Objective: To investigate the clinicopathological characteristics and diagnostic-therapeutic strategies of oncocytic mucoepidermoid carcinoma (OMEC) of the parotid gland, and to enhance awareness of this rare variant among clinicians and pathologists. Methods: The clinical data, imaging findings, histopathological features, immunophenotype, and molecular characteristics of two patients with parotid OMEC were retrospectively analyzed, and the relevant literature was reviewed. Results: Case 1 was a 50-year-old man who presented with a painless mass behind the right earlobe for more than 2 years. The patient underwent extended parotidectomy with preservation of the facial nerve. Histopathological examination revealed that the tumor was predominantly composed of oncocytic cells with a small proportion of mucous cells. Immunohistochemically, the tumor cells were partially positive for cytokeratin 5/6, cytokeratin 7, and P63. Special staining with alcian blue, periodic acid-Schiff, and phosphotungstic acid hematoxylin yielded positive results. The diagnosis of right parotid OMEC was established. No recurrence or metastasis was observed during a 1 year follow-up. Case 2 was a 61-year-old man with a 3-month history of a mass beneath the left ear. After partial parotidectomy at an outside institution, pathological consultation at the Stomatological Hospital of Jilin University demonstrated that the tumor consisted almost entirely of oncocytic cells, exhibited infiltrative growth, and lacked typical mucous, epidermoid, and intermediate cells. Fluorescence in situ hybridization confirmed positive mastermind-like transcriptional activator 2 (MAML2) gene rearrangement, establishing the diagnosis of left parotid OMEC. The patient subsequently underwent total parotidectomy with preservation of the facial nerve, and no recurrence was detected during a short-term 3 months follow-up. A review of the literature indicated that OMEC most commonly arises in the parotid gland and is generally a low-grade malignancy with favorable prognosis. When tumors are composed exclusively of oncocytic cells, exhibit minimal cytological atypia, and lack the classical cellular components of mucoepidermoid carcinoma, they are highly prone to misdiagnosis as oncocytoma, nodular oncocytic hyperplasia, or other benign oncocytic lesions. Accurate differential diagnosis relies on recognition of infiltrative growth patterns, supportive immunophenotypic markers (e.g., P63 positivity), and detection of characteristic MAML2 gene rearrangement. Complete surgical excision remains the treatment of choice. Conclusion OMEC dominated by oncocytic cells carries a high risk of clinical misdiagnosis. Integrating the assessment Conclusion OMEC dominated by oncocytic cells carries a high risk of clinical misdiagnosis. Integrating the assessment of infiltrative histopathological features with immunohistochemistry and molecular detection of MAML2 rearrangement is crucial for accurate diagnosis, appropriate assessment of tumor behavior, and optimal surgical decision making.

Purpose: This study aimed to evaluate the safety and efficacy of gemcitabine and cisplatin (GP) regimen in combination with immune checkpoint inhibitor sintilimab as neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) patients and the feasibility of the following selective bladder sparing surgery. Materials and Methods: Patients with histopathologically confirmed urothelial carcinoma without distant metastases (T2-4a, N ≤ 1, M0, American Joint Committee of Cancer 8th) and with adequate organ function will be enrolled. The therapeutic regimen was sintilimab 200 mg once on day 8, gemcitabine 1,000 mg/m2 and cisplatin 35 mg/m2 once on days 1 and 8, every 21 days for four cycles. The primary endpoint was pathologic complete response (pCR, pT0N0) rate. The secondary end points were ypT < 2 rate, R0 resection rate, event-free survival, and safety. Results: From May 4, 2020, to May 20, 2023, 55 patients were enrolled. Forty-six patients were evaluated for efficacy. Among the 42 patients who underwent surgery, 16 patients (38.0%) achieved pCR. Thirty-three patients (78.6%) achieved pT < 2. With a median follow-up of 15.7 months, the 1-year event-free survival was 91.3%. Notwithstanding the poor pathological baseline characteristic of a high T3-T4a proportion (39.1%), a promising bladder preservation (including 22 patients transurethral resection of bladder tumor, 5 patients partial cystectomy, and 4 surveillances) rate was achieved (67.4%). The most common grade ≥ 3 treatment-related adverse events was neutropenia (n=15, 27.3%), which was related to chemotherapy. There were no grade 3 immune-related adverse events. Conclusion Neoadjuvant GP plus sintilimab is a promising regimen for MIBC patients, with relatively high pT < 2 rate and triggering the emerging roles for the multi-disciplinary team decision-making for bladder sparing surgery.

