Objective To understand the antibody levels of diphtheria and tetanus among healthy population in Shanghai Pudong New Area, and to provide a scientific basis for improving the vaccine immunization strategy. Methods Random sampling was used to select healthy people of all ages in 16 communities in Shanghai Pudong New Area from 2018 to 2024, and serum samples were collected and tested for serum anti-diphtheria and tetanus toxin IgG antibodies by enzyme-linked immunosorbent assay (ELISA) method to analyze the antibody positivity rate (≥0.1 IU/ml) and the geometric mean concentration (GMC) of antibodies. Results A total of 3 312 serum samples were included, with a male-to-female ratio of 0.76:1, and 53.77% were local residents. The seropositivity rates and geometric mean concentrations (GMC) of both diphtheria and tetanus antibodies generally declined with increasing age, but exhibited a transient rebound in the 7y-. A total of 1 175 individuals (35.48%) were seropositive for diphtheria, with a GMC of 0.054 IU/mL. For tetanus, 988 individuals (29.83%) were seropositive, with a GMC of 0.033 IU/mL. Significant differences in seropositivity rates (χ²_diphtheria=950.005,χ²_tetanus=1 324.393) and GMC (H_diphtheria=1027.160,H_tetanus=1 142.007) were observed among different age groups (P<0.001). Significant differences in seropositivity rates (χ²_diphtheria=950.005,χ²_tetanus=1324.393) and GMC (H_diphtheria=1027.160,H_tetanus=1142.007) were also found across different years (P<0.001). Conclusion The prevalence of diphtheria and tetanus antibodies in the healthy population of Pudong New Area is relatively low, particularly among adults over 20 years of age with inadequate immunization. This underscores the need to reinforce the National Immunization Program (NIP) vaccine specifications for children under 6 years of age and implement an immunization strategy for adolescents or adults against diphtheria and tetanus.

Objective:Bioinformatics and experimental validation reveal the core genes of neutrophil extracellular traps(NETs)in chronic obstructive pulmonary disease(COPD).Methods:Chip data GSE8545,GSE10006,GSE11906,GSE19407 and GSE20257 were downloaded from GEO database,and the common differential expression genes(DEGs)of the first 4 datas were ob-tained through intersection and enrichment analysis were performed.Neutrophil extracellular traps differential expression genes(NETs-DEGs)were obtained by overlapping the NETs-related genes and the common DEGs,and GSE20257 was used to verify the NETs-DEGs and evaluate the diagnostic efficacy,and enrichment analysis was performed and mRNA expression level was verified in lung tissue of mice emphysema model.Results:A total of 149 common DEGs were acquired.DO analysis mainly concentrated in lung disease and COPD.GO functional annotation mainly involved in olefin metabolism,cytohormone metabolism,endoplasmic reticulum lumen,signaling receptors and oxidative stress activities.KEGG enrichment analysis mainly involved in cytochrome P450 metabo-lism,chemical carcinogenic reactive oxygen species,steroid hormone biosynthesis and phagosome,etc.GSE20257 dataset verifica-tion showed that NETs-DEGs TLR7 and CYP4F3 were up-regulated,and AUC values were 0.750 and 0.947.GO and KEGG mainly focused on fat-soluble vitamin catabolic signaling pathways,phagosomes,arachidonic acid monooxygenase activity,pattern recogni-tion receptors,arachidonic acid metabolism,Toll-like receptor signaling pathways and formation of NETs.Compared with air exposure group,mRNA expression levels of TLR7 and CYP4F3 in lung tissue of emphysema mice induced by cigarette smoke exposure were sig-nificantly increased(P<0.05).Conclusion:TLR7 and CYP4F3 may be the core genes in formation and release of NETs during the pathogenesis of COPD,which are expected to become the targets of immunotherapy for COPD.

Currently,there are practical and technical difficulties in the construction of clinical ques-tions in the development of clinical practice guidelines.Clinicians or guideline developers seldom construct clin-ical questions based the actual case scenario,leading to some information loss between structured and actual clinical connotation.To overcome this challenge,we proposed a case-guided questions construction approach,and carried out case research and verification in the formulation of the guideline.We found that this method could more efficiently and scientifically assist the formulation of clinical questions,and provide reference for clinicians or guideline developers.

