Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

Objective To investigate the expression of exosomal α-synuclein(α-syn),serum lipocalcitin-2(LCN-2)levels and the relationship with disease severity in Parkinson's disease(PD)patients.Methods 106 PD patients admitted to Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,from June 2020 to June 2023 were selected.The PD patients were divided into the early group(n=31),the middle group(n=45)and the late group(n=30)according to their conditions,and 92 healthy volunteers who had outpatient medical checkups during the same period were selected as the control group.The exosome α-syn and serum LCN-2 levels were detected,and the differences in exosome α-syn and serum LCN-2 levels were compared in PD patients with different disease severity levels.Factors affecting the prevalence of PD and the value of exosomal α-syn and serum LCN-2 in diagnosing PD were analyzed.Results The levels of exosomal α-syn(3 086.23±359.46 pg/ml)and serum LCN-2(4.92±1.32ng/ml)in the PD group were higher than those in the control group(1 993.24±244.35 pg/ml,1.96±0.34 ng/ml),and the differences were statistically significant(t=24.636,20.909,all P<0.05).The levels of exosomal α-syn(3 312.72±53.46pg/ml)and serum LCN-2(5.76±0.28ng/ml)in the late-stage group were higher than those in the early-stage(2 843.65±65.29pg/ml,4.02±0.32ng/ml)and the middle-stage group(3 102.35±105.48pg/ml,4.98±0.41ng/ml),and the differences were statistically significant(t=9.092～30.644,all P<0.05).Family history of PD,high level of exosomal α-syn and high level of LCN-2 were the risk factors for the development of PD(Wald χ2=8.121,7.002,4.805,all P<0.05).The AUC(95%CI)of diagnosing PD with serum LCN-2 in combination with exosome α-syn was higher than that of exosome α-syn,while serum LCN-2 alone was used for diagnosis(Z=4.869,5.103,all P<0.05).Conclusion Serum exosomal α-syn and serum LCN-2 levels are significantly higher in PD patients,which can be associated with the exacerbation of PD,and combined exosomal α-syn and serum LCN-2 can assess the risk of developing PD.

Central venous access device associated skin impairment is a common complication of indwelling central venous catheters in cancer patients. To further enhance the standardization of nursing staff's practice of central venous access device associated skin impairment, a clinical nursing practice guideline for central venous access device associated skin impairment in cancer patients was developed through the Delphi expert consultation and expert meeting methods in accordance with the methodology for developing evidence-based nursing practice guidelines. Recommendations cover four aspects of management requirements, assessment, prevention, and management of central venous access device associated skin impairment, providing a practical basis for clinical healthcare professionals to make scientific decisions on central venous access device associated skin impairment.

Objective To investigate the expression of exosomal α-synuclein(α-syn),serum lipocalcitin-2(LCN-2)levels and the relationship with disease severity in Parkinson's disease(PD)patients.Methods 106 PD patients admitted to Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,from June 2020 to June 2023 were selected.The PD patients were divided into the early group(n=31),the middle group(n=45)and the late group(n=30)according to their conditions,and 92 healthy volunteers who had outpatient medical checkups during the same period were selected as the control group.The exosome α-syn and serum LCN-2 levels were detected,and the differences in exosome α-syn and serum LCN-2 levels were compared in PD patients with different disease severity levels.Factors affecting the prevalence of PD and the value of exosomal α-syn and serum LCN-2 in diagnosing PD were analyzed.Results The levels of exosomal α-syn(3 086.23±359.46 pg/ml)and serum LCN-2(4.92±1.32ng/ml)in the PD group were higher than those in the control group(1 993.24±244.35 pg/ml,1.96±0.34 ng/ml),and the differences were statistically significant(t=24.636,20.909,all P<0.05).The levels of exosomal α-syn(3 312.72±53.46pg/ml)and serum LCN-2(5.76±0.28ng/ml)in the late-stage group were higher than those in the early-stage(2 843.65±65.29pg/ml,4.02±0.32ng/ml)and the middle-stage group(3 102.35±105.48pg/ml,4.98±0.41ng/ml),and the differences were statistically significant(t=9.092～30.644,all P<0.05).Family history of PD,high level of exosomal α-syn and high level of LCN-2 were the risk factors for the development of PD(Wald χ2=8.121,7.002,4.805,all P<0.05).The AUC(95%CI)of diagnosing PD with serum LCN-2 in combination with exosome α-syn was higher than that of exosome α-syn,while serum LCN-2 alone was used for diagnosis(Z=4.869,5.103,all P<0.05).Conclusion Serum exosomal α-syn and serum LCN-2 levels are significantly higher in PD patients,which can be associated with the exacerbation of PD,and combined exosomal α-syn and serum LCN-2 can assess the risk of developing PD.

Central venous access device associated skin impairment is a common complication of indwelling central venous catheters in cancer patients. To further enhance the standardization of nursing staff's practice of central venous access device associated skin impairment, a clinical nursing practice guideline for central venous access device associated skin impairment in cancer patients was developed through the Delphi expert consultation and expert meeting methods in accordance with the methodology for developing evidence-based nursing practice guidelines. Recommendations cover four aspects of management requirements, assessment, prevention, and management of central venous access device associated skin impairment, providing a practical basis for clinical healthcare professionals to make scientific decisions on central venous access device associated skin impairment.

