Objective To identify the feasibility of amide proton transfer-weighted imaging(APTw)and T2 mapping parameters in assessing microsatellite instability(MSI)in endometrial adenocarcinoma(EA). Methods Patients with clinically suspected endometrial cancer were prospectively enrolled and underwent MRI before the operation,which mainly included APTw and T2 mapping.Two radiologists independently performed regions of interest and measured the quantitative parameters.The intraclass correlation coefficients were used to assess the interobserver agreement,the independent samples t-test and Mann-Whitney U test were applied to compare quantitative variables between the MSI and microsatellite stable(MSS)groups,the receiver operator characteristic(ROC)curve was conducted to evaluate the predictive performances of different parameters,the Delong test was implemented to compare the area under the curve(AUC)between single parameters and their combination. Results Twenty-one patients in the MSI group and 37 patients in the MSS group were finally enrolled in this study.The results showed excellent observer agreements between two observers in assessing MRI parameters.APTw values[(2.72±0.52)% vs.(2.08±0.39)%,P<0.001]in the MSI group were significantly higher than those in the MSS group, T2 values [92.25(90.82, 99.91) ms vs.101.80(96.15, 112.13)ms, P<0.001]were significantly lower in the MSI group than those in the MSS group.The ROC curves showed that the AUCs of APTw and T2 values were 0.821 and 0.793,respectively,and no significant difference was observed between the two sequences(P＞0.05).The combination of APTw and T2 mapping yielded the highest AUC of 0.897,which was significantly higher than APTw and T2 mapping alone(both P＜0.05). Conclusion APTw and T2 mapping were valuable in assessing the MSI of EA,and the combination of the two parameters showed a higher diagnostic efficacy,thus providing an efficient basis for the selection of preoperative therapeutic modalities for the patients.

Objective To analyze the trend of disease burden changes in non-alcoholic fatty liver disease(NAFLD)in China from 1990 to 2021,and provide a basis for formulating prevention and treatment strategies.Methods The standardized incidence rate,prevalence,mortality and disability adjusted life year(DALY)rate of NAFLD in China from 1990 to 2021 in the Global Burden of Disease Study 2021 were extracted.The average annual percentage change of the rate was calculated by Joinpoint 4.2 and the age,period and birth cohort effects of the prevalence and DALY rate were analyzed by age-period-cohort model.Results Since 1990,the incidence rate and prevalence of NAFLD have been on the rise,while the mortality and DALY have been on the decline.The age effect of disease incidence and DALY rate shows an upward trend followed by a downward trend for both males and females.The period effect is based on the period from 1992 to 1996 as the reference group,and the overall trend of the disease incidence period effect curve shows a downward trend followed by an upward trend,with the period from 2002 to 2006 being the lowest point(RR=0.93).The period effect curves of DALY showed a downward trend from 1992 to 2011,and then tended to flatten out.The birth cohort effect was used as the reference group from 1972 to 1981,and the incidence rate showed a steady upward trend in the general population,male and female populations.The DALY rate showed an overall upward trend followed by a downward trend,with the peak occurring in the birth cohort group between 1922 and 1931.The DALY rate of NAFLD caused by smoking and high fasting blood glucose has shown a downward trend since 2014,and fasting blood glucose gradually becomes the dominant factor with age.Conclusions The prevalence of NAFLD in China has been on the rise from 1990 to 2021,but the DALY rate has significantly decreased.This suggests that current prevention and control strategies are effective,and further efforts should be made to raise residents' health awareness and control the occurrence and development of NAFLD.

