Atypical placental site nodules (APSN) are a rare form of trophoblastic disease in pregnancy. There is limited research on APSN, and treatment methods are controversial, with unclear prognosis. This study collected clinical and prognostic data of 5 patients diagnosed with APSN at Xiangya Hospital of Central South University from June 2008 to June 2023, aiming to provide a better understanding of the prognosis of APSN patients and offer scientific evidence for clinical treatment. The average age of the 5 APSN patients was 32.60 years, and all patients underwent dilation and curettage or hysteroscopic surgery or hysteroscopic surgery without hysterectomy. Except for one patient who was lost to follow-up after 30 days, the remaining 4 patients were followed up for 1.36 to 4.61 years. During the follow-up, gynecological ultrasound did not show abnormalities, and serum human chorionic gonadotropin (HCG) tests were negative, with no evidence of malignancy. A search of both English and Chinese databases yielded 8 articles reporting the diagnosis, treatment, and follow-up outcomes of APSN, with 37 cases cumulatively followed up. Among them, 2 (5.41%) cases developed epithelial trophoblastic tumors or placental site trophoblastic tumors during follow-up, but there is insufficient evidence to determine whether these tumors directly originated from APSN or were secondary to APSN. Currently, there is no direct evidence suggesting that APSN has the potential for malignant transformation. Patients with APSN who have completed their childbearing may consider preserving their uterus, but close follow-up is needed to further evaluate the prognosis.
Humans ; Female ; Pregnancy ; Adult ; Trophoblastic Tumor, Placental Site/pathology* ; Uterine Neoplasms/diagnosis* ; Prognosis ; Dilatation and Curettage ; Chorionic Gonadotropin/blood*

Objective To analyze differentially expressed microRNAs(DEmiRNAs)in osteoporosis(OP)and chronic obstructive pulmonary disease(COPD)using bioinformatics tools,and to explore the interrelationship between these two diseases.Methods Gene expression microarrays for OP and COPD were retrieved from the GEO database.Differential analysis was conducted using the limma pack-age in R software version 4.1.0,identifying DEmiRNAs between OP and COPD.The selected DEmiRNAs were then subjected to target gene prediction using the miRDB and TargetScan databases.Predicted target genes were analyzed for transcription factor predictions using KOBAS,followed by GO and KEGG pathway analyses.Protein-protein interaction(PPI)network data for the target genes were down-loaded from the STRING database and analyzed and visualized using Cytoscape to construct a PPI network and model.Results Four DEmiRNAs were identified as differentially expressed between OP and COPD microarrays:hsa-miR-631,hsa-miR-940,hsa-miR-508-5p and hsa-miR-1470.PPI network analysis revealed seven core genes:UBA52,UBE2I,UBE2N,STAM,IPO5,CD28 and STX6.Conclusion The interconnection between OP and COPD may be mediated through a series of physiological and pathological responses such as hypoxia,chronic inflammation,oxidative stress,calcium ion reabsorption,and mitochondrial autophagy.Of these,hsa-miR-940 exhibits the closest relationship between the two diseases,suggesting a pivotal role in linking their pathogenesis.

Objective:To investigate the effects of modified electroconvulsive therapy(MECT)in combina-tion with medication and medication alone on relapse and cognitive functioning in patients with major depressive disorder(MDD).Methods:Totally 324 patients meeting the diagnostic criteria ofthe DSM-5 for MDD were select-ed and divided into combined MECT group(n=117)and non-combined MECT group(n=207).At baseline and 5 years of follow-up,both groups completed the General Information Questionnaire,Montreal Cognitive Assessment(MoCA),and Hamilton Depression Scale(HAMD)to analyze associations between cognitive functioning and mul-tiple variables.Results:At baseline,there were no significant differences between the two groups on general infor-mation,MoCA,and HAMD scores(Ps＞0.05).After 5 years of follow-up,the relapse rate was lower in the com-bined MECT group than in the un-combined MECT group[(37.6％vs.72.0％),P＜0.001].MECT was a protec-tive factor against recurrence of MDD[RR(95％CI)=0.52(0.40-0.66)],and the MoCA scores were lower in the combined MECT group than in the un-combined MECT group[(20.9±3.5)vs.(23.6±4.2),β=-1.93,P＜0.001].Conclusion:Combined MECT is a protective factor against MDD recurrence.Its effects on the cognitive functioning of MDD patients may have long-term effects.

