Volume 102 ·  Issue 47 ·  2022

In 2022, the World Health Organization proposed a new classification for pituitary adenomas. The major nomenclature change from the previous edition was the transition from"adenoma"to"pituitary neuroendocrine tumor"(PitNETs). The new classification provided the detailed histological subtypes of PitNETs for routine use of antibodies such as pituitary transcription factors (PIT1, TPIT, SF1, GATA3, and ERα) and hormones. The major PIT1, TPIT, and SF1 lineage-defined PitNETs types and subtypes featured distinct morphologic, molecular, and clinical differences. Unlike the 2017 WHO classification, the 2022 WHO version updated some concepts as follows: (1) Mammosomatotroph, acidophil stem cell tumors and mixed somatotroph/lactotroph tumor represented distinct PIT1-lineage PitNETs; (2) The diagnostic category of PIT1-positive plurihormonal tumor was replaced by the immature PIT1-lineage tumor and the mature plurihormonal PIT1-lineage tumor; (3) The term"metastatic PitNET"was advocated to replace the previous terminology"pituitary carcinoma". The new classification emphasizes the importance of pathological classification of PitNETs. Obviously, accurate pathological interpretation is the key to judge the clinical treatment pathway and prognosis of patients.

To investigate the effect of individualized positive end expiratory pressure (PEEP) setting guided by chest electrical impedance tomography (EIT) on the incidence of hypoxemia in elderly patients undergoing robot-assisted radical prostatectomy in the post anesthesia care unit (PACU).

From September 2020 to October 2021, sixty elderly patients, with the American Association of Anesthesiologists (ASA) of Grade Ⅰ to Ⅲ, who underwent selective robot-assisted radical prostatectomy under general anesthesia in the Cancer Hospital Affiliated to Fudan University were selected. The participants were divided into two groups by the minimum randomized grouping method: EIT-PEEP group (EP group, n=30) and fixed PEEP group (FP group, n=30). After completion of tracheal intubation and establishment of pneumoperitoneum flexion posture, the individualized PEEP setting was guided by EIT in EP group, and the PEEP setting in FP group was 5 cmH₂O (1 cmH₂O=0.098 kPa) to the end of operation. During the operation, the ventilation mode of pressure regulation volume control was adopted. The driving pressure, dynamic lung compliance (Cdyn), oxygenation index and hemodynamics were recorded at 5 min (T₁), 30 min (T₂), 60 min (T₃) after PEEP setting and at the time of tracheal catheter removal (T₄) in both groups. The primary end point was the incidence of hypoxemia in PACU after extubation.

The incidence of hypoxemia after extubation was 3.3% (1/30) in EP group and 26.7% (8/30) in FP group (P=0.030). The difference of driving pressure between the two groups at T₂ [(13.1±2.4) cmH₂O vs (14.9±2.9) cmH₂O, P=0.012], T₃ [(12.7±2.4) cmH₂O vs (15.6±2.8) cmH₂O, P<0.001] was statistically significant. In EP group, Cdyn was improved at T₂ [(38.4±7.2) ml/cmH₂O vs (31.9±5.2) ml/cmH₂O, P=0.006] and T₃ [(37.5±9.0) ml/cmH₂O vs (30.4±5.9) ml/cmH₂O, P=0.001]. In EP group, PaO₂/FiO₂ increased at T₁ [(465.7±84.5) mmHg vs (383.5±58.0) mmHg, 1 mmHg=0.133 kPa, P<0.001], T₂ [(504.7±105.8) mmHg vs (418.9±73.7) mmHg, P=0.001], T₃ [(520.7±92.2) mmHg vs (423.2±90.7) mmHg, P<0.001], T₄ [(368.7±42.0) mmHg vs (339.5±54.9) mmHg, P=0.024].

The individualized PEEP setting guided by EIT can reduce the incidence of hypoxemia in elderly patients undergoing robot assisted radical prostatectomy in PACU.

To investigate the risk factors of intestinal infarction caused by acute mesenteric ischemia (AMI), and develop and validate a clinical prediction model of Nomogram plot for intestinal infarction caused by AMI.

From January 2014 to December 2020, 201 patients with AMI in the Affiliated Hospital of Yunnan University were selected as the modeling group, and 105 patients with AMI in the First Affiliated Hospital of Kunming Medical University were collected as the validation group. The age of patients in the modeling group was (62±12) years, and there were 70 males and 131 females. The age of patients in the validation group was (62±10) years old, and there were 69 males and 36 females. The clinical data including clinical manifestations, laboratory indicators and imaging indicators of patients in the two groups were retrospectively analyzed, and univariate and multivariate binary logistic regression analyses were performed to screen out risk factors for the progression of AMI to intestinal infarction. A Nomogram plot clinical prediction model for AMI causing intestinal infarction was developed using R software, and the differentiation, calibration and net clinical benefit of this Nomogram plot were evaluated by C-index, calibration curve and clinical decision analysis curve.

