ObjectiveTo identify and clarify the key issues faced by tertiary hospitals in responding to public health emergencies. MethodsA literature review index system was constructed， and key issues were identified using hierarchical analysis. ResultsAfter a systematic literature review， 20 types of problems faced by tertiary hospitals in responding to public health emergencies were identified. Three key issues were ultimately identified by prioritizing the issues that needed to be addressed. ConclusionThe key issues of tertiary hospitals in responding to public health emergencies are concentrated in the areas of emergency response capabilities and competencies of medical staff， the number of emergency response personnel， and the standardization and specificity of training and drills. Tertiary hospitals should focus on these issues in developing public health emergency response systems to improve the effectiveness of their emergency response.

ObjectiveTo identify the key issues in emergency response to public health emergencies in the Yangtze River Delta region， and to provide a basis for the formulation of relevant policies. MethodLiterature on emergency response to public health emergencies in the Yangtze River Delta region was systematically reviewed and collected， and 18 main problems were identified after collecting and organizing the problems. A questionnaire survey and cluster analysis were used to identify the key issues. ResultsThe study of 18 major problems revealed that "insufficient reserve of emergency medical supplies"， "insufficient financial investment to meet the needs of emergency response"， "lack of a sound mechanism for the deployment of supplies， resulting in the untimely deployment of materials"， were the key issues of emergency response to public health emergencies in the Yangtze River Delta region. ConclusionFuture development of the emergency response system in the Yangtze River Delta region should focus on accelerating the integration process of the Yangtze River Delta， establishing and improving information systems， optimizing the material storage and deployment network， prioritizing the fund investment and utilization mechanism， and improving the effectiveness of public health emergency response.

Objective To summarize our experience and the early and midterm outcomes of stented elephant trunk procedure for right-sided aortic arch (RAA) with Kommerell's diverticulum (KD). Methods From April 2013 to July 2020, patients with RAA and KD who underwent stented elephant trunk procedure at our center were collected. Surgery was performed under moderate hypothermic circulatory arrest combined with selective antegrade cerebral perfusion via median sternotomy. Results A total of 8 patients were included, including 7 males and 1 female with a mean age of 51.88±9.61 years. All patients had an aneurysmal KD and aberrant left subclavian artery. Preoperative comorbidities included acute Stanford type B aortic dissection in 1 patient, aortic arch pseudoaneurysm in 1 patient, acute type B intramural hematoma in 2 patients, and coronary artery disease in 1 patient. Concomitant procedures included reconstruction of the left subclavian artery in all patients and coronary artery bypass grafting in 1 patient. The mean time of operation, cardiopulmonary bypass, aortic cross-clamping, and selective cerebral perfusion was 6.25±1.16 h, 157.75±40.07 min, 77.75±33.10 min, and 28.50±5.55 min, respectively. No intraoperative death occurred. There was 1 in-hospital death. Follow-up was completed in all patients with a mean period of 3.58±2.08 years. No late death occurred. A persistent anastomotic leak of the proximal arch was detected in 1 patient, but reintervention was not performed because neither aortic dilatation nor symptoms of tracheal and esophageal compression were observed during the follow-up. The remaining 6 patients showed positive aortic remodeling with complete thrombosis of the aneurysmal KD, and neither aortic event nor tracheal and esophageal compression occurred. Conclusion Stented elephant trunk procedure is a safe and feasible technique for selected patients with RAA and KD, which can achieve favorable early and midterm outcomes.

