Objective To investigate the prevalence and related factors of sarcopenia among non-bedridden older adults in the community of Baoshan District using the China mini sarcopenia risk assessment 7(C-MSRA-7)combined with Ishii scoring system.Methods The older individuals consulting at 20 community health stations in Baoshan District between April 2025 and June 2025 were enrolled.Data were collected using a general information questionnaire,a dietary and lifestyle habits survey,the C-MSRA-7,and the mini nutritional assessment-short form(MNA-SF).Handgrip strength and anthropometric measurements were also obtained.Individuals with both Ishii score and C-MSRA-7 results positive were classified into the sarcopenia risk group,while the remaining participants were assigned to the non-sarcopenia risk group.Differences in lifestyle habits,dietary patterns,and nutritional status between the two groups were compared.Results A total of 2 611 valid questionnaires were retrieved.Univariate analysis showed statistically significant differences in alcohol consumption,physical activity frequency,body mass index(BMI),nutritional status,activities of daily living,and regularity of three meals in sarcopenia risk group(n=486)and non-sarcopenia risk group(n=2 125,P<0.05).Logistic regression analysis showed that advanced age(75-84 years:OR=2.55,95%CI 2.03-3.21;≥85 years:OR=3.98,95%CI 2.24-7.07),underweight status(OR=2.19,95%CI 1.50-3.19),weight loss＞2 kg(OR=4.52,95%CI 2.68-7.64)past 3 months,lack of regular physical activity(OR=1.77,95%CI 1.24-2.52),and alcohol consumption(OR=1.48,95%CI 1.07-2.05)were independent risk factors for sarcopenia(P<0.05).Behaviors related to healthy diet,including daily milk consumption(OR=0.40,95%CI 0.30-0.52),regular three meals(OR=0.56,95%CI 0.41-0.78),and high-quality protein intake(OR=0.70,95%CI 0.52-0.94),were protective factors(P<0.05).Conclusions Sarcopenia among community-dwelling,non-bedridden older adults is closely associated with physical activity levels,dietary habits,and nutritional status.Early identification of individuals at risk,enhanced nutritional education,and timely implementation of nutritional interventions and exercise programs are recommended for this population.
Objective To explore the clinical manifestations and ultrasound features of primary high-grade serous carcinoma of the fallopian tube(PHGSC-FT)under the new pathological criteria.Methods A retrospective study was conducted on 45 PHGSC-FT patients diagnosed by postoperative pathology at Obstetrics&Gynecology Hospital of Fudan University from April to June 2023.Clinical data,ultrasound characteristics,and prognosis were analyzed.Results The age of patients was(56.2±10.1)years,with postmenopausal women accounting for 68.9%.The main clinical symptoms were abdominal pain and(or)distension(53.3%),pelvic mass(31.1%),and abnormal vaginal discharge(11.1%).Preoperative ultrasound revealed that 40 cases presented mainly as solid pelvic or abdominal masses(82.5%,33/40),while 5 cases involved widely disseminated small lesions not describable by ultrasound;28 lesions had irregular shapes 70.0%.Intraoperative findings showed that the major lesions were located in the ovary in 27 cases(60.0%),fallopian tube in 7 cases(15.6%),extra-adnexal pelvic in 6 cases(13.3%),and widespread disseminated lesions in 5 cases(11.1%).The accuracy rate of ultrasound localization was 82.2%,and the accuracy rate for benign and malignant differential diagnosis was 75.6%.Serum carbohydrate antigen 125(CA125)levels were significantly lower in patients whose primary lesion was located in the fallopian tube than in those with lesions outside the fallopian tube(P=0.001).FIGO stage Ⅰ:4 cases(8.9%),stage Ⅱ:10 cases(22.2%),stage Ⅲ:23 cases(51.1%),and stage Ⅳ:8 cases(17.8%),with 3-year survival rates of 75.0%,80.0%,56.5%,and 50.0%,respectively.Conclusions PHGSC-FT predominantly occurs in postmenopausal women,and its biological behavior is characterized by"small primary lesion-large metastatic lesion".Prognosis of these patients is related to FIGO stage;Ultrasound demonstrates high accuracy in localization of large lesions and in determining benign versus malignant nature.
