AIM:To compare the postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens(ICL)implantation versus small incision lenticule extraction(SMILE)in myopia eyes.METHODS:Pub Med,EMBASE,W...AIM:To compare the postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens(ICL)implantation versus small incision lenticule extraction(SMILE)in myopia eyes.METHODS:Pub Med,EMBASE,Web of Science,Cochrane Library and several Chinese databases were searched at May 2021 to select relevant studies in comparison of clinical outcomes between ICL implantation and SMILE for myopia.The primary outcomes were efficacy,safety,and predictability.And the secondary outcomes were postoperative higher-order ocular aberrations(HOAs),modulation transfer function cutoff frequency(MTF),objective scatter index(OSI),contrast sensitivity and a quality of vision(Qo V)questionnaire.RESULTS:A total of 1036 eyes from 10 studies,of which 503 eyes underwent ICL implantation and 533 eyes underwent SMILE,were enrolled in this Meta-analysis.Pooled results revealed that ICL group had a better safety index and post-corrected distance visual acuity(CDVA)(P=0.007,<0.00001,respectively),and a lower percentage of eyes with a postoperative CDVA lost 1 line(P=0.007)than the SMILE group.No significant differences were found in comparison of the other primary outcomes.In the longterm follow-up(>6mo),ICL group had a lower total HOA,coma,and spherical aberration than SMILE group(P=0.003,<0.00001,0.04).Yet higher trefoil was found in ICL group at 6mo after surgery(P=0.003).Additionally,ICL group also had a higher MTF value(P=0.02),and a higher contrast sensitivity score for spatial frequencies of 1.5,6,and 12 cpds(P=0.02,0.005,0.02,respectively).And it also had a lower score of bothersome in Qo V questionnaire than SMILE group(P=0.003).CONCLUSION:ICL implantation and SMILE have similar and comparable outcomes in term of the efficacy and predictability for correcting high myopia.However,ICL group is relatively safer and also has better visual quality in comparison of SMILE group.展开更多
OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and...OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.展开更多
BACKGROUND Due to the poor prognosis of gastric cancer(GC),early detection methods are urgently needed.Plasma exosomal circular RNAs(circRNAs)have been suggested as novel biomarkers for GC.AIM To identify a novel biom...BACKGROUND Due to the poor prognosis of gastric cancer(GC),early detection methods are urgently needed.Plasma exosomal circular RNAs(circRNAs)have been suggested as novel biomarkers for GC.AIM To identify a novel biomarker for early detection of GC.METHODS Healthy donors(HDs)and GC patients diagnosed by pathology were recruited.Nine GC patients and three HDs were selected for exosomal whole-transcriptome RNA sequencing.The expression profiles of circRNAs were analyzed by bioinformatics methods and validated by droplet digital polymerase chain reaction.The expression levels and area under receiver operating characteristic curve values of plasma exosomal circRNAs and standard serum biomarkers were used to compare their diagnostic efficiency.RESULTS There were 303 participants,including 240 GC patients and 63 HDs,involved in the study.The expression levels of exosomal hsa_circ_0079439 were significantly higher in GC patients than in HDs(P<0.0001).However,the levels of standard serum biomarkers were similar between the two groups.The area under the curve value of exosomal hsa_circ_0079439 was higher than those of standard biomarkers,including carcinoembryonic antigen,carbohydrate antigen(CA)19-9,CA72-4,alpha-fetoprotein,and CA125(0.8595 vs 0.5862,0.5660,0.5360,0.5082,and 0.5018,respectively).The expression levels of exosomal hsa_circ_0079439 were significantly decreased after treatment(P<0.05).Moreover,the expression levels of exosomal hsa_circ_0079439 were obviously higher in early GC(EGC)patients than in HDs(P<0.0001).CONCLUSION Our results suggest that plasma exosomal hsa_circ_0079439 is upregulated in GC patients.Moreover,the levels of exosomal hsa_circ_0079439 could distinguish EGC and advanced GC patients from HDs.Therefore,plasma exosomal hsa_circ_0079439 might be a potential biomarker for the diagnosis of GC during both the early and late stages.展开更多
Deciphering the neuronal response to injury in the spinal cord is essential for exploring treatment strategies for spinal cord injury(SCI).However,this subject has been neglected in part because appropriate tools are ...Deciphering the neuronal response to injury in the spinal cord is essential for exploring treatment strategies for spinal cord injury(SCI).However,this subject has been neglected in part because appropriate tools are lacking.Emerging in vivo imaging and labeling methods offer great potential for observing dynamic neural processes in the central nervous system in conditions of health and disease.This review first discusses in vivo imaging of the mouse spinal cord with a focus on the latest imaging techniques,and then analyzes the dynamic biological response of spinal cord sensory and motor neurons to SCI.We then summarize and compare the techniques behind these studies and clarify the advantages of in vivo imaging compared with traditional neuroscience examinations.Finally,we identify the challenges and possible solutions for spinal cord neuron imaging.展开更多
BACKGROUND Multiple myeloma(MM)is a terminal differentiated B-cell tumor disease characterized by clonal proliferation of malignant plasma cells and excessive levels of monoclonal immunoglobulins in the bone marrow.Th...BACKGROUND Multiple myeloma(MM)is a terminal differentiated B-cell tumor disease characterized by clonal proliferation of malignant plasma cells and excessive levels of monoclonal immunoglobulins in the bone marrow.The translocation,(t)(4;14),results in high-risk MM with limited treatment alternatives.Thus,there is an urgent need for identification and validation of potential treatments for this MM subtype.Microarray data and sequencing information from public databases could offer opportunities for the discovery of new diagnostic or therapeutic targets.AIM To elucidate the molecular basis and search for potential effective drugs of t(4;14)MM subtype by employing a comprehensive approach.METHODS The transcriptional signature of t(4;14)MM was sourced from the Gene Expression Omnibus.Two datasets,GSE16558 and GSE116294,which included 17 and 15 t(4;14)MM bone marrow samples,and five and four normal bone marrow samples,respectively.After the differentially expressed genes were identified,the Cytohubba tool was used to screen for hub genes.Then,the hub genes were analyzed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis.Using the STRING database and Cytoscape,protein–protein interaction networks and core targets were identified.Potential small-molecule drugs were identified and validated using the Connectivity Map database and molecular docking analysis,respectively.RESULTS In this study,a total of 258 differentially expressed genes with enriched functions in cancer pathways,namely cytokine receptor interactions,nuclear factor(NF)-κB signaling pathway,lipid metabolism,atherosclerosis,and Hippo signaling pathway,were identified.Ten hub genes(cd45,vcam1,ccl3,cd56,app,cd48,btk,ccr2,cybb,and cxcl12)were identified.Nine drugs,including ivermectin,deforolimus,and isoliquiritigenin,were predicted by the Connectivity Map database to have potential therapeutic effects on t(4;14)MM.In molecular docking,ivermectin showed strong binding affinity to all 10 identified targets,especially cd45 and cybb.Ivermectin inhibited t(4;14)MM cell growth via the NF-κB pathway and induced MM cell apoptosis in vitro.Furthermore,ivermectin increased reactive oxygen species accumulation and altered the mitochondrial membrane potential in t(4;14)MM cells.CONCLUSION Collectively,the findings offer valuable molecular insights for biomarker validation and potential drug development in t(4;14)MM diagnosis and treatment,with ivermectin emerging as a potential therapeutic alternative.展开更多
