Purpose: The genomic characteristics of uterine sarcomas have not been fully elucidated. This study aimed to explore the genomic landscape of the uterine sarcomas (USs). Materials and Methods: Comprehensive genomic analysis through RNA-sequencing was conducted. Gene fusion, differentially expressed genes (DEGs), signaling pathway enrichment, immune cell infiltration, and prognosis were analyzed. A deep learning model was constructed to predict the survival of US patients. Results: A total of 71 US samples were examined, including 47 endometrial stromal sarcomas (ESS), 18 uterine leiomyosarcomas (uLMS), three adenosarcomas, two carcinosarcomas, and one uterine tumor resembling an ovarian sex-cord tumor. ESS (including high-grade ESS [HGESS] and low-grade ESS [LGESS]) and uLMS showed distinct gene fusion signatures; a novel gene fusion site, MRPS18A–PDC-AS1 could be a potential diagnostic marker for the pathology differential diagnosis of uLMS and ESS; 797 and 477 uterine sarcoma DEGs (uDEGs) were identified in the ESS vs. uLMS and HGESS vs. LGESS groups, respectively. The uDEGs were enriched in multiple pathways. Fifteen genes including LAMB4 were confirmed with prognostic value in USs; immune infiltration analysis revealed the prognositic value of myeloid dendritic cells, plasmacytoid dendritic cells, natural killer cells, macrophage M1, monocytes and hematopoietic stem cells in USs; the deep learning model named Max-Mean Non-Local multi-instance learning (MMN-MIL) showed satisfactory performance in predicting the survival of US patients, with the area under the receiver operating curve curve reached 0.909 and accuracy achieved 0.804. Conclusion USs harbored distinct gene fusion characteristics and gene expression features between HGESS, LGESS, and uLMS. The MMN-MIL model could effectively predict the survival of US patients.

AIM:To explore the role of stromal interaction molecule 1(STIM1)in the migration,invasion and angiogenesis of salivary adenoid cystic carcinoma(SACC),as well as its molecular mechanism.METHODS:Immu-nohistochemistry and Western blot were used to detect the expression level of STIM1 in human SACC tumor tissues and ad-jacent normal tissues.The TCGA database was analyzed to investigate the relationship between STIM1 expression and sur-vival in patients.A SACC-83 cell line with stable STIM1 overexpression(STIM1-OE)was established and divided into two groups:blank control(STIM1-Vec)group and STIM1-OE group.A nude mouse subcutaneous xenograft tumor model(n=6)was used to detect SACC growth.Transwell chamber assay,scratch test and dorsal root ganglion model were ap-plied to assess SACC migration and invasion.Immunohistochemistry was performed to detect the expression of CD34 and STIM1 in tumor tissues of nude mice.A nude mouse Matrigel plug model and human umbilical vein endothelial cell(HUVEC)tube formation assay were used to evaluate angiogenesis.Enzyme linked immunosorbent assay was employed to detect the levels of vascular endothelial growth factor(VEGF)and epidermal growth factor(EGF)in cell culture supernatants.RT-qPCR and Western blot were performed to detect the mRNA and protein expression levels of c-Myc,ribosomal protein L35(RPL35),ribosomal protein SA(RPSA),mitochondrial ribosomal protein L11(RPL11)and FAU ubiquitin like and ribo-somal protein S30 fusion(FAU).The STIM1-siRNA and RPL35-siRNA were transfected into SACC-83 cells,and the mi-gration,invasion and angiogenesis abilities of the cells were detected using the same methods as above.RESULTS:STIM1 was highly expressed in SACC,and the patients with high STIM1 expression had shorter survival time.In vivo,compared with STIM1-Vec group,STIM1-OE promoted tumor growth.In vitro,the number of migrating and invading SACC cells in STIM1-OE group was significantly increased,and the nerve invasion ability was also significantly en-hanced.Conversely,STIM1-siRNA significantly reduced the migration and invasion abilities of SACC cells.Additional-ly,STIM1-OE significantly promoted the expression of the vascular marker CD34,the secretion of VEGF and EGF,and the results of Matrigel plug and HUVEC tube formation assays indicated that STIM1-OE significantly promoted angiogene-sis.Silencing of RPL35 significantly inhibited SACC migration,invasion,and angiogenesis.RT-qPCR and Western blot results showed that the mRNA levels of RPL35,RPSA,MRPL11 and FAU were significantly increased(P<0.05),and the protein expression levels of STIM1,c-Myc and RPL35 were significantly increased(P<0.01).CONCLUSION:STIM1 drive the migration,invasion and angiogenesis of SACC by activating c-Myc/RPL35-mediated ribosome pathway.

