Objective To evaluate the efficacy and safety of the dose-adjusted etoposide,doxorubicin and cyclophosphamide with vincristine,prednisone and rituximab without radiotherapy(DA-EPOCH-R)regimen versus the modified cyclophosphamide,vincristine,doxorubicin,high-dose methotrexate(CODOX-M/IVAC-R)regimen in the treatment of patients with acquired immune deficiency syndrome(AIDS)-related Burkitt lymphoma(BL).Methods This single-center retrospective cohort study included 41 patients diagnosed with AIDS-related BL at Beijing Ditan Hospital,Capital Medical University,from December 2010 to June 2022.Among them,26 patients received the DA-EPOCH-R regimen(observation group),and 15 patients received the modified CODOX-M/IVAC-R regimen(control group).Clinical characteristics,laboratory findings,toxicities,and treatment outcomes were analyzed.Prognostic risk factors were assessed using a multivariate Cox proportional hazards model.Results Of the 41 enrolled patients,97.6％were male,with a median age of 43 years.The baseline median CD4+cell count was below 200 cells/μL in 41.5％of patients.After a median follow-up of 17 months,the complete response(CR)rate was significantly higher in the observation group compared to the control group(57.7％vs 33.3％).The median overall survival(OS)was also significantly prolonged in the observation group(18.0 months)versus the control group(6.7 months,95％CI:5.0-16.6)(P＜0.001).Treatment-related mortality was notably lower in the observation group(0％vs.26.7％,P＜0.01).Conclusion Compared to the modified CODOX-M/IVAC-R regimen,the DA-EPOCH-R regimen demonstrates superior survival benefits and enhanced safety in the treatment of AIDS-related BL,suggesting it as the preferred chemotherapy option for this patient population.

Objective:To explore the categories and characteristics of health behaviors of community residents in Dongfang City, Hainan Province, and to analyze the influencing factors of different categories.Methods:From March to May 2023, 795 community residents of Dongfang City were selected for the study using a simple random sampling method. General Information Questionnaire, Chinese version Short of Health Promotion Lifestyle Profile-Ⅱ, Health Conception Scale, and Self-rated Abilities for Health Practice Scale were used to conduct the survey. Cluster analysis was used to explore the health behavior categories of community residents, and a decision tree model was applied to analyze the influencing factors of different categories.Results:A total of 830 questionnaires were distributed, and 795 valid questionnaires were recovered, with a valid recovery rate of 95.78%. The health behaviors of 795 community residents in Dongfang City were divided into four categories of comprehensive behavior group (26.04%, 207/795), healthy behavior group (37.23%, 296/795), risky behavior group (18.99%, 151/795), and poor health behavior group (17.74%, 141/795). The decision tree model showed that exercise efficacy, gender, ethnicity, and clinical health concepts were the factors influencing different health behavior categories of community residents in Dongfang City ( P<0.05), with exercise efficacy being the core factor. Conclusions:There is heterogeneity in the health behavior of community residents in Dongfang City. Community healthcare workers can implement targeted health promotion measures according to the behavioral characteristics of the population.

Objective To evaluate the efficacy and safety of the dose-adjusted etoposide,doxorubicin and cyclophosphamide with vincristine,prednisone and rituximab without radiotherapy(DA-EPOCH-R)regimen versus the modified cyclophosphamide,vincristine,doxorubicin,high-dose methotrexate(CODOX-M/IVAC-R)regimen in the treatment of patients with acquired immune deficiency syndrome(AIDS)-related Burkitt lymphoma(BL).Methods This single-center retrospective cohort study included 41 patients diagnosed with AIDS-related BL at Beijing Ditan Hospital,Capital Medical University,from December 2010 to June 2022.Among them,26 patients received the DA-EPOCH-R regimen(observation group),and 15 patients received the modified CODOX-M/IVAC-R regimen(control group).Clinical characteristics,laboratory findings,toxicities,and treatment outcomes were analyzed.Prognostic risk factors were assessed using a multivariate Cox proportional hazards model.Results Of the 41 enrolled patients,97.6％were male,with a median age of 43 years.The baseline median CD4+cell count was below 200 cells/μL in 41.5％of patients.After a median follow-up of 17 months,the complete response(CR)rate was significantly higher in the observation group compared to the control group(57.7％vs 33.3％).The median overall survival(OS)was also significantly prolonged in the observation group(18.0 months)versus the control group(6.7 months,95％CI:5.0-16.6)(P＜0.001).Treatment-related mortality was notably lower in the observation group(0％vs.26.7％,P＜0.01).Conclusion Compared to the modified CODOX-M/IVAC-R regimen,the DA-EPOCH-R regimen demonstrates superior survival benefits and enhanced safety in the treatment of AIDS-related BL,suggesting it as the preferred chemotherapy option for this patient population.

