Objective:To construct a risk prediction model for pulmonary infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on decision tree method, and analyze nursing strategies.Methods:From March 2022 to June 2024, convenience sampling was used to select 162 patients with AECOPD at the First Affiliated Hospital of Zhengzhou University as study subjects. Patients with AECOPD complicated by pulmonary infection were designated as infection group ( n=82), while patients without pulmonary infection were designated as non-infection group ( n=80). Relevant clinical data were collected, and multiple Logistic regression was used to analyze the influencing factors of pulmonary infections in AECOPD patients, and a decision tree prediction model was established. Results:Multivariate Logistic regression analysis showed that age, glucocorticoid use time, hospital stay, mechanical ventilation history, diabetes, C-reactive protein and procalcitonin were the influencing factors of AECOPD patients with pulmonary infection ( P<0.05). The risk decision tree model of AECOPD patients with pulmonary infection based on the above factors showed that procalcitonin, C-reactive protein, mechanical ventilation history and diabetes were nodes, with four layers, six terminal nodes and four explanatory variables. The area under the receiver operating characteristic curve was 0.929 [95% CI (0.889, 0.968) ], the sensitivity was 0.854, the specificity was 0.875, and the predictive performance was good. Conclusions:Age, glucocorticoid use time, hospital stay, mechanical ventilation history, diabetes, C-reactive protein and procalcitonin are independent risk factors for AECOPD patients with pulmonary infection. The decision tree prediction model constructed has good predictive performance and can be used as a basis for selecting nursing strategies.

Objective:To construct a risk prediction model for pulmonary infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on decision tree method, and analyze nursing strategies.Methods:From March 2022 to June 2024, convenience sampling was used to select 162 patients with AECOPD at the First Affiliated Hospital of Zhengzhou University as study subjects. Patients with AECOPD complicated by pulmonary infection were designated as infection group ( n=82), while patients without pulmonary infection were designated as non-infection group ( n=80). Relevant clinical data were collected, and multiple Logistic regression was used to analyze the influencing factors of pulmonary infections in AECOPD patients, and a decision tree prediction model was established. Results:Multivariate Logistic regression analysis showed that age, glucocorticoid use time, hospital stay, mechanical ventilation history, diabetes, C-reactive protein and procalcitonin were the influencing factors of AECOPD patients with pulmonary infection ( P<0.05). The risk decision tree model of AECOPD patients with pulmonary infection based on the above factors showed that procalcitonin, C-reactive protein, mechanical ventilation history and diabetes were nodes, with four layers, six terminal nodes and four explanatory variables. The area under the receiver operating characteristic curve was 0.929 [95% CI (0.889, 0.968) ], the sensitivity was 0.854, the specificity was 0.875, and the predictive performance was good. Conclusions:Age, glucocorticoid use time, hospital stay, mechanical ventilation history, diabetes, C-reactive protein and procalcitonin are independent risk factors for AECOPD patients with pulmonary infection. The decision tree prediction model constructed has good predictive performance and can be used as a basis for selecting nursing strategies.

Objective:By analyzing resting state functional magnetic resonance imaging data, this study aims to explore the effects of glucocorticoids (GC), glucocorticoids combined with cyclophosphamide (CTX) and/or hydroxychloroquine sulfate (HCQ) treatment on brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations, providing a basis for early identification and intervention of changes in brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations.Methods:Systemic lupus erythematosus patients without major neuropsychiatric manifestations were divided into drug na?ve group, GC group, and GC combined with CTX and/or HCQ group based on their treatment status at the time of enrollment. Health controls (HCs) were selected based on gender, age, and education level. The low frequency amplitude (ALFF), fractional low frequency amplitude (fALFF), and regional homogeneity (ReHo) were calculated for each of the four groups of participants. When comparing multiple groups, χ2 test or Fisher's exact test was used for count data, analysis of variance or Kruskal-Wallis H test was used for continuous variables, and LSD method was used for post hoc comparisons. Results:After matching, 22, 30, 50, and 29 cases were finally included. There were significant differences in brain function in multiple brain regions among the four groups. Specifically, compared with the HCs group, the ALFF values of the right posterior central gyrus ( t=-2.96) and the right paracentral lobule ( t=-2.95) in the drug na?ve group were decreased. In the GC group, the ALFF values in the right paracentral lobule ( t=-2.93), the right posterior central gyrus ( t=-2.93) and the right anterior central gyrus ( t=-2.94) were decreased. The ALFF values of the right paracentral lobule ( t=-2.90) and the right anterior central gyrus ( t=-2.90) were decreased in GC+CTX and/or HCQ groups. Compared with the drug na?ve group, ALFF values were higher in the right posterior central gyrus ( t=-3.00) and the right rolandic operculum ( t=-2.91) in GC+CTX and/or HCQ groups. Compared with the HCs group, fALFF values of the right anterior central gyrus ( t=-2.95) and the left posterior central gyrus ( t=-2.97) in the drug na?ve group decreased, and fALFF values of the right anterior central gyrus ( t=-2.94) and the left posterior central gyrus ( t=-2.98) in the GC group decreased. fALFF values decreased in the left posterior central gyrus ( t=-2.91) of GC+CTX and/or HCQ groups. fALFF values in the right anterior central gyrus ( t=-2.89) were higher in GC+CTX and/or HCQ group than in GC group. Compared with HCs, the ReHo value in the right posterior central gyrus ( t=-2.97) of the drug na?ve group decreased, and the ReHo value in the right anterior central gyrus ( t=-2.95) of the GC group decreased. The ReHo of GC+CTX and/or HCQ group was higher in the right anterior central gyrus ( t=-2.91) than that of the drug na?ve group, and the ReHo of the right posterior central gyrus ( t=-2.93) was higher than that of the GC group. The above results were adjusted by Gaussian random-field (GRF) multiple comparison ( Pvoxel<0.005, Pcluste<0.010). Conclusion:Systemic lupus erythematosus patients without major neuropsychiatric manifestations have reduced functional activity in multiple brain regions of the whole brain. GC combined with CTX and/or HCQ may have better effects on improving brain function than GC alone, and it mainly acts on sensorimotor related brain regions.

