Zhejiang University Research Articles

Comparison of Weight Loss Induced by Dietary and Pharmaceuticals in Individuals with Overweight and Obesity: A Retrospective Study.

This study aims to evaluate the impact of low-carbohydrate diet, balanced dietary guidance, and pharmacotherapy on weight loss among individuals with overweight or obesity over a period of three months. The study involves 339 individuals with overweight or obesity and received weight loss treatment at the Department of Clinical Nutrition at the Second Affiliated Hospital of Zhejiang University, School of Medicine, between January 1st, 2020 and December 31st, 2023. The primary outcome is the percentage weight loss. Among the studied patients, the majority chose low-carbohydrate diet as their primary treatment (168 [49.56%]), followed by balanced dietary guidance (139[41.00%]) and pharmacotherapy (32 [9.44%]). The total percentage weight loss for patients who were followed up for 1 month, 2 months, and 3 months was 4.98 (3.04,6.29) %,7.93 (5.42, 7.93) % and 10.71 (7.74,13.83) %, respectively. Multivariable logistic regression analysis identified low-carbohydrate diet as an independent factor associated with percentage weight loss of ≥3% and ≥5% at 1 month (OR [odds ratio] =0.461, P＜0.05; OR=0.349, P＜0.001). The results showed that a low-carbohydrate diet was an effective weight loss strategy in the short term. However, its long-term effects were comparable to those observed with balanced dietary guidance and pharmacotherapy.

The prognostic value and biological significance of MRI CE-T1-based radiomics models in CNS5-identified GBM: a multi-center study.

Following the publication of the 2021 WHO Classification of Central Nervous System Tumors (CNS5), Following the publication of the 2021 WHO Classification of Central Nervous System Tumors (CNS5), prognostic markers of glioblastoma (GBM) need to be further explored. Radiomics is a non-invasive and reproducible method for the prognostic assessment of multiple solid tumors. This study aimed to explore the prognostic value and biological significance of MRI T1-weighted enhancement (CE-T1) based radiomics in GBM (CNS5). A six-features radiomics prognostic model was created to calculate the radiomics score (RS). High RS (HR = 3.718, 95%CI: 2.222 - 6.220, P < 0.001) was an independent risk factor for overall survival (OS). The correlation between RS and OS was externally verified based on the First Affiliated Hospital of Fujian Medical University cohorts (n = 93; HR = 2.015, 95% CI: 1.079 - 3.762, P = 0.028) and the Second Affiliated Hospital of Zhejiang University School of Medicine cohorts (n = 126; HR = 1.779, 95% CI: 1.023 - 3.091, P = 0.041). Through biological significance exploration, RS was found to be significantly correlated with DNA repair (P = 0.009) and glycolysis (P = 0.001) pathway enrichment scores. RS was associated with γδT cell infiltration and the expression of LAG3. The MRI CE-T1 based radiomics models can predict GBM (CNS5) prognosis noninvasively. RS is relevant to DNA repair, and may guide the screening of radiosensitive populations.

Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study.

In the clinic, pediatric acute necrotizing encephalopathy (ANE) primarily affects children under five years of age and is characterized by severe brain damage and high mortality. However, some challenges remain regarding the diagnosis and treatment of ANE. In the present study, we analyzed the clinical characteristics and related factors of ANE with the aim of providing improved diagnostic and treatment strategies. Thirty-four pediatric ANE patients admitted to Zhejiang University School of Medicine Hospital between February 2019 and December 2023 were included in this study. To identify the factors associated with mortality, clinical, laboratory and imaging data were analyzed with independent-sample t tests, Mann‒Whitney U tests, Fisher's exact probability tests and receiver operating characteristic (ROC) curve analyses. In this cohort of 34 patients, the most common symptoms were fever, seizures, altered consciousness, vomiting, diarrhea and shock. The mortality rate was 55.9%. Laboratory tests revealed that patients who died had higher creatinine, lactate, activated partial thromboplastin time (APTT), thrombin time (TT), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine kinase (CK), and D-dimer than survivors. Imaging examinations predominantly revealed symmetrical lesions in the thalamus. The fatal group displayed lower Glasgow Coma Scale (GCS) scores and severe complications. Other factors related to mortality included the arterial pH, GCS score and hospitalization duration. The most common symptoms of ANE are fever, seizures, altered consciousness, vomiting, diarrhea and shock, and ANE has a high mortality rate. The GCS score and arterial pH are critical biomarkers for assessing the severity of ANE.

