Xiang Yang No.1 People's Hospital

To systematically evaluate the efficacy and safety of first-line therapies and first-line-based combination therapies for treating monosymptomatic nocturnal enuresis (MNE) in children using a network meta-analysis. PubMed, Embase, the Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov were comprehensively searched to identify randomized controlled trials (RCTs) comparing either different first-line therapies or combination regimens involving first-line treatments versus monotherapy for MNE. Two researchers independently screened studies, extracted data according to predefined criteria, and assessed the methodological quality of the included trials. Data were analyzed using R software, with relative risk (RR) used as the effect size for dichotomous outcomes. The certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) approach. A total of 23 RCTs involving 2424 children and eight interventions were included. The network meta-analysis showed that desmopressin combined with oxybutynin, propiverine, solifenacin, or tolterodine was significantly more effective in achieving complete response (CR) than desmopressin monotherapy. Additionally, combinations of desmopressin with oxybutynin or tolterodine were superior to alarm monotherapy. No statistically significant differences were found among interventions regarding partial response (PR). For relapse rate, alarm monotherapy, desmopressin plus alarm, and desmopressin plus solifenacin were significantly better than desmopressin monotherapy. No significant differences in adverse events (AEs) were found across the interventions. In terms of CR, the top three interventions were desmopressin plus oxybutynin, desmopressin plus tolterodine, and desmopressin plus solifenacin. For PR, the leading treatments were desmopressin plus oxybutynin, desmopressin monotherapy, and alarm therapy. Regarding relapse rate, desmopressin plus solifenacin, alarm therapy, and desmopressin plus tolterodine ranked highest. For AEs, alarm therapy, desmopressin plus propiverine, and desmopressin monotherapy had the lowest incidence. The certainty of evidence for the primary outcome ranged from moderate to low according to the CINeMA assessment. Desmopressin combined with anticholinergic agents significantly improved CR versus desmopressin monotherapy and demonstrated partial significant superiority over alarm therapy alone. Among these, desmopressin plus oxybutynin demonstrated the best overall efficacy. Alarm therapy and desmopressin alone showed similar therapeutic effectiveness. Desmopressin monotherapy was associated with a higher relapse rate. Importantly, combination therapy did not significantly increase the risk of AEs compared to monotherapies. According to the CINeMA framework, the certainty of evidence was mostly low to moderate, highlighting the need for cautious interpretation and further high-quality trials.

Lung cancer remains a leading cause of cancer-related mortality worldwide. This study evaluated multidimensional biomarkers in bronchoalveolar lavage fluid (BALF) for the diagnosis and prognostic evaluation of lung cancer. This retrospective observational study included 100 patients who underwent clinically indicated bronchoscopy between April 2022 and April 2024, comprising 65 patients with histopathologically confirmed lung cancer and 35 patients with benign pulmonary diseases. BALF data obtained during routine clinical care were retrospectively collected for tumor markers (CEA, CYFRA21-1, NSE, ProGRP), cytokines (IL-6, IL-8, TNF-α, IL-10), ctDNA mutation profiles, and immune-cell subpopulations. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. Overall survival (OS) was analyzed using Kaplan-Meier methods and Cox proportional hazards regression. BALF concentrations of CEA, CYFRA21-1, NSE, ProGRP, IL-6, IL-8, and TNF-α were significantly higher in lung cancer patients than in benign controls, whereas IL-10 was lower, resulting in a markedly elevated IL-6/IL-10 ratio (all p < 0.05). ctDNA was detected more frequently in BALF than in peripheral blood (87.7% vs. 64.6%, p = 0.002), with higher variant allele frequencies and greater concordance with tissue genotyping (86.8%). Immune profiling showed increased regulatory T-cell proportions and M2 macrophage polarization with reduced CD8+ T-cell proportions in lung cancer BALF. In multivariable Cox analysis, advanced TNM stage, IL-6/IL-10 ratio >15, and CD8+/Treg ratio <1.5 were independent predictors of poorer OS. BALF provides tumor-proximal diagnostic and prognostic information in lung cancer. Enriched tumor markers, inflammatory imbalance, particularly the IL-6/IL-10 ratio, enhanced ctDNA detection, and local immunosuppressive immune features support the utility of BALF as a minimally invasive liquid biopsy for lung cancer evaluation and risk stratification.

