Objective To investigate the three-dimensional changes in hard and soft tissues before and after treatment with digitally fabricated maxillary skeletal expanders in patients with maxillary transverse deficiency.Methods Twenty late adolescents or adults with maxillary transverse deficiency treated at the Orthodontic Department of Affiliated Stomatological Hospital of Nanjing Medical Uni-versity using digitally fabricated maxillary skeletal expanders were included.Cone-beam computed tomography(CBCT)scans were ob-tained before and after treatment.Three-dimensional measurements were analyzed using Dolphin 3D 11.95 software,and statistical anal-ysis was performed with SPSS software.Paired t-tests were used to compare pre-treatment and post-treatment changes in hard and soft tissues.Results Significant increases were observed in anterior midpalatal suture width,posterior midpalatal suture width,maxillary apical base width,and maxillary alveolar width(P＜0.001).No significant changes were found in alveolar ridge inclination,alveolar ridge height,LSNA(P＞0.05).Significant increases occurred in apical distance,cementoenamel junction distance,and inter-fossa distance(P＜0.001),while first molar inclinationand ∠U1-SN remained stable(P＞0.05).Significant improvements were noted in upper airway volume,nasal floor base width,and nasal cavity width(P＜0.001).Conclusion For late adolescents or adults with max-illary transverse deficiency,digitally fabricated maxillary skeletal expanders can achieve near-parallel expansion of the midpalatal suture,effectively improving maxillary transverse dimensions and airway volume while minimizing dental side effects.

Objective To explore the clinical effect of totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunos-tomy for gastric cancer.Methods Ninety cases of gastric cancer patients were seleted,of which 45 cases undergoing Roux-en-Y esophagoje-junostomy for digestive tract reconstruction were set as the control group,while 45 cases undergoing hand-sewn esophagojejunostomy for digestive tract reconstruction were set as the observation group.Patients in the control group underwent laparoscopic-assisted total gastrectomy combined with Roux-en-Y esophagojejunostomy to reconstruct digestive tract,while patients in the observation group underwent totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunostomy to reconstruct digestive tract.The perioperative indicators and complications of patients in the two groups were compared.Results The surgical time,time of esophagojejunostomy,and time to get out of bed after surgery of patients in the observation group were significantly shorter than those in the control group(P<0.05),the pain score 24 hours after surgery was significantly lower than that in the control group(P<0.05).There was no statistically significant difference between the two groups in terms of the incidence of complications or Clavien-Dindo grading(P>0.05).Conclusion Hand-sewn esophagojejunostomy for digestive tract reconstruction has a good clinical effect in gastric cancer during totally laparoscopic total gastrectomy.It can shorten the surgical time and time of esophagojejunostomy,reduce postoperative pain,and accelerate postoperative recovery,whose safety is comparable to Roux-en-Y esophagojejunostomy.

Objective To investigate the three-dimensional changes in hard and soft tissues before and after treatment with digitally fabricated maxillary skeletal expanders in patients with maxillary transverse deficiency.Methods Twenty late adolescents or adults with maxillary transverse deficiency treated at the Orthodontic Department of Affiliated Stomatological Hospital of Nanjing Medical Uni-versity using digitally fabricated maxillary skeletal expanders were included.Cone-beam computed tomography(CBCT)scans were ob-tained before and after treatment.Three-dimensional measurements were analyzed using Dolphin 3D 11.95 software,and statistical anal-ysis was performed with SPSS software.Paired t-tests were used to compare pre-treatment and post-treatment changes in hard and soft tissues.Results Significant increases were observed in anterior midpalatal suture width,posterior midpalatal suture width,maxillary apical base width,and maxillary alveolar width(P＜0.001).No significant changes were found in alveolar ridge inclination,alveolar ridge height,LSNA(P＞0.05).Significant increases occurred in apical distance,cementoenamel junction distance,and inter-fossa distance(P＜0.001),while first molar inclinationand ∠U1-SN remained stable(P＞0.05).Significant improvements were noted in upper airway volume,nasal floor base width,and nasal cavity width(P＜0.001).Conclusion For late adolescents or adults with max-illary transverse deficiency,digitally fabricated maxillary skeletal expanders can achieve near-parallel expansion of the midpalatal suture,effectively improving maxillary transverse dimensions and airway volume while minimizing dental side effects.

