Evaluation of the effect of meteorological risk forecasting service intervention on acute onset and medical expenses of patients with COPD in Pudong New Area of Shanghai / 上海预防医学

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ2=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ2=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ2=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

Spinal cord electrical stimulation with neurophysiological monitoring for treatment of high-risk diabetic foot / 中华危重病急救医学

Objective:To evaluate the clinical efficacy of a single-session implantation of spinal cord electrical stimulation with neurophysiological monitoring a spinal cord electrical stimulator under general anesthesia with neurophysiological monitoring for the treatment of high-risk diabetic foot.Methods:The clinical data of seven patients with high-risk diabetic foot who underwent spinal cord electrical stimulation in neurosurgery ward nine of Tianjin Huanhu Hospital from May 2022 to May 2023 were collected. The operation was performed under general anesthesia with the "C" arm X ray machine guidance and neurophysiological monitoring. The arterial diameter and peak flow rate of lower extremity, lower extremity skin temperature (calf skin temperature, foot skin temperature), visual analog scale (VAS), continuous distance of movement, blood glucose level and toe wound were compared between patients before and after surgery.Results:A total of seven patients with high-risk diabetic foot were included. The diameters and peak flow rates of femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery and dorsal foot artery in both lower limbs were significantly improved after surgery. All patients had different degrees of lower limb pain before operation. After operation, VAS score decreased significantly (1.1±0.9 vs. 6.8±3.4), the pain was significantly relieved, and the calf skin temperature and foot skin temperature were significantly higher than those before surgery [calf skin temperature (℃): 33.3±0.9 vs. 30.9±0.7, foot skin temperature (℃): 31.4±0.8 vs. 29.1±0.6], fasting blood glucose and postprandial blood glucose were significantly lower than those before surgery [fasting blood glucose (mmol/L): 7.6±1.4 vs. 10.5±1.2, postprandial blood glucose (mmol/L): 9.3±2.3 vs. 13.5±1.1], the differences were statistically significant (all P < 0.01). The lower limb movement of all seven patients was significantly improved after surgery, including one patient who needed wheelchair travel before surgery, and one patient who had intermittent claudication before surgery. Among them, one patient needed wheelchair travel and one patient had intermittent claudication before surgery. All patients could walk normally at 2 weeks after operation. Among the seven patients, two patients had the diabetic foot wound ulceration before surgery, which could not heal for a long time. One month after surgery, blood flow around the foot wound recovered and the healing was accelerated. The wound was dry and crusted around the wound, and the wound healed well. Conclusion:For diabetic high-risk foot patients who are intolerant to diabetic peripheral neuralgia and local anesthesia spinal cord electrical stimulation test, one-time implantation of spinal cord electrical stimulator under general anesthesia under neurophysiological monitoring can effectively alleviate peripheral neuralgia and other diabetic foot related symptoms, improve lower limb blood supply, and reduce the risk of toe amputation. Clinical practice has proved the effectiveness of this technique, especially for the early treatment of diabetic high-risk foot patients.

Correlation between urinary protein levels and the incidence of chronic obstructive pulmonary disease in middle-aged and elderly population / 公共卫生与预防医学

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ2=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

Mitofusin2 Promotes ß Cell Maturation from Mouse Embryonic Stem Cells via Sirt3/Idh2 Activation.

ß cell dysfunction is the leading cause of diabetes. Adult ß cells have matured glucose-stimulated insulin secretion (GSIS), whereas fetal and neonatal ß cells are insensitive to glucose and are functionally immature. However, how ß cells mature and acquire robust GSIS is not fully understood. Here, we explored the potential regulatory proteins of ß cell maturation process and the capacity for GSIS. Combined with the data from public databases, we found that the gene expression of Mitofusin2 (Mfn2) showed an increasing trend from mouse neonatal ß cells to mature ß cells. Moreover, its protein expression increased during mouse embryonic pancreas development and ß cell differentiation from mouse embryonic stem cells. Knocking down Mfn2 reduced Urocortin3 (Ucn3) expression, GSIS, and ATP production in induced ß cells, while overexpressing it had the opposite effect. However, neither Mfn2 knockdown nor overexpression affected the differentiation rate of insulin-positive cells. In immature and mature ß cells, Mfn2 and its correlated genes were enriched in tricarboxylic acid (TCA) cycle-related pathways. The expressions of Sirtuin 3 (Sirt3) and isocitrate dehydrogenase 2 (NADP+) and mitochondrial (Idh2) were Mfn2-regulated during ß cell differentiation. Inhibiting Idh2 or Sirt3 reduced cellular ATP content and insulin secretion levels that increased by Mfn2 overexpression. Thus, Mfn2 modulated the induced ß cell GSIS by influencing the TCA cycle through Sirt3/Idh2 activation. We demonstrated that Mfn2 promoted embryonic stem cell-derived ß cell maturation via the Sirt3/Idh2 pathway, providing new insights into ß cell development. Our data contribute to understanding diabetes pathogenesis and offer potential new targets for ß cell regeneration therapies.

