Objective:The purpose of this study was to analyze the epidemiological characteristics of hand, foot, and mouth disease (HFMD) among individuals aged 6 years and above in Guangzhou from 2010 to 2023, with the intention that a scientific basis be provided for effective prevention and control measures in older age groups.Methods:Data on HFMD incidence among individuals aged 6 years and above in Guangzhou from 2010 to 2023 were collected and analyzed. Descriptive epidemiological methods were used to analyze the distributions and pathogen components of HFMD cases in Guangzhou residents aged 6 years and above. Spatial autocorrelation analysis and Getis-Ord Gi* analysis were conducted to identify the spatial clustering patterns of HFMD at the street town level. Results:From 2010 to 2023, the gender ratio of HFMD cases in persons aged 6 and above was 1.49∶1 in Guangzhou. The average annual incidence rate of HFMD among individuals aged 6 years and above in Guangzhou was 25.75 per 100 000. Furthermore, the reported incidence rate indicated an increased tendency. The annual incidence showed a bimodal distribution, with the main peak occurring from May to July and the secondary peak from September to October. HFMD incidence rates vary by townships, with hotspots clustered in urban and urban-rural regions. The dominant pathogen shifts from year to year. Enterovirus 71 (EV71) was the prevalent strain in 2010, followed by other enteroviruses and Coxsackievirus (CV)-A16 from 2011 to 2016. Since 2017, CV-A6 has steadily become the major pathogen.Conclusions:The incidence of HFMD cases among individuals aged 6 years and above in Guangzhou increased generally from 2010 to 2023, with hotspots localized in urban and urban-rural areas. The pathogen composition altered dramatically, with the proportion of EV71 dropping overall, while CV-A6 eventually became the dominating strain. Therefore, it is imperative to focus on the prevention and control of HFMD in this age group, especially by strengthening measures in areas with high prevalence.

Objective:To explore the cardioprotective effects of icariin (ICA) against radiation-induced cardiac disease (RICD) in C57BL/6 mice.Methods:A total of 48 female C57BL/6J mice aged 6-8 weeks were randomly divided into three groups: the control group (CON), the irradiation group (IR), and the irradiation combined with icariin group (IR+ ICA), with 16 mice in each group. The IR and IR+ ICA groups received a single cardiac irradiation at a dose of 30 Gy, while the CON group received no radiation treatment. The IR+ ICA group was treated with ICA (70 mg·kg -1·d -1) two weeks before irradiation until the end of the experiment through intragastric administration. In contrast, the CON and IR groups were treated with an equal volume of vehicle solution (0.5% sodium carboxymethyl cellulose, NaCMC) via intragastric administration. The mice′s mental status, food intake, body weight, and survival rates were monitored during the experiment. At two weeks post-irradiation, the venous blood of the mice was collected and serum was separated for the enzyme-linked immunosorbent assays (ELISA) of creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT/TNNT2). At 12 weeks post-irradiation, the cardiac function of the mice was assessed using echocardiography. After the mice were euthanized under anesthesia, the histopathological changes and fibrosis degree of their myocardial tissues were assessed using hematoxylin and eosin (HE) and Masson′s trichrome staining, followed by the calculation of collagen volume fraction (CVF). The differential gene expression of brain natriuretic peptide (BNP), transforming growth factor-β (TGF-β), and interleukin-6 (IL-6) in the cardiac tissues of the mice was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR). Apoptosis-related proteins and proteins associated with the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway were determined using Western blotting. The survival curves of the mice were plotted using Kaplan-Meier, and the survival differences of the mice among various groups