Purpose: This study aimed to evaluate the safety and efficacy of gemcitabine and cisplatin (GP) regimen in combination with immune checkpoint inhibitor sintilimab as neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) patients and the feasibility of the following selective bladder sparing surgery. Materials and Methods: Patients with histopathologically confirmed urothelial carcinoma without distant metastases (T2-4a, N ≤ 1, M0, American Joint Committee of Cancer 8th) and with adequate organ function will be enrolled. The therapeutic regimen was sintilimab 200 mg once on day 8, gemcitabine 1,000 mg/m2 and cisplatin 35 mg/m2 once on days 1 and 8, every 21 days for four cycles. The primary endpoint was pathologic complete response (pCR, pT0N0) rate. The secondary end points were ypT < 2 rate, R0 resection rate, event-free survival, and safety. Results: From May 4, 2020, to May 20, 2023, 55 patients were enrolled. Forty-six patients were evaluated for efficacy. Among the 42 patients who underwent surgery, 16 patients (38.0%) achieved pCR. Thirty-three patients (78.6%) achieved pT < 2. With a median follow-up of 15.7 months, the 1-year event-free survival was 91.3%. Notwithstanding the poor pathological baseline characteristic of a high T3-T4a proportion (39.1%), a promising bladder preservation (including 22 patients transurethral resection of bladder tumor, 5 patients partial cystectomy, and 4 surveillances) rate was achieved (67.4%). The most common grade ≥ 3 treatment-related adverse events was neutropenia (n=15, 27.3%), which was related to chemotherapy. There were no grade 3 immune-related adverse events. Conclusion Neoadjuvant GP plus sintilimab is a promising regimen for MIBC patients, with relatively high pT < 2 rate and triggering the emerging roles for the multi-disciplinary team decision-making for bladder sparing surgery.

A 70-year-old man had radical surgery for colon cancer one year before the symptoms of memory loss and decreasing cognitive function.Subsequent magnetic resonance imaging revealed a brain mass,which was surgically resected and confirmed to be metastatic intestinal adenocarcinoma.Immunohistochemistry of the primary tumor and brain metastasis showed mismatch repair deficiency.The patient received adjuvant chemotherapy after surgery.However,the brain metastasis relapsed one month after the last chemotherapy.Genetic testing on the resected colon tumor samples confirmed microsatellite instability-high with a high tumor mutation burden by 77.7 muts/Mb.The patient was subsequently treated with programmed death-1(PD-1)monoclonal antibody pembrolizumab(keytruda).The brain metastatic lesions were completely shrunk,and a complete clinical response was achieved.

Objective:To investigate the risk factors of depression in patients with lacunar cerebral infarction 3 months after discharge, and build a risk prediction model.Methods:The clinical data of 237 patients with lacunar cerebral infarction diagnosed and treated in the Second Affiliated Hospital of Wannan Medical College from January 1, 2021 to January 1, 2022 were retrospectively analyzed. Demographic data, laboratory indicators and risk factors of cardiovascular disease were collected when the patients were admitted to hospital. The patient health questionnaire-9 (PHQ-9) score was used to assess the risk of post-stroke depression (PSD) 3 months after discharge. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of depression. A predictive model was constructed based on the above risk factors. The predictive efficacy was evaluated by receiver operating characteristic (ROC) curve, and the clinical applicability of the predictive model was measured by calibration curve and decision curve.Results:Fifty-four patients with lacunar infarction (22.80%) showed symptoms of depression at 3 months after discharge. Multivariate logistic regression showed that women ( OR=2.952, 95% CI: 1.403-6.213, P=0.004), cystatin C ( OR=2.964, 95% CI: 1.222-7.191, P=0.016), apolipoprotein B ( OR=4.836, 95% CI: 1.533-15.258, P=0.007) were the independent risk factors for PSD in patients with lacunar infarction. Activity of daily living (ADL) score ( OR=0.939, 95% CI: 0.915-0.964, P<0.001) was a protective factor for PSD in patients with lacunar infarction. The area under the curve (AUC) of the prediction model was 0.779 (95% CI: 0.703-0.855, P<0.001), which was better than other predictors. Hosmer-Lemeshow H test showed that the model was well calibrated ( P=0.588). In addition, the prediction model of decision curve analysis had a good clinical applicability. Conclusions:The predictive model based on gender, laboratory indicators and daily life ability score can evaluate the risk of PSD in patients with lacunar infarction 3 months after discharge. It is good predictive efficacy and clinical applicability which worth clinical promotion and application.

