Comparing the efficacy and safety of low,medium,and high dosages of selexipag for treating pulmonary hypertension:A systematic review and meta-analysis

Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension(PAH),we performed a sys-tematic review and meta-analysis.Methods:Studies assessing PAH risk stratification indices,such as the World Health Organization functional class(WHO-FC),six-minute walk distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,right atrial pressure(RAP),cardiac index(CI)and mixed venous oxygen saturation(SvO2),were included.Results:Thirteen studies were included.Selexipag led to improvements in the 6MWD(MD:24.20 m,95%CI:10.74-37.67),NT-proBNP(SMD:-0.41,95%CI:-0.79-0.04),CI(MD:0.47 L/min/m^(2),95%CI:0.17-0.77)and WHO-FC(OR:0.564,95%CI:0.457-0.697).Subgroup analysis demonstrated that all three dosages improved the 6MWD.A moderate dosage led to improvements in the CI(MD:0.30 L/min/m^(2),95%CI:0.15-0.46)and WHO-FC(OR:0.589,95%CI:0.376-0.922).Within 6 months of treatment,only the WHO-FC and CI were significantly improved(OR:0.614,95%CI:0.380-0.993;MD:0.30 L/min/m^(2),95%CI:0.16-0.45,respectively).More than 6 months of treatment significantly improved the 6MWD,WHO-FC and NT-proBNP(MD:40.87 m,95%CI:10.97-70.77;OR:0.557,95%CI:0.440-0.705;SMD:-0.61,95%CI:-1.17-0.05,respectively).Conclusions:Low,medium,and high dosages of selexipag all exhibited good effects.When treatment lasted for more than 6 months,selexipag exerted obvious effects,even in the low-dosage group.This finding is important for guiding individualized treatments.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Diagnosis and therapy of tacrolimus toxicity in a liver transplant recipient during COVID-19 treatment

To the Editor:SARS-CoV-2,the pathogen responsible for the pandemic of coronavirus disease 2019(COVID-19),has had profound impacts on human health,and its antagonist Paxlovid is a commonly used treatment option[1].However,treatment selection for immunosuppressed patients,such as liver recipients,remains uncertain due to potential drug interactions and the risk of immunosuppressant dosage adjustment,which can cause liver injury[2].

Influence of blood glucose fluctuations on chemotherapy efficacy and safety in type 2 diabetes mellitus patients complicated with lung carcinoma

BACKGROUND Patients with type 2 diabetes mellitus(T2DM)have large fluctuations in blood glucose(BG),abnormal metabolic function and low immunity to varying degrees,which increases the risk of malignant tumor diseases and affects the efficacy of tumor chemotherapy.Controlling hyperglycemia may have important therapeutic implications for cancer patients.AIM To clarify the influence of BG fluctuations on chemotherapy efficacy and safety in T2DM patients complicated with lung carcinoma(LC).METHODS The clinical data of 60 T2DM+LC patients who presented to the First Affiliated Hospital of Ningbo University between January 2019 and January 2021 were retrospectively analyzed.All patients underwent chemotherapy and were grouped as a control group(CG;normal BG fluctuation with a mean fluctuation<3.9 mmol/L)and an observation group(OG;high BG fluctuation with a mean fluctuation≥3.9 mmol/L)based on their BG fluctuations,with 30 cases each.BGrelated indices,tumor markers,serum inflammatory cytokines and adverse reactions were comparatively analyzed.Pearson correlation analysis was performed to analyze the correlation between BG fluctuations and tumor markers.RESULTS The fasting blood glucose and 2-hour postprandial blood glucose levels in the OG were notably elevated compared with those in the CG,together with markedly higher mean amplitude of glycemic excursions(MAGE),mean of daily differences,largest amplitude of glycemic excursions and standard deviation of blood glucose(P<0.05).In addition,the OG exhibited evidently higher levels of carbohydrate antigen 19-9,carbohydrate antigen 125,carcinoembryonic antigen,neuron-specific enolase,cytokeratin 19,tumor necrosis factor-α,interleukin-6,and highsensitivity C-reactive protein than the CG(P<0.05).Pearson analysis revealed a positive association of MAGE with serum tumor markers.The incidence of adverse reactions was significantly higher in the OG than in the CG(P<0.05).CONCLUSION The greater the BG fluctuation in LC patients after chemotherapy,the more unfavorable the therapeutic effect of chemotherapy;the higher the level of tumor markers and inflammatory cytokines,the more adverse reactions the patient experiences.

