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BACKGROUND:Nanostructure modification of pure titanium surface is a hot research field of titanium implant surface treatment. OBJECTIVE:To evaluate the effect of nano-modified titanium surface treated with alkali heat treatment on early adhesion and growth of osteoblasts. METHODS:Four-grade pure titanium sheets with a diameter of 15 mm and a thickness of 1.5 mm were taken and processed in three groups:the smooth treatment group was polished step by step with 250 mesh,800 mesh,and 1 500 mesh silicon carbide sandpaper.In the sandblasting group,the smoothed titanium sheet was sandblasted with 100 μm Al2O3 particles at 0.45 MPa pressure,and then the acid etching was carried out.In the alkali heat treatment group,the smoothed titanium sheet was placed in the reactor,immersed in 10 mol/L NaOH solution,and heated in the oven at 100 ℃for 12 hours.The surface morphology,roughness,and hydrophilicity of three groups of titanium sheets were measured.MG63 osteoblasts were inoculated on the surface of three groups of titanium tablets,and the adhesion of the cells was observed by immunofluorescence staining. RESULTS AND CONCLUSION:(1)Scanning electron microscopy showed that the surface of titanium sheets in the smooth treatment group had uniform scratches;the surface of titanium sheets in the sandblasting group was uneven,and the surface of titanium sheets in the alkali heat treatment group had uniform nanoscale three-dimensional pore morphology.The roughness value of the titanium sheets in sandblasting and alkali heat treatment groups was higher than that in the smooth treatment group(P<0.05),and the water contact angle was lower than that in the smooth treatment group(P<0.05).(2)Immunofluorescence staining after 3 and 6 hours of inoculation of MG63 cells showed that the number of adhesion cells on the surface of the titanium sheet in the sandblasting group and alkali heat treatment group was higher than that in the smooth treatment group(P<0.05).Immunofluorescence staining 12 hours after inoculation showed that compared with the smooth treatment group,the actin skeleton of cells on the surface of titanium sheets in the sandblasting group and alkali heat treatment group was more extended,and most cells extended stronger pseudopodia,which was conducive to subsequent intercellular signal transduction and intercellular interaction.(3)The results showed that the nanostructures with certain biological activity could be prepared on the surface of a titanium sheet by alkali heat treatment,which was conducive to the early adhesion of osteoblasts.
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BACKGROUND:Talus cartilage injury is a common motor system disease.This type of injury will affect the patient's daily life and work ability,and may worsen the condition if left untreated.Surgical treatment is commonly used,but the selection of surgical methods and the evaluation of medium-and long-term follow-up results have always been difficult clinical problems. OBJECTIVE:To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium-and long-term follow-up. METHODS:A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects.The lesion site of talus was examined by MRI before operation,and the T1ρ and T2 values of different types were compared.Different surgical methods were selected according to the different T1ρ values.Group A(n=73)was treated with microfracture surgery with T1ρ<45 ms;group B(n=81)was treated with autogenous bone and cartilage transplantation with T1ρ≥45 ms.The general clinical characteristics and curative effects of patients under different surgical methods were compared;the important factors of postoperative recurrence were analyzed by multivariate Logistic regression,and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph,y=1-1/(1+e-z)regression equation to build a prediction model.The stability of the model was verified by cross-checking method. RESULTS AND CONCLUSION:(1)Classification of talus osteochondral injury in 154 patients(type Ⅰ:36 cases;type Ⅱ:37 cases;type Ⅲ:40 cases;type Ⅳ:41 cases),T1ρ and T2 values of the four groups were statistically significant(P<0.05);pairwise comparison was also statistically significant(all P<0.05).(2)After treatment of 154 patients,7 cases(4.6％)had local swelling,3 cases(2.0％)had pain aggravation,and 5 cases(3.3％)had wound infection.There were 2 cases(1.3％)with poor cartilage healing.(3)After treatment,there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot&Ankle Society score,visual analog scale score,plantar flexor motion range,dorsoextension motion range,subchondral bone marrow edema volume,interleukin-6,interleukin-8,C-reactive protein,procalcitonin,platelet-derived growth factor,transforming growth factor-β1,and efficacy(P<0.05).The total effective rate of group B(90％)was higher than that of group A(85％)(P<0.05).