Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.

Objective:To preliminarily investigate the applicability of a poliovirus pseudovirus-based neutralization assay in evaluating the immunogenicity of recombinant poliovirus vaccines and their in vivo potency in rats. Methods:Serum samples from rats immunized with recombinant poliovirus vaccines were tested using both the pseudovirus neutralization assay and the live-virus neutralization assay with Sabin strain. The consistency and correlation of the two methods were analyzed using the Kappa test and Spearman′s rank correlation.Results:For the neutralizing antibodies against typeⅠ, Ⅱ, and Ⅲ polioviruses, the Kappa values for consistency analysis of the two methods were 0.914, 1.000, and 0.751, respectively ( P<0.001), and the correlation coefficients ( R values) were 0.833, 0.927, and 0.859, respectively ( P<0.001). Conclusions:The test results of the two methods are consistent and show a good correlation, indicating that the pseudovirus neutralization assay can be applied to evaluating the immunogenicity of poliovirus vaccines and also can be used in rat potency tests.

Objective:To analyze the incidence and clinical phenotype of the concomitant extragenital malformations in the patients with female reproductive tract anomalies.Methods:A retrospective study was conducted using clinical data of hospitalized patients diagnosed with uterine, cervical, or vaginal malformations from January 2003 to December 2022 in Peking Union Medical College Hospital. The malformations were classified according to American Society for Reproductive Medicine müllerian anomalies classification 2021, and in each type, the incidence and specific manifestations of concomitant extragnital malformations were analyzed.Results:A total of 444 patients were included. The overall incidence of concomitant extragenital malformations was 43.5% (193/444), including urinary system, skeletal system, and other system malformations. Renal malformations on the obstructed side were present in all patients with oblique vaginal septum syndrome (100.0%, 78/78). The total incidence of concomitant extragnital malformations was as high as 8/11 in uterus didelphys, 43.5% (10/23) in unicornuate uterus, 33.6% (79/235) in Mayer-Rokitansky-Küster-Hauser syndrome, 18.8% (6/32) in septate uterus and 18.5% (12/65) in cervical agenesis. Urinary system malformations (30.6%, 136/444) and skeletal system malformations (13.5%, 60/444) were the most common concomitant malformations in all types, in which, unilateral renal agenesis and scoliosis were the most common.Conclusions:Urinary and skeletal system malformations are important features of female reproductive tract anomalies. Urologic ultrasonography and spinal roentgenogram are recommended for all patients with female reproductive tract anomalies.