Rare primary squamous cell carcinoma of the intrahepatic bile duct: A case report and review of literature

BACKGROUND Cholangiocarcinoma is the most common malignancy of the biliary tree and has a poor prognosis.Adenocarcinoma is the most common pathological type of cho-langiocarcinomas,but rare squamous,adenosquamous,and mucinous variants have been reported without adequate clinical data.CASE SUMMARY This report describes a rare case of primary squamous cell carcinoma(SCC)of the intrahepatic bile duct.The patient was admitted with a tumor in the hepatic caudate lobe with no obvious clinical symptoms.Examination revealed hepatitis B surface antigen positivity,a slight increase in alfa-fetoprotein to 16.34 ng/mL,and an irregular slightly heterogeneous enhancing lesion in the hepatic caudate lobe,which was initially thought to be hepatocellular carcinoma.Laparoscopic re-section was performed,and the final pathology suggested a rare primary SCC of the intrahepatic bile duct.Immunohistochemistry indicated positivity for villin,partial positivity for p63,and negativity for hepatocyte,CK7,CK8,CK19,and CK20.The Ki-67 index was approximately 60%.The patient received six cycles of Tegio chemotherapy.A new lesion was detected in the liver after 15 months.The surgery was performed,and the patient was followed-up at a local hospital.To date,no new lesions have been observed.CONCLUSION Surgery is the first choice for resectable lesions,and combined chemotherapy based on pathology is essential for increasing overall survival.

Klebsiella pneumoniae infections after liver transplantation:Drug resistance and distribution of pathogens,risk factors,and influence on outcomes

BACKGROUND Liver transplantation(LT)is the only curative treatment for end-stage liver disease.However,LT recipients are susceptible to infection,which is the leading cause of early mortality after LT.Klebsiella pneumoniae infections(KPIs)in the bloodstream are common in LT recipients.We hypothesized that KPIs and carbapenemresistant Klebsiella pneumoniae(CRKP)infections may affect the outcomes of LT recipients.AIM To assess KPI incidence,timing,distribution,drug resistance,and risk factors following LT and its association with outcomes.METHODS This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University,a tertiary hospital,from January 2015 to January 2023.We investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression analysis.RESULTS KPI incidence was 7.9%(n=32),with lung/thoracic cavity the most frequent site of infection;the median time from LT to KPI onset was 7.5 d.Of 44 Klebsiella pneumoniae isolates,43(97.7%)and 34(77.3%)were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline,respectively;>70%were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin.Female sex[odds ratio(OR)=2.827,95%confidence interval(CI):1.256-6.364;P=0.012],pre-LT diabetes(OR=2.794,95%CI:1.070-7.294;P=0.036),day 1 post-LT alanine aminotransferase(ALT)levels≥1500 U/L(OR=3.645,95%CI:1.671-7.950;P=0.001),and post-LT urethral catheter duration over 4 d(OR=2.266,95%CI:1.016-5.054;P=0.046)were risk factors for KPI.CRKP infections,but not KPIs,were risk factors for 6-month all-cause mortality post-LT.CONCLUSION KPIs occur frequently and rapidly after LT.Risk factors include female sex,pre-LT diabetes,increased post-LT ALT levels,and urethral catheter duration.CRKP infections,and not KPIs,affect mortality.

