ObjectiveTo investigate the efficacy， safety， and cost-effectiveness of endoscopic ultrasound （EUS）-guided coil placement combined with tissue adhesive injection in the treatment of gastric varices with spontaneous shunt. MethodsA retrospective analysis was performed for the patients with acute gastric variceal bleeding and spontaneous portosystemic shunt who were hospitalized and received balloon-occluded retrograde transvenous obliteration （BRTO） combined with endoscopic tissue adhesive injection or EUS-guided coil placement combined with tissue adhesive injection in Xiangyang Central Hospital from March 2019 to September 2022. The two surgical procedures were compared in terms of efficacy （technical success rate， 5-day rebleeding rate， 1-year rebleeding rate， and time to rebleeding）， safety （the incidence rate of ectopic embolism， the amount of tissue adhesive used， and the amount of lauromacrogol used）， and cost-effectiveness （hospital costs and length of hospital stay）. The t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier method was used to estimate the rebleeding. The chi-square test was used for comparison of categorical data between two groups. ResultsA total of 25 patients received successful EUS-guided coil placement and tissue adhesive injection， with a technical success rate of 100%， a median amount of 2.5 mL tissue adhesive used， a median amount of 11.0 mL lauromacrogol used， a mean length of hospital stay of 14.88±3.21 days， a mean hospital cost of 32 660.00±4 602.07 yuan， and a 5-day rebleeding rate of 0%； among these patients， 2 were lost to follow-up， and 23 patients with complete follow-up data had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 689 days. A total of 14 patients underwent modified BRTO combined with endoscopic tissue adhesive injection， with a technical success rate of 100%； a median amount of 5.0 mL tissue adhesive used during surgery， which was significantly higher than that used in EUS （U=39.000， P<0.001）； a median amount of 10.5 mL lauromacrogol used during surgery； a mean length of hospital stay of 15.38±4.94 days； a mean hospital cost of 57 583.47±18 955.40 yuan， which was significantly higher than that used in EUS （t=-6.310， P<0.001）； a 5-day rebleeding rate of 0%. No patient was lost to follow-up， and all 14 patients had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 244.50 days， with no significant difference between the two groups （χ²=1.448， P=0.229）. ConclusionEUS-guided coil placement combined with tissue adhesive injection is a relatively safe and effective technique for the treatment of gastric variceal bleeding and has a high technical success rate， a low incidence rate of serious adverse events， and similar efficacy to BRTO， with higher safety and cost-effectiveness.

Objective To investigate the expression of cystatin C(Cys C)and high-density lipopro-tein cholesterol(HDL-C)in the serum of patients with Alzheimer's disease(AD)and vascular dementia(VD),and their clinical application.Methods A total of 40 AD patients(AD group)and 40 VD patients(VD group)admitted to Jinhua Second Hospital from January 2020 to January 2022 were enrolled,and another 40 healthy individuals who taking physical examination in the hospital during the same period were subjected as control group.According to Montreal Cognitive Assessment Scale(MoCA)score,the AD patients were divided into mild(22 cases)and moderate to severe(18 cases)AD groups,and the VD patients were into mild(MoCA score 18-26,24 cases)and moderate to severe(MoCA score＜17,16 cases)VD group.Serum levels of Cys C and HDL-C were detected in all the participants,and the diagnostic efficacy of serum Cys C and HDL-C level for AD and VD was analyzed with ROC curve analysis.Results The serum levels of TC,TG,LDL-C and Cys C were significantly higher,and that of HDL-C was obviously lower in the AD and VD groups than the control group(P＜0.05).The Cys C level in the moderate to severe AD group and the moderate to severe VD group was higher than that in the mild AD group and the mild VD group(P＜0.05).There was no significant difference in HDL-C level among moder-ate to severe AD group,moderate to severe VD group,mild AD group and mild VD group(P＞0.05).The AUC value for the combined Cvs C and HDL-C for diagnosis of AD and VD were 0.980(95％CI:0.943-1.000)and 0.951(95％CI:0.905-0.996),respectively.Conclusion Detec-ting serum Cys C and HDL-C levels is simple and convenient.There are significant differences in their serum levels in the patients with AD and VD when compared with healthy population,which may become reference indicators for screening AD and VD.

Objective:To explore the treatment of thoracoabdominal combined injury in a child with heart rupture caused by sheep horns under limited medical conditions.Methods:To summarize the diagnosis and treatment of a child with thoracoabdominal combined injury and cardiac rupture who were treated with epidural anesthesia and having spontaneous breath, and even more there was no oxygen supply and perioperative monitoring during operation.Results:After the complete of thoracoabdominal exploration, the repair of heart, stomach and diaphragm, postoperative anti-infection, nutritional support and symptomatic treatment, the little patient recovered successfully.Conclusions:Thoracoabdominal injuries combined cardiac rupture requires rapid judgment of the patient’s condition, control of bleeding, discharge cardiac tamponade and cardiac repair as soon as possible. In order to save life, unconventional measures can be used when it is necessary.

