser energy screening: the right ear cartilages of 6 rabbits were irradiated with 1064 nm Nd∶YAG laser at different energy densities (50, 60, 70, 80, 90, 100 J/cm 2). Cartilages without skin and perichondrium were cut into the same thickness and size for HE staining, in order to observe the changes of chondrocytes and to determine the optimal laser energy density for shaping (hereinafter referred to as the optimal energy density). (2) Histological observation of rabbit ear cartilage: the right ears of 24 rabbits were irradiated with laser under the optimal energy density. Bilateral cartilage samples were collected immediately after surgery and at 1, 3 and 6 weeks after surgery for histological observation (HE, Masson and Sirius red staining). (3) Transcriptome sequencing and sample verification: the right ears of 3 rabbits were irradiated with laser under the optimal energy density, and the cartilages were harvested and mixed within 6 hours after irradiation, which was set as the laser irradiation group. Cartilages of the same region and size on the left ears were set as blank control group. Transcriptome RNA sequencing was performed, and the expression levels of related genes and proteins were detected by quantitative polymerase chain reaction (qPCR) and Western blotting. Results:(1) After laser irradiation with different energy density of 50-100 J/cm 2, HE staining showed that the chondrocytes could be changed at the laser energy density of 80 J/cm 2, without causing vacuolar deformation and coagulation necrosis, indicating that the damage degree was suitable.(2) After 80 J/cm 2 laser irradiation, histological observation revealed that there was an irradiated zone immediately after the operation. The overall morphology of chondrocytes in the radiation zone was elongated and exhibited spindle cell-like changes, with deep matrix staining and obvious refraction, as well as a relative increase of type Ⅱ collagen. At 1 week after irradiation, the radiation zone became shallower and the cell size recovered. From 3 weeks to 6 weeks, the matrix staining around the radiation zone gradually deepened and the overall cellular morphology was stretched again. (3) Transcriptome RNA sequencing revealed that there were 198 differentially expressed genes (70 up-regulated and 128 down-regulated) in the laser irradiated group compared with the blank control group. Through further screening and study, CREB3L2 gene expression was up-regulated in the laser irradiation group. qPCR results showed that the relative expression level of CREB3L2 mRNA in laser irradiation group was significantly higher than that in the blank control group, the difference was statistically significant( P<0.01). Western blotting showed that the relative expression level of CREB3L2 protein was higher than that of control group in a time-dependent manner, and the difference was statistically significant( P<0.01). Conclusions:After irradiation with long-pulsed 1064 nm Nd∶YAG laser, the expression level of CREB3L2 gene is up-regulated, which then induced chondrocyte rearrangement and proliferation, resulting in morphological and biomechanical changes of ear cartilage.

Objective:To investigate the molecular mechanism of rabbit ear cartilage remodeling induced by 1064 nm Nd∶YAG laser irradiation.Methods:Thirty-three rabbits were divided into 6 groups according to a random number table, and were used in the following experiments respectively: screening the optimal laser energy (6 rabbits), observing the changes of ear cartilage tissue immediately (6 rabbits), 1 week (6 rabbits), 3 weeks (6 rabbits), and 6 weeks after irridiation (6 rabbits), as well as transcriptome sequencing and verification (3 rabbits). The left ears of rabbits were used as untreated self-controls, while the right ears were irradiated. (1) Laser energy screening: the right ear cartilages of 6 rabbits were irradiated with 1064 nm Nd∶YAG laser at different energy densities (50, 60, 70, 80, 90, 100 J/cm 2). Cartilages without skin and perichondrium were cut into the same thickness and size for HE staining, in order to observe the changes of chondrocytes and to determine the optimal laser energy density for shaping (hereinafter referred to as the optimal energy density). (2) Histological observation of rabbit ear cartilage: the right ears of 24 rabbits were irradiated with laser under the optimal energy density. Bilateral cartilage samples were collected immediately after surgery and at 1, 3 and 6 weeks after surgery for histological observation (HE, Masson and Sirius red staining). (3) Transcriptome sequencing and sample verification: the right ears of 3 rabbits were irradiated with laser under the optimal energy density, and the cartilages were harvested and mixed within 6 hours after irradiation, which was set as the laser irradiation group. Cartilages of the same region and size on the left ears were set as blank control group. Transcriptome RNA sequencing was performed, and the expression levels of related genes and proteins were detected by quantitative polymerase chain reaction (qPCR) and Western blotting. Results:(1) After laser irradiation with different energy density of 50-100 J/cm 2, HE staining showed that the chondrocytes could be changed at the laser energy density of 80 J/cm 2, without causing vacuolar deformation and coagulation necrosis, indicating that the damage degree was suitable.(2) After 80 J/cm 2 laser irradiation, histological observation revealed that there was an irradiated zone immediately after the operation. The overall morphology of chondrocytes in the radiation zone was elongated and exhibited spindle cell-like changes, with deep matrix staining and obvious refraction, as well as a relative increase of type Ⅱ collagen. At 1 week after irradiation, the radiation zone became shallower and the cell size recovered. From 3 weeks to 6 weeks, the matrix staining around the radiation zone gradually deepened and the overall cellular morphology was stretched again. (3) Transcriptome RNA sequencing revealed that there were 198 differentially expressed genes (70 up-regulated and 128 down-regulated) in the laser irradiated group compared with the blank control group. Through further screening and study, CREB3L2 gene expression was up-regulated in the laser irradiation group. qPCR results showed that the relative expression level of CREB3L2 mRNA in laser irradiation group was significantly higher than that in the blank control group, the difference was statistically significant( P<0.01). Western blotting showed that the relative expression level of CREB3L2 protein was higher than that of control group in a time-dependent manner, and the difference was statistically significant( P<0.01). Conclusions:After irradiation with long-pulsed 1064 nm Nd∶YAG laser, the expression level of CREB3L2 gene is up-regulated, which then induced chondrocyte rearrangement and proliferation, resulting in morphological and biomechanical changes of ear cartilage.

