Although genome-wide association studies (GWASs) have identified many schizophrenia-associated variants, their biological mechanisms remain unclear. Using transcriptomic data from human brain tissues, we performed splicing quantitative trait locus (sQTL) analyses of schizophrenia-associated single-nucleotide polymorphisms and identified more than 17,000 sQTLs linked to previously unidentified splicing junctions. Functional prioritization and experimental validation highlighted the synonymous variant rs3935873 within the 16p11.2 GWAS locus strongly associated with an unannotated isoform DOC2A∆Val217-Pro218. rs3935873 was significantly associated with hippocampal volume, and hippocampal overexpression of DOC2A∆Val217-Pro218 in mice recapitulated schizophrenia-relevant behavioral deficits, phenotypes absent in DOC2AFull-Length-overexpressing mice. Overexpression of both isoforms altered excitatory synaptic transmission, structural modeling revealed divergent tertiary configurations between DOC2A∆Val217-Pro218 and DOC2AFull-Length, and interactome profiling highlighted that DOC2A∆Val217-Pro218 unique interactors are enriched in the myosin II complex and ankyrin binding, suggesting the acquisition of previously unknown structural and regulatory functions by DOC2A∆Val217-Pro218. Our study implicates dysregulated splicing in DOC2A as a functional mechanism for schizophrenia genetic risk and demonstrates how unannotated isoforms can reveal disease-relevant pathways.

BackgroundSepsis-induced multi-organ failure involves pathological crosstalk between mitochondrial dysfunction and hyperinflammation, yet endogenous protective mechanisms remain incompletely defined. This study investigates Growth Differentiation Factor 15 (GDF15) as a potential regulator of sepsis tolerance.MethodsUsing LPS-challenged mouse endotoxemia and a murine macrophage (RAW264.7) cell line model, we assessed GDF15’s functional role through: (1) recombinant Adeno-Associated Virus serotype 8 (rAAV8)-mediated tissue-specific overexpression, (2) siRNA knockdown, (3) pharmacological modulation (BAY 87-2243/Hypoxia-Inducible Factor 1-alpha (HIF-1α) inhibitor, Shikonin/PKM2 inhibitor, Asiaticoside/SMAD7 activator), and (4) comprehensive metabolic-inflammatory phenotyping including mitochondrial complex integrity (assessed via UQCRC1, Ubiquinol-Cytochrome c Reductase Core Protein 1), cytokine dynamics (TNF-α, IL-6) and lactate metabolism.ResultsLPS challenge induced time-dependent mitochondrial dysfunction concurrent with cytokine storms and compensatory GDF15 upregulation in both liver and macrophages. Hepatocyte-specific GDF15 overexpression attenuated injury through restored mitochondrial integrity, diminished macrophage infiltration, and reduced systemic inflammation, as evidenced by significantly lower levels of circulating TNF-α and IL-6. Mechanistically, GDF15 preserved mitochondrial homeostasis by inducing SMAD7 expression while suppressing HIF-1α accumulation and PKM2 nuclear translocation. Pharmacological HIF-1α/PKM2 inhibition recapitulated GDF15’s protective effects, restoring mitochondrial function and reducing inflammation even in GDF15-deficient models. Clinical analysis of a sepsis patient cohort (n=119) confirmed a significant elevation of circulating GDF15, with its levels strongly correlating with disease severity scores. Critically, SMAD7 activation attenuated HIF-1α accumulation and rescued mitochondrial failure independently of GDF15 status.ConclusionGDF15 orchestrates sepsis tolerance through the SMAD7-HIF-1α axis, preserving mitochondrial integrity while resolving metabolic-inflammatory dysregulation, notably by suppressing the release of pro-inflammatory cytokines such as TNF-α and IL-6. This study identifies GDF15 as a central guardian of mitochondrial-immune homeostasis in sepsis, positioning it as both a robust severity biomarker and a promising therapeutic target for mitochondrial resuscitation.