Objective:To explore the categories and characteristics of health behaviors of community residents in Dongfang City, Hainan Province, and to analyze the influencing factors of different categories.Methods:From March to May 2023, 795 community residents of Dongfang City were selected for the study using a simple random sampling method. General Information Questionnaire, Chinese version Short of Health Promotion Lifestyle Profile-Ⅱ, Health Conception Scale, and Self-rated Abilities for Health Practice Scale were used to conduct the survey. Cluster analysis was used to explore the health behavior categories of community residents, and a decision tree model was applied to analyze the influencing factors of different categories.Results:A total of 830 questionnaires were distributed, and 795 valid questionnaires were recovered, with a valid recovery rate of 95.78%. The health behaviors of 795 community residents in Dongfang City were divided into four categories of comprehensive behavior group (26.04%, 207/795), healthy behavior group (37.23%, 296/795), risky behavior group (18.99%, 151/795), and poor health behavior group (17.74%, 141/795). The decision tree model showed that exercise efficacy, gender, ethnicity, and clinical health concepts were the factors influencing different health behavior categories of community residents in Dongfang City ( P<0.05), with exercise efficacy being the core factor. Conclusions:There is heterogeneity in the health behavior of community residents in Dongfang City. Community healthcare workers can implement targeted health promotion measures according to the behavioral characteristics of the population.

Objective:To investigate the application value of metagenomics next-generation sequencing（mNGS）in the detection of pathogens and antimicrobial resistance genes in bronchoalveolar lavage fluid（BALF）of patients with severe pneumonia.Methods:Clinical data of 93 patients with severe pneumonia who underwent both BALF traditional microbial culture and mNGS testing from May 2020 to September 2021 in the intensive care unit of the Second Affiliated Hospital of Shandong First Medical University were retrospectively collected. Using traditional cultivation methods as the gold standard，analyze the sensitivity，specificity，bacterial resistance phenotype，and resistance genes of mNGS in detecting bacteria and fungi. SPSS 22.0 software was used to analyze the data.Results:The positive rate of mNGS was 84.9%（79/93），and the positive rate of traditional culture was 49.5%（46/93），and the difference was statistically significant（ χ2=26.56， P<0.01）. mNGS mixed infection detection rate was 60.2%（56/93），which was significantly higher than that of traditional culture 16.1%（15/93）（ χ2=38.29， P<0.01）. Using traditional cultivation methods as the gold standard，the sensitivity of mNGS for detecting bacteria and fungi was 97.8%（45/46），specificity was 31.0%（13/42），positive predictive value was 60.8%（45/74），and negative predictive value was 92.9%（13/14）. The consistency of the detection results between the two methods was 65.9%（58/88）. mNGS detected a total of 26 cases（28.0%）harboring resistance genes based on the mNGS results，the treatment regimen was adjusted in 50（53.8%）patients. Conclusion:The mNGS can improve the detection rate of pathogens in BALF of patients with severe pneumonia and can obtain antimicrobial drug resistance genes，which can provide the basis for clinical realization of precise antimicrobial drug-targeted therapy.

