Light adaptation enables the vertebrate visual system to operate over a wide range of ambient illumination. Regulation of phototransduction in photoreceptors is considered a major mechanism underlying light adaptation. However, various types of neurons and glial cells exist in the retina, and whether and how all retinal cells interact to adapt to light/dark conditions at the cellular and molecular levels requires systematic investigation. Therefore, we utilized single-cell RNA sequencing to dissect retinal cell-type-specific transcriptomes during light/dark adaptation in mice. The results demonstrated that, in addition to photoreceptors, other retinal cell types also showed dynamic molecular changes and specifically enriched signaling pathways under light/dark adaptation. Importantly, Müller glial cells (MGs) were identified as hub cells for intercellular interactions, displaying complex cell‒cell communication with other retinal cells. Furthermore, light increased the transcription of the deiodinase Dio2 in MGs, which converted thyroxine (T4) to active triiodothyronine (T3). Subsequently, light increased T3 levels and regulated mitochondrial respiration in retinal cells in response to light conditions. As cones specifically express the thyroid hormone receptor Thrb, they responded to the increase in T3 by adjusting light responsiveness. Loss of the expression of Dio2 specifically in MGs decreased the light responsive ability of cones. These results suggest that retinal cells display global transcriptional changes under light/dark adaptation and that MGs coordinate intercellular communication during light/dark adaptation via thyroid hormone signaling.
Animals ; Mice ; Dark Adaptation ; Light ; Retina ; Retinal Cone Photoreceptor Cells/metabolism* ; Adaptation, Ocular ; Neuroglia/physiology* ; Cell Communication ; Thyroid Hormones

【Objective】 To investigate dynamic regional homogeneity (dReHo) abnormality in end-stage renal disease (ESRD) patients by using resting-state functional magnetic resonance imaging (rs-fMRI). 【Methods】 A total of 26 ESRD patients and 26 healthy controls (HC) matched in gender, education level and age were included. Rs-fMRI scanning was performed in all subjects. All the subjects were tested by using auditory verbal learning test Huashan version (AVLT-H) and Montreal Cognitive Assessment (MoCA) to assess cognitive function before collection of MRI data. T-test was used to observe the difference in dReHo at global level between the two groups. Pearson and Spearman correlation analyses were made to estimate the correlation between abnormal brain regions and clinical scales. 【Results】 Compared with HC group, the dReHo value in ESRD patients reduced on the bilateral superior margin gyrus, left insula, left posterior central gyrus, and left putamen (P<0.05, replacement test correction). The dReHo values of left superior margin gyrus (r=-0.534, P=0.005) and left insula in ESRD patients (r=-0.422, P=0.032) were negatively correlated with the LR-S score, and the dReHo value of the left margin was negatively correlated with the SR-S score (r=-0.468, P=0.016). 【Conclusion】 There are abnormal dReHo values in several brain regions in ESRD patients during resting state, which is related to the patients’ cognitive function. The variation of dReHo value provides a new objective imaging basis for evaluating the cognitive function of ESRD patients.

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

Objective : To investigate whether serine/threonine kinase 3 ( AKT3) is able to reverse the synergistic inhibition of miR⁃22⁃3p/29a⁃3p on the activation of human hepatic stellate cell LX⁃2. Methods : TargetScan , Starbase , miRDB and DIANA were used to predict the common target genes of miR⁃22⁃3p and miR⁃29a⁃3p , and the base , miRDB and DIANA were used to predict the common target genes of miR⁃22⁃3p and miR⁃29a⁃3p , and the tein⁃protein interaction (PPI) . The binding free energy of candidate target genes with two miRNAs was analyzed by RNAhybrid , and their targeting relationship was determined by double luciferase reporting experiment. CCK⁃8 , Transwell and qRT⁃PCR were used to detect the proliferation , migration and the expression of fibrosis markers of LX-2 cells. Results : There were 24 common target genes of miR⁃22⁃3p and miR⁃29a⁃3p , and they were enriched in the hepatic fibrosis⁃related signaling pathways and biological processes. The binding free energy analysis of candidate target gene AKT3 with miR⁃22⁃3p and miR⁃29a⁃3p combined with the double luciferase experiment results showed that AKT3 was the common target gene of miR⁃22⁃3p and miR⁃29a⁃3p. The proliferation , migration and the mRNA expression of fibrosis markers of α ⁃smooth muscle actin ( α ⁃SMA) and type I collagen α1 chain (COL1A1) of LX⁃2 cells were inhibited by miR⁃22⁃3p and miR⁃29a⁃3p mimics independently or cooperatively ( P < 0. 05 ) , and AKT3 overexpression could reverse the synergistic inhibition of miR⁃22⁃3p and miR⁃29a⁃3p mimics on LX⁃2 ells mentioned⁃above (P < 0. 05) . Conclusion The overexpression of AKT3 can reverse the synergistic inhibition of miR⁃22⁃3p and miR⁃29a⁃3p on the activation of LX⁃2 cells.

