Efficacy and safety of secondary allogeneic hematopoietic stem cell transplantation in 70 patients with recurrent hematologic malignancies after transplantation / 中华血液学杂志

Objectives: To investigate the role of donor change in the second hematopoietic stem cell transplantation (HSCT2) for hematological relapse of malignant hematology after the first transplantation (HSCT1) . Methods: We retrospectively analyzed patients with relapsed hematological malignancies who received HSCT2 at our single center between Mar 1998 and Dec 2020. A total of 70 patients were enrolled[49 males and 21 females; median age, 31.5 (3-61) yr]. Results: Forty-nine male and 21 female patients were enrolled in the trial. At the time of HSCT2, the median age was 31.5 (3-61) years old. Thirty-one patients were diagnosed with acute myeloid leukemia, 23 patients with ALL, and 16 patients with MDS or other malignant hematology disease. Thirty patients had HSCT2 with donor change, and 40 patients underwent HSCT2 without donor change. The median relapse time after HSCT1 was 245.5 (26-2 905) days. After HSCT2, 70 patients had neutrophil engraftment, and 62 (88.6%) had platelet engraftment. The cumulative incidence of platelet engraftment was (93.1±4.7) % in patients with donor change and (86.0±5.7) % in patients without donor change (P=0.636). The cumulative incidence of CMV infection in patients with and without donor change was (64.0±10.3) % and (37.0±7.8) % (P=0.053), respectively. The cumulative incidence of grade Ⅱ-Ⅳ acute graft versus host disease was (19.4±7.9) % vs (31.3±7.5) %, respectively (P=0.227). The cumulative incidence of TRM 100-day post HSCT2 was (9.2±5.1) % vs (6.7±4.6) % (P=0.648), and the cumulative incidence of chronic graft versus host disease at 1-yr post-HSCT2 was (36.7±11.4) % versus (65.6±9.1) % (P=0.031). With a median follow-up of 767 (271-4 936) days, 38 patients had complete remission (CR), and three patients had persistent disease. The CR rate was 92.7%. The cumulative incidences of overall survival (OS) and disease-free survival (DFS) 2 yr after HSCT2 were 25.8% and 23.7%, respectively. The cumulative incidence of relapse, OS, and DFS was (52.6±11.6) % vs (62.4±11.3) % (P=0.423), (28.3±8.6) % vs (23.8±7.5) % (P=0.643), and (28.3±8.6) % vs (22.3±7.7) % (P=0.787), respectively, in patients with changed donor compared with patients with the original donor. Relapses within 6 months post-HSCT1 and with persistent disease before HSCT2 were risk factors for OS, DFS, and CIR. Disease status before HSCT2 and early relapse (within 6 months post-HSCT1) was an independent risk factor for OS, DFS, and CIR post-HSCT2. Conclusion: Our findings indicate that changing donors did not affect the clinical outcome of HSCT2.

Clinical characteristics of 11 patients with chronic lymphocytic leukemia with t (14;19) (q32;q13) / 中华血液学杂志

Objective: To analyze the clinicopathological characteristics of 11 cases of chronic lymphocytic leukemia (CLL) with t (14;19) (q32;q13) . Methods: The case data of 11 patients with CLL with t (14;19) (q32;q13) in the chromosome karyotype analysis results of the Blood Diseases Hospital, Chinese Academy of Medical Sciences from January 1, 2018, to July 30, 2022, were retrospectively analyzed. Results: In all 11 patients, t (14;19) (q32;q13) involved IGH::BCL3 gene rearrangement, and most of them were accompanied by +12 or complex karyotype. An immunophenotypic score of 4-5 was found in 7 patients and 3 in 4 cases. We demonstrated that CLLs with t (14;19) (q32;q13) had a mutational pattern with recurrent mutations in NOTCH1 (3/7), FBXW7 (3/7), and KMT2D (2/7). The very-high-risk, high-risk, intermediate-risk, and low-risk groups consisted of 1, 1, 6, and 3 cases, respectively. Two patients died, 8 survived, and 2 were lost in follow-up. Four patients had disease progression or relapse during treatment. The median time to the first therapy was 1 month. Conclusion: t (14;19) (q32;q13), involving IGH::BCL3 gene rearrangement, is a rare recurrent cytogenetic abnormality in CLL, which is associated with a poor prognosis.

