Objective:To explored the feasibility and efficacy of a rapid ramp-up,2-week maximum regimen of venetoclax(VEN)plus low-dose cytarabine(LDAC)for treating relapsed/refractory acute myeloid leukemia(R/R AML).Methods:We retrospectively analyzed patients with venetoclax-na?ve R/R AML treated with VEN+LDAC between October 2018 and November 2023.On the first day,patients received 200 mg of VEN,and the dose was quickly increased to 400 mg for the rest of the treatment;cytarabine was administered subcutaneously at a low dose of 20 mg/m2/day.The treatment duration was 10 or 14 days,depending on the condition of bone marrow hyperplasia determined on the 8th day of treatment.No patients received venetoclax monotherapy.All patients responding to salvage therapy received VEN+LDAC until disease progression or transplantation.Results:Among the patients,the median follow-up duration was 27.5 months.No clinical mani-festations of tumor lysis syndrome(TLS)occurred during the treatment.The overall response rate(ORR)was 68.75%,including four com-plete responses(CR),one complete remission with incomplete hematologic recovery(CRi),and six partial responses(PR).The median num-ber of best treatment result cycles was one cycle.The median overall survival(OS)in the whole cohort was 5.8(0.5-47.2)months;the medi-an progression-free survival(PFS)was 22.2(7.3-42.9)months.The major adverse events were grade 3-4 hematologic adverse events and in-fections.Conclusions:The 8th-day myelosuppression-adjusted VEN+LDAC regimen is a feasible salvage option with a reasonable safety pro-file in patients with venetoclax-na?ve R/R AML.Most patients tolerated the 14-day treatment;the response was generally rapid in the re-sponding patients.

OBJECTIVE To explore the protective effect and mechanism of Longshengzhi capsules on cerebral ischemia- reperfusion injury in rats. METHODS The model of middle cerebral artery occlusion （MCAO） was established by using the improved thread occlusion method. The experiment was divided into six groups： sham surgery group （only separating blood vessels without inserting thread plugs， given the same volume of normal saline）， model group （modeling， given the same volume of normal saline）， nimodipine group （positive control， modeling， dose of 20 mg/kg）， and low-dose， medium-dose， and high-dose groups of Longshengzhi capsules （modeling， doses of 0.72， 1.44 and 2.88 g/kg， respectively）， with 10 mice in each group. Each group was given corresponding medication solution/normal saline by gavage， once a day， for 7 consecutive days. One hour after the last administration， the Zea Longa scoring method was used to score the neurological deficits in each group of rats， and the ABC enzyme-linked immunosorbent assay was used to detect the serum levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in rats； TTC staining was used to observe the volume of cerebral infarction in rats and calculate the cerebral infarction volume ratio. Hematoxylin eosin staining was used to observe the pathological changes in the brain tissue of rats. Immunohistochemical staining was used to detect the positive expression of NLRP3 protein in the brain tissue of rats. Real-time fluorescence quantitative PCR was used to detect mRNA relative expressions of Toll-like receptor 4 （TLR4） and nuclear factor-κB （NF-κB） in the brain tissue of rats. Western blot assay was adopted to detect the relative expressions of TLR4， NLRP3 and phosphorylated NF-κB （p-NF-κB） protein in the brain tissue of rats and its intracellular NF-κB protein. RESULTS Compared with the sham surgery group， the neural dysfunction score， serum levels of TNF-α and IL-6， cerebral infarction volume ratio， relative expression levels of NF-κB and TLR4 mRNA， as well as protein relative expressions of TLR4， NLRP3 and p-NF-κB in the brain tissue， and relative protein expression of intracellular NF-κB were increased significantly in the model group （P＜0.01）； the enlarged gap and significant edema were observed in cortical nerve cells of brain tissue in rats， with a large amount of inflammatory cell infiltration； the positive expression of NLRP3 protein in brain tissue of rats obviously increased. Compared with the model group， the levels of the above indicators in the medium-dose and high-dose groups of Longshengzhi capsules， as well as the Nimodipine group， were reversed to varying degrees， and most differences were statistically significant （P＜0.05 or P＜0.01）； the pathological morphology observation showed a significant improvement， and the positive expression of NLRP3 protein in the brain tissue of rats was obviously reduced. CONCLUSIONS Longshengzhi capsules may inhibit TLR4/NF-κB/NLRP3 signaling pathway and neuroinflammatory response， thereby achieving a protective effect against cerebral ischemia-reperfusion injury in rats.

