Objective:To investigate the diagnostic value and influencing factors of endoscopic ultrasonography (EUS) for detecting rectal neuroendocrine neoplasms (R-NENs).Methods:A retrospective case-control study was performed on data of patients with suspected R-NENs by white light endoscopy who underwent endoscopic diagnosis and treatment or surgical operation and obtained pathological diagnosis at the Affiliated Hospital of Qingdao University from March 2016 to June 2023. Clinical data, EUS characteristics and pathological results were statistically analyzed, and the diagnostic accuracy of EUS for R-NENs were obtained by comparing the EUS results with the pathological results. Influencing factors affecting accuracy were analyzed by using the binary logistic regression model.Results:A total of 317 patients were included. The sensitivity, the specificity, the positive predictive value and the negative predictive value of EUS in diagnosing R-NENs were 98.03% (249/254), 34.92% (22/63), 85.86% (249/290) and 81.48% (22/27) respectively. The accuracy was 85.49% (271/317) and the Jorden index was 0.33. Tumor size ≤5 mm ( P=0.002, OR=2.892, 95% CI: 1.464-5.713), absence of surface vascular dilation ( P=0.019, OR=2.613, 95% CI: 1.170-5.837), normal tumor coloration ( P=0.001, OR=3.460, 95% CI: 1.645-7.279) and erythematous surface appearance ( P=0.048, OR=7.242, 95% CI: 1.015-51.680) were independent risk factors affecting the accuracy of R-NENs diagnosis by EUS. Depth assessment accuracy of EUS was 76.77% (195/254), with echo heterogeneity ( P<0.001, OR=4.008, 95% CI: 1.980-8.113) and surface depression ( P=0.035, OR=2.664, 95% CI: 1.073-6.615) emerging as significant factors affecting invasion depth evaluation. Conclusion:EUS demonstrates substantial clinical utility for R-NENs assessment, with diagnostic performance being significantly associated with tumor morphology and sonographic features. Macroscopic characteristics including tumor size, vascular patterns, and chromatic features influence diagnostic accuracy, while echo-textural heterogeneity and surface depression affect invasion depth precision. These findings underscore the clinical relevance of comprehensive EUS evaluation in R-NENs management.

Objective: To explore the relationship of physical activity (PA) and sedentary behavior (SB) with cardiorespiratory fitness (CRF) among middle schoold students in Tibet, so as to provide empirical references for improving the cardiorespiratory fitness and health levels of adolescents in Tibet. Methods: From August to December 2020, 1 225 junior and senior high school students were selected from 2 middle schools in Lhasa, Tibet Autonomous Region, using the stratified cluster random sampling method. Triaxial accelerometers were used to evaluate PA and SB behaviors, and the 20 meter shuttle run was employed to assess CRF among the middle school students. Isochronous substitution modeling was used to analyze the associations of SB, low intensity physical activity (LPA), and moderate vigorous physical activity (MVPA) with CRF, and the saturation threshold effect in the dose response relationship between MVPA and CRF was analyzed through restricted cubic spline and two stage linear regression. Results: After adjusting for covariates such as gender, body mass index and sleep quality score, isotemporal substitution analysis showed that among junior high school students aged 13-15, replacing 30 minutes of SB ( B =1.73) or LPA ( B =2.38) with MVPA were positively associated with CRF (both P <0.05). Among senior high school students aged 16-18, replacing SB ( B =0.99) or LPA ( B =1.38) with MVPA were also positively associated with CRF (both P <0.05). Restricted cubic spline and two piecewise linear regression analyses indicated that only middle school girls aged 13-18 exhibited a saturation threshold effect between MVPA and CRF (logarithmic likelihood ratio test=0.03), with the optimal CRF improvement observed at 60 minutes of MVPA per day ( B=0.13, P ＜ 0.01). Conclusions Reducing SB and LPA while increasing MVPA can improve CRF in Tibetan middle school students. To maximize CRF improvement, middle school girls should engage in at least 60 minutes of MVPA daily.

