Yancheng Second People's Hospital

Cardiovascular-Kidney-Metabolic (CKM) syndrome became the leading cause of death among U.S. adults in 2021. However, the relationship between different stages of CKM and the risk of all-cause mortality in the U.S. population remains unclear. Data from NHANES 2005–2018 and the Public-use Linked Mortality Files (LMF) were utilized in this study. Kaplan–Meier survival curves were generated to estimate survival probabilities across five CKM stages (stages 0 to 4) and compared using the log-rank test. Hazard ratio (HR) and 95% confidence interval (95%CI) for all-cause mortality were estimated using Cox proportional hazards regression models. Stratified analyses were conducted to explore potential effect modifications by age, sex, education, smoking status, drinking status and the Poverty Income Ratio (PIR). A total of 4,376 all-cause deaths were recorded during a median follow-up period of 7.25 years (IQR: 6.92–7.67). The risk of all-cause mortality increased progressively with higher CKM syndrome stages (P < 0.001). After multivariate adjustment, the risk of all-cause mortality for CKM stages 1 through 4 was 1.05 (95% CI: 0.81–1.44), 1.98 (95% CI: 1.54–2.56), 3.09 (95% CI: 2.36–4.06), and 4.47 (95% CI: 3.47–5.76) times higher than that for CKM stage 0, respectively. Additionally, subgroup analyses revealed that the risk of all-cause mortality in CKM stage 4 was higher among individuals under 60 years of age, females, current smokers, current drinkers, those with less than a high school education, and those with a household poverty index below1.3. Studies have found that populations with more advanced CKM staging have a higher risk of all-cause mortality. These findings underscore the need for targeted public health strategies to reduce mortality risk associated with CKM syndrome.

Artificial intelligence has achieved key technological breakthroughs in neural network, deep learning, precision analysis and other aspects, providing guidance and support for the technical barriers of acupuncture and moxibustion in basic research. Starting from the necessary links of literature and experimental exploration in the basic research of acupuncture and moxibustion, this paper analyzes the current acupuncture-moxibustion research mode and existing problems, summarizes the integrating points in the application artificial intelligence technology, and provides the basis and reference for the application prospect of artificial intelligence technology in basic research of acupuncture and moxibustion.

Low-risk human papillomaviruses HPV-6 and HPV-11 impose a substantial global burden of benign disease. While genomically similar to high-risk HPV types, their codon usage patterns remain uncharacterized. This study systematically deciphers these patterns in HPV-6 and HPV-11. Analysis included 214 HPV-6 and 100 HPV-11 genomes from the NCBI GenBank database. Genomic analysis identified a strong preference for A/U-ending synonymous codons (over 85% of preferred codons) and low GC content at third codon positions (<35%). Relative dinucleotide abundance analysis further revealed underrepresentation of ApA, CpG, and UpC, and overrepresentation of CpA and UpG, which critically shaped synonymous codon selection in both genotypes. While Effective Number of Codons (ENC) values >49 indicated limited overall codon bias, multi-method analyses (Parity Rule 2, ENC-plot, neutrality plot) established natural selection as the dominant evolutionary force over mutational pressure. Despite moderate host adaptation, a strategic mismatch exists between viral codon preferences and human tRNA abundance, potentially moderating translational efficiency to favor immune evasion and persistence. The Relative Codon Deoptimization Index (RCDI) values approaching 2 further support a moderate adaptation to human codon usage patterns.These findings provide crucial insights into the molecular evolution of low-risk HPVs and inform the development of codon-optimized therapeutic strategies, including vaccines targeting pathologies like genital warts and recurrent respiratory papillomatosis.

