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Fascia,the initial response site for mechanical stimulation in manipulations,is also the target of the effect of manipulations.As the essence of manipulation is"force",how mechanical stimuli are transduced into neuroelectric and biochemical signals in the fascia and how physical and chemical signals of the fascia initiate the mechanical stimulation effect are the common key questions in the study of the principle of manipulation.The physical changes in the fascial connective tissue caused by the manipulation,such as the deformation and displacement of the fascial tissue,can act on the nerve end receptors in the fascial layer and generate neural electrical signals;they can also activate the mechanoreceptors on the fascial cell membrane and convert mechanical signals into chemical signals via mechanosensitive ion channel transduction,triggering a physicochemical coupling response in the fascial microenvironment and producing mechanical stimulation through neuro-endocrine-immune system pathways.The"mechanical force of manipulation"in the fascia is transmitted through the meridian to facilitate the body's perception and transmission of mechanical stimulation signals,indicating that the fascia is the"sensor"of coupled response to the physicochemical information of mechanical stimulation of manipulation.
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Objective:To investigate and analyze the current status of health management (physical examination) service capabilities of medical institutions in Tianjin in 2021.Methods:It was a cross-sectional study. Using the census method, a questionnaire survey was conducted to obtain the health management (physical examination) service capabilities of 86 medical institutions in Tianjin in 2021. The questionnaire covered the basic information of the institution, human resources and equipment, physical examination items carried out, the annual number of people receiving physical examination, the degree of informatization, and the completion of quality control indicators. In this survey, a total of 86 questionnaires were distributed and 86 valid questionnaires were collected (100%). Mann-Whitney U test and χ2 test were used to compare the differences of health management (physical examination) indicators between public and private medical institutions, and to analyze the current health management (physical examination) service capabilities of medical institutions in Tianjin. Results:Among the 86 medical institutions included in the analysis, 53 (61.6%) were public institutions and 33 (38.4%) were private medical institutions. In terms of basic information, the proportion of comprehensive hospitals and level-3 medical institutions belonging to public institutions, as well as the time of health management (physical examination) business development, were significantly higher than those of private medical institutions [62.3% vs 30.3%, 62.3% vs 0, 11 (7, 5) years vs 7 (5, 10) years], and the proportion of independent setup of the physical examination center and the business area of health management (physical examination) were significantly lower than those of private institutions[33.3% vs 98.1%, 1 011 (600, 1 000) m 2 vs 2 000 (1 395, 2 782) m 2] (all P<0.05). In terms of practitioners, there were 2 964 health management (physical examination) practitioners in Tianjin in 2021, aged 43 (35, 56) years. The proportion of male practitioners, part-time practitioners, nurses, practitioners with intermediate professional title, chief inspection physician, health management specialist in public institutions and the time engaged in health management work of employees were all significantly higher than those in private medical institutions [20.6% vs 17.5%, 20.7% vs 8.1%, 33.8% vs 23.4%, 40.7% vs 27.3%, 7.1% vs 3.9%, 13.8% vs 4.7%, 6 (3, 11) years vs 5 (3, 8) years] (all P<0.05). In terms of business development, the implementation rates of preventive medical management, mental health management, hypertension risk management, health management contract service, pulmonary nodule management, health management intervention plan, health risk assessment, and health education programs in public institutions were significantly higher than those in private medical institutions (24.5% vs 0, 28.3% vs 0, 35.8% vs 15.2%, 39.6% vs 15.2%, 41.5% vs 12.1%, 50.9% vs 18.2%, 66.0% vs 36.4%, 83.0% vs 42.4%), and the annual health physical examination person-times, group and individual physical examination person-times in public institutions were significantly lower than those in private institutions [18 625 (11 844, 27 998) to 38 384 (10 832, 46 927), 14 818 (8 803, 23 915) to 28 663 (4 982, 41 927), 2 179 (1 221, 3 588) to 5 784 (1 461, 12 156)] (all P<0.05). Among the six quality control indicators of health examination, the completion rates of waist-hip circumference measurement in both types of institutions were low (<40%). Conclusion:Compared with public institutions, the talent echelon construction and service capability of health management (physical examination) in private medical institutions in Tianjin still needs to be improved.