Objective To assess the blood pressure control and its influencing factors among hypertensive patients in communities in different time periods by 24 h ambulatory blood pressure monitoring(24 h ABPM)and provide reference for optimizing the health management services for hypertension in communities. Methods A total of 765 hypertensive patients registered in the hypertension management project of national essential public health services in Sanxiang Town,Zhongshan City from October 2022 to September 2023 were identified as target subjects.The 24 h ABPM devices were distributed for blood pressure monitoring and a questionnaire survey was conducted to analyze the influencing factors of blood pressure control. Results Of all the participants,16.5% did not monitor blood pressure regularly,and 59.2% monitored blood pressure 1-2 times per week.The patients who were not on night shifts/staying up late had higher mean rates of achieving the target blood pressure and the circadian rhythm of blood pressure during 24 h,nighttime,and early morning than those who were on night shifts/staying up late(P<0.05 for all).The patients who never drank alcohol had higher rate of achieving the target blood pressure in early morning than those who drank alcohol(P<0.05).The average blood pressure during daytime,nighttime,and 24 h were different by sex(P<0.05 for all).The average blood pressure during nighttime was different by age and job types(P<0.05 for all).The average blood pressure during daytime,nighttime,and 24 h were different in patients with different body weight types(P<0.05 for all).The results of the multivariate logistic regression analysis showed that uncontrolled blood pressure during daytime was more likely to occur in male patients(OR=1.394,95%CI:1.045-1.858,P=0.024),and that during nighttime was more likely to be associated with male patients(OR=1.573,95%CI:1.088-2.275,P=0.016)and night shifts(OR=2.467,95%CI:1.198-5.077,P=0.014).It was difficult to achieve blood pressure control in early morning for the patients who drank alcohol for more than three times per week(OR=4.567,95%CI:1.629-12.807,P=0.004),woke up at night(OR=1.800,95%CI:1.125-2.878,P=0.014),and had night shifts(OR=1.579,95%CI:1.102-2.465,P=0.044).The patients on night shifts were more likely to have abnormal circadian rhythm of blood pressure(OR=1.753,95%CI:1.018-3.018,P=0.043). Conclusion The personal characteristics and lifestyle of hypertensive patients significantly affect the blood pressure control in different time periods(daytime,nighttime,and early morning)and the circadian rhythm of blood pressure.The family doctor team of community healthcare institutions can implement targeted and precise intervention measures for hypertensive patients according to the influencing factors of blood pressure control in different time periods,so as to achieve better management effects.

Objective To explore the contemporary prevalence,cumulative incidence,distribution characteristics,and correlates of social isolation among middle-aged and older adults aged 45 years and older in China. Methods This study utilized data from the China Health and Retirement Longitudinal Study.Cross-sectional studies with stratified analysis were conducted to investigate the prevalence of social isolation and its age,gender,and regional differences in 2018 and 2020.A cohort study and binary logistic regression models were employed to analyze the cumulative incidence of social isolation and its correlates from 2018 to 2020.Multiple imputation based on chained equations and sensitivity analyses based on complete-case data were employed to ensure the reliability of the analysis. Results In 2018,the weighted prevalence of social isolation among middle-aged and older adults was 16.48%(95%CI=15.67%-17.32%).In 2020,the weighted prevalence of social isolation among middle-aged and older adults was 18.84%(95%CI=17.93%-19.74%).Weighted stratified analyses indicated that the prevalence of social isolation was significantly higher among older adults,individuals residing in rural areas,and females.The weighted cumulative incidence of social isolation during 2018-2020 was 9.24%(95%CI=8.47%-10.02%).The analysis revealed that 34.02%(95%CI=32.85%-35.19%)of middle-aged and older adults exhibited depressive symptoms.Depressive symptoms(OR=1.38,95%CI=1.07-1.78,P=0.013)were significantly associated with an elevated risk of social isolation. Conclusion The study reveals the epidemiology of social isolation among middle-aged and older adults in China,identifying advanced age,female gender,rural residence,and depressive symptoms as key correlates.These findings emphasize the need for early health management strategies to address social isolation in these high-risk populations.

