Association of hepatitis B virus DNA levels with efficacy and safety outcomes in patients with hepatitis B virus-associated advanced hepatocellular carcinoma receiving tyrosine kinase inhibitor plus anti-PD-1 antibody: a multicenter propensity-matched study.

BACKGROUND: The efficacy and safety of tyrosine kinase inhibitors (TKIs) combined with anti-PD-1 antibodies (α-PD-1) in advanced hepatocellular carcinoma (HCC) with high hepatitis B virus (HBV) DNA levels (>500 IU/mL) remain unclear. METHODS: We retrospectively assessed patients from seven medical institutions diagnosed with HBV-related HCC, undergoing treatment with TKIs and α-PD-1 in conjunction with antiviral therapies. Based on HBV-DNA levels, patients were categorized into either high (HHBV-DNA, >500 IU/mL) or low HBV-DNA (LHBV-DNA, ≤500 IU/mL) cohorts Propensity score matching (PSM) was used to minimize baseline imbalance between groups. RESULTS: 149 patients were included, with 66 patients exhibiting HBV-DNA > 500 IU/mL and 83 patients presenting HBV-DNA ≤ 500 IU/mL. Compared with the LHBV-DNA cohort, the HHBV-DNA cohort had a greater incidence of serum HBeAg positivity, tumor diameter ≥ 10 cm, and vascular invasion. Following PSM, 57 individuals were enrolled in each group. Oncological outcomes were comparable between HHBV-DNA and LHBV-DNA cohorts before and after PSM. Before PSM, the median PFS and OS were 6.1 months and 17.5 months in the HHBV-DNA cohort and 6.7 months and 19.3 months in the LHBV-DNA cohort (all P > 0.05). After PSM, the median PFS and OS were 6.0 months and 19.5 months in the HHBV-DNA cohort and 6.0 months and 17.1 months in the LHBV-DNA cohort, respectively (all P > 0.05). Safety profiles were equivalent across cohorts with no fatal incidents reported. Seven patients (4.7 %) had HBV reactivation. 1 (0.7 %) from HHBV-DNA and 6 (4.0 %) from LHBV-DNA (P = 0.134). Only one patient developed HBV-related hepatitis. CONCLUSIONS: The effectiveness and safety of TKIs plus α-PD-1 in advanced HCC with HBV-DNA > 500 IU/mL were not compromised in the context of concomitant antiviral therapy.

Effect of Diabetes Mellitus on Implant Osseointegration of Titanium Screws: An Animal Experimental Study.

OBJECTIVE: To explore the effect of diabetes mellitus (DM) on implant osseointegration of titanium screws. METHODS: Sixty rats were randomly divided into a DM group and a control group (each group, n = 30). DM group rats were injected with 1% Streptozotocin solution at 65 mg/kg to establish a DM model. Titanium screws were implanted into the rats' distal femurs in both groups. The rats were sacrificed for micro-CT scanning, micro-indentation, biomechanical detection, confocal Raman microspectroscopy, and histological and histomorphometric analysis at 4, 8, and 12 weeks post-implantation, respectively. Messenger RNA (mRNA) expression and protein expression of the related growth factors around the implant were analyzed using real-time polymerase chain reaction and Western blots. RESULTS: At 4, 8 and 12 weeks, micro-CT scanning, hematoxylin-eosin (HE) staining, Gieson's acid-magenta staining, and fluorescent labeled staining showed disorder in the bone tissue arrangement, a lack of new bone tissue, poor maturity and continuity, and poor trabecular bone parameters around the implant in the DM group. At 4, 8, and 12 weeks, the interfacial bone binding rate in the DM group was significantly lower (16.2% ± 4.8%, 25.7% ± 5.7%, 42.5% ± 5.8%, respectively) than that in the control group (23.6% ± 5.2%, 40.8% ± 6.3%, 64.2% ± 7.3%, respectively; P < 0.05). At 8 and 12 weeks, the elastic modulus (17.0 ± 1.8 and 15.1 ± 1.5 GPa, respectively) and trabecular bone hardness (571 ± 39 and 401 ± 37 MPa, respectively) in the DM group were significantly lower than the elastic modulus (23.4 ± 2.3 and 23.8 ± 1.8 GPa, respectively) and trabecular bone hardness (711 ± 45 and 719 ± 46 MPa, respectively) in the control group (P < 0.05). The maximum load required for the prosthesis pull-out experiment in the DM group at 4, 8, and 12 weeks (55.14 ± 6.74 N, 73.34 ± 8.43 N, and 83.45 ± 8.32 N, respectively) was significantly lower than that in the control group (77.45 ± 7.48 N, 93.28 ± 8.29 N, and 123.62 ± 9.43 N, respectively, P < 0.05). At 8 and 12 weeks, the mineral-to-collagen ratio in the DM group (6.56 % ± 1.35% and 4.45%± 1.25%, respectively) was significantly higher than that in the control group (5.31% ± 1.42% and 3.62% ± 1.33%, respectively, P < 0.05). At 12 weeks, mRNA and protein expression levels of bone morphogenetic protein 2, transforming growth factor-ß1, vascular endothelial growth factor, osteopontin, osteocalcin, and runt-related transcription factor 2 in the DM group were significantly lower than that in the control group. CONCLUSIONS: DM can negatively affect bone osseointegration, manifesting as disorder in bone tissue arrangement around the implant, a lack of new bone tissue, poor maturity and continuity, poor trabecular bone parameters and lower expression of the related growth factors.

