BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

ObjectiveTo assess changes in the incidence， prevalence， and disability-adjusted life-year （DALY） burden of ulcerative colitis （UC） in China and worldwide from 1990 to 2023 using data from the Global Burden of Disease Study 2023 （GBD 2023）， and to examine demographic drivers and future trends. MethodsUC data for China， the world， and 204 countries and territories were extracted from the GBD 2023 Results Tool. Age-standardized incidence rate （ASIR）， age-standardized prevalence rate （ASPR）， and age-standardized DALY rate （ASDR）， with 95% uncertainty interval （UI）， were obtained. Joinpoint regression was used to estimate average annual percent change （AAPC） and 95% confidence interval （CI）. Spearman rank correlation， inequality and frontier analyses， Das Gupta decomposition， and autoregressive integrated moving average （ARIMA） models were used to assess associations with the sociodemographic index （SDI）， cross-country burden disparities， demographic drivers， and trends from 2024 to 2035， respectively. ResultsIn 2023， the ASIR， ASPR， and ASDR in China were 0.94， 5.95， and 5.94 per 100 000 population， respectively， lower than the corresponding global estimates of 2.87， 28.48， and 13.82 per 100 000 population. From 1990 to 2023， China’s ASIR and ASPR increased， with AAPCs of 2.720% （95% CI： 2.133%-3.309%） and 2.261% （95% CI： 1.617%-2.908%）， whereas the ASDR decreased （AAPC=-3.056%， 95% CI： -3.449% to -2.662%）. Globally， ASIR increased slightly， whereas ASPR and ASDR decreased. In China， the crude incidence， prevalence， and DALY rates peaked at ages 50-54 years， 60-64 years， and ≥95 years， respectively. ASIR and ASPR were positively correlated with SDI （r_s=0.5794 and 0.6177， both P<0.001）， whereas the correlation between ASDR and SDI was not statistically significant （r_s=0.0666， P=0.343）. In China， epidemiological change contributed most to increases in incident and prevalent cases， and changes in age-specific rates contributed most to the decline in DALYs； globally， population growth and population aging contributed most to the increase in DALYs. By 2035， China’s ASIR， ASPR， and ASDR were projected to be 1.23， 6.37， and 2.55 per 100 000 population， respectively. ConclusionsFrom 1990 to 2023， the age-standardized incidence and prevalence rates of UC increased in China， whereas the age-standardized DALY rate decreased， and peaks in absolute burden generally shifted toward middle-aged and older age groups. The projected directions may persist. These findings may provide reference for long-term UC management and health-resource planning.

ObjectiveTo assess changes in the incidence， prevalence， and disability-adjusted life-year （DALY） burden of ulcerative colitis （UC） in China and worldwide from 1990 to 2023 using data from the Global Burden of Disease Study 2023 （GBD 2023）， and to examine demographic drivers and future trends. MethodsUC data for China， the world， and 204 countries and territories were extracted from the GBD 2023 Results Tool. Age-standardized incidence rate （ASIR）， age-standardized prevalence rate （ASPR）， and age-standardized DALY rate （ASDR）， with 95% uncertainty interval （UI）， were obtained. Joinpoint regression was used to estimate average annual percent change （AAPC） and 95% confidence interval （CI）. Spearman rank correlation， inequality and frontier analyses， Das Gupta decomposition， and autoregressive integrated moving average （ARIMA） models were used to assess associations with the sociodemographic index （SDI）， cross-country burden disparities， demographic drivers， and trends from 2024 to 2035， respectively. ResultsIn 2023， the ASIR， ASPR， and ASDR in China were 0.94， 5.95， and 5.94 per 100 000 population， respectively， lower than the corresponding global estimates of 2.87， 28.48， and 13.82 per 100 000 population. From 1990 to 2023， China’s ASIR and ASPR increased， with AAPCs of 2.720% （95% CI： 2.133%-3.309%） and 2.261% （95% CI： 1.617%-2.908%）， whereas the ASDR decreased （AAPC=-3.056%， 95% CI： -3.449% to -2.662%）. Globally， ASIR increased slightly， whereas ASPR and ASDR decreased. In China， the crude incidence， prevalence， and DALY rates peaked at ages 50-54 years， 60-64 years， and ≥95 years， respectively. ASIR and ASPR were positively correlated with SDI （r_s=0.5794 and 0.6177， both P<0.001）， whereas the correlation between ASDR and SDI was not statistically significant （r_s=0.0666， P=0.343）. In China， epidemiological change contributed most to increases in incident and prevalent cases， and changes in age-specific rates contributed most to the decline in DALYs； globally， population growth and population aging contributed most to the increase in DALYs. By 2035， China’s ASIR， ASPR， and ASDR were projected to be 1.23， 6.37， and 2.55 per 100 000 population， respectively. ConclusionsFrom 1990 to 2023， the age-standardized incidence and prevalence rates of UC increased in China， whereas the age-standardized DALY rate decreased， and peaks in absolute burden generally shifted toward middle-aged and older age groups. The projected directions may persist. These findings may provide reference for long-term UC management and health-resource planning.