Objective To investigate the relationship between serum ferritin(SF)and metabolic associated fatty liver disease(MAFLD)in adolescents.Methods This study utilized data from 2017 to 2020 national health and nutrition examination survey database,ultimately including 559 adolescents aged 12～18 years,divided into MAFLD group(119 cases)and non-MAFLD group(440 cases).Data on demographic characteristics,serum iron metabolism indicators,liver function,lipid profiles,glucose levels,and other relevant parameters were collected.Liver steatosis and fibrosis were assessed using vibration-controlled transient elastography.Pearson correlation and Logistic regression analyses were performed to evaluate the relationship between SF and MAFLD.Results SF levels were significantly higher in MAFLD group compared to non-MAFLD group(P<0.05).Pearson correlation analysis indicated that SF was positively correlated with the controlled attenuation parameter,liver stiffness measurement,body mass index(BMI),alanine aminotransferase(ALT),γ-glutamyl transferase,triglycerides,and uric acid levels(P<0.05),but negatively correlated with high-density lipoprotein cholesterol levels(P<0.05).Adolescents were divided into 4 groups according to the quartiles of SF levels(Q1 goup:SF 1.9-25.6ng/ml;Q2 goup:SF 25.7-41.7ng/ml;Q3 goup:SF 41.8-70.4ng/ml;Q4 goup:SF 70.5-445.0ng/ml).The results of Logistic regression analysis showed that when the variables were not adjusted,the risk of MAFLD in Q4 group adolescents was significantly increased,this association disappeared after adjusting for gender,age,race,BMI,and other factors.BMI(OR=1.250,95％CI:1.176-1.329),globulin(OR=2.991,95％CI:1.218-7.343),ALT(OR=1.052,95％CI:1.003-1.104),and white blood cell count(OR=1.225,95％CI:1.041-1.441)were identified as independent risk factors for MAFLD.Conclusion SF levels are significantly elevated in adolescents with MAFLD but are not independently associated with the occurrence of MAFLD.BMI,globulin,ALT,and white blood cell count are important risk factors for adolescent MAFLD.

Objective To investigate the effects and mechanisms of high-fat diet(HFD)-induced obesity on male ze-brafish reproductive function.Methods Adult male zebrafish were divided into normal diet(ND)group and HFD group.Growth and metabolic conditions were evaluated by measuring body weight,body length,BMI,organ index,and glucose/lipid lev-els.Reproductive capacity was assessed via sperm concentration,motility,fertilization rate,and testosterone levels.Testicular tissues from both of groups were subjected to transeriptomic sequencing(RNA-seq).And qRT-PCR was used to validate the expression of genes.Results Compared to male zebrafish in ND group,the ones in HFD group exhibited hepatic steatosis and glucose/lipid meta-bolic disorders(P＜0.05).Testicular structural disorganization,along with reduced testosterone levels,decreased gonadosomatic in-dex,and impaired sperm concentration and motility occurred in HFD group(P＜0.05).GO analysis revealed that differentially ex-pressed genes were enriched in spermatogenesis and ciliary system,while KEGG analysis highlighted metabolic related pathways(pu-rine metabolism,thyroid hormone synthesis,mTOR signaling)and cell adhesion molecules.Twenty key differentially expressed genes were validated by qRT-PCR,which confirmed the reliability of RNA-Seq results.Conclusion Impairment of reproductive function induced by HFD in zebrafish may be associated with three regulatory mechanisms including ciliary system,metabolic dysregulation,and aberrant cell adhesion molecule signaling.This study provides mechanistic insights and identifies potential therapeutic targets for clinical management of diet-associated infertility.