Automatic segmentation and visualization of cortical and marrow bone in mandibular condyle on CBCT: a preliminary exploration of clinical application.

To develop a deep learning-based automatic segmentation method for cortex and marrow in mandibular condyle on cone-beam computed tomography (CBCT) images and explore its clinical application. 825 condyles of 490 CBCT images from 3 centers of Stomatology hospitalaffliated to Zhejiang University School of Medicinewere collected. A deep learning model was developed for simultaneous segmentation of cortex and marrow in mandibular condyle. It included a region of interest extraction network and a segmentation network based on 3D U-net, with modifications made to improve the segmentation boundaries. To evaluate its clinical potential, the model's segmentation efficiency and accuracy were compared with those of both junior and senior oral and maxillofacial radiologists. Additionally, the model's ability to assist junior radiologists in diagnosis through visualization and quantitative analysis of the generated 3D model was also assessed. The Dice similarity coefficient of the deep learning model was 0.901 (cortex), 0.969 (marrow), and 0.982 (entire condyle). Hausdorff distance was 0.755mm (cortex), 0.826mm (marrow), and 0.760mm (entire condyle). The model outperformed radiologists across all segmentation metrics, completing the task in merely 15.06s. With the assistance of visualization and quantitative analysis generated from the model's segmentation, the diagnostic accuracy of junior radiologists significantly improved. The proposed deep learning-based model achieved accurate and efficient segmentation for mandibular condylar cortex and marrow. It possessed capability to generate precise 3D models, facilitating visual quantitative measurement and aiding in the diagnosis of condylar bony changes. This model holds potential for clinical applications in orthognathic surgery, orthodontic treatment, and other TMJ-related interventions.

The value of lung ultrasound in the differential diagnosis of common lung diseases in newborns.

To investigate the value of lung ultrasound in the differential diagnosis of common neonatal lung diseases. A total of 160 newborns with suspected lung diseases admitted to the Department of Neonatology of Linping Branch of the Second Affiliated Hospital of Zhejiang University from January 2020 to June 2023, were selected for examination. Perform lung ultrasound within 24 hours of admission for above newborns, using the final clinical diagnosis as standard. Calculate the accuracy, sensitivity, and specificity of lung ultrasound technology in the diagnosing neonatal lung diseases, and assess its value in the differential diagnosis of common neonatal lung diseases. A total of 160 newborns suspected of having lung disease were finally diagnosed with lung disease in 142 cases. The accuracy of lung ultrasound in differentiating neonatal pneumonia, respiratory distress syndrome of the newborn, meconium aspiration syndrome, transient tachypnea of the newborn, pneumothorax, atelectasis, and pulmonary hemorrhage was 96.8%, 98.1%, 98.8%, 100%, 100%, 100%, and 100%, respectively. The detection rate of lung ultrasound examination for lung disease in newborns was 85.00%, with a sensitivity of 95.77%, specificity of 77.77%, positive predictive value of 97.14% and negative predictive value of 70.0%. The consistency test kappa value between lung ultrasound findings and the final clinical diagnosis of neonatal lung diseases is 0.846. Lung ultrasound holds significant value in the differential diagnosis of common lung diseases in newborns.

