Objectives:This study aimed to compare the clinical characteristics between light-chain cardiac amyloidosis(AL-CA)and transthyretin cardiac amyloidosis(ATTR-CA). Methods:A retrospective analysis was conducted in patients diagnosed with AL-CA and ATTR-CA at Peking University Third Hospital from January 2011 to October 2023.There were 35 patients diagnosed with AL-CA(AL-CA group)and 21 patients diagnosed with ATTR-CA(ATTR-CA group).Clinical manifestations,ECG,echocardiography and cardiac magnetic resonance(CMR)results were compared between patients with AL-CA and ATTR-CA. Results:Compared to the AL-CA group,the ATTR-CA group has a higher proportion of males(54.3%vs.90.5%,P=0.005),the proportion of patients with hypertension was lower(42.9%vs.9.5%,P=0.009).In terms of clinical manifestations,edema,proteinuria,renal insufficiency and serous effusion were more common in the AL-CA group,while the incidence of limb numbness was higher in the ATTR-CA group(all P＜0.05).There were significant differences in the incidence of limb lead low voltage(57.1%vs.28.6%,P=0.038)and conduction block(14.3%vs.61.9%,P=0.001)between the AL-CA group and ATTR-CA group on ECG.Although the AL-CA group had a shorter time interval from initial symptoms to diagnosis(6.0[2.0,15.0]months vs.35.0[14.0,56.5]months,P=0.002)and less pronounced left ventricular thickening on echocardiography(interventricular septum thickness:[13.3±2.0]mm vs.[15.7±2.2]mm,P=0.001;left ventricular mass:[198.4±67.8]g vs.[246.6±53.5]g,P=0.009)and CMR(interventricular septum thickness:[16.0±2.1]mm vs.[18.9±3.8]mm,P=0.033;left ventricular mass:[132.9±45.3]g vs.[194.7±50.8]g,P=0.011),the proportion of patients with NYHA grades Ⅲ-Ⅳ(48.6%vs.19.0%,P=0.027)was higher,the levels N-terminal B-type natriuretic peptide precursor and cardiac troponin T levels were higher(both P＜0.05),and the 1-year survival rate was lower in the AL-CA group than in the ATTR-CA group(65.7%vs.100%,P=0.001). Conclusions:AL-CA and ATTR-CA had differences in clinical and ECG manifestations.While the severity of left ventricular hypertrophy was less pronounced in AL-CA compared to ATTR-CA,cardiac function and prognosis were worse in AL-CA than in ATTR-CA.

Afferent baroreflex failure(ABF)is a rare disease.It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medul-la.The recognized causes include trauma,surgery in related areas(radical neck tumor surgery,carotid endarterectomy),neck radiotherapy,brain stem stroke,tumor growth paraganglioma and hereditary diseases,among which the most common cause is extensive neck surgery or radiotherapy for neck cancer.The main manifestations are fluctuating hypertension,orthostatic hypotension,paroxysmal tachycardia and bradycardia.This case is a young man,whose main feature is blood pressure fluctuation,accom-panied by neurogenic orthostatic hypotension(nOH).After examination,the common causes of hyper-tension and nOH were ruled out.Combined with the previous neck radiotherapy and neck lymph node dissection,it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection,which was called ABF.At the same time,the patient was complicated with chronic hyponatremia.Com-bined with clinical and laboratory examination,the final consideration was caused by syndrome of in-appropriate antidiuretic hormone(SIADH).Baroreceptors controlled the secretion of heart rate,blood pres-sure and antidiuretic hormone through the mandatory"inhibition"signal.We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery,which leads to abnormal blood pres-sure regulation and nOH,while the function of inhibiting ADH secretion was weakened,resulting in higher ADH than normal level and mild hyponatremia.The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate,and to alleviate the on-set of symptomatic hypotension.At present,drug treatment is still controversial,and non-drug treatment may alleviate some patients'symptoms,but long-term effective treatment still needs further study.The incidence of ABF is not high,but it may lead to serious cardiovascular and cerebrovascular events,and the mechanism involved is extremely complicated,and there are few related studies.The reports of rele-vant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complica-tions.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

