The value of the wireless stethoscope in patients with COVID-19 infection in a makeshift hospital.

OBJECTIVE: When COVID-19 sweeps the world, traditional stethoscopes are seen as infectious agents and then the use of stethoscopes is limited especially when health providers were in their personal protective equipment. These reasons led to the ignoring of the values of stethoscopes during pandemics. This study aims to explore the value of wireless stethoscopes in patients of a makeshift hospital. MATERIAL AND METHODS: 200 consecutive hospitalized patients with confirmed SARS-CoV-2 at Lingang Makeshift Hospital in Shanghai, China, were enrolled from April 10 to May 10, 2022 (Trial Registration Number: ChiCTR2000038272,2020/9/15). They were randomly divided into two groups. In group A (n = 100), patients were examined without a stethoscope. In group B (n = 100), lung breath sounds and heart sounds were examined with a wireless stethoscope, and positive signs were recorded. The duration of cough and tachycardia symptoms, as well as emergency cases, were compared between the two groups. In addition, the pressure, anxiety, and depression of patients in the two groups were investigated using the DAS-21 questionnaire scale, to observe the psychological impact of the stethoscope-based doctor-patient communication on patients in the makeshift hospital. RESULTS: There was no significant difference in baseline characteristics between the two groups. In group B, some significant positive signs were detected by wireless stethoscopes, including pulmonary rales and tachycardia, etc. Moreover, the therapeutic measures based on these positive signs effectively alleviated the symptoms of cough and tachycardia, which showed that the duration of symptoms was significantly shorter than that of group A (cough: 2.8 ± 0.9 vs. 3.6 ± 0.9; palpitation: 1.4 ± 0.7 vs. 2.6 ± 0.7). In particular, the number of emergency cases in group B is less than that in group A (1% vs. 3%), and the severity is lower. Notably, stethoscope-based doctor-patient communication was found to be effective in alleviating psychological measures of group B patients. CONCLUSION: Wireless stethoscopes in makeshift hospitals can avoid cross-infections and detect more valuable positive signs, which can help health providers make accurate decisions and relieve patients' symptoms more quickly. Moreover, stethoscope-based doctor-patient communication can diminish the psychological impacts of the epidemic on isolated patients in makeshift hospitals. Trial registration This study was registered in the Chinese Clinical Trial (ChiCTR2000038272) at http://www.chictr.org.cn . http://www.chinadrugtrials.org.cn/clinicaltrials.searchlistdetail.dhtml .

Spatiotemporal Distribution of HIV Self-testing Kits Purchased on the Web and Implications for HIV Prevention in China: Population-Based Study.

BACKGROUND: HIV self-testing (HIVST) holds great promise for expanding HIV testing. Nonetheless, large-scale data on HIVST behavior are scant. Millions of HIVST kits are sold through e-commerce platforms each year. OBJECTIVE: This study aims to analyze the spatiotemporal distribution of the HIVST kit-purchasing population (HIVSTKPP) in China. METHODS: Deidentified transaction data were retrieved from a leading e-commerce platform in China. A joinpoint regression model was used to examine annual trends of the HIVSTKPP rates by calculating average annual percentage change. Bayesian spatiotemporal analysis was performed to locate hot spots with HIVSTKPP rates. Spatial autocorrelation analysis and space-time cluster analysis were conducted to identify clusters of HIVSTKPP. High-high clusters of HIVSTKPP can be identified by spatial autocorrelation analysis, and high-high clusters indicate that a region and its surrounding region jointly had a higher-than-average HIVSTKPP rate. Spatial regression analysis was used to elucidate the association between the number of HIV testing facilities, urbanization ratio (the proportion of urban population in the total population), and gross domestic product per capita and the HIVSTKPP. RESULTS: Between January 1, 2016, and December 31, 2019, a total of 2.18 million anonymous persons in China placed 4.15 million orders and purchased 4.51 million HIVST kits on the web. In each of these 4 years, the observed monthly size of the HIVSTKPP peaked in December, the month of World AIDS Day. HIVSTKPP rates per 100,000 population significantly increased from 20.62 in 2016 to 64.82 in 2019 (average annual percentage change=48.2%; P<.001). Hot spots were mainly located in municipalities, provincial capitals, and large cities, whereas high-high clusters and high-demand clusters were predominantly detected in cities along the southeast coast. We found positive correlations between a region's number of HIV testing facilities, urbanization ratio, and gross domestic product per capita and the HIVSTKPP. CONCLUSIONS: Our study identified key areas with larger demand for HIVST kits for public health policy makers to reallocate resources and optimize the HIV care continuum. Further research combining spatiotemporal patterns of HIVST with HIV surveillance data is urgently needed to identify potential gaps in current HIV-monitoring practices.

Real-world evaluation of the Stemoscope electronic tele-auscultation system.

