Objective:To investigate the feasibility of the bortezomib, lenalidomide, and dexamethasone (VRD) regimen combined with autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with multiple myeloma (MM) and renal impairment, analyze treatment efficacy and renal responses stratified based on renal dysfunction severity, and explore the prognostic significance of early renal response and its affecting factors.Methods:This retrospective study, conducted at the First Affiliated Hospital of Soochow University, categorized 316 patients with newly diagnosed MM (NDMM) from August 2018 to October 2022 based on renal function for analysis of clinical characteristics, treatment response, and prognosis. Continuous variables were compared using t-tests or Mann-Whitney U tests, categorical variables utilizing Chi-square tests, survival outcomes employing Kaplan-Meier and Log-rank tests, and renal response predictors with logistic regression.Results:Patients were stratified based on baseline estimated glomerular filtration rate (eGFR) : normal [≥90 ml·min -1· (1.73 m 2) -1, n=160], mild [≥60 ml·min -1· (1.73 m 2) -1 to <90 ml·min -1· (1.73 m 2) -1, n=55], moderate [≥30 ml·min -1· (1.73 m 2) -1 to <60 ml·min -1· (1.73 m 2) -1, n=39], and severe impairment [<30 ml·min -1· (1.73 m 2) -1, n=62]. Moderate and severe renal impairment correlated with advanced International Staging System/Revised International Staging System classification, lower hemoglobin levels, frailty, and higher light-chain/IgD subtype prevalence ( P<0.05). Despite younger age ( P=0.001) and higher transplant rates ( P=0.041) in severe cases, overall response rates ( ORR: 93.7% ; ≥VGPR: 82.9% ) were comparable across groups ( P>0.05). Among 24 dialysis-dependent patients at diagnosis, 11 (45.8% ) achieved dialysis independence after induction [median: 3.0 (0.5–4.0) months], including 10 undergoing auto-HSCT. In 89 evaluable patients [baseline eGFR <50 ml·min -1· (1.73 m 2) -1], renal ORR (RORR) was 70.8% [rapid complete response: 31.5% ; rapid partial response: 11.2% ; rapid minimal response (RMR) : 28.1% ]. Renal response predicted better survival (overall survival: HR=0.36, 95% CI: 0.13–0.99, P=0.049). Moderate-to-severe renal impairment was associated with increased transplant-related adverse events and delayed engraftment ( P<0.05) ; however, auto-HSCT significantly improved outcomes after 33.5-month median follow-up (range: 2–65 months). Multivariate analysis identified 1q21+ ( OR=3.58, 95% CI: 1.17–11.02, P=0.026) and light-chain subtype ( OR=2.86, 95% CI: 1.08–7.69, P=0.036) as independent predictors of poor renal response. Conclusion:VRD regimen plus auto-HSCT demonstrates robust efficacy in NDMM, including patients with renal impairment, with a 70.8% RORR and manageable toxicity. Achieving ≥RMR correlates with superior prognosis, whereas 1q21+ and light-chain subtype independently predict inferior renal response.

Objective:To explore the relationship between Metabolic Score of Visceral Fat(METS-VF)and new-onset stroke in Chinese middle-aged and elderly individuals aged ≥45 years.Methods:This study is a prospective cohort study that included 3 311 participants from the China Health and Retirement Longitudinal Study(CHARLS)database, with new-onset stroke as the primary endpoint.The association between METS-VF and new-onset stroke was evaluated by Cox proportional hazards model, subgroup analysis and restricted cubic spline(RCS)analysis.Additionally, mediation analysis was used to assess the mediating effect of remnant cholesterol(RC)on the association between METS-VF and stroke.Results:During the 9-year follow-up period, 138(4.2%)middle-aged and elderly individuals experienced stroke.Compared with the lowest quartile group of METS-VF, the fully adjusted HR and 95% CI of new-onset stroke in the second, third and fourth quartiles were 1.78(1.03-3.08), 1.96(1.12-3.44)and 2.19(1.17-4.10), respectively with a statistically significant trend( P for trend<0.05). Mediation analysis indicated that the indirect effect mediated by RC accounted for 13.51% of the association between METS-VF and new-onset stroke( P=0.03), and RCS analysis revealed a linear dose-response relationship between METS-VF and stroke( P for overall=0.022, P for non-linearity=0.198); The results of the subgroup analyses were consistent with the main analyses( P interaction>0.05). Conclusions:METS-VF may serve as a potential biomarker in risk stratification of stroke, with RC partially mediating this association.