Objective: To systematically analyze the stability and decay kinetics of coagulation factors in thawed cryoprecipitate stored at different temperatures under the new storage guidelines, and to provide an evidence basis for optimizing storage strategies. Methods: A total of 30 bags of 2U cryoprecipitate prepared at our blood center from January to June 2025 were selected. After thawing in a 37℃ water bath and thorough mixing, each bag was equally divided into two portions and stored at room temperature (20-24℃) or under refrigerated temperature (2~6℃), respectively. Dynamic sampling was performed at 0, 4, 6, 24, 30, and 120 h after thawing to measure fibrinogen (FIB) content, coagulation factor Ⅷ(FⅧ) activity, and von Willebrand factor (vWF) activity. Two-way repeated measures ANOVA was used to evaluate the effects of storage temperature, time, and their interaction. A one-phase exponential decay model was applied to fit the decay kinetics of FⅧ activity and vWF activity. Results: After thawing, FⅧ activity and vWF activity in cryoprecipitate showed a decreasing trend with prolonged storage time, and a time×temperature interaction was observed for both factors (all P< 0.001). The decay rates of FⅧ activity and vWF activity were lower under room temperature storage than under refrigerated storage, with statistically significant differences between the two groups starting from 24 h. Kinetic fitting revealed that the half-life of FⅧ activity in the room temperature group (19.83 h) was 3.4 times longer than that in the refrigerated group (5.85 h); the half-life of vWF activity in the room temperature group (204.6 h) was 5.9 times longer than that in the refrigerated group (34.6 h). FIB content remained stable throughout the observation period under both storage temperatures, with no statistically significant differences. Conclusion: Storage of thawed cryoprecipitate at room temperature effectively delays the loss of FⅧ activity and vWF activity and reduces cryoprecipitate formation induced by low temperature, providing experimental evidence for optimizing transfusion strategies based on the decay kinetics of different coagulation factors and improving the utilization efficiency of cryoprecipitate resources.

Abstract Adolescents are a high risk group for non suicidal self injury (NSSI), and the severity of the issue has been increasing. However, stigma originating from self perceptions, the public, and healthcare professionals poses significant barriers to help seeking and recovery among adolescents with NSSI. The paper systematically reviews the main intervention strategies targeting NSSI related stigma in adolescents, along with their effectiveness, from three perspectives: educational approaches, contact based interventions, and public advocacy against stigma, aiming to inform the development of a scientific, effective, and multi stakeholder collaborative integrated intervention framework to provide a basis for reducing and ultimately eliminating stigma associated with adolescent NSSI.

Objective To gain insights into the biological characteristics of different populations of Culex tritaeniorhynchus within and around the Yellow Sea wetland from the perspective of the occurrence of resistance, we investigated the levels of resistance to deltamethrin and kdr gene mutation in the wetland and its peripheral areas. Methods Specimens were collected from Cx. tritaeniorhynchus populations at two monitoring sites in the Rare Bird National Nature Reserve and Tiaozi Ni Wetland Scenic Area, and also from two populations in Yancheng City and the Liuhe District of Nanjing, and the resistance of these mosquitoes to deltamethrin was determined using the CDC biotest bottle method. For each concentration of deltamethrin assessed, a random subset of exposed specimens was selected for amplification of the kdr gene fragment, followed by Sanger sequencing to identify and analyze resistance-associated mutations. Results The LC50 levels of deltamethrin among mosquitoes from the four populations in Luhe, Yancheng, the Rare Bird National Nature Reserve and the Tiaozi Ni Wetland Scenic Area were 2.048 5, 7.798 2, 3.473 3, and 17.695 5 mg/mL, respectively, with corresponding concentrations of deltamethrin ranging from 0.005 to 5.000,0.050 to 50.000,0.050 to 25.000 and 0.050 to 50.000 mg/mL, respectively. Furthermore, the ranges of the KT50 values were 11.76-107.43, 67.05-216.30,29.77-107.43 and 28.40-329.51 min; the 1-h knockdown rates were 34.58%-99.15%, 9.52%-43.80%, 55.09%-73.01%, and 10.09%-68.07%; and the 24-h mortality rates were 12.15%-67.52%,9.52%-79.56%,13.17%-82.21%, and 11.01%-78.99%, respectively. With respect to kdr gene mutation, we assayed a total of 63,70,59, and 57 mosquitoes for the four populations, for which we detected L1014F mutation frequencies of 14.29%, 35.00%, 20.34%, and 31.58%, respectively, with a majority of these mutations being heterozygous for resistance. In addition, five adult mosquitoes were identified has having synonymous mutations at site 1011[i. e. , AAT(asparagine)mutation to AAC(asparagine)]. Conclusions Our findings revealed the clear resistance of Cx. tritaeniorhynchus to deltamethrin in the Yancheng region of the Yellow Sea wetland, and the resistance phenotype and kdr frequency of Cx. tritaeniorhynchus in the wetland environment were comparable to those of Cx. tritaeniorhynchus in the wetland environment, thereby indicating that the resistance of different populations of Cx. tritaeniorhynchus was homogeneous under the pressure of different insecticide selection within and around the wetland. However, the underlying mechanisms need to be further studied.

