Taizhou Second People's Hospital

To investigate the efficacy and safety assessment of intensive post-operative recovery during thoracoscopic-assisted radical oesophageal carcinoma (OC) treatment. The meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and English terms were searched in PubMed, Embase, Cochrane Library (2020, Issue 1) and Web of Science, and the same Chinese terms were searched in China National Knowledge Internet and Wanfang Data, with the date range set from January 2010 to January 2020. Search engines, including Google Scholar and Baidu Library, were also applied for manual searches of relevant literature. The final number of articles included was 12, 11 of which were in Chinese and one in English. The basic data of the two groups were statistically analysed. Among 1049 OC patients, 527 were treated with enhanced recovery after surgery (ERAS) and 522 were treated with conventional perioperative management (control group), comparing the operative time, intraoperative blood loss, self-rating anxiety scale (SAS), visual analog scale (VAS), post-operative first venting time, chest tube removal time, post-operative hospitalisation time, post-operative hospitalisation cost, combined complication rate, lung infection rate, anastomotic leak rate and gastric emptying disorder rate. There were statistically significant differences between the ERAS group and the control group in terms of operative day anxiety score, post-operative Visual Analogue Scale, time to first post-operative anal vent, time to chest tube removal, post-operative hospital stay, hospitalisation cost and overall complication rate (weighted mean difference [WMD] = -5.61, 95% confidence interval [CI]: -7.95 to -3.28, P < 0.00001; WMD = -1.58, 95% CI: -1.58, -1.94 to -1.22, P < 0.00001; standardized mean difference [SMD] = -1.86, 95% CI: -2.53 to -1.18, P < 0.00001; SMD = -4.97, 95% CI: -6:73 to -3.21, P < 0.00001; WMD = -3.93, 95% CI: -4.80 to -3.07, P < 0.00001; WMD = -0.65, 95% CI: -0.74~-0.55, P < 0.00001 and relative risk [RR] =0.41, 95% CI: 0.33-0.51, P < 0.00001). ERAS reduced the incidence of pulmonary infection, anastomotic leak and impaired gastric emptying with a statistically significant difference (RR =0.45, 95% CI: 0.31-0.65, P < 0.0001; RR =0.34, 95% CI: 0.16-0.74, P < 0.05; RR =0.34, 95% CI: 0.16-0.73, P < 0.05). ERAS is effective in patients with OC undergoing thoracoscopic-assisted radical OC treatment to improve patients' clinical symptoms and reduce the incidence of adverse effects.

Air pollution and cardiovascular-kidney-metabolic (CKM) syndrome have emerged as major global public health challenges. However, limited evidence exists on the association between air pollution exposure and CKM incidence and progression. We analyzed data from participants across CKM stages 0-5 enrolled in the China Health and Retirement Longitudinal Study. Ambient air pollutant concentrations were obtained from the China High Air Pollutants database. Binary logistic regression and weighted quantile sum (WQS) regression models were applied to assess the impacts of individual and combined air pollutants on CKM incidence. Cumulative exposure models were employed to study the long-term effects of pollutants on CKM progression. CKM stages were modeled as ordered categorical outcomes using proportional odds models to examine the association between pollutant levels and CKM progression. A total of 4,026 individuals were included in the main analysis. Each interquartile range increase in particulate matter with aerodynamic diameters ≤ 1μm (PM1; OR = 1.008, 95% CI: 1.001-1.015, p < 0.05), ≤ 2.5μm (PM2.5; OR = 1.009, 95% CI: 1.002-1.015, p < 0.01 ), ≤ 10μm (PM10; OR = 1.010, 95% CI: 1.004-1.016, p < 0.01), nitrogen dioxide (NO2; OR = 1.011, 95% CI:1.004-1.018, p < 0.01), and ozone (O3; OR = 1.014, 95% CI: 1.006-1.021, p < 0.01) was significantly associated with increased CKM risk. The combined effect of multiple pollutants, reflected by the WQS index, was associated with a 77.7% higher risk of CKM incidence (OR = 1.777, 95% CI: 1.143-2.762, p < 0.05). PM10 (OR = 1.160, 95% CI: 1.059-1.270, p < 0.05) and sulfur dioxide (SO2; OR = 1.122, 95% CI: 1.018-1.236, p < 0.05) were significant contributors to CKM progression. In the cumulative effect analysis of 2,146 individuals, 5-year cumulative PM10 exposure was positively associated with CKM progression (OR = 1.027, 95% CI: 1.001-1.055, p < 0.05). Air pollution is a significant environmental determinant of both CKM incidence and progression. Combined and cumulative effects of multiple pollutants may further enhance CKM risk.

Metabolic syndrome (MetS) is highly prevalent among individuals with schizophrenia. However, substantial regional variation exists, and evidence from large samples of hospitalized patients in China remains limited. This study aimed to estimate the prevalence of MetS and to explore its associated factors among individuals with schizophrenia in China. We included 3042 participants with schizophrenia from 25 hospitals in Zhejiang Province from April to December 2022. MetS was defined according to the Chinese Diabetes Society (CDS) criteria, the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, and the International Diabetes Federation (IDF) criteria. The prevalence of MetS was estimated using the Clopper-Pearson method, and generalized additive models were used to fit smoothed age-specific prevalence curves. Multivariate logistic regression was used to explore potential factors associated with MetS. The overall prevalence of MetS was 34.9% (95% confidence interval [CI]: 33.2–36.7%), 42.6% (40.9–44.4%), and 38.9% (37.2–40.7%) based on the CDS, NCEP ATP III, and IDF criteria, respectively. The prevalence of MetS was significantly higher in female participants with schizophrenia compared to their male counterparts when applying the NCEP ATP III or IDF criteria. In addition, after reaching the age-specific peak, MetS prevalence declined in male participants but stabilized in females. High BMI (OR: 1.30 [1.27–1.33]) and comorbid endocrine diseases (OR: 1.79 [1.48–2.17]) were associated with increased odds of MetS. Metabolic syndrome is highly prevalent among individuals with schizophrenia, regardless of the diagnostic criteria used. Early identification and screening of metabolic abnormalities in individuals with schizophrenia should be considered.

