Objective To investigate the correlation between the expression of serum 25hydroxyvitamin D[25(OH)D]and growth differentiation factor 15(GDF-15)levels and the risk of malignancy in patients with metabolic syndrome(MS)and the development of combined thyroid nodules(TN).Methods From August 2019 to August 2023,185 MS patients who visited the First Affiliated Hospital of Xinjiang Medical University were regarded as the study subjects,according to the results of thyroid ultrasound examination,they were separated into MS group(n=73)and MS+TN group(n=112).According to the malignant grading of thyroid nodules,MS+TN patients were separated into benign group(n=89)and malignant group(n=23).Another 68 healthy individuals who underwent physical examinations were regarded as control group.Enzyme-linked immunosorbent assay(ELISA)was applied to determine the levels of serum 25(OH)D and GDF-15 in each group.Pearson was applied to analyze the correlation between serum 25(OH)D and GDF-15 levels and clinical indicators in MS in TN patients.Multivariate Logistic regression was applied to analyze the influencing factors of malignant TN in patients with MS combined with TN.Receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic value of serum 25(OH)D and GDF-15 levels in MS with malignant TN.Results Comparison of serum 25(OH)D(30.41±6.73 ng/ml,27.23±6.15 ng/ml,24.67±4.38 ng/ml)and GDF-15(167.99±22.56 ng/L,239.75±25.92 ng/L,286.63±26.04 ng/L)levels in control,MS and MS+TN groups,the differences were statistically significant(F=22.219,472.113,all P<0.05).Compared with the benign group,the serum 25(OH)D(26.28±4.53 ng/ml vs 18.44±3.79 ng/ml)level in the malignant group was obviously reduced,while the GDF-15(276.93±24.53 ng/L vs 324.17±31.89 ng/L)level was obviously increased,the differences were statistically significant(t=7.631,7.718,all P＜0.05).The BMI,age,FPG,TG,TSH and TGAb levels of patients in the malignant group were obviously higher than those in the benign group,the difference were statistically significant(t=2.868,3.523,3.542,3.603,4.581,5.516,all P＜0.05).Pearson correlation analysis,and the serum 25(OH)D level in MS patients with TN was negatively correlated with FPG,TSH,TG and TGAb levels(r=-0.302,-0.482,-0.524,-0.546,all P<0.001),while GDF-15 level was positively correlated with TG,TSH,TGAb and FPG levels(r=0.467,0.541,0.578,0.623,all P<0.05).Multivariate logistic regression analysis,GDF-15(OR=1.673,95%CI:1.146～2.442)was a risk factor for the occurrence of malignant TN in MS patients(P<0.05),and 25(OH)D(OR=0.744,95%CI:0.604～0.916)was a protective factor for the occurrence of malignant TN,the AUC values of serum 25(OH)D and GDF-15 levels in the diagnosis of MS combined with malignant TN were 0.813,0.799 and 0.930,respectively,and the combination was superior to the single diagnosis(Z=2.088,2.021,P=0.037,0.043).Conclusion The levels of serum 25(OH)D and GDF-15 in patients with MS combined with TN are obviously correlated with nodular nature.The decrease in serum 25(OH)D level and the increase in GDF-15 level are risk factors for malignant TN in MS patients.

Objective By population survey,to explore the epidemiological characteristics of gastric precancerous lesions in Lishui District of Nanjing and provide objective basis for the prevention and treatment of early gastric cancer.Methods From July 2021 to December 2022,21 977 patients who received endoscopy and/or 13C-UBT in Lishui District People's Hospital and 6 medical community units in Nanjing City were retrospectively analyzed for demography characteristics,detection rate of gastric precancerous lesions,and H.Pylori infection rate.Results(1)590 cases of gastric precancerous lesions were detected(detection rate 2.68%);(2)The total detection rate of precancerous lesions and three pathological types in males were all higher than those in females(all P<0.001);(3)The minimum age for the total detection rate of precancerous lesions in males and the mini-mum age for each pathological type were lower than in females(P<0.001,0.009,0.005,0.002);(4)The popu-lation total H.pylori infection rate was 23.10%,the H.pylori infection rate in patients with precancerous lesions was higher than that in non-precancerous lesions(P<0.001),both H.pylori infection rate of male and female in precancerous lesions were all higher than those of non-precancerous lesions of the same sex(all P<0.001),in addition,the H.pylori infection rate of male whether in precancerous or non-precancerous lesions was higher than that of female(all P<0.001);(5)The precancerous lesions detection rate in male,female,and the overall age range of 20～29 to 70～79 years is positively correlated with age growth(P<0.001),and rapidly decreases after the age of 79,the of H.pylori infection rate was also positively correlated with age growth(P<0.001),and the trend of age change(P<0.001)was parallel to the precancerous lesions detection rate.Conclusions The detec-tion rate of gastric precancerous lesions in this region is above the average level in China;the total H.pylori infec-tion rate is at a relatively low level in China;the H.pylori infection rate is parallel to the age trend of the detection rate of gastric precancerous lesions,and increases with age.

