Third People's Hospital of Hefei

Ferroptosis constitutes a pivotal pathological event following spinal cord injury and presents substantial challenges to the restoration of neurological function. Cystine-glutamate transporter SLC7A11 is essential for maintaining cellular redox homeostasis and resisting ferroptosis. However, the mechanisms underlying neuronal ferroptosis caused by SLC7A11 downregulation following spinal cord injury remain unclear. Herein, we provide evidence that tumor protein 53, a negative regulator of SLC7A11, was significantly upregulated post-spinal cord injury. Transcriptomic analysis indicated that tumor protein 53 was associated with injury severity. We subsequently confirmed that tumor protein 53 inhibition restored the expressions of SLC7A11 and glutathione peroxidase 4, alleviated neuronal ferroptosis, and improved neurological function in a contusion spinal cord injury rat model. The regulatory effects of tumor protein 53 on the transcription and ubiquitination of SLC7A11 were further elucidated using chromatin immunoprecipitation polymerase chain reaction and cleavage under targets and tagmentation techniques. Additionally, Kelch-like protein 4, an E3 ubiquitin ligase adaptor, was demonstrated to play an important role in the tumor protein 53-mediated ubiquitination of SLC7A11. In summary, the present study elucidated the possible mechanisms of tumor protein 53-mediated neuronal ferroptosis in spinal cord injury, thereby providing potential targets and insights for clinical translation.

To evaluate three LLMs (DeepSeek R1, Gemini 2.5 Flash, and GPT-4o) for generating structured, clinically interpretable outputs from free-text knee ultrasound reports. We retrospectively analyzed 359 de-identified knee ultrasound reports using four prompt strategies targeting (Prompt 1) information extraction, (Prompt 2) structured report generation, (Prompt 3) impression generation, and (Prompt 4) clinical recommendation generation. Two experienced physicians rated outputs using prespecified 5-point Likert rubrics for extraction quality, structuring quality, diagnostic usefulness, recommendation quality, readability, and subjective repeatability. Objective evaluations included Prompt 2 structural completeness and stability under a fixed slot schema (schema compliance, missing-item rate, and slot-level exact match), Prompt 3 objective repeatability via mapped binary findings (percent agreement and Cohen's κ across repeated runs), and Prompt 3 diagnostic performance against an expert binary reference standard (sensitivity/specificity, F1 score, balanced accuracy, and MCC; 95% confidence intervals via bootstrapping). For Chinese recommendation metrics, BLEU/ROUGE-L were computed using character-level tokenization. Across 359 knee ultrasound reports, GPT-4o demonstrated the strongest overall performance across extraction, diagnostic impression generation, and clinical recommendation tasks. It achieved the highest physician-rated scores for NER (4.0 ± 0.6) and diagnostic summarization (3.8 ± 0.7), along with the best diagnostic performance (F1-score = 0.79 vs 0.54 for DeepSeek R1 and 0.45 for Gemini 2.5 Flash, with the highest balanced accuracy and MCC). DeepSeek R1 showed competitive performance in structured reporting (4.0 ± 0.5) and repeatability (3.41 ± 0.06), with stable schema compliance and run-to-run consistency. Gemini 2.5 Flash consistently underperformed, particularly in NER accuracy (3.2 ± 0.7) and diagnostic recall (0.37). Objective analyses further confirmed superior structural completeness, repeatability, and semantic quality of recommendations for GPT-4o compared with the other models. GPT-4o consistently outperformed DeepSeek R1 and Gemini 2.5 Flash, supporting its potential to improve knee ultrasound report consistency and clinical utility.