Objective:To investigate the computed tomography (CT) examination anato-mical features and clinical significance of paraesophageal vein (PEV) in portal hypertension.Methods:The retrospective and descriptive study was conducted. The clinical data of 173 patients with portal hypertension who were admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2018 to June 2021 were collected. There were 124 males and 49 females, aged from 22 to 71 years, with a median age of 47 years. Observation indicators: (1) preoperative CT examinations; (2) surgical situations; (3) follow-up. Follow-up was conducted using outpatient examination to detect surgical effects once every 3 months within postoperative 6 months and once every 6 months after postoperative 6 months. The follow-up was up to June 2021. Measurement data with skewed distribution were represented as M(range) and count data were described as absolute numbers. Results:(1) Preoperative CT examinations. The CT detection rate of PEV in the 173 portal hyper-tension patients was 52.60%(91/173). Of 173 patients, 82 cases were negative with PEV and 91 cases were positive with PEV. Of the 91 patients who were positive with PEV, there were 46 cases with paraesophageal varices, 24 cases with thick PEV, 21 cases with thin PEV, 8 cases without esophageal varices and 83 cases accompanied with esophageal varices. Of the 83 patients who were accom-panied with esophageal varices, there were 44 cases with PEV converged alone with azygos vein or semiazygos vein, 39 cases with paraesophageal varices formed above the diaphragm confluent with esophageal varices into azygos vein. (2) Surgical situations. All the 173 patients underwent surgery successfully, including 8 cases undergoing splenectomy, 86 cases undergoing splenectomy combined with modified complete devascularization, 35 cases undergoing splenectomy combined with spontaneous gastrorenal shunt reconstructing devascularization, 41 cases undergoing splenectomy combined with PEV preserving devascularization and 3 cases undergoing splenectomy combined with PEV ring constriction. None of 173 patients had surgical relative death, 67 cases had complica-tions, including 3 cases undergoing splenectomy, 29 cases undergoing splenectomy combined with modified complete devascularization, 11 cases undergoing splenectomy combined with spontaneous gastrorenal shunt reconstructing devascularization, 23 cases undergoing splenectomy combined with PEV preserving devascularization and 1 case undergoing splenectomy combined with PEV ring constriction underwent complications. (3) Follow-up. Of the 173 patients, 159 cases were followed up for 6 to 42 months, with a median follow-up time of 28 months. In the 7 cases undergoing splenectomy who were followed up, there were 6 cases without esophageal varices and 1 case with recurrence of esophageal varices. In the 79 cases undergoing splenectomy combined with modified complete devascularization who were followed up, there were 5 cases without esophageal varices, 67 cases with mild to moderate residual of esophageal varices, 5 cases with severe residual of esophageal varices, 1 case with recurrence of esophageal varices and 1 case with recurrence of esophageal varices hemorrhage. In the 34 cases undergoing splenectomy combined with sponta-neous gastrorenal shunt reconstructing devascularization who were followed up, there were 7 cases without esophageal varices and 27 cases with mild to moderate residual of esophageal varices. In the 36 cases undergoing splenectomy combined with PEV preserving devascularization who were followed up, there were 4 cases without esophageal varices, 21 cases with mild to moderate residual of esophageal varices, 5 cases with severe residual of esophageal varices, 4 cases with recurrence of esophageal varices and 2 cases with recurrence of esophageal varices hemorrhage. In the 3 cases undergoing splenectomy combined with PEV ring constriction who were followed up, there were 2 cases with mild to moderate residual of esophageal varices, 1 case with severe residual of esophageal varices.Conclusions:The CT detection rate of PEV in portal hypertension patients is >50% and the internal diameter and distribution of blood vessels are different in patients. CT examination anatomical features of PEV can be used to guide the formula-tion of surgical methods.

