Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

PBL教学在眼科临床实习教学中对临床思维能力的培养

目的:探讨以问题为导向的教学方法(problem-based learning,PBL)在眼科临床实习教学中培养学生临床思维的教学效果。方法:选取2017/2018年上学期参加眼科学课程学习的临床本科学生141人,参加临床实习课时随机分为传统教学组(lecture based learning,LBL) 69人及PBL模式教学组72人。两组学生前期所学课程相同,高考入学成绩、性别、年龄、眼科实习时间差异均无统计学意义(P>0. 05)。实习结束通过学生课评问卷调查及临床考核成绩两种形式比较分析两种教学方式的教学效果。结果:学生对课程各种能力的培养满意度评价显示:参与PBL教学组各能力满意度均高于LBL组。其中学习兴趣提升、知识拓展能力、解决问题能力及医患沟通能力差异具有统计学意义(P<0. 05)。临床考核成绩中病例分析与技能操作两项PBL组高于LBL组,差异有统计学意义(P<0. 05)。结论:PBL教学法在眼科临床实习教学中的效果显著,有利于临床思维培养并提高教学质量。

经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效的影响因素分析

目的:探讨影响经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效的相关因素。方法:回顾性分析2015-07/2019-04在我院行经鼻内窥镜下鼻腔泪囊吻合手术治疗的泪囊炎患者380例413眼的临床资料,术后至少随访6mo,根据泪囊、鼻腔、吻合口、泪道功能恢复情况评定临床疗效,筛选影响手术效果的相关因素。结果:术后6mo时,未愈患者27例27眼(6.5%),治愈患者353例386眼(93.5%)。单因素分析结果表明,患者鼻中隔偏曲程度、小泪囊、反复泪道探通/泪道激光/泪道置管、复发性泪囊炎、术后定期复诊和术者开展手术时间均对手术疗效存在影响。Logistic回归分析结果显示,患者鼻中隔偏曲程度、小泪囊、术后是否定期复诊是泪囊炎患者行经鼻内窥镜下鼻腔泪囊吻合术临床疗效的危险因素。结论:经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效确切,术后治愈率较高。患者鼻中隔偏曲的严重程度、小泪囊和术后是否定期复诊是影响手术疗效的危险因素。术者娴熟的手术技术和规范的手术后处理及患者良好的医嘱依从性是手术成功的关键。

Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography

Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.

Histone deacetylase inhibitor suberoylanilide hydroxamic acid alleviates liver fibrosis by suppressing the transforming growth factor-β1 signal pathway

Background: Histone deacetylases(HDACs) inhibitors are new anti-fibrotic drugs that inhibit the activity of hepatic stellate cells. The present study focused on the anti-fibrotic function of HDAC inhibitor suberoylanilide hydroxamic acid(SAHA) by suppressing transforming growth factor-β1(TGF-β1) signaling. Methods: Male Sprague-Dawley rats were used to induce liver fibrosis with carbon tetrachloride(CCl 4) and LX2 cell(human hepatic stellate cell line) was stimulated by TGF-β1. Both animals and cells were treated with SAHA. The Smad7 and connective tissue growth factor(CTGF) mRNA levels were detected by real-time polymerase chain reaction(PCR). Western blotting was used to examine the protein levels of CTGF, Histone H3(H3), Smad7, Smad2/3, Acetyl-Histone H3(AH3), HDAC2, α-smooth muscle actin( α-SMA), HDAC6, p-Smad2/3 and HDAC8. In addition, the TGF-β1 and liver enzyme levels from rat serum were detected. Histopathological changes were examined by hematoxylin and eosin(HE), Sirius red and Masson trichrome staining. The α-SMA expression was detected by immumohistochemical staining. Results: Compared with control group, the TGF-β1 and liver enzyme levels from rat serum, together with the mRNA levels of CTGF and protein levels of CTGF, HDAC2, α-SMA, HDAC6, p-Smad2/3 and HDAC8 were elevated in fibrotic rats( P < 0.01). But the Smad7 mRNA and AH3 protein levels were notably suppressed in the fibrotic rats( P < 0.01). Pathological examination showed the typical changes of liver fibrosis in the fibrotic rats. After the treatment with SAHA, the levels of liver enzymes, TGF-β1, CTGF, HDAC2, α-SMA, HDAC6, p-Smad2/3 and HDAC8 were reduced( P < 0.01) and Smad7 and AH3 protein contents were elevated in liver fibrotic rats( P < 0.01). Moreover, immumohistochemistry showed that SAHA significantly suppressed the α-SMA protein content in fibrotic liver( P < 0.01). Conclusion: The HDAC inhibitor SAHA alleviated liver fibrosis by suppressing the TGF-β1 signaling.

