Objective:To develop a nomogram based on the monocyte-to-lymphocyte ratio (MLR) for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods:This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the Emergency and Cardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024. Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events: low MLR and high MLR group. MLR was defined as the ratio of monocytes to lymphocytes. Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression (including aortic dissection and penetrating aortic ulcers) within 30 days. The receiver operating characteristic (ROC) curve identified the optimal MLR cut-off value. Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days, based on which nomogram models were constructed: the clinical characteristics model and the clinical characteristics-MLR model. The DeLong test was used to evaluate the diagnostic performance of different risk models. The additional predictive value of MLR was assessed using the net reclassification index (NRI) and integrated discrimination improvement (IDI).Results:A total of 332 patients were included, of whom 217 were male (65.4%), with an average age of (64.3±9.4) years. A total of 107 aortic-related adverse events occurred during the 30-day follow-up period. The optimal cut-off value for MLR was 0.529. There were 189 cases in the low MLR group (MLR<0.529) and 143 cases in the high MLR group (MLR≥0.529). The rate of aortic-related adverse events was higher in the high MLR group compared to the low MLR group (44.1% (63/143) vs. 23.3% (44/189), P<0.001), mainly due to a higher rate of progression to aortic dissection (9.8% (14/143) vs. 1.1% (2/189), P<0.001) and penetrating aortic ulcers (31.5% (45/143) vs. 20.6% (39/189), P=0.025). Multivariate analysis identified diabetes ( OR=0.25, 95% CI 0.08-0.78, P=0.017), anemia ( OR=3.45, 95% CI 1.28-9.27, P=0.014), maximum descending aorta diameter ( OR=1.08, 95% CI 1.02-1.15, P=0.007), ulcer-like projections ( OR=4.04, 95% CI 2.26-7.24, P<0.001), and MLR ( OR=6.61, 95% CI 2.50-17.46, P<0.001) as independent predictors of aortic-related adverse events during the 30-day follow-up period. The clinical characteristics model includes diabetes, anemia, ulcer-like projections and maximum diameter of the descending aorta, and the clinical characteristics-MLR model includes the above clinical characteristics and MLR. The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone (0.784 (95% CI 0.736-0.841) vs. 0.742 (95% CI 0.691-0.788), P=0.031). The continuous NRI was 0.461 (95% CI 0.237-0.685, P<0.001) and the IDI was 0.077 (95% CI 0.043-0.112, P<0.001), indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy. Conclusion:The integration of MLR with other clinical characteristics improves the early identification of high-risk patients with acute uncomplicated type B aortic intramural hematoma, optimizing clinical decisions and improving patient outcomes.

Objective:To develop a nomogram based on the monocyte-to-lymphocyte ratio (MLR) for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods:This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the Emergency and Cardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024. Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events: low MLR and high MLR group. MLR was defined as the ratio of monocytes to lymphocytes. Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression (including aortic dissection and penetrating aortic ulcers) within 30 days. The receiver operating characteristic (ROC) curve identified the optimal MLR cut-off value. Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days, based on which nomogram models were constructed: the clinical characteristics model and the clinical characteristics-MLR model. The DeLong test was used to evaluate the diagnostic performance of different risk models. The additional predictive value of MLR was assessed using the net reclassification index (NRI) and integrated discrimination improvement (IDI).Results:A total of 332 patients were included, of whom 217 were male (65.4%), with an average age of (64.3±9.4) years. A total of 107 aortic-related adverse events occurred during the 30-day follow-up period. The optimal cut-off value for MLR was 0.529. There were 189 cases in the low MLR group (MLR<0.529) and 143 cases in the high MLR group (MLR≥0.529). The rate of aortic-related adverse events was higher in the high MLR group compared to the low MLR group (44.1% (63/143) vs. 23.3% (44/189), P<0.001), mainly due to a higher rate of progression to aortic dissection (9.8% (14/143) vs. 1.1% (2/189), P<0.001) and penetrating aortic ulcers (31.5% (45/143) vs. 20.6% (39/189), P=0.025). Multivariate analysis identified diabetes ( OR=0.25, 95% CI 0.08-0.78, P=0.017), anemia ( OR=3.45, 95% CI 1.28-9.27, P=0.014), maximum descending aorta diameter ( OR=1.08, 95% CI 1.02-1.15, P=0.007), ulcer-like projections ( OR=4.04, 95% CI 2.26-7.24, P<0.001), and MLR ( OR=6.61, 95% CI 2.50-17.46, P<0.001) as independent predictors of aortic-related adverse events during the 30-day follow-up period. The clinical characteristics model includes diabetes, anemia, ulcer-like projections and maximum diameter of the descending aorta, and the clinical characteristics-MLR model includes the above clinical characteristics and MLR. The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone (0.784 (95% CI 0.736-0.841) vs. 0.742 (95% CI 0.691-0.788), P=0.031). The continuous NRI was 0.461 (95% CI 0.237-0.685, P<0.001) and the IDI was 0.077 (95% CI 0.043-0.112, P<0.001), indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy. Conclusion:The integration of MLR with other clinical characteristics improves the early identification of high-risk patients with acute uncomplicated type B aortic intramural hematoma, optimizing clinical decisions and improving patient outcomes.