Objective:To analyze the application of indocyanine green (ICG) fluorescence imaging in laparoscopic resection of pancreatic cancer.Methods:Data of 15 patients undergoing laparoscopic surgery for pancreatic cancer in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Wannan Medical College from June 2022 to March 2023 were retrospectively analyzed, including 13 males and 2 females, aged (67.0±8.6) years. ICG were intraoperatively injected to visualize the lesion and guide surgical resection. The surgical methods, postoperative pathology, ICG fluorescence imaging and tumor margins were reviewd.Results:Among the patients, seven underwent laparoscopic pancreaticoduodenectomy, seven underwent laparoscopic radical antegrade modular pancreaticosplenectomy, and one conversed to open pancreaticoduodenectomy due to combined superior mesenteric vein reconstruction. Postoperative pathology confirmed pancreatic moderately differentiated adenocarcinoma in nine cases, pancreatic moderately-low differentiated adenocarcinoma in four cases, pancreatic follicular cell carcinoma in one case, and inflammatory lesion in one case. Negative surgical margins were confirmed in all cases. Pancreatic lesion were visualized in 14 cases (fluorescent delineation of the tumor capsule) but not well visualized in one case (with moderately differentiated adenocarcinoma). In the case of inflammatory disease, the lesion parenchyma were visualized.Conclusion:ICG injection in laparoscopic surgery enables visualization of pancreatic tumor, which facilitates tumor localization and margin determination.

[Objective] To analyze the changes of platelet extracellular vesicles (PEVs) content in apheresis at different storage periods, track the PEVs and transfusion efficacy of patients, and explore the mechanism of PEVs in relation to platelet storage damage and transfusion efficacy. [Methods] From November 2022 to April 2024, a total of 85 apheresis platelets samples were collected at Jiading District Blood Station. Flow cytometry was used to detect the content of PEVs on the day of collection and before transfusion. The changes in the content of PEVs stored for 1 to 5 days were observed. Patients with acute leukemia were selected as transfusion recipients, and their content of platelet count and PEVs before transfusion and within 24 hours after transfusion, and the efficacy were tracked to explore the mechanism of PEVs in relation to storage lesion and transfusion efficacy. [Results] The content of PEVs before platelet infusion (8.73±4.84) was significantly higher than that on the day of platelet collection (5.11±3.33), and the difference was statistically significant (P<0.01). The increase in the content of PEVs in storage for 2 to 5 days was 2.55±1.38, 3.49±2.63, 3.86±3.55 and 4.50±3.91, with statistically significant difference (P<0.05). The PEVs content in patients after blood transfusion was positively correlated with that before transfusion and that in apheresis platelet bags during transfusion (P<0.001) A total of 85 cases of apheresis platelet transfusion were conducted, with 61 effective transfusions having a CCI value of (13.43±4.70), and 24 transfusion refractoriness cases having a CCI value of (2.27±3.67), showing a statistically significant difference (P<0.001). The transfusion effectiveness rates for patients receiving different storage periods of apheresis platelets of 2 to 5 days were 88.89%, 68.42%, 68.18% and 57.14% respectively, with corresponding CCI values of 11.18±6.10, 10.43±6.77, 9.53±6.75 and 9.48±8.86, and there was no significant difference between CCI groups (P>0.05). There was no significant correlation between the PEVs content before and after transfusion and the efficacy of CCI (P>0.05). There was no significant correlation between the PEVs content before apheresis platelet transfusion and the efficacy of CCI (P>0.05). [Conclusion] The content of PEVs increased with the prolongation of storage time, which could be used as a potential blood quality evaluation and monitoring index during the storage period, but it was not significantly correlated with the efficacy of CCI in transfusion.