Neurotrophic keratopathy is a persistent defect of the corneal epithelium,with or without stromal ulceration,due to corneal nerve deficiency caused by a variety of etiologies.The treatment options for neurotrophic ker...Neurotrophic keratopathy is a persistent defect of the corneal epithelium,with or without stromal ulceration,due to corneal nerve deficiency caused by a variety of etiologies.The treatment options for neurotrophic keratopathy are limited.In this study,an ophthalmic solution was constructed from a chitosan-based thermosensitive hydrogel with long-term release of murine nerve growth factor(CTH-mNGF).Its effectiveness was evaluated in corneal denervation(CD)mice and patients with neurotrophic keratopathy.In the preclinical setting,CTH-mNGF was assessed in a murine corneal denervation model.CTH-mNGF was transparent,thermosensitive,and ensured sustained release of mNGF for over 20 hours on the ocular surface,maintaining the local mNGF concentration around 1300 pg/mL in vivo.Corneal denervation mice treated with CTH-mNGF for 10 days showed a significant increase in corneal nerve area and total corneal nerve length compared with non-treated and CTH treated mice.A subsequent clinical trial of CTH-mNGF was conducted in patients with stage 2 or 3 neurotrophic keratopathy.Patients received topical CTH-mNGF twice daily for 8 weeks.Fluorescein sodium images,Schirmer’s test,intraocular pressure,Cochet-Bonnet corneal perception test,and best corrected visual acuity were evaluated.In total,six patients(total of seven eyes)diagnosed with neurotrophic keratopathy were enrolled.After 8 weeks of CTH-mNGF treatment,all participants showed a decreased area of corneal epithelial defect,as stained by fluorescence.Overall,six out of seven eyes had fluorescence staining scores<5.Moreover,best corrected visual acuity,intraocular pressure,Schirmer’s test and Cochet-Bonnet corneal perception test results showed no significant improvement.An increase in corneal nerve density was observed by in vivo confocal microscopy after 8 weeks of CTH-mNGF treatment in three out of seven eyes.This study demonstrates that CTH-mNGF is transparent,thermosensitive,and has sustained-release properties.Its effectiveness in healing corneal epithelial defects in all eyes with neurotrophic keratopathy suggests CTH-mNGF has promising application prospects in the treatment of neurotrophic keratopathy,being convenient and cost effective.展开更多
在 10 年的经期上在一所中国综合医院在尸体调查肺的栓塞( PE )的流行和特征，并且评估预防的临死前的成就，诊断，并且从中国人民解放军队( PLA )医院将军的西方布朗奇的死亡的 PE.MethodsAll 医药记录的治疗回顾地被考察，为到2015年1...在 10 年的经期上在一所中国综合医院在尸体调查肺的栓塞( PE )的流行和特征，并且评估预防的临死前的成就，诊断，并且从中国人民解放军队( PLA )医院将军的西方布朗奇的死亡的 PE.MethodsAll 医药记录的治疗回顾地被考察，为到2015年12月31日的2006年1月1日的经期。尸体在被执行了的案例被识别并且进一步分析了。数字和有足的病人的详细特征被注意。与 PE 的诊断和治疗一起，，预防措施被记录 performed.ResultsDuring 10 年的时期， 1057 个病人在学习医院里死了， 278 验尸被执行(尸体率：26.3%) 。九个病人被发现有 PE (3.2%) ，并且在七个这些病人(2.5%) ， PE 被认为致命。栓塞在所有七个致命的 PE 案例在箱子和肺的动脉树的双边的主要树枝中被发现。正确 intracardiac 血栓在九个 PE 病人(55.6%) 中的五个被检测。有 PE 的所有病人在医药部门被就医了，并且仅仅在住院期间经历了外科。临死前的预防在九个 PE 盒子(22.2%) 中的二个中被执行。任何一个都没在 death.ConclusionsThe 发生前 9 个病人收到 PE 的临床的诊断，与 PE 联系的死亡率可以在不同赛跑和区域之中变化。在某些代表性的医药机构的借助于验尸的 PE 的连续监视是必要的。展开更多
Background:Early recurrence results in poor prognosis of patients with hepatocellular carcinoma(HCC)after liver transplantation(LT).This study aimed to explore the value of computed tomography(CT)-based radiomics nomo...Background:Early recurrence results in poor prognosis of patients with hepatocellular carcinoma(HCC)after liver transplantation(LT).This study aimed to explore the value of computed tomography(CT)-based radiomics nomogram in predicting early recurrence of patients with HCC after LT.Methods:A cohort of 151 patients with HCC who underwent LT between December 2013 and July 2019 were retrospectively enrolled.A total of 1218 features were extracted from enhanced CT images.The least absolute shrinkage and selection operator algorithm(LASSO)logistic regression was used for dimension reduction and radiomics signature building.The clinical model was constructed after the analysis of clin-ical factors,and the nomogram was constructed by introducing the radiomics signature into the clinical model.The predictive performance and clinical usefulness of the three models were evaluated using re-ceiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.Cali-bration curves were plotted to assess the calibration of the nomogram.Results:There were significant differences in radiomics signature among early recurrence patients and non-early recurrence patients in the training cohort(P<0.001)and validation cohort(P<0.001).The nomogram showed the best predictive performance,with the largest area under the ROC curve in the training(0.882)and validation(0.917)cohorts.Hosmer-Lemeshow testing confirmed that the nomogram showed good calibration in the training(P=0.138)and validation(P=0.396)cohorts.DCA showed if the threshold probability is within 0.06-1,the nomogram had better clinical usefulness than the clinical model.Conclusions:Our CT-based radiomics nomogram can preoperatively predict the risk of early recurrence in patients with HCC after LT.展开更多
Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no othe...Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no other identifiable cause)stroke.The traditional approach has been to use a fluoroscopically guided blocking device,but this is contraindicated in patients with severe allergies to contrast media or inability to undergo angiography.With the advancements in technology,ultrasonic robotic systems have become available for medical procedures.In the current study,we reported a case of using the ultrasonic robotic teleoperation system to achieve closure of PFO at the Chinese PLA General Hospital,Beijing,China.展开更多