Objective:To analyze the clinical and ultrasonic features of breast invasive ductal carcinoma in young women patients,and improve the accuracy of ultrasonic diagnosis of breast invasive ductal carcinoma in young patients.Methods:A retrospective study was conducted on patients with invasive ductal carcinoma who underwent surgery in the Second Hospital of Shandong University from December 2015 to June 2023,with complete clinical data,preopera-tive ultrasonography and postoperative pathology.All patients were divided into two groups:young group(≤35 year-old)and control group(>35 year-old).Univariate t-test and multivariate Logistic regression analyses were used to assess the factors.Results:There was a statistical difference between the young group and the control group in the accuracy of ultrasound diagnosis(young group 81%vs control group 94%,χ2=13.082,P=0.001).Compared with the control group,the young group had a shorter disease history,a higher proportion of multiple masses,posterior echo changes and hypo-vascular lesions(P<0.05).However,there was no statistical difference in family history of breast cancer,other cancer family history,clinical symptoms,size,lesion classification,palpation,location,aspect ratio,focus echo,shape,edge per-formance,bright ring sign,calcification characteristics,ER,PR,HER-2 and Ki67(P>0.05).Conclusion:The incidence rate of young breast IDC is low,while the misdiagnosis rate of ultrasound is relatively high.More attention should be paid when the patient has a short history,multiple masses,changes in the posterior echo and less lesion blood supply.

Objective To observe the value of 68Ga-DOTA-NOC PET/CT for diagnosing pheochromocytoma(PCC)and paraganglioma(PGL).Methods Thirty-eight patients with suspected or confirmed PCC/PGL who underwent 68 Ga-DOTA-NOC PET/CT were retrospectively enrolled,among them 20 cases underwent 131I-metaiodobenzylguanidine(MIBG)SPECT/CT during the same period.The value of 68Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL at individual and lesion levels were analyzed and compared to the results of 131I-MIBG SPECT/CT.Results Among 38 cases,there were 20 cases of PCC,14 cases of PGL,1 case of adrenocortical carcinoma and 3 cases of benign adrenal hyperplasia.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 68 Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL in all 38 cases was 87.88％(29/33),60.00％(3/5),93.55％(29/31),42.86％(3/7)and 84.21％(32/38),respectively.Totally 188 lesions were detected in 34 cases,with detection rate of 89.95％(188/209).For 20 patients who underwent both 2 kinds examinations,the detection rate of bone,lymph node,liver,lung metastases and the overall lesions of 68Ga-DOTA-NOC PET/CT were all higher than those of 131I-MIBG SPECT/CT(all P＜0.05).No significant difference of diagnostic accuracy of PCC/PGL was found between 68 Ga-DOTA-NOC PET/CT and 131I-MIBG SPECT/CT(P＞0.05).Conclusion The value of 68 Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL was comparable to that of 131I-MIBG SPECT/CT,but the former showed higher detection rate of metastases,hence being helpful to staging and risk stratification of PCC/PGL.

Objective:To investigate the clinical efficacy of moxibustion(Mox)combined with low-dose tadalafil(TAD)in the treatment of diabetes mellitus-induced erectile dysfunction(DMED)with the syndrome of Qi deficiency and blood stasis.Meth-ods:According to the inclusion and exclusion criteria,we selected 90 patients with DMED for this trial and equally randomized them into a Mox,a TAD,and a Mox combined with TAD(Mox+TAD)group to be treated by mild Mox applied to the acupoints Zusanli,Sanyinjiao and Yinlingquan qd alt,oral medication with low-dose TAD at 5 mg per dose qd,and combination of the above two thera-pies,respectively,all for 4 weeks.We obtained from the patients their IIEF-5 scores,traditional Chinese medicine(TCM)symptoms scores,Erectile Hardness Scale(EHS)scores,corpus cavernosal hemodynamic indexes,and the peak systolic velocity(PSV),end diastolic velocity(EDV)and resistance index(RI)of the corpus cavernosal arteries before and after treatment,and compared them among the three groups.Results:The total effectiveness rate was significantly higher in the Mox+TAD(90.0％)than in the Mox(46.7％)and TAD groups(60.0％)(P＜0.05).Compared with the baseline,the IIEF-5 and EHS scores were increased,while the TCM symptoms scores decreased in all the three groups after treatment,more significantly in the Mox+TAD group than in the other two(P＜0.05).And the PSV and RI were remarkably increased,while the EDV decreased(P＜0.05)in all the three groups(P＜0.05)after treatment,with PSV even higher in the Mox+TAD than in the Mox and TAD groups(P＜0.05).Conclusion:Moxi-bustion combined with tadalafil has a definite efficacy and safety for the treatment of DMED,which can effectively improve the erectile function of the patients by increasing penile blood supply,benefiting qi and activating blood circulation.