Objective To explore the mechanism of Qiliqiangxin protecting the cardiomyocytes against oxidative stress. Methods H9C2 cells were exposed to hydrogen peroxide (H2O2) to establish an oxidative stress-induced injury model and were divided into four groups: control group, H2O2 injury group, Qiliqiangxin rescue group (post-injury), and Qiliqiangxin prevention group (pre-treatment). Cell viability was assessed using cell counting Kit-8 (CCK-8) assay. Apoptosis rates were measured by flow cytometry. The expression of miR-21-5p was quantified using RT-qPCR. The levels of B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), phosphatase and tensin homolog (PTEN), phosphoinositide 3-kinase (PI3K), protein kinase B (Akt), and phosphorylated Akt (p-Akt) were evaluated by Western blot analysis. ResultsH2O2 significantly reduced cell viability and increased apoptosis of H9C2 cells (P＜0.05). No statistically significant difference was observed in the Qiliqiangxin rescue group. However, Qiliqiangxin pre-treatment markedly enhanced cell viability and reduced apoptotic rates compared with the H2O2 injury group (P＜0.05). These protective effects were associated with downregulation of PTEN and upregulation of Bcl-2/Bax ratio, miR-21-5p, PI3K, and p-Akt/Akt ratio. Conclusions Qiliqiangxin can protect H9C2 cells against oxidative stress-induced injury, which may be associated with regulation of miR-21-5p/PTEN/PI3K/Akt signaling pathway.
Objective To explore the metabolic characteristics and related factors in patients with diabetic retinopathy(DR).Methods A retrospective study was conducted on the clinical data of 467 diabetic patients hospitalized at the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2020 to September 2024.The patients were divided into the DR group(n=150)and the non-DR group(n=317).Liver stiffness measurement(LSM)and controlled attenuation parameter(CAP)were assessed using a transient elastography device,and graded into five levels.Basic data,LSM and CAP grading,and metabolic indicators were compared between the two groups.Univariate and multivariate logistic regression analyses were applied to identify factors influencing DR.Results Patients in the DR group were older than those in the non-DR group(P＜0.001).Compared with the non-DR group,fasting blood glucose(FBG),glycated hemoglobin A1C(HbA1C),and triglyceride(TG)levels were higher,while low-density lipoprotein cholesterol(LDL-C)was lower in the DR group(P＜0.05).Significant differences in LSM grading were observed between the two groups(P=0.006).Multivariate logistic regression analysis revealed that LSM grading(grade 2:OR=2.127,P=0.002;grade 3:OR=2.344,P=0.030;grade 4:OR=2.960,P=0.038),FBG(OR=1.233,P＜0.001),and serum creatinine(OR=1.013,P=0.006)were independent factors associated with DR.Conclusions FBG,serum creatinine,and LSM are related factors of DR.In clinical practice,attention should be paid to the coordinated management of blood glucose control,renal function monitoring,and liver fibrosis assessment,with early interventions to reduce the risk of DR.
Objective To analyze the clinical and imaging features of primary anorectal malignant melanoma(ARMM)and to improve the level of its early diagnosis and clinical management.Methods A retrospective analysis was performed on the clinical data,multimodal imaging features,treatment methods,pathological results,and follow-up information of 31 patients with pathologically diagnosed ARMM at Zhongshan Hospital,Fudan University from December 2016 to October 2025.Results Among the 31 patients,there were 11 males and 20 females,with age of 65(55,71)years.Twenty-one patients presented with hematochezia as the initial symptom(67.7%),and four asymptomatic patients were detected incidentally by physical examination.All the patients showed negative alpha-fetoprotein,carcinoembryonic antigen,and carbohydrate antigen 19-9.All 31 cases were solitary ARMM,of which 14(45.2%)were located in the anorectal region.CT was characterized by polypoid or fungating masses,absence of intestinal obstruction,moderate to marked enhancement;MRI was characterized by specific T1WI hyperintensity and restricted diffusion;PET/CT is characterized by high metabolism.According to Ballantyne staging,10 cases of stage Ⅰ,11 cases of stage Ⅱ and 10 cases of stage Ⅲ were found.Endoscopic resection was performed in 1 patient,transanal resection in 2 patients,and abdominoperineal resection(Miles operation)with routine lymph node dissection in 17 patients.The positive rates of S-100,HMB-45 and Melan-A in 20 surgical patients were 100%,95%and 100%,respectively,with a median Ki-67 proliferation index of 65%.Median postoperative follow-up duration of surgical patients was 34.5(2-90)months.During follow-up,8 patients(40%)developed recurrence and/or metastasis(median time was 11 months after surgery),with the liver and lungs being the most common metastatic sites.Conclusions Primary ARMM predominantly occurs in middle-aged and elderly women,hematochezia is the most common initial symptom.Diagnostic efficacy can be improved by combining characteristic imaging manifestations and immunohistochemical findings.ARMM is a highly malignant tumor with an overall poor prognosis,surgery remains the main therapeutic approach.