BACKGROUND Observational studies suggest inverse associations between serum vitamin levels and the risk of heart failure(HF). However, the causal effects of vitamins on HF have not been fully elucidated. Here, we cond...BACKGROUND Observational studies suggest inverse associations between serum vitamin levels and the risk of heart failure(HF). However, the causal effects of vitamins on HF have not been fully elucidated. Here, we conducted a Mendelian randomization(MR) study to investigate the causal associations between genetically determined vitamin levels and HF.METHODS Genetic instrumental variables for circulating vitamin levels, including vitamins A, B, C, D, and E, which were assessed as either absolute or metabolite levels were obtained from public genome-wide association studies. Summary statistics for single-nucleotide-polymorphisms and HF associations were retrieved from the HERMES Consortium(47,309 cases and 930,014controls) and FinnGen Study(30,098 cases and 229,612 controls). Two-sample MR analyses were implemented to assess the causality between vitamin levels and HF per outcome database, and the results were subsequently combined by meta-analysis.RESULTS Our MR study did not find significant associations between genetically determined circulating vitamin levels and HF risk. For absolute vitamin levels, the odds ratio for HF ranged from 0.97(95% confidence interval [CI]: 0.85–1.09, P = 0.41) for vitamin C to 1.05(95% CI: 0.61–1.82, P = 0.85) for vitamin A. For vitamin metabolites, the odds ratio ranged between 0.94(95% CI:0.75–1.19, P = 0.62) for α-tocopherol and 1.11(95% CI: 0.98–1.26, P = 0.09) for γ-tocopherol.CONCLUSION Evidence from our study does not support the causal effects of circulating vitamin levels on HF. Therefore,there may be no direct beneficial effects of vitamin intake on the prevention of primary HF.展开更多
Deep vein thrombosis(DVT)is a manifestation of venous thromboembolism,which can result from long-term bed and lead to pulmonary embolism(PE),stroke,mesenteric artery embolis,etc.Patients after surgery without bed-off ...Deep vein thrombosis(DVT)is a manifestation of venous thromboembolism,which can result from long-term bed and lead to pulmonary embolism(PE),stroke,mesenteric artery embolis,etc.Patients after surgery without bed-off activity may prone to thrombosis,but traditional anticoagulant therapy is a contraindication for them because of high risk of postoperative hemorrhage.Inferior vena cava filter(IVCF)implantation is the most effective method to intercept thrombosis from lower limb and to prevent PE.However,radiation and contrast agent limit its application.Our team have successfully performed an IVCF implantation guided by a mixed-reality(MR)system,[1]which is a chance for critically ill patients to allow the IVCF implantation exposed under no Xray and require no contrast agent.5G can help remote holographic projection images between distant range,meeting the needs of experts to guide the operation of critically ill patients.We describe a case of weak woman after neurosurgery who can not tolerate traditional interventional surgery to prevent DVT from falling off.We performed a mixed-reality system guided IVCF implantation under remote guidance of 5G communication.展开更多
Background: Traumatic colon injury(TCI) is a common disease during wartime. Prolongation of posttraumatic survival time is an effective approach to patient outcome improvement. However, there is a lack of basic resear...Background: Traumatic colon injury(TCI) is a common disease during wartime. Prolongation of posttraumatic survival time is an effective approach to patient outcome improvement. However, there is a lack of basic research in this field.This study aimed to elucidate the mechanisms underlying TCI progression and to develop novel regimens to buy time for TCI patients on the battlefield.Methods: A total of 669 Sprague–Dawley rats were used in this study. Surgical colon incision was performed to generate the TCI rat model. The landscape of colon microbiota compositions was depicted using 16S rRNA sequencing and metabolites in the intestinal contents were detected by metabolomics profiling. The signaling transduction in the intestinal epithelium was investigated using antibody microarrays and Western blotting. The enzyme-linked immunosorbent assay(ELISA) was conducted to measure the levels of interleukin-6 and tumor necrosis factor-α in intestines and plasma for the detection of inflammatory responses. Diamine oxidase, D-lactate and endotoxin in plasma and protein expression of zonula occludens 1 and occludin were selected as the indicators of intestinal barrier permeability. To investigate alterations of microbiota symbiosis, the relative abundances of specific bacterial genera were detected using quantitative real-time PCR(qRT-PCR).Results: As a type of lethal injury, TCI induced acute disruption of intestinal homeostasis, characterized by inflammatory responses, intestinal barrier hyperpermeability and microbiota dysbiosis(P<0.05). Significant alterations in bacterial metabolic patterns were detected with decreases in many metabolites. After a series of screenings,we found that oral administration of asparagine(Asn) and 3-indolepropionic acid(IPA) effectively prolonged posttraumatic survival time [Asn plus IPA vs. Vehicle: hazard ratio(HR)=0.105, 95%CI 0.031–0.356, P=0.0003] and restored intestinal homeostasis in TCI rats(P<0.05). Mechanistically, this combinational strategy protected the rats against TCI through synergistic activation of Akt signaling in the intestinal epithelium(P<0.05).Conclusions: Abrupt dysregulation of intestinal homeostasis plays a critical role in the progression toward TCI induced death. Oral administration of Asn plus IPA may serve as an effective regimen to restore intestinal functions and prolong the posttraumatic survival time.展开更多
BACKGROUND Malignant melanoma(MM)has shown an increasing incidence worldwide,and a potential to metastasize to almost any part of the body.Clinically,MM with bone metastasis as the initial manifestation is extremely r...BACKGROUND Malignant melanoma(MM)has shown an increasing incidence worldwide,and a potential to metastasize to almost any part of the body.Clinically,MM with bone metastasis as the initial manifestation is extremely rare.Spinal metastatic MM can cause spinal cord or nerve root compression,resulting in severe pain and paralysis.Currently,the primary clinical treatments for MM are surgical resection in conjunction with chemotherapy,radiotherapy,and immunotherapy.CASE SUMMARY Here,we report the case of a 52-year-old male who presented to the clinic with progressive low back pain and limited nerve function.No primary lesion or spinal cord compression was detected from computed tomography and magnetic resonance imaging of the lumbar vertebrae and positron emission tomography scan.A lumbar puncture biopsy confirmed the diagnosis of lumbar spine metastatic MM.Following surgical resection,the patient’s quality of life improved,symptoms were relieved,and comprehensive treatment was initiated,which prevented recurrence.CONCLUSION Spinal metastatic MM is clinically rare,and may cause neurological symptoms,including paraplegia.Currently,the clinical treatment plan consists of surgical resection in combination with chemotherapy,radiotherapy,and immunotherapy.展开更多
