Objective To compare the efficacy of trastuzumab plus pertuzumab(HP)combined with either nab-paclitaxel plus carboplatin or docetaxel plus carboplatin as neoadjuvant therapy for HER2-positive breast cancer in real-world clinical practice.Methods Clinical data of HER2-positive breast cancer patients who received neoadjuvant therapy with either HP combined with nab-paclitaxel plus carboplatin or HP combined with docetaxel plus carboplatin and subsequently underwent surgery were retrospectively collected from 11 tertiary grade-A hospitals in Hebei Province from June 2019 to December 2021.The total pathological complete response(tpCR)rates of the two groups were compared.Results A total of 76 patients were included in the study,with 47 in the nab-paclitaxel group and 29 in the docetaxel group.The tpCR rate was significantly higher in the nab-paclitaxel group than that in the docetaxel group(72.3%vs.48.3%,χ2=4.463,P=0.035).Subgroup analysis indicated that patients older than 40 years,with cN2-3,cTNM stage Ⅲ,hormone receptor-positive status,and Ki67>30%had significantly higher tpCR rates in the nab-paclitaxel group than those in the docetaxel group(P<0.05).Conclusion In real-world clinical practice,the efficacy of HP combined with nab-paclitaxel plus carboplatin as neoadjuvant therapy for HER2-positive breast cancer is superior to that of HP combined with docetaxel plus carboplatin.

Objective To observe the effects of electroacupuncture on central inflammatory response and neurotransmitter release in rats with post stroke spasticity(PSS);To exploring the mechanism in treating PSS based on IL-6/JAK2/STAT3 signaling pathway.Methods Totally 30 male SD rats were randomly divided into sham-operation group,model group and electroacupuncture group,with 10 rats in each group.The PSS model was prepared by the method of suture and N-methyl-D-aspartic acid receptor injection into internal capsule.The rats in the electroacupuncture group were electroacupulated on the affected side of the body at"Quchi"and"Yanglingquan"for 30 min/d for consecutive 7 d.The sham-operation group and the model group were only fixed without any interventions.The Zea Longa neurological function score and the modified Ashworth muscle tension score were evaluated before and after treatment in each group;the pathological changes of the cortex on the ischemic side were observed by HE staining;the contents of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and γ-aminobutyric acid(GABA)in cortex on the ischemic side were detected by ELISA;the content of glutamate(Glu)was detected by biochemical kit;Western blot was used to detect the expressions of tyrosine kinase 2(JAK2),p-JAK2,signal transduction and transcription activating factor 3(STAT3)and p-STAT3 protein in ischemic cortex;RT-PCR was used to detect the mRNA expressions of JAK2 and STAT3 in ischemic cortex.Results Compared with the sham-operation group,neurological function score and muscle tension score significantly increased in the model group(P<0.01),with disorganized neurons in cerebral cortex,nucleus accumbens,the contents of IL-6,TNF-α and Glu significantly increased,the content of GABA significantly decreased(P<0.01),and p-JAK2,p-STAT3 proteins and JAK2 and STAT3 mRNA expression significantly increased(P<0.01,P<0.05).Compared with the model group,the neurological function score and muscle tension score of rats in the electroacupuncture group were significantly decreased(P<0.05),the degree of neuronal damage in cerebral cortex was reduced,the cell contour was clear,the content of IL-6,TNF-α and Glu were significantly decreased,and the content of GABA significantly increased(P<0.05,P<0.01),p-JAK2,p-STAT3 protein and JAK2,STAT3 mRNA expression significantly decreased(P<0.01).Conclusion Electroacupuncture may alleviate central inflammatory response and improve limb spasticity of PSS model rats by inhibiting the IL-6/JAK2/STAT3 signaling pathway.

