Objective To solubly express the recombinant envelope glycoprotein G2 of Hantaan virus(HTNV) strain PS-6 in a prokaryotic system, and prepare its monoclonal antibodies(mAbs), in order to provide high-quality mAbs for antigen detection during related vaccine research and production.Methods The cDNA synthesized by reverse transcription of HTNV PS-6 RNA was used as a template to amplify the G2 gene by PCR, and the maltose-binding protein(MBP) tag gene was amplified by PCR using the plasmid pET-28a(+)-MBP-LA-PTH as the template. Both target genes were inserted into the vector pET-28a(+) via homologous recombination to construct the recombinant expression plasmid pET-28a(+)-MBP-PS-6-G2. The plasmid was transformed into competent E.coli BL21(DE3) cells, and after IPTG-induced expression, soluble recombinant G2 protein was obtained via three-step purification of Ni affinity chromatography → HRV-3C protease cleavage → Ni affinity chromatography. Three female BALB/c mice were immunized with the purified protein, hybridoma clones that stably secrete anti-G2 protein mAbs were screened by hybridoma fusion technology, and ascites was prepared and purified. The purity of mAbs was measured by SDS-PAGE, the specificity was identified by Western blot, and the relative affinity was determined by indirect ELISA.Results Colony PCR and double enzyme(XhoⅠ/NdeⅠ)digestion confirmed that the recombinant expression plasmid was constructed correctly. The expressed product had a relative molecular mass of approximately 95 000 and was expressed in a soluble form in the supernatant. The purified protein exhibited a concentration of 1. 2 mg/mL, a purity of > 95%, and specific binding to HTNV PS-6 mAbs. A total of four hybridoma cell lines, 3C4, 4D6, 2A8 and 5E2, were screened by hybridoma fusion technology, and the titers of ascites were 1∶10~6, 1∶10~6, 1∶10~6 and 1∶10~7, respectively. The purity of antibodies after purification was above 95%, and all of them could specifically recognize recombinant G2 protein and HTNV PS-6 inactivated virus bulk solution, with relative affinities of(0. 090 ± 0. 005),(0. 140 ± 0. 010),(0. 292 ± 0. 008) and(0. 237 ±0. 010) mg/mL, respectively.Conclusion The soluble expression of envelope glycoprotein G2 of HTNV PS-6 in prokaryotic system was successfully achieved by MBP solubilization tag and three-step purification process, and four mAbs with high specificity and affinity were obtained, providing a valuable biological tool for HTNV antigen detection and vaccine research.

Background and Aims:The Octoparms filter is a newly introduced domestically manufactured umbrella-shaped retrievable inferior vena cava (IVC) filter. A multicenter,parallel-controlled trial demonstrated its non-inferiority to the Celect filter. This study was performed to compare the clinical outcomes of the placement and retrieval of the Octoparms filter with those of the Denali filter to assess its safety and efficacy further.Methods:From May 2021 to May 2024,289 Denali filters (Denali group) and 78 Octoparms filters (Octoparms group) were placed and attempted to be retrieved at Beijing Shijitan Hospital,affiliated with Capital Medical University. After propensity score matching (PSM) of baseline characteristics,the incidence of filter tilt,wall apposition,vein wall penetration,retrieval success rates,and other relevant variables were compared between the two groups.Results:After PSM,77 patients were included in each group. Following matching,except for the significantly lower placement cost in the Octoparms group (P<0.05),all baseline characteristics (e.g.,gender,age,surgical indications,filter insertion route,IVC diameter,and angle) showed no statistically significant differences between the two groups (all P>0.05). The average indwelling time of the filter was longer in the Denali group compared to the Octoparms group (58 d vs. 47 d,P=0.004). There was no significant difference in the average filter tilt angle between the two groups (4.4° vs. 4.8°,P=0.71). While wall apposition or significant tilt was more frequent in the Octoparms group,the difference was not statistically significant (P>0.05). Both groups achieved a 100.0％ technical success rate for filter retrieval,with no complications such as filter fracture or vascular rupture during retrieval. Other retrieval-related variables (surgical approach,retrieval duration,retrieval techniques,and costs) also showed no significant differences between the two groups (all P>0.05).Conclusion:As a newly launched domestic filter,the Octoparms filter demonstrates comparable stability and retrieval rate to the Denali filter,and it is a safe and reliable choice.

