ObjectiveTo investigate the difference in the risk of cardiovascular diseases between patients with different subtypes of non-alcoholic fatty liver disease （NAFLD） from the perspective of metabolism， since cardiovascular events induced by metabolic disorders are the leading cause of death in NAFLD. MethodsThe cluster sampling method was used to conduct a multicenter cross-sectional study among three representative hospitals in Pudong New Area of Shanghai， China. A total of 37 122 sets of physical examination data from July 2022 to June 2023 were collected and stratified according to body mass index （BMI）. The chi-square test was used for comparison of continuous data between groups， and a multivariable Logistic regression analysis was used to investigate the association between NAFLD subtypes and cardiometabolic risk factors. ResultsA total of 9 372 cases of NAFLD were detected， with a detection rate of 25.25%， and more than 97% of these patients were diagnosed with metabolic associated fatty liver disease （MAFLD）. The subgroup analysis showed that the detection rates of lean， overweight， and obese NAFLD were 7.72%， 33.99%， and 63.56%， respectively. Compared with the patients with lean or overweight NAFLD， the patients with obese NAFLD showed a significantly higher proportion of patients with abnormalities in blood pressure， blood glucose， triglyceride （TG）， high-density lipoprotein （HDL） or uric acid （all P<0.001）. Among related risk factors， lean NAFLD was associated with the increase in total cholesterol （TC）（P<0.05）， while overweight NAFLD and obese NAFLD were not associated with TC abnormalities （P>0.05）； obese NAFLD was not associated with TG abnormalities， while lean NAFLD and overweight NAFLD were associated with TG abnormalities （both P<0.05）； all types of NAFLD were associated with the abnormalities of waist-hip ratio， blood pressure， blood glucose， low-density lipoprotein， HDL， and uric acid （all P<0.05）. ConclusionThe detection rates of different subtypes of NAFLD in Shanghai Pudong are close to those reported in China and globally， and the epidemiologic data of NAFLD can be used analogously for MAFLD. There are certain differences in the distribution and association of cardiometabolic risk factors between different subtypes of NAFLD， and targeted interventions should be formulated based on the metabolic characteristics of each type of NAFLD.

Objective:To explore the clinical features, genetic traits and prognosis status of acute myeloid leukemia (AML) patients with TP53 mutation.Methods:A retrospective case series study was performed. Clinical data of 42 AML patients with TP53 mutation abundance of at least 10% who were admitted to the First Hospital of Jilin University from April 2018 to August 2023 were collected. Chromosomal karyotypes were detected using fluorescence in situ hybridization (FISH), and next-generation sequencing (NGS) was performed on bone marrow samples from these patients. The Kaplan-Meier method was utilized to analyze the recurrence-free survival (RFS) of 22 patients who achieved complete remission (CR) after induction therapy, as well as the overall survival (OS) of 39 patients who underwent treatment. The Cox proportional hazards model was employed to analyze the factors influencing RFS and OS. Thirty-one patients who underwent induction therapy for ≥ 2 courses were divided into the non-refractory group (22 cases) and the refractory group (9 cases) based on whether CR was achieved after induction therapy, and the clinical and genetic characteristics and prognosis of the two groups were compared.Results:Among the 42 AML patients with TP53 mutation, there were 26 males and 16 females, with a median age [ M( Q1, Q3)] of 57.0 (44.0, 63.5) years. At the initial stage, the median white blood cell count in peripheral blood was 4.06×10 9/L (2.59×10 9/L, 27.36×10 9/L), the median proportion of bone marrow primitive cells was 45.25% (29.00%, 80.63%), the proportion of primitive and immature cells in bone marrow cell immune analysis was 28.70% (12.71%, 61.48%), and the median TP53 mutation abundance was 55.48% (38.72%, 73.31%). Among the 42 patients, 23 cases (54.76%) had complex chromosomal karyotypes, with the most frequent abnormal chromosomes being chromosome 5 (47.62%, 20 cases), chromosome 7 (45.24%, 19 cases) and chromosome 17 (26.19%, 10 cases). The mutant genes with high mutation frequency were DNMT3A (19.05%, 8 cases), N/KRAS (19.05%, 8 cases), ASXL1 (16.67%, 7 cases) and NPM1 (16.67%, 7 cases). Among the 39 patients with detailed TP53 mutation data, 36 had missense mutations and 3 had frameshift mutations. In the non-refractory and refractory groups, the N/KRAS mutation rates were 13.6% (3/22) and 55.6% (5/9), respectively ( P = 0.027). The median RFS time of 22 CR patients after induction therapy was 109 d (95% CI: 57-483 d). The results of multivariate Cox regression analysis showed that complex chromosomal karyotype was an independent risk factor for RFS ( HR = 11.819, 95% CI: 1.345-103.880, P = 0.028). The median RFS time of patients without and with complex chromosomal karyotypes was 842 d (95% CI: 0-1 716 d) and 148 d (95% CI: 88-208 d), respectively, and the difference in RFS between the two groups was statistically significant ( P = 0.001). The median OS time of 39 patients receiving treatment was 151 d (95% CI: 75-227 d). The results of multivariate Cox regression analysis showed that NPM1 gene mutation was an independent protective factor for OS ( HR = 0.289, 95% CI: 0.075-1.114, P = 0.071). The median OS time of patients with and without NPM1 gene mutation was 1 562 d (95% CI: 610- 1 710 d) and 136 d (95% CI: 99-173 d), respectively, and the difference in OS between the two groups was statistically significant ( P = 0.020). Conclusions:TP53-mutant AML patients often have poor chromosomal karyotypes and genetic abnormalities, while refractory AML patients often have N/KRAS mutation. The complex chromosomal karyotype is a risk factor for RFS, while NPM1 gene mutation is a protective factor for OS.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative option for patients with intermediate-high risk and relapsed/refractory acute myeloid leukemia (AML). Relapse remains the primary factor affecting the prognosis of patients after transplantation, with only a small number of patients achieving long-term survival after conventional salvage therapy. Molecular targeted drugs, as a new intervention measure, can significantly reduce the recurrence rate of AML after transplantation, without a significant increase in treatment-related adverse reactions. This article primarily focuses on the targeted drugs that are either in clinical use or in clinical trials, and reviews their role in maintenance therapy for AML after transplantation.

Objective To investigate the corrective effect of phacoemulsification with intraocular lens implantation combined with limbal relaxing incision(LRI)on cataract patients with corneal astigmatism.Methods A total of 39 patients(41 eyes)with cataract complicated by corneal astigmatism(the astigmatism was-2.0 to-0.5 D)who visited Department of Ophthalmology of The First Affiliated Hospital of Naval Medical University from Sep.2023 to May 2024 were enrolled.During phacoemulsification with intraocular lens implantation,LRI was performed to correct corneal astigmatism.Preoperative corneal astigmatism was measured using corneal topography and IOLMaster.Corneal astigmatism was re-examined 1 and 3 months after surgery,and Alpins method was used to analyze the changes of corneal astigmation before surgery and 1 month after surgery.The primary vector parameters,such as target induced astigmatism vector(TIA),surgically induced astigmatism vector(SIA),difference vector(DV),correction index and flattening index(FI),were observed.Results The preoperative corneal astigmatism was(-1.07+0.27)D,which was decreased to(-0.53+0.23)D 1 month postoperatively and(-0.55+0.24)D 3 months postoperatively(both P＜0.05).Vector analysis of corneal astigmatism showed that the TIA was(1.07+0.27)D,SIA was(0.99+0.42)D,DV was(0.53+0.24)D;correction index was 0.93+0.36(the ideal value is 1),suggesting slight undercorrection;the median of the angle of error had an absolute value of 18.15°,and the interquartile range was 15.19°;and the flattening effect was(0.70+0.45)D,the FI was 0.65+0.42,and the success rate was(50.42+19.29)％.Conclusion The combination of LRI with cataract surgery for correcting corneal astigmatism has demonstrated favorable corrective outcomes,especially for the correction of low to moderate corneal astigmatism.

