To analyze the clinical data and imaging examination data of a patient with metallic mercury poisoning from subcutaneous injection. The abdominal B-ultrasonograph results of the patient indicated multiple scattered hyperechoic spots accompanied by "comet tail" sign in the liver and right renal sinus, the nature of which was not clear and it was considered crystal deposition. The chest X-ray revealed scattered and multiple spot-like, snowflake-like and tree-cast-like high-density shadows in both lung fields. The chest computed tomography scan revealed multiple spot and patchy high-density shadows distributed in both lungs, considering hematogenous distribution deposits, and possible mercury poisoning. Laboratory test results showed that blood mercury level was 4.16 μmol/L and urine mercury level was 6 545.5 μg/g Cr. After 28 days of mercury chelation therapy, the abdominal ultrasound examination showed that the hyperechoic spots in the liver and right renal sinus were reduced compared with the previous examination. Metallic mercury poisoning from subcutaneous injection has specific manifestations in abdominal B-ultrasound imaging, which can provide a basis for the early diagnosis of metallic mercury poisoning in clinical practice and can be used to observe the efficacy of mercury chelation therapy.

BACKGROUND: The optimal antidepressant dosages remain controversial. This study aimed to analyze the efficacy of antidepressants and characterize their dose-response relationships in the treatments of major depressive disorders (MDD). METHODS: We searched multiple databases, including the Embase, Cochrane Central Register of Controlled Trials, PubMed, and Web of Science, for the studies that were conducted between January 8, 2016, and April 30, 2023. The studies are double-blinded, randomized controlled trials (RCTs) involving the adults (≥18 years) with MDD. The primary outcomes were efficacy of antidepressant and the dose-response relationships. A frequentist network meta-analysis was conducted, treating participants with various dosages of the same antidepressant as a single therapy. We also implemented the model-based meta-analysis (MBMA) using a Bayesian method to explore the dose-response relationships. RESULTS: The network meta-analysis comprised 135,180 participants from 602 studies. All the antidepressants were more effective than the placebo; toludesvenlafaxine had the highest odds ratio (OR) of 4.52 (95% confidence interval [CI]: 2.65-7.72), and reboxetine had the lowest OR of 1.34 (95%CI: 1.14-1.57). Moreover, amitriptyline, clomipramine, and reboxetine showed a linear increase in effect size from low to high doses. The effect size of toludesvenlafaxine increased significantly up to 80 mg/day and subsequently maintained the maximal dose up to 160 mg/day while the predictive curves of nefazodone were fairly flat in different dosages. CONCLUSIONS: Although most antidepressants were more efficacious than placebo in treating MDD, no consistent dose-response relationship between any antidepressants was observed. For most antidepressants, the maximum efficacy was achieved at lower or middle prescribed doses, rather than at the upper limit. REGISTRATION No. CRD42023427480; https://www.crd.york.ac.uk/prospero/display_record.php?
Humans ; Antidepressive Agents/therapeutic use* ; Depressive Disorder, Major/drug therapy* ; Dose-Response Relationship, Drug ; Randomized Controlled Trials as Topic

