Objective To Study the value of effected ejection fraction(eEF)in assessment of cardiac function in elderly patients with heart failure.Methods A total of 1 134 elderly inpatients in this hospital from January 2019 to December 2023 were selected as the research subjects.After admission,relevant examinations and tests were completed,and the cardiac function classification of the New York Heart Association(NYHA)was carried out.Sequential electrocardiogram(ECG)and echocardiogram examinations were completed before treatment.Age,under-lying diseases,left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proB-NP),and QT interval(QTc)of the ECG were included for classification and statistics,and eEF was obtained,and the evaluation value of eEF on cardiac function was analyzed.Results The numbers of patients with NY-HA cardiac function grades Ⅰ—Ⅳ were 86,434,454 and 160,respectively,and LVEF decreased with the in-crease of the NHYA cardiac function grade.There was statistically significant differences in LVEF among dif-ferent NHYA cardiac function classifications(P＜0.05).The QTc of the patients was(434.71±40.96)ms,the eEF was(8.73±2.03)ms,and the ln(NT-proBN)was 7.05±1.70.QTc,eEF,and ln(NT-proBN)all in-creased with the increase of the NHYA cardiac function classification,and there were statistically significant differences in indicators above among different NHYA cardiac function classfications(P＜0.05).There was a low correlation between QTc of the ECG,age and cardiac insufficiency(r＜0.5,P＜0.05);there was a high correlation between eEF,LVEF,and ln(NT-proBNP)and cardiac insufficiency(r≥0.5,P＜0.05).Conclusion eEF still has discriminatory value for patients with heart failure with preserved ejection fraction,and it is a good indicator for evaluating the cardiac function of elderly patients with heart failure.

Objective:To investigate the clinical effect of free anterolateral thigh myocutaneous flap combined with oral repair membrane in the reconstruction of nasal mucosa defect after maxillary malignant tumor surgery. Methods:A total of 12 patients with maxillary gingival squamous cell carcinoma and maxillary sinus cancer who had been treated in Department of Oral and Maxillofacial Surgery, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, were selected from November 2020 to November 2023. Free anterolateral thigh musculocutaneous flap transplantation combined with oral repair membrane were used in all patients. Meanwhile, maxillary soft and hard tissue defects and nasal mucosa defects left after tumor operation were repaired and reconstructed. The clinical effect was evaluated after 6-12 months follow-up. Results:Subtotal maxillary resection was performed in 1 case, total maxillary resection in 9 cases and extended maxillary resection in 2 cases. The musculocutaneous flaps of all patients survived, the facial appearance was basically symmetrical, no obvious depression deformity, the swallowing and speech function recovered well, the mouth and nasal cavity were closed completely, the food could be eaten through the mouth, and the lower nasal passage was not blocked. Conclusion:The free anterolateral thigh musculoflap combined with oral repair membrane can be used to repair and reconstruct maxillary malignant tumor complicated with extensive maxillary tissue and nasal mucosa defect after operation, and the appearance and function can be recovered well after operation, which is a choice for maxillary malignant tumor complicated with nasal mucosa defect.
Humans ; Myocutaneous Flap ; Plastic Surgery Procedures/methods* ; Maxillary Neoplasms/surgery* ; Carcinoma, Squamous Cell/surgery* ; Male ; Middle Aged ; Female ; Nasal Mucosa/surgery* ; Maxilla/surgery* ; Thigh/surgery* ; Maxillary Sinus Neoplasms/surgery*

Objective To analyze the medical malpractice technical appraisals accepted by a health administration department,and to provide suggestions for the work improvement of the health administration department and its affiliated medical institutions.Methods A total of 57 cases of technical appraisals for medical malpractice accepted from 2015 to 2023 were analyzed retrospectively.Yi fa hui's reasons for the failure of medical institutions were taken as the main classification basis of the medical fault.Results There were 51 cases of the first appraisal and 6 cases of the second appraisal.Among them,38 cases were completed,and the completion rate was 66.67%,involving 15 departments;17 cases were deemed medical accidents.The most frequent category was Grade 1 medical malpractice with minor liability borne by the healthcare provider,involving 8 types of faults.Conclusion The majority of appraisals accepted by a health administration department is the first appraisal,and the completion rate of appraisal needs to be improved.It is suggested that the health administration department should do well in the explanation and communication in the process of medical malpractice technical appraisal,and medical institutions should strengthen their supervision responsibility for clinical work.

