Efficacy observation of daratumumab-combination regimens for newly diagnosed multiple myeloma / 白血病·淋巴瘤

Objective:To investigate the efficacy and safety of daratumumab (Dara) - combination regimens for newly diagnosed multiple myeloma (NDMM).Methods:A retrospective case series study was conducted. The clinical data of 34 patients with NDMM receiving treatment regimen including Dara from Qilu Hospital of Shandong University, Yantai Yuhuangding Hospital, Huangdao Branch of Affiliated Hospital of Qingdao University and Taian City Central Hospital between April 2020 and March 2022 were retrospectively collected. The efficacy, survival and adverse reactions of patients were analyzed. Cox proportional risk model was used to analyze the factors affecting overall survival (OS) and minimal residual disease (MRD) turning negative.Results:Among 34 patients with NDMM, there were 19 males and 15 females, with 21 cases aged < 65 years and 13 cases aged ≥65 years. The median follow-up duration [ M ( Q1, Q3)] was 22 months (19 months, 26 months), the median of Dara treatment cycles was 7 (5, 11), and the overall response rate (ORR) reached 97.1% (33/34). There were statistically significant differences in the optimal efficacy of patients stratified by receiving hematopoietic stem cell transplantation or not and receiving different treatment cycles (all P ≤ 0.05), while there were no statistically significant differences in patients stratified by other clinical features (all P > 0.05). The 1-year progression-free survival rate was 79.4% and the 1-year OS rate was 94.1%. Multivariate Cox regression analysis showed that the cycle number of treatment regimens containing Dara was an independent influencing factor of MRD turning negative (6 cycles vs. 2 cycles, HR = 0.267, 95% CI: 0.076-0.935, P = 0.039); age ≥ 65 years was an independent risk factor for OS ( HR = 35.313, 95% CI: 1.709-729.669, P = 0.021). The incidence of hematological adverse reactions grade 3 or above was 20.6% (7/34), and the non-hematological adverse reactions primarily included infection [44.1% (15/34)] and edema of extremity and trunk [41.2% (14/34)]. Conclusions:The Dara-based regimens for NDMM exhibit a high ORR. The remission depth accelerated with the increasing number of treatment cycle, and the adverse reactions are mild.

Study on the therapeutic effect of different magnetic stimulation pelvic floor modes on perimenopausal myofascial pelvic pain syndrome / 重庆医学

Objective To investigate the clinical effect of different magnetic stimulation pelvic floor modes in the treatment of perimenopausal myofascial pelvic pain syndrome(MPSS).Methods A total of 60 perimenopausal women who were clinically diagnosed with MPSS in the hospital from May 2022 to May 2023 were selected as the research objects.They were divided into groups A,B and C by random number table method,with 20 cases in each group.All patients in the three groups were treated with pelvic floor myofascial manual release.Group A was given pelvic floor magnetic stimulation(alternating 10 Hz and 50 Hz),group B was given sacral nerve root magnetic stimulation(50 Hz),and group C was given pelvic floor magnetic stimu-lation combined with sacral nerve root magnetic stimulation at the same time.The three groups were treated twice a week for eight weeks.Visual analogue scale(VAS)was used to evaluate the degree of pelvic floor myofascial tenderness before and after treatment,and Glazer pelvic floor surface electromyography was used to evaluate pelvic floor muscle function.Results Compared with before treatment,the VAS scores of subjec-tive pain and pelvic floor myofascial tenderness in the three groups were decreased after treatment,and the differences were statistically significant(P<0.05).Compared with group A and group B,the VAS score of subjective pain and the VAS score of pelvic floor myofascial tenderness in group C were significantly decreased after treatment,and the differences were statistically significant(P<0.05).Compared with before treatment,the average amplitude and coefficient of variation(CV)of pre-rest potential and post-rest potential in the three groups were decreased after treatment,and the differences were statistically significant(P<0.05).Compared with before treatment,only the maximum amplitude of rapid contraction,the average amplitude of 10 s sustained contraction and 60 s sustained contraction and CV in group C were improved,and the differ-ences were statistically significant(P<0.05).Compared with group A and group B,the average amplitude and CV of pre-resting potential and post-resting potential in group C were decreased after treatment,the maxi-mum amplitude of rapid contraction and the average amplitude and CV of 10 s continuous contraction and 60 s persistent contraction were improved,and the differences were statistically significant(P<0.05).Conclusion Dif-ferent magnetic stimulation pelvic floor modes can effectively relieve pain and improve pelvic floor muscle strength in the treatment of perimenopausal MPSS,and the effect of pelvic floor magnetic stimulation com-bined with sacral nerve root magnetic stimulation is the best.

