Abstract:Objective: To explore the diagnostic value of the imaging features of hysterosalpingography (HSG) combined with clinical factors for intrauterine adhesions(IUA), and to evaluate its diagnostic performance in different types of IUA. Methods: A retrospective analysis was conducted on the clinical data of patients with suspected IUA who underwent diagnostic HSG at the Department of Intervention Radiology, Women's Hospital of Nanjing Medical University, between January 2019 and October 2024, and subsequently completed hysteroscopy. This cohort included 282 patients suspected of IUA (including 164 with preoperative three-dimensional ultrasound data). Univariate analysis was conducted to evaluate HSG imaging features, including the number and location of filling defects, tubal occlusion, and uterine cavity morphology, as well as clinical characteristics such as history of intrauterine procedures, abortion count, and menstrual flow reduction, etc. Variables demonstrating statistical significance (P < 0.05) were subsequently included in multivariate ordinal logistic regression analysis to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic and classification value of combined HSG imaging features and clinical factors for IUA. This value was further compared with that of three-dimensional ultrasound. Results: Hysteroscopy confirmed IUA in 251 cases (89.0%), who were further categorized according to the American Fertility Society (AFS) classification system into no IUA (n=31), mild IUA (n=64), moderate IUA (n=129), and severe IUA (n=58). The predictive factors of clinical features including induced abortion and imaging features including uterine filling defect were screened. For the diagnosis of IUA, the area under the receiver operating characteristic curve(AUC) was 0.920, with a sensitivity of 87.3% and a specificity of 80.7%. The AUC values for diagnosing mild IUA and severe IUA were 0.704 and 0.786, respectively, with sensitivities of 46.9% and 77.6%, and specificities of 87.6% and 65.2%. In comparison, three-dimensional ultrasound has shown a sensitivity of 81.4% and a specificity of 68.4% for diagnosing IUA. Conclusion: The combination of HSG imaging features and clinical features through multi-parameter indicators can effectively diagnose IUA and demonstrate good discriminatory efficacy for distinguishing between mild and severe IUA, and serves as a reliable tool for non-invasive screening while providing a basis for clinical stratified management.

Abstract:Objective: To explore the correlation between endometrial thickness in intrauterine insemination (IUI) cycles and clinical pregnancy outcomes. Methods: A retrospective analysis was conducted on 4 764 cycles of intrauterine sperm IUI in the Reproductive Medicine Center of Nanjing Drum Tower Hospital from 2016 to 2022. Based on the different endometrial thicknesses monitored by transvaginal ultrasound on the day of ovulation induction with human chorionic gonadotropin (hCG), the IUI cycles were divided into two groups: the endometrial thickness < 8 mm group (n=395) and the endometrial thickness ≥8 mm group (n=4 369). Differences in clinical pregnancy outcomes between the two groups were analyzed. Furthermore, a propensity score matching method was employed for a secondary analysis to control the influence of confounding variables, and univariate and multivariate Logistic regression analyses were applied to evaluate the effect of endometrial thickness on clinical pregnancy outcomes. Results: There were no statistically significant differences between the two groups in body mass index (BMI), basal follicle-stimulating hormone (FSH), duration of infertility, number of IUI cycles, IUI protocols, number of IUI, or total number of progressive motility (PR) sperm (all P > 0.05). However, there was a statistically significant difference in the type of infertility between the two groups (P < 0.05). Compared with the endometrial thickness < 8 mm group, the group with endometrial thickness ≥ 8 mm had a lower average age for both the female and male patients, and significantly higher levels of anti-Müllerian hormone (AMH) and antral follicle count (AFC) (all P < 0.05). The clinical pregnancy rate and live birth rate in the IUI cycles with endometrial thickness ≥ 8 mm were higher than those in the < 8 mm group (P < 0.05). There was no statistically significant difference in the early spontaneous abortion rate between the two groups (P > 0.05). After propensity score matching, endometrial thickness was found to have a significant effect on the live birth rate of IUI(P < 0.05). Univariate analysis indicated that factors such as female age, male age, female BMI, basal FSH, AMH, AFC, duration of infertility, endometrial thickness, and total number of PR sperm were significantly associated with the clinical outcomes of IUI(all P < 0.05). After adjusting for the significant confounding factors identified in the univariate analysis (except for basal FSH), multivariate logistic regression analysis revealed that endometrial thickness was not significantly associated with clinical pregnancy (OR=1.933, 95%CI: 0.929-4.022, P=0.078) or live birth (OR=1.838, 95%CI: 0.850-3.971, P=0.122). Conclusion: The endometrial thickness during the IUI cycle does not affect the clinical pregnancy outcome. The predictive value of endometrial thickness as a single ultrasound indicator in the IUI population is limited. Clinical decisions should comprehensively consider factors such as age, ovarian function, sperm factors, and uterine cavity factors. The decision on whether to cancel or terminate IUI should not be made solely based on endometrial thickness. However, when it comes to IUI cycles with too low endometrial thickness, clinical decisions still need to be made with caution.