(4)Age(OR=1.589,95％CI:0.305-1.252,P=0.036),interleukin-6(OR=1.737,95％CI:0.974-5.254,P=0.049),interleukin-8(OR=1.385,95％CI:1.066-4.355,P=0.034),C-reactive protein(OR=1.957,95％CI:1.323-2.178,P=0.035),transforming growth factor-β1(OR=1.459,95％CI:0.897-2.455,P=0.038),T1-ρ(OR=1.687,95％CI:0.854-3.321,P=0.026),T2(OR=1.843,95％CI:0.657-2.454,P=0.036),complications(OR=1.719,95％CI:0.654-3.464,P=0.019),and classification of osteochondral injury of talus(OR=3.789,95％CI:1.023-5.897,P=0.028)were independent risk factors for postoperative recurrence.Microfracture surgery(OR=0.751,95％CI:0.321-1.264,P=0.012)and autogenous bone and cartilage grafting(OR=0.649,95％CI:0.246-1.356,P=0.023)were independent protective factors for recurrence after medium-and long-term follow-up.(5)When T1ρ value≤35 ms,the risk of postoperative recurrence decreased rapidly,and when T1ρ value>35 ms,the risk of postoperative recurrence increased rapidly.(6)Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence,and the formula for postoperative recurrence was obtained.The probability of postoperative recurrence was calculated using the regression equation.When P=0.75,the maximum value of Jorden index was 77.728,indicating that the model has a better prediction effect.(7)It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods,improve the success rate of surgery and the quality of life of patients.
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Objective:To study influence of seamless management concept intervention on patients with coronary heart dis-ease(CHD).Methods:A total of 98 CHD patients treated in our hospital were randomly and equally divided into routine intervention group(received routine follow-up management based on routine treatment)and seamless management group(received seamless management intervention based on routine treatment)according to random number table method.Both groups were intervened for one year.General clinical data,levels of total cholesterol(TC),triglyceride(TG),high densi-ty lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and homocysteine(Hcy)before and after intervention and incidence rate of major adverse cardiovascular events(MACE)within one-year follow-up were compared between two groups.Results:Compared with routine intervention group,after intervention,there were signifi-cant reductions in levels of TC[(3.39±0.54)mmol/L vs.(2.95±0.59)mmol/L],LDL-C[(2.02±0.54)mmol/L vs.(1.74±0.53)mmol/L]and Hcy[(15.69±5.09)mmol/L vs.(13.41±4.96)mmol/L],and significant rise in HDL-Clevel[(1.33±0.40)mmol/L vs.(1.57±0.27)mmol/L]in seamless management group(P＜0.05 or＜0.01).Incidence rate of MACE during one-year follow-up in seamless management group was significantly lower than that of routine intervention group(8.16％vs.26.53％,P=0.014).Conclusion:Seamless management concept intervention can significantly improve blood lipid levels,reduce homocysteine level and incidence rate of major adverse cardiovascular events in patients with coronary heart disease.
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Objective To analyze the value of magnetic resonance proton density-weighted fat-saturated(PDWI-FS)sequence in the diagnosis of bone marrow edema(BME)in osteoarticular injury.Methods A total of 150 patients with bone and joint trauma were enrolled in the study.All patients underwent sagittal PDWI-FS sequence scan and conventional MRI sequence scan.The BME detection,signal intensity,image quality,and the signal-to-noise ratio and contrast-to-noise ratio of the lesions were compared between two methods.Results Both methods revealed that there were 225 sites of BME signs in 134 out of the 150 patients,with a higher prevalence in knee joint trauma patients.The signal intensity of the lesions was mainly grade 3 on PDWI-FS sequence and grade 2 on conventional MRI sequence,accounting for 97.78%(220/225)and 43.11%(97/225),indicating that the two methods graded signal intensity differently(Z=15.919,P<0.05).PDWI-FS sequence and conventional sequence had scores of 4.09±0.45 vs 3.88±0.39,3.65±0.42 vs 3.41±0.36,3.25±0.37 vs 3.14±0.35 and 4.21±0.38 vs 3.97±0.34 on lesion clarity,spatial resolution,anamorphosis and diagnostic confidence,and the former scored higher(t=4.319,5.314,2.645,5.765;P<0.05).The signal-to-noise ratio and contrast-to-noise ratio of the lesions on PDWI-FS sequence were 2.07±0.23 and 5.52±0.64,higher than 2.01±0.22 and 5.17±0.59 on conventional sequence,and the differences were statistically significant(t=2.309,4.925;P<0.05).Conclusion Compared with conventional MRI sequence,magnetic resonance PDWI-FS sequence can effectively enhance image quality and display lesions more clearly,providing more accurate information for the diagnosis of BME in osteoarticular injury.