Objective:To investigate the value of peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and serum lactate dehydrogenase (LDH) levels for predicting the occurrence of radiation pneumonia (RP) in small cell lung cancer.Methods:A total of 84 patients with small cell lung cancer who received image-guided radiotherapy in Xuzhou Cancer Hospital between September 2019 and September 2022 were retrospectively analyzed. They were divided into an RP group ( n = 25) and a non-RP group ( n = 59) according to whether RP occurred. Peripheral blood NLR and PLR and serum LDH levels were compared between the two groups before and after radiotherapy. The receiver operating characteristic curve (ROC curve) was used to analyze the value of peripheral blood NLR, PLR, and serum LDH levels for the diagnosis of RP in small cell lung cancer. Results:Before radiotherapy, there were no significant differences in peripheral blood NLR and PLR between the two groups (both P > 0.05). After radiotherapy, peripheral blood NLR and PLR in the RP group were (3.39 ± 0.81) and (129.06 ± 24.90), respectively, which were significantly higher than those in the non-RP group [(2.54 ± 0.71), (104.76 ± 26.26), t = 3.61, 3.83, both P < 0.05]. The NLR (2.86 ± 0.30) and PLR (110.07 ± 10.05) were the lowest in patients with grade 2 RP and they were highest in patients with grade 4 RP [(4.49 ± 0.63), (168.88 ± 14.11)]. The grade of RP was positively correlated with peripheral blood NLR and PLR. The sensitivity of peripheral blood NLR in the diagnosis of RP was 88.0%, the specificity was 66.1%, and the area under the curve (AUC) was 0.791. The sensitivity of PLR in the diagnosis of RP was 48.0%, the specificity was 94.9%, and the AUC was 0.735. The sensitivity of NLR combined with PLR in the diagnosis of RP was 92.0%, the specificity was 59.3%, and the AUC was 0.801. There was no significant difference in serum LDH levels between the two groups before and after radiotherapy (both P > 0.05). Logistic regression analysis showed that NLR and PLR were risk factors for RP in patients with small cell lung cancer ( OR = 2.309, 1.037; 95% CI: 1.061-5.024, 1.004-1.071). Conclusion:In patients with small cell lung cancer who develop RP, peripheral blood NLR, and PLR are markedly elevated compared with those in patients who do not develop RP, and combined detection of peripheral blood NLR and PLR has a high value for early diagnosis of RP in patients with small cell lung cancer.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women with reproductive age, which is associated with hyperandrogenism, insulin resistance, and ovulatory dysfunction. Progesterone receptor membrane component 1 (PGRMC1) can mediate progesterone to inhibit the apoptosis of ovarian granulosa cells and the growth of follicles, and to induce glucolipid metabolism disorder in ovarian granulosa cells, which is closely related to the occurrence and development of PCOS. This study aims to determine the expression of PGRMC1 in serum, ovarian tissue, ovarian granulosa cells, and follicular fluid in PCOS patients and non-PCOS patients, analyze the value of PGRMC1 in diagnosis and prognosis evaluation of PCOS, and investigate its molecular mechanism on ovarian granulosa cell apoptosis and glucolipid metabolism. METHODS: A total of 123 patients were collected from the Department of Obstetrics and Gynecology in Guangdong Women and Children Hospital (hereinafter referred to as "our hospital") from August 2021 to March 2022 and divided into 3 groups: a PCOS pre-treatment group (n=42), a PCOS treatment group (n=36), and a control group (n=45). The level of PGRMC1 in serum was detected by enzyme linked immunosorbent assay (ELISA). The diagnostic and prognostic value of PGRMC1 was evaluated in patients with PCOS by receiver operating characteristic (ROC) curve. Sixty patients who underwent a laparoscopic surgery from the Department of Obstetrics and Gynecology in our hospital from January 2014 to December 2016 were collected and divided into a PCOS group and a control group (n=30). The expression and distribution of PGRMC1 protein in ovarian tissues were detected by immunohistochemical staining. Twenty-two patients were collected from Reproductive Medicine Center in our hospital from December 2020 to March 2021, and they divided into a PCOS group and a control group (n=11). ELISA was used to detect the level of PGRMC1 in follicular fluid; real-time RT-PCR was used to detect the expression level of PGRMC1 mRNA in ovarian granulosa cells. Human ovarian granular cell line KGN cells were divided into a scrambled group which was transfected with small interfering RNA (siRNA) without interference and a siPGRMC1 group which was transfected with specific siRNA targeting PGRMC1. The apoptotic rate of KGN cells was detected by flow cytometry. The mRNA expression levels of PGRMC1, insulin receptor (INSR), glucose transporter 4 (GLUT4), very low density lipoprotein receptor (VLDLR), and low density lipoprotein receptor (LDLR) were determined by real-time RT-PCR. RESULTS: The serum level of PGRMC1 in the PCOS pre-treatment group was significantly higher than that in the control group (P<0.001), and the serum level of PGRMC1 in the PCOS treatment group was significantly lower than that in the PCOS pre-treatment group (P<0.001). The areas under curve (AUC) of PGRMC1 for the diagnosing and prognosis evaluation of PCOS were 0.923 and 0.893, respectively, and the cut-off values were 620.32 and 814.70 pg/mL, respectively. The positive staining was observed on both ovarian granulosa cells and ovarian stroma, which the staining was deepest in the ovarian granulosa cells. The average optical density of PGRMC1 in the PCOS group was significantly increased in ovarian tissue and ovarian granulosa cells than that in the control group (both P<0.05). Compared with the control group, the PGRMC1 expression levels in ovarian granulosa cells and follicular fluid in the PCOS group were significantly up-regulated (P<0.001 and P<0.01, respectively). Compared with the scrambled group, the apoptotic rate of ovarian granulosa cells was significantly increased in the siPGRMC1 group (P<0.01), the mRNA expression levels of PGRMC1 and INSR in the siPGRMC1 group were significantly down-regulated (P<0.001 and P<0.05, respectively), and the mRNA expression levels of GLUT4, VLDLR and LDLR were significantly up-regulated (all P<0.05). CONCLUSIONS Serum level of PGRMC1 is increased in PCOS patients, and decreased after standard treatment. PGRMC1 could be used as molecular marker for diagnosis and prognosis evaluation of PCOS. PGRMC1 mainly localizes in ovarian granulosa cells and might play a key role in regulating ovarian granulosa cell apoptosis and glycolipid metabolism.
Child ; Pregnancy ; Humans ; Female ; Polycystic Ovary Syndrome ; Apoptosis ; Granulosa Cells ; Lipid Metabolism ; Membrane Proteins ; Receptors, Progesterone

