Renji Hospital

Chronic kidney disease (CKD) is characterized by persistent inflammation and tubulointerstitial fibrosis leading to end‐stage renal disease. Transient receptor potential canonical 6 (TRPC6) channel inhibition mitigates tubular injury and renal fibrosis in murine models of unilateral ureteral obstruction (UUO) and 2‐month chronic post–ischemia‐reperfusion injury (2m post‐I/R). Through integrated analysis of single‐cell‐RNA‐sequencing (scRNA‐Seq) data from UUO mice treated with the selective TRPC6 inhibitor SH045, here the renoprotective cell composition and cell type‐specific transcriptional programs are defined. We explored translational aspects by conducting an in‐depth scRNA‐Seq analysis of kidney samples from patients with CKD. These results reveal global transcriptional shifts with a dramatic diversification of inflammatory cells, endothelial cells and fibroblasts. Notably, a distinct subpopulation of novel endothelial cells is delineated, which is termed ECRIN, that regulate inflammatory networks implicating VEGF and GAS signaling pathways. The data also indicates that inhibition of TRPC6 channels triggers a Prnp transcription factor regulatory network, which contributes to the alleviation of renal fibrosis. The key findings are supported at the protein level by immunofluorescence and western blot analysis. We observed similar patterns in the chronic 2m postI/R injury model. These findings provide novel insights into the potential therapeutic benefits of TRPC6 inhibition in CKD.

Background The mental health of emergency nurses exposed to workplace violence must be prioritized. Current resilience interventions require further investigation regarding the long‐term effects. Additionally, it remains unclear whether the level of violence influences the intervention effect. Aim of study To investigate the long‐term effect of the CARE program on resilience, and to assess differences in the effectiveness of the CARE program with various workplace violence levels. Methods This two‐armed quasi‐experimental study was conducted from March 2023 to October 2023, following the TREND checklist. Emergency nurses exposed to workplace violence (n = 71) were recruited in a tertiary hospital in Shanghai, China. The intervention group received the CARE program. The control group received routine violence training provided by the hospital. Data were collected at baseline, after the intervention, 4‐week, and 12‐week follow‐up. Results The scores of nurse resilience were significantly improved at the 4‐week follow‐up and the 12‐week follow‐up, as compared with the control group. Resilience, anxiety, perceived organizational support, and nurses’ intent to stay scores showed a significant effect in the group–time interaction effect. Subgroup analysis indicated that emergency nurses with high exposure to workplace violence demonstrate better resilience change scores than low‐risk emergency nurses. Conclusion The CARE program was effective in enhancing resilience, decreasing anxiety, and promoting perceived organizational support and nurses’ intent to stay among emergency nurses exposed to workplace violence. The effectiveness of the nurse resilience intervention was dependent on the level of workplace violence experienced at the beginning of the study. Implications for nursing and health policy This study provides an effective method to enhance the resilience of emergency nurses. The CARE program can be replicated and integrated into systematic education programs for all nurses. More efforts should be made to reduce the incidence of workplace violence in hospitals, such as establishing policies and implementing early warning systems to protect nurses' physical and mental health.

Renal cell carcinoma is characterized by a poor prognosis. Recently, renal cell carcinoma has been recognized as a metabolic disease associated with fatty acid metabolic reprogramming, although in-depth studies on this topic are still lacking. We found that fatty acid metabolism reprogramming in renal cell carcinoma is primarily characterized by high expression of FABP1. FABP1 + tumors significantly impact survival and display distinct differentiation trajectories compared to other tumor subclusters. They show elevated expression of angiogenesis and cell migration signals, with PLG-PLAT-mediated interactions with endothelial cells notably enhanced. Spatial transcriptomics show a prominent co-localization of FABP1 + tumors with endothelial cells, and their spatial distribution closely aligns with that of PLAT + endothelial cells. FABP1 + tumors exhibit a unique pattern in spatial transcriptomics, enriched in Extracellular Matrix and angiogenesis-related pathways. Through receptor-ligand interaction analysis, a novel PLG-PLAT functional axis was found between tumor epithelial cells and endothelial cells. Based on results of experiments, we infer that FABP1 + tumors can promote plasmin-related tumor angiogenesis by triggering the PLG-PLAT signaling axis. Finally, utilizing preclinical models, we suggest that targeting the FABP1-PLG-PLAT axis may serve as promising strategy enhancing the sensitivity of Tyrosine Kinase Inhibitor therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12943-025-02377-9.

