Risk factors for cognitive impairment in patients with chronic kidney disease

BACKGROUND Chronic kidney disease(CKD)patients have been found to be at risk of concurrent cognitive dysfunction in previous studies,which has now become an important public health issue of widespread concern.AIM To investigate the risk factors for concurrent cognitive dysfunction in patients with CKD.METHODS This is a prospective cohort study conducted among patients with CKD between October 2021 and March 2023.A questionnaire was formulated by literature review and expert consultation and included questions about age,sex,education level,per capita monthly household income,marital status,living condition,payment method,and hypertension.RESULTS Logistic regression analysis showed that patients aged 60-79 years[odds ratio(OR)=1.561,P=0.015]and≥80 years(OR=1.760,P=0.013),participants with middle to high school education(OR=0.820,P=0.027),divorced or widowed individuals(OR=1.37,P=0.032),self-funded patients(OR=2.368,P=0.008),and patients with hypertension(OR=2.011,P=0.041)had a higher risk of cognitive impairment.The risk of cognitive impairment was lower for those with a college degree(OR=0.435,P=0.034)and married individuals.CONCLUSION The risk factors affecting cognitive dysfunction are age,60-79 years and≥80 years;education,primary school education or less;marital status,divorced or widowed;payment method,selffunded;hypertension;and CKD.

Acoustic characterization of hydrate formation and decomposition in clay-bearing sediments

Understanding the acoustic characteristics of hydrates in various sediments is crucial for hydrate resource detection and safe and efficient exploitation,as hydrate occurrence patterns vary greatly in different sediments.In this work,sediments with different bentonite contents,water saturations,and types were prepared to investigate the characteristics of P-wave velocity(reflecting the magnitude of hydrate saturation in the sediment)and amplitude(reflecting the degree of hydrate-sediment cementation)during hydrate formation and depressurization.During hydrate formation,the P-wave velocity and amplitude have similar trends.As clay content increases,the P-wave velocity increase rates quickened.On the other hand,the increased rate of P-wave velocity slows down with the increase of water saturation in the clay-bearing sediments.Comparing various types of sediment shows that the water absorption and swelling of bentonite reduce the pore space,speeding up the cementation of the hydrate with the sediment and increasing P-wave velocity at a faster rate.Correspondence between P-wave velocity and hydrate saturation is strongly related to sediment type,clay content,and water saturation.The rapidly decreasing amplitude in the early stage of hydrate depressurization indicates that hydrate in clay-bearing sediments is weakly cemented to the sediments,which is prone to stratigraphic instability.The findings of this study offer guidance for hydrate resource assessments in clay-bearing sediments as well as geologic risk estimations during hydrate mining.

Effect of Jianpi Shengxue Tablet on Iron Metabolism and Nutritional Status in Patients with Renal Anemia:A Prospective,Randomized,Open,Parallel Controlled and Multicenter Clinical Study

Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled and randomly divided into two groups.Patients in the control group were treated with polysaccharide-iron complex,and those in the experimental group were administered Jianpi Shengxue tablet.After 8 weeks of continuous treatment,the therapeutic outcomes regarding anemia were compared between the two groups.Results After treatment,the red blood cell(RBC)count,hematocrit(HCT),reticulocyte percentage(RET),ferritin(SF),serum iron(SI),transferrin saturation(TSAT),and serum albumin(ALB)all increased(P<0.01),and the clinical symptom score and total iron binding capacity decreased(P<0.01)in the experimental group.Moreover,the improvements in RBC,HCT,RET,SF,SI,TAST,ALB,and clinical symptoms(fatigue,anorexia,dull skin complexion,numbness of hands and feet)in the experimental group were significantly greater than those in the control group(P<0.05).The total effective rate for treating renal anemia was significantly higher in the experimental group than in the control group(P<0.01).Conclusion The Jianpi Shengxue tablet demonstrates efficacy in treating renal anemia,leading to significant improvements in the laboratory examination results and clinical symptoms of patients with renal anemia.

