Objective: To investigate the awareness of core tuberculosis (TB) knowledge and the willingness to TB preventive intervention among secondary school students in Lanzhou City, so as to provide a reference basis for the prevention and control of TB in schools. Methods: From April to June 2024, a total of 1 127 secondary school students from 8 schools in 4 districts (counties) of Lanzhou City were recruited by stratified cluster sampling method to conduct a questionnaire survey on the awareness of core TB knowledge and the willingness for preventive intervention against latent tuberculosis infection. Data were analysed using χ 2 test and binary Logistic regression model. Results: The overall awareness rate of core TB knowledge among secondary school students in Lanzhou City was 74.48%, while only 25.91% demonstrated awareness of all core knowledge items. The lowest awareness was observed for the item "tuberculosis is a chronic infectious disease" (61.84%). About 94.85% of the students reported willingness to receive preventive interventions after a diagnosis of latent tuberculosis infection. Multifactorial Logistic regression analysis showed that students whose father s education was junior high school ( OR=3.14, 95%CI =1.22-8.08), senior high school or secondary vocational school ( OR=3.55，95%CI =1.16-10.86) had a higher willingness to receive preventive interventions than those whose father s education was primary school or below (both P <0.05). In addition, students who recognized "suspected tuberculosis" were also more likely to express willingness to receive preventive interventions ( OR=1.96, 95%CI =1.01-3.80, P <0.05). Conclusions The total awareness rate of core TB knowledge among secondary school students in Lanzhou City is low; willingness to receive preventive interventions for latent tuberculosis infection is high and it is related to father s literacy and core TB knowledge level.

INTRODUCTION: Lecanemab has shown promise in treating early Alzheimer's disease (AD), but its safety and efficacy in Chinese populations remain unexplored. This study aimed to evaluate the safety and 6-month clinical outcomes of lecanemab in Chinese patients with mild cognitive impairment (MCI) or mild AD. METHODS: In this single-arm, real-world study, participants with MCI due to AD or mild AD received biweekly intravenous lecanemab (10 mg/kg). The study was conducted at Hainan Branch, Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Patient enrollment and baseline assessments commenced in November 2023. Safety assessments included monitoring for amyloid-related imaging abnormalities (ARIA) and other adverse events. Clinical and biomarker changes from baseline to 6 months were evaluated using cognitive scales (mini-mental state examination [MMSE], montreal cognitive assessment [MoCA], clinical dementia rating-sum of boxes [CDR-SB]), plasma biomarker analysis, and advanced neuroimaging. RESULTS: A total of 64 patients were enrolled in this ongoing real-world study. Safety analysis revealed predominantly mild adverse events, with infusion-related reactions (20.3%, 13/64) being the most common. Of these, 69.2% (9/13) occurred during the initial infusion and 84.6% (11/13) did not recur. ARIA-H (microhemorrhages/superficial siderosis) and ARIA-E (edema/effusion) were observed in 9.4% (6/64) and 3.1% (2/64) of participants, respectively, with only two symptomatic cases (one ARIA-E presenting with headache and one ARIA-H with visual disturbances). After 6 months of treatment, cognitive scores remained stable compared to baseline (MMSE: 22.33 ± 5.58 vs . 21.27 ± 4.30, P = 0.733; MoCA: 16.38 ± 6.67 vs . 15.90 ± 4.78, P = 0.785; CDR-SB: 2.30 ± 1.65 vs . 3.16 ± 1.72, P = 0.357), while significantly increasing plasma amyloid-β 42 (Aβ42) (+21.42%) and Aβ40 (+23.53%) levels compared to baseline. CONCLUSIONS: Lecanemab demonstrated a favorable safety profile in Chinese patients with early AD. Cognitive stability and biomarker changes over 6 months suggest potential efficacy, though high dropout rates and absence of a control group warrant cautious interpretation. These findings provide preliminary real-world evidence for lecanemab's use in China, supporting further investigation in larger controlled studies. REGISTRATION ClinicalTrials.gov , NCT07034222.
Humans ; Alzheimer Disease/drug therapy* ; Male ; Female ; Aged ; Middle Aged ; Cognitive Dysfunction/drug therapy* ; Aged, 80 and over ; Amyloid beta-Peptides/metabolism* ; Biomarkers ; East Asian People

