Objective:To explore the predictive value of peripheral blood cytokine models on organ functional impairment after chimeric antigen receptor T(CAR-T) cell therapy in children with B-lineage lymphocytic leukemia.Methods:The clinical data of 44 children with acute B-lineage lymphoblastic leukemia who received CAR-T cell therapy at Children′s Hospital of Soochow University from September 2018 to October 2020 were retrospectively analyzed.Peripheral blood cytokines, including interleukin(IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-α, interferon(IFN)-γ and IL-17A, were measured daily for 14 days after receiving CAR-T cell therapy.The trend of peripheral blood cytokine levels was analyzed at the endpoint of organ function recovery or death within 14 days after CAR-T cell treatment.Receiver operating characteristic curve was used to establish a mathematical prediction model to predict the occurrence of organ damage in the children.Results:Of the 44 children, 31 cases were boys and 13 cases were girls, with a median age of 7.96 (5.19, 11.48)years.Cytokine release syndrome(CRS) response occurred in 95.5% (42/44) children, with 88.1% (37/42) had a grade 1-3 CRS response, and 16.7% (7/42) had a severe grade 4-5 CRS response.Using IL-6>3 892.95 pg/mL as cut-off value, the area under the curve(AUC) for predicting acute respiratory failure was 0.818, with a sensitivity of 0.8 and a specificity of 0.735, while combining IFN-γ>414.4 pg/mL, IL-6>3 892.95 pg/mL and IL-2>27.05 pg/mL were the three cut-off values, with an AUC of 0.741, sensitivity of 0.6 and specificity of 0.912 for predicting acute respiratory failure. Using IFN-γ>1 699.5 pg/mL as cut-off value, the AUC for predicting shock was 0.908, with a sensitivity of 0.722 and a specificity of 1.With IL-6>4 607.3 pg/mL as cut-off value, the AUC for predicting liver injury was 0.964, with a sensitivity of 1 and a specificity of 0.906, while combining both IL-6>4 607.3 pg/mL and IFN-γ>1 446.2 pg/mL as cut-off values, the AUC for predicting liver injury was 0.977, with a sensitivity of 1 and a specificity of 0.906.Combining both IL-6>6 972.2 pg/mL and IFN-γ>3 981.5 pg/mL predicted a positive predictive value of 62.5% and a negative predictive value of 94.4% for grade 4-5 CRS response, with an AUC of 0.846, a predictive sensitivity of 0.714 and a specificity of 0.838, and all children had a combination of two or more organ function injuries.Conclusion:The combination of IL-6 and IFN-γ can effectively predict the incidence of liver injury and cytokine release syndrome.The combination of peripheral blood cytokines IFN-γ, IL-6 and IL-2 can be used to predict the incidence of acute respiratory failure after the treatment of CAR-T cells in children with acute B-lineage lymphoblastic leukaemia.IFN-γ single index can be used to predict the incidence of shock.The combination of IL-6 and IFN-γ can be used to predict the incidence of liver injury and the severity of CRS.

Objective:To analyze the current situation of health education among medical staff at all levels of hospitals in Beijing, for references in improving the level of hospital health education.Methods:From July to November 2022, a stratified random sampling method was used to select medical staff from hospitals at all levels in Beijing as the survey subjects. A self-designed questionnaire was used to investigate the frequency of health education conducted by medical staff in six dimensions. The Likert 5-level scoring method was used to assign scores to the frequency of health education, and latent profile analysis was conducted on each score to explore the categories of health education conducted by medical staff.Results:2 792 questionnaires were effectively collected, among which 2 792 medical staff were surveyed, including 1 009 doctors, 1 609 nurses, and 174 technicians and pharmacists. The scores for the frequency of health education conducted in six dimensions: health education in the media or outside the hospital, health knowledge lectures in the hospital, outpatient health education, inpatient health education, health education during follow-up, and health prescriptions were (1.45±0.68) points, (1.68±1.01) points, (2.65±1.65) points, (2.76±1.74) points, (3.24±1.58) points, and (2.59±1.71) points respectively. According to latent profile analysis, healthcare personnel conducting health education could be divided into four categories: low development group (46.6%, 1 300 people), high development group (4.6%, 129 people), inpatient/follow-up development group (19.4%, 541 people), and outpatient/follow-up development group (29.4%, 822 people). The hospital level and profession of medical personnel in each category were different, and the differences were statistically significant( P<0.001). Conclusions:Medical staff in Beijing mainly carry out health education at such stages as patient follow-up, inpatient, and outpatient, but there is insufficient health education accessible in the media or outside the hospital. There are differences in the health education situation of medical personnel at different levels of hospitals and professions. It is recommended to build an efficient health education management system, actively explore new media-based health education channels, and reasonably allocate health education resources to comprehensively improve the health education of medical staff.