Advances in the Treatment of Carbapenem-Resistant Enterobacteriaceae Infection / 医药导报

With the continuous development of medical science and the widespread use of antibiotics,the problem of bacterial resistance is increasing,especially the increasing carbapenem-resistant Enterobacteriaceae(CRE)infection,and the high mortality rate,which brings great challenges to clinical treatment.In this paper,the mechanism of drug resistance,existing antibac-terial drugs,and exploratory treatment options for CRE are reviewed,and the research progress in treating CRE infection is dis-cussed to provide more reliable evidence and a theoretical basis for clinical practice.

Clinical characteristics analysis of multiple clustered polyps in the ileocecal region(9 cases) / 中国内镜杂志

Objective To analyze the etiology and clinical characteristics of multiple clustered polyps in the ileocecal region.Methods Nine patients with multiple clustered polyps only in the ileocecal region found from 2017 to 2022 were retrospectively collected,and their etiology and clinical characteristics were analyzed.Results There were 9 patients with multiple clustered polyps in the ileocecal region in this group.There were 7 males and 2 females.The age of onset was 28～73 years old,52(40.0,62.5)years old.There were 8 cases of abdominal discomfort or abdominal pain,4 cases of chronic diarrhea,2 cases of mucous stool and 1 case of dry stool.The number of polyps ranged from 4～17,and the diameter of polyps ranged from 0.2～1.0 cm.Pathological examination showed chronic inflammation of ileocecal mucosa with polyp formation in 8 cases,and canalicular adenoma with mild dysplasia in 1 case.7 cases ate more red meat food or processed products.6 cases had repeat colonoscopy,and 3 cases had recurrence.Conclusion Multiple clustered polyps appearing only in the ileocecal region are a special type of polyps closely related to inflammation,and endoscopic surgery is recommended followed by attention to control inflammation.

Clinical features of Guillain-Barré syndrome with positive anti sulfatide antibody in CSF and hyponatremia(report of one case) / 临床神经病学杂志

Objective To summarize the diagnosis and treatment experience of patients with Guillain-Barré syndrome(GBS)with positive anti sulfatide antibody in CSF.Methods The clinical data of a case of patient with GBS with positive anti sulfatide antibody in CSF in Department of Neurology,The Affiliated Brain Hospital of Nanjing Medical University in January,2023 were retrospectively analyzed,and the relevant literatures were reviewed.Results Two cases with GBS with positive anti sulfatide antibody in CSF from 2 literatures were retrieved,a total of 3 cases were retrieved.All cases were males.The onset duration was 4-6 d.Two patients with GBS with positive anti-sufatide antibody in CSF developed limb weakness,severe back and limb pain.Albuminocytologic dissociation in CSF and inefficacy of immunoglobin were found in the two cases.Severe hyponatremia secondary to intravenous immunoglobin was observed in our case.One patient presented with cranial nerve damage with mild elevation of CSF protein and improvement after immunoglobulin.Conclusion The plasmapheresis was recommended for the patients presenting with limb weakness with positive anti-sulfatide antibody in CSF in order to prevent inefficacy and severe hyponatremia secondary to intravenous immunoglobin.

Trans-fatty acid content in edible vegetable oil under different high temperatures / 上海预防医学

ObjectiveAn experimental method was established to determine the level of trans-fatty acids in edible vegetable oil and the changes of trans-fatty acid content during high-temperature simulated cooking. MethodsFour common edible vegetable oils on the market were selected， and three temperature points were set at 180 ℃ （light stir-fry）， 220 ℃ （fry） and 260 ℃ （stir fry）. The samples were taken after the heat treatment of 0， 1， 2， 3， 4， 5， 6 and 7 hours，respectively， to investigate the changes of trans-fatty acid content. ResultsUnder the heat treatment of 180 ℃ and 220 ℃， the content of trans-fatty acids remained basically stable in rapeseed oil， corn oil， soybean oil and olive oil. Under the heating condition of 260 ℃， the content of trans-fatty acids in these four vegetable oils increased significantly， and the absolute content of trans-fatty acids in rapeseed oil was the highest， reaching 6.84%. Soybean oil showed the larger increase， up to 247.90% from the initial content. The content of trans-fatty acids in olive oil increased from 0.26% to 1.69%， although the increase was large， but the absolute content of trans-fatty acids was still low. The content of trans-fatty acids in sesame oil increased significantly under the three temperatures， reaching 4.79% when heated at 260 ℃， and an increase of 369.61% compared with no heating. ConclusionTrans-fatty acid content in edible vegetable oils increases significantly in the cooking process， the higher the temperature and the longer the cooking time， the more significant the increase. It is recommended to avoid high temperature cooking and long time fried food.

