Objective:To study the expression of Toll like receptor 3 (TLR3) in human adenocarcinoma of the lung cells induced by respiratory syncytial virus (RSV) and its significance in the diagnosis of pneumonia in children.Methods:A549 cells were divided into RSV infection group [added 1 μg/ml Lipopolysaccharide (TLR3 agonist) transfected RSV virus after 150 μl intervention], Lipopolysaccharide stimulation group (added 1 μg/ml Lipopolysaccharide 150 μl intervention) and normal control group (normal culture). The mRNA expressions of tumor necrosis factor-α, interleukin 8, TLR3 protein and TLR3 in A549 Cells of different groups were compared. We prospectively selected 80 children with RSV infectious pneumonia admitted to Baoding Second Central Hospital from August 2019 to October 2021 as the RSV pneumonia group, and sixty children with common pneumonia were taken as the common pneumonia group, and 60 healthy children in our hospital were taken as the control group. The mRNA expression of serum TLR3 in different groups was compared, and the diagnostic efficacy of serum TLR3 in RSV pneumonia was evaluated by receiver operating characteristic.Results:There was a statistically significant difference in the expression of TLR3 protein among different groups of A549 cells ( P<0.001). The expression differences of TLR3 mRNA in different groups of A549 cells at different time points were statistically significant(all P<0.001). There was significant difference in the expression of tumor necrosis factor-α and interleukin 8 of A549 cells at different time points in different groups (all P<0.05). There was a statistically significant difference in the expression of serum TLR3 mRNA among the three groups of subjects ( F=155.237, P<0.001). The critical value for TLR3 gene diagnosis was 66.87, with corresponding sensitivity of 73.75%, specificity of 70.83%, and the area under curve (AUC) of 0.803(95% CI: 0.753-0.855). Conclusions:Respiratory syncytial virus induces human lung cancer cells and promotes disease progression through TLR3 expression; Serum TLR3 can be used for the diagnosis of RSV pneumonia.

[摘 要] 目的：探究miR-323a-3p、四次穿膜蛋白超家族成员1（TM4SF1）在NSCLC组织和细胞中的表达及两者间的靶向调控关系，观察两者表达对A549细胞增殖、迁移、侵袭和裸鼠移植瘤生长的影响。方法：收集2014年1月至12月间青海省人民医院手术切除的20例NSCLC组织及其相应的癌旁组织，qPCR和WB法检测癌组织中miR-323a-3p、TM4SF1 mRNA 和TM4SF1蛋白的表达。向A549细胞转染miR-323a-3p mimic，采用MTT法、Transwell法、WB法检测miR-323a-3p过表达对细胞的增殖、迁移和侵袭以及TM4SF1、细胞周期蛋白D1（cyclin D1）、p21、MMP-2、MMP-9蛋白表达的影响。采用生物信息学预测工具StarBase和双荧光素酶报告基因实验分析miR-323a-3p与TM4SF1靶向关系。将si-TM4SF1转染至A549细胞，以及分别将miR-323a-3p mimic与pcDNA或pcDNA-TM4SF1共转染A549细胞，评估细胞增殖、迁移和侵袭能力的变化；同时建立各组细胞的BALB/c裸鼠移植瘤模型，在14、21和28 d时测量并计算移植瘤体积。结果：与癌旁组织相比，NSCLC组织中miR-323a-3p表达水平明显下调，TM4SF1 mRNA和蛋白表达水平显著上调（均P<0.01）。miR-323a-3p过表达或抑制TM4SF1表达都会降低A549 细胞的增殖、迁移、侵袭能力及cyclin D1、MMP-2、MMP-9蛋白表达而促进p21蛋白表达，并且抑制A549细胞裸鼠移植瘤的生长（均P<0.01）。生物信息学StarBase工具预测和双荧光素酶基因报告实验结果显示miR-323a-3p能够靶向结合TM4SF1基因并调控 TM4SF1的表达。上调TM4SF1表达后，miR-323a-3p过表达对A549细胞恶性生物学行为及cyclin D1、MMP-2、MMP-9蛋白表达、移植瘤生长的抑制作用均被部分逆转（均P<0.01），对p21蛋白表达的促进作用也被逆转（P<0.01）。结论：miR-323a-3p 通过靶向下调肺癌A549细胞中TM4SF1的表达抑制细胞的增殖、迁移、侵袭和裸鼠移植瘤生长。