ObjectiveTo investigate the current awareness and optimization recommendations on pneumonia with unknown etiology (PUE) surveillance among Shanghai healthcare professionals, and to provide evidence for the improvement of the surveillance system. MethodsIn December 2024, healthcare professional participants from diverse medical and health institutions were randomly selected within each stratum using a stratified cluster sampling method in all 16 districts of Shanghai for questionnaire surveys on their knowledge and suggestions for optimization of the PUE surveillance system. Descriptive statistics analyses, multivariate logistic regressions, and content analyses were used for data analyses. ResultsA total of 385 survey subjects were involved in the study, including 119 professional staffs from disease prevention and control centers and 266 from medical institutions. Those who understood the case definition for PUE correctly accounted for 67.01% (258/385). Multivariate regression model analyses showed that female gender (aOR=2.22, 95%CI: 1.36‒3.66), professionals from disease control institutions (aOR=2.02, 95%CI: 1.12‒3.72), and those who self-assessed as being familiar with the monitoring system (aOR=2.18, 95%CI:1.23‒3.89) had better understanding of the definition. Overall, 89.61% (345/385) of the survey subjects acknowledged the necessity of the surveillance system. Small number of cases meeting the case definition (54.46%, 214/379), insufficient diagnostic awareness (39.84%, 151/379), and lack of incentives for case reporting (29.29%, 111/379) were major problems for the current surveillance system, with variations observed across different types of institutions. Suggested segments for optimizing the surveillance system included monitoring purpose, case definition, form of monitoring and reporting procedure, organization mechanism, and epidemiological investigation and response. ConclusionThe necessity of PUE surveillance is commonly recognized among healthcare workers. However, the existing system falls short in terms of mastery of case definition and overall surveillance adaptability. There is an urgent need for optimization and improvement to enhance the capacity for preventing and controlling emerging and sudden respiratory infectious diseases.

Introduction: Osteoporosis is associated with increased fracture risk, leading to significant morbidity and mortality. Despite established clinical guidelines, a substantial gap remains between recommended and actual prescribing practices. Patients at very high fracture risk have poorer outcomes and are recommended to receive anabolic or parenteral antiresorptive therapies. However, access to these treatments is limited in Malaysian government hospitals due to cost constraints. Methodology: This retrospective clinical audit evaluated osteoporosis treatment prescriptions among very high-risk patients attending the Osteoporosis Endocrine Clinic at Hospital Queen Elizabeth II from 2020 to 2025. Very high fracture risk was defined according to the American Association of Clinical Endocrinologists criteria, including recent fractures, fractures on therapy, multiple fractures, high fall risk, glucocorticoid use, very high FRAX probability (>30% major osteoporotic fracture or >4.5% hip fracture), or very low bone mineral density (T-score <−3.0). Results: A total of 120 patients were included, with a median age of 68 years (interquartile range [IQR] 62–73). Most were of Chinese ethnicity (60%, n = 72), with a median body mass index of 22.6 kg/m² (IQR 19.6–26). Secondary osteoporosis was present in 70% of patients, commonly due to aromatase inhibitor use (45%), glucocorticoid-induced osteoporosis (13.3%), thyroid disorders (10.8%), and vitamin D insufficiency (9.2%). Only 12% of patients (n = 14) received anabolic or parenteral antiresorptive therapy, while 88% (n = 106) were treated with oral alendronate. Among those on alendronate, 19.8% (n = 21) developed adverse outcomes, including treatment failure (n = 13), gastrointestinal side effects (n = 6), and atypical femoral fractures (n = 2). Conclusion The uptake of guideline-recommended therapy in very high-risk osteoporosis patients remains low. A notable proportion of patients treated with oral alendronate experienced adverse outcomes or suboptimal responses. Addressing financial and systemic barriers is crucial to improving access to advanced therapies and optimizing patient outcomes.
Prescriptions ; Osteoporosis

