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Objective:To compare the clinical features, X-ray, CT, MRI imaging findings of C 3, 4 single segment cervical spondylotic myelopathy among the elderly group, the middle-aged group and the young group. Methods:The medical records and imaging data of 51 cases of single segment C 3, 4 cervical spondylotic myelopathy treated from January 2017 to December 2021 were retrospectively reviewed. There were 10 cases in the young group, including 8 males and 2 females, 23-44 years, with an average age of 35.8±7.62 years; 14 cases in the middle-aged group, including 9 males and 5 females, 48-60 years, with an average age of 53.21±4.14 years; 27 cases in the elderly group, including 24 males and 3 females, 61-84 years, with an average age of 68.04±5.97 years. Based on the medical record data, the differences in clinical manifestations among the three groups (initial symptoms, symptom distribution, pathological sign distribution and JOA score) were analyzed. Based on the imaging data, the static factors (cervical osteophyte, alignment and thickness of cervical ligamentum flavum) and dynamic factors [overall cervical range of motion (ROM), individual segment cervical ROM, cervical instability and cervical nuchal ligament calcification] were analyzed. Anatomical factors (C 2-C 7 Cobb angle, C 4-C 7 Cobb angle, C 3 vertebral canal diameter, C 4 vertebral diameter, C 3 Pavlov ratio, C 4 Pavlov ratio) and spinal cord compression (spinal cord signal, compression position and compression nature) were also analyzed. Results:There were no statistically significant difference in gender distribution and height in three groups of patients ( P>0.05). In terms of clinical manifestations, there were statistically significant differences among the three groups in initial symptoms and chief symptoms ( P<0.05). The elderly group had upper limb weakness as the first symptom, lower limb weakness and abnormal gait as the chief complaint; the middle-aged group had upper limb numbness as the first symptom, upper limb numbness and weakness as the chief complaint; the young group had upper limb pain as the first symptom, upper limb numbness as the chief complaint. There were statistically significant differences in Hoffmann sign and Babinski sign among the three groups ( P<0.05). Hoffmann sign and Babinski sign were more common in the elderly group than in the young group ( P<0.05). There were significant differences among the three groups in total JOA score, JOA score of motor and lower limb motor JOA ( P<0.05). The total JOA score in the elderly group was lower than that in the young group ( P<0.05), especially for motor JOA score ( P<0.05), and lower limb motor JOA score ( P<0.05). There were no significant differences in first symptoms distribution, symptoms distribution, biceps reflex, triceps reflex, radial reflex or knee tendon reflex among the three groups ( P>0.05). In terms of static factors, there was significant difference in alignment and thickness of cervical ligamentum flavum among the three groups (P<0.05). The elderly group was more prone to slip than the young and middle aged groups ( P<0.05). The thickness of ligamentum flavum in the elderly group (2.18±0.68 mm) was thicker than that in the young group (1.60±0.30 mm) and the middle-elderly group (1.60±0.62 mm) ( P<0.05). There was no significant difference in cervical osteophyte among the three groups ( P>0.05). In terms of dynamic factors, there were statistically significant difference in C 3-C 7 ROM, C 4-C 7 ROM, C 3, 4 ROM and ossification of nuchal ligament among the three groups ( P<0.05). In the elderly group, C 3-C 7 ROM (22.18°) was larger than that in the young group (21.27°) ( P<0.05), while in the elderly group C 4-C 7 ROM (9.60°) was smaller than that in the young group (14.19°) ( P<0.05). In the elderly group, C 3, 4 ROM (15.30°) was larger than that in the young group (9.97°) ( P<0.05), and the elderly group was more prone to nuchal ligament calcification than the young and the middle-elderly group ( P<0.05). There were no significant difference among the three groups in C 4, 5 ROM, C 5, 6 ROM, C 6, 7 ROM or cervical instability ( P>0.05). For spinal cord compression, there were statistically significant differences among the three groups in the compression nature, compression location and MRI T2WI spinal cord signal ( P<0.05). The elderly group was more prone to anterior and posterior bony compression. The elderly group was more likely to show high signal intensity on spinal cord MRI T2WI than the young group ( P<0.05). For anatomical factors, there were statistically significant differences in C 2-C 7 Cobb, C 3 vertebral diameter and C 3 Pavolv among the three groups ( P<0.05) . The C 2-C 7 Cobb of the elderly group (21.06°) was larger than that of the young group (16.45°) ( P<0.05), and the C 3 diameter of the elderly group (9.61±0.33 mm) was smaller than