Objective:To apply the best evidence of hypoglycemia management for neonates delivered by mothers with gestational diabetes mellitus (GDM) in clinical practice and evaluate its curative effects.Methods:This study was a historical controlled study. The newborns delivered by GDM mothers who were admitted to the neonatal intensive care unit of a Class A hospital in Hefei from February to December 2019 were selected as the research objects by convenient sampling. Newborns delivered by GDM mothers admitted to the hospital during the application of evidence-based practice were the subjects of the pre-evidence study ( n=53) , and newborns delivered by GDM mothers admitted to the hospital after applying the evidence-based practice from September to December 2019 were used as evidence Post-application research subjects ( n=59) . Evidence-based nursing was used to obtain best evidence. Based on the evidence-based continuous quality improvement model as the theoretical framework, the evidence-based practice plan for neonatal hypoglycemia management of gestational diabetes mothers during delivery was constructed and applied. Before and after the application of evidence-based practice, 63 neonatal nurses and parents of neonates were surveyed with the self-made GDM Mothers' Newborn Hypoglycemia Management Questionnaire and the Chinese version of the Uncertainty of the Disease Parents Scale, respectively. And the changes in the incidence of hypoglycemia within 2 hours after birth was compared before and after the application of evidence-based practice. Results:A total of 7 pieces of evidence were used in the evidence-based practice. After the application of the evidence-based practice, the incidence of hypoglycemia in neonates delivered by mothers with gestational diabetes within 2 hours after birth decreased from 20.8% (11/53) to 3.4% (2/59) , and the difference was statistically significant (χ 2=8.206, P<0.05) . The score of the questionnaire on knowledge of hypoglycemia management of neonates delivered by mothers with gestational diabetes mellitus in 63 department nurses was increased from (7.00±1.43) to (7.84±1.18) , and the difference was statistically significant ( t=-12.253, P<0.05) . Before and after the application of evidence-based practice, scores of Mishel Uncertainty in Illness Scale for newborn parents were respectively 87.00 (65.00, 99.50) and 59.00 (43.00, 74.00) , and the difference was statistically significant ( U=728.500, P<0.01) . Conclusions:Evidence-based practice for blood glucose management of newborns delivered by gestational diabetic mothers can reduce the incidence of neonatal hypoglycemia and the uncertainty of their parents' diseases, improve nurses' neonatal hypoglycemia management level, and promote continuous improvement of nursing quality.

OBJECTIVES: To explore the prescribing habits of doctors, and to provide basis for rational use of antibiotics in clinical practice via investigating and analyzing the applications of antibiotics in treatment of coronavirus disease 2019 (COVID-19) in the designated hospital. METHODS: Specification, quantity, amount, defined daily dose system (DDDs), defined daily dose consumption (DDDc), antibiotics use density (AUD), composition, frequency of use, combined use of antibacterial drugs used in the hospital were analyzed between Feb. 2020 and Mar. 2020. RESULTS: A total of 25 antibiotic drugs in 12 categories were used. The total cost for antibiotic drugs was 1 million 238 thousand yuan, in which quinolone accounts for 48%, the third generation cephalosporin/lactamase inhibitors accounts for 15.86%, antifungals accounts for 14.17%, oxazolidone accounts for 13.46%, and carbapenms account for 12.73%. The top three drugs of DDDs and AUD were moxifloxacin hydrochloride tablets, moxifloxacin hydrochloride and sodium chloride injection, cefoperazone sodium and sulbactam sodium for injection. The proportion of patients who had been used more than two kinds of antibiotics was 22.36%. CONCLUSIONS Broad-spectrum, high-potency antibiotics are used at the beginning of COVID-19 treatment. The varieties of antibiotics meet the requirements of the management of antibiotics, and the utilization rate of antibiotics and the cost proportion of antibiotics in COVID-19 patients are within a reasonable range.In the future, for the treatment of COVID-19, we should continue to summarize the experience, improve the strategies, and rationally apply antibiotics on the basis of guidelines.
Anti-Bacterial Agents ; classification ; therapeutic use ; Betacoronavirus ; Coronavirus Infections ; drug therapy ; Humans ; Pandemics ; Pneumonia, Viral ; drug therapy

