Background Metabolic abnormalities and obesity/overweight are prevalent in peritoneal dialysis (PD) patients, and their interplay may significantly impact clinical outcomes. This study aimed to investigate the association between metabolic phenotypes (stratified by body mass index [BMI] and metabolic status) and all-cause mortality in PD patients. Methods This multicenter cohort study was conducted from January 1, 2001, to May 31, 2023. Participants were categorized into four metabolic phenotypes based on their BMI and metabolic status: Metabolically Healthy Overweight/Obesity (MHO), Metabolically Healthy Non-Overweight/Obesity (MHNO), Metabolically Unhealthy Overweight/Obesity (MUO), Metabolically Unhealthy Non-Overweight/Obesity (MUNO). The primary outcome is all-cause mortality. Cox regression analysis was employed to evaluate the association between metabolic phenotypes and all-cause mortality. Results The study cohort comprised 4305 participants, with 1034 deaths during follow-up. Compared with the MHNO subgroup patients, those in the MUNO subgroup (HR, 1.169; 95%CI, 1.007-1.356) and the MUO subgroup (HR, 1.206; 95% CI, 1.013-1.437) exhibited a higher risk of all-cause mortality, whereas patients in the MHO group did not show an increased risk (HR, 0.921; 95% CI, 0.718-1.181). These results were consistent in subgroup and sensitivity analyses. Conclusion In this cohort study, we found that patients with metabolic abnormalities showed a higher risk of all-cause mortality. The influence of BMI on all-cause mortality in PD patients varies with metabolic status; thus, metabolic status should be prioritized in risk stratification and personalized management for PD patients with overweight/obesity.

Background: The treatment of severe pulmonary tuberculosis (PTB) remains challenging, highlighting the need for prognostic tools. This study aimed to establish and validate a nomogram for predicting overall survival (OS) of PTB patients in the intensive care unit (ICU). Methods: A retrospective analysis was performed using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A total of 1,105 PTB patients were identified and randomly divided into training and validation cohorts. Least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection, followed by Cox regression to construct a predictive model. A nomogram was developed based on the selected predictors. Model performance was assessed by receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results: Eight predictors were identified: age, Acute Physiology Score (APS) III, partial pressure of oxygen (PO2), mean heart rate, mean temperature, platelet (PLT), albumin (ALB), and red blood cell (RBC) count. A nomogram was constructed to predict survival at 28, 180, and 365 days. The concordance index (C-index), area under the curve (AUC), and calibration plots showed good discrimination and calibration in both cohorts. Compared with APS III, the model demonstrated higher net reclassification improvement (NRI) and integrated discrimination improvement (IDI), confirming its superior clinical utility. Conclusions: We developed and validated a prognostic nomogram integrating eight clinical variables to predict survival in ICU patients with PTB. This tool may assist clinicians in early risk stratification and personalized management.

BACKGROUND:Given high symptom recurrence rates after discontinuation of antifungal therapy (AF), a comparison was made between AF alone and in combination with bronchoscopic aspergilloma removal (BRA) for treating post-tuberculosis chronic cavitary pulmonary aspergillosis (PTB-CCPA) patients, focusing on fungal ball clearance rate, relapse rate, and relapse risk factors. METHODS:This retrospective cohort study was conducted at Guangzhou Chest Hospital, China, from January 2014 to December 2021, with follow-up through October 2023. Patients with PTB-CCPA who met diagnostic criteria (cavitary tuberculosis history, CT-confirmed fungal balls, and microbiological/serological Aspergillus evidence) were included. RESULTS:The enrolled patients were divided into two groups: the control group (32 patients, 36.4%) received only AF, and the treatment group (56 patients, 63.6%) received a combination of AF and BRA (AF+BRA). The aspergilloma clearance rate in the cavity was 14.8% in the AF group and 100% in the AF+BRA group (p < 0.001). For patients who received AF less than 8 months, Kaplan-Meier survival curve analysis showed that the AF+BRA group had a significantly higher cumulative recurrence-free survival rate (p < 0.05). Notably, AF+BRA shortened the duration of oral AF compared with the AF treatment. Further analysis identified age ≥60 years (HR = 0.12, 95% CI 0.03-0.57, p = 0.007) and the disappearance or reduction in size of the aspergillomas (HR = 0.07, 95% CI 0.01-0.58, p = 0.014) as protective factors against recurrence, while more than one pulmonary cavity increased recurrence risk (HR = 7.4, 95% CI 1.67-32.69, p = 0.008). CONCLUSIONS:AF+BRA can eliminate Aspergillus fungal balls, may cure PTB-CCPA, shorten antifungal treatment duration, and reduce recurrence and mortality, suggesting that it is a superior treatment approach.