Purpose Renal dysfunction and vertebral fracture are both common in patients with type 2 diabetes mellitus (T2DM). However, the association between renal dysfunction and vertebral fracture has rarely been evaluated longitudinally. In this longitudinal study, we evaluated the associations between different subtypes of renal dysfunction and vertebral fracture (VF) in patients with type 2 diabetes. Methods This study recruited T2DM patients aged 50 years or older whose computed tomography (CT) imaging screening revealed no VFs from January 2019–December 2021. The participants were followed up annually until January 2024. The Genant score was used to define new-onset VFs. The renal dysfunction phenotypes were as follows: no renal dysfunction, estimated glomerular filtration rate (eGFR) decline or proteinuria, and eGFR decline + proteinuria. Cox proportional hazards models were used to assess the association between renal dysfunction and VF. Results A total of 135 patients developed new VFs over a median follow-up period of two years. A total of 270 patients without fractures were matched according to follow-up time and body mass index. Bone CT attenuation (HU) (adjusted hazard ratio (HR) = 0.97, 95% confidence interval (CI) 0.99–0.99) was independently associated with VF. eGFR decline or proteinuria and eGFR decline + proteinuria were associated with VF (adjusted HR = 1.98, 95% CI 1.35–2.92; adjusted HR = 2.53, 95% CI 1.30–4.92). Subgroup analyses revealed associations in women, patients without accompanying neuropathy, patients without vascular lesions, and patients who did not receive insulin therapy. The addition of renal dysfunction improved the area under the curve of the clinical model from 0.817 (95% CI: 0.78–0.85) to 0.839 (95% CI: 0.80–0.87) (p < 0.05). Conclusion Renal dysfunction was associated with VF in patients with T2DM. The addition of renal dysfunction improved the ability of bone mass to predict VF.

Photobiomodulation therapy (PBMt) using red light is an emerging non-invasive treatment modality, increasingly applied for managing neck and shoulder muscle discomfort. This article conducts a pilot study which explores the therapeutic potential of a portable and wearable 660 nm LED PBMt device in chronic neck pain. The pilot study was conducted as a self-controlled volunteer study using a dedicated 660 nm LED PBMt device for the treatment of chronic neck pain. Participants received continuous PBMt for a duration of four weeks. Assessments of neck pain and functionality were conducted using the visual analog scale (VAS), neck disability index (NDI), neck pressure pain threshold, and neck mobility, both at the outset and at two-week intervals post-treatment initiation. Additionally, Pittsburgh Sleep quality index (PSQI) Questionnaire was used to evaluated participants’ sleep quality. After two weeks of PBMt device application, there was a significant reduction in neck pain, improvement in pressure pain threshold, and enhancement in sleep quality. Neck mobility showed improvement following four weeks of continuous use. No adverse symptoms were reported by any participants. The wearable 660 nm LED PBMt device showed potential in alleviating symptoms of chronic neck pain and improving neck function. As a non-invasive, efficient and self-administered treatment option, it provided rapid symptom relief for chronic neck pain sufferers and contributes to an overall enhancement in health quality. However, its relative effectiveness remains to be determined in future research.

