Objective To explore the valve regurgitation status of left heart after the implantation of left ventricular assist device (LVAD) and its effect on prognosis of patients with LVAD implantation. Methods A total of 35 patients with cardiomyopathy who underwent magnetic levitation LVAD implantation at Zhongshan Hospital, Fudan University from February 2021 to July 2024 were retrospectively selected. Clinical data during hospitalization were collected, including preoperative basic data and postoperative valve regurgitation status. Telephone follow-ups were conducted to monitor patients’ survival status and transthoracic echocardiography was used to assess left valve function. Kaplan-Meier survival curves and log-rank test were employed to compare the survival rate of patients with different levels of valve regurgitation. Results The 35 patients had a mean age of (53.9±11.1) years, with 85.7% male, and 3 patients (8.6%) died during hospitalization. Preoperatively, 17 patients (48.6%) had moderate or greater mitral regurgitation, while all 35 patients had less than moderate aortic regurgitation. One month postoperatively, thirty patients were followed up, among which 24 patients (80%) had less than moderate mitral regurgitation, including 11 cases with alleviated regurgitation compared to pre-surgery; 6 patients (20%) had moderate or greater mitral regurgitation, including 4 cases with stable regurgitation and 2 cases with progression of regurgitation compared to pre-surgery; 2 patients (6.7%) had progression of aortic regurgitation to moderate or greater. The follow-up time was 1.2 (1.0, 2.1) years, with 1-year survival rate of 91.4% and 3-year survival rate of 71.1%. Survival analysis showed that the 3-year survival rate of patients with moderate or greater mitral regurgitation one month postoperatively was significantly lower than that of patients with less than moderate regurgitation (66.7% vs 83.3%, P＝0.046). Conclusions After the implantation of magnetic levitation LVAD, most patients showed improvement in mitral regurgitation, while aortic regurgitation remained unchanged. The degree of mitral regurgitation one month postoperatively is associated with prognosis.

Objective: To understand the prevalence of elevated blood pressure and its association with dietary patterns in children and adolescents in China, providing evidence for developing dietary intervention of hypertension in children and adolescents. Methods: Data were derived from the China Children s Nutrition and Health System Survey and Application Project(2019-2021). A stratified cluster random sampling method was used to include 7 933 participants from 28 survey sites in seven major regions of Northeast, North, Northwest, East, Central, South and Southwest China. Multivariate Logistic regression models were used to analyze associations between demographic characteristics, nutritional status and elevated blood pressure. Exploratory factor analysis identified dietary patterns, which were divided into three quartile groups (T3, T2, T1) based on factor scores (compliance for dietary pattern) from high to low, and multivariate Logistic regression model assessed the correlation between elevated blood pressure and dietary patterns. Results: The prevalence of elevated blood pressure was 15.4% among Chinese children aged 7-17 years. Significant differences were observed across nutritional status (reference: underweight; normal weight: OR =1.57; overweight: OR = 2.61 ; obesity: OR =3.85), urban/rural residence (reference: rural; urban: OR =0.86), and paternal education (reference: junior high school and below; bachelor degree or above: OR =0.68) ( P <0.05). The detection rates of high blood pressure in T3 group children and adolescents with four dietary patterns (staple food, animal based food, snacks, vegetables and fruits) were 15.7%, 14.6%, 16.8%, and 15.8%, respectively. After adjusting for residence, paternal education, and nutritional status, the "snack dietary pattern" (mainly candy, sugar sweetened beverages, and processed snacks) showed positive associations with elevated blood pressure in T2 ( OR =1.21) and T3 ( OR =1.19) tertiles ( P <0.05). Conclusions The snack dietary pattern is a related factor for elevated blood pressure in children and adolescents. Restricting unhealthy snack intake may promote cardiovascular health.

