OBJECTIVE To systematically evaluate the efficacy and safety of the sedative effect of remimazolam in endoscopy and to compare it with propofol and midazolam. METHODS Search PubMed, Embase, Cochrane Library, Wanfang database, CNKI and other databases to collect the literature of randomized controlled trials of remimazolam for sedation in endoscopy. The search period was from 2018 onwards when remimazolam was approved for clinical trials until April 2022. The search strategy included the following variable keywords: remimazolam, gastroscopy, bronchoscopy, and colonoscopy. The quality of the included literature was assessed and the collected data were subjected to meta-analysis by RevMan 5.4 software. RESULTS Ten relevant RCTs involving midazolam and propofol, involving a total of 2 076 patients were included in the analysis. The results showed that the sedative effect of remimazolam was significantly higher than that of midazolam [OR=0.03, 95%CI(0.02, 0.05), I2=0%, P<0.000 01]; but lower than that of propofol [OR=11.32, 95%CI(2.12, 60.56), I2=0%, P=0.005]. The onset time of remimazolam was longer than that of propofol, but shorter than that of midazolam; the recovery time was faster than that of propofol and midazolam. Compared with midazolam, there was no significant difference in the incidence of adverse reactions. Compared with propofol, remimazolam was associated with lower rates of hypotension, slowed heart rate, hypoxemia, and injection pain, but higher risk ratio of nausea, with no difference invomiting. CONCLUSION The sedative effect and onset of action of remimazolam are better than midazolam but less than propofol when used for endoscopy. Wake-up time is faster than that of propofol and midazolam. The incidence of respiratory and circulatory depression is lower with remimazolam than with propofol, and there are no significant differences in adverse effects compared with midazolam.

Objective: To understand and assess the current situation of primary and secondary school students health services in community health service organizations in Shenzhen, so as to provide a basis for upgrading the capacity of health services. Methods: A total of 684 community health service organizations and 587 part time health vice principals in the Shenzhen City were selected for the study in June 2022, and the special questionnaire surveys regarding primary and secondary school students health service capacity and the community health service organizations and part time health vice principals performance ability were administered in Shenzhen. SPSS 26.0 software was used for a descriptive analysis. Results: The staffing rate of general practitioners or clinical physicians in Shenzhen s community health service organizations was 99.9%, 67.1% of community health service organizations established counterpart collaborative relationships with schools, 50.8% of community health service organizations provided diagnostic and treatment services for students, 24.8% of community health service organizations provided health check up services for students, 85.2% of community health service organizations provided health guidance to schools, and 94.3% of community health service organizations had a part time vice principal of health with a score of (7.63±1.59) in the self assessment of their ability to carry out their duties, and space constraints and shortage of nursing were the main problems in promoting student medical check ups in the community health service organizations. Conclusions The community health service organizations in Shenzhen suffer from inadequate medical service resources and inadequate training for professional staff, resulting in low service capacity for providing physical examinations and health management for primary and secondary school students. There is a need to further promote the integrated development of education and health, and continuously enhance service capabilities, to promote the orderly development of student health work.

As a potential vectored vaccine,Newcastle disease virus(NDV)has been subject to various studies for vaccine development,while relatively little research has outlined the immunomodulatory effect of the virus in antigen presentation.To elucidate the key inhibitory factor in regulating the interaction of infected dendritic cells(DCs)and T cells,DCs were pretreated with the NDV vaccine strain LaSota as an inhibitor and stimulated with lipopolysaccharide(LPS)for further detection by enzyme-linked immunosorbent assay(ELISA),flow cytometry,immunoblotting,and quantitative real-time polymerase chain reaction(qRT-PCR).The results revealed that NDV infection resulted in the inhibition of interleukin(IL)-12p40 in DCs through a p38 mitogen-activated protein kinase(MAPK)-dependent manner,thus inhibiting the synthesis of IL-12p70,leading to the reduction in T cell proliferation and the secretion of interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),and IL-6 induced by DCs.Consequently,downregulated cytokines accelerated the infection and viral transmission from DCs to T cells.Furthermore,several other strains of NDV also exhibited inhibitory activity.The current study reveals that NDV can modulate the intensity of the innate?adaptive immune cell crosstalk critically toward viral invasion improvement,highlighting a novel mechanism of virus-induced immunosuppression and providing new perspectives on the improvement of NDV-vectored vaccine.

