With the aging population and the widespread implementation of lung cancer screening programs, an increasing number of elderly patients are undergoing curative lung resection. Due to diminished physiological reserve and complex comorbidities, this demographic exhibits a significantly higher incidence of severe perioperative complications (defined as Clavien-Dindo grade≥Ⅲ), which adversely affects both perioperative safety and long-term prognosis. In recent years, the research paradigm has shifted from univariate analysis toward multidimensional risk integration and the development of predictive models. This article systematically reviews the key risk factors for severe perioperative complications in elderly lung cancer patients, encompassing biological aging processes, frailty and sarcopenia, cardiopulmonary and renal functional reserves, inflammatory-immune and coagulation status, and perioperative interventions. Furthermore, it traces the evolution of risk assessment tools from traditional regression models to machine learning models that integrate multimodal data. The review also discusses common challenges in this field, including the standardization of outcome definitions, external validation, calibration assessment, and clinical translation. Future efforts should prioritize the deep integration of predictive tools with clinical decision support systems to establish a closed-loop care pathway from risk identification to stratified intervention, thereby effectively reducing complication rates and enhancing surgical outcomes for elderly lung cancer patients.

To evaluate the reliability of flash continuous glucose monitoring(CGM) and itsaccuracy in supporting clinical decision-making after pancreatic surgery.

Objective:To identify the risk factors for perioperative cardiac arrest (POCA) in elderly patients undergoing general anesthesia.Methods:This case-control study enrolled elderly patients aged ≥60 yr who underwent surgery under general anesthesia at Peking Union Medical College Hospital between January 1, 2013, and November 30, 2024. The case group consisted of patients who experienced POCA, defined as cessation of cardiac mechanical activity and loss of effective circulation, requiring immediate chest compressions and/or defibrillation within 24 h from entering the operating room to the end of anesthesia. The control group consisted of elderly patients without POCA, matched to cases by sex and date of surgery in a ratio of 1∶3. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for POCA based on patients′ baseline and surgical characteristics.Results:A total of 53 POCA cases and 159 matched controls were included. The results of multivariate logistic regression analysis identified an American Society of Anesthesiologists Physical Status classification of ≥Ⅲ ( OR=4.90, 95% confidence interval [ CI] 2.21-10.89, P<0.001) and the presence of peripheral vascular disease ( OR=2.53, 95% CI 1.10-5.81, P=0.028) as independent risk factors for POCA. Higher preoperative hemoglobin concentration was found to be a protective factor ( OR=0.97, 95% CI 0.95-0.99, P<0.001). Conclusions:An American Society of Anesthesiologists Physical Status classification of ≥Ⅲ and comorbid peripheral vascular disease are independent risk factors for POCA in elderly patients undergoing general anesthesia, while higher preoperative hemoglobin concentration serves as a protective factor.

OBJECTIVE: To investigate possible associations between physical function assessment scales, such as Short Physical Performance Battery (SPPB) and Berg Balance Scale (BBS), with all-cause mortality in acute decompensated heart failure (ADHF) patients. METHODS: A total of 108 ADHF patients were analyzed from October 2020 to October 2022, and followed up to May 2023. The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis, while for SPPB and BBS, univariate Cox regression analysis was followed by receiver operating characteristic curves, in which the area under the curve represented their predictive accuracy for all-cause mortality. Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores. Optimal cut-off value for BBS was then identified using restricted cubic spline plots, and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test. The clinical utility of BBS was measured using decision curve analysis. RESULTS: For baseline characteristics, age, female, blood urea nitrogen, as well as statins, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors, were predictive for all-cause mortality for ADHF patients. With respect to SPPB and BBS, higher scores were associated with lower all-cause mortality rates for both assessments; similar area under the curves were measured for both (0.774 for SPPB and 0.776 for BBS). Furthermore, BBS ≤ 36.5 was associated with significantly higher mortality, which was still applicable even adjusting for confounding factors; BBS was also found to have great clinical utility under decision curve analysis. CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients, as well as prognosticate on all-cause mortality. Moreover, prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.