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Objective To promote the construction of a national party building indicator system for public hospitals,provide reference for the development of system documents such as quality evaluation methods for party building work in public hospitals.Methods Conduct a comprehensive and systematic collection,organization,and analysis of policy documents related to party building in public hospitals in China since 2018,and organize expert discussions.Results The positive coefficients of the three rounds of expert discussions were all 100％,and the expert authority coefficient was 0.878.A party building indicator system was constructed with 7 primary indicators and 40 secondary indicators,including leadership system and decision-making mechanism,leadership team and cadre talent team construction,grassroots party organization construction,party member team construction,medical ethics and clean governance construction,party building work guarantee,and others.Conclusion The indicator system has been unanimously recognized by experts and is authoritative and feasible,laying the foundation for the refined party building work in public hospitals.
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Objective To analyze TCM master Yan Zhenghua's medication rules of ascending,descending,floating and sinking properties for the treatment of respiratory diseases,inherit his valuable academic experience.Methods Using four books edited by Professor Yan Zhenghua's disciples as the main source,Professor Yan Zhenghua's prescriptions for clinical treatment of respiratory diseases were systematically collected and analyzed.Statistical analysis was conducted on the patients'gender and age,differentiation of diseases and syndrome types of the prescriptions,as well as the properties of ascending,descending,floating and sinking,dosage,and commonly used pairs of Chinese materia medica.Results Totally 208 prescriptions were included in this study,involving 178 kinds of Chinese materia medica and 64 kinds of monarch drug,most of them were descending and sinking drug,and the whole prescription was mainly descending and sinking.On average,each prescription used 13.2 kinds of Chinese materia medica,and most dosage points were within the range of conventional dosage.Among later adding medicines,Houttuyniae Herba had the highest frequency of use.The medicinal pairs of Asteris Radix et Rhizoma-Cynanchi Stauntonii Rhizoma et Radix,Cynanchi Stauntonii Rhizoma et Radix-Stemonae Radix and Asteris Radix et Rhizoma-Stemonae Radix were often used.Armeniacae Semen Amarum,Fritillariae Thunbergii Bulbus,and Asteris Radix et Rhizoma were commonly used in those descending and sinking prescriptions.Conclusion In the treatment of respiratory diseases,Professor Yan Zhenghua prefers to use descending and sinking drugs with ascending and floating drugs and dual trend drugs to regulate qi activity,and has the characteristics of Menghe medical school,which is"mild and flexible medication".
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Objective:To compare the clinical benefits of classic endoscopic submucosal dissection (ESD) and hybrid ESD for the treatment of colorectal epithelium-derived tumors.Methods:The current investigation was a retrospective multicenter study of 418 patients who underwent ESD between January 2015 and April 2021 at Beijing Jishuitan Hospital. The patients were assigned to one of two groups based on the surgical procedure they underwent; a classic ESD group or a hybrid ESD group. The primary outcome was the rate of en bloc resection and complete resection. SPSS 26.0 was used for statistical analysis. Homogeneity of variance was assessed via Cochran′s test. Normally distributed data with homogeneity of variance were analyzed via the t-test for independent samples. Non-normally distributed data and data with unequal variance were analyzed via the Kruskal-Wallis non-parametric test. Categorical data were analyzed via the Chi-square test or Fisher′s exact test. Multivariable assessment was performed via logistic regression analysis. Results:The en bloc resection rates [89.4% (84/94) vs. 87.0% (194/223), χ2=0.34, P=0.558] and complete resection rates [85.1% (80/94) vs. 82.1% (183/223), χ2=0.33, P=0.510] were similar. Compared with classic ESD, procedures were shorter in the hybrid ESD group [22(7, 213) vs. 47(12, 680) min, Z=0.23, P<0.001], dissection was completed more rapidly [0.14(0.02, 0.32) vs. 0.10(0.02, 0.41) cm 2/min, Z=0.08, P<0.001], and there was a higher rate of perforation (9.6% vs. 2.2%, χ2=2.67, P=0.006). Laterally spreading tumor granular type nodular mixed, non-granular type pseudo-depressed, flat-elevated type (odds ratio 2.826, P=0.012), and tumor location (odds ratio 6.970, P=0.005) were independently associated with complete resection in the hybrid ESD group. Conclusion:Classic ESD and hybrid ESD had similar en bloc and complete resection rates for colorectal epithelium-derived tumors, but hybrid ESD had shorter operation times. With respect to hybrid ESD, factors associated with failure of complete resection included lesion type and crossing tissue boundaries.
