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Objective:To retrospectively analyze a pediatric case of X-linked hypophosphatemic rickets treated with Burosumab and improve clinicians′ awareness of the safety and effectiveness of the drug.Methods:Clinical data of the child were collected. Whole-exon genetic testing after parental consent confirmed X-linked hypophosphatemic rickets. During 18 months of Burosumab treatment, fasting blood phosphorus, alkaline phosphate, calcium, and calcium phosphate product were monitored every 11-14 days. Parathyroid hormone and 25 hydroxyvitamin D were checked every 2-6 weeks, while knee spacing, liver and kidney function, urinary calcium creatinine ratio, electrocardiogram were assessed every 3 months. Radiological imaging was performed every 6 months, with continuous follow-up of the child.Results:Whole-exon sequencing results showed a c. 1080_1081insCAATGTTA(p.T361Qfs*3) spontaneous heterozygous frameshift mutation in the PHEX gene in the child, which has not been reported previously. After the patient was treated with Burosumab for 18 months, the biochemical indexes were significantly improved, and the rickets score was reduced, without gingival abscess or other adverse events.Conclusion:The variant c. 1080_1081insCAATGTTA(p.T361Qfs*3) in the PHEX gene was identified as the cause of the patient′s condition. Burosumab, as a targeted therapeutic agent for X-linked hypophosphatemic rickets, showed significant treatment efficacy.
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ObjectiveTo explore the clinical characteristics of neurobrucellosis in Kashi, Xinjiang Uygur Autonomous Region, thus improve the diagnosis and treatment. MethodsA retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between December 2019 and January 2024. ResultsThe study included 9 males and 9 females, with a median age of 36 years (range: 17-54.5). A clear epidemiological history was found in all the 18 brucllosis patients, 12 of whom presented with meningoencephalitis, 5 meningitis, and 1 encephalitis. Two comorbided with spinal meningitis, 2 osteoarthritis and 1 epididymitis. Most frequently reported clinical symptoms were headache, fever and fatigue. The prevalence rates of brucellosis by rose bengal plate agglutination test (RBPT) and serum agglutination test (SAT) were 11/12 and 8/9, respectively. Two of 10 patients had positive blood cultures, four of 16 had positive cerebrospinal fluid (CSF) cultures and five of five were detected to be positive by next-generation sequencing (NGS) for pathogens in CSF. CSF showed exudative changes and elevated number of leukocytes, with predominance of single nucleated cells. All patients were treated with the combined use of two to four from the drugs like doxycycline, rifampicin, ceftriaxone, cefixime, minocycline, levofloxacin and sulfanilamide. Most patients had a favorable prognosis. ConclusionsNeurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas. If there are exudative changes in CSF, differential diagnoses can be made by serological testing, blood culture, CSF culture and NGS. NGS could significantly increase the accuracy for neurobrucellosis diagnosis.
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In recent years, there have been increasing reports of embolism or thrombosis in children with Mycoplasma pneumoniae pneumonia, and in severe cases, it can lead to disability or even endanger life.The coagulation dysfunction and thrombosis caused by Mycoplasma pneumoniae infection affect multiple organs, so it is necessary to pay attention to the early warning role of coagulation related indicators in severe and suspected cases.This article mainly summarizes the progress on coagulation abnormalities and thrombosis caused by Mycoplasma pneumoniae pneumonia both domestically and internationally in recent years.It reviews the coagulation abnormalities and blood related indicators caused by Mycoplasma pneumoniae pneumonia, with the aim of early detection and treatment, preventing related complications, and improving the quality of life in children.
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Objective To compare the efficacy and safety of pig-tail catheter-assisted 6.5 F guiding catheter and 6 F guiding catheter in transradial interventional treatment of coronary artery lesions.Methods A total of 390 patients with coronary artery lesions,who received percutaneous coronary intervention(PCI)at the Xijing Hospital of Air Force Medical University of China between January 2021 and June 2022,were enrolled in this study.By using the random number table method the patients were divided into pig-tail catheter-assistance group(n=130),6.5 F sheath group(n=130)and 6 F sheath group(n=130).The success rate of the guiding catheter being inserted in place,radial artery spasm,forearm pain or discomfort,forearm hematoma,radial artery wound compression time,hemostasis success rate,postoperative radial artery diameter,resolution time of distal swelling,pseudoaneurysm,and incidence of radial artery occlusion were compared between each other among the three groups.Results The differences in the time of guiding catheter being inserted in place,radial artery wound compression time,forearm hematoma,hemostasis success rate,postoperative radial artery diameter and incidence of radial artery occlusion between each other among the three groups were not statistically significant(all P>0.05).The differences in the intraoperative radial artery spasm and forearm pain or discomfort between 6.5 F sheath group and 6 F sheath group were not statistically significant(both P>0.05).The degrees of radial artery spasm and forearm pain or discomfort in the pig-tail catheter-assistance group were remarkably lower than those in the 6.5 F sheath group and 6 F sheath group(both P<0.05).Conclusion In transradial PCI,the use of 6.5 F guiding catheter carries the same safety and effectiveness as the use of 6 F guiding catheter,while the use of pig-tail catheter-assisted 6.5 F guiding catheter can improve radial artery spasm and reduce forearm pain.(J Intervent Radiol,2023,32:1174-1177)
