OBJECTIVE To explore the influencing factors for immune-related endocrine toxicity in the treatment of malignant solid tumors with sintilimab， aiming to provide a reference for rational drug use. METHODS Case data were collected from patients with malignant solid tumors， who were treated with sintilimab at the First Affiliated Hospital of Jinzhou Medical University from January 1， 2020 to December 31， 2024， using the electronic medical record system. The patients were divided into an endocrine immune-related adverse events （irAEs） group and a non-endocrine irAEs group based on whether they developed immune-related endocrine toxicity after sintilimab administration. The statistical significance of predictive variables was examined through univariate and multivariate Logistic regression methods. RESULTS A total of 224 patients were enrolled， including 138 cases （61.6%） in the non-endocrine irAEs group and 86 cases （38.4%） in the endocrine irAEs group. After univariate and multivariate Logistic regression analysis， a treatment period of 1-12 cycles was identified as an independent influencing factor for immune-related endocrine toxicity [OR＝7.175， 95%CI （1.239， 41.563）， P ＜0.05 ] ， immune-related hyperglycemia [OR＝6.600， 95%CI （1.053， 41.359）， P ＜0.05 ] ， and immune-related subclinical hypothyroidism [OR＝20.200， 95%CI （3.224， 126.558）， P ＜0.05 ] . The combination with paclitaxel-based drugs was identified as an independent influencing factor for immune-related subclinical hyperthyroidism [OR＝6.410， 95%CI （1.790， 22.955）， P ＜0.05 ] . CONCLUSIONS Among patients treated with sintilimab， the treatment cycle is a risk factor for immune-related endocrine toxicity， immune-related hyperglycemia and immune-related subclinical hypothyroidism. The combination of paclitaxel-based drugs is a risk factor for immune-related subclinical hyperthyroidism. It is recommended that when applying sintilimab in clinical practice， especially during the first few treatment cycles， the relevant endocrine indicators should be dynamically monitored in a standardized manner. In addition， special attention should be paid to patients treated with the combination of paclitaxel-based drugs to be vigilant against the occurrence of endocrine adverse events.

Objective To investigate the relationship between prolactin and mild cognitive impairment(MCI)in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods A total of 319 postmenopausal women with T2DM who were hospitalized in the Department of Endocrinology,Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University were enrolled in this study from August 2016 to October 2023.All the patients were divided into two groups according whether they had MCI:T2DM group(n=161)and MCI group(n=158).Differences in clinical characteristics were compared between the two groups.Pearson correlation was used to analyze the correlation between sex hormones and cognitive domains,and Logistic regression analysis was used to evaluate the influencing factors for MCI development.Results Serum prolactin levels were significantly lower in the MCI group than in the T2DM group[(5.5±2.1)vs(7.2±2.9)μg/L,P<0.05].Serum prolactin level was positively correlated with mini-mental state examination score,Montreal cognitive assessment score,immediate memory score,visuopatial constructional score,attention score and hippocampal volume(P<0.05),and negatively correlated with processing speed test(time)and executive function test(time)(P<0.05).Logistic regression analysis demonstrated that serum prolactin level was an influencing factor for the risk of MCI in postmenopausal women with T2DM(OR 0.715,95%CI 0.605～0.845,P<0.01).Conclusions The decrease of serum prolactin level is associated with an increased risk of MCI in postmenopausal women with T2DM.

