BACKGROUND:Toxic effects of excessive thyroid hormone on myocardium can not be ignored with the increased incidence of hyperthyroidism. As a quantitative marker of heart failure, brain natriuretic peptide has a good application prospect to estimate the changes of cardiac function and myocardial damage in hyperthyroid cardiomyopathy. OBJECTIVE:To explore the correlation of brain natriuretic peptide and cardiac function of rabbits with hyperthyroid cardiomyopathy exhibiting different left ventricular geometries. METHODS:Twenty New Zealand purebred rabbits were used in this study. Hyperthyroidism model was established by intraperitoneal injection of levothyroxine (45 μg/kg) for 4 weeks. The success of establishing model is defined upon the appearance of irritation, decreased body weight and increased appetite. Totaly 18 rats were successfuly established. The left ventricular data of hyperthyroidism rabbits were measured by conventional echocardiography. According to the classification of Ganauet al, the 18 hyperthyroidism rabbits were divided into two groups: concentric hypertrophy (n=7) and eccentric hypertrophy (n=11). In addition, ten rats, receiving intraperitoneal injection of 5 mL saline per day, were taken as the control group. RESULTS AND CONCLUSION: Plasma brain natriuretic peptide level of rabbits in the concentric hypertrophy and eccentric hypertrophy groups was obviously higher than that of the control group (alP < 0.01), and the level in the eccentric hypertrophy group was obviously higher than in the concentric hypertrophy group (P< 0.01). Compared with the control group, the average peak diastolic velocity of mitral ring was significantly lower in the concentric hypertrophy and eccentric hypertrophy groups (alP< 0.01), the average peak systolic velocity of mitral ring was also lower in the eccentric hypertrophy group (P < 0.01). The peak systolic and diastolic velocity had a negative correlation with brain natriuretic peptide (alP < 0.01). Experimental findings indicate that brain natriuretic peptide is a sensitive indicator to reflect the cardiac function and myocardial damage in rabbits with hyperthyroid cardiomyopathy, exhibiting different left ventricular geomeies.

Objective To investigate the feasibility, safety and technical superiority of mechanical thrombectomy using a direct aspiration first-pass thrombectomy (ADAPT) in treatment of patients with acute cerebral artery occlusion. Methods A retrospective study was conducted on all patients with acute ischemic stroke treated with mechanical thrombectomy in our institution from January 2013 to August 2016.Patients using ADAPT or stent retriever as a first-line endovascular procedure were compared for clinical characteristics, procedural variables and clinical outcomes. The technical superiority of ADAPT was analyzed in depth. Results During observation period, a total of 91 cases were performed endovascular treatment with mechanical thrombectomy. ADAPT was designed in 46 cases as a first-line endovascular procedure and was utilized in 38 cases (82.6%;ADAPT group), while primary stent retriever thrombectomy was performed in 21 patients(stent group). There was no significant difference in baseline clinical or radiographic factors between ADAPT and stent groups. Although rates of good neurological outcome (modified Rankin Scale(mRS) score≤2) at 90 days were similar between the ADAPT and stent groups (61%(23/38) vs 48%(10/21), P=0.247), National Institute of Health Stroke Scale (NIHSS) score at seven days (6.0(2.0, 9.3) vs 9.0(5.5, 18.5),Z=-2.031,P=0.021) and full recovery rate of neurological outcome (mRS score=0, 37%(14/38) vs 10%(2/21), P=0.022) were significantly better in the ADAPT group than in the stent group. There were no significant differences in rates of embolus to new territory (21%(8/38) vs 29%(6/21), P=0.365), Thrombolysis In Cerebral Infarction (TICI) 2b/3 grade revascularization (84%(32/38) vs 81%(17/21), P=0.507) and symptomatic intracerebral hemorrhage (0%(0/38) vs 10%(2/21), P=0.123) between the ADAPT and the stent groups, but the figures were better in the ADAPT group. Conclusions Mechanical thrombectomy using ADAPT is feasible and safe compared with stent retriever, with higher full recovery rate of neurological outcome and better NIHSS score.It is a method worthy of further exploration for endovascular mechanical recanalization.