AIM:To observe the effect of low oxygen concentration on the neural retina in human induced pluripotent stem cell(hiPSC)-derived retinal organoids(ROs).METHODS:The hiPSC and a three-dimensional culture method were use...AIM:To observe the effect of low oxygen concentration on the neural retina in human induced pluripotent stem cell(hiPSC)-derived retinal organoids(ROs).METHODS:The hiPSC and a three-dimensional culture method were used for the experiments.Generated embryoid bodies(EBs)were randomly and equally divided into hypoxic and normoxic groups.Photographs of the EBs were taken on days 38,45,and 52,and the corresponding volume of EBs was calculated.Simultaneously,samples were collected at these three timepoints,followed by fixation,sectioning,and immunofluorescence.RESULTS:The proportion of Ki67-positive proliferating cells increased steadily on day 38;this proliferationpromoting effect tended to increase tissue density rather than tissue volume.On days 45 and 52,the two groups had relatively similar ratios of Ki67-positive cells.Further immunofluorescence analysis showed that the ratio of SOX2-positive cells significantly increased within the neural retina on day 52(P<0.05).In contrast,the percentage of PAX6-and CHX10-positive cells significantly decreased following hypoxia treatment at all three timepoints(P<0.01),except for CHX10 at day 45(P>0.05).Moreover,the proportion of PAX6-/TUJ1+cells within the neural retinas increased considerably(P<0.01,<0.05,<0.05 respectively).CONCLUSION:Low oxygen promotes stemness and proliferation of neural retinas,suggesting that hypoxic conditions can enlarge the retinal progenitor cell pool in hiPSC-derived ROs.展开更多
BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of...BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.展开更多
Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Librar...Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang and Chinese biomedical literature database(CBM)were electronically searched to collect cross-sectional studies on the prevalence and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus from inception to November 1st,2022.After quality evaluation and data extraction of included studies,R4.2.2 software was used to perform metaanalysis.Results:A total of 7 Chinese and one English literatures involving 2208 participants were included.The results of meta-analysis showed that the prevalence rate of cognitive frailty in elderly diabetic patients was 17.1%(95%CI 8.7%to 30.9%).Subgroup analysis showed that the prevalence rate of cognitive frailty was 10.2%(95%CI 5.0%to 19.7%)in old diabetic adults in community,35.7%(95%CI 20.8%to 53.9%)in hospital,and the difference was statistically significant(P=0.01).The prevalence rate of cognitive frailty was 21.7%(95%CI 10.3%to 40.2%)in male diabetic old adults,24.2%(95%CI 13.3%to 40.1%)in female diabetic old adults,and the difference was not statistically significant(P=0.81).The rate was 12.6%(95%CI 6.6%to 22.5%)in 60~69 years old group,25.8%(95%CI 12.6%to 45.5%)in 70~79 years old group,53.0%(95%CI 23.9%to 80.2%)in diabetic old adults aged 80 years and above,and the difference was statistically significant(P=0.02).The influencing factors for cognitive frailty in diabetic old adults included educational level[OR=0.230,95%CI(0.117~0.454),P<0.0001],regular exercise[OR=0.357,95%CI(0.217~0.588),P<0.01],malnutrition[OR=2.372,95%CI(1.472~3.822),P=0.0004],depression[OR=3.207,95%CI(2.156~4.768),P<0.0001],and HbA1c≥7.0%[OR=3.112,95%CI(1.880~5.152),P<0.0001].Conclusion:The prevalence of cognitive frailty in Chinese elderly patients with diabetes is high,and there are differences in cognitive frailty prevalence among different sources and different ages.Educational level,exercise habits,nutritional status,depression and HbA1c are the factors affecting cognitive frailty in elderly patients with diabetes.Depression,malnutrition,HbA1c≥7.0%were risk factors,and high educational level,regular exercise were protective factors.Attention should be paid to early and accurate identification of cognitive frailty and intervention targeting influencing factors to delay or reverse its progression to adverse health outcomes.展开更多
BACKGROUND Hereditary hemorrhagic telangiectasia(HHT)is an autosomal dominant genetic disorder with an incidence of approximately 1 in 5000 in the general population.It is characterized by vasodilation,which affects s...BACKGROUND Hereditary hemorrhagic telangiectasia(HHT)is an autosomal dominant genetic disorder with an incidence of approximately 1 in 5000 in the general population.It is characterized by vasodilation,which affects specific organs,such as the skin,mucous membranes,brain,lungs,gastrointestinal tract,liver,and others.However,HHT rarely involves the portal venous system to cause serious clinical compli-cations.CASE SUMMARY A 68-year-old woman was admitted to the emergency department due to four consecutive days of abdominal pain and bloody stool and was subsequently diagnosed with HHT.Computed tomography angiography confirmed the presence of an arteriovenous fistula(AVFs).Considering this specific manifestation,whole exome sequencing was performed.After a comprehensive evaluation,a selective superior mesenteric artery embolization was prioritized to avoid intestinal ischemia.The postoperative symptoms of the patient were quickly relieved.Unfortunately,two months post-procedure the patient died from intestinal necrosis and abdominal infection related to remaining AVFs.CONCLUSION For patients with diffuse superior mesenteric AVFs,selective mesenteric arterial embolization may lead to positive short-term outcomes.展开更多
Developmental dysplasia of the hip(DDH)is one of the most common diseases causing hip pain in adults and is an important cause of osteoarthritis(OA).Borderline developmental dysplasia of the hip(BDDH)is a condition th...Developmental dysplasia of the hip(DDH)is one of the most common diseases causing hip pain in adults and is an important cause of osteoarthritis(OA).Borderline developmental dysplasia of the hip(BDDH)is a condition that falls between a normal hip and adult DDH.In BDDH,the lateral center-edge angle(LCEA)of the acetabulum is usually defined between 18°and 25°or 20°and 25°;however,this definition remains controversial.展开更多
Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exer...Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods: Data were collected from a total of 170 exertional heat stroke(EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC) curve(AUC) were used to screen exertional heat stroke score(EHSS) parameters, including but not limited body temperature(T), Glasgow Coma Scale(GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results: Through screening with a series of methods, as described above, the present study determined 12 parameters – body temperature(T), GCS, p H, lactate(Lac), platelet count(PLT), prothrombin time(PT), fibrinogen(Fib), troponin I(Tn I), aspartate aminotransferase(AST), total bilirubin(TBIL), creatinine(Cr) and acute gastrointestinal injury(AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low(EHSS<20) and high scores(EHSS>35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions: A total of 12 parameters – T, GCS, p H, Lac, PLT, PT, Fib, Tn I, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.展开更多
基金Supported by National Natural Science Foundation of China(No.82070937,No.81870640)National Science Foundation for Young Scientists of China(No.82101097)。
