Objective To identify the indicators associated with poor prognosis by retrospectively analyzing the clinical data of 129 patients with lung adenocarcinoma (LUAD) complicated by brain metastases (BMs). Methods We retrospectively assessed the clinical data of 129 LUAD patients with BMs who met the inclusion criteria. Follow-up was conducted through electronic medical record review and telephone consultations. Univariate survival analysis was performed using the Kaplan-Meier method with corresponding survival curves. Statistically significant variables identified in the univariate analysis were subsequently incorporated into a multivariate Cox proportional hazards regression model to further identify independent adverse prognostic factors affecting the survival of LUAD patients with BMs. Results The following factors were significantly associated with patient survival prognosis (P<0.05): pathological morphology, KPS score, number of BMs, presence of genetic variations, quantity of genetic variations, type of genetic variations, EGFR mutation status, Cyfra-211, and neutrophil-to-lymphocyte ratio (NLR) at initial diagnosis. Multivariate Cox regression analysis revealed that pathological morphology, KPS score, number of BMs, NLR at initial diagnosis, and presence of genetic variations served as independent prognostic factors for LUAD patients with BMs (P<0.05). Further analysis of the survival conditions of different treatment subgroups revealed that combined therapy could significantly increase the median survival period of patients, and the difference was statistically significant (P=0.034). Conclusion Solid and complex glandular structures, KPS score <80, ≥3 BMs, elevated NLR levels at initial diagnosis, and the presence of genetic alterations are identified as independent poor prognostic factors for LUAD patients with BMs. Combination therapy can significantly prolong the survival of patients.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is the predominant form of chronic liver disease worldwide. This study was designed to investigate the proportion and characteristics of MAFLD within the general Chinese population and to identify the contributory risk factors for liver fibrosis among MAFLD individuals. METHODS: The participants were recruited from a cohort undergoing routine health evaluations at the Third Hospital of Hebei Medical University between May 2019 and March 2023. The diagnosis of MAFLD was based on the established clinical practice guidelines. The fibrosis-4 index score (FIB-4) was employed to evaluate hepatic fibrosis, with a FIB-4 score of ≥1.3 indicating significant fibrosis. Binary logistic regression analyses were used to determine risk factors associated with significant hepatic fibrosis in MAFLD. RESULTS: A total of 22,970 participants who underwent comprehensive medical examinations were included in the analysis. The overall proportion of MAFLD was 28.77% (6608/22,970), with 16.87% (1115/6608) of these patients showing significant fibrosis as assessed using FIB-4. Independent risk factors for significant liver fibrosis in MAFLD patients were male (odds ratio [OR] = 0.676, 95% confidence interval [CI]: 0.558-0.821), hepatitis B surface antigen (HBsAg) positivity (OR = 2.611, 95% CI: 1.557-4.379), body mass index ≥23.00 kg/m 2 (OR = 0.632, 95% CI: 0.470-0.851), blood pressure ≥130/85 mmHg (OR = 1.885, 95% CI: 1.564-2.272), and plasma glucose ≥5.6 mmol/L (OR = 1.815, 95% CI: 1.507-2.186) (all P <0.001). CONCLUSIONS The proportion of MAFLD in an urban Chinese population is 28.77%. About 16.87% of MAFLD patients presented with significant liver fibrosis. Independent risk factors for significant liver fibrosis in MAFLD patients should be noticed.
Humans ; Male ; Female ; Liver Cirrhosis/pathology* ; Middle Aged ; Risk Factors ; Adult ; Fatty Liver/pathology* ; Aged ; China/epidemiology* ; Logistic Models ; Urban Population ; East Asian People

Stent migration is one of the common complications following transcatheter valve implantation. This study aims to design a "drum-shaped" balloon-expandable aortic valve stent to address this issue and conduct a mechanical analysis. The implantation process of the stent was evaluated using a method that combines numerical simulation and in vitro experiments. Furthermore, the fatigue process of the stent under pulsatile cyclic loading was simulated, and its fatigue performance was assessed using a Goodman diagram. The process of the stent migrating toward the left ventricular side was simulated, and the force-displacement curve of the stent was extracted to evaluate its anti- migration performance. The results showed that all five stent models could be crimped into a 14F sheath and enabled uniform expansion of the native valve leaflets. The stress in each stent was below the ultimate stress, so no fatigue fracture occurred. As the cell height ratio decreased, the contact area fraction between the stent and the aortic root gradually decreased. However, the mean contact force and the maximum anti-migration force first decreased and then increased. Specifically, model S5 had the smallest contact area fraction but the largest mean contact force and maximum anti-migration force, reaching approximately 0.16 MPa and 10.73 N, respectively. The designed stent achieves a "drum-shaped" change after expansion and has good anti-migration performance.
Stents ; Prosthesis Design ; Heart Valve Prosthesis ; Humans ; Aortic Valve/surgery* ; Stress, Mechanical ; Transcatheter Aortic Valve Replacement/instrumentation*

