American journal of translational research最新文献

Objective: To investigate whether adding ropivacaine local infiltration (RLI) to standard analgesia can improve functional recovery outcomes and safety in elderly patients undergoing total knee arthroplasty (TKA).

Methods: This retrospective study included 227 elderly patients who underwent unilateral TKA under spinal anesthesia between January 2023 and January 2025. According to different analgesic regimens, patients were divided into two groups: the conventional multimodal analgesia (CMA) group (n=105) and the RLI group (n=122). The cumulative use of morphine within 48 hours after surgery, visual analog scale (VAS) pain levels during activity, range of motion (ROM) of the knee joint, 6-minute walking distance, functional independence measurement (FIM) score, and incidence of adverse events were compared between the two groups.

Results: At 24 and 48 hours postoperatively, cumulative morphine use was significantly lower in the RLI group compared with the CMA groups (all P<0.05). Activity-related VAS pain scores were significantly lower in the RLI group at all evaluation time points (all P<0.05). In addition, the RLI group demonstrated greater knee ROM (48-hours: 95.84 vs. 92.16, P<0.001), longer six-minute walk distances (48-hours: 213.29 vs. 204.85, P=0.007), and higher FIM motor scores (57.05 vs. 54.49, P=0.008), compared with the CMA group. Patients in the RLI group had a lower incidence of itching and a relatively shorter hospital stay.

Conclusion: In elderly patients undergoing TKA, local infiltration analgesia (LIA) can alleviate early postoperative pain, reduce the use of opioid drugs, and promote faster functional recovery.

The purpose of this study was to explore the clinical, pathological, and immunohistochemical features of spiradenoma. The clinical and pathological data of seven patients were analyzed. The analysis revealed that the median age of onset was 34 years, with three patients presenting lesions on the extremities. Clinically, the lesions were mostly skin-colored or red subcutaneous nodules or masses, some of which were tender. Histopathological features included well-demarcated tumor masses composed of two types of cells: small cells with round, deeply stained nuclei and larger cells with lightly stained nuclei, accompanied by ductal differentiation and focal adenoid cystic structures. Lymphomonocytic infiltration was observed in the stroma. Immunohistochemical staining revealed positive expression of cytokeratin (CK) and cluster of differentiation 117 (CD117) in luminal cells and tumor protein p63 (p63) and smooth muscle actin (SMA) in outer myoepithelial cells. SRY-related HMG-box 10 (Sox10) expression was typically diffuse positive. Spiradenoma is a sweat gland tumor for which clinical specificity is lacking, but these nodules have distinct histopathological features. In most cases, a definitive diagnosis can be made with the aid of immunohistochemistry.

Objective: To investigate the effect of post-left atrial appendage (LAA) occlusion anticoagulation strategy adjustments on cognitive function in atrial fibrillation (AF) patients, showing the influence of these adjustments on long-term brain health.

Methods: In this retrospective cohort study, a total of 210 patients with AF subjected to left atrial appendage (LAA) closure between January 2022 and January 2025 were included. Among them, 103 patients received anticoagulation treatment following the procedure (observation group) and 107 did not (control group). The primary outcome - cognitive function - was evaluated using the Mini-Mental State Examination (MMSE) scale and other cognitive tests. The secondary outcomes, including major adverse events (stroke [ischemic, hemorrhagic], transient ischemic attack, major bleeding, and venous thrombotic event), blood biochemical values (fasting blood glucose [FBG], low-density lipoprotein [LDL], high-density lipoprotein (HDL), triglycerides (TG), prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen, and D-Dimer), and quality-of-life scores (Physical, Mental Health, and Social Functioning) were also recorded and compared between groups.

Results: Post-procedure anticoagulation therapy significantly improved both cognitive function and clinical outcomes in AF patients undergoing LAA occlusion. The observation group demonstrated significantly better performances in the MMSE, attention, working memory, and visual-spatial abilities (all P<0.001). The FBG and LDL levels (both P<0.001) were significantly lower in the observation group compared to the control group, as was the incidence of ischemic stroke (1.9 vs. 5.6%) (P = 0.032). Quality of life scores, including physical, mental, and social functioning, were all significantly better in the observation group (P<0.001). Anticoagulation effects were evident, with significantly prolonged PT and aPTT in the observation group (P<0.001). Logistic regression analysis identified anticoagulation therapy as a significant predictor of reduced cognitive impairment (OR = 0.940, 95% CI: 0.910-0.972, P<0.001), indicating its potential benefit in preserving cognitive function after LAA occlusion.