In recent years, the incidence of hepatocellular carcinoma (HCC) has risen year by year, leading to a high mortality rate. At present, surgical treatment is the major cure for HCC, and in general, HCC is diagnosed at late stages. Due to the heterogeneity of HCC and different sensitivities to drugs, the treatment efficacy of advanced HCC is poor. In this paper, we retrospectively analyzed the prog-ress of HCC treatments and reviewed important progression, which provides new view for the clinical improvement of the total surviv-al of patients with HCC.

We employed a multiplex polymerase chain reaction (PCR) coupled with capillary electrophoresis (mPCR-CE) targeting six Clostridium difficile genes, including tpi, tcdA, tcdB, cdtA, cdtB, and a deletion in tcdC for simultaneous detection and characterization of toxigenic C. difficile directly from fecal specimens. The mPCR-CE had a limit of detection of 10 colony-forming units per reaction with no cross-reactions with other related bacterial genes. Clinical validation was performed on 354 consecutively collected stool specimens from patients with suspected C. difficile infection and 45 isolates. The results were compared with a reference standard combined with BD MAX Cdiff, real-time cell analysis assay (RTCA), and mPCR-CE. The toxigenic C. difficile species were detected in 36 isolates and 45 stool specimens by the mPCR-CE, which provided a positive rate of 20.3% (81/399). The mPCR-CE had a specificity of 97.2% and a sensitivity of 96.0%, which was higher than RTCA (x = 5.67, P = 0.017) but lower than BD MAX Cdiff (P = 0.245). Among the 45 strains, 44 (97.8%) were determined as nonribotype 027 by the mPCR-CE, which was fully agreed with PCR ribotyping. Even though ribotypes 017 (n = 8, 17.8%), 001 (n = 6, 13.3%), and 012 (n = 7, 15.6%) were predominant in this region, ribotype 027 was an important genotype monitored routinely. The mPCR-CE provided an alternative diagnosis tool for the simultaneous detection of toxigenic C. difficile in stool and potentially differentiated between RT027 and non-RT027.
Clostridium Infections ; diagnosis ; Clostridium difficile ; genetics ; Electrophoresis, Capillary ; Feces ; microbiology ; Genes, Bacterial ; Humans ; Polymerase Chain Reaction ; Ribotyping ; Sensitivity and Specificity

We analyze the epidemiology,clinical features,and outcome of the patients with Creutzfeldt-Jakob diseases (CJD) in Guizhou Province from 2010 to 2015.The epidemiology,clinical characteristics and follow-up data of CJD suspected patients obtained from Guizhou CJD surveillance network were analyzed.The testing results of cerebrospinal fluid (CFS) and blood from the patients were also collected and analyzed.Results showed that a total of 11 CJD cases was found from 23 reported CJD suspected patients in Guizhou from 2010 to 2015,including 8 probable sporadic CJD(sCJD) cases,2 possible sCJD cases and 1 genetic CJD(gCJD) case.In 11 cases,rapidly progressive dementia was the major initial symptom,following by mental symptoms,extrapyramidal symptoms,signs and cerebellum cortical blindness.Clinical symptoms of progressive dementia were the main symptoms,following by visual or cerebellar dysfunction,myoclonus,cone system/extrapyramidal dysfunction,and akinetic mutism.Most of cases were abnormal in MRI (45.45％) and 14-3-3 protein detection in CSF(70％).The 14-3-3 blood samples of prion gene 129 amino acids (PRNP)polymorphisms were M/M type,excepting for 1 case gCJD confirmed diagnosis cases with D178N mutation in PRNP gene.Eleven CJD cases did not show season and regional clusterings and vocational tendency.The majority of the cases were male,the median age was 65,and mainly were the Han nationality.For all cases of CJD reported during that year for follow-up,the lost-tofollow-up rate was 27％,and the majority of cases died within one year.The sCJD cases were the majority in CJD cases of Guizhou Province,2010-2015.The epidemiological characteristics were similar to the national monitoring cases in the same period.

Objective We tried to observe the effects of Chinese herb fumigation and washing combined with electromyographic biofeedback on stroke patients with muscle cramp on limbs.Methods 84 patients who had muscle cramp on limbs were selected and divided into two groups randomly,namely the intervention group and the control group and both groups had 42 stroke patients.The intervention group was treated with routine treatment,Chinese herbal fumigation and washing and electromyographic biofeedback treatment.The control group received only routine treatment and electromyographic biofeedback treatment.We had compared and analyzed the Ashworth Spasticity Scale and the Daily Life Abihty Score (Barthel index) of the two groups at the time of the pre therapy,two weeks after the treatment and at the end of the treatment(after four weeks),respectively.Results There were no significant differences between the two groups in Barthel index,however,there were significant differences in Ashworth Spasticity Scale scores between the two groups four weeks after treatment,t=-3.84,P ＜ 0.05.Conclusions The effect of Chinese herb fumigation and washing combining with the electromyo-graphic biofeedback treatment is better than usage of the electromyographic biofeedback treatment alone on stroke patients with muscle cramp on limbs.