Objective:By analyzing resting state functional magnetic resonance imaging data, this study aims to explore the effects of glucocorticoids (GC), glucocorticoids combined with cyclophosphamide (CTX) and/or hydroxychloroquine sulfate (HCQ) treatment on brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations, providing a basis for early identification and intervention of changes in brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations.Methods:Systemic lupus erythematosus patients without major neuropsychiatric manifestations were divided into drug na?ve group, GC group, and GC combined with CTX and/or HCQ group based on their treatment status at the time of enrollment. Health controls (HCs) were selected based on gender, age, and education level. The low frequency amplitude (ALFF), fractional low frequency amplitude (fALFF), and regional homogeneity (ReHo) were calculated for each of the four groups of participants. When comparing multiple groups, χ2 test or Fisher's exact test was used for count data, analysis of variance or Kruskal-Wallis H test was used for continuous variables, and LSD method was used for post hoc comparisons. Results:After matching, 22, 30, 50, and 29 cases were finally included. There were significant differences in brain function in multiple brain regions among the four groups. Specifically, compared with the HCs group, the ALFF values of the right posterior central gyrus ( t=-2.96) and the right paracentral lobule ( t=-2.95) in the drug na?ve group were decreased. In the GC group, the ALFF values in the right paracentral lobule ( t=-2.93), the right posterior central gyrus ( t=-2.93) and the right anterior central gyrus ( t=-2.94) were decreased. The ALFF values of the right paracentral lobule ( t=-2.90) and the right anterior central gyrus ( t=-2.90) were decreased in GC+CTX and/or HCQ groups. Compared with the drug na?ve group, ALFF values were higher in the right posterior central gyrus ( t=-3.00) and the right rolandic operculum ( t=-2.91) in GC+CTX and/or HCQ groups. Compared with the HCs group, fALFF values of the right anterior central gyrus ( t=-2.95) and the left posterior central gyrus ( t=-2.97) in the drug na?ve group decreased, and fALFF values of the right anterior central gyrus ( t=-2.94) and the left posterior central gyrus ( t=-2.98) in the GC group decreased. fALFF values decreased in the left posterior central gyrus ( t=-2.91) of GC+CTX and/or HCQ groups. fALFF values in the right anterior central gyrus ( t=-2.89) were higher in GC+CTX and/or HCQ group than in GC group. Compared with HCs, the ReHo value in the right posterior central gyrus ( t=-2.97) of the drug na?ve group decreased, and the ReHo value in the right anterior central gyrus ( t=-2.95) of the GC group decreased. The ReHo of GC+CTX and/or HCQ group was higher in the right anterior central gyrus ( t=-2.91) than that of the drug na?ve group, and the ReHo of the right posterior central gyrus ( t=-2.93) was higher than that of the GC group. The above results were adjusted by Gaussian random-field (GRF) multiple comparison ( Pvoxel<0.005, Pcluste<0.010). Conclusion:Systemic lupus erythematosus patients without major neuropsychiatric manifestations have reduced functional activity in multiple brain regions of the whole brain. GC combined with CTX and/or HCQ may have better effects on improving brain function than GC alone, and it mainly acts on sensorimotor related brain regions.

