INTRODUCTION: Lecanemab has shown promise in treating early Alzheimer's disease (AD), but its safety and efficacy in Chinese populations remain unexplored. This study aimed to evaluate the safety and 6-month clinical outcomes of lecanemab in Chinese patients with mild cognitive impairment (MCI) or mild AD. METHODS: In this single-arm, real-world study, participants with MCI due to AD or mild AD received biweekly intravenous lecanemab (10 mg/kg). The study was conducted at Hainan Branch, Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Patient enrollment and baseline assessments commenced in November 2023. Safety assessments included monitoring for amyloid-related imaging abnormalities (ARIA) and other adverse events. Clinical and biomarker changes from baseline to 6 months were evaluated using cognitive scales (mini-mental state examination [MMSE], montreal cognitive assessment [MoCA], clinical dementia rating-sum of boxes [CDR-SB]), plasma biomarker analysis, and advanced neuroimaging. RESULTS: A total of 64 patients were enrolled in this ongoing real-world study. Safety analysis revealed predominantly mild adverse events, with infusion-related reactions (20.3%, 13/64) being the most common. Of these, 69.2% (9/13) occurred during the initial infusion and 84.6% (11/13) did not recur. ARIA-H (microhemorrhages/superficial siderosis) and ARIA-E (edema/effusion) were observed in 9.4% (6/64) and 3.1% (2/64) of participants, respectively, with only two symptomatic cases (one ARIA-E presenting with headache and one ARIA-H with visual disturbances). After 6 months of treatment, cognitive scores remained stable compared to baseline (MMSE: 22.33 ± 5.58 vs . 21.27 ± 4.30, P = 0.733; MoCA: 16.38 ± 6.67 vs . 15.90 ± 4.78, P = 0.785; CDR-SB: 2.30 ± 1.65 vs . 3.16 ± 1.72, P = 0.357), while significantly increasing plasma amyloid-β 42 (Aβ42) (+21.42%) and Aβ40 (+23.53%) levels compared to baseline. CONCLUSIONS: Lecanemab demonstrated a favorable safety profile in Chinese patients with early AD. Cognitive stability and biomarker changes over 6 months suggest potential efficacy, though high dropout rates and absence of a control group warrant cautious interpretation. These findings provide preliminary real-world evidence for lecanemab's use in China, supporting further investigation in larger controlled studies. REGISTRATION ClinicalTrials.gov , NCT07034222.
Humans ; Alzheimer Disease/drug therapy* ; Male ; Female ; Aged ; Middle Aged ; Cognitive Dysfunction/drug therapy* ; Aged, 80 and over ; Amyloid beta-Peptides/metabolism* ; Biomarkers ; East Asian People

Objective:Papillary thyroid carcinoma with a maximum tumor diameter of ≤1 cm was defined as papillary thyroid carcinoma (PTC). To explore the clinical risk factors of central lymph node metastasis (CLNM) in PTC at different locations.Methods:The clinical and pathological data of 1383 cases with solitary PTC in Hangzhou First People’s Hospital were retrospectively analyzed, and they were divided into isthmus group (175 cases), near-isthmus group (95 cases) and lateral lobe group (1113 cases) according to their tumor location. Univariate and multivariate analyses were used to analyze the relationship between gender, age, tumor maximum diameter, Hashimoto’s thyroiditis (HT) and CLNM, and the threshold for the occurrence of CLNM in each group of age and tumor maximum diameter was determined by the area under the receiver operating characteristic (ROC) .Results:The proportion of CLNM in the isthmus group, near-isthmus group and the lateral lobe group were 39.4% (69/175), 35.8% (34/95) and 29.6% (329/1113), respectively ( χ2=7.84, P=0.020). The intra-group comparison showed that there were statistical differences between the isthmus group and the lateral lobe group ( χ2=6.90, P=0.011), and there were no statistical differences between the isthmus group and near-isthmus group ( χ2=0.35, P=0.601), and near-isthmus group and the lateral leaf group ( χ2=1.62, P=0.313). Univariate and multivariate analysis showed that male ( OR: 3.697) and age < 38.5 years ( OR: 4.727) were independent risk factors for CLNM in PTC in the Isthmus Group, while male ( OR: 2.193), without HT ( OR: 1.702), tumor maximum diameter > 6.5 mm ( OR: 2.535) and age < 45.5 years ( OR: 3.030) were independent risk factors for CLNM in PTC in the lateral lobe group. Conclusions:Male sex and age are independent risk factors for CLNM in isthmus and lateral lobe PTC, and uncomplicated HT and tumor maximum diameter are also independent risk factors for CLNM in lateral lobe PTC. The incidence of CLNM in PTC in the isthmus, near-isthmus and lateral lobes decreased sequentially, and PTC in the near isthmus can not be simply regarded as the isthmus or lateral lobe PTC, and the lymph nodes in the central area should be fully evaluated before surgery to provide individualized treatment.