Objective To investigate the role of human umbilical cord mesenchymal stem cell-derived extracellular vesicle (hUC-MSC-EV) in the regeneration of fibrotic liver. Methods C57BL/6 mice were randomly divided into the 70% normal liver resection group (Oil+PHx group), 70% liver fibrosis resection group (CCl₄+PHx group) and 70% liver fibrosis resection+mesenchymal stem cell-derived extracellular vesicle (MSC-EV) treatment group (CCl₄+PHx+MSC-EV group), with 8 mice in each group. LX-2 cell lines were assigned into the phosphate buffer solution (PBS) group, transforming growth factor (TGF)-β group and TGF-β+MSC-EV group. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) in mice after partial liver resection were detected in each group. The expression levels of liver fibrosis and proliferation-related parameters were analyzed in each group. The messenger RNA (mRNA) expression levels of epidermal growth factor (EGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) in LX-2 cells were detected in each group, and their effects on HGF expression in mouse liver were observed. Results Compared with the Oil+PHx group, the serum levels of AST, ALT and LDH were up-regulated, and the degree of fibrosis was more severe, the positive area of Sirius red and α-smooth muscle actin (α-SMA) staining was larger, and the expression level of α-SMA protein was up-regulated in the CCl₄+PHx group. Compared with the CCl₄+PHx group, the serum levels of AST, ALT and LDH were decreased, the degree of fibrosis was slighter, the positive area of Sirius red and α-SMA staining was decreased, and the expression level of α-SMA protein was down-regulated in the CCl₄+PHx+MSC-EV group, and the differences were statistically significant (all P < 0.05). Compared with the Oil+PHx group, the protein expression levels of Ki67 and proliferating cell nuclear antigen (PCNA) were lower in the CCl₄+PHx group. Compared with the CCl₄+PHx group, the protein expression levels of Ki67 and PCNA were increased in the CCl₄+PHx+MSC-EV group, and the differences were statistically significant (all P < 0.05). Compared with the PBS group, the expression level of CollagenⅠ mRNA in LX-2 cells was increased, the expression level of α-SMA protein was up-regulated and the expression level of HGF protein was decreased in the TGF-β group. Compared with the TGF-β group, the expression level of CollagenⅠ mRNA in LX-2 cells was decreased, the expression levels of HGF mRNA and protein were increased, and the expression level of α-SMA protein was decreased in the TGF-β+MSC-EV group, the differences were statistically significant (all P < 0.05). The expression level of HGF protein in the CCl₄+PHx group was lower than that in the Oil+PHx group, whereas the difference was not statistically significant (P > 0.05). The expression level of HGF protein in the CCl₄+PHx+MSC-EV group was higher than that in the CCl₄+PHx group, and the difference was statistically significant (P < 0.05). Conclusions The regenerative capacity of fibrotic liver is weaker than that of normal liver. hUC-MSC-EV may alleviate liver fibrosis and improve liver regeneration by promoting HGF secretion from actived hepatic stellate cells and effectively enhancing the regenerative capacity of fibrotic liver.

