Objective To observe and compare the atomic force microscopy (AFM) images of Yersinia pestis EV76 and the changes in the morphology of the bacteria treated with normal serum and F1 antibody from rabbit,and to explore the immunoassay method to detect Yersinia pestis by AFM. Methods The Yersinia pestis were treated with normal serum and F1 antibody from rabbit and control buffer. All the prepared samples were observed and analyzed by AFM. The changes in the cell surface structures were probed and characterized through sectional analysis,especially the changes of Ra and Rq value. Results The normal morphology of Yersinia pestis was oval in shape with a relatively smooth surface, the size dimension of which was about 1.1-1.3 μm in length with a section profile of 0.8-1.0 μm in width and 0.04-0.06 μm in step height. The step height of the bacteria treated with the normal serum and F1 antibody was obviously enlarged. The shape of the bacteria treated with F1 antibody changed irregularly. Furthermore, the surface of the bacteria was more roughened. Conclusion The morphological characters of Yersinia pestis has been acquired through its AFM images. The morphology of Yersinia pestis treated with F1 antibody has changed greatly, and the index of roughness can be regarded as the distinguished index to detect Yersinia pestis by AFM.

Objective To explore the early diagnosis and risk factors for judging prognosis of acute respiratory distress syndrome (ARDS),and to provide references for clinical intervention.Methods Using the method for prospective cohort study,clinical data were collected from 64 ARDS and 66 high-risk ARDS patients in Department of Respiratory Diseases of Xinqiao Hospital from January 2013 to March 2016.They included patients' demographic data,Acute Physiology and Chronic Health Evaluation system Ⅱ (APACHE Ⅱ) score,oxygenation index,blood routine test,coagulation function and inflammatory markers (procalcitonin,C-reaction protein,tumor necrosis factor and interleukin-6) within 24h and the state of survival or death of the 24th day.Risk factors for predicting progression of the high-risk ARDS patients into ARDS patients and influencing the prognosis of the ARDS patients were analyzed by using logistic regression.Results Univariate logistic regression analysis found that the independent risk factors for progression of ARDS were APACHE Ⅱ score (OR=6.764,P=0.001),hypoproteinemia (OR=10.54,P=0.002),white blood cell count (OR=3.912,P=0.012),fibrinogen (OR=9.953,P=0.064),and D-dimer (OR=4.239,P=0.029).The mortality rate was 43.75％ (36/64) in ARDS group,and the oxygenation index (OR=6.573,P=0.014),platelet count (OR=9.376,P=0.003),hypoproteinemia (OR=10.738,P=0.056) were the independent risk factors of death in ARDS patients.Multivariate logistic regression showed that combination of multiple indicators for predicting ARDS improved the specificity,but reduce the sensitivity.APACHE Ⅱ and hypoproteinemia (sensitivity 62.50％,specificity 92.42％) and APACHE Ⅱ and D dimmer (sensitivity 62.07％,specificity 93.33％) had better specificity and sensitivity.The specificity and sensitivity of combining hypoproteinemia and platelet count to predict the risk of death in these patients were 77.78％ and 60.71％.Conclusions In high-risk ARDS patients,combining hypoproteinemia or APACHE Ⅱ score with D-dimer to judge the development of ARDS has good specificity but poor sensitivity.For ARDS patients,low oxygenation index,thrombocytopenia and hypoproteinemia indicate a poor prognosis.

