Objective:To investigate the clinicopathological features including immunophenotype, molecular characteristics, differential diagnosis and prognosis of SMARCB1-deficient renal medullary carcinoma (RMC) without sickle cell trait.Methods:The clinicopathological data of 12 cases of SMARCB1-deficient RMC without sickle cell trait were collected from 7 domestic institutions during the period of 2015 to 2024. Their clinical characteristics, morphological features and immunohistochemical properties were observed and analyzed. High-throughput DNA-targeted next-generation sequencing was performed, and follow-up data were gathered along with relevant literature review.Results:Among the 12 patients, 5 were female and 7 were male. The patients age ranged from 27 to 84 years with a median age of 58.5 (46.0, 71.0) years. None of them had sickle cell disease or other hemoglobinopathies. Eight cases occurred in the left kidney and 4 cases were located in the right kidney. The average maximum diameter of the tumor was 6.1 (4.0,7.5) cm, with a range of 2.0 to 14.9 cm (the median maximum diameter 5.5 cm). Histologically, the tumors showed poorly differentiated adenocarcinoma, arranged in solid and tubular patterns. Papillary structure was noted in 5 cases, cribriform structure in 3 cases, rhabdoid differentiation in 3 cases, and sarcomatoid differentiation in 2 cases. Inflammatory desmoplastic stromal reaction was observed in 8 cases, among which stromal myxoid degeneration was seen in 6 cases. Tumor necrosis was apparent in 6 cases. The tumor cells had abundant eosinophilic or clear cytoplasm and prominent nucleoli. The nuclear grading was grade 3 or 4 according to the International Society of Urological Pathology (ISUP). Immunohistochemical staining showed that the tumor cells of all 12 cases expressed PAX8 and loss of SMARCB1/INI1 protein expression, and 5 of 10 cases expressed OCT3/4. Seven samples had valid archived paraffin tissues for high-throughput DNA-targeted next-generation sequencing. The results showed that all 7 cases had pathogenic mutations in the SMARCB1 gene. The mutation sites included exon5 c.595A>T (p.K199*), exon2 c.200_207del (p.S67*), exon2 p.G69VfsTer16, exon7 c.986G>T (p.S329I), exon7 c.886A>T (p.K296*), exon6 c.635T>A (p.L212*), exon5 c.577del (p.M193Wfs16), and exon6 c.784del (p.V262Sfs5). Follow-up data were obtained for 6 of 12 patients. Among them, 1 patient had lung and bone metastases, 1 patient had liver and bone metastases and 1 patient had multiple bone metastases at the time of diagnosis; 1 patient had bone metastases 5 months after surgery. One patient died of postoperative complications 10 days after surgery, 4 patients died of tumors (the survival time ranged from 4 to 8 months), and 1 patient had no recurrence or metastasis during the 8-month follow-up after surgery.Conclusions:SMARCB1-deficient RMC without sickle cell trait is a highly aggressive and poorly differentiated renal cell carcinoma. It has similar histomorphology, immunophenotype, molecular characteristics and prognosis to RMC, which further supports that it is a sporadic subtype of RMC related to sickle cell trait.

Objective:To construct a scoring system for the main examination report of health examination and evaluate its effect.Methods:A historical control study design was used in this study. By sorting out the problems in 321 main examination reports from December 2023 by equal proportion random sampling method, the quality control plan of main examination report of 2024 was formulated and the "Quality Control Rating Table of Checkup Summary Report" was constructed, which included the principle of conclusion words, classification, sorting, dynamic comparison, disease analysis, health guidance, consistency, completeness, language expression, timeliness and physician. Each principle had its corresponding scoring standard, with a total score of 100 points, 91-100 classified as grade A, 61-90 classified as grade B, and≤60 classified as grade C. According to the "Quality Control Rating Table of Checkup Summary Report", 1 691 main examin reports from January to June 2024 were selected for analysis. In addition, the differences of those reports were analyzed according to categories of primary examination physicians in internal medicine and subspecialties.Results:Compared with December 2023, the proportion of grade A report in June 2024 increased by 111.3% ( χ2=133.38, P<0.001), while the proportion of grade B and C reports decreased by 84.7% ( χ2=61.82, P<0.001) and 97.6% ( χ2=42.36, P<0.001), respectively. In terms of scoring principles, compared with December 2023, the error rates of conclusion words, disease analysis, health guidance and consistency in June 2024 were improved by 54.9%, 46.7%, 62.9% and 100.0%, respectively ( χ2=27.68, 13.41, 48.34 and 7.84, all P<0.001). Additionally, compared with 2023, the total scores of the checkup summary reports of internal medicine and subspecialties in 2024 were increased by 6.8% ( t=-6.843, P<0.001) and 12.6% ( t=-5.321, P<0.001), respectively. Conclusion:The scoring system constructed through the"Quality Control Rating Table of Checkup Summary Report"is scientific, reasonable and practical, which can effectively improve the quality of the main examination report and has strong operability.