Prognostic and immunological roles of heat shock protein A4 in lung adenocarcinoma

BACKGROUND Heat shock protein A4(HSPA4)belongs to molecular chaperone protein family which plays important roles within variable cellular activities,including cancer initiation and progression.However,the prognostic and immunological significance of HSPA4 in lung adenocarcinoma(LUAD)has not been revealed yet.AIM To explore the prognostic and immunological roles of HSPA4 to identify a novel prognostic biomarker and therapeutic target for LUAD.METHODS We assessed the prognostic and immunological significance of HSPA4 in LUAD using data from The Cancer Genome Atlas database.The association between HSPA4 expression and clinical-pathological features was assessed through Kruskal-Wallis and Wilcoxon signed-rank test.Univariate/multivariate Cox regression analyses and Kaplan-Meier curves were employed to evaluate prognostic factors,including HSPA4,in LUAD.Gene set enrichment analysis(GSEA)was conducted to identify the key signaling pathways associated with HSPA4.The correlation between HSPA4 expression and cancer immune infiltration was evaluated using single-sample gene set enrichment analysis(ssGSEA).RESULTS Overexpressing HSPA4 was significantly related to advanced pathologic TNM stage,advanced pathologic stage,progression disease status of primary therapy outcome and female subgroups with LUAD.In addition,increased HSPA4 expression was found to be related to worse disease-specific survival and overall survival.GSEA analysis indicated a significant correlation between HSPA4 and cell cycle regulation and immune response,particularly through diminishing the function of cytotoxicity cells and CD8 T cells.The ssGSEA algorithm showed a positive correlation between HSPA4 expression and infiltrating levels of Th2 cells,while a negative correlation was observed with cytotoxic cell infiltration levels.CONCLUSION Our findings indicate HSPA4 is related to prognosis and immune cell infiltrates and may act as a novel prognostic biomarker and therapeutic target for LUAD.

Analysis of the Efficacy,Progression-Free Survival,and Safety of Anlotinib in Advanced Lung Cancer Treatment

Objective:To analyze the clinical efficacy,progression-free survival,and safety of anlotinib in the treatment of advanced lung cancer.Methods:A retrospective analysis was conducted using data from 60 patients with advanced lung cancer treated with anlotinib from May 2019 to May 2021.This analysis aimed to comprehensively evaluate the clinical efficacy,progression-free survival,and adverse reactions of anlotinib.Results:The median progression-free survival(PFS)for the 60 patients was 5.79 months,with an overall response rate(ORR)of 21%and a disease control rate(DCR)of 90%.In the first-line group,the median PFS was 6.20 months,ORR was 76.92%,and DCR was 84.61%.The second-line group showed a median PFS of 6.30 months,ORR of 28.57%,and DCR of 90.48%.In the third-line group,the median PFS was 5.34 months,ORR was 19.23%,and DCR was 92.30%.The single-agent group exhibited a median PFS of 5.09 months,ORR of 23.33%,and DCR of 76.67%.In the combination group,the median PFS was 6.53 months,ORR was 46.67%,and DCR was 100%.The combination group demonstrated a significantly higher medication effect than the single-drug group,and adverse drug reactions were mostly grade 1-2.Conclusion:Anlotinib exhibits a better disease control rate and survival benefit in the treatment of advanced lung cancer.The combination effect is superior to monotherapy,with relatively controllable adverse effects.

Investigation and Analysis of Lung Cancer Risk Factors in the Health Check-Up Population

Objective: To investigate and analyze the risk factors of lung cancer in the population of health checkups. Methods: A total of 500 cases of the health check-up population were selected for data study. Surveyed showed that 19 cases of lung cancer were grouped as the lung cancer group and the remaining 481 cases made up the control group, and the risk factors were analyzed. Results: Among men, there was a significant proportion of individuals aged 60-69 years old, and women aged 30-39 years old. Additionally, individuals aged 60 and above were at increased risk of developing lung cancer. The results of the multifactorial analysis were that the risk factors affecting the detection of lung cancer in healthy people were smoking history, family history of lung cancer, secondhand smoke, history of respiratory diseases, psychosomatic factors, living environment, and kitchen fumes. Conclusion: People over 60 years of age were prone to early lung cancer, followed by individuals aged 30-39 years. It is important to identify the risk factors of lung cancer to strengthen the screening of high-risk groups for early detection and treatment.

