Cancer cachexia is a multi-organ syndrome and closely related to changes in signal communication between organs, which is mediated by cancer cachexia factors. Cancer cachexia factors, being the general name of inflammatory factors, circulating proteins, metabolites, and microRNA secreted by tumor or host cells, play a role in secretory or other organs and mediate complex signal communication between organs during cancer cachexia. Cancer cachexia factors are also a potential target for the diagnosis and treatment. The pathogenesis of cachexia is unclear and no clear effective treatment is available. Thus, the treatment of cancer cachexia from the perspective of the tumor ecosystem rather than from the perspective of a single molecule and a single organ is urgently needed. From the point of signal communication between organs mediated by cancer cachexia factors, finding a deeper understanding of the pathogenesis, diagnosis, and treatment of cancer cachexia is of great significance to improve the level of diagnosis and treatment. This review begins with cancer cachexia factors released during the interaction between tumor and host cells, and provides a comprehensive summary of the pathogenesis, diagnosis, and treatment for cancer cachexia, along with a particular sight on multi-organ signal communication mediated by cancer cachexia factors. This summary aims to deepen medical community’s understanding of cancer cachexia and may conduce to the discovery of new diagnostic and therapeutic targets for cancer cachexia.

Objective:To analyze the epidemiological characteristics of imported malaria cases from 2019 to 2023 after the elimination of malaria in Shanxi Province, and provide reference for formulating scientific and effective malaria prevention and control strategies in Shanxi Province.Methods:The data of imported malaria cases were collected China Information System for Disease Control and Prevention and National Parasitic Disease Control Information Management System in Shanxi Province, from 2019-2023. Descriptive epidemiological method and SPSS 26.0 statistical software were used for descriptive epidemiological statistical analysis.Results:A total of 51 malaria cases were reported in Shanxi Province in 2019-2023, all imported from abroad. Among them, there were 38 cases of falciparum malaria (74.51%), 6 cases of plasmodium ovale (11.77%), 5 cases of plasmodium vivax (9.80%), 1 case of plasmodium triticum malaria (1.96%), and 1 case of mixed infections (1.96%), with nodeaths; cases were predominantly males (94.12%, 48/51) and workers who went abroad for work (84.31%,43/51); the median age of onset was 37 years old; and there were imported cases every month, with no obvious peak of incidence; Taiyuan City reported the most cases, accounting for 72.55% (37/51) of the total number of cases,the source of infection of cases was mainly from Africa (96.08%), with the Democratic Republic of the Congo (16 cases), Nigeria (6 cases), Equatorial Guinea (5 cases), Mozambique (3 cases), and Republic of the Congo (3 cases) in that order; the median time between the onset of disease and first diagnosis, and the median time between first diagnosis and confirmation, were two times longer than that of first diagnosis, and the median time between first diagnosis and confirmation was two times longer than that of first diagnosis. The M( Q1, Q3) intervals from onset to first diagnosis and from first diagnosis to confirmed diagnosis were 2(0,4) days and 1(0,3) days, respectively, with statistically significant differences between different years from onset to first diagnosis ( H=17.41, P=0.048), and from first diagnosis to confirmed diagnosis ( H=20.82, P=0.010). A total of 101 146 blood tests for febrile patients were conducted in the province during the five years, with the minimum number of blood tests in 2020 (19 867 person-times) and the maximum number of blood tests in 2023 (20 778 person-times). Conclusions:After the elimination of malaria in Shanxi Province from 2019 to 2023, all malaria cases were imported from abroad, and it is still necessary to strengthen the surveillance of people traveling to and from malaria-endemic areas, implement the combination of medical treatment and prevention, and jointly prevent and control the occurrence of imported malaria.

