Objective To explore the relationship between the types of bicuspid aortic valves(BAV)and the outcome of functional mitral regurgitation(FMR)and the affecting factors of FMR.Methods From Jun 2018 to Sep 2022,patients with severe BAV aortic valve stenosis(AS)complicated with FMR underwent post transcatheter aortic valve replacement(TAVR)in Zhongshan Hospital,Fudan University were retrospectively analyzed.The baseline information and imaging data of different BAV patients were collected.Logistic regression was used to analyze the factors affecting the outcome of FMR(improvement and non-improvement).Result A total of 100 patients with TAVR were included,including 49 patients with type 0 of BAV and 51 patients with type 1 of BAV.Compared with patients of type 1,patients of type 0 had younger age[(72.78±6.09)y vs.(77.00±8.35)y,P=0.050],lower male ratio(47%vs.73%,P= 0.009)higher BMI[(23.19±2.62)kg/m2 vs.(21.99±3.13)kg/m2,P=0.041],and lower incidence of aortic regurgitation(69%vs.92%,P=0.040).Compared with the non-improvement group,the improvement group had a lower incidence of coronary heart disease(5%vs.18%,P=0.042),higher incidence of pulmonary hypertension(20%vs.2%,P=0.007),larger left ventricular diastolic diameter[(51.98±6.74)mm vs.(48.04±7.72)mm,P=0.009]and higher maximum flow velocity[(4.86±0.95)cm/s vs.(4.47±0.75)cm/s,P= 0.023]of the aortic valve.The results of Logistic regression analysis showed that preoperative pulmonary hypertension,left ventricular end-diastolic diameter and maximum valvular flow velocity of BAV patients were the potential affecting factors of FMR improvement after TAVR.Conclusion No significant difference was found in FMR improvement between BAV patients of type 0 and type 1 after TAVR.For BAV patients with AS,preoperative pulmonary hypertension,larger left ventricular end-diastolic diameter,and faster aortic valve flow velocity were associated with higher FMR improvement rate.

The implementation of amplicon sequencing and metagenomic sequencing methods in the whole-genome sequen-cing for MPXV testing was compared,to provide a technical reference for sequencing,tracing,and epidemic prevention and control of MPXV.For amplicon sequencing,targeted amplification of the viral whole genome was performed on MPXV DNA,and was followed by next-generation sequencing of the amplification products.For metagenomic sequencing,next-generation sequencing was performed directly on MPXV DNA.After the sequences were obtained,software such as CLC and IGV were used to analyze the effective data percentage,sequencing depth,and whole-genome sequencing coverage under different sequen-cing depths for both sequencing methods,to evaluate sequencing quality.Nextclade was used to analyze virus typing,muta-tions,and deletions.Subsequently,the similarity and completeness of sequences obtained through both sequencing methods were further compared.On the basis of mapping to the refer-ence sequence of strain MPXV-M5312_HM12_Rivers(Gen-Bank number NC_063383.1),the percentage effective data obtained from amplicon sequencing and metagenomic sequen-cing was 99.72％and 7.54％,respectively,with a sequencing depth range of 0× to 334 839 ×,and 44 × to 1 000 ×.On the basis of a sequencing depth of 10 ×,the site coverage of the above was 90.3％and 100％,respectively.IGV was used to validate the whole-genome coverage under different sequencing depths.The depth coverage of whole-genome sites for metagenomic sequencing was uniform,whereas that of the whole-genome sites for amplicon sequencing was uneven and significantly differed.Virus typing and sequence similarity analysis indicated that the viral sequences obtained with the two sequencing methods all belonged to the Ⅱb B.1 lineage of MPXV.Comparison with the reference sequence indicated that metagenomic sequencing identified 73 nucleotide mutation sites,whereas amplicon sequen-cing identified 68 mutation sites.Further analysis demonstrated that seven common mutation sites of Ⅱb B.1 were not detected in the amplicon sequencing,and two false positive private mutation sites were identified.Amplicon or metagenomic sequencing methods thus can be flexibly used in MPXV virus whole-genome sequencing.Amplicon sequencing yields more effective data,whereas metagenomic sequencing provides better uniformity of coverage and sequence accuracy.This study provides a prelimi-nary understanding of the efficacy of each method and may serve as a technical reference for improving the success rate of whole-genome sequencing of MPXV.