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Objective:To investigate the microecological structure changes and correlation in blood, lung tissue and fecal intestine of mice with sepsis and acute lung injury.Methods:A total of 12 healthy male C57BL/6J mice were divided into the cecal ligation and perforation (CLP) group and sham operation (sham) group by random number table method, with six mice in each group. In the CLP group, acute lung injury model of sepsis mice was prepared by CLP method. In the sham group, only laparotomy but no perforation of cecal ligation was performed. Eye blood, lung tissue, and feces were collected from mice in each group 24 h after surgery. Lung tissue morphological changes were observed by HE staining, and 16s ribosome RNA sequencing was used to analyze the structural changes of microecology of the bacterial flora at each site in sepsis mice and find out the correlation.Results:(1) HE staining showed that mice in the CLP group had exudation into the alveolar cavity of the lung, disordered lung tissue structure, accompanied by a large number of inflammatory cell infiltration, and the lung histopathological score was significantly higher than that in the sham group ( P < 0.01). (2)α diversity analysis showed that there was no statistical significance in blood and fecal samples between the sham group and CLP group, while Ace index, Chao index and Simpson index in lung tissue samples were statistically significant ( P < 0.05). (3) β diversity analysis showed that the differences in blood and fecal samples were greater between the sham group and CLP group than that within the group, and analysis of Bray Curtis, weighted, and unweighted indexes were statistically significant ( P < 0.05). (4) At the phylum level, compared with the sham group, the abundance of Proteobacteria gradually increased, and the abundance of Firmicutes and actinobacteria was decreased in the CLP group. At the genus level, the sham group was dominated by Acinetobacter and Duchenne, while the CLP group was dominated by Escherichia coli and unclassified Enterobacter. Blood flora was more similar to lung tissue flora composition as compared with fecal flora. Conclusions:The distribution of bacterial flora in blood, lung tissue and intestine of sepsis mice with acute lung injury is partially overlapped.
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Objective:To observe the dynamic changes of soluble programmed cell death protein 1 (sPD-1) and cellular immunity and humoral immunity in patients with sepsis and septic shock, and to explore the relationship between sPD-1 and immunosuppression in sepsis.Methods:This study was a prospective cohort study. Patients with sepsis and septic shock admitted to the ICU of General Hospital of Ningxia Medical University from June 2018 to December 2018 were included as the study subjects, ordinary postoperative patients admitted to the ICU during the same period were included as the non-sepsis group, and healthy volunteers matched in age and sex were included as healthy controls. The sPD-1, lymphocyte count, serum immunoglobulin and lymphocyte subsets of peripheral blood on the first, third and seventh days after admission to the ICU were detected. The changes of sPD-1 and various immune indices in each group were compared, and the correlation between the indices was analyzed. For healthy controls and non-sepsis patients, only blood samples were tested on the day of inclusion.Results:A total of 90 patients [58 males and 32 females, aged (58.36±17.46) years] were included in this study, including 29 cases of sepsis, 31 cases of septic shock, 15 cases of non-sepsis, and 15 volunteers were recruited as healthy control group. The 28-day fatality rate of patients in the sepsis and septic shock groups was 28.3%. On the first day of ICU admission, the sPD-1 concentration were significantly higher in the septic shock group and sepsis group than those in the non-sepsis group and healthy control group [512.64 (216.85, 1039.41) pg/mL vs. 261.90 (191.96, 421.99) pg/mL vs. 191.56 (151.26, 232.66) pg/mL vs. 200.51 (162.14, 241.26) pg/mL, all P<0.05]. The sPD-1 concentration in the septic shock group was significantly higher than that in the sepsis group, and this phenomenon persisted for at least one week ( P<0.05). The lymphocyte count on the first day in the sepsis and septic shock groups were significantly lower than those in the healthy control and non-sepsis groups (all P<0.05), and the lymphocyte count in the septic shock group remained lower levels until the seventh day of ICU admission (all P<0.05). The percentage of lymphocytes and total T lymphocytes in the sepsis and septic shock groups were significantly lower than those in the healthy control and non-sepsis groups (all P<0.05), while the percentage of total B lymphocytes did not differ between groups (all P>0.05). The percentage of CD8+ T lymphocytes on the seventh day of ICU admission in the septic shock group was still significantly lower than that in the sepsis group [(18.36±2.23)% vs. (28.28±2.97)%, P<0.05]. The levels of serum immunoglobulin IgG and IgM were significantly lower in the sepsis and septic shock group than those in the healthy control and non-sepsis groups (all P<0.05), and the IgG and IgM in the sepsis and septic shock groups returned to normal on the seventh day of ICU admission. The area under the ROC curve was used to evaluate the predictive value of sPD-1 on poor prognosis, and the results showed that sPD-1 on the seventh day of ICU had a good predictive value for 28-day prognosis in patients with sepsis and septic shock, and the best cut-off value was 286.52 pg/mL, with a sensitivity of 100.00% and specificity of 56.25%. Conclusions:Immunosuppression occurs in patients with sepsis and septic shock in the early stage, and the duration of immunosuppression in patients with septic shock is prolonged, but humoral immunosuppression plays a major defense in the early stage, and cellular immunosuppression is dominant in the later stage.
