Objective To analyze the feasibility and efficacy of a deep convolutional neural network(DCNN)model based on chest CT images to evaluate bone mineral density(BMD).Methods A total of 1 048 health check subjects'2 096 central level images of lumbar 1 and 2 vertebral bodies were used for experiments and analysis in this retrospective study.According to the results of quanti-tative computed tomography(QCT)BMD measurement,the subjects were divided into three categories:normal,osteopenia,osteopo-rosis(OP).Herein,a DCNN segmentation model was constructed based on chest CT images[training set(n=1 096),tuning set(n=200),and test set(n=800)],the segmentation performance was evaluated using the Dice similarity coefficient(DSC)to com-pare the consistency with the manually sketched region of vertebral body.Then,the DCNN classification models 1(fusion feature construction of lumbar 1 and 2 vertebral bodies)and model 2(image feature construction of lumbar 1 alone)was developed based on the training set(n=530).Model performance was compared in a test set(n=418)by the receiver operating characteristic(ROC)curve analysis.Results When the number of images in the training set(n=300)was adopted,the DSC value was 0.950 in the test set.The results showed that the sensitivity,specificity and area under the curve(AUC)of model 1 and model 2 in diagno-sing osteopenia and OP were 0.716,0.960,0.952;0.941,0.948,0.980;0.638,0.954,0.940;0.843,0.959,0.978,respectively.The AUC value of normal model 1 was higher than that of model 2(0.990 vs 0.983,P=0.033),while there was no significant difference in AUC values between osteopenia and OP(P=0.210,0.546).Conclusion A DCNN may have the potential to evaluate bone mass based on chest CT images,which is expected to become an effective tool for OP screening.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia seen in clinical settings, which has been associated with substantial rates of mortality and morbidity. However, clinically available drugs have limited efficacy and adverse effects. We aimed to investigate the mechanisms of action of andrographolide (Andr) with respect to AF. We used network pharmacology approaches to investigate the possible therapeutic effect of Andr. To define the role of Andr in AF, HL-1 cells were pro-treated with Andr for 1 h before rapid electronic stimulation (RES) and rabbits were pro-treated for 1 d before rapid atrial pacing (RAP). Apoptosis, myofibril degradation, oxidative stress, and inflammation were determined. RNA sequencing (RNA-seq) was performed to investigate the relevant mechanism. Andr treatment attenuated RAP-induced atrial electrophysiological changes, inflammation, oxidative damage, and apoptosis both in vivo and in vitro. RNA-seq indicated that oxidative phosphorylation played an important role. Transmission electron microscopy and adenosine triphosphate (ATP) content assay respectively validated the morphological and functional changes in mitochondria. The translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) to the nucleus and the molecular docking suggested that Andr might exert a therapeutic effect by influencing the Keap1-Nrf2 complex. In conclusions, this study revealed that Andr is a potential preventive therapeutic drug toward AF via activating the translocation of Nrf2 to the nucleus and the upregulation of heme oxygenase-1 (HO-1) to promote mitochondrial bioenergetics.
Animals ; Rabbits ; Atrial Fibrillation/metabolism* ; Kelch-Like ECH-Associated Protein 1/metabolism* ; Signal Transduction ; NF-E2-Related Factor 2/pharmacology* ; Molecular Docking Simulation ; Oxidative Stress ; Energy Metabolism ; Mitochondria/metabolism* ; Inflammation/metabolism* ; Heme Oxygenase-1

