Objective: To investigate the relationship between serum alanine transaminase (ALT) and carotid intima media thickness (cIMT) in adolescents, providing evidence for early prevention and control strategies for cardiovascular structural abnormalities in adolescents. Methods: Data were obtained from the third follow up survey (from October to November 2023) of the "Huantai Children Cardiovascular Health Cohort", including 1 153 healthy adolescents with complete information. Analysis of variance (ANOVA) was used to compare cIMT across different ALT level groups, and multiple linear regression was employed to analyze the relationship between serum ALT levels and cIMT. Results: Significant differences in cIMT were observed among Q 1, Q 2, and Q 3 ALT level groups [(0.56±0.04) (0.57±0.04) (0.59±0.04)mm, respectively; F=3.61, P <0.01]. After adjusting for covariates, multiple linear regression revealed a positive correlation between ALT levels and cIMT ( β=0.18, P <0.01). Gender subgroup analysis showed similar results in males ( β=0.19, P <0.01), but no statistically significant association was found in females ( β=0.07, P = 0.54). Conclusions Elevated serum ALT levels are associated with an increased risk of vascular structural damage in adolescents, especially in boys. Early detection and control of abnormal serum ALT levels can help to reduce early vascular structural damage and further reduce the risk of adverse cardiovascular events.

Objectives:To investigate the efficacy and safety of anlotinib combined with niraparib in treating patients with platinum-resistant ovarian cancer.Methods:Thirty-five patients with pathological confirmed platinum-resistant ovarian cancer who experienced progression after receiving at least two lines of standard treatment were eligible. All of them were treated with anlotinib combined with niraparib between September 2019 and October 2021. The primary endpoint was progression-free survival (PFS). The second endpoints included overall survival, objective response rate (ORR), disease control rate (DCR) and safety. Survival analysis was performed using the Kaplan-Meier method and Log-rank test, and influence factor analysis was performed using Cox proportional risk regression models.Results:The best overall response showed that partial response was observed in 14 patients, stable disease was noted within 13 patients, and progressive disease was found in 8 patients. Therefore, the ORR and DCR of these 35 patients were 40.0% (95% CI:22.9%-57.1%) and 77.1% (95% CI:62.9%-91.4%), respectively. The median follow-up duration was 18.9 months (6.9-32.2). The median PFS was 6.5 months (95% CI:5.35-7.66). Multivariate Cox regression analysis for PFS indicated that age, Eastern Cooperative Oncology Group performance status (ECOG PS) score, International Federation of Gynecology and Obstetrics (FIGO) stage, and BRCA mutation status were independent factors influencing PFS ( P＜0.05). Additionally, the PFS in patients with BRCA mutation who have never received PARP inhibitor treatment was significantly longer than that in patients without BRCA mutation who have been exposed to prior PARPi treatment (15.0 vs 6.0 month, P=0.029). The most common treatment-related adverse reactions were fatigue (85.7%), hematologic toxic (85.7%) and hypertension (74.3%). There were no treatment-related deaths. Conclusion:Anlotinib combined with niraparib shows a promising efficacy and tolerable safety in platinum-resistant ROC patients.

