Efficacy of nab‑paclitaxel vs. Gemcitabine in combination with S‑1 for advanced pancreatic cancer: A multicenter phase II randomized trial

Patients with advanced pancreatic cancer (PC) need a cost-effective treatment regimen. The present study was designed to compare the efficacy and safety of nab-paclitaxel plus S-1 (AS) and gemcitabine plus S-1 (GS) regimens in patients with chemotherapy-naïve advanced PC. In this open-label, multicenter, randomized study named AvGmPC, eligible patients with chemotherapy-naïve advanced PC were randomly assigned (1:1) to receive AS (125 mg/m2 nab-paclitaxel, days 1 and 8; 80-120 mg S-1, days 1-14) or GS (1,000 mg/m2 gemcitabine, days 1 and 8; 80-120 mg S-1, days 1-14). The treatment was administered every 3 weeks until intolerable toxicity or disease progression occurred. The primary endpoint was progression-free survival (PFS). Between December 2018 and March 2022, 101 of 106 randomized patients were treated and evaluated for analysis (AS, n=49; GS, n=52). As of the data cutoff, the median follow-up time was 11.37 months [95% confidence interval (CI), 9.31-13.24]. The median PFS was 7.16 months (95% CI, 5.19-12.32) for patients treated with AS and 6.41 months (95% CI, 3.72-8.84) for patients treated with GS (HR=0.78; 95% CI, 0.51-1.21; P=0.264). The AS regimen showed a slightly improved overall survival (OS; 13.27 vs. 10.64 months) and a significantly improved ORR (44.90 vs. 15.38%; P=0.001) compared with the GS regimen. In the subgroup analyses, PFS and OS benefits were observed in patients treated with the AS regimen who had KRAS gene mutations and high C-reactive protein (CRP) levels (≥5 mg/l). The most common grade ≥3 adverse events were neutropenia, anemia and alopecia in the two groups. Thrombocytopenia occurred more frequently in the GS group than in the AS group. While the study did not meet the primary endpoint, the response benefit observed for AS may be suggestive of meaningful clinical activity in this population. In particular, promising survival benefits were observed in the subsets of patients with KRAS gene mutations and high CRP levels, which is encouraging and warrants further investigation. This trial was retrospectively registered as ChiCTR1900024588 on July 18, 2019.

MRI radiomics for predicting intracranial progression in non-small-cell lung cancer patients with brain metastases treated with epidermal growth factor receptor tyrosine kinase inhibitors

AIM

To identify clinical and magnetic resonance imaging (MRI) radiomics predictors specialised for intracranial progression (IP) after first-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment in non-small-cell lung cancer (NSCLC) patients with brain metastases (BMs).

MATERIALS AND METHODS

Seventy EGFR-mutated NSCLC patients with a total of 212 BMs who received first-line EGFR-TKI therapy were enrolled. Radiomics features were extracted from the BM regions on the pretreatment contrast-enhanced T1-weighted images, and the radiomics score (rad-score) of each BM was established based on the selected features. Furthermore, the mean rad-score derived from the average rad-score of all included BMs in each patient was calculated. Univariate and multivariate logistic regression analyses were performed to identify potential predictors of IP. Prediction models based on different predictors and their combinations were constructed, and nomogram based on the optimal prediction model was evaluated.

RESULTS

Thirty-three (47.1 %) patients developed IP, and the remaining 37 (52.9 %) patients were IP-free. EGFR-19del mutation (OR 0.19, 95 % CI 0.05-0.69), third-generation TKI treatment (OR 0.33, 95 % CI 0.16-0.67) and mean rad-score (OR 5.71, 95 % CI 1.65-19.68) were found to be independent predictive factors. Models based on these three predictors alone and in combination (combined model) achieved AUCs of 0.64, 0.64, 0.74, and 0.86 and 0.64, 0.64, 0.75, and 0.84 in the training and validation sets, respectively, and the combined model demonstrated optimal performance for predicting IP.

CONCLUSIONS

The model integrating EGFR-19del mutation, third-generation TKI treatment and mean rad-score had good predictive value for IP after EGFR-TKI treatment in NSCLC patients with BM.

Realization of a crosstalk-avoided quantum network node using dual-type qubits of the same ion species

Generating ion-photon entanglement is a crucial step for scalable trapped-ion quantum networks. To avoid the crosstalk on memory qubits carrying quantum information, it is common to use a different ion species for ion-photon entanglement generation such that the scattered photons are far off-resonant for the memory qubits. However, such a dual-species scheme can be subject to inefficient sympathetic cooling due to the mass mismatch of the ions. Here we demonstrate a trapped-ion quantum network node in the dual-type qubit scheme where two types of qubits are encoded in the S and F hyperfine structure levels of 171Yb+ ions. We generate ion photon entanglement for the S-qubit in a typical timescale of hundreds of milliseconds, and verify its small crosstalk on a nearby F-qubit with coherence time above seconds. Our work demonstrates an enabling function of the dual-type qubit scheme for scalable quantum networks.

[Analysis and prediction of burden of viral hepatitis C-associated diseases in China from 1990 to 2044]

OBJECTIVE

To measure the burden of hepatitis C-associated diseases in China from 1990 to 2019, and to predict its changes from 2020 to 2044, so as to provide insights into formulation of the targeted hepatitis C control strategy.

METHODS

The total burden due to hepatitis C-associated diseases in China from 1990 to 2019 were extracted from the Global Burden of Disease 2019 (GBD 2019) data resources, and the trends in age-standardized prevalence, incidence, mortality and disability-adjusted life years (DALYs) rate of hepatitis C-associated acute hepatitis C (AHC), chronic liver diseases (CLD) and liver cancer in China from 1990 to 2019 were evaluated in China from 1990 to 2019 using estimated annual percentage change (EAPC). In addition, the changes in the burden of hepatitis C-associated diseases were predicted in China from 2020 to 2044 using a Bayesian model.

RESULTS

The prevalence, incidence, mortality and DALY rate of hepatitis C-associated diseases all appeared an overall tendency towards a decline in China from 1990 to 2019 (EAPC = -2.64%, -2.24%, -3.81% and -3.90%, respectively); however, there was a minor rise in the incidence and prevalence of hepatitis C-associated diseases from 2015 to 2019. The overall prevalence of hepatitis C-associated diseases reduced from 2 152.7/105 in 1990 to 1 254.1/105 in 2019 in China, with a reduction of 41.7%. The overall incidence reduced from 87.9/105 in 1990 to 55.0/105 in 2019 in China, with a reduction of 37.4%, and the highest incidence was seen for AHC, followed by CLD and liver cancer. The overall mortality and DALY rate of hepatitis C-associated diseases was 4.0/105 and 100.8/105 in China from 1990 to 2019, with CLD showing the largest contributions to the gross mortality and DALY. The mortality and DALY rate of hepatitis C-associated diseases were 5.5/105 and 142.4/105 among men in China in 2019, which were both much higher than among women (2.8/105 and 60.3/105, respectively), and the overall prevalence (1 604.9/105), mortality (30.2/105) and DALYs (437.1/105) of hepatitis C-associated diseases were all highest among patients at ages of 70 years and older, and the highest incidence was seen among patients at ages of 0 to 9 years (167.3/105). The incidence of hepatitis C-associated diseases was predicted to rise in China from 2020 to 2044; however, the DALY rate was projected to appear a tendency towards a decline.

CONCLUSIONS

Although the burden of hepatitis C-associated diseases showed a tendency towards a decline in China from 1990 to 2019, the burden remained high, and was predicted to slightly rise from 2020 to 2044. High attention should be paid to screening of hepatitis C among infants and treatment among adults.

[Burden of hepatitis B-associated diseases in China from 1990 to 2030]

OBJECTIVE

To measure the burden of hepatitis B-associated diseases in China from 1990 to 2019, and to predict its changes from 2020 to 2030.