OBJECTIVES: Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life. This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum Women into Chinese and to evaluate its reliability and validity in the Chinese population. METHODS: The questionnaire was translated using the Brislin model. A cross-sectional study was conducted among pregnant and postpartum women to assess the content validity, construct validity, Cronbach's α coefficient, test-retest reliability, and split-half reliability of the Chinese version. RESULTS: A total of 72 women were included, with 6.9% being pregnant and 93.1% postpartum; the age was (32.3±3.6) years. The Chinese version of the questionnaire contains 4 dimensions and 45 items. The content validity index of individual items ranged from 0.833 to 1.000, with a scale-level content validity index of 0.977 and intraclass correlation coefficients (ICCs) exceeding 0.90. The overall Cronbach's α coefficient was 0.891, with subscale coefficients ranging from 0.732 to 0.884 (all ICCs>0.70). The test-retest reliability of the total scale was 0.833, and for the 4 dimensions, bladder, bowel, prolapse, and sexual function, the values were 0.776, 0.579, 0.732, and 0.645, respectively. The split-half reliability was 0.74. CONCLUSIONS The Chinese version of the questionnaire demonstrated good reliability and validity, indicating its applicability in assessing pelvic floor dysfunction and associated risk factors during pregnancy and postpartum.
Humans ; Female ; Surveys and Questionnaires ; Pregnancy ; Adult ; Postpartum Period ; Psychometrics ; Pelvic Floor Disorders/diagnosis* ; Cross-Sectional Studies ; Quality of Life ; Pelvic Floor/physiopathology* ; Reproducibility of Results ; China ; Translations ; Young Adult

OBJECTIVE: To reveal the effects and potential mechanisms by which synaptic vesicle glycoprotein 2A (SV2A) influences the distribution of amyloid precursor protein (APP) in the trans-Golgi network (TGN), endolysosomal system, and cell membranes and to reveal the effects of SV2A on APP amyloid degradation. METHODS: Colocalization analysis of APP with specific tagged proteins in the TGN, ensolysosomal system, and cell membrane was performed to explore the effects of SV2A on the intracellular transport of APP. APP, β-site amyloid precursor protein cleaving enzyme 1 (BACE1) expressions, and APP cleavage products levels were investigated to observe the effects of SV2A on APP amyloidogenic processing. RESULTS: APP localization was reduced in the TGN, early endosomes, late endosomes, and lysosomes, whereas it was increased in the recycling endosomes and cell membrane of SV2A-overexpressed neurons. Moreover, Arl5b (ADP-ribosylation factor 5b), a protein responsible for transporting APP from the TGN to early endosomes, was upregulated by SV2A. SV2A overexpression also decreased APP transport from the cell membrane to early endosomes by downregulating APP endocytosis. In addition, products of APP amyloid degradation, including sAPPβ, Aβ _1-42, and Aβ _1-40, were decreased in SV2A-overexpressed cells. CONCLUSION These results demonstrated that SV2A promotes APP transport from the TGN to early endosomes by upregulating Arl5b and promoting APP transport from early endosomes to recycling endosomes-cell membrane pathway, which slows APP amyloid degradation.
Amyloid beta-Protein Precursor/genetics* ; Membrane Glycoproteins/genetics* ; Animals ; Protein Transport ; Nerve Tissue Proteins/genetics* ; Humans ; Mice ; Endosomes/metabolism* ; trans-Golgi Network/metabolism*

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To construct a pelvic floor muscle training program for patients undergoing radical prostatectomy,and to provide a reference for clinical practice.Methods The evidence related to pelvic floor muscle training in patients undergoing radical prostatectomy was systematically searched and the quality was evaluated.The draft of pelvic floor muscle training program for patients undergoing radical prostatectomy was constructed based on the KAP theory and it was demonstrated and revised by expert meetings.From February to March 2023,Delphi method was used to determine the final scheme.37 patients were selected as the control group and 38 patients as the experimental group to implement the scheme and evaluate the application effect.Results 2 rounds of Delphi consultations were conducted among 17 experts,and the recovery rate of the questionnaire was 100％.The expert authority coefficient was 0.89.The Kendall harmony coefficients of the importance and feasibility of the second round of consultation were 0.270 and 0.209(P＜0.001).The coefficient of variation of importance and feasibility of items were 0～0.18 and 0～0.20.The final program included 3 first-level items,8 second-level items and 29 third-level items.1 month after surgery,there was no significant difference in urinary incontinence score(P=0.242)and there was significant difference in pelvic floor muscle training compliance(P=0.011)between 2 groups.Conclusion The program was applied preliminary in clinical practice and it was confirmed with scientific and practical meaning,so it can provide a reference for clinical nursing.