The worldwide trend shows a continuous increase in pulmonary infections caused by nontuberculous mycobacteria (NTM), with Mycobacterium abscessus (M. abscessus) emerging as a major concern as the most common rapidly growing opportunistic pathogen. It poses a substantial risk, causing severe respiratory, skin, and mucosal infections, especially among patients suffering from chronic pulmonary disease and cystic fibrosis (CF). The diverse virulence factors and complex resistance mechanisms of M. abscessus create formidable challenges in clinical management. As pivotal effectors in innate immunity, macrophages are essential in initiating immune responses against M. abscessus and constitute a central component of the host immune network. A thorough insight into how M. abscessus interacts with the host's immune defense is crucial for deepening our understanding of this infection. This review summarizes the pathogenic mechanisms and host immune responses to M. abscessus, with the goal of providing insights into the escalating challenges posed by this increasingly virulent and resistant pathogen.

BACKGROUND:Peritonitis is a serious complication of peritoneal dialysis (PD). Inflammatory indices derived from routine complete blood count (CBC) parameters-including the pan-immune inflammatory value (PIV), systemic immune-inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-monocyte ratio (PMR)-have shown prognostic value in various diseases. However, their comparative utility in predicting PD-associated peritonitis (PDAP) remains unclear. This multicenter cohort study aimed to evaluate and compare these indices to identify the best predictor of PDAP. METHODS:We retrospectively enrolled 2,036 PD patients from 10 centers. The associations between inflammatory markers (PIV, SII, PLR, NLR, MLR, PMR) and peritonitis risk were analyzed using restricted cubic splines. Optimal cut-offs were determined by ROC analysis. Survival differences were assessed using Kaplan-Meier curves and log-rank tests. Independent predictors were identified via multivariate Cox regression, with model discrimination evaluated by the C-index. Subgroup analyses were conducted by gender, age, body mass index (BMI), diabetes, albumin, PD vintage, and residual renal function. RESULTS:The median age was 51.0 years, 55.01% were male, and median dialysis vintage was 49.47 months. Diabetes prevalence was 21.02%. Over the follow-up, 147 patients (7.22%) developed peritonitis. Among the indices evaluated, PIV, SII, and PLR showed significant nonlinear associations with peritonitis risk (all P < 0.05). Adjusted hazard ratios were 2.004 for PIV, 2.144 for SII, and 2.063 for PLR. Adjusted C-indices were 0.67 (PIV), 0.70 (SII), and 0.70 (PLR). No significant interactions were found in subgroup analyses. CONCLUSION:Elevated PIV, SII, and PLR levels at PD initiation independently predict higher peritonitis risk. Although their discriminative ability is moderate, these routine, cost-effective indices may aid risk stratification and help identify patients needing closer monitoring or preventive interventions.

Low blood glucose levels and high urea nitrogen levels affect patient prognosis, but few studies have investigated whether the blood urea nitrogen to glucose (BGR) ratio predicts the risk of death.This retrospective research examined the connection between the BGR and 365-day mortality in patients with chronic kidney disease (CKD) stages 1–4 admitted to an intensive care unit (ICU). The study utilized data from 6,380 patients in the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2), taking into account confounding factors such as demographics, vital signs, laboratory indicators, and comorbidities. The study employed both univariate and multivariate Cox regression analyses stratified by BGR quartiles. Additionally, restricted cubic spline regression and inflection point analysis were used to explore the linear relationship between BGR and 365-day mortality, while Kaplan-Meier curve analysis was used to observe mortality changes under different BGR stratifications. Subgroup and mediating effect analyses were performed to evaluate the robustness of BGR’s effect on 365-day mortality. The study found a cumulative 365-day mortality rate of 34.2% among CKD stages 1–4 patients, with a 2.43-fold increase in the risk of death associated with BGR and at least a 44% increase in the risk of death for each unit increase in BGR (P = 0.022). A significant nonlinear relationship was identified, showing a stepwise change in the risk of death with a marked increase in the slope of the curve for BGR values below 0.52 and above 0.9 (P < 0.001). Subgroup analyses indicated interactions between BGR and factors such as age, sepsis, first-day antibiotic use, and cerebrovascular disease (P < 0.05). In conclusion, this study confirms that BGR is a significant and stable predictor of 1-year mortality risk in patients with CKD stages 1–4. Interventions aimed at timely adjustment, correction of metabolic imbalances, reduction of inflammation, and management of BGR levels are beneficial for reducing mortality in this patient population.

