Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective To investigate the characteristics and clinical significance of serum immunoglob-ulins in patients with Cronkhite-Canada syndrome(CCS).Methods This retrospective study included CCS patients admitted to Peking Union Medical College Hospital from December 2009 to September 2024 who under-went serum immunoglobulin testing.Clinical manifestations and ancillary examination results were analyzed ret-rospectively.Results Fifty-two patients were included(male:36[69.2%],female:16[30.8%]),with median onset age of 60(54-64)years and median diagnostic delay of 5(3-12)months.Common manifesta-tions included diarrhea(86.5%),abdominal pain(40.4%),hematochezia(19.2%),weight loss(86.5%),nail malnutrition(100.0%),pigmentation(88.5%),hair loss(84.6%),and hypogeusia(69.2%).Serum IgG reduction occurred in 21 patients(50.0%),while total IgE elevation was observed in 20(71.4%).Elevated serum IgG4 levels were noted in 11 patients(23.4%),with no significant clinical differences between IgG4-elevated and normal groups.IgG4 levels showed no statistical difference between active(n=43)and remission(n=27)groups.The hair loss rate was significantly higher in the total IgE-ele-vated group than that in the normal total IgE group(P=0.0383).Conclusions CCS patients exhibit periph-eral blood immunoglobulin disorders,with elevated IgE levels correlating with hair loss.This suggests an im-mune-mediated mechanism may underlie hair loss in CCS.

Objective To investigate the risk factors of platelet transfusion refractoriness(PTR)in patients undergoing hematopoietic stem cell transplantation(HSCT)and its influence on the prognosis of the patients.Methods A total of 104 patients who underwent HSCT in The First Affiliated Hospital of Naval Medical University from February 2018 to February 2021 were enrolled and assigned to PTR group(n=36)or non-PTR group(n=68).The clinical data of the two groups were collected to investigate PTR-related factors in HSCT patients.The patients were followed up for 3 years after transplantation,and the survival and the influence of PTR on the prognosis were analyzed.Results The proportions of no platelet antibody matching,blood transfusion≥6 times,high fever,splenomegaly,infection,and skin and mucous membrane bleeding in the PTR group were significantly higher than those in the non-PTR group(P<0.05).The platelet count on admission in the PTR group was significantly lower than that in the non-PTR group(P<0.05).No platelet antibody matching(β=-0.837),blood transfusion≥6 times(β=0.905),high fever(β=0.516),splenomegaly(β=0.773),and infection(β=0.695)were independent risk factors of PTR in HSCT patients(P<0.05).The rates of overall survival(OS)and recurrence-free survival(RFS)in the PTR group were significantly lower than those in the non-PTR group(P<0.05).After multivariate adjustment,PTR was associated with poorer OS(HR=2.764,95%CI:1.267-6.643)and RFS(HR=2.139,95%CI:1.046-5.114).Conclusion The occurrence of PTR in HSCT patients is related to platelet antibody matching,blood transfusion frequency,high fever,splenomegaly,and infection.PTR can affect the prognosis of HSCT patients,and shorten the OS and RFS.