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Objective:To study the impacts of pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM) and gestational weight gain (GWG) on perinatal outcomes and mode of delivery.Methods:From November 2016 to December 2017, single-pregnancy women in early pregnancy (<13 weeks) regularly checked-up at our hospital were enrolled in this prospective cohort study and followed up until delivery. They were assigned into four groups according to pre-pregnancy BMI: obese group (≥28.0 kg/m 2), overweight group(24.0-<28.0 kg/m 2), normal group (18.5-<24.0 kg/m 2) and underweight group(<18.5 kg/m 2). A 75-g oral glucose tolerance test was performed at 24-28 weeks of pregnancy to screen for GDM. The optimal GWG was 11.0-16.0 kg for underweight group, 8.0-14.0 kg for normal group, 7.0-11.0 kg for overweight group and 5.0-9.0 kg for obesity group. The effects of pre-pregnancy BMI, GDM and GWG on perinatal outcomes and delivery mode were evaluated using multivariate logistic regression methods. Results:A total of 802 pregnant women were included. The incidences of pre-pregnancy overweight and obesity were 21.8% and 8.9%, respectively. The incidence of GDM was 14.1%. 57.2% of the participants experienced excessive GWG. The incidences of macrosomia, low birth weight and premature birth were 7.1%, 2.7% and 2.2%, respectively. The incidence of Cesarean delivery (C-section) was 37.7%. Pre-pregnancy obesity [adjusted odds ratio ( AOR)=4.355, 95% confidence interval ( CI) 1.900-9.980] and excessive GWG ( AOR=3.799, 95% CI 1.796-8.034) were independent risk factors for macrosomia. Excessive GWG was a protective factor for low birth weight ( AOR=0.279, 95% CI 0.084-0.928) and inadequate GWG was a risk factor for low birth weight ( AOR=10.954, 95% CI 3.594-33.382) and premature birth ( AOR=8.796, 95% CI 2.628-29.438). Compared with the normal group, overweight group had an increased risk of C-section ( AOR=1.817, 95% CI 1.119-2.949). Compared with pregnant women without pre-pregnancy overweight/obesity, GDM nor excessive GWG, any combination of two of the above-mentioned three factors increased the risks of macrosomia ( AOR=3.908, 95% CI 1.630-9.370) and C-section ( AOR=2.269, 95% CI 1.325-3.886). The risks of macrosomia and C-section were the highest when all three factors existed. Conclusions:Pre-pregnancy obesity and excessive GWG are independent risk factors for macrosomia and pre-pregnancy overweight is a risk factor of C-section. Exposure to any two of the three factors (pre-pregnancy overweight/obesity, GDM and excessive GWG) increases risks of macrosomia and C-section and the highest risk is observed when all three factors are present.
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Objective@#The aim of the study was to investigate the association of outdoor physical activity and insomnia symptoms with depressive symptoms in college students, so as to provide a theoretical basis for preventing and improving depression of the college students.@*Methods@#A sample survey of 9 349 college students from 4 colleges and universities in 3 provinces in Hubei, Jiangxi and Chongqing were conducted from November to December 2021. The Patient Health Questionnaire, Insomnia Severity Index and outdoor physical activity questionnaire were used to evaluate the depressive symptoms, insomnia symptoms and outdoor activities of college students, respectively. The χ 2 test was used to compare the difference of the positive rate of depressive symptoms in college students. Logistic regression analysis was used to analyze the association between outdoor physical activity, insomnia symptoms and depressive symptoms. Generalized linear model was used to analyze the association of interaction effect of outdoor activity and insomnia symptoms with depressive symptoms.@*Results@#The detection rate of depressive symptoms in college students was 37.4%. Significant differences in the detection rate of depressive symptoms were observed among college students with different majors, nationalities,educational backgrounds, family residence, family type, family economic conditions, study burden, number of friends, father s education level,mother s education level( P <0.05). Logistic regression analysis showed that outdoor physical activity ( OR=0.51-0.69, P <0.01) and insomnia symptoms ( OR=6.15-21.30, P <0.01) were associated with depressive symptoms( P <0.01). Generalized linear model showed that insomnia symptoms( B =0.57), outdoor physical activity ( B =-0.15) and their interaction terms ( B =-0.02) were associated with college students depression( P <0.05).@*Conclusion@#This study suggests that insufficient time for outdoor physical activity and insomnia symptoms may increase the risk of depressive symptoms in college students. College students with insufficient time for outdoor physical activity and insomnia have a higher risk of developing depressive symptoms.
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【Objective:】 Third-party research participants recruitment companies and their recruitment businesses are in the ascendant. To analyze the current situation of company construction, clinical trial application, and ethical review, and discuss and propose ethical management suggestions based on work experience. 【Methods:】 The recruitment of research participants related to the projects approved by the ethics committee in our hospital in the past two years was investigated by questionnaire to comprehend and analyze the data of the third-party recruitment company in construction, application, and ethical review. 【Results:】 This paper found the problems of the third-party recruitment company in the application of clinical trials, the company’s own construction, and the standardization of ethical review, and analyzed the phenomenon and causes of the problems based on work experience. 【Conclusion:】 Although the application of third-party recruitment companies is becoming more and more extensive, it is still in a mixed state of pros and cons. It is necessary for all parties to work together to further standardize and constrain them, so as to protect the rights and interests of research participants and effectively support clinical trial research.