ObjectiveTo construct a nomogram model for prediction of constipation risk in adult patients with cardiovascular disease (CVD). MethodsA total of 780 adult patients with CVD admitted to Zhongshan Hospital, Fudan University from June 15, 2025 to August 15, 2025 were prospectively enrolled and randomly divided into a training set and a validation set at a 7∶3 ratio. Risk factors for constipation were identified using the least absolute shrinkage and selection operator (LASSO) and Firth logistic regressions, and a nomogram model was subsequently constructed in the training set. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the discrimination ability of the model. Calibration curve and decision curve analysis (DCA) were used to assess calibration and clinical applicability. The value of model was evaluated in the validation set. ResultsAmong 780 adult patients with CVD, 391 patients (50.1%) developed constipation. Eleven variables were selected by LASSO regression and Firth logistic regression, and a nomogram model was constructed. The ROC curve showed that the AUCs of the model to predict constipation in adult patients with CVD in training and validation sets were 0.881 and 0.883, respectively. Calibration curves and DCA demonstrated good calibration and predictive performance of the model in training and validation sets. ConclusionsThe nomogram model based on LASSO-Firth logistic regression demonstrates good predictive performance and may serve as a useful tool for identifying adult patients with CVD at high risk of constipation.
Objective To evaluate the characteristics,related therapeutic regimens,risk factors of cardiovascular adverse events(CVAEs)and prognosis in the current therapy of newly diagnosed multiple myeloma(NDMM)patients in China.Methods A retrospective observational study was performed on patients with NDMM treated at Zhongshan Hospital,Fudan University,from January 2013 to October 2021.The propensity score matching at a ratio of 1∶1 was employed to balance baseline confounders between the therapeutic group and the control group,and CVAEs incidences were compared between the corresponding groups.Independent risk factors for CVAEs were identified through Fine-Gray competing risk regression model.Kaplan-Meier survival curves and log-rank tests were used to assess overall survival and progression-free survival of patients.Results A total of 829 patients with NDMM were analyzed,with a median of 33.1 months of follow-up for survivors.CVAEs occurred in 65 patients(7.8%)during first-line treatment,and a total of 74 events were recorded,with 52.7%grade 3 or greater in severity.Arrhythmia(particularly atrial fibrillation),thrombotic event(TE),and heart failure were the most common types.The median time from treatment to the first occurrence of CVAEs was 26 days,while the medium occurrence time of TE was later than the other events(76 d vs 19 d,P=0.003).The exposure to immunomodulatory drugs was related to a higher incidence of TEs,whereas other therapeutic regimens,including bortezomib,didn't show the effect of cardiovascular toxicity.Results of multivariate analysis showed that Eastern Cooperative Oncology Group performance status＞2,symptomatic heart diseases within three months before treatment,and estimated glomerular filtration rate≤50 mL•min-1•(1.73 m2)-1 were independent risk factors for CVAEs.Compared with patients without CVAE,patients who experienced CVAEs had significantly inferior progression-free survival and overall survival,and higher cardiovascular mortality(P＜0.001).Conclusions The incidence of CVAE is relatively high during first-line treatment in NDMM patients,and the prognosis of CVAE patients is poor.The risk of CVAE is significantly increased in patients with underlying cardiovascular diseases.
