Objective To investigate the correlation between total oxidation state(TOS),superoxide dis-mutase(SOD),glutathione reductase(GR)and androgen receptor(AR)expression,as well as their predictive value for castration-resistant prostate cancer(CRPC).Methods A retrospective analysis was conducted on the clinical data of 382 patients with prostate cancer who received endocrine therapy in our hospital from Janu-ary 2021 to March 2023.These patients were divided into a CRPC group(91 cases)and a non-CRPC group(291 cases)based on whether they progressed to CRPC within one year.The clinical data of the two groups were compared,and the levels of TOS,SOD,GR,and AR expression before and after treatment were com-pared between the two groups.The correlation between TOS,SOD,GR,and AR expression was analyzed using the Spearman method.The relationship between TOS,SOD,GR,and AR expression in the CRPC group was analyzed using partial correlation analysis.Logistic regression analysis was used to investigate the impact of TOS,SOD,and GR on the occurrence of CRPC after 1 month of treatment,and receiver operating charac-teristic(ROC)curve analysis was used to evaluate the predictive efficacy of TOS,SOD,and GR on CRPC af-ter 1 month of treatment.Results Gleason score ≥8 and T4 in clinical stage in CRPC group were higher than those in non-CRPC group,and the difference was statistically significant(P＜0.05).After 1 month and 1 year of treatment,the positive expression rates of TOS and AR in both groups were higher than before treatment,while the levels of SOD and GR were lower than before treatment,with a statistically significant difference(P＜0.05).After 1 month and 1 year of treatment,the TOS level and AR positive expression rate in the CRPC group were higher than those in the non-CRPC group,while the SOD and GR levels were lower than those in the non-CRPC group,with statistical significance(P＜0.05).Spearman correlation analysis showed that TOS was positively correlated with AR expression in the CRPC group after 1 month and 1 year of treat-ment(P＜0.05),while SOD and GR were negatively correlated with AR expression(P＜0.05).Logistic re-gression analysis showed that,Gleason score ≥8,T4 in clinical stage,and TOS,SOD,and GR after 1 month of treatment were all associated with the occurrence of CRPC(P＜0.05).It was found that after adjusting for Gleason score and clinical stage,TOS,SOD,and GR were still independent factors for CRPC after 1 month of treatment(P＜0.05).The ROC curve analysis results showed that the area under the curve of TOS,SOD,and GR combined to predict CRPC after 1 month of treatment was 0.938(95％CI:0.908-0.960),which was higher than that of each indicator alone.Conclusion The expression of TOS,SOD,GR,and AR is correlated to some extent,and combined detection has certain predictive value for CRPC.It can be used as an auxiliary indicator for clinical prediction of CRPC and has certain guiding value for subsequent clinical decisions for patients.

Objective:To analyze the efficacy and safety of a fully biodegradable occluder for the treatment of ventricular septal defects through percutaneous and transthoracic strategies.Methods:A case series study was conducted.The clinical data of 38 pediatric patients with a ventricular septal defect treated with a fully biodegradable occluder at Central China Fuwai Hospital from January 2023 to July 2024 were retrospectively analyzed.Among these patients, 15 received the percutaneous approach(percutaneous approach group) and the other 23 adopted the transthoracic approach(transthoracic approach group).The diagnosis was confirmed by transthoracic echocardiography before operation in all patients.The percutaneous approach was defined as establishing a venous-arterial track through X-ray and then placing an occluder under the guidance of transthoracic echocardiograph.The transthoracic approach was achieved by establishing a delivery track with a special hollow bougie through a small right subaxillary incision under the real-time guidance of esophageal ultrasound and then delivery and put an occluder.The clinical data of the patients, including general characteristics, electrocardiograms, echocardiograms and the biodegradable occluder system were collected and analyzed.Categorical variables were tested using the chi-square or Fisher′s exact test.Continuous variables were verified using the t-test or Mann-Whitney U test. Results:The patients were aged (5.7±3.9) years on average, with an average weight of 19.5(14.9, 25.9) kg.There were 39.5%(15 cases) of males among the patients included.The average size of the ventricular septal defect was 4.1(4.0, 5.0) mm.A simple perimembrane ventricular septal defect was detected in 29 patients (76.3%), concomitant membranous aneurysm in 4 patients (10.5%), an intracristal ventricular septal defect in 3 patients (7.9%), and a muscular ventricular septal defect in 2 patients (5.3%).Preoperative aortic and tricuspid valve regurgitations accounted for 5.3%(2/38) and 81.6%(31/38), respectively.The average age was (9.0±3.9) years in the percutaneous approach group and (3.6±1.9) years in the transthoracic approach group.In terms of the cardiac structure, the percutaneous approach group had smaller Z values of the left atrial anterior-to-posterior diameter (-0.5±0.6 vs.0.5±1.0, P<0.01) and the left ventricular end-diastolic diameter (-0.5±1.1 vs.0.8±0.8, P<0.01), and a smaller ventricular septal defect [4.0(3.9, 4.2) mm vs.4.5(4.0, 5.5) mm, P=0.01] than the transthoracic approach group.Regarding the operation, the percutaneous approach group had a larger difference between the waist diameter of the selected occluder and the diameter of the ventricular septal defect [2.8(2.0, 3.0) mm vs.2.0(1.5, 2.5) mm, P=0.02], shorter operative time [(61.5±27.3) minutes vs.(91.5±31.4) minutes, P=0.01], and a shorter hospital stay [8(5, 9) days vs.12(9, 15) days, P<0.01] than the transthoracic approach group.Both groups achieved immediate occlusion postoperatively, with no residual shunts and no grade Ⅲ atrioventricular conduction block.Five new cases of bundle branch blocks and 1 case of trivial aortic valve regurgitation occurred in the transthoracic approach group. Conclusions:Both percutaneous and transthoracic approaches are safe and effective in interventional closure of ventricular septal defects, but the former is more applicable to slightly older or heavier patients with a smaller ventricular septal defect, who need a larger occluder.