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【Objective】 To analyze the efficacy of scrotum cold compress combined with antibiotics on necrospermia patients with seminal tract infection. 【Methods】 We made a retrospective analysis of the patients who were confirmed as necrospermia by more than 2 times of semen examination and positive by sperm bacteria culture at the Andrology Department of our center from January 2019 to September 2022. The experiment group patients who were cured by scrotum cold compress combined with sensitive antibiotics and L-carnitine were divided into experiment group A (1 time/day) and experiment group B (2 times/day) according to the daily times of scrotum cold compress. Meanwhile, only sensitive antibiotics and L-carnitine were administered in the control group patients. We recorded the improvement of sperm parameters and the number of negative sperm bacterial cultures in different groups at 4 weeks, 8 weeks, and 12 weeks of treatment. 【Results】 A total of 145 patients were enrolled in the study. According to the principle of randomization, 49 patients in group A, 49 patients in group B, and 47 patients in the control group were enrolled. After 4 weeks of treatment, there was no significant difference between the experiment group and the control group in terms of abstinence time, the number of negative sperm bacterial cultures, semen pH, sperm ratio of forward motility, or the sperm survival rate (all P>0.05). In terms of the sperm survival rate, group B (53.1±14.1) was superior to group A (46.2±16.4) (P<0.05). In the results of the treatment at 8 weeks, the number of negative sperm bacterial cultures was significantly higher in the experiment group (74/98) than in the control group (26/47) (χ2=5.14, P<0.05). Sperm ratio of forward motility was higher in the experiment group (26.5±11.9) than in the control group (22.8±12.6). The experimental group (53.1±14.6) also had a significantly higher sperm survival rate than the control group (47.6±13.4) (P<0.05). However, the number of negative sperm bacterial cultures, sperm ratio of forward motility, and the sperm survival rate were lower in experiment group A (35/49, 25.5±10.3, 51.1±15.0) than in experiment group B (39/49, 27.5±13.2, 55.1±14.2), but there was no statistical difference between the two groups (all P>0.05). After 12 weeks of treatment, the number of negative sperm bacterial cultures in the experimental group (67/98) was significantly higher than that in the control group (21/47) (χ2=6.11, P<0.05). Sperm ratio of forward motility in the experiment group (30.9±11.2) was higher than that in the control group (24.7±13.4) (P<0.05). The experiment group (56.3±13.0) had a significantly higher sperm survival rate than the control group (46.7±12.0, P<0.01). However, in terms of the number of negative sperm bacterial cultures, sperm ratio of forward motility, and the sperm survival rate, there were no statistical differences between group A (31/49, 28.8±10.0, 55.9±12.7) and group B (36/49, 32.8±12.1, 56.7±13.4) (all P>0.05). 【Conclusion】 Scrotum cold compress combined with antibiotics is superior to only antibiotic treatment on necrospermia patients with seminal tract infection, especially in the sperm ratio of forward motility and sperm survival rate, but it has little relationship with the times of cold compressions per day. Therefore, the method deserves application in this type of patients’ diagnosis and treatment.
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PurposeEnhanced understanding of the dynamic changes in the dysregulated inflammatory response in COVID-19 may help improve patient selection and timing for immunomodulatory therapies. MethodsWe enrolled 323 COVID-19 inpatients on different levels of baseline respiratory support: i) Low Flow Oxygen (37%), ii) Non-Invasive Ventilation or High Flow Oxygen (NIV_HFO, 29%), iii) Invasive Mechanical Ventilation (IMV, 27%), and iv) Extracorporeal Membrane Oxygenation (ECMO, 7%). We collected plasma samples upon enrollment and days 5 and 10 to measure host-response biomarkers. We classified subjects into inflammatory subphenotypes using two validated predictive models. We examined clinical, biomarker and subphenotype trajectories and outcomes during hospitalization. ResultsIL-6, procalcitonin, and Angiopoietin-2 were persistently elevated in patients at higher levels of respiratory support, whereas sRAGE displayed the inverse pattern. Patients on NIV_HFO at baseline had the most dynamic clinical trajectory, with 26% eventually requiring intubation and exhibiting worse 60-day mortality than IMV patients at baseline (67% vs. 35%, p<0.0001). sRAGE levels predicted NIV failure and worse 60-day mortality for NIV_HFO patients, whereas IL-6 levels were predictive in IMV or ECMO patients. Hyper-inflammatory subjects at baseline (<10% by both models) had worse 60-day survival (p<0.0001) and 50% of them remained classified as hyper-inflammatory on follow-up sampling at 5 days post-enrollment. Receipt of combined immunomodulatory therapies (steroids and anti-IL6 agents) was associated with markedly increased IL-6 and lower Angiopoietin-2 levels (p<0.05). ConclusionsLongitudinal study of systemic host responses in COVID-19 revealed substantial and predictive inter-individual variability, influenced by baseline levels of respiratory support and concurrent immunomodulatory therapies.