OBJECTIVE: To assess the value of single sperm sequencing in preimplantation genetic testing for monogenic disease (PGT-M). METHODS: A Chinese couple with two children whom had died of Spinal muscular atrophy (SMA) and attended the Jiangxi Provincial Maternal and Child Health Care Hospital in June 2020 was selected as the subject. Eleven single sperm samples were isolated by mechanical immobilization and subjected to whole genome amplification. Real-time PCR and Sanger sequencing were used to detect the SMN1 variants in the single sperm samples. Genomic DNA of the wife, her parents and the husband, as well as one single sperm sample harboring the SMN1 variant and two single sperm samples without the variant were used for the linkage analysis. Targeted capture and high-throughput sequencing were carried out to test 100 single nucleotide polymorphisms distributed within 2 Mb up- and downstream the variant site. The haplotypes linked with the SMN1 variants were determined by linkage analysis. Blastocyst embryos were harvested after fertilizing by intracytoplasmic sperm injection. Cells from the trophoblasts of each embryo were biopsied and subjected to whole genome amplification and targeted capture and high-throughput sequencing to determine their carrier status. Chromosomal aneuploidy of wild-type embryos was excluded. An euploid embryo of high quality was transferred. Amniotic fluid sample was taken at 18 weeks of gestation to confirm the status of the fetus. RESULTS: Genetic testing showed that the couple both had deletion of exons 7 ~ 8 of the SMN1 gene. The wife has inherited the deletion from her father, while the husband was de novo. The haplotypes of the husband were successfully constructed by single sperm sequencing. Preimplantation genetic testing has indicated that 5 embryos had harbored the heterozygous variant, 4 embryos were of the wild type, among which 3 were euploid. Prenatal diagnosis during the second trimester of pregnancy has confirmed that the fetus did not carry the deletion. CONCLUSION By single sperm sequencing and PGT-M, the birth of further affected child has been successfully avoided.
Humans ; Pregnancy ; Female ; Child ; Male ; Preimplantation Diagnosis ; East Asian People ; Semen ; Genetic Testing ; Muscular Atrophy, Spinal/genetics* ; Aneuploidy ; Blastocyst/pathology* ; High-Throughput Nucleotide Sequencing ; Spermatozoa

Objective:To explore the value of polar body sequencing in preimplantation genetic testing (PGT) for monogenic disease of a female patient with Van der Woude syndrome.Methods:PGT based on polar body sequencing was performed for a female patient with Van der Woude syndrome caused by a de novoIRF6 pathogenic variant. Totally six oocytes were fertilized by intracytoplasmic sperm injection (ICSI). The first, second polar bodies and the trophoblast ectoderm cells of blastocysts were biopsied respectively. Sanger sequencing was used to detect the pathogenic variant in the biopsied cells after genome-wide amplification. The genotypes and pathogenic possibilities of the embryos were inferred according to the genotypes of corresponding tested polar bodies. In order to prevent the absence of transplantable embryos due to the failure of blastocyst culture, vitrification was performed on an embryo with good morphology and low pathogenic possibility before blastocyst formation. The 175 single nucleotide polymorphisms (SNPs) within the 1M region upstream and downstream from the pathogenic variant location were tested by targeted capture sequencing in the couple and selected polar bodies and embryos to construct the haplotypes. An embryo with low pathogenic possibility was transferred. Prenatal diagnosis was strongly recommended after successful pregnancy. Prenatal and postnatal follow-up were performed. Results:Totally six first polar bodies and six second polar bodies were obtained. The pathogenic variant was successfully sequenced in 11 polar bodies. Among the six embryos, one embryo with low pathogenic possibility was vitrified on day 4 (D4) after fully informed consent of the couple; one embryo developed to blastocyst was detected with high pathogenic possibility; the other four embryos were degenerated during blastocyst culture. The SNP haplotypes closely linked to the pathogenic variant location were successfully constructed by linkage analysis. The haplotype analysis of the embryos was in consistent with Sanger sequencing. The D4 embryo with low pathogenic possibility was transferred. The couple refused to conduct invasive prenatal diagnosis after pregnancy. None orofacial clefts were detected after the baby was born, and the pathogenic variant was not detected in the neonatal cord blood either.Conclusion:This study successfully blocked a female patient with Van der Woude syndrome caused by a de novoIRF6 pathogenic variant give birth to an affected baby by polar body sequencing based preimplantation genetic testing for monogenic disease.

