基于Lasso回归的老年股骨颈骨折关节置换术后谵妄预测模型的构建

目的 分析老年股骨颈骨折关节置换术后谵妄的危险因素,并构建Nomogram预测模型。方法 回顾性分析2019年1月至2020年12月于烟台市烟台山医院接受关节置换术的195例65岁以上股骨颈骨折患者的临床资料。记录患者的一般基线资料、血常规检查、炎症相关指标、生化检查指标、凝血与D-二聚体指标及动脉血气分析指标。根据术后是否发生谵妄分为谵妄组与非谵妄组,计算谵妄发病率;利用最小绝对收缩选择算子(Lasso)回归和多因素Logistic回归分析术后谵妄的危险因素并建立Nomogram预测模型。结果 老年股骨颈骨折关节置换术后谵妄率为16.4%。LassoLogistic回归模型显示,性别[OR=0.16,95%CI(0.06,0.44)]、手术方式[OR=3.26,95%CI(1.02,10.37)]、白蛋白[OR=1.19,95%CI(1.03,1.38)]为术后谵妄的独立危险因素。预测模型的曲线下面积(area under the curve,AUC)为0.833,提示Nomogram预测模型有较好的预测能力、精准度。结论 性别、年龄、手术方式、白蛋白是术后谵妄独立风险因素。Nomogram预测模型能够方便地进行术后谵妄风险预测。

Neoadjuvant chemotherapy for locally advanced cervical cancer reduces surgical risks and lymph-vascular space involvement

Neoadjuvant chemotherapy(NACT),which can reduce the size and therefore increase the resectability of tumors,has recently evolved as a treatment for locally advanced cervical cancer.NACT has been reported to decrease the risk of pathologic factors related to prognosis of cervical cancer.To further assess the effects of NACT on surgery and the pathologic characteristics of cervical cancer,we reviewed 110 cases of locally advanced cervical cancer treated with radical hysterectomy with or without NACT at the People's Hospital of Peking University between January 2006 and December 2010.Of 110 patients,68 underwent platinum-based NACT prior to surgery(NACT group) and 42 underwent primary surgery treatment(PST group).Our results showed 48 of 68(70.6%) patients achieved a complete response or partial response to NACT.Estimated blood loss,operation time,and number of removed lymph nodes during surgery,as well as complication rates during and after surgery were not significantly different between the NACT group and the PST group.The rates of deep stromal invasion,positive parametria,positive surgical vaginal margins,and lymph node metastasis were not significantly different between the two groups.However,the rate of lymph-vascular space involvement(LVSI) was significantly lower in the NACT group than in the PST group(P = 0.021).In addition,the response rate of NACT was significantly higher in the patients with chemotherapeutic drugs administrated via artery than via vein.Our results suggest that NACT is a safe and effective treatment for locally advanced cervical cancer and significantly decreases the rate of LVSI.

Role of LAP^+CD4^+ T cells in the tumor microenvironment of colorectal cancer

AIM To investigate the abundance and potential functions of LAP^+CD4^+ T cells in colorectal cancer(CRC). METHODS Proportions of LAP^+CD4^+ T cells were examined in peripheral blood and tumor/paratumor tissues of CRC patients and healthy controls using flow cytometry. Expression of phenotypic markers such as forkhead box(Fox)p3, cytotoxic T-lymphocyte-associated protein(CTLA)-4, chemokine CC receptor (CCR)4 and CCR5 was measured using flow cytometry. LAP^-CD4^+ and LAP^+CD4^+ T cells were isolated using a magnetic cellsorting system and cell purity was analyzed by flow cytometry. Real-time quantitative polymerase chain reaction was used to measure expression of cytokines interleukin (IL)-10 and transforming growth factor(TGF)-β.RESULTS The proportion of LAP^+CD4^+ T cells was significantly higher in peripheral blood from patients (9.44% ± 3.18%) than healthy controls (1.49% ± 1.00%, P < 0.001). Among patients, the proportion of LAP^+CD4^+ T cells was significantly higher in tumor tissues(11.76% ± 3.74%) compared with paratumor tissues (3.87% ± 1.64%, P < 0.001). We also observed positive correlations between the proportion of LAP^+CD4^+ T cells and TNM stage(P < 0.001), distant metastasis(P < 0.001) and serum level of carcinoembryonic antigen(P < 0.05). Magnetic-activated cell sorting gave an overall enrichment of LAP^+CD4^+ T cells (95.02% ± 2.87%), which was similar for LAP^-CD4^+ T cells(94.75% ± 2.76%). In contrast to LAP^-CD4^+ T cells, LAP^+CD4^+ T cells showed lower Foxp3 expression but significantly higher levels of CTLA-4, CCR4 and CCR5(P < 0.01). LAP^+CD4^+ T cells expressed significantly larger amounts of IL-10 and TGF-β but lower levels of IL-2, IL-4, IL-17 and interferon-γ, compared with LAPCD4+ T cells.CONCLUSION LAP^+CD4^+ T cells accumulated in the tumor microenvironment of CRC patients and were involved in immune evasion mediated by IL-10 and TGF-β.