Analysis of the Prevalence Characteristics of Lung Nodules and Their Influencing Factors in The Health Check-Up Population

Objective: To study the prevalence characteristics of pulmonary nodules and their influencing factors in the health check-up population. Methods: A total of 500 cases of health checkups were selected for the data study to analyze the detection and prevalence characteristics of pulmonary nodules. The influencing factors between the pulmonary nodules group and the no pulmonary nodules group were analyzed. Results: A total of 209 cases were detected, of which there were more males than females, and for female patients, the detection rate increased with age (P < 0.05). The distribution of gender, age, smoking, respiratory symptoms, and exposure to kitchen fumes between the two groups was compared (P < 0.05). The multifactorial analysis concluded that risk factors include, respiratory symptoms, older age, exposure to kitchen fumes, and smoking. In addition, patients who exercised more had a lower risk of developing lung nodules. Conclusion: The detection rate of pulmonary nodules was high in the health check-up population and the influencing factors analyzed involved the presence of respiratory symptoms, older age, kitchen fume exposure, and smoking, while the positive influencing factor was increased exercise.

Analysis of the Current Situation and Influencing Factors of Social Isolation Among the Elderly in the Community

Objective: To investigate the current situation of social isolation among the elderly in the community, and to analyze its influencing factors. Methods: A total of 265 elderly people were selected to conduct the survey using the general information questionnaire and the Chinese version of the social isolation scale for the elderly. Results: The social isolation score of the elderly was (20.15 ± 0.23). Factors such as age, education level, economic status, and social participation ability influenced the social isolation score (P < 0.05). Conclusion: The social isolation of the elderly is more serious, and the social isolation can be alleviated by improving the level of education and the economic situation and strengthening social participation.

Analysis on Characteristic Diagnosis Technology and Application Progress of Jing Nationality Medicine

Jing Medicine, as an important part of China’s ethnic medicine and culture, is characterized by its unique theories, rich content, and abundant resources, showcasing distinctive features of minority regions. The Jing ethnic group is distributed in coastal and border areas of China, and after thousands of years of development, it has formed a rich marine-oriented medical system in the struggle against the environment and diseases, displaying unique medication characteristics and clinical efficacy. According to Jing Medicine, the human body is an organic whole that is unified with the natural and social environment. It believes that the heavens and earth are the spirits of all things, and all things possess spiritual energy, which is closely connected to the human body’s spiritual energy. The utilization of marine organisms in medicine is the greatest feature of Jing Medicine, and it is a common approach used by the local population for disease prevention and treatment. To further explore Jing Medicine, improve the repository of ethnic medicine culture, and address the insufficient understanding of Jing Medicine in traditional Chinese medicine culture, this article provides a comprehensive review of the distinctive diagnostic and therapeutic theories, techniques, and applications of internal and external treatments in Jing Medicine.

Current situation of COVID-19 treating with combination of traditional Chinese and Western medicine

It has been reported that COVID-19 patients are categorized into four groups:the mild types defined as mild clinical symptoms restricted within upper respiratory tract infection,the moderate ones defined as fever and respiratory symptoms with radiological findings of pneumonia without the severe or critical features,the severe ones defined as the respiratory failure and the rapid disease progression,and the critical ones defined as septic shock and multiple organ failure requiring mechanical ventilation and circulatory support.

Clinical Characteristics and Outcomes of Severe or Critical COVID-19 Patients Presenting No Respiratory Symptoms or Fever at Onset

It is difficult to identify suspected cases of atypical patients with coronavirus disease 2019(COVID-19),and data on severe or critical patients are scanty.This retrospective study presents the clinical,laboratory,and radiological profiles,treatments,and outcomes of atypical COVID-19 patients without respiratory symptoms or fever at onset.The study examined ten atypical patients out of 909 severe or critical patients diagnosed with COVID-19 in Wuhan Union Hospital West Campus between 25 January 2020 and 10 February 2020.Data were obtained from the electronic medical records of severe or critical patients without respiratory symptoms or fever at onset.Outcomes were followed up to discharge or death.Among 943 COVID-19 patients,909(96.4%)were severe or critical type.Of the severe or critical patients,ten(1.1%)presented without respiratory symptoms or fever at admission.The median age of the ten participants was 63 years(interquartile range(IQR):57–72),and seven participants were men.The median time from symptom onset to admission was 14 d(IQR:7–20).Eight of the ten patients had chronic diseases.The patients had fatigue(n=5),headache or dizziness(n=4),diarrhea(n=5),anorexia(n=3),nausea or vomiting(n=3),and eye discomfort(n=1).Four patients were found to have lymphopenia.Imaging examination revealed that nine patients had bilateral pneumonia and one had unilateral pneumonia.Eventually,two patients died and eight were discharged.In the discharged patients,the median time from admission to discharge lasted 24 d(IQR:13–43).In summary,some severe or critical COVID-19 patients were found to have no respiratory symptoms or fever at onset.All such atypical cases should be identified and quarantined as early as possible,since they tend to have a prolonged hospital stay or fatal outcomes.Chest computed tomography(CT)scan and nucleic acid detection should be performed immediately on close contacts of COVID-19 patients to screen out those with atypical infections,even if the contacts present without respiratory symptoms or fever at onset.