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ObjectiveTo analyze the trends, cooperation, topics and hotspots of researches about multi-level rehabilitation service system in China. MethodsThe literature on multi-level rehabilitation service system in China was searched and screened in databases of CNKI from 1983 to 2023. The number of the articles was described, and the cooperation, research hotspots and changing trend were analyzed using VOSviewer. ResultsA total of 4 643 articles were included. The number of the articles tended to increase and developed in stages. Nine groups with five or more researchers were found, and seven of them cooperated with each other. The most frequent keywords were community-based rehabilitation (occurrence 1 251 with connection strength 1 780), stroke (occurrence 674 with connection strength 1 126), family rehabilitation (occurrence 412 with connection strength 514), rehabilitation nursing (occurrence 178 with connection strength 240) and quality of life (occurrence 156 with connection strength 311). The researchers initially focused on disability rehabilitation, then focused on community-based rehabilitation and family rehabilitation, and gradually focused on the quality of life, activities of daily living, satisfaction, mental health, negative emotion and healthcare consortium in recent years. ConclusionThe researches about multi-level rehabilitation service system are developing in China, focusing on community-based rehabilitation, stroke, family rehabilitation, rehabilitation nursing and quality of life. The cooperation among scholar groups need to be strengthened. Quality of life, activities of daily living, satisfaction, mental health, negative emotion and healthcare consortium may be the hotspots in the future.
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The occurrence of Kaposi′s sarcoma (KS) is closely related to Kaposi′s sarcoma-associated herpesvirus (KSHV) infection of endothelial cells. KSHV infection can present as various types of KS, and clinical features, severity and prognosis differ among different types of KS. Classic KS is characterized by localized lesions and slow progression, AIDS-related KS and endemic KS are highly aggressive, and iatrogenic KS needs control of the primary disease during treatment. Therefore, individualized therapies should be developed according to the clinical classifications and characteristics of KS. This review summarizes treatment modalities of and research progress in KS.
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Objective:To analyze the three-dimensional radiographic characteristics of calcifying odon-togenic cyst and calcifying epithelial odontogenic tumor using spiral computed tomography(CT)and cone-beam computed tomography(CBCT).Methods:Clinical records,histopathological reports,and CBCT or non-enhanced spiral CT images of 19 consecutive patients with calcifying odontogenic cyst(COC)and 16 consecutive patients with calcifying epithelial odontogenic tumor(CEOT)were retrospec-tively acquired,and radiographic features,including location,size,expansion,internal structure and calcification,were analyzed.Results:Among the 19 COC cases(12 males and 7 females,with an average age of 27 years),89.5％(17/19)of the lesions originated from the anterior and premolar areas,100.0％of them exhibited cortex expansion,and 78.9％had discontinued cortex.Among the 16 CEOT cases(3 males and 13 females,with an average age of 36 years),81.3％(13/16)of the lesions were in the premolar and molar areas,56.3％of them exhibited cortex expansion,and 96.8％had discontinued cortex.According to the distribution of internal calcifications,these lesions were divided in-to:Ⅰ(non-calcification type):absence of calcification;Ⅱ(eccentric marginal type):multiple calcifi-cations scattered along one side of the lesion;Ⅲ(diffused type):numerous calcifications diffusely dis-tributed into the lesion;Ⅳ(plaque type):with a ≥ 5 mm calcified patch;V(peri-coronal type):multiple calcifications clustered around impacted teeth.Calcifications were present in 73.7％of COC le-sions,including 9 type Ⅱ,3 type Ⅲ and 2 type Ⅳ lesions,and 42.8％of CEOT lesions had calcifica-tion images,including 2 type Ⅲ and 5 type V lesions.Six COC lesions had odontoma-like images.Moreover,8 of 9 type Ⅰ CEOTs were histologically Langerhans cell-rich subtype,which had a smaller size(with an average mesiodistal diameter of 17.8 mm)and were not associated with impacted teeth.Conclusion:COC lesions tended to originate from the anterior part of the jaw and exhibit cortex expan-sion,and were sometimes associated with odontoma.CEOT commonly occurred in the posterior jaw and had discontinued cortex.Two lesions had significantly different calcification map.Over 70％of COC le-sions had calcification images,which were mostly scattered along one side of the cysts,far from the im-pacted teeth.Approximately 60％of CEOT lesions exhibited smaller size and non-calcification,and the remaining CEOT cases often had calcification images clustered around the impacted teeth.
