Objective:To analyze the incidence of liver function injury in patients infected with 2019-nCoV omicron variant and its influencing factors.Methods:The clinical data and laboratory findings of 897 COVID-19 patients infected with omicron variant in Zhejiang province from February 23 to July 14, 2022 were retrospectively analyzed. Patients were divide into liver function injury group ( n=243) and non-liver function injury group ( n=654) based on liver function indicators. The clinical characteristics and laboratory tests were compared between the two groups, and influencing factors of liver function injury were analyzed. SPSS 26.0 statistical software was used for data analysis. Results:The incidence of liver injury in this series was 27.09% (243/897). The median age of patients in liver injury group was older, the body mass index (BMI) was higher( Z=-6.237 and -2.166, both P<0.05), the proportions of patients with hypertension and diabetes, and with severe clinical classification were higher ( χ2=17.087, 27.509 and 12.945, all P<0.01) ; the proportion of vaccinated patients was lower ( χ2=17.766, P<0.01) than those in non-liver injury group. The levels of platelet, hemoglobin, albumin and potassium in liver injury group were lower than those in non-liver injury group ( Z=-4.631, -2.368, -10.593 and -2.141, all P<0.05), while serum ALT, AST, γ-GT, urea nitrogen, glucose and hs-CRP levels were higher than those in the non-liver injury group ( Z=-7.451, -8.663, -4.410, -3.824, -3.278 and -3.884, all P<0.01). Multivariate Logistic regression analysis showed that age ( OR=2.580, 95% CI 1.429-4.657, P=0.002), history of diabetes ( OR=3.650, 95% CI 1.698-7.849, P=0.001), and decreased hemoglobin ( OR=1.993, 95% CI 1.066-3.726, P=0.031) and increased hs-CRP ( OR=1.797, 95% CI 1.283-2.517, P=0.001) were risk factors associated with liver function injury, while vaccination ( OR=0.499, 95% CI 0.312-0.798, P=0.004) was the protective factor for liver function. Conclusion:Liver function injury is frequently observed in COVID-19 patients infected with omicron variant, which is linked to age, underlying disease, and elevated inflammatory markers; while vaccination can lower the risk of liver injury in infected patients.

Salivary gland cancer includes a group of heterogeneous malignant tumors. The latest WHO classification of head and neck tumors divides salivary gland cancer into 22 histopathological subtypes. The most common clinical subtypes include mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary duct carcinoma, acinar cell carcinoma and secretory carcinoma, etc. The histomorphology of the subtypes of salivary gland cancer overlaps, making diagnosis and differential diagnosis difficult. The main treatment for salivary gland cancer is tumor resection and postoperative radiotherapy as appropriate. Even in cases of local progression, recurrence and metastasis, the treatment options available are limited, mainly palliative treatment. Accurate determination of tumor receptor expression, genome and pathway changes is the key to changing the prognosis of patients with local progression or distant metastasis. In this paper, the known genetic mutations, amplifications and protein expression profiles of common salivary gland cancer histological subtypes was summarized, and the significance of the above-mentioned molecular genetic changes for disease diagnosis, future research and personalized targeted therapy was analyzed.

Humans have been struggling for two centuries to reduce the health and economic burden caused by pneumococcal infection. Invasive pneumococcal disease （IPD）， meningitis， and acute otitis media caused by pneumococcus occur worldwide， especially in infants， children and elderly. Pneumococcus is resistant to most antibiotics and vaccines remain the most effective measure against the pneumococcal epidemic. The development of the pneumococcal vaccine was initiated at the beginning of 21 century. In 2014， incidence and mortality of pneumococcal pneumonia and IPD induced by vaccine serotypes decreased accordingly after the introduction of 13-valent pneumococcal conjugate vaccine （PCV）. Subsequently， the new challenge is to further improve the low response of some existing vaccine serotypes， include more serotypes in the PCV， and research on the application of PCV in specific populations. This review briefly describes the development of PCV.

Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic inflammation and aggressive arthritis. The basic pathological changes of RA include intra-articular hyperplasia synovitis and extra-articular vasculitis, symmetrical joint cavity effusion and stenosis, and the formation of pannus leading to the destruction of articular cartilage or joint accessory structures. In the course of RA, swelling and pain of the affected joints occur, causing joint deformities, joint stiffness, and joint dysfunction, and eventually disability. In recent years, significant progress has been made in the study of the relationship between nerve growth factor (NGF) and RA immunopathology. The results of existing studies have shown that the level of NGF in the synovial fluid of RA patients is elevated, suggesting that NGF plays an important role in immune inflammation-mediated pain behavior. In addition, nerve growth factor precursors (including proNGF and proBDNF, etc.) can promote cell apoptosis and inflammation. Among them, the levels of proBDNF and its receptors have significant changes in the blood of RA patients. Therefore, it can be inferred that proNGF and proBDNF may become new targets for RA treatment. According to the latest international domestic research results, in this paper the research progress of NGF and RA in immunopathology, immune inflammatory response, pain behavior, etc. were briefly introduced, and the potential application value of NGF in the treatment of RA was summarized.

Objective To analyze cervical sagittal parameters change after anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) in cervical myelopathy.Methods 80 patients with cervical myelopathy who underwent anterior cervical surgery between March 2013 and October 2014 were analyzed in this study.44 patients (24 males,20 females) were operated by ACDF,with an average age of 59.5±4.26 years old and 36 patients (20 males,16 females) were operated by ACCF,with an average age of 62.5±3.85 years old.Japanese Orthopaedic Association (JOA) scores,visual analogue scale (VAS) and neck disability index (NDI) were obtained in all patients preoperatively,6 months after surgery and at the latest follow-up.Standing radiographs of cervical spine,CT (3D) and MR were obtained preoperatively,6 months after surgery and at the latest follow-up.Cervical sagittal parameters were assessed with the following 3 parameters:C2-7 Cobb angle,C2-7 sagittal vertical axis (C2-7 SVA) and T1-Slope.Results All the patients were followed up from 18 to 26 months,with the average time of 22 months.The group of ACDF:JOA scores,VAS scores and NDI scores changed from 8.1±1.4,5.8±1.2,22.2±5.9 to 13.2±1.8,1.5±1.4,10.5± 4.8.The group of ACCF:JOA scores,VAS scores and NDI scores changed from 7.3±1.6,4.9±1.5,24.2±4.3 to 13.9±1.1,1.7±1.2,11.3±4.2.There was no significant difference of JOA scores,VAS scores and NDI scoresbetween two group (t=1.544,0.887,1.666;P=0.134,0.382,0.107).The group of ACDF:C2-7 Cobb angle,C2-7 SVA and T1-Slope angle changed from 17.5°±4.7°,20.3±9.3 mm,35.2°±8.6° to 29.5°±5.2°,11.2±8.6 mm,28.7°±8.2°.The group of ACCF:C2-7 Cobb angle,C2-7 SVA and T1-Slope angle changed from 16.8°±5.1°,19.5±8.6 mm,34.6°±9.1° to 25.3°±4.2°,15.7±9.2 mm,30.3°±7.9°,with significant difference between the two group (t=2.75,2.45,2.34;P=0.039,0.045,0.043).The changes of T1-Slope angle in ACDF group were more significantly (P＜ 0.05).In each group,compared with patients who had low T1-Slope (＜ 25°) preoperatively,the C2-7 SVA in the patients with high T1-Slope (＞25°) was decreased significantly.Compared with patients who had high T1-Slope preoperatively,the C2-7 Cobb in the patients with low T1-Slope was increased significantly.Conclusion Good curative effect could be achieved by ACDF and ACCF in cervical myelopathy.Both surgical methods can maintain the curvature of the cervical alignment and improve the sagittal balance parameters of the cervical alignment.Consideringthe cervical sagittal balance,the ACDF is more suitable for the patient with high T1-Slope angle preoperatively.