Natural products are essential sources of antitumor drugs. One such molecule, β-elemene, is a potent antitumor compound extracted from Curcuma wenyujin. In the present investigation, a series of novel 13,14-disubstituted nitric oxide (NO)-donor β-elemene derivatives were designed, with β-elemene as the foundational compound, and subsequently synthesized to evaluate their therapeutic potential against leukemia. Notably, the derivative labeled as compound 13d demonstrated a potent anti-proliferative activity against the K562 cell line, with a high NO release. In vivo studies indicated that compound 13d could effectively inhibit tumor growth, exhibiting no discernible toxic manifestations. Specifically, a significant tumor growth inhibition rate of 62.9% was observed in the K562 xenograft tumor mouse model. The accumulated data propound the potential therapeutic application of compound 13d in the management of leukemia.
Humans ; Mice ; Animals ; Cell Line, Tumor ; Nitric Oxide Donors/pharmacology* ; Sesquiterpenes/pharmacology* ; Leukemia/drug therapy* ; Biological Assay ; Cell Proliferation

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

Objective:To explore the short-term clinical efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (hrTMS) in thalamic pain.Methods:A prospective study was performed; 41 patients with thalamic pain who received hrTMS in Department of Neurology, Anqing Medical Center Affiliated to Anhui Medical University from December 2022 to August 2023 were selected. According to different stimulation sites, these patients were divided into S2 group (intervening secondary sensory cortex of the unaffected side, n=21) and M1 group (intervening primary motor cortex of the unaffected side, n=20). Before treatment, at the 1 st weekend after pseudo-stimulation treatment and at the 1 st, 2 nd and 3 rd weeks after effective stimulation treatment, short-form McGill Pain Questionnaire (SF-MPQ) was performed, and N100 amplitude was monitored by myoelectric evoked potentiometer; adverse reactions during treatment cycles were observed. Results:(1) Compared with those before treatment, scores of sensory item, emotional item and visual analogue scale (VAS), and present pain intensity in S2 group were significantly decreased at the 2 nd and 3 rd weeks after effective stimulation treatment ( P<0.05). Compared with those before treatment, scores of sensory item and VAS, and present pain intensity in M1 group were significantly decreased at the 2 nd weeks after effective stimulation treatment, and scores of sensory item, emotional item and VAS, and present pain intensity in M1 group were significantly decreased at the 3 rd weeks after effective stimulation treatment( P<0.05). At the 3 rd weeks after effective stimulation treatment, compared with the M1 group, the S2 group had significantly decreased scores of sensory item, emotional item, and VAS, and present pain intensity (5.35±0.54 vs. 4.86±0.74; 3.55±0.69 vs. 3.14±0.57; 5.50±0.69 vs. 5.00±0.78; 2.20±0.42 vs. 1.81±0.41, P<0.05). (2) Compared with those before treatment, N100 amplitude in S2 group and M1 group was significantly increased at the 2 nd and 3 rd weeks after effective stimulation treatment ( P<0.05). At the 3 rd weeks after effective stimulation treatment, the S2 group had significantly higher N100 amplitude than the M1 group (3.43±0.60 vs. 3.00±0.65, P<0.05). (3) No adverse reactions such as seizure or scalp burning occurred in the 2 groups during the treatment cycles, without significant difference in headache or tinnitus incidences ( P>0.05). Conclusion:The hrTMS on secondary sensory cortex and primary motor cortex of the unaffected side can relief the short-term pain intensity in patients with thalamic pain, without obvious side effects; and hrTMS on secondary sensory cortex enjoys better effect.

Objective : To study the preparation method of silane and bone morphogenetic protein⁃2 (BMP⁃2) on the nano⁃porous titanium surface and evaluate the osteogenic ability of the prepared surface. Methods : Silane and BMP⁃2 modified nano⁃porous titanium surfaces were constructed by alkali⁃heat treatment , silanization modification and BMP⁃2 grafting. Scanning electron microscopy , X ⁃ray photoelectron spectroscopy , infrared spectroscopy and water contact angle tests were used to characterize the changes of surface morphology , elements , functional groups and hydrophilicity during the preparation process. Immunofluorescence was used to observe the BMP⁃2 grafted on the surface. Cell activity test and cell fluorescence staining were used to analyze the ability to promote osteoblast adhesion and proliferation , and alkaline phosphatase activity was used to evaluate the ability to promote cell osteogenesis. Results : Material characterization results confirmed that silane and BMP⁃2 were successfully immobilized on the nano⁃porous titanium surface. Cell evaluation confirmed that the prepared surface not only significantly enhanced the adhesion and proliferation of osteoblasts , but also greatly enhanced the osteogenic ability of osteoblasts. Conclusion The constructed surface has better compatibility with osteoblasts and is expected to improve the osseointegration ability of titanium⁃based implants.

