To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

Objective To investigate the microbiota composition and diversity between autogenous and anautogenous Culex pipiens pallens, so as to provide insights into unraveling the pathogenesis of autogeny in Cx. pipiens pallens. Methods Autogenous and anautogenous adult Cx. pipiens pallens samples were collected at 25 ℃, and the hypervariable regions of the microbial 16S ribosomal RNA (16S rRNA) gene was sequenced on the Illumina NovaSeq 6000 sequencing platform. The microbiota abundance and diversity were evaluated using the alpha diversity index, and the difference in the microbiota structure was examined using the beta diversity index. The microbiota with significant differences in the abundance between autogenous and anautogenous adult Cx. pipiens pallens samples was identified using the linear discriminant analysis effect size (LEfSe). Results The microbiota in autogenous and anautogenous Cx. pipiens pallens samples belonged to 18 phyla, 28 classes, 70 orders, 113 families, and 170 genera, and the dominant phyla included Proteobacteria, Bacteroidetes, and so on. At the genus level, Wolbachia was a common dominant genus, and the relative abundance was (77.6 ± 11.3)% in autogenous Cx. pipiens pallens samples and (47.5 ± 8.5)% in anautogenous mosquito samples, while Faecalibaculum (0.4% ± 0.1%), Dubosiella (0.5% ± 0.0%) and Massilia (0.5% ± 0.1%) were specific species in autogenous Cx. pipiens pallens samples. Alpha diversity analysis showed that higher Chao1 index and ACE index in autogenous Cx. pipiens pallens samples than in anautogenous samples (both P values > 0.05), and lower Shannon index (P > 0.05) and Simpson index (P < 0.05) in autogenous Cx. pipiens pallens samples than in anautogenous samples. LEfSe analysis showed a total of 48 significantly different taxa between autogenous and anautogenous Cx. pipiens pallens samples (all P values < 0.05). Conclusion There is a significant difference in the microbiota diversity between autogenous and anautogenous Cx. pipiens pallens.

Microglia, originating from primitive macrophages in the yolk sac, serves as both immune system defenders and regulators of homeostasis. These cells exhibit two primary polarization states: conventionally activated(M1)and alternatively activated(M2). The polarization of microglia plays a crucial role in influencing inflammatory disorders, metabolic imbalances, and neural degeneration. This process is implicated in various aspects of ocular diseases, especially age-related macular degeneration(AMD), including inflammation, oxidative stress and pathological angiogenesis. The distinct functional phenotypes of microglia impact disease progression and prognosis. Thus, regulating the polarization or functional phenotype of microglia at different stages of AMD holds promise for personalized therapeutic approaches. This comprehensive review outlines the involvement of microglia polarization in both physiological and pathological conditions, emphasizing its relevance in AMD. The discussion underscores the potential of polarization as a foundation for personalized treatment strategies for AMD.

Objective:To investigate the application and effectiveness of slit-lamp microscope demonstration combined with supervisory clinical teaching in ophthalmology training for general practice residents.Methods:Sixty general practice residents who underwent ophthalmology training in Fifth Affiliated Hospital of Sun Yat-sen University from March 2021 to March 2023 were randomly assigned to 2 groups. In the traditional teaching group ( n=29), the teaching was primarily led by the instructors, and trainees observed and recorded the clinical findings under their guidance; while in the combined teaching group ( n=31), the trainees received integrated slit-lamp microscope demonstration and supervisory outpatient teaching. Both groups underwent a unified exit examination after the training, with the scores based on knowledge, diagnostic skills, comprehensive evaluation and overall performance. Additionally, satisfaction with the teaching process was assessed through questionnaires completed by both trainees and instructors. Results:There were no significant differences in gender composition, age and initial exam scores between the two groups (all P>0.05). Upon completion of the training, the combined teaching group scored higher in ophthalmology knowledge, outpatient diagnostic skills, and overall performance compared to the traditional teaching group (all P<0.05). Satisfaction scores from both trainees and instructors were also higher in the combined teaching group compared to the traditional teaching group (all P<0.05). Conclusion:The use of slit-lamp microscope demonstration combined with supervisory outpatient teaching can significantly enhance the effectiveness of ophthalmology training for general practice residents.