Abstract Background: FCR (fludarabine, cyclophosphamide, and rituximab) has been demonstrated to improve outcomes in previously untreated Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) CLL patients, but only for suitable patients, which limits it clinical application.Lower toxicity strategies, such as Bendamustine-Obinutuzumab or Bendamustine-Rituximab, demonstrated better tolerability but did not achieve comparable efficacy.BTK inhibitors (BTKi) are recommended for long-term therapy in CLL/SLL and time-limited treatment regimen has been hot topics. In fit patients, exploration of time-limited therapy models such as fixed-duration or MRD-guided therapies has shown promising results. However, such exploration were needed in unfit patients.Orelabrutinib is a novel, potent, and highly selective BTK inhibitor that offers better deep remission compared to other BTK inhibitors.Therefore, this study aims to explore a more effective treatment regimen for unfit patients with newly diagnosed CLL/SLL by using Orelabrutinib plus Bendamustine and Obinutuzumab (OBG) regimen as first-line therapy. The first stage analysis was published at 66th ASH meeting and this time we report the update of interim analysis. Methods: This is a multiple-center, phase II, single-arm study aimed at evaluating the efficacy and safety of OBG regimen as first-line treatment for CLL/SLL unfit patients without 17p-/TP53 mutations. Unfit defined as patients age > 65 years old or CIRS scores≥6.The primary endpoints include the rate of complete response (CR) combined with undetectable minimal residual disease (uMRD) at the end of 7 cycles (CR/CRi & uMRD, with patients achieving incomplete CR categorized as CRi). The secondary endpoints include CRR, ORR, and safety. Dosage regimen:Orelabrutinib 150 mg, po, qd, D1-D28;Bendamustine: 70 mg/m², intravenous injection, administered on Day 2 and Day 3 of Cycle 1, and on Day 1 and Day 2 of Cycles 2-6. Obinutuzumab: Cycle 1: 100 mg on day 1, 900 mg on day 2 (or 1000 mg on day 1), and 1000 mg on days 8 & 15. Cycle 2-6, 1000 mg/m² on Day 1. Each treatment cycle lasts 28 days. The first cycle us BG regiment to reduce tumor burden, followed by 5 cycles of OBG, and then one cycle of orelabrutinib monotherapy. Result: From December 2023 to March 2025, a total of 13 patients were enrolled, all of whom completed at least 4 cycles of treatment, with 11 patients completing 7 cycles. The median age was 66 years (range: 53–70). 76.9% patients were males and 23.1% were females. ECOG PS scores were distributed as follows: score of 0 in 69.2% and score of 1 in 30.8%. Rai staging showed that 38.5% patients were stage I/II, while 61.5% were III/IV. IGHV mutation was present in 76.9% of the patients. Efficacy results: 72.7% (7/11) had achieved CR&uMRD at the end of all 7 cycles, with an ORR of 100% and 100% achieved PB uMRD4. Among all patients who completed at least four cycles (n=13), ORR was 92.3%, and 46.2% achieved CR. Safety results: Among all treated patients, ≥Grade-3 AEs occurred in four patients (include 3 neutropenia, 2 thrombocytopenia, 2 infections, 1 involving herpes zoster). All patients fully recovered from the adverse event without any impact on their subsequent treatment. No cases were reported for hypertension (any grade), atrial fibrillation (any grade), or bleeding events (≥Grade-3) across all participants treated during this study period. Conclusions: The Time-Limited Treatment of OBG regimen shows efficacy in unfit CLL/SLL patients, which achieved high rates of complete response combined with undetectable minimal residual disease. Safety analysis indicates that the OBG regimen is well-tolerated and adverse events are manageable. These findings support further investigation of the OBG regimen to optimize treatment outcomes in this patient population.

