OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors （ICIs） as first-line therapy for advanced gastric cancer. METHODS PubMed， Web of Science， Embase， The Cochrane Library， Wanfang Data， CNKI， and VIP databases were searched to collect phase Ⅲ clinical randomized controlled trials （RCTs） on ICIs as first-line therapy for advanced gastric cancer， as well as abstracts from relevant oncology academic conferences. The search period spanned from database inception to June 1， 2025. After screening literature， extracting data， and assessing quality， a network meta-analysis was performed using R software version 4.3.2. RESULTS A total of 8 studies involving 7 801 patients were included. Network meta-analysis results showed that， in terms of efficacy， compared with chemotherapy （Chemo）， SHR-1701_Chemo， Cadonilimab_Chemo， Sintilimab_Chemo， Pembrolizumab_Chemo， and Tislelizumab_Chemo significantly prolonged median overall survival （OS） and median progression free survival （PFS） in patients （P＜0.05）； whereas Nivolumab_Chemo only significantly improved median PFS （P＜0.05）. Surface under the cumulative ranking curve （SUCRA） results indicated that the top 2 interventions for median OS were SHR-1701_Chemo and Cadonilimab_Chemo； for PFS， the top 2 were Cadonilimab_Chemo and SHR-1701_Chemo. For patients with combined positive score （CPS） ≥5 points for programmed death-ligand 1 （PD-L1）， Cadonilimab_Chemo and SHR- 1701_Chemo also demonstrated the optimal OS and PFS benefits （P＜0.05）. Regarding safety， there were no statistically significant differences among the interventions in the incidence of any adverse events （AEs） or grade ≥3 AEs （P＞0.05）. The SUCRA ranking for the incidence of any AEs showed the top 2 were SHR-1701_Chemo and Chemo； for grade ≥3 AEs， the top 2 were Chemo and Sugemalimab_Chemo. CONCLUSIONS For patients with advanced gastric cancer， Cadonilimab_Chemo and SHR-1701_Chemo demonstrate the best benefits in terms of OS and PFS， with their advantages remaining clear in patients with PD-L1 CPS≥5 points. In terms of safety， the risk of developing any AEs and grade ≥3 AEs is relatively lowest with Chemo.

Objective: To compare the effects of aerobic exercise at maximal fat oxidation (FATmax) and FATmax intensity exercise combined with resistance training (RT), and dietary restriction on the body composition, vascular endothelial function and ferroptosis in obese female university students, so as to provide a reference for exploring the mechanisms by which exercise improves vascular endothelial function. Methods: From February to May 2024, 70 obese female university students were recruited from Shanxi University and randomly divided into control group ( n =24), FATmax group ( n =24) and FATmax+RT group ( n =22). From March 4 to May 26, 2024 control group maintained their normal living habits, FATmax group performed aerobic exercise at FATmax intensity three times per week for 60 minutes per session; FATmax +RT group performed combined aerobic and resistance exercise at FATmax intensity three times per week for 60 minutes per session. The daily dietary calorie intake for all groups was determined according to resting energy expenditure. Body composition, vascular endothelial function and ferroptosis were measured before and after the intervention. Results: After 12 weeks of intervention, there were statistically significant differences in body mass, BMI, body fat, waist hip ratio and muscle mass among the three groups ( F =10.93, 5.88, 65.28, 21.14, 2.25, all P < 0.05). Compared with the control group, participants in both the FATmax group and the FATmax+RT group showed significant reductions in body weight, BMI, body fat and waist hip ratio (all P <0.05). Body fat and waist hip ratio in FATmax+RT group were lower than those in FATmax group, and muscle mass was higher than those in FATmax group and control group (both P <0.05). After 12 weeks of intervention, significant differences were observed among the three groups in serum NO, GSH, serum ferritin levels and FMD ( F = 9.14, 9.67, 4.78, 135.70, all P <0.05). Compared with the control group, the serum NO, GSH levels and FMD significantly increased, and the serum ferritin level decreased (all P <0.05) of obese female university students in FATmax group and FATmax+RT group. Serum GSH level and FMD increased and serum ferritin level decreased in FATmax +RT group when compared with FATmax group (all P <0.05). Conclusions With the same exercise training duration and frequency, FATmax intensity aerobic exercise, alone or combined with resistance and dietary restriction, can significantly improve the body composition, vascular endothelial function and inhibit ferroptosis of obese female university students. However, FATmax intensity aerobic exercise combined with resistance training has more pronounced effects.