Shock (OR=13.69, 95%CI: 2.31-88.87), body temperature ≥38.0 ℃ (OR=6.39, 95%CI: 1.85-22.11), white blood cells (WBC) ≥18×10⁹/L (OR=1.19, 95%CI: 1.03-1.37), intestinal changes on CT (OR=0.17, 95%CI: 0.04-0.66), peritoneal irritation (OR=0.06, 95%CI: 0.01-0.26), and pH≤7.34 (OR=0.00, 95%CI: 0.00-0.01) were risk factors for intestinal infarction caused by AMI. Body temperature ≥38.0 ℃ (sensitivity: 81.5%, specificity: 87.0%), WBC ≥18×10⁹/L (sensitivity: 84.0%, specificity: 83.0%) and pH ≤7.34 (sensitivity: 70.4%, specificity: 76.7%) were cut-off values for progression to intestinal infarction in patients with AMI. The Nomogram plot prediction model of intestinal infarction induced by AMI was established by using the above parameters and validated internally and externally. The C index of validation group and modeling group were 0.96 (95%CI: 0.921-0.999) and 0.98 (95%CI: 0.962-0.996), respectively. The calibration curves of the validation group and the modeling group were shaped near the reference line, and the deviation from the reference line was low. The clinical decision analysis curves of validation group and modeling group showed that the clinical prediction model of Nomogram could bring better clinical net benefit for AMI patients.

Shock, temperature, white blood cells, intestinal changes on CT, peritoneal irritation sign, and PH are independent risk factors for AMI-induced intestinal infarction. The Nomogram plot established by these factors can effectively predict the probability of AMI patients progressing to intestinal infarction.

To explore the diagnostic value of different serological markers and the correlation with disease phenotype in inflammatory bowel disease (IBD).

The clinical data of 445 IBD patients in Peking Union Medical College Hospital from June 2010 to December 2020 were retrospectively collected, including 223 cases of ulcerative colitis (UC) [111 males, 112 females, with a median age of 46(20,79) years] and 222 cases of Crohn′s disease (CD) [147 males, 75 females, with a median age of 39 (19, 72) years]. The positive rates of serum anti-neutrophil cytoplasmic antibodies (ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), goblet cell autoantibodies (GAB) and pancreatic autoantibodies (PAB) in the two groups were analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of UC and CD were calculated. Logistic regression was performed to analyze the relationship between different combinations of antibodies and disease phenotype.

The positive rates of ASCA and PAB in CD patients were 34.7% (77/222) and 38.3% (85/222), respectively, which were higher than those in UC patients [10.3% (23/223) and 4.5% (10/223), P<0.001]. The positive rate of ANCA in UC patients was 50.2% (112/223), which was higher than that in CD patients [5.4% (12/222), P<0.001]. The positive rates of serum GAB in CD and UC patients were 21.6% (48/222) and 28.3% (63/223), respectively, with no significant difference (P=0.760). In patients with CD, the sensitivity of mono-marker ASCA (+), dual-marker ASCA (+) ANCA (-), quadruple-marker ASCA (+) ANCA (-) PAB (+) GAB (-) in diagnosing CD was 34.7%, 32.9%, 20.7%, the specificity was 89.7%, 95.5%, 100.0%, the positive predictive value was 77.0%, 90.1%, 100.0%, and the negative predictive value was 58.0%, 58.7%, 55.9%, respectively. In patients with UC, the sensitivity of mono-marker ANCA (+), dual-marker ANCA (+) ASCA (-), quadruple-marker ANCA (+) ASCA (-) PAB (-) GAB (+) in diagnosing UC was 50.2%, 40.4%, 24.2%, the specificity was 94.6%, 95.5%, 100.0%, the positive predictive value was 90.3%, 90.0%, 100.0%, and the negative predictive value was 65.4%, 61.4%, 56.8%, respectively. Mono-marker ASCA (+) (OR=3.39, 95%CI: 1.59-7.21), dual-marker ASCA (+) ANCA (-) (OR=2.87, 95%CI: 1.34-6.14), triple-marker ASCA (+) ANCA (-) GAB (-) (OR=3.09, 95%CI: 1.31-7.31) and quadruple-marker ASCA (+) ANCA (-) PAB (+) GAB (-) (OR=3.15, 95%CI: 1.56-8.03) were associated with stenosis and/or penetrating type CD. The mono-marker ANCA (+) (OR=2.69, 95%CI: 1.42-5.12) and dual-marker ANCA (+) ASCA (-) (OR=2.11, 95%CI: 1.03-4.16) were associated with extensive colonic lesions in UC.

