An innovative on-site real-time avian influenza virus(AIV)detection method was estab-lished by integratingrecombinase-aided amplification(RAA)with the clustered regularly inter-spaced short palindromic repeats(CRISPR)/CRISPR-associated protein(Cas)system.After analy-zing 120 sequences of the M gene of avian influenza viruses of different subtypes publicly available on NCBI,the RAA primers and crRNA were designed based on the identified highly conserved segment and used for RAA nucleic acid amplification.After the amplified products were transferred to a CRISPR/Cas13a detection system,the fluorescence values were monitored throughout the re-action process to indicate the results.The sensitivity and specificity of the RAA-CRISPR/Cas13a method were validated using gradient dilutions(106-100 copies/μL)of positive plasmids and sev-en other avian viruses.Fifty clinical samples were tested using this method and compared with the national standard fluorescence RT-PCR method.The results indicated that the detection limit for RAA-CRISPR/Cas13a method was 102 copies/μL,a two-fold improvement over the standard RAA.Specificity assay showed the established method only detected AIV with no cross-reactivity with other seven avian viruses.Compared to the national standard fluorescence RT-PCR method,this method exhibited 100％specificity,95.24％accuracy,and 98.00％consistency in detection of clinical samples.In conclusion,a universal and rapid RAA-CRISPR/Cas13a for detection of AIV was established with the capacity of achieving detection within 60 minutes at 37 ℃,which provides a rapid,sensitive,and specific on-site detection method for AIV.

Taking Wuzhou as an example,this paper investigates the construction of the standardized Party affairs system in public hospitals and the path for enhancing Party building quality.It clarifies the connotations and relationships of Party build-ing,Party affairs,and Party affairs standardization,and elaborates on the necessity and path of Party affairs standardization.Sub-sequently,an analysis of the current situation and existing problems,such as insufficient understanding,weak implementation,limited capabilities,and poor integration,is presented.Then,improvement measures,including Party committee guidance,pre-cise training,system construction,and practical promotion of relevant work,are proposed.Finally,the paper discusses the con-struction and improvement of the standardized Party affairs system,team building,and the deep integration of Party building and hospital operations,providing a reference for improving Party building quality in public hospitals.

Objective:To study a classifier used to classify arrhythmia electrocardiogram (ECG) signals under the inter-patient paradigm to improve the accuracy of automatic classification and solve the limitations of manual diagnosis of arrhythmia.Methods:A SVM+XGBoost ensemble classifier with four modules including preprocessing, feature extraction, support vector machine (SVM) training and ensemble classification was constructed. ECG signal was preprocessed, and R-R interval, high-order statistics, local binary patterns and wavelet components were used as features to train independent SVM classifiers. Then, XGboost algorithm was used to integrate independent SVM classifiers and output arrhythmia classification results. The integrated classifiers were trained and tested on MIT-BIH database.Results:The overall classification accuracy of the ensemble classifier for arrhythmia was 0.867 and the average sensitivity was 0.782.Conclusions:The proposed ensemble classifier can realize automatic and accurate classification of arrhythmia ECG signals under the inter-patient paradigm, and can be used for clinical auxiliary diagnosis.

