The incidence of deep venous thrombosis (DVT) is higher for severe pneumonia patients hospitalized in respiratory intensive care unit (RICU). Currently, no validated risk assessment tool specifically exists for evaluating DVT risk in this population. This study aimed to develop a screening tool to estimate the risk of in-hospital DVT in patients with severe pneumonia admitted to the RICU. In this retrospective cohort study, least absolute shrinkage and selection operator (LASSO) regression was used to identify candidate predictors of in-hospital DVT. We then developed two prediction models, a support vector machine (SVM) algorithm and a nomogram model, to predict DVT risk in patients with severe pneumonia in the RICU. We included 368 patients with severe pneumonia admitted to the RICU. DVT occurred in 124 patients (33.7

ABSTRACT Aim To evaluate the efficacy of establishing a nurse‐coordinated and guideline‐driven care by advanced stroke nurses for acute ischemic stroke (AIS). Background Specialised nursing care is usually not integrated enough to provide high quality of interdisciplinary care for patients with AIS . Design A prospective study with retrospective controls. Method A total of 231 patients with AIS were prospectively enrolled to receive the nurse‐coordinated and guideline‐driven care for intravenous thrombolysis (prospective cohort). A retrospective cohort using propensity‐score matching at a 1:1 ratio retrieved reviews of 231 cases. The primary endpoint was early major improvement in the National Institute of Health Stroke Scale (NIHSS) scores at 24 h after thrombolysis. Secondary outcome measures included treatment time of each link at different stages, functional independence, EuroQoL 5‐dimension three‐level scale (EQ‐5D‐3L) scores and adverse events. Results The rate of early major improvement in NIHSS score was 57.19% and 42.0% in the prospective and retrospective cohorts with a rate ratio of 1.361 (95% CI: 1.127–1.643) indicating superiority ( p = 0.002). A higher rate of functional independence was observed in the prospective cohort as compared to controls (77.9% vs. 68.8%, p = 0.035). The mean time from admission was 17.11 ± 9.64 min for imaging, 21.75 ± 8.42 min for femoral artery puncture and 51.43 ± 9.64 min for thrombolysis in the prospective cohort, which were shorter than those in controls (all p < 0.001). EQ‐5D‐3L scores were better in prospective cases than in controls within 90 days after thrombolysis (all p < 0.05). A lower incidence of symptomatic intracranial haemorrhage was observed in the prospective cohort, while no significant difference in mortality up to 90 days was found between the two cohorts. No Patient or Public Contribution Although patients and the public were not directly involved in the design or conduct of this study, the research findings provide critical evidence that nursing‐led, guideline‐driven coordination directly improves the efficacy and safety in the management of patients with AIS by ensuring timely reaction, consistent application of evidence‐based protocols and enhanced multidisciplinary teamwork. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2200056818

Background Intrinsic capacity (IC), encompassing locomotive, cognitive, vitality, sensory and psychological domains, is central to defining healthy aging. Establishing norms for IC is crucial for understanding the aging process in Chinese population. Distinct aging patterns could be further captured to guide future studies and clinical practice. Methods In a nationwide cross-sectional community-based study, a total of 6025 elderly participants were recruited from 24 provincial administrative regions in China. IC was assessed over the 5 domains for each participant. Descriptive statistics and generalised additive models were employed to construct norms of IC as function of age, stratified by education or biological sex. A cosine similarity matrix of participants was further computed, upon which graph-based Louvain community detection algorithm (CDA) was applied to capture distinct aging patterns in the population. Results Population norms for the 5 IC domains were established. Data-driven CDA captured 5 distinct aging patterns: 1. Healthy aging (N = 2315), where all IC domains were relatively preserved; 2. Sensory dominant aging (N = 534), where sensory function showed the most profound impairment in aging; 3. Vitality dominant aging (N = 397), where vitality was the single most impaired domain; 4. Locomotion dominant aging (N = 608), in which motor function was persistently below average; and 5. Global accelerated aging (N = 2171), where all the 5 IC domains profoundly declined with age. Conclusions This study provided the norms of IC in aging Chinese population. More importantly, 5 distinct aging patterns were identified, which is of both clinical and scientific interest.

