Nucleoside (acid) analogues (NAs) have become the primary treatment for chronic hepatitis B (CHB), but the impact of type 2 diabetes (T2DM) on the efficacy was unclear.

To identify the effect of T2DM on the efficacy of NAs antiviral therapy in CHB patients.

Patients with CHB who underwent liver biopsy in Tianjin Second People's Hospital from January 2015 to June 2023 and newly treated with NAs were included (n=350) .The patients were divided into T2DM-CHB group and CHB group according to their medical history. After matching according to gender, age, HBV DNA level, HBeAg status, ALT and AST level, 238 patients were finally included (T2DM-CHB group: n=70; CHB group: n=168). The patient's medication status, as well as liver and renal function, virological indicators and other data were reviewed once every 6 months for a total of 5 years. To evaluate the effectiveness of early treatment of NAs, follow-up was conducted once at the first and third months after the initiation of antiviral therapy.

After receiving NAs treatment, the serum lgHBV DNA level in T2DM-CHB group was significantly higher than that in CHB group at 1, 3, 6 and 18 months (P<0.05). The HBsAg value of T2DM-CHB group was significantly higher than that of CHB group at 12, 30 and 36 months (P<0.05). Kaplan-Meier survival curve showed that there was a significant difference between the two groups in the time to achieve complete virological response (CVR) for the first time (χ²=14.144, P<0.001), and the median time of first CVR in T2DM-CHB group and CHB group was 18.9 months and 14.3 months respectively. The cumulative clearance rate and seroconversion rate of HBeAg in T2DM-CHB group were lower than those in CHB group at 6, 12, 18, 24 and 30 months after treatment (P<0.05). In terms of liver function recovery, the accumulation rate of normal liver function in T2DM-CHB group was also lower than that in CHB group at 1, 3, 6, 12, 18 and 24 months after treatment (P<0.001). The results of multivariate Cox regression showed that T2DM (HR=0.706, 95%CI=0.584-0.854), HBV DNA (HR=0.624, 95%CI=0.534-0.730), eGFR (HR=1.197, 95%CI=1.017-1.409) were the factors influencing the time of the first CVR in patients with CHB (P<0.05) .

The combination of T2DM weakened the virological response of CHB patients to NAs, and prolonged the time to achieve CVR and liver function recovery.

China has the highest disease burden of esophageal cancer in the world. Early detection of esophageal cancer and precancerous lesions is key to improving patient survival rates and reducing incidence and mortality rates.

To explore the clinical application value of the esophageal novel cell collector in screening esophageal lesions, and to provide a basis for the governmental health departments to formulate more effective cancer prevention and control policies and public health programs.

From January 2024 to January 2025, 261 patients who completed esophageal novel cell collection, endoscopy, and pathological biopsy were conducted at nine hospitals in the Xinjiang region, including the First Affiliated Hospital of Shihezi University, Hongxing Hospital of the 13th Division, Beitun Hospital of the 10th Division, Kashi Campus of the General Hospital of the 3rd Division, Korla Hospital of the 2nd Division, Fourth Division Hospital, Seventh Division Hospital, Xinjiang Uygur Autonomous Region People's Hospital, and Tumushuk City of Third Division General Hospital. Using pathological biopsy as the gold standard, combined with morphological findings under gastroscopy, the subjects were divided into the early esophageal cancer and precancerous lesion group (n=34), the reflux esophagitis group (n=150), and the esophageal mucosa without abnormalities group (control group) (n=77). The diagnostic efficacy of cytological examination using a novel esophageal cell collector was evaluated in different populations.

Cytological examination results: 4 cases of cancer cells, 27 cases of high-grade intraepithelial lesions, 12 cases of low-grade intraepithelial lesions, 101 cases of atypical squamous cells, 111 cases of squamous cell hyperplasia/inflammatory cells, and 6 cases with no intraepithelial lesions or malignant cells. Endoscopic and pathological biopsy results: 4 cases of squamous cell carcinoma/adenocarcinoma cells, 19 cases of high-grade intraepithelial neoplasia, 11 cases of low-grade intraepithelial neoplasia, 20 cases of atypical squamous cells, 15 cases of inflammatory cells, 115 cases of regional edema/cell hyperplasia, and 77 cases of normal cells. The area under the receiver operating characteristic (ROC) curve of the novel esophageal cell collector for screening early esophageal cancer and precancerous lesions in the early esophageal cancer and precancerous lesion group and the control group was 0.933, with a sensitivity of 94.12%, a specificity of 67.53%, a positive predictive value of 56.14%, and a negative predictive value of 96.30%, and an overall accuracy of 75.68%. The area under the ROC curve of the novel esophageal cell collector for screening early esophageal cancer and precancerous lesions in the early esophageal cancer and precancerous lesion group and the reflux esophagitis group was 0.902, with a sensitivity of 94.12%, a specificity of 42.00%, a positive predictive value of 26.89%, a negative predictive value of 96.92%, and an overall accuracy of 51.63%. The new esophageal cell collector was highly safe (with a severe adverse event rate of 0) and highly acceptable (with an average visual analog scale score of 1.3). 93.9% (245/261) of participants indicated their willingness to undergo follow-up examinations for esophageal lesions using this method.

The novel esophageal cell collector demonstrates good diagnostic efficacy for early esophageal cancer and precancerous lesions, reducing the need for unnecessary endoscopic examinations. It features simple operation, high efficiency, safety, and high patient acceptability.

Liver fibrosis is a major risk factor for overall and liver-specific mortality of chronic hepatitis B (CHB) combined with non-alcoholic fatty liver disease (NAFLD) . Combination of type 2 diabetes mellitus (T2DM) or hyperuricemia (HUA) accelerates the progression of liver fibrosis in CHB patients combined with NAFLD. Therefore, accurately assessing the stage of liver fibrosis using non-invasive diagnostic models is crucial for effective treatment and control of CHB combined with NAFLD disease progression.

To compare the efficacy of five non-invasive diagnostic models[fibrosis-4 (FIB-4) , aspartate aminotransferase-to-platelet ratio index (APRI) , aspartate-to-alanine aminotransferase ratio (AAR) , S index, and gamma-glutamyl transpeptidase to platelet ratio index (GPRI) ] in diagnosing advanced liver fibrosis in CHB patients combined with NAFLD and T2DM/HUA, and to assess their feasibility for grassroots implementation.

One hundred and ninety-five CHB patients combined with NAFLD diagnosed by clinical evidence and liver pathology admitted in the Beijing Ditan Hospital, Capital Medical University from 2008 to 2021 were retrospectively recruited. They were divided into CHB&NAFLD (n=46) , CHB&NAFLD&T2DM (n=80) , and CHB&NAFLD&HUA groups (n=69) based on the comorbidities of T2DM or HUA. Using pathological results as the gold standard for diagnosis of liver fibrosis, DeLong's test was used to compare the area under the receiver operating characteristic curve (AUC) and diagnostic performance of five non-invasive indicators for the assessment of liver fibrosis progression in the three groups. Additionally, clinical utility of each model was evaluated using decision curve analysis (DCA) .

In the CHB&NAFLD group, the AUC of FIB-4 in diagnosing liver fibrosis was 0.740, and that of AAR was 0.468, with an AUC difference of 0.272. In the CHB&NAFLD&T2DM group, FIB-4 also exhibited the highest diagnostic performance (AUC=0.677) , while the S index had the lowest AUC (0.588) . In the CHB&NAFLD&HUA group, FIB-4 maintained the highest diagnostic performance (AUC=0.753) , while AAR had the lowest AUC (0.609) . Although FIB-4 performed the best in all three groups, its diagnostic performance was significantly lower in the CHB&NAFLD&T2DM group compared to the CHB&NAFLD group (P<0.001) and CHB&NAFLD&HUA group (P<0.001) . DCA showed that FIB-4 had a slightly higher clinical net benefit in the CHB&NAFLD and CHB&NAFLD&HUA groups. The optimal cut off value for FIB-4 in the CHB&NAFLD&T2DM group was 1.425, which was higher than that in the CHB&NAFLD group (cut off=1.117) and the CHB&NAFLD&HUA group (cut off=1.305) .

The FIB-4 index is practical for assessing liver fibrosis in CHB patients combined with NAFLD and T2DM/HUA at the grassroots level. However, FIB-4 has a lower diagnostic efficacy and higher cutoff value in assessing liver fibrosis in CHB&NAFLD patients combined with T2DM than CHB&NAFLD and CHB&NAFLD&HUA patients. These results suggest that it is necessary to evaluate CHB&NAFLD patients with T2DM in combination with their specific characteristics and optimize the diagnostic strategy to improve accuracy.

The global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly increasing, and its risk significantly inflates when being combined with type 2 diabetes mellitus (T2DM) . The triglyceride glucose-body mass index (TyG-BMI) , as a noninvasive marker of insulin resistance, has demonstrated predictive value for MAFLD in non-diabetic populations, yet its diagnostic efficacy in T2DM patients remains unclear.

To evaluate the diagnostic utility of TyG-BMI in MAFLD combined with T2DM.

From 2022 to 2023, a total of 1 347 T2DM patients aged 18 years or above were recruited from the Health Management Center of the People's Hospital of Longhua, Shenzhen. Based on whether combined with MAFLD, patients were divided into two groups: the T2DM-only group (n=601) and the T2DM combined with MAFLD group (n=746) . Clinical data were compared between the two groups. Logistic regression analysis was performed to evaluate the correlations of triglyceride glucose index (TyG) , body mass index (BMI) , and TyG-BMI with T2DM combined with MAFLD. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of TyG, BMI, serum uric acid to creatinine ratio (SUA/Scr) , and TyG-BMI in T2DM combined with MAFLD.

Compared with the T2DM-only group, patients in the T2DM combined with MAFLD group showed significantly higher proportion of men, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , total cholesterol (TC) , triglycerides (TG) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) , uric acid (UA) , fasting plasma glucose (FPG) , glycated hemoglobin (HbA_1c) , BMI, TyG, SUA/Scr, and TyG-BMI levels (P<0.05) , while significantly lower level of blood urea nitrogen (BUN) , high-density lipoprotein cholesterol (HDL-C) and age (P<0.05) . After adjusting for confounders, multivariate Logistic regression analysis showed that TyG (OR=2.989, 95%CI=2.278-3.922, P<0.001) , BMI (OR=1.395, 95%CI=1.324-1.470, P<0.001) , and TyG-BMI (OR=1.039, 95%CI=1.034-1.044, P<0.001) were influencing factors for T2DM combined with MAFLD. ROC curve analysis demonstrated that the sensitivity of TyG, BMI, SUA/Scr, and TyG-BMI in predicting T2DM complicated with MAFLD was 74.7%, 73.7%, 62.0%, and 85.8%, respectively; the specificity was 60.7%, 71.3%, 55.0%, and 66.3%, respectively; and the area under the ROC (AUC) was 0.739, 0.793, 0.608, and 0.833, respectively. The results of Delong test indicated that the AUC of TyG-BMI for T2DM complicated with MAFLD was significantly larger than that of BMI, TyG, and SUA/Scr (Z=8.224, 12.501, and 5.632, respectively; P<0.001) .

TyG, BMI, and TyG-BMI all demonstrate diagnostic value in T2DM complicated with MAFLD. However, TyG-BMI exhibits superior diagnostic value than TyG, BMI, and SUA/Scr.

Special education rehabilitation therapy is the main method to improve the core symptoms of autism spectrum disorder (ASD) ; however, most children with ASD have comorbid gastrointestinal dysfunction such as constipation, abdominal pain, and nausea, which severely affect their physical and mental health. Snap shots improve gastrointestinal function, and vitamin D (VitD) is involved in neurological development and immune regulation is closely related to symptoms and function in children with ASD; and the efficacy of snap needles combined with VitD in treating behavioral and gastrointestinal symptoms in children with ASD needs to be studied.

