Objective:To study the comprehensive surgical treatment of brucellosis with chest wall cysts as the main manifestation.Methods:Retrospective analysis was made on the general information epidemiological characteristics, clinical manifestations, laboratory examinations, imaging examinations, treatment and outcomes of five patients with brucellosis mainly manifested by chest wall cysts admitted to the 948 Hospital of the People's Liberation Army from July 2019 to June 2022.Results:Among the 5 patients, there were 4 males and 1 female, aged between 23 and 64 years old, with a clear history of contact with cattle and sheep. The main clinical manifestation was painless cystic masses on the chest wall. Both the serum tiger red plate agglutination test (RBPT) and the test tube agglutination test (SAT) were positive. Four cases were infected with Brucella and one case was infected with Actinobacillus pleuropneumoniae (considered as Brucella infection based on the overall condition). All patients exhibited abnormal chest wall signals (manifesting as hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging) on magnetic resonance imaging(MRI), and were ultimately diagnosed with brucellosis presenting predominantly as chest wall cysts. After complete removal of the chest wall cyst through surgery, a combination treatment of rifampicin capsules and doxycycline hyclate tablets was given for 6 weeks. There were no significant adverse reactions and the wound healed in one stage. During the postoperative follow-up period of 11 - 40 months, MRI reexamination demonstrated no evidence of chest wall cyst recurrence, and all SAT results were negative. Conclusions:Patients with brucellosis presenting as chest wall cysts are clinically rare and lack specific symptoms. Surgical resection of the affected lesion combined with early, standardized, combined, and full course antimicrobial therapy results in a good prognosis for the patient.

Objective:To study the comprehensive surgical treatment of brucellosis with chest wall cysts as the main manifestation.Methods:Retrospective analysis was made on the general information epidemiological characteristics, clinical manifestations, laboratory examinations, imaging examinations, treatment and outcomes of five patients with brucellosis mainly manifested by chest wall cysts admitted to the 948 Hospital of the People's Liberation Army from July 2019 to June 2022.Results:Among the 5 patients, there were 4 males and 1 female, aged between 23 and 64 years old, with a clear history of contact with cattle and sheep. The main clinical manifestation was painless cystic masses on the chest wall. Both the serum tiger red plate agglutination test (RBPT) and the test tube agglutination test (SAT) were positive. Four cases were infected with Brucella and one case was infected with Actinobacillus pleuropneumoniae (considered as Brucella infection based on the overall condition). All patients exhibited abnormal chest wall signals (manifesting as hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging) on magnetic resonance imaging(MRI), and were ultimately diagnosed with brucellosis presenting predominantly as chest wall cysts. After complete removal of the chest wall cyst through surgery, a combination treatment of rifampicin capsules and doxycycline hyclate tablets was given for 6 weeks. There were no significant adverse reactions and the wound healed in one stage. During the postoperative follow-up period of 11 - 40 months, MRI reexamination demonstrated no evidence of chest wall cyst recurrence, and all SAT results were negative. Conclusions:Patients with brucellosis presenting as chest wall cysts are clinically rare and lack specific symptoms. Surgical resection of the affected lesion combined with early, standardized, combined, and full course antimicrobial therapy results in a good prognosis for the patient.

Objective To construct and validate a risk prediction model for poor inhalation in chronic obstructive pulmonary disease(COPD)patients receiving inhaler therapy,providing a decision support tool for personalized prevention of poor inhalation.Methods A cross-sectional study was conducted to collect data related to COPD patients receiving inhaler therapy,forming a dataset.The dataset was randomly divided into a training set and a test set in a ratio of 4∶1.Four different methods for missing value imputation,3 methods for variable feature selection,and 18 machine learning algorithms were employed to successfully construct 216 models on the training set.The monte carlo simulation method was used for resampling in the test set to validate the models,with the area under curve(AUC),accuracy,precision,recall,and F1 score used to evaluate model performance.The optimal model was selected to build the poor inhalation prediction platform.Results A study involving 308 patients with COPD found that 135(43.8%)were at risk of adverse inhalation.Using 33 predictor variables,216 risk prediction models were developed.Of these models,the ensemble learning algorithm yielded the highest average AUC of 0.844,with a standard deviation of 0.058[95%CI=(0.843,0.845)].The differences in predictive performance among the 216 models were statistically significant(P＜0.01).Under the ensemble learning algorithm,adherence to inhaler use(38.087 4%),inhaler satisfaction(25.680 1%),literacy(24.031 3%),number of inhalers(5.482 3%),age(4.204 5%)and number of acute exacerbations in the past year(2.184 7%)contributed most to the predictive model.The model exhibited superior performance,with an AUC of 0.869 3,an accuracy of 83.87%,a precision of 86.96%,a recall of 74.07%,and an F1 score of 0.8.Conclusion This study has developed a predictive model for poor inhalation risk in COPD inhaler therapy patients using machine learning algorithms,which exhibits strong predictive capabilities and holds potential clinical application value.