Expression of long non-coding RNA MTATP6P1 in melanoma and its effect on melanoma cell proliferation, migration and invasion by targeting miRNA-411-5p / 肿瘤研究与临床

Objective:To investigate the expression of long non-coding RNA (lncRNA) MTATP6P1 in melanoma and its effect on the proliferation, migration and invasion of melanoma cells by targeting miRNA-411-5p (miR-411-5p).Methods:A total of 461 samples of melanoma tissues and paracancerous tissues (>2 cm from the tumor margin) were collected from the tumor-associated lncRNA database (TANRIC database updated in July 2021), and the expression of MTATP6P1 was compared between the two groups. The bioinformatics software lncRNA Disease v2.0 was used to predict the possible binding site microRNA (miRNA) of MTATP6P1. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to detect the relative expression level of MTATP6P1 in melanoma cells A-375, WM266-4, VMM5A, A2058 and normal human epidermal melanocytes PIG1; and the lowest relative expression level of cells in MTATP6P1 were divided into MTATP6P1 group (transfected with MTATP6P1 overexpression plasmid) and NC group (transfected with blank plasmid). The proliferation ability of A-375 cells was detected by using CCK-8 method; the migration ability of A-375 cells was detected by using scratch test; the invasion ability of A-375 cells was detected by using Transwell assay; the targeting relationship between MTATP6P1 and miR-411-5p was detected by using dual luciferase reporter gene assay; Western blot was used to detect the expression of ERK signaling pathway related proteins in cells.Results:The relative expression levels of MTATP6P1 in melanoma tissues and adjacent tissues were 9.82±0.58 and 11.56±0.16, respectively. The expression level of MTATP6P1 in melanoma tissues was lower than that in paracancerous tissues ( t = 9.56, P = 0.009). The relative expression levels of MTATP6P1 in normal human epidermal melanocyte PIG1 and melanoma cells A-375, WM266-4, VMM5A, and A2058 were 1.01±0.13, 0.12±0.02, 0.66±0.04, 0.39±0.07, 0.49±0.05; the relative expression level of MTATP6P1 in melanoma cells was lower than that in PIG1 cells (all P < 0.05), and then A-375 cells with the lowest relative expression level were taken to perform the subsequent experiments. The relative expression levels of MTATP6P1 in A-375 cells of MTATP6P1 group and NC group were 14.83±1.67 and 1.02±0.30, respectively ( t = 8.13, P < 0.001). After 16, 24, 32, and 40 h of culture, the proliferation ability of the cells in the MTATP6P1 group was lower than that in NC group (all P < 0.05). The scratch healing rates of A-375 cells in MTATP6P1 group and NC group were (26±7)% and (55±4)%, respectively; the scratch healing rate in MTATP6P1 group was lower than that in NC group ( t = 3.48, P = 0.009). The invasive number of A-375 cells in MTATP6P1 group and NC group were (32±12) and (116±17), respectively; the number of invasive cells in MTATP6P1 group was lower than that in NC group ( t = 4.11, P = 0.006). The results of dual luciferase reporter gene assay showed that there was a targeting relationship between MTATP6P1 and miR-411-5p. The relative expression level of miR-411-5p in A-375 cells of MTATP6P1 group and NC group was 1.04±0.16 and 5.37±0.68, respectively; the expression level of miR-411-5p in MTATP6P1 group was lower than that in NC group ( t = 6.20, P < 0.001). The expressions of ERK signaling pathway proteins p-Ras, p-Raf, p-MEK1, p-RSK, and AP-1 in A-375 cells of MTATP6P1 group were lower than those in NC group. Conclusions:MTATP6P1 inhibits the proliferation, migration and invasion of melanoma A-375 cells through targeting miR-411-5p.