Objective:Papillary thyroid carcinoma with a maximum tumor diameter of ≤1 cm was defined as papillary thyroid carcinoma (PTC). To explore the clinical risk factors of central lymph node metastasis (CLNM) in PTC at different locations.Methods:The clinical and pathological data of 1383 cases with solitary PTC in Hangzhou First People’s Hospital were retrospectively analyzed, and they were divided into isthmus group (175 cases), near-isthmus group (95 cases) and lateral lobe group (1113 cases) according to their tumor location. Univariate and multivariate analyses were used to analyze the relationship between gender, age, tumor maximum diameter, Hashimoto’s thyroiditis (HT) and CLNM, and the threshold for the occurrence of CLNM in each group of age and tumor maximum diameter was determined by the area under the receiver operating characteristic (ROC) .Results:The proportion of CLNM in the isthmus group, near-isthmus group and the lateral lobe group were 39.4% (69/175), 35.8% (34/95) and 29.6% (329/1113), respectively ( χ2=7.84, P=0.020). The intra-group comparison showed that there were statistical differences between the isthmus group and the lateral lobe group ( χ2=6.90, P=0.011), and there were no statistical differences between the isthmus group and near-isthmus group ( χ2=0.35, P=0.601), and near-isthmus group and the lateral leaf group ( χ2=1.62, P=0.313). Univariate and multivariate analysis showed that male ( OR: 3.697) and age < 38.5 years ( OR: 4.727) were independent risk factors for CLNM in PTC in the Isthmus Group, while male ( OR: 2.193), without HT ( OR: 1.702), tumor maximum diameter > 6.5 mm ( OR: 2.535) and age < 45.5 years ( OR: 3.030) were independent risk factors for CLNM in PTC in the lateral lobe group. Conclusions:Male sex and age are independent risk factors for CLNM in isthmus and lateral lobe PTC, and uncomplicated HT and tumor maximum diameter are also independent risk factors for CLNM in lateral lobe PTC. The incidence of CLNM in PTC in the isthmus, near-isthmus and lateral lobes decreased sequentially, and PTC in the near isthmus can not be simply regarded as the isthmus or lateral lobe PTC, and the lymph nodes in the central area should be fully evaluated before surgery to provide individualized treatment.