Based on ASCA or ANCA, the combination with PAB or GAB, is conducive to IBD diagnosis, and is associated with stenosis and/or penetrating type of CD and extensive type of UC.

To explore the relationship between left ventricular artery coupling and left ventricular work in patients with septic shock, and further clarified their predictive value for the prognosis of septic shock.

In total, 56 patients with septic shock admitted in the Department of Critical Care Medicine of Peking Union Medical College Hospital were retrospectively enrolled between January 2016 and July 2021. The hemodynamic indexes and clinical data monitored by pulse indicator continuous cardiac output (PICCO) at different time points were collected. To reveal alterations of arterial elastance index (EaI), end-systolic elastance index (EesI), EaI/EesI, stroke work (SW), total cardiac function (PVA), and left ventricular ejection efficiency (LVEf) in patients with septic shock at different time points. The patients were divided into the death group (n=20) and survival group (n=36) according to the outcome of the ICU. The relationship between left ventricular work and left ventricular arterial coupling and its prognostic value were statistically analyzed.

A total of 56 patients were enrolled, 32 males and 24 females, aged (61±15) years. There was a significantly difference in EaI/EesI and LVEf between survivors and non-survivors with septic shock at 6 h (P<0.05). Further analysis showed that the correlation between EaI/EesI and LVEf was most evident at 6 h after intervention. EaI/EesI was negatively correlated with SW (r_s=-0.500, P<0.001), and highly negative with LVEf (r_s=-0.959, P<0.001). Both univariate logistic regression and multivariate regression analysis showed that EaI/EesI (adjusted OR=42.783, 95%CI: 2.725-671.819, P=0.008) and LVEf (adjusted OR=2.293, 95%CI:1.222-4.301, P=0.010) were risk factors for ICU prognosis of patients with septic shock. The receiver operating characteristic (ROC) curve analysis showed that EaI/EesI [area under the curve (AUC)=0.742±0.083, P=0.004; cut-off value 6.10, sensitivity 88.9%, specificity 65.0%] and LVEf (AUC=0.733±0.084, P=0.006; cut-off value 0.24, sensitivity 88.8%, specificity 60.0%) were both effective indicators for predicting the prognosis of patients with septic shock in the ICU. Moreover, EaI/EesI had a better prognosis value than LVEf (ΔAUC=0.120, Z=6.528, P=0.036).

It′s indicated that EaI/EesI was significantly correlated with SW and LVEf after 6 h of septic shock intervention; EaI/EesI and LVEf are risk factors and effective predictors of ICU prognosis in patients with septic shock. The predictive efficacy of EaI/EesI is greater than LVEF.

To identify clinical subphenotypes of sepsis by clinical variables, and the association between fluid balance (FB) and outcomes in sepsis patients with different subphenotypes.

Data were derived from China Critical Care Sepsis Trial. A total of 2 075 patients were included in the study, with a mean age of (62.5±17.4) years, 1 362 (65.6%) were male, 713 (34.3%) were female. In-hospital mortality was the primary outcome. Clinical variables were entered into the latent profile analysis (LPA) model which was used to identify the subphenotypes of sepsis. Multivariable logistic regression model was used to explore the association of FB on the first 2 days admitted to ICU and in-hospital mortality.

Total of 687 (33.1%) patients died in the hospital. Four subphenotypes of sepsis were identified by the PLA model: 1 421 (68.5%) patients were identified as profile 1, which was characterized by the lowest in-hospital mortality (28.3%, 402/1 421) and was considered as the baseline subphenotype; profile 2 was characterized by multiple organ dysfunction(232, 11.2%); profile 3 was characterized by respiratory dysfunction (196, 9.4%) and profile 4 was characterized by kidney injury/failure (226, 10.9%). Profile 2 showed the highest in-hospital mortality (54.3%, 126/232), followed by profile 4 (39.4%, 89/226), profile 3 (35.7%, 70/196). Profile 2 had the highest FB of 68.5(34.7, 89.4)ml/kg on day 1 and decreased rapidly to 29.4(13.6, 49.8) ml/kg on day 2. Multivariable analysis showed that for every 10 ml/kg of FB increased on the first 48 hours admitted to ICU, the risk of in-hospital mortality decreased 14% (OR=0.86, 95%CI: 0.81-0.97) in profile 2, and increased 4% (OR=1.04, 95%CI:1.02-1.07) in profile 4. However, there were no significant association between FB on the fist 2 days admitted to ICU and the risk of in-hospital mortality in profile 1 (OR=1.06, 95%CI: 0.94-1.19)and in profile 3 (OR=0.99, 95%CI: 0.94-1.05).

