OBJECTIVE: Recombination events are common and serve as the primary driving force of diverse human adenovirus (HAdV), particularly in children with acute respiratory tract infections (ARIs). Therefore, continual monitoring of these events is essential for effective viral surveillance and control. METHODS: Respiratory specimens were collected from children with ARIs between January 2022 and December 2023. The penton base, hexon, and fiber genes were amplified from HAdV-positive specimens and sequenced to determine the virus type. In cases with inconsistent typing results, genes were cloned into the pGEM-T vector to detect recombination events. Metagenomic next-generation sequencing (mNGS) was performed to characterize the recombinant HAdV genomes. RESULTS: Among 6,771 specimens, 277 (4.09%, 277/6,771) were positvie for HAdV, of which 157 (56.68%, 157/277) were successfully typed, with HAdV-B3 being the dominant type (91.08%, 143/157), and 14 (5.05%, 14/277) exhibited inconsistent typing results, six of which belonged to species B. The penton base genes of these six specimens were classified as HAdV-B7, whereas their hexon and fiber genes were classified as HAdV-B3, resulting in a recombinant genotype designated P7H3F3, which closely resembled HAdV-B114. Additionally, a partial gene encoding L1 52/55 kD was identified, which originated from HAdV-B16. CONCLUSION A novel recombinant, P7H3F3, was identified, containing sequences derived from HAdV-B3 and HAdV-B7, which is similar to HAdV-B114, along with additional sequences from HAdV-B16.
Humans ; Adenoviruses, Human/isolation & purification* ; Respiratory Tract Infections/epidemiology* ; Child, Preschool ; Child ; Recombination, Genetic ; Male ; Beijing/epidemiology* ; Infant ; Female ; Phylogeny ; Adenovirus Infections, Human/epidemiology* ; Acute Disease ; Genome, Viral

Objective To investigate the key factors influencing the implementation of long-acting injection-promoting policies and propose effective improving paths.Methods Qualitative interviews were carried out for stakeholders involved in the promotion of long-acting injections,based on the consolidated framework for implementation research.Additionally,countermeasures for identified barriers were proposed based on expert recommendations for implementation changes.Results A total of 46 health administrators,healthcare workers,and patients in Beijing were interviewed.The study identified several barriers in the strength and quality of evidence,adaptability,relative advantage,complexity and cost,patient needs and resources,external collaboration,external policies and incentives,organizational structural characteristics,and self-efficacy.Conclusions From the perspectives and experiences of stakeholders,the promotion of long-acting injections has shown initial success but still faces multiple obstacles.It is recommended that efforts should be made to coordinate and adapt policies,improve and incentivize relative organizations,and continuously strengthen the advocacy and education for individuals.
Humans ; Beijing ; Delayed-Action Preparations ; Health Personnel ; Health Policy ; Injections

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective To analyze the effects of irbesartan(IBN)regulating the stromal cell-derived factor-1(SDF-1)/CXC chemokine receptor 4(CXCR4)pathway on proliferation,migration,and radiosensitivity of lung cancer cells.Methods Human lung cancer A549 cells were randomly divided into the A549 group(without treatment),radiation group(4 Gy X-ray radiation),IBN group(1 μmol/L IBN treatment for 24 hours),IBN+radiation group(1 μmol/L IBN treatment for 24 hours+4 Gy X-ray radiation),pcDNA3.1 group(transfected with pcDNA3.1+1 μmol/L IBN treatment for 24 hours+4 Gy X-ray radiation),and SDF-1 group(transfected with pcDNA3.1 SDF-1+1 μmol/L IBN treatment for 24 hours+4 Gy X-ray radiation).The cell viability,colony formation,apoptosis,and migration of each group were observed.The leakage rate of lactate dehydrogenase(LDH)and Ang Ⅱ levels in cells were detected.Immunofluorescence method was applied to analyze the number of γH2AX focal points of cells in each group.Western blot was applied to detect the expression of proliferation and apoptosis related proteins and SDF-1/CXCR4 pathway related proteins.Results Both radiation and IBN treatment inhibited the proliferation and migration of A549 cells,promoted cell apoptosis,upregulated the number of γH2AX focal points and LDH leakage rate,upregulated the expression of Caspase-3,Bax,and Caspase-7,and downregulated the level of Ang Ⅱand expression of SDF-1,CXCR4,Bcl-2 and PCNA(P<0.05).The combined treatment of radiation and IBN further enhanced the changes of the above indicators(P<0.05).And SDF-1 treat-ment effectively reversed the effects of radiation and IBN treatment on the changes of the above indicators(P<0.05).Conclusion IBN can limit proliferation and migration of lung cancer cells,and increase radiosensitivity by inhibiting the SDF-1/CXCR4 pathway.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

