Safety and efficacy of oral nemonoxacin versus levofloxacin in treatment of community-acquired pneumonia: A phase 3, multicenter,randomized, double-blind,double-dummy,active-controlled,non-inferiority trial

Background/Purpose

Nemonoxacin is a novel nonfluorinated quinolone with excellent in vitro activity against most pathogens in community-acquired pneumonia (CAP), especially Gram-positive isolates. The purpose of this study was to assess the efficacy and safety of nemonoxacin compared with levofloxacin in patients with CAP.

肌钙蛋白T试纸条预测充血性心力衰竭预后的意义

目的探讨肌钙蛋白T(TNT)试纸条在预测充血性心力衰竭(CHF)预后的价值。方法将CHF患者64例,按心功能分级分为轻、重度心功能不全组各34例,30例,用试纸条检测TNT,阳性判断临界值为0.1μg/L。结果轻、重度心功能不全组TNT阳性数各为0例,8例,有显著差异(P＜0.05);TNT阳性死亡率50%较阴性死亡率3.57%高(P＜0.05);TNT阳性住院日数(36.36±14.64)d较阴性住院数(23.82±11.29)d长(P＜0.05);TNT阳性预测患者死亡率特异性为93.01%,敏感性为66.67%。结论用试纸条测试TNT对CHF预后具有一定的预测价值。     

胆道结石术后继发急性胆管炎病原菌及sCD14-ST和IL-8的诊断价值

目的探讨胆道结石术后继发急性胆管炎病原菌及可溶性CD14亚型(sCD14-ST)、白细胞介素-8(IL-8)的诊断价值。方法选择海南医学院第一附属医院2017年1月-2019年6月收治的胆道结石术后继发急性胆管炎患者62例作为研究对象,纳入研究组,选择同期医院收治的胆道结石术后未继发急性胆管炎的患者60例设为对照组;对研究组患者病原菌进行统计;比较不同急性胆管炎程度、不同预后结局患者血清sCD14-ST、IL-8水平;采用受试者工作特征曲线评估血清sCD14-ST、IL-8水平对于患者不良预后的诊断价值。结果 62例患者共培养分离病原菌67株,其中革兰阴性菌43株占64.18%,革兰阳性菌21株占31.34%,真菌3株占4.48%,以大肠埃希菌为主;重度急性胆管炎患者血清sCD14-ST、IL-8分别为(91.38±25.67)pg/ml、(45.28±13.61)pg/ml高于中度患者分别为(74.34±19.65)pg/ml、(32.06±10.44)pg/ml及轻度患者(P均<0.001),中度患者血清sCD14-ST、IL-8水平高于轻度患者(P均<0.001);预后不良患者急性胆管炎血清sCD14-ST、IL-8分别为(89.84±25.09)pg/ml、(41.94±12.28)pg/ml高于预后良好患者(P<0.05);sCD14-ST、IL-8对胆道结石术后急性胆管炎患者预后的截断值分别为65.65、29.31 pg/ml,其曲线下面积分别为0.841、0.768。结论胆道结石术后继发急性胆管炎病原以革兰阴性菌为主;运用血清sCD14-ST、IL-8可较好区分疾病严重程度,且对患者预后具有一定预测价值。     

重症肺炎支原体肺炎老年人血清纤维蛋白原、血小板反应蛋白 -1表达及其与预后的相关性

目的检测重症肺炎支原体肺炎( MPP)病人血清纤维蛋白原( FIB)和血小板反应蛋白 -1(TSP-1)的表达情况，并探究其表达水平与 MPP病人预后的相关性。方法选取 2017年 3月至 2018年 12月在海南医学院第一附属医院收治的 MPP老年人 89例作为研究对象，其中重症 MPP 46例作为重症组，轻症 MPP 43例作为对照组。采用酶联免疫吸附测定( ELISA)检测各组研究对象血清 FIB、TSP-1的表达水平；通过受试者操作特征曲线( ROC曲线)评估血清 FIB、TSP-1表达水平对重症 MPP的诊断价值；分析病人预后不良情况发生率；并采用 logistic回归分析老年人发生预后不良的相关影响因素。结果重症组血清 FIB、TSP-1表达水平分别为( 4.93±1.16)g/L、(375.42±34.13)μg/L，显著高于对照组的( 3.85±0.97)g/L、(316.71±23.05)μg/L(P<0.05)。ROC结果显示，血清 FIB和 TSP-1单独及联合诊断重症 MPP的曲线下面积(AUC)分别为 0.796、0.900、0.926，血清 FIB联合 TSP-1诊断重症 MPP的灵敏度和特异度分别为 84.82%、90.65%。高 FIB组、高 TSP-1组老年人病人预后不良发生率分别为54.55%(12/22)、 55.00%(11/20)，显著高于低 FIB组的 16.67%(4/24)及低 TSP-1组的 19.23%(5/26)(P<0.05)。 logistic回归分析显示，血清 FIB、TSP-1表达水平是影响重症 MPP病人发生预后不良的独立危险因素(均 P<0.05)。结论 FIB和 TSP-1在重症 MPP病人血清中的表达水平明显升高，且其高表达与病人预后不良有关，均可作为重症 MPP的早期诊断及预后评估的潜在生物学指标。     

