ObjectiveTo investigate the triglyceride-glucose (TyG) index and the level of serum homocysteine (Hcy) in association with the incidence of stroke in type 2 diabetes mellitus (T2DM) patients. MethodsBased on the chronic disease risk factor surveillance cohort in Pudong New Area, Shanghai, excluding those with stroke in baseline survey, T2DM patients who joined the cohort from January 2016 to October 2020 were selected as the research subjects. During the follow-up period, a total of 318 new-onset ischemic stroke patients were selected as the case group, and a total of 318 individuals matched by gender without stroke were selected as the control group. The Cox proportional hazards regression model was used to adjust for confounding factors and explore the serum TyG index and the Hcy biochemical indicator in association with the risk of stroke. ResultsThe Cox proportional hazards regression results showed that after adjusting for confounding factors, the risk of stroke in T2DM patients with 10 μmol·L⁻¹-¹ and Hcy>15 μmol·L⁻¹ was 1.532 times (95%CI: 1.017‒2.309 times, P=0.041) and 1.738 times (95%CI: 1.119‒2.699 times, P=0.014) higher respectively, compared to T2DM patients with Hcy≤10 μmol·L⁻¹. T2DM patients with TyG>9.074 had 1.396 times higher risk of stroke (95%CI: 1.091‒1.787, P=0.008) compared to those with TyG≤9.074. The study found that urea and α1-antitrypsin (α1-AT) were independent risk factors for the incidence of stroke in T2DM patients. For every unit increase in urea andα1-AT, the risk of stroke in T2DM patients increased by 233.6% (HR=3.336, 95%CI: 1.588‒7.009, P=0.001) and 11.3% (HR=1.113, 95%CI: 1.028‒1.205, P=0.008), respectively. Cumulative risk curves showed that Hcy>10 μmol·L⁻¹ and TyG>9.074 accelerated the time to stroke occurrence in T2DM patients. ConclusionElevated levels of Hcy>10 μmol·L⁻¹ and a higher TyG index are risk factors for stroke in T2DM patients. Effective interventions for Hcy and TyG should be conducted for diabetic patients to reduce the incidence of stroke.

The announcement of the 9th edition of TNM staging system for thymic tumors was one of the highlights at the World Conference on Lung Cancer 2023. The revision, based on a larger and more detailed database, provides changes and confirmation from the last system. The 9th edition of TNM staging system aims to balance statistical significance and clinical feasibility. The birth of an improved TNM staging system heralds the changes that will follow in clinical practice and scientific research.

Objective To assess the nutritional status of vitamin D and associated factors among adults of six ethnic minority groups native to Yunnan Province,and provide evidence for policy making.Methods Between May 2019 and August 2020,a total of 690 adults were selected from Jinuo,Bulang,Jingpo,Deang,Achang and Pumi ethnic groups according to the sex and age composition in the 6th national census.A questionnaire survey and an anthropometric examination were conducted by trained health workers,and serum 25(OH)D levels were determined with high-performance liquid chromatography-tandem mass spectrometry.Results The median of serum 25(OH)D was 28.7(P25～P75∶24.3～33.8)ng/mL,and the prevalence of vitamin D sufficiency,insufficiency and deficiency were 44.2%、47.5%and 8.3%,respectively.There were significant differences in serum 25(OH)D levels among the six ethnic groups(χ2=139.29,P<0.01).Multivariate logistic regression showed that ethnic groups living in higher latitude areas(Pumi,Jingpo,Deang,and Achang),women,and those whose BMI≥24.0 were more likely to be vitamin D insufficient or deficient.Conclusion More than half of the ethnic adults suffer from vitamin D malnutrition which also varies across ethnicities.Further surveillance and interventions among key areas and populations are needed.

