Interferon regulatory factor 4 (IRF4) is a critical transcription factor that governs the differentiation of cluster of differentiation 4⁺ (CD4⁺) T cells. The pathogenesis and progression of psoriasis are primarily attributed to an immune imbalance stemming from the overproduction of interleukin-17A (IL-17A) by T lymphocytes. However, the role of IRF4 in psoriasis remains unexplored. In this study, we found that IRF4 activity is increased in the cutaneous lesions of patients with psoriasis in response to stimulation by IL-23A and IL-1β. This IRF4 elevation heightens its binding to the E1A binding protein p300 (EP300) promoter, triggering the transcription of downstream retinoic acid receptor-related orphan receptor-γt (RORγt) and increasing the secretion of IL-17A, thereby establishing the IL-1β/IL-23A-IRF4-EP300-RORC-IL-17A inflammatory cascade in psoriasis. The alleviation of imiquimod (IMQ)-induced psoriatic-like symptoms was achieved through the creation of a Irf4 ^-/- gene deletion mouse model and pharmacological inhibition using antisense oligonucleotides targeted for Irf4. This amelioration was accompanied by a decreased number of IL-17A-producing CD4⁺ T cells in the skin. The findings of this study suggest that IRF4 plays a crucial role in the promotion of inflammation and exacerbation of IMQ-induced psoriasiform dermatitis. Consequently, IRF4 targeting could be a promising therapeutic strategy.

OBJECTIVE: To explore the risk factors affecting the prognosis of patients with sepsis complicated with acute pulmonary embolism, and to construct and validate a nomogram predictive model for in-hospital mortality risk. METHODS: Based on the American Medical Information Mart for Intensive Care (MIMIC-III, MIMIC-IV) databases, the data were collected on patients with sepsis complicated with acute pulmonary embolism from 2001 to 2019, including baseline characteristics, and vital signs, disease scores, laboratory tests within 24 hours of admission to the intensive care unit (ICU), and interventions. In-hospital mortality was the outcome event. The total samples were divided into training and testing sets in a 7:3 ratio by random sampling. Univariate Cox regression analysis was used to verify the impact of all variables on the risk of in-hospital mortality, thereby screen potential influencing factors. Subsequently, a stepwise bi-directional regression method was applied to select factors one by one, leading to the construction of a nomogram prediction model. Collinearity testing was used to demonstrate the absence of strong multicollinearity among the influencing factors in the nomogram prediction model. The discrimination of the nomogram model, sequential organ failure assessment (SOFA), and simplified pulmonary embolism severity index (sPESI) was evaluated using C-index in the test set. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of various models for in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism. RESULTS: A total of 562 patients with sepsis complicated with acute pulmonary embolism were included, including 393 in the training set and 169 in the testing set. Univariate Cox regression analysis showed that 30 factors associated with in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism. Through stepwise bi-directional regression, 12 variables were ultimately selected, including gender, presence of malignant tumors, body temperature, red cell distribution width (RDW), blood urea nitrogen (BUN), serum potassium, prothrombin time (PT), 24-hour urine output, mechanical ventilation, vasoactive drugs, warfarin use, and sepsis-induced coagulopathy (SIC). Collinearity testing indicated no strong multicollinearity among the influencing factors [all variance inflation factor (VIF) > 10]. A nomogram model was constructed using the 12 variables mentioned above. The nomogram model predicted the C-index and its 95% confidence interval (95%CI) of in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism better than SOFA score and sPESI [0.771 (0.725-0.816) vs. 0.579 (0.519-0.639), 0.608 (0.554-0.663)]. The ROC curve showed that the area under the curve (AUC) and its 95%CI of the nomogram model were higher than those of the SOFA score and sPESI [0.811 (0.766-0.857) vs. 0.630 (0.568-0.691), 0.623 (0.566-0.680)]. These findings were consistently replicated in the internal validation of the testing set. In both the training and testing sets, Delong's test showed that the AUC of the nomogram model was significantly higher than the SOFA score and sPESI (both P < 0.05). CONCLUSION The nomogram model demonstrated good predictive effectiveness for the risk of in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism, enabling clinicians to predict mortality risk in advance and take timely interventions to reduce mortality.
Humans ; Pulmonary Embolism/mortality* ; Hospital Mortality ; Nomograms ; Sepsis/complications* ; Prognosis ; Risk Factors ; Intensive Care Units ; Male ; Female ; Middle Aged ; Aged

