北京大学学报（医学版）最新文献

Objective: To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure, with a focus on identifying the threshold effect, and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients.

Methods: Using a stratified random sampling method, individual reimbursement data of heart failure patients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted. A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect. The annual outpatient service utilization indicators included the annual outpatient visits, annual outpatient expenses, annual outpatient drug expenses, and annual outpatient self-expenses within the policy. Hospitalization rate indicators comprised the annual hospitalization rate, rehospitalization rate within 30 days, and rehospitalization rate within 90 days.

Results: (1) The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate. However, the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant; (2) The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified. When the prior-year annual outpatient visits were less than or equal to the threshold (12 visits), the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant, and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold (12 visits). Correspondingly, the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan, respectively.

Conclusion: There is a threshold effect of prior-year annual outpatient service utilization on the current year' s annual hospitalization rate in heart failure patients. These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitalization rates. Specifically, policymakers should consider the identified thresholds when designing reimbursement policies for heart failure patients, which may help to optimize the use of medical resources and reduce the burden of medical expenses.

Kidney transplantation is widely recognized as the optimal treatment for children with end-stage renal disease (ESRD), offering significant improvements in growth, development, and long-term quality of life compared with prolonged dialysis. However, kidney transplantation in low-age (< 5 years old) and low-weight (< 15 kg) children presents significant clinical challenges due to their delicate vascular structures, limited surgical space, and complex perioperative management. This report presents two cases of kidney transplantation in low-age, low-weight children performed at Peking University People' s Hospital. Case 1: a 2-year-3-month-old boy (8.8 kg), presenting a preoperative serum creatinine of 248 μmol/L post-dialysis and the estimated glomerular filtration rates (eGFR) of 35.17 mL/(min·1.73 m²). Case 2: a 3-year-8-month-old girl (11.25 kg), presenting a preoperative creatinine of 281 μmol/L post-dialysis and the eGFR of 22.63 mL/(min·1.73 m²). Both recipients underwent transplantation via the extraperitoneal approach, with end-to-side anastomosis of the donor renal artery and vein to the recipient' s common iliac artery and vein, respectively. The ureters were anastomosed to the bladder using the tunnel technique, and double-J stents were placed intraoperatively. The surgeries were uneventful, and both patients exhibited rapid recovery of renal function. Postoperatively, serum creatinine levels decreased to 26 μmol/L (Case 1) and 39 μmol/L (Case 2) by the third day, with the eGFR reaching 245.23 mL/(min·1.73 m²) and 164.12 mL/(min·1.73 m²), respectively. No complications, such as vascular thrombosis, ureteral stenosis, or abdominal compartment syndrome were observed during follow-up. A comprehensive literature review was conducted to contextualize these cases within global advancements in pediatric renal transplantation. Current evidence highlights the growing adoption of kidney transplantation for low-age, low-weight children, though debates persist regarding optimal surgical strategies (specifically, the intraperitoneal versus extraperitoneal approaches). This case report underscores the feasibility of the extraperitoneal approach in overcoming anatomical limitations of low-weight pediatric recipients, with distinct advantages including reduced gastrointestinal complications and enhanced accessibility for post-operative ultrasound monitoring. Furthermore, mean arterial pressure (MAP) and central venous pressure (CVP) were systematically monitored intraoperatively to ensure optimal renal blood perfusion and graft viability. Our single-center experience provides valuable insights into surgical strategy selection and perioperative management for this high-risk population. Nevertheless, larger multicenter studies are warranted to validate long-term outcomes and refine standardized protocols.

Objective: To analyze the factors associated with non-radiographic bone erosion in gout patients, to improve the understanding of bone erosion in gout, and to promote the early detection of bone erosion.

Methods: A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022. Bone erosion was detectable by ultrasound but not detected by X-ray as non-radiographic bone erosion; no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion. A case-control study was used, and the two groups were matched 1 ∶ 2 according to age and sex. The differences between the two groups were compared in terms of general information, joint involvement characteristics, laboratory indicators and complications. In the univariate analysis, P < 0.1 was included in the multivariate analysis, and the conditional Logistic regression was used for the multivariate analysis. P < 0.05 was considered to have statistically significant differences.

