Objective:To investigate the clinical subtypes of acute aortic dissection (AAD) through latent class analysis.Methods:This study was a multicenter retrospective cohort study. Patients with AAD admitted to five hospitals, including Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Henan Provincial People′s Hospital, Central China Fuwai Hospital of Zhengzhou University (Fuwai Central China Cardiovascular Hospital), the Third Affiliated Hospital of Xinxiang Medical University and the Second Affiliated Hospital of Chongqing Medical University, between August 2010 and December 2021 were enrolled. Based on clinical and biological characteristics, latent class analysis (models with 2 to 5 latent classes) was conducted to classify the enrolled patients. The optimal classification scheme was determined using model fitting evaluations, including log-likelihood (LL), entropy, Lo-Mendell-Rubin adjusted likelihood ratio test and so on. Clinical data of different subtypes were compared, and in-hospital mortality was analyzed across the entire population and among subgroups receiving different treatments.Results:A total of 2 689 AAD patients, aged 54 (46, 63) years were included, with 1 305 (48.5%) having DeBakey type Ⅰ, 156 (5.8%) type Ⅱ, and 1 228 (45. 7%) type Ⅲ dissections. The cohort comprised 2 134 (79.4%) males. The overall in-hospital mortality rate was 22.8% (613/2 689). Latent class analysis indicated that a two-class model was optimal (LL=147 413.242, entropy=0.812, and PLMRT<0.001). Patients were classified into two subtypes, named clinical subtype 1 and clinical subtype 2. Compared to clinical subtype 1, clinical subtype 2 had a higher proportion of females, was older, had more dissections involving the ascending aorta, and exhibited higher rates of organ dysfunction (elevated alanine aminotransferase and creatinine levels) and inflammatory response (neutrophilia) (all P<0.05). Clinical subtype 2 also showed higher in-hospital mortality compared to subtype 1 (26.3% (238/905) vs. 21.0% (375/1 784), P=0.002). Among patients undergoing surgical treatment, clinical subtype 2 had higher mortality than subtype 1 (40.1% (67/167) vs. 30.0% (101/337), P=0.027). However, no significant differences in mortality were observed between the two subtypes among patients receiving medical therapy or endovascular and hybrid procedures (all P>0.05). Conclusions:Comprehensive latent class analysis identifies two subtypes of AAD with distinct clinical characteristics and treatment responses. These findings provide new insights into individualized clinical decision-making and prognostic evaluation for AAD patients.

Objective:To investigate the antibiotic resistance of Helicobacter pylori (Hp) and to evaluate the eradication efficacy of individualized treatment for Hp in children. Methods:A retrospective cohort study was conducted on 227 children who visited the Department of Gastroenterology, Capital Center for Children′s Health, Capital Medical University from June 2022 to December 2023 due to gastrointestinal symptoms. All patients underwent gastroscopy and tested positive on 13C-urea breath testing. They were grouqed according to the Hp culture and drug susceptibility test. Children with positive Hp culture received personalized treatment based on the results of their drug sensitivity tests, while the other children who didn′t undergo Hp culture received empirical treatment. The effects of different treatment groups was compared by chi-square test or Fisher exact probability test. Results:A total of 227 children with Hp infection (121 males and 106 females) were included, with the age of 11.7 (8.9, 13.6) years. Among the 131 samples submitted for testing, 105 cases (80.1%) had positive results. Only 9.5% (10/105) of patients were sensitive to 6 antibiotics. The resistance rates to clarithromycin, metronidazole and levofloxacin were 90.5% (95/105), 86.7% (91/105) and 22.9% (24/105) respectively. The resistance rate to both clarithromycin and metronidazole was 77.1% (81/105). The resistance rate to both levofloxacin and metronidazole was 19.0% (20/105). The resistance rate to both levofloxacin and clarithromycin was 21.9% (23/105). The resistance rate to these three antibiotics was 16.2% (17/105). No strains resistant to furazolidone, amoxicillin or tetracycline hydrochloride were found. Eighty-nine cases were treated with bismuth quadruple therapy based on the drug sensitivity results, and the overall eradication rate was 88.8% (79/89), including 42 treatment-naive cases with a 100% eradication rate (42/42) and 47 retreatment cases with a 78.7% eradication rate (37/47). The eradication rate of empirical treatment was 75.7% (56/74). Among them, 65 patients received amoxicillin, clarithromycin and omeprazole because of negative penicillin skin tests, with a 75.4% (49/65) eradication rate; 9 patients received clarithromycin, metronidazole, omeprazole and bismuth with positive penicillin skin tests, achieving 7/9 eradication rate. The comparison of eradication rates between two treatment groups suggested a statistically significant difference ( P<0.05). No statistically significant difference was found in drug reactions such as nausea, vomiting, and rash between the two groups ( P>0.05). Conclusions:Hp strains had a relatively high dual resistance to clarithromycin and metronidazole, especially clarithromycin. For areas with a high resistance rate to clarithromycin, the bismuth quadruplet of clarithromycin removal combined with bismuth agent can be chosen as empirical treatment. In medical institutions where drug susceptibility test can be conducted, personalized treatment plans are recommended as the first-line treatment.

