Alzheimer's disease(AD)is a severe threat to human health and one of the three major causes of human death.Double-stranded RNA-dependent protein kinase(PKR)is an interferon-induced protein kinase involved in innate immunity.In the occurrence and development of AD,PKR is upregulated and continu-ously activated.On the one hand,the activation of PKR triggers an integrated stress response in brain cells.On the other hand,it indirectly upregulates the expression of 3-site amyloid precursor protein cleaving enzyme 1 and facilitates the accumulation of amyloid-β protein(Aβ),which could activate PKR activator to further activate PKR,thus forming a sustained accumulation cycle of Aβ.In addition,PKR can promote Tau phosphorylation,thereby reducing microtubule stability in nerve cells.Inflammation in brain tissue,neurotoxicity resulted from Aβaccumulation,and disruption of microtubule stability led to the progression of AD and the declines of memory and cognitive function.Therefore,PKR is a key molecule in the development and progression of AD.Effective PKR detection can aid in the diagnosis and prediction of AD progression and provide opportunities for clinical treat-ment.The inhibitors targeting PKR are expected to control the activity of PKR,thereby controlling the progression of AD.Therefore,PKR could be a target for the development of therapeutic drugs for AD.

Objective To evaluate the short-term clinical efficacy of photodynamic therapy(PDT)assisted mechanical debridement(MD)in the treatment of peri-implantitis.Methods According to the new international classification of periodontal diseases and peri-implant diseases in 2018,single tooth implants diagnosed as peri-implantitis were included.Before treatment,the probing depth(PD),modified sulcus bleeding index(mSBI),and modified plaque index(mPLI)were recorded as the baseline,with mSBI≥1 sites as the treatment sites.The MD group was a control group,and only mechanical subgingival debridement was performed.The PDT group was treated with photodynamic therapy twice,immediately after subgingival debridement and one week after.Follow-up was ar-ranged at 6 and 12 weeks after the end of treatment to examine the changes in PD,mSBI,and mPLI at the included implant treatment sites.Results A total of 35 patients were included in this study,with 38 teeth affected by peri-implantitis and 154 treatment sites.The PDT group and MD group included 20 and 18 implants respectively,with a total of 78 treatment sites included in the PDT group,51 sites with PD≥6 mm,and 27 sites with PD＜6 mm.A total of 76 treatment sites were included in the MD group,including 53 sites with PD≥6 mm and 23 sites with PD＜6 mm.At baseline,there was no statistically significant difference in PD,mSBI,and mPLI between the two groups.At 6 and 12 weeks after treatment,there were statistically significant differences in clinical indicators between the two groups compared to baseline(P＜0.05).Among them,the mSBI in the PDT group was significantly lower than that in the MD group at 6 weeks after treatment(P＜0.05).At sites with PD≥6 mm,the mSBI of the PDT group was significantly lower than that of the MD group at 6 and 12 weeks after treatment(P＜0.05).The number of implants in the PDT group and MD group that reached the treatment endpoint at 12 weeks follow-up was 70.00%and 55.56%,respectively,and there was no difference between the two groups(P＞0.05).Conclusion Photodynamic therapy assisted with mechanical debridement can effectively treat peri-implantitis and is a safe and ef-fective auxiliary method,and has significant therapeutic effects on in-flammation control and improvement of mSBI in those sites with PD≥6 mm.

Objective To observe the value of deep learning(DL)models for automatic classification of echocardiographic views.Methods Totally 100 patients after heart transplantation were retrospectively enrolled and divided into training set,validation set and test set at a ratio of 7∶2∶1.ResNet18,ResNet34,Swin Transformer and Swin Transformer V2 models were established based on 2D apical two chamber view,2D apical three chamber view,2D apical four chamber view,2D subcostal view,parasternal long-axis view of left ventricle,short-axis view of great arteries,short-axis view of apex of left ventricle,short-axis view of papillary muscle of left ventricle,short-axis view of mitral valve of left ventricle,also 3D and CDFI views of echocardiography.The accuracy,precision,recall,F1 score and confusion matrix were used to evaluate the performance of each model for automatically classifying echocardiographic views.The interactive interface was designed based on Qt Designer software and deployed on the desktop.Results The performance of models for automatically classifying echocardiographic views in test set were all good,with relatively poor performance for 2D short-axis view of left ventricle and superior performance for 3D and CDFI views.Swin Transformer V2 was the optimal model for automatically classifying echocardiographic views,with high accuracy,precision,recall and F1 score was 92.56％,89.01％,89.97％and 89.31％,respectively,which also had the highest diagonal value in confusion matrix and showed the best classification effect on various views in t-SNE figure.Conclusion DL model had good performance for automatically classifying echocardiographic views,especially Swin Transformer V2 model had the best performance.Using interactive classification interface could improve the interpretability of prediction results to some extent.

