Guangxi Maternal and Child Health Hospital

We present the case of a 54-year-old woman with an incidentally discovered left renal hilar mass. Imaging examination revealed a large, heterogeneous mass of fat density in the left renal pelvis, accompanied by a tumor thrombus extending into the renal vein and inferior vena cava (IVC), consistent with a Mayo level II thrombus—a finding reported in fewer than 50 cases worldwide. A preoperative diagnosis of renal angiomyolipoma (RAML) was established. Despite the patient’s strong preference for nephron-sparing surgery (NSS), intraoperative findings of extensive hilar invasion and calyceal involvement, along with significant hemorrhage, necessitated conversion to radical left nephrectomy with IVC thrombectomy. Histopathological examination confirmed the diagnosis of classic RAML, as indicated by positive immunohistochemical staining for Human Melanoma Black 45 (HMB45), Melanoma Antigen Recognized by T-cells 1 (Melan-A), and Smooth Muscle Actin (SMA), and negative staining for Cytokeratins (CK), S-100 Protein (S-100), and Desmin. The tumor thrombus was derived from the RAML. The patient recovered well postoperatively, with no recurrence or metastasis observed at the 8-month follow-up. This case underscores the surgical challenges of large hilar RAMLs with venous extension and highlights the importance of preoperative planning and intraoperative adaptability.

BackgroundFor patients with poor glycemic control of adult type 1 diabetes mellitus (T1DM), in addition to managing blood glucose levels, it is worth exploring further as an early warning indicator of blood glucose control.Methods56 adults with T1DM, aged between 18 and 70 years, were included in the study. Data on body composition and laboratory indicators, including phase angle values and HbA1c levels, were collected. Statistical analysis was conducted to determine the correlation and the strength of association between the phase angle, and HbA1c levels.ResultsPearson’s correlation and linear regression models indicated a negative correlation between phase angle and HbA1c levels, even after controlling for age and weight in both males and females.ConclusionThe results indicate a significant negative relationship between Phase angle and HbA1c levels. Beyond being a simple body composition parameter, Phase angle can be used as a clinical indicator of improved blood glucose control.

Adolescent negative emotions are a major public health concern. Physical exercise is often associated with better emotional health, yet the psychological processes underlying this association, particularly in Chinese adolescents, are not fully understood. This study examined whether stress perception and emotional sensitivity are related to the association between physical exercise and negative emotions. A cross-sectional survey was conducted with 1,471 adolescents (54.52% male; Mean age = 13.16, SD = 1.01) from ten middle schools in Guangxi Province, China. Validated Chinese versions of established instruments assessed physical exercise (Youth Physical Activity Rating Scale), negative emotions (PANAS Negative Affect subscale), stress perception (Perceived Stress Scale), and emotional sensitivity operationalized through emotional contagion susceptibility. Path analysis using maximum likelihood estimation with robust standard errors tested the hypothesized sequential mediation model. Bootstrap confidence intervals (5,000 resamples) evaluated indirect effects. Path analysis revealed good model fit (χ²/df = 3.62, CFI = 0.96, TLI = 0.94, SRMR = 0.05, RMSEA = 0.04). Physical exercise demonstrated significant direct (β = -0.13, 95% CI [-0.22, -0.09]) and indirect (β = -0.12, 95% CI [-0.27, -0.08]) associations with negative emotions. Stress perception accounted for 40% of the total association between physical exercise and negative emotions (β = -0.10, 95% CI [-0.16, -0.07]). The sequential indirect association via stress perception and emotional sensitivity accounted for 8% of the total association (β = -0.02, 95% CI [-0.05, -0.01]). The direct path from physical exercise to emotional sensitivity was non-significant (β = -0.04, p = 0.23), which is consistent with an indirect-only pattern via stress perception in the specified model. The findings are consistent with a sequential mediation model in which physical exercise is associated with lower negative emotions both directly and indirectly, primarily through lower stress perception and, to a lesser extent, through a sequential pathway involving emotional sensitivity. Although the cross-sectional design does not permit causal conclusions, the observed pattern of associations highlights physical exercise and stress perception as important contextual factors to consider when developing strategies to support adolescent emotional health.

