OBJECTIVE: To explore the influencing factors on the prognosis of patients with multiple myeloma (MM) after bortezomib treatment, and construct a decision tree risk prediction model based on the influencing factors. METHODS: One hundred and seventy MM patients admitted to the People's Hospital of Jianyang City from January 2019 to June 2022 were selected as research subjects, and divided into poor prognosis group and good prognosis group according to the prognosis after bortezomib treatment. The clinical data of the patients were analyzed, univariate and logistic regression analysis were used to screen influencing factors, SPSS Modeler software was used to construct a decision tree prediction model, and the diagnostic performance of the decision tree risk prediction model was analyzed. RESULTS: The incidence of poor prognosis in 170 MM patients after bortezomib-based chemotherapy was 21.18%. Kappa light chain level≥19.4 mg/L, platelet count (PLT) ≤100×10⁹/L, homocysteine (Hcy) >22 μmol/L, serum creatinine (Scr) ≥176 μmol/L, lactate dehydrogenase (LDH) ≥300 U/L, serum ferritin (SF) >500 mg/L, and β₂-microglobulin (MG) >6 μg/L were independent risk factors for poor prognosis in MM patients after bortezomib treatment (all P < 0.05). The decision tree model selected 7 explanatory variables (Kappa light chain level, LDH, PLT, SF, β₂-MG, Scr, and Hcy) as nodes of the model, among which Kappa light chain level was the most important predictor. In addition, the area under the ROC curve (AUC) values of the decision tree model and logistic regression model were 0.895 and 0.881, respectively. The prediction performance of the decision tree model was better than that of the logistic regression model ( Z=3.325, P =0.005). CONCLUSION The decision tree model has high value in predicting the prognosis after bortezomib treatment in MM patients, which can screen high-risk factors that affect poor prognosis, providing practical references for clinical healthcare professionals to take preventive treatment for high-risk MM patients.
Humans ; Bortezomib/therapeutic use* ; Multiple Myeloma/diagnosis* ; Decision Trees ; Prognosis ; Algorithms ; Risk Factors ; Male ; Female ; Middle Aged

OBJECTIVES: The magnesium depletion score (MDS) is considered more reliable than traditional approaches for predicting magnesium deficiency in humans. We explored the associations of MDS and dietary magnesium intake with diabetes. METHODS: We obtained data from 18,853 participants in the National Health and Nutrition Examination Survey 2011-2018. Using multivariate regression and stratified analysis, we investigated the relationships of both MDS and magnesium intake with diabetes. To compute prevalence ratios (PRs), we employed modified Poisson or log-binomial regression. We characterized the non-linear association between magnesium intake and diabetes using restricted cubic spline analysis. RESULTS: Participants with MDS ≥2 exhibited a PR of 1.26 (95% confidence interval [CI], 1.19 to 1.34) for diabetes. Per-standard deviation (SD) increase in dietary magnesium intake was associated with a lower prevalence of diabetes (PR, 0.91; 95% CI, 0.87 to 0.96). Subgroup analyses revealed a positive association between MDS ≥2 and diabetes across all levels of dietary magnesium intake, including the lowest (PR, 1.35; 95% CI, 1.18 to 1.55), middle (PR, 1.23; 95% CI, 1.12 to 1.35), and highest tertiles (PR, 1.25; 95% CI, 1.13 to 1.37; pinteraction<0.001). Per-SD increase in magnesium intake was associated with lower diabetes prevalence in participants with MDS <2 (PR, 0.92; 95% CI, 0.87 to 0.98) and those with MDS ≥2 (PR, 0.91; 95% CI, 0.84 to 0.98; pinteraction=0.030). CONCLUSIONS MDS is associated with diabetes, particularly among individuals with low magnesium intake. Adequate dietary magnesium intake may reduce diabetes risk, especially in those with high MDS.

Objective    To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results    The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion    Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective    To evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass. Methods    In this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation. Results    There was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01). Conclusion    Application of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.

Pseudouridine(Ψ)is the most prevalent post-transcriptional RNA modification and is widespread in small cellular RNAs and mRNAs.However,the functions,mechanisms,and precise distribution of Ψs(especially in mRNAs)still remain largely unclear.The landscape of Ψs across the transcriptome has not yet been fully delineated.Here,we present a highly effective model based on a convolutional neural network(CNN),called PseudoUridyLation Site Estimator(PULSE),to analyze large-scale profiling data of Ψ sites and characterize the contextual sequence features of pseudouridylation.PULSE,consisting of two alternatively-stacked convolution and pooling layers followed by a fully-connected neural network,can automatically learn the hidden patterns of pseu-douridylation from the local sequence information.Extensive validation tests demonstrated that PULSE can outperform other state-of-the-art prediction methods and achieve high prediction accu-racy,thus enabling us to further characterize the transcriptome-wide landscape ofΨ sites.We fur-ther showed that the prediction results derived from PULSE can provide novel insights into understanding the functional roles of pseudouridylation,such as the regulations of RNA secondary structure,codon usage,translation,and RNA stability,and the connection to single nucleotide vari-ants.The source code and final model for PULSE are available at https://github.com/mlcb-thu/PULSE.

