OBJECTIVE To explore the influencing factors for immune-related endocrine toxicity in the treatment of malignant solid tumors with sintilimab， aiming to provide a reference for rational drug use. METHODS Case data were collected from patients with malignant solid tumors， who were treated with sintilimab at the First Affiliated Hospital of Jinzhou Medical University from January 1， 2020 to December 31， 2024， using the electronic medical record system. The patients were divided into an endocrine immune-related adverse events （irAEs） group and a non-endocrine irAEs group based on whether they developed immune-related endocrine toxicity after sintilimab administration. The statistical significance of predictive variables was examined through univariate and multivariate Logistic regression methods. RESULTS A total of 224 patients were enrolled， including 138 cases （61.6%） in the non-endocrine irAEs group and 86 cases （38.4%） in the endocrine irAEs group. After univariate and multivariate Logistic regression analysis， a treatment period of 1-12 cycles was identified as an independent influencing factor for immune-related endocrine toxicity [OR＝7.175， 95%CI （1.239， 41.563）， P ＜0.05 ] ， immune-related hyperglycemia [OR＝6.600， 95%CI （1.053， 41.359）， P ＜0.05 ] ， and immune-related subclinical hypothyroidism [OR＝20.200， 95%CI （3.224， 126.558）， P ＜0.05 ] . The combination with paclitaxel-based drugs was identified as an independent influencing factor for immune-related subclinical hyperthyroidism [OR＝6.410， 95%CI （1.790， 22.955）， P ＜0.05 ] . CONCLUSIONS Among patients treated with sintilimab， the treatment cycle is a risk factor for immune-related endocrine toxicity， immune-related hyperglycemia and immune-related subclinical hypothyroidism. The combination of paclitaxel-based drugs is a risk factor for immune-related subclinical hyperthyroidism. It is recommended that when applying sintilimab in clinical practice， especially during the first few treatment cycles， the relevant endocrine indicators should be dynamically monitored in a standardized manner. In addition， special attention should be paid to patients treated with the combination of paclitaxel-based drugs to be vigilant against the occurrence of endocrine adverse events.

Objective To explore the impact of different delay time of umbilical cord ligation on the outcome of preterm infants.Methods A total of 266 preterm infants born in the obstetric department of this hospital from January 2021 to December 2022 were selected as the research subjects and divided into the in-stant group(umbilical cord ligation immediately after birth,n=53),30 s group(delayed umbilical cord liga-tion for 30 s,n=50),60 s group(delayed umbilical cord ligation for 60 s,n=55),90 s group(delayed umbili-cal cord ligation for 90 s,n=55)and 120 s group(delayed umbilical cord ligation for 120 s,n=52)according to the random number table method.The Hb and HCT levels and the incidence rates of anemia,blood transfu-sion,hyperbilirubinemia,intracranial hemorrhage,necrotizing enterocolitis(NEC)and bronchopulmonary dys-plasia(BPD)after birth were compared among 5 groups.Results The Hb and HCT levels at 24 h after birth in the 60,90,120 s groups were higher than those in the instant group and 30 s group,moreover the 120 s group was higher than the 60 s group and 90 s group,and the differences were statistically significant(P＜0.05).The anemia incidence rate and blood transfusion rate in the 60,90,120 s groups were lower than those in the instant group and 30 s group,and the differences were statistically significant(P＜0.05).The hyperbil-irubinemia incidence rate in the 120 s group was higher than that in the other 4 groups,and the difference was statistically significant(P＜0.05).The intracranial hemorrhage incidence rate in the 60,90,120 s groups were lower than those in the instant group and 30 s group,and the differences were statistically significant(P＜0.05).The NEC incidence rate in the 60 s and 90 s group was lower than that in the instant group and 30 s group,but the 120 s group was higher than that in the other 4 groups,and the differences were statistically significant(P＜0.05).The BPD incidence rate had no statistical difference among 5 groups(P＞0.05).Con-clusion Delayed umbilical cord ligation for 60 s or 90 s could improve the outcomes of preterm infants.

Objective To assess the correlation between the body mass index(BMI)and short-term prognosis in the patients with acute myocardial infarction complicating cardiogenic shock(AMI-CS).Methods A total of 262 patients with diagnosed AMI-CS hospitalized in this hospital from January 2013 to February 2022 were selected as the study subjects,and a total of 255 patients with AMI-CS were included after excluding the patients with incomplete clinical data,no coronary angiography,loss to follow-up and low BMI(<18.5 kg/m2).Among them,those with BMI of 18.5-<24.0 kg/m2 were included in the normal BMI group(n=150),and those with BMI of≥24.0 kg/m2 were included in the overweight or obese group(n=105).The baseline data,auxiliary examinations and treatment measures of the patients were collected,and the patients who did not die at the time of discharge were followed up by telephone on 30 d after AMI onset,and the survival status of the patients,whether having major adverse cardiovascular events(MACE)occurrence and the occurrence time were obtained.The correlation between BMI and endpoint events was assessed by the COX regression model.Results The proportion of complicating atrial fibrillation,BNP and urea levels in the overweight or obesity group were lower than those in the normal BMI group,the BMI and Hb levels were higher than those in the normal BMI group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the results of cardiovascular examination between the two groups(P>0.05).The use rate of β-receptor blockers in the overweight or obese group was higher than that in the normal BMI group,and the difference was statistically significant(P<0.05).On 30 d of follow-up,the all-cause mortality rate in the overweight or obese group was 39.0%,which was lower than 44.0%in the normal BMI group,but the difference was not statistically significant(P=0.430);there was no statistically signifi-cant difference in the incidence rate of each MACE event and the total incidence rate of MACE between the two groups(P>0.05).The BMI normal group served as the control,the risk of death and the occurrence risk of MACE events in the overweight or obese group had no significant increase(P>0.05).The short-term prognosis had no significant interaction between BMI and the patients in different subgroups(P>0.05).Con-clusion The short-term prognosis has no significant difference between the overweight/obese AMI-CS pa-tients and normal BMI AMI-Cs patients.