Objective:To observe the clinical efficacy of gentle moxibustion at different temperatures in treating people with diarrhea-predominant bowel syndrome(IBS-D)due to spleen deficiency.Methods:A total of 108 IBS-D patients were divided into two groups using the random number table method,with 54 participants in each group.Moxibustion group 1 received gentle moxibustion at(43±1)℃at bilateral Tianshu(ST25)and Zusanli(ST36),lasting 30 min each session;moxibustion group 2 received gentle moxibustion at(37±1)℃at the same points.Both groups received the intervention 3 times weekly for a total of 18 sessions.Abdominal pain intensity,stool form,pattern-based efficacy,quality of life,and mental health assessments were performed at weeks 0,3,6,and 8.Results:The total effective rate for abdominal pain intensity was 87.8%in moxibustion group 1 versus 51.1%in moxibustion group 2,and the difference was statistically significant(P<0.05).When the treatment finished,abdominal pain intensity,the Bristol score,IBS-symptom severity scale(IBS-SSS)score,self-rating anxiety scale(SAS)score,and self-rating depression scale(SDS)score dropped significantly in both groups(P<0.05),and the IBS-quality of life(IBS-QOL)score increased markedly(P<0.05).Between-group comparisons demonstrated that abdominal pain intensity,the Bristol general score,IBS-SSS score,traditional Chinese medicine(TCM)pattern score,and SDS score were significantly lower in moxibustion group 1 than in moxibustion group 2 at treatment week 6(P<0.05),and the IBS-QOL score was notably higher in moxibustion group 1(P<0.05).Conclusion:Whether at 43℃or 37℃,gentle moxibustion at Tianshu(ST25)and Zusanli(ST36)can improve abdominal pain,stool form,and quality of life,reduce disease severity,and mitigate TCM pattern in IBS-D patients;43℃gentle moxibustion performs better than 37℃gentle moxibustion in improving abdominal pain,stool form,disease severity,TCM pattern,quality of life,anxiety,and depression in IBS-D.

Objective:To observe the clinical efficacy of gentle moxibustion at different temperatures in treating people with diarrhea-predominant bowel syndrome(IBS-D)due to spleen deficiency.Methods:A total of 108 IBS-D patients were divided into two groups using the random number table method,with 54 participants in each group.Moxibustion group 1 received gentle moxibustion at(43±1)℃at bilateral Tianshu(ST25)and Zusanli(ST36),lasting 30 min each session;moxibustion group 2 received gentle moxibustion at(37±1)℃at the same points.Both groups received the intervention 3 times weekly for a total of 18 sessions.Abdominal pain intensity,stool form,pattern-based efficacy,quality of life,and mental health assessments were performed at weeks 0,3,6,and 8.Results:The total effective rate for abdominal pain intensity was 87.8%in moxibustion group 1 versus 51.1%in moxibustion group 2,and the difference was statistically significant(P<0.05).When the treatment finished,abdominal pain intensity,the Bristol score,IBS-symptom severity scale(IBS-SSS)score,self-rating anxiety scale(SAS)score,and self-rating depression scale(SDS)score dropped significantly in both groups(P<0.05),and the IBS-quality of life(IBS-QOL)score increased markedly(P<0.05).Between-group comparisons demonstrated that abdominal pain intensity,the Bristol general score,IBS-SSS score,traditional Chinese medicine(TCM)pattern score,and SDS score were significantly lower in moxibustion group 1 than in moxibustion group 2 at treatment week 6(P<0.05),and the IBS-QOL score was notably higher in moxibustion group 1(P<0.05).Conclusion:Whether at 43℃or 37℃,gentle moxibustion at Tianshu(ST25)and Zusanli(ST36)can improve abdominal pain,stool form,and quality of life,reduce disease severity,and mitigate TCM pattern in IBS-D patients;43℃gentle moxibustion performs better than 37℃gentle moxibustion in improving abdominal pain,stool form,disease severity,TCM pattern,quality of life,anxiety,and depression in IBS-D.

