Nanchong Central Hospital

Milky pleural effusion usually suggests chylothorax. We report a case of massive empyema caused by Streptococcus viridans presenting with milky pleural fluid. Biochemical and microbiological analyses were essential to establish the diagnosis and distinguish empyema from chylothorax.

Biopsy of cervical level IV lymph nodes is clinically important but technically challenging because the available needle corridor is often short and adjacent to major cervical vessels. Although core needle biopsy is generally preferred when preserved tissue architecture and ancillary studies are required, ultrasound-guided semiautomatic side-cut needles (US-SABN) and ultrasound-guided modified Menghini needles (US-MMT) have not been directly compared in this anatomically constrained setting. We retrospectively analyzed 290 consecutive patients who underwent ultrasound-guided biopsy of cervical level IV lymph nodes between January 2019 and August 2024 at two tertiary centers. The primary endpoint was sample adequacy. Secondary endpoints included specimen length, use of immunohistochemistry, and procedure-related complications graded according to the CIRSE classification. Categorical variables were compared using Pearson's chi-square test or Fisher's exact test, as appropriate, and continuous variables were compared using the Mann-Whitney U test. Sample adequacy was similar between US-MMT and US-SABN (94.9% [167/176] vs. 93.0% [106/114]; P = 0.676). Use of immunohistochemistry was also similar (52.3% [92/176] vs. 55.3% [63/114]; P = 0.705). US-MMT yielded longer tissue cores than US-SABN (median, 15.0mm [IQR, 10.0-20.0] vs. 10.0mm [IQR, 7.0-15.0]; P < 0.001). Complication rates were low in both groups (1.1% [2/176] vs. 1.8% [2/114]; P = 0.647), and all complications were minor, self-limited hematomas (CIRSE grade 1). In exploratory within-device analyses, specimen length varied by operator experience. US-MMT and US-SABN achieved comparable sample adequacy and low complication rates for biopsy of cervical level IV lymph nodes. Although US-MMT yielded longer tissue cores, this did not translate into differences in sample adequacy, use of immunohistochemistry, or complication rates. Findings from subgroup analyses stratified by operator experience are hypothesis-generating and require prospective validation.

To examine the association between cardiometabolic index (CMI), including baseline CMI and cumulative average CMI (CumCMI), and the risk of cardiovascular disease (CVD) among Chinese middle-aged and older adults with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3, and to explore its potential utility for risk assessment in this population. Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). A total of 6,991 participants aged ≥ 45 years with CKM syndrome stages 0-3 were included. Participants were categorized into quartiles according to CMI and CumCMI levels. Cox proportional hazards regression models with sequential adjustments were used to assess associations with incident CVD. Restricted cubic spline (RCS) models were applied to explore dose-response relationships. Subgroup and sensitivity analyses were conducted to assess the consistency of the findings. During a median follow-up of 10 years, 1599 (23.14%) participants developed CVD. In fully adjusted models, participants in the highest baseline CMI quartile (Q4) had a significantly higher risk of CVD compared with those in the lowest quartile (Q1) (HR = 1.347, 95% CI: 1.161-1.563; P for trend = 0.0001). Each 1-SD increase in baseline CMI was associated with a 8.0% higher CVD risk (HR = 1.080, 95% CI: 1.031-1.131). For CumCMI, Q4 versus Q1 was associated with a 40.9% higher CVD risk (HR = 1.409, 95% CI: 1.124-1.768), with a 11.5% increase in risk per 1-SD increment (HR = 1.115, 95% CI: 1.039-1.196). Restricted cubic spline (RCS) analyses revealed a significant non-linear association between CMI and CVD risk (Poverall < 0.001; Pnonlinear = 0.003), with a threshold value of 0.462. CMI showed statistically significant associations with incident stroke, but not with incident heart disease. Both baseline CMI and cumulative average CMI are independently associated with incident CVD among middle-aged and older adults with CKM syndrome stages 0-3, demonstrating a non-linear threshold relationship. Cumulative exposure to elevated CMI shows a stronger association with CVD risk, supporting the value of longitudinal assessment of cardiometabolic status for CVD risk assessment in this population.

PurposeTo investigate independent risk factors and construct an internally validated risk prediction model for invasive pulmonary fungal infection (IPFI) in patients with lung cancer.Patients and MethodsClinical data from 250 consecutive lung cancer inpatients admitted to Nanchong Central Hospital between February 2022 and March 2025 were retrospectively analyzed; 41 patients developed IPFI and 209 did not. Patients were randomly assigned to a training set (n=175) and a validation set (n=75) at a 7:3 ratio. Candidate predictors were screened by univariate logistic regression, reduced using least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation, and entered into multivariable logistic regression to construct a nomogram. Model performance was evaluated using bootstrap internal validation (1000 resamples), calibration curves and goodness-of-fit testing, receiver operating characteristic analysis, and decision curve analysis.ResultsDiabetes mellitus, invasive procedures, systemic glucocorticoid use, lower CD4+ T-cell count, and length of hospital stay >14 days were associated with IPFI and were retained as independent predictors in the final model. The model showed good discrimination, with an area under the curve of 0.876 (95% CI: 0.809–0.944) in the training set and 0.861 (95% CI: 0.750–0.973) in the validation set, and demonstrated clinical net benefit across threshold probability ranges of 0.03–0.90 (training) and 0.04–0.78 (validation).ConclusionThis nomogram may support early risk stratification for IPFI among lung cancer inpatients, while confirmation in external, multi-center cohorts is needed before broader clinical application.