Objective:To investigate the predictive value of myoglobin (Mb) for the prognosis of sepsis related chronic critical illness (CCI).Methods:Retrospective study was conducted on septic patients with the length of ICU stay equal or greater than 14 days, and sepsis-related organ failure assessment (SOFA) score equal or greater than 2 on the 14th day in ICU in the First Department of Critical Care Medicine at the First Affiliated Hospital of Sun Yat-sen University from January 2017 to March 2020. Patients′ clinical and laboratory data were collected on the 1st and 14th day in ICU. The survival on day 28 in ICU was recorded. According to the myoglobin levels on day 1 and day 14, all subjects were divided into myoglobin elevation group and decline group. Kaplan-Meier survival curve was used to compare the cumulative survival rate at day 28. Cox regression analysis was used to analyze the independent risk factors of mortality. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of myoglobin.Results:A total of 131 patients with sepsis related CCI were recruited, including 58 patients in the elevation group and 73 in the decline group. The Mb level in elevation group on day 1 was significantly lower than that in decline group [172.40(59.99, 430.53) μg/L vs. 413.60(184.40, 1 328.50) μg/L, Z=3.749, P=0.000], and the Mb level on day 14 was the opposite change in two groups [483.65(230.38, 1 471.75)μg/L in elevation group vs. 132.20(76.86, 274.35)μg/L in decline group, Z=5.595, P=0.000]. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate of the elevation group was significantly lower than that of decline group (χ2=7.051, P=0.008). Cox ratio regression analysis suggested that elevated myoglobin was an independent risk factor for 28-day mortality in septic patients with CCI ( OR=2.534, 95% CI 1.212-5.295, P=0.013). ROC curve analysis suggested that the sensitivity of myoglobin elevation in predicting mortality related to CCI within 28 days was 64.5%, and the specificity was 32.0% with area under the curve(AUC) 0.661(95% CI 0.550-0.773, P=0.007) and Jorden Index was 0.325. Conclusion:Elevated myoglobin, an independent risk factor for mortality within 28 days in ICU, can predict the prognosis of sepsis related chronic critical illness.

Objective To explore the difference of psychological state and the change of psycho logical state between mastectomy group for the purpose of changing gender identity and breast reduction surgery group for the purpose of improving physical beauty.Methods The psychological evaluation scale of three layers and twelve dimensions was used to evaluate the psychological status of 24 patients who underwent clinical breast masculine surgery and aesthetic breast reduction before and after operation.The psychological characteristics between the two groups before and after operation were compared and analyzed.Data analysis was carried out through Stata 13.0 software package.Results There were significant differences in depression factor,anxiety factor and obsessive compulsive symp tom factor in the aesthetic breast reduction group before and after operation (t=2.194,2.183,2.090;P=0.039,0.040,0.048,P＜0.05).There were significant differences in depression factor,anxiety factor,obsessive-compulsive symptom factor,bullying factor,psychological self,physical self and social self before and after mastectomy (t=4.188,3.730,2.484,2.570,5.898,3.531,3.162,P=0.000,0.001,0.021,0.018,0.000,0.002,0.005,P＜0.05).There were significant differ ences in depression,anxiety,psychoticism,obsessive-compulsive symptoms,psychological self,physiological self and social self between mastectomy group and aesthetic mastectomy group before operation.(t=2.629,4.081,2.097,4.246,5.419,2.600,2.545;P=0.015,0.001,0.048,0.000,0.000,0.016,0.018,P＜0.05).There was significant difference in postoperative depression,anxiety and obsessive-compulsive symptoms between the mastectomy group and the aesthetic mastectomygroup (t=2.117,2.170,3.764;P=0.046,0.041,0.001,P＜0.05).Conclusions Plastic surgeons should pay attention to the psychological status and personality characteristics of different beauty seekers and give psychological guidance,which is of great significance to improve the medical experience and surgical effect of the beauty seekers.