The relationship between Ki-67 expression and clinical prognosis in patients with resectable acral melanoma (AM) remains unclear. This study explores the prognostic role of Ki-67 in AM using data from 324 patients across five Chinese centers. Patients were divided into low Ki-67 expression and high Ki-67 expression groups based on pathological reports. The log-rank test was used to compare disease-free survival (DFS) and overall survival (OS), and the Cox proportional hazards regression model was employed to identify prognostic factors. Among the 324 patients included in the study, 181 (55.8%) were in the low Ki-67 expression group, and 143 (44.2%) were in the high Ki-67 expression group. The high Ki-67 expression group exhibited a higher incidence of tumor thickness > 4 mm (45.5% vs 24.3%, P < 0.001), ulceration (65.7% vs 54.1%, P = 0.035), stage III (31.5% vs 16.0%, P < 0.001), LDH ≥ 250 U/L (14.0% vs. 6.6%, P = 0.028), and positive sentinel lymph nodes (28.0% vs 11.1%, P = 0.029). High Ki-67 predicted shorter DFS (26.8 vs 74.1 months, P = 0.025) and OS (52.1 months vs NR, P < 0.001). Multivariate analysis identified Ki-67, age, stage and LDH as independent OS predictors.

BACKGROUND:Sepsis-associated acute lung injury (ALI) is characterized by endothelial inflammation and metabolic reprogramming. Growth Differentiation Factor 15 (GDF15), a stress-inducible cytokine, may regulate immunometabolic crosstalk, but its endothelial-specific role remains undefined. METHODS:Using LPS-induced septic mice and human endothelial cells, GDF15 expression was dysregulated via AAV-mediated overexpression or siRNA knockdown. Pharmacological modulators included: HIF-1α inhibitor BAY 87-2243, HIF-1α activator 1,4-DPCA, LDHA inhibitor FX-11, and sodium lactate. Endothelial inflammation was evaluated through adhesion molecules (ICAM-1, VCAM-1, VEGF-A) and cytokines (TNF-α, IL-6) at protein levels. RESULTS:GDF15 was upregulated in pulmonary endothelia of septic mice and contributed to endothelial dysfunction, evidenced by elevated adhesion molecules (ICAM-1/VCAM-1/VEGF-A), cytokines (TNF-α/IL-6), and impaired barrier repair. GDF15 overexpression alleviated lung injury and inflammation, while its knockdown aggravated pathology. Mechanistic studies revealed that GDF15 inhibits the HIF-1α/LDHA glycolytic axis activated by LPS, reducing cytokine storm and leukocyte adhesion. Critically, HIF-1α inhibitor (BAY 87-2243) and LDHA inhibitor (FX-11) phenocopied GDF15 protection, whereas HIF-1α activator (1,4-DPCA) and sodium lactate negated it, establishing HIF-1α/LDHA as the primary effector pathway. CONCLUSION:GDF15 emerges as a critical endothelial protector in sepsis by suppressing HIF-1α/LDHA-mediated immunometabolic dysregulation. Its synergistic interplay with glycolytic inhibitors highlights a novel therapeutic strategy to target both inflammatory and metabolic drivers of ALI.

La r & aacute;pida evoluci & oacute;n de la inteligencia artificial ha permitido desarrollar chatbots con un enorme potencial en campos como el de la medicina, especialmente en el laboratorio cl & iacute;nico. Realizamos un an & aacute;lisis sistem & aacute;tico de las ventajas e inconvenientes que supone la utilizaci & oacute;n de chatbots en este campo, profundizando en sus posibles aplicaciones para el diagn & oacute;stico de enfermedades. La fiabilidad y veracidad cient & iacute;fica de los chatbots se ven determinadas por diversos factores, entre los que se encuentran la calidad de los datos, los sesgos de los modelos, la protecci & oacute;n de la privacidad, y los requisitos de retroalimentaci & oacute;n del usuario. Sin embargo, el marco jur & iacute;dico existente, como la Ley sobre inteligencia artificial (IA) de la UE, no garantiza por s & iacute; solo la veracidad y fiabilidad de los contenidos, por lo que no podemos depender & uacute;nicamente del mismo, haciendo necesario el empleo de dos herramientas de evaluaci & oacute;n, METRICS y CLEAR, herramientas dise & ntilde;adas para evaluar de manera integral la calidad de la informaci & oacute;n relacionada con la salud generada por IA.