were compared using the log-rank test. Results:After irradiation, the mice in the IR group showed lethargy, as well as decreased food intake and activity, while these symptoms in the IR+ ICA group were significantly alleviated. At two weeks post-irradiation, the CK-MB and cTnT levels of the IR group were significantly elevated compared with the CON group ( t = 5.28, 8.89, P < 0.01). At 12 weeks post-irradiation, the mice in the IR group exhibited significantly decreased body weight ( t = 2.47, P < 0.05) and decreased survival rates ( HR = 8.25, 95% CI: 1.157-58.770, P < 0.05) compared with the CON group. Echocardiography revealed that the IR group featured decreased left ventricular ejection fraction (EF), decreased fractional shortening (FS), and increased left ventricular end-diastolic diameter (LVDD) compared with the CON group ( t = 7.02, 4.45, P < 0.05). Histopathological examination revealed that the IR group suffered from cardiomyocyte edema, disordered arrangement, and increased fibrosis, with an elevated CVF. The IR group exhibited significantly upregulated gene expression of BNP, TGF-β, and IL-6 in cardiac tissues compared with the CON group ( t = 4.23, 6.39, 4.61, P < 0.05). After-irradiation, the IR group exhibited upregulated apoptosis-related proteins Cleaved Caspase-3 and Bax ( t = 6.29, 9.54, P < 0.05), decreased Bcl-2 expression ( t = 8.20, P < 0.001), and decreased phosphorylation levels of PI3K and Akt ( t = 6.47, 3.42, P < 0.001). The symptoms of the mice were partially ameliorated after treatment with ICA. Specifically, the mice in the IR+ ICA group exhibited higher body weight ( t = 5.13, P < 0.001) and significantly higher survival rates ( HR = 0.121, 95% CI: 0.017-0.864, P < 0.05) than the IR group. Compared to the IR group, the IR+ ICA group showed elevated cardiac function indicators EF and FS( t = 3.23, 3.05, P < 0.05), and reduced LVDD ( t = 3.02, P < 0.05). The histopathological analysis revealed mitigated edema and disordered arrangement of cardiomyocytes in the IR+ ICA group. Furthermore, the IR+ ICA group exhibited significantly lower BNP, TGF-β, and IL-6 expression levels than the IR group ( t = 2.83, 4.15, 2.96, P < 0.05). The expression of apoptosis-related proteins Cleaved Caspase-3 and Bax was lower ( t = 3.23, 3.24, P < 0.05), Bcl-2 expression was higher ( t = 5.92, P < 0.001), and restored phosphorylation levels of PI3K and Akt ( t = 2.89, 8.35, P < 0.001). Conclusions:Icariin has protective effects against the RICD. It alleviates cardiomyocyte apoptosis possibly by upregulating the phosphorylation levels of PI3K and Akt.

Crigler-Najjar syndrome (CNS) and Gilbert syndrome (GS; OMIM: 143500) are rare autosomal recessive diseases that cause unconjugated hyperbilirubinemia due to decreased UGT1A1 enzyme activity. Crigler-Najjar syndrome type 2 (CNS2; OMIM: 606785) increases the risk of gallbladder stone formation and cholecystitis, while GS seldom causes health issues. We found a 28-year-old male patient with recurring right upper abdomen pain who experienced persistent jaundice from birth. CNS2 with gallbladder stones and cholecystitis was diagnosed after genetic testing revealed rare double homozygous mutations A(TA)₇TAA (rs3064744) and P229Q (rs35350960) in the UGT1A1 gene. After pedigree investigation, we found that the patient's parents with modestly increased bilirubin had compound heterozygous mutations A(TA)₇TAA and P229Q, which were GS. Bioinformatics analysis showed that A(TA)₇TAA is in the TATA-box region of the gene UGT1A1 promoter, affecting gene transcriptional initiation, whereas P229Q modifies protein three-dimensional structure and may be harmful. In this pedigree, double homozygous mutations have a more severe phenotype than compound heterozygous mutations. Inherited causes of hyperbilirubinemia should be suspected after ruling out biliary obstruction, and early bilirubin reduction (< 103 µmol/L (6 mg/dL)) may reduce the risk of complications like cholecystitis in CNS2 patients, though further studies with longer follow-up are needed to confirm this observation.
