The authors regret that there was an error in Fig.3 of the published article.The area under the curve(AUC)and 95%confidence interval(CI)values for the prediction of N2 disease were incorrectly displayed in the figure....The authors regret that there was an error in Fig.3 of the published article.The area under the curve(AUC)and 95%confidence interval(CI)values for the prediction of N2 disease were incorrectly displayed in the figure.This graphical error does not affect the study conclusions or the reported results elsewhere in the manuscript.The corrected version of Fig.3 is provided below.展开更多
Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction mode...Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction model for postoperative recurrence in pancreatic cancer patients, incorporating multiple preoperative, intraoperative, and postoperative factors to assist clinical decision-making. Methods: A retrospective study was conducted on 216 patients who underwent surgical treatment for pancreatic malignancy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2023. An independent external validation cohort of 76 patients from the Second Affiliated Hospital of Chongqing Medical University was used to validate the model. Seven independent risk factors for postoperative recurrence were identified through univariate and multivariate Cox regression analyses. The model’s performance was evaluated using the concordance index (C-index) and ROC curves, and its accuracy and clinical value were assessed using calibration curves and decision curve analysis (DCA). Results: The predictive model demonstrated good discriminatory power, with a C-index of 0.72 in the training cohort and 0.66 in the validation cohort. The ROC curves for predicting recurrence at 3, 6, and 12 months postoperatively showed AUC values ranging from 0.72 to 0.83, indicating strong predictive value. Calibration curves and DCA confirmed the model’s accuracy and clinical utility. Conclusion: This study successfully developed and validated a clinical prediction model that incorporates seven independent risk factors for postoperative recurrence in pancreatic cancer. The model provides a useful tool for predicting recurrence risk, aiding in the identification of high-risk patients, and informing clinical decision-making.展开更多
Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland....Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland.During November2014 to June 2016,the prospective study was conducted in 13 hospitals.The hospitalized children under 18 years old who met the criteria for CAP were enrolled.The throat swabs or nasopharyngeal aspirates(NPAs) were collected which were then screened 18 respiratory viruses using multiplex PCR assay.Viral pathogens were present in 56.6%(1539/2721) of the enrolled cases,with the detection rate of single virus in 39.8% of the cases and multiple viruses in 16.8% of the cases.The most frequently detected virus was respiratory syncytial virus(RSV)(15.2%,414/2721).The highest detection rate of virus was in <6-month-age group(70.7%,292/413).RSV,human metapneumovirus(HMPV),human parainfluenza viruses(HPIVs) and influenza B virus(Flu B) showed the similar prevalence patterns both in north and south China,but HPIVs,Flu A,human bocavirus(HBoV),human adenovirus(HAdV) and human coronaviruses(HCoVs) showed the distinct circulating patterns in north and south China.Human enterovirus/human rhinovirus(HEV/HRV)(27.6%,27/98),HBoV(18.4%,18/98),RSV(16.3%,16/98) and HMPV(14.3%,14/98) were the most commonly detected viruses in severe pneumonia cases with single virus infection.In conclusion,viral pathogens are frequently detected in pediatric CAP cases and may therefore play a vital role in the aetiology of CAP.RSV was the most important virus in hospitalized children with CAP in Chinese mainland.展开更多
Objective:Evidence on the prognostic value of autologous stem cell transplantation(ASCT)and minimal residual disease(MRD)dynamics of patients with newly diagnosed multiple myeloma(NDMM)in China is limited.Our objectiv...Objective:Evidence on the prognostic value of autologous stem cell transplantation(ASCT)and minimal residual disease(MRD)dynamics of patients with newly diagnosed multiple myeloma(NDMM)in China is limited.Our objective in the current study was to understand the current care paradigm and outcomes of these patients.Methods:This longitudinal cohort study used historical data from three top-tier hematologic disease care hospitals that contributed to the National Longitudinal Cohort of Hematological Diseases-Multiple Myeloma.Treatment regimens[proteasome inhibitor(PI)-,immunomodulatory drug(IMiD)-,PI+IMiD-based,and conventional],post-induction response,ASCT and MRD status,and survival outcomes[progression-free survival(PFS)and overall survival(OS)]were evaluated.Results:In total,454 patients with NDMM were included(median age,57 years;59.0%males)with a median follow-up of 58.7 months.The overall response rate was 91.0%,83.9%,90.6%,and 60.9%for PI-,IMiD-,PI+IMiD-based,and conventional regimens,respectively.Patients with ASCT during first-line therapy(26.2%)had a longer PFS and OS than patients who did not receive ASCT[median PFS,42.9 vs.21.2 months,P<0.001;median OS,not reached(NR)vs.65.8 months,P<0.001].The median OS was NR,71.5,and 56.6 months among patients with sustained MRD negativity,loss of MRD negativity,and persistent MRD,respectively(P<0.001).Multivariate analysis revealed that the lactic dehydrogenase level,International Staging System stage,extra-medullary disease,and upfront ASCT were independent factors in predicting OS among NDMM patients.Conclusions:Our study showed that novel agent-based regimens,first-line ASCT,and sustained MRD negativity were associated with a superior outcome for patients with NDMM in China(Identifier:NCT04645199).展开更多
Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disea...Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disease, providing the opportunity for early intervention and therapy at the time point when they are most effective and may prevent later symptoms or complications. Therefore, through this study, we introduced a simple high-resolution melting （HRM） assay for KS screening and evaluated its clinical sensitivity and specificity in three medical centers using 1373 clinical blood samples. The HRM assay utilized a single primer pair to simultaneously amplify specific regions in zinc finger protein, X-linked （ZFX） and zinc finger protein, Y-linked （ZFY）. In cases of KS, the ratios of ZFX/ZFYare altered compared to those in normal males. As a result, the specific melting profiles differ and can be differentiated during data analysis. This HRM assay displayed high analytical specificity over a wide range of template DNA amounts （5 ng-50 ng） and reproducibility, high resolution for detecting KS mosaicism, and high clinical sensitivity （100%） and specificity （98.1%）. Moreover, the HRM assay was rapid （2 h per run）, inexpensive （0.2 USD per sample）, easy to perform and automatic, and compatible with both whole blood samples and dried blood spots. Therefore, this HRM assay is an ideal postnatal population-based KS screening tool that can be used for different age groups.展开更多