Objective To explore clinical value of cardiac MRI feature tracking (CMR-FT) in evaluation of left ventricular global and regional myocardial strain in hypertrophic cardiomyopathy (HCM).Methods Totally 60 patients with HCM (HCM group) and 10 healthy volunteers (control group) were enrolled and underwent cardiac MR.MR Sequences included fast imaging employing steady state acquisition (FIESTA) and late gadalinum enhancement (LGE) at ventricular short-axis,two-chamber and four-chamber planes.The patients in HCM group were divided into LGE negative subgroup and LGE positive subgroup.CMR-FT processing software was used to measure myocardial global radial peak strain (GPSR),global circumferential peak strain (GPSC) and global longitudinal peak strain (GPSL).The radial,circumferential and longitudinal peak strain (PSR,PSC and PSL) at the apex,middle and basal parts of left ventricular were also measured as well.Resuits GPSR,GPSC,GPSL in LGE positive subgroup,LGE negative subgroup and control group had significant differences (all P＜0.05),and showed upward trends.Except PSL at the apex had no significent difference among three groups,PSR,PSC and PSL at the apex,middle and basal parts had significant differences (all P＜0.05),and also showed upward trends.There were positive correlations between the LVEF,SV and GPSR,GPSC,GPSL (all P＜0.05).The area under ROC curve of GPSR,GPSC and GPSL in diagnosis of HCM were 0.79,0.82,0.77 (all P＜0.05),and the area under ROC curve of GPSC was the largest.Conclusion The CMR-FT technology can find myocardial strain dysfunction in HCM sensitively,and the longitudinal strain is damaged earlier or worse than circumferential and radial strains.

Objective: To compare laparoscopic cholecystectomy (LC) with or without percutaneous transhepatic gallbladder drainage (PTGD) for acute severe cholecystitis. Methods: According to the predefined inclusion and exclusion criteria, 23 articles were selected for this meta-analysis. All patients were treated with LC with or without PTGD. A meta-analysis was used to analyze the clinical efficacy. Results: Compared with LC, all the surgical indicators of LC with PTGD were significantly better than LC alone (all P≤0.05), including the operation time: 95%CI(-27.24, -9.27); intraoperative blood loss: 95%CI(-50.25, -40.19); postoperative hospital stay: 95%CI(-3.63, -0.64); rates of conversion to open abdomen: OR=0.48, 95%CI(0.32, 0.74); rates of incision infection: OR=0.49, 95%CI(0.25, 0.99); drainage tube indwelling time: 95%CI(-2.07, -1.19); gastrointestinal function recovery time: 95%CI(-1.73, -0.77); rates of bile leakage: OR=0.23, 95%CI(0.12, 0.44); and rates of complications: OR=0.36, 95%CI(0.27, 0.48). Conclusion Compared with LC alone, PTGD+ LC is the preferred treatment for acute severe cholecystitis.

Objective: Accumulating evidence has shown that aberrant alternative splicing events are closely associated with the onset and development of cancer. However, whether genetic variants-associated alternative splicing is linked to risk of endometrial cancer remains largely uncertain. Methods: We identified single nucleotide polymorphisms (SNPs) locates in the splicing number trait locus (sQTL) of endometrial cancer using the CancerSplicing QTL database. In parallel with bioinformatics analysis, we conducted a case-control study comprising 2,000 cases and 2,013 controls to assess the association between identified SNP which possesses mRNA splicing function and endometrial cancer susceptibility. Furthermore, we used the Kaplan-Meier Plotter, The Human Protein Atlas, SPNR, and Spliceman2 databases for sQTL and differential gene expression analyses to identify the genetic variant which most potentially influence the risk of endometrial cancer through alternative splicing to reveal the potential mechanism by which candidate SNPs regulate the risk of endometrial cancer. Results: The results indicated that SNP rs7128029 AConclusion These findings suggest that SNP rs7128029-mediated alternative splicing events in PSMD13 are associated with endometrial cancer risk and may be a potential early screening biomarker for endometrial cancer-susceptible populations.