Objective To explore the effects of the diet safety instructions and interventions on aspiration pneumonia in elderly patients with dysphagia. Methods The multidisciplinary team was established involved clinical physicians, dietitians, therapists and nurses. The study investigated 40 elderly long-stay patients with dysphagia who were capable of oral feeding were selected according with the inclusive criteria. After the swallowing assessment and diet safety instructions, the participants were divided into intervention group (n=20) and control group (n=20) under the principle of voluntariness and matching selection. The patients of intervention groups were supplied with all mushy diet; the patients of control group had semi-solid, thick liquid, partial mushy diet, etc. depended on participants′ swallowing situations and tastes. Both groups of patients were oral feeding on their own or with help. The incidence of bucking, food refusal and feeding time per meal were investigated during the three months, and the aspiration pneumonia incidence of two groups were retrospectively analyzed three months before interventions. Results In the intervention group, the incidence of bucking (109), food refusal (22) and feeding time per meal [(18. 64 ± 5. 05) min] were lower than those in the control group [bucking (272);food refusal (135); feeding time per meal (25. 78 ± 8. 37) min] (χ2 =7. 369, 4. 433;t= -4. 363;P<0. 05). After three months′interventions, the incidence of aspiration pneumonia in both groups was decreased that the intervention group was 13 ∶ 4 and the control group was 11 ∶ 7 (χ2 =20. 742,13. 809;P<0. 05). The control group had two cases with bucking aspiration and one cases with multiple organ failure and death after nasal feeding; the intervention group had no dropout. Conclusions A close cooperation of multi-discipline team can significantly improve the detection rate and feeding safety management of elderly patients with dysphagia. The diet intervention and safety eating management can reduce the incidence of aspiration pneumonia and promote the patients′quality of life.

Objective To investigate the effects of enteral nutrition support with different doses of glutamine on nutritional status and gastrointestinal function in elderly critically ill patients.Methods Totally 90 critically ill patients were randomly divided into three group:the control group without glutamine (group A),enteral nutrition with low glutamine [0.3 g/(kg· d)] (group B),and high glutamine [0.6 g/(kg· d)] groups (group C).Fasting blood samples were collected on days 1,7,and 14 after the initiation of study,and then the indicators including serum diamine oxidase,glutamine,transferin (TF),prealbumin (PA),hemoglobin (HGB),albunin,and nitrogen balance were determined.In addition,the gastrointestinal complications including bloating,diarrhea,and gastric retention were recorded.Results On the 7th and 14th days,the serum glutamine levels in groups B and C were (1 886.8 ±420.5),(2 228.6 ±440.2) μg/L;(1 889.6 ± 436.1),(2 174.3 ± 440.8) μg/L,respectively,which were significantly higher than those in group A [(1 612.0 ±493.5),(1 869.7 ±559.8) μg/L] (P =0.027,P =0.008).The serum diamine oxidase levels were also significantly lower in group B [(2 310 ± 1 271),(1 602.5 ± 1 137.9) U/L] and group C [(2 076.3 ±567),(1 586.3 ±530.9) U/L] than in group A [(3 250 ±923),(2 476 ±862) U/L] (P =0.000,P =0.000).The serum TF and PA levels were significantly increased on the 7th day (P =0.023,P =0.047),and the HGB was significantly higher on 14th day (P =0.003),The number of patients who had undergone successful implementation of enteral nutrition were 4 and 3 in groups B and C,and the number of patients who had achieved the target volume of enterral nutrition was 25 and 27 in groups B and C,which were significantly larger than those in group A (12 and 13,respectively) (P =0.008,P =0.000).The gastrointestinal complication was also significantly decreased after the administration of enterral nutrition with glutamine.Conclusions Enteral nutrition with glutamine can improve intestinal mueosa barrier and nutritional status in elderly critically ill patients.Thus,it helps to reduce gastrointestinal complications and transition time of total enteral nutrition.

In order to control real-time sampling and achieve smooth scroll wave in the epicardial mapping system, which has 128 channels and a sampling rate of 2kHz/channel, we have designed a user interface using Direct-Draw in cooperation with multiple-thread technology and extracting method. This method has proven to be feasible in animal experiment.
Algorithms ; Animals ; Artificial Intelligence ; Body Surface Potential Mapping ; methods ; Electrophysiologic Techniques, Cardiac ; instrumentation ; methods ; Pericardium ; physiology ; Signal Processing, Computer-Assisted ; instrumentation ; Software