Objective To investigate the relationship between serum orexin-A(OXA)and aspartate amin-otransferase(AST)levels and the disease severity and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 167 AIS patients(AIS group)treated at Hebei Provincial People's Hospital from January 2021 to January 2024 and 84 healthy individuals undergoing physical examinations(control group)were selected as the research objects.AIS patients were categorized by severity into mild AIS group[National Institutes of Health Stroke Scale(NIHSS)score＜5,42 cases],moderate AIS group(NIHSS score 5—＜16,56 cases),moderate-to-severe AIS group(NIHSS score 16—＜21,36 cases),and severe AIS group(NIHSS score ≥21,33 cases).Based on 3-month prognosis(modified Rankin scale),patients were divided into poor prognosis group(＞2 grade,54 cases)and good prognosis group(≤2 grade,113 cases).Spearman correlation analysis was used to assess the relationship between NIHSS scores and serum OXA and AST levels in AIS pa-tients.Multivariate unconditional Logistic regression was used to determine the relationship between serum OXA and AST levels and the prognosis of AIS patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum OXA and AST levels for prognosis.Results Compared with the control group,serum OXA level in the AIS group was lower,while AST level was higher(P＜0.05).Ser-um OXA level progressively decreased,and AST level progressively increased across the mild,moderate,mod-erately severe,and severe AIS groups(P＜0.05).NIHSS score was negatively correlated with serum OXA level and positively correlated with AST level in AIS patients(P＜0.05).High OXA level was an independent protective factor for poor prognosis in AIS patients,while high AST level was an independent risk factor(P＜0.05).The area under the curve(AUC)of the combined assessment of serum OXA and AST levels in predic-ting poor prognosis in AIS patients was 0.873,which was greater than the AUC of OXA(0.793)and AST(0.770)alone(P＜0.05).Conclusion In AIS patients,lower serum OXA level and higher AST level are as-sociated with disease severity and poor prognosis.The combined evaluation of serum OXA and AST levels has higher predictive value for AIS prognosis.

Objective To observe the characteristics of gut microbiota in patients with type 2 diabetes mellitus(T2DM)with different traditional Chinese medicine(TCM)syndrome types,and to further explore the key microbial communities and functional differences affecting syndrome differentiation.Methods A total of 45 patients who visited the Department of Geriatrics,Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine in 2023 were enrolled.These included 15 T2DM patients with qi-yin deficiency and blood stasis syndrome(Group A),15 T2DM patients with qi-yin deficiency syndrome(Group B),and 15 non-diabetic patients from the same period(Group C).Fecal samples were collected,and 16S rRNA sequencing and analysis were performed.Results 1)A total of 1 564 operational taxonomic units(OTUs)were obtained from the three groups of patients,with 224,127,and 351 unique OTUs identified in Groups A,B and C,respectively.2)Both α-and β-diversity analyses indicated differences among the gut microbiota of the three groups.For instance,in the α-diversity analysis,the Sobs index showed significant inter-group differences(P＜0.01).Group A(264.00±88.84)was significantly higher than Group B(145.90±87.0)(P＜0.01),while Group B was significantly lower than Group C(229.7±112.4)(P＜0.05).In the β-diversity analysis,the principal coordinate analysis(PCoA)indicated a clear separation among groups(R=0.1610,P＜0.01).The R values in the Anosim/Adonis analysis ranged from 0.144 to 0.196,and the R2 values ranged from 0.067 to 0.083,all indicating differences in inter-group comparisons(P＜0.01).3)At the phylum level,Firmicutes,Actinobacteriota,and Bacteroidota were predominant in all groups.Among them,Bacteroidota exhibited significant inter-group differences(P＜0.05),with its abundance in Group A being significantly higher than that in Group B(P＜0.01).4)Analysis of differences in microbiota composition,combined with linear discriminant analysis effect size(LEfSe)and Random Forest analysis,revealed that,at the genus level,the microbiota biomarkers between Group A and Group B were Parabacteroides,Bacteroides,g_unclassified_f_Lachnospiraceae,Roseburia,and Aspergillus,those between Group B and Group C were Erysipelotrichaceae_UCG-003 and Ruminococcus,and those between Group A and Group C were Parabacteroides,Anaerotruncus,and Oscillibacter.The results were validated by receiver operating characteristic(ROC)curve analysis,which suggested that the microbiota biomarkers between Group A and Group B(AUC=0.91;95％CI,0.80-1.00),Group B and Group C(AUC=0.84;95％CI,0.69-0.99),Group A and Group C(AUC=0.87;95％CI,0.75-0.99)had good diagnostic efficacy.5)The study identified 116 major pathways with inter-group differences through Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis.For example,the enrichment degree of ABC transporter pathway in Group A(2.58±0.36)was significantly lower than those in Group B(2.90±0.48)and Group C(3.11±0.66)(P＜0.05).These pathways were associated with metabolism and environmental information processing.g.Conclusion The differences in the gut microbiota characteristics and functions among patients with specific TCM syndromes of T2DM may provide references for TCM syndrome differentiation and therapeutic mechanisms.

