Objective: To explore the relationship and internal path between activities of daily living (ADL), sleep quality and mental health of community elderly people in Shanghai. Methods: A questionnaire survey was conducted among community residents aged 60 years and older seeing doctors in community health care center of five streets in Shanghai during Sept to Dec, 2021 using convenience sampling. Activities of Daily Living (ADL), Pittsburgh Sleep Quality Index (PSQI) and 10-item Kessler Psychological Distress Scale (K10) were adopted in the survey. Single factor analysis, correlation analysis and multiple linear regression were used to analyze the data. The effect relationship between the variables was tested using Bootstrap's mediated effects test. Results: A total of 1 864 participants were included in the study. The average score was 15.53±4.47 for ADL, 5.60±3.71 for PSQI and 15.50±6.28 for K10. The rate of ADL impairment, poor sleep quality, poor and very poor mental health of the elderly were 23.6%, 27.3%, 11.9% and 4.9%, respectively. ADL and sleep quality were all positively correlated with mental health(r=0.321, P < 0.001; r=0.466, P < 0.001); ADL was positively correlated with sleep quality(r=0.294, P < 0.001). Multiple linear results of factors influencing mental health showed that ADL (β=0.457, 95%CI: 0.341-0.573), sleep quality(β=0.667, 95%CI: 0.598-0.737) and mental health were positively correlated (P < 0.001). Sleep quality partially mediated the relationship between ADL and mental health (95%CI: 0.078-0.124) with an effect size of 33.0%. Conclusion: Sleep quality is a mediator between ADL and mental health among community elderly people. Improving ADL and sleep quality may improve mental health in the population.
Objective: To obtain guiding recommendations for the development of fertility preservation in female patients of reproductive age, so as to promote the scientific, standardized and orderly implementation of fertility preservation work. Methods: A previous questionnaire survey was used to determine the preliminary recommendations, a modified Delphi method was used to invite 18 domestic experts of fertility preservation to conduct two rounds of expert consultation. Then we adjusted and summarized recommendations according to the results of the consultation. Results: Finally, 14 guiding recommendations for the development of fertility preservation in female patients of reproductive age were obtained according to the results of the Delphi consultation, including 5 recommendations at technical level, 5 recommendations at political level and 4 recommendations at educational level. At technical level, it was proposed to establish a standardized operation process; at political level, it was proposed to improve the relevant legislation of fertility preservation in China to protect the safety and interests of patients; at educational level, it was suggested to take various forms to promote the mass dissemination of fertility preservation knowledge. Conclusion: Guiding recommendations for fertility preservation in female patients of reproductive age can provide detailed and comprehensive guidance for promoting fertility preservation in female patients of reproductive age in Shanghai, and provide reference for carrying out fertility preservation in other regions.
Objective: An isotemporal substitution model was used to explore the associations between activities including 10 minutes per day of physical activity (PA), sedentary behavior (SB), and sleep (SLP), and depressive symptoms among vocational school students with and without depressive symptoms. Methods: Questionnaire survey was conducted on grade one to grade three students attending vocational schools in Shanghai and Jiangsu Province from Dec 2021 to Jan 2022. Fourteen schools were selected using the convenience cluster sampling method. The selected students were categorized into depressive symptoms group and non-depressive symptoms group according to the Centre for Epidemiologic Studies Depression Scale (CES-D) scores. Results: A total of 40 339 questionnaires were collected, of which 10 086 were able to clearly remember the time of physical activity in the past week, and 8 149 were valid after data cleaning. According to the valid questionnaires, 5 496 students (67.44%) were in the non-depressive symptoms group and 2 653 (32.56%) were in the depressive symptoms group. The mean age of the students were (16.70±1.19) years. In the non-depressive symptoms group, substituting moderate physical activity (MPA) for all the other behaviors was negatively associated with CES-D scores, while substituting vigorous physical activity (VPA) for MPA and SB was positively associated with CES-D scores. In the depressive symptoms group, substituting walking, SB, and SLP with MPA was negatively associated with CES-D scores, respectively. The associations of MPA substituted for walking, SB, and SLP with CES-D scores were much stronger in the depressive symptoms group than in the non-depressive symptoms group. Conclusion: The detection rate of depressive symptoms was high among vocational students. Substituting MPA for walking, SB, and SLP were negatively associated with CES-D scores, with a stronger association observed in the depressive symptoms group than in the non-depressive symptoms group.
