Objective To determine the current prevalence and risk factors of metabolic syndrome (MS) among adult residents in Chinese developed areas.Methods The clinical data of 6614 adult residents,including 4051 women,from Guangdong and Jiangsu provinces from China Diabetes and Metabolic Disorders Study (2007-2008) were analyzed.Age and sex standardized prevalences of MS were calculated according to the criteria of Chinese Diabetes Society (CDS),US National Cholesterol Education Program Adult Treatment Panel Ⅲ (ATP Ⅲ),International Diabetes Federation (IDF) and Joint Interim Statement (JIS),respectively.Logistic regression analysis was performed to identify the risk factors of MS.Results Age and sex standardized prevalences of MS were 17.88％ (CDS),28.50％ (ATP Ⅲ),21.99％ (IDF) and 31.50％ (JIS),respectively.The prevalences of residents with at least one metabolic abnormality were 67.86％ (CDS) 79.56％ (ATP Ⅲ),79.62％ (IDF) and 80.74％ (JIS),respectively.MS was more common in female than in male by the ATPⅢ and IDF criterion (ATPⅢ:30.63％ vs 26.45％,P ＜0.01 ; IDF:26.04％ vs 17.91％,P ＜ 0.01),while the prevalence was higher in male by CDS criteria (15.94％ vs 19.87％,P ＜0.01).There was no significant difference in the MS prevalence between the rural and the urban residents.Kappa test showed ATP Ⅲ and JIS criteria were most homogenous (κ =0.95,P ＜ 0.01).The risk factors for MS by the logistic regression model were male,older age,lower degree of education,family history of hypertension and obesity,drinker as well as uncontrolled diet.Conclusion The prevalence of MS is high in the adult residents of Chinese developed areas (Guangdong and Jiangsu provinces),whatever diagnostic criterion was used.Effective measures should be taken to control the modifiable MS risk factors.

Objective To investigate the semen quality and the influence of urogenital Ureaplasma urealyticum infection in pre‐conception males in Shanghai .Methods From Jan ,2014 to Nov ,2015 ,5 306 preconception males in our andrology department were received semen analysis .The difference of semen index between ages and urogenital Ureaplasma urealyticum infected or not were analyzed .Results The average pH value was(7 .27 ± 0 .14) ,the average volume was(3 .15 ± 1 .42)mL ,the average sperm concen‐trationwas(57.51±40.22)×106/mL,theaverageoftotalspermcountwas(172.83±134.90)×106 ,theaveragevitalityratioof grade(A+B) sperm was(38 .50 ± 17 .54)% ,the average motile sperm ratio was(46 .36 ± 20 .08)% ,the average of total motile sperm count was(89 .86 ± 92 .82) × 106 .Motile sperm ratio of preconception males from twenty to twenty nine was(49 .60 ± 20 .70)% ,total motile sperm count was(93 .40 ± 95 .83) × 106 ,which was greater than other ages .Ureaplasma urealyticum turned to positive in 2 311 cases was (43 .55% ) .There were statistically significant differences in total sperm count ,total motile sperm count ,sperm concentration ,vitality ratio of grade A sperm ,vitality ratio of grade(A+B) sperm ,motile sperm ratio ,seminal acid phosphatase ,seminalα‐glucosidase and seminal plasma fructose between positive and negative samples(P<0 .01) .There was differ‐ence in pH and seminal plasma zinc between positive and negative samples(P<0 .05) .Conclusion The sperm quality of preconcep‐tion males in Shanghai is not encouraging ,urogenital Ureaplasma urealyticum infection in preconception men is very important .

Objective To explore the effectiveness of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC) patients with EGFR double mutations containing rare mutations.Methods From March 2007 to January 2017,NSCLC patients with EGFR double mutations containing rare mutations confirmed by histopathology and EGFR mutation detections at Renmin Hospital of Wuhan University,Zhongnan Hospital of Wuhan University and Hubei Cancer Hospital were enrolled.According to the mutation types,patients were divided into double activating mutations group and activating mutations with insensitive mutations group.The effectiveness of TKIs in NSCLC patients with EGFR double mutations containing rare mutations and different mutation types was analysis.Results Among the 2 637 NSCLC patients underwent EGFR mutation detections,19 patients were confirmed as EGFR double mutations containing rare mutations.Fifteen patients received EGFR-TKIs therapy,the objective response rate (ORR),disease control rate (DCR) and median progression free survival (PFS) were 46.7％ (7/15),73.3％ (11/15) and 8.1 months,respectively.In patients with double activating mutations,two patients had partial response (PR),one patient had a stable disease (SD).In the activating mutations with insensitive mutations group,five patients had PR,three patients had SD,four patients had no effect.Conclusion Patients with EGFR double mutations containing rare mutations have a general response to EGFR-TKIs,and this result can provide a reference for the treatment of those patients.