Humans ; Male ; Glucuronosyltransferase/genetics* ; Adult ; Crigler-Najjar Syndrome/complications* ; Cholecystitis/etiology* ; Homozygote ; Mutation ; Pedigree

Objective:The purpose of this study was to analyze the epidemiological characteristics of hand, foot, and mouth disease (HFMD) among individuals aged 6 years and above in Guangzhou from 2010 to 2023, with the intention that a scientific basis be provided for effective prevention and control measures in older age groups.Methods:Data on HFMD incidence among individuals aged 6 years and above in Guangzhou from 2010 to 2023 were collected and analyzed. Descriptive epidemiological methods were used to analyze the distributions and pathogen components of HFMD cases in Guangzhou residents aged 6 years and above. Spatial autocorrelation analysis and Getis-Ord Gi* analysis were conducted to identify the spatial clustering patterns of HFMD at the street town level. Results:From 2010 to 2023, the gender ratio of HFMD cases in persons aged 6 and above was 1.49∶1 in Guangzhou. The average annual incidence rate of HFMD among individuals aged 6 years and above in Guangzhou was 25.75 per 100 000. Furthermore, the reported incidence rate indicated an increased tendency. The annual incidence showed a bimodal distribution, with the main peak occurring from May to July and the secondary peak from September to October. HFMD incidence rates vary by townships, with hotspots clustered in urban and urban-rural regions. The dominant pathogen shifts from year to year. Enterovirus 71 (EV71) was the prevalent strain in 2010, followed by other enteroviruses and Coxsackievirus (CV)-A16 from 2011 to 2016. Since 2017, CV-A6 has steadily become the major pathogen.Conclusions:The incidence of HFMD cases among individuals aged 6 years and above in Guangzhou increased generally from 2010 to 2023, with hotspots localized in urban and urban-rural areas. The pathogen composition altered dramatically, with the proportion of EV71 dropping overall, while CV-A6 eventually became the dominating strain. Therefore, it is imperative to focus on the prevention and control of HFMD in this age group, especially by strengthening measures in areas with high prevalence.

Objective:To explore the cardioprotective effects of icariin (ICA) against radiation-induced cardiac disease (RICD) in C57BL/6 mice.Methods:A total of 48 female C57BL/6J mice aged 6-8 weeks were randomly divided into three groups: the control group (CON), the irradiation group (IR), and the irradiation combined with icariin group (IR+ ICA), with 16 mice in each group. The IR and IR+ ICA groups received a single cardiac irradiation at a dose of 30 Gy, while the CON group received no radiation treatment. The IR+ ICA group was treated with ICA (70 mg·kg -1·d -1) two weeks before irradiation until the end of the experiment through intragastric administration. In contrast, the CON and IR groups were treated with an equal volume of vehicle solution (0.5% sodium carboxymethyl cellulose, NaCMC) via intragastric administration. The mice′s mental status, food intake, body weight, and survival rates were monitored during the experiment. At two weeks post-irradiation, the venous blood of the mice was collected and serum was separated for the enzyme-linked immunosorbent assays (ELISA) of creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT/TNNT2). At 12 weeks post-irradiation, the cardiac function of the mice was assessed using echocardiography. After the mice were euthanized under anesthesia, the histopathological changes and fibrosis degree of their myocardial tissues were assessed using hematoxylin and eosin (HE) and Masson′s trichrome staining, followed by the calculation of collagen volume fraction (CVF). The differential gene expression of brain natriuretic peptide (BNP), transforming growth factor-β (TGF-β), and interleukin-6 (IL-6) in the cardiac tissues of the mice was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR). Apoptosis-related proteins and proteins associated with the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway were determined using Western blotting. The survival curves of the mice were plotted using Kaplan-Meier, and the survival differences of the mice among various groups were