OBJECTIVE To investigate the intervention effect and mechanism of Wuwei baogan pill on mice with non- alcoholic fatty liver disease （NAFLD）. METHODS The mice were given high-fat and high-sugar diet for 19 weeks to induce NAFLD model. The model mice were randomly grouped into model group， positive control group （polyene phosphatidylcholine capsules， 23.30 mg/kg）， Wuwei baogan pill low-dose， medium-dose and high-dose groups （0.11， 0.23， 0.45 g/kg）， with 8 mice in each group； the normal group was additionally set up without modeling. Administration groups were given relevant medicine intragastrically， and model group and normal group were given constant volume of normal saline， once a day， for consecutive 4 weeks. After the last administration， glucose metabolism （including fasting blood glucose， fasting insulin， insulin resistance index）， liver function [liver index， alanine aminotransferase （ALT）， aspartate aminotransferase （AST），liver tissue pathological score]， lipid metabolism [triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， and high- density lipoprotein cholesterol （HDL-C）] were measured； the pathological morphology of liver tissue， as well as fibrosis， lipid droplet formation， and glycogen synthesis were observed； the levels of free fatty acid （FFA） in serum and inflammatory factors in liver tissue [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and IL-1β] were detected； the expressions of insulin receptor substrate/phosphoinositide 3-kinase/protein kinase B/ glycogen synthase kinase 3β （IRS/PI3K/AKT/GSK3β） signaling pathway-related protein in liver tissue were investigated. RESULTS After intervention with high-dose Wuwei baogan pill， liver index of NAFLD mice， serum levels of ALT， AST， FFA， TC， TG and LDL-C， the levels of TNF-α， IL-6 and IL-1β in liver tissue， fasting blood glucose， fasting insulin， insulin resistance index， liver tissue pathological score， proportions of fibrotic staining area and lipid droplet staining area all significantly decreased （P＜0.05）； the level of HDL-C， proportion of glycogen staining area， the phosphorylation of IRS1， PI3K， AKT and GSK3β protein increased significantly （P＜0.05）； the degree of liver cell necrosis and steatosis was reduced， and the fibrotic lesions were alleviated. The above indexes of mice were improved in Wuwei baogan pill low-dose and medium-dose groups， but there was no statistically significant difference in some indexes. CONCLUSIONS Wuwei baogan pill can regulate lipid and glucose metabolism disorders in the liver of NAFLD mice， and improve liver injury， the mechanism of which may be associated with the activation of IRS/PI3K/AKT/GSK3β signaling pathway.

OBJECTIVE To investigate the intervention effect and mechanism of Wuwei baogan pill on mice with non- alcoholic fatty liver disease （NAFLD）. METHODS The mice were given high-fat and high-sugar diet for 19 weeks to induce NAFLD model. The model mice were randomly grouped into model group， positive control group （polyene phosphatidylcholine capsules， 23.30 mg/kg）， Wuwei baogan pill low-dose， medium-dose and high-dose groups （0.11， 0.23， 0.45 g/kg）， with 8 mice in each group； the normal group was additionally set up without modeling. Administration groups were given relevant medicine intragastrically， and model group and normal group were given constant volume of normal saline， once a day， for consecutive 4 weeks. After the last administration， glucose metabolism （including fasting blood glucose， fasting insulin， insulin resistance index）， liver function [liver index， alanine aminotransferase （ALT）， aspartate aminotransferase （AST），liver tissue pathological score]， lipid metabolism [triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， and high- density lipoprotein cholesterol （HDL-C）] were measured； the pathological morphology of liver tissue， as well as fibrosis， lipid droplet formation， and glycogen synthesis were observed； the levels of free fatty acid （FFA） in serum and inflammatory factors in liver tissue [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and IL-1β] were detected； the expressions of insulin receptor substrate/phosphoinositide 3-kinase/protein kinase B/ glycogen synthase kinase 3β （IRS/PI3K/AKT/GSK3β） signaling pathway-related protein in liver tissue were investigated. RESULTS After intervention with high-dose Wuwei baogan pill， liver index of NAFLD mice， serum levels of ALT， AST， FFA， TC， TG and LDL-C， the levels of TNF-α， IL-6 and IL-1β in liver tissue， fasting blood glucose， fasting insulin， insulin resistance index， liver tissue pathological score， proportions of fibrotic staining area and lipid droplet staining area all significantly decreased （P＜0.05）； the level of HDL-C， proportion of glycogen staining area， the phosphorylation of IRS1， PI3K， AKT and GSK3β protein increased significantly （P＜0.05）； the degree of liver cell necrosis and steatosis was reduced， and the fibrotic lesions were alleviated. The above indexes of mice were improved in Wuwei baogan pill low-dose and medium-dose groups， but there was no statistically significant difference in some indexes. CONCLUSIONS Wuwei baogan pill can regulate lipid and glucose metabolism disorders in the liver of NAFLD mice， and improve liver injury， the mechanism of which may be associated with the activation of IRS/PI3K/AKT/GSK3β signaling pathway.