The occurrence and development of tumors are determined by both intrinsic and microenvironmental factors. The components of the tumor microenvironment exhibit great heterogeneity resulting in either pro-tumor or anti-tumor effects. The deep exploration of tumor immune microenvironment gave birth to the hypothesis of cancer immunoediting, which is supported by more and more evidence. Cancer immunoediting is accomplished through the interactions among various cells and factors in the microenvironment. While many molecular mechanisms have been studied, the cellular mechanisms of cancer immunoediting have been paid attention. This article explores the roles of cellular mechanisms in the cancer immunoediting, including immunogenic cell death, cellular senescence and neutrophil extracellular trap. The elucidation of these mechanisms not only reveals the complexity of the pathogenesis and progression of tumors, but also provides new targets and prognostic indicators for the diagnosis and treatment of tumors.

Objective:To evaluate the prevalence, potential risk factors, and correlation between coronary and peripheral microvascular dysfunction in heart failure with non-reduced ejection fraction (nHFrEF) patients.Methods:This was a prospective registry study. nHFrEF patients admitted to Zhongshan Hospital affiliated with Fudan University from December 2021 to December 2023 were enrolled. According to coronary flow reserve (CFR) or reactive congestion index (RHI), enrolled patients were divided into coronary microvascular endothelial dysfunction (CMD) group (CFR<2.5) and no CMD group (CFR≥2.5) or peripheral microvascular endothelial dysfunction (MED) group (RHI<1.67) and no MED group (RHI≥1.67). Patients′ general information, laboratory and auxiliary examination data were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of CMD and MED in nHFrEF patients, and Spearman correlation analysis was used to evaluate the correlation between MED and CMD.Results:A total of 142 nHFrEF patients were enrolled, aged 69.0 (59.0, 74.0) years, with a male proportion of 66.9% (95/142). The grouping results were as follows: (1) According to CFR, there were 73 cases in the CMD group and 69 cases in the no CMD group; (2) According to RHI, there were 57 cases in the MED group and 85 cases in the no MED group. The prevalence of CMD and MED in this study was 51.4% (73/142) and 40.1% (57/142), respectively. Univariate logistic regression analysis showed that increased heart rate, chronic kidney disease, atrial fibrillation, elevated N-terminal pro-B type natriuretic peptide levels, and increased urinary albumin/creatinine ratio were risk factors for CMD, while increased RHI was a protective factor for CMD; Atrial fibrillation is a risk factor for MED, while increased CFR is a protective factor for MED. Incorporating clinically significant variables from univariate analysis into multivariate analysis, the results showed that increased heart rate and elevated RHI remained risk and protective factors for CMD, respectively; increased CFR remains a protective factor for MED. Spearman correlation analysis showed that CFR was negatively correlated with lg urinary albumin/creatinine ratio, lg cardiac troponin T, lg N-terminal pro-B type natriuretic peptide, and heart rate; RHI is positively correlated with CFR.Conclusions:The prevalence of CMD and MED in nHFrEF patients is high, and the two have a certain positive correlation. Increased heart rate and RHI are risk and protective factors for CMD, respectively, while increased CFR is a protective factor for MED. MED may be a potential therapeutic target for nHFrEF patients.