METHODS

The age-standardized prevalence, incidence, mortality and disability-adjusted life years (DALY) rate of hepatitis B-associated diseases in China from 1990 to 2019 were extracted from the Global Burden of Disease 2019 (GBD 2019) data resources, and the trends in burdens of hepatitis B-associated diseases were evaluated from 1990 to 2019 using estimated annual percentage change (EAPC) and annual percent change (APC). In addition, the changes in the burden of hepatitis B-associated diseases were predicted in China from 2020 to 2023 using the Bayesian model.

RESULTS

The overall incidence of hepatitis B-associated diseases reduced from 2 725.98/105 in 1990 to 1 397.31/105 in 2019 in China [estimated annual percentage change (EAPC) = -2.35%, 95% confidential interval (CI): (-2.58%, -2.13%)], with a reduction in the prevalence from 12 239.53/105 in 1990 to 6 566.12/105 in 2019 [EAPC = -2.34%, 95% CI: (-2.54%, -2.14%)], a reduction in the mortality from 24.67/105 in 1990 to 8.07/105 in 2019 [EAPC = -4.92%, 95% CI: (-5.37%, -4.47%)], and a reduction in the DALY rate from 793.38/105 in 1990 to 247.71/105 in 2019 [(EAPC = -5.15%, 95% CI: (-5.64%, -4.66%)]. The DALY rate of hepatitis B-associated diseases were mainly attributed to liver cancer, and the DALY rate of hepatitis B-associated diseases appeared a tendency towards a rise in China from 2012 to 2019 [APC = 1.30%, 95% CI: (0.16%, 2.45%)]. The overall burden of hepatitis Bassociated diseases was higher in males than in females, and the DALY rate of hepatitis B-associated diseases increased with age, with the greatest DALY rate seen among patients at ages of 50 to 69 years. The overall incidence of hepatitis B-associated diseases was projected to be 866.79/105 in China in 2030, with the greatest incidence seen in acute hepatitis B (854.87/105), and the burden of hepatitis B-associated diseases was predicted to decline in China from 2020 to 2030; however, the burden of liver disease was projected to appear a tendency towards a rise.

CONCLUSIONS

The burden of hepatitis B-associated diseases appears an overall tendency towards a decline in China from 1990 to 2030; however, the burden of liver cancer appears a tendency towards aggravation. Early diagnosis and treatment of liver cancer should be given a high priority.

Stereotactic Ablative Radiotherapy Boost to Bladder Tumor for Bladder Preservation in Patients with Muscle-Invasive Bladder Cancer

PURPOSE/OBJECTIVE(S)

Previous studies showed that selective bladder-sparing approach using TMT is an established therapy of MIBC with outcomes that are comparable to those of radical cystectomy. However, it has been shown that the 5-year local recurrence in the bladder is greater than 40% after TMT. One of the possible reasons was that the RT dose to the bladder tumor or tumor bed was insufficient. Thus, we assessed the effectiveness and safety of Stereotactic Ablative Radiotherapy (SABR) boost to bladder tumor or tumor bed for patients with muscle invasive bladder cancer (MIBC).

MATERIALS/METHODS

A total of 59 consecutive patients with cT2-4 bladder cancer underwent transurethral resection of bladder tumor (TURBT). TURBT was visibly complete in 25 cases. Patients received SABR to the tumor or tumor bed in the bladder followed by conventionally fractionated RT (CFRT) to pelvis and total bladder with concomitant weekly radio-sensitizing chemotherapy. During SABR intravesical installation of isovolumetric saline through urinary catheter ensured adequate bladder filling. Response rate was assessed by cystoscopic evaluation and pelvic MRI or CT. Toxicities were reported per the RTOG acute and late Radiation Morbidity Scoring Schema.

RESULTS

The median age of all patients was 76 years (35-90 years). All patients completed SBRT boost and 61% patients received concurrent Gemcitabine chemotherapy. After a median follow-up time of 28 months, the rate of local control (LC) at 3 years was 90.0%. The overall survival (OS) and cancer-specific survival (CSS) rates at 3 years were 61.6% and 77.5%, respectively. Of the surviving patients, 84.4% have a disease-free and functioning bladder. Acute grade 3 gastrointestinal (GI) or genitourinary (GU) toxicities occurred in only 1.7% of the patients. Late grade 3 GU toxicity occurred in 5.1% of the patients. No patients experienced grade 4 GI or GU toxicities.

CONCLUSION

SABR boost followed by chemoradiation to the pelvis was found to be a well-tolerated and effective treatment for MIBC patients who are either not candidates for cystectomy or who desire bladder preservation. Randomized study is required to further evaluate this novel tri-modality treatment paradigm.

[Chest hemorrhage after left total pulmonary resection for secondary rifampin-resistant tuberculosis:a case report]

The patient had received five courses of anti-tuberculosis treatment for recurrent tuberculosis. The drug sensitivity test results of the first three courses showed drug-sensitive pulmonary tuberculosis, and the fourth diagnosis was rifampin-resistant tuberculosis (RR-TB), complicated by chronic obstructive pulmonary disease, type Ⅱ respiratory failure, pulmonary heart disease, and heart failure (grade Ⅲ). The patient stopped taking the anti-tuberculosis drugs on his own in the eighth month of receiving the resistant treatment. After admission, the symptoms improved temporarily after receiving oxygen therapy, anti-infection, and anti-tuberculosis treatment. Because of hemoptysis, the patient underwent arterial embolization by catheterization, but a large amount of hemoptysis occurred shortly thereafter. Emergency left total lung resection and gauze packing for hemostasis were performed. After surgery, the patient's vital signs were maintained with mechanical ventilation and vasopressors. Forty-eight hours after surgery, the gauze was removed, and the patient underwent tracheotomy, enteral nutrition, and anti-tuberculosis treatment. After discharge, the patient underwent rehabilitative exercise and anti-resistant tuberculosis therapy. The patient's condition remained stable for more than six months of follow-up.

[Effect of sugammadex on postoperative nausea and vomiting after surgery for intracranial aneurysm]

Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),>0.5-2.0 hours(T2),>2.0-6.0 hours (T3),>6.0-12.0 hours (T4) and >12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). The results regarding the occurrence of complications in patients with different levels of PONV at different time intervals after surgery in the two groups were as follows: in the T3 time period of group N, a significant difference was observed only in the occurrence of postoperative complications among patients with different levels of PONV (χ2=24.786, P<0.01). However, in the T4 time period, significant differences were found in the occurrence of postoperative complications among both the same level and different level PONV patients (χ2=15.435, 15.435, both P<0.01). Significant differences were also observed in the occurrence of postoperative complications among the same level and different level PONV patients in both the T3 and T4 time periods of group S (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.

A Foley catheter 'the jack of all trades': a literature review of its common and novel uses

The Foley catheter is one of the most commonly used devices in modern surgical practice. Developed for draining the urinary bladder, this humble catheter has been employed for many other purposes ranging from urine output monitoring to complex urological investigations. Over time, it has evolved into being applied in more complex and innovative ways in various other specialties apart from urology. In this review article, we describe some of the common and novel uses of this deceptively simple device, and discuss the scope of its application in modern medicine.

Safety profile and outcomes of intraoperative ultrasound-guided remnant cholecystectomy

INTRODUCTION

Subtotal cholecystectomy (STC) is a safe approach in difficult cholecystectomies to prevent bile duct and vascular injury. However, the gallbladder remnant can become symptomatic, necessitating further surgical intervention. This study evaluates the safety profile and perioperative outcomes of remnant cholecystectomy (RC) performed under intraoperative ultrasound guidance.

METHODS

We retrospectively reviewed the records of all patients that underwent RC under intraoperative ultrasound guidance in 2009 and 2019. Pre-, intra- and postoperative details of patients who underwent RC were obtained from patients' electronic and paper copy records.

