[Objective] To explore the risk factors of postoperative fever in primary aldosteronism (PA) patients. [Methods] Clinical data of 116 PA patients undergoing adrenalectomy in Peking University People's Hospital during Jan.2018 and Jul.2021 were retrospectively analyzed.Based on postoperative body temperature, the patients were divided into fever group (body temperature ≥38.0 ℃, n=41) and non-fever group (body temperature <38.0 ℃, n=75). Clinical features were analyzed between the two groups.The fever group was subdivided into low fever group (38.0 ℃≤body temperature <38.5 ℃, n=19) and high fever group (body temperature ≥38.5 ℃, n=22). The clinical data of the subgroups were compared. [Results] The incidence of postoperative fever was 35.3%.Logistic regression analysis showed that lower lowest potassium on records (OR=0.419, 95%CI: 0.196-0.894, P=0.025), lower high-density lipoprotein cholesterol (HDL-C) (OR=0.112, 95%CI: 0.018-0.687, P=0.018), and postoperative adrenal insufficiency (OR=4.158, 95%CI: 1.731-9.989, P=0.001) were independent risk factors for postoperative fever.There was no difference between the high and low fever groups.After surgery, infection occurred in 1 patient, adrenal insufficiency in 40 (34.5%) patients, but long-term follow-up indicated that no patients needed lifelong glucocorticoid replacement. [Conclusion] Fever is a common postoperative complication in PA patients, most likely due to transient adrenal insufficiency.Glucocorticoid supplementation should be administered appropriately and timely based on laboratory tests and clinical manifestations.Evaluation of adrenal function is highly recommended for patients undergoing adrenalectomy.

ObjectiveTo explore the correlation between general anesthesia and mild cognitive impairment in older adults so as to provide new ideas for early prevention and timely intervention of mild cognitive impairment（MCI）. MethodsBased on the baseline survey of the Hubei memory and aging cohort study（2018-2023）， the participants completed a thorough neuropsychological assessment and physical examination， and self-reported a history of general anesthesia and surgery. The association of general anesthesia and MCI in the elderly was analyzed using the logistic regression model. In addition， the stratification and interaction analysis of anesthesia history， anesthesia number and physical intellectual exercise were conducted separately. ResultsA total of 5 069 older adults aged 65 and above were included in this study， including 3 692 city dwellers and 1 377 rural people， among whom were 2 584 women （51%）. Out of the 1 472 participants with history of general anesthesia， 249 people （17.4%） had MCI. After controlling for confounding factors， there was a 39.6% increased risk of MCI in older adults who underwent general anesthesia ［OR=1.396，95%CI（1.169，1.668），P<0.001］， suggesting that general anesthesia may be an independent influence on MCI. For the older adults who had one general anesthesia ［OR=1.235，95%CI（1.001，1.523），P=0.049］， two general anesthesia ［OR=1.779，95%CI （1.292，2.450），P<0.001］， and three OR more general anesthesia ［OR=2.395，95%CI （1.589，3.610），P<0.001］， their risks of MCI were increased by 23.5%， 77.9%， and 139.5%， respectively. Compared with the older adults without a history of general anesthesia who did not exercise， the risk of developing MCI was significantly negatively correlated with the exercise group， cognitive exercise group， and combined exercise and cognitive exercise groups （all P<0.001）. The risk of developing MCI in the exercise group was 60.2% of that in the no exercise group ［OR = 0.602， 95% CI（0.456， 0.795）］， the risk in the cognitive exercise group was 42.4% of that in the no exercise group ［OR = 0.424， 95% CI（0.294， 0.613）］， and the risk in the combined exercise and cognitive exercise group was 27.0% of that in the no exercise group ［OR = 0.270， 95% CI （0.208， 0.353）］. In the older adults with a history of general anesthesia， compared with the no exercise group， the risk of developing MCI was significantly negatively correlated with the cognitive exercise group and the combined exercise and cognitive exercise group （all P < 0.05）. The risk of developing MCI in the cognitive exercise group was 47.7% of that in the no exercise group ［OR=0.477， 95% CI （0.256，0.892）］， the risk in the combined exercise and cognitive exercise group was 34.5% of that in the no exercise group ［OR=0.345， 95% CI （0.220， 0.540）］， while the risk in the exercise-only group did not show a significant difference. ConclusionThe risk of MCI increased significantly in older adults with a history of general anesthesia， and this risk increased with the times of anesthesia. Physical and mental exercise reduces the risk of MCI. it is recommended that older adults with a history of anesthesia incorporate physical and mental exercise into their daily lives to prevent mild cognitive impairment.