Association of vitamin D and polymorphisms of its receptor with antiviral therapy in pregnant women with hepatitis B

BACKGROUND The interruption of mother-to-child transmission(MTCT)is considered important to decrease the individual and population morbidity of hepatitis B virus(HBV)infection as well as the global burden of hepatitis B.Serum vitamin D(VD)is associated with hepatitis B.AIM To assess whether baseline VD levels and single nucleotide polymorphisms of the VD receptor gene(VDR SNPs)are associated with the efficacy of tenofovir disoproxil fumarate(TDF)in the prevention of MTCT in pregnant women with high HBV viral loads.METHODS Thirty-eight pregnant women who were at high risk for MTCT of HBV(those with an HBV DNA level≥2×10^(5)IU/mL during 12-24 wk of gestation)receiving antiviral therapy of TDF between June 1,2019 and June 30,2021 in Mianyang were included in this retrospective study.The women received 300 mg TDF once daily from gestational weeks 24-28 until 3 mo after delivery.To further characterize the clinical relevance of maternal serum HBV DNA levels,we stratified patients according to HBV DNA level as follows:Those with levels<2×10_(5)(full responder group)vs those levels≥2×10^(5)IU/mL(partial responder group)at delivery.Serum levels of 25-hydroxyvitamin D[25(OH)D],liver function markers,virological parameters,VDR SNPs and other clinical parameters were collected to analyze their association with the efficacy of TDF.The Mann-Whitney U test or t test was used to analyze the serum levels of 25(OH)D in different groups.Multiple linear regressions were utilized to analyze the determinants of the maternal HBV DNA level at delivery.Univariate and multivariate logistic regression analyses were employed to explore the association of targeted antiviral effects with various characteristics at baseline and delivery.RESULTS A total of 38 pregnant women in Mianyang City at high risk for MTCT of HBV were enrolled in the study.The MTCT rate was 0%.No mother achieved hepatitis B e antigen or hepatitis B surface antigen(HBsAg)clearance at delivery.Twenty-three(60.5%)participants were full responders,and 15(39.5%)participants were partial responders according to antiviral efficacy.The present study showed that a high percentage(76.3%)of pregnant women with high HBV viral loads had deficient(<20 ng/mL)or insufficient(≥20 but<31 ng/mL)VD levels.Serum 25(OH)D levels in partial responders appeared to be significantly lower than those in full responders both at baseline(25.44±9.42 vs 17.66±5.34 ng/mL,P=0.006)and delivery(26.76±8.59 vs 21.24±6.88 ng/mL,P=0.044).Serum 25(OH)D levels were negatively correlated with maternal HBV DNA levels[log(10)IU/mL]at delivery after TDF therapy(r=-0.345,P=0.034).In a multiple linear regression analysis,maternal HBV DNA levels were associated with baseline maternal serum 25(OH)D levels(P<0.0001,β=-0.446),BMI(P=0.03,β=-0.245),baseline maternal log10 HBsAg levels(P=0.05,β=0.285)and cholesterol levels at delivery(P=0.015,β=0.341).Multivariate logistic regression analysis showed that baseline serum 25(OH)D levels(OR=1.23,95%CI:1.04-1.44),maternal VDR Cdx2 TT(OR=0.09,95%CI:0.01-0.88)and cholesterol levels at delivery(OR=0.39,95%CI:0.17-0.87)were associated with targeted antiviral effects(maternal HBV DNA levels<2×10^(5) at delivery).CONCLUSION Maternal VD levels and VDR SNPs may be associated with the efficacy of antiviral therapy in pregnant women with high HBV viral loads.Future studies to evaluate the therapeutic value of VD and its analogs in reducing the MTCT of HBV may be justified.

