Objective To explore differentially expressed proteins in the serum exosomes of acute myeloid leukemia(AML)patients and healthy controls by using the proteomics method,and provide new biomarker for the diagnosis and treatment of AML.Methods A total of 76 AML patients diagnosed and treated in the First People's Hospital of Honghe State from November 2022 to June 2024 were selected as the experimental group,and 60 healthy physical examination participants were selected as the control group.Tandem Mass Tag(TMT)labeled proteomics was used to identify the differences in protein expression in serum exosomes between the experimental and control groups,and the identified differentially expressed proteins were subjected to bioinformatics analysis.Western-Blot was used to verify the differentially expressed proteins.Results Comparedwith healthy controls,146 aberrantly expressed proteinswere detected in serum exosomes of AML patients,of which 89 were up-regulated and 57 were down-regulated.Among them,Alpha-1-antichymotrypsin(α1-ACT),Angiogenin(ANG),Vitronectin(VIT),Clusterin(Clu),Fibronectin(FN),Keratin type I cytoskeletal-18(KRT18),and actinin alpha4(ACTN4)showed changed significantly.Gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis indicated that differentially expresseproteins were involved in biological processes such as neutrophil immunity,neutrophil degranulation,neutrophil activation immune response,and protein activation cascade,significantly enriched in 25 biological pathways including complement and coagulation cascades,extracellular matrix(ECM)-receptor interaction,and hypoxia-inducible factor-1(HIF-1)signaling pathways.Western-blot validation results showed that compared with the control group,the expression levels of ANG,Clu and FN in the serum exosomes of AML patients were significantly increased,while the expression level of ACTN4 was significantly decreased,with statistically significant differences(t=-11.854～18.569,all P<0.05).The expression levels of ANG and FN were correlated with white blood cell count(F=8.888,7.818,all P<0.05)and cytogenetics(F=8.619,7.983,P<0.05).The expression level of Clu protein was correlated with white blood cell count(F=2.571,P<0.05),but not significantly associated with cytogenetics(F=1.886,P>0.05).ANG,FN and Clu showed no significant correlation with FAB classification(F=0.175,0.434,0.042,all P>0.05).Conclusion The expression of exosomal proteins in the serum of AML patients compared to healthy individuals are significant differences,which may serve as serological markers for the diagnosis and treatment of AML.

Objective To explore differentially expressed proteins in the serum exosomes of acute myeloid leukemia(AML)patients and healthy controls by using the proteomics method,and provide new biomarker for the diagnosis and treatment of AML.Methods A total of 76 AML patients diagnosed and treated in the First People's Hospital of Honghe State from November 2022 to June 2024 were selected as the experimental group,and 60 healthy physical examination participants were selected as the control group.Tandem Mass Tag(TMT)labeled proteomics was used to identify the differences in protein expression in serum exosomes between the experimental and control groups,and the identified differentially expressed proteins were subjected to bioinformatics analysis.Western-Blot was used to verify the differentially expressed proteins.Results Comparedwith healthy controls,146 aberrantly expressed proteinswere detected in serum exosomes of AML patients,of which 89 were up-regulated and 57 were down-regulated.Among them,Alpha-1-antichymotrypsin(α1-ACT),Angiogenin(ANG),Vitronectin(VIT),Clusterin(Clu),Fibronectin(FN),Keratin type I cytoskeletal-18(KRT18),and actinin alpha4(ACTN4)showed changed significantly.Gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis indicated that differentially expresseproteins were involved in biological processes such as neutrophil immunity,neutrophil degranulation,neutrophil activation immune response,and protein activation cascade,significantly enriched in 25 biological pathways including complement and coagulation cascades,extracellular matrix(ECM)-receptor interaction,and hypoxia-inducible factor-1(HIF-1)signaling pathways.Western-blot validation results showed that compared with the control group,the expression levels of ANG,Clu and FN in the serum exosomes of AML patients were significantly increased,while the expression level of ACTN4 was significantly decreased,with statistically significant differences(t=-11.854～18.569,all P<0.05).The expression levels of ANG and FN were correlated with white blood cell count(F=8.888,7.818,all P<0.05)and cytogenetics(F=8.619,7.983,P<0.05).The expression level of Clu protein was correlated with white blood cell count(F=2.571,P<0.05),but not significantly associated with cytogenetics(F=1.886,P>0.05).ANG,FN and Clu showed no significant correlation with FAB classification(F=0.175,0.434,0.042,all P>0.05).Conclusion The expression of exosomal proteins in the serum of AML patients compared to healthy individuals are significant differences,which may serve as serological markers for the diagnosis and treatment of AML.

