Background and purpose:Approximately 30%of patients with metastatic colorectal cancer(CRC)develops pulmonary metastasis,yet less than 10%are eligible for surgical resection.Radiofrequency ablation(RFA)serves as an alternative therapy for non-surgical candidates,but the relationship between its efficacy and tumor diameter remains controversial.This study aimed to investigate the impact of tumor size on survival outcomes and local progression risk in CRC patients with pulmonary metastasis after RFA,and to validate the clinical utility of a 3 cm threshold for prognosis.Methods:This retrospective study included CRC patients with pulmonary metastasis who underwent RFA at Fudan University Shanghai Cancer Center between January 2016 and December 2024.Patients were stratified into two groups based on maximum lesion diameter:≤3 cm(Small group)and 3-5 cm(Large group).Patient inclusion criteria:⑴ pathologically confirmed lung metastases originating from CRC,with metastases limited to the lungs or extra-pulmonary metastatic lesions having been radically treated;⑵ maximum lesion diameter<5 cm;⑶complete clinical data available;⑷ complete imaging data available,including computed tomography(CT)images during ablation and contrast-enhanced CT images during postoperative follow-up;⑸ follow-up time of at least＞6 months after RFA;⑹ technical complete ablation;⑺ fewer than 3 pulmonary metastatic lesions.Exclusion criteria:⑴ target lesions previously treated with local therapies such as RFA or radiotherapy;⑵ patients unable to tolerate RFA;⑶ patients with follow-up time＜6 months after RFA.Three senior interventional physicians performed percutaneous RFA under guidance of a 64-slice spiral CT scanner.Chest contrast-enhanced CT scans obtained 1 month after RFA were used as the baseline,followed by contrast-enhanced CT scans every 3 months for 1 year,then every 6 months for subsequent follow-up.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethical approval number:2108241-11).Primary endpoints included overall survival(OS),progression-free survival(PFS),and local tumor progression(LTP).Kaplan-Meier analysis and multivariate COX regression were employed to evaluate the independent prognostic value of tumor size.Results:A total of 134 patients who met the inclusion criteria were ultimately enrolled,including 77 in the Small group and 57 in the Large group.With a median follow-up of 35 months,the≤3 cm group demonstrated superior 1-,3-,and 5-year OS rates(100.0%,95.1%,74.2%)compared to the 3-5 cm group(94.7%,36.8%,27.0%,P＜0.0001),and the≤3 cm group demonstrated superior 1-,3-,and 5-year PFS rates(90.9%,34.4%,23.3%)compared to the 3-5 cm group(13.8%,0.0%,0.0%,P＜0.000 1).The≤3 cm group also exhibited significantly lower 1-,3-,and 5-year LTP rates(0.0%,19.7%,33.6%)compared to the 3-5 cm group(46.0%,75.5%,75.5%,P＜0.000 1).Multivariable analysis identified tumor diameter＞3 cm as an independent predictor of worse OS[hazard ratio(HR)=6.49,95%CI:3.18-13.24,P＜0.001],while elevated preoperative carcinoembryonic antigen(CEA)(≥5 ng/mL)correlated with shorter OS(HR=1.82,P=0.033).Conclusion:CRC patients with pulmonary metastasis and tumor diameters of 3-5 cm exhibited significantly inferior survival outcomes after RFA compared to the≤3 cm group.A tumor diameter of 3 cm can serve as a critical threshold for selecting RFA indications,and combining preoperative CEA levels can optimize patient stratification.

Objective:This study was to explore the behavioral and electroencephalographic characteristics of impaired cognitive flexibility in patients with obsessive-compulsive disorder (OCD) with comorbid obsessive-compulsive personality disorder(OCPD).Methods:A cross-sectional study was designed to collect data prospectively from OCD patients who visited the psychology departments at two top-tier hospitals in Changsha between September 2019 and December 2021. The study included 31 patients with OCD+OCPD(18 males, 13 females; aged 15-46 (22.8±8.4) years) and 39 patients with OCD only(25 males, 14 females; aged 15-34 (21.6±4.2) years). Additionally, 32 age-matched healthy controls(HC: 18 males, 14 females; aged 18-25 (20.8±1.7) years). All participants completed the Task-Switching paradigm while behaioral and event-related potentials(ERPs) were recorded simultaneously. Repeated measures analysis of variance was used to compare the group differences in behavioral and ERP data(electrode sites: FZ, FCZ, CZ, PZ; ERP components: amplitude and latency of P2, N2, and P3).Results:The reaction times in both the comorbid and OCD groups were significantly longer than those in the healthy control group ((1 182±287) ms and (1 119±194) ms vs. (886±95) ms; F=18.48, both P<0.001). Accuracy rates in the comorbid and OCD groups were also significantly lower than in the healthy control group ((77±14)% and (77±13)% vs. (84±7)%; F=4.00, both P<0.05). In the task-switching condition, the N2 latency at the CZ electrode was significantly shorter in the comorbid and OCD groups compared to the healthy control group ((290±22) ms and (291±29) ms vs. (308±27) ms; F=3.81, both P<0.05). Furthermore, at the FZ and FCZ electrodes, the N2 latency in the comorbid group was significantly shorter in the switching task compared to the repetition task. Conclusion:OCD patients with comorbid OCPD show more severe cognitive flexibility impairments and display abnormal electrophysiological patterns.