Acute carbon monoxide poisoning (ACMP) is one of the most common gas poisonings in the emergency department, with tens of thousands of people seeking medical attention for carbon monoxide (CO) poisoning each year. The severity of poisoning is dependent upon environmental and human factors, with hypoxia and oxidative stress being important mechanisms of cardiac toxicity induced by CO. Myocardial involvement is common in moderate to severe ACMP, including myocardial injury, myocardial infarction, arrhythmia, and sudden death, which are associated with a high risk of death. Ferroptosis is a cell death mechanism caused by iron-dependent lipid peroxidation (LPO), although ferroptosis has been shown to play a critical role in various cardiovascular diseases, the potential mechanism by which it contributes to ACMP-induced myocardial injury is unclear. This review discusses the established link between ferroptosis and cardiovascular disease and summarizes the potential role of ferroptosis in ACMP-induced myocardial injury and the detrimental effects of ACMP on the heart. Elucidating these mechanisms could guide the development of novel therapeutic strategies that target ferroptosis to mitigate ACMP-induced myocardial injury. This review aims to provide a theoretical foundation for future research on the potential use of ferroptosis as a therapeutic target for ACMP-induced myocardial injury.
Humans ; Carbon Monoxide Poisoning/complications* ; Ferroptosis ; Lipid Peroxidation ; Myocardium/pathology* ; Oxidative Stress

Neuronal intranuclear inclusion disease （NIID） is a rare neurodegenerative disorder caused by the expression of expanded GGC repeat sequences in the 5' untranslated region of the NOTCH2NLC gene， with the pathological hallmark of the formation of eosinophilic intranuclear inclusions in the nervous system and multiple visceral organs. Due to the diverse clinical manifestations of patients， NIID was once considered a heterogeneous disease， posing significant challenges to diagnosis. In recent years， with the application of skin biopsy and genetic testing techniques， the diagnostic rate of NIID has been improved， but there is still a lack of unified process for confirmed diagnosis. This article reports a patient with recurrent acute encephalitis-like episodes as the prominent symptom， systematically summarizes and presents the imaging changes that occurred with the progression of the disease， and finally confirms the diagnosis of NIID through genetic testing， so as to provide a valuable reference for the clinical diagnosis of adult-onset NIID.

Objective To analyze the association between glutamyl transpeptidase(GGT)and the risk of newly diagnosed diabetes mellitus(DM)in middle aged and elderly population.Methods A retrospective cohort study was conducted,with baseline data sourced from the Beijing sub center population of the"Risk Evaluation of Cancersin Chinese Diabetic Individuals:A Longitudinal Study(REACTION)".A total of 6425 non DM individuals were enrolled in this study.All the participantswere divided into four groups according to GGT levels:G1(GGT<14.6 U/L,n=1601),G2(14.6 U/L≤GGT<19.3 U/L,n=1601),G3(19.3 U/L≤GGT<27.3 U/L,n=1613)and G4(GGT≥27.3 U/L,n=1610)group.They were followed up for 3.2 years.Results During follow-up,556 new DM cases were found,with a cumulative incidence rate of 8.7%.Logistic regression analysis showed that GGT was an independent risk factor for new DM in the non DM population,the risk of new DM in the G3,G4 groups was 1.730 times(95%CI 1.321～2.265,P<0.001)and 1.960 times(95%CI 1.493～2.587,P<0.001)of G1 group,respectively.GGT is also an independent risk factor for new DM in the impaired glucose regulation(IGR),the risk of new DM was 1.530 times higher in the G3 group(95%CI 1.123～2.094,P=0.008),and 1.750 times higher in the G4 group(95%CI 1.271～2.415,P=0.001)than in the G1 group.GGT is not an independent risk factor for new DM in participants with normal glucose tolerance(P>0.05).Conclusions GGT is a risk factor for new onset DM in IGR population.