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of subsequent radiotherapy (RT) following first-line treatment with durvalumab plus chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC). METHODS: A total of 122 patients with ES-SCLC from three hospitals during July 2019 to December 2021 were retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to address potential confounding factors. The primary focus of our evaluation was to assess the impact of RT on progression-free survival (PFS) and overall survival (OS). RESULTS: After IPTW analysis, 49 patients received durvalumab plus platinum-etoposide (EP) chemotherapy followed by RT (Durva + EP + RT) and 72 patients received immunochemotherapy (Durva + EP). The median OS was 17.2 months vs . 12.3 months (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.17-0.85, P = 0.020), and the median PFS was 8.9 months vs . 5.9 months (HR: 0.56, 95% CI: 0.32-0.97, P = 0.030) in Durva + EP + RT and Durva + EP groups, respectively. Thoracic radiation therapy (TRT) resulted in longer OS (17.2 months vs . 14.7 months) and PFS (9.1 months vs . 7.2 months) compared to RT directed to other metastatic sites. Among patients with oligo-metastasis, RT also showed significant benefits, with a median OS of 17.4 months vs . 13.7 months and median PFS of 9.8 months vs . 5.9 months compared to no RT. Continuous durvalumab treatment beyond progression (TBP) prolonged OS compared to patients without TBP, in both the Durva + EP + RT (NA vs . 15.8 months, HR: 0.48, 95% CI: 0.14-1.63, P = 0.238) and Durva + EP groups (12.3 months vs . 4.3 months, HR: 0.29, 95% CI: 0.10-0.81, P = 0.018). Grade 3 or 4 adverse events occurred in 13 (26.5%) and 13 (18.1%) patients, respectively, in the two groups; pneumonitis was mostly low-grade. CONCLUSION Addition of RT after first-line immunochemotherapy significantly improved survival outcomes with manageable toxicity in ES-SCLC.
Humans ; Small Cell Lung Carcinoma/therapy* ; Retrospective Studies ; Male ; Female ; Middle Aged ; Lung Neoplasms/therapy* ; Aged ; Antibodies, Monoclonal/therapeutic use* ; Adult ; Immunotherapy/methods* ; Aged, 80 and over