that of the young group (10.38±1.19 mm) ( P<0.05). The C 3 Pavolv of the elderly group (0.52±0.03) was lower than that of the young group (0.59±0.11) ( P<0.05). In the presence of lordosis, C 4-C 7 Cobb in the elderly group (4.96°±4.05°) was smaller than that in the young group (12.42°±4.83°) and the middle-aged group (10.07°±6.14°) ( P<0.05). In the presence of kyphosis, C 4-C 7 Cobb in the elderly group (4.02°±1.19°) was larger than that in the young group (0.06°±0.01°) and the middle-aged group (1.83°±0.93°) ( P<0.05). There were no significant differences in C 3-C 7 Cobb, C 4 vertebral diameter or C 4 Pavolv among the three groups ( P>0.05). Conclusion:Young patients mostly have anteriorly soft compression of disc herniation, and most of them complain of neck and upper limb pain, while spinal cord compression and clinical manifestations are relatively mild. For the elderly patients, most of them have C 3 retrolisthesis, with the pinching type bony compression of spinal cord from both anteriorly and posteriorly, and their complaints are usually upper limb numbness, mostly accompanied by radiographically severe spinal cord compression and clinically gait abnormalities. In the middle-aged patients, the rigid compression of anterior calcified disc herniation is the main reason, and the numbness of upper limb is the chief complain.
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Objective:To investigate the prognostic value of metabolic parameters of 18F-fluorodeoxyglucose ( 18F-FDG) positron emission computed tomography/computed tomography(PET/CT) in advanced non-small cell lung cancer(NSCLC) treated with first-line immune checkpoint inhibitor (ICI) combined with chemotherapy. Methods:A retrospective study was conducted to evaluate patients with advanced NSCLC who underwent baseline PET/CT before treatment at the Affiliated Cancer Hospital of Zhengzhou University from 2019 to 2021. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-offs for metabolic parameters of PET/CT, including total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and maximum standard uptake value (SUV max). Kaplan-Meier method, Log-rank test, and Cox regression model were used to calculate the overall survival (OS) and the progression-free survival(PFS). Results:A total of 44 patients were enrolled. Univariate analysis showed that the factors influencing PFS were TMTV and the number of metastatic sites ( χ2=4.19, 11.28, P<0.05) and the factors influencing OS were TMTV and TLG ( χ2=14.96, 6.05, P<0.05). Multivariate analysis suggested that number of metastatic sites was an independent prognostic marker for PFS ( P=0.011) and TMTV was an independent prognostic marker for OS ( P=0.038). Conclusions:TMTV is a prognostic indicator of OS while the number of metastatic sites is a prognostic indicator of PFS in advanced NSCLC patients who received first-line ICI combined with chemotherapy, but further prospective studies are needed.
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Objective:To analyze the conventional quality control result of Leksell Icon Gamma Knife cone-beam CT and evaluate long-term stability of cone-bem CT.Methods:QA TOOL Plus was used to verify the accuracy of cone-beam CT. The phantom Catphan 503 was scanned, and the image spatial resolution, contrast to noise ratio and homogeneity were analyzed.Results:The maximum deviation in image volume of cone-beam CT was 0.09-0.17 mm, which passed the accuracy test. At the scanning patterns with CT dose index of 2.5 and 6.3 mGy, the spatial resolution was very stable at 7 and 8 lp/cm respectively. The contrast noise ratio and uniformity meet the reference requirements.Conclusions:The conventional quality control results of Leksell Icon Gamma Knife cone-beam CT are stable in 12 months. In addition to referring to the manufacturer′s baseline value, the unified analysis and evaluation standard for Gamma Knife need to be further improved for the quality control of cone-beam CT.
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The military vocational education is facing the reform under the background of "Internet +" education. O2O teaching is a model that combines the online teaching resource platform with the offline traditional education, and it is consistent with the development trend of contemporary military vocational education. In this study, we analyze the comparative advantages of O2O teaching model in military vocational education, including the multi-dimensional teaching content, the interactive teaching method, and the autonomy of teaching design. In this model, students become the subject of learning, and the process of storing knowledge will be transformed into the application and creation of knowledge. This paper also elucidates the feasibility of O2O teaching in the military vocational education, and further discusses its design in application from the point of view of managers, teachers and learners.
