Cases In Group Research Articles

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study.

Studies of chylothorax after congenital heart disease in infants are rare. Chylothorax has a higher incidence in infancy, but its risk factors are not well understood. The purpose of this study is to investigate the risk factors of chylothorax after congenital heart surgery in infants. This retrospective study included 176 infants who underwent congenital heart disease surgery at the Guangdong Cardiovascular Institute, China, between 2016 and 2020. According to the occurrence of chylothorax, the patients were divided into a control group (n = 88) and a case group (n = 88). Univariate and multivariate logistic regression were performed to analyse the incidence and influencing factors of chylothorax after congenital heart surgery in infants. Between 2016 and 2020, the annual incidence rate fluctuated between 1.55% and 3.17%, and the total incidence of chylothorax was 2.02%. Multivariate logistic regression analysis showed that postoperative albumin (p = 0.041; odds ratio [OR] = 0.095), preoperative mechanical ventilation (p = 0.001; OR = 1.053) and preterm birth (p = 0.002; OR = 5.783) were risk factors for postoperative chylothorax in infants with congenital heart disease. The total incidence of chylothorax was 2.02% and the annual incidence rate fluctuated between 1.55% and 3.17% between 2016 and 2020. Premature infants, longer preoperative mechanical ventilation and lower albumin after congenital heart surgery may be risk factors for chylothorax. In addition, infants with chylothorax are inclined to be infected, need more respiratory support, use a chest drainage tube for longer and remain longer in hospital.

Gene Biomarkers in Congenital Hyperinsulinism

Congenital hyperinsulinism (CHI) is a rare type of disease that causes a severe drop in blood sugar in infants. This diseaseprevents reaching enough sugar to the child’s brain and causes lifelong and permanent damage. This study aims to investigate genebiomarkers in congenital hyperinsulinism. In this study, after reviewing the texts and searching for the bioinformatics databases of NCBI,Genecards, Swiss-prot, Diseasome, etc., the genes involved in the disease based on at least one of the methods in-vivo, in-vitro, and insilicohas been extracted as candidate genes. The expression data obtained from each group was standardized compared to the controlgroup to compare the results in case and control groups. Then, the connection network of expression data of candidate genes in patientsand healthy people were drawn separately with the help of MATLAB software (Version 9.1), and the correctness of these networks anddetermined biomarkers were checked using the rectome and diseasome database. All statistical calculations were done using R and Matlabsoftware. In the present study, the essential genes of CHI disease were identified using 5 central criteria, including maximum neighborhoodcomponent, degree, closeness, radiality, and betweeness. Based on the results of the central criteria method, INS-PRKACA-PRKACBPRKACG-AKT1 genes had the most repetitions. According to the identification of the most effective genes related to CHI disease in thepresent study, it is suggested that further studies need to be designed at the in vitro and clinical levels on the identified effective genes asdiagnostic biomarkers of CHI disease.

Humoral Cytokine Levels in Patients with Herpes Zoster: A Meta-Analysis.

The neurocutaneous disease caused by the reactivation of varicella-zoster virus (VZV) is called herpes zoster (HZ). The virus remains in the spinal cord back root after the chickenpox disappears. Diminished immune function can reactivate VZV, causing severe neuropathic pain that can last for months or even years, leading to postherpetic neuralgia (PHN), which severely affects the patient's quality of life. Much literature compares various cytokine levels in the body fluids HZ and PHN patients; however, no studies comprehensively evaluate them. The Cochrane Library, PubMed, Web of Science, and Medline were screened for studies on cytokine levels in body fluids of HZ and PHN patients in the English language. Healthy individuals were selected as the control group, and the standardized mean difference (SMD) between the case and control groups was imputed using a fixed-effects or random-effects model and expressed as a 95% confidence interval (CI). The Newcastle-Ottawa Scale (NOS) was used to assess article quality. This meta-analysis included 13 articles with 1373 participants. Compared with the control group, the HZ group had significantly higher levels of interleukin (IL)-4, IL-6, IL-10, Hcy, and C-reactive protein (CRP), whereas the levels of CD3+ T and CD4+ T lymphocytes were reduced. Additionally, PHN patients had significantly higher levels of IL-6 and IL-1β compared with the control group. This meta-analysis provides compelling evidence that CRP, Hcy, IL-1β, IL-4, IL-6, IL-8, and IL-10 are associated with the genesis and development of HZ and PHN. These markers can be used to improve the diagnosis and treatment of these diseases.Furthermore, for making the results more convincing, it is necessary to harmonize sample acquisition techniques and analytical methods and also require larger, more rigorously designed studies with broader subgroups and sex/age-matched controls.