BACKGROUND:Lumbar disc degeneration is a common disease that causes lower back pain and lower limb neurological symptoms.The balance of collagen metabolism plays an important role in maintaining the stability of the intervertebral discs.OBJECTIVE:To review the research progress in the imbalance of collagen metabolism in intervertebral disc degeneration.METHODS:The first author searched for relevant literature published before May 2024 in CNKI,PubMed and Web of Science databases.Search terms were"degenerative disc disease,""collagen metabolism,""collagenase family,""collagen synthesis related factors,"and"collagen breakdown related factors"in Chinese and English.Seventy-six articles were finally included for review.RESULTS AND CONCLUSION:In the process of intervertebral disc degeneration,the balance of collagen metabolism plays a crucial role in maintaining the stability of the normal intervertebral disc.When intervertebral disc degeneration occurs,a large amount of pro-inflammatory factors,collagenase,and oxidative stress reactions occur in the intervertebral disc,which increases the breakdown of collagen in the intervertebral disc.At the same time,it inhibits the generation of growth factors,collagen synthase,and collagen synthesis-related factors,resulting in a decrease in collagen synthesis in the intervertebral disc.The combined effect of the above two conditions disrupts the balance of collagen metabolism in the intervertebral disc,further exacerbating the process of intervertebral disc degeneration.

Objective:To investigate the impact of postoperative complications on adverse outcomes following curative-intent resection for gallbladder cancer (GBC).Methods:The multi-center real-world study was conducted. The clinicopathological data of 629 patients with GBC, who were admitted to 14 medical centers including The First Affiliated Hospital of Army Medical University from the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, from April 2020 to April 2024 were collected. There were 225 males and 404 females, aged (64±10)years. Patients underwent open curative-intent resection for GBC. Observation indicators: (1)surgery, postoperative complica-tions and adverse outcomes; (2) analysis of risk factors affecting postoperative adverse outcomes in patients and population attributable fraction (PAF). Missing data in predictor variables were addressed using multiple imputation with chained equations, while cases with missing outcome variables were addressed using the "multiple imputation then deletion (MID)" strategy. The severity of multicollinearity among independent variables was assessed using the variance inflation factor (VIF) test. Multivariable possion regression models with log link and robust error variance were construc-ted incorporating restricted cubic splines (3 knots) to address nonlinear relationships in continuous variables, calculating adjusted relative risk ( RR) with corresponding 95% confidence interval ( CI). Adjusted PAF was calculated for each imputed dataset using the AF package of R software, with subsequent pooling performed according to Rubin's rules. Results:(1) Surgery, postoperative complications and adverse outcomes. All 629 patients underwent curative-intent resection for GBC, of which 143 cases had postoperative complications, including 68 cases of intra-abdominal ascites, 39 cases of pulmonary infection, 21 cases of bile leakage, 12 cases of intra-abdominal hemorrhage, 11 cases of liver failure, 10 cases of pan-creatic fistula, 10 cases of wound infection, 10 cases of gastroparesis, 7 cases of cholangitis, 7 cases of sepsis. The same patient could have more than one kind of complication. Of 629 patients, there were 19 cases of postoperative 90-day death and 11 cases of missing data, 42 cases with post-operative 90-day reoperation