In ophthalmology,the quality of fundus images is critical for accurate diagnosis,both in clinical practice and in artificial intelligence(AI)-assisted diagnostics.Despite the broad view provided by ultrawide-field(UWF...In ophthalmology,the quality of fundus images is critical for accurate diagnosis,both in clinical practice and in artificial intelligence(AI)-assisted diagnostics.Despite the broad view provided by ultrawide-field(UWF)imaging,pseudocolor images may conceal critical lesions necessary for precise diagnosis.To address this,we introduce UWF-Net,a sophisticated image enhancement algorithm that takes disease characteristics into consideration.Using the Fudan University ultra-wide-field image(FDUWI)dataset,which includes 11294 Optos pseudocolor and 2415 Zeiss true-color UWF images,each of which is rigorously annotated,UWF-Net combines global style modeling with feature-level lesion enhancement.Pathological consistency loss is also applied to maintain fundus feature integrity,significantly improving image quality.Quantitative and qualitative evaluations demonstrated that UWF-Net outperforms existing methods such as contrast limited adaptive histogram equalization(CLAHE)and structure and illumination constrained generative adversarial network(StillGAN),delivering superior retinal image quality,higher quality scores,and preserved feature details after enhancement.In disease classification tasks,images enhanced by UWF-Net showed notable improvements when processed with existing classification systems over those enhanced by StillGAN,demonstrating a 4.62%increase in sensitivity(SEN)and a 3.97%increase in accuracy(ACC).In a multicenter clinical setting,UWF-Net-enhanced images were preferred by ophthalmologic technicians and doctors,and yielded a significant reduction in diagnostic time((13.17±8.40)s for UWF-Net enhanced images vs(19.54±12.40)s for original images)and an increase in diagnostic accuracy(87.71%for UWF-Net enhanced images vs 80.40%for original images).Our research verifies that UWF-Net markedly improves the quality of UWF imaging,facilitating better clinical outcomes and more reliable AI-assisted disease classification.The clinical integration of UWF-Net holds great promise for enhancing diagnostic processes and patient care in ophthalmology.展开更多
At the end of 2022,the adjustment of the coronavirus disease 2019(COVID-19)pandemic control policy in China resulted in alarge-scale increase in public infection.To compare the fertility parameters of male patients be...At the end of 2022,the adjustment of the coronavirus disease 2019(COVID-19)pandemic control policy in China resulted in alarge-scale increase in public infection.To compare the fertility parameters of male patients before and after the adjustments ofthe COVID-19 pandemic control policy in China,we collected data on patients’medical histories and laboratory examinations ontheir first visits between June 2022 and March 2023 in five different hospitals.Data were divided into five groups according tothe timeline of the policy adjustment.The data we collected from male patients included semen quality and serum reproductivehormone levels,and intergroup comparisons were made using the Mann–Whitney U and Chi-square tests.In total,16784 casesunderwent regular semen analysis,11180 had sperm morphology assessments,and 7200 had reproductive hormone analyses.Thedata showed declining trends in semen volume,sperm motility,and the progressive sperm motility rate after the policy adjustment.Subgroup comparison revealed an initial decrease and gradual recovery in progressive motility rate.Sperm morphology analysisshowed increased neck and tail abnormalities after the policy adjustment.No significant change in hormone levels was observed.Following the adjustment of the COVID-19 prevention policy in China,a decline in sperm motility and morphology was observed.This trend may gradually recover over 2 months.After the policy adjustment,reproductive hormone levels were relatively stablethroughout,except for an increase in luteinizing hormone(LH).These changes in semen parameters suggest that the policyadjustment had a short-to medium-term impact on male reproductive function.展开更多
AIM To assess the impact of short infliximab(IFX)infusion on hospital resource utilization and costs.METHODS All inflammatory bowel diseases(IBD)patients who received IFX 1 h infusion from March 2007 to September 2014...AIM To assess the impact of short infliximab(IFX)infusion on hospital resource utilization and costs.METHODS All inflammatory bowel diseases(IBD)patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis.Demographic,clinical and infusion related data were collected.The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity.In addition,indirect patient-related cost savings were evaluated.RESULTS One hundred and twenty-five patients were recruited(64 with ulcerative colitis and 61 with Crohn's disease).Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years(SD:±13).Adverse infusion reactions were reported in less than 4%both before and after short infusion.The total number of infusions across the selected centers was of 2501(30.5%short infusions).In the analyzed cohort,1143 h were saved(762 in the infusion and 381 in observation phases)through the rapid IFX infusion protocol.This time saving(-15%compared to the standard protocol in infusion phase)represents,from the hospital perspective,an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments.This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use.Hence,an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services.The analysis showed that the short infusion increased the infusion units capacity up to 50%on days when the IFX infusions were scheduled(infusion phase).Furthermore,the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase(observation)leading to a time saving of 10%on average among the analyzed centers.Finally,the short infusion protocol has been demonstrated to lead to indirect cost savings of€138/patient(average-€17.300 on the whole cohort).CONCLUSION A short IFX infusion protocol can be considered time and cost saving in comparison to the standard infusion protocol both from the hospital's perspective,as it contributes to increase infusion units capacity,and the patients'perspective,as it reduces indirect costs and the impact of treatment on everyday life and work productivity.展开更多
BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for ...BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.展开更多
Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integro...Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integrons and antibiotic susceptibility of clinical isolates of P. aeruginosa. Two hundred and five P. aeruginosa strains were collected from the seven general state hospitals in Turkey. They were characterized by antimicrobial susceptibility testing, screened for class 1 and class 2 integrons, and evaluated for the association between antibiotic resistance phenotypes and the presence of integrons. intI gene was amplified in 10 isolates (4.87%) by PCR and in seven isolates of them (70%) were found different gene cassettes. The aadA gene integrated into the class 1 integrons was most frequently found and it was followed by aac genes and blaOXA family genes. Sequence analysis of variable regions of the class 1 integrons showed five gene cassette arrays;aadA1(99%), aac(3)-Id(82%)-orf-aac(3”)-Ia(99%), aac(3)-Ie(83%)-blaoxa10(100%)- aadA1 (100%), aadA6(99%, 100%), aac(6’)-I(97%)-orf-aadA2(99%). No class 2 integron was detected. This study is the first multicenter study for class 1 integrons and it indicates the low rate of presence of class 1 gene cassette in P. aeruginosa.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
