Anticoagulation therapy for pulmonary embolism involving a myxoma mimicking,giant type C thrombus: A case report

Right heart thrombus (RHTh) with concurrent acute pulmonary embolism (PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh (type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography (TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh.     

高频手术电极的研究进展

高频手术电极集切割、电凝和止血等作用于一体,能快速实现组织的离断、消融与闭合,在临床中的应用越来越广泛。高频手术电极按施加的电流频率范围可以分为普通高频电极和射频电极。该文主要介绍高频手术电极的工作原理与分类,并结合国内外高频手术电极的研究现状,对其在外科手术中的应用进行综述,并对其发展进行展望。     

Clinicopathological characteristics,prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma

PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.     

Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998–2020

Archives of Sexual Behavior - Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social...     

CircCDR1as Suppresses Bone Microvascular Endothelial Cell Activity and Angiogenesis Through Targeting miR‐135b/ FIH‐1 Axis

ObjectiveThe current study investigated the role of CircCDR1as on angiogenesis of bone microvascular endothelial cells (BMECs) isolated from non‐traumatic ONFH.MethodsForty corticosteroid‐induced ONFH patients received THA were enrolled in our study. Expressions of CircCDR1as, miR‐135b, and FIH‐1 were detected by qRT‐PCR in affected necrosis tissue and non‐affected normal tissue. Bone microvascular endothelial cells (BMEC) were isolated from six patients and treated with 0.1 mg/mL hydrocortisone to establish a GC‐damaged model of BMECs. Circ CDR1as plasmid and miR‐135b mimic were transfected into BMECs. BMEC proliferation was assessed using MTT assays. The migration ability of cells was detected by scratch‐wound assays. Matrigel assay was performed to detect angiogenesis in vitro. Western blot assay was used to detect HIF‐1α, VEGF, and FIH‐1 expressions. FISH, RNA pull down, RIP, and luciferase assay were carried out to determine the interaction of CircCDR1as, miR‐135b, and FIH‐1.ResultsCircCDR1as was upregulated(2.02 ± 0.30 vs. 1.00 ± 0.10,P < 0.001) whereas miR‐135b was downregulated (0.55 ± 0.12 vs. 1.00 ± 0.10,P < 0.001) in affected tissues than in non‐affected tissues. Expression of CircCDR1as and FIH‐1 were negatively associated with miR‐135b in affected tissues (CircCDR1as with miR‐135b: r = −0.506, P < 0.001; FIH‐1 with miR‐135b r = −0.510, P < 0.001). Total blood tubule density was increased when CircCDR1as was silenced compared with NC (P < 0.01 vs. NC). The number of migrated BMECs were significantly increased in CircCDR1as silencing group compared with NC group (P < 0.05 vs. NC). In addition, CircCDR1as plasmids transfection increased the protein expressions of FIH‐1 (P < 0.05 vs. NC) and reduced the HIF‐1α as well as VEGF expression compared with NC group (P < 0.05 vs. NC). FISH, RNA pull down, RIP, and luciferase assay identified that FIH‐1 was a target of miR‐135b and could be modulated by CircCDR1as.ConclusionCircCDR1as decreases angiogenesis and proliferation of BMECs by sponging miR‐135b and upregulate FIH‐1.     

The Effect of a PEEK Material‐Based External Fixator in the Treatment of Distal Radius Fractures with Non‐Transarticular External Fixation

ObjectiveTo explore the effect of a PEEK material‐based external fixator in the treatment of distal radius fractures with non‐transarticular external fixation.MethodsThere were 48 patients in this prospective comparative study. They were divided into two groups according to the materials used: the PEEK group and the titanium group. Wrist dorsiflexion, palmar flexion, pronation, supination, radial deviation, ulnar deviation, grip strength of the palm on the affected side, kneading force, Visual Analogue Scale/Score (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, operation time, frequency of fluoroscopy procedures, and X‐ray results were compared between the two groups. Functional recovery was evaluated at the last follow‐up according to the wrist joint evaluation criteria.ResultsThe baseline data were comparable between the two groups, and no significant differences were found in age, sex, fracture types (P > 0.05). There was no significant difference between the two groups in the results of DASH, grip strength, and recovery of pinch force and wrist function (dorsiflexion, clavicle, ulnar deviation, deviation, pronation, and supination) (P > 0.05). Normal limb function was achieved in the two groups of patients at an average of 6 weeks after surgery, and there was no significant difference in X‐ray examination radial height (10.60 ± 1.59 vs 11.00 ± 1.53, P = 0.687), radial inclination (1.11 ± 0.24 vs 1.12 ± 0.24, P = 0.798), volar tilt (10.33 ± 2.13 vs 10.00 ± 2.08, P = 0.660), ulnar variance (20.87 ± 3.00 vs 20.38 ± 3.04, P = 0.748), and step‐off persistence (1.73 ± 0.69 vs 1.68 ± 0.72, P = 0.425) between the two groups (P > 0.05). However, the operation time (54.80 ± 12.20 vs 85.23 ± 15.14, P = 0.033) and number of fluoroscopy procedures (36.93 ± 6.89 vs 64.77 ± 9.74, P = 0.000) in the PEEK group were significantly reduced compared with those in the titanium group.ConclusionCompared with the traditional titanium external fixator, the PEEK composite external fixator has advantages, such as a shorter operation time and fewer fluoroscopy procedures when used to treat different types of distal radius fracture.     