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Hepatolithiasis is a common biliary tract disease in China and other Asian countries.It has insidious onset,recurrent disease,and may lead to biliary cirrhosis or even cancer in the late stage without inter-vention.At present,surgery is considered to be the best choice for treatment.In the 21st century of minimally inva-sive surgery,traditional procedures such as partial hepatectomy,choledochotomy,cholangioenterostomy and liver transplantation can be performed with the assistance of laparoscopy and da Vinci robots,and emerging endoscopic techniques such as endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic cho-ledochoscopic lithotripsy(PTCSL)have also been developed,bringing better treatment for patients with hepatoli-thiasis.As treatment options are becoming more varied,there are also some clinical problems that need to be addressed.In this article,we would like to briefly review the current surgical treatment modalities in order to provide a theoretical basis for optimizing the treatment modalities.
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Objective:To investigate the prevalence and related factors of chronic kidney disease (CKD).Methods:A total of 42 223 subjects who received annual physical examination from January to December 2019 were selected as the research objects, a cross-sectional study was conducted. They were divided into CKD patients and healthy control groups. The basic information of the subjects was collected by questionnaire, including age, sex, marital status, education level, smoking history, drinking history, physical exercise and previous disease history, etc. The height, weight, waist circumference and blood pressure of the subjects were measured through physical examination, and laboratory indicators including fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, blood uric acid, creatinine and urine routine were collected. The influencing factors of CKD were analyzed by logistic regression.Results:A total of 42 223 subjects were included in the study. The prevalence of CKD was 5.62%, with 7.77% in males and 3.39% in females. The prevalence of CKD increased with age. The prevalence of CKD was the highest in ≥80 years old (25.84%), followed by 70-79 years old (13.08%), the prevalence of CKD in males was higher than that in females in all age groups. Most of the detected CKD patients were in the early stage (stage 1-2), and the total prevalence of early CKD was 5.13%, and the total prevalence of stage 3-5 was 0.49%. Multivariate logistic regression analysis showed that age 70-79 years old ( OR: 1.63, 95% CI: 1.17-2.27),≥80 years old ( OR: 0.82, 95% CI: 2.61-5.91), male ( OR: 1.55, 95% CI: 2.61-5.91), high diastolic blood pressure ( OR: 1.014, 95% CI: 1.007-1.021), high fasting blood glucose level ( OR: 1.22, 95% CI: 1.17-1.27), SUA ( OR: 1.001, 95% CI: 1.000-1.002), hypertension ( OR: 1.44, 95% CI: 1.23-1.68), coronary heart disease ( OR: 1.36, 95% CI: 1.10-1.69) and stroke ( OR: 1.63, 95% CI: 1.09-2.43) were independent risk factors for CKD (all P<0.05); Physical activity 15-30 min/day ( OR: 0.81, 95% CI: 0.71-0.93),>60 min/day ( OR: 0.82, 95% CI: 0.70-0.96) was a protective factor for the prevalence of CKD (all P<0.05) Conclusion:The prevalence of CKD in the health check-up population is low, and most of them are in the early stage of the disease. The prevalence of CKD is related to male, old age, physical exercise, elevated diastolic blood pressure, elevated blood glucose, elevated blood uric acid, hypertension, coronary heart disease, and stroke.