INTRODUCTION:Acute ischemic stroke (AIS) is a cerebrovascular disease associated with high disability and mortality. Tirofiban, a platelet glycoprotein IIb/IIIa receptor antagonist, is used in conjunction with thrombolysis for bridging therapy, but its effectiveness and safety compared with thrombolysis alone in patients with stroke are not well-established. MATERIAL AND METHODS:PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) from inception to June 17, 2025. Trials reporting the effectiveness and safety of tirofiban bridging after thrombolysis compared with thrombolysis only in patients with acute ischemic stroke were included. RESULTS:Six RCTs with 1524 participants were included. Tirofiban plus thrombolysis significantly favored improved neurologic function based on both modified Rankin Scale (MRS) 0-2 (Log risk ratio [RR] 0.17; p < 0.001) at day 90. There was no significant difference in symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage(aICH), bleeding from other sites and mortality between the 2 groups (LogRR 0.60; p = 0.21; LogRR -0.04; p = 0.87; LogRR 0.09; p = 0.74; LogRR 0.04; p = 0.90). CONCLUSIONS:Tirofiban plus thrombolysis was associated with better functional outcomes, but not sICH, aICH, bleeding from other sites, or mortality among patients with AIS compared with thrombolysis only. Further studies should focus on its safety profile and application to target patients.

Introduction: It is recommended that blood pressure (BP) in patients with acute ischemic stroke should be monitored closely before and until 24 hours after thrombolysis. This study aimed to develop a BP monitoring protocol for acute ischemic stroke patients using smart wearable devices and investigate its feasibility and effectiveness. Methods: 160 stroke patients in the emergency department of a designated advanced stroke center from were recruited from March to September 2023 (Fig.1). The intervention group received the BP monitoring protocol using smart wearable devices, while the control group received traditional bedside BP monitoring using standalone devices. Process evaluation indicators included feasibility, fidelity, and stakeholder acceptability. Outcome evaluation indicators included adherence to BP monitoring guidelines, time from admission to intravenous thrombolysis, National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and the incidence of symptomatic intracranial hemorrhage. Results: The implementation rate of BP monitoring guidelines from before intravenous thrombolysis to 24 hours after thrombolysis in the experimental group was 90.00 (87.50, 95.00) %, and that in the control group was 87.50 (82.50, 92.50) % (Table 1). The results of the process evaluation showed that the feasibility and intervention fidelity of this study were good. Interviews with stakeholders (11 nurses and 11 patients) revealed that the implementation of the intervention protocol was beneficial in improving nursing efficiency and timely detection of disease changes, but the protocol needed further improvement. Conclusion: The BP monitoring protocol for stroke patients undergoing intravenous thrombolysis based on smart wearable devices is scientifically sound and feasible. It can enhance adherence to BP monitoring guidelines and promote the implementation of evidence-based nursing practices.

Abstract Background It is recommended that blood pressure (BP) in patients with acute ischemic stroke (AIS) should be monitored closely before and until 24 hours after thrombolysis. The guideline adherence to BP monitoring in clinical practice can be influenced by a variety of factors. Interventions integrated with knowledge on influencing factors have been widely used to improve guideline adherence. Aim To evaluate if the BP monitoring program based on smart wearable devices (BPMP-SWD) can improve the adherence of intravenous thrombolytic (IVT) care in patients with AIS. Methods This study is a prospective, open-label, endpoint-blinded, single-center, randomized controlled trial, randomized in a 1:1 ratio to either the control or intervention group at a comprehensive stroke center. The BP in the control group will be monitored using a conventional bedside monitoring device and the intervention group will be monitored using a smart wearable device. The primary outcome is the guideline adherence to BP monitoring for IVT. The secondary outcomes include the feasibility, fidelity and acceptance of smart wearable devices. Based on pilot data, a total of 160 patients with AIS undergoing IVT will be recruited. Discussion This study may provide novel evidence on improving the adherence to intravenous thrombolytic BP monitoring and support the wider implementation of smart wearable devices-based intervention to promote evidence-based practice. Trial registration The Chinese Clinical Trial Registry ChiCTR2300069063 (Date of registration 03.06.2023)

