Endotoxins are common exogenous pyrogens. Excessive endotoxins in medical devices and injections can lead to serious consequences such as sepsis, septic shock, and even death. Therefore, endotoxin detection plays a crucial role in medical, pharmaceutical, and food sectors. The wide application of Limulus amebocyte lysate (LAL) has led to a sharp decline in the number of horseshoe crabs. Moreover, the LAL assay has limitations such as interbatch variations and difficulty in quantification. The recombinant factor C (rFC) assay is stable between batches, highly sensitive, and capable of quantitation, and thus it can be used as an alternative for the LAL assay. However, the high cost and complex procedures involved in producing recombinant factor C have limited the widespread application of this method. In order to simplify the preparation and reduce the production cost of recombinant factor C, this study focuses on the production of recombinant factor C based on the baculovirus expression system. Multiple measures such as a high-yield and anti-apoptotic vector qBac-IIIG, the optimal signal peptide, and the optimized codon were used to reach the goal of endotoxin detection with cell supernatant. This method simplifies the steps of protein purification. The sensitivity of the supernatant reached 0.05 EU/mL in a 1-L fermentation system, and 500 000 detecting reactions can be supported per liter of fermentation broth. This study increases the yield and activity of recombinant factor C, simplifies the procedures of protein purification, and reduces the cost, laying a foundation for the promotion and application of recombinant factor C in endotoxin detection.
Animals ; Recombinant Proteins/genetics* ; Horseshoe Crabs/chemistry* ; Baculoviridae/metabolism* ; Endotoxins/analysis* ; Protein C/biosynthesis* ; Genetic Vectors/genetics* ; Arthropod Proteins/genetics* ; Enzyme Precursors ; Serine Endopeptidases

Objective:To investigate the impact of body mass index (BMI) on delayed extubation of patients with acute Stanford type A aortic dissection (ATAAD).Methods:A total of 400 ATAAD patients who were admitted to our hospital from October 2021 to October 2023 and underwent surgical treatment were selected as the research objects. According to BMI, they were divided into obese group (BMI≥28 kg/m 2, 119 cases) and non-obese group (BMI<28 kg/m 2, 281 cases). The differences of preoperative clinical characteristics, intraoperative and postoperative data between the two groups were compared. Starting from transferring to the ICU and ending with the first successful extubation, The risk factors of postoperative invasive mechanical ventilation time ≥ 48 h in ATAAD patients were analyzed, and the predictive efficacy of related factors for postoperative invasive mechanical ventilation time ≥ 48 h in ATAAD patients was evaluated. Results:Compared with the non-obese group, the proportion of hypertension, diabetes, admission heart rate, admission systolic blood pressure, admission diastolic blood pressure and preoperative white blood cell count in the obese group were significantly increased, and the differences were statistically significant ( P<0.05). The cardiopulmonary bypass time, aortic cross-clamp time, operation time, red blood cell transfusion volume, invasive mechanical ventilation time, secondary operation rate and total hospitalization cost in the obese group were significantly higher than those in the non-obese group, and the differences were statistically significant ( P<0.05). Univariate logistic regression analysis showed that BMI, cardiopulmonary bypass time, ascending aortic cross-clamp time, operation time, age, hypertension, and red blood cell transfusion were related factors for postoperative invasive mechanical ventilation time ≥48 h in ATAAD patients ( P<0.05). Logistic multivariate regression analysis showed that increased BMI ( OR=1.213, P<0.05) and increased age ( OR=1.020, P<0.05) were independent risk predictors of postoperative invasive mechanical ventilation time≥48 h in ATAAD patients. Receiver operating characteristic curve ( ROC) analysis showed that the area under the ROC curve ( AUC) of BMI for predicting the duration of postoperative invasive mechanical ventilation in ATAAD patients≥48 h was 0.682 ( P<0.05), and the best predictive cut-off value was 25.64 kg/m 2. Conclusion:BMI≥28kg/m 2 increases the difficulty of surgery and the duration of invasive mechanical ventilation in ATAAD patients. BMI has a high predictive value for the duration of invasive mechanical ventilation in ATAAD patients after surgery ≥48 h, and effective intervention measures can be formulated to improve the treatment effect of patients.