Objective: To evaluate the value of high-throughput sequencing (HTS) data reanalysis that does not include ERBB2 copy number variation (CNV) analysis, in identifying ERBB2 amplification in patients with colorectal cancer. Methods: The HTS data of 252 cases of colorectal cancer diagnosed by pathological biopsy who received peripheral blood cfDNA HTS detection samples were retrospectively analyzed. According to the HTS data of ERBB2 non-amplified samples judged by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH), the number of chromosome 17 (Chr17) reads in the total number of reads was calculated the range of the ratio was initially determined as the threshold for prompting ERBB2 amplification. Suspected positive samples were screened according to thresholds and verified by digital PCR, IHC and FISH. Results: The proportion of the number of Chr17 reads accounts for the number of total reads in the 89 cases of ERBB2 non-amplified samples determined by IHC and/or FISH ranged from 0.188 to 0.299 (0.239±0.192). Using 0.298(1.25 times the mean) as the threshold indicating ERBB2 amplification, the data of 163 samples were analyzed, of which 7 cases were suspected to be positive, and the ratio ranged from 0.302 to 0.853. Among them, 5 cases were determined to be positive by IHC and/or FISH, and 6 cases were confirmed to be positive by digital PCR. The ratio of the number of Chr17 reads to the number of total reads was positively correlated with the ratio of ERBB2/EIF2C1, and the correlation was good (r2=0.909). Conclusion: The high-throughput sequencing data that does not cover the ERBB2 CNV analysis has a certain hint value for ERBB2 amplification in patients with colorectal cancer.
Objective: To compare the clinical characteristics, peripheral blood inflammatory cells and levels of oxidative stress indicators between severe asthma and non-severe asthma patients, analyze the effects of neutrophils and oxidative stress molecules on the severity of asthma, and build a biological model for early prediction of severe asthma. Methods: From Aug 2018 to Jul 2019, 67 adult patients with stable asthma in our hospital were enrolled in this study. The clinical characteristics, peripheral blood inflammatory cells and levels of oxidative stress indicators of severe asthma group and non-severe asthma group were compared. Single factor Logistic regression analysis was conducted on severe asthma to screen out the most important five variables. Multifactor Logistic regression analysis was further conducted to establish a prediction model for severe asthma. Results: There were 25 severe asthma patients in this cohort, who had a longer course of disease, more frequent acute attacks, poorer asthma control, higher peripheral neutrophils, more severe obstructive ventilation dysfunction, lower myeloperoxidase (MPO) level and higher superoxide dismutase (SOD) than non-severe asthma patients. The patients with higher peripheral blood neutrophil count or proportion were more likely to show severe asthma, more frequent acute attacks, and more obvious reduction of pulmonary ventilation function. A panel of biomarkers, centered on peripheral blood neutrophil count and oxidative stress indicators SOD, human 8-epi-prostaglandin F2α (8-iso-PGF2α), could build a model to predict severe asthma. Conclusion: There are significant differences in clinical characteristics, peripheral blood inflammatory cells, and oxidative stress index levels between severe asthma patients and non-severe asthma patients. In stable asthma patients, levels of neutrophils and oxidative stress indicators such as SOD had an impact on the severity of asthma. The prediction model of severe asthma established on this basis provides a new idea for early recognition of severe asthma.
