Objective:To compare the efficacy of articaine infiltration anesthesia and lidocaine nerve block anesthesia in pulpotomy of deciduous mandibular second molars.Methods:Single blind crossover test was used for the pediatric patients who required bilateral de-ciduous mandibular second molar pulpotomy were given articaine infiltration anesthesia and lidocaine nerve block anesthesia respectively before the 2 times of operation.After the injection of anesthetic drugs and dental pulp treatment,the patients'responses to pain were e-valuated through sound,eye and body movements,and Wong-Baker facial pain rating scales.Quantitative comparisons were made.Student's t-test and chi-square test were performed for the collected data.Results:50 pediatric patients who met the inclusion criteria and successfully completed 2 treatments without any missed visits or adverse events.During the process of articaine infiltration anesthe-sia,the scores of the 3 indicators of pain severity,namely sound,eye and body movements,were lower than those of lidocaine nerve block anesthesia(P＜0.05).The analysis of facial pain rating scales also suggested that patients'pain and discomfort during the infiltra-tion anesthesia process with articaine were milder(P＜0.05).During the treatment of pulpotomy,both pain assessment methods showed no statistically significant difference in pain perception between the 2 anesthesia injections(P＞0.05).Conclusion:Articaine infiltra-tion anesthesia may effectively replace lidocaine nerve block anesthesia in pulp treatment of mandibular primary molars.

Objective:To explore the application value of next-generation sequencing (mNGS) technology in patients with Herpes simplex pneumonia mixed infection.Methods:The clinical data of pneumonia patients who underwent alveolar lavage fluid mNGS technology and traditional pathogen detection in the Affiliated Hospital of Yangzhou University from June 2018 to January 2021 were retrospectively collected.Results:A total of 41 patients with mNGS Herpes simplex type 1 (HSV-1) test (4 HSV-1 carriers, 37 HSV-1 infections) were enrolled in this study, including 22 males and 19 females. The age ranged from 46 to 83 years old, with a median age of 67 years. The higher proportion of pathogens in 25 cases of HSV-1 co-infection detected by mNGS were Pneumocystis jiroveci (6 cases, 24.0%), Acinetobacter baumannii (4 cases, 16.0%), and Klebsiella pneumoniae (4 cases, 16.0%), and Aspergillus fumigatus (3 cases, 12.0%). The difference in the Simpson's diversity index in the HSV-1carrier group, HSV-1 single infection group and HSV-1 mixed infection group was statistically significant ( P<0.05). Compared with 12 cases of HSV-1 single infection, the time for body temperature to return to normal for 25 cases of HSV-1 mixed infection was [(5.16±2.04)days vs (3.75±1.29)days], and course of antibiotic treatment was longer [(10.60±2.18)d vs (8.92±1.98)d]. Conclusions:The mNGS technology has obvious advantages in identifying HSV-1 mixed infections, which is beneficial to physicians to treat them accurately.

OBJECTIVE To explore the factors influencing the failure of tigecycline in the treatment of multidrug-resistant Acinetobacter baumannii （MDRAb） pneumonia， and to provide a basis for the rational use of tigecycline. METHODS The information of patients with MDRAb pneumonia who were treated with tigecycline in the ICU of our hospital during Aug. 2020-Jun. 2022 were collected retrospectively. The patients were divided into treatment failure group and treatment success group according to the curative effect. The basic information， acute physiology and chronic health evaluation Ⅱ （APACHE-Ⅱ） score， laboratory indicators， and medication-related information were recorded and compared between 2 groups. Logistic regression analysis was conducted for analyzing the influential factors inducing the failure of tigecycline in the treatment of MDRAb pneumonia. RESULTS A total of 102 cases of MDRAb pneumonia received tigecycline therapy， with 71 in the treatment success group and 31 in the treatment failure group. Compared with the treatment success group， the patients in the treatment failure group had higher APACHE Ⅱ score （P＜0.05）， and more cases with abnormal coagulation function and comorbidities ≥2 types （P＜0.05）. After the treatment of tigecycline， procalcitonin level of the treatment failure group was significantly higher than that of the treatment success group （P＜0.05）. Logistic regression analysis showed that the independent risk factors for the failure of tigecycline in the treatment of MDRAb pneumonia included abnormal coagulation function and APACHE-Ⅱ score ≥20 （P＜0.05）； doubling the first dose was a protective factor （P＜0.05）. CONCLUSIONS In patients with MDRAb pneumonia with APACHE-Ⅱ score ≥20 and abnormal coagulation function， tigecycline therapy is more likely to fail； doubling the first dose of tigecycline has better efficacy in the treatment of MDRAb pneumonia.