Diabetic Kidney Disease (DKD) is a major cause of End-Stage Renal Disease (ESRD) and lacks effective treatments. Tangmaikang Granules (TMK), a multi-herb traditional Chinese medicine formulation, have shown potential in managing DKD. However, the precise active components, molecular mechanisms, and therapeutic advantages of TMK remain unclear. This study tests the hypothesis that TMK granules exert protective effects on DKD by targeting multiple pathways involved in oxidative stress, inflammation, and apoptosis in podocytes through a multi-targeted approach. The aim was to identify TMK's bioactive components, evaluate its therapeutic potential, and uncover its molecular mechanisms in DKD. The bioactive constituents in TMK were determined through ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Drug targets were identified using SwissTargetPrediction and SuperPred, whereas DKD-associated targets were obtained from the GeneCards, DisGeNET, OMIM, and TTD databases. A Protein-Protein Interaction (PPI) network was constructed, and key targets were identified via topological analysis. Molecular docking and dynamics simulations were performed to evaluate stable binding interactions. GO and KEGG pathway enrichment analyses were conducted to uncover relevant signaling pathways. TMK's effects on oxidative stress, inflammation, and apoptosis in podocytes were assessed using CCK-8, flow cytometry, RT-qPCR, ELISA, and Western blot assays. Thirty active compounds and 384 potential therapeutic targets were identified, with eight key targets. Pathway enrichment analysis revealed TMK's involvement in AGE-RAGE, EGFR, HIF-1, and apoptosis pathways, affecting inflammatory cytokine responses and oxidative stress. In vitro experiments demonstrated that TMK significantly reduced oxidative stress, inflammation, and apoptosis in podocytes by inhibiting the MAPK and NF-κB pathways. TMK granules target DKD through a multi-component, multi-target strategy, effectively mitigating oxidative stress and suppressing inflammatory and apoptotic pathways. This study integrates advanced computational and experimental methods, demonstrating TMK's unique therapeutic potential and providing a robust foundation for its clinical application in DKD management.

The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Lymph node metastasis is a crucial prognostic factor in AEG patients. This study investigated the utility of lymph node ratio (LNR, the ratio of metastatic nodes to the total number of examined lymph nodes) in predicting the prognosis of AEG patients. The study conducted a retrospective analysis of 257 patients with AEG who underwent radical gastrectomy with lymphadenectomy. The patients were categorized into low-LNR (L-LNR) and high-LNR (H-LNR) groups, and their corresponding clinicopathological characteristics and survival rates were compared. Receiver Operating Characteristic (ROC) curves were generated to evaluate the sensitivity and specificity of LNR. The cutoff value for dividing the L-LNR group, and the H-LNR group was 0.20. In the L-LNR group, the 1, 3, and 5-year disease-free survival (DFS) rates and overall survival (OS) rates were higher than H-LNR group. Patients in the L-LNR group had better prognoses than those in the H-LNR group (P<0.001). Univariate analysis identified that vascular invasion, lymphatic invasion and LNR were risk factors for DFS and OS. Additionally, multivariate analysis demonstrated that LNR was independent risk factor for DFS and OS. In the subgroup analysis stratified by TNM stage, patients in the L-LNR group demonstrated better DFS and OS compared to those in the H-LNR group. The ROC curve identified that the LNR has good sensitivity and specificity for prognostic prediction in AEG patients, especially in stage III. Patients with LNR greater than 0.2 experienced significantly shorter OS and DFS in patients with AEG, especially in TNM stage III.

Immune cells and inflammatory cytokines collectively contribute to the pathogenesis of rosacea. However, the causality between immune cells, inflammatory cytokines and rosacea remains unclear. This study employed Mendelian randomization analysis to investigate the causality among 731 immune cells, 91 inflammatory cytokines, and rosacea. The inverse variance weighted, Mendelian randomization Egger, simple mode, weighted median, and weighted mode analyses were implemented to investigate causality. Sensitivity analyses were conducted to evaluate reliability of findings. Our research results indicated that 3 immune cells can increase risk of rosacea, 4 immune cells can decrease risk of rosacea. Among them, transitional (TR) B cell %lymphocyte (odds ratio [OR] = 1.170, 95% confidence interval [CI] = 1.001–1.368), CD25 on IgD− CD24− B cell (OR = 1.151, 95% CI = 1.013–1.307), and HLA DR on CD14− CD16+ monocyte (OR = 1.136, 95% CI = 1.007–1.281) increased risk of rosacea. Central memory CD4− CD8− T cell absolute count (OR = 0.952, 95% CI = 0.889–1.019), CCR7 on naive CD4+ T cell (OR = 0.928, 95% CI = 0.866–0.995), CD14+ CD16− monocyte absolute count (OR = 0.915, 95% CI = 0.857–0.977), and CD62L− myeloid dendritic cell (mDC; OR = 0.928, 95% CI = 0.862–0.999) decreased risk of rosacea. Meanwhile, the findings revealed that C-X-C motif chemokine 11 (CXCL11) levels (OR = 1.265, 95% CI = 0.985–1.625) and T-cell surface glycoprotein CD6 isoform levels (OR = 1.372, 95% CI = 1.069–1.761) increased risk of rosacea, while monocyte chemoattractant protein-1 levels (OR = 0.772, 95% CI = 0.621–0.960) and programmed cell death 1 ligand 1 levels (OR = 0.739, 95% CI = 0.557–0.981) decreased risk of rosacea. This study establishes a theoretical framework for comprehensively investigating the relationships between immune cells, inflammatory cytokines, and rosacea. It also offers valuable references for identifying novel therapeutic targets for rosacea.