Incidence and clinical characteristics of engraftment syndrome after syngeneic hematopoietic stem cell transplantation in patients with hematological diseases / 中华血液学杂志

Objective: To explore the incidence and clinical characteristics of engraftment syndrome (ES) after syngeneic hematopoietic stem cell transplantation (syn-HSCT) in patients with hematological diseases. Methods: The clinical data of 21 patients who received syn-HSCT at People's Hospital of Peking University from January 1994 to May 2018 were retrospectively analyzed. Results: Seven (33.3% ) of 21 patients developed ES. The onset of ES symptoms occurred at a median of 8 (range: 5-13) days after HSCT, and the diagnosis of ES occurred at a median of 10 (range: 7-14) days after HSCT. Steroids were administered immediately after the diagnosis of ES, the median time of symptom continuance was 2 (range: 1-5) days, and all patients showed complete resolution of ES symptoms. In the multivariate analysis, patients with acute myeloid leukemia and faster neutrophil reconstitution were the risk factors for ES (HR=15.298, 95% CI 1.486-157.501, P=0.022, and HR=17.459, 95% CI 1.776-171.687, P=0.014) . Meanwhile, there was no significant difference in the overall survival and disease-free survival between patients with ES and those without ES. Conclusion: A high incidence of ES was observed in syn-HSCT recipients. Moreover, the prognosis of ES was excellent.

Dynamic monitoring of plasma Epstein-Barr Virus DNA load can predict the occurrence of lymphoproliferative disorders after haploidentical hematopoietic stem cell transplantation / 中华血液学杂志

Objective: To determine the optimal cutoff value of Epstein-Barr virus (EBV) DNA load that can assist in the diagnosis of post-transplant lymphoproliferative disease (PTLD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: The data of patients with EBV infection after haplo-HSCT from January to December 2016 were retrospectively analyzed. Through constructing the receiver operating characteristic (ROC) curve and calculating the Youden index to determine the cutoff value of EBV-DNA load and its duration of diagnostic significance for PTLD. Results: A total of 94 patients were included, of whom 20 (21.3% ) developed PTLD, with a median onset time of 56 (40-309) d after transplantation. The median EBV value at the time of diagnosis of PTLD was 70,400 (1,710-1,370,000) copies/ml, and the median duration of EBV viremia was 23.5 (4-490) d. Binary logistic regression was used to analyze the peak EBV-DNA load (the EBV-DNA load at the time of diagnosis in the PTLD group) and duration of EBV viremia between the PTLD and non-PTLD groups. The results showed that the difference between the two groups was statistically significant (P=0.018 and P=0.001) . The ROC curve was constructed to calculate the Youden index, and it was concluded that the EBV-DNA load ≥ 41 850 copies/ml after allogeneic hematopoietic stem cell transplantation had diagnostic significance for PTLD (AUC=0.847) , and the sensitivity and specificity were 0.611 and 0.932, respectively. The duration of EBV viremia of ≥20.5 d had diagnostic significance for PTLD (AUC=0.833) , with a sensitivity and specificity of 0.778 and 0.795, respectively. Conclusion: Dynamic monitoring of EBV load in high-risk patients with PTLD after haplo-HSCT and attention to its duration have important clinical significance, which can help clinically predict the occurrence of PTLD in advance and take early intervention measures.

Review on exposure characteristics and health effects of per- and poly-fluoroalkyl substances / 环境与职业医学

Per- and poly-fluoroalkyl substances (PFAS) are a new type of persistent organic pollutants that have received extensive attention in recent years. This article reviewed the population characteristics of environmental exposure to PFAS, as well as the potential health effects. Previous studies have verified that people are exposed to PFAS mainly through ingestion, and food and water are the dominant contributors. In terms of exposure characteristics, geographical, gender, age, and occupational differences have an impact on the level of PFAS exposure in the corresponding populations by influencing their behavioral characteristics and metabolic levels, with occupational exposure receiving more attention, especially in the exploration of novel PFAS. PFAS associate with a variety of adverse health effects caused by hepatorenal toxicity, immunotoxicity, reproductive toxicity, neurotoxicity, and carcinogenicity. However, some of the conclusions are not completely consistent, and the published epidemiological studies have focused on children and young people, lacking relevant data of the elderly. Future research can pay more attention to the elderly population and carry out validation exploration on controversial conclusions.