Objective:To analyze the application value of color Doppler ultrasound,microribonucleic acid-19a(miR-19a)and miR-210 in carotid artery stenosis.Methods:A total of 102 patients with carotid artery stenosis who were diagnosed and treated in Cangzhou People's Hospital from October 2020 to October 2022 were selected as the research group,and 102 health persons who underwent color Doppler ultrasound of physical examination in hospital at the same period were selected as the health control group.Both two groups underwent color Doppler ultrasound examination and digital subtraction angiography(DSA)within one week after admitted to hospital.The miR-19a and miR-210 between the two groups were compared,and the miR-19a and miR-210 of patients with different stenosis degrees of research group also were compared.And then,the diagnostic values of color Doppler,miR-19a,miR-210 and the combination of them were analyzed in diagnosing carotid artery stenosis.Results:The results of color Doppler ultrasound in detecting common carotid artery 102 patients of research group indicated that 15 cases were normal,and 15 cases occurred mild stenosis,and 21 cases occurred moderate stenosis,and 21 cases occurred severe stenosis and 33 cases occurred complete occlusion.The miR-19a of the research group was significantly higher than that of the health control group,and the miR-210 of the research group was significantly lower than that of the health control group(t=10.755,-5.903,P<0.05).The miR-19a results of the research group indicated that the miR-19a of mild stenosisthat of moderate stenosis>severe stenosis>complete occlusion,and the differences were statistical significant(F=160.399,147.462,P<0.05),respectively.The receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)values of color Doppler ultrasound,miR-19a,miR-210 and combined diagnosis of them for carotid artery stenosis were respectively 0.892,0.842,0.729 and 0.978,and the sensitivity and specificity of the combined diagnosis were respectively 97.1%and 95.1%.Conclusion:The combined diagnosis of color Doppler ultrasound,miR-19a and miR-210 has higher diagnostic value for carotid artery stenosis.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To study the risk factors of unplanned reoperation within 30 days after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 207 patients who underwent LPD in the Lihuili Hospital Affiliated to Ningbo University from February 2017 to October 2022 were retrospectively analyzed. There were enrolled 118 males and 89 females, aged (65.1±11.1) years old. Patients were divided into the reoperation group ( n=15) and non-reoperation group ( n=192) based on whether unplanned reoperation was performed within 30 days after LPD. The risk factors of unplanned reoperation were analyzed with univariate and multivariate logistic regression analysis. Results:The rate of unplanned reoperation within 30 days after LPD was 7.2%(15/207). The unplanned reoperation group exhibited a higher incidence of complications 80% (12/15), mortality 13.3% (2/15), and extended hospital stay (32.9±20.1)d compared to the non-reoperation group, which incidences of complications, mortality and extended hospital stay were 40.1% (77/192)( χ2=9.04, P=0.003), 0.5%(1/192)( χ2=8.28, P=0.004), and (17.9±8.6)d ( t=-2.79, P=0.014), respectively. Unplanned reoperation was associated with diabetes, intraoperative bleeding >130 ml, preoperative serum prealbumin <0.15 g/L, pancreatic texture and pancreatic duct diameter (all P<0.05). Multivariate logistic regression analysis identified diabetes ( OR=4.991, 95% CI: 1.431-17.415), preoperative serum prealbumin <0.15 g/L ( OR=4.06, 95% CI: 1.178-14.043), soft pancreatic texture ( OR=3.900, 95% CI: 1.146-13.272) and pancreatic duct diameter ≤3 mm ( OR=3.449, 95% CI: 1.009-11.789) as independent risk factors for unplanned reoperation within 30 days. Conclusion:Preoperative diabetes, preoperative serum prealbumin levels <0.15 g/L, soft pancreatic texture and pancreatic duct diameter ≤3 mm were independent risk factors for unplanned reoperation within 30 days after LPD.