RESULTS

Ninety-seven patients underwent STC during the study period. Of this cohort, 16 patients (16.5%) presented with symptomatic gallbladder remnant over a median follow-up period of 14 months (interquartile range [IQR] 2-26). The median age was 64 years (IQR 54-69) with an equal male-to-female distribution. The median body mass index was 31kg/m2 (IQR 28-33). Twelve of 16 patients (75%) then proceeded to elective RC. Intraoperative ultrasound was used in all cases to identify the location of the remnant gallbladder and biliary anatomy. The median operative time was 88min (IQR 80-96), with 67% completed laparoscopically. No patients suffered bile duct injury. The median hospital stay was 3 days (IQR 1-5). During the follow-up period, eight patients (67%) reported symptom resolution.

CONCLUSIONS

RC is a safe operation that can be performed laparoscopically even after previous open subtotal cholecystectomy. We recommend the routine use of intraoperative ultrasound as an adjunct for identifying remnant gallbladder and biliary anatomy in all patients.

[Association between clinical phenotypes of hypertrophic cardiomyopathy and Ca2+ gene variation gene variation]

Objective: To observe the association between clinical phenotypes of hypertrophic cardiomyopathy (HCM) patients and a rare calcium channel and regulatory gene variation (Ca²⁺ gene variation) and to compare clinical phenotypes of HCM patients with Ca²⁺ gene variation, a single sarcomere gene variation and without gene variation and to explore the influence of rare Ca²⁺ gene variation on the clinical phenotypes of HCM. Methods: Eight hundred forty-two non-related adult HCM patients diagnosed for the first time in Xijing Hospital from 2013 to 2019 were enrolled in this study. All patients underwent exon analyses of 96 hereditary cardiac disease-related genes. Patients with diabetes mellitus, coronary artery disease, post alcohol septal ablation or septal myectomy, and patients who carried sarcomere gene variation of uncertain significance or carried>1 sarcomere gene variation or carried>1 Ca²⁺ gene variation, with HCM pseudophenotype or carrier of ion channel gene variations other than Ca²⁺ based on the genetic test results were excluded. Patients were divided into gene negative group (no sarcomere or Ca²⁺ gene variants), sarcomere gene variation group (only 1 sarcomere gene variant) and Ca²⁺ gene variant group (only 1 Ca²⁺ gene variant). Baseline data, echocardiography and electrocardiogram data were collected for analysis. Results: A total of 346 patients were enrolled, including 170 patients without gene variation (gene negative group), 154 patients with a single sarcomere gene variation (sarcomere gene variation group) and 22 patients with a single rare Ca²⁺ gene variation (Ca²⁺ gene variation group). Compared with gene negative group, patients in Ca²⁺ gene variation group had higher blood pressure and higher percentage of family history of HCM and sudden cardiac death (P<0.05); echocardiographic results showed that patients in Ca²⁺ gene variation group had thicker ventricular septum ((23.5±5.8) mm vs. (22.3±5.7) mm, P<0.05); electrocardiographic results showed that patients in Ca²⁺ gene variation group had prolonged QT interval ((416.6±23.1) ms vs. (400.6±47.2) ms, P<0.05) and higher RV5+SV1 ((4.51±2.26) mv vs. (3.50±1.65) mv, P<0.05). Compared with sarcomere gene variation group, patients in Ca²⁺ gene variation group had later onset age and higher blood pressure (P<0.05); echocardiographic results showed that there was no significant difference in ventricular septal thickness between two groups; patients in Ca²⁺ gene variation group had lower percentage of left ventricular outflow tract pressure gradient>30 mmHg (1 mmHg=0.133 kPa, 22.8% vs. 48.1%, P<0.05) and the lower early diastolic peak velocity of the mitral valve inflow/early diastolic peak velocity of the mitral valve annulus (E/e') ratio ((13.0±2.5) vs. (15.9±4.2), P<0.05); patients in Ca²⁺ gene variation group had prolonged QT interval ((416.6±23.1) ms vs. (399.0±43.0) ms, P<0.05) and lower percentage of ST segment depression (9.1% vs. 40.3%, P<0.05). Conclusion: Compared with gene negative group, the clinical phenotype of HCM is more severe in patients with rare Ca²⁺ gene variation; compared with patients with sarcomere gene variation, the clinical phenotype of HCM is milder in patients with rare Ca²⁺ gene variation.

[Analysis of time for diagnosis of nontuberculous mycobacterial lung disease and its associated factors in a tuberculosis-designated hospital in Shanghai]

Objective: To investigate the pathogenic characteristics, bacteriological diagnosis time and its associated factors among patients with nontuberculous mycobacterial (NTM) lung disease in a large tuberculosis-designated hospital in Shanghai from 2020 to 2021, in order to improve diagnosis efficiency and formulate precision treatment. Methods: On the basis of the Tuberculosis Database in Shanghai Pulmonary Hospital, NTM patients diagnosed by the Department of Tuberculosis between January 2020 and December 2021 were screened. Demographic, clinical and bacterial information were retrospectively collected. Chi-square test, paired-sample nonparametric test and logistic regression model were used to analyze the factors associated with the diagnosis time of NTM lung disease. Results: A total of 294 patients with bacteriologically confirmed NTM lung disease were included in this study, 147 males and 147 females with a median age of 61(46, 69) years. Of them, 227 (77.2%) patients had comorbidity of bronchiectasis. Species identification results showed that Mycobacterium Avium-Intracellulare Complex was the main pathogen of NTM lung disease (56.1%), followed by Mycobacterium kansasii (19.0%) and Mycobacterium abscessus (15.3%). Species such as Mycobacterium xenopi and Mycobacterium malmoense were rarely identified, accounting for a total proportion of only 3.1%. Positive culture rates for sputum, bronchoalveolar lavage fluid and puncture fluid were 87.4%, 80.3% and 61.5%, respectively. Paired-sample analysis showed that the positive rate of sputum culture was significantly higher than that of smear microscopy (87.1% vs. 48.4%, P<0.01), while no statistical difference was observed between sputum and bronchoalveolar lavage fluid on positive culture rate (78.7% vs. 77.3%, P>0.05). Patients with cough or expectoration were observed with 4.04-fold (95%CI 1.80-9.05) or 2.95-fold (95%CI 1.34-6.52) higher probability of positive sputum culture, compared to those without. Regarding bronchoalveolar lavage fluid, female or patients with bronchiectasis had a 2.82-fold (95%CI 1.16-6.88) or 2.38-fold (95%CI 1.01-5.63) higher probability to achieve a positive culture. The median time to diagnosis of NTM lung disease was 32 (interquartile range: 26-42) days. The results of multivariable analysis showed that patients with symptom of expectoration (aOR=0.48, 95%CI 0.29-0.80) needed a shorter diagnosis time in comparison with patients without expectoration. With Mycobacterium Avium-Intracellulare Complex as a reference, lung disease caused by Mycobacterium abscessus needed shorter diagnosis time (aOR=0.43, 95%CI 0.21-0.88), whereas those caused by rare NTM species were observed to require a longer diagnosis time (aOR=8.31, 95%CI 1.01-68.6). Conclusion: The main pathogen causing NTM lung disease in Shanghai was Mycobacterium Avium-Intracellulare Complex. Sex, clinical symptoms and bronchiectasis had an impact on the positive rate of mycobacterial culture. The majority of patients in study hospital were timely diagnosed. Clinical symptoms and NTM species were associated with the bacteriological diagnosis time of NTM lung disease.

Influence of recombinant human B-type natriuretic peptide on improving ventricular function in patients with ST elevation myocardial infarction

OBJECTIVE

The aim of this study was to investigate the effect of recombinant human B-type natriuretic peptide (rhBNP) on improving ventricular function in patients with ST-elevation myocardial infarction (STEMI).

