Objective To explore the clinical characteristics of patients with drug-induced liver injury(DILI),so as to provide references for its diagnosis and treatment.Methods The clinical data of inpatients diagnosed as DILI in The Third Affiliated Hospital of Naval Medical University(Second Military Medical University),from Jan.2017 to Dec.2021 were retrospectively analyzed,including basic information,underlying diseases,drug use history,clinical manifestations,laboratory indexes,severity and prognosis of DILI.Results Among 145 patients with DILI,112 cases(77.24％)were hepatocellular type,25 cases(17.24％)were cholestatic type,and 8 cases(5.52％)were mixed type.The types of drugs causing DILI mainly included traditional Chinese medicine,proprietary Chinese medicine and anti-infective drugs,and the proportions were 48.72％(76/156),16.03％(25/156),and 10.26％(16/156),respectively.The common clinical manifestations of DILI patients were jaundice(76.55％),poor appetite(52.41％),and fatigue(49.66％).The levels of alanine transaminase(ALT),aspartate transaminase,alkaline phosphatase(ALP),total bilirubin(TBil),γ-glutamyl transferase and albumin(ALB),as well as the length of hospital stay and severity distribution were significantly different among different types of liver injury(all P＜0.05).The levels of ALT and ALB in the good prognosis group were significantly higher than those in the poor prognosis group,while the levels of TBil and international normalized ratio in the good prognosis group were significantly lower than those in the poor prognosis group(all P＜0.05).Multivariate analysis showed that INR was an independent predictor of the prognosis of DILI(P＜0.05).Conclusion Serum biochemistry indicators can help to identify the clinical classification and prognosis of DILI.Traditional Chinese medicine,proprietary Chinese medicine and other drugs can cause DILI.Medical staff should pay attention to it and strengthen public health education.

Objective:To summarize the best evidence for the management of ovarian hyperstimulation syndrome in patients undergoing assisted reproductive therapy.Methods:Evidence related to the management of ovarian hyperstimulation syndrome in patients undergoing assisted reproductive therapy,including guidelines,clinical decision,best clinical practice,systematic evaluation,expert consensus and evidence summary and related original research were systematically searched in UpToDate,BMJ Best Practice,World Health Organization(WHO)website,Guidelines International Network(GIN),National Institute for Health and Clinical Excellence(NICE)website,National Guidelines website,American Society for Reproductive Medicine(ASRM)website,New York Academy of Sciences(NYAS)website,Joanna Briggs Institute(JBI)database,Cochrane Library,CINAHL,PubMed,Wanfang database,CNKI,and China Biomedical Literature Database from inception to May 31,2024.Two researchers independently evaluated the quality of the literature,and a senior researcher made the final decision for literature inclusion.Results:A total of 15 articles were included in the study.Following quality assessment,one article was excluded.The remaining 14 articles included 5 practice guidelines,3 systematic reviews,2 expert consensuses,1 evidence summary,and 3 from UpToDate.Ultimately,27 pieces of evidence were identified across five key aspects:risk assessment,disease monitoring,early prevention,institutional management and health education.Conclusion:The updated evidence indicates that the monitoring and prevention of ovarian hyperstimulation syndrome should start early,personalized treatment plans should be provided for patients,and the rational allocation of treatment resources needs to be promoted to enhance effective management of ovarian hyper-stimulation syndrome.

Objective:To investigate and analyse the current status of screening and management of diabetic kidney disease (DKD) in six provinces and cities in China.Methods:The qualitative research method of focus group interview was adopted, based on the semi-structured interview outline, the clinical medical and disease control personnel in Tianjin, Chongqing, Gansu, Hubei, Heilongjiang, and Guangdong were interviewed. The interview transcripts were analyzed using thematic analysis, and MAXQDA analysis software was used for data management and analysis.Results:A total of 6 interviews were conducted with 49 interviewees. Forty respondents (81.6%) claimed that DKD screening was critical; 53.1% think that it was not easy for patients to obtain DKD screening services; 40.8%, 26.5% and 14.3% of the people believed that the technology of DKD screening services was moderate, simple or very simple, respectively. Of the respondents,16.3% thought that the cost of DKD screening service was relatively expensive, while 83.7% thought that the cost was inexpensive; 75.5% of the respondents believed that the patients could receive early DKD screening service. The factors of fully implementing medical reform policies, changing concepts and actively serving patients, and integrating external resources in medical and health institutions at all levels and of all types were conducive to the development of DKD screening and management services. The lack of technology and personnel for DKD screening services at the grassroots level, the lack of trust in the service capabilities of grassroots medical institutions by patients, the low level of patient awareness, and the novel coronavirus infection epidemic had an adverse impact on the development of DKD screening and management services.Conclusion:The screening and management services for DKD are relatively limited in China, and there is a significant fragmentation in the management and care of diabetes and DKD.