Hepatitis B virus (HBV)-specific CD8⁺ T cells play a central role in controlling HBV infection; however, their function is impaired during chronic HBV infection, manifesting as a state of dysfunction. Recent studies have revealed that CD8⁺ T cell dysfunction in chronic HBV infection differs from the classical exhaustion observed in other viral infections or tumors. In 2024, several pivotal studies further elucidated novel mechanisms underlying CD8⁺ T cell dysfunction in chronic HBV infection and identified new therapeutic targets, including 4-1BB and transforming growth factor-beta (TGF-β). This review, while elucidating the dysfunction of CD8⁺ T cells in chronic HBV infection and its underlying mechanisms, focuses on summarizing the key findings from these latest studies and explores their translational value and clinical significance.
Humans ; Hepatitis B, Chronic/virology* ; CD8-Positive T-Lymphocytes/immunology* ; Hepatitis B virus/physiology* ; Animals ; Transforming Growth Factor beta/immunology*

Lacking therapeutic targets highlights the crucial roles of chemotherapy and radiotherapy in the clinical management of triple-negative breast cancer (TNBC). To relieve the side effects of the chemoradiotherapy combination regimen, we design and develop a self-assembled micelle nanosystem consisting of perfluorocarbon chain-modified cisplatin prodrug. By incorporating perfluorodecalin, this nanosystem can effectively carry ozone and promote irradiation-derived reactive oxygen species (ROS) production. By leveraging the perfluorocarbon sidechain, the nanosystem exhibits efficient internalization by TNBC cells and effectively escapes from lysosomal entrapment. Under X-ray irradiation, ozone-generated ROS disrupts the intracellular redox balance, thereby facilitating the release of cisplatin in a reduction-responsive manner mediated by reduced glutathione. Moreover, oxygen derived from ozone decomposition enhances the efficacy of radiotherapy by alleviating tumor hypoxia. Notably, the combination of irradiation with ozone-loaded cisplatin prodrug nano system synergistically prompts antitumor efficacy and reduces cellular/systemic toxicity in vitro and in vivo. Furthermore, the combo regimen remodels the tumor microenvironment into an immune-favored state by triggering immunogenic cell death and relieving hypoxia, which provides a promising foundation for a combination regimen of immunotherapy. In conclusion, our nanosystem presents a novel strategy for integrating chemotherapy and radiotherapy to optimize the efficacy and safety of TNBC clinical treatment.

OBJECTIVES: To construct a bone tumor classification model based on feature decoupling and fusion for processing modality loss and fusing multimodal information to improve classification accuracy. METHODS: A decoupling completion module was designed to extract local and global bone tumor image features from available modalities. These features were then decomposed into shared and modality-specific features, which were used to complete the missing modality features, thereby reducing completion bias caused by modality differences. To address the challenge of modality differences that hinder multimodal information fusion, a cross-attention-based fusion module was introduced to enhance the model's ability to learn cross-modal information and fully integrate specific features, thereby improving the accuracy of bone tumor classification. RESULTS: The experiment was conducted using a bone tumor dataset collected from the Third Affiliated Hospital of Southern Medical University for training and testing. Among the 7 available modality combinations, the proposed method achieved an average AUC, accuracy, and specificity of 0.766, 0.621, and 0.793, respectively, which represent improvements of 2.6%, 3.5%, and 1.7% over existing methods for handling missing modalities. The best performance was observed when all the modalities were available, resulting in an AUC of 0.837, which still reached 0.826 even with MRI alone. CONCLUSIONS The proposed method can effectively handle missing modalities and successfully integrate multimodal information, and show robust performance in bone tumor classification under various complex missing modality scenarios.
Humans ; Bone Neoplasms/diagnosis* ; Multimodal Imaging/methods* ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Image Processing, Computer-Assisted/methods* ; Algorithms

