Esophageal cancer is one of the most common malignant tumors in China and dysphagia caused by malignant stenosis is the most common symptom of advanced esophageal cancer. The inability to eat orally seriously affects the quality of life of patients with advanced esophageal cancer, and poor nutritional status caused by dysphagia limits the implementation of standard treatment programs such as radiotherapy and chemotherapy, resulting in a decline in survival. The 125I radioactive stent is a novel treatment for malignant stenosis. Studies have shown that it can relieve dysphagia and prolong patients' survival compared to traditional esophageal stents. In this article, the treatment of malignant stenosis in advanced esophageal cancer and the clinical application progress of 125I radioactive stents were reviewed.

Objective To investigate the effect of ursodeoxycholic acid(UDCA)on the symptoms after severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in patients with primary biliary cholangitis(PBC)and their family member.Methods A questionnaire survey was conducted to collect related information from 171 PBC patients who attended The First Affiliated Hospital of Air Force Medical University before March 22,2023 and 128 family members,including demographic information,comorbidities,UDCA administration,SARS-CoV-2 infection,vaccination,symptoms,therapeutic medication,and the changes in liver disease-related symptoms.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.Results The median age was 51 years in the PBC patients and 49 years in the family members,with no significant difference between the two groups(P>0.05).Compared with the family member group,the PBC group had significantly lower body mass index(22.2±2.4 kg/m2 vs 23.3±2.9 kg/m2,P<0.001)and proportion of male individuals(10%vs 55%,P<0.001).All PBC patients received UDCA at a dose of 13—15 mg/kg,and SARS-CoV-2 infection rate was 100%in both groups.The family members had a significantly higher SARS-CoV-2 vaccination rate than the PBC patients(91%vs 57%,P<0.001).Compared with the family members,the PBC patients had significantly milder symptoms of sneezing,nasal obstruction,chest pain,and abnormal taste(P<0.05).Compared with the family members,the PBC patients had significantly lower rates of use of compound cold medicine(11%vs 20%,P<0.05)and Lianhua Qingwen capsules(12%vs 21%,P<0.05).For the PBC patients after SARS-CoV-2 infection,the liver disease-related symptoms such as fatigue,abdominal distension,dry mouth and dry eyes,pruritus,and yellow skin were aggravated by 37%,2%,27%,10%,and 3%,respectively.Conclusion Compared with the immediate family members of PBC patients who do not take UDCA,the PBC patients receiving UDCA do not show a reduction in SARS-CoV-2 infection rate,but UDCA may have a certain effect on alleviating infection-related symptoms in such patients.PBC patients may still experience the aggravation of liver disease-related symptoms after SARS-CoV-2 infection,and the long-term effect on PBC patients after SARS-CoV-2 infection should be taken seriously in clinical practice.

Abstract: Objective To analysis the genetic evolution characteristics of hemagglutinin (HA) gene of influenza A(H1N1)pdm virus in Changsha City from 2016-2023, to understand the trend of the HA genetic evolution and the mutations of the amino acid. It provides a scientific basis for the prevention and control of influenza epidemics, as well as the screening of vaccines under the new situation. Methods The A(H1N1)pdm09 virus strains from Changsha City from 2016 to 2023 were isolated using SPF chicken embryos, and then the HA genes were sequenced by MiSeq of Illumina Inc. The homology of HA gene was analyzed by MegAlign of the DNASTAR, and the phylogenetic tree was constructed using the Neighbor Joining (NJ) method in the Molecular Evolutionary Genetics Analysis version 11 (MEGA11). Results The homology of the HA gene of A(H1N1)pdm virus in Changsha from 2016 to 2023 was between 94.8%-99.9%, with the HA gene homology decreasing annually. The homology between the isolated strains of A(H1N1)pdm09 in Changsha City from 2016 to 2023 and the WHO recommended vaccine strain ranged from 96.8% to 99.0%, indicating a relatively good match between the flu isolates and the recommended vaccine strain. The phylogenetic tree of the HA gene of the A(H1N1)pdm09 influenza virus in Changsha City showed that the HA gene evolved into several different branches within the 6B branch, and it had currently evolved to 6B.1A.5a.2a branch. Constant mutations had occurred at the amino acid sites of the four antigenic determinant clusters of HA protein. Currently, amino acid mutations had occurred at 15 antigenic sites within the four antigenic determinant clusters, and the newly emerged A186T antigen mutant site in the isolates from 2023 was worth recent notice. The receptor-binding sites are relatively conserved in loop 130, minor amino acid mutations occurred in loop 220, whether the amino acid mutation site in loop 190 is becoming more stable needs to be further monitored. Taking A/California/07/2009 (CY121680) as the reference strain, most of the A(H1N1) pdm09 isolates in Changsha was increased 162 NQTY glycosylation site and was decreased 276 NTTC glycosylation site, and the glycosylation mutations at these two sites have become more stable recently. Conclusions The HA genes of influenza A(H1N1)pdm virus in Changsha are constantly evolving and mutating, suggesting influenza surveillance should be strengthened continuously.