To evaluate the efficacy and safety of nimotuzumab combined with docetaxel and cisplatin (TPN) as the first-line therapy in patients with recurrent or metastatic nasopharyngeal carcinoma (RM-NPC). In this multicenter, open-label, phase 2 trial (ClinicalTrials.gov identifier: NCT03708822), patients with RM-NPC received intravenous nimotuzumab (200 mg on days 1, 8, and 15), docetaxel (75 mg/m2 on day 1), and cisplatin (75 mg/m2 on day 1) every 3 weeks for 6 cycles. The primary endpoint was the objective response rate (ORR), and the secondary endpoints included the disease control rate (DCR), duration of response (DOR), time to response (TTR), progression-free survival (PFS), overall survival (OS), and safety. Between October 15, 2018, and July 20, 2022, 52 patients were enrolled. The ORR and DCR in the intention-to-treat population were 65.4

Background: Diffuse large B - cell lymphoma (DLBCL) is the most common subtype of non - Hodgkin lymphoma. Approximately 30% - 40% of DLBCL cases involve the gastrointestinal tract, forming primary gastrointestinal DLBCL (PGI - DLBCL). DLBCL with gastrointestinal involvement has unique clinical features, such as higher invasiveness, and a prognostic pattern different from that of node - derived DLBCL. Mid - term efficacy evaluation is a key link in adjusting treatment strategies, but there is currently a lack of reliable biomarkers to assist in judging treatment responses. The neutrophil - to - lymphocyte ratio (NLR), as an indicator reflecting the balance between systemic inflammation and immunity, has been confirmed to be related to prognosis in various malignant tumors. On the one hand, mid - term treatment response is a strong predictor of prognosis; on the other hand, NLR may supplement the deficiency of imaging evaluation by reflecting the treatment - induced inflammatory state or immune suppression. Methods: We conducted a retrospective analysis among patients with newly diagnosed diffuse large B - cell lymphoma (DLBCL) involving the gastrointestinal tract from 2022 to 2024. NLR was calculated using records from complete blood counts (CBC) of 107 newly diagnosed DLBCL patients. A higher NLR is associated with an increase in absolute neutrophil count, a decrease in lymphocyte count, and systemic inflammatory markers. Among the 82 patients who had mid - term evaluation, 73 patients responded to chemotherapy (mid - term evaluation was CR or PR), with NLR M (Q₁, Q₃) = 6.12 (3.58, 15.20), and 9 patients had no response, with NLR M (Q₁, Q₃) = 3.02 (2.23, 4.73). There was a significant difference between the two groups. Patients were divided into two groups according to the median baseline neutrophil-to-lymphocyte ratio (NLR), and there were significant differences between the two groups in terms of HGB, ALB, FIB, Na, Cl, β2-MG, LDH, HDL-C, and LDL-C. In the mid - term evaluation, for each 1 unit decrease in NLR, the risk of non - response events during mid - term treatment was reduced to 0.109 times the original (95% confidence interval [CI] 0.013 - 0.910, OR). After adjusting for covariates such as gender, age, BMI, albumin, hemoglobin, platelets, sodium ions,ECOG score,extranodal organ involvement, underlying diseases, whether it is double - expressor lymphoma, and treatment methods, the results showed that compared with individuals with lower NLR (≤3.49), individuals with higher NLR (>3.49) had a lower chemotherapy response rate (odds ratio OR 0.4, 95% confidence interval [CI] 0.002 - 0.981). The initial NLR level at diagnosis was negatively correlated with the mid - term chemotherapy response rate in patients with gastrointestinal DLBCL. Conclusion: This conclusion further verifies that in clinical evaluation, the mid - term efficacy of chemotherapy can be judged based on the baseline level of NLR at admission. It is expected to establish a mid - term evaluation model with NLR as the core, make up for the deficiency of existing prognostic tools (such as IPI score) in dynamic evaluation, and promote the precise management of gastrointestinal DLBCL.

An imbalance in the serum sodium to chloride ratio (Na/Cl) was linked to higher mortality among heart failure patients. Nonetheless, the prognostic significance of Na/Cl in individuals undergoing peritoneal dialysis (PD) remains unexplored. This study seeks to explore the association between initial Na/Cl levels and mortality in PD patients. The study, conducted across multiple centers, included 3341 patients undergoing PD from January 1, 2005, to December 31, 2021. Patients were stratified into quartiles according to baseline Na/Cl and followed up for a median of 5.77 years. To explore the association between Na/Cl levels and mortality, we employed Cox proportional hazards models, competing risks models, and restricted cubic spline analysis. Of 3341 patients, 722 patients died, including 259 cardiovascular deaths. Following adjustments for comorbidities and multiple covariates, individuals in the highest Na/Cl quartile (>1.42) exhibited lower all-cause mortality (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.47-0.86) and cardiovascular mortality (HR 0.38, 95% CI 0.22-0.67) compared with those in the lowest quartile (<1.33). A similar pattern was also found when Na/Cl was dealt with continuous variables. Initial levels of Na/Cl at the start of PD were negatively correlated with all-cause mortality and cardiovascular mortality in PD patients.