Results: Among the 41 patients with non-radiographic bone erosion, the top three joints with bone erosion before its occurrence were metatarsophalangeal joint (12 cases), ankle (10 cases), and knee (7 cases). There were 82 patients undetected with bone erosion. There were no significant differences in general information between the two groups (P>0.05), including age, gender, body mass index, and alcohol consumption history. The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected, and the former had more affected joints (P=0.02), and a higher proportion of patients with at least 3 attacks of gout per year (P < 0.001). There were no significant differences in serum uric acid, fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, creatinine, homocysteine, white blood cell count, and urine pH between the two groups (P>0.05). The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout, with an OR (95%CI) of 5.139 (1.529-17.271).

Conclusion: At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion, and these patients should be given more attention to achieving treatment targets.

Objective: To evaluate the safety and oncological outcomes of robot-assisted laparoscopic inferior vena cava (IVC) segmental resection in renal tumor with IVC tumor thrombus (IVCTT).

Methods: Clinical data from renal tumor patients undergoing robot-assisted laparoscopic IVC segmental resection at Peking University Third Hospital from Jan. 2021 to Feb. 2025 were retrospectively analyzed. Data collection included baseline demographics, tumor characteristics, perioperative parameters, and follow-up outcomes. Surgical records and pathological reports were retrieved from the electronic medical record system. Continuous variables were presented as median (P₂₅, P₇₅), and categorical variables as frequency (percentage).

Results: Forty-four patients were enrolled. The cohort comprised 31 males and 13 females, with a median age of 62 (55, 68) years. Right-sided tumors were observed in 39 cases and left-sided in 5 cases. Median tumor diameter was 8.1 (6.1, 10.1) cm. Mayo classifications included grade Ⅱ (n=37), Ⅲ (n=6), and Ⅳ (n=1). Neoadjuvant therapy was administered to 23 patients. Seventeen patients were complicated by IVC bland thrombus. Median operative time was 224.0 (167.3, 303.8) min, with intraoperative blood loss of 500.0 (300.0, 850.0) mL. Transfusion was administered to 19 patients, with a median blood transfusion of 800.0 (400.0, 1 200.0) mL. Postoperative complications occurred in 25 cases (56.8%), classified as Clavien-Dindo grade Ⅰ (n=8) and grade Ⅱ (n=17). Procedure-specific complications included deep vein thrombosis (n=6), transfusion-requiring anemia (n=5), lower extremity edema (n=2), and pulmonary embolism (n=2), with no procedure- related mortality. Median postoperative serum creatinine was 116.0 (86.5, 157.5) μmol/L. Pathological examination identified clear cell renal cell carcinoma as the predominant subtype, observed in 34 cases (77.3%). Pathological staging revealed T3b (n=12), T3c (n=29), and T4 (n=3) disease, with nodal involvement (N1) in 8 cases and distant metastasis (M1) in 17. At a median follow-up of 10 months (range: 1-49 months), cancer-specific mortality occurred in 3 patients, while 1 succumbed to other causes. Disease progression included pulmonary metastasis (n=5), hepatic metastasis (n=4), and local recurrence (n=4). Adjuvant therapy regimens comprised targeted-immunotherapy combinations (n=9) and targeted monotherapy (n=18).

Conclusion: Robot-assisted laparoscopic IVC segmental resection achieves precise thrombus removal with confirmed short-term efficacy in renal tumor with IVCTT, though vigilance against vascular complications remains critical.

Objective: To explore the risk factors of adverse events during the perioperative period of transurethral resection of bladder tumor (TURBT) in bladder cancer patients with coronary atherosclerotic heart disease (CAD).

Methods: We retrospectively analyzed the clinical data of bladder cancer patients who underwent TURBT in Beijing Anzhen Hospital from June 2022 to September 2024. All patients with bladder cancer and CAD underwent coronary computed tomography angiography (CCTA) for diagnosis and assessment of CAD before surgery. Based on the CCTA results, the patients with bladder cancer and CAD were divided into two groups: those with mild to moderate coronary stenosis and those with severe coronary stenosis. The severe coronary stenosis group was further divided into two subgroups based on whether they received low-molecular-weight heparin (LMWH) bridging therapy or continued their antiplatelet treatment before surgery. Perioperative anticoagulation and antiplatelet strategies were adjusted according to the opinions of the specialists. The incidence of adverse events within 30 days postoperatively was followed up and analyzed.