Background and Aims:The Octoparms filter is a newly introduced domestically manufactured umbrella-shaped retrievable inferior vena cava (IVC) filter. A multicenter,parallel-controlled trial demonstrated its non-inferiority to the Celect filter. This study was performed to compare the clinical outcomes of the placement and retrieval of the Octoparms filter with those of the Denali filter to assess its safety and efficacy further.Methods:From May 2021 to May 2024,289 Denali filters (Denali group) and 78 Octoparms filters (Octoparms group) were placed and attempted to be retrieved at Beijing Shijitan Hospital,affiliated with Capital Medical University. After propensity score matching (PSM) of baseline characteristics,the incidence of filter tilt,wall apposition,vein wall penetration,retrieval success rates,and other relevant variables were compared between the two groups.Results:After PSM,77 patients were included in each group. Following matching,except for the significantly lower placement cost in the Octoparms group (P<0.05),all baseline characteristics (e.g.,gender,age,surgical indications,filter insertion route,IVC diameter,and angle) showed no statistically significant differences between the two groups (all P>0.05). The average indwelling time of the filter was longer in the Denali group compared to the Octoparms group (58 d vs. 47 d,P=0.004). There was no significant difference in the average filter tilt angle between the two groups (4.4° vs. 4.8°,P=0.71). While wall apposition or significant tilt was more frequent in the Octoparms group,the difference was not statistically significant (P>0.05). Both groups achieved a 100.0％ technical success rate for filter retrieval,with no complications such as filter fracture or vascular rupture during retrieval. Other retrieval-related variables (surgical approach,retrieval duration,retrieval techniques,and costs) also showed no significant differences between the two groups (all P>0.05).Conclusion:As a newly launched domestic filter,the Octoparms filter demonstrates comparable stability and retrieval rate to the Denali filter,and it is a safe and reliable choice.

Objective:To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods:A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results:One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group( M(IQR),3.0(4.3) vs.4.0(5.8), Z=-2.038, P=0.040).Additionally, the chronic venous insufficiency patients′ quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217, P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference ( χ2=0.453, P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference ( χ2=4.800, P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions:CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

Objective:To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods:A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results:One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group( M(IQR),3.0(4.3) vs.4.0(5.8), Z=-2.038, P=0.040).Additionally, the chronic venous insufficiency patients′ quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217, P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference ( χ2=0.453, P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference ( χ2=4.800, P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions:CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

Objective:To evaluate the diagnostic evaluation process and the effectiveness and safety of intracavitary therapy for pelvic congestion syndrome (PCS).Methods:A retrospective analysis was conducted on 38 patients admitted to Beijing Shijitan Hospital affiliated to Capital Medical University from March 2019 to February 2022. Combined with the patient′s symptoms, PCS was diagnosed by color Doppler ultrasound, computed tomography venography (CTV), and venography. The ovarian vein was embolized with controllable spring coil and polydocanol foam sclerosing agent. The patients were followed up 1, 3 and 6 months after operation.Results:The total surgical success rate of 38 patients was 100%, and the incidence of complications was 5.3%(2/38); Spring coils (2.8±0.3)per person; The dosage of hardener was (7.0±2.1)ml/person. The improvement rate of patient symptoms was 97.4%(37/38); After 1, 3, and 6 months of surgery, color Doppler ultrasound was reexamined and no recanalization was observed in the embolized ovarian veins; The diameter of the parauterine vein was (2.8±0.5)mm, which was significantly lower than the preoperative (7.5±1.9)mm ( P<0.05); The Visual Analogue Scale (VAS) score was significantly lower than the preoperative score [(2.12±1.87)points vs (7.58±0.82)points, P<0.001]. Conclusions:Process based assessment is helpful in identifying and diagnosing PCS patients who urgently need treatment; Endovascular treatment based on embolization of ovarian vein with controllable spring coil and foam sclerosing agent is minimally invasive, safe and effective.

BACKGROUND: Epidermal growth factor receptor (EGFR) mutations are often associated with non-EGFR genetic alterations, which may be a reason for the poor efficacy of EGFR tyrosine kinase inhibitors (TKIs). Here we conducted this study to explore whether EGFR-TKIs combined with chemotherapy would benefit advanced lung adenocarcinoma patients with both sensitive EGFR mutation and concomitant non-EGFR genetic alterations. METHODS: Cases of advanced lung adenocarcinoma with EGFR mutation combined with concomitant non-EGFR genetic alterations were retrospectively collected. And the patients were required to receive first-line EGFR-TKIs and chemotherapy combination or EGFR-TKIs monotherapy. Demographic, clinical and pathological data were collected, and the electronic imaging data were retrieved to evaluate the efficacy and time of disease progression. Survival data were obtained through face-to-face or telephone follow-up. The differences between the two groups in objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were investigated. RESULTS 107 patients were included, including 63 cases in the combination group and 44 cases in the monotherapy group. The ORR were 78% and 50% (P=0.003), and DCR were 97% and 77% (P=0.002), respectively. At a median follow-up of 13.7 mon, a PFS event occurred in 38.1% and 81.8% of patients in the two groups, with median PFS of 18.8 mon and 5.3 mon, respectively (P<0.000,1). Median OS was unreached in the combination group, and 27.8 mon in the monotherapy group (P=0.31). According to the Cox multivariate regression analysis, combination therapy was an independent prognostic factor of PFS CONCLUSIONS: In patients with EGFR-mutant advanced lung adenocarcinoma with concomitant non-EGFR genetic alterations, combination of TKIs and chemotherapy was significantly superior to EGFR-TKIs monotherapy, which should be the preferred treatment option.
Adenocarcinoma of Lung/genetics* ; ErbB Receptors/genetics* ; Humans ; Lung Neoplasms/pathology* ; Mutation ; Protein Kinase Inhibitors/therapeutic use* ; Retrospective Studies

