Objective:This study aimed to evaluate the therapeutic efficacy of early bedside plasma adsorption (PA) combined with pulse high-volume hemofiltration (PHVHF) in patients with septic shock and acute kidney injury (AKI).Methods:A prospective randomized controlled trial was conducted, enrolling septic shock patients with AKI admitted to the intensive care unit of Linyi Central Hospital between January 2022 and January 2024. Participants were randomly assigned to either the Continuous Veno-Venous Hemofiltration (CVVH) group or the integrated treatment group (PHVHF+PA). Both groups received standard care following the 2021 Surviving Sepsis Campaign guidelines. Both groups received standard treatment according to the 2021 Surviving Sepsis Campaign guidelines. The CVVH group received standard CVVH, while the integrated therapy group underwent PHVHF [substitution fluid rate: 85 mL/(kg·h)] combined with PA. Organ function indices, hemodynamic parameters, inflammatory markers, critical illness scores before treatment, at 24 h and 72 h after treatment, and 28-day survival outcomes were monitored. Categorical data were analyzed using the χ2 test, continuous variables were compared with independent samples t-test, repeated-measures data were analyzed by ANOVA, and 28-day survival was evaluated using Kaplan-Meier curves.Results:A total of 56 septic shock patients with AKI were enrolled and randomly divided into CVVH group ( n=27) and integrated therapy group ( n=29). The baseline characteristics including age, gender, and body mass index were comparable between groups (all P>0.05). No significant differences in organ function or hemodynamic parameters were observed before treatment (all P>0.05). At 24 h post-treatment, both groups showed significant improvements in serum creatinine (Scr), mean arterial pressure, heart rate, and lactate levels (all P<0.05), with reduced norepinephrine requirements ( P<0.05). The integrated treatment group demonstrated significant improvements in oxygenation index (PaO 2/FiO 2), total bilirubin, APACHEⅡ and SOFA scores (all P<0.05). By 72 h, the integrated therapy group exhibited significantly higher PaO 2/FiO 2, platelet counts, and MAP, alongside lower total bilirubin, Scr, HR, norepinephrine dosage, and Lac (all P<0.05). Both groups showed reductions in APACHEⅡ, SOFA scores, procalcitonin, C-reactive protein, TNF-α, IL-6, and IL-10 (all P<0.05). The integrated treatment group had shorter ICU stays [(8.9±2.8) d vs. (11.2±3.6) d, P=0.005), and higher 28-day renal function recovery rates [15(51.7%) vs. 8(29.6%), P=0.033] than CVVH group, though no significant differences were observed in 7-day or 28-day survival rates between groups (both P>0.05). Conclusions:Compared to CVVH, the combined therapy of PHVHF and PA demonstrates superior efficacy in eliminating inflammatory mediators and enhancing organ function. However, this combination does not significantly influence 28-day survival outcomes in patients.

With the improvement of diagnosis and treatment level, most breast cancer patients survive in a chronic state for a long time, and the issue of concomitant diseases of breast cancer (CDBC) has become increasingly prominent. All-round and full-cycle management of these comorbidities can help improve patients’ quality of life and prognosis. General practice, with its long-term, comprehensive and responsible health care that is person-centered, family-based, community-wide and oriented to the maintenance and promotion of overall health, presents new opportunities for the health management of CDBC. This article will explore the application of consultation-liaison general practice through the integrated general and specialist care in the comprehensive management of CDBC, aiming to raise people’s awareness of it and promote the development of consultation-liaison general practice and the management model of the "Internet plus general practitioner team" , which will surely contribute to the all-round management of concomitant diseases in breast cancer patients.

With the improvement of diagnosis and treatment level, most breast cancer patients survive in a chronic state for a long time, and the issue of concomitant diseases of breast cancer (CDBC) has become increasingly prominent. All-round and full-cycle management of these comorbidities can help improve patients’ quality of life and prognosis. General practice, with its long-term, comprehensive and responsible health care that is person-centered, family-based, community-wide and oriented to the maintenance and promotion of overall health, presents new opportunities for the health management of CDBC. This article will explore the application of consultation-liaison general practice through the integrated general and specialist care in the comprehensive management of CDBC, aiming to raise people’s awareness of it and promote the development of consultation-liaison general practice and the management model of the "Internet plus general practitioner team" , which will surely contribute to the all-round management of concomitant diseases in breast cancer patients.