Objective To evaluate the application of TeamSTEPPS in training of community osteoporosis management team .Methods The TeamSTEPPS was applied for training of osteoporosis management team, and 1 513 residents aged ≥45 year were screened for osteoporosis in Kangjian community from January 2014 to March 2017.The identified patients with osteopenia and osteoporosis were intervened for one year.Cognitive level of the risk factors and symptoms associated with osteoporosis were assessed by questionnaires before and after the intervention .The bone density was examined at baseline and 6 months, 12 months after intervention.The effect of intervention was evaluated .Results A total of 467 patients (30.87%) with osteopenia and 476 patients (31.46%) with osteoporosis were detected .The cognitive levels of osteoporosis risk factors , including low calcium, vitamin D deficiency, lack of exercise, low weight, women menopause, matrilineal family history, smoking, excessive alcohol drinking and coffee drinking, were higher than those before intervention ( χ2＝62.909,78.742,59.974,50.478,29.512, 34.699,6.500,15.779,6.089,all P＜0.05).The awareness rates of symptoms , including lower back pain or body bone pain, shorter height and hunchback , low energy or nonviolent fracture , were also increased (χ2＝59.942,76.220,16.856,all P＜0.01).After intervention, the bone mineral density levels were increased compared to those before intervention (F＝530.28, P＜0.01 for osteopenia group; F＝339.51, P＜0.01 for osteoporosis group ); meanwhile, the differences were also significant between 6 months, 12 months after intervention and before intervention , between 12 months and 6 months after intervention (t＝-0.452,-0.968,-0.516,all P＜0.01 for osteopenia group; t＝-0.530,-1.045,-0.518, all P＜0.01 for osteoporosis group ).Conclusion The community osteoporosis management team trained by TeamSTEPPS can effectively improve the management levels of osteoporosis among residents in the community.

Objective To prepare 5-aminolevulinic acid (ALA) and hematoporphyrin monomethyl ether (HMME) hydrogel suppositories and to evaluate their photosensitizer transfer efficiencies in rectal tumor tissue.Methods The BALB/c mice implanted SW837 rectal cancer cells subcutaneously were randomly divided into four groups:intrarectal suppository administration group,cutaneous administration group,intratumoral injection group and intravenous injection group.Fluorescence spectrophotometry was used to measure the concentration of protoporphyrin Ⅸ (PpⅨ) and HMME in rectal wall,skin and tumor tissue.The distribution of photosensitizer was determined by a fluorescence spectroscopy system.Results The concentration of PpⅨ in the ALA suppository administration group was 9.76 times (1 h) and 5.80 times (3 h) higher than that in the cutaneous administration group,and the differences were statistically significant (all P＜0.05).The maximal penetration depth of ALA in tumor tissue was about 3-6 mm at 2 h after the cutaneous administration.After the HMME suppository administration,the concentration of HMME in the rectal wall was very low.The maximal penetration depth of HMME in tumor tissue was less than 2 mm after the cutaneous administration.Conclusions ALA is more likely to penetrate mucosal barrier compared to skin tissue.The hydrogel suppository based rectal administration is expected to be a new administration method for the rectal cancer photodynamic therapy using ALA.

Objective To explore the killing effect of dielectric barrier discharge (DBD) plasma on tumor cells and to analyze the DBD-induced apoptosis mechanism.Methods Thiazolyl blue tetrazolium bromide (MTT) assay method was used to detect the killing effect of low temperature plasma on the cytotoxicity of normal spleen leukocytes and acute promyelocytic leukemia cells (LT-12) at different doses.The changes of reactive oxygen species (ROS) level were measured after plasma treatment.The cell apoptosis rate was detected by Annexin V/PI double staining at different doses.The expression of apoptosis-related genes and proteins was detected by qRT-PCR and Western Blot.Results MTT results showed that the killing effect of plasma treatment was dose-dependent and time-dependent.The cell survival rate after 8 hours of treatment decreased from 98％ to 63％ with the dose increasing from 30 s to 240 s.The survival rate decreased from 78％ (2 h) to 39％ (24 h) after the treatment with a same dose (e.g.240 s).Annexin V/PI double staining results demonstrated that the plasma effect can induce apoptosis,and the apoptosis rate was not only positively correlated with the plasma dose,but also with the post-plasma time.The longer the post-plasma time,the higher was the apoptosis rate.The apoptotic rate of the 60 s dose treatment after 12 h was 48％ that increased to 55.3％ with the dose of 120 s.The production of reactive oxygen species (ROS) detected by flow cytometry also showed a time correlation of the plasma treatment.After the plasma treatment,the ROS level immediately increased to 1.24 times,and sharply increased to 5.39 times after 20 h post-plasma.The experimental results of qRT-PCR and Western blot showed that the expression of the genes and proteins of Caspase family and Bcl-2 family was very active at 8 to 12 h post-plasma treatment.Conclusions Low-temperature plasma can effectively kill tumor cells,and apoptosis is the main mechanism of death.The molecular mechanism of apoptosis of tumor cells induced by low temperature plasma was preliminary confirmed.