Background Genome-wide association studies (GWAS) have identified HLA-G and LILRB1/2 loci associated with cancer risk. LILRB1 and LILRB2 are distinct inhibitory immune checkpoint receptors. LILRB1-mediated inhibition leads to impairment of cytotoxicity and proliferation of T cells and preventing the efficient engulfment of tumor cells by macrophages as a 'don't eat me' signal. LILRB2 suppresses the stimulation immune response of myeloid cells, especially in the tumor microenvironment. Blocking LILRB1/LILRB2 interaction with their ligands can be an effective immunotherapy for treating cancer. D2M has developed a dual antagonist antibody targeting both LILRB1 and LILRB2, named DM926. Methods DM926 was characterized in a series of assays to evaluate biological and physicochemical properties. DM926 was assessed in a series of in vitro functional assays using human PBMC, CD8+ T cells, NK cells, human monocyte-derived macrophages (hMDMs), tumor-associated macrophages (TAMs) and Dendric cells (DC). The target occupancy was performed in human whole blood in vitro and in LILRB1/2 transgenic mice in vivo. The stability was evaluated in vitro in fresh human serum and in vivo in B6 mice and LILRB1/2 transgenic mice. DM926 was evaluated in multiple xenograft mouse tumor models with adoptive transfer of human macrophages or PBMC. Results DM926 has sub-nanomole binding affinities to both LILRB1 and LILRB2. DM926 efficiently blocked the interactions of LILRB1 and LILRB2 to their ligands. DM926-mediated LILRB1/2 blockade modulated the function of immune cells: 1) released HLA-G mediated inhibition on TCR activation in Jurkat cells over-expressing LILRB1; 2) enhanced the cytotoxicity of CD8+ T cells and NK cells to lyse tumor cells; 3) enhanced phagocytosis of tumor cells by macrophages; 4) enhanced TNFα expression and inhibited IL10 expression in LPS-stimulated human PBMC; 5) reprogramed both hMDMs and TAMs induced by tumor cells to polarize toward a more inflammatory phenotype, leading to enhanced T-cell responses stimulated by DCs and inhibition of tumor cell growth. DM926 exhibited efficient target occupancy and stability in vitro and in vivo. DM926 demonstrated significant anti-tumor activity in xenograft tumor models with adoptive transfer hMDM or PBMC. Conclusions DM926 has demonstrated desirable characteristics. DM926 reprograms suppressive myeloid cells to a stimulatory state, eliciting phagocytotic function of macrophages, promoting cytotoxicity of CD8+ T and NK cells, and enhancing the activation of lymphoid cells. DM926 demonstrated significant antitumor activities in mouse tumor models. DM926 exhibited excellent stability in vitro and in vivo. The data warranted further development of DM926 as an immunotherapeutic for solid malignancies. Ethics Approval All uses of human material have been approved by the Institutional Review Board at ABI-Lab. All animal studies and procedures were approved by the Institutional Animal Care and Use Committee (IACUC) at Worcester Polytechnic Institution (WPI).

The use of machine learning (ML) in predicting disease prognosis has increased, and researchers have adopted different methods for variable selection to optimize early screening for AIS to determine its prognosis as soon as possible. We aimed to improve the understanding of the predictors of poor functional outcome at three months after discharge in AIS patients treated with intravenous thrombolysis and to construct a highly effective prognostic model to improve prediction accuracy. And four ML methods (random forest, support vector machine, naive Bayesian, and logistic regression) were used to screen and recombine the features for construction of an ML prognostic model. A total of 352 patients that had experienced AIS and had been treated with intravenous thrombolysis were recruited. The variables included in the model were NIHSS on admission, age, white blood cell count, percentage of neutrophils and triglyceride after thrombolysis, tirofiban, early neurological deterioration, early neurological improvement, and BP at each time point or period. The model's area under the curve for predicting 30‐day modified Rankin scale was 0.790 with random forest, 0.542 with support vector machine, 0.411 with naive Bayesian, and 0.661 with logistic regression. The random forest model was shown to accurately evaluate the prognosis of AIS patients treated with intravenous thrombolysis, and therefore they may be helpful for accurate and personalized secondary prevention. The model offers improved prediction accuracy that may reduce rates of misdiagnosis and missed diagnosis in patients with AIS.

