AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR), and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS: A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital, Sun Yat-sen University from 2022 to 2023 were included, including 95 first-diagnosed DR patients and 105 patients without DR, and all patients underwent OCTA examination and a collection of demographics and renal function parameters. After a quality check, automated measurements of the foveal avascular zone area, vessel density(VD), and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS: Using random forest and multivariate Logistic regression methods, we developed a diagnostic model for DR based on 12 variables(age, FBG, SBP, DBP, HbA1c, ALT, ALP, urea/Scr, DM duration, HUA, DN, and CMT). Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window, AUC=0.837 vs 0.819, P=0.03). In the study of DN patients, the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD; outer VD; full VD; outer PD; full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model. Meanwhile, compared with the 3 mm×3 mm window, the microvascular parameters in the 6 mm× 6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.

Purpose To investigate the expression of bone sialoprotein(BSP)in the tissues and cells of endome-trial cancer(EC)and its effects on the proliferation and invasion of EC cells.Methods The expression of BSP was assessed by immunohistochemistry in 235 EC tissues and 88 normal endometrial tissues,and its correlation with clinico-pathological features was analyzed.Western blot was used to compare BSP levels between human endometrial carcinoma cell line(HHUA)and normal human endumetial epithelial cells(HEEC).BSP was knocked down in HHUA cells via transient transfection,and the cells were divided into blank control group and BSP-knockdown group.The effects of BSP knockdown on cell cycle,proliferation,migration,invasion,and apoptosis were evaluated using PI staining,CCK-8,scratch,Transwell,and Annexin V-FITC assays,respectively.Protein levels of TGF-β signaling pathway compo-nents were analyzed by Western blot.Results BSP expression was significantly higher in EC tissues than in normal endometrium(P＜0.001)and correlated with lymph node metastasis and advanced FIGO stage(P＜0.05).BSP pro-tein level was also significantly elevated in HHUA cells(2.455 8±0.008 9)compared to HEECs(1.571 2±0.005 4)(P＜0.01).After knockdown,compared with the control group,the proliferation index(74.4±3.33),migration rate(0.48±0.03),and invasion ability(0.36±0.11)of the cells were increased,and the apoptosis rate(25.97％)of the cells was increased(P＜0.05).Furthermore,the expression levels of TGF-β signaling pathway downstream proteins TGF-β1(0.290 4±0.002 3)、TGF-β2(0.292 9±0.001 6)、Smad2(0.469 3±0.001 1)、Smad3(0.247 0±0.001 7)、pAKT(0.382 1±0.001 9)、ATK(0.119 6±0.001 6)and MEK1(0.258 9±0.000 3)in the BSP-knockdown group of EC cells decreased(P＜0.01).Conclusion BSP is highly expressed in endometrial cancer and promotes cancer cell proliferation,invasion,and metastasis by activating the TGF-β signaling pathway.

Purpose To investigate the expression of bone sialoprotein(BSP)in the tissues and cells of endome-trial cancer(EC)and its effects on the proliferation and invasion of EC cells.Methods The expression of BSP was assessed by immunohistochemistry in 235 EC tissues and 88 normal endometrial tissues,and its correlation with clinico-pathological features was analyzed.Western blot was used to compare BSP levels between human endometrial carcinoma cell line(HHUA)and normal human endumetial epithelial cells(HEEC).BSP was knocked down in HHUA cells via transient transfection,and the cells were divided into blank control group and BSP-knockdown group.The effects of BSP knockdown on cell cycle,proliferation,migration,invasion,and apoptosis were evaluated using PI staining,CCK-8,scratch,Transwell,and Annexin V-FITC assays,respectively.Protein levels of TGF-β signaling pathway compo-nents were analyzed by Western blot.Results BSP expression was significantly higher in EC tissues than in normal endometrium(P＜0.001)and correlated with lymph node metastasis and advanced FIGO stage(P＜0.05).BSP pro-tein level was also significantly elevated in HHUA cells(2.455 8±0.008 9)compared to HEECs(1.571 2±0.005 4)(P＜0.01).After knockdown,compared with the control group,the proliferation index(74.4±3.33),migration rate(0.48±0.03),and invasion ability(0.36±0.11)of the cells were increased,and the apoptosis rate(25.97％)of the cells was increased(P＜0.05).Furthermore,the expression levels of TGF-β signaling pathway downstream proteins TGF-β1(0.290 4±0.002 3)、TGF-β2(0.292 9±0.001 6)、Smad2(0.469 3±0.001 1)、Smad3(0.247 0±0.001 7)、pAKT(0.382 1±0.001 9)、ATK(0.119 6±0.001 6)and MEK1(0.258 9±0.000 3)in the BSP-knockdown group of EC cells decreased(P＜0.01).Conclusion BSP is highly expressed in endometrial cancer and promotes cancer cell proliferation,invasion,and metastasis by activating the TGF-β signaling pathway.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*

Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

To investigate the clinical features and prognostic significance in myelodysplastic syndrome (MDS) patients with DTA (DNMT3A,TET2,ASXL1) mutations. Clinical characteristics of 140 patients diagnosed as de novo MDS at People′s Hospital of Xinjiang Uygur Autonomous Region from September 2015 to December 2019 were retrospectively analyzed. Next-generation sequencing was used to detect 34 related genes in MDS patients. DTA mutations and the correlation with progression-free survival (PFS) and overall survival (OS) in MDS patients were evaluated. Among 140 MDS patients, DTA mutations was detected in 62 (44.3%) patients. And the positive rate of DTA mutations in IPSS-R lower-risk group was 65.4%, significantly higher than that of higher-risk group (31.8%)( P=0.000). Compared with the non-mutated group, patients with DTA mutations had a lower rate of conversion to leukemia (9.7% vs . 29.5%, P=0.004).Survival analysis showed that PFS in patients with DTA mutations was comparable as that in MDS patients without DTA mutations ( P=0.787), but the median OS was significantly shorter (16 months vs . 20 months, P=0.022).According to IPSS-R classification, the median OS in patients with and without DTA mutation was only statistically significant in the higher-risk group (15 months vs. 18 months, P=0.034).Among 62 patients with DTA mutations, 60 (96.8%) had additional gene mutations. DTA mutations were not independent prognostic factors when mutation frequency is greater than 10% were considered in Cox regression model ( P>0.05). DTA mutations often developed in the early stage of MDS, therefore they were more common in IPSS-R lower-risk subgroup which was correlated to the low rate of conversion to leukemia. In conclusion, DTA mutations are not associated with disease progression, but predict unfavorable survival when other add-on genes are mutated.

Objective:To investigate the effect of LINC00261 on the radiosensitivity of nasopharyngeal carcinoma and tumor formation and its underlying mechanism in nude mice.Methods:qRT-PCR was used to detect the relative expression levels of miR-620 and LINC00261 in radiosensitive and radioresistant nasopharyngeal carcinoma tissues. After the 6-10B and HNE-3 cells were irradiated with 0, 2, 4, 6, and 8 Gy 60Coγ-ray, the relative expression levels of miR-620 and LINC00261 were measured by qRT-PCR. After over-expression or silencing of LINC00261 and inhibition of miR-620 expression, the cells were irradiated with 4 Gy 60Coγ-ray. Clone formation assay was performed to detect the radiosensitivity of nasopharyngeal carcinoma cells. Flow cytometry was used to detect cell apoptosis. Western blot was utilized to detect the expression levels of Cleaved caspase-3 and Cleaved caspase-9 proteins. Luciferase reporter assay was adopted to analyze the targeting relationship between LINC00261 and miR-620. The changes in tumor formation were observed in tumor-bearing nude mice. Results:Compared with the radiosensitive tissues, the expression of LINC00261 was significantly down-regulated, whereas that of miR-620 was significantly up-regulated in radioresistant tissues (both P<0.05). After different doses of irradiation, the expression of LINC00261 was significantly down-regulated, whereas that of miR-620 was significantly up-regulated in 6-10B and HNE-3 cells (both P<0.05). After overexpression of LINC00261 and interference with miR-620 expression, the expression levels of Cleaved caspase-3 and Cleaved caspase-9 were significantly up-regulated (both P<0.05), the cell apoptosis rate was remarkably increased ( P<0.05) and the cell survival fraction was significantly enhanced in 6-10B and HNE-3 cells ( P<0.05). LINC00261 targetedly regulated the expression of miR-620. Overexpression of miR-620 could attenuate the radiosensitization and pro-apoptotic effects of LINC00261 overexpression on nasopharyngeal carcinoma cells. LINC00261 overexpression could significantly reduce the tumor formation weight of nasopharyngeal carcinoma in nude mice ( P<0.05). Conclusion:Overexpression of LINC00261 can increase the radiosensitivity of nasopharyngeal carcinoma cells probably by targeted regulation of miR-620 expression.

