Objective·To explore the predictive value of diuretic renal scintigraphy parameters such as 20-minute residual rate(R20)for pyeloplasty in children with congenital unilateral ureteropelvic junction obstruction(UPJO).Methods·The clinical data and diuretic renal scintigraphy results of 110 children with congenital unilateral UPJO who were first treated at the Department of Nuclear Medicine,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from August 2018 to August 2023 were retrospectively analyzed.The imaging results and the progress of hydronephrosis were followed up after the first diuretic renal scintigraphy.According to the outcome event of pyeloplasty due to the progression of hydronephrosis,the children were divided into operation group and non-operation group.Age,gender,side of hydronephrosis,and baseline diuretic renal scintigraphy parameters including blood perfusion rate(BPR),differential renal function(DRF),time to peak(Tmax),time to half(T1/2)and R20 were compared between the two groups.Logistic regression was used to analyze the effect of various parameters on the progression of hydronephrosis.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of diuretic renal scintigraphy parameters for surgical intervention.Wilcoxon test was used to compare the examination parameters of two diuretic renal dynamic imaging.Results·During the follow-up,60 children underwent pyeloplasty after progression,and the other 50 children did not progress.The differences in DRF,Tmax,T1/2 and R20 between the two groups of children at baseline were statistically significant(all P<0.05).Univariate and multivariate Logistic regression analysis showed that only R20 was an independent predictor of pyeloplasty(OR=4.730,95%CI 1.009-1.178,P=0.030).R20 predicted pyeloplasty with a sensitivity of 88.3%,specificity of 56%,the area under the ROC curve of 0.758(95%CI 0.667-0.850,P=0.000),and the cut-off value of 90.08%.During the follow-up,38 children underwent the second diuretic renal scintigraphy,and the DRF was lower than before.The difference between the two DRFs was statistically significant(Z=-2.589,P=0.010),especially in children with R20≥90.08%(Z=-2.166,P=0.030).R20 in the non-operation group decreased significantly compared with the baseline(Z=-2.062,P=0.039).However,R20 in the operation group was higher than baseline,but the difference was not statistically significant(P>0.05).Conclusion·R20 plays an important role in the prediction of pyeloplasty in children with congenital unilateral UPJO.For children with R20≥90.08%,pyeloplasty should be performed as soon as possible to prevent further deterioration of renal function.

Tumor metastasis depends on the dynamic balance of the actomyosin cytoskeleton. As a key component of actomyosin filaments, non-muscle myosin-IIA disassembly contributes to tumor cell spreading and migration. However, its regulatory mechanism in tumor migration and invasion is poorly understood. Here, we found that oncoprotein hepatitis B X-interacting protein (HBXIP) blocked the myosin-IIA assemble state promoting breast cancer cell migration. Mechanistically, mass spectrometry analysis, co-immunoprecipitation assay and GST-pull down assay proved that HBXIP directly interacted with the assembly-competent domain (ACD) of non-muscle heavy chain myosin-IIA (NMHC-IIA). The interaction was enhanced by NMHC-IIA S1916 phosphorylation via HBXIP-recruited protein kinase PKCβII. Moreover, HBXIP induced the transcription of PRKCB, encoding PKCβII, by coactivating Sp1, and triggered PKCβII kinase activity. Interestingly, RNA sequencing and mouse metastasis model indicated that the anti-hyperlipidemic drug bezafibrate (BZF) suppressed breast cancer metastasis via inhibiting PKCβII-mediated NMHC-IIA phosphorylation in vitro and in vivo. We reveal a novel mechanism by which HBXIP promotes myosin-IIA disassembly via interacting and phosphorylating NMHC-IIA, and BZF can serve as an effective anti-metastatic drug in breast cancer.