Objective:To explore the effects of free gracilis muscle flap combined with sural nerve transfer for reconstruction of digital flexion and sensory function of hand in patient with severe wrist electric burn.Methods:A retrospective observational study was conducted. From January 2017 to December 2020, 4 patients with wrist high-voltage electric burn admitted to the Department of Burns of the First People's Hospital of Zhengzhou and 4 patients with wrist high-voltage electric burn admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital met the inclusion criteria, including 6 males and 2 females, aged 12 to 52 years. They were all classified as type Ⅱ wrist high-voltage electric burns with median nerve defect. In the first stage, the wounds were repaired with free anterolateral thigh femoral myocutaneous flap. In the second stage, the free gracilis muscle flap combined with sural nerve transplantation was used to reconstruct the digital flexion and sensory function of the affected hand in 3 to 6 months after wound healing. The cut lengths of muscle flap and nerve were 32 to 38 and 28 to 36 cm, respectively. The muscle flap donor area and nerve donor area were both closed and sutured. The survival condition of gracilis muscle flap and sural nerve, the wound healing time of recipient area on forearm, the healing time of suture in muscle flap donor area and nerve donor area were observed and recorded after operation, and the recovery of donor and recipient areas was followed up. In 2 years after operation, the muscle strength of thumb and digital flexion and finger sensory function after the hand function reconstruction were evaluated with the evaluation criteria of the hand tendon and nerve repair in the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association.Results:All the gracilis muscle flap and sural nerve survived successfully after operation. The wound healing time of recipient area on forearm was 10 to 14 days after operation, and the healing time of suture in muscle flap donor area and nerve donor area was 12 to 15 days after operation. The donor and recipient areas recovered well. In the follow-up of 2 years after operation, the muscle strength of thumb and digital flexion was evaluated as follows: 4 cases of grade 5, 3 cases of grade 4, and 1 case of grade 2; the finger sensory function was evaluated as follows: 4 cases of grade S3 +, 2 cases of grade S3, and 2 cases of grade S2. Conclusions:For patients with hand dysfunction caused by severe wrist electric burn, free gracilis muscle flap combined with sural nerve transplantation can be used to reconstruct the digital flexion and sensory function of the affected hand. It is a good repair method, which does not cause great damage to thigh muscle flap donor area or calf nerve donor area.

Objective:To analyze common respiratory pathogens epidemiology in hospitalized children with lower respiratory tract infection (LRTI) in a single center in Shanghai, and to provide the basic data support for clinical diagnosis and treatment of children with LRTI in Shanghai.Methods:Children with LRTI in Children′s Hospital of Fudan University were enrolled from January 1, 2015 to December 31, 2019, and respiratory samples were collected and tested by direct immunofluorescence assay and real time polymerase chain reaction. The epidemiological characteristics of different respiratory pathogens were analyzed. Chi-square test was used for statistical analysis.Results:A total of 18 716 children were included, the total detection rate of respiratory pathogens was 36.96% (6 918/18 716), and the most frequent detected pathogen was Mycoplasma pneumoniae (MP) (15.31%(2 866/18 716)), followed by respiratory syncytial virus (RSV) (10.40%(1 946/18 716)) and parainfluenza virus Ⅲ (PIV-Ⅲ) (4.65%(871/18 716)). The detection rate of pathogens in female was significantly higher than that in male (38.48%(2 936/7 630) vs 35.92%(3 982/11 086), χ2=12.72, P<0.001). RSV and influenza virus A (Flu-A) infections peaked in winter. The detection rates of influenza virus B (Flu-B) and human metapneumovirus (MPV) were higher in winter and spring. PIV-Ⅲ infection peaked in spring and summer. The peak of PIV-Ⅱ infection occurred in summer and autumn. The infections of adenovirus (ADV), MP, Chlamydia trachomatis (CT) and PIV-Ⅰ were prevalent throughout the year without significant seasonality. The detection rate of RSV declined with age, while the detection rate of MP increased with age. The co-infection rate was 1.65%(309/18 716), and the predominant co-infection type was MP and RSV (0.37%(70/18 716)). Conclusions:A variety of pathogens lead to children′s LRTI in Shanghai from 2015 to 2019, with the common infection of MP, RSV and PIV-Ⅲ. Different pathogens showed different epidemiological characteristics in age and season distributions.