Nonpharmacological (alternative) interventions (NPIs) for pain relief during vaginal delivery have gained popularity, as adjuncts to pharmacological interventions or as primary treatment. We searched PubMed/Medline, EMBASE, and Ovid Discovery for observational trials published through May 2024. This meta-analysis examined the effectiveness and safety of some NPIs for labor pain management using the Meta-Mar online software. NPIs, including massage, virtual reality, heat therapy, hydrotherapy, and aromatherapy, were compared with placebo or routine care (RC). The random-effects model was used for the meta-analysis due to significant variations in methodology among the included studies, including intervention duration, patient age, and intervention approaches. The quality of the included studies was assessed using the Cochrane risk of bias 2 (RoB 2). Network analysis was used to determine which NPIs were most associated with pain intensity and labor duration outcomes. Of the 7,542 selected studies, 41 met the inclusion criteria. Compared with RC, heat therapy (standardized mean difference [SMD] = -1.26; 95% confidence interval [CI]: -1.84, -0.69; p < 0.001) and massage (SMD = -0.69; 95% CI: -1.14, -0.23; p = 0.017) reduced pain intensity during the first stage of labor. Compared with placebo, aromatherapy increased pain intensity during the first stage of labor (SMD = 0.23; 95% CI: 0.00, 0.45; p = 0.048). Compared with RC, heat therapy (SMD = -1.26; 95% CI: -1.84, -0.69; p < 0.001) and aromatherapy (SMD = -0.15; 95% CI: -0.18, -0.11; p < 0.01) reduced pain intensity during the first stage of labor in primiparous women. Compared with placebo, massage (SMD = -1.05; 95% CI: -3.19, -1.10; p < 0.01) reduced pain intensity during the first stage of labor in primiparous women. Compared with RC, NPIs were more effective in reducing pain intensity during the first stage of labor in both developing and developed countries. Virtual reality and heat therapy reduced the duration of the first stage of labor compared with RC. The current NPIs were more effective in reducing the duration of the second stage of labor in developing countries compared with RC. The incidence of emergency cesarean sections was higher in virtual reality (32%), massage (36%), and hydrotherapy (29%) and lower in aromatherapy (18%) than in RC. Most studies were of low quality with a high risk of bias. The present NPIs, such as heat therapy and massage, may reduce pain intensity and labor duration. However, the increased rate of emergency cesarean section and the high risk of bias indicated that caution should be exercised when interpreting these findings.

Human metapneumovirus (hMPV) is a significant contributor to pediatric respiratory hospitalizations. This study aimed to delineate the epidemiological patterns, clinical characteristics, and outcomes in a large cohort of hospitalized children with hMPV infection. From April 2021 to November 2023, 5,021 children with acute respiratory infections were enrolled at a tertiary care center. Respiratory samples underwent targeted next-generation sequencing (tNGS) for comprehensive microbial detection. Clinical, laboratory, and imaging data were analyzed to compare disease severity between cases with single hMPV detection and those with multiple microbial detections. hMPV was detected in 12.5% (629/5,021) of cases. Strikingly, 94.8% (596/629) of these cases had co-detection of additional respiratory microbes, predominantly in hMPV-bacteria-virus (212/596) and hMPV-bacteria (123/596) combinations. Commonly co-detected agents included Haemophilus influenzae (40.8%, 257/629) and Mycoplasma pneumoniae (23.1%, 145/629). Cases with multiple microbial detections were associated with elevated serum amyloid A (median 26.4 vs. 5.9mg/L, P = 0.018), prolonged hospitalization (6.0 vs. 5.0days, P = 0.003), and higher costs (¥8,237.5 vs. ¥3,906.5, P < 0.001). Among the 629 hMPV-positive cases, 309 (49.1%) required respiratory support. Pulmonary consolidation and hypoxemia were the most common respiratory complications, while gastrointestinal dysfunction and myocardial damage were the primary non-respiratory complications. The median hospital stay was 6days. Of these, 34 cases (5.4%) required intensive care unit (ICU) admission, and two cases (0.3%) resulted in mortality. These severe outcomes occurred exclusively in cases where multiple microbes were detected. The respiratory microbiome in children hospitalized with hMPV is overwhelmingly complex, with frequent co-detection of multiple microbes (94.8%), which is associated with significant clinical burdens, including prolonged hospitalization, increased need for respiratory support, and higher treatment costs. tNGS, with its ability to simultaneously identify multiple microbes, shows potential diagnostic value in uncovering this complexity and could be promising for guiding clinical management and antibiotic stewardship.