Objective To compare the early predictive value of different scoring systems for the severity,organ failure and complications of acute pancreatitis(AP)in elderly patients under the newly revised Atlanta criteria.Methods Patients with acute pancreatitis treated was collected.After admission,complete the computed tomography severity index(CTSI),the bedside index of severity in acute pancreatitis(BISAP),the pancreatis 3(PANC-3)and the harmlessness acute pancreatitis score(HAPS).The area under receiver operating characteristic(ROC)curve(AUC),sensitivity,specificity and Yordan's index of four scores for predicting SAP,local pancreatic complications and multiple organ failure were compared.Results The areas under the ROC curve predicted by the CTSI,BISAP,PANC-3 and HAPS scoring systems for SAP were 0.76,0.91,0.48 and 0.55;sensitivities of 75.87％,89.61％,61.18％and 78.38％;specificity of 80.29％,74.72％,67.48％and 69.69％;Yordan's index of 0.56,0.64,0.29 and 0.48,respectively.The AUC of CTSI,BISAP,PANC-3 and HAPS scoring systems for predicting local pancreatic complications were 0.94,0.82,0.59 and 0.64;sensitivity of 74.59％,68.23％,71.11％and 69.28％;specificity of 93.88％,83.01％,78.59％and 76.46％;Yordan's index were 0.68,0.51,0.50 and 0.46,respectively.The AUC of CTSI,BISAP,PANC-3 and HAPS scoring systems for predicting multiple organ failure were 0.60,0.84,0.64 and 0.80,sensitivities were 54.18％,74.82％,58.59％and 65.67％,specificity were 76.11％,77.20％,72.68％and 89.36％,Jordan's indices were 0.30,0.52,0.31 and 0.55,respectively.Conclusion BISAP score is higher than CTSI,HAPS and PANC-3 scoring system in predicting the accuracy of sap and the risk of multiple organ failure.

Objective:To evaluate the diagnostic accuracy of the convolutional neural network（CNN） in diagnosing nasopharyngeal carcinoma using endoscopic narrowband imaging. Methods:A total of 834 cases with nasopharyngeal lesions were collected from the People's Hospital of Guangxi Zhuang Autonomous Region between 2014 and 2016. We trained the DenseNet201 model to classify the endoscopic images, evaluated its performance using the test dataset, and compared the results with those of two independent endoscopic experts. Results:The area under the ROC curve of the CNN in diagnosing nasopharyngeal carcinoma was 0.98. The sensitivity and specificity of the CNN were 91.90% and 94.69%, respectively. The sensitivity of the two expert-based assessment was 92.08% and 91.06%, respectively, and the specificity was 95.58% and 92.79%, respectively. There was no significant difference between the diagnostic accuracy of CNN and the expert-based assessment （P=0.282, P=0.085）. Moreover, there was no significant difference in the accuracy in discriminating early-stage and late-stage nasopharyngeal carcinoma（P=0.382）. The CNN model could rapidly distinguish nasopharyngeal carcinoma from benign lesions, with an image recognition time of 0.1 s/piece. Conclusion:The CNN model can quickly distinguish nasopharyngeal carcinoma from benign nasopharyngeal lesions, which can aid endoscopists in diagnosing nasopharyngeal lesions and reduce the rate of nasopharyngeal biopsy.
Humans ; Nasopharyngeal Carcinoma ; Narrow Band Imaging ; China ; Neural Networks, Computer ; Nasopharyngeal Neoplasms/diagnostic imaging*

To rapidly and accurately identify novel SARS-CoV-2 variants,we used combined 2nd and 3rd generation sequen-cing technology to sequence and analyze the viral genomes of two specimens from SARS-CoV-2 infection cases imported into Fujian Province.Nanopore and Illumina techniques were used to perform whole genome sequencing of SARS-CoV-2.A pangolin system was used to determine the virus type.Evolutionary analysis software was used to construct the phylogenetic tree.Next-clade was used to analyze the whole genome variation,and estimate ACE2 receptor affinity and immune escape ability.Two complete genome sequences of SARS-CoV-2 were obtained from respiratory specimens from the two cases,with lengths of 29 665 bp and 29 682 bp.The average genome coverage were＞99.0％,and the virus typing results all indicated Omicron BQ.1 lineage.Phylogenetic analysis demonstrated that the two viruses were located in the same cluster of the Omicron BQ.1 line-age.On the basis of these findings and epidemiological data,we speculated that the two cases might have originated from the same infection.Variation analysis indicated that the two viruses shared all 77 mutation sites;except for S:A27S and S:24-26del,all were characteristic mutation sites of the BQ.1 lineage.The predicted ACE2 receptor affinity and immune escape abili-ty scores of the two viruses were both＞0.6,thus suggesting significant changes in their biological characteristics and requiring continuous monitoring and warning.The combined 2nd and 3rd generation sequencing technology was successfully applied to i-dentify the first BQ.1 lineage of the SARS-CoV-2 imported into Fujian Province,considering the timeliness and accuracy of whole genome sequencing,thus providing a technical reference for SARS-CoV-2 variant monitoring.

