The use of translational medicine in Chinese hospitals ap- pears to have become easier over the last decade. Products developed in the laboratory can sometimes be applied in the clinic under life-saving circumstances....The use of translational medicine in Chinese hospitals ap- pears to have become easier over the last decade. Products developed in the laboratory can sometimes be applied in the clinic under life-saving circumstances. Arteannuin is one of the most successful examples of translation during the past decade in China, having been used to treat more than one million patients with malaria. However, several approaches developed in the laboratory, with proven benefits to patients,展开更多
Background Inflammation is an important element of the pathophysiological process of heart failure (HF) and is correlated with subtypes of HF. The association between multiple biomarkers of inflammation and HF subtype...Background Inflammation is an important element of the pathophysiological process of heart failure (HF) and is correlated with subtypes of HF. The association between multiple biomarkers of inflammation and HF subtypes in Chinese subjects remains unclear. This study aimed to compare the differences in inflammation biomarkers among Chinese patients with different subtypes of HF who have been identified to date. Methods We included 413 consecutive patients with HF,including 262 with preserved ejection fraction (HFpEF),55 with middle-ranged ejection fraction (HFmrEF) and 96 with reduced ejection fraction (HFrEF). Ten inflammation biomarkers were analyzed and compared according to the HF subtypes. One hundred contemporary non-HF subjects were also recruited as the control group. Moreover,the correlations between the inflammatory biomarkers and left ventricular ejection fraction of the HF subtypes were assessed. Results The mean age of the HF patients was 65.0 ± 12.0 years,65.8% were male. Distinct subtypes of HF demonstrated different inflammation biomarker panels. IL-6,PTX-3,ANGPTL-4 and TNF-α were correlated with HFrEF;IL-1β and PTX-3 were correlated with HFmrEF;and IL-1β and IL-6 were correlated with HFpEF. The multivariable logistic regression showed that IL-1β[relative ratio (RR)= 1.08,95% CI: 1.02–1.15,P = 0.010],IL-6 (RR = 1.03,95% CI: 1.01–1.06,P = 0.016),PTX-3 (RR = 1.31,95% CI: 1.11–1.55,P = 0.001),and ANGPTL-4 (RR = 1.05,95% CI: 1.02–1.07,P < 0.001) were independently associated with HF,while IL-6 (RR = 1.03,95% CI: 1.01–1.04,P = 0.019),PTX-3 (RR = 1.23,95% CI: 1.06–1.43,P = 0.007),and ANGPTL-4 (RR = 1.03,95% CI: 1.01–1.06,P = 0.005) were independently associated with the HF subtype. Conclusions Diverse inflammation biomarkers have multifaceted presentations according to the subtype of HF,which may illustrate the diverse mechanisms of inflammation in Chinese HF patients. IL-6,PTX-3,and ANGPTL-4 were independent inflammation factors associated with HFrEF and HF.展开更多
Objectives To investigate the prevalence and characteristics of pulmonary embolism （PE） at autopsy in a Chinese general hospital over a period of 10 years, and to evaluate the antemortem achievement of the prophylax...Objectives To investigate the prevalence and characteristics of pulmonary embolism （PE） at autopsy in a Chinese general hospital over a period of 10 years, and to evaluate the antemortem achievement of the prophylaxis, diagnosis, and treatment of PE. Methods All medical records of deaths from the West Branch of the Chinese People＇s Liberation Army （PLA） General Hospital were retrospectively re- viewed, for the period of January 1, 2006 to December 31, 2015. Cases in which autopsies had been performed were identified and further analyzed. The numbers and detailed characteristics of patients who had PEs were noted. Prophylactic measures, along with diagnosis and treatment of PE, were recorded, if performed. Results During the 10-year period, 1057 patients died in the study hospital and 278 necrop- sies were performed （autopsy rate： 26.3%）. Nine patients were found to have PE （3.2%）, and in seven of these patients （2.5%）, the PE was considered to be fatal. Embolisms were found in the trunk and bilateral main branches of the pulmonary artery tree in all seven of the fatal PE cases. Right intracardiac thrombosis was detected in five of the nine PE patients （55.6%）. All patients with PE had been hospitalized in medical departments, and only one had undergone surgery during hospitalization. Antemortem prophylaxis was performed in two of the nine PE cases （22.2%）. None of the 9 patients had received a clinical diagnosis of PE before death. Conclusions The incidence of and death rate associated with PE may vary among different races and regions. Continuous monitoring of PE by means of necropsy in certain representative medical institutions is necessary.展开更多
The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a...The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.展开更多
Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential inf...Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.展开更多
Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in...Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.展开更多
In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in ped...In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in pediatric liver transpl-antation(LT),as well as the relationship between immune rejection after LT and DSA.Currently,LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure.However,acute and chronic re-jection continues to be a significant cause of graft dysfunction and loss.HLA mismatch significantly reduces graft survival and increases the risk of acute rejection.Among them,D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT.The adverse impact of HLA-DSAs on LT recipients is already established.Therefore,the evaluation of HLA and DSA is crucial in pediatric LT.展开更多