To observe the effects of acupuncture combined with VitD on behaviors and gastrointestinal symptoms in autistic children based on special education rehabilitation therapy.

A total of 84 children with ASD who received rehabilitation training in Gansu Province Hospital Rehabilitation Center and Affiliated Hospital of Gansu University of Chinese Medicine from April 2022 to June 2024 were selected as the research objects. They were randomly divided into two groups (42 cases in the observation group and 42 cases in the control group) according to the random number table method. Finally, 40 cases were included in each group after exclusion criteria. The control group was treated with special education rehabilitation therapy, while the observation group was treated with press-needle combined with vitamin D₂ on the basis of special education rehabilitation therapy. Both groups were treated for 3 months. The Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), TCM Gastrointestinal Symptom Scores and serum 25-hydroxyvitamin D[25- (OH) D] levels of the two groups of ASD children before and after treatment were observed and compared to evaluate the efficacy of the intervention methods in the two groups.

Compared with before treatment, the scores of ABC, CARS, SRS and TCM Gastrointestinal Symptom in both groups of ASD children decreased after treatment (P<0.05) ; after treatment, the scores of ABC, CARS, SRS and TCM Gastrointestinal Symptom in the observation group were lower than those in the control group (P<0.05). Compared with before treatment, the level of 25- (OH) D in the control group decreased after treatment, while that in the observation group increased (P<0.05) ; after treatment, the level of 25- (OH) D in the observation group was higher than that in the control group (P<0.05). The total effective cases in the observation group were 36 (90.0%), and 30 (75.0%) in the control group. The total effective rate of the observation group was higher than that of the control group (P<0.05) .

Acupuncture combined with VitD has a significant therapeutic effect on children with autism, effectively improving children's social interaction and behavior abilities, alleviating gastrointestinal discomfort, enhancing quality of life, and improving rehabilitation training outcomes.

The triglyceride-glucose (TyG) index is closely related to liver diseases. However, there is a lack of studies on the association between the longitudinal TyG index trajectories and liver stiffness in the elderly population, both at home and abroad.

This study aims to analyze the association between longitudinal trajectories of triglyceride-glucose index and liver stiffness status in elderly individuals.

The population was derived from the West China Elderly Preventive and Treatment Merging Cohort, comprising 2 736 individuals who participated in three or more health examinations between 2017 and 2022. Participants were aged ≥60 years, had complete triacylglycerol and blood glucose measurements, and had no history of chronic liver disease at baseline. The group trajectory model (GBTM) was applied to establish the long-term longitudinal trajectories of the TyG index, and a binary Logistic regression model was used to analyze the association between the longitudinal trajectories of the TyG index and liver stiffness.

Among the participants, 376 individuals (13.7%) had elevated liver stiffness (LSM>7 kPa). The TyG longitudinal trajectories were divided into 5 groups, including 337 individuals (12.3%) in the low-stable group, 1 172 individuals (42.8%) in the medium-low-stable group, 921 individuals (33.7%) in the medium-stable group, 268 individuals (9.8%) in the medium-high-increasing group, and 38 individuals (1.4%) in the highest-to-medium-high group. Logistic regression analysis showed that, after adjusting for confounding factors, compared to the low-stable group, the medium-low-stable group (OR=1.94, 95%CI=1.13-3.43), medium-stable group (OR=3.04, 95%CI=1.57-5.99), medium-high increasing group, and highest-to-medium-high group (OR=3.31, 95%CI=1.02-10.36) had increased risk for elevated liver stiffness.

Elderly populations should be concerned about changes in the level of the TyG index, and when the TyG index is persistently high (≥8.78), liver health should be further examined.

Endoscopic retrograde cholangiopancreatography (ERCP) is a standard method for the diagnosis and treatment of biliary and pancreatic diseases, but post-ERCP pancreatitis (PEP) is one of the serious complication. Non steroidal anti-inflammatory drugs (NSAIDs) may play a role in the prevention of PEP due to their anti-inflammatory and analgesic effects. To explore the appropriate timing of medication and the effect of combined medication can help reduce the risk of PEP occurrence.

This study aimed to evaluate the administration timing and influencing factors of NSAIDs in PEP prevention, in order to determine the best application in clinical practice.

A total of 866 patients who underwent ERCP in the Department of General Surgery and Oncology of Handan Central Hospital from December 2021 to December 2023 were included as the research objects. According to the random number table method, they were divided into preoperative medication group (431 cases) and postoperative medication group (435 cases). Among them, the preoperative medication group was divided into the preoperative medication alone subgroup (210 cases) and the preoperative combined medication subgroup (221 cases), and the postoperative medication group was divided into the postoperative medication alone subgroup (247 cases) and the postoperative combined medication subgroup (188 cases). In the preoperative medication alone subgroup, 75 mg diclofenac sodium was intramuscularly injected 30 min before ERCP, and in the preoperative medication combination subgroup, 100 mg indomethacin suppository was added to the anal plug at the same time; The single drug group was given 75 mg diclofenac sodium intramuscularly immediately after ERCP, and the combined drug group was given 75 mg diclofenac sodium intramuscularly and 100 mg indomethacin suppository anal plug simultaneously after ERCP. All interventions were single dose. The main outcome measures included the incidence and severity of PEP, the incidence of postoperative perforation, bleeding, and cholangitis. Multivariate Logistic regression was used to analyze the influencing factors of PEP.

There was a statistically significant difference in the incidence of PEP among the four subgroups (P<0.05). The incidence of PEP in the preoperative medication alone subgroup was lower than that in the postoperative medication alone subgroup and the postoperative combination subgroup (P<0.05), and the incidence of PEP in the preoperative combination subgroup was lower than that in the postoperative medication alone subgroup and the postoperative combination subgroup (P<0.05) ; There was no significant difference in the severity of PEP and the incidence of adverse reactions among the four subgroups (P>0.05). The results of multivariate Logistic regression analysis showed that, BMI≥24 kg/m² (OR=3.751, 95%CI=2.293-6.136), alcohol abuse (OR=2.624, 95% CI=1.520-4.529), diabetes mellitus (OR =2.687, 95%CI=1.559-4.634), intubation time >10 min (OR=4.229, 95%CI=2.531-7.066) and the use of double guide wire technology (OR=3.542, 95%CI=2.159-5.809) were the independent risk factors of PEP (P<0.05), B-ultrasound showed that extrahepatic bile duct dilatation was a protective factor for PEP (OR=0.573, 95%CI=0.347-0.947, P<0.05) .

BMI≥24 kg/m², alcohol abuse, diabetes, intubation time >10 min and the use of double guide wire technology are independent risk factors for the occurrence of PEP. Preoperative prophylactic use of indomethacin suppositories and diclofenac sodium before ERCP can effectively reduce the risk of PEP.

Symptom clusters refers to two or more than two symptoms occurring at the same time and influencing each other. At present, symptom clusters in gastric cancer patients receiving chemotherapy obtained from different studies are not same, and there is a certain heterogeneity, which is not conducive to the management and intervention of symptom clusters.

To identify the characteristics, composition and assess the current research status of the symptom clusters of gastric cancer patients receiving chemotherapy, and to provide valuable insights for future studies on symptom clusters.

Following the PRISMA extended list of scope review report as the methodological framework, a literature search was performed in the PubMed, Web of Science, Medline, CINAHL, CNKI, Wanfang Data, VIP and SinoMed databases to identify relevant studies about symptom clusters in patients with gastric cancer from inception until May 24, 2023. The included studies were thoroughly analyzed to extract pertinent information.

A total of 12 articles were included. The elements of identifying symptom clusters included symptom assessment and analysis methods. There were 20 kinds of symptom clusters during chemotherapy. Before chemotherapy, the symptom clusters of disease, the symptom clusters digestive tract, the symptom clusters of emotional, the symptom clusters of stomach specific and the symptom clusters of nervous system appearing. After the first chemotherapy, the symptom clusters of physical, the symptom clusters of image change and the symptom clusters of energy deficiency appearing. After the 3rd chemotherapy, the type and composition of symptom clusters after chemotherapy were the most complex. After the 6th chemotherapy, the symptom clusters of chemotherapy would appear.

During receiving chemotherapy, the gastric cancer patient experienced a variety of symptom clusters with dynamic change, which changes with the progression of chemotherapy stage. Future research can explore the gastric cancer patients with specific symptom assessment tools, combined with the symptoms of advanced analysis technology such as network analysis, to accurately identify symptoms clusters at an early stage and build the symptoms of precise management solution.

The incidence of postoperative frailty is notably high among patients with colorectal cancer. Numerous studies have established a strong association between frailty and adverse outcomes, including postoperative complications and mortality. Given that frailty is a dynamic process, there is a scarcity of research exploring its occurrence and progression in colorectal cancer patients.

To investigate the developmental trajectory of postoperative frailty in patients with colorectal cancer and identify its influencing factors through a longitudinal research approach and to provide a theoretical basis for managing frailty in this population.

We employed a convenience sampling method to select patients with colorectal cancer from Jiangsu Provincial People's Hospital between July and December 2022. Data on general information and relevant factors were collected from the participants. The Tilburg Frailty Scale was utilized to assess frailty at four intervals: preoperatively, and then at 1 month, 3 months, and 6 months post-surgery. The growth mixture model was constructed to delineate the developmental trajectory of postoperative frailty and Logistic regression was used to analyze the factors influencing frailty in colorectal cancer patients.

A total of 374 patients completed the survey. By fitting the frailty data at four time points, results showed three optimal trajectory models: Health Improvement Type (n=305, 81.5%), Frailty Improvement Type (n=25, 6.7%), and Frailty Persistence Type (n=44, 11.8%). For clinical relevance, the latter two types were merged into a "Frailty Heterogeneity Trajectory". Multivariate Logistic regression analysis revealed several influencing factors for the frailty heterogeneity trajectory: age (OR=1.141, 95%CI=1.065-1.223), nutritional score (OR=0.424, 95%CI=0.303-0.594), number of comorbidities (OR=2.884, 95%CI=1.158-7.184), neoadjuvant therapy (OR=29.510, 95%CI=5.511-158.007), stoma establishment (OR=37.313, 95%CI=8.604-161.819), postoperative chemoradiotherapy (OR=95.071, 95%CI=17.664-511.674), depression level (OR=2.673, 95%CI=1.336-5.350), and social support (OR=0.881, 95%CI=0.797-0.974) (P<0.05) .

Postoperative frailty in patients with colorectal cancer demonstrates three distinct developmental trajectories: "Health Improvement Type""Frailty Improvement Type", and "Persistent Frailty Type". Healthcare professionals should identify the heterogeneous trajectory groups early on, particularly the latter two types, and implement targeted interventions to enhance their long-term health outcomes.

As is widely recognized, exercise can effectively prevent and alleviate non-alcoholic fatty liver disease (NAFLD), but its mechanism remains to be further explored. In recent years, studies have revealed that the polarization of liver macrophages is closely associated with NAFLD. Based on a review of the characteristics of macrophage polarization at each stage of NAFLD, this article further analyzes the influence of exercise on macrophage polarization and its therapeutic efficacy for NAFLD. The results indicate that under normal circumstances, the resident Kupffer macrophages in the liver maintain a dynamic banlance between the pro-inflammatory M1 and anti-inflammatory M2 phenotypes. In the early stage of NAFLD, aerobic exercises of different intensities can suppress the increase of M1/M2 ratio and exert remarkable effects on the early stage of NAFLD by inhibiting the infiltration of exogenous macrophages or the polarization of Kupffer cells towards the M1 phenotype. With the further development of NAFLD, liver macrophages gradually exhibited an increased phenomenon of stress-induced M2 polarization. However, at this juncture, the principal role of M2 macrophages is manifested in facilitating the activation of hepatic stellate cells and the differentiation of the extracellular matrix, thereby inducing liver fibrosis and even cirrhosis or liver cancer. In summary, this study suggests that macrophage polarization may be a new target for exercise to prevent NAFLD. Blocking the infiltration of exogenous macrophages or inhibiting the M1 polarization of Kupffer cells may be an important strategy to prevent the progression of NAFLD. However, when the disease progresses to the stage of fibrosis, cirrhosis, or liver cancer, avoiding the stress-induced M2 polarization of macrophages may be an effective therapeutic target.