Objective To investigate predictive value of soluble growth stimulation-expressed gene 2 protein(sST2),cardiac troponin T(cTnT),and creatine kinase-myocardial band(CK-MB)for steroid resistance and prognosis in patients with immune checkpoint inhibitor-associated myocarditis(ICIAM).Methods A total of 28 patients with ICIAM were prospectively enrolled from March 2023 to February 2024 at Zhongshan Hospital,Fudan University.All participants were divided into the steroid-resistant ICIAM(srICIAM)group and the non-srICIAM group.Baseline serum levels of sST2,cTnT and CK-MB were detected prior to treatment initiation.ROC curve analysis was applied to evaluate the predictive value of these biomarkers,and Kaplan-Meier survival analysis was performed to explore the relationship between sST2 and all-cause mortality.Results Baseline sST2,cTnT,and CK-MB levels were significantly higher in the srICIAM group(n=15)than in the non-srICIAM group(n=13,P＜0.05).Combination of cTnT and sST2 improved predictive performance for srICIAM(AUC=0.857,sensitivity 0.714,specificity 1.000).After 6 months of follow-up,the high sST2 group had a significantly higher all-cause mortality than the low sST2 group(P=0.016).Conclusions The combination of sST2 and cTnT could effectively predict srICIAM,and elevated sST2 is associated with increased higher all-cause mortality in ICIAM patients,providing a basis for early risk stratification and treatment optimization.
Objective To explore the predictive value of forkhead box P3(FOXP3)mRNA expression in cord blood derived regulatory T cells(Tregs)and the associated cytokines interleukin-10(IL-10)and transforming growth factor-β(TGF-β)for early-onset atopic dermatitis(AD)in infants.Methods The healthy full-term newborns delivered vaginally at Shanghai Fifth People's Hospital from September 2023 to April 2024 were enrolled.Umbilical vein blood was collected at birth to measure FOXP3 mRNA expression by RT-PCR and IL-10 and TGF-β concentrations by ELISA.Follow-up was performed at 6 weeks,3 months,and 6 months postnatally via telephone or outpatient visits to assess the occurrence of AD in infants.Based on the occurrence of AD at 6 months of age,the infants were divided into an AD group and a control group.The indicators related to mothers and infants were compared between the two groups.Logistic regression analysis was used to identify risk factors for the development of AD in infants within 6 months after birth,and a predictive model was constructed.The performance of the model in predicting early-onset AD was evaluated using receiver operating characteristic(ROC)curve analysis.Results A total of 59 infants completed 6-month follow-up,with 17(28.8%)diagnosed with AD.No significant differences were observed in gestational age,sex,birth weight,presence of siblings,smoking expossure,maternal dietary preferences(egg,milk,or seafood intake),maternal age and education level,or cord blood IL-10 levels between two groups.There were significant differences in season of birth,family history of atopic disease,feeding method,and cord blood levels of FOXP3 mRNA and TGF-β between two groups(P＜0.05).Logistic regression analysis showed low levels of cord blood FOXP3 mRNA and TGF-β,and family history of atopic disease were risk factors for early-onset AD in infants(P＜0.05).A predictive model was constructed using risk factors.The area under the curve of the combined model was 0.821(95%CI 0.680-0.962),with a sensitivity of 76.5%and a specificity of 85.7%.Conclusion Reduced cord blood FOXP3 mRNA and TGF-β level,and a family history of atopic diseases could be used to predict early-onset AD in infants.
