Objective:To predict the 3-year cancer-specific survival(CSS)of patients with non-meta-static T3a renal cell carcinoma after surgery.Methods:A total of 336 patients with pathologically con-firmed T3a N0-1M0 renal cell carcinoma(RCC)who underwent surgical treatment at the Department of Urology,Peking University Third Hospital from March 2013 to February 2021 were retrospectively collect-ed.The patients were randomly divided into a training cohort of 268 cases and an internal validation co-hort of 68 cases at an 4∶1 ratio.Using two-way Lasso regression,variables were selected to construct a nomogram for predicting the 3-year cancer-specific survival(CSS)of the patients with T3aN0-1M0 RCC.Performance assessment of the nomogram included evaluation of discrimination and calibration ability,as well as clinical utility using measures such as the concordance index(C-index),time-dependent area un-der the receiver operating characteristic curve[time-dependent area under the curve(AUC)],calibra-tion curve,and decision curve analysis(DCA).Risk stratification was determined based on the nomo-gram scores,and Kaplan-Meier survival analysis and Log-rank tests were employed to compare progres-sion-free survival(PFS)and cancer-specific survival(CSS)among the patients in the different risk groups.Results:Based on the Lasso regression screening results,the nomogram was constructed with five variables:tumor maximum diameter,histological grading,sarcomatoid differentiation,T3a feature,and lymph node metastasis.The baseline data of the training and validation sets showed no statistical differences(P＞0.05).The consistency indices of the column diagram were found to be 0.808(0.708-0.907)and 0.903(0.838-0.969)for the training and internal validation sets,respectively.The AUC values for 3-year cancer-specific survival were 0.843(0.725-0.961)and 0.923(0.844-1.002)for the two sets.Calibration curves of both sets demonstrated a high level of consistency between the actual CSS and predicted probability.The decision curve analysis(DCA)curves indicated that the column dia-gram had a favorable net benefit in clinical practice.A total of 336 patients were included in the study,with 35 cancer-specific deaths and 69 postoperative recurrences.According to the line chart,the patients were divided into low-risk group(scoring 0-117)and high-risk group(scoring 119-284).Within the low-risk group,there were 16 tumor-specific deaths out of 282 cases and 36 postoperative recurrences out of 282 cases.In the high-risk group,there were 19 tumor-specific deaths out of 54 cases and 33 post-operative recurrences out of 54 cases.There were significant differences in progression-free survival(PFS)and cancer-specific survival(CSS)between the low-risk and high-risk groups(P＜0.000 1).Conclusion:A nomogram model predicting the 3-year CSS of non-metastatic T3a renal cell carcinoma patients was successfully constructed and validated in this study.This nomogram can assist clinicians in accurately assessing the long-term prognosis of such patients.

Objective:To understand the relationship between lipid accumulation product (LAP) and hyperuricemia in physical examination population.Methods:This was a cross-sectional study. The analysis was based on baseline data from a retrospective cohort study. Total of 44 294 people who received physical examination in the Health Management Center of Xiangya Hospital of Central South University from January to December 2012 were selected as subjects with whole-group sampling method. All the subjects aged ≥18 years with complete study variables. The minimum waist circumference of the subjects was calculated to determine the criteria for calculating LAP in those population. With LAP as the observed variable and hyperuricemia as the outcome variable, LAP was divided into four groups according to the interquartile interval (Q 1-Q 4 groups): group Q 1<10.56 cm·mmol/L, 10.56 cm·mmol/L≤Q 2<20.79 cm·mmol/L, 20.79 cm·mmol/L≤Q 3<38.94 cm·mmol/L, Q 4≥38.94 cm·mmol/L. Five models were constructed with logistic regression analysis. No confounding factors was adjusted in Model 1, model 2 was adjusted for age and gender; and model 3 was further adjusted for body mass index, hypertension, hyperlipidemia, creatinine and glomerular filtration rate; model 4 was further adjusted education level, occupation, health insurance, smoking, drinking, diet scores and physical exercise; model 5 was further adjusted the family history of gout, diabetes and hypertension. And the relationship between different LAP levels and hyperuricemia was analyzed. Results:In this study, the minimum waist circumference in the physical examination population was 58 cm and 53 cm for men and women, respectively. The total incidence of hyperuricemia was 13.4% in this population, 5.94% for women and 19.40% for men. When the confounding factors were not adjusted (model 1), the risk of hyperuricemia in women′s LAP Q 2 to Q 4 groups was 1.76 times (95% CI: 1.42-2.17), 5.08 times (95% CI: 4.20-6.14) and 12.58 times (95% CI: 10.43-15.18), and it was 1.68 times (95% CI: 1.43-1.96), 2.74 times (95% CI: 2.36-3.18), and 5.32 times (95% CI: 4.62-6.14) in men, respectively. After gender stratification and adjustment for confounding factors (model 5), the risk still existed, compared with that in Q 1 group of LAP, the risk of hyperuricemia in women in Q 4 group was 8.28 times higher (95% CI: 2.50-27.38) and 3.31 times higher in men (95% CI: 1.57-6.95). Conclusion:The risk of hyperuricemia in health examination population increases with LAP, especially in women.