Objective:To investigate the correlation between the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), and cardiovascular calcification in patients on maintenance hemodialysis (MHD), and to evaluate their predictive value for cardiovascular calcification.Methods:This retrospective case-control analysis was conducted on the clinical data of 362 patients with chronic kidney disease who underwent regular hemodialysis for >3 months at the Hemodialysis Center of the Second People′s Hospital of Hefei from December 2018 to December 2023. Patients were divided into a cardiovascular calcification group (216 cases) and a cardiovascular non-calcification group (146 cases). The cardiovascular calcification group was further categorized according to different calcification sites, with 69 cases in the vascular calcification group, 79 in the valve calcification group, and 68 in the vascular and valve calcification group. Spearman correlation analysis was used to assess the correlation between cardiovascular calcification and various indicators. Risk factors for cardiovascular calcification in patients with MHD were analyzed using binary logistic regression analysis. The predictive value of the NLR and MHR for cardiovascular calcification was analyzed using the receiver operating characteristic (ROC) curve.Results:This study enrolled 362 cases, including 233 males and 129 females aged 29-89 years. Age, the NLR, and the MHR were positively correlated with cardiovascular calcification in patients on MHD ( r=0.338, 0.383, and 0.391, respectively, all P<0.05). In contrast, serum magnesium was negatively correlated with cardiovascular calcification ( r=-0.169, P<0.05). Age ( OR=1.063, 95% CI 1.036-1.092, P<0.001), male sex ( OR=2.017, 95% CI 1.104-3.685, P=0.023), neutrophil count ( OR=1.737, 95% CI 1.326-2.276, P<0.001), the NLR ( OR=1.722, 95% CI 1.310-2.263, P<0.001), and the MHR ( OR=1.352, 95% CI 1.153-1.586, P<0.001) were identified as independent risk factors for cardiovascular calcification in patients on MHD. Serum magnesium ( OR=0.034, 95% CI 0.001-0.797, P=0.036) was a protective factor. The combined area under the curve (AUC) of the NLR and MHR was the largest (AUC=0.804, 95% CI 0.759-0.850); the AUC for the NLR and MHR used alone was 0.725 (95% CI 0.672-0.779) and 0.730 (95% CI 0.677-0.783), respectively. Conclusions:The MHR, and the NLR are independent risk factors for cardiovascular calcification in patients with MHD. The combination of the MHR and NLR has a greater clinical predictive value for cardiovascular calcification.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective To investigate the characteristics and clinical significance of serum immunoglob-ulins in patients with Cronkhite-Canada syndrome(CCS).Methods This retrospective study included CCS patients admitted to Peking Union Medical College Hospital from December 2009 to September 2024 who under-went serum immunoglobulin testing.Clinical manifestations and ancillary examination results were analyzed ret-rospectively.Results Fifty-two patients were included(male:36[69.2%],female:16[30.8%]),with median onset age of 60(54-64)years and median diagnostic delay of 5(3-12)months.Common manifesta-tions included diarrhea(86.5%),abdominal pain(40.4%),hematochezia(19.2%),weight loss(86.5%),nail malnutrition(100.0%),pigmentation(88.5%),hair loss(84.6%),and hypogeusia(69.2%).Serum IgG reduction occurred in 21 patients(50.0%),while total IgE elevation was observed in 20(71.4%).Elevated serum IgG4 levels were noted in 11 patients(23.4%),with no significant clinical differences between IgG4-elevated and normal groups.IgG4 levels showed no statistical difference between active(n=43)and remission(n=27)groups.The hair loss rate was significantly higher in the total IgE-ele-vated group than that in the normal total IgE group(P=0.0383).Conclusions CCS patients exhibit periph-eral blood immunoglobulin disorders,with elevated IgE levels correlating with hair loss.This suggests an im-mune-mediated mechanism may underlie hair loss in CCS.

Objective:To investigate the correlation between the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), and cardiovascular calcification in patients on maintenance hemodialysis (MHD), and to evaluate their predictive value for cardiovascular calcification.Methods:This retrospective case-control analysis was conducted on the clinical data of 362 patients with chronic kidney disease who underwent regular hemodialysis for >3 months at the Hemodialysis Center of the Second People′s Hospital of Hefei from December 2018 to December 2023. Patients were divided into a cardiovascular calcification group (216 cases) and a cardiovascular non-calcification group (146 cases). The cardiovascular calcification group was further categorized according to different calcification sites, with 69 cases in the vascular calcification group, 79 in the valve calcification group, and 68 in the vascular and valve calcification group. Spearman correlation analysis was used to assess the correlation between cardiovascular calcification and various indicators. Risk factors for cardiovascular calcification in patients with MHD were analyzed using binary logistic regression analysis. The predictive value of the NLR and MHR for cardiovascular calcification was analyzed using the receiver operating characteristic (ROC) curve.Results:This study enrolled 362 cases, including 233 males and 129 females aged 29-89 years. Age, the NLR, and the MHR were positively correlated with cardiovascular calcification in patients on MHD ( r=0.338, 0.383, and 0.391, respectively, all P<0.05). In contrast, serum magnesium was negatively correlated with cardiovascular calcification ( r=-0.169, P<0.05). Age ( OR=1.063, 95% CI 1.036-1.092, P<0.001), male sex ( OR=2.017, 95% CI 1.104-3.685, P=0.023), neutrophil count ( OR=1.737, 95% CI 1.326-2.276, P<0.001), the NLR ( OR=1.722, 95% CI 1.310-2.263, P<0.001), and the MHR ( OR=1.352, 95% CI 1.153-1.586, P<0.001) were identified as independent risk factors for cardiovascular calcification in patients on MHD. Serum magnesium ( OR=0.034, 95% CI 0.001-0.797, P=0.036) was a protective factor. The combined area under the curve (AUC) of the NLR and MHR was the largest (AUC=0.804, 95% CI 0.759-0.850); the AUC for the NLR and MHR used alone was 0.725 (95% CI 0.672-0.779) and 0.730 (95% CI 0.677-0.783), respectively. Conclusions:The MHR, and the NLR are independent risk factors for cardiovascular calcification in patients with MHD. The combination of the MHR and NLR has a greater clinical predictive value for cardiovascular calcification.