Permeability is one of the determinants of intestinal absorption and oral bioavailability. The non-cell-based permeation model is a kind of in vitro permeability measurement tool, which has the advantages of high efficiency, low cost, stable property, easy to use and customizable. According to the barrier type, non-cell-based permeation model can be divided into biomimetic barriers containing (phosphate) lipids and non-biomimetic barriers without lipids. Biomimetic permeation models include parallel artificial membrane permeability assay, vesicle-based permeation assay and PermeaPad®. Non biomimetic permeation models include Hollow fiber membrane models based on polyether sulfone materials. In foreign countries, the application of these four barriers for different purposes is gradually becoming a hot spot in drug absorption research. However, in China, there are only more applied studies on PMAPM and few published applied studies on the other three barriers. In order to meet the development needs of insoluble drug formulations, the author summarized the permeability devices and permeability calculation methods, searched the application of non-cell-based permeation model in the permeability of BSCⅡ drugs in recent years, and summarized the characteristic applications of three Biomimetic permeation models and hollow fiber membranes.

Objective To establish a deep learning model for testing the feasibility of combining magnetic resonance imaging(MRI)deep learning features with clinical features for preoperative prediction of cytokeratin 19(CK19)status of hepatocellular carcinoma(HCC).Methods A retrospective experiment was conducted based on the data of 116 HCC patients with confirmed CK19 status.A single sequence multi-scale feature fusion deep learning model(MSFF-IResnet)and a multi-scale and multi-modality feature fusion model(MMFF-IResnet)were established based on the hepatobiliary phase(HBP),diffusion weighted imaging(DWI)sequences of enhanced MRI images,and the clinical features significantly correlated with CK19 status.The classification performance of the models were evaluated to assess the effectiveness of the deep learning models for predicting CK19 status of HCC before surgery.Results Multivariate analysis showed that an increased neutrophil-to-lymphocyte ratio(P=0.029)and incomplete tumor capsule(P=0.028)were independent predictors of CK19 expression in HCC.The deep learning models improved by multi-scale feature fusion and multi-modality feature fusion methods achieved better classification results than the traditional machine learning models and baseline models,and the final MMFF-IResnet model showed the best classification performance with an AUC of 84.2%,an accuracy of 80.6%,a sensitivity of 80.1%and a specificity of 81.2%.Conclusion The multi-scale and multi-modality feature fusion model based on MRI and clinical parameters is capable of predicting CK19 status of HCC,demonstrating the feasibility of combining deep learning methods with MRI and clinical features for preoperative prediction of CK19 status.

Objective To establish a deep learning model for testing the feasibility of combining magnetic resonance imaging(MRI)deep learning features with clinical features for preoperative prediction of cytokeratin 19(CK19)status of hepatocellular carcinoma(HCC).Methods A retrospective experiment was conducted based on the data of 116 HCC patients with confirmed CK19 status.A single sequence multi-scale feature fusion deep learning model(MSFF-IResnet)and a multi-scale and multi-modality feature fusion model(MMFF-IResnet)were established based on the hepatobiliary phase(HBP),diffusion weighted imaging(DWI)sequences of enhanced MRI images,and the clinical features significantly correlated with CK19 status.The classification performance of the models were evaluated to assess the effectiveness of the deep learning models for predicting CK19 status of HCC before surgery.Results Multivariate analysis showed that an increased neutrophil-to-lymphocyte ratio(P=0.029)and incomplete tumor capsule(P=0.028)were independent predictors of CK19 expression in HCC.The deep learning models improved by multi-scale feature fusion and multi-modality feature fusion methods achieved better classification results than the traditional machine learning models and baseline models,and the final MMFF-IResnet model showed the best classification performance with an AUC of 84.2%,an accuracy of 80.6%,a sensitivity of 80.1%and a specificity of 81.2%.Conclusion The multi-scale and multi-modality feature fusion model based on MRI and clinical parameters is capable of predicting CK19 status of HCC,demonstrating the feasibility of combining deep learning methods with MRI and clinical features for preoperative prediction of CK19 status.

