Organophosphorus pesticides(OPs)are widely used in global agriculture,and pose a serious threat to ecological environment and human health due to their high environmental persistence and biological toxicity.Colorimetric sensing strategies based on the inhibition of acetylcholinesterase(AChE)have become an important method for detecting OPs because of their simplicity and high specificity.However,the sensitivity is limited by the insufficient catalytic efficiency of traditional nanozymes.In this study,a one-step solvothermal method was used to synthesize polyoxometalate nanoribbons(POM)loaded with gold nanoparticles(Au NPs),named Au-POM.Experimental results showed that Au-POM could catalyze the decomposition of H2O2 in an acidic environment(pH 4.0),demonstrating typical peroxidase-like activity.Based on this,an AChE,choline oxidase(ChOx)and Au-POM nano enzyme cascade catalytic system was constructed.In this system,AChE specifically catalyzed the hydrolysis of acetylcholine(ACh)to choline,and then ChOx mediated the oxidation of choline to produce H2O2.During this process,Au-POM acted as a peroxidase-like enzyme to catalyze the decomposition of H2O2 to generate reactive oxygen species,triggering a specific oxidation reaction of the chromogenic substrate 3,3',5,5'-tetramethylbenzidine(TMB)into oxidized form.When the OP pesticide ethoprophos(EP)was present,it inhibited the activity of AChE and blocked the generation of ACh and H2O2,indirectly inhibiting the oxidation of TMB.The color and absorbance of the solution changed in a concentration-dependent manner.The detection limit of this method for EP was 1.05 μmol/L,and the linear response range was 20-180 μmol/L(R2=0.998).This method was applied to detection of environmental water samples and coriander samples with satisfactory results,providing a reliable technical platform for monitoring of OPs in environment and food.

Objective To investigate the prognostic value of the platelet-to-lymphocyte ratio(PLR)at different early time points in adult patients undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted,selecting 55 adult patients who underwent VA-ECMO treatment at the First Hospital of Jiaxing from June 2020 to October 2022 as the study subjects.Then,the patients'gender,age,past history[including hypertension,diabetes,heart disease,chronic obstructive pulmonary disease(COPD)],and the reason for extracorporeal membrane pulmonary oxygenation(ECMO)adjuvant therapy[including severe myocarditis,acute myocardia infarction,in-hospital and out-of-hospital cardiac arrest,severe closed craniocerebral injury,severe pneumonia,pelvic fracture,other(pulmonary embolism,electrocution,traumatic hepatic rupture,post-partum hemorrhage,severe acute pancreatitis,crush syndrome)],acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)at the time of admission,and ECMO peripheral blood tests[creatinine,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood lactate acid(Lac),white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin(Hb),and platelet count(PLT)]and the last time prior to ECMO assistance,24 hours prior to the occurrence of acute kidney injury(AKI),and 24 hours after the occurrence of AKI.PLR levels at 24 hours ECMO,and the proportion of continuous renal replacement therapy(CRRT).The patients were divided into a death group and a survival group based on their 30-day prognosis and further categorized into a CRRT group and a non-CRRT group based on whether CRRT was administered.Clinical indicators of patients with different prognosis and the differences in PLR levels between CRRT and non-CRRT groups were compared.Logistic regression analysis was used to identify independent risk factors affecting the 30-day prognosis of VA-ECMO patients.The receiver operator characteristic(ROC curves)were plotted to evaluate the prognostic predictive value of each risk factor.Results Compared to the survival group,the death group had significantly higher APACHEⅡscores,SOFA scores,LYM and proportion receiving CRRT[APACHEⅡscore:34.00(28.50,36.00)vs.25.00(14.75,34.00),SOFA score:5.00(4.00,6.50)vs.3.00(2.00,5.25),LYM(×109/L):3.40±1.97 vs.2.24±2.11,proportion receiving CRRT:91.30%(21/23)vs.62.50%(20/32)],and a significantly lower level of the last PLR prior to ECMO adjuvant[30.00(21.06,48.17)vs.58.82(41.80,145.72)],and the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the levels of the last PLR before ECMO assistance[odds ratio(OR)=0.965,95%confidence interval(95%CI)was 0.938-0.993,P=0.013],APACHEⅡscore at the time of admission(OR=1.121,95%CI was 1.018-1.234,P=0.020),and CRRT(OR=7.734,95%CI was 1.042-57.401,P=0.045)were independent risk factors affecting the prognosis of the VA-ECMO patients at 30 days after adjuvant;the ROC curve analysis showed that APACHEⅡscore,CRRT and the last PLR level before ECMO assistance had a predictive value for the prognosis of VA-ECMO patients 30 days after assistance,in which the APACHEⅡscore+the last PLR level before ECMO assistance had the greatest predictive value in predicting the prognosis of the patients,with area under the curve(AUC)of 0.846,with a sensitivity of 62.5%and a specificity of 95.7%.Higher early PLR levels were associated with better prognosis.In the CRRT group,PLR levels at 24 hours before ECMO initiation,24 hours before AKI onset,and 24 hours after AKI onset were significantly lower than those in the non-CRRT group(all P<0.05).Conclusion Early PLR levels and CRRT administration have significant predictive value for the prognosis of patients undergoing VA-ECMO therapy.

