Objective To explore the relationship between pyroptosis and treatment in non-small cell lung cancer patients treated with tyrosine kinase inhibitors targeted therapy. Methods Stable transfection strains with common EGFR mutations found in clinical practice were constructed through lentiviral transfection. LDH and Western blot experiments were conducted to determine the degree and mechanism of pyroptosis after osimertinib treatment. Animal experiments verified the effect of pyroptosis on treatment efficacy. ELISA was used to explore the potential connection between pyroptosis and tumor immunotherapy. Results After osimertinib treatment on stable lines, the EGFR-L858R mutation had obvious pyroptosis at the morphology and protein levels. Western blot experiment confirmed that pyroptosis was mediated by GSDME (P < 0.0001). Experiments through the overexpression of GSDME and corresponding animal studies discovered that the degree of pyroptosis affected the treatment outcome. Blood analysis revealed that the level of IL-1β secreted by EGFR-L858R and EGFR-L858R-GSDME-OE mice after treatment was higher than that of the control group (P < 0.0001), and it may regulate tumor immunity to a certain extent. Conclusion Osimertinib can induce pyroptosis in EGFR-L858R mutant strains mediated by GSDME, and the level of pyroptosis in cell lines is positively correlated with therapeutic effect to a certain extent.

Objective To summarize the clinical experience of successful intervention in single chronic coronary actery total ocdusion (CTO) lesions by the transradial.Methods A retrospective analysis was conducted in 103 patients with single CTO lesions who got intervention treatment by the radial artery.Results ( 1 ) Of the 103 cases,57 cases had unstable angina,12 cases had stable angina,and 34 cases chronic myocardial infarction.Lesions' block time was ≤ 6 months in 83 cases,and ＞ 6 months in 20 cases.(2)The path vessels of the 103 patients have no severe tortuosity and anatomical structure variation.Fifty-one cases occurred left anterior descending occlusion,25 cases occurred left circumflex branches occlusion,and 27 cases occurred right coronary artery occlusion.Furthermore,24 cases had chronic complete occlusion,and 79 cases had chronic functional block.The side branches did not block in 91 cases,no lesions(bridge) collateral formation occurred in 87 cases,lesions length was less than 15 mm in 67 cases,and tapered lesions was observed in 81 cases.( 3 ) Final intervention rate via Judkins,XB,EBU guide catheter was 37.86％,30.10％ and 29.13％ respectively.(4)the PILOT successfully through the lesions for the series wire guided was 64.08％.(5) 1.25 mm diameter series with a balloon through the first lesions and successful expanding was observed in 57 cases (55.34％),and 1.5 mm diameter series with a balloon occurred in 38 cases(36.89％ ).Conclusion Intervention treatment by the radial of single CTO lesions is feasible for experienced performers.The successful intervention depends on path vessels unimpeded,target vessels with characteristic pathological features and reasonable choice of instruments.

Objective:To observe the value of tracer methodology combined case-based study (CBS) model in the standardized residency training of medical record writing.Methods:A total of 91 residents who were newly recruited from The Sixth Affiliated Hospital of Sun Yat-sen University in July 2019 were selected as the subjects and randomly divided into test group ( n=47) and control group ( n=44). The tracer methodology combined CBS model was used for test group while the traditional model was used for control group to compare the knowledge of medical record writing, performance of medical record writing and feedback to teaching in two groups. SPSS 21.0 was used for t test and chi-square test. Results:The correct response rate in knowledge of medical record writing, the normative scores and integrity scores after training were significantly higher than those before training ( P<0.05). The normative and integrity scores were significantly increased after training, and those in the test group were significantly higher than those in the control group [(90.3±3.5) and (91.3±3.2) vs. (88.6±3.5) and (89.8±3.0), P<0.05, respectively]. The test group was significantly superior to the control group in the autonomous learning ability [97.8% (44/45) vs. 82.9% (34/41)], communication ability [95.6% (43/45) vs. 78.0% (32/41)] and acceptance of teaching form [97.8% (44/45) vs. 82.9% (34/41)] ( P<0.05). Conclusion:The tracer methodology combined CBS model is a good way in the pre-job training of medical record writing for residents, which can mobilize the subjective initiative of the trainees and teachers, complete the teaching tasks and obtain better teaching value.