Gefitinib improves severe bronchorrhea and prolongs the survival of a patient with lung invasive mucinous adenocarcinoma:A case report

BACKGROUND Lung invasive mucinous adenocarcinoma(LIMA),formerly referred to as mucinous bronchioloalveolar carcinoma,is a rare disease that usually presents as bilateral lung infiltration,is unsuitable for surgery and radiotherapy,and shows poor response to conventional chemotherapy.CASE SUMMARY We report a 56-year-old Chinese man with a history of smoking and epidermal growth factor receptor mutation-positivity who was initially misdiagnosed as severe pneumonia,but was ultimately diagnosed as a case of invasive mucinous adenocarcinoma of the lung by computed tomography-guided percutaneous lung biopsy.Bronchorrhea and dyspnea were improved within 24 h after initiation of gefitinib therapy and the radiographic signs of bilateral lung consolidation showed visible improvement within 30 d.After more than 11 months of treatment,there is no evidence of recurrence or severe adverse events.CONCLUSION Although the precise mechanism of the antitumor effects of gefitinib are not clear,our experience indicates an important role of the drug in LIMA and provides a reference for the diagnosis and treatment of this disease.

Efficacy and safety of Lianhuaqingwen capsules in high-risk common type COVID-19 pneumonia:A multicenter retrospective study

Objective:To evaluate the clinical safety and efficacy of Lianhuaqingwen(LHQW)capsules in patients with high-risk common type COVID-19 pneumonia.Methods:A retrospective multicenter study on 383 high-risk common type COVID-19 pneumonia cases was conducted.Patients were categorized as the standard treatment(SDT)group(n=168)and the LHQW+SDT group(n=215).The primary endpoint was the rate of symptom(fever,fatigue,coughing)recovery and the secondary endpoints included the time to symptom recovery,the proportion of patients with improvement in chest CT images,the proportion of patients with clinical cure,the timing and rate of negative conversion of SARS-CoV-2 RNA assay.Results:The recovery rate was significantly higher in the LHQW+SDT group as compared with the SDT group(89.7%vs.72.0%,P<0.01).The combined use of LHQW+SDT also showed shorter time for symptom recovery,as well as shorter time for individual symptom of fever,fatigue and coughing recovery than use of SDT alone.A higher proportion of patients in the LHQW+SDT group with improvements in chest CT images and clinical cure(77.7%vs.57.1%,P<0.01)but the proportion of patients deteriorating to severe cases(1%vs.25%,P<0.01)in this group was significant lower than those in the SDT group.No significant difference in negative conversion rate of viral assay results was observed(76.8%vs.75.0%,P>0.05).No serious adverse events were reported.Conclusions:LHQW capsules could be recommended to ameliorate clinical symptoms and reduce the rate of deteriorating to severe cases for high-risk common type COVID-19 pneumonia.

Association of C-reactive protein and complement factor H gene polymorphisms with risk of lupus nephritis in Chinese population

BACKGROUND Complement overactivation is a major driver of lupus nephritis(LN).Impaired interactions of C-reactive protein(CRP)with complement factor H(CFH)have been shown as a pathogenic mechanism that contributes to the overactivation of complement in LN.However,genetic variations of neither CRP nor CFH show consistent influences on the risk of LN.AIM To examine whether genetic variations of CRP and CFH in combination can improve the risk stratification in Chinese population.METHODS We genotyped six CRP single nucleotide polymorphisms(SNPs)(rs1205,rs3093062,rs2794521,rs1800947,rs3093077,and rs1130864)and three CFH SNPs(rs482934,rs1061170,and rs1061147)in 270 LN patients and 303 healthy subjects.RESULTS No linkage was found among CRP and CFH SNPs,indicating lack of genetic interactions between the two genes.Moreover,CRP and CFH SNPs,neither individually nor in combination,are associated with the risk or clinical manifestations of LN.Given the unambiguous pathogenic roles of the two genes.CONCLUSION These findings suggest that the biological effects of most genetic variations of CRP and CFH on their expressions or activities are not sufficient to influence the disease course of LN.