Objective To explore the clinical effect of totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunos-tomy for gastric cancer.Methods Ninety cases of gastric cancer patients were seleted,of which 45 cases undergoing Roux-en-Y esophagoje-junostomy for digestive tract reconstruction were set as the control group,while 45 cases undergoing hand-sewn esophagojejunostomy for digestive tract reconstruction were set as the observation group.Patients in the control group underwent laparoscopic-assisted total gastrectomy combined with Roux-en-Y esophagojejunostomy to reconstruct digestive tract,while patients in the observation group underwent totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunostomy to reconstruct digestive tract.The perioperative indicators and complications of patients in the two groups were compared.Results The surgical time,time of esophagojejunostomy,and time to get out of bed after surgery of patients in the observation group were significantly shorter than those in the control group(P<0.05),the pain score 24 hours after surgery was significantly lower than that in the control group(P<0.05).There was no statistically significant difference between the two groups in terms of the incidence of complications or Clavien-Dindo grading(P>0.05).Conclusion Hand-sewn esophagojejunostomy for digestive tract reconstruction has a good clinical effect in gastric cancer during totally laparoscopic total gastrectomy.It can shorten the surgical time and time of esophagojejunostomy,reduce postoperative pain,and accelerate postoperative recovery,whose safety is comparable to Roux-en-Y esophagojejunostomy.

OBJECTIVE: To retrospectively analyze the clinical characteristics, co-mutated genes in newly diagnosed acute myeloid leukemia (AML) patients with NRAS and KRAS gene mutations, and the impact of NRAS and KRAS mutations on prognosis. METHODS: The clinical data and next-generation sequencing results of 80 newly diagnosed AML patients treated at our hospital from December 2018 to December 2023 were collected. The clinical characteristics, co-mutated genes of NRAS and KRAS , and the impact of NRAS and KRAS mutations on prognosis in newly diagnosed AML patients were analyzed. RESULTS: Among 80 newly diagnosed AML patients, NRAS mutations were detected in 20 cases(25.0%), and KRAS mutations were detected in 9 cases(11.3%). NRAS mutations predominantly occurred at codons 12 and 13 of exon 2, as well as codon 61 of exon 3, while KRAS mutations were most commonly occurred at codons 12 and 13 of exon 2, all of which were missense mutations. There were no statistically significant differences observed in terms of age, sex, white blood cell count(WBC), hemoglobin(Hb), platelet count(PLT), bone marrow blasts, first induction chemotherapy regimen, CR1/CRi1 rates, chromosome karyotype, 2022 ELN risk classification and allogeneic hematopoietic stem cell transplantation(allo-HSCT) among the NRAS mutation group, KRAS mutation group and NRAS/KRAS wild-type group (P >0.05). KRAS mutations were significantly correlated with PTPN11 mutations (r =0.344), whereas no genes significantly associated with NRAS mutations were found. Survival analysis showed that compared to the NRAS/KRAS wild-type group, patients with NRAS mutation had a relatively higher 5-year overall survival (OS) rate and relapse-free survival (RFS) rate, though the differences were not statistically significant (P =0.097, P =0.249). Compared to the NRAS/KRAS wild-type group, patients with KRAS mutation had a lower 5-year OS rate and RFS rate, with no significant differences observed (P =0.275, P =0.442). There was no significant difference in the 5-year RFS rate between the KRAS mutation group and NRAS mutation group (P =0.157), but the 5-year OS rate of patients with KRAS mutation was significantly lower than that of patients with NRAS mutation (P =0.037). CONCLUSION In newly diagnosed AML patients, KRAS mutation was significantly correlated with PTPN11 mutation. Compared to patients with NRAS/KRAS wild-type, those with NRAS mutation showed a more favorable prognosis, while patients with KRAS mutation showed a poorer prognosis; however, these differences did not reach statistical significance. Notably, the prognosis of AML patients with KRAS mutation was significantly inferior compared to those with NRAS mutation.
Humans ; Leukemia, Myeloid, Acute/diagnosis* ; Mutation ; Prognosis ; Proto-Oncogene Proteins p21(ras)/genetics* ; GTP Phosphohydrolases/genetics* ; Retrospective Studies ; Membrane Proteins/genetics* ; Female ; Male ; Middle Aged ; Adult ; Aged