氮掺杂石墨烯气凝胶锚定RuP纳米粒子用于水合肼氧化辅助产氢

氢能是替代传统燃料的理想清洁能源。电解水析氢由于其环保和低成本的特性而受到广泛关注,然而,阳极析氧反应(OER)的缓慢动力学降低了制氢效率。因此,肼氧化反应(HzOR)以其低的理论电压电位(−0.33 V vs.RHE)成为了OER的合理替代方案。本工作中,以三维多孔的石墨烯气凝胶(GA)为导电基底,将Ru^(Ⅲ)-聚乙烯亚胺(Ru^(Ⅲ)-PEI)配合物吸附在GA表面。通过植酸(PA)和PEI之间的氢键相互作用GA进一步吸附PA,形成Ru^(Ⅲ)-PEI-GA-PA复合物。对Ru^(Ⅲ)-PEI-GAPA复合物前驱体进行磷化后,合成了锚定在N掺杂GA上的RuP纳米粒子(RuP/N-GA)。在热解过程中,在GA表面形成了超小的RuP纳米粒子。此外,PEI和PA的分解可以将丰富的N和P杂原子引入GA的结构中。因此,RuP/N-GA复合物具有高效的HzOR性能,在10 mA∙cm^(−2)时的工作电位低至−54 mV。此外,这种低Ru负载的新型RuP/N-GA复合物具有良好的析氢反应(HER)活性,电流密度为10 mA∙cm^(−2)时的HER过电势为−19.6 mV。在各种RuP/N-GA复合物中,RuP/N-GA-900具有最小的HER塔菲尔斜率(37.03 mV∙dec−1),表现出了最快的HER动力学。同时也表明RuP/N-GA-900的HER过程具有与Pt类似的Heyrovsky机制。理论计算结果表明,锚定结构和N杂原子的存在可以促进肼在RuP纳米粒子上的氧化。肼分子吸附在RuP/N-GA上的自由能为−0.68 eV,表明掺杂的N可以调节Ru活性位点的电子结构,有助于增强Ru的HzOR活性。此外,RuP/N-GA复合物对HER和HzOR均表现出优于商业Pt/C的循环稳定性和长期稳定性。基于RuP/N-GA复合物的双功能活性,所构建的双电极肼分解系统在10 mA∙cm^(−2)下表现出41 mV的极低分解电压就可以产氢,实现了低电压下节能制氢的目标。RuP/N-GA复合物优异的电催化活性归因于超小的RuP纳米粒子提供了丰富的Ru活性位点。此外,GA骨架中N的掺杂与RuP纳米颗粒之间的协同效应有助于提高RuP/N-GA复合物的活性。三维多孔的N-GA加速了电荷转移和传质过程,并且N-GA和RuP纳米粒子之间的相互作用增强了RuP纳米粒子对HER和HzOR的电催化活性。这项工作提出了一种HzOR辅助制氢的双功能电催化剂,并为通过吸附-磷化法设计和合成先进电催化剂提供了新思路。

Guideline for the diagnosis and treatment of rheumatoid arthritis with integrated traditional Chinese medicine and Western medicine to increase efficiency and reduce toxicity

Rheumatoid arthritis imposes a huge disease burden.Existing practice guidelines do not meet the needs of integrated traditional Chinese medicine and Western medicine in the treatment of rheumatoid arthritis.We established a guideline working group consists of a steering committee,a secretary group,an evidence evaluation group,a consensus group and a review group and developed a guideline following the guidance of the World Health Organization Handbook and the Chinese Medical Association.The guideline includes 35 recommendations which reached consensus by the two rounds Delphi surveys.These recommendations were formulated to address the following themes of most concern to clinician:diagnostic imaging,disease staging,traditional Chinese medicine syndromes,effectiveness and toxicity of integrated traditional Chinese medicine and Western medicine.