BackgroundWe analyzed the prevalence and clinical characteristics of children with plastic bronchitis (PB) caused by severe Mycoplasma pneumoniae (SMPP) and explored its risk factors.MethodsThis retrospective study included pediatric patients with SMPP who were admitted to the Respiratory Department of Children’s Hospital of Soochow University and underwent fiberoptic bronchoscopy (FB) treatment between January 1 and December 31, 2024. The SMPP patients were divided into a PB group and a non-PB group according to whether there was a plastic shape under FB. Epidemiological characteristics, general information, clinical manifestations, laboratory findings, imaging features, and treatment regimens were collected and compared between the two groups. Risk factors for PB were identified using logistic regression analysis, and their predictive value was assessed with receiver operating characteristic (ROC) curves.ResultsThis study incorporated a total of 510 children diagnosed with SMPP, with 60 and 450 assigned to the PB and non-PB groups, respectively. The epidemic peak of SMPP occurred in summer and autumn; the highest detection rate of PB was recorded in winter (19.30%), with the PB positivity rate peaking in December (32.26%). In the PB group, fever days, runny nose, diminished breath sounds, abnormal liver function, abnormal coagulation function, number of bronchoscopic interventions, neutrophil percentage, C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D-dimer, atelectasis, and pleural effusion were all significantly higher compared to the non-PB group (P < 0.05). In the PB group, lymphocyte percentage and platelet count were significantly lower compared to the non-PB group (P < 0.05). Multivariate logistic regression analysis identified LDH, pleural effusion, and length of hospital stay as independent predictors of PB in children. The combination of these three indicators yielded a notably higher predictive value, with an area under the receiver operating characteristics curve (AUC) of 0.911 (95% CI: 0.868∼0.953).ConclusionLDH, pleural effusion, and length of hospital stay were independent risk factors for PB in SMPP children. For children suspected of PB, pediatricians should pay close attention to the above indicators, strive for early diagnosis and treatment, and improve prognosis.

M1 macrophage exosomes (M1-Exos) have been shown to play a significant role in regulating Lung adenocarcinoma (LUAD) progression. Krüppel-Like Factor 6 (KLF6) is a widely expressed nuclear transcriptional regulator involving in various key cellular processes and functions as a tumor suppressor. Here, this study aimed to investigate the role of KLF6 in LUAD and whether M1-Exos function in LUAD by KLF6.Levels of mRNA and protein were detected using qRT-PCR and western blotting. Exosomes were isolated from M1 macrophages and co-cultured with LUAD cell lines for functional analysis. In vitro analyses were conducted using 5-ethynyl-2'-deoxyuridine assay, flow cytometry and transwell assay. The N6-methyladenosine (m6A) modification profile was analyzed using the methylated RNA immunoprecipitation assay and the interaction was determined by RNA Immunoprecipitation assay. The murine model was established for in vivo analysis.M1 macrophage exosomes suppressed LUAD cell proliferation, migration and invasion. Further analyses showed that KLF6 was packaged in M1 macrophage exosomes and could be transferred into LUAD cells. Functionally, the incubation of KLF6-decreased M1 macrophage exosomes led to the enhancement of LUAD cell proliferation, migration and invasion. Mechanistically, alkylation repair homolog protein 5 (ALKBH5), an RNA m6A demethylase, could reduce KLF6 m6A modification and then broke the stabilization of KLF6and decreased its expression in M1 macrophages and LUAD cells. Importantly, ALKBH5 reversed the anticancer effects of M1-Exo on LUAD cells. Moreover, the inhibition of LUAD tumor growth in vivo mediated by M1-Exo was also impeded by ALKBH5.In conclusion,M1 macrophage exosomes inhibited LUAD growth by reducing ALKBH5-mediated KLF6 demethylation.

Spinal metastases may cause pain, neurological compromise, paraplegia, and limb movement disorders; their management requires a comprehensive approach. Alongside systemic anti-tumor therapies, focal interventions such as radiotherapy, bone-modifying agents, and surgery are crucial for slowing disease progression and managing pain in spinal metastases. However, substantial variations exist in radiotherapy regimens for spinal metastases. In this study, we aimed to investigate the safety and efficacy of hypofractionated radiation therapy (HFRT) regimens at our hospital, specifically to evaluate pain relief and incidence of re-irradiation after HFRT. In this retrospective study, data from 58 patients diagnosed with spinal metastasis who received HFRT (4.5-10Gy * 3-7F) at our center between December 2017 and June 2022 were analyzed. All patients were followed up from the initiation of HFRT to either death or their last follow-up visit. Degree of pain was assessed using the numeric rating scale (NRS) before and after 1 month of HFRT. A multivariate Cox regression model was established to identify the independent risk factors for prognostic analysis of spinal metastasis. HFRT could effectively manage pain in patients with spinal metastasis. The pain scores were significantly decreased after HFRT (3.43 vs. 1.5, p < 0.001), with 84.5% patients experiencing improved pain relief 1 month after radiotherapy. No cases of radiation myelitis were observed during the follow-up period. Furthermore, the incidence of re-radiotherapy was significantly increased in patients with spinal metastases who received moderate HFRT (< 5 Gy/day) (p = 0.01, HR = 0.43). HFRT significantly reduced pain scores and reirradiation rates without increasing radiation myelitis incidence for spinal metastases.

