Changchun 208 Hospital

Radiation-induced acute rectal injury (RARI) is a common early toxicity after radiotherapy for cervical cancer (CC) and remains difficult to predict before treatment, which can adversely affect life quality of patients. We aimed to develop a combined dual-radiomics and deep learning (DL) model to improve the prediction of RARI in CC patients treated with radiotherapy. This retrospective study included 200 CC patients from one hospital, randomly divided into training (n=160), internal validation (n=40) cohorts and external validation (n=40) from another hospital. Patients were classified as RARI (CTCAE v5.0 grade≥2) or Non-RARI (grade<2). Radiomic and dosiomic features were extracted from CT images and dose distributions, and DL features were learned using 3D CNNs. The performance of radiomics, dosiomics, DL and hybrid features models for RARI prediction was compared using the receiver operating characteristic (ROC) curve with measurement of the area under the curve (AUC). For radiomics combining dosiomics, XGBoost achieved the best performance with AUCs of 0.786 and 0.755 in internal and external validation cohorts, respectively. For DL, Resnet_with_CBAM achieved the best performance in the input of combining CT and dose distribution with AUCs of 0.786 and 0.773 in internal and external validation cohorts, respectively. Nomogram integrating radiomics, dosiomics, DL features, and clinical factor improved the AUC to 0.810, 0.803 in internal and external validation cohorts, respectively. The nomogram integrating radiomics, dosiomics, DL, and clinical factors can improve the predictive performance for RARI in CC patients followed by radiotherapy.

Plasma fibrinogen is essential in thrombosis and fibrinolysis, yet its dynamic changes pre- and post-intravenous thrombolysis (IVT) for predicting brain injury severity and prognosis in acute ischemic stroke (AIS) patients remain unclear. This study examined how fibrinogen trends before and after IVT correlate with brain injury severity and clinical outcomes in IVT-treated patients. This multicenter study prospectively enrolled AIS patients treated with IVT at 16 hospitals and recorded their fibrinogen trends before and after thrombolysis. Levels of brain injury markers were measured to represent the extent of brain injury, including glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1), S100β, and neuron-specific enolase (NSE). Prognostic indicators included early neurological deterioration (END), hemorrhagic transformation, infarct volume, National Institutes of Health Stroke Scale (NIHSS) score at 7 days, 3-month poor outcome (modified Rankin Scale [mRS] score > 1), and mortality. A total of 827 patients were enrolled, with 207 exhibiting elevated fibrinogen levels 24 h after IVT. Patients with elevated fibrinogen levels exhibited significantly higher levels of brain injury markers (GFAP, UCH-L1, S100β), larger infarct volumes, higher NIHSS scores at 7 days, and a higher incidence of END and poor outcomes compared to those with non-elevated fibrinogen levels. Both univariate and multivariate analyses identified elevated fibrinogen levels after IVT as an independent predictor of severe brain injury, larger infarct volume, higher NIHSS score, occurrence of END, and poor outcomes. Elevated fibrinogen levels 24 h after IVT are independently associated with more severe brain injury and worse clinical outcomes in AIS patients.

PurposeGynecological laparoscopic surgery is a common minimally invasive procedure, but postoperative recovery quality remains an important clinical concern. This study aimed to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery in patients undergoing gynecological laparoscopic surgery.Patients and MethodsIn this prospective, randomized, single-blind, controlled trial, patients scheduled for gynecological laparoscopic surgery under general anesthesia at a tertiary hospital in China between April and December 2022 were enrolled. Participants were randomized into the TEAS group and the control group. In the TEAS group, bilateral stimulation of Neiguan, Zusanli, and Hegu acupoints was initiated 30 minutes before anesthesia induction and maintained until the end of surgery. In the control group, electrodes were applied without electrical stimulation (sham procedure). The primary outcome was the incidence of postoperative nausea and vomiting (PONV) within 24 hours. Secondary outcomes included the Quality of Recovery-40 (QoR-40) scores, Pittsburgh Sleep Quality Index (PSQI) scores, pain intensity assessed by numerical rating scale (NRS), and patient-controlled analgesia (PCA) usage.ResultsA total of 85 patients completed the study (TEAS group, n=42; control group, n=43). The incidence of 24-hour PONV was significantly lower in the TEAS group compared to the control group (42.9% vs 67.4%, P=0.023). QoR-40 scores at 48 hours postoperatively were significantly higher in the TEAS group (P<0.001). Additionally, the TEAS group exhibited lower blood glucose levels 30 minutes after skin incision (P=0.045), reduced intraoperative remifentanil consumption (P=0.031), fewer total and effective PCA demands (P=0.004 and P=0.039, respectively), and earlier recovery of gastrointestinal function (all P<0.05).ConclusionPerioperative TEAS effectively reduces the incidence of early postoperative nausea and vomiting and enhances recovery quality in patients undergoing gynecological laparoscopic surgery, but the improvements in QoR-30 scores were statistically significant but not clinically significant. These benefits may be attributed to attenuated stress responses, improved sleep quality, and decreased analgesic requirements.