compared using the log-rank test. Results:After irradiation, the mice in the IR group showed lethargy, as well as decreased food intake and activity, while these symptoms in the IR+ ICA group were significantly alleviated. At two weeks post-irradiation, the CK-MB and cTnT levels of the IR group were significantly elevated compared with the CON group ( t = 5.28, 8.89, P < 0.01). At 12 weeks post-irradiation, the mice in the IR group exhibited significantly decreased body weight ( t = 2.47, P < 0.05) and decreased survival rates ( HR = 8.25, 95% CI: 1.157-58.770, P < 0.05) compared with the CON group. Echocardiography revealed that the IR group featured decreased left ventricular ejection fraction (EF), decreased fractional shortening (FS), and increased left ventricular end-diastolic diameter (LVDD) compared with the CON group ( t = 7.02, 4.45, P < 0.05). Histopathological examination revealed that the IR group suffered from cardiomyocyte edema, disordered arrangement, and increased fibrosis, with an elevated CVF. The IR group exhibited significantly upregulated gene expression of BNP, TGF-β, and IL-6 in cardiac tissues compared with the CON group ( t = 4.23, 6.39, 4.61, P < 0.05). After-irradiation, the IR group exhibited upregulated apoptosis-related proteins Cleaved Caspase-3 and Bax ( t = 6.29, 9.54, P < 0.05), decreased Bcl-2 expression ( t = 8.20, P < 0.001), and decreased phosphorylation levels of PI3K and Akt ( t = 6.47, 3.42, P < 0.001). The symptoms of the mice were partially ameliorated after treatment with ICA. Specifically, the mice in the IR+ ICA group exhibited higher body weight ( t = 5.13, P < 0.001) and significantly higher survival rates ( HR = 0.121, 95% CI: 0.017-0.864, P < 0.05) than the IR group. Compared to the IR group, the IR+ ICA group showed elevated cardiac function indicators EF and FS( t = 3.23, 3.05, P < 0.05), and reduced LVDD ( t = 3.02, P < 0.05). The histopathological analysis revealed mitigated edema and disordered arrangement of cardiomyocytes in the IR+ ICA group. Furthermore, the IR+ ICA group exhibited significantly lower BNP, TGF-β, and IL-6 expression levels than the IR group ( t = 2.83, 4.15, 2.96, P < 0.05). The expression of apoptosis-related proteins Cleaved Caspase-3 and Bax was lower ( t = 3.23, 3.24, P < 0.05), Bcl-2 expression was higher ( t = 5.92, P < 0.001), and restored phosphorylation levels of PI3K and Akt ( t = 2.89, 8.35, P < 0.001). Conclusions:Icariin has protective effects against the RICD. It alleviates cardiomyocyte apoptosis possibly by upregulating the phosphorylation levels of PI3K and Akt.

Objective To investigate the values of serum procalcitonin (PCT), anti-thrombin Ⅲ (AT-Ⅲ), D-dimer (D-D), fibrinogen (FIB), thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) in the early diagnosis of pediatric sepsis. Methods A total of 82 children with sepsis in the Pediatric Intensive Care Unit (PICU) of General Hospital of Hunan University of Medicine from June 2020 to June 2023 were selected as sepsis group. Meanwhile, 90 children with respiratory tract infections in the general ward were included in general infection group, and 100 healthy children in the Department of Pediatric Health were selected as control group. The levels of serum PCT, AT-Ⅲ, D-D, FIB, TT, APTT and PT were compared among the three groups. Results Compared with the general infection group and the control group, the sepsis group had significantly higher serum PCT and D-D levels, prolonged TT, APTT and PT in the four-items of coagulation test, and reduced AT-Ⅲ and FIB levels (P < 0.05). The areas under the curve (AUCs) for the diagnosis of pediatric sepsis by serum PCT, AT-Ⅲ, D-D, PT, APTT, TT and FIB levels were 0.949, 0.174, 0.911, 0.869, 0.855, 0.834 and 0.242 respectively; among these indexes, serum PCT showed the highest diagnostic value, with the maximum Youden index at a cut-off value of 0.62 μg/L, and the diagnostic sensitivity and specificity were 86.6% and 79.0% respectively. The AUC for the combined diagnosis of pediatric sepsis by the seven indicators was 0.966. Conclusion The detection of serum PCT, AT-Ⅲ, D-D and four items of coagulation test is of great value in the early diagnosis and differential diagnosis of pediatric sepsis.

