Objective To explore the diagnostic efficiency of inflammatory cytokines in chronic obstruc-tive pulmonary disease(COPD)complicating pneumonia.Methods A total of 215 patients with COPD admit-ted and treated in the First Affiliated Hospital of Nanjing Medical University from July 2021 to August 2023 were selected as the study subjects.According to whether or not complicating pneumonia,the patients with complicating pneumonia were included in the observation group(n=87)and those with simple COPD were included in the control group(n=128).The changes of inflammation cytokines[procalcitonin(PCT),tumor necrosis factor-α(TNF-α),C reactive protein(CRP),interleukin-6(IL-6),WBC]and lung function indicators[peak expiratory flow rate(PEF),breathing volume in the first second(FEV1),forced vital capacity(FVC)]were compared between the two groups.The diagnostic efficiency of inflammatory cell factors in COPD com-plicating pneumonia as well as the correlation between the inflammatory cytokines and the lung function in the patients with COPD complicating pneumonia were analyzed.Results The levels of PCT,CRP,IL-6,TNF-αand white blood cell count(WBC)in the observation group were significantly higher than those in the control group(P＜0.05),and FEV1,FVC and PEF in the observation group were significantly lower than those in the control group(P＜0.05).The diagnostic efficiency of joint detection of PCT,CRP,IL-6,TNF-α and WBC in diagnosing COPD complicating pneumonia was better,the sensitivity was 90.80％,the specificity was 90.62％,the area under the curve(AUC)was 0.967.The correlation analysis revealed that the PCT,CRP,IL-6,TNF-α and WBC levels in the patients with COPD complicating pneumonia were negatively correlated with FEV1,FVC and PEF levels(P＜0.05).Conclusion The patients with COPD complicating pneumonia exhibit the typical inflammatory responses and deterioration of lung function.The combined detection of relevant in-flammatory indicators has the good diagnostic efficiency for it.

Objective To investigate the diagnostic value of biparametric magnetic resonance imaging(bpMRI)radiomics combined with prostate-specific antigen density(PSAD)in predicting low-grade and high-grade prostate carcinoma(PCa).Methods The clinical and imaging data of patients with PCa confirmed by pathology in Taizhou Central Hospital from June 2018 to October 2022 were retrospectively analyzed.According to Gleason grade group(GGG),GGG≤2 was defined as low-grade PCa,and GGG＞2 was defined as high-grade PCa.PCa patients with different grades were randomly divided into training group and test group according to a ratio of 7∶3.Radiomics features were extracted based on T2 weighted imaging(T2WI)and apparent diffusion coefficient(ADC)sequences.Feature selection and dimensionality reduction were carried out using maximum relevance minimum redundancy,least absolute shrinkage and selection operator,and 5-fold cross validation was performed to retain the best radiomics features.Receiver operating characteristic(ROC)curve and Delong's test were used to evaluate the performance of each model.Decision curve analysis(DCA)was used to evaluate the clinical utility of the model.Results Among all the models,T2WI-ADC-PSAD combined model had the best diagnostic efficiency,the area under the curve(AUC)in training group and test group were 0.882,0.772,respectively.Delong's test showed that in training group,there was no significant difference in AUC between T2WI-ADC-PSAD model and T2WI model(P＞0.05),but there were significant differences between T2WI-ADC-PSAD model and other models(P＜0.05).In test group there were no significant differences in AUC between T2WI-ADC-PSAD model and other models(P＞0.05).The DCA showed that the T2WI-ADC-PSAD model provided a higher net benefit for clinical decision-making when the threshold probability was less than 97％.Conclusion BpMRI radiomics combined with PSAD can improve the diagnostic efficiency of low-grade and high-grade PCa,and guide the treatment decision of patients.