Characteristics of lymphocyte subsets and inflammatory factors in patients with COVID-19

ObjectiveThis research aims to examine the involvement of lymphocyte subsets and inflammatory cytokines in the development and progression of COVID-19. Methods164 COVID-19 patients were admitted to hospital between December 2022 and January 2023. Based on lung CT scans and whether it is necessary for intensive care unit (ICU) admission, they were categorized into: severe groups (84) and mild disease groups (80). Peripheral blood were also collected from 101 healthy examinees and 164 patients. Flow cytometry (FCM) was used to measure the absolute and relative counts of lymphocyte subsets, while chemiluminescence was used to detect the level of inflammatory cytokines. ResultsThe COVID-19 patient group exhibited lower count of lymphocytes subsets than healthy control group. Moreover, COVID-19 patient case presented higher content of cytokines (IL-6, IL-4, IL-8, IL-10, and TNF-α) expression compared to healthy control case. Within the COVID-19 patient group, individuals with severe disease showed lower counts of lymphocytes subsets than the mild disease case. Furthermore, IL-6 levels in severe case were higher than the mild disease patients case. Multi-variate logistic regression analysis confirmed IL-6 (odds ratio: 0.985 [0.977–0.993]), CD3+ T cells (odds ratio:1.007 [1.004–1.010]), CD8+ T cells (odds ratio:1.016 [1.009–1.023]), and CD19+ B cells (odds ratio:1.011 [1.002–1.020]) independently predicted severe progression. ROC curve results indicated AUC for lymphocytes in patients with severe COVID-19 was 0.8686 (0.8112–0.9260), CD3+ T cells was 0.8762 (0.8237–0.9287), CD8+ T cells was 0.7963 (0.7287–0.8638), CD4+ T cells was 0.8600 (0.8036–0.9164), CD19+ B cells was 0.7217 (0.6434–0.8001), NK cells was 0.6492 (0.5627–0.7357), age was 0.6699 (0.5877–0.7521), diabetes was 0.5991 (0.5125–0.6857), and IL-6 was 0.7241 (0.6479–0.8003). Furthermore, the ROC curves for different factors (CD3+ T cells, age, IL-6) yielded an AUC of 0.9031 (0.8580–0.9483). ConclusionsThe research indicated that COVID-19 patients experience a decrease in lymphocytes subset and an increase in the inflammatory factor IL-6, particularly in the severe case group. As a result, the count of lymphocyte subset (CD3+ T cells) and the content of inflammatory cytokine (IL-6) can serve as predictive markers for assessing the severity of COVID-19 and developing treatment plans efficacy.

Association between BMI and osteoporotic fractures at different sites in Chinese women: a case-control retrospective study in Changsha

BackgroundOsteoporotic fractures are a growing problem in an aging society. The association between body mass index (BMI) and osteoporotic fractures varies by fracture site and ethnicity. Limited knowledge exists regarding this association in native Chinese, particularly utilizing local databases as reference sources.ObjectiveTo investigate the association between BMI and osteoporotic fractures at different sites in Chinese women.MethodsThree thousand ninety-eight female patients with radiographic fractures and 3098 age- and sex-matched healthy controls without fractures were included in the study. Both of them underwent assessment using dual-energy X-ray absorptiometry (DXA), with BMD measurements calculated using our own BMD reference database. Participants were classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese BMI classification standard.ResultsThere were 2296 (74.1%) vertebral fractures, 374 (12.1%) femoral neck fractures, and 428 (13.8%) other types of fractures in the case group. Bone mineral density (BMD) was almost lower in the fracture groups compared to the control groups (p = 0.048 to < 0.001). Compared with normal weight, underweight had a protective effect on total [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.49 –0.75; P< 0.001], and lumbar fractures (OR = 0.52; 95% CI, 0.41 – 0.67; P < 0.001), while obesity was associated with an increased risk for total (OR = 2.26; 95% CI, 1.85 – 2.76; P < 0.001), lumbar (OR = 2.17; 95% CI, 1.72 – 2.73; P < 0.001), and femoral neck fractures (OR = 4.08; 95% CI, 2.18 – 7.63; P < 0.001). Non-linear associations were observed between BMI and fractures: A J-curve for total, lumbar, and femoral neck fractures, and no statistical change for other types of fractures. Underweight was found to be a risk factor for other types of fracturess after adjusting for BMD (OR = 2.29; 95% CI, 1.09 – 4.80; P < 0.001). Osteoporosis and osteopenia were identified as risk factors for almost all sites of fracture when compared to normal bone mass.ConclusionsUnderweight has a protective effect on total and lumbar spine fractures in Chinese women, while obesity poses a risk factor for total, lumbar, and femoral neck fractures. The effect of BMI on fractures may be mainly mediated by BMD.

