Early risk stratification remains challenging in patients with acute aortic dissection (AAD). This study aims to evaluate the prognostic value of neutrophil percentage-to-albumin ratio (NPAR) for in-hospital mortality in patients with acute aortic dissection. We performed a multicenter retrospective cohort study including 2,596 patients with AAD from five tertiary hospitals in China between 2010 and 2021. NPAR was calculated as neutrophil percentage divided by serum albumin concentration at admission. Patients were categorized into tertiles according to NPAR levels. The primary outcome was all-cause in-hospital mortality. Cox proportional hazards models were applied to assess the association between NPAR and mortality, adjusting for demographic and clinical confounders. Discriminative performance was evaluated using receiver operating characteristic (ROC) analysis. A total of 576 patients (22.2

OBJECTIVE:The objective is to investigate the association of hyperuricaemia and hyperglycaemia with an increased risk of mortality in acute aortic dissection (AAD). DESIGN:Retrospective multicentre cohort study. SETTING:De-identified information of patients was collected from electronic medical records between 2010 and 2021 across five hospitals in China. PARTICIPANTS:A total of 2603 AAD patients from 5337 patients who underwent arterial aortic computed tomographic angiography were selected after three rounds of screening. MAIN OUTCOME MEASURE:All-cause in-hospital mortality. RESULTS:Of the 2603 patients, 20.3% were women, and the mean age was 54 years old. In-hospital mortality risk escalated linearly with increased levels of uric acid (P non-linearity=0.1699) and serum glucose (P non-linearity=0.2423). The per SD of increment in uric acid was associated with 40% (1.40, 1.22 to 1.60) in HR and 95% CI of AAD all-cause in-hospital mortality and 39% (1.39, 1.22 to 1.58) in serum glucose after full adjustment. Patients with a decrease in uric acid and/or serum glucose within the 7 days preceding admission showed significantly lower in-hospital mortality compared with those without a decrease. Notably, patients exhibiting both hyperuricaemia and serum glucose>180.2 mg/dL faced over double mortality risk (2.21, 1.58 to 3.10) compared with those with normal uric acid and normal serum glucose levels. CONCLUSIONS:Hyperuricaemia and hyperglycaemia are significantly associated with an increased risk of mortality among AAD patients in the Han Chinese population. These findings suggest the importance of monitoring and managing uric acid and glucose levels in AAD patients to potentially improve outcomes.

BACKGROUND:Data on the association between the degree of platelet and coagulative-fibrinolytic variables abnormalities and the risk of in-hospital mortality in acute aortic dissection (AAD) are limited. MATERIALS AND METHODS:This multicentre retrospective cohort study included patients diagnosed with AAD by aortic computed tomographic angiography between 2010 and 2021 in five tertiary hospitals in China. The primary outcome was defined as all-cause mortality during hospitalization. Associations between platelet counts, coagulation-fibrinolytic parameters and all-cause in-hospital mortality were assessed using Cox proportional hazards regression models. RESULTS:Among the 2567 participants, the median age was 54 years (interquartile range, IQR: 47-63); 531 (20.7%) were female, and the in-hospital mortality rate was 589 (23.0%). The Cox proportional hazards regression model indicated that lower platelet count, prothrombin activity (PTA), and fibrinogen levels and longer prothrombin time (PT) and thrombin time (TT) were linearly positively associated with an increased risk of in-hospital mortality (p < 0.05). A non-linear and positive association was confirmed between D-dimer levels and in-hospital mortality risk (p < 0.05). Additionally, a significant interaction between platelet counts and D-dimer levels was observed (p = 0.029). According to the subgroup analysis, compared to those in the reference group, those with thrombocytopenia (<140 × 109/L) and high D-dimer levels (>14.6 µg/mL) had a 3.59-fold increased risk of in-hospital mortality (HR, 3.59; 95% CI, 2.00-6.42). CONCLUSIONS:Our analysis revealed associations between changes in platelet count, PT, PTA, TT, fibrinogen and D-dimer levels and outcomes in patients with AAD. Furthermore, the combined effect of thrombocytopenia and high D-dimer levels significantly increased the risk of in-hospital mortality.