Objective: To evaluate the accuracy and feasibility of coronary artery calcium score ( CACS) on virtual non-contrast scan ( VNC) images obtained from coronary artery CT angiography ( CCTA) scan with dual －layer spectral detector CT (SDCT) ． Methods : The data of 197 patients who underwent CCTA scan in hospital were analyzed retrospectively，and 88 patients with CACS ＞0 were further analyzed． Linear regression analysis of CACS and coronary artery calcium volume ( CACV) of true non-contrast (TNC) images and VNC images ( CACS-TNC， CACS-VNC，CACV-TNC，CACV-VNC) was performed to obtain linear regression equation and correction coefficients λ 1AVG and λ2AVG ．CACS-VNC and CACV-VNC were corrected by the corresponding regression equation and recorded as CCACS-VNC and CCACV-VNC，respectively．Spearman correlation coefficient was used for correlation analysis and Bland-Altman plot was used for consistency test．Mann-Whitney U test was used to compare the difference between the two groups. Results : For the total coronary artery，there was a strong correlation between CACS- TNC and CACS-VNC (rs = 0. 952，P ＜0. 001 ，λ 1AVG = 2. 19 ) ，CACV-TNC and CACV-VNC ( rs = 0. 954，P < 0. 001，λ2AVG = 1. 93) ．The results of Mann-Whitney U test showed that there was no significant difference between CACS-TNC and CCACS-VNC or between CACV-TNC and CCACV-VNC，and the Bland-Altman plot showed good consistency between CACS-TNC and CCACS-VNC ，CACV-TNC and CCACV-VNC． Conclusion VNC images based on SDCT can accurately measure CACS and be used for cardiovascular risk classification，which is expected to replace TNC scan and reduce the radiation dose of patients.

Objective:To investigate the influencing factors for anastomotic biliary stric-ture after liver transplantation.Methods:The retrospective case-control study was conducted. The clinical data of 428 recipients who underwent allogeneic orthotopic liver transplantation in the First Hospital of Jilin University from September 2014 to August 2021 were collected. There were 324 males and 104 females, aged (52±10)years. Observation indicators: (1) surgical conditions of recipients; (2) occurrence of anastomotic biliary stricture after liver transplantation and its treat-ment; (3) analysis of influencing factors for anastomotic biliary stricture after liver transplantation. Follow-up was conducted using outpatient examination to detect occurrence of anastomotic biliary stricture and treatment up to August 30, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were represented as absolute numbers, and the chi-square test was used for comparison between groups. Logistic regression model was used for multivariate analysis. Results:(1) Surgical conditions of recipients: the operation time of 428 recipients was 465(420,520)minutes, the cold ischemia time was 368(320,450)minutes, and the volume of intraoperative blood loss was 2 500(1 500,4 000)mL. Of the 428 recipients, 142 cases were performed continuous biliary posterior wall anastomosis + interrup-ted anterior wall anastomosis by polygluconate sutures, 286 cases were anastomosed with polypro-pylene sutures, including 169 cases undergoing continuous biliary posterior wall anastomosis combined with interrupted anterior wall anastomosis, 73 cases undergoing completely interrupted biliary anterior and posterior wall anastomosis, and 44 cases undergoing completely continuous biliary anterior and posterior wall anastomosis. None of the 428 recipients had indwelling T tubes. (2) Occurrence of anastomotic biliary stricture after liver transplantation and its treatment:all the 428 recipients were followed up for 3 to 72 months, with a median follow-up time of 28 months. During the follow-up, 50 patients developed anastomotic biliary stricture, of which 41 patients were treated with endoscopic retrograde cholangiopancreatography, 8 patients were treated with percutaneous transhepatic cholangial drainage, and 1 patient was treated with surgery, showing no recurrence. (3)Analysis of influencing factors for anastomotic biliary stricture after liver transplanta-tion: results of univariate analysis showed that anastomosis method and donor liver cold ischemia time were related factors for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation ( χ2=15.74, Z=-2.04, P<0.05). Results of multivariate analysis showed that completely interrupted biliary anterior and posterior wall anastomosis and donor liver cold ischemia time were independent influencing factors for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation ( odds ratio=0.25, 1.00, 95% confidence interval as 0.08-0.85, 1.00-1.01, P<0.05). Conclusions:Suture type is not an influencing factor for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation. Completely interrupted biliary anterior and posterior wall anastomosis and donor liver cold ischemia time were independent influencing factors.