Objective To investigate the role of long non-coding RNA(lncRNA)-ROR in mediating epithelial-mesenchymal transformation(EMT)and its impact on radiotherapy resistance in nasopharyngeal carcinoma cells.Methods Nasopharyngeal carcinoma cells CNE2 were divided into blank group,negative control(NC)group and lncRNA-ROR siliencing group;or were divided into blank group,radiotherapy group,radiotherapy+NC group,and radiotherapy+lncRNA-ROR overexpression group(radiotherapy treated with 6 Gy radiation for 24 h).The CNE2 proliferation was detected by cell counting kit 8 method.The cell migration was detected by cell scratch test and Transwell cell migration test.The apoptosis ratio was detected by flow cytometry,and the apoptosis-related proteins and epithelial-mesenchymal transition proteins were detected by Western blotting.Results Compared with the blank group and NC group,the proliferation ability of nasopharyngeal carcinoma cells CNE2 was decreased after inhibition of lncRNA-ROR expression for 48 and 72 h(all P＜0.05).The mobility of CNE2 cells after lncRNA-ROR expression inhibition was lower than that in the NC group(P＜0.05).The migration ability of CNE2 cells in the radiotherapy+lncRNA-ROR overexpression group was higher than that in the radiotherapy group and radiotherapy+NC group(both P＜0.05).Compared with the radiotherapy group and radiotherapy+NC group,the apoptosis rates of CNE2 cells in the radiotherapy+lncRNA-ROR overexpression group was decreased(both P＜0.05).After lncRNA-ROR inhibition,the expression of activated caspase 3 and caspase 9 proteins was increased(both P＜0.05),while the expression of activated caspase 3 and caspase 9 proteins was decreased in the radiotherapy+overexpressed lncRNA-ROR group(both P＜0.05).Inhibition of lncRNA-ROR increased the expression of epithelial marker proteins(E-cadherin,β-catenin),and decreased the expression of interstitial marker proteins(N-cadherin,vimentin).The epithelial marker protein expression was decreased and interstitial marker protein expression was increased in CNE2 cells in the radiotherapy+lncRNA-ROR overexpression group compared with the radiotherapy group and radiotherapy+NC group(all P＜0.05).Conclusion lncRNA-ROR can affect the radiotherapy resistance of nasopharyngeal carcinoma cells by regulating their proliferation,migration,apoptosis and EMT,and it is a potential target for reversing the radiotherapy resistance of nasopharyngeal carcinoma cells.

Objective:To investigate the clinicopathological factors affecting the long-term survival of patients with duodenal papillary carcinoma (DPC) after pancreaticoduodenectomy (PD).Methods:The clinicopathological and follow-up data of patients with DPC who underwent PD at the First Affiliated Hospital of Anhui Medical University and the Second Hospital of Anhui Medical University from Jan 2015 to Dec 2021 were retrospectively analyzed.Results:All 73 cases have been followed-up. The median follow-up time was 60 months. Multivariate analysis of COX proportional risk model showed that positive lymph node metastasis and tumor size over 2.5 cm were common independent risk factors for OS and DFS. Lymph node metastasis was confirmed pathologically in 20 patients. Multivariate analysis results of Logistic regression model showed that smoking, tumor breaking through the serous layer and tumor low differentiation were independent risk factors for lymph node metastasis.Conclusions:Poor prognosis was associated with tumors that were larger than 2.5 cm, and with lymph node metastases. Preoperative smoking history, tumor breaking through the serous layer and low tumor differentiation were the predictors of positive lymph node metastasis.

Objective To observe the impact factors of the diagnostic accuracy of fine needle aspiration biopsy(FNAB)for papillary thyroid carcinoma(PTC).Methods Totally 468 patients with single PTC confirmed by postoperative pathology who underwent FNAB before surgery were enrolled.The impact of clinica,l ultrasonic and pathological features on the accuracy of FNAB diagnosis were analyzed.Results The accuracy of FNAB for diagnosing PTC was 71.37%(334/468).The maximum diameter and location of PTC were both impact factors of the diagnostic accuracy of FNAB.The maximum diameter of 0.7 cm was the optimal cutoff value of FNAB for diagnosing PTC,and the diagnostic accuracy of FNAB for PTC with the maximum diameter＜0.7 cm and those≥0.7 cm was 62.96%(119/189)and 77.06%(215/279),respectively.The diagnostic accuracy of FNAB for PTC located in the difficult and easy area of puncture was 52.53%(52/99)and 76.42%(282/369),respectively.The diagnostic accuracy of FNAB for PTC with the maximum diameter≥0.7 cm and located in the easy area,≥0.7 cm and located in the difficult area,＜0.7 cm and located in the easy area,＜0.7 cm and located in the difficult area was 80.43%(185/230),61.22%(30/49),69.78%(97/139)and 44.00%(22/50),respectively.Conclusion The maximum diameter and location of PTC were both impact factors of the diagnostic accuracy of FNAB.

Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

The human gut is populated by a complex community of microbiota that coexists with the host to maintain homeostasis.Macrogenomic and metabonomics analysis shows that the imbalance in gut microbiota composition and diversity, some bacterial components, metabolites and the signaling pathways mediated by them are involved in the occurrence and development of a variety of diseases, especially in the elderly.Intestinal microorganisms are one of the important factors affecting age-related diseases and can provide insights on treatment strategies for the elderly.This review focuses on the composition of the intestinal microbiota, interaction between the microbiota and the host, features of the gut microbiota in common geriatric diseases and pathogenic mechanisms.

Breast cancer is the most common cancer in women all over the world, and it is also the main cause of cancer death in women. In 2018, there were about 2.09 million of new breast cancer cases and 630 thousand of death cases worldwide. The incidence rate of breast cancer varies in different regions of the world, but all of them were on the rise. Although the incidence (36.1/10⁵) and mortality (8.8/10⁵) of female breast cancer in China were relatively low worldwide, the number of female breast cancer cases and deaths in China ranks first in the world. Moreover, the incidence and mortality of female breast cancer in China are increasing in recent year. Breast cancer is a multifactorial disease, mainly including genetic factors, environmental factors and behavioral lifestyle factors, etc. This review aims to explore the epidemiology and related risk factors of breast cancer in the world, so as to understand the prevalence of breast cancer and provide help for the prevention, intervention and early detection of breast cancer.