Objective To explore the risk factors of immunoglobulin resistance in children with Kawasaki disease and the effect of different treatments.Methods The clinical data of 1460 children with Kawasaki disease who were diagnosed and treated with IG in Tongji Hospital,Huazhong University of Science and Technology were included.The risk factors of IG resistance in Kawasaki disease were screened by Logistic regression analysis,and the IG resistance groups were divided into 5 groups accord-ing to different treatment regimens(group A:once IG+glucocorticoid,group B:twice IG,group C:twice IG+glucocorticoid,group D:twice IG+glucocorticoid+ulinastatin,group E:twice IG+ulinastatin),and the effects of different drug regimens in IG resistant group were analyzed.Results Multivariate Logistic regression analysis showed that the fever time was≤4 days be-fore the first dose of IG(OR 2.21,P＜0.05),monocyte count(OR1.515,P＜0.05),lymphocyte count(OR 1.117,P＜0.05),RDW-SD(OR1.083,P＜0.05),neutrophil ratio(OR 1.07,P＜0.05),erythrocyte sedimentation rate(OR 1.02,P＜0.05)and se-rum albumin concentration(OR 0.84,P＜0.05)were independent risk factors of IG resistance.There was no significant difference in the rate of coronary artery dilatation,the degree of coronary artery dilatation,and the duration of fever after the first dose of IG in IG resistant groups.Conclusion The fever time≤4 days before the first dose of IG,the increase of monocyte count,the increase of lymphocyte count,the increase of RDW-SD,the increase of neutrophil ratio,the increase of ESR,and the decrease of serum albumin concentration are the independent risk factors of IG resistance.There was no significant difference between the effect of glucocorticoid and ulinastatin on IG resistance in KD and that of IG alone.Glucocorticoid and ulinastatin combined with IG can not benefit patients.

Objective To study the correlation between apolipoprotein AⅣ (APOA4) and leucine-rich α-2 glycoprotein 1 (LRG1) expression and clinicopathological features in breast cancer tissues. Methods Clinical data of 120 patients diagnosed with breast cancer after surgical treatment and postoperative pathology were collected from the Third People's Hospital of Zigong City from March 2020 to September 2022. Western blotting (WB) was used to observe the expression of APOA4 and LRG1 in breast cancer tissues and corresponding paracuncinoma tissues (>5cm from the margin of cancer tissues). Analyzed the relationship between the expression of APOA4 and LRG1 and the clinicopathological features of breast cancer. The correlation between the expression of APOA4 and LRG1 was analyzed by Pearson methed. Kaplan-Meier survival analysis of the relationship between APOA4 and LRG1 protein expression and prognosis. Results The results of WB detection showed that the expression levels of APOA4 (2.81±0.74)and LRG1(1.01±0.26)in breast cancer tissues were significantly higher than those in normal breast tissues (1.26±0.38,0.57±0.12),and the differences were statistically significant (t=20.411,16.832,all P<0.05). Pearson correlation analysis showed that APOA4 was positively correlated with LRG1 protein expression in breast cancer tissues (r=0.624,P=0.014). The expression levels of APOA4 and LRG1 proteins in breast cancer tissues with ER positive,PR positive and lymph node metastasis in cTNM stage Ⅱ to Ⅲ were higher than those in breast cancer tissues with ER negative,PR negative and no lymph node metastasis in cTNM stage Ⅰ,and the differences were statistically significant (t=1.770～3.284,all P<0.05). The expression of APOA4 protein in breast cancer tissues with BMI ≥ 23.5kg/m2 was higher than that in breast cancer tissues with BMI<23.5kg/m2,and the difference was statistically significant (t=1.736,P=0.043). Kaplan-Meier survival analysis showed that the cumulative overall survival rates (83.13％,84.93％) of the APOA4 high expression group and LRG1 high expression group were lower than those of the APOA4 low expression group and LRG1 low expression group (94.74％,91.49％,and the differences were statistically significant (Log Rankx2==4.778,3.956,P=0.029,0.047). Conclusion Both APOA4 and LRG1 proteins are highly expressed in breast cancer tissues,and are involved in the occurrence and invasion of breast cancer. They are expected to become a reference index for diagnosis and treatment and prognosis prediction.