Objective: By analyzing relevant literature of long COVID, we aimed to understand the current research status, hotspots and trends in this field. Methods: Based on Web of Science core collection data, bibliometric analysis was used as the main research method. The results were visualized with VOSviewer. A comprehensive analysis was performed from various perspectives including trends in publication, journal distribution, highly cited papers, international research collaboration networks, and clusters of keywords, etc. Results: The field of long COVID has garnered significant global academic attention. A total of 7 877 related articles were retrievable, with a total citation count of 103 389 and an average citation count of 13.13 per article. Among them, the United States published the most articles (1 780 articles, 22.59%), while China ranked fifth in publication volume (686 articles, 8.71%). The international scientific cooperation network reflected the close collaborative relationships between countries in long COVID research, predominantly involving the United States, the United Kingdom, Italy, India, and China. Keywords clustering indicated that the current main research focuses in the long COVID field include: clinical manifestations, epidemiological characteristics, risk factors, and mechanisms of occurrence, treatment and rehabilitation measures of long COVID, and its impact on public and social life. Conclusion: This article reveals the current state, research hotspots and trends in the long COVID field, providing valuable references for related research institutions, scholars as well as health administrative office.
Objective: To evaluate the value of magnetic resonance imaging(MRI) in prenatal diagnosis of fetal Chiari malformation. Methods: The prenatal MRI findings of 27 cases of Chiari malformation confirmed by follow-up in Obstetrics and Gynecology Hospital, Fudan University from Feb 2010 to Feb 2022 were retrospectively analyzed and compared with ultrasound findings. Results: Twenty-seven pregnant women, aged from 16-36 years (average 28.0 years) and 27 fetuses with gestation from 15.3-38.4 weeks (average 24.3 weeks) were studied. There were 18 cases of Chiari Ⅱ (Chiari malformation type Ⅱ, CMⅡ), 3 cases of Chiari Ⅲ (CMⅢ), 6 cases of Chiari Ⅳ (CMⅣ). CMⅡ and CMⅢ images showed brain herniation, descending pons, narrowing or disappearance of the posterior fossa cistern and the fourth ventricle, the subarachnoid space disappears. There were 17 cases of hydrocephalus, 2 cases of cerebrospinal fluid loss, 17 cases of "lemon head" and "banana cerebellar" signs, 4 cases of encephalocele, 15 cases of spinal bifida, 3 cases of lower spinal cord and 2 cases of spinal cavity, 4 cases of spinal angular deformity and 6 cases of other malformations. In CMⅣ, there were 2 cases of undeveloped cerebellum and 4 cases of cerebellum and brainstem dysplasia, hydrocephalus in 5 cases, posterior fossa cistern widening in 4 cases, and other malformations in 4 cases. MRI showed the posterior fossa structure and spinal cord more clearly than ultrasound, and could find lesions not detected by ultrasound. Conclusion: Prenatal MRI can be used as a complementary examination of ultrasound, which can improve the accuracy of diagnosis of Chiari malformation, reduce the rate of missed diagnosis, and clarify the classification of Chiari malformation.
Objective: To construct a measurement tool for atrial fibrillation (AF) patients' experience of catheter ablation, in order to provide quantifiable basis for improving the patients' perioperative experience. Methods: From Jun 2022 to Apr 2023, literature analysis, qualitative research, Delphi expert consultation, and analytic hierarchy process were used to determine the content and weight of various indicators of the measurement tool. Results: The enthusiasm of experts in 3 rounds was 100%. The authority coefficient of experts was 0.946, 0.961 and 0.976. The Kendal harmony coefficients of the 2 and 3 rounds of expert consultation was 0.130 and 0.370 (P < 0.001). The final measurement tool included 46 items and 5 dimensions, including operational and technical quality experience, comfort management experience, information and communication experience, emotional support experience, service process and response experience. Conclusion: The preliminary construction of measurement tool for AF patients' experience of catheter ablation, which were based on the features of specialty, could not only evaluate the patients' experience accurately, but also provide a basis for targeted improvement of medical and nursing service quality.
