Objective Predictive value of mismatch repair(MMR)protein expression in endometrial cancer(EC)tissues and blood immune-inflammatory marker levels on postoperative survival.Methods A total of 118 patients with EC who were treated at Jiamusi Central Hospital from January 2017 to January 2020 were selected as study subjects.The status of MMR proteins in endometrial cancer tissues was analyzed by immunohistochemistry,and based on the staining results,patients were divided into a MMR-deficient group(dMMR group,n=40)and a MMR-proficient group(pMMR group,n=78).The preoperative systemic immune-inflammation index(SII)was calculated.The pelvic lymph node status of the patients was observed.Enzyme-linked im-munosorbent assay(ELISA)was used to detect serum levels of tumor necrosis factor-alpha(TNF-α),interleukin(IL)-1β,IL-6 and C-reactive protein(CRP)in the patients.Disease-free survival(DFS)and overall survival(OS)as well as their influencing factors were analyzed between the two groups.Results Comparison of age,FIGO stage,tumor histopathology,pelvic lymph node status and SII between the pMMR group and dMMR groups in patients,and the differences were statistically significant(Z/t/χ2=3.202～11.151,all P＜0.05).The average DFS of patients in pMMR group and dMMR group was 1 477 days and 756 days,the average OS was 1 588 and 826 days respectively,and the differences between the two groups were statistically significant(Log Rank χ2=24.804,30.411,all P<0.001).COX regression analysis showed that SII was an independent influencing factor of DFS in EC patients(Wald χ2=8.152,P<0.05).SII,pelvic lymph node status and MMR status were independent influencing factors of OS in EC patients(Wald χ2=7.066,5.936,6.971,all P<0.05).The ability of combining MMR status with SII to predict DFS and OS in EC patients was further improved,with AUC of 0.793 and 0.859,sensitivity of 72.4%and 75.0%,specificity of 78.3%and 80.0%,respectively.Conclusion MMR status and increased SII are independent influencing factors of poor postoperative prog-nosis of EC patients,and their combination is helpful to predict disease-free survival and overall survival of EC patients.

The transendothelial transport of low-density lipoprotein(LDL)and its subendothelial accumulation represent a central pathogenic mechanism in atherogenesis.This process involves a variety of receptors and molecular mechanisms that work together to regulate the transport of LDL in endothelial cells and its accumulation in blood vessel wall.In addition to receptor-mediated transport mechanisms,physiological and pathological factors such as hormones,inflammatory mediators and metabolites also play an important role in it.Recent studies have further elucidated the critical regulatory roles of these factors in LDL transendothelial transport,suggesting that targeting LDL transcytosis may represent an effective strategy for the prevention of early atherosclerosis and the treatment of related vascular diseases.This review summarizes recent advances in this field and discusses their potential clinical applications.

Objective Predictive value of mismatch repair(MMR)protein expression in endometrial cancer(EC)tissues and blood immune-inflammatory marker levels on postoperative survival.Methods A total of 118 patients with EC who were treated at Jiamusi Central Hospital from January 2017 to January 2020 were selected as study subjects.The status of MMR proteins in endometrial cancer tissues was analyzed by immunohistochemistry,and based on the staining results,patients were divided into a MMR-deficient group(dMMR group,n=40)and a MMR-proficient group(pMMR group,n=78).The preoperative systemic immune-inflammation index(SII)was calculated.The pelvic lymph node status of the patients was observed.Enzyme-linked im-munosorbent assay(ELISA)was used to detect serum levels of tumor necrosis factor-alpha(TNF-α),interleukin(IL)-1β,IL-6 and C-reactive protein(CRP)in the patients.Disease-free survival(DFS)and overall survival(OS)as well as their influencing factors were analyzed between the two groups.Results Comparison of age,FIGO stage,tumor histopathology,pelvic lymph node status and SII between the pMMR group and dMMR groups in patients,and the differences were statistically significant(Z/t/χ2=3.202～11.151,all P＜0.05).The average DFS of patients in pMMR group and dMMR group was 1 477 days and 756 days,the average OS was 1 588 and 826 days respectively,and the differences between the two groups were statistically significant(Log Rank χ2=24.804,30.411,all P<0.001).COX regression analysis showed that SII was an independent influencing factor of DFS in EC patients(Wald χ2=8.152,P<0.05).SII,pelvic lymph node status and MMR status were independent influencing factors of OS in EC patients(Wald χ2=7.066,5.936,6.971,all P<0.05).The ability of combining MMR status with SII to predict DFS and OS in EC patients was further improved,with AUC of 0.793 and 0.859,sensitivity of 72.4%and 75.0%,specificity of 78.3%and 80.0%,respectively.Conclusion MMR status and increased SII are independent influencing factors of poor postoperative prog-nosis of EC patients,and their combination is helpful to predict disease-free survival and overall survival of EC patients.

