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.

社区1~3岁儿童语言发育与屏幕暴露的相关性调查研究

目的 分析研究社区1~3岁儿童语言发育与屏幕暴露的相关性,为儿童屏幕暴露现状提供改进意见。方法 选取2016年1月-2018年7月于本院儿童保健门诊随访的1~3岁幼儿共827例,男童406例,女童421例,平均年龄为(24.5±5.3)月。采用自制式调查问卷,由本科保健医生指导调查对象的父母或抚养人现场完成,并结合Gesell 婴幼儿发育量表评估调查对象语言发育情况。结果 827例儿童中,93例诊断为语言发育迟缓,734例语言发育正常。两组儿童接触屏幕年龄段、儿童性别、家庭情况、母亲文化程度、父亲文化程度、母亲年龄、屏幕暴露时间、入睡是否规律、接触屏幕时家长陪同和限制屏幕暴露时间差异均有统计学意义(P＜0.05),控制混杂因素影响后多因素Logistic回归分析结果显示,屏幕暴露时间>2 h(OR=1.687,95%CI:1.022~2.236,P<0.001)、接触屏幕时无家长陪同(OR=2.035,95%CI:1.588~2.634,P=0.002)、未限制屏幕暴露时间(OR=1.475,95%CI:1.087~2.156,P=0.035)为语言发育迟缓的重要危险因素。结论 长时间的屏幕暴露会影响家庭语言环境和儿童睡眠,不利于儿童的语言发育,建议家长禁止小于18月的儿童接触屏幕,大于18月的儿童在家长陪同讲解下接触屏幕,时间控制在2 h以内,严格避免睡觉前观看电子屏幕。     

First-Pass Arrival Interval of Ultrasound Contrast Medium in the Hepatic Artery and Portal Vein as a Marker for Assessment of Liver Transplant Recipients

BackgroundThis study measures the first-pass arrival times in the hepatic artery and portal vein of the transplanted liver using contrast-enhanced ultrasound (CEUS) and assess its correlation with graft performance in the early posttransplant period.MethodsThis study evaluated 35 liver transplant recipients who underwent CEUS examination within 1 month of transplant surgery. CEUS under contrast-specific harmonic imaging mode were recorded for 60 seconds immediately after intravenous administration of microbubble ultrasound contrast medium (Sonazoid, GE Healthcare, Oslo, Norway). The recorded video clips were reviewed by 2 readers to determine the first-pass arrival times in the hepatic artery and portal vein, and the difference between the 2 was defined as the arterial-portal arrival interval (APAI). Laboratory data on the same date of CEUS examination were collected as indicators to correlate with APAI.ResultsThe intra- and inter-rater reliability for APAI measurement were excellent, with intraclass correlation coefficients > .95. The mean APAI was 4.5 ± 1.8 seconds (range, 2.0-10.5 seconds). The APAI was positively correlated with the serum total bilirubin level (r = 0.357, P = .035) and negatively correlated with the platelet count (r = −0.354, P = .037). At the 5 second cutoff point, a total serum bilirubin of >8 mg/dL was reported in 5 of 11 patients (45.4%) with APAI of >5 seconds and in only 3 of 24 patients (12.5%) with APAI of <5 seconds (P < .05).ConclusionsThe APAI is a quantitative marker that links the hemodynamics and the clinical status of the liver graft.     

Junctional adhesion molecule-like protein as a novel target for kaempferol to ameliorate lung adenocarcinoma