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Objective:To observe the effect of Tuina(Chinese therapeutic massage)combined with functional training in improving clinical symptoms and balance function in patients with meniscus injury. Methods:A total of 93 patients with grade Ⅰ-Ⅱ meniscus injury were randomly divided into a functional training group,a Tuina group,and a combination group,with 31 cases in each group.The Tuina group received Tuina manipulation.The functional training group underwent functional training under the supervision of physicians.The combination group received Tuina manipulation in addition to the functional training.The treatment course of all three groups was 8 weeks.The clinical symptoms were observed before the intervention and after 4 and 8 weeks of interventions,and the changes in knee injury and osteoarthritis outcome score(KOOS)and Y-balance test(YBT)were compared. Results:There was no statistically significant difference in the total response rate among the three groups after treatment(P>0.05).The total and subscale KOOS in the three groups were significantly higher than those before treatment after 4 and 8 weeks of interventions(P<0.05).There was a statistically significant difference in the total KOOS between the combination group and the functional training group after 4 and 8 weeks of interventions(P<0.05);there was a statistically significant difference in the score of daily living ability and sports and recreation function between the two groups after 8 weeks of interventions(P<0.05).The YBT balance coefficients of the affected and non-affected knees of the three groups were significantly improved after 4 and 8 weeks of interventions(P<0.05),and there was no statistically significant difference among the groups(P>0.05). Conclusion:Tuina,functional training,and their combination can improve clinical symptoms and balance function in patients with grade Ⅰ-Ⅱ meniscus injury.Tuina combined with functional training is significantly effective in improving daily living ability and sports and recreation function.
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Objective@#To evaluate health risks of five heavy metals in drinking water of rural schools in Henan Province, so as to provide scientific basis for drinking water safety in rural schools.@*Methods@#Totally 1 269 drinking water samples were collected and analyzed for five heavy metals (As, Cd, Cr 6+ , Pb, Hg) concentration in 106 cities and counties of Henan Province, and its spatial distribution characteristics were explored by geographic information system (GIS). Risk assessment method recommended by the United States Environmental Protection Agency (U.S. EPA) was applied to evaluate health risks from five heavy metals through oral ingestion.@*Results@#The qualified rate of As concentration was 100%, and the qualified rates of Cd, Cr 6+ , Pb and Hg were 99.9% , 99.9%, 99.5%, 99.6%. The highest carcinogenic risk was As (3.05×10 -5 ), followed by Cr 6+ (2.73×10 -5 ), and the highest non carcinogenic risk was As (0.158 3), followed by Pb(0.041 7). The carcinogenic risk and non carcinogenic risk were all higher in girls than boys. The carcinogenic and non carcinogenic risks were differences in different regions( P <0.05).@*Conclusion@#Health risks of five heavy metals in drinking water for rural schools in Henan Province were within the acceptable risk level recommended by EPA. As, Cr 6+ and Pb were the main health risk factors in drinking water, and that might impact negatively the healthy growth of primary and middle school students. These should be future efforts of drinking water safety management.
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Malignant tumors of digestive system are highly prevalent malignant tumors that seriously threaten human health around the world. At present, the curative efficacy and prognosis of traditional treatment methods cannot reach the expectation, so it is urgent to find new targets for cancer treatment and realize targeted therapy for tumors. Abnormal energy metabolism in tumor cells is regarded as a hallmark of cancer, and malignant tumor cells absorb glucose through aerobic glycolysis pathway, and obtain a small amount of energy and produce lactate under the catalysis of a series of enzymes. Lactate dehydrogenase A (Lactate dehydrogenase A, LDHA), as a key enzyme in the aerobic glycolysis pathway of tumor cells, plays an important role in the metabolic changes of tumor cells. Studies have demonstrated that LDHA has high expression characteristics in a variety of tumor cells,and its high expression in clinic is often related to the poor prognosis and high metastasis rate of tumors, which is expected to be a new target for cancer therapy. This article reviews the role of LDHA in the development of digestive system tumors and the research progress of related drugs.
