Exosomes are nanoscale particles secreted by various cells,including immune,stem,and tumor cells.They are enriched with bio-active substances that transport tumor information,mediate intercellular communication,and regulate multiple physiological processes and tumor microenvironment(TME)remodeling.Exosomes secreted by different tumor cell types exhibit cell-specific characteristics,contain various factors involved in immune regulation,and can interact with all types of immune cells.Cancer immunoediting is a process in which the immune system can both constrain and promote tumor development,involving three phases:elimination,equilibrium,and escape.Tu-mor-derived exosomes play diverse roles during these stages,both promoting anti-tumor immunity and inhibiting the anti-tumor activity of immune cells.Collectively,understanding the immunoediting role of exhausted T cells(TEXs)in regulating the immune microenvironment in lung cancer provides novel insights into antitumor therapy.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

OBJECTIVE: To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. METHODS: Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. RESULTS: Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. CONCLUSION Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.
Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Tibia/surgery* ; Osteotomy/methods* ; Rickets ; External Fixators ; Retrospective Studies ; Treatment Outcome

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.

Objective:To analyze the monitoring results of iodine deficiency disorders among residents in Rizhao City, Shandong Province, from 2016 to 2018.Methods:Information of monitoring data on iodine deficiency disorders of residents of Rizhao City, Shandong Province from 2016 to 2018 was collected from the Center for Disease Control and Prevention of Rizhao City, Shandong Province. The analysis carried out included iodine content of drinking water for residents of Rizhao City in 2017; iodine contents of salt in the home of 8 - 10 years of children, pregnant women; urine iodine levels of 8 - 10 years of children, pregnant women; and thyroid volume of 8 - 10 years of children from 2016 to 2018.Results:A total of 431 drinking water samples were collected in Rizhao City in 2017, the median of iodine in water was 4.8 μg/L. In 2016 - 2018, the rate of non-iodized edible salt in the homes of children and pregnant women in Rizhao City were 11.09% (153/1 380), 19.07% (302/1 584) and 6.92% (90/1 301); the consumption rate of qualified iodized salt were 80.94% (1 117/1 380), 65.03% (1 030/1 584) and 84.63% (1 101/1 301), respectively. Of these, the highest rate of non-iodized edible salt was in 2017 (χ 2 = 75.38, P < 0.05), and with the lowest consumption rate of qualified iodized salt (χ 2 = 56.52, P < 0.05). Totally 829, 891 and 881 urine samples were tested for 8 - 10 years of children, and the medians of urine iodine were 195.8, 243.0 and 164.8 μg/L, respectively. Totally 396, 381 and 420 urine samples were tested for pregnant women, and the medians of urine iodine were 161.5, 148.3 and 105.2 μg/L, respectively. The rates of goiter in 8 - 10 years of children were 1.50% (13/866), 0.89% (8/901) and 1.25% (11/881), respectively, and the difference between years was not statistically significant (χ 2 = 1.41, P > 0.05). Conclusions:Rizhao City is an area of environmental iodine deficiency, local residents iodine nutrition in general is at an appropriate level. However, pregnant women show iodine deficiency in recent years, which will be the focus of scientific iodine supplementation measures.

Objective To study the superiority of severe multiple trauma treatment model based on damage control strategy. Methods In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. Results A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25％. Conclusions The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma.