Objective:To explore the risk factors for primary Sjogren′s syndrome-associated interstitial lung diseases (pSS-ILD) and to evaluate the diagnostic value of NLR and other predictors of pSS-ILD.Methods:A retrospective study of 63 patients with pSS-ILD and 201 patients with pSS visited our hospital from January 2016 to December 2023 was conducted. The general characteristics, clinical symptoms, laboratory indicators and treatment of the patients were collected. Correlation analyses were performed using the point bi-serial correlation test and Spearman′s Rho test, and binary logistic regression analysis was applied to explore the risk factors for the development of pSS-ILD. We assessed the value of diagnostic tools in relation to pSS-ILD by plotting receiver operating characteristic (ROC) curves.Results:①The proportion of males(14.29% vs. 4.48%, χ2=7.26, P=0.007), age at onset [(53±13)years old vs. (47±15)years old, t=2.55, P=0.011], neutrophil-to-lymphocyte ratio (NLR)[3.52(2.28, 6.49) vs. 1.64(1.23, 3.12), Z=-5.94, P<0.001], systemic immune-inflammatory index (SII) [653.34(328.08, 1 393.54) vs. 316.56(185.57, 593.65), Z=-5.26, P<0.001], C-reactive protein (CRP) [3.53(2.95, 9.76)mg/L vs. 2.82(1.67, 5.00)g/L, Z=-2.24, P=0.025], complement C3 [0.93(0.84, 1.02)g/L vs. 0.76(0.66, 0.85)g/L, Z=-5.33, P<0.001], and ESSDAI [4(3, 6) vs. 2(2, 4), Z=-5.70, P<0.001] levels were higher in the pSS-ILD than in non-ILD group, while the proportion of dry eyes (62.7%, χ2=13.37, P<0.001), proportion of anti-SSA/Ro60 antibody positivity (76.1%, χ2=8.77, P=0.012), rheumatoid factor (RF) positiveity [25.90(20.00, 83.30)U/ml, Z=-3.58, P<0.001], immunoglobulin G (IgG)[15.60(12.30, 21.90)g/L, Z=-3.28, P=0.001], immunoglobulin A (IgA)[3.21(2.32, 3.76)g/L, Z=-2.22, P=0.026], and immunoglobulin M (IgM)[1.29(0.93, 1.86)g/L, Z=-4.02, P<0.001) levels were higher in the non-ILD group. ②Correlation analysis showed that age at onset ( r=0.16, P<0.011), NLR ( r=0.43, P<0.001), SII ( r=0.41, P<0.001), and C3 ( r=0.27, P<0.001) were positively correlated with pSS-ILD, whereas IgG ( r=-0.18, P=0.005), IgM ( r=-0.19, P=0.002) were negatively correlated with pSS-ILD. Meanwhile, age at onset ( r=0.27, P<0.001), NLR ( r=0.30, P<0.001), and SII ( r=0.27, P<0.001) were positively correlated with ESSDAI score. ③Regression analysis showed that high levels of NLR[ OR(95% CI)=2.559(1.650, 3.969), P<0.001], C3[ OR(95% CI)=35.228(5.685, 218.309), P<0.001] might be risk factors for pSS-ILD. ④The area under the curve (AUC) for the diagnosis of pSS-ILD by NLR was 0.748, with a diagnostic sensitivity and specificity of 97.01% and 39.68%, respectively; the AUC for C3 was 0.727, with a diagnostic sensitivity and specificity of 66.67% and 79.03%, respectively; and the AUC for the joint predictive probability (Pre_1) of NLR and C3 was 0.812, with a sensitivity and specificity of 93.33% and 54.84%, respectively. Conclusion:High levels of NLR, C3 may be risk factors for pSS-ILD. NLR and C3 are adjunctive tools for the diagnosis of pSS-ILD, and the combination of the two increases the predictive value.