BACKGROUND: With the spread of COVID-19, telemedicine has played an important role, but tele-auscultation is still unavailable in most countries. This study introduces and tests a tele-auscultation system (Stemoscope) and compares the concordance of the Stemoscope with the traditional stethoscope in the evaluation of heart murmurs. METHODS: A total of 57 patients with murmurs were recruited, and echocardiographs were performed. Three cardiologists were asked to correctly categorize heart sounds (both systolic murmur and diastolic murmur) as normal vs. abnormal with both the Stemoscope and a traditional acoustic stethoscope under different conditions. Firstly, we compared the in-person auscultation agreement between Stemoscope and the conventional acoustic stethoscope. Secondly, we compared tele-auscultation (recorded heart sounds) agreement between Stemoscope and acoustic results. Thirdly, we compared both the Stemoscope tele-auscultation results and traditional acoustic stethoscope in-person auscultation results with echocardiography. Finally, ten other cardiologists were asked to complete a qualitative questionnaire to assess their experience using the Stemoscope. RESULTS: For murmurs detection, the in-person auscultation agreement between Stemoscope and the acoustic stethoscope was 91% (p = 0.67). The agreement between Stemoscope tele-auscultation and the acoustic stethoscope in-person auscultation was 90% (p = 0.32). When using the echocardiographic findings as the reference, the agreement between Stemoscope (tele-auscultation) and the acoustic stethoscope (in-person auscultation) was 89% vs. 86% (p = 1.00). The system evaluated by ten cardiologists is considered easy to use, and most of them would consider using it in a telemedical setting. CONCLUSION: In-person auscultation and tele-auscultation by the Stemoscope are in good agreement with manual acoustic auscultation. The Stemoscope is a helpful heart murmur screening tool at a distance and can be used in telemedicine.

Factors associated with fetal karyotype in spontaneous abortion: a case-case study.

BACKGROUND: Most embryos that spontaneously abort during early pregnancy are found to have chromosomal abnormalities. The purpose of this study is to explore the factors involved in chromosome aberrations during embryogenesis. METHODS: A case-case study was performed to compare the risk factors for spontaneous abortion with and without embryo chromosome aberration. A total of 160 cases of spontaneous abortion were enrolled from a tertiary general hospital in Kunming. KaryoLite BACs-on-Beads (KL-BoBs) and fluorescence in situ hybridization (FISH) were employed to determine chromosomal constitution of abortion chorion villus samples. Maternal serum levels of homocysteine (Hcy) were detected by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Information about clinical background and environmental exposure was collected through a self-designed questionnaire. To identify the inherited chromosomal abnormalities, couples with chromosomal abnormalities in abortus were recalled for karyotyping. RESULTS: The overall rate of chromosomal abnormalities was 62.5% (100/160, KL-BoBs combined with FISH) including 51.9% (83/160) aneuploidies, 6.3% (10/160) polyploidies, and 4.4% (7/160) structural abnormalities. Only one case of structural abnormality was found to be inherited from maternal balanced translocation. Compared to abortus with normal karyotype, abortus with abnormal karyotype showed a positive association with parental age and elevated maternal serum homocysteine (Hcy) level, but negative association with previous miscarriage and perceived noise. CONCLUSIONS: Embryonic chromosomal aberrations accounted for the majority of spontaneous abortion cases. A combination of internal and external factors may induce spontaneous abortion through fetal chromosomal aberrations or other pathogenic mechanisms.

The Impact of COVID-19 Restrictions on Online Sales of HIV Self-Test Kits and Implications for HIV Prevention: Analysis of Transaction Data from a Leading E-commerce Platform in China.

BACKGROUND: The effect of the COVID-19 epidemic on HIV self-testing (HIVST) remains unclear. We aimed to quantify the impact of COVID restrictions on HIVST kit purchasing behaviors in mainland China. METHODS: Deidentified transaction data were retrieved from a large online shopping platform. An interrupted time series model was constructed to examine the impact of COVID restrictions on the weekly number of anonymous customers purchasing HIVST kits, online orders, and purchased kits. RESULTS: A total of 2.32 million individuals submitted 4.46 million orders for 4.84 million HIVST kits between January 7, 2016, and April 22, 2020. Compared with expected levels, assuming COVID-19 epidemic and related restrictions had not happened, the number of purchasers, orders, and kits decreased by an estimated 10,500 (51.7%), 18,000 (55.3%), and 18,500 (54.9%) in the first week (January 23, 2020, to January 29, 2020) after COVID restrictions were implemented, respectively. As restrictions eased, the number of purchasers, orders, and kits increased by an average of 7.4%, 4.8%, and 4.9% per week, respectively. In the first week after COVID restrictions were lifted (April 9, 2020, to April 15, 2020), the number of purchasers returned to expected levels, whereas the number of orders and kits were still lower than expected levels. The impact of COVID restrictions on outcomes at the beginning of COVID restrictions and the increasing trends of outcomes were larger among those living in regions with higher COVID-19 incidence (eg, Wuhan city and Hubei province). CONCLUSIONS: Online sales of HIVST kits were significantly impacted by COVID restrictions, and HIVST kit purchasing patterns returned to expected levels after restrictions were lifted.