Objective:To investigate the relationship between cardiometabolic index (CMI) and hyperuricemia (HUA) in the health examination population.Methods:It was a cross-sectional study. A total of 21 720 individuals who received health examinations in Xiangya hospital, Central South University between 2020 and 2021 were recruited in this study. Multivariate logistic regression analysis was used to determine the independent correlation between CMI and HUA, and stratified analysis was applied to check whether there were population differences. Then the predictive value of CMI for hyperuricemia in the health examination population was evaluated with the area under the receiver operator characteristic (ROC) curve.Results:Among the 21 720 subjects, 4 418 (20.34%) were detected with HUA. In the HUA group, the body mass index (BMI), waist-to-hip ratio, CMI, total cholesterol, triglyceride, systolic blood pressure, diastolic blood pressure, fasting blood glucose, 2-hour postprandial blood glucose, and blood creatinine levels were all significantly higher than those in the normal uric acid group, while high-density lipoprotein and epidermal growth factor receptor (eGFR) were significantly lower (all P<0.05). Multiple logistic regression analysis showed that after adjusting for relevant factors, CMI was significantly positively correlated with HUA ( OR=1.16, 95% CI: 1.129-1.192); and with the increase of CMI, the risk of HUA increased gradually. Stratified analysis and interaction test according to gender, age, BMI, hypertension, abnormal blood glucose and glomerular filtration rate indicated that CMI was positively associated with the occurrence of HUA in all populations. Compared with that in people with abnormal blood glucose, the correlation between CMI and HUA was more obvious in people with normal blood glucose. The area under the ROC curve (AUC) for CMI to predict HUA was 0.723(95% CI: 0.715-0.731), with a specificity of 0.636 and a sensitivity of 0.698, and the cut-point was 0.693. Conclusion:There was a significant positive correlation between CMI and HUA in the health examination population, which has good predictive value for HUA.

OBJECTIVE To investigate the role of clinical pharmacists in the treatment of a patient with Epstein-Barr （EB） virus encephalitis. METHODS Clinical pharmacist participated in drug diagnosis and therapy for a patient with EB virus encephalitis. According to the physiological characteristics of the disease and the pharmacokinetic-pharmacodynamic characteristics of antibiotics， clinical pharmacists suggested that the dose should be adjusted as ceftriaxone 2 g， q12 h+meropenem 2 g， q8 h. Based on the uncontrolled infection of the patient， pharmacists suggested that ceftriaxone should be stopped and vancomycin 1 million U and q12 h should be used as alternative therapy. According to the results of etiology， pharmacists suggested that acyclovir should be discontinued and replaced with ganciclovir 5 mg/kg， q12 h. The electrolyte disturbance of the patient may be adverse drug reactions caused by Mannitol injection， it was recommended to stop the drug. RESULTS The clinician followed the advice of the clinical pharmacists. After treatment， the patient improved and was discharged. CONCLUSIONS Clinical pharmacists can carry out pharmaceutical care for patients with EB virus encephalitis， assist physicians in optimizing the treatment plan of patients， and ensure the effectiveness and safety of drug treatment.