Objective:To evaluate the epidemiological characteristics and influencing factors of out-of-hospital sudden cardiac death (SCD) in Hangzhou from 2016 to 2019.Methods:SCD events recorded by Hangzhou Emergency Center from January 1, 2016 to December 31, 2019 were reviewed. Demographic and mortality data were recorded, and the distribution patterns of SCD events in terms of date, time, and population with different characteristics were observed. Time series analysis method and a distributed lag nonlinear model based on quasi-Poisson distribution were used to explore the possible nonlinear association between ambient temperature and SCD incidence.Results:A total of 4 744 out-of-hospital sudden death events were recorded by Hangzhou Emergency Center from January 1, 2016 to December 31, 2019. After excluding non-SCD events and observed events with missing items, 3 743 SCD events were finally included in the study. The survey results showed that the incidence of out-of-hospital SCD in Hangzhou was 96.5 cases per 100 000 person-years. Most of the people who experienced SCD were aged ≥60 years. The incidence in males (2 462 cases, 66%) was significantly higher than that in females (1 281 cases, 34%), and the proportion of events occurring during the day (2 737 cases, 73%) was significantly higher than that at night (1 006 cases, 27%), mainly occurring between 7: 00 and 9: 00. High temperature was associated with an increased risk of SCD. When the average daily temperature was higher than 25.5 ℃, the risk of SCD increased with the further increase of average daily temperature.Conclusions:SCD events mainly occur in the elderly population aged ≥60 years, with a significantly higher incidence in males than in females, and more frequently during the day than at night, mainly between 7: 00 and 9: 00 in the morning. High temperature is closely related to the risk of SCD. It is particularly important to carry out targeted SCD screening and prevention for different populations and implement appropriate prevention strategies for high-risk groups of SCD in high-temperature weather.

Objective To investigate the anti-inflammatory protective effects of remimazolam on microglial cells and elucidates the potential molecular mechanisms underlying these effects. Methods The mouse microglial cell line (BV2) was selected as the research object. The following groups were set up:the control group (complete medium),the Rema group (200 μg/mL remimazolam),the model group (1 μg/mL lipopolysaccharide,LPS),and different-concentration administration groups (1 μg/mL LPS+50,100,200 μg/mL remimazolam). In the Rema group,cells were treated with 200 μg/mL remimazolam alone for 26 h. In the model group,cells were treated with LPS for 24 h. In the different-concentration administration groups,cells were pre-treated with different concentrations of remimazolam for 2 h,and then treated with LPS for 24 h. The effects of LPS and remimazolam on the morphology of BV2 cells were observed and evaluated using an optical microscope. Cell viability was determined using the CCK-8 assay,while the expression and secretion of inflammatory cytokines were quantified by quantitative real-time PCR and ELISA. Reactive oxygen species (ROS) levels were measured using a fluorescent probe. Additionally,malondial-dehyde (MDA) content,superoxide dismutase (SOD) activity,and glutathione peroxidase (GSH) activity were evaluated using respective assay kits. Western blot analysis was conducted to examine the protein expression levels of Bax,Bcl-2,IL-1β,RAGE,NF-κB,p-NF-κB,IκBα,p-IκBα,iNOS,and Arg-1. Immunofluorescence staining was employed to visualize NF-κB nuclear translocation and M1/M2 polarization in the cells. Results Compared to the control group,LPS-treated BV2 cells demonstrated significantly reduced cell viability,elevated expression and se-cretion of inflammatory cytokines (TNF-α,IL-6,IL-1β),decreased activities of SOD and GSH,and increased in-tracellular levels of MDA and ROS. Additionally,RAGE protein levels were upregulated,along with enhanced phos-phorylation of IκBα and NF-κB,leading to observable NF-κB nuclear translocation. The expression of the M1 marker iNOS was upregulated,while that of the M2 marker Arg-1 was downregulated. In contrast,in the LPS+Rema group,cell viability was restored,expression and secretion of inflammatory cytokines were attenuated,SOD and GSH activities were improved,and levels of MDA and ROS were reduced compared to the LPS group. Furthermore,RAGE protein expression and phosphorylation levels of IκBα and NF-κB were diminished,inhibiting NF-κB nuclear translocation. The expression of the M1 marker iNOS was downregulated,while that of the M2 marker Arg-1 was up-regulated. Conclusion Remimazolam mitigates LPS-induced inflammation by facilitating the transition of microglial cells from the M1 to the M2 phenotype via modulation of the NF-κB pathway and reduction of ROS production.