Taking the Department of Pathology of Duke University as an example, this paper compares and analyzes the training mode of pathology residents in China and the United States. It is found that the organization and management system and supervision and assessment system of residency training in China have been improved, but it is still necessary to strengthen the in-depth implementation of humanistic education and training subjects for residents. Pathologist training should be based on "elite education" as the guiding ideology, to cultivate high-quality, high-level outstanding clinical pathology personnel as the specific goal, to build a solid foundation of clinical medicine.

Objective: To investigate the clinicopathological features of malignant peritoneal mesothelioma（MPM） in correlation with prognosis and independent prognostic factors. Methods: One hundred MPM specimens were collected at Beijing Shijitan Hospital, Capital Medical University, from January 2013 to December 2021. Asbestos exposure, CA125, ascites, peritoneal cancer index（PCI） score,complete cell reduction（CC） score, tumor–node–metastasis（TNM） staging, histological type, vascular tumor thrombus, nerve invasion and Ki-67 proliferation index were studied. Clinical follow-up data were reviewed to correlate with pathological prognostic factors using a Kaplan –Meier estimator and Cox proportional hazards regression model for both univariate and multivariate analyses.Results: The study participants comprised 48 males and 52 females. The median age was 54（24-72） years. There were 19 patients with asbestos exposure history（19%）, 90 patients with ascites（90%）, 58 patients with CA125 ≥35 U/mL（59%）, 56 patients with PCI scores of ≥25（56%）, 49 patients with CC scores of 0-1（49%）, and 51 patients with CC scores of 2-3（51%）. There were 79 cases of epithelioid type（79%）and 21 cases of non-epithelioid type（21%） MPM. There were 10 patients（10%） with stage Ⅰ disease, and 45 patients（45%） had stages Ⅱor Ⅲ disease, respectively. Univariate analysis revealed that the survival-related parameters included asbestos exposure, PCI score, CA125,histological type, Ki-67 proliferation index, and TNM stage. Multivariate analysis results revealed that the risk of death in patients with asbestos exposure history was 2.3 times higher than that in patients with no asbestos exposure history（95% confidence interval [CI]: 0.233-0.806, P=0.008）, the risk of death in patients with PCI scores of ≥25 was 2.9 times higher than that in patients with scores of ＜25（95% CI:0.200-0.612, P＜0.001）, and the risk of death in patients with Ki-67 ＞10% was 5.9 times higher than that in patients with Ki-67 ≤10%（95%CI: 0.072-0.401,P＜0.001）. There was significant difference in Ki-67 index between epithelioid and non-epithelioid MPM. Conclusions: Asbestos exposure history, PCI score, and Ki-67 proliferation index are independent prognostic factors in MPM patients.