Objective:To explore the association between albumin-corrected serum calcium (ACSC) levels and 30-day all-cause mortality in patients hospitalized for community-acquired bacterial pneumonia (CABP).Methods:A secondary analysis was conducted on 1 899 patients with CABP from a Norwegian cohort study. The relationship between baseline ACSC levels and 30-day mortality was assessed using multivariable logistic regression models, adjusted for potential confounders.Results:A significant positive correlation was found between ACSC levels and 30-day mortality risk after adjusting for confounding variables ( OR=1.95, 95% CI=1.48-2.58). When ACSC levels were categorized into tertiles (T1-T3), a trend analysis revealed that the T2 and T3 groups had significantly higher mortality risks compared to the lowest tertile (T1), with odds ratios ( OR) and 95% confidence intervals ( CI) of 1.52(95% CI: 0.97-2.38) and 2.21 (95% CI: 1.44-3.39), respectively ( P for trend <0.001). Subgroup analyses demonstrated no significant interactions across predefined subgroups (all P for interaction > 0.05). Conclusions:In patients with CABP and admission ACSC levels of ≥8.6 mg/dL, higher ACSC levels were positively associated with an increased risk of 30-day mortality. These findings highlight the potential prognostic value of ACSC levels in CABP patients.

Objective:s To investigate the risk factors for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in patients with acute carbon monoxide poisoning (ACOP) and to develop predictive models based on machine learning algorithms.Methods:Patients with ACOP hospitalized at the First Affiliated Hospital of Zhengzhou University from August 2019 to October 2024 were included, with the occurrence of DEACMP as the outcome measure. The dataset was randomly divided into training and validation sets at a ratio of 7:3. Lasso regression was used to select features influencing the outcome in training sets. Nine machine learning models—including Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Machine (SVM)—were constructed. Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) calculated for each model. Calibration curves were used to assess accuracy, and decision curve analysis (DCA) was applied to evaluate clinical utility. The SHapley Additive exPlanations (SHAP) method was employed to visualize and interpret the best-performing model.Results:A total of 264 ACOP patients were included, of whom 54 (20.5%) developed DEACMP. Lasso regression identified eight key feature variables. Based on these factors, predictive models were constructed, showing good AUC stability across the nine machine learning models in both training (0.92–0.99) and validation sets (0.85–0.91). The RF model performed best, with an AUC of 0.99 in the training set and 0.90 in the validation set; its calibration curve and DCA curve also demonstrated excellent performance. SHAP analysis of the RF model revealed the importance ranking of factors from highest to lowest as follows: Glasgow Coma Scale (GCS) score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, diastolic blood pressure (DBP), and drinking history.Conclusions:The RF model exhibited the highest predictive performance for DEACMP occurrence in ACOP patients. The influencing factors, ranked in order of importance from highest to lowest, are as follows: GCS score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, DBP, and drinking history.

Objective:To assess the current status of geriatrics department development in public general hospitals at or above the second grade in Shandong province.Methods:A cross-sectional survey was conducted from October 27 to November 3, 2023 using a web-based electronic questionnaire to investigate the current status of geriatrics department development in all public general hospitals at or above the second grade across 16 prefecture-level cities in Shandong province.The survey included participation from medical department staff and managers of geriatric medicine departments.Results:Shandong province has 355 public general hospitals at or above the second grade, of which 337 completed the questionnaire.Among these 337 hospitals, 92.28%(311/337)have established geriatric departments, 83.09%(280/337)have set up geriatric clinics, 69.14%(233/337)have independent geriatric wards, and 71.51%(241/337)have implemented comprehensive geriatric assessments(CGA).Regarding the configuration of geriatric departments, 60.24%(203/337)of hospitals met the requirement of having at least 20 ward beds, 34.42%(116/337)met the doctor-to-bed ratio requirement of at least 0.3, and 22.26%(75/337)met the nurse-to-bed ratio requirement of at least 0.6.Only 13 hospitals met all the requirements for geriatric wards, beds, doctors, and nurses, accounting for 3.86%(13/337)of the participating hospitals.Conclusions:The establishment of geriatrics departments in second-grade or higher public general hospitals in Shandong province has surpassed the national target in China ahead of schedule.Most hospitals have established geriatric clinics and wards and have implemented CGA.However, significant challenges remain, including a shortage of ward beds and a lack of medical staff.