La rápida evolución de la inteligencia artificial ha permitido desarrollar chatbots con un enorme potencial en campos como el de la medicina, especialmente en el laboratorio clínico. Realizamos un análisis sistemático de las ventajas e inconvenientes que supone la utilización de chatbots en este campo, profundizando en sus posibles aplicaciones para el diagnóstico de enfermedades. La fiabilidad y veracidad científica de los chatbots se ven determinadas por diversos factores, entre los que se encuentran la calidad de los datos, los sesgos de los modelos, la protección de la privacidad, y los requisitos de retroalimentación del usuario. Sin embargo, el marco jurídico existente, como la Ley sobre inteligencia artificial (IA) de la UE, no garantiza por sí solo la veracidad y fiabilidad de los contenidos, por lo que no podemos depender únicamente del mismo, haciendo necesario el empleo de dos herramientas de evaluación, METRICS y CLEAR, herramientas diseñadas para evaluar de manera integral la calidad de la información relacionada con la salud generada por IA.

In recent years, with the rapid development of artificial intelligence technology, chatbots have demonstrated significant potential in the medical field, particularly in medical laboratories. This study systematically analyzes the advantages and challenges of chatbots in this field and delves into their potential applications in disease diagnosis. However, the reliability and scientific nature of chatbots are influenced by various factors, including data quality, model bias, privacy protection, and user feedback requirements. To ensure the accuracy and reliability of output content, it is essential to not only rely on legal frameworks such as the EU AI Act for necessary protection but also to employ two assessment tools, METRICS and CLEAR. These tools are designed to comprehensively evaluate the quality of AI-generated health information, thereby providing a solid theoretical foundation and support for clinical practice.

Clinical research has suggested that chronic HBV infection exerts a certain effect on the occurrence of cardiovascular disease by regulating cholesterol metabolism in liver cells. High serum apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio plays a certain role in the above regulation, and it serves as a risk factor for cardiovascular disease. However, whether the ApoB/ApoA1 ratio is correlated with chronic HBV infection and its disease progression remains unclear. In accordance with the inclusion and exclusion criteria, all 378 participants administrated at Renmin Hospital of Wuhan University from March 2021 to March 2022, fell into Healthy Control (HC) group (50 participants), Hepatocellular carcinoma (HCC) group (107 patients), liver cirrhosis (LC) group (64 patients), chronic hepatitis B (CHB) group (62 patients), chronic hepatitis C (CHC) group (46 patients) and Hepatitis E Virus (HEV) group (49 patients). Serum ApoA1 and ApoB concentrations were measured at admission, and the ApoB/ApoA1 ratio was determined. The levels of laboratory parameters in the respective group were compared and ApoB/ApoA1 ratios in HCC patients and LC patients with different severity were further analyzed. ROC curves were plotted to analyze the early diagnostic ability of ApoB/ApoA1 ratio for HBV-associated HCC. Logistic regression and restricted cubic spline analysis were used to explore the correlation between ApoB/ApoA1 ratio and LC and HCC risk. A comparison was drawn in terms of ApoB/ApoA1 ratio between the groups, and the result was expressed in descending sequence: HEV group > CHB group > LC group > HCC group > CHC group > HC group, early-stage HCC < middle-stage HCC < advanced-stage HCC, Class A LC < Class B LC < Class C LC. Serum ApoB/ApoA1 ratio combined diagnosis with AFP exhibited the capability of increasing the detection efficacy and specificity of AFP for HCC and AFP-negative HCC. The incidence of LC and HCC in the respective logistic regression model showed a negative correlation with the serum ApoB/ApoA1 ratio in CHB patients (P < 0.05). After all confounding factors covered in this study were regulated, the result of the restricted cubic spline analysis suggested that in a certain range, serum ApoB/ApoA1 ratio showed an inverse correlation with the prevalence of LC or HCC in CHB patients. Serum ApoB/ApoA1 ratio in CHB patients may be conducive to identifying high-risk patients for HCC or LC, such that LC and HCC can be early diagnosed and treated.