Objective:To analyze the correlation between related indexes of serum lipid and insulin resistance and cognitive impairment in middle-aged and elderly people with mild cognitive impairment (MCI).Methods:In this cross-sectional study, 262 middle-aged and elderly patients with a Montreal Cognitive Function Scale (MoCA) cognitive score greater than or equal to 18 points who underwent physical examination in the Health Management Center of Beijing Tiantan Hospital Affiliated to Capital Medical University from January 1 to July 31, 2021 were selected as subjects. According to the cognitive function and MoCA score, the patients were divided into MCI group (143 cases) and normal cognition group (119 cases). Basic data, fasting blood glucose, triglyceride (TG), total cholesterol, apolipoprotein E(ApoE) genotype and other clinical indicators were collected. Hypothesis test was used to compare the differences in basic data, related indicators of blood lipid and insulin resistance between the two groups. Spearman correlation analysis was used to analyze the correlation between related indicators of blood lipid and insulin resistance and MoCA score in the two groups.Results:The age and the proportion of patients with hypertension, coronary heart disease and diabetes in the MCI group were all significantly higher than those in normal cognition group [(54.83±8.29) vs (50.76±6.34) years, 37.76% vs 31.93%, 4.20% vs 0.84%, 16.08% vs 8.40%] (all P<0.05). The elevation of serum TG ( r=-0.50, 95% CI:-0.88--0.12), TG glucose product index (TyG) ( r=-0.75, 95% CI:-1.29--0.20) and TG to high-density lipoprotein cholesterol ratio (TG/HDL-C) ( r=-0.52, 95% CI:-0.91--0.13) were all negatively correlated with MoCA score (all P<0.05). After adjusting for age and gender, the elevation of TG ( r=-0.39, 95% CI:-0.75--0.31) and TG/HDL-C ( r=-0.43, 95% CI:-0.80--0.05) were both still negatively correlated with MoCA score (both P<0.05). There was no significant correlation between all indexes and MoCA scores in the normal cognition group (all P>0.05). The elevated TG was negatively correlated with MoCA score in the MCI group ( r=-0.70, 95% CI:-1.23-0.16, P=0.017). There was no significant correlation between elevated TG and MoCA score in patients carrying ApoE ε2 and ApoE ε3 genotypes in MCI group (all P>0.05). Conclusion:Elevated related indexes of blood lipids and insulin resistance are negatively correlated with cognitive scores in middle-aged and elderly people with MCI, and it′s more obvious in patients with ApoE ε4 genotype.

Objective:To explore the curative effect of laparoscopic surgery for hepatic cysticercosis.Methods:Search the literature from February 2010 to February 2020 on literature platforms such as Wanfang Data, VIP, CNKI, Pubmed, ScienceDirect, Web of Science, etc. the key words were "肝囊型包虫病" , "细粒棘球蚴" , "手术" , "开腹手术" , "腹腔镜" , "微创手术" , " echinococcosis " , " liver or hepatic " , " laparoscopic or minimal invasive " . Data on intraoperative indicators (e.g., operation time, bleeding volume), postoperative complications, hospital stay, recurrence rate, etc. in the literature included in the study were extracted and meta-analyzed.Results:A total of 9 articles were included, including 2 prospective studies and 7 retrospective case-control studies. A total of 1031 patients were enrolled, including 272 in the laparoscopic group and 759 in the laparotomy group. The results of the meta-analysis showed that the total postoperative complication rate in the laparoscopic group was lower than that in the laparotomy group ( OR=1.64, 95% CI: 1.10-2.45, P<0.05). Incision-related complications in the laparoscopy group and laparotomy group the difference was statistically significant ( OR=2.81, 95% CI: 1.03-7.70, P<0.05), and the hospital stay in the laparoscopic group was shorter ( SMD=1.21, 95% CI: 0.47-1.96, P<0.05). There was no significant difference between the two groups in operation time, postoperative bile leakage, residual cavity infection and effusion, and postoperative recurrence rate ( P>0.05). Conclusions:Under the premise of strictly grasping the indication of laparoscopic surgery, the incidence of complications after laparoscopic surgery is low, the hospitalization time is short.