Abstract:Objective: To explore the application value of immunohistochemistry (IHC) combined with Sanger sequencing versus next-generation sequencing (NGS) in the molecular classification of endometrial carcinoma (EC). Methods: Clinical data of 123 patients with EC between October 2019 and June 2023 were retrospectively analyzed. Among them, 48 cases were classified using IHC combined with Sanger sequencing, and 75 cases were classified using NGS technology. The molecular classification results of the two groups were compared. Additionally, 10 representative samples covering the four molecular subtypes, POLE ultramutated(POLEmut), mismatch repair deficiency(dMMR), no specific molecular profile(NSMP), and p53 abnormal(p53abn), with varying clinical stages and histological grades were selected for a comparative analysis of the results obtained from IHC combined with Sanger sequencing and NGS. Results: Among the 123 EC patients, 12(9.7%) were POLEmut, 31(25.2% ) were dMMR, 67(54.5% ) were NSMP, and 13 (10.6%) were p53abn. Of the 48 cases assessed by IHC combined with Sanger sequencing, 1(2.1% ) was POLEmut, 12(25.0%) were dMMR, 29(60.4%) were NSMP, and 6(12.5%) were p53abn. Among the 75 cases assessed by NGS, 11(14.7%) were POLEmut, 19 (25.3%) were dMMR, 38(50.7%) were NSMP, and 7(9.3%) were p53abn. The validation experiment on 10 samples showed that IHC combined with Sanger sequencing and NGS yielded completely consistent results in detecting POLE mutations and microsatellite status. However, IHC had a 10% (1/10) missed detection rate for aberrant p53 expression. Conclusion: IHC combined with Sanger sequencing and NGS show good consistency in the molecular classification of EC. Nevertheless, NGS offers advantages in detecting POLE mutations and complex subtypes, contributing to improved classification accuracy and reduced risk of clinical misjudgment.

Abstract:Objective: To investigate the expression characteristics of protein tyrosine phosphatase non-receptor type 6(PTPN6)in gastric cancer tissues, evaluate its correlation with natural killer (NK) cell infiltration and activation, and further elucidate the regulatory role and molecular mechanisms of PTPN6 in malignant phenotypes such as gastric cancer cell proliferation and that in NK cell cytotoxic activity. Methods: Based on the Asian Cancer Research Group(ACRG)gastric cancer cohort and integrated single-cell data, the expression level of PTPN6 in gastric cancer tissues and its correlation with NK cell infiltration and activation levels were analyzed. CCK-8, EdU, colony formation, and Transwell assays were used to evaluate the effects of silencing or overexpressing PTPN6 on the proliferation, migration, and invasion of MKN1 and AGS cells. Flow cytometry was employed to detect apoptosis levels and NK cell-mediated killing efficiency. qRT-PCR was used to measure the expression levels of human leukocyte antigen-class Ⅰ(HLA-Ⅰ) molecules. Whole-exome sequencing was applied to assess the genomic similarity between gastric cancer organoids and primary tissues, and a co-culture model of gastric cancer organoids and NK cells was used to evaluate NK cell killing efficiency. A PTPN6-overexpressing YTN16 gastric cancer cell line was constructed and subcutaneously inoculated into NCG and C57BL/6 mice, followed by flow cytometric analysis of tumor-infiltrating NK cells. Transcriptome sequencing was performed to identify potential downstream molecules and signaling pathways regulated by PTPN6. Results: PTPN6 expression was significantly upregulated in gastric cancer tissues and negatively correlated with NK cell infiltration and activation levels. Knockdown of PTPN6 inhibited gastric cancer cell proliferation, enhanced NK cell killing sensitivity, and downregulated HLA-I molecule expression. In contrast, PTPN6 overexpression promoted malignant phenotypes of gastric cancer cells, reduced NK cell killing activity, and upregulated HLA-I molecule expression. In vivo mouse xenograft experiments showed that PTPN6 overexpression accelerated tumor growth in C57BL/6 mice and reduced the proportion of NK cell infiltration in tumor tissues. Transcriptome sequencing analysis indicated that PTPN6 overexpression activated signaling pathways such as PI3K/AKT, MYC, and NF-κB. Conclusion: PTPN6 is highly expressed in gastric cancer and promotes tumor cell proliferation and invasion by activating signaling pathways such as PI3K/AKT. Its expression is negatively correlated with NK cell infiltration and activation levels, and it mediates immune escape by regulating HLA-I molecule expression in gastric cancer cells. This study provides a new potential target and theoretical basis for immunotherapy in gastric cancer.