Background: Sepsis is a common disease in the intensive care unit (ICU). In recent years, the incidence rate and mortality rate remain high. Early diagnosis of sepsis is crucial for treatment and can effectively reduce mortality. So far, the ability of serum peptidylarginine deaminase 2 (PAD2) in the diagnosis and prognosis of sepsis patients is still unclear. We conducted this study to reveal the clinical value of PAD2 as a biomarker for sepsis patients. Methods: A prospective study method was used to select 207 patients in the ICU of Renmin Hospital of Wuhan University from May 2022 to May 2023. They were divided into the sepsis group (n = 135) and control group (n = 72), and data were collected within 24 h of hospitalization. Sepsis patients were divided into a survival group (n = 80) and a non-survival group (n = 55) based on their 28-day survival status. Using statistical methods to evaluate the diagnostic and prognostic value of PAD2 in sepsis. Results: The serum PAD2 concentrations in the sepsis group were significantly higher than in the control group (median 16.70 vs 35.32 ng/ml, P < 0.001). Multivariate logistic regression analysis showed that the Quick Sequential Organ Failure Assessment (qSOFA), C-reactive protein (CRP), procalcitonin (PCT), and PAD2 were independent risk factors for sepsis. The Receiver operating characteristic (ROC) curve showed that the combined diagnostic value of qSOFA, CRP, PCT, and PAD2 was the highest. The serum PAD2 concentrations in the nonsurvival group of patients with sepsis were significantly higher than those in the survival group (median 29.26 vs 50.08 ng/ml, P < 0.05). The COX regression analysis showed that PAD2, sequential organ failure score Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation (APACHE II) score were independent factors affecting the prognosis of sepsis patients. The ROC analysis showed that the combined prognostic value of PAD2, SOFA, and APACHE II scores was significantly higher than any single indicator. The Kaplan-Meier survival analysis showed that patients with PAD2 <= 48.62 ng/ml had a better prognosis. Conclusion: The significant increase in serum PAD2 concentrations in patients is an independent risk factor affecting the occurrence of sepsis and 28-day mortality. The combination of PAD2 and other indicators can further improve the diagnostic and prognostic value for ICU sepsis patients.

Objective To explore the diagnostic value of serum pyruvate kinase M2(PKM2)and procalcitonin(PCT)in sepsis.Methods One hundred and nineteen sepsis patients(sepsis group)admitted to the Intensive Care Unit(ICU)of Wuhan University People's Hospital from April 2022 to January 2023,and 73 non sepsis patients(non sepsis group)admitted to the ICU during the same period were selected as the study subjects.Detect and compare the serum lev-els of PKM2 and PCT in two groups of patients within 24 hours of admission,and use Spearman correlation test to analyze the correlation between serum PKM2 and PCT levels in sepsis patients;Using a multivariate logistic regression model to an-alyze the impact of various indicators on the occurrence of sepsis;Draw a receiver operating characteristic(ROC)curve to evaluate the diagnostic value of serum PKM2,PCT,and their combination in sepsis,and calculate the area under the curve(AUC).Results Compared with the non sepsis group,the serum PKM2 and PCT levels in the sepsis group were signifi-cantly increased(Z/P=9.373/＜0.001,9.013/＜0.001).There is a positive correlation between serum PKM2 and PCT levels in sepsis patients(r=0.322,P＜0.001).Multivariate logistic regression analysis showed that elevated levels of serum PKM2 and PCT were independent risk factors for sepsis occurrence[OR(95％CI)=1.182(1.078-1295),1582(1.186-2.110)].The ROC curve shows that the AUC of serum PKM2,PCT,and their combination for diagnosing sepsis were 0.903,0.888,and 0.941,respectively,with sensitivity of 0.863,0.918,and 0.932,and specificity of 0.798,0.748,and 0.857,respectively.The com-bined diagnostic efficacy of the two was higher than that of individual detection(Z/P=2.560/0.011,3.423/＜0.001).Conclu-sion The elevated serum PKM2 level in patients with sepsis is an independent risk factor for sepsis and is positively cor-related with PCT.Combined detection of the two has high diagnostic value.