ObjectiveTo explore the role of serine/threonine protein kinase 4 (mammalian STE20-like protein kinase 4, MST4) in myocardial infarction (MI) and the underlying molecular mechanisms. MethodsWestern blot was performed to assess MST4 expression in peripheral blood mononuclear cells (PBMCs) from four MI patients and four healthy controls. Immunofluorescence staining was used to compare the co-expression of MST4 and macrophages in ischemic regions and non-ischemic regions in myocardial tissues from MI patients. The mouse models of MI were established and divided into an MST4 functional inhibition (treated with Hesperadin) group and a control group ( 12 mice in each group), and cardiac function of model was evaluated by echocardiography; Masson’s trichrome staining was employed to assess cardiac collagen deposition post-MI, and peripheral blood N-terminal pro-brain natriuretic peptide (NT-proBNP) level was measured using ELISA. Further, MST4-inhibited bone marrow-derived macrophages (BMDMs) were constructed in vitro, and immunofluorescence was used to detect the expression of the reparative macrophage marker arginase 1 (Arg1), and RT-qPCR was employed to examine changes in the expression of genes associated with reparative macrophages. Western blot analysis was performed to evaluate the activation status of mitogen-activated protein kinase (MAPK) pathway-related proteins. ResultsMST4 expression was significantly increased in PBMCs from patients with MI and co-localized with CD68+ macrophages in ischemic cardiomyopathy tissues (P＜0.000 1). In the mouse models of MI, compared with control group, Hesperadin group had increased left ventricular ejection fraction (P＜0.05), lower peripheral blood NT-proBNP level (P＜0.000 1), and did not alter total F4/80+ macrophage abundance. In vitro, MST4 inhibition promoted reparative macrophage-associated gene expression and suppressed protein phosphorylation in MAPK pathway (P＜0.05). ConclusionsInhibition of MST4 promotes macrophage polarization toward a reparative phenotype through modulation of MAPK pathway, thereby improving post-MI cardiac remodeling and outcome.
ObjectiveTo explore the clinical characteristics and short-term prognosis of postoperative acute myocardial infarction (PAMI) after cardiac surgery. MethodsA retrospective study was conducted on 45 PAMI patients who underwent coronary angiography after cardiac surgery at Zhongshan Hospital, Fudan University, from February 2015 to February 2025. General information, type of surgery, onset time and causes of PAMI, and in-hospital recovery condition were collected. Univariate logistic regression was used to analyze factors related to in-hospital survival. ResultsThe patients’ age was (62.40±11.72) years, 31 cases (68.89%) were male, 21 cases (46.67%) had hypertension. Twenty-six patients (57.78%) underwent cardiac valve surgery, and 16 patients (35.56%) received coronary artery bypass grafting. The onset time of PAMI was 24 (0, 48) hours, with 38 cases (84.44%) developing within 48 hours after surgery. Twenty-eight patients (62.22%) presented with new lesions in coronary arteries/bypass grafts, and 20 patients (44.44%) were considered to have thrombus-induced PAMI. Nine patients died in hospital, 13 patients failed to recover and were discharged automatically, and 23 patients were discharged after recovery. Univariate logistic regression analysis showed that new lesion in coronary arteries/bypass grafts was risk factor for in-hospital survival (OR=0.235, P=0.036). ConclusionsPAMI frequently occurs within 48 hours post-cardiac surgery, and thrombosis is the most common cause of PAMI. New lesions in coronary arteries/bypass grafts are closely correlated with poor short-term prognosis.
ObjectiveTo explore factors associated with early postoperative hormonal remission in patients with prolactinoma and to develop prediction models based on clinical and radiological features. MethodsData from 107 patients with prolactinoma who underwent transsphenoidal surgery at The First People’s Hospital of Huai’an, Nanjing Medical University between January 2020 and December 2024 was collected, included general clinical characteristics, preoperative laboratory indicators, and imaging features. Based on whether early postoperative prolactin (PRL) levels normalized, patients were divided into a remission group (n=76) and a non-remission group (n=31). Univariate logistic regression was used for preliminary evaluation of candidate variables, followed by LASSO regression for feature selection. Multiple machine learning models were constructed, including logistic regression, random forest, support vector machine, K-nearest neighbors, naive Bayes, decision tree, neural network, and gradient boosting decision tree (GBDT). All models were trained and evaluated using ten-fold cross-validation, with comprehensive assessment of model performance based on the area under the ROC curve (AUC), accuracy, sensitivity, specificity, precision, and F1 score. ResultsThe maximum diameter of tumors in the non remission group was larger than that in the remission group (P=0.019), and the incidence of tumor stroke and preoperative PRL levels were significantly higher than those in the remission group (P＜0.001). Univariate analysis showed that sex, maximum tumor diameter, tumor stroke, and preoperative PRL levels were influencing factors for early postoperative hormone response in patients with prolactinoma (P＜0.05). The comparison results of machine learning models show that the neural network model performs the best (AUC=0.921) and has good clinical application value, followed by the GBDT model (AUC=0.893) and the support vector machine model (AUC=0.884). Other models also show certain predictive ability. ConclusionsSex, preoperative PRL levels, maximum tumor diameter, Hounsfield unit value, and tumor stroke are important factors affecting early hormone response after prolactinoma surgery. The machine learning model constructed based on the above variables has good predictive performance, and performs the best and has good clinical application value.
