Objective To explore the short-term efficacy and safety of AngioJet mechanical thrombus removal,large lumen cathe-ter thrombus aspiration,and simple catheter-directed thrombolysis(CDT)for the treatment of acute deep venous thrombosis(DVT)of lower extremity.Methods A total of 75 patients with acute lower extremity DVT received interventional therapy were analyzed retrospectively,including 22 patients in AngioJet mechanical thrombus removal(group A),32 patients in large lumen catheter thrombus aspiration(group B),and 21 patients in simple CDT(group C).The short-term efficacy,health economics index,laboratory index and complications of the three groups were compared.Results The success rate of the three groups was 100％.Group A had superior thrombus clearance rates,lower dosages of urokinase,shorter thrombolysis durations,and shorter hospital stays compared to groups B and C.However,the hospitalization costs in group A were significantly higher than those in groups B and C,with statistically significant differences(P＜0.05).No significant renal dysfunction and severe complications were observed in the three groups.Post-operative creatinine levels in group A were higher than those in groups B and C,with statistically significant differences(P＜0.05).Both groups A and B experienced significant decreases in hematocrit postoperatively,and the absolute decrease and percentage decrease in hematocrit in group A were significantly greater than those in group C,with statistically significant differences(P＜0.05).Conclusion Compared to large lumen catheter thrombus aspiration and simple CDT treatment,AngioJet mechanical thrombus removal demonstrates higher efficiency in thrombus clearance rate but is associated with higher costs and risks of renal dysfunction.Postoperative care should focus on protecting renal function.

Objective To discuss the clinical value of tumor burden score(TBS)in predicting the prognosis of patients with early-to-middle hepatocellular carcinoma(HCC)after receiving transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA).Methods The clinical data of 79 HCC patients,who received TACE combined with MWA at the Affiliated Nantong Third Hospital of Nantong University of China from January 2013 to December 2019,were retrospectively analyzed.Time-dependent ROC curve and area under the ROC curve(AUC)were used to evaluate the accuracy of TBS(TBS2=maximum tumor diameter2+number of tumor lesions2)in predicting 5-year survival and tumor-free survival.The optimal cut-off value of TBS was selected according to K-Means method,and the HCC patients were divided into three groups for survival analysis.Cox multivariate analysis screened out the independent factors affecting the prognosis of HCC patients after receiving TACE combined with MWA.Results ROC curve statistics showed that the AUC of TBS in predicting the 5-year survival rate of HCC patients after receiving TACE combined with MWA was 0.815,which was the best value,the AUC of maximum tumor diameter was 0.684,and the AUC of tumor number was 0.640.According to the optimal cut-off value,79 HCC patients were divided into three groups:TBS≤1.9 points(n=34,43.1％,group A),1.9＜TBS≤ 3.3 points(n=25,31.6％,group B),and TBS＞3.3 points(n=20,25.3％,group C).The survival analysis indicated that the 5-year overall survival rate in group A,group B and group C was 76.5％,56.7％and 6.3％respectively.With the increase of TBS value,the 5-year survival rate of patients decreased gradually.The differences in the 5-year survival rate between each other among the three groups were statistically significant(P＜0.05).The differences in the tumor-free survival rate between each other among the three groups were also statistically significant(P＜0.05),besides,with the increase of TBS value,the tumor-free survival rate decreased gradually.Multivariate analysis revealed that TBS was an independent factor affecting the overall survival rate and tumor-free survival rate in HCC patients after receiving TACE combined with MWA.Conclusion TBS can well predict the prognosis of HCC patients after receiving TACE combined with MWA.