In the implementation of exemption from ethical review,medical institutions equate exemption from ethical review with no ethical review or simple review,misunderstand the scope of exemption from ethical review,confuse the concepts of de-identification and anonymization,and equate privacy with personal information.The implementation faced challenges such as the coordination of conditions for exempt review with other regulations,the lack of clear decision-making subjects for exempting from ethical review,the legality and compliance of using general informed consent for biological samples and information data,as well as non-traceability and the risk of being re-identified of anonymous information for exemption from ethical review.Measures such as improving relevant laws and regulations,perfecting the construction and management of information databases and biological sample libraries,strengthening the project management and process supervision of exemption from ethical review,and implementing scientific review can ensure the legal and compliant implementation of exemption from ethical review by medical and health institutions.

BACKGROUND: Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control. METHODS: The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months. RESULTS: Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P  < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group. CONCLUSION: Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state. TRIAL REGISTRATION Chictr.org, ChiCTR2000039799.
Humans ; Quality of Life ; China ; Arthritis, Rheumatoid/drug therapy* ; Piperidines/therapeutic use* ; Treatment Outcome ; Antirheumatic Agents/therapeutic use* ; Pyrroles/therapeutic use*

Nowadays, the new healthcare industry is closely integrated with the new-generation information techniques such as mobile Internet, Internet of things, cloud computing, and big data, which proposes higher requirements for the teaching objectives and contents of the optional course of medical informatics for non-informatics students in medical colleges and universities. Based on the actual teaching demands and the training objectives of clinical medical students, the teaching contents of the optional course of medical informatics were scientifically optimized and allocated. With "small datasets and basic application of electronic medical records/electronic health records" in medical informatics education as the main contents, numeric data, text data, and image data were modularized in medical information processing, and the methods of flipped classroom and case-driven teaching were adopted. The commonly used methods in machine learning (such as regression, classification, and clustering methods) were introduced and applied in task-based case studies, and the comprehensive algorithm case report was used for course assessment and evaluation. The teaching practice has shown that the above exploration not only stimulated the interest in the optional course of medical informatics among students, but also effectively implemented the "five early" mode of early prediction, early adjustment, early identification, early diagnosis, and early treatment among medical students.

ObjectiveTo evaluate the warning effect of different tobacco packaging on teenagers and provide an objective evidence for improving tobacco packaging in China. MethodsA multi-stage cluster sampling method was used to investigate students from two middle schools and two high schools in Huangpu District， Shanghai with a self-filled questionnaire survey， and a total of 1 238 valid questionnaires were collected. Epidata 3.1 was used to input data and SPSS 20.0 was used for data analysis. ResultsAbout 69% of the respondents supported printing pictures of diseases on tobacco packages in China， and 81.58% thought graphic warnings should cover more than 70% of the tobacco package. The effect of graphic health warning labels was better than that of text-only warning labels （P<0.05）， and the effect of real photos was better than abstract pictures. In addition， labels with real graphic warnings had the highest scores in terms of preventing youth smoking and the degree of support， which was significantly different from abstract graphic warning labels and text-only warning labels （P<0.05）. ConclusionCigarette packs with graphic health warnings have a stronger effect on teenagers than plain text health warnings. Teenagers support the use of graphic warnings. It is recommended to apply graphic health warnings with real photos of diseases on the cigarette packages to maximize the effect of the health warnings.

Objective:To discuss the problems existing in the implementation of the Chinese health industry standard WS 523-2019 by testing SPECT device.Methods:Under the WS 523-2019 standards, a total of 10 SPECT devices were tested with regard to their SPECT reconstructed spatial resolution (SRSR), system planar sensitivity (SPS), system spatial resolution (SSR), whole body system spatial resolution (WSSR), intrinsic uniformity (IU), intrinsic count rate performance (ICR), intrinsic spatial resolution (ISR) and intrinsic spatial linearity(ISL).Result:Under the requirements of WS 523-2019 standards for qualified limits, there are 3 devices with ISL unqualified and the rest of the performances qualified. The new standards basically can meet the clinical requirements and reflected the overall performance of SPECT.Conclusions:The distance between the radiation source and the surface of the detector has great influence on the spatial resolution.In the measurement of ISL, there must be a lead grid separately in the x and y directions. The lead grids with the parallel slits shall be positioned on the detector with the center slit centered on the detector. It is suggested to add rotation center in the new standards.