Lipids play a crucial role in maintaining normal physiological functions, and cancer patients often exhibit dyslipidemia, which can affect prognosis. Phase angle (PA) is an objective index reflecting the structural integrity and function of human cell membrane, which is positively correlated with the nutritional status of the body, and is often used to predict survival and therapeutic effect. Currently, the lipid profile characteristics of digestive system cancer patients and their impact on PA remain unclear.

To analyze the lipid profile characteristics of patients with digestive system tumors and investigate their influence on PA.

A retrospective study was conducted on 142 patients admitted to the Affiliated Anqing First People's Hospital of Anhui Medical University between July 2020 and December 2023. General patient data, performance status (PS) scores and patient-generated subjective global assessment (PG-SGA) scores were collected. Lipid profile indicators and PA were measured, and patients were divided into a normal PA group and a low PA group based on PA levels. Differences in general characteristics and lipid levels between the two groups were compared. Binary logistic regression was used to analyze the influencing factors of PA. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of lipid indicators for PA.

Among the 142 patients, 104 (73.24%) were male, and 38 (26.76%) were female, with a mean age of (65.0±10.8) years. The low PA group comprised 64 patients (45.07%), while the normal PA group included 78 patients (54.93%). Significant differences were observed between the two groups in terms of sex, age, PS score and PG-SGA score (P<0.05). The low PA group had lower levels of total cholesterol (TC), triacylglycerol (TG) and low density lipoprotein (LDL) compared to the normal PA group (P<0.05), while no significant difference was found in high density lipoprotein (HDL) levels (P>0.05). Binary Logistic regression analysis revealed that female sex (OR=0.251, 95%CI=0.086-0.731) and age>65 (OR=0.281, 95%CI=0.108-0.727) were protective factors for PA≥4.4°, whereas TC (OR=6.142, 95%CI=2.795-13.494) was a risk factor for PA≥4.4°. The AUC for TC in predicting PA≥4.4° was 0.803 (95%CI=0.733-0.874), with a sensitivity of 75.6%, specificity of 71.9%, and an optimal cutoff value of 4.25 mmol/L. The AUC for LDL in predicting PA≥4.4°was 0.790 (95%CI=0.717-0.863), with a sensitivity of 76.9%, specificity of 67.2%, and an optimal cutoff value of 2.46 mmol/L. The AUC for TG in predicting PA≥4.4° was 0.609 (95%CI=0.517-0.702), with a sensitivity of 55.1%, specificity of 64.1%, and an optimal cutoff value of 1.05 mmol/L.

Lipid metabolism in digestive system tumor patients is influenced by multiple factors. The levels of TC and LDL have a relatively high predictive value for PA≥4.4°. Controlling both levels within an appropriate range (TC: 4.25-5.55 mmol/L, LDL: 2.46-3.91 mmol/L) is conducive to maintaining normal PA and may potentially improve prognosis.

Pancreatitis is a common disease of the digestive system, seriously affecting the quality of life of patients and imposing a public medical burden on families and society.

To analyse the trend of change in the burden of pancreatitis in China from 1990 to 2021, compare it with the global burden of disease, and predict the burden of pancreatitis in China from 2022 to 2031, so as to provide a reference basis for the prevention and treatment of pancreatitis in China.

Utilizing open data from the Global Burden of Disease (GBD) database (1990-2021), we analyzed the characteristics of pancreatitis burden in China and worldwide. Temporal trends in pancreatitis burden were calculated using the Joinpoint regression model, and the autoregressive integrated moving average model (ARIMA) was extended to predict the disease burden of pancreatitis from 2022 to 2031.

In China, the age-standardized incidence rate (ASIR) decreased from 35.352 per 100 000 in 1990 to 23.529 per 100 000 in 2021, the age-standardized prevalence rate (ASPR) declined from 35.326 per 100 000 to 24.146 per 100 000, the age-standardized mortality rate (ASMR) dropped from 0.983 per 100 000 to 0.637 per 100 000, and the age-standardized DALY rate (ASDR) fell from 29.770 per 100 000 to 18.267 per 100 000. Globally, ASIR, ASPR, ASMR, and ASDR also exhibited declining trends, but with smaller magnitudes of decline. The average annual percentage changes (AAPC) for China's ASIR, ASPR, ASMR, and ASDR were -1.340, -1.246, -1.400, and -1.574, respectively, which significantly outperformed the global declining trends (-0.441, -0.990, -0.468, and -0.527). Over the next decade, the ASPR of pancreatitis in China is projected to decrease from 24.08 per 100 000 in 2022 to 21.21 per 100 000 in 2031, ASMR are expected to decline from 0.64 per 100 000 to 0.53 per 100 000, and ASDR are predicted to drop from 17.98 per 100 000 to 14.63 per 100 000.

Analysis of data from 1990 to 2021 indicates that the disease burden of pancreatitis has shown a declining trend both in China and globally. In China, the ASIR, ASPR, ASMR, and ASDR have all demonstrated decreasing trends. The corresponding AAPC were significantly more favorable than the global levels. Projections based on the ARIMA model suggest that the ASIR in China will remain stable over the next decade, while the ASPR, ASMR, and ASDR associated with pancreatitis are predicted to decline.

China is not only a high-burden country for tuberculosis (TB) but also bears the largest global burden of hepatitis B. The dual prevalence of TB and hepatitis B poses significant challenges, as co-infected patients face higher risks of treatment failure and relapse. A key clinical challenge lies in ensuring the effective implementation of anti-tuberculosis regimens while minimizing the incidence of liver injury and avoiding treatment interruptions caused by hepatic complications. Due to limited clinical research data in this area in China, comprehensive diagnostic and treatment guidelines for pulmonary TB complicated by chronic hepatitis B virus (HBV) infection have yet to be established. Based on this, and referencing relevant domestic and international guidelines and consensus documents, the National Clinical Research Center for Infectious Diseases Jiangxi Branch, Jiangxi Provincial Key Laboratory of Tuberculosis organized a panel of experts from various fields including tuberculosis, infectious diseases, hepatology, and pathology to conduct intensive discussions and develop 11 expert consensus recommendations. This consensus aims to provide guidance for standardized diagnosis and treatment as well as scientific management of tuberculosis patients co-infected with HBV.

38.4% of patients with colorectal cancer died from non-cancer disease, with cardiovascular disease being the most important cause, accounting for 20.3% of the total deaths. Cardiovascular toxicity associated with targeted therapy is not uncommon, most notably hypertension.

The study aimed to determine the overall incidence and risk of cardiovascular toxicity associated with fruquintinib in metastatic colorectal cancer.

We searched CNKI, Wanfang Data, CBM, PubMed, Embase, Web of Science and Cochrane Library databases for single-arm clinical trials and randomized controlled trials (RCTs) relevant to fuquintinib therapy in patients with metastatic colorectal cancer. The search time limit was from the establishment of the databases to May 2024. Literature screening, data extraction, and quality evaluation were performed independently by two investigators. The meta-analysis was conducted using R 4.3.3 software.

Eight articles involving six single-arm clinical trials and three randomized controlled trials were included. The meta-analysis results showed that the incidence rates of all-grade hypertension and hemorrhage were 35% (95%CI=0.25-0.45) and 24% (95%CI=0.10-0.37), respectively. For high-grade events, the rates were 15% for hypertension (95%CI=0.10-0.20), 1% for hemorrhage (95%CI=0-0.02), 3% for embolic and thrombotic events (95%CI=0.02-0.05), and 1% for cardiac diseases (95%CI=0-0.02). Fruquintinib was associated with increased risks for both all-grade and high-grade hypertension, as well as all-grade hemorrhage, with RR of 3.93 (95%CI=2.95-5.24), 12.33 (95%CI=5.31-28.63), and 1.84 (95%CI=1.36-2.50) respectively, but not for high-grade hemorrhage (RR=1.06, 95%CI=0.35-3.23), embolic and thrombotic events (RR=3.35, 95%CI=0.89-12.55), or cardiac diseases (RR=0.62, 95%CI=0.18-2.14) .

The use of fruquintinib is associated with a significantly increased risk of developing cardiovascular toxicity, primarily for lower-grade events, in patients with metastatic colorectal cancer.

Pancreatic cancer is a highly malignant disease with a poor prognosis. Currently, there is a lack of effective early detection methods, resulting in most patients being diagnosed at an advanced stage or with distant metastasis. Furthermore, the unique tumor microenvironment poses challenges for traditional treatment modalities such as surgery, radiotherapy, and chemotherapy. This article provided a comprehensive review of the latest advancements in pancreatic cancer treatment both domestically and internationally. It also summarized relevant literature on targeted therapy and immunotherapy for pancreatic cancer. The article highlighted that continuous developments in gene sequencing and multi-omics research deepened our understanding of the molecular mechanisms and gene expression profiles associated with pancreatic cancer. Consequently, numerous signaling pathways and targets had been identified along with an array of targeted therapy and immunotherapy drugs. As a result, the treatment approach for pancreatic cancer was gradually shifting from a conventional "one-size-fits-all" strategy to more precise individualized treatments, ushering in new possibilities for combating this disease. This study offered novel insights that could guide further research on targeted therapy and immunotherapy for pancreatic cancer

Chronic fatigue syndrome (CFS) is a chronic debilitating disease of unknown etiology associated with intestinal microecological dysregulation and disturbances in bacterial metabolism, and there are significant differences in the composition of the intestinal flora and intestinal permeability between patients with CFS and healthy populations, but the characteristics of the intestinal flora suggestive of CFS populations of different ages have rarely been reported.

To explore the characteristics of intestinal flora of CFS patients in different age groups, and to provide scientific basis for risk prevention and control of CFS in different age stages.

CFS patients from outpatient clinics of Sichuan Integrative Medicine Hospital between February 2021 and October 2021 were selected as the study subjects, and divided into three groups: 20 cases in the young group (18-34 years old), 20 cases in the middle-aged group (35-55 years old), and 20 cases in the old-aged group (56-80 years old). Basic information of the cases was collected, stool specimens were collected, and 16S rRNA high-throughput sequencing was used to detect the intestinal flora, and bioinformatics and statistical analysis were performed.

Differences in species composition and relative abundance were observed in CFS patients of different ages, with higher Pielou_e index of intestinal flora in the old-aged group, with statistically significant differences compared to the middle-aged group (P<0.05), and significant separation of the aggregated flora in the middle-aged group from the other two groups (P<0.01). Coprococcus, Megamonas, Dialister, and Acinetobacter were the core flora of the young group, and Ruminococcus was the core flora of the old group. The relative abundance of Pseudomonadales, Moraxellaceae, and Acinetobacter in the young group was higher than the middle-aged and old-aged groups (P<0.05). The relative abundance of Erysipelatoclostridium and Sellimonas in the middle-aged group was higher than the young and old-aged groups (P<0.05). The relative abundance of Eggerthellaceae and Bilophila in the old-aged group was higher than the young and the middle-aged group (P<0.05) .

There are differences in the diversity and composition of the intestinal flora of CFS patients in different age groups, and it was initially found that Acinetobacter and Erysipelatoclostridium can be used as the key flora to differentiate the intestinal flora of old-aged, middle-aged and young CFS patients.