A clinical randomized controlled trail of an intelligent robot-assisted minimally invasive reduction system for treatment of unstable pelvic fractures / 中华创伤骨科杂志

Objective:To compare the short-term efficacy between our self-designed intelligent robot-assisted minimally invasive reduction system and conventional freehand reduction assisted by fluoroscopy in the treatment of unstable pelvic fractures by robot or fluoroscopy-assisted internal fixation with percutaneous screws.Methods:A prospective randomized controlled trial was conducted to include eligible 35 patients with unstable pelvic fracture who were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from December 2021 to October 2022. They were randomized into 2 groups. The observation group[17 cases, 10 males and 7 females with an age of (44.0±17.4) years] was treated with robot-assisted minimally invasive reduction, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws; the control group[18 cases, 12 males and 6 females with an age of (38.8±15.0) years] was treated with freehand reduction assisted by fluoroscopy, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws. The 2 groups were compared in terms of operation time, intraoperative bleeding, successful reduction, reduction quality, incidence of surgical complications and postoperative functional scores.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). The intraoperative fluoroscopy frequency[(32.4±17.5) times] and fluoroscopy time [(19.8±10.4) s] in the observation group were significantly lower or shorter than those in the control group [(60.8±26.6) times and (38.2±16.1) s], and the rate of successful reduction in the observation group was 100.0% (17/17), significantly higher than that in the control group[72.2% (13/18)] ( P<0.05). There was no significant difference between the 2 groups in intraoperative bleeding, operation time, reduction error, excellent and good rate of reduction after operation by Matta scoring, or Majeed functional score at 12 weeks after operation ( P>0.05). Conclusion:In the treatment of unstable pelvic fractures, since our self-designed intelligent robot-assisted minimally invasive reduction system can plan autonomously the reduction paths and accomplish minimally invasive reduction of the fracture with 3D images real-time monitoring, it is advantageous over conventional reduction methods in a higher success rate and less radiation exposure.

Comparison of efficacy and safety of BR regimen and R-CHOP regimen in the treatment of newly diagnosed follicular lymphoma / 中国综合临床

Objective:Compare the clinical efficacy and safety of bendamustine combined with rituximab (BR regimen) and rituximab combined with standard CHOP regimen (R-CHOP regimen) in the treatment of newly diagnosed follicular lymphoma (FL).Methods:Adopting a prospective case-control study method. 104 newly diagnosed FL patients admitted to Beijing Aerospace General Hospital from January 2018 to January 2022 were selected and randomly divided into an observation group and a control group using a random number table method, with 52 patients in each group. The observation group was treated with bendamustine combined with rituximab, while the control group was treated with rituximab combined with standard CHOP regimen. Both groups were treated for 6 consecutive courses of treatment, with a 21 day treatment period. Compare the serum lactate dehydrogenase (LDH) levels before and after treatment between two groups β 2-Microglobulin (β 2-microglobulin, β 2-MG level, improvement in quality of life after treatment, long-term survival, clinical efficacy, and incidence of adverse reactions. Measurement data is represented by paired t-tests for intra group comparisons, and independent sample t-tests for inter group comparisons; Counting data is represented as an example (%), and inter group comparisons are made using χ 2-test, Wilcoxon rank sum test was used for comparing rank data. Survival analysis was conducted using the Log Rank test. Results:After treatment, serum LDH and The levels of β 2-MG were lower than before treatment [LDH: (262.34±37.24) U/L ratio (323.45±44.46) U/L, (287.23±43.19) U/L ratio (318.28±52.35) U/L; β 2-MG: (2.72±0.30) mg/L compared to (3.45±0.37) mg/L, (2.93±0.28) mg/L compared to (3.37±0.42) mg/L, t-values of 7.60, 3.30, 11.05, 6.29, P values of <0.001, 0.001, <0.001, <0.001, <0.001], and the observation group was lower than the control group ( t-values of 3.15, 3.69, P values of 0.002, <0.001, respectively). After 6 courses of treatment, the quality of life in the observation group improved in 27 cases, stabilized in 22 cases, and decreased in 3 cases; The quality of life in the control group improved in 18 cases, stabilized in 26 cases, and decreased in 8 cases. The improvement of quality of life in the observation group was better than that in the control group ( Z=-2.03, P=0.042). The progression free survival period in the observation group was longer than that in the control group [52.53 months (95% confidence interval: 49.16-55.89 months) compared to 38.84 months (95% confidence interval: 32.44-45.24 months)], and the difference was statistically significant (Log Rank χ 2=4.06, P=0.044), there was no statistically significant difference in overall survival between the two groups ( P=0.217). The complete remission rate in the observation group was higher than that in the control group [88.46%(46/52) vs 71.15%(37/52)], χ 2=4.83, P=0.028], there was no statistically significant difference in objective response rates between the two groups ( P=0.485). The incidence of nausea, vomiting, leukopenia, neutropenia, alopecia, and fatigue in the observation group was lower than that in the control group, and the differences were statistically significant (all P<0.05). Conclusions:Both the BR regimen and R-CHOP regimen can significantly reduce serum tumor marker levels in the treatment of newly diagnosed FL. However, the BR regimen has a higher complete response rate, better patient quality of life, longer PFS, fewer toxic side effects, and more significant overall efficacy.

