Objective:To evaluate the effect of exogenous short-chain fatty acids (SCFAs) preconditioning on the expression of zonula occludens-1 (ZO-1) in lung tissues of rats undergoing extracorporeal circulation (ECC).Methods:Thirty-six clean-grade healthy adult male Sprague-Dawley rats, weighing 320-420 g, were divided into sham operation group (S group), ECC group (E group) and SCFAs group, with 12 rats in each group. Seven days before the ECC, short-chain fatty acids dissolved in 2 ml of normal saline was given by gavage daily in SCFAs group, while the equal volume of normal saline was given by gavage in S group and E group. On the 8th day, E group and SCFAs group underwent arteriovenous catheterization and ECC for 1 h, while S group only underwent catheterization without ECC. Lung tissues were collected to observe the pathological results and detect the expression of ZO-1 (by Western blot), and the wet/dry lung weight ratio was calculated.Results:Compared with S group, the wet/dry lung weight ratio was significantly increased ( P<0.05), the expression of ZO-1 protein in lung tissue was down-regulated ( P<0.05), and the pathological damage of lung tissues was aggravated in E group and SCFAs group. Compared with E group, the wet/dry lung weight ratio was significantly decreased, the expression of ZO-1 protein in lung tissues was up-regulated ( P<0.05), and the pathological damage of lung tissues was significantly alleviated in SCFAs group. Conclusions:The mechanism by which SCFAs preconditioning attenuates lung injury may be related to up-regulation of ZO-1 expression in lung tissues of rats undergoing ECC.

Objective:To analyze the epidemiological characteristics and spatiotemporal distribution of hepatitis C in Henan province from 2012 to 2022.Methods:The case report data on hepatitis C from counties and districts in Henan between 2012 and 2022 were collected. The distribution characteristics were analyzed by descriptive epidemiological methods, and GeoDa1.2 software was used to perform spatial autocorrelation analysis. The spatiotemporal epidemiological analysis was conducted using SaTScan 10.1 software.Results:A total of 274 485 hepatitis C cases were reported in Henan from 2012 to 2022. The reported annual average incidence rate was 25.84/100 000 and showed an overall downward trend from 2012 to 2022 ( Z=-4.05, P<0.001). More cases were reported in women. The cases were mainly aged 40-69 years and farmers. Spatial autocorrelation analysis showed that the reported cases of hepatitis C present spatial clustering during 2012—2022, and the areas with high incidence were mainly distributed in counties or districts of Zhengzhou, Zhumadian, Xuchang, Zhoukou, and Nanyang. One class I clustering area was detected by spatiotemporal scanning, which mainly covered Xuchang, Pingdingshan and the surrounding counties ( LLR=16 117.73, RR=1.81, P<0.001). Conclusion:The reported cases of hepatitis C in Henan Province show an overall downward trend from 2012 to 2022 and present spatiotemporal clustering. The seasonal regularity of the hepatitis C epidemic is not obvious. People aged 40-69 years old and farmers are the key population for prevention and control.

Objective:To investigate the application value of multi-parameter ultrasound in the non-invasive assessment of renal fibrosis in patients with chronic kidney disease（CKD）.Methods:From December 2023 to April 2024，77 CKD patients（CKD group）and 30 healthy individuals（control group）from Renmin Hospital of Wuhan University were prospectively collected. The CKD group was further classified into mild（ n = 30），moderate（ n = 25）and severe（ n = 22）groups according to pathological assessment of renal fibrosis. Ultrasound parameters and clinical data of all patients were collected for group comparisons. Ultrasound parameters that showed statistically significant differences in univariate analysis were incorporated into a Logistic regression model to identify independent influencing factors. ROC curve was constructed，and the area under the curve（AUC）was calculated for statistical evaluation. Results:① The moderate and severe groups compared to control group，as well as the severe group compared to the mild and moderate groups，showed increased levels of SCr and BUN，and decreased level of eGFR，with statistically significant differences（all P < 0.05）. The kidney length and renal parenchymal thickness in the moderate group were smaller than those in the control group，while the kidney length，renal parenchymal thickness，and renal cortical thickness in the severe group were smaller than those in the control，mild，and moderate groups，with statistically significant differences among the groups（all P < 0.05）. The Vmax in the severe group was lower than those in the control，mild，and moderate groups，while the RI was higher than those in the control，mild，and moderate groups，with statistically significant differences（all P < 0.05）. ②In superb microvascular imaging，perfusion levels were predominantly grade 5 in the control and mild groups（83.3%，25/30；70.0%，21/30），grade 4 in the moderate group（48.0%，12/25），and grade 3 in the severe group（63.6%，14/22）. No significant differences were observed between the mild and control groups，or between the moderate and severe groups（all P>0.05），significant differences in blood flow perfusion were found between other groups（ P < 0.05）.③Shear wave elastography and super-resolution imaging revealed that mean of Young's modulus（Emean）in renal cortex increased progressively from the mild to the severe group，while microvascular density decreased. Except for Emean，which did not show significant differences between the moderate and severe groups（ P > 0.05），all other parameters showed significant differences between groups（ P < 0.05）. ④ROC curve analysis indicated that differentiating the control group from the mild group using Emean and microvascular density，the AUC was 0.769（95% CI = 0.631 - 0.872， P<0.001），with a sensitivity of 0.821 and specificity of 0.539. For the combined use of Emean，microvascular density，peak inter-arterial velocity，and resistance index for distinguishing mild from moderate-to-severe fibrosis resulted in an AUC of 0.902（95% CI = 0.843 - 0.972，P < 0.001），with a sensitivity of 0.967 and specificity of 0.755. These multi-parameter combined diagnostic approaches outperformed single ultrasound parameters. Conclusions:Multi-parameter ultrasound technology can display multidimensional renal changes in patients with CKD and effectively assess the degree of renal fibrosis. It is expected to become a non-invasive，highly sensitive tool for evaluating renal fibrosis in CKD.