Abstract Vitamin D (Vit D) deficiency is prevalent worldwide, and the prevalence of childhood obesity is increasing globally. Many studies have supported that Vit D deficiency may be an important cause of childhood obesity, and the level of serum Vit D among obese children decreases,simultaneously. Both Vit D deficiency and obesity among children interact through direct factors, molecular mechanisms and environmental factors, but the mechanism of interaction has not been fully elucidated. In the future, higher level research in evidence based medicine could be conducted to explore the association between childhood obesity and Vit D deficiency and the possible mechanisms of their interaction, in order to provide scientific evidence for the prevention and control of Vit D deficiency and obesity among children.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To explore the changes in serum angiotensin(Ang)and angiotensin Ⅳ(AngⅣ)levels in patients with acute cerebral infarction(ACI),and analyze the correlation of their lev-els with cognitive dysfunction and severity of the disease.Methods A total of 280 ACI patients admitted in our hospital from January 2020 to January 2023 were enrolled in this study.According to the results of Mini-Mental Status Examination(MMSE),they were divided into normal cogni-tive group(MMSE score:≥ 27,n=147)and cognitive impairment(score:＜27,n=133),and those in the latter group were further assigned into mild(score:21-26,n=50),moderate(score:10-20,n=44)and severe(score:＜10,n=39)cognitive impairment subgroups.In addition,Pul-licino formula was used to calculate the infarct volume(V),and then 280 ACI patients were clas-sified into mild(V＜5 cm3,n=80),moderate(V 5-10 cm3,n=130),and severe(with＞10 cm3,n=70)infarction groups.The serum levels of Ang and Ang Ⅳ were compared among above different groups.Pearson correlation analysis was applied to study the correlation of serum Ang and Ang Ⅳ levels with cognitive dysfunction and its severity in the ACI patients.Results The se-rum Ang and Ang Ⅳ levels were higher in the cognitive impairment group than the normal cogni-tive group(P＜0.01).Significant differences were seen in their levels among the mild,moderate,and severe cognitive impairment subgroups(P＜0.01),and the levels were significantly highest in the severe cognitive impairment subgroup,followed by the moderate and then the mild subgroups(P＜0.01).There were also obvious differences in the serum levels of the two indicators among the severe,moderate,and mild infarction groups(P＜0.01).Pearson correlation analysis indicated that their serum levels were positively correlated with cognitive impairment(r=0.764,P=0.000;r=0.792,P=0.000),and with severity of infarction(r=0.801,P=0.000;r=0.807,P=0.000).Multivariate logistic regression analysis revealed that age,hypertension,diabetes,hyperlipidemia,smoking,genetics,and Ang and Ang Ⅳ levels were high-risk factors for cognition impairment.Conclusion Serum Ang and Ang Ⅳ levels are higher in ACI patients,and their levels are raised with increasing severity of cognitive impairment and increasing infarct size,in a positive correla-tion.The serum levels can be used as marker for cognitive impairment and severity of ACI.In addition,there are many high-risk factors for cognition,and serum Ang and Ang Ⅳ levels are also one of them.Clinically,the treatment plan should be optimized by combining these high-risk fac-tors to reduce the incidence of cognitive impairment after ACI.

Objectives:To understand the differences in clinical characteristics, treatment status, and prognosis between outpatient and inpatient heart failure patients in the real world.Methods:A prospective, multicenter registration study was conducted to select 972 outpatient or inpatient heart failure patients from 24 different regions and levels of hospitals in China from December 2012 to November 2014. Demographic and clinical data, as well as treatment status, were collected and followed up at 1 year. The difference in medication treatment status between baseline and 1-year follow-up was compared using McNemar paired χ 2 test. Pearson χ 2 test was used to compare the differences in clinical data, treatment status, and outcomes between outpatient and inpatient patients. Results:There were 610 outpatient patients (62.8%), and the proportion of outpatient patients under 65 years old was higher than that of hospitalized patients [44.9%(274/610) vs 35.1%(127/362), P<0.05]. The proportion of NYHA grade Ⅲ/Ⅳ patients was as high as 50.8%(310/610), and 92.5%(564/610) of outpatient patients had difficulty breathing while walking uphill. 27.9%(170/610) of outpatient patients had jugular vein pressure greater than 6 cmH 2O, and 24.3%(148/610) of outpatient patients had pulmonary moist rales. There was no significant difference in the main causes of heart failure between outpatient and inpatient patients ( P=0.063), with ischemic cardiomyopathy being the main cause. At baseline, the use of beta blockers in outpatient patients was higher than that in hospitalized patients [63.0%(384/610) vs 54.4%(197/362), P<0.05], while the use of diuretics and aldosterone receptor antagonists was lower than that in hospitalized patients [53.1%(324/610) vs 72.1%(261/362), 49.5%(302/610) vs 61.3%(222/362), P<0.05]. There was no statistically significant difference in the use of ACEI/ARB between the two groups [67.4%(411/610) vs 62.4%(226/362), P>0.05]. At one-year follow-up, the use of ACEI/ARB in outpatient patients decreased [63.5%(360/567) vs 67.4%(411/610), P<0.05], the usage rate of aldosterone receptor antagonists in hospitalized patients decreased by [50.3%(165/328) vs 61.3%(222/362), P<0.05]. The one-year all-cause mortality rate of the two groups of patients was close to [6.7%(41/610) vs 9.4%(34/362), P=0.124], The hospitalization rate for heart failure in the outpatient group was lower than that of hospitalized patients [25.4%(155/610) vs 36.5%(132/362), P<0.05], but still>25.0%. Conclusions:Outpatient heart failure patients still have obvious symptoms and signs, and the prognosis is poor. The standardized management of outpatient heart failure patients cannot be ignored.