Risk factors and clinical characteristics of surgical site infections in athletes undergoing Achilles tendon repair surgery.

Achilles tendon ruptures are common in athletes, requiring surgical intervention. However, the risk of surgical site infections (SSIs) post-surgery poses significant challenges. This study aims to analyse the risk factors and microbial aetiology associated with SSIs in athletes undergoing Achilles tendon repair. A comprehensive retrospective analysis was conducted from May 2021 to July 2023. The study included 25 patients with SSIs (case group) and 50 patients without SSIs (control group) post Achilles tendon repair surgery. Inclusion criteria encompassed patients with medically confirmed Achilles tendon ruptures who underwent surgical repair. Exclusion criteria included prior tendon pathologies and significant chronic illnesses. Diagnostic criteria for SSIs involved symptoms like elevated body temperature and localized tenderness, along with laboratory confirmations such as positive microbiological cultures. The study utilized VITEK® 2 for bacterial identification and involved statistical analyses like univariate and multivariate logistic regression. The study identified Staphylococcus aureus as the primary pathogen in SSIs. Significant risk factors included lack of prophylactic antibiotic use, presence of diabetes, open wounds and prolonged surgery duration. Univariate analysis revealed stark contrasts in these factors between infected and non-infected groups, while multivariate analysis underscored their importance in SSI development. S. aureus emerged as the predominant pathogen in SSIs post Achilles tendon repair. Critical risk factors such as absence of prophylactic antibiotics, diabetes, open wounds and extended surgery duration play a vital role in SSIs. Addressing these factors is essential for better postoperative outcomes in Achilles tendon repair surgeries.

IL-18 and CD14 variants in chronic HBV predisposition: a case-control study with in silico analyses focused on transcription and splicing

Hepatitis B virus (HBV), a vaccine-avoidable infection, is a health concern worldwide, leading to liver disorders such as acute self-constraint and chronic hepatitis, liver failure, hepatic cirrhosis, and even hepatocellular carcinoma if untreated. ‘Immunogeneticprofiling’, genetic variations of the pro- and anti-inflammatory cytokines responsible for regulating the immune responses, cause person-to-person differences and impact the clinical manifestation of the disease. The current experimental–bioinformatics research was conducted to examine whether promoteric IL-18–rs187238 C > G and –rs1946518 T > G and intronic CD14–rs2569190 A > G variations are associated with chronic HBV. A total of 400 individuals (200 in each case and control group) participated in the study and were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The data was also assessed bioinformatics-wise for conservation, genomic transcription and splicing, and protein interactions. Findings proposed that unlike the IL-18–rs1946518 T > G and CD14–rs2569190 A > G, the IL-18–rs187238 C > G is a protector against chronic HBV (odds ratio [OR] = 0.62, 95% confidence intervals [CI]: 0.46–0.83, and p = 0.002). The TG/CC/AA, TG/CC/AG, TT/CC/AG, and GG/CC/AA combined genotypes significantly increased chronic HBV risk (p < 0.05), while the IL-18 G/T and G/G haplotypes lessened it (p < 0.05). Moreover, IL-18–rs1946518 T > G is in the protected genomic regions across mammalian species. In contrast to the IL-18–rs1946518 T > G, IL-18–rs187238 C > G is likely to create novel binding sites for transcription factors, and the CD14–rs2569190 A > G presumably changed the ribonucleic acid splicing pattern. More research on larger populations and other ethnicities is required to authenticate these results.

Value of high‑risk human papillomavirus detection combined with colposcopy in the diagnosis of cervical cancer and precancerous lesions.