Objective:To investigate the clinicopathological characteristics and prognosis of pT 3a stage non-clear cell renal cell carcinoma (nccRCC). Methods:The clinical data of 438 patients with pT 3a stage renal cell carcinoma treated by surgery at Peking University Third Hospital from March 2013 to March 2023 were retrospectively analyzed. Among them, there were 58 cases in the nccRCC group and 380 cases in the clear cell RCC (ccRCC) group. There were statistically significant differences in age, American Society of Anesthesiologists (ASA) classification, and comorbidities between the two groups (all P<0.05). Therefore, propensity score matching was used to adjust the baseline data of the two groups. After matching, there were 58 cases in the nccRCC group and 232 cases in the ccRCC group. There were no statistically significant differences in gender (male/female: 34/24 cases and 165/67 cases), age (53.3±16.8 years and 56.6±11.6 years), ASA classification (1/2/3/4: 19/34/5/0 cases and 60/163/8/1 cases), comorbidities (present/absent: 16/42 cases and 76/156 cases), tumor maximum diameter [6.7 (5.3, 8.4) cm and 5.8 (4.6, 7.8) cm], and nephron sparing surgery(yes/no: 4/54 cases and 15/217 cases) (all P > 0.05). The overall survival (OS) and progression-free survival (PFS) of two groups were compared, the Kaplan-Meier method was employed to plot survival curves. Cox proportional hazards regression model was used to analyze the relationship between different pT 3a characteristics in the nccRCC group and progression-free survival. Results:In the matched cohort, the median follow-up time for the nccRCC group and ccRCC group were 28.0 (16.3, 45.3) months and 31.0 (18.0, 57.0) months, respectively. The pathological types in the nccRCC group included chromophobe renal cell carcinoma (20 cases, 34.5%), papillary renal cell carcinoma (20 cases, 34.5%), Xp11.2 translocation renal cell carcinoma (8 cases, 13.8%), mucinous tubular and spindle cell carcinoma (3 cases, 5.2%), and other or unclassified renal cell carcinoma (7 cases, 12.1%). There was no statistical significance between the nccRCC and ccRCC groups in terms of invasion of the renal vein without involvement of the vein wall (yes/no: 5/53 cases and 41/191 cases), vascular invasion (yes/no: 18/40 cases and 52/180 cases), invasion of the perirenal fat (yes/no: 15/43 cases and 39/193 cases), invasion of the renal pelvis and sinus (yes/no: 51/7 cases and 200/32 cases), or sarcomatoid differentiation (yes/no: 2/56 cases and 4/228 cases)(all P > 0.05). However, there was a statistically significant difference in lymph node involvement (yes/no: 3/229 cases and 9/49 cases, P < 0.01). The 5-year PFS and OS of nccRCC group were 67% (95% CI 52%-86%) and 70% (95% CI 55%-89%) respectively. While the 5-year PFS and OS of ccRCC group were 78% (95% CI 70%-86%) and 87% (95% CI 81%-93%) respectively. There was no statistically significant difference in PFS between the two groups ( P>0.05), but there was a statistically significant difference in OS ( P<0.01). Furthermore, within specific pathological types, the 5-year PFS and OS rates of chromophobe renal cell carcinoma were 88% (95% CI 67%-100%) and 86% (95% CI 63%-100%) respectively, followed by papillary renal cell carcinoma with 5-year PFS of 55% (95% CI 33%-91%) and 5-year OS of 65% (95% CI 44%-97%), and Xp11.2 translocation renal cell carcinoma with 5-year PFS of 38% (95% CI 9%-100%) and 5-year OS of 43% (95% CI 10%-100%). The difference in PFS and OS between ccRCC, chromophobe renal cell carcinoma, papillary renal cell carcinoma, and Xp11.2 translocation renal cell carcinoma was statistically significant ( P<0.01). In addition, the multivariate Cox regression analysis revealed that the independent risk factor for PFS in nccRCC patients is the invasion of the renal vein without venous wall involvement ( HR = 8.0, 95% CI 1.8-36.2, P<0.01). Conculsions:Compared to ccRCC, pT 3a nccRCC is more prone to lymph node metastasis. Among them, papillary renal cell carcinoma and Xp11.2 translocation renal cell carcinoma have a poorer prognosis, resulting in an overall lower survival period for pT 3a nccRCC patients. Among different pT 3a characteristics, invasion of the renal vein without invading the vein wall is an independent risk factor for PFS in nccRCC patients.