Objective:To investigate the efficacy and safety of oral maintenance therapy with tegafur for residual lesions in patients with locally advanced esophageal squamous cell carcinoma (ESCC) after chemoradiotherapy.Methods:A retrospective cohort study was conducted. A total of 38 patients with locally advanced ESCC who had residual lesions after receiving albumin bound paclitaxel combined with platinum chemoradiotherapy from March 2019 to September 2021 in Jiangsu Province Suqian Hospital were selected. All patients were divided into the maintenance treatment group (20 cases) and the non-maintenance treatment group (18 cases) based on whether they received oral maintenance therapy with tegafur after chemoradiotherapy. The progression-free survival (PFS) of both groups was compared and the adverse reactions of the maintenance treatment group were analyzed.Results:There were no statistically significant differences in baseline data between the 2 groups (both P > 0.05). The 1, 2, 3-year PFS rates for the maintenance treatment group were 95.0%, 78.1%, and 58.3%, respectively, with a median PFS time of 33.65 months (95% CI: 29.04-38.26 months); the 1, 2, 3-year PFS rates in the non-maintenance treatment group were 88.9%, 54.5%, and 12.1%, respectively, with a median PFS time of 25.08 months (95% CI: 20.97-29.18 months); there was a statistically significant difference in PFS between the 2 groups ( χ2 = 5.36, P = 0.021). The common adverse reactions in the maintenance treatment group included hematological adverse reactions, hand foot syndrome, decreased appetite, and fatigue. The more common adverse reactions were neutropenia [85.0% (17/20)] and leukopenia [65.0% (13/20)]; 9 cases experienced grade 3-4 adverse reactions, which were relieved by adjusting the dosage or discontinuing the medication. Conclusions:Oral maintenance therapy with tegafur may improve the survival of ESCC patients with residual lesions after chemoradiotherapy and the adverse reactions are controllable.

By analyzing the problems existing in the existing medical service model,this paper explores the core health needs of people in the era of intelligent medical care,and puts forward people-oriented,"4S-PAMA"(Self-Perception,Self-Assessment,Self-Management,Self-Adaption)health service model with individual active health promotion as the core.At the same time to build a multi-level,many modules,interactive health management of traditional Chinese medicine harbor as the breakthrough point,science and technology innovation as the means,through to transform traditional medical center or create new health management,in order to further carry out"perception model of the health management"model applied to provide theoretical basis.

Objective:To evaluate the safety and feasibility of double-port laparoscopic cholecystectomy (LC) combined with transcystic common bile duct (CBD) exploration using ultrafine choledochoscopy on patients with gallbladder stones and common bile duct stones.Methods:Clinical data of 35 patients undergoing double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy in Anhui No.2 Provincial People’s Hospital from December 2021 to June 2024 were retrospectively analyzed, including 8 males and 27 females, aged (45.8±18.1) years. In all patients, the diameter of the gallbladder duct was greater than 3 mm, the maximum diameter of the stones was less than 10 mm, and the number of stones was less than 5, and the gallbladder ducts were normal. Magnetic resonance cholangiopancreatography (MRCP) was used to measure the diameter of CBD, the number and the maximum diameter of stones. The operative time, intraoperative blood loss, postoperative anal exhaust time, postoperative hospital stay and complications (including abdominal infection, biliary tract infection, bile leakage, bleeding, etc.) of all patients were analyzed. The incidence of bile duct stenosis, residual stone or stone recurrence were followed up by telephone or outpatient review.Results:MRCP measurement indicated that the common bile duct diameter of patients was (8.1±1.3) mm. Single CBD stone occurred in 27 cases (77.1%, 27/35), and the mean maximum diameter of CBD stones was (3.9±1.3) mm. All patients successfully underwent the procedure. The operative time was (80.1±10.9) min, the intraoperative blood loss was (25.5±10.2) ml, the recovery time of postoperative anal exhaust was (17.3±4.7) h, and the postoperative hospital stay was (2.5±0.6) d. There were no complications such as abdominal and biliary tract infection, bile leakage and bleeding. All patients were followed up for 1-30 months, with a median follow-up time of 12 months. No biliary stricture, residual stones or recurrence occured during the follow-ups.Conclusion:In selected cases, double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy could be safe and feasible, with less trauma, quick recovery and short operative time.

Objective To design a digital intelligence-driven critical treatment platform to implement integrated treatment procedure inside and outside the hospital and intelligent whole-course managment from pre-hospital emergency care to discharge for critically ill patients.Methods The platform was designed with 5G,IoT,big data and aritificial intelligence techniques and developed with Java language,which adopted Oracle database-based data management and front-end and back-end separation mode,with the front end realized by Vue.js framework and the back end by microservice architecture.There were five functional modules for pre-hospital emergency care,multidisciplinary joint diagnosis and treatment,critical care,quality control management and post-discharge follow-up involved in the platform.Results The platform developed simplified the treatment procedure,enhanced the timeliness of emergency care,decreased the workload of nursing staffs and improved medical service efficiency and working efficiency effectively.Conclusion The platform increases first aid quality and treatment efficiency and provides critically ill patients with high-quality medical experience.[Chinese Medical Equipment Journal,2025,46(1):38-43]

BACKGROUND: Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China. METHODS: Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate. RESULTS: Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05). CONCLUSIONS: This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics. REGISTRATION ClinicalTrials.gov , NCT03484806.
Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Heart Valve Diseases/therapy* ; Kaplan-Meier Estimate ; Tertiary Care Centers ; Treatment Outcome

BACKGROUND: Gout is a chronic disease primarily caused by elevated urate levels, severely affecting joint health. Its global distribution varies, and updated data for China are lacking. This study aimed to analyze the current burden and trends of gout globally and in China, examining the burden by gender, age, and risk factors while providing future predictions. METHODS: This descriptive epidemiological secondary analysis utilized data from the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2021 study. Age-standardized incidence rate (ASIR), prevalence rate (ASPR), and disability-adjusted life years (DALYs) rates (ASDR) were used to assess the gout burden. Trends from 1990 to 2021 were analyzed across global regions, genders, and sociodemographic index (SDI) levels. The burden in China was further examined by gender, age, and associated risk factors. The Bayesian age-period-cohort (BAPC) model was used to predict future trends. Gout burden in China and the United States was compared. RESULTS: In 2021, gout affected 57 million people globally, with 9.4 million new cases and 1.75 million DALYs. From 1990 to 2021, the ASIR, ASPR, and ASDR increased by 17.2%, 21.9%, and 21.3%, respectively. Males experienced a significantly higher burden, with greater ASIR, ASPR, and ASDR increasing with higher SDI levels. In China, male ASIR, ASPR, and ASDR were over 2.8 times those of females, and the burden increased with age. In 2021, 31.4% of gout-related DALYs in China were attributed to high body mass index and 7.6% to kidney dysfunction. Between 1990 and 2021, the high body mass index-related burden of gout rose annually for both genders, while the kidney dysfunction-related gout burden remained stable. By 2050, the burden of gout in China is expected to continue increasing, with a slower rise in females and a decline in males after an initial increase. However, the overall burden will remain substantial. In comparison, the gout burden will be higher in the United States than in China. CONCLUSIONS Gout is becoming a significant health burden globally and in China, particularly among Chinese males and older individuals. With the aging population and lifestyle changes exacerbating the issue, effective strategies and measures are essential to prevent or reduce gout-related health issues.
Humans ; Gout/epidemiology* ; Male ; Female ; Incidence ; Middle Aged ; Prevalence ; China/epidemiology* ; Adult ; Risk Factors ; Aged ; Global Burden of Disease ; Disability-Adjusted Life Years ; Young Adult ; Adolescent ; Quality-Adjusted Life Years