Background and Aims Open access (OA) publishing improved the reach of scientific discoveries, particularly among researchers in lower-income countries. However, OA publishing still has a global imbalance. This bibliometric analysis evaluates anaesthesia OA journals to explore geographical and economic disparities in publication volume. Methods We queried the Directory of Open Access Journals for OA anaesthesia-related journals between 2014 and 2024. Data from the included journals were analysed using Scopus, from which we extracted the year of publication and the corresponding author’s affiliation. Additional metrics were obtained from each journal website. Countries were then categorised by income level and geographical region. Results Thirty-four anaesthesiology OA journals were analysed, encompassing 27,634 publications from 120 countries. The leading contributors were India (23.96%), the USA (14.98%) and China (6.54%). Low-income countries accounted for 0.37% of total publications, followed by upper-middle-income (17.97%), lower-middle-income (29.07%), and high-income (52.54%) countries. The geographical distribution of publication volume was as follows: Southeast Asia (25.38%), Europe (23.18%), Western Pacific (18.92%), Americas (23.91%), Eastern Mediterranean (8.03%) and Africa (0.59%). Nineteen journals required a mean article processing charge (APC) of US $2,164.89, accounting for 51.89% of the total publications. India ranked first in non-APC journals, while the USA led in APC journals . Conclusion While OA publishing enhances accessibility for readers, it still presents challenges for authors, particularly in economically disadvantaged countries. Significant geographical and economic disparities exist in OA publication volume, likely due to limited investment and structural barriers in lower-income countries.

Falling has become a significant factor in the mortality of elderly people. Little is known about whether sarcopenia can be a risk factor for falls in older adults. This study aims to assess the association between sarcopenia and falls among older Chinese according to the updated diagnostic guidelines of the Asian Working Group on Sarcopenia 2019 (AWGS 2019). We used data from the 2011 baseline and 2015 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). This study examined the relationship between sarcopenia status and falls through cross-sectional analysis. Cox proportional hazards regression models were conducted to investigate the effect of sarcopenia status on subsequent falls, with the report of hazard ratio (HR). A total of 5,337 participants aged at least 60 years (51.3% men; mean age 67.6 ± 6.3) were enrolled in this analysis from the CHARLS 2011. The study revealed that the prevalence of falls was significantly higher in the possible sarcopenia and sarcopenia groups compared to the no sarcopenia group, with rates of 15.8%, 19.4%, and 24%, respectively. Logistic regression was utilized to investigate the association between sarcopenia and falls. Both possible sarcopenia (OR: 1.22, 95% CI: 1.03–1.45) and sarcopenia (OR: 1.64, 95% CI: 1.23–2.19) were positively associated with higher odds of falls (all p < 0.05). During the 4 years of follow-up, 1490 cases (29.9%) with incident falls were identified. In the longitudinal analysis, individuals with diagnosed sarcopenia (HR: 1.32, 95% CI: 1.11–1.57) were more likely to have new-onset incident falls than their no-sarcopenia peers. Sarcopenia in the elderly is an independent risk factor for falls, with health screening and intervention reducing fall risk and improving quality of life.

Objectives To establish a practical tool for the prediction of mortality in polytrauma patients. Design Secondary analysis of data from a public database. Setting A tertiary hospital in Switzerland. Participants 2406 polytrauma patients were enrolled in this study, and the mean age was 44.4±19.9 years with 74.8% men. Interventions No. Outcome measures Logistic regression analysis was conducted to explore the relationship between early deaths and variables. Nomogram model was established based on predictive factors. Model effectiveness was assessed by its discrimination, calibration and decision curve analysis. Causal mediation analysis was used to explore the relationships among risk factors. Results Independent predictive variables analysed by logistic regression were: age, Glasgow Coma Scale (GCS), base excess (BE) and serum lactate. A nomogram model was established based on those risk factors, and the area under the curve of the nomogram for early death was 0.85, which was better than existing traumatic scorings. Besides, calibration plots and decision curve analysis demonstrated better performance than traumatic scorings with better internal validation. The effect of GCS on early death partly depended on BE and lactate. Conclusion Our study found that early mortality was associated with age, GCS, BE and serum lactate on admission, and lactate was more important in early death. A simple prediction model of early mortality in polytrauma patients was developed with accessible parameters assessed on admission.