The behavior of cesium adsorption on zirconyl pyrophosphate

Zirconyl pyrophosphate(ZrP_2O_7) was prepared and Cs adsorption behavior was studied.Results show that the distribution coefficient of Cs adsorption on ZrP_2O_7 was about 2800 mL/g.Ion exchange capacity of ZrP_2O_7 was0.35 mmol/g.In dynamic tests,Cs can be separated from other fission products very well by ZrP_2O_7.The ZrP_2O_7was stable both at high temperatures and in high concentration of nitric acid.The Cs adsorption by ZrP_2O_7 is a monolayer and chemical adsorption.

Radiological and clinical outcomes of midline lumbar fusion on sagittal lumbar-pelvic parameters for degenerative lumbar diseases

BACKGROUND Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes.The impact of midline lumbar fusion(MIDLF)on sagittal lumbar-pelvic alignment for the management of degenerative lumbar diseases is still unknown.AIM To analyze the effects of short-segment MIDLF and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on sagittal lumbar-pelvic parameters.METHODS We retrospectively analyzed 63 patients with degenerative lumbar diseases who underwent single-segment MIDLF or MIS-TLIF.The imaging data of patients were collected before surgery and at the final follow-up.The radiological sagittal parameters included the lumbar lordosis(LL),lower LL,L4 slope(L4S),L5 slope(L5S),L5 incidence(L5I),L1 axis and S1 distance(LASD),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),and PI-LL mismatch(PI-LL).Additionally,the clinical outcomes,including lower back and leg pain visual analog scale(VAS)and Oswestry disability index(ODI)scores,were also analyzed.RESULTS In both groups,LL and Lower LL significantly increased,while L5I and LASD significantly decreased at the final follow-up compared to that recorded prior to operation(P<0.05).In the MIDLF group,L4S significantly decreased compared to that recorded prior to operation(P<0.05),while the mean SS significantly increased and the PT significantly decreased compared to that recorded prior to operation(P<0.05).In the MIS-TLIF group,SS slightly increased and the mean PT value decreased compared to that recorded prior to operation,but without a statistically significant difference(P>0.05).However,the PI-LL in both groups was significantly reduced compared to that recorded prior to operation(P<0.05).There was no significant difference in the sagittal lumbar-pelvic parameters between the two groups prior to operation and at the final follow-up(P>0.05).In addition,the change in sagittal lumbar-pelvic parameters did not differ significantly,except forΔLASD within the two groups(P>0.05).The mean lower back and leg pain VAS and ODI scores in both groups were significantly improved three months after surgery and at the final follow-up.Though the mean ODI score in the MIDLF group three months after surgery was slightly higher than that in the MIS-TLIF group,there was no significant difference between the two groups at the final follow-up.CONCLUSION Short-segment MIDLF and MIS-TLIF can equally improve sagittal lumbar parameters such as LL,Lower LL,L5I,and LASD in the treatment of lumbar degenerative diseases.However,MIDLF had a larger impact on pelvic parameters than MIS-TLIF.

Administration of modified Gegen Qinlian decoction for hemorrhagic chronic radiation proctitis: A case report and review of literature