The global prevalence and incidence of metabolic associated fatty liver disease (MAFLD) co-occurring with type 2 diabetes mellitus (T2DM) are increasing, significantly elevating the risk of liver-related adverse outcomes. In clinical practice, early screening and diagnosis of high-risk MAFLD patients with hyperglycemia are crucial to slowing disease progression.

Based on the relationship between T2DM and MAFLD, this study evaluates the impact of hyperglycemia on hepatic steatosis and liver fibrosis in MAFLD using large-scale health examination data and aims to identify key factors influencing the development of MAFLD with hyperglycemia.

Data from 18 286 individuals who underwent health examinations at the First Affiliated Hospital of Soochow University from March to July 2024 were analyzed. The dataset included demographic information, medical history, abdominal ultrasound results, biochemical markers, and routine blood tests. Individuals meeting the MAFLD diagnostic criteria were classified into the MAFLD group, which was further stratified into three subgroups according to the Fibrosis-4 index (FIB-4) scores: T1 (FIB-4<1.30, n=4 275), T2 (1.30≤FIB-4≤2.67, n=924), and T3 (FIB-4>2.67, n=59). Clinical indicators among these subgroups were compared. Additionally, the MAFLD group was divided into two subgroups: MAFLD with hyperglycemia (n=752) and MAFLD without hyperglycemia (n=4 506), based on a history of diabetes, fasting blood glucose (FBG) ≥7.0 mmol/L, or glycated hemoglobin A1c (HbA_1c) ≥6.5% (meeting any one criterion). Differences in hepatic steatosis and liver fibrosis-related indicators between these subgroups were analyzed. Univariate and multivariate Logistic regression analyses were performed to identify key factors associated with MAFLD with hyperglycemia. The predictive performance of a combined model for MAFLD with hyperglycemia was evaluated using the receiver operating characteristic (ROC) curve analysis.

Among the T1, T2, and T3 groups, significant differences (P<0.05) were observed in clinical indicators, including smoking, hypertension, diabetes, hyperlipidemia, hyperuricemia, coronary heart disease, age, BMI, FBG, HbA_1c, platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), red blood cell distribution width (RDW), neutrophil count (NEUT), lymphocyte count (LYM), monocyte count (MONO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), albumin (ALB), glutamyl transferase (GGT), uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), alkaline phosphatase (ALP), and estimated glucose processing rate (eGDR). Moreover, the fatty liver index (FLI), hepatic steatosis index (HSI), and ZJU index were significantly higher in the MAFLD with hyperglycemia group compared to the MAFLD without hyperglycemia group (P<0.05). Additionally, the FIB-4, AST/PLT ratio index (APRI), non-alcoholic fatty liver disease fibrosis score (NFS), and BMI, AST/ALT and diabetes score (BARD) were also higher in the MAFLD with hyperglycemia group (P<0.05). The samples of MAFLD with hyperglycemia and MAFLD without hyperglycemia groups were randomly divided into training and validation sets at 1∶1 ratio respectively. In the training set, univariate and multivariate Logistic regression analyses identified age, waist circumference (WC), hypertension, hyperlipidemia, TG, GGT, UA and BUN as key influencing factors associated with MAFLD with hyperglycemia (P<0.05). Further ROC analysis of these factors demonstrated moderate predictive accuracy for MAFLD with hyperglycemia (0.53≤AUC≤0.75). A predictive model incorporating these eight key factors achieved an AUC of 0.805 (95%CI=0.781-0.828), with a sensitivity of 75.8% and specificity of 72.6%. Validation of this combined model in the validation set yielded a positive predictive value of 70.5%, a negative predictive value of 73.1%, and an overall predictive accuracy of 72.7%.

Among MAFLD patients stratified by FIB-4, significant differences in hypertension, FBG, HbA_1c, PLT, WBC, RBC, LYM, AST, and eGDR were observed across the three subgroups. Hyperglycemia exacerbates hepatic steatosis and liver fibrosis in MAFLD. Furthermore, age, WC, hypertension, hyperlipidemia, TG, GGT, UA and BUN were identified as significant risk factors for the progression of MAFLD to MAFLD with hyperglycemia. The predictive model incorporating these eight indicators enhances the accuracy of assessing hyperglycemia risk in MAFLD, potentially providing a reference for the early differential diagnosis in clinical practice.

Gastric cancer (GC) causes a heavy burden in China. Predicting individual GC risk can help to identify high-risk groups early, and then take targeted interventions to avoid or delay GC progression.

Establish and validate a nomogram model for predicting individual GC risk.

From January 2020 to July 2021, GC patients ≥40 years were diagnosed from the cancer registry system in 14 counties (districts) of Anhui province, Henan province, Shandong province and Jiangsu province were selected as the case group (684 cases). Match the general population with a frequency of 1∶2 based on gender, age, place of residence and health status matching people as a control group (1 368 cases). All subjects were randomly divided into training set (1 641 cases) and validation set (411 cases) according to a ratio of 8∶2. Multivariate Logistic regression analysis was used to screen variables and establish nomogram prediction model. The receiver operating characteristic (ROC) curve of the model predicting the risk of GC was drawn, the discrimination and calibration of the model were evaluated via the area under the ROC curve (AUC) and the Hosmer-Lemeshow test. The model was verified by Bootstrap method and the decision curve analysis (DCA) was used to evaluate the clinical practicability of the model.

Multivariate Logistic regression analysis showed that salty tastes (OR=1.690, 95%CI=1.333-2.142), dry and hard diet (OR=1.596, 95%CI=1.145-2.225), spicy food tastes (OR=1.387, 95%CI=1.093-1.760), exposure to secondhand smoking (OR=1.880, 95%CI=1.473-2.399), frequent tantrums (OR=3.283, 95%CI=2.236-4.819), history of stomach disease (OR=4.008, 95%CI=3.046-5.273), the family history of cancer (OR=1.549, 95%CI=1.170-2.051), Helicobacter pylori (Hp) infection (OR=1.298, 95%CI=1.028-1.693), high-salt diet (OR=1.338, 95%CI=1.033-1.734) were independent risk factors for GC (P<0.05). Junior high school education (OR=0.616, 95%CI=0.468-0.811), high school education or above (OR=0.491, 95%CI=0.342-0.703), regular diet (OR=0.542, 95%CI=0.405-0.726), the garlic consumption (OR=0.501, 95%CI=0.394-0.636) were protective factors for GC (P<0.05). The AUC for predicting GC risk in the training and validation sets was 0.768 (95%CI=0.744-0.792) and 0.776 (95%CI=0.728-0.823), respectively. The verification results of Bootstrap method showed that the calibration curve was in good agreement with the actual curve (Brier score of training set=0.177; Brier score of verification set=0.176) ; Hosmer-Lemeshow results showed that the model had a good fit (training set: χ²=4.408, P=0.819; verification set: χ²=4.650, P=0.794). The DCA curve showed that when the threshold is between 0.05 and 0.79, patients can benefit clinically using the nomogram model to predict the risk of GC occurrence.

The nomogram model constructed in this study could predict individual GC risk, early identify high-risk groups and help to formulate targeted and individualized interventions.

Type 2 diabetes mellitus (T2DM) is the most common type of diabetes. The incidence of metabolic associated fatty liver disease (MAFLD) in T2DM patients is higher than that in non - diabetic patients. Therefore, it is of great significance to find effective indicators for predicting the occurrence of MAFLD in T2DM patients.

This study aims to explore the predictive value of the ratio of fasting C-peptide to diabetes duration (FCP/DD) for the occurrence of MAFLD in patients with T2DM, providing a potential indicator for the early prevention and management of MAFLD.

This study enrolled 532 patients diagnosed with T2DM at the Department of Endocrinology, Hebei General Hospital from September 2018 to December 2021. Demographic data were collected, and fasting blood samples were obtained to assess biochemical parameters. The FCP/DD was computed using a predefined formula. Participants were stratified into MAFLD (n=359) and non-MAFLD (n=173) groups based on the presence or absence of MAFLD. Further classification into low FCP/DD (n=266) and high FCP/DD (n=266) groups was performed according to the median FCP/DD ratio. The relationship between the FCP/DD ratio and MAFLD incidence in T2DM patients were examined using Spearman rank correlation and Logistic regression analyses. The predictive efficacy of the FCP/DD ratio for MAFLD was evaluated by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC) .

The FCP/DD in the MAFLD group was higher than that in the non-MAFLD group (P<0.05). The incidence of MAFLD in the high FCP/DD group was higher than that in the low FCP/DD group (P<0.05). The Spearman rank correlation analysis results showed that in patients with T2DM and MAFLD, FCP/DD was negatively correlated with age and high-density lipoprotein cholesterol (HDL-C), and positively correlated with BMI, fasting blood glucose (FBG), glycated hemoglobin (HbA_1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and triglyceride-glucose index (TyG) (P<0.05). The results of multivariate Logistic regression analysis showed that after adjusting for confounding factors, a high level of FCP/DD was an independent risk factor for the occurrence of MAFLD in T2DM patients (P<0.05). The ROC curve results showed that the AUC of FCP/DD for predicting the occurrence of MAFLD in T2DM patients was 0.829 (95%CI=0.791-0.867), the AUC of FCP was 0.758 (95%CI=0.711-0.805), the AUC of HbA_1c was 0.525 (95%CI=0.471-0.578), and the AUC of TyG was 0.733 (95%CI=0.689-0.778) .

The level of FCP/DD was significantly increased. T2DM patients with high levels of FCP/DD had a higher risk of developing MAFLD. FCP/DD ratio has better predictive value than FCP, HbA_1c, TyG for combined MAFLD in T2DM patients.

Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) are the two most common metabolic diseases worldwide. The coexistence of MAFLD and T2DM has a high prevalence rate and accelerates disease progression, imposing a significant disease burden on patients and posing a major public health challenge. MAFLD and T2DM mutually influence each other, sharing common pathogenic mechanisms. Developing effective co-management strategies for MAFLD and T2DM is a critical clinical priority. This review elaborates on recent advances in the epidemiology, pathogenesis, screening, monitoring, and treatment of T2DM combined with MAFLD. It highlights that the co-existence of T2DM and MAFLD has become a common clinical phenomenon with each condition exacerbating the development and progression of the other. Screening for MAFLD should be implemented in T2DM patients. Non-invasive diagnostic tools such as the Fibrosis 4 Index and NAFLD Fbrosis Score can be used for routine screening, though their accuracy requires further validation. Additionally, medications like sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have been shown to improve outcomes in patients with T2DM and MAFLD, effectively preventing cardiovascular events. This review provides reference for the optimization of clinical diagnosis and treatment strategy of T2DM combined with MAFLD and the formulation of clinical "glycohepatic co-management" strategy.

The evolution of diagnostic term from non-alcoholic fatty liver disease (NAFLD) to the metabolic dysfunction-associated fatty liver disease (MAFLD) aims to highlight the critical role of "metabolic dysfunction" in the development and progression of fatty liver diseases. As one of the most common metabolic disorders globally, type 2 diabetes mellitus (T2DM) is now considered as the most common complication of MAFLD. The two diseases interact in ways that adversely affect various systems within the body. With regard to this situation, it is urgently to fully implement the "holistic medical approach" and explore a full-cycle and comprehensive management model for patients with both T2DM and MAFLD, which is of great significant for improving their prognosis. This article summarizes the epidemiology and pathogenesis of patients with MAFLD and T2DM, and shared the innovative practices of the new multidisciplinary management model, aiming to provide more support for the co-management of MAFLD and T2DM.