In the present study, the diagnostic value of high risk-human papillomavirus (HR-HPV) combined with colposcopy for the detection of cervical cancer and precancerous lesions was evaluated. A total of 397 patients with confirmed cervical disease were enrolled between August 2020 and December 2021. According to the pathological diagnosis, the patients were divided into cervical intraepithelial neoplasia grade I (CIN I; n=153 cases), CIN II (n=101 cases), CIN III (n=86 cases) and cervical cancer (n=57 cases) groups. The HR-HPV-positive rate of the patients with different lesion types was compared, and the consistency of colposcopy and pathological examination results were assessed. For cervical cancer and precancerous lesions, the diagnostic value and efficacy of HR-HPV testing, colposcopy and combined HR-HPV testing and colposcopy examination were compared using pathological examination results as the gold standard. The results of the present study demonstrated that in patients with cervical cancer, the positive rate of HR-HPV (100.00%; n=57/57) was higher than that in patients with precancerous lesions, and the positive rate of HR-HPV in patients with CIN I type (36.60%, n=56/153) was lower than that in patients with CIN II (83.17%, n=84/101) and CIN III (82.56%, n=71/86) types (P<0.05). There was no significant difference in the HR-HPV-positive rate between patients with CIN II and CIN III (P>0.05). Cohen's κ coefficient for colposcopy examination and pathological examination of patients with cervical cancer and precancerous lesions was 0.622, the diagnostic accuracy was 90.43% (n=359/397), the positive predictive value was 65.57% (n=40/61), and the negative predictive value was 94.94% (n=319/336). Receiver operating characteristic curve analysis demonstrated that the area under the curve of the combined examination in the diagnosis of cervical cancer and precancerous lesions was 0.904, which was higher than that of colposcopy (0.820) or HR-HPV testing (0.802) alone (P<0.05). The results of the present study indicated that HR-HPV detection combined with colposcopy has diagnostic value for cervical cancer and precancerous lesions.

LEVELS OF PROCALCITONIN IN THE PATIENTS OF SEPSIS

Sepsis, a life-threatening complication of an infection, resulting from release of cytokines in the bloodstream to fight an infection, ultimately triggering inflammation throughout the body. This can cause a cascade of changes that damage multiple organ systems, leading them to fail, sometimes even resulting in death.Crucial steps for a successful treatment and positive outcomes, are an early diagnosis and differentiation from non-infectious causes. PCT is biomarker that has diagnostic, therapeutic and prognostic significance. The study was undertaken to identify whether serum pro-calcitonin can act as a superior marker in septicemia. Material Method-This is prospective case control-pilot study.Total 60 subjects were included, Case group comprised of 30 IPD patients of sepsis, whereas 30 heathy individuals were included in control group. Levels of PCT, CRP levels and neutrophil count were analyzed in both the groups .PCT levels were analyzed by electrochemiluminescence method using commercially available kit &amp; CRP levels by Nephelometry method respectively. Neutrophil counts were done on Sysmex five-part cell counter. Result- The levels of Neutrophils (%), PCT (ng/ml) and CRP (mg/L) were significantly high is study group with mean of 79.94 ± 16.9, 7.27 ± 18.6 and 64.2±49.9 respectively in study group with p value &lt;0.001.CRP and PCT are similarly significant markers with co-relation coefficient of 0.518. Conclusion-Procalcitonin can be used as an inflammatory marker for sepsis with added significance of diagnostic as well as a prognostic marker.

The Influence of Foxp3 Treg Cell Gene Polymorphism (rs3761548) on FoxP3 Gene Expression in Patients with Chronic Hepatitis B Virus Infection

: Immune responses are pivotal in hepatitis B virus (HBV) infection, where Regulatory T cells (Treg) can contribute to sustaining the infection by suppressing immune responses. Forkhead box P3 (FoxP3) is the central regulator of Treg cells. In this case-control study, we investigated the role of FoxP3 -3279 (rs3761548) C/A polymorphism in the context of HBV infection. The study encompassed 140 healthy individuals as the control group and 70 individuals with chronic hepatitis B virus (CHBV) as the case group. The rs3761548 polymorphism was analyzed using the restriction fragment length polymorphism-PCR (PCR-RFLP) method. Furthermore, we evaluated FoxP3 gene expression in both HBV-positive and control groups using Real-Time PCR. The results revealed that the frequency of the AA genotype in the case and control groups was 52.9% and 44.3%, respectively, yielding an odds ratio (OR) of 1.411 with a 95% confidence interval (CI) ranging from 0.793 to 2.509. However, this difference did not achieve statistical significance (P = 0.242). Notably, the AC genotype was significantly more prevalent in the control group compared to the case group (P = 0.000). Moreover, FoxP3 gene expression was significantly higher in CHBV infection cases compared to the control group (P = 0.000). These findings suggest that the observed polymorphism may play a role in the pathogenesis and persistence of HBV infection. Nevertheless, further research is warranted to comprehensively investigate this phenomenon.

