Covalently closed circular DNA(cccDNA)in hepatocytes is the replication intermediate of hepa-titis B virus(HBV),which is closely related to HBV replication.Meanwhile,it is the transcriptional template of pregenomic RNA(pgRNA),and most of the HBV RNA in serum is derived from unreversed transcribed pgRNA.In recent years,many studies have demonstrated that HBV RNA has an important role in monitoring disease progression and predicting the prognosis of chronic HBV-infected patients,and is a potential biomarker of chronic viral hepatitis B.This article provides an overview of the molecular characterisation of HBV RNA,detection methods and research progress in clinical applications.

Background:Identifying missed diagnoses of polyps is significant in reducing the incidence of colorectal cancer.Until now,the role of repeat colonoscopy during colorectal polypectomy in reducing themissed diagnoses of polyps is sparsely studied.Aims:To analyze the value of repeat colonoscopy during colorectal polypectomy in reducing themissed diagnoses of polyps.Methods:One hundred and forty-six patients in the first affiliated hospital of Ningbo University who underwent polypectomy were consecutively recruited for repeat colonoscopy from January 2020 to January 2021.The number,size,and location of missed polyps were recorded and analyzed during colorectal polypectomy.Univariate logistic regression analysis was used to analyze the independent risk factors of missed polyps.Results:There were 86 males and 60 females among the 146 enrolled patients,which aged(55.54±10.51)years.The overall missed polyps'rate was 27.17%.We found that all missed polyps were sessile polyps and<10 mm in size,the difference was significant in the left colon.Univariate logistic regression analysis showed that the endoscopist' experience was an independent risk factor for missed polyps.Conclusions:Endoscopist'experience was an independent risk factor for missed polyps.Repeat colonoscopy could reduce the missed polyps.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

Objective:To study the clinical phenotype and molecular genetic characteristics of a Chinese Han family with X-linked retinoschisis (XLRS), and to determine the associated gene variations.Methods:A pedigree investigation was performed.The clinical characteristics and pedigree analysis of a Han Chinese family line with XLRS was conducted in August 2021 at the Xiamen Eye Center Affiliated to Xiamen University.All patients and the carriers underwent comprehensive medical history collection and routine ophthalmological examinations, including visual acuity, non-contact tonometer, slit lamp microscope, direct ophthalmoscope, and optical coherence tomography.The proband and some patients underwent medical optometry, fundus photography or wide-angle fundus photography, and electroretinogram examination.Peripheral venous blood samples were collected from the family members, and whole exome sequencing (WES) analysis was performed on the proband samples.For variants screened by WES, the expanded verification in other patients and normal persons in the family was carried out by Sanger sequencing.Multiple bioinformatic tools were used to analyze the pathogenicity of variants.This study protocol was approved by the Ethics Committee of Xiamen Eye Center of Xiamen University (No.XMYKZX-KY-2021-012). Written informed consent forms were obtained from each subject or guardian of minors.CADD, FATHMM and other bioinformatics tools were used to analyze the pathogenicity of the variation sites.Results:The Han XLRS pedigree consisted of 8 individuals in 3 generations.Out of the 3 cases diagnosed with XLRS based on clinical evaluation, all were male.The mother of the proband was a carrier of related genes.There were 5 persons with normal phenotypes.There was no history of consanguineous marriages within the family, and the disease was shown to be intergenerational, which is consistent with the recessive inheritance of the X chromosome.None of the patients had a history of systemic disease or any other abnormal manifestations.The prevailing feature of ophthalmopathy was poor binocular vision since childhood.The proband and his younger brother had spoke split in the macula, and their grandfather showed atrophy of retinal nerve fibers.Genetic analysis revealed a hemizygous variation c. 214G>C: p.Glu72Gln in the RS1 gene in all the patients in this family.The proband's mother was heterozygous at this site, and all other phenotypically normal family members exhibited wild type at this site.This variant was predicted to be a deleterious variation and likely to cause disease based on bioinformatics analysis. Conclusions:The proband and patients in this Han Chinese family have the known c. 214G>C: p.Glu72Gln hemizygous variation of the RS1 gene and exhibit mild XLRS, which was consistent with the recessive inheritance of X chromosome.