Objective To investigate the efficacy and safety of hybrid surgery for the recanalization of carotid artery occlusion after stenting.Methods Clinical data and results of 17 patients with occlusion after carotid artery stenting and treated with hybrid surgery from June 2016 to April 2023 at the Department of Neurosurgery Cerebral Blood Flow Reconstruction Center of Xuanwu Hospital,Capital Medical University were retrospectively analyzed.According to whether the recanalization was successful,17 patients were divided into the the successful recanalization group and the failed recanalization group.Successful recanalization was defined as achieving modified thrombolysis in cerebral infarction(mTICI)grade ≥2b and residual stenosis＜50％.Baseline data(age,sex,body mass index,smoking history,alcohol consumption history,hypertension history,diabetes history,hyperlipidemia history,coronary heart disease history),clinical data(National Institutes of Health Stroke Scale[NIHSS]score at admission,fasting blood glucose,low density lipoprotein,high density lipoprotein,total cholesterol,triglyceride,occlusion side and segment,combination with severe stenosis or occlusion of the contralateral carotid artery,opening of the anterior communicating artery,opening of the posterior communicating artery,compensation of the external and internal carotid artery,compensation of the pia artery,stump morphology,and time from imaging diagnosis of occlusion to recanalization)were documented and compared between groups.The recanalization of occlusive vessels and perioperative complications were recorded.Imaging and clinical follow-up were performed 3,6 months and≥1 year after surgery.Results Among the 17 patients,the ratio of successful recanalization was 13/17.One patient had re-occlusion after operation,which was re-opened after thrombolysis,but neck hematoma with dyspnea occurred,and recovered after emergency operation.There was no postoperative stroke or death.The incidence of perioperative complications was 1/17.Compared with the successful recanalization group,the levels of high density lipoprotein and total cholesterol in the failed recanalization group were higher,and the differences between the groups were statistically significant(high density lipoprotein[1.3±0.3]mmol/L vs.[0.9±0.3]mmol/L,t=-2.139;total cholesterol:[4.2±0.8]mmol/L vs.[3.1±0.7]mmol/L,t=-2.649;both P＜0.05);There were no significant differences in other baseline data and clinical data(all P＞0.05).Imaging follow-up was completed in 9 of the 13 patients in the successful recanalization group,and the follow-up time was 3.8-36.9 months,with a median follow-up time of 22.8(12.8,34.7)months.Among them,1 patient(1/9)developed restenosis of recanalization vessels at 33.0 months after surgery and underwent stent implantation again.Conclusions The preliminary analysis showed that the occlusion after carotid artery stenting had better recanalization success and lower perioperative complications.In patients with chronic occlusion after carotid stenting,the application of a hybrid surgery for opening may be attempted under multimodal imaging assessment.

Streptococcus parasuis(S.parasuis)is a close relative of S.suis and can cause meningi-tis,pneumonia or systemic symptoms in affected animals.In this paper,the dominant strain was i-solated from diseased pigs with pneumonia in Jilin,China,and the isolated strain was identified as S.parasuis by 16S rRNA,it was named WYF-8B.Resistance was tested by the susceptibility tablet diffusion method,and WYF-8B was resistant to bacitracin,sulfamethoxoprim,lincomycin,erythro-mycin,fosfamycin,azithromycin,penicillin,doxycycline,cotrimotrixazole,sulfamisoxazole,cipro-floxacin,enrofloxacin,tetracycline,benzoxacillin,gentamicin,efazolin,and ampicillin.It was highly sensitive to florfenicol,chloramphenicol.Iochemical identification revealed that WYF-8B could fer-ment salicylic acid,maltose,lactose,sucrose,oxaesin,and glucose;nonfermentable mannitol,urea,raffinose,xylose,arabinose,and sorbitol.Using the second-generation whole-genome sequencing technology to study the WYF-8B resistant genotype,it was found that it carried the macrolide anti-biotic resistance genes Mef(E)and ErmB;resistance genes pbp2b,pbp1a,and pbp2x to β-lactam antibiotics;resistance genes gyrA,parC,and grlB to fluoroquinolones;resistance genes ANT(6)-Ia,AAC(6')-Ie-APH(2')-Ia,ANT(9)-Ia,APH(3')-Ⅲa to aminoglycoside antibiotics;re-sistance groups lnuB,lmrC,lmrD against lincomide antibiotics;resistance gene tetM to tetracy-cline antibiotics;the resistance gene of bacitracin,bcrA.The results found that the resistance phe-notype matches the resistance genotype of the sequencing results.The study of WYF-8B virulence factors found that WYF-8B carried 13 virulence factors(pavA,fbp 54,clpP,cps 4,cps 4 I,wbtB,cps,sI,tufA,galE,hasC,groEL,wrbtL,wbbtF),which mainly acted to promote bacterial diffu-sion,transfer,settlement,antiphagocytosis and immune evasion.The results of drug sensitivity test provide a reference for the study of clinical medication of S.parasuis,and drug resistance pheno-type and virulence factors lay the foundation for the research and development of new drugs and vaccines.