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Objective To investigate radiation doses to examinees undergoing computed tomography (CT) scanning of different body parts (the head, chest, and abdomen) in medical institutions of Shijiazhuang, China, and to provide a reference for optimizing radiation protection for examinees in medical institutions. Methods March 2021 to March 2022, eleven medical institutions of radiation monitoring in Shijiazhuang were surveyed for the basic information, scanning parameters, and dosimetric data of a total of 930 adults and children who received CT examinations. The dosimetric data of the subjects were analyzed and compared with the domestic and international diagnostic reference levels and the results of other cities in China. Results In the above hospitals, the CTDIvol(P50) of CT subjects in children's group were 17.42-50.45 mGy, 2.13-14.01 mGy and 3.58-28.20 mGy, respectively. DLP(P50) ranges from 228.87 to 966.97 mGy·cm, 33.20 to 296.03 mGy·cm, and 74.90 to 926.53 mGy·cm, respectively. In the adult group, the CTDIvol(P50) in the head, chest and abdomen of CT subjects were 37.28-54.05 mGy, 6.43-14.99 mGy and 8.28-18.75 mGy, respectively. DLP(P50) ranges from 372.81 to 630.56 mGy·cm, from 219.77 to 467.93 mGy·cm, and from 313.86 to 689.87 mGy·cm, respectively. The distribution of radiation doses in different-grade hospitals varied greatly. The abdomen dose of the children's hospital was higher than other hospitals. Especially the primary hospitals were significantly higher than the recommended diagnostic reference level (DRL). Conclusion In some secondary and primary hospitals, the setting of CT scanning parameters was simplified, not specific to the subjects’ age and body types. They should strictly comply with the principal of optimizing radiation protection to strengthen radiation dose optimization and supervision, reducing the radiation dose of examinees in future examinations .
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AIM: To detect the expression of interleukin(IL)-36(α, β, γ)in tears of patients undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT), investigate its correlation with ocular surface microenvironment, and further analyze the relationship between its expression and ocular graft-versus-host disease(oGVHD).METHODS: Prospective study. A total of 35 patients(70 eyes)underwent allo-HSCT in the hematology department of our hospital in January 2020 were selected, and 35 healthy volunteers(70 eyes)with appropriate age and gender were selected as normal control group. The patients in the allo-HSCT group were followed up 3 times after operation once every 3mo. The subjects with postoperative ocular symptoms were divided into oGVHD and Non-oGVHD group.Ocular surface disease index(OSDI)questionnaire, Schirmer test, tear break-up time(TBUT), corneal fluorescein staining(FL), and conjunctival impression cytology(CIC)was conducted in three groups. Furthermore, the expression levels of IL-36(α,β,γ)in tears were detected by ELISA.RESULTS: In the normal control group, IL-36(α, β, γ)expression levels were 74.32±5.27, 70.02±8.43, 97.41±8.66 pg/mL, respectively; in the allo-HSCT group, IL-36(α, β, γ)baseline expression levels were 77.27±7.03, 74.53±7.53, 100.77±9.74 pg/mL, with no statistically significant differences between the two groups(t=1.648, 1.954, 1.262, all P>0.05). There were no significant differences in IL-36α, IL-36β and IL-36γ in Non-oGVHD group at different time points(P>0.05), while there were significant differences in IL-36α, IL-36β and IL-36γ in oGVHD group at different time points(P<0.05). Compared with Non-oGVHD group, the levels of IL-36α and IL-36β at different time points were significantly increased in oGVHD group(all P<0.05).IL-36(α, β, γ)of oGVHD group was positively correlated with OSDI score, FL and CIC, while it was negatively correlated with TBUT and Schirmer test(all P<0.05).CONCLUSION: Evaluation of levels of tear IL-36(α, β, γ)can be of significance in diagnosing oGVHD after allo-HSCT. IL-36(α, β, γ)is highly expressed in the tears of oGVHD patients before the onset of ocular symptoms, and it is correlated with the ocular surface parameters.