OBJECTIVE:To investigate the difference in gut microbiota between population with damp-heat constitution(DHC)and balanced constitution(BC).METHODS:A multi-centered cross-sectional casecontrol study was conducted,which...OBJECTIVE:To investigate the difference in gut microbiota between population with damp-heat constitution(DHC)and balanced constitution(BC).METHODS:A multi-centered cross-sectional casecontrol study was conducted,which included 249 participants with damp-heat constitution or balanced constitution.Baseline information of participants was collected,and stool samples were collected for gut microbiota analysis.Principal coordinate analysis,linear discriminant analysis effect size analysis,receiver operating characteristic,random forest model,and phylogenetic investigation of communities by reconstruction of unobserved states methods were used to reveal the relationship between gut microbiota and the damp-heat constitution.RESULTS:Compared to those in the BC group,the richness and diversity of the microbiota,specifically those of several short-chain fatty acid producing genera such as Barnesiella,Coprobacter,and Butyricimonas,were significantly decreased in the DHC group.Regarding biological functions,flavonoid biosynthesis,propanoate metabolism,and nucleotide sugar metabolism were suppressed,while arachidonic acid metabolism and glutathione metabolism were enriched in the DHC group.Finally,a classifier based on the microbiota was constructed to discriminate between the DHC and BC populations.CONCLUSION:The gut microbiota of the DHC population exhibits significantly reduced diversity and is closely related to inflammation,metabolic disorders,and liver steatosis,which is consistent with clinical observations,thus serving as a potential diagnostic tool for traditional Chinese medicine constitution discrimination.展开更多
DearEditor,SinceDecemberr2019,severeaacute respiratory syndrome coronavirus 2(SARS-CoV-2)has widely spread worldwide,and we have been fighting against coronavirus disease 2019(COVID-19)for more than 4 years[1].Accordi...DearEditor,SinceDecemberr2019,severeaacute respiratory syndrome coronavirus 2(SARS-CoV-2)has widely spread worldwide,and we have been fighting against coronavirus disease 2019(COVID-19)for more than 4 years[1].According to the statistics of the World Health Organization(WHO),more than 775 million individuals have incurred COVID-19,and 7 million deaths have been recorded.展开更多
Background and Aims:Epidemiological data on bacterial infections in cirrhosis in China remain limited.Therefore,we aimed to conduct a multicenter study to investigate the characteristics and outcomes of patients with ...Background and Aims:Epidemiological data on bacterial infections in cirrhosis in China remain limited.Therefore,we aimed to conduct a multicenter study to investigate the characteristics and outcomes of patients with cirrhosis and bacterial infections in China.Methods:We retrospectively enrolled 1,438 hospitalized adult patients with cirrhosis and bacterial or fungal infections from 24 hospitals across China between January 2018 and September 2024.Data on demographics,clinical features,microbiology,treatment,and outcomes were collected.Results:A total of 1,783 infection episodes were recorded,including 1,668 first infections and 115 second infections.Most infections were community-acquired(86.6%).Pneumonia was the most common infection type(26.7%),followed by spontaneous bacterial peritonitis(19.5%)and spontaneous bacteremia(14.1%).Among 754 pathogens isolated from 620 patients,Klebsiella pneumoniae(20.1%)was nearly as common as Escherichia coli(21.7%).Multidrug-resistant(MDR)organisms accounted for 41.0%of(20.1%)was nearly as common as Escherichia coli(21.7%).Multidrug-resistant(MDR)organisms accounted for 41.0%of all isolates,with extended-spectrum p-lactamase-producing Escherichia coli being the most prevalent MDR strain(8.9%of patients).Adherence to empirical antibiotic treatment guidelines from the European Association for the Study of the Liver was significantly lower in this cohort compared to the global study(21.5%vs.61.2%,P<0.001),accompanied by a lower clinical resolution rate(63.5%vs.79.8%,P<0.001).Conclusions:The clinical and microbiological characteristics of bacterial infections in patients with cirrhosis in China differ substantially from those reported in other regions.These findings highlight the need for region-specific management and prevention strategies,particularly in light of the changing microbiological landscape,high MDR prevalence,and suboptimal antibiotic practices.展开更多
Background and Aims:Chronic hepatitis B(CHB)remains a significant global health challenge,and effective antiviral therapies are essential for long-term management.This study aimed to evaluate the real-world effectiven...Background and Aims:Chronic hepatitis B(CHB)remains a significant global health challenge,and effective antiviral therapies are essential for long-term management.This study aimed to evaluate the real-world effectiveness and safety of tenofovir amibufenamide(TMF)in a cohort of patients with chronic hepatitis B(CHB).Methods:In this multicenter,prospective,real-world cohort study,194 CHB patients were recruited from four hospitals between August 2021 and August 2022.Patients were divided into treatment-naïve(TN,n=123)and treatment-experienced(TE,n=71)groups.The TN group was further subdivided into TMF(n=63)and tenofovir disoproxil fumarate(TDF,n=60)subgroups.In the TE group,patients transitioned from prior antiviral therapies(entecavir or TDF)to TMF after meeting criteria for poor virological response or safety concerns.Treatment response was evaluated in terms of virological effectiveness and alanine transaminase normalization rates.Virological response(VR),ALT normalization rates,renal function markers,and lipid profiles were monitored.Results:In the TN cohort,VR rates at 24 and 48 weeks were 42.86%and 90.48%for TMF,and 60.00%and 83.33%for TDF.ALT normalization rates at 24 and 48 weeks for TMF were 56.82%and 70.45%(according to AASLD 2018 standards).In the TE group,VR rates at 24 and 48 weeks were 83.1%and 91.55%,respectively.ALT normalization rates were 86.67%and 93.33%(local standards),and 66.67%and 76.67%(AASLD 2018 standards)(z=-2.822,P=0.005).Additionally,TMF showed improved renal safety over TDF,with no significant differences in lipid concentrations.Conclusions:TMF is comparable to TDF in terms of CHB treatment effectiveness,with better renal safety and no impact on lipid levels.In TE patients,transitioning to TMF therapy does not affect antiviral treatment outcomes.展开更多
Objective To explore and quantify the association of hot night exposure during the sperm development period(0–90 lag days) with semen quality.Methods A total of 6,640 male sperm donors from 6 human sperm banks in Chi...Objective To explore and quantify the association of hot night exposure during the sperm development period(0–90 lag days) with semen quality.Methods A total of 6,640 male sperm donors from 6 human sperm banks in China during 2014–2020were recruited in this multicenter study.Two indices(i.e.,hot night excess [HNE] and hot night duration[HND]) were used to estimate the heat intensity and duration during nighttime.Linear mixed models were used to examine the association between hot nights and semen quality parameters.Results The exposure-response relationship revealed that HNE and HND during 0–90 days before semen collection had a significantly inverse association with sperm motility.Specifically,a 1 ℃ increase in HNE was associated with decreased sperm progressive motility of 0.0090(95% confidence interval[CI]:–0.0147,–0.0033) and decreased total motility of 0.0094(95% CI:–0.0160,–0.0029).HND was significantly associated with reduced sperm progressive motility and total motility of 0.0021(95% CI:–0.0040,–0.0003) and 0.0023(95% CI:–0.0043,–0.0002),respectively.Consistent results were observed at different temperature thresholds on hot nights.Conclusion Our findings highlight the need to mitigate nocturnal heat exposure during spermatogenesis to maintain optimal semen quality.展开更多
Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization s...Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization statistics,there were approx-imately 604,000 new EC cases and 544,000 EC-related deaths globally with China reporting approximately 320,000 new cases and 300,000 deaths,mainly from esophageal squamous cell carcinoma(ESCC)3.Although there has been progress in the treatment of EC,the long-term prognosis of patients with R0 resection and lymph node-positive disease contin-ues to be suboptimal4.A retrospective analysis performed by our center suggested that the median overall survival(OS)of lymph node-positive patients with EC who received postoper-ative adjuvant radiotherapy(PART)was 29 months compared to 21 months for surgery alone with 3-year survival rates of 43%and 36%,respectively,indicating a potential survival ben-efit of PART5.展开更多
Objective:This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer(EC)patients across multiple hospitals in China.Methods:This was...Objective:This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer(EC)patients across multiple hospitals in China.Methods:This was a multicenter study comprising of newly diagnosed EC cases from Beijing,Hebei,Henan,Hubei,Zhejiang,and Guangdong Province of China.Their baseline characteristics and treatment methods data were collected from their medical records.The EpiData software was used for data quality control.The Kaplan-Meier method was used to estimate their overall survival(OS),and the Cox’s proportional hazard regression model was used to estimate hazard ratios(HR)and 95%confidence interval(CI).Results:The 3-and 5-year OS rates of the 5283 investigated EC patients were 49.98%and 39.07%,respectively.Their median survival was 36.00 months.The median survival time of females was longer than that of males(females vs.males:45.00 vs.33.00,P<0.001).The 5-year OS rate of patients who never-smoked was higher than that of smokers(never-smokers vs smokers:40.73%vs.37.84%,P=0.001).There was no significant difference in the 5-year OS rate between drinkers and never-drinkers(drinkers vs never-drinkers:34.22%vs.29.65%,P=0.330).In multivariate analysis,pathological stage(stage II:HR=1.80,95%CI=1.40-2.31;stage III:HR=2.62,95%CI=2.06-3.34;stage IV:HR=3.90,95%CI=2.98-5.09),poor differentiation/undifferentiated(HR=1.34,95%CI=1.11-1.63),not married status(HR=2.45,95%CI=1.49-4.04),production and service personnel(HR=1.36,95%CI=1.01-1.83)and farming/fishing(HR=1.40,95%CI=1.12-1.76)were independent prognostic risk factors for poor EC survival.Tumors in the thoracic or abdominal part of the esophagus,female and family history of any cancer were independent factors predictive of a good EC OS.Conclusion:Gender,marital status,occupation,family history of any cancer,tumor topographical site,differentiation status,and pathological stage were associated with the survival rate of EC.This study reveals important clinical characteristics of esophageal cancer patients in China and provides helpful information for their clinical management and surveillance.展开更多
Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and sid...Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM. Methods： We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects. Results： An additive scoring system （range： 0-5）, based on age, Katz＇s Activity of Daily Living （ADL） and Lawton＇s Instrumental Activity of Daily Living （IADL） 〈5 and Charlson Comorbidity Index （CC1） was developed to identify three groups： fit （score = 0）; intermediate-fitness （score = 1 ）; and fi＇ail （score ≥2）. The 3-year OS was 63% in fit patients, 63% in intermediate-fimess patients, and 49% in frail patients ≥3 hematologic adverse events （AEs） were documented in 45 （35.4%） fit, 34 （34%） intermediate-fitness, and 121 （30.2%） frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness （hazard ratios [HR]： 0.99, 95% confidence interval [CI]： 0.54 1.47, P = 1.000） and in frail patients （tfR： 1.16, 95% CI： 0.70-1.93, P- 0.558） compared with fit ones. Conclusions： MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in fi＇ailty with International Staging System （ISS） ll/lll was the worst in all patients.展开更多
Background:In light of the significant clinical benefits of antibody-drug conjugates in clinical trials,the human epidermal growth factor receptor 2(HER2)-low category in breast cancers has gained increasing attention...Background:In light of the significant clinical benefits of antibody-drug conjugates in clinical trials,the human epidermal growth factor receptor 2(HER2)-low category in breast cancers has gained increasing attention.Therefore,we studied the clinicopathological characteristics of Chinese patients with hormone receptor(HR)-positive/HER2-low early-stage breast cancer and developed a recurrence risk prediction model.Methods:Female patients with HR-positive/HER2-low early-stage breast cancer treated in 29 hospitals of the Chinese Society of Breast Surgery(CSBrS)from Jan 2015 to Dec 2016 were enrolled.Their clinicopathological data and prognostic information were collected,and machine learning methods were used to analyze the prognostic factors.Results:In total,25,096 patients were diagnosed with breast cancer in 29 hospitals of CSBrS from Jan 2015 to Dec 2016,and clinicopathological data for 6486 patients with HER2-low early-stage breast cancer were collected.Among them,5629 patients(86.79%)were HR-positive.The median follow-up time was 57 months(4,76 months);the 5-year disease-free survival(DFS)rate was 92.7%,and the 5-year overall survival(OS)rate was 97.7%.In total,412 cases(7.31%)of metastasis were observed,and 124(2.20%)patients died.Multivariate Cox regression analysis revealed that T stage,N stage,lymphovascular thrombosis,Ki-67 index,and prognostic stage were associated with recurrence and metastasis(P<0.05).A recurrence risk prediction model was established using the random forest method and exhibited a sensitivity of 81.1%,specificity of 71.7%,positive predictive value of 74.1%,and negative predictive value of 79.2%.Conclusion:Most of patients with HER2-low early-stage breast cancer were HR-positive,and patients had favorable outcome;tumor N stage,lymphovascular thrombosis,Ki-67 index,and tumor prognostic stage were prognostic factors.The HR-positive/HER2-low early-stage breast cancer recurrence prediction model established based on the random forest method has a good reference value for predicting 5-year recurrence events.Registritation:ChiCTR.org.cn,ChiCTR2100046766.展开更多
文摘The authors regret that there was an error in Fig.3 of the published article.The area under the curve(AUC)and 95%confidence interval(CI)values for the prediction of N2 disease were incorrectly displayed in the figure.This graphical error does not affect the study conclusions or the reported results elsewhere in the manuscript.The corrected version of Fig.3 is provided below.