Conclusion: Post-procedural anticoagulation therapy significantly improves cognitive function, reduces ischemic stroke incidence, and enhances quality of life in AF patients following LAA occlusion, highlighting its clinical value in management.

Purpose: To develop and validate a radiomics model that uses multiple magnetic resonance imaging (MRI) sequences to accurately distinguish hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH), thereby improving diagnostic precision and decision-making.

Methods: We conducted a retrospective analysis including 196 patients (97 in HCC and 99 in FNH) diagnosed at the Zhangzhou Affiliated Hospital of Fujian Medical University (August 2011-December 2021). Radiomics features were extracted from the MRI images. LASSO logistic regression models were constructed for feature selection and to differentiate HCC from FNH. The model was further validated using a temporally independent cohort of 91 patients (49 HCC, 42 FNH) from the same institution (January 2022-December 2023). The area under the curve (AUC), accuracy, sensitivity, and specificity were used to evaluate the model's performance.

Results: We obtained 34 features for T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast enhanced imaging (CEI). The radiomics model demonstrated high diagnostic performance, with AUCs of 0.992 and 0.958 in the training and internal validation, respectively. In the independent external validation set, the model maintained strong performance with an AUC of 0.903, sensitivity of 88.9%, and specificity of 87.2%. In the training and internal validation, the model also showed high accuracy (0.956 and 0.867, respectively) and sensitivity (0.957 and 0.900, respectively). The integrated T2WI + DWI + CEI (TDC)-clinical data model demonstrated higher diagnostic accuracy than the TDC-only model.

Conclusion: The developed multimodal MRI radiomics model effectively differentiated HCC from FNH and offers a non-invasive diagnostic tool that surpasses traditional imaging techniques. Further research is warranted to confirm these findings and explore the model's applications in broader clinical settings.

Objectives: To investigate the impact of the timing of invasive mechanical ventilation (IMV) on 28-day clinical outcomes in patients with severe pneumonia (SP) complicated by gastrointestinal dysfunction.

Methods: This retrospective study enrolled 104 patients with SP and gastrointestinal dysfunction who received IMV. Based on the time from meeting IMV criteria to its initiation, patients were divided into an Early Group (≤6 hours, n = 52) and a Delayed Group (>6 hours, n = 52). Clinical efficacy, scores [Clinical Pulmonary Infection Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), Gastrointestinal Dysfunction Score (GIDS)], inflammatory markers [C-reactive protein (CRP), Tumor necrosis factor-α (TNF-α), Procalcitonin (PCT)], blood gas parameters [Oxygenation index (PaO₂/FiO₂) and Arterial partial pressure of oxygen (PaO₂)], gastrointestinal function, and prognosis were compared.

Results: The total effective rate was significantly higher in the Early Group (86.54%) than that in the Delayed Group (76.92%) (P<0.05). Intergroup comparisons at 48 and 72 hours post-IMV revealed that the Early Group demonstrated superior improvement in APACHE II scores, GIDS, blood gas parameters, inflammatory markers, and gastrointestinal markers [Gastrin (GAS), Diamine oxidase (DAO)] (all P<0.05). Furthermore, the Early Group had a higher 28-day survival probability, shorter ICU stay and ventilation duration, and a significantly lower overall incidence of adverse reactions (19.23% vs. 53.84%) (P<0.05).

Conclusions: For patients with SP and gastrointestinal dysfunction, early IMV initiation within 6 hours is more effective in mitigating systemic inflammation, improving blood gas exchange and gastrointestinal function, optimizing infection control, reducing adverse events, and ultimately improving clinical prognosis.

Objective: To examine difference in the low-density lipoprotein cholesterol/lymphocyte (LDL-C/LYM) ratio between the acute exacerbation and stable phases of chronic obstructive pulmonary disease (COPD) and assess its diagnostic and prognostic value.

Methods: A total of 196 hospitalized COPD patients were retrospectively analyzed, including 96 in the acute exacerbation phase and 100 in the stable phase. Demographics, inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6), white blood cell count (WBC), monocyte percentage (MO%)], pulmonary function indices [percentage of predicted forced expiratory volume in one second (FEV₁% pred), FEV₁/forced vital capacity (FVC), peak expiratory flow (PEF)], and LDL-C/LYM ratios were collected. Intergroup comparisons, correlation analyses, and receiver operating characteristic (ROC) curve analysis were performed.