Objective: To explore the operation effect of the improved full-appointment mode of ambulatory chemotherapy, so as to provide reference for further improving the treatment process. Methods: The enhanced full-appointment mode had been implemented in Fudan University Shanghai Cancer Center outpatient information system, which seamlessly integrated daytime chemotherapy assessment with comprehensive information management, formulated precise rules for chemotherapy appointments, and ensured efficient integration of relevant data.A comparative analysis was conducted between the period after optimization (Jan to Sep 2022) and the corresponding period in the previous year (Jan to Sep 2021), considering factors such as patient waiting time, human involvement, patient safety during chemotherapy, as well as nurse and patient satisfaction. Results: After optimization, the time spent by patients was reduced from 52.12 (32.73-83.05) to 20.04 (11.87-41.10) minutes, with statistically significant difference (z=-78.144, P < 0.001). Additionally, the time spent by patients before and after optimization was significantly different in the distribution of < 30 minutes, 30-60 minutes, and > 60 minutes (χ2=5 958.455, P < 0.001). Previously, one nurse and 2-3 security personnel were required to schedule appointments in the daytime chemotherapy center, while after optimization, there was no longer a need for nurses to arrange appointment windows and the number of security personnel was reduced to one, thereby optimized human operations. It was observed that the number of cases involving chemotherapy infusion reactions decreased from 59 to 46 following optimization, and the number of patients requiring rescue observation reduced from four to one. Notably, no rescue events occurred during non-day shifts, thus enhanced patient safety during treatment hours outside regular working hours. Furthermore, there was a statistically significant improvement in both nurses' and patients' satisfaction levels before and after implementation of these optimizations (P < 0.05). Conclusion: The modified full appointment mode reduced patient waiting time, optimized human resources utilization, enhanced patient safety during chemotherapy, and improved satisfaction levels among both nurses and patients. The implementation of the modified full appointment mode for daytime chemotherapy centers was beneficial to their overall operation.
Objective: To explore the eradication rate of human papillomavirus (HPV) and gestational outcome of patients with high-grade squamous intraepithelial disease of the cervix (HSIL) after loop electrosurgical excision procedure (LEEP) by transvaginal dissection of the vesicorectal form the cervix. Methods: A total of 53 patients treated with LEEP by transvaginal dissection of the vesicorectal form the cervix in Obstetrics and Gynecology Hospital, Fudan University from Jan to Dec, 2019 were investigated. Clinical information of cervical cytological examination, HPV test and cervical biopsy under colposcopy were followed up for 6, 12 and 24 months post-LEEP were collected. HPV infection in these 53 patients were compared before and after LEEP surgery. The rate of successful fertility of the cohort, the HPV conversion rate of patients with hysterectomy and LEEP done were compared. The association between the pathological type and positive surgical margin and the association between HPV infection type and positive surgical margin were analyzed. Results: HPV infection rate of was 94.3% (50/53) and the proportion of HPV16 and/or 18 infection was 75.5% (40/53). Mono-HPV infection rate (69.8%, 37/53) was significantly higher than mixed HPV infection rate (22.7%, 13/53). Thirty-eight patients (71.7%) were found with positive surgical margin in previous LEEP operation. Fifteen patients had recurrence (28.3%) and 40 patients (75.5%) successfully delivered baby after surgery. Postoperative pathology was mainly HSIL, accounting for 66% (30/53), and 28.3% patients (15/53) had no pathological change. Forty cases had satisfying fertility-conservative operation outcome with negative surgical margin, and 38 patients eradicated HPV infection after LEEP, which took up 95% of patients with satisfying fertility-conservative operation. There was no significant difference of positive resection margin rate in between groups of HPV16/18 infection and other types. Five cases had successful delivery (12.5%, 5/40) with 1 case of vaginal delivery and 4 cases of cesarean section. Among these 5 cases, 3 cases undertook preventive cervical cerclage, with 1 case of vaginal delivery and 2 cases of cesarean sections. Conclusion: HPV eradication rate and surgical outcome could be significantly improved by LEEP with transvaginal dissection of the vesicorectal from the cervix, which satisfied the fertility preservation of females at reproductive age.