Objective:To explore the application effect of double-check standard process for ultrasound reports in health examinations.Method:A historical control study design was used in this study. A total of 11 909 health examination ultrasound reports from the Health Center of the First Affiliated Hospital of Zhengzhou University from February to April in 2021 were selected by systematic sampling method, the double-check standard process was adopted in those reports. The existing problems were categorized, organized and analyzed, and relevant measures for continuous quality improvement were formulated. Then, 13 939 and 15 833 health examination ultrasound reports from February to April in 2022 and 2023 respectively were selected for effect analysis.Results:Compared with those in February to April in 2021, the overall (double-check), initial check and secondary check ultrasound report accuracy rates in February to April in 2023 increased by 5.73%, 3.07% and 1.99%, respectively ( χ2=132.58, 46.80, 127.44, all P<0.001). In terms of trend changes, from February to April 2021 to February to April 2023, the error rates of the following five issues all showed a declining trend: misspellings, inconsistencies between descriptions and conclusion, need for doctor′s signature on the report, missing images, and errors in thyroid/breast color Doppler grading ( χ2=98.93, 30.13/14.59, 3.98, 14.6, all P<0.05). The error rate of ultrasound reports after continuous quality improvement was significantly lower than before. Conclusion:The double-check standard process for ultrasound reports in health examinations can effectively improve the quality of health examination ultrasound reports.

Objective:To evaluate the association between triglyceride-glucose(TyG) index level, their variability, and the risk of incident hyperuricemia(HUA).Methods:A total of 1 583 cases with good compliance who underwent follow-up at the health examination center of a tertiary hospital physical in Zhengzhou were enrolled. The TyG index mean(TyG-mean) and variability indexes, including standard deviation(TyG-SD), coefficient of variation(TyG-CV), and adjusted standard deviation(adj-TyG-SD), were calculated based on TyG index values from three consecutive annual health check-ups. Cox proportional risk regression model was used to assess the relationship between the variability of TyG index and the risk of new-onset HUA; the dose-response relationship between different TyG indexes and HUA was examined using restricted cubic spline(RCS). Results:After a 3-year follow-up, 146 participants developed incident HUA. Both TyG-mean and TyG index variability indicators were significantly higher in the HUA group compared to the non-HUA group( P<0.05). After adjusting for multiple confounders, each standard deviation σincrease in TyG-SD, TyG-CV, and adj-TyG-SD was associated with a 1.23-fold(95% CI 1.06-1.43), 1.22-fold(95% CI 1.05-1.42), and 1.26-fold(95% CI 1.08-1.45) higher risk of incident HUA, respectively. RCS analysis revealed a nonlinear association between adj-TyG-SD and HUA risk( P<0.05), with a critical threshold of 0.55 at a hazard ratio( HR) of 1. Conclusions:Increased TyG index variability is associated with a higher risk of incident HUA, with adj-TyG-SD showing the strongest correlation with HUA risk.

Objective:To investigate the clinicopathological features including immunophenotype, molecular characteristics, differential diagnosis and prognosis of SMARCB1-deficient renal medullary carcinoma (RMC) without sickle cell trait.Methods:The clinicopathological data of 12 cases of SMARCB1-deficient RMC without sickle cell trait were collected from 7 domestic institutions during the period of 2015 to 2024. Their clinical characteristics, morphological features and immunohistochemical properties were observed and analyzed. High-throughput DNA-targeted next-generation sequencing was performed, and follow-up data were gathered along with relevant literature review.Results:Among the 12 patients, 5 were female and 7 were male. The patients age ranged from 27 to 84 years with a median age of 58.5 (46.0, 71.0) years. None of them had sickle cell disease or other hemoglobinopathies. Eight cases occurred in the left kidney and 4 cases were located in the right kidney. The average maximum diameter of the tumor was 6.1 (4.0,7.5) cm, with a range of 2.0 to 14.9 cm (the median maximum diameter 5.5 cm). Histologically, the tumors showed poorly differentiated adenocarcinoma, arranged in solid and tubular patterns. Papillary structure was noted in 5 cases, cribriform structure in 3 cases, rhabdoid differentiation in 3 cases, and sarcomatoid differentiation in 2 cases. Inflammatory desmoplastic stromal reaction was observed in 8 cases, among which stromal myxoid degeneration was seen in 6 cases. Tumor necrosis was apparent in 6 cases. The tumor cells had abundant eosinophilic or clear cytoplasm and prominent nucleoli. The nuclear grading was grade 3 or 4 according to the International Society of Urological Pathology (ISUP). Immunohistochemical staining showed that the tumor cells of all 12 cases expressed PAX8 and loss of SMARCB1/INI1 protein expression, and 5 of 10 cases expressed OCT3/4. Seven samples had valid archived paraffin tissues for high-throughput DNA-targeted next-generation sequencing. The results showed that all 7 cases had pathogenic mutations in the SMARCB1 gene. The mutation sites included exon5 c.595A>T (p.K199*), exon2 c.200_207del (p.S67*), exon2 p.G69VfsTer16, exon7 c.986G>T (p.S329I), exon7 c.886A>T (p.K296*), exon6 c.635T>A (p.L212*), exon5 c.577del (p.M193Wfs16), and exon6 c.784del (p.V262Sfs5). Follow-up data were obtained for 6 of 12 patients. Among them, 1 patient had lung and bone metastases, 1 patient had liver and bone metastases and 1 patient had multiple bone metastases at the time of diagnosis; 1 patient had bone metastases 5 months after surgery. One patient died of postoperative complications 10 days after surgery, 4 patients died of tumors (the survival time ranged from 4 to 8 months), and 1 patient had no recurrence or metastasis during the 8-month follow-up after surgery.Conclusions:SMARCB1-deficient RMC without sickle cell trait is a highly aggressive and poorly differentiated renal cell carcinoma. It has similar histomorphology, immunophenotype, molecular characteristics and prognosis to RMC, which further supports that it is a sporadic subtype of RMC related to sickle cell trait.