Objective:To investigate the diagnostic value and influencing factors of endoscopic ultrasonography (EUS) for detecting rectal neuroendocrine neoplasms (R-NENs).Methods:A retrospective case-control study was performed on data of patients with suspected R-NENs by white light endoscopy who underwent endoscopic diagnosis and treatment or surgical operation and obtained pathological diagnosis at the Affiliated Hospital of Qingdao University from March 2016 to June 2023. Clinical data, EUS characteristics and pathological results were statistically analyzed, and the diagnostic accuracy of EUS for R-NENs were obtained by comparing the EUS results with the pathological results. Influencing factors affecting accuracy were analyzed by using the binary logistic regression model.Results:A total of 317 patients were included. The sensitivity, the specificity, the positive predictive value and the negative predictive value of EUS in diagnosing R-NENs were 98.03% (249/254), 34.92% (22/63), 85.86% (249/290) and 81.48% (22/27) respectively. The accuracy was 85.49% (271/317) and the Jorden index was 0.33. Tumor size ≤5 mm ( P=0.002, OR=2.892, 95% CI: 1.464-5.713), absence of surface vascular dilation ( P=0.019, OR=2.613, 95% CI: 1.170-5.837), normal tumor coloration ( P=0.001, OR=3.460, 95% CI: 1.645-7.279) and erythematous surface appearance ( P=0.048, OR=7.242, 95% CI: 1.015-51.680) were independent risk factors affecting the accuracy of R-NENs diagnosis by EUS. Depth assessment accuracy of EUS was 76.77% (195/254), with echo heterogeneity ( P<0.001, OR=4.008, 95% CI: 1.980-8.113) and surface depression ( P=0.035, OR=2.664, 95% CI: 1.073-6.615) emerging as significant factors affecting invasion depth evaluation. Conclusion:EUS demonstrates substantial clinical utility for R-NENs assessment, with diagnostic performance being significantly associated with tumor morphology and sonographic features. Macroscopic characteristics including tumor size, vascular patterns, and chromatic features influence diagnostic accuracy, while echo-textural heterogeneity and surface depression affect invasion depth precision. These findings underscore the clinical relevance of comprehensive EUS evaluation in R-NENs management.

Objective:To evaluate the prevalence, potential risk factors, and correlation between coronary and peripheral microvascular dysfunction in heart failure with non-reduced ejection fraction (nHFrEF) patients.Methods:This was a prospective registry study. nHFrEF patients admitted to Zhongshan Hospital affiliated with Fudan University from December 2021 to December 2023 were enrolled. According to coronary flow reserve (CFR) or reactive congestion index (RHI), enrolled patients were divided into coronary microvascular endothelial dysfunction (CMD) group (CFR<2.5) and no CMD group (CFR≥2.5) or peripheral microvascular endothelial dysfunction (MED) group (RHI<1.67) and no MED group (RHI≥1.67). Patients′ general information, laboratory and auxiliary examination data were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of CMD and MED in nHFrEF patients, and Spearman correlation analysis was used to evaluate the correlation between MED and CMD.Results:A total of 142 nHFrEF patients were enrolled, aged 69.0 (59.0, 74.0) years, with a male proportion of 66.9% (95/142). The grouping results were as follows: (1) According to CFR, there were 73 cases in the CMD group and 69 cases in the no CMD group; (2) According to RHI, there were 57 cases in the MED group and 85 cases in the no MED group. The prevalence of CMD and MED in this study was 51.4% (73/142) and 40.1% (57/142), respectively. Univariate logistic regression analysis showed that increased heart rate, chronic kidney disease, atrial fibrillation, elevated N-terminal pro-B type natriuretic peptide levels, and increased urinary albumin/creatinine ratio were risk factors for CMD, while increased RHI was a protective factor for CMD; Atrial fibrillation is a risk factor for MED, while increased CFR is a protective factor for MED. Incorporating clinically significant variables from univariate analysis into multivariate analysis, the results showed that increased heart rate and elevated RHI remained risk and protective factors for CMD, respectively; increased CFR remains a protective factor for MED. Spearman correlation analysis showed that CFR was negatively correlated with lg urinary albumin/creatinine ratio, lg cardiac troponin T, lg N-terminal pro-B type natriuretic peptide, and heart rate; RHI is positively correlated with CFR.Conclusions:The prevalence of CMD and MED in nHFrEF patients is high, and the two have a certain positive correlation. Increased heart rate and RHI are risk and protective factors for CMD, respectively, while increased CFR is a protective factor for MED. MED may be a potential therapeutic target for nHFrEF patients.

