Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion

AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

Heparanase inhibition leads to improvement in patients with acute gastrointestinal injuries induced by sepsis

BACKGROUND Patients with sepsis are at high risk for acute gastrointestinal injury(AGI),but the diagnosis and treatment of AGI due to sepsis are unsatisfactory.Heparanase(HPA)plays an important role in septic AGI(S-AGI),but its specific mechanism is not completely understood,and few clinical reports are available.AIM To explore the effect and mechanism of HPA inhibition in S-AGI patients.METHODS In our prospective clinical trial,48 patients with S-AGI were randomly assigned to a control group to receive conventional treatment,whereas 47 patients were randomly assigned to an intervention group to receive conventional treatment combined with low molecular weight heparin.AGI grade,sequential organ failure assessment score,acute physiology and chronic health evaluation II score,D-dimer,activated partial thromboplastin time(APTT),anti-Xa factor,interleukin-6,tumour necrosis factor-α,HPA,syndecan-1(SDC-1),LC3B(autophagy marker),intestinal fatty acid binding protein,D-lactate,motilin,gastrin,CD4/CD8,length of intensive care unit(ICU)stay,length of hospital stay and 28-d survival on the 1^(st),3^(rd) and 7^(th) d after treatment were compared.Correlations between HPA and AGI grading as well as LC3B were compared.Receiver operator characteristic(ROC)curves were generated to evaluate the diagnostic value of HPA,intestinal fatty acid binding protein and D-lactate in S-AGI.RESULTS Serum HPA and SCD-1 levels were significantly reduced in the intervention group compared with the control group(P<0.05).In addition,intestinal fatty acid-binding protein,D-lactate,AGI grade,motilin,and gastrin levels and sequential organ failure assessment score were significantly decreased(P<0.05)in the intervention group.However,LC3B,APTT,anti-Xa factor,and CD4/CD8 were significantly increased(P<0.05)in the intervention group.No significant differences in interleukin-6,tumour necrosis factor-α,d-dimer,acute physiology and chronic health evaluation II score,length of ICU stay,length of hospital stay,or 28-d survival were noted between the two groups(P>0.05).Correlation analysis revealed a significant negative correlation between HPA and LC3B and a significant positive correlation between HPA and AGI grade.ROC curve analysis showed that HPA had higher specificity and sensitivity in diagnosis of S-AGI.CONCLUSION HPA has great potential as a diagnostic marker for S-AGI.Inhibition of HPA activity reduces SDC-1 shedding and alleviates S-AGI symptoms.The inhibitory effect of HPA in gastrointestinal protection may be achieved by enhanced autophagy.

Bladder preservation in complicated invasive urothelial carcinoma following treatment with cisplatin/gemcitabine plus tislelizumab:A case report

BACKGROUND Invasive urothelial carcinoma(UC)with squamous and glandular differentiation is a highly malignant and complicated pathological subtype,and the standard care is radical cystectomy(RC).However,urinary diversion after RC significantly reduces patient quality of life,thus bladder-sparing therapy has become a research hotspot in this field.Recently,five immune checkpoint inhibitors have been approved for systemic therapy of locally advanced or metastatic bladder cancer by the Food and Drug Administration,but the efficacy of immunotherapy combined with chemotherapy for invasive UC is still unknown,especially for pathological subtypes with squamous and glandular differentiation.CASE SUMMARY We report the case of a 60-year-old male who complained of repetitive painless gross hematuria and was diagnosed with muscle-invasive bladder cancer with squamous and glandular differentiation,defined as cT3N1M0 according to the American Joint Committee on Cancer,who had a strong desire to preserve the bladder.Immunohistochemical staining revealed that programmed cell deathligand 1(PD-L1)expression in the tumor was positive.Thus,a transurethral resection to maximize removal of the bladder tumor was performed under cystoscopy,and the patient subsequently received a combination of chemotherapy(cisplatin/gemcitabine)and immunotherapy(tislelizumab)treatment.No tumor recurrence in the bladder was observed following pathological and imaging examination after 2 cycles and 4 cycles of treatment,respectively.The patient achieved bladder preservation and has been tumor-free for more than two years.CONCLUSION This case shows that the combination of chemotherapy and immunotherapy might be an effective and safe treatment strategy for PD-L1 expression positive UC with divergent histologic differentiation.

