Objective:To investigate the protective effects of Huoxue Rongluo Decoction on hypoxic-ischemic brain damage (HIBD) rats; To clarify the expression of AMPK signaling pathway during HIBD injury and repair.Methods:On the basis of the hypoxia ischemia reperfusion model, an improved hypoxia bottle was used to establish a full-term HIBD rat model. Totally 60 successfully modeled mice were divided into model group and TCM group using a random number table method, with 30 mice in each group and 30 mice in a control group. Two hours before surgery, TCM group was orally administered with Huoxue Rongluo Decoction 1.17 g/100 g (equivalent dose). The control group and model group were orally administered with equal volume of physiological saline. Two hours after surgery, it was orally administered again, twice a day, for consecutive 5 d. Behavioral tests (convulsion assessment, Longa score, suspension test, water maze test) were used to evaluate the motor nerve function and long-term learning ability of young rats in different groups. HE staining and electron microscopy were used to observe the pathological changes of brain tissue and mitochondrial damage. Evans blue (EB) staining and brain water content measurement were used to detect blood-brain barrier permeability and brain edema. The expression of AMPK signaling pathway related genes in brain tissues of different groups of young rats was detected by PCR array technique.Results:Compared with the model group, the convulsions of the rats in the TCM group were improved, the Longa score was significantly reduced, the grip strength test score and suspension time were significantly improved, the escape latency was significantly shortened, and the number of crossing platforms significantly increased ( P<0.05); the degree of neuronal and mitochondrial damage in the TCM group was reduced, and cerebral vascular permeability and brain water content were significantly reduced ( P<0.01). The results of PCR array showed that compared with the control group, 2 genes were significantly up-regulated and 12 genes were significantly down-regulated in the brain tissue of the model group; compared with TCM group, 15 genes were relatively down-regulated in the model group. Conclusion:Huoxue Rongluo Decoction can significantly reduce the degree of brain injury after HIBD, improve the motor nerve function and long-term learning and cognitive ability of model rats, and its damage repair mechanism is related to the expression regulation of AMPK signaling pathway related genes.

BackgroundPatients after percutaneous coronary intervention （PCI） are prone to experience depression， which has been shown to significantly affect patients' quality of recovery in postoperative period. Resourcefulness plays an important role between stress and depression， yet there is insufficient research evidence on the predictive effect of intellectual resourcefulness levels on depressive symptoms among patients undergoing PCI. ObjectiveTo investigate the cross-lagged effect between level of resourcefulness and depressive symptoms among patients after PCI， so as to provide references for alleviating depressive symptoms in patients after PCI. MethodsA total of 363 patients who had undergone PCI in Tangshan Gongren Hospital from September to December 2019 were selected using random sampling technique. All participants were subjected to complete Chinese Resourcefulness Scale （CRS） and Chinese version of Cardiac Depression Scale （C-CDS） at both baseline and two years after PCI. A structural equation model was constructed to determine the cross-lagged effect between the level of resourcefulness and depressive symptoms in patients. ResultsMale patients scored higher on CRS （t=-19.871， P<0.01） and lower on C-CDS （t=25.557， P<0.01） after two years of PCI compared with female patients after PCI. Correlation analysis indicated that the baseline CRS score was positively correlated with two years after PCI CRS score （r=0.550， P<0.01）， C-CDS score of baseline was positively correlated with two years after PCI C-CDS score （r=0.524， P<0.01）， baseline CRS score was negatively correlated with C-CDS scores at both baseline （r=-0.717， P<0.01） and two years after PCI （r=-0.472， P<0.01）， and two years after PCI， CRS score was negatively correlation with C-CDS score （r=-0.618， P<0.01）. The cross-lagged analysis revealed that baseline CRS score significantly predicted CRS score of two years after PCI （β=0.382， P<0.01） and C-CDS score of two years after PCI （β=-0.200， P<0.01）. Baseline C-CDS score significantly predicted C-CDS score of two years after PCI （β=0.381， P<0.01） and CRS score of two years after PCI （β=-0.235， P<0.01）. There was a reciprocal relationship between baseline CRS score and baseline C-CDS score （β=-0.717， P<0.01）. ConclusionThe established cross-lagged model yields the presence of a reciprocal prediction of level of resourcefulness and depressive symptoms measured in patients at two time points. The higher the baseline level of resourcefulness， the lighter the depressive symptoms experienced by patients two years after PCI surgery.The more severe the baseline depressive symptoms， the lower the patients' level of resourcefulness two years after PCI surgery.［Funded by Project of Hebei Provincial Department of Science and Technology （number， 182777154）］