文摘Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction model for postoperative recurrence in pancreatic cancer patients, incorporating multiple preoperative, intraoperative, and postoperative factors to assist clinical decision-making. Methods: A retrospective study was conducted on 216 patients who underwent surgical treatment for pancreatic malignancy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2023. An independent external validation cohort of 76 patients from the Second Affiliated Hospital of Chongqing Medical University was used to validate the model. Seven independent risk factors for postoperative recurrence were identified through univariate and multivariate Cox regression analyses. The model’s performance was evaluated using the concordance index (C-index) and ROC curves, and its accuracy and clinical value were assessed using calibration curves and decision curve analysis (DCA). Results: The predictive model demonstrated good discriminatory power, with a C-index of 0.72 in the training cohort and 0.66 in the validation cohort. The ROC curves for predicting recurrence at 3, 6, and 12 months postoperatively showed AUC values ranging from 0.72 to 0.83, indicating strong predictive value. Calibration curves and DCA confirmed the model’s accuracy and clinical utility. Conclusion: This study successfully developed and validated a clinical prediction model that incorporates seven independent risk factors for postoperative recurrence in pancreatic cancer. The model provides a useful tool for predicting recurrence risk, aiding in the identification of high-risk patients, and informing clinical decision-making.
基金This study was supported by National Science and Technology Supported Projects(grant number:2013BAI09B11)the National Major Science&Technology Project for Control and Prevention of Major Infectious Diseases in China(grant number:2018ZX10201002-008-008,2017ZX10103004-004)。
文摘Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland.During November2014 to June 2016,the prospective study was conducted in 13 hospitals.The hospitalized children under 18 years old who met the criteria for CAP were enrolled.The throat swabs or nasopharyngeal aspirates(NPAs) were collected which were then screened 18 respiratory viruses using multiplex PCR assay.Viral pathogens were present in 56.6%(1539/2721) of the enrolled cases,with the detection rate of single virus in 39.8% of the cases and multiple viruses in 16.8% of the cases.The most frequently detected virus was respiratory syncytial virus(RSV)(15.2%,414/2721).The highest detection rate of virus was in <6-month-age group(70.7%,292/413).RSV,human metapneumovirus(HMPV),human parainfluenza viruses(HPIVs) and influenza B virus(Flu B) showed the similar prevalence patterns both in north and south China,but HPIVs,Flu A,human bocavirus(HBoV),human adenovirus(HAdV) and human coronaviruses(HCoVs) showed the distinct circulating patterns in north and south China.Human enterovirus/human rhinovirus(HEV/HRV)(27.6%,27/98),HBoV(18.4%,18/98),RSV(16.3%,16/98) and HMPV(14.3%,14/98) were the most commonly detected viruses in severe pneumonia cases with single virus infection.In conclusion,viral pathogens are frequently detected in pediatric CAP cases and may therefore play a vital role in the aetiology of CAP.RSV was the most important virus in hospitalized children with CAP in Chinese mainland.
基金supported by grants from CAMS Innovation Fund for Medical Sciences(CIFMSGrant No.2022-I2M-1-022)。
文摘Objective:Evidence on the prognostic value of autologous stem cell transplantation(ASCT)and minimal residual disease(MRD)dynamics of patients with newly diagnosed multiple myeloma(NDMM)in China is limited.Our objective in the current study was to understand the current care paradigm and outcomes of these patients.Methods:This longitudinal cohort study used historical data from three top-tier hematologic disease care hospitals that contributed to the National Longitudinal Cohort of Hematological Diseases-Multiple Myeloma.Treatment regimens[proteasome inhibitor(PI)-,immunomodulatory drug(IMiD)-,PI+IMiD-based,and conventional],post-induction response,ASCT and MRD status,and survival outcomes[progression-free survival(PFS)and overall survival(OS)]were evaluated.Results:In total,454 patients with NDMM were included(median age,57 years;59.0%males)with a median follow-up of 58.7 months.The overall response rate was 91.0%,83.9%,90.6%,and 60.9%for PI-,IMiD-,PI+IMiD-based,and conventional regimens,respectively.Patients with ASCT during first-line therapy(26.2%)had a longer PFS and OS than patients who did not receive ASCT[median PFS,42.9 vs.21.2 months,P<0.001;median OS,not reached(NR)vs.65.8 months,P<0.001].The median OS was NR,71.5,and 56.6 months among patients with sustained MRD negativity,loss of MRD negativity,and persistent MRD,respectively(P<0.001).Multivariate analysis revealed that the lactic dehydrogenase level,International Staging System stage,extra-medullary disease,and upfront ASCT were independent factors in predicting OS among NDMM patients.Conclusions:Our study showed that novel agent-based regimens,first-line ASCT,and sustained MRD negativity were associated with a superior outcome for patients with NDMM in China(Identifier:NCT04645199).
文摘Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disease, providing the opportunity for early intervention and therapy at the time point when they are most effective and may prevent later symptoms or complications. Therefore, through this study, we introduced a simple high-resolution melting （HRM） assay for KS screening and evaluated its clinical sensitivity and specificity in three medical centers using 1373 clinical blood samples. The HRM assay utilized a single primer pair to simultaneously amplify specific regions in zinc finger protein, X-linked （ZFX） and zinc finger protein, Y-linked （ZFY）. In cases of KS, the ratios of ZFX/ZFYare altered compared to those in normal males. As a result, the specific melting profiles differ and can be differentiated during data analysis. This HRM assay displayed high analytical specificity over a wide range of template DNA amounts （5 ng-50 ng） and reproducibility, high resolution for detecting KS mosaicism, and high clinical sensitivity （100%） and specificity （98.1%）. Moreover, the HRM assay was rapid （2 h per run）, inexpensive （0.2 USD per sample）, easy to perform and automatic, and compatible with both whole blood samples and dried blood spots. Therefore, this HRM assay is an ideal postnatal population-based KS screening tool that can be used for different age groups.
基金supported by the National Natural Science Foundation of China(82020108006 and 81730025 to Chen Zhao,U2001209 to Bo Yan)the Excellent Academic Leaders of Shanghai(18XD1401000 to Chen Zhao)the Natural Science Foundation of Shanghai,China(21ZR1406600 to Weimin Tan).