AIM:This study investigates the effect of fibroblast growth factor 21(FGF21)long-acting ana-logue PF-05231023 on promoting the"browning"of white adipose tissue(WAT)by inhibiting mitophagy in WAT and the molecular mechanisms involved.METHODS:Using a high-fat diet(HFD)to replicate an obesity model in mice,18 C57BL/6J mice were divided into three groups:normal control(NC)group,HFD group,and PF-05231023 intervention(PF+HFD)group,each consisting of 6 mice.After 12 weeks of feeding,the mice were anaesthetized,their eyeballs were removed to collect blood samples,and serum was separated to measure levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C)、alanine aminotransferase(ALT),and aspartate aminotransferase(AST)in mouse serum.The inguinal WAT(iWAT),epididymal WAT(eWAT)and liver were collected.Part of the tis-sues were used for Western blot experiments to measure the protein levels of"browning"related markers uncoupling pro-tein-1(Ucp-1)and peroxisome proliferator-activated receptor γ coactivator-1α(PGC-1α),as well as mitophagy-related markers PTEN-induced kinase 1(Pink1),parkin,beclin-1 and microtubule-associated protein 1 light chain 3-Ⅱ(LC3-Ⅱ).Another part of the tissues was fixed in paraformaldehyde for subsequent HE and immunohistochemical staining.3T3-L1 cells were induced to mature adipocytes using the classic"cocktail"method.The CCK-8 assay was used to assess the impact of different concentrations of PF-05231023 intervention on cell viability.After 48 h of PF-05231023 intervention,the 3T3-L1 cell clumps were collected for Western blot experiments to measure the expression levels of"browning"related markers Ucp-1 and PGC-1α,as well as mitochondrial autophagy-related markers Pink1,parkin,beclin-1,and LC3-Ⅱ proteins.Oil red O staining was performed to detect cell accumulation,and immunofluorescence staining was used to mea-sure Ucp-1 protein content.Subsequently,3T3-L1 cells were divided into the normal group,PF-05231023 intervention group,Pink1 agonist MTK458 intervention group,and MTK458+PF-05231023 intervention group.Cell clumps were col-lected for Western blot experiments to measure the markers as mentioned above.RESULTS:The key findings of our study indicate that the PF-05231023 intervention did not affect energy intake in mice but significantly reduced the weight,liver weight,and fat weight of mice induced by a high-fat diet(P<0.05).The intervention also decreased lipid accumula-tion(TC,TG、LDL-C)and liver damage(ALT,AST)and alleviated hepatocyte vacuolization and adipocyte size(P<0.05).Compared with the HFD group,the PF-05231023 intervention increased the levels of Ucp-1 and PGC-1α protein expression in iWAT and eWAT(P<0.01).Immunohistochemical staining showed higher Ucp-1 protein content in the PF-05231023 intervention group than in the HFD group.The PF-05231023 intervention dose-dependently increased Ucp-1 and PGC-1α protein expression levels in mature 3T3-L1 cells(P<0.01),reduced cellular lipid accumulation,and immu-nofluorescence staining showed increased Ucp-1 protein content in mature 3T3-L1 cells after PF-05231023 intervention.The PF-05231023 intervention inhibited mitochondrial autophagy-related indicators Pink1,parkin,beclin-1,and LC3-Ⅱ protein expression levels in iWAT,eWAT,and induced mature 3T3-L1 cells(P<0.05).The MTK intervention increased Pink1,parkin,beclin-1,and LC3-Ⅱ protein expression levels,increased Ucp-1 protein expression level,compared with the MTK intervention group,after MTK and PF-05231023 co-intervention,partially decreased Pink1,parkin,beclin-1,and LC3-Ⅱ protein expression levels,and partially restored Ucp-1 protein expression level(P<0.01).CONCLUSION:(1)Intervention with PF-05231023 can improve obesity and related metabolic disorders induced by a high-fat diet in mice;(2)PF-05231023 intervention can inhibit white adipose tissue(WAT)and induce mature 3T3-L1 cell mitochondria autophagy,promoting"browning"by inhibiting mitochondrial autophagy;(3)Its mechanism may be related to the inhibi-tion of the Pink1-parkin signalling pathway.