Objective:To design and develop a swallowing function training system suitable for stroke patients with swallowing disorders, and investigate patients' acceptance of the system based on sufficient experience.Methods:This system was jointly designed by a multidisciplinary team, targeting stroke patients with swallowing disorders. By combining virtual reality (VR) technology, it achieved visual and interesting knowledge guidance, systematic and targeted swallowing function training, and real-time, feedback based on supervision and review. From March to May 2022, convenience sampling was used to select 39 stroke patients with swallowing disorders from Beijing Chaoyang Hospital affiliated with Capital Medical University. On the basis of fully experiencing the system, the system was evaluated from seven dimensions, including perceived usefulness, perceived ease of use, perceived ease of learning, perceived applicability, perceived security, perceived satisfaction, and intention to use.Results:The acceptance evaluation score of the rehabilitation training system for 39 stroke patients with swallowing disorders was 162 (147, 170). There were statistically significant differences in the acceptance evaluation scores of the rehabilitation training system for patients with different levels of education, job types, cumulative time spent using smartphones every day, and willingness to learn swallowing training, whether they understood VR devices or technologies, and whether they considered swallowing training important ( P<0.05) . Conclusions:This system benefits from the visualization effect and a good sense of immersion of VR technology. Compared to traditional methods, it increases the fun, immersion, and feedback of the rehabilitation training process, and patients have a high acceptance of the system, which can be promoted and used.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Objective:To evaluate percutaneous mechanical thrombectomy (PMT) using Aspirex device for treating acute iliofemoral deep vein thrombosis (IFDVT).Methods:The clinical and follow-up data of 68 patients with IFDVT at our institution from Jan 2019 to Jun 2021 was retrospectively analyzed.Results:Twenty-six patients who had received PMT combined with auxiliary catheter directed thrombolysis (CDT) were included into group A, and 42 patients received CDT alone were into group B.The final thrombus clearance rates were more than 50%, and the clinical efficacy of thrombolysis was achieved. Group A associated a significant reduction in lysis duration and UK dosage and hospital days and degree of detumescence after 24 h compared with group B,and all aforementioned differences were statistically significant. Hospitalization costs in group A were more than group B. At one year follow-up, there were no significant differences between the two groups in the cumulative prevalence post-thrombotic syndrome (PTS) and the Villalta score and primary patency (92.0% vs. 90.0% , χ2=0.059, P=0.807). Conclusions:The application of PMT using the Aspirex device for acute IFDVT was safe and effective, which could accelerate the clearance of thrombus, and reduce UK dosage, lysis duration, hospital days. However, it increased the hospitalization costs.