Objective:To investigate the semen characteristics of male patients with autosomal dominant polycystic kidney disease (ADPKD) complicated by infertility and the impact of PKD1 mutations on their reproductive outcomes following preimplantation genetic testing for monogenic diseases (PGT-M). Methods:A retrospective cohort study was conducted to analyze the clinical data of ADPKD patients in the Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2023. The study included two groups: observation group consisting of male infertility patients with ADPKD aged 20-45 years ( n=78), and control group comprising ADPKD patients with PKD1 mutations who demonstrated normal semen parameters ( n=5). According to the type of mutation, the patients were further divided into the PKD1 truncated mutation group and the non-truncated mutation group. Baseline data, ovulation induction outcomes and PGT-M clinical outcomes were compared between the two groups. Binary logistic regression analysis was used to assess the effects of age, family history, mutation type and mutation position on semen quality and live birth rates. Results:In the observation group, there were 28 cases of asthenozoospermia, 38 cases of oligoasthenozoospermia, and 12 cases of azoospermia. The total sperm count and forward motility ratio of patients with asthenozoospermia, oligoasthenozoospermia, and azoospermia in the observation group were significantly different from those in control group (all P<0.001). Genetic diagnosis revealed PKD1 mutations in 70 cases, PKD2 mutation in 1 case, and no known pathogenic mutations were identified in 7 cases. Among the 70 ADPKD patients with PKD1 mutations, 52 couples underwent PGT-M assisted reproduction. The blastocyst formation rate was significantly lower in the non-truncating mutation group [44.74% (51/114)] than in the truncating mutation group [58.76% (161/274), P=0.011]. No statistically significant differences were observed between the two groups in other parameters including age of both partners, semen parameters, number of oocytes retrieved, two pronuclei (2PN) rate, number of available embryos, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, and live birth rate (all P>0.05). Binary logistic regression analysis showed that neither PKD1 mutation type nor PKD1 mutation site was an independent factor affecting semen parameters and live birth rate in ADPKD patients (all P>0.05). Conclusions:Asthenospermia and oligoasthenospermia are the most common semen phenotypes in ADPKD-associated male infertility. The PKD1 mutation type and location are not associated with abnormal semen parameters in ADPKD-associated infertility patients. PKD1 mutation types do not affect the outcomes of PGT-M in infertile patients with ADPKD.

Objective:To investigate the semen characteristics of male patients with autosomal dominant polycystic kidney disease (ADPKD) complicated by infertility and the impact of PKD1 mutations on their reproductive outcomes following preimplantation genetic testing for monogenic diseases (PGT-M). Methods:A retrospective cohort study was conducted to analyze the clinical data of ADPKD patients in the Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2023. The study included two groups: observation group consisting of male infertility patients with ADPKD aged 20-45 years ( n=78), and control group comprising ADPKD patients with PKD1 mutations who demonstrated normal semen parameters ( n=5). According to the type of mutation, the patients were further divided into the PKD1 truncated mutation group and the non-truncated mutation group. Baseline data, ovulation induction outcomes and PGT-M clinical outcomes were compared between the two groups. Binary logistic regression analysis was used to assess the effects of age, family history, mutation type and mutation position on semen quality and live birth rates. Results:In the observation group, there were 28 cases of asthenozoospermia, 38 cases of oligoasthenozoospermia, and 12 cases of azoospermia. The total sperm count and forward motility ratio of patients with asthenozoospermia, oligoasthenozoospermia, and azoospermia in the observation group were significantly different from those in control group (all P<0.001). Genetic diagnosis revealed PKD1 mutations in 70 cases, PKD2 mutation in 1 case, and no known pathogenic mutations were identified in 7 cases. Among the 70 ADPKD patients with PKD1 mutations, 52 couples underwent PGT-M assisted reproduction. The blastocyst formation rate was significantly lower in the non-truncating mutation group [44.74% (51/114)] than in the truncating mutation group [58.76% (161/274), P=0.011]. No statistically significant differences were observed between the two groups in other parameters including age of both partners, semen parameters, number of oocytes retrieved, two pronuclei (2PN) rate, number of available embryos, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, and live birth rate (all P>0.05). Binary logistic regression analysis showed that neither PKD1 mutation type nor PKD1 mutation site was an independent factor affecting semen parameters and live birth rate in ADPKD patients (all P>0.05). Conclusions:Asthenospermia and oligoasthenospermia are the most common semen phenotypes in ADPKD-associated male infertility. The PKD1 mutation type and location are not associated with abnormal semen parameters in ADPKD-associated infertility patients. PKD1 mutation types do not affect the outcomes of PGT-M in infertile patients with ADPKD.