Periodontology is one of the important disciplines in oral clinical medicine, which covers a wide range of subjects and intersects with many basic disciplines. Under the environment of the implementation of modular teaching in Shanghai Jiao Tong University School of Medicine, the assessment method with separate propositions for the teaching and research section is still adopted. There is a mismatch between the assessment mode and the curriculum setting; the basic subject propositions are difficult to be combined with clinical cases; the knowledge point assessment is single, and the students' ability to integrate the knowledge points cannot be assessed. The development and construction of the comprehensive examination database for periodontology was based on curriculum integration, gathering the teaching backbones of various disciplines, focusing on periodontology, radiating all related disciplines, unifying the proposition outline, proposition type, proposition principle, combining with relevant knowledge points of various disciplines based on clinical cases, and tried to apply to clinical students majoring in stomatology. The use of the examination database promotes students' ability to flexibly apply theoretical knowledge to clinical case analysis, further promotes the reform of modular teaching, lays a solid foundation for future clinical work, and meanwhile provides an important basis for directions of the teaching and research section.

【Objective】 To investigate the relationship between ABO blood types and the risk of malignant tumors in Chaoshan area, Guangdong. 【Methods】 Chi-square test was used to analyze the distribution of ABO blood types between 45 890 patients with malignant tumors from the Cancer Hospital of Shantou University Medical College and 42 465 healthy blood donors from Shantou Central Blood Bank. 【Results】 Among the main types of malignant tumors, the distributions of ABO blood types in patients with esophageal cancer or head and neck cancer were significantly different from that in the normal population (χ²=11.16, P<0.05; χ²=74.36, P<0.05; respectively). People with type B were identified with high risk of esophageal cancer and head and neck cancer (OR=1.09, 95% CI=1.03-1.15, P<0.05; OR=1.46, 95% CI=1.34-1.60, P<0.05), whereas those with type A or O were identified with low risk of head and neck cancer (OR=0.87, 95% CI=0.79-0.96, P<0.05; OR=0.83, 95% CI=0.76-0.90, P<0.05). 【Conclusion】 ABO blood type distribution in patients with esophageal cancer or head and neck cancer in Chaoshan area may be different from that in normal population, suggesting that different ABO blood types may be associated with the risk of esophageal cancer and head and neck cancer.

Objective:To analyze the consistency and correlation between the Chinese Version of Swanson Nolan and Pelham, Version Ⅳ Scale (SNAP-Ⅳ) and the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) in the assessment of attention deficit hyperactivity disorder (ADHD), thus providing a reliable basis for the diagnosis of ADHD, and reducing the misdiagnosis rate and missed diagnosis rate.Methods:Clinical data of children to be diagnosed as ADHD in the Department of Children′s Rehabilitation, Yuying Children′s Hospital of the Second Affiliated Hospital of Wenzhou Medical University from October 2019 to July 2020 were collected.A total of 282 SNAP-Ⅳ and IVA-CPT profiles were collected, and the Kappa test and Pearson test were used to retrospectively analyzed for their consistency and correlation in the diagnosis of ADHD. Results:SNAP-Ⅳ and IVA-CPT were consistent in the diagnosis of ADHD (Kappa value=0.514, total coincidence rate=65.6%, P<0.000 1). Inattention subset scores of SNAP-Ⅳ were consistent with the assessment of ADHD by IVA-CPT (Kappa value=0.485, total coincidence rate=75.5%, P<0.000 1). Inattention subset scores of SNAP-Ⅳ were negatively correlated with the Full Scale Attention Quotient (FAQ) in IVA-CPT ( r=-0.71, P<0.000 1). Hyperactivity-impulsive subscale in the SNAP-Ⅳ and IVA-CPT were consistent in the assessment of hyperactivity-impulsive behavior (Kappa value=0.585, total coincidence rate=81.6%, P<0.000 1). Hyperactivity-impulse subset scores were negatively correlated with the Full Scale Response Control Quotient (FRCQ) in IVA-CPT ( r=-0.74, P<0.000 1). Conclusions:Both SNAP-Ⅳ and IVA-CPT have certain diagnostic potential of ADHD, showing good consistency and correlation.They can be both used to provide a more comprehensive diagnosis basis, thereby reducing the misdiagnosis rate and missed diagnosis rate of ADHD.

