Effect of volatile versus propofol anaesthesia on major complications and mortality after cardiac surgery: a multicentre randomised trial.

BACKGROUND: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).

Cytokines as drivers: Unraveling the mechanisms of epithelial-mesenchymal transition in COVID-19 lung fibrosis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), like other viruses, can induce proliferation of myofibroblasts and even lead to fibrosis in the lung. Epithelial-mesenchymal transition (EMT) is thought to play an essential role in the pathogenesis of Coronavirus disease 19 (COVID-19). EMT is originally a critical process that regulates the development of different tissues in the embryo, but in inflammatory situations, EMT tries to be activated again to control inflammation or even heal inflammatory damage. However, in pathological situations, such as chronic viral infections (e.g., COVID-19) or pulmonary fibrosis initiation, this benign healing transforms into sinister nature, pushing the lung into the fibrotic process. Notably, the cytokines released by inflammatory cells and the chronic inflammatory microenvironment shared by fibrotic cells promote each other as critical factors in the induction of pathological EMT. In the induction of SARS-CoV-2 virus, cytokines are an essential mediator of EMT transformation, and a summary of whether COVID-19 patients, during the infection phase, have many persistent inflammatory mediators (cytokines) that are a causative factor of EMT has not yet appeared. The following common signaling drivers, including Transforming growth factor beta (TGF-ß), cytokines, Notch signaling pathway, Wnt and hypoxia signaling pathways, drive the regulation of EMT. In this review, we will focus on 3 key EMT signaling pathways: TGF-ß, Leucine zipper transcription factor like 1 (LZTFL1) and the common interleukin family expressed in the lung. TGF-ß-induced SNAIL and LZTFL1 were identified as regulatory EMT in COVID-19. For cytokines, the interleukin family is a common inducer of EMT and plays an essential role in the formation of the microenvironment of fibrosis. We sought to demonstrate that cytokines act as "communicators" and build the "microenvironment" of fibrosis together with EMT as a "bridge" to induce EMT in fibrosis. The mechanisms utilized by these two pathways could serve as templates for other mesenchymal transformations and provide new potential therapeutic targets.

Prevalence and risk factors of emergence agitation among pediatric patients undergo ophthalmic and ENT Surgery: a cross-sectional study.

BACKGROUND: Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children with EA tend to carry the risk of self-harm, have longer periods of recovery and delayed hospital discharge. Consequently, EA needs to be monitored and risk factors ought to be emphasized to implement preventative measures. The objective of this study was to describe EA and to identify risk factors after pediatric ophthalmic or ENT surgery. METHODS: Between September 2021 and December 2021, a cross-sectional study was conducted in 100 children aged of 0-12 years who underwent ophthalmic or ENT surgery. The Watcha scale was used to observe and record EA, which was defined at levels of 3 or 4 at any time in the post-anesthesia care unit (PACU). The pain intensity was graded with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale after surgery. Patient and surgery-related characteristics, the behavioral criteria of EA, the pharmacologic and non-pharmacologic interventions and recovery outcomes were objectively recorded. A binary logistic regression model was constructed to identify the associated factors of EA. RESULTS: From the 100 analyzed children, 58 were males and 42 were females, and 44 patients received ophthalmic surgery and 56 ENT surgery. The median age was 6 (IQR 4-7) years. The overall incidence of EA among pediatrics was 30% (34.5% for ENT and 24.4% for ophthalmic surgery). High preoperative modified Yale Preoperative Anxiety scale (m-YPAS) grade (OR = 1.19, 95%CI 1.06-1.33, P = 0.003) and high postoperative FLACC score (OR = 3.36, 95%CI 1.88-6.02, P < 0.001) were risk factors for EA. CONCLUSIONS: This study identified that preoperative anxiety and postoperative pain are associated with EA in children after ophthalmic or ENT surgery. Preoperative anxiety assessment and management, and administration of adjunct analgesic treatments should be considered in the routine care.

A WeChat applet-based national remote emergency system for malignant hyperthermia in China: a usability study.