Objective:To construct a scoring system for the main examination report of health examination and evaluate its effect.Methods:A historical control study design was used in this study. By sorting out the problems in 321 main examination reports from December 2023 by equal proportion random sampling method, the quality control plan of main examination report of 2024 was formulated and the "Quality Control Rating Table of Checkup Summary Report" was constructed, which included the principle of conclusion words, classification, sorting, dynamic comparison, disease analysis, health guidance, consistency, completeness, language expression, timeliness and physician. Each principle had its corresponding scoring standard, with a total score of 100 points, 91-100 classified as grade A, 61-90 classified as grade B, and≤60 classified as grade C. According to the "Quality Control Rating Table of Checkup Summary Report", 1 691 main examin reports from January to June 2024 were selected for analysis. In addition, the differences of those reports were analyzed according to categories of primary examination physicians in internal medicine and subspecialties.Results:Compared with December 2023, the proportion of grade A report in June 2024 increased by 111.3% ( χ2=133.38, P<0.001), while the proportion of grade B and C reports decreased by 84.7% ( χ2=61.82, P<0.001) and 97.6% ( χ2=42.36, P<0.001), respectively. In terms of scoring principles, compared with December 2023, the error rates of conclusion words, disease analysis, health guidance and consistency in June 2024 were improved by 54.9%, 46.7%, 62.9% and 100.0%, respectively ( χ2=27.68, 13.41, 48.34 and 7.84, all P<0.001). Additionally, compared with 2023, the total scores of the checkup summary reports of internal medicine and subspecialties in 2024 were increased by 6.8% ( t=-6.843, P<0.001) and 12.6% ( t=-5.321, P<0.001), respectively. Conclusion:The scoring system constructed through the"Quality Control Rating Table of Checkup Summary Report"is scientific, reasonable and practical, which can effectively improve the quality of the main examination report and has strong operability.

Objective:To explore the application effect of double-check standard process for ultrasound reports in health examinations.Method:A historical control study design was used in this study. A total of 11 909 health examination ultrasound reports from the Health Center of the First Affiliated Hospital of Zhengzhou University from February to April in 2021 were selected by systematic sampling method, the double-check standard process was adopted in those reports. The existing problems were categorized, organized and analyzed, and relevant measures for continuous quality improvement were formulated. Then, 13 939 and 15 833 health examination ultrasound reports from February to April in 2022 and 2023 respectively were selected for effect analysis.Results:Compared with those in February to April in 2021, the overall (double-check), initial check and secondary check ultrasound report accuracy rates in February to April in 2023 increased by 5.73%, 3.07% and 1.99%, respectively ( χ2=132.58, 46.80, 127.44, all P<0.001). In terms of trend changes, from February to April 2021 to February to April 2023, the error rates of the following five issues all showed a declining trend: misspellings, inconsistencies between descriptions and conclusion, need for doctor′s signature on the report, missing images, and errors in thyroid/breast color Doppler grading ( χ2=98.93, 30.13/14.59, 3.98, 14.6, all P<0.05). The error rate of ultrasound reports after continuous quality improvement was significantly lower than before. Conclusion:The double-check standard process for ultrasound reports in health examinations can effectively improve the quality of health examination ultrasound reports.