Objective:To investigate the relationship between advanced glycation end products (AGEs) in the lens and type 2 diabetes mellitus.Methods:226 subjects were recruited between August 14 to September 14, 2018 from the Endocrinology Department of Central South University Xiangya Hospital, the Third Hospital of Changsha City, and the Fourth Hospital of Changsha City. The OGTT test, combined with clinical indicators, were used as the gold standard. Subjects were screened for type 2 diabetes using both the lens AGE fluorescence assay and the gold standard. Drawing the receiver operating characteristic (ROC) curve, we calculated the area under the curve (AUC) and its 95% CI and calculated the AGE for the diagnosis of type 2 diabetes. Sensitivity, specificity, Youden index, Kappa value, and its 95% CI, and the optimal cut-off value were determined according to the Youden index. Taking diabetes as the outcome indicator and AGE as the binary indicator, three logistic regression models were constructed. Stratified by age and sub-center, the differences between fasting blood glucose and 2 h postprandial blood glucose were compared between the AGE-negative and AGE-positive groups to determine the relationship between AGE and diabetes. Results:The area under the ROC curve was 0.86(95% CI: 0.81-0.91). According to the Youden index, the optimal cut-off point for AGE was 0.24. At this time, the sensitivity was 82.86(95% CI: 77.81-87.91), the specificity was 77.06(95% CI: 71.43-82.7), the Youden index was 59.92(95% CI: 53.36-66.49), the Kappa value was 79.62(95% CI: 74.22-85.02). Except for the 20-39-year-old group, the fasting blood glucose and 2 h postprandial blood glucose of the AGE-positive group in different age groups, different sub-centers, and the general population were higher than those of the AGE-negative group (all P<0.05). After adjusting for the confounding effects of age, gender, and sub-center (model 3), the relative risk of diabetes in the AGE-positive group was 11.75 times higher than the AGE-negative group (95% CI: 5.61-24.60), all with P<0.001. Conclusion:There was a high correlation between AGE in the lens and the risk of type 2 diabetes. When the cut-off point of AGE is 0.24, it had high sensitivity and specificity and could be used as a practical tool for early screening of type 2 diabetes.

Objective:To investigate the correlation between hyperuricemia and hypertension in hospital employees.Methods:A cohort was constructed from staff participating health checkups at the Xiangya Hospital of Central South University, baseline health examinations and questionnaires were conducted from February 1, 2011, to January 29, 2012; 502 participants were excluded according to the nadir criteria, and 3 525 participants were followed-up from February 1, 2012, to December 31, 2018, according to the results of annual employee checkups. The participants were divided into the normal uric acid (3 232 cases) and hyperuricemia groups (293 cases) according to the baseline examination results. The presence of hyperuricemia was used as an observation index and occurrence of hypertension within 7 years was used as an outcome indicator. Age, sex, body mass index, creatinine, LDL cholesterol, triacylglycerol, HDL cholesterol, fasting glucose, marriage, education, job position, smoking, alcohol consumption, and exercise status were used as confounding factors to construct five Cox regression models and calculate their HR values, adjusted HR values, and 95% CI to analyze the relationship between hyperuricemia and the occurrence of hypertension in the overall population and female and male populations. Results:The follow-up of the study participants was conducted for a period of (6.19±1.25) years, with a total of 21 831 person-years of follow-up. The 7-year cumulative prevalence of hypertension was 16.5% in the total population, 12.5% in the female population, 30.1% in the male population, 14.1% in the normal uric acid group, and 42.0% in the hyperuricemia group. The prevalence density of hypertension was 26.6, 19.6, 53.8, and 22.4 per 1 000 person-years in the total, female, male, and normouricemic groups, respectively. Without adjusting for any confounding variables, the risk of hypertension was higher in the total population, female population, and male population in the hyperuricemia group than in the normal uric acid group [ HR=3.86, 5.69, 1.60, (95% CI: 3.17-4.72, 4.36-7.43, 1.18-2.16)] (all P<0.05); after gradually adjusting for confounders, this correlation was only manifested in the female population [adjusted HR=1.91 (95% CI: 1.08-3.36)] (all P<0.05), and the difference was not statistically significant in the male population ( P>0.05). Conclusion:Among female hospital employees, hyperuricemia is an independent risk factor for the development of hypertension.

Anterior mediastinal inflammatory myofibroblastoma is a rare tumor with insidious onset and easy misdiagnosis. In this report, we presented a case of anterior mediastinal inflammatory myofibroblastoma with thymoma. The mediastinal tumor was found by physical examination, and the prognosis was good after surgical treatment. For this disease, operation is an effective method for definite diagnosis and treatment, and complete excision can achieve good outcomes.