Genetic inhibition of MLKL exerts protective effects against cognitive impairment and neuroinflammation in a cerebral small vessel disease model / 中国药理学与毒理学杂志

OBJECTIVE To identify the role of mixed lineage kinase domain like protein(MLKL)in cerebral small vessel disease(CSVD)and explore the underlying mechanism.METHODS Transient bilateral common carotid artery occlusion(tBCCAO)was used to establish a mouse model of CSVD.Immunofluorescence staining and Western blotting were used to observe the expres-sions of RIPK3/MLKL signaling molecules in brain tissues at 7,14 and 28 d after tBCCAO.Open field test,rotarod test,Y-maze and novel object recognition test were used to observe the effect of MLKL knockout on cognitive func-tion after tBCCAO.Blood-brain barrier(BBB)disruption was observed by sodium fluorescein permeability test and the expressions of tight junction proteins.Immunoflu-orescence staining and Western blotting were used to detect the expression of microglia marker Iba-1,astro-cyte marker GFAP,and NLRP3/Caspase-1 signaling mol-ecules in the hippocampus of CSVD mice.ELISA was used to detect the level of inflammatory factors(TNF-α,IL-1β,IL-18)in hippocampus.RESULTS The expres-sions of RIPK3/MLKL signaling molecules increased in cortex and hippocampus after tBCCAO,especially on day 14.The expression of pMLKL mainly increased in neurons,glia cells and endothelial cells in CSVD mice.MLKL knockout improved the cognitive functions such as motor learning,spatial learning and working memory,and object recognition ability in CSVD mice.MLKL knock-out alleviated the leakage of sodium fluorescein and attenuated the down-regulation of tight junction proteins at 1 d and 14 d after tBCCAO.At 14 d after tBCCAO,MLKL knock out inhibited the activations of microglia and astrocytes,attenuated the expressions of NLRP3/cas-pase-1 molecules,and decreased the levels of inflamma-tory factors in the hippocampus of mice.CONCLUSION Genetic inhibition of MLKL exerts protective effects against cognitive impairment by ameliorating BBB dam-age and neuroinflammation in a mouse cerebral small vessel disease model.

Inhibition of subicular seizure-labeled c-fos+ neurons alleviates cognitive deficit in epilepsy / 中国药理学与毒理学杂志

OBJECTIVE Cognitive deficit is a com-mon comorbidity in temporal lobe epilepsy(TLE)and that is not well controlled by current therapeutics.Currently,how epileptic seizure affects cognitive performance remains largely unclear.The subiculum is the major out-put of the hippocampus,which projects to entorhinal cor-tex and other more distinct brain regions.Physiologically,the subiculum codes spatial working memory and naviga-tion information including place,speed,and trajectory.Importantly,prior studies have noted the importance of the subiculum in the beginning,spreading,and generaliz-ing process of hippocampal seizure.How seizure-activated neurons in subiculum participate in cognitive impairment remains largely elusive.METHODS In this study,we sought to label the subicular seizure-activated c-fos+ neu-rons with a special promoter with enhanced synaptic activity-responsive element E-SARE in the subiculum,combined with chemogenetics and designer receptors exclusively activated by designer drugs(DREADDs),Ca2+ fiber photometry approaches,and behavioral tasks,to reveal the role of these neurons in cognitive impairment in epilepsy.RESULTS We found that chemogenetic inhibi-tion of subicular seizure-tagged c-fos+ neurons(mainly CaMK Ⅱ α+ glutamatergic neurons)alleviates seizure generalization and improves cognitive performance in the hippocampal CA3 kindling TLE model.While inhibition of seizure-labeled c-fos+ GABAergic interneuron shows no effect on seizure and cognition.As a comparison,che-mogenetic inhibition of the whole subicular CaMK Ⅱ α+ neuron impairs cognitive function in na?ve mice in basal condition.Notably,inhibition of subicular seizure-tagged c-fos+ neurons enhances the recruitment of cognition-responsive c-fos+ neurons via increasing neural excitability during cognition tasks.CONCLUSION Our results dem-onstrate that subicular seizure-activated c-fos+ neurons contribute to cognitive impairment in TLE,suggesting sei-zure-tagged c-fos+ neurons as the potential therapeutic target to alleviate cognitive impairment in TLE.

