Dawu County People's Hospital

BackgroundThe Prognostic Nutritional Index (PNI) is a critical biomarker reflecting the nutritional and immune status of cancer patients. Its association with the prognosis of various malignant tumors has been extensively investigated. However, a comprehensive systematic evaluation of the prognostic significance of PNI across different cancer types remains limited.MethodsThis umbrella review conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library to include meta-analyses that assessed survival outcomes related to cancer across diverse malignancy categories. The quality of the evidence was evaluated utilizing the GRADE and AMSTAR tools. Effect sizes, expressed as hazard ratios (HR) or odds ratios (OR), were synthesized using either random-effects or fixed-effects models. Additionally, analyses of heterogeneity, indicated by I2, and assessments of publication bias were performed as appropriate.ResultsThe Prognostic Nutritional Index (PNI) demonstrates associations across multiple cancer types, with a low PNI significantly linked to poor prognosis in 12 categories of malignant tumors. The HRs for 103 outcomes ranged from 1.15 to 2.98 (p < 0.05). The overall quality of evidence is predominantly low or very low, as assessed by the GRADE criteria, affecting 89.3% of outcomes. This is largely attributed to heterogeneity (47.8% with I2 > 50%), publication bias (40%), and limitations in AMSTAR scoring. Notably, 11 outcomes provided moderate-quality evidence, all indicating substantial effect sizes. Specifically, PNI shows significant prognostic value in breast cancer (preoperative overall survival [OS] HR = 2.56, postoperative HR = 2.63), cervical cancer (OS HR = 2.98), and among patients receiving immunotherapy (e.g., lung cancer immune checkpoint inhibitor [ICI] group OS HR = 2.68).ConclusionA low Prognostic Nutritional Index is consistently associated with poorer outcomes across various cancer types, particularly in predicting responses to immunotherapy. However, due to the current limited quality of evidence, it cannot yet be recommended as a standalone prognostic or decision-making tool across all tumors. Future rigorously designed, multi-center studies are required to validate its clinical utility.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/,CRD42025111093.

Diabetes-associated cognitive impairment (DACI) represents a debilitating complication lacking effective therapeutics. Extracellular vesicles (EVs) demonstrate a paradoxical dual role in DACI pathophysiology. Under diabetic conditions, EVs secreted by metabolically dysregulated adipose tissue and activated circulating inflammatory cells deliver neurotoxic cargo (miR-9-3p, miR-125a-5p) inducing neuronal ferroptosis, synaptic loss, and blood-brain barrier disruption via MEK/ROCK signaling. Brain-derived EVs enriched in complement proteins and mitochondrial markers serve as minimally invasive diagnostic biomarkers validated in multicenter cohorts. Conversely, mesenchymal stem cell-derived and brain endothelial cell-derived EVs exhibit substantial therapeutic potential, attenuating neuroinflammation, promoting neurogenesis, and restoring cognitive function across preclinical models. Clinical translation confronts challenges in GMP-compliant manufacturing, regulatory harmonization, and standardized potency assays. Engineering strategies encompassing cargo optimization and surface modification for brain targeting offer transformative solutions. This review establishes an integrated framework for developing EV-based diagnostics and therapeutics to address this prevalent complication.

This study evaluated the association between preoperative cognitive performance and postoperative delirium (POD) using a multicenter prospective cohort, and explored potential causality using Mendelian randomization (MR) analysis. We analyzed data from 2257 patients aged ≥ 75 years undergoing elective noncardiac and noncranial surgeries across 16 Chinese medical centers. Preoperative cognitive assessment using Mini-Cog revealed 28.4% of patients had cognitive impairment (score ≤ 2). POD occurred in 9.7% of patients, with higher incidence among those with cognitive impairment. Logistic regression demonstrated that cognitive impairment was significantly associated with increased POD risk (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.55-2.74; p < 0.001). This association persisted after adjustment for demographic, preoperative, and intraoperative factors, and was confirmed through propensity score matching and inverse probability treatment weighting analyses. A nearly linear inverse association was observed between Mini-Cog scores and POD incidence. Complementary MR analysis using 139 SNPs from European ancestry data suggested that higher cognitive performance might be associated with decreased delirium risk (inverse-variance weighted OR, 0.74; 95% CI, 0.59-0.93; p = 0.009). Although these results point to a potential link between preoperative cognition and POD, interpretation of causality should be approached with caution, particularly given differences in populations and genetic datasets.