Mycophenolic acid(MPA),the active moiety of both mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS),serves as a primary immunosuppressant for maintaining solid organ transplants.Therapeutic drug...Mycophenolic acid(MPA),the active moiety of both mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS),serves as a primary immunosuppressant for maintaining solid organ transplants.Therapeutic drug monitoring(TDM)enhances treatment outcomes through tailored approaches.This study aimed to develop an evidence-based guideline for MPA TDM,facilitating its rational application in clinical settings.The guideline plan was drawn from the Institute of Medicine and World Health Organization(WHO)guidelines.Using the Delphi method,clinical questions and outcome indicators were generated.Systematic reviews,Grading of Recommendations Assessment,Development,and Evaluation(GRADE)evidence quality evaluations,expert opinions,and patient values guided evidence-based suggestions for the guideline.External reviews further refined the recommendations.The guideline for the TDM of MPA(IPGRP-2020CN099)consists of four sections and 16 recommendations encompassing target populations,monitoring strategies,dosage regimens,and influencing factors.High-risk populations,timing of TDM,area under the curve(AUC)versus trough concentration(C0),target concentration ranges,monitoring frequency,and analytical methods are addressed.Formulation-specific recommendations,initial dosage regimens,populations with unique considerations,pharmacokinetic-informed dosing,body weight factors,pharmacogenetics,and drug–drug interactions are covered.The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy,promoting standardization of MPA TDM,and enhancing treatment efficacy and safety.展开更多
BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognos...BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.展开更多
Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19...Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients,divided into two groups:ECMO and non-ECMO,based on whether preoperative ECMO was utilized.We evaluated the patients'surgical conditions,postoperative complications,and survival rates.Additionally,the analysis focused on the differences and correlations in clinical characteristics,inflammatory markers,and long-term survival outcomes.Results:There was no statistically significant difference in perioperative survival rates between the ECMO group(85.7%)and the non-ECMO group(83.3%).However,the ECMO group exhibited significantly higher levels of inflammatory markers,including Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-6(IL-10),Tumor Necrosis Factor-a(TNF-α),and C-reactive protein(CRP),compared to the non-ECMO group(p<0.05).Notably,IL-6,IL-8,and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation.The cohort demonstrated a mean donor-recipient weight ratio of 1.38±0.39,with successful cardiac remodeling observed in recipients of oversized grafts,with the highest Donor-RecipientWeight Ratio(DRWR)reaching 3.0.Conclusions:The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT.Despite the inflammatory response and perioperative complications,ECMO proves to be an effective bridging strategy,ultimately enhancing overall outcomes in PHT.展开更多
Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regene...Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.展开更多
BACKGROUND Fibrosis is a critical event in the progression of pediatric nonalcoholic fatty liver disease(NAFLD).AIM To develop less invasive models based on machine learning(ML)to predict significant fibrosis in Chine...BACKGROUND Fibrosis is a critical event in the progression of pediatric nonalcoholic fatty liver disease(NAFLD).AIM To develop less invasive models based on machine learning(ML)to predict significant fibrosis in Chinese NAFLD children.METHODS In this cross-sectional study,222 and 101 NAFLD children with available liver biopsy data were included in the development of screening models for tertiary hospitals and community health centers,respectively.Predictive factors were selected using least absolute shrinkage and selection operator regression and stepwise logistic regression analyses.Logistic regression(LR)and other ML models were applied to construct the prediction models.RESULTS Simplified indicators of the ATS and BIU indices were constructed for tertiary hospitals and community health centers,respectively.When models based on the ATS and BIU parameter combinations were constructed,the random forest(RF)model demonstrated higher screening accuracy compared to the LR model(0.80 and 0.79 for the RF model and 0.72 and 0.77 for the LR model,respectively).Using cutoff values of 90%for sensitivity and 90%for specificity,the RF models could effectively identify and exclude NAFLD children with significant fibrosis in the internal validation set(with positive predictive values and negative prediction values exceeding 0.80),which could prevent liver biopsy in 60%and 71.4%of NAFLD children,respectively.CONCLUSION This study developed new models for predicting significant fibrosis in NAFLD children in tertiary hospitals and community health centers,which can serve as preliminary screening tools to detect the risk population in a timely manner.展开更多
