Objective:To explore the association between adverse outcomes of preterm infants and obstetric factors such as infection,maternal disease and treatment measures in patients with preterm premature rupture of membranes(PPROM),so as to provide more accurate and effective prediction and intervention methods for im-proving maternal and infant prognosis.Methods:A retrospective analysis was conducted on the clinical data of 534 PPROM patients who gave births in the obstetrics department of The Second Hospital of Tianjin Medical Uni-versity from January 1,2018,to August 31,2023.Based on the presence of severe preterm birth complications in premature infants(including bronchopulmonary dysplasia,necrotizing enterocolitis,retinopathy of prematurity,neonatal infectious pneumonia,neonatal respiratory distress syndrome,neonatal hypoxic-ischemic encephalopa-thy,and neonatal sepsis)or death,the patients were divided into two groups:the adverse outcome group(n=121)and the non-adverse outcome group(n=413).The study compared differences between the two groups in general conditions,pregnancy complications and comorbidities,treatment and management,amniotic fluid and pla-cental infections.Logistics regression analysis was used to identify obstetric factors associated with adverse out-comes in preterm infants.Results:Univariate analysis revealed that patients in the adverse outcome group had smaller gestational weeks at delivery,longer intervals between membrane rupture and delivery,and a lower rate of vaginal delivery compared to those in the non-adverse outcome group.They also had a higher proportion of con-current cervical insufficiency,antepartum hemorrhage,hypertensive disorders of pregnancy,and anemia of preg-nancy.The use of prenatal magnesium sulfate and glucocorticoids for fetal lung maturity promotion before delivery was higher,and the effective coverage rates of prophylactic antibiotics was lower.The positive rates of amniotic fluid bacterial culture,the proportion of clinical chorioamnionitis,and histological chorioamnionitis were higher.All of the above differences were statistically significant(P＜0.05).Multivariate analysis revealed that positive amniotic fluid bacterial culture(OR 4.602,95％CI 2.303-9.196,P＜0.05),anemia of pregnancy(OR 4.192,95％CI 2.064-8.510,P＜0.05),and cervical insufficiency(OR 9.435,95％CI 1.138-78.261,P＜0.05)were independ-ent risk factors for adverse outcomes in preterm infants among PPROM patients,while gestational weeks at deliv-ery(OR0.466,95％CI 0.370-0.586,P＜0.05),effective coverage of prophylactic antibiotics before delivery(OR 0.286,95％CI 0.121-0.673,P＜0.05),and treatment for lung maturity promotion(OR 0.225,95％CI 0.107-0.474,P＜0.05)were protective factors for adverse outcomes in premature infants in PPROM patients.Conclu-sions:The adverse outcomes of preterm infants in PPROM patients are closely related to obstetric factors such as infection,maternal diseases,and treatment measures.Among these,positive amniotic fluid bacterial culture,a-nemia during pregnancy,and cervical insufficiency are independent risk factors for adverse outcomes in premature infants in PPROM patients.On the other hand,gestational age at deli very,effective coverage of prenatal antibiot-ics,and pulmonary maturity promotion therapy are protective factors.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To explore the association between adverse outcomes of preterm infants and obstetric factors such as infection,maternal disease and treatment measures in patients with preterm premature rupture of membranes(PPROM),so as to provide more accurate and effective prediction and intervention methods for im-proving maternal and infant prognosis.Methods:A retrospective analysis was conducted on the clinical data of 534 PPROM patients who gave births in the obstetrics department of The Second Hospital of Tianjin Medical Uni-versity from January 1,2018,to August 31,2023.Based on the presence of severe preterm birth complications in premature infants(including bronchopulmonary dysplasia,necrotizing enterocolitis,retinopathy of prematurity,neonatal infectious pneumonia,neonatal respiratory distress syndrome,neonatal hypoxic-ischemic encephalopa-thy,and neonatal sepsis)or death,the patients were divided into two groups:the adverse outcome group(n=121)and the non-adverse outcome group(n=413).The study compared differences between the two groups in general conditions,pregnancy complications and comorbidities,treatment and management,amniotic fluid and pla-cental infections.Logistics regression analysis was used to identify obstetric factors associated with adverse out-comes in preterm infants.Results:Univariate analysis revealed that patients in the adverse outcome group had smaller gestational weeks at delivery,longer intervals between membrane rupture and delivery,and a lower rate of vaginal delivery compared to those in the non-adverse outcome group.They also had a higher proportion of con-current cervical insufficiency,antepartum hemorrhage,hypertensive disorders of pregnancy,and anemia of preg-nancy.The use of prenatal magnesium sulfate and glucocorticoids for fetal lung maturity promotion before delivery was higher,and the effective coverage rates of prophylactic antibiotics was lower.The positive rates of amniotic fluid bacterial culture,the proportion of clinical chorioamnionitis,and histological chorioamnionitis were higher.All of the above differences were statistically significant(P＜0.05).Multivariate analysis revealed that positive amniotic fluid bacterial culture(OR 4.602,95％CI 2.303-9.196,P＜0.05),anemia of pregnancy(OR 4.192,95％CI 2.064-8.510,P＜0.05),and cervical insufficiency(OR 9.435,95％CI 1.138-78.261,P＜0.05)were independ-ent risk factors for adverse outcomes in preterm infants among PPROM patients,while gestational weeks at deliv-ery(OR0.466,95％CI 0.370-0.586,P＜0.05),effective coverage of prophylactic antibiotics before delivery(OR 0.286,95％CI 0.121-0.673,P＜0.05),and treatment for lung maturity promotion(OR 0.225,95％CI 0.107-0.474,P＜0.05)were protective factors for adverse outcomes in premature infants in PPROM patients.Conclu-sions:The adverse outcomes of preterm infants in PPROM patients are closely related to obstetric factors such as infection,maternal diseases,and treatment measures.Among these,positive amniotic fluid bacterial culture,a-nemia during pregnancy,and cervical insufficiency are independent risk factors for adverse outcomes in premature infants in PPROM patients.On the other hand,gestational age at deli very,effective coverage of prenatal antibiot-ics,and pulmonary maturity promotion therapy are protective factors.

Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

A retrospective analysis was conducted on a MonoMAC syndrome case admitted in October 2022 to the First Affiliated Hospital of Zhejiang University School of Medicine. The patient, a 16-year-old female with a history of persistent monocytopenia and mild anemia for several years, experienced recurrent symptoms of cough, expectoration, and fever, leading to multiple visits to the hospital. The diagnosis of MonoMAC syndrome was confirmed through comprehensive assessments including routine blood tests, pathogen metagenomic sequencing, lung and bone marrow biopsies, and next-generation sequencing of peripheral blood. The patient underwent haploidentical hematopoietic stem cell transplantation, with a smooth course of transplantation, achieving neutrophil engraftment on + 16 d and platelet engraftment on + 17 d, eventually restoring normal monocyte and NK cell counts. MonoMAC syndrome patients often initially present with infectious symptoms, and the diagnosis can be established based on significant monocytopenia in routine blood tests, history of non-tuberculous mycobacterial infections, and GATA2 germline mutations. Allogeneic hematopoietic stem cell transplantation may be required for some patients to improve their prognosis.

Objective To investigate the effect of remimazolam(Rem)on apoptosis of intestinal epithelial cells in burned rats by regulating Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor-κB(NF-κB)signaling pathway.Methods The successfully constructed burned rat model was randomly divided into the model group,the Rem low dose treatment(Rem-L)group,the Rem medium dose treatment(Rem-M)group and the Rem high dose treatment(Rem-H)group,and Rem-H+TLR4 activator(LPS)group.Healthy rats were taken as the control group.After blood samples were collected from tail vein of rats and intestinal tissue samples were taken after euthanasia.Serum levels of inflammatory cytokines interleukin-1β and IL-6 were detected by enzyme-linked immunosorbent assay(ELISA).HE staining was applied to observe the morphology of intestinal tissue.TUNEL detection kit was used to detect apoptosis.Immunohistochemistry was used to detect the expression of tight junction proteins ZO-1 and Occludin.Immunoblotting experiments were used to detect the expression levels of apoptotic proteins Bax and TLR4/MyD88/NF-κB signaling pathway proteins.Results Compared with the control group,cell arrangement was disordered with inflammation,and IL-1β and IL-6 levels and apoptosis rate were increased,expression levels of Bax,TLR4,MyD88 and p-NF-κB/NF-κB were up-regulated,and expression levels of ZO-1 and Occludin were down-regulated in the model group(P＜0.05).Compared with the model group,inflammatory infiltration of intestinal mucosa was gradually reduced in the Rem-L,Rem-M and Rem-H groups,the apoptosis rate,IL-1β and IL-6 levels were decreased,the expression levels of Bax,TLR4,MyD88 and p-NF-κB/NF-κB were down-regulated,and the expression of ZO-1 and Occludin was up-regulated in a dose-dependent manner(P＜0.05).Compared with the Rem-H group,the tissue inflammation was aggravated,the apoptosis rate,levels of IL-1β and IL-6 were increased,expression levels of Bax,TLR4,MyD88 and p-NF-κB/NF-κB were up-regulated,and expression levels of ZO-1 and Occludin were down-regulatedin in the Rem-H+LPS group(P＜0.05).Conclusion Remimazolam may alleviate the damage of intestinal epithelial cells in burned model rats by inhibiting TLR4/MyD88/NF-κB signaling pathway,thus protecting intestinal mucosa.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.