中南大学学报(医学版)最新文献

Ultraviolet (UV) radiation, one of the critical environmental carcinogenic factors, promotes skin photoaging and carcinogenesis by inducing DNA damage, oxidative stress, and chronic inflammatory cascades. N6-methyladenosine (m6A)-modifying enzymes (writers, erasers, and readers) play bidirectional regulatory roles in UV-mediated skin pathology. In photoaging, the reactive oxygen species (ROS)-m6A axis accelerates collagen degradation and epithelial-mesenchymal transition (EMT) through modulation of matrix metalloproteinases (MMPs), inflammatory mediators, DNA damage repair, apoptosis, and collagen metabolism. In skin cancers, m6A regulators promote tumor progression by influencing oncogenic signaling, proliferation, invasion, metastasis, and immune evasion. Bioactive monomeric compounds derived from traditional Chinese medicine, including polyphenols, saponins, and alkaloids, can regulate the activity of m6A enzymes to interfere with photoaging and UV-induced skin carcinogenesis. This study integrates current evidence to establish an m6A-targeted epigenetic intervention framework for UV-induced skin injury and highlights the potential of synergistic multi-component m6A-modulating therapeutic strategies as a future research priority.

Immune checkpoint inhibitors (ICIs) play a significant role in tumor treatment, but the immune-related adverse events (irAEs), which brings about have also attracted much attention. Among them, toxic epidermal necrolysis (TEN) is one of the most severe skin toxic reactions. This article reports a case of a bladder cancer patient who developed TEN after receiving ICIs treatment. The male patient was diagnosed with bladder cancer in November 2023. On April 29, 2024, he was admitted to the Third Hospital of Changsha for antitumor treatment. In May 2024, he developed immune-related myocarditis after treatment with toripalimab. On July 6, 2024, the patient switched to envafolimab treatment, and on July 16, he developed rashes and eventually progressed to TEN. After treatment with glucocorticoids and related symptomatic measures, the patient improved. TEN is a rare but serious irAE in ICIs treatment. Suspected patients should be intervened early, and patients who have already developed it should be actively treated, in order to enhance the understanding and management of TEN caused by ICIs treatment.

Objectives: The global prevalence of type 2 diabetes mellitus (T2DM) continues to rise, and cognitive impairment caused by T2DM is particularly common among elderly patients. This study aims to explore the influencing factors of cognitive function decline in elderly patients with T2DM, so as to provide references for the prevention of cognitive impairment in elderly patients with T2DM.

Methods: A total of 376 patients aged over 60 years with T2DM without cognitive impairment who visited the Department of Geriatrics and Endocrinology of Third Xiangya Hospital for the first time from June 2019 to December 2020 were selected. General information, lifestyle behaviors, laboratory-related indicators, activities of daily living, and depression scores were collected. One year after discharge, cognitive function was reassessed. According to the reassessment scores, patients were divided into a cognitive function maintenance group and a cognitive function decline group. Logistic regression analysis was used to explore the risk factors for cognitive function decline in elderly patients with T2DM.

Results: The incidence of cognitive function decline in elderly patients with T2DM at 1 year was 13.3%. Univariate analysis revealed that there were statistically significant differences between the cognitive function decline group and the cognitive function maintenance group in age, educational level, marital status, smoking history, amount of physical exercise, housework performance, Instrumental Activities of Daily Living (IADL) score, and 2 hours postprandial glucose (2hPG) (P<0.05). Multivariate logistic regression analysis showed that age (OR=2.795, 95% CI 1.785 to 4.375, P<0.001), 2hPG (OR=1.232, 95% CI 1.087 to 1.397, P=0.001), housework performance (OR=2.438, 95% CI 1.017 to 5.844, P=0.046), and physical exercise time ≥1 hour/day (OR=0.107, 95% CI 0.012 to 0.916, P=0.041) were independent influencing factors for cognitive function decline in patients with T2DM.

Conclusions: Advanced age, high 2hPG, less housework, and physical exercise time <1 hour/day are risk factors for cognitive function decline in patients with T2DM. Reasonable control of postprandial blood glucose and increasing physical activity and housework time may help delay cognitive function decline in patients with T2DM.

Objectives: Kallmann syndrome (KS) is a rare inherited disorder characterized by congenital hypogonadotropic hypogonadism and reduced or absent olfactory function. In addition to gonadal dysgenesis and structural abnormalities, KS patients may present with extensive psychosocial dysfunction and behavioral changes. This study aims to evaluate the effects of self-stigma, impulsivity, and insomnia on anxiety and depression in KS patients and to explore the interrelationships among these factors.