文摘AIM:To compare the postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens(ICL)implantation versus small incision lenticule extraction(SMILE)in myopia eyes.METHODS:Pub Med,EMBASE,Web of Science,Cochrane Library and several Chinese databases were searched at May 2021 to select relevant studies in comparison of clinical outcomes between ICL implantation and SMILE for myopia.The primary outcomes were efficacy,safety,and predictability.And the secondary outcomes were postoperative higher-order ocular aberrations(HOAs),modulation transfer function cutoff frequency(MTF),objective scatter index(OSI),contrast sensitivity and a quality of vision(Qo V)questionnaire.RESULTS:A total of 1036 eyes from 10 studies,of which 503 eyes underwent ICL implantation and 533 eyes underwent SMILE,were enrolled in this Meta-analysis.Pooled results revealed that ICL group had a better safety index and post-corrected distance visual acuity(CDVA)(P=0.007,<0.00001,respectively),and a lower percentage of eyes with a postoperative CDVA lost 1 line(P=0.007)than the SMILE group.No significant differences were found in comparison of the other primary outcomes.In the longterm follow-up(>6mo),ICL group had a lower total HOA,coma,and spherical aberration than SMILE group(P=0.003,<0.00001,0.04).Yet higher trefoil was found in ICL group at 6mo after surgery(P=0.003).Additionally,ICL group also had a higher MTF value(P=0.02),and a higher contrast sensitivity score for spatial frequencies of 1.5,6,and 12 cpds(P=0.02,0.005,0.02,respectively).And it also had a lower score of bothersome in Qo V questionnaire than SMILE group(P=0.003).CONCLUSION:ICL implantation and SMILE have similar and comparable outcomes in term of the efficacy and predictability for correcting high myopia.However,ICL group is relatively safer and also has better visual quality in comparison of SMILE group.
基金supported by the National Key Research and Development Program of China(2016YFC1300300)。
文摘OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.
基金Supported by the National Key Research and Development Program,No.2019YFA0903802,2022YFC2503600,and 2016YFC1303601.
文摘BACKGROUND Due to the poor prognosis of gastric cancer(GC),early detection methods are urgently needed.Plasma exosomal circular RNAs(circRNAs)have been suggested as novel biomarkers for GC.AIM To identify a novel biomarker for early detection of GC.METHODS Healthy donors(HDs)and GC patients diagnosed by pathology were recruited.Nine GC patients and three HDs were selected for exosomal whole-transcriptome RNA sequencing.The expression profiles of circRNAs were analyzed by bioinformatics methods and validated by droplet digital polymerase chain reaction.The expression levels and area under receiver operating characteristic curve values of plasma exosomal circRNAs and standard serum biomarkers were used to compare their diagnostic efficiency.RESULTS There were 303 participants,including 240 GC patients and 63 HDs,involved in the study.The expression levels of exosomal hsa_circ_0079439 were significantly higher in GC patients than in HDs(P<0.0001).However,the levels of standard serum biomarkers were similar between the two groups.The area under the curve value of exosomal hsa_circ_0079439 was higher than those of standard biomarkers,including carcinoembryonic antigen,carbohydrate antigen(CA)19-9,CA72-4,alpha-fetoprotein,and CA125(0.8595 vs 0.5862,0.5660,0.5360,0.5082,and 0.5018,respectively).The expression levels of exosomal hsa_circ_0079439 were significantly decreased after treatment(P<0.05).Moreover,the expression levels of exosomal hsa_circ_0079439 were obviously higher in early GC(EGC)patients than in HDs(P<0.0001).CONCLUSION Our results suggest that plasma exosomal hsa_circ_0079439 is upregulated in GC patients.Moreover,the levels of exosomal hsa_circ_0079439 could distinguish EGC and advanced GC patients from HDs.Therefore,plasma exosomal hsa_circ_0079439 might be a potential biomarker for the diagnosis of GC during both the early and late stages.
基金supported by the National Natural Science Foundation of China,No.82272478(to PT)。
文摘Deciphering the neuronal response to injury in the spinal cord is essential for exploring treatment strategies for spinal cord injury(SCI).However,this subject has been neglected in part because appropriate tools are lacking.Emerging in vivo imaging and labeling methods offer great potential for observing dynamic neural processes in the central nervous system in conditions of health and disease.This review first discusses in vivo imaging of the mouse spinal cord with a focus on the latest imaging techniques,and then analyzes the dynamic biological response of spinal cord sensory and motor neurons to SCI.We then summarize and compare the techniques behind these studies and clarify the advantages of in vivo imaging compared with traditional neuroscience examinations.Finally,we identify the challenges and possible solutions for spinal cord neuron imaging.
基金National Key Research and Development Program of China,No.2021YFC2701704the National Clinical Medical Research Center for Geriatric Diseases,"Multicenter RCT"Research Project,No.NCRCG-PLAGH-20230010the Military Logistics Independent Research Project,No.2022HQZZ06.
文摘BACKGROUND Multiple myeloma(MM)is a terminal differentiated B-cell tumor disease characterized by clonal proliferation of malignant plasma cells and excessive levels of monoclonal immunoglobulins in the bone marrow.The translocation,(t)(4;14),results in high-risk MM with limited treatment alternatives.Thus,there is an urgent need for identification and validation of potential treatments for this MM subtype.Microarray data and sequencing information from public databases could offer opportunities for the discovery of new diagnostic or therapeutic targets.AIM To elucidate the molecular basis and search for potential effective drugs of t(4;14)MM subtype by employing a comprehensive approach.METHODS The transcriptional signature of t(4;14)MM was sourced from the Gene Expression Omnibus.Two datasets,GSE16558 and GSE116294,which included 17 and 15 t(4;14)MM bone marrow samples,and five and four normal bone marrow samples,respectively.After the differentially expressed genes were identified,the Cytohubba tool was used to screen for hub genes.Then,the hub genes were analyzed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis.Using the STRING database and Cytoscape,protein–protein interaction networks and core targets were identified.Potential small-molecule drugs were identified and validated using the Connectivity Map database and molecular docking analysis,respectively.RESULTS In this study,a total of 258 differentially expressed genes with enriched functions in cancer pathways,namely cytokine receptor interactions,nuclear factor(NF)-κB signaling pathway,lipid metabolism,atherosclerosis,and Hippo signaling pathway,were identified.Ten hub genes(cd45,vcam1,ccl3,cd56,app,cd48,btk,ccr2,cybb,and cxcl12)were identified.Nine drugs,including ivermectin,deforolimus,and isoliquiritigenin,were predicted by the Connectivity Map database to have potential therapeutic effects on t(4;14)MM.In molecular docking,ivermectin showed strong binding affinity to all 10 identified targets,especially cd45 and cybb.Ivermectin inhibited t(4;14)MM cell growth via the NF-κB pathway and induced MM cell apoptosis in vitro.Furthermore,ivermectin increased reactive oxygen species accumulation and altered the mitochondrial membrane potential in t(4;14)MM cells.CONCLUSION Collectively,the findings offer valuable molecular insights for biomarker validation and potential drug development in t(4;14)MM diagnosis and treatment,with ivermectin emerging as a potential therapeutic alternative.