Objective To assess the situation and influencing factors of occupational burnout among the staff at the Center for Disease Control and Prevention (CDC) in Sichuan Province. Methods A total of 1 038 CDC staff members in Sichuan Province were selected as the study subjects using the stratified random sampling method. Occupational burnout of the staff was assessed using the Maslach Burnout Inventory General Survey via an online questionnaire. Results The detection rate of occupational burnout was 42.3% (439/1 038). Binary logistic regression analysis result showed that, after controlling for confounding factors such as education level and alcohol consumption, CDC staffs aged at 20-<31, 31-<41, and 41-<51 years were at higher risk of occupational burnout compared with those ≥51 years (all P<0.05). CDC staffs with 5-<10 or ≥10 years of service had higher occupational burnout risk compared with those with <5 years (both P<0.05). CDC staffs with poor or fair health status, irregular diet, and poor sleep quality had higher risk of occupational burnout compared with those healthy, have regular diet, and good sleep quality (all P<0.05). The risk of occupational burnout increased with higher overtime frequency (all P<0.05). Conclusion Occupational burnout among CDC staffs in Sichuan Province is relatively high. Age, years of service, health status, diet, sleep quality, and overtime frequency are key influencing factors.

[摘 要] 目的：探究包被蛋白复合体β1亚基（COPB1）在食管鳞状细胞癌（ESCC）中的表达，及其对ESCC细胞恶性生物学行为的影响、作用机制及临床意义。方法：采用2014～2018年间在河北医科大学第四医院生物样本库中82例ESCC组织及癌旁组织，常规培养正常食管鳞状上皮细胞HEEC和食管癌细胞KYSE-150、KYSE-170、Eca109、TE1、KYSE-30、KYSE-450，用转染试剂将pcDNA3.1-vector（空载体）、pcDNA3.1-COPB1载体，si-NC和si-COPB1转染至KYSE-150、TE1细胞中，记为NC、COPB1-OE、si-NC和si-COPB1组。用数据库数据分析COPB1 mRNA在泛癌组织中的表达及其表达与免疫细胞浸润的关系，qPCR法检测ESCC组织和细胞中COPB1、PIK3CB、CD68、CD163、CD206、ARG1、IL-10 mRNA水平表达情况，WB法检测ESCC组织和各组细胞中的COPB1、PI3K、CD68、CD163、CD206、p-AKT蛋白表达，克隆形成实验和MTS实验检测各组细胞的增殖能力，划痕愈合实验和Transwell实验检测各组细胞的迁移和侵袭能力，免疫组织化学染色（IHC）法检测ESCC组织中COPB1和CD206蛋白表达。以人单核细胞白血病细胞（THP-1）构建巨噬细胞模型，用佛波酯（PMA）和IL-3和IL-4和ESCC细胞上清液诱导巨噬细胞转型，用qPCR和WB法检测CD68和CD206m RNA和蛋白的表达。结果：COPB1在泛癌组织和ESCC组织中均呈高表达且与淋巴结转移和TNM分期有关联（均P < 0.01），COPB1高表达的ESCC患者总生存期短（P < 0.05），COPB1是潜在的ESCC的诊断标志物。COPB1在KYSE-150和TE1细胞中也呈高表达（均P < 0.05），过表达或敲减COPB1可明显抑制或促进KYSE-150和TE1细胞的增殖能力、迁移和侵袭能力（均P < 0.05）。COPB1表达变化诱导的差异表达基因主要富集于PI3K/AKT通路（均P < 0.001）, COPB1可促进PI3K/AKT通路的活化（P < 0.05），COPB1高表达可导致M2型巨噬细胞浸润增加（P < 0.05），COPB1高表达促进TAM/M2极化（P < 0.05）。结论：COPB1在ESCC组织中呈高表达，其可激活PI3K/AKT通路及调控肿瘤免疫微环境促进 ESCC发生发展，COPB1有望成为ESCC诊断和预后的生物标志物及治疗靶点。

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Clamshell incision is widely used in the surgical resection of complex mediastinal tumors, but it is also controversial. Its advantages are the full exposure of the field of vision and the huge operating space, while its disadvantages are the destruction of chest wall muscles and respiratory function impairment. At present, there is a lack of norms for the selection and application of Clamshell incisions, and the definition of complex mediastinal tumors is ambiguous and the dimensions are single. Therefore, this article reviews the literature and combines practical experience to systematically summarize the application progress of Clamshell incisions in the surgical resection of complex mediastinal tumors, with the aim of providing guidance for clinical work.