Tumor is a serious threat to human health. At present, surgical resection, chemoradiotherapy, targeted therapy and immunotherapy are the main therapeutic strategies. Monoclonal antibody has gradually become an indispensable drug type in the clinical treatment of cancer due to its high efficiency and low toxicity. Phage antibody library technology (PALT) is a novel monoclonal antibody preparation technique. The recombinant immunoglobulin variable region of heavy chain (VH)/variable region of light chain (VL) gene is integrated into the phage vector, and the antibody is expressed on the phage surface in the form of fusion protein to obtain a diverse antibody library. Through the process of adsorption-elution-amplification, the antibody library can be screened to obtain the antibody molecule with specific binding antigen as well as its gene sequence. PALT has the advantages of short antibody production cycle, strong plasticity of antibody structure, large antibody yield, high diversity and direct production of humanized antibodies. It has been used in screening tumor markers and preparation of antibody drugs for breast cancer, gastric cancer, lung cancer and liver cancer. This article reviews the recent progress and the application of PALT in tumor therapy.
Humans ; Bacteriophages/genetics* ; Immunoglobulin Variable Region/genetics* ; Gene Library ; Antibodies, Monoclonal/therapeutic use* ; Immunotherapy ; Peptide Library

Objective:To investigate the predictive value of systemic inflammatory response index (SIRI) for early neurological deterioration (END) and clinical outcome in patients with branch atherosclerotic disease (BAD).Methods:Consecutive patients with BAD admitted to the Department of Neurology, Jiangyin People’s Hospital Affiliated to Southeast University from September 2021 to September 2022 were retrospectively included. The clinical data were collected and SIRI was calculated. The calculation method of SIRI was neutrophil count × monocyte count/lymphocyte count. END was defined as an increase of ≥2 in the total score of the National Institutes of Health Stroke Scale (NIHSS) or an increase of ≥1 in the motor function score within 1 week of onset. The modified Rankin Scale was used for outcome evaluation at 3 months after onset, with a score >2 were defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between SIRI and END, as well as poor outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SIRI for poor outcome. Results:A total of 125 patients with BAD were included, of which 62 (49.6%) had END and 32 (25.6%) had poor outcome. The multivariate logistic regression analysis showed that intravenous thrombolysis (odds ratio [ OR] 1.083, 95% confidence interval [ CI] 1.082-1.240; P=0.043) and high SIRI ( OR 1.465, 95% CI 1.150-3.676; P=0.028) were independent risk factors for END in patients with BAD; END ( OR 1.130, 95% CI 1.032-1.384; P=0.006), high baseline NIHSS score ( OR 1.571, 95% CI 1.184-2.101; P=0.003) and high SIRI ( OR 2.062, 95% CI 1.152-3.672; P=0.01) were independent risk factors for poor outcome in patients with BAD. ROC curve analysis showed that the area under the curves for SIRI, baseline NIHSS score, and the both combined prediction of poor outcome were 0.66 (95% CI 0.54-0.78), 0.70 (95% CI 0.58-0.81), and 0.83 (95% CI 0.74-0.93), respectively. Conclusions:High SIRI is an independent risk factor for END and poor outcome in patients with BAD. The SIRI and baseline NIHSS scores have certain predictive value for poor outcome in patients with BAD, and their combined diagnostic value is higher.

