Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Objective:To investigate the effect and mechanism of isorhynchophylline (IRN) on angiotensin Ⅱ(Ang Ⅱ)-induced cardiac hypertrophy.Methods:H9c2 cells were co-cultured with Ang Ⅱ and different concentrations of IRN (0, 5, 10, 25, 50 μmol/L). The cell surface area and mRNA levels of cardiac hypertrophy markers atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and β-myosin heavy chain (β-MHC) were detected to elucidate the effect of IRN on myocardial hypertrophy and the most effective concentration. H9c2 cells were co-cultured with Ang Ⅱ and IRN (25 μmol/L) at different times (0, 6, 12, 24 h) to elucidate the most effective time of inhibition. The phosphorylation levels of the signaling pathway were detected, and the effects of IRN and Akt inhibitor MK2206 on the phosphorylation levels of the signaling pathway were further explored to elucidate the underlying mechanisms.Results:Compared with the control group, the surface area of H9c2 cells, and the mRNA expression of myocardial hypertrophy markers ANP, BNP and β-MHC were significantly increased (all P<0.05). Pretreated with different concentrations of IRN (5, 10, 25, 50 μmol/L) could inhibit the increase in cell surface area induced by AngⅡ (all P<0.05), especially at the concentration of 25 μmol/ L ( P<0.01). IRN could time-dependently inhibit AngⅡ-induced activation of ANP, BNP, β-MHC mRNA (all P<0.05). AngⅡ caused increased phosphorylation levels of Akt, GSK3β, mTOR and FOXO3a. IRN could block AngⅡ-induced phosphorylation of the Akt signaling pathway. Conclusion:IRN attenuates AngⅡ-induced cardiomyocyte hypertrophy by inhibiting the Akt signaling pathway.

Objective:To investigate the prevalence of frailty among elders aged ≥60 years in the Beijing community and analyze the risk factors of frailty.Methods:This is a cross-sectional study. A total of 1936 older persons in Baizhifang Community in Beijing were included between May and September 2023. Their frailty was evaluated by Fried Frailty Phenotype Scale. Mini Nutritional Assessment-Short Form (MNA-SF), Short Physical Performance Battery (SPPB), and Geriatric Depression Scale (GDS) were used to evaluate nutritional status, physical function, and depression, respectively. The prevalence and risk factors of frailty among the elderly in the community were analyzed.Results:A total of 168 individuals met the criteria for frailty, and the prevalence of frailty was 8.7%. Compared to the non-frail group, the frail group was predominantly female (71.4% vs 62.2%; χ 2=5.59, P=0.018), older [(72.1±6.6) vs (69.9±6.0) ages; t=-5.25, P<0.001], unmarried (1.8% vs 0.8%; χ 2=8.60, P=0.014), with lower education levels (10.7% vs 3.5%; χ 2=23.38, P<0.001), poorer self-assessed health (22.6% vs 6.5%; χ 2=69.80, P<0.001), lower MNA-SF scores [(12.2±2.2) vs (13.0±1.4) scores; t=6.29, P<0.001], lower SPPB scores [(8.4±1.9) vs (10.2±1.6) scores; t=14.62, P<0.001], higher GDS scores [(4.0±3.8) vs (1.9±2.1) scores; t=-11.48, P<0.001], and worse vision, hearing, and olfactory functions (48.2% vs 34.1%, 36.9% vs 23.0%, 9.5% vs 3.0%; χ 2=13.37, 16.11, 40.58, all P<0.001). They were also more likely to suffer from hypertension (70.8% vs 56.7%; χ 2=12.52, P<0.001), diabetes (42.3% vs 29.4%; χ 2=12.06, P<0.001), osteoarthritis (46.4% vs 30.3%; χ 2=18.39, P<0.001) and stroke (19.0% vs 13.3%; χ 2=4.28, P=0.039). Logistic regression analysis showed that frailty was independently associated with nutritional status ( OR=0.8, 95% CI: 0.7-0.9, P<0.001), depressive symptoms ( OR=1.1, 95% CI: 1.1-1.2, P<0.001), olfactory function ( OR=2.1, 95% CI: 1.4-3.0, P<0.001; OR=2.9, 95% CI: 1.4-5.9, P=0.003), and physical function ( OR=0.6, 95% CI: 0.6-0.7, P<0.001) after adjusting for covariates. Conclusions:The prevalence of frailty among elderly people in community is relatively high. Frailty in community elders is associated with physical function, psychological function, nutritional status, and olfactory function decline.