Objective To observe the effects of electroacupuncture on post-stroke spasticity(PSS)rats and the relationship between microglia polarization-mediated neuroinflammation and neurotransmitter glutamate(Glu)and γ-aminobutyric acid(GABA)in cerebral cortex;To investigate the possible mechanism of electroacupuncture to relieve PSS.Methods Male SD rats were randomly divided into sham-operation group,model group and electroacupuncture group,with 10 rats in each group.A rat model of PSS was prepared using suture method combined with internal capsule injection of NMDA receptor.The electroacupuncture group selected"Quchi"and"Yanglingquan"electroacupuncture for 30 minutes per day,for 7 days,the model group and the sham-operation group were fixed at the same time without intervention.Zea Longa neurological function score and modified Ashworth muscular tone score were evaluated,and electrophysiology was tested;kits were used to GABA,Glu,tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)content in ischemic cortex;Western blot was used to detect the expression of GABRA1 and GAD67 protein in ischemic cortex;The co-expression of ionized calcium-binding protein 1(Iba-1),inducible nitric oxide synthase(iNOS)and Arg-1 were detected by immunofluorescence staining.Results Compared with the sham-operation group,the neurological function score and muscle tone score of the model group rats significantly increased(P<0.01),and muscle tone significantly increased(P<0.01);the contents of GABA and IL-10 in ischemic cortex significantly decreased(P<0.01),and the contents of TNF-α and Glu significantly increased(P<0.01),Glu/GABA ratio increased(P<0.01),GABRA1 and GAD67 protein expression significantly decreased(P<0.01),the co-expression of Iba-1 and iNOS significantly increased(P<0.01),while the co-expression of Iba-1 and Arg-1 was significantly decreased(P<0.01).Compared with the model group,the nerve function score and muscle tone score of the electroacupuncture group rats were significantly reduced(P<0.05),and muscle tone was significantly reduced(P<0.01);the contents of GABA and IL-10 in ischemic cortex significantly increased(P<0.01),and the contents of TNF-α and Glu significantly decreased(P<0.01),Glu/GABA ratio decreased(P<0.01),the protein expressions of GABRA1 and GAD67 significantly increased(P<0.01),the co-expression of Iba-1 and iNOS significantly decreased(P<0.01),while the co-expression of Iba-1 and Arg-1 significantly increased(P<0.05).Conclusion Electroacupuncture can effectively alleviate PSS,and its mechanism of action may be related to electroacupuncture regulating microglia polarization and reduing neuroinflammation.

The development mode of public hospitals has shifted from scale expansion to improving quality and efficien-cy,and specialized operation and management is an important means to improve the performance of surgical departments.Howev-er,at present,there is a gap in the performance appraisal of specialized operators,requiring the hospital to formulate a specific and accurate performance appraisal plan for the management department.Taking hospital Z as an example,based on post value(IPE),this paper analyzes the idea of its performance appraisal plan in detail,and analyzes the specific application of its per-formance allocation with specialized operation assistant as an example.Based on IPE,the responsibility,rank and performance distribution coefficient of hospital management positions can effectively solve the difficulties that the total work and quality of hos-pital management departments are difficult to quantify,and also provide some reference for the formulation of performance apprais-al plan of specialized operation staff in public hospitals.

Objective To investigate the predictive value of preoperative blood inflammatory markers for the recurrence risk in patients with basal cell carcinoma(BCC).Methods A total of 225 patients with BCC were divided into the high-risk recurrence group(155 cases)and the low-risk recurrence group(70 cases).General information and preoperative hematological indicators were collected in the two groups of patients.The neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),systemic inflammation marker(SIM)and platelet-to-lymphocyte ratio(PLR)were calculated.Receiver operating characteristic(ROC)curves were used to determine the predictive value of hematological markers with statistically significant differences between the two groups for BCC recurrence and to establish optimal cutoff values.Univariate and multivariate Logistic regression analyses were conducted to identify factors influencing BCC recurrence.A multivariate Logistic regression model was established to predict the recurrence risk of BCC.Area under the curve(AUC)and the Hosmer-Lemeshow test were used to evaluate the prediction efficiency and goodness-of-fit of the model.Results ROC analysis identified that optimal cutoff values for LMR and SIM were 5.12 and 0.86,respectively.Univariate Logistic regression analysis showed that LMR,SIM,ulceration at the primary tumor site,UV exposure and tumor maximum diameter were factors influencing BCC recurrence.Multivariate Logistic regression revealed that SIM≥0.86,tumor maximum diameter≥2.0 cm and UV exposure were risk factors for BCC recurrence,while LMR≥5.12 had a protective effect.The Logistic prediction model for BCC recurrence risk was Logit(P)=-1.598-1.517×LMR+1.323×SIM+2.406×UV exposure+3.465×tumor maximum diameter,with good model fit(P=0.725)and an AUC of 0.869(95%CI:0.822-0.917)for predicting BCC recurrence risk.Conclusion Monitoring preoperative LMR and SIM levels can assist in assessing the risk of recurrence in BCC patients and provide important guidance for clinical decision-making.