Background Injury poses a serious threat to human health. As global warming continues to intensify, there is an urgent need to explore the impact of temperature changes on injury deaths. However limited research has focused on this issue. Objective To investigate the relationship between daily mean temperature change (Tm) and injury death, as well as to estimate the associated future death burden in Hunan Province. Methods We employed an individual-level, time-stratified case-crossing design to establish a conditional logistic regression model to analyze the exposure-response relationship between daily mean temperature change and injury death in Hunan Province from 2013 to 2018. Consequently, we conducted subgroup analysis of gender, age group, and injury type. Finally, we estimated the excess burden of injury death attributable to temperature changes under a sustainable development path [low emission scenario (SSP1-2.6)], regional competition path [high emission scenario (SSP3-7.0)], or fossil fuel development path [very high emission scenario (SSP5-8.5)]. Results The study collected 155577 injury deaths in Hunan Province. The results indicated that for each 1 ℃ increment in daily mean temperature, the cumulative excess risk (CER) of injury mortality among Hunan residents increased by 0.71% (95%CI: 0.53%, 0.90%). Notably, the CER for intentional injuries (1.06%, 95%CI: 0.51%, 1.61%) was higher than that for unintentional injuries (0.66%, 95%CI: 0.46%, 0.87%). Warmer temperatures were positively associated with CER of mortality due to drowning, falls, transport injuries, assaults, and suicides, while they were negatively associated with mortality due to poisoning. Compared with 2010–2019, for 2090–2099, the excess mortality rate (EMR) due to ambient temperature increase in Hunan Province under the SSP5-8.5 scenario (14.62/100000, 95%CI: 10.81/100000, 18.40/100000) would be higher than that of the SSP3-7.0 scenario (10.28/100000, 95%CI: 7.58/100000, 12.97/100000) and the SSP1-2.6 scenario (3.35/100000, 95%CI: 2.46/100000, 4.23/100000); the EMR would be around 2.5 times among men (20.64/100000, 95%CI: 14.44/100000, 26.8/100000) than that among women (8.33/100000, 95%CI: 3.98/100000, 12.6/100000). Among unintentional injuries, the leading contributors to EMR would be drowning (4.46/100000), falls (3.96/100000), and transport injuries (2.96/100000). And among intentional injuries, the EMR for suicide (2.08/100000) would be higher than that for assault (0.47/100000). Conclusion Climate warming will increase the total burden of injury-related deaths among residents in Hunan Province, especially in the absence of effective mitigation strategies and measures. It is necessary to strengthen the prevention and control of severe injuries closely related to temperature changes, such as drowning, falls, traffic, and suicides injuries, in order to reduce injury deaths associated with climate change.