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Hepatocellular carcinoma (HCC) is considered to be one of the most aggressive tumors. It often occurs in patients with chronic liver disease and liver cirrhosis. Although research achievements have been attained in the current treatment methods, the opportunity of radical hepatectomy or transcatheter arterial chemoembolization has been lost due to the unobvious progression and no obvious symptoms until the late stage, which results in the poor prognosis. Tumor cells need more energy than normal cells. They maintain their growth, proliferation, and metastasis through metabolic reprogramming. Therefore, metabolic reprogramming is one of the signs of tumorigenesis. Glucose metabolism, lipid metabolism, amino acid metabolism, and nucleotide metabolism are several common cellular metabolism modes. Because the liver is the main organ of lipid metabolism, the occurrence and development of HCC is often accompanied by abnormal lipid metabolism. A variety of enzymes, proteins, genes, signaling pathways, and metabolites are involved in the lipid metabolism reprogramming of HCC. Their abnormal expression can promote lipid synthesis and lipid droplet accumulation through a variety of mechanisms, and further affect the proliferation, migration, invasion, autophagy, apoptosis, and angiogenesis of HCC cells. In recent years, traditional Chinese medicine (TCM) has demonstrated great potential in the treatment of tumors, which has attracted wide attention of scholars. The effective components in Chinese herbal medicines and Chinese medicine compound prescriptions can inhibit the de novo synthesis of lipids, lower the level of lipid accumulation, and then inhibit the occurrence and development of HCC by regulating the lipid metabolism-related enzymes, proteins, and signaling pathways. This review summarizes the mechanism of the factors regulating lipid metabolism in HCC and the research progress in the TCM inhibition of HCC by regulating lipid metabolism reprogramming, and makes an outlook on the application prospect of lipid metabolism as a new target of TCM in the treatment of HCC, aiming to provide reference for the clinical treatment of HCC.
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Liver fibrosis is a reversible pathological process caused by chronic liver damage and a major risk factor for hepatocellular carcinoma (HCC). Hepatic stellate cell (HSC) activation is considered the main target for liver fibrosis therapy. However, the efficiency of this strategy is limited due to the complex microenvironment of liver fibrosis, including excessive extracellular matrix (ECM) deposition and hypoxia-induced imbalanced ECM metabolism. Herein, nilotinib (NIL)-loaded hyaluronic acid (HA)-coated Ag@Pt nanotriangular nanozymes (APNH NTs) were developed to inhibit HSCs activation and remodel the microenvironment of liver fibrosis. APNH NTs efficiently eliminated intrahepatic reactive oxygen species (ROS) due to their inherent superoxide dismutase (SOD) and catalase (CAT) activities, thereby downregulating the expression of NADPH oxidase-4 (NOX-4) and inhibiting HSCs activation. Simultaneously, the oxygen produced by the APNH NTs further alleviated the hypoxic microenvironment. Importantly, the released NIL promoted collagen depletion by suppressing the expression of tissue inhibitor of metalloproteinase-1 (TIMP-1), thus synergistically remodeling the microenvironment of liver fibrosis. Notably, an in vivo study in CCl4-induced mice revealed that APNH NTs exhibited significant antifibrogenic effects without obvious long-term toxicity. Taken together, the data from this work suggest that treatment with the synthesized APNH NTs provides an enlightening strategy for remodeling the microenvironment of liver fibrosis with boosted antifibrogenic activity.
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Heart failure with preserved ejection fraction (HFpEF) is a syndrome with highly heterogeneous clinical symptoms, and its incidence has been increasing in recent years. Compared with heart failure with reduced ejection fraction (HFrEF), HFpEF has a worse prognosis. Traditional therapies targeting the internal mechanisms of the heart show limited or inefficacy on HFpEF, and new therapeutic targets for HFpEF are expected to be found by focusing on the extracardiac mechanisms. Recent studies have shown that cardiopulmonary pathophysiological interaction exacerbates the progression of HFpEF. Hypertension, systemic vascular injury, and inflammatory response lead to coronary microvascular dysfunction, myocardial hypertrophy, and coronary microvascular remodeling. Acute kidney injury affects myocardial energy production, induces oxidative stress and catabolism of myocardial protein, which leads to myocardial dysfunction. Liver fibrosis mediates heart injury by abnormal protein deposition and inflammatory factors production. Skeletal muscle interacts with the sympathetic nervous system by metabolic signals. It also produces muscle factors, jointly affecting cardiac function. Metabolic syndrome, gut microbiota dysbiosis, immune system diseases, and iron deficiency promote the occurrence and development of HFpEF through metabolic changes, oxidative stress, and inflammatory responses. Therefore, the research on the extracardiac mechanisms of HFpEF has certain implications for model construction, mechanism research, and treatment strategy formulation.