Objective To explore the echocardiographic features of critically ill patients with infection,and to evaluate the predictive value of echocardiographic parameters for 28-day mortality and myocardial injury.Methods Using a single-center prospective cohort design,120 critically ill patients with infection admitted to the Intensive Care Unit,Jinshan Hospital of Fudan University from January 2024 to January 2025 were enrolled consecutively.According to the severity of infection,patients were divided into the sepsis group(n=75)and the non-sepsis group(n=45).Cox proportional hazards models and modified Poisson regression were used to analyze risk factors of 28-day all-cause mortality and myocardial injury.Kaplan-Meier survival curve and log-rank test were used to assess prognosis differences among patients with different ultrasound parameters.ROC curve and area under the curve(AUC)were applied to evaluate the predictive performance of ultrasound parameters,and restricted cubic spline(RCS)model was used to explore nonlinear relationships.Results The E/e' ratio was significantly higher in the sepsis group than in the non-sepsis group(P＜0.001),while left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were lower in the sepsis group(P＜0.05).The Cox proportional hazards model found no association between ultrasound parameters and 28-day all-cause mortality.Modified Poisson regression showed that,after adjusting for confounding factors,elevated E/e' was an independent risk factor of myocardial injury(RR=1.12,95%CI 1.07-1.17,P＜0.001).Survival analysis demonstrated that patients with E/e'＞10.9 had lower 28-day survival rates(P=0.02),and the AUC for E/e' predicting myocardial injury was 0.835.RCS analysis suggested a nonlinear relationship between E/e' and myocardial injury risk(P＜0.001).Conclusions E/e',LVEF,and LVFS have no significant predictive value for 28-day mortality risk in critically ill patients with infections.Elevated E/e' is an independent risk factor of myocardial injury in such patients,with a nonlinear relationship.
ObjectiveTo explore the impact of wearable devices in assisting disease monitoring on heart-focused anxiety in patients with tachyarrhythmias. MethodsA cross-sectional study design was conducted. 305 patients with tachyarrhythmias who attended the department of cardiology of Zhongshan Hospital, Fudan University in Shanghai from July 2025 to December 2025 were enrolled as the research subjects, and clinical data of patients were collected. Univariate analysis and multiple stepwise regression analysis were used to analyze the impact of wearable devices in assisting disease monitoring on patients’ heart-focused anxiety. ResultsThe mean score of heart-focused anxiety in the 305 patients with tachyarrhythmias was 33.16±9.70. Among them, 104(34.10%) patients used wearable devices in assisting disease monitoring. The results of univariate analysis and multiple stepwise regression showed that the use of wearable devices in assisting disease monitoring was an influencing factor for heart-focused anxiety (P＜0.05), and the patients who used wearable devices in assisting disease monitoring had a significantly lower level of heart-focused anxiety (P＜0.05). ConclusionsThe use of wearable devices in assisting disease monitoring is associated with a lower level of heart-focused anxiety in patients with tachyarrhythmias. Medical staff can guide patients to rationally use wearable devices in assisting disease monitoring on the basis of evaluating their needs and device operation capabilities.