Objective:To analyze mobility limitation condition and its relationship with cognitive function in community-dwelling elderly.Methods:In this cross-sectional study, a total of 1 935 older adults aged≥60 years were recruited from May to September 2023 in Beijing Baizhifang Community Health Service Center and its five subordinate health service stations (Baizhifang Hutong health service station, Nancaiyuan community health service station, Youanmen community health service station, Younei West Street health service station and Shuanghuaili community health service station). The Short Physical Performance Battery (SPPB) was used to assess the mobility capacity of the elderly, and the elderly were divided into two groups with SPPB, the elderly with a SPPB≤9 points were grouped into mobility limitation group (645 cases), and the ones with a SPPB≥10 points were considered with normal mobility capacity (1 290 cases). The cognitive function of the older adults was assessed with the mini-mental state examination; and the gender, age, calf circumference, history of chronic disease, frailty status, cognitive function, nutritional status, depression status, hearing and vision condition of the two groups were compared with χ2 test or Mann-Whitney U non-parametric test. Multiple logistic regression analysis was used to analyze the mobility limitation and its relationship with cognitive function in the older adults. Results:Mobility limitation was found in 33.33% (645/1 935) of community-dwelling older adults. The proportions of advanced age, female, hypertension, diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, frailty, depression, cognitive impairment, hearing decline, and vision decline in the mobility limitation group were all significantly higher than those in the normal mobility capacity group (31.32% vs 13.41%, 69.92% vs 59.61%, 65.27% vs 54.03%, 33.80% vs 28.60%, 27.91% vs 19.53%, 17.83% vs 11.47%, 10.54% vs 7.36%, 13.18% vs 2.02%, 18.45% vs 6.59%, 14.73% vs 7.75%, 30.54% vs 20.31%, 45.58% vs 30.39%) (all P<0.05). Advanced age ( OR=2.542, 95% CI: 1.977-3.269), female ( OR=1.736, 95% CI: 1.390-2.167), stroke ( OR=1.426, 95% CI: 1.065-1.911), depression ( OR=2.292, 95% CI: 1.656-3.174), cognitive impairment ( OR=1.601, 95% CI: 1.154-2.220), frailty ( OR=5.199, 95% CI: 3.219-8.397) and vision decline ( OR=1.405, 95% CI: 1.124-1.756) were all positively correlated with the mobility limitation in the community-dwelling older adults (all P<0.05). Conclusion:The older adults in the community have a higher risk of mobility limitation, mobility limitation is a positive correlation factor of cognitive impairment.