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Humans , Heart Failure/diagnosis , Stroke Volume/physiology , Myocardium/metabolism , Cardiomyopathies/metabolism , Hypertension , Ventricular Function, LeftABSTRACT
Objective:To investigate the imaging characteristics on contrast-enhanced ultrasound(CEUS)of carotid plaque instability and their correlation with histopathological changes in elderly patients.Methods:Twenty-three patients undergone carotid endarterectomy(CEA)at the Department of Neurosurgery of Beijing Hospital from June 2018 to November 2020 were retrospectively enrolled, including 27 males and 5 females, aging from 60 to 87(68.1±6.3)years.They were diagnosed with moderate to severe carotid artery stenosis(50%-99%)based on digital subtraction angiography(DSA).Carotid artery CEUS was conducted before surgery, and HE staining and CD34 immunohistochemical staining were used to record histopathological scores and microvessel density(MVD)counts.Results:The mean pathological score and MVD count were 2.46±0.66 and 37.17±12.88 for 32 cases with hypoechoic patterns, 22.42±0.55 and 38.06±13.66 for 18 cases with mixed echo patterns, and 2.75±0.35 and 23.50±9.192 for 2 cases with strong echo patterns, respectively.CEUS grading was positively correlated with histopathology score and MVD count( r=0.53、0.76, all P<0.01). Conclusions:Low echo and mixed echo plaques are more unstable than strong echo plaques.CEUS can be used to comprehensively assess the vulnerability of atherosclerotic plaques and to decide the optimal surgical time for patients with carotid atherosclerotic plaque stenosis.
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Objective:To investigate the relationship between wall shear stress (WSS) and the degree of lumen stenosis and plaque characteristics in patients with atherosclerotic stenosis in the middle brain.Methods:Thirty-four patients with moderate to severe unilateral middle cerebral artery stenosis in Nanjing First Hospital from June 2020 to June 2021 were analyzed retrospectively. All patients underwent routine magnetic resonance imaging and vascular wall imaging to obtain plaque parameters such as plaque area, remodeling mode and remodeling index. Based on magnetic resonance angiography, a computational fluid dynamics model was established to simulate the local hemodynamics near the lesion and quantify WSS. The patients were divided into high WSS group and low WSS group according to the median WSS. The differences of clinical baseline data, degree of lumen stenosis and plaque characteristics between the two groups were compared. Pearson correlation analysis was used to calculate the correlation between WSS and lumen stenosis and plaque characteristics.Results:A total of 34 patients were included in this study, 17 in the high WSS group and 17 in the low WSS group. Compared with the low WSS group, the plasma homocysteine level in the high WSS group was lower [(11.10±4.96) μmol/L vs (16.97±6.98) μmol/L, t=-2.83, P=0.010], the degree of stenosis was lower (0.56±0.05 vs 0.66±0.08, t=-4.54, P<0.001), and the proportion of positive lumen remodeling was higher (12/17 vs 4/17, P=0.015). Pearson correlation analysis showed that the degree of lumen stenosis was negatively correlated with WSS ( r=-0.44, P=0.011), and the plaque area was not correlated with WSS. Conclusions:WSS in middle cerebral artery stenosis is related to the degree of lumen stenosis and the mode of vascular remodeling. Higher WSS has poor stability, but lower WSS is more likely to cause lumen stenosis.