Introduction Continuous monitoring of vital signs during and after ischaemic stroke was recommended by the ‘Guidelines for the Early Management of Patients with Acute Ischaemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischaemic Stroke’. Vital sign data can be associated with disease conditions and prognosis, while there is limited evidence regarding continuous monitoring of vital signs during and after acute ischaemic stroke. The wearable intelligent vital sign monitoring device is small and lightweight and constantly monitors the health status during daily activities. However, wearable intelligent vital sign monitoring devices have not been widely used in clinical practice so far. Therefore, we will investigate the effectiveness and safety of wearable intelligent vital sign monitoring devices in early in-hospital management and monitoring programmes for patients with acute ischaemic stroke. This paper presents the study protocol.Methods and design This study is a prospective, multicentre, observational registry study starting from 20 March 2023 to 20 March 2025. A total of 5740 patients with acute ischaemic stroke from 10 Chinese hospitals are planned to be enrolled. Continuous vital sign data, demographics, medical history, medication history, treatments, laboratory tests, imaging scans and follow-up data will be collected. Follow-up time points were 30 days after discharge, 30 days after intravenous thrombolysis, 3 months after intravenous thrombolysis and 12 months after intravenous thrombolysis (until March 2026). The primary outcome included the evaluation of the modified Rankin Scale at 3 months, as well as the assessment of the rate of symptomatic and asymptomatic intracranial haemorrhage throughout the hospitalisation period.Ethics and dissemination This study has been approved by the Medical Ethics Committee of Xuanwu Hospital, Capital Medical University ([2022] 203). We plan to disseminate the research findings through publication in peer-reviewed scientific journals and presentations at international conferences.Trial registration number ChiCTR2300069512.

目的 探讨原发CD5阳性的弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)的临床病理及分子学特征.方法 收集18例原发CD5+DLBCL的临床资料,采用免疫组化EnVision两步法检测CD3、CD5、CD7、CD20、PAX-5、CD10、BCL-6、BCL-2、C-MYC、MUM1等表达;应用FISH法检测C-MYC、BCL-2及BCL-6基因断裂;采用一代测序法检测MYD88 L265 P、CD79B Y196F的突变;并复习相关文献.结果 18例CD5+DLBCL中有3例(16.7％)CD30阳性;13例(72.2％)C-MYC阳性,16例(88.9％)BCL-2阳性,其中C-MYC和BCL-2双阳性12例(66.7％);15例(83.3％)BCL-6阳性;14例(81.8％)伴p53突变(13例错义突变、1例无义突变).10例(55.6％)肿瘤细胞PD-1阳性,阳性率5％～80％;肿瘤浸润淋巴细胞PD-1阳性,阳性率5％～60％.8例(44.4％)肿瘤细胞PD-L1阳性,阳性率2％～80％;免疫细胞PD-L1均阳性,阳性率3％～90％.C-MYC在2例(11.1％)中检测有扩增,无重排.BCL-2有3例(16.7％)扩增,1例(5.6％)重排.BCL-6检测有1例(5.6％)扩增,1例(5.6％)重排,1例(5.6％)既有扩增又有重排.MYD88检测到4例突变(22.2％),CD79B检测有8例突变(44.4％),其中3例同时具有MYD88和CD79B突变(16.7％).结论 原发CD5+DLBCL中MYC和BCL-2阳性率高,但突变率低.肿瘤细胞及免疫细胞中PD-1及PD-L1的阳性率较高,PD-1/PD-L1抑制剂可能是其有效的治疗途径.

恶性腹膜间皮瘤（malignant peritoneal mesothelioma，MPM）是原发于腹膜的罕见恶性肿瘤。33%~50%的弥漫MPM患者有石棉接触史。发病年龄以50~70岁多见。近85%的MPM有BAP1基因改变。本文报道1例31岁女性上皮样型MPM无石棉接触史伴有遗传性肿瘤基因STK11突变。临床表现为盆腔肿块。镜下排列呈管状、条状、筛状，肿瘤细胞为上皮样，中度核异型性、有核仁，间质富含小血管，伴有广泛的黏液变性。免疫组织化学广谱细胞角蛋白、波形蛋白、Calretinin、D2-40、间皮素细胞、WT-1均阳性。全外显子基因检测示遗传性肿瘤基因STK11突变。腹腔镜手术并化疗后3个月盆腔肿物复发。.