Objective To evaluate the influence of dosage,operation method,adverse reaction of endoscopic photodynamic therapy (EPDT) on its therapeutic efficacy in rabbit models of in-situ rectal cancer,so as to provide preclinical basis of photodynamic therapy for rectal cancer.Methods 20 rabbits with in-situ VX2 rectal cancer were randomly divided into control group,PDT low dose group,intermediate dose group,and high dose group.At 24 h before PDT,photosensitizer (hermimether) was intravenously injected into rabbits.630 nm semiconductor laser was used as light source.The growth of the tumor was observed by conventional endoscopy and endoscopic ultrasonography,and the survival time,general conditions and adverse reactions were recorded.The histopathological changes were observed by hematoxylin-eosin staining.Results At 7 d after PDT,the total response rates of low dose,intermediate dose and high dose group respectively were 40％ (slight),80％ (60％ remarkable and 20％ slight),100％ (20％ remarkable and 80％ slight).The average survival times of the three groups were 14 d,10 d and 5 d,respectively.The main adverse reactions were inflammation,intestinal obstruction,intestinal peristalsis loss and death.Conclusions The dosage of PDT is an important factor to influence the curative effect.The appropriate dose of PDT will have a better effect on the treatment of rectal cancer.A thorough study of these problems is helpful to the clinical application of PDT in the treatment of rectal cancer.

Objective: To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment. Methods: Totally 29 patients with severe cervical kyphosis(Cobb angle>50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively. There were 19 males and 10 females. The average age was 32.6 years ranging from 14 to 53 years. According to the etiology, 12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis, 1 had kyphosis due to anterior graft subsidence), 5 had neurofibromatosis, 4 had infective kyphosis, 8 had idiopathic cervical kyphosis. The curvature of cervical angle was measured by two-line Cobb method. The severity of cervical kyphosis was evaluated by kyphosis index (KI). Parameters including kyphosis levels, the apex of the kyphosis, C_2-7 sagittal vertical axis(SVA) and T₁ slope were also measured on lateral radiographs in the neutral position in each patient. The pre- and post-operative Japanese Orthopaedic Association(JOA) scores, visual analogue scale (VAS) of neek pain, neck disability index (NDI) and cervical alignment were compared. All patients were treated by skull traction. Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor. Results: Skull traction was performed for an average of 6.3 days. The mean vertebral number in kyphotic region was 4.7. The average operation time was 155 minutes and blood loss was 135 ml. The preoperative C_2-7Cobb angle was 46.6°±18.1° in average. It was reduced to 11.4°±6.4° in average after operation. The Cobb angle of operation region was 72.9°±19.6° in average before operation. It was reduced to 11.2°±6.4° in average after operation. The kyphosis region correction rate was 84.6%. The mean preoperative C_2-7SVA changed from (3.8±14.6) mm to (12.6±7.8) mm postoperatively. The mean preoperative T₁ slope changed from -10.6°±16.4° to 7.1°±14.9° postoperatively. The average postoperative C_2-7 Cobb angle, Cobb angle of kyphosis region, KI, C_2-7 SVA and T₁ slope changed significantly compared with preoperation (F=12.700-218.200, all P<0.01). The average postoperative JOA, VAS and NDI scores improved significantly compared with preoperation (F=225.500, 217.900, 131.200, all P<0.01). Conclusion For severe cervical kyphosis, anterior correction is a safe and effective technique, sufficient decompression will be achieved.