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Objective:To investigate the current situation of students' academic procrastination behavior in medical colleges and universities and its influencing factors, and to put forward suggestions to reduce the academic procrastination of medical students.Methods:A total of 1 327 undergraduate students from three medical colleges and universities in Heilongjiang Province were randomly selected to receive questionnaire investigation on life satisfaction, anxiety, and academic procrastination. SPSS 23.0 was used for data analysis.Results:①The total procrastination scores of medical students were (35.00±8.92) points. ②There were statistical differences in the academic procrastination of medical students with different genders, whether the only children, the reasons for choosing the major, and the level of achievement ( P < 0.05). There was no statistical difference in academic procrastination among medical students of different ages and grades ( P > 0.05). ③Medical students' procrastination was positively correlated with their anxiety level ( r = 0.102, P < 0.01), and negatively correlated with life satisfaction ( r = -0.117, P < 0.01). ④Regression analysis showed that the following six predictive variables including the level of achievement, gender, life satisfaction, anxiety, reasons for choosing the major, and whether the only children could effectively explain the variance of 14.2% academic procrastination of medical students. Conclusion:The overall degree of academic procrastination of medical students is higher than that of non-medical students. And the students' achievement level, gender, life satisfaction, anxiety, the reasons for choosing this major and whether the only child are the influencing factors of academic procrastination.
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Intracranial atherosclerotic lesions are a common cause of ischemic stroke. Hemodynamics plays an important role in the formation and development of atherosclerosis and the risk assessment of clinical ischemic stroke events. As an evaluation method of cerebral hemodynamics, computational fluid dynamics can intuitively obtain hemodynamic parameters and provide valuable information for clinical diagnosis and treatment. This article reviews the application progress of computational fluid dynamics in evaluating peripheral hemodynamics of intracranial atherosclerotic lesions.
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Objective:To observe the effect of the cortical blood perfusion parameter of wash-in area under curve (iAUC) with contrast-enhanced ultrasound(CEUS) on the effect of short-term outcomes of stent implantation in patients with severe renal artery stenosis (RAS).Methods:Retrospective analysis was performed on 82 patients with unilateral severe RAS who received stent implantation in Beijing Hospital from October 2017 to December 2019. According to the baseline iAUC before CEUS, all patients were divided into the poorly-perfused group (iAUC<850.0 dB×s) (37 cases) and the well-perfused group (iAUC≥850.0 dB×s) (45 cases). Baseline and perioperative clinical-imaging data were analyzed between the two groups. Followed up for 10-12 (11.5±1.7) months, Kaplan-Meier survival curves and Log-rank test were used to analyze the rate of adverse cardiac and renal vascular events and hypertension control rates.Results:Compared with the well-perfused group, the poorly-perfused group showed a longer course of hypertension, more diabetic patients, higher systolic blood pressure, diastolic blood pressure, 24 h average systolic blood pressure, and 24 h average diastolic blood pressure, lower glomerular filtration rate, and severe renal artery stenosis. Besides, the iAUC, wash-out AUC and the peak intensity were lower, the average transit time was longer, and the hypoglycemic treatment rate was higher (all P<0.05). Kaplan-Meier survival curve and Log-rank test analysis showed that the occurrence of cardio-renal vascular events ( HR=0.361, 95% CI=0.144-0.907, P=0.012) and renal function deterioration rate ( HR=0.286, 95% CI=0.090-0.914, P=0.035) in the well-perfused group were significantly lower than those in the poorly-perfused group. The blood pressure results demonstrated that the effective rate of hypertension treatment in the well-perfused group was significantly higher than that in the poorly-perfused group (93.3% vs 59.5%, P<0.001), but the improvement rate of hypertension (60.0% vs 43.2%) and cure rate (28.9% vs 16.2%) were not statistically significant between the two groups(all P>0.05). Conclusions:Severe RAS patients with decreased baseline iAUC often have diabetes, longer duration of hypertension, significantly reduced glomerular filtration rate and more severe RAS, short-term outcomes are worse with stent implantation.