Objective:To explore the feasibility, accuracy and reproducibility of a novel, fully automated three-dimensional echocardiography right ventricular(RV) quantification software(3D Anto RV) to evaluate the RV volume and RV ejection fraction (RVEF) using artificial intelligence in patients after heart transplantation (HT) comparing with the gold reference-cardiac magnetic resonance (CMR).Methods:Forty-six patients after HT who were scheduled for echocardiogram at their routine follow-up examinations and also agreed to undergo CMR examination within the following 24 hours in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2018 to June 2019 were prospectively included. The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV) and RVEF of HT patients were measured by CMR 3D Auto RV and conventional semi-automated three-dimensional echocardiography RV quantification software (Tomtec 4D RV function 2.0). The results of the 3D Auto RV and conventional semi-automated Tomtec were respectively compared with CMR using paired two-tailed student′s t-tests, Pearson correlation coefficients and Bland-Altman analyses. Results:The feasibility of the 3D Auto RV was 87%.The fully automated analysis realized in 27 (59%) patients by 3D Auto RV and the analysis time required only (12±1)s. The results of the remaining 19 (41%) patients needed manual adjustment and the mean analysis time in manual adjustment was also <2 min that was shorter than the conventional semi-automated three-dimensional echocardiography RV quantification software[(108±15)s vs (160±34)s, P<0.001]. For the results of RV volumes: There were good correlations between the 3D Auto RV and CMR, conventional semi-automated Tomtec and CMR for the measurements of RVEDV, RVESV and RVSV ( r=0.77-0.84, all P<0.001). In addition, compared with CMR, although there were significantly underestimated RV volumes by the 3D Auto RV and conventional semi-automated Tomtec, the negative bias was smaller in the 3D Auto RV than the conventional semi-automated Tomtec. For the results of RVEF: the corresponding RVEF derived from 3D Auto RV and CMR showed an excellent correlation and consistency ( r=0.84, P<0.001; bias=-1.1%, Limit of agreement=-8.1%-6.0%). In addition, the correlations between the manual adjustment by 3D Auto RV and the CMR ( r=0.63-0.72, all P<0.001) was lower than the correlations between the 3D Auto RV and the CMR ( r=0.76-0.82, all P<0.001) for RV volumes and RVEF.Finally, 3D Auto RV had a good reproducibility. Conclusions:The new fully 3D Auto RV quantification software underestimate RV volumes that less than the conventional semi-automated Tomtec. And the 3D Auto RV quantification software can accurately evaluate the RVEF in patients after HT with rapid analysis and higher reproducibility, which may also support the routine adoption of this method during follow-ups of HT patients in the daily clinical workflow.