Depression is a common mental illness in adolescents, and some patients do not respond well after medication, which may be partly related to vitamin D deficiency and insufficient calcium intake. This paper reports a 15-year-old patient with depression, whose condition was still unstable and the effect was not good despite routine use of antidepressant drugs and psychological intervention. After adequate supplementation of vitamin D and calcium, the patient's depression improved significantly, and the follow-up for 4 months, the condition was stable and did not recur.

The incidence of parathyroid hyperfunction is high and its clinical manifestations are diverse. Some patients develop chest tightness and palpitations as the main discomfort, which may be caused by the hypocalcemia and hypercalcemia related to negative calcium balance and parathyroid hyperfunction. We report a case of 53 years old male with parathyroid hyperfunction who was diagnosed with osteoporosis before and received conventional regular supplementation of vitamin D and calcium supplements. However, his condition worsened and he developed chest tightness and palpitation. After 1 month of sufficient supplementation of calcium, the symptoms of chest tightness and palpitation disappeared completely. Then we continued to provide the patients enough vitamin D and calcium supplementation actively. After 1 year of follow-up, the patient's condition was stable. His discomfort of chest tightness and palpitation never recurred, and all the bone metabolism indicators returned to normal.

Objective:To analyze the clinical efficacy and safety of camrelizumab combined with apatinib as a second-line therapy for unresectable hepatocellular carcinoma (HCC).Methods:Ninety-four cases with mid-and advanced-stage HCC who received camrelizumab combined with apatinib as second-line treatment were enrolled. Routine blood test, blood biochemical indexes, tumor stage, tumor imaging characteristics, previous treatment strategies and other clinical data before treatment were documented. Imaging examination follow-up results and adverse reactions during treatment were followed up until the end of follow-up or loss of follow-up or death. Kaplan-Meier method was used to analyze the clinical efficacy.Results:As of the last follow-up, 94 cases with mid-and advanced-stage HCC had received camrelizumab combined with apatinib as second-line treatment. Among them, 15 cases were lost to follow-up, 31 cases died, and 48 cases survived. The overall remission rate was 31.9%. The overall disease control rate was 71.3%. The median time to disease-free progression was 6.6 months. The median time to disease progression was not yet available. The 1-year cumulative survival rate was 62.3%. Grade 3 and above adverse reactions mainly included were thrombocytopenia (7.4%), abdominal pain (4.3%), active hepatitis (4.3%), leukopenia (4.3%), diarrhea (3.2%), hand-foot syndrome (3.2%). All adverse reactions were effectively controlled.Conclusion:Camrelizumab combined with apatinib can effectively prolong the survival period of patients with mid-and advanced-stage HCC, and it is well tolerated.

A 25-year-old man with extensive burn due to industrial dust explosion was admitted to the First Affiliated Hospital of Naval Medical University on 16th October, 2018. Four days after the first skin grafting and vacuum sealing drainage surgery, the patient developed signs of uncontrolled severe inflammation and shock. However, several atypical manifestations interfered the diagnosis of septic shock. After giving emergency treatment including fluid resuscitation, broad-spectrum antibiotics, and administration of vasopressor agents, the patient′s condition was alleviated, but quickly relapsed and deteriorated, with acute pulmonary edema appeared in the evening of the same day. Finally, the condition was reversed by completely removing the negative pressure devices on upper limbs and thorough dressing change. This case suggests that the diagnosis and treatment of infection in patients with extensive burn need comprehensive analysis. Timely intervention of the wound is the key to control the exacerbation of sepsis. In addition, the possibility of pulmonary edema in patients with sepsis should be on high alert.