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Objective:To evaluate the effect of deep learning based on DWI and fluid attenuated inversion recovery (FLAIR) to construct a prediction model of the onset time in acute stroke.Methods:A total of 324 cases of acute stroke with clear onset time, from January 2017 to May 2020 in Nanjing First Hospital, were retrospectively enrolled and analyzed. The patients were divided into a training set of 226 patients and a test set of 98 patients according to the complete randomization method using a 7∶3 ratio, and the patients were divided into ≤ 4.5 h and >4.5 h according to symptom onset time in each group. The acute infarction areas on DWI and the corresponding high signal area on FLAIR were manually outlined by physician. Using the InceptionV3 model as the basic model for image features extraction, the deep learning prediction model based on single sequence (DWI, FLAIR) and multi sequences (DWI+FLAIR) were established and verified. Then the area under curve (AUC), accuracy of human readings, single sequence model and multi sequence model in predicting the acute stroke onset time from imaging were compared.Results:DWI-FLAIR mismatch was found in 94 cases (94/207) of patients with symptom onset time from imaging ≤ 4.5 h, while in 28 cases (28/117) of patients with symptom onset time from imaging >4.5 h. ROC analysis showed that the AUC of DWI-FLAIR mismatch in predicting acute stroke onset time from imaging was 0.607, and the accuracy was 60.2%. The prediction model of deep learning based on single sequence showed that the AUC of FLAIR was 0.761 and the accuracy was 71.4%; the AUC of DWI was 0.836 and the accuracy was 81.6%. The AUC of predicting stroke onset time based on the multi-sequence (DWI+FLAIR) deep learning model was 0.852, which was significantly better than that of manual identification ( Z = 0.617, P = 0.002), FLAIR sequence deep learning model ( Z = 2.133, P = 0.006) and DWI sequence deep learning model ( Z = 1.846, P = 0.012). Conclusion:The deep learning model based on DWI and FLAIR is superior to human readings in predicting acute stroke onset time from imaging, which could provide guidance for intravenous thrombolytic therapy for acute stroke patients with unknown onset time.
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Objective:To establish and validate a prognostic model of a contrast-enhanced ultrasound scoring(CEUS)system for evaluating renal artery stenosis(RAS)in the elderly.Methods:This was a single-center retrospective study.A total of 324 elderly RAS patients admitted to Beijing Hospital from October 2017 to July 2020 were randomly assigned into the model group(n=174)and the validation group(150)in a 1∶1 ratio.Clinical and imaging data of patients on admission including general conditions, previous medical history, blood pressure, blood creatinine, renal artery stenosis and cortical blood perfusion in the affected kidney and renal function(GFR)at 1-year follow-up were collected.Univariate and multivariate logistic regression was used to establish a model of the CEUS scoring system.The receiver operating characteristic(ROC)curve and area under the ROC curve(AUC)were used to evaluate prediction accuracy.Clinical application value of the CEUS scoring system model was evaluated via decision curve analysis using a nomogram.Results:Baseline clinical and radiomic data had no significant difference between the model group and the validation group( P>0.05). Multivariate logistic regression analysis results showed that age( OR=1.242, 95% CI: 1.081-1.427, P<0.01), diabetes( OR=1.545, 95% CI: 1.107-2.156, P<0.05), blood pressure( OR=1.328, 95% CI: 1.056-1.670, P<0.05), renal function( OR=2.374, 95% CI: 1.216-3.887, P<0.01)and cortical blood perfusion parameter( OR=2.646, 95% CI: 1.553-6.369, P<0.01)were risk factors for the deterioration of renal function during 1 year follow-up.Based on these results, a nomogram for the CEUS scoring system model was drawn, and its consistency index, the C-Index, was 0.725(95% CI: 0.653-0.776). The AUC of the CEUS scoring system was 0.824 and the Youden index was 0.711 in the model group, with a specificity of 0.774 and a sensitivity of 0.837.The AUC of the CEUS scoring system was 0.853 and the Youden index was 0.715 in the validation group, with a specificity of 0.684 and a sensitivity of 0.889.There was no significant difference in ROC curve between the two groups( D=1.387, P>0.05). In addition, calibration charts of the two models showed that the calibration curve of the CEUS scoring system was close to the standard curve, with no statistically significant difference( P>0.05). Conclusions:The CEUS scoring system model can be used to predict the risk of worsening renal function in elderly RAS patients during 1-year follow-up.