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BackgroundSecondary infection (SI) diagnosis in COVID-19 is challenging, due to overlapping clinical presentations, practical limitations in obtaining samples from the lower respiratory tract (LRT), and low sensitivity of microbiologic cultures. Research QuestionCan metagenomic sequencing of plasma microbial cell-free DNA (mcfDNA-Seq) help diagnose SIs complicating COVID-19? Study Design and MethodsWe enrolled 42 inpatients with COVID-19 classified as microbiologically-confirmed SI (Micro-SI, n=8), clinically-diagnosed SI (Clinical-SI, n=13, i.e. empiric antimicrobials), or no clinical suspicion for SI (No-Suspected-SI, n=21) at time of enrollment. From baseline and follow-up plasma samples (days 5 and 10 post-enrollment), we quantified mcfDNA for all detected microbes by mcfDNA sequencing and measured nine host-response biomarkers. From LRT samples among intubated subjects, we quantified bacterial burden with 16S rRNA gene quantitative PCR. ResultsWe performed mcfDNA-Seq in 82 plasma samples. Sequencing was successful in 60/82 (73.2%) samples, which had significantly lower levels of human cfDNA than failed samples (p<0.0001). McfDNA detection was significantly higher in Micro-SI (15/16 [94%]) compared to Clinical-SI samples (8/14 [57%], p=0.03), and unexpectedly common in No-Suspected-SI samples (25/30 [83%]), similar to detection rate in Micro-SI. We detected culture-concordant mcfDNA species in 13/16 Micro-SI samples (81%) and mcfDNA levels tracked with SI outcome (resolution or persistence) under antibiotic therapy. McfDNA levels correlated significantly with LRT bacterial burden (r=0.74, p=0.02) as well as plasma biomarkers of host response (white blood cell count, IL-6, IL-8, and SPD, all p<0.05). Baseline mcfDNA levels were predictive of worse 90-day survival (hazard ratio 1.30 [1.02-1.64] for each log10 mcfDNA, p=0.03). InterpretationHigh circulating levels of mcfDNA in a substantial proportion of patients with COVID-19 without clinical suspicion for SI suggest that SIs may often remain undiagnosed. McfDNA-Seq, when clinically available, can offer a non-invasive diagnostic tool for pathogen identification, with prognostic value on host inflammatory response and clinical outcomes.
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Objective:To analyze the electrophysiological characteristics of subacute combined degeneration of spinal cord in 10 patients with nitrous oxide poisoning.Methods:Ten patients with nitrous oxide poisoning (case group) and 20 controls (control group)treated in Dalian Municipal Central Hospital Affiliated of Dalian Medical University from January 2016 to January 2020 were included in this study. MRI and electrophysiological examinations were performed on the head, cervical spine and thoracic spine, including distal motor latency (DML), motor nerve amplitude (CMAP), motor conduction velocity (MNCV), sensory conduction velocity (SNCV), sensory nerve amplitude (SNAP), N20 latency of upper limb cortical somatosensory evoked potential and P40 latency of lower limb cortical somatosensory evoked potential. The above indexes were compared between the two groups.Results:In the case group, DML of motor nerve was prolonged, MNCV was slowed down, CMAP was decreased, SNCV was slowed down and SNAP was decreased compared with the control group, the differences were statistically significant ( P<0.05). The incubation periods of N20 and P40 in the case group were longer than those in the control group: (32.70 ± 3.34) ms vs. (18.85 ± 1.37) ms, (57.00 ± 4.08) ms vs. (38.40 ± 1.54) ms, the differences were statistically significant ( t = 16.20, 18.20, P<0.01). The inverted "V" type T 2 long signal of cervical spinal cord and thoracic spinal cord could be seen on MRI of cervical or cervical and thoracic vertebrae in 5 patients. Conclusions:Nitrous oxide poisoning can cause obvious subacute combined degeneration of spinal cord, involving peripheral nerve and spinal cord damage. Peripheral nerve damage can involve motor fibers and sensory fibers, mainly axonal damage, accompanied by demyelination damage, especially in both lower limbs.