Deuterium, an element recognized for its close association with cancer, is involved in every stage from tumorigenesis and basic research methodologies to clinical diagnosis, therapeutic interventions, and drug development. Several significant findings have emerged in this field. This review explores the potential mechanisms by which deuterons influence cancer initiation and progression in the form of deuterium oxide including deuterium-enriched water (DEW) and deuterium-depleted water (DDW). Besides, deuterium, a stable hydrogen isotope with unique physicochemical properties, also plays a pivotal role in detection and drug discovery. We delve into the importance of deuterium-labeled compound detection techniques—such as hydrogen–deuterium exchange mass spectrometry, deuterium metabolism imaging, Raman deuterium isotope probe techniques, and the applications of AI in Deuterium-related detection techniques—in identifying tumor biomarkers, elucidating metabolic pathways, and validating drug targets. The advantages and limitations of these techniques, particularly in the realm of imaging, are discussed. Deuterium-substituted drugs, such as donafenib, offer notable pharmacokinetic superiorities, including a significantly longer half-life and reduced toxicity compared to conventional chemotherapeutic agents. These characteristics make them promising candidates for cancer chemotherapy. In summary, this review examines the role of deuterium-related molecules in cancer development, detection, and treatment, including DEW, DDW, deuterium-substituted drugs, and deuterium-labeled compounds. Additionally, it highlights the latest advancements in deuterium-labeled compound detection technologies.

This research effort was designed to retrospectively analyze the safety and efficacy of immune checkpoint inhibitors (ICIs) deployed in combination with chemotherapy in extensive-stage small cell lung cancer (ES-SCLC). ES-SCLC patients diagnosed at Guangzhou Chest Hospital from January 1, 2018, through June 30, 2022, were divided into two groups: an IEP group (administered ICIs with etoposide and platinum-based chemotherapy) and an EP group (chemotherapy only). Median overall survival (OS) and progression-free survival (PFS) served as the primary endpoints for analysis, while secondary endpoints that were assessed included objective response rate (ORR), 1- and 2-year OS, and safety. Subgroup analyses explored sites of metastatic progression and ICI types. In total, 102 patients were enrolled, including 33 in the IEP group and 69 in the EP group. The median OS was significantly longer in the IEP group (14.3 vs. 10.8 months, P = 0.028), while the median PFS showed no significant difference (5.9 vs. 5.3 months, P = 0.746). In subgroup analyses, those patients with brain metastases were found to have derived benefit from IEP treatment (median OS 15.9 vs. 8.3 months, hazard ratio [HR], 0.266 [95

BackgroundPostoperative pulmonary complications (PPCs) significantly impact surgical outcomes, and Controlling Nutritional Status (CONUT) score, a simple and easily available nutritional score, has been demonstrated to be significantly associated with postoperative patient outcomes and complications, including PPCs. However, there are few studies that specifically focus on patients undergoing radical surgery for colorectal cancer (CRC).MethodsWe retrospectively analyzed the clinical data of 2,553 patients who underwent radical surgery for CRC at the Sixth Affiliated Hospital of Sun Yat-sen University. Patients were divided into three groups: normal nutrition group (CONUT≤1), mild malnutrition group (2 ≤ CONUT≤4), and moderate-to-severe malnutrition group (CONUT≥5). Risk factors for PPCs and all-cause mortality were evaluated by multivariate regression. In addition, we assessed surgical outcomes including ICU admission, hospital stay, 1-year mortality and tumor-related mortality.ResultsThe incidence of PPCs was 9.0% (n = 230). Multiple regression showed that the higher the CONUT score, the higher the risk of PPCs (mild malnutrition group vs. normal nutrition group, OR: 1.61, 95% CI: 1.18–2.20, p = 0.003; moderate-to-severe malnutrition group vs. normal nutrition group, OR: 2.41, 95% CI: 1.51–3.84, p < 0.001). All-cause mortality was significantly higher in moderate-to-severe malnutrition group than that in normal nutrition group, HR: 1.88, (95% CI: 1.34–2.62, p < 0.001). Older age, male sex, chronic heart disease, open surgery, blood transfusion during surgery, distant metastasis of tumor and colon tumor were all risk factors for PPCs. Furthermore, the malnutrition groups had poor surgical outcomes including postoperative pneumonia (mild vs. normal nutrition, OR: 1.64, 95% CI: 1.07–2.52, p = 0.024; moderate-to-severe vs. normal nutrition, OR: 2.51, 95% CI: 1.36–4.62, p = 0.00), ICU admission (mild vs. normal nutrition, OR: 2.16, 95% CI: 1.31–3.56, p = 0.002; moderate-to-severe vs. normal nutrition, OR: 3.86, 95% CI: 2.07–7.20, p < 0.001), hospital stay ≥14 days (mild vs. normal nutrition, OR: 1.30, 95% CI: 1.08–1.56, p = 0.006) and 1-year mortality (mild vs. normal nutrition, HR: 1.65, 95% CI: 1.11–2.46, p = 0.014; moderate-to-severe vs. normal nutrition, HR: 2.27, 95% CI: 1.28–4.02, p = 0.005).ConclusionThe preoperative CONUT score is a potential indicator for predicting PPCs and surgical outcomes in CRC patients.