BACKGROUND: Early control of low-density lipoprotein cholesterol (LDL-C) is crucial for reducing the progress of cardiovascular disease. However, its additional role to the risk of primary osteoporosis in men with coronary heart disease was inconclusive. Our study aims to determine the association of LDL-C and its trajectories for osteoporosis risk in the middle-aged and aged men of China. METHODS: The retrospective cohort study of 1546 men aged 69.74 ± 11.30 years conducted in Beijing, China from 2015 to 2022. And the incidence of primary osteoporosis was annually recorded. LDL-C trajectories were further identified by latent class growth model using repeated measurements of LDL-C. The association of baseline LDL-C for osteoporosis was estimated using hazard ratio (HR) with 95% CI in Cox proportional hazard model, while mean level and trajectories of LDL-C for osteoporosis were evaluated using odds ratio (OR) with 95% CI in logistic regression model. RESULTS: During the median 6.2-year follow-up period, 70 men developed primary osteoporosis. The higher level of baseline LDL-C (HR = 1.539, 95% CI: 1.012-2.342) and mean LDL-C (OR = 2.190, 95% CI: 1.443-3.324) were associated with higher risk of osteoporosis in men with coronary heart disease after adjusted for covariates. Compared with those in the LDL-C trajectory of low-stable decrease, participants with medium-fluctuant trajectory, whose longitudinal LDL-C started with a medium LDL-C level and appeared an increase and then decrease, were negatively associated with osteoporosis risk (OR = 2.451, 95% CI: 1.152-5.216). And participants with initially high LDL-C level and then a rapid decrease demonstrated a tendency towards reduced risk (OR = 0.718, 95% CI: 0.212-2.437). CONCLUSIONS Elevated LDL-C level and its long-term fluctuation may increase the risk of primary osteoporosis in men. Early controlling a stable level of LDL-C is also essential for bone health.

Objective To investigate the therapeutic mechanism of Pterocarya hupehensis Skan total flavonoids(PHSTF)for rheumatoid arthritis(RA).Methods Twenty-five male SD rats were randomly divided into normal control group,RA model group,PHSTF treatment(45 and 90 mg/kg)groups,and Tripterygium glycosides(TPG)tablet(10 mg/kg)group(n=5).Except for those in the normal control group,all the rats were subjected to collagen-induced arthritis(CIA)modeling using a secondary immunization method,after which PHSTF and TPG were administered via gavage once daily for 4 weeks.After the treatments,serum levels of TNF-α and IL-1β were measured using ELISA,and ankle joint pathologies were assessed with HE staining;the expression of citrullinated histone H3(Cit-H3),a neutrophil extracellular trap(NET)marker,in the ankle joints was evaluated with immunohistochemistry.In primary cultures of rat peripheral blood neutrophils stimulated with phorbol ester(PMA),the effects of PHSTF(100 and 200 μg/mL)on the expressions of Cit-H3,peptidylarginine deiminase 4(PADI4),neutrophil elastase(NE),and myeloperoxidase(MPO)were examined with Western blotting;immunofluorescence assay was used to observe Cit-H3 expression and NET formation in the cells.Results In the CIA rat models,PHSTF significantly alleviated ankle swelling,decreased serum levels of TNF-α and IL-1β,improved histopathological changes in the ankle joints,and reduced Cit-H3 expression in both the serum and ankle joint cartilage.In the isolated rat neutrophils,PHSTF showed no significant effect on cell viability but strongly inhibited PMA-induced NET release.Conclusion PHSTF can alleviate RA by inhibiting the formation of NETs.