Acute lung injury represents the most probable organ injury in the context of severe acute pancreatitis, with the exception of the pancreas, which is primarily distinguished by respiratory insufficiency, manifested as shortness of breath, cyanosis, and diminished lung compliance. Nevertheless, the precise pathogenesis remains incompletely elucidated. Despite the administration of protective measures, the quality of life of patients with severe acute pancreatitis complicated by acute lung injury remains adversely affected.

To systematically evaluate the risk factors of severe acute pancreatitis complicated with acute lung injury.

Computer searches were conducted on CNKI, Wanfang database, VIP, PubMed, Web of Science and EBSCO databases to search relevant studies on the risk factors of severe acute pancreatitis complicated with lung injury from the establishment of the database to October 2023. Two researchers independently screened literature, extracted data, evaluated literature quality and evidence level, and conducted meta-analysis using RevMan 5.3 software. Begg's test in Stata17.0 was used for publication bias analysis.

A total of 10 studies were included, all of which were case-control studies, including 1 053 patients with severe acute pancreatitis. The results of meta-analysis showed that increased age (SMD=0.58, 95%CI=0.03-1.14, P=0.04), elevated fasting blood glucose (SMD=0.45, 95%CI=0.27-0.64, P<0.000 01), and an elevated respiratory rate (>30 breaths/min) (OR=6.18, 95%CI=3.20-11.94, P<0.000 01), the occurrence of fever (OR=12.92, 95%CI=4.41-37.84, P<0.000 01), the occurrence of pleural effusion (OR=7.19, 95%CI=3.25-15.91, P<0.000 01), decreased albumin (SMD=-0.77, 95%CI=-0.98 to -0.56, P<0.000 01), combined with obesity (OR=3.11, 95%CI=1.94-4.98, P<0.000 01), decreased calcium ion (SMD=-0.63, 95%CI=-0.85 to -0.42, P<0.000 01), combined with acidosis (OR=2.15, 95%CI=1.03-4.49, P=0.04), elevated C-reactive protein (SMD=0.79, 95%CI=0.56-1.03, P<0.000 01), decreased hemoglobin (SMD=-0.77, 95%CI=-1.10 to -0.43, P<0.000 01), elevated blood amylase (SMD=0.21, 95%CI=0.01-0.42, P=0.04), increased urinary amylase (SMD=0.40, 95%CI=0.03-0.77, P=0.03), elevated Ranson score (SMD=0.87, 95%CI=0.66-1.08, P<0.000 01), a rise in APACHE Ⅱ score (SMD=0.77, 95%CI=0.58-0.96, P<0.000 01), increased CT severity index score (SMD=0.39, 95%CI=0.19-0.59, P<0.000 01), elevated BISAP (SMD=0.62, 95%CI=0.37-0.88, P<0.000 01), severe acute pancreatitis with hyperlipidemia (OR=1.68, 95%CI=1.05-2.67, P=0.03), combined with SIRS (OR=9.57, 95%CI=4.03-22.72, P<0.000 01), number of organ injury (≥2) (OR=6.94, 95%CI=3.34-12.59, P<0.000 01), the occurrence of infection (OR=4.59, 95%CI=2.42-8.71, P<0.000 01) were risk factors for severe acute pancreatitis complicated with acute lung injury. The results of the publication bias analysis demonstrated that no significant publication bias was observed for the 14 factors (age, obesity, glucose, albumin, calcium ions, C-reactive protein, serum amylase, respiratory rate, Ranson score, APACHE Ⅱ score, CT severity index score, BISAP, hyperlipidemicity and pleural effusion) for which the analyses were conducted (P>0.05). The GRADE evidence evaluation demonstrated that a total of 11 risk factors (age, respiratory rate, pleural effusion, obesity, hemoglobin, serum amylase, urinary amylase, Ranson score, BISAP, hyperlipidemicity and organ damage) exhibited moderate quality, while 10 (fasting blood glucose, fever, albumin, calcium ions, acidosis, C-reactive protein, APACHE Ⅱ score, CT severity Index score, SIRS and infection) demonstrated low quality.

Age increase, fasting blood glucose, amylase, C-reactive protein, urinary amylase increase, albumin, hemoglobin, calcium ion concentration decrease, respiratory rate (>30 breaths/min), Ranson score, APACHE Ⅱ score, CT severity index score, BISAP score high, SAP subtype - hyperlipidemia, fever, acidosis, obesity, pleural effusion, SIRS, organ involvement (≥2) and infection were the risk factors for ALI in SAP patients. In the future, it is necessary to carry out further high-level research to prove the above research results.

Semaglutide, as one of the glucagon-like peptide-1 (GLP-1) receptor agonists, has significant potential for alleviating the progression of non-alcoholic fatty liver disease (NAFLD). However, its mechanism of action remains unclear.

To investigate the effect of semaglutide on hepatic lipid metabolism, further explore the pathogenesis of NAFLD and help clinical diagnosis and treatment.

Between September and November 2022, 30 SPF-grade male SD rats, aged 5-8 weeks with a body weight of (180±20) g, were acclimatized for one week and then randomly divided into three groups of control, model, and intervention, with 10 rats in each. The NAFLD rat model was prepared, and the intervention group received semaglutide at 40 μg/kg dissolved in 0.9% saline solution subcutaneously. The control and model groups received an equivalent volume of 0.9% saline subcutaneously. The general condition of the rats was observed, with hematoxylin-eosin (HE) staining and Oil Red O staining to examine liver tissue lesions. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and liver tissue triglyceride (TG) levels were measured. Real-time polymerase chain reaction (RT-PCR) was used to detect mRNA expression of fatty acid synthase (FAS), acetyl-CoA carboxylase 1 (ACC1), carnitine palmitoyltransferase 1α (CPT1α), acyl-CoA oxidase (AOX), fatty acid transport protein 36 (FAT/CD36), liver fatty acid-binding protein (LFABP), apolipoprotein B (ApoB), and microsomal triglyceride transfer protein (MTTP). Western blotting assay was used to detect FAT/CD36 protein levels.

There was no death of animals in all groups during the experimental period, and the rats in the control group exhibited smooth and glossy fur with good spirit, while the rats in the model group and intervention group showed a significant reduction in body weight, disorganized and lusterless hair, reduced activity and depressed spirit with the increase in feeding time. The body weight of the model group was lower than that of the control group at the end of the intervention, and the intervention group was higher than that of the model group (P<0.05). The liver weight of the model group was higher than the control group, and lower in the intervention group (P<0.05). The levels of ALT, AST, and TG were higher than those in the model group than in the control group, and lower in the intervention group (P<0.05). The levels of CPT1α, AOX, LFABP, ApoB, and MTTP were lower in the model group than in the control group, and the level of FAT/CD36 was lower in the intervention group (P<0.05). The model group had higher levels of FAT/CD36 than the control group, and the intervention group had lower levels than the model group (P<0.05) .

Semaglutide alleviated hepatic lipid deposition in NAFLD rats, potentially related to the downregulation of FAT/CD36 expression.

Frailty and metabolic syndrome (MetS) are both common geriatric conditions and may have potentially important links in terms of risk factors, body composition and metabolic mechanisms, which could jointly affect the prognosis of older patients with gastric cancer. Clearly distinguishing the characteristics of the two syndromes and elucidating their intrinsic relationship can help to develop precise and targeted preoperative management strategies.

To compare the characteristics of preoperative frailty and MetS in older patients with gastric cancer, focusing on general information, blood indicators and body compositions, then analyze their correlation.

A total of 286 patients aged 60 to 80 years who were admitted to the Gastrosurgery Department of the Jiangsu Province Hospital for gastric malignancy from August 2021 to August 2022 were included and divided into the four groups: the frailty group (n=45), the MetS group (n=58), the frailty+MetS group (n=12) and the normal group (n=171) based on the presence of frailty and MetS, and the clinical indicators of these groups were compared. With frailty as the dependent variable, Logistic regression analysis was conducted to investigate the correlation of MetS and the diagnostic indicators with preoperative frailty.

Statistically significant differences were observed among the four groups in terms of age, comorbidities, Nutritional Risk Screening 2002 (NRS2002) scores>3, fasting blood glucose, triglyceride, high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), hemoglobin, albumin, height, body mass, waist circumference, BMI, fat content, fat mass index, body fat percentage, visceral fat area, skeletal muscle content, skeletal muscle mass index, limb skeletal muscle mass index, muscle percentage, fat to muscle ratio and muscle to fat ratio (P<0.05). Multivariate Logistic regression analysis showed that age (OR=1.115, 95%CI=1.046-1.190), history of smoking (OR=2.156, 95%CI=1.134-4.096), NRS2002 score>3 (OR=2.359, 95%CI=1.159-4.802), CRP (OR=1.038, 95%CI=1.003-1.073) and central obesity (OR=0.405, 95%CI=0.183-0.896) were the risk factors for frailty in older patients with gastric cancer (P<0.05) .

The frailty group showed advanced age, elevated levels of inflammation and increased nutritional risk, along with an overall decline in fat and muscle composition. The MetS group showed increased comorbidities, elevated inflammation and albumin levels, abnormal markers of glycolipid metabolism, and overall increased fat and muscle composition. The frailty+MetS group had increased comorbidities, abnormal fasting blood glucose and HDL-C levels with increases only in fat-related components but no significant changes in muscle components. Thus, frailty was not significantly associated with MetS in this study.

The incidence of colorectal cancer ranks second among cancers in China and colorectal cancer is also one of the most common malignant tumors in the digestive system. With the development of medical research and technology, the diagnostic and therapeutic strategies of colorectal cancer are continuously evolving. The National Comprehensive Cancer Network (NCCN) is closely following the forefront and released the 2024 V1/V2 versions of the NCCN Clinical Practice Guidelines for Rectal Cancer on January 29 and April 4, 2024 respectively. The two revisions of the guidelines mainly focus on the latest research progress in molecular detection, immunotherapy, targeted therapy, neoadjuvant therapy and disease surveillance. This article analyzed the key updates of the 2024 V1/V2 NCCN guidelines, aiming to provide a more accurate reference for clinical rectal cancer diagnosis and treatment practice.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and the prevalence of NAFLD in China has continued to increase over the past 20 years. Some cohort studies have confirmed the causal relationship between NAFLD and dysglycaemia, but the temporal relationship between the two remains unclear.

To analyse the bidirectional time-series association between NAFLD and dysglycemia using cross-lagged panel models with the Beijing Health Management Cohort as the study population.

Based on the Beijing Health Management Cohort Study, follow-up data were collected from 2016 to 2021, with one follow-up visit per year, including questionnaire and physical examination information. According to the pre-established inclusion and exclusion criteria, 44 838 study subjects were finally included. A cross-lagged panel model was constructed using hepatic steatosis (HS) and fasting plasma glucose (FPG) as surrogate indicators of NAFLD and dysglycaemia, and stratified by gender and BMI to explore the temporal relationship between NAFLD and dysglycaemia in different populations.

(1) In the total population, the cross-lagged path coefficient β_{baseline HS→follow-up FPG} was statistically significant (P<0.05) at 0.009 (95%CI=0.002-0.016) ; however, the cross-lagged path coefficient in the opposite direction was not statistically significant (P>0.05). (2) In women, the cross-lagged path coefficients in both directions were statistically significant (P<0.05) with β_{baseline HS→follow-up FPG} of 0.025 (95%CI=0.015-0.035), and β_{baseline FPG→follow-up HS} of 0.026 (95%CI=0.014-0.038) ; in men, the cross-lagged path coefficients in both directions were not statistically significant (P>0.05). (3) Among those with BMI≥25.0 kg/m², the cross-lagged path coefficient β_{baseline HS→follow-up FPG} was statistically significant (P<0.05) at 0.114 (95%CI=0.103-0.125) ; however, the cross-lagged path coefficients in the opposite direction were not statistically significant (P>0.05) ; and among those with BMI <25.0 kg/m², the cross-lagged path coefficients in both directions were statistically significant (P>0.05). Cross-lagged path coefficients were statistically significant (P<0.05), with β_{baseline HS→follow-up FPG} of 0.101 (95%CI=0.092-0.111) and β_{baseline FPG→follow-up HS} of 0.021 (95%CI=0.012-0.031) .

