Peking University People's Hospital

This study aimed to characterise the expression and functional heterogeneity of CD49f across CD4+ T cell subsets in human peripheral blood, and to investigate alterations in regulatory T cells (Tregs) and CD4+ T cells in patients with systemic lupus erythematosus (SLE), together with their clinical relevance. A total of 43 newly diagnosed, treatment-naïve SLE patients and 21 age- and sex-matched healthy controls were enrolled. Peripheral blood mononuclear cells were analysed by flow cytometry to assess CD49f expression in CD4 + FoxP3+ Tregs and non-Treg CD4+ T cells. Phenotypic and function-related markers were compared between CD49f + and CD49f- subsets. IL-10 production was evaluated as a functional readout in CD49f-defined Treg subsets. Associations between CD49f-related populations and clinical parameters were analysed, and receiver operating characteristic (ROC) curve analysis was performed to explore their potential clinical relevance. CD49f expression was higher in CD4 + FoxP3+ Tregs than in other CD4+ T cells. CD49f + CD4+ T cells exhibited increased CD226 and decreased CD45RA expression, consistent with an activated phenotype. CD49f + Tregs were enriched in the CD45RA-FoxP3int subset and showed higher CD226 but lower GZMB and Helios expression, indicating attenuated suppressive phenotypic features. In healthy controls, CD49f + Tregs displayed significantly higher IL-10 production than CD49f- Tregs, whereas this functional distinction was lost in SLE patients. The proportions of CD49f + subsets were significantly increased in SLE and correlated with multiple clinical indicators. ROC analysis revealed moderate discriminative performance of CD49f-related subsets, with AUC values ranging from 0.640 to 0.786. In conclusion,CD49f identifies distinct phenotypic and functional states within CD4+ T cells and Tregs. CD49f + CD4+ T cells exhibit activation features, while CD49f + Tregs show phenotypic attenuation accompanied by functional heterogeneity that is preserved in health but disrupted in SLE. Increased CD49f expression in SLE reflects immune imbalance and suggests potential value as a cellular immunological marker rather than a standalone diagnostic tool.

To investigate the triglyceride-glucose index (TyG) as a predictor of glycaemic variability phenotypes in patients with type 2 diabetes mellitus (T2DM) using continuous glucose monitoring (CGM)-derived metrics, guiding personalized management. This cross-sectional study analysed 279 T2DM patients who underwent 14-day CGM monitering from community hospitals in Ningbo, China. Participants were stratified by TyG tertiles. Spectral clustering with complexity-invariant dynamic time warping identified distinct glycaemic variability glucotypes. Comprehensive CGM metrics spanning time-domain, frequency-domain, event-based, and circadian rhythm domains were evaluated. Multivariable logistic regression assessed associations between TyG and glycaemic phenotypes. Across TyG tertiles, we observed progressive increases in HbA1c (6.8 ± 1.5%, 7.2 ± 1.2%, 7.3 ± 1.3%, p = 0.011), fasting glucose (6.1 ± 1.1, 7.2 ± 1.6, 8.5 ± 2.8 mmol/L, p < 0.001), and triglycerides (0.9 ± 0.2, 1.4 ± 0.4, 2.7 ± 1.0 mmol/L, p < 0.001). Most notably, patients in the highest TyG tertile exhibited sustained hyperglycaemia with lower TIR (81.8% to 72.8 to 70.3%, p = 0.001), elevated TAR (15.9% vs. 29.1%, p < 0.001), and paradoxically reduced TBR (2.3% to 1.4% to 0.6%, p = 0.014) and CV (26.2% to 25.8% to 23.8%, p = 0.021). Frequency domain analysis demonstrated that elevated TyG was associated with high-level, low-frequency glucose oscillations. Higher TyG tertiles demonstrated increased prevalence of severe variability glucotype (32.3% to 53.8% to 63.4%), with TyG emerging as the strongest independent predictor (OR = 1.87, 95% CI: 1.42-2.50, p < 0.001). Elevated TyG identifies a distinct glycaemic phenotype characterized by high-level, low-frequency oscillations, sustained hyperglycaemia, and minimal hypoglycaemic risk. T2DM patients with high TyG levels may be appropriate candidates for more intensified glucose-lowering strategies.

To address the current lack of standardized protocols for vestibular infant screening (VIS), this clinical consensus aims to establish a clinical consensus on VIS in infants aged 0-12 months. Given a frequent co-occurrence of vestibular dysfunction in children with sensorineural hearing loss (SNHL) and the significant impact of vestibular dysfunction on early development, early identification and management are critical. This clinical consensus was developed by a panel of 28 international experts in pediatric otolaryngology and vestibular disorders through a structured, multi-round Delphi process. Panelists were selected based on clinical and academic expertise, representing 26 institutions across Asia and Europe. A comprehensive literature review (2000-2024) informed the initial draft of consensus statements. The consensus was reached through three iterative rounds of anonymous rating and feedback, followed by virtual discussions. Statements achieving ≥ 80% agreement were retained in the final consensus, which focused on screening tools, target populations, optimal timing, and standardized cVEMP recording protocols for infants. The expert panel reached consensus on key recommendations in four domains: screening tool, target screening population, timing of vestibular function screening, and recording protocol for cervical vestibular evoked myogenic potential (cVEMP). This clinical consensus provides foundational guidance for the implementation of VIS in infants, advocating for standardized protocols to improve early diagnosis and intervention. Widespread adoption of these recommendations may enhance developmental outcomes by enabling timely detection and management of vestibular dysfunction in early childhood.

The current pathological diagnosis of lymph node metastasis is time-consuming, labor-intensive, and dependent on sectioning of paraffin blocks. Herein, in a prospective cohort of patients with breast cancer, we validated dynamic full-field optical coherence tomography (D-FFOCT), a virtual pathology tool integrating deep learning for nodal metastasis detection, and offering rapid and label-free histologic approximations of fresh tissues. In a prospective dual-center cohort of 155 patients with breast cancer, 747 freshly bisected lymph node slides were obtained via D-FFOCT. Surgeons interpreted each slide with histopathology as the gold standard. A deep learning model was trained on 28,911 patches (corresponding to 590 slides) and tested on 7,736 patches (corresponding to 157 slides). The results were mapped to the slide level for potential intraoperative evaluation. D-FFOCT strongly correlated with hematoxylin and eosin (H&E)-stained histological images. Surgeons achieved 97.10% specificity in nodal diagnosis with D-FFOCT. The performance of the artificial intelligence (AI) model was not inferior to that of human experts and had a sensitivity/specificity of 87.88%/91.94% and an area under the receiver operating characteristic curve of 0.899 at the slide level. The human-AI collaborative system reduced labor requirements by 75% and increased the specificity by 6.5%, to 98.39%. D-FFOCT has excellent potential as a tool for assessing lymph node metastatic status without tissue preparation or consumption. The integration of D-FFOCT with deep learning decreases labor demands and maintains high accuracy, thereby enabling streamlined nodal prediction independent of routine pathology procedures.