Objective: To study the effect of drinking carbohydrate drinks before cesarean section on mothers and neonates, and to explore the application value of drinking carbohydrate drinks before cesarean section. Methods: The clinical data of 206 singleton women who underwent selective cesarean section in Obstetrics and Gynecology Hospital, Fudan University from Jun 2020 to Jun 2021 were retrospectively studied. Patients were divided into enhanced recovery after delivery (ERAD)group and control group according to whether drinking carbohydrate drinks before cesarean section. A retrospective cohort study was conducted to analyze the effect of preoperative carb drinks on preoperative fluid supplementation, postoperative rehabilitation and neonatal prognosis. Results: Among patients who fasted for less than 12 hours, the ERAD group had a lower fluid supplementation rate and a smaller average fluid supplementation volume compared to the control group (P < 0.05). The ERAD group had a lower rate of prokinetic agent using after surgery (P < 0.05). Among women without a history of abdominal surgery, the ERAD group had less blood loss 24 hours after surgery (P < 0.05). There were no significant differences in postoperative fever rate, incidence of nausea and vomiting, time of first flatus, neonatal apgar score, exit observation room neonatal blood, and neonatal neonatal intensive care unit (NICU) admission rate between the two groups. Among newborns with high-risk factors for hypoglycemia, the ERAD group had lower enter observation room neonatal blood compared to the control group, and a higher incidence of hypoglycemia (P < 0.05). Conclusion: Oral intake of carbohydrate drinks before cesarean section may be beneficial in reducing fluid supplementation before elective cesarean section, promoting postoperative gastrointestinal function recovery, and reducing postoperative bleeding. However, it may be related to the occurrence of neonatal hypoglycemia.
Objective: To investigate the influence of arm position on ultrasound-guided subclavian vein puncture and placement. Methods: A total of 90 patients undergoing general anesthesia in Qingpu Branch of Zhongshan Hospital, Fudan University from Aug to Dec 2021 were randomly divided into abduction group (n=45) and adduction group (n=45). The central venous catheter was placed in the plane of subclavian vein under real-time ultrasound guidance. The one-time success rate of puncture, total success rate of puncture and puncture complications of the two groups were observed and recorded. Results: In the process of real-time ultrasound-guided subclavian vein puncture, the success rate of one-time puncture in abduction group was 88.9% (40/45), which was significantly higher than that in adduction group (68.9%, 31/45), the difference was statistically significant (P=0.020). The total success rate of puncture was 95.6% (43/45) in abduction group and 82.2% (37/45) in adduction group, and the difference was statistically significant (P=0.044). In terms of puncture complications, there were 8 cases of puncture failure in adduction group, including 2 cases of local hematoma, and there were 2 cases of puncture failure in abduction group without local hematoma. No pneumothorax occurred in the two groups, and all the failed cases were replaced by ipsilateral internal jugular vein puncture. Conclusion: In patients undergoing general anesthesia, 90° arm abduction is convenient for real-time ultrasound-guided subclavian vein puncture and catheterization, which is worthy of clinical promotion.
Objective: To analyze the budget impact of a price increase for carotid endarterectomy (CEA) on the total expenditure of health insurance expenditure in China. Methods: We set 2021 as the base year, and 2022-2026 as the study years. A budget impact analysis model was developed to calculate the expenditure of health insurance funds over the next 5 years following a 30% price increase for carotid endarterectomy. Data on the target population, treatment costs, and market share changes both nationwide and in four sample cities were used. The data was collected in May to Jul 2022. Results: The price increase for carotid endarterectomy will reduce total health insurance fund expenditures nationwide by 143.176 2 million yuan over five years. Total health insurance fund expenditures in the sample cities will also decrease to varying degrees. The higher the price increase for the surgical procedure, the greater the decrease in total expenditure of the health insurance fund. The market share of the surgical procedure has the greatest impact on the total expenditure of the health insurance fund. Conclusion: Increasing the price of carotid endarterectomy may lead to increase in its market share and decline in the health insurance fund expenditures in future five years.