Objective:To analyze the current situation of dosimetry audits for linear accelerators in China comprehensively based on the literature, including the range of output dose deviation and the qualified rate of output dose deviation.Methods:Literature search including non-full-text was carried out in CNKI database for literature on output dose verification using dosimeter comparison and quality control test, respectively. Data extraction and analysis were carried out for each kind of eligible literature. The data on the number of tested linear accelerators, the number of qualified linear accelerators, the qualified rate of output dose deviation and the range of output dose deviation were extracted, and the total qualified rate of output dose deviation was calculated based on the total number of tested linear accelerators and the total number of qualified linear accelerators. The data on qualified rate of output dose deviation and output dose deviation in past years were sorted out and their trend was analyzed.Results:A total of 11 literatures using dosimeter comparison method for output dose verification were retrieved, and the total qualified rate of the output dose deviation reported in these literatures was 90.7%. The qualified rate of the output dose deviation in the early years was either as low as 75% or as high as 100%, and remained around 90% in recent years. A total of 19 literatures using quality control test method for output dose verification were retrieved, and the total qualified rate of X-ray and electron beam output dose deviation reported in these literatures was 86.5% and 78.4%, respectively. Of the 12 data on X-ray output dose qualified rate in 2014-2019, 8 were below 90.0% and 4 were above 90.0%. Of the 7 data on X-ray output dose qualified rate in 2020-2023, 2 were below 90.0% and 5 were greater than or equal to 90.0%. The qualified rate of electron beam output dose was 46.2%-80.0% before 2021 and 100% from 2021 to 2023.Conclusions:The qualified rate of the output dose deviation of linear accelerators in China reported in the literature in recent years is on the rise, but the total qualified rate of the output dose deviation of linear accelerators in China is still lower than in developed countries. In order to ensure the therapeutic effect of the patients undergoing radiotherapy, measures should be taken to reduce the output dose deviation of linear accelerators and improve the level of qualified rate of output dose verification.

Objective:To investigate the correlation between basic lung function indicators and functional prognosis of spi-nal cord injury (SCI),and provide a basis for accurately judging the prognosis and improving the recovery ef-fect in the early clinical stage.Method:A retrospective analysis was made of 398 patients who met the inclusion and exclusion criteria in thedepartment of rehabilitation medicine of the first affiliated hospital of the air force military medical universityfrom June 2018 to May 2022. The data of patients' age,sex,body mass index (BMI),time from admission to injury,length of stay,ASIA classification and injury level,hematological indicators (white blood cell count,red blood cell count,hemoglobin concentration),and basic lung function test indicators at admission in-cluding tidal volume (VT),vital capacity (VC),forced vital capacity (FVC),forced expiratory volume in one second (FEV1),forced expiratory volume in one second/forced vital capacity (FEV1/FVC),peak expirato-ry flow (PEF),25％ forceful exhalation forced expiratory flow at 25％ of FVC exhaled(FEF25),forced expira-tory flow at 50％ of FVC exhaled(FEF50),forced expiratory flow at 75％ of FVC exhaled(FEF75),maximal voluntary ventilation (MVV),maximal voluntary ventilation/maximal predicted voluntary ventilation (MVV/MVVpre) were collected. The mean relative function gain (mRFG) of the modified Barthel index was used as the dependent variable,and the unit and multiple linear regression methods were used to identify the relevant factors affecting the prognosis of SCI patients,especially the underlying lung function indicators.Result:The single and multiple linear regression analysis showed that the prognosis of SCI patients was signifi-cantly related to the ASIA classification (B=11.064,P=0.019),length of stay (B=0.125,P=0.005) and VC (B=5.177,P=0.014). The cut-off value for VC judging the prognosis of SCI patients was 2.39L.Conclusion:Low VC is an independent risk factor for functional outcome in patients with SCI.The detection of basic lung function at the time of admission can help to judge the functional prognosis of patients with SCI. For the patients with VC below 2.39L,the prognosis is worse. Close attention should be paid to these patients,and more adequate rehabilitation treatments should be involved to maximize the improvement of pa-tients' daily living ability.

Objective:To analyze the current situation of dosimetry audits for linear accelerators in China comprehensively based on the literature, including the range of output dose deviation and the qualified rate of output dose deviation.Methods:Literature search including non-full-text was carried out in CNKI database for literature on output dose verification using dosimeter comparison and quality control test, respectively. Data extraction and analysis were carried out for each kind of eligible literature. The data on the number of tested linear accelerators, the number of qualified linear accelerators, the qualified rate of output dose deviation and the range of output dose deviation were extracted, and the total qualified rate of output dose deviation was calculated based on the total number of tested linear accelerators and the total number of qualified linear accelerators. The data on qualified rate of output dose deviation and output dose deviation in past years were sorted out and their trend was analyzed.Results:A total of 11 literatures using dosimeter comparison method for output dose verification were retrieved, and the total qualified rate of the output dose deviation reported in these literatures was 90.7%. The qualified rate of the output dose deviation in the early years was either as low as 75% or as high as 100%, and remained around 90% in recent years. A total of 19 literatures using quality control test method for output dose verification were retrieved, and the total qualified rate of X-ray and electron beam output dose deviation reported in these literatures was 86.5% and 78.4%, respectively. Of the 12 data on X-ray output dose qualified rate in 2014-2019, 8 were below 90.0% and 4 were above 90.0%. Of the 7 data on X-ray output dose qualified rate in 2020-2023, 2 were below 90.0% and 5 were greater than or equal to 90.0%. The qualified rate of electron beam output dose was 46.2%-80.0% before 2021 and 100% from 2021 to 2023.Conclusions:The qualified rate of the output dose deviation of linear accelerators in China reported in the literature in recent years is on the rise, but the total qualified rate of the output dose deviation of linear accelerators in China is still lower than in developed countries. In order to ensure the therapeutic effect of the patients undergoing radiotherapy, measures should be taken to reduce the output dose deviation of linear accelerators and improve the level of qualified rate of output dose verification.