Objective To investigate the relationship between serum melatonin and prostaglandin E2(PGE2)levels with disease severity and prognosis of necrotizing enterocolitis(NEC)in premature infants.Methods A total of 215 premature infants diagnosed with NEC(NEC group)admitted to our hospital between January 2022 and February 2025 and 80 healthy premature infants(control group)were prospectively enrolled.NEC cases were stratified by Bell's staging divided into mild(n=67),moderate(n=90),and severe(n=58)subgroups.Serum levels of melatonin and PGE2 were measured by enzyme-linked immunosorbent assay.Spearman correlation analysis was used to assess the relationship between serum melatonin,PGE2 levels and Bell staging.According to the 28-day prognosis assessment,NEC infants were divided into a poor prognosis group and a good prognosis group.Multivariate logistic regression and ROC analysis were used to explore the association and predictive value of serum melatonin and PGE2 levels in NEC prognosis,and decision curve analysis(DCA)was used to evaluate clinical net benefit.Results Compared with the control group,the NEC group had significantly lower serum melatonin levels and higher PGE2 levels(P<0.05).Among the NEC subgroups,serum melatonin levels decreased and PGE2 levels increased progressively from mild to severe NEC(P<0.05).Serum melatonin was negatively correlated with Bell stage,while PGE2 was positively correlated(P<0.05).The 28-day poor prognosis rate in NEC infants was 18.60%(40/215).Severe disease and elevated PGE2 were independent risk factors for poor prognosis,while higher birth weight and increased melatonin were independent protective factors(P<0.05).The area under the ROC curve(AUC)for predicting prognosis using melatonin,PGE2,and their combination was 0.797,0.780,and 0.880,respectively,with the combined prediction performing significantly better than either biomarker alone(P<0.05).DCA indicated that when the threshold probability exceeded 0.1,the net benefit of the combined model was greater than that of either marker alone.Conclusion In premature infants with NEC,reduced serum melatonin and elevated PGE2 levels are associated with increased disease severity and poor prognosis.The combination of serum melatonin and PGE2 levels provides high predictive value for prognosis.

Objective:To explore the psychological experience of ICU nurses caring for young patients with suicide attempts in a general hospital, and to lay a foundation for the study of psychological adjustment and intervention for ICU nurses.Methods:Twelve ICU nurses who had experience of caring for suicide attempted- young patients from Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University were selected by using descriptive qualitative research method and the maximum difference method of the purposive sampling during October to December in 2023, and semi-structured in-depth personal interviews were conducted. Traditional content analysis method was used to sort out and analyze the data and extract the themes.Results:A total of 12 nurses completed the interview, 5 males, 7 females, aged 23-38(29.33 ± 4.14) years, three themes and seven sub-themes were extracted: psychological characteristics of care (avoidance of active communication, fear of care, empathy); the support required for nursing care (support from colleagues; support from nursing managers); self-growth after caregiving (self-growth in terms of life and death, and self-growth in terms of children′s education).Conclusions:ICU nurses have a certain degree of psychological pressure when taking care of young patients with suicide attempts, which will produce empathy for patients and affect their self-values. At the same time, they need support from colleagues and nursing managers. Therefore, general hospitals should pay attention to the psychological state of ICU nurses, carry out the targeted communication training and mental health support for ICU nurses, and help them gain positive nursing career growth and values.