Objective:To explore the changes of peripheral blood Th17/Treg and serum cytokines in AECOPD patients with secondary pulmonary fungal infection.Methods:Selected the clinical data of 27 AECOPD patients who were admitted between January 2018 to March 2020 in the Department of Respiratory Medicine, Hai'an People's Hospital Affiliated to Nantong University with fungal infection (fungal infection group), and 58 AECOPD patients without fungal infection (non-fungal infection group) who received treatment in the hospital during the same period. Compared the general clinical data, peripheral blood Th17 and Treg cell levels, Th17/Treg ratio, interleukin-17 (IL-17), interleukin-23 (IL-23), interferon-γ (interferon-γ, IFN-γ), and transforming growth factor-β (TGF-β) levels. Meanwhile, compared the levels of Th17 and Treg cells in peripheral blood, the ratio of Th17/Treg and serum cytokines in patients with different infection severity in fungal infection group. The measurement data with normal distribution were compared by independent samplet t-test between the two groups, one-way ANOVA between multiple groups, LSD-t test for pairwise comparision, and χ 2 test for counting data. Results:In the 27 AECOPD patients with fungal infection group, the pathogen distribution was 65.52% (19/27) of candida albicans, 10.34% (3/27) of candida tropicalis,10.34% (3/27) of candida albicans, and 6.90% (2/27) of Aspergillus. The level of Th17 [(16.18±3.15) % and (12.34±2.64) %, t=5.87, P<0.001)], the ratio of Th17/Treg [(4.70±0.85) and (2.41±0.51), t=22.87, P<0.001] in Patients with fungal infection group were higher than those in the non-fungal group. The level of Treg [(3.42±0.42) % and (5.13±0.51) %, t=20.77, P<0.001] in Patients with fungal infection group was lower than those in the non-fungal group. The levels of IL-17 [(85.67±21.51) μg/L and (53.64±14.36) μg/L, t= 8.12, P<0.001], and IL-23 [(61.38±16.58) μg/L and (38.29±12.60) μg/L, t=7.10, P<0.001] in Patients with fungal infection group were higher than those in non-fungal infection group, but the levels of IFN-γ ((47.75±17.72) μg/L and (62.37±19.06) μg/L, t=3.37, P=0.001) and TGF-β ((110.34±26.03) μg/L and (131.40±35.03) μg/L, t=2.87, P=0.007) were lower than those in non-fungal infection group, and the differences were statistically significant. There were statistically significant differences in the ratio of Th17/Treg, and the levels of Th17, Treg cells and cytokine among patients with different infection severity in the fungal infection group. With the increase of infection severity, the levels of Th17 ((13.06±1.98)%, (15.94±2.11)%, (17.75±2.20)%, F=10.19, P<0.001), the ratios of Th17/Treg ((5.01±0.60), (5.66±0.69), (6.52±0.65), F=10.77, P<0.001), the levels of IL-17 ((63.39±11.64) μg/L,(78.66±12.82) μg/L, F=9.01, P=0.001), and IL-23 ((42.52±13.11) μg/L, (59.97±15.25) μg/L, (69.75±14.30) μg/L, F=7.41, P=0.003) were increase, the levels of Treg ((4.33±0.39)%, (3.32±0.42)%, (2.50±0.35)%, F=44.42, P<0.001), IFN-γ ((57.78±10.52) μg/L, (48.82±10.39) μg/L, (38.90±10.56) μg/L, F=6.50, P=0.006), TGF-β ((126.62±18.94) μg/L, (115.34±13.66) μg/L, (102.52±17.73) μg/L, F=4.25, P=0.026) were significantly decreased. Conclusion:The imbalance of Th17/Treg ratio and related serum cytokines play an important role in the process of lung fungal infection in AECOPD patients, and their imbalance is related to the severity of fungal infection. Therefore, the levels of Th17/Treg and serum cytokines should be closely monitored in AECOPD patients.