Objective To assess the efficacy and safety of tacrolimus combined with prednisone for treat-ment of refractory idiopathic membranous nephropathy(IMN)patients whose serum anti-phospholipase A2receptor (PLA2R)antibody titers were persistent high. Methods An open prospective study of 12 refractory IMN patients was performed in Guangzhou First People's Hospital between June of 2012 and June 2016.The 12 patients failed to re-spond after a standard course of 6 months in a conventional immunosuppressive therapy(cyclophosphamide,myco-phenolate mofetil or cyclosporine A)combined with prednisone and the patients'serum anti-PLA2R antibody titers were persistent high. They were divided into two groups:The tacrolimus group received tacrolimus combined with prednisone for 12 months and the control group received the same or another conventional immunosuppressive therapy for 6 months.Results At the end of the sixth month after enrollment,proteinuria and serum albumin levels in the ta-crolimus group were significantly improved as compared with those in the control group(P<0.01),and eGFR was higher in the tacrolimus group than in the control group(P<0.05).Severe proteinuria and hypoalbuminemia still re-mained in the control group,and eGFR in the control group declined significantly prior to enrollment(P<0.01).Af-ter 6-month treatment,none of the control group became negative for serum anti-PLA2R antibody,and achieved clini-cal remission. Five patients(83.3%)in the tacrolimus group became negative for serum anti-PLA2R antibody and achieved clinical remission(complete remission in two patients and partial remission in three).After 12-month treat-ment,complete remission was achieved in four patients(66.7%)in the tacrolimus group.Conclusions Persistent high serum anti-PLA2R antibody titers may be a cause of no response to a conventional immunosuppressive therapy in refractory IMN patients.For these patients,tacrolimus combined with prednisone may be an effective alternative treat-ment for disappearance of anti-PLA2R antibody and remission.

Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with prednisone in the treatment of idiopathic membranous nephropathy (IMN) patients with positive serum phospholipase A2 receptor (PLA2R) antibody.Methods An open prospective study was performed on twenty-four biopsy-proven IMN patients with positive serum PLA2R antibody in Guangzhou First People''s Hospital from June 2012 to June 2016.The 24 patients were divided into two groups: MMF group in which MMF combined with prednisone was given for 12 months and CTX group in which intravenous cyclophosphamide (CTX) was monthly given combined with oral prednisone.Results After 6 months of immunosuppressive therapy,complete remission and partial remission rates were 25.0% vs.16.7% and 25.0% vs.25.0% in the MMF group and CTX group,respectively (P>0.05).In the MMF group and CTX group,serum PLA2R antibody in the same amount (8/12,66.7%) of patients turned negative.At the end of twelve-month treatment,all patients with negative PLA2R antibodies achieved complete or partial remission.Clinical remission (including complete and partial remission) rates in the MMF group and CTX group were both 66.7%.After immunosuppressive therapy,the levels of proteinuria and serum albumin in the two groups were significantly improved,but no significant difference were found between the two groups (proteinuria:F within-grouP=98.688,P<0.01;F between-grouP=0.133,P=0.719;F cross-grouP=1.223,P=0.304;serum albumin:F within-grouP=30.629,P<0.01;F between-grouP=0.137,P=0.715;F cros-grouP=0.455,P=0.565).At the end of six and twelve months of treatment,the proteinuria (after six months,MMF group: (2 893±2 515) mg/g vs.(6 236±2 117) mg/g,t=-3.522,P=0.002;CTX group: (2 690±2 254) mg/g vs.(5 386±2 447) mg/g,t=-2.808,P=0.010;after twelve months,MMF group:1 025(99-4 635) mg/g vs.(6 236±2 117) mg/g,Z=-3.291,P<0.0005;CTX group: (775(41-3 517) mg/g vs.(5 386±2 447) mg/g,Z=-3.118,P=0.001) and serum albumin levels (after six months,MMF group: (28.5±9.7) g/L vs.(19.8±4.4) g/L,t=2.841,P=0.012;CTX group: (29.0±7.6) g/L vs.(22.3±4.1) g/L,t=2.690,P=0.016;at the end of twelve months of treatment,,MMF group: (32.4±8.5) g/L vs.(19.8±4.4) g/L,t=4.570,P<0.0005;TX group: (32.2±7.9) g/L vs.(22.3±4.1) g/L,t=3.862,P=0.001) of the two groups were better than those prior to treatment.Conclusion For the IMN patients with positive serum PLA2R antibody,MMF combined with prednisone was as effective as conventional CTX combined with prednisone in the negative conversion of PLA2R antibody and the remission.The negative conversion of PLA2R antibody after 6 months of immunosuppressive treatment was an important indicator of predicting the remission.