Background::The goal of the assisted reproductive treatment is to transfer one euploid blastocyst and to help infertile women giving birth one healthy neonate. Some algorithms have been used to assess the ploidy status of embryos derived from couples with normal chromosome, who subjected to preimplantation genetic testing for aneuploidy (PGT-A) treatment. However, it is currently unknown whether artificial intelligence model can be used to assess the euploidy status of blastocyst derived from populations with chromosomal rearrangement.Methods::From February 2020 to May 2021, we collected the whole raw time-lapse videos at multiple focal planes from in vitro cultured embryos, the clinical information of couples, and the comprehensive chromosome screening results of those blastocysts that had received PGT treatment. Initially, we developed a novel deep learning model called the Attentive Multi-Focus Selection Network (AMSNet) to analyze time-lapse videos in real time and predict blastocyst formation. Building upon AMSNet, we integrated additional clinically predictive variables and created a second deep learning model, the Attentive Multi-Focus Video and Clinical Information Fusion Network (AMCFNet), to assess the euploidy status of embryos. The efficacy of the AMCFNet was further tested in embryos with parental chromosomal rearrangements. The receiver operating characteristic curve (ROC) was used to evaluate the superiority of the model. Results::A total of 4112 embryos with complete time-lapse videos were enrolled for the blastocyst formation prediction task, and 1422 qualified blastocysts received PGT-A ( n = 589) or PGT for chromosomal structural rearrangement (PGT-SR, n = 833) were enrolled for the euploidy assessment task in this study. The AMSNet model using seven focal raw time-lapse videos has the best real-time accuracy. The real-time accuracy for AMSNet to predict blastocyst formation reached above 70% on the day 2 of embryo culture, and then increased to 80% on the day 4 of embryo culture. Combing with 4 clinical features of couples, the AUC of AMCFNet with 7 focal points increased to 0.729 in blastocysts derived from couples with chromosomal rearrangement. Conclusion::Integrating seven focal raw time-lapse images of embryos and parental clinical information, AMCFNet model have the capability of assessing euploidy status in blastocysts derived from couples with chromosomal rearrangement.

With the recent ongoing autumn/winter 2022 COVID-19 wave and the adjustment of public health control measures, there have been widespread SARS-CoV-2 infections in Chinese mainland. Here we have analyzed 369 viral genomes from recently diagnosed COVID-19 patients in Shanghai, identifying a large number of sublineages of the SARS-CoV-2 Omicron family. Phylogenetic analysis, coupled with contact history tracing, revealed simultaneous community transmission of two Omicron sublineages dominating the infections in some areas of China (BA.5.2 mainly in Guangzhou and Shanghai, and BF.7 mainly in Beijing) and two highly infectious sublineages recently imported from abroad (XBB and BQ.1). Publicly available data from August 31 to November 29, 2022 indicated an overall severe/critical case rate of 0.035% nationwide, while analysis of 5706 symptomatic patients treated at the Shanghai Public Health Center between September 1 and December 26, 2022 showed that 20 cases (0.35%) without comorbidities progressed into severe/critical conditions and 153 cases (2.68%) with COVID-19-exacerbated comorbidities progressed into severe/critical conditions. These observations shall alert healthcare providers to place more resources for the treatment of severe/critical cases. Furthermore, mathematical modeling predicts this autumn/winter wave might pass through major cities in China by the end of the year, whereas some middle and western provinces and rural areas would be hit by the upcoming infection wave in mid-to-late January 2023, and the duration and magnitude of upcoming outbreak could be dramatically enhanced by the extensive travels during the Spring Festival (January 21, 2023). Altogether, these preliminary data highlight the needs to allocate resources to early diagnosis and effective treatment of severe cases and the protection of vulnerable population, especially in the rural areas, to ensure the country's smooth exit from the ongoing pandemic and accelerate socio-economic recovery.

