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The emerging SARS-CoV-2 variants have made great challenges to current vaccine and pandemic control strategies. B.1.1.529 (Omicron), which was classified as a variant of concern (VOC) by the World Health Organization on November 26th, 2021, has quickly become the dominant circulating variant and causing waves of infections. It is urgent to understand the current immune status of the general population given that pre-existing immunity has been established by national vaccination or exposure to past variants. Using sera from 85 individuals (including 21 convalescents of natural infection, 15 cases suffered a breakthrough infection after vaccination, and 49 vaccinated participants without infection history), we showed that the cross-neutralizing activity against VOCs such as Omicron can be detected in 53 (62.4%) cases, although less potent than against the Wuhan-1 strain (WT), with a 3.9-fold reduction in geometric mean neutralizing titer (GMT) (130.7, 95% CI 88.4-193.3 vs 506, 355.8-719.7, respectively). Subgroup analysis revealed significantly enhanced neutralizing activity against WT and VOCs in Delta convalescent sera. The neutralizing antibodies against Omicron were detectable in 75% of convalescents and 44.9% of healthy donors (p = 0.006), with a GMT of 289.5, 180.9-463.3 and 42.6, 31.3-59, respectively. However, the protective effect against VOCs was weaker in young convalescents (aged < 18y), with a detectable rate of 50% and a GMT of 46.4 against Omicron, similar to vaccinees. The pan-sarbecovirus neutralizing activities were not observed in vaccinated SARS-CoV-1 survivors. A booster dose significantly increased the breadth and magnitude of neutralization against WT and VOCs to different degrees than full vaccination. In addition, we showed that COVID-19 inactivated vaccines can elicit Omicron-specific T cell responses. The positive rates of ELISpot reactions were 26.7% (4/15) and 43.8% (7/16) in the full vaccination group and the booster vaccination group, respectively. The neutralizing antibody titers declined while T-cell responses remain robust over 6 months. These findings will inform the optimization of public health vaccination and intervention strategies to protect diverse populations against SARS-CoV-2 variants.
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Objective:To explore the clinical characteristics of autosomal dominant polycystic kidney disease (ADPKD).Methods:Clinical data of 103 patients with ADPKD first admitted to Renmin Hospital of Wuhan University from July 2017 to April 2021 were retrospectively analyzed. The clinical characteristics of patients in different renal function stages were analyzed, and multiple linear regression analysis was used to analyze the factors reflecting the severity of the disease.Results:Among the 103 patients with ADPKD, there were 49 males (47.6%), aged (51.23±10.99) years old. The extrarenal manifestation was mainly polycystic liver (64/71). The main clinical symptoms were gross hematuria (25 cases, 24.3%), lumbar distend and pain (37 cases, 35.9%) and hypertension (69 cases, 67.0%), appearing in the whole course of the disease. Early treatment was mainly drug conservative treatments (58 cases, 56.3%), followed by renal cyst aspiration (34 cases, 33.0%), and surgical treatments (11 cases, 10.7%). Patients in chronic kidney disease (CKD) stage 5 were mainly treated with conservative treatments (28/34). Laboratory examination results showed that hemoglobin, platelet, lymphocyte percentage and albumin in CKD stage 4-5 were lower than those in CKD stage 1-3 (all P<0.05) ; prothrombin time (PT), PT-international standardized ratio and plasma osmotic concentration in CKD stage 4-5 were higher than those in CKD stage 1-3 (all P<0.05). Multiple linear regression analysis showed that hemoglobin ( β=0.249, P=0.005), platelet ( β=0.207, P=0.005), lymphocyte percentage ( β=0.305, P<0.001) and plasma osmotic concentration ( β=-0.362, P<0.001) were correlated with estimated glomerular filtration rate. Conclusions:The clinical manifestations of ADPKD patients are hypertension, lumbar distend and pain, and gross hematuria, which can run through the whole stage of CKD. Polycystic liver is more common in extrarenal system. Hemoglobin, platelets, lymphocyte percentage and concentration osmotic concentration may be related to the disease progression of ADPKD.
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Objective:To search, evaluate and integrate the best evidence of exercise rehabilitation intervention after PCI in patients with acute myocardial infarction, so as to provide evidence-based basis for clinical doctors and nurses to intervene in exercise rehabilitation of patients.Methods:We searched PubMed, China National Knowledge Infrastructure, Wanfang Data and other domestic and foreign databases, guide websites and professional association websites about the evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI. The search period is from January 2010 to June 2021. The quality of the included literature was evaluated by two researchers, and the literature evidence in accordance with the quality standard was extracted.Results:A total of 20 articles were included, and 39 pieces of evidence were summarized from 11 aspects, such as the establishment of multidisciplinary team, evaluation, exercise prescription, exercise monitoring and so on.Conclusions:This study summarized the best evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI, and provided theoretical support for clinical practice. It is suggested to combine the clinical situation and patients' wishes to promote the transformation of the best evidence to clinical practice.
