[摘 要] 目的：探究地塞米松联合阿比特龙对去势抵抗性前列腺癌（CRPC）患者尿流动力学、外周血循环肿瘤细胞雄激素受体剪切变异体7（AR-V7）、人同源盒基因B13（HoxB13）水平及生存预后的影响。方法：回顾性选取本院收治的114例CRPC患者病历资料，根据治疗方案分为对照组（予以0.5 mg地塞米松治疗，n = 51）和观察组（予以0.5 mg地塞米松联合1 000 mg阿比特龙治疗，n = 63）。比较两组疗效、尿动力学、外周血循环肿瘤细胞AR-V7、HoxB13水平以及生存预后。结果：观察组63例，对照组51例。治疗8周后，观察组疾病控制率与客观缓解率（分别为42.86%与96.83%）均显著高于对照组（分别为23.53%与86.27%）（P < 0.05）。观察组的最大尿流率[（14.58 ± 1.02）mL/s vs （11.18 ± 1.16）mL/s）]、平均尿流率[（12.92 ± 1.21）mL/s vs （9.83 ± 0.59）mL/s）]均显著高于对照组，而剩余尿量[（24.12 ± 1.96）mL vs （28.03 ± 1.68）mL）]显著低于对照组（均P < 0.05）。观察组与对照组的AR-V7 mRNA表达水平相近[（1.78 ± 0.32） vs （1.68 ± 0.46）]，差异无统计学意义（P > 0.05）；但观察组的HoxB13 mRNA表达水平显著低于对照组[（1.21 ± 0.27） vs （1.57 ± 0.37），P < 0.05]。观察组的中位无进展生存期[6.22个月（95%CI：5.63~6.63）]显著长于对照组[3.66个月（95%CI：3.01~3.74）]（P < 0.05）；观察组的3年总生存率为12.70%，显著高于对照组的0.00%（P < 0.05）。结论：地塞米松联合阿比特龙治疗CRPC患者具有显著疗效，能明显改善患者尿流动力，下调外周血循环肿瘤细胞中HoxB13的表达，未显著影响AR-V7的表达，还能延长患者PFS，提高3年总生存率。

BACKGROUND: Meningeal metastasis (MM) is a form of malignant metastasis where tumor cells spread from the primary site to the pia mater, dura mater, arachnoid, subarachnoid space, and other cerebrospinal fluid compartments. Lung cancer is one of the most common malignant tumor types with MM. MM not only signifies that the lung cancer has progressed to an advanced stage but also leads to a range of severe clinical symptoms due to meningeal involvement. Currently, the risk factors associated with the development of MM are not fully elucidated. The aim of this study was to investigate the risk factors for MM in patients with lung adenocarcinoma (LUAD) who underwent non-surgical interventions, in order to identify LUAD patients at high risk for MM. METHODS: This retrospective study analyzed the clinical data of patients diagnosed with LUAD at the First Affiliated Hospital of Zhengzhou University from January 2020 to July 2024. Missing data were imputed using multiple imputation methods, and risk factors were identified through LASSO, univariate, and multivariate Logistic regression analyses. RESULTS: A total of 170 patients with LUAD were included in this study and divided into two groups: 87 patients with MM and 83 patients without MM. Univariate and multivariate Logistic regression analyses revealed that younger age at diagnosis (P=0.004), presence of the epidermal growth factor receptor (EGFR) L858R gene mutation (P=0.008), and concurrent liver metastasis at baseline (P=0.004) were independent risk factors for developing MM in LUAD patients who did not undergo surgical intervention. Conversely, higher baseline globulin levels (P=0.039) and the presence of the anaplastic lymphoma kinase (ALK) gene mutation (P=0.040) were associated with a reduced risk of MM development. CONCLUSIONS Age at diagnosis, EGFR L858R mutation status, ALK gene mutation status, concurrent liver metastasis, globulin levels at baseline were significantly associated with the risk of developing MM in patients with LUAD patients who did not undergo surgical intervention. For patients diagnosed at a younger age, carrying the EGFR L858R mutation, or presenting with baseline liver metastasis, early implementation of tertiary prevention strategies for MM is crucial. Regular monitoring of MM status should be conducted in these high-risk groups.
Humans ; Male ; Adenocarcinoma of Lung/therapy* ; Female ; Middle Aged ; Risk Factors ; Lung Neoplasms/therapy* ; Retrospective Studies ; Aged ; Meningeal Neoplasms/genetics* ; Adult

Heparin-induced thrombocytopenia(HIT)is an antibody-mediated adverse reaction to heparin that is clinically manifested as a progressive reduction in platelet count after heparin administration,leading to venous and/or arterial thromboembolism and even death in severe cases.Acquired thrombocytopenia is commonly observed in hospitalized patients,the pathological mechanism is associated with drugs,autoimmune diseases,and consumptive thrombocytopenia.Patients with HIT frequently have complex clinical situations,and their manifestations are often atypical or mixed with other symptoms and signs,posing significant challenges to diagnosis and treatment for clinicians.Through the multidisciplinary diagnosis and treatment process of a HIT patient,this paper discusses HIT occurrence mechanism,clinical evaluation,laboratory testing and alternative anticoagulant therapy,so as to provide reference for doctors to accurately identify and effectively intervention in clinical practice.