钻孔内镜下微创手术对高血压脑出血患者血清去甲肾上腺素、5-羟色胺和神经功能的影响

目的探讨钻孔内镜下微创手术对高血压脑出血患者血清去甲肾上腺素(NE)、5-羟色胺(5-HT)和神经功能的影响。方法回顾性分析2017年11月-2020年11月该院92例高血压脑出血患者的临床资料,依据治疗方案不同分为观察组和对照组,各46例。观察组行钻孔内镜下微创手术,对照组行软通道穿刺抽吸引流。对比两组患者手术相关指标;比较两组患者术前、术后1和7 d血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD),血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、NE和5-HT水平;比较术前、术后7和30 d美国国立卫生研究院卒中量表(NIHSS)、斯堪的纳维亚卒中量表(SSS)评分及术后3个月预后情况。结果观察组手术时间长于对照组(P<0.05),术中出血量多于对照组(P<0.05),血肿清除率高于对照组(P<0.05);术后7和30 d,观察组NIHSS评分较对照组低,SSS评分较对照组高(P<0.05);观察组术后1 d血清IL-6、CRP及PRA、AngⅡ和ALD水平高于对照组(P<0.05),术后7 d血清IL-6、CRP及PRA、AngⅡ和ALD水平低于对照组(P<0.05);观察组术后1和7 d血清NE和5-HT水平高于对照组(P<0.05);两组患者术后3个月均无死亡病例,观察组预后优于对照组(P<0.05)。结论高血压脑出血患者行钻孔内镜下微创手术,可调节患者血清炎性因子,恢复肾素-血管紧张素系统,血肿清除率较高,减少血肿对NE、5-HT的抑制及相关不利影响,促进神经功能恢复,有助于改善患者预后。

结直肠息肉样病变内镜活检和内镜切除术后病理差异分析

目的探讨结直肠息肉样病变的内镜活检病理与内镜切除术后病理的差异,分析其相关危险因素以及内镜活检的局限性。方法回顾性分析结直肠息肉样病变52例,内镜活检病理包括增生性息肉、炎性息肉以及腺瘤伴低级别上皮内瘤变(LGIN)或高级别上皮内瘤变(HGIN)。所有患者根据内镜下分型及大小选择不同的内镜下切除方式:圈套器高频电切除术、内镜下黏膜切除术(EMR)以及内镜黏膜下剥离术(ESD)。统计患者的临床资料、镜下特点、活检病理及内镜切除术后的病理差异,分析病理结果发生显著差异的危险因素。结果52例患者中,24例的活检病理与内镜切除病理存在差异,总体差异率为46.2%。其中增生性息肉、炎性息肉、LGIN以及HGIN活检与内镜切除病理的差异率分别为20.0%、42.9%、44.4%及54.5%。直径大于2.0 cm和病变表面充血是影响病理学差异的关键因素(P<0.05)。结论内镜活检对于结直肠息肉样病变性质的判断有一定的局限性,应警惕其对结直肠癌前病变及癌变的延迟诊治以及漏诊。

结直肠息肉伴高级别瘤变内镜下切除术后复发因素的分析

目的探讨结直肠息肉伴高级别瘤变内镜切除术后息肉复发的危险因素,为临床监测提供参考依据。方法收集2013年7月-2017年3月该院结直肠息肉伴高级别瘤变行内镜切除术且有术后随访资料的患者67例,统计术后复发情况,并进行回顾性分析。对患者特征和可能影响术后息肉复发的相关因素[性别、年龄、体重指数(BMI)、吸烟史、饮酒史、息肉部位、大小、形态及数目]进行单因素和多因素分析。结果结直肠息肉伴高级别瘤变内镜切除术后1、2和3年息肉复发率分别为7.5%、17.7%和23.5%。术后3年息肉累计复发率为41.8%,其中高级别瘤变累计复发率为7.5%。高龄、肥胖、直径> 2.0 cm息肉和多发性息肉的患者术后复发率较高,多因素分析显示息肉数目是息肉复发的独立危险因素(OR=3.191,95%CI:1.056~9.641)。结论结直肠息肉伴高级别瘤变内镜切除术后息肉复发率较高,且随着随访时间的延长而升高。术前息肉数目是预测息肉复发的重要因素。

Early surgical intervention in culture-negative endocarditis of the aortic valve complicated by abscess in an infant:A case report

BACKGROUND Surgical therapy of infective endocarditis(IE)involving aortic valves and mitral valves is widespread.However,there are few reports concerning patients with culture-negative endocarditis complicated by the appearance of comorbid valvular perforation and abscess.Therefore,real-time surveillance of changes in cardiac structure and function is critical for timely surgical management,especially in patients who do not respond to medical therapy.CASE SUMMARY Here,we report an atypical case in a 9-mo-old infant without congenital heart disease but with symptoms of intermittent fever and macular rashes.Physical examination,laboratory tests,and electrocardiograms suggested a diagnosis of IE,although the result of blood cultures was exactly negative.After treatment with antibiotic drugs,the patient got a transient recovery.On the 9th day,we proceeded with continuous echocardiogram due to fever again and the results revealed aortic valve abscess with perforation,regurgitation,vegetation,and pericardial effusion.Intraoperative monitoring revealed aortic valve perforation,presence of apothegmatic cystic spaces below the left coronary cusp of the aortic valve,and severe aortic valve regurgitation.Aortic valve repair was performed by autologous pericardial patch plasty.The patient was discharged after 4 wk of treatment and no complications occurred after surgery.CONCLUSION Our case demonstrated the necessity of serial echocardiography monitoring for possible adverse symptoms of IE in pediatric patients.