Complete blood count changes in sudden sensorineural hearing loss caused by Streptococcus suis bacterial meningitis at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar from January 2019 – May 2023

Introduction: Sudden sensorineural hearing loss (SSNHL) is an emergency case that requires immediate and comprehensive management. This condition can be caused by Streptococcus suis bacterial meningitis. Complete blood counts (CBC) examinations are often carried out in SSNHL patients that caused by infection. Some CBC components can be clinical indicators of the severity and prognosis of SSNHL. Objective: To find out the differences in CBC among S. suis bacterial meningitis patients with SSNHL and S. suis bacterial meningitis patients with normal hearing at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar from January 2019 – May 2023. Methods: This study used an analytical research design using a retrospective case control method to compare CBC results (hematocrit, NLR, PLR, MLR, RDW and MPV) in 40 cases patients with SSNHL due to S. suis bacterial meningitis and 40 controls patients with S. suis bacterial meningitis patients with normal hearing. Result: In this study, it was found that there is no significant difference between case group compared to control group in terms of CBC results. The mean hematocrit value was 40.67 (± 4.45) in cases and 40.87 (± 4.08) in controls, with p-value 0.842. The mean MPV value was 9.82 (± 1.58) in cases and 9.33 (± 1.78) in controls, with p-value 0.200. The mean NLR value in the case group was 24.46, while in the control group it was 28.79, with p-value 0.124. The mean PLR value in the case group was 200.01, while in the control group it was 247.80, with p-value 0.126. The mean MLR value was 1.33 in cases and 1.19 in controls, with p-value 0.303. The mean RDW value was 12.98 in cases and 12.81 in controls, with p-value 0.950. Conclusion: From 40 people suffering SSNHL due to S. suis bacterial meningitis it was found that most of research subjects are men (75%) and the average age of subjects is 53 years. This study found that there were no significant differences between the results of mean hematocrit, NLR, PLR, MLR, RDW and MPV in patients with SSNHL due to S. suis bacterial meningitis compared to controls.

Rebooting nuclear medicine specialist education under the COVID-19 pandemic: From plenary lectures to active e-learning.

Despite major reforms of specialist training in the Nordic countries towards concrete learning outcomes and promoting active learning, most specialist courses continue to be based on lectures. We redesigned our mandatory 5-day course in clinical nuclear medicine (NM) that was last held in 2016 towards active learning. Thirty 1-h lectures were replaced with 10 thematic blocks of 3 h each. Each block was taught by a single teacher in a blend of short introductory lectures alternating with small groups of residents reading NM cases from our newly established national case library in diagnostic format. Due to COVID-19, the entire course in 2021 needed to be run on a videoconferencing system rather than in a computer laboratory as had been originally planned. At the end of the course, we conducted the same anonymized survey as in 2016. All 19 course participants responded. 74% fully agreed that the e-course format had been 'good'. One hundred per cent fully agreed that the practical exercises were 'useful' versus 50% in 2016 (p < 0.001). In their free text answers on the merits or downsides of e-learning, 12/12 respondents only mentioned advantages. Our newly established library of anonymized teaching cases within our national health network is an effective tool for organising courses based on active learning. Despite the change towards distance learning enforced by the pandemic, course participants reported the same high levels of satisfaction with active learning in small groups as in the earlier traditional lecture-based course format.

Emergency department utilisation and treatment for trauma-related presentations of adolescents aged 16–18: a retrospective cross-sectional study

BackgroundA recent study conducted at our tertiary hospital emergency department (ED) reviewed ED consultations and found that adolescents aged 16–18 years present significantly more often for trauma and psychiatric problems than adults over 18 years. Accidental injuries are one of the greatest health risks for children and adolescents. In view of the increased vulnerability of the adolescent population, this study aimed to further analyse trauma-related presentations in adolescents.MethodsWe conducted a single-centre, retrospective, cross-sectional study of all adolescent trauma patients aged 16 to 18 years presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from January 2013 to July 2017. We analysed presentation data as well as inpatient treatment and cost-related data. Data of female and male patients were compared by univariable analysis. A comparison group was formed consisting of 200 randomly chosen patients aged 19–25 years old with the same presentation characteristics. Predictive factors for surgical treatment were obtained by multivariable analysis.ResultsThe study population included a total of 1,626 adolescent patients aged 16–18 years. The predominant causes for ED presentation were consistent within case and comparison groups for sex and age and were sports accidents, falls and violence. Male patients were more likely to need surgical treatment (OR 1.8 [95% CI: 1.2–2.5], p = 0.001) and consequently inpatient treatment (OR 1.5 [95% CI: 1.1–2.1], p = 0.01), associated with higher costs (median 792 Swiss francs [IQR: 491-1,598]). Other independent risk factors for surgical treatment were violence-related visits (OR 2.1 [95% CI: 1.3–3.5, p = 0.004]) and trauma to the upper extremities (OR 2.02 [95% CI: 1.5–2.8], p < 0.001). Night shift (OR 0.56 [95% CI: 0.37–0.86], 0.008) and walk-in consultations (OR 0.3 [95% CI: 0.2; 0.4, < 0.001] were preventive factors for surgical treatment.ConclusionsMale adolescents account for the majority of emergency visits and appear to be at higher risk for accidents as well as for surgical treatment and/or inpatient admission due to sports accidents or injuries from violence. We suggest that further preventive measures and recommendations should be implemented and that these should focus on sport activities and injuries from violence.