Objective:To analyze the efficacy and safety of a fully biodegradable occluder for the treatment of ventricular septal defects through percutaneous and transthoracic strategies.Methods:A case series study was conducted.The clinical data of 38 pediatric patients with a ventricular septal defect treated with a fully biodegradable occluder at Central China Fuwai Hospital from January 2023 to July 2024 were retrospectively analyzed.Among these patients, 15 received the percutaneous approach(percutaneous approach group) and the other 23 adopted the transthoracic approach(transthoracic approach group).The diagnosis was confirmed by transthoracic echocardiography before operation in all patients.The percutaneous approach was defined as establishing a venous-arterial track through X-ray and then placing an occluder under the guidance of transthoracic echocardiograph.The transthoracic approach was achieved by establishing a delivery track with a special hollow bougie through a small right subaxillary incision under the real-time guidance of esophageal ultrasound and then delivery and put an occluder.The clinical data of the patients, including general characteristics, electrocardiograms, echocardiograms and the biodegradable occluder system were collected and analyzed.Categorical variables were tested using the chi-square or Fisher′s exact test.Continuous variables were verified using the t-test or Mann-Whitney U test. Results:The patients were aged (5.7±3.9) years on average, with an average weight of 19.5(14.9, 25.9) kg.There were 39.5%(15 cases) of males among the patients included.The average size of the ventricular septal defect was 4.1(4.0, 5.0) mm.A simple perimembrane ventricular septal defect was detected in 29 patients (76.3%), concomitant membranous aneurysm in 4 patients (10.5%), an intracristal ventricular septal defect in 3 patients (7.9%), and a muscular ventricular septal defect in 2 patients (5.3%).Preoperative aortic and tricuspid valve regurgitations accounted for 5.3%(2/38) and 81.6%(31/38), respectively.The average age was (9.0±3.9) years in the percutaneous approach group and (3.6±1.9) years in the transthoracic approach group.In terms of the cardiac structure, the percutaneous approach group had smaller Z values of the left atrial anterior-to-posterior diameter (-0.5±0.6 vs.0.5±1.0, P<0.01) and the left ventricular end-diastolic diameter (-0.5±1.1 vs.0.8±0.8, P<0.01), and a smaller ventricular septal defect [4.0(3.9, 4.2) mm vs.4.5(4.0, 5.5) mm, P=0.01] than the transthoracic approach group.Regarding the operation, the percutaneous approach group had a larger difference between the waist diameter of the selected occluder and the diameter of the ventricular septal defect [2.8(2.0, 3.0) mm vs.2.0(1.5, 2.5) mm, P=0.02], shorter operative time [(61.5±27.3) minutes vs.(91.5±31.4) minutes, P=0.01], and a shorter hospital stay [8(5, 9) days vs.12(9, 15) days, P<0.01] than the transthoracic approach group.Both groups achieved immediate occlusion postoperatively, with no residual shunts and no grade Ⅲ atrioventricular conduction block.Five new cases of bundle branch blocks and 1 case of trivial aortic valve regurgitation occurred in the transthoracic approach group. Conclusions:Both percutaneous and transthoracic approaches are safe and effective in interventional closure of ventricular septal defects, but the former is more applicable to slightly older or heavier patients with a smaller ventricular septal defect, who need a larger occluder.