BACKGROUND: Osteoporosis (OP) has become a major public health issue, threatening the bone health of middle-aged and elderly people from all around the world. Changes in the gut microbiota (GM) are correlated with the maintenance of bone mass and bone quality. However, research results in this field remain highly controversial, and no systematic review or meta-analysis of the relationship between GM and OP has been conducted. This paper addresses this shortcoming, focusing on the difference in the GM abundance between OP patients and healthy controls based on previous 16S ribosomal RNA (rRNA) gene sequencing results, in order to provide new clinical reference information for future customized prevention and treatment options of OP. METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we comprehensively searched the databases of PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI). In addition, we applied the R programming language version 4.0.3 and Stata 15.1 software for data analysis. We also implemented the Newcastle-Ottawa Scale (NOS), funnel plot analysis, sensitivity analysis, Egger's test, and Begg's test to assess the risk of bias. RESULTS: This research ultimately considered 12 studies, which included the fecal GM data of 2033 people (604 with OP and 1429 healthy controls). In the included research papers, it was observed that the relative abundance of Lactobacillus and Ruminococcus increased in the OP group, while the relative abundance for Bacteroides of Bacteroidetes increased (except for Ireland). Meanwhile, Firmicutes, Blautia, Alistipes, Megamonas, and Anaerostipes showed reduced relative abundance in Chinese studies. In the linear discriminant analysis Effect Size (LEfSe) analysis, certain bacteria showed statistically significant results consistently across different studies. CONCLUSIONS: This observational meta-analysis revealed that changes in the GM were correlated with OP, and variations in some advantageous GM might involve regional differences.
Middle Aged ; Aged ; Humans ; Gastrointestinal Microbiome/genetics* ; RNA, Ribosomal, 16S/genetics* ; Genes, rRNA ; Osteoporosis ; Feces

Objective:To investigate the relationship between waist circumference and hyperuricemia in occupational population in Changsha city.Methods:Based on a retrospective cohort design, a total of 1 197 employees from 70 organizations who received 4 or more years of continuous physical examinations in Xiangya hospital from January 1, 2014 to December 31, 2018 were included in this study. The physical examination data of the year 2014 were set as baseline data, while the data between January 1, 2015 and December 31, 2018 were used as follow-up data. According to interquartile range of the waist circumference, the subjects was divided into four groups: the first quartile ( Q1),<77 cm for men and <68 cm for women; the second quartile ( Q2), 77 cm ≤ and<82 cm for men, 68 cm ≤ and <73 cm for women; the third quartile ( Q3), 82 cm ≤ and <87 cm for men, 73 cm ≤and <78 cm for women; the fourth quartile ( Q4), ≥87 cm for men, ≥78 cm for women. Among them, Q1 was set as the control group, and Q2, Q3 and Q4 as the exposed groups. Three models were established for the total population, men and women, respectively. The confounding factors were not adjusted in model Ⅰ. The model Ⅱ was adjusted for age, gender and body mass index (the male or female population were not adjusted for sex). Confounders including age, gender, body mass index, hypertension, fasting glucose, blood creatinine, triacylglycerol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were adjusted for model Ⅲ. Cox regression analysis was used to compare the hazard ratio ( HR), adjusted hazardratio (a HR) and their 95% CIs for the development of hyperuricemia in the subjects with different waist circumference over the 4 years. Results:Total of 1 197 subjects were followed-up for (2.05±1.18) years and 2 448 person-years. A total of 208 cases of hyperuricemia were identified in the total population during the 4 years (45 women/163 men), with a cumulative incidence of 17.4% (6.4% in women/33.3% in men) and an incidence density of 84.9/1 000 person-years (31.8/1 000 person-years in women, 157.6/1 000 person-years in men). And 626, 609, 629, and 584 person-years were followed-up in the 4 groups, respectively; with 15, 30, 59, and 104 cases of hyperuricemia occurred during 4 years, respectively. The cumulative incidence rates of hyperuricemia in the 4 yearswas 5.5%, 9.2%, 20.8% and 32.8%, respectively; and the incidence densities was 24.0/1 000 person-years, 49.3/1 000 person-years, 93.8/1 000 person-years and 178.1/1 000 person-years, respectively. Compared with that in the Q1 group, the risk of hyperuricemia was increased in the Q4 group, with a HR (95% CI) of 2.70 (1.81 to 4.04), P<0.05. After adjusted for confounding factors in the total population, the a HR (95% CI) of hyperuricemia was 2.12 (1.39 to 3.24), P<0.05. This risk remained when stratified by gender and adjusted for confounding factors. Compared with the Q1 group, the a HR (95% CI) of hyperuricemia in the Q4 group was 1.91 (1.18 to 3.09) for the male population and 2.93 (1.14 to 7.56) for the female population, respectively (both P<0.05). Conclusion:Among the occupational population, the risk of hyperuricemia increases with increase of waist circumference.