Cigarette Smoke or Motor Vehicle Exhaust Exposure Induces PD-L1 Upregulation in Lung Epithelial Cells in COPD Model Rats.

A high smoking-independent chronic obstructive pulmonary disease (COPD) prevalence is observed in lung cancer patients. However, the underlying connection between these two diseases still remains unclear. Cigarette smoking and ambient air pollution are common risk factors for COPD and lung cancer. In this study, we established rat COPD model through exposure to cigarette smoke (CS) or motor vehicle exhaust (MVE). The model rats developed COPD-like phenotypes, manifested as lung functions decline, lung inflammation, emphysema-like alveolar enlargement and airway remodeling. The programmed death-ligand 1 (PD-L1), a factor contributing to immune escape of tumor cells, was overexpressed in lungs from COPD model rats, though more severe COPD phenotypes did not bring with further PD-L1 overexpression in lung. The upregulations of proinflammatory cytokines and PD-L1 were also observed in cultured human bronchial epithelial cells BEAS-2B upon treatment with cigarette smoke extract (CSE) or diesel-related particulate matter 2.5 (PM2.5, SEM1650b). The inflammatory cytokines produced in BEAS-2B cells reflected the PD-L1 levels. Furthermore, ERK1/2, a kinase mediating PD-L1 upregulation in premalignant bronchial cells or NSCLC cells, and STAT1/3, which was reportedly associated with PD-L1 expression in lung tumors, were activated in COPD rats' lungs or in BEAS-2B cells treated with CSE or PM2.5. Therefore, we proposed that inflammation associated PD-L1 overexpression in airway epithelial cells could be the underlying factor facilitating lung cancer incidence in COPD.

Induction of neutralizing antibodies against SARS-CoV-2 variants by a multivalent mRNA-lipid nanoparticle vaccine encoding SARS-CoV-2/SARS-CoV Spike protein receptor-binding domains

To address the need for multivalent vaccines against Coronaviridae that can be rapidly developed and manufactured, we compared antibody responses against SARS-CoV, SARS-CoV-2, and several variants of concern in mice immunized with mRNA-lipid nanoparticle vaccines encoding homodimers or heterodimers of SARS-CoV/SARS-CoV-2 receptor-binding domains. All vaccine constructs induced robust anti-viral antibody responses, and the heterodimeric vaccine elicited an IgG response capable of cross-neutralizing SARS-CoV, SARS-CoV-2 Wuhan-Hu-1, B.1.351 (beta), and B.1.617.2 (delta) variants.

Construction of training system for first aid ability of nurses in Head and Neck Oncology Department / 中国实用护理杂志

Objective:To develop a training system for head and neck oncology nurses to improve the emergency response competency to recognize and response to acute and critical medical conditions.Methods:Based on literature review and semi-structured interviews with 12 nurses, two rounds of consultation with 15 head and neck cancer care specialists from 6 Tertiary hospitals using Delphi method were conducted to establish the training system for head and neck oncology nurses.Results:The authority coefficients of experts were 0.87 and 0.89, respectively. The coefficient of variation of each item ranged from 0 to 0.167. The coefficients of concordance ranged from 0.243 to 0.403 ( P<0.01). There was statistical significance after Chi-square test ( χ2 values were 14.60-436.64, all P<0.01). In the final training system, training aims included 5 first-level indicators and 16 second-level indicators; training contents included 5 first-level indicators, 16 second-level indicators, and 60 third-level indicators. Conclusions:The authority coefficients and the coefficients of concordance of the experts for the training system were both high. The training system can be applied to improve the emergency response competency of head and neck oncology nurses.