Small-molecule 7,8-dihydroxyflavone counteracts compensated and decompensated cardiac hypertrophy via AMPK activation

BACKGROUND Pathological cardiac hypertrophy is a compensated response to various stimuli and is considered a key risk factor for heart failure.7,8-Dihydroxyflavone(7,8-DHF)is a flavonoid derivative that acts as a small-molecule brain-derived neurotrophic factor mimetic.The present study aimed to explore the potential role of 7,8-DHF in cardiac hypertrophy.METHODS Kunming mice and H9c2 cells were exposed to transverse aortic constriction or isoproterenol(ISO)with or without 7,8-DHF,respectively.F-actin staining was performed to calculate the cell area.Transcriptional levels of hypertrophic markers,including ANP,BNP,andβ-MHC,were detected.Echocardiography,hematoxylin-eosin staining,and transmission electron microscopy were used to examine the cardiac function,histology,and ultrastructure of ventricles.Protein levels of mitochondria-related factors,such as adenosine monophosphate-activated protein kinase(AMPK),and peroxisome proliferator-activated receptorγcoactivator-1α(PGC-1α),were detected.RESULTS 7,8-DHF inhibited compensated and decompensated cardiac hypertrophy,diminished the cross-sectional area,and alleviated the mitochondrial disorders of cardiomyocytes.Meanwhile,7,8-DHF reduced the cell size and repressed the mRNA levels of the hypertrophic markers of ISO-treated cardiomyocytes.In addition,7,8-DHF activated AMPK and PGC-1αsignals without affecting the protein levels of mitochondrial dynamics-related molecules.The effects of 7,8-DHF were eliminanted by Compound C,an AMPK inhibitor.CONCLUSIONS These findings suggest that 7,8-DHF inhibited cardiac hypertrophy and mitochondrial dysfunction by activating AMPK signaling,providing a potential agent for the treatment of pathological cardiac hypertrophy.

Prediction of the mechanism of berberine in the prevention and treatment of colorectal adenoma cancerizat based on network pharmacology and molecular docking technology

To predict the potential mechanism of prevention and treatment of colorectal adenoma canceration by berberine and the docking of main key targets by computer virtual method.Methods:The related targets of berberine,colorectal adenoma and colorectal cancer were collected in various databases;the key targets were obtained by intersection;the protein protein interaction network and 6 kinds of enrichment analysis of key potential targets were completed by corresponding databases;the main key targets and berberine molecules were obtained for molecular docking.Results:There were 319 unique targets for berberine,3,279 for intestinal adenoma and 4,119 for colorectal cancer.The protein protein interaction network of key target involved 66 proteins.In the results of Gene Ontology enrichment,28 items related to biological process,28 items related to cell composition,30 items related to molecular function,26 items related to Kyoto Encyclopedia of Genes and Genomes pathway enrichment,35 items related to TargetScan microRNA,15 items related to Human Phenotype Ontology.TP53 and CYCS are the 2 key targets involved in the system enrichment.After docking,berberine was closely bound to theα-helix and β-fold of TP53 protein,and to theα-helix of CYCS protein.Conclusion:The potential mechanism of berberine in the prevention and treatment of colorectal adenoma canceration may be related to the regulation of cell apoptosis,metabolic pathways and biological activities of various enzymes.berberine,as a small molecular ligand,has the characteristics of multi-target,multi-channel and multi-system mechanism.In the prediction results,berberine,as a small molecular ligand,can closely bind with the main key targets related to colorectal adenoma canceration.

Data Mining Method for Exploring the Composition Law and Therapeutic Mechanism of Chinese medicine of macroscopic

Background:Based on the theory of"cancer toxin"in traditional Chinese medicine(TCM),combined with data mining method,this paper discusses the prescription and medication law of macroscopic"cancer toxin".Methods Sort out the relevant prescriptions of macroscopic"cancer toxin"and carry out correlation analysis.Results The results showed that the main therapeutic drugs for macroscopic"cancer toxin"were invigorating the spleen and Qi,regulating the Qi mechanism,eliminating toxin and pathogenic factors,eliminating dampness and swelling,promoting blood circulation and removing blood stasis,attacking toxin,softening and firmness,and dredging collaterals to relieve pain.Conclusion High frequency medicine embodies the core of tangible macroscopic"cancer toxin"treatment,and the new prescription composition embodies the fundamental treatment.At the same time,the mechanism of macroscopic"cancer toxin"was analyzed to pave the way for further clinical practice.

