Objective:To explore the association between cardiometabolic multimorbidity(CMM), the number of cardiometabolic diseases(CMD)and mild cognitive impairment(MCI)among the older adults in urban communities.Methods:Based on the baseline data of the Hubei Memory and Aging Cohort Study(HMACS)from 2018 to 2023, CMM was defined as the coexistence of two or more CMDs(Type 2 diabetes, stroke and ischemic heart disease). Multivariate logistic regression was employed to examine the association between CMM, the number of CMDs and the prevalence of MCI, as well as subgroup heterogeneity.Results:This study included 6 113 urban participants aged ≥65 years(55.6% were female; mean age 71.9±5.7 years). The prevalence of MCI was 19.3%, with an increasing trend observed as the number of CMD increased(17.7%, 20.5%, 24.6%, 28.3%). After adjusting for all variables, a significant association was observed between CMM group and the prevalence of MCI( OR: 1.24, 95% CI: 1.01-1.52)compared with the non-CMM group.As the number of CMD increased, the prevalence of MCI increased( Ptrend=0.011), but the association was only significant in the group with two CMDs.Subgroup analyses revealed that in males( OR: 1.48, 95% CI: 1.10-2.00), those with more than 9 years of education( OR: 1.52, 95% CI: 1.15-2.02), and those with hypertension( OR: 1.33, 95% CI: 1.05-1.67), CMM was significantly associated with MCI, and the association with MCI increased significantly with the increase in the number of CMDs(all Pfor trend <0.05). Conclusions:Among urban community-dwelling older adults aged ≥65 years in China, CMM and the cumulative number of CMDs are significantly associated with an increase of MCI, particularly in males, those with higher education levels, and those with hypertension.In the future, the need for enhanced MCI screening for CMM patients should be strengthened, and targeted prevention and control of cognitive impairment should be implemented for high-risk populations.

TAFRO syndrome is an idiopathic systemic inflammatory disease that overlaps with idiopathic multicentric Castleman disease (iMCD). The clinical features of TAFRO syndrome include thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis/renal insufficiency (R) and organomegaly (O). The paper reports a special clinical subtype of iMCD—TAFRO syndrome in a patient, manifested as multiple-system involvement including serous effusion (ascites), fever, thrombocytopenia, anemia, multiple lymphadenopathies, pancreatitis and renal insufficiency. Bone marrow biopsy pathology showed active bone marrow hyperplasia. Renal biopsy revealed renal thrombotic microangiopathy, acute renal tubular interstitial injury combined with chronic lesions. Lymph node biopsy demonstrated lymphoproliferative lesions consistent with Castleman disease (hyaline vascular type). Following diagnosis, glucocorticoids, tacrolimus, rituximab and lenalidomide were administered, resulting in significant symptomatic improvement: ascites disappeared, and urinary findings, erythrocyte counts, renal function and hematological indexes normalized. The paper describes the patient's clinical manifestations, diagnosis and treatment process, and prognosis, and reviews relevant literature, to improve clinicians' understanding of this rare disease.

Objective:To explore the association between cardiometabolic multimorbidity(CMM), the number of cardiometabolic diseases(CMD)and mild cognitive impairment(MCI)among the older adults in urban communities.Methods:Based on the baseline data of the Hubei Memory and Aging Cohort Study(HMACS)from 2018 to 2023, CMM was defined as the coexistence of two or more CMDs(Type 2 diabetes, stroke and ischemic heart disease). Multivariate logistic regression was employed to examine the association between CMM, the number of CMDs and the prevalence of MCI, as well as subgroup heterogeneity.Results:This study included 6 113 urban participants aged ≥65 years(55.6% were female; mean age 71.9±5.7 years). The prevalence of MCI was 19.3%, with an increasing trend observed as the number of CMD increased(17.7%, 20.5%, 24.6%, 28.3%). After adjusting for all variables, a significant association was observed between CMM group and the prevalence of MCI( OR: 1.24, 95% CI: 1.01-1.52)compared with the non-CMM group.As the number of CMD increased, the prevalence of MCI increased( Ptrend=0.011), but the association was only significant in the group with two CMDs.Subgroup analyses revealed that in males( OR: 1.48, 95% CI: 1.10-2.00), those with more than 9 years of education( OR: 1.52, 95% CI: 1.15-2.02), and those with hypertension( OR: 1.33, 95% CI: 1.05-1.67), CMM was significantly associated with MCI, and the association with MCI increased significantly with the increase in the number of CMDs(all Pfor trend <0.05). Conclusions:Among urban community-dwelling older adults aged ≥65 years in China, CMM and the cumulative number of CMDs are significantly associated with an increase of MCI, particularly in males, those with higher education levels, and those with hypertension.In the future, the need for enhanced MCI screening for CMM patients should be strengthened, and targeted prevention and control of cognitive impairment should be implemented for high-risk populations.