BACKGROUND:Numerous basic and clinical trials have confirmed that the low survival rate after bone marrow mesenchymal stem cell transplantation is a serious constraint on its long-term therapeutic effect.Previous studies have shown that apoptosis-related factors play an important role in the apoptosis of bone marrow mesenchymal stem cells,of which apoptosis-inducing factor may be a key factor. OBJECTIVE:Bone marrow mesenchymal stem cells,of which apoptosis-inducing factor was knocked down,were transplanted into infarcted myocardium of mice,aiming to certify the importance of apoptosis-inducing factor in the survival of bone marrow mesenchymal stem cells to further recover cardiac function after infarction. METHODS:Firstly,bone marrow mesenchymal stem cells were infected with LV-AIF-shRNA lentivirus to down-regulate the expression of apoptosis-inducing factor protein.Flow cytometry,western blot assay,and RT-qPCR were used to detect the infection efficiency of lentivirus.CCK-8 assay was used to detect the cell viability of bone marrow mesenchymal stem cells with apoptosis-inducing factor knockdown under hypoxic and ischemic conditions.Then,with the mouse model of acute myocardial infarction constructed,the normal bone marrow mesenchymal stem cells and bone marrow mesenchymal stem cells with apoptosis-inducing factor gene knockdown were transplanted into the model,respectively.The expression of apoptosis-inducing factor was examined by fluorescence immunoassay.Serum brain natriuretic peptide levels were detected by ELISA.Cardiac ultrasound was used to detect cardiac function.Myocardial fibrosis was observed by Masson staining.The expression of SRY gene was detected by RT-qPCR in apoptosis-inducing factor-knocked bone marrow mesenchymal stem cells after transplantation,reflecting cell survival. RESULTS AND CONCLUSION:(1)Bone marrow mesenchymal stem cells with apoptosis-inducing factor gene knockdown were successfully established by LV-AIF-shRNA lentivirus infection,following 97.7%of infection efficiency,and notably decline of the expression of apoptosis-inducing factor(P<0.001).(2)Under ischemia and hypoxia,the cell viability of apoptosis-inducing factor knockdown bone marrow mesenchymal stem cells was significantly increased compared with normal bone marrow mesenchymal stem cells.(3)Compared with normal bone marrow mesenchymal stem cells after transplantation,the survival number of bone marrow mesenchymal stem cells in the infarcted myocardium after apoptosis-inducing factor gene knockdown was significantly increased to 3.71 times(P<0.001),and the apoptosis-inducing factor protein expression and myocardial fibrosis degree in the infarcted area were significantly reduced.(4)Compared with normal bone marrow mesenchymal stem cells,the serum brain natriuretic peptide level of bone marrow stem cells with apoptosis-inducing factor gene knockdown after transplantation was significantly decreased(P<0.05),and left ventricular ejection fraction and left ventricular shortening fraction were significantly improved(P<0.05).(5)These findings confirm that apoptosis-inducing factor gene knockdown can reduce myocardial fibrosis and improve cardiac function after acute myocardial infarction via enhancing the bone marrow mesenchymal stem cell viability and increasing the bone marrow mesenchymal stem cell survival after transplantation in the donor.