Objective To investigate the relationship between prolactin and mild cognitive impairment(MCI)in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods A total of 319 postmenopausal women with T2DM who were hospitalized in the Department of Endocrinology,Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University were enrolled in this study from August 2016 to October 2023.All the patients were divided into two groups according whether they had MCI:T2DM group(n=161)and MCI group(n=158).Differences in clinical characteristics were compared between the two groups.Pearson correlation was used to analyze the correlation between sex hormones and cognitive domains,and Logistic regression analysis was used to evaluate the influencing factors for MCI development.Results Serum prolactin levels were significantly lower in the MCI group than in the T2DM group[(5.5±2.1)vs(7.2±2.9)μg/L,P<0.05].Serum prolactin level was positively correlated with mini-mental state examination score,Montreal cognitive assessment score,immediate memory score,visuopatial constructional score,attention score and hippocampal volume(P<0.05),and negatively correlated with processing speed test(time)and executive function test(time)(P<0.05).Logistic regression analysis demonstrated that serum prolactin level was an influencing factor for the risk of MCI in postmenopausal women with T2DM(OR 0.715,95%CI 0.605～0.845,P<0.01).Conclusions The decrease of serum prolactin level is associated with an increased risk of MCI in postmenopausal women with T2DM.

Objective To investigate the value of the absolute number of lymphocyte subpopulations as an early warning indicator for children with SMPP(severe mycoplasma pneumonia,SMPP)and to analyze the character-istics observed via bronchoscopy,thereby providing a valuable reference for the early diagnosis of SMPP.Methods This study included 102 children with Mycoplasma pneumoniae pneumonia(MPP),comprising 54 cases of common MPP and 48 cases of SMPP.The lymphocyte subpopulations,clinical characteristics,and laboratory indicators were analyzed.Results There were statistically significant differences between the two groups in the absolute number levels of lymphocyte subpopulations CD3+CD19-T,CD4+T,CD3-CD19+B,CD3-/CD16+CD56+NK cells(P<0.05).The absolute numbers of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells showed negative correlations with serum ferritin,LDH,CRP,and D-D,respectively(P<0.05).Multifactorial logistic regression analysis identified the absolute numbers of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells as independent risk factors for severe Mycoplasma pneumoniae pneumonia(SMPP).ROC analysis demonstrated that the areas under the curve for diagnosing SMPP based on the absolute numbers of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells were 0.711,0.887,0.856,and 0.860,respectively,with sensitivities of 47.4%,80.8%,82.1%,and 92.3%,and specificities of 89.7%,87.2%,75%,and 70.5%,respectively.The combined ROC curve of the four lymphocyte subsets had an area of 0.983,with a sensitivity of 97.4%and specificity of 92.3%.The proportions of bronchoscopy findings and microscopic examination of mucus plugs in the SMPP group were significantly higher than those in the ordinary MPP group(P<0.05).In the mucoid plug subgroup,the absolute numbers of CD3?CD19?T cells and CD4?T cells were significantly lower compared to the non-mucoid plug subgroup,while the percentage of CD8?T cells increased and the CD4?/CD8? ratio decreased(all P<0.05).Conclusions The absolute number of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells in peripheral blood serves as a highly sensitive and specific predictor of small airway mucus plugging phenomenon(SMPP)and can thus be utilized as a potential biomarker for SMPP.Microscopic analysis under SMPP conditions reveals a high prevalence of mucus plugs,necessitating proactive bronchoscopic intervention.Furthermore,the significant imbalance in T cell subpopulations is strongly correlated with the formation of mucus plugs observed during bronchoscopy.