Objective:To comprehensively evaluate the tricuspid valve, right heart anatomical characteristics and related dynamic parameters in patients with different degrees of functional tricuspid regurgitation (FTR) using four-dimensional auto tricuspid valve quantitative(4D Auto TVQ), four-dimensional auto right ventricle quantitative(4D Auto RVQ), and four-dimensional auto left atrium quantitative(4D Auto LAQ), and to investigate the structural and functional changes of the tricuspid valve and right heart in them.Methods:Sixty-three patients with FTR diagnosed by echocardiography at the First Affiliated Hospital of Guangxi Medical University from February to July 2022 were prospectively selected as the case group, including 30 patients with mild FTR and 33 patients with moderate or above FTR, and 30 healthy subjects were selected as the control group. Transthoracic echocardiography was used for two-dimensional and three-dimensional image acquisition of the heart. The tricuspid regurgitation volume, left ventricular ejection fraction (LVEF), right ventricular global strain (RVGS) were measured by 2D images, and pulmonary artery systolic pressure (PASP) were measured from the tricuspid regurgitation pressure difference. The 3D images were imported into EchoPAC 204 to obtain the tricuspid valve, right heart structure and related dynamic parameters. The annulus area (AA), annulus perimeter(AP), spherical index (SI), annulus area change fraction (AC), coaptation point height (CPH), and tenting volume (TV) were measured by 4D Auto TVQ. The right atrial maximum volume (RAVmax) and right atrial minimum volume (RAVmin) were measured by 4D Auto LAQ. Right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were measured by 4D Auto RVQ. After standardizing the dimension parameters with body surface area (BSA), the differences in the above parameters were compared between the three groups, the correlation between regurgitant volume and each parameter was compared by correlation analysis, and the independent factors of increased tricuspid regurgitant volume were investigated by univariate and multivariate linear regression analysis.Results:There were statistically significant differences in PASP, AA/BSA, AP/BSA, AC, TV, RAVmax/BSA, RAVmin/BSA, RVFAC, RVGS, and TAPSE between the three groups (all P<0.05). There were statistically significant differences in LVEF, CPH, RVEDV/BSA, and RVESV/BSA in the moderate and above FTR group compared with the control and mild FTR groups (all P<0.05). Correlation analysis showed that RAVmin was the most highly correlated with tricuspid regurgitant volume ( r=0.875, P<0.001) and TV and end-systolic annulus area(ESAA) were highly correlated with tricuspid regurgitant volume ( r=0.747, 0.683; both P<0.001) in patients with FTR. Multifactorial linear regression showed that RAVmin, TV and regurgitant volume were independently positively correlated (β=0.721, 0.205; both P<0.05). Conclusions:The four quantification technique can provide valid structural and functional information by quantifying the tricuspid valve as well as the right heart in patients with FTR, and RAVmin and TV are independent correlates of increased tricuspid regurgitant volume.

