Early prediction of severe COVID-19 in patients with Sjögren's syndrome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the predictive value of blood cell ratios and inflammatory markers for adverse prognosis in patients with primary Sjögren's syndrome (PSS) combined with coronavirus disease 2019 (COVID-19).@*METHODS@#We retrospectively collected clinical data from 80 patients with PSS and COVID-19 who visited the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University from December 2022 to February 2023. Inclusion criteria were (1) meeting the American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome; (2) confirmed diagnosis of COVID-19 by real-time reverse transcription polymerase chain reaction or antigen testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); (3) availability of necessary clinical data; (4) age > 18 years. According to the clinical classification criteria of the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial the 10th Revised Edition)", the patients were divided into the mild and severe groups. Disease activity in primary Sjögren' s syndrome was assessed using the European League Against Rheumatism (EULAR) Sjögren' s syndrome disease activity index (ESSDAI). Platelet-lymphocyte ratio (PLR), C-reactive protein-lymphocyte ratio (CLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other laboratory data were compared between the two groups within 24-72 hours post-infection.@*RESULTS@#The mild group consisted of 66 cases with an average age of (51. 52±13. 16) years, and the severe group consisted of 14 cases with an average age of (52.64±10.20) years. Disease activity, CRP, platelets, PLR, and CLR were significantly higher in the severe group compared with the mild group (P < 0.05). Univariate analysis using age, disease activity, CRP, platelets, PLR, and CLR as independent variables indicated that disease activity, CRP, PLR, and CLR were correlated with the severity of COVID-19 (P < 0.05). Multivariate logistic regression analysis further confirmed that PLR (OR=1.016, P < 0.05) and CLR (OR=1.504, P < 0.05) were independent risk factors for the severity of COVID-19 in the critically ill patients. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for PLR and CLR was 0.708 (95%CI: 0.588-0.828) and 0.725 (95%CI: 0.578-0.871), respectively. The sensitivity for PLR and CLR was 0.429 and 0.803, respectively, while the highest specificity was 0.714 and 0.758, respectively. The optimal cutoff values for PLR and CLR were 166.214 and 0.870, respectively.@*CONCLUSION@#PLR and CLR, particularly the latter, may serve as simple and effective indicators for predicting the prognosis of patients with PSS and COVID-19.

The influencing factors of long-term care insurance demand in China: An empirical study based on Jiangsu Province / 中国卫生政策研究

Objective: To explore the influencing factors of the long-term care insurance demand in Jiangsu province and provide reference for the establishment and improvement of a perfect long-term care insurance system in China. Methods:Factor analysis,multiple regression analysis and logistic regression analysis were applied for analy-zing the survey data collected from Jiangsu province. Results: (1) From the perspective of subjective attitude fac-tors,nursing expenses,family ability to pay,insurance concepts, nursing needs and chronic disease awareness and long-term care insurance demand are positively correlated,and the impact was significant;(2) From the perspective of demographic factors, residents with a high level of education are more willing to buy long-term care insurance. Conclusions: The Chinese government should take full account of the influencing factors of long-term care insurance demand,improve the income of urban and rural residents,increase promotional activities,and encourage nursing in-stitutions to develop at different levels,and build a government-led long-term care service system.

Effects of granulocyte colony-stimulating factor on repair of injured canine arteries / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endothelial progenitor cells (EPCs) derived from bone marrow may differentiate into endothelial cells and participate in endothelial repair. These cells can be mobilized into peripheral blood by cytokines, including granulocyte colony-stimulating factor (G-CSF). In the present study, we investigated the effects of G-CSF on neointimal formation and restenosis in a canine model of arterial balloon injury.</p><p><b>METHODS</b>Sixteen male beagle dogs were injected subcutaneously with 20 microg x kg(-1) x d(-1) recombinant human G-CSF (n = 8) or normal saline (n = 8) for 1 week. On the fifth day of treatment, the dogs underwent renal arterial angioplasty. At 8 weeks after arterial balloon injury, angiographic observations were made and injured arteries were processed for morphometric analysis of neointimal formation.</p><p><b>RESULTS</b>Peripheral white blood cell counts were increased by 3.34-fold compared to baseline on the fifth day of administration of G-CSF. Angiographies revealed that one stenosis had occurred among the eight injured renal arteries from dogs treated with G-CSF, whereas all injured renal arteries from dogs treated with normal saline remained patent. The mean extent of stenosis among injured arteries was 18.3% +/- 17.9% in the G-CSF treated group compared to 12.5% +/- 7.6% in the saline treated control group (P = 0.10). G-CSF treatment slightly increased neointimal thickness (0.42 +/- 0.15 mm vs 0.25 +/- 0.06 mm, P = 0.08) with an intima to media ratio of 0.83 +/- 0.49 vs 0.54 +/- 0.18 (P = 0.11).</p><p><b>CONCLUSIONS</b>G-CSF treatment does not attenuate neointimal hyperplasia and restenosis formation in a canine model of renal arterial injury, suggesting that the therapeutic strategy for preventing restenosis by stem cell mobilization should be investigated further.</p>