Objective To establish a hybrid deep learning lung sound classification model based on convolutional neural network(CNN)-long short-term memory(LSTM)for electronic auscultation.Methods Wavelet transform was used to extract features from the dataset,transforming lung sound signals into energy entropy,peak value and other features.On this basis,a classification model based on hybrid algorithm incorporating CNN and LSTM neural network was constructed.The features extracted by wavelet transform were input into CNN module to obtain the spatial features of the data,and then the temporal features were detected through LSTM module.The fusion of the two types of features enabled the classification of lung sounds through the model,thereby assisting in the diagnosis of pulmonary diseases.Results The accuracy rate and F1 score of CNN-LSTM hybrid model were significantly higher than those of other single models,reaching 0.948 and 0.950.Conclusion The proposed CNN-LSTM hybrid model demonstrates higher accuracy and more precise classification,showcasing broad potential application value in intelligent auscultation.

Objective To propose a method for mitigate the impact of anomaly points(such as dust,bubbles,scratches on the chip surface,and minor indentations)in images on the results of digital droplet PCR(ddPCR)detection to achieve high-throughput,stable,and accurate detection.Methods We propose a Filter Faster R-CNN ddPCR detection model,which employs Faster R-CNN to generate droplet prediction boxes followed by removing the anomalies within the positive droplet prediction boxes using an outlier filtering module(Filter).Using a plasmid carrying a norovirus fragment as the template,we established a ddPCR dataset for model training(2462 instances,78.56%)and testing(672 instances,21.44%).Ablation experiments were performed to test the effectiveness of 3 filtering branches of the Filter for anomaly removal on the validation dataset.Comparative experiments with other ddPCR droplet detection models and absolute quantification experiments of ddPCR were conducted to assess the performance of the Filter Faster R-CNN model.Results In low-dust and dusty environments,the Filter Faster R-CNN model achieved detection accuracies of 98.23%and 88.35%for positive droplets,respectively,with composite F1 scores reaching 99.15%and 99.14%,obviously superior to the other models.The introduction of the filtering module significantly enhanced the positive accuracy of the model in dusty environments.In the absolute quantification experiments,a regression line was plotted using the results from commercial flow cytometry equipment as the standard concentration.The results show a regression line slope of 1.0005,an intercept of-0.025,and a determination coefficient of 0.9997,indicating high consistency between the two results.Conclusion The ddPCR detection technique using the Filter Faster R-CNN model provides a robust detection method for ddPCR under various environmental conditions.

Objective:To assess the effectiveness and feasibility of carrier detection for Spinal muscular atrophy (SMA) by using digital PCR assay.Methods:Peripheral blood samples were collected from 214 pregnant women who were routinely screened for SMA carriers, of which 204 were randomly selected samples and 10 were samples with known copy numbers of SMN1 exons 7 and 8. Samples with known copy numbers of SMN1 exons 7 and 8 were randomly mixed into the experiment to validate the performance of the digital PCR assay. The copy numbers of SMN1 exons 7 and 8 and SMN2 exons 7 and 8 in peripheral blood samples were detected by digital PCR assay. The results of SMN1 exons 7 and 8 were compared with those of the quantitative PCR method to assess the reliability and clinical performance of the digital PCR assay. Results:Among the 204 random samples, digital PCR has detected five samples with simultaneous heterozygous deletion of SMN1 exons 7 and 8, three samples with heterozygous deletion of SMN1 exon 8 only, and 196 samples with no deletion of SMN1 exons 7 and 8. Ten samples with known SMN1 exons 7 and 8 copy numbers were detected with the expected values. The digital PCR test results were fully consistent with that of the quantitative PCR. Conclusion:The results of digital PCR for the detection of copy number variation of SMN1 exons 7 and 8 were consistent with qPCR. Digital PCR assay was able to clearly distinguish the copy number of the target genes, therefore can be used for SMA carrier screening. Moreover, it can also detect copy number of SMN2 exons 7 and 8, which can provide more information for genetic counseling.