Results: LDL-C/LYM ratio was significantly higher during acute exacerbation (P < 0.001), positively correlated with CRP, IL-6, WBC, and MO% (r = 0.404-0.606), and negatively with FEV₁% pred, FEV₁/FVC, and PEF (r = -0.310 to -0.402) (all P < 0.001). No significant correlation between LDL-C/LYM ratio and pulmonary function indices were found in the stable group. ROC analysis showed that the LDL-C/LYM ratio had the highest diagnostic accuracy for acute exacerbation [area under the curve (AUC) = 0.828], outperforming other markers, and it correlated positively with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging (r = 0.419, P < 0.001).

Conclusion: The LDL-C/LYM ratio is elevated during COPD exacerbations and reflects inflammation and lung function decline, serving as a simple biomarker for diagnosis and prognosis.

Objective: To construct a microscopic inferior epigastric vein-internal spermatic vein model based on testis-related indexes in infertile men with asthenospermia for predictingtreatment efficacy.

Methods: A total of 264 male infertile patients with oligoasthenospermia and varicocele combined with nutcracker syndrome who received treatment of the inferior epigastric-internal spermatic vein under the microscope were collected and retrospectively analyzed. They were divided into a training set (n = 185) and a verification set (n = 79). Demographic characteristics of the patients and testicular-related indicators were collected. Univariate and multivariate analyses were used to screen for risk factors affecting the surgical effect, and a predictive model was constructed. The nomogram was drawn and its clinical application value was evaluated.

Results: Multivariate logistic regression analysis showed that testicular volume, sperm motility, testicular artery blood flow velocity, testosterone level, the degree of varicocele, and the severity of nutcracker syndrome were independent risk factors for the surgical outcome. The constructed predictive model performed well in the training set and the verification set, with the C-index being 0.849 and 0.847, respectively. Decision curve analysis showed that the model had clinical application value within a certain threshold probability range. The prognostic model displayed strong discrimination performance, as evidenced by external validation.

Conclusion: The predictive model and nomogram constructed based on testis-related indicators are valuable for evaluating the therapeutic effect of inferior epigastric-internal spermatic vein surgery under the microscope, and also helpful for clinicians to predict the surgical effect and formulate an individualized treatment plan.

Objective: To evaluate the diagnostic use of integrating multi-parameter flow cytometry (FCM), histopathology, and gene mutation analysis for lymphoma classification using intact lymph node (LN) samples.

Methods: Intact LN samples from 109 patients with lymphadenopathy were retrospectively analyzed by pathology, multi-color FCM, and next-generation sequencing (NGS) targeting 62 lymphoma-related genes.

Results: FCM immunophenotyping showed high concordance with pathology (56/56 lymphoma cases detected by FCM were pathologically confirmed). PD-1 on T cells was significantly elevated in B-cell lymphoma (BCL), especially diffuse large BCL (DLBCL) (P<0.05). All BCLs exhibited monotypic intracellular cKappa or cLambda expression. Significant differences in cell size (FSC) were observed: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) (mean FSC: 89.42±6.01) and Follicular Lymphoma cells (FL; 93.88±4.94) were smaller than normal B-cells (102.09±11.58), while DLBCL cells (121.84±9.17) were larger (all P<0.05). Subtypes showed distinct mutation profiles, including IGHV (9/11) in CLL/SLL; BCL2 (5/7) and EZH2 (4/7) in FL; and BCL6 (5/13) in DLBCL. Mutation-guided FCM confirmed BCL2 protein expression in two FL cases and BCL6 in one DLBCL case. T/NK-cell lymphomas showed aberrant antigen expression and restricted TRBC1 clonality (1.17%±1.61% or >96.4%) outside the normal polyclonal range (36.60%±7.21%).

Conclusion: FCM on intact LNs is a robust tool with high pathologic concordance. Integrating genetic mutation data with FCM provides a powerful, multi-parameter strategy. This approach moves beyond standard immunophenotyping to include mutation-associated antigens, thereby refining lymphoma classification and enhancing diagnostic accuracy.

Background: Bu-Yi-Xin-Shen formula (BYXSF) is used for the treatment of post-percutaneous coronary intervention (PCI) angina. This study combined bioinformatics and experimental verification to investigate its mechanism of action.