Predictive value of mNUTRIC score for chronic critical illness in elderly patients with sepsis / 中华急诊医学杂志

Objective:To explore the predictive value of the modified NUTrition risk in the critically ill (mNUTRIC) score for chronic critical illness (CCI) in elderly sepsis patients.Methods:A prospective observational study was conducted. Elderly sepsis patients admitted to Medical Intensive Care Unit (MICU) of General Hospital of Southern Theatre Command for more than 24 h from August 2019 to January 2021 were enrolled. Age, sex, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, acute gastrointestinal injury (AGI) score, clinical frailty score and mNUTRIC score at admission, length of ICU stay, usage of mechanical ventilation and renal replacement therapy were recorded. According to the occurrence of CCI, patients were divided into the CCI group and rapid recovery (RAP) group, and the differences between the two groups were compared. The risk factor of CCI after sepsis in elderly patients were analyzed by log-binomial regression analysis. Receiver operating characteristic (ROC) analysis was performed for mNUTRIC score. Differences were considered significant at P<0.05. Results:Of the enrolled 91 sepsis patients, 14 (15%) patients died within the first week, 37 (41%) exhibited RAP and 40 (44%) developed CCI. The CCI patients were significantly older and presented a higher APACHE Ⅱ score, CFS score, mNUTRIC score, and usage of mechanical ventilation and renal replacement therapy compared with the RAP patients ( P<0.05). Multivariate regression analysis revealed that mNUTRIC score was an independent risk factor for the development of CCI in elderly sepsis patients, prevalence ratio was 1.503 (95% CI: 1.007-2.244). The area under the curve (AUC) of mNUTRIC score was 0.706 (95% CI: 0.592-0.805). Conclusions:The mNUTRIC score at the time of admission in the intensive care unit can be used to predict CCI after sepsis in elderly sepsis patients.

Nodal marginal zone lymphoma with elevated monoclonal IgM: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the clinicopathological features, diagnosis, differential diagnosis and treatment of nodal marginal zone lymphoma (NMZL) with elevated monoclonal IgM.Methods:The clinical data of one NMZL patient with elevated monoclonal IgM treated at Yancheng No.1 People's Hospital in July 2020 were retrospectively analyzed, and the related literature was analyzed.Results:The patient was a 57-year-old female and the main clinical manifestations were fatigue and bone pain in left rib. Serum immunofixation electrophoresis showed IgM-κ type M proteinemia, bone marrow cytology showed a few plasmacytoid lymphocytes, bone marrow biopsy and immunohistochemistry showed B-cell non-Hodgkin lymphoma, bone marrow genetic testing showed MYD88 L265p and CXCR4 were both negative, postoperative pathology result of retroperitoneal lymph node biopsy was marginal zone lymphoma (mature small B type, prone to NMZL),and immunohistochemistry results: CD3, CD5, CD138, κ, λ, CD10, Cyclin D1 were negative, CD20, Pax-5, CD23 (FDC), bcl-2 were positive; Ki-67 positive index < 5%. The final diagnosis was NMZL with elevated monoclonal IgM. Partial remission was achieved after 8 cycles of reduced-dose CHOP regimen; thalidomide was used in the maintenance treatment, the disease condition was stable until August in 2021 and the follow-up was continuing.Conclusions:NMZL with elevated monoclonal IgM is relatively rare. Its diagnosis should be differentiated from Waldenstr?m macroglobulinemia and other inert B-cell lymphomas. Currently, there is no standard treatment and following the principle of individualized treatment can improve the prognosis of patients.

Microecological characteristics of different types of vaginitis and their correlation with HPV infection / 国际生物医学工程杂志

Objective:To retrospectively analyze the relationship between different types of vaginal infection, vaginal microecology, and human papillomavirus (HPV) infection.Methods:A retrospective analysis of 6056 patients who underwent vaginal microecology examination was performed, and patients with vaginal infection or HPV detection were screened out. The detection rates of various types of vaginal infection, HPV infection, and infection in different age groups were calculated.Results:A total of 2 737(45.2%) vaginal infection patients were screened, with 7 types of vaginal infection covered. The top three detection rates of vaginal infection were bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and aerobic vaginal infection (AV). In 6056 patients, 1843 patients underwent HPV detection, among which the top three positive rates of HPV were BV, mixed infection, and VVC. The first three cases of vaginal infection with high-risk HPV infection were BV, mixed infection, and BV intermediate type. The age distribution of different types of vaginal infection combined with HPV infection was different, and the age at which it occurred and the trend of change with age were obvious.Conclusions:BV is closely related to HPV infection. It is suggested that HPV detection should be performed simultaneously in BV patients with vaginal infection, especially those aged 30 to 40 years, which has important clinical significance for HPV screening and prevention.