文摘In ophthalmology,the quality of fundus images is critical for accurate diagnosis,both in clinical practice and in artificial intelligence(AI)-assisted diagnostics.Despite the broad view provided by ultrawide-field(UWF)imaging,pseudocolor images may conceal critical lesions necessary for precise diagnosis.To address this,we introduce UWF-Net,a sophisticated image enhancement algorithm that takes disease characteristics into consideration.Using the Fudan University ultra-wide-field image(FDUWI)dataset,which includes 11294 Optos pseudocolor and 2415 Zeiss true-color UWF images,each of which is rigorously annotated,UWF-Net combines global style modeling with feature-level lesion enhancement.Pathological consistency loss is also applied to maintain fundus feature integrity,significantly improving image quality.Quantitative and qualitative evaluations demonstrated that UWF-Net outperforms existing methods such as contrast limited adaptive histogram equalization(CLAHE)and structure and illumination constrained generative adversarial network(StillGAN),delivering superior retinal image quality,higher quality scores,and preserved feature details after enhancement.In disease classification tasks,images enhanced by UWF-Net showed notable improvements when processed with existing classification systems over those enhanced by StillGAN,demonstrating a 4.62%increase in sensitivity(SEN)and a 3.97%increase in accuracy(ACC).In a multicenter clinical setting,UWF-Net-enhanced images were preferred by ophthalmologic technicians and doctors,and yielded a significant reduction in diagnostic time((13.17±8.40)s for UWF-Net enhanced images vs(19.54±12.40)s for original images)and an increase in diagnostic accuracy(87.71%for UWF-Net enhanced images vs 80.40%for original images).Our research verifies that UWF-Net markedly improves the quality of UWF imaging,facilitating better clinical outcomes and more reliable AI-assisted disease classification.The clinical integration of UWF-Net holds great promise for enhancing diagnostic processes and patient care in ophthalmology.
基金supported by a grant from the Beijing Municipal NaturalScience Foundation(No.7194332)the Shandong Province Natural ScienceFoundation(No.ZR2022ZD19).
文摘At the end of 2022,the adjustment of the coronavirus disease 2019(COVID-19)pandemic control policy in China resulted in alarge-scale increase in public infection.To compare the fertility parameters of male patients before and after the adjustments ofthe COVID-19 pandemic control policy in China,we collected data on patients’medical histories and laboratory examinations ontheir first visits between June 2022 and March 2023 in five different hospitals.Data were divided into five groups according tothe timeline of the policy adjustment.The data we collected from male patients included semen quality and serum reproductivehormone levels,and intergroup comparisons were made using the Mann–Whitney U and Chi-square tests.In total,16784 casesunderwent regular semen analysis,11180 had sperm morphology assessments,and 7200 had reproductive hormone analyses.Thedata showed declining trends in semen volume,sperm motility,and the progressive sperm motility rate after the policy adjustment.Subgroup comparison revealed an initial decrease and gradual recovery in progressive motility rate.Sperm morphology analysisshowed increased neck and tail abnormalities after the policy adjustment.No significant change in hormone levels was observed.Following the adjustment of the COVID-19 prevention policy in China,a decline in sperm motility and morphology was observed.This trend may gradually recover over 2 months.After the policy adjustment,reproductive hormone levels were relatively stablethroughout,except for an increase in luteinizing hormone(LH).These changes in semen parameters suggest that the policyadjustment had a short-to medium-term impact on male reproductive function.
基金Correspondence to:Maria Cappello,MD,Gastroenterology and Hepatology Section,Dipartimento Biomedico di Medicina Interna e Specialistica,University of Palermo,Piazza Delle Cliniche 2,90127 Palermo,Italy.marica.cappello61@gmail.com Telephone:+39-091-6552280 Fax:+39-091-6552156
文摘AIM To assess the impact of short infliximab(IFX)infusion on hospital resource utilization and costs.METHODS All inflammatory bowel diseases(IBD)patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis.Demographic,clinical and infusion related data were collected.The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity.In addition,indirect patient-related cost savings were evaluated.RESULTS One hundred and twenty-five patients were recruited(64 with ulcerative colitis and 61 with Crohn's disease).Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years(SD:±13).Adverse infusion reactions were reported in less than 4%both before and after short infusion.The total number of infusions across the selected centers was of 2501(30.5%short infusions).In the analyzed cohort,1143 h were saved(762 in the infusion and 381 in observation phases)through the rapid IFX infusion protocol.This time saving(-15%compared to the standard protocol in infusion phase)represents,from the hospital perspective,an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments.This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use.Hence,an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services.The analysis showed that the short infusion increased the infusion units capacity up to 50%on days when the IFX infusions were scheduled(infusion phase).Furthermore,the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase(observation)leading to a time saving of 10%on average among the analyzed centers.Finally,the short infusion protocol has been demonstrated to lead to indirect cost savings of€138/patient(average-€17.300 on the whole cohort).CONCLUSION A short IFX infusion protocol can be considered time and cost saving in comparison to the standard infusion protocol both from the hospital's perspective,as it contributes to increase infusion units capacity,and the patients'perspective,as it reduces indirect costs and the impact of treatment on everyday life and work productivity.
文摘BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.
基金supported by Recep Tayyip Erdogan University Research Fund Grants BAP-2013.102.03.12 and BAP-2013.102.03.13.
文摘Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integrons and antibiotic susceptibility of clinical isolates of P. aeruginosa. Two hundred and five P. aeruginosa strains were collected from the seven general state hospitals in Turkey. They were characterized by antimicrobial susceptibility testing, screened for class 1 and class 2 integrons, and evaluated for the association between antibiotic resistance phenotypes and the presence of integrons. intI gene was amplified in 10 isolates (4.87%) by PCR and in seven isolates of them (70%) were found different gene cassettes. The aadA gene integrated into the class 1 integrons was most frequently found and it was followed by aac genes and blaOXA family genes. Sequence analysis of variable regions of the class 1 integrons showed five gene cassette arrays;aadA1(99%), aac(3)-Id(82%)-orf-aac(3”)-Ia(99%), aac(3)-Ie(83%)-blaoxa10(100%)- aadA1 (100%), aadA6(99%, 100%), aac(6’)-I(97%)-orf-aadA2(99%). No class 2 integron was detected. This study is the first multicenter study for class 1 integrons and it indicates the low rate of presence of class 1 gene cassette in P. aeruginosa.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
基金National Nonprofit Institute Research Grant for the Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences:Mechanism of Regulating Phlegm-Dampness Constitution to Prevent Metabolic Diseases based on Gut Microbiota-host DNA Methylation(No.YZ-202151)。
文摘OBJECTIVE:To investigate the difference in gut microbiota between population with damp-heat constitution(DHC)and balanced constitution(BC).METHODS:A multi-centered cross-sectional casecontrol study was conducted,which included 249 participants with damp-heat constitution or balanced constitution.Baseline information of participants was collected,and stool samples were collected for gut microbiota analysis.Principal coordinate analysis,linear discriminant analysis effect size analysis,receiver operating characteristic,random forest model,and phylogenetic investigation of communities by reconstruction of unobserved states methods were used to reveal the relationship between gut microbiota and the damp-heat constitution.RESULTS:Compared to those in the BC group,the richness and diversity of the microbiota,specifically those of several short-chain fatty acid producing genera such as Barnesiella,Coprobacter,and Butyricimonas,were significantly decreased in the DHC group.Regarding biological functions,flavonoid biosynthesis,propanoate metabolism,and nucleotide sugar metabolism were suppressed,while arachidonic acid metabolism and glutathione metabolism were enriched in the DHC group.Finally,a classifier based on the microbiota was constructed to discriminate between the DHC and BC populations.CONCLUSION:The gut microbiota of the DHC population exhibits significantly reduced diversity and is closely related to inflammation,metabolic disorders,and liver steatosis,which is consistent with clinical observations,thus serving as a potential diagnostic tool for traditional Chinese medicine constitution discrimination.