Hypoxic pulmonary hypertension(HPH)is a kind of chronic high-altitude sickness disease,which is also the initiation link of high-altitude sickness such as pneumocardial disease and high-altitude pulmonary edema.Its main features are persistent vasoconstriction and irreversible remodeling of blood vessels.HPH has greatly impacted the health of people in the plat-eau section.As a typical representative of ethnic medicine,Zang medicine embodies the wisdom of the Zang people in their long-term struggle against diseases.Adapting to local conditions for a long time,Zang medicine has unique advantages in the treatment of HPH.By reviewing the pathogenesis of HPH and the research of single Zang medicine and the complex prescription of Zang medicine in the treatment of HPH,this article aims to provide a theoretical basis for the physiological and pathological research of HPH and to provide a reference for the clinical application of Zang medicine.

Nutcracker syndrome complicated with chronic kidney disease is easy to be missed clinically.We report a case of nutcracker syndrome (NCS) complicated with IgA nephropathy, and summarize the clinical features of nutcracker syndrome complicated with chronic kidney disease.Through literature search, we found that Nutcracker with chronic kidney disease is not rare.We think that we should pay attention to the possibility of chronic kidney disease when Nutcracker (+ ) is combined with persistent or massive proteinuria, and percutaneous renal biopsy is helpful for the diagnosis and treatment.

Objective:To investigate the prevalence of chronic constipation in maintenance hemodialysis (MHD) patients and analyze the risk factors of chronic constipation.Methods:Using the cross-sectional survey method, patients who received MHD in Huadu District People′s Hospital of Guangzhou from September 1, 2021 to September 30, 2021 were enrolled as the research objects. The patient′s demographic, general data and laboratory results were collected. The anxiety level and quality of life were assessed by questionnaires. The patients were divided into constipation group and non-constipation group according to whether they had chronic constipation. The Rome Ⅳ criteria was used to diagnose chronic constipation, and the differences of clinical data between the constipation group and the non-constipation group were compared. The risk factors of chronic constipation in MHD patients were analyzed by logistic regression analysis method.Results:A total of 321 MHD patients were enrolled in this study, with 168 males, 153 females and age of (59.5±13.4) years old (ranged from 29 to 87 years old). There were 160 patients (49.8%) with chronic constipation. The proportions of males, long dialysis age, taking sevelamer and lanthanum carbonate, diabetic nephropathy, and diabetes in the constipation group were higher than those in the non-constipation group, and the differences between the two groups were statistically significant (all P<0.05). The serum calcium, serum phosphorus, calcium-phosphorus product, anxiety scores, average weekly ultrafiltration volume/dry weight in the constipation group were significantly higher than those in the non-constipation group (all P<0.05), and the serum albumin, serum magnesium, urea clearance index (Kt/V) and geriatric nutritional risk index were significantly lower than those in the non-constipation group (all P<0.05). The results of logistic regression analysis showed that moderate to severe anxiety (moderate, OR=3.233, 95% CI 1.339-7.805, P=0.009; severe, OR=5.103, 95% CI 1.906-13.663, P=0.001), existed risk of nutrition (low risk, OR=3.705, 95% CI 1.440-9.533, P=0.007; moderate risk, OR=5.638, 95% CI 2.557-12.430, P<0.001; severe risk, OR=15.097, 95% CI 4.112-55.436, P<0.001), >60 years old (≤40 years old as a reference, OR=4.050, 95% CI 1.366-12.006, P=0.012), diabetes history ( OR=2.224, 95% CI 1.253-3.946, P=0.006), taking sevelamer ( OR=2.290, 95% CI 1.207-4.346, P=0.011), and calcium-phosphorus product ( OR=1.704, 95% CI 1.329-2.186, P<0.001), intact parathyroid hormone ( OR=1.013, 95% CI 1.003-1.022, P=0.007), blood urea nitrogen ( OR=1.092, 95% CI 1.002-1.189, P=0.045) and serum magnesium ( OR=0.042, 95% CI 0.006-0.294, P=0.001) were the independent influencing factors for chronic constipation in MHD patients. Conclusions:The prevalence of chronic constipation in MHD patients is 49.8%. Adequate dialysis, improving calcium and phosphorus metabolism, improving nutritional status, relieving anxiety, and increasing serum magnesium level may help to reduce the risk of chronic constipation in MHD patients.