Objective To investigate the molecular mechanism through which calenduloside E inhibits hepatocellular carcinoma(HCC)cell proliferation and migration.Methods HCC cell lines HepG2 and Huh7 treated with calenduloside E were examined for changes in cell viability using CCK-8 assay and expressions of GPX4,SLC7A11,LC3,P62 and phosphorylation of Akt/mTOR using Western blotting.The effects LY294002 and Rapamycin(the inhibitor and activator of autophagy,respectively)on proliferation and migration of calenduloside E-treated HCC cells were evaluated using EdU and Transwell assays.The TCGA database was used to explore the expression levels of GPX4 and SLC7A11 in HCC and normal liver tissues and their correlation with the patients'survival outcomes.GPX4 and SLC7A11 expressions were also detected in HCC cells and normal hepatocytes using RT-qPCR and Western blotting.Results Calenduloside E obviously inhibited the viability of HCC cells.GPX4 and SLC7A11 were highly expressed in HCC tissues and cell lines,and their expression levels were negatively correlated with the patients'survival.In HCC cell lines,calenduloside E significantly inhibited the expressions of GPX4 and SLC7A11 proteins,activated the Akt-mTOR pathway,and enhanced the expression of LC3 II.The inhibitory effect of calenduloside E on GPX4 and SLC7A11 expressions was significantly enhanced by rapamycin but attenuated by LY294002.Inhibiting the autophagy pathway obviously diminished the inhibitory effect of calenduloside E on proliferation and migration of HCC cells,while activating this pathway produced the opposite effect.Conclusion Calenduside E inhibits the proliferation and migration of HCC cells by down-regulating GPX4 and SLC7A11 expression via the autophagy pathway.

Purpose To examine the clinicopathologic,immunohistochemical,and molecular genetic characteristics and differential diagnosis of low-grade oncocytic tumor(LOT)of kidney with CK7 positive and CD117 negative,so as to enhance the understanding of this tumor among pathologists.Methods A total of five cases of renal LOT from the First Affiliated Hospi-tal of Soochow University between December 2016 and February 2023 were included in this analysis.The clinicopathological fea-tures,immunophenotype,genetic characteristics,and prognosis were evaluated using HE staing,immunohistochemical staining,and Sanger sequencing.Additionally,relevant literature was re-viewed to supplement the findings.Results Among the cohort of five patients,four were female and one was male,aged 57-70 years with a median age of 65 years and an average age of 64.8 years.Clinical presentation revealed that only the first case exhibited frequent urination accompanied by intermittent lumba-go,while the remaining cases were asymptomatic and incidental-ly discovered.Imaging studies demonstrated space-occupying le-sions with clear boundaries and even internal echoes on B-ultra-sonography,and patchy low-density shadows in the center with obvious edge enhancement on CT.Grossly,the tumor was nodu-lar,with a maximum diameter ranging from 2.1 to 7.6 cm,and an average diameter of 4.04 cm,with a solid section.Micro-scopically,the boundary of LOT was consistently well-defined,with a thick capsule.The arrangement of tumor cells was ob-served to be both dense and sparse,accompanied by fresh bleed-ing foci and proteinoid secretions.Focal lymphocyte aggrega-tion,hepatic plate like and hepatic sinusoid like structures,thick-walled blood vessels,false nodules of tumor cells,and old hemorrhage were also noted.The tumor cells exhibited uniformi-ty in shape,appearing round or polygonal,with eosinophilic and fine granular cytoplasm.The nuclei were of similar size and shape,appearing round or oval with a clear nuclear membrane.The histological features of the tumor included 2-grade small nu-cleoli,perinuclear halos,binuclear cells,and nuclear shrink-age,but no mitotic figures were detected.The immunophenotyp-ic analysis revealed strongly diffuse expression of CK7 in the tumor cells,while CD117 was negative.The Ki67 proliferation index was low.Sanger sequencing identified mutations in mTORC1 pathway genes in four cases,including three mutations in MTOR and one mutation in RHEB.The patients underwent either local or radical nephrectomy,and were followed up for a period ranging from 2 to 52 months,during which all patients re-mained free of recurrence.Conclusion The low-grade,eosino-philic,and rare renal tumor known as LOT exhibits inert behav-ior.At present,the follow-up results show that complete resec-tion of local operation is sufficient,and the prognosis is good.It is important to distinguish this lesion from other eosinophilic re-nal tumors.

