Objective To compare and analyze the application value of domestic Octoparms and imported Celect inferior vena cava filter(IVCF)in the interventional treatment of venous thromboembolism(VTE).Methods Forty patients with VTE were randomly divided into Octoparms group(experimental group)and Celect group(control group)according to the double-blinded method of the central random system.All the patients underwent filter placement,catheter-directed thrombolysis and filter retrieval.The primary end point was the success of filter placement and retrieval,and the secondary end point included indwelling complications such as the occurrence of pulmonary embolism(PE)and filter tilt and migration.Results Forty patients were enrolled in this study,22 patients and 18 patients were divided into the experimental group and the control group,respectively.Among them,11 cases were identified with right lower extremity deep vein thrombosis,29 cases with left lower extremity deep vein thrombosis,17 cases with PE,and 6 cases with inferior vena cava thrombosis.The success rate of IVCF placement was 100%in all participants.Immediately after filter place-ment,the angle of filter tilt was(3.8±2.3)° in the experimental group and(4.9±2.8)° in the control group(t=1.44,P=0.16).Filter retrieval was successful in 21 cases(21/22,95.5%)of the experimental group and 17 cases(17/18,95.5%)of the control group.There was no significant difference between the two groups(t=0.14,P=0.89).The mean indwelling time of filter was(8.0±2.1)days in the experimental group and(9.7±3.1)days in the control group(t=0.73,P=0.47).The angle of filter tilt was(5.3±3.4)° in the experimental group and(5.7±7.7)° in the control group(t=0.19,P=0.85).There was no significant difference for filter placement and retrieval between the two groups(t=0.48 and 2.00,P=0.06 and 0.64,respectively).There were no complications of filter migration,strut penetration or new PE in both groups.Conclusion The application value of domestic Octoparms and impor-ted Celect IVCF is similar in interventional treatment of VTE.

Background Fine particulate matter (PM_2.5) in ambient air is an important carrier of heavy metals and polycyclic aromatic hydrocarbons (PAHs), and long-term inhalation of heavy metals and PAHs poses a potential threat to human health. Objective To analyze the ambient PM_2.5 concentrations and the distribution characteristics and sources of heavy metals and PAHs in PM_2.5 in an urban area of Taizhou City, aiming to provide basic data and a scientific basis for local air pollution management and population health prevention. Methods From 9am to 8pm on the 10th to 16th of each month from 2017 to 2022 (23 h·d⁻¹), a monitoring point was set up on the top floor of a building in the main urban area of Taizhou to collect PM_2.5 samples (sampling flow rate: 2.3 m³·h⁻¹) and measure its concentration. The characteristics of 12 heavy metals and 16 priority PAHs in PM_2.5 were analyzed. The pollution sources of heavy metals and PAHs were determined by enrichment factor method and isomer characteristic ratio method, respectively. Results From 2017 to 2022, the average daily concentration of PM_2.5 in this urban area ranged from 4 to 141 μg·m⁻³, and the median annual concentrations were lower than the national secondary standard limit. The seasonal concentration of PM_2.5 was as follows: winter>spring>summer and autumn, and the difference was statistically significant (H=134.077, P<0.01). The concentration of PM_2.5 in 2017.1 to 2020.1 was higher than that in 2020.2 to 2022.12 (Z=−3.989, P<0.01). The main heavy metal pollutants in this area were manganese (Mn), lead (Pb), arsenic (As), nickel (Ni), and chromium (Cr). Except for beryllium (Be) and mercury (Hg), the concentrations of other heavy metals had seasonal differences (P<0.01), higher in winter and spring than in summer and autumn. Except for manganese (Mn) and arsenic (As), the concentrations of other heavy metals were higher from 2017.1 to 2020.1 than from 2020.2 to 2022.12, and the difference was statistically significant (P<0.05). The results of enrichment factor indicated anthropogenic pollution sources of antimony (Sb), cadmium (Cd), and selenium (Se). The average daily concentration of PAHs ranged from 0.88 to 24.56 ng·m⁻³, with a seasonal trend of winter>spring>autumn>summer, and the difference was statistically significant (H=231.387, P<0.01). Among the 16 PAHs, the top pollutants were benzo [b] fluoranthene (BbF) (25.36%), indene [1,2,3-c,d] pyrene (IcdP) (11.22%), and benzo [g,h,i] perylene (BghiP) (9.02%). The results of characteristic ratio method showed that the 16 PAHs pollutants were produced by a combined action of gasoline buring, coal burning, and biomass burning. Conclusion In selected urban area of Taizhou City, the concentrations of PM_2.5, heavy metals, and PAHs all show a downward trend year by year at a relatively low level, and obvious seasonal distributions which are higher in winter and spring. Man-made pollution is the main source of heavy metals, and automobile exhaust emissions, industrial coal burning, and waste incineration may be the main sources of PAHs.

