A 67-year-old female patient with postoperative recurrence of stage Ⅳright renal cell carcinoma and multiple intracranial metastases was treated with sorafenib and sintilimab.Within 2 weeks,the patient had a fever and red spotted rash in facial,back,buttocks and limb.After 2 days,the fever completely relieved,but subcutaneous exudation appeared on the skin of both elbow joints,buttocks,and outer thighs,followed by gradual epidermal lysis and detachment with skin ulceration.After 4 days,the patient's epidermolysis area was greater than 30％of the body surface area.The patient was diagnosed with toxic epidermal necrolysis(TEN).The adverse reaction correlation was assessed by ALDEN SCORE sheet.The adverse reaction of TEN was"likely"caused by sorafenib and sintilimab.After withdrawal and treatment,the TEN was cured.This paper explores the correlation between the TEN and the combination use of sorafenib and sintilimab and the management.This paper will provide reference for the early diagnosis and correct treatment of TEN.

Background/Aims: Despite the high efficacy of direct-acting antivirals (DAAs), approximately 1–3% of hepatitis C virus (HCV) patients fail to achieve a sustained virological response. We conducted a nationwide study to investigate risk factors associated with DAA treatment failure. Machine-learning algorithms have been applied to discriminate subjects who may fail to respond to DAA therapy. Methods: We analyzed the Taiwan HCV Registry Program database to explore predictors of DAA failure in HCV patients. Fifty-five host and virological features were assessed using multivariate logistic regression, decision tree, random forest, eXtreme Gradient Boosting (XGBoost), and artificial neural network. The primary outcome was undetectable HCV RNA at 12 weeks after the end of treatment. Results: The training (n=23,955) and validation (n=10,346) datasets had similar baseline demographics, with an overall DAA failure rate of 1.6% (n=538). Multivariate logistic regression analysis revealed that liver cirrhosis, hepatocellular carcinoma, poor DAA adherence, and higher hemoglobin A1c were significantly associated with virological failure. XGBoost outperformed the other algorithms and logistic regression models, with an area under the receiver operating characteristic curve of 1.000 in the training dataset and 0.803 in the validation dataset. The top five predictors of treatment failure were HCV RNA, body mass index, α-fetoprotein, platelets, and FIB-4 index. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model (cutoff value=0.5) were 99.5%, 69.7%, 99.9%, 97.4%, and 99.5%, respectively, for the entire dataset. Conclusions Machine learning algorithms effectively provide risk stratification for DAA failure and additional information on the factors associated with DAA failure.

BACKGROUND: Ventricular remodeling after acute anterior wall ST-segment elevation myocardial infarction (AAMI) is an important factor in occurrence of heart failure which additionally results in poor prognosis. Therefore, the treatment of ventricular remodeling needs to be further optimized. Compound Danshen Dripping Pills (CDDP), a traditional Chinese medicine, exerts a protective effect on microcirculatory disturbance caused by ischemia-reperfusion injury and attenuates ventricular remodeling after myocardial infarction. OBJECTIVE: This study is designed to evaluate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function after AAMI on a larger scale. METHODS: This study is a multi-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial. The total of 268 patients with AAMI after primary percutaneous coronary intervention (pPCI) will be randomly assigned 1:1 to the CDDP group (n=134) and control group (n=134) with a follow-up of 48 weeks. Both groups will be treated with standard therapy of ST-segment elevation myocardial infarction (STEMI), with the CDDP group administrating 20 tablets of CDDP before pPCI and 10 tablets 3 times daily after pPCI, and the control group treated with a placebo simultaneously. The primary endpoint is 48-week echocardiographic outcomes including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). The secondary endpoint includes the change in N terminal pro-B-type natriuretic peptide (NT-proBNP) level, arrhythmias, and cardiovascular events (death, cardiac arrest, or cardiopulmonary resuscitation, rehospitalization due to heart failure or angina pectoris, deterioration of cardiac function, and stroke). Investigators and patients are both blinded to the allocated treatment. DISCUSSION This prospective study will investigate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function in patients undergoing pPCI for a first AAMI. Patients in the CDDP group will be compared with those in the control group. If certified to be effective, CDDP treatment in AAMI will probably be advised on a larger scale. (Trial registration No. NCT05000411).
Humans ; ST Elevation Myocardial Infarction/therapy* ; Stroke Volume ; Ventricular Remodeling ; Prospective Studies ; Microcirculation ; Ventricular Function, Left ; Myocardial Infarction/etiology* ; Treatment Outcome ; Percutaneous Coronary Intervention/adverse effects* ; Heart Failure/drug therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Randomized Controlled Trials as Topic ; Multicenter Studies as Topic