Objective:To compare the efficacy of endoscopic submucosal dissection (ESD) and modified-endoscopic mucosal resection (M-EMR) for G1 rectal neuroendocrine tumors (RNETs) .Methods:Data of 121 patients with pathologically confirmed G1 RNETs treated with ESD ( n=105) or M-EMR ( n=16) in Nanjing Drum Tower Hospital from January 2017 to September 2020 were retrospectively analyzed. The complete resection rate, complication incidence, hospital stay, treatment cost and other indicators of the two groups were compared by using inverse probability of treatment weighting (IPTW). Results:There were significant differences in tumor number ( χ2=8.76, P=0.003), tumor invasion depth ( χ2=6.96, P=0.008), utilization of metal clips [82.9% (87/105) VS 93.8% (15/16), χ2=8.78, P=0.003], number of metal clips ( χ2=8.41, P=0.016), hemostasis using hot clamp [78.1% (82/105) VS 18.7% (3/16), χ2=20.64, P<0.001], traction procedure [2.9% (3/105) VS 18.7% (3/16), χ2=4.45, P=0.035] and treatment cost (17 568.6 ± 8 911.0 yuan VS 8 120.8±1 528.2 yuan, t=3.65, P<0.001) between the ESD group and the M-EMR group. After verifying the stability of the results using IPTW sensitivity analysis, there was still significant difference in the treatment cost ( t=2.07, P<0.001). Conclusion:Both ESD and M-EMR demonstrate comparable efficacy in treating G1 RNETs; however, M-EMR exhibites lower treatment costs.

Objective:To investigate the risk factors for the relapse of autoimmune pancreatitis (AIP) after steroid therapy.Methods:Clinical data of 72 AIP patients treated with steroids in Nanjing Drum Tower Hospital from January 2012 to December 2023 were collected retrospectively. AIP patients were divided into relapse group ( n=25) and non-relapse group ( n=47) based on the presence or absence of their relapse after steroid therapy. Patients' age of onset, gender, history of diabetes mellitus, first clinical manifestations, serum IgG4 and CA19-9 level, imaging features and other organ involvements were recorded. Oral prednisone was used at an initial dose of 0.6 mg·kg -1·d -1, gradually reduced to 5-10 mg/d and then maintained at a low dose. The follow-up period started from steroid initiation to the last follow-up or relapse. The presence of maintenance steroid treatment, time interval between onset and steroid initiation, the presence of significant IgG4 decrease and the presence of persistently enlarged pancreas after therapy were recorded. The cumulative relapse rate curve after steroid therapy was drawn by Kaplan-Meier method. Univariate and multivariate analyses were performed by Cox proportional hazard regression model. The receiver operator characteristic curves (ROC) were plotted and the area under the curve (AUC) was calculated. The Log-Rank test was used to analyze the differences on the relapse between different groups. The subgroup forest plot was drawn to assess the effect of risk factors on the relapse of AIP in different subgroups. Results:The 72 patients with AIP had a median follow-up of 42 (12-127) months. 34.7% (25/72) of patients relapsed after steroid therapy during the follow-up period. The percentages of patients whose first clinical manifestation was abdominal distension or acute pancreatitis, whose interval between onset and steroid initiation was more than 1 year and whose pancreases were persistently enlarged after steroid therapy in the relapse group were higher than those in the non-relapse group, and the differences were all statistically significant (all P value <0.05). The 1-, 3- and 5-year cumulative relapse rate after steroid therapy was 20.8%, 34.1% and 37.8%, respectively. Univariate analysis found that the first clinical manifestations of abdominal distension or acute pancreatitis, interval between onset and steroid initiation more than 1 year, and persistently enlarged pancreas after steroid therapy were all significantly associated with relapse (all P value <0.05). Multivariate analysis found that interval between onset and steroid initiation more than 1 year and persistently enlarged pancreas after steroid therapy were independent risk factors for relapse of AIP [hazard ratio ( HR)=3.606 and 6.515, 95% confidence interval (95% CI) 1.362-9.854 and 2.088-20.326]. Kaplan-Meier survival curves showed that the relapse rate after steroid therapy was higher in AIP patients whose interval between onset and steroid initiation was more than 1 year than in those whose interval was less than 1 year (55.6% versus 27.8%), and the relapse rate in AIP patients with persistently enlarged pancreas after steroid therapy was higher than that in those without it (77.8% versus 28.6%), and the differences were both statistically significant (both P<0.05). Subgroup forest plot showed that persistently enlarged pancreas after steroid therapy was an independent risk factor for relapse of AIP regardless of the presence of a diabetes mellitus history, the first manifestation of abdominal pain, the diffuse or focal type in pancreatic imaging, and the presence of dilated pancreatic duct or not (all P value <0.05). Conclusions:Time interval between onset and steroid initiation more than 1 year and persistently enlarged pancreas after steroid therapy were independent risk factors for the relapse of AIP after steroid therapy.