Abstract Background Clinical studies have found that chronic HBV infection affects the occurrence of cardiovascular disease by regulating cholesterol metabolism in liver cells. High serum apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio participates in the above regulation and is a risk factor for cardiovascular disease. However, it is unclear whether the ApoB/ApoA1 ratio is associated with chronic HBV infection and its disease progression.Method According to the inclusion and exclusion criteria, all 328 participants treated at Renmin Hospital of Wuhan University from March 2021 to March 2022, were divided into HCC group (107 cases), LC group (64 cases), CHB group (62 cases), Chronic hepatitis C (CHC) group (46 cases) and Hepatitis E Virus (HEV) group (49 cases). Serum ApoA1 and ApoB concentrations were measured at admission, and the ApoB/ApoA1 ratio was calculated. We compared the levels of laboratory parameters in each group and further analyzed ApoB/ApoA1 levels in HCC patients and LC patients with different severity. ROC curves were plotted to analyze the early diagnostic ability of ApoB/ApoA1 ratio for HBV-related HCC. Logistic regression and restricted cubic spline analysis were used to investigate the association between ApoB/ApoA1 ratio and LC and HCC risk.Result Comparison of ApoB/ApoA1 ratio between the groups: HEV group > CHB group > LC group > HCC group > CHC group, early-stage HCC > middle-stage HCC > advanced-stage HCC, Class A LC > Class B LC > Class C LC. Serum ApoB/ApoA1 ratio combined diagnosis with AFP could improve the detection efficacy and specificity of AFP for HCC.The incidence of LC and HCC in each logistic regression model was negatively correlated with the serum ApoB/ApoA1 ratio in CHB patients (P < 0.05). After adjusting for all confounding factors included in this study, restricted cubic spline analysis found that within a certain range, serum ApoB/ApoA1 ratio was inversely associated with the prevalence of LC or HCC in CHB patients.Conclusion Serum ApoB/ApoA1 ratio in CHB patients may help identify high-risk patients for HCC or LC, thereby preventing the development of HCC or LC, or early diagnosis of HCC.

目的 探讨血清补体 C1q在炎症性肠病(inflammatory bowel disease,IBD)中的诊断与预后作用.方法 采用回顾性随机直接抽样法,选取 2021 年 1 月至 2022 年 7 月武汉大学人民医院住院患者 274 例,包括 IBD患者 180 例,其中克罗恩病(Crohn's dis-ease,CD)患者 95 例(CD组),溃疡性结肠炎(ulcerative colitis,UC)患者 85 例(UC组),分别采用 CDAI和改良 Mayo评分评估 CD和UC患者的疾病活动度;结直肠癌患者 94 例(结直肠癌组).另选取同期健康体检者 79 名作为正常对照组.比较各组之间的 C1q水平,分析 C1q水平与其他指标的相关性以及 C1q水平与 IBD患者营养状况、器官损伤、电解质水平及凝血功能的关系,用 ROC 曲线评估 C1q预测价值.结果 UC组和 CD组患者血清 C1q 低于正常对照组,结直肠癌组患者血清 C1q 低于 UC 组和 CD 组(P＜0.05);IBD组内,疾病活动度重度组患者血清 C1q 低于缓解期及轻度组;RBC、DBIL、TBIL、白蛋白、肌酐、肾小球滤过率、血钙、血沉、PT、APTT等指标与 C1q明显相关;此外,C1q水平可以评价 IBD 患者营养状况、器官损伤、电解质水平及凝血功能;C1q 对 IBD患者预后有较高的诊断价值.结论 血清 C1q水平对 IBD的病情和预后有潜在的临床价值.