Objective:To explore the intolerable uncertainty level and its related factors in female patients re-ceiving in vitro fertilization and embryo transfer.Methods:A total of 503 female patients receiving in vitro fertiliza-tion and embryo transfer in a tertiary reproductive hospital in Shandong province were selected.Theywere assessed with a self-designed general information questionnaire,the Intolerance of Uncertainty scale-12(IUS-12),Fertility Problem Inventory(FPI,including social concern,sexual concern,relationship concern,need for parenthood,and re-jection of childfree lifestyle),and Hospital Anxiety and Depression Scale(HADS).Results:The score of IUS-12 was 28(13,60).Multiple stepwise regression analysis showed that having children,having anxiety symptoms,the scores of social concern,sexual concern and need for parenthood were positively associated with IUS-12 scores(β=0.11,0.19,0.21,0.13,0.25),and rejection of childfree lifestyle was negatively associated with IUS-12 scores(β=-0.18).Conclusion:It suggests that the unbearable uncertainty of women receiving in vitro fertilization and embryo transfer is related to whether they have children,social concerns,sexual concerns,need for parenthood,and rejection of childfree lifestyle.

Objective:To compare the anesthetic potency of dexmedetomidine combined with remifentanil for colonoscopy in the patients with different body mass indexes (BMIs) to assess the clinical significance of the influence of weight on the level of pain during the procedure.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-64 yr, undergoing elective colonoscopy, were divided into 3 groups based on the BMI: group Ⅰ (underweight group, BMI<18.5 kg/m 2), group Ⅱ (normal weight group, BMI 18.5-24.0 kg/m 2), and group III (overweight group, 24.0 kg/m 2 < BMI <30.0 kg/m 2). The prescribed dose of dexmedetomidine was infused within 2 min, then remifentanil was infused as a bolus of 1 μg/kg within 2 min followed by an infusion of 0.1 μg · kg -1 · min -1 throughout the surgery, and then colonoscopy was performed in patients of each group. The up-and-down sequential allocation was used to determine the dose of dexmedetomidine, the initial dose of dexmedetomidine in each group was 0.3 μg/kg, and the ratio between the two successive doses was 1.2. The positive response was defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score > 1 and occurrence of body movement during the operation. Each time the dose of dexmedetomidine increased/decreased in the next patient depending on whether or not the response was positive. The median effective dose (ED 50) and 95% confidence interval ( CI) of dexmedetomidine were calculated using the Dixon-Massey formula. Results:Compared with group Ⅰ (0.42 [95% CI 0.38-0.47] μg/kg), the ED 50 of dexmedetomidine was significantly decreased in group II (0.23 [95% CI 0.19-0.32] μg/kg) and in group III (0.18 [95% CI 0.13-0.22] μg/kg) ( P<0.05). The ED 50 of dexmedetomidine was significantly decreased in group Ⅲ when compared with group Ⅱ ( P<0.05). Conclusions:With the increase of patients′ BMIs, the anesthetic potency of dexmedetomidine for colonoscopy is significantly enhanced when combined with remifentanil, indicating that clinicians should pay attention to the influence of weight on the level of pain during procedures.

Currently the main treatment of acute myeloid leukemia (AML) is chemotherapy combining hematopoietic stem cell transplantation. However, the unbearable side effect of chemotherapy and the high risk of life-threatening infections and disease relapse following hematopoietic stem cell transplantation restrict its application in clinical practice. Thus, there is an urgent need to develop alternative therapeutic tactics with significant efficacy and attenuated adverse effects. Here, we revealed that umbilical cord-derived mesenchymal stem cells (UC-MSC) efficiently induced AML cell differentiation by shuttling the neutrophil elastase (NE)-packaged extracellular vesicles (EVs) into AML cells. Interestingly, the generation and release of NE-packaged EVs could be dramatically increased by vitamin D receptor (VDR) activation in UC-MSC. Chemical activation of VDR by using its agonist 1α,25-dihydroxyvitamin D3 efficiently enhanced the pro-differentiation capacity of UC-MSC and then alleviated malignant burden in AML mouse model. Based on these discoveries, to evade the risk of hypercalcemia, we synthetized and identified sw-22, a novel non-steroidal VDR agonist, which exerted a synergistic pro-differentiation function with UC-MSC on mitigating the progress of AML. Collectively, our findings provided a non-gene editing MSC-based therapeutic regimen to overcome the differentiation blockade in AML.

【Objective】 To investigate the effects of formononetin (FMN) on cardiomyocyte apoptosis and HSP90/AKT in rats with dilated cardiomyopathy-mediated heart failure. 【Methods】 Echocardiography, ELISA, histological staining, and TUNEL staining were used to observe the protective effect of different doses of FMN on dilated cardiomyopathy-mediated heart failure in rats and the apoptosis of cardiomyocytes. The potential targets of formononetin on dilated cardiomyopathy-mediated heart failure were obtained from TCMSP, DisGeNet, GeneCards, and other databases, the key targets were obtained according to the protein-protein interaction (PPI) network, and the key targets were verified by molecular docking. Western blotting was used to further verify the regulatory role of key targets in the treatment of dilated cardiomyopathy-mediated heart failure with formononetin. 【Results】 Formononetin could reduce the levels of LVIDS, LVIDD, NT-pro BNP, cTn-T, CK, CK-MB, and LDH in rats with dilated cardiomyopathy-mediated heart failure, increase the levels of EF and FS, and reduce the apoptosis of cardiomyocytes. FMN had a strong binding effect on 10 key targets (AKT1, HSP90AA1, CASP3, MAPK1, MMP9, SRC, ALB, HRAS, IGF1, and EGFR) screened by network pharmacology, with HSP90AA1 and AKT1 having the strongest binding effect. Formononetin decreased the expression of HSP90, AKT and downstream CASP3 protein, but increased the expression of p-AKT in myocardial tissue. 【Conclusion】 Formononetin may inhibit the expression of HSP90, promote phosphorylation of AKT to p-AKT, and inhibit the expression of CASP3, thereby reducing the apoptosis of cardiomyocytes and improving myocardial tissue damage, so as to achieve the purpose of treating dilated cardiomyopathy-mediated heart failure.

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases