治疗方式对中晚期人乳头状瘤病毒阴性口咽癌患者的生存率和生存质量的影响

目的探讨中晚期人乳头状瘤病毒阴性口咽癌治疗方式和方法的改变对患者生存率和生存质量状况的影响，为口咽癌的治疗提供合适的治疗方案。方法回顾分析我院2015年1月~2020年12月住院的口咽癌患者，通过病例分析及影像学资料、病理资料补充，共筛选出符合纳入和排除标准的405例患者，建立患者个人治疗资料信息库，按治疗方式对研究对象分类；通过随访采用Kaplan-meier、Log-rank计算和对比分析总生存率以及各种治疗方式的生存率；通过UW-QOL（4）问卷对无瘤生存者行生存质量自评，并通过统计学分析比较各种治疗方式的生存质量。结果该研究对象按治疗方式共分为3类：化疗+手术+放疗（CSRT）146例、手术+放疗（SRT）138例、放疗+化疗（RCT）121例。1、3、5年的总体生存率85.1%、67.1%、56.9%，CSRT、SRT、RCT三种治疗方式生存率无统计学意义（P > 0.05）。共发放UW-QOL（4）问卷280份，实收202份，回收率为72.14%，3种治疗方式生存质量问卷平均总分值比较顺序CSRT > SRT > RCT，统计学分析CSRT与SRT、RCT之间有统计学意义（P < 0.05），但SRT与RCT无统计学意义（P > 0.05）。结论CSRT、SRT、RCT均可作为局部中晚期口咽癌治疗方式的选择，CSRT较SRT、RCT有较好的患者治疗后生存质量。     

DNAM-1通过IL-2/STAT-5通路调节Ⅰ型调节性T细胞的增殖和功能

目的探讨DNAM-1对Ⅰ型调节性T细胞（Tr1细胞）活化、增殖和功能的影响及相关分子机制。方法利用anti-CD3/CD28激活小鼠T细胞，采用流式细胞术分别检测静息和激活状态下CD4⁺ T细胞和Tr1细胞DNAM-1分子表达变化；分离DNAM-1基因敲除小鼠（KO小鼠）脾脏初始CD4⁺ T细胞并体外诱导Tr1细胞，流式细胞术检测CD25和CD69活化分子表达水平，CFSE标记后检测增殖能力，IL-2刺激前后检测KO小鼠Tr1细胞分泌IL-10和转录激活蛋白（p-STAT5）水平变化。结果流式细胞术结果显示：与静息状态下相比较，激活状态的CD4⁺ T细胞和Tr1细胞表达DNAM-1分子均增高（P＜0.05）；敲除DNAM-1不影响小鼠脾脏Tr1细胞的数量和比例，但KO小鼠Tr1细胞表达细胞激活分子CD25和CD69均降低，差异有统计学意义（P＜0.05）；与WT小鼠比较，KO小鼠诱导型Tr1细胞体外增殖能力降低（P＜0.05）；与WT组Tr1细胞比较，KO小鼠Tr1细胞分泌抑制性细胞因子IL-10水平降低（P＜0.05），给予IL-2刺激后仍无法逆转，表达Il-10 mRNA和Gzmb mRNA水平降低（P＜0.05）；给予不同剂量IL-2刺激Tr1细胞后，KO小鼠Tr1细胞表达p-STAT5水平相比较WT组均降低（P＜0.05）。结论DNAM-1参与Tr1细胞的活化和增殖，并通过IL-2/STAT5信号通路影响Tr1细胞抑制功能。     

Hypercalcemia Associated with the Ectopic Expression of 25-hydroxyvitamin D3-1α-hydroxylase in Diffuse Large B-cell Lymphoma

An 82-year-old man was transferred to our hospital due to impaired consciousness. His albumin-corrected calcium level was 14.2 mg/dL, intact parathyroid hormone (PTH) and PTH-related protein levels were reduced, and his 1,25-dihydroxyvitamin D [1,25(OH)₂VitD] level was elevated at 71.5 pg/mL. Computed tomography revealed masses on the bilateral ribs. The mass on the rib was biopsied and diagnosed as diffuse large B-cell lymphoma (DLBCL). Immunostaining of the biopsy sample with the anti-CYP27B1 antibody revealed the ectopic expression of 1α-hydroxylase in the lesion. We herein report a rare case of hypercalcemia induced by the overproduction of 1,25(OH)₂VitD in DLBCL ectopically expressing 1α-hydroxylase.     

Association of blood pressure and hypertension with radiographic damage among the patients with ankyloing spondylitis

To investigate the association of blood pressure and hypertension with disease severity among the patients with ankyloing spondylitis (AS). There were 167 AS patients enrolled in the cross-sectional study. Blood pressure was measured and the presence of hypertension was recorded. Patient’s disease severity, including disease activity, functional ability, patient’s global assessments, physical mobility and radiographic damage were evaluated. ESR and CRP levels were tested. We recorded patient’s medication use of NSAIDs, DMARDs and TNF-α blockers. Smoking, exercise habit, diabetes mellitus, hypercholesterolemia and obesity indices were assessed. Multivariate linear regression showed that systolic blood pressure was associated with TNF-α blocker [standard coefficient (β) = 0.194, P = .007], DMARDs (β = 0.142, P = .046), age (β = 0.211, P = .003), male gender (β = 0.242, P = .001) and body mass index (BMI) (β = 0.245, P = .001). Diastolic blood pressure was associated with cervical rotation (β = −0.174, P = .037), lateral lumbar flexion (β = −0.178, P = .019), m-SASSS (β = 0.198, P = .038) and BMI (β = 0.248, P = .003). Notably, multivariate logistic regression showed that hypertension was associated with m-SASSS (OR = 1.033, P = .033), age (OR = 1.098, P = .0010) and BMI (OR = 1.210, P = .003). Using ROC cure analyses, age, BASMI, BASRI-Total, m-SASSS, waist circumference, BMI and waist-to-height ratio were useful in predicting hypertension, and m-SASSS is the best (AUC = 0.784, P < .001). Advanced radiographic damage is an independent risk factor of hypertension in AS, and m-SASSS is the most useful disease severity parameter in predicting the presence of hypertension. Advanced radiographic damage, poor cervical rotation, lateral lumbar flexion, older age, male gender, TNF-α blocker, DMARDs use and obesity are associated with increased blood pressure.     

Emergence of genetically linked vaccine-originated poliovirus type 2 in the absence of oral polio vaccine,Jerusalem, April to July 2022

We report an emergence and increase in poliovirus type 2 detection via routine wastewater surveillance in three non-overlapping regions in the Jerusalem region, Israel, between April and July 2022. Sequencing showed genetic linkage among isolates and accumulation of mutations over time, with two isolates defined as vaccine-derived polioviruses (VDPV). This demonstrates the emergence and potential circulation of type 2 VDPV in a high-income country with high vaccine coverage and underscores the importance of routine wastewater surveillance during the polio eradication.     

Heterogeneity of immune control in chronic hepatitis B virus infection: Clinical implications on immunity with interferon-α treatment and retreatment

Hepatitis B virus (HBV) infection is a global public health issue. Interferon-α (IFN-α) treatment has been used to treat hepatitis B for over 20 years, but fewer than 5% of Asians receiving IFN-α treatment achieve functional cure. Thus, IFN-α retreatment has been introduced to enhance antiviral function. In recent years, immune-related studies have found that the complex interactions between immune cells and cytokines could modulate immune response networks, in-cluding both innate and adaptive immunity, triggering immune responses that control HBV replication. However, heterogeneity of the immune system to control HBV infection, particularly HBV-specific CD8⁺ T cell heterogeneity, has consequ-ential effects on T cell-based immunotherapy for treating HBV infection. Altogether, the host’s genetic variants, negative-feedback regulators and HBV components affecting the immune system''s ability to control HBV. In this study, we reviewed the literature on potential immune mechanisms affecting the immune control of HBV and the clinical effects of IFN-α treatment and retreatment.     

Comparing immunogenicity and efficacy of two different mRNA-based COVID-19 vaccines as a fourth dose; six-month follow-up,Israel, 27 December 2021 to 24 July 2022

We assess the immunogenicity and efficacy of Spikevax and Comirnaty as fourth dose COVID-19 vaccines. Six months post-fourth-dose, IgG levels were higher than pre-fourth dose at 1.58-fold (95% CI: 1.27–1.97) in Spikevax and 1.16-fold (95% CI: 0.98–1.37) in Comirnaty vaccinees. Nearly 60% (159/274) of vaccinees contracted SARS-CoV-2. Infection hazard ratios (HRs) for Spikevax (0.82; 95% CI: 0.62–1.09) and Comirnaty (0.86; 95% CI: 0.65–1.13) vaccinees were similar, as were substantial-disease HRs, i.e. 0.28 (95% CI: 0.13–0.62) and 0.51 (95% CI: 0.27–0.96), respectively.     