Objective:To explore the moderating effect of sense of coherence in the relationship between occupational stress and depression.Methods:From June to September in 2018, migrant workers were purposively selected from the urban (including office buildings, shopping malls, barber shops or restaurants and other service enterprises) and suburban (including microelectronics, internet, clothing processing and art design and other factories) areas of Shanghai. A total of 3 034 people were investigated and 2 573 valid questionnaires were collected. Patient health questionnaire (PHQ), sense of coherence questionnaire (SOC) and job content questionnaire (JCQ) were used to investigate the levels depression, sense of coherence and occupational stress. Hierarchical regression analysis was used to analyze the moderating effect of sense of coherence on occupational stress and depression, and SPSS PROCESS macro program and Bootstrap method were used to further explore the moderating effect of sense of coherence.Results:The age of total 2 573 migrant workers was (28.24±7.33) years old and 49.79% of them were males. The scores of depression, occupational stress and sense of coherence were 6.67±4.74, 28.45±4.38 and 62.02±10.89, respectively. The depression level was positively correlated with occupational stress ( r=0.33, P=0.007), and negatively correlated with sense of coherence ( r=-0.53, P=0.003). The hierarchy regression analysis suggested that the interaction between occupational stress and sense of coherence was associated with depression symptom (β=-0.07, P=0.001). Bootstrap analysis showed that occupational stress was not associated with depression symptom with high level of sense of sense of coherence (β=0.04, 95% CI=-0.01-0.10), while occupational stress was associated with depression symptom with low level of sense of sense of coherence (β=0.19, 95% CI=0.14-0.23). Conclusion:The high level of sense of coherence has a moderating effect on the relationship between occupational stress and depressive symptoms, while the low level of sense of coherence does not have this effect.

Objective:To explore the moderating effect of sense of coherence in the relationship between occupational stress and depression.Methods:From June to September in 2018, migrant workers were purposively selected from the urban (including office buildings, shopping malls, barber shops or restaurants and other service enterprises) and suburban (including microelectronics, internet, clothing processing and art design and other factories) areas of Shanghai. A total of 3 034 people were investigated and 2 573 valid questionnaires were collected. Patient health questionnaire (PHQ), sense of coherence questionnaire (SOC) and job content questionnaire (JCQ) were used to investigate the levels depression, sense of coherence and occupational stress. Hierarchical regression analysis was used to analyze the moderating effect of sense of coherence on occupational stress and depression, and SPSS PROCESS macro program and Bootstrap method were used to further explore the moderating effect of sense of coherence.Results:The age of total 2 573 migrant workers was (28.24±7.33) years old and 49.79% of them were males. The scores of depression, occupational stress and sense of coherence were 6.67±4.74, 28.45±4.38 and 62.02±10.89, respectively. The depression level was positively correlated with occupational stress ( r=0.33, P=0.007), and negatively correlated with sense of coherence ( r=-0.53, P=0.003). The hierarchy regression analysis suggested that the interaction between occupational stress and sense of coherence was associated with depression symptom (β=-0.07, P=0.001). Bootstrap analysis showed that occupational stress was not associated with depression symptom with high level of sense of sense of coherence (β=0.04, 95% CI=-0.01-0.10), while occupational stress was associated with depression symptom with low level of sense of sense of coherence (β=0.19, 95% CI=0.14-0.23). Conclusion:The high level of sense of coherence has a moderating effect on the relationship between occupational stress and depressive symptoms, while the low level of sense of coherence does not have this effect.

Objective:To observe the effects of community traditional Chinese medicine (TCM) health management of patients with chronic obstructive pulmonary disease (COPD).Methods:From June 2017 to June 2018, 79 patients were selected as study subjects. These patients were randomly divided into two groups. The TCM management group had 39 patients (of which 26 were male), with an average age of (70.77±5.91) years and the course of disease of (7.97±3.12) years. The control group had 40 patients (of which 25 were males), with an average age of (70.60±5.93) years and the course of disease of (7.70±3.01) years. Both groups were given conventional western medicine treatment. The TCM management group was administered TCM health management for 1 year on the basis of the conventional western medicine treatment. This management included establishing electronic archives for COPD patients, Hu Xi Tu-Na, Baduanjin, acupoint massage, acupoint plaster, and dietary guidance according to the TCM physique identification. Management and follow-up of patients was continuous. The TCM syndrome score, CAT score, number of acute exacerbations, and lung function of COPD patients were recorded before and after 1 year of treatment.Results:In the TCM management group, there were 6 cases of clinical control, with 8 and 19 cases displaying obvious and effective effects, respectively. The total effective rate was 84.61%. In the control group, there were 2 cases of clinical control, with 3 cases and 25 cases displaying obvious and effective effects, respectively. The total effective rate was 75.00%. The curative effect of the TCM syndrome in the TCM management group was better than that in the control group. In the TCM management group，the CAT score was (7.46±3.28) points and the number of acute exacerbations was (4.21±2.61) times, the forced expiratory volume (FEV 1) in the first second was (1.99±0.79) L, and the forced vital capacity (FVC) was (2.63±0.92) L. In the control group, the CAT score was (10.38±4.68), the number of acute exacerbations was (6.03±3.00), FEV 1 was (1.66±0.65) L, and FVC was (2.41±0.81) L. The CAT score and the number of acute exacerbations in the TCM management group decreased, while the number of FEV 1 increased, which was statistically significant compared to the control group. Conclusion:Community TCM health management can improve the symptoms of COPD patients at a stable stage, reduce the number of acute exacerbations, and improve lung function.