Meloxicam Inhibits Hepatocellular Carcinoma Progression and Enhances the Sensitivity of Immunotherapy via the MicroRNA-200/PD-L1 Pathway.

BACKGROUND: Hepatocellular carcinoma (HCC) has become the sixth most common cancer and the third leading cause of cancer death in the world. Although the research achievements of tumor immunotherapy have made great progress, especially the combination of immune targeted therapy has achieved good curative effect in HCC, but only a few patients are suitable for it and benefit from it. Therefore, there is an urgent need to find new effective drugs to treat HCC or to enhance the sensitivity of immunotherapy. METHODS: Meloxicam, a COX2 inhibitor with strong anti-HCC potential, was screened from 800 small molecules approved by FDA. The effect of meloxicam on the proliferation, invasion, and migration of HCC cell lines was evaluated by cell phenotype analysis. The Human Protein Atlas database and the TISCH database were used to analyze COX2 data in single cells, and the TISIDB database was used to analyze the correlation of COX2 with immune function. The real-time quantitative polymerase chain reaction (qRT-PCR) and western blot were used to evaluate the level of PD-L1 and CD155 in HCC cell lines treated with meloxicam and further explore its possible mechanism. In vivo experiments were applied to verify the effect of meloxicam combined with anti-PD1 therapy on HCC tumor growth in mice. RESULTS: Meloxicam can significantly inhibit the proliferation, invasion, and migration of HCC cells. The TISIDB database indicated that the COX2 was strongly associated with immunoinhibitors and immunostimulators. Meloxicam upregulated the level of PD-L1 in HCC cell lines and animal models. In terms of mechanism, meloxicam inhibited microRNA-200, thereby upregulating PD-L1. In vitro experiments showed that both meloxicam and anti-PD1 had inhibitory effects on the growth of HCC tumors. Compared with meloxicam and anti-PD1 alone, the combination therapy showed stronger antitumor properties. Immunohistochemical analysis confirmed that meloxicam enhanced the antitumor immune activity in the tumor microenvironment. CONCLUSION: Our study showed meloxicam inhibited HCC progression and enhanced the sensitivity of immunotherapy via the microRNA-200/PD-L1 pathway.

Master genes and co-expression network analysis in peripheral blood mononuclear cells of patients with gram-positive and gram-negative sepsis / 浙江大学学报·医学版

OBJECTIVE@#To investigate the functional pathways enriched and differentially expressed genes (DEGs) in peripheral blood mononuclear cells (PBMCs) of patients with gram-positive and gram-negative sepsis.@*METHODS@#Dataset GSE9960 obtained from NCBI GEO database containing PBMC samples from 16 non-infectious systematic inflammatory response syndrome (SIRS) patients, 17 gram-positive septic patients and 18 gram-negative septic patients were included in the study. Functional pathway annotations were conducted by gene set enrichment analysis and weighted gene co-expression network analysis. DEGs were filtered and master DEGs were then validated in PBMCs of gram-positive septic, gram-negative septic and non-infectious SIRS patients.@*RESULTS@#The enriched gene sets in gram-positive sepsis and gram-negative sepsis were significantly different. The results indicated the opposite co-expression networks in SIRS and gram-negative sepsis, and the entirely different co-expression networks in gram-positive and gram-negative sepsis. Furthermore, we validated that @*CONCLUSIONS@#The results indicate that there are differences in the mechanism and pathogenesis of gram-positive and gram-negative sepsis, which may provide potential markers for sepsis diagnosis and empirical antimicrobial therapy.