Objective:To analyze the prognostic value of systemic inflammatory score (SIS) in patients with unresectable stage Ⅲ non-small cell lung cancer (NSCLC) treated by definitive chemoradiotherapy (dCRT) combined with or without consolidation immunotherapy with immune checkpoint inhibitor (ICI).Methods:The medical record data of 229 patients who received dCRT from January 2014 to December 2017 and 183 patients who received dCRT combined with any form of ICI (induction, concurrent, consolidation or combination) from August 2018 to August 2022 in the Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. Upon admission, 1 and 3 months after treatment (efficacy evaluation) and upon tumor recurrence, peripheral blood count was collected, and neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and SIS were calculated, respectively. The SIS before, 1 and 3 months after treatment was defined as SIS 0, SIS 1 and SIS 3, respectively. Overall survival (OS) was considered as the primary endpoint. All patients were divided into dCRT group and dCRT+ICI group according to whether received immunotherapy, and then divided into different subgroups based on the cutoff value of SIS determined by X-Tile software. The prognostic value of SIS was evaluated by Kaplan-Meier survival analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficiency. The predictive value of SIS was compared with inflammatory indexes (NLR, PLR) and independent prognostic factors. Results:In the dCRT group, the optimal cutoff value of SIS 0 was 590×10 9 and 530×10 9 in the dCRT+ICIs group. Univariate and multivariate analyses indicated that SIS 0 was an independent predictive factor of OS, progression - free survival (PFS), local - recurrence free survival (LRFS) and distant metastasis free survival (DMFS) in the dCRT group, but not associated with DMFS in the dCRT+ICI group. In the dCRT group, SIS 1>970×10 9 (optimal cutoff value) predicted poor OS ( HR=2.512, 95% CI=1.622-3.198, P<0.001), PFS ( HR=1.726, 95% CI=1.187-2.509, P=0.004), and DMFS ( HR=1.625, 95% CI=1.029-2.564, P=0.037). In the dCRT+ICI group, SIS 3>1570×10 9 (optimal cutoff value) indicated poor OS ( HR=5.107, 95% CI=1.731-15.069, P=0.003). In both groups, the AUC of SIS was higher than NLR, PLR and other traditional clinicopathological predictive indexes except T stage. Conclusions:SIS before treatment can be considered as an independent, dependable and easily acquired prognostic marker in patients with unresectable stage Ⅲ NSCLC treated by dCRT or dCRT+ICI. In the dCRT+ICI group, the optimal time point of post-radiotherapy SIS (3 months after treatment) is postponed than that (1 month after treatment) in the dCRT group.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Background and purpose:Human papilloma virus(HPV)infection status is crucial for diagnosing cervical precancerous lesions and classifying cervical cancer.High-risk(HR)HPV is often linked to P16 protein overexpression,so P16 detection via immunohistochemistry(IHC)is commonly used to assess HPV infection.However,the differences between HPV status and P16 expression remains unclear.An in-depth study of the correlation between HPV and P16 is essential for clinical guidance.Methods:We retrospectively collected clinical and pathological data of cervical lesions from 618 patients diagnosed at the Department of Pathology,Fudan University Shanghai Cancer Center from January 2020 to December 2023(Ethical number:050432-4-2307E).Polymerase chain reaction(PCR)reverse dot hybridization was used to detect HPV including HR and low-risk(LR)subtypes,and immunohistochemistry was used to detect P16 for comparative analysis.Based on different clinical and pathological diagnoses,the sensitivity and specificity of P16 expression in evaluating HPV infection were evaluated.Among the 618 cases of cervical lesions,there were 92 cases of cervical squamous cell carcinoma,257 cases of cervical adenocarcinoma,79 cases of high-grade squamous intraepithelial lesions(HSIL),105 cases of low-grade squamous intraepithelial lesions(LSIL),and 85 cases of chronic cervical inflammation.Results:According to clinical diagnosis,the HR-HPV positive rate in cervical squamous cell carcinoma was 88.0%(81/92),the P16 positive rate was 91.3%(84/92),and the overall consistency rate between P16 and HPV detection was 90.2%(88/92);for HR-HPV infection,the sensitivity and specificity of P16 were 96.3%and 45.5%.The positive rate of HR-HPV in adenocarcinoma was 