Objective:To develop a Pain Management Nursing Competency Evaluation Index System for surgical nurses, providing a framework for assessing their pain management competency and guiding in-service training programs.Methods:From December 2023 to July 2024, a research team employed literature analysis, semi-structured interviews, expert consultations, and the analytic hierarchy process (AHP) to determine the content and weight of the competency evaluation index system. A cross-sectional survey was subsequently conducted using convenience sampling on 788 surgical nurses to test the internal consistency, test-retest reliability, and content validity of the index system.Results:The response rates for the two rounds of expert consultations were both 100% (46/46), with an expert authority coefficient of 0.921; the Kendall′s coefficients of expert opinions for the primary indicators were 0.106 and 0.245, respectively. The final index system included seven primary indicators (routine pain assessment, assessment and management of active and unexpected pain, pharmacological pain management, patient-controlled analgesia nursing, non-pharmacological pain management, pain related education for patients and their families, and professional development), 23 secondary indicators, and 78 tertiary indicators. The overall Cronbach α was 0.991, the test-retest reliability was 0.493, the item-level content validity index ranged from 0.96 to 1.00, and the scale-level content validity index was 0.98.Conclusions:The pain management nursing competency evaluation index system for surgical nurses is scientifically valid, reliable, and practical. It offers a solid foundation for evaluating the pain management competencies of surgical nurses and designing targeted in-service training programs.

Objective:To investigate whether killer immunoglobulin-like receptor(KIR)genotypes and haplotype are associated with the dry eye disease(DED)in a Chinese Han population.Methods:Polymerase chain reaction with sequence-specific primers(PCR-SSP)method was used to genotype KIR genes in 106 DED patients and 220 healthy controls.Results:A total of 23 KIR geno-types were found in DED patients and healthy controls,including 10 newly discovered KIR genotypes.The genotype G and haplotype 4 were associated with respectively increased risk of DED(P=0.025,P=0.004);while the haplotype 2 appeared to have an inverse asso-ciation with the disease(P=0.016).The frequency of KIR genotype B/B in DED patients was also significantly higher than that in con-trol group(P=0.027).KIR haplotype A and B had distinctive centromeric(Cen)and telomeric(Tel)gene-content motifs,and the Cen-B/B was associated with increased risk of DED(P=0.037).Conclusion:There may be an association between KIR genotype and hap-loid type with DED in Han population.

Objective:To evaluate the relationship between intraoperative hypothermia and early postoperative pulmonary complications (PPCs) in pediatric patients undergoing living donor liver transplantation (LDLT).Methods:This was a retrospective study. Medical records of pediatric patients of either sex, aged 4-24 months, diagnosed with congenital biliary atresia who underwent LDLT from January 2021 to March 2023 were collected from the electronic medical record system of Tianjin First Central Hospital. The collected data included general characteristics, intraoperative conditions, and PPCs such as postoperative pediatric acute respiratory distress syndrome, pneumonia, pleural effusion, atelectasis, and pulmonary edema within 1 week after operation. Additional indicators comprised the difference in systemic immune-inflammation index (SII) between 1 day before surgery and at the end of surgery (ΔSII), concentration of hypersensitive C-reactive protein (hs-CRP) at the end of surgery, postoperative mechanical ventilation time, and duration of intensive care unit stay. Pediatric patients were divided into PPCs group and non-PPCs group based on the development of PPCs. Logistic regression analysis was used to determine the relationship between factors associated with intraoperative hypothermia and PPCs.Results:A total of 226 pediatric patients were included in the study, with 126 cases in PPCs group and 100 cases in non-PPCs group. The results of logistic regression analysis showed that pre-reperfusion hypothermia, duration of hypothermia, ΔSII and concentrations of hs-CRP at the end of operation were independent risk factors for the occurrence of PPCs ( P<0.05). The area under the receiver operating characteristic curve of pre-reperfusion hypothermia and duration of hypothermia in predicting PPCs was 0.594 (95% confidence interval [ CI] 0.521-0.668, P=0.015) and 0.702 (95% CI 0.634-0.770, P<0.001), respectively. The area under the receiver operating characteristic curve of combination of factors associated with hypothermia (pre-reperfusion hypothermia, duration of hypothermia) and inflammatory indicators (ΔSII, plasma hs-CRP concentration at the end of surgery) in predicting PPCs was 0.977 (95% CI 0.959-0.995, P<0.001). Conclusions:Pre-reperfusion hypothermia and duration of hypothermia are independent risk factors for early PPCs in infants, and their predictive value for the development of PPCs is higher when combined with ΔSII and plasma hs-CRP concentration in pediatric patients undergoing LDLT.

