Objective To explore the mediating effect of triglyceride-glucose(TyG)index on the risk of proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods 734 patients with T2DM who underwent routine physical examination in Quyang Road Community Health Service Center,Shanghai from March 2023 to May 2023 were enrolled.The results of basic information,biochemical indicators,abdominal ultrasound and other results were collected.All patients were divided into the normal group,microproteinuria group,and massiveproteinuria group,and stratification analyses were underwent according to glycated hemoglobin(HbA1c),body mass index(BMI),TyG index,and presence or absence of non-alcoholic fatty liver disease(NAFLD).Factors affecting proteinuria in T2DM patients were analyzed.Multivariate logistic regression was used to analyze the impact of TyG index and NAFLD on proteinuria in type 2 diabetes population.Regression coefficient sequential test was used to analyze whether TyG mediates NAFLD associated proteinuria.Results There were statistically significant differences in age,BMI,urinary creatinine,HbA1c,TyG index,etc.among the normal group,microproteinuria group,and massiveproteinuria group(all P＜0.05);there was no statistically significant difference in gender among the three groups.Multivariate logistic regression analysis showed that taking the HbA1c＜7％and BMI＜24 kg/m2 group as a reference,the patients with HbA1c≥7％and BMI≥24 kg/m2 had the highest risk of proteinuria(P=0.022),followed by the HbA1c≥7％and BMI＜24 kg/m2 group(P=0.039).Taking the TyG index(7.65-8.69)as a reference,the risk of proteinuria in the(9.45-11.90)group was 3.321 times(P＜0.001).The mediation effect analysis showed that the TyG mediated NAFLD associated proteinuria(P＜0.001),with the mediation effect accounting for 55.70％of the total effect.Conclusion TyG index may be an independent risk factor for proteinuria in patients with T2DM,and the prevalence of proteinuria is high in patients with poor control in HbA1c and excessive BMI,and TyG may partially mediate the risk of proteinuria in patients with T2DM.

Twelve DEK-NUP214 fusion gene-positive patients with acute myeloid leukemia and on allo-HSCT treatment at the Hematology Hospital of the Chinese Academy of Medical Sciences from November 2016 to August 2022 were included in the study, and their clinical data were retrospectively analyzed. The patients comprised five men and seven women with a median age of 34 (16-52) years. At the time of diagnosis, all the patients were positive for the DEK-NUP214 fusion gene. Chromosome karyotyping analysis showed t (6;9) (p23;q34) translocation in 10 patients (two patients did not undergo chromosome karyotyping analysis), FLT3-ITD mutation was detected in 11 patients, and high expression of WT1 was observed in 11 patients. Nine patients had their primary disease in the first complete remission state before transplantation, one patient had no disease remission, and two patients were in a recurrent state. All patients received myeloablative pretreatment, five patients received sibling allogeneic hematopoietic stem cell transplantation, and seven patients received haploid hematopoietic stem cell transplantation. The median number of mononuclear cells in the transplant was 10.87 (7.09-17.89) ×10 8/kg, and the number of CD34 + cells was 3.29 (2.53-6.10) ×10 6/kg. All patients achieved blood reconstruction, with a median time of 14 (10-20) days for neutrophil implantation and 15 (9-27) days for platelet implantation. The 1 year transplant-related mortality rate after transplantation was 21.2%. The cumulative recurrence rates 1 and 3 years after transplantation were 25.0% and 50.0%, respectively. The leukemia free survival rates were (65.6±14.0) % and (65.6±14.0) %, respectively. The overall survival rates were (72.2±13.8) % and (72.2±13.8) %, respectively.