Background and Aims:Elderly patients with inguinal hernia are prone to intraoperative hypothermia due to diminished thermoregulatory capacity,which may increase the risk of postoperative complications such as infection,seroma,and cognitive dysfunction.This study aimed to investigate the relationship between intraoperative body temperature and postoperative complications in elderly patients undergoing inguinal hernia repair and to evaluate its predictive value.Methods:Clinical data of 358 elderly patients who underwent tension-free inguinal hernia repair at the Affiliated Hospital of Southwest Medical University from April 2018 to October 2024 were retrospectively analyzed.Patients were divided into a hypothermia group(<36.0℃)and a normothermia group(≥36.0℃)according to intraoperative temperature levels.Perioperative parameters and postoperative complications were compared between the two groups.Independent risk factors for complications were identified using multivariate logistic regression,and the predictive performance of intraoperative temperature was evaluated by receiver operating characteristic(ROC)curve analysis.Results:Compared with the normothermia group,patients with intraoperative hypothermia had significantly longer operative time,higher postoperative white blood cell(WBC)count and neutrophil-to-lymphocyte ratio(NLR),and an increased incidence of complications(25.0%vs.3.8%,P<0.001).Multivariate analysis identified age,NRS 2002 score,intraoperative blood loss,postoperative WBC,postoperative NLR,and intraoperative hypothermia as independent risk factors for postoperative complications.ROC analysis showed that intraoperative temperature had a good predictive value for complications(AUC=0.717,optimal cutoff=36.42℃,sensitivity=70.0%,specificity=89.5%).Conclusion:Intraoperative hypothermia significantly increases postoperative complication risk in elderly patients undergoing inguinal hernia repair.Maintaining intraoperative temperature above 36.4℃may reduce the incidence of complications and improve perioperative outcomes.

Objective:To investigate the related factors of cognitive impairment in middle-aged and old-aged patients with type 2 diabetes mellitus(T2DM).Methods:A total of 970 patients with T2DM(585 middle-aged group and 385 old-aged group)were selected from residents of a large community in Beijing from September to December 2018.The Mini-Mental State Examination(MMSE)was used to assess the cognitive func-tion.Multivariate logistic regression was used to analyze the related factors.Results:The detection rates of cognitive impairment were 12.0％and 13.5％in middle-aged and old-aged patients with T2DM,respectively.Among mid-dle-aged patients with T2DM,work(OR=0.22,95％CI:0.03-0.77)and education at the junior college or un-dergraduate level and above(OR=0.18,95％CI:0.04-0.55)were protective factors for cognitive impair-ment.Myocardial infarction(OR=4.13,95％CI:1.26-13.63)was a risk factor for cognitive impairment.Among old-aged patients with T2DM,drinking tea 1-2 times a week(OR=0.11,95％CI:0.01-0.58)and education at the junior college or undergraduate level and above(OR=0.19,95％CI:0.05-0.54)were protective factors for cognitive impairment.Stroke(OR=3.64,95％CI:1.55-8.39)and good sleep self-assessment(OR=2.75,95％CI:1.13-7.35)were risk factors for cognitive impairment.Conclusion:Cognitive impairment in middle-aged pa-tients with T2DM is related to work,education level and myocardial infarction,and cognitive impairment in old-aged patients with T2DM is related to lifestyle,education level and stroke.