Systematic evaluation of maternal and infant health literacy assessment tools based on COSMIN guidelines

Background:To systematically evaluate the measurement performance of the maternal and child health literacy scale and the study’s methodological quality and to provide a reference for selecting and developing related health outcome measurement tools.Methods:Databases such as CNKI,PubMed,and Embase were searched,and the search time frame was established until January 2023.The literature was independently screened by two researchers.The methodological quality and measurement performance of the included scales were evaluated using the health measurement tool selection criteria,and the evaluation results were summarized and analyzed using descriptive analysis.Results:A total of six papers were included,covering six specific scales,with significant differences in the methodological quality and measurement performance of their development studies,none of which evaluated hypothesis testing,the validity of scales,cross-cultural validity,measurement error,or responsiveness.Conclusion:The methodological quality and scale measurement performance of the maternal health literacy inventory in pregnancy,the women’s reproductive health literacy in pregnancy questionnaire,and the maternal and infant health literacy scale development studies are relatively high,but the number of studies on maternal and infant health literacy specific scales is relatively insufficient,and more studies should be conducted in the future.

微粒皮移植联合医用自凝集水凝胶修复家兔全层皮肤缺损的实验研究

目的评价自凝集水凝胶(医用可注射聚羧甲基葡萄糖胺凝胶)的皮内刺激反应,以及该材料与微粒皮移植联用对全层皮肤缺损的疗效。方法依据国家标准GB/T 16886.10—2005,对该材料进行皮内刺激反应安全性评价。麻醉家兔背部,切除3.5 cm×3.5 cm 全层皮肤。切下的皮肤裁剪成1 mm×1 mm 的微粒皮,将微粒皮在创面上摆放,滴洒水凝胶原液于创面。通过凝胶自凝完成微粒皮固定,用制备好的异体兔脱细胞真皮紧密覆盖创面、缝合。观察4 周,修复创面做病理观察。结果自凝集水凝胶无潜在的皮内刺激。凝胶联合微粒皮移植术4 周后伤口完全愈合且有毛发生长,病理切片可见皮肤创面修复,炎症细胞浸润较轻。结论自凝集水凝胶对局部皮肤组织无刺激。凝胶联合微粒皮移植可促使创面皮肤组织的修复再生。

某综合医院住院患者精神障碍患病率、识别率及危险因素调查分析

目的了解某综合医院住院患者精神障碍的患病情况和影响因素、识别率及心理干预效果。方法采用一阶段调查法,调查某综合医院2014年6~8月内科、外科及妇产科等所有非精神病科室597名住院患者精神障碍的患病率、发病率及危险因素。所得数据采用SPSS 22.0进行统计分析。结果 (1)精神障碍患病率为17.6%;不同精神障碍患病率依次为:抑郁障碍9.4%、广泛性焦虑障碍3.7%、心境恶劣1.7%、自杀1.2%、轻躁狂发作1.2%、惊恐障碍为0.3%、场所恐惧症为0.5%、社交恐惧症为0.2%、强迫症为1.0%、创伤后应激障碍为2.0%、酒滥用或酒依赖为2.0%、非酒精类精神活性物质使用障碍为0.5%、精神性疾患为0.7%、神经性厌食为0.7%、神经性贪食为0.2%、反社会人格障碍为0.0%。(2)患病率最高的4个科室依次为消化内科44.9%、康复科25.0%、老年病房24.1%、神经内科19.0%。(3)精神障碍患者的识别率为51.4%;识别率最高的4个科室依次为神经内科87.5%、神经外科71.4%、呼吸内科60.0%、老年病房53.8%。(4)多因素Logistic回归分析显示,科室、居住方式、心理疾病史和就诊意愿为影响因素。结论 (1)某综合医院住院患者精神障碍患病率较低,识别率较高。(2)内科、独居、有过心理疾病史、对精神障碍有负性看法的住院患者为精神障碍的高发人群;对外伤术后的患者应排除是否存在创伤后应激障碍。