Objective To elucidate the influence of two procedures aortic root remodeling using a straight tubular artificial vessel while preserving the aortic valve and the Florida sleeve procedure on the biomechanics of the aortic root.Methods Five finite element models of the aortic root were reconstructed using computed tomography angiography images,including two cases of aortic root remodeling(A1 and A2),two cases of the Florida sleeve procedure(B1 and B2),and one control group without aortic root pathology(C).Numerical simulations were performed to obtain the blood flow and pressure distribution result to assess the differences in the hemodynamics of the aortic root.Results There were no significant differences in the peak systolic velocity between the two procedures and the control.However,the flow velocity after aortic root remodeling was smoother,similar to the model of the control group,with a more stable average aortic pressure and wall shear stress.In the Florida sleeve procedure,high-speed blood flow affected the vessel wall,leading to various degrees of wall shear stress and pressure concentrations along the aortic wall.Conclusions After aortic root replacement with valve preservation,blood flow patterns in the reconstructed aortic root depended on postoperative changes in sinus geometry.Both surgical procedures showed favorable blood flow patterns;however,the flow pattern after aortic root remodeling was more stable than that after the Florida sleeve procedure.

Objective To investigate the role and mechanism of zinc finger protein 281(ZNF281)in high glucose(HG)-induced epithelial-mesenchymal transition(EMT)and extracellular matrix(ECM)synthesis in renal tubular epithelial cells(RTECs).Methods HG induced RTECs were used to construct a diabetic kidney disease cell model,and cells were divided into the control group,the HG group and the mannitol group.Cell proliferation viability was detected by CCK-8.The expression of ZNF281 was knocked down in HG-treated RTECs using small interfering RNA(siRNA).HG-induced RTECs after knockdown of ZNF281 were divided into the control group,the HG group,the HG+ZNF281 siRNA group and the HG+ZNF281 vector group.Adenosine monophosphate-activated protein kinase(AMPK)was activated using AMPK agonist,acadexin(AICAR),and then cells were divided into the control group,the HG group,the HG+AICAR group and the HG+dimethyl sulfoxide group.The expression levels of ZNF281,EMT and ECM synthesis-related indexes were detected by qPCR and Western blot assay.Results Compared with the control group,the protein and mRNA expression levels of vimentin,α-smooth muscle actin(α-SMA),fibronectin(FN)and collagen Ⅰ(Col Ⅰ)were significantly higher,and the expression of E-cadherin was significantly lower in the HG group.Compared with the HG group,the protein and mRNA expression levels of EMT and ECM synthesis-related indexes were significantly changed in the HG+ZNF281 siRNA group and the HG+AICAR group.The protein and mRNA expression levels of ZNF281 were significantly reduced in the HG+AICAR group compared with the HG group.In cells co-treated with AICAR and transfected with ZNF281 plasmid,the expression levels of vimentin,α-SMA,FN and Col Ⅰ were significantly higher in the AICAR+ZNF281 group,and E-cadherin was significantly lower compared with that of the vector group.Conclusion AMPK inhibits EMT and ECM synthesis in HG-treated RTECs by negatively regulating the expression level of ZNF281.

Objective To analyze the effect of a high salt diet on ovarian mitochondrial function.Methods Twenty female ICR mice were randomly divided into a normal salt diet(NSD)group and a high salt diet(HSD)group(n = 10 each).The NSD group was given a normal salt diet and the HSD group was given an 8%NaCl diet for 4 weeks.A high salt-treated cell model was established by inducing COV-434 cells cultured in vitro with NaCl.Western blotting was used to detect the protein expression of superoxide dismutase(SOD)and ComplexesⅠ-Ⅴ.The activity of SOD and succinate dehydrogenase(SDH)was detected kinetically.A chemiluminescence assay was used to detect adenosine triphosphate(ATP)levels.Results Compared with the NSD,the HSD significantly reduced the expression level of ComplexⅠin ovarian mitochondria(P＜0.01),significantly increased the expression level of ComplexⅤ(P＜0.05),and significantly reduced the activity of SDH and content of ATP(P＜0.01).The expression level of ComplexesⅠandⅡdecreased significantly(P＜0.05),expression level of ComplexⅤ increased significantly(P＜0.05),activity of SDH decreased significantly(P＜0.01),and content of ATP was insufficient(P＜0.01)in COV-434 cells cultured under high salt conditions.Conclusion High salt can lead to mitochondrial dys-function in the mouse ovary,such as imbalanced oxidative homeostasis,changed expression level of electron transport chain complexes,blocked tricarboxylic acid cycle,and insufficient ATP level.