Abstract:Objective: To investigate the role and mechanism of the tRNA-derived fragment AsnGTT-33 (tRF-AsnGTT-33) in podocyte injury within a murine model of adriamycin(ADR)-induced nephropathy. Methods: An ADR nephropathy mouse model was established via a single tail vein injection of ADR(10 mg/kg). tRF-AsnGTT-33 adeno-associated virus(AAV)(0.5 mL per mouse)was administered via tail vein to achieve in vivo overexpression. Renal function was assessed by measuring serum creatinine (Scr) levels using the sarcosine oxidase method and blood urea nitrogen (BUN) levels using the urease method. Renal pathological injury was evaluated by hematoxylin and eosin staining(HE) and periodic acid-schiff staining(PAS) to observe glomerular and tubular damage. The mRNA and protein expression levels of the podocyte markers nephrin and podocin were analyzed by quantitative PCR(qPCR)and Western blot, respectively. In vitro, podocyte injury was induced by 1 mg/L ADR. Following transfection with a tRF-AsnGTT-33 mimic, the expression levels of nephrin and podocin were detected by qPCR and Western blot. The miRDB database was used to predict Ras-related protein RAB21 as a potential target gene. The effect of tRF-AsnGTT-33 overexpression on RAB21 expression was subsequently examined in both cultured podocytes and mouse renal tissues. Results: Renal tissues from ADR nephropathy mice exhibited significantly downregulated tRF-AsnGTT-33 expression,accompanied by markedly elevated Scr and BUN levels, reduced expression of nephrin and podocin, and aggravated renal pathological injury, including thickening of the glomerular basement membrane, intratubular protein casts, and interstitial fibrosis. Overexpression of tRF-AsnGTT-33 significantly lowered Scr and BUN levels, alleviated pathological damage, and upregulated the expression of nephrin and podocin. In ADR-induced podocytes, tRF-AsnGTT-33 expression was decreased, along with reduced nephrin and podocin expression; these effects were reversed by tRF-AsnGTT-33 overexpression. Furthermore, tRF-AsnGTT-33 overexpression led to a significant downregulation of RAB21 expression in both podocytes and mouse renal tissues. Conclusion: tRF-AsnGTT-33 may alleviate ADR-induced podocyte injury by targeting RAB21, providing a theoretical foundation for identifying novel therapeutic targets for chronic kidney disease.