Objective:To investigate the feasibility of oblique overlap anastomosis plus single flap valvuloplasty (OSF) for reconstruction after laparoscopic proximal gastrectomy.Methods:The C-shaped seromuscular flap (2.5 × 3.5 cm), which was 2 cm from the top of the remnant stomach, was extracorporeally created on the anterior wall of the remnant stomach. The stomach was opened approximately 1.0 cm above the lower edge of the mucosal flap. Four supporting stitches were sutured around the hole and the right wall of the esophageal stump was incised with a support suture to prevent the linear stapler from entering the submucosa. Liner stapler was inclined to the left side of the esophagus at an angle of about 30 degrees to the longitudinal axis of the esophagus for oblique anastomosis between the dorsal side of the esophagus and the anterior stomach and then esophagogastrostomy was performed with the length of anastomosis was 4 cm. Entry hole was suture with 3 stitches and then the linear stapler was used for closing the entry hole. Finally, the seromuscular flap was closed using barbed sutures.Results:Clinical data of 11 patients with Siewert type II esophagogastric junction adenocarcinoma who underwent radical gastrectomy and reconstruction by OSF between January 2022 and May 2023 were retrospectively collected. There were 7 males and 4 females. The average age was (69.9±7.8) years, the BMI was (21.7±7.2) kg/m 2 and the tumor size was (2.1±0.6) cm. OSF reconstruction was successfully completed in all 11 patients. The median operative time was 275 (270-428) minutes, the time for OSF reconstruction was 112 (80-140) minutes, and the blood loss was 50 (20-400) ml. The pathological stage was 0-I in 7 cases and II-III in 4 cases. The patients were fed on the 4th day (4-7 days) and discharged from hospital on the 7th day (6-9 days) after surgery. No patient had gastroesophageal reflux symptoms of grade B and above, and no patient took anti-reflux medicine. Conclusions:OSF is a safe and feasible treatment for Siewert type II esophagogastric junction adenocarcinoma.

Objective:To investigate the pollution levels and influencing factors of polybrominated diphenyl ethers (PBDEs) in household dust in five cities in northern China.Methods:Based on the "Chinese Indoor Environment and Health Surveillance" project carried out by the National Institute of Environmental Health, Chinese Center for Disease Control and Prevention in 2018-2019, during the warm season (April 2018 to September 2018) and the cold season (November 2018 to March 2019), Lanzhou in Northwest China, Shijiazhuang in North China, Panjin in Northeast China, Luoyang in Central China, and Qingdao in East China were selected as the research sites. A total of 87 families were recruited to study residences in real-life scenarios. At the same time, dust samples were collected to detect the concentration of PBDEs. The level of household environmental indicators was measured, and the residential building characteristics and family behavior habits were collected through questionnaires. A total of 142 valid dust samples and 140 valid questionnaires were obtained. The differences in PBDE concentrations across seasons, wind zones, residential building characteristics, and family habits were analyzed. The exploratory factor analysis was performed to investigate the possible sources of PBDEs, and multivariate linear regression was used to explore the factors influencing PBDEs in household dust.Results:The M ( Q1,Q3) of total PBDE concentrations in 142 household dust samples in five cities was 144.51 (106.61, 222.65) ng/g in the warm season and 145.10 (98.57, 180.65) ng/g in the cold season, respectively. There were seasonal differences in the concentration of ∑ 12PBDEs in Luoyang and Shijiazhuang ( P<0.01). The concentration of BDE-71 was highest among PBDE homologues, followed by BDE-66 and BDE-47. Three factors were extracted by exploratory factor analysis in the warm season, and the cumulative variance contribution rate was 67.90%. The multivariate linear regression showed that the house completion less than ten years [ β (95% CI): 0.186 (0.013, 0.359)], infrequent home cooking [ β (95% CI):-0.342 (-0.570, -0.114)], and increased residential PM 10 concentration [ β (95% CI): 0.001 (0.000, 0.002)] during the warm season, as well as the house far from driveway [ β (95% CI): 0.093 (0.013, 0.172)], house area less than 90 m 2 [ β (95% CI):-0.138 (-0.264, -0.013)], and lower residential xylene concentration [ β (95% CI):-0.006 (-0.011, -0.001)] during the cold season might be related to the elevated concentrations of ∑ 12PBDEs in household dust. Conclusion:The pollution of PBDEs in household dust in five northern cities is at a medium to high level. Years of house completion, frequency of cooking at home, residential PM 10 concentration, distance from house to driveway, house area, and residential xylene concentration may influence household PBDE concentrations.