山慈菇提取物通过下调AEG-1表达抑制人结直肠癌SW480细胞迁移和侵袭＊

目的 本研究旨在观察山慈菇提取物对人结直肠癌SW480细胞迁移和侵袭能力的影响，并探讨其分子机制。方法 取人结直肠癌SW480细胞作为研究对象，采用划痕实验和Transwell法检测细胞迁移和侵袭能力，采用短发夹RNA（Short hairpin RNA，shRNA）干扰技术沉默SW480细胞中星形细胞上调基因-1（astrocyte elevated gene-1，AEG-1）基因的表达，利用Western blot法检测基质金属蛋白酶-2，9（matrix metalloproteinase-2，9，MMP-2，9）、E-钙粘蛋白（E-cadherin）和AEG-1等蛋白的表达变化。结果 山慈菇提取物可使人结直肠癌SW480细胞愈合率、迁移率和侵袭率均显著下降（P < 0.05），下调MMP2、MMP9和AEG-1蛋白表达水平（P < 0.05）以及上调E-cadherin蛋白表达水平（P < 0.05），上述作用均具有浓度依赖性。经shRNA干扰AEG-1基因表达后，SW480细胞中AEG-1蛋白表达水平显著下降（P < 0.05）；同时AEG-1干扰SW480细胞中E-cadherin蛋白表达水平显著升高（P < 0.05），MMP2和MMP9蛋白表达水平均显著下降，同时单独或者联合山慈菇提取物组的细胞迁移率、侵袭率也降低（P < 0.05）。结论 山慈菇提取物能浓度依赖性地抑制人结直肠癌SW480细胞迁移和侵袭，这可能与山慈菇提取物抑制AEG-1蛋白表达，继而下调MMP2、MMP9蛋白表达和上调E-cadherin蛋白表达有关。     

Exploring a 7-gene prognostic model based on ferroptosis for efficiently guiding immunotherapy in melanoma patients

PurposeAlthough skin cutaneous melanoma (SKCM) is a relatively immunotherapy-sensitive tumor type, there is still a certain fraction that benefits less from treatment. Ferroptosis has been demonstrated to modulate tumor progression in many cancer types. This study focused on ferroptosis-related genes to construct a prognostic model for SKCM patients.Materials and methodsGene expression profiles of SKCM samples were obtained from public databases. Unsupervised consensus clustering was used to determine molecular subtypes related to ferroptosis. Least absolute shrinkage and selection operator (LASSO) and stepwise Akaike information criterion (stepAIC) were applied to construct a prognostic model based on differentially expressed genes between two molecular subtypes.ResultsC1 and C2 subtypes were identified with differential prognosis and immune infiltration. A 7-gene prognostic model was constructed to classify samples into high-FPRS and low-FPRS groups. Low-FPRS group with favorable prognosis had higher immune infiltration and more enriched immune-related pathways than the high-FPRS group. The two groups showed distinct sensitivity to immunotherapy, with the low-FPRS group predicted to have more positive response to immunotherapy than the high-FPRS group. A nomogram based on the FPRS score and clinical features was built for more convenient use.ConclusionsThe critical role of ferroptosis involved in SKCM development was further validated in this study. The prognostic model was efficient and stable to be applied in clinical conditions to support clinicians in determining personalized therapy for SKCM patients especially those with metastasis.     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

不同表面处理方法在纳米混合树脂复合材料修复中的应用

目的： 分析不同表面处理方法和粘接剂自酸蚀功能单体对树脂-复合材料界面即时修复粘结强度和完整性的影响。方法： 采用纳米树脂复合材料制作98个树脂复合材料,随机分为A1、A2、B1、B2、C、D组,各14个试件。表面未处理的试件作为阳性对照组（14个试件）。A1组用Gluma 通用粘接剂系统抛光,A2组用Gluma 通用粘接剂系统抛光、喷砂,B1组用Tokuyama Bond ForceⅡ^TM粘结系统抛光,B2组用Tokuyama Bond ForceⅡ^TM抛光、喷砂,C组仅经抛光样品组。D组仅做喷砂。采用与底物相同的树脂复合材料,对修复后试件进行剪切粘结强度（shear bond strength,SBS）测试,所有样本均进行电子显微镜扫描、测定表面轮廓,进行失效分析。采用SPSS 20.0软件包对数据进行统计学处理。结果： D组修复粘结强度显著高于阴性对照组（P<0.05）,A1、A2、B2、B1组粘结强度显著高于C、D组（P<0.05）;B1、D或A1组相比,粘结强度无显著差异（P>0.05）;B2组、阳性对照组粘结强度无显著差异（P>0.05）。除喷砂、TBFⅡ外,阳性对照组粘合强度值显著高于A1、C组（P<0.05）。抛光后表面粘合失效率高于喷砂样本（P<0.05）;抛光、Gluma处理样品粘合失败率高于抛光、TBFⅡ处理样品（P<0.05）;喷砂、TBFⅡ处理的表面内聚破坏率高于抛光、TBFⅡ处理（P<0.05）。抛光技术的表面粗糙度与喷砂技术相比,较规则且粗糙度较低（P<0.05）。结论： 经喷砂处理的复合材料基材加TBFⅡ,其修复粘结性最强,且表面内聚破坏率较高,TBFⅡ处理粘合失败率低。但经喷砂处理后的材料易堆积食物残渣,而抛光后的材料则不易发生。使用喷砂处理的复合材料基材上加TBFⅡ的患者,需正确有效地维护口腔卫生。