Objective To observe and compare the effect of remimazolam combined with nalbuphine and midazolam combined with nalbuphine on postoperative recovery in elderly patients undergoing fibrobronchoscopy.Methods A total of 112 elderly patients undergoing fibrobronchoscopy,56 males and 56 females,aged ≥ 65 years,BMI 18.5-28.0 kg/m2,ASA physical status I or Ⅱ,were ran-domly divided into two groups:midazolam group and remimazolam group,56 patients in each group.The midazolam group received midazolam 0.03 mg/kg combined with nalbuphine 0.1 mg/kg for anesthesia.The remimazolam group received remimazolam 0.1 mg/kg combined with nalbuphine 0.1 mg/kg for anesthesia.HR,MAP,SpO2,and RR were recorded after entering room,before anesthesia induction,5 minutes after anesthesia induction,and at the end of the operation.The onset time of anesthesia,the time of awakening,the time of operation,the time of discharge,the number of successful cases of sedation,the number of suc-cessful cases of endoscopy,and the occurrence of adverse events were recorded.The satisfaction of the pa-tient,anesthesiologist,and endoscopist were also recorded.Results Compared with the midazolam group,HR and MAP were significantly increased 5 minutes after induction and the end of operation in the remima-zolam group(P＜0.05),the onset time of anesthesia and the time of awakening were significantly short-ened(P＜0.05),the incidence of hypotension,respiratory depression and nausea and vomiting were sig-nificantly reduced(P＜0.05),and the rae of very satisfaction of the operating physician was significantly increased(P＜0.05).There were no significant differences in the time of separation,the success rate of sedation and the success rate of endoscopy between the two groups.Conclusion Compared with midazolam,remimazolam combined with nalbuphine can be safely used for flexible bronchoscopy in elderly patients,reduce recovery time and adverse reactions,which is conducive to rapid postoperative recovery.

Objective : To examine the association between acute exposure to traffic-related air pollutants (TRAP) NOX and NO2 and outpatient visits of pediatric respiratory diseases. Methods : Data regarding outpatient visits to Department of Respiratory Diseases of Beijing Children's Hospital from 2015 to 2020 were collected, and the concentrations of nitrogen oxides (NOX), nitrogen dioxide (NO2) and other TRAP were collected from the surveillance sites assigned by the Peking University Health Science Center. A time-stratified case-crossover design was employed, and a conditional logistic regression model was created to examine the association between NOX and NO2 acute exposure and outpatient visits of pediatric respiratory diseases. Results : The daily mean outpatient visits of pediatric respiratory diseases were 571 (interquartile range, 554) person-times among children at ages of 0 to 14 years in Beijing Children's Hospital from 2015 to 2020, and the daily mean outpatient visits for upper respiratory tract infections (URI), bronchitis, and pneumonia were 265 (interquartile range, 282), 143 (interquartile range, 178) and 128 (interquartile range, 120) person-times, respectively. The daily mean concentrations of atmospheric NOX and NO2 were 67.8 (interquartile range, 50.7) and 49.3 (interquartile range, 30.7) μg/m3, respectively. Conditional logistic regression analysis showed the largest lagged effect of NOX and NO2 on pediatric respiratory diseases at cumulative lags of 0 to 7 days. An increase in NOX concentrations by an interquartile range resulted in the excess risks of URI, bronchitis and pneumonia by 6.87% (95%CI: 6.37%-7.38%), 7.25% (95%CI: 6.51%-7.99%), and 5.51% (95%CI: 4.69%-6.33%), and an increase in NO2 concentrations by an interquartile range resulted in excess risks of URI, bronchitis and pneumonia by 5.71% (95%CI: 5.12%-6.31%), 5.32% (95%CI: 4.51%-6.14%), and 4.83% (95%CI: 3.91%-5.75%), respectively. NOX and NO2 presented a more remarkable effect on outpatient visits of pediatric respiratory diseases among children at ages of over 5 years. Conclusion NOx and NO2 acute exposure may increase the outpatient visits of pediatric respiratory diseases.