Preliminary study on the value of the new community acquired pneumonia severity index / 中华急诊医学杂志

Objective To explore the value of a new community-acquired pneumonia severity index(CPSI) in predicting the severity and mortality of patients with community-acquired pneumonia(CAP).Methods A retrospective analysis was conducted.Patients with CAP in critical care medicine of the First People's Hospital of Chenzhou were enrolled in this study.According to whether the patients died within 28 days,patients were divided into the survival group and the death group.The difference of sex,age,vital signs,blood test,the lowest Glasgow coma score (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sepsis related organ failure assessment (SOFA)score,CURB-65 (confusion,uremia,respiratory rate,BP,age 65 years) score,pneumonia severity index (PSI) score and community-acquired pneumonia severity index (CPSI) score were compared between the two groups.Logistic regression analysis was performed for the scoring systems with statistical significance in univariate analysis.The receiver operating characteristic (ROC) was drawn to analyze the prognostic value of each scoring system.Results Totally 283 patients were enrolled in this study (184 survivals and 99 deaths,mortality rate 35％).Univariate analysis showed that age,mechanical ventilation (MV) ratio,the fastest heart beat rate (HR),the lowest systolic blood pressure (SBP),the lowest mean blood pressure (MAP),pressure adjusted shock index (PASI),inspired oxygen concentration (FiO2),arterial oxygen partial pressure (PaO2),and oxygenation index (PO2/FiO2),blood urea nitrogen concentration (BUN),serum creatinine concentration (Scr),urine output,length of ICU stay,the lowest GCS,and APACHE Ⅱ score were significantly different between the two groups (P＜0.05).Multivariate regression analysis showed that CPSI score and SOFA score were independent risk factors for patients with CAP.The ROC curve of CAP patients was predicted in each scoring system,and the area under the ROC curve of CPSI score (0.728),SOFA and age score (0.708),PSI score (0.701),APACHE Ⅱ score (0.690),CURB-65 score (0.687) and SOFA score (0.683) gradually decreased.The sensitivity and specificity of the area under curve prediction showed that CPSI score was superior to the other scores.Conclusions The CPSI score can evaluate the severity of CAP patients,efficiently predict the outcome of patients with CAP,and can be widely used in clinical practice.

Anti-gamma-aminobutyric acid B receptor encephalitis:2 cases report and literatures review / 中华老年医学杂志

Objective To discuss the characteristics of clinical features,diagnosis and therapy procedure of Anti-gamma-aminobutyric acid B (anti-GABAB)receptor encephalitis.Methods Procedure of clinical diagnosis and treatment in two patients with anti-GABAB receptor encephalitis were retrospected in Neurological Department of Tianjin Huanhu Hospital and the characteristics of anti-GABAB receptor encephalitis were analyzed with literature review.Results In both patients,the clinical manifestations were epileptic seizure,which was a focal seizure at first,seconded by generalized tonic clonic seizure,with frequent attacks or epilepticus state.Significant cognitive and memory impairments and psychological and behavioral abnormalities were observed during the course of the disease.Abnormal MRI signals were found in mesial temporal lobe,with normal electroencephalography.Antibody against anti-GABABreceptor was positive in both cerebrospinal fluid and blood,and immune regulation therapy was effective.Conclusions The patients present with epileptic seizures,seconded by cognitive and memory impairment,often accompanied by MR imagingrevealed mesial temporal lobe lesion.And positive anti-GABAB receptor antibody is major characteristics of anti-GABAB receptor encephalitis.The patients often combine small cell lung cancer,and Immune regulation therapy is effective.

The ED50 of dexmedetomidine for suppressing cardiovascular responses to placement of laryngeal mask in female patients with induction of propofol / 实用医学杂志

