To explore the latent profile characteristics of fear of progression (FoP) in patients with Behçet′s disease (BD) and analyze its influencing factors.

As a second-generation immunomodulatory imide drug, lenalidomide enhances immunomodulatory effects while reducing neurotoxicity. It synergistically regulates adaptive and innate immune responses through both cereblon (CRBN)-dependent and independent mechanisms, and also exerts multiple biological effects including anti-angiogenesis and anti-fibrosis. Therefore, it has been gradually explored for the treatment of rare immune-mediated inflammatory diseases (IMIDs) in recent years. Existing studies suggest that lenalidomide has potential therapeutic efficacy in diseases such as immunoglobulin G4-related disease and Behçet'sdisease. However, relevant evidence is mainly derived from case reports, and its optimal dosage, applicable populations and long-term safety remain to be further verified. This review summarizes the mechanisms of action of lenalidomide and the research progress of its application in rare IMIDs, with the aim of providing references for future mechanistic exploration and clinical practice.

With continuous advancements in the concepts of minimally invasive surgery,pancreatic surgery is gradually undergoing a transformative shift toward minimally invasive approaches.Compared with traditional open surgeries,minimally invasive procedures offer advantages such as reduced trauma,faster recovery,and fewer complications.However,due to the complex anatomical structure of the pancreas and the technical difficulties of surgical procedures,the widespread adoption of minimally invasive pancreatic surgery still faces numerous technical challenges.Currently,laparoscopic pancreaticoduodenectomy(LPD)is primarily performed in large,specialized centers with experienced teams and well-established systems.Given the high technical complexity and associated risks,reducing intraoperative risks and minimizing postoperative complications remain key focuses and major challenges in current research.This review is focused on intraoperative risk control and postoperative complication management in complex minimally invasive pancreatic surgery.We conducted a comprehensive review of recent advances in China and abroad,covering the latest progress in preoperative assessment,intraoperative procedures,complication prevention,quality management,and technological innovation.Furthermore,we discussed potential development directions in minimally invasive pancreatic surgery,including technical refinement,discipline development,procedural standardization,and multi-center collaboration.Our goal is to promote a continued progress toward more standardized,personalized,and intelligent surgical practices—ultimately benefiting a broader population of patients with pancreatic diseases.

Objective : To investigate the correlation between the pan-immune inflammation value (PIV) and clini- cal and pathological features of primary IgA nephropathy (IgAN) ，and to evaluate the clinical significance of PIV in primary IgAN． Methods: 200 patients with primary IgAN diagnosed by renal biopsy were selected as the re- search subjects．General information，laboratory indicators，pathologic features of renal biopsy，and calculations of platelet to lymphocyte count ratio(PLR) ，neutrophil to lymphocyte count ratio(NLR) ，PIV，and other relevant in- dices about patients were collected．According to the median PIV，subjects were divided into low PIV group (PIV ≤194. 81) and high PIV group ( PIV ＞194. 81) ，and the clinical and pathological data of the two groups were compared and analyzed．Using Spearman rank correlation analysis and logistic regression analysis，the relationship between PIV and primary IgAN in terms of clinical and pathological aspects was explored． Results: There were sta- tistical significance in age，gender，height，hyperuricemia，hemoglobin，absolute neutrophil count (ANC) ，absolute monocytes count，platelet，PLR , NLR , serum uric acid，immunoglobulin G(IgG) ，immunoglobulin A(IgA) / com- plement 3 ( C3) ，and fusion degree of the podocyte foot between the two sets (P＜0. 05) ．The result of correlation analysis indicated that PIV was positively correlated with ANC，platelet，absolute monocytes count，PLR , NLR , serum creatinine，C3，serum uric acid，and fusion degree of the podocyte foot，but negatively correlated with IgG， IgA/ C3，IgA/ C4．The degree of podocyte foot process fusion was positively correlated with PIV，ANC，total choles- terol，and 24-hour urinary protein to creatinine ratio，and negatively correlated with albumin(ALB) ，IgG，IgA，and IgA/ C3．Logistic regression analysis further indicated that ALB was an independent protective factor for the occur- rence of podocyte foot process fusion in primary IgAN，and PIV was an independent risk factor for the occurrence of podocyte foot process fusion in primary IgAN． Conclusion PIV is closely related to the clinical symptoms and pathological lesions of primary IgAN．ALB is an independent protective factor for the occurrence of podocyte foot process fusion in primary IgAN，and PIV is an independent risk factor for the occurrence of podocyte foot process fu- sion in primary IgAN，which can be used as an auxiliary indicator of clinical and pathological results，providing valuable information for risk assessment and treatment plan formulation of primary IgAN．