To analyze the research trends and cutting-edge hot spots in the field of multimorbidity in older adults from 2000 to 2023 to provide reference for related research.

Objective To investigate the clinical effect of two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of complex hepatolithiasis. Methods A retrospective analysis was performed for the clinical data of 118 patients with complex hepatolithiasis who were admitted to 3201 Hospital of Xi'an Jiaotong University Health Science Center from January 2018 to June 2020, and according to the surgical procedure, they were divided into PTCSL group with 60 patients and surgery group with 58 patients. All patients were followed up for half a year to 3 years via telephone and outpatient service. The two groups were compared in terms of general information, perioperative indicators (including time of operation, intraoperative blood loss, incision length, time to first flatus and time to first defecation after surgery, time to extraction of abdominal drainage tube, and length of hospital stay), changes in liver function and inflammatory indicators, postoperative complications (bile leakage, acute cholangitis, wound infection, and venous thrombosis of lower extremities), stone clearance rate and recurrence rate, and quality of life. The two-independent-samples t -test was used for comparison of continuous data between two groups; the paired t -test was used for comparison between different periods of time within group; the chi-square test was used for comparison of categorical data between two groups. Results Compared with the surgery group, the PTCSL group had significantly shorter time of operation, time to first flatus and time to first defecation after surgery, and time to extraction of abdominal drainage tube, a significantly lower intraoperative blood loss, and a significantly shorter incision length (all P < 0.05). On day 1 after surgery, both groups had significant reductions in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ( P < 0.05) and a significant increase in white blood cell count (WBC) ( P < 0.05), and the PTCSL group had significantly lower levels of ALT, AST, and WBC than the surgery group (all P < 0.05). Compared with the surgery group, the PTCSL group had significantly lower incidence rates of postoperative bile leakage (5.0% vs 17.2%, P < 0.05), acute cholangitis (3.3% vs 13.8%, P < 0.05), wound infection (1.7% vs 10.3%, P < 0.05), and venous thrombosis of lower extremities (1.7% vs 12.1%, P < 0.05). Compared with the surgery group, the PTCSL group had a significantly higher stone clearance rate (58.3% vs 37.9%, P < 0.05) and a significantly lower long-term stone recurrence rate (10.0% vs 20.7%, P < 0.05). The PTCSL group had significantly higher quality of life scores than the surgery group (all P < 0.05). Conclusion For the treatment of complex hepatolithiasis, two-step PTCSL can effectively remove stones, with the advantages of fast postoperative recovery, low recurrence rate and incidence rate of complications, and high quality of life, and therefore, it is an effective alternative surgical procedure.

Purpose: The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities. Materials and Methods: We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort. Results: A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis. Conclusion Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.

Purpose: The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities. Materials and Methods: We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort. Results: A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis. Conclusion Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.

[Abstract] Objective: To develop a new type of CD7 chimeric antigen receptor modified T cell (CD7-CAR-T) for the treatment of CD7 positive acute myeloid leukemia (AML), and to observe its killing effect on CD7 positive AML cells. Methods: The CD7-CAR lentiviral vector was constructed based on the CD7 Nanobody sequence and costimulatory domain sequence of CD28 and 4-1BB. The lentiviral particles were packaged and used to co-transfect human T cells with protein expression blocker (PEBL), so as to prepare CD7- CAR-T cells. Real time cellular analysis (RTCA) was used to monitor the cytotoxicity of CD7-CAR-T cells on CD7 overexpressed 293T cells. Flow cytometry assay was used to detect the effect of CD7-CAR-T cells on proliferation and cytokine secretion of AML cells with high, medium and low CD7 expressions (KG-1, HEL and Kasumi-1 cells, respectively). Results: CD7-CAR-T cell was successfully constructed and its surface expression of CD7 was successfully blocked. Compared with T cells, CD7-CAR-T cells could significantly inhibit the proliferation of CD7-293T cells and promote the release of TNF, Granzyme B and INF-γ; in addition, CD7-CAR-T cells also significantly promoted the apoptosis (t=147.1, P<0.01; t=23.57, P<0.01) and cytokine release (P<0.05 or P<0.01) in CD7 positive KG-1 and HEL cells, but had little effect on Kasumi-1 cells that only expressed minimal CD7 antigen (t=0.7058, P>0.05). Conclusion: CD7-CAR-T cells can specifically kill CD7-positive AML cells in vitro.

Alzheimer′s disease (AD) is an incurable disease in the field of major chronic diseases. Subjective cognitive decline (SCD) is a clinical risk factor for AD. The standardized screening and intervention in individuals with SCD are of great importance in early prevention and treatment of AD. According to the clinical criteria proposed by The characterisation of subjective cognitive decline, which was published online in Lancet Neurology, the article summarized the definition of SCD, the latest perspective of clinical standards in SCD, and the results of AD preclinical SCD research. The purpose of this work was to provide concrete guidance and recommendations for making clinical decisions in diagnosis and scientific research on SCD.