There was a unidirectional temporal relationship from NAFLD to dysglycaemia in the total population and in the population with BMI≥25.0 kg/m²; and there was a bidirectional temporal relationship between NAFLD and dysglycaemia in the female population and in the population with BMI<25.0 kg/m², which provides clues for adopting the treatment idea of co-prevention of the two disorders, NAFLD and dysglycaemia, in clinical practice.

Inflammatory bowel disease (IBD) patients suffer from recurrent and prolonged disease episodes, resulting in a high disease burden, which seriously affects patients' quality of life. Different types of disease burden have different impacts on the health status of patients, however, the current distribution of disease burden types in IBD patients and their influencing factors are not clear and need to be further explored.

To explore the potential profiles of disease burden in patients with IBD, and to analyze the influencing factors of different potential profiles.

Convenience sampling method was used to select 241 IBD patients from Tenth People's Hospital, Tongji University from June to October 2023. General information questionnaire, Chinese version of the Inflammatory Bowel Disease Disk Scale, and Psychological Resilience Scale were used to conduct the survey. Potential profile analysis was categorized the burden of disease for IBD patients, and multiple Logistic regression was explored the differences in the characteristics of different categories of patients.

A total of 250 questionnaires were distributed in this study and 241 valid questionnaires were recovered, with a valid questionnaire recovery rate of 96.4%. The disease burden characteristics of IBD patients could be categorized into 3 potential profiles: high burden-disease coping difficulties type (n=147, 61.0%) , medium burden-perceived pain and image type (n=75, 31.1%) , and low burden-psycho-emotional type (n=19, 7.9%) . The results of multiple Logistic regression analysis showed that the high burden-disease coping difficulties type was compared with the low burden-psycho-emotional type, patients with unstable jobs and high education level were easily categorized into high burden-disease coping difficulties type, while patients with high annual income, long disease duration, no complications and favorable psychological resilience were easily categorized into low burden-psycho-emotional type. Comparing the medium burden-perceived pain and image type with the low burden-psycho-emotional type, the older the patients, the higher the literacy level, the higher the number of follow-ups, and the lack of surgical experience were easily categorized into the medium burden-perceived pain and image type, and the patients with high annual income, long disease duration, no complications, and favorable psychological resilience were easily categorized into the low burden-psycho-emotional type. Comparing the medium burden-perceived pain and image type with the high burden-disease coping difficulties type patients who were married, had no regular job, and had long disease duration were likely to be categorized in the high burden-disease coping difficulties type, whereas patients who had a high number of follow-ups and no surgical treatment were likely to be categorized in the medium burden-perceived pain and image type (P<0.05) .

The disease burden of IBD patients has a distinct categorical profile and is divided into three potential profiles: high burden-disease coping difficulties type, medium burden-perceived pain and image type, and low burden-psycho-emotional type, which are influenced by age, marital status, job status, education level, annual income, disease duration, frequency of follow-up, surgical experience, complications, and level of psychological resilience. Healthcare professionals should pay attention to identifying the disease burden levels of different patients, focusing on high-burden patients, strengthening IBD symptom management and psychological interventions, and improving patients' disease coping ability and psychological resilience levels to reduce their disease burden.

Diet plays a critical role in the development, progression and prognosis of inflammatory bowel disease (IBD) . Given that specific nutritional guidelines are limited, nutritional management for patients with IBD remains challenging and fraught with uncertainty. Although previous studies have demonstrated that artificial intelligence (AI) shows promising applications in the nutritional management of patients with chronic diseases, research specifically focused on its application in the nutritional management of patients with IBD remains limited.

To conduct a scoping review of studies on AI in nutrition management of patients with IBD.

Following the methodology of scoping reviews, the databases of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, IEEE Xplore, Association for Computing Machinery Digital Library, SinoMed, CNKI, Wanfang Data, and VIP were systematically searched from inception to March 2024 for studies on the application of AI in the nutritional management of patients with IBD. According to the established inclusion and exclusion criteria, two investigators independently screened the literature, and the basic characteristics of the selected studies were extracted.

A total of 15 studies were included. The applications of AI in this field include exploring the relationship between diet and IBD, assisting in nutritional assessment, and aiding nutritional interventions. The majority of utilization AI technologies in the included studies are machine learning, with some also employing additional techniques such as natural language processing and deep neural networks.

AI is beneficial for exploring healthy dietary patterns for patients with IBD and providing personalized nutritional guidance. However, its application in the field of nutritional management in patients with IBD is still in its infancy. Future efforts should focus on strengthening multidisciplinary collaboration, emphasizing the integration of clinical guidelines, and assessing the effectiveness of AI applications in clinical settings to enhance the rigor and accuracy of the results.

The 2024.V4 of the NCCN Clinical Practice Guidelines for Colon Cancer provides important updates on pathological testing of systemic therapy for colon cancer, dose of chemoradiotherapy, and treatment and management of metastatic colon cancer. Firstly, the guidelines emphasize the importance of genomic testing in the systemic treatment of metastatic colon cancer. Secondly, the dose of chemoradiotherapy and targeted therapeutic targets of locally advanced colon cancer were modified. Finally, the new drug repitinib for the second-line treatment of metastatic colon cancer provides a new option for patients with positive neurotrophic tyrosine receptor kinase (NTRK) gene fusion. In terms of patient management, the importance of general practice to patients' quality of life and psychological support was emphasized. Through the interpretation of the above content, this paper is expected to provide references for the diagnosis, treatment and prognosis of colon cancer, ensure that patients receive timely specialized treatment, and provide references for the precision treatment of colon cancer.

In 2024, the National Comprehensive Cancer Network (NCCN) has updated three editions of the Clinical Practice Guidelines for Gastric Cancer. These updates encompass multiple crucial areas of diagnosis, treatment, and follow-up monitoring for gastric cancer. It elevates the significance of next-generation sequencing in precision therapy for gastric cancer, refines the limitations for Epstein-Barr virus (EBV) testing and first-line immunotherapy in advanced stages. Adjustments have been made to the preoperative medication cycle for neoadjuvant immunotherapy, a new NTRK-targeted therapy drug was added in the second-line therapy, and a more detailed approach to postoperative monitoring and supplementation for nutritional deficiencies has been introduced. Notably, this version marks the first inclusion of endoscopic treatment pathways for early-stage gastric cancer and diagnostic and treatment pathways for single peritoneal metastasis in advanced gastric cancer. Additionally, it provides a comprehensive elaboration on the application principles of several emerging surgical techniques combined with intraperitoneal treatments. The updated content fully embodies the trend towards precision, personalized, and multidisciplinary treatment. This article will focus on the diagnosis, surgical treatment, systemic treatment, follow-up monitoring and other aspects of the guideline, in order to provide guidance and help for clinical practice.

In recent years, the extensive application of transcriptome sequencing technology in the field of liver cancer has provided assistance in genomic and biological studies of liver cancer. Summarizing and analyzing the literature on RNA-seq applied to liver cancer research in the last two decades can help to provide researchers with a comprehensive understanding of the research hotspots and latest progress in this field, and provide reference for subsequent research.

To evaluate the application of RNA-seq in various aspects of liver cancer research, such as treatment, diagnosis, and pathogenesis as a whole by bibliometric analysis, so as to reveal the global distribution of research hotspots in the field of RNA-seq applied to liver cancer, and predict the development trend of this field in the future.

Web of Science database was searched for English literature related to the application of RNA-seq to liver cancer research from 2001 to 2022, and the number of publications was analyzed using Microsoft Excel 2016 software. CiteSpace software was used for visualization of authors, countries, institutions, and keywords.

A total of 1 397 documents on the application of RNA-seq to liver cancer research were retrieved in the database, and the analysis results showed that the core group of authors in this field had been formed; China has the largest number of publications, but the research depth is slightly lacking, the United States has the second largest number of publications after China, but with the highest centrality (0.44) ; most of the institutions with a high publication volume are located in China, and most of the institutions with greater influence are located in the United States; the keyword analysis showed that the research hotspots in the field include the molecular mechanism, gene expression and molecular markers related to the occurrence and development of liver cancer.

The molecular mechanism of liver cancer development, biomarkers and therapeutic targets of the disease are the current research hotspots in this field, and clinical precision medicine may be a key research direction in the future.

The gastric precancerous conditions includes gastric mucosal atrophy and intestinal metaplasia, which is key link in the occurrence and development of gastric cancer, and its prevalence is on the rise in China. This paper details the conceptual difference between gastric precancerous conditions and precancerous lesions, identifies the evaluation methods of patients with high risk of carcinogenesis in gastric precancerous conditions from the aspects of endoscopy, pathological histology, and biomarkers, and summarizes the pathogenesis of gastric precancerous conditions. This paper shows that the cancer risk of gastric precancerous conditions is related to various factors such as the degree, range and subtype of lesions. In the microenvironment of gastric mucosa, imbalance and disorder of oxidation and antioxidant effect, energy metabolism, immune homeostasis, cell proliferation and death are the pathogenesis of gastric precancerous conditions. A comprehensive and prudent assessment of the cancer risk of gastric precancerous conditions is needed in clinical practice, thus providing patients with appropriate surveillance and follow-up programs to improve the detection rate of early gastric cancer. This paper can provide powerful evidence-based medical evidence for high-risk screening and prevention measures of gastric precancerous conditions in China, provide a reference for the in-depth development of mechanism research and new drug development.

Malnutrition has become one of the adverse complications in patients with cirrhosis, and early nutritional screening and early identification of patients with cirrhosis can effectively improve clinical outcomes, however, the types of nutritional screening tools for patients with cirrhosis are varied and not yet standardized, and further research is needed.

To evaluate the applicability of 4 nutritional screening tools for patients with cirrhosis.

CNKI, VIP, Wanfang Data, PubMed, Embase, Cochrane Library and Web of Science were searched for diagnostic studies related to nutritional screening tool screens for malnutrition in cirrhotic patients. The search time was limited to December 2023. Two researchers individually read and filtered the literatures, extracted data, and assessed the bias risk of the incorporated researches. RevMan 5.4.1, Meta-DiSc, and StataMP 17.0 were used to perform network meta-analysis. The sensitivity, specificity, positive predictive value and negative predictive value of different nutritional screening tools were ranked by the surface under the cumulative ranking curve (SUCRA) .