Predictive factors for the post embolization fever after transcatheter arterial chemoembolization in hepatocellular carcinoma patients:a single center study in China

Background and Objectives:Post embolization fever(PEF)is one of the most common symptoms of post embolization syndrome(PES).This study aimed to determine and validate a model to predict PEF after transcatheter arterial chemoembolization(TACE)in hepatocellular carcinoma(HCC)patients.Methods:Clinical data of HCC patients who underwent TACE with platinum was retrospectively collected in our center from 2017 to 2018.Predictive factors were screened by multivariate logistic regression.The accuracy and discriminative ability of these factors were evaluated by the receiver operating characteristic(ROC)curve using the derivation cohort and an independent validation cohort.Results:A total of 367 patients were included,of whom 53(14.4%)patients had PEF.Fevers were detected in 44 of 252 patients in the derivation cohort and 9 of 115 patients in the validation cohort.Predictors for PEF identified in multivariate logistic regression included Lipiodol emulsion dose(OR,1.081;95%CI,1.006-1.162),number of concomitants uses of hepatoprotectants(OR,0.619;95%CI,0.419-0.914),K+levels(OR,2.992;95%CI,1.225-7.308),and albumin-bilirubin(ALBI)grade(OR,2.249;95%CI,1.040-4.862).Furthermore,the area under the ROC curve of the derivation and validation cohorts were 0.798 and 0.874,respectively.Conclusions:Our study demonstrated that Lipiodol emulsion dose,number of concomitant uses of hepatoprotectants,K+levels,and ALBI grade are independent risk factors for PEF.The multivariate logistic model of these factors shows a discriminative ability to predict PEF in the patients who underwent TACE.

New approaches in agent-based modeling ofcomplex financial systems

Agent-based modeling is a powerful simulation technique to understand the collective behavior and microscopic interaction in complex financial systems. Recently, the concept for determining the key parameters of agent-based models from empirical data instead of setting them artificially was sug- gested. We first review several agent-based models and the new approaches to determine the key model parameters from historical market data. Based on tile agents＇ behaviors with heterogeneous personal preferences and interactions, these models are successful in explaining the microscopic origi- nation of the temporal and spatial correlations of financial markets. We then present a novel paradigm combining big-data analysis with agent-based modeling. Specifically, from internet query and stock market data, we extract the information driving forces and develop an agent-based model to simulate the dynamic behaviors of complex financial systems.

General Higher-Order Breather and Hybrid Solutions of the Fokas System

Fokas system is the simplest(2+1)-dimensional extension of the nonlinear Schr?dinger(NLS) equation(Eq.(2), Inverse Problems 10(1994) L19-L22). By appropriately limiting on soliton solutions generated by the Hirota bilinear method, the explicit forms of n-th breathers and semi-rational solutions for the Fokas system are derived. The obtained first-order breather exhibits a range of interesting dynamics. For high-order breather, it has more rich dynamical behaviors. The first-order and the second-order breather solutions are given graphically. Using the long wave limit in soliton solutions, rational solutions are obtained, which are used to analyze the mechanism of the rogue wave and lump respectively. By taking a long waves limit of a part of exponential functions in f and g appeared in the bilinear form of the Fokas system, many interesting hybrid solutions are constructed. The hybrid solutions illustrate various superposed wave structures involving rogue waves, lumps, solitons, and periodic line waves. Their rather complicated dynamics are revealed.

Assessing the product quality and biological activities of barley(Hordeum vulgare L.)grasses at different harvest times

Barley(Hordeum vulgare L.)grasses(BG)have attracted considerable interest due to their multiple physiological activities and health benefits.In this paper,eight BG at four different growth stages were collected:seedling,tillering,stem elongation,and heading,and their product qualities and biological activities were examined and studied.Results demonstrated that harvest time obviously influenced proximate composition,surface color,and amino acid profile.Z21 and Z23 harvested at the seedling and early tillering stages,respectively,had higher total phenolic content(TPC)and total flavonoid content(TFC)than the other BG.Moreover,Z21 and Z23 possessed better DPPH radical-scavenging ability,antioxidant capacity,andα-glucosidase inhibitory activity,which were positively correlated with TPC,TFC,and protein and total amino acid contents.Our findings suggested that the early tillering stages were the preferable harvest times for BG with good product quality and biological properties.