Objective:To investigate the association of urinary cadmium levels with peripheral leukocyte classification counts among middle-aged and older adults aged 40 to 89 years in selected areas of China.Methods:The research was based on the survey of the impact of soil quality of agricultural land on human health in typical areas conducted in 2019-2020. A total of 5 600 middle-aged and older adults aged 40 to 89 years were included by using a multi-stage stratified random sampling method. Baseline characteristics of the subjects were collected and physical examinations were performed. Random midstream urine was collected to measure urinary cadmium and urinary creatinine and fasting venous blood was collected to measure the leukocyte count, neutrophil count, lymphocyte count, monocyte count and eosinophil count. The linear mixed effect model was used to analyse the association of urinary cadmium levels with leukocyte classification counts, and the dose-response relationship between them was analyzed by using the restricted cubic spline (RCS) function.Results:The age of the subjects was (63.17±12.02) years; 2 851 (50.91%) were males; and the M ( Q 1, Q 3) of urinary creatinine-corrected urinary cadmium levels was 2.69 (1.52, 4.69) μg/g·creatinine. After adjusting for confounding factors, the results of linear mixed effects model analysis showed that for each 1-unit increase in urinary creatinine-corrected urinary cadmium level, the percentage change [% (95% CI)] of leukocyte count and lymphocyte count was -1.70% (-2.61%, -0.79%) and -1.57% (-2.86%, -0.26%), respectively. RCS function showed a negative linear relationship between urinary creatinine-corrected urinary cadmium levels and leukocyte counts and lymphocyte counts, respectively (all Pnon-linear>0.05). Conclusion:Urinary cadmium levels are negatively associated with leukocyte count and lymphocyte count among middle-aged and older adults aged 40 to 89 years in selected areas of China.

Objective:To investigate the association of urinary cadmium levels with peripheral leukocyte classification counts among middle-aged and older adults aged 40 to 89 years in selected areas of China.Methods:The research was based on the survey of the impact of soil quality of agricultural land on human health in typical areas conducted in 2019-2020. A total of 5 600 middle-aged and older adults aged 40 to 89 years were included by using a multi-stage stratified random sampling method. Baseline characteristics of the subjects were collected and physical examinations were performed. Random midstream urine was collected to measure urinary cadmium and urinary creatinine and fasting venous blood was collected to measure the leukocyte count, neutrophil count, lymphocyte count, monocyte count and eosinophil count. The linear mixed effect model was used to analyse the association of urinary cadmium levels with leukocyte classification counts, and the dose-response relationship between them was analyzed by using the restricted cubic spline (RCS) function.Results:The age of the subjects was (63.17±12.02) years; 2 851 (50.91%) were males; and the M ( Q 1, Q 3) of urinary creatinine-corrected urinary cadmium levels was 2.69 (1.52, 4.69) μg/g·creatinine. After adjusting for confounding factors, the results of linear mixed effects model analysis showed that for each 1-unit increase in urinary creatinine-corrected urinary cadmium level, the percentage change [% (95% CI)] of leukocyte count and lymphocyte count was -1.70% (-2.61%, -0.79%) and -1.57% (-2.86%, -0.26%), respectively. RCS function showed a negative linear relationship between urinary creatinine-corrected urinary cadmium levels and leukocyte counts and lymphocyte counts, respectively (all Pnon-linear>0.05). Conclusion:Urinary cadmium levels are negatively associated with leukocyte count and lymphocyte count among middle-aged and older adults aged 40 to 89 years in selected areas of China.

Objective:To improve the skin toxicity management model of tumor targeted drugs based on evidence-based practice method and apply it to clinical practice.Methods:Using the evidence-based practice method of Joanna Briggs Institute, evidence of skin toxicity management of tumor targeted drugs was formed by searching relevant guidelines and evidence-based medical literature at home and abroad, and conducting interviews and surveys with nurses and patients. Based on the evidence and in consultation with evidence-based medicine, nursing and clinical experts, the evidence was transformed into management improvement plans, and the skin toxicity checklist and care checklist were developed. The improvement scheme was applied to clinical practice, the training of nurses was strengthened, the nursing process was standardized and improved, and various forms of health education were provided to patients. Patients with skin toxicity who received targeted drug therapy in the Department of Oncology of Anhui Cancer Hospital from May to August 2023 were collected. Implementation of various management indicators by nurses before and after management improvement were compared. The occurrence and severity of skin toxicity in patients were compared to verify the effect of the improvement.Results:A total of 35 tumor patients with skin toxicity to targeted drugs were entered, including 26 males and 9 females, with age (60±10) years. Compared with before, the implementation rate of the 5 indicators after the management improvement, including the evaluation of skin toxicity and risk factors by nurses using the common terminology criteria for adverse events version 5.0, the qualified status of related nursing documents, the health education of skin care, and regular follow-up of patients, were significantly increased (from 0-31.4% up to 80%-100%), the differences were statistically significant (all P<0.05). After improvement, the incidence and severity of skin rash, skin dryness, skin reaction of hands and feet, and paronychia were significantly reduced, the score of skin care knowledge questionnaire was significantly increased [6.00(5.00, 8.00) vs. 8.00(7.00, 9.00), P=0.002], and the dermatology life quality index was significantly decreased [8.00(6.00, 9.00) vs. 6.00(5.00, 8.00), P=0.033]. The differences in anxiety and depression scores were not statistically significant (both P>0.05). Conclusion:The skin toxicity management of targeted drugs based on JBI evidence-based practice method can standardize the clinical nursing practice of nurses, improve the severity of skin toxicity in tumor patients, and improve their quality of life.