Objective:To explore the value of polar body sequencing in preimplantation genetic testing (PGT) for monogenic disease of a female patient with Van der Woude syndrome.Methods:PGT based on polar body sequencing was performed for a female patient with Van der Woude syndrome caused by a de novoIRF6 pathogenic variant. Totally six oocytes were fertilized by intracytoplasmic sperm injection (ICSI). The first, second polar bodies and the trophoblast ectoderm cells of blastocysts were biopsied respectively. Sanger sequencing was used to detect the pathogenic variant in the biopsied cells after genome-wide amplification. The genotypes and pathogenic possibilities of the embryos were inferred according to the genotypes of corresponding tested polar bodies. In order to prevent the absence of transplantable embryos due to the failure of blastocyst culture, vitrification was performed on an embryo with good morphology and low pathogenic possibility before blastocyst formation. The 175 single nucleotide polymorphisms (SNPs) within the 1M region upstream and downstream from the pathogenic variant location were tested by targeted capture sequencing in the couple and selected polar bodies and embryos to construct the haplotypes. An embryo with low pathogenic possibility was transferred. Prenatal diagnosis was strongly recommended after successful pregnancy. Prenatal and postnatal follow-up were performed. Results:Totally six first polar bodies and six second polar bodies were obtained. The pathogenic variant was successfully sequenced in 11 polar bodies. Among the six embryos, one embryo with low pathogenic possibility was vitrified on day 4 (D4) after fully informed consent of the couple; one embryo developed to blastocyst was detected with high pathogenic possibility; the other four embryos were degenerated during blastocyst culture. The SNP haplotypes closely linked to the pathogenic variant location were successfully constructed by linkage analysis. The haplotype analysis of the embryos was in consistent with Sanger sequencing. The D4 embryo with low pathogenic possibility was transferred. The couple refused to conduct invasive prenatal diagnosis after pregnancy. None orofacial clefts were detected after the baby was born, and the pathogenic variant was not detected in the neonatal cord blood either.Conclusion:This study successfully blocked a female patient with Van der Woude syndrome caused by a de novoIRF6 pathogenic variant give birth to an affected baby by polar body sequencing based preimplantation genetic testing for monogenic disease.

Objective:To explore the effects of long noncoding RNA adenosine diphosphate-dependent glucokinase antisense RNA 1(ADPGK-AS1) on the proliferation, migration and invasion of human retinoblastoma (RB) Y-79 cells and its regulatory effect on microRNA-623 (miR-623).Methods:The peritumoral tissue and RB specimens were collected from 39 eyes of 39 patients with RB during surgery in The First Affiliated Hospital of Zhengzhou University and Zhumadian Central Hospital from February 2017 to November 2018.Real-time fluorescence quantitative PCR was employed to detect the expression of ADPGK-AS1 and miR-623 in the specimens.Human RB line Y-79 cells were cultured in vitro and divided into small interfering RNA-normal control (siRNA-NC) group, siRNA-ADPGK-AS1 group, microRNA (miR)-NC group, miR-623 group, siRNA-ADPGK-AS1+ anti-miR-NC group and siRNA-ADPGK-AS1+ anti-miR-623 group.The cell proliferation rate was detected by MTT method.Transwell cell experiment was performed to detect the number of migrating and invading cells.The dual luciferase reporter experiment was used to evaluate the targeting relationship between ADPGK-AS1 and miR-623.The expression of Ki-67, matrix metalloproteinases (MMP)-2, and MMP-9 in the cells was detected by Western blot assay.Written informed consent was obtained from each patient prior to any medical examination and treatment.This study protocol adhered to the Declaration of Helsinki.The use of the human specimens was approved by an Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2017-KY-73). Results:Compared with the peritumoral tissue, the relative expression level of ADPGK-AS1 in the RB tissue was significantly increased, and the relative expression level of miR-623 was significantly reduced ( t=40.522, 48.497; both at P<0.01). Compared with the siRNA-NC group, both the relative expression level of Ki-67 protein and the proliferation A value of RB Y-79 cells were significantly reduced in the siRNA-ADPGK-AS1 group ( t=26.833, 18.522; both at P<0.01). The relative expression levels of MMP-2 and MMP-9 proteins in the siRNA-ADPGK-AS1 group were significantly lower than those in the siRNA-NC group ( t=22.123, 26.183; both at P<0.01). The number of migrating and invading cells in the siRNA-ADPGK-AS1 group was significantly less than that in the siRNA-NC group ( t=12.385, 19.201; both at P<0.01). The dual luciferase report experiment confirmed that ADPGK-AS1 targeted miR-623.The protein expression levels of the Ki-67, MMP-2 and MMP-9 in the miR-623 group were significantly lower than those in the miR-NC group ( t=22.137, 22.200, 21.094; all at P<0.01). Compared with the miR-NC group, the proliferation A value of Y-79 cells in the miR-623 group was significantly lower, and the number of migrating and invadoing cells was significantly less ( t=16.398, 11.400, 17.846; all at P<0.01). The relative expressions levels of Ki-67, MMP-2 and MMP-9 proteins in the siRNA-ADPGK-AS1+ anti-miR-623 group were significantly higher than those in the siRNA-ADPGK-AS1+ anti-miR-NC group ( t=20.795, 17.493, 23.479; all at P<0.01). Compared with the siRNA-ADPGK-AS1+ anti-miR-NC group, the proliferation A value of Y-79 cells in the siRNA-ADPGK-AS1+ anti-miR-623 group was significantly increased ( t=15.600, P<0.01), and the number of migrating and invading cells was obviously elevated ( t=14.495, 17.855; both at P<0.01). Conclusions:Knockdown of ADPGK-AS1 gene can inhibit the proliferation, migration and invasion of Y-79 cells by up-regulating the expression of miR-623.