Objective:To evaluate the value of D-dimer(D-D) levels in the diagnosis of thromboembolism in children with severe Mycoplasma pneumoniae pneumonia (SMPP).Methods:A case control study was conducted on 51 SMPP patients admitted to Qingdao Women and Children′s Hospital Affiliated to Qingdao University and Jining First People′s Hospital from January 1, 2021 to August 1, 2024.They were divided into a thrombus group (19 cases) and a non-thrombus group (32 cases) according to whether they had thromboembolism.The characteristics of the cases were analyzed.Logistic regression was used to analyze the relationship between increased D-D levels and the risk of thrombosis.The value of D-D levels in predicting thromboembolism in SMPP patients was evaluated by the receiver operating characteristic curve.Results:Of the 19 patients with thrombosis, 11 had with pulmonary thrombosis, 6 had cerebrovascular thrombosis, 3 had heart thrombosis, 1 had spleen artery thrombosis, and 3 had multiple site thrombosis.Compared with the non-thrombus group, the thrombus group had higher D-D levels[(18.5±4.9) mg/L vs.(3.1±0.8) mg/L, t=3.118, P=0.006], higher C-reactive protein levels[25.5(15.5, 92.7) mg/L vs.7.9(3.9, 21.4) mg/L, Z=3.292, P=0.001], higher lactate dehydrogenase levels[484(351, 743) U/L vs.347(285, 396) U/L, Z=2.770, P=0.006] and a higher proportion of pleural effusion[63.1%(12/19) vs.25.0%(8/32), χ2=7.282, P=0.009].Increased D-D levels were an independent risk factor for thromboembolism in SMPP patients ( P=0.005, OR=1.254, 95% CI: 1.069-1.472).When the D-D level was used for predicting thromboembolism in SMPP patients, its cut-off value was 4.46 mg/L, its Youden index was 0.707, its area under the curve was 0.893(95% CI: 0.807-0.979), its sensitivity was 89.5%, its specificity was 81.2%, and its negative predictive value was 92.9%. Conclusions:D-D levels have high value in predicting thromboembolism in SMPP patients, and it can help timely identify patients at high risk.

Objective To explore the therapeutic mechanism of berberine in atopic dermatitis(AD)rats based on PI3K/Akt/NF-kappa B signaling pathway.Methods Sixty adult male Wistar rats were randomly divided into the blank group(normal rats),the control group(AD model,50 mg/kg berberine treatment)and the experimental group(AD model,200 mg/kg berberine treatment),with 20 rats in each group.The levels of interleukin-4(IL-4),interleukin-13(IL-13)and tumor necrosis factor-α(TNF-α)were determined by enzyme-linked immunosorbent assay(ELISA)at 1 d,7 d and 14 d of intervention.The protein levels of PI3K,p-PI3K,Akt,p-Akt and NF-κB p65 were detected by Western blot assay.Pathological changes of rat skin tissue were analyzed by HE staining.Results After intervention for 1 d,7 d and 14 d,serum levels of IL-4,IL-13,TNF-α and PI3K,p-PI3K,Akt,p-Akt and NF-kappa B p65 were higher in the control group than those in the blank group(P＜0.05).After intervention for 7 d and 14 d,the levels of the above indicators were lower in the experimental group than those in the control group(P＜0.05).After 14 days of intervention,compared with the blank group,the skin tissue of rats in the control group and the experimental group showed obvious pathological changes,including thickening of epidermis layer,excessive keratinization of the stratum comeum,thickening of spinous layer and a large infiltration of inflammatory cells in dermis.The pathological damage of rat skin tissue was significantly alleviated in the experimental group.Conclusion Berberine can inhibit the activation of PI3K/Akt/NF-kappa B signaling pathway,reduce serum level of inflammatory factors and reduce pathological damage of skin tissue in AD rats.

In recent years, the incidence of dry eye disease(DED)is increasing, positioning it as one of the most prevalent diseases affecting the ocular surface. Inflammatory response is the pathological basis of DED, involving various inflammatory mediators and inflammatory signaling pathways. Consequently, anti-inflammatory treatment emerges as a fundamental strategy for preventing and managing DED. This review summarizes the classic inflammatory factors involved in the development and progression of DED, including interleukins, tumor necrosis factor, matrix metalloproteinases, chemokines, and cell adhesion molecules. It also discusses the relevant inflammatory signaling pathways: the MAPKs pathway, NF-κB pathway, Wnt pathway and TLR pathway. Additionally, this review addresses the mechanisms of action and alterations in relevant biomarkers associated with current first-line recommended anti-inflammatory therapies, including corticosteroids, immunosuppressants, nonsteroidal anti-inflammatory drugs, and traditional Chinese medicine approaches to inflammation management. This comprehensive overview aims to enhance understanding of the inflammatory mechanisms underlying DED while exploring future therapeutic prospects.