Abstract:Objective: To investigate the clinical and pulmonary function characteristics, risk of acute exacerbation, and associated correlations in moderate-to-severe stable chronic obstructive pulmonary disease (COPD) patients with inspiratory plateau on the flow-volume (F-V) curve. Methods: A total of 109 patients with moderate-to-severe stable COPD [forced expiratory volume in the first second as a percentage of predicted value (FEV₁% pred) <60% and forced vital capacity (FVC) ≥ lower limit of normal] who underwent pulmonary function tests at the First Affiliated Hospital of Nanjing Medical University from January 2022 to July 2024 were enrolled. Patients were divided into inspiratory plateau group(n=53) and non-inspiratory plateau group matched for FEV₁%pred(n=56) based on the presence or absence of inspiratory plateau. Demographic data, types of inhaled medications, acute exacerbation, chest CT findings, pulmonary function parameters, and clinical comorbidities were collected and compared between the two groups. Multivariate logistic regression identified factors associated with the F-V curve inspiratory plateau. A diagnostic model for identifying the inspiratory plateau in patients with moderate-to-severe stable COPD was constructed and calibrated using the Hosmer-Lemeshow test, and evaluated using the area under the receiver operating characteristic curve(AUC). Chi-square test was used to preliminarily explore the association between inspiratory plateau and various comorbidities in patients with moderate-to-severe stable COPD. Results: ①The difference in the proportion of pulmonary function stages between the two groups was not statistically significant (P > 0.05). ②The inspiratory plateau group exhibited significantly lower values for peak expiratory flow as a percentage of predicted value, peak inspiratory flow(PIF), total lung capacity as a percentage of predicted value, and alveolar volume as a percentage of predicted value, but significantly higher values for the ratios of peak expiratory flow (PEF) to PIF(PEF/PIF), the ratios of forced expiratory volume in the first second(FEV₁) to PEF(FEV₁/PEF), resistance at 5 Hz(R₅) as a percentage of predicted value, resistance at 20 Hz(R₂₀) as a percentage of predicted value, the difference between R₅ and R₂₀(R₅-R₂₀), and resistance of central airway(Rcentral) compared to the non-inspiratory plateau group(P < 0.05). ③No statistically significant difference was found in the rate of acute exacerbation between groups(P > 0.05), although the inspiratory plateau group exhibited a higher acute exacerbation rate and slightly higher hospitalization rate. ④A diagnostic model was constructed using PIF, PEF/PIF, FEV₁/PEF and Rcentral. The optimal thresholds for the influencing factors within this model were PIF≤3.91 L/s, PEF/PIF≥0.830, FEV₁/PEF≥0.369 s and Rcentral≥1.905 cmH₂O/(L·s). This model demonstrated strong discriminatory power with an AUC of 0.945. The Hosmer-Lemeshow goodness-of-fit test yielded a P-value of 0.957, indicating good model calibration. ⑤Compared with the non-inspiratory plateau group, the inspiratory plateau group had higher prevalences of upper airway stenosis and central pulmonary malignancy, and the differences were statistically significant (P < 0.05). Conclusion: Moderate-to-severe stable COPD patients with inspiratory plateau in the F-V curve frequently exhibit increased overall airway resistance, suggesting potential upper airway and surrounding disorders. Therefore, the presence of an inspiratory plateau should be carefully evaluated in pulmonary function reports of moderate-to-severe stable COPD. A multi-parameter model incorporating PIF, PEF/PIF, FEV₁/PEF, and Rcentral may be utilized for identification, facilitating early detection of comorbidities in COPD patients.

Abstract:Objective: To evaluate and compare the predictive values of preoperative neutrophil to lymphocyte ratio (NLR), postoperative NLR, postoperative/preoperative NLR ratio, preoperative systemic inflammatory response index (SIRI), postoperative SIRI, and postoperative/preoperative SIRI ratio for post-endoscopic retrograde cholangiopancreatography (ERCP)pancreatitis (PEP)in patients with choledocholithiasis. Method: Clinical data including preoperative and postoperative blood routine results, intraoperative ERCP conditions, basic information and medical history of 549 patients with choledocholithiasis undergoing ERCP were collected. The patients were divided into the PEP group(n=43)and the non-PEP group(n=506). The levels of NLR and SIRI before and after ERCP were compared between the two groups, the postoperative to preoperative ratios of NLR and SIRI were calculated, the differences in levels of these indicators between the two groups were compared, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of each indicator for PEP. Results: Significant differences were observed between the PEP group and the non-PEP group in preoperative NLR, postoperative NLR, preoperative SIRI, postoperative SIRI, postoperative/preoperative NLR ratio and postoperative/preoperative SIRI ratio(all P < 0.05). The areas under the ROC curve(AUC)of postoperative/preoperative NLR ratio and postoperative/preoperative SIRI ratio were both above 0.800, and the postoperative/preoperative SIRI ratio had a higher sensitivity of 95.3% and specificity of 70.2% than other indicators. Conclusions: The postoperative/preoperative NLR ratio and postoperative/preoperative SIRI ratio have reference value for predicting PEP in choledocholithiasis patients undergoing ERCP.