Objective:To evaluate the association between triglyceride-glucose(TyG) index level, their variability, and the risk of incident hyperuricemia(HUA).Methods:A total of 1 583 cases with good compliance who underwent follow-up at the health examination center of a tertiary hospital physical in Zhengzhou were enrolled. The TyG index mean(TyG-mean) and variability indexes, including standard deviation(TyG-SD), coefficient of variation(TyG-CV), and adjusted standard deviation(adj-TyG-SD), were calculated based on TyG index values from three consecutive annual health check-ups. Cox proportional risk regression model was used to assess the relationship between the variability of TyG index and the risk of new-onset HUA; the dose-response relationship between different TyG indexes and HUA was examined using restricted cubic spline(RCS). Results:After a 3-year follow-up, 146 participants developed incident HUA. Both TyG-mean and TyG index variability indicators were significantly higher in the HUA group compared to the non-HUA group( P<0.05). After adjusting for multiple confounders, each standard deviation σincrease in TyG-SD, TyG-CV, and adj-TyG-SD was associated with a 1.23-fold(95% CI 1.06-1.43), 1.22-fold(95% CI 1.05-1.42), and 1.26-fold(95% CI 1.08-1.45) higher risk of incident HUA, respectively. RCS analysis revealed a nonlinear association between adj-TyG-SD and HUA risk( P<0.05), with a critical threshold of 0.55 at a hazard ratio( HR) of 1. Conclusions:Increased TyG index variability is associated with a higher risk of incident HUA, with adj-TyG-SD showing the strongest correlation with HUA risk.

Background: This study investigated the independent and joint impacts of the geriatric nutritional risk index (GNRI) and frailty index (FI) on all-cause and cause-specific mortality in patients with diabetes. Methods: This study included 1,790 National Health and Nutrition Examination Survey participants between 1999 and 2018. GNRI and FI were used to assess patients with diabetes, who were categorized into low GNRI and high GNRI groups, as well as low FI and high FI groups, to evaluate older adults’ nutritional status. These groups were combined into four categories. Weighted Cox proportional hazards models, Kaplan-Meier survival curves, and restricted cubic spline regression models were applied to assess the independent and joint associations of GNRI and FI with all-cause and cause-specific mortality in patients with diabetes. Results: The median follow-up period was 100 months, during which 720 deaths occurred. An independent linear dose-response relationship between GNRI, FI, and all-cause mortality risk was observed. The combination of low GNRI and high FI was significantly associated with increased risk of all-cause mortality (hazard ratio, 1.65; 95% confidence interval [CI], 1.02 to 2.68) for the low GNRI+low FI group, 2.03 (95% CI, 1.61 to 2.55) for the high GNRI+high FI group, and 3.65 (95% CI, 2.38 to 5.58) for the low GNRI+high FI group. Stratified analysis (reference: high GNRI+low FI group) showed an increased mortality risk among men in the low GNRI+high FI group. Conclusion The combination of low GNRI and high FI was independently and jointly associated with increased risk of all-cause, cardiovascular disease, diabetes, and hypertension mortality, particularly among men.

Objective:To explore the potential correlation between cumulative pulse pressure (cumPP) level and metabolic syndrome (MetS), and to provide insights for MetS management.Methods:A total of 3 968 subjects who underwent health checkup were selected to form a research cohort, and the data were categorized into three groups based on the tertiles of cumPP levels. Cox proportional hazards regression model was employed to analyze the association between different cumPP levels and the incidence of new-onset MetS. Results:The risk of MetS increased with the increased tiers of the cumPP levels (2.5%, 4.3%, and 4.6%, Ptrend<0.001) during the median follow-up period of 2.16 years. Spearman rank correlation analysis showed that cumPP was positively correlated with waist circumference, systolic blood pressure, diastolic blood pressure and fasting plasma glucose (all P<0.05). The Cox proportional hazards regression adjusted model showed that the risk of MetS in Q2 and Q3 was higher than that in Q1 in the total population, and the same results were observed in males (all P<0.05), while there was no statistical significance in females. Model 3 of the total population adjusted for a variety of confounding factors displayed a higher risk of MetS in Q3 compared with that in Q1[1.654 (95% CI 1.272-2.151) ]. When stratified by sex, and the risk of MetS in Q3 was 1.665 times higher than that in Q1 (95% CI 1.245-2.227), while there was no statistically significant risk in female. According to the visual nomogram of independent risk factors screened by multivariate analysis based on Cox proportional hazards regression model, the incidence of MetS at 1 year, 2 years, and 3 years was 0.18%, 3.97% and 7.39%, respectively. In addition, the dose-response curve was plotted according to cumPP, suggesting that the risk of MetS gradually increased with the increase of cumPP in the total population. Subgroup analyses based on baseline systolic blood pressure levels showed that higher cumPP levels were associated with a higher risk of developing MetS, regardless of whether systolic blood pressure was abnormal. Conclusions:Elevated cumPP levels is significantly related to the incidence of new-onset MetS. Maintaining pulse pressure within an appropriate range over long term is crucial for the management of MetS.