Given that ovarian stimulation is vital for assisted reproductive technology (ART) and results in elevated serum estrogen levels, exploring the impact of elevated estrogen exposure on oocytes and embryos is necessary. We investigated the effects of various ovarian stimulation treatments on oocyte and embryo morphology and gene expression using a mouse model and estrogen-treated mouse embryonic stem cells (mESCs). Female C57BL/6J mice were subjected to two types of conventional ovarian stimulation and ovarian hyperstimulation; mice treated with only normal saline served as controls. Hyperstimulation resulted in high serum estrogen levels, enlarged ovaries, an increased number of aberrant oocytes, and decreased embryo formation. The messenger RNA (mRNA)‍-sequencing of oocytes revealed the dysregulated expression of lysine-specific demethylase 6b (Kdm6b), which may be a key factor indicating hyperstimulation-induced aberrant oocytes and embryos. In vitro, Kdm6b expression was downregulated in mESCs treated with high-dose estrogen; treatment with an estrogen receptor antagonist could reverse this downregulated expression level. Furthermore, treatment with high-dose estrogen resulted in the upregulated expression of histone H3 lysine 27 trimethylation (H3K27me3) and phosphorylated H2A histone family member X (γ-H2AX). Notably, knockdown of Kdm6b and high estrogen levels hindered the formation of embryoid bodies, with a concomitant increase in the expression of H3K27me3 and γ-H2AX. Collectively, our findings revealed that hyperstimulation-induced high-dose estrogen could impair the demethylation of H3K27me3 by reducing Kdm6b expression. Accordingly, Kdm6b could be a promising marker for clinically predicting ART outcomes in patients with ovarian hyperstimulation syndrome.
Female ; Mice ; Demethylation/drug effects* ; Embryonic Stem Cells ; Estrogens/administration & dosage* ; Gene Expression/drug effects* ; Histones/metabolism* ; Jumonji Domain-Containing Histone Demethylases/metabolism* ; Mice, Inbred C57BL ; Oocytes ; Ovary/drug effects* ; Reproductive Techniques, Assisted ; Animals

BACKGROUND:Neuroinflammation is a major cause of exacerbation after spinal cord injury.In recent years,pyroptosis has received much attention due to its remarkable pro-inflammatory features.Some of these natural products can significantly inhibit the inflammatory response and improve the damaged nerve function by regulating the level of pyroptosis after spinal cord injury,which provides a new therapeutic idea for spinal cord injury.OBJECTIVE:To summarize the mechanism of action of natural products in regulating pyroptosis for the treatment of spinal cord injury,with a view to providing lessons and references for future research on the treatment of spinal cord injury.METHODS:The search terms"spinal cord injury,pyroptosis,inflammasome,natural products,natural compounds,traditional Chinese medicine"in Chinese and English were used to search for relevant literature since the establishment of the database up to September 2024 in the databases of PubMed,Web of Science,WanFang,and CNKI.According to the inclusion and exclusion criteria,75 relevant articles were finally obtained.RESULTS AND CONCLUSION:(1)Pyroptosis is an important pro-inflammatory pathway in spinal cord injury,and controlling pyroptosis is an effective way to improve damaged nerve function.(2)Some natural products can regulate pyroptosis via the NLRP3/Caspase-1 classical pyroptosis pathway,the NF-κB-related pathway,other upstream pathways such as Nrf2/HO-1,and autophagy,thereby affecting the level of tissue inflammation and accelerating neurological recovery after spinal cord injury.(3)The anti-pyroptosis effects of these natural products are mostly dependent on the NLRP3 classical pyroptosis pathway,and there is a lack of studies on other pyroptosis pathways.(4)There are still many problems in this field,such as the fact that these natural products are not currently supported by evidence from appropriate clinical studies.(5)The natural product has great potential in regulating pyroptosis and is expected to be a powerful weapon in the treatment of spinal cord injury.

Objective To explore the value of inflammatory load index(IBI)in the diagnosis and prognosis of gastric cancer patients.Methods Clinical data of patients who underwent gastric cancer surgery in the Department of General Surgery of the Second Hospital of Lanzhou University from January 2016 to December 2018 were retrospectively analyzed,and the patients were divided into the high IBI group and the low IBI group based on the optimal cut-off value of IBI.ROC curve was used to determine the optimal cut-off value of IBI,and the survival curve was constructed using the Kaplan-Meier method,and the differences between groups were examined using the Log-rank test.Cox regression analysis was performed to study the prognostic factors of gastric cancer patients.Results The best cut-off value for IBI diagnosis was 8.796,and the best cut-off value for prognosis was 28.75.IBI was related to the clinical case characteristics of gastric cancer patients,such as surgical access,the degree of differentiation,CK7,CK20,LMP-1,and Ki-67(P＜0.05).The results of univariate analysis showed that intraoperative bleeding,preoperative CEA,preoperative CA125,preoperative CA199,IBI,tumor diameter size,margins of incision,vascular invasion,nerve invasion,pT stage and pN stagewere the influencing factors on the prognosis of gastric cancer patients(P＜0.05).The results of multifactorial regression analysis showed that intraoperative bleeding,preoperative CEA,preoperative CA199,IBI,tumor diameter size,pT stage and pN stagewere independent risk factors affecting the prognosis of gastric cancer patients(P＜0.05).The median OS of patients in the high IBI group and low IBI group were 32.9 months and 74.8 months,respectively,with statistically significant differences(P＜0.001).Conclusion IBI is an independent risk factor for poor prognosis of patients with gastric cancer,and it has a good predictive value in diagnosis and prognosis.

