Objective:To explore the prognostic value of peripheral blood lymphocyte subsets in patients with newly diagnosed multiple myeloma (NDMM) .Methods:The study retrospectively analyzed 133 patients with NDMM admitted to the General Hospital of Tianjin Medical University General Hospital between 2017 and 2022. The least absolute shrinkage and selection operator (LASSO) regression was used to screen the predictive subgroups from the peripheral blood lymphocyte subsets, and the optimal cutoff value was calculated through receiver operating characteristic curve analysis. A nomogram was constructed based on the results of the multiple-factor analysis, and the predictive performance of the nomogram was evaluated by the concordance index and calibration curve. Kaplan-Meier curves and log-rank tests were conducted to compare the differences in overall survival (OS) and progression-free survival between the high-risk and low-risk immune risk scores groups.Results:Using LASSO regression, the percentages and absolute counts of CD16 +CD56 + NK cells, CD3 + T lymphocytes, CD3 +CD8 + T lymphocytes, and CD3 -CD19 + B lymphocytes were selected as predictive subgroups. The immune risk score of patients with NDMM was calculated based on the coefficients of each lymphocyte subgroup. The area under the curve of the immune risk score was 0.737, and the optimal cutoff value was -1.834. Based on this, the patients were divided into high-risk and low-risk groups. Survival analysis showed a significant difference in the 3-year OS rate between the high-risk and low-risk immune risk score groups (87.4% vs 49.0%, P<0.001), and a significant difference in the 3-year OS rate between the high-risk and low-risk immune risk score groups in patients with minimal residual disease negative (100% vs 68.6%, P=0.001). Multivariate analysis showed that serum calcium ( P=0.034), high-risk cytogenetic abnormalities ( P=0.002), and immune risk score ( P<0.001) were prognostic factors for patients with NDMM, and a nomogram was constructed based on these factors. The consistency index of the nomogram was 0.793, and the calibration curve showed good predictive ability. The nomogram can accurately classify the risk of different prognostic staging systems. Conclusions:The combined analysis of lymphocyte subsets in the peripheral blood has an important value in predicting the prognosis of patients with NDMM.

Objective:To explore the prognostic value of peripheral blood lymphocyte subsets in patients with newly diagnosed multiple myeloma (NDMM) .Methods:The study retrospectively analyzed 133 patients with NDMM admitted to the General Hospital of Tianjin Medical University General Hospital between 2017 and 2022. The least absolute shrinkage and selection operator (LASSO) regression was used to screen the predictive subgroups from the peripheral blood lymphocyte subsets, and the optimal cutoff value was calculated through receiver operating characteristic curve analysis. A nomogram was constructed based on the results of the multiple-factor analysis, and the predictive performance of the nomogram was evaluated by the concordance index and calibration curve. Kaplan-Meier curves and log-rank tests were conducted to compare the differences in overall survival (OS) and progression-free survival between the high-risk and low-risk immune risk scores groups.Results:Using LASSO regression, the percentages and absolute counts of CD16 +CD56 + NK cells, CD3 + T lymphocytes, CD3 +CD8 + T lymphocytes, and CD3 -CD19 + B lymphocytes were selected as predictive subgroups. The immune risk score of patients with NDMM was calculated based on the coefficients of each lymphocyte subgroup. The area under the curve of the immune risk score was 0.737, and the optimal cutoff value was -1.834. Based on this, the patients were divided into high-risk and low-risk groups. Survival analysis showed a significant difference in the 3-year OS rate between the high-risk and low-risk immune risk score groups (87.4% vs 49.0%, P<0.001), and a significant difference in the 3-year OS rate between the high-risk and low-risk immune risk score groups in patients with minimal residual disease negative (100% vs 68.6%, P=0.001). Multivariate analysis showed that serum calcium ( P=0.034), high-risk cytogenetic abnormalities ( P=0.002), and immune risk score ( P<0.001) were prognostic factors for patients with NDMM, and a nomogram was constructed based on these factors. The consistency index of the nomogram was 0.793, and the calibration curve showed good predictive ability. The nomogram can accurately classify the risk of different prognostic staging systems. Conclusions:The combined analysis of lymphocyte subsets in the peripheral blood has an important value in predicting the prognosis of patients with NDMM.