NLRP3参与的细胞焦亡在眼科疾病的研究进展

核苷酸结合寡聚化结构域(NOD)样受体家族含Pryrin结构域蛋白3(NLRP3)炎性体是位于细胞内的一种蛋白质复合体,大量的活性氧(ROS)释放后可激活细胞内NLRP3炎性小体的产生,这个炎性小体由NLRP3、半胱氨酸蛋白酶募集结构域(ASC)及半胱氨酸蛋白酶-1前体(pro-caspase-1)组成,NLRP3炎性小体在组装成型的同时活化caspase-1。随后caspase-1对细胞因子白介素1和白介素18(pro-IL-1/18)进行切割,使其成为成熟形式行使其促炎功能。细胞焦亡是炎症小体介导的依赖于caspase-1的细胞程序性死亡。本文就NLRP3炎性小体的结构、功能及其与细胞焦亡之间的关系以及在眼科疾病中的研究进展做以综述。

Effects of etanercept on the apoptosis of ganglion cells and expression of Fas, TNF-α, caspase-8 in the retina of diabetic rats

AIM: To evaluate the effects of etanercept on the expression of Fas, tumor necrosis factor-alpha(TNF-α) and caspase-8 in the early stage of the apoptotic pathway in diabetic rats, and to explore the therapeutic effect of etanercept on diabetic retinopathy.METHODS: A total of 60 Sprague-Dawley(SD) rats were randomly and evenly divided into 3 groups with 20 rats each, including control group, and diabetic groups with or without treatment. Streptozotocin(STZ)-induced diabetic rats were established for diabetic groups. Blood glucose and body weight were measured weekly. All the rats were sacrificed at the 12 wk after treatment. The expressions of Fas, TNF-α and caspase-8 in rat retina were quantitatively detected by PCR and Western blot. The leakage of Evan blue was adopted to measure the retinal vascular leakage quantitatively, and to compare it among different groups. TUNEL method was used to compare the amount of apoptotic bodies quantitatively in rat retina ganglion cells under electron microscope.RESULTS: The expressions of Fas, TNF-α and caspase-8 in each group were compared via PCR and Western blot, in which the diabetic group with treatment was lower than those without treatment(P<0.01), but all the diabetic groups were higher than the control group(P<0.01). Evans blue leakage in the diabetic treatment group was lower than those without treatment(P<0.01), but those in the control group was the lowest compared with the other two groups(P<0.01). TUNEL method showed that the apoptoticbodies of retina in the diabetic treatment group was lower than those without treatment(P<0.01), while those in the control group was the lowest compared with the other two groups(P<0.01). CONCLUSION: Etanercept can effectively reduce the expression of Fas, TNF-α and caspase-8, as well as the retinal leakage and retinal cell apoptosis in diabetic rats.

Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis

BACKGROUND In recent decades,an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis(IPN)because of the benefits in reducing postoperative multiple organ failure and mortality.However,there are limited published data regarding infection recurrence after treatment of this patient population.AIM To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.METHODS Medical records for 193 IPN patients,who underwent minimally invasive treatment between February 2014 and October 2018,were retrospectively reviewed.Patients,who survived after the treatment,were divided into two groups:one group with infection after drainage catheter removal and another group without infection.The morphological and clinical data were compared between the two groups.Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence.Sensitivity and specificity for diagnostic performance were determined.RESULTS Of the 193 IPN patients,178 were recruited into the study.Of them,9(5.06%)patients died and 169 patients survived but infection recurred in 13 of 178 patients(7.30%)at 7(4-10)d after drainage catheters were removed.White blood cell(WBC)count,serum C-reactive protein(CRP),interleukin-6,and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without(all P<0.05).In addition,drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection(P=0.025 and P<0.0001,respectively).Although these parameters all correlated positively with the incidence of infection(all P<0.05),only WBC,CRP,procalcitonin levels,and catheter length were identified as independent predictors for infection recurrence.The sensitivity and specificity for infection prediction were high in WBC count(≥9.95×109/L)and serum procalcitonin level(≥0.05 ng/mL)but moderate in serum CRP level(cut-off point≥7.37 mg/L).The catheter length(cut-off value≥8.05 cm)had a high sensitivity but low specificity to predict the infection recurrence.CONCLUSION WBC count,serum procalcitonin,and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients.These biomarkers should be considered before removing the drainage catheters.