Although computerized physician order entry systems improve order transmission and patient safety, overdependence on these systems can impede users' communication. This ethnographic study explored physician-nurse communication surrounding computerized physician order entry systems using a sociotechnical framework. Fieldwork conducted in a tertiary teaching hospital comprised 89 hours of participant observation, and individual semistructured interviews were held with seven nurses and five physicians. In addition, documents and artifacts were collected. Three core themes emerged. First, computerized physician order entry quality-related issues undermined the work efficiency of physicians and nurses. Specifically, usability was error prone because of cognitive overload, and the system was unable to perform relevant traces and raise alerts, demonstrating poor interoperability. Second, social factors, including insufficient training, unclear responsibilities, and a lack of awareness concerning interdisciplinary communication, compounded communication problems. Last, environmental factors, including noncoterminous spaces and times and insufficient technical support, impeded the resolution of communication problems. Technical and social contextual factors relating to computerized physician order entry systems jointly affected physician-nurse communication. Cognitive issues and insufficient alerts impacted work efficiency the most and were compounded by contextual individual- and team-related factors and environmental factors. Therefore, improved functions of computerized physician order entry systems and interprofessional communication training are required to optimize technical and social aspects of physician-nurse communication.

Background Despite the continuing effort in investigating the preventive therapies for stroke-associated pneumonia (SAP), which is closely associated with unfavorable outcomes, conclusively effective therapy for the prevention of SAP is still lacking. Remote ischemic conditioning (RIC) has been proven to improve the survival in the sepsis model and inflammatory responses have been indicated as important mechanisms involved in the multi-organ protection effect of RIC. This study aimed to assess the safety and the preliminary efficacy of RIC in the prevention of SAP in patients with acute ischemic stroke. Methods We performed a proof-of-concept, pilot open-label randomized controlled trial. Eligible patients (age > 18 years) within 48 h after stroke onset between March 2019 and October 2019 with acute ischemic stroke were randomly allocated (1:1) to the RIC group and the control group. All participants received standard medical therapy. Patients in the RIC group underwent RIC twice daily for 6 consecutive days. The safety outcome included any adverse events associated with RIC procedures. The efficacy outcome included the incidence of SAP, changes of immunological profiles including mHLA-DR, TLR-2, and TLR-4 as well as other plasma parameters from routine blood tests. Results In total, 46 patients aged 63.1 ± 12.5 years, were recruited (23 in each group). Overall, 19 patients in the RIC group and 22 patients in the control group completed this study. No severe adverse event was attributed to RIC procedures. The incidence of SAP was lower in the remote ischemic conditioning group (2 patients [10.5%]) than that in the control group (6 patients [27.3%]), but no significant difference was detected in both univariate and multivariate analysis ( p = 0.249 and adjusted p = 0.666). No significance has been found in this pilot trial in the level of immunological profiles HLA-DR, TLR4 and TLR2 expressed on monocytes as well as blood parameters tested through routine blood tests between the two groups ( p > 0.05). The IL-6 and IL-1β levels at day 5 after admission in the RIC group were lower than those in the control group ( p < 0.05). Interpretation This proof-of-concept pilot randomized controlled trial was to investigate RIC as a prevention method for SAP. Remote ischemic conditioning is safe in the prevention of SAP in patients with acute ischemic stroke. The preventive effect of RIC on SAP should be further validated in future studies.

Aggressive angiomyxoma (AAM) is an uncommon locally infiltrative tumor that frequently occurs in the pelvic soft tissues of female patients; it has a high rate of local recurrence. However, AAM is extremely rare in males. Herein, we present the case of a 70-year-old man with a gradually enlarging painless mass in the scrotum. The patient underwent local excision of the scrotal AAM, with no local relapse after 17 months of follow-up. In addition to the present case, the clinicopathological features of males with AAM reported in literature (to the best of our knowledge) are discussed in this report. The literature review revealed that the gross morphology, clinical process, and histopathology of AAM in males resemble those of AAM in females. In particular, estrogen receptor/progesterone receptor has been shown to be expressed in male patients, which may provide an option for hormone therapy. Moreover, in males, a lower recurrence rate has been observed after surgery to remove the tumor. However, more data are needed to validate this observation. This report emphasizes the importance of considering AAM as the differential diagnosis of myxoid neoplasms in male genital areas.