The redox biosynthesis system has important applications in green biomanufacturing of chiral compounds. Formate dehydrogenase (FDH) catalyzes the oxidation of formate into carbon dioxide, which is associated with the reduction of NAD(P)⁺ into NAD(P)H. Due to this property, FDH is used as a crucial enzyme in the redox biosynthesis system for cofactor regeneration. Nevertheless, the application of natural FDH in industrial production is hampered by low catalytic efficiency, poor stability, and inefficient coenzyme utilization. This review summarized the structural characteristics and catalytic mechanism of FDH, as well as the advances in protein engineering of FDHs toward improved enzyme activity, catalytic efficiency, stability and coenzyme preference. The applications of using FDH as a coenzyme regeneration system for green biomanufacturing of chiral compounds were summarized.
Catalysis ; Coenzymes/metabolism* ; Formate Dehydrogenases/metabolism* ; NAD/metabolism* ; Protein Engineering

Objective:To explore the feasibility and advantages of planned initiation of extracorporeal membrane oxygenation(ECMO)prior to liver transplantation.Methods:From November 2017 to July 2021, clinical data were retrospectively reviewed for 3 liver transplantation recipients assisted by ECMO.There were such preoperative symptoms of right ventricular dysfunction as fatigue, chest tightness and palpitations.In the first case, right heart catheterization was not performed due to patient refusal; another two patients were screened by transthoracic Doppler echocardiography(TDE)and diagnosed through right heart catheterization as portopulmonary hypertension(POPH)and pulmonary hypertension.Results:Three recipients with pulmonary hypertension received catheterization in right femoral artery and vein.After freeing of diseased liver and before blocking inferior vena cava, V-A ECMO support was performed.The dose of heparin was adjusted according to activated clotting time(ACT)and perioperative vital signs remained stable.They were ventilated for 54, 12 and 62 hours and supported by ECMO for 27, 61 and 14 hours.All were smoothly discharged.During a mean follow-up period of 26(9-22)months, liver functions were normal.Conclusions:Patients with end-stage liver disease with pulmonary hypertension should undergo routine TDE examinations during waiting period before liver transplantation.Those with pulmonary hypertension should undergo further right heart catheterization to confirm the diagnosis and severity of the disease.Planned application of ECMO through multidisciplinary consultations can expand surgical indications for liver transplantation, maintain intraoperative hemodynamic stability and facilitate smooth liver transplantation and postoperative patient recovery.

Objective To compare the difference of efficacy and adverse effects between TEC-NX regimen (Docetaxel + Epirubicin + Cyclophosphamide sequential Vinorelbine + Capecitabine) with TEC regimen (Docetaxel + Epirubicin + Cyclophosphamide) in the adjuvant chemotherapy of locally advanced breast cancer.Methods A retrospective study was conducted to select 58 patients with locally advanced breast cancer who underwent ≥4 axillary lymph node metastasis from April 2008 to April 2015 at the International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University School of Medicine.All patients were female,average age was 48 years old,rang from 29 to 63 years old.Patients were divided into TEC-NX group (n =23) and TEC group (n =35) according to different treatment methods.TEC-NX group patients received chemotherapy with TEC-NX regimen and TEC group patients received chemotherapy with TEC regimen.The 3-year overall survival rate and 3-year disease-free survival rate were compared between the two groups.The differences in adverse reactions such as myelosuppression,liver dysfunction and fever were compared between the two groups.The Chi-square test was used to compare the count data between the two groups;the survival analysis was performed by Kaplan-Meier method.Results The 3-year overall survival rate was 91.3％ in the TEC-NX group and 91.4％ in the TEC group,and the difference was not statistically significant (P =0.995).The 3-year disease-free survival rate was 73.9％ in the TEC-NX group and 85.7％ in the TEC group,and the difference was not statistically significant (P=0.289).The incidence of grade Ⅲ or Ⅳ myelosuppression in the TEC-NX group was 26.0％,which was significantly lower than that in the TEC group (65.7％),and the difference was statistically significant (P =0.009).The incidence of liver dysfunction was 91.3％ in the TEC-NX group,and there was not statistically significant compared with 93.5％ in the TEC group (P =0.523).The incidence of fever in the TEC-NX group was 17.4％,which was not statistically significant compared with the TEC group (14.3％) (P =0.749).Conclusion In adjuvant chemotherapy for locally advanced breast cancer,the TEC-NX regimen does not improve 3-year overall survival and disease-free survival compared with the TEC regimen,but the TEC-NX regimen significantly reduced the incidence of grade Ⅲ or Ⅳ myelosuppression.