Myocardial dysfunction is the most serious complication of sepsis. Sepsis-induced myocardial dysfunction (SMD) is often associated with gastrointestinal dysfunction, but its pathophysiological significance remains unclear. The present study found that patients with SMD had higher plasma gastrin concentrations than those without SMD. In mice, knockdown of the gastrin receptor, cholecystokinin B receptor (Cckbr), aggravated lipopolysaccharide (LPS)-induced cardiac dysfunction and increased inflammation in the heart, whereas the intravenous administration of gastrin ameliorated SMD and cardiac injury. Macrophage infiltration plays a significant role in SMD because depletion of macrophages by the intravenous injection of clodronate liposomes, 48 h prior to LPS administration, alleviated LPS-induced cardiac injury in Cckbr-deficient mice. The intravenous injection of bone marrow macrophages (BMMs) overexpressing Cckbr reduced LPS-induced myocardial dysfunction. Furthermore, gastrin treatment inhibited toll-like receptor 4 (TLR4) expression through the peroxisome proliferator-activated receptor α (PPAR-α) signaling pathway in BMMs. Thus, our findings provide insights into the mechanism of the protective role of gastrin/CCKBR in SMD, which could be used to develop new treatment modalities for SMD.

Background Research on the relationship between ambient temperature and preterm birth has received increasing attention, but the conclusions of the previous literature are inconsistent. Objective To explore the impact of environmental temperature exposure in Ningbo on premature delivery of pregnant women. Methods The birth information, preterm birth data, and age of pregnant women from January 2016 to September 2020 were collected by the electronic medical record system of Ningbo Women’s and Children’s Hospital. Meteorological data for the same period were obtained through Ningbo Meteorological Bureau, including daily average temperature, daily average relative humidity, and daily average air pressure. Daily concentrations of SO₂, NO₂, and PM₁₀ were derived through the air quality real-time release system on the website of Ningbo Environmental Protection Bureau. A distributed lag nonlinear model was used to analyze the impact of environmental temperature on preterm birth by stratifying pregnant women’s age and birth delivery mode. Results The incidence rate of preterm birth in Ningbo from 2016 to 2020 was 5.91%. The exposure-response curve between environmental temperature and preterm birth presented a “U” shape. Taking 22.5 ℃ as a reference, the cumulative effect of 31 ℃ (the 95th percentile) and 32 ℃ (the 99th percentile) over a 21-day lag on preterm delivery was statistically significant, and the related RR (95%CI) values were 1.67 (1.05-2.65) and 1.85 (1.09-3.14) respectively. The results of stratified analysis showed that among pregnant women ≥30 years old, the 21-day cumulative effects of 31 ℃ and 32 ℃ on preterm delivery were statistically significant, and the related RR (95%CI) values were 2.09 (1.08-4.05) and 2.36 (1.11-5.03) respectively; among pregnant women with natural delivery, the 21-day cumulative effect of 32 ℃ on preterm delivery was statistically significant, and the RR (95%CI) was 1.95 (1.02-3.74). Conclusion Exposure of pregnant women to high temperature during pregnancy could increase the risk of preterm birth, and there is a delayed cumulative effect.