[Analysis of the factors related to glomerular filtration rate in type 2 diabetes without albuminuria].

OBJECTIVE: To analyze the risk factors affecting the glomerular filtration rate (GFR) in type 2 diabetic patients without albuminuria. METHODS: A total of 131 type 2 diabetic patients with normal urinary albumin excretion rate (UAER) were divided into normal GFR group and decreased GFR group. The factors relevant to GFR were analyzed by multiple factors regression. RESULTS: Age, course of diabetes, systolic blood pressure, prevalence of hypertension, the level of serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid (UA) were significantly higher in decreased GFR group than in normal GFR group. Multivariate regression showed that SCr, age, systolic blood pressure, and UA were negatively correlated to GFR. CONCLUSION: Reduced GFR occurs in some type 2 diabetic patients without albuminuria. SCr, age, systolic blood pressure and UA are the major factors related to decreased GFR. The degree of early renal damage in diabetic patients can be better evaluated by combining GFR and UAER.

[Association of glycosylated hemoglobin A1c control with the complications in type 2 diabetic patients].

OBJECTIVE: To investigate the status of glycosylated hemoglobin A1c (GHbA(1c)) control in type 2 diabetic patients and its relation to diabetic complications. METHODS: A total of 676 patients with type 2 diabetes were investigated for GHbA(1c) level and the diabetic complications. The patients were divided into two groups with GHbA(1c) >7% and GHbA(1c)< or =7%, and the relation of GHbA(1c) with the complications was analyzed. RESULTS: The rate of good GHbA(1c) control (GHbA(1c)< or =7%) was 35.1% (237/676) in these patients, and 64.9% (439/676) of the patients showed poor GHbA(1c) control (GHbA(1c)>7%). The rates of hypertension and cerebralovascular complications were significantly higher in patients with GHbA(1c)>7% than in those with GHbA(1c)< or =7% (69.9% vs 55.7%, and 21.8% vs 8.9%, respectively, P<0.001), but the rate of coronary heart disease was comparable between the two groups (18.7% vs 17.3%, P>0.05). The patients with poor GHbA(1c) control had significantly higher incidences of diabetic peripheral neuropathy and fatty liver than those with good GHbA(1c) control (46.0% vs 35.0%, and 36.9% vs 25.3%, respectively, P<0.01), but no significant differences were found in the incidences of diabetic nephropathy (18.7% vs 16.5%), diabetic retinopathy (30.8% vs 27.4%) or diabetic feet (5.0% vs 3.8%) between the two groups (P>0.05). CONCLUSION: Type 2 diabetic patients have generally low rate of successful GHbA(1c) control, which can be associated with the occurrence of diabetic complications, suggesting the necessity of more rigorous diabetic health education and GHbA(1c) monitoring in these patients.

[The influence of elective course of emergency treatment for medical students on the cultivation of first aid knowledge and skill of cardio-pulmonary resuscitation].

OBJECTIVE: To investigate the influence of elective course of emergency treatment for medical students on the cultivation of first aid knowledge and skills of cardio-pulmonary resuscitation. METHODS: Senior students major in medicine of our university were randomly divided into observation group and contrast group with 30 students in each group according to whether an elective course of emergency treatment was given or not. All of them then received a test of first aid knowledge and cardio-pulmonary resuscitation skills. RESULTS: The theoretical exam scores in observation group and contrast group were respectively 78.5+/-9.1 and 46.7+/-15.6. The scores in observation group were significantly higher than that in contrast group (P < 0.01). Cardio-pulmonary resuscitation skills scores in observation group and contrast group were respectively 7.32+/-0.83 and 6.63+/-0.91. The scores in observation group were significantly higher than that in contrast group (P < 0.01). The number of failure for closed cardiac massage in 60 times in observation group and contrast group was respectively 5.06+/-0.58 and 5.77+/-0.63. The number of mouth to mouth artificial respiration in 4 times in observation group and contrast group was 0.92+/-0.16 and 1.10+/-0.17, respectively. There were notable differences in the number of failure in resuscitation maneuvers between two groups (both P < 0.01), observation group being obviously poorer than contrast group. CONCLUSION: An elective course of emergency treatment given to medical students plays an important role in the cultivation of first aid knowledge and skills in cardio-pulmonary resuscitation. It is therefore necessary that emergency medicine is included as a required course in medical college.