In order to understand the prevalence and genetic variation of H9N2 subtype avian influ-enza virus in Shandong,a total 492 tracheal and lung tissue samples collected from chicken farms with respiratory symptoms in partial areas in Shandong were detected by H9 subtype AIV real-time RT-PCR,and the positive samples were inoculated with chicken embryos for two generations.Whole genome sequences of the positive strains by applying Illumina Miaseq platform,and genetic evolution and mutation at positions associating with viral pathogenicity and transmissibility were analyzed.The results showed that there were 72 samples were positive for H9 subtype AIV among the 492 samples,with a positive rate of 14.63％.Thirty-four strains of H9 subtype AIV were ob-tained from the positive samples after passing through chicken embryo,meanwhile,the 34 isolates were all H9N2 subtype AIV by whole genome sequencing analysis.By analyzing the evolutionary tree of HA and NA genes,HA and NA genes of the 34 H9N2 AIV strains belonged to Y280-like branch and F/98-like branch,respectively.Meanwhile,based on above branches,there were obvious time node subbranch,which one was"isolates before 2013",another one was"isolates after 2013".The HA cleavage sites of thirty-four H9N2 strains were all 325PSRSSR↓GLF333,which met the se-quence characteristics of the lowly pathogenic avian influenza virus,and the HA receptor binding site 226 amino acid was leucine,which had the characteristics of blinding to a-2,6 mammalian sialic acid receptors.Among the internal amino acid sites that are key to mammalian adaptation,all strains had an I368V mutation in the PB1 gene that enhanced viral transmissibility in mammals and the PB2 genes of some strains were mutated to enhance the mammalian adaptation of I292 V and A588 V.The above results illustrated that the H9N2 subtype AIV gene segments in Shandong have different degrees of recombination and gene variation,so it is necessary to strengthen the monito-ring of virus variation.

This study was performed to investigate the features of HBV-specific CD8+T cell reactivity in patients with chronic hepatitis B(CHB),HBV-induced liver cirrhosis(LC)or hepatocellular carcinoma(HCC).A total of 124 CHB patients,36 LC patients,and 114 HCC patients were enrolled in this study.The reactive HBV-specific CD8+T cells in peripheral blood were enumerated using an innovative ELISPOT system.In addition,19 CHB patients and 20 HCC patients were longitudinally monitored with an interval of 3-5 months.Data showed that the numbers of reactive HBV-specific CD8+T cells in CHB group were not significantly different from that in LC group,but obviously lower than that in HCC group(P=0.009 9),especially HBsAg-,HBpol-and HBe/cAg-specific CD8+T cells.In CHB group,the patients with normal ALT level,AST level,or low HBV-DNA load showed significantly more reactive HBV-specific CD8+T cells than the patients with abnormal ALT level,abnormal AST level,or high HBV-DNA load.Furthermore,the duration of NUCs treatment had an impact on the HBV-specific CD8+T cell reactivity in CHB patients,while different NUCs at the same treatment duration did not bring different reactivity of HBV-specific T cells.In LC group,the HBeAg-positive patients presented much more reactive HBV-specific CD8+T cells than the HBeAg-negative patients did.In HCC group,the numbers of reactive HBV-specific CD8+T cells in the patients with normal AFP level or normal DCP level were significantly higher than that in the patients with abnormal AFP level or abnormal DCP level.Longitudinal monitoring results showed that HBV-specific CD8+T cell reactivity displayed a slow upward trend in the CHB patients undergoing NUCs treatment,and an obvious increasing in the HCC patients undergoing combined treatment of targeted drugs and immunotherapy.Taken together,the features of HBV-specific CD8+T cell reactivity are distinct among the CHB,LC and HCC patients,and are influenced by virological indicators,tumor markers and treatment regimens.Therefore,more attention should be paid to the changes of HBV-specific CD8+T cell reactivity during clinical treatment.