Objective:To explore abnormal microstructural changes of white matter in patients with white matter lesions(WML) using diffusion tensor imaging(DTI), and to determine the association of such abnormalities of DTI parameters with executive function.Methods:Totally 34 patients with WML were recruited from the department of Neurology, Beijing Tiantan Hospital, Capital Medical University from March 2012 to May 2019.All patients with WML were scored with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA), and assessed with Montreal cognitive assessment (MoCA) and clinical dementia rating(CDR). They were divided into WML-cognitive normal group, WML-vascular cognitive impairment-non dementia group and WML-Dementia group.The Stroop color and word test (SCWT), trail making test-A (TMTA), digit symbol test and verbal fluency test were carried out to evaluate executive function.In addition, the healthy elderly without WML lesions were selected as the control group after they were examined by MRI, and all brains of the subjects went through DTI with Siemens 3.0 T MR.The data were collected and analyzed by voxel based analysis (VBA). The anisotropy and mean diffusion coefficient of DTI in the region of interest (ROI) and other regions in the brain were studied in the four groups, and their correlation with scores of executive function in WML patients was analyzed.Results:(1)In these executive function test, there were significant differences between the patients with cognitive impairment (WML-VAD group, WML-VCIND group) and normal cognition group(WML-CN group, NC group), such as SCWT(B)(65.54±6.24 vs 43.67±0.95, 76.75±2.13 vs 43.67±0. 95, 65.54±6.24 vs 43.66±1.81, 76.75±2.13 vs 43.66±1.81), SCWT(C)(88.58±6.76 vs 61.63±1.31, 96.37±1.47 vs 61 63±1.31, 88.58±6.76 vs 66.31±8.19, 96.37±1.47 vs 66.31±8.19), TMTA(40.47±2.76 vs 30.92±0.47, 44.24±1.43 vs 30.92±0.47, 44.24±1.43 vs 31.99±2.07, 40.47±2.76 vs 31.99±2.07), TMTB(88.66±6.55 vs 80.34±0.61, 96.70±1.72 vs 80.34±0.61, 88.66±6.55 vs 83.10±5.91, 96.70±1.72 vs 83. 10±5.91), Digit Symbol Test(39.25±5.63 vs 47.00±2.55, 31.27±3.93 vs 47.00±2.5, 39.25±5.63 vs 48.86±4.34, 31.27±3.93 vs 48.86±4.34) and Verbal Fluency Test(8.94±1.00 vs 11.71±0.47, 6.64±0.81 vs 11.71±0.47, 8.94±1.00 vs 10.86±0.69, 6.64±0.81 vs 10.86±0.69) scores ( P<0.05); In the patients with cognitive impairment, there were significant differences between WML-VAD group and WML-VCIND group, such as SCWT(B), SCWT(C), TMTA, TMTB, digit symbol test and verbal fluency test scores ( P<0.05); There were significant differences between WML-CN patients and NC group in the scores of SCWT (C), verbal fluency test( P<0.05). (2)FA values in the genu of corpus callosum and the inferior longitudinal fasciculus were negatively correlated with the time of SCWT (B), SCWT (C) and the TMTA( r=-0.436--0.471), but positively correlated with the scores of digit symbol test and verbal fluency test( r=0.428-0.573). MD values in the genu of corpus callosum, the superior/inferior longitudinal fasciculus and the inferior fronto-occipital fasciculus were positively correlated with the time of SCWT (B), SCWT (C) and TMTA( r=0.432~0.609), but negatively correlated with the scores of digit symbol test and verbal fluency test( r=-0.424--0.630, all P<0.003125 after emendation). Conclusion:The executive function of patients with WML-Dementia decreases significantly.The more serious the damage of white matter microstructure, the more serious the damage of executive of function.

Objective:To analyze the characteristic of nerve tracts in different stages of cognitive impairment caused by white matter hypertensities, applying diffusion tensor imaging-peak width of skeletonized mean diffusivity as evaluation indicator.Methods:Demographic characteristics and vascular risk factors of all subjects were recorded.Screened out 50 subjects without WMH and whose MoCA scale was more than or equal 26 points as normal control group.Then, we assessed 85 patients with WMH using the MoCA scale and clinical dementia assessment. Of 85 patients, 45 cases were divided into the normal cognition group, 23 cases were assigned into non-dementia vascular cognitive impairment group, and 17 cases into the vascular dementia group.The diffusion tensor imaging-peak width of skeletonized mean diffusivity marking method was used to compare the integrity of white matter fibers in WMH patients with varying degrees of cognitive impairment and normal control group.Results:The difference of PSMD among the four groups was statistically significant(CN group: 3.558±0.157, VCIND group: 4.128±0.222, VaD group: 5.469±0.000, NC group: 2.612±0.105, F=42.479, P<0.05). PSMD in WMH groups were higher than that in NC group (all P<0.05). There was no significant difference between WMH-VCIND group and WMH-CN group ( P=0.067). The PSMD of WMH-VAD group was higher than that of WMH-CN group and WMH-VCIND group (both P<0.05). Conclusion:PSMD can accurately detect white matter fiber damage caused by WMH.The degree of WMH combined cognitive decline was not completely consistent with the degree of PSMD increase.Compared with the cases with normal WMH cognition, PSMD was not significantly increased when WMH was combined with VCIND, while PSMD was significantly increased when WMH was combined with VaD.DTI-PSMD value as imaging marker can provide objective basis for clinical diagnosis of WMH-VaD.