OBJECTIVE: To analyze the clinical characteristics of elderly patients with sepsis, identify the key factors affecting their clinical outcomes, construct a death risk assessment scale for elderly patients with sepsis, and evaluate its predictive value. METHODS: A retrospective case-control study was conducted. The clinical data of sepsis patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of Wenzhou Medical University from September 2021 to September 2023 were collected, including basic information, clinical characteristics, and clinical outcomes. The patients were divided into non-elderly group (age ≥ 65 years old) and elderly group (age < 65 years old) based on age. Additionally, the elderly patients were divided into survival group and death group based on their 30-day survival status. The clinical characteristics of elderly patients with sepsis were analyzed. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for 30-day death in elderly patients with sepsis, and the regression equation was constructed. The regression equation was simplified, and the death risk assessment scale was established. The predictive value of different scores for the prognosis of elderly patients with sepsis was compared. RESULTS: (1) A total of 833 patients with sepsis were finally enrolled, including 485 in the elderly group and 348 in the non-elderly group. Compared with the non-elderly group, the elderly group showed significantly lower counts of lymphocyte, T cell, CD8⁺ T cell, and the ratio of T cells and CD8⁺ T cells [lymphocyte count (×10⁹/L): 0.71 (0.43, 1.06) vs. 0.83 (0.53, 1.26), T cell count (cells/μL): 394.0 (216.0, 648.0) vs. 490.5 (270.5, 793.0), CD8⁺ T cell count (cells/μL): 126.0 (62.0, 223.5) vs. 180.0 (101.0, 312.0), T cell ratio: 0.60 (0.48, 0.70) vs. 0.64 (0.51, 0.75), CD8⁺ T cell ratio: 0.19 (0.13, 0.28) vs. 0.24 (0.16, 0.34), all P < 0.01], higher natural killer cell (NK cell) count, acute physiology and chronic health evaluation II (APACHE II) score, ratio of invasive mechanical ventilation (IMV) during hospitalization, and 30-day mortality [NK cell count (cells/μL): 112.0 (61.0, 187.5) vs. 95.0 (53.0, 151.0), APACHE II score: 16.00 (12.00, 21.00) vs. 13.00 (8.00, 17.00), IMV ratio: 40.6% (197/485) vs. 31.9% (111/348), 30-day mortality: 28.9% (140/485) vs. 19.5% (68/348), all P < 0.05], and longer length of ICU stay [days: 5.5 (3.0, 10.0) vs. 5.0 (3.0, 8.0), P < 0.05]. There were no statistically significant differences in the levels of inflammatory markers such as C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukins (IL-2, IL-4, IL-6, IL-10) between the two groups. (2) In 485 elderly patients with sepsis, 345 survived in 30 days, and 140 died with the 30-day mortality of 28.9%. Compared with the survival group, the patients in the death group were older, and had lower body mass index (BMI), white blood cell count (WBC), PCT, platelet count (PLT) and higher IL-6, IL-10, N-terminal pro-brain natriuretic peptide (NT-proBNP), total bilirubin (TBil), blood lactic acid (Lac), and ratio of in-hospital IMV and continuous renal replacement therapy (CRRT). Multivariate Logistic regression analysis indicated that BMI [odds ratio (OR) = 0.783, 95% confidence interval (95%CI) was 0.678-0.905, P = 0.001], IL-6 (OR = 1.073, 95%CI was 1.004-1.146, P = 0.036), TBil (OR = 1.009, 95%CI was 1.000-1.018, P = 0.045), Lac (OR = 1.211, 95%CI was 1.072-1.367, P = 0.002), and IMV during hospitalization (OR = 6.181, 95%CI was 2.214-17.256, P = 0.001) were independent risk factors for 30-day death in elderly patients with sepsis, and the regression equation was constructed (Logit P = 1.012-0.244×BMI+0.070×IL-6+0.009×TBil+0.190×Lac+1.822×IMV). The regression equation was simplified to construct a death risk assessment scale, namely BITLI score. Receiver operator characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) of BITLI score for predicting death risk was 0.852 (95%CI was 0.769-0.935), and it was higher than APACHE II score (AUC = 0.714, 95%CI was 0.623-0.805) and sequential organ failure assessment (SOFA) score (AUC = 0.685, 95%CI was 0.578-0.793). The determined cut-off value of BITLI score was 1.50, while achieving a sensitivity of 83.3% and specificity of 74.0%. CONCLUSIONS Elderly patients with sepsis often have reduced lymphocyte counts, severe conditions, and poor prognosis. BMI, IL-6, TBil, Lac, and IMV during hospitalization were independent risk factors for 30-day death in elderly patients with sepsis. The BITLI score constructed based above risk factors is more precise and reliable than traditional APACHE II and SOFA scores in predicting the outcomes of elderly patients with sepsis.
Humans ; Sepsis/mortality* ; Aged ; Retrospective Studies ; Risk Assessment ; Case-Control Studies ; Prognosis ; Male ; Female ; Intensive Care Units ; Risk Factors ; Aged, 80 and over ; Logistic Models ; Middle Aged