The identification of influenza viruses and SARS-CoV-2 has garnered increasing attention due of their longstanding global menace to human life and health. The point-of-care test is a potential approach for identifying influenza viruses and SARS-CoV-2 in clinical settings, leading to timely discovery, documentation, and treatment. The primary difficulties encountered with conventional detection techniques for influenza viruses and SARS-CoV-2 are the limited or inadequate ability to identify the presence of the viruses, the lack of speed, precision, accuracy, sensitivity, and specificity, often resulting in a failure to promptly notify disease control authorities. Recently, point-of-care test methods, along with nucleic acid amplification, optics, electrochemistry, lateral/vertical flow, and minimization, have been demonstrated the characteristics of reliability, sensitivity, specificity, stability, and portability. A point-of-care test offers promising findings in the early detection of influenza viruses and SARS-CoV-2 in both scientific research and practical use. In this review, we will go over the principles, advantages, limitations, and real-world applications of point-of-care diagnostics. The significance of constraints of detection, throughput, sensitivity, and specificity in the analysis of clinical samples in settings with restricted resources is underscored. This discussion concludes with their prospects and challenges.

Automatic skin cancer segmentation is crucial for digital medical research, clinical diagnosis, and quantitative analysis. However, the presence of diverse melanoma types and unclear boundaries of cancer areas pose significant challenges for segmentation. Although deep learning methods have made significant advancements, most current solutions struggle to accurately handle noise interference. In this work, we propose a novel feature engineering based Bspline fuzzy C-means (BFCM) for skin lesion segmentation in dermoscopy images. Specifically, we train the Mask-RCNN for cancer detection to obtain ROI. Then, the morphological operation, named black hat, and thresholding strategies are used for hair removal in ROI. Finally, B-spline fuzzy C-means is applied to the reconstructed image using feature fusion by local accumulative spectral histograms (LASH), and the fuzzy membership is defined by B-Spline filtering. The LASH joins the nonlocal information from the bilateral filter (BF), morphological reconstructed (MR), and differential excitation (DE). This present approach not only captures information-rich features but also provides efficient segmentation results. It has demonstrated around a 2% enhancement in multiple metrics (JSI, DSC, SE, SP, and ACC) when compared to the Mask RCNN segmentation method and the local similarity-based FGFCM. These results confirm its effectiveness and consistent achievement of satisfactory segmentation performance.

Objective. Head and neck (H&N) cancers are prevalent globally, and early and accurate detection is absolutely crucial for timely and effective treatment. However, the segmentation of H&N tumors is challenging due to the similar density of the tumors and surrounding tissues in CT images. While positron emission computed tomography (PET) images provide information about the metabolic activity of the tissue and can distinguish between lesion regions and normal tissue. But they are limited by their low spatial resolution. To fully leverage the complementary information from PET and CT images, we propose a novel and innovative multi-modal tumor segmentation method specifically designed for H&N tumor segmentation. Approach. The proposed novel and innovative multi-modal tumor segmentation network (LSAM) consists of two key learning modules, namely L2-Norm self-attention and latent space feature interaction, which exploit the high sensitivity of PET images and the anatomical information of CT images. These two advanced modules contribute to a powerful 3D segmentation network based on a U-shaped structure. The well-designed segmentation method can integrate complementary features from different modalities at multiple scales, thereby improving the feature interaction between modalities. Main results. We evaluated the proposed method on the public HECKTOR PET-CT dataset, and the experimental results demonstrate that the proposed method convincingly outperforms existing H&N tumor segmentation methods in terms of key evaluation metrics, including DSC (0.8457), Jaccard (0.7756), RVD (0.0938), and HD95 (11.75). Significance. The innovative Self-Attention mechanism based on L2-Norm offers scalability and is effective in reducing the impact of outliers on the performance of the model. And the novel method for multi-scale feature interaction based on Latent Space utilizes the learning process in the encoder phase to achieve the best complementary effects among different modalities.

Objective The study aimed to investigate whether lymphopenia and red blood cell distribution width (RDW) elevation are associated with an increased risk of mortality in acute aortic dissection (AAD). Methods This multicenter retrospective cohort study enrolled patients diagnosed with AAD by aortic computed tomographic angiography (CTA) from 2010 to 2021 in five teaching hospitals in central-western China. Cox proportional hazards regression and Kaplan-Meier curves were used in univariable and multivariable models. Clinical outcomes were defined as all-cause in-hospital mortality, while associations were evaluated between lymphopenia, accompanied by an elevated RDW, and risk of mortality. Results Of 1903 participants, the median age was 53 (interquartile range [IQR], 46–62) years, and females accounted for 21.9%. Adjusted increased risk of mortality was linearly related to the decreasing lymphocyte percentage ( P -non-linearity = 0.942) and increasing RDW ( P -non-linearity = 0.612), and per standard deviation (SD) of increment lymphocyte percentage and RDW was associated with the 26% (0.74, 0.64–0.84) decrement and 5% (1.05, 0.95–1.15) increment in hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality, respectively. Importantly, lymphopenia and elevation of RDW exhibited a significant interaction with increasing the risk of AAD mortality ( P -value for interaction = 0.037). Conclusions Lymphopenia accompanied by the elevation of RDW, which may reflect the immune dysregulation of AAD patients, is associated with an increased risk of mortality. Assessment of immunological biomarkers derived from routine tests may provide novel perspectives for identifying the risk of mortality.