5 Chinese and 5 English literatures were incorporated, totaling 10, including 1 299 patients; and four nutritional screening tools were included: the Nutritional Risk Screening 2002 (NRS2002), the Royal Free Hospital-Nutritional Prioritization Tool (RFH-NPT), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Assessment (SGA). The findings of meta-analysis revealed that the combined sensitivity of the four nutritional screening tools was 0.65 (95%CI=0.56-0.73), 0.93 (95%CI=0.89-0.96), 0.77 (95%CI=0.72-0.82), respectively. The combination specificity was 0.87 (95%CI=0.83-0.91), 0.72 (95%CI=0.64-0.79), 0.81 (95%CI=0.68-0.90), and MUST only be studied separately, without the combination sensitivity and combination specificity. The results of network meta-analysis showed the sensitivity and negative predictive value of SGA were lower than that of RFH-NPT (OR=0.03, 95%CI=0-0.55; OR=0.08, 95%CI=0.01-0.81, P<0.05) ; and the sensitivity and negative predictive value of RFH-NPT were higher than that of NRS2002 (OR=44.33, 95%CI=3.94-498.52; OR=17.68, 95%CI=2.13-147.05, P<0.05). The results of the combined subject work characterization curve (SROC) showed that the area under the SROC curve (AUC) for screening for malnutrition in cirrhotic patients was 0.86 for NRS2002, 0.90 for RFH-NPT, and 0.85 for SGA. The SUCRA values of the tools ranked in terms of combined sensitivity from highest to lowest were RFH-NPT (SUCRA=99.5%) >MUST (SUCRA=43.0%) >SGA (SUCRA=39.0%) >NRS2002 (SUCRA=18.5%) ; the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: MUST (SUCRA=91.4%) >NRS2002 (SUCRA=49.1%) >SGA (SUCRA=39.8%) >RFH-NPT (SUCRA=19.7%) ; the SUCRA values of these tools ranked in terms of positive predictive value from highest to lowest were MUST (SUCRA=95.2%) >RFH-NPT (SUCRA=37.4%) >NRS2002 (SUCRA=36.1%) >SGA (SUCRA=31.3%) ; the SUCRA values of these tools ranked in terms of negative predictive value from highest to lowest were RFH-NPT (SUCRA=99.1%) >MUST (SUCRA=44.9%) >SGA (SUCRA=39.4%) >NRS2002 (SUCRA=16.7%) .

The current evidence shows that RFH-NPT and MUST are suitable, but this conclusion still needs to be further confirmed by large samples and multiple high-quality studies.

With the prevalence of obesity, the incidence of non-alcoholic fatty liver disease (NAFLD) is increasing, the risk of liver fibrosis and liver cancer is also increasing. Screening for early fibrosis is of great significance. International guidelines recommend fibrosis-4 (FIB-4) index as an indicator for screening hepatic fibrosis. However, it is unclear whether FIB-4 index screening is affected by type 2 diabetes and BMI in screening for early fibrosis.

To evaluate whether the effectiveness of FIB-4 index in primary care screening is affected by type 2 diabetes and BMI.

A total of 110 patients diagnosed with NAFLD by liver biopsy in the Affiliated Hospital of Hangzhou Normal University from 2013 to 2023 were selected as the study objects. They were divided into type 2 diabete (T2DM) group and non-T2DM group according to T2DM. According to BMI, they were divided into normal weight group, overweight group and obesity group. According to the liver biopsy results, they were divided into F0-F1 group and F2-F4 group. FIB-4 index was calculated and the differences among each group were compared. Spearson correlation was used to analyze the correlation between FIB-4 index and various indexes. The accuracy of FIB-4 index was evaluated via receiver operating characteristics (ROC) curves. The area under ROC curve (AUC) was calculated and Delong test was used to compare AUC differences between groups.

The comparison results of FIB-4 index showed that the T2DM group was higher than non-T2DM group, and F0-F1 group was lower than F2-F4 group with statistical significance (P<0.05). There was no significant difference in FIB-4 index among normal weight group, overweight group and obesity group (P>0.05). Correlation analysis showed that FIB-4 index was positively correlated with age, aspartate aminotransferase, fasting glucose and fibrosis (P<0.05), and negatively correlated with platelet count (P<0.05). The AUC of FIB-4 index in the diagnosis of NAFLD was 0.77 (95%CI=0.68-0.86, P<0.001) and the AUC of FIB-4 index in the diagnosis of NAFLD with T2DM was 0.85 (95%CI=0.72-0.98, P<0.001). The AUC of FIB-4 index in the diagnosis of NAFLD without T2DM was 0.71 (95%CI=0.58-0.84, P=0.006). Delong test results showed that there was no significant difference in AUC between the T2DM group and the non-T2DM group (Z=1.509, P=0.131). The AUC of FIB-4 index in the diagnosis of NAFLD was 0.91 (95%CI=0.76-1.00, P=0.029) in the normal group, 0.65 (95%CI=0.46-0.83, P=0.125) in the overweight group, and 0.82 (95%CI=0.70-0.94, P<0.001) in the obese group. The AUC of the normal group was higher than that of the overweight group, and the difference was statistically significane (Z=2.037, P=0.042). There was no significant difference in AUC between the obese group and the normal group or the overweight group (Z=0.876, P=0.381; Z=1.452, P=0.146) .

FIB-4 is not affected by T2DM in the assessment of early fibrosis in NAFLD patients, but has a certain relationship with BMI.

Obesity is an important risk factor for the development of fatty liver. The current diagnostic indexes of obesity cannot effectively reflect the role of adipose tissue distribution in the development of fatty liver.

To assess the correlation of the baseline visceral adiposity index (VAI) and the Chinese visceral adiposity index (CVAI) with the risk of fatty liver.

This was a retrospective cohort study involving 17 086 adults receiving physical examination at the Health Management Center of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from February 2018 to November 2021. Physical examination records were reviewed by the electronic information system of the Health Management Center, and baseline characteristics, physical examination findings, laboratory testing and equipment inspection data were collected. Fatty liver was determined by follow-up abdominal ultrasound and computed tomography (CT). Follow-up was ended in December 2022, and follow-up events were recorded as the interval from non-occurrence of fatty liver at baseline to the first onset of fatty liver or at the end of the follow-up. Subjects were divided into fatty liver group and non-fatty liver group. Baseline VAI and CVAI were compared between groups. They were further divided into four groups based on the quartiles of baseline VAI and CVAI, and the incidence of fatty liver was compared. The correlation of VAI and CVAI with fatty liver was identified by Cox regression. The potential of VAI and CVAI in predicting fatty liver was assessed by the receiver operating characteristic (ROC) curves. Differences in the area under the curve (AUC) between VAI and CVAI were compared by the Delong's test.

The mean age, BMI and follow-up period of the subjects were (44.3±13.2) years old, (23.2±2.6) kg/m², and (2.7±1.1) years, respectively. By the end of follow-up, fatty liver was detected in 2 523 (14.8%) subjects. The incidence of fatty liver was significantly higher in men than women [19.4% (1 837/9 461) vs. 9.0% (686/7 625), P<0.001]. The VAI and CVAI of the fatty liver group were significantly higher than those of the non-fatty liver group (P<0.05). Trend testing showed that the incidence of fatty liver significantly increased with the increasing baseline VAI (χ²_trend=1 034.9) and CVAI (χ²_trend=1 334.8) (both P<0.001). Multivariate Cox regression showed that the risk of fatty liver in the VAI-Q4 group and CVAI-Q4 group was 2.579 times (95%CI=2.088-3.186) and 3.375 times (95%CI=2.488-4.576) that of the VAI-Q1 group, respectively. The ROC curve showed that the AUC of CVAI in predicting fatty liver was greater than that of VAI (0.737 vs. 0.708, P<0.001). Stratified analysis showed that CVAI was significantly correlated with the occurrence of fatty liver in gender, age and BMI subgroups (P<0.001) .

Baseline CVAI is significantly correlated with fatty liver development, and superior to VAI in predicting fatty liver.

Deficiency of fluid and blood is the main clinical manifestation of middle- and advanced-stage patients with esophageal cancer, but there are few reports about the metabolomic characteristics of esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood.

To investigate the metabolomic characteristics of esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood.

From April to December 2022, 35 esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood, were selected as the case group in the departments of TCM and Thoracic Surgery, the Fourth Hospital of Hebei Medical University, meanwhile 35 healthy volunteers were selected as the control group. Serum specimens were collected, and metabolomic characteristics was analyzed by ultra performance liquid chromatography-mass spectrometry, and then screened the differential metabolites metabolic pathways.

A total of 88 differential metabolites with substance secondary matching names were screened out; 5 key metabolic pathways with significant difference and 11 related differential metabolites were further screened out. The 5 key metabolic pathways were β-Alanine metabolism pathway, Sphingolipid metabolism pathway, Linoleic acid metabolism pathway, Glycine, serine and threonine metabolism pathway, and Arachidonic acid metabolism pathway. Of the 11 related differential metabolites, β-Alanine, Phosphatidylcholine, L-homoserine, and L-allothreonine were significantly down-regulated, whereas Carnosine, Linoleic acid, 9, 10-DHOME, Hydroxypyruvic acid, Arachidonic acid, Heparin B3, and Thromboxane B2 were significantly up-regulated.

There are metabolic pathways with significant difference and related differential metabolites in esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood, which mainly involved in metabolic abnormality of energy, such as amino acids and fatty acids.

Camrelizumab is a PD-1 inhibitor independently developed in China, which has been approved for use in the treatment of esophageal cancer. However, its efficacy and safety data in clinical practice are still lacking.

This study is aimed at assessing the Camrelizumab-based regimens' safety and efficacy for locally advanced and metastatic esophageal cancer in the real world, and explore whether the reactive cutaneous capillary endothelial proliferation (RCCEP) could predict the efficacy of carrelizumab under different treatment modalities.

Cases of locally advanced and metastatic esophageal cancer treated with camrelizumab-based regimens in the Fourth Hospital of Hebei Medical University between 1 November 2019 and 31 May 2022 were retrospectively examined. Progression free survival (PFS), overall survival (OS), disease control rate (DCR), objective remission rate (ORR) and adverse events were evaluated. Using the Kaplan-Meier approach to compute the median and estimated 95% CI for PFS and OS. Comparing the survival function of patients in the RCCEP group and without RCCEP group.

A total of 70 patients were included in the study. In all patients, the efficacy was evaluated as CR 11 (15.7%), PR 35 (50.0%), SD 17 (24.3%), PD 7 (10%), ORR 65.7% (46/70) and DCR 90.0% (63/70). In the 47 patients who receiving first-line to third-line treatment, the median PFS was 8.1 months (95%CI=6.46 to 9.74 months) and the 1-year PFS rate was 34.0%. The median OS was not reached, the 1-year OS rate of 76.3%. In the 23 patients who receiving neoadjuvant therapy, all patients achieved R0 resection, and 6 patients (26.1%) achieved pCR. In terms of safety, the most observed TRAEs included RCCEP (65.7%), nausea/vomiting (42.8%), anemia (37.1%), fatigue (37.1%) and alopecia (34.2%). The incidence of adverse reactions≥grade 3 was 21.4% (15/70), mainly including leukopenia (5.7%), neutropenia (5.7%) and thrombocytopenia (4.3%). Four patients developed immune related adverse reactions≥grade 3, including one case of grade 3 myocarditis, one case of grade 3 pneumonia, one case of grade 3 rash and one case of grade 4 nephritis. All patients were relieved after symptomatic or glucocorticoid treatment and no drug-related deaths occurred. RCCEP was associated with the efficacy of camrelizumab. The ORR (76.1% vs 45.8%, P=0.010) and DCR (97.8% vs 75.0%, P=0.009) of patients with RCCEP were higher than those without RCCEP. The median PFS (18 months vs 7.4 months, P=0.015) and OS (not reaching vs 15.7 months, P<0.001) of patients with RCCEP were significantly longer than those without RCCEP.

In the real world, camrelizumab-based regimens achieved good disease control and tolerance for treating locally advanced and metastatic esophageal carcinoma. In different treatment modalities, RCCEP could predicts the efficacy of camrelizumab.

As the prevalence of insomnia is gradually increasing, it is seriously affecting the mental and work status of patients. The gut microbiota is considered to be a risk factor for insomnia, but there is a relative lack of evidence to accurately recognize the relationship between gut microbiota and insomnia.

Using two-sample Mendelian randomization as a research methodology to explore the causal relationship between gut microbiota and insomnia.