Objective:To estimate the burden of influenza-associated outpatient consultations in China from 2011 to 2021 surveillance years to provide a reference for developing influenza prevention, control strategies, and vaccination policies.Methods:Data on influenza-like illness (ILI) and virological confirmation of sentinel specimens from 2011 to 2021 surveillance years were extracted from China's national sentinel surveillance system. Generalized additive models were fitted to estimate influenza-associated excess ILI outpatient burden, accounting for seasonal baselines and meteorological factors.Results:Influenza was associated with an average of 1.66 (95% CI: 1.51-1.80) excess ILI consultations per 1 000 person-years (py) in China each year from 2011 to 2021 surveillance years. The influenza-associated outpatient burden was similar across different virus types/subtypes. Influenza A(H1N1)pdm09 led to a higher rate of influenza- associated ILI consultations [0.65 (95% CI: 0.53-0.76) per 1 000 py] compared to other types/subtypes. The age groups with the highest burdens were children aged 0-4 years and 5-14 years, with excess outpatient consultation rates of 15.23 (95% CI: 13.73-16.73) per 1 000 py and 13.53 (95% CI: 12.49-14.52) per 1 000 py, respectively. Conclusions:Influenza caused many outpatient consultations in China, particularly among children aged 0-14. Continuous influenza monitoring and disease burden assessment should be conducted, and close attention should be paid to the changing trends of various influenza virus types/subtypes. When formulating vaccination strategies, priority should be given to recommending vaccination for high-risk populations, such as children.

Objective:To estimate the burden of influenza-associated outpatient consultations in China from 2011 to 2021 surveillance years to provide a reference for developing influenza prevention, control strategies, and vaccination policies.Methods:Data on influenza-like illness (ILI) and virological confirmation of sentinel specimens from 2011 to 2021 surveillance years were extracted from China's national sentinel surveillance system. Generalized additive models were fitted to estimate influenza-associated excess ILI outpatient burden, accounting for seasonal baselines and meteorological factors.Results:Influenza was associated with an average of 1.66 (95% CI: 1.51-1.80) excess ILI consultations per 1 000 person-years (py) in China each year from 2011 to 2021 surveillance years. The influenza-associated outpatient burden was similar across different virus types/subtypes. Influenza A(H1N1)pdm09 led to a higher rate of influenza- associated ILI consultations [0.65 (95% CI: 0.53-0.76) per 1 000 py] compared to other types/subtypes. The age groups with the highest burdens were children aged 0-4 years and 5-14 years, with excess outpatient consultation rates of 15.23 (95% CI: 13.73-16.73) per 1 000 py and 13.53 (95% CI: 12.49-14.52) per 1 000 py, respectively. Conclusions:Influenza caused many outpatient consultations in China, particularly among children aged 0-14. Continuous influenza monitoring and disease burden assessment should be conducted, and close attention should be paid to the changing trends of various influenza virus types/subtypes. When formulating vaccination strategies, priority should be given to recommending vaccination for high-risk populations, such as children.

Objective To explore the short-term efficacy and safety of AngioJet mechanical thrombus removal,large lumen cathe-ter thrombus aspiration,and simple catheter-directed thrombolysis(CDT)for the treatment of acute deep venous thrombosis(DVT)of lower extremity.Methods A total of 75 patients with acute lower extremity DVT received interventional therapy were analyzed retrospectively,including 22 patients in AngioJet mechanical thrombus removal(group A),32 patients in large lumen catheter thrombus aspiration(group B),and 21 patients in simple CDT(group C).The short-term efficacy,health economics index,laboratory index and complications of the three groups were compared.Results The success rate of the three groups was 100％.Group A had superior thrombus clearance rates,lower dosages of urokinase,shorter thrombolysis durations,and shorter hospital stays compared to groups B and C.However,the hospitalization costs in group A were significantly higher than those in groups B and C,with statistically significant differences(P＜0.05).No significant renal dysfunction and severe complications were observed in the three groups.Post-operative creatinine levels in group A were higher than those in groups B and C,with statistically significant differences(P＜0.05).Both groups A and B experienced significant decreases in hematocrit postoperatively,and the absolute decrease and percentage decrease in hematocrit in group A were significantly greater than those in group C,with statistically significant differences(P＜0.05).Conclusion Compared to large lumen catheter thrombus aspiration and simple CDT treatment,AngioJet mechanical thrombus removal demonstrates higher efficiency in thrombus clearance rate but is associated with higher costs and risks of renal dysfunction.Postoperative care should focus on protecting renal function.