Objective:To summarize experience of managing adult Langerhans cell histiocytosis(LCH) in hypothalamic-pituitary region(HPR) from Shanghai Huashan Hospital.Methods:Adult HPR-LCH patients diagnosed at oar endocrinology department from January 2013 to February 2022 were included. Clinical characteristics and treatment response were retrospectively analyzed.Results:A total of 27 adult HPR-LCH patients were included, with 14 cases involving the hypothalamus(H group) and 13 cases without(group NH). The common radiological findings included thickening of the pituitary stalk(25/27, 92.6%). At the time of diagnosis, 14 cases(51.9%) presented with panhypopituitarism, and 19 cases(70.4%) exhibited metabolic abnormalities. The group H had higher proportions of adrenal insufficiency, central hypothyroidism, panhypopituitarism, and diabetes compared to group NH(78.6% vs 23.1%; 78.6% vs 23.1%; 92.9% vs 30.8%, 35.7% vs 0%, respectively, all P<0.05). Hypothalamus syndrome was identified in 71.4%(10/14) of group H. The inital diagnosis rate was 79.2%(19/24), with 48.1% and 51.9% through biopsy of sellar and extrasellar lesions, respectively. Repeated biopsies confirmed the diagnosis in 25.9%(7/27) of cases. The peripheral lesions included bone, thyroid, lung, lymph node, thymus and liver. Out of 20 cases treated with chemotherapy, the objective response rate was 85% at 12 weeks. Four cases received local therapy, one case received traditional Chinese medicine treatment, one case abandoned treatment, and one case was lost to follow-up. The median follow-up time was 28(range 15 to 54) months. During this period, there were 3 deaths in group H and 1 death in group NH. Conclusion:Adult HPR-LCH patients presented with diabetes insipidus and high prevalences of hypopituitarism, hypothalamus syndrome and metabolic abnormalities. Typical imaging features were pituitary stalk thickening. A solitary mass in the HPR was usually very small, posing a great challenge for early diagnosis. Systemic evaluation would help to clarify the diagnosis. Patients with hypothalamus involvement had a higher mortality rate, suggesting the hypothalamus as a risk organ with poor prognosis.

Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.

Objective:To investigate the efficacy of acellular allogeneic dermal matrix (ADM) combined with autologous razor-thin scalp grafts in scar rehabilitation.Methods:A retrospective study was conducted on patients who underwent skin grafts transplantation to repair scar in the Department of Burns and Plastic Surgery of the First People’s Hospital of Chenzhou from July 2015 to December 2021. All the patients were divided into the observation group and the control group according to surgical methods. The observation group was treated with ADM combined with autologous razor-thin scalp grafts to repair the wound after scar resection, and the control group was treated with split-thickness skin grafts (STSGs) to repair the wound. Efficacy evaluation: On the 1st, 7th and 14th day after surgery, the patients in the two groups scored the pain degree of the donor sites through the visual analogue scale (VAS), with a score of 0 indicating no pain and a score of 10 indicating severe pain. The grid method was used to measure the surviving area of the skin and calculate the surviving proportion of the skin grafts. The wound healing time in donor and recipient sites were recorded. The postoperative complication was recorded, and the incidence of complications was calculated. Scars in donor and recipient sites were observed at the 3rd, 6th, 9th and 12th month after surgery, and the scars in recipient sites were scored by the Vancouver scar scale (VSS), with a total score of 0-13 points, and the higher the score, the more serious the scars were. SPSS 22.0 software was used for statistical analysis of the data. The normally distributed continuous data were represented as Mean±SD, and analyzed by t-test, and the non-normally distributed continuous data were represented as M ( Q1, Q3), and the Wilcoxon rank-sum test was used for comparison between groups. Enumeration data were expressed as examples and (or) percentages, and chi-square test was used for comparison between groups. The differences were considered statistically significant for probability values P<0.05. Results:A total of 50 patients, including 28 males and 22 females, aged (38.5±13.9) years, were enrolled in the observation group, and the wound area caused by scar resection and release was (70.4±17.7) cm 2. The scars were on upper limb in 16 cases, lower limb in 15 cases, trunk in 11 cases, neck in 8 cases. The control group included 50 patients, 30 males and 20 females, aged (34.8±14.6) years, and the wound area caused by scar resection and release was (66.2±16.5) cm 2. The scars were on upper limb in 15 cases, lower limb in 11 cases, trunk in 13 cases, neck in 11 cases. There was no significant difference in