With the development of technology and instruments, more and more giant liver tumors have been resected under laparoscopy. Compared with traditional approach hepatectomy, anterior hepatectomy is more suitable for laparoscopic resection of huge liver tumors, and it is also more in line with the " tumor-free principle" when it is used in the resection of liver malignant tumors. Our team summarized the experiences and lessons of laparoscopic hepatectomy and communicated with domestic and foreign experts to form a set of single center standardized process of laparoscopic anterior right hepatectomy, which is summarized as follows.

Objective: To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors. Methods: The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model. Results: (1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level, tumor diameter, pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (χ²=5.451, 4.900, 8.256, 4.419, 5.858, P<0.05), and pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ²=5.828, 6.968, 4.077, P<0.05). Multivariate analysis showed that preoperative ALP level, tumor diameter, and lymph node metastasis were independent factors influencing the postoperative 2-year overall survival rate of patients [hazard ratio (HR)=2.539, 2.619, 2.201, 95% confidence interval (CI) : 1.174-5.491, 1.209-5.673, 1.104-4.391, P<0.05)]; pathological type of tumor and lymph node metastasis were independent factors influencing the postoperative 2-year disease-free survival rate of patients (HR=2.254, 2.296, 95%CI: 1.170-4.344, 1.206-4.374, P<0.05). ③ Survival analysis: pathological type of tumor was an associated factor for the postoperative 2-year overall survival rate and 2-year disease-free survival rate of patients. Of the 87 patients with T3 gallbladder cancer, there was no significant difference in the postoperative 2-year overall survival rate between the 64 patients with gallbladder adenocarcinoma and 23 with gallbladder adenosquamous carcinoma (68.8% vs. 34.8%, χ²=8.256, P>0.05), but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3% vs. 30.4%, χ²=5.828, P<0.05). (3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis. ① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months, with a range from 3.2 to 82.7 months. The postoperative 2-year overall survival rate was 68.8%, and the postoperative 2-year disease-free survival rate was 56.3%. ② For the 64 patients with T3 stage gallbladder adenocarcinoma, univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (χ²=4.012, 8.837, P<0.05). The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (χ²=6.361, P<0.05). Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.244, 0.382, 95%CI: 0.088-0.674, 0.176-0.831, P<0.05). ③ Survival analysis: range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 64 patients with T3 stage gallbladder adenocarcinoma, the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8% and 69.7%, versus 51.6% and 41.9% of the patients undergoing standard lymph node dissection (χ²=8.837, 6.361, P<0.05). (4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. ① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months, with a range from 1.1 to 70.3 months. The postoperative 2-year overall survival rate was 34.8%, and the postoperative 2-year disease-free survival rate was 30.4%. ② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma, univariate analysis showed that preoperative ALP level, lymph node metastasis, range of hepatectomy, and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (χ²=5.288, 4.574, 12.960, 4.106, P<0.05). The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ²=7.364, 10.582, P<0.05). Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102, 0.153, 95%CI: 0.012-0.880, 0.033-0.718, P<0.05). ③ Survival analysis: range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma, the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5% and 75.0%, versus 6.7% and 6.7% of the patients undergoing hepatic wedge resection (χ²=12.960, 10.528, P<0.05). Conclusions Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer. The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma. Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma. Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection, and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy.