OBJECTIVE：To study the effects of augmented renal clearance （ARC）on blood trough concentration of patients receiving high-dose regimen of teicoplanin. METHODS ：Patients who received high-dose regimen of teicoplanin in the ICU were prospectively collected from the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital during Jul. 2018-Jun. 2020. They were divided into ARC group and normal renal function group according to corrected creatinine clearance. The dosage regimen of teicoplanin in the two groups were loading dose of 600 mg，q12 h×3 doses，maintenance dose of 6-10 mg/kg，qd，and the dosage was adjusted in combination with creatinine clearance rate and blood trough concentration. The trough concentration of blood samples which were collected 30 min before the 4th and 8th-10th dosage of teicoplanin were determined by HPLC. Trough concentration ，clinical efficacy ，Gram-positive bacterial clearance rate and the occurrence of ADR were compared between 2 groups. RESULTS ：A total of 56 patients were included and divided into ARC group （18 cases）and normal renal function group （38 cases）. ARC group had younger age （P＜0.001）and lower serum albumin level （P＝0.025）than normal renal function group. The trough concentrations before administration of the 4th and 8th-10th dosage in ARC group were lower than normal renal function group （P＝0.034；P＝0.035）. The trough concentrations in the ARC group and normal renal function group before 8th-10th dosage were all higher than 30 min before the 4th dosage （P＝0.003；P＜0.001）. The clinical efficacy rate and the clearance rate of Gram-positive bacteria in ARC group were 77.8％ and 76.2％，which were lower than those of the normal renal function group ，but there was no statistical difference （P＝0.195；P＝0.223）. There was no liver function damage ，hemocytopenia and allergic reaction in both groups ，but in the normal renal function group ，the causal relationship between acute renal damage and teicoplanin was assessed as “very likely ”in one patient. CONCLUSIONS ：ARC patients are younger ，most of them have hypoproteinemia，and the blood trough concentrations of teicoplanin in high-dose regimen are significantly lower than those of normal renal function patients. For critical ill ARC patients ，it is advisable to increase the loading dose of teicoplanin to make the trough concentration reach the target concentration range quickly.

Objective:To study the patterns of tocilizumab (TCZ) use, its efficacy and safety in patients with rheumatoid arthritis (RA) in routine clinical practice.Methods:A total of 407 patients with RA were enrolled from 23 centers and treated with TCZ within 8 weeks prior to the enrollment visit, and were followed for 6-month. The patterns of TCZ treatment at 6 months, the effectiveness and safety outcomes were recorded. Statistical analysis was performed using SAS version 9.4.Results:A total of 396 patients were included for analysis, in which 330 (83.3%) patients received TCZ combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 16.7%(66/396) received TCZ monotherapy. At baseline, TCZ was initiated in 56.6%(224/396) and 9.6%(38/396) of patients after failure of DMARDs and other biological agents (bDMARDs) respectively. During the 6-month follow-up period, the mean frequency of TCZ administration was (3.7±1.6), the mean TCZ dosage was (7.4±1.2) mg/kg, and the mean interval between doses was (40±13) days. 120(25.8%) patients were on TCZ treatment at the end of the study. Improvements in disease activity, systemic symptoms and patient report outcomes were observed at the end of the study. 22.7%(90/396) patients experienced at least one treatment related adverse event, and 8 patients experienced at least one serious adverse event.Conclusion:This study demonstrates that TCZ treatment is effective in patients with RA when being treated for 6 months with an acceptable safety profile. The duration of TCZ treatment needs to be extended.