Objective To explore the effect of peripheral blood markers on the efficacy and prognosis of patients with advanced esophageal cancer treated with immune checkpoint inhibitors (ICIs). Methods The case data of 61 patients with advanced esophageal cancer who met the inclusion criteria were collected. Data on clinical indicators and peripheral blood markers as well as objective response rate (ORR) and progression-free-survival (PFS) were obtained. Results The median PFS of the included patients was 7.10 months (95%CI: 5.12-9.07). The ORR of patients with baseline lactate dehydrogenase (LDH) < 201 was better than that of patients with LDH≥201 (P < 0.05). Univariate analysis showed that baseline LDH0 < 201, neutrophil to lymphocyte ratio (NLR) < 3.9, platelet-to-lymphocyte ratio (PLR) < 240.3, and LDH1 < 249.0 two weeks after ICI treatment were significantly associated with significant improvement in PFS (P < 0.05). In multivariate analysis, patients with NLR0 < 3.9 had longer PFS (P < 0.05). Conclusion LDH0 < 201, NLR0 < 3.9, PLR0 < 240.3, and LDH1 < 249.0 are positively correlated with the prognosis of patients with advanced esophageal cancer treated with ICIs.

Objective To investigate the impact of PD1-TCF1+CD8+ stem-like memory T cells on immunotherapy prognosis and tertiary lymphoid structure in tumors. Methods Pathological tissue sections were collected from 33 patients treated with immunotherapy, 18 cases of NSCLC and 15 cases of ESCC. The expression of PD1-TCF1+CD8+T cells was detected through quantitative analysis by multiplex immunofluorescence. Survival curves were described by the Kaplan-Meier method. Pearson's correlation test was used for correlation analysis. Results The high levels of PD1-TCF1+CD8+T cells had a better PFS in NSCLC and ESCC cohorts. In the NSCLC cohort, high levels of PD1-TCF1+CD8+ T cells were significantly and positively correlated with the number (P=0.0151) and size (P=0.0007) of TLSs. Conclusion In patients with NSCLC and ESCCs, high PD1-TCF1+CD8+ stem-like memory T cell expression indicates improved prognosis and immune response and is associated with the formation of TLSs in the tumor microenvironment of NSCLC.

For the last decade,the incidence of kidney neoplasms has shown an obvious rising trend in the world. The most common histopathological type of kidney neoplasms is clear cell renal cell carcinoma (ccRCC),which has a poor prognosis. ccRCC is generally accompanied by reprogramming of glucose,fatty acid,glutamine,tryptophan and arginine metabolic networks and pathways. Reprogramming of metabolic net-works and pathways enables tumor cells to proliferate rapidly,survive in conditions of nutrient depletion and hy-poxia,and escape surveillance by epidemic systems. New strategies have been developed to the treatment of ccRCC by targeting key proteins or enzymes involved in metabolic reprogramming pathways.

The emergence of immune checkpoint inhibitors (ICIs) has greatly changed the treatment strategy of non-small cell lung cancer (NSCLC). Although ICIs are effective, there are still many patients who cannot benefit from immunotherapy alone. The current research direction focuses on the combination of multiple treatment schemes. Radiotherapy can upregulate immunogenic cell surface markers, and regulate the expressions of immune checkpoints. A large number of preclinical and clinical studies are exploring the efficacy and safety of ICIs combined with radiotherapy in various clinical stages of NSCLC, including radiotherapy timing, optimal dose, dose distribution and so on.

With the increasing understanding of the complex interaction between the tumor microenvironment and immune therapy, the role of immune checkpoint inhibitors in the treatment of head and neck squamous cell carcinoma (HNSCC) has gained significant attention. Immune checkpoint inhibitors targeting programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) , cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) , and T cell immunoglobulin domain and mucin domain-3 (TIM-3) , such as pembrolizumab, durvalumab, tremelimumab, ipilimumab, and LY3321367, have been applied in numerous clinical trials as monotherapies and combination therapies for the treatment of recurrent or metastatic HNSCC. Further research into the efficacy and safety of these immune checkpoint inhibitors in clinical trials may provide more effective strategies for the treatment of patients with recurrent or metastatic HNSCC.

Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept ofmetabolic inflammatory syndrome ( MIS). According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome ( MS) . Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96. 2%, which was higher than that of MS (71. 3%). Among 4 components of MIS, atherosclerosis showed the highest detective rate (75.6%). MIS[OR=2.252(95%CI1.026-4.942),P=0.043],atherosclerosis[OR=2.726(95% CI1.953-3. 804),P<0. 001], and MS[OR=1. 915 (95%CI 1. 444-2. 540),P<0. 01] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.

Pain management plays an essential role in the improvement of clinical outcome and patient satisfaction of total knee arthroplasty (TKA). With the emergence of preemptive analgesia, preventive analgesia and other analgesia concepts, the whole process of perioperative pain management and multimodal analgesia during perioperative period has become the most important principle of pain management for TKA. The use of classical analgesia drugs like acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid drugs still have important position. At the same time, various kinds of regional block analgesia represented by femoral nerve block, adductor canal block, peri-articular multimodal drug mixture injection, etc., have precise analgesic effects and less adverse reactions. Their role in the multimodal analgesia system after TKA is increasingly apparent.