ObjectiveTo describe the prevalence and dynamic pain characteristics of dysmenorrhea among female medical students through a menstrual diary-based observational study. MethodsFrom April to June 2021, female students were recruited from a medical college in Shanghai to complete menstrual diaries and record dysmenorrhea-related characteristics for two menstrual cycles. Dysmenorrhea severity was assessed using the visual analogue scale (VAS) (no pain: 0; mild: 1‒3; moderate: 4‒6; severe: 7‒10). A total of 323 diaries were collected, of which 303 were 93.81% valid (valid response rate: 93.81%), covering 596 complete menstrual cycles. Among them, 293 participants completed diaries for two cycles and were included in the analysis of persistent dysmenorrhea. Period, point, and persistent prevalence of dysmenorrhea were calculated using the number of participants as the denominator. Paired comparisons were performed using Cochran’s Q test and Bonferroni-adjusted McNemar tests. Using menstrual cycles with dysmenorrhea as the unit of analysis, the distributions of pain onset, peak timing, and pain duration across different severities were compared using the χ² tests or Fisher’s precision probability tests. ResultsAmong 303 female college students, 269 experienced dysmenorrhea during the first recorded cycle, and 288 had dysmenorrhea in any cycle. Among 596 complete menstrual cycles recorded, 527 were associated with dysmenorrhea (88.42%), and among 293 students who completed 2 complete recorded cycles, 239 had persistent dysmenorrhea. The period, point, and persistent prevalence of dysmenorrhea among female college students were 95.05% (288/303), 88.78% (269/303), and 81.57% (239/293), respectively (Q=61.61, P<0.001). The prevalence of persistently severe dysmenorrhea was 5.12% (15/293). Among the 527 dysmenorrheic cycles, there were statistically significant differences in the distribution of pain onset time (P=0.003) and pain duration (P<0.001) among different degrees of dysmenorrhea; mild dysmenorrhea mostly started on the first day of menstruation (52.83%), and moderate dysmenorrhea mostly started before menstruation (50.19%). Pain duration increased with severity; the proportions of cycles with pain lasting ≥4 days were 13.20%, 43.03%, and 51.56% for mild, moderate, and severe dysmenorrhea cycles, respectively. For all severity groups, mean pain scores peaked on the first day of menstruation and then decreased day by day to a stable level. ConclusionDysmenorrhea is highly prevalent among female medical students, and differences exist across pain severity levels in onset time, duration, and dynamic changes in pain. Identification and health guidance for those with persistently moderate-to-severe dysmenorrhea should be strengthened, and medical evaluation should be conducted when necessary.

Objective:To compare the impact of different treatment strategies on the survival outcomes in rectal cancer patients with poor response to neoadjuvant therapy, and to explore the survival-related influencing factors.Methods:A retrospective cohort study was conducted. Between January 2018 and November 2022, the clinical, pathological, and follow-up data of 106 rectal cancer patients who received neoadjuvant therapy and were evaluated as grade 4 or 5 based on the Magnetic Resonance Tumor Regression Grade (mrTRG) from the rectal cancer database at Peking Union Medical College Hospital were retrospectively collected. Based on the post-neoadjuvant therapy assessment, patients were classified into three groups: the chemotherapy-radiotherapy group (23 patients), the consolidation therapy group (18 patients), and the standard treatment group (65 patients). General condition, pathological findings, selection of neoadjuvant therapy, comorbidities, as well as 3-year expected DMFS and OS were observed in the three groups.Results:All 106 patients were followed up, with a median follow-up time of 28 (21, 38) months. The overall 3-year DMFS rate was 60%, and the 3-year OS rate was 74%. The 3-year DMFS in the standard treatment and consolidation therapy groups were 74% and 72%, respectively; the 3-year OS were 84%, 81%, respectively. The Log-rank test showed that there was no significant difference in the 3-year expected DMFS and OS between the standard treatment group and the consolidation therapy group (both P>0.05), but both groups had better survival outcomes than the chemotherapy-radiotherapy