Objective To analyze the risk factors affecting liver regeneration after laparoscopic anatomic liver resection(LALR),and to explore the relationship between postoperative liver regeneration and the prognosis of patients.Methods A retrospective analysis was conducted on the clinical data of 156 patients with liver cancer who underwent LALR treatment at the People's Hospital Affiliated to Shandong First Medical University from January 2021 to December 2023.Three-dimensional liver reconstruction and simulated resection were performed based on CT examination,and the postoperative liver regeneration rate was calculated.The patients were divided into the high regeneration group and the low regeneration group based on the median liver regeneration rate 1 month after surgery,and the univariate and multivariate analyses were performed to analyze the risk factors affecting postoperative liver regeneration.The relationships between post-operative liver regeneration capacity and tumor-free survival rate and overall survival rate of patients were analyzed using the Kaplan-Meier survival curve.Results Significant difference was observed between the future remnant liver volume(FRLV)1 week after operation and the remnant liver volume(RLV)after operation(P<0.05).The liver regeneration rates 1 month and 3 months after operation were significantly higher than that 1 week after operation(P<0.05).The net growth rate of liver volume 1 week after operation was significantly higher than that 1 month and 3 months after operation(P<0.05).The median liver regeneration rate 1 month after operation was 27.81%.Univariate analysis showed that gender,age,drinking history,combined with liver cirrhosis,preoperative predictional RLV,preoperative predictional standard residual liver volume(SRLV),and postoperative platelet count(PLT)were closely related to liver regeneration after operation(P<0.05).Multivariate analysis showed that combined with liver cirrhosis,and high preoperative predictional RLV and SRLV were the independent factors affecting liver regeneration after operation(P<0.05).The postoperative follow-up showed that the cumulative tumor-free survival rate of the high regeneration group was lower than that of the low regeneration group(61.20%vs.75.28%,Log-rank χ2=3.577,P=0.043),and there was no statistically significant difference in the cumulative overall survival rate between the two groups(74.63%vs.80.89%,Log-rank χ2=1.024,P=0.312).Conclusion For patients with liver cancer undergoing LALR,combined with liver cirrhosis,and high preoperative predictional RLV and SRLV are the independent risk factors influencing early postoperative liver regeneration.Moreover,the higher the patients' postoperative liver regeneration capacity,the lower the tumor-free survival rate.

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.

Objective:To understand the knowledge, attitudes, and behaviors of residents in areas endemic for severe fever with thrombocytopenia syndrome (SFTS) and the factors influencing these aspects, to provide a scientific basis for the prevention and control of SFTS among residents in endemic areas.Methods:A multi-stage sampling method was used to select subjects for a questionnaire survey, and the collected data were analyzed and compared.Results:The awareness rate of SFTS-related knowledge among residents in the endemic areas of Qingdao was 14.38%, while the awareness rate of tick-related knowledge was 69.78%. The mean score for protective attitudes among residents in the endemic areas was 24.50±4.09, and the mean score for protective behaviors was 11.20±2.76. Among residents of different ages, occupations, and educational levels, comparisons of SFTS-related knowledge awareness rates ( χ2=293.553, P<0.001; χ2=495.216, P<0.001; χ2=677.272, P<0.001), tick-related knowledge awareness rates ( χ2=29.986, P<0.001; χ2=23.239, P=0.002; χ2=41.003, P<0.001), protective attitude scores ( H=52.094, P<0.001; H=33.446, P<0.001; H=81.715, P<0.001), and protective behavior scores ( H=52.344, P<0.001; H=28.465, P<0.001; H=67.061, P<0.001) showed statistically significant differences. Comparisons of these same factors among residents of different genders showed no statistically significant differences ( χ2=1.159, P=0.282; χ2=0.298, P=0.585; t=-0.808, P=0.419; t=-1.229, P=0.219). Comparisons of tick-related knowledge awareness rates among residents with different frequencies of outdoor work showed no statistically significant differences ( χ2=5.367, P=0.147); however, comparisons of SFTS-related knowledge awareness rates, protective attitude scores, and protective behavior scores among residents with different frequencies of outdoor work showed statistically significant differences ( χ2=117.010, P<0.001; F=4.127, P=0.006; H=56.280, P<0.001). Multivariate linear regression analysis revealed that older age, lower educational level, and less frequent outdoor work were associated with lower protective behavior scores ( t=-3.479, P<0.001; t=4.861, P<0.001; t=-7.753, P<0.001). Conclusions:Residents in the epidemic areas of SFTS have a low level of knowledge, attitude and practice. Factors influencing protective behaviors include age, occupation, educational level, and frequency of outdoor work. Farmers are a group that requires particular attention.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.