Although olaparib has demonstrated substantial clinical benefits as maintenance therapy in BRCA mutation-carrying women with newly diagnosed advanced ovarian cancer, its effectiveness in patients without BRCA mutations remains poorly investigated. This study aims to provide the first evidence on the efficacy of mono-olaparib maintenance therapy in such context. Using real-world data from 11 high-volume tertiary care centers in China, a retrospective cohort study was conducted to assess the efficacy and safety of olaparib as first-line maintenance therapy in patients with BRCA wild-type ovarian cancer. The primary objective was 1-year progression-free survival rate. Safety was also evaluated. Fifty patients with a median age of 54 years were included, and all of them tested negative for BRCA mutations but positive for homologous recombination deficiency (HRD). The 1-year PFS rate was 75.2% (95% CI, 63.4 to 89.2), and the median PFS was 21.0 months (95% CI, 13.8 to 28.2). All the patients received olaparib at a starting dose of 300 mg twice daily, and none experienced serious adverse events (AEs). Eight (16%) patients had dose adjustment, but none discontinued olaparib treatment due to AEs. We provide the first evidence that mono-olaparib could be a safe and effective maintenance treatment option for patients newly diagnosed with HRD-positive/BRCA wild-type ovarian cancer.
Humans ; Female ; Phthalazines/adverse effects* ; Piperazines/administration & dosage* ; Middle Aged ; Ovarian Neoplasms/genetics* ; Retrospective Studies ; Adult ; Aged ; Poly(ADP-ribose) Polymerase Inhibitors/administration & dosage* ; China ; Maintenance Chemotherapy ; BRCA2 Protein/genetics* ; Antineoplastic Agents/adverse effects* ; Progression-Free Survival ; BRCA1 Protein/genetics*

Objective:To investigate the application value of metagenomics next-generation sequencing（mNGS）in the detection of pathogens and antimicrobial resistance genes in bronchoalveolar lavage fluid（BALF）of patients with severe pneumonia.Methods:Clinical data of 93 patients with severe pneumonia who underwent both BALF traditional microbial culture and mNGS testing from May 2020 to September 2021 in the intensive care unit of the Second Affiliated Hospital of Shandong First Medical University were retrospectively collected. Using traditional cultivation methods as the gold standard，analyze the sensitivity，specificity，bacterial resistance phenotype，and resistance genes of mNGS in detecting bacteria and fungi. SPSS 22.0 software was used to analyze the data.Results:The positive rate of mNGS was 84.9%（79/93），and the positive rate of traditional culture was 49.5%（46/93），and the difference was statistically significant（ χ2=26.56， P<0.01）. mNGS mixed infection detection rate was 60.2%（56/93），which was significantly higher than that of traditional culture 16.1%（15/93）（ χ2=38.29， P<0.01）. Using traditional cultivation methods as the gold standard，the sensitivity of mNGS for detecting bacteria and fungi was 97.8%（45/46），specificity was 31.0%（13/42），positive predictive value was 60.8%（45/74），and negative predictive value was 92.9%（13/14）. The consistency of the detection results between the two methods was 65.9%（58/88）. mNGS detected a total of 26 cases（28.0%）harboring resistance genes based on the mNGS results，the treatment regimen was adjusted in 50（53.8%）patients. Conclusion:The mNGS can improve the detection rate of pathogens in BALF of patients with severe pneumonia and can obtain antimicrobial drug resistance genes，which can provide the basis for clinical realization of precise antimicrobial drug-targeted therapy.