Objective Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures.However,the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge ev...Objective Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures.However,the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge even for the most experienced surgeon.In this study,we describe in detail a novel unlocking closed reduction technique(UCRT)frame that allows strong traction for bilateral posterior pelvic ring displacement and presents preliminary clinical outcomes.Methods We retrospectively reviewed 32 patients with bilateral displaced posterior pelvic ring disruptions(AO/OTA 61-C2 and C3)who were initially treated with this technique between July 2017 and July 2022.According to the AO/OTA clas-sification,there were 9 cases(28.12%)of 61-C2,and 23 cases(71.88%)of 61-C3.There were 11 males,21 females,with an average age of 38.1 years.The interval from injury to operation was 4-27 days,with a cut-off of 12.5 days(receiver operat-ing characteristic curve).Operative time,blood loss,and postoperative radiographic findings were recorded.The functional outcomes and complications were followed.Results A total of 30(93.8%)patients achieved successful closed reduction,whereas 2 required open reduction.The success-ful closed reduction rate was 95.5%(21/22)in patients whose injury-to-operation time was less than 12.5 days.The vertical displacement percent correction of the obviously displaced hemipelvis was 70.20%±16.79%on average.The average degree of pelvic deformity correction was 64.86%±17.71%.Thirty patients were followed up for at least 12 months(12-36 months),and no complications of nonunion or redisplacement were observed.The Matta-Tornetta scoring standard revealed that the excellent(25/30)and good(4/30)rate was 96.7%.The Majeed clinical efficacy score revealed that the overall excellent and good rate was 100%.One patient had INFIX-related infection,and 2 reported numbness in the lateral thigh.The numbness was improved after INFIX removal.Conclusions This study presents an updated technique for closed reduction using a UCRT frame for bilateral posterior pelvic ring disruption,which has been shown to be effective,as indicated by excellent surgical and functional outcomes.展开更多
Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelin...Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.展开更多
Hematopoietic cell transplantation(HCT)is the curative cornerstone for a wide spectrum of high-risk hematological malignancies and selected non-malignant disorders(1).As indications expand and survival improves,HCT su...Hematopoietic cell transplantation(HCT)is the curative cornerstone for a wide spectrum of high-risk hematological malignancies and selected non-malignant disorders(1).As indications expand and survival improves,HCT survivors increasingly face chronic complications,psychosocial distress,and long-term quality-of-life impairments that demand continuous,multidisciplinary management(2,3).However,the rapid evolution of transplantation contrasts sharply with the lag in specialized nursing capacity,credentialing,and governance systems in China.This commentary integrates national policy directives,recent workforce data,and clinical experience to examine current deficits,highlights the clinical value of nurse-led continuity-of-care,and proposes a sustainable framework for hematology specialist nurse-driven HCT care.展开更多
Objective:Both allogeneic hematopoietic stem cell transplantation(allo-HSCT)and autologous HSCT(ASCT)are important therapies for extranodal natural killer/T-cell lymphoma(ENKTCL);however,no large-scale,multicenter stu...Objective:Both allogeneic hematopoietic stem cell transplantation(allo-HSCT)and autologous HSCT(ASCT)are important therapies for extranodal natural killer/T-cell lymphoma(ENKTCL);however,no large-scale,multicenter study has compared the efficacy and safety between allo-HSCT and ASCT in these patients.Our multicenter,real-world study aimed to evaluate the outcomes of allo-HSCT vs.ASCT as consolidation in ENKTCL patients who had achieved a complete response(CR)or partial response(PR).Methods:This was a multicenter,retrospective study with nine hospitals in China,and 114 patients with ENKTCL were enrolled.Sixty patients received ASCT and 54 received allo-HSCT.The primary outcome was progression-free survival(PFS).In the sensitivity analysis,propensity score matching(PSM)analyses were conducted to adjust for baseline prognostic factors.Landmark analysis were conducted to minimize immortal-time bias.Results:Patients in the allo-HSCT group presented with more adverse prognostic factors.Allo-HSCT group showed a significantly better PFS and a lower disease progression rate compared with ASCT group in patients with Ann Arbor stageⅢ/Ⅳdisease(PFS:100%vs.82.0%,P=0.023;disease progression rate:0 vs.25.4%,P=0.024),those with intermediate/high prognostic index of natural killer lymphoma(PINK)scores(PFS:100%vs.84.4%,P=0.034;disease progression rate:0 vs.22.1%,P=0.034),those with intermediate/high international prognostic index(IPI)scores(PFS:100%vs.82.0%,P=0.038;disease progression rate:0 vs.25.4%,P=0.038),or those receiving HSCT at PR(PFS:100%vs.50%,P=0.046;disease progression rate:0 vs.50%,P=0.046)at the 1.5-4.0 follow-up.In multivariate analysis,receiving ASCT was significantly associated with a poorer PFS[hazard ratio(HR)=2.23,P=0.038]and overall survival(OS)(HR=2.45,P=0.045).In the sensitivity analysis,patients receiving allo-HSCT showed a significantly better PFS(70.3%vs.39.1%,P=0.039),OS(73.9%vs.42.0%,P=0.044),and a lower disease progression rate(22.6%vs.57.0%,P=0.017)compared with those receiving ASCT after propensity score matching.Conclusions:ENKTCL patients with high-risk characteristics could benefit more from allo-HSCT as consolidation.展开更多