Objective:To investigate the death risk prediction factors of acute pancreatitis (AP) patients in intensive care unit (ICU), and to establish a death prediction model and evaluate its efficacy.Methods:A retrospective cohort study was conducted using the data in the Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ). The clinical data of 285 AP patients admitted to the ICU in the database were collected, including age, gender, blood routine and blood biochemical indicators, comorbidities, simplified acute physiology score Ⅲ (SAPS Ⅲ) and hospital prognosis. By using univariate analysis, the differences in the clinical data of the patients were compared between the two groups. Binary multivariate Logistic regression analysis was used to screen out independent predictors of in-hospital death in AP patients. A death prediction model was established, and the nomogram was drawn. The receiver operator characteristic curve (ROC curve) was plotted, and the area under the ROC curve (AUC) was used to test the discrimination of the prediction model. In addition, the prediction model was compared with the SAPSⅢ score in predicting in-hospital death. The calibration ability of the prediction model was evaluated by the Hosmer-Lemeshow goodness of fit test, and a calibration map was drawn to show the calibration degree of the prediction model.Results:Among 285 patients with AP, 29 patients died in the hospital and 256 patients survived. Univariate analysis showed that the patients in the death group were older than those in the survival group (years old: 70±17 vs. 58±16), and had higher white blood cell count (WBC), total bilirubin (TBil), serum creatinine (SCr), blood urea nitrogen (BUN), red blood cell volume distribution width (RDW), proportion of congestive heart failure and SAPSⅢ score [WBC (×10 9/L): 18.5 (13.9, 24.3) vs. 13.2 (9.3, 17.9), TBil (μmol/L): 29.1 (15.4, 66.7) vs. 16.2 (10.3, 29.1), SCr (μmol/L): 114.9 (88.4, 300.6) vs. 79.6 (53.0, 114.9), BUN (mmol/L): 13.9 (9.3, 17.8) vs. 6.1 (3.7, 9.6), RDW: 0.152 (0.141, 0.165) vs. 0.141 (0.134, 0.150), congestive heart failure: 34.5% vs. 14.8%, SAPSⅢ score: 66 (52, 90) vs. 39 (30, 48), all P < 0.05]. Multivariate Logistic regression analysis showed that age [odds ratio ( OR) = 1.038, 95% confidence interval (95% CI) was 1.005-1.073], WBC ( OR = 1.103, 95% CI was 1.038-1.172), TBil ( OR = 1.247, 95% CI was 1.066-1.459), BUN ( OR = 1.034, 95% CI was 1.014-1.055) and RDW ( OR = 1.344, 95% CI was 1.024-1.764) were independent risk predictors of in-hospital death in patients with AP. Logistic regression model was established: Logit ( P) = 0.037×age+0.098×WBC+0.221×TBil+0.033×BUN+0.296×RDW-12.133. ROC curve analysis showed that the AUC of the Logistic regression model for predicting the in-hospital death of patients with AP was 0.870 (95% CI was 0.794-0.946), the sensitivity was 86.2%, and the specificity was 78.5%, indicating that the model had good predictive performance, and it was superior to the SAPSⅢ score [AUC was 0.831 (95% CI was 0.754-0.907), the sensitivity was 82.8%, and the specificity was 75.4%]. A nomogram model was established based on the result of multivariate Logistic regression analysis. The calibration map showed that the calibration curve of the nomogram model was very close to the standard curve, with the goodness of fit test: χ 2 = 6.986, P = 0.538, indicating that the consistency between the predicted death risk of the nomogram model and the actual occurrence risk was relatively high. Conclusions:The older the AP patient is, the higher the WBC, TBil, BUN, and RDW, and the greater the risk of hospital death. The death prediction Logistic regression model and nomogram model constructed based on the above indicators have good discrimination ability and high accuracy for high-risk patients with hospital death, which can accurately predict the probability of death in AP patients and provide a basis for prognosis judgment and clinical treatment of AP patients.

To analyze the methodological and reporting quality of systematic reviews of prediction models published in Chinese journals, with the aim of providing reference for enhancing the overall quality of Chinese systematic reviews of prediction models.

Objective:To study the clinical characteristics of neonatal community-acquired Novel Coronavirus (COVID-19) Omicron variant infection.Methods:From March 30 to May 15, 2022, the epidemiological characteristics, clinical manifestations and outcomes of neonatal cases of community-acquired COVID-19 Omicron variant infection admitted to the isolation ward of our hospital were analyzed.Results:A total of 7 neonates infected with community-acquired COVID-19 Omicron variant were treated, including 3 males and 4 females. All of them were term infants with clear epidemiological exposure history. The infection was originated from caregivers of close contact (parents or babysitters). The main clinical symptoms was upper respiratory tract infection, including fever (6 cases), nasal congestion (6 cases), cough (5 cases), runny nose (2 cases), poor appetite (2 cases) and diarrhea (1 case). On admission, no abnormalities were found in blood routine examination and C-reactive protein (CRP). All but one case had normal serum amyloid A (SAA). No obvious abnormalities were found on chest X-ray. All patients were isolated in single-patient rooms after admission. They received standard symptomatic treatment and regular nucleic acid tests. The first negative nucleic acid results came on median 17 d(8~26 d) after the onset of the disease. The patients were discharged after two consecutive (24 h apart) nucleic acid tests with CT value ≥35 and continued health-monitor at home. On discharge, 5 patients had nasal congestion and 2 of them had cough. During the follow-up 4~6 weeks after discharge, all patients gradually recovered without positive nucleic acid results.Conclusions:All 7 neonates with community-acquired COVID-19 Omicron variant infection have epidemiological exposure history. The main clinical symptoms are long-lasting upper respiratory tract infections. It takes a relatively long time for the nucleic acid to turn negative, however, the overall short-term prognosis is good.

