Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To investigate the effect of nuclear factor-erythroid 2-related factor 2 (Nrf2) gene on the proliferation and apoptosis of colorectal adenocarcinoma cells in vitro, and the role of Nrf2 gene in regulation of epithelial-mesenchymal transition (EMT) pathway.Methods:Three Nrf2 small interfering RNA (siRNA) sequences were designed and synthesized, namely siRNA-223, siRNA-538 and siRNA-756, and the unrelated sequences were designed and synthesized. The plasmids carrying various siRNA sequences of Nrf2 were constructed, and the plasmids carrying siRNA sequences and the plasmids carrying unrelated sequences were transfected into human colorectal adenocarcinoma Caco-2 cells, namely interference group and empty vector group, respectively. Additionally, Caco-2 cells without any treatment were used as the control group. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blotting (WB) methods were used to detect the relative expression of Nrf2 gene in transcription and translation levels in each group of cells, in order to verify the interference effect of Nrf2; the siRNA with the best interference effect was selected for subsequent experiments. CCK-8 method was used to detect the proliferation ability of each group of cells (expressed as absorbance value); RT-qPCR was used to detect the relative expression of EMT pathway-related factors [vimentin (Vim), N-cadherin (N-cad) and E-cadherin (E-cad)] in transcription level in each group of cells; WB method was used to detect the expression of pro-apoptotic protein Bax in each group of cells.Results:The results of RT-qPCR and WB methods showed that compared with the control group and the empty group, the relative expression of Nrf2 gene in transcription and translation levels in Caco-2 cells of the siRNA-756 interference group were the lowest, and the differences were statistically significant (all P < 0.05). The CCK-8 results showed that the absorbance values of Caco-2 cells in the control group, empty group and siRNA-756 interference group after 48 hours of culture were (100±5)%, (94±4)% and (82±5)%, respectively; compared with the control group and the empty group, the siRNA-756 interference group had lower absorbance value, and the differences were statistically significant (all P < 0.05). The results of RT-qPCR method showed that the relative expression of Vim and N-cad in transcription level in the siRNA-756 interference group were higher than those in the control group and the empty vector group, and the differences were statistically significant (all P < 0.05); the relative expression of E-cad in transcription level was lower than those in the control group and the empty vector group, and the differences were statistically significant (both P < 0.05). The results of WB method showed that the relative expression of Bax protein in the siRNA-756 interference group was higher than that in the control group, and the difference was statistically significant ( P < 0.05). Conclusions:Interference with Nrf2 expression in vitro can weaken the proliferation and anti-apoptotic abilities of human colorectal adenocarcinoma Caco-2 cells. The mechanism may be that Nrf2 regulates the expression of Vim, N-cad and E-Cad in the EMT pathway to enhance the EMT ability of tumor cells.

Objective:To understand the thyroid function of the physical examination population in Tangshan area, and analyze the effects of thyroid function on blood lipids, fasting blood glucose (FPG), and serum 25 hydroxyvitamin D [25(OH)D].Methods:A population from the Tangshan area who underwent physical examinations at the Kailuan General Hospital from June 2020 to June 2021 was selected as the study subjects and the levels of their thyroid serological indicators [thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (TT3), and thyroid hormone (TT4)] were tested. According to thyroid function, they were divided into normal group, hyperthyroidism group, hypothyroidism group, subclinical hyperthyroidism group, and subclinical hypothyroidism group. We compared the blood lipid indicators [triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], FPG, and 25(OH)D levels in different subgroups, and the Pearson correlation analysis was used to investigate the correlation between TSH levels and blood lipids, FPG, and 25(OH)D levels.Results:In this study, 2 884 subjects were selected from the physical examination population in Tangshan area. The proportion of people with abnormal thyroid function was 12.03%(347/2 884), among which the proportion of subclinical thyroid function abnormal population in the total thyroid function abnormal population was 80.69%(280/347). As men age, the proportion of thyroid dysfunction in the age groups of 21-<30 years old, 30-<40 years old, 40-<50 years old, and ≥50 years old was 5.06%(4/79), 7.52%(33/439), 8.91%(53/595), and 9.95%(66/663), respectively. The proportion of thyroid dysfunction in the above age group of women was 14.02%(15/107), 15.06%(61/405), 15.47%(67/433), and 29.45%(48/163). The serum TG, TC, LDL-C, and 25(OH)D levels in the hyperthyroidism group were lower than those in the normal group, while HDL-C and FPG levels were higher than those in the normal group, with statistically significant differences (all P<0.05). The serum TG and TC in the hypothyroidism group were higher than those in the normal group, while FPG and 25(OH)D were lower than those in the normal group, with statistically significant differences (all P<0.05). TSH levels were positively correlated with TC and LDL-C, while negatively correlated with FPG and 25(OH)D (all P<0.05). Conclusions:Subclinical thyroid dysfunction is the main cause of thyroid dysfunction in the Tangshan area, and TSH levels are correlated with blood lipids, fasting blood glucose, and serum 25(OH)D levels.