group (10% and 39%, respectively; all P<0.001). Multivariate Cox regression analysis indicated that the chemotherapy-radiotherapy only regimen was an independent risk factor for DMFS (HR=12.425, 95% CI: 4.436–34.594, P<0.001), and the independent risk factors for OS were chemotherapy-radiotherapy only regimen (HR=8.991, 95%CI:2.220–36.403, P=0.002) and age≥65 years (HR=3.495, 95%CI: 1.017–12.009, P=0.047). Stratified analysis showed that chemotherapy-radiotherapy only regimen was the independent risk factors for DMFS and OS in patients with extramural vascular invasion (EMVI) positive ( n=66) and mesorectal fascial invasion (MRF) positive (n=56) (all P<0.05). Whether consolidation therapy was added to the standard neoadjuvant treatment regimen was not an independent factor affecting 3-year expected DMFS or OS in rectal cancer patients with poor response to neoadjuvant therapy. Further comparisons between the standard neoadjuvant treatment and consolidation therapy groups showed no statistically significant differences in spincter-preservation rate or postoperative complication rates (both P>0.05). However, the consolidation therapy group had a longer interval between the end of radiotherapy and surgery [80.1 (50.8, 109.4) days vs. 61.8 (48.8, 74.8) days, P<0.001], and a higher incidence of chemotherapy-related adverse effects ([10/18] vs. 26.2% [17/65], P=0.018). Conclusion:In rectal cancer patients with poor response to neoadjuvant therapy and clear adverse prognostic features before surgery (locally advanced stage, MRF positive or EMVI positive), the addition of short- or long-course chemotherapy-based systemic therapy does not provide short- or long-term survival benefits. Moreover, an extended chemotherapy duration increases the incidence of chemotherapy-related adverse effects.

Objective:To analyze the predictive role of WT1 expression levels pre-and early post-transplantation on relapse and overall survival(OS)in patients with acute myeloid leukemia(AML)undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT)during their first complete remission(CR1).Methods:A retrospective analysis was conducted on the clinical data of 107 adult AML patients who underwent allo-HSCT during their CR1 at our center between May 2012 and December 2021.The predictive role of bone marrow WT1 expression levels before transplantation and at 3 and 6 months post-transplantation on relapse and OS was explored in combination with relevant clinical factors.Results:The median follow-up time for the 107 patients was 70(range:11-117)months.Among the patients,15 cases died.Kaplan-Meier survial analysis showed that the 3-year overall survival(OS)rate was 85.0％.20 patients experienced relapse,with a median time to relapse of 8(range:0.5-44)months and a l-year cumulative relapse rate of 13.1％.The overall median value of WT1 before transplantation,3 months after transplantation,and 6 months after transplantation was 0.26％(range:0％-23.64％),with an upper quartile value of 0.74％.No statistically significant differences in WT1 expression levels were observed among the pre-transplantation,3-month post-transplantation,and 6-month post-transplantation time points(P=0.227).Univariate analysis showed that patients with WT1 levels＞0.74％at 3 months post-transplantation had a higher 1-year relapse rate(P=0.029)and lower 3-year OS rate(P＜0.001)compared to patients with WT1 levels ≤0.74％.Other significant factors affecting 1-year relapse included stem cell source(P=0.041)and chronic graft-versus-host disease(cGVHD)(P=0.013).For 3-year OS,additional influencing factors were genetic high risk(P=0.048)and stem cell source(P=0.016).Multivariate analysis revealed that WT1 level＞0.74％at 3 months post-transplantation had a trend to affect 1-year relapse rate(HR=3.309,95％CI:0.958-11.431,P=0.058),while the absence of cGVHD was an independent risk factor for 1-year relapse(HR=3.473,95％CI:0.749-16.100,P=0.037).Only WT1 level＞0.74％at 3 months post-transplantation was an independent risk factor for 3-year OS(HR=6.886,95％CI:2.402-19.738,P＜0.001).Conclusion:High WT1 expression level at 3 months post-transplantation in AML patients undergoing allo-HSCT during CR1 affects the 1-year relapse rate and 3-year OS,and is an independent risk factor affecting 3-year OS.These findings suggest that dynamic monitoring of WT1 expression levels has certain value in prognostic assessment of AML patients who received allo-HSCT during CR1.