and 7 cases with missing data, 44 cases with postoperative 90-day readmission and 3 cases with missing data, 155 cases with prolonged postoperative hospital stay and 3 cases with missing data. (2) Analysis of risk factors affecting the postoperative adverse outcomes in patients and PAF. Results of multivariate analysis showed that pulmonary infection and liver failure were independent risk factors for postoperative 90-day mortality ( RR=3.74, 12.15, 95% CI as 1.18-11.83, 1.98-74.48, P<0.05). Pulmonary infection demons-trated the highest PAF as 4.61% (95% CI as 3.94%-5.28%, P<0.05). Intra-abdominal ascites, pulmonary infection, bile leakage, and intra-abdominal hemorrhage were independent risk factors for post-operative 90-day reoperation ( RR=4.80, 3.62, 3.46, 4.99, 95% CI as 2.49-9.26, 1.42-9.21, 1.34-8.92, 1.55-16.06, P<0.05). Intra-abdominal ascites demonstrated the highest PAF as 8.65% (95% CI as 8.22%-9.08%, P<0.05). Intra-abdominal ascites, bile leakage, and liver failure were independent risk factors for postoperative 90-day readmission ( RR=6.20, 3.33, 14.33, 95% CI as 3.21-11.95, 1.33-8.35, 3.72-55.28, P<0.05). Intra-abdominal ascites demonstrated the highest PAF as 9.11% (95% CI as 8.85%-9.37%, P<0.05). Intra-abdominal ascites, pulmonary infection, bile leakage, liver failure, and wound infection were independent risk factors for prolonged postoperative hospital stay ( RR=2.29, 2.21, 2.26, 2.14, 3.35, 95% CI as 1.63-3.23, 1.41-3.46, 1.32-3.86, 1.11-4.13, 1.70-6.60, P<0.05). Intra-abdominal ascites demonstrated the highest PAF as 6.03% (95% CI as 5.71%-6.35%, P<0.05). Conclusion:Pulmonary infection is the most significant risk factor for postoperative 90-day mortality after curative-intent resection for GBC, while intra-abdominal ascites is the most significant risk factor for postoperative 90-day reoperation, postoperative 90-day readmission, and prolonged postoperative hospital stay.

Objective Build a predictive model integrating radiomics features with clinical characteristics for the prognosis prediction of acute anterior circulation large vessel occlusion(LVO)stroke patients after mechanical thrombectomy(MT),and explore its predictive value.Methods Patients with acute ischemic stroke who underwent endovascular treatment for LVO of the anterior circulation were enrolled consecutively from the endovascular treatment registry database for acute anterior circulation ischemic stroke(ACTUAL)and the Nanjing stroke registry system from January 2014 to January 2025 retrospectively.Baseline,clinical and imaging data were collected from enrolled patients,including gender,age,medical history(atrial fibrillation,hypertension,diabetes),smoke history,admission blood pressure,blood glucose,National Institutes of Health stroke scale(NIHSS)score,Alberta stroke program early CT score(ASPECTS),occluded blood vessels(internal carotid artery,middle cerebral artery),trial of Org 10172 in acute stroke treatment(TOAST)classification(atherosclerotic,cardiogenic embolism,others),collateral status(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASITN/SIR]classification),the onset-to-door time,the time from onset to puncture,the operation time,the time from onset to recanalization,recanalization status(modified thrombolysis in cerebral infarction[mTICI]score),symptomatic intracerebral hemorrhage(sICH)within 72 hours after MT and functional outcome at 90 days post-MT(modified Rankin scale[mRS]score).Divide all patients into a training set and a validation set in a ratio of 7∶3.The training set is used to build the predictive model,and the validation set is used to verify the predictive model.In the training set,patients were divided into a good prognosis group(mRS score 0-2)and a poor prognosis group(mRS score 3-6),the variables with P＜0.05 from the univariate Logistic regression analysis were enrolled into the multivariate Logistic regression analysis to screen the clinical risk factors affecting prognosis.The preoperative head MR axial diffusion weighted imaging sequence images of patients in the training set were selected.The Pyradiomics toolkit of the Python 3.6 platform was used to implement radiomics feature extraction.After conducting consistency analysis on the extracted features,standardization processing was performed.In the training set,feature dimension reduction is carried out on the radiomics feature values obtained after extraction and processing.The least