Objective:To investigate the effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma (ESCC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 1 148 ESCC patients who were admitted to the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from January 2020 to December 2021 were collected. There were 789 males and 359 females, aged (67±7)years. All patients under-went thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Observation indicators: (1) incidence of sarcopenia in patients with ESCC; (2) comparison of general data between ESCC patients complicated with sarcopenia and those without sarcopenia; (3) comparison of clinical outcomes between ESCC patients complicated with sarcopenia and those without sarcopenia; (4) analysis of influencing factors for sarcopenia in ESCC patients. Measurement data of normal distri-bution were represented by Mean± SD, and comparison between groups was conducted using the t test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi-square test. Ordinal data was analyzed using the Mann-Whitney U test. Logistic regression analysis was used to conduct univariate analysis. Logistic backward stepwise regression model was used to conduct multivariate analysis. Results:(1) Incidence of sarcopenia in patients with ESCC. Among 1 148 ESCC patients, 469 cases were complicated with sarcopenia, 679 were without sarcopenia. The incidence of sarcopenia was 40.854%(469/1 148). Among the 469 patients with sarcopenia, there were 313 males and 156 females. There were 125 cases <65 years old, 145 cases ≥65 years old but <70 years old, 106 cases ≥70 years old but<75 years old, 93 cases ≥75 years old, respectively. (2) Comparison of general data between patients with ESCC complicated with sarco-penia and those without sarcopenia. The age, tumor diameter, body mass index, cases in stage T1, T2, T3, preoperative albumin, preoperative serum prealbumin, psoas muscle index, psoas muscle density were (68±7)years, (3.3±1.5)cm, (22.4±2.9)kg/m 2, 100, 105, 264, (43±4)g/L, (193±38)mg/dL, (3.9±0.8)cm 2/m 2, (48±8)HU of 469 ESCC patients complicated with sarcopenia, versus (66±7)years, (3.2±1.4)cm, (23.8±3.0)kg/m 2, 173, 170, 336, (44±4)g/L, (206±37)mg/dL, (6.0±2.2)cm 2/m 2, (50±7)HU of 679 ESCC patients without sarcopenia, showing significant differences between the two groups ( t=5.74, 2.11, 7.57, Z=-2.93, t=2.25, 5.52,20.36, 4.18, P<0.05). (3) Comparison of clinical outcomes between patients with ESCC complicated with sarcopenia and those without sarcopenia. The duration of postoperative hospital stay, cases with postoperative hospital stay>30 days, pneumonia, acute respiratory failure, anastomotic fistula, and abnormal heart rhythm were (17±9)days, 32, 158, 39, 33, and 103 of 469 ESCC patients complicated with sarcopenia, respectively, versus (15±6)days, 15, 102, 18, 19, and 85 of 679 ESCC patients without sarcopenia, showing significant differences between the two groups ( t=4.89, χ2=15.04, 55.17, 18.86, 11.52, 18.06, P<0.05). (4) Analysis of influencing factors for sarcopenia in ESCC patients. Results of multivariate analysis showed that age ≥65 years was an independent risk factor for sarcopenia in ESCC patients ( odds ratio=1.64, 95% confidence interval as 1.26-2.14, P<0.05). Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m 2 were independent protective factors for sarcopenia in ESCC patients ( odds ratio=0.64, 0.72, 0.53, 95% confidence interval as 0.50-0.82, 0.56-0.92, 0.41-0.69, P<0.05). Conclusions:Age ≥65 years is an independent risk factor for sarcopenia in ESCC patients. Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m 2 are independent protective factors for sarcopenia in ESCC patients. Compared with patients without sarcopenia, ESCC patients with sarcopenia are more prone to postoperative compli-cations such as pneumonia, acute respiratory failure, anastomotic fistula, and arrhythmia, and have a longer postoperative hospital stay.