Objective To investigate the medical cost and clinical efficacy of the new quadruple regimen with sodium-glucose linked transporter 2(SGLT2)inhibitor in treatment of heart failure(HF),and to provide economic reference for choosing treatment drugs for HF patients.Methods A total of 86 HF patients hospitalized in Ningbo Medical Center Lihuili Hospital from January 2022 to January 2023 were retrospectively selected as study objects.According to actual HF treatment regimen,the patients were divided into experimental group and control group,43 cases in each group.The experimental group received the new quadruple therapy regimen,and the control group received classical therapy regimen.Clinical efficacy,cardiovascular events and direct medical costs within 1 year were compared between two groups.Incremental cost-effectiveness ratio(iCER)was calculated,and sensitivity analysis was performed on the results.Results The direct medical costs of patients in experimental group were slightly higher than those in control group,but there was no statistically significant difference between two groups(￥12513.0 vs.￥11508.9,t=-0.079,P=0.125).There was no significant difference in total effective rate between experimental group and control group(81.40％vs.74.4％,x2=1.237,P=0.539).There was no significant difference in cardiovascular events within 1 year between two groups(x2=0.073,P=0.787).The cost-effectiveness ratio(C/E)of experimental group and control group were 15372.3 and 15468.9,respectively,and iCER was 143.5.Sensitivity analysis showed that the results were robust.Conclusion The clinical efficacy of control group and experimental group for HF was similar,but the C/E of experimental group was slightly higher than that of control group,and the new quadruple regimen with SGLT2 inhibitors had more pharmacoeconomic advantages.

Objective:To explore the effects of health education based on evidence-based practice using the knowledge to action model (KTA) on patients with osteoporosis and lumbar vertebral fractures.Methods:Totally 108 patients with osteoporosis and lumbar vertebral fractures admitted in the the Xingtai General Hospital of North China Medical and Health Group from October 2017 to October 2019 were selected and divided into an observation group and a control group according to the random number table, with 54 patients in each group. Patients in both groups received routine treatment and care. Patients in the control group received routine health education, while patients in the observation group received health education received health education based on evidence-based practice using KTA. The rehabilitation status [Oswestry dysfunction index (ODI) , Barthel index] between the two groups of patients, as well as the knowledge level (osteoporosis knowledge questionnaire) , living habits and quality of life [The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) ] before and after the intervention were compared.Results:After 3 months of intervention, the ODI of the two groups decreased while the Barthel index increased ( P< 0.05) ; and the ODI of the observation group was lower than that of the control group, while the Barthel index score was higher than that of the control group, with statistically significant differences ( P< 0.05) . After 3 months of intervention, the risk factors, exercise knowledge, calcium knowledge scores and total scores of the osteoporosis knowledge questionnaire in the two groups increased, with statistically significant differences ( P< 0.05) , which were higher in the observation group than in the control group, with statistically significant differences ( P< 0.05) . After 3 months of intervention, the ratio of smoking and drinking in the observation group was lower than that in the control group, and the ratio of exercise and calcium supplementation was higher than that in the control group, with statistically significant differences ( P< 0.05) . After 3 months of intervention, the scores in all dimensions of the WHOQOL-BREF of the two groups increased ( P< 0.05) , and the scores in the physical, psychological and social dimensions of the observation group were higher than those of the control group, with statistically significant differences ( P< 0.05) . Conclusions:The health education based on evidence-based practice using KTA in patients with osteoporosis and lumbar vertebral fractures helps to improve patients' related knowledge levels, living habits, rehabilitation effects, and quality of life.

Objective To investigate the expression of E-cadherin(E-cad),N-cadherin(N-cad),β-catenin (β-cat),which are the markers of Epithelial-mesenchymal transition and analyze their relationships with the clinicopathological features and the prognosis of the laryngeal squamous cell carcinoma.Methods The expression levels of E-cad,N-cad,β-cat in 76 tumor tissues and their corresponding adjacent normal laryngeal tissues were determined by immunohistochemistry method.Relationships between the proteins' expression and clinicopathological features were analyzed.Survival curves were calculated using the Kaplan-Meier method.Differences in the survival rates were analyzed by the log-rank test among different expression groups.Cox's regression model was used to examine the independent predictor of the prognosis of the laryngeal cancer.Results The expression levels of E-cad,N-cad,β-cat in tumor tissues and adjacent normal tissues were statistically significant (P ＜ 0.001).The expression level of E-cad and β-cat in the laryngeal carcinoma was related to lymph node metastasis,clinical pathological stage and differentiation degree (P ＜ 0.05),while N-cad expression level was associated with clinical stage and differentiation degree (P＜0.05).The expression of E-cad was correlated with the expression of β-cat (P =0.001),and the expression of N-cad was correlated with β-cat (P =0.02),but the expression of E-cad was not correlated with N-cad.There were four subgroups of patterns of E-cad and N-cad expression:E-cad (+)/N-cad (-),E-cad (+) /N-cad (+),E-cad (-) /N-cad (-),E-cad (-) /N-cad (+).The expression level of each group was related to the clinical pathological stage and differentiation degree (P ＜ 0.05).The expression level of E-cad/β-cat was associated with lymph node metastasis,clinical pathological stage and differentiation degree (P ＜ 0.01).Log-rank analysis showed that the prognosis of negative and positive groups was statistically different (P ＜ 0.05),and the combined analysis showed that the prognosis of E-cad/N-cad or E-cad/β-cat group was significantly different (P ＜ 0.01).Cox's regression model analysis showed that the clinical stage and β-cat were independent predictors of the prognosis of laryngeal carcinoma.Conclusions The low expression of E-cad,high abnormal expression of N-cad and β-cat played an important role in the occurrence and development of laryngeal carcinoma.It can provide a reference for evaluating clinical prognosis.The clinical pathological stage and β-cat can be used as independent predictors for the prognosis of laryngeal carcinoma.