Association of ABO blood groups with the severity of coronary artery disease: a cross-sectional study

Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups. Results The Gensini score was significantly higher in the blood group A than in the non-A groups(41.2 ± 32 vs. 38 ± 27;P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD(β= 3.298, 95% CI: 0.91–6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score(P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension. Conclusion In this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes.

Predictors of recurrent angina in patients with no need for secondary revascularization

BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording to the TIMI frame count were assessed using multivariate linear regression.RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris.By multivariate logistic regression, the following characteristics were statistically identified as riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate linear regression, the statistical risk factors for TIMI frame count included: female sex,older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.

Effects of initial states on the quantum correlations in the generalized Grover search algorithm

We investigate the correlations between two qubits in the Grover search algorithm with arbitrary initial states by numerical simulation.Using a set of suitable bases,we construct the reduced density matrix and give the numerical expression of correlations relating to the iterations.For different initial states,we obtain the concurrence and quantum discord compared with the success probability in the algorithm.The results show that the initial states affect the correlations and the limit point of the correlations in the searching process.However,the initial states do not influence the whole cyclical trend.

Quantum walk search algorithm for multi-objective searching with iteration auto-controlling on hypercube

Shenvi et al.have proposed a quantum algorithm based on quantum walking called Shenvi-Kempe-Whaley(SKW)algorithm,but this search algorithm can only search one target state and use a specific search target state vector.Therefore,when there are more than two target nodes in the search space,the algorithm has certain limitations.Even though a multiobjective SKW search algorithm was proposed later,when the number of target nodes is more than two,the SKW search algorithm cannot be mapped to the same quotient graph.In addition,the calculation of the optimal target state depends on the number of target states m.In previous studies,quantum computing and testing algorithms were used to solve this problem.But these solutions require more Oracle calls and cannot get a high accuracy rate.Therefore,to solve the above problems,we improve the multi-target quantum walk search algorithm,and construct a controllable quantum walk search algorithm under the condition of unknown number of target states.By dividing the Hilbert space into multiple subspaces,the accuracy of the search algorithm is improved from p_(c)=(1/2)-O(1/n)to p_(c)=1-O(1/n).And by adding detection gate phase,the algorithm can stop when the amplitude of the target state becomes the maximum for the first time,and the algorithm can always maintain the optimal number of iterations,so as to reduce the number of unnecessary iterations in the algorithm process and make the number of iterations reach t_(f)=(π/2)(?).

Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope:A case report

BACKGROUND Syncope presents with diagnostic challenges and is associated with high healthcare costs.Neurogenic orthostatic hypotension(nOH)as one cause of syncope is not well established.We review a case of syncope caused by nOH in a patient with Parkinson's disease.CASE SUMMARY We describe a case of syncope caused by nOH in Parkinson's disease and review the literature.A 70-year-old man with Parkinson's disease had uncontrolled blood pressure for 1 mo,with blood pressure ranging from 70/40 to 220/112 mmHg,and once lost consciousness lasting for several minutes after getting up.Ambulatory blood pressure monitoring indicated nocturnal hypertension(up to 217/110 mmHg)and morning orthostatic hypotension(as low as 73/45 mmHg).Seated-to-standing blood pressure measurement showed that the blood pressure dropped from 173/96 mmHg to 95/68 mmHg after standing for 3 min from supine position.A diagnosis of nOH with supine hypertension was made.During the course of treatment,Midodrine could not improve the symptoms.Finally,the patient's blood pressure stabilized with simple strategies by strengthening exercises,reducing the duration of lying in bed in the daytime,and consuming water intake before getting up.CONCLUSION nOH is one of the causes of syncope.Ambulatory blood pressure monitoring is a cost-effective method for its diagnosis,and non-pharmacological measures are still the primary management methods.

Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system

BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

Meta-analysis of the efficacy and safety of Lianhua Qingwen combined with western medicine in the treatment of common patients with new coronary pneumonia

Objective:To evaluate the clinical efficacy of Lianhua Qingwen combined with Western medicine in the treatment of common patients with new coronary pneumonia by Meta analysis system.Methods:Computer retrieval of Chinese Journal Full-text Database,Weipu Chinese Scientific and Technical Periodical Full-text Database,Wanfang Data Knowledge Service Platform,Chinese Biomedical Literature Database,PubMed Database and manual retrieval of relevant literature.The search period is from database establishment to April 2020 Two researchers independently searched,screened the literature,and performed data extraction and quality evaluation on the included literature according to the Cochrane systematic review methodology.RevMan5.3 software was used for Meta analysis.Results:A total of 5 RCT literatures were included in this study,and the total effect value was combined using a fixed-effect model.As a result,3 literatures were used for clinical efficacy statistics RR=2.59,95%CI(1.68,3.98),Z=4.32,P<0.05,statistically significant;there are 3 literatures on the disappearance rate of the main symptoms,including the disappearance of fever,cough and fatigue,subgroup study,no heterogeneity between the three groups(I2=0%,P=0.88),combined with RR=3.27,95%CI(2.18,4.91),Z=5.75,P<0.05,with statistical significance;there are 3 articles with statistics on the disappearance rate of comorbidities RR=13.68,95%CI(2.80,66.79),Z=3.23,P<0.05,which is statistically significant;there are 2 literatures that count the fever remission time MD=-1.07,95%CI(-1.77,-0.37),Z=2.99,P<0.05,Statistically significant;2 literatures reported aggravating conditions in the treatment group,RR=0.33,95%CI(0.13,0.81),Z=2.41,P<0.05,statistically significance.Conclusion:Lianhua Qingwen combined with Western medicine is effective in the treatment of common patients with new coronary pneumonia,and there are few adverse reactions.However,due to the limitations of the included literature,the Meta analysis results also have corresponding limitations,so more high-quality RCT is needed to further In-depth study.

Successful treatment of congenital palate perforation: A case report

BACKGROUND Congenital palate perforation is extremely rare. There is controversy about its exact etiology and appropriate management. Here, a case of congenital palatal perforation is reported. The diagnosis and treatment of the disease are summarized.CASE SUMMARY A full-term neonate boy was referred for oral and craniomaxillofacial surgery with a finding of a hole in the palate at birth. The operation was postponed after pediatric consultation because of the patient’s poor nutrition and underweight for his age. At the age of 10 mo, the patient underwent modified von Langenbeck palatoplasty. He was followed for four years after surgery without any signs of re-rupture. His speech was satisfactory.CONCLUSION Considering the anatomy and etiology, congenital palate perforation can be classified as isolated or associated with submucous cleft palate, and the treatment procedure should be altered accordingly.

Effects of bilirubin on perioperative myocardial infarction and its long-term prognosis in patients undergoing percutaneous coronary intervention

BACKGROUND Although bilirubin is known to be an antioxidant,any relationship with coronary heart disease remains controversial.To the best of our knowledge,no previous study has investigated the association between bilirubin and perioperative myocardial infarction(PMI),including its long-term prognosis.AIM To investigate the impact of bilirubin levels on PMI in patients undergoing percutaneous coronary intervention(PCI),and long-term prognosis in post-PMI patients.METHODS Between January 2014 and September 2018,10236 patients undergoing elective PCI were enrolled in the present study.Total bilirubin(TB)and cardiac troponin I(cTnI)levels were measured prior to PCI and cTnI at further time-points,8,16 and 24 h after PCI.Participants were stratified by pre-PCI TB levels and divided into three groups:<10.2;10.2-14.4 and>14.4μmol/L.PMI was defined as producing a post-procedural cTnI level of>5×upper limit of normal(ULN)with normal baseline cTnI.Major adverse cardiovascular events(MACEs)included cardiac death,MI,stroke and revascularization during a maximum 5-year follow-up.RESULTS PMI was detected in 526(15.3%),431(12.7%)and 424(12.5%)of patients with pre-PCI TB levels of<10.2,10.2-14.4 and>14.4μmol/L(P=0.001),respectively.Multivariate logistical analysis indicated that patients with TB 10.2-14.4 and>14.4μmol/L had a lower incidence of PMI[TB 10.2-14.4μmol/L:Odds ratio(OR):0.854;95%confidence interval(CI):0.739-0.987;P=0.032;TB>14.4μmol/L:OR:0.846;95%CI:0.735-0.975;P=0.021]compared with patients with TB<10.2μmol/L.Construction of a Kaplan-Meier curve demonstrated a higher MACE-free survival time for patients with higher TB than for those with lower TB(log-rank P=0.022).After adjustment for cardiovascular risk factors and angiographic characteristics,multivariate Cox analysis showed that a TB level>14.4μmol/L was associated with a reduced risk of MACEs compared with a TB level<10.2μmol/L(hazard ratio 0.667;95%CI:0.485-0.918;P=0.013).CONCLUSION Bilirubin was a protective factor in PMI prediction.For post-PMI patients,elevated bilirubin levels were independently associated with a reduced risk of MACEs during long-term follow-up.