Purpose: This study aims to explore whether neoadjuvant chemotherapy with immunotherapy (NACI) leads to different tumor shrinkage patterns, based on magnetic resonance imaging (MRI), compared to neoadjuvant chemotherapy (NAC) alone in patients with triple-negative breast cancer (TNBC). Additionally, the study investigates the relationship between tumor shrinkage patterns and treatment efficacy was investigated. Methods: This retrospective study included patients with TNBC patients receiving NAC or NACI from January 2019 until July 2021 at our center. Pre- and post-treatment MRI results were obtained for each patient, and tumor shrinkage patterns were classified into three categories as follows: 1) concentric shrinkage (CS); 2) diffuse decrease; and 3) no change.Tumor shrinkage patterns were compared between the NAC and NACI groups, and the relevance of the patterns to treatment efficacy was assessed. Results: Of the 99 patients, 65 received NAC and 34 received NACI. The CS pattern was observed in 53% and 20% of patients in the NAC and NACI groups, respectively. Diffuse decrease pattern was observed in 36% and 68% of patients in the NAC and NACI groups. The association between the treatment regimens (NAC and NACI) and tumor shrinkage patterns was statistically significant (p = 0.004). The postoperative pathological complete response (pCR) rate was 45% and 82% in the NAC and NACI groups (p < 0.001), respectively. In the NACI group, 17% of patients with the CS pattern and 56% of those with the diffuse decrease pattern achieved pCR (p = 0.903). All tumor shrinkage patterns were associated with achieved a high pCR rate in the NACI group. Conclusion Our study demonstrates that the diffuse decrease pattern of tumor shrinkage is more common following NACI than that following NAC. Furthermore, our findings suggest that all tumor shrinkage patterns are associated with a high pCR rate in patients with TNBC treated with NACI.

Objective:To explore the clinical and laboratory characteristics of acquired immunodeficiency syndrome (AIDS) patients complicated with disseminated nontuberculous mycobacterial (NTM) disease, in order to provide basis for clinical therapy.Methods:The clinical findings, imaging and etiological data of the 71 AIDS patients complicated with disseminated NTM disease admitted to Beijing You′an Hospital from June 2016 to June 2021 were retrospectively analyzed.Results:Among 71 patients with disseminated NTM disease, the most common initial symptom was fever, followed with cough, expectoration, fatigue, poor appetite, abdominal pain and diarrhea. Seventy point four percent (50/71) of these patients had at least two comorbidities, with oral candida infection, cytomegalovirus infection, syphilis, pneumocystis pneumonia and bacterial pneumonia being the most common. Hemoglobin ((87.8±24.2) g/L) and albumin ((27.3±7.0) g/L) levels significantly decreased, while erythrocyte sedimentation rate ((59.8±28.6) mm/1 h) and C-reactive protein ((74.7±50.8) mg/L) levels increased in most cases. The median CD4 + T lymphocyte count was 7×10 6/L. The median time of positive blood culture of NTM was 260 h. Among the 71 patients, 40 cases (56.3%) were infected with Mycobacterium avium, 15 cases (21.1%) with Mycobacterium intracellulare, 10 cases (14.1%) with Mycobacterium colombiense, three cases (4.2%) with Mycobacterium marseillense and three cases (4.2%) with Mycobacterium kansasii.The frequent imaging findings were patchy and nodular shadows in lungs, and most patients had mediastinal or hilar lymph node enlargement and splenomegaly. Conclusions:AIDS complicated with disseminated NTM disease is prevalently occurred in patients with severe immune deficiency, and most of the bacteria belong to the Mycobacterium avium- intracellulare complex. Early obtaining positive etiological results of NTM is essential to guide the correct clinical diagnosis and accurate treatment.