Objective To investigate the correlations of serum levels of platelet activation com-plex-1(PAC-1)and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)with neu-rological deficit and clinical prognosis in patients with acute cerebral infarction(ACI).Methods A total of 170 ACI patients(ACI group)and 85 healthy volunteers(control group)were enrolled in this study.Based on severity of neurological deficit assessed by the National Institutes of Health Stroke Scale(NIHSS)score,ACI patients were divided into of mild neurological deficit group(43 cases),moderate neurological deficit group(57 cases),moderate-to-severe neurological deficit group(37 cases),and severe neurological deficit group(33 cases).Additionally,based on the 6-month fol-low-up prognosis,ACI patients were divided into 51 cases of poor prognosis group and 119 cases of good prognosis group.Enzyme-linked immunosorbent assay was used to measure serum levels of PAC-1 and sTWEAK.Spearman correlation analysis was performed to evaluate their correlations with NIHSS scores in ACI patients.Multivariate unconditional Logistic regression analysis was conducted to determine their relationships with clinical prognosis.Receiver operating characteristic curves were used to explore their evaluation efficacy for poor clinical prognosis.Results Serum levels of PAC-1 and sTWEAK were significantly higher in the ACI group than in the control group(P＜0.05).Ser-um levels of PAC-1 and sTWEAK increased sequentially in the mild,moderate,moderate-to-severe,and severe neurological deficit groups(P＜0.05).Spearman correlation analysis showed that serum levels of PAC-1 and sTWEAK were positively correlated with NIHSS scores in ACI patients(rs=0.715 and 0.706,respectively;P＜0.001).Multivariate unconditional Logistic regression analysis revealed that older age,higher NIHSS score,larger infarct volume,higher PAC-1 level,and higher sTWEAK level were independent risk factors for poor prognosis in ACI patients(P＜0.05).The ar-ea under the curve for the combined assessment of serum PAC-1 and sTWEAK levels for poor clini-cal prognosis in ACI patients was 0.895,which was greater than the areas under the curve for the individual assessments(0.792 and 0.786,respectively;P＜0.05).Conclusion Elevated serum levels of PAC-1 and sTWEAK are closely related to increased neurological deficit and poor clinical prognosis in ACI patients.The combined detection of these two markers has high evaluation efficacy for clinical prognosis in ACI patients.

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.

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 study the differences in the structure and load of hair follicle microbiota in non-lesional areas among patients with moderate-to-severe acne vulgaris and healthy individuals,and to explore the relationship between microorganisms and the severity of acne vulgaris.Method·A cross-sectional study was used.Patients with moderate or severe acne vulgaris(referred to as acne)and healthy volunteers who visited the Department of Dermatology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,from August 2022 to August 2023.16S rRNA high-throughput sequencing and quantitative real-time polymerase chain reaction(qPCR)were performed on the follicular contents from the non-lesional areas of the faces of patients with moderate or severe acne and healthy volunteers to analyze the diversity,species composition,and microbial load differences in hair follicle bacteria in patients with different severity of acne.Results·Ten patients with moderate acne,eleven patients with severe acne,and eleven healthy volunteers were included.There were no statistically differences in general data such as age and gender ratio among the three groups.Bacterial α-diversity was significantly lower in both the moderate and severe acne groups compared to the healthy group(P=0.020,P=0.013).The principal coordinates analysis(PCoA)plot showed that the sample distribution of the healthy group was relatively concentrated,with small differences within the group,and the distribution of samples in the moderate and severe acne groups exhibited a certain trend but was relatively scattered,with differences between the groups.There were differences in the trend distribution of the three sample groups,and there were differences in the microbial community structure between the groups.The results of similarity analysis showed significant differences in β-diversity and low similarity in species composition between the healthy and moderate acne groups(P=0.027)and between the healthy and severe acne groups(P=0.017),and high species similarity between the moderate acne and severe acne groups(P=0.160).The dominant bacterial groups at the phylum level were Actinobacteria,Firmicutes,Proteobacteria,and Bacteroidetes.At the genus level,the dominant bacteria in the healthy group were Propionibacterium and unclassified Actinomycetales,and the dominant bacteria in both acne groups were Staphylococcus and Propionibacterium.Compared to the healthy group,the relative abundance of Staphylococcus species in the hair follicles in non-lesional areas of the moderate and severe acne groups was significantly increased(P=0.010,P=0.019).Compared with the healthy control group,the hair follicle microbiota load in non-lesional areas of both the moderate and severe acne groups was significantly increased(both P=0.001).Compared with the moderate acne group,the bacterial load in the hair follicle samples of the severe acne group was significantly increased(P=0.017).Conclusion·The microbial community structure of hair follicles in non-lesional areas of patients with moderate or severe acne is different from that of healthy individuals,and the microbial diversity in the acne group is significantly reduced.The relative abundance of Staphylococcus species in the hair follicles in non-lesional areas of the moderate or severe acne groups is significantly increased compared to the healthy group.As the severity of acne increases,the bacterial load in hair follicles in non-lesional areas significantly increases.This research suggests that the occurrence and severity of acne may be related to the community structure and load of hair follicle microbiota.