Objective:To analyze the characteristics of inhibitory control and cognitive flexibility in hearing-impaired children.Methods:From March to April 2023, a convenience sampling method was used to select 33 hearing-impaired children from a special education school in Meizhou City, Guangdong Province, and 35 normal-hearing children from two ordinary schools as participants. Inhibitory control and cognitive flexibility of the participants were assessed by the Flanker task and the dimensional change card sorting (DCCS) task. Statistical analysis was conducted using SPSS 26.0 software, and independent sample t-test was used to compare the differences in reaction time and accuracy rate between two groups of participants. Results:There were no significant differences in the Flanker task reaction time ((558.39±123.65) ms vs (566.11±118.20) ms) and accuracy rate((0.93±0.10) vs (0.96±0.04))between hearing-impaired children and normal-hearing children ( t=-0.295, -1.645, both P>0.05). The hearing-impaired children had significantly longer reaction time ((1 019.60±131.08) ms)than the normal-hearing children ((857.85±129.19) ms) ( t=4.046, P=0.001) in the DCCS task, while there was no statistically significant difference in the accuracy rate between hearing-impaired children (0.62±0.16) and normal-hearing children (0.57±0.15) ( t=-1.602, P>0.05). Conclusion:There is no difference in inhibitory control ability between hearing-impaired children and normal-hearing children, but the hearing-impaired children have a lag in cognitive flexibility.

Objective To investigate the predictive value of acute ischemic stroke associated pneumonia score (AIS-APS) combined with systemic immune inflammation index (SII) in the early clinical outcome of stroke-associated pneumonia (SAP). Methods A retrospective study method was conducted involving 287 AIS patients who were diagnosed and treated in Zhujiang Hospital,Southern Medical University from January 2022 to December 2023. The patients were divided into SAP group (79 cases) and non-SAP group (208 cases) according to whether SAP occurred. Collect the following data,include the patient's basic information[gender,age,body mass index (BMI),smoking history],previous history[atrial fibrillation,congestive heart failure,chronic obstructive pulmonary disease (COPD),diabetes history],laboratory test results[biochemical indicators:blood glucose,triglycerides (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),glycated hemoglobin (HbA1c) and blood indicators:white blood cell count (WBC),neutrophilic count (NEU),lymphocyte count (LYM),platelet count (PLT)],SII,National Institutes of Health Stroke Scale (NIHSS) score at admission,AIS-APS,the difference of the above indexes between the two groups with different prognosis was compared. The risk factors for SAP were screened by Logistic regression analysis,and the predictive value of AIS-APS and SII for SAP was evaluated by receiver operator characteristic curve (ROC curve). Patients were followed up for 90 days to analyze the association between AIS-APS and SII and early outcomes. Use Pearson correlation analysis to analyze the correlation between SII and AIS-APS risk levels and patient prognosis. Results Compared with non-SAP group,patients with atrial fibrillation,congestive heart failure,COPD and proportion of patients with smoking history and TG,WBC,NEU,SII,NIHSS and AIS-APSY were significantly higher in SAP group[atrial fibrillation:13.92％ (11/79) vs. 7.12％ (15/208),congestive heart failure:32.92％ (26/79) vs. 26.44％ (55/208),COPD:34.17％ (27/79) vs. 24.52％ (51/208),smoking history:15.18％ (12/79) vs. 7.69％ (16/208),TG (mmol/L):1.79 (1.31,2.53) vs. 1.40 (1.03,1.99),WBC (×109/L):8.98 (6.78,9.15) vs. 6.02 (4.29,8.17),NEU (×109/L):5.20 (4.03,7.99) vs. 4.69 (3.31,5.53),SII:1145.9 (895.50,1346.3) vs. 545.80 (385.50,639.10),NIHSS score:6.00 (3.00,11.00) vs. 2.00 (1.00,4.75),AIS-APS:28.02 (14.29,33.17) vs. 22.98 (19.78,28.15),all