Objective To investigate the molecular mechanism through which calenduloside E inhibits hepatocellular carcinoma(HCC)cell proliferation and migration.Methods HCC cell lines HepG2 and Huh7 treated with calenduloside E were examined for changes in cell viability using CCK-8 assay and expressions of GPX4,SLC7A11,LC3,P62 and phosphorylation of Akt/mTOR using Western blotting.The effects LY294002 and Rapamycin(the inhibitor and activator of autophagy,respectively)on proliferation and migration of calenduloside E-treated HCC cells were evaluated using EdU and Transwell assays.The TCGA database was used to explore the expression levels of GPX4 and SLC7A11 in HCC and normal liver tissues and their correlation with the patients'survival outcomes.GPX4 and SLC7A11 expressions were also detected in HCC cells and normal hepatocytes using RT-qPCR and Western blotting.Results Calenduloside E obviously inhibited the viability of HCC cells.GPX4 and SLC7A11 were highly expressed in HCC tissues and cell lines,and their expression levels were negatively correlated with the patients'survival.In HCC cell lines,calenduloside E significantly inhibited the expressions of GPX4 and SLC7A11 proteins,activated the Akt-mTOR pathway,and enhanced the expression of LC3 II.The inhibitory effect of calenduloside E on GPX4 and SLC7A11 expressions was significantly enhanced by rapamycin but attenuated by LY294002.Inhibiting the autophagy pathway obviously diminished the inhibitory effect of calenduloside E on proliferation and migration of HCC cells,while activating this pathway produced the opposite effect.Conclusion Calenduside E inhibits the proliferation and migration of HCC cells by down-regulating GPX4 and SLC7A11 expression via the autophagy pathway.

Objectives:To investigate the efficacy and safety of anlotinib combined with niraparib in treating patients with platinum-resistant ovarian cancer.Methods:Thirty-five patients with pathological confirmed platinum-resistant ovarian cancer who experienced progression after receiving at least two lines of standard treatment were eligible. All of them were treated with anlotinib combined with niraparib between September 2019 and October 2021. The primary endpoint was progression-free survival (PFS). The second endpoints included overall survival, objective response rate (ORR), disease control rate (DCR) and safety. Survival analysis was performed using the Kaplan-Meier method and Log-rank test, and influence factor analysis was performed using Cox proportional risk regression models.Results:The best overall response showed that partial response was observed in 14 patients, stable disease was noted within 13 patients, and progressive disease was found in 8 patients. Therefore, the ORR and DCR of these 35 patients were 40.0% (95% CI:22.9%-57.1%) and 77.1% (95% CI:62.9%-91.4%), respectively. The median follow-up duration was 18.9 months (6.9-32.2). The median PFS was 6.5 months (95% CI:5.35-7.66). Multivariate Cox regression analysis for PFS indicated that age, Eastern Cooperative Oncology Group performance status (ECOG PS) score, International Federation of Gynecology and Obstetrics (FIGO) stage, and BRCA mutation status were independent factors influencing PFS ( P＜0.05). Additionally, the PFS in patients with BRCA mutation who have never received PARP inhibitor treatment was significantly longer than that in patients without BRCA mutation who have been exposed to prior PARPi treatment (15.0 vs 6.0 month, P=0.029). The most common treatment-related adverse reactions were fatigue (85.7%), hematologic toxic (85.7%) and hypertension (74.3%). There were no treatment-related deaths. Conclusion:Anlotinib combined with niraparib shows a promising efficacy and tolerable safety in platinum-resistant ROC patients.

Based on the domestic and foreign research on the application of self-disclosure in gynecological cancer patients, the relevant concepts, main modes of self-disclosure, measuring tools, research status and influencing factors of self-disclosure in gynecological cancer patients are reviewed. In order to provide a reference for the research on self-disclosure of gynecological cancer population, and promote the development of self-disclosure.