absolute shrinkage and selection operator(LASSO)model was used to screen the features.The support vector machine(SVM),k-nearest neighbor,lightweight gradient boosting algorithm,random forest method and extreme gradient boosting algorithm are used to respectively construct models based on the screened radiomics features,use grid search with cross validation(GridSearchCV)to gain specific parameters in each model.The receiver operating characteristic(ROC)curve was used to analyze and compare the area under the curve(AUC)of each radiomics model,screen the most suitable radiomics model,and verify it in the validation set.The predicted probability value of prognosis calculated by this model is taken as the radiomics score.In the training set,the radiomics scores and the screened clinical risk factors were taken as independent variables,and a multivariate Logistic regression analysis was conducted.A nomogram was used to construct a comprehensive prediction model of radiomics plus clinical factors for predicting the prognosis of MT in acute stroke patients of LVO.The AUC of the clinical factor prediction model,the radiomics prediction model,and the radiomics plus clinical factor comprehensive prediction model were compared in the training set and the validation set,respectively.Results A total of 107 acute anterior LVO patients who underwent MT were included,comprising 72 males and 35 females,aged 27 to 87 years,with a median age of 64(56,71)years.There were 74 cases in the training set,among which 48 cases had a good prognosis and 26 cases had a poor prognosis.There were 33 cases in the validation set,among which 24 cases had a good prognosis and 9 cases had a poor prognosis.The NIHSS score of patients in the training set was lower than that of patients in the validation set(12[8,19]points vs.15[11,21]points,P=0.03),while there were no statistically significant differences in the remaining baseline,clinical and imaging data compared with the validation set(all P＞0.05).(1)Included the variables with P＜0.05 from the univariate Logistic regression analysis into the multivariate Logistic regression analysis.The results showed that age(OR,1.066,95％CI 1.003-1.133,P=0.039)and admission NIHSS score(OR,1.126,95％CI 1.028-1.233,P=0.011)were independent risk factors for poor prognosis of MT in patients with acute anterior circulation LVO stroke.(2)A total of 725 radiomics features were extracted.The results of intra-observer consistency analysis showed that the median intraclass correlation coefficient(ICC)of radiomics features was 0.75(0.56,0.87),and there were 424 features with ICC＞0.7 and 127 features with ICC＞0.9.The results of the inter-observer consistency analysis showed that the median ICC of radiomics features was 0.73(0.53,0.86).After dimensionality reduction using the LASSO,12 most relevant features were selected and incorporated into the radiomics-based prognostic model.The AUCs of the radiomics prediction models constructed by applying SVM,k-nearest neighbor,lightweight gradient boosting algorithm,random forest method and extreme gradient boosting algorithm were 0.803,0.890,0.969,1.000 and 1.000,respectively.The AUCs in the validation set were 0.769,0.743,0.817,0.792 and 0.799,respectively.SVM was selected as the final algorithm for the construction of the radiomics model.The radiomics data were input into SVM to obtain the radiomics score of each patient.(3)A comprehensive predictive nomogram model combining radiomics and clinical factors was constructed based on radiomics score,age,and the NIHSS score at admission.In the validation group,the integrated model demonstrated a significantly higher AUC-ROC(0.918,95％CI 0.831-0.969)compared to the radiomics model(AUC 0.803,95％CI0.694-0.886,P=0.026)and the clinical-feature model(AUC 0.784,95％CI0.674-0.872,P=0.009).In the validation set,there were no statistically significant difference among the integrated model(AUC 0.935,95％CI 0.792-0.991),radiomics model(AUC 0.769,95％CI 0.589-0.897,P=0.111)and the clinical-feature model(AUC 0.894,95％CI 0.737-0.974,P=0.602).The integrated model exhibited good calibration in both the training set and the validation set(Hosmer-Lemeshow test,P values were respectively 0.350,0.580).Conclusion The integrated radiomics-clinical model can provide effective prediction of MT on outcomes in acute anterior circulation LVO stroke patients,and it may offer an objective basis for clinical decision-making.