Objective:To analyze the clinical characteristics of different types of anomalous origin of the coronary artery.Methods:A case-series study was conducted.Based on the clinical data of children diagnosed with anomalous origin of the coronary artery at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from January 2013 to January 2023, the diseases of different types of anomalous origin of the coronary artery were summarized.Results:A total of 177 children with anomalous origin of the coronary artery were treated.Among them, 122 children developed the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), including 54 males and 68 females, with a median age of 1.2 years; 6 children developed the anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), including 3 males and 3 females, with a median age of 4.3 years; 9 children developed the anomalous left coronary artery from the right coronary sinus (ALCA), including 6 males and 3 females, with a median age of 9.5 years; 40 children developed the anomalous right coronary artery from the left coronary sinus (ARCA), including 24 males and 16 females, with a median age of 7.7 years.Most children diagnosed with ALCAPA had onset within 1 year of age, with chronic heart failure as the main manifestation, and young children were often accompanied by severe mitral regurgitation.A total of 111 children underwent surgery, and 11 children died.Six children with ARCAPA had no obvious clinical symptoms and were treated by operation according to the principle of double coronary circulation after diagnosis.Nine children with ALCA started with syncope, chest pain or abdominal pain after exercise.Eight of the children underwent surgical treatment, including 1 who received a heart transplant.Of the 40 children with ARCA, 23 children had clinical manifestations, with chest tightness, syncope, and chest pain after exercise as chief complaints; 16 children were tested positive for treadmill exercise before surgery; and a total of 13 children received surgical treatment.Conclusions:Different types of anomalous origin of the coronary artery vary in severity.The clinical manifestations of the anomalous origin of the left coronary artery are generally serious, and most of such patients have the risk of cardiac insufficiency or sudden death.Once diagnosed, surgical treatment should be performed timely.The clinical manifestations of the anomalous origin of the right coronary artery are relatively mild, and only a few may have serious consequences, which are usually treated according to the principle of individualization or double coronary circulation.

Objective:To investigate diagnostic and prognostic value of actin-binding protein ANLN in clear cell renal cell carcinoma(ccRCC)and its relationship with tumor microenvironment.Methods:Gene expression data and clinical data for ccRCC were downloaded from The Cancer Genome Atlas(TCGA).Relationship between ANLN expression and clinicopathological features was assessed by Wilcoxon rank sum test and Logistic regression.Receiver operating characteristic(ROC)curve was used to assess diagnostic value of ANLN expression in ccRCC.Kaplan-Meier and Cox regression analysis were used to investigate effect of ANLN expression on overall survival.Gene set enrichment analysis(GSEA)was used to identify signaling pathways associated with ANLN in ccRCC.Relationship between ANLN expression and immune infiltration was analyzed by ESTIMATE algorithm,tumor immune estima-tion resource(TIMER)and CIBERSORT algorithms.Relationship between ANLN and drug sensitivity was calculated using CellMiner database.Results:ANLN expression was significantly upregulated in ccRCC tissues.ANLN expression in ccRCC was correlated with clinicopathological features.ROC analysis showed that ANLN had a high diagnostic value in ccRCC.High ANLN expression was signifi-cantly associated with poor prognosis.Multivariate Cox regression analysis showed that high ANLN expression was an independent risk factor for overall survival in ccRCC patients.GSEA showed that ANLN was associated with multiple signaling pathways.In terms of immunity,ANLN was closely associated with tumor microenvironment,immune infiltration and immune checkpoint molecules in ccRCC.ANLN expression was negatively correlated with sensitivity of most antitumor drugs.Conclusion:ANLN is a potential diagnos-tic and prognostic biomarker and immunotherapeutic target for ccRCC.