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Objective:To evaluate the practicability and effectiveness of nursing plan for elderly patients with urinary incontinence after operation.Methods:The patients admitted to the Department of Urology and Gynecology in a Grade 3A general hospital from September to October 2019 were selected as the control group, and the patients admitted from December 2019 to January 2020 as the intervention group. In the quasi-experimental study, the control group was given routine discharge guidance, and the intervention group was given a nursing plan for elderly patients with urinary incontinence to observe the preliminary effect of the nursing program for a period of 2 months.Results:Two months after implementation, the total scores of discharge preparation, quality of life and satisfaction of urinary incontinence in the intervention group was (125.08 ±17.64), (58.79 ±5.52) and (96.09 ±2.53) respectively, which were significantly different from those in the control group ( P<0.05). Conclusion:The preliminary verification of the scheme has a certain feasibility, has a certain guiding significance for nurses, and is helpful to improve the discharge preparation of elderly surgical patients with urinary incontinence and improve their satisfaction and quality of life when they are discharged.
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Objective:To explore the risk factors of acute kidney injury(AKI) in patients after radical nephrectomy.Methods:We retrospectively collected clinical information of 920 patients with renal cell carcinoma who underwent radical nephrectomy at Zhongshan Hospital, Fudan University from February 2013 to September 2017. There were 612 male and 308 female patients included in this study, with a median age of 60 (range from 20-75 years). 313 patients (34.0%) had hypertension, 132 patients (14.3%) had diabetes, and 111 patients (12.1%) had smoking history. 829 cases (90.1%) were in stage 1-2 for preoperative renal function staging, and 91 cases (9.9%) were in stage 3-5. Preoperative hemoglobin was lower than the lower limit of normal in 391 cases (42.5%), white blood cell count increased in 66 cases (7.2%), and platelet increased in 72 cases (7.8%). Albumin was lower than the lower limit of normal in 65 cases (7.1%), lactate dehydrogenase increased in 73 cases (7.9%). blood urea nitrogen increased in 48 cases (5.2%), uric acid increased in 123 cases (13.4%), and urinary protein was positive in 88 cases (9.7%). 496 cases (53.9%) underwent open surgery and 424 (46.1%) underwent laparoscopic surgery. The changes in serum creatinine were followed up within 48 hours after surgery. AKI was defined according to the KDIGO standard. Logistic regression was used to analyze the risk factors for postoperative stage 2-3 AKI in patients.Results:Stage 1-3 AKI occurred on 627, 42 and 10 patients during hospitalization, respectively. Univariate analysis showed that diabetes ( OR=2.34, P=0.01), positive urine protein ( OR=2.22, P=0.04), and elevated white blood cell count ( OR=2.54, P=0.02) were significantly associated with postoperative stage 2-3 AKI. Multivariate logistic regression analysis showed that diabetes ( OR=2.51, P=0.01) and elevated white blood cell count ( OR=2.69, P=0.02) were independent risk factors for postoperative stage 2-3 AKI. Conclusion:Renal cell carcinoma patients with diabetes or preoperative elevated white blood cell count are more likely to develop stage 2-3 AKI after radical nephrectomy.
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Objective:To evaluate the expression of Vimentin and its relationship with clinical pathological data and prognosis in patients with metastatic renal cell carcinoma (mRCC).Methods:A total of 269 mRCC patients, from June 2007 to June 2017, treated with tyrosine kinase inhibitors (TKI) in Zhongshan Hospital, Fudan University were included in the study. Vimentin was assessed by immunohistochemistry on continuous paraffin embedded slides. To analyzed the relationship between Vimentin expression and clinicopathological data and prognosis. Measurement data were expressed as mean±standard deviation ( Mean± SD). The relationship between Vimentin expression and clinicopathological data of mRCC patients was determined by Chi-square test. Survival analysis used Kaplan-Meier survival curve, Log-rank test to judge the relationship between Vimentin expression and patient′s overall survival, and COX regression analysis was used for univariate and multivariate analysis. Results:Vimentin was expressed in cytoplasm of tumor cells. Vimentin expression in mRCC patients′ tissues was positively correlated with tumor Fuhrman grade ( P=0.002), and negatively correlated with prognostic overall survival ( P=0.001). Multivariate regression analysis showed that Vimentin expression was an independent risk factor for overall survival in patients with mRCC ( P=0.006). Conclusions:Vimentin expression can be used as a prognostic indicator of mRCC. It is expected that Vimentin can provide prediction for the prognosis of mRCC patients treated with TKI.