When patients initially present with atrial fibrillation along with an enlarged heart and heart failure, followed by atrioventricular block, it's essential to consider genetic factors.^([1])Genetic testing can off...When patients initially present with atrial fibrillation along with an enlarged heart and heart failure, followed by atrioventricular block, it's essential to consider genetic factors.^([1])Genetic testing can offer crucial diagnostic evidence, aiding in prognosis assessment and the adoption of appropriate treatment strategies.展开更多
Objective The associations of serum trace element levels with disease progression and survival duration were assessed in individuals diagnosed with sporadic amyotrophic lateral sclerosis(sALS)in China.Methods Clinical...Objective The associations of serum trace element levels with disease progression and survival duration were assessed in individuals diagnosed with sporadic amyotrophic lateral sclerosis(sALS)in China.Methods Clinical data,including diagnostic indicators,clinical characteristics,Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)scores,and serum concentrations of calcium(Ca),magnesium(Mg),iron(Fe),copper(Cu),and zinc(Zn),were collected for hospitalized patients with sALS between 2018 and 2021.Correlation analysis,random forest analysis,and the Gehan-Breslow-Wilcoxon test were used to evaluate the relations between serum trace element levels,disease progression,and survival duration.Results Lower serum Ca levels and higher Mg levels were observed in patients with ALSFRS-R scores<39.Serum Mg was significantly negatively correlated with ALSFRS-R,trunk,and respiratory scores.Serum Cu and Zn also showed significant negative correlations with the respiratory score,whereas Ca and Fe were not significantly correlated with the ALSFRS-R score.The serum levels of Ca,Mg,Cu,Zn,and Fe remained consistent regardless of the site of disease onset.ALSFRS-R analysis revealed that serum Ca and Mg had a substantial effect on the total ALSFRS-R score,with serum Mg significantly influencing the course of the disease.Notably,low serum Mg levels were associated with extended survival times in patients with sALS.Conclusion Serum levels of Ca and Mg play critical roles in the progression of sALS,and a reduced serum Mg level is related to an extended survival time.展开更多
Ischemic stroke remains a leading cause of disability and death,with mesenchymal stem cell-derived exosomes emerging as a promising therapeutic avenue.However,the optimal timing and underlying therapeutic mechanisms o...Ischemic stroke remains a leading cause of disability and death,with mesenchymal stem cell-derived exosomes emerging as a promising therapeutic avenue.However,the optimal timing and underlying therapeutic mechanisms of exosome treatment require further elucidation.In this study,we used a murine model of middle cerebral artery occlusion to investigate the therapeutic efficacy of human umbilical cord mesenchymal stem cell-derived exosomes administered intravenously at an early(6 hours)or delayed(3 days)time point post-ischemia.Compared with delayed treatment,early administration of exosomes resulted in significantly superior efficacy,as evidenced by improved neurological function scores and reduced infarct volumes.Transcriptomic analysis of brain tissues from mice receiving early exosome treatment revealed marked downregulation of inflammation-related genes,including Ccl2,Ccl5,Cxcl10,Il-1β,Il-6,Itgam,Itgax,and Tnf-α.Metabolomic profiling of these brain tissues further identified modulation of key metabolites,including trimethylamine N-oxide,glutathione,1-stearoyl-rac-glycerol,and phosphatidylcholine,suggesting that alteration of metabolic pathways contributes to the therapeutic effect.Integrated transcriptomic and metabolomic analysis pinpointed significant modulation of pathways involving metabolism of eicosapentaenoic acid,lysine,propanoate,and tyrosine.These findings suggest that umbilical cord mesenchymal stem cell-derived exosomes,particularly when administered early post-ischemia,exert their neuroprotective effects by broadly suppressing inflammatory pathways and modulating key metabolic processes in the ischemic brain,highlighting their potential as a therapeutic intervention for ischemic stroke.展开更多
Previous research has demonstrated the feasibility of repairing nerve defects through acellular allogeneic nerve grafting with bone marrow mesenchymal stem cells.However,adult tissue–derived mesenchymal stem cells en...Previous research has demonstrated the feasibility of repairing nerve defects through acellular allogeneic nerve grafting with bone marrow mesenchymal stem cells.However,adult tissue–derived mesenchymal stem cells encounter various obstacles,including limited tissue sources,invasive acquisition methods,cellular heterogeneity,purification challenges,cellular senescence,and diminished pluripotency and proliferation over successive passages.In this study,we used induced pluripotent stem cell-derived mesenchymal stem cells,known for their self-renewal capacity,multilineage differentiation potential,and immunomodulatory characteristics.We used induced pluripotent stem cell-derived mesenchymal stem cells in conjunction with acellular nerve allografts to address a 10 mm-long defect in a rat model of sciatic nerve injury.Our findings reveal that induced pluripotent stem cell-derived mesenchymal stem cells exhibit survival for up to 17 days in a rat model of peripheral nerve injury with acellular nerve allograft transplantation.Furthermore,the combination of acellular nerve allograft and induced pluripotent stem cell-derived mesenchymal stem cells significantly accelerates the regeneration of injured axons and improves behavioral function recovery in rats.Additionally,our in vivo and in vitro experiments indicate that induced pluripotent stem cell-derived mesenchymal stem cells play a pivotal role in promoting neovascularization.Collectively,our results suggest the potential of acellular nerve allografts with induced pluripotent stem cell-derived mesenchymal stem cells to augment nerve regeneration in rats,offering promising therapeutic strategies for clinical translation.展开更多