Objective:To investigate the effects of cyclic tensile stress on the function and degeneration of nucleus pulposus cells.Methods:The human primary nucleus pulposus cells were isolated and cultured. The cyclic tensile stress (100 000 μ?, 10% tensile strain, 0.1 Hz, 8 640 cycles) was loaded on the cells for 24 h. The proliferation of the cells was examined by MTT method. The cell cycle and apoptosis were detected through flow cytometry. Gene expression profile chip was used to detect the differentially expressed genes between the tensile stress group and control group. The function of these gene was analyzed by bioinformatics. The expression of inflammatory related factors, TGF-β, matrix degrading enzymes and extracellular matrix molecules were examined by qRT-PCR.Results:The cyclic tensile stress significantly promoted proliferation and cell cycle of nucleus pulposus cells. The cell percentage of S phase ( t=5.336, P<0.05) and G2/M phase ( t=7.288, P<0.01) was significantly different between the tensile stress group and control group. The cyclic tensile stress inhibited apoptosis of nucleus pulposus cells (8.56%±0.48% vs 10.63%±0.32%, t=4.474, P<0.05). A total of 866 differentially expressed genes were detected. Gene ontology analysis showed the roles of these genes in cells including focal adhesion, extractable matrix, membrane raft, condensed chrome kinetochore, cytoskeleton, etc. The cyclic tensile stress significantly affected the mRNA expression of inflammatory related factors, TGF-β genes, matrix proteinase and extracellular matrix molecules. Compared with the control group, the mRNA expression of inflammatory related factors IL15 ( t=5.379, P<0.05), IGF1 ( t=5.454, P<0.05) and IGFBP7 ( t=13.57, P<0.01) were significantly decreased in the tensile stress group; The mRNA expression of TGF-β genes TGFB1 ( t=6.931, P<0.05), TGFB2 ( t= 15.56, P<0.01) and TGFB3 ( t=7.744, P<0.05) were significantly increased in the tensile stress group; The mRNA expression of matrix proteinase ADAMTS3 ( t=5.241, P<0.05) and MMP19 ( t=24.72, P<0.01) were significantly decreased, and TIMP3 ( t=8.472, P<0.01) increased in the tensile stress group; The mRNA expression of extracellular matrix molecules COL2A1 ( t=5.871, P<0.05), FLRT2 ( t=5.216, P<0.05) and FN1 ( t=4.289, P<0.05) were significantly increased. Conclusion:The cyclic tensile stress promoted cell cycle and proliferation and inhibited apoptosis of nucleus pulposus cells. The cyclic tensile stress may affect the function and degeneration of nucleus pulposus cells by regulating the expression of inflammatory related factors, TGF-β, matrix degradation enzymes and ECM molecules.

Objective:To investigate the epidemiological characteristics of classic human astrovirus (HAstV) among children under five years old with acute diarrhea, and to understand the role of HAstV in children acute diarrhea.Methods:A total of 1 010 fecal specimens were collected in 1 010 outpatients under five years old with acute diarrhea admitted to Children′s Hospital of Fudan University, Shanghai from January 2012 to December 2016. Reverse transcription polymerase chain reaction (PCR) or PCR was used for screening classic HAstV, group A rotavirus, norovirus and adenovirus. Genotypes of classic HAstV were determined by nucleotide sequencing and phylogenetic tree analysis.Results:The overall positive rate of classic HAstV was 2.7%(27/1 010). The detection rates of classic HAstV from 2012 to 2016 were 6.9%(10/144), 3.5%(5/144), 2.1%(3/144), 1.5%(4/265) and 1.6%(5/313), respectively. Almost 96.3%(26/27) of children infected with HAstV were 0 to 36 months of age. The prevalence of classic HAstV infections displayed a typical autumn/winter seasonality except in 2016. All the positive classic HAstV strains were genotyped as HAstV-1 with two lineages of HAstV-1a and HAstV-1b. Among them, the lineage of HAstV-1a was the predominant subtype (63.0%, 17/27). There were 77.8%(21/27) of the children with acute diarrhea only infected with classic HAstV, whereas for the remaining cases a variety of other enteric viruses were detected (three cases co-infected with HAstV and group A rotavirus, two cases co-infected with HAstV and adenovirus, and one case co-infected with HAstV, group A rotavirus and adenovirus).Conclusions:Children infected with HAstV are mainly less than 36 months of age. Although the genotype of classic HAstV detected in this study is single, but the lineages are in a state of dynamic change. Long-time and continuous monitor for the epidemiology of classic HAstV is needed to avoid outbreak of diarrhea in children.

