Objective To analyze the expression of vascular endothelial growth factor receptor-3(VEGFR3)and adaptor protein containing PH domain,PTB domain,and leucine zipper motif 1(APPL1)in non-small cell lung cancer(NSCLC)and their relationship with clinical pathology.Methods A total of 100 patients with NSCLC admitted to the First Affiliated Hospital of Bengbu Medical University from January 2019 to December 2020 were selected as the study objects,and the NSCLC tissues and adjacent tissues of the patients were collected.The expression of VEGFR3 and APPL1 was detected by immunohistochemistry,and the relationship between VEGFR3 and APPL1 expression and clinical pathology of patients was analyzed,as well as the predictive value of VEGFR3 and APPL1 for prognosis of patients with NSCLC.Results The posi-tive rates of VEGFR3 and APPL1 in NSCLC tissues and adjacent tissues were significantly different(P<0.05).The positive rate of VEGFR3 was significantly different in patients with different histological type,lymph node metastasis and tumor invasion(P<0.05).The positive rate of APPL1 was significantly different in patients with different histological type and tumor invasion(P<0.05).Spearman correlation analysis showed that VEGFR3 was positively correlated with APPL1 expression(r=0.330,P<0.05).The relative expression levels of VEGFR3 and APPL1 in death group were higher than those in survival group,and the difference was statistically significant(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve of relative expression levels of VEGFR3 and APPL1 to predict the prognosis of NSCLC patients was 0.843(95%CI:0.757-0.908)and 0.799(95%CI:0.707-0.872).Conclusion The ex-pression of VEGFR3 and APPL1 in NSCLC patients is related to their clinical pathological features.The relative ex-pression levels of VEGFR3 and APPL1 are of great value in predicting the prognosis of NSCLC patients.

Objective:To investigate the clinical efficacy of insulin combined with zoledronic acid in the treatment of type 2 diabetes mellitus (T2DM) complicated by osteoporosis and its effects on bone metabolism and pancreatic β-cell function.Methods:A retrospective analysis was conducted on the clinical data of 68 patients with T2DM complicated by osteoporosis who were treated at Wenling Hospital of Traditional Chinese Medicine from January 2021 to December 2023. The patients were divided into a control group and a study group, with 34 cases in each group. The control group received treatment with zoledronic acid combined with acarbose, while the study group received insulin combined with zoledronic acid. The clinical efficacy and improvements in bone metabolism (bone-specific alkaline phosphatase, alkaline phosphatase, osteoprotegerin), bone density, and pancreatic β-cell function (homeostasis model assessment of beta-cell function and homeostasis model assessment of insulin resistance) were evaluated and compared between the two groups. Additionally, the incidence of adverse reactions was also compared between the two groups.Results:The clinical overall effective rate in the study group was significantly higher than that in the control group [91.18% (31/34) vs. 67.65% (23/34), χ2 = 5.76, P < 0.05]. The levels of bone-specific alkaline phosphatase [(44.92 ± 5.92) μg/L], alkaline phosphatase [(109.12 ± 9.46) U/L], and osteoprotegerin [(331.42 ± 13.92) ng/L]in the study group were significantly higher than those in the control group [(38.25 ± 4.78) μg/L, (102.95 ± 9.23) U/L, (312.26 ± 13.11) ng/L, t = -5.11, -2.72, -5.84, all P < 0.05]. After treatment, the bone density indicators in the study group [(0.80 ± 0.12) g/cm2, (0.84 ± 0.13) g/cm2, (0.82 ± 0.10) g/cm2, (0.83 ± 0.11) g/cm2]were significantly higher than those in the control group [(0.72 ± 0.11) g/cm2, (0.73 ± 0.09) g/cm2, (0.71 ± 0.12) g/cm2, (0.74 ± 0.09) g/cm2, t = -2.87, -7.38, -4.11, -3.69, all P < 0.05]. The homeostasis model assessment of beta-cell function and homeostasis model assessment of insulin resistance in the study group were (54.97 ± 5.42) and (1.61 ± 0.89), respectively, which were significantly different from those in the control group [(43.11 ± 5.23), (2.46 ± 0.96), t = -25.97, 3.79, both P < 0.05]. There was no statistically significant difference in the incidence of adverse reactions between the two groups ( χ2 = 0.36, P > 0.05). Conclusions:Insulin combined with zoledronic acid can enhance clinical efficacy in patients with T2DM complicated by osteoporosis, improve bone metabolism, boost pancreatic β-cell function, and demonstrate good safety.