Background and Aims:Elderly patients with inguinal hernia are prone to intraoperative hypothermia due to diminished thermoregulatory capacity,which may increase the risk of postoperative complications such as infection,seroma,and cognitive dysfunction.This study aimed to investigate the relationship between intraoperative body temperature and postoperative complications in elderly patients undergoing inguinal hernia repair and to evaluate its predictive value.Methods:Clinical data of 358 elderly patients who underwent tension-free inguinal hernia repair at the Affiliated Hospital of Southwest Medical University from April 2018 to October 2024 were retrospectively analyzed.Patients were divided into a hypothermia group(<36.0℃)and a normothermia group(≥36.0℃)according to intraoperative temperature levels.Perioperative parameters and postoperative complications were compared between the two groups.Independent risk factors for complications were identified using multivariate logistic regression,and the predictive performance of intraoperative temperature was evaluated by receiver operating characteristic(ROC)curve analysis.Results:Compared with the normothermia group,patients with intraoperative hypothermia had significantly longer operative time,higher postoperative white blood cell(WBC)count and neutrophil-to-lymphocyte ratio(NLR),and an increased incidence of complications(25.0%vs.3.8%,P<0.001).Multivariate analysis identified age,NRS 2002 score,intraoperative blood loss,postoperative WBC,postoperative NLR,and intraoperative hypothermia as independent risk factors for postoperative complications.ROC analysis showed that intraoperative temperature had a good predictive value for complications(AUC=0.717,optimal cutoff=36.42℃,sensitivity=70.0%,specificity=89.5%).Conclusion:Intraoperative hypothermia significantly increases postoperative complication risk in elderly patients undergoing inguinal hernia repair.Maintaining intraoperative temperature above 36.4℃may reduce the incidence of complications and improve perioperative outcomes.

Objective:To investigate the related factors of cognitive impairment in middle-aged and old-aged patients with type 2 diabetes mellitus(T2DM).Methods:A total of 970 patients with T2DM(585 middle-aged group and 385 old-aged group)were selected from residents of a large community in Beijing from September to December 2018.The Mini-Mental State Examination(MMSE)was used to assess the cognitive func-tion.Multivariate logistic regression was used to analyze the related factors.Results:The detection rates of cognitive impairment were 12.0％and 13.5％in middle-aged and old-aged patients with T2DM,respectively.Among mid-dle-aged patients with T2DM,work(OR=0.22,95％CI:0.03-0.77)and education at the junior college or un-dergraduate level and above(OR=0.18,95％CI:0.04-0.55)were protective factors for cognitive impair-ment.Myocardial infarction(OR=4.13,95％CI:1.26-13.63)was a risk factor for cognitive impairment.Among old-aged patients with T2DM,drinking tea 1-2 times a week(OR=0.11,95％CI:0.01-0.58)and education at the junior college or undergraduate level and above(OR=0.19,95％CI:0.05-0.54)were protective factors for cognitive impairment.Stroke(OR=3.64,95％CI:1.55-8.39)and good sleep self-assessment(OR=2.75,95％CI:1.13-7.35)were risk factors for cognitive impairment.Conclusion:Cognitive impairment in middle-aged pa-tients with T2DM is related to work,education level and myocardial infarction,and cognitive impairment in old-aged patients with T2DM is related to lifestyle,education level and stroke.

Objective To analyze the association between glutamyl transpeptidase(GGT)and the risk of newly diagnosed diabetes mellitus(DM)in middle aged and elderly population.Methods A retrospective cohort study was conducted,with baseline data sourced from the Beijing sub center population of the"Risk Evaluation of Cancersin Chinese Diabetic Individuals:A Longitudinal Study(REACTION)".A total of 6425 non DM individuals were enrolled in this study.All the participantswere divided into four groups according to GGT levels:G1(GGT<14.6 U/L,n=1601),G2(14.6 U/L≤GGT<19.3 U/L,n=1601),G3(19.3 U/L≤GGT<27.3 U/L,n=1613)and G4(GGT≥27.3 U/L,n=1610)group.They were followed up for 3.2 years.Results During follow-up,556 new DM cases were found,with a cumulative incidence rate of 8.7%.Logistic regression analysis showed that GGT was an independent risk factor for new DM in the non DM population,the risk of new DM in the G3,G4 groups was 1.730 times(95%CI 1.321～2.265,P<0.001)and 1.960 times(95%CI 1.493～2.587,P<0.001)of G1 group,respectively.GGT is also an independent risk factor for new DM in the impaired glucose regulation(IGR),the risk of new DM was 1.530 times higher in the G3 group(95%CI 1.123～2.094,P=0.008),and 1.750 times higher in the G4 group(95%CI 1.271～2.415,P=0.001)than in the G1 group.GGT is not an independent risk factor for new DM in participants with normal glucose tolerance(P>0.05).Conclusions GGT is a risk factor for new onset DM in IGR population.