Objective To delve into the causal relationship between 211 gut microbiota and sepsis employing bidirectional Mendelian randomization(MR).Methods The gut microbiota genome-wide association study(GWAS)data from the Microbiome Genetics Consortium(MiBioGen,n = 18 340)and sepsis GWAS data from the FinnGen(n = 286 146)were harnessed for this study.Initially,single nucleotide polymorphisms(SNP)significantly associated with the relative abundance of 211 gut microbiota taxa were identified as instrumental variables using predefined selection criteria.The primary analytical approach was characterized by the application of inverse variance weighting(IVW),with the effect measure represented by the odds ratio(OR)to assess the results of MR.To ensure precision and reliability,analyses were conducted,including leave-one-out analysis,heterogeneity testing,and tests for pleiotropy at both coherent and incoherent levels.Results The increased risk of sepsis was associated with the elevated abundance of Collinsella[OR = 1.28,95%confidence interval(95%CI)was 1.06-1.56,P = 0.01]and Ruminococcus(OR = 1.19,95%CI was 1.05-1.35,P = 0.005).Furthermore,a protective effect against the development of sepsis was observed in association with the increased abundance of Prevotella(OR = 0.88,95%CI was 0.79-0.97,P = 0.01)and Firmicutes(OR = 0.86,95%CI was 0.75-0.996,P = 0.04).No obvious heterogeneity and irrelevant level pleiotropy were detected.Conclusion Collinsella and Ruminococcus increase the risk of sepsis,while Prevotella and Firmicutes have protective effects against sepsis.

Objective:To investigate the clinical value of modified acute aortic dissection risk score in the early diagnosis of acute aortic dissection (AAD).Methods:The general, clinical, and imaging data of 162 patients who complained of chest and back pain who received treatment between January 2019 and January 2021 in the Department of Emergency, The Second Hospital of Jiaxing, China were collected for this study. The included patients were divided into control (non-AAD, n = 120) and observation (AAD, n = 42) groups according to whether they were diagnosed with AAD. The indexes with statistical significance between the two groups were analyzed using multivariate logistic regression analysis. A score table was established according to the size of OR value. The modified AAD risk score was predicted using the receiver operating curve. Results:Multivariate logistic regression analysis showed that male sex, family history, sudden severe chest and back pain, bilateral blood pressure asymmetry, hypertension, abnormal ultrasound, and D-dimer level were independent risk factors for the diagnosis of AAD (statistical values = 7.84, 6.96, 7.04, 11.38, 7.12, 8.15, 15.07, 9.11, all P < 0.05). Taking the total score of 5 as the prediction standard, the specificity and sensitivity in the prediction of the occurrence of AAD were 84.94% and 95.43%, respectively. The area under the receiver operating curve regarding the modified AAD risk score was 0.909. Conclusion:The modified AAD risk score can be used to conveniently and quickly predict the occurrence of AAD and has a high predictive value. This study is highly innovative and scientific.

Objective:To construct a risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors, so as to provide an effective reference for clinical implementation of flap necrosis risk screening.Methods:The overall study period was from December 2020 to June 2021. Based on evidence, the item pool of the risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors was preliminarily established. Using the Delphi method, 16 experts engaged in flap transplantation were selected for three rounds of consultation, and the risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors was initially established. The weights were given to all indicators through the paired comparison.Results:In the first round, 16 questionnaires were distributed, and 15 valid questionnaires were recovered. In the second and third rounds, 15 questionnaires were distributed, and 15 valid questionnaires were recovered. Expert authority coefficients of the three rounds of expert consultation were 0.851, 0.853 and 0.853, respectively. The Kendall coordination coefficients of the three rounds of expert consultation were 0.377, 0.302 and 0.302 ( P<0.05) . The final constructed risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors included 3 first-level indicators, 8 second-level indicators, and 32 third-level indicators. The weights were assigned to each indicator by paired comparison, and the weights of the first-level indicator patient factor, treatment factor, and nursing factor were 0.36, 0.38, and 0.26, respectively. Conclusions:The risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors constructed by combining evidence-based and Delphi method is highly scientific and reliable. Its clinical applicability and effectiveness can be further verified in the future clinical flap evaluation process.