Abstract:Objective: To evaluate the prognosis of patients with combined non-esophagogastric variceal spontaneous portosystemic shunt(SPSS) undergoing transjugular intrahepatic portosystemic shunt(TIPS) combined with embolization. Methods: We performed a retrospective analysis of 603 cirrhotic patients who underwent TIPS at the First Affiliated Hospital of Nanjing Medical University between January 2018 and June 2024. After applying inclusion and exclusion criteria, patients were divided into two groups: the SPSS group (n=141) and the non-esophagogastric variceal SPSS group (Non-EGV-SPSS group, n=58). Baseline data, preoperative and postoperative portal vein pressure, intraoperative parameters, and postoperative outcomes(such as upper gastrointestinal rebleeding, stent dysfunction, hepatic encephalopathy, and survival prognosis) were collected and analyzed, Logistic regression analysis was employed to determine independent predictors of adverse prognosis. Results: During follow-up, 64 patients(32.2%) developed overt hepatic encephalopathy. Rebleeding occurred in 42 cases (21.2%) of patients, among which 7 cases received endoscopic treatment, 19 cases received interventional treatment, and 16 cases received medical treatment. Sixty-two cases(31.2%) died, among which 10 died of gastrointestinal rebleeding. The rebleeding risk of both groups was significantly associated with the reduction of portal pressure gradient(P=0.021). The Non-EGV-SPSS group exhibited a significantly higher rebleeding risk compared with the SPSS group(36.2% vs. 14.9%,P=0.001). In contrast, no statistically significant differences were noted in mortality(36.2% vs. 29.1%,P=0.400) or hepatic encephalopathy incidence(37.9% vs. 29.8%,P=0.317) between the two groups. Age(HR=1.049,95%CI:1.020~1.079,P=0.001) and serum creatinine(HR=1.012,95%CI:1.002~1.023,P=0.017) were independent risk factors for post-operative hepatic encephalopathy. Pre-operative Non-EGV-SPSS was an independent risk factor for post-operative rebleeding; Age(HR=1.025,95%CI:1.002~1.047,P=0.030) and serum total bilirubin level(HR=1.002,95%CI:1.000~1.005,P=0.012) were independent risk factors for post-operative mortality. Conclusion: In cirrhotic patients undergoing TIPS, preoperative non-esophagogastric variceal SPSS is associated with an increased postoperative rebleeding risk, which correlates with changes in portal vein pressure. However, non-esophagogastric variceal SPSS does not significantly impact postoperative mortality or the incidence of hepatic encephalopathy.