This study aimed to compare the predictive performance of CT-derived Hounsfield units (HU) and MRI-based vertebral bone quality (VBQ) scores for pedicle screw loosening (PSL) following single-level lumbar spinal fusion in patients with various types of degenerative lumbar disorders. A retrospective analysis was conducted on patients who underwent transforaminal lumbar interbody fusion (TLIF) at our institution between April 2021 and December 2023. PSL was identified on lumbar X-ray obtained at 12-month follow-up, defined as a radiolucent zone of ≥ 1mm around the pedicle screw. VBQ score and HU value were measured using preoperative MRI and CT, respectively. Receiver operating characteristic (ROC) curve analysis was performed to evaluate and compare the predictive capabilities of HU and VBQ for PSL. Across all patients (n = 154), the area under the curve (AUC) of the VBQ score (AUC = 0.807; 95% confidence interval (CI): 0.727-0.888; P < 0.001) exceeded those of the CT HU value (AUC = 0.702; 95% CI: 0.598-0.806; P = 0.001), although the difference was not statistically significant (PAUC = 0.168). In the lumbar spinal stenosis (LSS) subgroup (n = 65), AUC of VBQ score (AUC = 0.887; 95% CI: 0.793-0.980; P < 0.001) was larger than those of the CT HU value (AUC = 0.686; 95% CI: 0.532-0.841; P = 0.034), with significant difference (PAUC = 0.050). VBQ and HU scores exhibit differing predictive capabilities for PSL across distinct types of lumbar degenerative disease. Notably, VBQ demonstrated superior predictive performance in the LSS subgroup. These findings suggest VBQ may be a valuable adjunct in preoperative bone quality assessment and surgical decision-making for LSS patients.

ObjectiveCongenital diaphragmatic hernia (CDH) and congenital diaphragmatic eventration (CDE) exhibit overlapping imaging features that can contribute to diagnostic challenges. The aim of this study is to systematically and retrospectively examine the clinical and imaging characteristics of CDH and CDE to delineate their differences in diagnosis, treatment, and prognosis assessment, thereby providing a foundation for evidence-based clinical decision-making.MethodsA retrospective analysis was conducted on 78 cases of CDH and 20 cases of CDE diagnosed between January 2020 and December 2024 at a single institution. Imaging modalities reviewed included chest radiography, gastrointestinal contrast studies, ultrasonography, and computed tomography, in conjunction with clinical data. Key imaging parameters assessed were the integrity of the diaphragmatic contour, diaphragmatic motion, mediastinal displacement, thoracoabdominal organ position, pulmonary development, and amniotic fluid volume.ResultsThe sensitivity of X-ray and CT was (CDH 97.43% vs 100%, CDE 80.00% vs 90.00%), and the sensitivity of CT was higher than that of X-ray. The examination results were significantly associated with disease classification, which had statistical significance (P <0.05). In terms of diaphragm integrity and other malformations, CT examination showed significantly higher sensitivity than X-ray examination (100% vs 91.02%,6.41% vs 2.56%). However, in terms of paradoxical movement of the diaphragm, X-ray dynamic examination showed higher sensitivity than CT examination (80.00% vs 0%). Surgical management of CDH was more complex, influenced by the type and extent of the hernia as well as associated anomalies, and often necessitated intensive postoperative care. In contrast, surgical intervention for CDE was less complicated and associated with more favorable outcomes.ConclusionDespite certain overlapping imaging findings, CDH and CDE present distinct radiologic and clinical profiles. Comprehensive comparative imaging analysis enhances the understanding of their underlying pathophysiological differences, facilitates accurate diagnosis, and supports the development of tailored management strategies to improve clinical outcomes and long-term quality of life.

The expression of collagen receptors by cancer cells serves a vital function in the regulation of cell behavior. These receptors are capable of sensing the signals generated by alterations in the collagen state, thereby contributing to the maintenance of cellular homeostasis. The discoidin domain receptor (DDR)1 functions as a critical sensor of collagen fiber state and composition, regulating tumor cell growth, response to therapy, and patient survival. We evaluated the role of collagen alpha-5(IV) chain (COL4A5) in nasopharyngeal carcinoma (NPC) and the detailed mechanism. GSE118719 and GSE68799 datasets were included to identify COL4A5 as a hub gene in NPC. Transcriptional activation of COL4A5 by nuclear factor 1/C (NFIC) mediated DDR1/Akt signaling activation, promoted NPC cell proliferation, migration, invasion, and curbed apoptosis in vitro, and exacerbated malignant progression of subcutaneous tumors in nude mice. NFIC and COL4A5 were significantly overexpressed in the tumors of NPC patients, and their expressions were significantly positively correlated. The overexpression of NFIC and COL4A5 was closely related to the tumor, node, metastases stage of NPC patients. Collectively, our results suggest that NFIC transcriptionally activates COL4A5 and upregulates its expression, which mediates DDR1/Akt signaling and promotes the malignant behavior of NPC cells, leading to NPC progression.