Results: A total of 80 bladder cancer patients with CAD who underwent TURBT were included in the study. Among the 80 patients with CAD, 55 (68.8%) had mild to moderate coronary stenosis, and 25 (31.2%) had severe coronary stenosis. Compared with those had mild to moderate coronary stenosis, the patients who had severe coronary stenosis had a higher incidence of postoperative bleeding and pulmonary embolism, although the differences were not statistically significant (P>0.05). However, the incidence of postoperative myocardial infarction was significantly higher in the patients who had severe coronary stenosis (P=0.034). Among the patients with severe coronary stenosis, 8 (32.0%) received LMWH bridging therapy before TURBT, and 17 (68.0%) continued their previous antiplatelet treatment. Compared with those who continued antiplatelet treatment, the patients who received LMWH bridging therapy had a higher incidence of postoperative bleeding and pulmonary embo-lism, although the differences were not statistically significant (P>0.05). However, the incidence of postoperative myocardial infarction was significantly higher in the LMWH bridging group (P=0.032).

Conclusion: Patients with mild-to-moderate coronary stenosis demonstrate relatively low perioperative risk during TURBT procedures and may safely undergo TURBT following antiplatelet therapy discontinuation. Conversely, those with severe coronary stenosis exhibit significantly higher perioperative risk and require intensive monitoring. In bladder cancer patients with concomitant severe coronary stenosis, perioperative LMWH bridging therapy is associated with increased myocardial infarction risk, whereas continued antiplatelet therapy does not elevate postopera

Objective: To analyze the inflammatory indexes and cytokines levels in serum and saliva of patients with chronic periodontitis (CP), and to explore the value of single index or multiple indexes combined detection in the clinical diagnosis and treatment of CP.

Methods: The serum and saliva specimens of 42 CP patients and 38 periodontal healthy people admitted to the Department of Periodontology in Peking University Hospital of Stomatology were detected by inflammatory indexes and cytokines. According to clinical periodontal parameters, CP patients were performed by clinical staging, and the correlation between inflammatory indexes and cytokines levels and the severity of CP was analyzed. To evaluate the levels of inflammatory indexes and cytokines in serum and saliva samples in the periodontal health group and CP group. Three inflammatory indexes were involved in this study: C-reactive protein (CRP), serum amyloid A (SAA), procalcitonin (PCT); and 12 cytokines: Interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17, interferon (IFN)-α, IFN-γ, and tumor necrosis factor α (TNF-α). The Spearman correlation statistical method was used to analyze the correlation between the levels of inflammatory indexes and cytokines and the severity of chronic periodontitis. Mann-Whitney U test was used to identify the indicators with differences between the groups, the optimal indicators were identified through binary Logistic regression analysis with stepwise selection, and the area under the curve (AUC) of receiver operating characteristic (ROC) was used to evaluate the diagnostic efficiency.

Results: By testing the levels of inflammatory markers and cytokines in patients with chronic periodontitis with dif-ferent clinical stages, it was found that CRP, SAA, IL-8 in serum and IL-1β, IL-6, IL-8, IL-12P70, IL-17, TNF-α in saliva were significantly positively correlated with the severity of chronic periodontitis. Compared with the periodontal healthy group, the serum levels of CRP, SAA, IL-2, IL-5, IL-8, IL-12P70, IL-17 and IFN-α in the CP group were significantly increased (All P < 0.05). The AUC of SAA, IL-2, IL-8, IL-12P70, IL-17, IFN-α, combination 1 (IL-2+IL-8) and combination 2 (CRP+SAA+IL-12P70) were >0.7, and the AUC of combination 2 (0.998) was the highest, with high sensitivity (97.6%) and specificity (97.4%). The levels of IL-1β, IL-6, IL-8 and IL-12P70 in the saliva of the CP group were significantly higher than those in the periodontal healthy group, while the levels of IL-4 in the saliva were significantly lower than those in the periodontal healthy group (All P < 0.05). The AUC of IL-6, IL-8 and combination 3 (IL-4+IL-6+IL-8) were >0.7, and the AUC of combination 3 (0.852) was the highest. In the comparative analysis of diagnostic efficacy between single index and multi-index combined, combination 2, combination 1, and serum IL-8 demonstrated the h