Objective:The Social Isolation Scale for people with type 2 diabetes mellitus (T2DM) was developed and tested for reliability and validity, which provided an effective tool for measuring the social isolation level of patients with T2DM.Methods:The initial scale was developed through literature review, qualitative interviews, and expert consultation. Convenience sampling method was used to select T2DM patients who met the inclusion and exclusion criteria for questionnaire survey. The item analysis method was used to select the items of the scale. Exploratory and confirmatory factor analyses were used to evaluate construct validity. The content validity of the scale was evaluated by the scale-level content validity index and the item-level content validity index. The criterion validity was verified by using the Lubben Social Network Scale-6 and the De Jong Gierveld Loneliness Scale. Reliability was tested through internal consistency and test-retest reliability.Results:Through literature review and qualitative interviews, 30 items of the scale were selected to form the first version scale. After two rounds of inquiries from 16 experts (expert authority coefficient = 0.897), the second version of the scale was formed. A total of 407 questionnaires were distributed in two stages using the second version scale. Among the 407 patients, there were 214 males and 193 females. Exploratory factor analysis extracted 4 common factors, with a cumulative variance contribution rate of 61.338%. The final scale was determined to include 4 dimensions and 16 items, with the dimensions being "social support network", "frequency of social participation", "satisfaction with interpersonal relationships", and "diabetes-related sense of isolation".The average content validity index at the scale level was 0.929, the content validity index at the item level was 0.830 - 1.000, and the criterion validity was - 0.647 and 0.681. The Cronbach′s α coefficient of the total scale was 0.822, and the test-retest reliability was 0.858.Conclusions:The Social Isolation Scale for people with T2DM has good reliability and validity. It is a reliable and valid tool for assessing social isolation in T2DM patients.

Objective Based on the theory of"stomach disharmony leads to restlessness",the causal relationship between gastroesophageal reflux disease and insomnia was discussed by Mendel randomization method with two samples.Methods The data were collected from genome-wide association studies,the exposure factor was gastroesophageal reflux disease,and the outcome variable was insomnia.Mendel randomization analysis is realized by inverse variance weighted method,MR-Egger method,simple model method,weighted model method and weighted median method.Sensitivity analysis includes pleiotropic test,heterogeneity test and one-by-one elimination test,and is calculated by MR-Egger method,Cochran Q test and one-out-of-one method in turn.Results A total of 75 single nucleotide polymorphisms(SNPs)were screened.The inverse variance weighted method showed that gastroesophageal reflux disease increased the risk of insomnia(OR=1.255,95%CI:1.071-1.470,P<0.05).The weighted median method also confirmed that there was a positive causal relationship between gastroesophageal reflux disease and insomnia(OR=1.403,95%CI:1.117-1.762,P<0.05).Multiple sensitivity analysis indicated that there was no pleiotropy and heterogeneity in the results of Mendelian randomized analysis,which verified the stability of the research results.Conclusion There is a positive causal relationship between gastroesophageal reflux disease and insomnia,which enriches the theoretical connotation of"stomach disharmony leads to restlessness"from the genetic point of view and lays a foundation for further study.

OBJECTIVE To investigate the pharmacological efficacy and mechanism of action of Atractylenolide Ⅰ(Atr-Ⅰ)in inhibiting colorectal cancer.METHODS Among three active compounds of Atractylodes macrocephala,Atr-Ⅰ exhibited the highest anti-tumor potency by MTT assay.The optimal concentration of Atr-Ⅰ was determined.The effect of Atr-Ⅰ on LoVo cell prolifera-tion was assessed via a clonogenic assay,while its impact on apoptosis and cell cycle progression was evaluated using flow cytometry.The influence of Atr-Ⅰ on the migration and invasion of LoVo cell line was examined through wound healing and Transwell migration assays.Western blot analysis was performed to explore the effects and mechanisms of Atr-Ⅰ on proteins associated with mi-gration,proliferation,and epithelial-mesenchymal transition(EMT)in LoVo cells.The CT26 mouse subcutaneous tumor model was established,and histopathological analysis was conducted using hematoxylin-eosin(HE)staining.Western blot was also used to assess the effects of Atr-Ⅰ on EMT-related proteins in mouse tissues to elucidate underlying mechanisms.RESULTS Atr-Ⅰ significantly reduced colorectal cancer cell viability,with statistically significant differences between treatment and control groups(P<0.05,P<0.01).Atr-Ⅰ induced apoptosis in LoVo cells,with the treatment group showing significant differences compared to the control(P<0.05,P<0.01).Cell cycle analysis revealed that Atr-Ⅰ exerted anti-tumor effects by inducing G2/M phase arrest,with increased G2 phase cell numbers in the LoVo treatment group compared to the control(P<0.05).Wound healing and Transwell migration assays confirmed that Atr-Ⅰ significantly inhibited tumor cell migration and invasion(P<0.05,P<0.01).Western blot analysis demonstra-ted that Atr-Ⅰ specifically suppressed the expression of c-Myc and Bcl-2(P<0.05),as well as cell cycle-related proteins CDK1,Cyclin B1,and Cyclin D1(P<0.05),and angiogenesis-related proteins VEGF and MMP9(P<0.05).Additionally,Atr-Ⅰ down-regulated EMT-related protein N-cadherin and upregulated E-cadherin expression(P<0.05).It also reduced the expression of p-AKT and p-S6K1(P<0.05).CONCLUSION Atr-Ⅰ exhibits potent anti-tumor effects against colorectal cancer,potentially through modulation of the AKT/S6K1 signaling pathway.