Objective:To investigate the efficacy of cytoreductive radical prostatectomy (CRP) in patients with oligometastatic prostate cancer, and to assess its impact on progression-free survival (PFS), overall survival (OS), as well as the incidence and severity of complications.Methods:A prospective, monocentric non-randomized controlled trial including 80 cases of oligometastatic prostate cancer admitted to the Second Affiliated Hospital of Air Force Military Medical University from January 2020 to June 2024 was conducted. There were 40 patients each assigned to CRP group and no local treatment (NLT) group. The study used multivariate analysis to account for potential biases, analyzed the effects of CRP on PFS, OS as well as circulating tumor cell (CTC) and DNA methylation status. Meanwhile, the incidence and severity of complications were recorded. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for inter-group comparison. Count data and rank data were expressed as number of cases and percentage, and Chi-test was used for comparison between groups. Kaplan-Meier method was used to calculate PFS and OS, and Log-rank test was used to compare differences between groups. Multivariate analysis was performed using Cox proportional hazard regression model. A time-dependent Cox regression model was used to consider the effect of follow-up time on the results. Results:The PFS and OS in the CRP group were significantly better than those in the NLT group. The PFS rates in CRP group and NLT group at 12 months were 60% and 35% ( P=0.030). The OS rates at 12 months in the CRP group reached 80%, compared to 50% in the NLT group ( P=0.040). The level of CTC in the CRP group decreased from 50 cells/mL at first month to 5 cells/mL at 12th month, and the DNA methylation status decreased from 0.75 at first month to 0.30 at 12th month, which were significantly better than those in the NLT group ( P<0.05). The incidence of complications decreased gradually from first month to 12th month, with the CRP group from 30% to 10%, and the NLT group from 25% to 12% ( P=0.080). Although the severity of complications was slightly higher in the CRP group than in the NLT group at the early stage, the difference in severity gradually narrowed and eventually became similar between the two groups by the 12th month of follow-up. Conclusion:CRP significantly prolonged PFS and OS in patients with oligometastatic prostate cancer, reduced tumor burden, and despite a higher incidence of early complications, overall safety was good.

Objective To compare the clinical application value of medical glue and a new-type medical anchor positioning needle in thoracoscopic resection of pulmonary nodules.Methods A total of 182 patients with pulmonary nodules,who received video-assisted thoracic surgery(VATS)at the Department of Thoracic Surgery of Affiliated Hospital of Shaoxing University of China between January 2020 and December 2022,were enrolled in this study.Preoperative CT-guided localization of the pulmonary nodule was performed in all patients,including medical glue positioning in 89 patients(medical glue group)and anchor needle positioning in 93 patients(anchor needle group).The incidences of pneumothorax and bleeding,the time spent for positioning,the interval between localization and operation,the time spent for operation,and the radiation dose during localization process were recorded and the data were statistically analyzed.Results The success rate of positioning was 100％(93/93)in the anchor needle group and 96.7％(86/89)in the medical glue group.There was no statistically significant difference between the two groups(P>0.05).The incidence of bleeding was 31.2％(29/93)in the anchor needle group and 15.7％(14/89)in the medical glue group,and the difference between the two groups was statistically significant(P<0.05).The incidence of pneumothorax was 30.1％(28/93)in the anchor needle group and 20.2％(18/89)in the medical glue group,and there was no significant difference between the two groups(P>0.05).No statistically significant difference in the time spent for operation existed between the two groups(P>0.05).The time spent for positioning and the interval between localization and operation in the medical glue group were longer than those in the anchor needle group,and the radiation dose in the medical glue group was higher than that in the anchor needle group,and the differences between the two groups were statistically significant(P<0.05).Conclusion For the preoperative localization of ground glass opacity(GGO)or solitary pulmonary nodule(SPN),both medical glue positioning method and anchor needle positioning method have high clinical application value.The clinical and interventional physicians should adopt appropriate positioning method according to the patient's condition.

For two young female patients with extramedullary recurrence of reproductive system after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. And the characteristics of extramedullary relapse of reproductive system are summarized for exploring possible effective treatments.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.