Objective: To investigate a cluster of coronavirus disease 2019(COVID-19)caused by latent infection in Haikou,so as to provide reference for the prevention and control of COVID-19 clusters. Methods: An epidemiological investigation was conducted according to the COVID-19 Prevention and Control Program(Fourth Edition). The course of diagnosis and treatment,clinical characteristics and field investigation data were collected to analyze the transmission chain and the intergeneration between cases. Results : Among 39 people involved,five confirmed cases and two asymptomatic infections were found,with an attack rate of 17.95%. The cases aged from 40 to 65 years and lived in the dormitories near the farm of Dongshan. The first case(named Case 1)closely contacted with a confirmed case of COVID-19 in Chengmai from January 28 to February 10,was isolated on February 13 and developed symptoms on February 16. The other six cases(Case 2 to Case 7)shared the water source with Case 1 from January 28 to February 13(within the incubation period of Case 1). They needed to open the power switch outside Case 1's room and the water valve in Case 1's washroom before the use of water. They might be infected by contacting the doorknob and the water valve contacted by Case 1,or by the aerosol formed after Case 1 used the washroom,then infected each other when living together. The onset of Case 2 to Case 7 was earlier than Case 1,and they had no travelling history in Hubei Province 14 days before and contacted no confirmed cases except Case 1. Therefore,Case 1 was the source of the cluster during his incubation period of COVID-19. Conclusion This was a cluster of COVID-19 due to latent transmission by living in the same area and touching the same objects indirectly,which indicated that COVID-19 was infectious in the incubation period.

Objective: To explore the effect of fine particulate matters (PM_2.5) exposure on emergency visits and outpatient visits of 5 hospitals in Beijing, Shanghai and Guangzhou from 2013 to 2015. Methods: Using convenient sampling method, 5 general hospitals in Beijing, Shanghai and Guangzhou were selected which included Beijing hospital, China-Japan friendship hospital, Xinhua hospital affiliated to Shanghai jiaotong University School of Medicine, the liwan hospital of the third affiliated hospital and the first affiliated hospital of Guangzhou Medical University. The emergency and outpatient data, air pollution monitoring data and meteorological data were collected from January 1, 2013 to December 31, 2015. A generalized additive model was used to analyze the effect of PM_2.5 exposure on daily hospital emergency and outpatient visits, and Meta analysis was used to obtain the combined effect value. Results: The number of emergency and outpatient visits of 5 hospitals was 1 378 501 and 18 139 779 in total, respectively. The mean±SD of PM_2.5 exposures in Beijing hospital, China-Japan friendship hospital, Xinhua hospital affiliated to Shanghai jiaotong University School of Medicine, the liwan hospital of the third affiliated hospital and the first affiliated hospital of Guangzhou Medical University were (81.8±68.7), (83.2±69.7), (54.4±34.1), (43.5±24.8) μg/m³, respectively. Results of single pollutant model analysis showed that 0-1 day lag concentrations of PM_2.5 had the largest effect on emergency visits and outpatient visits. For a 10 μg/m³ increase of PM₂.5 concentration, excess risk (ER) (95%CI) of emergency and outpatient visits was 0.56% (0.14%, 0.99%) and0.63% (0.07%, 1.19%), respectively. After adjusting for O₃, NO₂, SO₂, and CO, for a 10 μg/m³ increase of PM_2.5 concentrations, the ER (95%CI) of emergency visits was 0.50% (0.10%, 0.90%), 0.34% (-0.02%, 0.69%), 0.36% (0.02%, 0.69%) and 0.56% (0.10%, 1.03%), respectively and the ER (95% CI) of outpatient visits was 0.65% (0.08%, 1.21%), 0.29% (-0.17%, 0.75%), 0.48% (-0.06%, 1.03%) and 0.48%(-0.02%, 0.99%), respectively. Conclusion Our results suggested that PM_2.5 exposure can increase emergency and outpatient visits of 5 hospitals in Beijing, Shanghai and Guangzhou.