BACKGROUND:Globally, infections account for 10% of new cancer cases, and cancer can compromise the immune system, increasing the risk of infections. With advances in cancer treatment, widespread use of immunotherapy, and prolonged survival of cancer patients, the coexistence of tuberculosis (TB) and cancer is becoming increasingly common in clinical settings. AIM:This review aims to explore the interaction between tuberculosis (TB) and tumors, particularly lung cancer (LC), and to identify appropriate clinical management approaches. RESULTS:LC patients with a history of TB have higher adjusted risk ratios for both all-cause and cancer-specific 3-year mortality compared to those without a history of TB. TB may elevate the risk of developing tumors through mechanisms such as chronic inflammation, altered immune responses, and DNA damage. Conversely, cancer patients, whether due to the disease itself or immune dysfunction caused by anti-tumor treatments, may be more susceptible to TB. The coexistence of TB and tumors presents significant challenges in clinical management, making the development of treatment strategies and quality-of-life improvements crucial. CONCLUSION:There is a close relationship between TB and cancer, with TB potentially serving as a risk factor for cancer, and cancer influencing susceptibility to TB. Effective clinical management is essential to enhance treatment strategies and improve the quality of life for patients with both TB and cancer.

ABSTRACT Background Histone deacetylase (HDAC) inhibitors demonstrated a synergistic anti‐tumor effect with rituximab and chemotherapy in preclinical studies on diffuse large B‐cell lymphoma (DLBCL). This phase 2 trial aimed to evaluate the efficacy and safety of chidamide, an orally active HDAC inhibitor, plus the R‐GemOx regimen for relapsed/refractory (R/R) DLBCL. Methods Patients with transplantation‐ineligible R/R DLBCL received chidamide (20 mg, oral, days 1, 4, 8, 11, 15, and 18), rituximab (375 mg/m2, day 1), gemcitabine (1000 mg/m2, day 2), and oxaliplatin (100 mg/m2, day 2) in a 21‐day cycle for 6 cycles (induction phase), followed by chidamide (20 mg, oral, twice weekly on Mondays and Thursdays) until disease progression or intolerable toxicity (maintenance phase). The primary endpoint was overall response rate (ORR). Results Between June 19, 2019 and July 5, 2022, 54 patients were enrolled. The ORR was 59.3% (95% CI: 45.0–72.4). With a median follow‐up of 38.1 months (interquartile range: 19.5–48.2), the median progression‐free survival and overall survival were 7.4 (95% CI: 5.2–14.2) and 23.9 (95% CI: 15.2‐not reached) months, respectively. The most common grade 3/4 treatment‐emergent adverse events (TEAEs) were neutropenia (40.7%), thrombocytopenia (33.3%), and leukopenia (27.8%). Whole‐exome sequencing showed that CREBBP mutations and BTG2 mutations were associated with poor response and survival. Conclusion Chidamide plus R‐GemOx demonstrated promising anti‐tumor activity with acceptable toxicities in transplantation‐ineligible R/R DLBCL patients. Patients with CREBBP mutations and BTG2 mutations had inferior response and survival. Trial Registration ClinicalTrials.gov identifier: NCT04022005