Objective:To investigate the current status of prevention and treatment of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension patients in Ningxia region.Methods:The retrospective and descriptive study was conducted. The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected, including 85 cases in Ningxia Hui Autonomous Region People′s Hospital, 73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region, 59 cases in the Wuzhong People′s Hospital, 52 cases in the Qingtongxia People′s Hospital, 50 cases in the Guyuan People′s Hospital, 47 cases in the Yuanzhou District People′s Hospital of Guyuan City, 47 cases in the Yinchuan Second People′s Hospital, 40 cases in the General Hospital of Ningxia Medical University, 40 cases in the Tongxin People′s Hospital, 35 cases in the Yinchuan First People′s Hospital, 34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region, 32 cases in the Zhongwei People′s Hospital, 30 cases in the Lingwu People′s Hospital, 30 cases in the Wuzhong New District Hospital, 30 cases in the Yanchi People′s Hospital, 29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine, 28 cases in the Shizuishan Second People′s Hospital, 25 cases in the Shizuishan First People′s Hospital, 21 cases in the Haiyuan People′s Hospital, 20 cases in the Pengyang People′s Hospital, 13 cases in the Longde People′s Hospital. There were 538 males and 282 females, aged (56±13)years. Observation indicators: (1) clinical charac-teristics of cirrhotic portal hypertension patients; (2) overall prevention and treatment of EVB in cirrhotic portal hypertension patients; (3) prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical characteristics of cirrhotic portal hypertension patients: of 820 cirrhotic portal hypertension patients, 271 cases were in compensated stage and 549 cases were in decompensated stage. Of the 271 cases in compensated stage, there were 183 maels and 88 females, aged (53±12)years. There were 185 Han people, 85 Hui people and 1 case of other ethic group. The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B, 4 cases of alcoholic liver disease, 8 cases of viral hepatitis C, and 48 cases of other etiology. There were 235 cases of Child-Pugh grade A and 36 cases lack of data. Of the 549 cases in decompensated stage, there were 355 males and 194 females, aged (57±14) years. There were 373 Han people, 174 Hui people and 2 cases of other ethic group. The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B, 33 cases of alcoholic liver disease, 10 cases of viral hepatitis C, and 114 cases of other etiology. There were 80 cases of Child-Pugh grade A, 289 cases of grade B, 170 cases of grade C and 10 cases lack of data. (2) Overall prevention and treatment of EVB in cirrhotic portal hypertension patients: of 271 patients in compensated stage, 38 cases received non-selective β-blocker (NSBB) therapy, 16 cases received endoscopic treatment, 6 cases received interventional therapy. Of 549 patients in decompensated stage, 68 cases received NSBB therapy, 46 cases received endoscopic treatment, 28 cases received interventional therapy. (3) Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals: of 271 patients in compensated stage, 181 cases came from tertiary hospitals, of which 28 cases received NSBB therapy, 15 cases received endoscopic treatment, 6 cases received interventional therapy. Ninety cases came from secondary hospitals, of which 10 cases received NSBB therapy, 1 cases received endoscopic treatment. There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals ( χ2=0.947, P>0.05), while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals ( χ2=5.572, P<0.05). Of 549 patients in decompensated stage, 309 cases came from tertiary hospitals, of which 22 cases received NSBB therapy, 29 cases received endoscopic treatment, 22 cases received interventional therapy. Two hundreds and fourty cases came from secondary hospitals, of which 46 cases received NSBB therapy, 17 cases received endoscopic treatment, 6 cases received interven-tional therapy. There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals ( χ2=18.065, 5.956, P<0.05). Conclusions:The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low. For patients with compensated liver cirrhosis, the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals. For patients with decompensated liver cirrhosis, the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals, but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.