Objective:To investigate the pathogen spectrum of acquired immunodeficiency syndrome (AIDS) patients with pulmonary opportunistic infections in the local area, and to evaluate the clinical application of metagenomic next-generation sequencing (mNGS) in these patients.Methods:From January to December 2021, AIDS patients with pulmonary infections admitted to Zhongnan Hospital of Wuhan University were enrolled. Their bronchoalveolar lavage fluid (BALF) was subjected to mNGS and coventional pathogen detection.Routine pathogen detection methods included smear, culture, polymerase chain reaction (PCR), and immunochromatographic colloidal gold. Fisher′s exact probability method was used for statistical analysis.Results:A total of 69 patients were included, and all of them were tested positive for mNGS. Among them, 53 cases (76.8%) were positive for fungi and viruses, 40 cases (58.0%) were positive for bacteria (excluding Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM)), six cases were positive for MTB, 11 cases were positive for NTM, and seven cases were positive for other pathogens. Mixed infections with two or more pathogens were found in 89.9%(62/69) of the patients. Among the conventional pathogen detections of BALF, 79.7%(55/69) of the patients were positive for pathogens, including 42 cases positive for Pneumocystis jirovecii PCR, 16 cases positive for BALF culture, nine cases positive for MTB PCR, and five cases positive for Cryptococcus antigen. The total detection rate of mNGS was 100.0%(69/69), which was higher than that of the conventional pathogen detection rate of 79.7%(55/69), and the difference was statistically significant (Fisher′s exact probability method, P<0.001). The specificity of mNGS detection was 88.4%. Combining clinical and two detection methods, the top five pathogens were Pneumocystis jirovecii (62.3%(43/69)), Candida (29.0%(20/69)), MTB (20.3%(14/69)), NTM and Talaromyces marneffei (15.9%(11/69), each). Fifty-three patients (76.8%) had co-infection with virus. Conclusions:The main cause of pulmonary infection in AIDS patients in this area is mixed infection, and Pneumocystis jirovecii is the most common pathogen. mNGS could significantly improve the pathogen detection rate in AIDS patients with pulmonary infections.