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Objective: To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma, based on anatomic studies and surgeries. Methods: Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen. The anatomical landmarks and the extent of exposure were recorded. Six clinical cases who were treated in Eye & ENT Hospital, Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages, including 3 males and 3 females, aged 42 to 69 years old. Descriptive analysis was used in this research. Results: On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle, this approach could fully expose the parapharyngeal, petrosal and paraclival segment internal carotid arteries, and safely deal with the lesions of jugular foramen and petroclival region. The 6 patients in our study tolerated the procedure well. Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction. Conclusion: Endoscopic transoral approach is a safe, minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.
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Male , Female , Humans , Adult , Middle Aged , Aged , Nasopharyngeal Carcinoma , Jugular Foramina , Neoplasm Recurrence, Local , Endoscopy/methods , Nasopharyngeal Neoplasms/surgeryABSTRACT
Objective:To investigate the effect of the 3t sensorial saturation in the application of relieving pain and comfort due to femoral vein blood sampling in preterm infants, so as to provide the reference for the selection of clinical nursing plans.Methods:This was a quasi experimental study. A total of 110 preterm infants admitted to the neonatal unit of Shanxi Children′s Hospital from August 2021 to March 2022 were selected and divided into the control group and intervention group with 52 cases respectively by the random number table method. The control group implemented conventional care, and the intervention group implemented the 3t sensorial saturation method including taste, touch and talk on the basis of the control group. The pain and comfort of two groups were evaluated by the Premature Infant Pain Profile (PIPP) and COMFORTneo Scale at 3 min before, during, and 3 min after blood, and the heart rate and SpO 2 of the two groups were compared. Results:Finally, 52 premature infants were included in both groups. The PIPP score, the total score of the COMFORTneo Scale, the heart rate and SpO 2 were 2.00 (1.00, 3.00), 6.50 (6.00, 7.75), 4.00 (3.00, 5.00), 7.00 (6.00, 8.00), 17.00 (15.00, 19.00), 9.50 (9.00, 10.00) points, (137.29 ± 8.58), (148.31 ± 8.89), (143.06 ± 7.61) times/min, 0.980 (0.970, 0.990), 0.960 (0.950, 0.970), 0.980 (0.970, 0.990) in the intervention group, 2.00 (1.25, 3.00), 12.00 (11.00, 13.00), 7.00 (6.00, 8.00), 7.00 (6.00, 9.00), 25.00 (23.00, 27.00), 20.00 (19.00, 22.00) points, (141.54 ± 10.57), (179.71 ± 14.62), (162.00 ± 14.32) times/min, 0.980 (0.960, 0.990), 0.940 (0.920, 0.958), 0.960 (0.940, 0.978). The results of generalized estimating equation analysis showed that the PIPP score, total COMFORTneo Scale score and SpO 2 via different time points, subgroups, and subgroups with time points were statistically significant (Wald χ2 values were 16.72-2 489.71, all P<0.05). The results of two-factor repeated measures ANOVA showed that the interaction effects of heart rate via different time points, subgroups, and subgroups with time points were statistically significant ( F=253.08, 105.02, 77.17, all P<0.05). Conclusions:The 3t sensorial saturation method can effectively reduce pain during femoral vein blood sampling in preterm infants, can improve the comfort level of preterm infants, is conducive to the stabilization of vital signs in preterm infants, and is suitable for promotion and application in clinical care.
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Objective:To investigate the current situation of paternal self-efficacy of support breastfeeding of late prematurity and analyze the factors affectingpaternal self-efficacy of support breastfeeding.Methods:This study was a cross-sectional survey. From July to October 2021, the fathers of 210 late prematurity in Neonatology and NICU wards of Shanxi Children′s Hospital, were selected by convenience sampling method for the research object. The survey was carried out using the General Information Questionnaire, Iowa Infant Feeding Attitude Scale and Father Support Breastfeeding Self-Efficacy Scale-Short Form, multiple linear regression was used to analyze the influencing factors of paternal self-efficacy of support breastfeeding of late prematurity.Results:The total score of Father Support Breastfeeding Self-Efficacy Scale-Short Form was 46.22 ± 10.03, and the total score of Iowa Infant Feeding Attitude Scale was 59.31 ± 5.65, which were positively correlated ( r = 0.224, P<0.01). In the multiple linear regression analysis, whether or not to receive breastfeeding education, feeding methods, family opinions, and fathers′ attitudes towards breastfeeding were the main factors affecting fathers′ self-efficacy in supporting breastfeeding ( t values were - 3.07 to 2.35, all P<0.05). Conclusions:The paternal support breastfeeding of late prematurity level was at a lower level. It is suggested that medical staff should not only pay attention to puerpera and baby, but also pay attentionto father and family, and construct personalized health education based on co-parenting theory.