gender composition, age, skin graft site and the wound area caused by scar resection and release between these two groups ( P > 0.05). On the 1st, 7th and 14th day after surgery, the VAS scores of the observation group were 6.35 (5.11, 7.67) points, 4.95 (3.63, 6.46) points and 0.73 (0.18, 1.39) points, while the control group were 8.25 (7.14, 9.19) points, 7.00 (5.45, 8.06) points and 0.80(0.20, 1.55)points, respectively. The VAS score of the observation group was lower than that of the control group on the 1st and 7th day after surgery ( Z=-4.53, -3.86, both P < 0.001), and there was no significant difference in VAS score between the two groups on the 14th day after surgery ( P > 0.05). There was no significant difference between the two groups in terms of the survival ratio of skin grafts [(95.6±2.1) % vs. (95.8±2.3) %] ( P>0.05) and the postoperative incidence of complications [18% (9/50) vs. 10% (5/50)] ( P>0.05). The wound healing time in the donor sites in both groups were (6.80±0.88) days, (13.30±1.83) days ( t=-22.70, P<0.001), while the wound healing time in the recipient sites in both groups were 14.33 (12.73, 15.76) days and 8.91 (7.76, 10.67) days ( Z=-7.31, P<0.001). The average follow-up time was 21.8 months, the observation group had no scar formation at the donor site, while the control group had different degrees of scar hyperplasia. There was no significant difference in VSS scores between the two groups at the 3rd and 6th month after surgery ( P>0.05), while the VSS scores of the observation group at 9th and 12th month after surgery were 5.96 (4.81, 7.15) points and 5.85 (4.81, 6.75) points, which were significantly lower than those of in the control group [7.04(5.93, 8.14)points, 6.92(5.81, 8.06)points] ( Z=-2.82, P=0.005; Z=-3.54, P<0.001). Conclusion:The use of ADM combined with autologous razor-thin scalp graft to repair the wound after scar resection can effectively improve the appearance and function of the repair area, and reduce the pain and avoid scar hyperplasia in the donor sites.

Objective:To investigate the efficacy of acellular allogeneic dermal matrix (ADM) combined with autologous razor-thin scalp grafts in scar rehabilitation.Methods:A retrospective study was conducted on patients who underwent skin grafts transplantation to repair scar in the Department of Burns and Plastic Surgery of the First People’s Hospital of Chenzhou from July 2015 to December 2021. All the patients were divided into the observation group and the control group according to surgical methods. The observation group was treated with ADM combined with autologous razor-thin scalp grafts to repair the wound after scar resection, and the control group was treated with split-thickness skin grafts (STSGs) to repair the wound. Efficacy evaluation: On the 1st, 7th and 14th day after surgery, the patients in the two groups scored the pain degree of the donor sites through the visual analogue scale (VAS), with a score of 0 indicating no pain and a score of 10 indicating severe pain. The grid method was used to measure the surviving area of the skin and calculate the surviving proportion of the skin grafts. The wound healing time in donor and recipient sites were recorded. The postoperative complication was recorded, and the incidence of complications was calculated. Scars in donor and recipient sites were observed at the 3rd, 6th, 9th and 12th month after surgery, and the scars in recipient sites were scored by the Vancouver scar scale (VSS), with a total score of 0-13 points, and the higher the score, the more serious the scars were. SPSS 22.0 software was used for statistical analysis of the data. The normally distributed continuous data were represented as Mean±SD, and analyzed by t-test, and the non-normally distributed continuous data were represented as M ( Q1, Q3), and the Wilcoxon rank-sum test was used for comparison between groups. Enumeration data were expressed as examples and (or) percentages, and chi-square test was used for comparison between groups. The differences were considered statistically significant for probability values P<0.05. Results:A total of 50 patients, including 28 males and 22 females, aged (38.5±13.9) years, were enrolled in the observation group, and the wound area caused by scar resection and release was (70.4±17.7) cm 2. The scars were on upper limb in 16 cases, lower limb in 15 cases, trunk in 11 cases, neck in 8 cases. The control group included 50 patients, 30 males and 20 females, aged (34.8±14.6) years, and the wound area caused by scar resection and release was (66.2±16.5) cm 2. The scars were on upper limb in 15 cases, lower limb in 11 cases, trunk in 13 cases, neck in 11 cases. There was no significant difference in gender composition, age, skin graft site and the wound area caused by scar resection and release between these two groups ( P > 0.05). On the 1st, 7th and 14th day after surgery, the VAS scores