基金supported in part by the projects of National Natural Science Foundation of China(Nos.82100526,82241034,and 82330010)National Key R&D Program of China(No.2024YFC3044500).
文摘DearEditor,SinceDecemberr2019,severeaacute respiratory syndrome coronavirus 2(SARS-CoV-2)has widely spread worldwide,and we have been fighting against coronavirus disease 2019(COVID-19)for more than 4 years[1].According to the statistics of the World Health Organization(WHO),more than 775 million individuals have incurred COVID-19,and 7 million deaths have been recorded.
基金supported by the National Key Research and Development Program of China(No.2022YFC2304500,No.2021YFC2301800)the National Natural Science Foundation of China(No.81870425)+1 种基金the Fundamental Research Funds for the Central Universities(2023QZJH50)the Medical and Health Research Project of Zhejiang Province(2022RC141).
文摘Background and Aims:Epidemiological data on bacterial infections in cirrhosis in China remain limited.Therefore,we aimed to conduct a multicenter study to investigate the characteristics and outcomes of patients with cirrhosis and bacterial infections in China.Methods:We retrospectively enrolled 1,438 hospitalized adult patients with cirrhosis and bacterial or fungal infections from 24 hospitals across China between January 2018 and September 2024.Data on demographics,clinical features,microbiology,treatment,and outcomes were collected.Results:A total of 1,783 infection episodes were recorded,including 1,668 first infections and 115 second infections.Most infections were community-acquired(86.6%).Pneumonia was the most common infection type(26.7%),followed by spontaneous bacterial peritonitis(19.5%)and spontaneous bacteremia(14.1%).Among 754 pathogens isolated from 620 patients,Klebsiella pneumoniae(20.1%)was nearly as common as Escherichia coli(21.7%).Multidrug-resistant(MDR)organisms accounted for 41.0%of(20.1%)was nearly as common as Escherichia coli(21.7%).Multidrug-resistant(MDR)organisms accounted for 41.0%of all isolates,with extended-spectrum p-lactamase-producing Escherichia coli being the most prevalent MDR strain(8.9%of patients).Adherence to empirical antibiotic treatment guidelines from the European Association for the Study of the Liver was significantly lower in this cohort compared to the global study(21.5%vs.61.2%,P<0.001),accompanied by a lower clinical resolution rate(63.5%vs.79.8%,P<0.001).Conclusions:The clinical and microbiological characteristics of bacterial infections in patients with cirrhosis in China differ substantially from those reported in other regions.These findings highlight the need for region-specific management and prevention strategies,particularly in light of the changing microbiological landscape,high MDR prevalence,and suboptimal antibiotic practices.
基金supported by the National Key Research and Development Program of China(2023YFC2308105).
文摘Background and Aims:Chronic hepatitis B(CHB)remains a significant global health challenge,and effective antiviral therapies are essential for long-term management.This study aimed to evaluate the real-world effectiveness and safety of tenofovir amibufenamide(TMF)in a cohort of patients with chronic hepatitis B(CHB).Methods:In this multicenter,prospective,real-world cohort study,194 CHB patients were recruited from four hospitals between August 2021 and August 2022.Patients were divided into treatment-naïve(TN,n=123)and treatment-experienced(TE,n=71)groups.The TN group was further subdivided into TMF(n=63)and tenofovir disoproxil fumarate(TDF,n=60)subgroups.In the TE group,patients transitioned from prior antiviral therapies(entecavir or TDF)to TMF after meeting criteria for poor virological response or safety concerns.Treatment response was evaluated in terms of virological effectiveness and alanine transaminase normalization rates.Virological response(VR),ALT normalization rates,renal function markers,and lipid profiles were monitored.Results:In the TN cohort,VR rates at 24 and 48 weeks were 42.86%and 90.48%for TMF,and 60.00%and 83.33%for TDF.ALT normalization rates at 24 and 48 weeks for TMF were 56.82%and 70.45%(according to AASLD 2018 standards).In the TE group,VR rates at 24 and 48 weeks were 83.1%and 91.55%,respectively.ALT normalization rates were 86.67%and 93.33%(local standards),and 66.67%and 76.67%(AASLD 2018 standards)(z=-2.822,P=0.005).Additionally,TMF showed improved renal safety over TDF,with no significant differences in lipid concentrations.Conclusions:TMF is comparable to TDF in terms of CHB treatment effectiveness,with better renal safety and no impact on lipid levels.In TE patients,transitioning to TMF therapy does not affect antiviral treatment outcomes.
基金funded by the Guangdong Provincial Natural Science Foundation of China(No.2022A1515011517).
文摘Objective To explore and quantify the association of hot night exposure during the sperm development period(0–90 lag days) with semen quality.Methods A total of 6,640 male sperm donors from 6 human sperm banks in China during 2014–2020were recruited in this multicenter study.Two indices(i.e.,hot night excess [HNE] and hot night duration[HND]) were used to estimate the heat intensity and duration during nighttime.Linear mixed models were used to examine the association between hot nights and semen quality parameters.Results The exposure-response relationship revealed that HNE and HND during 0–90 days before semen collection had a significantly inverse association with sperm motility.Specifically,a 1 ℃ increase in HNE was associated with decreased sperm progressive motility of 0.0090(95% confidence interval[CI]:–0.0147,–0.0033) and decreased total motility of 0.0094(95% CI:–0.0160,–0.0029).HND was significantly associated with reduced sperm progressive motility and total motility of 0.0021(95% CI:–0.0040,–0.0003) and 0.0023(95% CI:–0.0043,–0.0002),respectively.Consistent results were observed at different temperature thresholds on hot nights.Conclusion Our findings highlight the need to mitigate nocturnal heat exposure during spermatogenesis to maintain optimal semen quality.