Objective To evaluate the efficacy of uterine artery embolization(UAE)for the treatment of adenomyosis(AM)and to discuss the factors predicting efficacy.Methods The clinical data of 44 patients with AM,who received UAE at The Second Affiliated Hospital of Soochow University from January 2020 to August 2022,were retrospectively analyzed.Based on the MRI findings,serum CA125 levels and follow-up dysmenorrhea scores,the efficacy of UAE and the factors predicting efficacy were analyzed.Results A single UAE treatment was performed in all 44 patients with AM.Follow-up check with MRI at 12 months after treatment showed that the mean uterine volume decreased from preoperative(299.60±182.42)cm3 to postoperative(173.14±104.00)cm3,with a volume reduction of 36.64％(P＜0.05).The dysmenorrhea score decreased from preoperative(7.70±2.60)points to postoperative(2.20+2.37)points,with a relief rate of 88.64％(P＜0.05),and no severe adverse reactions occurred.Enhanced MRI demonstrated that in 30 patients(68.18％)the AM lesions presented as complete necrosis foci.In the patients whose preoperative lesions were completely necrotic,the mean preoperative serum CA125 level was(101.97±60.30)U/mL,the mean ADC value was(1.012+0.271)mm2/s,which were obviously lower than those in the patients whose preoperative lesions were incompletely necrotic(P＜0.05).The mean T2 signal ratio(T2SR)value in the patients whose preoperative lesions were completely necrotic was(0.582±0.198),which was significantly higher than that in the patients whose preoperative lesions were incompletely necrotic(P＜0.05).The analysis of receiver operating characteristic(ROC)curve showed that the preoperative area under the curve(AUC),sensitivity,and specificity for preoperative CA125 were 0.844,60％and 80％respectively;the AUC,sensitivity,and specificity for preoperative ADC were 0.760,80％and 65％respectively;and the AUC,sensitivity,and specificity for preoperative T2SR were 0.760,80％and 70％respectively.ADC＜1.116 × 10-3 mm2/s,T2SR＞0.479,and CA125＜109.10 U/mL could be used as the reliable predictive factors for the efficacy of UAE treatment for AM.Conclusion UAE can effectively alleviate dysmenorrhea symptoms in patients with AM,and it is clinically safe and effective.ADC,T2SR,and CA125 can be used as the reliable predictive factors for the efficacy of UAE treatment for AM,which are helpful in predicting the lesion response and selecting the reasonable therapeutic options for patients.

Objective To develop an erythrocyte-based delivery system for butyrylcholinesterase(BChE)that is capable of prophylaxis against organophosphorus nerve agents.Methods Recombinant BChE was produced and analyzed for oligomerization via polyacrylamide gel electrophoresis(PAGE)and Western blotting.A modified hypotonic preswelling method was employed to prepare BChE-loaded erythrocytes.The drug loading capacity and encapsulation efficiency were quantified using enzyme-linked immunosorbent assay(ELISA).Catalytic activity was assessed in vitro with an activity detection kit.The system was characterized via scanning electron microscopy(SEM),flow cytometry and a hematology analyzer.Results Recombinant BChE predominantly existed as dimers(85％dimer,15％monomer).The optimized volume ratio of erythrocytes to hypotonic solution was determined as 1:7.Compared with native and empty erythrocytes,BChE-loaded erythrocytes exhibited significantly higher catalytic activity(P＜0.001).The mean corpuscular volume of BChE-loaded erythrocytes increased(P＜0.001),while the mean content of corpuscular hemoglobin and hemoglobin in erythrocytes per 100 mL decreased(P＜0.001).SEM revealed no morphological differences(biconcave disc shape).Hypotonic preswelling moderately increased erythrocyte apoptosis(P＜0.001),but no statistical difference was observed between BChE-loaded and hypotonic-treated erythrocytes(P＞0.05).CD47 expression remained unchanged compared to native erythrocytes(P＞0.05).Conclusion The modified hypotonic preswelling method can generate BChE-loaded erythrocytes that retain the characteristics of native erythrocytes while conferring catalytic activity,offering a novel strategy for clinical intervention against organophosphorus poisoning.