Objective:To investigate the clinical value of radiomics based on computed tomography (CT) examination in preoperative differential diagnosis of pancreatic serous cystadenoma (SCA) and mucinous cystadenoma (MCA).Methods:The retrospective case-control study was conducted. The clinicopathological and imaging data of 154 patients with pancreatic cystic neoplasms who were admitted to the First Affiliated Hospital, Zhejiang University School of Medicine from January 2012 to December 2019 were collected. There were 24 males and 130 females, aged (50±13)years. Of the 154 patients, 99 cases were diagnosed as SCA and 55 cases were diagnosed as MCA. All the 154 patients underwent plain and enhanced CT scan of pancreas before operation. The clinical characteristics, radiology features and radiomics features of all patients were collected to construct the clinical characteristics model, radiology model, radiomics model and fused model. The receiver operating characteristic (ROC) curve of each model was drawn, and those constructed models were evaluated by area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value and negative predictive value. Based on the optimal model, the nomogram was constructed. Observation indicators: (1) establishment and validation of clinical characteristics model; (2) establishment and validation of radiology model; (3) establishment and validation of radiomics model; (4) establishment and validation of fused model; (5) nomogram of fused model. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results:(1) Establishment and validation of clinical characteristics model: 3 clinical characteristics, including age, symptoms and preoperative serum CA19-9, were selected using multinomial logistic linear regression analysis to construct the clinical characteristics model. Result of the multinomial logistic linear regression analysis was expressed by formula ①: clinical characteristics model score=0.635-0.007×age+0.054×clinical symptoms+0.108×preoperative serum CA19-9. The ROC curve for the test dataset of clinical characteristics model was drawn. The AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of clinical characteristics model were 0.611(95% confidence interval as 0.488?0.734, P<0.05), 56.6%, 66.7%, 56.3%, 41.5%, 78.4% for the training dataset and 0.771(95% confidence interval as 0.624?0.919, P<0.05), 77.8%, 63.1%, 88.5%, 80.1%, 76.7% for the test dataset, respectively. (2) Establishment and validation of radiology model: 5 radiology characteristics, including tumor location, the number of tumors, tumor diameter of cross section, lobulated tumor and polycystic tumor (more than 6), were selected using multinomial logistic linear regression analysis to construct the radiology model. Result of the multinomial logistic linear regression analysis was expressed by formula ②: radiology model score=?0.034+0.300×tumor location+0.202×the number of tumors+0.014×tumor diameter of cross section?0.251×lobulated tumor?0.170×polycystic tumor (more than 6). The ROC curve for the test dataset of radiology model was drawn. The AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of radiology model were 0.862(95% confidence interval as 0.791?0.932, P<0.05), 78.8%, 81.8%, 77.5%, 62.8%, 90.2% for the training dataset and 0.853(95% confidence interval as 0.713?0.994), P<0.05), 88.9%, 89.4%, 88.5%, 85.0%, 92.0% for the test dataset, respectively. (3) Establishment and validation of radiomics model: 4 categories of a total 1 067 radiomics features were extracted from 154 patients with pancreatic cystic neoplasms, including 7 first-order histogram features, 53 texture features, 848 wavelet features and 159 local binary pattern features. A total of 896 stable radiomics features were retained to construct the model, based on the condition of intraclass correlation coefficient >0.9. After selected by variance threshold and correlation coefficient threshold, 350 radiomics features were retained. Fifty synthetic radiomics features were constructed based on the original features in order to obtain potential radiomics features, and the total number of radiomics features was 400. After analyzed by the five-fold recursive feature elimination, 22 radiomics features were screened out, including 13 wavelet features, 7 synthetic radiomics features and 2 local binary pattern features. The support vector machine algorithm was used to construct the radiomics model. The penalty coefficient 'C' and parameter 'γ' of the radiomics model were 35.938 and 0.077, respectively. The kernel function of the radiomics model was 'radial basis function kernel'. The ROC curve of radiomics model using 5-fold cross validation was drawn. The average AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the radiomics model were 0.870 ( P<0.05), 83.1%, 81.8%, 83.8%, 73.8% and 89.2%, respectively. (4) Establishment and validation of fused model: the fused model was constructed after selecting the tumor location and lobulated tumor of radiology characteristics and radiomics score. Result of the multinomial logistic linear regression analysis was expressed by formula ③: fused model socre=?0.154+0.218×tumor location?0.223×lobulated tumor+0.621×radiomics score. The ROC curve for the test dataset of fused model was drawn. The AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of fused model were 0.893(95% confidence interval as 0.828?0.958, P<0.05), 83.7%, 81.8%, 84.5%, 71.1%, 90.9% for the training dataset and 0.966(95% confidence interval as 0.921?0.999, P<0.05), 91.1%, 84.2%, 96.2%, 94.1%, 89.3% for the test dataset, respectively. (5) Nomogram of fused model: the nomogram of fused model was illustrated with the Youden index of 0.416. Conclusion:The prediction model based on the radiomics signature and radiological features extracted from preoperative CT examination can make the differential diagnosis of pancreatic SCA from MCA.

Objective:To explore the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of relapsed/refractory acute myeloid leukemia (AML).Methods:The clinical data of 35 patients with relapsed/refractory AML treated with allo-HSCT in the Affiliated Cancer Hospital of Zhengzhou University from June 2011 to October 2018 was retrospectively analyzed. The overall survival (OS), disease-free survival (DFS), graft versus host disease (GVHD) incidence, transplantation related mortality and recurrence rate were calculated, and the risk factors affecting prognosis were analyzed.Results:Hematopoietic reconstitution was obtained in all patients after transplantation. The 100 d incidence of grade Ⅱ-Ⅳ acute GVHD was (22.9±7.7)%, and the 3-year incidence of chronic GVHD was (49.5±10.60)%. The median follow-up time after transplantation was 14.1 months (4.2-89.4 months). In all cases, 18 cases survived (including 16 cases of DFS), and 17 cases died. Fourteen cases relapsed, and the median recurrence time was 4.7 months (2.9-32.4 months). The 3-year OS rate and DFS rate were (44.4±9.3)% and (43.0±9.5)%, respectively. Univariate analysis showed that the non-remission disease before transplantation, poor genetic risk grade before transplantation and recurrence after transplantation were the risk factors for OS (all P < 0.05). The 3-year OS rates in complete remission before transplantation group and non-remission before transplantation group were (63.2±12.0)% and (15.7±12.8)% ( P = 0.025), the 3-year DFS rates were (62.2±12.3)% and (15.3±12.7)% ( P = 0.028), and the 3-year recurrence rates were (28.2±10.7)% and (80.6±15.7)% ( P = 0.057). The 3-year recurrence rate in genetic high-risk group was higher than that in middle-risk group and low-risk group [100.0%, (45.0±12.1)% and (14.3±13.2)%, P = 0.045]. The 3-year tansplantation related mortality was (18.7±7.7)%. Conclusions:Allo-HSCT is an effective method for salvage treatment of relapsed/refractory AML, and recurrence is the main factor affecting survival. Reducing tumor load before transplantation is very important for reducing recurrence and improving curative effect.