PATIENTS AND METHODS

In this retrospective study, 96 patients with STEMI admitted to Cangzhou Central Hospital from June 2017 to June 2019 were recruited and randomized to either a control group or an experimental group, with 48 patients in each group. Patients in both groups were given conventional pharmacological therapy, and an emergency coronary intervention was performed within 12 hours. Patients in the experimental group received rhBNP intravenously postoperatively, whereas patients in the control group received an equal amount of 0.9% NaCl solution through an intravenous drip. Postoperative recovery indicators were compared between the two groups.

RESULTS

Patients treated with rhBNP showed better postoperative respiratory frequency, heart rate, blood oxygen saturation, pleural effusion, acute left heart remodeling after surgery and central venous pressure at 1-3 days after surgery than those without (p<0.05). Early diastolic blood flow velocity/early diastolic motion velocity (E/Em) and wall-motion score indices (WMSI) of patients in the experimental group were markedly lower compared to the control group one week after surgery (p<0.05). Patients receiving rhBNP had better left ventricular ejection fraction (LVEF) and WMSI six months after surgery and higher left ventricular end diastolic volume (LVEDV) and LVEF one week after surgery than the controls (p<0.05). Administration of rhBNP for patients with STMI provided a higher treatment safety by significantly reducing the incidence of left ventricular remodeling and complication than conventional medication (p<0.05).

CONCLUSIONS

Intervention with rhBNP in STEMI patients could effectively inhibit ventricular remodeling, alleviate symptoms, reduce adverse complications and improve ventricular function.

Chronological and Replicative Aging of CD51+/PDGFR-α+ Pulp Stromal Cells

As a crucial source of mesenchymal stromal cells, CD51⁺/PDGFR-α⁺ human dental pulp stromal cells (hDPSCs) are promising seeding cells for regenerative medicine. Cellular senescence hinders the translational application of hDPSCs. However, it remains unclear whether chronological and replicative senescence results in distinct outcomes for hDPSCs. To investigate the influence of senescence on DPSCs, we used transgenic lineage tracking, immunofluorescence, flow cytometry, and various molecular experiments to depict the dynamic pattern of hDPSCs in mice and humans during chronological and replicative senescence. The data demonstrated that CD51⁺/PDGFR-α⁺ cells were decreased in chronological senescence. Impaired self-renewal and higher ossificatory differentiation were observed in chronologically senescent hDPSCs. Regarding replicative senescence, a decreased CD51⁺ but upregulated PDGFR-α⁺ population was observed in culture. Furthermore, weakened self-renewal and osteogenic differentiation were observed in replicatively senescent hDPSCs. In summary, CD51⁺/PDGFR-α⁺ hDPSCs decrease in chronologically aged pulp, with self-renewal that is impaired without impaired osteogenic differentiation. However, replicative senescence has a different impact: self-renewal and ossific differentiation are impaired and CD51 expression is reduced, but PDGFR-α expression remains. These findings demonstrate the different outcomes of chronological and replicative senescence in CD51⁺/PDGFR-α⁺ hDPSCs. Furthermore, we revealed that impaired self-renewal is the core dysfunction for both types of cellular aging and that osteogenic differentiation capability differs between them. This study provides insights into the influence of chronological and replicative senescence on the characteristics and capabilities of hDPSCs. These advances provide fundamental knowledge to alleviate cellular aging of CD51⁺/PDGFR-α⁺ hDPSCs and promote their translational applications.

[Diagnostic value of rapid exchange test in patients with peritoneal dialysis catheter dysfunction]

A total of 36 patients with suspected peritoneal dialysis (PD) catheter dysfunction in the First Hospital of China Medical University from June 2020 to August 2022 were included, and five patients with normal PD catheter were also included as the control group. There were 22 males and 19 females, and aged (45±21) years. The volume of rapid-phase drainage in the control and dysfunction groups was (2 086±65) and (1 181±637) ml, and the total drainage time was (15.2±1.3) and (38.3±14.9) min, respectively. The volume of rapid-phase drainage in the dysfunction group was reduced and the total drainage time was longer than that in the control group (both P<0.05). Compared with group with PD catheter migration, the duration of new bag instillation was prolonged, the drainage volume in the rapid-phase was reduced, the total drainage duration was prolonged, and the ultrafiltration volume was decreased in the group with PD catheter obstruction (all P<0.05). The rapid exchange test can provide an early preliminary diagnosis of PD catheter dysfunction and identify the type of catheter dysfunction.

[Construction and analysis of functional network of hemi-brain in patients with brain tumors before and after anesthesia based on resting-state functional magnetic resonance imaging]

Objective: To construct and analyze the functional network changes of hemi-brain in patients with brain tumor before and after anesthesia by using resting state functional magnetic resonance imaging (rs-fMRI). Methods: A total of 18 right-handed patients were prospectively included (6 males and 12 females). The patients underwent glioma resection in Peking University International Hospital from December 2018 to December 2021, and age ranged from 20 to 65 (45.1±13.6) years, with American Society of Anesthesiologists (ASA) grade of Ⅰ-Ⅱ. MRI scans were performed while the patient was awake and at the depth of surgical anesthesia. The functional network of healthy lateral brain was constructed and analyzed by means of graph theory, and its global and local topological properties were calculated. Global topology attributes included global efficiency (Eg), local efficiency (Eloc), clustering parameters (Cp), length parameter of shortest path (Lp), and small world (SW). Topology attributes of nodes included node degree (ND), node efficiency (NE) and between centrality (BC). The global and nodal topological properties of the hemi-brain network were compared between patients with different hemispherical space occupying under wakefulness and anesthesia. Results: At the awake state, Eloc and Cp in the global topological attributes of hemi-brain network were 0.259±0.007 and 0.197±0.010, respectively, and decreased to 0.242±0.013 and 0.177±0.021, respectively after anesthesia, with statistically significant differences (all P<0.01). The topological attributes of the nodes in hemi-side brain showed that ND, NE and BC were increased in the default mode network-related brain regions, while NE and BC were decreased in the limbic system and subcortical structures. Eloc and Cp were 0.258±0.008 and 0.198±0.008 respectively in the patients with left hemisphere space occupying, and decreased to 0.241±0.011 and 0.177±0.015 respectively after anesthesia, with statistically significant differences (all P<0.01). However, only Eloc decreased in patients with right hemisphere space occupying after anesthesia, and Eloc was 0.260±0.006 and 0.243±0.016 respectively when awake and after anesthesia, with statistically significant differences (P<0.05). The topological attributes of nodes in patients with space occupying in different cerebral hemispheres showed bidirectional changes after anesthesia, and patients with space occupying in the left cerebral hemisphere were more likely to be widely affected after anesthesia. The effects of anesthetic drugs may show hemispheric laterality. If the tumor was in the dominant hemisphere, the compensatory function of the dominant side was more likely to be damaged. Conclusions: During anesthesia-induced loss of consciousness in patients with brain tumors, both the ability to integrate information and the functional connections between local regions are weakened, and some brain regions have functional connection reorganization. The changes of brain network after anesthesia are bidirectional regulation.

Observation of Non-Markovian Spin Dynamics in a Jaynes-Cummings-Hubbard Model Using a Trapped-Ion Quantum Simulator

The Jaynes-Cummings-Hubbard (JCH) model is a fundamental many-body model for light-matter interaction. As a leading platform for quantum simulation, the trapped ion system has realized the JCH model for two to three ions. Here, we report the quantum simulation of the JCH model using up to 32 ions. We verify the simulation results even for large ion numbers by engineering low excitations and thus low effective dimensions; then we extend to 32 excitations for an effective dimension of 2^{77}, which is difficult for classical computers. By regarding the phonon modes as baths, we explore Markovian or non-Markovian spin dynamics in different parameter regimes of the JCH model, similar to quantum emitters in a structured photonic environment. We further examine the dependence of the non-Markovian dynamics on the effective Hilbert space dimension. Our Letter demonstrates the trapped ion system as a powerful quantum simulator for many-body physics and open quantum systems.