Objective To explore the association between serum uric acid levels and the cumulative incidence risk of atrial fibrillation,and to evaluate the predictive value of different uric acid levels for the onset of atrial fibrillation.Methods A retrospective selection of 451 879 participants from the large-scale prospective epidemiological cohort UK Biobank,aged 40-69 years,all completed a median follow-up of 13.6 years.Participants were divided into groups based on the interquartile range of serum uric acid levels(Q1-Q4)related to gender and whether they were diagnosed with hyperuricemia.Cox proportional hazards model,sensitivity analysis,and other methods were used to compare baseline data and atrial fibrillation incidence during follow-up among each group of participants.Results Individuals with higher baseline uric acid levels tended to be older,more obese,and had lower education levels and a history of cancer,along with significantly higher levels of triglyceride,low-density lipoprotein cholesterol,and C-reactive protein,but lower high-density lipoprotein cholesterol levels(P<0.001);the highest uric acid group showed the highest diabetes prevalence(6.49%).Participants with higher serum uric acid levels(log-rank P<0.05)or diagnosed with hyperuricemia had significantly higher incidence of atrial fibrillation(P<0.001).After adjusting for potential confounders,compared to Q1 uric acid level group,the Q4 level was associated with a 20%increased risk of atrial fibrillation(HR=1.20,95%CI 1.16-1.25).Each 74.7 μmol/L increase in uric acid level was associated with a 9%increased incidence risk of atrial fibrillation(HR=1.09,95%CI 1.08-1.11).Individuals with hyperuricemia had a 20%increased incidence risk of atrial fibrillation(HR=1.20,95%CI 1.17-1.24).A nonlinear association was observed between uric acid levels and the incidence risk of atrial fibrillation(P for nonlinearity<0.01).Subgroup analysis indicated significant heterogeneity of the risk effect across subgroups,with a higher risk associated with hyperuricemia in females.Conclusions Elevated blood uric acid levels may increase the cumulative risk of atrial fibrillation,and this pathogenic effect is significantly correlated with age,race,cancer history,body mass index,and sex.
Extracorporeal circulation serves as a vital auxiliary approach in cardiac surgery, and its introduction and application have directly driven a clinical revolution in cardiac surgical procedures. With the continuous advancement of clinical techniques in cardiac surgery, extracorporeal circulation technology has undergone constant innovation. To align with the trend of minimally invasive surgery, minimally invasive extracorporeal circulation (MiECC) technology has emerged. Its feasibility and safety have been preliminarily verified in clinical practice. This paper synthesizes domestic and international literature to expound on the development of MiECC and its advantages in clinical applications, aiming to further promote its adoption in China.
Objective To explore the incidence and risk factors of sarcopenia in non-dialysis patients with stage 5 chronic kidney disease(CKD).Methods Non-dialysis stage 5 CKD patients in Jiading District Central Hospital Affiliated Shanghai University of Medicine&Health Sciences from October 2023 to October 2024 were enrolled and divided into the non-sarcopenia group and the sarcopenia group according to lean tissue index(LTI)and handgrip strength(HGS).Demographic data of patients were collected and biochemical indicators were detected.Serum advanced glycation end products(AGEs)were detected by competitive ELISA.Multivariate logistic regression analysis was conducted to analyze the risk factors of sarcopenia in these patients.The diagnostic efficacy of the risk factors was evaluated by the receiver operating characteristic(ROC)curve.Results A total of 102 non-dialysis stage 5 CKD patients with(68.52±7.39)years,were enrolled,including 61 male(59.8%).Among them,24 were diagnosed with sarcopenia(23.5%).Compared with patients in non-sarcopenia group,patients in sarcopenia group were older and had higher interleukin-6(IL-6)and AGEs,lower body mass index(BMI)and lower serum albumin(sAlb;P＜0.05).Multivariate logistic regression showed that advanced age(OR=1.153,95%CI 1.045-1.273,P=0.005),higher IL-6(OR=1.165,95%CI 1.042-1.302,P=0.007)、lower sAlb(OR=0.675,95%CI 0.542-0.840,P=0.001),and higher serum AGEs(OR=1.105,95%CI 1.013-1.206,P=0.024)were independent risk factors of sarcopenia in non-dialysis CKD 5 patients.The areas under the curve(AUC)for the age,IL-6,sAlb,and serum AGEs were 0.896,0.643,0.658,and 0.724,respectively.Conclusions Sarcopenia is common in non-dialysis stage 5 CKD patients,and the risk of sarcopenia is higher in non-dialysis stage 5 CKD patients with advanced age,higher IL-6,lower sAlb,and higher serum AGEs.
The patient was a 56-year-old man who presented with abnormal urinalysis findings of over one month’s duration. Serological tests revealed an elevated serum free light chain κ/λ ratio, and immunofixation electrophoresis detected an IgG-κ monoclonal band. Renal biopsy demonstrated membranous nephropathy, with electron-dense deposits observed in the subepithelial space and mesangium on electron microscopy. Immunofluorescence confirmed glomerular deposits of IgG1/IgG3-κ. Based on clinical manifestation, bone marrow flow cytology, and lymph node pathology, the patient was diagnosed with small lymphocytic lymphoma (SLL), and membranous nephropathy with light chain-restricted deposition (IgG1/IgG3-κ) secondary to SLL. After receiving obinutuzumab treatment, the patient’s proteinuria partially remitted, the lymph nodes significantly shrank, and clinical remission was achieved.