Objective:To investigate the clinical efficacy of insulin combined with zoledronic acid in the treatment of type 2 diabetes mellitus (T2DM) complicated by osteoporosis and its effects on bone metabolism and pancreatic β-cell function.Methods:A retrospective analysis was conducted on the clinical data of 68 patients with T2DM complicated by osteoporosis who were treated at Wenling Hospital of Traditional Chinese Medicine from January 2021 to December 2023. The patients were divided into a control group and a study group, with 34 cases in each group. The control group received treatment with zoledronic acid combined with acarbose, while the study group received insulin combined with zoledronic acid. The clinical efficacy and improvements in bone metabolism (bone-specific alkaline phosphatase, alkaline phosphatase, osteoprotegerin), bone density, and pancreatic β-cell function (homeostasis model assessment of beta-cell function and homeostasis model assessment of insulin resistance) were evaluated and compared between the two groups. Additionally, the incidence of adverse reactions was also compared between the two groups.Results:The clinical overall effective rate in the study group was significantly higher than that in the control group [91.18% (31/34) vs. 67.65% (23/34), χ2 = 5.76, P < 0.05]. The levels of bone-specific alkaline phosphatase [(44.92 ± 5.92) μg/L], alkaline phosphatase [(109.12 ± 9.46) U/L], and osteoprotegerin [(331.42 ± 13.92) ng/L]in the study group were significantly higher than those in the control group [(38.25 ± 4.78) μg/L, (102.95 ± 9.23) U/L, (312.26 ± 13.11) ng/L, t = -5.11, -2.72, -5.84, all P < 0.05]. After treatment, the bone density indicators in the study group [(0.80 ± 0.12) g/cm2, (0.84 ± 0.13) g/cm2, (0.82 ± 0.10) g/cm2, (0.83 ± 0.11) g/cm2]were significantly higher than those in the control group [(0.72 ± 0.11) g/cm2, (0.73 ± 0.09) g/cm2, (0.71 ± 0.12) g/cm2, (0.74 ± 0.09) g/cm2, t = -2.87, -7.38, -4.11, -3.69, all P < 0.05]. The homeostasis model assessment of beta-cell function and homeostasis model assessment of insulin resistance in the study group were (54.97 ± 5.42) and (1.61 ± 0.89), respectively, which were significantly different from those in the control group [(43.11 ± 5.23), (2.46 ± 0.96), t = -25.97, 3.79, both P < 0.05]. There was no statistically significant difference in the incidence of adverse reactions between the two groups ( χ2 = 0.36, P > 0.05). Conclusions:Insulin combined with zoledronic acid can enhance clinical efficacy in patients with T2DM complicated by osteoporosis, improve bone metabolism, boost pancreatic β-cell function, and demonstrate good safety.