The Influence of Curriculum of English Major on Oral Communicative Competence: A Case Study of Zhejiang University of Science and Technology

The Influence of Curriculum of English Major on Oral Communicative Competence: A Case Study of Zhejiang University of Science and Technology

A nomogram to predict the risk of relapse in patients with minimal change disease: a retrospective cohort study

Background Minimal change disease (MCD) is a common pathological type of nephrotic syndrome. Relapses of MCD present a significant challenge for patients. This study aims to develop a predictive model for evaluating the probability of relapse in patients with MCD. Methods This study enrolled 152 patients with biopsy-confirmed MCD, all of whom received exclusive glucocorticoid treatment at the First Affiliated Hospital of Zhejiang University in Hangzhou, China, between October 2012 and April 2021. The Cox regression analysis was utilized to identify the risk factors associated with the relapse in MCD, and a nomogram was constructed to predict the probability of relapse. Results The results demonstrated that serum immunoglobulin E (IgE) levels > 936 IU/mL, age ≤ 30 years old, estimated glomerular filtration rate (eGFR) < 90 mL/(min × 1.73 m2), serum total cholesterol (TCh) levels > 12.3 mmol/L, and time to remission were independent risk factors associated with relapses in patients with MCD. A nomogram was established and achieved a concordance index of 0.726 (95% CI = 0.659–0.793). The receiver operating characteristic curves demonstrated areas under the curve of 0.771, 0.853, and 0.811 for the prediction of relapse at 1-, 2-, and 3-year intervals after achieving remission in MCD patients respectively. These findings along with the calibration curves indicated the good discrimination and calibration performance of the nomogram in this cohort. Conclusion: The established nomogram provides a valuable tool for the identification of patients with MCD who are at risk of relapse, which may facilitate prompt treatment for these patients.

Esketamine administered epidurally as an adjuvant to epidural ropivacaine for labour analgesia: a prospective, double-blind dose-response study.

To investigate the efficacy of esketamine as an adjuvant to epidural ropivacaine for labour analgesia by determining its effect on the median effective concentration (EC50) in a 20 ml volume of ropivacaine. A prospective, double-blind dose-response study. This study was conducted in Women's Hospital, School of Medicine, Zhejiang University, China. One hundred and fifty parturients who requested epidural analgesia were recruited in this study to randomly receive epidural ropivacaine alone or with esketamine of 0.2 mg ml-1, 0.3 mg ml-1, 0.4 mg ml-1 or 0.5 mg ml-1, respectively. The primary outcome, EC50 of ropivacaine, was determined using an up-down sequential allocation technique. The secondary outcomes were analgesia characteristics, Ramsay Sedation Scale score, labour duration, caesarean section rate and adverse effects. The EC50 of ropivacaine with the addition of esketamine at concentrations of 0.3 mg ml-1, 0.4 mg ml-1 and 0.5 mg ml-1 resulted in significant reductions in the EC50 of ropivacaine to 0.050%, 0.044% and 0.043%, respectively, from baseline (esketamine 0 mg ml-1) (p<0.0001). However, reductions of the EC50 of ropivacaine were similar among the groups with esketamine of 0.3 mg ml-1, 0.4 mg ml-1 and 0.5 mg ml-1 (p>0.05). The Ramsay Sedation Scale score was higher and more dizziness was observed in the Group of esketamine 0.5 mg ml-1 compared with all other groups (p<0.0001). During the peripartum period, no differences in sensory blockade level, Bromage score, labour duration and percentage of caesarean delivery were found among the groups. Under the conditions of this study, the addition of epidural esketamine of 0.3 mg⋅mL-1, 0.4 mg⋅mL-1 and 0.5 mg⋅mL-1 offered a similar ropivacaine dose-sparing effect; 0.5 mg⋅mL-1 of esketamine produced more adverse effects. ChiCTR2100054348.

Effects of low temperature on near-nozzle breakup and droplet size distribution in airblast kerosene spray