Objective:To compare clinical characteristics of patients with atopic prurigo nodularis (APN) versus non-APN (NAPN), and to analyze differences in the therapeutic response to dupilumab.Methods:A retrospective study was conducted. Clinical data were collected from patients with atopic dermatitis and those with prurigo nodularis, who visited the Department of Dermatology, Southwest Hospital, Army Medical University from January 2017 to December 2022. These patients were divided into the APN group and NAPN group according to the inclusion and exclusion criteria (types of skin lesions and the presence or absence of history of atopic diseases). Clinical characteristics, laboratory examination results, and comorbidities were compared between the 2 groups, so were the eczema area and severity index (EASI) scores, investigator′s global assessment (IGA) scores and itch numeric rating scale (NRS) scores at 0, 4, 12 weeks after the treatment with dupilumab.Results:A total of 233 patients with NAPN and 177 with APN were enrolled, and their ages were 57 (48, 68) and 43 (20, 57) years, respectively. Before the treatment, the serum IgE levels and eosinophil counts were significantly higher in the APN patients than in the NAPN patients ( Z = -4.40, -3.92, respectively, both P < 0.001) ; compared with the NAPN patients, the APN patients more frequently presented with skin lesions on the trunk (71.64% [117/177] vs. 54.08% [126/233], P < 0.05), limbs (71.75% [127/177] vs. 61.37% [143/233], P < 0.05) and the whole body (28.36% [53/177] vs. 20.17% [47/233], P < 0.05) ; the incidence rates of xeroderma, erythema, papules and crusting were significantly higher in the APN patients than in the NAPN patients (all P < 0.05), and the APN patients more frequently presented with symmetrically distributed lesions; however, there were no significant differences in the incidence rates of secondary lesions such as scratches (38.98% [67/177] vs. 33.91% [79/233]) and ulcers (18.64% [33/177] vs. 18.03% [42/233]) between the two groups (both P > 0.05). The proportions of patients with chronic kidney diseases, cardiovascular diseases, liver diseases and diabetes were significantly higher in the NAPN group than in the APN group (all P < 0.05). There were 13 patients with APN and 5 with NAPN who received a 12-week dupilumab treatment and had complete follow-up results. No significant differences were observed in the EASI, IGA or NRS scores before the treatment between the 2 groups (all P < 0.05) ; after the 12-week treatment, the improvement of EASI score was significantly higher in the APN group than in the NAPN group ( P < 0.05), while there were no significant differences in the improvement of NRS and IGA scores between the 2 groups (both P > 0.05) . Conclusion:The clinical manifestations, laboratory examination results, and comorbidities differed between the NAPN and APN patients, however, they both showed good therapeutic response to dupilumab.

Objective To explore the construction of self-efficacy model of hepatocellular carcinoma patients. Methods A total of 290 patients with hepatocellular carcinoma from Wuhan Union Hospital were selected by convenient sampling method. The patients were investigated with general information questionnaire,self-management efficacy scale,Self-rating Depression Scale and Social Support Scale. χ2test was applied to high level self-management efficacy group and not high level self-management efficacy group. The significant factor through univariate analysis (P < 0.05) was used to investigate the influencing factors of self-efficacy in patients with hepatocellular carcinoma by Logistic regression analysis.The structural equation model of self-efficacy model of hepatocellular carcinoma patients was obtained by inputting the status survey data into Amos 23.0 software, and the correlation between the variables of the model was analyzed. Results Logistic regression analysis showed that age(P=0.018),marital status(P=0.030)and income(P=0.034)were the influencing factors of self-efficacy in patients with hepatocellular carcinoma.The model of fitness model was established by χ 2/df=2.381,root mean square residual=0.008,goodness-of-fit index=0.945,adjusted goodness-of-fit index=0.906,normed fit index=0.951,incremental fit index=0.971, comparative fit index=0.971,root mean square error of approximation=0.071,the model had a good fit,could reflect the relationship between the variables, social support for patients with hepatocellular carcinoma depression direct effect of-0.209,social support for patients with hepatocellular carcinoma self-efficacy direct effect of 0.241,depression on the effect of self-efficacy on patients with hepatocellular carcinoma was-0.171. The model recognizes that depression was a risk factor for self-efficacy in patients with hepatocellular carcinoma and that social support was a protective factor. Conclusions In clinical work,health care workers should pay attention to the influencing factors and protective factors of self- efficacy of patients with hepatocellular carcinoma.The self-efficacy model of hepatocellular carcinoma patients can be used to improve the quality of life of patients with hepatocellular carcinoma.