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Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapies (CBT) on the cognitive function and alcohol craving in patients with alcohol dependence.Methods:From March 2019 to September 2021, a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group (rTMS+ sham CBT, n=41), CBT treatment group (CBT+ sham rTMS, n=34), rTMS+ CBT treatment group( n=36) and control group (sham rTMS+ sham CBT, n=39). At baseline (before treatment), 2nd week, 8th week, 12th week and 24th week, alcohol dependence scale (ADS) was used to evaluate the degree of alcohol dependence, the obsessive compulsive drinking scale (OCDS) was used to assess patients' drinking craving, and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS, OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis. Results:(1)The patients in the four groups were evaluated with ADS scale at baseline, 12th week and 24th week respectively.The interaction of group×time( F=1.279, P=0.279) and the main effect of group were not significant ( F=0.882, P=0.454), and the main effect of time was significant ( F=12.925, P<0.001) .Further simple effect analysis showed that the ADS score of rTMS+ CBT group was lower than that of baseline(14.48±5.70, 10.00±6.51) ( P=0.01) at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline, 2nd week, 8th week, 12th week and 24th week, and the interaction of group×time was significant ( F=2.015, P=0.042). Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+ CBT group at each follow-up time node were lower than those at baseline period (all P<0.05). (3)Patients in the four groups were assessed with MoCA scale at baseline, 8th week, 12th week and 24th week, and the interaction of group×time was not significant ( F=1.660, P=0.106), and the main effect of group and the main effect of time were significant ( F=2.964, P=0.038; F=14.239, P<0.001). Further simple effect analysis showed that the score of MoCA scale in CBT group at the 24th week was higher than that at baseline (21.73±5.81, 24.60±3.98)( P=0.029), the score of MoCA scale in rTMS+ CBT group at the 24th week was higher than that at the 8th week (23.50±6.01, 25.95±2.87) ( P=0.006), and the score of MoCA scale in rTMS group at the 12th week was higher than that in control group (22.08±6.64, 26.64±2.46)( P=0.009). Conclusion:rTMS combined with CBT can be effective in improving alcohol craving and cognitive function in patients with alcohol dependence, and has a good long-term effect.
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Objective:To explore the effectiveness, safety and cost between urinary follicle stimulating hormone (uFSH) and recombinant follicle stimulating hormone (rFSH) in controlled ovarian stimulation (COS) in China.Methods:Data were collected from 16 reproductive centers in China covering oocytes collection time from May 1, 2015 to June 30, 2018. Eligible patients were over 18 years old, adopting COS with uFSH (uFSH group) or rFSH (rFSH group) as start gonadotropins (Gn), and using in vitro fertilization (IVF) and (or) intracytoplasmic sperm injection for fertilisation, excluding frozen embryo recovery cycle. Generalised estimating equation was used to address the violation of independency assumption between cycles due to multiple IVF cycles for one person and clustering nature of cycles carried out within one center. Controlling variables included age, body mass index, anti-Müllerian hormone level, cause of infertility, ovulation protocol, type of fertilisation, number of embryos transferred, number of days of Gn use.Results:Totally 102 061 cycles met eligibility criteria and were included in the analyses. In terms of effectiveness, after controlling relevant unbalanced baseline characteristics, compared with rFSH group, the high oocyte retrieval (>15 oocytes was considered high retrieval) rate of uFSH group significantly decreased in gonadotropin-releasing hormone agonist protocol ( OR=0.642, P<0.01) and in gonadotropin-releasing hormone antagonist protocol ( OR=0.556, P=0.001), but the clinical pregnancy rate per transfer cycle and the live birth rate per transfer cycle significantly increased ( OR=1.179, OR=1.169, both P<0.01) in both agonist and antagonist protocols. For safety, multiple analysis result demonstrated that in the agonist protocol, compared with rFSH group, the incidence of moderate to severe ovarian hyperstimulation syndrome of uFSH group significantly decreased ( OR=0.644, P=0.002). The differences in ectopic pregnancy rate and multiple pregnancy rate between the uFSH and rFSH groups were not significant ( P=0.890, P=0.470) in all patients. In terms of cost, compared with rFSH group, the uFSH group had lower total Gn costs for each patient ( P<0.01). Conclusion:For patients who underwent COS, uFSH has better safety, and economic profiles over rFSH in China.
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Objective:To develop a model of stellate ganglion block (SGB) in mice and investigate the effect of SGB on cerebral cortical blood flow.Methods:Thirty clean-grade healthy male C57BL/6 mice, aged 8-9 weeks, weighing 23-27 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), left SGB group (group L), left normal saline group (group SL), right SGB group (group R) and right normal saline group (group SR). Group C received no intervention.SGB was performed with 0.25% ropivacaine 0.08 ml via percutaneous posterior approach in L and R groups, while the equal volume of normal saline 0.08 ml was given instead at the location of left and right stellate ganglion in SL and SR groups, respectively.The cerebral cortical blood flow was determined using laser speckle contrast imaging system before SGB (T 0) and at 10, 30, 60, 90 and 120 min after SGB (T 1-5). Results:Mice developed ptosis on the block side, indicating that the model of SGB was successfully developed in L and R groups.There was no significant difference in cerebral cortical blood flow at each time point among C, SL and SR groups ( P>0.05), and cerebral cortical blood flow on the block side decreased at T 1, began to increase at T 2, peaked at T 3, and decreased at T 5 which was still higher than that at T 0 in group L and group R ( P<0.01). Compared with C and SL groups, the left cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group L ( P<0.01). Compared with C and SR groups, the right cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group R ( P<0.01). There were no significant differences in cerebral cortical blood flow at each time point between group C and group SL and between group C and group RL ( P>0.05). Conclusions:The mouse model of SGB via percutaneous posterior approach is successfully developed.Unilateral SGB can affect cerebral cortical blood flow on the block side, which shows a transitory decrease followed by a sustained significant increase.