Experimental study on heavy ion single-event effects in flash-based FPGAs

With extensive use of flash-based field-programmable gate arrays(FPGAs) in military and aerospace applications, single-event effects(SEEs) of FPGAs induced by radiations have been a major concern. In this paper, we present SEE experimental study of a flash-based FPGA from Microsemi Pro ASIC3 product family. The relation between the cross section and different linear energy transfer(LET) values for the logic tiles and embedded RAM blocks is obtained. The results show that the sequential logic cross section depends not too much on operating frequency of the device. And the relationship between 0 →1 upsets(zeros) and 1 →0 upsets(ones) is different for different kinds of D-flip-flops. The devices are not sensitive to SEL up to a LET of 99.0 Me V cm2/mg.Post-beam tests show that the programming module is damaged due to the high-LET ions.

Comparative study of mutations in SNP loci of K-RAS, hMLH1 and h MSH2 genes in neoplastic intestinal polyps and colorectal cancer

AIM: To clarify the molecular mechanism involved in pathogenesis of colorectal cancer as well as clinical significance of genetic analysis of histological samples.

MicroRNA标志物在早期诊断室间隔缺损中的价值

目的 评价血浆microRNA(miRNA)在室间隔缺损(VSD)早期诊断中的临床应用价值以及作为VSD分子诊断标志物的可行性,并建立临床早期诊断模型。方法 采用以济南市儿童医院、泰安市妇幼保健院为基础的病例-对照研究方法开展本次研究。研究分为VSD组85例和对照组80例,分3个阶段进行检测:首先选取VSD组及其匹配对照组各3例,应用miRNA全基因组表达谱芯片进行初筛;然后扩大样本量(20例VSD组vs 15例对照组),对选定的8个有差异的miRNA采用实时荧光定量聚合酶链反应(qRT-PCR)进行芯片结果的验证;最后进一步扩大样本(62例VSD组vs 62例对照组)进行qRT-PCR检测,筛选先天性心血管病早期诊断的生物标志物,建立多指标的Logistic回归模型,并应用MedCalc软件进行受试者工作特征(ROC)曲线分析评价诊断模型的价值。结果 芯片杂交初筛结果显示,与对照组比较,有36个表达有差异的miRNA(P<0.05),两阶段大样本qRT-PCR验证,检测到5种血浆miRNA(let-7e-5p、miR-155-5p、miR-222-3p、miR-433-3p和miR-487b-5p)在VSD中的表达差异有统计学意义(P<0.05),可以选择作为具有VSD早期诊断意义的生物标志物。5种血浆miRNA的ROC曲线下面积(AUC)分别在0.678~0.832,其中miR-222-3p的ROC曲线下面积最大为0.832。建立多指标Logistic回归分析模型,5种血浆miRNAs联合模型可提高VSD的诊断效率,ROC曲线下面积达到0.955,敏感性和特异性分别为83.87%和95.16%;3种血浆miRNA(let-7e-5p、miR-155-5p、miR-222-3p)联合诊断模型,ROC曲线下面积达到0.910,敏感性和特异性分别为82.30%和90.30%,接近5个miRNA的诊断效率。结论 5种血浆miRNA作为VSD早期诊断标志物,具有一定的可信性。将其整合后可建立起多指标的联合诊断模型。联合3种血浆miRNA构建诊断模型可提高VSD的诊断效率,临床应用价值更大。

Effect of irradiation on temperature performance of dispersioncompensation no-core cascade optical-fiber sensor coated with polydimethylsiloxane film