Objective:To investigate the predictive value of measurement parameters of left atrial appendage by coronary CTA (CCTA) for the risk of cardiogenic stroke (CS) in patients with nonvalvular atrial fibrillation (NVAF).Methods:The clinical and examination data of 179 patients with NVAF who underwent CCTA examination were retrospectively analyzed. The selected patients were grouped according to the outbreak of acute ischemic stroke and TIA within 2 years after CCTA examination. Patients who met the criteria for CS were selected as cases (87 patients), and those with neither stroke nor TIA as controls (92 patients). The diameter and area of left atrial appendage (LAA) orifice, the LAA depth, and the LAA volume were measured by using dedicated software. The parameter was corrected using the body surface area (BSA) to obtain the correction index of corresponding parameter. The independent samples t test, Mann-Whitney U test, and Chi-square test were used to compare the differences in various indicators between the two groups. Binary logistic regression was used to analyze the impacts of body mass index (BMI), hyperlipidemia, the duration years of atrial fibrillation, left atrial appendage area index (LAAOA Index), and the left atrial appendage emptying fraction (LAAEF) on the risk of CS. The ROC curve was used to evaluate the predictive value of LAAOA Index and LAAEF for the onset of CS. Results:The correction index of the left atrial appendage orifice maximum and minimum diameter, the left atrial appendage orifice area, and the maximum & minimum left atrial appendage volume and the LAAEF in the case group were (1.80±0.21) cm/m 2, (1.19±0.17) cm/m 2, (3.20±0.71) cm 2/m 2, (7.91±1.92) ml/m 2, (5.03±1.40) ml/m 2, (36.20±10.54)%, and those value in the control group were (1.64±0.24) cm/m 2, (1.06±0.19) cm/m 2, (2.65±0.64) cm 2/m 2, (6.61±1.68) ml/m 2, (3.67±1.28) ml/m 2, (45.25±10.07)%, the differences were statistically significant ( t= 4.783, 4.647, 5.481, 4.826, 6.823, and -5.875, all P<0.001). Binary logistic regression analysis showed that the increase in LAAOA Index ( P= 0.005) and the decrease in LAAEF ( P<0.001) were independent risk factors for CS in NVAF patients. The area under the ROC curve (AUC) of LAAOA Index was 0.712 (95%CI 0.639-0.777), and the best diagnostic cut-off was 3.16 cm 2/m 2; the AUC of LAAEF was 0.734 (95%CI 0.663-0.797), the cut-off was 38.71%; the AUC of LAAOA Index-LAAEF was 0.786 (95%CI 0.718-0.843). The difference of AUC value between LAAOA Index and LAAEF was not statistically significant ( Z= 0.448, P= 0.654). The difference of AUC between the LAAOA Index-LAAEF and LAAOA Index ( Z=2.667, P=0.008) and between the LAAOA Index-LAAEF and LAAEF ( Z=2.061, P=0.039) were statistically significant. Conclusions:CCTA can provide a one-stop and relatively accurate evaluation of the size and function of the left atrial appendage by post-processing the coronary vascular scan data. Left atrial appendage measurement parameters from CCTA can be used as a supplement to the CHA2DS2-VASc score, and provide quantitative indicators for the risk assessment of CS in patients with NVAF.

Objective:To investigate the expression and clinical significance of effector T cell (Teff), regulatory T cell (Treg) and their cytokines in patients with vitiligo.Methods:84 patients with vitiligo (38 cases in stable stage, 46 cases in advanced stage) who were admitted to the Dermatology Department of the Dezhou People's Hospital between June 2018 and June 2019 and 30 healthy people (control group) were enrolled in the study. The levels of Teff subsets and Treg cells in peripheral blood were detected by flow cytometry. The levels of Teff subsets and Treg cells-associated cytokines were detected by enzyme-linked immunosorbent assay (ELISA). The relationship between Teff subsets and Treg cells levels in peripheral blood, relationship between Teff subgroups, Treg cells-associated cytokines and course of vitiligo, skin lesion area were analyzed.Results:The levels of T helper cell (Th)17 and Th22 in peripheral blood of vitiligo group were significantly higher than those of control group, while levels of Treg cells were significantly lower than control group ( P<0.05). Compared with the stable vitiligo group, the levels of Th17 and Th22 in peripheral blood were higher and levels of Treg cells were lower in the advanced vitiligo group ( P<0.05). Treg cell level was negatively correlated with Th17 cell level ( r=-0.303, P=0.001), and negatively correlated with Th22 cell level ( r=-0.200, P=0.033). The levels of serum interleukin (IL)-17 and IL-22 in vitiligo group were significantly higher than those in control group, while the level of transforming growth factor-β (TGF-β) was significantly lower than that in control group ( P<0.05). Compared with the stable vitiligo group, levels of serum IL-17 and IL-22 were higher and level of TGF-β was lower in the advanced vitiligo group ( P<0.05). Correlation analysis showed that levels of IL-17 and IL-22 were positively correlated with skin lesion area ( r=0.361, 0.288, P<0.05), and level of TGF-β was negatively correlated with skin lesion area ( r=-0.312, P<0.05). Conclusions:Teff/Treg cells are unbalanced in patients with vitiligo, showing obvious shift to Teff subsets. The progression of vitiligo may be related to Teff subsets and Treg cells-associated cytokines.