该文采用文献研究、逻辑分析和经验总结的方法,总结该校在开展早期接触临床双语教学课程设计的有益探索,借鉴国外类似课程及国内其他课程开展双语教学的经验,在充分利用早期接触临床课程重视实践、注重体验、关注知识融合等优点的基础上,讨论通过优化课程设计、加强教师培养等多种方式,在早期接触临床课程中有机融入双语教学,增加学生英语知识在现实场景中的应用机会,让学生英语沟通和专业交流能力切实升级,培养适应我国医药卫生事业发展的高水平医学人才.

Sepsis is a systemic inflammatory response to invading pathogens, leading to high mortality rates in intensive care units worldwide. Krüppel‐like factor 4 (KLF4) is an important anti‐inflammatory transcription factor. In this study, we investigate the anti‐inflammatory role of KLF4 in caecal ligation and puncture (CLP)‐induced septic mice and lipopolysaccharide (LPS)‐induced RAW264.7 cells and its potential mechanism. We found that KLF4 was down‐regulated in CLP‐induced septic mice and in LPS‐induced RAW264.7 cells, and that its overexpression led to increased survival rates of septic mice along with inhibited inflammatory response in vivo and in vitro. ITGA2B was up‐regulated in the setting of sepsis and was inhibited by KLF4 overexpression. ITGA2B knock‐down mimicked the effects of KLF4 overexpression on septic mice and LPS‐induced RAW264.7 cells. TLR4 promoted the phosphorylation of ERK1/2 and then up‐regulated the ubiquitination and the degradation of KLF4, thereby elevating the expression of ITGA2B. Moreover, TLR4 knock‐down or treatment with PD98059 (a MEK inhibitor) inhibited inflammatory response in the setting of sepsis in vivo and in vitro. Furthermore, this effect of PD98059 treatment was lost upon KLF4 knock‐down. Collectively, these results explain the down‐regulation of KLF4 in sepsis, namely via TLR4 promotion of ERK1/2 phosphorylation, and identify ITGA2B as the downstream gene of KLF4, thus highlighting the anti‐inflammatory role of KLF4 in sepsis.

Abstract We, the Editors and Publisher of the journal Artificial Cells, Nanomedicine, and Biotechnology, have retracted the following article: Lei Yu & ChunWen Li (2019) Formaldehyde inhibits proliferation of bronchial epithelial cells by down-regulating miR-375. Artificial Cells, Nanomedicine, and Biotechnology, 47:1, 2293–2297, DOI: 10.1080/21691401.2019.1624369 It has come to our attention that the full authorship list and affiliations for this manuscript were changed after the article was submitted. We have contacted the corresponding author for an explanation, but we have not received a satisfactory explanation. As determining authorship is core to the integrity of published work, we are therefore retracting the article. The corresponding author listed in this publication has been informed. We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

OBJECTIVE:To investigate the effect of paraquat (PQ) on reactive oxygen species (ROS) and neutrophil apoptosis and its possible signal transduction pathways.METHODS:Cultured neutrophils were treated with different concentrations of PQ for 6-24 h. The apoptosis rate of neutrophils and ROS content were determined by flow cytometry. The exoressions of nuclear factor kappa B (NF-κB) and Caspase 3 were detected by Western blot. These parameters were checked again after NF-κB and Caspase 3 antagonist were applied.RESULTS:PQ could boost ROS generation and depress neutrophil apoptosis significantly. At the same time PQ could enhance the expression of NF-κB and inhibit the expression of Caspase 3. These effects could be reversed by ROS inhibitor diphenyleneiodonium (DPI) and NF-κB inhibitor pyrrolidinedithiocarbamate (PDTC).CONCLUSION:PQ is a potent inducer of ROS and can inhibit neutrophil apoptosis by activating NF-κB and surpressing Caspase 3 activity.