Analysis of the etiologies of female infertility in Yunnan minority areas.

BACKGROUND: The present study aims to provide a comparative analysis of the etiologies of female infertility between Dehong, on the Yunnan Frontier, and Kunming. METHODS: A retrospective study, which included 941 infertile females in Kunming who were treated in the First People's Hospital of Yunnan Province and infertile females who were treated in the local hospital in Dehong from January 2016 to November 2018, was conducted. A comparative analysis of the etiologies of infertility in the two regions was then carried out. RESULTS: In patients with primary infertility, ovulation disorder (15.03%) was the main cause of infertility in Kunming, and pelvic inflammatory disease (25.59%) was the main cause in Dehong. With regard to secondary infertility, although pelvic inflammatory disease was the main cause of infertility in both regions, the incidence of intrauterine adhesions in Kunming was significantly higher than in Dehong. CONCLUSIONS: The etiology of infertility showed different epidemiological characteristics depending on the region, hence individualized treatment should be given accordingly.

Effect of the Methylation Level on the Grape Fruit Development Process.

Grapevine is extensively grown for fresh table grapes, wine, and other processed products worldwide. DNA methylation levels are regulated by DNA methylation maintenance and DNA methylation removal involved in the grapevine growth. We comprehensively analyzed the transcriptome and metabolome of the 'Kyoho' fruit with or without demethylation and screened for a large number of differential genes and metabolites. Color, hardness, and aroma are the most obvious traits reflecting the ripening of grapes. We used gas chromatography-mass spectrometry and high-performance liquid chromatography to understand the changes in metabolites during ripening. We cloned many key genes selected by transcriptome analysis and found that intron retention was observed in VvCHS, VvDFR, and VvGST. The imbalance of methylation levels affects the alternative splicing of pre-mRNA, which makes the translation process abnormal and affects gene expression. In addition, analyzing promoters of some genes, such as proVvGST4 and proVvUFGT, found that the promoters of these genes after demethylating were more difficult to methylate. Taken together, this study will provide new insights into comprehension of the molecular mechanism of methylation during ripening of grape berries. In addition, the study provides some genetic information to help guide our improvement, cultivation, and management of grapes in the future.

Analysis of pregnancy outcome after anastomosis of oviduct and its influencing factors.

BACKGROUND: This study aims to investigate the influencing factors of pregnancy after laparoscopic oviduct anastomosis. METHODS: The data of 156 cases of laparoscopic oviduct anastomosis in our hospital were analyzed. RESULTS: The pregnancy rate decreased with age (P < 0.005). The pregnancy rate after six years of anastomosis was higher in those with ligation (P < 0.005). The postoperative pregnancy rate significantly increased in subjects with oviduct lengths of > 7 cm (P < 0.01). The pregnancy rate of isthmus end-to-end anastomosis was higher (P < 0.005). The pregnancy rate after bilateral tubal recanalization was higher than that after unilateral tubal recanalization (P < 0.005). The pregnancy rate after laparoscopic tubal ligation and laparoscopic anastomosis was higher than that of open tubal ligation and laparoscopic anastomosis (P < 0.005). CONCLUSION: The pregnancy rate after laparoscopic oviduct anastomosis is higher in subjects below 35 years old, with a ligation duration of < 6 years, and a length of oviduct of > 7 cm, and those who underwent isthmus anastomosis and laparoscopic oviduct ligation and recanalization.

Surgical endodontic treatment of refractory periapical periodontitis with extraradicular biofilm.

OBJECTIVE: This study explored the effect of surgical endodontic treatment of refractory periapical periodontitis with extraradicular biofilm. STUDY DESIGN: Endodontic surgery was conducted on a case of refractory periapical periodontitis with extraradicular biofilm. During the procedure, the samples of periapical tissues were collected for microbiologic analysis. The resected root ends were observed under scanning electron microscope. The patient was recalled every 3 months to evaluate the treatment effect for 1 year. RESULTS: The samples yielded 1 type of facultative anaerobic bacteria (Streptococcus sanguis) and 2 types of obligate anaerobic bacteria (Porphynomonas endodontalis and Prevotella oralis). Mature bacteria biofilms were formed on the surface of the root apexes. At the 1-year recall visit, the radiograph and the clinic examination showed the refractory periapical periodontitis was cured successfully. CONCLUSIONS: The periapical bacterial biofilm may contribute to the refractory periapical periodontitis. Endodontic surgery is a good option for definitive removal of an established extraradicular infection.