Externalizing Behavior Problems Among Hui Ethnicity Left-Behind Children in Rural China: A Cross-Sectional Study

Objective@#This study aimed to investigate the prevalence of externalizing behavior problems (EBPs) and its influencing factors among Hui left-behind children (LBC) in rural China. @*Methods@#A cross-sectional study was conducted among school students from the southern rural areas in Ningxia, China (2012–2013). The general self-made questionnaire, Egma Minnen av Bardndosna Uppforstran, Eysenck Personality Questionnaire (for Children), Piers-Harris Children’s Self-Concept Scale, and Achenbach’s Child Behavior Checklist (for parents) were used to investigate the related information. Binary logistic regressions were conducted. @*Results@#The prevalence of EBPs in boys Hui LBC was significantly higher than that of non-LBC (12.37% vs. 6.84%, χ2=4.09, and p=0.04). Multivariate logistic regression analysis showed that low self-awareness of behavior (odds ratio [OR]=29.78), introversion (OR=21.67) and intermediate personality (OR=15.83), poor academic performance (OR=11.65) and both parent migrating (OR=2.73) were the risk factors for the EBPs of Hui LBC, while middle and high father refusal and denial (OR=0.11, OR=0.09) were their protective factors. @*Conclusion@#Our findings suggest that both parent migrating is a potential risk factor for EBPs among Hui LBC. Hui boys LBC should be paid more attention when formulating relevant policies.

Clinicopathological characteristics and prognosis of gastrointestinal vascular tumours.

To evaluate the clinicopathological characteristics and prognosis of gastrointestinal vascular tumours. By reviewing the information from the electronic medical record system and pathology database of Hangzhou First People's Hospital affiliated with Zhejiang University School of Medicine and Jiaxing First People's Hospital from June 2008 to December 2019, 31 patients pathologically diagnosed with vascular tumours were included in this study. The age of onset, sex differences, clinical manifestations, imaging and endoscopic characteristic manifestations, pathological characteristics, treatment methods and prognosis were analysed. The pathological classification was haemangiolymphangioma, haemangioma, and lymphangioma in 8, 14, and 9 cases, respectively. The age of onset was 44-66 years, with no significant difference according to sex (P = 0.583); 32.26% (10/31) of patients had no noticeable symptoms, 37.5% (12/31) of patients had gastrointestinal bleeding, and 6.45% (2/31) of patients, all with lymphangioma, had intestinal obstruction. The lesions were located in and below the duodenum. Endoscopy showed colour differences. Both endoscopic and surgical treatments were safe and effective. The mean survival time was 57.06 ± 35.64 months. Regarding vascular tumours without typical symptoms, the main pathological classification is haemangioma. Vascular tumours are often clinically identified because of bleeding or obstruction and can be treated with endoscopy or surgery. Clinical follow-up is recommended because no invasive manifestations or instances of recurrence were observed.

A 180-day mortality predictive score based on frailty syndrome in elderly patients with sepsis: a Logistic regression analysis model / 中华危重病急救医学