目的：探讨脂肪酸结合蛋白（ H－FABP）在异丙肾上腺素诱导的心肌缺血中对评价心肌损伤中的价值。方法将128只大鼠随机分成4组，采用异丙肾上腺素建立不同程度的心肌缺血模型，分为正常对照组和低、中、高剂量实验组，取4个时间点，用 Western印迹法检测不同程度心肌缺血大鼠血清中H－FABP表达水平，分析心肌缺血后血清H－FABP含量与时间关系，分析大鼠心肌缺血严重程度与血清H－FABP含量之间关系。结果①心肌缺血大鼠模型建立成功，大鼠心肌缺血后血清中H－FABP含量2 h已有升高，4 h明显增高，与正常对照组差异显著（ P＜0．05），16 h已有下降，32 h基本降至正常。②大鼠血清H－FABP升高的倍数随其心肌缺血程度加重而递增（P＜0．05）。结论 H－FABP在心肌缺血发生的早期即有明显升高，持续时间较短，H－FABP可作为缺血心肌损伤早期诊断的心肌标志物和评价损伤程度指标。

Medical interns’practice in emergency department is more difficult than in any other bran-ches due to its covering disease kinds of uncertainty .Emergency medicine clinical features need to de-velop specific emergency clinical thinking .In addition ,any other clinical departments can also encoun-ter their own emergency problems .Utilize differential diagnosis of symptoms as the breakthrough point ,pay attention to vital signs checked ,combined with the necessary examination ,which can ef-fectively reduce the emergency medicine clerkship missed diagnosis ,misdiagnosis ,and thus set a good emergency clinical thinking .

Clinical practice for medical students is an important stage of change from student to doctor.The thinking mode in theory study stage is from cause to the clinical manifestation,which objectively brings difficulty to intern.However,bedside practice teaching method based on symptom differential diagnosis can resolve these questions by changing the intern thinking mode from cause first to symptom first and cultivate medical students good clinical thinking habits.

Objective To investigate the effects of hydrogen sulfide on sepsis-induced cardiac dysfunction in rats.Methods Male SD rats were randomly ( random number) divided into 4 groups:control group ( Ⅰ group),sepsis group ( Ⅱ group),sepsis + NaHS group (Ⅲ group),sepsis + PAG group (Ⅳ group). Cecal ligation and puncture technique was used in Ⅱ, Ⅲ, Ⅳ group. Hemodynamic was observed,and H2S synthesis,CSE (cystathionine-r-lyase) mRNA,MPO activity and the level of TNF-α,IL-1β were determined.The morphological changes and infiltration of inflammatory cells in myocardium were also observed.Results Compared with Ⅰ group,H2S synthesis,the levels of TNF-α,IL-1 β,the activity of MPO increased ( P ＜ 0.05 or P ＜ 0.01 ),and the expression of CSE-mRNA increased,and blood pressure of rats decreased significantly in Ⅱ group.Compared with Ⅱ group,H2S synthesis,the levels of TNF-α,IL-1β and the activity of MPO increased (P ＜ 0.05),the expression of CSE mRNA did not change noticeably ( P ＞ 0.05),and blood pressure of rats decreased more significantly in Ⅲ group.Compared with Ⅱ group, H2S level decreased,the levels of TNF-α,IL-1β and the activity of MPO decreased significantly,the expression of CSE mRNA decreased and blood pressure of rats decreased in Ⅵ group (P ＜0.05).Histopathological changes of myocardium were aggravated in the following severity order: Ⅰ ＜ Ⅳ ＜＜ Ⅲ.Conclusions CSE/H2S system of the myocardium was upregulated in sepsis rats.Hydrogen sulfide could raise the levels of MPO,TNF-α,IL-1β,aggravating myocardial injury. Contrarily,the inhibitor of H2S could counteract it.