Objective:To improve the skin toxicity management model of tumor targeted drugs based on evidence-based practice method and apply it to clinical practice.Methods:Using the evidence-based practice method of Joanna Briggs Institute, evidence of skin toxicity management of tumor targeted drugs was formed by searching relevant guidelines and evidence-based medical literature at home and abroad, and conducting interviews and surveys with nurses and patients. Based on the evidence and in consultation with evidence-based medicine, nursing and clinical experts, the evidence was transformed into management improvement plans, and the skin toxicity checklist and care checklist were developed. The improvement scheme was applied to clinical practice, the training of nurses was strengthened, the nursing process was standardized and improved, and various forms of health education were provided to patients. Patients with skin toxicity who received targeted drug therapy in the Department of Oncology of Anhui Cancer Hospital from May to August 2023 were collected. Implementation of various management indicators by nurses before and after management improvement were compared. The occurrence and severity of skin toxicity in patients were compared to verify the effect of the improvement.Results:A total of 35 tumor patients with skin toxicity to targeted drugs were entered, including 26 males and 9 females, with age (60±10) years. Compared with before, the implementation rate of the 5 indicators after the management improvement, including the evaluation of skin toxicity and risk factors by nurses using the common terminology criteria for adverse events version 5.0, the qualified status of related nursing documents, the health education of skin care, and regular follow-up of patients, were significantly increased (from 0-31.4% up to 80%-100%), the differences were statistically significant (all P<0.05). After improvement, the incidence and severity of skin rash, skin dryness, skin reaction of hands and feet, and paronychia were significantly reduced, the score of skin care knowledge questionnaire was significantly increased [6.00(5.00, 8.00) vs. 8.00(7.00, 9.00), P=0.002], and the dermatology life quality index was significantly decreased [8.00(6.00, 9.00) vs. 6.00(5.00, 8.00), P=0.033]. The differences in anxiety and depression scores were not statistically significant (both P>0.05). Conclusion:The skin toxicity management of targeted drugs based on JBI evidence-based practice method can standardize the clinical nursing practice of nurses, improve the severity of skin toxicity in tumor patients, and improve their quality of life.

Objective:To explore the effects of anhedonia, childhood abuse, and depression on suicidal ideation, and the mediating role of anhedonia in adolescents.Methods:A total of 7 431 middle school students were invited to participate in the study. Suicidal ideation, depression, childhood abuse, and anhedonia were assessed by the Positive and Negative Suicide Ideation Scale (PANSI), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ) and Temporal Experience of Pleasure Scale (TEPS); according to the score of suicidal ideation, a total score of 36 was used as the cut-off score, all students were divided into the group with suicidal ideation ( n=1 265) and the group without suicidal ideation ( n=6 166). Difference test was performed using independent sample t-test and χ 2 test; Correlation analysis was performed by Pearson correlation; The process macro program compiled by Hayes was used to conduct the regulated mediation model analysis; The mediation effect values and 95%bootstrap confidence intervals of depressive symptoms between childhood maltreatment and suicidal ideation were analyzed by the bootstrap method; Simple slope analysis was utilized to examine the interaction effects for depression and anhedonia. Results:The detection rate of adolescent suicidal ideation was 17.02% (1 265/7 431);Childhood abuse significantly positively predicted depression ( β=0.56, P<0.001); depression significantly positively predicted suicidal ideation ( β=0.59, P<0.001); depression and anhedonia interaction significantly predicted suicidal ideation ( β=-0.05, P<0.001); simple slope analysis indicates that low anhedonia depression predicted suicidal ideation ( β=0.51, P<0.001) than the high anhedonia group ( β=0.47, P<0.001). Conclusion:Depression partially mediates the effects of childhood abuse on suicidal ideation, and anhedonia modulates the effects of childhood abuse on suicidal ideation. As the level of anhedonia gradually increases, the predictive effect of depression on suicidal ideation gradually decreases.