Objective This study aims to assess the coverage of human papillomavirus(HPV)testing and the prevalence of HPV infection among men who have sex with men(MSM)using geosocial networking apps in China.It also explores the related influencing factors to provide evidence for designing effective prevention and control strategies for this population. Methods The study was conducted from July to August 2024 and recruited participants via the Blued app.Univariate and multivariate logistic regression models were used to analyze factors associated with HPV testing and infection among MSM. Results Among the 1,080 participants,23.3% had undergone HPV testing,and 43.3% of those tested were positive for HPV. The main reason for HPV testing was the presence or suspicion of HPV-related symptoms(n=224,58.9%).Logistic regression analysis showed that MSM with higher levels of HPV knowledge,higher income,and those who self-identified as homosexuals were more likely to undergo HPV testing.Additionally,MSM with higher HPV knowledge,those who self-identified as homosexuals,those who had sex with women in the past six months,and HIV-positive MSM were identified as high-risk groups for HPV infection. Conclusions In China,the HPV testing rate among MSM using geosocial networking apps is low.However,the prevalence of HPV infection remains relatively high.Therefore,the government and community should enhance HPV knowledge dissemination,promote HPV testing,and improve the accessibility and quality of HPV testing services.By doing so,they can increase the testing coverage and effectively control the spread of HPV among MSM.

Objective To investigate the value of repeat renal biopsy in the treatment and prognosis of nephrotic syndrome(NS)and acute kidney injury(AKI)following immunosuppressive therapy in patients with lupus nephritis(LN).Methods A retrospective analysis was conducted for the clinicopathological data and follow-up records of LN patients undergoing repeat renal biopsy at Peking Union Medical College Hospital from January 1,2009 to December 31,2021.Results A total of 76 patients(55 females,72.4%)were included in this study,with the mean age at the first biopsy being(29.0±10.4)years,the median inter-biopsy interval of 4.0(2.0,7.0) years,and the median total follow-up duration of 7.5(5.0,13.8)years.Pathological transformation occurred in 46(60.5%)patients,and 2 patients had comorbid diabetic nephropathy.At repeat renal biopsy,50(65.8%) patients presented NS.These patients demonstrated lower estimated glomerular filtration rate(eGFR)(P<0.001),higher chronicity index(CI)(P=0.029),and higher complement C3(P<0.001)and C4(P<0.001)levels than those with NS at the first renal biopsy(n=50).Among the 28(36.8%) patients with AKI at repeat renal biopsy,8(28.6%)experienced acute exacerbation of chronic renal insufficiency.These patients exhibited higher serum creatinine level(P=0.002),C4 level(P=0.033),CI(P=0.042),and prevalence of thrombotic microangiopathy(P=0.046)than the patients showing AKI at the first renal biopsy(n=16),while the activity index(AI)showed no significant difference(P=0.051).Over 50% of NS and AKI patients underwent treatment modifications post-repeat renal biopsy,with clinical remission rates comparable to those after the first renal biopsy(both P>0.05).Elevated CI(≥5,P=0.001)and serum creatinine(≥140 μmol/L,P<0.001)at repeat renal biopsy were identified as independent risk factors for poor prognosis.The patients with AKI at repeat renal biopsy had higher incidence of endpoint events than the non-AKI patients(P=0.015).Neither AKI at the first renal biopsy nor NS at both biopsies had significant associations with prognosis.Conclusions Repeat renal biopsy reveals not only sustained high disease activity but also accelerates chronic progression in LN patients,which underscore its critical role in guiding the therapy for severe LN post-immunosuppression.AKI,CI≥5,and serum creatinine ≥140 μmol/L at repeat renal biopsy are strongly associated with poor prognosis.

The establishment and development of neonatal intensive care unit(NICU)have significantly increased the survival rate of premature infants.However,the diagnosis,treatment,and surgeries performed in NICU may expose neonates to more noxious stimuli.As the neonatal period is crucial for brain development,these noxious stimuli may cause irreversible damage to the neonatal nervous system.Existing clinical studies have shown that repetitive noxious stimuli during the neonatal period can lead to poor brain development,persistent hyperalgesia,and various sequelae.However,the underlying mechanisms remain unclear,and effective treatment methods are lacking.This article summarizes the effects of repetitive noxious stimuli during the neonatal period on neural development and the complications,aiming to provide a basis for the neonatal analgesia management and the prevention and treatment of related sequelae.