Objective To explore the role of transvertebral transposition of the spinal cord in the treatment of the pa?tients suffering from angular kyphoscoliosis with neurologic deficit. Methods Twelve patients with at least 1 year follow?up, in?cluding 5 females and 7 males, suffering from neurologic deficit secondary to angular kyphoscoliosis underwent transvertebral transposition of the spinal cord and posterior correction from January 2005 to June 2013 were retrospectively analyzed. The initial age averaged 21±14 years. The etiologies of deformity were congenital kyphoscoliosis in 9 patients, idiopathic kyphoscoliosis in 3 patients. Preoperative spinal cord function graded by Frankel criteria was 3 cases of grade C and 9 of grade D. The initial major curve was 79.4°±16.2° with a global kyphosis of 68.3°±25.0°. The change of distance between spinal cord and canal on the convex side at the apex was measured on MR images to evaluate the efficacy of transposition;in addition, Cobb angle on coronal and sagit?tal plane was evaluated before surgery, on discharge and at the last follow?up. Results All patients were followed up for 2 years on average (1-5 years). The post operation spinal function evaluated by Frankel criteria were as follow:with grade C of 1 case, grade D of 4 cases and grade E of 7 (7 cases changed one grade, 1 case changed two grades, 4 cases did not change obvious). At the last follow?up, all the cases got obvious recovery of spinal function, with 1 case of grade C and 11 of grade D (10 cases changed one grade, 2 cases changed two grades). The distance between spinal cord and canal on the convex side at the apex changed from 11.9±6.4 mm to 9.8±6.9 mm. After surgery, the major curve improved to 39.3°±15.1° with 50.3%±20.5%correction rate, and the mean loss of correction was 6.1%±7.5%. The mean kyphosis was 41.3°±16.6°, demonstrating a 39.0%±13.0%correction rate im?mediately after operation, and showing 3.1%±4.2%correction loss at the final follow?up. No neurologic complications or no death occurred intra?and post?operatively. No screw or rod fracture, instrumentation loosening and pseudarthrosis were found during fol?low?up. Conclusion Transvertebral transposition of the spinal cord and posterior correction is a useful procedure for the recovery of neurologic deficit secondary to angular kyphoscoliosis, with good results of deformity correction.

OBJECTIVETo analyze the mutation of COL9A2 gene and investigate the molecular pathogenesis of pathological myopia in a Han Chinese population.

METHODSMutation in the coding region of the COL9A2 gene was screened by Sanger sequencing in 200 subjects with pathological myopia and 200 normal controls. The detected variants were genotyped by SNaPshot method in another 200 myopic cases and 200 normal controls.

RESULTSSanger sequencing has failed to detect the reported D281fs frameshift mutation in the 200 cases. A novel variant, c.143G>C heterozygous missense mutation in exon 2, was identified in a myopic subject, and another novel variant, c.884G>A heterozygous missense mutation in exon 17, was found in another case. Neither was found in normal controls. One SNP (rs2228564) was detected in the coding region of the COL9A2 gene, but there was no significant difference in its allelic frequencies between the two groups (P> 0.05). Genotyping of the remainder 200 cases and 200 controls by SNaPshot method has found a c.143G>C in 1 case and c.884G>A in 2 cases, though no significant difference between the two groups was detected (P> 0.05).

CONCLUSIONThe D281fs frameshift mutation in the COL9A2 gene is not associated with pathological myopia in the studied Han Chinese population. Two novel mutations, c.143G>C in exon 2 and c.884G>A in exon 17 of the COL9A2 gene, may contribute to the development of pathological myopia.

Asian Continental Ancestry Group ; genetics ; China ; ethnology ; Collagen Type IX ; genetics ; Frameshift Mutation ; Humans ; Myopia, Degenerative ; genetics ; Sequence Analysis, DNA