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective:To evaluate the efficacy and safety of oral semaglutide versus sitagliptin in Chinese patients with type 2 diabetes mellitus(T2DM) inadequately controlled with metformin. Methods:The PIONEER 12 study was a phase Ⅲ clinical trial. Chinese patients were prospectively randomized to oral semaglutide(3mg, 7 mg, and 14 mg) or sitagliptin 100 mg. The primary endpoint was the change in HbA 1C from baseline to week 26, and the confirmatory secondary efficacy endpoint was the change in body weight from baseline to week 26. Results:Totally 1 084 Chinese participants(mean age 53 years, male 62.2%, mean duration of diabetes 5.5 years, HbA 1C 8.2%, and body weight 74.3 kg) were enrolled. The changes in HbA 1C at week 26 from baseline were -0.9%, -1.4%, and -1.6% for oral semaglutide 3 mg, 7 mg, and 14 mg, respectively, and -0.7% for sitagliptin. Compared to sitagliptin, oral semaglutide 3 mg, 7 mg, and 14 mg significantly reduced HbA 1C [estimated treatment difference(ETD), -0.2%(95% CI -0.4--0.0), -0.8%(95% CI -0.9--0.6), and -0.9%(95% CI -1.1--0.8), respectively; 3 mg, P=0.011, 7 mg and 14mg, P<0.001]. The estimated mean changes in body weight at week 26 from baseline were -1.1 kg, -2.5 kg, and -3.4 kg for oral semaglutide 3 mg, 7 mg, and 14 mg, respectively, and -0.4 kg for sitagliptin 100 mg. Compared with sitagliptin, oral semaglutide 3 mg, 7 mg, and 14 mg significantly reduced body weight [ETD, -0.8 kg(95% CI -1.3--0.2), -2.1 kg(95% CI -2.6--1.6), and -3.0 kg(95% CI -3.5--2.5), respectively; 3 mg, P=0.004, 7 mg and 14 mg, P<0.001]. The overall incidence of adverse events was similar across all treatment groups. The most common adverse events were gastrointestinal disorders, mostly mild or moderate in severity and transient in duration. Conclusions:Oral semaglutide resulted in significantly greater reduction in HbA 1C and body weight versus sitagliptin at week 26, with a favorable safety and tolerability profile in Chinese T2DM patients inadequately controlled with metformin.

A 11-year old female patient with severe thalassemia, receipt a lentivirus-based cell and gene therapy (CGT) therapy in Shenzhen Children′s Hosptial on July 27th, 2021. At the two follow-up visits after discharge, patient were continuously tested positive for HIV screening through HIV Ag/Ab Combo assay (chemiluminescence Immunoassay), and the viral load results of HIV-1 nucleic acid testing (NAT) were both>5 000 copies/ml. The patient can be diagnosed with HIV infection according to the National Guideline for Detection of HIV/AIDS(2020 Revised Edition). The thorough investigation findings and supplementary experiment results indicated that the false-positive HIV-1 NAT results was caused by cross-reactivity between the target sites detected by conventional HIV-1 NAT reagents and the lentiviral vectors fragments integrated into the genome of patient′s hematopoietic stem/progenitor cells. In conclusion, it is important for laboratories to select appropriate HIV-1 NAT testing platforms which won′t cause cross-reactivity for the testing of samples from patients who have been treated with HIV-derived vectors. It is also recommended to design and develop NAT testing platforms with multiple target regions labeled by different fluorescents for HIV NAT supplementation experiment to reduce the risk of false-positive diagnoses of HIV infection.

ObjectiveTo establish a dose-effect curve for semi-automatic analysis of dicentric chromosomes(DC) based on an automatic chromosome analysis system. Methods A total of three healthy volunteers were recruited as the study subjects, and their peripheral blood was collected and stimulated by X-ray at doses of 0.00, 0.10, 0.25, 0.50, 0.75, 1.00, 2.00, 3.00, 4.00, and 5.00 Gy, with the absorbed dose rate of 1.0 Gy/min. Images of DC in the mid-stage of cell division were collected using a high-throughput automatic chromosome analysis system. The DCScore software was used to automatically analyze DC aberrations, and a dose-effect curve for semi-automatic analysis of DC was fitted after manual confirmation. The fitted dose-effect curve for semi-automatic analysis of DC was validated for accuracy using three proficiency test samples from the national quality assessment of biological dose. Results The incidence of DC increased with increasing irradiation doses in the range of 0.00-5.00 Gy (P<0.01). The dose-effect curve for the fitted semi-automatic analysis of DC was ŷ =0.000 8 (±0.000 2) +0.009 2(±0.000 9) D+0.014 2(±0.000 4) D² (R²= 0.999 8). The relative deviation between the estimated dose and the actual dose of the three test samples was about 20.00%, indicating curve applicability for biological dose estimation. Moreover, excluding the time spent on manual analysis, the semi-automatic analysis method increased the analysis efficiency by 26.0 times. Conclusion The semi-automatic analysis dose-effect curve for DC stimulated by X-ray is constructed for biological dose estimation, which can reduce the manual analysis time, and holds great potential for application in nuclear emergency response to large-scale radiation accidents.