Objective:To investigate the association of Subclinical Carotid AtheroSclerosis (SCAS) and prediabetes or Diabetes Mellitus (DM)in the healthy people.Methods:From September 2018 to June 2019, participants who underwent physical examination in the Health Management Center of Beijing Tiantan Hospitial were enrolled consecutively. The baseline characters were collected prospectively. Carotid Ultrasound was evaluated by radiologists according to the standard operating protocol. Univariable analysis and multivariable logistic analysis were used to estimate the association of prediabetes or DM with SCAS.Results:Totally 401 participants were eligible and enrolled. The mean age was (52.2±10.4) years and 43.7% (252/401) of them were females. The prevalence of DM and SCAS were 16.4% (66/401) and 48.9% (196/401) respectively. In the univariate analysis, elder age (≥60 years old) ( OR=5.93, 95% CI: 3.86-9.09, P<0.001), hypertension ( OR=2.76, 95% CI: 1.84-4.15, P<0.01), prediabetes( OR=1.67, 95% CI: 1.08-2.58, P<0.05) and DM ( OR=3.60, 95% CI: 1.97-6.58, P<0.01), cigarettes smoking ( OR=2.64, 95% CI: 1.82-3.81, P<0.001), lower HDLlevel<1.04 mmol/L ( OR=1.58, 95% CI: 1.04-2.42, P<0.001) and hyperhomocysteinemia (≥15 μmol/L)( OR=1.69, 95% CI: 1.17-4.04, P<0.01) were associated with higher prevalence of SCAS. On the contrary, female sex ( OR=0.53, 95% CI: 0.39-0.74, P<0.001) was associated with lower prevalence of SCAS. In the multivariable logistic analysis, elder age(≥60 years old) ( OR=6.04, 95% CI: 3.13-11.7, P<0.01), hypertension ( OR=2.14, 95% CI: 1.13-3.87, P<0.05), cigarettes smoking ( OR=2.19, 95% CI: 1.21-3.98, P<0.05) and DM ( OR=2.32, 95% CI: 1.16-4.67, P<0.05) were associated with SCAS independently. The association between prediabetes and SCAS was not statistically significant. Conclusions:DM is independently associated with SCAS in neurological healthy people, while prediabetes tended to increase the risk of SCAS.

Accurate identification of cell types from single-cell RNA sequencing (scRNA-seq) data plays a critical role in a variety of scRNA-seq analysis studies.This task corresponds to solving an unsupervised clustering problem,in which the similarity measurement between cells affects the result significantly.Although many approaches for cell type identification have been proposed,the accuracy still needs to be improved.In this study,we proposed a novel single-cell clustering framework based on similarity learning,called SSRE.SSRE models the relationships between cells based on subspace assumption,and generates a sparse representation of the cell-to-cell similarity.The sparse representation retains the most similar neighbors for each cell.Besides,three classical pairwise similarities are incorporated with a gene selection and enhancement strategy to further improve the effectiveness of SSRE.Tested on ten real scRNA-seq datasets and five simulated data-sets,SSRE achieved the superior performance in most cases compared to several state-of-the-art single-cell clustering methods.In addition,SSRE can be extended to visualization of scRNA-seq data and identification of differentially expressed genes.The matlab and python implementations of SSRE are available at https://github.com/CSUBioGroup/SSRE.