Objective To provide the evidence for clinical medication safety by the investigation of the risk factors of linezolid-related thrombocytopenia in cancer patients in the department of hepatobiliary surgery. Methods Patients who received linezolid for anti-infective treatment from January 2017 to December 2021 were selected. The patients were divided into thrombocytopenia group and non-thrombocytopenia group according to whether thrombocytopenia occurred or not after administration of linezolid. The general data and laboratory indicators of the two groups were compared, and the risk factors of linezolid-related thrombocytopenia were screened by multivariate logistic regression analysis. Results A total of 104 patients were included in the study, including 84 patients who underwent surgery and 20 patients who did not. The incidence of linezolid-related thrombocytopenia was 24.0%. There were significant differences in gender, age, duration of linezolid use, platelet count, white blood cell count, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin, creatinine, estimated glomerular filtration rate between the two groups (P<0.05); logistic regression analysis suggested that age ≥60 years (OR=7.093; P=0.017), duration of linezolid use ≥12 days (OR=4.399; P=0.035), baseline platelet count ≤200×10⁹/L (OR=8.470; P=0.004), baseline AST≥50 U/L (OR=15.465; P<0.001), and baseline white blood cell count ≥11×10⁹/L (OR=11.436; P=0.001) were the risk factors for linezolid-related thrombocytopenia in cancer patients. Conclusion During the treatment of linezolid in cancer patients, attention should be paid to the adverse reactions of thrombocytopenia in the patients, especially those with old age, long-term treatment, low baseline platelets, poor baseline liver function, and high baseline white blood cell counts.

Animals ; Bone Morphogenetic Protein 4 ; Cardiovascular Diseases ; Endothelial Cells ; Fibroblasts ; Humans ; In Vitro Techniques ; Induced Pluripotent Stem Cells ; Lipoproteins ; Mesoderm ; Methods ; Mice ; Models, Animal ; Pluripotent Stem Cells ; Swine

Regenerative therapy holds great promise in the development of cures of some untreatable diseases such as cardiovascular diseases, and pluripotent stem cells (PSCs) including induced PSCs (iPSCs) are the most important regenerative seed cells. Recently, differentiation of human PSCs into functional tissues and cells in vitro has been widely reported. However, although porcine reports are rare they are quite essential, as the pig is an important animal model for the in vitro generation of human organs. In this study, we reprogramed porcine embryonic fibroblasts into porcine iPSCs (piPSCs), and differentiated them into cluster of differentiation 31 (CD31)-positive endothelial cells (ECs) (piPSC-derived ECs, piPS-ECs) using an optimized single-layer culture method. During differentiation, we observed that a combination of GSK3β inhibitor (CHIR99021) and bone morphogenetic protein 4 (BMP4) promoted mesodermal differentiation, resulting in higher proportions of CD31-positive cells than those from separate CHIR99021 or BMP4 treatment. Importantly, the piPS-ECs showed comparable morphological and functional properties to immortalized porcine aortic ECs, which are capable of taking up low-density lipoprotein and forming network structures on Matrigel. Our study, which is the first trial on a species other than human and mouse, has provided an optimized single-layer culture method for obtaining ECs from porcine PSCs. Our approach can be beneficial when evaluating autologous EC transplantation in pig models.