Atomization of low-temperature fuel is encountered in extreme operating conditions of liquid propulsion systems such as cold start and high-altitude relight for aeroengines. Fuel temperature has a great impact on airblast spray characteristics by influencing fuel viscosity and thus the gas–liquid interaction, which raises the demand to clarify the temperature-dependent transition in near-nozzle breakup behavior and the corresponding droplet size distribution. A liquid-centered swirl coaxial injector is tested on the low-temperature swirl spray and combustion test rig at Zhejiang University, using 25 kHz high-speed digital off-axis holography. RP-3 aviation kerosene is atomized under ignition conditions at temperatures of 233, 253, and 301 K, fuel pressures of 0.03 and 0.69 MPa, and air pressure ranging from 0 to 4.0 kPa. Time-resolved near-nozzle dynamics suggest four types of elementary breakup processes: wavy-sheet breakup, pulsating breakup, membrane-type breakup, and nonaxisymmetric Rayleigh breakup. Each process alternately dominates the near field as fuel Reynolds number (Ref) and aerodynamic Weber number (Weg) decrease, corresponding to four primary breakup modes. A mode classification plot is summarized. Spray structures show an extended breakup length and reduced spray cone angle as fuel temperature (Tf) decreases. Increasing air pressure (Pg) promotes spray expansion at 0.03 MPa, but contracts spray cone at 0.69 MPa. Cross-sectional Sauter mean diameter (SMD) distribution indicates a solid-cone spray at 0.03 MPa and a hollow cone spray at 0.69 MPa. Lowering Tf will rise the SMD in the spray center at 0.03 MPa and transform the toroidal SMD distribution at 0.69 MPa into a solid one. Finally, a temperature-related SMD model is derived considering the exponential viscosity–temperature relationship, and a good fit with R2 &amp;gt; 0.95 is achieved. This research aims to deepen the understanding of the effects of low temperature on the transition of near-nozzle atomization characteristics for airblast sprays. Both spray visualization and SMD results provide reference for numerical simulations and near-nozzle spray modeling.

The relationship between sleep quality and quality of life in middle-aged and older inpatients with chronic diseases: Mediating role of frailty and moderating role of self-esteem

ObjectiveThis study aimed to investigate the influence of sleep quality on the quality of life in middle-aged and older inpatients with chronic diseases (MAOICDs) while examining the mediating role of frailty and the moderating role of self-esteem. MethodsThis study utilized a cross-sectional design. Between October 2021 and February 2022, we administered questionnaires to 319 subjects at the Second Hospital of Zhejiang University School of Medicine, Zhejiang Province, China. The questionnaire consisted of the General Information Scale, the Cumulative Disease Rating Scale, the Sleep Quality Questionnaire, the Frailty Scale, the Self-Esteem Scale, and the Quality of Life Questionnaire. Data were analyzed using SPSS 25.0 software and PROCESS3.5 macros for descriptive statistics, correlation analysis, and tests for mediating and moderating effects. ResultsThe results of this study suggest that sleep quality is negatively related to quality of life and mediated by frailty. Self-esteem plays a moderating role in the relationship between frailty and quality of life. ConclusionFrailty mediates the relationship between sleep quality and quality of life. Meanwhile, self-esteem plays a moderating role in the relationship between frailty and life quality. Specifically, the correlation between frailty and life quality becomes stronger at higher levels of self-esteem. Therefore, to improve the life quality of MAOICDs, interventions should focus not only on enhancing sleep quality and reducing frailty but also on helping patients maintain an appropriate level of self-esteem.

Impact of non-invasive ventilation on microbial colonisation patterns in preterm infants: a single-centre study.

The objective of this study is to assess the relationship between non-invasive ventilation (NIV) and the colonisation of oral and nasal microbiota in preterm infants within the neonatal intensive care unit (NICU). A prospective cohort study. The NICU of Zhejiang University Children's Hospital. Patients include preterm infants with a gestational age of 28-35 weeks, enrolled within the first 24 hours of life. Infants were categorised based on respiratory support: NIV, which included nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation or high-flow nasal cannula; and no respiratory support, defined as room air or low-flow nasal cannula at ≤2 L/min. The primary outcome was the colonisation of oral and nasal microbiota at 5 days post birth, measured by colony-forming units per millilitre (CFU/mL), with colonisation defined as bacterial growth >103 CFU/mL. The study included 100 preterm infants, with 50 in each group. Nasal microbial colonisation was observed in 56% (28/50) of the NIV group, significantly higher than the 28% in the no respiratory support group. No significant differences were found in oral colonisation. Adjusted binary logistic regression showed an association between NIV and increased risk of nasal colonisation (adjusted OR=2.91, 95% CI 1.12 to 7.58, p=0.028). NIV in preterm infants was linked to a higher risk of nasal microbial colonisation. This finding suggests the need for further research and consideration of infection control strategies in the NICU.