Objective:The aim of the study was to use a network pharmacological method and experimental validation to examine the mechanism of Scutellaria baicalensis (SB) against hepatocellular carcinoma (HCC).Methods:The traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP) and GeneCards were used for screening of targets of SB for the treatment of HCC. Cytoscape (3.7.2) software was used to construct the "drug-compound-intersection target interaction" interaction network. The STING database was used to analyze the interactions of the previous intersecting targets. The results were visualized and processed by performing GO (Gene Ontology) enrichment analysis and KEGG (Kyoto Encyclopedia of Genes and Genomes) signaling pathway enrichment analysis at the target sites. The core targets were docked with the active components by AutoDockTools-1.5.6 software. We used cellular experiments to validate the bioinformatics predictions.Results:A total of 92 chemical components and 3258 disease targets including 53 intersecting targets were discovered. The results showed that wogonin and baicalein, the main chemical components of SB, could inhibit the viability and proliferation of hepatocellular carcinoma cells, promote apoptosis through the mitochondrial apoptotic pathway, and effectively act on AKT1, RELA, and JUN targets.Conclusion:SB has multiple components and targets in the treatment of HCC, providing possible potential targets for the treatment of HCC and providing a basis for further research.

Objective:To explore the effect of high intensity interval training (HIIT) on cardiac rehabilitation in patients after heart transplantation.Methods:According to the search terms, the search was conducted on China National Knowledge Infrastructure, VIP, WanFang Data, China Biology Medicine disc, Web of Science, PubMed, Cochrane Library, Embase, and EBSCO. The search time limit was from the establishment of the database to January 31, 2022. After 2 researchers screened the article, extracted information, and evaluated the quality, a Meta-analysis was conducted using RevMan 5.4 software.Results:According to the inclusion and exclusion criteria, 10 English articles were selected, including 191 patients in the intervention group and 212 patients in the control group, with a total of 403 patients. Meta-analysis showed that during cardiac rehabilitation exercise in patients after heart transplantation, HIIT could improve peak oxygen uptake in cardiopulmonary function exercise testing [ MD=1.98, 95% confidence interval ( CI) (0.55, 3.41), P=0.007], peak heart rate in chronotropic responses [ MD=6.93, 95% CI (2.62, 11.24), P=0.002], and muscle exercise ability [ MD=337.18, 95% CI (12.02, 62.35), P=0.04]. There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, peak systolic blood pressure, peak diastolic blood pressure, resting heart rate and respiratory exchange rate between the two groups ( P>0.05). A subgroup analysis of peak oxygen uptake was conducted based on the intervention period and the start time of rehabilitation exercise after heart transplantation. The results showed that there were statistically significant differences in peak oxygen uptake between the intervention group and the control group when the intervention period was ≤ 12 weeks or the start time was > 6 weeks ( P<0.01) . Conclusions:HIIT effectively improves the peak oxygen uptake, peak heart rate, and muscle exercise activity of patients after heart transplantation. HIIT has a significant impact on peak oxygen uptake when the rehabilitation exercise start time after heart transplantation is > 6 weeks or the intervention period is ≤ 12 weeks.

OBJECTIVE Based on the current difficulties in early diagnosis of HBV-related hepatocellular carcinoma (HBV-HCC), we assessed the values of preoperative serum fibrinogen-like protein 1 (FGL1) by itself and in combination with alpha-fetoprotein (AFP) for the diagnosis of HBV-HCC. METHODS We used ELISA and chemiluminescence assays to detect the serum levels of FGL1 and AFP, respectively. RESULTS Serum FGL1 level in the HBV-HCC group was significantly higher than in the chronic HBV (CHBV) group, the liver cirrhosis (LC) group, and the healthy control (HC) group. Serum FGL1 had an outstanding performance in distinguishing AFP-negative HBV-HCC from different control conditions. In the patients with AFP-negative HBV-HCC, the sensitivity of serum FGL1 was high. Moreover, serum FGL1 had a stronger performance than AFP in distinguishing early-stage HBV-HCC. CONCLUSIONS Serum FGL1 is significantly elevated among patients with HBV-HCC, including those with negative AFP and with disease at an early stage. Hence, serum FGL1 may serve as a potential diagnostic marker in the early diagnosis of HBV-HCC.