The accidental displacement of tooth roots into the mandibular canal is a serious complication during tooth extractions in oral and maxillofacial surgery, often resulting in direct damage to the structural and functional integrity of the inferior alveolar neurovascular bundle (IANB). This article reviews the anatomical features of the mandibular canal, the IANB, and adjacent tooth roots; identifies high-risk factors and anatomically vulnerable sites for root displacement; and outlines the clinical manifestations and radiographic characteristics of intraoperative root intrusion into the mandibular canal. Furthermore, management principles, surgical approaches and techniques, inferior alveolar nerve injury treatment, and prognostic considerations are discussed. The aim of this review is to provide a comprehensive clinical reference for improving surgical outcomes, and reducing postoperative complications.
Humans ; Tooth Extraction/adverse effects* ; Mandible/surgery* ; Tooth Root ; Mandibular Nerve/anatomy & histology* ; Postoperative Complications/prevention & control* ; Intraoperative Complications ; Mandibular Nerve Injuries/etiology*

Objective:To analyze the relationship between genotype and clinical phenotype of the MYH7-R453C mutation in five Chinese hypertrophic cardiomyopathy (HCM) families.Methods:A retrospective cohort study was conducted on 527 unrelated HCM probands who were first diagnosed at the First Affiliated Hospital of Air Force Medical University (Xijing Hospital) from February 2014 to July 2018, and the high-throughput whole exome targeted sequencing of 96 genes related to hereditary cardiovascular disease was performed on the probands. The probands carrying the MYH7-R453C mutation were screened out, and their family members carrying the mutation were verified using Sanger sequencing. Healthy individuals without family history of genetic diseases from the same period and ethnicity were recruited as controls. Clinical data such as echocardiography, 12-lead electrocardiogram, and cardiac magnetic resonance imaging of the probands and their family members were collected, and the correlation between patient genotype and clinical phenotype was analyzed. Endpoint or key events were recorded through hospital re-examination or telephone follow-up.Results:The MYH7-R453C mutation was detected in 5 HCM probands, and clinical data and genetic results of 20 family members, including probands, were collected. Among them, 13 carried the MYH7-R453C mutation, of which 12 were diagnosed with HCM, and one child (F1Ⅲ 5) experienced early changes of HCM. The seven family members who did not carry the MYH7-R453C mutation had normal echocardiograms and 12-lead electrocardiograms. Among the 12 patients diagnosed with HCM, 2 experienced (F2Ⅱ 7, F5Ⅰ 2) sudden cardiac death, 2 experienced (F1Ⅲ 1, F3Ⅲ 3) events of sudden cardiac death survival, 2(F1Ⅱ 2, F3Ⅱ 1) died from heart failure during the follow-up period. Combined with the initial visit and follow-up, 4 families (F1, F2, F3, F5) had a family history of sudden death, among which 3 families probands or multiple family members experiencing sudden death before the age of 30 and adverse outcomes such as implantation of implantable cardioverter-defibrillators after sudden death survival. Conclusions:In the five families with HCM carrying MYH7-R453C mutations, genotype is highly correlated with clinical phenotype, and patients have a high risk of sudden death and poor prognosis. Early diagnosis of individuals carrying the MYH7-R453C gene mutation, both within the patient′s family and in the patients themselves, is crucial for initiating early treatment, preventing sudden death, and assessing prognosis.