Objective:To evaluate the effect of the positive P-glycoprotein expression on the efficacy of patient-controlled intravenous analgesia (PCIA) with sufentanil or pentazocine in patients with cancer pain.Methods:This was a retrospective cohort study. The medical records of patients with cancer pain of either sex, aged 54-71 yr, weighing 49-67 kg, with TNM stage Ⅱ-Ⅳ, who were treated in People′s Hospital of Lishui from January 2020 to January 2024, were collected. The expression of P-glycoprotein in tumor tissues was determined by the immunohistochemical method. Patients with negative P-glycoprotein expression in tumor tissues were divided into 2 groups: sufentanil group (group S 1) and pentazocine group (group P 1). Patients with positive P-glycoprotein expression in tumor tissues were divided into 2 groups: sufentanil group (group S 2) and pentazocine group (group P 2). The patients in 4 groups received 48 h of PCIA when visual analogue scale > 5 cm. The PCIA solution contained sufentanil 2 μg/kg and tropisetron 10 mg in 100 ml of normal saline in S 1 and S 2 groups or pentazocine 3 mg/kg+ tropisetron 10 mg in 100 ml of normal saline in P 1 and P 2 groups. The PCIA pump was set up to deliver a 1 ml bolus dose with a 10-min lockout interval and background infusion at 2 ml/h after a loading dose of 5 ml. Flurbiprofen 50 mg was intravenously injected when visual analogue scale > 3 cm during analgesia. The consumption of sufentanil, pentazocine and flurbiprofen within 4 h, >4-12 h, > 12-24 h and > 24-48 h of PCIA was recorded. The occurrence of adverse reactions such as respiratory depression (SpO 2<90%), nausea or/and vomiting, pruritus and bradycardia was recorded. Results:One hundred patients were finally included, with 25 in each group. There was no significant difference in the consumption of sufentanil, usage rate of flurbiprofen and incidence of respiratory depression, nausea and vomiting, pruritus and bradycardia during analgesia at each time period during PCIA between group S 1 and group S 2 ( P>0.05). Compared with group P 1, the consumption of pentazocinein was significantly increased within 4 h, > 4-12 h, and > 24-48 h of PCIA ( P<0.05), and no significant change was found in the usage rate of flurbiprofen at each time period and the incidence of respiratory depression, nausea or/and vomiting, pruritus and bradycardia during analgesia in group P 2 ( P>0.05). Conclusions:Positive P-glycoprotein expression may weaken the efficacy of PCIA with pentazocine, but exerts no effect on the efficacy of PCIA with sufentanil in patients with cancer pain.

Objective:To investigate the dynamic changes of oral saliva flow, pH value, and bacterial flora before and after radiotherapy in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiotherapy, and to analyze the influencing factors of severe radioactive oral mucositis.Methods:One hundred NPC patients who received radiotherapy for the first time in the Head and Neck Radiotherapy Ward of Shandong Cancer Hospital and Institute from June 2, 2021 to December 30, 2022 were selected. Oral saliva flow, pH value and bacterial flora were measured at 5 time points, namely before radiotherapy, 15 times of radiotherapy, 35 times of radiotherapy, 1 month and 3 months after radiotherapy in patients with NPC, and the dynamic changes of 3 indicators were analyzed at each time. The factors of the occurrence of severe radioactive oral mucositis in patients with NPC were analyzed by univariate and multivariate logistic regression 15 times of radiotherapy.Results:The saliva flow of patients with NPC before radiotherapy, 15 times of radiotherapy, 35 times of radiotherapy, 1 month after and 3 months after radiotherapy were (16.51±1.29), (8.64±1.31), (5.15±1.14), (4.78±1.36) and (5.67±1.27) ml, respectively, with a statistically significant difference ( F=2 171.94, P<0.001). Oral saliva flow decreased to the lowest level 1 month after radiotherapy and then increased (all P<0.05). The pH values of patients with NPC before radiotherapy, 15 times of radiotherapy, 35 times of radiotherapy, 1 month after and 3 months after radiotherapy were 8.28±0.67, 5.87±0.53, 5.32±0.55, 6.04±0.83, 6.74±0.63, respectively, with a statistically significant difference ( F=370.43, P<0.001). The pH value decreased successively after 15 and 35 times of radiotherapy, and gradually increased 1 month and 3 months after radiotherapy (all P<0.05). There was a statistically significant difference ( χ2=18.24, P<0.001) in the detection rate of pathogenic bacteria in patients with NPC before radiotherapy (6%, 6/100), 15 times of radiotherapy (62%, 62/100), 35 times of radiotherapy (60%, 60/100), 1 month after radiotherapy (40%, 40/100) and 3 months after radiotherapy (29%, 29/100). Compared with before radiotherapy, there were statistically significant differences in the detection rates of pathogenic bacteria between 15 times of radiotherapy and 35 times of radiotherapy ( χ2=1.90, P=0.001; χ2=1.63, P=0.005). There was no statistically significant difference in the detection rate of pathogenic bacteria between 15 times of radiotherapy and 35 times of radiotherapy ( χ2=0.27, P=0.644). Compared with before radiotherapy, there was no statistically significant difference in the detection rate of pathogenic bacteria 1 month after radiotherapy and 3 months after radiotherapy ( χ2=1.30, P=0.024; χ2=0.83, P=0.149). Of 100 cases of NPC radiotherapy, 70 patients developed severe radiation oral mucositis (≥ grade 3). There were statistically significant differences in severe radioactive oral mucositis among patients with different smoking history ( χ2=8.84, P=0.003), alcohol drinking ( χ2=23.94, P<0.001), chemotherapy ( χ2=40.41, P<0.001), oral hygiene ( χ2=8.16, P=0.004), oral pH ( χ2=16.83, P<0.001) and oral pathogens ( χ2=8.80, P=0.003). Multivariate analysis showed that, alcohol drinking ( OR=2.23, 95% CI: 1.98-6.04, P=0.006), chemotherapy ( OR=3.13, 95% CI: 2.62-6.87, P<0.001) and oral pathogens ( OR=3.11, 95% CI: 1.04-9.31, P=0.043) were independent influencing factors for the occurrence of severe radioactive oral mucositis in NPC patients with radiotherapy. Conclusion:The oral saliva flow of patients with NPC decreases gradually from the beginning of radiotherapy to the lowest 1 month after radiotherapy and then increases. The pH value gradually decreases from the beginning of radiotherapy to 35 times of radiotherapy, and gradually increases from 1 month to 3 months after radiotherapy. The detection rate of pathogenic bacteria increases rapidly from the beginning of radiotherapy to 15 times of radiotherapy, and the growth rate is stable from 15 times of radiotherapy to 35 times of radiotherapy, and tended to be normal 1 month after radiotherapy. Drinking history, chemotherapy history and oral pathogens are independent risk factors influencing the occurrence of severe radioactive oral mucositis.

Objective:To investigate the value of artificial intelligence (AI) cytomorphologic analysis system in the cytomorphological diagnosis and therapeutic evaluation of acute myeloid leukemia (AML).Methods:Bone marrow smear samples were collected from 150 patients with newly diagnosed and treated acute myeloid leukemia who were inpatients and outpatients at the Department of Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 1, 2021 to July 31, 2022 for retrospective analysis. Among them, there were 50 patients in the newly diagnosed group, including 28 males and 22 females, with the onset age of 43.5(32.3,58.8)years. There were 100 patients in the post-treatment group, including 36 males and 64 females, with the onset age of 34.5(23.0,47.0)years. The results from cytomorphology expert were used as the gold standard and the Python 3.6.7 was used for analysis to evaluate the accuracy, sensitivity, and specificity of the AI cytomorphologic analysis system for blast cell recognition in AML diagnosis and treatment.Results:The proportion of blasts in AI analysis of 50 samples in the newly diagnosed group was≥20%, which met the diagnostic criteria of AML. AI analysis of blasts had an accuracy of 90.3%, sensitivity of 85.5%, and specificity of 98.0%. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.882, P<0.001). Meanwhile, in the post-treatment group, the sensitivity and specificity of AI analysis of blasts were 89.7% and 99.2%, respectively. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.957, P<0.001). According to AI analysis data, there are 8 samples in this group whose AI efficacy evaluation results on AML are inconsistent with expert analysis. Conclusion:AI cytomorphologic analysis system has high accuracy, sensitivity and specificity for blast cell recognition in AML morphological diagnosis and therapeutic evaluation.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis mediated by anti-NMDAR antibody. Current studies have found that most patients with anti-NMDAR encephalitis have a good prognosis after immunotherapy and tumor therapy, but there are still 4.5%-36.4% patients with relapse. It is important to identify the risk factors for the prevention of relapse. This article aims to review the relapse risk factors of NMDAR encephalitis in order to provide help for the prevention of relapse.