Objective To elucidate whether increased palmitic acid(PA)content after obesity can inhibit KLF4 expression through up-regulation of DNMT1/3b,which in turn regulates the biological behavior of endometrial cancer(EC)cells.Methods General data were collected from non-EC control individuals(n=120)and EC patients(n=30)to analyze the differences in obesi-ty-related phenotypes between the two groups;Endometrial tissues from non-EC control individuals(n=20)and cancer tissues from EC patients(n=20)were collected,and the expression of KLF4 and DNMT1/3b was detected by immunohistochemistry in the endometrial tissues;invitro culture of EC cells was carried out;mRNA and protein expression levels of DNMTs/KLF4/MMP2 and other factors in the cells were detected by qRT-PCR and Western blotting.Transwell and scratch assay were used to detect the proliferation,migration and invasion ability of EC cells;An EC hormonal tumor model was constructed in obese mice,and the tumor-forming ability of EC cells or EC cells overexpressing KLF4 was observed in mice.Results The weight,body mass index,plasma LDL and free fatty acid content of EC patients were significantly higher than that of non-cancer subjects(P＜0.05);The percentage of overweight/obese individuals was higher in EC patients than that of non-cancer subjects(73.33％vs.50.00％,P＜0.05);The expression level of KLF4 in tumor tissues of EC patients was significantly lower,and the expres-sion level of DNMT1/3b was significantly higher.The expression level of KLF4 was significantly negatively correlated with the level of FFAs in serum.After PA treatment,the expression level of KLF4 in EC cells was significantly reduced,the expression levels of DNMT1/3b and MMP2 were significantly increased,and the cell migration and invasion ability was significantly en-hanced,with no significant effect on the cell proliferation ability.Up-regulation of KLF4 significantly reduced the expression lev-el of MMP2 and weakened the migration and invasion ability of EC cells;Down-regulation of KLF4 significantly increased the expression level of MMP2 and enhanced the migration and invasion ability of EC cells;PA treatment with concomitant up-regu-lation of KLF4 significantly reversed the promotional effect of PA treatment on the MMP2 expression level as well as migration and invasion ability of EC cells.The expression levels of KLF4 in EC cells were both significantly increased after down-regula-tion of DNMT1 and DNMT3b;PA treatment with simultaneous down-regulation of DNMT1 and DNMT3b,significantly re-versed these results.The tumor-forming ability of EC cells was significantly enhanced in high-fat diet-induced obese mice,whereas tumor-forming ability of EC cells was significantly reduced in high-fat diet-induced obese mice after overexpression of KLF4.Conclusion Increased plasma PA content after obesity promotes endometrial cancer cell migration,invasion,and in vivo tumor-forming ability by inhibiting KLF4 expression through down-regulation of DNMT1/DNMT3b.