Expression of PHF19 in lung adenocarcinoma and its effect on immune microenvironment

Objective:To investigate the expression level,clinical prognosis,genetic changes,methylation value,biological function and immunomodulatory effects of PHF19 in lung adenocarcinoma.Methods:Based on the RNA cohort data of lung adenocarcinoma in the Cancer Genome Atlas(TCGA)database,the expression difference of PHF19 between lung adenocarcinoma and normal tissues and the relationship between the expression level and the prognosis of patients were analyzed by using TIMER database and UALCAN database.The gene mutation of PHF19 in lung adenocarcinoma was analyzed in cBioPortal database and TIMER database.The promoter methylation level of PHF19 in lung adenocarcinoma was analyzed in UALCAN database.The enrichment of PHF19 co-expression gene was analyzed in LinkedOmics database and KEGG database.The correlation between the expression of PHF19 in lung adenocarcinoma and the level of immunoinfiltration was explored in the TIMER database.Results:The expression of PHF19 in lung adenocarcinoma tissues was up-regulated,and its high expression was significantly correlated with the pathological stage,lymph node metastasis and shortened overall survival of lung adenocarcinoma patients.Genetic variation was found in 0.9%of patients,amplification and missense mutation were the most common mutations,and TP53 mutation could lead to the high expression of PHF19.The promoter methylation level of PHF19 significantly decreased in lung adenocarcinoma.The function of PHF19 was focused on the process of cell mitosis and cell cycle.The expression level of PHF19 was significantly correlated with tumor immune cell infiltration and immune checkpoint expression.Conclusion:PHF19 can be used as a marker of poor prognosis of lung adenocarcinoma and plays an important role in the occurrence and development of lung adenocarcinoma.

Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

BACKGROUND At present,understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease(COPD)patients experiencing acute worsening symptoms and respiratory failure remains relatively limited.This report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD exacerbation.AIM To determine whether pressure-controlled ventilation(PCV)can lower peak airway pressures(PAPs)and reduce the incidence of barotrauma compared to volume-controlled ventilation(VCV),without compromising clinical outcomes and oxygenation parameters.METHODS We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation,with 400 receiving mechanical ventilation for the respiratory failure.The participants were divided into two different groups,who were administered either VCV or PCV,along with appropriate management.We thereafter observed patients'attributes,clinical factors,and laboratory,radiographic,and arterial blood gas evaluations at the start and during their stay in the intensive care unit(ICU).We have also employed appropriate statistical methods for the data analysis.RESULTS Both the VCV and PCV groups experienced significant enhancements in the respiratory rate,tidal volume,and arterial blood gas values during their time in the ICU.However,no significant distinctions were detected between the groups in terms of oxygenation indices(partial pressures of oxygen/raction of inspired oxygen ratio)and partial pressures of carbon dioxide improvements.There was no considerable disparity observed between the VCV and PCV groups in the hospital mortality(32%vs 28%,P=0.53),the number of days of ICU stay[median interquartile range(IQR):9(6-14)d vs 8(5-13)d,P=0.41],or the duration of the mechanical ventilation[median(IQR):6(4-10)d vs 5(3-9)d,P=0.47].The PCV group displayed lower PAPs compared to the VCV group(P<0.05)from the beginning of mechanical ventilation until extubation or ICU departure.The occurrence of barotrauma was considerably lower in the PCV group in comparison to the VCV group(6%vs 16%,P=0.03).CONCLUSION Both VCV and PCV were found to be effective in treating patients with acute COPD exacerbation.However,PCV was associated with lower PAPs and a significant decrease in barotrauma,thus indicating that it might be a safer ventilation method for this group of patients.However,further large-scale study is necessary to confirm these findings and to identify the best ventilation approach for patients experiencing an acute COPD exacerbation.