Objective: Analyze the changes of indicator of antimicrobial usage and detection rate of multidrug-resistant gram-negative bacteria (MDR-GNB), in order to evaluate the impact of antimicrobial stewardship program (ASP). Methods: The antimicrobial stewardship program was implemented since December 2011 at the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University. Intensified effort was made from 2014 to 2017. We divided the program into four stages, one before ASP (2010-2011) and three after ASP (2012-2013 as the first, 2014-2015 as the second and 2016-2017 as the third post-ASP stages). The usage rates in outpatient,emergency department and inpatient, along with the antibiotic use density (AUD, defined as daily doses/per 100 patient-days), the AUD of the third-generation cephalosporins and carbapenems in inpatient were reviewed retrospectively. The detection rates of extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli, ESBLs-producing Klebsiella pneumonia, carbapenem-resistant E. coli, carbapenem-resistant Klebsiella pneumonia, carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa were also analyzed at the same time. The correlation analysis between the detection rate of MDR-GNB and the indicator of antimicrobial usage was made. Result: Among four stages, the usage rates were 55.2% (560 578/1 015 540) , 38.1% (493 554/1 296 336) , 26.8% (378 602/1 411 595) and 23.1% (347 817/1 502 817) in outpatient, 75.6% (429 582/568 230) , 61.4% (382 558/623 138) , 43.6% (265 102/608 071) and 35.1% (218 484/622 397) in emergency department, and 76.0% (30 568/40 221) , 53.7% (30 437/56 636) , 49.9% (37 395/74 895) and 50.3% (35 493/70 544) in inpatient, respectively. All indicators decreased significantly (χ²=297 811.798, 3 155 704.783, 5 592.037, P<0.01). The AUD in inpatient was 38.4,31.8,21.7 and 19.41,and the AUD of the third-generation cephalosporins were 13.83, 11.21, 6.20 and 6.84, respectively, which decreased significantly after ASP (r=-0.878, -0.781, P<0.05). The AUD of carbapenems were 1.94,1.77,1.87 and 1.93, respectively (r=0.123, P>0.05). A total of 11 289 strains of bacteria were collected, including 5 589 strains of E. coli, 2 823 strains of K.pneumoniae, 1 637 strains of A. baumandii, and 1 240 strains of P. aeruginosa.The detection rates of ESBLs-producing E.coli and ESBLs -producing K. pneumoniae in four stages were 75.4% (1 034/1 371) , 66.6% (893/1 341) , 57.8% (834/1 443) , 46.7% (670/1 434) and 78.7% (547/695) , 67.5% (455/674) , 49.3% (421/854) , 32.5% (195/600) , respectively,both decreased significantly (χ²=266.204; 328.805, P<0.01). The detection rates of Carbapenem-resistant A. baumannii were 28.2% (115/408) , 26.7% (126/472) , 24.3% (125/515) and 12.0% (29/242) respectively,and showed significant decreasing trend after ASP (χ²=18.112, P<0.01). The detection rates of carbapenem-resistant P. aeruginosa were 11.3% (40/355) , 18.5% (58/313) , 13.4% (46/343) and 7.0% (16/229) , respectively,with the most obvious decrease in the third stage after ASP. The detection rates of carbapenem-resistant E. coli and carbapenem-resistant K. pneumonia were continuously lower (<5%). There were positive correlations between the detection rates of ESBLs-producing E. coli and K. pneumoniae and all usage indicators (r₁=0.930, 0.974, 0.746, 0.958, 0.842; r₂=0.910, 0.960, 0.765, 0.963, 0.898, P<0.05). Conclusion The antimicrobial stewardship program can effectively reduce both the usage of antimicrobial and the production of MDR-GNB, which has great value to promote rational clinical use of antimicrobials and reduce bacterial resistance.