54.5%(140/257),the positive rate of P16 was 58.8%(151/257),and the overall consistency rate between P16 and HPV detection was 82.5%(212/257);for HR-HPV infection,the sensitivity and specificity of P16 were 87.9%and 76.1%.In HSIL,the HR-HPV positive rate was 75.9%(60/79),the positive rate of P16 was 70.9%(56/79),and the overall consistency rate between P16 and HR-HPV detection was 82.2%(65/79);for HR-HPV infection,the sensitivity and specificity of P16 were 85.0%and 73.7%.In LSIL,the HR-HPV positive rate was 73.3%(77/105),the positive rate of P16 was 8.5%(9/105),and the overall consistency rate between P16 and HR-HPV detection was 33.3%(35/105);for HR-HPV infection,the sensitivity and specificity of P16 were 10.4%and 96.4%.In chronic cervical inflammation,the HR-HPV positive rate was 20%(17/85),the positive rate of P16 was 0.0%(0/85);for HR-HPV infection,the sensitivity and specificity of P16 were 0.0%and 100.0%.There was a significant positive correlation between P16 positivity and HPV16/18 in cervical squamous cell carcinoma,adenocarcinoma,and HSIL(P=0.000),while there was no significant correlation in LSIL and chronic cervical inflammation(P＞0.05).Conclusion:In cervical squamous cell carcinoma and adenocarcinoma,the consistency of P16 expression and HPV DNA positivity are high,especially in HPV16/18 subtype.There is a good concordance between HR-HPV positivity and P16 protein overexpression.The positive expression of P16 in HSIL may initially reflect HPV infection status.However,in LSIL and chronic cervicitis,P16 expression may not accurately correlate with HPV infection.The inconsistency between P16 and HPV DNA testing could be influenced by multiple factors,including HPV subtypes,histopathological categories,specimen quality,and technical limitations.In clinical practice,it is recommended to conduct comprehensive analysis or employ multiple diagnostic methods to confirm HPV infection status for precise evaluation.

Objective To investigate the value of the absolute number of lymphocyte subpopulations as an early warning indicator for children with SMPP(severe mycoplasma pneumonia,SMPP)and to analyze the character-istics observed via bronchoscopy,thereby providing a valuable reference for the early diagnosis of SMPP.Methods This study included 102 children with Mycoplasma pneumoniae pneumonia(MPP),comprising 54 cases of common MPP and 48 cases of SMPP.The lymphocyte subpopulations,clinical characteristics,and laboratory indicators were analyzed.Results There were statistically significant differences between the two groups in the absolute number levels of lymphocyte subpopulations CD3+CD19-T,CD4+T,CD3-CD19+B,CD3-/CD16+CD56+NK cells(P<0.05).The absolute numbers of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells showed negative correlations with serum ferritin,LDH,CRP,and D-D,respectively(P<0.05).Multifactorial logistic regression analysis identified the absolute numbers of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells as independent risk factors for severe Mycoplasma pneumoniae pneumonia(SMPP).ROC analysis demonstrated that the areas under the curve for diagnosing SMPP based on the absolute numbers of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells were 0.711,0.887,0.856,and 0.860,respectively,with sensitivities of 47.4%,80.8%,82.1%,and 92.3%,and specificities of 89.7%,87.2%,75%,and 70.5%,respectively.The combined ROC curve of the four lymphocyte subsets had an area of 0.983,with a sensitivity of 97.4%and specificity of 92.3%.The proportions of bronchoscopy findings and microscopic examination of mucus plugs in the SMPP group were significantly higher than those in the ordinary MPP group(P<0.05).In the mucoid plug subgroup,the absolute numbers of CD3?CD19?T cells and CD4?T cells were significantly lower compared to the non-mucoid plug subgroup,while the percentage of CD8?T cells increased and the CD4?/CD8? ratio decreased(all P<0.05).Conclusions The absolute number of CD3+CD19-T,CD4+T,CD3-CD19+B,and CD3-/CD16+CD56+NK cells in peripheral blood serves as a highly sensitive and specific predictor of small airway mucus plugging phenomenon(SMPP)and can thus be utilized as a potential biomarker for SMPP.Microscopic analysis under SMPP conditions reveals a high prevalence of mucus plugs,necessitating proactive bronchoscopic intervention.Furthermore,the significant imbalance in T cell subpopulations is strongly correlated with the formation of mucus plugs observed during bronchoscopy.