Objective:To establish the minimum number of negative lymph nodes (nLN) required for patients undergoing gastrectomy.Methods:This was a retrospective cohort study with inclusion criteria as follows: (1) radical gastrectomy; (2) histologically confirmed adenocarcinoma; (3) complete tumor staging information; and (4) known number of lymph nodes harvested. The exclusion criteria were: (1) other concurrent malignant tumors; (2) metastatic or recurrent gastric cancer; (3) initial surgery performed at another hospital; (4) preoperative neoadjuvant therapy; (5) distant metastasis; and (6) incomplete clinical data or follow-up information. Based on the above criteria, a total of 11 167 patients with gastric adenocarcinoma who underwent radical subtotal gastrectomy (RSG) or radical total gastrectomy (RTG) in the Department of Gastric Surgery, Fudan University Shanghai Cancer Center between January 1, 2000, and December 31, 2022, were included in the study. Among them, there were 7 596 cases in the RSG group and 3 571 cases in the RTG group. Restricted cubic spline (RCS) analysis was used to determine the ideal threshold for nLN for RSG and RTG patients. Survival analysis was conducted using Kaplan-Meier (KM) curves and log-rank tests, and propensity score matching (PSM) was utilized to balance parameters between two groups. Furthermore, subgroup analysis was conducted for RSG patients based on tumor location (upper, middle and lower) to determine the minimum number of nLN in each subgroup.Results:For patients who underwent RSG, the mean number of nLN was 21.9, with a median of 21. RCS analysis showed that more than 21 nLN was associated with better survival. Moreover, both pre- and post-PSM analysis confirmed that patients with nLN ≥21 had better survival benefits compared to those with nLN <21 (overall survival [OS]: P<0.001 before PSM, P=0.013 after PSM; disease-free survival [DFS]: P<0.001 before PSM, P=0.013 after PSM). For patients who underwent RTG, the mean number of nLN was 23.5, with a median of 22. Here RCS analysis indicated that more than 22 nLN was associated with better postoperative survival in RTG patients, and both pre- and post-PSM analysis confirmed that patients with nLN ≥22 had better survival benefits compared to those with nLN<22 (OS: P<0.001 both before and after PSM; DFS: P<0.001 both before and after PSM). Subgroup analysis showed that for RSG patients with tumor located in the upper part, having ≥17 nLN (OS: both P<0.001), and for RSG patients with tumor located in the middle and lower part, having ≥22 nLN (OS: both P<0.001), were associated with better prognoses. Conclusions:For patients who receive RSG, the minimal number of nLN is ideally ≥21 (upper ≥17, middle and lower ≥22). Similarly, for patients who receive RTG, the minimum number of nLN ideally is 22.