BACKGROUND: Malignant hyperthermia (MH) is a rare anesthetic emergency with a high mortality rate in China. We developed a WeChat applet-based National Remote Emergency System for Malignant Hyperthermia (MH-NRES) to provide a real-time emergency system to help Chinese anesthesiologists deal with MH crises. However, it is imperative that close attention should be paid to the usability of the applet. PURPOSE: The objectives of this study were to (1) evaluate the usability of the applet-based MH-NRES for anesthesiologists; and (2) to test the validity and reliability of a modified mHealth app usability questionnaire. METHODS: A modified User Version of the Mobile Application Rating Scale (uMARS) was designed. Together with System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ), another two well-validated questionnaires, uMARS were then used to evaluate the usability of MH-NRES. The Cronbach alpha of the total score and the subscales of uMARS was calculated to evaluate the internal consistency. The correlation coefficients among three questionnaires were calculated. RESULTS: In this study, 118 anesthesiologists provided responses to the questionnaire. The overall mean uMARS score was 4.43 ± 0.61, which ranged from 3 to 5. The mean PSSUQ score were in good to excellent range with mean of 6.02 ± 0.97, which ranged from 3.19 to 7. The overall SUS score was 76.0 ± 17.6, which ranged from 45 to 100. The total uMARS score had excellent internal consistency (Cronbach alpha = 0.984). uMARS and its subscales were strongly correlated with PSSUQ (coefficient 0.758-0.819, P < 0.001) and SUS (coefficient 0.535-0.561, P < 0.001), respectively. CONCLUSIONS: Data obtained from the usability evaluation questionnaires in this study indicated a high quality of the MH-NRES on the ease of use, satisfaction and perceived usefulness, which suggest this system might be a useful tool for anesthesiologists' education and management of MH crises. Future feedback from high-fidelity simulation and clinical scenarios are need for further usability evaluation of this system.

The role of different educational programs in specialty preference among Chinese medical students: a cross-sectional study.

BACKGROUND: The imbalanced supply of physicians in different specialties and the decreasing number of young doctors in China have made it important to understand specialty preference and influencing factors and to evaluate the role of different programs in specialty choice and career planning among Chinese medical students to help shape the social healthcare system and ensure adequate medical practitioners in each specialty. METHOD: A cross-sectional study comprising medical students from 5-year and 8-year program was conducted online. Demographics, specialty preferences and influencing factors, and career planning situations were collected and analysed by the chi-square test. Binary logistic regression analysis was performed in each program to identify the association between influencing factors and each specialty. RESULTS: A total of 128 students (57.03% 5-year, 42.97% 8-year) responded to our survey. More 8-year students had a doctor in their household than 5-year students (25.45% vs. 10.96%, p < 0.05). The most preferred specialty among 5-year students was surgery, followed by others and internal medicine, while that most preferred by 8-year students was surgery, followed by internal medicine, obstetrics/gynecology and anesthesiology. Compared with 5-year students, more 8-year students considered 'personal competencies' (66.67% vs. 40.85%, p < 0.05), 'the reputation of the specialty' (18.52% vs. 7.04%, p ≤ 0.05), 'fewer doctor‒patient disputes' (27.78% vs. 11.27%, p < 0.05) and 'advice from family members' (24.07% vs. 7.04%, p < 0.05) influential. Among 5-year students, 'personal competencies' was positively associated with preference for surgery and 'work-life balance' was negatively associated. Among 8-year students, 'personal competencies' and 'work-life balance' were positively associated with internal medicine, while 'interests in the specialty' and 'broad career prospects' were negatively related. Many students need further career guidance, and personalized tutoring was the most wanted method. CONCLUSIONS: There was no difference between 5-year and 8-year students regarding specialty preference, but bias existed, possibly due to the influence of the real-world situation. Improving the working environment and welfare might be beneficial for developing a balanced distribution of the workforce among different medical departments. It is necessary for medical schools to develop programs accordingly to help them better plan their future careers.

Design, Synthesis, and Antifungal Activity of Some Novel Phenylthiazole Derivatives Containing an Acylhydrazone Moiety.