TAFRO syndrome is an idiopathic systemic inflammatory disease that overlaps with idiopathic multicentric Castleman disease (iMCD). The clinical features of TAFRO syndrome include thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis/renal insufficiency (R) and organomegaly (O). The paper reports a special clinical subtype of iMCD—TAFRO syndrome in a patient, manifested as multiple-system involvement including serous effusion (ascites), fever, thrombocytopenia, anemia, multiple lymphadenopathies, pancreatitis and renal insufficiency. Bone marrow biopsy pathology showed active bone marrow hyperplasia. Renal biopsy revealed renal thrombotic microangiopathy, acute renal tubular interstitial injury combined with chronic lesions. Lymph node biopsy demonstrated lymphoproliferative lesions consistent with Castleman disease (hyaline vascular type). Following diagnosis, glucocorticoids, tacrolimus, rituximab and lenalidomide were administered, resulting in significant symptomatic improvement: ascites disappeared, and urinary findings, erythrocyte counts, renal function and hematological indexes normalized. The paper describes the patient's clinical manifestations, diagnosis and treatment process, and prognosis, and reviews relevant literature, to improve clinicians' understanding of this rare disease.

Objective To identify easily confused Chinese herbal pieces by micro-macroscopical identification method,and study its application value in quality acceptance of Chinese herbal pieces in medical institutions.Methods Using the method of micro-macroscopical identification,with the help of related instruments,the microscopic characteristics of 10 groups of 31 kinds of Chinese herbal pieces,which were easy to be confused and could not be observed by naked eye and ordinary magnifying glass,were analyzed and summarized according to the classification of different medicinal parts,such as flowers,fruits,seeds,whole grass,roots and rhizomes,stems,and others,and pictures were taken to save them.Results The micro-characters of 10 groups of 31 easily confused Chinese herbal medicines,including Eriocauli flos,Eriocaulon sexangulare,Eriocaulon australe,Aurantii fructus,Citrus changshan-huyou,Chaenomelis fructus,Chaenomeles cathayensis,Perillae fructus,Perillae fructus(Physalis alba),Perillae fructus(Wild),Astragali complanati semen,Astragalus chinensis,Selaginellae herba,Selaginella pulvinata,Selaginella moellendorfii,Selaginella doederleinii,Selaginella uncinata,Lysimachiae herba,Lysimachia hemsleyana,Desmodium styracifolium,Dryopteris crassirhizoma,Woodwardia japonica,Brainea insignis,root of Valvate actinidia,Actinidia arguta,Tripterygium wilfordii,root of Romanet grape,Trogopterus dung,Bat dung,Hare dung and Silkworm sand were observed.The various traditional Chinese medicines possessed unique identification characteristics.Flower-based medicines could be studied for their color,tissue structure,and surface features such as texture and trichomes.Fruit-based medicines could be studied for their fruit peel structure,color,degree of development,and outer characteristics such as cuticle layer and wax.Seed-based medicines could be studied for their morphology,size,color,and texture.Whole plant-based medicines could be studied for leaf length-to-width ratio,widest point,surface characteristics,and splitting situation,as well as stem trichomes and stomata.Root-based medicines,rhizome-based medicines,and stem-based medicines could be studied for their bark,wood structure,and the morphology and arrangement of vascular bundles or ducts.Other kinds of medicines could be studied from their sources,and these unique micro-characteristic identification features could be easily discovered with the help of a microscope.Conclusion Compared with the traditional characteristic identification,micro-macroscopical identification is more capable of improving the accuracy of Chinese herbal pieces identification,which is economical,practical,simple and intuitive,and can be popularized as a commonly used identification method of herbal medicines in medical institutions,and it is a feasible solution to realize the rapid inspection of herbal medicines.