基金supported by PLA General Hospital Program,No.LB20201A010024(to LW).
文摘Neurotrophic keratopathy is a persistent defect of the corneal epithelium,with or without stromal ulceration,due to corneal nerve deficiency caused by a variety of etiologies.The treatment options for neurotrophic keratopathy are limited.In this study,an ophthalmic solution was constructed from a chitosan-based thermosensitive hydrogel with long-term release of murine nerve growth factor(CTH-mNGF).Its effectiveness was evaluated in corneal denervation(CD)mice and patients with neurotrophic keratopathy.In the preclinical setting,CTH-mNGF was assessed in a murine corneal denervation model.CTH-mNGF was transparent,thermosensitive,and ensured sustained release of mNGF for over 20 hours on the ocular surface,maintaining the local mNGF concentration around 1300 pg/mL in vivo.Corneal denervation mice treated with CTH-mNGF for 10 days showed a significant increase in corneal nerve area and total corneal nerve length compared with non-treated and CTH treated mice.A subsequent clinical trial of CTH-mNGF was conducted in patients with stage 2 or 3 neurotrophic keratopathy.Patients received topical CTH-mNGF twice daily for 8 weeks.Fluorescein sodium images,Schirmer’s test,intraocular pressure,Cochet-Bonnet corneal perception test,and best corrected visual acuity were evaluated.In total,six patients(total of seven eyes)diagnosed with neurotrophic keratopathy were enrolled.After 8 weeks of CTH-mNGF treatment,all participants showed a decreased area of corneal epithelial defect,as stained by fluorescence.Overall,six out of seven eyes had fluorescence staining scores<5.Moreover,best corrected visual acuity,intraocular pressure,Schirmer’s test and Cochet-Bonnet corneal perception test results showed no significant improvement.An increase in corneal nerve density was observed by in vivo confocal microscopy after 8 weeks of CTH-mNGF treatment in three out of seven eyes.This study demonstrates that CTH-mNGF is transparent,thermosensitive,and has sustained-release properties.Its effectiveness in healing corneal epithelial defects in all eyes with neurotrophic keratopathy suggests CTH-mNGF has promising application prospects in the treatment of neurotrophic keratopathy,being convenient and cost effective.
文摘在 10 年的经期上在一所中国综合医院在尸体调查肺的栓塞( PE )的流行和特征，并且评估预防的临死前的成就，诊断，并且从中国人民解放军队( PLA )医院将军的西方布朗奇的死亡的 PE.MethodsAll 医药记录的治疗回顾地被考察，为到2015年12月31日的2006年1月1日的经期。尸体在被执行了的案例被识别并且进一步分析了。数字和有足的病人的详细特征被注意。与 PE 的诊断和治疗一起，，预防措施被记录 performed.ResultsDuring 10 年的时期， 1057 个病人在学习医院里死了， 278 验尸被执行(尸体率：26.3%) 。九个病人被发现有 PE (3.2%) ，并且在七个这些病人(2.5%) ， PE 被认为致命。栓塞在所有七个致命的 PE 案例在箱子和肺的动脉树的双边的主要树枝中被发现。正确 intracardiac 血栓在九个 PE 病人(55.6%) 中的五个被检测。有 PE 的所有病人在医药部门被就医了，并且仅仅在住院期间经历了外科。临死前的预防在九个 PE 盒子(22.2%) 中的二个中被执行。任何一个都没在 death.ConclusionsThe 发生前 9 个病人收到 PE 的临床的诊断，与 PE 联系的死亡率可以在不同赛跑和区域之中变化。在某些代表性的医药机构的借助于验尸的 PE 的连续监视是必要的。
基金the National Key Research and Development Program of China(2019YFC0118104)the National Natural Science Foundation of China(82001808)+2 种基金the Beijing Natural Science Foundation(7222319)the Beijing Munici-pal Science&Technology Commission(Z21100002921047)the Capital’s Clinical Applied Research Project(Z181100001718013).
文摘Background:Early recurrence results in poor prognosis of patients with hepatocellular carcinoma(HCC)after liver transplantation(LT).This study aimed to explore the value of computed tomography(CT)-based radiomics nomogram in predicting early recurrence of patients with HCC after LT.Methods:A cohort of 151 patients with HCC who underwent LT between December 2013 and July 2019 were retrospectively enrolled.A total of 1218 features were extracted from enhanced CT images.The least absolute shrinkage and selection operator algorithm(LASSO)logistic regression was used for dimension reduction and radiomics signature building.The clinical model was constructed after the analysis of clin-ical factors,and the nomogram was constructed by introducing the radiomics signature into the clinical model.The predictive performance and clinical usefulness of the three models were evaluated using re-ceiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.Cali-bration curves were plotted to assess the calibration of the nomogram.Results:There were significant differences in radiomics signature among early recurrence patients and non-early recurrence patients in the training cohort(P<0.001)and validation cohort(P<0.001).The nomogram showed the best predictive performance,with the largest area under the ROC curve in the training(0.882)and validation(0.917)cohorts.Hosmer-Lemeshow testing confirmed that the nomogram showed good calibration in the training(P=0.138)and validation(P=0.396)cohorts.DCA showed if the threshold probability is within 0.06-1,the nomogram had better clinical usefulness than the clinical model.Conclusions:Our CT-based radiomics nomogram can preoperatively predict the risk of early recurrence in patients with HCC after LT.
基金the National Key Research and Development Program(2021YFC2501106)the Key Discipline Construction Project of Chinese PLA Medical College during the 13^(th) Five-Year Plan Period(A350109).
文摘Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no other identifiable cause)stroke.The traditional approach has been to use a fluoroscopically guided blocking device,but this is contraindicated in patients with severe allergies to contrast media or inability to undergo angiography.With the advancements in technology,ultrasonic robotic systems have become available for medical procedures.In the current study,we reported a case of using the ultrasonic robotic teleoperation system to achieve closure of PFO at the Chinese PLA General Hospital,Beijing,China.