Research hotspots and trends of mesenchymal stem cell-derived extracellular vesicles for drug delivery: a bibliometric and visualization analysis from 2013 to 2023.

Our study aims to provide a comprehensive overview of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) in drug delivery research, focusing on the period between 2013 and 2023. Given the increasing global interest in this field, we utilized bibliometric tools to explore publication trends, key contributors, and thematic research clusters. Data was collected from the Web of Science (WoS) database, and an in-depth bibliometric analysis was conducted using VOSviewer. The analysis encompassed bibliographic coupling, co-citation, co-authorship, and co-occurrence trends, offering a structured insight into global research activity. We also employed Citespace to further analyze thematic clusters in this domain. Our analysis revealed a total of 1,045 publications related to MSC-EVs in drug delivery over the past decade, showing a steady increase in research output. China led in publication count, H-index, prolific authors, and research funding, while the United States ranked highest in total citations, average citation counts, and H-index performance. Pharmaceutics emerged as the leading journal by publication volume, with the Journal of Controlled Release having the strongest total link strength. Top institutions driving research included Shanghai Jiao Tong University, Zhejiang University, and Harvard University. VOSviewer analysis identified four major research clusters: tissue engineering, cancer, neurological diseases, and targeted delivery. Citespace analysis refined this further into ten thematic areas, including differentiation, tissue regeneration, and drug resistance. This bibliometric assessment provides a holistic visualization of the research landscape for MSC-EVs in drug delivery, underlining the significant contributions of China and the United States. Our findings underscore the increasing global importance of MSC-EV research and highlight emerging themes that will likely guide future research directions. The insights from this study offer a foundational framework for identifying nascent frontiers in MSC-EV-based drug delivery.

Serum autotaxin positively associates with hypertension in postmenopausal women: a single center study in China.

Autotaxin is an adipokine involved in metabolic disorders. The aim of the current study was to evaluate serum autotaxin levels in hypertensive postmenopausal women and establish a relationship between autotaxin and other comorbidities in this special group. This single-center study included postmenopausal women who received annual health examinations at the First Affiliated Hospital, College of Medicine, Zhejiang University in Zhejiang, China. The metabolic and demographic characteristics of the subjects, including age, sex, height, weight, blood pressure, and biochemical indices, were collected. The serum autotaxin level was measured via ELISA. The Kolmogorov-Smirnov test, Student's t test, Mann-Whitney U test, χ2 test, receiver operating characteristic (ROC) curve analysis, Spearman correlation analysis and multivariate logistic regression analysis were adopted for statistical analysis. This pilot observational study included 25 hypertensive postmenopausal women and 25 age-matched normotensive controls. Hypertensive patients presented significant metabolic disturbances with greater comorbidities such as nonalcoholic fatty liver disease, obesity, overweight, diabetes, hypertriglyceridemia and hyperuricemia (P < 0.05), impaired renal health with higher uric acid levels (P < 0.001), and slightly elevated creatinine levels (P = 0.156) with lower estimated glomerular filtration rates (eGFRs) (P = 0.195). The serum autotaxin level was markedly greater in the hypertensive group (239.0±59.6 ng/ml vs. 192.7 ± 49.0 ng/ml; P < 0.01) and was positively associated with systolic blood pressure; diastolic blood pressure; and alanine transaminase, triglycerides (TG), creatinine, and uric acid levels and inversely associated with the eGFR (P < 0.05) among postmenopausal women. Serum autotaxin levels positively predicted hypertension, with an AU-ROC of 0.750 [95% confidence interval (CI): 0.613-0.888] and a Youden index of 0.480 at a cutoff of 225 ng/ml. In the multivariate logistic regression analysis, after adjustment for demographic and metabolic parameters (including age, BMI, ALT, TB, uric acid, FBG, TG, LDL and creatinine), autotaxin (ATX) remained independently positively correlated with the risk of hypertension [odds ratio: 1.016, 95% CI 1.001-1.031; P < 0.05). Among postmenopausal women, the serum autotaxin level is significantly elevated in the hypertensive group compared with age-matched normotensive controls. ATX is related to multiple metabolic disorders and renal health, suggesting that autotaxin has potential as a multiorgan therapeutic target for cardiovascular-metabolic-renal disorders.