Objective:To explore the effect of high intensity interval training (HIIT) on cardiac rehabilitation in patients after heart transplantation.Methods:According to the search terms, the search was conducted on China National Knowledge Infrastructure, VIP, WanFang Data, China Biology Medicine disc, Web of Science, PubMed, Cochrane Library, Embase, and EBSCO. The search time limit was from the establishment of the database to January 31, 2022. After 2 researchers screened the article, extracted information, and evaluated the quality, a Meta-analysis was conducted using RevMan 5.4 software.Results:According to the inclusion and exclusion criteria, 10 English articles were selected, including 191 patients in the intervention group and 212 patients in the control group, with a total of 403 patients. Meta-analysis showed that during cardiac rehabilitation exercise in patients after heart transplantation, HIIT could improve peak oxygen uptake in cardiopulmonary function exercise testing [ MD=1.98, 95% confidence interval ( CI) (0.55, 3.41), P=0.007], peak heart rate in chronotropic responses [ MD=6.93, 95% CI (2.62, 11.24), P=0.002], and muscle exercise ability [ MD=337.18, 95% CI (12.02, 62.35), P=0.04]. There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, peak systolic blood pressure, peak diastolic blood pressure, resting heart rate and respiratory exchange rate between the two groups ( P>0.05). A subgroup analysis of peak oxygen uptake was conducted based on the intervention period and the start time of rehabilitation exercise after heart transplantation. The results showed that there were statistically significant differences in peak oxygen uptake between the intervention group and the control group when the intervention period was ≤ 12 weeks or the start time was > 6 weeks ( P<0.01) . Conclusions:HIIT effectively improves the peak oxygen uptake, peak heart rate, and muscle exercise activity of patients after heart transplantation. HIIT has a significant impact on peak oxygen uptake when the rehabilitation exercise start time after heart transplantation is > 6 weeks or the intervention period is ≤ 12 weeks.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis mediated by anti-NMDAR antibody. At present, the pathogenesis of the disease is not completely clear, and reliable animal models are of great significance for the study of its pathogenesis and pathophysiological process. The authors reviewed the reports of anti-NMDAR encephalitis′s animal models in recent years, and discussed the advantages and limitations of each model, in order to provide a more suitable animal model for further research on anti-NMDAR encephalitis.

Objective:To explore the association analysis of clinical characteristics and prognoses with cerebrospinal fluid antibody titer in patients with anti N-methyl- D-aspartic acid (NMDA) receptor encephalitis. Methods:Thirty-eight patients with anti-NMDA receptor encephalitis, admitted to our hospital from June 2014 to March 2019, were chosen. According to the titer results of anti-NMDA receptor antibodies reported by the first cerebrospinal fluid specimens, they were divided into low antibody titer group (antibody titer 1:10 and 1:32) and high antibody titer group (antibody titer 1:100 and 1:320). The clinical characteristics and prognoses of these patients were compared.Results:Of these 38 patients, 14 were into the group of low antibody titer, and 24 were into the group of high antibody titer. Patients in the low antibody titer group had significantly higher incidences of headache and laloplegia, and statistically lower serum antibody positive rate ( P<0.05). There were no significant differences between the two groups in other prodromal symptoms including fever, respiratory symptoms and life events, other common clinical manifestations including psychobehavioral abnormalities or cognitive impairment, seizures, motor disorders and decreased consciousness level, staying in ICU or not, intubating endotracheal tube or not, length of stay in ICU, time from symptom onset to definite diagnosis, and occurrence of complications, skull MRI, EEG, and lab results, modified Rankin scale (mRS) scores at discharge, time required to recover to mRS score of 0-1 after discharge, and mRS scores at follow-up. Conclusion:Cerebrospinal fluid antibody titer has limited significance in evaluating disease severity and guiding diagnosis and treatment in patients with anti-NMDA receptor encephalitis at acute stage.