Objective:To survey the post competency of general practitioners who completed residency training in Suzhou Municipal Hospital.Methods:A questionnaire survey on post competency of general practitioners was conducted from January to March 2022. General practitioners who completed standardized residential training in Suzhou Municipal Hospital from 2009 to 2021 were randomly selected for the survey. The self-designed questionnaire included the basic information and post competency in terms of clinical, public health, research and teaching abilities as well as medical ethics and humanism. A self-evaluation was also performed and the abilities were graded (A 86-100, B 70-85, C 55-69, D 0-54), and grade A was classified as excellent.Results:A total of 163 questionnaires were distributed and 157 valid ones were collected with a recovery rate of 96.3%. Among 157 respondents 62 (39.5%) were males. The participants mainly worked in urban community health service institutions (78 (49.7%)), and most of them worked as general practice (119 (75.8%)). For the self-assessment of clinical skills, the proportion of respondents with excellent abilities in history taking, basic drug use, diagnosis and treatment of common diseases, and chronic disease management was 58.8% (70/119), 57.1% (68/119), 54.6% (65/119) and 54.6% (65/119), respectively. The proportion of respondents with excellent abilities in evidence-based clinical decision making, physical examination, tests interpretation, referral services, family medical services, rehabilitation services, first aid, and psychological counseling and treatment was 43.7% (70/119), 42.9% (52/119), 38.7% (46/119), 37.8% (45/119), 33.6% (40/119), 22.7% (27/119), 21.0% (25/119), and 16.8% (20/119), respectively. For the self-assessment of basic public health service ability, the proportion of respondents with excellent abilities in health education, disease prevention and control, health management, health care for key and special groups, handling public health emergencies, management of infectious diseases, epidemiology-based community diagnosis and community health leadership was 38.7% (46/119), 33.6% (40/119), 33.6% (40/119), 26.1% (31/119), 25.2% (30/119), 2.7% (27/119), 22.7% (27/119), and 21.0% (25/119), respectively. For humanistic literacy, the proportion of respondents with excellent abilities in privacy protection, sense of responsibility for patients, understanding patients′ needs, effective communication and cooperation with patients was 82.4% (98/119), 73.9% (88/119), 61.3% (73/119), 55.5% (66/119) and 2.1% (62/119), respectively. For research and teaching, the proportion of respondents with excellence abilities in continuous learning and innovation, training and teaching and literature retrieval was 47.9% (57/119), 10.9% (13/119), 10.1% (12/119), respectively. In addition 56.3% (67/119) of respondents were interested in scientific research, 23.5% (28/119) had published articles as the first author or correspondence author, and only 6.7% (8/119) had scientific research projects in the last 5 years.Conclusion:The post competency of general practitioners who received standardized residency training in our hospital varies in different aspects, their abilities in basic public health service, scientific research and teaching are relatively low, which need to be strengthened.

Objective:To analyze the correlation between phonographic cardiac function and uterine artery resistance index (RI) in pregnant women with hypertension of different conditions during pregnancy by color Doppler ultrasonically.Methods:A total of 100 pregnant women with gestational hypertension admitted to Lishui People′s Hospital from January 2020 to February 2021 were selected and divided into gestational hypertension group (40 cases), mild pre-eclampsia group (30 cases) and severe pre-eclampsia group (30 cases) according to the severity of their disease. Another 30 normal pregnant women who underwent physical examination during the same period were selected as the control group. The left ventricular function parameters isovolumetric relaxation time (IVRT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume(LVESV), left atrial volume index (LAVI) and uterine arter RI in 4 groups were quantitatively analyzed by ultrasound during 28 to 38 weeks of gestation. The correlation between cardiac ultrasound parameters and of pregnant women RI were analyzed.Results:As the severity of the disease, the levels of IVRT, LVEDV, LVESV, LAVI were gradually rised, and the level of LVEF was gradually decreased, there were significant differences among the 4 groups ( P<0.05). The uterine arter RI in the control group, gestational hypertension group, mild pre-eclampsia group and severe pre-eclampsia group was 0.42 ± 0.04, 0.50 ± 0.05, 0.54 ± 0.11, 0.58 ± 0.06, there was significant difference ( F = 34.11, P<0.001), and as the severity of the disease , the level of uterine arter RI was gradually rised, there were significant differences among the 4 groups ( P<0.05). Pearson correlation analysis showed that IVRT had certain correlation with RI in the 4 groups ( r = 0.331, 0.450, 0.531, 0.582; P<0.05). In mild and severe pre-eclampsia group, there were a certain correlation between LVEDV, LVESV and RI (in mild pre-eclampsia group: r = 0.360 and 0.411, P<0.05; in severe pre-eclampsia group: r = 0.383 and 0.451, P<0.05). Conclusions:The left heart function of pregnant women with different conditions evaluated by ultrasound showed a downward trend, and the uterine artery RI increased gradually in pregnant women with severe pre-eclampsia, and RI was closely related to the cardiac ultrasound parameter IVRT.