Methods: A total of 206 patients with confirmed KS were recruited from the Xiangya Hospital and Henan Provincial People's Hospital. Multivariable Logistic regression analysis was used to identify independent factors associated with anxiety and depression, and a serial multiple-mediator model was applied to characterize pathway effects.

Results: The cohort of KS patients demonstrated substantial psychological and social burden, including self-stigma, impulsivity, insomnia, loneliness, anxiety, depression, and overall social isolation tendencies. Logistic regression analysis indicated that self-stigma (OR=1.112, P=0.003), loneliness (OR=1.198, P=0.007), and insomnia (OR=1.098, P=0.017) were independent factors the presence of anxiety and depression in KS patients. Mediation-effect modeling further showed that impulsivity and insomnia significantly mediated the effect of self-stigma on anxiety and depression in KS (indirect effect 3=0.013, P=0.008; 95% CI 0.004 to 0.024; c'=0.147, P<0.001; 95% CI 0.091 to 0.201).

Conclusions: This study preliminarily identified the major modifiable factors associated with anxiety and depression in KS patients, including self-stigma, loneliness, and insomnia. Impulsivity and insomnia demonstrated significant serial mediation effects linking self-stigma to affective outcomes. Multidimensional intervention strategies targeting stigma reduction, impulsivity regulation, and sleep-quality improvement may help alleviate anxiety-depression symptoms and ultimately improve overall quality of life in patients with KS.

Dieulafoy's disease is a rare condition that can cause acute, life-threatening massive gastrointestinal bleeding and is prone to misdiagnosis and missed diagnosis. From May 2023 to April 2024, 3 patients with Dieulafoy's disease within diverticula of the descending duodenum complicated by upper gastrointestinal bleeding were admitted to the Affiliated Hospital of Zunyi Medical University and Dafang County People's Hospital. Their clinical data and diagnostic and therapeutic processes are reported to enhance awareness of this disease. All patients presented with massive gastrointestinal bleeding, manifested as recurrent hematemesis and hematochezia with large-volume bleeding, and were diagnosed by emergency gastroscopy as having Dieulafoy's disease within diverticula of the descending duodenum. After medical therapy, the outcomes were unsatisfactory in all 3 cases. Endoscopic examination revealed active bleeding located in the descending duodenum; using a side-viewing duodenoscope, the lesions were observed to be within the diverticula of the descending duodenum. Hemostasis was successfully achieved in all cases by endoscopic hemoclip placement. Dieulafoy's disease within diverticula of the descending duodenum complicated by gastrointestinal bleeding is relatively rare in clinical practice. For gastrointestinal bleeding of unclear etiology, endoscopic examination should maintain a high index of suspicion for the descending duodenum, and duodenoscopy should be used when necessary. Particular attention should be paid to rare bleeding causes occurring within diverticula to avoid missed or incorrect diagnoses that could delay treatment.

Objectives: The prevalence and complexity of high-fall injuries pose major challenges to injury-mechanism interpretation, which currently relies largely on forensic autopsy. The finite element method (FEM) can elucidate biomechanical mechanisms of skeletal injury and quantify the relationship between fracture risk and fall height, providing evidence for forensic injury analysis and scene reconstruction.

Methods: Using adult upright feet-first landing as a representative scenario, a finite element approach based on the total human model for safety (THUMS) was applied to simulate bilateral feet-first impacts onto a rigid surface from heights of 1 to 50 m. Skeletal biomechanical responses were systematically evaluated using von Mises stress analysis, Logistic regression modeling, and hierarchical clustering.

Results: Stress concentration followed a longitudinal axial distribution along the body's vertical axis, with a dual-path load-transmission mechanism identified. Step-change biomechanical responses were observed at the foot, tibial ends, femoral neck, and spine, indicating abrupt increases in fracture risk at critical heights. Logistic regression successfully generated fracture-risk prediction models for fibular ends, pelvis, and skull. The fastest height-dependent fracture-risk escalation occurred at the fibular ends, followed by the skull, whereas the pelvis showed the slowest but still significant risk increase. Hierarchical clustering combined with biomechanical-mechanism interpretation stratified fall heights into 5 clusters and 3 injury phases: Local energy-dissipation phase (<7 meters), axial conduction stage (7 to 16 meters), and systemic composite injury phase (>16 meters).

Conclusions: FEM reveals the dual-path load-transmission mechanism of skeletal injury in upright feet-first landing. The established fracture-risk-height prediction models and injury-pattern-to-height mapping models provide biomechanical evidence for forensic inference of fall height.