A temperature measurement device can produce data deviations and can even be damaged in a high-dose radiation environment.To reduce the radiation damage to such a device and improve the temperature measurement accuracy in a radiation environment,a temperature sensor based on optical-fiber sensing technology is proposed.This sensor has a cascade structure composed of a single-mode fiber(SMF),a dispersion-compensation fiber(DCF),a nocore fiber(NCF),and another SMF(SDNS).The DCF and NCF are coated with a polydimethylsiloxane(PDMS)film,which is a heat-sensitive material with high thermal optical and thermal expansion coefficients.In experiments,PDMS was found to produce an irradiation crosslinking effect after irradiation,which improved the temperature sensitivity of the SDNS sensor.The experimental results showed that within a range of 30–100℃,the maximum temperature sensitivity after irradiation was 62.86 pm/℃,and the maximum transmission sensitivity after irradiation was 3.353×10^(-2)dB/℃,which were 1.22 times and 2.267 times the values before irradiation,respectively.In addition,repeated temperature experiments verified that the SDNS sensor coated with the PDMS film had excellent temperature repeatability.Furthermore,it was found that with an increase in the irradiation intensity,the irradiation crosslinking degree of PDMS increased,and the temperature sensitivity of the sensor was improved.The proposed sensor could potentially be applied to temperature measurement in a nuclear-radiation environment.

Dental focal infection-induced ventricular and spinal canal empyema: A case report

BACKGROUND Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease that is clinically associated with extremely high morbidity and mortality.Traditional cerebrospinal fluid(CSF)bacterial culture is time-consuming,with a low positive rate,which frequently results in severe irreversible consequences.The next-generation sequencing technique is an emerging pathogenic microorganism detection method that can obtain results in a short time with high accuracy,thus providing great assistance in the clinical diagnosis and treatment of this disease.CASE SUMMARY This paper reports a rare case of dental focal infection-induced ventricular and spinal canal empyema.During the course of treatment at a local hospital,the patient had negative results from repeated CSF bacterial cultures and was empirically given vancomycin treatment.After transfer to our hospital,the nextgeneration sequencing technique was adopted to determine that the pathogenic microorganisms were multiple anaerobic infectious bacteria derived from the oral cavity.The antibiotic therapeutic scheme was adjusted in a timely manner,and the ventricular and spinal canal inflammation was also controlled.However,the antibiotics that had been applied at the local hospital were not able to cover all pathogenic microorganisms,which resulted in irreversible injury to the brain stem,finally leading to patient death.CONCLUSION Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease with high morbidity and mortality.Any delay in diagnosis and treatment will result in irreversible consequences.The early application of the next-generation sequencing technique can obtain results in a short time and clarify a diagnosis.Appropriate antibiotic treatment combined with suitable surgical intervention is the key to managing this disease.

Construction and analysis of an ulcer risk prediction model after endoscopic submucosal dissection for early gastric cancer

BACKGROUND Endoscopic submucosal dissection(ESD) has been widely used in the treatment of early gastric cancer(EGC). A personalized and effective prediction method for ESD with EGC is urgently needed.AIM To construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression.METHODS A total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were divided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic(ROC) curve was used to estimate the predictive model performance.RESULTS One month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41%(40/196)(ulcer group), and the incidence of no ulcers was 79.59%(156/196)(non-ulcer group). There were statistically significant differences in the course of disease, Helicobacter pylori infection history, smoking history, tumor number, clopidogrel medication history, lesion diameter, infiltration depth, convergent folds, and mucosal discoloration between the groups. Gray’s medication history, lesion diameter, convergent folds, and mucosal discoloration, which were the 4 nonzero regression coefficients, were screened by LASSO regression analysis. Further multivariate logistic analysis showed that lesion diameter [Odds ratios(OR) = 30.490, 95%CI: 8.584-108.294], convergent folds(OR = 3.860, 95%CI: 1.060-14.055), mucosal discoloration(OR = 3.191, 95%CI: 1.016-10.021), and history of clopidogrel(OR = 3.554, 95%CI: 1.009-12.515) were independent risk factors for ulcers after ESD in patients with EGC(P < 0.05). The ROC curve showed that the area under the curve of the risk prediction model for ulcers after ESD in patients with EGC was 0.944(95%CI: 0.902-0.972).CONCLUSION Clopidogrel medication history, lesion diameter, convergent folds, and mucosal discoloration can predict the occurrence of ulcers after ESD in patients with EGC.