Objective:To investigate the completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients in the national multicenter real-world database.Methods:The prospective real-world study was conducted. The clinicopathological data of 1 074 patients who underwent surgical treatment for mid and low rectal cancer in 47 national medical institutions, including Peking Union Medical College Hospital et al, from May 12,2023 to May 11,2024 were collected. Observation indicators: (1) clinical characteristics of patients with mid and low rectal cancer; (2) initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer; (3) initial imaging evaluation of patients with mid and low rectal cancer; (4) imaging evaluation after neoadjuvant therapy for patients with mid and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absoluter numbers and/or percentages. Results:(1) Clinical characteristics of patients with mid and low rectal cancer. Of the 1 074 patients, there were 713 males and 361 females, aged 63(56,70)years. The body mass index of 1 074 patients was 24(21,26)kg/m 2.For American Society of Anesthesiologists classification, there were 147 cases of stage Ⅰ, 641 cases of stage Ⅱ, 157 cases of stage Ⅲ, 2 cases of stage Ⅳ, and there were 127 cases missing data. (2) Initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer. Of the 1 074 patients, there were 787 cases (73.28%) undergoing complete colonoscopy, and there were only 197 cases (18.34%) undergoing immunohistochemical evaluation of all four mismatch repair proteins. (3) Initial imaging evaluation of patients with mid and low rectal cancer. Of the 1 074 patients, there were 842(78.40%) patients completing magnetic resonance imaging (MRI) or ultrasound evaluation, and there were 914(85.10%) patients completing chest, abdomen, and pelvis enhanced computed tomography (CT) evaluation. In the 149 patients completing rectal ultrasound evaluation, there were 122 cases (81.88%) comple-ting T staging evaluation, and there were 81 cases (54.36%) completing N staging evaluation. In the 808 patients completing rectal MRI evaluation, there were 708 cases (87.62%) completing T staging evaluation, and there were 590 cases (73.02%) completing N staging evaluation. (4) Imaging evalua-tion after neoadjuvant therapy for patients with mid and low rectal cancer. Of the 388 patients with neoadjuvant therapy, there were 332 patients (85.57%) completing MRI or ultrasound evaluation, and there were 327 patients (84.28%) completing chest, abdomen, and pelvis enhanced CT evalua-tion. In the 70 patients completing rectal ultrasound evaluation, there were 65 cases (92.86%) com-pleting T staging evaluation, and there were 49 cases (70.00%) completing N staging evaluation. In the 327 patients completing rectal MRI evaluation, there were 246 cases (75.23%) completing T staging, and there were 228 cases (69.72%) completing N staging evaluation. Conclusion:The com-pletion rate of tumor imaging evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients on a national scale is relatively good.

Aim Mouse model of myocardial hypertro-phy was established via intraperitoneal injection of iso-proterenol(ISO)in mice.This approach allows for an in-depth investigation into the pharmacological effects and mechanisms of action of emodin,offering novel in-sights and directions for the improvement of myocardial hypertrophy.Methods The mice were randomly di-vided into the following groups:control group(CON),emodin group(EMO),MAPK activator control group(EMO+Ani),model group(ISO),treatment group(ISO+EMO),and activator intervention group(ISO+EMO+Ani).After treatment with emodin and inter-vention with MAPK activator,the heart weight ratio and cardiac size of each group were observed.Hematoxy-lin-eosin(HE)staining was used to observe the patho-logical changes in cardiac tissue,and kits were utilized to measure the levels of GSH,LDH,and MDA in the serum.Western blot was employed to detect the protein expression levels of inflammatory and oxidative factors,as well as p-p38,p-ERK,p38,and ERK in cardiac tis-sue.Results Emodin can significantly inhibit the production of myocardial inflammatory and oxidative factors induced by ISO,thereby effectively alleviating the degree of myocardial hypertrophy and fibrosis.Af-ter the p38/ERK signaling pathway was specifically ac-tivated by farnesol,the improvement effect of emodin on myocardial hypertrophy was weakened.Further comparison revealed that,compared with the myocardi-al hypertrophy pathological model group,the pathologi-cal protein expression levels in the farnesol-treated group showed no significant difference,and were even higher in some indicators.Conclusion Emodin can effectively inhibit the release of inflammatory factors and improve the state of oxidative stress by modulating the p38/ERK signaling pathway,thereby exerting an ameliorative effect on myocardial hypertrophy.