Objective:To explore the relationship between serum phosphate levels and poor prognosis in children with sepsis.Methods:A retrospective cohort study was conducted to the children with sepsis or septic shock admitted to Gansu Provincial Maternal and Child Health Hospital from 2017 to 2023.Based on the pretreatment serum phosphate values of the children，they were divided into hypophosphatemia group，normal blood phosphate group，and hyperphosphatemia group.The clinical data of characteristics,length of hospital stay and regression of septic children in different serum phosphate groups were recorded,and the prognosis of the children was followed up 3 months after discharge from the hospital.The relationship between serum phosphate levels and prognosis of sepsis in children was explored using univariate and multivariate Logistic regression analysis.Results:A total of 200 children aged 0-14 years diagnosed with sepsis were included,of whom 100 cases (50.0%) had hypophosphatemia,43 cases (21.5%) had hyperphosphatemia,and 57 cases (28.5%) had normophosphate status (normophosphate group).Compared with the normophosphate and hypophosphate groups,the proportion of critically ill patients in the pediatric critical illness score of the hyperphosphatemia group was significantly increased.The incidence of septic shock increased by 5.5% and 24.1%,respectively（ P=0.032）.The duration of mechanical ventilation was significantly longer than the other two groups ( P=0.013).Multivariate Logistic regression analysis showed that the 3-month post-discharge mortality rate ( RR=6.960，95% CI 1.580-30.667， P=0.010) and total mortality ( RR=6.880,95% CI 2.038-23.233, P=0.002) of septic children in the hyperphosphatemia group were 6.960 and 6.880 times higher than those in the normophosphate group,and the differences were statistically significant. Conclusion:Elevated serum phosphate levels may be an early warning factor for poor prognosis of sepsis in children,and PICU healthcare professionals should pay attention to this indicator and take timely diagnostic and therapeutic measures to improve the prognosis.

Objective:To explore the relationship between serum phosphate levels and poor prognosis in children with sepsis.Methods:A retrospective cohort study was conducted to the children with sepsis or septic shock admitted to Gansu Provincial Maternal and Child Health Hospital from 2017 to 2023.Based on the pretreatment serum phosphate values of the children，they were divided into hypophosphatemia group，normal blood phosphate group，and hyperphosphatemia group.The clinical data of characteristics,length of hospital stay and regression of septic children in different serum phosphate groups were recorded,and the prognosis of the children was followed up 3 months after discharge from the hospital.The relationship between serum phosphate levels and prognosis of sepsis in children was explored using univariate and multivariate Logistic regression analysis.Results:A total of 200 children aged 0-14 years diagnosed with sepsis were included,of whom 100 cases (50.0%) had hypophosphatemia,43 cases (21.5%) had hyperphosphatemia,and 57 cases (28.5%) had normophosphate status (normophosphate group).Compared with the normophosphate and hypophosphate groups,the proportion of critically ill patients in the pediatric critical illness score of the hyperphosphatemia group was significantly increased.The incidence of septic shock increased by 5.5% and 24.1%,respectively（ P=0.032）.The duration of mechanical ventilation was significantly longer than the other two groups ( P=0.013).Multivariate Logistic regression analysis showed that the 3-month post-discharge mortality rate ( RR=6.960，95% CI 1.580-30.667， P=0.010) and total mortality ( RR=6.880,95% CI 2.038-23.233, P=0.002) of septic children in the hyperphosphatemia group were 6.960 and 6.880 times higher than those in the normophosphate group,and the differences were statistically significant. Conclusion:Elevated serum phosphate levels may be an early warning factor for poor prognosis of sepsis in children,and PICU healthcare professionals should pay attention to this indicator and take timely diagnostic and therapeutic measures to improve the prognosis.