P<0.05],while LYM was significantly decreased[×109/L:1.13 (0.95,2.25) vs. 1.62 (1.29,2.67),P<0.05]. Logistic regression analysis showed that atrial fibrillation,congestive heart failure,COPD,TG,SII and AIS-APS were all independent risk factors for AIS occurrence of SAP[odds ratio (OR) were 1.258,1.040,1.338,1.583,1.631 and 1.407,respectively,95％ confidence interval (95％CI) were 1.093-1.210,1.006-1.109,1.145-1.274,1.205-1.874,1.504-1.759,and 1.267-1.673,respectively;P values were 0.002,0.045,0.037,0.034,0.010,0.018,respectively]. ROC curve analysis shows:SII,AIS-APS and their combined detection had predictive value for the occurrence of SAP. When SII and AIS-APS were combined,area under the curve (AUC) increased to 0.894,the sensitivity increased to 83.67％,and the specificity increased to 88.65％,P=0.012,which was significantly better than SII and AIS-APS alone. At 90 days of follow-up,SII and AIS-APS risk levels were found to be strongly associated with the prognosis of AIS patients,with higher SII and AIS-APS risk levels predicting poor prognosis. Pearson correlation analysis showed that both SII and AIS-APS risk levels were positively correlated with the prognosis of AIS patients (r values were 0.906 and 0.418,respectively,both P<0.05). Conclusion AIS-APS combined with SII can effectively predict the risk of SAP and is closely related to the early clinical outcomes of patients.

Objective To investigate the predictive value of acute ischemic stroke associated pneumonia score (AIS-APS) combined with systemic immune inflammation index (SII) in the early clinical outcome of stroke-associated pneumonia (SAP). Methods A retrospective study method was conducted involving 287 AIS patients who were diagnosed and treated in Zhujiang Hospital,Southern Medical University from January 2022 to December 2023. The patients were divided into SAP group (79 cases) and non-SAP group (208 cases) according to whether SAP occurred. Collect the following data,include the patient's basic information[gender,age,body mass index (BMI),smoking history],previous history[atrial fibrillation,congestive heart failure,chronic obstructive pulmonary disease (COPD),diabetes history],laboratory test results[biochemical indicators:blood glucose,triglycerides (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),glycated hemoglobin (HbA1c) and blood indicators:white blood cell count (WBC),neutrophilic count (NEU),lymphocyte count (LYM),platelet count (PLT)],SII,National Institutes of Health Stroke Scale (NIHSS) score at admission,AIS-APS,the difference of the above indexes between the two groups with different prognosis was compared. The risk factors for SAP were screened by Logistic regression analysis,and the predictive value of AIS-APS and SII for SAP was evaluated by receiver operator characteristic curve (ROC curve). Patients were followed up for 90 days to analyze the association between AIS-APS and SII and early outcomes. Use Pearson correlation analysis to analyze the correlation between SII and AIS-APS risk levels and patient prognosis. Results Compared with non-SAP group,patients with atrial fibrillation,congestive heart failure,COPD and proportion of patients with smoking history and TG,WBC,NEU,SII,NIHSS and AIS-APSY were significantly higher in SAP group[atrial fibrillation:13.92％ (11/79) vs. 7.12％ (15/208),congestive heart failure:32.92％ (26/79) vs. 26.44％ (55/208),COPD:34.17％ (27/79) vs. 24.52％ (51/208),smoking history:15.18％ (12/79) vs. 7.69％ (16/208),TG (mmol/L):1.79 (1.31,2.53) vs. 1.40 (1.03,1.99),WBC (×109/L):8.98 (6.78,9.15) vs. 6.02 (4.29,8.17),NEU (×109/L):5.20 (4.03,7.99) vs. 4.69 (3.31,5.53),SII:1145.9 (895.50,1346.3) vs. 545.80 (385.50,639.10),NIHSS score:6.00 (3.00,11.00) vs. 2.00 (1.00,4.75),AIS-APS:28.02 (14.29,33.17) vs. 22.98 (19.78,28.15),all P<0.05],while LYM was significantly decreased[×109/L:1.13 (0.95,2.25) vs. 1.62 (1.29,2.67),P<0.05]. Logistic regression analysis showed that atrial