Objective: To evaluate the predictive value for baseline levels of high sensitivity C-reactive protein (hs-CRP) in morbidity of pulmonary embolism (PE). Methods: We conducted a prospective cohort study of 101510 subjects in Kailuan Group by regular physical examination from 2006-07 to 2007-10, and 94314 subjects were enrolled by relevant criteria including 75252 male and 19062 female. The baseline levels of hs-CRP were divided by quartile levels as①hs-CRP<0.3l mg/L,n=25592,②hs-CRP (0.3l-0.77) mg/L,n=21746,③hs-CRP (0.78-1.9) mg/L,n=23504 and④hs-CRP≥2.0 mg/L,n=23472. The subjects were followed-up for (81.5 ± 4.76) months, the morbidity of PE was collected and the predictive value of baseline levels of hs-CRP for PE occurrence was evaluate by multivariable Cox proportional hazard regression analysis. Results: The total PE morbidity was 0.15%, the female subjects were similar with male subjects,P>0.05. As the increased baseline level of hs-CRP, PE occurrence was elevated accordingly,P<0.05. Multivariable Cox proportional hazard regression analysis presented that with adjusted age, gender, smoking, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), fasting blood glucose (FBG), neutrophile granulocyte (NEU), white blood cells (WBC) and heart rate (HR), the subjects in the highest quartile group had 2.84 times higher risk for PE occurrence than the subjects in the lowest quartile group. With the elevated baseline level of hs-CRP, the subjects’ mean age, BMI, SBP, FBG and NEU levels increased accordingly, allP<0.05; while DBP, TG and HR were similar between quartile③ and quartile④ groups, allP>0.05. WBC counts had the increasing trend in quartile①,②,③ groups and had the decreasing trend in quartile④ group, while it was similar between quartile③ and quartile④ groups,P>0.05. Conclusion: Baseline hs-CRP level may predict the risk of PE morbidity; the increased hs-CRP level could be used as one of the predictors for PE occurrence.

Ten novel podophyllotoxin derivatives (IIIa-IIIi and IV) were synthesized by three-step reactions using podophyllotoxin and N-benzyloxycarbonyl glycine-L-proline as raw material. The structures of the target compounds were confirmed by 1H NMR, 13C NMR and MS. MTT method was used to test anti-tumor activity of the target compounds on HepG2, THP-1, HeLa and MCF-7 cells. The results showed that all the target compounds had inhibitory activity against HepG2, THP-1, HeLa and MCF-7 cells, and the inhibitory activity of IIIa on HepG2 cells was the most prominent with an IC50 value of 0.58 nmol/L. The binding mode of compound IIIa and FAPα was studied by molecular docking. Compound IIIa could bind to multiple sites of FAPα enzyme.

Objective:To investigate the clinical features, efficacy and risk factors for the development of anemia in newly-diagnosed multiple myeloma (NDMM) patients with anemia.Methods:A retrospective case-control study was conducted. General data and laboratory findings of 165 NDMM patients hospitalized at the People's Hospital of Qiannan in Guizhou Province and Affiliated Zhongshan Hospital of Dalian University from January 2018 to December 2022 were retrospectively analyzed. The patients were treated with chemotherapy regimens based on at least 2 new drugs including proteasome inhibitors and immunomodulators, and the efficacy was assessed after 4 cycles of treatment. According to peripheral blood hemoglobin (Hb) concentration, patients were divided into anemia group (Hb < 100 g/L) and non-anemia group (Hb ≥ 100 g/L). The general data, hematological indexes, and treatment effects of the two groups were compared. Pearson correlation coefficient was used to analyze the correlation between Hb and hematological indexes; multivariate logistic regression was used to analyze the risk factors for the occurrence of anemia in patients with NDMM; anemia defined by Hb was used as the gold standard, and receiver operating characteristic (ROC) curve was used to analyze the effect of the above risk factors for anemia on judging the occurrence of anemia in MM patients.Results:There were 120 cases in the anemia group with a median age [ M ( Q1, Q3)] of 64 years old (59 years old,74 years old), including 61 (50.8%) males and 59 (49.2%) females, and 45 cases in the non-anemia group with a median age of 61 years old (54 years old, 68 years old), including 27 (60.0%) males and 18 (40.0%) females. The age of patients and the proportion of patients with Durie-Salmon (DS) stage Ⅲ, international staging system (ISS) stage Ⅲ, renal impairment, and hypercalcemia in the anemia group were higher than those in the non-anemia group (all P < 0.05); peripheral blood platelet counts and serum albumin concentrations in the anemia group were lower than those in the non-anemia group, and the differences were statistically significant (all P < 0.05); the concentrations of globulin, the erythrocyte sedimentation rate (ESR) and serum β 2-microglobulin (β 2-MG) concentration, creatinine concentration, uric acid concentration, serum corrected calcium concentration, and the proportion of abnormal plasma cells in bone marrow in the anemia group were higher than those in the non-anemic group, and the differences were statistically significant (all P < 0.05). The objective remission rate in the anemia group was lower than that in the non-anemia group [42.5% (51/120) vs. 71.1% (32/45), χ2 = 10.72, P = 0.001]. Pearson correlation coefficient showed that Hb concentration was positively correlated with serum albumin concentration and platelet count ( r values were 0.569 and 0.229, both P < 0.05), and it was negatively correlated with ESR, globulin, β 2-MG, creatinine, uric acid, serum corrected calcium concentration and the proportion of abnormal plasma cells in bone marrow ( r values were -0.318, -0.465, -0.373, -0.230, -0.303, -0.248, and -0.368, all P < 0.05). Multivariate logistic regression analysis showed that the increased serum albumin concentration was the independent protective factor for the occurrence of anemia in patients with NDMM ( OR = 0.891, 95% CI: 0.798-0.994, P = 0.039), and the increased proportion of abnormal plasma cells in bone marrow was the independent risk factor for the occurrence of anemia in patients with NDMM ( OR = 0.941, 95% CI: 0.908-0.974, P = 0.001). ROC curve analysis showed that the areas under the curve for the occurrence of anemia in NDMM patients based on serum albumin concentration and the proportion of abnormal plasma cells in bone marrow were 0.813 (95% CI: 0.743-0.882, P < 0.001) and 0.792 (95% CI: 0.715-0.870, P < 0.001). Conclusions:Compared with NDMM patients without anemia, NDMM patients with anemia have abnormalities in several tests and poor treatment outcomes, and these patients should be actively corrected for anemia and hypovitaminosis, and clear plasma cell load as early as possible in conjunction with antimyeloma therapy.