Objective:To evaluate the immunogenicity and immune persistence of human rabies vaccine (Vero cell) in healthy people aged 10-17 years and compare it with a group of adults aged 18-60 years.Methods:This study was conducted between July 2021 and November 2022 with Shangyu district and Shengzhou city of Shaoxing city, Zhejiang Province selected as the research sites. Zagreb regimen (2-1-1 schedule) and Essen regimen (1-1-1-1-1 schedule) were used for rabies vaccine administration. Serum samples were collected at different time points before and after immunization to compare the differences in seropositivity rates and geometric mean concentrations (GMC) between the 10-17 age group and the 18-60 age group.Results:A total of 1 200 healthy participants aged 10-60 were included, with 157 individuals (13.1%) in the 10-17 age group and 1 043 individuals (86.9%) in the 18-60 age group. Both groups displayed a nearly 100% seropositivity rate at 3, 6 and 12 months, and the participants in the same age group had similar antibody levels. The GMC of antibodies gradually increased after vaccination and peaked on 14 d. The 10-17 age group showed higher GMC of antibodies than the 18-60 age group at 14 d after the first dose (Zagreb regimen: 81.85 IU/ml vs 63.15 IU/ml, t=2.411, P=0.018; Essen regimen: 86.61 IU/ml vs 69.24 IU/ml, t=3.906, P<0.001). Similar differences were observed in the GMC of antibodies at 14 d and 3 months after the full vaccination course, but these differences gradually decreased and disappeared at 6 and 12 months after vaccination. Conclusions:Human rabies vaccine (Vero cell) has lasting immune protection in all participants within one year after vaccination, with no significant differences between the two vaccination regimens. Participants aged 10-17 have higher antibody levels compared to adults aged 18-60, but there is no significant difference in immune persistence between the two age groups.

Objectives:To investigate the prognostic value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with atrial fibrillation(AF)and heart failure(HF).Methods:Patients with AF and HF from hospitals diagnosed by the Heart Failure Center in Guangdong Province between January 2017 and December 2021 were selected.Major adverse cardiovascular events(MACE)were used as the follow-up endpoint.Statistical methods such as the area under the receiver operating characteristic(ROC)curve(AUC),net reclassification index(NRI),and integrated discrimination improvement(IDI)were applied to evaluate the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with AF and HF.Results:A total of 1 839 patients were enrolled in this study,comprising 703 patients in the MACE group and 1 136 patients in the non-MACE group.Compared with the non-MACE group,the MACE group exhibited significantly advanced age,higher prevalence of New York Heart Association class Ⅳ and coronary artery disease,lower diastolic blood pressure and estimated glomerular filtration rate levels,and elevated serum N-terminal pro-B-type natriuretic peptide concentrations(all P<0.05).Additionally,significantly lower proportions of patients in the MACE group received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocorticoid receptor antagonists,or anticoagulant therapy(all P<0.05).Multivariable logistic regression analysis revealed that each 1-point increment in both CHA2DS2-VASc and R2CHA2DS2-VASc scores was associated with approximately 10%increased risk of MACE.ROC curve analysis demonstrated that the AUC values for predicting MACE in AF patients with HF were 0.555(95%CI:0.528-0.582,P<0.001)for CHA2DS2-VASc and 0.576(95%CI:0.549-0.608,P<0.001)for R2CHA2DS2-VASc,indicating marginally superior discriminatory capacity of the R2CHA2DS2-VASc score.Delong's test confirmed statistically significant differences between the two scoring systems(P=0.001).The R2CHA2DS2-VASc score demonstrated a NRI of 0.259(95%CI:0.166-0.352,P<0.001)and an IDI of 0.007(95%CI:0.005-0.010,P<0.001)compared with the conventional CHA2DS2-VASc score.Although the R2CHA2DS2-VASc score exhibited slightly better predictive accuracy and outcome discrimination capacity than the original scoring system,both scores demonstrated suboptimal clinical predictive performance.Conclusions:Both the R2CHA2DS2-VASc and CHA2DS2-VASc scores show suboptimal performance for predicting the risk of MACE in patients with AF and HF,and the predicting performance of R2CHA2DS2-VASc score is marginally superior to CHA2DS2-VASc score in this patient cohort.