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Acupuncture, a therapeutic treatment defined as the insertion of needles into the body at specific points (ie, acupoints), has growing in popularity world-wide to treat various diseases effectively, especially acute and chronic pain. In parallel, interest in the physiological mechanisms underlying acupuncture analgesia, particularly the neural mechanisms have been increasing. Over the past decades, our understanding of how the central nervous system and peripheral nervous system process signals induced by acupuncture has developed rapidly by using electrophysiological methods. However, with the development of neuroscience, electrophysiology is being challenged by calcium imaging in view field, neuron population and visualization in vivo. Owing to the outstanding spatial resolution, the novel imaging approaches provide opportunities to enrich our knowledge about the neurophysiological mechanisms of acupuncture analgesia at subcellular, cellular, and circuit levels in combination with new labeling, genetic and circuit tracing techniques. Therefore, this review will introduce the principle and the method of calcium imaging applied to acupuncture research. We will also review the current findings in pain research using calcium imaging from in vitro to in vivo experiments and discuss the potential methodological considerations in studying acupuncture analgesia.
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Cálcio , Terapia por Acupuntura , Acupuntura , Analgesia por Acupuntura/métodos , Pontos de Acupuntura , TecnologiaRESUMO
@#Objective To analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA). Methods The clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed. Results The average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%). Conclusion The pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.
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Objective To explore the change of brain functional connectivity strength in patients with type 2 diabetes mellitus(T2DM)and its neuropathological mechanism.Methods Fifty-six T2DM patients who visited Gansu Provincial Hospital from October 2017 to March 2021 were selected as T2DM group,and 48 healthy controls were selected as control group.A prospective study was conducted on the changes in brain function in T2DM patients by analysis of resting state functional connectivity strength(FCS)and functional connectivity(FC)based on seed points.Brain functional magnetic resonance imaging,clinical variable collection,and neuropsychological testing of patients in two groups were performed.We calculate the FCS value,evaluate the brain function changes of the two groups in the resting state,take the brain regions with significant differences between the groups as the seed points and perform functional connectivity analysis with the whole brain.Correlation analysis was conducted between the FCS,FC values of the different brain regions and clinical variables such as fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),thyroid hormone(TSH)levels,as well as the scores of mini mental state examination(MMSE),Montreal cognitive assessment(MoCA),clock drawing test(CDT),Hamilton Depression Rating Scale(HAMD-24)and Hamilton Anxiety Scale(HAMA).Results Compared with control group,the HAMD-24 and HAMA scores in T2DM group significantly increased(P<0.01),while the MoCA scores decreased(P<0.05);In T2DM group,the FCS value of the right middle temporal gyrus increased(GRF correction,voxel level P<0.001,clustering level P<0.05),and the FC value of the right middle temporal gyrus-left anterior cingulate cortex decreased(GRF correction,voxel level P<0.001,clustering level P<0.05).Correlation analysis showed that the FC value of right middle temporal gyrus-left anterior cingulate cortex in T2DM patients was negatively correlated with HAMD-24 score(r=-0.395,P=0.003),HbA1c level(r=-0.303,P=0.023),and positively correlated with TSH level(r=0.324,P=0.017).Conclusions The increase of FCS value in the right middle temporal gyrus and the decrease of FC value in the right middle temporal gyrus-left anterior cingulate cortex may be important neuroimaging features of brain function damage in T2DM patients.HbA1c may play an important role in the process of brain damage in T2DM patients.