Glucagonoma is a rare neuroendocrine tumor derived from the pancreatic α cells, and alopecia is an uncommon clinical manifestation. We report a case of glucagonoma presenting with marked alopecia, aiming to raise clinicians′ awareness of this rare presentation.

Objective:To develop a method of employing flow cytometry to directly detect the γ-H2AX expression levels in peripheral blood lymphocytes of mice through fixation and lysis and to evaluate the feasibility of applying this method to research on the radiation-related biological effects and the efficacy evaluation of radioprotective drugs.Methods:A total of 41 male C57BL/6J mice were used. First, 21 mice were randomly divided into 7 groups according to different radiation doses (0, 1, 2, 4, 6, 8, and 10 Gy) with 3 mice in each group. Blood samples were collected from the tail vein of mice at 1, 4, 8, and 24 h after irradiation and immediately fixed with formaldehyde. Red blood cells (RBC) were lysed with Triton X-100, and γ-H2AX was labeled with specific antibodies. DRAQ5 dye was used to further exclude debris and anucleate cells. The mean fluorescence intensity of γ-H2AX in lymphocyte populations was directly analyzed by flow cytometry through forward and side scatter, and dose-effect curves after irradiation were established. Then, the other 20 mice were divided into radiation alone groups and radiation combined with WR-2721 administration groups at 4 and 6 Gy, respectively, with 5 mice in each group. Blood samples were collected from the tail vein of mice at 1, 4, 8, and 24 h after irradiation to detect the average fluorescence intensity of γ-H2AX in lymphocytes, which was used to evaluate the degree of DNA damage in mice and the therapeutic effect of WR-2721.Results:The expression of γ-H2AX in peripheral blood lymphocytes of mice significantly increased with the increase of radiation doses, and reached a peak at 1-2 h and then decreased. The dose-effect relationship was significant ( R2 = 0.9914). At 24 h after 4 and 6 Gy irradiation, compared with the radiation alone groups, the average fluorescence intensity of γ-H2AX in the radiation combined with WR-2721 administration groups was lower (144.8 ± 8.0 and 109.5 ± 9.7, vs. 178.0 ± 18.5 and 136.6 ± 5.4), with statistically significant difference ( t = 3.78, 5.48, P < 0.05). The average fluorescence intensity of γ-H2AX at 24 h after irradiation was consistent with the lowest values of the three blood cell lines at 7 or 14 d after irradiation. Conclusions:The application of flow cytometry with a fixation/dissolution protocol to directly detect the mean fluorescence intensity of γ-H2AX in peripheral blood lymphocytes of mice has significant application value in radiation biology effect research, radiation protection drug screening, and efficacy evaluation.

Objective To investigate the expression of serum tumor-associated antigens(TAAs)in patients with rheumatoid arthritis(RA)and analyze their clinical significance for RA.Methods A total of 214 RA patients were enrolled in the RA group,while 198 age-and gender-matched healthy individuals were included in the HC group.Rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(Anti-CCP),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleu-kin-6(IL-6),ferritin levels,as well as gender,age,disease duration,disease activity score(DAS28)and clinical manifestations were collected from the RA group.The expression of TAAs in RA patients and the clinical characteristics of TAA-positive patients were analyzed.Spearman correla-tion analysis was used to evaluate the relationships between TAAs and clinical indicators in RA pa-tients.Results The positive rate of carbohydrate antigen 125(CA125)in the RA group was 8.88％,which was significantly higher than 1.01％ in the HC group(P＜0.001).Serum CA125 and cytok-eratin fragment 19(CYFRA21-1)levels in the RA group were significantly higher than those in the HC group,whereas alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate anti-gen 199(CA199)and neuron-specific enolase(NSE)levels were significantly lower(P＜0.001).TAA-positive patients had significantly older age and higher rates of pulmonary interstitial lesions compared to TAA-negative patients(P＜0.05).Patients with DAS28 scores＞5.1 had significantly higher CA125 levels than those with DAS28 scores ≤5.1(P＜0.05).CA125 levelswere positively corre-lated with DAS28 scores,ESR,RF,and anti-CCP antibodies(r=0.142,0.140,0.268,0.183;P＜0.05).Conclusion In RA patients,the positivity rate and levels of some serum TAAs are ele-vated,and TAA-positive patients tend to be older and have higher incidence of pulmonary interstitial lesions.CA125 levels are positively correlated with RA disease activity.