Objective:To explore the prognosis after radical resection for stage Ⅰ gastric cancer and the application value of adjuvant chemotherapy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 3 353 patients with stage Ⅰ gastric cancer who were admitted to Fudan University Shanghai Cancer Center from January 2000 to December 2022 were collected. There were 2 369 males and 984 females, aged 60(range, 21-91) years. All patients underwent radical R 0 resection. Observation indicators: (1) clinicopathological characteristics of patients; (2) influencing factors for postoperative prognosis of patients; (3) prognostic analysis of patients; (4) construction and validation of a predictive model for the efficacy of postoperative adjuvant chemotherapy. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and the Log-rank test was used for survival analysis. Based on the multivariate analysis result, a nomogram prediction model was constructed to predict survival benefit. Results:(1) Clinicopatho-logical characteristics of patients. The highly, moderately, and poorly differentiated tumors were observed in 16, 234, 396 cases of 646 patients aged <50 years and 279, 1 617, 811 cases of 2 707 pati-ents aged ≥50 years, respectively, showing a significant difference in degree of tumor differentiation between them ( P<0.05). For 297 patients in stage T1N1M0, cases aged <50 years and ≥50 years were 71 and 226, cases of males and females were 184 and 113, cases with negative and positive vascular invasion were 37 and 260, cases with negative and positive nerve invasion were 275 and 22, cases without and with postoperative adjuvant chemotherapy were 222 and 75, respectively. The above indicators for 678 patients in stage T2N0M0 105, 573, 533, 145, 517, 161, 526, 152, 563, 115, respectively. There were significant differences in the above indicators between the two groups ( P<0.05). (2) Influencing factors for postoperative prognosis of patients. Results of multivariate analysis showed that age ≥50 years, stage T2, moderately differentiated tumor, the number of lymph nodes dissected <16, positive vascular invasion, carcinoembryonic antigen (CEA) ≥5 μg/L, and CA19-9 ≥37 U/mL were independent risk factors for disease-free survival (DFS) after surgery for stage Ⅰ gastric cancer ( hazard ratio=4.600, 1.555, 1.835, 1.362, 1.451, 1.571, 2.134, 95% confidence interval as 2.806-7.541, 1.205-2.006, 1.016-3.314, 1.059-1.753, 1.057-1.993, 1.100-2.243, 1.257-3.625, P<0.05). Age ≥50 years, stage T2, the number of lymph nodes dissected <16, positive vascular invasion, CEA ≥5 μg/L, and CA19-9 ≥37 U/mL were independent risk factors for overall survival (OS) after surgery for stage Ⅰ gastric cancer ( hazard ratio=5.208, 1.597, 1.373, 1.520, 1.464, 2.356, 95% confidence interval as 3.028-8.955, 1.231-2.072, 1.060-1.777, 1.099-2.104, 1.004-2.134, 1.385-4.009, P<0.05). Postoperative adjuvant chemotherapy was an independent protective factor for both DFS and OS after surgery for stage I gastric cancer ( hazard ratio=0.361 0.297, 95% confidence interval as 0.177-0.736, 0.131-0.674, P<0.05). (3) Prognostic analysis of patients. According to the results of multi-variate analysis, among 3 353 patients, there were significant differences in 5-year DFS rate and 10-year OS rate between patients aged <50 years and ≥50 years ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients in TNM stage ⅠA and ⅠB ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients in stage T1N0M0, T1N1M0, T2N0M0 ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients with the highly, moderately, and poorly differentiated tumors ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients with the number of lymph lodes dissected <16 and ≥16 ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate between patients with negative and positive vascular invasion ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05), among patients in stage T1N0M0, T1N1M0, T2N0M0 who received no postoperative adjuvant chemotherapy ( P<0.05). For patients in stage T1N1M0, there was no significant difference in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P>0.05).Results of stratified analysis showed that for patients aged ≥ 50 years, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). For patients in stage T2N0M0, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). For patients with positive vascular invasion, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). (4) Construction and validation of a predictive model for the efficacy of adjuvant chemotherapy. A nomogram predictive model was constructed based on the multivariate analysis results of OS and used for calculating net benefits and distribution. Among the 3 096 patients without postoperative adjuvant chemotherapy, 1 009 cases had a predicted net benefit of >5%-10%, and 250 patients had a predicted net benefit >10%. The predicted survival analysis further verified that the predicted benefit of adjuvant chemotherapy was consistent with the prognosis of patients. Conclusions:Patients with age ≥50 years, stage T2 tumors, moderately differentiated tumor, the number of lymph nodes dissected <16, positive vascular invasion have worse survival prognosis postoperative. Postoperative adjuvant chemotherapy provides better prognosis in high-risk patients. Patients in stage T1N1M0 have lower recurrence and survival risks, of whom with 1 metastatic lymph node is more suitable for follow-up rather than postoperative adjuvant chemotherapy.