This study aims to analyze the screening results and epidemiological characteristics of prostate cancer (PCa) among elderly males in the rural areas of Songjiang, Shanghai City, through the implementation of a preliminary prostate-specific antigen (PSA) screening based on a community-linkage model, and to explore an effective screening approach. A retrospective observational study design was employed to collect data from residents who underwent PSA screening at Songjiang Hospital affiliated to Shanghai Jiao Tong University School of Medicine, in collaboration with multiple community health service centers in Songjiang District, Shanghai City, between June 2022 and June 2024, through free clinics and annual health examinations. Prostate biopsy was recommended for individuals with total PSA (tPSA) levels >10 ng/ml and those with 4 ng/ml≤tPSA≤10 ng/ml and abnormal free-to-total PSA (f/tPSA) ratios. Clinical characteristics of detected PCa patients were analyzed. Follow-up was conducted through phone calls and home visits by family doctors, coupled with enhanced health education. The results indicated that a total of 17 198 residents participated in the screening, among which 2 234 (12.99%) had tPSA levels between 4 ng/ml and 10 ng/ml, and 257 (1.49%) had tPSA levels >10 ng/ml. Ultimately, 417 residents underwent prostate biopsy, with 171 being diagnosed with PCa, yielding a positive biopsy rate of 41.00% and a PCa detection rate of 0.99%. The predominant pathological subtype among PCa patients was adenocarcinoma (168 cases, 98.24%). Of the 146 PCa patients who received treatment, the majority were classified as intermediate or high-risk (124 cases, 84.93%). Furthermore, with the optimization of the screening model, there was a significant increase in the proportion of subsequent outpatient visits. In conclusion, the community-linkage-based PSA screening model demonstrated high effectiveness in screening for PCa among elderly males in the rural areas of Songjiang, Shanghai City. Epidemiological findings revealed that PCa patients in this region are primarily composed of intermediate and high-risk groups, highlighting the need for intensified early screening and health education.

AIM To study the chemical constituents from Euphorbia humifusa Willd.and their in vitro anti-hepatoma activity.METHODS Silica gel,D101 macroporous adsorption resin and semi-preparative RP-HPLC were used for isolated and purified,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The anti-hepatocellular carcinoma activity was determined by MTT mothod.RESULTS Eighteen compounds were isolated and identified as 22-O-angeloyl-R1-barrigenol(1),dimethyl 3,3'-[oxybis(4,1-phenylene)](2E,2'E)-diacrylate(2),N-(3-methoxy-1,3-dioxopropyl)-D-tryptophan methyl ester(3),N-acetyltryptophan methyl ester(4),N-(methoxycarbonyl)-tryptophan methyl ester(5),(3β,5α,17β)-4,4,8,14-tetramethyl-18-norandrostane-3,17-diol(6),3β,18,19β-trihydroxylupane(7),pregnenolone(8),3-hydroxy-5,6-epoxy-7-megastigmen-9-one(9),dehydrovomifoliol(10),loliolide(11),2,2'-oxybis(1,4-di-tert-butylbenzene)(12),dibutyl phthalate(13),4-methoxycinnamic acid(14),3,4-dimethoxycinnamic acid(15),methyl 4-hydroxybenzoate(16),kaempferol(17),quercetin(18).The IC50 values of compounds 1,7 and 8 on HepG2 cells were(17.27±0.92),(19.11±2.14)and(7.53±1.09)μmol/L,respectively.CONCLUSION Compounds 1-16 are first isolated from this plant.Compounds 1,7 and 8 have anti-hepatoma activity.

AIM To investigate the variations in mercury dissolution from HgS-containing traditional medicines in three kinds of simulated gastrointestinal dissolution media.METHODS 39 batches of 15 types of HgS-containing traditional medicines were collected,total mercury content and dissolved mercury concentrations in simulated gastric fluid,simulated intestinal fluid,and L-cysteine-containing simulated intestinal fluid were measured.The maximum daily intake of total mercury and soluble mercury was calculated based on the maximum daily clinical dosage.RESULTS Among the 15 types of medicines,the maximum daily intake of total mercury varied by 156 times,the daily intake of soluble mercury varied by 3 502 times in simulated gastric fluid,313 times in simulated intestinal fluid,and 10 663 times in L-cysteine-containing simulated intestinal fluid,approximately.CONCLUSION For the 15 types of HgS-containing traditional medicines,the daily maximum intake of soluble mercury showed greater variations than that of total mercury.Soluble mercury concentration is more closely correlated with intestinal absorption of mercury and thus represents a more rational quality control indicator for HgS-containing traditional medicines.