OBJECTIVE: To investigate the incidence and risk factors of hypothermia in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT), and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT. METHODS: A prospective study was conducted. AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method. Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition. The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37 centigrade. The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution, and the heating line temperature was set at 41 centigrade. The patient's temperature was then continuously monitored. Hypothermia was defined as a temperature lower than 36 centigrade or a drop of more than 1 centigrade from the basal body temperature. The incidence and duration of hypothermia were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients. RESULTS: A total of 73 patients with AKI treated with CRRT were eventually enrolled, including 37 in the dialysate heating group and 36 in the reverse-piped heating group. The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group [40.5% (15/37) vs. 69.4% (25/36), P < 0.05], and the hypothermia occurred later than that in the reverse-piped heating group (hours: 5.40±0.92 vs. 3.35±0.92, P < 0.01). Patients were divided into hypothermic and non-hypothermic groups based on the presence or absence of hypothermia, and a univariate analysis of all indicators showed a significant decrease in mean arterial pressure (MAP) in hypothermic patients (n = 40) compared with the non-hypothermic patients [n = 33; mmHg (1 mmHg ≈ 0.133 kPa): 77.45±12.47 vs. 94.42±14.51, P < 0.01], shock, administration of medium and high doses of vasoactive drug (medium dose: 0.2-0.5 μg×kg^-1×min^-1, high dose: > 0.5 μg×kg^-1×min^-1) and CRRT treatment were significantly increased [shock: 45.0% (18/40) vs. 6.1% (2/33), administration of medium and high doses of vasoactive drugs: 82.5% (33/40) vs. 18.2% (6/33), administration of CRRT (mL×kg^-1×h^-1): 51.50±9.38 vs. 38.42±10.97, all P < 0.05], there were also significant differences in CRRT heating types between the two groups [in the hypothermia group, the main heating method was the infusion line heating, which was 62.5% (25/40), while in the non-hypothermia group, the main heating method was the dialysate heating, which was 66.7% (22/33), P < 0.05]. Including the above indicators in a binary multivariate Logistic regression analysis, it was found that shock [odds ratio (OR) = 17.633, 95% confidence interval (95%CI) was 1.487-209.064], mid-to-high-dose vasoactive drug (OR = 24.320, 95%CI was 3.076-192.294), CRRT heating type (reverse-piped heating; OR = 13.316, 95%CI was 1.485-119.377), and CRRT treatment dose (OR = 1.130, 95%CI was 1.020-1.251) were risk factors for hypothermia during CRRT in AKI patients (all P < 0.05), while MAP was protective factor (OR = 0.922, 95%CI was 0.861-0.987, P < 0.05). CONCLUSIONS AKI patients have a high incidence of hypothermia during CRRT treatment, and the incidence of hypothermia can be effectively reduced by heating CRRT treatment fluids. Shock, use of medium and high doses of vasoactive drug, CRRT heating type, and CRRT treatment dose are risk factors for hypothermia during CRRT in AKI patients, with MAP is a protective factor.
Humans ; Continuous Renal Replacement Therapy ; Incidence ; Prospective Studies ; Acute Kidney Injury ; Dialysis Solutions