Objective To determine the trend of emergency department (ED)mortality of a tertiary general hospital from 2004 to 2014 in order to find the factors that may impact on ED mortality.Methods Mortality in ED was estimated according to the ratio of ED visiting patients to ED deaths.And the data of all ED deaths in 2004,2009 and 2014 were collected.Variance analysis and chi-square test were used for data analysis.Results During the past decade,ED visiting patients was increased significantly by 38.0% in 2014,compared with those in 2004,and the mortality was also increased accordingly from 0.7% in 2004, to 0.9% in 2009,to 1.2% in 2014 (P <0.01).Finally,a total of 1,091 deaths occurred in these three years were included for further evaluation.There were no significant changes in average age and gender distribution,and the average age was 61.9 and the male /female ratio was 1.36∶1 during past decade.The number of adults under 40 years old (18 -39)increased from 7.5% in 2004,to 10.6% in 2009,to 14.4% in 2014 (P <0.05).Both the facilities were upgraded and the number of staffs in ED increased markedly.The cardiovascular illness,cerebrovascular diseases,and sudden death were the leading causes of ED death during past decade.The incidences of trauma and tumor remained unchanged.Average time consumed from onset of illness to arrival to ED didn’t vary significantly during past decade.The study showed no changes in use of ambulance,but remarkable increases in number of non-compliant patients or their family from 18.3% in 2004,to 25.6% in 2009,to 38.3% in 2014 (P <0.01).The percentage of patients in the night time was higher,but there were no significant changes in number of emergency patients in the night time and during holidays in the past decade,but the mean ED stay time increased obviously from 22.4 h in 2004 to 53.3 h in 2014 (P <0.05 ).Conclusions During the past decade,although ED facilities and number of staffs have been improved apparently,ED mortality rate still keeps on escalating. The increase in ED mortality rate may be related to the severely ill patients presenting to ED,the obvious decrease in compliance of patients and the prolonged ED stay time.

Aged ; Female ; Humans ; Myocardial Infarction ; diagnosis ; Polycythemia Vera ; complications

Objective To investigate the diagnostic value of parametric imaging of contrast-enhanced ultrasound (CEUS) in retroperitoneal tumors using SonoLiver software. Methods Sixty cases of retroperitoneal tumors were analyzed by CEUS with SonoLiver software. The color-mapped images of timedependent indexes, such as rise time(RT), time to peak(TTP), mean transit time(mTT), were abserved in the regions of interests(ROIS). The degree of the coincidence between pathologic diagnosis and parametric imaging diagnosis was carefully study by comparing parametric images with histopathological findings.Results 1 ) There was statistical significance of RT, TTP and mTT between the benign and malignant retroperitoneal tumors. 2) The time-dependent parametric images were obvious different between benign lesions and malignant lesions. The malignant lesions enjoyed a confused boundary and distribute disorderly,while the benign tumors had a clear distribution. There was a good coincidence degree between pathologic diagnosis and parametric imaging diagnosis(κ =0. 625, P =0. 000). Sensibility, specificity, the rate of misdiagnosis and missed diagnosis, the degree of accuracy respectively was 85.3 ％, 76.9 ％, 23.1 ％, 14.7 ％,81.7％ by the new diagnosis method. Conclusions Parametric imaging is a very useful way of evaluating the level of blood flow with the tumors and provides a new vision in the diagnosis of retroperitoneal tumors. It demonstrates retroperitoneal tumors clearly and objectively.