BackgroundEpilepsy is a prevalent chronic neurological disorder. A substantial proportion of patients develop drug-resistant epilepsy. Existing antiepileptic drugs are associated with adverse effects and demonstrate limited efficacy in refractory cases. Oxidative stress plays a critical role in the pathogenesis of epilepsy. Antioxidants such as vitamin D, vitamin E, and melatonin, as well as dietary therapies like the ketogenic diet, have garnered attention as potential adjunctive treatments. However, existing studies exhibit significant controversy and heterogeneity.ObjectiveTo evaluate the efficacy and safety of antioxidants and dietary therapies in the treatment of epilepsy, and to provide evidence-based support for clinical decision-making.MethodsSystematic searches were conducted in PubMed, Web of Science, Embase, and the Cochrane Library. Eighteen eligible meta-analyses were selected for umbrella review based on predefined criteria. Pooled relative risks (RR) with 95% confidence intervals (CI) were calculated using random-effects or fixed-effects models. Heterogeneity was assessed using the I2 statistic, and evidence quality was evaluated with the AMSTAR 2 tool.ResultsDietary therapies—particularly the Low Glycemic Index Treatment (LGIT)—significantly increased the likelihood of achieving ≥50% (RR: 1.95; 95% CI: 1.58–2.33) and ≥90% (RR: 3.33; 95% CI: 1.51–5.14) seizure reduction. However, dietary therapies were ineffective in achieving seizure freedom (RR: 0.68; 95% CI: 0.00–1.36). In subgroup analyses of ≥50% seizure reduction, antioxidants did not demonstrate significant efficacy. Both antioxidants and dietary therapies significantly increased the overall incidence of adverse events (RR: 1.56; 95% CI: 1.19–1.92). Specifically, the ketogenic diet elevated the risks of dyslipidemia (RR: 3.56; 95% CI: 2.00–5.11), weight loss (RR: 4.80; 95% CI: 3.43–6.17), constipation (RR: 3.02; 95% CI: 1.55–4.48), and kidney stones (RR: 5.24; 95% CI: 3.73–6.74). Melatonin was ineffective in reducing seizure frequency (RR: 0.30; 95% CI: 0.00–0.63). Considerable heterogeneity was observed across studies.ConclusionDietary therapies—notably LGIT—demonstrate clear efficacy in reducing seizure frequency but do not facilitate seizure freedom. Current evidence does not support the use of antioxidants as effective adjunctive therapy for epilepsy. These interventions, particularly the ketogenic diet, are associated with increased risks of adverse effects, necessitating careful benefit–risk assessment in clinical application.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251166437, identifier: CRD420251166437.

BackgroundAs benign prostatic hyperplasia (BPH) becomes increasingly prevalent, there is a growing need for simple and accurate methods to predict its risk. This study aimed to develop and validate a prediction model to identify males at high risk of developing BPH.MethodsThe model was developed using data from 210,408 participants in the UK Biobank and externally validated with 5394 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 294 participants from the Fengshen study. Six methods were employed to construct prediction models utilizing readily available medical characteristics at baseline. The DeLong tests were used to assess the differences in the area under the curves (AUCs). Cox regression was adopted to examine the relationships between the predictors and BPH.ResultsDuring a median follow-up period of 13.2 years (interquartile range [IQR] 12.3–14.0), 7.0 years (IQR 6.8–7.0) and 4.0 years (IQR 2.2–5.0), 18,681 males in the UK Biobank, 309 males in the CHARLS, and 27 males in the Fengshen study developed BPH. The model developed using the LightGBM method exhibited the highest discriminative capability among the six methods. Following feature reduction based on importance ranking, a full model with 17 predictors was established for BPH prediction (AUC = 0.688 ± 0.004). Age was the most important feature that contributed to the model, with older males showing a higher hazard ratio (HR) of 1.091 (95% confidence interval [CI] 1.089–1.094) for BPH incidence. Furthermore, a final simplified model was developed using five predictors (age, hypertension time, blood glucose, urate, and serum creatinine) identified in both the CHARLS and Fengshen studies for potential clinical application. It has been transformed into a user-friendly web tool to facilitate clinical utility.ConclusionsThe model, incorporating five easily accessible predictors with acceptable predictive abilities for incident BPH, can help identify individuals at high risk of BPH in the general population.Supplementary InformationThe online version supplementary material available at 10.1186/s41256-025-00456-4.