Objective:To review the literature and summarize the clinical characteristics and treatment methods of rectal buttonhole tears associated with vaginal delivery.Methods:Using the keywords "rectal tear and delivery" "rectal laceration and delivery" "rectal lesion and delivery", and "rectal buttonhole tear", we conducted a search for Chinese-language papers published on the Yiigle, CNKI (China National Knowledge Infrastructure), Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform. Additionally, using the same keywords in English, we searched for papers published on PubMed and Embase. The search period covers from the establishment of the databases up to November 15, 2023. Cases with a clear diagnosis of rectal buttonhole tears associated with vaginal delivery were included. Data on maternal age, parity, gestational weeks, neonatal birth weight, time of rectal tear discovery, whether episiotomy was performed, whether instrumental delivery was used, details of the rectal tear, management after discovering the tear, and prognosis were analyzed. Descriptive statistical analysis was used.Results:A total of 30 papers were included, published from 1952 to 2023, encompassing 48 cases of vaginal delivery with rectal buttonhole tears. (1) Age and parity: The median age of patients was 28.0 years (range 21-44 years), with primiparas and multiparas accounting for 72.5% (29/40) and 27.5% (11/40), respectively. (2) Gestational weeks: The median gestational age at delivery was 39.0 weeks (range 36.0-41.0 weeks). (3) Neonatal birth weight: The median birth weight of the neonates was 3 595 g (range 2 320-4 250 g), with four cases of macrosomia (birth weight≥4 000 g), accounting for 9.5% (4/42) of singleton births. (4) Time at identification of rectal buttonhole tear: Rectal tears were discovered before fetal delivery in 26.7% (12/45) of cases and after delivery in 73.3% (33/45) of cases. (5) Location: Rectal buttonhole tears most commonly occurred at the midline of the posterior vaginal wall (65.6%, 21/32), followed by the right side of the episiotomy wound (12.5%, 4/32). (6) Relationship between rectal buttonhole tears and delivery mode: Rectal buttonhole tears can occur in spontaneous vaginal delivery, episiotomy, and instrumental vaginal delivery. They may occur during the first or second stage of labor. (7) Timing of rectal tear suturing and prognosis: 93.4% (45/48) of patients underwent primary rectal suturing, among whom, 93.3% (42/45) had good healing, while 6.7% (3/45) developed rectovaginal fistula postoperatively.Conclusions:Rectal buttonhole tear is a rare complication of vaginal delivery and should be recognized. If identified promptly and repaired with primary suturing, the prognosis is generally favorable.