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Objective:To investigate the protective effect of carbon monoxide releasing molecule 2 (CORM-2) on intestinal barrier by regulating the differentiation of T lymphocytes in rats with hemorrhagic shock.Methods:Healthy male Sprague-Dawley rats ( n=56) were randomly (random number) divided into the sham operation group, shock group, dimethyl sulfoxide (DMSO) control group, inactivated carbon monoxide release molecule-2 (iCORM-2) pretreatment group and three pretreatment CORM-2 with the doses of 2, 4 and 6 mg/kg separately. The hemorrhagic shock was induced with the use of a modified Wiggers model. Rats in the CORM-2 group and iCORM-2 group were intraperitoneally injected with CORM-2 with the doses of 2, 4 and 6 mg/kg and 6 mg/kg iCORM-2 instantly before shock induction. Rats in the DMSO group received intraperitoneal administration of 2% DMSO with the same volume of iCORM-2. Rats in the shock group and sham operation group were not pretreated before inducing shock. Mean arterial pressure of each rat was recorded at different phases after catheterization or shock. Twenty-three hours after shock induction, the permeability of intestinal barrier was measured by FITC-dextran flux, and then ileum tissues were harvested to observe histopathologic changes. Immunohistochemistry was used to detect the expression of transcription factors T-bet and Foxp3 of intestinal mucosa in rats, and the expression of interferon-γ (IFN-γ), interleukin-10 (IL-10) and transforming growth factor-β (TGF-β) in intestinal mucosa was measured by Western blot. One-way analysis of variance or Kruskal Wallis rank sum test was used to compare the difference among groups for normal or non-normal distributed data. Results:Compared with the sham operation group, serum concentrations of FITC-dextran were significantly increased in the shock group, DMSO group and iCORM-2 group (all P<0.05). The concentrations of FITC-dextran in serum of three CORM-2 pretreatment groups pretreatment were significantly decreased compared with other groups undergoing shock (all P<0.05). Rats in the shock group, DMSO group and iCORM-2 group showed severe ileum injury. CORM-2 intervention resulted in alleviation of intestinal mucosal injury in rats with shock, and rats in groups pretreatment CORM-2 at the doses of 4 and 6 mg/kg exhibited integrity of anatomic ileac structure. Compared with the sham operation group, T-bet levels of intestinal intraepithelial lymphocytes were increased in shock group and DMSO group (all P<0.05). Compared with the shock group, levels of T-bet were decreased in intestinal epithelium of three groups pretreatment with CORM-2 at the doses of 2, 4 and 6 mg/kg (all P<0.05). Foxp3 levels in intestinal intraepithelial lymphocytes of the iCORM-2 group and two groups pretreatment with CORM-2 at the doses of 4 and 6 mg/kg were increased compared with the shock group and DMSO group (all P<0.05), but there was no significant difference among the shock group, DMSO group and group pretreatment with CORM-2 at 6 mg/kg (all P>0.05). The shock group showed increased expression of IFN-γ (all P<0.05), but unchangeable expression of IL-10 and TGF-β (all P>0.05) compared with the sham operation group. Compared with the shock group, the expression levels of IL-10 in three groups pretreatment with CORM-2 at the doses of 2, 4 and 6 mg/kg were significantly increased (all P<0.05), and the expression levels of TGF-β were increased in two groups pretreatment with CORM-2 at the doses of 4 and 6 mg/kg (all P<0.05). The expression of IFN-γ in group pretreatment with CORM-2 at 6 mg/kg was significantly decreased compared with the shock group ( P<0.05). Conclusions:CORM-2 inhibited the activation of type 1 helper T cells to decrease the expression of proinflammatory factors and upregulated the expression of anti-inflammatory factors. Thus, CORM-2 reduced gut inflammation and protected the intestinal barrier.
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Objective:To evaluate the risk factors for diaphragmatic dysfunction of patients with sepsis and septic shock, and the application value of bedside ultrasound.Methods:Patients with sepsis and septic shock in the Intensive Care Unit (ICU), General Hospital of Ningxia Medical University from January 2020 to May 2021 were prospectively recruited as the research subjects, general postoperative patients and healthy volunteers were admitted as postoperative control and normal control groups. General clinical data were collected, patients with sepsis and septic shock were dynamically observed high sensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6), serum albumin, transferrin, prealbumin levels, blood lactate, Pcv-aCO 2, ScvO 2, etc.; and indirect calorimetry was used to measure the resting energy level of the patient to calculate the missing energy value. Bedside ultrasound was used to dynamically evaluate the changes of diaphragm excursion (DE),inspiratory diaphragm thickness, and expiratory diaphragm thickness, to calculate relevant parameters. DE<10 mm or diaphragmatic thickness fraction (DTF) < 20% was diagnosed as diaphragmatic dysfunction. Results:(1) On day 1 in the ICU, the DE of the septic shock group, sepsis group and postoperative control group were significantly lower than that in the normal control group [10.3 (9.0, 13.6) mm, 12.3 (9.1, 15.0) mm, 12.9 (10.5, 15.7) mm vs. 22.0 (16.0, 24.6) mm, all P<0.05], and the incidence of DTF<20% was significantly higher than in the normal control group (32.7%, 41.9%, 33.3% vs. 0 %, all P<0.05), and the incidence of DE<10 mm in the septic shock group and sepsis group was significantly higher than that of postoperative control group and normal control group (36.7%, 35.5% vs. 10.0%, 0%, respectively, all P<0.05). On day 7, the DE in the septic shock group was significantly lower than that in the sepsis group [10.5 (6.8, 13.5) mm vs. 14.4 (10.6, 18.6) mm, P<0.05].(2) Correlation analysis of each index: The DE of patients with sepsis and septic shock on day 1, 3, and 7 was negatively correlated with the hs-CRP ( r=-0.253, -0.436, -0.455, all P<0.05); On day 3, DE was also negatively correlated with IL-6 ( r=-0.338, P=0.009); and DTF was negatively correlated with hs-CRP ( r=-0.375, P=0.004). On day 1, there was a positive correlation between DTF and serum transferrin levels in patients with sepsis and septic shock ( r=0.221, P=0.049). On day 3 and 7, the DE was positively correlated with serum prealbumin levels ( r=0.318, 0.408, both P<0.05). Conclusions:Patients with sepsis and septic shock have developed diaphragmatic dysfunction on day 1 in the ICU, which is mainly manifested as decreased in diaphragm mobility and diaphragmatic thickness fraction, and is related to inflammation and high protein catabolism.