Objective:To investigate the expression of LACTB and GST-π in endometrial carcinoma and their correlation with estrogen and progesterone receptors.Methods:A total of 165 patients with endometrial cancer admitted to our hospital from Jan. 2015 to Oct. 2020 were selected to observe the expression of LACTB, GST-π, estrogen and progesterone receptors in patients with different tumor stages, degrees of differentiation, muscular infiltration, tissue type, tumor diameter and whether there was lymph node metastasis. The correlation between the expression of LACTB and GST-π and the expression of female and progesterone receptors and the survival of patients with different expressions of LACTB and GST-π were analyzed.Results:The LATCB positive rate decreased in patients with tumor stage III to IV, high differentiation, myometrial infiltration ≥1/2, tissue type I, tumor diameter <2 cm and no lymph node metastasis ( P<0.05), and the GST-π positive rate was not statistically significant ( P>0.05). The positive rate of GST-π in patients with chemotherapy resistance was higher than that in patients with chemotherapy sensitivity, and the difference was statistically significant ( P<0.05). The positive rate of estrogen receptor decreased in patients with tumor stage III to IV, high differentiation, tissue type II, no lymph node metastasis, and chemotherapy resistance, and the difference was statistically significant ( P<0.05). The positive rate of progesterone receptor decreased in patients with tumor stage III to IV, low differentiation, tissue type I and no lymph node metastasis, and the difference was statistically significant ( P<0.05). In this study, 110 patients with LACTB positive expression were detected, with an average LACTB positive staining intensity (25.92±4.77) %, and 99 patients with GST-π positive expression were detected, with an average GST-π positive staining intensity (27.46±4.83). A total of 50 patients with LACTB positive and GST-π negative had an average survival time of (41.48±5.52) months, a total of 39 patients with LACTB negative and GST-π positive had an average survival time of (21.25±3.15) months, and a total of 60 patients with LACTB positive and GST-π positive had an average survival time of (21.25±3.15) months. The mean survival time of 16 patients with both LACTB negative and GST-π negative was 29.31±3.77 months. The mean survival time was 31.54±4.61 months. Pearson correlation test showed that the staining intensity of LACTB positive staining was positively correlated with the survival time of patients. The positive staining intensity of GST-π was negatively correlated with survival (correlation coefficient =0.392, -0.284, P<0.01). Pearson correlation analysis showed that LACTB was positively correlated with estrogen and progesterone receptors. GST-π was negatively correlated with estrogen receptor ( P<0.05) . Conclusions:The expression of LACTB in patients with endometrial cancer is associated with the disease of the patients. The survival of patients with high expression is longer. The expression of GST-π is associated with the chemotherapy resistance of patients, both of which can be used as indicators to evaluate the prognosis of patients. Moreover, the expressions of LACTB and GST-π are correlated with the expression of female and progesterone receptors, which may be regulated by the expression of female and progesterone receptors.

Objective:To investigate the value of serum gastrin-17 (G-17), pepsinogen (PG) I and II, and narrow-band imaging endoscopy in combination for identifying early gastric cancer.Methods:A total of 86 patients with suspected gastric cancer admitted to Zhoushan Hospital from January to September 2021 were included in this study. These patients underwent serum G-17, PG I, and PG II examination and narrow-band imaging endoscopy. PG I/PG II ratio (PGR) was calculated. Taking pathological results as a gold standard, the sensitivity, specificity, and accuracy of serum G-17, PG I, PG II, and narrow-band imaging endoscopy in combination for identifying early gastric cancer were calculated.Results:Serum G-17 level and PGR in the gastric cancer group were (20.14 ± 4.59) pmol/L and (20.21 ± 4.50) μg/L, respectively, which were significantly higher than (17.06 ± 4.05) pmol/L and (17.15 ± 4.08) μg/L in the atrophic gastritis group ( q = 4.12, 3.77, both P < 0.05) and (12.35 ± 3.31) pmol/L and (10.82 ± 5.26) μg/L in the non-atrophic gastritis group ( q = 9.34, 10.39, both P < 0.05). PG I and PGR in the gastric cancer group were (63.90 ± 14.41) μg/L and (3.17 ± 2.08), respectively, which were significantly lower than (79.34 ± 16.25) μg/L and (5.04 ± 3.61) in the atrophic gastritis group ( q = 5.33, 3.44, both P < 0.05) and (106.42 ± 20.18) μg/L and (9.22 ± 4.06) in the non-atrophic gastritis group ( q = 13.16, 9.97, both P < 0.05). Among the 86 patients included, gastric cancer was determined by biopsy in 43 patients. Pathological results showed that 37 patients had early gastric cancer and 6 patients had gastric cancer involving the muscle layer or serous layer. Narrow-band imaging endoscopy results showed that 83.78% (31/37) of patients had early gastric cancer. Serum G-17, PG, and narrow-band imaging endoscopy in combination showed that 91.89% (34/37) of patients had early gastric cancer. Taking pathological results as a gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value of serum G-17 combined with PG for screening early gastric cancer were 72.97% (27/37), 77.55% (38/49), 71.05% (27/38), and 79.17% (38/48), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of narrow-band imaging endoscopy for screening early gastric cancer were 83.78% (31/37), 85.71% (42/49), 83.10% (31/38), and 87.50% (42/48). The sensitivity and specificity of serum G-17, PG, and narrow-band imaging endoscopy in combination for screening early gastric cancer were 91.89% (34/37) and 91.84% (45/49), respectively. Conclusion:Serum G-17, pepsinogen, and narrow-band imaging endoscopy in combination can improve the diagnostic accuracy of early gastric cancer and is an effective method for screening early gastric cancer.

