Shoulder pain ranks the third in musculoskeletal pain,with relatively high incidence in the population.Early diagnosis of shoulder diseases is crucial.Deep learning(DL)in shoulder joint imaging was conducive to clinical diagnosis,treatment and prognosis evaluation of shoulder diseases.The research progresses of DL in shoulder joint imaging were reviewed in this article.

With reference to the teaching reform of standardized training cases based on organ systems, a teaching case writing team has been established, integrating the teaching experts in basic medicine, clinical medicine, humanities medicine, and other fields. Through collective lesson preparation and discussion, non-fictional comprehensive scenario writing techniques have been used based on organ systems and oriented by competency development, and the teaching cases for postgraduate students were written on the basis of real cases, which lays a solid foundation for the hierarchical and progressive cultivation and improvement of the quality of competency cultivation for postgraduate students through case teaching based on organ systems.

By identifying and analyzing the problems and difficulties in the implementation process of student stratification, goal stratification, practice stratification, and assessment stratification in standardized residency training, this article proposes to fully leverage the main role of professional bases in hierarchical and progressive teaching for standardized residency training and strengthen the specific responsibilities of professional base teaching groups in discussing hierarchical and progressive teaching plans, evaluation standards, and assessments. It is also necessary to scientifically implement student stratification, achieve consistent stratification goals, strengthen the training of hierarchical and progressive teaching concepts and teaching abilities for teachers, enhance the ability for homogeneous and hierarchical evaluation, and develop countermeasures that combine stage training goal process evaluation with dynamic personalized teaching by mentors, so as to provide a useful reference for further promoting the reform of standardized residency training using a hierarchical and progressive teaching model.

The Omicron family of SARS-CoV-2 variants are currently driving the COVID-19 pandemic. Here we analyzed the clinical laboratory test results of 9911 Omicron BA.2.2 sublineages-infected symptomatic patients without earlier infection histories during a SARS-CoV-2 outbreak in Shanghai in spring 2022. Compared to an earlier patient cohort infected by SARS-CoV-2 prototype strains in 2020, BA.2.2 infection led to distinct fluctuations of pathophysiological markers in the peripheral blood. In particular, severe/critical cases of COVID-19 post BA.2.2 infection were associated with less pro-inflammatory macrophage activation and stronger interferon alpha response in the bronchoalveolar microenvironment. Importantly, the abnormal biomarkers were significantly subdued in individuals who had been immunized by 2 or 3 doses of SARS-CoV-2 prototype-inactivated vaccines, supporting the estimation of an overall 96.02% of protection rate against severe/critical disease in the 4854 cases in our BA.2.2 patient cohort with traceable vaccination records. Furthermore, even though age was a critical risk factor of the severity of COVID-19 post BA.2.2 infection, vaccination-elicited protection against severe/critical COVID-19 reached 90.15% in patients aged ≽ 60 years old. Together, our study delineates the pathophysiological features of Omicron BA.2.2 sublineages and demonstrates significant protection conferred by prior prototype-based inactivated vaccines.
Humans ; Aged ; Middle Aged ; COVID-19/prevention & control* ; SARS-CoV-2 ; Pandemics/prevention & control* ; China/epidemiology* ; Disease Outbreaks/prevention & control* ; Vaccination

Objective:To investigate the prevalence of pretreatment drug resistance and the genetic polymorphism of CRF08_BC strains among HIV-1 patients in China.Methods:This cross-sectional survey involved the plasma samples of HIV patients in a national pretreatment HIV drug resistance survey conducted in 2018. RNA was extracted from the samples. The fragments containing protease and partial reverse transcriptase (PR/RT) regions were obtained and sequenced. Drug resistance was analyzed using Stanford HIVdb Program. Differences in polymorphic mutations between drug-resistant and non-drug-resistant HIV-1 strains were analyzed by Chi-square test or Fisher′s exact test. The association between drug-resistant and polymorphic mutations was evaluated using CorMut R package. Molecular transmission networks were constructed using HIV-TRACE software. Results:Totally 465 partial pol sequences were obtained from individuals with CRF08_BC infection in 25 provinces and cities. The total pretreatment drug resistance rate was 17.8% (83/465). The pretreatment drug resistance rates to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) were 16.6% (77/465), 1.1% (5/465) and 0.9% (4/465), respectively. The resistance rate to rilpivirine (RPV) was the highest (15.7%, 73/465). The most common mutation was E138A (11.6%, 54/465). There were six polymorphic mutations (S162C, K102Q, T200A, V179E, I202V, T200M) that co-variated with E138A. The molecular transmission network showed that patients infected with CRF08_BC strains carrying the resistant mutations at position E138 mainly gathered in clusters in Yunnan and Sichuan, and the highest degree of connection was in Lincang, Yunnan. Conclusions:In China, HIV-1 CRF08_BC-infected patients showed a high rate of pretreatment resistance to one of the second-generation NNRTIs, namely RPV. Further researches were warranted to evaluate the impacts of co-mutations of the E138A mutation and polymorphic sites on HIV resistance and replicative capacity.