Progressing vasopressor-refractory hypotension is a major contributor to the high mortality of septic shock.The effect of corticosteroids on peripheral vascular circulation recovery and immune modulation is crucial to the survival of patients with septic shock .However, despite more than fifty years of animal experiments and human trials, the role of corticosteroid therapy in septic shock , its proper applications including dosage, duration and withdrawal remain uncertain and controversial .This paper reviews the development of research , the mechanism, application, and the future direction of low-dose glucocorticoids in the treatment of septic shock .

ObjectiveTo discuss the role of neuronavigaition technique in localizing and facilliating microsurgical resection of intracranial ateriovenous malformations (AVM) .Methods Forty-three cases with intracranial AVM treated microneurosurgically asisting by Stryker Leibinger neuronavigation system were retrospectively analyzed.Results After reaching neuronavigation calculated technical accuracy (less than 2 mm) and continual intraoperative navigating accuracy, all of the 43 AVM lesions were completely resected.In 41 patients, syptoms were significantly improved (95.4％) at discharge, new neurofuntion defection were found in 2 patients(4.6％) , no death occured.ConclusionNeuronavigation techniques helps the surgery in planning a precise surgical approach to the targeted AVM lesion and tracing the neurovascular structures ,improves the safety of the surgery and the functional outcome of the patients, contribute to lesion resection and reduce operative complications.

Objective To describe MR findings in inflammatory myofibroblastic tumor(IMT)of the soft tissue.Methods MR manifestations of 11 cases of IMT of the soft tissue were retrospectively analyzed,and the MR findings were correlated with surgical and histological results.Results The pathological classification of the tumors was type Ⅰ in 1 case,type Ⅱ in 4 cases.mainly type Ⅱ admixed with type Ⅰ in 3 cases,and mainly type Ⅱ admixed with type Ⅲ in 3 cases.In 4 cases with primary tumor,the tumors were spheroid in shape,with well-defined margin and pseudocapsule.In 2 cases with primary axillary tumor and 5 cases with recurrent tumor,the tumors were irregular in shape,with ill-defined margin and invasion of adjacent structures.The tumors were mainly isointensive in T1-weighted images.Tumors of different pathological classifications had different signal intensities in T2-weighted images:1 case of type Ⅰ tumor was bright:4 cases of type Ⅱ tumor and 3 cases of type Ⅱ tumor admixed with type Ⅰ tumor were slig}ltly bright;3 cases of type Ⅱ tumor admixed with type Ⅲ were isointense or slightly hypointense in signal.All of the 11 eases in the study exhibited"pitaya cross-section sign"in T2-weighted sequence,which referred to discrete punctuate foci of relatively hypointensity in the background of hyperintensity,slightly hypointensity or isointensity.All of the 11 cases exhibited inhomogeneously significant enhancement after gadolinium administration.In the follow-up of the 6 cases of primary tumor,4 cases had recurrence,1 case had no recurrence,and 1 ease was lost in the follow-up process.In the follow-up of the 5 cases of recurrent tumor,4 cases showed recurrence again,and 3 cases were lost in the follow-up process.Conclusions The IMT of the soft tissue has characteristic MR features.The signal intensity of the tumor on T2-weighted sequence could reflect the pathological type of the tumor to some extent."pitaya cross-section sign"could be a pathogenomic sign of the IMT of the soft tissue.

Objects To assess the effect of BMP(bone morphogenetic protein) in orthotopit grafting with an autogenous cranial bone flap in cranioplasty.Methods 45 cases (48 locations ) have been reconstructed by orthotopic repair with autogenous bone flap, it has been divided into two group;26 locations of them using porous autogenous bone flap plus BMP (group Ⅰ), 22 locations of them only using porous autogenous bone flap(group Ⅱ), All cases have been closely followed up for 1～2 years with X-ray and CT , including postoperative complications, absorption or regeneration of the bone flap. Results No flexible with the porous autogenous bone flap was seen , and the appearance was perfectly. The bone graft survival and besetting apposition were all right. The gap disappears gradually. It is obvious that the osteotylus come into being. The density of bone flap was normal in group Ⅰ. 5 cases in group Ⅱ have shown that bone partial absorption occurred and the density reducing in the center of the flaps,and with the significant difference. Conclusions The local application of BMP can avoid bone flap absorption and stimulate osteotylus morphofogenesis.