Objective To determine the ED50 of dexmedetomidine for suppressing cardiovascular responses to placement of laryngeal mask airway (LMA) in patients undergoing gynecological laparoscopic surgery with induction of propofol. Methods ASA I or II Patients aged 18 to 55 undergoing elective gynecological laparoscopic surgery were enrolled. After an bolus dose of dexmedetomidine over 10 min , anaesthesia was induced with target-controled propofol, and then bolus of vecuronium of 0.1 mg/kg was injected when the BIS was between 45 and 55. LM palcement was performed 3 minutes after vecuronium injection. The modified Dixon ’ s up-and-down method was used to determine the bolus dose of dexmedetomidine , starting from 1.0 μg/kg (step size:0.1 μg/kg). Cardiovascular response was defined as an increase in SBP and/or HR by 15% of baseline within 2 min after placement of LMA. The test ended after at least 7 crossovers ( successive ‘response’ or ‘non-response’) were obtained. Probit analysis was used to calculate ED50, ED95 and 95% confidence interval (CI). Results The ED50 and ED95 (95% confidence interval) of dexmedetomidine for suppressing cardiovascular responses to placement of LMA was 0.65 μg/kg (0.44-0.80) μg/kg and 0.94 μg/kg (0.79-2.47) μg/kg. Conclusion Under induction of target-controled propofol , the ED50 of dexmedetomidine is 0.65 μg/kg for suppressing cardiovascular responses to placement of LMA in female patients.

Toxicity of outer membrane vesicles derived from Acinetobacter baumannii strains with different drug-resistance spectrums / 中华临床感染病杂志

Objective To compare the toxicity of outer membrane vesicles ( OMVs) secreted by Acinetobacter baumannii strains with different drug-resistance spectrums.Methods Four Acinetobacter baumannii strains with different drug-resistance spectrums were collected (strain 33, 3237, B29 and 10), and OMVs produced by these strains were extracted and purified.BCA assay was used to determine the protein concentrations, and RAW264.7 cells were incubated with different concentrations of OMVs for 24 h. Cell viability was measured with CCK-8 assay, and gene expression of tumor necrosis factor-alpha ( TNF-α) , interleukin-6 ( IL-6) , interleukin-1 beta ( IL-1β) , keratinocyte-derived chemokine ( KC) and macrophage inflammatory protein 2 (MIP-2) was assessed by quantitative real-time PCR.One-way ANOVA was used for data analysis.Results According to the result of drug susceptibility test, strain 10 was extensively drug-resistant Acinetobacter baumannii ( XDRAB ) strain, strain B29 was multi-drug resistance Acinetobacter baumannii (MDRAB) strain, while strain 33 and 3237 were non-MDRAB strains.After incubated with different concentrations of OMVs for 24 h, cell viability of RAW264.7 declined with the increase of OMVs concentrations.OMVs released from strain10, B29 and 3237 significantly lowered the cell viability at the concentration of 5 μg/mL, while the cytotoxicity of OMVs released from strain 33 was much weaker, and no remarkable decrease in cell viability was observed even at the concentration of 25 μg/mL.OMVs of all strains induced the release of TNF-α, IL-6, IL-1β, KC and MIP-2 in RAW264.7 cells, and the levels of theses cytokines were increased with the concentration of OMVs.Inflammatory response in cells incubated with OMVs from strain 33 was the weakest, while OMVs from strain 10 induced strongest inflammatory response.KC and MIP-2 levels were significantly higher in RAW264.7 cells incubated with OMVs from strain 10 with a concentration of 5 μg/mL than that incubated with OMVs from other strains ( F=19.094 and 19.032,P<0.05 or <0.01).Conclusions OMVs from Acinetobacter baumannii strains with different drug-resistance spectrums are of different toxicity.OMVs from XDRAB and MDRAB strains have higher toxicities and may induce stronger inflammatory response.

CD4+ and CD8+ T cell levels as well as clinical features in HIV-positive patients with drug eruption / 中华皮肤科杂志

Objective To explore the role of viral infection in the development of drug eruption in patients with HIV infection, and to evaluate the efficacy of antiviral treatment. Methods This study enrolled 87 HIV-positive patients, including 11 with and 76 without drug eruption, all of whom received highly active antiretroviral therapy(HAART). Clinical data on, baseline CD4+ and CD8+ T cell counts and CD4/CD8 ratio in these subjects were retrospectively analyzed. Results The severity of drug eruption was mild in the 11 HIV-positive patients, with a mean latency period of (14.00 ± 8.10)(range, 8 - 34)days. Of the 11 patients with drug eruption, 7 had liver function impairment, which was not in accordance with the severity of skin lesions. Drug eruption was controlled in all the 11 patients after anti-anaphylactic treatment without withdrawal of antiviral drugs. Compared with 75 HIV-positive patients without drug eruption, the 11 HIV-positive patients with drug eruption showed significantly increased baseline CD4 + T cell counts (493.00 ± 245.68 (range, 42 - 810)/μl vs. 347.81 ± 167.00 (range, 11 - 814)/μl, t = 647.50, P 0.05), CD4/CD8 ratio(0.40 ± 0.27 vs. 0.29 ± 0.16, P > 0.05), or percentage of patients with a CD4/CD8 ratio below the lower limit of normal (9/10 vs. 68/69 (98.55%), P >0.05). Conclusions The latency period of drug eruption seems to be long in HIV-positive patients receiving HAART, and mild drug eruption can be complicated by liver function impairment in the patients. Relatively high CD4 + counts may be a risk factor for the development and aggravation of drug eruption in HIV-positive patients.