The eutR gene deletion mutant of Salmonella enteritidis was successfully constructed by homologous recombination.Through the study of its biochemical characteristics,motility,resist-ance to stress in vitro and survival ability in RAW 264.7 cells,it was found that the biochemical characteristics and motility of the eutR gene deletion mutant of Salmonella enteritidis had no sig-nificant change compared with the wild type of Salmonella enteritidis.The ability of eutR gene de-letion strain of Salmonella enteritidis to resist acid,alkali and oxidation was significantly reduced,while the ability to resist heat was not significantly changed;the survival ability of eutR gene dele-tion strain in RAW 264.7 cells was significantly reduced compared with the wild type.In order to further analyze the effect of eutR gene on the expression of virulence factors of Salmonella enterit-idis,the relative expression levels of invH,ssav,ssrA,xthA,orf245,sodC,lrp,mrr1 and hflk virulence genes of the deletion strain and the wild strain were detected by SYBR Green PCR.It was found that the expression of the virulence factors mentioned above in the eutR gene deletion strain of Salmonella enteritidis was significantly down-regulated compared with that in the wild-type strain.The LD50 of the eutR gene-deleted strain of Salmonella enteritidis was determined by ani-mal experiments,and the results showed that the LD50 of the eutR gene-deleted strain was higher than that of the wild-type strain,indicating that the eutR gene could affect the virulence of Salmonella.This study clarified the effect of eutR gene on the survival ability,some biological characteristics and virulence of Salmonella enteritidis in macrophages,and provided a new gene knockout target for the development of attenuated Salmonella enteritidis genetic engineering vac-cine.