Objective:To investigate the interactive effect of mismatch repair (MMR) protein status and adverse clinicopathological features on prognosis of stage Ⅰ-Ⅲ colon cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 650 patients with colon cancer of stage Ⅰ-Ⅲ who were admitted to 7 hospitals in China from January 2016 to December 2017 were collected. There were 963 males and 687 females, aged 62(53,71)years. Patients were classified as 230 cases of MMR deficiency (dMMR) and 1 420 cases of MMR proficiency (pMMR) based on their MMR protein status. Observation indicators: (1) comparison of clinicopathological characteristics between patients of different MMR protein status; (2) analysis of factors affecting the survival outcomes of patients of dMMR; (3) analysis of factors affecting the survival outcomes of patients of pMMR; (4) interaction analysis of MMR and adverse clinicopathological features on survival outcomes. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the Mann-Whitney U test. The random forest interpolation method was used for missing values in data interpolation. Univariate analysis was conducted using the COX proportional risk regression model, and multivariate analysis was conducted using the COX stepwise regression with forward method. The coefficient of multiplication interaction effect was obtained using the interaction term coefficient of COX proportional risk regression model. Evaluation of additive interaction effects was conducted using the relative excess risk due to interaction ( RERI). Results:(1) Comparison of clinicopathological characteristics between patients of different MMR protein status. There were significant differences in age, T staging, the number of lymph node harvest, the number of lymph node harvest <12, high grade tumor between patients of dMMR and pMMR ( P<0.05). (2) Analysis of factors affecting the survival outcomes of patients of dMMR. Results of multivariate analysis showed that T staging, N staging, the number of lymph node harvest <12 were independent factors affecting the disease-free survival (DFS) of colon cancer patients of dMMR ( hazard ratio=3.548, 2.589, 6.702, 95% confidence interval as 1.460-8.620, 1.064-6.301, 1.886-23.813, P<0.05). Age and N staging were independent factors affecting the overall survival (OS) of colon cancer patients of dMMR ( hazard ratio=1.073, 10.684, 95% confidence interval as 1.021-1.126, 2.311-49.404, P<0.05). (3) Analysis of factors affecting the survival outcomes of patients of pMMR. Results of multivariate analysis showed that age, T staging, N staging, vascular tumor thrombus were independent factors affecting the DFS of colon cancer patients of pMMR ( hazard ratio=1.018, 2.214, 2.598, 1.549, 95% confidence interval as 1.006-1.030, 1.618-3.030, 1.921-3.513, 1.118-2.147, P<0.05). Age, T staging, N staging, high grade tumor were independent factors affecting the OS of colon cancer patients of pMMR ( hazard ratio=1.036, 2.080, 2.591, 1.615, 95% confidence interval as 1.020-1.052, 1.407-3.075, 1.791-3.748, 1.114-2.341, P<0.05). (4) Interaction analysis of MMR and adverse clinicopathological features on survival outcomes. Results of interaction analysis showed that the multiplication interaction effect between the number of lymph node harvest <12 and MMR protein status was significant on DFS of colon cancer patients ( hazard ratio=3.923, 95% confidence interval as 1.057-14.555, P<0.05). The additive interaction effects between age and MMR protein status, between high grade tumor and MMR protein status were significant on OS of colon cancer patients ( RERI=-0.033, -1.304, 95% confidence interval as -0.049 to -0.018, -2.462 to -0.146). Conclusions:There is an interaction between the MMR protein status and the adverse clinicopathological features (the number of lymph node harvest <12, high grade tumor) on prognosis of colon cancer patients of stage Ⅰ-Ⅲ. In patients of dMMR, the number of lymph node harvest <12 has a stronger predictive effect on poor prognosis. In patients of pMMR, the high grade tumor has a stronger predictive effect on poor prognosis.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