Objective To investigate the effects of baicalein on the expression of inflammatory factors in bronchial epithelial cell(BEC),and explore the underlying regulatory mechanisms involved.Methods Log-phase 16 HBE cells were categorized into five groups:the normal control group,the toluene diisocyanate(TDI)-stimulated group,and the low-,medium-,and high-dose baica-lein groups.The normal control group was cultured with standard medium,while the TDI-stimulated group was treated with TDI-human serum albumin(TDI-HSA)to establish an asthma-like cell model.Following TDI-HSA stimulation,the low-,medium-,and high-dose baicalein groups were intervened with baicalein at final concentrations of 10,20 and 40μmol/L for48hours.Cell viability was assessed using the CCK-8 assay,and lactate dehydrogenase(LDH)release assays were performed to evaluate the LDH release rate.Flow cytometry was used to determine the rate of pyroptosis.Enzyme-linked immunosorbent assays(ELISA)were conducted to measure the levels of interleukin-1β(IL-1β),interleukin-6(IL-6)and interleukin-18(IL-18)in the culture supernatants.Protein ex-pression levels of NLR family,pyrin domain-containing protein 3(NLRP3),cysteine-dependent aspartate-specific protease 1(caspase-1),Gasdermin D and apoptosis-associated speck-like protein containing a CARD(ASC)were examined via Western blot analysis.Results Compared with the normal control group,the cell viability in the TDI stimulation group decreased(P＜0.05),and the LDH release rate,pyroptosis rate,and the levels of IL-1β,IL-6 and IL-18 in the supernatant all increased(P＜0.05).Com-pared with the TDI-stimulated group,the cell viability in the low-,medium-,and high-dose baicalein groups increased(P＜0.05),while the LDH release rate,pyroptosis rate,and the levels of IL-1β,IL-6 and IL-18 in the supernatant all decreased(P＜0.05),and all in a dose-dependent manner(P＜0.05).Compared with the normal control group,the protein expressions of NLRP3,caspase-1,Gasdermin D and ASC in the TDI-stimulated group were all increased(P＜0.05).Compared with the TDI-stimulated group,the protein expressions of NLRP3,caspase-1,Gasdermin D and ASC in the low-,medium-and high-dose baicalein groups were all decreased(P＜0.05),also in a dose-dependent manner(P＜0.05).Conclusion Baicalein may alleviate TDI-induced the expression of inflammatory factors in BEC by modulating the pyroptosis pathway.Through this mechanism,scutellarin enhances cell viabil-ity and reduces the rate of pyroptosis.

Objective:To explore the prognostic value of assessing plasma thrombin-antithrombin complex (TAT) and D-dimer (D-D) in patients with acute ischemic stroke (AIS).Methods:This prospective cohort study enrolled 538 AIS patients admitted to the General Hospital of Tianjin Medical University from July 2021 to May 2024, including 306 males and 232 females, with an average age of (69.5±11.5) years. Among them, there were 147 cases of lacunar infarction, 166 cases of large artery atherosclerosis type, 122 cases of cardioembolic type, and 103 cases of cancer-related type. Follow-up observations were conducted on enrolled patients, data within 30 days after the initiation of acute phase treatment for one week were collected, thrombus-related cerebral ischemic events recurrence served as the endpoint event, starting from August 5, 2021, to June 19, 2024. During the follow-up period, 68 patients experienced endpoint events, including 14 cases of large artery atherosclerosis type, 23 cases of cardioembolic type, and 31 cases of cancer-related type. The plasma levels of TAT and D-D were determined by chemiluminescence method and enzyme-linked immunofluorescence assay respectively. The receiver operating characteristic (ROC) curve was used to analyze the prediction performance of TAT and D-dimer for recurrent ischemic events in AIS patients during the 30-day follow-up period, and the Kaplan-Meier curve was used for survival analysis.Results:Statistically differences were observed in the plasma TAT and D-D levels among patients with different types of AIS ( P<0.05), with cancer-related type had higher levels than cardioembolic type ( P<0.05), and cardioembolic type had higher levels than large artery atherosclerosis type ( P<0.05). In the non-recurrent ischemic event group, the plasma TAT and D-D levels of patients with large artery atherosclerosis type, cardioembolic type and cancer-related type were lower in post-treatment than pre-treatment ( P<0.05). In the recurrent ischemic event group, the plasma D-D levels were higher in post-treatment than pre-treatment in the patients with large artery atherosclerosis type ( P<0.05); there was no statistically difference between the post-treatment and pre-treatment in plasma TAT and D-D levels in patients with cardioembolic type ( P>0.05); in patients with cancer-related type, the TAT and D-D levels were lower in post-treatment than pre-treatment ( P<0.05), but higher than those in the non-recurrence group ( P<0.05). The ROC curve showed that the area under the curve for predicting the risk of ischemic event recurrence within 30 days in AIS patients by plasma TAT combined with D-D on day 7 after treatment was all >0.9 (0.950 for large artery atherosclerosis type, 0.965 for cardioembolic type, and 0.907 for cancer-related types). Survival analysis indicated that various patients with both indicators above the critical value had an increased cumulative risk probability of adverse events (log-rank χ 2=93.667, 109.266, and 58.433, respectively, with all P<0.001). Conclusion:The changes of plasma TAT and D-D levels in AIS patients are associated with stroke type and coagulation activation, and dynamic monitoring of these two indicators could help evaluate the treatment effect and predict the risk of recurrent ischemic events.