Objective:To establish a 180-day mortality predictive score based on frailty syndrome in elderly sepsis patients [elderly sepsis score (ESS)].Methods:A prospective study for sepsis patients aged 60 years and above who were admitted to a medical intensive care unit of the General Hospital of Southern Theatre Command from January 1st, 2018 to December 31st, 2018 was conducted. Univariate analysis was performed on 19 independent variables including gender, age, body mass index (BMI), tumor, charlson comorbidity index (CCI), activity of daily living (ADL), instrumental activity of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), clinical frail scale (CFS), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHEⅡ, APACHEⅣ), modified NUTRIC score (MNS), multiple drug resistance (MDR), mechanical ventilation (MV), continuous renal replacement therapy (CRRT) and palliative care. Continuous independent variables were converted into classified variables. Multivariate binary regression analysis of risk factors was conducted to screen independent risk factors which affecting 180-day mortality in elderly sepsis patients. Then a 180-day mortality predictive score was established, and the discrimination of the mortality of patients using CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS scores were compared.Results:A total of 257 patients were enrolled, with a 180-day mortality of 60.7%. Univariate analysis showed that age, tumor, CCI, ADL, IADL, MMSE, CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS, MDR, MV, CRRT, palliative care were risk factors of 180-day mortality in elderly sepsis patients [age: odds ratio ( OR) = 1.027, 95% confidence interval (95% CI) was 1.005-1.050, P = 0.018; tumor: OR =2.001, 95% CI was 1.022-3.920, P = 0.043; CCI: OR = 1.193, 95% CI was 1.064-1.339, P = 0.003; ADL: OR = 0.851, 95% CI was 0.772-0.940, P = 0.001; IADL: OR = 0.894, 95% CI was 0.826-0.967, P = 0.005; MMSE: OR = 0.962, 95% CI was 0.937-0.988, P = 0.004; CFS: OR = 1.303, 95% CI was 1.089-1.558, P = 0.004; SOFA: OR = 1.112, 95% CI was 1.038-1.191, P = 0.003; GCS: OR = 0.918, 95% CI was 0.863-0.977, P = 0.007; APACHEⅡ: OR = 1.098, 95% CI was 1.053-1.145, P < 0.001; APACHEⅣ: OR = 1.032, 95% CI was 1.020-1.044, P < 0.001; MNS: OR = 1.315, 95% CI was 1.159-1.493, P < 0.001; MDR: OR = 2.029, 95% CI was 1.197-3.437, P = 0.009; MV: OR = 6.408, 95% CI was 3.480-11.798, P < 0.001, CRRT: OR = 2.744, 95% CI was 1.529-4.923, P = 0.001, palliative care: OR = 5.760, 95% CI was 2.177-15.245, P < 0.001]. By binary regression analysis, CFS stratification ( OR = 1.934, 95% CI was 1.267-2.953, P = 0.002), MV ( OR = 4.531, 95% CI was 2.376-8.644, P < 0.001), CRRT ( OR = 2.471, 95% CI was 1.285-4.752, P = 0.007), palliative care ( OR = 6.169, 95% CI was 2.173-17.515, P = 0.001) were independent risk factors of 180-day mortality in elderly patients with sepsis. The model of "ESS = 0.660×CFS stratification+1.511×MV+0.905×CRRT+1.820×palliative care" was established. Receiver operating characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) for predicting 180-day mortality by ESS was 0.785 (95% CI was 0.730-0.834, P < 0.001). When the best cut-off value was 2.2 points, its sensitivity was 78.9%, specificity was 70.3%, the positive predictive value was 80.4%, and the negative predictive value was 68.3%. Simplified ESS was defined as "0.5×CFS stratification+1.5×MV+1×CRRT+2×palliative care". ROC curve analysis showed that AUC for predicting 180-day mortality by simplified ESS was 0.784 (95% CI was 0.729-0.833, P < 0.001). When the best cut-off value was 2.0 points, sensitivity was 76.9%, specificity was 70.3%, the positive predictive value was 80.0%, and the negative predictive value was 66.4%. Compared with CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ and MNS, ESS had a significant difference in discriminating 180-day mortality in elderly patients with sepsis (AUC was 0.785 vs. 0.607, 0.607, 0.600, 0.664, 0.702, 0.657, 95% CI: 0.730-0.734 vs. 0.537-0.678, 0.537-0.677, 0.529-0.671, 0.598-0.730, 0.638-0.766, 0.590-0.725, all P < 0.05). Conclusions:CFS, MV, CRRT, and palliative care are independent risk factors of 180-day mortality in elderly patients with sepsis. We established ESS based on these risk factors. The ESS model has good discrimination and can be used as a reference and assessment tool for prediction and treatment guidance in elderly patients with sepsis.

Nutrition support in the chronic critically ill patients / 中华危重病急救医学

Over the last decade, chronic critically ill (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of care bundles has significantly decreased early deaths of critically ill patients, and have allowed them to survive previously lethal multiple organ failure (MOF). However, more and more survivors leave persistent low grade organ dysfunctions, depend on continues organ support, need to stay in ICU, and become CCI patients. These patients experience a persistent immune dysregulation with persistent inflammation, immunosuppression, and catabolic syndrome. Therefore, malnutrition is an important feature of patients with CCI, and nutritional support is a crucial part of their treatment. The main strategies of nutritional support are as follows: providing sufficient calories and proteins with appropriate anabolic agents to promote anabolic metabolism, using immunomodulators to improve immune suppression and inflammatory responses, and supplementing micronutrients to enhance metabolic support. In this review, the nutritional assessment, calorie assessment, protein assessment and other nutrient supplementation (such as β blocker, testosterone and oxandrolone, immunonutrition, vitamins) of CCI patients were reviewed, so as to provide reference for the treatment of CCI.