Sevoflurane is a cornerstone of pediatric anesthesia but poses risks for neurodevelopmental toxicity. While dysregulation of iron metabolism and autophagy have been implicated, the precise molecular link, particularly the role of NCOA4-mediated ferritinophagy in driving ferroptosis, remains a critical knowledge gap. This study aimed to determine whether and how the NCOA4-ferritinophagy-GPX4 axis mediates sevoflurane-induced neuronal ferroptosis in the developing brain. The involvement of NCOA4-mediated ferritinophagy and ferroptosis in sevoflurane-induced neurotoxicity was examined using both in vitro PC12 cell models and in vivo neonatal Sprague-Dawley rat models. In vitro, PC12 cells were exposed to sevoflurane and subsequently treated with Ferrostatin-1 (Fer-1), 3-Methyladenine (3-MA), or NCOA4-targeted siRNA. Assessments included measurements of cell viability, oxidative stress markers, and the expression levels of ferroptosis-related genes and proteins. In in vivo, neonatal rats were exposed to sevoflurane, followed by evaluation of hippocampal damage and cognitive function using Western blot analysis, hematoxylin and eosin staining, immunohistochemistry, and the Morris water maze test. Exposure to sevoflurane significantly decreased cell viability and intracellular glutathione levels while increasing levels of reactive oxygen species, malondialdehyde, and ferrous iron levels in PC12 cells. Expression of NCOA4 was upregulated, whereas GPX4 and ferritin expression were downregulated. Among the treatments, Fer-1 demonstrated greater efficacy in mitigating these changes compared to 3-MA or NCOA4 silencing. In neonatal rats, sevoflurane induced hippocampal neuronal damage, elevated NCOA4 expression and LC3-II/LC3-I ratio, reduced GPX4 and ferritin levels, and impaired spatial learning and memory. Fer-1 conferred superior neuroprotective effects compared to 3-MA. Sevoflurane induces ferroptotic neuronal death in the developing brain through activation of the NCOA4-ferritinophagy-GPX4 pathway. These findings highlight the vulnerability of the developing hippocampus to disruptions in iron metabolism and ferroptosis, and underscore the potential of ferroptosis-targeted neuroprotective strategies in pediatric anesthesia.

The COVID-19 pandemic has significantly affected healthcare, particularly surgical care. Although short-term effects on surgical outcomes have been examined, understanding of long-term postoperative prognosis and pain management in COVID-19 patients remains limited. This knowledge gap is critical as the pandemic evolves and the need for optimized postoperative care becomes increasingly important. The primary objective of this study was to evaluate the impact of COVID-19 infection on postoperative outcomes and pain management in surgical patients. We aimed to assess surgical mortality, complication rates, and postoperative pain levels in COVID-19-positive patients relative to a closely matched control group. We conducted a retrospective cohort study of COVID-19 patients admitted to the ICU following surgery. Data were collected on baseline characteristics, postoperative complications, mortality and pain scores. Univariate and multivariate linear regression models were used to evaluate the impact of COVID-19 infection on postoperative pain. Stratified and interaction analyses were additionally performed to examine the robustness of these associations across subgroups. Mortality rates and the incidence of sepsis were significantly higher in the COVID-19 cohort. Patients with COVID-19 also experienced longer duration of mechanical ventilation in the ICU and prolonged ICU stays. In the fully adjusted multivariate linear regression model, COVID-19 infection was positively associated with higher postoperative visual analog scale pain scores (β = 1.51; 95% CI: 1.03-1.98; p < 0.001), corresponding to an average increase of 1.51 units in postoperative pain. Stratified analysis largely corroborated these findings across subgroups. Surgical intervention in patients with COVID-19 was associated with higher mortality and sepsis rates, longer ICU stays, and increased postoperative pain scores. These findings highlight the need for continued research to optimize surgical care and improve patient outcomes in the evolving post-pandemic era.