Effect of autologous dendritic cell cytokine-induced killer on refractory metastatic colorectal cancer: a matched case-control comparative study.

Patients with metastatic colorectal cancer (mCRC) who are refractory to two or more lines of systemic chemotherapy have limited therapeutic options. The aim of this study was to evaluate the effect of autologous dendritic cell cytokine-induced killer (DC-CIK) transfer on the survival of patients with mCRC who are refractory or intolerant to at least two lines of systemic chemotherapies. A matched case-control comparative study was conducted with patients who received DC-CIK immunotherapy in addition to standard chemotherapy (cases) and those with standard chemotherapy alone (controls). The primary objective was to compare the duration of oncologic survival, including overall survival (OS) and progression-free survival (PFS), between the two groups. A total of 27 cases and 27 controls were included. The median OS in the DC-CIK case group was 18.73 ± 5.48 months, which was significantly longer than that in the control group (14.23 ± 1.90 months, p = 0.045). However, there was no significant difference in PFS between the two groups (p = 0.086). Subgroup analysis showed that in patients with liver or extra-regional lymph node metastasis, DC-CIK cases had longer OS than controls (17.0 vs. 11.87 months, p = 0.019; not match vs. 6.93 months, p = 0.002, respectively). In patients with Eastern Cooperative Oncology Group (ECOG) scale 0 or wild RAS/BRAF, DC-CIK cases showed a significant increase in OS duration compared to controls (28.03 vs. 14.53 months, p = 0.038; 18.73 vs. 11.87 months, p = 0.013, respectively). The addition of autologous DC-CIK to standard chemotherapy had a positive effect on OS of patients with refractory mCRC, especially those with liver or extra-regional lymph node metastasis, ECOG = 0, and wild RAS/BRAF status.

Experimental Study on the Flexural Properties of Steel-Fibre-Reinforced Concrete Specimens with Different Heights

Flexural strength is an important mechanical property of steel-fibre-reinforced concrete. By designing three-point bending tests of concrete with five specimen heights, three steel fibre types, and two steel fibre mixing methods, the effects of the specimen height, steel fibre mixing method, and steel fibre type on the peak load, effect of size, section characteristics, strain characteristics, and characteristics of the load–displacement curve of concrete specimens were studied. The results show that the peak load of the control group is basically linear with the height of the specimen. After adding three kinds of steel fibres, the peak load of the specimen is greater than that of the control group in the same case. The peak load of the specimen increases by adding three kinds of steel fibres, and the increase is closely related to the height of the specimen. The residual stage of the load–displacement curve of the milling steel fibre and the end hook steel fibre are relatively flat, while the residual stage of the load–displacement curve of the shear steel fibre is relatively large, and the residual load is also greater than the residual load of the shear steel fibre. The specimens in the control group show brittle failure characteristics. As the height of the specimens increases, the failed section of the specimens is smoother. The development of cracks in the steel fibre specimens is more tortuous than that of the control group, showing ductile failure characteristics. Some tensile failure zones are still present where the fibres are densely distributed, and the failure characteristics of the specimens are further explained and proven by the strain characteristics.