Objective:To evaluate the efficacy by using domestic recombinant human thyroid-stimulating hormone (rhTSH) in patients with differentiated thyroid cancer (DTC) before or after 131I therapy. Methods:From May 2019 to November 2020, a total of 24 patients with DTC (5 males, 19 females, median age 41 years) in Peking Union Medical College Hospital and Affiliated Tumor Hospital of Zhengzhou University were enrolled into the open-label, dose escalation phase Ⅰ study. All patients were divided into 4 domestic rhTSH dose groups: 0.9 mg×1 d (group A), 0.9 mg×2 d (group B), 1.8 mg×1 d (group C), 1.8 mg×2 d (group D) in succession, with 6 patients in each group. Each patient underwent rhTSH phase and thyroid hormone withdrawal (THW) phase. The end point included safety, tolerability, the quality of life (hypothyroidism symptom and sign score (Billewicz score), profile of mood states (POMS)), effectiveness (thyroid-stimulating hormone (TSH) and thyroglobulin (Tg) levels, diagnostic whole-body scan (Dx-WBS)) and pharmacokinetic characteristics (peak time, peak concentration) of rhTSH. Paired t test and Wilcoxon signed rank test were used for statistical analysis. Results:There were no dose-limiting toxicities, serious adverse events, or no grade ≥3 adverse events reported. The quality of life in rhTSH phase was significantly better than those in THW phase, including the lower Billewicz score (-53.00(-53.00, -53.00) vs -39.50(-47.00, -23.00); S=119.50, P<0.001) and the lower POMS score (91.92±12.06 vs 99.67±19.13; t=0.95, P=0.025). Serum TSH level was increased from 0.04(0.02, 0.11) mU/L (baseline) to 150.00(105.20, 173.31) mU/L 24 h after the last rhTSH administration, which was increased along with the elevation of rhTSH doses. In the THW phase, patients′ TSH levels were≥30 mU/L after 23 d (median) of THW, with the median of 73.51(57.22, 106.22) mU/L. Median Tg level of baseline was 0.10(0.10, 0.41) μg/L, which reached a peak of 0.85(0.12, 3.01) μg/L at 48 h after rhTSH administration. The peak Tg level in the THW phase was 0.88(0.15, 8.04) μg/L. The Dx-WBS consistency rate between rhTSH and THW phase was 95.8%(23/24). Conclusion:rhTSH is a safe and effective method to stimulate the serum Tg level and radioiodine uptake in patients undergoing post-operation or post- 131I assessment for DTC, as well as maintain a higher quality of life in comparison to THW phase.

Recently, with the development and the continuous improvement of various CRISPR systems represented by CRISPR/Cas9, gene editing technology has been gradually improved, and widely applied to the preparation of animal models of human diseases. The gene edited animal models provide important materials for the study of pathogenesis, pathological process, prevention and treatment of human diseases. At present, the gene edited animal models used in human disease research include mainly the rodent models represented by mice and rats, and large animal models represented by pigs. Among them, rodents differ greatly from humans in all aspects of their bodies and have short life span as well, which cannot provide effective evaluation and long-term tracking for the research and treatment of human diseases. On the other hand, pig is closer to human in physiology, anatomy, nutrition and genetics, which provides an important animal model in the field of organ transplantation and human disease research. In this paper, the application of the gene edited animal models was summarized in the researches of 5 human diseases such as neurodegenerative diseases, familial hypertrophic cardiomyopathy, cancer, immunodeficiency diseases and metabolic diseases. We hope this paper will provide a reference for the research of human diseases and the preparation of relative animal models.
Animals ; CRISPR-Cas Systems ; Clustered Regularly Interspaced Short Palindromic Repeats ; Disease Models, Animal ; Gene Editing ; Humans

Objective To investigate the expression of bone marrow γ-H2AX in the patients with multiple myeloma(MM) and its correlation with the prognosis.Methods The patients with newly diagnosed MM in this hospital were selected as the case group,and the patients with non-hemopoietic system tumor without obvious morphological abnormalities by bone marrow smear and biopsy served as the control group.The immunohistochemistry was adopted to detect the expression level of bone marrow γ-H2AX in the cases group and control group,the image-Pro Plus(IPP) semiquantitative analysis was performed.The expression differences were compared between the two groups,moreover the case group was re-divided into the strong expression group and weak expression group according to γ-H2AX expression level.Then the relation ship between γ-H2AX expression level and the prognosis in the patients with MM.Results The bone marrow γ-H2AX expression level in the case group was significantly higher than that in the control group (P＜0.05);the level of γ-H2AX expression in the strong expression group was significantly stronger than that in the weak expression group (P＜0.05).Conclusion The level of γ-H2AX expression was higher among MM patients,and the over expression of γ-H2AX predicts the shorter survival time.

Objective: To develop a new method for the determination of calcipotriol ointment by high-speed counter-current chro-matography(HSCCC). Methods: An HSCCC method was used coupled with two-phase solvent system consisting of petroleum benzine-ethanol -water(2: 1: 0. 5, v/v/v). The injection volume was 1. 0 ml and the detection wavelength was set at 265 nm. Results: The proposed method showed good linearity within the range of 4.02-40.20 μg·ml-1(r=0.999 4). The average recovery was 99.2%, and the RSD was 0. 4% (n=9) . Conclusion: The HSCCC method is simple and rapid, and suitable for the determination of calcipo-triol ointment.