Objective:To investigate the characteristics of HBV-specific T cell reactivity among pregnant, postpartum and non-pregnant women at childbearing age with chronic HBV infection.Methods:A total of 100 patients with chronic HBV infection were enrolled in this study, including 43 pregnant women (pregnant group), 26 patients giving birth within six months (postpartum group), and 31 non-pregnant patients at childbearing age (non-pregnant group). The functional HBV-specific T cells in peripheral blood were detected by ELISPOT. Clinical data as well as the results of virological and serological tests of HBV were collected for stratified analysis.Results:There was no significant difference in the number of functional HBV-specific T cells between the pregnant group and the postpartum group, but the number was significantly lesser in the pregnant group than in the non-pregnant group ( P<0.05). Furthermore, the number of functional HBV-specific T cells was significantly higher in the nucleoside analogues (NUCs)-treated pregnant women than in the NUCs-untreated pregnant women ( P<0.05). Among the patients without NUCs treatment, there were no significant differences in the numbers of hepatitis B envelope antigen/hepatitis B core antigen (HBeAg/HBcAg)-specific T cells between the pregnant group and the postpartum group, but the numbers were lower in the pregnant group than in the non-pregnant group ( P<0.05). Among the NUCs-treated patients, there was no significant difference in the number of functional HBV-specific T cells between the pregnant group and the non-pregnant group, and the numbers in the two groups were significantly higher than that in the postpartum group (both P<0.05). Additionally, receiver operating characteristic (ROC) curve indicated that the number of functional HBV-specific T cells in combination with HBV DNA load [area under the curve (AUC)=0.807] or hepatitis B surface antigen (HBsAg) levels (AUC=0.916) had a good predictive performance for hepatitis progression during pregnancy. Conclusions:Pregnancy can reduce HBV-specific T cell reactivity in women with chronic HBV infection, but NUCs treatment may improve the function of specific T cells. Routine monitoring of HBV-specific T cells during pregnancy and postpartum period can provide valuable guidance for the evaluation of immune function and treatments.

BACKGROUND: There is little published evidence about the role of non-alcoholic fatty liver disease (NAFLD) in the progression from prehypertension to hypertension. This study was conducted to investigate the association of NAFLD and its severity with the risk of hypertension developing from prehypertension. METHODS: The study cohort comprised 25,433 participants from the Kailuan study with prehypertension at baseline; those with excessive alcohol consumption and other liver diseases were excluded. NAFLD was diagnosed by ultrasonography and stratified as mild, moderate, or severe. Univariable and multivariable Cox proportional hazard regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension according to the presence and 3 categories of severity of NAFLD. RESULTS: During a median of 12.6 years of follow-up, 10,638 participants progressed to hypertension from prehypertension. After adjusting for multiple risk factors, patients with prehypertension and NAFLD had a 15% higher risk of incident hypertension than those without NAFLD (HR = 1.15, 95% CI 1.10-1.21). Moreover, the severity of NAFLD was associated with the incidence of hypertension, which was higher in patients with more severe NAFLD (HR = 1.15 [95% CI 1.10-1.21] in the mild NAFLD group; HR = 1.15 [95% CI 1.07-1.24] in the moderate NAFLD group; and HR = 1.20 [95% CI 1.03-1.41] in the severe NAFLD group). Subgroup analysis indicated that age and baseline systolic blood pressure may modify this association. CONCLUSIONS NAFLD is an independent risk factor for hypertension in patients with prehypertension. The risk of incident hypertension increases with the severity of NAFLD.
Humans ; Non-alcoholic Fatty Liver Disease/complications* ; Prehypertension/diagnosis* ; Risk Factors ; Hypertension ; Incidence

Objective To investigate the clinical efficacy of endoscopic assisted minimally invasive trans foraminal lumbar interbody fusion(MIS-TLIF)and traditional open TLIF in the treatment of senile degenerative spondylolisthesis.Methods From January 2020 to March 2021,100 elderly patients with degenerative spondylolisthesis were selected and divided into MIS-TLIF group and TLIF group according to the surgical method,with 50 cases in each group.The preoperative and postoperative VAS,Japanese Orthopedic Association score(JO A)and Oswestry disability index(ODI),and the rate of interbody fusion and the incidence of complications were compared and analyzed between the two groups.Results In MIS-TLIF group,the operative time,intraoperative blood loss,incision length,postoperative drainage volume and hospital stay were(167.5±54.2)minutes,(173.8±47.1)ml,(3.5±0.7)cm,(69.6±16.3)ml,and(8.3±2.7)days,respectively.In the TLIF group,it was(136.3±38.9)minutes,(281.0±50.3)ml,(10.0±2.1)cm,(148.4±28.2)ml,and(11.2±3.1)days,respectively.The difference between the two groups was statistically significant(P＜0.05).The VAS,JO A and ODI scores of MIS-TLIF group were(2.17±0.62)points,(21.72±3.14)points and(13.22 ±2.43)points,respectively.The results in TLIF group were(3.24±1.06)points,(17.06±2.85)points and(16.83±2.87)points,respectively,and there was statistical significance between the two groups(P＜0.05).There was no significant difference in the rate of interbody fusion between the two groups at 12 months after operation(P＞0.05).The incidence of postoperative complications in MIS-TLIF group(8.00％)was significantly lower than that in TLIF group(24.00％,P＜0.05).Conclusion MIS-TLIF assisted by endoscope has the advantages of less trauma,faster recovery and less postoperative complications,and the short-term curative effect is more satisfactory than TLIF.