Objective:To investigate the relationship between inherited dysplasminogenemia and cerebral infarction (CI) by phenotype and gene mutation analysis of 2 inherited dysplasminogenemia pedigrees.Methods:Retrospective analysis was carried out on clinical data of 2 patients diagnosed with CI who were treated in the Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University in January and March 2021, and peripheral venous blood samples were collected from proband 1 and his family members (8 subjects, 4 generations in total) and proband 2 and her family members (5 subjects of 3 generations in total), and their plasminogen (PLG) activity (PLG:A), protein C activity, protein S activity, antithrombin activity and the content of PLG antigen (PLG: Ag), fibrinogen, D-dimer and fibrinogen degradation products were measured for definite diagnosis. All 19 exons,5′ and 3′ untranslated regions of PLG were amplified with polymerase chain reaction, and the amplification products were analyzed by direct DNA sequencing. The results were compared with human PLG reference sequences published in the National Center for Biotechnology Information database using Chromas software to find the mutation sites, and confirmed by reverse sequencing.Results:Both of the 2 patients with confirmed CI had a young onset, and PLG: A was reduced to 21% in the proband 1 and to about 50% in 4 family members; PLG: A was reduced to about 50% in the proband 2 and 2 family members; PLG:Ag and the above tests were essentially normal in both probands and family members. Gene analysis showed that the proband 1 had the homozygous mutation of c.1858G>A in exon 15, the 4 family members of the proband 1, proband 2 and her 2 family members had the heterozygous mutation of c.1858G>A in exon 15, which resulted in a mutation of alanine at position 620 in PLG to threonine (p.Ala620Thr).Conclusions:The decrease of PLG:A was caused by the p.Ala620Thr missense mutation of PLG gene. Proband having CI may be related to the inhibition of fibrinolytic function in the organism due to the p.Ala620Thr missense mutation.

Salvianolic acid injection play an important role in cardiovascular diseases by promoting angiogenesis, improving hemorheology, anti-platelet aggregation, anti-inflammatory, anti-oxidative stress, improving endothelial cell function, and inhibiting atherosclerosis. However, mechanismstudies focusing on molecular level are quite few. Although there are many adverse reactions and many factors causing adverse reactions, the incidence rate of adverse reactions is low with safety.

Objective To explore the intervention effect of low-dose vitamin D on glucose metabolism of patients with impaired glucose regulation. Methods A total of196 subjects receiving oral glucose tolerance test were enrolled in this study, including individuals with normal glucose tolerance ( NGT group, n=67) and indi-viduals with impaired glucose regulation (IGR group, n=129). The IGR group was divided into intervention group ( n=64) and non-intervention group ( n=65) according to vitamin D intervention ( for 1 year) performed or not. Clinical data and biochemical parameters were collected. Results The level of serum 25(OH)D3 was significantly lower in the IGR group than that of normal control group ( P<0. 05) . After 1 year of low-dose vita-min D intervention, insulin sensitivity increased and insulin resistance decreased in the intervention group as compared with non-intervention group. Diabetes developed less frequently in the intervention group ( 25 of 64 [ 39. 1％] ) compared with non-intervention group ( 30 of 65 [ 46. 2％] ) . But there was no significant differ-ent in diabetes prevalence between the two groups. Conclusions Vitamin D intervention can improve insulin sensitivity and reduce insulin resistance in patients with impaired glucose regulation. Low dose vitamin D can improve the abnormal glucose metabolism outcome in patients with impaired glucose regulation.