BackgroundSuccinylcholine, a commonly used depolarizing neuromuscular blocking relaxant, may produce fasciculation and postoperative myalgia as adverse effects. Although rocuronium pretreatment may attenuate this adverse effect, the median effective dose remains undetermined, as does the influence of age on it. This study was carried out to explore the median effective dose of pretreated rocuronium in inhibiting succinylcholine-induced fasciculation and to investigate the influence of age on the median effective dose of rocuronium.MethodsSeventy-two adult participants undergoing elective general anesthesia were stratified according to age: Group R1 (18–44 years), Group R2 (45–59 years), and Group R3 (60–80 years). The initial dose of prophylactic rocuronium was set at 0.04 mg/kg. Midazolam 0.05 mg/kg, sufentanil 0.4 µg/kg, propofol 1.5–2.5 mg/kg, and succinylcholine 2 mg/kg were then sequentially administered 1.5 min later, then fasciculation was assessed. The rocuronium doses were adjusted according to the assessment of fasciculation using Dixon sequential method, with a ratio of 1.1 between adjacent doses. The occurrence and grades of fasciculation, adverse reactions of rocuronium, and endotracheal intubating condition were recorded. The median effective dose and 95% confidence interval of rocuronium were calculated.ResultsThe median effective dose and 95% confidence interval of prophylactic rocuronium for the prevention of succinylcholine-induced fasciculation were 0.027 mg/kg (95% confidence interval: 0.026–0.028 mg/kg), 0.026 mg/kg (95% confidence interval: 0.024–0.029 mg/kg), and 0.026 mg/kg (95% confidence interval: 0.025–0.027 mg/kg) in Group R1, Group R2, and Group R3, respectively. No significant differences exist in the median effective dose among the three groups (P > 0.05). Only one patient experienced temporary diplopia in Group R2. No significant differences were found in fasciculation grades or endotracheal intubation conditions among the groups.ConclusionProphylactic intravenous rocuronium effectively prevents succinylcholine-induced fasciculation, with the median effective dose remaining consistent across age groups (18–44, 45–59, and 60–80 years).Trial registrationThe study was registered at ClinicalTrials.gov (Registration number: NCT05909696) on June 10, 2023. URL: https://clinicaltrials.gov/.

Introduction Proximal humeral fractures are increasingly common, particularly among older people, whereas the prognosis of surgical treatments for these fractures remains substantially uncertain. In China, where the ageing population is rapidly growing, high-quality prospective data on surgical outcomes, complications and cost-effectiveness are lacking. To address this gap, we propose to initiate a prospective, multicentre cohort study on surgical treatment for proximal humeral fractures in China—Cohort of Acute Shoulder Trauma (CAST) study.Methods and analysisThe CAST is a multicentre, prospective cohort study enrolling patients with acute proximal humeral fractures undergoing surgical treatments at eight hospitals in China between May 2024 and December 2029. Patients can receive any of the surgical treatment methods which include percutaneous Kirschner wire fixation, external fixation, open reduction and internal fixation using locking plates or intramedullary nails, suture anchors and shoulder arthroplasty. We will collect patient-reported outcome measures (Quick Disabilities of the Arm, Shoulder and Hand), Constant-Murley, American Shoulder and Elbow Surgeons, EuroQol 5-Dimension and Visual Analogue Scale), physical examination results, imaging assessments (based on X-rays, ultrasound, CT and MRI scans), laboratory tests (including inflammatory cytokines) and data on medical costs. We will follow patients at 1 day, and at 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. The planned sample size is 1500 patients.Ethics and disseminationThe study protocol has been approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University (Approval No. 2024-ky-104(K)). Written informed consent will be obtained from all participants. Findings from the CAST study will be disseminated through peer-reviewed journals and academic conferences.Study registration numberChiCTR2500109651.

Metalloimmunotherapies are emerging as promising treatment for cancer and infectious diseases by harnessing immune responses involving metal ions. However, their potential role in tissue regeneration remains unclear. In the context of chronic periodontitis, an inflammatory disease characterized by accumulated inflammatory cells and progressive alveolar bone loss, we report new effects of copper on inflammatory resolution and alveolar bone regeneration by enhancing lymphatic drainage. We first construct an injectable and thermosensitive hydrogel using catechol-conjugated chitosan (CHI-C) and pluronic F-127 (PF-127) to enhance the adhesive capacity of nanocomposite. Then, copper-containing mesoporous bioactive glass nanoparticles (Cu-BGs) are fabricated for sustained release of copper ions in acidic environments and mixed with VEGFC (a growth factor increasing lymphangiogenesis) into the hydrogel (Cu/VEGFC@Hy). We confirm the in vitro impact of copper on proliferation and migration of lymphatic endothelial cells (LECs) and smooth muscle cells (SMCs), key components of collecting lymphatic vessels. RNA-seq analysis reveals that copper promotes proliferation in LECs and SMCs by targeting COX4i2/ERK pathway. In periodontitis model, Cu/VEGFC@Hy significantly improves the reconstruction of collecting lymphatic vessels, accelerating lymphatic drainage and rejuvenating alveolar bone mass. Overall, the well-designed Cu/VEGFC@Hy effectively reduces inflammatory accumulation by promoting lymphatic vessel formation and tissue regeneration in inflammatory diseases. STATEMENT OF SIGNIFICANCE: This study introduces a pioneering metalloimmunotherapy approach for chronic periodontitis, utilizing copper ions to enhance lymphatic drainage and alveolar bone regeneration. We developed an injectable, thermosensitive hydrogel incorporating copper-containing mesoporous bioactive glass nanoparticles and VEGFC, which synergistically promotes the reconstruction of collecting lymphatic vessels and reduces inflammatory accumulation. Our findings reveal a novel mechanism where copper ions stimulate the proliferation and migration of lymphatic endothelial and smooth muscle cells via the COX4i2/ERK pathway. This work not only offers a promising biomaterial-based therapy for periodontitis but also broadens the application of metal ions in tissue engineering and regenerative medicine, with potential implications for other inflammatory diseases.