Abstract:Objective: To quantitatively evaluate the degree of renal cortical fat infiltration in patients with type 2 diabetes mellitus (T2DM) using magnetic resonance iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification (IDEAL-IQ) technology, analyze its quantitative correlation with different grades of insulin resistance (IR), and explore the mediating effect of renal tubular injury between them. Methods: A total of 124 patients diagnosed with T2DM from July 2022 to October 2025 were prospectively enrolled. According to the homeostasis model assessment of insulin resistance (HOMA-IR), the patients were divided into the mild IR group (HOMA-IR 2.5-5.0, n=42), moderate IR group (HOMA-IR 5.1~10.0, n=40) and severe IR group (HOMA-IR>10.0, n=42). All subjects underwent renal 3.0T MRI-IDEAL-IQ examination to quantitatively measure the renal cortical fat fraction (FF). Glycometabolic indicators including fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), renal function indicators including serum creatinine (Scr) and estimated glomerular filtration rate (eGFR), and renal tubular injury markers including urine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and urine albumin/creatinine ratio (UACR) were detected, and HOMA-IR was calculated. The differences in renal cortical FF, renal tubular injury markers and renal function indicators among different IR grade groups were compared. Pearson correlation analysis was used to explore the correlation between renal cortical FF and various indicators. Multiple linear regression analysis was performed to verify the independent effect of IR on renal cortical FF. Mediation effect analysis was adopted to investigate the mediating role of renal tubular injury between IR and renal cortical fat infiltration. Results: With the aggravation of IR grading, renal cortical FF, NGAL, KIM-1, UACR and Scr in patients showed a gradual increasing trend, while eGFR showed a gradual decreasing trend, with statistically significant differences among all grade groups (P < 0.05). Pearson correlation analysis revealed that renal cortical FF was highly positively correlated with HOMA-IR, KIM-1, UACR, and the comprehensive score of renal tubular injury (r=0.834, P<0.001; r=0.810, P < 0.001; r=0.834, P < 0.001; r=0.831, P < 0.001), moderately positively correlated with NGAL, Scr, and BUN (r=0.673-0.772, all P < 0.001), and highly negatively correlated with eGFR (r=-0.817, P < 0.001). Multiple linear regression analysis indicated that after adjusting for age, gender, body mass index (BMI), and HbA1c, HOMA-IR was still an independent risk factor for the increase of renal cortical FF in T2DM patients (β=0.419, P < 0.001). Mediation effect analysis showed that renal tubular injury (comprehensive score of NGAL+KIM-1+UACR) had a partial mediation effect between IR and cortical fat infiltration, accounting for 45.98% of the total effect. Conclusion: The degree of renal cortical fat infiltration in T2DM patients has a significant dose-effect relationship with IR grade. IR directly promotes renal cortical fat deposition, and also indirectly mediates the occurrence and development of renal cortical fat infiltration by inducing renal tubular injury. Renal cortical FF quantitatively detected by IDEAL-IQ technology can be used as a non-invasive imaging indicator to reflect the degree of IR and early renal tubular injury in T2DM patients, providing a new perspective for the early assessment of diabetic renal complications.

Abstract:Objective: To investigate the expression of tumor-associated macrophages(TAMs) in early gastric carcinoma(EGC) and their clinicopathological significance. Methods: A retrospective analysis was conducted on 109 patients with EGC who underwent radical gastrectomy at the Second People's Hospital of Changzhou between January 2006 and December 2022. Expression of CD68 and CD163 was assessed by immunohistochemistry in tumor regions and paired adjacent non-tumor mucosa. Macrophage expression was compared between tumor and non-tumor regions, and the associations between TAMs and clinicopathological characteristics were further analyzed. The CD163/CD68 ratio was dichotomized using a receiver operating characteristic(ROC) derived cut-off value and included in logistic regression analyses to identify risk factors for lymph node metastasis(LNM) in EGC. ROC analysis was further performed to evaluate the discriminatory ability of the endoscopic curability assessment(eCura) system, both alone and in combination with the CD163/CD68 ratio, for predicting LNM, and the DeLong test was used to compare the area under the curve(AUC). Overall survival was analyzed using the Kaplan-Meier method. Results: Compared with paired adjacent non-tumor mucosa, CD163 and CD68 scores were significantly higher in tumor regions(CD163: 10% vs. 5%; CD68: 35% vs. 10%; P < 0.001 for both), whereas the CD163/CD68 ratio was significantly lower(0.33 vs. 0.50, P < 0.001). A high CD163/CD68 ratio was significantly associated with poor tumor differentiation, submucosal invasion, and LNM(P < 0.05). Multivariate logistic regression identified the CD163/CD68 ratio as an independent risk factor for LNM in EGC(P < 0.05). The discriminatory ability for LNM was significantly improved when the eCura system was combined with the CD163/CD68 ratio(AUC=0.774) compared with the eCura system alone(AUC=0.706, P=0.023). No significant association was observed between TAMs(CD163 and CD68 scores, CD163/CD68 ratio) and 5-year overall survival in patients with EGC. Conclusion: Tumor-associated macrophages may participate in the tumorigenesis of EGC. The CD163/CD68 ratio is closely associated with LNM in EGC and may serve as an indicator of the tumor immune microenvironment. When combined with the eCura system, the CD163/CD68 ratio provides additional information for risk stratification of LNM in EGC.