TCM diagnosis and treatment theory of chronic complete occlusion of coronary artery based on etiology and pathogenesis

Chronic total occlusive disease of the coronary artery belongs to the category of"chest palsy"and"true heart pain"in traditional Chinese medicine.Its etiology has two aspects:deficiency of blood,blood stasis,qi stagnation,and phlegm.Failure can be caused by deficiency or disease.The pathogenesis of this disease is caused by obstruction of the heart pulse,and its pathogenesis can be transformed into each other.The theory of traditional Chinese medicine believes that the general rule is not painful.Therefore,the treatment of coronary CTO lesions should be based on the combination of Tong and Tong tonic.The chronic complete occlusive disease of the coronary artery can be treated through Xuanbi Tongyang,Huoxue Tongluo,and Aroma Wentong.Based on the Chinese medicine's understanding of the etiology and pathogenesis of coronary CTO lesions,it provides a basis for the diagnosis and treatment of traditional Chinese medicine,solves the problems of interventional medicine in western medicine,and gives play to the unique advantages of traditional Chinese medicine for clinical diagnosis and treatment.

PFNA-Ⅱ combined with preoperative accurate measurement evaluation for the treatment of senile femoral fractures between rotor

Objective:Research PFNA-Ⅱcombined with preoperative accurate measurement of senile femoral fracture between the rotor of the clinical application value.Methods:Fiftytwo patients with intertrochanteric fractures admitted to our hospital from January 2017 to October 2019 were selected and divided into the traditional group and the measurement group according to the random number table method,with 26 patients in each group.The traditional group could not make accurate measurement before operation,but the measurement group could make accurate measurement before operation.Postoperative follow-up was conducted for at least 6 months to compare The Times of intraoperative X-ray fluoroscopy,operation time,intraoperative blood loss,and TAD,Harris score and improved BADL score of the hip joint between the two groups.Results:The number of intraoperative X-ray fluoroscopy in the measured group was less than that in the conventional group(15.08+/-2.10 vs 19.81±2.21 times,t=7.920,P=0.000).The operation time of the measured group was lower than that of the traditional group(78.46+/-3.68 vs 89.62+/-5.28 minutes,t=8.841,P=0.000).Intraoperative blood loss was less in the measured group than in the conventional group(146.15+/-24.18 vs 163.46+/-22.62 ml,t=2.666,P=0.010).There was no statistically significant difference in TAD values between the two groups(23.73+/-2.49 vs 24.04+/-2.63 mm,t=0.433,P=0.667).There is no interaction between intervention mode and time factor(F=0.362,P=0.698).There was statistical difference in Harris scores between different timepoints before and after the operation,in other words,there was time effect(F=378.110,P=0.000).There was no statistical difference in Harris scores between the 2 groups,in other words,there was no group effect(F=0.874,P=0.354).All the Harris scores of the two groups increased with time,and the increase trend was consistent(39.69+/-3.27,68.27+/-5.06,82.54+/-6.21 points,F=49.333,P=0.000;39.15+/-3.46,67.00+/-4.24,80.84+/-7.12 points,F=53.460,P=0.000).There was no significant difference in the improved BADL score between the two groups 6 months after surgery(t=0.587,P=0.560).Conclusion:PFNA-Ⅱcombined with preoperative accurate measurement in the application of the elderly femoral fracture between the rotor is safe and effective,not only can shorten the operation time,less intraoperative blood loss and the number of perspective,while reducing the risks of medical radiation.