Clinical Characteristics and Prognostic Factors of Nephrotic Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation.

Aims/Background Although the incidence of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively low, it can significantly affect patients' quality of life and may even be life-threatening. Therefore, it is essential to investigate the clinical manifestations and prognosis of patients with NS after allo-HSCT, as well as to identify potential high-risk factors associated with this condition. Methods We investigated the incidence rate of NS in 1457 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the First Affiliated Hospital, Zhejiang University School of Medicine between June 2007 and March 2020. Among these, we identified 12 patients who developed NS after allo-HSCT (NS group). For comparison, we selected a control group of 48 patients matched by gender and transplantation time who did not develop NS. Univariate and multivariate logistic regression analyses were performed using SPSS software, version 25.0 (IBM Corp., Armonk, NY, USA) to identify independent risk factors for NS. Results Among the 1457 patients, 12 (0.82%) developed post-transplantation NS, with a median onset time of 14.99 months (range: 5.39-48.43 months) after transplantation. Univariate analysis indicated that the occurrence of post-transplantation NS was significantly correlated with total cholesterol (TC) levels at 6 months post-transplantation (p = 0.041), triglycerides (TG) and TC levels at 1 year post-transplantation (p = 0.004 and p = 0.011, respectively), and cytomegalovirus (CMV) infection (p = 0.002). Multivariate analysis revealed that CMV infection (p = 0.004, odds ratio = 15.871; 95% confidence interval: 2.465-102.194) was independently associated with the development of NS. Conclusion After allo-HSCT, NS may manifest as a form of chronic graft-versus-host disease. CMV infection is a risk factor for developing NS. Effective management through the administration of calcium inhibitors and corticosteroids can enable long-term survival in these patients.

Analysis of the Application of Artificial Intelligence in Mahjong

Over the past few years, AI-based models for Mahjong have received a substantial amount of contribution due to the advancements in machine learning and game theory. In this review, these state-of-the-art AI models are considered, including Tjong, Kanachan, Suphx, and Zhejiang University’s developed model. The deployed approaches are disparately represented by reinforcement learning, Monte Carlo tree search (MCTS), and deep neural networks, all of which aim at solving the issues that come with the game’s structure, such as incomplete and overburdening information. The Tjong model complements the power of the transformer architecture with hierarchical decision-making and in turn, brings strategic depth to the gameplay. Kanachan employs Q-learning and MCTS to optimize decision-making, while Suphx combines these methods with the novel ideas of Double Q-learning and Thompson Sampling to achieve higher performance than seen before. The integration of reinforcement learning and a new evaluation model imbues the model with the unique properties of both learning machines and human expertise, namely depth and intelligence. As a result of all these exploits, obstacles still exist, the most notable among them are the management of completely unknown information, handling long-distance games, and the strategic balance between offense and defense. In the future, determinants of probabilistic reasoning, the improvement of deep learning systems, and the prowess of reward shaping will result in AI improvement in Mahjong.

Correlation of IGF2 levels with sperm quality, inflammation, and DNA damage in infertile patients.