Crop fungal diseases pose a serious threat to global crop production and quality. Developing new and efficient fungicides is an important measure to control crop diseases. Phenylthiazole was found to be an excellent antifungal skeleton based on our previous study on the structural optimization and biological activity of the natural product thiasporine A. To find new fungicides, 45 phenylthiazole derivatives containing an acylhydrazone moiety were designed and synthesized by the principle of active substructure splicing. Forty-two of the forty-five compounds are novel, except for compounds E1, E14, and E33. Their structures were structurally characterized by 1H NMR, 13C NMR, and HRMS. The antifungal activities of the target compounds against Magnaporthe oryzae Colletotrichum camelliaet, Bipolaris maydis, and Sclerotinia sclerotiorum were evaluated at 25 µg/mL. The bioassay results revealed that most of these compounds exhibited excellent antifungal activities against M. oryzae and C. camelliaet at 25 µg/mL. In particular, compounds E4, E10, E14, E17, E23, E26, and E27 showed the inhibition rate of more than 80% against M. oryzae, with EC50 values of 1.66, 2.01, 2.26, 1.45, 1.50, 1.29, and 2.65 µg/mL, respectively, which were superior to that of the commercial fungicides Isoprothiolane (EC50 = 3.22 µg/mL) and Phenazine-1-carboxylic acid (EC50 = 27.87 µg/mL). The preliminary structure-activity relationship (SAR) results suggested that introducing methyl, halogen, or methoxy at the ortho-position of R1 and the para-position of R2 can endow the final structure with excellent antifungal activity against M. oryzae. The current results provide useful data for developing phenylthiazole derivatives as new fungicides for controlling rice blast caused by M. oryzae.

Surface plasmon resonances boost the transverse magneto-optical Kerr effect in a CoFeB slab covered by a subwavelength gold grating for highly sensitive detectors.

Herein, we have theoretically investigated the sensing performance-including enormous increase in the sensitivity and figure of merit (FOM)-of a magneto-optical surface plasmon resonance (MOSPR) sensor, which is based on the transverse magneto-optical Kerr effect (T-MOKE) in a ferromagnet coupled with a noble-metal grating. Specifically, we propose to use a CoFeB magnetic slab covered by a subwavelength, periodic gold grating configured as a magnetoplasmonic heterostructure. In such a device, sharp, Fano-like T-MOKE signals of high amplitude can be achieved due to the surface plasmon resonances (SPRs) excited in the presence of the gold grating, especially after optimizing the grating period. Tiny changes in the refractive index of an analyte surrounding the MOSPR sensor can be measured by analyzing the shift in the angle of incidence of the resonance positions of the T-MOKE signals. By calculating these resonance positions, we have demonstrated that it is possible to achieve a considerable sensitivity of 105° RIU-1 and a FOM as high as ∼102. Such a MOSPR sensing system can be exploited in biosensors with high detection limits.

Functional characterization of the transcription factors AhR and ARNT in Nilaparvata lugens.

In the present study, the aryl hydrocarbon receptor (AhR) and aryl hydrocarbon receptor nuclear translocator (ARNT) of Nilaparvata lugens were cloned and identified. The NlAhR and NlARNT expression levels significantly increased after imidacloprid, etofenprox and isoprocarb treatments. Knockdowns of NlAhR and NlARNT increased the susceptibility of N. lugens to imidacloprid, etofenprox and isoprocarb, and the detoxification enzyme activities were also significantly decreased. In addition, NlCYP301A1, NlGSTt1 and NlCarE7 were significantly down-regulated after injections of dsNlAhR and dsNlARNT, with the NlCarE7 expression decreasing by greater than 80%. Moreover, after knocking down NlCarE7, the susceptibility of N. lugens to etofenprox and isoprocarb significantly increased. Both NlAhR and NlARNT bound the NlCarE7 promoter and significantly enhanced the transcriptional activity. Our research revealed the functional roles of transcription factors NlAhR and NlARNT in the detoxification metabolism of N. lugens. The results provide a theoretical basis for the pest management and comprehensive control of N. lugens and increase our knowledge of insect toxicology.

Recent advances in the detection of respiratory virus infection in humans.

Respiratory tract viral infection caused by viruses or bacteria is one of the most common diseases in human worldwide, while those caused by emerging viruses, such as the novel coronavirus, 2019-nCoV that caused the pneumonia outbreak in Wuhan, China most recently, have posed great threats to global public health. Identification of the causative viral pathogens of respiratory tract viral infections is important to select an appropriate treatment, save people's lives, stop the epidemics, and avoid unnecessary use of antibiotics. Conventional diagnostic tests, such as the assays for rapid detection of antiviral antibodies or viral antigens, are widely used in many clinical laboratories. With the development of modern technologies, new diagnostic strategies, including multiplex nucleic acid amplification and microarray-based assays, are emerging. This review summarizes currently available and novel emerging diagnostic methods for the detection of common respiratory viruses, such as influenza virus, human respiratory syncytial virus, coronavirus, human adenovirus, and human rhinovirus. Multiplex assays for simultaneous detection of multiple respiratory viruses are also described. It is anticipated that such data will assist researchers and clinicians to develop appropriate diagnostic strategies for timely and effective detection of respiratory virus infections.