Effect of high flux hemodialysis on renal anemia and soluble transferrin receptor in hemodialysis patients

Objective: To investigate the effect of high throughput hemodialysis on soluble transferrin receptor in hemodialysis patients and the improvement of renal anemia. Methods: 132 patients receiving maintenance hemodialysis in our hospital from July 2017 to July 2019 were selected and divided into control group and observation group according to the random number table method, with 66 cases each. The observation group was treated with high-flux hemodialysis, while the control group was treated with low-flux hemodialysis for 6 months. Compare two groups before and after treatment serum beta 2 microglobulin (beta 2 - MG), serum creatinine (Scr), blood urea nitrogen (BUN) level, anemia related index [red blood cells deposited (HCT), hemoglobin (Hb), reticulocyte percentage (Ret%)], iron metabolism index [serum ferritin (SF), transferrin saturation (TSAT)、Hepcidin(Hepc)], soluble transferrin receptor (sTfR) levels and adverse reactions. Results: the levels of 2-MG, Scr and BUN in the two groups before treatment were compared (P>0.05). After treatment, Scr and BUN levels in the two groups were significantly decreased (P<0.05), but were compared between the two groups (P>0.05). The level of 2-MG in the observation group was lower than that in the control group (P<0.05). Before treatment, sTfR, Hb, HCT level and Ret% of the two groups were compared(P>0.05). After treatment, Hb and HCT levels in the observation group were higher than those in the control group, while Ret% were lower than those in the control group, (P<0.05). Before treatment, the levels of ST、TAST、sTfR and Hepc in the two groups were compared (P>0.05). After treatment, the level of ST and TAST in the observation group was higher than that in the control group, The levels of sTfR and Hepc were lower than the control group (P<0.05). The overall incidence of adverse reactions in the observation group (8.93%) was lower than that in the control group (10.14%), with no significant difference (P>0.05). Conclusion: The high-throughput hemodialysis department significantly improved renal anemia in hemodialysis patients, reduced serum sTfR level, and had fewer adverse reactions and higher safety.

Early efficacy of endoscopic translaminar and intervertebral foraminal approaches in the treatment of lumbar disc herniation

Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.

Toward Selective Synthesis of Protein Olympiadanes via Orthogonal Active Templates in One Step

Unlike small molecules,the topological complexity of macromolecules remains largely unexplored due to the huge synthetic challenge.Herein,we report the development of orthogonal active templates for concise and selective synthesis of protein[n]heterocatenanes toward protein olympiadanes.An active template(AT-Snoop)was first developed based on the isopeptide-bond-forming RrgA domain with comparable efficiency and excellent orthogonality to the previously reported active template(AT-Spy)based on the CnaB2 domain.Their combination facilitated the selective synthesis of protein[n]catenanes from multiple components in one step and the resulting structures were verified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis,size exclusion chromatography,liquid chromatography-mass spectrometry,and proteolytic digestion experiments.The results offered a promising solution to tackling the daunting challenge of precision synthesis of protein olympiadane with five distinct ring components.Not only did the success provide new tools for proteintopology engin eering but alsospurred and fueled the future exploitation of topology-related functional benefits in protein science.

Active Template Synthesis of Protein[n]Catenanes Using Engineered Peptide–Peptide Ligation Tools

The expansion of protein topological diversity requires new and efficient synthetic tools.Herein,we report the second and third generations of the SpyStapler-mediated SpyTag/BDTag ligation system for the efficient synthesis of 4-arm star proteins and the repurposing of the third generation as an active template to enable the synthesis of higher-order protein[n]catenanes(n=3,4,and 5).SpyStapler003 has a higher affinity to its cognate SpyTag and BDTag reactive pairs relative to the original SpyStapler.Hence,it can overcome much more profound steric hindrance in protein ligation and improve the efficiency of the resulting active template tool to facilitate the construction of radial protein[n]catenanes.Various proteins of interest,such as dihydrofolate reductase and the nanobody KN035,can be modularly incorporated into the[n]catenanes with intact activity.Combination of passive and active template strategies gives rise to linear protein[4]catenanes,which further expands the current topological diversity.Moreover,higher-order protein catenation not only leads to enhanced thermal stability and proteolytic resistance but also higher affinity of the nanobody via multivalent effects.Our study provides tools useful for bioconjugation and new topological protein scaffolds for the multivalent display of enzymes and antibodies.