Papillary thyroid carcinoma is the most common pathological subtype of thyroid cancer in both children/adolescents (TCCA) and adults (TCA). TCCA manifests more aggressive and invasive behaviors than TCA, which may be attributed to specific genomic alterations. To better understand the specific molecular, pathological and clinical manifestations of TCCA, we retrospectively analyzed a cohort of 60 patients with sporadic papillary thyroid carcinoma, including 20 TCCAs and 40 TCAs. Fine-needle aspiration tissue samples from these cases were analyzed using next-generation sequencing. Demographics, ultrasound features, postoperative pathology and radiation exposure history were compared between TCCAs and TCAs. To validate our findings, we integrated data from 28 prior studies, resulting in a larger cohort of 1,483 sporadic TCCAs. Multiple gene mutations were more prevalent in TCCAs than TCAs (p=0.013), such as BRAFV600E coexisting with KMT2 family genes or PTEN. Although BRAFV600E was the most common single nucleotide variant in TCCAs (25%, 5/20), its prevalence was significantly lower than in TCAs (95%, 38/40, p<0.0001). RET oncogenic fusions were detected exclusively in TCCAs, with an incidence of 20% (4/20). Compared with TCAs, TCCAs were associated with larger tumor diameters (p<0.001), more advanced tumor staging (T3-T4, p<0.001; N2, p=0.002), higher incidence of extrathyroidal extension (TCCA: 25%, TCA: 5%, p=0.036) and more frequent lymph node metastasis (TCCA: 70%, TCA: 27.5%, p=0.0024). Importantly, TCCAs harboring BRAFV600E alongside other mutations (e.g., ATM, PTEN or KMT2 family genes) exhibited more severe clinical manifestations, including larger tumors and higher rates of lymph node metastasis, compared with those harboring BRAFV600E alone. TCCAs exhibit more aggressive and invasive clinical manifestations than TCAs, particularly in cases with RET fusions or BRAFV600E coexisting with other point mutations. Targeted comprehensive molecular profiling may aid in the diagnosis and treatment of TCCA.

Abstract Background: Moderate to Late Preterm Infants (32-36 weeks gestation) face unique challenges in achieving successful oral breastfeeding despite their physiological advantages over early preterm infants. This study identifies gestational age-specific predictors of oral breastfeeding success in Chinese neonatal intensive care units (NICU). Methods: A cross-sectional design analyzed 292 mother-infant dyads from two tertiary hospitals in Yancheng, China (August 2024–February 2025). Validated instruments assessed infant factors (feeding readiness, functional status), maternal factors (self-efficacy, milk sufficiency, social support), and hospital factors (breastfeeding practices/support). Structural Equation Modeling (SEM) was used to predicte the factors of oral breastfeeding on moderate to late preterm (32–36 weeks, n = 292) infants. Results: For moderate to late peterm infants, breastfeeding self-efficacy (β = 0.27, p &lt; 0.01), social support (β = 0.15, p &lt; 0.05), and readiness for oral feeding (β = 0.29, p &lt; 0.01) were significant predictors. Hospital factors exerted the strongest influence: breastfeeding practices (β = 0.60–0.70, p &lt; 0.01) and support policies (β = 0.16–0.24, p &lt; 0.05). SEM models showed excellent fit (RMSEA = 0.00 for late preterm). Conclusion: Maternal psychosocial factors and hospital environments critically influence breastfeeding outcomes in Moderate to Late Preterm Infants. Interventions should bolster maternal confidence, leverage social networks, and standardize NICU breastfeeding protocols. These findings support tailored, evidence-based guidelines for this understudied population.