Objective:To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods:The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed. According to the treatment method, they were divided into observation group ( n=42) and control group ( n=44). The control group was treated with modified Okutsu method of endoscopic carpal tunnel release (ECTR), and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group. The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria, and their excellent and good recovery rates were compared. The median nerve sensory conduction velocity (SCV), motor nerve conduction velocity (MCV), sensory nerve action potential (SNAP) amplitude, and motor nerve distal motor latency (DML) of the two groups were measured by electromyography before operation, and 14 d, 30 d, and 90 d after operation. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to evaluate the upper-extremity function of the two groups before operation, and 14 d, 30 d, and 90 d after operation, and the pinch strength and grip strength of the two groups before operation, and 14 d, 30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer. Results:After three months of follow-up, the excellent and good recovery rate of the observation group (85.71%) was significantly higher than that of the control group (70.45%), with a significant statistical difference ( P<0.05). The DASH scores of the observation group were significantly lower than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The DMLs of the observation group were significantly shorter than those of the control group at 14 d, 30 d, and 90 d after operation, while the SNAPs were significantly bigger than those of the control group ( P<0.05). The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). Conclusion:Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome, which can enhance the electrophysiological function of their median nerves, and their daily functioning, to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.

Objective:To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods:The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed. According to the treatment method, they were divided into observation group ( n=42) and control group ( n=44). The control group was treated with modified Okutsu method of endoscopic carpal tunnel release (ECTR), and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group. The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria, and their excellent and good recovery rates were compared. The median nerve sensory conduction velocity (SCV), motor nerve conduction velocity (MCV), sensory nerve action potential (SNAP) amplitude, and motor nerve distal motor latency (DML) of the two groups were measured by electromyography before operation, and 14 d, 30 d, and 90 d after operation. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to evaluate the upper-extremity function of the two groups before operation, and 14 d, 30 d, and 90 d after operation, and the pinch strength and grip strength of the two groups before operation, and 14 d, 30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer. Results:After three months of follow-up, the excellent and good recovery rate of the observation group (85.71%) was significantly higher than that of the control group (70.45%), with a significant statistical difference ( P<0.05). The DASH scores of the observation group were significantly lower than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The DMLs of the observation group were significantly shorter than those of the control group at 14 d, 30 d, and 90 d after operation, while the SNAPs were significantly bigger than those of the control group ( P<0.05). The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). Conclusion:Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome, which can enhance the electrophysiological function of their median nerves, and their daily functioning, to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.

Objective:To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy combined with arthroscopic minimally invasive treatment on sports traumatic ankle arthritis (STAA) during perioperative period.Methods:The clinical data of 138 patients with STAA admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were collected. According to the treatment methods adopted, they were divided into 3 groups, 46 cases were treated with conventional surgery (group A), 43 cases were treated with arthroscopic minimally invasive treatment (group B), and 49 cases received HBO (HBO was started 3 days before the operation and restarted the second day after the operation) combined with arthroscopic minimally invasive treatment (group C). The clinical efficacies in the 3 groups of patients were observed. The Mcguire scores and the scores of visual analogue scale (VAS) for pain before and after operation were recorded. The postoperative ankle function recovery time, postoperative recovery treatment time, postoperative joint swelling and pain symptoms subsiding time, as well as the operation time, intraoperative blood loss, and length of hospital stay, were recorded.Results:After treatment, the Mcguire scores of the patients in group B and C were significantly higher than those of the group A, and the VAS scores were significantly reduced; after treatment, the Mcguire scores of the patients in group C were significantly higher than that of the group B, and the VAS scores was significantly reduced, with significantly statistical differences ( P<0.05, or P<0.01). After treatment, the total effective rates of the group B (86.0%) and the group C (95.9%) were significantly higher than that of the group A (71.7%), and the total effective rate of the group C was significantly higher than that of the group B, all were with significantly statistical differences ( P<0.05, or P<0.01). The operation time, intraoperative blood loss, and length of hospital stay of the group B and C were significantly lower than those of the group A ( P<0.05, or P<0.01); the length of hospital stay of the patients in the group C was significantly lower than that of the patients in the group B ( P<0.05), but their operation time and intraoperative blood loss were no significant difference ( P>0.05). The postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group B and C were significantly lower than those of the patients in the group A ( P<0.05, or P<0.01); the postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group C were significantly lower than those of the patients in the group B, with significantly statistical differences ( P<0.05). Conclusion:HBO combined with arthroscopic minimally invasive treatment on STAA can significantly improve the clinical efficacy and help restore ankle joint function.