BACKGROUND: Percutaneous vertebroplasty (PVP) is usually used for osteoporotic thoracolumbar fractures,which has various advantages such as easy to operate, short operation time, less trauma, rapid recovery,analgesic effect and so on. But its application is restricted due to nerve compression symptoms and pulmonary embolism caused by bone cement leakage. Thereafter, how to reduce the leakage of bone cement is an issue of concern.OBJECTIVE: To investigate the relationship between the lumbar quantitative computed tomography (QCT) values and contrast agent dispersion in osteoporotic thoracolumbar fractures. METHODS: Sixty cases of osteoporotic thoracolumbar fractures undergoing PVP were enrolled, and received QCT examination before surgery, and contrast agent was injected intraoperatively. X-ray examination was conducted to detect the bone mineral density, contrast agent dispersion and leakage of bone cement, and the relationship between the lumbar QCT values and contrast agent dispersion as well as leakage of bone cement.RESULTS AND CONCLUSION: (1) There were 110 vertebral fractures, and 74 vertebrae with contrast agent diffusing more than vertebral midline, accounting for 67.3%. There was significant difference in the contrast agent dispersion among groups (P < 0.05). (2) The bone cement leakage showed no significant difference among groups after injected with bone cement by unilateral or bilateral approach (P > 0.05). (3) These results suggest that contrast agent dispersion in osteoporotic thoracolumbar fractures has a certain relationship with the lumbar QCT values, and lumbar QCT values with more contrast agent dispersion, but the lumbar QCT values have no correlation with bone cement leakage. Therefore, choosing a appropriate approach based on the QCT values and contrast agent dispersion can reduce leakage and improve the safety of PVP.

Objective To test the clinical effects of the expiration control device with mask in the treat-ment of chronic obstructive pulmonary disease. This device developed by the author. Methods A total of 102 pa-tients were treated by the device. Among them ,50 patients received positive end-expiratory pressure and 52 with expiratory flow retard and blocked function. Differences in carbon dioxide partial pressure(PaCO2),oxygen partial pressure(PaO2)and pH of the arterial blood gas analysis were compared ,as well as differences in forced vital ca-pacity(FVC),forced expiratory volume for1 sec(FEV1),tidal volume(VT)of pulmonary function before and af-ter treatment. Results (1) In the positive end-expiratory pressure group ,there were significant differences of FVC,FEV1 and VT before and after treatment(2.95 ± 0.32)L vs(3.22 ± 0.35)L,(1.88 ± 0.17)L vs(2.00 ± 0.15)L,(335.28 ± 43.59)mL vs(364.64 ± 44.28)mL,(P<0.01)differences of PaCO2,PaO2 and pH before and after treatment had statistical significance(50.42 ± 4.77)mmHg vs(48.42 ± 3.76)mmHg,(65.42 ± 4.60)mmHg vs (68.50 ± 4.69)mmHg,(7.35 ± 0.030)vs(7.37 ± 0.037)(P<0.05).(2)In the expiratory flow retard and blocked group,differences of FVC,FEV1andVT before and after treatment had statistical significance(2.93 ± 0.22)L vs (3.10 ± 0.27)L,(1.83 ± 0.14)L vs(1.91 ± 0.16)L,(335.48 ± 44.16)mL vs(362.46 ± 38.66)mL(P<0.05), differences of PaCO2,PaO2 and pH before and after treatment had statistical significance(52.39 ± 3.37)mmHg vs (50.06 ± 3.92)mmHg,(68.05 ± 3.80)mmHg vs(68.99 ± 4.57)mmHg,(7.34 ± 0.035)vs(7.37 ± 0.036)(P<0.05). Conclusion This device can improve the ventilation function in patients with COPD. It is easy to use ,safe and effective,with high clinical application value.