Objective: To study the diagnostic value of a multi-gene molecular testing in cytologically indeterminate thyroid nodules. Methods: From February 2018 to September 2018, patients with thyroid nodules who underwent fine needle aspiration(FNA) at Peking University Cancer Hospital were enrolled. Three hundred and sixty patients were included, consisting of 86 men and 274 women, with a mean age of 45.8 years (between 13 and 89 years old). Among 391 nodules, 141 were cytologically inderminate and 75 were resected. FNA samples underwent prospective testing using a next-generation sequencing (NGS) assay, which included 16 genes for point mutations and 26 types of gene fusions. The testing results of indeterminate nodules were compared with surgical outcomes, to determine the diagnostic performance. The results were compared with the BRAF V600E single gene mutation analysis by χ² test. Results: The multi-gene testing showed a sensitivity of 73.2%, specificity of 96.8%, positive predictive value of 96.8%, and negative predictive value of 73.2%. The diagnostic accuracy of multi-gene testing was significantly higher than the BRAF V600E mutation test (83.3% vs 73.6%, χ²=31.588, P<0.01). Conclusion Multi-gene testing in FNA samples is an effective method to diagnose cytologically indeterminate thyroid nodules, which has a higher accuracy than BRAF V600E mutation detection.

OBJECTIVE To discuss the efficacy and safety of Onyx embolization for the treatment of maxillofacial arteriovenous malformation(mAVMs). METHODS Between February 2013 to May 2014, 16 patients with mAVMs received embolotherapy in our department. Eight cases' mAVMs located in mandibular region, 5 cases located in the maxillary region and the other 3 cases located near the orbital region. Embolotherapy with Onyx was carried out in all patients and all the patients were followed-up. The effect of embolization was evaluated according to the deformity arteriolar blood flow. RESULTS After the embolization, angiograpy showed that complete occlusion of mAVMs was achieved in 3 cases, 50%-90%occlusion in 10 cases, <50% occlusion in 3 cases, and the overall response rate was 81.25% (13/16). After operation, temporary decreased vision was obtained in one patient and recovered after 20 days, no permanent visual abnormality was found in all of the cases. Complications as distending pain, fever disappeared in 13 patients, improved in 2 patients and became worse in one patient. There was no case of skin necrosis occurred. Follow-up for 6 months after treatment, the deformity arteriolar blood flow larger than before was found in 2 cases and the others were stable. CONCLUSION Onyx embolization for the treatment of maxillofacial arteriovenous malformation is a safe and effective method, the short term curative effect has been confirmed while the long term curative effect should be further evaluated.

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy(SAE).Methods From Jan 2013 to Oct 2014,we used the criteria of systemic inflammatory response syndrome (SIRS)positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit (ICU).Results Among 6 comatose patients with evidence of infection,3 cases were secondary infection after hemorrhagic stroke,1 case was secondary infection after trauma,and the other 2 cases were primary infection.All patients met the diagnosis of SIRS -positive sepsis with encephalopathy.Among them,the presence of SIRS 3 criteria was in 2 cases,four criteria in 4 cases. All patients with severe brain failure (100%),in addition to 5 cases with acute respiratory failure caused by lung injury,one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases (33.3%),the cerebral ischemic lesions in four cases(66.7%).The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions,and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case,eventually with a poor prognosis.Conclusion SAE is a common critically illness,the use of the new classifi-cation criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy.