背景 冠状动脉旁路移植术是临床治疗冠状动脉病变及心功能不全的有效术式,可在体外循环或非体循环下进行,而体外循环冠状动脉旁路移植术较易造成心肌缺血再灌注损伤、全身炎症反应,导致术后并发症发生风险增高;而非体外循环冠状动脉旁路移植术无需在心脏停搏的前提下进行.目的 比较体外与非体外循环冠状动脉旁路移植术治疗冠心病的疗效及其对患者心功能的影响.方法 回顾性选取武汉大学人民医院2017年10月至2019年10月收治的冠心病患者100例,按手术方式分为对照组46例和观察组54例.对照组患者采用体外循环冠状动脉旁路移植术治疗,观察组患者采用非体外循环冠状动脉旁路移植术治疗.比较两组患者手术时间、术中出血量、重症监护室入住时间、出院时间、植入支架支数、血管活性药物使用时间、住院费用及术前、术后1 d心功能指标〔心脏指数(CI)、左心室做功指数(LVSWI)、右心室做功指数(RVSWI)〕.随访1个月,比较两组患者并发症发生率.结果 观察组手术时间、重症监护室入住时间、出院时间、血管活性药物使用时间短于对照组,术中出血量、住院费用少于对照组(P<0.05).两组患者术前CI、LVSWI、RVSWI比较,差异无统计学意义(P>0.05);术后1 d观察组患者CI、LVSWI、RVSWI高于对照组(P<0.05).两组患者术后1 d CI分别高于本组术前,LVSWI、RVSWI分别低于本组术前(P<0.05).观察组患者并发症发生率低于对照组(P<0.05).结论 与体外循环下冠状动脉旁路移植术比较,非体外循环冠状动脉旁路移植术治疗冠心病可有效缩短治疗时间,减少术中出血量及住院费用,对患者心功能的影响较小,且安全性较高.

目的 评估纤维蛋白原样蛋白1(FGL-1)对乙型肝炎病毒(HBV)相关肝细胞癌的诊断价值.方法 研究对象为2019年1-11月招募于武汉大学人民医院肿瘤科、传染科以及体检中心的102例HBV相关肝细胞癌患者(肝细胞癌组)、41例HBV感染后肝硬化患者(肝硬化组)以及48例健康对照者(对照组).比较各组甲胎蛋白及FGL-1水平,采用受试者工作特征曲线分析FGL-1和甲胎蛋白单独以及联合对肝细胞癌的鉴别诊断价值.结果 肝细胞癌组甲胎蛋白、FGL-1水平均高于对照组和肝硬化组[75.70(7.50,1 907.33)μg/L 比 3.00(2.20,4.20)、5.20(2.20,11.98)μg/L;46.28(21.83,121.15)μg/L 比0.67(0.48,0.91)、21.24(9.85,25.10)μg/L],差异均有统计学意义(均P＜0.05).在肝细胞癌组与对照组鉴别诊断时,FGL-1的曲线下面积(AUC)达到1.000,敏感度为99.02％,特异度高达100.00％,此时甲胎蛋白的AUC仅为0.899,且敏感度仅为78.43％,而二者联合的AUC为1.000,敏感度和特异度均为100.00％.在肝细胞癌组与肝硬化组鉴别诊断时,FGL-1的AUC为0.799,高于甲胎蛋白的0.747,且在甲胎蛋白特异度仅有82.93％时,FGL-1的特异度仍保持为100.00％,而二者联合的AUC为0.874,敏感度为71.57％,特异度为100.00％.在肝细胞癌组与对照组+肝硬化组鉴别诊断时,FGL-1的AUC为0.907,此时甲胎蛋白的AUC为0.829,虽然甲胎蛋白敏感度(78.43％)高于FGL-1(65.69％),但特异度远不及FGL-1(78.65％比98.88％),而二者联合的AUC为0.942,敏感度为73.53％,特异度为100.00％.结论 FGL-1在诊断HBV相关肝细胞癌时诊断价值强于甲胎蛋白,FGL-1可以作为肝细胞癌的非侵入性诊断指标,且FGL-1与甲胎蛋白联合后诊断效能进一步提升.