Objective:To explore the effects of anhedonia, childhood abuse, and depression on suicidal ideation, and the mediating role of anhedonia in adolescents.Methods:A total of 7 431 middle school students were invited to participate in the study. Suicidal ideation, depression, childhood abuse, and anhedonia were assessed by the Positive and Negative Suicide Ideation Scale (PANSI), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ) and Temporal Experience of Pleasure Scale (TEPS); according to the score of suicidal ideation, a total score of 36 was used as the cut-off score, all students were divided into the group with suicidal ideation ( n=1 265) and the group without suicidal ideation ( n=6 166). Difference test was performed using independent sample t-test and χ 2 test; Correlation analysis was performed by Pearson correlation; The process macro program compiled by Hayes was used to conduct the regulated mediation model analysis; The mediation effect values and 95%bootstrap confidence intervals of depressive symptoms between childhood maltreatment and suicidal ideation were analyzed by the bootstrap method; Simple slope analysis was utilized to examine the interaction effects for depression and anhedonia. Results:The detection rate of adolescent suicidal ideation was 17.02% (1 265/7 431);Childhood abuse significantly positively predicted depression ( β=0.56, P<0.001); depression significantly positively predicted suicidal ideation ( β=0.59, P<0.001); depression and anhedonia interaction significantly predicted suicidal ideation ( β=-0.05, P<0.001); simple slope analysis indicates that low anhedonia depression predicted suicidal ideation ( β=0.51, P<0.001) than the high anhedonia group ( β=0.47, P<0.001). Conclusion:Depression partially mediates the effects of childhood abuse on suicidal ideation, and anhedonia modulates the effects of childhood abuse on suicidal ideation. As the level of anhedonia gradually increases, the predictive effect of depression on suicidal ideation gradually decreases.

Objective:To evaluate the pancreatic subclinical dysfunction after intensity-modulated radiation therapy (IMRT) for gastric cancer by analyzing biochemical indexes and pancreatic volume changes, and to reduce the dose of pancreas by dosimetric prediction and dose limitation.Methods:30 patients with gastric cancer who received 45 Gy postoperative adjuvant radiotherapy were retrospectively selected. The pancreas was delineated and its dose and anatomical relationship with planning target volume (PTV) were evaluated. Fasting blood glucose, serum lipase and amylase, and pancreatic volume changes before and after radiotherapy were analyzed. The correlation between the changes of biochemical indexes and volume and pancreatic dose was evaluated by Pearson analysis. The threshold of the dosimetric prediction was obtained by receiver operating characteristic (ROC) curve. Finally, the feasibility of dosimetric limitation in IMRT was assessed.Results:The pancreatic volume of 30 patients was 37.6 cm 3, and 89.0% of them were involved in PTV. D mean of the pancreas was 45.92 Gy, and 46.45 Gy, 46.46 Gy and 45.80 Gy for the pancreatic head, body and tail, respectively. The fasting blood glucose level did not significantly change. The serum lipase levels were significantly decreased by 66% and 77%(both P<0.001), and the serum amylase levels were significantly declined by 24% and 38%(both P<0.001) at 6 and 12 months after radiotherapy. Pancreatic volumes of 22 patients was decreased by 47% within 18 months after radiotherapy. ROC curve analysis showed that pancreatic V 45Gy had the optimal predictive value for the decrease by 1/3 of serum lipase and amylase levels at 6 months and serum amylase level at 12 months after radiotherapy, and the cut-off value was V 45Gy<85%. Pancreatic D mean yielded the optimal predictive value for the decrease by 2/3 of serum lipase level at 12 months after radiotherapy, and the cut-off value was D mean<45.01 Gy. After" whole pancreas" and" outside PTV pancreas" dose limit, V 45Gy of the pancreas was decreased by 11% and 7%, D mean of the pancreas was declined by 2% and 2%, and D mean of the pancreatic tail was decreased by 3%, respectively. Conclusions:Serum lipase and amylase levels significantly decline at 6 and 12 months after adjuvant radiotherapy for gastric cancer, and pancreatic volume is decreased significantly within 18 months after radiotherapy. Pancreatic V 45Gy<85% and D mean<45.01 Gy are the dose prediction values for the decrease of serum lipase and amylase levels. The dose can be reduced to certain extent by dosimetric restriction.