Objective:To construct a metrological safety evaluation model for large medical equipment based on the perspective of metrological safety,and to explore its application value in the management of large medical equipment.Methods:According to the different safety risk sources,the diagnosis and treatment area of large medical equipment was divided into five types:light source,electricity,water,radiation and information.The metrological safety assessment indicators were empowered by combining subjective and objective methods,and engineering support strategies were developed according to the metrological safety levels and safety change trends.A total of 48 large medical equipment in clinical use in The 960th Hospital of PLA Joint Logistic Support Force from 2020 to 2023 were selected.The 42 sets of equipment used during 2020 to 2021 adopted the conventional fault maintenance support mode(referred to as the conventional support mode),and the 43 sets of equipment used from 2022-2023(including 37 in conventional mode and 6 newly added)adopted the metrology safety technical support mode(referred to as metrology safety support mode).The metrology safety management ability score,metrological inspection qualification levels and metrological safety management effects of large medical equipment were compared between the two management modes.Results:The evaluation scores of theoretical knowledge,safety awareness,practical operation and emergency level indicators of large medical equipment use management personnel of the metrology safety support model were(17.39±1.38)points,(17.87±1.08)points,(27.68±1.45)points and(27.96±1.24)points,respectively,which were higher than those of the conventional support mode,the difference was statistically significant(t=4.234,4.371,5.832,3.764,P＜0.05).The average metrological inspection qualified rates(％)of medical imaging equipment,life support equipment,clinical laboratory equipment,operating room equipment and other equipment using the metrology safety support mode were(95.19±2.56)％,(95.56±1.79)％,(94.64±2.42)％,(96.20±2.01)％and(93.46±2.22)％,respectively,which were higher than those of the conventional support mode,the difference was statistically significant(t=3.846,2.809,2.405,2.492,2.742,P＜0.05).The proportion of large medical equipment rated as high safety level and low safety level in the metrological safety support model were 67.44％(29/43)and 4.65％(2/43),respectively,the proportion of high safety level was higher than that in the conventional support mode,and the proportion of low safety level was lower than that in the conventional support mode,the difference was statistically significant(x2=4.261,7.085,P＜0.05).Conclusion:The large medical equipment metrological safety support mode based on the safety perspective can improve the safety management ability of personnel related to equipment use and management,improve the operation quality and performance level of equipment,increase the proportion of high-safety level metrology safety of large medical equipment,and reduce the proportion of low-safety level.

METHODS: We retrospectively collected CT scan data from 276 patients with pathologically confirmed primary bone tumors from 4 medical centers in Guangdong Province between January, 2010 and August, 2021. A convolutional neural network (CNN) was employed as the deep learning architecture. The optimal baseline deep learning model (R-Net) was determined through transfer learning, and an optimized model (S-Net) was obtained through algorithmic improvements. Multivariate logistic regression analysis was used to screen the clinical features such as sex, age, mineralization location, and pathological fractures, which were then connected with the imaging features to construct the deep learning fusion model (SC-Net). The diagnostic performance of the SC-Net model and machine learning models were compared with radiologists' diagnoses, and their classification performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1 score. RESULTS: In the external test set, the fusion model (SC-Net) achieved the best performance with an AUC of 0.901 (95% CI: 0.803-1.00), an accuracy of 83.7% (95% CI: 69.3%-93.2%) and an F1 score of 0.857, and outperformed the S-Net model with an AUC of 0.818 (95% CI: 0.694-0.942), an accuracy of 76.7% (95% CI: 61.4%-88.2%), and an F1 score of 0.828. The overall classification performance of the fusion model (SC-Net) exceeded that of radiologists' diagnoses. CONCLUSIONS The deep learning fusion model based on multi-center CT images and clinical features is capable of accurate classification of osseous and chondroid matrix mineralization and may potentially improve the accuracy of clinical diagnoses of osteogenic versus chondrogenic primary bone tumors.
Humans ; Deep Learning ; Bone Neoplasms/diagnostic imaging* ; Retrospective Studies ; Tomography, X-Ray Computed/methods* ; Neural Networks, Computer ; Male ; Female ; ROC Curve ; Algorithms