Primary aldosteronism(PA)is the most common cause of secondary hypertension,yet its diagnosis remains under-recognized,with a high rate of missed diagnoses.This condition significantly impacts multiple systems,including the cardiovascular,renal,metabolic,and skeletal systems,resulting in notable complications.Patients with Klinefelter syndrome(KS)exhibit a markedly higher prevalence of metabolic disorders,which may further exacerbate cardiovascular and endocrine dysfunction.Here we report a patient who presented with refractory hypertension and an incidentally discovered adrenal mass,and was ultimately diagnosed with a left adrenal aldosterone-producing adenoma combined with KS.We provide a detailed description of the patient's clinical manifestations,biochemical indices,diagnostic process,and postoperative histopathological findings in order to enhance the understanding of PA and KS and their potential interconnections,which offers diagnostic insights to reduce misdiagnosis and missed diagnoses.

Objective:To explore the risk factors for primary Sjogren′s syndrome-associated interstitial lung diseases (pSS-ILD) and to evaluate the diagnostic value of NLR and other predictors of pSS-ILD.Methods:A retrospective study of 63 patients with pSS-ILD and 201 patients with pSS visited our hospital from January 2016 to December 2023 was conducted. The general characteristics, clinical symptoms, laboratory indicators and treatment of the patients were collected. Correlation analyses were performed using the point bi-serial correlation test and Spearman′s Rho test, and binary logistic regression analysis was applied to explore the risk factors for the development of pSS-ILD. We assessed the value of diagnostic tools in relation to pSS-ILD by plotting receiver operating characteristic (ROC) curves.Results:①The proportion of males(14.29% vs. 4.48%, χ2=7.26, P=0.007), age at onset [(53±13)years old vs. (47±15)years old, t=2.55, P=0.011], neutrophil-to-lymphocyte ratio (NLR)[3.52(2.28, 6.49) vs. 1.64(1.23, 3.12), Z=-5.94, P<0.001], systemic immune-inflammatory index (SII) [653.34(328.08, 1 393.54) vs. 316.56(185.57, 593.65), Z=-5.26, P<0.001], C-reactive protein (CRP) [3.53(2.95, 9.76)mg/L vs. 2.82(1.67, 5.00)g/L, Z=-2.24, P=0.025], complement C3 [0.93(0.84, 1.02)g/L vs. 0.76(0.66, 0.85)g/L, Z=-5.33, P<0.001], and ESSDAI [4(3, 6) vs. 2(2, 4), Z=-5.70, P<0.001] levels were higher in the pSS-ILD than in non-ILD group, while the proportion of dry eyes (62.7%, χ2=13.37, P<0.001), proportion of anti-SSA/Ro60 antibody positivity (76.1%, χ2=8.77, P=0.012), rheumatoid factor (RF) positiveity [25.90(20.00, 83.30)U/ml, Z=-3.58, P<0.001], immunoglobulin G (IgG)[15.60(12.30, 21.90)g/L, Z=-3.28, P=0.001], immunoglobulin A (IgA)[3.21(2.32, 3.76)g/L, Z=-2.22, P=0.026], and immunoglobulin M (IgM)[1.29(0.93, 1.86)g/L, Z=-4.02, P<0.001) levels were higher in the non-ILD group. ②Correlation analysis showed that age at onset ( r=0.16, P<0.011), NLR ( r=0.43, P<0.001), SII ( r=0.41, P<0.001), and C3 ( r=0.27, P<0.001) were positively correlated with pSS-ILD, whereas IgG ( r=-0.18, P=0.005), IgM ( r=-0.19, P=0.002) were negatively correlated with pSS-ILD. Meanwhile, age at onset ( r=0.27, P<0.001), NLR ( r=0.30, P<0.001), and SII ( r=0.27, P<0.001) were positively correlated with ESSDAI score. ③Regression analysis showed that high levels of NLR[ OR(95% CI)=2.559(1.650, 3.969), P<0.001], C3[ OR(95% CI)=35.228(5.685, 218.309), P<0.001] might be risk factors for pSS-ILD. ④The area under the curve (AUC) for the diagnosis of pSS-ILD by NLR was 0.748, with a diagnostic sensitivity and specificity of 97.01% and 39.68%, respectively; the AUC for C3 was 0.727, with a diagnostic sensitivity and specificity of 66.67% and 79.03%, respectively; and the AUC for the joint predictive probability (Pre_1) of NLR and C3 was 0.812, with a sensitivity and specificity of 93.33% and 54.84%, respectively. Conclusion:High levels of NLR, C3 may be risk factors for pSS-ILD. NLR and C3 are adjunctive tools for the diagnosis of pSS-ILD, and the combination of the two increases the predictive value.