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Objective To investigate the principles of diagnosis and treatment of non-hereditary bilateral synchronous renal cell carcinoma.Methods This retrospective study analyzed 36 cases of non-hereditary bilateral synchronous renal cell carcinoma in our hospital from January 2008 to December 2016,including 30 males and 6 females.A total of 74 renal tumors were found,in which 34 patients had bilateral single kidney tumor and 2 patients had two tumors in one kidney.The diameter of tumors ranged from 1 cm to 11 cm,with an average of (6.8 ±4.1)cm.The patients that underwent nephron-sparing surgery(NSS) got 4-12 points,with an average of (6.1 ±3.4) points in R.E.N.A.L.score and 3-13 points,with an average of (6.9 ± 3.7) points in Zhongshan score.The patients are classified into 4 groups according to operation methods.In group A,16 patients underwent bilateral NSS,which the preoperative creatinine was 63-103 μmol/L with an average of (80.9 ± 11.4) μmol/L.In group B,7 patients underwent one side of NSS before contralateral radical nephrectomy (RN),which preoperative creatinine was 59-87 μmol/L with an average of (75.7 ± 8.9)μmol/L.In group C,7 patients underwent one side of RN before contralateral NSS,preoperative creatinine was 57-107 μmol/L,with an average of (77.6 ± 19.2) μmol/L.In group D,6 patients underwent one side of NSS or RN and spare the contralateral side,2 of which shifted from NSS to RN after finding tumor invaded pelvis and upper ureter during surgery.Of all the 16 patients with bilateral NSS,4 patients underwent surgery on the side where tumor had a higher score in the first phase and then the side where tumor had a lower score in the second phase,11 underwent surgeries in an opposite order.One patient underwent bilateral NSS simultaneously.Group A,B and C are taken into final analysis.Result All the 30 patients underwent surgery successfully.The operation time of NSS ranged from 60 to 110 min with an average of (88.6 ± 23.6) min and RN ranged from 40 to 90 min with an average of (72.3 ± 21.4) min.The warm ischemia time of NSS was 12-40 mins with an average of (29.5 ± 9.7)min.The creatinine of Group A was 62-117 μmol/L with an average of (89.4 ± 15.8) μmol/L and 57-392 μmol/L with an average of (129.6 ±74.9)μmol/L one month after the first and second surgery respectively.The creatinine of Group B was 64-115 μmol/L with an average of (94 ± 14.4) μmol/L and 93-453 μmol/L with an average of (190.4 ± 117.2)μ mol/L one month after the first and second surgery respectively.The creatinine of Group C was 84-113 μmol/L with an average of (90.1 ± 12.1) μ mol/L and 88-156 μmol/L with an average of (121.4 ± 24.8)μmol/L one month after the first and second surgery respectively.One patient in Group B and C developed lung metastases.One patient in Group B occurred oliguria after the second stage of surgery,and gradually improved after one week of hemodialysis.The creatine showed no significant difference among Group A,B and C before operation,after the first and second stage (P ＞ 0.05).Postoperative hospital stay after the first stage surgery was 3-16 days with an average of (6.7 ± 3.4) d,and 3-16 d with an average of (6.2 ± 3.2)d after the second stage,respectively.Conclusions In principle,bilateral renal tumors should be treated with NSS,wbich can protect renal functions as much as possible.Among patients who can undergo bilateral NSS,the first-stage surgery should be operated on the simpler and easier side to preserve the kidney of one side as much as possible to lay a good foundation for the second stage surgery.Among patients who undergo one side of RN and the other side of NSS,NSS is recommended for the first stage,and RN for the contralateral second stage after the renal function of the operated side was restored.