fibrillation,congestive heart failure,COPD,TG,SII and AIS-APS were all independent risk factors for AIS occurrence of SAP[odds ratio (OR) were 1.258,1.040,1.338,1.583,1.631 and 1.407,respectively,95％ confidence interval (95％CI) were 1.093-1.210,1.006-1.109,1.145-1.274,1.205-1.874,1.504-1.759,and 1.267-1.673,respectively;P values were 0.002,0.045,0.037,0.034,0.010,0.018,respectively]. ROC curve analysis shows:SII,AIS-APS and their combined detection had predictive value for the occurrence of SAP. When SII and AIS-APS were combined,area under the curve (AUC) increased to 0.894,the sensitivity increased to 83.67％,and the specificity increased to 88.65％,P=0.012,which was significantly better than SII and AIS-APS alone. At 90 days of follow-up,SII and AIS-APS risk levels were found to be strongly associated with the prognosis of AIS patients,with higher SII and AIS-APS risk levels predicting poor prognosis. Pearson correlation analysis showed that both SII and AIS-APS risk levels were positively correlated with the prognosis of AIS patients (r values were 0.906 and 0.418,respectively,both P<0.05). Conclusion AIS-APS combined with SII can effectively predict the risk of SAP and is closely related to the early clinical outcomes of patients.

Objective:To investigate the risk factors for positive margins after endoscopic submucosal dissection (ESD) for early gastric cancer and precancerous lesions, and to follow up the recurrence.Methods:The endoscopic, clinical and pathological data of 489 patients with early gastric cancer or precancerous lesions treated by ESD in Fujian Provincial Hospital from January 2015 to December 2020 were retrospectively collected. They were categorized into a negative group (371 cases), a low-grade intraepithelial neoplasia (LGIN)-positive group (79 cases), and a high-grade intraepithelial neoplasia (HGIN) or cancer-positive group (39 cases) according to the different margins. Logistic regression was used to analyze the risk factors for positive margins, the Kaplan-Meier method and log-rank test to compare the risk of recurrence in different margin groups, and the Cox proportional risk regression model to explore the associated factors that caused recurrence in those with positive margins.Results:In the 489 patients, the positive resection margin rate was 24.1% (118/489), of which HGIN or cancer accounted for 33.1% (39/118). LGIN-positive margin was more likely to occur for lesions larger than 10 cm 2 ( OR=1.58, 95% CI: 1.13-2.08, P=0.033), in the presence of ulcers ( OR=2.92, 95% CI: 1.37-4.54, P=0.012) and for 1-2 years of ESD experience [ OR=1.69 (1-2 years VS 5-6 years), 95% CI: 1.51-1.94, P=0.026]. Those located in the upper 1/3 of the stomach [ OR=3.64 (upper 1/3 VS lower 1/3), 95% CI: 1.27-5.50 P=0.010] and submucosal infiltration (SM1 VS M1+M2: OR=2.37, 95% CI: 1.04-5.72, P=0.028; SM2 VS M1+M2: OR=6.08, 95% CI: 1.31-12.75, P=0.002) were high risk factors for HGIN/cancer-positive margin. Postoperative follow-up was completed in 337 patients, with a median follow-up time of 26.0 (22) months. The overall cumulative recurrence was 5.3% (18/337), 2.1% (5/239) in the negative margin group, 8.3% (6/72) in the LGIN-positive margin group, and 26.9% (7/26) in the HGIN/cancer-positive group, with statistically significant differences among the 3 groups ( P<0.05). Risk factors for recurrence in the positive margin group included positive basal margins ( HR=5.17, 95% CI: 1.47-14.09, P=0.011) and SM1 invasion ( HR=4.82, 95% CI: 1.38-14.77, P=0.013). Conclusion:Positive margins after ESD for early gastric cancer and precancerous lesions are related to lesion location, size, presence of ulceration, depth of infiltration, and endoscopists' experience. The overall risk of recurrence is higher in those with positive margins than in those with negative margins. Additional treatments need to be considered comprehensively for those with submucosal invasion and positive basal margins.