Pyrochemical reprocessing has emerged as a crucial alternative to conventional hydrometallurgical methods for the reprocessing of spent nuclear fuel (SNF), particularly for high-burnup SNF from advanced reactors. Unlike the Plutonium Uranium Recovery by Extraction (PUREX) process, which encounters challenges with high-burnup SNF, pyrochemical reprocessing facilitates the direct processing of short-cooled fuel through electroreduction and electrorefining in molten salt. This review presents the research advancements in electroreduction and electrorefining within the context of pyrochemical reprocessing of SNF, systematically introducing the latest findings across five key areas: the electroreduction of oxide SNF pellets composed of various materials, anode materials, solid cathode materials, liquid cathode materials, and molten salt systems utilized in the electroreduction and electrorefining processes. Finally, the article summarizes the pressing issues currently facing electroreduction and electrorefining and proposes directions for future research.

Introduction Cardiovascular diseases (CVD) represents a leading cause of morbidity and mortality worldwide, including China. Accurate prediction of CVD risk and implementation of preventive measures are critical. This study aimed to develop a short-term risk prediction model for CVD events among individuals aged ≥60 years in Shanghai, China. Methods Stratified random sampling recruited elderly individuals. Retrospective data (2016–2022) were analyzed using Lasso-Cox regression, followed by a multivariable Cox regression model. The risk scoring was visualized through a nomogram, and the model performance was assessed using calibration plots and receiver operating characteristic curves. Results A total of 9,636 individuals aged ≥60 years were included. The Lasso-Cox regression analysis showed male gender (HR=1.482), older age (HR=1.035), higher body mass index (HR=1.015), lower high-density lipoprotein cholesterol (HR=0.992), higher systolic blood pressure (HR=1.009), lower diastolic blood pressure (HR=0.982), higher fasting plasma glucose (HR=1.068), hypertension (HR=1.904), diabetes (HR=1.128), and lipid-lowering medication (HR=1.384) were related to higher CVD risk. The C-index in the training and validation data was 0.642 and 0.623, respectively. Calibration plots indicated good agreement between predicted and actual probabilities. Conclusion This short-term predictive model for CVD events among the elderly population exhibits good accuracy but moderate discriminative ability. More studies are warranted to investigate predictors (gender, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, hypertension, and lipid-lowering medication) of CVD incidence for the development of preventive measures.

Liver metastasis is prevalent among patients with neuroendocrine prostate cancer (NEPC) and other types of neuroendocrine (NE) cancers, featuring with an aggressive clinical course and a dismal prognosis. However, the cellular and molecular mechanisms underlying liver‐specific metastatic tropism in NE cancers remain poorly understood. Intriguingly, it is found that NEPC liver metastatic foci are frequently associated with thrombi. NEPC cells express an aberrantly elevated level of glycosyltransferase Galnt9. Notably, the Galnt9‐mediated O‐GalNAc glycosylation on the cell membrane of NE cancer cells, particularly on the adhesion molecule Annexin A2, activates the mannose‐binding lectin (MBL) complement signaling in the liver. This cascade stimulates platelet activation and thrombus formation, ultimately facilitating hepatic metastasis of NEPC. Inhibition of O‐GalNAc glycosylation or knockdown of Galnt9 demonstrates efficacy in restraining the liver metastasis of NEPC, small cell lung cancer (SCLC), and colorectal neuroendocrine cancer. These findings identify Galnt9‐mediated O‐GalNAc glycosylation as a targetable mechanism driving liver metastasis through activation of MBL complement and coagulation cascades across a broad spectrum of NE cancers.