Objective To observe the incidence,clinical characteristics,related factors,adverse events during hospitalization and short-term prognosis of postprandial hypotension (PPH) in elderly patients with coronary heart disease.Methods One hundred and sixty-eight elderly patients with coronary heart disease hospitalized in the Department of Cardiology,Second Hospital of Hebei Medical University from January 2014 to January 2015 were selected as the research subjects.They were monitored by 24 h ambulatory blood pressure monitoring.According to the diagnostic criteria of PPH,they were divided into postprandial hypotension group (PPH group) 34 cases and non-postprandial hypotension group (NPPH group) 134 cases.The clinical characteristics,risk factors related to PPH,occurrence of adverse events and prognosis of all-cause death,cardiovascular and cerebrovascular adverse events were compared between the two groups.Results Among 168 elderly patients with coronary heart disease,thirty-four patients had PPH,and the incidence rate was 20.2％ (34/168).The average systolic blood pressure before meals in PPH group was (139.8± 18.6) mmHg (1 mmHg =0.133 kPa).The proportion of taking calcium antagonists was 50.0％ (17/34) higher than that in NPPH group (127.4± 13.2) mmHg,27.6％ (37/134).The difference between the two groups was statistically significant (t =6.463,x2=6.232,P＜ 0.05).PPH was higher in breakfast and dinner than in lunch;the higher the basal systolic blood pressure level,the higher the incidence of PPH.Logistic regression analysis showed that the basal systolic blood pressure level and age were positively correlated with the occurrence of PPH (r =0.301,r =0.208,P＜ 0.05).Follow-up for 26 months showed that the incidence of all-cause death and cerebrovascular events in PPH group was higher than that in NPPH group (x2 =5.800,11.560,P＜ 0.05).Conclusion The incidence of PPH in elderly patients with coronary heart disease during hospitalization is 20.2％.Breakfast and dinner at three meals are prone to PPH.Older age and high systolic blood pressure level will increase the incidence of PPH.PPH will increase the incidence of mid-term all-cause death and cerebrovascular events.

Objective? To explore the effects of National Institute for Health and Care Excellence (NICE) Guideline based palliative care in end-stage heart failure patients. Methods? From October 2016 to May 2017, we selected end-stage heart failure patients from four wards of cardiovascular department at a ClassⅢ Grade A hospital in Zhengzhou as subjects by convenience sampling. Patients from the first to the third ward were in experimental group (n=143), and those from the fourth ward were in control group (n=135). Control group carried out routine palliative care. On the basis of that in control group, experimental group adopted individual palliative care according to the National Institute for Health and Care Excellence (NICE) guideline. Four months after intervention, we compared the intervention effects with the Chinese version of palliative care outcome scale (POS) and the medical outcomes study short form 12-item version 2 (SF-12v2). Results? Four months after intervention, the total score of POS of patients in experimental group was lower than that in control group with a statistical difference (P＜ 0.01). The total scores of physical and mental health of SF-12v2 of patients in experimental group were higher than those in control group with statistical differences (P＜ 0.01). Conclusions?NICE guideline based palliative care can reduce the anxiety of patients and their family members, and can improve quality of life of patients.

Objective To investigate the clinical effect of anterior internal fixation plus vacuum sealing drainage in the treatment of ulnar and radial fractures of Gustilo type Ⅲ.Methods Twenty-eight patients with open ulnar and radial fracture of Gustilo type Ⅲ were managed from April 2007 to March 2014,and were divided into four groups(n =4).Group A were managed with external fixator and conventional changing dressings.Group B were managed with internal fixation and vacuum sealing drainage.Group C were managed with external fixator and vacuum sealing drainage.Group D were managed with internal fixation and conventional changing dressings.Result Twenty-eight cases were adopted telephone follow-up for 6 to 27 months.The soft tissue recovery time of each group respectively was (20.5 ± 2.37) days,(14.7 ±2.16) days,(15.6 ±2.17) days and(19.7 ±2.18) days.The hospital stay of each group respectively was (9.7 ± 2.54) weeks,(4.7 ± 1.46) weeks,(5.2 ± 2.34) weeks and 8.6 ± 2.16) weeks.The fracture healing time of each group respectively was (19.6 ± 2.74) weeks,(13.1±1.84) weeks,(18.1 ±2.54) weeks and (14.7 ± 1.74) weeks.There was significant difference of these data between the two groups(P ＜ 0.05).Conclusions Anterior internal fixation plus vacuum sealing drainage is a better way to treat ulnar and radial fractures of Gustilo type Ⅲ.The technique has short period,less complications,less painful and less expense.