Objective:To analyze the trend of premature death of non-communicable diseases (NCDs) in Wuxi from 2008 to 2018 and evaluate the influence of premature mortality probability caused by four main NCDs on life expectancy.Methods:Based on the mortality data collected by Wuxi Mortality Registration System and the population data collected by Wuxi Public Security Bureau during 2008-2018, this study analyzes the trend of the probability of premature death on malignant tumors, cardiovascular and cerebrovascular diseases, chronic respiratory diseases, and diabetes. The impact on life expectancy was analyzed by using the methods of abridged life table, Joinpoint regression, and life expectancy contribution decomposition.Results:From 2008 to 2018, the total probability of premature death of four main NCDs in Wuxi were declined consistently from 11.25% to 9.25% (AAPC = -2.0%, 95% CI: -2.6--1.5), higher in female (from 7.74% to 5.91%) than that in male (from 14.49% to 12.51%). The Wuxi resident's life expectancy increased by 1.86 years (from 78.66 to 80.52 years), in males and 1.26 years (from 83.85 to 85.11 years) in females, respectively. The decline of premature death of malignant tumors, cardiovascular and cerebrovascular diseases and chronic respiratory system diseases had a positive contribution to life expectancy, which contributed 0.34 years (23.90%), 0.15 years (10.50%), and 0.03 years (2.36%) to the life expectancy growth, respectively. Among which, premature death of cardiovascular and cerebrovascular diseases in men aged 40-55y had a negative contribution to life expectancy (-0.04 years). The probability of premature death of males with diabetes was on the rise (AAPC = 7.1%, 95% CI: 2.8-11.6), which negatively contributed to life expectancy for both males and females, reducing life expectancy by 0.03 years (-2.14%) in Wuxi. Conclusion:The premature death probability of four main NCDs in Wuxi declined consistently from 2008 to 2018, which played a positive role in the growth of life expectancy. Compared with females, males had a higher premature death probability and a slower rate of decline. More intervention and health management of premature male death on cardiovascular and cerebrovascular diseases and diabetes should be conducted to improve life expectancy further.