Purpose To explore the effect of Calumenin(CALU)on migration and invasion ability of gastric cancer cells,as well as epithelial-mesenchymal transition(EMT).Methods The immunohistochemical experiments and Western blot were applied to evaluate the protein level of CALU in gastric cancer.After constructing a gastric canc-er cell line with low expression of CALU,CCK8 assay,wound-healing analysis and Transwell migration and invasion assays were performed to determine cell proliferation,Migration and invasion ability.Western blot was performed to an-alyse the effect of CALU knockdown on EMT molecules.Results CALU expression was significantly higher in gastric cancer tissues compared to normal gastric tissues(P＜0.05),and high CALU expression was significantly associated with TNM stage and lymph node metastasis(P＜0.05).Compared with GES-1 cells,the protein expression of CALU upregulated in gastric cancer cells(P＜0.05).CALU knockdown suppressed the proliferation,migration,invasion of BGC823 cells and SGC7901 cells(P＜0.05).Rescue experimental evidence showed that synonymous mutations of CALU could reverse the inhibitory effect of CALU knockdown on the proliferation,migration,and invasion ability of gastric cancer cells(P＜0.05).Knockdown of CALU resulted in the downregulation of vimentin and Snail expression,while E-cadherin and β-catenin expression were upregulated in human gastric cancer cells(P＜0.05).Conclusion CALU knockdown inhibits the proliferation,migration,invasion,and EMT of human gastric cancer cells.

Aim To investigate the effect of cordycepin(COR)on gentamicin(GEN)-induced nephrotoxicity and the molecular mechanism of inhibiting oxidative stress and ferroptosis induced by GEN.Methods The oral SD rats were divided into a control group,GEN group,and GEN+COR group.Following the success-ful setting up of the animal model,the serum creatinine(CR)and urea nitrogen(BUN)levels of rats were measured,and renal tissue injury was assessed using HE staining.In addition,the contents of malondialde-hyde and glutathione in kidney tissues of SD rats in each group were detected,and the expressions of fer-roptosis markers GPX4 and SLC7A11 were analyzed by Western blot.Results Compared with the control group,CR and BUN in GEN-stimulated group signifi-cantly increased(P＜0.01),and the level of CR and BUN was effectively reduced after 50 mg·kg-1 COR oral administration.HE results also showed that COR could alleviate the kidney tissue damage caused by GEN.COR could reverse the increase of malondialde-hyde level and the decrease of glutathione level caused by GEN in rat kidney tissue,and COR could restore the decrease of GPX4 and SLC7A11 protein levels induced by GEN.Conclusion COR can reduce GEN-induced kidney injury by inhibiting oxidative stress and ferrop-tosis.

Purpose To characterize the clinicopathological features of gastrointestinal mesenchymal tumors(GMTs)resected via endoscopic techniques.Methods A retrospective analysis was conducted on 495 cases of endo-scopically resected GMTs.Clinical information,histomorphological findings,immunohistochemical profiles,and mo-lecular characteristics were reviewed.Results The cohort included 495 patients aged 20-78 years(median:53 years).The majority of tumors were located in the stomach(58.8％)and esophagus(36.8％).Histologically,most tumors consisted of spindle cells,with a minority composed of epithelioid cells;fibrocollagenous or myxoid stroma was occasionally observed.Immunohistochemically,leiomyomas showed diffuse positivity for α-SMA(98.8％)and desmin(99.3％),gastrointestinal stromal tumors(GISTs)expressed CD117(99.4％),DOG1(97.6％),and CD34(97.0％),and schwannomas were positive for S-100(93.7％).The predominant tumor types were leiomyomas(54.1％)and GISTs(33.7％),while the remaining 12.2％comprised other rare types.Various endoscopic resection techniques were employed based on the tumors' anatomical depth,including endoscopic submucosal dissection(ESD,40.5％),submucosal tunneling endoscopic resection(STER,17.1％),endoscopic mucosal resection(EMR,16.5％),endoscopic full-thickness resection(EFTR,13.9％),and endoscopic submucosal excavation(ESE,12.0％).EMR and ESD were primarily used for superficial lesions,while deeper tumors with were more often treated with STER,EFTR,and ESE.The rate of negative resection margins was lower in GISTs(72.2％)and other tumors with indistinct margins,compared to leiomyomas(92.6％)and those with well-defined boundaries.Conclusion Leiomyomas and GISTs are the most common gastrointestinal mesenchymal tumors resected via endoscopy.A variety of resection techniques are applicable depending on tumor location and depth.Accurate pathological diagnosis should be based on HE morphology,supplemented by endoscopic findings,margin status,immunohistochemistry,and necessary molecular tests.