Background and Aims:Acute inferior vena cava thrombosis(IVCT)commonly occurs secondary to inferior vena cava filter(VCF)implantation.If not promptly treated,it may lead to serious complications such as bilateral lower limb swelling and pulmonary embolism and can also reduce the likelihood of successful filter retrieval.Percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)are currently the main interventional treatments for IVCT,but comparative studies evaluating their efficacy and safety remain limited.This study was to conduct a prospective randomized controlled trial to compare the clinical efficacy and safety of AngioJet mechanical thrombectomy versus conventional CDT in the treatment of acute IVCT and to explore factors influencing filter retrieval rates,thereby providing evidence-based guidance for clinical decision-making.Methods:From January 2022 to December 2024,patients diagnosed with acute IVCT following VCF implantation were prospectively enrolled at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University.Patients were randomly assigned to either the CDT group(n=46)or the PMT group(n=48)according to the interventional procedure used.The two groups were compared in terms of filter retrieval rates,thrombus clearance outcomes,operative time,thrombolytic drug dosage,and incidence of complications.Logistic regression analysis was used to identify factors associated with primary filter retrieval.Results:A total of 94 patients were enrolled,with 46 in the CDT group and 48 in the PMT group.Compared to the CDT group,the PMT group demonstrated a significantly higher primary filter retrieval rate(77.1%vs.43.5%),grade Ⅲ thrombus clearance rate(70.8%vs.37.0%),and better postoperative thrombus scores.Additionally,the PMT group required lower urokinase doses and shorter thrombolysis duration(all P<0.05).The overall filter retrieval rate and 3-month IVC patency were similar between groups,both exceeding 93%.Regarding safety,the CDT group had a higher incidence of catheter-related infections and medical adhesive-related skin injury,while vagal reflex symptoms were more frequent in the PMT group.Logistic regression analysis identified thrombus clearance rate as an independent factor significantly associated with primary filter retrieval in the PMT group(OR=190.773,P<0.05).Conclusion:Compared to CDT,AngioJet mechanical thrombectomy combined with manual aspiration achieves higher thrombus clearance and primary filter retrieval rates in the treatment of acute IVCT while also reducing thrombolysis duration and drug dosage.However,attention should be paid to the increased risk of vagal reflex symptoms.There was no significant difference between the two groups in secondary filter retrieval rates or long-term IVC patency.The choice of intervention should be based on the patient's condition,timing of filter retrieval,and individualized clinical considerations.