Objective:To investigate the correlation between basic lung function indicators and functional prognosis of spi-nal cord injury (SCI),and provide a basis for accurately judging the prognosis and improving the recovery ef-fect in the early clinical stage.Method:A retrospective analysis was made of 398 patients who met the inclusion and exclusion criteria in thedepartment of rehabilitation medicine of the first affiliated hospital of the air force military medical universityfrom June 2018 to May 2022. The data of patients' age,sex,body mass index (BMI),time from admission to injury,length of stay,ASIA classification and injury level,hematological indicators (white blood cell count,red blood cell count,hemoglobin concentration),and basic lung function test indicators at admission in-cluding tidal volume (VT),vital capacity (VC),forced vital capacity (FVC),forced expiratory volume in one second (FEV1),forced expiratory volume in one second/forced vital capacity (FEV1/FVC),peak expirato-ry flow (PEF),25％ forceful exhalation forced expiratory flow at 25％ of FVC exhaled(FEF25),forced expira-tory flow at 50％ of FVC exhaled(FEF50),forced expiratory flow at 75％ of FVC exhaled(FEF75),maximal voluntary ventilation (MVV),maximal voluntary ventilation/maximal predicted voluntary ventilation (MVV/MVVpre) were collected. The mean relative function gain (mRFG) of the modified Barthel index was used as the dependent variable,and the unit and multiple linear regression methods were used to identify the relevant factors affecting the prognosis of SCI patients,especially the underlying lung function indicators.Result:The single and multiple linear regression analysis showed that the prognosis of SCI patients was signifi-cantly related to the ASIA classification (B=11.064,P=0.019),length of stay (B=0.125,P=0.005) and VC (B=5.177,P=0.014). The cut-off value for VC judging the prognosis of SCI patients was 2.39L.Conclusion:Low VC is an independent risk factor for functional outcome in patients with SCI.The detection of basic lung function at the time of admission can help to judge the functional prognosis of patients with SCI. For the patients with VC below 2.39L,the prognosis is worse. Close attention should be paid to these patients,and more adequate rehabilitation treatments should be involved to maximize the improvement of pa-tients' daily living ability.

Objective:To evaluate the clinical efficacy of C-type endoscopic submucosal dissection (C-ESD) for rectal neuroendocrine tumors (NEN).Methods:The retrospective analysis was performed on data of 55 patients who underwent ESD for rectal NEN at the Department of Endoscopy in Quanzhou First Hospital from January 2018 to July 2021. Patients were divided into the C-ESD group ( n=28) and the conventional ESD group ( n=27). The dissection time, the dissection speed, the number of submucosal injections, the enbloc resection rate, the curative resection rate and the rate of postoperative complications of the two groups were compared. Results:There were no statistically significant differences in basic information between the two groups ( P>0.05). The dissection time was 13.8±4.2 min in the C-ESD group and 19.9±3.9 min in the conventional ESD group with statistically significant difference ( t=5.649, P<0.001). The dissection speed in the C-ESD group was 0.08±0.04 cm 2/min, which was faster than 0.06±0.04 cm 2/min in the conventional ESD group ( t=2.218, P=0.031). The number of submucosal injections in the C-ESD group was less than that in the conventional ESD group [2 (1, 2) VS 3 (2, 3), Z=-8.701, P<0.001]. The lesions were enbloc resected in both groups. The curative resection rate in the C-ESD group was 100.0% (28/28) and 88.9% (24/27) in the conventional ESD group with statistically significant difference ( P=0.011). There were 7 cases of postoperative complications in the conventional ESD group, including 1 delayed bleeding, 5 delayed perforation and 1 muscularis propria injury, while no postoperative complications occurred in the C-ESD group ( P=0.004). Conclusion:C-ESD is a safe and effective treatment strategy for colorectal NEN, which can shorten the dissection time, improve the dissection speed, reduce the number of submucosal injections, improve the curative resection rate, and reduce complications.