Objective:To explore the clinical value and therapeutic effects of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction using an oblique pedicled rectus abdominis myocutaneous flap(ORAMF).Methods:The data of patients admitted to Hunan Cancer Hospital from May to September 2023 who underwent breast cancer resection followed by immediate breast reconstruction with ORAMF were analyzed retrospectively. Surgical methods: firstly, axillary anterior sentinel lymph node biopsy and subcutaneous glandular excision for breast cancer were performed through a lateral chest incision using an endoscopic technique. Subsequently, a unilateral ORAMF was prepared by removing the epidermis and creating subcutaneous tunnels on the surface of the rectus abdominis myocutaneous flap under direct visualization. The subcutaneous tunnel of the flap was then extended to the deep surface of the breast with the assistance of an endoscope, allowing for the transfer of the ORAMF to reconstruct the breast. Post surgery, the flap survival was monitored, and after discharge, patients received enhanced anti-scar treatment and functional rehabilitation exercises. Follow-up assessments included the evaluation of the reconstructed breast shape, incision scarring in both the donor and recipient areas, abdominal wall function, tumor recurrence and metastasis.Results:A total of 8 female patients with unilateral breast cancer were included in this study, aged between 27 and 52 years, with a mean age of 41.7 years old. The body mass index of the patients ranged from 19.1 to 22.5 kg/m 2. All patients had early-stage breast cancer. During the operation the average mass of the resected breast was 245 g(ranging from 220 to 285 g). The length of the lateral thoracotomy incision varied from 6.9 to 9.5 cm, with a mean length of 7.7 cm. In 3 cases, the ipsilateral ORAMF was used for breast reconstruction, while in 5 cases, the contralateral ORAMF was utilized. The dimensions of the flap were as follows: length (20.4±0.7) cm, width (10.8±1.5) cm, thickness (5.4±0.9) cm, with the volume of the flap cutting ranging from 19.7 cm×9.2 cm×4.4 cm to 21.2 cm×11.8 cm×5.9 cm. All of the flaps exhibited good blood supply and survived successfully without the need for additional anastomotic vessels. The patients were followed up for a period of 8 to 10 months post-operation, with an average follow-up of 8.7 months. The reconstructed breasts maintained a good shape and texture, showing no contracture or deformation of the flap, and were generally symmetrical with the healthy breast. The incisions in both the flap donor area and the recipient area had healed well, leaving only linear scars, and the function of the abdominal wall was not significantly compromised. No recurrence or metastasis was observed during the follow-up period. Conclusion:The endoscopic technique helps to preserve the integrity of the breast skin tissue to the greatest extent possible, reducing scarring and assisting in the creation of subcutaneous tunnels to facilitate the transposition of the ORAMF for breast reconstruction. For carefully selected patients with moderately small breasts and ample subcutaneous tissue in the lower abdomen, the preparation of a unilateral ORAMF for breast reconstruction can yield superior results. This approach minimizes additional damage to the donor area, enhancing the safety of the surgery while significantly reducing the complexity of the operation.

OBJECTIVE To observe the clinical efficacy of Maitong Jun'an Decoction in treating coronary heart disease(CHD)angina of qi deficiency and blood stasis type,and preliminarily elucidate its possible mechanism of action through transcriptomics meth-ods.METHODS A total of 140 patients with CHD angina of qi deficiency and blood stasis type were included and randomly divided into a treatment group and a control group,with 70 cases in each group.During the treatment period,3 patients in the control group dropped out.The control group received basic Western medicine treatment for secondary prevention of CHD,while the treatment group received Maitong Jun'an Decoction in addition to the treatment in the control group.The treatment period for both groups was 8 weeks.Before and after treatment,the patients in both groups were evaluated for the TCM syndrome score,Canadian Cardiovascular Society(CCS)angina grading,Seattle angina questionnaire(SAQ)score,self-rating anxiety scale(SAS),self-rating depression scale(SDS)score,and adverse reactions.The peripheral blood of 9 patients before and after treatment was selected for transcriptomic sequencing based on the principle of gender,age,and disease duration matching.RESULTS After treatment,the TCM syndrome scores and total scores of the 2 groups were significantly reduced(P<0.01).The treatment group was better than the control group in improving chest pain,chest tightness,shortness of breath,fatigue and total score(P<0.05,P<0.01);the overall improvement rate of CCS angina grading in the treatment group was better than that in the control group(P<0.05);the SAQ,SAS and SDS scores of the 2 groups were significantly reduced before and after treatment(P<0.01),and the SAQ score of the treatment group was improved better than that of the control group(P<0.05,P<0.01).The transcriptomics results showed that there were 862 significantly different mR-NAs before and after treatment,including 509 up-regulated and 353 down-regulated.GO analysis showed that there were 666 biologi-cal processes in the differentially expressed mRNAs,mainly including viral gene expression,translation initiation,RNA catabolism,etc.There were 112 cell components,mainly including focal adhesion,ribosome subunit,nuclear spot,etc.There were 94 molecular functions,mainly including double-stranded RNA binding,cadherin binding,transcription co-regulatory factor activity,etc.KEGG analysis showed that the differentially expressed mRNAs enriched in 20 signaling pathways,mainly including glycerophospholipid me-tabolism pathway,AMPK signaling pathway,ribosome pathway,etc.CONCLUSION Maitong Jun'an Decoction can improve clini-cal symptoms in patients with CHD angina of qi deficiency and blood stasis type.Its mechanism of action is multi-target and multi pathway,mainly related to the regulation of glycerophospholipid metabolism pathway,AMPK signaling pathway,ribosome pathway.