Objective:To explore the resistance to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase inhibitors (INSTIs) of HIV-1 CRF55_01B and the transmission of drug-resistant strains among HIV-1 CRF55_01B infected patients before antiviral treatment in China.Methods:HIV-1 RNA was extracted from plasma samples of the patients infected with CRF55_01B in the national surveillance of HIV drug resistance before antiviral treatment in 2018. A 1 056 bp gene fragment of protease/reverse transcriptase (PR/RT) region and an 846 bp gene fragment of integrase (IN) region were obtained and sequenced. Drug resistance was analyzed by using all drugs included in the Stanford University HIV db Program, HIV-1 molecular network analysis was performed with software HIV-TRACE and polymorphism mutations of CRF55_01B integrase gene region were analyzed.Results:A total of 178 samples from 26 provinces, municipalities and autonomous regions in China were analyzed, and 170 sequences of CRF55_01B PR/RT region and 170 sequences of IN region of corresponding samples were obtained. The drug resistance rate was 15.3% (26/170). The drug resistance rates of PIs, NRTIs, NNRTIs and INSTIs were 1.2% (2/170), 1.2% (2/170), 15.3% (26/170), 0.6% (1/170), respectively. The level of drug resistance was mostly low. NNRTIs drug resistance mutations were mainly V179D/E co-appeared with other mutations, and 84.1% (143/170) of the infected patients carrying V179D/E alone showed potential drug resistance. INSTIs drug resistance mutation was G163R, and showed low resistance to EVG and RAL. The molecular network access rate was 30.0%(51/170)according to the 0.9% gene distance threshold. The resistant strains were transmitted between men with homosexual transmission and heterosexually transmitted people, and both carried resistant mutations E138G and V179E. In the integrase region, CRF55_01B and CRF01_AE and B subtypes showed high mutation frequency difference in 5 sites (T215A、G134N、I135V, K136R and L101I/V).Conclusions:Before antiviral treatment, CRF55_01B infected patients in China had a high resistance to NNRTIs. Strains carrying both E138G and V179E resistance mutations were transmitting in clusters. The prevalence of CRF55_01B integrase inhibitor resistant strains is low, but some genetic polymorphisms with high mutation rate in the integrase gene region have potential influence on drug sensitivity. The influence of drug resistance of new recombinant strains on antiviral therapy in China needs to be further monitored and analyzed.

OBJECTIVE：To study the effects of Calpeptin inhibitor Calpeptin on the transformation and stemness markers expression induced by estradiol（E2），and to investigate its mechanism. METHODS ：Taking human mammary epithelial cells MCF-10A as research object ，transformed cells were induced by E 2 treatment. Cells were divided into control group （0.1％DMSO）， E2-transformed group （50 nmol/L），E2-transformed+Calpeptin group （50 nmol/L E 2+1 μmol/L Calpeptin），then continuously treated with corresponding drug-containing culture medium for 15 generations. Then ，MTT assay was used to determine the proliferation rate of cells （24，48 h）；plate colony test was used to detect the Clone formation rate of cells ；the number of sphere-forming cells was measured by suspension spheroidization test ；mRNA expressions of stemness marker （CD44，Nanog，OCT4）and extracellular sigal-regulated kinase （ERK）were detected by RT-qPCR ，and protein expressions of CD 44，Nanog，OCT4 ，ERK and p-ERK were detected by Western blotting assay. Another E 2-transformed cells were divided into control group （0.1％DMSO）and U0126 （ERK inhibitor ）group（10 μmol/L）. Clone formation rate ，the number of sphere-forming ，protein expressions of CD 44，Nanog， OCT4，ERK and p-ERK were determined with above methods ，and to validate the relationship of ERK inhibition with transformed cell behavior and the expression of stemness markers. RESULTS ：Compared with control group ，proliferation rate and clone formation rate of E 2 transformed group were increased significantly （P＜0.01），and the number of sphere-forming was increased significantly（P＜0.01）；mRNA expression levels of CD 44，Nanog，OCT4，ERK and protein expression levels of CD 44，Nanog， OCT4 and p-ERK in cells were increased significantly （P＜0.01）. Compared with E 2-transformed group ，proliferation rate （24，48 h）and clone formation rate of E 2-transformed + Calpeptin group were decreased significantly （P＜0.01），and the number of sphere-forming was decreased significantly （P＜0.05）；mRNA expression levels of CD 44，Nanog，OCT4 ，ERK and protein expression levels of CD 44，Nanog，OCT4，p-ERK in cells were decreased significantly （P＜0.05 or P＜0.01）. After treated with ERK inhibitor U 0126，clone formation rate of E 2-transformed cells ，the number of sphere-forming ，protein expression levels of CD44，Nanog，OCT4 and p-ERK were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS ：Calpeptin can inhibit the transformation and the expression of stemness markers of human mammary epithelial cells MCF- 10A，and the mechanism of it may be associated with inhibiting the activation of Calpain-ERK signaling pathway.