基金supported by the National Natural Science Foundation of China(Grant No.82172567)the Key R&D Plan of Jiangxi Province(Grant No.2021BBG71006)the Key Project of Science and Technology Innovation of Health Commission of Jiangxi Province(Grant Nos.2023ZD005 and 2024ZD008).
文摘Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization statistics,there were approx-imately 604,000 new EC cases and 544,000 EC-related deaths globally with China reporting approximately 320,000 new cases and 300,000 deaths,mainly from esophageal squamous cell carcinoma(ESCC)3.Although there has been progress in the treatment of EC,the long-term prognosis of patients with R0 resection and lymph node-positive disease contin-ues to be suboptimal4.A retrospective analysis performed by our center suggested that the median overall survival(OS)of lymph node-positive patients with EC who received postoper-ative adjuvant radiotherapy(PART)was 29 months compared to 21 months for surgery alone with 3-year survival rates of 43%and 36%,respectively,indicating a potential survival ben-efit of PART5.
基金This study was funded by the National Key Research and Development Program of China(2018YFC1313100)a grant from the National Natural Scientific Foundation of China(81871922).
文摘Objective:This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer(EC)patients across multiple hospitals in China.Methods:This was a multicenter study comprising of newly diagnosed EC cases from Beijing,Hebei,Henan,Hubei,Zhejiang,and Guangdong Province of China.Their baseline characteristics and treatment methods data were collected from their medical records.The EpiData software was used for data quality control.The Kaplan-Meier method was used to estimate their overall survival(OS),and the Cox’s proportional hazard regression model was used to estimate hazard ratios(HR)and 95%confidence interval(CI).Results:The 3-and 5-year OS rates of the 5283 investigated EC patients were 49.98%and 39.07%,respectively.Their median survival was 36.00 months.The median survival time of females was longer than that of males(females vs.males:45.00 vs.33.00,P<0.001).The 5-year OS rate of patients who never-smoked was higher than that of smokers(never-smokers vs smokers:40.73%vs.37.84%,P=0.001).There was no significant difference in the 5-year OS rate between drinkers and never-drinkers(drinkers vs never-drinkers:34.22%vs.29.65%,P=0.330).In multivariate analysis,pathological stage(stage II:HR=1.80,95%CI=1.40-2.31;stage III:HR=2.62,95%CI=2.06-3.34;stage IV:HR=3.90,95%CI=2.98-5.09),poor differentiation/undifferentiated(HR=1.34,95%CI=1.11-1.63),not married status(HR=2.45,95%CI=1.49-4.04),production and service personnel(HR=1.36,95%CI=1.01-1.83)and farming/fishing(HR=1.40,95%CI=1.12-1.76)were independent prognostic risk factors for poor EC survival.Tumors in the thoracic or abdominal part of the esophagus,female and family history of any cancer were independent factors predictive of a good EC OS.Conclusion:Gender,marital status,occupation,family history of any cancer,tumor topographical site,differentiation status,and pathological stage were associated with the survival rate of EC.This study reveals important clinical characteristics of esophageal cancer patients in China and provides helpful information for their clinical management and surveillance.
文摘Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM. Methods： We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects. Results： An additive scoring system （range： 0-5）, based on age, Katz＇s Activity of Daily Living （ADL） and Lawton＇s Instrumental Activity of Daily Living （IADL） 〈5 and Charlson Comorbidity Index （CC1） was developed to identify three groups： fit （score = 0）; intermediate-fitness （score = 1 ）; and fi＇ail （score ≥2）. The 3-year OS was 63% in fit patients, 63% in intermediate-fimess patients, and 49% in frail patients ≥3 hematologic adverse events （AEs） were documented in 45 （35.4%） fit, 34 （34%） intermediate-fitness, and 121 （30.2%） frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness （hazard ratios [HR]： 0.99, 95% confidence interval [CI]： 0.54 1.47, P = 1.000） and in frail patients （tfR： 1.16, 95% CI： 0.70-1.93, P- 0.558） compared with fit ones. Conclusions： MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in fi＇ailty with International Staging System （ISS） ll/lll was the worst in all patients.
基金supported by grants from the Youth Cultivation Fund of Beijing Medical Ward Foundation(No.20180502)Beijing Medical Ward Foundation(Nos.YXJL-2016-0040-0065,YXJL-2020-0941-0736)Chinese junior breast surgeon research award fund(No.2020-CHPASLP-01)
文摘Background:In light of the significant clinical benefits of antibody-drug conjugates in clinical trials,the human epidermal growth factor receptor 2(HER2)-low category in breast cancers has gained increasing attention.Therefore,we studied the clinicopathological characteristics of Chinese patients with hormone receptor(HR)-positive/HER2-low early-stage breast cancer and developed a recurrence risk prediction model.Methods:Female patients with HR-positive/HER2-low early-stage breast cancer treated in 29 hospitals of the Chinese Society of Breast Surgery(CSBrS)from Jan 2015 to Dec 2016 were enrolled.Their clinicopathological data and prognostic information were collected,and machine learning methods were used to analyze the prognostic factors.Results:In total,25,096 patients were diagnosed with breast cancer in 29 hospitals of CSBrS from Jan 2015 to Dec 2016,and clinicopathological data for 6486 patients with HER2-low early-stage breast cancer were collected.Among them,5629 patients(86.79%)were HR-positive.The median follow-up time was 57 months(4,76 months);the 5-year disease-free survival(DFS)rate was 92.7%,and the 5-year overall survival(OS)rate was 97.7%.In total,412 cases(7.31%)of metastasis were observed,and 124(2.20%)patients died.Multivariate Cox regression analysis revealed that T stage,N stage,lymphovascular thrombosis,Ki-67 index,and prognostic stage were associated with recurrence and metastasis(P<0.05).A recurrence risk prediction model was established using the random forest method and exhibited a sensitivity of 81.1%,specificity of 71.7%,positive predictive value of 74.1%,and negative predictive value of 79.2%.Conclusion:Most of patients with HER2-low early-stage breast cancer were HR-positive,and patients had favorable outcome;tumor N stage,lymphovascular thrombosis,Ki-67 index,and tumor prognostic stage were prognostic factors.The HR-positive/HER2-low early-stage breast cancer recurrence prediction model established based on the random forest method has a good reference value for predicting 5-year recurrence events.Registritation:ChiCTR.org.cn,ChiCTR2100046766.