Interleukin-6 promotes proliferative vitreoretinopathy by inducing epithelial-mesenchymal transition via the JAK1/STAT3 signaling pathway.

Purpose: Interleukin-6 (IL-6) is elevated in intraocular fluid from eyes with proliferative vitreoretinopathy (PVR), but the exact role of the cytokine is still unclear. We investigated the function and mechanism of IL-6 in retinal pigment epithelium (RPE) cell biology in vitro and in a mouse model in vivo. Methods: After treatment with various concentrations of IL-6, RPE cell proliferation was assessed with cell counting kit-8 (CCK-8) assay, and epithelial-mesenchymal transition (EMT) markers were evaluated using western blotting and immunofluorescent staining. The activation of JAK1/STAT3 signaling was determined with western blotting. Moreover, the effects of blockade of IL-6/JAK1/STAT3 signaling were investigated using pharmacological inhibitor S3I-201. For in vivo studies, the PVR model was induced with intravitreal injection of dispase/collagenase in wild-type and IL-6 knockout mice. The severity of PVR was evaluated with histological analysis. The expression of IL-6, gp130, and EMT markers was assessed with quantitative real-time PCR and western blotting. Results: IL-6 statistically significantly induced RPE cell proliferation and EMT in a dose-dependent manner in vitro, which was accompanied by rapid phosphorylation of JAK1 and STAT3. Blockade of the IL-6/JAK1/STAT3 pathway with S3I-201 apparently inhibited RPE proliferation and EMT. Furthermore, IL-6 and gp130 overexpression, and JAK1/STAT3 signaling hyperactivation were detected in the retinas of the wild-type mice at 1, 3, and 7 days after dispase/collagenase injection. Finally, we confirmed that IL-6 deficiency markedly alleviated mouse PVR development via inhibiting EMT. Conclusions: These findings indicate that IL-6 promotes PVR by inducing RPE proliferation and EMT via the JAK1/STAT3 signaling pathway. We provided new evidence that therapeutic strategies to block IL-6 may be beneficial for PVR.

Exfoliated Graphite Nanosheets Coating on Nano-grained SnO2/Li4Ti5O12 as a High-Performance Anode Material for Lithium-Ion Batteries.

The SnO2/Li4Ti5O12/C compound was gained via hydrothermal, sintering, and ball milling methods. Nano-grained SnO2/Li4Ti5O12 are homogeneously wrapped in a sheet-like graphite. Li4Ti5O12 possesses cyclic stability and superior rate capacity. Meanwhile, the SnO2/Li4Ti5O12 hybrid can supply abundant active sites for absorption of Li+, mitigate chemical stress in cycling, and prevent the ultrathin graphite nanosheets from stacking. Besides, the sheet-like graphite could reduce volume variation in cycling and reduce transmission distance for the electron or Li+. Therefore, an outstanding electrochemical property of the SnO2/Li4Ti5O12/C composite can be obtained.

Sevoflurane modulates breast cancer cell survival via modulation of intracellular calcium homeostasis.

BACKGROUND: Some retrospective and in vitro studies suggest that general anesthetics influence breast cancer recurrence and metastasis. We compared the effects of general anesthetics sevoflurane versus propofol on breast cancer cell survival, proliferation and invasion in vitro. The investigation focused on effects in intracellular Ca2+ homeostasis as a mechanism for general anesthetic-mediated effects on breast cancer cell survival and metastasis. METHODS: Estrogen receptor-positive (MCF7) and estrogen receptor-negative (MDA-MB-436) human breast cancer cell lines along with normal breast tissue (MCF10A) were used. Cells were exposed to sevoflurane or propofol at clinically relevant and extreme doses and durations for dose- and time-dependence studies. Cell survival, proliferation and migration following anesthetic exposure were assessed. Intracellular and extracellular Ca2+ concentrations were modulated using Ca2+ chelation and a TRPV1 Ca2+ channel antagonist to examine the role of Ca2+ in mediating anesthetic effects. RESULTS: Sevoflurane affected breast cancer cell survival in dose-, time- and cell type-dependent manners. Sevoflurane, but not propofol, at equipotent and clinically relevant doses (2% vs. 2 µM) for 6 h significantly promoted breast cell survival in all three types of cells. Paradoxically, extreme exposure to sevoflurane (4%, 24 h) decreased survival in all three cell lines. Chelation of cytosolic Ca2+ dramatically decreased cell survival in both breast cancer lines but not control cells. Inhibition of TRPV1 receptors significantly reduced cell survival in all cell types, an effect that was partially reversed by equipotent sevoflurane but not propofol. Six-hour exposure to sevoflurane or propofol did not affect cell proliferation, metastasis or TRPV1 protein expression in any type of cell. CONCLUSION: Sevoflurane, but not propofol, at clinically relevant concentrations and durations, increased survival of breast cancer cells in vitro but had no effect on cell proliferation, migration or TRPV1 expression. Breast cancer cells require higher cytoplasmic Ca2+ levels for survival than normal breast tissue. Sevoflurane affects breast cancer cell survival via modulation of intracellular Ca2+ homeostasis.