Abstract:Objective: To evaluate the efficacy of acyclovir in treating infectious mononucleosis (IM) among children of different age groups using propensity score matching (PSM) method. Methods: This retrospective cohort study included hospitalized children diagnosed with IM at the Children's Hospital of Nanjing Medical University between January 2018 and December 2023. Patients were categorized into three age groups according to the age: the infancy and early childhood group(<3 years), preschool group(4-6 years), and school-age group(7-13 years). According to whether acyclovir was administered, patients were divided into an antiviral group and a control group. After balancing baseline confounding factors by the PSM method, the differences in prognostic indicators between the two groups were compared. Results: A total of 733 children with IM were enrolled, with a mean age of(4.78 ± 0.51)years old. The most common manifestations included cervical lymphadenopathy (96.0%), fever(86.6%), hepatomegaly(75.6%), splenomegaly(72.6%), pharyngitis(68.9%), and eyelid edema(57.4%). Before PSM, there were statistically significant differences in fever, pharyngitis, hepatosplenomegaly, white blood cell count, proportion of atypical lymphocytes, CD4⁺/CD8⁺ ratio and plasma EBV-DNA load among children of different age groups(all P < 0.05). After PSM, 46 pairs in the infancy and early childhood group, 58 pairs in the preschool group and 30 pairs in the school-age group were successfully matched(all P > 0.05). Compared with the control group, the antiviral group in the infant infancy and early childhood group had longer time required for the resolution of pharyngitis, the reduction of white blood cell count to <10×10⁹/L, but shorter time required for the decrease of plasma EBV-DNA load to < 500 copies/mL(all P < 0.05); the antiviral group in the preschool group had longer time required for temperature recovery and pharyngitis resolution, but shorter time required for the reduction of serum alanine transaminase(ALT)to < 40 U/L and plasma EBV-DNA load to < 500 copies/mL(all P < 0.05); the antiviral group in the school-age group had longer hospital stay and time required for temperature recovery(all P < 0.05). At 30 days after treatment, there was no statistically significant difference in the recovery of splenomegaly among all age groups between the two groups. Conclusion: Acyclovir therapy may accelerate viral clearance and promote liver function recovery in infants and preschool children with IM, but it does not significantly improve clinical symptoms or overall disease course. Its clinical benefit appears to be age-dependent.

Abstract:Given the close association between amino acid metabolism disorders and the occurrence and progression of coronary heart disease (CHD), this article aims to systematically summarize the correlations, mechanisms of action, and clinical application prospects of relevant amino acid metabolic abnormalities with CHD. A systematic review approach was adopted to analyze the role of metabolic abnormalities of homocysteine, branched-chain amino acids, aromatic amino acids, and other amino acids in CHD-related pathological processes. Meanwhile, the potential impacts of amino acid metabolites and gut microbiota on CHD were explored. Multiple amino acid metabolic abnormalities were confirmed to be associated with CHD risk, which influence disease progression by participating in pathological processes such as atherosclerosis, thrombosis, and endothelial dysfunction. Amino acid metabolism indicators have shown promising clinical application potential in CHD risk prediction, auxiliary diagnosis, and therapeutic intervention. Despite existing contradictions and limitations in current research, amino acid metabolism disorders, as a new target for CHD prevention and treatment, hold clinical value and research potential, providing a new direction for cardiovascular disease research.

Abstract:Selenium is an essential trace nutrient for the human body, playing a crucial role in maintaining redox homeostasis, immune function, and cellular homeostasis. With the rapid development and interdisciplinary convergence of nutritional epidemiology, tumor biology, and bioinorganic chemistry, the potential role of selenium in tumorigenesis, progression, and prognosis has garnered increasing attention. Extensive epidemiological, animal experimental, and clinical intervention studies indicate that selenium metabolic homeostasis or dietary intake levels are closely associated with the risk of developing various cancers, disease progression, and patient prognosis. However, results vary across different populations, tumor types, and study designs, exhibiting dose-dependent effects, tumor specificity, and individual heterogeneity. This systematic review summarizes recent epidemiological and clinical research progress on selenium and common tumors, and summarizes the relationship between selenium exposure levels and tumor incidence risk and prognosis in different tumor types. It aims to provide theoretical reference for the scientific application of selenium in tumor prevention and treatment, and to provide theoretical basis for future large-scale population and clinical intervention studies.