Objective:To study the predictive value of hour-specific total serum bilirubin(TSB) nomogram combined with clinical risk factors in the risk of hyperbilirubinemia.Method:Perinatal clinical data of newborns born in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai Pudong New Area People's Hospital and Shanghai Pudong Hospital from August 2017 to July 2018 were collected in this prospective study. Transcutaneous bilirubin (TcB) was monitored before discharge from hospital. Enrolled neonates were followed up for 28 days. The patients were assigned to neonatal hyperbilirubinemia group (NHB) and non-hyperbilirubinemia group (Non-HB) according to the occurrence of hyperbilirubinemia. The predictive value of models for the risk of hyperbilirubinemia was evaluated by receiver operating characteristic (ROC) curves and Logistic regression analysis.Result:A total of 8 664 newborns were included in this study, with 1 196 cases of hyperbilirubinemia, with an incidence of 13.8%. Logistic regression analysis showed that maternal blood type O, premature rupture of membranes, male gender, gestational age 35~37 weeks, subcutaneous ecchymosis/cranial edema, and breastfeeding were independent risk factors for NHB ( P<0.05). The area under receiver operative characteristic curve (ROC) of predischarge bilirubin risk zone only was 0.874(95% CI 0.861~0.885, P<0.05)and for all independent risk factors was 0.664 (95% CI 0.647~0.680, P<0.05). The area under ROC curve was 0.891 (95% CI 0.880~0.902, P<0.05) by combining predischarge bilirubin risk zone with clinical risk factors. Conclusion:Predischarge bilirubin risk zone combined with clinical risk factors can reasonably predict neonatal hyperbilirubinemia well.

Objective:To explore the current status and influencing factors of knowledge, attitude and practice of nurses in Thoracic Surgery Department on thoracic drainage tube nursing after pneumonectomy, aiming to provide a basis for the training of clinical thoracic surgery specialist nursing personnel.Methods:Using the convenient sampling method, a total of 319 nurses in Henan Province were selected as research objects from August 13 to November 13, 2020, and self-designed questionnaire on knowledge, attitude and practice of thoracic drainage tube nursing after pneumonectomy was used to investigate. A total of 319 questionnaires were issued and 300 valid questionnaires were returned, with an effective recovery rate of 94.04%.Results:The total score of knowledge, attitude and practice of 300 Thoracic Surgery Department nurses on thoracic drainage tube nursing after pneumonectomy and scores of knowledge, attitude and behavior dimensions were respectively (72.09±6.65) , (7.96±2.51) , (26.04±2.24) and (38.09±4.78) . The results of multiple linear regression analysis showed that main influencing factors of nursing knowledge of Thoracic Surgery Department nurses on thoracic drainage tube after pneumonectomy were education level, professional title and position ( P<0.05) . The influential factor of attitude was working years ( P<0.05) . The influencing factors of behavior were knowledge, attitude, position and whether participated a thoracic drainage training or not ( P<0.05) . The influencing factor of total score of knowledge, attitude and practice was professional title ( P<0.05) . Conclusions:Thoracic Surgery Department nurses have a positive attitude towards thoracic drainage tube nursing after pneumonectomy, but their knowledge and behavior level need to be improved. Nursing leaders should carry out thoracic drainage tube nursing training according to the different characteristics of nurses. At the same time, they need to encourage nurses to actively learn new knowledge and constantly update their own knowledge system, so as to change nursing behavior and improve the quality of thoracic surgery.

We constructed bicistronic expression system containing AH6 promoter, 5' UTR and its fore 38 bp sequence from Corynebacterium glutamicum, followed by a conserved Shine-Dalgarno (SD) sequence for xylanase expression. The two major secretory pathways signal peptide in C. glutamicum, Tat (CgR0949) and Sec (CspB) dependent signal peptide were added before xylanase for its secretion. Fed-batch cultivation was done in a 5 L jar for high-level xylanase secretion. The enzyme properties of the purified xylanase were then studied, including the effect of temperature and pH on its activity. The xylanase could be secreted into the culture supernatant when the Sec-dependent signal peptide CspB was used, but none was detected when CgR0949 was used. The secretory production level of xylanase in a flask was 486.2 U/mL and become 1 648.7 U/mL when in a 5 L jar, which was 3.4 fold as in the flask. The optimal pH and temperature of xylanase were pH 4.5 and 45 ℃, respectively. Its activity was 80% of initial activity after pretreatment at 4 ℃ for 24 h at pH 4-11, 95% after incubation below 50 ℃ for 15 min, and 20% when the temperature above 60 ℃. The xylanase could be efficiently secreted into the culture medium by C. glutamicum using its own genetic elements, and the secretion level could be improved through large-scale fed-batch cultivation. This bicistronic expression system can provide a useful tool for heterologous proteins secretion in C. glutamicum. In addition, the catalyze activity of xylanase could be further improved by enzyme properties study.
Corynebacterium glutamicum ; Promoter Regions, Genetic ; Protein Sorting Signals ; Protein Transport