This paper reports a case of disseminated intravascular coagulation(DIC) that occurred early after hybrid surgery for type B aortic dissection with an aortic arch aneurysm. Through analyzing the clinical manifestations, imaging findings, and treatment response of the patient, we propose that massive false-lumen thrombosis may serve as a critical trigger for early postoperative coagulation activation leading to DIC. Corresponding treatment strategies are suggested to enhance clinicians' ability to recognize and manage this critical condition.

Objective:To systematically evaluate the qualitative study on real experiences of HIV/AIDS adolescents transitioning to adult healthcare.Methods:The qualitative research on the real experiences of HIV/AIDS adolescents transitioning to adult healthcare was electronically searched in PubMed, Web of Science, CINAHL, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The search period was from January 1, 2010, to November 5, 2024. The methodological quality of the included literature was evaluated according to the Joanna Briggs Institute Center for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research. The results were synthesized through the aggregate integration method.Results:A total of 11 articles were included, 52 outcomes were distilled, and similar outcomes were grouped into nine new categories, which were synthesized to form three integrative outcomes (attitudes toward transitioning to adult healthcare, multiple dilemmas faced in transitioning to adult healthcare, and need for comprehensive support during transition to adult healthcare) .Conclusions:HIV/AIDS adolescents have complex attitudes about transitioning to adult healthcare and face multifaceted challenges in the transition process. Healthcare professionals should pay attention to the real experiences of adolescents during the transition period and work with parents and peers to provide holistic support, and meet the diverse needs of adolescents.

Objective:To compare the clinical outcomes of immediate breast reconstruction using latissimus dorsi flap with implant versus mesh with implant based on BREAST-Q evaluation.Methods:From the clinical database of the First Affiliated Hospital of Nanjing Medical University, the patients who underwent immediate breast reconstruction after total mastectomy from January 2020 to December 2023 were selected as the research subjects. All breast reconstruction surgeries were performed by the same surgeon. Patients were divided into two groups according to surgical methods: the latissimus dorsi muscle flap combined with implant immediate breast reconstruction group (LD group) and the mesh combined with implant immediate breast reconstruction group (mesh group). Patients were followed up in outpatient clinics or by telephone one year after surgery. The BREAST-Q was used to evaluate the surgical outcomes of both groups from four dimensions: psychosocial well-being, sexual well-being, chest-physical well-being, and breast satisfaction. The score range for each dimension was 0-100, with higher scores indicating greater patient satisfaction with quality of life and surgical outcomes. Statistical analysis was performed using SPSS 22.0 software. Normally distributed measurement data were expressed as Mean ± SD, and comparisons between the two groups were performed using independent sample t-test. Count data were expressed as number of cases and percentages, and comparisons between groups were performed using chi-square test or Fisher’s exact test. P<0.05 was considered statistically significant. Results:A total of 123 patients were included, with 59 patients in the LD group and 64 patients in the mesh group. In the LD group, the mean age was (37.7±7.0) years, body mass index (BMI) was (22.6±2.6) kg/m 2, and clinical tumor staging showed 2, 22, 30, and 5 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. In the mesh group, the mean age was (39.1±7.0) years, BMI was (22.6±2.8) kg/m 2, and clinical tumor staging showed 1, 25, 38, and 0 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. There were no statistically significant differences between the two groups in baseline characteristics including age, BMI, and clinical tumor staging (all P>0.05). One year after surgery, the BREAST-Q result showed no statistically significant differences between the LD group and mesh group in psychosocial well-being [(83.0±19.8) points vs. (80.8±19.3) points] and sexual well-being [(62.1±30.4) points vs. (65.8±25.6) points] (all P>0.05). However, the LD group had lower chest-physical well-being scores than the mesh group [(40.6±9.7) points vs. (45.1±9.6) points, P<0.05], while breast satisfaction scores were higher in the LD group than in the mesh group [(68.0±17.8) points vs. (59.8±12.6) points, P<0.01]. Conclusion:Immediate breast reconstruction by both latissimus dorsi flap with implant and mesh with implant can improve patients’ psychosocial and sexual well-being by enhancing breast appearance. However, LD technique provides better breast satisfaction, while the mesh technique offers advantages in physical well-being of the chest wall and upper body. Surgeons should select the most appropriate breast reconstruction technique based on patients’ anatomical conditions, treatment history, and individual needs to optimize postoperative quality of life and satisfaction.