Objective To analyze the feasibility of serum exosome hsa_circ_0084443 as a biomarker for early diagnosis of diabetic foot ulcer.Methods GSE114236 chip data from the Gene Expression Omnibus(GEO)database was downloaded to screen the differentially expressed circular DNA(circRNA).From December 2019 to August 2021,44 T2DM patients with diabetic foot ulcer(DFU)who received treatment at Baoji Central Hospital were included as the study subjects,all patients had Wagner grades 1～2.In addition,185 newly diagnosed T2DM patients without comorbidities(DM group)were included as controls during the same period.Serum samples from all participants were collected for extracting purified serum exosomes.The expression of serum exosomal hsa_circ_0084443 was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR),and the differences among different groups was compared.Spearman rank correlation analysis was used to investigate the relationship between serum exosomal hsa_circ_0084443 and Ankle-Brachial Index(ABI).Receiver operating characteristic(ROC)curves was used to analyze the efficacy of serum exosomal hsa_circ_0084443 in diagnosing early DFU.Results By analyzing the GSE114236 dataset,it was found that hsa_circ_0084443 was the circRNA with the highest differential expression.In the whole cohort analysis,the expression of serum exosome hsa_circ_0084443 in DFU group was significantly higher than that in DM group[1.18(0.84,2.06)vs 0.73(0.51,1.16)],and the differences was statistically significant(Z=-4.219,P<0.001).The expression level of serum exosome hsa_circ_0084443 in DFU group was negatively correlated with ABI(r=-0.420,P=0.005).After adjusting for age,smoking history and creatinine,the increased expression level of serum exosome hsa_circ_0084443 was still an independent risk factor for DFU(P＜0.001).Finally,the area under ROC curve(AUC)of serum exosome hsa_circ_0084443 for the diagnosis of early DFU was 0.705.Conclusion Serum exosome hsa_circ_0084443 is highly expressed in DFU patients and can be used as an important marker for early diagnosis of DFU.

Coronary heart disease with angina pectoris,characterized by myocardial ischemic injury as its fundamental pathological mechanism,represents a prevalent cardiovascular condition.The"State-Target Differential Diagnosis and Treatment"presents a holistic regulatory framework,integrating macroscopic state regulation with microscopic targeting.Guided by this approach,the pathological evolution of coronary heart disease is examined through four dimensions:"state-target-cause-effect."The"cause"encompasses both the pathogenesis and etiological factors of traditional Chinese and Western medicine.The"effect"manifests as adverse cardiovascular events,including myocardial infarction and heart failure.The"state"delineates the progressive development pattern of qi to blood to deficiency,beginning with qi stagnation and cold congealment in the initial stage,followed by blood stasis and phlegm obstruction in the intermediate stage,and culminating in qi-blood deficiency in the advanced stage.The"target"encompasses multi-level therapeutic interventions addressing both symptomatic manifestations and clinical indicators.Building on this theoretical foundation,this research focuses on the pattern of qi sinking and blood stasis commonly observed in late-stage angina,systematically elucidating its state regulation and targeting therapeutic strategies.Using the clinical empirical formula Shengxian Quyu Decoction as the baseline state prescription,an in-depth investigation was conducted to determine optimal combination patterns of symptom-and biomarker-targeted medications.This study aims to establish a modernized differential treatment system for angina pectoris with the pattern of qi sinking and blood stasis,providing novel research perspectives and theoretical foundations for enhancing clinical efficacy and reducing the risk of cardiovascular events.