Objective To investigate the relationship between serum melatonin and prostaglandin E2(PGE2)levels with disease severity and prognosis of necrotizing enterocolitis(NEC)in premature infants.Methods A total of 215 premature infants diagnosed with NEC(NEC group)admitted to our hospital between January 2022 and February 2025 and 80 healthy premature infants(control group)were prospectively enrolled.NEC cases were stratified by Bell's staging divided into mild(n=67),moderate(n=90),and severe(n=58)subgroups.Serum levels of melatonin and PGE2 were measured by enzyme-linked immunosorbent assay.Spearman correlation analysis was used to assess the relationship between serum melatonin,PGE2 levels and Bell staging.According to the 28-day prognosis assessment,NEC infants were divided into a poor prognosis group and a good prognosis group.Multivariate logistic regression and ROC analysis were used to explore the association and predictive value of serum melatonin and PGE2 levels in NEC prognosis,and decision curve analysis(DCA)was used to evaluate clinical net benefit.Results Compared with the control group,the NEC group had significantly lower serum melatonin levels and higher PGE2 levels(P<0.05).Among the NEC subgroups,serum melatonin levels decreased and PGE2 levels increased progressively from mild to severe NEC(P<0.05).Serum melatonin was negatively correlated with Bell stage,while PGE2 was positively correlated(P<0.05).The 28-day poor prognosis rate in NEC infants was 18.60%(40/215).Severe disease and elevated PGE2 were independent risk factors for poor prognosis,while higher birth weight and increased melatonin were independent protective factors(P<0.05).The area under the ROC curve(AUC)for predicting prognosis using melatonin,PGE2,and their combination was 0.797,0.780,and 0.880,respectively,with the combined prediction performing significantly better than either biomarker alone(P<0.05).DCA indicated that when the threshold probability exceeded 0.1,the net benefit of the combined model was greater than that of either marker alone.Conclusion In premature infants with NEC,reduced serum melatonin and elevated PGE2 levels are associated with increased disease severity and poor prognosis.The combination of serum melatonin and PGE2 levels provides high predictive value for prognosis.

Objective:To investigate whether killer immunoglobulin-like receptor(KIR)genotypes and haplotype are associated with the dry eye disease(DED)in a Chinese Han population.Methods:Polymerase chain reaction with sequence-specific primers(PCR-SSP)method was used to genotype KIR genes in 106 DED patients and 220 healthy controls.Results:A total of 23 KIR geno-types were found in DED patients and healthy controls,including 10 newly discovered KIR genotypes.The genotype G and haplotype 4 were associated with respectively increased risk of DED(P=0.025,P=0.004);while the haplotype 2 appeared to have an inverse asso-ciation with the disease(P=0.016).The frequency of KIR genotype B/B in DED patients was also significantly higher than that in con-trol group(P=0.027).KIR haplotype A and B had distinctive centromeric(Cen)and telomeric(Tel)gene-content motifs,and the Cen-B/B was associated with increased risk of DED(P=0.037).Conclusion:There may be an association between KIR genotype and hap-loid type with DED in Han population.

Objective To explore the effects of glycyrrhizic polysaccharide(GP)on the biological activity of salivary adenoid cystic carcinoma tumor cells and its mechanisms of anti-tumor action.Methods GP was prepared,and human adenoid cystic carcinoma high-metastatic cell line SACC-LM and low-metastatic cell line SACC-83 were used as target cells.Different concentrations of GP were used for intervention.The cell counting kit-8(CCK-8)assay was employed to detect cell proliferation and apoptosis.Reverse transcrip-tion polymerase chain reaction(RT-PCR)and Western blot experiments were conducted to detect the expression of genes and proteins related to tumor invasion and metastasis.The scratch assay was used to observe the effect of GP on the migration ability of SACC cells.In vivo experiments were conducted to verify the inhibitory effect of GP on tumor cells.Results Glycyrrhiza polysaccharides signifi-cantly inhibited the proliferation and migration of the highly metastatic human adenoid cystic carcinoma cell line SACC-LM by regulating the expression of epithelial-mesenchymal transition(EMT)-related markers.In vivo experiments showed that glycyrrhiza poly-saccharides had no significant hepatotoxicity,could significantly reduce the volume and weight of tumors,and inhibit the growth rate of tumors in nude mice.Conclusion GP has a certain inhibitory effect on the growth and migration ability of SACC.