Depression is a frequently-seen mental disorder that profoundly affects the survival and quality of life of individuals.Present clinical medicine therapies for depression are not fully efficacious and novel therapeutic agents and targets remain necessary.Bupleuri Radix-Paeoniae Radix(BR-PRA),an essential and crucial compo-nent of traditional antidepressant compound,possesses the beneficial effect of lowering toxicity and amplifying the antidepressant effect when utilized in combination.The underlying mechanisms of these synergistic effects may involve the suppression of inflammation and oxidative stress,the regulation of monoamine neurotransmitters,brain-derived neurotrophic factors,the modulation of the hypothalamus-pituitary-adrenal axis,and the metabolism of various amino acids and energy.This article summarizes the synergistic effects and antidepressant pharmacological effects of BR-PRA herb-pair,thereby providing valuable insights into the potential advantages of this combination and its potential mechanisms of antidepressant action.

Objective To assess the value of cone-beam computed tomography (CBCT) in evaluating the response of unresectable liver cancer to transarterial chemoembolization (TACE). Methods A total of 55 unresectable liver cancer patients with 90 lesions who received TACE at the First People’s Hospital of Liangshan Yi Autonomous Prefecture between July 2021 and July 2023 were enrolled in the study. The response to TACE was evaluated using the modified Response Evaluation Criteria in Solid Tumors one month post-treatment. The value of lesion diameter, volume, and density on CBCT images in predicting the response to TACE was assessed using the area under the receiver operating characteristic curve. Results Of the 55 patients treated with TACE, 26 achieved complete response, 17 achieved partial response, 9 showed stable disease, and 3 had progressive disease. Of the 90 lesions, 48 achieved complete response, 20 achieved partial response, 17 showed stable disease, and 5 had progressive disease. On CBCT images, the mean diameter, volume, and density of lesions with complete and non-complete responses were (20.9 ± 9.9) mm, (1719.3 ± 777.9) mm³, and (143.7 ± 87.9) HU, versus (10.9 ± 7.7) mm, (890.0 ± 327.4) mm³, and (38.8 ± 33.3) HU, respectively, with significant differences between the two groups (t=10.6, 79.8, and 65.5; all P < 0.01). One month post-treatment, CT scans displayed no enhanced areas in lesions with complete response and visible enhanced areas in lesions with non-complete response, with mean lesion diameter and density of (14.1 ± 6.2) mm and (78.8 ± 30.3) HU, respectively. In addition, the areas under the receiver operating characteristic curves of lesion diameter, volume, and density on CBCT images were 0.935, 0.955, and 0.981, respectively, in distinguishing between complete and non-complete responses following TACE. Using a cut-off value of 82.5 HU for predicting response to TACE, the lesion density had sensitivity, specificity, positive predictive value, and negative predictive value of 95.5%, 100.0%, 100.0%, and 95.0%, respectively. Conclusion CBCT is effective in predicting the short-term response of liver cancer to TACE.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

Objective To explore the clinical diagnostic value of peripheral blood procalcitonin(PCT)and neutrophil lymphocyte ratio(NLR)levels in elderly patients with strangulated inguinal hernia.Methods The clinical data of 112 elderly patients with acute incarcerated inguinal hernia from January 2019 to December 2022 were retrospectively analyzed,and were divided into strangulated group and non-strangulated group according to the intraoperative exploration.Multivariate Logistic regression analysis of risk factors of strangulated inguinal hernia in the elderly.Evaluation of PCT and NLR levels in peripheral blood by ROC curve in the clinical diagnosis of strangulated inguinal hernia in the elderly.Results The NLR and PCT in the strangulation group[(4.54±1.67)and(6.74±2.42)ng/ml]were higher than those in the non-strangulation group[(3.78±1.48)and(4.97±2.53)ng/ml](P＜0.05).Multivariate Logistic regression analysis showed that preoperative NLR and PCT levels were risk factors for strangulated inguinal hernia in the elderly(P＜0.05).Both NLR and PCT have high clinical diagnostic value for strangulated inguinal hernia in the elderly(AUC＞0.7),and the combined detection of NLR and PCT can improve the diagnostic efficiency(AUC=0.792).Conclusion PCT and NLR levels in peripheral blood have high clinical diagnostic value for strangulated inguinal hernia in the elderly,and combined detection of NLR and PCT can improve the diagnostic efficiency.