Objective:To compare the prevalence of frailty and related factors in middle-aged and elderly people aged ≥45 years in island and mountainous areas of Taizhou, Zhejiang Province.Methods:Based on cross-sectional design, stratified cluster sampling and quota sampling methods were adopted. One administrative district was randomly selected from each of six coastal and three inland administrative districts in Taizhou during July to August, representing two different geographical terrains. In the island area (Jiaojiang District), all residents aged ≥45 years were included by cluster sampling. In the mountainous area (Xianju County), participants were selected through quota sampling, with same gender and age distributions. Data about their demographic characteristics, lifestyle and health-related factors were collected through questionnaire surveys and laboratory examinations. The prevalence of frailty was assessed using the Fried frailty phenotype scale. Hierarchical analysis and multivariate logistic regression analysis were used to compare the influencing factors of frailty.Results:A total of 1 011 local residents were studied, in whom island and mountainous residents accounted for 48.1% (486/1 011) and 51.9% (525/1 011) respectively; men and women accounted for 45.9% (464/1 011) and 54.1% (547/1 011) respectively. Middle-aged (45-49 years), younger elderly (60-74 years), and older elderly (≥75 years) residents accounted for 38.6% (390/1 011), 44.6% (451/1 011), and 16.8% (170/1 011) respectively. The overall prevalence rate of frailty was 3.6% (36/1 011), the prevalence rate was 3.7% (17/464) in men and 3.5% (19/547) in women. The prevalence rates in age groups 45-59,60-74 years and ≥75 years were 0.3% (1/390), 2.2% (10/451), and 14.7% (25/170), respectively. The prevalence rates of frailty and pre-frailty in island area were 6.0% (29/486) and 39.1% (190/486), respectively, which was higher than those in mountainous area (1.3%, 7/525) and (30.9%, 162/525). After adjusting for potential confounding factors, the risk for frailty in island residents was significantly higher than that in mountainous residents (a OR=1.55,95% CI: 1.07-2.25, P=0.019). In island area, older age (60-74 years:a OR=2.52,95% CI: 1.56-4.13; ≥75 years:a OR=11.65,95% CI:5.38-26.70), being women (a OR=1.94,95% CI: 1.20-3.17), suffering from depression (a OR=1.09,95% CI:1.02-1.17) were associated with frailty symptoms. In mountainous area, older age was also associated with an increased risk of frailty symptoms, but the OR value was lower than those in island area (60-74 years: a OR=1.74,95% CI:1.04-2.94;≥75 years: a OR=4.78,95% CI:2.45-9.50). Polydrug use (a OR=2.08,95% CI: 1.14-3.80) and suffering from depression (a OR=1.10,95% CI: 1.02-1.18) had significant positive association with frailty symptoms. Higher education level had significant negative association with frailty symptoms (junior high school: a OR=0.40,95% CI: 0.21-0.75; senior high school and technical secondary school: a OR=0.29,95% CI: 0.15-0.53; college or above:a OR=0.22,95% CI: 0.11-0.42). Conclusions:The prevalence of frailty in middle-aged and elderly community residents was significantly higher in island area than in mountainous area in Taizhou. The frailty-related factors varied with area. The elderly people (≥75 years) and women in island area had higher risk for frailty. Older age and suffering from depression were the independent risk factors for frailty. It is necessary to pay attention to the health risk factors and special environment in island area, and take comprehensive intervention measures to delay the process of debilitation and improve the quality of life of middle-aged and elderly people.