Objective:To investigate the therapeutic effect of Flow-through anterolateral thigh perforator flap (ALTPF) or medial sural artery perforator flap (MSAPF) in repair of Gustilo III C wound of foot.Methods:From July 2015 to June 2021, 8 patients with Gustilo III C wound of foot were treated in the Department of Foot and Ankle Surgery of Wuxi No.9 People’s Hospital. The patients were 7 males and 1 female, aged 25-62 years old, and (45.88±12.96) years old in average. Flow-through ALTPF or Flow-through MSAPF were used to repair the defect according to the size of the wound and the length and diameter of the defect vascular. Among the patients, 6 were repaired with free Flow-through ALTPF, and 2 with free Flow-through MSAPF. The size of flap was 9 cm×5 cm-22 cm×8 cm with (115.00±46.16) cm 2 in average, and the vascular bridging was 6-12 cm in length, with (8.75±2.50) cm in average. All patients received outpatient follow-up. The appearance of the flap, blood supply of affected limb, healing of fracture and dislocation and the recovery of limb function were recorded. Maryland score was used to evaluate functional recovery. Results:The flaps survived uneventfully in all 8 patients, and the wounds in donor site healed primarily. All patients were followed-up for 6-22 months with (12.25±5.39 ) months in average. At the last follow-up, all the flaps had satisfactory contour in soft texture and blood supply without occlusion in the bridging vessels. The fractures and dislocation were healed, and the appearance and function of the foot recovered satisfactorily. The Maryland score showed excellent in 3 patients, good in 4 patients and fair in 1 patient.Conclusion:Flow-through ALTPF or MSAPF can selectively used to reconstruct the Gustilo III C wound of foot in one stage. The functional recovery of the affected limb was satisfactory and the clinical effect was good.

Objective:To investigate the expression of Mucosal-associated invariant T (MAIT) cells in the peripheral blood of ankylosing spondylitis (AS) patients, and to analyze its clinical significance.Methods:Sixty-four AS patients from September 2020 to September 2022 in Fujian Provincial Hospital and 60 healthy controls were enrolled. The expression of MAIT cells and CD69 +MAIT cells were detected by immunofluorescence. Spondylarthritis research consortium of Canada (SPARCC) scores of sacroiliac joint magnetic resonance imaging (MRI) were calculated and were analyzed based on clinical data. The changes of MAIT cells were observed in 7 patients with AS after treatment. t test, variance analysis and Pearson correlation analysis were used for statistical analysis. Results:The expression of MAIT cells in the peripheral of AS patients was significantly lower than that in the controls [(2.81±0.27)% and (4.46±0.86)% respectively, t=2.33, P=0.022], while CD69 +MAIT cells were significantly higher [(12.0±1.0)% and (7.8±1.2)% respectively, t=2.31, P=0.024]. The level of CD69 +MAIT cells were significantly positively correlated with erythrocyte sedimentation rate (ESR) ( r=0.39, P=0.010), C-reactive protein (CRP) ( r=0.36, P=0.012), ASDAS ( r=0.35, P=0.013) and SPARCC scores ( r=0.38, P=0.006) of AS patients. ASDAS scores and CD69 +MAIT cells obviously decreased in 7 treated AS patients ( F=7.62, P=0.007 and F=4.97, P=0.027 respectively). Conclusion:The expression of peripheral MAIT cells in AS patients is lower than that in healthy controls, but the number of the activated MAIT cells is increased. Levels of activated MAIT cells may in some extent reflect the inflammatory state and disease activity of AS, as well as inflammatory destruction of sacroiliac joint, and therapeutic effect. MAIT cells may partially participate in the inflammatory response and play a role in the pathogenesis of AS.

Child ; Consensus ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Respiratory System

Objective:To investigate the effect of six degree of freedom (6-DOF) bed combined with cone beam computed tomography (CBCT) in the on-line correction of setup errors in patients with primary rectal cancer.Methods:The clinicopathological data of 17 patients with primary rectal cancer in Department of Radiotherapy, Third Hospital of Peking University from July 2013 to January 2014 were collected. There were 14 males and 3 females, a median age of 65 years. The difference of CBCT and 6-DOF bed combined with CBCT online correction of patients with positioning error were retrospectively analyzed.Results:Before position correction, the first CBCT verification of setup errors in the three translation directions including X (left and right), Y (in and out) and Z (up and down) directions were (0.06±0.25) cm, (0.13±0.40) cm and (-0.28±0.31) cm, respectively. The setup errors of RX (rotation pitch), RY(rolling) and RZ (left and right rotation) directions were (0.62±1.15)°, (-0.19±0.99)°, and (-0.34 ± 0.84)°, respectively . After correction of IGRT combined with six freedom of bed, the setup errors of translation X, Y and Z were (0.01±0.09) cm, (-0.01±0.05) cm and (-0.03±0.08) cm, respectively, and the setup errors of rotation RX, RY and RZ directions were (-0.16±0.40)°, (0.36±0.31)°and (-0.01±0.25)°, respectively. There were significant differences in translation direction (X, Y and Z direction) and rotation direction (Rx, RY and RZ) before and after 6-DOF bed combined with CBCT correction (all P<0.05). In the translation direction, the higher frequency range of Z-direction error value was 0.20-0.79 cm. In the rotation direction, the frequency range of error in Rx direction was 0.20°-2.99°. There was no significant difference between bone mode and gray scale model registration ( P>0.05). With the progress of radiotherapy, the setup errors of X, Z, Rx, RY and RZ directions increased except Y direction. Conclusions:In radiotherapy, six freedom bed combined with CBCT is helpful to correct the setup errors of patients with primary rectal cancer. Six freedom bed may be used to correct the setup errors of patients with primary rectal cancer online. Image-guided radiation therapy (IGRT) is recommended for bone pattern registration in patients with rectal cancer.