Objective: To investigate the value of serum hepcidin in assessment of liver inflammation activity among patients with chronic hepatitis B ( CHB ), so as to provide insights into the assessment of liver inflammation activity among CHB patients. Methods: A total of 79 CHB patients who were admitted to the Affiliated Hospital of Hangzhou Normal University were selected as the experimental group, while 40 healthy volunteers were randomly sampled as controls. Subjects'demographic data, liver function tests and iron metabolism parameters were collected from medical records, and serum hepcidin was measured using enzyme-linked immunosorbent assay ( ELISA ). In addition, ultrasound-guided liver biopsy was performed in CHB patients, and mild and moderate-to-severe CHB were classified according to liver inflammation activity and degree of liver fibrosis. Serum hepcidin levels were compared between the experimental and control groups and between patients with mild and moderate-to-severe CHB. The value of serum hepcidin in assessment of liver inflammation activity was examined among CHB patients using the receiver operating characteristic ( ROC ) curve analysis. Results: Subjects in the experimental group included 54 men ( 68.35% ) and had a mean age of ( 39.06±10.67 ) years, while the controls included 24 men (60.00%) and had a mean age of ( 42.43±11.44 ) years. Lower hepcidin levels were measured in the experimental group than in the control group [( 11.70±5.64 ) vs. ( 17.82±3.63 ) μg/L; P<0.05 ]. There were 54 patients with mild CHB ( 68.35% ) and 25 cases with moderate-to-severe CHB ( 31.65% ), and lower hepcidin levels were detected in patients with moderate-to-severe CHB than in those with mild CHB [ ( 6.92±2.21 ) vs. ( 13.95±5.36 ) μg/L; P<0.05 ]. The area under the ROC curve, optimal cut-off, sensitivity and specificity of serum hepcidin were 0.903 ( P<0.05 ), 10.365 μg/L, 100.0% and 72.2% for assessment of moderate-to-severe CHB, respectively. Conclusion Serum hepcidin is feasible to evaluate the liver inflammatory activity among patients with CHB.

Objective:To investigate the correlation between serum ferritin (SF) level and liver damage in the acute stage of dengue fever.Methods:A retrospective study was conducted to analyze 171 cases diagnosed with dengue fever as dengue fever group and 130 healthy patients as control group in Hangzhou 3A grade hospital from July to December 2017. Clinical data, SF and liver function related indicators were collected from both groups: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) to analyze the correlation between liver damage and SF in patients with dengue fever.Results:ALT, AST, and SF levels were significantly higher in the dengue fever group than those in the healthy control group ( Z = 11.553, 15.054 and 15.163, P < 0.001). SF levels were higher in the dengue fever combined with liver damage group than those without the liver damage group ( z = 6.930, P < 0.001). However, there was no statistically significant differences in age, gender, peak body temperature, and history of liver disease ( P > 0.05). In addition, Spearman’s correlation analysis showed that SF was positively correlated with ALT, AST, and TBIL ( r = 0.464, 0.531 and 0.315, P < 0.001). Among dengue patients with different SF levels, there were significant difference in ALT, AST levels and incidence of liver damage ( H = 14.240 and 17.584, χ2 = 49.547, P < 0.001). Patients with higher SF levels had higher ALT, AST levels and incidence of liver damage. Binary logistic regression analysis showed that hyperferritinemia (SF≥500 ng/ml) was the risk factor for dengue fever combined with liver damage ( OR = 8.120, P < 0.001). Furthermore, ROC curve analysis showed that the AUC for SF to judge dengue fever combined liver damage was 0.846 (95% CI: 0.785-0.908), and the sensitivity and specificity when the SF cut-off value was 1 506 ng/ml were 74.8% and 83.3%. Conclusion:There is a certain correlation between the SF level and the degree of liver damage in acute stage of dengue fever patients, and hyperferritinemia is a risk factor for dengue fever combined with liver damage.

Lung cancer is one of the most common malignancies with the highest incidence rate and mortality rate worldwide, and non-small cell lung cancer (NSCLC) accounts for about 85%. Only 5% NSCLC patients are anaplastic lymphoma kinase (ALK) rearrangement positive NSCLC, but the prognosis of these patients is poor, and treatment is urgent. Ensartinib (X-396), a next-generation ALK tyrosine kinase inhibitor (ALK-TKI), has shown greater potency on inhibiting ALK activity and controlling brain metastases than crizotinib, which is indicated for the treatment of crizotinib-resistant, ALK-positive NSCLC patients. Several phase I to III clinical trials included both healthy volunteers and NSCLC patients have been conducted both in China and abroad. In this review, we briefly summarized the results of these trials, and preliminary efficacy, safety, pharmacology and pharmacokinetics/pharmacodynamics of ensartinib were discussed.