Abstract Purpose: To investigate the impact of obstructive sleep apnea (OSA) on depression inacute ischemic stroke (AIS) patients within 14 days post-stroke, and to develop and validate a nomogram for predicting early post-stroke depression (PSD) risk. Methods: This retrospective cohort study enrolled AIS patients admitted to Hefei Second People's Hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9; cutoff ≥5). Demographic, clinical vascular risk factors, insomnia, uric acid（UA）, and apnea-hypopnea index（AHI）were collected. Multivariable logistic regression identified independent predictors of early PSD. A nomogram incorporating significant predictors was developed and internally validated using bootstrap resampling (1,000 repetitions). Model performance was evaluated by C-statistic and calibration curves. Clinical utility was assessed via decision curve analysis. Results: Among 138 AIS patients (median AHI: 18.15 events/h [IQR:11.70–28.82]), moderate-to-severe OSA (AHI≥15) prevalence was 60.1% (83/138), and early PSD incidence was 50.7% (70/138). Regression analysis revealed: 1. Continuous AHI model: Insomnia (OR=6.507, 95% CI:2.931–14.447; P<0.001), uric acid（UA）(OR=1.006, 95% CI:1.001–1.011; P=0.027), and AHI (OR=1.039, 95% CI:1.007–1.072; P=0.016) independently predicted PSD. 2. Categorical AHI model: Moderate-to-severe OSA (OR=2.248, 95% CI:1.006–5.023; P=0.048), insomnia (OR=5.825, 95% CI:2.672–12.702; P<0.001), and uric acid (OR=1.006, 95% CI:1.001–1.011; P=0.013) were significant predictors. The nomogram demonstrated good discrimination (C-statistic=0.784, 95% CI:0.704–0.863) and calibration. Decision curve analysis confirmed clinical utility across threshold probabilities. Conclusion: Insomnia, UA, and AHI are independent risk factors for early depression in AIS patients, while moderate to severe OSA further increases this risk. The nomogram constructed based on the above factors shows good predictive efficacy for early depression in AIS patients.

BackgroundPeripheral arterial disease is a common vascular condition characterized by the narrowing of peripheral arteries, leading to reduced blood flow and increased risk of cardiovascular events such as myocardial infarction, stroke, and limb amputation. Despite its impact, peripheral arterial disease remains underdiagnosed, making early identification crucial for improving outcomes. The neutrophil percentage-to-albumin ratio, reflecting systemic inflammation and nutritional status, has been proposed as a potential biomarker for assessing peripheral arterial disease risk.MethodsThis study used data from the National Health and Nutrition Examination Survey from 1999 to 2004, including 2864 participants after excluding those with missing data on peripheral arterial disease status, neutrophil percentage-to-albumin ratio, and covariates. Peripheral arterial disease was diagnosed using the ankle–brachial index, with an ankle–brachial index value less than 0.90 indicating peripheral arterial disease. Neutrophil percentage-to-albumin ratio was calculated as the percentage of neutrophils in total white blood cells divided by serum albumin levels. Logistic regression models were used to examine the association between neutrophil percentage-to-albumin ratio and peripheral arterial disease, adjusting for potential confounders, including age, sex, race, educational level, body mass index, hypertension, hyperlipidemia, diabetes, and smoking. A nonrestricted cubic spline analysis was used to assess the nonlinear relationship between neutrophil percentage-to-albumin ratio and peripheral arterial disease.ResultsElevated neutrophil percentage-to-albumin ratio was significantly associated with an increased peripheral arterial disease risk. In the unadjusted model, the highest neutrophil percentage-to-albumin ratio quartile (Q4) had an odds ratio of 2.67 (95% confidence interval, 1.78–4.01; P < 0.001). This association remained significant after adjusting for age, sex, and other confounders, with an odds ratio of 1.86 (95% confidence interval, 1.21–2.85; P = 0.004) in the fully adjusted model. Cubic spline analysis revealed a threshold at a neutrophil percentage-to-albumin ratio of 13.71, above which peripheral arterial disease risk increased significantly. Subgroup analyses indicated stronger associations in individuals with hypertension, hyperlipidemia, and diabetes.ConclusionElevated neutrophil percentage-to-albumin ratio is associated with an increased peripheral arterial disease risk, with a threshold effect at a neutrophil percentage-to-albumin ratio of 13.71. Neutrophil percentage-to-albumin ratio may serve as a valuable, cost-effective biomarker for early peripheral arterial disease detection and risk stratification, particularly in high-risk populations.