Proteomic insights into the pathophysiology of hypertension-associated albuminuria: Pilot study in a South African cohort

BackgroundHypertension is an important public health priority with a high prevalence in Africa. It is also an independent risk factor for kidney outcomes. We aimed to identify potential proteins and pathways involved in hypertension-associated albuminuria by assessing urinary proteomic profiles in black South African participants with combined hypertension and albuminuria compared to those who have neither condition.MethodsThe study included 24 South African cases with both hypertension and albuminuria and 49 control participants who had neither condition. Protein was extracted from urine samples and analysed using ultra-high-performance liquid chromatography coupled with mass spectrometry. Data were generated using data-independent acquisition (DIA) and processed using Spectronaut™ 15. Statistical and functional data annotation were performed on Perseus and Cytoscape to identify and annotate differentially abundant proteins. Machine learning was applied to the dataset using the OmicLearn platform.ResultsOverall, a mean of 1,225 and 915 proteins were quantified in the control and case groups, respectively. Three hundred and thirty-two differentially abundant proteins were constructed into a network. Pathways associated with these differentially abundant proteins included the immune system (q-value [false discovery rate] = 1.4 × 10− 45), innate immune system (q = 1.1 × 10− 32), extracellular matrix (ECM) organisation (q = 0.03) and activation of matrix metalloproteinases (q = 0.04). Proteins with high disease scores (76–100% confidence) for both hypertension and chronic kidney disease included angiotensinogen (AGT), albumin (ALB), apolipoprotein L1 (APOL1), and uromodulin (UMOD). A machine learning approach was able to identify a set of 20 proteins, differentiating between cases and controls.ConclusionsThe urinary proteomic data combined with the machine learning approach was able to classify disease status and identify proteins and pathways associated with hypertension-associated albuminuria.

Utilizing the sublingual form of squalene in COVID-19 patients: a randomized clinical trial

In this study, the efficacy of sublingual squalene in decreasing the mortality rate among patients with COVID-19 was investigated. Squalene was extracted from pumpkin seed oil with a novel method. Then, the microemulsion form of squalene was prepared for sublingual usage. In the clinical study, among 850 admitted patients, 602 eligible COVID-19 patients were divided in two groups of control (N = 301) and cases (N = 301) between Nov 2021 and Jan 2022. Groups were statistically the same in terms of age, sex, BMI, lymphocyte count on 1st admission day, hypertension, chronic kidney disease, chronic respiratory disease, immunosuppressive disease, and required standard treatments. The treatment group received five drops of sublingual squalene every 4 h for 5 days plus standard treatment, while the control group received only standard treatment. Patients were followed up for 30 days after discharge from the hospital. The sublingual form of squalene in the microemulsion form was associated with a significant decrease in the mortality rate (p < 0.001), in which 285 (94.7%) cases were alive after one month while 245 (81.4%) controls were alive after 1 month of discharge from the hospital. In addition, squalene appears to be effective in preventing re-hospitalization due to COVID-19 (p < 0.001), with 141 of controls (46.8%) versus 58 cases (19.3%). This study suggests sublingual squalene in the microemulsion as an effective drug for reducing mortality and re-hospitalization rates in COVID-19 patients.Trial Registration Number: IRCT20200927048848N3.

Numerical Simulation Study on the Effect of Preinjected CO2 on the Hydraulic Fracturing Behavior of Shale Oil Reservoirs.

Due to the low permeability and apparent mechanical anisotropy of shale reservoirs, shale oil production highly depends on the performance of hydraulic fracturing of the tight reservoir. Pre-injection of CO2 before hydraulic fracturing treatment has been proven beneficial to enhance shale oil production. A comprehensive understanding of the effect of changes in the properties of shale reservoirs after preinjected CO2 on the hydraulic fracturing behavior of shale reservoirs is essential to improve the stimulated reservoir volume (SRV) of shale oil reservoirs. In this study, comprehensive evaluating parameters were proposed to specify the variation of mechanical properties of shale rock at different soaking times of CO2 based on published testing parameters of shale. Accordingly, a three-dimensional (3D) numerical model was established and three groups of horizontal well fracturing cases with different cluster spacings were conducted based on the adaptive FE-DE method to simulate and compare the hydraulic fracturing behavior in the reservoirs with different mechanical properties. We established a quantitative relationship between the alterations in reservoir properties and the stimulated reservoir volume. The results indicate that both the brittleness and conductivity properties of shale rock are dramatically improved as the increment of soaking time of CO2. It is beneficial to improve the SRV, and the initiation pressure is reduced with the increment of soaking time of CO2. However, as the stress shadow effect is involved in the horizontal well fracturing, the complexity of the hydrofracturing crack is significantly enhanced to restrain the development of hydrofracturing crack. When the cluster spacing is larger, the stress shadow effect is weakened, and the weakening effect of CO2 soaking on reservoir is more obvious.

Urinary exosomal mRNA as a biomarker for the diagnosis of bladder cancer.