Correlation analysis between muscle CT measurement parameters, energy expenditure and risk of acute exacerbation in patients with stable chronic obstructive pulmonary disease / 中国医师进修杂志

Objective:To explore the correlation between muscle CT measurement parameters, energy expenditure and acute exacerbation in patients with stable chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 146 patients with stable COPD from March 2020 to November 2021 in Lu′an Hospital Affiliated to Anhui Medical University (Lu′an People′s Hospital) were retrospectively analyzed. The clinical data were recorded; the lung function was measured by bronchodilator test. The cross-sectional area and CT value of the pectoral muscle were measured by reconstructed CT images of the mediastinum; the total energy consumption was calculated by Weir formula. Acute exacerbations within 3 and 12 months were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for acute exacerbation in patients with stable COPD. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of total energy expenditure, pectoral muscle cross-sectional area and pectoral muscle CT value for predicting acute exacerbation in patients with stable COPD.Results:Among 146 patients with stable COPD, 38 cases (26.03%) developed acute exacerbation within 3 months (acute exacerbation group), and 108 cases (73.97%) did not develop acute exacerbation (non-acute exacerbation group). The proportion of age<60 years old, rate of acute exacerbation within 12 months and rate of pulmonary function grading Ⅲ to Ⅳ in acute exacerbation group were significantly higher than those in non-acute exacerbation group: 71.05% (27/38) vs. 47.22% (51/108), 52.63% (20/38) vs. 30.56% (33/108) and 63.16% (24/38) vs. 37.96% (41/108), the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value were significantly lower than those in non-acute exacerbation group: (2 036.28 ± 163.13) J/d vs. (2 389.59 ± 204.71) J/d, (28.79 ± 3.45) cm 2 vs. (31.61 ± 4.56) cm 2 and (29.79 ± 3.06) HU vs. (34.52 ± 4.38) HU, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that age ≥60 years old, lower total energy expenditure, smaller pectoral muscle cross-sectional area and lower pectoral muscle CT value were independent risk factors for acute exacerbation in patients with stable COPD ( OR = 26.493, 1.015, 1.245 and 1.437; 95% CI 3.745 to 187.405, 1.008 to 1.022, 1.002 to 1.546 and 1.109 to 1.861; P<0.01 or <0.05). The ROC curve analysis result showed that combined prediction of the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value for acute exacerbation in patients with stable COPD had the largest area under the curve (0.962), with a sensitivity of 86.1%, a specificity of 80.8%, and the optimal cutoff values of 2 206.12 J/d, 32.39 cm 2 and 31.63 HU, respectively. Conclusions:The elderly age, smaller pectoral muscle cross-sectional area, lower pectoral muscle CT value and lower total energy expenditure are independent risk factors for acute exacerbation in patients with stable COPD. The combination of pectoral muscle cross-sectional area, pectoral muscle CT value and total energy expenditure has a good predictive effect on the risk of acute exacerbation in patients with stable COPD, and relevant indexes can be paid attention to in clinical treatment.

Enlightenment on the Construction of Medical Professionalism from the Perspective of Moral Injury / 中国医学伦理学

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries. Medical professionalism is a comprehensive expression of physician’s clinical abilities, relationships and values between different subjects. In practice, white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of "always centering on the interests of the patient" in specific diagnosis and treatment behaviors. At the same time, fulfilling the promises and expectations of medicine to the public. For these reasons, selfless dedication, self-sacrifice, and one-way pure altruism are all internalized into the basic requirements of medical professionalism: doctors should not only have the skill to revive the dead, but also have the benevolence of evangelists; they not only need to achieve maximum efficiency in technology, but also achieve the highest truth, goodness, and beauty in virtue. When these qualities are exaggerated or unattainable due to uncontrollable reasons, there will be a rift between the entrenched value systems and practical needs. In recent years, the global epidemic has had a huge impact on the medical system and medical staff, and the moral beliefs, role expectations, and value systems of doctors have also been impacted unprecedentedly, resulting in moral injury. The international research on moral injury in medical field has also received attention. China is currently in the adjustment period of epidemic related policies, with medical personnel bearing the brunt. Therefore, referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism, which emphasizes one-way pure altruism, dedication and weakening or even neglecting personal well-being, and current medical practices. And constructing a moral injury early warning-repair system that focuses on doctors, patients, medical teams, medical institutions, medical environments, health systems, and other stakeholders, and ensuring its healthy operation. Not only in extreme periods, but also in ordinary daily diagnosis and treatment, it can support doctors to actively, safely, and healthily fulfill their mission of saving lives and helping injuries.