Lycophytes and seed plants constitute the typical vascular plants. Lycophytes have been thought to have no paleo-polyploidization although the event is known to be critical for the fast expansion of seed plants. Here, genomic analyses including the homologous gene dot plot analysis detected multiple paleo-polyploidization events, with one occurring approximately 13-15 million years ago (MYA) and another about 125-142 MYA, during the evolution of the genome of Selaginella moellendorffii, a model lycophyte. In addition, comparative analysis of reconstructed ancestral genomes of lycophytes and angiosperms suggested that lycophytes were affected by more paleo-polyploidization events than seed plants. Results from the present genomic analyses indicate that paleo-polyploidization has contributed to the successful establishment of both lineages-lycophytes and seed plants-of vascular plants.
Evolution, Molecular ; Genome, Plant ; Genomics ; Phylogeny ; Polyploidy ; Selaginellaceae/genetics*

Objective:To evaluate the application value of metagenomic next-generation sequencing(mNGS) for patients with severe pneumonia of unknown pathogen.Methods:The clinical data of 8 patients with unknown pneumonia pathogens who were assisted by the alveolar lavage fluid mNGS technology treated in Affiliated Hospital of Yangzhou University from June 2019 to February 2020 were retrospectively analyzed, including alveolar lavage fluid smear, culture, and the sequencing result.The clinical characteristics and mNGS detection results were comprehensively analyzed.According to the results of mNGS and the judgment of the clinician, the patients were divided into confirmed pathogens group and undetermined pathogens group, and the Simpson's diversity index of two groups was compared.Results:Among 8 cases, there were 5 males and 3 females, and the median age was 62.5 years (ranged from 41 to 71 years). All of them had chronic diseases except 1 case, including diabetes, chronic obstructive pulmonary disease and kidney transplantation.mNGS was positive in 8 patients, and conventional test was positive in 3 patients.The comparison of the Simpson's diversity index between the identified pathogenic group and the undetermined pathogenic group showed statistically significant difference [(0.398 ± 0.222) vs.(0.763 ± 0.061), t=2.709, P=0.035]. The positive results of mNGS were different from that of conventional test in 2 patients.The nucleic acid number in 3 cases of Pneumocystis carinii with mNGS positive results ranged from 120 to 15 580, with genomic coverage rates from 24.6% to 99.8%. Conclusion:mNGS can help physicians acquire information of the pathogenic bacteria quickly and comprehensively, especially for patients with unknown pneumonia pathogenic bacteria.

Antiepileptic drugs (AEDs) are the main treatments of epilepsy, but their use is usually limited by adverse reactions, among them psychiatric and behavioral ones including aggressive behavior. Levetiracetam , perampanel, and topiramate , which have diverse mechanisms of action, have been associated with aggressive behavior. 5-HT and γ-aminobutyric acid (GABA), especially glutamate [via α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate receptor (AMPA) receptor] seem to play key roles. Other mechanisms involve hormones, epigenetics and alternative psychosis. Neurological and/or mental health disorders tend to increase aggressive behavior sensitivity. The adverse reactions caused by AEDs are getting more and more attention. Clinicians may identify and manage this side effect as early as possible, if the risk factors and underlying mechanisms of aggressive behavior induced by antiepileptic we find. This article will explain the possible mechanisms.

Objective To investigate the correlation between sexual dysfunction( SD) and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University,and 120 matched healthy women were taken as the control group. WWE were treated with antiepileptic drugs ( AEDs) for one year or more. The Chinese version of female sexual function index ( FSFI) was used to investigate the sexual function of the subjects. The chemiluminescence method was used to detect the sex hormones levels such as prolactin ( PRL),follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene poly-morphism. Chi-square test,t-test and binary logistic regression were used for statistical analysis. The differ-ences of the sexual function,sex hormone,ER genotype,and allele frequency were compared between the two groups. And the correlation between SD and ER gene polymorphism was analyzed. Results ( 1) The pro-portion of SD in Chinese Han WWE was 70. 5%(79/112),while that was 24. 2%(29/120) in the control group. The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2. 072,P=0. 039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0. 001;P=0. 001). (3) Binary logistic regression a-nalysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR= 6. 074, 95% CI: 1. 257-29. 352, P= 0. 025; OR= 0. 412, 95% CI: 0. 201-0. 842, P= 0. 015 ). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE,and PvuII CC genotype may be the risk genotype of SD in WWE.

Objective: To investigate the correlation between sexual dysfunction(SD)and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods: A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University, and 120 matched healthy women were taken as the control group.WWE were treated with antiepileptic drugs (AEDs) for one year or more.The Chinese version of female sexual function index (FSFI) was used to investigate the sexual function of the subjects.The chemiluminescence method was used to detect the sex hormones levels such as prolactin(PRL), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene polymorphism.Chi-square test, t-test and binary logistic regression were used for statistical analysis.The differences of the sexual function, sex hormone, ER genotype, and allele frequency were compared between the two groups.And the correlation between SD and ER gene polymorphism was analyzed. Results: (1) The proportion of SD in Chinese Han WWE was 70.5%(79/112), while that was 24.2%(29/120) in the control group.The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2.072, P=0.039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0.001; P=0.001). (3) Binary logistic regression analysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR=6.074, 95%CI: 1.257-29.352, P=0.025; OR=0.412, 95%CI: 0.201-0.842, P=0.015). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE, and PvuII CC genotype may be the risk genotype of SD in WWE.