Objective To investigate the high risk factors of endometrial polyps (EPs)in infertile patients and its impact on the pregnancy outcome after embryo transfer.Methods A case-control trail was conducted on the infertility patients who undergoing embryo transfer in our hospital for the first time after hysteroscopy from January 2016 to December 2022.Their clinical data were collected and retrospectively analyzed.Univariate and stepwise logistic regression analyses were used to identify the risk factors for EPs,and the impact of polyps on the pregnancy outcomes of assisted reproductive pregnancy was analyzed with propensity score matching (PSM)at a 1:2 ratio.Results A total of 388 patients diagnosed with Eps and undergoing hysteroscopic endometrial polypectomy were assigned into the Eps group,and 2163 non-polyp patients were into the non-Eps group.Univariate analysis showed statistical differences were observed in age[31 (29,34)vs 31 (28,33),P=0.002],history of pelvic inflammatory disease (42.78％vs 64.17％,P=0.000),age at menarche[14 (12,14)vs 13 (12,14)years old,P=0.000],number of pregnancies[0 (0,1 )vs 1 (0,2),P=0.000],primary infertility (60.30％vs 50.20％,P=0.000),duration of infertility[4 (2.1,6.0)vs 4 (2.0,6.0)years,P=0.002],concomitant endometriosis (9.53％ vs 6.52％,P=0.032),concomitant uterine fibroids (11 .85％vs 6.93％,P=0.001 ),and basal estrogen level[38.12 (27.00,59.00)vs 36.00 (25.00,53.00)μg/L,P=0.016]between the 2 groups.Logistic stepwise regression analysis indicated that age (OR=1 .082,95％CI:1 .053～1 .113,P<0.05 ),primary infertility (OR=2.951,95％CI:1 .990～4.376,P<0.05),and elevated basal estrogen (OR=1 .003,95％CI:1 .001～1 .005,P<0.05)were risk factors for Eps.The postoperative biochemical pregnancy rate (59.28％vs 52.70％),clinical pregnancy rate (53.09％vs 45.48％),and live birth rate (43.81％vs 35.82％)were significantly higher in the matched Eps group than the non-Eps group (P<0.05 ).No statistical difference was observed in pregnancy outcome in the patients with different polyp locations and sizes.The patients with multiple polyps had an obvious higher rate of early miscarriage than those with single polyp (17.27％ vs 7.29％,P<0.05 ),while those with recurrent polyps also had a higher rate of early miscarriage than those with primary polyps (27.78％vs 11.23％,P<0.05).Conclusion Age,primary infertility,and elevated basal estrogen are risk factors for Eps in infertility patients,while hysteroscopic endometrial polypectomy prior to embryo transfer results in improved pregnancy outcomes in those with Eps.The location and size of endometrial polyps have weak impact on pregnancy outcomes following embryo transfer,but,the presence of multiple or recurrent polyps may elevate the risk of early miscarriage.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

We aimed to evaluate the effectiveness and safety of single-course initial regimens in patients with low-risk gestational trophoblastic neoplasia (GTN). In this trial (NCT01823315), 276 patients were analyzed. Patients were allocated to three initiated regimens: single-course methotrexate (MTX), single-course MTX + dactinomycin (ACTD), and multi-course MTX (control arm). The primary endpoint was the complete remission (CR) rate by initial drug(s). The primary CR rate was 64.4% with multi-course MTX in the control arm. For the single-course MTX arm, the CR rate was 35.8% by one course; it increased to 59.3% after subsequent multi-course MTX, with non-inferiority to the control (difference -5.1%,95% confidence interval (CI) -19.4% to 9.2%, P = 0.014). After further treatment with multi-course ACTD, the CR rate (93.3%) was similar to that of the control (95.2%, P = 0.577). For the single-course MTX + ACTD arm, the CR rate was 46.7% by one course, which increased to 89.1% after subsequent multi-course, with non-inferiority (difference 24.7%, 95% CI 12.8%-36.6%, P < 0.001) to the control. It was similar to the CR rate by MTX and further ACTD in the control arm (89.1% vs. 95.2%, P =0.135). Four patients experienced recurrence, with no death, during the 2-year follow-up. We demonstrated that chemotherapy initiation with single-course MTX may be an alternative regimen for patients with low-risk GTN.
Antineoplastic Combined Chemotherapy Protocols/adverse effects* ; Dactinomycin/adverse effects* ; Female ; Gestational Trophoblastic Disease/drug therapy* ; Humans ; Methotrexate/therapeutic use* ; Pregnancy ; Retrospective Studies

Early recognition and treatment for early warning electrocardiogram (ECG) of sudden death are very important to prevent and treat malignant arrhythmia and sudden death. Previous studies have found that R-on-T and T wave alternation, and QT interval prolongation are closely related to malignant arrhythmia or sudden death, which are included in the critical value of ECG.By analyzing the ECG characteristics of 4 patients with sudden death, we found that although the causes of the patients were different, there were transient prolongation of QT interval after premature contraction in 12 lead ECG, followed by malignant arrhythmia or sudden death. Thus, we thought that the transient prolongation of QT interval after premature contraction had a high value for warning malignant arrhythmia or sudden death. This phenomenon should be paid enough attention to reduce the risk of sudden death.
Arrhythmias, Cardiac/diagnosis* ; Death, Sudden ; Death, Sudden, Cardiac ; Electrocardiography ; Humans ; Long QT Syndrome/diagnosis*