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Objective@#To analyze the incidence and trends for incidence of stroke in Jinhua City from 2015 to 2020, so as to provide insights into stroke control.@*Methods@#The data pertaining to incidence of stroke among registered residents in Jinhua City from 2015 to 2020 were collected from Zhejiang Provincial Information Management System for Surveillance on Chronic Diseases. The incidence of stroke was estimated and standardized to the Sixth National Population Census in 2010. The trend in incidence of stroke was evaluated using annual percent change (APC).@*Results@#Totally 120 993 stroke cases were reported in Jinhua City from 2015 to 2020, and the annual mean crude incidence and standardized incidence of stroke were 415.68/105 and 339.67/105, respectively. There were no significant trends in crude incidence (APC=0.30%, t=0.234, P=0.827) and standardized incidence of stroke (APC=-0.99%, t=0.946, P=0.398). The crude incidence of stroke was significantly higher in men than in women (457.38/105 vs. 372.62/105; χ2 =1 262.329, P<0.001), and the crude incidence of stroke appeared a tendency towards a rise with age (χ2 trend=377 708.263, P<0.001), with a tendency towards a decline among residents at ages of 75 years and older (APC=-2.66%, t=3.078, P=0.037). There were 94 038 residents with ischemic stroke (77.72%) and 24 176 residents with hemorrhagic stroke (19.98%), and both the crude incidence (APC=1.78%, t=3.440, P=0.026) and standardized incidence of hemorrhagic stroke (APC=2.66%, t=3.911, P=0.017) appeared a tendency towards a decline.@* Conclusions@#The incidence of stroke remained relatively stable in Jinhua City from 2015 to 2020; however, the overall incidence was still high. Ischemic stroke was the predominant type of stroke, and men and middle-aged and elderly people are at high risk of stroke.
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BACKGROUND: Bone grafting is an important surgical procedure to reconstruct alveolar bone defects in patients with cleft lip and palate. Polyphosphate (PolyP) is a physiological polymer present in the blood, primarily in platelets. PolyP plays a role as a phosphate source in bone calcium phosphate deposition. Moreover, the cleavage of high-energy bonds to release phosphates provides local energy necessary for regenerative processes. In this study, polyP is complexed with calcium to form Calcium polyP microparticles (Ca-polyP MPs), which were shown to have osteoinductive properties in preclinical studies. The aim of this study was to evaluate the feasibility, safety, and osteoinductivity of Ca-polyP MPs, alone or in combination with BCP, in a first-in-human clinical trial. METHODS: This single-blinded, parallel, prospective clinical pilot study enrolled eight adolescent patients (mean age 18.1: range 13-34 years) with residual alveolar bone cleft. Randomization in two groups (four receiving Ca-polyP MPs only, four a combination of Ca-polyP MPs and biphasic calcium phosphate (BCP)) was performed. Patient follow-up was 6 months. Outcome parameters included safety parameters and close monitoring of possible adverse effects using radiographic imaging, regular blood tests, and physical examinations. Osteoinductivity evaluation using histomorphometric analysis of biopsies was not possible due to COVID restrictions. RESULTS: Due to surgical and feasibility reasons, eventually, only 2 patients received Ca-polyP MPs, and the others the combination graft. All patients were assessed up to day 90. Four out of eight were able to continue with the final assessment day (day 180). Three out of eight were unable to reach the hospital due to COVID-19 restrictions. One patient decided not to continue with the study. None of the patients showed any allergic reactions or any remarkable local or systematic side effects. Radiographically, patients receiving Ca-polyP MPs only were scored grade IV Bergland scale, while patients who got the BCP/Ca-polyP MPs combination had scores ranging from I to III. CONCLUSIONS: Our results indicate that Ca-polyP MPs and the BCP/Ca-polyP MPs combination appear to be safe graft materials; however, in the current setting, Ca-polyP MPs alone may not be a sufficiently stable defect-filling scaffold to be used in alveolar cleft repair. TRIAL REGISTRATION: Indonesian Trial Registry under number INA-EW74C1N by the ethical committee of Faculty of Medicine, Hasanuddin University, Makassar, Indonesia with code number 1063/UN4.6.4.5.31/PP36/2019 .