Objective: To investigate different doses of the analgesic effects of dezocine comparing with sufentanil after laryngectomy. Methods: A total of 129 patients who underwent elective partial laryngectomy from Feb 2022 to Jan 2023 were randomly assigned to dezocine 0.5 mg/kg group (group D1), dezocine 0.6 mg/kg group (group D2) and sufentanil 2 μg/kg group (group S). Twenty-four hours amount of drugs, the visual analogue scale (visual analogue scale, VAS) and 48 h total pressing times of PCA (patient-controlled intravenous analgesia, PCIA)were compared among the three groups at 6, 12, 24 and 48 h after operation, and the postoperative adverse reactions (nausea, vomiting, dizziness, urinary retention and respiratory depression) were recorded. Results: There was no significant difference in 24 h amount of drugs among the three groups. The VAS score of group D1 was higher than that of group S at 6 h postoperatively (P < 0.05), but did not differ significantly among the three groups at 12, 24 and 48 h. There was no significant differences in the number of compressions and postoperative adverse reactions among the three groups. Conclusion: Compared with sufentanil, 0.6 mg/kg dezocine can provide the same degree of analgesic effect. However, no advantage was found to reduce adverse reactions.
Objective: To study the feasibility on automatic contouring of pelvic intestinal tube based on deep learning for radiotherapy images. Methods: A total of 100 patients with diagnosis of rectal cancer, received radiotherapy in Zhongshan Hospital, Fudan University from 2019 to 2021, were randomly selected. Sixty cases were randomly enrolled to train the models, and the other 40 cases were applied to test. Based on the original small intestine model in automatic segmentation software AccuContour, 60, 40 and 20 (2 groups) cases in the model cases were used to train the models Rec60, Rec40, Rec20A and Rec20B with manual contouring as ground truth. Other 40 cases for test were applied to evaluate the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95) and average symmetric surface distance (ASSD) between the manual contouring and original model along with model Rec60. The DSC of the 5 groups of auto-segmentations were compared as well. The paired t tests were performed for each pair of the original model and 4 trained models. Results: The small bowel contoured by trained models were more similar to the manual contouring. They could distinguish the boundary of the intestinal tube better and distinguish the small bowel from the colon. The average DSC, HD95 and ASSD of Rec60 were 0.16 higher (P < 0.001), 12.4 lower (P < 0.001) and 5.14 lower (P < 0.001) than the original model respectively. According to the paired t tests, there were no statistical differences in DSC between the 4 training models and the original model. No statistical difference was observed between Rec60 and Rec40, while they were both significantly different from the two Rec20 models. There was no statistical difference between Rec20B and Rec20B. Conclusion: For radiotherapy images, model training can effectively improve the accuracy of intestinal tube delineation. Forty cases were enough for training an optimal model of automatic segmentation for pelvic intestinal tube in AccuContour software.
Objective: To establish a mouse model of type Ⅰ tricho-hepato-enteric syndrome (THES) induced by Ttc37 deficiency. Methods: Ttc37 flox strain was established by site-specifically inserted loxP sites into Ttc37 gene via CRISPR/CAS9 technology. Ubiquitously expressed CAG-Cre was introduced for all-tissue removal of Ttc37 in Ttc37flox/flox; CAG-Cre mice. The knock-out effect was confirmed by fluorescence quantitative PCR and Western blot. Phenotypic evaluations were conducted in 8-week-old mice including hematoxylin-eosin staining of skin, spleen, liver, bladder, and gastrointestinal tract (GI), serum enzyme activity assay of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), measurement of serum hemoglobin level, and ELISA for IgG and IgM level upon antigen immunization. Results: Similar to type Ⅰ THES patients, Ttc37flox/flox; CAG-Cre mice exhibited impaired development of hair shaft, epidermis, B cell and eyes, while liver, GI, bladder and serum hemoglobin level seemed normal under unstressed condition. Conclusion: A novel mouse model of type Ⅰ THES was constructed successfully, which was applicable for pathological study.
Tricuspid regurgitation (TR) cases are widely distributed in China. Poor clinical drug efficacy, high surgical risk, and poor prognosis for right heart failure are found in patients with moderate or severe TR. In recent years, with the innovation of valve instruments and the development of technology, transcatheter tricuspid valve treatment could be a new choice for high-risk TR patients in surgery. Many TR animal models have emerged these years for the research of the mechanism of TR and for the clinical verification of instruments. Therefore, this review focuses on how to develop an animal model of TR and discusses the advantages and disadvantages of these techniques.