BackgroundUterine fibroids located at cesarean section scar sites are rare and differ clinically from conventional fibroids, frequently causing abnormal uterine bleeding and infertility. Traditional surgical approaches (laparotomy, laparoscopy, or vaginal surgery) necessitate incision of the scar site, resulting in significant tissue damage. We present a successful case of hysteroscopic resection for such fibroids, demonstrating the minimally invasive advantages of this approach.Case summaryA 49-year-old multiparous woman with a history of cesarean delivery presented with a 2-year history of menorrhagia and prolonged menstrual cycles, exacerbated over the preceding month. Gynecological ultrasound revealed heterogeneous hypoechogenicity within the cervical canal, measuring approximately 5.3 cm × 3.5 cm × 3.3 cm in size. The physical examination revealed an enlarged uterus, approximately the size of 11 cm × 8 cm × 7 cm. Hematologic workup showed the hemoglobin (HGB) level of 65 g/L. Based on these examination results, a clinical diagnosis of “uterine fibroids, secondary anemia” was conducted. Hysteroscopy examination showed that the base of the uterine fibroid was attached to the scar site of the original cesarean section, without a pedicle, and the main body of the fibroid remained in the cervical canal—intraoperative definitive diagnosis: intramural fibroids at the scar site of the uterus. Therefore, a hysteroscopic approach with a bipolar resectoscope was used to remove the intramural fibroids in the scar area of the uterus. The procedure consumed 22,000 ml of fluid distension media (0.9% NaCl) and lasted for 1 h and 45 min. The postoperative pathological diagnosis was uterine leiomyoma, consistent with the preoperative diagnosis. A follow-up was conducted 3 months after surgery, and a gynecological ultrasound examination showed complete removal of uterine fibroids.ConclusionThis case confirmed that hysteroscopic resection of cesarean scar intramural fibroids is a feasible, safe, and minimally invasive approach.

Abstract Objectives Acute respiratory distress syndrome (ARDS) is linked to high mortality rates, with effective assessment of the condition critical to improving patient prognosis. The aim is to explore the value of serum miR-221-3p and lung ultrasound (LUS) score on the prognosis of ARDS, with the aim of providing meaningful references for clinical evaluation and therapeutic strategies. Methods The study cohort comprised 156 patients diagnosed with sepsis-induced ARDS. MiR-221-3p levels were quantified using RT-qPCR. Prognostic significance was determined by the ROC curve and Logistic analysis. Furthermore, a cell injury model was established in human pulmonary microvascular endothelial cells (HPMECs) induced by LPS, and the effects of miR-221-3p on cell viability and apoptosis of HPMECs were examined utilizing CCK-8 and flow cytometry. ELISA was utilized to evaluate the role of miR-221-3p on inflammatory factors and cell adhesion molecules. Results In deceased ARDS patients, elevated levels of serum miR-221-3p demonstrated a notable positive correlation with APACHE II score, SOFA score, procalcitonin, and LUS score. Notably, miR-221-3p and LUS score were identified as prognostic factors associated with patient mortality, and the integration of these two assays resulted in a more accurate assessment of patient prognoses. In HPMECs exposed to LPS, miR-221-3p silencing enhanced cell survival, suppressed apoptosis, and reduced levels of inflammatory cytokines (TNF-α, IL-6, IL-1β) and adhesion molecules (ICAM-1, E-selectin). Conclusions MiR-221-3p, combined with LUS assessment, holds prognostic value in ARDS. Its involvement in inflammation and cellular damage suggests a modulatory effect on disease advancement.

Myocardial infarction (MI) is a global health concern that necessitates continued advancements in diagnostic and therapeutic modalities. Nanotechnology facilitates prompt diagnosis and personalized treatment. This manuscript explicitly reviews the application of innovative methodologies for identifying cardiac biomarkers to facilitate the early diagnosis of MI and its clinical management. Nanoscale agents such as nanoparticles and nanosensors have been employed for this purpose. Technological advancements in medical imaging are revolutionizing therapeutic approaches while reducing morbidity and mortality typically associated with cardiac tissue injury. Besides all, applications of nanotechnology in therapeutics have proven extremely effective. The development of nanoparticle-based customized drug delivery systems will contribute to more effective treatments, fewer side effects, and improved therapeutic outcomes. Biomaterials and nanoscale surgical technologies may benefit patients with MI by promoting tissue regeneration and repair. This manuscript also investigates the ethical and legal limitations that could prevent seamless incorporation of nanotechnology into clinical practice.