Abstract:Leptomeningeal metastasis (LM) is a rare yet devastating complication of solid tumors, frequently occurring in patients with lung cancer, breast cancer, or malignant melanoma, with an incidence of approximately 1%-5%. Diagnosis remains difficult, prognosis is poor, and no standardized treatment currently exists. Intrathecal administration, as a therapeutic approach, enables the direct delivery of drugs into the subarachnoid space, thereby increasing local drug concentrations. Conventional intrathecal chemotherapeutic agents primarily include methotrexate, cytarabine, and thiotepa. In recent years, with advances in drug development, a variety of novel chemotherapeutics, targeted agents, and immune checkpoint inhibitors have gradually been introduced into intrathecal therapy. Furthermore, in-depth investigation into the pathogenesis of LM, along with the development of diagnostic techniques such as detection of circulating tumor cells and circulating tumor DNA in cerebrospinal fluid is offering new opportunities for LM diagnosis and therapeutic strategies. This review provides a comprehensive summary of the current diagnostic approaches and research progress in intrathecal treatment for LM.

Abstract:Recurrence following colorectal cancer(CRC)surgery poses a major challenge to long-term patient survival. Early and accurate prediction of recurrence is essential for formulating individualized adjuvant treatment strategies. Circulating tumor DNA (ctDNA) and systemic inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), serve as two important types of biomarkers, providing prognostic information from the perspectives of tumor molecular residual disease and host immune-inflammatory responses, respectively. However, the application of either marker alone has certain limitations. This article focuses on exploring the biological synergistic mechanisms and clinical predictive value of their combined application. ctDNA can directly reflect minimal residual disease, with its warning window typically occurring several months earlier than radiographic recurrence. Systemic inflammatory markers, on the other hand, reflect the state of the tumor-associated immune microenvironment. The two are closely related in the pathophysiological process of "inflammation promoting the release and persistence of ctDNA". Currently, although prospective evidence on their combined use is still accumulating, theoretical models and preliminary studies in other cancer types suggest that combined detection may enable more refined stratification of recurrence risk, thereby guiding individualized clinical decisions, including intensified adjuvant therapy and anti-inflammatory interventions. At present, this combined strategy still faces challenges such as high detection costs, insufficient standardization, and complexity in result interpretation. In the future, rigorous prospective cohort studies should be conducted, integrating multi-omics data and artificial intelligence analysis to construct and validate multimodal prediction models that incorporate ctDNA and inflammatory markers, thereby advancing the precision management of postoperative recurrence in CRC.

Abstract:Respiratory syncytial virus (RSV) poses a serious threat to the health of infants, young children, and the elderly, and there are currently no specific antiviral drugs or ideal vaccines available. The virus is divided into two subtypes, A and B, which differ antigenically and exhibit periodic epidemic patterns. The prefusion (pre-F) protein is a key target for vaccine development, and the level of antibodies it induces is closely related to immune protection. Children generally exhibit higher antibody levels, whereas infants and the elderly tend to have lower levels. Coronavirus disease 2019 (COVID-19) prevention and control measures have altered the epidemiological pattern of RSV, leading to a widespread decline in population antibody levels. However, the overall distribution of antibodies in the post-pandemic era remains unclear. Neutralizing antibodies serve as an important indicator for evaluating protective efficacy, but current detection methods still face limitations in terms of throughput, standardization, and accuracy. Most current research focuses on antibody responses following vaccination, which have been shown to exhibit subtype cross-reactivity and dynamic changes. However, understanding of the patterns of neutralizing antibody changes after natural infection remains limited. Additionally, there is insufficient research on the factors influencing antibody levels and their short-term dynamics before and after epidemic seasons. This review summarizes recent advances in immune research on the RSV pre-F protein, characteristics of population antibody levels and their influencing factors, and evaluation of neutralizing antibody detection methods. It also discusses the impact of the COVID-19 pandemic on RSV epidemic patterns and population immunity, as well as current challenges related to antibody persistence, detection standardization, and all-age serological studies.

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