Single nucleotide polymorphisms (SNPs) significantly associated with the relative abundance of 196 gut microorganisms were extracted as instrumental variables (IVs) according to predefined thresholds using pooled statistics of the gut microbiota from the largest available genome-wide meta-analysis of association studies conducted by the MiBioGen consortium (n=18 340). Pooled statistics for insomnia were obtained from the UK Biobank (n=462 341). Inverse variance weighting (IVW), MR-Egger regression, weighted median (WME), and weighted multinomial (WM) were used to detect the causal relationship between gut microbiota and insomnia, with IVW being the predominant method, and the results were assessed according to the effect indicator dominance ratio (OR) and 95% confidence interval (CI). Sensitivity analysis, heterogeneity test, gene multiplicity test, MR multiplicity residual and outlier test (MR-PRESSO) were combined to verify the stability and reliability of the results. Reverse Mendelian randomization analysis was also performed on the colonies found to be causally associated with insomnia.

IVW results showed that genus_Roseburia (OR=0.787, 95%CI=0.671-0.923, P_FDR=0.016), genus_Erysipelatoclostridium (OR=0.880, 95%CI=0.794-0.976, P_FDR=0.077), genus_Paraprevotella (OR=0.891, 95%CI=0.801-0.991, P_FDR=0.083), genus_Ruminococcaceae UCG014 (OR=0.818, 95%CI=0.697-0.961, P_FDR=0.072), family_Pasteurellaceae (OR=0.897, 95%CI=0.814-0.988, P_FDR=0.081), order_Pasteurellales (OR=0.897, 95%CI=0.814-0.988, P_FDR=0.094) were associated with insomnia, and no genetic pleiotropy or significant heterogeneity of IVs was found. According to the results of reverse MR analysis, insomnia had no significant causal effect on gut microbiota.

The abundance of six species of GM from the genus_Roseburia, genus_Erysipelatoclostridium, genus_Paraprevotella, genus_Ruminococcaceae UCG014 group, family_Pasteurellaceae, and order_Pasteurellales is negatively correlated with the risk of developing insomnia, i.e., decreased abundance increased the risk of developing insomnia and is a protective factor against insomnia.

The incidence of primary non-viral hepatocellular carcinoma (NBNC-HCC) continues to increase, and abnormal lipid metabolism accompanied by inflammation is one of the main causes of NBNC-HCC, so the detection and evaluation of inflammatory markers may be an important method to predict the prognosis of NBNC-HCC.

To investigate the prognostic value of monocyte/high-density lipoprotein ratio (MHR) as a predictor in patients with NBNC-HCC.

A total of 119 patients diagnosed with NBNC-HCC at the Third Hospital of Hebei Medical University between January 2013 and February 2020 were enrolled. General information and laboratory test results were collected. Patients were divided into four groups based on the quartiles of their MHR values: Q1 (MHR<0.33, n=28), Q2 (0.33≤MHR<0.66, n=31), Q3 (0.66≤MHR<1.59, n=30), and Q4 (MHR≥1.59, n=30). Patients were followed up regularly, and data on their survival status and time of death were recorded. The primary endpoint was the overall survival (OS) of patients with NBNC-HCC. Restricted cubic splines (RCS) were plotted to assess the correlation between MHR at admission and patient mortality. Receiver operating characteristic (ROC) curves were plotted to analyze the value of MHR at admission in predicting 36-month survival of patients with NBNC-HCC. Cox proportional hazards models and BP neural network models were used to analyze the independent risk factors for patients with NBNC-HCC. The Kaplan-Meier method was used to plot survival curves for the prognosis of patients with NBNC-HCC, and the Log-rank test was performed.

There were statistically significant differences in diabetes, proportion of surgeries, Barcelona Clinic Liver Cancer (BCLC) stage, aspartate aminotransferase (AST), C-reactive protein (CRP), gamma-glutamyltransferase (γ-GT), cholinesterase (CHE), urea (UREA), creatinine (Scr), high-density lipoprotein cholesterol (HDL-C), white blood cell count (WBC), red blood cell count (RBC), monocyte count (MONO), neutrophil count (NEUT), and albumin-bilirubin (ALBI) score among the Q1 to Q4 groups (P<0.05). ROC curves were plotted for MHR, MONO, and HDL-C to predict the prognosis of patients with NBNC-HCC. The results showed that MHR (AUC=0.822, 95%CI=0.742-0.903, P<0.05) had a better predictive effect on patient prognosis than MONO (AUC=0.723, 95%CI=0.618-0.828) (Z=4.34, P<0.05) and HDL-C (AUC=0.216, 95%CI=0.119-0.313) (Z=2.088, P<0.05). Multivariate Cox regression analysis showed that BCLC stage B-D, CRP, and MHR were independent risk factors for all-cause mortality in patients with NBNC-HCC (P<0.05). After adjusting for hypertension, smoking, alcohol consumption, diabetes, alanine aminotransferase (ALT), and AST, Q2 (OR=1.926, 95%CI=1.005-3.689, P=0.015), Q3 (OR=3.418, 95%CI=1.774-6.586, P<0.05), and Q4 (OR=7.677, 95%CI=3.773-15.621, P<0.05) were risk factors for patient mortality. RCS results showed a non-linear dose-response relationship between MHR at admission and the risk of mortality in patients with NBNC-HCC (P_trend<0.001, P_{non-linearity}<0.001). When MHR at admission was>0.67, the hazard ratio (HR) was>1, indicating that MHR at admission was a risk factor for mortality in patients with NBNC-HCC (P<0.05). BP neural network model analysis found that the main factors affecting the prognosis of patients with NBNC-HCC included BCLC stage (100.0%), vascular invasion (76.3%), extrahepatic metastasis (40.6%), MHR (39.3%), CRP (38.7%), ALBI score (35.5%), total bilirubin (35.0%), MONO (34.8%), and NEUT (29.8%). There was a statistically significant difference in the cumulative survival rates among the Q1 to Q4 groups (χ²=61.86, P<0.001) .

MHR was related to the prognosis of NBNC-HCC patients with a good predictive value.

The prevalence of non-alcoholic fatty liver disease (NAFLD) significantly increases in patients with type 2 diabetes mellitus (T2DM). However, the correlation of NAFLD with visceral fat area (VFA) and thyroid nodules in T2DM patients has been rarely reported.

This study aims to investigate the influencing factors for NAFLD in T2DM patients, and the correlation of NAFLD with VFA, thyroid nodules, and thyroid function in this population.

Hospitalized T2DM patients in the Department of Endocrinology, the Fourth Affiliated Hospital of Guangxi Medical University (Liuzhou Worker's Hospital) from January 2018 to April 2023 were retrospectively recruited. They were divided into two groups based on abdominal ultrasound findings: NAFLD group and non-NAFLD group. General data, including VFA, subcutaneous fat area (SFA), insulin function, thyroid function, prevalence of thyroid nodules, blood glucose levels, lipid levels, and liver and kidney function were compared between the two groups. Additionally, patients were divided into visceral obesity group (VFA≥100 cm²) and non-visceral obesity group (VFA < 100 cm²) based on VFA. Age, sex, prevalence of NAFLD and thyroid nodule were compared between the two groups. Spearman correlation analyses were employed to investigate factors associated with NAFLD and VFA, as well as their correlation with thyroid nodules. Influencing factors for the volume of thyroid nodules were explored as well. Furthermore, binary Logistic regression analysis was used to determine risk factors for both NAFLD and thyroid nodules in T2DM patients. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of BMI, waist-hip circumference, and waist-hip ratio, VFA, homeostatic model assessment for insulin resistance (HOMA-IR) in predicting NAFLD in T2DM patients and their optimal cut-off values.

A total of 578 T2DM patients were enrolled in this study, including 293 (50.69%) patients in the NAFLD group and 285 in the non-NAFLD group. The age of the NAFLD group was significantly lower than that of non-NAFLD group [ (57.0±12.8) years vs. (59.3±11.6) years, P<0.05]. Compared to those of the non-NAFLD group, patients in the NAFLD group had significantly higher body weight, body mass index (BMI), waist circumference, hip circumference, VFA, SFA, glycated hemoglobin (HbA_1c), fasting insulin levels (FINS), fasting C-peptide levels (FCP), HOMA-IR, homeostasis model assessment of β-cell function (HOMA-β), free triiodothyronine levels (FT₃), serum uric acid (SUA), total cholesterol (TC), triglyceride (TG) and C-reactive protein (CRP), but significantly lower serum creatinine (SCr) (P<0.05). There were 251 cases in the visceral obesity group and 327 cases in the non-visceral obesity group. The age of the visceral obesity group was significantly lower than that of the non-visceral obesity group [ (55.3±13.4) years vs. (60.3±10.8) years, P<0.05]. The incidence of NAFLD was significantly higher in the visceral obesity group than that of non-visceral obesity group (P<0.05). However, there was no significant difference in the prevalence of thyroid nodules between the visceral obesity group and non-visceral obesity group (64.94% vs. 59.82%, P>0.05). Spearman correlation analysis revealed that the occurrence of NAFLD in T2DM patients was positively correlated with body mass, BMI, waist circumference, hip circumference, waist-to-hip ratio, VFA, SFA, HbA_1c, FINS, FCP, HOMA-IR, HOMA-β, total triiodothyronine (TT₃), FT₃, and CRP (P<0.05), but negatively correlated with age (P<0.05). VFA in T2DM patients was found to be significantly correlated with gender, age, height, body mass, BMI, waist circumference, hip circumference, waist-to-hip ratio, SFA, diastolic blood pressure (DBP), FINS, FCP, HOMA-IR, HOMA-β, TT₃, FT₃, CRP and NAFLD (P<0.05). The thyroid nodule area showed a negative correlation with height, thyroid stimulating hormone (TSH) and waist-to-hip ratio (P<0.05), while it showed positive correlations with sex, age, TT₃, TT₄ and thyroglobulin (P<0.05). Univariate unconditional Logistic regression analysis revealed that age, weight, BMI, waist circumference, hip circumference, VFA, SFA, HbA_1c, FCP, HOMA-IR, FT₃, SCr, SUA, TC and TG were the influencing factors for NAFLD in T2DM patients. Binary Logistic regression results demonstrated that body weight (OR=0.962), VFA (OR=1.025), SFA (OR=1.006), FT₃ (OR=1.429) and HOMA-IR (OR=1.140) were the influencing risk factors for NAFLD in T2DM patients. Gender (OR=0.342), age (OR=1.073) and free thyroxine (FT₄) (OR=1.140) were influencing factors for thyroid nodules in T2DM patients (P<0.05). ROC curve results showed that the area under the curve (AUC) of BMI, waist circumference, hip circumference, waist-to-hip ratio, VFA and HOMA-IR was 0.704, 0.704, 0.705, 0.629, 0.757, and 0.569, respectively. The optimal cut-off value, sensitivity and specificity of them were listed as follows: BMI (25.37 kg/m², 67.7%, 36.0%), waist circumference (84.5 cm, 67.3%, 36.4%), hip circumference (96.5 cm, 69.4%, 38.9%), waist-to-hip ratio (0.895, 38.8%, 19.1%), VFA (88.4 cm² in female and 99.45 cm² in male, 78.9%, 35.3%), and HOMA-IR (3.08, 64.3%, 49.8%) .

The prevalence of NAFLD and thyroid nodules in T2DM patients significantly increase, but not correlated. Obese T2DM patients, especially those with visceral obesity, are more likely to suffer from NAFLD, thyroid nodules, hyperlipidemia, hyperuricemia and other metabolic diseases. HOMA-IR is a influencing factor for NAFLD in T2DM patients, but it is not a influencing factor for thyroid nodules. BMI, waist circumference, hip circumference and VFA are predictive factors of NAFLD in T2DM patients, and VFA has the highest diagnostic value and HOMA-IR has the lowest value. VFA predicts NAFLD in T2DM patients with the optimal cut-off value of 88.4 cm², which is equal in females and 99.45 cm² in males.