Objective To investigate programmed death including necroptosis,apoptosis,autophagy,ferroptosis,and pyroptosis in bone marrow megakaryocytes of mice during sepsis and its impact on platelet production capacity and coagulation function in mice.Methods C57BL/6J mice were randomly divided into a sham operation group(sham group)and a sepsis model group(CLP group).Peripheral blood platelets and coagulation function were measured by abdominal aortic blood sampling at 24 h postoperatively in both sham and CLP groups.After the mice were sacrificed,long bones of both lower limbs were taken,and bone marrow megakaryocytes were extracted using megakaryocyte separation solution and immunomagnetic bead separation.Laser confocal microscopy was used to observe the activation of programmed death-related marker molecules in mouse bone marrow megakaryocytes.Flow cytometry was used to detect programmed death rate,platelet production phenotype,and platelet surface markers(CD41,CD42b,CD61)of megakaryocytes.Western blotting was used to detect the expression of programmed death-related proteins in megakaryocytes.Results Compared with the sham group,the CLP group showed significant decreases in the number of platelets during acute sepsis(24 h)(P<0.000 1),significant increases in platelet distri-bution width(PDW)and mean platelet volume(MPV)(P<0.01),significant prolonging of thrombin time(TT),prothrombin time(PT),and activated partial thromboplastin time(APTT)(P<0.000 1,P<0.001,P<0.01),and significant reduction in fibrinogen(Fib)(P<0.000 1).Compared with the Con/sham group,the LPS/CLP group exhibited significant increases in the platelet production phenotype of megakaryocyte,the number of PLP in the supernatant,and the expression levels of platelet surface markers(CD41,CD42b,CD61).The rates of megakaryocyte necroptosis/apoptosis,pyroptosis,and ferroptosis were significantly elevated at 24 h post-CLP surgery.Laser confo-cal microscopy showed significant activation of LC3,P-MLKL,Caspase-1,and Fe2+in megakaryocytes of mice after CLP surgery.Western blotting results revealed that the CLP group exhibited a significant increase in the activa-tion rate of necroptosis-related protein P-MLKL(P<0.001),a significant increase in the cleavage of pyroptosis-related proteins GSDMD and GSDMD-N(P<0.01,P<0.001,respectively),a significant increase in the expres-sion of ferroptosis-related protein ACSL4(P<0.01),and a significant decrease in the expression of GPX4(P<0.01)compared to the sham group.Additionally,the CLP group demonstrated significant increases in the expression of apoptosis-related protein Bax,the cleavage of autophagy-related protein LC3B-Ⅱ,and the expression of P62(P<0.05,P<0.001,P<0.001,respectively).Inhibition of apoptosis with programmed cell death inhibitors decreased platelet production function of megakaryocyte,while inhibition of necroptosis and pyroptosis had limited effects on platelet production function of megakaryocyte.Inhibition of ferroptosis and autophagy enhanced platelet production function of megakaryocyte.Conclusion Significant programmed death of megakaryocytes was observed during the acute phase of sepsis(24 h).Among those megakaryocytes,apoptosis is an important mechanism for the differentia-tion of platelet production phenotype and increased platelet production capacity of megakaryocyte.Overactive autophagy and ferroptosis in megakaryocytes lead to megakaryocyte dysfunction,which is an important mechanism for coagulation abnormalities in sepsis.