Characterization of Hot Deformation of near Alpha Titanium Alloy Prepared by TiH2-Based Powder Metallurgy

TiH₂-basd powder metallurgy (PM) is one of the effective ways to prepared high temperature titanium alloy. To study the thermomechanical behavior of near-α titanium alloy and proper design of hot forming, isothermal compression test of TiH₂-based PM near-α type Ti-5.05Al-3.69Zr-1.96Sn-0.32Mo-0.29Si (Ti-1100) alloy was performed at temperatures of 1123–1323 K, strain rates of 0.01-1 s⁻¹, and maximum deformation degree of 60%. The hot deformation characteristics of alloy were analyzed by strain hardening exponent (n), strain rate sensitivity (m), and processing map, along with microstructure observation. The flow stress revealed that the difference in softening/hardening behavior at temperature of 1273–1323 K and the strain rate of 1 s⁻¹ compared to the lower deformation temperature and strain rate. The strain hardening exponents at temperatures of 1123 K are all negative under all strain rates, and the most severe flow softening with minimum value of n was observed at 1123 K and 1 s⁻¹. The strain rate sensitives showed that the peak region with m value greater than 0.5 generally appeared in the high temperature range of 1273–1323 K, while strain rate sensitivity at low temperature behaved differently with strain rates. The processing map developed for strain of 0.6 exhibited high power dissipation efficiency at high temperatures of 1273–1323 K and a low strain rate of 0.01 s⁻¹, due to microstructure evolution of β phase. The decrease of strain rate at 1323 K resulted in the formation of globularization of α lamellae. The instability domain of flow behavior was identified in the temperature range of 1123–1173 K and at the strain rate higher than 0.01 s⁻¹ reflecting the localized plastic flow and adiabatic shear banding, and inhomogenous microstructure. The variation of power dissipation energy (η) slope with strain demonstrated that the power dissipation mechanism during hot deformation has been changed from temperature-dependent to microstructure-dependent with the increase of temperature for the alloy deformed at 0.1 s⁻¹. Eventually, the optimum processing range to deform the material is at 1273–1323 K and a strain rate range of 0.01–0.165 s⁻¹ (lnε˙ = −4.6–−1.8).     

改良骨科机器人辅助椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效分析

目的评价改良示踪器固定方式的骨科机器人（以下简称改良骨科机器人）辅助经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗单节段骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）的疗效。方法 回顾分析2017年12月—2021年1月收治且符合选择标准的155例单节段OVCF患者临床资料，根据手术方式分为机器人组（87例，采用改良骨科机器人辅助PKP治疗）和C臂组（68例，采用C臂X线机透视下PKP治疗）。两组患者性别、年龄、身体质量指数、骨密度T值、治疗节段、椎体压缩程度及术前疼痛视觉模拟评分（VAS）、椎体中线高度、Cobb角等一般资料比较差异均无统计学意义（P>0.05）。收集并比较两组疗效评价指标，临床指标包括工作通道建立时间、术中透视剂量及骨水泥注入量、手术前后VAS评分及并发症发生情况，影像学指标包括穿刺偏移程度、骨水泥弥散程度、骨水泥渗漏情况及手术前后椎体中线高度、Cobb角。 结果机器人组工作通道建立时间明显少于C臂组，术中透视剂量明显大于C臂组（P<0.001）；两组骨水泥注入量差异无统计学意义（t=1.149，P=0.252）。所有患者均获随访，随访时间10～14个月，平均12个月。除机器人组术中VAS评分显著优于C臂组（P<0.05）外，其余各时间点两组VAS评分比较差异均无统计学意义（P>0.05）。两组均无感染、脊髓或神经损伤、肺栓塞等严重并发症发生；机器人组5例（5.7%）、C臂组7例（10.2%）发生相邻节段骨折，发生率比较差异无统计学意义（χ²=1.105，P=0.293）。机器人组术后1 d穿刺偏移程度、术后1 d骨水泥弥散程度以及术后1 个月、末次随访时的椎体中线高度和Cobb角均明显优于C臂组（P<0.05）。机器人组8例（9.1%）、C臂组16例（23.5%）发生骨水泥渗漏，机器人组骨水泥渗漏发生率明显低于C臂组（χ²=5.993，P=0.014）；两组均无椎管内渗漏。结论相比传统C臂X线机透视下PKP，改良骨科机器人辅助单节段PKP可明显减轻患者术中疼痛，缩短工作通道建立时间，提高患者手术满意度，在减少穿刺偏移程度和改善骨水泥弥散程度方面具有明显优势。