Objective To propose a method for mitigate the impact of anomaly points(such as dust,bubbles,scratches on the chip surface,and minor indentations)in images on the results of digital droplet PCR(ddPCR)detection to achieve high-throughput,stable,and accurate detection.Methods We propose a Filter Faster R-CNN ddPCR detection model,which employs Faster R-CNN to generate droplet prediction boxes followed by removing the anomalies within the positive droplet prediction boxes using an outlier filtering module(Filter).Using a plasmid carrying a norovirus fragment as the template,we established a ddPCR dataset for model training(2462 instances,78.56%)and testing(672 instances,21.44%).Ablation experiments were performed to test the effectiveness of 3 filtering branches of the Filter for anomaly removal on the validation dataset.Comparative experiments with other ddPCR droplet detection models and absolute quantification experiments of ddPCR were conducted to assess the performance of the Filter Faster R-CNN model.Results In low-dust and dusty environments,the Filter Faster R-CNN model achieved detection accuracies of 98.23%and 88.35%for positive droplets,respectively,with composite F1 scores reaching 99.15%and 99.14%,obviously superior to the other models.The introduction of the filtering module significantly enhanced the positive accuracy of the model in dusty environments.In the absolute quantification experiments,a regression line was plotted using the results from commercial flow cytometry equipment as the standard concentration.The results show a regression line slope of 1.0005,an intercept of-0.025,and a determination coefficient of 0.9997,indicating high consistency between the two results.Conclusion The ddPCR detection technique using the Filter Faster R-CNN model provides a robust detection method for ddPCR under various environmental conditions.

Objective:To evaluate the feasibility, accuracy, effectiveness and safety of a novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction.Methods:A retrospective case series study was conducted to analyze the 35 patients with injury to the lower cervical spine or cervicothoracic junction who had been treated by a novel manual placement of cervical 7 pedicle screws at Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University from March 2015 to July 2021. There were 16 males and 19 females, with an age of (52.7±13.2) years. The core of this placement was to determine the entry point of cervical 7 pedicle screws. After the intersection of the upper edge of the cervical 7 lamina and the medial edge of the superior articular process was recorded as point A while the intersection of the lateral edge of the inferior articular process and the lower edge of the transverse process as point B, the intersection of the outer and middle 1/3 of the AB line was taken as the screw entry point, with the screw placement angle perpendicular to the lamina line or slightly inclined from 30° to 40° to the head side and outward. The length, diameter and placement angle of the cervical 7 pedicle screws were recorded and compared postoperatively between the left and right sides to explore the feasibility of this novel manual placement. According to the Rampersaud method, the screw positions were graded 1 week and 6 months after operation to evaluate the accuracy of this manual placement. The visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score were compared between preoperation, 1 week and 6 months after operation to evaluate the effectiveness of this placement. The postoperative complications were counted to evaluate the safety of this method. Loosening, displacement and breakage of the screws were observed by CT scanning at 6 months after operation.Results:This case series was followed up for (9.8±1.7) months. There was no significant difference in the length, diameter or placement angle of the screws between the left and right sides ( P>0.05). A total of 66 cervical 7 pedicle screws were placed. There was no change in the screw position grading at 1 week or 6 months after surgery. Grade A was achieved in 64 screws, Grade B in 2 screws, and Grade C or D in none. The VAS scores before operation, 1 week and 6 months after operation were respectively 4.4±1.7, 3.8±1.0 and 1.1±1.1, and the JOA scores respectively 6.7±2.2, 13.2±1.5 and 15.3±1.2. The VAS and JOA scores at 1 week and 6 months after operation were significantly improved compared with the preoperative values ( P<0.05). The improvement rates in JOA at 1 week and 6 months after operation were 62.7%±13.3 % and 83.9%±11.6%, respectively. There were no complications related to the placement of cervical 7 pedicle screws; there was no wound hematoma or infection. No loosening, displacement or breakage of the screws was observed by the 6-month follow-up. Conclusion:The novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction is feasible, accurate, effective and safe.