基金supported by the National Natural Science Foundation of China(Grant No.81970341)Beijing Natural Science Foundation(Grant No.7232157).
文摘BACKGROUND Observational studies suggest inverse associations between serum vitamin levels and the risk of heart failure(HF). However, the causal effects of vitamins on HF have not been fully elucidated. Here, we conducted a Mendelian randomization(MR) study to investigate the causal associations between genetically determined vitamin levels and HF.METHODS Genetic instrumental variables for circulating vitamin levels, including vitamins A, B, C, D, and E, which were assessed as either absolute or metabolite levels were obtained from public genome-wide association studies. Summary statistics for single-nucleotide-polymorphisms and HF associations were retrieved from the HERMES Consortium(47,309 cases and 930,014controls) and FinnGen Study(30,098 cases and 229,612 controls). Two-sample MR analyses were implemented to assess the causality between vitamin levels and HF per outcome database, and the results were subsequently combined by meta-analysis.RESULTS Our MR study did not find significant associations between genetically determined circulating vitamin levels and HF risk. For absolute vitamin levels, the odds ratio for HF ranged from 0.97(95% confidence interval [CI]: 0.85–1.09, P = 0.41) for vitamin C to 1.05(95% CI: 0.61–1.82, P = 0.85) for vitamin A. For vitamin metabolites, the odds ratio ranged between 0.94(95% CI:0.75–1.19, P = 0.62) for α-tocopherol and 1.11(95% CI: 0.98–1.26, P = 0.09) for γ-tocopherol.CONCLUSION Evidence from our study does not support the causal effects of circulating vitamin levels on HF. Therefore,there may be no direct beneficial effects of vitamin intake on the prevention of primary HF.
基金supported by Capital Clinical Application Research Project(No.Z181100001718042)Cultivation and Enrichment of Front-Line Teachers,Battle Field Internal Medicine of Construction of Key Military Disciplines,13th Five Year Plan(No.A350109)。
文摘Deep vein thrombosis(DVT)is a manifestation of venous thromboembolism,which can result from long-term bed and lead to pulmonary embolism(PE),stroke,mesenteric artery embolis,etc.Patients after surgery without bed-off activity may prone to thrombosis,but traditional anticoagulant therapy is a contraindication for them because of high risk of postoperative hemorrhage.Inferior vena cava filter(IVCF)implantation is the most effective method to intercept thrombosis from lower limb and to prevent PE.However,radiation and contrast agent limit its application.Our team have successfully performed an IVCF implantation guided by a mixed-reality(MR)system,[1]which is a chance for critically ill patients to allow the IVCF implantation exposed under no Xray and require no contrast agent.5G can help remote holographic projection images between distant range,meeting the needs of experts to guide the operation of critically ill patients.We describe a case of weak woman after neurosurgery who can not tolerate traditional interventional surgery to prevent DVT from falling off.We performed a mixed-reality system guided IVCF implantation under remote guidance of 5G communication.
基金funded by the National Basic Research Program of China(2019YFB1311505)the National Natural Science Foundation of China(82073192,81773135)。
文摘Background: Traumatic colon injury(TCI) is a common disease during wartime. Prolongation of posttraumatic survival time is an effective approach to patient outcome improvement. However, there is a lack of basic research in this field.This study aimed to elucidate the mechanisms underlying TCI progression and to develop novel regimens to buy time for TCI patients on the battlefield.Methods: A total of 669 Sprague–Dawley rats were used in this study. Surgical colon incision was performed to generate the TCI rat model. The landscape of colon microbiota compositions was depicted using 16S rRNA sequencing and metabolites in the intestinal contents were detected by metabolomics profiling. The signaling transduction in the intestinal epithelium was investigated using antibody microarrays and Western blotting. The enzyme-linked immunosorbent assay(ELISA) was conducted to measure the levels of interleukin-6 and tumor necrosis factor-α in intestines and plasma for the detection of inflammatory responses. Diamine oxidase, D-lactate and endotoxin in plasma and protein expression of zonula occludens 1 and occludin were selected as the indicators of intestinal barrier permeability. To investigate alterations of microbiota symbiosis, the relative abundances of specific bacterial genera were detected using quantitative real-time PCR(qRT-PCR).Results: As a type of lethal injury, TCI induced acute disruption of intestinal homeostasis, characterized by inflammatory responses, intestinal barrier hyperpermeability and microbiota dysbiosis(P<0.05). Significant alterations in bacterial metabolic patterns were detected with decreases in many metabolites. After a series of screenings,we found that oral administration of asparagine(Asn) and 3-indolepropionic acid(IPA) effectively prolonged posttraumatic survival time [Asn plus IPA vs. Vehicle: hazard ratio(HR)=0.105, 95%CI 0.031–0.356, P=0.0003] and restored intestinal homeostasis in TCI rats(P<0.05). Mechanistically, this combinational strategy protected the rats against TCI through synergistic activation of Akt signaling in the intestinal epithelium(P<0.05).Conclusions: Abrupt dysregulation of intestinal homeostasis plays a critical role in the progression toward TCI induced death. Oral administration of Asn plus IPA may serve as an effective regimen to restore intestinal functions and prolong the posttraumatic survival time.
基金Supported by The National Defense Science and Technology Foundation Enhancement Plan,No.2019-JCJQ-JJ-147.
文摘BACKGROUND Malignant melanoma(MM)has shown an increasing incidence worldwide,and a potential to metastasize to almost any part of the body.Clinically,MM with bone metastasis as the initial manifestation is extremely rare.Spinal metastatic MM can cause spinal cord or nerve root compression,resulting in severe pain and paralysis.Currently,the primary clinical treatments for MM are surgical resection in conjunction with chemotherapy,radiotherapy,and immunotherapy.CASE SUMMARY Here,we report the case of a 52-year-old male who presented to the clinic with progressive low back pain and limited nerve function.No primary lesion or spinal cord compression was detected from computed tomography and magnetic resonance imaging of the lumbar vertebrae and positron emission tomography scan.A lumbar puncture biopsy confirmed the diagnosis of lumbar spine metastatic MM.Following surgical resection,the patient’s quality of life improved,symptoms were relieved,and comprehensive treatment was initiated,which prevented recurrence.CONCLUSION Spinal metastatic MM is clinically rare,and may cause neurological symptoms,including paraplegia.Currently,the clinical treatment plan consists of surgical resection in combination with chemotherapy,radiotherapy,and immunotherapy.
基金Supported by the National Nature Science Foundation of China(No.82070937,No.81870640,No.82000923).