Objective To elucidate whether increased palmitic acid(PA)content after obesity can inhibit KLF4 expression through up-regulation of DNMT1/3b,which in turn regulates the biological behavior of endometrial cancer(EC)cells.Methods General data were collected from non-EC control individuals(n=120)and EC patients(n=30)to analyze the differences in obesi-ty-related phenotypes between the two groups;Endometrial tissues from non-EC control individuals(n=20)and cancer tissues from EC patients(n=20)were collected,and the expression of KLF4 and DNMT1/3b was detected by immunohistochemistry in the endometrial tissues;invitro culture of EC cells was carried out;mRNA and protein expression levels of DNMTs/KLF4/MMP2 and other factors in the cells were detected by qRT-PCR and Western blotting.Transwell and scratch assay were used to detect the proliferation,migration and invasion ability of EC cells;An EC hormonal tumor model was constructed in obese mice,and the tumor-forming ability of EC cells or EC cells overexpressing KLF4 was observed in mice.Results The weight,body mass index,plasma LDL and free fatty acid content of EC patients were significantly higher than that of non-cancer subjects(P＜0.05);The percentage of overweight/obese individuals was higher in EC patients than that of non-cancer subjects(73.33％vs.50.00％,P＜0.05);The expression level of KLF4 in tumor tissues of EC patients was significantly lower,and the expres-sion level of DNMT1/3b was significantly higher.The expression level of KLF4 was significantly negatively correlated with the level of FFAs in serum.After PA treatment,the expression level of KLF4 in EC cells was significantly reduced,the expression levels of DNMT1/3b and MMP2 were significantly increased,and the cell migration and invasion ability was significantly en-hanced,with no significant effect on the cell proliferation ability.Up-regulation of KLF4 significantly reduced the expression lev-el of MMP2 and weakened the migration and invasion ability of EC cells;Down-regulation of KLF4 significantly increased the expression level of MMP2 and enhanced the migration and invasion ability of EC cells;PA treatment with concomitant up-regu-lation of KLF4 significantly reversed the promotional effect of PA treatment on the MMP2 expression level as well as migration and invasion ability of EC cells.The expression levels of KLF4 in EC cells were both significantly increased after down-regula-tion of DNMT1 and DNMT3b;PA treatment with simultaneous down-regulation of DNMT1 and DNMT3b,significantly re-versed these results.The tumor-forming ability of EC cells was significantly enhanced in high-fat diet-induced obese mice,whereas tumor-forming ability of EC cells was significantly reduced in high-fat diet-induced obese mice after overexpression of KLF4.Conclusion Increased plasma PA content after obesity promotes endometrial cancer cell migration,invasion,and in vivo tumor-forming ability by inhibiting KLF4 expression through down-regulation of DNMT1/DNMT3b.

Objective:To explore the neurological adverse events (AE) associated to brexucabtagene autoleucel (brexu-cel) and their risk of occurrence.Methods:Neurological AE reports related to brexu-cel were collected through the US FDA Adverse Event Reporting System database from July 1, 2020 to September 31, 2022. The AEs were classified and counted according to the system organ class (SOC) and preferred term (PT) of Medical Dictionary for Regulatory Activities (MedDRA) 24.1. The information component ( IC) method and the reporting odds ratio ( ROR) method were used to perform signal mining. AEs with ≥3 reports and a lower limit of 95% confidence interval ( CI) for IC>0 or that for ROR>1 were defined as positive risk signals. The proportion of patients who suffered fatal outcomes after experiencing neurological AEs related to brexu-cel was analyzed. Results:A total of 1 960 neurological AE reports related to brexu-cel were collected, involving 559 patients and 22 PTs. Fifteen positive signals (PT) were detected by using the IC and ROR methods. The top 5 PTs in the number of AE reports were immune effector cell-associated neurotoxicity syndrome (153 reports), altered mental status (32 reports), encephalopathy (29 reports), tremor (27 reports), and aphasia (25 reports); the top 5 PTs with the high signal intensity were immune effector cell-associated neurotoxicity syndrome ( IC=7.81, ROR=235.74), encephalopathy ( IC=4.74, ROR=26.96), aphasia ( IC=4.28, ROR=19.58), cerebral edema ( IC=3.35, ROR=10.24), and incontinence ( IC=3.04, ROR=8.22); incontinence (6 cases, IC=3.04, ROR=8.22) was not recorded in the drug instruction. Patients involved in 17 PTs, out of the 22 PTs, had fatal outcomes, and the proportion of deaths from immune effector cell-associated neurotoxicity syndrome was 18% (28/153). The PTs with a proportion of patient deaths >50% were unresponsive to stimuli (80%, 4/5), brain oedema (75%, 6/8), cerebrovascular accident (67%, 2/3), lethargy (60%, 3/5), and seizure (57%, 4/7). Conclusions:Neurological AEs related to brexu-cel are common, of which incontinence is not yet recorded in the drug instruction. The clinical outcomes of some AEs (unrespontive to stimulus, brain oedema, and lethargy) are poor and should be closely monitored.