Short message service (SMS) can enhance compliance and reduce cancellations in a sedation gastrointestinal endoscopy center: a prospective randomized controlled trial.

Many outpatients who inadequately prepared for the procedure were cancelled on the day of the examination for various reasons. The aim of study was to investigate whether short message service (SMS) can improve patients' compliance and reduce cancellation rates. Outpatients scheduled for sedation gastrointestinal endoscopy were randomly assigned to mobile phone SMS group or control group. Patients in the control group received a leaflet on preparation instructions, while patients in the SMS group received SMS reminders after making an appointment. A total of 1786 patients were analyzed. There was a significant reduction in the rate of cancellations for patients in the SMS group (4.8%) compared with patients in the control group (8.0%) (P<0.001). Patients in the SMS group were 40% less likely to be cancelled by medical staff than patients in the control group. The compliance score of the two groups based on demographic and clinic characteristic distribution showed that for both male and female patients, the compliance score was higher in the SMS group than that in the control group (P=0.023, P<0.001, respectively). Additionally, the compliance score was also significantly higher in the SMS group among patients who were under 50 years old, less than an undergraduate education level, experiencing their first time for procedure, or whose procedures were gastroscopy, waiting time was between 4 and 15 days, and schedules were in morning (P≤0.032). SMS reminders can be considered a complement to conventional preparation instructions, which could help improve the compliance of outpatients and reduce the rate of cancellations.

Clinical comparison of propofol-remifentanil TCI with sevoflurane induction/maintenance anesthesia in laparoscopic cholecystectomy.

UNLABELLED: Objective : We aimed to compare the anesthetic characteristics between total intravenous anesthesia (TIVA) using propofol-remifentanil with target control infusion (TCI) and volatile induction and maintenance anesthesia (VIMA) using sevoflurane and sufentanyl for patients undergoing laparoscopic cholecystectomy. METHODS: A total of 120 patients undergoing laparoscopic cholecystectomy were randomly assigned to two groups. Patients in group T received TCI of propofol-remifentanil for induction and maintenance. Patients in group S received sevoflurane-sufentanyl for induction and maintenance. RESULTS: Patients in group S had a significantly faster induction time than patients in group T (109s vs.44s). The emergence time in terms of time to extubation was comparable between the two groups, while the time to eyes opening (419s vs.483s, p=0.006) and duration in PACU were longer in group S (44 min vs.53 min, p=0.017). Ten (17.2%) patients in group S were administered an antihypertensive drug when gallbladder issues were present, while only 1(1.7%) patient needed this drug in group T (p=0.004).More patients in group T than in group S received fentanyl for analgesia in PACU (88%vs.70%, p=0.013). The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in group S than in group T (20% vs.38%, p=0.027). CONCLUSION: Both techniques had advantages and disadvantages in laparoscopic cholecystectomy; none of the techniques studied was superior.

Polycyclic aromatic hydrocarbons in coastal rivers in Jiangsu Province, China: Spatial distribution, source apportionment and human impacts.

The ocean is the ultimate sink for all pollutants, rivers are important channels for land-based pollutants to enter the oceans. Riverine transport of polycyclic aromatic hydrocarbons (PAHs) to coastal seas in China poses environmental threats. This study examined the spatial and temporal distribution of PAHs in coastal rivers in Yancheng City in Jiangsu Province of China, with the aim of identifying their likely sources, concentrations, and influencing factors. Surface sediments were taken from the Xinyanggang River (XYR) and the Sheyang River (SYR). The concentrations of Æ©16PAHs in river sediments were measured on average 477.05 ng/g dry weight (dw), with values varying from 2.18 to 6351.42 ng/g, indicating a moderate pollution level, with a dominance of high molecular weight (HMW) PAHs. The XYR exhibited significantly higher PAHs concentrations compared to the SYR. The key sources of PAHs were vehicle emissions (47.87%), coal and natural gas combustion (35.07%). Geographically weighted regression and redundancy analysis linked PAHs pollution to distinct land use patterns and socioeconomic indicators, highlighting urban land as the major contributor, driven by high urbanization and industrialization (70.91%). In XYR, industrial activities and transport emissions were major contributors, while in SYR, agricultural activities predominantly influenced PAHs pollution. Urgent mitigation strategies are needed to reduce PAHs pollution in river sediments, mitigating ecological and human risks associated with these contaminants.