Objective: To evaluate 3D imaging technology in the preoperative evaluation of breast conserving surgery. Methods: A ret-rospective analysis was conducted using clinical data from 38 patients who underwent breast conserving surgery that was assisted by 3D imaging technology in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from April 2017 to January 2019. All 38 patients underwent 3.0-T breast magnetic resonance imaging (MRI) examination before surgery, and 3D reconstruction of virtu-al images was constructed through 3D modeling of medical digital imaging and communication (DICOM) data. The predicted resected tissue volume was compared with the volume of the actual resected specimen, and the surgical margin and postoperative aesthetics of the breast conserving surgery were evaluated. Results: The reconstructed 3D model clearly displayed the anatomical structures of the breast, tumor, gland, and blood vessels, and their relationship in 3D spaces. The goodness of fit of the 3D model to the practical sit-uation was 97.4% (37/38). In terms of the resection tissue volume, there was no significant difference between the predicted results (PRTV) and actual results (ARTV) [(61.7 ± 20.1) mL vs. (65.1 ± 20.7) mL, P>0.05]. There was a strong positive correlation between ARTV and PRTV (P<0.01). One patient underwent supplementary secondary surgery, resulting in an incidence of 2.6% (1/38). The postopera-tive satisfaction for breast conserving surgery was 100% (38/38). Conclusions: 3D imaging technology clearly displays the anatomical relationship between breast tumor and surrounding tissues, and correctly assesses breast volume, guiding surgical resection.

Objective This article reviews the curriculum framework, teaching content, teaching method and application effects of stimulation teaching of hospice care for nursing undergraduates and reveals its inspirations to China, in order to provide a reference for the further development of China's hospice education.

Background Researches showed that microperimetry can exhibit more tiny visual function damage than conventional perimetry in glaucomatous eyes.However,the study on fixation stability of glaucoma is still rare until now.Objective This study was to compare the correlation between microperimetry Maia (Macular Integrity Assessment) and Humphrey perimetry,and to investigate the changes of the fixation stability in glaucoma patients with hemifield defect.Methods This study proposal was approved by Medical Ethic Committee of Peking University First Hospital.A cross-sectional study was performed under the informed consent of each subject.Thirtyfive eyes of 35 glaucoma patients with hemifield defect by 24-2 Humphrey perimetry were included in Peking University First Hospital from December 2013 to March 2014,and 30 eyes of 30 normal volunteers served as controls.Both Humphery (10-2) and Maia (expert 10-2) were performed on the subjects respectively and the correlation of the results between Humphery (10-2) and Maia (expert 10-2) were analyzed.Then the patients with normal hemifield on Humphrey were assigned to Maia normal group and Maia abnormal group.Fixation stability differences were compared between glaucoma group and normal control group,and between Maia normal group and Maia abnormal group.Results The moderately positive correlation was found in the mean sensitivity between Maia microperimetry and Humphrey perimetry (r=0.403,P =0.001),and the average threshold of Maia microperimetry was moderately positive correlated with the mean defect (MD) of Humphrey perimetry in glaucoma patients (r=0.438,P =0.008).The fixation stability parameter P1 was (67±17)％ and (87±10)％,and that of P2 was (70±16)％ and (88±9)％;the 63％ bicurve elipse area (BCEA) was (5.08±1.55) °2and (2.21±0.60) °2,and the 95％ BCEA was (14.74± 6.04) °2 and (2.86 ± 1.17)°2 in the glaucoma group and normal control group,respectively,showing significant decreases of P1 and P2 and increases of 63％ BCEA and 95％ BCEA in the glaucoma group compared with the normalcontrol group (t=-5.604,-4.831,9.885,11.086,all at P=0.000).In Maia normal group and Maia abnormal group,the P1 was (79±8)％ and (63±17)％,the P2 was (81±10)％ and (67±16)％,the 63％ BCEA was (3.19±0.65)°2 and (5.70±1.22)°2 and the 95％ BCEA was (9.10±2.60)°2 and (19.35±5.01)°2,respectively.Compared with the Maia normal group,the P1 and P2 were significantly lower,and 63％ BCEA and 95 ％ BCEA were higher in the Maia abnormal group (t=-2.468,P=0.019;t=-2.371,P=0.024;t =5.514,P=0.000;t=5.575,P=0.000).Conclusions Maia microperimetry and Humphrey perimetry yield a good correlation for glaucomatous macular function examination.In addition,Maia microperimetry showed that fixation stability decreased in glaucoma patients with hemifield defect.