精准医学时代的发展,推动了病理研究的深入,临床对病理报告中信息内涵的要求也越来越高,尤其需要能够指导临床治疗及预后判断的病理指标.早在1982年,美国解剖和外科病理主任协会(Association of Directors of Anatomic and Surgical Pathology,ADASP)就指出,对于各种类型肿瘤报告的客观要求,是以统一的形式按照完整性、术语化以及序列化的原则来表示[1].因此,推动实施肿瘤病理报告标准化,与时俱进不断深化和细化,使病理报告既有写实性、依靠性,更有前瞻性、引导性,一直是临床病理工作的重要指导思想和工作方法.

目的:探讨甲状腺乳头状癌(PTC)患者颈部淋巴结转移与原发灶临床病理特征和BRAFV600E基因突变的关联性,阐明PTC患者颈部淋巴结转移的影响因素.方法:选择因PTC在本院手术治疗的患者,回顾性分析其临床资料,包括患者年龄,性别,原发灶部位和数量,淋巴结转移数量和位置;病理学资料,包括肿瘤的位置、大小、数目和包膜侵犯,瘤周纤维包裹,检出砂粒体,脉管和神经受累.检测PTC组织中BRAF V600E基因突变情况,分析颈部淋巴结转移与PTC患者临床特征、病理学特点和BRAF V600E基因突变的关联性,采用多因素Logistic回归模型分析PTC患者颈部淋巴结转移的影响因素.结果:共选择PTC患者321例,其中发生颈部淋巴结转移者129例(40.2％).279例(86.9％)患者伴有BRAF V600E基因突变,但BRAF V600E基因突变与PTC淋巴结转移无关联(P>0.05).PTC患者颈部淋巴结转移与患者发病年龄、肿瘤最大径、甲状腺双侧叶多原发灶、检出砂粒体和脉管受侵有关联(P<0.05或P<0.01).多因素Logistic回归分析,PTC患者年龄(OR=0.729,95％CI:0.600～0.885)、肿瘤最大径(OR=1.796,95％CI:1.326～2.433)、原发灶数量(OR=1.947,95％CI:1.225～3.096)、检出砂粒体(OR=2.578,95％CI:1.037～6.409)和脉管受侵(OR=8.856,95％CI:1.929～40.656)是PTC患者淋巴结转移的影响因素.结论:PTC患者发生颈部淋巴结转移与患者年龄、肿瘤最大径、原发灶数量、检出砂粒体和脉管受侵有关联,与BRAF V600E基因突变无关联.

Blood pressure (BP) monitored within 24 h from the beginning of intravenous thrombolysis (IVT) with alteplase, is one of the important factors affecting the prognosis of patients with acute ischemic stroke (AIS). This study aimed to explore longitudinal BP trajectory patterns and determine their association with stroke prognosis after thrombolysis. From November 2018 to September 2019, a total of 391 patients were enrolled consecutively during the study period, and 353 patients were ultimately analyzed. Five systolic (SBP) and four diastolic blood pressure (DBP) trajectory subgroups were identified. The regression analysis showed that when compared with the rapidly moderate stable group, the continuous fluctuation-very high level SBP group (odds ratio [OR]: 2.743, 95% confidence interval [CI]: 1.008-7.467) was associated with early neurological deterioration (END). Both the rapid drop-high level SBP (OR: 0.448, 95% CI: 0.219-0.919) and DBP groups (OR: 0.399, 95% CI: 0.219-0.727) were associated with early neurological improvement (ENI). Moreover, there was a U-shaped correlation between the OR value of SBP trajectory group and favorable outcome (the modified Rankin Scale [mRS] score 0-2) at 3 months: the slow drop-low level SBP group represent a well-established unfavorable outcome risk factor (OR:5.239, 95% CI: 1.271-21.595), and extremely high SBP-the continuous fluctuation-very high level SBP group, are equally associated with elevated unfavorable outcome risk (OR:3.797, 95% CI: 1.486-9.697). The continuous fluctuation-very high level DBP group was statistically significant in mRS (OR: 3.387, CI: 1.185-9.683). The BP trajectory groups show varying clinical features and risk of neurological dysfunction. The findings may help identify potential candidates for clinical BP monitoring, control, and specialized care.