Objective:To investigate the effect of six degree of freedom (6-DOF) bed combined with cone beam computed tomography (CBCT) in the on-line correction of setup errors in patients with primary rectal cancer.Methods:The clinicopathological data of 17 patients with primary rectal cancer in Department of Radiotherapy, Third Hospital of Peking University from July 2013 to January 2014 were collected. There were 14 males and 3 females, a median age of 65 years. The difference of CBCT and 6-DOF bed combined with CBCT online correction of patients with positioning error were retrospectively analyzed.Results:Before position correction, the first CBCT verification of setup errors in the three translation directions including X (left and right), Y (in and out) and Z (up and down) directions were (0.06±0.25) cm, (0.13±0.40) cm and (-0.28±0.31) cm, respectively. The setup errors of RX (rotation pitch), RY(rolling) and RZ (left and right rotation) directions were (0.62±1.15)°, (-0.19±0.99)°, and (-0.34 ± 0.84)°, respectively . After correction of IGRT combined with six freedom of bed, the setup errors of translation X, Y and Z were (0.01±0.09) cm, (-0.01±0.05) cm and (-0.03±0.08) cm, respectively, and the setup errors of rotation RX, RY and RZ directions were (-0.16±0.40)°, (0.36±0.31)°and (-0.01±0.25)°, respectively. There were significant differences in translation direction (X, Y and Z direction) and rotation direction (Rx, RY and RZ) before and after 6-DOF bed combined with CBCT correction (all P<0.05). In the translation direction, the higher frequency range of Z-direction error value was 0.20-0.79 cm. In the rotation direction, the frequency range of error in Rx direction was 0.20°-2.99°. There was no significant difference between bone mode and gray scale model registration ( P>0.05). With the progress of radiotherapy, the setup errors of X, Z, Rx, RY and RZ directions increased except Y direction. Conclusions:In radiotherapy, six freedom bed combined with CBCT is helpful to correct the setup errors of patients with primary rectal cancer. Six freedom bed may be used to correct the setup errors of patients with primary rectal cancer online. Image-guided radiation therapy (IGRT) is recommended for bone pattern registration in patients with rectal cancer.

This study adopted the 4 pairs of simple sequence repeats(SSR) primers selected by National Resource Center for Chinese Meteria Medica (CACMS) to detect 29 populations of Dendrobium officinale samples from 9 main places of production; 5,7,4 and 3 polymorphism bands were amplified from these 4 pairs of SSR primers. The DNA identities of different populations were constructed by SSR. The 29 D. officinale populations could be divided into 4 classes. The clustering result was related to the places of production. Samples from Yunnan,Guizhou,Sichuan provinces were classified into one category,while samples from Anhui and Guangxi provinces were classified into another category. Samples from Guangdong Danxia,Zhejiang Yongkang,Zhejiang Leqing and Taining belonged to a category. PopGene (version 1.32) software was applied to calculate the genetic similarity of the 29 D. officinale populations. The similarities was between 0.403 4 and 1.0.Based on the genetic similarity,the genetic consistency included three classes,A,B and C. Samples with a similar geographical location and landform environment have higher genetic similarities,which indicate the same genetic background. This paper provides reference information to study the identification, selection and breeding of good varieties.

Objective To investigate the epidemic character of injuries among rural left-behind children, so as to provide evidence for strategies and processes on preventing injuries. Methods Using stratified cluster sampling, a town was randomly selected from each of the two layers with different economic development levels in Qingxin district, Qingyuan city, Guangdong Province. The local left-behind children of 3-9 grades from 3 elementary schools and 3 middle schools were randomly selected from the local area. The student self-administered questionnaire was used to investigate the occurrence of injuries, personal circumstances, family environment and school situation in the past year. Data of injury situation, personal situation, family situation and school situation during last year were analysed by Chi-square and multiple logistic analysis. Results Injuries were reported to occur in 440 left-behind children, with an injury rate of 17.5%. Significant difference of injury rate was observed between groups divided by grades, being only-child in family, health conditions, anxiety, getting along with other students, teacher’s attitude to students, emphasizing security by teachers, knowledge level about injury, and injury-relative behaviors (all P<0.05). Multivariate logistic regression model results suggested that middle school, physical health, behavioral level, and relationship with classmates are protective factors, anxiety is a risk factor (OR=1.262,95%CI:1.009~1.577,P=0.041). Conclusions We have to take some comprehensive methods to prevent injuries that are influenced by all kinds of factors. While constructing an advantage circumstance to left-behind children, their awareness of security should also be improved to reduce the occurrence of injuries.