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Objective The aim of this study was to draw single-cell transcriptome profiles of high-grade serous ovarian cancer(HGSOC),borderline ovarian cancer(OC),and normal ovaries in order to identify biomarkers that can diagnose and predict the prognosis of OC.Methods The differentially expressed genes between HGSOC,borderline OC,and normal ovarian tissues were ana-lyzed using single-cell data sequenced(SRA database:PRJNA756768).The cell subsets associated with tumor progression were screened by functional enrichment,cell communication between different subsets was analyzed by Cellchat,and cell differentiation traj-ectories were explored by pseudotime analysis to finally determine the subsets most relevant to tumor progression.Combined with OC transcriptome data of OC from the Cancer Genome Atlas(TCGA)with patient prognosis,biomarkers for diagnosing and predicting sur-vival of OC patients were ultimately screened.Results After using t-distribution stochastic neighbor embedding(t-SNE)for di-mensionality reduction,nine cell subpopulations were obtained:endothelial cells,myeloid cells,fibroblasts,T cells,stromal cells,B cells,and 3 epithelial cell subpopulations(C1,C4,and C7).Further analysis revealed that copy number variation(CNV)in the C4 group had the highest score in HGSOC,higher than those of borderline OC and normal ovaries,and was negatively correlated with prognosis.DMKN was a key marker gene in this group.Transcriptome analysis of OC in the TCGA database showed a close correlation between DMKN and poor prognosis(P=0.026),and the diagnostic efficacy of DMKN for OC was significant(A UC=0.906).Con-clusion This study is based on single-cell sequencing data to screen for DMKN,which can effectively diagnose and predict the prognosis of OC.This study provides new ideas for the diagnosis and prognosis prediction of OC.
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Tuberculosis is a serious zoonotic disease causing approximately 10 million new cases worldwide every year.The emergence of various drug-resistant strains of Mycobacterium tuberculosis is currently an important challenge intuberculosispre-vention and control,and an urgent need exists to develop new anti-tuberculosis drugs to treat drug-resistant tuberculosis and shorten the treatment time.The discovery of drug targets is a bottleneck inthe development of new anti-tuberculosis drugs.At present,the widely reported drug targets for tuberculosis include primarily new targets related to the biosynthesis of Mycobac-terium tuberculosis components and immune metabolic pathways.In addition,host-directed therapiestargeting the host immune system have become a research hotspot in recent years.Adjuvant host-directed therapies can enhance the therapeutic effect of tuberculosis and shorten treatment times by affecting granuloma formation,autophagy,host immune metabolism and the intra-cellular killing mechanism,as well as regulating pulmonary inflammation.The discovery of these new targets provides new ide-as for the future development of safe and effective new anti-tuberculosis drugs.
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Objective To investigate the impact of anemia and chronic kidney disease(CKD)on the prognosis of elderly patients with HFpEF.Methods A retrospective cohort study was conducted on 224 very old patients(age ≥80 years)with HFpEF admitted to Department of General Medi-cine of No.960 Hospital of PLA Joint Logistics Support Force from January 2016 to March 2023.According to their estimated glomerular filtration rate(eGFR)and hemoglobin level at admis-sion,they were divided into non-CKD+non-anemia group(88 cases),CKD group(14 cases),ane-mia group(79 cases)and CKD+anemic group(43 cases).The patients in the anemic group were further divided into mild(67 cases)and moderate-to-severe anemia subgroups(12 cases),and those of the CKD+anemia group were divided into CKD+mild anemia subgroup(31 cases)and CKD+moderate anemia subgroup(12 cases).The endpoints of follow-up included all-cause death,cardiovascular death and the end of follow-up.The relationships of CKD and anemia with progno-sis in elderly HFpEF patients were analyzed.Results During the follow-up period,all-cause mor-tality occurred in 100 patients(44.6％)and cardiovascular death in 32 patients(14.3％).Kaplan-Meier survival curve analysis showed that the CKD+anemia group had significantly higher rates of all-cause and cardiovascular death than the non-CKD+non-anemia,CKD and anemia groups(P＜0.01).Cox regression analysis indicated that the risk of all-cause mortality and cardiovascu-lar mortality was significantly higher in the CKD+moderate anemia subgroup than the non-CKD+non-anemia group(HR=6.43,95％CI:2.82-14.68,P=0.000;HR=10.63,95％CI:2.17-51.95,P=0.004).The risk of cardiovascular death was obviously higher in the moderate-to-severe anemia subgroup than in the non-CKD+non-anemia group(HR=4.96,95％CI:1.19-20.72,P=0.028).Conclusion Moderate-to-severe anemia is an independent risk factor for cardiovascular death in elderly HFpEF patients,and CKD complicated with moderate anemia significantly increa-ses the risk of all-cause mortality and cardiovascular death in elderly HFpEF patients.