Cholesterol-lowering therapy is necessary in patients with hypercholesterolaemia, particularly those at high risk of atherosclerotic cardiovascular disease(ASCVD). However, in clinical practice, it is important to avoid initiating lipid-modifying treatment indiscriminately without first identifying the underlying cause. Several key principles should be emphasized in lipid management. First, cholesterol reduction should be appropriate, avoiding excessive lowering that could lead to overcorrection. Second, comprehensive management is crucial; for patients with ASCVD, lifestyle modification, including weight reduction, smoking cessation, limiting alcohol consumption, and alleviating anxiety, as important as lipid-modifying therapy. Additionally, attention should be paid to the potential adverse effects of low cholesterol levels, which warrant close monitoring throughout treatment. Finally, further evidence is needed to address the ongoing controversies regarding certain clinical outcomes.

OBJECTIVE: To assess the independent and combined effects of air pollutants, meteorological factors, and greenspace exposure on new tuberculosis (TB) cases. METHODS: TB case data from Shanghai (2013-2018) were obtained from the Shanghai Center for Disease Control and Prevention. Environmental data on air pollutants, meteorological variables, and greenspace exposure were obtained from the National Tibetan Plateau Data Center. We employed a distributed-lag nonlinear model to assess the effects of these environmental factors on TB cases. RESULTS: Increased TB risk was linked to PM _2.5, PM ₁₀, and rainfall, whereas NO ₂, SO ₂, and air pressure were associated with a reduced risk. Specifically, the strongest cumulative effects occurred at various lags: PM _2.5 ( RR = 1.166, 95% CI: 1.026-1.325) at 0-19 weeks; PM ₁₀ ( RR = 1.167, 95% CI: 1.028-1.324) at 0-18 weeks; NO ₂ ( RR = 0.968, 95% CI: 0.938-0.999) at 0-1 weeks; SO ₂ ( RR = 0.945, 95% CI: 0.894-0.999) at 0-2 weeks; air pressure ( RR = 0.604, 95% CI: 0.447-0.816) at 0-8 weeks; and rainfall ( RR = 1.404, 95% CI: 1.076-1.833) at 0-22 weeks. Green space exposure did not significantly impact TB cases. Additionally, low temperatures amplified the effect of PM _2.5 on TB. CONCLUSION Exposure to PM _2.5, PM ₁₀, and rainfall increased the risk of TB, highlighting the need to address air pollutants for the prevention of TB in Shanghai.
China/epidemiology* ; Humans ; Air Pollutants/analysis* ; Tuberculosis/epidemiology* ; Incidence ; Meteorological Concepts ; Particulate Matter/adverse effects* ; Environmental Exposure ; Male ; Female ; Adult ; Air Pollution ; Middle Aged

As a multifactorial chronic metabolic disorder with complex causes and serious health risks, obesity has drawn significant societal and medical attention. This article systematically reviewed the latest advancements in the clinical diagnosis and treatment of obesity. A disease-centered diagnosis and treatment concept has been proposed, which combines BMI and introduces a brand-new clinical diagnosis and treatment standard centered on fat content and functional disorders, such as new diagnostic markers like adipose tissue distribution, visceral adiposity, and waist-to-height ratio, to conduct a comprehensive assessment and lifespan management of patients. In recent years, novel biomarkers and artificial intelligence (AI)-assisted diagnosis have provided new tools for the diagnosis and treatment of obesity. In terms of treatment, combined therapy based on lifestyle and behavioral intervention has been widely recognized. The advent of new weight-loss drugs, such as glucagon-like peptide-1(GLP-1), minimally invasive techniques such as endoscopic sleeve gastrectomy(ESG), which reduced surgical risks, have provided possibilities for the treatment of obesity. The current concept of obesity management has become increasingly mature, feasible, and standardized. The construction principles of a weight management center, characterized by centralized management and individualized treatment, ensure the long-term stability of body weight and promote a healthy quality of life for patients with obesity.