Background: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is an extremely rare and highly aggressive subtype of peripheral T-cell lymphoma that primarily arises in the intestine. MEITL exhibits a high resistance to conventional chemotherapy and a strong tendency for relapse, resulting in a dismal prognosis. The median overall survival is only about seven months, with most patients succumbing to gastrointestinal complications such as perforation, obstruction, or bleeding. In recent years, advances in molecular biology have highlighted the increasingly important role of genetic testing in the diagnosis and treatment of MEITL. This approach not only facilitates the identification of molecular characteristics of the tumor but also supports the development of individualized treatment strategies. To further elucidate the clinical and genetic features of this disease, we conducted a retrospective analysis of 11 MEITL patients treated at our center. Methods: Patients diagnosed with MEITL between July 16, 2023 and December 15, 2024 were enrolled in the analysis. Cut-off date for follow-up was July 24, 2025. Clinical data were collected using the electronic medical record system, including age, sex, disease stage, presenting symptoms, and laboratory findings. Heatmaps were drawn to visualize the results of genetic testing, treatment modalities, and patient outcomes. Survival outcomes between different subtypes were compared using Kaplan-Meier curves. Results: The mean age of the patients was 56.6 years (SD = 12.6), and 9 patients (81.8%) were male. Eight patients (72.7%) were classified as Ann Arbor stage IV and Lugano stage IV. The most frequently involved site was the ileum (n = 6). Most cases expressed CD3 (100%), TIA1 (100%), CD56 (81.8%), and CD7 (72.7%), but were negative for CD30, CD20, CD103, and EBER (all 0%). The most frequently mutated genes were STAT5B (72.7%), SETD2 (63.6%), and JAK3 (45.5%). The median overall survival was 3.0 months (95 % CI 2.0–4.0); Seven patients (63.6%) underwent surgery, and nine (81.8%) received chemotherapy. The complete response (CR) rate was 18.1%. Although the optimal management of MEITL remains unclear, surgery combined with chemotherapy may help improve patient prognosis. Two patients underwent CHOP combined with histone deacetylase (HDAC) or PI3Kδ inhibitors as their frontline regimen, and both of them were survival until follow-up cutoff date. Conclusion: Based on present data, the most frequently mutated pathways in MEITL patients was JAK-STAT pathway. Surgery combined with chemotherapy may prolong their overall survival. And CHOP combined with HDAC or PI3Kδ inhibitors may decrease risk of mortality of them. However, the relationship between patient prognosis and gene mutations in MEITL should be further investigated.

Background:Primary small intestinal lymphoma (PSIL) is a rare malignancy with heterogeneous clinical and pathological features, making accurate diagnosis challenging. Objectives:To investigate the clinical value of double-balloon enteroscopy (DBE) combined with endoscopic ultrasonography (EUS) in the diagnosis of small intestinal lymphoma. Design:Retrospective cohort study. Methods:We retrospectively reviewed 21 patients with pathologically confirmed PSIL who underwent both DBE and EUS at the Department of Small Intestinal Endoscopy, The Sixth Affiliated Hospital of Sun Yat-sen University, between September 2022 and May 2025. Clinical data were collected and analyzed in combination with pathological findings. Results:A total of 21 patients were included (12 males, 9 females; median age of 52 years, range 31-87 years. Subtypes of B-cell lymphomas included diffuse large B-cell lymphoma (n = 5), follicular lymphoma (n = 3), and mucosa-associated lymphoid tissue lymphoma (n = 6). T-cell lymphomas included peripheral T-cell lymphoma (n = 7). Endoscopic findings were classified into five categories (1): hypertrophic type (2), exophytic tumor type (3), follicular/polypoid type (4), ulcerative type, and (5) diffusion type. EUS classification included superficial spreading (38.1%, 8/21), diffuse infiltrative (42.9%, 9/21), and nodular (19.0%, 4/21). Conclusion:DBE combined with EUS provides complementary morphological and structural information for the diagnosis of PSIL, improving clinical recognition and subtype characterization. Future multicenter studies with larger cohorts are warranted to validate these findings and establish standardized diagnostic protocols.

