OBJECTIVE: In order to investigate the interaction between the cytokines and keratinocyte and determine the role of cytokines in hyperproliferative of chronic otitis media with cholesteatoma, we observe the expression of matrix metalloproteinase 9 (MMP9), vascular endothelial growth factor (VEGF), keratinocyte growth factor (KGF) and its receptor (KGFR) in middle ear cholesteatoma. METHOD: We examined the expression of MMP9, VEGF, KGF, KGFR and Ki-67 by immunohistochemistry in 50 specimens from chronic otitis media with cholesteatoma and 15 specimens from the normal skin of external auditory meatus. Ki-67 as an evaluation of cholesteatoma proliferation markers were used to detect the keratinocyte proliferative activity. RESULT: (1) The expression of VEGF and MMP9 in cholesteatoma specimens was higher than normal skin, and the difference was statistically significant (t = 4.914, P < 0.01; t = 3.284, P < 0.01). (2) The expression of KGF and KGFR in middle ear tissues was higher than normal skin, and the difference was statistically significant (t = 4.814, P < 0.01; t = 3.104, P < 0.01); The expression of KGF and KGFR increased, and the expression of Ki-67 also correspondly increased in the cholesteatoma. (3) In the tissue MMP9 and VEGF were positive. Mean optical density increased as well. KGF expression also increased accordingly. CONCLUSION MMP9, VEGF, KGF and KGFR proteins played an important role in hyperproliferation of cholesteatoma tissues. VEGF, MMP9 and KGF had a synergistic effect in hyperproliferation of cholesteatoma tissues.
Cholesteatoma, Middle Ear ; pathology ; Cytokines ; metabolism ; Ear Canal ; metabolism ; Ear, Middle ; metabolism ; Fibroblast Growth Factor 7 ; metabolism ; Humans ; Immunohistochemistry ; Keratinocytes ; cytology ; Ki-67 Antigen ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Otitis Media ; pathology ; Receptor, Fibroblast Growth Factor, Type 2 ; metabolism ; Vascular Endothelial Growth Factor A ; metabolism

Objective To observe the effect of the health education and skills training for caregivers on health status of stroke patients and their family caregivers. Methods Hospitalized stroke patients were divided into the intervention group (n=38) and the control group (n= 36). Both groups received rehabilitation training for 1 month in hospital. The family caregivers of intervention group received Timing It Right education and skills training in addition. All the patients were assessed with the European Stroke Scale (ESS), Mini-Mental State Examination (MMSE), simple Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), and the caregivers were assessed with the General Health Questionnaire (GHQ-12) before and 3 months after intervention. Results The scores of ESS, FMA, MBI improved more in intervention group than in the control group after intervention (P<0.05), as well as their caregivers in the items of playing a useful part, under stress, overcoming difficulties, enjoying normal activities, facing up to problems, feeling unhappy and depressed, lossing confidence, thinking of self as worth of GHQ-12 (P<0.05). Conclusion Health education and skills training for family caregivers can improve the health of caregivers, and further improve the function outcome of stroke patients.

Objective To observe the effects of individual occupational therapy on cognitive impairment of elderly with stroke. Methods 60 elderly stroke patients with cognitive impairment were divided into treatment group (n=30) and control group (n=30). All the patients accepted routine rehabilitation, and the treatment group accepted individual occupational therapy in addition. They were evaluated with Mini-mental State Examination (MMSE) and modified Barthel index (MBI) before and after treatment. Results The score of MMSE increased significantly in the treatment group after treatment (P<0.001), but was not different significantly in the control group (P>0.05). The score of MBI increased significantly in both groups after treatment (P<0.05), and increased more in the treatment group than in the control group (P<0.001). Conclusion Individual occupational therapy can improve the cognitive function and the activities of daily living for the elderly stroke patients with cognitive impairment.

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN),and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment.Methods A retrospective cohort study was conducted.Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1,2007 to December 1,2016 were enrolled.All subjects were treated with CTX in combination with glucocorticoids.The patients were divided into two groups:remission group and no remission group.Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients.Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5％).Among them,141 patients (61.8％) had complete remission (CR),the median time for CR was 8(6,12) months,and the median time for partial remission (PR) was 3(1,4) months.The median follow-up time for this study was 25(13,43) months.Compared with the remission group,the serum albumin level was lower in the non-remission group,the 24-hour urine protein content,the blood complement C3 and C4 levels were higher,and the pathological stage was milder (all P ＜ 0.05).Multivariate logistic regression analysis suggested that the levels of baseline serum albumin,complement C4,and pathological stage were independent predictors of clinical remission in IMN patients.Twenty-four non-remission patients were treated with CNI.The overall response rate was 66.7％(16/24) at 6 months and 77.3％(17/22) at 12 months.Conclusions The levels of baseline albumin,blood complement C4,and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids.The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.

Objective:To introduce our experience in the treatment of infection related to lower long bone fracture in adults.Methods:From January 2017 to December 2020, 31 adult patients with infection related to lower long bone fracture were treated at Department of Orthopaedics, the 7th Medical Center, General Hospital of the People's Liberation Army. They were 20 males and 11 females with an age of (35.7±16.7) years. There were 9 cases of acute infection, 3 cases of delayed infection and 19 cases of late infection. They were treated according to their stage of infection, respectively, by retaining or removing the internal fixation, debridement, bone grafting and bone lengthening. They were followed up regularly for at least 12 months to observe their symptoms, signs, indexes of imaging and blood tests. Paley score for fracture union was recorded at the last follow-up.Results:All the 31 patients were followed up for 13.0(13.0, 31.0) months. Of the 9 patients with acute infection, 6 retained the implant, 1 removed the implant for dressing change due to intolerability and 2 removed the implant due to unsatisfactory infection control. Of the 3 patients with delayed infection, 1 retained the implant and 2 removed the implant because of unsatisfactory infection control. Of the 19 patients with delayed infection, 5 were treated with local bone graft, 6 with Masqulet technique and 8 with bone transfer following debridement and implant removal. All patients were cured without recurrence of infection. According to Paley's scoring, 25 cases were excellent, 5 were good, and 1 was fair.Conclusions:Treatment of infection related to lower long bone fracture in adults should be carried out according to its clinical stage. For acute and delayed infection, implants should be preserved as much as possible; for chronic infection, implants should be removed to perform bone and soft tissue reconstruction after thorough debridement. Personalized diagnosis and treatment protocols can lead to satisfactory clinical results.