BACKGROUND Hemorrhagic chronic radiation proctitis(CRP) is a common late complication of irradiation of the pelvis and seriously impairs life quality. There is no standard treatment for hemorrhagic CRP. Medical treatment, interventional treatment, and surgery are available, but they are limited in their applications due to nondefinite efficacy or side effects. Chinese herbal medicine(CHM), as a complementary or alternative therapy, may provide another option for hemorrhagic CRP treatment.CASE SUMMARY A 51-year-old woman with cervical cancer received intensity-modulated radiation therapy and brachytherapy with a total dose of 93 Gy fifteen days after hysterectomy and bilateral adnexectomy. She received six additional cycles of chemotherapy with carboplatin and paclitaxel. Nine months after radiotherapy treatment, she mainly complained of 5-6 times diarrhea daily and bloody purulent stools for over 10 d. After colonoscopy examinations, she was diagnosed with hemorrhagic CRP with a giant ulcer. After assessment, she received CHM treatment. The specific regimen was 150 mL of modified Gegen Qinlian decoction(GQD) used as a retention enema for 1 mo, followed by replacement with oral administration of 150 mL of modified GQD three times per day for 5 mo. After the whole treatment, her diarrhea reduced to 1-2 times a day. Her rectal tenesmus and mild pain in lower abdomen disappeared. Both colonoscopy and magnetic resonance imaging confirmed its significant improvement. During treatment,there were no side effects, such as liver and renal function damage.CONCLUSION Modified GQD may be another effective and safe option for hemorrhagic CRP patients with giant ulcers.

Rat model for study of the essence of spleen deficiency and dampness in Chinese medicine

Objective:To explore the essence of spleen deficiency and dampness in Chinese medicine by successfully constructing a rat model with this syndrome.Methods:Rat models with the syndrome of dampness and spleen deficiency were established with the use of a high-fat,low-protein diet and excessive fatigue induced by loaded swimming.A total of 25 common clinical serological markers were tested.The T test,rank test,and partial least squares regression-discriminant analysis were used to analyze the data.Results:Total protein,albumin,motilin,interferon-γ,interleukin-2,immunoglobulin A,immunoglobulin G,and complement 3 levels in the model rats were lower than those in the control group(P=0.029,P=0.032,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,respectively).The serum creatinine,total cholesterol,aldosterone,antidiuretic hormone,gastrin,interleukin-4,somatostatin,atrial natriuretic peptide,and vasoactive intestinal peptide levels in the model group were higher than those in the control group(P<0.001,P=0.015,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,respectively).There was no statistical difference between the two groups in aspartate transaminase,alanine aminotransferase,globulin,albumin/globulin,blood urea nitrogen,high-density lipoprotein,and low-density lipoprotein.The model animal syndrome used two important variables in analysis with partial least squares regression-discriminant analysis.At the same time,the two dimensions were difficult to distinguish for each biological index.Conclusion:Spleen deficiency is often associated with dampness.The index that represents spleen deficiency can also represent dampness.Cytokines,immunoglobulins,and gastrointestinal hormones play a major causative role in both spleen deficiency and dampness.

同种异体小鼠腹腔异位心脏移植模型的学习曲线

同种异体小鼠腹腔异位心脏移植模型是技术复杂的小动物显微手术。对于初学者必须经历一个学习曲线过程。学习曲线包括三个阶段:(1)熟悉供体和受体小鼠的局部解剖;(2)掌握供体小鼠心脏采集和受体小鼠腹腔大血管的准备;(3)掌握大血管的吻合技术。学习曲线的瓶颈在于大血管的吻合技术。学习曲线中的渐进要点是"认识、熟悉、准备、提速"。

Characteristic differences in essential oil composition of six Zanthoxylum bungeanum Maxim.(Rutaceae) cultivars and their biological significance

Great variations have been found in composition and content of the essential oil of Zanthoxylum bungeanum Maxim. （Rutaceae）, resulting from vari- ous factors such as harvest time, drying and extraction methods （Huang et al., 2006; Shao et al., 2013）, sol- vent and herbal parts used （Zhang, 1996; Cao and Zhang, 2010; Wang et al., 2011）. However, in terms of artificial introduction and cultivation, there is little research on the chemical composition of essential oil extracted from Z. bungeanum Maxim.

Non-metallic inclusions in electroslag remelting:a review

Non-metallic inclusion in electroslag remelting is a constant topic that has been studied for decades.Different results and conclusions are obtained on some of the subjects from these previous investigations.These differences originate in part from different experimental conditions,including original inclusion chemistries in consumable electrode,slag composition,oxygen level,liquid metal compositions,deoxidation schemes,and melting rates of electroslag remelting.The advances in the operating practices of inclusion control in electroslag remelting production are reviewed.Inclusion evolution during the electroslag remelting and related processing parameters are also reviewed and assessed.The role of the reoxidation of liquid steel during electroslag remelting on oxide inclusion composition is discussed.The generation of inclusions in remelted ingot is critically assessed.Perspective and remaining issues are noted.