OBJECTIVES: To analyze the distribution of Y chromosome azoospermia factor (AZF) microdeletions and their association with testicular development in male pediatric patients with congenital reproductive system disorders, including hypospadias, cryptorchidism, and disorders of sex development (DSD). METHODS: A prospective cohort study was conducted on pediatric patients admitted to the Department of Urology of Shanghai Children's Hospital from November 2021 to December 2023. The observation group included boys with hypospadias, cryptorchidism, or DSD, while the control group comprised boys with phimosis, indirect inguinal hernia, or hydrocele. Blood samples were collected for AZF microdeletion analysis using multiplex PCR to detect 15 sequence-tagged sites. Testicular ultrasound was performed to record testicular position and volume. Propensity score matching (PSM) was used to balance the groups. After matching, testicular volume differences were assessed. Stratified analyses compared testicular volume among children with AZF microdeletions, the control group, and children without micro-deletions in observation group. RESULTS: A total of 493 children were enrolled (observation group: 463; control group: 30). No Y chromosome microdeletions were detected in the control group. Four boys in the observation group had AZF microdeletions: one with cryptorchidism (AZFc+AZFd), one with isolated hypospadias (AZFc), and two with DSD (one with AZFb+AZFc+AZFd and one with AZFa). Ultrasonography measured 888 testicles. After PSM, testicular volume was significantly smaller in the observation group than in the control group (P<0.01). Stratified analysis revealed that among children under 9 years, those with AZF microdeletions tended to be older but had smaller testicular volumes compared to the control group and those without microdeletions in the observation group, although differences were not statistically significant (all P>0.05). Among children over 9 years, ages were comparable, but children with AZF microdeletions had smaller testicular volumes than the other two groups (statistical analysis was not performed due to small sample size). CONCLUSIONS The prevalence of Y chromosome microdeletions is higher in male children with congenital reproductive system disorders compared to the general population, particularly in those with DSD. Hypospadias, cryptorchidism, DSD, and AZF microdeletions may be associated with delayed testicular development in these children.

Objective:To investigate the value of using ultrasound excited contrast agents to assess extracorporeal hydrostatic pressure on the basis of ultrasound contrast imaging.Methods:An extracorporeal hydrostatic pressure evaluation system was established. The changes in contrast intensity was first evaluated for the same concentration of microbubble contrast agent at ambient pressures of 20, 25, 30, 35, 40, and 45 cmH 2O. Contrast agents with the same initial intensity were placed at different pressures for 1 s, 3 s, and 5 s, and the percentage change in contrast agent intensity was analyzed to select the optimal excitation time. Finally, the contrast agent at different pressures was stimulated using an acoustic excitation device, and correlation analysis was performed using the Pearson product moment correlation coefficient. Linear regression analysis was used to establish the relationship between different pressures and the percentage change in intensity. Results:When the ambient pressure was varied under 6 gradients of 20, 25, 30, 35, 40, and 45 cmH 2O, the contrast strength decreased with the pressure increased, and there was a negative correlation between contrast strength and the pressure ( r=-0.971, P<0.001). Under different pressures, the contrast agent intensity showed different degrees of natural decrease in 1 s, 3 s, and 5 s. The difference in the percentage change in contrast agent intensity in each pressure gradient was not statistically significant in 1 s ( P>0.05), whereas the differences in the percentage change in contrast agent intensity in 3 s and 5 s were statistically significant in each pressure gradient (all P<0.05). After microbubble contrast agent was stimulated by ultrasound excitation for 1s, the percentage change in contrast agent intensity was significantly correlated with ambient pressure ( r=-0.976, P<0.001). A linear regression model was fitted with the percentage change in contrast agent intensity after 1 s of stimulation as the independent variable and the pressure as the dependent variable, with the model equation: y=60.075-2.559×x1, where x1 is the percentage change in contrast agent ( R2=0.952, P<0.001). Conclusions:The percentage change in contrast intensity after 1 s of ultrasound excitation of microbubble contrast agent is a favorable predictor of hydrostatic pressure at 6 pressure gradients of 20, 25, 30, 35, 40, and 45 cmH 2O, which may provide a new method for noninvasive monitoring of portal vein pressure for clinicans.