Objective: To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones. Methods: From September 2018 to March 2019, 48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis (primary group, 38 patients) and recurrent choledocholithiasis group (recurrent group, 10 patients). The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA. The Chao1 estimator indicated the richness of the biliary bacterial flora, and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora. The bacterial flora distribution was explored from different levels of phylum, class, order, family, genus and species. Chi-square test and t test were performed for statistical analysis. Results: The Chao1 estimator of the primary group was higher than that of the recurrent group (419.413±118.704 vs. 396.000±70.483), and the difference was statistically significant (t=3.130, P=0.003). At the level of the phylum, the highest abundance of bacteria in the primary group was Firmicute (56.48%), the highest abundance of bacteria in the recurrent group was Proteobacteria (57.79%). The dominant bacteria of the recurrent group was Proteobacteria, which was inconsistent with that of the primary group, and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups (χ²=0.962 and -2.619, both P<0.05). At the genus level, the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group (9.75% vs. 20.77%, 10.86% vs. 22.01%, respectively), and the differences were statistically significant (χ²=0.354 and 0.503, both P<0.05). The abundance of Morganella of the recurrent group was higher than that of the primary group (9.00% vs. 0.44%), and the difference was statistically significant (χ²=-2.025, P=0.049). At the species level, the abundance of Bacillus unclassified, Carnobacterium maltaromaticum and Bacillus circulans of the primary group were all higher than those of the recurrent group (17.78% vs. 8.84%, 2.39% vs. 1.11%, 2.59% vs. 0.74%, respectively), and the differences were all statistically significant (χ²=2.540, 2.643 and 2.515, all P<0.05). The abundance of Aeromonas veronii of recurrent group was higher than that of the primary group (2.04% vs. 0.01%), and the difference was statistically significant (χ²=-2.397, P=0.021). The bacteria that had significant effects in the primary group included Lactococcus (P=0.012), Lactobacillus (P=0.033) and Geobacillus (P=0.021), while in the recurrent group, which included Enterobacter (P=0.007), Aeromonadaceae (P=0.001), Actinomycetes (P=0.009), and Aeromonas (P=0.001). Conclusions There are differences in abundance and composition of biliary bacterial flora between the recurrent group and the primary group. It remains to be further studied whether the changes of some bacterial flora correlated with the recurrence of common bile duct stones.

Objective To investigate the change and significance of regulatory T cells (Tregs) in peripheral blood in patients with acute and chronic gout. Methods Flow cytometry was used to detect the ratio of Tregs in peripheral blood of healthy controls, patients with acute gout and patients with chronic gout. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of transforming growth factor (TGF)-βand interleukin (IL)-1βin plasma. Then, statistical analysis was conducted to analyze the changes and significance in different stages of gout, such as F test, Kruskal-Walls H test, q test and Pearson and Spearman correlation analysis. Results ① The percentage of CD4+CD25+Foxp+Treg/CD4+ T cells in peripheral blood was (1.22±0.27)％ in control group. While in patients with acute gout, it was (1.51±0.43)％, and (0.47±0.26)％in patients with chronic gout. There were statistical significant difference among the three groups ( F=101.39, P<0.05). The percentage of Tregs in acute gout group was significantly higher than that in control group and chronic gout group, while it was significantly lower in chronic gout group than in control group ( P<0.05). ②The concentration of TGF-β in plasma was (170 ±12) ng/L in control group, (214 ±77) ng/L in patients with acute gout and (179±21) ng/L in patients with chronic gout, the difference was statistically-significant (F=6.20, P<0.05). The concentration of TGF-β in plasma in acute gout group was significantly higher than the control group and chronic gout group, the difference was statistically significant (P<0.05), while the difference between chronic gout group and the control group was not statistically significant ( P>0.05). ③The con-centration of IL-1β in plasma in the control group was (4.8 ±1.3) ng/L, while that in patients with acute and chronic gout was (10.1±8.5) ng/L and (11.50±12.57) ng/L respectively, the difference between these three groupswas stati-sticallysignificant (P<0.05). The concentration of IL-1β in plasma in acute gout group and chronic gout group wassignificantly higher than that in the control group, the difference was statistical significant ( P<0.05). There was no significant difference between acute gout and chronic gout (P>0.05) patients. ④ The percentage of Tregs in peripheral blood of gout patients was negatively correlated with the duration of disease and the number of gout attacks within six months (duration of disease: r =-0.381, P <0.01 ; number of gout attacks: r=-0.518, P<0.01). But there wasno significant correlation to the concentration of TGF-β and IL-1β. Conclusion Tregsincreasesin acute gout and participate in the alleviation of gout inflammation, while the persistence of chronic gout may be related to the decrease of Tregs. Therefore, Tregs play an important regulatory role in the transformation of acute and chronic gout.