Objective:To investigate the characteristics and clinical effects of laparoscopic pneumovesical Cohen and laparoscopic Lich-Gregoir ureteral replantations for the treatment of primary obstructive megaloureter (POM) in children.Methods:A randomized controlled study was conducted.The clinical data of 51 children with unilateral POM admitted to the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2023 were collected.Random number table method was used in the selection of surgical methods.They were divided into the laparoscopic pneumovesical Cohen ureteral replantation group (group A, 22 cases) and the laparoscopic Lich-Gregoir ureteral replantation group (group B, 29 cases) according to the surgical method.The anterior-posterior diameter(APD), maximum ureteral diameter and differential renal function parameters on the affected side were measured by color Doppler ultrasound of the urinary system, and compared between and within the two groups before and after surgery.The operation time, blood loss and postoperative intubation time were compared between the two groups.The incidence of postoperative complications such as reflux, bladder spasm, urinary retention and urinary tract infection was recorded.The independent and paired sample t-tests were used for statistical analysis. Results:The operation time and hematuria duration of group B [(125.7±14.2) min, (1.5±0.6) d] were significantly shorter than those of group A [(142.6±14.7) min, (2.8±0.7) d] (all P<0.05). The APD, maximum ureteral diameter, and differential renal function on the affected side of group A were (21.7±7.9) mm, (11.6±3.2) mm, and (28.2±4.9)% before surgery, and (10.3±4.5) mm, (6.0±2.0) mm and (43.8±4.4)% after surgery, respectively.The APD, maximum ureteral diameter, and differential renal function on the affected side of group B were (21.1±5.6) mm, (11.3±4.6) mm, and (30.2±5.5)% before surgery, and (10.2±4.5) mm, (6.6±2.0) mm, and (42.4±5.2)% after surgery, respectively.There was no statistically significant difference in the values of APD, maximum ureteral diameter, and differential renal function before and after surgery between the two groups of children (all P>0.05). However, there were statistically significant differences in the values of APD, maximum ureteral diameter, and differential renal function before and after surgery between the same group of children (all P<0.01). No significant difference was found in intraoperative blood loss, postoperative intubation time, and postoperative complications between the two groups (all P>0.05). Conclusions:Both surgical methods are effective in the treatment of POM in children.Laparoscopic Lich-Gregoir ureteral replantation has advantages of less operation time compared with laparoscopic pneumovesical Cohen ureteral replantation.

To investigate the infection status of two arboviruses,akabane orthobunyavirus(AKAV)and bluetongue virus(BTV),in cattle herds of Guizhou Province,we employed the indirect ELISA method to detect AKAV and BTV antibody levels in the present experiment.A total of 1504 bovine serum samples from 37 large-scale farms and 88 free-range households from 26 districts or coun-ties of 7 cities(prefectures)of Guizhou Province were collected to detect AKAV antibody levels.Additionally,1 241 serum samples from 30 large-scale farms and 15 free-range households in 19 districts or counties of 3 cities(prefectures)were tested for BTV antibody levels.Moreover,two influencing factors,breeding mode and sampling season,were statistically analyzed for their effects.The results showed that the overall positive rate of AKAV antibodies was 11.64％(175/1 504),with individual positive rates of 13.20％(123/934)and 9.12％(52/570)in large-scale farms and free-range households,respectively.No significant differences were observed between the two groups.However,the farm positive rate(64.86％,24/37)in large-scale farms was significantly higher than that(26.14％,23/88)in free-range households.Seasonal statistics showed that the positive rate was highest during the summer season at 60.00％(12/20).The total positive rate of BTV antibodies was 25.42％(222/1 241).The farm positive rate and individual positive rate in free-range households were 66.67％(10/15)and 41.91％(57/136),respectively.For large-scale farms,these rates were 60.00％(18/30)and 14.93％(165/1 105),respectively.The individual pos-itive rate in free-range households was significantly higher than that in large-scale farms.Seasonal statistics showed that the positive rates in summer and autumn seasons were 50.00％(5/10)and 72.41％(21/29),respectively,both of which were significantly higher than those in winter and spring seasons.All these findings indicated that both AKAV and BTV were present to a certain ex-tent in Guizhou Province,with seasonality.Furthermore,differences were observed between the different breeding modes.Our results could provide a data reference for the formulation of preven-tion and control measures for the two insect-borne diseases.

To establish a rapid visual detection method for Akabane virus(AKAV)on site,specific primers and probes based on the S fragment of AKAV were designed in this experiment.Corre-sponding groups were added to the primers or probes to fulfil the requirement of the combination of recombinase polymerase amplification(RPA)with lateral flow dipstick(LFD).The reaction temperature and time,concentrations of the primer and probe were optimized to establish the RPA-LFD method for detecting AKAV.After that,the specificity,sensitivity and clinical reliability of the method were evaluated.The results showed that after 20 minutes of reaction at 37 ℃,the test results could be read on LFD paper.There was no cross reaction against blue tongue virus,Pasteurella multocida,bovine infectious rhinotracheitis virus and bovine Mycoplasma bovis,and the detection limit was 2.5 × 100 copies/μL of standard plasmid.Detection of clinical samples showed a consistent results with that by RT-PCR method.These findings indicated that the RPA-LFD method established had the advantages of good specificity,high sensitivity,simple operation and visualization,and could be applied to clinical detection,which provides new technical support for the rapid diagnosis and prevention and control of AKAV.