Abstract Background This study investigated hospital mortality rates among patients with nephrotic syndrome (NS) and tuberculosis (TB) using data from the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2) database. The aim was to assess the impact of TB infection on in-hospital mortality risk in NS patients. Methods A total of 2167 NS patients were enrolled, among whom 1079 were co-infected with TB. Potential confounding factors included demographics, vital signs, laboratory values, acute physiology score, clinical treatments, and comorbidities. Univariate logistic regression was conduted to identify in-hospital mortality risk factors and multivariable multifactorial logistic regression was performed to explore the TB’s impact on in-hospital mortality. A restricted cubic spline regression analysis was carried out to investigate the linear relationship between hemoglobin, albumin, and in-hospital mortality. Stratified analyses were conducted for age, gender, sepsis, and acute kidney injury(AKI) stage to determine their effect on mortality of NS co-infected with TB. Results The prevalence of NS co-infected with TB was 49.8%, with a 14.6% in-hospital mortality rate, representing a 44% increased risk (P=0.005). The adjusted multivariable analysis revealed a mortality risk exceeding 20%. Among patients with sepsis, the incidence was 48.3% in those without TB and 46.7% in those co-infected with TB, with a 63% incidence of AKI within 7 days. Sepsis was associated with a 2.54-fold increase in mortality risk, and AKI stage 3 had an odds ratio (OR) of 9.03. Subgroup analyses suggested that both sepsis and AKI were independent risk factors for mortality. Hemoglobin and albumin exhibitedL-shaped linear relationships with in-hospital mortality, acting as protective factors below the inflection point. Only 1.8% received steroid treatments (NS 2.6%, NS and TB 0.9%), and 10.1% underwent continuous renal replacement therapy. Conclusions Our study results revealed significantly increased in-hospital mortality risk among NS patients with concurrent TB infection, alongside numerous complications. Sepsis and AKI independently increase mortality risk in NS patients co-infected with TB. These findings inform disease severity assessment and prognosis determination in adult NS patients with TB co-infection.

Background: In chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) fit patients, exploration of time-limited therapy models such as fixed-duration or minimal residual disease (MRD) guided therapies has shown promising results, highlighting the need for similar investigations in unfit patients. Based on orelabrutinib's selective BTK inhibition with minimal impact on ITK kinase, which preserves obinutuzumab's antibody-dependent cellular cytotoxicity (ADCC) effect, and leveraging obinutuzumab's enhanced ADCC and antibody-dependent cellular phagocytosis (ADCP) capabilities alongside bendamustine's cytotoxicity, we explored a time-limited therapy model combining orelabrutinib, bendamustine, and obinutuzumab (OBG) in unfit CLL/SLL patients. Methods: This multicenter, exploratory study enrolled previously untreated patients with unfit CLL/SLL without del 17p or TP53 mutation. Patients received one cycle of the BG regimen for tumor reduction, followed by five cycles of the OBG regimen, and finally one cycle of orelabrutinib monotherapy (bendamustine: C1 (70 mg/m2, d2, d3), C2-C6 (90 mg/m2, d1, d2); obinutuzumab: C1 (100 mg d1, 900 mg d2, 1000 mg d8, d15); C2-C6 (1000 mg, d1); orelabrutinib: oral 150 mg, once daily, 28-day cycles). The definition of an “unfit patient” is aged 65 years or older, or has a CIRS (Cumulative Illness Rating Scale) score > 6. Primary endpoints include the rate of complete response (CR) combined with undetectable minimal residual disease (uMRD) at the end of 7 cycles (CR/CRi & uMRD, with patients achieving incomplete CR categorized as CRi). Secondary endpoints encompass CR/CRu & uMRD rates at the end of 7 cycles (CRu defined as splenic longest diameter ≤ 16 cm with other criteria meeting CR/CRi standards), uMRD rate (detected via NGS at a level of 10-6)，progression-free survival (PFS), and overall survival (OS). Results: As of July 2024, eight patients have been enrolled. Data showed a 100% CR/CRi & uMRD after 7 cycles, with peripheral blood and bone marrow uMRD rates of 100% and 87.5%, respectively. CR/CRi with uMRD was achieved in 87.5% of cases, indicating potential clinical benefits. Safety analysis revealed thrombocytopenia and neutropenia in seven patients, with adverse events ≥ Grade 3 occurring in 25% of cases, all reversible. No incidences of bleeding or atrial fibrillation were reported. One patient experienced Grade 3 pulmonary infection, now resolved. Conclusion: The OBG regimen demonstrates efficacy as a promising time-limited therapy in unfit CLL/SLL patients, achieving high rates of complete response (CR) combined with undetectable minimal residual disease (uMRD). Safety analysis indicates that the OBG regimen is well-tolerated, with manageable adverse events such as reversible thrombocytopenia and neutropenia observed in a subset of patients. These findings support further investigation of the OBG regimen to optimize treatment outcomes in this patient population.