预测肝细胞癌腹腔镜肝切除术后复发风险的列线图模型

背景与目的肝细胞癌(hepatocellular carcinoma,HCC)患者手术切除术后5年复发率很高(60%)。腹腔镜肝切除术(laparoscopic hepatectomy,LH)不断发展,但鲜有研究对LH与传统手术方法治疗HCC的疗效进行比较。本研究旨在建立一种预测HCC患者LH后复发风险的列线图模型。方法收集432例病理确诊为HCC并首次接受LH治疗且手术切缘>1cm的患者的临床资料。评估了其临床病理特征对无复发生存期(recurrence-free survival,RFS)的影响,在此基础上,使用训练队列(n=324)建立了列线图,并在现有的验证队列(n=108)中进行了内部验证。结果乙型肝炎表面抗原[风险比(hazard ratio,HR),1.838;P=0.044]、肿瘤数目(HR,1.774;P=0.003)、癌栓(HR,2.356;P=0.003)、癌细胞分化程度(HR,0.745;P=0.080)和肿瘤微血管浸润(HR,1.673;P=0.007)是训练队列中RFS的独立预后因素,并用于建立列线图。采用列线图预测RFS的C-index为0.786,高于第8版美国癌症联合会TNM分期系统(C-index,0.698)和巴塞罗那临床肝癌分期系统(C-index,0.632)。校准曲线也证明了列线图预测结果与实际生存一致性较高。受试者工作特征曲线分析表明,与其他系统相比,该列线图对RFS的预测效果更佳,具有更高的阈值概率,这在验证队列中也得到了证实。结论我们建立和验证了可将HCC患者首次接受LH后复发风险量化的列线图,该列线图可应用于临床,辅助医生对患者制订个性化术后监测方案。

Immune Responses to Trichloroethylene and Skin Gene Expression Profiles in Sprague Dawley Rats

Objective To characterize the immune reaction in SD rats exposed to trichloroethylene （TCE） and to identify the gene expression profiles involved in skin after TCE exposure. Methods Fifteen percent of TCE was injected intradermally into the rat back （100 μL/120 g） at intervals of 7 days. Whole blood was collected 24 h after the fifth or seventh intradermic administration of TCE. The percentages of CD4＋ and CD8＋ of T lymphocytes were measured by a flow cytometer. The concentrations of IFN-gamma and 1L-4 in the serum were semi-quantified by ELISA. Total RNAs of skin samples at 3 h or 24 h after the seventh dose of TCE in SD rats were extracted, and gene expression proftles of these tissues were analyszed by rat toxicology U34 array of Affymetrix. Results Obvious decline of CD4＋ in T lymphocytes was observed in the TCE-administer group. No significant concentration differences in IFN-gamma and IL-4 were found between TCE-treated and control rats. Gadd45a and Mel were significantly up regulated in skin tissue 24 h after TCE exposure. The expression regulation of immune response factors was as active as proteins associated with lipid metabolism and synthesis process in these skin samples of SD rats exposed to TCE. Conclusion T-helper type 1 cells mediate immune response can not be elicited in TCE-treated SD rats, but certain immune disorder can be induced.

Rogue waves for the(2+1)-dimensional Myrzakulov–Lakshmanan-Ⅳ equation on a periodic background

In this paper, the rogue wave solutions of the(2+1)-dimensional Myrzakulov–Lakshmanan(ML)-Ⅳ equation, which is described by five component nonlinear evolution equations, are studied on a periodic background. By using the Jacobian elliptic function expansion method, the Darboux transformation(DT) method and the nonlinearization of the Lax pair, two kinds of rogue wave solutions which are expressed by Jacobian elliptic functions dn and cn, are obtained.The relationship between these five kinds of potential is summarized systematically. Firstly, the periodic rogue wave solution of one potential is obtained, and then the periodic rogue wave solutions of the other four potentials are obtained directly. The solutions we find present the dynamic phenomena of higher-order nonlinear wave equations.