The effect of c-di-GMP (3'-5'-cyclic diguanylic acid) on the biofilm formation and adherence of Streptococcus mutans.

Depending on a biofilm lifestyle, Streptococcus mutans (S. mutans) is thought to be one of the primary causative agents of dental caries. Biofilm formation and adhesion are crucial physiological functions and virulence factors for S. mutans. Thus, attempts to control the development of dental caries only by inhibiting one of the several virulence factors are not effective. Cyclic diguanylate (c-di-GMP) [bis(3',5')-cyclic diguanylic acid] is a prokaryotic cyclic dinucleotide second messenger that has been implicated in determining the timing and amplitude of complex biological processes from biofilm formation and virulence to photosynthesis. Here, we demonstrate that this signaling molecule also plays a role in the ability of S. mutans to initiate biofilm formation and adhere to tooth surfaces. To test this hypothesis, S. mutans UA159 and its gcp gene knockout mutant were assayed for their ability to initiate biofilm formation and adherence. The spatial distribution and architecture of the biofilms were examined by scanning electron microscopy. These results show that inactivation of the gcp gene resulted in the formation of an abnormal biofilm. We confirmed that c-di-GMP was effective in preventing biofilm formation of S. mutans UA159. We also found that extracellular c-di-GMP inhibited the adherence of S. mutans to tooth surfaces and reduced (>50%) biofilm formation compared to the untreated control. These results indicate that c-di-GMP attenuates the caries-inducing virulence factors of S. mutans. This suggests that c-di-GMP may be used alone or in combination with other antimicrobial agents, and that such a treatment could be developed into a novel method to prevent tooth decay.

Clinical observation in 2 representative cases of vertical root fracture in nonendodontically treated teeth.

Root fractures in nonendodontically treated teeth have been reported to occur primarily in Chinese. Two representative cases of vertical root fractures in nonendodontically treated teeth are presented. In the first case, there were vertical fractures in both mesial and distal roots of the mandibular right first molar. In the second case, there were vertical fractures in the mesial roots of both the mandibular left and right first molars. Their radiographic features were obtained. Both had clinically intact crowns with no or minimal restorations and periodontal defects. Diagnosis could be obtained with the use of radiographic examination.

Protective immunity in rats by intranasal immunization with Streptococcus mutans glucan-binding protein D encapsulated into chitosan-coated poly(lactic-co-glycolic acid) microspheres.

Recombinant Streptococcus mutans glucan-binding protein D (rGbpD) was incorporated into poly(lactic-co-glycolic acid) (PLGA) microspheres which then were surface-coated with chitosan. The microspheres, with a mean diameter of ca. 1.8 microm, were intranasally administered in rats. There were elevated salivary immunoglobulin A and serum immunoglobulin G antibody responses to rGbpD, as well as lower molar caries scores in immunized animals as compared to sham immunized ones. The chitosan-coated PLGA microspheres are thus potentially useful for antigen delivery in dental caries vaccination.

[Immunization with the fusion protein of GBD of Streptococcus mutans glucan binding protein-A against dental caries in SD rats].

PURPOSE: To observe the effect of immunization with the fusion protein of GBD of Streptococcus mutans glucan binding protein-A against dental caries. METHODS: Purified fusion protein of GBD of Streptococcus mutans glucan binding protein-A was used to immune SD rats by subcutaneous injection route. The rats were fed with Keyes Diet 2000 and infected by S.mutans. The caries level was determined and the result was analyzed by t test. RESULTS: The caries score of SD rats decreased in the group of immunized with GBD fusion protein,P<0.01. CONCLUSION: Immunization with GBD fusion protein resulted in significantly reduced dental caries after infection with S.mutans Ingbritt. Supported by PLA Tenth Five-Year Key Project (01Z089).

[Expression of GBD gene of Streptococcus mutans glucan binding protein A in mammalian cells].

OBJECTIVE: To evaluate the expression of recombinant plasmid pcDNA3.1/GBD of glucan binding protein of Streptococcus mutans in mammalian cells COS-7. METHODS: Eukaryotic plasmid carrying encoding gene of GBD of Streptococcus mutans gbpA was constructed and the plasmid was introduced into COS-7 cells by Lipofectamine reagent. The transient expressed protein in COS-7 cells was detected by immunochemistry technique. RESULTS: The positive expression was detected in plasma of the cells which were transfected with recombinant plasmid pcDNA3.1/GBD. The cells which were transfected with pcDNA3.1 were negative. CONCLUSION: GBD can translate and express in COS-7 cells after transfected with recombinant plasmid pcDNA3.1/GBD. The expressed protein locates in the plasma and the protein is able to combine with anti-GbpA antibody. The expressed protein has the antigenicity and is a candidate gene vaccine.