Objective:To investigate the epidemiological and molecular biological characteristics of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) in blood culture. Methods:hVISA was detected using Mueller-Hinton agar containing 5 μg/ml of teicoplanin (MHA5T) and Populats profiles/area under the curve (PAP/AUC). Staphylococcal cassette chromosome mec ( SCCmec), Staphylococcus aureus protein A ( spa) and accessory gene regulator ( agr) typing and multilocus-sequence typing (MLST) were analyzed using PCR. Difference in autolysis between hVISA and vancomycin-sensitive Staphylococcus aureus (VSSA) isolates were evaluated with Triton X-100-inducd autolysis. Expression of vraR, mgrA, icaA, icaR, pbp4 and agr genes in hVISA and VSSA strains were detected by real-time PCR. Results:The positive detection rate of methicillin-resistant Staphylococcus aureus (MRSA) in blood culture was 39.5% (136/344) in our hospital. Among the MRSA strains, there were 31 strains of hVISA (22.8%). The minimum inhibitory concentrations (MIC) of vancomycin were mainly 1.5 μg/ml (54.8%) and 2 μg/ml(25.8%)against hVISA isolates, and 0.5 μg/ml (46.7%) and 0.75 μg/ml (39.0%) against VSSA isolates. The predominant clone of hVISA was ST239- SCCmecⅢ-t030- agrⅠ accounting for 71.0% (22/31). The autolysis of hVISA isolates decreased significantly as compared with that of VSSA isolates ( χ2=13.583, P=0.032). Compared with VSSA strains, the expression of vraR, mgrA and icaA genes in hVISA strains increased by 1.58, 1.53 and 1.06 times ( P<0.01), while the expression of icaR, agr and pbp4 genes decreased by 0.85, 0.61 and 1.03 times ( P<0.05). Conclusions:The prevalence rate of hVISA in our hospital reached 22.8% and the main epidemic clone was ST239- SCCmecⅢ-t030- agrⅠ, which should be paid great attention to clinically. Rational use of antibiotics, strengthening the prevention and control of nosocomial infection, and avoiding the spread of hVISA strains and the emergence of VISA and VRSA (vancomycin-resistance Staphylococcus aureus) were also necessary.

Objective To analyze the imaging findings and pathological basis of seminoma and improve the understanding and diagnostic accuracy.Methods The imaging findings of seminoma in 67 patients proved by histopathology were analyzed retrospectively.The tumor location,size,contour,periphery,density or signal and contrast enhancement patterns were evaluated,and these were compared with the pathological results.Results All of the 67 cases were male.46 cases were located in testicular,10 cases in the pelvic cavity,6 cases in the peritoneal and retroperitoneal,4 cases in the mediastinum,1 case in the brain.On non-enhanced CT,testicular lesions appeared to be nodular or lobular masses with clear margin.Some cases showed cystic-solid masses.And the solid component was located in the edge of the lesion,and the irregular necrosis areas of low density was located in the center.Fat and calcification component were not found in the mass.After contrast administration,the masses showed heterogeneous enhancement.The thickened and tortuous testicular arteries were seen in 11 cases in arterial phase,and thickened and twisted testicular veins were seen in 9 cases in the venous phase.The imaging findings of the mass at the other location were without features.Conclusion Testicular seminoma has significant characteristics,thickened testicular arteries and/or draining veins on enhanced CT can help the diagnosis.Imaging features of extragonadal primary seminoma are not characteristic.Combined with clinical history and signs,it is possible to improve the diagnostiic accuracy of seminoma.