Cellular and Molecular Mechanisms of Intestinal Fibrosis

Intestinal fibrosis associated stricture is a common complication of inflammatory bowel disease usually requiring endoscopic or surgical intervention. Effective anti-fibrotic agents aiming to control or reverse intestinal fibrosis are still unavailable. Thus, clarifying the mechanism underpinning intestinal fibrosis is imperative. Fibrosis is characterized by an excessive accumulation of extracellular matrix (ECM) proteins at the injured sites. Multiple cellular types are implicated in fibrosis development. Among these cells, mesenchymal cells are major compartments that are activated and then enhance the production of ECM. Additionally, immune cells contribute to the persistent activation of mesenchymal cells and perpetuation of inflammation. Molecules are messengers of crosstalk between these cellular compartments. Although inflammation is necessary for fibrosis development, purely controlling intestinal inflammation cannot halt the development of fibrosis, suggesting that chronic inflammation is not the unique contributor to fibrogenesis. Several inflammation-independent mechanisms including gut microbiota, creeping fat, ECM interaction, and metabolic reprogramming are involved in the pathogenesis of fibrosis. In the past decades, substantial progress has been made in elucidating the cellular and molecular mechanisms of intestinal fibrosis. Here, we summarized new discoveries and advances of cellular components and major molecular mediators that are associated with intestinal fibrosis, aiming to provide a basis for exploring effective anti-fibrotic therapies in this field.

Clinical Characteristics and Obstetric Outcomes of Pregnant Women Who Underwent Surgery for Adnexal Torsion / 中山大学学报(医学科学版)

ObjectiveTo explore the clinical characteristics and obstetric outcomes of pregnant women who underwent surgery for adnexal torsion at different gestational weeks. MethodsA retrospective study was done on 39 women who underwent surgery for adnexal torsion during pregnancy in the First Affiliated Hospital， Sun Yat-sen University between March 2013 and March 2023， with 18 cases in 1st trimester （<14 weeks）， 11 in 2nd trimester （14-27+6 weeks） and 10 in 3rd trimester （≥28 weeks）. The clinical characteristics， treatment and obstetric outcomes were compared among the three groups. ResultsThe 1st trimester group had higher proportion of assisted reproductive technology （ART） use than the 2nd and 3rd trimester groups （P=0.026）. There was no significant difference in the clinical manifestations， including abdominal pain， nausea， vomiting and fever among the three groups， while elevated white blood cells （WBC） counts was more commonly seen in the 2nd and 3rd trimester groups. Adnexal masses <5 cm in diameter occurred in 0， 18.2%， and 10.0% of cases in 1st， 2nd and 3rd trimester groups respectively （P=0.014）. No statistical significance was found in the location of twisted adnexa， number of circles or pathological nature. The 1st trimester group had a higher sensitivity of ultrasound in the diagnosis of adnexal torsion compared with the 2nd and 3rd trimester groups （77.8%， 36.4%， 20.0%； P=0.008）. More laparoscopic surgery were performed in the 1st trimester group than the other two groups （55.6% ， 27.3%， 0.0%； P=0.008）. There was no significant difference in gestational week of delivery， delivery mode， newborn gender， neonatal birth weight and follow-up of newborns among the three groups. The 3rd trimester group showed a higher risk of preterm delivery （P=0.050）. ConclusionsDuring the 1st trimester of pregnancy， adnexal torsion is more common in patients using ART and ultrasound plays a crucial role in the diagnosis. During the 2nd and 3rd trimester， adnexal torsion should be suspected in patients with abdominal pain and elevated WBC but no aspetic inflammation. Laparoscopic surgery is safe for adnexal torsion during pregnancy and can achieve a favorable maternal and neonatal outcome.