Objective To explore the characteristics and influencing factors of drug-induced liver injury(DILI)associated with the postoperative use of propacetamol,and to provide guidance for rational clinical medication.Methods A retrospective analysis was conducted on hospitalized patients who underwent surgical treatment and were administered propacetamol from January 2022 to June 2024.Cases were screened based on established inclusion and exclusion criteria.Statistical analyses were performed on patients'demographic data,medication information,liver function indicators before and after medication,comorbid conditions,and concomitant medications to assess the incidence and influencing factors of propacetamol-related DILI.A multivariate Logistic regression analysis was conducted to identify related risk factors.Results A total of 7,579 patients were sampled,of which 2,114 met the inclusion criteria.Among them,531 patients(25.1%)experienced DILI,primarily presenting with abnormal liver function indicators.This included elevated alanine aminotransferase in 379 cases(71.4%),elevated aspartate aminotransferase in 197 cases(37.1%),elevated alkaline phosphatase in 209 cases(39.4%),and elevated total bilirubin in 92 cases(17.3%).Univariate analysis revealed that there were significant differences in gender,height,age,weight,body mass index(BMI),duration of propacetamol use,total medication dosage,concomitant use of hepatic-metabolized antibiotics,and history of liver disease between the DILI group and non-DILI group(P<0.05).Multivariate Logistic regression analysis showed that patient gender,BMI,total propacetamol dosage,liver-related diseases,and concomitant use of hepatic-metabolized antibiotics as independent risk factors for DILI(P<0.05).Conclusion The use of propacetamol for postoperative analgesia presents a risk for liver injury,and the risk is particularly pronounced in males,obesity,high-dose dosing,patients with underlying hepatic disease,and comorbid hepatic metabolism of antimicrobial drug use.It is recommended to strengthen the monitoring of liver function in clinical application,strictly control the dosage and duration of treatment,and avoid co-administration with hepatotoxic drugs to ensure the safety of drug use.

Objective:To analyze the relationship between serum GATA binding protein-3(GATA3)and eosinophilic cationic protein(ECP)and lung function indexes in children with obliterated bronchiolitis and their predictive value for poor prognosis.Methods:96 children with bronchiolitis obliterans admitted to our hospital from January 2022 to July 2024 were divided into mild group(34 cases)and moderate to severe group(62 cases)according to their severity.Serum GATA3,ECP levels and lung function indexes were detected in the two groups,and Pearson correlation was used to analyze the correlation between serum GATA3,ECP levels and lung function indexes.According to the levels of serum GATA3 and ECP,they were divided into high GATA3 group and low GATA3 group,high ECP group and low ECP group.The incidence of adverse prognosis in different groups was compared.Area under ROC curve(AUC)was used to evaluate the predictive efficacy of serum GATA3 combined with ECP for poor prognosis.Results:The levels of serum GATA3 and ECP in moderate and severe group were higher than those in mild group(P＜0.05).By Pearson correlation analysis,serum GATA3 and ECP levels were negatively correlated with tidal volume(VT),peak-to-expiratory volume(VPEFNE)and peak-to-time ratio(TPTEF/TE)in children with bronchiolitis obliterans(P＜0.05).The incidence of adverse prognosis in the high GATA3 group was higher than that in the low GATA3 group,and the incidence of adverse prognosis in the high ECP group was higher than that in the low ECP group(P＜0.05).ROC curve analysis showed that serum GATA3 combined with ECP had a sensitivity of 90.45％,specificity of 52.37％and AUC of 0.893 in predicting adverse prognosis of children with bronchiolitis obliterans.Conclusion:Serum GATA3 and ECP are closely related to pulmonary function indexes in children with bronchiolitis obliterans.The combined effect of GATA3 and ECP is better in predicting poor prognosis,and it has a certain suggestive role in evaluating the disease.

Objective:To investigate the effects of different BMI classifications on rehabilitation outcomes and complications after total knee arthroplasty(TKA).Methods:Clinical data of 88 patients who underwent TKA in our hospital from January 2022 to June 2024 were retrospectively analyzed.According to the World Health Organization(WHO)BMI standards,patients were divided into normal weight group(18.5 ≤BMI＜24.9 kg/m2),overweight group(25.0≤BMI＜29.9 kg/m2),mild obesity group(30.0≤BMI＜34.9 kg/m2),and severe obesity group(BMI≥35.0 kg/m2).Baseline data,operation time,intraoperative blood loss,hospital stay,postoperative knee function scores,pain scores,range of motion(ROM),and incidence of complications were compared among groups.Results:With the increase of BMI,operation time was prolonged,intraoperative blood loss increased,and hospital stay extended,with statistically significant differences(P＜0.05).At 3-month and 6-month follow-ups,Knee Society Score(KSS)and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)showed that functional recovery decreased with increasing BMI(P＜0.05).Regarding postoperative complications,the incidence of poor incision healing,infection,and deep vein thrombosis(DVT)in the obese groups was significantly higher than in the normal weight and overweight groups(P＜0.05).Conclusion:BMI is an important factor affecting rehabilitation outcomes and complications after TKA.Patients with high BMI have slower functional recovery and higher complication rates.For patients with high BMI,preoperative weight loss and individualized rehabilitation programs should be considered to improve TKA prognosis.