【Objective】 To investigate whether 17β-estradiol (βE2) can activate the NF-E2-related factor 2(Nrf2) pathway to resist the downregulation of retinal function induced by light damage. 【Methods】 Two weeks after female SD rats were castrated, they were divided into the following six groups: control group (control), light-damage group (LD), saline group, saline light-damage group (saline-LD), βE2 group, and βE2 light-damage group (βE2-LD). Rats in the light-damage were exposed to 8000-lux fluorescence for 12 h after 18 h of dark adaptation. Then electroretinogram (ERG), immunofluorescence, Real-time PCR and immunohistochemical detection were performed after one day of dark recovery. 【Results】 The results of ERG showed that ERG was lower in LD group than in control group (P<0.05). After light damage, ROS was increased and the mRNA expressions of antioxidant genes, such as Sod1, Sod2, Cat, Glrx1, Glrx2, Txn1, and Txn2 were decreased (all P<0.05). After βE2 administration, compared with those in saline-LD, ROS level was decreased, the levels of Nrf2 protein and antioxidant genes were increased, and ERG was recovered to a certain extent in βE2-LD (P<0.05). 【Conclusion】 βE2 can restore the function of rat retina, and its mechanism might be related to the upregulation of Nrf2 and antioxidant genes.

Objective:To explore the incidence and risk factors of peripherally inserted central catheter (PICC) related upper extremity venous thrombosis (UEVT) in patients with head and neck neoplasm so as to provide a basis for preventing thrombosis.Methods:This study used the design of prospective cohort study. From January 2016 to March 2018, UEVT follow-up examination by B ultrasound was carried out for 1 137 head and neck neoplasm patients with PICC selected by convenience sampling. Single factor and multivariate Cox regression were used to determine the risk factors of PICC related UEVT.Results:There were 3.6% (41/1 137) of patients with PICC related UEVT. Multivariate Cox regression showed that the independent risk factors of PICC related UEVT included the older patients ( RR=1.04, 95% CI: 1.01-1.07, P=0.013) , being with a history of PICC catheterization ( RR=3.22, 95% CI: 1.53-6.77, P=0.002) and high frequency of catheter delivery ( RR=1.98, 95% CI: 1.30-3.00, P=0.001) . Conclusions:Patients with head and neck neoplasm have the low incidence of PICC related UEVT. The independent risk factors of PICC related UEVT in patients with head and neck neoplasm include the older ages, history of PICC catheterization and high frequency of catheter delivery. Positive intervention should be carried out for those patients which may reduce the incidence of PICC related thrombosis.

Objective: To investigate the atypical computed tomography (CT) features of primary small intestinal lymphoma (PSIL), and its correlation with pathology. Methods: From July 2007 to June 2018, at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, the clinical features and CT imaging data of 29 histopathologically diagnosed PSIL with atypical CT features were retrospectively analyzed. Results: A total of 29 cases were all confirmed as Non-Hodgkin′s lymphoma including 23 cases of B cell lymphoma and six cases of peripheral T cell lymphoma. In 24 PSIL patients, the intestinal wall was unevenly thickened. While five cases had intra- and extra-intestinal masses. Images of four PSIL patients showed heterogeneous density at unenhanced CT scan, five cases presented with heterogeneous mild to moderate enhancement and five cases demonstrated with obvious enhancement at portal venous phase. Multiple ulcers in mucosa were found in 20 cases, and obviously abnormal mucosal enhancement was found in five cases, and 13 cases showed rough serosa layer of intestinal wall and the fat gap around the intestinal wall disappeared. Adjacent organs were involved in four cases and intestinal obstruction occurred in eight cases. Conclusion The atypical imaging of PSIL can be heterogeneous density of the lesion, heterogeneous or obvious enhancement at enhanced scan, multiple ulcers on the mucosal surface, thickening of the mucosal surface, blurred peripheral fat space, involvement of adjacent organs and intestinal obstruction.