Insulin-like growth factor 2 (IGF2) is a critical endocrine mediator implicated in male reproductive physiology. To investigate the correlation between IGF2 protein levels and various aspects of male infertility, specifically focusing on sperm quality, inflammation, and DNA damage, a cohort of 320 male participants was recruited from the Women's Hospital, Zhejiang University School of Medicine (Hangzhou, China) between 1st January 2024 and 1st March 2024. The relationship between IGF2 protein concentrations and sperm parameters was assessed, and Spearman correlation and linear regression analysis were employed to evaluate the independent associations between IGF2 protein levels and risk factors for infertility. Enzyme-linked immunosorbent assay (ELISA) was used to measure IGF2 protein levels in seminal plasma, alongside markers of inflammation (tumor necrosis factor-alpha [TNF-α] and interleukin-1β [IL-1β]). The relationship between seminal plasma IGF2 protein levels and DNA damage marker phosphorylated histone H2AX (γ-H2AX) was also explored. Our findings reveal that IGF2 protein expression decreased notably in patients with asthenospermia and teratospermia. Correlation analysis revealed nuanced associations between IGF2 protein levels and specific sperm parameters, and low IGF2 protein concentrations correlated with increased inflammation and DNA damage in sperm. The observed correlations between IGF2 protein levels and specific sperm parameters, along with its connection to inflammation and DNA damage, underscore the importance of IGF2 in the broader context of male reproductive health. These findings lay the groundwork for future research and potential therapeutic interventions targeting IGF2-related pathways to enhance male fertility.

Assessment of health-related quality of life of children with idiopathic nephrotic syndrome and their caregivers in China

AimsThe primary aim of this study was to characterize the health-related quality of life (HRQoL) and identify the associated factors among children aged 2 to 18 in China diagnosed with idiopathic nephrotic syndrome (INS). Additionally, the study aimed to evaluate the HRQoL and caregiving burden of their caregivers and investigate the correlation between the HRQoL of the children and that of their caregivers.MethodsThis study recruited 181 children diagnosed with INS from Children’s Hospital, Zhejiang University School of Medicine in China. The proxy-reported PedsQL Generic Core Module (PedsQL™ 4.0 GCM) was used to measure the HRQoL of children, and the EuroQol five-dimensional questionnaire, five-level version (EQ-5D-5L) was applied to measure caregivers’ HRQoL. Differences in scale scores and total scores of PedsQL™ 4.0 GCM were assessed using t-tests and one-way ANOVA. Multivariate linear regression analysis was used to identify the factors associated with children’s HRQoL. Pearson correlation analysis evaluated the correlation between children’s HRQoL and caregiver’s HRQoL.ResultsHRQoL of Children with INS declines with increasing age, and children aged 5-18 had lower scores in physical functioning, emotional functioning, school functioning, psychosocial health summary score, and total PedsQL™ 4.0 GCM score compared to healthy children. Various factors, including the mother filling out the questionnaire, the father being unemployed, and the use of other medications except for steroids, were associated with worse HRQoL of children (p values < 0.05). Additionally, a correlation exists between children’s HRQoL and their caregivers’ HRQoL.ConclusionThis study evaluated the HRQoL of children aged 2-18 years diagnosed with INS in China, along with the HRQoL of their caregivers. Multiple factors potentially influence the HRQoL of children. A significant correlation was observed between the HRQoL of children and their caregivers, who frequently experienced varying levels of caregiving burden. Therefore, it is recommended that healthcare professionals prioritize optimizing HRQoL for children with INS and their caregivers.

Robotic right colectomy versus laparoscopic right colectomy in patients with right colon cancer: a comparative study

BackgroundThe study aimed to compare the clinical outcomes of robotic right colectomy (RRC) versus laparoscopic right colectomy (LRC) in patients diagnosed with right colon cancer, given the increasing adoption of robotic surgical techniques and their potential benefits in oncologic surgery.MethodsThis retrospective comparative study included patients who underwent right colectomy at Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, between January 2019 and May 2022. The primary outcomes measured were the number of lymph nodes harvested. Key secondary outcomes included the operation time, intraoperative blood loss, postoperative complications, hospitalization costs, overall survival (OS), and disease-free survival (DFS). Data were analyzed using multivariable Cox proportional hazards regression to adjust for potential confounders.ResultsA total of 225 patients (aged 65.23 ± 11.45, 108 males) with right colon cancer were included, with 100 (44.4%) patients underwent RRC. Patients who underwent RRC had significantly more lymph nodes harvested (27.69 ± 12.59 vs. 24.43 ± 9.42, P = 0.028), and incurred higher total hospitalization costs compared to those with LRC (9.68 ± 7.12 vs. 5.28 ± 1.23 ten-thousand-yuan, P < 0.001). The OS and DFS were comparable between RRC and LRC (both P > 0.05) within a median follow-up of 27 (range, 9–44) months. Multivariable cox proportional hazards regression showed that patients underwent RRC had significantly higher risk for all-cause death compared with those underwent LRC [hazards ratio (HR) = 2.303, 95% confidence intervals (CI): 1.625–3.265, P < 0.001].ConclusionPatients underwent RRC seemed to have significantly more numbers of lymph nodes harvested and higher risk for all-cause death and higher hospitalization costs compared with those underwent LRC. These findings suggest a need for careful consideration of the benefits and risks associated with robotic versus laparoscopic right colectomy in clinical practice.Trial registrationNot applicable.