Importance The successful implementation of artificial intelligence (AI) in health care depends on its acceptance by key stakeholders, particularly patients, who are the primary beneficiaries of AI-driven outcomes. Objectives To survey hospital patients to investigate their trust, concerns, and preferences toward the use of AI in health care and diagnostics and to assess the sociodemographic factors associated with patient attitudes. Design, Setting, and Participants This cross-sectional study developed and implemented an anonymous quantitative survey between February 1 and November 1, 2023, using a nonprobability sample at 74 hospitals in 43 countries. Participants included hospital patients 18 years of age or older who agreed with voluntary participation in the survey presented in 1 of 26 languages. Exposure Information sheets and paper surveys handed out by hospital staff and posted in conspicuous hospital locations. Main Outcomes and Measures The primary outcome was participant responses to a 26-item instrument containing a general data section (8 items) and 3 dimensions (trust in AI, AI and diagnosis, preferences and concerns toward AI) with 6 items each. Subgroup analyses used cumulative link mixed and binary mixed-effects models. Results In total, 13 806 patients participated, including 8951 (64.8%) in the Global North and 4855 (35.2%) in the Global South. Their median (IQR) age was 48 (34-62) years, and 6973 (50.5%) were male. The survey results indicated a predominantly favorable general view of AI in health care, with 57.6% of respondents (7775 of 13 502) expressing a positive attitude. However, attitudes exhibited notable variation based on demographic characteristics, health status, and technological literacy. Female respondents (3511 of 6318 [55.6%]) exhibited fewer positive attitudes toward AI use in medicine than male respondents (4057 of 6864 [59.1%]), and participants with poorer health status exhibited fewer positive attitudes toward AI use in medicine (eg, 58 of 199 [29.2%] with rather negative views) than patients with very good health (eg, 134 of 2538 [5.3%] with rather negative views). Conversely, higher levels of AI knowledge and frequent use of technology devices were associated with more positive attitudes. Notably, fewer than half of the participants expressed positive attitudes regarding all items pertaining to trust in AI. The lowest level of trust was observed for the accuracy of AI in providing information regarding treatment responses (5637 of 13 480 respondents [41.8%] trusted AI). Patients preferred explainable AI (8816 of 12 563 [70.2%]) and physician-led decision-making (9222 of 12 652 [72.9%]), even if it meant slightly compromised accuracy. Conclusions and Relevance In this cross-sectional study of patient attitudes toward AI use in health care across 6 continents, findings indicated that tailored AI implementation strategies should take patient demographics, health status, and preferences for explainable AI and physician oversight into account.

Primary large B-cell lymphoma of immune-privileged sites (IP-LBCL) is a newly categorized disease entity in the 5th WHO Classification of Tumors. Through an analysis of 53 primary adrenal large B-cell lymphoma (PA-LBCL) cases, we unraveled the similarity to IP-LBCL in clinical presentation, pathologic features, and genetic landscape. Our findings reveal a predominant immunophenotype of CD10-/BCL6+/MUM1+ in PA-LBCL, mirroring that observed in IP-LBCL, and a shared mutation spectrum characterized by the notable presence of PIM1, MYD88 L265P, and CD79B mutations. In addition, the results of RNA sequencing showed that there are significant differences in the expression profiles of PA-LBCL and SA-LBCL. The top 5 RNAs with the most significant expression differences were RPL23AP82, IGSF21, CMKLR, PTPRG, and PRKCA. Moreover, PA-LBCL exhibited a more favorable prognosis than DLBCL-NOS with secondary adrenal involvement. The results of this study indicate that PA-LBCL shares similar clinical features, immunophenotypes, and molecular genetic profiles with IP-LBCL, suggesting that it may belong to a subtype of IP-LBCL. This research has improved our understanding of lymphoma, especially those occurring in atypical sites, and reshaped our concept of lymphoma classification and management. We suggest considering incorporating PA-LBCL into IP-LBCL in the future classification of lymphoma.