Objective:To analyze the risk factors for asparaginase-associated pancreatitis (AAP) in children with acute lymphoblastic leukemia (ALL) after treatment with pegaspargase and evaluate the predictive value of pediatric sequential organ failure assessment (SOFA) score, pediatric acute pancreatitis severity (PAPS) score, Ranson′s score and pediatric Ministry of Health, Labour and Welfare of Japan (JPN) score for severe AAP.Methods:Cross-sectional study.The clinical data of 328 children with ALL who received pegaspargase treatment in the Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University from January 2014 to August 2021, as well as their clinical manifestations, laboratory examinations, and imaging examinations were collected.The SOFA score at the time of AAP diagnosis, PAPS score and Ranson′s score at 48 hours after AAP diagnosis, and JPN score at 72 hours after AAP diagnosis were calculated, and their predictive value for severe AAP was evaluated by the receiver operating characteristic (ROC) curve.Results:A total of 6.7%(22/328) of children had AAP, with the median age of 6.62 years.AAP most commonly occurred in the induced remission phase (16/22, 72.7%). Three AAP children were re-exposed to asparaginase, and 2 of them developed a second AAP.Among the 22 AAP children, 16 presented with mild symptoms, and 6 with severe symptoms.The 6 children with severe AAP were all transferred to the Pediatric Intensive Care Unit (PICU). There were no significant differences in gender, white blood cell count at first diagnosis, immunophenotype, risk stratification, and single dose of pegaspargase between the AAP and non-AAP groups.The age at diagnosis of ALL in the AAP group was significantly higher than that in the non-AAP group ( t=2.385, P=0.018). The number of overweight or obese children in the AAP group was also higher than that in the non-AAP group ( χ2=4.507, P=0.034). The areas under the ROC curve of children′s JPN score, SOFA score, Ranson′s score, and PAPS score in predicting severe AAP were 0.919, 0.844, 0.731, and 0.606, respectively.The JPN score ( t=4.174, P=0.001) and the SOFA score ( t=3.181, P=0.005) showed statistically significant differences between mild and severe AAP. Conclusions:AAP is a serious complication in the treatment of ALL with combined pegaspargase and chemotherapy.Older age and overweight or obesity may be the risk factors for AAP.Pediatric JPN and SOFA scores have predictive value for severe AAP.

Objective:To analyze the present situation and influencing factors of operational efficiency of tertiary public hospitals in Anhui province, so as to provide reference for promoting the development of medical and health care in Anhui province.Methods:The operational efficiency index of performance appraisal of national tertiary public hospitals was taken as the research index system. The operational efficiency data of 75 tertiary public hospitals in Anhui province in 2020 and 2021 were extracted from the " 2021 Performance Appraisal Analysis Report of Anhui Provincial Tertiary Public Hospitals" compiled by the Anhui Provincial Public Hospital Supervision and Management Center. The entropy weight TOPSIS method was used to evaluate the operational efficiency, and logistic regression analysis was used to identify the influencing factors of operational efficiency of tertiary public hospitals in Anhui province.Results:Among the 9 operational efficiency indicators, 7 indicators showed better data in 2021 than in 2020. The proportion of medical service revenue in medical revenue and the proportion of personnel expenses in operating expenses were the key indicators affecting the operational efficiency. Multivariate logistic regression analysis showed that specialized hospitals ( OR=3.350, 95% CI 1.068-11.591) and annual outpatient visits>500 000 ( OR=0.248, 95% CI 0.073-0.845) were the influencing factors on the operational efficiency of tertiary public hospitals in Anhui province ( P<0.05). Conclusions:The operational efficiency of tertiary public hospitals in Anhui province was improved overall in 2021 compared with 2020. It is suggested to further optimize the structure of hospital revenue and expenditure, promote the implementation of hierarchical diagnosis and treatment policy, and optimize the allocation of health resources, so as to guide hospitals to improve operational efficiency through connotative development.

Objective:To analyze the present situation and influencing factors of operational efficiency of tertiary public hospitals in Anhui province, so as to provide reference for promoting the development of medical and health care in Anhui province.Methods:The operational efficiency index of performance appraisal of national tertiary public hospitals was taken as the research index system. The operational efficiency data of 75 tertiary public hospitals in Anhui province in 2020 and 2021 were extracted from the " 2021 Performance Appraisal Analysis Report of Anhui Provincial Tertiary Public Hospitals" compiled by the Anhui Provincial Public Hospital Supervision and Management Center. The entropy weight TOPSIS method was used to evaluate the operational efficiency, and logistic regression analysis was used to identify the influencing factors of operational efficiency of tertiary public hospitals in Anhui province.Results:Among the 9 operational efficiency indicators, 7 indicators showed better data in 2021 than in 2020. The proportion of medical service revenue in medical revenue and the proportion of personnel expenses in operating expenses were the key indicators affecting the operational efficiency. Multivariate logistic regression analysis showed that specialized hospitals ( OR=3.350, 95% CI 1.068-11.591) and annual outpatient visits>500 000 ( OR=0.248, 95% CI 0.073-0.845) were the influencing factors on the operational efficiency of tertiary public hospitals in Anhui province ( P<0.05). Conclusions:The operational efficiency of tertiary public hospitals in Anhui province was improved overall in 2021 compared with 2020. It is suggested to further optimize the structure of hospital revenue and expenditure, promote the implementation of hierarchical diagnosis and treatment policy, and optimize the allocation of health resources, so as to guide hospitals to improve operational efficiency through connotative development.