OBJECTIVE: To evaluate the application value of 40 Hz auditory event related potential(40 Hz AERP) in hearing assessment in workers exposed to noise by observing the consistency between pure tone audiometry(PTA) and 40 Hz AERP. METHODS: A total of 240 ears of 120 workers who exposed to noise with PTA high-frequency hearing threshold > 25 dB were selected as the research subjects using the convenient sampling method. The thresholds of PTA and 40 Hz AERP at different frequencies were investigated. According to the average hearing threshold of PTA language frequency, the workers were divided into normal hearing group and mild-, medium-, medium-severe-, severe-hearing loss groups, and the difference and correlation between the thresholds of 40 Hz auditory potential and PTA were analyzed. RESULTS: The response thresholds of 40 Hz AERP of 0.5, 1.0, 2.0 kHz in ears of normal hearing group, and mild-and moderate-hearing loss groups were higher than the PTA hearing threshold(P<0.01), while the 40 Hz AERP response thresholds of 0.5 kHz in the ears of medium-severe-and severe-hearing loss groups were lower than the hearing thresholds of PTA(P<0.05). The different value of the response threshold of 40 Hz AERP and PTA of 1.0 and 2.0 kHz in ears of normal hearing group was higher than 0.5 kHz(median: 25.0 vs 15.0 dBHL, 30.0 vs 15.0 dBHL, P<0.01). Except for 0.5 and 1.0 kHz of mild-hearing loss group, the different value of the response threshold of 40 Hz AERP and PTA in ears of the other hearing loss groups were lower than that of the normal hearing group(P<0.01). The 40 Hz AERP response threshold was frequency-specific and correlated well with PTA at the same frequency. The correlation coefficients of 0.5, 1.0 and 2.0 kHz were 0.744, 0.732 and 0.665 respectively(P<0.01). CONCLUSION: It is feasible to evaluate PTA in noise-exposed workers using 40 Hz AERP response threshold, but the 40 Hz AERP cannot completely replace PTA. The measurement frequency and the degree of hearing loss should be considered simultaneously.

OBJECTIVE: To observe the clinical effect of multistep breathing training combined with acupoint plastering on the treatment of patients with occupational coal worker's pneumoconiosis(CWP). METHODS: Eighty cases of male occupational CWP patients were selected as the research subject using convenient sampling method. They were divided into control group(40 cases) and treatment group(40 cases) according to random number table method. The control group was given conventional treatment, while the treatment group received multistep respiratory training combined with acupoint plastering for 12 weeks based on conventional symptomatic treatment. Before and after treatment, clinical curative effect, pulmonary function, immune function, the total score of Chronic Obstructive Pulmonary Disease Assessment Test(CAT) Questionnaire and 6 minutes walk distance(6 MWDS) in two groups were observed. RESULTS: Before treatment, there was no statistical difference on forced vital capacity(FVC), ratio of forced expiratory volume in one second(FEV_1)/FVC, lymphocyte cluster of differentiation(CD) 4~+/CD8~+ ratio, percentage of natural killer cells(NK), total CAT scores and 6 MWD(P>0.05). After treatment, the FVC, FEV_1/FVC ratio and lymphocyte CD4~+/CD8~+ ratio increased [median: 78.3% vs 80.7%, 68.7% vs 72.5%, 1.16 vs 2.00, P<0.01], 6 MWD was increased [(430.6±45.9) vs(494.8±58.7) m, P<0.01], and CAT total score was decreased [(18.1±5.6) vs(15.5±5.3) points, P<0.01] in the treatment group compared with the control group. There was no significant difference in NK cell percentage between the two groups(P>0.05). CONCLUSION: Multistep respiratory training combined with acupoint plastering can alleviate the clinical symptoms such as cough, and shortness of breath of patients with CWP, improve their lung function, regulate the function of immunity, as well as improve sports endurance.

Regenerative therapy holds great promise in the development of cures of some untreatable diseases such as cardiovascular diseases, and pluripotent stem cells (PSCs) including induced PSCs (iPSCs) are the most important regenerative seed cells. Recently, differentiation of human PSCs into functional tissues and cells in vitro has been widely reported. However, although porcine reports are rare they are quite essential, as the pig is an important animal model for the in vitro generation of human organs. In this study, we reprogramed porcine embryonic fibroblasts into porcine iPSCs (piPSCs), and differentiated them into cluster of differentiation 31 (CD31)-positive endothelial cells (ECs) (piPSC-derived ECs, piPS-ECs) using an optimized single-layer culture method. During differentiation, we observed that a combination of GSK3β inhibitor (CHIR99021) and bone morphogenetic protein 4 (BMP4) promoted mesodermal differentiation, resulting in higher proportions of CD31-positive cells than those from separate CHIR99021 or BMP4 treatment. Importantly, the piPS-ECs showed comparable morphological and functional properties to immortalized porcine aortic ECs, which are capable of taking up low-density lipoprotein and forming network structures on Matrigel. Our study, which is the first trial on a species other than human and mouse, has provided an optimized single-layer culture method for obtaining ECs from porcine PSCs. Our approach can be beneficial when evaluating autologous EC transplantation in pig models.