The construction of pcDNA 3.1 RASSF1 eukaryotic vector and the influence of RASSF1 on apoptosis of hepatocarcinoma cell line / 中国医师杂志

Objective To construct pcDNA3.1 RASSF1 eukaryotic vector and observe the influence of RASSF1 on the apoptosis of hepatocarcinoma cell line HepG2. Methods RASSF1 gene was amplifled from human RASSF1 cDNA by polymerase chain reaction (PCR) and cloned into pcDNA3.1. The recombinant plasmid pcDNA3. 1 RASSF1 was transfected into hepatocarcinoma HepG2 cell line. The expression of RASSF1 was examined by Western blot. The influence of RASSF1 on the cell apoptosis was measured by Annexin V/PI assay. Results DNA enzyme digestion and sequencing results showed that recombinant plasmid pcDNA3. 1-RASSF1 was successfully constructed. RASSF1 protein was overexpressed in HepG2 cell line transfected with pcDNA3. 1-RASSF1 plasmid. The apoptosis rate of blank, pcDNA3. 1 and pcDNA3. 1-RASSF1 group was (5.8 ±0.42)%, (7.48 ±0.68)% and (35. 1 ±3. 15)%, respectively.Conclusion The pcDNA3. 1- RASSF1 eukaryotic vector was successfully constructed, RASSF1 protein overexpression could induce apoptosis in HepG2 cell line.

Research on the efficacy of endoscopic resection of thyroid benign tumor / 中国基层医药

Objective To observe the efficacy of endoscopic resection with thyroid benign tumor. Methods 60 cases of thyroid benign tumor were randomly divided into the endoscopic group and the traditional group, 30 cases in each group. The operation time, blood loss ,drainage volume, postoperative hospital stay, postoperative complications and hospitalization expenses in two groups were compared. Results There was no significant difference ( P >0. 05) between the two groups of postoperative hospital stay; endoscopic group blood loss (25.3 ± 15.6) ml significantly less than the traditional group (57. 2 ± 33. 8) ml, the difference was statistically significant ( P < 0. 05); endoscopic postoperative drainage volume ( 85.6 ± 53.2) ml significantly more than the traditional group ( 23. 5 ±37.2) ml (P < 0. 05); endoscopic operative time of ( 105.3 ± 23. 5) min, while the traditional group ( 80. 4 ±25. 3 ) min, the difference was significant ( P < 0. 05 ); hospitalization costs were significantly higher than conventional endoscopy group ( P < 0. 05). Both groups were not have obvious complications postoperation. Conclusion Compared with traditional open surgery, endoscopic surgery for benign thyroid tumors has advantages of superior cosmetic results and less bleeding,it is a good choice for the treatment of the disease.

Relationship between smooth muscle cell hyperplasia and plasma tissue factor after percutaneous coronary intervention in porcine model / 中国介入心脏病学杂志

Objective To discuss the relationship between plasma levels of tissue factor(TF) in the circulation and the development of smooth muscle cells(SMC) hyperplasia after percutaneous coronary intervention(PCI) in porcine models.Methods Thirty swines were used and their coronary arteries were injured by balloon dilatation.Morphological measurements included neointimal area and the extent of area stenosis.Plasma TF level was measured before and after PCI.The relationship between TF and neointimal area was calculated.Results Different degrees of intimal hyperplasia were found among all vessels and the rate of restenosis was 60%.Plasma TF levels were significant higher in vessels which subsequently developed restenosis(30 minutes after PCI: 688.36?91.57 ng/L vs 514.87?68.73 ng/L,24 hours after PCI: 706.09?89.59 ng/L vs 539.22?70.51 ng/L,P