Objective:To investigate the risk factors and prognoses of cerebral venous sinus thrombosis (CVST) caused by pegasparaginase (PEG-Asp).Methods:A total of 252 children with acute lymphoblastic leukemia (ALL) were treated with PEG-Asp chemotherapy in our hospital from December 2016 to July 2021, including 8 children with CVST. The clinical manifestations, laboratory and imaging features, treatments and prognoses of these children with CVST caused by PEG-Asp were analyzed retrospectively.Results:(1) CVST occurred during induction chemotherapy in 4 children, during re-induction chemotherapy in 3 children, and during consolidation stage in one child. CVST occurred in two children who received PEG-ASP chemotherapy once, in one child who received PEG-Asp chemotherapy twice, and 5 children who received PEG-Asp chemotherapy more than twice. The median time between CVST occurrence and last treatment of PEG-Asp was 20.5 d. (2) The clinical manifestations included paroxysmal headache ( n=4), nausea or vomiting ( n=3), convulsions ( n=2) and persistent blurred vision ( n=1). (3) CVST appeared at the sigmoid sinus ( n=6), transverse sinus ( n=4) and superior sagittal sinus ( n=4), of which one child was complicated with hemorrhage in left frontal parietal and right parietal cortex, and one with reversible posterior encephalopathy syndrome; 8 children were not complicated with thrombus in other parts. (4) Some of the children were complicated with abnormal blood coagulation. When CVST occurred, fibrinogen level decreased in 3 children, anti-thrombin III level decreased in 2 children, and D-dimer level increased in 3 children. (5) Six children were treated with low molecular weight heparin (LMWH), of which, 4 were treated with rivasaban and one with warfarin sequentially. The total course of anticoagulation was 56 d. (6) The symptoms of 6 children disappeared after anticoagulation; Magnetic resonance venography (MRV) showed disappeared thrombus in 4 children and reduced thrombus range in 2 children. One child with intracranial hemorrhage did not use PEG-Asp anymore; 7 accepted PEG-Asp further during follow-up chemotherapy, of which one had CVST recurrence and the range of thrombus was reduced after anticoagulant therapy. Conclusions:When children with ALL develop unexplained neurological symptoms during PEG-Asp chemotherapy, CVST should be highly vigilant. Enhanced MRI and MRV should be performed for early diagnosis. Some children are complicated with abnormal blood coagulation, and LMWH, warfarin and rivasaban are effective. The prognosis is good and there are no sequelae. Most children accepted PEG-Asp again will not have CVST again.

Objective:To explore the effect of empowerment health education on the biochemical indicators and self-efficacy of elderly diabetic patients, so as to provide a theoretical basis for choosing a health education model suitable for elderly diabetic patients.Methods:From January to July of 2020, convenience sampling was used to select 130 elderly diabetic patients who were treated in the Geriatric Outpatient Clinic of Beijing Friendship Hospital affiliated to Capital Medical University as the research object. All patients were divided into the intervention group and the control group according to the visit time, 65 cases in each group. The control group conducted regular health education, and the intervention group implemented empowerment health education. The blood glucose, blood lipid indexes and self-efficacy scores of the two groups of patients before and three months after the intervention were compared.Results:After intervention, the levels of glycosylated hemoglobin and triacylglycerol in the intervention group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . There was no significant difference in fasting blood glucose, two hours postprandial blood glucose, and low-density lipoprotein cholesterol levels between the two groups after intervention ( P>0.05) . The total scores of self-efficacy and the scores of strategic efficacy, and executive efficacy of the intervention group after the intervention were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Empowerment health education is more effective than conventional health education in improving the self-efficacy of elderly diabetic patients, especially in terms of strategic efficiency and executive efficiency, and has a certain effect of improving some clinical biochemical indicators of elderly diabetic patients.