Objective To observe the value of MDCT in diagnosis of double outlet right ventricle (DORV). Methods Clinical and imaging data of 36 patients with DORV confirmed with operation or cardioangiography were retrospectively analyzed. The preoperative results of MDCT and echocardiography (Echo) were compared with surgical findings. Results MDCT definitely diagnosed 34 patients with DORV, while 2 patients were misdiagnosed, and the accurate diagnostic rate was 94.44% (34/36).The accurate diagnostic rate of Echo was 75.00% (27/36), and the difference was statistically significant (P=0.022). Moreover, in the relationship of ventricular septal defect (VSD) with large artery and the special relationship of the large artery in DORV, the diagnostic accuracy of MDCT was 100% (36/36), of Echo was 80.56% (29/36), and the difference was statistically significant (P=0.017). For totally 119 intracardiac and extracardiac malformations in all 36 patients, no significant statistical difference of diagnostic accuracy for detecting intracardiac malformation was found between MDCT and Echo (P=0.474), whereas for extracardiac malformations, the diagnostic accuracy of MDCT (98.72% [77/78]) was higher than that of Echo (69.23% [54/78], P<0.001). Conclusion MDCT could diagnose DORV and combined malformation definitely, therefore providing important guidance for surgical planning.

Objective To evaluate the medium and long term safety and efficacy of sacrospinous ligament fixation (SSLF) performed with conventional instruments in treating stage Ⅲ-Ⅳ pelvic organ prolapse (POP).Methods A prospective cohort analysis was conducted in the Peking Union Medical College Hospital,between May 2007 and June 2015,enrolling 55 women with stage Ⅲ-Ⅳ POP who intended to receive SSLF.Primary end points were objective success rates using pelvic organ prolapse quantitation system (POP-Q) and subjective satisfaction rates with questionnaires after surgery according to vaginal examination and related questionnaires for all patients who received SSLF eventually.Exploratory outcomes included perioperative parameters and complications.Results Of these 55 POP patients enrolled,52 (95％,52/55) received SSLF using conventional surgical instruments,the other 3 cases converted to ischial spinous fascia fixation due to difficulty exposing.Medium blood loss during operation was 100 ml (20-300 ml) and operative time 60 minutes (20-165 minutes).Pelvic hematoma with diameters of 5 cm and 7 cm were observed in two patients,both recovered fully with conservative methods.All patients were able to micturate spontaneously after catheter withdrawal.One patient reported right thigh pain after operation which remained till 3-month follow-up and relieved after physiotherapy.The objective success rate was 100％ (52/52) at 3 months.With a medium follow-up time of 23.7 months,the objective success rate was 98％ (51/52),the recurrence rate was 2％ (1/52) and the satisfactory rate was 94％ (49/52).De novo urinary incontinence occurred in 6％ (3/52) of patients.Conclusion Most POP could be corrected with SSLF using conventional instruments which is a feasible,economic and effective procedure for Asian patients with medium compartment prolapse.

Objective To evaluate the immunopotentiating effect of cyclic guanosine monophos-phate-adenosine monophosphate (cGAMP) as an adjuvant on norovirus (GⅡ. 4) virus like particles (VLPs) in the development of norovirus vaccine. Methods BALB/c mice were intramuscularly immunized with norovirus (GⅡ.4) VLPs composed of capsid protein VP1 in combination with cGAMP or Al(OH)3. Norovirus VLPs-specific antibodies in serum were detected by ELISA. A synthetic histo-blood group antigen (HBGA)-VLPs blocking assay was used to analyze neutralizing antibodies against norovirus VLPs in serum samples. Results Immunization with norovirus VLPs in the presence of cGAMP induced a strong humoral immune response in BALB/c mice. Levels of specific IgG antibodies in serum induced by using cGAMP as the adjuvant were significantly higher than those induced by using Al(OH)3adjuvant when immunization of BALB/c mice with the same dosage of VLPs. The antibody level induced by 1 μg of VLPs in combination with cGAMP was equivalent to that elicited by 10 μg of VLPs combined with Al(OH)3adjuvant. Results of the synthetic HBGA-VLPs blocking assay showed that the blocking rate in cGAMP+VLPs immunization group were significantly higher than that in Al(OH)3+VLPs immunization group when using the same dosage of VLPs. No significant difference in blocking rate was observed between cGAMP+VLPs(1 μg) and Al(OH)3+VLPs (10 μg) immunization groups. Conclusion cGAMP significantly enhanced the specific humoral immune response induced by norovirus (GⅡ.4) VLPs in mice as compared with Al(OH)3adjuvant. It might be used as a novel adjuvant to replace the traditional aluminum adjuvant in the development of norovir-us vaccine.