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Objective:To investigate the effect of self-made Bushen Jiangu Decoction on bone transformation markers in elderly patients with osteoporotic vertebral compression fracture after operation, and to evaluate the clinical efficacy.Methods:Prospective cohort study. A total of 92 patients with osteoporotic vertebral compression fracture after operation in Fangshan Hospital of Beijing University of Chinese Medicine from April 2020 to December 2021 who met the inclusion criteria were divided into 2 groups by random drawing method, with 46 in each group. The control group was treated with routine western medicine after operation, and the observation group was treated with self-made Bushen Jiangu Decoction on the basis of the control group. Both groups were treated for 3 months. TCM symptom scores were performed before and after treatment, and the prognosis of the patients was evaluated with the Chinese Osteoporosis Quality of Life (COQOL), VAS scale, and the Oswestry Dysfunction Index (ODI). The levels of amino terminal propeptide (PINP), cross-linked terminal peptide β special sequence (β-CTX) and bone morphogenetic protein 6 (BMP6) of type Ⅰ procollagen were determined by contrast chromogenic method with o-benzaldehyde. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 95.7% (44/46) in the observation group and 82.6% (38/46) in the control group, and there was a significant difference between the two groups ( χ 2=4.04 , P=0.044). After treatment, the scores of fracture nonunion, pain in back and loin, chilliness and lassitude, and pallor in the observation group were significantly lower than those in the control group ( t values were 4.84, 4.09, 4.87, 4.14, respectively, P<0.01). The scores of COQOL, VAS and ODI in the observation group were significantly lower than those in the control group ( t values were 6.26, 10.57 and 6.15, respectively, P<0.01). The levels of PINP [(44.93±5.86)μg/L vs. (49.76±6.02)μg/L, t=3.90] and β-CTX [(0.49±0.17) μg/L vs. (0.68±0.20) μg/L, t=4.91] in observation group were significantly lower than those in the control group after treatment ( P<0.05). The level of BMP6 [(81.23±9.14) μg/L vs. (75.14±8.25) μg/L, t=3.36] in observation group was significantly higher than that of the control group ( P<0.05). During the treatment,the incidence of adverse reactions in the observation group was 13.0% (6/46), while that in the control group was 8.7% (4/46), and there was no significant difference between the two groups ( χ 2=0.45, P=0.503). Conclusion:The self-made Bushen Jiangu Decoction combined with conventional western medicine therapy can adjust the level of bone transformation markers in elderly patients with osteoporotic vertebral compression fractures, improve the lumbar function and quality of life, and improve the clinical efficacy.
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Objective:To explore the therapeutic experience of early postoperative hemorrhage (EPOH) from pancreaticojejunal anastomosis after pancreaticoduodenectomy (PD).Methods:A retrospective review was conducted to summarize the clinical data of a typical case of EPOH from pancreaticojejunal anastomosis after PD in Binzhou Second People′s Hospital, and the main causes and treatment of EPOH were analyzed.Results:Due to reasons such as the slender pancreatic duct, the pancreatic duct was not found after twice transections of the pancreas during the surgery. To prevent poor pancreatic fluid drainage and related complications, the pancreatic stump was not effectively sutured, and a vertical mattress suture method was used for the pancreaticojejunal anastomosis. The patient developed severe EPOH on the surgery day. Due to the fact that the digestive tract reconstruction was a biliary pancreatic separation method, the cause of EPOH was diagnosed from pancreaticojejunal anastomosis through imaging and endoscopy. After active medical treatment, the patient recovered and was discharged.Conclusion:For the treatment of pancreatic stump after PD, precise suturing should be performed on the stump while ensuring smooth pancreatic duct drainage, in order to avoid EPOH from pancreaticojejunal anastomosis to the greatest extent possible.