Objective To explore abnormal microstmctural changes of white matter in patients with white matter lesions using diffusion tensor imaging(DTI),and to determine the association of such abnormalities of DTI parameters with cognitive function.Methods The objects who have already confirmed with WML were collected from March 2012 to February 2018 through magnetic resonance imaging (MRI) scan from the neurology department of Beijing Tiantan Hospital.Use The hamilton depression scale(HAMD) and the hamilton anxiety scale (HAMA) to eliminate anxiety and depression,and divided into WML-CN group,WML-VCIND group and WML-VAD group with Mini-mental state examination (MMSE),Montreal Cognitive Assessment (MOCA)and clinical dementia rating(CDR).In addition,select the healthy elderly people without WML by MRI scan as the normal control group.All of the subjects were detected with the superconduct magnetic resonance imaging system (German SIEMENS 3.0T) for the DTI scanning.Original images were processed with VBA.Then explore the changes of FA and MD of DTI in whole brain and regions of interest in NC group,WML-CN group,WML-VCIND group and WWML-VAD group,and its correlation with the severity of cognitive impairment in patients with WML.Results The damage degree of the fiber microstructure of brain white matter was significantly correlated with the total grade point of MoCA (P＜0.01).In figure FA,the variance analysis of F test results showed that the significant brain areas were the splenium of the corpus callosum,the genu of corpus callosum,bilateral posterior internal capsule,retrolenticular part of internal capsule,anterior thalamic radiation,partial inferior longitudinal fasciculus and inferior fronto-occipital fasciculus,cingulate,external capsule,upper and posterior part of the radiation crowns,partial superior longitudinal fasciculus,etc.(P＜0.05 after FWE correction based on TFCE method).In Figure MD,the variance analysis of F test results showed that the statistically significant brain areas mainly included the left external capsule and hook,partial genu and splenium of corpus callosum,Bilateral,bilateral inferior fronto-occipital fasciculus,inferior longitudinal fasciculus,anterior thalamic radiation,retrolenticular part of internal capsule,cingulate,etc (P＜ 0.05 after FWE conection based on TFCE).Conclusion No matter whether cognitive impairment exists in patient with WML or not,all DTI parameters are different from those of normal people.The integrity of white matter fiber has been damaged with different degrees.The more severe the cognitive impairment in the external manifestations of patients with WML,the greater the damage to the intrinsic white matter microstructure.

Objective To investigate the differences of pre-hospital delay time in acute ST-elevation myocardial infarction (STEMI)between the advanced age group(>75 years old)and control group(≤75 years old).Methods Four hundreds patients with STEMI in the cardiology and emergency departments of the First Affiliated Hospital and Affiliated Luoyang Central Hospital of Zhengzhou University from January 2013 to March 2015 were selected and divided into two groups according to the age,the ad-vanced age group (>75 years old)and control group(≤75 years old).The patients′data were inquired and recorded for conducting the statistical analysis.Results The proportion of pre-hospital delay time < 6 h in the advanced age group was significantly lower than that in the control group and the time for conducting coronary angiography was longer than that in the control group,the differences were statistically significant(P <0.05).The mortality rates of intra-hospital,on 30 d and half a year after discharge in the advanced age group were higher than those in the control group,the differences between the two groups were statistically signif-icant (P <0.05).Conclusion The advanced age patients receiving active therapy are relatively less,which is mainly due to the wor-ry on the age related adverse reactions.

Objective To investigate the multi -slice CT angiography(MSCTA)findings and explore the clinical value of cavernous transformation of the portal vein(CTPV).Methods CT and clinical materials of 29 cases CTPV were retrospectively analyzed.Results Portal vein obstruction and surrounding fine dialated portoportal collat-erals were found in all 29 cases,Gastroesophageal varices and abnormal hepatic perfusion signs were detected in 25 patients and 8 cases respectively.Pericholedochal venous plexus and cystic vein were dilated and varicose in 9 cases. Conclusion Multi -slice CT has an important clinical role in CTPV diagnosis and treatment,and it can be used to evaluate the the portal vein obstructed status,the collateral vessels,and the accompanied complications of CTPV.