Sediment Records of Polybrominated Diphenyl Ethers (PBDEs) from the Anhui Province Section of Yangtze River,China

This study investigated the temporal changes of PBDEs in the sediment cores from the Anhui Province section of Yangtze River (YR), China. The dramatic increase of ∑Br₃-Br₉-BDEs and BDE-209 concentrations in cores in the period of ca. 1990–2008 was consistent with the booming of regional and national production and consumption of household appliances and electronics. Following declines in BDE-209 and ∑Br₃-Br₉-BDEs concentrations can be associated with the deceasing use of legacy commercial PBDE mixtures in recent years. Compared with the different regions around the world, sediments in the YR were moderately polluted by PBDEs. The levels and the detection rates of BDE-209 were highest among the detected PBDEs single congener. The composition analysis indicated that Deca-BDE, Octa-BDE, and Penta-BDE were the dominant forms in the YR. The increasing trends of both BDE-209 and ∑Br₃-Br₉-BDEs in the YR during 1990s and 2000s largely reflected the time periods for transferring PBDE sources from the developed countries to China. TOC and finer particles were strongly correlated with distributions of PBDEs in sediments.

     

Can Swimming Microalgal Cells be Vehicles for ZnO Nanoparticle Transportation and Thus Lead to Zn Diffusion?

The concentration of eco-toxic zinc oxide nanoparticles (nZnO) in aquatic ecosystems is increasing, and an effective method for their removal is needed. We hypothesize that microalgal cells may act as nZnO vehicles—if the nZnO concentration does not affect their swimming ability—enabling Zn diffusion and sedimentation. We conducted experiments using flasks connected via a U-type vessel; the first flask contained nZnO suspensions and second flask contained artificial seawater, respectively. We added microalgae to the first flask and illuminated the second. The microalgae appeared to promote sedimentation. However, only a few microalgal cells passed via phototaxis into the second flask, so the detection of nZnO or Zn ions in the second flask was not possible. Therefore, to confirm whether the microalgae affect Zn transportation, a more accurate method to detect nZnO or Zn ions at very low concentrations is needed.

     

2004-2018年中国老年居民慢性非传染性疾病死亡水平与变化趋势

目的分析2004-2018年中国≥65岁老年居民慢性非传染性疾病(慢性病)死亡水平及变化趋势,预测2019-2023年慢性病年龄标化死亡率。方法利用2004-2018年中国死因监测数据集中老年居民死亡数据,分析不同性别、城乡、地区的慢性病粗死亡率、年龄标化死亡率、构成比及变化趋势。采用2010年第六次全国人口普查的人口构成计算年龄标化死亡率;采用加权最小二乘法拟合Joinpoint回归模型,计算全时间段内平均年度变化百分比(AAPC)及95%可信区间;采用对数线性模型预测年龄标化死亡率。结果2004-2018年我国老年居民慢性病年龄标化死亡率从4697.05/10万降至3555.35/10万,平均每年下降2.0%(95%CI:-2.7%~-1.3%)。不同性别、城乡、地区间年龄标化死亡率呈下降趋势。东部地区(AAPC=-2.1%,95%CI:-2.8%~-1.3%)、中部地区(AAPC=-2.8%,95%CI:-3.4%~-2.1%)下降速度均快于西部地区(AAPC=-0.8%,95%CI:-1.8%~0.2%)。慢性病死亡构成比从89.82%上升至91.41%,平均每年上升0.1%(95%CI:0.1%~0.2%)。预计至2023年,男性年龄标化死亡率(3906.23/10万)仍高于女性(2708.43/10万);农村年龄标化死亡率(3283.20/10万)与城市(3250.01/10万)相接近;西部地区(3782.48/10万)与东部地区(3037.01/10万)、中部地区(3249.24/10万)的年龄标化死亡率的差距将进一步拉大。结论2004-2018年我国老年居民慢性病年龄标化死亡率呈下降趋势,死亡构成比呈上升趋势,建议以老年人群中男性居民和西部地区居民作为今后慢病防控关注的重点人群。     

IgG抗体亲和力试验判定麻疹病例的价值

目的评价麻疹IgG抗体亲和力试验对判定麻疹病例的价值。方法以中国疾病预防控制信息系统2013-2015年天津市麻疹实验室确诊病例和麻疹排除病例为研究对象。回顾性追溯保存的病例血清,开展麻疹IgG抗体亲和力试验,重新对麻疹排除病例进行归类。结果共收集到326例麻疹病例血标本,其中实验室确诊病例267例,排除病例59例,≥20岁病例占92.33%(301/326)。麻疹IgG抗体亲和力试验显示,确诊病例和排除病例中麻疹IgG高亲和力抗体的比例分别为66.95%(158/236)和91.23%(52/57),差异有统计学意义(χ²⁼13.33,P<0.001)。根据判定标准,15.25%(9/59)排除病例被重新判定为麻疹病例,其中8例是高亲和力抗体,有含麻疹成分疫苗(MCV)免疫史,判定为继发性免疫失败病例;1例为低亲和力抗体,有典型的麻疹临床症状,无MCV免疫史。结论麻疹IgG抗体亲和力试验能够提供有参考意义的血清学证据,可以减少麻疹急性期血清学诊断中由于IgM抗体假阴性而造成的错误排除。