Objective To investigate the relationship between serum interleukin-1β(IL-1β),C-reactive pro-tein to albumin ratio(CAR)and heparin-binding protein(HBP)levels and secondary pulmonary Candida albi-cans infection during chemotherapy in patients with lung cancer.Methods A total of 175 patients with lung cancer admitted to this hospital from January 2018 to April 2022 were selected,and all patients were treated with chemotherapy.According to whether they had secondary pulmonary Candida albicans infection,they were divided into infection group(37 cases)and non-infection group(138 cases).The clinical data,serum levels of IL-1β,HBP and CAR were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of secondary pulmonary Candida albicans infection in patients with lung cancer during chemotherapy.The receiver operating characteristic(ROC)curve was used to analyze the pre-dictive value of serum IL-1β,CAR and HBP for secondary pulmonary Candida albicans infection during chemo-therapy,and the prognosis of lung cancer patients with different serum IL-1β,HBP levels and CAR were com-pared.Results There were significant differences in smoking,pathological stage,diabetes mellitus,chemo-therapy cycle,chronic obstructive pulmonary disease and anatomical location between the infection group and the non-infection group(P＜0.05).The serum levels of IL-1β,HBP and CAR in the infection group were higher than those in the non-infection group(P＜0.05).Multivariate Logistic regression analysis showed that smoking,diabetes,anatomical site,chronic obstructive pulmonary disease,pathological stage,chemotherapy cycle and serum IL-1β,HBP,CAR were the influencing factors of secondary pulmonary Candida albicans infec-tion in patients with lung cancer during chemotherapy(P＜0.05).The area under the curve(AUC)of serumIL-1β,CAR and HBP in predicting pulmonary Candida albicans infection was 0.779,0.732 and 0.796,respec-tively.The AUC of the combination of the three was 0.931,and the sensitivity and specificity were 86.49％and 90.58％,respectively.The survival rate of lung cancer patients with high levels of IL-1β,CAR and HBP was sig-nificantly lower than that of patients with low levels of Il-1β,CAR and HBP(P＜0.05).Conclusion The in-crease of serum IL-1β,CAR and HBP levels in patients with lung cancer is related to secondary pulmonary Candida albicans infection during chemotherapy.Detection of these serum Il-1β,CAR and HBP levels is helpful to predict the risk of pulmonary Candida albicans infection and death.

Objective To investigate the effects of menaquinone-4(MK4)on the activation and function of CD8+T cells.Methods An in vitro culture system for primary mouse CD8+T cells was established by isolating these cells from the spleen using CD8a T cell isolation kit.The isolated CD8+T cells were then incubated and activated in a 96-well plate coated with anti-CD3/CD28 antibodies.The impact of MK4 on the activation and cytokine secretion of CD8+T cells was explored by quantifying the expression levels of CD8+T cell activation receptors and cytokines using flow cytometry.Additionally,the concentrations of these cytokines in the culture supernatant were measured by enzyme-linked immunosorbent assay(ELISA).The influence of MK4 on the anti-tumor function of CD8+T cells was evaluated by co-culturing colorectal cancer MC38 cells of mice with CD8+T cells at different ratios,and the effect of MK4 was assessed by detecting tumor cell apoptosis.Results High-purity primary CD8+T cells of mice(97.5％)were isolated using the magnetic bead,which could be activated by pre-coated CD3/CD28 antibodies and showed proliferation.Compared with the control group,the MK4-treated group exhibited increased expressions of CD25,CD69 and CD44 on CD8+T cells,as well as higher production and secretion levels of interleukin-2(IL-2),interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α)and granzyme B.In addition,CD8+T cells in the MK4-treated group induced a higher percentage of tumor cell apoptosis(36.7％)compared with the control group(29.1％).Conclusion MK4 can enhance the activation of CD8+T cells and promote anti-tumor functions.

Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.