Objective:To assess the current status of geriatrics department development in public general hospitals at or above the second grade in Shandong province.Methods:A cross-sectional survey was conducted from October 27 to November 3, 2023 using a web-based electronic questionnaire to investigate the current status of geriatrics department development in all public general hospitals at or above the second grade across 16 prefecture-level cities in Shandong province.The survey included participation from medical department staff and managers of geriatric medicine departments.Results:Shandong province has 355 public general hospitals at or above the second grade, of which 337 completed the questionnaire.Among these 337 hospitals, 92.28%(311/337)have established geriatric departments, 83.09%(280/337)have set up geriatric clinics, 69.14%(233/337)have independent geriatric wards, and 71.51%(241/337)have implemented comprehensive geriatric assessments(CGA).Regarding the configuration of geriatric departments, 60.24%(203/337)of hospitals met the requirement of having at least 20 ward beds, 34.42%(116/337)met the doctor-to-bed ratio requirement of at least 0.3, and 22.26%(75/337)met the nurse-to-bed ratio requirement of at least 0.6.Only 13 hospitals met all the requirements for geriatric wards, beds, doctors, and nurses, accounting for 3.86%(13/337)of the participating hospitals.Conclusions:The establishment of geriatrics departments in second-grade or higher public general hospitals in Shandong province has surpassed the national target in China ahead of schedule.Most hospitals have established geriatric clinics and wards and have implemented CGA.However, significant challenges remain, including a shortage of ward beds and a lack of medical staff.

Objective:To investigate the clinicopathological features, diagnosis, and prognosis of renal solitary fibrous tumor (SFT).Methods:Five cases of renal SFT with unequivocal diagnoses at the Affiliated Hospital of Qingdao University between January 2011 and July 2025 were subject to analyses of their clinical, morphological, immunophenotypic, and molecular characteristics, accompanied by a literature review.Results:Two males and three females aged between 45 and 62 years were included, all of whom presented with the discovery of a renal mass during routine physical examinations. Gross examination showed that the five tumors were all confined in the kidney. The tumors were nodular with maximum diameters ranging from 2.5 cm to 11.0 cm (mean, 5.8 cm). Upon cross-sectioning, they exhibited gray-white or gray-yellow cut surface. Histologically, the tumor cells exhibited oval or short spindle shapes in four cases, presenting with varying densities and arranged in short bundles, woven patterns, and irregular formation. Various amounts of coarse collagen and scattered staghorn blood-vessels were found in the stroma. In one case (case 5), the tumor cells were long spindle-shaped, densely organized in bundles, and interwoven, exhibiting inconspicuous boundaries, moderate nuclear atypia, and at least 4 mitotic figures per 10 high-power fields. Irregular patchy collagen deposition was particularly prominent at the edges of the tumor tissue. In two cases (cases 3 and 5), scattered and various amounts of renal tubules were observed in the tumor. Two cases (cases 4 and 5) demonstrated focal invasion of the renal parenchyma, although no necrosis was noted. Immunohistochemical staining showed that the tumor cells were diffusely and strongly positive for vimentin and STAT6 in all 5 cases, and positive for CD34. Bcl-2 positivity was present in 4 of the 5 cases. All cases were negative for CKpan, EMA, PAX8, HMB45, Melan A, SMA, and S-100 protein. The p53 status was wild type, and the Ki-67 index ranged from 1% to 8%. Next-generation sequencing was conducted on one case (case 4), revealing the NAB2 (exon 3)::STAT6 (exon 18) gene fusion. The 5 patients were followed up for 1 to 158 months (mean, 56 months), and all were alive with no recurrence or metastasis.Conclusions:SFT of the kidney are rare and morphologically similar to extrarenal SFT. Key morphological features include short spindle-shaped tumor cells arranged in bundles, interwoven patterns or irregularly, accompanied by staghorn blood-vessels and scattered coarse hyaline collagen fibers. SFT with epithelial inclusions may represent a relatively common histological subtype in the kidney. Immunohistochemical staining that demonstrates diffuse and strong positivity for STAT6 and CD34 is instrumental in diagnosing this tumor. The pathogenesis is linked to the centromeric inversion of chromosome 12q, resulting in the fusion of the NAB2 and STAT6 genes. Most of these tumors exhibit favorable prognosis.