Objective:To investigate the regulatory mechanism of long non-coding RNA (lncRNA) NEF on T cell immune function in postmenopausal osteoporosis (PMOP) mice.Methods:Female Balb/c mice were used to construct OVX model ( n=46) and sham control group ( n=16) . Bone marrow mesenchymal stem cells (BM-SCs) from these two groups of mice were cultured. NEF recombinant expression vector (pIRSE2-NEF) was constructed and transfected into BMSCs. RT-qPCR was used to detect NEF and miR-21 levels in BMSCs cells in sham group, OVX group, and pIRSE2-NEF group. Luciferase gene report experiment was used to verify the binding effect of NEF and miR-21. The remaining 40 OVX mice were divided into 4 groups, including OVX group ( n=10) , pIRSE2-NEF injection group (pIRSE2-NEF group, n=10) , pIRSE2-NEF combined with PD-1 inhibitor group (pIRSE2-NEF+ PD-L1-IN-1 group, n=10) , and pIRSE2-NEF combined with miR-21 mimic (mimic) group (pIRSE2-NEF+ mimic group, n=10) . The remaining 10 mice in sham group were used as the control group. ELI-SA was used to detect the levels of IFN-γ, IL-2, IL-4, IL-13 and PD-1/PD-1L in peripheral blood. Flow cytometry was used to detect the shift of serum Treg-Th17 cell subsets. Results:Compared with the Sham group (1.01±0.04, 1.00±0.03) , the expression of NEF in BMSCs of OVX group was down-regulated (0.23±0.01) , and miR-21 was up-regulated (2.96±0.05) ( P<0.05) . Compared with OVX group (1.23±0.15, 5.20±0.31) , NEF in BMSCs cells of Pirse2-nef group was significantly up-regulated (6.83±0.35) ( P<0.05) , while miR-21 was down-regulated (0.29±0.11) ( P<0.05) .NEF has a direct binding base site with miR-21.The levels of IFN-γ (3.25±0.21) , IL-2 (2.44±0.06) and Th17/Treg ratio (3.18±0.65) in peripheral blood of mice in OVX group were significantly higher than those in Sham group (1.03±0.02, 1.00±0.01, 0.86±0.09) (all P<0.05) . The levels of IL-4 (0.45±0.02) , IL-13 (0.43±0.07) , PD-1 (0.24±0.03) and PD-1L (0.51±0.06) were significantly lower than those of Sham group (1.00±0.04, 1.00±0.02, 1.00±0.03, 1.00±0.00) ( P<0.05) ; Compared with OVX, IFN-γ (2.02±0.06) , IL-2 (0.88±0.01) and Th17/Treg ratio (1.43±0.22) in Pirse2-nef group were decreased. The levels of IL-4 (0.87±0.03) , IL-13 (0.84±0.07) , PD-1 (0.79±0.06) and PD-1L (0.77±0.06) were increased (all P<0.05) ; Compared with Pirse2-nef group, IFN-γ (2.89±0.06) , IL-2 (2.07±0.07) and Th17/Treg ratio (2.39±0.38) were increased in Pirse2-nef+ PD-L1-in-1 group. The levels of IL-4 (0.68±0.03) , IL-13 (0.76±0.08) , PD-1 (0.52±0.02) and PD-1L (0.83±0.04) were decreased (all P<0.05) . Moreover, the pIRSE2-NEF+ mimic group had the same adjustment effect as the pIRSE2-NEF+ PD-L1-IN-1 group. Conclusion:lncRNA-NEF improves immune imbalance and PD-1/PD-1L-mediated Treg-Th17 cell balance in postmenopausal osteoporosis mice by sponging miR-21.

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

Objective:Our previous micro-array study revealed that long non-coding RNA (lncRNA), such as ENST00000538790 and NR_125790, were differently expressed in parathyroid carcinoma compared with those in parathyroid adenoma. Diagnostic value of lncRNAs (ENST00000538790 and NR_125790) and scoring models derived from these lncRNAs in parathyroid carcinoma were investigated in this study.Methods:Fifty-seven fresh tissue samples from patients with hyperparathyroidism were collected. Eleven patients were diagnosed with parathyroid carcinoma, while 46 patients were found with parathyroid adenoma. The expression levels of five lncRNAs (ENST00000511928, ENST00000538790, ENST00000618339, NR_125790, and ENST00000485384) were detected with realtime quantitative PCR (RT-qPCR). LncRNA scores were calculated using these lncRNAs, and their value in parathyroid carcinoma diagnosis were also assessed.Results:It was found that expression levels of ENST00000511928 and ENST00000538790 were up-regulated in parathyroid carcinoma compared with parathyroid adenoma ( P<0.05), while the levels of ENST00000618339, NR_125790, and ENST00000485384 were decreased in parathyroid carcinoma ( P<0.05). Among these lncRNAs, ENST00000538790 and NR_125790 were independent risk factors for parathyroid carcinoma ( P<0.05). Hence, "log score" and "logistic score" were calculated with ENST00000538790 and NR_125790 levels. The areas under the receiver operating characteristic curve for "log score" and "logistic score" were up to 0.935 and 0.943 respectively in parathyroid carcinoma ( P<0.05), and were found to be greater than those from single lncRNA or classic clinical indices, such as serum calcium ( P<0.05). Conclusion:LncRNA scores with lncRNA ENST00000538790 and NR_125790 may play potential role in diagnosis of parathyroid carcinoma.