OBJECTIVE: The CYP4V2 gene of two pedigrees affected with Bietti crystalline corneoretinal dystrophy was analyzed to indentify the cause of the disease and provide a basis for clinical diagnosis. METHODS: The probands were subjected to next generation sequencing (NGS). Suspected variants were verified by Sanger sequencing. Pathogenicity of the variants were searched through relevant databases and PubMed by following the ACMG guidelines. RESULTS: A homozygous variant in the CYP4V2 gene c. (802-8) _810delTCATACAGGTCATCGCTinsGC was detected in proband from pedigree 1, parents did not detect; CYP4V2 genes c. (802-8)_810delTCATACAGGTCATCGCTinsGC and c. 958 C>T (p.Arg320X) compound heterozygous variants existed in the proband of pedigree 2,both parents were variant carriers. The results of Sanger sequencing showed that the variant of CYP4V2 gene in the two families was consistent with the NGS sequencing. The c. (802-8)_810delTCATACAGGTCATCGCTinsGC of CYP4V2 gene was splicing variant, and both splicing variant and nonsense variant could produce truncated nonfunctional protein products. Based on standards and guidelines by American College of Medical Genetics and Genomics, the CYP4V2 genes c. (802-8)_810del TCATACAGGTCATCGCTinsGC and c. 958 C>T (p.Arg320X) were predicted to be pathogenic variants (PVS1+PS1+PM2+PM3). CONCLUSION The homozygous variant c. (802-8) _810delTCATACAGGTCATCGCTinsGC and the complex heterozygous variants c. (802-8) _810delTCATACAGGTCATCGCTinsGC and c.958C>T (p.Arg320X) in CYP4V2 gene are the cause of the disease in the probands of two pedigrees , respectively.
Corneal Dystrophies, Hereditary/pathology* ; Cytochrome P450 Family 4/genetics* ; Genetic Variation ; Humans ; Mutation ; Pedigree ; Phenotype ; Retinal Diseases/pathology*

Objective:To assess the association between the different prehospital transfer pathways to the hospital and reperfusion delay in patients with ST segment elevation myocardial infarction (STEMI).Methods:We retrospective collected 320 STEMI patients aged 18 years or older who underwent primary percutaneous coronary intervention (PPCI) from June 1, 2016 to July 31, 2018. They were divided into three groups according to different prehospital transfer pathways: patients directly transferred from the field by ambulance to PCI-capable center hospital (field transfer group, n=29); patients transferred by ambulance from PCI-incapable hospitals to PCI-capable center hospital (inerhospital transfer group, n=111); patients transferred by friends or relatives to PCI-capable center hospital (self-transfer group, n=180). The basic characteristic attributes, reperfusion time and fatal complications such as acute left heart failure cases (ALHF) cases, ventricular fibrillation (VF) cases, and in hospital death were collected and compared. In addition, logistic regression analysis was used to analyze uni- and multivariate of door-to-balloon (D2B) time less than 90 min. Results:The S2FMC interval were 118 min (50, 377) min , FMC-to-balloon interval were 87 min (66, 120.5) min and the onset-to-balloon time were 221 min (135, 482.5) min. The above three interval in the interhospital transfer group were longer than those in the field transfer and self-transfer groups ( P<0.05). S2FMC accounted for 51.14% of onset-to-balloon time in the field transfer group, 63.29% in the interhospital transfer group and 55.26% in the self transfer group. The door-to-catheter room interval were 33 min (9, 53.5) min. The interval in the interhospital transfer group were shorter than those in the field transfer and self-transfer groups ( P<0.05). The interval in the self-transfer group were longer than those in the interhospital transfer and field transfer groups ( P<0.05). Multiple regression analysis showed that the interhospital transfer group ( OR=15.251, 95% CI: 5.328-43.657, P<0.01), field transfer group ( OR=8.219, 95% CI: 1.861-36.307, P=0.005), FMC2ECG time ( OR=0.975, 95% CI: 0.962-0.989, P<0.01), and smoking ( OR=2.099, 95% CI: 1.015-4.341, P=0.045) were independent predictor of goal time less than 90 min ( P<0.05 for all variables). Adverse events in STEMI patients mainly occurred within 6 h of the initial symptoms. The incidence of VF was 3.75% (95% CI: 3.73%-3.77%), ALHF was 10.94% (95% CI: 7.52%-14.36%) and in-hospital mortality was 2.5% (95% CI: 0.79%-4.21%). There was no significant difference in the incidence of adverse events among the three groups ( P>0.05). Conclusions:The symptoms of STEMI patients are at risk in the early stage. Ambulances can shorten the reperfusion time, but the ambulance system is less used by patients. It is necessary to further optimize the treatment process of non-PCI hospitals and strengthen the popularity of emergency knowledge related to chest pain among residents, so as to shorten the reperfusion time.