Objective To analyze the feasibility of serum exosome hsa_circ_0084443 as a biomarker for early diagnosis of diabetic foot ulcer.Methods GSE114236 chip data from the Gene Expression Omnibus(GEO)database was downloaded to screen the differentially expressed circular DNA(circRNA).From December 2019 to August 2021,44 T2DM patients with diabetic foot ulcer(DFU)who received treatment at Baoji Central Hospital were included as the study subjects,all patients had Wagner grades 1～2.In addition,185 newly diagnosed T2DM patients without comorbidities(DM group)were included as controls during the same period.Serum samples from all participants were collected for extracting purified serum exosomes.The expression of serum exosomal hsa_circ_0084443 was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR),and the differences among different groups was compared.Spearman rank correlation analysis was used to investigate the relationship between serum exosomal hsa_circ_0084443 and Ankle-Brachial Index(ABI).Receiver operating characteristic(ROC)curves was used to analyze the efficacy of serum exosomal hsa_circ_0084443 in diagnosing early DFU.Results By analyzing the GSE114236 dataset,it was found that hsa_circ_0084443 was the circRNA with the highest differential expression.In the whole cohort analysis,the expression of serum exosome hsa_circ_0084443 in DFU group was significantly higher than that in DM group[1.18(0.84,2.06)vs 0.73(0.51,1.16)],and the differences was statistically significant(Z=-4.219,P<0.001).The expression level of serum exosome hsa_circ_0084443 in DFU group was negatively correlated with ABI(r=-0.420,P=0.005).After adjusting for age,smoking history and creatinine,the increased expression level of serum exosome hsa_circ_0084443 was still an independent risk factor for DFU(P＜0.001).Finally,the area under ROC curve(AUC)of serum exosome hsa_circ_0084443 for the diagnosis of early DFU was 0.705.Conclusion Serum exosome hsa_circ_0084443 is highly expressed in DFU patients and can be used as an important marker for early diagnosis of DFU.

Background and purpose:Approximately 30%of patients with metastatic colorectal cancer(CRC)develops pulmonary metastasis,yet less than 10%are eligible for surgical resection.Radiofrequency ablation(RFA)serves as an alternative therapy for non-surgical candidates,but the relationship between its efficacy and tumor diameter remains controversial.This study aimed to investigate the impact of tumor size on survival outcomes and local progression risk in CRC patients with pulmonary metastasis after RFA,and to validate the clinical utility of a 3 cm threshold for prognosis.Methods:This retrospective study included CRC patients with pulmonary metastasis who underwent RFA at Fudan University Shanghai Cancer Center between January 2016 and December 2024.Patients were stratified into two groups based on maximum lesion diameter:≤3 cm(Small group)and 3-5 cm(Large group).Patient inclusion criteria:⑴ pathologically confirmed lung metastases originating from CRC,with metastases limited to the lungs or extra-pulmonary metastatic lesions having been radically treated;⑵ maximum lesion diameter<5 cm;⑶complete clinical data available;⑷ complete imaging data available,including computed tomography(CT)images during ablation and contrast-enhanced CT images during postoperative follow-up;⑸ follow-up time of at least＞6 months after RFA;⑹ technical complete ablation;⑺ fewer than 3 pulmonary metastatic lesions.Exclusion criteria:⑴ target lesions previously treated with local therapies such as RFA or radiotherapy;⑵ patients unable to tolerate RFA;⑶ patients with follow-up time＜6 months after RFA.Three senior interventional physicians performed percutaneous RFA under guidance of a 64-slice spiral CT scanner.Chest contrast-enhanced CT scans obtained 1 month after RFA were used as the baseline,followed by contrast-enhanced CT scans every 3 months for 1 year,then every 6 months for subsequent follow-up.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethical approval number:2108241-11).Primary endpoints included overall survival(OS),progression-free survival(PFS),and local tumor progression(LTP).Kaplan-Meier analysis and multivariate COX regression were employed to evaluate the independent prognostic value of tumor size.Results:A total of 134 patients who met the inclusion criteria were ultimately enrolled,including 77 in the Small group and 57 in the Large group.With a median follow-up of 35 months,the≤3 cm group demonstrated superior 1-,3-,and 5-year OS rates(100.0%,95.1%,74.2%)compared to the 3-5 cm group(94.7%,36.8%,27.0%,P＜0.0001),and the≤3 cm group demonstrated superior 1-,3-,and 5-year PFS rates(90.9%,34.4%,23.3%)compared to the 3-5 cm group(13.8%,0.0%,0.0%,P＜0.000 1).The≤3 cm group also exhibited significantly lower 1-,3-,and 5-year LTP rates(0.0%,19.7%,33.6%)compared to the 3-5 cm group(46.0%,75.5%,75.5%,P＜0.000 1).Multivariable analysis identified tumor diameter＞3 cm as an independent predictor of worse OS[hazard ratio(HR)=6.49,95%CI:3.18-13.24,P＜0.001],while elevated preoperative carcinoembryonic antigen(CEA)(≥5 ng/mL)correlated with shorter OS(HR=1.82,P=0.033).Conclusion:CRC patients with pulmonary metastasis and tumor diameters of 3-5 cm exhibited significantly inferior survival outcomes after RFA compared to the≤3 cm group.A tumor diameter of 3 cm can serve as a critical threshold for selecting RFA indications,and combining preoperative CEA levels can optimize patient stratification.