Objective:To explore the factors influencing the clinical outcome of complex high-risk indicated patients percutaneous coronary intervention (CHIP-PCI) assisted by extracorporeal membrane oxygenation (ECMO).Methods:The clinical data of patients with CHIP-PCI assisted by ECMO in the First Affiliated Hospital of Zhengzhou University from April 2018 to April 2022 were retrospectively collected and analyzed. Patients were divided into the survival and death groups according to the in-hospital survival status. The baseline characteristic, the results of coronary angiography, and the use of ECMO, blood products and drug were compared between the two groups. The 24-h rate of change of biochemical test indicators after the use of ECMO were calculated and the univariate analysis was analyzed using rank sum test. According to the univariate analysis, the variables ( P<0.05) were included in multivariate logistic regression to analyze the factors affecting the clinical outcomes of patients. Results:A total of 67 CHIP patients who completed PCI with ECMO were included. In the survival group ( n=36), the duration of ECMO treatment was 59 (41, 87) h, 9 cases received continuous renal replacement therapy, and 11 cases received IABP. In the death group ( n=31), the duration of ECMO treatment was 31 (19, 80) h, 12 cases received continuous renal replacement therapy and10 cases received IABP. The proportion of patients with chronic total occlusion lesions (CTOs) in the survival group was lower than that in the death group, the duration of ECMO of the survival group was longer than that of the death group ( P<0.05). Multivariate logistic regression analysis showed that 24-h lactate change rate ( OR=2.864, 95% CI: 1.185-6.918, P=0.019), 24-h eGFR change rate ( OR=0.050, 95% CI: 0.003-0.871, P=0.040), 24-h D-dimer change rate ( OR=1.497, 95% CI: 1.044-2.146, P=0.028) and 24-h direct bilirubin change rate ( OR=2.617, 95% CI: 1.121-6.111, P=0.026) were associated with in-hospital mortality. Conclusions:Within 24 h after CHIP-PCI assisted by ECMO, the rapid decline in lactic acid, D-dimer and direct bilirubin, and the rapid recovery of eGFR, are associated with the decreased risk of hospital mortality from CHIP.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Background Long-term excessive consuming sugar-sweetened beverages have a negative impact on health. In order to decrease the consumption of sugar-sweetened beverages and create a healthy food environment, the Health Commission of Shenzhen Municipality pioneered to enforce health warning labels presented in commercial locations vending sugar-sweetened beverages based on relevant provisions of the Health Regulations of Shenzhen Special Economic Zone，but its effect has not yet been evaluated. Objective To evaluate the impact of presenting health warning labels in commercial locations vending sugar-sweetened beverages in Shenzhen. Methods A multi-stage stratified sampling method was used to randomly select one street in each of the 10 districts (excluding the Shenzhen Shantou Special Cooperation Zone) of Shenzhen followed by a convenience sampling to select sampling sites to conduct an undercover investigation on the presentation of health warning labels for sugar-sweetened beverages in six different types of venues (n=232) such as shopping malls, ordinary supermarkets/convenience stores, self-service vending machines, catering service places, medical institutions, and venues serving minors' education and activities. At the same time, 238 site managers, 1002 adult consumers, and 7396 child and adolescent consumers were interviewed. Results Among 213 commercial locations vending sugar-sweetened beverages, the rate of health warning label installation was 26.3%, with the highest installation rate in shopping malls (55.0%). Among site managers, 47.8% were aware that commercial locations were required to install health warning labels, and 50.0% were aware of the standards for setting up health warning labels. The higher the awareness of relevant regulations, the higher the rate of installation of health warning labels. More than half of site managers (55.3%) believed that after installing health warning labels, the sales of sugar-sweetened beverages and sugar-sweetened beverages in large-volume packages had decreased compared to the same period in previous years. Most of the interviewed consumers indicated that if they saw the health warning labels for sugar-sweetened beverages, they would buy less, give up purchasing, or choose low-sugar or sugar-free beverages, and also discourage their family members or friends from drinking such beverages. Compared with participants without awareness of the health warning labels, both adult and child and adolescent consumers with awareness of the health warning labels believed that the installation is beneficial to their good eating habits and reported a higher proportion of discouraging family members or friends from drinking such beverages, with a lower frequency of consuming sugar-sweetened beverages. Conclusion Health warning labels for sugar-sweetened beverages have a significant effect on promoting behavior changes, and both site managers and citizens have a high level of support for them. However, in view of the low voluntary compliance rate of commercial locations and the installation rate of health warning labels, the publicity and enforcement of the Health Regulations of Shenzhen Special Economic Zone should be enhanced.

In order to explore the effect of peptidoglycan hydrolase on the viable cell counts of Bacillus amyloliquefaciens and the yield of alkaline protease, five peptidoglycan hydrolase genes (lytC, lytD, lytE, lytF and lytG) of B. amyloliquefaciens TCCC111018 were knocked out individually. The viable cell counts of the bacteria and their alkaline protease activities before and after gene deletion were determined. The viable cell counts of the knockout mutants BA ΔlytC and BA ΔlytE achieved 1.67×10⁶ CFU/mL and 1.44×10⁶ CFU/mL respectively after cultivation for 60 h, which were 32.5% and 14.3% higher than that of the control strain BA Δupp. Their alkaline protease activities reached 20 264 U/mL and 17 265 U/mL, respectively, which were 43.1% and 27.3% higher than that of the control strain. The results showed that deleting some of the peptidoglycan hydrolase genes effectively maintained the viable cell counts of bacteria and increased the activity of extracellular enzymes, which may provide a new idea for optimization of the microbial host for production of industrial enzymes.
Bacillus amyloliquefaciens/genetics* ; Bacterial Proteins ; Cell Count ; Endopeptidases/genetics* ; N-Acetylmuramoyl-L-alanine Amidase/genetics*