Objective This study aimed to analyze the knowledge, attitude, behavior, and practice of pneumococcal vaccination in type 2 diabetes mellitus patients. Methods From January to March 2018, 3000 patients with type 2 diabetes mellitus were randomly selected from patients with type 2 diabetes registered and managed in community health service centers to participate in a questionnaire survey, using multi-stage cluster random sampling. The questionnaire included basic information, pneumococcal vaccine awareness, and pneumococcal vaccination status and inoculation intention, 2896 valid questionnaires were collected. The chi-squared test and multivariate logistic regression analysis were used to analyze the knowledge, attitude, behavior, and practice and influencing factors of pneumococcal vaccination. Results Of all the patients, 1267 (43.75％) patients with type 2 diabetes were willing to receive pneumococcal vaccination, and 23 (0.79％) patients with type 2 diabetes were vaccinated against pneumococcal, 1295(44.72％) patients with type 2 diabetes believed that patients with chronic diseases were susceptible to pneumococcal. Eight hundred seventy-seven (30.38％) patients believed that pneumococcal vaccination for chronic disease patients could reduce the risk of outpatient, hospitalization and death. Seven hundred ninety-nine (27.59％) patients believed that diabetic patients were the primary recipients of the pneumococcal vaccine. Multivariate logistic regression analysis showed that retired patients; those who thought that patients with chronic diseases were susceptible to pneumonia; those who thought that pneumococcal vaccination could reduce the risk of needing outpatient care, hospitalization, and death;and those who thought that diabetes was the priority of pneumococcal vaccination were more willing to receive pneumococcal vaccination (OR=1.442, 0.764, 1.494, 1.713, P all<0.05). Conclusion Patients with type 2 diabetes in Shenzhen have lower pneumococcal vaccine awareness, inoculation intention, and vaccination rates. Health education on the prevention of diabetes complications and pneumococcal vaccination should be promoted.

Objective To investigate the clinical significance of biochemical markers in EBC and serum in patients with bronchial asthma and chronic obstructive pulmonary disease overlap syndrome(ACOS). Methods We selected Patients with chronic airway inflammatory diseases in our hospital,These patients underwent clinical trial after the stable phase,including 18 ACOS patients,22 asthma patients,24 COPD patients and 20 healthy non-smokers in the same period.8-isoPG and other inflammatory factors levels in EBC and serum were measured in the selected patients. A comparative analysis was performed. Results The levels of EBC 8-isoPG in the ACOS group were significantly higher than those in the healthy control group,The levels of serum and EBC 8-isoPG in the ACOS group were significantly higher than the asthma group and the COPD group(P < 0.05). The level of 8-isoPG in EBC was not related to age,smoking index,weight,and FEV1value(P>0.05).Conclusions Inflam-matory factors including 8-isoPG,are involved in chronic inflammation in lung tissues of patients with ACOS. 8-isoPG in EBC may have potential value in identifying ACOS from COPD and asthma as biomarkers and deserve further study.

Objective:To validate an enzyme linked immunosorbent assay (ELISA) method for the quantification of rhCNB in long-tailed macaque sera.Methods: The linear,sensitivity,accuracy,precision and recovery were determined using ELISA.Results:The present ELISA method had high linearity within 0.195 ng/ml-12.5 ng/ml,the working curve of rhCNB was Y=15.1X-0.26, R2=0.996 8 , the method showed good sensitivity of 0.195 ng/ml, the accuracy were in the range of 91.9%-108.8%, and the Coefficient of variation ( CV) for inter-assay were 3.55%,1.39%and 4.71%,the intra-assay were 1.59%,3.2%and 3.8%,all less than 10%, the recoveries were in the range of 88.5% -108.3%, <110% .Thus the method was coincidence with requirement.Conclusion:Double antibody sandwich ELISA assay of rhCNB in long-tailed macaque sera has good sensitivity ,accuracy, precision and recovery and it can be used to measure rhCNB concentration in biological samples .