Effect of cerium on microstructure,eutectic carbides and Laves phase in electroslag remelted 15Cr-22Ni-1Nb austenitic heat-resistant steel

The dendrites,eutectic carbides,Laves phase and microsegregation of alloying element in electroslag remelted 15Cr-22Ni-1Nb austenitic heat-resistant steel with varying cerium contents were studied.The liquidus and solidus temperatures of the steel were determined to reveal the effect of cerium on solidification temperature interval and local solidification time of the steel.The secondary dendrite arm spacing decreases from 57.10 to 40.18μm with increasing the cerium content from 0 to 0.0630 wt.%.The eutectic NbC and Laves phase in as-cast ingots exhibit blocky and honeycomb morphology,respectively.The area fractions and sizes of eutectic NbC and Laves phase in as-cast ingots decrease with the increase in cerium content.The atomic percentage of Laves phase-forming element(Ni,Nb,Cr,Mo and Si)decreases with the increase in cerium content of the steel.The microsegregation of Mo,Ni,Si,Cr and Nb decreases with increasing the cerium content,which is favorable to reducing both the amount and sizes of eutectic NbC and Laves phase in as-cast ingots.The solidification temperature interval and local solidification time of the steel decrease as the cerium content is increased from 0 to 0.0630 wt.%,which inhibits the growth of dendrites,eutectic NbC and Laves phase.

New Species of the Isolated Psaroniaceous Rachis from the Early Permian in China

A new kind of marattialean raches are reported from the coal balls in Coal Seam No.7 in the upper part of the Taiyuan Formation （early Early Permian） from Taiyuan, Shanxi, China and are assigned to the genus Stipitopteris Grand＇Eury （Psaroniaceae）. The present specimens are different from all six reported species of the genus, and are therefore proposed as a new species： Stipitopteris shanxiensis. The raches of the new species are generally dorsi-ventrally flattened. The main raches usually exhibit scales of different forms on their surface. Beneath the epidermis is a zone of parenchymatous cells, some of which contain tannin-like contents. Inside this is a zone of small sclerenchymatous cells. Inward are the ground tissue and vascular bundles. The vascular bundles are continuous and are in two circles： the outer circle assumes a transversely elliptical shape with the gap and pinna trace, and the inner circle assumes a shallow C.shape with inrolled ends. The ground tissue located at the inner side of the vascular bundle is composed of thicker-walled parenchymatous cells. The cells of the ground tissue are vertically elongated in longitudinal sections. Subordered raches are smaller and have simpler structures than the main raches. The parenchyma zone beneath the epidermis is thinner, usually one to two cells wide and the sclerenchyma zone is usually absent. The scales are poorly developed and there is only one C-shaped vascular bundle. The new species is comparable to the crosiers of Psaroniaceae of the Euramerican Flora in some aspects, for example, it has a dorsi-ventrally flattened rachis and scales on the surface of the rachis. However, the other features and the preservative conditions of the present specimens indicate that they are not crosiers, but fully developed or mature raches. The new species is the first well-studied anatomically-preserved rachis of Psaroniaceae from the Cathaysian Flora and bears significance not only in understanding the anatomy and taxonomy of Psaroniaceae in the Cathaysian Flora, but also in the relationship between the Euramerican Flora and the Cathaysian Flora.

Eutectic precipitates and microstructure of electroslag remelted 15Cr-22Ni austenitic heat-resistant steel with varying Nb contents

The microstructure,eutectic carbides and intermetallic compounds in as-cast ingots with varying Nb contents produced by electroslag remelting were studied.The solidification behavior,microsegregation of alloying elements and its influence on precipitates were analyzed.The increase in Nb content from 0.64 to 1.40 wt.%has no effect on the dendrite morphology and secondary dendrite arm spacing.The total area fraction of eutectic NbC and Laves phase in as-cast ingots increases with the increase in Nb content.The eutectic precipitates in the ingot with 0.64 wt.%Nb are mainly NbC,and the others are Fe_(2)Nb-type Laves phase.Increasing the Nb content of the steel significantly promotes the precipitation of Laves phases and lowers the precipitation temperature of NbC eutectic carbides.Eutectic carbide M_(2)C is precipitated only in the ingot with 1.4 wt.%Nb.The average concentration of Nb in both interdendritic and intragranular regions increases with the increase in Nb content of the steel,leading to a change in the morphology of Fe_(2)Nb-type Laves phase from honeycomb to blocky.Increasing the Nb content exerts little effect on the microsegregation degrees of Si,Mo,Cr and Ni in the steel.