Background and purpose:Gastric-type endocervical adenocarcinoma(G-EAC)is a rare variant of endocervical adenocarcinoma,characterized by atypical clinical manifestations and elusive lesions.Due to these factors,G-EAC is prone to being missed or misdiagnosed,significantly impacting the prognosis.Lobular endocervical glandular hyperplasia(LEGH)and atypical LEGH(aLEGH)are considered to be precancerous lesions of G-EAC.These conditions also present overlapping clinical,pathologic and imaging manifestations,making it challenging to differentiate between them preoperatively.The purpose of this study was to investigate the correlation between magnetic resonance imaging(MRI)findings of cystic-solid lesions in the cervix and their underlying pathology in order to enhance the accuracy of distinguishing between LEGH and G-EAC,ultimately aiding in the early diagnosis and appropriate management of these conditions.Methods:Clinical,imaging and pathological data of 37 LEGH and 53 G-EAC patients who attended the Obstetrics and Gynecology Hospital of Fudan University from July 2016 to August 2023 were collected.Analysis was conducted using Pearson Chi-square χ2,Fisher's exact tests and so on.Multivariate analyses were performed using logistic regression.Receiver operating characteristic(ROC)curves were used for performance evaluation.Results:In this study,differences in age,symptoms,extent,size,composition,degree of enhancement,cervical stromal ring,endometrium invasion,pelvic lymph nodes enlargement,and hydrohystera were statistically significant between the two groups(P＜0.05).In the LEGH and aLEGH groups,lesions were primarily localized to the epithelial layer of the endocervical canal.These lesions were predominantly simple cystic(32/37),and the cystic walls often displayed significant enhancement(31/37).In contrast,the G-EAC group presented with lesions involving the myometrium of the uterine cervix(42/53).These lesions were characterized by a solid component in the majority of cases(52/53),a tendency for the disappearance of the cervical stromal ring(46/53).Logistic regression analysis revealed that among the MRI features,lesion composition(OR=50.064)and incomplete cervical stromal ring(OR=40.180)were significant predictors for G-EAC.ROC analysis,incorporating lesion size,composition,enhancement degree,cervical stromal ring,and endometrial involvement,yielded an area under curve(AUC)of 0.970(95%CI:0.931-1.008).Conclusion:Combining multiple MRI features of cystic-solid lesions in the cervix aids in distinguishing between LEGH and G-EAC.

Objective·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea(OSA)published worldwide.Methods·The guidelines of OSA were retrieved in PubMed,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,SinoMed,MedSci,The Cochrane Library,and the websites such as Medlive,U.S.Preventive Services Task Force(USPSTF),National Institute for Health and Care Excellence(NICE),New Zealand Guidelines Group(NZGG),Scottish Intercollegiate Guidelines Network(SIGN),and Guidelines International Network(GIN)from establishment to December 2022.Two reviewers screened the literature and extracted the main information independently,using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)and Reporting Items for Practice Guidelines in Healthcare(RIGHT)to evaluate the quality of the included OSA guidelines.Subgroup analysis was performed according to the publication regions of guidelines.The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient(ICC).All the included guidelines were read entirely and the clinical questions they raised were summarized.Results·A total of 35 OSA guidelines were included.The ICC value of 0.975 showed a good inter-evaluator agreement.The results of AGREE Ⅱ showed that the average score of all guidelines was(63.60±16.45)%,with a minimum of 23.40%and a maximum of 91.67%.In the six domains,the scores of"Rigor of development"[(56.07±25.89)%]and"Applicability"[(53.57±15.52)%]were relative low.The average reporting rate of RIGHT of all the included guidelines was(67.84±20.03)%,with a minimum of 14.29%and a maximum of 94.29%,and the three domains with the lowest reporting rates were"Review and quality assurance"[(31.40±45.51)%],"Funding and conflict of interest declaration and management"[(56.43±33.95)%]and"Other aspects"[(56.19±36.85)%].Subgroup analysis showed that guidelines in Asian had a lower score in"Rigor of development"and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe(both P<0.05),and the reporting rates in the domains of"Evidence"and"Other information"of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe(P<0.05).These guidelines focused on 42 clinical questions which were classified to 3 aspects,i.e.screening and diagnosis,treatment and long-term management of OSA.Conclusion·The quality of current global OSA guidelines varies a lot,and they need to be strengthened in terms of rigor of development,applicability,review and quality assurance,funding and conflict of interest declaration and management,especially those in Asia.