Purpose: To explore the clinical value of serum calcium (Ca) in elderly patients with sepsis. Materials and methods: The clinical data and laboratory data of elderly patients with sepsis (n = 165) and elderly population for physical examination (n = 67) in a tertiary hospital from January 2020 to November 2020 were collected. We analyzed serum Ca levels in sepsis and septic shock firstly, and then continued to investigate them in the survival group and the death group. Meanwhile, we also assessed the correlation between serum Ca and PCT. Results: The serum Ca levels of the elderly patients with sepsis were lower than that of the control group (median 1.98 vs 2.31 mmol/L, P < 0.001), and the more severe the sepsis, the lower the serum Ca levels. Sepsis patients with decreased serum Ca had higher shock rate and mortality. There was a negative correlation between serum Ca and PCT (r = -02957, P < 0.001). Conclusion: Serum Ca has a certain value for the early recognition of elderly patients with sepsis and the judgment of the severity of the disease. (C) 2021 Elsevier Inc. All rights reserved.

Background: Former studies have revealed that fluoroquinolone (FQ) can induce aortic expansion and rupture. While FQ is widely used in perioperative anti-infection therapy, its impact on graft patency and patient survival is unknown. Methods: Coronary artery bypass grafting (CABG) data were extracted from the MIMIC-III database. Chi-square tests, Fisher’s exact tests, t-tests, or ANOVAs were used to compare baseline data between groups determined by FQ therapy status, depending on the data type. Propensity score matching was used to establish a balanced cohort. Cox regression was used to investigate the impact of FQ on CABG patient survival, whereas paired t-tests were used to analyze secondary results. Results: Of the 5030 patients who underwent CABG, 937 (18.6%) received oral or intravenous FQ therapy. Using propensity score matching, these 819 patients were successfully matched with 819 controls in a 1:1 ratio. Cox regression showed that FQ significantly decreased survival among CABG patients (HR: 1.62, 95% CI: 1.21–2.15, p = 0.001). Furthermore, FQ usage was associated with longer hospitalization (<0.0001), ICU duration (<0.0001), ventilation period (<0.0001), and duration of vasopressor administration (<0.0001). Conclusions: Perioperative FQ therapy was associated with worse prognosis and a more difficult recovery among patients with CABG.

The chronic rejection responses and side effects of the systematic administration of immunosuppressants are the main obstacles to heart allograft and patient survival. The development of xenotransplantation also urgently requires more efficient immune regulation strategies. Herein, it is demonstrated that lymph-node (LN)-targeted drug delivery can realize LN-specific immunomodulation with attenuated immune suppression on distant peripheral immune organs to effectively prolong long-term survival after heart transplantation in a chronic murine heart transplantation model. A chemokine C-C motif ligand 21 (CCL21) specific aptamer for LN targeting is decorated onto the surface of the hybrid nanoparticular delivery vector mainly composed of CaCO3 /CaP/heparin. The targeting delivery system can dramatically enhance accumulation of the loaded immunosuppressant, fingolimod hydrochloride (FTY720), in draining lymph nodes (dLNs) for inducing powerful immune suppression. By promoting the generation of endogenous regulatory T cells (Tregs ) and decreasing the proportion of effector T cells (Teffs ) in dLNs after heart transplantation, the LN-targeting strategy can effectively regulate local immune responses instead of systemic immunity, which reduces the incidence of long-term complications. This study provides an efficient strategy to improve the survival rate after organ transplantation by precise and localized immunoregulation with minimized side effects of immunosuppression.