Objective:To investigate the isolation characteristics and the antibiotic resistance of Streptococcus pneumoniae in hospitalized children from the Bao′an District of Shenzhen for many consecutive years, and to provide evidence for the assessment as well as clinical prevention and treatment of Streptococcus pneumoniae infection. Methods:The isolation rate and sample source of Streptococcus pneumoniae isolates as well as age composition of hospitalized children in Bao′an Maternal and Child Health Hospital of Shenzhen city from January 2012 to December 2018 were retrospectively analyzed.The susceptibility of the isolates to antibiotics was tested by disk diffusion method and E-test method. Results:(1) From 2012 to 2018, a total of 90 807 specimens were retrospectively summarized, 9 193 strains of Streptococcus pneumoniae were isolated, with an isolation rate of 10.1%, which was the first pathogen; 98.68% (9 072/9 193 cases) from respiratory tract samples and 97.20% from sputum samples.Among 107 strains isolated from aseptic body fluid specimens, 97 strains were blood specimens. Streptococcus pneumoniae was the most common bacteria with positive culture in aseptic body fluids.(2) The isolation rate of Streptococcus pneumoniae was 10.7% in children under 2 years old, 10.2% in children between 2 and 5 years old and 4.1% in children over 5 years old.About 97% of Streptococcus pneumoniae isolates came from children under 5 years old.(3) According to breakpoints of non-meningitis strains, the sensitivity rate of parenteral Penicillin was 93.18%, the mediation rate was 6.79%, the resistance rate was only 0.03%, the lowest drug concentration to inhibit the growth of 50% bacteria(MIC 50) value was 0.50 and the lowest drug concentration to inhibit the growth of 90% bacteria(MIC 90) value was 2.00; the sensitivity rate of Ceftria-xone was 76.55%, the mediation rate was 20.18%, the resistance rate was 3.26%, the MIC 50 value was 1.00 and the MIC 90 value was 2.00; when interpreted by the breakpoint of meningitis strains, the resistance rate of extra-gastrointestinal Penicillin reached 77.22%, and the mediation rate of Ceftriaxone increased to 30.48% and the drug resistance rate reached 18.45%.The drug resistance rates of Erythromycin, Clindamycin, Tetracycline and Compound neomycin were all over 85.00%.The resistance rates against Levofloxacin and Chloramphenicol were 0.16% and 7.85% respectively.No Vancomycin-resistant Streptococcus pneumoniae was found. Conclusions:Streptococcus pneumoniae is the first bacterial pathogen causing respiratory tract and invasive infection in hospitalized children under 5 years old in this area.Penicillin is still the preferred drug for non-meningitis pneumococcal infection, but the drug resistance rate is high in meningitis patients.

Objective: To explore HIV-1 drug resistance and influencing factors among people living with HIV/AIDS before antiretroviral therapy in Liangshan Yi Autonomous Prefecture (Liangshan). Methods: Between January 1 and June 30, in both 2017 and 2018, a cross-sectional survey was conducted in Liangshan HIV-1 pol sequences were gathered and analyzed according to WHO Guidelines on HIV drug resistance surveillance of 2014. Both HyPhy 2.2.4 and Cytoscape 3.6.1 software were used to analyze the drug resistant strains of HIV-1 transmission network. Results: A total of 464 people living with HIV/AIDS was recruited. The proportion of HIV-1 CRF07_BC subtype was 88.6% (411/464), with HIV-1 drug resistance rate was 9.9% (46/464). The HIV-1 drug resistance rates of non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors(NRTI) and protease inhibitors (PI) were 6.7% (31/464), 1.9% (9/464) and 0.4% (2/464) respectively. New recombinant strains of HIV-1 URF_01BC subtype was independently clustered according to the drug resistant mutation sites. Results from the multivariate logistic analysis showed that injected drug users group had higher risk on HIV-1 drug resistance (aOR=3.03, 95%CI:1.40-6.54) than heterosexual group among people living with HIV/AIDS. Conclusions HIV-1 drug resistance rate had already been in a high level before antiretroviral therapy was in place. The newly identified recombinant strains of HIV-1 URF_01BC subtype were independently clustered according to the drug resistant mutation sites. It was necessary to strengthen the prevention of the HIV-1 drug resistant strains transmission.

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post-exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization′s position paper on rabies vaccine in 2018 and related research progress in recent.