Background and Aims:Acute inferior vena cava thrombosis(IVCT)commonly occurs secondary to inferior vena cava filter(VCF)implantation.If not promptly treated,it may lead to serious complications such as bilateral lower limb swelling and pulmonary embolism and can also reduce the likelihood of successful filter retrieval.Percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)are currently the main interventional treatments for IVCT,but comparative studies evaluating their efficacy and safety remain limited.This study was to conduct a prospective randomized controlled trial to compare the clinical efficacy and safety of AngioJet mechanical thrombectomy versus conventional CDT in the treatment of acute IVCT and to explore factors influencing filter retrieval rates,thereby providing evidence-based guidance for clinical decision-making.Methods:From January 2022 to December 2024,patients diagnosed with acute IVCT following VCF implantation were prospectively enrolled at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University.Patients were randomly assigned to either the CDT group(n=46)or the PMT group(n=48)according to the interventional procedure used.The two groups were compared in terms of filter retrieval rates,thrombus clearance outcomes,operative time,thrombolytic drug dosage,and incidence of complications.Logistic regression analysis was used to identify factors associated with primary filter retrieval.Results:A total of 94 patients were enrolled,with 46 in the CDT group and 48 in the PMT group.Compared to the CDT group,the PMT group demonstrated a significantly higher primary filter retrieval rate(77.1%vs.43.5%),grade Ⅲ thrombus clearance rate(70.8%vs.37.0%),and better postoperative thrombus scores.Additionally,the PMT group required lower urokinase doses and shorter thrombolysis duration(all P<0.05).The overall filter retrieval rate and 3-month IVC patency were similar between groups,both exceeding 93%.Regarding safety,the CDT group had a higher incidence of catheter-related infections and medical adhesive-related skin injury,while vagal reflex symptoms were more frequent in the PMT group.Logistic regression analysis identified thrombus clearance rate as an independent factor significantly associated with primary filter retrieval in the PMT group(OR=190.773,P<0.05).Conclusion:Compared to CDT,AngioJet mechanical thrombectomy combined with manual aspiration achieves higher thrombus clearance and primary filter retrieval rates in the treatment of acute IVCT while also reducing thrombolysis duration and drug dosage.However,attention should be paid to the increased risk of vagal reflex symptoms.There was no significant difference between the two groups in secondary filter retrieval rates or long-term IVC patency.The choice of intervention should be based on the patient's condition,timing of filter retrieval,and individualized clinical considerations.

Objective To investigate the effects of baicalein on the expression of inflammatory factors in bronchial epithelial cell(BEC),and explore the underlying regulatory mechanisms involved.Methods Log-phase 16 HBE cells were categorized into five groups:the normal control group,the toluene diisocyanate(TDI)-stimulated group,and the low-,medium-,and high-dose baica-lein groups.The normal control group was cultured with standard medium,while the TDI-stimulated group was treated with TDI-human serum albumin(TDI-HSA)to establish an asthma-like cell model.Following TDI-HSA stimulation,the low-,medium-,and high-dose baicalein groups were intervened with baicalein at final concentrations of 10,20 and 40μmol/L for48hours.Cell viability was assessed using the CCK-8 assay,and lactate dehydrogenase(LDH)release assays were performed to evaluate the LDH release rate.Flow cytometry was used to determine the rate of pyroptosis.Enzyme-linked immunosorbent assays(ELISA)were conducted to measure the levels of interleukin-1β(IL-1β),interleukin-6(IL-6)and interleukin-18(IL-18)in the culture supernatants.Protein ex-pression levels of NLR family,pyrin domain-containing protein 3(NLRP3),cysteine-dependent aspartate-specific protease 1(caspase-1),Gasdermin D and apoptosis-associated speck-like protein containing a CARD(ASC)were examined via Western blot analysis.Results Compared with the normal control group,the cell viability in the TDI stimulation group decreased(P＜0.05),and the LDH release rate,pyroptosis rate,and the levels of IL-1β,IL-6 and IL-18 in the supernatant all increased(P＜0.05).Com-pared with the TDI-stimulated group,the cell viability in the low-,medium-,and high-dose baicalein groups increased(P＜0.05),while the LDH release rate,pyroptosis rate,and the levels of IL-1β,IL-6 and IL-18 in the supernatant all decreased(P＜0.05),and all in a dose-dependent manner(P＜0.05).Compared with the normal control group,the protein expressions of NLRP3,caspase-1,Gasdermin D and ASC in the TDI-stimulated group were all increased(P＜0.05).Compared with the TDI-stimulated group,the protein expressions of NLRP3,caspase-1,Gasdermin D and ASC in the low-,medium-and high-dose baicalein groups were all decreased(P＜0.05),also in a dose-dependent manner(P＜0.05).Conclusion Baicalein may alleviate TDI-induced the expression of inflammatory factors in BEC by modulating the pyroptosis pathway.Through this mechanism,scutellarin enhances cell viabil-ity and reduces the rate of pyroptosis.

Heparin-induced thrombocytopenia(HIT)is an antibody-mediated adverse reaction to heparin that is clinically manifested as a progressive reduction in platelet count after heparin administration,leading to venous and/or arterial thromboembolism and even death in severe cases.Acquired thrombocytopenia is commonly observed in hospitalized patients,the pathological mechanism is associated with drugs,autoimmune diseases,and consumptive thrombocytopenia.Patients with HIT frequently have complex clinical situations,and their manifestations are often atypical or mixed with other symptoms and signs,posing significant challenges to diagnosis and treatment for clinicians.Through the multidisciplinary diagnosis and treatment process of a HIT patient,this paper discusses HIT occurrence mechanism,clinical evaluation,laboratory testing and alternative anticoagulant therapy,so as to provide reference for doctors to accurately identify and effectively intervention in clinical practice.