Objective:To retrospect the blood transfusion status of patients with extensive burns in multiple centers and analyze its influencing factors.Methods:A retrospective case series study was conducted. Clinical data of 455 patients with extensive burns who met the inclusion criteria and were admitted to the burn centers of 3 hospitals from January 2016 to June 2022 were collected, including 202 patients from the First Affiliated Hospital of Nanchang University, 179 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine, and 74 patients from the First Affiliated Hospital of Anhui Medical University. The following data were collected from patients during their hospitalization, including infusion of red blood cells, plasma, and platelets during hospitalization; age, gender, body mass index, combined underlying diseases, cause of injury, time of admission after injury, type of admission, total burn area, full-thickness burn area, combination of inhalation injury, combination of other trauma, and combination of pulmonary edema; the blood lactic acid, serum creatinine, total bilirubin, and albumin values within 24 h of admission; combination of bloodstream, wound, lung, and urinary tract infection, and combination of sepsis; the number of escharectomy or tangential excision and skin grafting surgery (hereinafter referred to as surgery) and total surgical blood loss volume; occurrence of hemoglobin<70 g/L, admission to intensive care unit (ICU), conduction of mechanical ventilation and continuous renal replacement therapy (CRRT), length of hospital stay, and prognosis were recorded. In 602 surgeries of patients within 14 days after injury, data including area of escharectomy or tangential excision and skin graft harvesting, duration of operation, and surgical blood loss volume per surgery, operation site, and use of tourniquet and wound graft were collected. Data were statistically analyzed with Mann-Whitney U test, Kruskal-Wallis H test, and Spearman correlation analysis. Combined with the results of single factor analysis and clinical significance, multiple linear regression analysis was performed to screen the independent influencing factors of red blood cell infusion volume and plasma infusion volume, as well as blood loss volume per surgery. Results:During the whole hospitalization period, 437 (96.0%) patients received blood transfusion therapy, including 435 (95.6%) patients, 410 (90.1%) patients, and 73 (16.0%) patients who received transfusion of plasma, red blood cells, and platelets, respectively. The patients were mainly male, aged 18 to 92 years. There were statistically significant differences in the plasma infusion volume among patients with different combination of underlying disease, combination of inhalation injury, combination of other trauma, combination of pulmonary edema, combination of bloodstream infection, combination of wound infection, combination of lung infection, combination of urinary tract infection, combination of sepsis, occurrence of hemoglobin value <70 g/L, admission to ICU, conduction of mechanical ventilation, and conduction of CRRT (with Z values of -2.06, -4.67, -2.11, -6.13, -9.56, -4.93, -8.08, -4.78, -9.12, -6.55, -9.37, -11.46, and -7.17, respectively, P<0.05). The total burn area, full-thickness burn area, blood lactic acid value within 24 h of admission, serum creatinine value within 24 h of admission, albumin value within 24 h of admission, number of surgeries, and total surgical blood loss volume were correlated with the plasma infusion volume of patients (with r values of 0.39, 0.51, 0.14, 0.28, -0.13, 0.47, and 0.56, respectively, P<0.05).There were statistically significant differences in the red blood cell infusion volume among patients with different gender, combination of inhalation injury, combination of other trauma, combination of pulmonary edema, combination of bloodstream infection, combination of wound infection, combination of lung infection, combination of urinary tract infection, combination of sepsis, occurrence of hemoglobin value <70 g/L, admission to ICU, conduction of mechanical ventilation, and conduction of CRRT (with Z values of -2.00, -4.34, -3.10, -4.22, -8.24, -7.66, -8.62, -4.75, -7.42, -9.36, -6.12, and -8.31, -6.64, respectively, P<0.05). The age, total burn area, full-thickness burn area, blood lactic acid value within 24 h of admission, serum creatinine value within 24 h of admission, total bilirubin value within 24 h of admission, number of surgeries, and total surgical blood loss volume were correlated with the red blood cell infusion volume of patients (with r values of 0.12, 0.22, 0.49, 0.09, 0.18, 0.13, -0.15, 0.69, and 0.77, respectively, P<0.05). Combined underlying diseases, full-thickness burn area, combined pulmonary edema, serum creatinine value within 24 h of admission, combined sepsis, conduction of CRRT, number of surgeries, and total surgical blood loss volume were the independent influencing factors for plasma infusion volume during hospitalization in patients with extensive burns (with standardized regression coefficients of 0.09, 0.16, 0.12, 0.07, 0.11, 0.15, 0.31, and 0.26, respectively, P<0.05). Female, full-thickness burn area, serum creatinine value within 24 h of admission, combined sepsis, occurrence of hemoglobin value <70 g/L, conduction of CRRT, and total surgical blood loss volume were the independent influencing factors for red blood cell infusion volume during hospitalization in patients with extensive burns (with standardized regression coefficients of 0.10, 0.12, 0.10, 0.11, 0.05, 0.19, and 0.54, respectively, P<0.05). There were statistically significant differences in blood loss volume per surgery of patients with different surgical site and wound graft (with Z values of -2.54 and -2.27, respectively, P<0.05). The area of escharectomy or tangential excision and skin graft harvesting and duration of operation were correlated with the blood loss volume per surgery of patients (with r values of 0.40 and 0.21, respectively, P<0.05). The area of escharectomy or tangential excision and skin graft harvesting, duration of operation, and active wound grafts were the independent influencing factors for blood loss volume per surgery of patients with extensive burns (with standardized regression coefficients of 0.41, 0.16, and 0.12, respectively, P<0.05). Conclusions:The major factors influencing blood transfusion status in patients with extensive burns are female, combined underlying diseases, full-thickness burn area, serum creatinine value within 24 h of admission, combined pulmonary edema, occurrence of hemoglobin value <70 g/L, combined sepsis, conduction of CRRT, number of surgery, and total surgical blood loss volume. In addition, the area of escharectomy or tangential excision and skin graft harvesting, duration of operation, and active wound grafts indirectly affect the patient's blood transfusion status by affecting the blood loss volume per surgery.

One of the distinct hallmarks of cancer cells is aerobic glycolysis (Warburg effect). Lactate dehydrogenase A (LDHA) is thought to play a key role in aerobic glycolysis and has been extensively studied, while lactate dehydrogenase C (LDHC), an isoform of LDHA, has received much less attention. Here we showed that human LDHC was significantly expressed in lung cancer tissues, overexpression of Ldhc in mice could promote tumor growth, and knock-down of LDHC could inhibit the proliferation of lung cancer A549 cells. We solved the first crystal structure of human LDHC4 and found that the active-site loop of LDHC4 adopted a distinct conformation compared to LDHA4 and lactate dehydrogenase B4 (LDHB4). Moreover, we found that (ethylamino) (oxo)acetic acid shows about 10 times selective inhibition against LDHC4 over LDHA4 and LDHB4. Our studies suggest that LDHC4 is a potential target for anticancer drug discovery and (ethylamino) (oxo)acetic acid provides a good start to develop lead compounds for selective drugs targeting LDHC4.