Objective:To explore the clinical value and therapeutic effects of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction using an oblique pedicled rectus abdominis myocutaneous flap(ORAMF).Methods:The data of patients admitted to Hunan Cancer Hospital from May to September 2023 who underwent breast cancer resection followed by immediate breast reconstruction with ORAMF were analyzed retrospectively. Surgical methods: firstly, axillary anterior sentinel lymph node biopsy and subcutaneous glandular excision for breast cancer were performed through a lateral chest incision using an endoscopic technique. Subsequently, a unilateral ORAMF was prepared by removing the epidermis and creating subcutaneous tunnels on the surface of the rectus abdominis myocutaneous flap under direct visualization. The subcutaneous tunnel of the flap was then extended to the deep surface of the breast with the assistance of an endoscope, allowing for the transfer of the ORAMF to reconstruct the breast. Post surgery, the flap survival was monitored, and after discharge, patients received enhanced anti-scar treatment and functional rehabilitation exercises. Follow-up assessments included the evaluation of the reconstructed breast shape, incision scarring in both the donor and recipient areas, abdominal wall function, tumor recurrence and metastasis.Results:A total of 8 female patients with unilateral breast cancer were included in this study, aged between 27 and 52 years, with a mean age of 41.7 years old. The body mass index of the patients ranged from 19.1 to 22.5 kg/m 2. All patients had early-stage breast cancer. During the operation the average mass of the resected breast was 245 g(ranging from 220 to 285 g). The length of the lateral thoracotomy incision varied from 6.9 to 9.5 cm, with a mean length of 7.7 cm. In 3 cases, the ipsilateral ORAMF was used for breast reconstruction, while in 5 cases, the contralateral ORAMF was utilized. The dimensions of the flap were as follows: length (20.4±0.7) cm, width (10.8±1.5) cm, thickness (5.4±0.9) cm, with the volume of the flap cutting ranging from 19.7 cm×9.2 cm×4.4 cm to 21.2 cm×11.8 cm×5.9 cm. All of the flaps exhibited good blood supply and survived successfully without the need for additional anastomotic vessels. The patients were followed up for a period of 8 to 10 months post-operation, with an average follow-up of 8.7 months. The reconstructed breasts maintained a good shape and texture, showing no contracture or deformation of the flap, and were generally symmetrical with the healthy breast. The incisions in both the flap donor area and the recipient area had healed well, leaving only linear scars, and the function of the abdominal wall was not significantly compromised. No recurrence or metastasis was observed during the follow-up period. Conclusion:The endoscopic technique helps to preserve the integrity of the breast skin tissue to the greatest extent possible, reducing scarring and assisting in the creation of subcutaneous tunnels to facilitate the transposition of the ORAMF for breast reconstruction. For carefully selected patients with moderately small breasts and ample subcutaneous tissue in the lower abdomen, the preparation of a unilateral ORAMF for breast reconstruction can yield superior results. This approach minimizes additional damage to the donor area, enhancing the safety of the surgery while significantly reducing the complexity of the operation.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.