Activated PKB/GSK-3β synergizes with PKC-δ signaling in attenuating myocardial ischemia/reperfusion injury via potentiation of NRF2 activity: Therapeutic efficacy of dihydrotanshinone-I

@#Disrupted redox status primarily contributes to myocardial ischemia/reperfusion injury (MIRI). NRF2, the endogenous antioxidant regulator, might provide therapeutic benefits. Dihydrotanshinone-I (DT) is an active component in Salvia miltiorrhiza with NRF2 induction potency. This study seeks to validate functional links between NRF2 and cardioprotection of DT and to investigate the molecular mechanism particularly emphasizing on NRF2 cytoplasmic/nuclear translocation. DT potently induced NRF2 nuclear accumulation, ameliorating post-reperfusion injuries via redox alterations. Abrogated cardioprotection in NRF2-deficient mice and cardiomyocytes strongly supports NRF2-dependent cardioprotection of DT. Mechanistically, DT phosphorylated NRF2 at Ser40, rendering its nuclear-import by dissociating from KEAP1 and inhibiting degradation. Importantly, we identified PKC-δ-(Thr505) phosphorylation as primary upstream event triggering NRF2-(Ser40) phosphorylation. Knockdown of PKC-δ dramatically retained NRF2 in cytoplasm, convincing its pivotal role in mediating NRF2 nuclear-import. NRF2 activity was further enhanced by activated PKB/GSK-3β signaling via nuclear-export signal blockage independent of PKC-δ activation. By demonstrating independent modulation of PKC-δ and PKB/GSK-3β/Fyn signaling, we highlight the ability of DT to exploit both nuclear import and export regulation of NRF2 in treating reperfusion injury harboring redox homeostasis alterations. Coactivation of PKC and PKB phenocopied cardioprotection of DT in vitro and in vivo, further supporting the potential applicability of this rationale. Graphical abstract

Meta-analysis of the effect of psychological nursing on the functional recovery of patients with dysphagia after stroke / 中国实用护理杂志

Objective:To evaluate the influence of psychological nursing on the functional recovery of patients with dysphagia after stroke using the method of Meta analysis.Methods:A computer search of PubMed, Cochrane Library, Web of Science, VIP, Wanfang Data, China Knowledge Infrastructure Engineering and China Biomedical Literature Database was used to collect the psychological nursing on the function of patients with dysphagia after stroke. The data were collected from June 1956 to August 2020. The literature of randomized controlled studies using Revman 5.3 for Meta analysis.Results:A total of 7 controlled studies on the impact of the use of the core quality of life scale (QLQ-C30) and the treatment efficacy survey on the functional recovery of patients with dysphagia after stroke and the impact of quality of life were included, with a total of 660 samples. The results of Meta analysis showed that the average difference of mental function after psychological nursing intervention was statistically significant [weight mean difference( WMD)=-16.66, 95% CI -18.09--15.22, P<0.001]; in the physical function score, the intervention group performed relatively significant difference compared with the control group ( WMD=-14.10, 95% CI -16.26--11.95, P<0.001); the average difference in social function after psychological nursing intervention was statistically significant ( WMD=-13.52, 95% CI -15.64--11.41, P<0.001); in the quality of life score, the control group performed worse than the intervention group ( WMD=-14.58, 95% CI -15.86--13.31, P<0.001); the treatment effect of the intervention group was better than that of the control group, and the difference was statistically significant [odds ratio ( OR=0.16, 95% CI 0.08-0.32, P<0.001]. Conclusions:Through the intervention of psychological care, the swallowing disorder of stroke patients is relieved and the quality of life is improved.

Clinical application of clot waveform analysis / 中华检验医学杂志

Bleeding and thrombotic diseases are closely related to various clinical departments. Laboratory-related tests play an important role in disease diagnosis and differential diagnosis, risk assessment, cause finding, and efficacy monitoring. Clot waveform analysis (CWA), as an automated coagulation detection technology, can provide more valuable information about the entire coagulation process of a plasma sample. A large number of studies have showed that CWA has certain value in the evaluation of coagulation status of COVID-19 patients, the judgment of clinical phenotype of hemophilia A (HA) patients, and the monitoring of direct oral anticoagulant drugs (DOAC). In-depth interpretation and application of CWA in different clinical settings can provide more laboratory information for diagnosis and treatment of bleeding and thrombotic diseases.