Objective To analysis the relationship between of waist-to-height ratio(WHtR) and the non-alcoholic fatty liver disease(NAFLD).Methods A total of 7 896 were selected as observed subjects from the Kailuan Group in 2011-2012 health physical examination.A questionnaire survey,blood biochemical and abdominal ultrasound examination were finished by trained medical staff.According to previous study recommended cut points the observed subjects was divided into two groups:abdominnal obesity group(WHtR≥0.5,n=3 185) and non-abdominnal obesity group(WHtR<0.5,n=479).According to the WHtR and its quartile,the observed subjects was divided into four groups(first(WHtR<0.47),second(0.47≤WHtR<0.51),third(0.51≤WHtR<0.55) and forth(WHtR≥0.55) quartile groups).NAFLD detection rate of the four groups were Compared.Multiple Logistic regression analysis was used to analyze the influencing factors of the NAFLD.Results (1)The detection rate of NAFLD in abdominnal obesity group was higher than that in non-obesity group(62.7% vs.21.5%,P<0.01).Along with increasing WHtR level in the 4 quartile groups,the incidence of NAFLD was progressively increased,being 12.6 %,38.1%,57.5% and 72.5% respectively in the total population.After stratified by gender,15.1%,40.6%,59.6% and 75.0% in male,7.8%,31.5%,48.3% and 63.8% in female.In the same WHtR group,the NAFLD detection rate of male was higher than female,the differences were statistically significant(P<0.01).(2)Multiple logistic regression analysis showed that compared with the first quartile group,the second,third and forth quartile groups had increased risk of NAFLD after adjusting age,gender and other risk factors,the OR value being 3.19,5.93 and 9.81 in the total population.After adjusting above factors,the OR value being 3.12,6.02 and 10.45 in male,3.32,5.37 and 7.57 in female,respectively.Conclusion The incidence of NAFLD is increased along with the increasing the WHtR.

Objective To investigate the effect of Yunnan Baiyao Plaster on serum related markers levels in the patients with stroke ,to evaluate its improvement effect on the neurological dysfunction and pain and to analyze its effect mechanism .Methods Eighty cases of hemorrhagic stroke treated in the neurosurgical department of our hospital from February 2015 to June 2016 were screened as the research subjects and divided into the control group and observation group according to the random number table method ,40 cases in each group .All subjects were given the routine treatment ,while the observation group received the external use of Yunnan Baiyao Plaster around the head operative incision and drilling ,to give Yunnan white ointment ,with the attaching area of 5 cm × 4 cm ,once daily ,for consecutive 7 d ,meanwhile took oral Yunnan Baiyao Plaster 0 .5 g with warm boiling water ,once daily for consecutive 7 d .The serum markers levels before and after treatment ,neural function defect score ,decline proportion of NIHSS scores and prognostic indicators were compared between the two groups .Results The mean pain value within 1 week in the obser-vation group was lower than that in the control group ,the difference was statistically significant (P<0 .05);the pain peak value and valley value within 1 weeks had no statistical difference between the observation group and control group ,the difference was not statistically significant (P> 0 .05);after 2 weeks ,ET ,TNF-α and IL-1β levels in the observation group and control group were lower than those before treatment in the intra-group comparison ,while the comparison between the two groups showed that the ob-servation group was lower than the control group ,the difference was statistically significant (P<0 .05);the decrease rate of NIH-SS scores within 2 weeks in the observation group was (74 .4 ± 5 .2)% ,which was higher than (66 .3 ± 10 .3)% in the control group ,the difference was statistically significant (P<0 .05);the occurrence rate of severe complications within 2 weeks in the ob-servation group was 7 .5% (3/40) ,the mortality rate was 2 .5% (1/40) ,which in the control group were 12 .5% (5/40) and 2 .5%(1/40) ,the difference was not statistically significant (P>0 .05) .Conclusion The combined treatment of Yunnan Baiyao Plaster in the patients with hemorrhagic stroke conld relieve pain and reduce the neurological deficit ,which might be related to the mechanism of anti-inflammation and analgesia .

Objective To investigate the effects of waist-to-hip ratio (WHR) on the formation of carotid plaque in the middle-aged and elderly people.Methods A total of five thousand and ninety-nine participants who have taken physical examination in Tangshan Kailuan Company from June 2010 to October 2011(above 40 years old,no previous history of ischemic stroke,transient ischemic attack,myocardial infarction) were enrolled in this study.Questionnaire survey,blood biochemical and carotid artery ultrasound examination were used to examine the subjects.According to WHR,quartile division was used to divide the subjects into four groups.The detection rates of carotid plaque among the 4 groups were compared.Multivariate logistic regression analysis was used to analyze the factors effecting carotid artery plaques.Results (1) The detection rate of carotid artery plaque increased with the increase of WHR,the rates of the first,second,third and fourth group were 20.7% (571/2 753),21.9% (604/2 753),27.5% (758/2 753) and 29.8% (820/2 753) respectively.The difference was statistically significant(P=0.000).(2) Logistic regression model was used to analyze multiple factors affecting the detection rate of carotid plaque.After the correction of other factors,compared with the first group,the carotid artery plaque detection rate in the second,third,fourth group were all increased,the OR values were 1.23(95%CI:1.10~1.54),1.65(95%CI:1.52~2.13),1.67(95%CI:1.54~2.17),respectively.Conclusion The increased WHR in the middle-aged and elderly population may increase the risk of carotid plaque formation.