Objective: To investigate the efficacy and safety of Posaconazole (Posa) in prophylaxis and salvage treatment of invasive fungal infections (IFI) during neutropenia in pediatric patients with leukemia. Methods: A total of 18 pediatric patients (55 case-time) with leukemia in neutropenia stage receiving Posa treatment from December 2015 to August 2017 in Zhujiang Hospital of Southern Medical University, were analyzed retrospectively.Taking one induction chematherapy or one consolidation chemotherapy stage receiving Posa treatment was defined as 1 case-time. Results: Out of 18 participants, 13 cases were patients with acute myeloid leukemia (AML) and 5 cases were patients with acute lymphocytic leukemia (ALL), including 36 males and 19 females.Median age of the participants was 7 years, ranged from 10 months to 14 years.Out of 55 case times, 45 of them were of primary prevention and the neutropenia periods ranged from 4 to 46 days, with the median of 15 days, and 93.33% of them were prevented from fungal infection.However, 3 of the 45 cases had sudden fungal infections and the Voriconazole was an effective treatment, and no one died.Six cases in this study experienced secondary prevention, and no patient experienced reinfection.The neutropenia terms of the 6 cases ranged from 10 to 17 days, with the median of 14 days.Four patients who suffered from Voriconazole and/or Carbophenol therapy failure received Posa as a rescue therapy and the response rate was 100%.None of patients had Posa intolerance due to severe adverse reaction and no Posa treatment-related grade Ⅱ toxic effects occurred. Conclusions Posa is an effective and safe therapy for pediatric patients with leukemia and IFI, and available for long-time usage.Serious adverse reaction is rare.

To examine the expression of vasohibin-1, metastasis-associated in colon cancer-1 (MACC1) and KAI1 proteins in serous ovarian cancer and their clinical significance.
 Methods: In 124 specimens of serous ovarian cancer (serous ovarian cancer group) and 30 specimens of ovarian serous cystadenoma (ovarian serous cystadenoma group), the expression of vasohibin-1, MACC1 and KAI1 protiens were detected by immunohistochemistry ElivisionTM method.
 Results: In the serous ovarian cancer group, the positive rates of vasohibin-1 and MACC1 proteins were 48.4% and 58.1%, respectively, which were both higher than those in the ovarian serous cystadenoma group (10.0% and 13.3%, respectively); while the positive rate of KAI1 protein in the serous ovarian cancer group was 33.9%, which was lower than that in the ovarian serous cystadenoma group (86.7%), there were significant differences between the 2 groups (all P<0.05). In the serous ovarian cancer group, the expression of the 3 proteins were closely related to the pathological grade, Federation International of Gynecology and Obstetrics (FIGO) stage and pelvic lymph node metastasis (all P<0.05). The KAI1 protein was negatively correlated with the levels of vasohibin-1 and MACC1 (r=-0.500, -0.600, respectively, both P<0.01); while there was a positive correlation between the vasohibin-1 and the MACC1 (r=0.518, P<0.01). Kaplan-Meier survival analysis showed that the over-expression of vasohibin-1, MACC1 and the low-expression of KAI1 protein were related to the survival rates (all P<0.05). Multi-factor analysis showed that the expression of vasohibin-1, KAI1 protein and the FIGO stage were independent prognosis factors for radical operation of serous ovarian cancer (RR=2.185, 3.893, 0.413; 95% CI=1.263-3.779, 2.190-6.921, 0.251-0.681; all P<0.05).
 Conclusion: The up-regulation of vasohibin-1, MACC1 and down-regulation of KAI1 in serous ovarian cancer are related to the tumor differentiation, clinical stage, metastasis and prognosis. Combined detection of these indexes is useful in predicting the progression and prognosis of serous ovarian cancer.
Carcinoma, Ovarian Epithelial ; Cell Cycle Proteins ; Colonic Neoplasms ; Female ; Humans ; Kangai-1 Protein ; Neoplasm Staging ; Ovarian Neoplasms ; Prognosis ; Trans-Activators ; Transcription Factors