BackgroundCommunity-based management improve chronic disease outcomes, but their impact on disease perception and frailty in chronic obstructive pulmonary disease (COPD) patients remains underexplored.ObjectiveTo identify factors influencing disease perception in elderly COPD patients and assess the role of community-based management.MethodsIn this cross-sectional study, 223 COPD patients aged ≥60 years (diagnosed per the 2021 Guidelines for Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease) were randomly selected. Dyspnoea severity was graded via the mMRC scale; COPD severity incorporated spirometry (FEV1/FVC) and symptom burden (COPD Assessment Test). Participants completed the Brief Illness Perception Questionnaire (BIPQ), Tilburg Frailty Indicator (TFI), and a general information survey. Differences between community-managed (n=81) and non-community-managed (n=142) groups were compared. Pearson’s correlation and multivariate linear regression analyses identified predictors of disease perception.ResultsMean BIPQ score was 46.87±7.47 (moderate threat perception), and frailty score was 8.02±2.38. Disease perception positively correlated with total frailty and its subdomains (P<0.05). Community-managed patients had significantly lower BIPQ and TFI scores (P<0.05). Regression revealed disease duration (β=0.28), dyspnoea severity (β=0.22), and frailty (β=0.19) as positive predictors of disease perception; community management (β=−0.15) and older age (β=−0.12) were negative predictors (P<0.05). The model explained 46.0% of variance (R2=0.46, F=18.03, P<0.001).ConclusionElderly patients with COPD demonstrated strong links between disease perception and frailty. Community-based management considerably reduced these scores, indicating its potential to improve patient outcomes.

ObjectiveThis study aimed to analyze the correlation between serum levels of Procalcitonin (PCT) and C-reactive protein (CRP) and the occurrence and severity of Bronchopulmonary Dysplasia (BPD) in Extremely Low Birth Weight (ELBW) and Very Low Birth Weight (VLBW) neonates, and to identify associated risk factors.MethodsA retrospective analysis was conducted on 213 ELBW/VLBW neonates admitted between January 2021 and January 2024. According to BPD diagnosis, they were categorized into a control group (n=62, without BPD) and an observation group (n=151, with BPD). The observation group was further stratified by severity into mild (n=71), moderate (n=46), and severe (n=34) BPD. Serum PCT and CRP levels were compared across groups. The correlation between these biomarkers and BPD severity was analyzed, and risk factors for BPD were investigated.ResultsPCT and CRP levels were significantly higher in the observation group than in the control group (P<0.05). A significant increasing trend in both PCT and CRP levels was observed with worsening BPD severity (P<0.05). Spearman analysis confirmed positive correlations between BPD severity and PCT (r=0.354) and CRP (r=0.472) levels (P<0.05). Multivariate logistic regression identified intrauterine infection, gestational age <28 weeks, assisted ventilation >2 weeks, infectious pneumonia, and FiO2 >40% as independent risk factors for BPD (P<0.05).ConclusionIn this retrospective study, elevated serum PCT and CRP levels were positively associated with the severity of BPD in ELBW/VLBW neonates. The identified risk factors, including intrauterine infection, gestational age <28 weeks, prolonged assisted ventilation, infectious pneumonia, and high FiO2, are independently associated with BPD. These findings suggest that monitoring these biomarkers and risk factors may warrant intensified clinical attention.

Background and objectivesIn canonical knowledge, long-segment intraspinal schwannomas (SCHs) require laminectomies at all involved levels for complete exposure. To evaluate a minimally invasive, limited-exposure strategy for gross total resection (GTR) of multi-level intraspinal SCHs.MethodsA retrospective analysis was conducted on 11 patients with intraspinal SCHs involving ≥ 3 vertebral segments who underwent laminectomy confined to critical vertebrae, achieving gross total resection without full exposure of all involved levels. The surgical approach involved focused laminectomy targeting critical vertebrae, intracapsular decompression, and meticulous microsurgical dissection. Follow-up included clinical assessments and MRI evaluations at 3 months and 1-year post-surgery.ResultsThe cohort comprised 4 females and 7 males, with a median age of 50 years. Lesions were predominantly located in the cervical spine. Ten cases exhibited cystic lesions, while one presented a fully solid tumor. The average surgical time was 119 ± 15.6 minutes. Laminectomy was performed within 2 levels (6 cases) or 1 level (5 cases). All patients achieved complete symptom resolution at discharge, with no perioperative complications. During a mean follow-up of 23.5 ± 13.0 months, no cases of postoperative spinal instability or tumor recurrence were identified.ConclusionFor long-segment intraspinal SCHs, particularly cystic lesions, minimizing the number of laminectomy levels to achieve GTR is technically feasible and clinically safe.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00423-025-03932-0.