Objective:To investigate the age-specific distribution characteristics of plantar pressure parameters in healthy children aged 3-12 years.Methods:This cross-sectional study retrieved data from the hospital information system in January 2025 for 272 children aged 3-12 years who underwent physical examinations and voluntarily completed plantar pressure analysis at Beijing Children′s Hospital, Capital Medical University, from July 2022 to December 2024. Demographic and clinical data, including anthropometric measurements (height and weight), flatfoot diagnosis and plantar pressure parameters (maximum pressure, time to maximum force, and contact time percentage in bilateral forefoot, midfoot, and hindfoot) were recorded. Participants were categorized into 3 age groups (3-6 years, 7-9 years, and 10-12 years) and were grouped by gender as well. Intergroup comparisons used one-way ANOVA or least-significant difference test or χ2 tests. Spearman′s rank correlation assessed the relationship between flatfoot prevalence and age. Results:Among 272 children (143 boys, 129 girls), age groups comprised 3-6 years (118 children, 64 boys and 54 girls), 7-9 years (96 children, 49 boys and 47 girls), and 10-12 years (58 children, 30 boys and 28 girls). Flatfoot prevalence was higher in boys than in that of girls (41.3% (59/143) vs. 28.7% (37/129), χ2=4.70, P=0.030), and negatively correlated with age ( r=-0.21, P<0.001). There all had statistically differences in the maximum pressure values of the bilateral forefoot and hindfoot among the 3 age groups (all P<0.001), and after pairwise comparison, those of the group of aged 3-6 years were all the lowest, and those of the group of aged 10-12 years were all the highest (all P<0.05). The maximum pressure values of bilateral midfoot in the group of aged 10-12 years were all higher than those of the other two groups (all P<0.001). There had no statistically differences in the time maximum force value of the bilateral forefoot among the 3 age groups (all P>0.05). The time maximum force values of bilateral midfoot in the group of aged 3-6 years were all lower than those of the other two groups (all P<0.05). There all had statistically differences in the time maximum force value of the bilateral hindfoot among the 3 age groups (all P<0.001), and after pairwise comparison, those of the group of aged 3-6 years were all the lowest, and those of the group of aged 10-12 years were all the highest (all P<0.05). There all had statistically differences in the contact time percentage values of the bilateral forefoot among the 3 age groups (all P<0.001), and after pairwise comparison, those of the group of aged 3-6 years were all the lowest, and those of the group of aged 10-12 years were all the highest (all P<0.05). There had no statistically differences in the contact time percentage values of the bilateral midfoot among the 3 age groups (all P>0.05). There all had statistically differences in the contact time percentage values of the bilateral hindfoot among the 3 age groups (all P<0.001), and after pairwise comparison, those of the group of aged 3-6 years were all lower than those of the other two groups (all P<0.05). Conclusion:Plantar pressure parameters exhibit distinct age-related patterns, reflecting the development of gait patterns and foot arch formation, which will be useful for monitoring physical growth and sports rehabilitation.

Undifferentiated spindle cell sarcoma of the prostate is clinically rare. This article reports a case of a 29-year-old male who presented on February 7，2022，with a two-week history of localized pain in the perineal area and spermatic cord. The diagnosis of prostatic undifferentiated spindle cell sarcoma was confirmed by imaging studies and prostate needle biopsy pathology. After consultation by the urologic oncology multidisciplinary team and considering the patient's preference，a treatment plan of radical radiotherapy combined with chemotherapy，immunotherapy，and targeted therapy was adopted，Partial stereotactic body radiotherapy（P-SBRT）was delivered to the tumor center with a total dose of 74.4 Gy，combined with cisplatin and pembrolizumab. Lung metastasis progression occurred 1.5 months after radiotherapy，and treatment was switched to a combination of pirarubicin，ifosfamide，pembrolizumab，and bevacizumab. After 39 months of follow-up，the disease remained well-controlled with preserved organ function and long-term survival. This case，utilizing a multidisciplinary comprehensive diagnosis and treatment model，provides a reference for organ-preserving non-surgical management in patients with prostate soft tissue sarcoma.