Objective:To evaluate the effect of exogenous short-chain fatty acids (SCFAs) preconditioning on the expression of zonula occludens-1 (ZO-1) in lung tissues of rats undergoing extracorporeal circulation (ECC).Methods:Thirty-six clean-grade healthy adult male Sprague-Dawley rats, weighing 320-420 g, were divided into sham operation group (S group), ECC group (E group) and SCFAs group, with 12 rats in each group. Seven days before the ECC, short-chain fatty acids dissolved in 2 ml of normal saline was given by gavage daily in SCFAs group, while the equal volume of normal saline was given by gavage in S group and E group. On the 8th day, E group and SCFAs group underwent arteriovenous catheterization and ECC for 1 h, while S group only underwent catheterization without ECC. Lung tissues were collected to observe the pathological results and detect the expression of ZO-1 (by Western blot), and the wet/dry lung weight ratio was calculated.Results:Compared with S group, the wet/dry lung weight ratio was significantly increased ( P<0.05), the expression of ZO-1 protein in lung tissue was down-regulated ( P<0.05), and the pathological damage of lung tissues was aggravated in E group and SCFAs group. Compared with E group, the wet/dry lung weight ratio was significantly decreased, the expression of ZO-1 protein in lung tissues was up-regulated ( P<0.05), and the pathological damage of lung tissues was significantly alleviated in SCFAs group. Conclusions:The mechanism by which SCFAs preconditioning attenuates lung injury may be related to up-regulation of ZO-1 expression in lung tissues of rats undergoing ECC.

Objectives:To investigate the prognostic value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with atrial fibrillation(AF)and heart failure(HF).Methods:Patients with AF and HF from hospitals diagnosed by the Heart Failure Center in Guangdong Province between January 2017 and December 2021 were selected.Major adverse cardiovascular events(MACE)were used as the follow-up endpoint.Statistical methods such as the area under the receiver operating characteristic(ROC)curve(AUC),net reclassification index(NRI),and integrated discrimination improvement(IDI)were applied to evaluate the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with AF and HF.Results:A total of 1 839 patients were enrolled in this study,comprising 703 patients in the MACE group and 1 136 patients in the non-MACE group.Compared with the non-MACE group,the MACE group exhibited significantly advanced age,higher prevalence of New York Heart Association class Ⅳ and coronary artery disease,lower diastolic blood pressure and estimated glomerular filtration rate levels,and elevated serum N-terminal pro-B-type natriuretic peptide concentrations(all P<0.05).Additionally,significantly lower proportions of patients in the MACE group received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocorticoid receptor antagonists,or anticoagulant therapy(all P<0.05).Multivariable logistic regression analysis revealed that each 1-point increment in both CHA2DS2-VASc and R2CHA2DS2-VASc scores was associated with approximately 10%increased risk of MACE.ROC curve analysis demonstrated that the AUC values for predicting MACE in AF patients with HF were 0.555(95%CI:0.528-0.582,P<0.001)for CHA2DS2-VASc and 0.576(95%CI:0.549-0.608,P<0.001)for R2CHA2DS2-VASc,indicating marginally superior discriminatory capacity of the R2CHA2DS2-VASc score.Delong's test confirmed statistically significant differences between the two scoring systems(P=0.001).The R2CHA2DS2-VASc score demonstrated a NRI of 0.259(95%CI:0.166-0.352,P<0.001)and an IDI of 0.007(95%CI:0.005-0.010,P<0.001)compared with the conventional CHA2DS2-VASc score.Although the R2CHA2DS2-VASc score exhibited slightly better predictive accuracy and outcome discrimination capacity than the original scoring system,both scores demonstrated suboptimal clinical predictive performance.Conclusions:Both the R2CHA2DS2-VASc and CHA2DS2-VASc scores show suboptimal performance for predicting the risk of MACE in patients with AF and HF,and the predicting performance of R2CHA2DS2-VASc score is marginally superior to CHA2DS2-VASc score in this patient cohort.