Objective Analyze the changes of indicator of antimicrobial usage and detection rate of multidrug‐resistant gram‐negative bacteria (MDR‐GNB), in order to evaluate the impact of antimicrobial stewardship program (ASP). Methods The antimicrobial stewardship program was implemented since December 2011 at the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University. Intensified effort was made from 2014 to 2017. We divided the program into four stages, one before ASP (2010-2011) and three after ASP (2012-2013 as the first, 2014-2015 as the second and 2016-2017 as the third post‐ASP stages). The usage rates in outpatient,emergency department and inpatient, along with the antibiotic use density (AUD, defined as daily doses/per 100 patient‐days), the AUD of the third‐generation cephalosporins and carbapenems in inpatient were reviewed retrospectively. The detection rates of extended‐spectrum β‐lactamases (ESBLs)‐producing Escherichia coli , ESBLs‐producing Klebsiella pneumonia , carbapenem‐resistant E. coli , carbapenem‐resistant Klebsiella pneumonia , carbapenem‐resistant Acinetobacter baumannii and carbapenem‐resistant Pseudomonas aeruginosa were also analyzed at the same time. The correlation analysis between the detection rate of MDR‐GNB and the indicator of antimicrobial usage was made. Result Among four stages, the usage rates were 55.2%(560 578/1 015 540), 38.1% (493 554/1 296 336), 26.8%(378 602/1 411 595) and 23.1%(347 817/1 502 817)in outpatient, 75.6% (429 582/568 230), 61.4%(382 558/623 138), 43.6%(265 102/608 071) and 35.1%(218 484/622 397) in emergency department, and 76.0%(30 568/40 221), 53.7%(30 437/56 636), 49.9%(37 395/74 895) and 50.3%(35 493/70 544) in inpatient,respectively. All indicators decreased significantly(χ2=297 811.798, 3 155 704.783, 5 592.037, P<0.01). The AUD in inpatient was 38.4,31.8,21.7 and 19.41,and the AUD of the third‐generation cephalosporins were 13.83, 11.21, 6.20 and 6.84, respectively, which decreased significantly after ASP (r=-0.878,-0.781, P<0.05). The AUD of carbapenems were 1.94,1.77,1.87 and 1.93, respectively (r=0.123, P>0.05). A total of 11 289 strains of bacteria were collected, including 5 589 strains of E. coli , 2 823 strains of K. pneumoniae , 1 637 strains of A. baumandii , and 1 240 strains of P. aeruginosa . The detection rates of ESBLs‐producing E. coli and ESBLs‐producing K. pneumoniae in four stages were 75.4%(1 034/1 371), 66.6%(893/1 341), 57.8%(834/1 443), 46.7% (670/1 434) and 78.7% (547/695), 67.5%(455/674), 49.3%(421/854), 32.5%(195/600), respectively,both decreased significantly (χ2=266.204;328.805, P<0.01). The detection rates of Carbapenem‐resistant A. baumannii were 28.2%(115/408), 26.7%(126/472), 24.3%(125/515) and 12.0%(29/242) respectively,and showed significant decreasing trend after ASP (χ2=18.112, P<0.01). The detection rates of carbapenem‐resistant P. aeruginosa were 11.3%(40/355), 18.5%(58/313), 13.4%(46/343) and 7.0%(16/229), respectively,with the most obvious decrease in the third stage after ASP. The detection rates of carbapenem‐resistant E. coli and carbapenem‐resistant K. pneumonia were continuously lower (<5%). There were positive correlations between the detection rates of ESBLs‐producing E. coli and K. pneumoniae and all usage indicators ( r 1=0.930, 0.974, 0.746, 0.958, 0.842;r2=0.910, 0.960, 0.765, 0.963, 0.898,P<0.05). Conclusion The antimicrobial stewardship program can effectively reduce both the usage of antimicrobial and the production of MDR‐GNB, which has great value to promote rational clinical use of antimicrobials and reduce bacterial resistance.

Objective To evaluate the value of perioperative multimodal stratified analgesia guided by PPRS-CYMZ 2.0. Methods One hundred and sixteen patients of both sexes, aged 16-85 yr, of A-merican Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective surgery in our hospital in August 2016, were included in this study and assigned into empirical analgesia group(group E, n=79) and stratified analgesia group(group S, n=73). The risk of postoperative pain was estimated by an expe-rienced associate chief anesthesiologist based on his clinical experience, and the perioperative analgesic protocol was determined in group E. The risk of postoperative pain was assessed using the perioperative pain risk scale PPRS-CYMZ 2.0 by another experienced associate chief anesthesiologist, the risk was stratified according to the scores, and the corresponding stratified analgesic protocol was determined in group S. Vis-ual analog scale scores and parents′satisfaction with analgesia were recorded on postoperative day 30. The requirement for preventive analgesia, total pressing times of patient-controlled analgesia(PCA)pump in 0-6 h, 6-24 h and 24-72 h periods, PCA background infusion dose and consumption of rescue analgesics were recorded. The development of adverse events during postoperative hospital stay and postoperative re-covery were also recorded. Analgesia-related parameters of medical economics were calculated. Results There was no significant difference in postoperative pain risk stratification between group E and group S(P>0.05), and the majority of patients were at moderate risk. Compared with group E, no significant change was found in visual analog scale scores on postoperative day 30, PCA background infusion dose or incidence of postoperative adverse effects(P>0.05), the requirement for preventive analgesia and satisfaction scores were significantly increased in high risk patients, the consumption of rescue analgesics was decreased in moderate risk patients(P<0.05), no significant change was found in the total pressing times of PCA pump in each time period in low risk patients(P>0.05), the total pressing times of PCA pump was significantly decreased, and the direct analgesic cost per patient and total analgesic cost were decreased in moderate and high risk patients, and the first ambulation time and length of postoperative hospital stay were shortened in high risk patients in group S(P<0.05). Conclusion PPRS-CYMZ 2.0 can achieve perioperative multi-modal stratified analgesia and individualized treatment.