Coronary heart disease with angina pectoris,characterized by myocardial ischemic injury as its fundamental pathological mechanism,represents a prevalent cardiovascular condition.The"State-Target Differential Diagnosis and Treatment"presents a holistic regulatory framework,integrating macroscopic state regulation with microscopic targeting.Guided by this approach,the pathological evolution of coronary heart disease is examined through four dimensions:"state-target-cause-effect."The"cause"encompasses both the pathogenesis and etiological factors of traditional Chinese and Western medicine.The"effect"manifests as adverse cardiovascular events,including myocardial infarction and heart failure.The"state"delineates the progressive development pattern of qi to blood to deficiency,beginning with qi stagnation and cold congealment in the initial stage,followed by blood stasis and phlegm obstruction in the intermediate stage,and culminating in qi-blood deficiency in the advanced stage.The"target"encompasses multi-level therapeutic interventions addressing both symptomatic manifestations and clinical indicators.Building on this theoretical foundation,this research focuses on the pattern of qi sinking and blood stasis commonly observed in late-stage angina,systematically elucidating its state regulation and targeting therapeutic strategies.Using the clinical empirical formula Shengxian Quyu Decoction as the baseline state prescription,an in-depth investigation was conducted to determine optimal combination patterns of symptom-and biomarker-targeted medications.This study aims to establish a modernized differential treatment system for angina pectoris with the pattern of qi sinking and blood stasis,providing novel research perspectives and theoretical foundations for enhancing clinical efficacy and reducing the risk of cardiovascular events.

Objective:This study was to explore the behavioral and electroencephalographic characteristics of impaired cognitive flexibility in patients with obsessive-compulsive disorder (OCD) with comorbid obsessive-compulsive personality disorder(OCPD).Methods:A cross-sectional study was designed to collect data prospectively from OCD patients who visited the psychology departments at two top-tier hospitals in Changsha between September 2019 and December 2021. The study included 31 patients with OCD+OCPD(18 males, 13 females; aged 15-46 (22.8±8.4) years) and 39 patients with OCD only(25 males, 14 females; aged 15-34 (21.6±4.2) years). Additionally, 32 age-matched healthy controls(HC: 18 males, 14 females; aged 18-25 (20.8±1.7) years). All participants completed the Task-Switching paradigm while behaioral and event-related potentials(ERPs) were recorded simultaneously. Repeated measures analysis of variance was used to compare the group differences in behavioral and ERP data(electrode sites: FZ, FCZ, CZ, PZ; ERP components: amplitude and latency of P2, N2, and P3).Results:The reaction times in both the comorbid and OCD groups were significantly longer than those in the healthy control group ((1 182±287) ms and (1 119±194) ms vs. (886±95) ms; F=18.48, both P<0.001). Accuracy rates in the comorbid and OCD groups were also significantly lower than in the healthy control group ((77±14)% and (77±13)% vs. (84±7)%; F=4.00, both P<0.05). In the task-switching condition, the N2 latency at the CZ electrode was significantly shorter in the comorbid and OCD groups compared to the healthy control group ((290±22) ms and (291±29) ms vs. (308±27) ms; F=3.81, both P<0.05). Furthermore, at the FZ and FCZ electrodes, the N2 latency in the comorbid group was significantly shorter in the switching task compared to the repetition task. Conclusion:OCD patients with comorbid OCPD show more severe cognitive flexibility impairments and display abnormal electrophysiological patterns.

ObjectiveTo explore the relationship between the occupational noise exposure and arteriosclerosis in mechanical manufacturing workers. Methods A total of 453 employees of a machinery manufacturing enterprise were selected as the study subjects using the judgment sampling method. The noise exposure levels in their workplaces were measured, and their cumulative noise exposure (CNE) was assessed based on the type of job-noise exposure matrix and occupational hazard exposure history. Pure-tone audiometry was performed on the research subjects, and their brachial-ankle pulse wave velocity (baPWV) was measured. Results The CNE was (91±11) dB(A) per year and the median baPWV was 1 278.0 cm/s in the research subjects. The results of the generalized linear regression model analysis showed that for every one dB(A) per year increase in CNE, the baPWV of the general population increased by 0.20% ［95% confidence interval (CI) 0.10%-0.30%, P<0.01］, with an increase of 0.17% in males (95%CI 0.06%-0.28%, P<0.01) and 0.28% in females (95%CI 0.07%-0.49%, P<0.01). Using the hearing loss as an outcome indicator for high intensity noise exposure, the results showed that baPWV increased by 7.04% (95%CI 2.42%-11.87%, P<0.01) in individuals with bilateral hearing loss, and by 9.84% and 6.53% (95%CI 3.07%-17.07% and 2.13%-11.11%, all P<0.01) in individuals with elevated high-frequency hearing thresholds in both ears and in either ear, respectively. There was no significant association in elevated speech-frequency hearing thresholds and arteriosclerosis (P>0.05). Conclusion Occupational noise exposure may increase the risk of arteriosclerosis.