Objective:To analyze the epidemiological characteristics and spatiotemporal distribution of hepatitis C in Henan province from 2012 to 2022.Methods:The case report data on hepatitis C from counties and districts in Henan between 2012 and 2022 were collected. The distribution characteristics were analyzed by descriptive epidemiological methods, and GeoDa1.2 software was used to perform spatial autocorrelation analysis. The spatiotemporal epidemiological analysis was conducted using SaTScan 10.1 software.Results:A total of 274 485 hepatitis C cases were reported in Henan from 2012 to 2022. The reported annual average incidence rate was 25.84/100 000 and showed an overall downward trend from 2012 to 2022 ( Z=-4.05, P<0.001). More cases were reported in women. The cases were mainly aged 40-69 years and farmers. Spatial autocorrelation analysis showed that the reported cases of hepatitis C present spatial clustering during 2012—2022, and the areas with high incidence were mainly distributed in counties or districts of Zhengzhou, Zhumadian, Xuchang, Zhoukou, and Nanyang. One class I clustering area was detected by spatiotemporal scanning, which mainly covered Xuchang, Pingdingshan and the surrounding counties ( LLR=16 117.73, RR=1.81, P<0.001). Conclusion:The reported cases of hepatitis C in Henan Province show an overall downward trend from 2012 to 2022 and present spatiotemporal clustering. The seasonal regularity of the hepatitis C epidemic is not obvious. People aged 40-69 years old and farmers are the key population for prevention and control.

Objective:To explore the surgical treatment strategies for Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures.Methods:A retrospective analysis was performed on the clinical data of 25 adult patients with Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures, admitted to the Upper Extremity Orthopaedics Department of Zhengzhou Orthopaedic Hospital from June 2013 to June 2023. There were 15 males and 10 females, with an average age of 43.5±14.7 years (range: 20-67 years). Among them, 5 cases were complicated with humeroulnar joint dislocation. The patients were divided into two groups: 17 cases were treated with open reduction and internal fixation (ORIF) of radial head fractures combined with ORIF of proximal ulnar fractures (open reduction group), and 8 cases were treated with radial head replacement combined with ORIF of proximal ulnar fractures (radial head replacement group). At the last follow-up, elbow joint range of motion was recorded, and pain, elbow function, and subjective upper limb function were evaluated using the Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder and Hand (DASH) scale. The incidence of complications was also recorded.Results:All 25 patients were followed up for an average of 25.6±9.0 months (range: 12-45 months). At the last follow-up, the affected elbows in the open reduction group had a flexion of 124.47°±12.59° (range, 90°-140°), extension of 21.12°±10.07° (range, 10°-50°), pronation of 48.59°±11.62° (range, 20°-61°), and supination of 48.53°±8.43° (range, 30°-60°). In the radial head replacement group, the affected elbows showed flexion of 128.75°±13.17° (range, 100°-140°), extension of 14.00°±7.71° (range, 0°-25°), pronation of 61.25°±10.26° (range, 60°-80°), and supination of 71.88°±10.33° (range, 60°-80°). The MEPS score in the open reduction group was 82(75, 85) points (range, 55-90 points), the VAS pain score was 1(1, 2) points (range, 0-3 points), and the DASH score was 9(8, 14) points. In the radial head replacement group, the MEPS score was 90(85, 90) points (range, 85-90 points), the VAS pain score was 1(0, 1) points (range, 0-1 points), and the DASH score was 5(5, 6) points. Complications included 5 cases of heterotopic ossification, 1 case of incision infection, 1 case of nonunion, 1 case of ulnar nerve injury combined with traumatic arthritis, and 1 case of proximal radioulnar bone bridge formation.Conclusions:Both radial head replacement and open reduction internal fixation combined with proximal ulnar fracture fixation can effectively treat Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures. There was no significant difference in postoperative flexion and extension, but the radial head replacement group demonstrated better forearm rotation and DASH scores postoperatively.