Objective To explore the value of superb microvacular imaging ( SMI) technology in differentiating thyroid microcarcinomas from benign micronodules comparing with contrast‐enhanced ultrasound (CEUS) . Methods A total of 195 thyroid micronodules ( ≤1 .0 cm) from 172 patients were examined using CEUS and SMI ,and the findings were reviewed and evaluated in comparison to the pathological results . Results Of all the 195 thyroid nodules ,pathologic findings revealed that 140 (71 .8% ) were malignant and 55 (28 .2% ) were benign ,CEUS diagnosed that 127 (65 .1% ) were malignant and 68 (34 .9% ) were benign ,and SMI diagnosed that 129 (66 .2% ) were malignant and 66 (33 .8% ) were benign . There were no differences between the SMI and CEUS in terms of sensitivity ( 90 .0% vs 87 .9% ) , specificity ( 94 .5% vs 92 .7% ) ,accuracy ( 91 .3% vs 89 .2% ) ,positive predictive value ( 97 .7% vs 96 .9% ) and negative predictive value ( 92 .9% vs 87 .9% ) ( P > 0 .05 for all) . Conclusions SMI can effectively observe the perforating blood vessels of thyroid micronodules , which plays an important role in differentiating of benign and malignant thyroid micronodules .

OBJECTIVETo investigate the efficacy of detachable balloon for splenic artery trunk embolization in patients with cirrhotic portal hypertension and hypersplenism.

METHODSEight patients with cirrhotic portal hypertension received splenic artery trunk disconnection using detachable balloons under the guidance of digital subtraction angiography. The diameter and blood flow of the portal vein, the superior mesenteric vein, the splenic vein and the hepatic artery were measured by color Doppler ultrasound. Markers of liver function and blood coagulation, and routine blood parameters were assessed. Gastroscopy was used to evaluate to the degree of gastroesophageal varices. All complications experienced during the perioperative period were recorded.

RESULTSThe portal vein diameter decreased from 1.55±0.38 cm to 1.55±0.38 cm, and the splenic artery diameter decreased from 1.45±0.10 cm to 1.41±0.09 cm (P < 0.05). The portal vein blood flow was reduced from 971.52±174.77 ml/min to 785.86±100.17 ml/min, and the splenic vein blood flow decreased from 938.01±208.86 ml/min to 644.02±188.15 ml/min, while the hepatic artery blood flow increased from 261.25±65.47 ml/min to 449.32±84.05 ml/min (P < 0.05). The symptoms of splenism were improved effectively, with platelet counts rising from 37.75±10.61*109/L to 138.63±28.22*109/L after the procedure (P < 0.05). There were no episodes of severe complications or death in the perioperative period, and all patients showed remarkable improvement in markers of liver function and coagulation function, and improvement of esophagogastric varices.

CONCLUSIONSThe interventional disconnection technique of the splenic artery trunk using detachable balloon for the treatment of portal hypertension and hypersplenism is safe and effective.

Angiography, Digital Subtraction ; Embolization, Therapeutic ; Esophageal and Gastric Varices ; Hemodynamics ; Hepatic Artery ; Humans ; Hypersplenism ; Hypertension, Portal ; Mesenteric Veins ; Platelet Count ; Portal Vein ; Splenic Artery

Objective To investigate the clinical effect of endovascular embolization in treating spinal dural arteriovenous fistulae, and to discuss its imaging manifestations. Methods A total of 7 patients with spinal dural arteriovenous fistulae were included in this study. Endovascular embolization was carried out in all the 7 patients. The clinical data, including epidemiology, spinal MRI and DSA manifestations, therapeutic method and follow-up findings, were retrospectively analyzed. Results Abnormal MRI manifestations of spinal cord were demonstrated in all 7 patients. After the diagnosis was confirmed by DSA, endovascular embolization was carried out. All patients were followed up for 6 months, and their clinical symptoms were improved in different degrees. N-butyl cyanoacrylate (NBCA) glue was used as embolization agent in 4 cases, and no recurrence was observed in them. Onyx liquid glue was used in 3 patients, and in one of them the arteriovenous fistula recurred. Conclusion For the treatment of spinal dural arteriovenous fistulae, endovascular embolization is effective and safe although further investigation is still needed.