Objective:To investigate the diagnostic values of human epididymis protein 4 (HE4), endothelial cell specific molecule-1 (ESM-1) and epidermal growth factor receptor (EGFR) for lung cancer.Methods:The clinical data of 90 patients with lung cancer and 50 patients with benign lung diseases diagnosed by the pathological examination in Tangshan People's Hospital from December 2019 to January 2021 were retrospectively analyzed, and 40 healthy physical examiners in the same period were selected as the controls. The serum HE4 levels were detected by electrochemiluminescence method. The serum ESM-1 and EGFR levels were tested by enzyme-linked immunosorbent assay. The differences in serum HE4, ESM-1 and EGFR levels between the three groups were compared; logistic regression analysis was used to screen out the effective indicators for the diagnosis of lung cancer and to construct a prediction model for the diagnosis of lung cancer. Using pathological diagnosis result as the gold standard, the receiver operating characteristic (ROC) curve was drawn, and the diagnostic efficacy of indicators for lung cancer was evaluated.Results:The levels of serum HE4 in lung cancer group, benign lung diseases group and healthy control group were 119.55 pmol/L (82.06 pmol/L, 189.00 pmol/L), 58.84 pmol/L (45.62 pmol/L, 69.41 pmol/L) and 42.67 pmol/L (37.09 pmol/L, 51.84 pmol/L), the levels of ESM-1 were 33.00 ng/ml (25.85 ng/ml, 47.40 ng/ml), 20.14 ng/ml (11.93 ng/ml, 28.90 ng/ml) and 15.39 ng/ml (11.84 ng/ml, 20.19 ng/ml), and the levels of EGFR were 46.60 pg/ml (37.45 pg/ml, 58.98 pg/ml), 32.77 pg/ml (26.27 pg/ml, 40.86 pg/ml) and 30.43 pg/ml (27.54 pg/ml, 35.75 pg/ml), and the differences in each indicator among the three groups were statistically significant (all P < 0.001). The levels of serum HE4, ESM-1 and EGFR in lung cancer group were higher than those in benign lung diseases group and healthy control group. In patients with lung cancer, logistic regression analysis was performed with HE4 (X 1), ESM-1 (X 2) and EGFR (X 3) as the independent variables and pathological diagnosis as the dependent variable, and a lung cancer prediction regression model was established: P = 0.171X 1+0.351X 2+0.184X 3-24.660. The accuracy of this model in predicting lung cancer could reach 98.5%, and serum HE4, ESM-1 and EGFR were risk factors for the occurrence of lung cancer (all P < 0.05). The area under ROC curve from high to low was HE4 (0.960), ESM-1 (0.942) and EGFR (0.859). The diagnostic sensitivity of serum HE4 63.67 pmol/L for lung cancer was 86.7%, and the specificity was 97.5%. Both serum HE4 ( r = 0.304, P = 0.004) and ESM-1 ( r = 0.416, P < 0.001) were correlated with EGFR. Conclusions:Serum HE4, ESM-1 and EGFR can be used as effective indicators for the diagnosis of lung cancer, and the prediction model established based on the three serum tumor markers is of good value for the diagnosis and prediction of lung cancer.

Objective:To analyze the coronary angiographic (CAG) characteristics of coronary artery lesion (CAL) in children with Kawasaki disease (KD), and to clarify the necessity of CAG in the diagnosis and treatment of KD combined with CAL in children.Methods:It was a retrospective study to analyze the clinical data, electrocardiogram, echocardiography, time and findings of CAG in children with KD and CAL who underwent CAG in Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2013 to August 2022.The distribution, type, severity, and prognosis of CAL were analyzed.Results:A total of 117 children with KD and CAL were included in the analysis.The onset age of KD was from 2 months to 12.8 years old, and the age of performing CAG was from 8 months to 18.1 years old.A total of 234 coronary artery lesions were detected in 117 cases.Among them, CAL in the right coronary artery (RCA), left anterior descending branch (LAD), left main coronary artery and left circumflex artery were detected in 96 branches(41.1%), 78 branches(33.3%), 44 branches(18.8%), and 16 branches(6.8%), respectively.Unilateral coronary artery involvement was detected in 43 cases (36.8%), of which LAD was the dominant; while bilateral involvement was detected in 74 cases (63.2%), among which, LAD and RCA were the most involved arteries.Stratified by the degree of coronary involvement, large coronary aneurysms and severe coronary stenosis were most frequently occurred in the RCA and LAD.In contrast, 10 cases (13.6%), 20 cases (24.3%), 55 cases (45.8%) and 37 cases (67.3%) of intraluminal lesions were found in small, medium and large coronary aneurysms, and stenosis or occlusion, respectively.The incidence of intraluminal lesions tended to be higher in the site of severe lesions.CAG showed stenosis or occlusion in a total of 55 cases, and collateral circulation at varying degrees was found in cases of severe stenosis or occlusion.Conclusions:CAL in children with KD are complex and varied.Although clinical symptoms, routine electrocardiogram and cardiac ultrasound may indicate severe CAL.Their applications are limited by the diagnosis of the type (especially stenosis), degree, and extent of CAL, as well as the detection of extracoronary lesions.CAG is of great significance to identify vascular lesions and guide clinical management of KD combined with CAL in children.