Objective:To report a case of acute kidney injury caused by rhabdomyolysis and summarize its etiology, pathogenesis, and treatment strategy.Methods:The clinical data of a case of rhabdomyolysis complicated by acute kidney injury admitted to Affiliated Huadu Hospital of Southern Medical University on August 30, 2020, were collected, including clinical manifestation, auxiliary examination, and disease outcome. Referring to the previous literature reports of rhabdomyolysis complicated by acute kidney injury, this paper discusses its etiology, monitors and analyzes some indicators such as serum creatinine, blood urea nitrogen, creatine kinase, myoglobin, and 24-hour urine volume during the treatment, and summarizes the clinical diagnosis and treatment ideas of the disease.Results:This case developed an intestinal infection after an unclean diet, which induced rhabdomyolysis and acute kidney injury. Renal pathology after renal biopsy showed that renal biopsy result was consistent with an acute tubulointerstitial injury caused by myoglobin tubular nephropathy. The biochemical indexes such as creatine kinase and myoglobin decreased rapidly after ordinary hemodialysis, but the levels of serum creatinine and blood urea nitrogen did not decrease markedly, and there was continuous oliguria. After switching to hemodialysis filtration and continuous intensive dialysis treatment, the levels of serum creatinine and blood urea nitrogen decreased rapidly, the amount of urine increased gradually, and finally, the renal function recovered.Conclusion:For acute kidney injury caused by rhabdomyolysis, early sufficient blood purification can accelerate the clearance of myoglobin, promote the recovery of the injured kidney, and improve the prognosis of the disease.

Objective:To investigate the correlation between triglyceride-glucose (TyG) index on admission and unfavorable outcomes of patients with moderate-to-severe traumatic brain injury (msTBI) at 6 months postinjury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 277 patients with msTBI admitted to Affiliated Jiangyin Hospital of Nantong University from January 2019 to December 2022, including 208 males and 69 females, aged 18-88 years [(57.0±15.1)years]. Glasgow Coma Scale (GCS) scores on admission were 3-8 points in 168 patients and 9-12 points in 109. According to the Glasgow Outcome Scale-Extended (GOSE) assessment at 6 months after injury, there were 121 patients with unfavorable outcomes (GOSE≤4 points) and 156 with favorable outcomes (GOSE≥5 points). The following indicators of the patients were recorded, including gender, age, history of diabetes, cause of injury, admission GCS, GCS motor score (GCSM), pupillary light reflex, worst Marshall CT classification within the first 24 hours after admission, admission TyG index, Mean Amplitude of Glycemic Excursions (MAGE) within 24 hours after admission, GCSM decline≥2 points within 72 hours after admission, craniotomy or not after admission, and prognosis, etc. TyG index served as the exposure variable focused in this study, which was calculated with fasting triglycerides and fasting blood glucose within 24 hours after admission. The 6-month prognosis of the patients was designated as the outcome variable of the study. After the patients were divided into different groups according to the three quantiles of the TyG index and unfavorable or favorable outcomes, the univariate analysis was conducted on watch variables, and variables with statistically significant differences were included in directed acyclic graphs (DAGs) for further identification of confounding variables. Factors which were found with no statistical significance in the univariate analysis but might affect insulin resistance after injury according to the authors′ previous researches were also included in the DAGs analysis. Three Logistic regression models were designed (Model 1 without correction, Model 2 with core variables of International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) corrected, and Model 3 with confounding variables screened by DAGs corrected) to analyze whether the TyG index was an independent risk factor for the prognosis of msTBI patients. The optimal Logistic regression model was selected and then restricted cubic spline (RCS) was employed to investigate the relationship between the TyG index and the unfavorable outcomes.Results:The univariate analysis suggested that there were significant differences in gender, history of diabetes, MAGE, GCSM decline, and prognosis among the three quantiles of the TyG index ( P<0.05 or 0.01). Significant differences in age, history of diabetes, GCSM, pupillary light reflex, Marshall CT classification, TyG index, MAGE and GCSM decline were observed between unfavorable and favorable outcome groups ( P<0.05 or 0.01). The results of Logistic regression analysis that identified the confounding variables that influenced the correlation between the TyG index and unfavorable prognosis with DAGs suggested that a high TyG index level was significantly correlated with unfavorable outcomes in msTBI patients. Moreover, Model 3 that was corrected with confounding variables screened by DAGs had an optimal goodness-of-fit and adaptability. Model 3-based further RCS analysis indicated that the risk of unfavorable outcomes following msTBI may increase approximately linearly with the increase in TyG index within a certain range (TyG index<9.79). Conclusions:A high TyG index level on admission is the identified as an independent risk factor for unfavorable outcomes of patients with msTBI at 6 months postinjury. As the TyG index level increases, the risk of unfavorable outcomes also rises and may show a linear increasing trend within a certain range (TyG index<9.79).