Objective To investigate the risk factors for cardiovascular disease(CVD)in patients with rheumatoid arthritis(RA).Methods Clinical data of 225 patients with RA admitted to the Second Affiliated Hospital of Zhengzhou University from January 2023 to September 2024 were collected,and the patients were divided into CVD group(n=50)and non-CVD group(n=175)according to whether they were complicated by CVD.Univariate and multivariate Logistic regression was used to analyze the risk factors of CVD in RA patients.Results Univariate Logistic regression analysis showed that age,hematocrit,red cell volume distribution width(RDW),erythrocyte sedimentation rate,neutrophil to high density lipoprotein ratio(NHR)and platelet to lymphocyte ratio(PLR)were all influencing factors for CVD in RA patients(P＜0.05).Multivariate Logistic regression analysis showed that age,RDW,NHR and PLR were all risk factors for CVD in RA patients(P＜0.05).The results of receiver operating characteristic curve analysis showed that the area under the curve(AUC)of age,RDW,NHR and PLR diagnosed CVD in RA patients were 0.844,0.797,0.572 and 0.713,respectively.The combined diagnosis AUC of four indexes was 0.898.Conclusion The risk of CVD in RA patients is influenced by many factors,and the combination of age,RDW,NHR,and PLR can improve early diagnosis of CVD in RA patients.

OBJECTIVE: To explore the association between blood glucose trajectories within 7 days of intensive care unit (ICU) admission and mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS). METHODS: Based on the MIMIC-IV database, sepsis-associated ARDS patients with daily blood glucose monitoring data within 7 days of ICU admission were selected. Blood glucose trajectories were analyzed using group-based trajectory modeling (GBTM), and the optimal number of groups was determined based on the minimum Akaike information criterion (AIC), Bayesian information criterion (BIC), average posterior probability (AvePP), odds of correct classification (OCC), and proportion of group membership (Prop). Baseline characteristics including demographics, comorbidities, severity scores, vital signs, laboratory indicators within the first 24 hours of ICU admission, and treatments were collected. Kaplan-Meier survival curves were used to compare 28-day and 1-year survival across trajectory groups. Multivariate Logistic regression was performed to evaluate the associations between glucose trajectory groups and in-hospital mortality, ICU mortality. The incidence of hypoglycemia within 7 days in the ICU was analyzed among different groups. RESULTS: A total of 3 869 patients with sepsis-associated ARDS were included, with a median age of 63.52 (52.13, 73.54) years; 59.6% (2 304/3 869) were male. Based on glucose levels within 7 days, patients were categorized into three groups: persistent hyperglycemia group (glucose maintained at 10.6-13.1 mmol/L, n = 894), moderate glucose group (7.8-8.9 mmol/L, n = 1 452), and low-normal glucose group (6.1-7.0 mmol/L, n = 1 523). There were statistically significant differences in 28-day mortality and 1-year mortality among low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [28-day mortality: 11.42% (174/1 523), 19.83% (288/1 452), 25.50% (228/894), χ ² = 82.545, P < 0.001; 1-year mortality: 23.31% (355/1 523), 33.75% (490/1 452), 39.49% (353/894), χ ² = 77.376, P < 0.001]. Kaplan-Meier analysis showed that higher glucose trajectories were associated with significantly lower 28-day and 1-year cumulative survival rates (Log-rank test: χ ² were 83.221 and 85.022, both P < 0.001). There were statistically significant differences in in-hospital mortality and ICU mortality among the low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [in-hospital mortality: 9.65% (147/1 523), 19.70% (286/1 452), 24.50% (219/894), χ ² = 102.020, P < 0.001; ICU mortality: 7.22% (110/1 523), 16.05% (233/1 452), 20.13% (180/894), χ ² = 93.050, P < 0.001]. Logistic regression confirmed that, using the persistent hyperglycemia group as the reference, the low-normal glucose group had significantly lower risks of in-hospital mortality and ICU mortality after multiple factor adjustment. Although the moderate glucose group showed a trend toward lower mortality, the differences were not statistically significant. Using the moderate glucose group as a reference, the low-normal glucose group had 43.1% lower in-hospital mortality [odds ratio (OR) = 0.569, 95% confidence interval (95%CI) was 0.445-0.726, P < 0.001] and 42.0% lower ICU mortality (OR = 0.580, 95%CI was 0.439-0.762, P < 0.001). There was no statistically significant difference in the incidence of hypoglycemia within 7 days of ICU admission among low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [2.82% (43/1 523), 2.69% (39/1 452), 3.02% (27/894), χ ² = 0.226, P = 0.893]. CONCLUSIONS Blood glucose trajectories during ICU stay are closely associated with prognosis in patients with sepsis-associated ARDS. Persistent hyperglycemia (10.6-13.1 mmol/L) is linked to significantly higher short- and long-term mortality.
Humans ; Respiratory Distress Syndrome/etiology* ; Sepsis/blood* ; Intensive Care Units ; Male ; Female ; Middle Aged ; Blood Glucose/metabolism* ; Hospital Mortality ; Aged