Low-level laser therapy (LLLT), a noninvasive photobiomodulation technique, employs red or near-infrared (NIR) light (600-1 000 nm) with power outputs ranging from 5 to 500 mW. It exerts therapeutic effects through molecular mechanisms, specifically the activation of cytochrome C oxidase (CCO) and the modulation of intracellular signaling pathways. By enhancing mitochondrial adenosine triphosphate (ATP) synthesis, LLLT mitigates oxidative stress, regulates the reactive oxygen species (ROS)/glutathione peroxidase (GSH-Px)/superoxide dismutase (SOD) axis, and activates key pathways, including phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) and mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK). These mechanisms confer antioxidant, anti-inflammatory, and pro-regenerative properties to LLLT, making it a viable intervention for dermatological conditions, oncological therapies, and musculoskeletal disorders. Recent preclinical studies underscore LLLT' s potential in male reproductive health. Specifically, it ameliorates cavernosal fibrosis and endothelial dysfunction in erectile dysfunction (ED) models by upregulating the PI3K/Akt and MAPK/ERK pathways. In the context of sperm biology, LLLT enhances motility and acrosomal integrity in both fresh and cryopreserved spermatozoa. This is achieved through mitochondrial metabolic reprogramming, such as CCO-mediated electron transport chain activation, redox homeostasis restoration, and epigenetic modulation involving DNA methylation and histone acetylation. Additionally, LLLT alleviates scrotal heat-induced oligospermia by promoting seminiferous epithelial differentiation, elevating serum testosterone levels, and suppressing lipid peroxidation. These findings highlight the translational potential of LLLT in regenerative medicine, particularly for male sexual and reproductive disorders. Future research efforts should focus on interdisciplinary collaborations spanning life sciences, engineering, and physics. The goal is to optimize laser parameters, including wavelength, irradiance, and treatment duration, and establish standardized protocols. Rigorous preclinical and clinical investigations are paramount to validate the safety, efficacy, and long-term outcomes of LLLT, ultimately paving the way for its integration into precision medicine frameworks for urological and reproductive therapies.

Objective: To investigate the relationship between oxidative stress-related genes and prostate cancer (PCa) from a multi-omics perspective using summary-data-based Mendelian randomization (SMR), colocalization analysis, and cellular experiments.

Methods: Summary-level data on DNA methylation, gene expression, and circulating proteins were obtained and filtered. The PRACTICAL consortium was used as the discovery cohort, with the deCODE database serving as the validation cohort. SMR analysis and heterogeneity in dependent instruments (HEIDI) tests were conducted to assess the association and heterogeneity between oxidative stress-related genes and PCa. Colocalization analysis was performed to determine whether oxidative stress-related genes and PCa shared common causal variants. Finally, CCK-8 assays, wound healing assays, and Transwell invasion assays and Western blotting, were conducted to examine the effects of oxidative stress-related genes on the biological behavior of the PCa cell line C4-2.

Results: Multi-omics analysis identified SCP2 as significantly associated with increased PCa risk across gene methylation, gene expression, and circulating protein levels. GSTP1 showed significant associations at the methylation and protein levels, while LPO was associated at the protein level. At the methylation level, SCP2 sites cg00581603 (OR=1.11, 95%CI: 1.05-1.17) and cg13078931 (OR=1.12, 95%CI: 1.05-1.18) were identified as pathogenic. Among the four methylation sites in GSTP1, only cg05244766 (OR=0.89, 95%CI: 0.84-0.95) was considered protective. At the gene expression level, SCP2 (OR=1.05, 95%CI: 1.02-1.07) was also found to be a pathogenic factor. At the circulating protein level, SCP2 (OR=2.10, 95%CI: 1.34-3.29) showed a consistent pathogenic trend. In addition, GSTP1 (OR=1.16, 95%CI: 1.07-1.25) and LPO (OR=1.12, 95%CI: 1.05-1.19) were significantly associated with increased PCa risk. Further functional assays demonstrated that knockdown of SCP2 significantly reduced the oncogenic phenotype of prostate cancer cells.

Conclusion: Through integrated multi-omics analysis and experimental validation, this study confirmed a significant association between SCP2 and increased PCa risk. These findings enhance our understanding of PCa pathogenesis and provide new potential targets and therapeutic directions for PCa treatment.