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Objectives: To evaluate the tumor-infiltrating PD-1 positive lymphocytes and regulatory T cells (Treg) as prognosis predic-tors of metastatic renal cell carcinoma (mRCC), and investigate the expression of PD-1 and Treg cells in mRCC and elucidate their corre-lation with clinicopathological parameters and prognosis. Methods: A total of 269 mRCC patients from June 2007 to June 2017 in Zhongshan Hospital, Fudan University, were included in the study. The expression of PD-1 and Tregs in mRCC samples were detected by immunohistochemistry. The relationship between the expression of PD-1 and Tregs was analyzed. Results: PD-1 positive expression in mRCC was 31.60% (85/269) and it was positively correlated with the tumor Fuhrman grade and negatively correlated with progno-sis. Tumor infiltration of Tregs in mRCC was 36.80% (99/269), and it was also positively correlated with the tumor Fuhrman grade and negatively correlated with prognosis. Univariate analysis showed that PD-1 positive lymphocytes and high Treg infiltration numbers were negatively correlated with overall survival (OS) and progression free survival (PFS) rates. Thus, PD-1 positive lymphocytes and high Treg infiltration numbers are independent prognostic indicators of OS and PFS and when combined, they can render a better pre-diction for prognosis. Conclusions: Intra-tumoral infiltration of PD-1 positive lymphocytes and Tregs can be used as significant prognos-tic indicators of mRCC, and the combined predictive effect is better than the individual predictive effect. Therefore, evaluating the number of PD-1 positive lymphocytes or infiltrating Tregs in mRCC is helpful in clinically estimating mRCC prognosis in patients.
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Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)and multi-phasic enhanced MRI in the classification of clear cell renal cell carcinoma(ccRCC).Methods The data of 91 patients with pathologically confirmed ccRCC who all underwent multi-phasic enhanced MRI and IVIM-DWI examination were analyzed retrospectively. According to Fuhrman classification criteria,grade Ⅰ - Ⅱ were defined as low-grade group(n=73),grade Ⅲ - Ⅳ were defined as high-grade group(n=18).Mann-Whitney U test,independent sample t test and receiver operating characteristic(ROC)analysis were used for statistical analysis.Results The maximal diameter and pathological stage of ccRCC in the low-grade group were lower than those in the high-grade group,and the differences between the two groups were statistically significant(P<0.001 and P=0.003). The signal intensity and enhancement rate of ccRCC in the high-grade group in corticomedullary phase and parenchyma phase were lower than those in the low-grade group,but there was no significant difference between the two groups(all P>0.05).The ADC and D values of ccRCC in the high-grade group were lower than those in the low-grade group,and the differences between the two groups were statistically significant(P=0.007 and P=0.009).However,there was no significant difference of D *and f between the two groups(P=0.604 and P=0.695).Conclusion Multi-phasic enhanced MRI scanning has a limited value in the classification of ccRCC.IVIM-DWI derived diffusion-related parameters(ADC and D)is of great significance for differentiating between high-grade and low-grade ccRCC.
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Objective To evaluate the efficacy of using dual laser system in off clamp nephronsparing surgery.Methods We used dual laser system in the patients who underwent off-clamp NSS between Jan 2016 and Apr 2016 in our institution.There were 16 males and 8 females with average age of 49 years.Mean tumor size was 1.9 cm (range 0.8-3.2 cm).The mean R.E.N.A.L.score was 3.8 (range 3-6).The mean Zhongshan score was 3.5(range 3-5).The mean ZⅡ(zero ischemia index)was 1.6(range 1-4).The Evolve Dual (980 nm/1 470 nm) laser system set at 60 W in continuous mode was used.Results Offclamp NSS was successfully performed in 22 patients except for renal artery occlusion in 2 case.Mean operative time was 74 min(range 50-100 min);The average estimated blood loss was 52.9 ml(range 10-200 ml);Mean postoperative drainage was 65.4 ml(range 20-150ml);Mean postoperative hospital stay was 5.2 days (range:4-7days).No severe post-operative complication was found.The mean pre-and postoperative serum creatinine levels were 76.2 μmol/L(range:48-112μ mol/L) and 81.5μ mol/L(range:54-122 μ mol/L) with no significant difference(P ＞0.05).The postoperative pathology indicated that 20 cases of clear cell carcinomas,3 cases of chromophobe renal cell carcinomas,one case of papillary carcinoma.Conclusions Dual laser system can be used in off clamp nephron-sparing surgery safely and effectively.
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Objective To explore the family quality of life and family support status of children with disabilities, as well as the relation-ship between them in China. Methods A total of 3198 families with children with disabilities were surveyed with Chinese Version of Family Quality of Life Scale and Family Support Scale. Results The satisfaction of family quality of life was (3.48±0.75), in the middle level. The support degree was (1.68 ± 0.57), in the low level. The family quality of life highly correlated with professional support (r=0.67, P<0.001), and also correlated with support from relatives, social organizations, friends and spouse (r=0.36~0.55, P<0.01). Conclusion China is lacking of family-centered support services to children with disabilities, that can significantly predict family quality of life. It is needed to organize the family-to-family help organizations and social welfare services, improve the social finance allowance, with the overarching purpose to improve the family quality of life for families with children with disabilities in China.