文摘AIM:To observe the effect of low oxygen concentration on the neural retina in human induced pluripotent stem cell(hiPSC)-derived retinal organoids(ROs).METHODS:The hiPSC and a three-dimensional culture method were used for the experiments.Generated embryoid bodies(EBs)were randomly and equally divided into hypoxic and normoxic groups.Photographs of the EBs were taken on days 38,45,and 52,and the corresponding volume of EBs was calculated.Simultaneously,samples were collected at these three timepoints,followed by fixation,sectioning,and immunofluorescence.RESULTS:The proportion of Ki67-positive proliferating cells increased steadily on day 38;this proliferationpromoting effect tended to increase tissue density rather than tissue volume.On days 45 and 52,the two groups had relatively similar ratios of Ki67-positive cells.Further immunofluorescence analysis showed that the ratio of SOX2-positive cells significantly increased within the neural retina on day 52(P<0.05).In contrast,the percentage of PAX6-and CHX10-positive cells significantly decreased following hypoxia treatment at all three timepoints(P<0.01),except for CHX10 at day 45(P>0.05).Moreover,the proportion of PAX6-/TUJ1+cells within the neural retinas increased considerably(P<0.01,<0.05,<0.05 respectively).CONCLUSION:Low oxygen promotes stemness and proliferation of neural retinas,suggesting that hypoxic conditions can enlarge the retinal progenitor cell pool in hiPSC-derived ROs.
基金supported by the National Clinical Research Center for Geriatric Diseases(No.NCRCGPLAGH-20190003)the Chinese Cardiovascular Health Alliance-Advanced Fund(No.2019-CCAACCESS-054).
文摘BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.
基金Military Medical Innovation Project (No.18CXZ034)National Key Research andDevelopment Program (No.2018YFC2001400,2020YFC2008601)。
文摘Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang and Chinese biomedical literature database(CBM)were electronically searched to collect cross-sectional studies on the prevalence and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus from inception to November 1st,2022.After quality evaluation and data extraction of included studies,R4.2.2 software was used to perform metaanalysis.Results:A total of 7 Chinese and one English literatures involving 2208 participants were included.The results of meta-analysis showed that the prevalence rate of cognitive frailty in elderly diabetic patients was 17.1%(95%CI 8.7%to 30.9%).Subgroup analysis showed that the prevalence rate of cognitive frailty was 10.2%(95%CI 5.0%to 19.7%)in old diabetic adults in community,35.7%(95%CI 20.8%to 53.9%)in hospital,and the difference was statistically significant(P=0.01).The prevalence rate of cognitive frailty was 21.7%(95%CI 10.3%to 40.2%)in male diabetic old adults,24.2%(95%CI 13.3%to 40.1%)in female diabetic old adults,and the difference was not statistically significant(P=0.81).The rate was 12.6%(95%CI 6.6%to 22.5%)in 60~69 years old group,25.8%(95%CI 12.6%to 45.5%)in 70~79 years old group,53.0%(95%CI 23.9%to 80.2%)in diabetic old adults aged 80 years and above,and the difference was statistically significant(P=0.02).The influencing factors for cognitive frailty in diabetic old adults included educational level[OR=0.230,95%CI(0.117~0.454),P<0.0001],regular exercise[OR=0.357,95%CI(0.217~0.588),P<0.01],malnutrition[OR=2.372,95%CI(1.472~3.822),P=0.0004],depression[OR=3.207,95%CI(2.156~4.768),P<0.0001],and HbA1c≥7.0%[OR=3.112,95%CI(1.880~5.152),P<0.0001].Conclusion:The prevalence of cognitive frailty in Chinese elderly patients with diabetes is high,and there are differences in cognitive frailty prevalence among different sources and different ages.Educational level,exercise habits,nutritional status,depression and HbA1c are the factors affecting cognitive frailty in elderly patients with diabetes.Depression,malnutrition,HbA1c≥7.0%were risk factors,and high educational level,regular exercise were protective factors.Attention should be paid to early and accurate identification of cognitive frailty and intervention targeting influencing factors to delay or reverse its progression to adverse health outcomes.
基金the Youth Independent Innovation Science Project of PLA General Hospital,No.22QNFC058.
文摘BACKGROUND Hereditary hemorrhagic telangiectasia(HHT)is an autosomal dominant genetic disorder with an incidence of approximately 1 in 5000 in the general population.It is characterized by vasodilation,which affects specific organs,such as the skin,mucous membranes,brain,lungs,gastrointestinal tract,liver,and others.However,HHT rarely involves the portal venous system to cause serious clinical compli-cations.CASE SUMMARY A 68-year-old woman was admitted to the emergency department due to four consecutive days of abdominal pain and bloody stool and was subsequently diagnosed with HHT.Computed tomography angiography confirmed the presence of an arteriovenous fistula(AVFs).Considering this specific manifestation,whole exome sequencing was performed.After a comprehensive evaluation,a selective superior mesenteric artery embolization was prioritized to avoid intestinal ischemia.The postoperative symptoms of the patient were quickly relieved.Unfortunately,two months post-procedure the patient died from intestinal necrosis and abdominal infection related to remaining AVFs.CONCLUSION For patients with diffuse superior mesenteric AVFs,selective mesenteric arterial embolization may lead to positive short-term outcomes.
文摘Developmental dysplasia of the hip(DDH)is one of the most common diseases causing hip pain in adults and is an important cause of osteoarthritis(OA).Borderline developmental dysplasia of the hip(BDDH)is a condition that falls between a normal hip and adult DDH.In BDDH,the lateral center-edge angle(LCEA)of the acetabulum is usually defined between 18°and 25°or 20°and 25°;however,this definition remains controversial.
基金supported by the National Natural Science Foundation of China (81671966)the Beijing Natural Science Foundation (7182155)+2 种基金the Application Research and Achievement Extension of Clinical Characteristics in Chinese Capital Foundation (Z171100001017160)the Cultivation Program for Military Medical Science and Technology Youth-Growth Project (16QNP139)the Clinical Research Support Foundation of Chinese PLA General Hospital (2015FC-ZHCG-1002)。
文摘Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods: Data were collected from a total of 170 exertional heat stroke(EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC) curve(AUC) were used to screen exertional heat stroke score(EHSS) parameters, including but not limited body temperature(T), Glasgow Coma Scale(GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results: Through screening with a series of methods, as described above, the present study determined 12 parameters – body temperature(T), GCS, p H, lactate(Lac), platelet count(PLT), prothrombin time(PT), fibrinogen(Fib), troponin I(Tn I), aspartate aminotransferase(AST), total bilirubin(TBIL), creatinine(Cr) and acute gastrointestinal injury(AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low(EHSS<20) and high scores(EHSS>35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions: A total of 12 parameters – T, GCS, p H, Lac, PLT, PT, Fib, Tn I, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.