Objective To explore the role of CC chemokine ligand-18(CCL18)positive tumor-associated macrophages in immune escape of gastric cancer and their impact on the tumor microenvironment.Methods Three gastric cancer patient cohorts were included in Zhongshan Hospital,Fudan University(449 cases in the radical surgery cohort,46 cases in the palliative treatment cohort,and 48 cases in the flow cytometry analysis cohort),and one group of patients from The Cancer Genome Atlas(TCGA)database were included.The CCL18+tumor-associated macrophage gene signature was obtained from the TCGA database,and differential gene expression in the TCGA cohort was analyzed based on this signature.Immunofluorescence was used to assess the infiltration of CCL18+tumor-associated macrophages in tissue microarrays of patients from two treatment cohorts.The association between CCL18+tumor-associated macrophages and clinical outcomes as well as related gene expression was examined.Using single-cell suspensions derived from tumor tissues,flow cytometry was employed to evaluate the immunophenotype of CCL18+tumor-associated macrophages;the potential therapeutic effects of blocking CCL18 in gastric cancer were assessed through in vitro culture.Results In curative surgery cohort,patients with high infiltration of CCL18+tumor-associated macrophages had shorter overall survival and disease-free survival compared to those with low infiltration(P＜0.01).In palliative cohort,patients with high infiltration of CCL18+tumor-associated macrophages exhibited shorter progression-free survival compared to those with low infiltration(P=0.015).The proportion of exhausted CD8+T cells was significantly increased in the cancer tissues with high infiltration of CCL18+tumor-associated macrophages compared to those with low infiltration(P＜0.001).Tumors with high CCL18+tumor-associated macrophages gene signature expressed significantly higher level of programmed death-ligand 1(PD-L1)and transforming growth factor-β(TGF-β)than those with low CCL18+tumor-associated macrophages gene signature in TCGA queue(P＜0.001).The expression levels of PD-L1 and TGF-β were higher in CCL18+tumor-associated macrophages than those in CCL18-tumor-associated macrophages(P＜0.05).After CCL18 intervention,the proportions of cytotoxic CD8+T cells and apoptotic epithelial cells(Annexin Ⅴ+)were increased(P＜0.05),while the proportion of proliferating epithelial cells(Ki67+)was decreased(P＜0.001).Conclusion CCL18+tumor-associated macrophages infiltration is associated with prognoses in patients with gastric cancer,and might promote an immunosuppressive microenvironment in gastric cancer by expressing PD-L1 and TGF-β,and blockade of CCL18 might be a new direction for gastric cancer treatment.
Objective To explore the effect of sex on the incidence of immune-related cutaneous adverse event(ircAE)during immunotherapy for gastric cancer,and to further analyze the correlation between sex,ircAE and prognosis.Methods A retrospective analysis was conducted on patients with advanced gastric cancer who received immune checkpoint inhibitors at the Department of Oncology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Medical School,Nanjing University,from February 1,2022,to December 31,2024.Clinicopathological characteristics,occurrence of ircAE,and survival data were collected.The incidence of ircAE was compared between male and female patients.Kaplan-Meier method was used to plot survival curves,and univariate Cox regression analysis was performed to assess prognostic factors.Results A total of 116 patients with advanced gastric cancer were enrolled,including 76 males(65.5%)and 40 females(34.5%).The overall incidence of ircAE was 23.28%,with a higher incidence in male patients than in female patients(28.95%vs 12.50%,P=0.046).Kaplan-Meier survival analysis on 86 patients with complete follow-up data indicated that patients with ircAE had longer overall survival(OS)than those without ircAE(P=0.045).Univariate Cox regression analysis showed that male(HR=0.43,95%CI 0.22-0.83,P=0.012)was associated with prolonged OS.Conclusions In gastric cancer immunotherapy,male patients are more likely to develop ircAE and have longer OS than female patients,and the occurrence of ircAE may be related to prolonged OS.