Objective The number of children diagnosed with autism spectrum disorder (ASD)has increased dramatically in the past years.Parents of children with ASD usually experience a variety of chronic and acute stressors that may decrease marital satisfaction and family functioning.The aim was to explore the characteristics of parental per-sonality,mood disorders and family functions of the Children with ASD and to explore the relevance factors in order to draw out methods to improve parental family functions.Methods A cross -sectional survey was conducted and 593 outpatients with ASD diagnosed in Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine form January 201 0 to January 201 4 were straight into the group,their parents were tested by Family Assessment Device (FAD),Zung Self -Rating Depression Scale(SDS),Zung Self -Rating Anxiety Scale(SAS)and Eysenck Personality Questionnaire(EPQ).SPSS 1 7.0 software was adopted to establish the database and statistical analysis.Results Ac-cording to FAD,parents of children with ASD had lower scores in problem solving[(2.1 0 ±0.37)scores]and roles [(2.09 ±0.27)scores](t =-6.669,P =0.000;t =-1 8.707,P =0.000)than the standard scores,while other di-mensions score were significantly higher than the standard scores in communicdtion[(2.25 ±0.35)scores],emotional reaction[(2.38 ±0.40)scores],emotional involvement[(2.36 ±0.37)scores],behavioral control[(2.31 ±0.27) scores]and general function[(2.1 2 ±0.38)scores],there were significant differences(t =3.1 35,1 1 .1 1 5,1 6.997, 37.1 1 6,8.064;P =0.002,0.000,0.000,0.000,0.000).For EPQ of parents,mother had obviously higher scores than father in psychoticism scale[(53.68 ±1 .36)scores vs (52.65 ±1 .1 7)scores,t =-1 3.841 ,P =0.000],and signifi-cantly lower scores in Lie scale[(52.27 ±0.79)scores vs (52.1 7 ±0.75)scores,t =2.449,P =0.01 4].Compared to fathers,mothers were coded as higher depression and anxiety scores(t =-6.276,-6.440,all P =0.000)and higher prevalence rate(χ2 =1 5.893,27.592,all P =0.000),which were statistically significant.According to the asso-ciation study of FAD and the others(especially in mood of parents),it was found that several dimensions showed obvious correlation.Conclusions Parents of children with ASD have family function damaged badly,except for prob-lem solving and roles.The parents showed different personality traits and mood disorders,particularly mothers′mood disorder problem was prominent.Parental family functioning were closely related to their personality traits and emotional disorders in various dimensionalities,which was worthy of attention.

Objective To investigate adherence and the influence factors among patients who are on antiretrovirus therapy (ART) of 3 provinces in China. Methods This study selected 18?year?old and older AIDS patients as the survey objects who initiated anti?retrovirus therapy between April and September of 2014 and kept on the treatment for one year in Yunnan,Sichuan,and Hu'nan province. Information of demography, treatment and social support was collected by questionnaires. Adopt SSRS questionnaire to calculate the information of objective support, subjective support and utilization of social support.χ2 test and logistic regression were performed to examine relationships between factors and adherence. Results A total of 386 patients with medication were investigated. Among them, there were 365 (94.6%) cases who were compliant to the ART, and 357 (92.5%) cases can take their pills on time, and 29 (7.5%) cases take their medication in excess of the prescribed time more than two hours. Social support score was 27.2 ± 7.3, including objective support score (5.6 ± 2.7), subjective support score (16.1 ± 4.8), and utilization of social support (5.5 ± 1.9). Multivariate logistic regression analysis revealed that adherence was significantly associated with the correct cognition of medication (OR (95%CI):3.24 (1.17-9.00)), the self?awareness of the drug regimen was not complexity (OR (95%CI): 9.34 (3.27-26.68)), taking medication 1 time a day (OR (95%CI): 4.00 (1.35-11.84)), and the batter utilization of social support (OR (95%CI): 1.49 (1.06-2.01)). Married/cohabiting or farmers tend to be nonadherenced, while the OR (95%CI) was 0.24 (0.08-0.67) and 0.23 (0.08-0.69), respectively. Conclusion The patients among these provinces were compliant to the ART, and most of them can take their pills on time. The social support score of these patients was lower than normal person. Participants who have correct cognition of medication, thinking their drug regimen was not complexity; Taking medication 1 time a day or have high level of utilization of social support showed a significantly higher level of self?reported adherence.

Objective To investigate adherence and the influence factors among patients who are on antiretrovirus therapy (ART) of 3 provinces in China. Methods This study selected 18?year?old and older AIDS patients as the survey objects who initiated anti?retrovirus therapy between April and September of 2014 and kept on the treatment for one year in Yunnan,Sichuan,and Hu'nan province. Information of demography, treatment and social support was collected by questionnaires. Adopt SSRS questionnaire to calculate the information of objective support, subjective support and utilization of social support.χ2 test and logistic regression were performed to examine relationships between factors and adherence. Results A total of 386 patients with medication were investigated. Among them, there were 365 (94.6%) cases who were compliant to the ART, and 357 (92.5%) cases can take their pills on time, and 29 (7.5%) cases take their medication in excess of the prescribed time more than two hours. Social support score was 27.2 ± 7.3, including objective support score (5.6 ± 2.7), subjective support score (16.1 ± 4.8), and utilization of social support (5.5 ± 1.9). Multivariate logistic regression analysis revealed that adherence was significantly associated with the correct cognition of medication (OR (95%CI):3.24 (1.17-9.00)), the self?awareness of the drug regimen was not complexity (OR (95%CI): 9.34 (3.27-26.68)), taking medication 1 time a day (OR (95%CI): 4.00 (1.35-11.84)), and the batter utilization of social support (OR (95%CI): 1.49 (1.06-2.01)). Married/cohabiting or farmers tend to be nonadherenced, while the OR (95%CI) was 0.24 (0.08-0.67) and 0.23 (0.08-0.69), respectively. Conclusion The patients among these provinces were compliant to the ART, and most of them can take their pills on time. The social support score of these patients was lower than normal person. Participants who have correct cognition of medication, thinking their drug regimen was not complexity; Taking medication 1 time a day or have high level of utilization of social support showed a significantly higher level of self?reported adherence.