Health-related quality of life with pembrolizumab monotherapy in patients with previously treated advanced microsatellite instability high/mismatch repair deficient endometrial cancer in the KEYNOTE-158 study

OBJECTIVE

Pembrolizumab demonstrated a clinically meaningful objective response rate in patients with previously treated, advanced MSI-H/dMMR endometrial cancer in the multicohort phase 2 KEYNOTE-158 study (ClinicalTrials.gov, NCT02628067). We present health-related quality of life (HRQoL) results for these patients.

METHODS

This analysis included patients from cohorts D (endometrial cancer with any MSI status) and K (any MSI-H/dMMR solid tumor except colorectal) who had previously treated, advanced MSI-H/dMMR endometrial cancer. Patients received pembrolizumab 200 mg Q3W for 35 cycles. EORTC QLQ-C30 and EQ-5D-3L questionnaires were administered at baseline, at regular intervals during treatment, and 30 days after treatment discontinuation. Pre-specified exploratory analyses included changes from baseline to week 9 in QLQ-C30 global health status (GHS)/QoL and EQ-5D-3L visual analog scale (VAS) score for all patients and by best overall response.

RESULTS

84 of 90 enrolled patients completed ≥1 HRQoL questionnaire and were included in the analysis. QLQ-C30 and EQ-5D-3L compliance rates were 90% and 94%, respectively, at baseline, and 92% and 93% at week 9. Mean (95% CI) QLQ-C30 GHS/QoL scores improved from baseline to week 9 by 6.08 (0.71-11.46) points in the overall population, with greater improvement in patients who achieved complete or partial response (11.67 [5.33-18.00]-point increase). Mean (95% CI) EQ-5D-3L VAS scores improved by 6.00 (2.25-9.75) points in the overall population and 9.11 (5.24-12.98) points in patients with CR/PR.

CONCLUSIONS

Pembrolizumab maintained or improved HRQoL in patients with previously treated, advanced MSI-H/dMMR endometrial cancer, further supporting efficacy and safety results from KEYNOTE-158 and pembrolizumab use in this setting.

Observation of supersymmetry and its spontaneous breaking in a trapped ion quantum simulator

Supersymmetry (SUSY) helps solve the hierarchy problem in high-energy physics and provides a natural groundwork for unifying gravity with other fundamental interactions. While being one of the most promising frameworks for theories beyond the Standard Model, its direct experimental evidence in nature still remains to be discovered. Here we report experimental realization of a supersymmetric quantum mechanics (SUSY QM) model, a reduction of the SUSY quantum field theory for studying its fundamental properties, using a trapped ion quantum simulator. We demonstrate the energy degeneracy caused by SUSY in this model and the spontaneous SUSY breaking. By a partial quantum state tomography of the spin-phonon coupled system, we explicitly measure the supercharge of the degenerate ground states, which are superpositions of the bosonic and the fermionic states. Our work demonstrates the trapped-ion quantum simulator as an economic yet powerful platform to study versatile physics in a single well-controlled system.

Quantum Simulation of the Two-Dimensional Weyl Equation in a Magnetic Field

Quantum simulation of 1D relativistic quantum mechanics has been achieved in well-controlled systems like trapped ions, but properties like spin dynamics and response to external magnetic fields that appear only in higher dimensions remain unexplored. Here we simulate the dynamics of a 2D Weyl particle. We show the linear dispersion relation of the free particle and the discrete Landau levels in a magnetic field, and we explicitly measure the spatial and spin dynamics from which the conservation of helicity and properties of antiparticles can be verified. Our work extends the application of an ion trap quantum simulator in particle physics with the additional spatial and spin degrees of freedom.

Experimental Realization of the Rabi-Hubbard Model with Trapped Ions

Quantum simulation provides important tools in studying strongly correlated many-body systems with controllable parameters. As a hybrid of two fundamental models in quantum optics and in condensed matter physics, the Rabi-Hubbard model demonstrates rich physics through the competition between local spin-boson interactions and long-range boson hopping. Here, we report an experimental realization of the Rabi-Hubbard model using up to 16 trapped ions and present a controlled study of its equilibrium properties and quantum dynamics. We observe the ground-state quantum phase transition by slowly quenching the coupling strength, and measure the quantum dynamical evolution in various parameter regimes. With the magnetization and the spin-spin correlation as probes, we verify the prediction of the model Hamiltonian by comparing theoretical results in small system sizes with experimental observations. For larger-size systems of 16 ions and 16 phonon modes, the effective Hilbert space dimension exceeds 2^{57}, whose dynamics is intractable for classical supercomputers.

Study of the intentional replantation procedure used to treat a tooth with a palatogingival groove: A case report

In order to clarify the prognosis of intentional replantation used for palatogingival groove treatment for long-term follow-up observation, the case of a patient with a maxillary lateral incisor with palatogingival groove was investigated. The intentional replantation was carried out to preserve the tooth. The periodontal pocket and the apical bone defect were almost completely repaired at 12-month follow-up. However, the infection was reoccurred after 25-month follow-up examinations. The infected tooth was extracted, of which the root was investigated by histological analysis. Therefore, the reason of the replant failure and the pathways of bacterial infection was investigated.

Key words:Palatogingival groove, intentional tooth replantation, bacterial infection, maxillary lateral incisor.

Label-Free Histology and Evaluation of Human Pancreatic Cancer with Coherent Nonlinear Optical Microscopy

Surgeries achieving maximal tumor resection remain the major effective treatment of pancreatic cancer. Rapid and precise intraoperative diagnosis of pancreatic tissues is critical for optimum surgical outcomes but is challenging for the current staining-based histological methods. We demonstrated that label-free coherent nonlinear optical microscopy with combined stimulated Raman scattering (SRS) and second harmonic generation (SHG) could reveal key diagnostic features of both normal and cancerous human pancreatic tissues. Adjacent pairs of tissue sections from resection margins of 37 patients were imaged by SRS and hematoxylin and eosin staining for direct comparison, demonstrating high diagnostic concordance (Cohen's kappa, κ > 0.97) between them. Fresh unprocessed tissues showed well-preserved histoarchitectures including pancreatic ducts, islets, acini, and nerves. Moreover, the area ratios of collagen fibers were analyzed and found to correlate with the drainage pancreatic amylase level (odds ratio = 28.0, p = 0.0017). Our results indicated that SRS/SHG histology provides potential for rapid intraoperative diagnosis of pancreatic cancer as well as a predictive value of postoperative pancreatic fistula.

Evaluating perioperative glycemic status after different types of pancreatic surgeries via continuous glucose monitoring system: a pilot study

Background

Perioperative glycemic status after pancreatic surgery has never been described. However, it's essential for optimal perioperative glucose management and understanding the pathogenesis of new-onset diabetes mellitus (NODM) after pancreatectomy. Continuous glucose monitoring (CGM) system provides us a helpful tool for closely monitoring and studying perioperative glucose change. This study tried to describe and compare perioperative glucose level and glycemic variability between different types of pancreatic surgeries via CGM device.

Methods

This study was designed as a prospective observational study. Eighteen patients were enrolled and were grouped by different types of surgery received: control group (CTRL), pancreaticoduodenectomy (PD), distal pancreatectomy (DP), and total pancreatectomy (TP). CGM devices were implanted and initiated right after the surgery. Mean glucose value (MGV), coefficient of variation (CV), mean of daily difference (MODD), continuous overall net glycemic action (CONGA), and time above range (TAR)/time below range (TBR) was compared between groups to assess glucose level and glycemic variability.

Results

TP showed the highest MGV and CV among all groups (P<0.001), while CTRL showed the lowest (P<0.001). PD and DP had similar MGV and CV lower than TP but higher than CTRL (P<0.001). TP had the highest MODD and CONGA, CTRL had the lowest, but no significant differences were found between groups. TP had the highest TAR (24.29%) and the lowest TBR (1.28%), while the control group showed the opposite. The differences in TAR/TBR between groups were all significant (P<0.05).