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Objective: To explore the molecular features of chronic myelomonocytic leukemia (CMML) . Methods: According to 2022 World Health Organization (WHO 2022) classification, 113 CMML patients and 840 myelodysplastic syndrome (MDS) patients from March 2016 to October 2021 were reclassified, and the clinical and molecular features of CMML patients were analyzed. Results: Among 113 CMML patients, 23 (20.4%) were re-diagnosed as acute myeloid leukemia (AML), including 18 AML with NPM1 mutation, 3 AML with KMT2A rearrangement, and 2 AML with MECOM rearrangement. The remaining 90 patients met the WHO 2022 CMML criteria. In addition, 19 of 840 (2.3%) MDS patients met the WHO 2022 CMML criteria. At least one gene mutation was detected in 99% of CMML patients, and the median number of mutations was 4. The genes with mutation frequency ≥ 10% were: ASXL1 (48%), NRAS (34%), RUNX1 (33%), TET2 (28%), U2AF1 (23%), SRSF2 (21.1%), SETBP1 (20%), KRAS (17%), CBL (15.6%) and DNMT3A (11%). Paired analysis showed that SRSF2 was frequently co-mutated with ASXL1 (OR=4.129, 95% CI 1.481-11.510, Q=0.007) and TET2 (OR=5.276, 95% CI 1.979-14.065, Q=0.001). SRSF2 and TET2 frequently occurred in elderly (≥60 years) patients with myeloproliferative CMML (MP-CMML). U2AF1 mutations were often mutually exclusive with TET2 (OR=0.174, 95% CI 0.038-0.791, Q=0.024), and were common in younger (<60 years) patients with myelodysplastic CMML (MD-CMML). Compared with patients with absolute monocyte count (AMoC) ≥1×10(9)/L and <1×10(9)/L, the former had a higher median age of onset (60 years old vs 47 years old, P<0.001), white blood cell count (15.9×10(9)/L vs 4.4×10(9)/L, P<0.001), proportion of monocytes (21.5% vs 15%, P=0.001), and hemoglobin level (86 g/L vs 74 g/L, P=0.014). TET2 mutations (P=0.021) and SRSF2 mutations (P=0.011) were more common in patients with AMoC≥1×10(9)/L, whereas U2AF1 mutations (P<0.001) were more common in patients with AMoC<1×10(9)/L. There was no significant difference in the frequency of other gene mutations between the two groups. Conclusion: According to WHO 2022 classification, nearly 20% of CMML patients had AMoC<1×10(9)/L at the time of diagnosis, and MD-CMML and MP-CMML had different molecular features.
Assuntos
Humanos , Idoso , Pessoa de Meia-Idade , Leucemia Mielomonocítica Crônica/genética , Prognóstico , Fator de Processamento U2AF/genética , Mutação , Síndromes Mielodisplásicas/genética , Leucemia Mieloide Aguda/genéticaRESUMO
Objective:To explore the clinical risk factors of post-transplantation diabetes mellitus (PTDM) and establish a risk prediction model in kidney recipients.Methods:The clinical data and postoperative bedside measurements of blood glucose (BG) were retrospectively reviewed for 305 renal transplant recipients at First Affiliated Hospital of Zhejiang University School of Medicine from October 2018 to August 2019.According to whether or not PTDM occurred, they were assigned into two groups of PTDM (n=34) and non-PTDM (n=271). Risk factors were screened through single/multi-factor Logistic regression and PTDM prediction model was established.Results:The incidence rate of PTDM was 11.15%(34/305). Logistic regression analysis indicated that deceased donor, age ≥40 years, female, pre-hemoglobin A1c (Pre-HbA1c) and postoperative bedside BG value ≥11.1 mmol/L were the correlated factors for the occurrence of PTDM.Among them, female ( OR=3.13, 95% CI: 1.28-7.61), Pre-HbA1c ( OR=2.05, 95% CI: 1.12-3.74) and BG ≥11.1 mmol/L at 4pm Day 2/3 post-operation ( OR=19.08, 95% CI: 4.34-83.87) were risk factors for the occurrence of PTDM, The area under the model curve was 0.86 (95% CI: 0.79-0.93) with a Jordan index of 0.65, a sensitivity of 82.8% and a specificity of 82.3%. Conclusions:Female, Pre-HbA1c and fasting BG at 4 pm Day 2/3 post-operation ≥ 11.1 mmol/L are risk factors for the occurrence of PTDM.The prediction model has a decent predictive value.It is conducive to early clinical interventions and lowering the incidence rate of PTDM.