Objective To discuss the clinical efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with carrelizumab and sorafenib in treating advanced hepatocellular carcinoma(HCC).Methods The clinical data of 36 HCC patients,who were admitted to the Affiliated Nantong Third Hospital of Nantong University of China to receive HAIC combined with carrelizumab and sorafenib from August 2019 to August 2020,were collected.According to modified Response Evaluation Criteria in Solid Tumors(mRECIST),the objective response rate(ORR)and disease control rate(DCR)of the combination therapy were evaluated.The Common Terminology Criteria Adverse Events Version 5.0 developed by American National Cancer Institute was used to evaluate the clinical safety.Results After receiving 4 cycles of FOLFOX-HAIC,the ORR and DCR of the patients were 38.9％and 77.8％respectively.The patients were followed up for 30 months.The median progression-free survival(mPFS)was 306 days(95％CI:242.7-369.3),and the median overall survival(mOS)was 515 days(95％CI:2 482.5-547.5).After HAIC treatment,one patient was successfully changed to surgical operation.The overall incidence of adverse events were 100％.There were 9 adverse events(25％)above grade m,including severe abdominal pain(n=2,5.6％),nausea(n=1,2.8％),vomiting(n=1,2.8％),elevated alanine aminotransferase(n=3,8.3％),elevated aspartate aminotransferase(n=1,2.8％),and death due to pulmonary failure caused by severe immune-induced pneumonia(n=1,2.8％).Conclusion For the treatment of advanced HCC,HAIC combined with carrelizumab and sorafenib has better ORR and DCR with controllable safety,which provides a new option for the treatment of advanced HCC.However,studies with large sample size need to be conducted before its long-term survival benefit of patients can be further validated.

Pain is one of the most prevalent health problems. Current medications for pain are mainly anticonvulsants， tricyclic antidepressants， and opioidergic drugs. However， their therapeutic effectiveness is limited during application， and some even have severe side effects. In recent years， research on natural ingredients from Chinese herbal medicine has been extensively conducted for their analgesic activities. A series of natural ingredients represented by alkaloids， coumarins， flavonoids， and terpenoids have shown great analgesic activity， and further studies on their analgesic mechanism have found that most natural products have multi-target analgesic mechanisms. It can exert analgesic effects by blocking ion channels， regulating related receptors， or inducing anti-inflammatory or antioxidant effects. In addition， many traditional Chinese medicine （TCM） formulas have shown great analgesic ability after clinical application and have multiple complex analgesic mechanisms. The drug cloud （dCloud） theory can better describe the mechanisms， and it can represent the complete therapeutic spectrum of multi-target analgesics from two dimensions， namely the "direct efficacy" that directly inhibits pain signals and the "background efficacy" that targets the root causes of pain. The authors summarized the research progress of natural ingredients with analgesic effects found in Chinese herbal medicine so far， as well as the analgesic efficacy and potential mechanisms of TCM formulas with great analgesic effects in clinical applications， so as to provide a new basis for searching for new analgesic drugs from TCM.

OBJECTIVE: To explore the genetic etiology of recurrent hydatidiform mole (RHM) and provide accurate guidance for reproduction. METHODS: Peripheral venous blood samples of the probands with RHM and members from 5 unrelated pedigrees were collected. Genomic DNA was extracted by using routine method, and whole exome sequencing was carried out to detect variants of RHM-associated genes including NLRP7 and KHDC3L. Sanger sequencing and real-time quantitative PCR (RT-qPCR) were used to validate the candidate variants and delineate their parental origin. RESULTS: Homozygous or compound heterozygous variants of the NLRP7 gene were identified in four patients from three pedigrees, which included a homozygous deletion of exon 1 to 4 of NLRP7 in patient P1 and her elder sister, compound heterozygous variants of NLRP7 c.939delG (p.Q314Sfs*6) pat and c.1533delG (p.N512Tfs*4) mat in patient P2, and compound heterozygous variants of NLRP7 c.2389_2390delTC (p.A798Qfs*6) pat and c.2165A>G (p.D722G) mat in patient P4. All variants were interpreted as pathogenic or likely pathogenic according to the American College of Medical and Genomics (ACMG) guidelines. Among these, NLRP7 exons 1 to 4 deletion, c.939delG (p.Q314Sfs*6), c.1533delG (p.N512Tfs*4) and c.2389_2390delTC (p.A798Qfs*6) were unreported previously. CONCLUSION Variants of the NLRP7 gene probably underlay autosomal recessive RHM in the three pedigrees, and definitive molecular diagnosis is beneficial for accurate genetic counseling. Above finding has also enriched the spectrum of the NLRP7 variants underlying RHM.
Adaptor Proteins, Signal Transducing/genetics* ; Aged ; China ; Female ; Homozygote ; Humans ; Hydatidiform Mole/pathology* ; Mutation ; Pedigree ; Pregnancy ; Sequence Deletion