Objective·To analyze the imaging characteristics and diagnostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET/CT)in mantle cell lymphoma(MCL)and explore its application to distinguishing between classic and aggressive variants of MCL.Methods·A retrospective analysis was conducted on the 18F-FDG PET/CT images and clinical data of 116 pathologically confirmed,newly diagnosed MCL patients.The imaging features of intra-and extra-nodal lesions were summarized.The accuracy of 18F-FDG PET/CT in diagnosing bone marrow and gastrointestinal involvement in MCL was evaluated.Furthermore,differences in 18F-FDG PET/CT findings and clinical characteristics between the classic and aggressive variants of MCL were analyzed.Results·Among the 116 patients,100.0%showed positive findings on 18F-FDG PET/CT,with 99.1%exhibiting abnormal lymph nodes and 85.3%having extra-nodal involvement.The most common extra-nodal sites were the spleen,Waldeyer's ring,bone marrow,and gastrointestinal tract.Compared with bone marrow aspiration results,the sensitivity,specificity,and accuracy of 18F-FDG PET/CT for detecting bone marrow involvement in MCL were 43.4%,91.5%,and 66.0%,respectively.When compared with endoscopic biopsy results,the sensitivity of 18F-FDG PET/CT for detecting gastric and intestinal involvement was 100.0%and 94.1%,respectively,with specificity of 75.0%and 100.0%,and accuracy of 92.9%and 94.7%,respectively.There were significant differences in the highest maximum standardized uptake value(SUVmax)and Ki-67 index between the classic and aggressive variants of MCL,with SUVmax positively correlated with Ki-67 index.By using SUVmax>10.4 as the diagnostic threshold,the sensitivity and specificity for differentiating between the classic and aggressive variants of MCL were 73.9%and 77.4%,respectively,with an AUC value of 0.797.Conclusion·18F-FDG PET/CT demonstrates a high detection rate for both intra-and extra-nodal lesions in MCL patients.It exhibits high specificity in diagnosing bone marrow involvement and high sensitivity and specificity in diagnosing gastrointestinal involvement,providing reliable non-invasive diagnostic information for MCL bone marrow and gastrointestinal involvement.However,it is not a substitute for pathological examination.Additionally,the positive correlation between SUVmax and Ki-67 index allows SUVmax to effectively differentiate between the classic and aggressive variants of MCL,with a higher SUVmax(>10.4)indicating a higher likelihood of the aggressive variant.These findings have clinical implications for treatment planning and prognosis assessment.

Objective To explore the efficacy and safety of recombinant human anti-severe acute respiratory syn-drome coronavirus 2(anti-SARS-CoV-2)monoclonal antibody injection(F61 injection)in the treatment of patients with coronavirus disease 2019(COVID-19)combined with renal damage.Methods Patients with COVID-19 and renal damage who visited the PLA General Hospital from January to February 2023 were selected.Subjects were randomly divided into two groups.Control group was treated with conventional anti-COVID-19 therapy,while trial group was treated with conventional anti-COVID-19 therapy combined with F61 injection.A 15-day follow-up was conducted after drug administration.Clinical symptoms,laboratory tests,electrocardiogram,and chest CT of pa-tients were performed to analyze the efficacy and safety of F61 injection.Results Twelve subjects(7 in trial group and 5 in control group)were included in study.Neither group had any clinical progression or death cases.The ave-rage time for negative conversion of nucleic acid of SARS-CoV-2 in control group and trial group were 3.2 days and 1.57 days(P=0.046),respectively.The scores of COVID-19 related target symptom in the trial group on the 3rd and 5th day after medication were both lower than those of the control group(both P＜0.05).According to the clinical staging and World Health Organization 10-point graded disease progression scale,both groups of subjects improved but didn't show statistical differences(P＞0.05).For safety,trial group didn't present any infusion-re-lated adverse event.Subjects in both groups demonstrated varying degrees of elevated blood glucose,elevated urine glucose,elevated urobilinogen,positive urine casts,and cardiac arrhythmia,but the differences were not statistica-lly significant(all P＞0.05).Conclusion F61 injection has initially demonstrated safety and clinical benefit in trea-ting patients with COVID-19 combined with renal damage.As the domestically produced drug,it has good clinical accessibility and may provide more options for clinical practice.