Objective:To investigate the correlation between long-term statin use and Helicobacter pylori( Hp)infection in the elderly, and to compare the effects of rosuvastatin combined with bismuth-containing quadruple therapy for Hp eradication on lipid levels in elderly patients with mixed hyperlipidemia. Methods:A retrospective analysis was conducted on 1 181 elderly patients with hyperlipidemia, cardiovascular and cerebrovascular diseases, and peripheral arterial disease who were treated at the First Hospital of Lanzhou University between March 2019 and December 2023.According to the results of carbon 14 urea breath test(C 14-UBT), the subjects were divided into the Hp infection group and the non- Hp infection group.Multivariate logistic regression methods were used to analyze the correlation between Hp infection and statin use.A prospective case-control analysis was conducted on 109 patients with mixed hyperlipidemia and Hp infection treated during the same period, they were treated with rosuvastatin combined with bismuth-containing quadruple therapy for Hp eradication.The successful eradication people were selected as the eradication group (n=95). Patients with hyperlipidemia and Hp infection unwilling eradication was selected as the control group (n=109), and treated with rosuvastatin.Changes in lipid levels were compared over a consecutive 6-month period. Results:The overall Hp infection rate was 53.94%(637/1 181). Univariate analysis showed that the infection rate in women was higher than in men.Body mass index(BMI), low-density lipoprotein cholesterol(LDL-C), fasting blood glucose(FBG)levels in the Hp(+ )group were higher than in the Hp(-)group.Long-term low-dose aspirin users had a higher infection rate than non-users.The infection rate was lower in statin users than in non-users[42.65%(374/877) vs.55.59%(169/304), χ2=15.234, P<0.001]. Multivariate analysis showed that women had a higher infection risk than men ( OR=1.441, 95% CI: 1.102-1.729, P=0.011). Higher FBG and LDL-C levels increased the risk of Hp infection ( OR=1.406, 95% CI: 1.271-2.286, P<0.001, OR=1.118, 95% CI: 1.017-1.387, P=0.010). Aspirin use increased the risk of Hp infection( OR=1.162, 95% CI: 1.034-1.294, P=0.021), while statin use reduced the risk of Hp infection ( OR=0.177, 95% CI: 0.018-0.311, P<0.001). The Hp eradication rate was 87.16%(95/109). At 1-and 2-months post-eradication, statistically significant differences were observed between the eradication and control groups in LDL-C, total cholesterol(TC), changes from baseline, and target achievement rates(all P<0.05). At 1-month post-eradication, a statistically significant difference was observed in high-density lipoprotein cholesterol(HDL-C) levels between the two groups.Additionally, at both 1-and 2-months post-eradication, significant differences were found in the changes in HDL-C levels from baseline between the eradication group and the control group(all P<0.05). Conclusions:Long-term statin use in the elderly may reduce the risk of Hp infection.Rosuvastatin combined with a standard quadruple therapy does not improve the Hp eradication rates in elderly patients with mixed hyperlipidemia, but it facilitates short-term achievement of cholesterol targets.