Objective To investigate the application of percutaneous transluminal balloon dilatation (PTA) in catheter replacement within patients with catheter-related central vein disease (CVD). Methods Thirteen cases of CVD patients from Jan 2015 to Mar 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. All of them underwent digital subtraction angiography (DSA) to clarify problem origin. Suitable balloons were chosen to dilate the original catheters or the occlusive veins, and then the original catheters were replaced. PTA was used to help catheter replacement and all patients were followed up for 6 months. Results Four of the 13 patients were found stuck when replacing catheters. All of them successfully had catheters removed with PTA (Hong's techniques). All patients had successfully catheter replacement with blood flow volume>250 ml/min. Among 4 patients with edema, 3 patients showed better within 6 months. Only 3 patients needed warfarin to keep blood flow volume>250 ml/min within 6 months. Conclusions PTA shows advantages of lesser trauma, better tolerance and higher success rate in patients with catheter-related CVD. It can also relieve symptoms resulting from occlusive central vein.

Objective To analyze the history and present situation of international medical device with visualization softwareto provide references for medical device development in China.Methods CiteSpace visualization software was used to explore international literatures related to medical device from the aspects of yearly quantity,research direction,research organization,quoted literature and etc from 2005 to 2014.Results Medical device drew increasing attention from corresponding researchers,whose development depended on international cooperation.Medical device related closely to engineering and medicine,and had to paid attention to informatization and clinical requirements.Conclusion CiteSpace software is of great value for the study on medical device.

Objective To observe the effect of moxibustion on the learning ability and memory of rat models of Alzheimer’s disease (AD) and the expression of amyloidβ protein (Aβ)-42, interleukin (IL)-1β, and IL-2, for unveiling the function and mechanism of moxibustion in treating AD.Method Forty-eight healthy male Sprague-Dawley rats were randomized into a sham-operation group, a model group, a Western medication group, and a moxibustion group, 12 rats in each group. The AD model rats were established by injection of Streptozotocin (STZ) into bilateral ventricles. From the 10th day after the operation, the moxibustion group started to receive moxibustion at Baihui (GV 20), Mingmen (GV 4), Changqiang (GV 1), and Guanyuan (CV 4); meanwhile, the Western medication group received Donepezil hydrochloride via intragastric administration. After 30-day treatment, the learning and memory ability was tested by using water maze, the hippocampal Aβ-42 was examined by immunohistochemical method, and the expression of hippocampal IL-1β and IL-2 was by double-antibody sandwich ELISA.Result Compared to the model group, moxibustion significantly down-regulated the levels of Aβ-42 (P<0.05) and IL-1β protein (P<0.05), up-regulated the level of IL-2 protein (P<0.05) in hippocampus, and markedly improved the learning and memory of AD rats (P<0.05).Conclusion Moxibustion can enhance the immunity and learning ability, which is plausibly related to the down-regulation of IL-1β, up-regulation of IL-2, and improvement of Aβ-42 in hippocampus.

Objective To investigate effect of tiotropium bromide combined with formoterol on oxidative stress and lipid peroxidation in peripheral blood in elderly patients with chronic obstructive pulmonary disease.Methods 80 elderly patients with chronic obstructive pulmonary disease from our hospital were selected and divided into conventional group and experimental group, conventional group on the basis of conventional therapy was treated with salmeterol xinafoate and fluticasone propionate powder for inhalation with 2 suction per times, 2 -3 times per day for 14d.Experimental group was treated with tiotropium bromide spray combined with formoterol fumarate powder for inhalation with 2 suction per times, 2-3 times per day for 14 d.7 d for a period of treatment, after 2 courses of the treatment, changes of clinical signs, blood gas levels, peripheral blood oxidative stress products and lipid peroxidation and inflammatory factors were compared before and after treatment.Results Compared with conventional group,the recovery time were shorter(P<0.05) ,and blood gas levels, peripheral blood oxidative stress products and lipid peroxidation, inflammatory factors were lower(P<0.05). Conclusion Tiotropium bromide combined with formoterol can significantly reduce airway hyperresponsiveness, inhibit inflammation, relieve clinical symptoms.And the drug resistance is low, the side effect is small, the clinical curative effect is ideal, may be the clinical treatment effective plan, and has the vital significance.