AIM To explore the clinical effects of Jinfukang Oral Liquid combined with thymosin α1 on patients with non-small cell lung cancer due to Dual Deficiency of Qi and Yin.METHODS Seventy-five patients were randomly assigned into thymosin α1 group(15 cases)for 4-week administration,Jinfukang Oral Liquid group(30 cases)for 4-week administration,and combination group(30 cases)for 4-week administration.The changes in TCM clinical syndrome effects,immunity indices(CD3+T,Th,CTL,total NK,CD56dim CD16+NK,NKT,Treg,MDSC),lethality/inhibition ratios(CTL/Treg,total NK/Treg,NKT/Treg,CTL/MDSC,total NK/MDSC,NKT/MDSC)and FACT-L scores were detected.RESULTS The Jinfukang Oral Liquid group and combination group demonstrated higher total effective rates than the thymosin α1 group(P＜0.05).After the treatment,the Jinfukang Oral Liquid group and combination group displayed increased NKT(P＜0.05)and decreased MDSC(P＜0.05),which were more obvious than those in the thymosin α1 group(P＜0.05),and higher NKT was observable in the Jinfukang Oral Liquid group(P＜0.05);the Jinfukang Oral Liquid group and combination group displayed increased lethality/inhibition ratios(P＜0.05),among which NKT/Treg,CTL/MDSC,total NK/MDSC,NKT/MDSC were higher than those in the thymosin α1 group(P＜0.05),and higher CTL/MDSC,NKT/MDSC were observable in the Jinfukang Oral Liquid group(P＜0.05);the Jinfukang Oral Liquid group(except for physiological status,society and family status)and combination group(except for society and family status)displayed increased FACT-L scores(P＜0.05).CONCLUSION For the patients with non-small cell lung cancer due to Dual Deficiency of Qi and Yin,Jinfukang Oral Liquid single use or combined with thymosin α1 can enhance peripheral blood immune surveillance,inhibit immune escape,restore the balanced state of tumor immune responses,and improve TCM syndromes and life quality.

Objective:To evaluate the association between erectile dysfunction(ED)and myocardial infarction(MI)using two sample Mendelian randomization.Methods:A Mendelian randomization study was conducted using comprehensive data on ED and MI from extensive genome-wide association data.Using inverse variance weighted analysis for causal relationships,and correct for confounding factors using multivariate Mendelian randomization,the potential mediating effects were evaluated as well.Based on Gene-card data,the genes related to ED and MI were identified.Molecular docking was used to reveal spontaneously bound drug molecules.Results.Our study found that exposure to ED was a risk factor for MI(OR:1.001 0,95％CI:1.000 2-1.001 8,P=0.017 7),which also held true in the validation dataset(OR:1.028 5,95％CI:1.005 0-1.052 6,P=0.017 2).No statistically significant heterogeneity or horizontal pleiotropy was found.The results of reverse Mendelian randomization analysis showed any reverse causal re-lationship between ED and MI.In multivariate Mendelian randomization analysis,after excluding confounding factors(excluding tri-glycerides and high-density lipoprotein),the P-value remained less than 0.05,and the OR ranged from 1.000 1 to 1.000 7,indica-ting that ED was still a risk factor for MI.In the mediation analysis,it was found that the current mediation ratio of smoking to MI was 13.06％.In summary-data-based mendelian randomization analysis,it was found that the gene PTPN11 was a common target gene for MI and ED(OR=0.990,P＜0.001).Subsequent molecular docking with sildenafil,clopidogrel,and dapoxetine could spontaneous-ly bind to the PTPN11 gene receptor.Conclusion:There is a causal relationship between ED and MI,with smoking as a potential mediating factor,and the gene PTPN11 being a co-target gene.