Objective:To understand the incidence of diabetes and influencing factors, the trend of FPG change and risk for mortality in HIV-infected individuals after antiretroviral therapy (ART) in Dehong Dai and Jingpo Autonomous Prefecture (Dehong).Methods:The HIV/AIDS treatment database was collected from China Information System for Disease Control and Prevention. This retrospective cohort study was conducted in HIV-infected individuals with access to ART in Dehong during 2004-2020.The Cox proportional hazard regression model was used to analyze the incidence density of diabetes, the influencing factors and risk for mortality in HIV-infected individuals with access to ART, mixed linear effects model was used to analyze the trend of FPG change and predict FPG in those with different glucose metabolic status at baseline survey. Statistical analysis was performed using software SAS 9.4.Results:A total of 8 763 HIV-infected individuals were included, in whom 8 432 (96.2%) had no diabetes, 331 had diabetes. The incidence density of diabetes was 2.31/1 000 person years. Multivariate Cox proportional hazard regression analysis revealed that 30- 59 years old, BMI ≥24.0 kg/m 2, Efavirenz (EFV) based initial treatment regimen and impaired fasting glucose (IFG) at baseline survey were significantly and positively associated with incidence of diabetes. Mixed effect model revealed that FPG was positively correlated with the duration of ART, age and baseline FPG. Suffering from diabetes was a risk factor for mortality in HIV-infected individuals both at baseline survey and during follow-up. Conclusions:The risk for diabetes increased in HIV-infected individuals who were 30-59 years old, baseline BMI ≥24.0 kg/m 2, received EFV based initial treatment, and IFG in HIV-infected individuals after antiretroviral therapy in Dehong, 2004-2020. It is important to pay close attention to their blood glucose, and patients with high blood glucose should receive treatment as early as possible.

Objective To evaluate the clinical use of the baseline CT angiography(CTA)quantitative score(self-designed collateral circulation quantitative,SD-CCQ)in determining the collateral circulation compensation status in patients with acute ischemic stroke(AIS),as well as the reliability and accuracy of the SD-CCQ score and the Alberta Stroke Program Early CT Score(ASPECTS).Methods Retrospective analysis was made on the clinical and imaging data,including CT,CTA and DWI image data,of 84 patients who were admitted for acute ischemic stroke to the Department of Neurorehabilitation of Zhongshan Hospital of Traditional Chinese Medicine from January 2020 to December 2022.Their CTA source images were annotated using a multi-task deep learning method for vascular segmentation.The ASPECTS score and SD-CCQ score were then applied to the CTA images following vascular segmentation in order to assess the collateral circulation compensation of AIS patients.The Kappa test was used to assess the consistency of the two methods used to assess collateral circulation,and the multifactorial Logistic regression analysis was used to examine the relationship between the SD-CCQ and the prognosis of the AIS patients.Results ASPECTS score had good consistency with SD-CCQ score in evaluating collateral circulation in AIS patients(κ=0.65,P＜0.001),and the diagnostic accuracy of the latter for benign collateral circulation in AIS was 96.15％.Logistic regression analysis showed that the new collateral circulation score,baseline NIHSS,and DWI infarct volume were the main factors affecting the long-term prognosis of AIS patients.Conclusion The new scoring system SD-CCQ can be used to evaluate the compensatory status of collateral circulation in AIS patients,which may help in clinical treatment decision-making and prognosis prediction.

Objective To compare the dose difference of intensity-modulated radiotherapy (IMRT) with different gantry angle between target volumes and surrounding normal tissues in lumbar spinal metastases therapy. Methods Ten patients with lumbar spinal metastases were enrolled in the study. Three plans with the same prescription dose of 3000 cGy/10f were designed by seven-equal beams (plan-A), five-back beams (plan-B) and seven-back beams (plan-C). All the plans were designed with the same objective function and dose limiting condition. The difference of dosimetric parameters of planning target volume (PTV), organ at risk (OAR), normal tissues, and treatment parameters in all the plans were compared with SPSS 21.0 statistical software. Results All the plans satisfied the clinical requirement. There was no significant difference in the D_mean, D_2%, D_98%, CI and HI of PTV between plan-A and plan-C (P >0.05), and these parameters of plan-A and plan-C were better than plan-B (P < 0.05). Compared with the other two plans, plan-B reduced the dosimetric parameters of bilateral kidney (P < 0.05), whereas plan-B increased the D_max of spinal cord (P < 0.05). The V₅ and V₁₀ of normal tissue of plan-B were lower than the other two plans while the V₁₅, V₂₀ and V₂₅ showed inverse relationship (P < 0.05). plan-B had certain advantages in shortening the monitor units and treatment time (P < 0.05).. Conclusions The seven-equal beams (plan-A) and seven-back beams (plan-C) IMRT plans can provide better target dose distribution, and reduce the D_max of spinal cord. Five-back beams (plan-B) IMRT plan had certain advantages in protecting bilateral kidney and shortening treatment time.