Objective:To analyze the clinical features of patients with pyogenic liver abscess (PLA) and the application of mNGS in PLA, thus to provide reference for clinical diagnosis and treatment.Methods:The demographic and clinical data of 549 patients with liver abscess admitted to Zhongshan Hospital Affiliated to Fudan University from December 2015 to June 2020 were analyzed retrospectively. According to the detection of Klebsiella pneumoniae in 246 patients with positive etiological test results, the patients were divided into two groups: KPLA group and nKPLA group, and clinical characteristics of the two groups were compared. At the same time, the application value of mNGS in PLA was analyzed.Results:Among the 549 patients, the main clinical symptom of PLA was fever ( n= 503, 91.6%) and other clinical symptoms included chills and abdominal pain. Most patients had a single abscess ( n= 464, 84.5%) located in the right lobe ( n = 368, 67.0%), with a size between 5 and 10 cm ( n= 341, 62.1%). A total of 246 patients had positive etiological test results, including 202 KPLA patients which was the main pathogen of liver abscess. The prevalence of diabetes and fatty liver was higher in KPLA patients ( P < 0.05), but there were more culture of liver positive factors in nKPLA patients ( P < 0.001). Among the 109 patients with traditional microbiological results, 92 patients were suspected to KPLA (Klebsiella pneumoniae), of which 14 patients (15.2%) were multidrug resistant (MDR) infection; 17 patients were suspected to nKPLA, of which 10 patients (58.8%) were MDR infection; the incidence of MDR infection in patients with nKPLA was significantly higher than that in patients with KPLA ( P < 0.05). The positive rate of mNGS in plasma was 85.2%, the positive rate of traditional microbial culture in plasma was 14.8%, the positive rate of mNGS in pus was 96.2% and traditional microbial culture in pus was 65.4%. The positive rate of traditional culture was significantly lower than that of mNGS ( P < 0.05). Conclusions:PLA is usually manifested as fever, single and at the right lobe of the liver. Klebsiella pneumoniae is the most common pathogenic bacteria of PLA, which is more common in patients with diabetes and fatty liver, while non-Klebsiella pneumoniae is relatively more common in patients with culture of liver positive factors. The positive detection rate of mNGS is high, which has a unique advantage in pathogen detection.

Objective:To investigate the reliability of gene detection results using pleural effusion from patients with lung adenocarcinoma, and evaluate the clinical application value of pleural effusion supernatant in gene detection of lung adenocarcinoma.Methods:A total of 145 patients with lung adenocarcinoma pathologically confirmed from February 2015 to December 2019 were included, including 129 patients from Peking University Cancer Hospital & Institute and 16 patients from the First Hospital of Fangshan District. In this study, 55 pleural effusion supernatant samples, 52 plasma samples, and 48 tumor tissue samples were selected to targeted next-generation sequencing (NGS) of 1, 021 cancer-related genes, and the ability of gene detection of pleural effusion supernatant, tumor tissue, and plasma were compared.Results:The mutation rate of pleural effusion supernatant was 100.00%, the median maximum somatic allele frequency (MSAF) was 16.40%, and the chromosomal copy number detection (CNV) was 45.45%, showed no statistically significant difference compared with the tumor tissue samples (95.56%, 26.55% and 45.83%, respectively, P>0.05); However, it showed many advantages compared with plasma samples (90.38%, 2.50% and 9.62%). Among the drug-related driver genes, the percentage of EGFR mutation carrier in pleural effusion supernatant, tumor tissue and plasma were 61.82%, 58.33% and 38.46% respectively, the percentagein pleural effusion was higher than that in plasma ( P<0.05), but had no statistical difference compared with the tissue ( P>0.05). Conclusions:Pleural effusion supernatant has high reliability and effectiveness in detecting gene mutation. When lung adenocarcinoma patients are difficult to obtain tumor tissue clinically, it can be used as a substitute sample for genetic testing.