Objective : To study the resistance pattern of streptomycin and ethambutol in Mycobacterium tuberculosis in Luoyang area , guide clinical medication and supplement epidemiological data on local drug⁃resistant tuberculosis . Methods : The positive results of high⁃resolution melting curve (HRM) in 2 941 cases in Luoyang area were analyzed to assess the risk factors associated with streptomycin and ethambutol resistance . Results : Of the 2 941 HRM⁃positive patients , 18 . 4% were resistant to streptomycin and 8. 0% were ethambutol . Both streptomycin and ethambutol and resistance rates were higher in men than those in women ( 19. 0% vs 16. 9% , P = 0. 129 ; 8. 0% vs 7. 9% , P = 0. 987) . The resistance rates to streptomycin and ethambutol were higher in urban than those in rural areas (21 . 3% vs 16. 6% , P = 0. 002 ; 9. 8% vs 6. 9% , P = 0. 004) . The resistance rate was much higher in previously treated patients than those newly diagnosed for MTB infection (25 . 8% vs 17. 3% , P < 0. 001 ; 12. 1% vs 7. 4% , P = 0. 002) . The resistance rates to streptomycin were higher in the < 51 years than those in the > 50 years group (21 . 1% vs 16. 1% , P < 0. 001) . According to age , the highest resistance rates to streptomycin and ethambutol occurred in the age range of 31 - 35 years and 56 - 60 years in men , respectively , while in the age range of 21 - 25 years and 56 - 60 years in women , respectively . In multivariate models , prior treatment history , age less than 51 years , and urban area were positively associated with streptomycin and ethambutol resistance after adjusting for smear results and year testing . Conclusion Men , prior treatment history , age less than 51 years , and urban residents are key monitoring targets for streptomycin and ethambutol resistant tuberculosis .

Objective:To explore the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children.Methods:A prospective non-randomized controlled study was conducted. From January 2022 to April 2023, 40 children with severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. According to the willingness of the children or their families, the children were assigned to conventional rehabilitation group and combined rehabilitation group. During the study, 8 children dropped out of the study, 17 children were finally included in the conventional rehabilitation group with 6 males and 11 females, aged (8.5±2.4) years, and 15 children were included in the combined rehabilitation group with 5 males and 10 females, aged (9.6±2.5) years. The children in the 2 groups received conventional burn rehabilitation treatment in the hospital, including active and passive activity training, scar massage, and pressure therapy. The children in combined rehabilitation group received resistance training with elastic band of 3 to 5 times per week after discharge, and the children in conventional rehabilitation group received daily activity ability training after discharge. Before home rehabilitation training (1 week before discharge) and 12 weeks after home rehabilitation training, the grip strength was measured using a handheld grip dynamometer, the muscle strengths of the upper and lower limbs were measured using a portable dynamometer for muscle strength, lean body mass was measured by bioelectrical impedance measuring instrument, and the 6-min walking distance was measured. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, or Fisher's exact probability test. Results:After 12 weeks of home rehabilitation training, the grip strengths of children in combined rehabilitation group and conventional rehabilitation group were (15±4) and (11±4) kg, respectively, which were significantly higher than (10±4) and (9±4) kg before home rehabilitation training (with t values of -9.99 and -11.89, respectively, P values all <0.05); the grip strength of children in combined rehabilitation group was significantly higher than that in conventional rehabilitation group ( t=3.24, P<0.05). After 12 weeks of home rehabilitation training, the muscle strengths of upper and lower limbs of children in combined rehabilitation group (with t values of -11.39 and -3.40, respectively, P<0.05) and the muscle strengths of upper and lower limbs of children in conventional rehabilitation group (with t values of -7.59 and -6.69, respectively, P<0.05) were significantly higher than those before home rehabilitation training, and the muscle strengths of upper and lower limbs of children in combined rehabilitation group were significantly higher than those in conventional rehabilitation group (with t values of 3.80 and 7.87, respectively, P<0.05). After 12 weeks of home rehabilitation training, the lean body mass of children in combined rehabilitation group was significantly higher than that before home rehabilitation training ( t=0.21, P<0.05). After 12 weeks of home rehabilitation training, the 6-min walking distances of children in conventional rehabilitation group and combined rehabilitation group were significantly longer than those before home rehabilitation training (with t values of -5.33 and -3.40, respectively, P<0.05), and the 6-min walking distance of children in combined rehabilitation group was significantly longer than that in conventional rehabilitation group ( t=3.81, P<0.05). Conclusions:Conventional burn rehabilitation treatment in hospital and home resistance training with elastic band for 12 weeks after discharge can significantly improve the muscle function and walking ability of severely burned children.