Methods: We retrieved relevant target data from public databases to determine candidate therapeutic targets of BYXSF in post-PCI angina. Key targets were then determined using protein-protein interaction (PPI) network and functional enrichment assays. Molecular docking was used to identify core active ingredients, while toxicity evaluation helped assess their safety profiles. After that, single-cell RNA sequencing (scRNA-seq) uncovered critical cell types and the expression patterns of target genes. Finally, in vivo animal experiments provided evidence for the activation of pathways related to these key targets, further validating the proposed mechanism.

Results: Functional enrichment analysis indicated that phosphatidylinositol 3-kinase-AKT (PI3K-Akt) and Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathways were significantly enriched. Combined with the high interaction degree of genes in the PPI network, PIK3R1, PIK3CA, PIK3CB, EGFR, AKT1, and SRC were determined as key targets. Then, five active ingredients (benzoylnapelline, quercetin, liquiritigenin, sexangularetin, and deltoin) with the lowest binding energies (< -8 kcal/mol) were identified by molecular docking. These active ingredients were found to influence toxicity through processes including vascular inflammation and lipid metabolism/atherosclerosis. The scRNA-seq revealed monocytes as the core cell type mediating BYXSF's therapeutic effects, with distinct expression levels of key targets between high- and low-score groups. Finally, in vivo experiments confirmed that BYXSF alleviated post-PCI angina by regulating the PI3K-Akt and NF-κB signaling pathways.

Conclusion: PIK3R1, PIK3CA, PIK3CB, EGFR, AKT1, and SRC were key genes in the PI3K-Akt and NF-κB pathways, and monocytes were major targets of BYXSF in post-PCI angina. Animal experiments validated this mechanism, laying a foundation for the further development of BYXSF as a therapeutic agent.

Objective: To investigate the impact of Neoadjuvant Hormonal Therapy (NHT) on surgical prognosis and survival in patients with high-risk localized prostate cancer.

Methods: A retrospective analysis was conducted on 371 high-risk prostate cancer patients who were treated at Baoji Central Hospital and Norinco General Hospital from January 2017 to January 2020. The patients were randomly divided into a training set of 286 cases (134 in the non-NHT group and 151 in the NHT group) and a validation set of 86 cases (42 in the non-NHT group and 44 in the NHT group). All patients underwent radical prostatectomy combined with pelvic lymph node dissection (RP+PLND). The baseline characteristics of the training and validation sets were collected. Surgical efficacy indicators (positive surgical margin rate, operative time, blood loss, etc.), 5-year overall survival (OS), metastasis-free survival (MFS), and biochemical recurrence-free survival (BRFS) were compared between the non-NHT and NHT groups in the training set. Independent risk factors for mortality were identified through univariate and multivariate analyses.

Results: There were no significant differences in the baseline characteristics between the non-NHT and NHT groups in both the validation and training sets. In the training set, the NHT group demonstrated significantly better outcomes than the non-NHT group in terms of positive surgical margin rate (14.57% vs. 39.55%, P < 0.001), intraoperative blood loss (428.64±45.31 ml vs. 494.98±62.36 ml, P < 0.001), and operative time (143.00 min vs. 148.00 min, P < 0.001). The 5-year OS, MFS, and BRFS rates in the NHT group were 82.12% (124/151), 66.23% (100/151), and 40.02% (71/151), respectively, which were significantly higher than 55.97% (75/134), 44.03% (59/134), and 27.61% (37/134) in the non-NHT group (P < 0.001 for all). Multivariate analysis identified non-NHT treatment (OR = 7.528, P < 0.001), open surgery (OR = 4.581, P < 0.001), high clinical stage, high postoperative Gleason score, and high preoperative Prostate-Specific Antigen (PSA) as independent risk factors for mortality. Robotic-assisted surgery significantly reduced the incidence of long-term complications such as urethral stricture and bladder neck contracture compared with open surgery (P < 0.05 for all).

Conclusion: Preoperative NHT can improve surgical efficacy and long-term survival in patients with high-risk prostate cancer without increasing perioperative risks. Robotic-assisted surgery reduces long-term complications. NHT and preoperative PSA can serve as strong predictive indicators for the Nomogram model, providing references for individualized treatment. Further exploration of the optimal course of NHT and precision stratification guided by molecular markers is needed in the future.