Feature Deconstruction Strategy Based Identification of Acute Features Associated With Impairment of Activities of Daily Living in Patients With Traumatic Brain Injury / 中山大学学报(医学科学版)

ObjectiveTo identify acute phase features associated with the prognosis of traumatic brain injury （TBI）. MethodsThrough two traditional strategies， correlation analysis and prediction model， and one innovative research strategy based on feature deconstruction， a retrospective analysis was conducted using demographic， acute phase and chronic phase features of 354 TBI patients to identify acute phase features associated with activities of daily living （ADL） in chronic phase of TBI. For feature deconstruction strategy， the LASSO （Least Absolute Shrinkage and Selection Operator） algorithm was used to build a prediction model that could effectively predict ADL based on non-ADL chronic phase features. The model could indicate the key chronic phase dimensions determining the ADL in TBI patients. We then identified demographic and acute phase variables that were significantly associated with these key chronic phase features. ResultsThe feature deconstruction strategy revealed that ADL could be deconstructed into chronic phase dimensions such as weak limbs in TBI population. Importantly， to the best of our knowledge， this strategy revealed for the first time the association of these important acute phase features with specific chronic phase impairment features. For example， TBI patients had a higher risk for chronic phase recent memory impairment if they had a prolonged coma time and low GCS scores at acute phase ［scaled coma time OR95%CI = 94.288 （35.095， 273.231）； scaled GCS OR95%CI = 0.068 （0.030， 0.147）］； the patients had a higher risk for insight impairment and disorientation at chronic phase if they had hydrocephalus at acute phase ［insight impairment OR95%CI = 6.760 （3.653，12.855） ； disorientation OR95%CI = 6.538 （3.530， 12.490）］. All strategies showed that the strongest risk factors for ADL damage in the chronic phase included prolonged coma time and low GCS scores as well as hydrocephalus. ConclusionThis study provides an innovative research strategy to establish the association between acute injury features and chronic recovery features， and to identify demographic and acute phase features associated with the prognosis of TBI.

Comparison of Diagnostic Performance Between PI-RADS v2.1 and PI-RADS v2 for Prostate Cancer: A Meta-analysis / 肿瘤防治研究

Objective To compare the diagnostic performance of PI-RADS v2.1 and PI-RADS v2 in the detection of clinically significant prostate cancer(csPCa) by Meta-analysis. Methods The major biomedical databases were searched (CNKI, CBM, Medline, and Embase) with the keywords "PIRADS v2.1" or "PI-RADS v2.1". The Quality Assessment of Diagnostic Accuracy Studies Tool v2 (QUADAS-2) was used to evaluate literature quality. Meta-analysis was performed using STATA17.0 and ReMan5.4 software. Forest plots were used to represent the sensitivity and specificity of PI-RADS v2.1 and PI-RADS v2 for each study. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were combined, and diagnostic performance was evaluated using asummary receiver operating characteristic curve (SROC). Subgroup analysis was performed on three covariables: tumor location, threshold, and the nationality of authors. Results A total of 12 studies were included, involving 3 158 patients and 3 243 lesions. Forall zones and the whole gland, PI-RADS v2.1 had a larger area under the SROC curve (AUC) for csPCa performance, compared with PI-RADS v2. Subgroup analysis: PI-RADS v2.1 also had a larger area under the SROC (AUC) to detect transitional zone csPCa. Different diagnostic thresholds: when a score of 4 was used for the threshold, PI-RADS v2.1 had the maximum area under SROC (AUC) for csPCa performance detection. Author nationality: Researches of PI-RADS v2.1 in Chinese authors had the largest area under the SROC (AUC) in detecting csPCa performance. Conclusion Compared with PI-RADS v2, the diagnostic performance of PI-RADS v2.1 in detecting csPCa is not obviously improved and overall specificity is still low.

Emotional and behavioral effects of after-school tutoring on school-age children in a district in Shanghai / 上海预防医学

ObjectiveTo explore the effects of after-school tutoring for school-age children on their emotions and behaviors， and to provide a basis for developing after-school tutoring and psychological support strategies for school-age children. MethodsFour elementary schools in a district of Shanghai were selected by simple random sampling method. Whole group sampling was conducted by class， and parents of students were surveyed by general questionnaire and the scale of strengths and difficulties. Information was collected on the basic conditions of children and families and the results were compared and analyzed. ResultsThis study showed that 88.26% of children attended extracurricular classes， of which 26.16% attended 3 or more classes， 42.5% attended cultural classes， 28.3% attended sports classes， and 59.8% attended art classes. Children who did not attend classes had higher pro-social scores. Children who attended reading class had lower scores for emotional problems that was a protective factor for emotional problems. Children who chose extracurricular programs in sports and reading also had lower overall scores for difficulties. Excessive use of electronic devices by school-age children on weekdays or weekends had a negative effect on emotional and conduct problem scores regardless of whether they chose extracurricular programs. It appeared that the choice of cultural programs， art programs and different levels of exercise intensity had no effect on children's emotions and behaviors. ConclusionFor children with low pro-social level， extracurricular classes should be carefully selected. For extracurricular classes， more reading and sports-related courses can be considered， which have positive effects on school-age children’s emotions and behaviors. Regardless of the choice of extracurricular classes， try to avoid excessive online classes.