基金supported by the National Natural Science Foundation of China(81230061,81121004,and 81230041)the Military Medical Foundation(AWS11J008)the National Basic Research Program of China(2012CB518105)
文摘The use of translational medicine in Chinese hospitals ap- pears to have become easier over the last decade. Products developed in the laboratory can sometimes be applied in the clinic under life-saving circumstances. Arteannuin is one of the most successful examples of translation during the past decade in China, having been used to treat more than one million patients with malaria. However, several approaches developed in the laboratory, with proven benefits to patients,
基金supported by the National Natural Science Foundation of China (No.31701155)the National Key Research and Development Program of China (2017YFC 0114001)Chinese PLA General Hospital Medical Big Data Research and Development Project (No.2017MBD-007)
文摘Background Inflammation is an important element of the pathophysiological process of heart failure (HF) and is correlated with subtypes of HF. The association between multiple biomarkers of inflammation and HF subtypes in Chinese subjects remains unclear. This study aimed to compare the differences in inflammation biomarkers among Chinese patients with different subtypes of HF who have been identified to date. Methods We included 413 consecutive patients with HF,including 262 with preserved ejection fraction (HFpEF),55 with middle-ranged ejection fraction (HFmrEF) and 96 with reduced ejection fraction (HFrEF). Ten inflammation biomarkers were analyzed and compared according to the HF subtypes. One hundred contemporary non-HF subjects were also recruited as the control group. Moreover,the correlations between the inflammatory biomarkers and left ventricular ejection fraction of the HF subtypes were assessed. Results The mean age of the HF patients was 65.0 ± 12.0 years,65.8% were male. Distinct subtypes of HF demonstrated different inflammation biomarker panels. IL-6,PTX-3,ANGPTL-4 and TNF-α were correlated with HFrEF;IL-1β and PTX-3 were correlated with HFmrEF;and IL-1β and IL-6 were correlated with HFpEF. The multivariable logistic regression showed that IL-1β[relative ratio (RR)= 1.08,95% CI: 1.02–1.15,P = 0.010],IL-6 (RR = 1.03,95% CI: 1.01–1.06,P = 0.016),PTX-3 (RR = 1.31,95% CI: 1.11–1.55,P = 0.001),and ANGPTL-4 (RR = 1.05,95% CI: 1.02–1.07,P < 0.001) were independently associated with HF,while IL-6 (RR = 1.03,95% CI: 1.01–1.04,P = 0.019),PTX-3 (RR = 1.23,95% CI: 1.06–1.43,P = 0.007),and ANGPTL-4 (RR = 1.03,95% CI: 1.01–1.06,P = 0.005) were independently associated with the HF subtype. Conclusions Diverse inflammation biomarkers have multifaceted presentations according to the subtype of HF,which may illustrate the diverse mechanisms of inflammation in Chinese HF patients. IL-6,PTX-3,and ANGPTL-4 were independent inflammation factors associated with HFrEF and HF.
文摘Objectives To investigate the prevalence and characteristics of pulmonary embolism （PE） at autopsy in a Chinese general hospital over a period of 10 years, and to evaluate the antemortem achievement of the prophylaxis, diagnosis, and treatment of PE. Methods All medical records of deaths from the West Branch of the Chinese People＇s Liberation Army （PLA） General Hospital were retrospectively re- viewed, for the period of January 1, 2006 to December 31, 2015. Cases in which autopsies had been performed were identified and further analyzed. The numbers and detailed characteristics of patients who had PEs were noted. Prophylactic measures, along with diagnosis and treatment of PE, were recorded, if performed. Results During the 10-year period, 1057 patients died in the study hospital and 278 necrop- sies were performed （autopsy rate： 26.3%）. Nine patients were found to have PE （3.2%）, and in seven of these patients （2.5%）, the PE was considered to be fatal. Embolisms were found in the trunk and bilateral main branches of the pulmonary artery tree in all seven of the fatal PE cases. Right intracardiac thrombosis was detected in five of the nine PE patients （55.6%）. All patients with PE had been hospitalized in medical departments, and only one had undergone surgery during hospitalization. Antemortem prophylaxis was performed in two of the nine PE cases （22.2%）. None of the 9 patients had received a clinical diagnosis of PE before death. Conclusions The incidence of and death rate associated with PE may vary among different races and regions. Continuous monitoring of PE by means of necropsy in certain representative medical institutions is necessary.
文摘The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.
基金supported by the National Natural Science Foundation of China(82422045).
文摘Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.
文摘Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.
文摘In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in pediatric liver transpl-antation(LT),as well as the relationship between immune rejection after LT and DSA.Currently,LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure.However,acute and chronic re-jection continues to be a significant cause of graft dysfunction and loss.HLA mismatch significantly reduces graft survival and increases the risk of acute rejection.Among them,D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT.The adverse impact of HLA-DSAs on LT recipients is already established.Therefore,the evaluation of HLA and DSA is crucial in pediatric LT.