The association between three prevalent autoimmune disorders and the likelihood of developing prostate cancer: a Mendelian randomization study.

Numerous studies establish a significant correlation between autoimmune disorders (AIDs) and prostate cancer (PCa). Our Mendelian randomization (MR) analysis investigates the potential connection between rheumatoid arthritis (RA) and PCa, aiming to confirm causal links between systemic lupus erythematosus (SLE), hyperthyroidism, and PCa. Summary statistics from genome-wide association studies provided data on PCa and three AIDs. MR analysis, using IVW as the main approach, assessed causal relationships, validated by sensitivity analysis. IVW revealed a correlation between genetically anticipated RA and PCa, notably in Europeans (OR = 1.03; 95% CI 1.01-1.04, p = 2*10-5). Evidence supported a lower PCa risk in individuals with SLE (OR = 0.94; 95% CI 0.91-0.97, p = 2*10-4) and hyperthyroidism (OR = 0.02; 95% CI 0.001-0.2, p = 2*10-3). Weighted mode and median confirmed these findings. No pleiotropic effects were observed, and MR heterogeneity tests indicated dataset homogeneity. Our study establishes a causal link between RA, SLE, hyperthyroidism, and PCa.

Development and validation of nomograms to predict survival of neuroendocrine carcinoma in genitourinary system: A population-based retrospective study.

Neuroendocrine carcinoma (NEC) is a rare yet potentially perilous neoplasm. The objective of this study was to develop prognostic models for the survival of NEC patients in the genitourinary system and subsequently validate these models. A total of 7125 neuroendocrine neoplasm (NEN) patients were extracted. Comparison of survival in patients with different types of NEN before and after propensity score-matching (PSM). A total of 3057 patients with NEC, whose information was complete, were extracted. The NEC influencing factors were chosen through the utilization of the least absolute shrinkage and selection operator regression model (LASSO) and the Fine & Gary model (FGM). Furthermore, nomograms were built. To validate the accuracy of the prediction, the efficiency was verified using bootstrap self-sampling techniques and receiver operating characteristic curves. LASSO and FGM were utilized to construct three models. Confirmation of validation was achieved by conducting analyses of the area under the curve and decision curve. Moreover, the FGS (DSS analysis using FGM) model produced higher net benefits. To maximize the advantages for patients, the FGS model disregarded the influence of additional occurrences. Patients are expected to experience advantages in terms of treatment options and survival assessment through the utilization of these models.

Renal pelvis metastasis following surgery for breast angiosarcoma: a case report and literature review.

Renal metastasis of breast angiosarcoma is rare. This article reports the medical records of a patient diagnosed with breast angiosarcoma who underwent radical mastectomy and was found to have multiple lung metastases 3 years after surgery and renal pelvic metastasis 4 years after surgery. The patient underwent robot-assisted laparoscopic radical nephroureterectomy and sleeve resection of the intramural segment of the ureter, and postoperative pathology and immunohistochemical staining confirmed the diagnosis of renal pelvic metastasis of breast angiosarcoma. The patient received anlotinib for lung metastases following surgery and was followed up for 4 months after surgery. Currently, the patient has symptoms of coughing and hemoptysis but no other discomfort. The diagnosis and treatment of this rare malignant tumor remain challenging.

A Case of Asymptomatic Tracheoesophageal Fistula.

The tracheoesophageal fistula (TEF) is an abnormal flow between the esophagus and the trachea. Most patients with TEF experience severe symptoms. Asymptomatic TEF is rare. In this case report, a 47-year-old woman planned to undergo orthopedic surgery under general anesthesia. She had no symptoms related to TEF, and the preoperative chest computed tomography was also normal. However, there was significant airway resistance after induction. Using a fiber bronchoscope, a TEF was discovered. The TEF found after anesthesia due to high airway pressure is unusual, and the outcome and treatment of these patients need to be further discussed.