Efficacy comparison of intravitreal injection of Conbercept versus Aflibercept in the treatment of pachychoroid neovasculopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe and compare the clinical efficacy and safety of intravitreal injection of conbercept or aflibercept in the treatment of pachychoroid neovasculopathy(PNV).METHODS:Retrospective case-control study. A total of 33 patients(35 eyes)diagnosed as PNV in our hospital from February 2018 to October 2022 were divided into 14 cases(14 eyes)in conbercept group and 19 cases(21 eyes)in aflibercept group according to the treatment methods. The best corrected visual acuity(BCVA), subfoveal choroidal thickness(SFCT)and central macular thickness(CMT), injection times and clinical complications of the two groups were compared before and 1, 3 and 6mo after treatment.RESULTS:BCVA, CMT and SFCT in both groups were significantly improved after 1, 3 and 6mo of treatment(all P&#x0026;#x003C;0.05). During the whole follow-up period, the number of intravitreal injections in the two groups were 2(2, 3)and 2(1.5, 2)respectively, and there was no significant difference(P=0.423). No serious complications occurred during the treatment of the two groups.CONCLUSION:Both intravitreal injections of conbercept and aflibercept can treat PNV with similar therapeutic effects. The desired clinical outcome is achieved by improving the anatomy while improving visual acuity.

Research progress of opaque bubble layer created in corneal stroma during femtosecond laser surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE)are the mainstream corneal refractive surgeries at present. Despite efficacy, safety and predictability they have showed in refractive error correction, there are still complications relating to femtosecond laser, such as suction loss and opaque bubble layer(OBL), due to that the production of corneal flap or lenticule is dependent on the femtosecond laser. OBL is a complication that is unique to femtosecond laser surgery and the bubbles are generated from photo-disruptive effect towards corneal tissues which consisted of water vapor and carbon dioxide, and OBL gradually formed when the bubbles are trapped in the stroma. The bubbles can influence the intraoperative manipulation and postoperative visual quality. This review discusses the mechanism, grading, classification, and influencing factors of OBL and its effects on intraoperative manipulations and postoperative recovery, in the hope of providing reference and basis for further clinical studies.

Research hotspots and trends of artificial intelligence in diabetic retinopathy based on bibliometrics and high-impact papers / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze research hotspots and trends of artificial intelligence in diabetic retinopathy(DR)based on bibliometrics and high-impact papers.METHODS: Papers on artificial intelligence in DR research published in the Web of Science Core Collection(WoSCC)from January 1, 2012, to December 31, 2022 were retrieved. The data was analyzed by CiteSpace software to examine annual publication number, countries, institutions, source journal, research categories, keywords, and to perform an in-depth analysis of high-impact papers.RESULTS: A total of 1 009 papers on artificial intelligence in DR from 79 countries were included in the study, with 272 papers published in 2022. Notably, China and India contributed 287 and 234 papers, respectively. The United Kingdom exhibited a centrality score of 0.31, while the United States boasted an impressive H-index of 48. Three prominent institutions in the United Kingdom(University of London, Moorfields Eye Hospital, and University College London)and one institution in Egypt(Egyptian Knowledge Bank)all achieved a notable H-index of 14. The primary academic disciplines associated with this research field encompassed ophthalmology, computer science, and artificial intelligence. Burst keywords in the years 2021～2022 included transfer learning, vessel segmentation, and convolutional neural networks.CONCLUSION: China emerged as the leading contributor in terms of publication number in this field, while the United States stood out as a key player. Notably, Egyptian Knowledge Bank and University of London assumed leading roles among research institutions. Additionally, IEEE Access was identified as the most active journal within this domain. The research focus in the field of artificial intelligence in DR has transitioned from AI applications in disease detection and grading to a more concentrated exploration of AI-assisted diagnostic systems. Transfer learning, vessel segmentation, and convolutional neural networks hold substantial promise for widespread applications in this field.