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BACKGROUNDTreatment of severe Corona Virus Disease 2019 (COVID-19) is challenging. We performed a phase 2 trial to assess the efficacy and safety of human umbilical cord-mesenchymal stem cells (UC-MSCs) to treat severe COVID-19 patients with lung damage, based on our phase 1 data. METHODSIn this randomized, double-blind, and placebo-controlled trial, we recruited 101 severe COVID-19 patients with lung damage. They were randomly assigned to receive either UC-MSCs (4 x 107 cells per infusion) or placebo on day 0, 3, and 6. The primary endpoint was an altered proportion of whole lung lesion volumes from baseline to day 28. Other imaging outcomes, 6-minute walk test, maximum vital capacity, diffusing capacity, and adverse events were recorded and analysed. RESULTS100 COVID-19 patients were finally recruited to receive either UC-MSCs (n = 65) or placebo (n = 35). UC-MSCs administration exerted numerical improvement in whole lung lesion volume from baseline to day 28 compared with the placebo (the median difference was -13.31%, 95%CI -29.14%, 2.13%, P=0.080). UC-MSCs significantly reduced the proportions of solid component lesion volume compared with the placebo (median difference: -15.45%; 95% CI -30.82%, -0.39%; P=0.043). The 6-minute walk test showed an increased distance in patients treated with UC-MSCs (difference: 27.00 m; 95% CI 0.00, 57.00; P=0.057). The incidence of adverse events was similar in the two groups. CONCLUSIONSUC-MSCs treatment is a safe and potentially effective therapeutic approach for COVID-19 patients with lung damage. (Funded by The National Key R&D Program of China and others. ClinicalTrials.gov number, NCT04288102.)
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By April 28, 2020, the global pandemic of COVID-19 has resulted in over 3 million infections and more than 200, 000 deaths. As the epidemic of COVID-19 has been basically controlled in China, the asymptomatic infection becomes one of most serious challenges for "External defense input, internal defense rebound" currently. Studies have shown that patients with asymptomatic infections are highly contagious in the early stage, most of whom are in the pre-symptomatic stage. Children and pregnant women have a higher incidence of asymptomatic infections, but the impacts are not yet clear. This article reviews the definition, epidemiological characteristics, contagiousness, viral shedding and cause of persistent positive nucleic acid in asymptomatic patients. Active detection of nucleic acids and antibodies and timely diagnosis and treatment of asymptomatic cases are the critical issues for the prevention and control of COVID-19.
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Objective:To summarize the echocardiography and pathological features of fetal Kabuki syndrome.Methods:This study retrospectively analyzed the echocardiography and pathological features of seven fetuses with KMT2D pathogenic variants confirmed by copy number variation sequencing, and who were identified as complex congenital heart disease by fetal echocardiography, at Beijing Anzhen Hospital, Capital Medical University and other multi-center collaborative hospitals on fetal congenital heart diseases from January 2013 to May 2018. All the seven fetuses were artificially aborted. Descriptive statistics were used for data analysis. Results:(1) The seven pregnant women aged 29 (27-32) years and had an abortion at 23 (22-25) gestational weeks. There were three male and four female fetuses. (2) Pathogenic mutations in KMT2D gene were detected in all seven cases, including one nonsense mutation and six frameshift mutations. (3) All fetuses had left heart obstruction with or without aortic arch dysplasia/interruption of the aortic arch. There were three with hypoplastic left heart syndrome, two with a single ventricle, one with aortic atresia, and one with severe mitral valve dysplasia. Other cardiovascular abnormalities included aortic arch branch abnormalities, double-outlet of the right ventricle, ventricular septal defect, tricuspid atresia, pulmonary valve stenosis (nearly atresia) complicated by pulmonary dysplasia, persistent left superior vena cava, and patent or closed foramen ovale. Secondary changes included enlargement of the right atrium and right ventricle, and dilatation of the pulmonary artery or ductus arteriosus. (4) Four of the seven fetuses showed multiple extracardiac system abnormalities, including facial deformities (two cases), pulmonary dysplasia (two cases), digestive abnormalities(two cases), and urogenital system abnormalities (two cases). Conclusions:The main features of echocardiography for fetal Kabuki syndrome are left heart obstruction, often complicated by other congenital cardiovascular abnormalities.