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Objective:To establish a soft tissue 3-dimension(3D)finite element model of human palate.Methods:Based on the intrinsic finite element model of human maxilla,palatal mucoperiosteum flap with the thickness of 3.06 mm was added on the oral side of the plate model by ANSYS software,material property of the soft tissue was loaded,the soft tissue 3D finite element model of the palate was established.Results:By applying finite element method,the established 3D finite element model could reflect biomechani-cal properties of the soft tissue of the palate on computer.Conclusion:The 3D finite element model of the soft tissue of human palate provides the foundation for further study.
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Objective:To study the impact of palatal scar force on the maxilla with unilateral cleft palate by finite element model. Methods:A 3-dimension finite element model of maxilla with cleft palate containing soft tissue was established,the soar force on the maxilla was analyzed by ansys.Results:Cleft area was identified as the center of rotation,cleft side of the maxilla reflected clock-wise rotation and non-cleft side anticlockwise rotation.The maxilla moved from outside to inside in cross section and front to back in the sagittal plane,and the former was greater than the latter.The outside of alveolar process was subjected to stress of mainly drawing force,the inside to stress of mainly compressive force.The deformation of maxilla was mainly in the front-end.Deformation of the alveolar was greater than that of maxilla body.Among deformations of three dimensions,the width was the largest,the length was the smallest,and the height was between both above.Conclusion:Along with the rotation of the maxilla,cleft area becomes gradually smaller.Among the three dimensions,the width is the largest,the length is the smallest and the height is between the both.The af-fect on maxilla is mainly in the front-end.The affect on the alveolar is greater than that on the maxilla body.
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Objective To evaluate the hematological adverse events of sunitinib in treatment of advanced renal cell carcinoma.Methods Forty-four male patients and 18 female patients were included in this study.They were all with metastatic renal cell carcinoma and received sunitinib treatment at the dose of 50 mg daily in repeated 6 weeks cycle (4 weeks on and 2 weeks off).Toxicity was assessed every cycle with tumor assessments every 2 cycles via CT or PET-CT.Results Fifty patients (80.6％) had experienced treatment-related hematotoxicity,including leucocytopenia,anemia and thrombocytopenia.Severe hematological adverse events ( grade 3 -4 ) occured in 18 patients ( 29.0％ ) and slight events ( grade 1 - 2 ) in others (51.6％).Most of the hematological adverse events were manageable and reversible and treatment-changes (dose reduction,interruption) were necessary in severe cases.Almost half of the dose reduction (9/21,42.9％ ) were owing to hematotoxicity.Conclusions Sunitinib of 50 mg dose on schedule 4/2 is effective and well-tolerated in advanced renal carcinoma patients.Hematological adverse events are frequent in Chinese patients and can be controlled well.
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Objective To evaluate the efficacy and safety of sunitinib in patients with metastatic renal cell carcinoma. Methods Twenty-three male patients and 8 female patients were included in this study.All patients were metastatic renal cell carcinoma with prior radical nephrectomy or biopsy.Patients received treatment with sunitinib in repeated 6-week cycles,consisting of 4 weeks of 50 mg daily sunitinib administration followed by 2 weeks off treatment(schedule 4/2).CT scan was used to evaluate the efficacy every 2 cycles. Results Twenty-four of the patients could be evaluated the efficacy.None of them achieved complete responses,5 achieved partial responses,15 were in stable and 4 were with disease progression including 1 death.Four patients were forced to stop treatments because of poor general condition,lack of financial support or hepatic injury.Three cases could not be evaluated because of no long enough follow-up.The objective response rate was 21%(5/24)and disease control rate was 83%(20/24).The common adverse effects included hand-foot syndrome,diarrhea,anorexia,stomatitis,hemorrhagic tendency and hematotoxicity.But almost all of them were curable by using adjuvant drugs. Conclusions Sunitinib is efficient in the treatment of metastatic renal cell carcisoma.Most of the side effects are tolerable or curable.
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Tissue engineering of oral and maxillofacial surgery is a newly subject and animportant branch of tissue engineering. The study is to evaluate fundamental medical ethics principle in the tissue engineering of oral and maxillofacial surgery on the view medical ethcs. Strengthening the ethical education on oral and maxillofacial surgeon and right education on patients are in favor of development of tissue engineering in the oral and maxillofacial surgery.