Objective:To evaluate the role of Angiojet thrombus clearance device in the treatment of dialysis access thrombosis.Methods:The clinical data of 37 patients with Angiojet thrombus clearance due to hemodialysis thrombosis from May 2019 to May 2021 were retrospectively analyzed.Results:The clinical success rate was 100%, the mean operation time was (42±21) minutes. The time of aspiration was (35±18) s, and the average length of occlusion was (8±5) cm. All patients were treated with balloon dilation after aspiration. The average postoperative dialysis flow was (270±15) ml/min. The mean length of stay was (2.0±1.5) days. There were no surgically related deaths, no vascular rupture or bleeding, no major complications. Dilated local pseudoaneurysm formation was observed in 5 patients after dilation by angiography without special treatment. The mean follow-up time was 11 months. The primary patency rate was 85% and the secondary patency rate was 87% at 6 months post operatively.Conclusion:Angiojet thrombus removal device has the advantages of minimally invasive, short operation time and repeatability.

Objective:To study the impact of Roux-en-Y reconstruction with isolated pancreatic drainage (RYR) on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods:The data of 203 patients who underwent PD at 5 clinical centers from January 2014 to June 2020 were collected. According to the method of reconstruction of the digestive tract, the patients were divided into the RYR group ( n=88) and the conventional loop reconstruction (CLR) group ( n=115). The incidence and severity of DGE were compared between groups. The risk factors of clinically relevant DGE (CR-DGE) after PD were analysed by univariate and multivariate analyses. Results:Of 203 patients, there were 124 males and 79 females, aged (61.6±10.2) years. The overall incidence of DEG was 27.6% (56/203). The incidence of CR-DGE in the RYR group was significantly lower than that in the CLR group [13.6%(12/88) vs 26.1%(30/115), P=0.030]. Patient age of more than 65 years ( OR=2.966, 95% CI: 1.162-8.842, P=0.024), clinically relevant pancreatic fistula ( OR=3.041, 95% CI: 1.122-8.238, P=0.029), ascites and abdominal infection ( OR=10.000, 95% CI: 2.552-39.184, P=0.001), and CLR ( OR=3.206, 95% CI: 1.162-8.842, P=0.024) were identified as independent risk factors for CR-DGE. The duration of hospitalization and hospital expenditure of patients were significantly increased in the CR-DGE group ( P<0.05). Conclusions:Patients over 65 years with clinically relevant pancreatic fistula, with ascites or abdominal infection after operation, had a higher evidence of CR-DGE. Roux-en-Y reconstruction with isolated pancreatic could helped to decrease the incidence of CR-DGE after PD.

Objective:To assess the change rules of fetal cervical, thoracic and lumbar spinal volume and centrum volume with gestational ages.Methods:The 3.0 T MRI was performed on 55 fetal specimens ranging from 17 to 42 gestational weeks with sequence of three dimensional T 2WI. Among 55 samples, 20 samples were obtained from spontaneous abortion of pregnant women and 35 samples were obtained from induced labor of mothers due to serious diseases. The fetal specimen was derived from sectional imaging anatomy research institute of the medical school of Shandong University. No spinal abnormalities were found on CT scans. The cervical, thoracic and lumbar spinal volume was obtained by delineating the vertebral body contour on the reconstructed cross-sectional image with the OsiriX software (www.osirix-viewer.com). And the volume of the cervical, thoracic and lumbar spine was divided by the number of the vertebral bodies to obtain the centrum unit volume. Five lumbar vertebral bodies were measured one by one. Regression analysis was made between the volume of cervical, thoracic and lumbar spine and gestational weeks, and between the volume of lumbar vertebral bodies and gestational weeks to analyze the growth rule of spine. Results:(1) The cervical, thoracic and lumbar spine volume increased linearly with gestational ages, and the linear regression equation was as follows: cervical spine volume (mm 3) =-1 260.937+81.235×gestational week ( R2=0.974, P<0.05), thoracic spine volume (mm 3) =-5 933.521+347.503×gestational week ( R2=0.972, P<0.05), lumbar spine volume (mm 3) =-5 130.912+294.473×gestational week ( R2=0.976, P<0.05). (2) The order from large to small of fetal spinal growth rate was thoracic, lumbar and cervical segment. Within the same gestational age, the order from large to small of spinal volume was thoracic, lumbar and cervical segment. The order from large to small of centrum unit volume growth rate was lumbar, thoracic and cervical vertebrae. (3) The volume of each lumbar vertebral body also increased linearly with gestational age. Conclusion:The cervical, thoracic and lumbar volume show a good correlation with the gestational weeks in the second and third trimester fatal specimens, and the growth rate of different segments is different.