Purpose: The present study investigated the association between Systematic COronary Risk Evaluation (SCORE)-estimated cardiovascular risk and carotid stiffening in a middle-aged population using ultrafast pulse wave velocity (ufPWV). Methods: This study enrolled 683 participants without known cardiovascular disease or diabetes mellitus who underwent ufPWV measurements. Clinical interviews, physical examinations, laboratory findings, carotid intima-media thickness (cIMT), pulse wave velocity (PWV) at the beginning of systole (PWV-BS), and PWV at the end of systole (PWV-ES) were assessed. Each participant underwent an assessment of SCORE risk based on major cardiovascular risk factors (CVRFs), including age, sex, smoking, systolic blood pressure (SBP), and total cholesterol (TC). Crude and adjusted odds ratios (ORs) with 95% confidence intervals and ordinal logistic regression were used. Overall CVRFs were adjusted to assess ORs. Results: cIMT and carotid stiffening in PWV-BS and PWV-ES were significantly different between sex subgroups (all P<0.05), but only PWV-ES increased gradually in age and SCORE-estimated risk subgroups (all P<0.05). Compared with cIMT (r=0.388, P<0.001) and PWV-BS (r=0.159, P<0.001), PWV-ES was more strongly correlated with SCORE categories (r=0.405, P<0.001). Higher PWV-ES values were associated with SCORE categories independently of sex, SBP, TC, and smoking in moderate-risk and high-risk subgroups (OR, 1.63; P<0.001 and OR, 2.12; P=0.024, respectively), but were not independent of age in all risk subgroups (all P>0.05). Conclusion Carotid stiffening quantified by ufPWV is linked to SCORE categories, and elevated PWV-ES may aid in cardiovascular risk stratification.

"Reinforcing earth for generating metal" is based on the treatment principle of the five-element theory of traditional Chinese medicine （TCM）， which states that "reinforcing mother viscera for treating deficiency of child viscera". Based on the principle of inter-generating relationship in the five elements that earth generates metal， by strengthening the functions of the internal organs belonging to "earth" （spleen and stomach） to indirectly nourish the internal organs belonging to "metal" （lungs and large intestine）. Using reinforcing earth for generating metal in the treatment of lung cancer， according to the principle of "reinforcing mother viscera for treating deficiency of child viscera"， by strengthening the function of "earth" viscera， the treatment effect of "metal" viscera can be achieved. The metabolic disorder， inflammatory response， and immune regulation caused by the changes in the composition and structure of intestinal microbiota are involved in the occurrence and development of lung cancer， which is consistent with the theory of “the external and internal relationship between the lung and the large intestine” in TCM. From the perspective of intestinal microbiota microecology， the paper discusses the pathogenesis of "earth disease leads to metal disorders" that the gut microbiota dysbiosis causes lung cancer and the treatment method of "reinforcing earth for generating metal" by regulating the microecological balance of gut microbiota in lung cancer， suggesting the great significance of "reinforcing earth for generating metal" therapy aiming at microecological balance of gut microbiota in the treatment of lung cancer， in order to provide a different perspective for the treatment of lung cancer with TCM.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

The combination of the immunotherapy (i.e., the use of monoclonal antibodies) and the conventional chemotherapy increases the long-term survival of patients with lymphoma. However, for patients with relapsed or treatment-resistant lymphoma, a novel treatment approach is urgently needed. Chimeric antigen receptor T (CAR-T) cells were introduced as a treatment for these patients. Based on recent clinical data, approximately 50% of patients with relapsed or refractory B-cell lymphoma achieved complete remission after receiving the CD19 CAR-T cell therapy. Moreover, clinical data revealed that some patients remained in remission for more than two years after the CAR-T cell therapy. Other than the CD19-targeted CAR-T, the novel target antigens, such as CD20, CD22, CD30, and CD37, which were greatly expressed on lymphoma cells, were studied under preclinical and clinical evaluations for use in the treatment of lymphoma. Nonetheless, the CAR-T therapy was usually associated with potentially lethal adverse effects, such as the cytokine release syndrome and the neurotoxicity. Therefore, optimizing the structure of CAR, creating new drugs, and combining CAR-T cell therapy with stem cell transplantation are potential solutions to increase the effectiveness of treatment and reduce the toxicity in patients with lymphoma after the CAR-T cell therapy.
Cell- and Tissue-Based Therapy ; Humans ; Immunotherapy, Adoptive ; Lymphoma/therapy* ; Receptors, Antigen, T-Cell ; Receptors, Chimeric Antigen

Antineoplastic Agents ; chemistry ; pharmacology ; Carcinoma, Hepatocellular ; drug therapy ; immunology ; pathology ; Cytokines ; immunology ; Drug Screening Assays, Antitumor ; Glypicans ; antagonists & inhibitors ; immunology ; Humans ; Ligands ; Liver Neoplasms ; drug therapy ; immunology ; pathology ; T-Lymphocytes ; drug effects ; immunology