Objective:To explore the effect of task-driven group workshop learning method on teaching satisfaction degree and practical ability in Mongolian medical nursing students.Methods:From September 2018 to January 2020, using convenient sampling method, a total of 38 Mongolian undergraduate nursing students of grade 2016 of Mongolian Medical College of Inner Mongolia Medical University were recruited as control group to receive traditional method, and the teaching practice activities were arranged after the main content was completed. Another 39 students of grade 2017 were recruited as observational group to receive task-driven group workshop learning method. The preparation of teaching practice tasks will run through all stages of teaching. The differences of students′ achievement, teaching satisfaction and autonomous learning ability between the two groups were compared.Results:The grade of observational group was 84.81 ± 3.45, higher than 76.16 ± 3.59 of the control group , which had significant difference ( t=-5.35, P<0.05). The score of teaching satisfaction of observational group was 82.00 ± 11.62, higher than 70.94 ± 6.65 in the control group, which had significant difference ( t=-5.10, P<0.05). The dimensions of information ability, cooperation ability and total score of the Autonomous Learning Ability Scale in observational group scored 39.28 ± 6.46, 24.54 ± 3.45, 98.13 ± 14.58, which were higher than 36.18 ± 5.46, 22.39 ± 3.59, 91.37 ± 11.47 in the control group, which had significant difference ( t=-2.27, -2.67, -2.26, all P<0.05). Conclusions:The task-driven group workshop learning method can improve the study result and the satisfaction of teaching, it can also improve the information ability and cooperation ability in Mongolian medical nursing students, which is worthy of reference in nursing teaching.

Objective:To investigate the application effects of a one-time filling root canal in root canal therapy in plateau areas and evaluate its feasibility in oral clinic in plateau areas.Methods:Sixty-eight patients who received root canal therapy for anterior teeth and premolars (75 teeth) from August to December 2018 in Shannan People's Hospital were included in this study. They were divided into control group ( n = 33; 36 teeth) and observation group ( n = 35; 39 teeth) according to odd and even numbers of admission date. Patients in the control group received conventional root canal therapy and those in the observation group underwent one-time root canal filling therapy. Efficacy was compared between the two groups. Results:After 1 week, 2 weeks and 1 month of treatment, the success rate in the control group was 88.9%, 94.4%, 100.0%, respectively, and it was 87.2%, 94.9% and 100.0%, respectively in the observation group. There was no significant difference in success rate between the two groups at three time points studied (all P > 0.05). Conclusion:One-time filling root canal therapy can achieve ideal therapeutic effects under strict control of surgical indications. This method is worthy of clinical promotion especially in plateau areas.

Genome sequences of 4 644 representative strains from human gut microbiota were analyzed to mine gene clusters for biosynthesis of novel secondary metabolites, as well as genes encoding antibiotic resistance and virulence factors. AntiSMASH analysis showed that more than 60% of the representative strains encoded at least one secondary metabolite gene cluster, and 8 potential novel secondary metabolite gene clusters were identified from 8 unculturable bacteria. The secondary metabolite gene clusters in human intestine are mainly composed of nonribosomal peptide synthetase (NRPS), bacteriocin, arylpolyene, terpene, betalactone and NRPS like gene clusters distributed in Clostridia, Bacilli, Gammaproteobacteria, Bacteroidia, Actinobacteria and Negativicutes. PathoFact analysis showed that genes encoding antibiotic resistance and virulence factors are widely distributed in representative strains, but the frequency encoded by potential pathogens is significantly higher than that of non-potential pathogens. The frequency of genes encoding secretory toxins such as outer membrane protein, PapC N-terminal domain, PapC C-terminal domain, peptidase M16 inactive domain, and non-secretory toxins such as nitroreductase family, AcrB/AcrD/AcrF family, PLD-like domain, Cupin domain, putative hemolysin, S24-like peptidase, phosphotransferase enzyme family, endonuclease/ exonuclease/ phosphatase family, glyoxalase/ bleomycin resistance was high in potential pathogens. This study may facilitate mining new microbial natural products from the intestinal microbiome, understanding the colonization and infection mechanism of intestinal microorganisms, and providing targeted prevention and treatment of intestinal microbial related diseases.
Humans ; Virulence ; Multigene Family ; Bacteria ; Drug Resistance, Microbial ; Virulence Factors ; Peptide Hydrolases