Objective To investigate the effect and mechanism of action of epigallocatechin-3-gallate(EGCG)in the treatment of experimental metabolic dysfunction-associated steatohepatitis(MASH),and to provide a basis for clinical development and application.Methods A total of 32 experimental C57BL/6J mice were randomly divided into normal diet group(Con group with 8 mice)and model group with 24 mice.The mice in the model group were given a high-trans fatty acid high-carbohydrate(HFHC)diet for 24 weeks to establish a model of MASH,and at the end of week 24,the mice in the model group were further divided into HFHC group,EGCG treatment group(100 mg·kg-1·d-1),and obeticholic acid treatment group(10 mg·kg-1·d-1),with 8 mice in each group.After 6 weeks of treatment,samples were collected to observe the general conditions of mice;the content of triglycerides(TG)and hydroxyproline in liver tissue and the serum levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were measured;HE staining,oil red O staining,and picrosirius red staining were used to observe liver histopathological changes.In the in vitro experiment,L02 cells were induced with free fatty acid(FFA)to establish a model of lipid deposition,and the cells were divided into Con group,FFA group,and EGCG group.The content of TG in cells was measured,as well as the results of oil red O staining and the relative mRNA expression levels of TNF-α,CCL2,and CXCL10.The transcriptomics technique was used to identify differentially expressed genes between the Con group,the HFHC group,and the EGCG group and perform the GSEA analysis,and pathways with a P-adjust value of<0.05 that were associated with MASH were further classified into metabolism-related pathways and inflammation-related pathways.The specific signaling pathways in each category were ranked based on the degree of enrichment,and key genes in the top three pathways were verified by PCR in vivo.Key genes in the NOD-like receptor signaling pathway were verified by Western blotting.A one-way analysis of variance was used for comparison of normally distributed continuous data with homogeneity of variance between multiple groups,and the least significant difference t-test was used for further comparison between two groups.Results Compared with the HFHC group,the EGCG group had significant reductions in the content of TG in liver tissue(P<0.05)and the serum levels of ALT and AST(P<0.05).Oil red O staining showed significant alleviation of hepatocyte fatty degeneration in the EGCG group,HE staining showed that EGCG effectively alleviated inflammation,and picrosirius red staining showed a significant reduction in the number of fibrous tissue after EGCG treatment.There was a significant reduction in the content of hydroxyproline in liver tissue after EGCG intervention(P<0.01).Cell experiments showed that compared with the FFA group,the EGCG group had a significant reduction in the content of TG,and oil red O staining showed the disappearance of lipid droplets in the EGCG group compared with the FFA group,with significant reductions in the relative mRNA expression levels of the inflammatory factors TNF-α,CCL2,and CXCL10(all P<0.01).The transcriptomics analysis identified 230 differentially expressed genes between the HFHC group and the EGCG group,among which there were 108 upregulated genes and 122 downregulated genes.EGCG significantly reduced the levels of the key proteins TLR4,NLRP3,and IL-1β in the NOD-like receptor signaling pathway in liver tissue(all P<0.05).Conclusion EGCG can significantly alleviate lipid deposition,inflammation,and fibrosis in the mouse model of MASH and improve lipid deposition and inflammatory injury in L02 cells,possibly by regulating the NOD-like receptor signaling pathway.