In recent years, the incidence of dry eye disease(DED)is increasing, positioning it as one of the most prevalent diseases affecting the ocular surface. Inflammatory response is the pathological basis of DED, involving various inflammatory mediators and inflammatory signaling pathways. Consequently, anti-inflammatory treatment emerges as a fundamental strategy for preventing and managing DED. This review summarizes the classic inflammatory factors involved in the development and progression of DED, including interleukins, tumor necrosis factor, matrix metalloproteinases, chemokines, and cell adhesion molecules. It also discusses the relevant inflammatory signaling pathways: the MAPKs pathway, NF-κB pathway, Wnt pathway and TLR pathway. Additionally, this review addresses the mechanisms of action and alterations in relevant biomarkers associated with current first-line recommended anti-inflammatory therapies, including corticosteroids, immunosuppressants, nonsteroidal anti-inflammatory drugs, and traditional Chinese medicine approaches to inflammation management. This comprehensive overview aims to enhance understanding of the inflammatory mechanisms underlying DED while exploring future therapeutic prospects.

Objective To understand the status of quality control in occupational medical examination (OME) institutions in Guizhou Province. Methods A total of 124 registered OME institutions actively conducting OME in Guizhou Province were selected as the study subjects using the judgment sampling method. The evaluation was conducted by on-site document reviews, practical skill assessments, and investigation of OME practices for quality evaluation and analyzing their quality control performance. Results The public institutions accounted for 71.0% with a 41.5% of OME workload, while private institutions accounted for 29.0% with a 58.5% of OME workload among these 124 OME institutions. The overall pass rate for quality evaluation of OME institutions was 16.9% (21/124), with a total of 1 296 items failed to pass the quality evaluation. Among the unqualified items, organizational structure, quality control management systems, OME quality control, and information reporting accounted for 15.2%, 21.7%, 52.8%, and 10.3%, respectively. The unqualified rate of quality assessment items of OME institutions was 24.5% (1 296/5 288), and the unqualified rate was lower in public institutions compared with private institutions (22.4% vs 29.3%, P<0.01). The rates of the three key unqualified items, including chest radiography conclusion evaluation, audiogram calculation and conclusion evaluation, and blood lead comparison were 9.8%, 74.8% and 71.4%, respectively. The rates of unqualified audiometry operation test and chief physician theory test were 74.8% and 9.7%, respectively. Conclusion The quality of OME institutions in Guizhou Province requires continuous improvement, particularly in enhancing the abilities of audiometry operation, calculating audiogram results and conducing right conclusion, and blood lead inter-laboratory comparision.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To investigate the incidence of shoulder work-related musculoskeletal disorders (WMSDs) among occupational population in China, and to explore their intrinsic association with personal and work-related factors.Methods:In April 2024, 73497 valid questionnaires of the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire were retrospectively analyzed from June 2018 to December 2023 in 22 provinces and 29 key industries in China, and the general information, occurrence of WMSDs and related risk factors of key occupational populations in different regions in China were collected. By using Chi-square test and confirmatory factor analysis, the relationship between shoulder fatigue and pain in key occupational groups and individual factors, work type, work posture and work organization was discussed, and the internal relationship was analyzed based on structural equation model.Results:Higher incidence of shoulder fatigue and pain were associated with female, lack of physical exercise, uncomfortable working posture and neck leaning forward ( P<0.05). Structural equation model analysis showed that work type, work posture and work organization were strongly correlated ( r=0.58, 0.55). Work organization and work type were strongly correlated with shoulder fatigue ( r=0.65) and moderately correlated with shoulder fatigue ( r=0.21). Shoulder fatigue was moderately associated with shoulder pain ( r=0.40). Individual factors, work type, work posture and shoulder fatigue could directly affect shoulder pain ( OR=0.07, -0.09, 0.17 and 0.40), and work type and work posture could also indirectly affect shoulder pain through shoulder fatigue ( OR=0.08, 0.03). Work organization only indirectly affected shoulder pain through shoulder fatigue ( OR=0.26) . Conclusion:The main influencing factor of shoulder pain is shoulder fatigue, followed by work posture and individual factors. Structural equation model can better reflect the complex relationship between work type, work posture and work organization and shoulder WMSDs. Improving work posture and work organization may be an effective way to control the influence of shoulder fatigue on shoulder pain.