Artemether (Art) is a derivative of artemisinin, originally sourced from traditional Chinese herbal medicine, with improved bioavailability, and is widely used for malaria treatment. Recently, its potential effects on diabetic complications, particularly diabetic kidney disease (DKD), have attracted increasing attention. This study aimed to evaluate the therapeutic effects of Art on DKD and to explore the underlying mechanisms. Specifically, we investigated the protective role of Art against high glucose (HG)-induced inflammatory biomarkers (transforming growth factor-β1 [TGF-β1], tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], and interleukin-6 [IL-6]) and fibrosis in human renal proximal tubular epithelial (HK-2) cells, focusing on the involvement of peroxisome proliferator-activated receptor gamma (PPARγ) in DKD. To mimic diabetic conditions, HK-2 cells were exposed to HG (30 mM) to induce inflammation and fibrosis. The therapeutic effects of Art (100 and 200 μm) were assessed by immunofluorescence, real-time RT-PCR, and Western blot analyses. Our results demonstrated that Art effectively reversed the HG-induced upregulation of inflammatory and fibrogenic markers in HK-2 cells (∗p < 0.05, ∗∗p < 0.001, and ⁣##p < 0.001). Additionally, Art pretreatment restored the HG-suppressed expression of PPARγ (∗p < 0.05 and ⁣##p < 0.001), suggesting that Art exerts its antifibrotic effects by modulating PPARγ and inhibiting the TGF-β/Smad pathway. This hypothesis was further supported by siRNA-mediated knockdown of PPARγ, which significantly diminished Art's antifibrotic effects (∗p < 0.05, ∗∗p < 0.001, and ⁣##p < 0.001). In conclusion, our study indicates that Art protects renal tubular epithelial cells by partially modulating PPARγ-dependent inhibition of the TGF-β/Smad pathway, thereby mitigating HG-induced inflammation and fibrosis. These findings suggest that Art holds promising therapeutic potential for DKD treatment.

A simple yet effective strategy for detecting and in situ degrading tetracycline offers an innovative dual-purpose solution for treating organic pollutants.

Currently, validated biomarkers for assessing hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) are lacking. We aimed to validate a test combining GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin C-terminal hydrolase-L1) to indicate the absence of HT after IVT. We prospectively enrolled consecutive patients with stroke treated with IVT from 16 hospitals. Serum GFAP and UCH-L1 levels were measured 24 hours after IVT. Cases from 1 hospital were randomly assigned to the training (70%) and testing (30%) cohorts for internal validation. The external validation cohort included patients from the other 15 hospitals. Cutoff levels of GFAP and UCH-L1 for assessing the absence of HT were established in the training cohort and subjected to internal and external verification. A total of 1063 patients were included. Both GFAP and UCH-L1 levels were independently associated with HT, infarct volume, and 3-month outcome; levels lower than cutoff (12.6 and 63.1 pg/mL, respectively) excluded patients with HT with a negative predictive value of 98.31% (95% CI, 89.70%-99.91%) and detection sensitivity of 98.08% (95% CI, 88.42%-99.90%) in the training cohort. In the testing and validation cohorts, negative predictive value was 100% (95% CI, 75.93%-100%) and 100% (95% CI, 82.19%-100%), respectively, and the sensitivity was 100% (95% CI, 80.76%-100%) and 100% (95% CI, 77.08%-100%), respectively. Serum GFAP and UCH-L1 levels exhibit high sensitivity and negative predictive value for indicating the absence of HT 24 hours after IVT, which supports their potential role in assessing patients' condition after IVT.

With the prevalence of sequentially-emerged sublineages including BA.1, BA.2 and BA.5, SARS-CoV-2 Omicron infection has transformed into a regional epidemic disease. As a sublineage of BA.5, the BA.5.2.48 outbroke and evolved into multi-subvariants in China without clearly established virological characteristics. Here, we evaluated the virological characteristics of two isolates of the prevalent BA.5.2.48 subvariant, DY.2 and DY.1.1 (a subvariant of DY.1). Compared to the normal BA.5 spike, the double-mutated DY.1.1 spike demonstrates efficient cleavage, reduced fusogenicity and higher hACE2 binding affinity. BA.5.2.48 demonstrated enhanced airborne transmission capacity than BA.2 in hamsters. The pathogenicity of BA.5.2.48 is greater than BA.2, as revealed in Omicron-lethal H11-K18-hACE2 rodents. In both naïve and convalescent hamsters, DY.1.1 shows stronger fitness than DY.2 in hamster turbinates. Thus regional outbreaking of BA.5.2.48 promotes the multidirectional evolution of its subvariants, gaining either enhanced pathogenicity or a fitness in upper airways which is associated with higher transmission.