Objective To observe the value of CT radiomics nomogram for predicting Ki-67 expression of thymus epithelial tumors.Methods Totally 163 patients with thymus epithelial tumor,including 114 patients in training set and 49 patients in validation set were retrospectively enrolled.The patients were further divided into low expression(＜50％)and high expression(≥50％)subgroups according to Ki-67 index.Multivariate logistic regression analysis was performed to screen independent predicting factors of Ki-67 expression in thymus epithelial tumors,and clinical-CT model was constructed.The optimal radiomics features were extracted and screened based on chest plain and venous phase enhanced CT images,respectively.Then radiomics modelplain and radiomics modelenhanced were constructed,and Radscoreplain and Radscoreenhanced were calculated,respectively.The nomogram model was constructed based on clinical-CT model,Radscoreplain and Radscoreenhanced.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each model for predicting Ki-67 expression of thymus epithelial tumors.Results Patient's gender and enhanced CT value of lesion were both independent predicting factors of Ki-67 expression in thymus epithelial tumors(both P＜0.05).The AUC of clinical-CT model,radiomics modelplain,radiomics modelenhanced and nomogram model for predicting Ki-67 expression was 0.736,0.814,0.836 and 0.857 in training set,which was 0.746,0.746,0.750 and 0.799 in validation set,respectively.Conclusion CT radiomics nomogram could be used to predict Ki-6 7 expression of thymus epithelial tumors.

OBJECTIVE: We propose a novel region- level self-supervised contrastive learning method USRegCon (ultrastructural region contrast) based on the semantic similarity of ultrastructures to improve the performance of the model for glomerular ultrastructure segmentation on electron microscope images. METHODS: USRegCon used a large amount of unlabeled data for pre- training of the model in 3 steps: (1) The model encoded and decoded the ultrastructural information in the image and adaptively divided the image into multiple regions based on the semantic similarity of the ultrastructures; (2) Based on the divided regions, the first-order grayscale region representations and deep semantic region representations of each region were extracted by region pooling operation; (3) For the first-order grayscale region representations, a grayscale loss function was proposed to minimize the grayscale difference within regions and maximize the difference between regions. For deep semantic region representations, a semantic loss function was introduced to maximize the similarity of positive region pairs and the difference of negative region pairs in the representation space. These two loss functions were jointly used for pre-training of the model. RESULTS: In the segmentation task for 3 ultrastructures of the glomerular filtration barrier based on the private dataset GlomEM, USRegCon achieved promising segmentation results for basement membrane, endothelial cells, and podocytes, with Dice coefficients of (85.69 ± 0.13)%, (74.59 ± 0.13)%, and (78.57 ± 0.16)%, respectively, demonstrating a good performance of the model superior to many existing image-level, pixel-level, and region-level self-supervised contrastive learning methods and close to the fully- supervised pre-training method based on the large- scale labeled dataset ImageNet. CONCLUSION USRegCon facilitates the model to learn beneficial region representations from large amounts of unlabeled data to overcome the scarcity of labeled data and improves the deep model performance for glomerular ultrastructure recognition and boundary segmentation.
Humans ; Electrons ; Endothelial Cells ; Learning ; Podocytes ; Kidney Diseases

ObjectiveTo investigate the effect of multimodal mirror therapy on upper limb and hand function in stroke patients. MethodsFrom April, 2021 to August, 2022, 60 stroke patients from the Department of Rehabilitation Medicine of Zhejiang Provincial People's Hospital were randomly divided into group A (n = 20), group B (n = 20) and group C (n = 20). All the patients accepted routine rehabilitation, while group B accepted mirror therapy, and group C accepted multimodal mirror therapy, in addition, for six weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Upper Extremity Function Test (UEFT) and modified Barthel Index (MBI), while the maximum grip strength and pinch strength of the affected hand were measured. ResultsThe FMA-UE score, UEFT score, maximum hand grip strength and pinch strength, and MBI scores improved in all groups after treatment (|t| > 7.878, P < 0.001), and it was the most in group C (F > 12.563, P < 0.001). ConclusionMultimodal mirror therapy may further improve the upper limb motor function and hand function of stroke patients, as well as the strength of the affected hand and the activities of daily living.