ObjectiveAlthough there have been improvements in targeted therapy and immunotherapy, the majority of lung adenocarcinoma (LUAD) patients still lack effective therapies. Consequently, it is urgent to screen for new diagnosis biomarkers and pharmacological targets. Junctional adhesion molecule-like protein (JAML) was considered to be an oncogenic protein and may be a novel therapeutic target in LUAD. Kaempferol is a natural flavonoid that exhibits antitumor activities in LUAD. However, the effect of kaempferol on JAML is still unknown.MethodsSmall interfering RNA was used to knockdown JAML expression. The cell viability was determined using the cell counting kit-8 assay. The proliferation of LUAD cells was evaluated using the 5-ethynyl-2′-deoxyuridine incorporation assay. The migration and invasion of LUAD cells were evaluated by transwell assays. Molecular mechanisms were explored by Western blotting.ResultsJAML knockdown suppressed proliferation, migration and invasion of LUAD cells, and JAML deficiency restrained epithelial-mesenchymal transition (EMT) via inactivating the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) pathway. Using a PI3K activator (740Y-P), rescue experiments showed that phenotypes to JAML knockdown in LUAD cells were dependent on the PI3K/AKT/mTOR pathway. Kaempferol also inhibited proliferation, migration and invasion of A549 and H1299 cells and partially suppressed EMT through the PI3K/AKT/mTOR pathway. Knockdown of JAML ameliorated the inhibitory effect of kaempferol on LUAD cells. Kaempferol exerted anticancer effects by targeting JAML.ConclusionJAML is a novel target for kaempferol against LUAD cells.Please cite this article as: Wu Q, Wang YB, Che XW, Wang H, Wang W. Junctional adhesion molecule-like protein as a novel target for kaempferol to ameliorate lung adenocarcinoma. J Integr Med. 2023; 21(3): 268–276.     

胰十二指肠切除术后胰瘘合并出血二次手术2例并国内文献复习

目的 关于胰十二指肠切除术后胰瘘合并出血的二次手术方式缺乏相应的指南及专家共识,本文旨在复习胰十二指肠切除术后胰瘘合并出血的二次手术方式并探讨胰十二指肠切除术后胰瘘合并出血治疗方案。方法 回顾分析2例胰十二指肠切除术后C级胰瘘合并出血的诊疗及手术过程,对胰十二指肠切除术后胰瘘合并出血的二次手术方式进行文献复习。结果 2例胰十二指肠切除术后C级胰瘘合并出血的患者,均在保守治疗无效的情况下进行了二次手术。患者1在探查胰肠吻合口时,发现门静脉出血,确切止血后重新行原位的胰肠吻合术,最终痊愈出院;患者2由于胰瘘导致了迟发性的出血及腹腔感染,在二次手术时并未发现明确的责任血管,手术中对出血风险较高的血管进行了结扎,并对胰肠吻合口进行了加针修补,最终患者因全身多器官功能衰竭死亡。结论 PD术后胰瘘合并出血的治疗需要介入科、重症医学科、普外科的多学科参与,外科手术仍然是PD术后胰瘘合并出血的关键一环。     

Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis: Report of four cases

BACKGROUNDLiver cancer is a malignant tumor with a high incidence. At present, the most effective treatment is laparoscopic hepatectomy (LH). Indocyanine green fluorescence imaging (ICG-FI) has become an important tool in LH, and the most common fluorescent types of tumors are total fluorescence, partial fluorescence, and rim fluorescence.CASE SUMMARYWe presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type. When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis, the liver segment or subsegment with obstructed bile drainage will show strong fluorescence. Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSIONThis type of partial fluorescence can indicate local biliary compression, and the resection method is related to bile drainage, which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.     

飞秒激光辅助白内障手术在硬核白内障患者中的应用

目的：分析飞秒激光辅助白内障手术(FLACS)在硬核白内障患者中的应用效果。

方法：回顾性分析我院FLACS(观察组)和传统超声乳化术(对照组)治疗的硬核白内障患者各42例42眼的临床资料。记录两组患者手术情况及术后恢复情况。

结果：观察组平均超声功率、实际及有效超声乳化时间、术后3d角膜水肿程度均低于对照组(P<0.05)。两组术后矫正远视力(CDVA)、裸眼远视力(UCDVA)和角膜内皮细胞丢失率变化情况均为：术后3d>术后1wk>术后1mo,而观察组变化幅度大于对照组(P<0.05)。观察组术后各时间点角膜内皮细胞密度高于对照组(P<0.05)。

结论：FLACS治疗硬核白内障效果显著。