基金supported by the National Natural Science Foundation of China(NSFC)(No.72304007)the Huatong Guokang Medical Research Fund(No.2023HT010)。
文摘Mycophenolic acid(MPA),the active moiety of both mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS),serves as a primary immunosuppressant for maintaining solid organ transplants.Therapeutic drug monitoring(TDM)enhances treatment outcomes through tailored approaches.This study aimed to develop an evidence-based guideline for MPA TDM,facilitating its rational application in clinical settings.The guideline plan was drawn from the Institute of Medicine and World Health Organization(WHO)guidelines.Using the Delphi method,clinical questions and outcome indicators were generated.Systematic reviews,Grading of Recommendations Assessment,Development,and Evaluation(GRADE)evidence quality evaluations,expert opinions,and patient values guided evidence-based suggestions for the guideline.External reviews further refined the recommendations.The guideline for the TDM of MPA(IPGRP-2020CN099)consists of four sections and 16 recommendations encompassing target populations,monitoring strategies,dosage regimens,and influencing factors.High-risk populations,timing of TDM,area under the curve(AUC)versus trough concentration(C0),target concentration ranges,monitoring frequency,and analytical methods are addressed.Formulation-specific recommendations,initial dosage regimens,populations with unique considerations,pharmacokinetic-informed dosing,body weight factors,pharmacogenetics,and drug–drug interactions are covered.The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy,promoting standardization of MPA TDM,and enhancing treatment efficacy and safety.
文摘BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.
基金supported by National Key Research and Development Program of China(Grant Nos.2021YFC2701700&2021YFC2701703)Special Research Project on Family Planning of the Logistics Support Department of the Military Commission(20JSZ15).
文摘Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients,divided into two groups:ECMO and non-ECMO,based on whether preoperative ECMO was utilized.We evaluated the patients'surgical conditions,postoperative complications,and survival rates.Additionally,the analysis focused on the differences and correlations in clinical characteristics,inflammatory markers,and long-term survival outcomes.Results:There was no statistically significant difference in perioperative survival rates between the ECMO group(85.7%)and the non-ECMO group(83.3%).However,the ECMO group exhibited significantly higher levels of inflammatory markers,including Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-6(IL-10),Tumor Necrosis Factor-a(TNF-α),and C-reactive protein(CRP),compared to the non-ECMO group(p<0.05).Notably,IL-6,IL-8,and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation.The cohort demonstrated a mean donor-recipient weight ratio of 1.38±0.39,with successful cardiac remodeling observed in recipients of oversized grafts,with the highest Donor-RecipientWeight Ratio(DRWR)reaching 3.0.Conclusions:The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT.Despite the inflammatory response and perioperative complications,ECMO proves to be an effective bridging strategy,ultimately enhancing overall outcomes in PHT.
基金supported by the National Natural Science Foundation of China(81925027,82002275,and 32271421)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.
基金Supported by National Natural Science Foundation of China,No.82272433Fujian Provincial Key Laboratory of Hepatic Drug Research,No.2022-YF-0050+1 种基金the Major Science and Technology Projects for Health of Zhejiang Province,No.WKJ-ZJ-2216the Cyrus Tang Foundation for Young Scholar,No.2022(2022-B126).
文摘BACKGROUND Fibrosis is a critical event in the progression of pediatric nonalcoholic fatty liver disease(NAFLD).AIM To develop less invasive models based on machine learning(ML)to predict significant fibrosis in Chinese NAFLD children.METHODS In this cross-sectional study,222 and 101 NAFLD children with available liver biopsy data were included in the development of screening models for tertiary hospitals and community health centers,respectively.Predictive factors were selected using least absolute shrinkage and selection operator regression and stepwise logistic regression analyses.Logistic regression(LR)and other ML models were applied to construct the prediction models.RESULTS Simplified indicators of the ATS and BIU indices were constructed for tertiary hospitals and community health centers,respectively.When models based on the ATS and BIU parameter combinations were constructed,the random forest(RF)model demonstrated higher screening accuracy compared to the LR model(0.80 and 0.79 for the RF model and 0.72 and 0.77 for the LR model,respectively).Using cutoff values of 90%for sensitivity and 90%for specificity,the RF models could effectively identify and exclude NAFLD children with significant fibrosis in the internal validation set(with positive predictive values and negative prediction values exceeding 0.80),which could prevent liver biopsy in 60%and 71.4%of NAFLD children,respectively.CONCLUSION This study developed new models for predicting significant fibrosis in NAFLD children in tertiary hospitals and community health centers,which can serve as preliminary screening tools to detect the risk population in a timely manner.
基金supported by the National Key Research and Development Program of China(2022YFC2504303)Innovation Foundation of National Clinical Research Center for Orthopaedics,Sports Medicine&Rehabilitation(2021-NCRC-CXJJ-ZH-24)Medical Innovation and Transformation Incubation Project of Tongji Hospital(2022ZHFY10).