of the observation group were 6.35 (5.11, 7.67) points, 4.95 (3.63, 6.46) points and 0.73 (0.18, 1.39) points, while the control group were 8.25 (7.14, 9.19) points, 7.00 (5.45, 8.06) points and 0.80(0.20, 1.55)points, respectively. The VAS score of the observation group was lower than that of the control group on the 1st and 7th day after surgery ( Z=-4.53, -3.86, both P < 0.001), and there was no significant difference in VAS score between the two groups on the 14th day after surgery ( P > 0.05). There was no significant difference between the two groups in terms of the survival ratio of skin grafts [(95.6±2.1) % vs. (95.8±2.3) %] ( P>0.05) and the postoperative incidence of complications [18% (9/50) vs. 10% (5/50)] ( P>0.05). The wound healing time in the donor sites in both groups were (6.80±0.88) days, (13.30±1.83) days ( t=-22.70, P<0.001), while the wound healing time in the recipient sites in both groups were 14.33 (12.73, 15.76) days and 8.91 (7.76, 10.67) days ( Z=-7.31, P<0.001). The average follow-up time was 21.8 months, the observation group had no scar formation at the donor site, while the control group had different degrees of scar hyperplasia. There was no significant difference in VSS scores between the two groups at the 3rd and 6th month after surgery ( P>0.05), while the VSS scores of the observation group at 9th and 12th month after surgery were 5.96 (4.81, 7.15) points and 5.85 (4.81, 6.75) points, which were significantly lower than those of in the control group [7.04(5.93, 8.14)points, 6.92(5.81, 8.06)points] ( Z=-2.82, P=0.005; Z=-3.54, P<0.001). Conclusion:The use of ADM combined with autologous razor-thin scalp graft to repair the wound after scar resection can effectively improve the appearance and function of the repair area, and reduce the pain and avoid scar hyperplasia in the donor sites.

Objective:To explore the correlations of neurological function recovery and intraoperative bone window parameters with intracranial pressure (ICP) changes at perioperative period in patients with large hemispheric infarction (LHI) after standard large bone flap decompression.Methods:Forty LHI patients accepted standard large bone flap decompression in Department of Neurosurgery, People's Hospital of Zhengzhou University from December 2020 to December 2023 were enrolled. ICP was measured before decompression, at the time of bone flap removal, during dural opening, and 24 h after decompression. Correlations of National Institutes of Health Stroke Scale (NIHSS), Extended Glasgow Outcome Scale (GOSE) and Glasgow Coma Scale (GCS) score changes, length and area of the bone window, bone window area/cranial bone area, infarct brain tissue volume/brain tissue volume with ICP changes were analyzed by Pearson's correlation. Length and area of bone window in patients with good neurological function recovery (NIHSS score decreased by≥5, GOSE score increased by≥3, or GCS score increased by≥3 before and after decompression) were calculated.Results:ICP at the time of bone flap removal, during dural opening, and 24 h after decompression was significantly lower than that before decompression ( P<0.05); ICP at the time of bone flap removal was higher than that at 24 h after decompression and during dural opening. Reduction between ICP before decompression and that during dural opening was more obvious than ICP reduction before and 24 h after decompression and ICP reduction before decompression and at the time of bone flap removal, with significant differences ( P<0.05). Postoperative NIHSS scores were significantly lower than preoperative ones ( P<0.05), and both postoperative GOSE and GCS scores were significantly higher than preoperative ones ( P<0.05). Decrease of NIHSS score, increase of GOSE and GCS scores before and after decompression were positively correlated with ICP reduction before and 24 h after decompression ( r=0.386, P=0.018; r=0.411, P=0.033; r=0.319, P=0.037); length and area of the bone window were positively correlated with ICP reduction before and 24 h after decompression ( r=0.461, P=0.028; r=0.536, P=0.034); bone window area/cranial bone area was positively correlated with ICP reduction before and 24 h after decompression ( r=0.438, P=0.027), while infarct brain tissue volume/brain tissue volume was negatively correlated with ICP reduction before and 24 h after decompression ( r=-0.371, P=0.031). Of the 40 patients, 25 had good neurological function recovery after decompression, with length of the bone window ranged 12.3-16.7 cm and area of the bone window ranged 54.5-91.9 cm 2. Conclusion:Standard large bone flap decompression can reduce ICP and improve prognosis in LHI patients; intraoperative bone window parameters are obviously correlated with ICP reduction before and 24 h after decompression; length of the bone window ranged 12.3-16.7 cm and area of the bone window ranged 54.5-91.9 cm 2 are suggested for decompression.