Objective:To explore the application effect of multimodal quantitative rehabilitation exercise in patients with ankylosing spondylitis and to provide reference for patients′ rehabilitation exercise.Methods:The quasi-experimental study method was used to select 78 patients with ankylosing spondylitis admitted to Rheumatology and Immunology Department of First Affiliated Hospital of Xinjiang Medical University from February 2021 to February 2022 as the research objects. The 39 patients admitted from February 2021 to August 2021 as the control group, and 39 patients admitted from September 2021 to February 2022 as the experimental group. The control group adopted conventional rehabilitation exercise program, and the experimental group adopted multimodal quantitative rehabilitation exercise program. The Bath ankylosing spondylitis disease activity index, Bath ankylosing spondylitis function index, inflammatory factors after 6 months of intervention were compared between the two groups.Results:The Bath ankylosing spondylitis disease activity index in the experimental group after 6 months of intervention was (2.35 ± 0.81) points, and that in the control group was (3.47 ± 1.04) points, with a statistically significant difference ( t = 4.02, P<0.05). The Bath ankylosing spondylitis disease activity index in the two groups were analyzed by repeated measurement variance. The differences of time effect, inter group effect and interaction effect were statistically significant ( Fgroup = 11.27, Ftime = 62.05, Finteraction = 5.47, all P<0.05). The Bath ankylosing spondylitis function index in the experimental group after 6 months of intervention was (2.11 ± 0.32) points, and that in the control group was (3.07 ± 0.58) points, with a statistically significant difference ( t = 4.03, P<0.05). The Bath ankylosing spondylitis function index in the two groups were analyzed by repeated measurement variance. The differences in time effect, inter group effect and interaction effect were statistically significant ( Fgroup = 21.44, Ftime = 42.25, Finteraction = 16.67, all P<0.05). After 6 months of intervention, C-reactive protein, interleukin-6, transforming growth factor β, tumor necrosis factor-α were (43.15 ± 2.21) mg/L, (3.28 ± 0.85) mg/L, (41.67 ± 9.04) ng/L, (176.63 ± 20.15) ng/L respectively in the experimental group, and (50.12 ± 1.67) mg/L, (5.27 ± 0.68) mg/L, (48.65 ± 8.96) ng/L, (194.56 ± 19.45) ng/L respectively in the control group. There was a statistically significant difference in the content of inflammatory factors between the two groups ( t values were 2.05-4.45, all P<0.05). Conclusions:Multimodal quantitative rehabilitation exercise can improve the physiological function of ankylosing spondylitis patients′spine, reduce the disease activity of patients, and promote the rehabilitation of patients.

Objective:To study the characteristics and influencing factors of coping styles of clinical ophthalmic interns under psychological stress, so as to provide scientific basis for promoting the mental health development of medical students.Methods:In 2019, 103 students of Sun Yat-sen University who participated in clinical practice of ophthalmology were investigated by cluster sampling with general situation questionnaire and simple coping style questionnaire. The database was established by Epidata, and the data was statistically analyzed by SPSS 25.0 software.Results:The scores of positive coping and negative coping were (1.70±0.10) and (1.30±0.05) respectively, which were all lower than the norm ( P < 0.001). The scores of non first time practice students were 0.087 points higher than those of first time practice students; the scores of eight-year students were 0.124 points higher than those of five-year students; the scores of positive coping increased by 0.015 points for each level of family income increase. Men scored 0.027 points higher than women in negative coping scores; eight-year students scored 0.053 points lower than five-year students in negative coping scores; family income increased by one grade, negative coping scores decreased by 0.017 points; rural registered residence students scored 0.035 points higher than urban registered residence students in negative coping scores; non first practice students scored 0.074 points higher than the first practice students in negative coping scores. Conclusion:Educators should pay close attention to the coping styles of clinical ophthalmic interns, carry out mental health education and guidance of coping methods according to the characteristics of different groups, take effective measures to improve students' stress coping ability and promote the smooth development of clinical practice in ophthalmology.