To study the diagnostic value of mRNA expression in urinary exocrine body in bladder cancer. From February 2022 to December 2022, 60 patients diagnosed with bladder cancer by pathology in the Department of Urology, Affiliated Hospital of Chengde Medical University were selected as the case group. In total, 40 healthy subjects receiving physical examinations were selected as the control group. 100 mL of morning urine samples were collected from the subjects in both groups based on the same standard. Three subjects were randomly selected from each group. Urinary exosomes were extracted by differential ultracentrifugation. High-throughput sequencing (RNA-seq) was used to detect mRNA expression profiles in urinary exosomes and identify differentially expressed genes. Bioinformatic analysis was performed to predict major biological functions of differentially expressed genes and related signaling pathways. RT-PCR validated expression levels of differentially expressed genes in urinary exosomes between the two groups. ROC curves evaluated the diagnostic value of differential genes for bladder cancer. Spearman's correlation analysis determined correlations between differentially expressed genes and the occurrence of bladder cancer. ROC curves speculated the diagnostic value of using combined differentially expressed genes. Compared with normal subjects, there were 189 significantly differentially expressed genes in urinary exosomes of bladder cancer patients, including 33 up-regulated and 156 down-regulated. According to go and kyoto encyclopedia of genes and genomes (KEGG) analysis, the above differentially expressed genes may participate in the occurrence and development of bladder cancer through the MAPK pathway, PPAP signaling pathway, PI3K Akt signaling pathway and Hippo signaling pathway, affect protein and lipid metabolism, RNase activity, polysaccharide synthesis, signal transduction and other biological processes, and participate in cell proliferation, death, movement and adhesion, as well as cell differentiation and signal transduction. RT-PCR verified that the expression of tmeff1, SDPR, ACBD7, SCG2 and COL6A2 in the two groups of samples was statistically significant ( P < 0.05). The ROC curve showed that the area under curve area under the curve of the five differential genes were 0.6934, 0.7746, 0.7239, 0.6396 and 0.6610, respectively. The sensitivity was 42.11%, 64.86%, 47.37%, 73.53% and 76.47%, and the specificity was 90%, 81.36%, 96.36%, 61.02% and 58.18%, respectively. Spearman correlation analysis showed that tmeff1, SDPR and acbd7 were associated with the occurrence of bladder cancer. The ROC curve of the combined diagnosis of the three and the two combined diagnoses suggested that the area under the curve of the combined diagnosis of SDPR and acbd7 was 0.7945, the sensitivity was 89.09%, and the specificity was 60.53%. The gene expression profile in urinary exosomes of bladder cancer patients has changed significantly, and the differential genes may play an important biological role in the occurrence and development of bladder cancer. The combined detection of urinary exosome SDPR and ACBD7 has a certain diagnostic value for bladder cancer.

Biomechanical evaluation of a new intramedullary nail compared with proximal femoral nail antirotation and InterTAN for the management of femoral intertrochanteric fractures.

Purpose: Surgical treatment is the main treatment method for femoral intertrochanteric fractures (FIFs), however, there are lots of implant-related complications after surgery. Our team designed a new intramedullary nail (NIN) to manage such fractures. The purpose of this study was to introduce this new implant and compare it with proximal femoral nail antirotation (PFNA) and InterTAN for treating FIFs. Methods: An AO/OTA 31-A1.3 FIF model was built and three fixation models were created via finite element method, comprising PFNA, InterTAN, and the NIN. Vertical, anteroposterior (A-P) bending, and torsional loads were simulated and applied to the three fixation models. Displacement and stress distribution were monitored. In order to compare PFNA and the NIN deeply, finite element testing was repeated for five times in vertical load case. Results: The finite element analysis (FEA) data indicated that the NIN possessed the most outstanding mechanical properties among the three fixation models. The NIN model had lower maximal stress at implants compared to PFNA and InterTAN models under three load conditions. The trend of maximal stress at bones was similar to that of maximal stress at implants. Besides, the NIN model showed smaller maximal displacement compared with PFNA and InterTAN models under vertical, A-P bending, and torsional load cases. The trend for maximal displacement of fracture surface (MDFS) was almost identical with that of maximal displacement. In addition, there was significant difference between the PFNA and NIN groups in vertical load case (p < 0.05). Conclusion: Compared with PFNA and InterTAN, the NIN displayed the best mechanical properties for managing FIFs, including the lowest von Mises stress at implants and bones, and the smallest maximal displacement and MDFS under vertical, A-P bending, and torsional load cases. Therefore, this study might provide a new choice for patients with FIFs.