Efficacy of multimodal analgesia based on the concept of enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer

Objective: To explore the effect of multimodal analgesia based on the concept of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic radical gastrectomy (LRG) for gastric cancer (GC). Methods: Clinical data of 128 patients undergoing LRG for GC, admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from March 2021 to March 2022, were retrospectively analyzed. Among them, 66 patients received a multimodal analgesic management based on ERAS (ERAS group), and 62 patients were treated with conventional mode of analgesia (control group). Pain levels, rehabilitation status, as well as inflammatory factors and stress response indicators before and after surgery were compared between the two groups. Results: There was no significant difference in baseline data between the two groups (P&gt;0.05). The postoperative pain and recovery in the ERAS group were better than those in the control group (P&lt;0.05). After the surgery, serum levels of tumor necrosis factor-alpha (TNF-α), Interleukin 6 (IL-6), and C-reactive protein (CRP) in both groups increased compared to before the surgery, but were significantly lower in the ERAS group compared to the control group (P&lt;0.05). After the surgery, serum malondialdehyde (MDA) and xanthine oxidase (XOD) levels in both groups increased, while superoxide dismutase (SOD) levels decreased compared to preoperative levels. The observed postoperative levels of serum MDA and XOD were significantly lower in the ERAS group, while the postoperative SOD levels were higher compared to the control group (P&lt;0.05). Conclusions: Patients undergoing LRG for GC can benefit from a multimodal pain management plan based on ERAS to reduce postoperative pain, alleviate inflammation, stress responses, and shorten the postoperative recovery process. doi: https://doi.org/10.12669/pjms.40.10.10088 How to cite this: Xu L, Yao L, Qin J, Xu H. Efficacy of multimodal analgesia based on the concept of enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer. Pak J Med Sci. 2024;40(10):2190-2195. doi: https://doi.org/10.12669/pjms.40.10.10088 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Characteristics of early cognitive development in children with Williams syndrome: a prospective cohort study

To investigate the early cognitive development characteristics of children with Williams syndrome (WS) at different age stages. From September 2018 to June 2023, 106 children diagnosed with WS at the Department of Pediatric Health Care, Children's Hospital, Zhejiang University School of Medicine, aged 1 to <5 years, were prospectively enrolled. All children underwent Gesell developmental diagnostic assessments to analyze the cognitive development characteristics of WS children across different age groups. The average age of the 106 WS children was (3.1±1.2) years; 58 were male, and 48 were female. There were no significant differences in developmental levels between males and females in the five domains of gross motor skills, fine motor skills, language, personal-social skills, and adaptive behavior (P>0.05). The incidence rates of mild, moderate, severe, and profound developmental disabilities among children of different age groups showed no significant differences (P>0.05). Comparisons of developmental levels in gross motor skills, language, personal-social skills, and adaptive behavior among different age groups were also not statistically significant (P>0.05). With the increase of age, the developmental level of fine motor skills showed a decreasing trend (P<0.05). There were no significant differences in verbal IQ and non-verbal IQ within each age group of WS children (P>0.05). The overall developmental level of WS children stabilizes with age, and their early language abilities do not significantly exceed their non-verbal abilities.