Objective:To investigate the effect of linalutide on adipocytokine, blood glucose and renal function in diabetic nephropathy (DN) patients.Methods:One hundred DN patients diagnosed and treated by Chengdu Second People′s Hospital and Chunxi Community Health Service Center of Jinjiang District and Shuyuan Community Health Service Center of Jinjiang District from January 2018 to June 2019 were selected and divided into metformin group (48 cases) and combined group (52 cases) according to different treatment regimens. Metformin group was treated with metformin, the combined group was treated with linalutide on the basis of metformin group, and both groups were treated for 12 weeks. The therapeutic efficacy, adipocytokine index adiponectin (ADPN), secretory-type curl-related proteins-5(SFRP5), omentin-1; blood glucose index fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbA 1c), fasting insulin (FINS), insulin resistance index(HOMA-IR), and renal function index urinary albumin excretion rate (UAER), albumin creatinine ratio(ACR), liver-type fatty acid binding protein(L-FABP) were compared between the two groups and the prognosis was analyzed. Results:The total effective rate in the combined group at 4, 8 and 12 weeks were higher than those in the metformin group and the longer treatment, the higher total effective, there were statistical differences ( χ2 group = 4.61, χ2 time point = 78.57, P<0.05). Before treatment, there were no significant differences in serum FBG, 2hPBG, HbA 1c, FINS, HOMA-IR, ADPN, SFRP5, omentin-1, urine UAER, ACR and L-FABP between the two groups ( P>0.05). After treatment, the levels of serum FBG, 2hPBG, HbA 1c, FINS, HOMA-IR, urine UAER, ACR and L-FABP in the combined group were lower than those in the metformin group: (7.17 ± 1.62) mmol/L vs. (8.75 ± 2.11) mmol/L, (5.54 ± 1.11)mmol/L vs. (6.56 ± 1.08) mmol/L, (6.63 ± 0.92)% vs. (7.95 ± 0.89)%, (7.12 ± 1.17) mU/L vs. (8.72 ± 1.58)mU/L, 3.52 ± 0.88 vs. 4.04 ± 0.70, (28.65 ± 3.22) mg/24 h vs. (65.42 ± 6.85) mg/24 h, (56.24 ± 7.68) μg/mg vs. (92.68 ± 9.29) μg/mg, (8.62 ± 1.08) μg/(g·Cr) vs. (14.62 ± 1.85) μg/(g·Cr); the levels of ADPN, SFRP5 and omentin-1 were higher than those in the metformin group: (14.53 ± 2.43) mg/L vs. (10.21 ± 2.12) mg/L, (12.81 ± 2.31) μg/L vs. (8.75 ± 2.18) μg/L, (48.49 ± 5.28) μg/L vs. (36.57 ± 4.32) μg/L, there were statistical differences ( P<0.05). After treatment, the incidence of end-point events in the combined group was 7.69% (4/52), which was lower than that in the metformin group 22.92% (11/48), and there was statistical differences ( χ2 = 4.57, P<0.05). The survival analysis showed that the survival time and median survival time after treatment in the combined group were higher than those in the metformin group ( P<0.05). Conclusions:Linalutid can effectively improve blood glucose level and renal function in DN patients, and has obvious effect on adipocykine secretion, which is conducive to improve prognosis.

Objective To explore the effects of quality control circle on improving sense of coherence of nurses in Operating Room. Methods Quality control circle activities were carried out based on the theme of“improving sense of coherence in nurses of Operating Room”. Current situation was investigated according to the activity steps with the result that sense of coherence in nurses of Operating Room was low and that was negative correlation with age and job seniority. Then, the activity steps followed with analyzing the reasons, formulating and carrying out appropriate strategies and promoting them. Results Scores of sense of coherence, comprehensibility, manageability and meaningfulness increased from (3. 95 ± 0. 43), (5. 12 ± 0. 46), (3. 26 ± 0. 55), (3. 33 ± 0. 51) to (4. 32 ± 0. 46), (5. 87 ± 0. 19), (4. 28 ± 0. 61), (4. 61 ± 0. 76) with statistically significant differences (P<0. 05). Conclusions Activities of quality control circle are significantly effective in improving sense of coherence in nurses of Operating Room. Activities of quality control circle can effectively improve nurses′ psychological endurance and adjustment ability, mobilize work enthusiasm, improve work efficiency and quality, reduce the occurrence of error accidents and enhance comprehensive ability of team of quality control circle.

We describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography an-giography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta start-ing immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a‘rule-out’ test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation.

Biomarkers ; metabolism ; Bone Diseases ; metabolism ; Humans ; Multiple Myeloma ; metabolism

OBJECTIVETo construct three-dimensional (3D) models of renal stones and perform percutaneous nephrolithotomy (PCNL) virtual surgery simulation. Methods CT images were obtained from 8 patients with renal stones. Images segmentation and reconstruction were performed using MIMICS 10.0 software to construct the 3D model of the renal stones, which provided the anatomical relationships between the kidney and the adjacent organs. The optimal PCNL virtual surgery simulation for each individual case was performed using FreeForm Modeling System on the basis of the 3D model.

RESULTSEight 3D models of renal stone were constructed. The 3D model of the renal stones represented the interrelationships of the stones, intrarenal vessel, and the collecting system with the adjacent anatomical structures. Individualized PCNL virtual surgery simulations including percutaneous puncture, dilatation and pneumatic lithotripsy were performed successfully in all the 8 3D models.

CONCLUSIONDigital 3D model of renal stone provides the reliable and comprehensive imaging information for surgical design, and PCNL virtual surgery simulation has important clinical significance to improve the stone clearance rate and reduce the surgical complications.

Adult ; Female ; Humans ; Imaging, Three-Dimensional ; Kidney Calculi ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Software ; Tomography, Spiral Computed ; User-Computer Interface

Objective To study the image segmentation, three-dimensional (3D) reconstruction and simulation operation of choledocholithotomy and T-tube drainage based on the computed tomagraphy (CT) data of patient with choledocholithiasis. Methods Patient with choledocholithiasis underwent 64-slice spiral CT imaging. The images segmentation and 3D reconstruction were performed by Medical Image Process System (MIPS) to construct the 3D model of the hepatobiliary system. The model was modified by FreeForm Modeling System. The virtual surgical instruments were developed by GHOST SDK software, and were imported to the virtual surgery. Results The data of plain, arterial phase, venous phase and portal venous phase scanning were collected, and the data stored in DICOM format were transformed to BMP format. A model of the hepatobiliary system was constructed after the data was segmented by MIPS, and then the model was exported in the STL format. The data in STL format were imported to FreeForm Modeling System for smoothing the model. Different structures were assigned different colors to make the model more vivid. The self-developed virtual surgical instruments were imported to the system, and the virtual surgery for choledocholithiasis was performed with PHANToM. Conclusions With the help of MIPS, the image segmentation and 3D reconstruction of the model are finished rapidly and effectively. After the virtual surgical instruments are developed in FreeForm Modeling System, the virtual surgery can be achieved in the 3D model with the assistance of PHANToM.