Zinc finger proteins, particularly members of the Krüppel-associated box zinc finger proteins (KRAB-ZFPs), play critical roles in regulating gene expression, cell cycle progression, and epigenetic modifications. Despite the growing body of research on KRAB-ZFPs, the role of ZNF433, a relatively less studied member of this family, remains poorly understood in the context of cancer. We conducted multi-dimensional analyses using publicly available databases, including TCGA and GTEx, to evaluate ZNF433's expression patterns, genetic mutations, survival outcomes, immune microenvironment interactions, and diagnostic potential across different cancers. Functional enrichment and protein interaction network analyses were also performed to explore its potential involvement in cancer-related pathways. Our findings revealed that ZNF433 is significantly downregulated in most cancer types, with stage-dependent expression patterns observed in KIRC and KIRP. High expression of ZNF433 was associated with improved overall survival (OS) in HNSC and KIRC, while in ESCA and PRAD, it was correlated with poorer disease-free survival (DFS). Additionally, high ZNF433 levels were linked to better DFS in BRCA, KIRP, THYM, and KIRC. ZNF433 expression was also closely associated with genomic instability markers, including tumor mutational burden (TMB), microsatellite instability (MSI), and mismatch repair (MMR) deficiencies. Furthermore, ZNF433 exhibited significant regulatory roles within the tumor immune microenvironment. Diagnostic analysis showed that ZNF433 has strong diagnostic potential in LAML and TGCT, and moderate diagnostic value in other cancers. Our study highlights the potential of ZNF433 as a diagnostic and prognostic biomarker and provides new insights into its potential as a therapeutic target.

To evaluate the feasibility, safety, and efficacy of local anesthesia applied to percutaneous nephrolithotomy (PCNL) under Enhanced Recovery After Surgery (ERAS) for treating upper urinary tract stones. This study was a prospective, single-center randomized controlled study in which the patients were randomly divided into two groups: 40 in the ERAS PCNL under local anesthesia (ERAS-LA) group and 40 in the ERAS PCNL under general anesthesia (ERAS-GA) group). The primary indicators were stone-free rate; the secondary outcomes were intraoperative and postoperative complications, intraoperative and postoperative VAS pain scores and postoperative stress response indicators. A meta-analysis was also performed using RevMan 5.4 software by searching relevant literatures in PubMed/Medline, Web of Science and Embase. The stone clearance rates at 48 h were similar between the two groups [ERAS-LA: 85.0% (34/40) vs. ERAS-GA: 87.5% (35/40), P = 0.800] and both 90% at 1 month. The incidence of surgical complications was similar between the two group. The intraoperative pain score in ERAS-LA group was 2.90 ± 0.74, and the postoperative 24-h pain score was comparable between the two groups (ERAS-LA: 2.65 ± 1.35 vs. ERAS-GA: 2.63 ± 0.98, P = 0.925), with good pain control. The mean total operative time was lower in ERAS-LA group than in ERAS-GA group (68.15 ± 24.11 min vs. 82.125 ± 20.42 min, P = 0.006). Postoperative hemoglobin change values (3.38 ± 3.00 × 109/L vs. 5.22 ± 4.18 × 109/L, P = 0.027) and stress response factors including C-reactive protein (8.39 ± 7.46 mg/L vs. 10.47 ± 10.30 mg/L, P = 0.035) and interleukin-6 (5.40 ± 1.50 pg/ml vs. 10.57 ± 1.82 pg/ml, P = 0.041) were significantly lower in ERAS-LA group. The mean catheter retention, fistula retention, and postoperative hospital stay were all significantly lower in ERSA-LA group than in ERSA-GA group (2.3%, 2.9%, and 5.08 days vs. 3.33%, 4.38%, and 6.35 days, P < 0.05). The results of the meta-analysis were similar to that of our study. Local anesthesia applied to ERAS-managed PCNL have a comparable stone clearance rates and complication rates, and a faster postoperative recovery, lower surgical stress, length of stay, anesthesia costs and hospital costs than general anesthesia. http://www.medresman.org.cn, identifier (ChiCTR2100045681).