Purpose To evaluate the predictive performance of mean apparent propagator-magnetic resonance imaging(MAP-MRI)combined with habitat analysis for determining O6-methylguanine-DNA methyltransferase(MGMT)promoter methylation status in glioma.Materials and Methods This retrospective study analyzed MRI and clinical data from 55 patients with surgically confirmed glioma at Fujian Medical University Union Hospital from January 2019 to December 2023.All patients underwent structural and diffusion-weighted imaging.Three-dimensional volumes of interest were delineated in the tumor solid region using ImageJ software.The nn-FAE tool was used to segment the tumor solid region into two habitat subregions based on mean diffusivity(MD)maps:high-MD and low-MD habitats.Average diffusion parameter values were extracted from the entire tumor solid region and each habitat subregion.Differences in parameters between methylated and unmethylated groups were compared,and the area under the curve was calculated.Results Among 55 patients,significant differences were observed in all MAP-MRI parameters and MD in the tumor solid region and low-MD habitat,as well as all parameters in the high-MD habitat between methylated and unmethylated groups(t/Z=-3.780-3.153,all P<0.05).The return-to-origin probability(RTOP)in the low-MD habitat demonstrated the highest diagnostic performance,with the area under the curve improving from 0.771 before habitat analysis to 0.827 after habitat analysis.In the high-grade subgroup,significant differences were observed in return-to-axis probability(RTAP)and RTOP in the tumor solid region;RTOP,non-Gaussianity,non-Gaussianity axial,and RTAP in the low-MD habitat;and non-Gaussianity in the high-MD habitat(t/Z=-2.820--1.976,all P<0.05).RTOP in the low-MD habitat again showed optimal diagnostic efficacy(the area under the curve 0.725 before habitat analysis,0.798 after).Multivariate analysis identified RTAP and RTOP in the tumor solid region and low-MD habitat as independent predictors of MGMT methylation.Conclusion MAP-MRI diffusion parameters demonstrate the ability to predict MGMT promoter methylation status in glioma,with superior performance compared with diffusion tensor imaging.Habitat imaging further enhances the predictive efficacy of MAP-MRI parameters for MGMT promoter methylation.

Objective:To construct the prokaryotic expression vector of Coxsackievirus A16(CA16)viral protein 1(Vp1),express it in Escherichia coli(E.coli)BL21,purify the protein,prepare rabbit polyclonal antibodies,and identify the immunoreactivity of the antibodies.Methods:Bioinformatics online tools were used to predict the amino acid composition,conserved domains,secondary and tertiary structures of the Vp1 protein.The Vp1 gene of CA16 was amplified and cloned into the prokaryotic expression vector pET28a(+).The pET28a-Vp1 was transformed into E.coli BL21,and the expression was induced using isopropyl β-D-thiogalactopyranoside(IPTG).Western blotting method was used to identify the induced expression of Vp1 protein,and the induction time and temperature were optimized to improve the expression efficiency.Two female SPF New Zealand white rabbits were taken,and the purified recombinant protein Vp1 was used to immunize the rabbits to prepare rabbit anti-Vp1 protein polyclonal antibodies.The antibody titer was determined by ELISA method,and the immunoreactivity of the antibodies was identified by Western blotting method.Results:The bioinformatics analysis results showed that the Vp1 gene encoded 297 amino acids,with a relative molecular mass of 33 046.39 and an isoelectric point of 8.32,belonging to a hydrophilic protein;in the secondary structure,α-helix accounted for 15.15％,random coil accounted for 67.68％,and extended strand accounted for 17.17％.Sequencing of the recombinant plasmid pET28a-Vp1 confirmed that the pET28a-Vp1 plasmid was correctly constructed.The Western blotting results showed that the target protein was expressed in the IPTG induction group at a relative molecular mass of 33 000,and the target protein was mainly expressed in inclusion bodies.The optimal induction conditions for protein expression were IPTG concentration of 0.4 mmol·L-1,temperature of 16℃,and induction time of 20 h.The ELISA assay results showed that the titer of the rabbit polyclonal antibody was 1:1 024 000.The Western blotting results showed that the Vp1 rabbit polyclonal antibody could bind to the viral Vp1 protein in the CA16-infected cells.Conclusion:The polyclonal antibody against CA16 Vp1 is successfully prepared,and this antibody has significant binding characteristics to CA16 Vp1,which can be used for the diagnosis of enterovirus infection and the development of treatment methods.