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Objective:To investigate the expression of vitamin D receptor(VDR)in biliary epithelial cells of children with biliary atresia(BA)and explore the correlation between VDR epression levels and clinical pathological prognosis.Methods:A total of 48 BA patients who underwent Kasai surgery in the Pediatric Surgery Department of the Second Affiliated Hospital of Xi′an Jiaotong University from January 2017 to December 2020 with confirmed pathological results were selected as the study subjects.Immunohistochemistry was used to determine the expression of VDR in biliary epithelial cells, and Masson staining was used to determine the degree of liver tissue fibrosis.Based on the VDR expression levels, the 48 BA patients were divided into the significantly low VDR expression group(30 cases)and the normal/high expression group(18 cases).Laboratory testing results within 1 week before Kasai surgery and liver shear wave elastography(SWE)data were collected for all patients.Follow-up was conducted for a period of 0 to 60 months after Kasai surgery or liver transplantation, meanwhile, the occurrence of refractory cholangitis and auto-liver survival time were collected.Results:There was a negative correlation between the degree of liver fibrosis and SWE value in children with BA( r=-0.805, P<0.01).In comparison between the two groups, the significantly low VDR expression group had higher SWE values[(20.57±1.28)kPa vs.(18.02±1.41)kPa, P<0.05], higher liver injury biochemical indicators[ALT(215.8±24.7)U/L vs.(182.6±21.2)U/L, P=0.021; AST(165.4±22.3)U/L vs.(139.6±21.4)U/L, P=0.014], a higher frequency of post-Kasai surgery refractory cholangitis(60.00% vs.22.22%, P=0.037), and a shorter median autologous liver survival time(27.00 months vs.36.00 months, P=0.032)than those in the normal/high expression group. Conclusion:The significant decrease in VDR expression in biliary epithelial cells may serve as an indicator of poor prognosis in BA.
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Mycoplasma pneumoniae pneumonia is an important component of community-acquired pneumonia, which can cause severe extrapulmonary complications of digestive, cardiovascular, blood, urinary and other systems.Accurate and effective biomarkers are significant for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia.Recent studies have shown that new biomarkers such as IL-35, IL-17, neutrophil to lymphocyte ratio(NLR) and S100 protein are involved in the development of Mycoplasma pneumoniae pneumonia.In order to provide reference for the clinical diagnosis and treatment of Mycoplasma pneumoniae pneumonia, this paper reviews the progress of new biomarkers in Mycoplasma pneumoniae pneumonia.
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A large proportion of patients with non-small cell lung cancer (NSCLC) are diagnosed with metastatic and incurable advanced lung cancer at the time of discovery, so these patients are given no surgical opportunity and have a low 5-year survival rate. In the era of immunotherapy, many kinds of immune checkpoint inhibitors (ICIs) have been approved as the first/second-line treatment for patients with advanced NSCLC with negative driving genes and have been combined with radiotherapy as an important treatment strategy for patients with advanced NSCLC. The innovative strategy of combining radiotherapy and immunotherapy has shown feasibility as supported by practical evidence in clinical research. A preclinical experiment of observing the immune mechanism at the molecular and cellular levels preliminarily revealed the interaction among tumor, radiation, and immune system. This paper briefly reviews the progress of combined radiotherapy and immunotherapy in the treatment of advanced NSCLC with negative drvier genes.
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Acute-on-chronic liver failure (ACLF) is a type of complex clinical syndrome that is mainly characterized by acute deterioration of liver function based on chronic liver disease, hepatic and extrahepatic organ failures, and a high short-term mortality rate. The comprehensive medical treatment efficacy of ACLF is currently limited; thus, liver transplantation is the only viable potential treatment method. However, considering the severe liver donor shortage, economic and social costs, as well as the differences in disease severity and prognosis of different disease courses, it is particularly important to accurately assess the benefits of liver transplantation in patients with ACLF. Early identification and prediction, timing, prognosis, and survival benefits are discussed here by combining the latest research findings so as to optimize the liver transplantation treatment strategy for ACLF.