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Objective:To investigate the advantage of three dimensional(3D)-printed tissue compensators in radiotherapy for superficial tumors at irregular sites.Methods:A subcutaneous xenograft model of prostate cancer in nude mice was established. Mice were randomly divided into no tissue compensator group( n=6), common tissue compensator group( n=6), and 3D-printed tissue compensator group( n=6). Computed tomography (CT) images of nude mice in the 3D-printed tissue compensator group were acquired. Compensator models were made using polylactic acid, and material properties were evaluated by measuring electron density. CT positioning images of the three groups after covering the corresponding tissue compensators were acquired to delineate the gross tumor volume (GTV). Nude mice in the three groups were irradiated with 6 MV X-rays at the prescribed dose. The prescribed dose for the three groups was 1 500 cGy. The dose distribution in the GTV of the three groups was calculated and compared using the analytical anisotropic algorithm in the Eclipse 13.5 treatment planning system. The metal-oxide-semiconductor field-effect transistor was used to verify the actual dose received on the skin surface of nude mice. Results:The air gap in the 3D-printed tissue compensator group and the common tissue compensator group was 0.20±0.07 and 0.37±0.07 cm 3, respectively ( t=4.02, P<0.01). For the no tissue compensator group, common tissue compensator group, and 3D-printed tissue compensator group, the D95% in the target volume was (1 188.58±92.21), (1 369.90±146.23), and (1 440.29±45.78) cGy, respectively ( F=9.49, P<0.01). D98% was (1 080.13±88.30), (1 302.76±158.43), and (1 360.23±48.71) cGy, respectively ( F=11.17, P<0.01). Dmean was (1 549.08±44.22), (1 593.05±65.40), and (1 638.87±40.83) cGy, respectively ( F=4.59, P<0.05). The measured superficial dose was (626.03±26.75), (1 259.83±71.94), and (1 435.30±67.22) cGy, respectively ( F=263.20, P<0.001). The percentage variation in tumor volume growth after radiation was not significantly different between the common tissue compensator group and the 3D-printed tissue compensator group ( P>0.05). Conclusions:3D-printed tissue compensators fit well to the body surface, which reduces air gaps, effectively increases the dose on the body surface near the target volume, and provides ideas for radiotherapy for superficial tumors at some irregular sites.
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Objective:To analyse the clinical characteristics and antiviral therapy in immunosuppressed hospitalized patients with influenza.Methods:The clinical data of 273 patients with positive influenza A or B virus nucleic acid admitted in Peking University People’s Hospital from November 2015 to March 2022 were retrospectively analyzed. Among them, 123 were immunosuppressed and 150 were non-immunosuppressed. The clinical characteristics and antiviral therapy in immunosuppressed patients with influenza were analyzed. SPSS 22.0 software was used to analyze the data.Results:Chemotherapy for malignancies was the most common cause of immunosuppression (61.8%, 76/123), followed by haemopoietic stem cell transplantation (24.4%, 30/123). The common symptoms were fever (93.5%, 115/123) and cough (41.5%, 51/123). The proportions of co-infections (22.8%, 28/123) and complications (43.9%, 54/123) in immunosuppressed hospitalized patients were higher than those in non-immunosuppressed patients ( χ2=9.365 and 7.496, both P<0.01). Compared with single drug therapy, combination of antiviral drugs did not shorten the fever time, negative conversion time of virus nucleic acid and the length of hospital stay, and reduce the death ( U/ χ2=312.5, 356.0, 749.5 and 0.185, all P>0.05). Compared to patients without corticosteroids use, the use of corticosteroids did not increase mortality in immunosuppressed patients ( χ2=2.508, P=0.113). Conclusions:Classical symptoms may be absent in immunosuppressed patients with influenza, and early detection of influenza virus is still an important means of early diagnosis. Co-infections and complications are more common in immunosuppressed influenza patients. Immunosuppressed influenza patients did not benefit from the combination of antiviral therapy.