Safety evaluation of iodine-125 seed implantation in rabbit liver tissue / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the safety of iodine-125 seed implantation in the liver.</p><p><b>METHODS</b>Twenty New Zealand rabbits were divided into control and treatment groups and in the latter, iodine-125 seeds of 37 MBq were implanted into the liver under CT guidance whereas nonradioactive seeds were implanted in the control rabbits. Four weeks after implantation, white blood cell count, liver functions, and renal functions were measured or evaluated for comparison with those before implantation. The rabbits were then anesthetized to collect the liver tissue for pathological examination with HE staining and cell apoptosis assay.</p><p><b>RESULTS</b>Obvious hepatic tissue necrosis was observed around the radioactive seeds in the treatment group. At a 5 mm distance to the seeds, a distinct boundary occurred between the necrotic hepatic cells and normal cells. The control rabbits, however, had normal liver structure around the seeds implanted. In situ cell apoptosis examination showed a distinct band of apoptotic cells in the liver tissue of rabbits in the treatment group, which was not found in the control group. Two weeks after iodine-125 irradiation, alanine aminotransferase significantly increased in the treatment group (t=6.285, P<0.001), but recovered two weeks later (t=2.002, P=0.06). No significant alterations occurred in aspartate aminotransferase, blood urea nitrogen, serum creatinine, hemoglobin, serum total bilirubin, white blood cell count, or platelet count after the seed implantation.</p><p><b>CONCLUSION</b>Iodine-125 seed implantation in the liver results in conformal irradiation dose distribution without obvious effects on the vital organs, demonstrating iodine-125 seed implantation as a safe and minimally invasive technique for hepatic cancer treatment.</p>

Relationship of HepG2 cell sensitivity to continuous low dose-rate irradiation with ataxia-telangiectasia mutated phosphorylation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the changes of ataxia-telangiectasia mutated (ATM) phosphorylation in HepG(2) cells in relation to HepG(2) cell survival under continuous low dose-rate irradiation.</p><p><b>METHODS</b>HepG(2) cells were exposed to equivalent irradiation doses delivered at either a continuous low dose-rate (7.76 cGy/h) or a high dose-rate (4500 cGy/h), and the phosphorylated ATM proteins and surviving fraction of HepG(2) cells after the exposures were compared.</p><p><b>RESULTS</b>The phosphorylation of ATM protein was maximal at 0.5 Gy irradiation delivered at either a high doserate or a continuous low doserate. As the radiation dose increased, ATM protein phosphorylation decreased under continuous low dose-rate irradiation, but remained stable under high dose-rate irradiation. With comparable ATM protein phosphorylation induced by continuous low dose-rate irradiation and high dose-rate irradiation, there was no significant difference in the surviving fraction of HepG(2) cells (P>0.05), but at a significantly lower ATM protein phosphorylation level than that induced by high dose-rate irradiation, continuous low dose-rate irradiation resulted in increased cell killing (P<0.01).</p><p><b>CONCLUSION</b>Continuous low dose-rate irradiation increases HepG(2) cells radiosensitivity as compared with high dose-rate irradiation. Increased cell killing following continuous low dose-rate irradiation is associated with reduced phosphorylated ATM protein, and inhibition of ATM phosphorylation may increase the radiosensitivity of HepG(2) cells.</p>

Triple-phase helical CT in the differential diagnosis between small hepatocellular carcinoma and small hepatic cavernous hemangioma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To scrutinize the enhancement pattern at hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) by helical CT examination in order to differentiate small hepatocellular carcinoma (SHCC) from small hepatic cavernous hemangioma (SHCH).</p><p><b>METHODS</b>In 38 patients (41 lesions) with SHCC and 35 patients (45 lesions) with SHCH, the images at HAP, PVP and DP were recorded as to the characteristic of enhancements with the average CT value at the HAP monitored and compared.</p><p><b>RESULTS</b>The enhancement patterns of SHCC at the HAP, PVP, and DP were assessed as hyper-hypo-hypodense in 20 lesions, hyper-iso-hypodense in 6 lesions, hyper-hyper-hypodense in 3 lesions, hyper-iso-isodense in 5 lesions, iso-hypo-hypodense in 3 lesions, and hypo-hypo-hypodense in 4 lesions. The enhancement patterns of the SHCH were assessed as a peripheral hyperdense nodular at HAP, then progressively enlarged at PVP and turned into a isodense or homogeneous hyperdense nodular at DP in 27 lesions, hyper-hyper-iso or hyperdense in 9 lesions, hyper-iso-isodense in 3 lesions, hypo-hypo-hypodense in 6 lesions. The enhancement CT values at the HAP of homogeneous hyperdense SHCC and SHCH were (40.4 +/- 15.5) Hounsfield Unit (HU) and (102.8 +/- 18.9) HU respectively (P < 0.01).</p><p><b>CONCLUSION</b>Most of the small hepatocellular carcinoma and small hepatic cavernous hemangioma have typical appearance by triple-phase helical CT examination, and can easily and properly be diagnosed. But it is difficult to distinguish SHCC from SHCH with atypical appearance in isolated cases. Hence differentiation may be difficult. Therefore, further examinations such as MRI, ultra-sonography or isotope scintigraphy are helpful in the differential diagnosis.</p>