Nonalcoholic fatty liver disease (NAFLD) is a metabolic liver disease that ranges from relatively benign hepatic steatosis to nonalcoholic steatohepatitis (NASH). NASH is characterized by persistent liver damage, inflammation, and fibrosis which significantly increases the risk of end-stage liver diseases, such as liver cirrhosis and hepatocellular carcinoma. The pathogenesis of NAFLD/NASH is not yet fully understood, but its recent epigenetic advances have provided new insights into the mechanisms of this disease. This review summarized recent progress in this area which has laid a solid foundation for elucidating the pathogenesis of NAFLD and provides potential targets for early detection, diagnosis, and treatment of this disease.
Ultrasound measurement of fetal biological parameters is an important indicator for evaluating fetal intrauterine growth and development, and its corresponding fetal growth standards are important criteria for determining whether the measurement parameters are normal or have fetal growth restriction. There are classic regional standards of prenatal ultrasonic measurement that have been used for many years, as well as international standards that have received widespread attention in recent years. However, there is no unified global standard. This paper reviewed the development process and clinical application status of fetal growth standards, explore future research trends, with a view to providing reference value for clinical practice.
With the increasing application of immune checkpoint inhibitors (ICI) in anti-tumor therapy, ICI related infections are often neglected. Mycobacterium tuberculosis (MTB) is also a common pathogen. We reported a case of ICI related pulmonary tuberculosis from Zhongshan Hospital, Fudan University. Meanwhile, 18 cases of ICI related tuberculosis infection were collected through literature search, and the characteristics of ICI related tuberculosis were analyzed to improve the understanding in clinic practice. All the cases were confirmed TB including 15 cases of pulmonary tuberculosis (1 case with complication of intestinal tuberculosis) and 4 cases of extra-pulmonary tuberculosis (1 case of disseminated tuberculosis, bone tuberculosis, tuberculous pericarditis and tuberculous pleurisy, respectively). The chest CT characteristics of pulmonary tuberculosis mainly included centrilobular nodules, ground glass nodules, empty lesions, patchy shadows, consolidation and large infiltration. Eighteen cases started anti-tuberculosis treatment, while 4 cases continued ICI treatment. Three cases suspended ICI (2 cases had remission after reuse) and 11 cases stopped ICI, and 1 case was not mentioned. ICI related tuberculosis may be a direct complication of tumor immunotherapy. It is necessary to screen tuberculosis infection and exclude active tuberculosis before immunotherapy. If there are suspected symptoms such as fever, cough and sputum during ICI treatment, active tuberculosis should be taken into account.
Superior vena cava syndrome (SVCS) is a group of clinical syndromes caused by obstruction of the superior vena cava and its major branches from various causes. Pulmonary artery stenosis (PS) is a complication of lung cancer or mediastinal tumours. SVCS combined with PS due to pulmonary metastases from bladder cancer is extremely rare and has not been reported in the literature. Here we reported an old male patient with pulmonary metastases from bladder cancer presenting with swelling of the head, neck and both upper limbs. SVCS combined with PS was clarified by pulmonary artery computed tomography angiography (CTA)and digital subtraction angiography (DSA). Endovascular stenting was used to treat SVCS. Angiography also showed that PS had not caused pulmonary hypertension and did not need to be treated. The swelling of the patient's head, neck and upper limbs was gradually reduced after the procedure.
This article introduced the basic theory of non-parametric regression and its application in medical and public health research for methodological reference. We conducted Cox proportional hazard models with restricted cubic splines using chronic disease management data from a Center for Disease Control and Prevention. We aimed to explore the separate and combined effects of mean fasting blood glucose level and glucose variability on all-cause mortality among individuals with type 2 diabetes. A non-linear association was observed between glucose variability and the risk of all-cause mortality. The association between glucose variability and all-cause mortality was stronger at higher mean fasting blood glucose levels compared to lower levels. The non-parametric regression methods comprehensively explored dose-response relationships between continuous exposure and outcome, revealing the combined effects of continuous exposures, which provided recommendations for targeted interventions. The method showed promising application value in medical and public health research.