Conclusions

TP had the highest mean glucose level and the greatest glycemic variability. PD and DP had similar results: a higher mean glucose level than control but lower than TP. For glycemic variability, PD and DP seemed to have a near-normal result resembling the control group. CGM is useful for glucose monitoring in the perioperative management of pancreatic surgery.

417 Initial Choice of Imaging Investigation for Patients Presenting with Acute Pancreatitis: Should MRCP Be First Line in Selected Patients?

Introduction

Current guidelines for acute pancreatitis advocate abdominal ultrasound (AUS) as the first-line imaging investigation to identify if gallstones are the cause of pancreatitis. However, many patients have a history of cholecystectomy or present with known gallstones and deranged liver function tests (LFTs). In these patients, magnetic resonance cholangiopancreatography (MRCP) is indicated due to its higher sensitivity and specificity for detecting choledocholithiasis.

Method

This retrospective audit reviewed all consecutive patients who presented to the surgical assessment unit with acute pancreatitis over one month. Their past surgical history, bloods and imaging were reviewed.

Results

Of the 30 patients, seventeen (57%) had no previous cholecystectomy or known gallstones, nine (30%) had previous cholecystectomy and eight (27%) had known gallstones, seven (88%) of which presented with deranged LFTs. Of the seventeen patients who should have had AUS first (n = 17), thirteen (76%) had AUS first, none had MRCP first and four (24%) had computerised tomography (CT) first. Of the patients in whom MRCP was indicated first-line (n = 13), seven (54%) had AUS first, none had MRCP first, four (31%) had CT first and two (15%) went straight to endoscopic retrograde cholangiopancreatography having had recent outpatient MRCPs. In the seven patients in whom MRCP was indicated but AUS was performed first, six (86%) underwent subsequent MRCP.

Conclusions

MRCP should be considered the first line imaging investigation for patients presenting with acute pancreatitis and a history of cholecystectomy or known gallstones with deranged LFTs, as AUS rarely prevents the need for subsequent MRCP.

416 Hyperlipasaemia In an Adult Hospital Population: A Retrospective Audit Demonstrating A High Proportion of Non-Pancreatic Causes of a Diagnostically Raised Lipase

Introduction

Serum lipase is considered to be a more specific test than amylase for acute pancreatitis, and a rise of over three times the laboratory upper limit of normal (ULN) is considered diagnostic. This single-centre retrospective audit assessed the accuracy of a raised lipase in confirming acute pancreatitis.

Method

All patients with a raised lipase (&gt;78 U/L) admitted over one month were reviewed. Patients whose lipase was measured &gt;48 hours after admission were excluded. Cross-sectional imaging and discharge summaries were reviewed to determine the cause of hyperlipasaemia. Receiver Operator Characteristics (ROC) analysis was performed to determine the most accurate cut-off value for diagnosing acute pancreatitis.

Results

Ninety-nine patients were included. The most common causes of raised lipase (&gt;78 U/L) were pancreatitis (37%), hepatobiliary (15%), gastroduodenal (8%) and renal (8%) disease. In patients with a lipase &gt;234 U/L (3xULN, n = 46), the most common causes were pancreatitis (70%), drugs (9%), hepatobiliary (9%), gastroduodenal (4%) and renal (4%) disease. ROC analysis showed lipase to have an area under the curve (AUC) of 0.89 (95% CI 0.84-0.96, p &lt; 0.0001). Using the laboratory cut-off of 234 U/L (3xULN), lipase had a sensitivity, specificity, and positive likelihood ratio (PLR) of 86.5%, 77.4% and 3.8. Increasing the lipase cut-off did not improve the specificity without compromising the sensitivity of the test.

Conclusions

A lipase cut-off of 3xULN is an appropriate cut-off for a biochemical diagnosis of acute pancreatitis. However, up to 30% of patients with lipase values above this cut-off may have alternative diagnoses that should be considered.

Experimental Realization of Multi-ion Sympathetic Cooling on a Trapped Ion Crystal

Trapped ions are one of the leading platforms in quantum information science. For quantum computing with large circuit depth and quantum simulation with long evolution time, it is of crucial importance to cool large ion crystals at runtime without affecting the internal states of the computational qubits, thus the necessity of sympathetic cooling. Here, we report multi-ion sympathetic cooling on a long ion chain using a narrow cooling beam focused on two adjacent ions, and optimize the choice of the cooling ions according to the collective oscillation modes of the chain. We show that, by cooling a small fraction of ions, cooling effects close to the global Doppler cooling limit can be achieved. This experiment therefore demonstrates an important enabling step for quantum information processing with large ion crystals.

MiR-182 inhibits oxidative stress and epithelial cell apoptosis in lens of cataract rats through PI3K/Akt signaling pathway

OBJECTIVE

The aim of this study was to investigate the influences of micro ribonucleic acid (miR)-182 on oxidative stress and epithelial cell apoptosis in the lens of cataract rats through the phosphatidylinositol 3-hydroxy kinase/protein kinase B (PI3K/Akt) pathway.

MATERIALS AND METHODS

A total of 36 Sprague-Dawley rats were randomly assigned into three groups, including normal group (n=12), model group (n=12), and miR-182 mimics group (n=12). Rats in normal group were first normally fed. After establishing the cataract model, rats in model group were intraperitoneally injected with normal saline. Meanwhile, rats in miR-182 mimics group were intraperitoneally injected with miR-182 mimics. At 7 d after operation, materials were sampled. The expressions of B-cell lymphoma 2 (Bcl-2) and Bcl-2 associated X protein (Bax) were detected via immunofluorescence. The protein expressions of PI3K and Akt were detected using Western blotting. Moreover, the expression level of miR-182 was measured via qPCR. Cell apoptosis was evaluated using terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL). In addition, the content of superoxide dismutase (SOD) and malondialdehyde (MDA) was determined using enzyme-linked immunosorbent assay (ELISA).

RESULTS

Compared with normal group, both model group and miR-182 mimics group exhibited significantly up-regulated expression level of Bax and down-regulated expression of Bcl-2 (p<0.05). MiR-182 mimics group had markedly lower expression level of Bax and higher expression level of Bcl-2 than model group (p<0.05). Western blotting results demonstrated that the protein expression levels of PI3K and Akt in model and miR-182 mimics groups were considerably higher than those in normal group (p<0.05). Meanwhile, their protein expression levels in miR-182 mimics group were significantly higher than those in model group (p<0.05). In comparison with normal group, the expression level of miR-182 was markedly up-regulated in both model group and miR-182 mimics group (p<0.05). Moreover, its expression level in miR-182 mimics group was considerably higher than that in model group (p<0.05). TUNEL-positive cells increased significantly in both model group and miR-182 mimics group when compared with normal group (p<0.05). However, they were remarkably reduced in miR-182 mimics group when compared with model group (p<0.05). Compared with normal group, model and miR-182 groups exhibited substantially decreased SOD content and increased MDA content (p<0.05).

CONCLUSIONS

MiR-182 inhibits oxidative stress and epithelial cell apoptosis in the lens of cataract rats by activating the PI3K/Akt signaling pathway.

736 Optimal Time for Cholecystectomy After ERCP

Introduction

Recent research on the management of cholecystolithiasis with co-existing choledocholithiasis suggests performing cholecystectomy within 24 hours after ERCP has favourable outcomes. However, this target can be difficult to achieve in the NHS due to limited resources.

Method

This retrospective study includes 444 patients who underwent successful ERCP before cholecystectomy. We examined the impact of the duration of ERCP to cholecystectomy and post ERCP complications on operative difficulty and patient outcomes. We also report on gallstone related readmissions and rate of retained stones.

Results

The median duration from ERCP to cholecystectomy was 75 days, with a 14% readmission rate between their first successful ERCP and cholecystectomy.