Objective:To explore the neurological adverse events (AE) associated to brexucabtagene autoleucel (brexu-cel) and their risk of occurrence.Methods:Neurological AE reports related to brexu-cel were collected through the US FDA Adverse Event Reporting System database from July 1, 2020 to September 31, 2022. The AEs were classified and counted according to the system organ class (SOC) and preferred term (PT) of Medical Dictionary for Regulatory Activities (MedDRA) 24.1. The information component ( IC) method and the reporting odds ratio ( ROR) method were used to perform signal mining. AEs with ≥3 reports and a lower limit of 95% confidence interval ( CI) for IC>0 or that for ROR>1 were defined as positive risk signals. The proportion of patients who suffered fatal outcomes after experiencing neurological AEs related to brexu-cel was analyzed. Results:A total of 1 960 neurological AE reports related to brexu-cel were collected, involving 559 patients and 22 PTs. Fifteen positive signals (PT) were detected by using the IC and ROR methods. The top 5 PTs in the number of AE reports were immune effector cell-associated neurotoxicity syndrome (153 reports), altered mental status (32 reports), encephalopathy (29 reports), tremor (27 reports), and aphasia (25 reports); the top 5 PTs with the high signal intensity were immune effector cell-associated neurotoxicity syndrome ( IC=7.81, ROR=235.74), encephalopathy ( IC=4.74, ROR=26.96), aphasia ( IC=4.28, ROR=19.58), cerebral edema ( IC=3.35, ROR=10.24), and incontinence ( IC=3.04, ROR=8.22); incontinence (6 cases, IC=3.04, ROR=8.22) was not recorded in the drug instruction. Patients involved in 17 PTs, out of the 22 PTs, had fatal outcomes, and the proportion of deaths from immune effector cell-associated neurotoxicity syndrome was 18% (28/153). The PTs with a proportion of patient deaths >50% were unresponsive to stimuli (80%, 4/5), brain oedema (75%, 6/8), cerebrovascular accident (67%, 2/3), lethargy (60%, 3/5), and seizure (57%, 4/7). Conclusions:Neurological AEs related to brexu-cel are common, of which incontinence is not yet recorded in the drug instruction. The clinical outcomes of some AEs (unrespontive to stimulus, brain oedema, and lethargy) are poor and should be closely monitored.

Artemisia annua is the main natural source of artemisinin production. In A. annua, extended drought stress severely reduces its biomass and artemisinin production while short-term water-withholding or abscisic acid (ABA) treatment can increase artemisinin biosynthesis. ABA-responsive transcription factor AabZIP1 and JA signaling AaMYC2 have been shown in separate studies to promote artemisinin production by targeting several artemisinin biosynthesis genes. Here, we found AabZIP1 promote the expression of multiple artemisinin biosynthesis genes including AaDBR2 and AaALDH1, which AabZIP1 does not directly activate. Subsequently, it was found that AabZIP1 up-regulates AaMYC2 expression through direct binding to its promoter, and that AaMYC2 binds to the promoter of AaALDH1 to activate its transcription. In addition, AabZIP1 directly transactivates wax biosynthesis genes AaCER1 and AaCYP86A1. The biosynthesis of artemisinin and cuticular wax and the tolerance of drought stress were significantly increased by AabZIP1 overexpression, whereas they were significantly decreased in RNAi-AabZIP1 plants. Collectively, we have uncovered the AabZIP1-AaMYC2 transcriptional module as a point of cross-talk between ABA and JA signaling in artemisinin biosynthesis, which may have general implications. We have also identified AabZIP1 as a promising candidate gene for the development of A. annua plants with high artemisinin content and drought tolerance in metabolic engineering breeding.