Objective:To investigate the reliability of gene detection results using pleural effusion from patients with lung adenocarcinoma, and evaluate the clinical application value of pleural effusion supernatant in gene detection of lung adenocarcinoma.Methods:A total of 145 patients with lung adenocarcinoma pathologically confirmed from February 2015 to December 2019 were included, including 129 patients from Peking University Cancer Hospital & Institute and 16 patients from the First Hospital of Fangshan District. In this study, 55 pleural effusion supernatant samples, 52 plasma samples, and 48 tumor tissue samples were selected to targeted next-generation sequencing (NGS) of 1, 021 cancer-related genes, and the ability of gene detection of pleural effusion supernatant, tumor tissue, and plasma were compared.Results:The mutation rate of pleural effusion supernatant was 100.00%, the median maximum somatic allele frequency (MSAF) was 16.40%, and the chromosomal copy number detection (CNV) was 45.45%, showed no statistically significant difference compared with the tumor tissue samples (95.56%, 26.55% and 45.83%, respectively, P>0.05); However, it showed many advantages compared with plasma samples (90.38%, 2.50% and 9.62%). Among the drug-related driver genes, the percentage of EGFR mutation carrier in pleural effusion supernatant, tumor tissue and plasma were 61.82%, 58.33% and 38.46% respectively, the percentagein pleural effusion was higher than that in plasma ( P<0.05), but had no statistical difference compared with the tissue ( P>0.05). Conclusions:Pleural effusion supernatant has high reliability and effectiveness in detecting gene mutation. When lung adenocarcinoma patients are difficult to obtain tumor tissue clinically, it can be used as a substitute sample for genetic testing.

Objective:To explore the clinical efficacy of consolidation chemotherapy combined with microtransplantation in the treatment of elderly patients with acute myeloid leukemia (AML).Methods:The clinical data of 45 elderly patients with AML in Suzhou Yongding Hospital from January 2016 to December 2018 were retrospectively analyzed. After 1 or 2 courses of induced chemotherapy, the patients achieved complete response (CR). Among them, 20 patients were given consolidation chemotherapy (single group), and 25 patients were given consolidation chemotherapy combined with microtransplantation (combined group). After 3 courses of treatment, the minimal residual disease (MRD), quantitative expression of WT1 gene and adverse reactions were compared between 2 groups; the quality of life before treatment and after treatment was evaluated by quality of life-BREF (QOL-BREF). The patients were followed up to November 1, 2020, and the median follow-up was 30 months. The overall survival and progress-free survival (PFS) were recorded.Results:The MRD negative rate and WT1 gene negative rate after treatment in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 25.00% (5/20) and 52.00% (13/25) vs. 20.00% (4/20), and there were statistical differences ( P<0.05). The recovery times of neutrophils and platelets in combined group were significantly shorter than those in single group: 10 (8, 12) d vs. 16 (13, 20) d and 14 (11, 17) d vs. 24 (19, 30) d, and there were statistical differences ( Z = 3.152 and 4.285, P<0.05). No adverse reactions such as liver and kidney abnormalities or gastrointestinal reactions occurred in 2 groups; and no specific graft versus host disease (GVHD) occurred in the combined group. The each item scores of QOL-BREF after treatment in combined group were significantly higher than those in single group, and there were statistical differences ( P<0.01). The 2-year overall survival rate and PFS rate in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 35.00% (7/20) and 52.00% (13/25) vs. 25.00% (5/20), and there were statistical differences ( χ2 = 4.235 and 4.742, P = 0.040 and 0.029). Conclusions:Consolidation chemotherapy combined with microtransplantation is effective and safe in the treatment of elderly patients with AML. It can significantly improve the quality of life, and improve the overall survival rate and PFS rate.