文摘Objective Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures.However,the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge even for the most experienced surgeon.In this study,we describe in detail a novel unlocking closed reduction technique(UCRT)frame that allows strong traction for bilateral posterior pelvic ring displacement and presents preliminary clinical outcomes.Methods We retrospectively reviewed 32 patients with bilateral displaced posterior pelvic ring disruptions(AO/OTA 61-C2 and C3)who were initially treated with this technique between July 2017 and July 2022.According to the AO/OTA clas-sification,there were 9 cases(28.12%)of 61-C2,and 23 cases(71.88%)of 61-C3.There were 11 males,21 females,with an average age of 38.1 years.The interval from injury to operation was 4-27 days,with a cut-off of 12.5 days(receiver operat-ing characteristic curve).Operative time,blood loss,and postoperative radiographic findings were recorded.The functional outcomes and complications were followed.Results A total of 30(93.8%)patients achieved successful closed reduction,whereas 2 required open reduction.The success-ful closed reduction rate was 95.5%(21/22)in patients whose injury-to-operation time was less than 12.5 days.The vertical displacement percent correction of the obviously displaced hemipelvis was 70.20%±16.79%on average.The average degree of pelvic deformity correction was 64.86%±17.71%.Thirty patients were followed up for at least 12 months(12-36 months),and no complications of nonunion or redisplacement were observed.The Matta-Tornetta scoring standard revealed that the excellent(25/30)and good(4/30)rate was 96.7%.The Majeed clinical efficacy score revealed that the overall excellent and good rate was 100%.One patient had INFIX-related infection,and 2 reported numbness in the lateral thigh.The numbness was improved after INFIX removal.Conclusions This study presents an updated technique for closed reduction using a UCRT frame for bilateral posterior pelvic ring disruption,which has been shown to be effective,as indicated by excellent surgical and functional outcomes.
基金funded by National Natural Science Foundation of China(82072846 to Xu B).
文摘Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
文摘Hematopoietic cell transplantation(HCT)is the curative cornerstone for a wide spectrum of high-risk hematological malignancies and selected non-malignant disorders(1).As indications expand and survival improves,HCT survivors increasingly face chronic complications,psychosocial distress,and long-term quality-of-life impairments that demand continuous,multidisciplinary management(2,3).However,the rapid evolution of transplantation contrasts sharply with the lag in specialized nursing capacity,credentialing,and governance systems in China.This commentary integrates national policy directives,recent workforce data,and clinical experience to examine current deficits,highlights the clinical value of nurse-led continuity-of-care,and proposes a sustainable framework for hematology specialist nurse-driven HCT care.
基金supported by Talent development plan for the future in Medical-Engineering Integration by BRACDCHE and ZTA,National Key Research and Development Program of China(No.2022YFC2502600,No.2022YFC2502606)the Beijing Natural Science Foundation(No.Z230016)+2 种基金the National Natural Science Foundation of China(No.82570262,No.82170206,and No.82170208)Science and Technology Plan of Tongzhou District(No.KJ2024CX045)Shanghai Municipal Health Commission Project of Disciplines of Excellence(No.20224Z0022).
文摘Objective:Both allogeneic hematopoietic stem cell transplantation(allo-HSCT)and autologous HSCT(ASCT)are important therapies for extranodal natural killer/T-cell lymphoma(ENKTCL);however,no large-scale,multicenter study has compared the efficacy and safety between allo-HSCT and ASCT in these patients.Our multicenter,real-world study aimed to evaluate the outcomes of allo-HSCT vs.ASCT as consolidation in ENKTCL patients who had achieved a complete response(CR)or partial response(PR).Methods:This was a multicenter,retrospective study with nine hospitals in China,and 114 patients with ENKTCL were enrolled.Sixty patients received ASCT and 54 received allo-HSCT.The primary outcome was progression-free survival(PFS).In the sensitivity analysis,propensity score matching(PSM)analyses were conducted to adjust for baseline prognostic factors.Landmark analysis were conducted to minimize immortal-time bias.Results:Patients in the allo-HSCT group presented with more adverse prognostic factors.Allo-HSCT group showed a significantly better PFS and a lower disease progression rate compared with ASCT group in patients with Ann Arbor stageⅢ/Ⅳdisease(PFS:100%vs.82.0%,P=0.023;disease progression rate:0 vs.25.4%,P=0.024),those with intermediate/high prognostic index of natural killer lymphoma(PINK)scores(PFS:100%vs.84.4%,P=0.034;disease progression rate:0 vs.22.1%,P=0.034),those with intermediate/high international prognostic index(IPI)scores(PFS:100%vs.82.0%,P=0.038;disease progression rate:0 vs.25.4%,P=0.038),or those receiving HSCT at PR(PFS:100%vs.50%,P=0.046;disease progression rate:0 vs.50%,P=0.046)at the 1.5-4.0 follow-up.In multivariate analysis,receiving ASCT was significantly associated with a poorer PFS[hazard ratio(HR)=2.23,P=0.038]and overall survival(OS)(HR=2.45,P=0.045).In the sensitivity analysis,patients receiving allo-HSCT showed a significantly better PFS(70.3%vs.39.1%,P=0.039),OS(73.9%vs.42.0%,P=0.044),and a lower disease progression rate(22.6%vs.57.0%,P=0.017)compared with those receiving ASCT after propensity score matching.Conclusions:ENKTCL patients with high-risk characteristics could benefit more from allo-HSCT as consolidation.
基金Military Healthcare Special Scientific Research Project(25BJZ31, awarded to SHI XM)。
文摘When patients initially present with atrial fibrillation along with an enlarged heart and heart failure, followed by atrioventricular block, it's essential to consider genetic factors.^([1])Genetic testing can offer crucial diagnostic evidence, aiding in prognosis assessment and the adoption of appropriate treatment strategies.