Non-alcoholic fatty liver disease (NAFLD) is characterized by increased fat depositions in the liver while the patients do not have drinking history.NAFLD has a prevalence of 10％ ～40％ in global,25％ ～26％ in Western populations.From 2004 to 2013,the numbers of new patients on the waitlist who had NASH increased by 170％ in America.The prevalence of NAFLD in China is 20％.With the decrease of HBV and HCV and the increase of diabetes mellitus type 2 and obesity,NAFLD will become the most common chronic liver disease in China over the next 20 years.NAFLD related end-stage liver disease will become the most common indication of liver transplantation.In this paper,the epidemiological features,pathogenesis,indication and prognosis of liver transplantation are reviewed.

OBJECTIVE：To construc t the evaluation system of the research quality of medical insurance budget impact analysis （BIA），and to provide feasible evaluation tool for related departments as medical insurance department. METHODS ：Based on BIA guidance documents and relevant empirical literatures of ISPOR ，Canada，Poland，the United States and other countries ， combined with expert interview ，the relevant elements of medical insurance negotiation BIA material were confirmed （including key elements and adjuctive elements ）. The scale and system was established to calculate total score of BIA research quality evaluation. RESULTS ：Key elements included three data blocks as target population ，market situation and treatment cost ，involving 14 key elements such as total population ，new drug scenario market share ，treatment cost ，etc.. According to the degree of compliance，0-3 points were assigned and the lowest score after normalization was taken as the basic score of BIA research quality. The adjunctive elements included five data blocks as title & abstract ，research background ，analysis framework ，result presentation and other ，including 23 adjunctive elements such as title ，abstract，research angle ，research time limit ，etc.. According to whether there is quality grade difference ，the elements were divided into type A and type B ；the grade score （0-4 points）and 0/1 score（1 point for yes and 0 point for no ）were used respectively ，and the additional score of BIA research quality was obtained after calculation and addition. According to the addition of different weights （0.67 and 0.33）of basic score and additional score ，the total score system of BIA research quality evaluation could be calculated. CONCLUSIONS ：This study successfully constructed a new BIA quality evaluation system ，which can be used for the quality evaluation of BIA research submitted by medical insurance drug negotiation.

BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94％ and 86.13％, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.

Objective: To explore the relationship between parental control and aggressive behavior of middle school students. Methods: Random cluster sampling was used to select 1 046 students.Information was collected through the Chinese version of Parental Control Questionnaire and Buss ＆ Perry Aggression Questionnaire. Results: The score on anger were high among female students and the total score were high among male students(t=6.28,2.56,P<0.01).Multiple comparison showed. the grade two junior middle school students’aggression level is significantly higher than grade three junior middle school students and grade one, two high school students(t=3.22,4.07,3.01,P<0.05). There were significant gender differences in parental control,father’s behavior control and father’s psychological control(P<0.05).Parental control shows a significant grade difference,multiple comparison showed, parental control among junior middle school students is significantly higher than that among high school students(t=3.22, 4.07, 3.01, P<0.05).Parental control and aggressiveness of the students were significantly positively correlated(r=0.16,0.29).There was a significant positive correlation between the psychological control of the parents and the aggressiveness of the boys(r=0.26,0.23).The behavior control and psychological control of the parents were positively correlated with the aggressiveness of the girls(r=0.09,0.13,0.29,0.35)(P<0.05).The Logistic regression analysis showed,father’s psychological control(OR=0.50,95%CI=0.21-0.79) and mother’s psychological control(OR=0.32,95%CI=0.02-0.62) showed significant positive association with aggression of the boys.Mother’s psychological control(OR=0.55,95%CI=0.23-0.87)and parents’ control(OR=0.17,95%CI=0.01-0.33) were positively associated with aggression of the girls(P<0.05). Conclusion Effective intervention of parental control might help prevent and control aggressive behavior of middle school students.