Objective:To investigate the effect of hybrid intensity modulated radiotherapy (Hy-IMRT) on immune function in patients with locally advanced breast cancer surgery and the treatment efficacy.Methods:A total of 94 patients with locally advanced breast cancer who underwent modified radical mastectomy for breast cancer and required postoperative radiotherapy in Changzhou Cancer Hospital in Jiangsu Province from January 2015 to January 2017 were selected. The patients were divided into Hy-IMRT group (observation group, 47 cases) and three-dimensional conformal radiotherapy (3DCRT) group (control group, 47 cases) according to the random number table method. The dose and related radiophysical parameters of the respective target areas of the two groups, adverse reactions during and after radiotherapy, cytokines and T lymphocyte subsets before and after radiotherapy, 3-year local recurrence rate, distant metastasis rate and mortality were observed and compared between the two groups.Results:The dose obtained by 95% (D 95%) [(4 945.6±36.1) Gy vs. (4 754.0±35.6) Gy] and target area conformity (CI) of the target volume (0.7±0.1 vs. 0.5±0.1) in the observation group were greater than those in the control group, and the differences were statistically significant (both P<0.05); the target volume of 110% of the prescription dose (V 110%) [(1.6±0.5) cm 3 vs. (8.4±1.2) cm 3], the target volume of more than 105% of the prescription dose (V 105%) [(19.3±3.5) cm 3 vs. (26.6±5.6) cm 3] and the heterogeneity index (HI) (1.1±0.1 vs. 1.3±0.1) in the observation group were all smaller than those of the control group, and the differences were statistically significant (all P < 0.05). The incidence of acute skin adverse reactions [53.2% (25/47) vs. 74.5% (35/47)] and the incidence of bone marrow suppression [40.4% (19/47) vs. 70.2% (33/47)] in the observation group were lower than those in the control group, and the differences were statistically significant (both P < 0.05). There were no significant differences in levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), CD4 +, CD8 +, and CD4 +/CD8 + between the two groups before radiotherapy (all P > 0.05). At the end of radiotherapy, the levels of IL-6, TNF-α and CD8 + were higher in both groups than before radiotherapy (all P < 0.05), and CD4 + and CD4 +/CD8 + were lower than before radiotherapy (both P < 0.05). The levels of IL-6, TNF-α and CD8 + in the observation group were lower than those in the control group, while the CD4 + and CD4 +/CD8 + were higher than those in the control group (all P < 0.05). The 3-year local recurrence rate [34.04% (16/47) vs. 42.55% (20/47)], distant metastasis rate [25.53% (12/47) vs. 38.30% (18/47)] and mortality rate [14.89% (7/47) vs. 19.15% (9/47)] in the observation group were lower than those in the control group, but the differences were not statistically significant (all P > 0.05). Conclusion:Compared with 3DCRT, the Hy-IMRT has less effect on the immune function of locally advanced breast cancer patients after modified radical resection, and the incidences of acute skin reaction and bone marrow adverse reaction are low.

OBJECTIVE： To synthetize the synthesis of mitoxantrone and evaluate its quality. METHODS： Crude product of mitoxantrone was prepared by slow oxidation of 1，4，5，8-tetrahydro-anthraquinone with N-（2-hydroxyethyl） ethylenediamine in water bath at 50 ℃ for 2 h under argon protection and in dry air for 4 h. The crude product was crystallized by ethanol-n-hexane  （4 ∶ 1，V/V） mixture solution， which was cooled overnight and then washed by ethanol-n-hexane mixture for many times. The melting range， pH value of solution， ultraviolet-visible absorption spectrum， infrared structural characteristics， drying weight loss （water loss rate） and critical relative humidity （CRH） of the purified products （4 batches） were investigated. HPLC method was used to determine the contents of mitoxantrone. RESULTS： The mitoxantrone was prepared successfully， and synthetic yield of mitoxantrone was 34.3％； the melting point ranged from 159.1-163.6 ℃. The aqueous solution was alkaline （pH 7.63-9.54）； there was a maximum ultraviolet absorption peak at 235-245 nm； there was a maximum absorption peak of visible light at 590-600 nm； the infrared characteristics were consistent with those described of mitoxantrone in the 2015 edition of the Infrared Spectrum Collection of Drugs； water loss rate were －0.83％-2.36％； CRH value was 54.7％， and the average content of the product was 78.1％（n＝4） by HPLC method. CONCLUSIONS： The mitoxantrone is synthesized under mild， non-toxic and harmless experiment conditions. The synthesis step is simple， the cost is low and the yield is high. The quality of products meets the quality requirements.