In this study， name， origin， producing areas， harvesting time and processing methods of ancient Alismatis Rhizoma were systematically researched by consulting the literature of ancient herbs， medical and prescription books， so as to provide a basis for the development of famous classical formula containing this herb. According to textual research， the main base of ancient Alismatis Rhizoma was Alisma plantago-aquatica and A. orientale. A. canaliculatum and A. gramineum and other genera were sometimes used as the source of Alismatis Rhizoma， there was a confusion of medicinal varieties. The earliest producing area of Alismatis Rhizoma was in today's Henan province， and later Hanzhong， Shaanxi province， became the high-quality producing area of Alismatis Rhizoma. Since the Ming dynasty， its production area expanded to Fujian. In the Qing dynasty， Jian'ou in Fujian was the authentic production area of Alismatis Rhizoma. In the period of the Republic of China， Sichuan and Jiangxi were added to the production areas of Alismatis Rhizoma. Based on the research results， it is suggested that the dried tubers of A. orientale from Fujian and Jiangxi or A. plantago-aquatica from Sichuan should be used in the famous classical formulas. In ancient times， Alismatis Rhizoma was processed by wine， but most of the standards and specifications in modern times are no longer included the processing specifications of Alismatis Rhizoma with wine. Although salt-processed Alismatis Rhizoma is commonly used in modern times， it didn't become one of the main processing methods until the Qing dynasty. According to the relevant national documents， it is suggested that Alismatis Rhizoma without clear processing requirements in famous classical formulas should be used as raw products， and the formulas with processing requirements should be selected as processed products such as salt and wine according to the meaning of the formulas.

ObjectiveWearing protective masks for a long time causes a large number of frontline health care workers to suffer different degrees of pressure injury or facial skin rupture in response to COVID-19. This paper aims to analyze the occurrence characteristics and related factors of pressure injury related to devices, and provide the basis for taking countermeasures. Methods There was online investigation of skin injuries caused by wearing protective equipment in medical staff. Descriptive analysis was carried out on the occurrence characteristics of pressure-induced injury, and influencing factors were analyzed through logistic regression model. ResultsThere were a total of 2901 valid questionnaires. The results showed that the incidence of pressure injury caused by protective equipment was 26.34%, mainly in the bridge of the nose (20.41%), cheek (20.23%), auricle (17.82%) and forehead (8.86%). Multivariate Logistic regression model analysis showed that the major associated factors, which presented increasing risk, were sweating and dampness (OR=12.72, 95%CI 8.36-17.30), wearing level-3 protective equipment (OR=3.55, 95%CI 2.47-5.08), wearing level-2 protective equipment (OR=3.37, 95%CI 2.47-4.60), wearing time (OR=1.29, 95%CI 1.05~1.58) and occupation (OR=1.57, 95%CI 1.00~2.49). Conclusion There is the high incidence of pressure injuries to health care workers caused by protective equipment against COVID-19. The main risk factors for facial stress injury of medical staff are sweating and dampness, wearing level-3 and level-2 protective equipment and wearing time.

Asymptomatic Infections ; Betacoronavirus ; Carrier State ; Coronavirus Infections ; transmission ; Female ; Humans ; Middle Aged ; Pandemics ; Pneumonia, Viral ; transmission

Ischemic stroke is one of the leading causes of death worldwide. In the post-stroke stage, cardiac dysfunction is common and is known as the brain-heart interaction. Diabetes mellitus worsens the post-stroke outcome. Stroke-induced systemic inflammation is the major causative factor for the sequential complications, but the mechanism underlying the brain-heart interaction in diabetes has not been clarified. The NLRP3 (NLR pyrin domain-containing 3) inflammasome, an important component of the inflammation after stroke, is mainly activated in M1-polarized macrophages. In this study, we found that the cardiac dysfunction induced by ischemic stroke is more severe in a mouse model of type 2 diabetes. Meanwhile, M1-polarized macrophage infiltration and NLRP3 inflammasome activation increased in the cardiac ventricle after diabetic stroke. Importantly, the NLRP3 inflammasome inhibitor CY-09 restored cardiac function, indicating that the M1-polarized macrophage-NLRP3 inflammasome activation is a pathway underlying the brain-heart interaction after diabetic stroke.

Through consulting the herbs and medical books of past dynasties, combining with modern literature and field investigation, this paper made textual research on the name, origin, producing area, harvesting and processing of Bupleuri Radix used in the Catalogue of Ancient Classical Prescriptions(the first batch).From Han to the Southern and Northern Dynasties, the source of Bupleuri Radix was a mixture of Bupleurum and Peucedanum, it's hard to define the origin of authentic products.In Tang Dynasty, Caryophyllaceae had been used as Bupleuri Radix. In Song Dynasty, it was clear that the genuine production area of Bupleuri Radix was Yinzhou, its origin was B. corzonerifolium and B. yinchowense.After the Ming Dynasty, B. chinense gradually became the mainstream. It has been confirmed that there were differences in the efficacy between Stellaria dichotoma in Caryophyllaceae and Bupleurum in Umbelliferae, however, the use of S. dichotoma is still attributed to Bupleuri Radix. In the Qing Dynasty, S. dichotoma was distinguished from Bupleuri Radix as another medicine. Among the prescriptions containing Bupleuri Radix included in the Catalogue of Classical Prescriptions in Ancient China(the first batch), the mainstream of genuine Bupleuri Radix should be B. scorzonerifolium and B. chinense. It is suggested that the genuine base of Bupleuri Radix should be selected according to the current resources and industrial development of Bupleuri Radix, and it should conform to the Chinese Pharmacopoeia.
Bupleurum/chemistry* ; China ; Drugs, Chinese Herbal ; Medicine, Chinese Traditional ; Plant Roots/chemistry* ; Prescriptions