Objective:To study the effect of Compound Duzhong Jiangu Granules on joint function, quality of life and inflammatory factors in patients with Kashin-Beck disease.Methods:By group design, 135 patients with Kashin-Beck disease in Chongxin County, Pingliang City, Gansu Province, were selected and divided into intervention group (100 cases treated with Compound Duzhong Jiangu Granules, 12 g/bag, 1 bag/time, 3 times/day, treatment for 1 month) and control group (35 cases treated with ibuprofen, 0.3 g/capsule, 1 capsule/time, 2 times/day, treatment for 2 weeks) according to the randomized, single-blind principle. The changes of joint dysfunction index score, joint function improvement rate, total scores of Kashin-Beck disease quality of life (KBDQOL) and scores of each dimension were analyzed before treatment, 1 month and 3 months after treatment. The serum levels of interleukin-6 (IL-6), nuclear factor κB (NFκB)-p65, inducible nitric oxide synthase (NOS2), nitric oxide (NO), and prostaglandin E2 (PGE2) were detected by enzyme-linked immunosorbent assay before treatment and 1 month after treatment.Results:The total scores of joint dysfunction index of the intervention group and the control group 1 month after treatment and 3 months after treatment were lower than those before treatment, but 3 months after treatment was higher than 1 month after treatment ( P < 0.001). One month after treatment, the total effective rates of joint function improvement in the intervention group and the control group were 68.00% (68/100) and 54.55% (18/33), respectively; 3 months after treatment, the total effective rates of the intervention group and the control group were 36.00% (36/100) and 39.39%(13/33), respectively. The total scores and scores of each dimension of KBDQOL were not significant for the main effect of the group ( P > 0.05), but significant for the main effect at the time point ( P < 0.05), and there was no interactive effect ( P > 0.05). There were significant differences in the scores of social support and mental status dimensions in the intervention group at different time points ( P < 0.001). And in the intervention group, the total score, the scores of physical function, activity limitation, economy and overall health dimensions were statistically significant between before treatment and 1 month after treatment, 1 month after treatment and 3 months after treatment( P < 0.05); however, there was no significant difference between before treatment and 3 months after treatment ( P > 0.05). One month after treatment, the serum PGE2 levels of both groups were decreased ( P < 0.05), and there was no difference in other inflammatory factors at different groups and time points ( P > 0.05). Conclusion:Compound Duzhong Jiangu Granules can effectively inhibit the inflammatory reaction of patients with Kashin-Beck disease, promote the improvement of joint function and improve the quality of life in various aspects.

Malignant tumors are diseases that seriously threaten human health and social development. Traditional tumor therapies such as surgery, radiotherapy, chemotherapy and targeted therapy cannot fully meet the needs of clinical treatment, and emerging immunotherapy has become a research hotspot in the field of tumor treatment. Immune checkpoint inhibitors (ICIs) have been approved as a tumor immunotherapy method for the treatment of various tumors, such as lung cancer, liver cancer, stomach cancer and colorectal cancer, etc. However, during the clinical use of ICIs, only a small number of patients experienced durable responses, which also led to drug resistance and adverse reactions. Therefore, the identification and development of predictive biomarkers is crucial to improve the therapeutic efficacy of ICIs. The predictive biomarkers of tumor ICIs mainly include tumor biomarkers, tumor microenvironment biomarkers, circulation-related biomarkers, host environmental biomarkers and combinatorial biomarkers. They are of great significance for screening, individualized treatment and prognosis evaluation of tumor patients. This article reviews the advances of predictive markers for tumor ICIs therapy.
Humans ; Immune Checkpoint Inhibitors/therapeutic use* ; Lung Neoplasms ; Biomarkers ; Immunotherapy/methods* ; Biomarkers, Tumor/genetics* ; Prognosis ; Tumor Microenvironment