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Humans , Liver Transplantation , Acute-On-Chronic Liver Failure , Prognosis , Liver CirrhosisABSTRACT
Objective: To investigate the clinical, pathological and immunophenotypic features, molecular biology and prognosis of fibrin-associated large B-cell lymphoma (LBCL-FA) in various sites. Methods: Six cases of LBCL-FA diagnosed from April 2016 to November 2021 at the Beijing Friendship Hospital, Capital Medical University, Beijing, China and the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China were collected. The cases were divided into atrial myxoma and cyst-related groups. Clinical characteristics, pathological morphology, immunophenotype, Epstein Barr virus infection status, B-cell gene rearrangement and fluorescence in situ hybridization of MYC, bcl-2, bcl-6 were summarized. Results: The patients' mean age was 60 years. All of them were male. Three cases occurred in atrial myxoma background, while the others were in cyst-related background, including adrenal gland, abdominal cavity and subdura. All cases showed tumor cells located in pink fibrin clot. However, three cyst-related cases showed the cyst wall with obviously fibrosis and inflammatory cells. All cases tested were non germinal center B cell origin, positive for PD-L1, EBER and EBNA2, and were negative for MYC, bcl-2 and bcl-6 rearrangements, except one case with MYC, bcl-2 and bcl-6 amplification. All of the 5 cases showed monoclonal rearrangement of the Ig gene using PCR based analysis. The patients had detailed follow-ups of 9-120 months, were treated surgically without radiotherapy or chemotherapy, and had long-term disease-free survivals. Conclusions: LBCL-FA is a group of rare diseases occurring in various sites, with predilection in the context of atrial myxoma and cyst-related lesions. Cyst-related lesions with obvious chronic inflammatory background show more scarcity of lymphoid cells and obvious degeneration, which are easy to be missed or misdiagnosed. LBCL-FA overall has a good prognosis with the potential for cure by surgery alone and postoperative chemotherapy may not be necessary.
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Humans , Male , Middle Aged , Atrial Fibrillation , Epstein-Barr Virus Infections , Fibrin/genetics , Herpesvirus 4, Human/genetics , In Situ Hybridization, Fluorescence , Lymphoma, Large B-Cell, Diffuse/pathology , Myxoma , Proto-Oncogene Proteins c-bcl-2/genetics , Proto-Oncogene Proteins c-bcl-6/geneticsABSTRACT
Objective: To explore the changes in bacterial community structure, antibiotic resistance genome, and pathogen virulence genome in river water before and after the river flowing through Haikou City and their transmission and dispersal patterns and to reveal anthropogenic disturbance's effects on microorganisms and resistance genes in the aquatic environment. Methods: The Nandu River was divided into three study areas: the front, middle and rear sections from the upstream before it flowed through Haikou City to the estuary. Three sampling sites were selected in each area, and six copies of the sample were collected in parallel at each site and mixed for 3 L per sample. Microbial community structure, antibiotic resistance, virulence factors, and mobile genetic elements were analyzed through bioinformatic data obtained by metagenomic sequencing and full-length sequencing of 16S rRNA genes. Variations in the distribution of bacterial communities between samples and correlation of transmission patterns were analyzed by principal co-ordinates analysis, procrustes analysis, and Mantel test. Results: As the river flowed through Haikou City, microbes' alpha diversity gradually decreased. Among them, Proteobacteria dominates in the bacterial community in the front, middle, and rear sections, and the relative abundance of Proteobacteria in the middle and rear sections was higher than that in the front segment. The diversity and abundance of antibiotic resistance genes, virulence factors, and mobile genetic elements were all at low levels in the front section and all increased significantly after flow through Haikou City. At the same time, horizontal transmission mediated by mobile genetic elements played a more significant role in the spread of antibiotic-resistance genes and virulence factors. Conclusions: Urbanization significantly impacts river bacteria and the resistance genes, virulence factors, and mobile genetic elements they carry. The Nandu River in Haikou flows through the city, receiving antibiotic-resistant and pathogen-associated bacteria excreted by the population. In contrast, antibiotic-resistant genes and virulence factors are enriched in bacteria, which indicates a threat to environmental health and public health. Comparison of river microbiomes and antibiotic resistance genomes before and after flow through cities is a valuable early warning indicator for monitoring the spread of antibiotic resistance.