Objective:To carry out prenatal screening and diagnosis for a woman with advanced maternal age.Methods:Non-invasive prenatal testing (NIPT) was carried out to determine the risk of fetal chromosome aneuploidy. Aminiocentesis was proceeded for fetal chromosomal karyotyping and copy number variation sequencing (CNV-seq). The fetus was subjected to systematic ultrasound screening in the second trimester.Results:NIPT has indicated there was a loss of fetal sex chromosome. Karotyping of the amniocyte showed a mosaic sex chromosome abnormality 45, X[53]/46, X, + mar[7]. The result of fetal DNA CNV-seq was seq[GRCh37]del(Yq11.1q12) chrY: g. 13 104 553-28 819 361del, seq[GRCh37]del(Yp11.32p11.2) chrY: g. 10 001-9 873 915del (mosaic ratio: 30%). Ultrasonography discovered that the fetus had renal dysplasia and male external genitalia. The karyotypes of the couple were both normal.Conclusion:Multiple genetic tests should be carried out for fetus with a high risk for chromosome aneuploidies signaled by NIPT. It is difficult to predict the post-natal phenotype for fetuses with mosaic sex chromosomal aneuploidies. The couple should be carefully counseled upon genetic counseling.

Objective:To investigate the cognitive status of the elderly in rural areas and explore the characteristics and influencing factors of subjective cognitive decline (SCD).Methods:A baseline survey was conducted among 5 765 rural elderly people aged 60 years old or above from March to September 2018.Subjective cognitive decline questionnaire(SCD-Q9), mini-mental state examination(MMSE), verbal fluency test (VFT), Chinese auditory verbal learning test (CAVLT), digital span test(DST)and activities of daily living(ADL)were used in the survey.The result of the survey indicated that there were 2 654 subjects with SCD (SCD group) and 1 008 subjects with normal cognitive function (NC group). Social support rating scale (SSRS) and short version of geriatric depression scale-15(GDS-15) were used to evaluate their psychosocial status.Descriptive analysis and Logistic regression analysis were conducted by SPSS 26.0 software.Results:(1) Compared with NC group, the SCD group had the following characteristics: delayed recognition rate(8.25 ±2.51), (12.38 ±2.53), reverse digit span (2.63±1.37), (3.69±1.45), social support (69.81±8.71), (64.40±9.44), GDS-15 (2.27±2.63), (1.31±2.17), and the differences were statistically significant (all P<0.05). However, there were no significant differences in the following characteristics: MMSE score (21.62±5.73), (21.47±5.84), speech fluency (27.80±7.35), (28.25±7.56), ADL score (20.70±1.35), (20.77±1.30), all P>0.05.(2) There were no significant differences in diet structure, blood glucose, blood lipid, cerebrovascular disease, diabetes, epilepsy and coronary heart disease between SCD group and NC group (all P>0.05). (3)SCD was mainly affected by age( β=0.06, OR=2.29, 95% CI=1.09-4.85), depression( β=-0.01, OR=2.96, 95% CI=0.68-4.94), hypertension( β=-0.17, OR=1.89, 95% CI=1.11-2.15), and low level of social support( β=2.07, OR=1.49, 95% CI=1.32-2.12) (all P<0.05). Conclusion:The scores of delayed recognition and reverse digit span in patients with SCD are lower than those with normal cognitive function.The other objective cognitive functions are basically normal.Old age, low social support level, depression, low education level and hypertension are the risk factors of SCD.

Objective:To investigate the efficacy and safety of programmed death-1 (PD1) inhibitor combined with transcatheter arterial chemoembolization (TACE) in the treatment of huge primary liver cancer.Methods:From June 2016 to December 2019, the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed. The tumor size ranged from 10.1 to 18.8 cm, with an average of (14.2±2.3) cm. The patients were divided into TACE group (TACE treatment, 18 cases) and combined group (one week after TACE, patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days, 13 cases), according to whether patients receiving PD1 inhibitors. The patients were followed up. The disease control rate (DCR) were compared between the two groups using Mann-Whitney U test. The median overall survival (OS) and progression free survival (PFS) were calculated by Kaplan-Meier method. Results:The DCR in combined group (53.8%, 7/13) was higher than that in TACE group (22.2%, 4/18), and the difference was statistically significant ( Z=-2.13, P=0.04). The median PFS (5.0 months) in combined group was longer than that in TACE group (3.0 months), the difference was statistically significant (χ2=4.39, P=0.04). The median OS (15 months) in combined group was longer than that in control group (9 months), and the difference was statistically significant (χ2=5.51, P=0.02). Conclusion:The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.