Objective:To investigate the relationship between thyroid autoimmunity and pregnancy outcome in patients with unexplained recurrent abortion.Methods:A retrospective cohort study of 354 patients with normal thyroid function with recurrent abortion of unknown cause admitted to Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 2015 to June 2022 was used to detect thyroid antibody and thyroid function levels during pregnancy or early pregnancy. They were divided into TAI group ( n=144) and non-TAI group ( n=210) according to whether thyroid autoimmunity (TAI) was complicated or not. Tracking pregnancy outcomes. Results:Compared with the non-TAI group, the TAI group had a higher proportion of pregnancy outcomes resulting in miscarriage [42.4%(61/144) vs 27.1%(57/210), P=0.004]. In patients with unexplained recurrent abortion, TAI significantly increased the risk of spontaneous abortion [ OR(95% CI): 2.13(1.34, 3.41), P=0.001]. Positive TPOAb or TgAb also increased the risk of spontaneous abortion [ OR(95% CI): 2.18(1.37, 3.50), P=0.001; OR(95% CI): 2.33(1.31, 4.13), P=0.004]. TAI, TPOAb and TgAb had no significant interaction with age ( P=0.482, 0.724, 0.740). Conclusions:TAI is positively associated with the risk of spontaneous abortion in patients with unexplained recurrent abortion. TAI may be a potential risk factor for unexplained recurrent abortion, expanding the diagnosis and treatment of unexplained recurrent abortion.

Objective:To compare the phylotypes of Staphylococcus epidermidis (SE) in skin lesions of acne vulgaris patients versus hair follicles of healthy people, and to analyze their roles in the pathogenesis of acne vulgaris. Methods:A cross-sectional study was conducted from August 2022 to August 2023. Patients with moderate acne vulgaris, as well as healthy volunteers, were enrolled from the Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University. SE strains were isolated from the pustules of acne vulgaris patients and hair follicles of healthy volunteers. Housekeeping genes were amplified by PCR. Sequencing and multilocus sequence typing were performed to compare the phylotypes and genetic relationships of strains from different sources.Results:The acne group consisted of 28 patients (10 males and 18 females) with the age being 22.6 ± 2.6 years, while the healthy group consisted of 19 volunteers (7 males and 12 females) with the age being 22.4 ± 0.96 years. There were no significant differences in age or gender ratio between the two groups (both P > 0.05). The positive rates of SE in the samples of the acne group and the healthy group were 60.71% (17/28) and 73.68% (14/19), respectively, with no significant difference between the two groups ( P = 0.53). The 144 SE strains from the healthy group could be divided into 10 sequence types (STs), and the most common ST was ST35 (8 cases), followed by ST73 (4 cases), ST193 (2 cases), ST59 (2 cases) and ST540 (2 cases) ; 190 SE strains from the acne group could be divided into 16 STs, and the most common STs were ST59 (6 cases) and ST73 (6 cases), followed by ST802 (3 cases), ST130 (3 cases) and ST35 (2 cases). The positive rate of ST35 was significantly lower in the acne group than in the healthy group ( P = 0.018), while there were no significant differences in the positive rates of other STs between the two groups (all P > 0.05). The evolutionary tree analysis showed that the SE strains were mainly distributed in 3 branches. Most of the SE strains from the healthy group belonged to clade A. The proportion of SE strains in clade A ( M[ Q]) was significantly lower in the acne group (25% [85%]) than in the healthy group (100% [33.33%], P = 0.025), while the proportion of SE strains in clade B was significantly higher in the acne group (14.29% [89.17%]) than in the healthy group (0[0], U = 62, P = 0.010), and there was no significant difference in the proportion of SE strains in clade D between the acne group (0 [57.14%]) and healthy group (0[4.17%], P = 0.420) . Conclusion:The phylotypes of SE strains differed between acne vulgaris patients and healthy controls, possibly associated with the occurrence and development of acne vulgaris.