Objective:To investigate the correlation of LymphGen genotyping with the clinicopathologic characteristics, efficacy and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was conducted. The clinicopathological data and follow-up information of 132 DLBCL patients diagnosed and treated in the First Affiliated Hospital of Soochow University from January 2016 to January 2022 were collected. LymphGen genotyping was made based on the results of second-generation sequencing. The distributions of the main subtypes in the whole group and the stratification of all clinicopathological features were analyzed. The short-term efficacy of patients with different gene subtypes was compared. Survival analysis of patients with different gene subtypes was performed by using the Kaplan-Meier method.Results:Among the 132 patients, 69 were males and 63 were females. The median age was 60 years, with the age ranging from 13 to 87 years. Hans typing: germinal center B cell (GCB) type was detected in 49 cases, non-GCB type was detected in 81 cases, and the remaining 2 cases were unknown. Ann Arbor staging: 31 cases with stage Ⅰ-Ⅱ, 89 cases with stage Ⅲ-Ⅳ, and 9 primary central nervous system lymphoma (PCNSL) cases without stage, and the remaining 3 cases with unknown stage. Among the 132 patients, 64 cases (48.5%) were genotyped with LymphGen, including 6 cases (4.5%) of MCD subtype, 18 cases (13.6%) of A53 subtype, 17 cases (12.9%) of BN2 subtype, 3 cases (2.3%) of EZB subtype, 5 cases (3.8%) of ST2 subtype, and 15 cases (11.4%) of composite subtype, and 68 cases (51.5%) of the other subtypes; N1 subtype was not detected. The differences in the proportion of MCD subtype [5.0% (3/60) vs. 4.2% (3/71)], A53 subtype [16.7% (10/60) vs. 11.3% (8/71)], BN2 subtype [6.7% (4/60) vs. 18.3% (13/71)], EZB subtype [5.0% (3/60) vs. 0 (0/71)], ST2 subtype [5.0% (3/60) vs. 2.8% (2/71)], composite subtype [18.3% (11/60) vs. 5.6% (4/71)], other types [43.3% (26/60) vs. 57.7% (41/71)] were statistically significant between the patients with lactate dehydrogenase (LDH) < 245 U/L and those with LDH ≥245 U/L ( P = 0.023). There were no statistically significant differences in genotype distribution among subgroups with different age, gender, B symptoms, Hans typing, primary site, involvement site, Ann Arbor stage, international prognostic index score/international extranodal lymphoma study group score (all P > 0.05). After 4-6 courses treatment in PCNSL patients and 6-8 courses of standard first-line treatment in non-PCNSL patients, 17 patients with BN2 subtype [including 9 cases of complete remission (CR) and 4 cases of partial remission (PR)] and 3 patients with EZB subtype (including 2 cases of CR) had the higher proportion of those achieving good treatment outcomes. However, 15 patients with the composite subtype showed the worst outcomes including 5 cases of CR, 4 cases of PR, 1 case of stable disease, 3 cases of disease progression, and 2 death cases. The CR rates of the composite subtype group, non-composite subtype group, and other groups were 33.3% (5/15), 44.9% (22/49), and 66.2% (45/68), respectively; and the difference among these groups was statistically significant ( P = 0.034). The CR rate of composite type patients with BN2 subtype was higher compared to composite subtype patients without BN2 subtype (5/8 vs. 0/7), and the difference was statistically significant ( P = 0.023); 7 patients with A53 subtype combined with other subtypes except BN2 subtype did not achieve CR; 2 cases had PR, 3 cases had disease progression and 2 cases died. The median follow-up time was 26 months (ranging from 1 to 86 months) until the last follow-up in March 2023. There were no statistically significant differences in overall survival and progression-free survival among patients with different gene subtypes (all P > 0.05). Conclusions:The distribution of gene subtypes in DLBCL patients may be correlated with LDH levels. Patients with different gene subtypes show variations in short-term efficacy. The composite type patients with A53 subtype and without BN2 subtype have poor treatment outcomes, but no differences in overall survival and progression-free survival of patients with different gene subtypes are observed.

OBJECTIVE To construct a comprehensive evaluation index system for anti-lung cancer drugs， and to provide a basis for drug selection and rational clinical use. METHODS Based on the Guidelines for the Management of Comprehensive Clinical Evaluation of Drugs （2021 edition for trial use）， a preliminary evaluation index system framework and an index preselection pool were initially formulated through literature analysis. The evaluation indices were then selected and modified by using the Delphi method. The weights of each index were determined through expert scoring and relevant calculations， thereby establishing a comprehensive evaluation index system for anti-lung cancer drugs. Referred to Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions， scoring detailed rules for clinical comprehensive evaluation indexes of anti-lung cancer drugs were formulated. The constructed comprehensive evaluation index system and scoring detailed rules were applied to conduct empirical evaluation of the anti-lung cancer drug pembrolizumab. RESULTS The constructed comprehensive evaluation index system for anti-lung cancer drugs included 6 primary indicators and 15 secondary indicators. The weights of the primary indicators were as follows： safety （18）， efficacy （38）， economy （15）， innovation （9）， suitability （10）， and accessibility （10）. The scoring detailed rules for the comprehensive evaluation index system for anti-lung cancer drugs had been preliminarily established. The results of empirical evaluation showed that the comprehensive evaluation score （61 points） of pembrolizumab combined with chemotherapy regimen was higher than that of the monotherapy chemotherapy regimen （56 points）. The former demonstrated superior efficacy， innovation and suitability compared to the latter， while the latter exhibited better safety and economy. CONCLUSIONS The constructed comprehensive evaluation index system for anti-lung cancer drugs has the potential for generalizability and practical application， providing a reference basis for rational clinical drug use.