Objective To investigate the efficacy of continuous saline bladder irrigation(CSBI)after a single immediate instillation of chemotherapy(SIIC)in patients with low-and immediate-risk non-muscle-invasive bladder cancer(NMIBC)undergoing transurethral resection of bladder tumor(TURBT).Methods Clinical data of 211 patients with with low-and immediate-risk NMIBC,who underwent TURBT in our hospital during Jan.2004 and Dec.2019 were collected.The patients were divided into two groups according to whether CSBI was conducted after SIIC.The recurrence rate,progression rate,recurrence-free survival and progression-free survival of the two groups were compared.Cox univariate and multivariate regression analyses were used to investigate whether CSBI was a risk factor for recurrence and progression.Results There were no significant differences in baseline data,recurrence rate and progression rate between the two groups(P＞0.05).There was no significant difference in recurrence-free survival between the two groups,but the progression-free survival was shorter in CSBI group(x2=8.270,P=0.004).Multivariate Cox regression analysis indicated that diabetes(HR:2.240,95％CI:1.066-4.704,P=0.033)and multiple tumors(HR:3.060,95％CI:1.639-5.711,P＜0.001)were independent risk factors for recurrence and CSBI(HR:7.914,95％CI:1.710-36.632,P=0.008)was an independent risk factor for progression.Conclusion CSBI after SIIC may increase the risk of progression in patients with low-and immediate-risk NMIBC,but a larger sample size is needed for validation.

Objective To retrieve,evaluate and summarize the relevant evidences of oral health manage-ment in the community elderly people to provide reference for community medical staffs.Methods The evi-dences on oral health management of the comunity elderly people were systematically retrieved from various guide websites and Chinese and English databases.The retrieval limit was from the database establishment to September 2021.The research group conducted the evaluation and extracted the evidences according to the rel-evant literature evaluation criteria.Results A total of 17 literatures were included,including 5 guidelines,4 expert consensuses and 8 systematic reviews.A total of 28 pieces of evidences were summarized from the five aspects of assessment and examination,daily life management,management of special oral problems,denture management,and education and training.Conclusion Community medical staffs should fully consider the clin-ical situation,department resources and patient wishes,and conduct the evidence application to increase the o-ral health level of the community elderly people.

Amyotrophic Lateral Sclerosis (ALS) is a complex neurodegenerative disorder characterized by progressive axonopathy, jointly leading to the dying back of the motor neuron, disrupting both nerve signaling and motor control. In this review, we highlight the roles of axonopathy in ALS progression, driven by the interplay of multiple factors including defective trafficking machinery, protein aggregation, and mitochondrial dysfunction. Dysfunctional intracellular transport, caused by disruptions in microtubules, molecular motors, and adaptors, has been identified as a key contributor to disease progression. Aberrant protein aggregation involving TDP-43, FUS, SOD1, and dipeptide repeat proteins further amplifies neuronal toxicity. Mitochondrial defects lead to ATP depletion, oxidative stress, and Ca²⁺ imbalance, which are regarded as key factors underlying the loss of neuromuscular junctions and axonopathy. Mitigating these defects through interventions including neurotrophic treatments offers therapeutic potential. Collaborative research efforts aim to unravel ALS complexities, opening avenues for holistic interventions that target diverse pathological mechanisms.
Humans ; Amyotrophic Lateral Sclerosis/therapy* ; Animals ; Axons/metabolism* ; Mitochondria/metabolism* ; Motor Neurons/pathology*