Our analysis showed a statistically significant negative correlation between ERCP-to-cholecystectomy duration and postoperative stay. Readmissions increased with time, but this did not reach statistical significance. The occurrence of post ERCP complications significantly increased postoperative stay and the open conversion rate.

Conclusions

In contrast to recent research, our analysis suggests that early cholecystectomy post ERCP is not associated with better outcome. However, the impact of gallstone related readmissions needs further analysis. Post ERCP complication could serve as a predictor for operative difficulty and longer postoperative stay. It should be considered when planning the cholecystectomy.

[Analysis of clinical characteristics of 481 HBV-related liver cirrhotic patients with low viral load]

Objective: To analyze the clinical characteristics of HBV-related liver cirrhotic patients with low viral load. Methods: A retrospective analysis on 481 inpatients with HBV-related cirrhosis with low viral load [HBV DNA≤2 000 IU/ml (10(4) copies/ml)] general condition, virological indicators, liver function-related indicators, complications, and incidence of complications were analyzed. The t-test was used to compare the average measurement data, and the χ (2) test was used to compare the count data. Results: 481 cases were mainly male (male/female: 324/157), aged 20-83 (53.31 ± 11.67) years old. Han nationality accounted for 71.518%. 386 cases were HBsAg positive. 391 cases were HBeAg positive, and 140 cases were HBV DNA positive. The average value of bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase, platelets, and prothrombin were 50.59 ± 91.25 (μmol/L), 33.68 ± 7.5 (g/L), and 60.66 ± 106.95(U/L), 63.37 ± 86.19(U/L), 106.65 ± 83.22(×10(9)/L), 68.82% ± 25.33%, respectively. CTP class A/B/C had 220/150/111 cases. The average values of CTP, MELD, APRI and FIB-4 were 7.61 ± 2.58, 10.98 ± 5.79, 2.34 ± 3.56, 6.91 ± 8.04, respectively. The overall incidence of complications in HBV-related cirrhotic patients with low viral load, HBV DNA negative, HBV DNA positive, HBsAg negative, and HBsAg positive were 80.0%, 82.7%, 73.6%, 85.3%, and 78.8%, respectively. Among them, 283 cases (58.84%), 197 cases (55.77%), 86 cases (61.43%), 52 cases (54.74%) and 231 cases (59.84%) were of hypersplenism, and 267 cases (55.51%), 197 cases (55.77%), 70 cases (50.00%), 56 cases (58.95%), and 211 cases (54.66%) were of esophagogastric varices. There were 59 cases (12.27%), 48 cases (14.08%), 11 cases (7.86%), 12 cases (12.63%), and 47 cases (12.18%) of rupture of esophageal and gastric varices, respectively. 202 cases (42.00%), 147 cases (43.11%), 55 cases (39.29%), 42 cases (44.21%), and 160 cases (41.45%) were of ascites, respectively. 17 cases (3.53%), 12 cases (3.52%), 5 cases (3.5%), 2 cases (2.11%), 15 (3.89%) cases were of hepatic encephalopathy, respectively. There were 6 cases (1.25%), 3 cases (0.88%), 3 cases (2.14%), 0 cases (0%), 6 cases (1.55%) of liver cancer. 29 cases (6.03%), 21 cases (6.16%), 8 cases (5.71%), 9 cases (9.47%) and 20 cases (5.18%) were of portal vein thrombosis. Compared with the overall incidence of complications, 341 HBV DNA-negative patients and 95 HBsAg-negative patients still had higher incidence of complications. The patients were grouped by age, and in < 40 years old, 40-50 years old, and > 50 years old, the overall complications were 80.8% in 42 cases, 76.8% in 116 cases and 81.7% in 227 cases, and the difference was not statistically significant. Conclusion: HBV infection patients with low viral load, and those whose HBsAg has disappeared, are still at risk of developing liver cirrhosis and even serious complications, and whether such population need antiviral therapy and benefit from it deserves further research.

Forensic Analysis of 105 Autopsy Cases of Psychiatric Patients

Abstract

Objective To provide reference for medical and health services and forensic expertise, the causes and manners of death of psychiatric patients were analyzed retrospectively. Methods A total of 105 autopsy cases of psychiatric patients accepted and settled by Institute of Forensic Science of Criminal Investigation Police University of China from 2004 to 2019 were collected. The cases were divided into four groups： disease death, suicidal death, accidental death and homicidal death. The common causes of death of each group were statistically analyzed and the differences in age, disease duration, body mass index （BMI） and gender among the groups were assessed. Results Of the 105 cases, 60 were male and 45 were female, the course of psychosis was （12.9±10.4） years, the age of the deceased was （51.3±11.4） years, and 61.0% was schizophrenic. There were 50 cases （47.6%） in the disease death group, in which the psychiatric patients were the oldest and had the longest course of psychosis and lowest BMI. Pulmonary thromboembolism, respiratory infections, and cardiogenic disease were the most common causes of death in the group. There were 26 accidental deaths （24.8%）, among which traffic accidents were the most common cause of death. There were 15 homicidal deaths （14.3%）, all of which were male, with craniocerebral injury being the most common cause of death. There were 14 suicidal deaths （13.3%）. In suicidal death group, the age of the deceased was the youngest, the course of psychosis was the shortest and falling from the height was the most common way to commit suicide. Conclusion Understanding the common causes of death of psychiatric patients may contribute to developing measures to reduce the mortality rate of the population. It is necessary to investigate the age, course of psychosis and gender of the deceased when assessing the manner of death.

Silencing of lncRNA XIST suppresses proliferation and autophagy and enhances vincristine sensitivity in retinoblastoma cells by sponging miR-204-5p

OBJECTIVE

Retinoblastoma (RB) is the most prevalent intraocular malignancy in childhood. Long non-coding RNAs (lncRNAs) have been found as critical oncogenic drivers and tumor suppressor in RB. The aim of the present work was to investigate the impact and mechanism of XIST on RB cell autophagy and vincristine (VCR) sensitivity.

MATERIALS AND METHODS

The levels of XIST and miR-204-5p were assessed by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Western blot analysis was used for the determination of related protein levels. Cell proliferation and IC50 value of VCR were detected using the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay. Flow cytometry was performed to evaluate cell apoptosis. The activities of caspase-3 and caspase-9 were identified using a corresponding assay kit. The direct interaction between XIST and miR-204-5p was confirmed using Dual-Luciferase reporter assay. Xenograft model was established to observe the effect of XIST on RB in vivo.

RESULTS

Our data indicated that XIST was highly expressed in RB tissues and cell lines. XIST knockdown weakened the proliferation and autophagy and enhanced VCR sensitivity in RB cells. XIST acted as a molecular sponge of miR-204-5p. Moreover, the regulatory effects of XIST silencing on RB cell proliferation, autophagy and VCR sensitivity were mediated by miR-204-5p. Additionally, XIST silencing weakened tumor growth and enhanced VCR sensitivity in vivo through up-regulating miR-204-5p.

CONCLUSIONS

Our current study suggested that XIST silencing suppressed RB progression and promoted VCR sensitivity in vitro and in vivo at least partially by acting as a miR-204-5p sponge, highlighting a powerful therapeutic strategy for RB treatment.