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Humans , Rivers , Virulence Factors/genetics , RNA, Ribosomal, 16S/genetics , Microbiota/genetics , Anti-Bacterial Agents , Drug Resistance, Microbial/geneticsABSTRACT
Objective: To analyze the drug resistance and genomic characteristics of a strain of serogroup O139 Vibrio cholerae producing cholera toxin isolated from the bloodstream of a person with bacteremia. Methods: The broth dilution method and automatic drug sensitivity analyzer were used to determine the antibiotic sensitivity of the strain. The complete genome sequence of the strain was obtained by using second-generation gene sequencing and nanopore sequencing. BLAST software was used for comparison and analysis with CARD, Resfinder, ISfinder, VFDB, and other databases. The drug-resistant genes, insertion sequences and virulence genes carried by the strain were identified. MEGA 5.1 software was used to construct a genetic phylogenetic tree based on the core genomic single nucleotide polymorphisms. Results: V. cholerae SH400, as the toxigenic strain, carried multiple virulence-related genes and four virulence islands. The strain was resistant to streptomycin, tetracycline and cotrimoxazole, carrying corresponding drug-resistant genes. The strain also carried IncA/C plasmid with the size of 172914 bp and contained 10 drug-resistant genes. Combined with the genomic evolutionary relationship, this study found that the drug-resistant genes and drug-resistant plasmids carried among strains showed certain aggregation. The traditional ST type of strain SH400 was ST69, and the cgMLST type was a new type highly similar to cgST-252. Conclusion: This strain of serogroup O139 V. cholerae carries the ctxAB gene, multiple drug-resistant genes and IncA/C plasmid, and there are multiple drug-resistant islands.
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Objective: To observe the clinical pathology features, and immune microenvironment of HER-2 intratumoral heterogeneity breast cancer. Methods: Thirty cases of HER-2 intratumoral heterogeneous breast cancer were retrospectively analyzed in Tianjin Medical University Cancer Institute and Hospital from November 2017 to June 2020. HER-2 expression was detected by immunohistochemistry and verified by dual color silver-enhanced in-situ hybridization (D-SISH). HER-2 intratumoral positive and negative regions were divided. The pathological characteristics, subtype, and the level of tumor infiltrating lymphocytes (TILs) and the expression of programmed cell death-ligand 1 (PD-L1) were evaluated respectively. Results: The proportion of HER-2 positive cells of the breast cancer ranged from 10% to 90%. The pathological type was mainly invasive non-special typecarcinoma. Six cases presented different pathological types between HER-2 positive and negative regions. The HER-2-positive areas included 2 cases of carcinoma with apocrine differentiation, and the negative areas included 2 cases of invasive micropapillary carcinoma, 1 case of invasive papillary carcinoma, and 1 case of carcinoma with apocrine differentiation. In HER-2 positive regions, 17 cases were Luminal B and 13 cases were HER-2 overexpressed types. There were 22 cases of Luminal B and 8 cases of triple negative tumors in the HER-2 negative areas. The levels of TILs in HER-2 positive and negative areas accounted for 53.3% (16/30) and 26.7% (8/30), respectively, with a statistically significant difference (P=0.035). The positive expression of PD-L1 in HER-2 positive area and HER-2 negative area were 6 cases and 9 cases, respectively. Among 8 cases with HER-2 negative regions containing triple negative components, 4 cases were positive for PD-L1 expression. Conclusions: In the case of HER-2 intratumoral heterogeneity, it is necessary to pay attention to both HER-2 positive and negative regions, and evaluate subtype separately as far as possible. For HER-2 intratumoral heterogeneous breast cancer containing triple negative components, the treatment mode can be optimized by refining the intratumoral expression of PD-L1.
Subject(s)
Humans , Female , Breast Neoplasms/pathology , Retrospective Studies , B7-H1 Antigen/metabolism , Lymphocytes, Tumor-Infiltrating/pathology , Carcinoma , Tumor Microenvironment , Triple Negative Breast Neoplasms/pathology , Prognosis , Biomarkers, Tumor/metabolismABSTRACT
The parabrachial nucleus (PBN) integrates interoceptive and exteroceptive information to control various behavioral and physiological processes including breathing, emotion, and sleep/wake regulation through the neural circuits that connect to the forebrain and the brainstem. However, the precise identity and function of distinct PBN subpopulations are still largely unknown. Here, we leveraged molecular characterization, retrograde tracing, optogenetics, chemogenetics, and electrocortical recording approaches to identify a small subpopulation of neurotensin-expressing neurons in the PBN that largely project to the emotional control regions in the forebrain, rather than the medulla. Their activation induces freezing and anxiety-like behaviors, which in turn result in tachypnea. In addition, optogenetic and chemogenetic manipulations of these neurons revealed their function in promoting wakefulness and maintaining sleep architecture. We propose that these neurons comprise a PBN subpopulation with specific gene expression, connectivity, and function, which play essential roles in behavioral and physiological regulation.