文摘Objective The associations of serum trace element levels with disease progression and survival duration were assessed in individuals diagnosed with sporadic amyotrophic lateral sclerosis(sALS)in China.Methods Clinical data,including diagnostic indicators,clinical characteristics,Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)scores,and serum concentrations of calcium(Ca),magnesium(Mg),iron(Fe),copper(Cu),and zinc(Zn),were collected for hospitalized patients with sALS between 2018 and 2021.Correlation analysis,random forest analysis,and the Gehan-Breslow-Wilcoxon test were used to evaluate the relations between serum trace element levels,disease progression,and survival duration.Results Lower serum Ca levels and higher Mg levels were observed in patients with ALSFRS-R scores<39.Serum Mg was significantly negatively correlated with ALSFRS-R,trunk,and respiratory scores.Serum Cu and Zn also showed significant negative correlations with the respiratory score,whereas Ca and Fe were not significantly correlated with the ALSFRS-R score.The serum levels of Ca,Mg,Cu,Zn,and Fe remained consistent regardless of the site of disease onset.ALSFRS-R analysis revealed that serum Ca and Mg had a substantial effect on the total ALSFRS-R score,with serum Mg significantly influencing the course of the disease.Notably,low serum Mg levels were associated with extended survival times in patients with sALS.Conclusion Serum levels of Ca and Mg play critical roles in the progression of sALS,and a reduced serum Mg level is related to an extended survival time.
基金supported by the National Key R&D Program of China,Nos.2021YFA1101703/2021YFA1101700(to YD).
文摘Ischemic stroke remains a leading cause of disability and death,with mesenchymal stem cell-derived exosomes emerging as a promising therapeutic avenue.However,the optimal timing and underlying therapeutic mechanisms of exosome treatment require further elucidation.In this study,we used a murine model of middle cerebral artery occlusion to investigate the therapeutic efficacy of human umbilical cord mesenchymal stem cell-derived exosomes administered intravenously at an early(6 hours)or delayed(3 days)time point post-ischemia.Compared with delayed treatment,early administration of exosomes resulted in significantly superior efficacy,as evidenced by improved neurological function scores and reduced infarct volumes.Transcriptomic analysis of brain tissues from mice receiving early exosome treatment revealed marked downregulation of inflammation-related genes,including Ccl2,Ccl5,Cxcl10,Il-1β,Il-6,Itgam,Itgax,and Tnf-α.Metabolomic profiling of these brain tissues further identified modulation of key metabolites,including trimethylamine N-oxide,glutathione,1-stearoyl-rac-glycerol,and phosphatidylcholine,suggesting that alteration of metabolic pathways contributes to the therapeutic effect.Integrated transcriptomic and metabolomic analysis pinpointed significant modulation of pathways involving metabolism of eicosapentaenoic acid,lysine,propanoate,and tyrosine.These findings suggest that umbilical cord mesenchymal stem cell-derived exosomes,particularly when administered early post-ischemia,exert their neuroprotective effects by broadly suppressing inflammatory pathways and modulating key metabolic processes in the ischemic brain,highlighting their potential as a therapeutic intervention for ischemic stroke.
基金supported by the National Natural Science Foundation of China,No.32171356(to YW)Self-Support Research Projects of Shihezi University,No.ZZZC2021105(to WJ)+1 种基金Capital Medical University Natural Science Cultivation Fund,No.PYZ23044(to FQM)Beijing Municipal Natural Science Foundation,No.7244410(to JHD)。
文摘Previous research has demonstrated the feasibility of repairing nerve defects through acellular allogeneic nerve grafting with bone marrow mesenchymal stem cells.However,adult tissue–derived mesenchymal stem cells encounter various obstacles,including limited tissue sources,invasive acquisition methods,cellular heterogeneity,purification challenges,cellular senescence,and diminished pluripotency and proliferation over successive passages.In this study,we used induced pluripotent stem cell-derived mesenchymal stem cells,known for their self-renewal capacity,multilineage differentiation potential,and immunomodulatory characteristics.We used induced pluripotent stem cell-derived mesenchymal stem cells in conjunction with acellular nerve allografts to address a 10 mm-long defect in a rat model of sciatic nerve injury.Our findings reveal that induced pluripotent stem cell-derived mesenchymal stem cells exhibit survival for up to 17 days in a rat model of peripheral nerve injury with acellular nerve allograft transplantation.Furthermore,the combination of acellular nerve allograft and induced pluripotent stem cell-derived mesenchymal stem cells significantly accelerates the regeneration of injured axons and improves behavioral function recovery in rats.Additionally,our in vivo and in vitro experiments indicate that induced pluripotent stem cell-derived mesenchymal stem cells play a pivotal role in promoting neovascularization.Collectively,our results suggest the potential of acellular nerve allografts with induced pluripotent stem cell-derived mesenchymal stem cells to augment nerve regeneration in rats,offering promising therapeutic strategies for clinical translation.