Objective To investigate the relationship between the level of circulating CD133+/KDR+ endothelial progenitor cells (EPCs) and outcome in patients with acute ischemic stroke.Methods Inpatients with first-ever ischemic stroke within 24 hfrom the onset and age-and sex-matched healthy subjects were enrolled in the study.The demographic and clinical data of the patients were collected.The level of CD133+/KDR+ EPCs was detected by flow cytometry.All patients were followed up at 90 d.The modified Rankin Scale was used to evaluate the clinical outcome,0-2 was defined as good outcome and >2 was defined as poor outcome.Results A total of 126 consecutive patients with first-ever ischemic stroke within 24 hfrom the onset and 60 age-and sex-matched healthy subjects were enrolled.In patients with ischemic stroke,33 (26.19%) were large artery atherosclerosis (LAA),74 (58.73%) were small artery occlusion (SAO),19 (15.08%) were cardioembolism (CE);82 (65.08%) had good outcomes and 44 (34.92%) had poor outcomes.The number of circulating EPCs at baseline in patients of the LAA subtype (0.071%±0.018%),CE subtype (0.068%±0.16%) and SAO subtype (0.118%±0.12%) was significantly lower than that in the control group (0.246%±0.052%;all P<0.05),and the CE subtype (P=0.028) and LAA subtype (P=0.037) were significantly lower than the SAO subtype;the CE subtype was lower than the LAA subtype,but the difference was not statistically significant (P=0.762).The proportions of patients with LAA subtype (40.91% vs.18.29%;χ2=7.577,P=0.006) and CE subtype (29.55% vs.7.32%;χ2=11.049,P=0.001) and atrial fibrillation (29.55% vs.10.98%;χ2=6.582,P=0.009),and age (69.64±9.62 years vs.61.12±7.31 years;t=5.570,P<0.001),and baseline NIHSS score (14.16±4.22 vs.6.96±2.04;t=12.919,P<0.001),baseline systolic blood pressure (176.06±13.42 mmHg vs.164.12±11.69 mmHg,1 mmHg=0.133 kPa;t=5.187,P<0.001),low-density lipoprotein cholesterol (2.92±0.52 mmol/L vs.2.49±0.36 mmol/L;t=5.447,P<0.001),fasting blood glucose (8.76±2.88 mmol/L vs.6.82±2.24 mmol/L;t=4.185,P<0.001),C-reactive protein (7.62±1.82 mg/L vs.4.57±1.58 mg/L;t=9.790,P<0.001),and D-dimer (1.14±0.08 mg/L vs.0.97±0.22 mg/L;t=4.946,P<0.001) levels in the poor outcome group were significantly higher than those in the good outcome group,while the proportion of the SAO subtype patients (29.55% vs.74.39%;χ2=23.759,P<0.001),high-density lipoprotein cholesterol (0.94±0.68 mmol/L vs.1.16±0.14 mmol/L;t=2.829,P=0.005),and baseline EPCs (0.069%±0.018% vs.0.098%±0.021%;t=7.755,P<0.001) were significantly lower than those in the good outcome group.Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio 1.242,95% confidence interval 1.126-1.372;P<0.001),CE subtype (odds ratio 3.460,95% confidence interval 1.312-5.146;P=0.016),and the lower baseline EPCs (odds ratio 1.632,95% confidence interval 1.006-3.024;P<0.001) were the independent risk factors for poor outcome in patients.Conclusion s The level of circulating EPCs was decreased significantly in patients with acute ischemic stroke,and the lower level of baseline EPCs was an independent predictor of poor outcome in patients with ischemic stroke at 90 d.