Objective To explore the features of early onset schizophrenia spectrum disorder (EOS),and also the difference between childhood onset schizophrenia spectrum disorder (COS) and adolescent onset schizophrenia spectrum disorder (AOS).Methods A retrospective analysis on demographic feature,pre-morbid situation,clinical characteristics and curative effect,was conducted based on the history review of EOS patients in children and adolescent department from 2006 to 2012,the differences between COS subgroup (≤13 ys,n=113) and AOS subgroup (＞13 ys,n=192),were compared by t-test and Chi-square.Correlation analysis and logistic regression were used to explore the risk factor for curative effect of EOS.Result 30.8％ (94/305) of EOS children had a history of psychosis in their family members; the most common symptoms in EOS included hallucination,delusion,and formal thought disorder in order; the rate of significantly improved in first episode psychosis in in-patient clinic was 71.3％ (216/303).Abnormal development history was more common in COS (21.2％,24/113) than it in AOS (11.5％,22/192;x2=5.31,P=0.030),while the symptom of delusion (61.9％ (70/113) vs.(142/192) ; x2=4.84,P=0.029)and the rate of significantly improved(64.3％(72/112) vs.75.4％(144/191),x2=6.63,P=0.034)were significantly higher in AOS than it in COS.When significantly improved was designated as 1 and without significant improvement was designated as 0,social withdrawal and comorbidity with mental retardation or Asperger syndrome,fit the logistic regression equation very well (x2=31.63,P＜0.01),were risk factors for curative effect of EOS.Conclusion The curative effect of COS is probably not as good as AOS.Much more abnormal development history is in COS,which may suggest a more significant biological basis in COS.Social withdrawal and comorbidity with neurodevelopmental disorder may be the risk factors in prognosis of EOS.

Objective To explore the features of early onset schizophrenia spectrum disorder (EOS),and also the difference between childhood onset schizophrenia spectrum disorder (COS) and adolescent onset schizophrenia spectrum disorder (AOS).Methods A retrospective analysis on demographic feature,pre-morbid situation,clinical characteristics and curative effect,was conducted based on the history review of EOS patients in children and adolescent department from 2006 to 2012,the differences between COS subgroup (≤13 ys,n=113) and AOS subgroup (＞13 ys,n=192),were compared by t-test and Chi-square.Correlation analysis and logistic regression were used to explore the risk factor for curative effect of EOS.Result 30.8％ (94/305) of EOS children had a history of psychosis in their family members; the most common symptoms in EOS included hallucination,delusion,and formal thought disorder in order; the rate of significantly improved in first episode psychosis in in-patient clinic was 71.3％ (216/303).Abnormal development history was more common in COS (21.2％,24/113) than it in AOS (11.5％,22/192;x2=5.31,P=0.030),while the symptom of delusion (61.9％ (70/113) vs.(142/192) ; x2=4.84,P=0.029)and the rate of significantly improved(64.3％(72/112) vs.75.4％(144/191),x2=6.63,P=0.034)were significantly higher in AOS than it in COS.When significantly improved was designated as 1 and without significant improvement was designated as 0,social withdrawal and comorbidity with mental retardation or Asperger syndrome,fit the logistic regression equation very well (x2=31.63,P＜0.01),were risk factors for curative effect of EOS.Conclusion The curative effect of COS is probably not as good as AOS.Much more abnormal development history is in COS,which may suggest a more significant biological basis in COS.Social withdrawal and comorbidity with neurodevelopmental disorder may be the risk factors in prognosis of EOS.