[The role and mechanism of NORAD in proliferation and apoptosis of mouse mesangial cells induced by high glucose]

Objective: To uncover the role and mechanism of non-coding RNA-activated by DNA damage (NORAD) in proliferation and apoptosis of mouse mesangial cells induced by high glucose. Methods: SV40-MES-13 cells were divided into high glucose group and low glucose group according to the concentration of glucose in the culture medium. After 24 hours of treatment, SV40-MES-13 cells were transfected with si-NORAD and si-Toll-like receptor (TLR4), and real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the expression of NORAD and TLR4. NORAD, TLR4 overexpression plasmids and small interfering RNA were transfected into SV40-MES-13 cells respectively. Cell counting kit (CCK-8) assay, 5-ethynyl-2'-deoxyuridine (EdU) assay and flow cytometry were performed to determine the results of cell proliferation and apoptosis. Luciferase activity and their mRNA levels were detected after cotransfection of pGL3-NORAD WT and miR-520h mimics or pGL3-TLR4 WT and miR-520h mimics. After cotransfection of si-NORAD and miR-520h inhibitors, TLR4 overexpression plasmids and miR-520h mimics, and cotransfection of si-TLR4 and miR-520h inhibitors, the levels of NORAD, miR-520h and TLR4, as well as cell proliferation were detected to verify the regulatory relationship among them. Results: NORAD and TLR4 were upregulated in SV40-MES-13 cells in high glucose group (1.65±0.08 vs 1.00±0.06, P=0.003; 1.96±0.09 vs 1.01±0.07, P=0.001). Overexpression of NORAD and TLR4 promoted the proliferative ability (1.34±0.04 vs 0.85±0.04, P=0.001; 1.33±0.02 vs 0.82±0.03, P<0.001) and inhibited the apoptosis in SV40-MES-13 cells (0.45±0.03 vs 0.94±0.06, P=0.001; 0.51±0.05 vs 0.99±0.03, P=0.001). The dual-luciferase reporter gene assay showed that miR-520h was confirmed to bind to NORAD and TLR4. The expression of NORAD and miR-520h affected each other, and miR-520h mimics reduced the expression of TLR4. The expression of TLR4 in cotransfected NORAD small interference RNA and miR-520h inhibitor was higher than that in NORAD small interference RNA alone (0.74±0.03 vs 0.55±0.03, P=0.014). Cotransfection of miR-520h mimics and TLR4 overexpression plasmids increased cell proliferation compared with miR-520h mimics alone (0.73±0.01 vs 0.61±0.02, P=0.007). Cotransfection of miR-520h inhibitors and TLR4 small interference RNA reduced cell proliferation compared with miR-520h inhibitors alone (1.31±0.04 vs 1.55±0.04, P=0.013). Conclusions: The regulatory loop NORAD/miR-520h/TLR4 promotes the proliferative ability and inhibits apoptosis in glomerular mesangial cells induced by high glucose.

[The value of intraoperative monitoring of cerebral oxygen saturation on postoperative cognitive function in elderly patients undergoing cardiac surgery]

Objective: To investigate the effect of cerebral oxygen saturation (rSO₂) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing cardiac anesthesia. Methods: Retrospective analysis was performed on 113 elderly patients (age 65-89) underwent cardiac surgery in Peking University International Hospital from June 2017 to December 2019, 67 male and 46 female patients were included. All operations were performed under general anesthesia, cardiopulmonary bypass, rSO₂ and other relevant monitoring. Statistical analysis of the elderly patients with complications, cardiac surgery history, time of CPB, baseline value of rSO₂ (rSO_{2 baseline}), lowest intraoperative value of rSO₂ (rSO_{2 min}), time of operation, length of stay in CCU, length of hospital stay; Preoperative and postoperative NSE values; number of postoperative POCD and postoperative deaths were recorded. All data were obtained from the medical records system and anesthesia information system of Peking University International Hospital and risk factors related to POCD were analyzed by Logistic regression. Results: POCD occurred in 19 patients (16.8%), and also, intraoperative rSO₂ decreased by more than 30% over the baseline. The variance of rSO₂ (rSO_{2 baseline}-rSO_{2 min}) in POCD group and non-POCD group was (18.0±2.7) and (6.6±2.3), the variance of NSE (NSE _{after surgery}-NSE _{before surgery}) was (31.3±9.7) and (9.5±3.0) μg/L, respectively. The differences were statistically significant (t=18.35, 17.70, all P<0.05). rSO₂ variability was positively correlated with NSE variability (r=0.697, P<0.05). Logistic regression analysis showed that the variation degree of rSO₂ [OR(95%CI)was 0.374(0.059-1.895)]、 patients combined with diabetes mellitus [OR(95%CI)was 0.493 (0.041-1.812), history of stroke [OR(95%CI)was 0.325 (0.084-0.917)] and atrial fibrillation [OR(95%CI)was 0.176 (0.091-0.943)] were the risk factors for POCD. Conclusion: POCD can be predicted by monitoring the decline range of rSO₂ intraoperatively. rSO₂ is recommended as a routine monitoring item for elderly patients undergoing cardiac surgery.

Partial pancreatic tail preserving subtotal pancreatectomy for pancreatic cancer: Improving glycemic control and quality of life without compromising oncological outcomes

BACKGROUND

Total pancreatectomy (TP) is usually considered a therapeutic option for pancreatic cancer in which Whipple surgery and distal pancreatectomy are undesirable, but brittle diabetes and poor quality of life (QoL) remain major concerns. A subset of patients who underwent TP even died due to severe hypoglycemia. For pancreatic cancer involving the pancreatic head and proximal body but without invasion to the pancreatic tail, we performed partial pancreatic tail preserving subtotal pancreatectomy (PPTP-SP) in selected patients, in order to improve postoperative glycemic control and QoL without compromising oncological outcomes.

AIM

To evaluate the efficacy of PPTP-SP for patients with pancreatic cancer.

METHODS

We retrospectively reviewed 56 patients with pancreatic ductal adenocarcinoma who underwent PPTP-SP (n = 18) or TP (n = 38) at our institution from May 2014 to January 2019. Clinical outcomes were compared between the two groups, with an emphasis on oncological outcomes, postoperative glycemic control, and QoL. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and EORTC PAN26). All patients were followed until May 2019 or until death.

RESULTS

A total of 56 consecutive patients were enrolled in this study. Perioperative outcomes, recurrence-free survival, and overall survival were comparable between the two groups. No patients in the PPTP-SP group developed cancer recurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreatic fistula. Patients who underwent PPTP-SP had significantly better glycemic control, based on their higher rate of insulin-independence (P = 0.014), lower hemoglobin A1c (HbA1c) level (P = 0.046), lower daily insulin dosage (P < 0.001), and less frequent hypoglycemic episodes (P < 0.001). Global health was similar in the two groups, but patients who underwent PPTP-SP had better functional status (P = 0.036), milder symptoms (P = 0.013), less severe diet restriction (P = 0.011), and higher confidence regarding future life (P = 0.035).

CONCLUSION

For pancreatic cancer involving the pancreatic head and proximal body, PPTP-SP achieves perioperative and oncological outcomes comparable to TP in selected patients while significantly improving long-term glycemic control and QoL.

[Development of a hyperkalemia risk assessment model for patients with chronic kidney disease]

Objective: To investigate risk factors for hyperkalemia among chronic kidney disease (CKD) patients and establish a risk assessment model for predicting hyperkalemia events. Methods: Clinical data of CKD patients (stage 3 to 5) hospitalized between May 2017 and June 2020 from 14 hospitals were retrospectively collected and divided into training dataset and validation dataset through balanced random sampling. Multivariate logistic regression analysis was used to analyze risk factors for hyperkalemia in CKD patients and the factors were scored. Receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Meanwhile, the cut-off value with the best sensitivity and specificity were used to verify the accuracy of the model in validation dataset. Results: A total of 847 CKD patients were enrolled and further divided into training dataset (n=675) and validation dataset (n=172). There were 555 males and 292 females, with a mean age of (57.2±15.6) years. Multivariate logistic regression analysis showed that age, CKD stage, history of heart failure, history of serum potassium ≥5.0 mmol/L, diabetes, metabolic acidosis, and use of medications that increase serum potassium levels were risk factors for causing hyperkalemia in patients with CKD. Risk assessment model was established based on these risk factors. The AUC of the ROC curve was 0.809. Using 4 as the cut-off value, the sensitivity and specificity for predicting hyperkalemia events reached 87.1% and 57.0%, respectively. Conclusion: The model established in the current study can be used for predicting hyperkalemia events in clinical practices, which offers a new way to optimize serum potassium management in patients with CKD.