Objective To investigate the changes of the expression of HIF-1α (hypoxia induciblefactor-1a) mRNA in myocardium of rats after cardiopulmonary resuscitation (CPR) and the intervention effects of exogenous hydrogen sulfide on it. Method Forty five male SD rats were randomly divided into three groups: control group ( n = 15 ), cardiopulmonary resuscitation group ( CPR group, n = 15 ) and NaHS + CPR group (n = 15 ) . Rats of control group were anesthetized and intubated without asphyxia and cardiac arrest. The rats of CPR group and NaHS + CPR group were operated to induce cardiac arrest by asphyxiation. In the rats of NaHS + CPR group, NaHS in dose of 50 ug/kg was administrated via the femoral venous line 1 minute before CPR. Hemodynamic was monitored continuously. The expression of HIF - lα mRNA in myocardium of rats in each group was determined by using RT-PCR and the activity of myeloperoxidase (MPO) in the myocardium of rats in each group was assayed by using a patent reagent box 6 h after CPR. The histopathological changes of myocardium were also observed. The t- test was used for statistical analysis. Results There was no statistically significant difference in hemodynamic changes between CPR group and CPR + NaHS group ( P ＞ 0. 05 ) . When compared with the control group, the activity of MPO and the expression of HIF-1α mRNA in CPR group and CPR + NaHS group were both increased, and those increased in CPR + NaHS group was more significant (P ＜ 0. 05) . When compared with CPR group, the expression of HIF-1α mRNA in CPR + NaHS group was higher, however, the activity of MPO in CPR + NaHS group was lower ( P ＜ 0. 05) . There were various histopathological changes of myocardium of rats found in CPR group and CPR + NaHS group, and the damage of myocardium of rats in CPR group was more obvious than that in CPR + NaHS group. Conclusions The expression of HIF-1α mRNA in myocardium of rats was increased after CPR. Exogenous hydrogen sulfide can protect myocardium cells from resuscitation-perfusion injury, and the protection is associated with increase in expression of HIF 1 αmRNA.

Objective To study the effects of Tanshinone on serum levels of procollagen type Ⅰcarboxy terminal peptide(PⅠCP) and procollagen type Ⅲ amino terminal peptide(PⅢNP) in spontaneously hypertensive rats(SHRs).Methods Twenty four male SHRs were randomly divided into positive control,Tanshinone and valsartan groups.Eight male Wistar rats were as normal control group.After 4 w intervention,blood pressure(BP)of the rat tail,weight of myocardium were measured,the collagen volume fraction(CVF) in the myocardial tissues were calculated by VG staining and the contents of PⅠCP,PⅢNP were measured with radio immunoassay.Results BP,ventricular mass,ventricular mass index and CVF of positive control group were higher than those of other groups(P<0.01).The contents of PⅠCP and PⅢNP in positive control group also were increased significantly than those in other groups(P<0.05).After 4 w intervention,BP(P<0.01),ventricular mass,ventricular mass index(P<0.05) and CVF(P<0.01) of Tanshinone group and valsartan group were lower than those of positive control group.The contents of PⅠCP and PⅢNP in Tanshinone group and valsartan group were also decreased significantly than those in positive control groups(P<0.05).Conclusions Tanshinone could inhibit myocardial fibrosis of SHRs,which may be by suppressing the synthesis of collagen.

To investigate the interaction and involvement of sodium hydrosulfide (NaHS), a H2S donor, on hippocampus of rats suffering from sepsis-associated encephalopathy, rats were subjected to cecal ligation and puncture (CLP)-induced sepsis. Adult male Sprague-Dawley rats were randomly divided into four groups: Sham group, CLP group, CLP+NaHS group and CLP+aminooxyacetic acid (AOAA, an inhibitor of H2S formation) group. The four groups were observed at 3, 6, 9, 12 h after treatment. We examined hippocampal H2S synthesis and the expression of cystathionine-β-synthetase (CBS), a major enzyme involved in the H2S synthesis in hippocampus. CBS expression was detected by reverse transcription polymerase chain reaction (RT-PCR). The concentrations of inflammatory cytokines (TNF-α, IL-1β) were determined in hippocampus by using enzyme-linked immunosorbent assay (ELISA). Neuronal damage was studied by histological examination of hippocampus. In CLP group, H2S synthesis was significantly increased in hippocampus compared with sham group and it peaked 3 h after CLP (P<0.05). Sepsis also resulted in a significantly upregulated CBS mRNA in hippocampus. The levels of TNF-α and IL-1β in the hippocampus were substantially elevated at each time point of measurement (P<0.05), and they also reached a peak value at about 3 h. Administration of NaHS significantly aggravated sepsis-associated hippocampus inflammation, as evidenced by TNF-α and IL-1β activity and histological changes in hippocampus. In septic rats pretreated with AOAA, sepsis-associated hippocampus inflammation was reduced. It is concluded that the rats subjected to sepsis may suffer from brain injury and elevated pro-inflammatory cytokines are responsible for the process. Furthermore, administration of H2S can increase injurious effects and treatment with AOAA can protect the brain from injury.

2005年美国心脏协会(American Heart Association,AHA)心肺复苏(CPR)与心血管急救(ECC)指南,简化了心肺复苏程序,强调胸外按压的重要性.近年来随着研究的不断深入对这些治疗措施又有了一些新的认识,同时也有一些新的发现.本文将对其主要研究成果:胸外按压、电除颤、药物及复苏后治疗的最新进展作一简要综述.