BackgroundFirst aid knowledge popularization volunteerism provides medical students with opportunities to develop practical skills. However, there is currently limited attention to First aid knowledge popularization volunteerism, especially regarding the experiences of volunteers themselves. Therefore, our study explored the motivation, challenges, and benefits of undergraduate medical students participating in first aid knowledge popularization volunteerism based on the expectancy-value theory.MethodsThis qualitative descriptive study, guided by Expectancy-Value Theory, explored the motivations, challenges, and benefits of undergraduate medical students participating in first aid knowledge popularization volunteerism. We conducted 27 semi-structured interviews with first aid knowledge popularization volunteerism team members recruited from a medical university in Sichuan Province, China. Theoretical saturation was achieved through iterative data collection and analysis, with the final sample size determined when no new themes emerged from additional interviews. Data were analyzed using Braun and Clarke's thematic analysis approach.ResultsOur study identified three main themes with eleven subthemes. Motivations included voluntary spirit, self-achievement, reward mechanism, and peer influence. Challenges comprised skill deficiencies, psychological challenges, objective constraints, and time constraints. Benefits encompassed psychological benefits, incentives, and skill enhancement.ConclusionOur study research results indicate that the motivation of undergraduate students in first aid knowledge popularization volunteerism stems from the dual effects of internal drive and external motivation. The challenges they face mainly come from the influence of internal obstacles and external limitations, while the ultimate benefits are reflected in both psychological growth and ability improvement. Universities should develop specialized first aid education curricula integrating emergency simulation scenarios and establish FAKPV-specific peer mentorship programs to enhance motivation, provide specialized training combining first aid techniques with community-specific public education pedagogy to address challenges, and create systematic opportunities for volunteers to witness direct impact through follow-up assessments and real-time feedback to maximize benefits.

ObjectiveTesticular germ cell tumors (TGCTs), the most prevalent malignancy in males aged 15–40 years, exhibit suboptimal prognosis despite therapeutic advances. This study aimed to identify novel diagnostic biomarkers and elucidate their molecular mechanisms in TGCTs pathogenesis.MethodsThrough integrated bioinformatics analysis of public TCGA(The Cancer Genome Atlas)datasets and clinical specimen validation (n = 14), we screened LINC01272 as a candidate biomarker. RNA immunoprecipitation (RIP) assays were employed to verify the interaction between LINC01272 and fused in sarcoma (FUS). Functional experiments including siRNA-mediated gene silencing, transwell migration/invasion assays, and CCK-8 proliferation tests were performed in TGCTs cell lines (Tcam-2 and NCCIT).ResultsLINC01272 is significantly highly expressed in TGCT tissues. High LINC01272 levels indicate shorter overall and recurrence-free survival periods for patients; the predictive value is particularly significant in the subgroup with low tumor mutation burden. Silencing LINC01272 can inhibit the migration, invasion and proliferation of Tcam-2 and NCCIT cells, and down-regulate N-cadherin and Vimentin, while up-regulating LAMA1. RIP assays confirmed the direct binding of LINC01272 to FUS. FUS silencing can replicate the tumor suppressive effect of LINC01272 deletion, while FUS overexpression can reverse the inhibition of migration, invasion and proliferation caused by LINC01272 silencing.ConclusionWe identified the LINC01272-FUS axis as a critical regulatory pathway in TGCTs progression, providing mechanistic insights for developing liquid biopsy biomarkers and RNA-targeted therapies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12935-025-04095-0.