Objective:To analyze the etiological distribution and phylogenetic characteristics of hand, foot and mouth disease (HFMD) in Qujing city of Yunnan Province in 2020.Methods:Stool samples were collected from HFMD cases in Qujing city in 2020 and virus RNA was extracted directly from treated stool suspensions. Virus VP4 gene sequences were firstly amplified using MD91/OL68-1 primer pairs and sequenced, then the virus serotypes were determined by BLAST search on the GenBank. Virus entire VP1 gene sequences were amplified and sequenced. Virus serotypes were identified online using Enterovirus Genotyping Tool Version 0.1. Sequences of reference virus genotypes/sub-genotypes were downloaded according to references. Phylogenetic trees were constructed by MEGA5.2 software and the genetic characteristics were analyzed.Results:A total of 47 strains of enteroviruses (EVs) were detected with a detection rate of 10.22% (47/460). The detected viruses were coxsackievirus A4 (CVA4, 0.65%, 3/460), CVA6 (7.83%, 36/460), CVA10 (0.87%, 4/460) and CVA16 (0.87%, 4/460). All were enterovirus species A (EVA), while other group viruses were not detected. The predominant virus was CVA6, accounting for 7.83% (36/460). EVA71 was not detected. CVA4 strains of C2 and C4 subgenotypes were co-circulating strains in Qujing city. CVA6 subgenotype D3a and CVA16 subgenotype B1a were also circulated in Qujing city. All CVA10 strains were in a separate lineage.Conclusions:Similar to the previous situation in China, the detection rates of EVA71 and CVA16 were very low, even zero. This study showed that CVA6 was the predominant virus, indicating a HFMD outbreak caused by CVA6 in Qujing city in 2020. The phylogenetic analysis showed CVA10 isolates belonged to a separate lineage, which might be unique to Qujing city. Laboratory and molecular epidemiological surveillance of non-EVA71 and non-CVA16 viruses, especially CVA6 and CVA10 should be strengthened in the future.

Objective:To investigate the risk factors of cervical lymph node metastasis (LNM) and survival analysis in patients with medullary thyroid carcinoma (MTC) .Methods:93 patients with MTC admitted to the Department of General Surgery and Department of Otorhinolaryngology, First Medical Center of PLA General Hospital from Sep. 2008 to Aug. 2020 were analyzed retrospectively, including 45 males and 48 females, with an average age of 47 years old. SPSS 26.0 statistical software was used for data processing of the initial surgical year and procedures, tumor pathological stages, preoperative calcitonin (Ctn) level, preoperative carcinoembryonic antigen (CEA) level, LNM status, recurrence free survival (RFS) , etc. The risk factors of LNM and prognosis of MTC patients were analyzed by COX univariate and multivariate regression. Kaplan Meier method was used to estimate the survival rates of independent risk factors affecting prognosis and draw their survival curves.Results:The median follow-up time of 93 patients was 53 months, ranging from 2 to 192 months. The 1-year, 3-year, 5-year and 10-year survival rates were 97.8%, 96.6%, 94.6% and 88.9% respectively. Multivariate COX regression analysis showed that Initial surgical procedures ( P=0.018) and preoperative Ctn level ( P=0.012) were independent risk factors of central cervical LNM. Preoperative Ctn level ( P=0.028) and Capsule invasion ( P=0.024) were the independent risk factors of lateral cervical LNM. Preoperative Ctn level≥180.30 pg/ml and ≥234.15pg/ml indicated central and lateral cervical LNM respectively (all P<0.001) . Distant metastasis was an independent risk factor of RFS ( P=0.037) of MTC. Conclusions:Standardized surgical procedures are recommended for initial treatment of MTC, which can reduce the possibility of residual occult metastasis and the risk of reoperation. Distant metastasis affects prognosis of MTC.