Objective: To analyze the treatment efficacy in the vertically impacted maxillary central incisors using cone-beam CT (CBCT) and explore the treatment timing and the influence of orthodontic traction on the root development and alveolar bone height in the mixed dentition. Methods: Twenty-two patients with vertically impacted maxillary central incisor who were admitted to the Department of Orthodontics, Stomatological Hospital affiliated to Nanjing Medical University from December 2012 to December 2017 were selected [12 males and 10 females, (9.2±0.9) years]. Based on the dental age, patients were classified as early treatment group (teeth ranging from a third to two thirds of root formation, n=12) and late treatment group (teeth with nearly or fully complete root formation, n=10). The contralateral maxillary central incisor was used as the control. Three-dimensional reconstruction of CBCT before treatment, after treatment and one year after treatment was carried out to measure root length, tooth surface area, tooth volume, labial and lingual apical alveolar bone thickness, the loss of labial alveolar bone height and intraosseous root ratio. The clinical crown length was measured in the mouth. The difference values of the measurement variables between the impacted teeth and the control teeth were calculated and analyzed(measurement values of impacted teeth were subtracted from control values). Results: The values of root length difference beween the impacted teeth and the control teeth in the early and late treatment group were (1.58±1.56) mm and (2.57±1.00) mm, respectively after the treatment and the values were significantly less than those corresponding values before treatment [(3.47±1.40) and (3.36±0.79) mm] (P<0.05). After the treatment, the values of the surface area and volume difference between the impacted teeth and the control teeth in the early treatment group [(0±34) mm² and (-10±44) mm³] were significantly less than those corresponding values before treatment [(38±31) mm² and (55±70) mm³] (P<0.05). The value differences of any measurement variables between the early and late treatment group were not significantly different after the treatment (P>0.05). The root length and intraosseous root ratio of the impacted teeth after the treatment in the early and late treatment group were significantly less than those of the control teeth after the treatment (P<0.05). The clinical crown length, the loss of labial alveolar bone height of the impacted teeth after the treatment were significantly larger than those of the control teeth after the treatment (P<0.05). Conclusions Orthodontic traction promoted the root growth and development of the vertically impacted maxillary central incisors. However, the root length and alveolar bone height still cannot reach the normal level after treatment. Treatment timing had no effect on root development and alveolar bone height of vertically impacted maxillary central incisors in mixed dentition.

Objective To analyze the treatment efficacy in the vertically impacted maxillary central incisors using cone?beam CT (CBCT) and explore the treatment timing and the influence of orthodontic traction on the root development and alveolar bone height in the mixed dentition. Methods Twenty?two patients with vertically impacted maxillary central incisor who were admitted to the Department of Orthodontics, Stomatological Hospital affiliated to Nanjing Medical University from December 2012 to December 2017 were selected [12 males and 10 females, (9.2±0.9) years]. Based on the dental age, patients were classified as early treatment group (teeth ranging from a third to two thirds of root formation, n=12) and late treatment group (teeth with nearly or fully complete root formation, n=10). The contralateral maxillary central incisor was used as the control. Three?dimensional reconstruction of CBCT before treatment, after treatment and one year after treatment was carried out to measure root length, tooth surface area, tooth volume, labial and lingual apical alveolar bone thickness, the loss of labial alveolar bone height and intraosseous root ratio. The clinical crown length was measured in the mouth. The difference values of the measurement variables between the impacted teeth and the control teeth were calculated and analyzed (measurement values of impacted teeth were subtracted from control values). Results The values of root length difference beween the impacted teeth and the control teeth in the early and late treatment group were (1.58±1.56) mm and (2.57±1.00) mm, respectively after the treatment and the values were significantly less than those corresponding values before treatment [(3.47 ± 1.40) and (3.36 ± 0.79) mm] (P<0.05). After the treatment, the values of the surface area and volume difference between the impacted teeth and the control teeth in the early treatment group [(0 ± 34) mm2 and (-10 ± 44) mm3] were significantly less than those corresponding values before treatment [(38±31) mm2 and (55±70) mm3] (P<0.05). The value differences of any measurement variables between the early and late treatment group were not significantly different after the treatment (P>0.05). The root length and intraosseous root ratio of the impacted teeth after the treatment in the early and late treatment group were significantly less than those of the control teeth after the treatment (P<0.05). The clinical crown length, the loss of labial alveolar bone height of the impacted teeth after the treatment were significantly larger than those of the control teeth after the treatment (P<0.05). Conclusions Orthodontic traction promoted the root growth and development of the vertically impacted maxillary central incisors. However, the root length and alveolar bone height still cannot reach the normal level after treatment. Treatment timing had no effect on root development and alveolar bone height of vertically impacted maxillary central incisors in mixed dentition.