Four subphenotypes of sepsis were identified according to the clinical variables, which showed different characteristics, distributions, outcomes and responses to fluid balance.

To investigate the characteristics of gut microbiota in type 2 diabetes mellitus (T2DM) patients with hypertriglyceridemia (HTG).

Eighty-one patients first diagnosed with T2DM were enrolled in the Third Xiangya Hospital of Central South University from January 2018 to December 2020, including 58 patients [46 males and 12 females, aged (43±13) years] with HTG [HTG group, triglyceride (TG)≥1.7 mmol/L]. There were 23 cases without HTG (NTG group), including 20 males and 3 females, aged (46±13) years. According to the severity of HTG, the patients of HTG group were divided into severe HTG group (STG group, TG ≥5.6 mmol/L) and mild HTG group (MTG group, 1.7 mmol/L≤TG<5.6 mmol/L). Thirty healthy controls were matched accordingly, including 21 males and 9 females, aged (45±6) years. Clinical laboratory indicators and feces of the subjects were collected and 16S rRNA sequencing was performed to compare the differences in intestinal flora among the groups.

The Shannon and Simpson indexes in HTG group were lower than those in NTG group and healthy control group (5.02±0.91 vs 5.45±0.55 and 5.60±0.63, P=0.003; 0.90±0.06 vs 0.93±0.04, 0.94±0.04, P=0.002). Compared with healthy control group and NTG group, the abundance of intestinal P_Proteobacteria, g_Escherichia_Shigella, s_Escherichia_Coli and g_Clostridium_sensu_stricto_1 increased in HTG group, while the abundance of p_Firmicutes, g_Faecalibacterium and Faecalibacterium_prausnitzii decreased. The abundance of g_Clostridium_sensu_stricto_1 in the STG group was higher than that of NTG and MTG groups, while the abundance of g_Faecalibacterium decreased. Spearman correlation analysis suggested that g_Clostridium_sensu_stricto_1 was positively correlated with glycosylated hemoglobin (r=0.22, P=0.044), fasting blood glucose (r=0.36, P=0.001), TG (r=0.27, P=0.015) and total cholesterol (r=0.44, P<0.001). Logistic regression analysis indicated that g_Faecalibacterium was a protective factor for T2DM with HTG(OR=0.90, 95%CI:0.83-0.97, P=0.006).

The intestinal flora of T2DM patients with HTG was dysregulated, which was manifested as decreased diversity, increased abundance of P_Proteobacteria and decreased abundance of p_Firmicutes. g_Faecalibacterium is a protective factor for T2DM with HTG.

To explore the efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy (TON).

The clinical data of 47 children with TON treated with endoscopic optic nerve decompression in the Department of Neurosurgery of Beijing Tongren Hospital from November 2010 to October 2021 were retrospectively analyzed, and the visual acuity before and after treatment was compared. The clinical factors were taken as independent variables, and visual improvement was taken as dependent variable for multivariate Cox regression analysis to observe the factors that may affect the efficacy.

There were 47 patients in this study, including 35 males and 12 females, and the age ranged from 3.0 to 12.0 (7.2±2.3) years. After surgery and hormone treatment, 28 (59.6%) cases obtained visual improvement. Univariate analysis showed that the improvement rate of visual acuity in patients with residual vision after injury was higher than that in patients without vision [85.0% (17/20) vs 40.7% (11/27), P=0.002], while the improvement rate of visual acuity in patients with dislocated optic canal fracture was lower than that in those without fracture [42.1% (8/19) vs 71.4% (20/28), P=0.044]. The improvement rate of visual acuity in patients with operation time interval ≤7 d was higher than that in patients with operation time interval>7 d [80.8% (21/26) vs 33.3% (7/21), P=0.001]. Multivariate Cox regression analysis showed that post-traumatic residual visual acuity (HR=3.805, 95%CI: 1.087-13.318, P=0.037) and operation time interval≤7 d (HR=2.883, 95%CI: 1.084-7.662, P=0.034) were protective factors for post-surgical visual acuity.

Endoscopic optic nerve decompression can effectively improve the visual acuity of children with TON. Post-traumatic residual visual acuity and operation time interval ≤7 d are independent protective factors for post-surgical visual acuity.

To analyze the clinical characteristics and risk factors of periventricular-intraventricular hemorrhage (PIVH) in extremely low birth weight infants (ELBWI).

From January 2019 to January 2022, the clinical data of 238 ELBWI admitted to the intensive care unit of Henan Provincial Children′s Hospital within 1 week after birth and regular head color ultrasound examination were retrospective reviewed. The infants were divided into PIVH group and non-PIVH group according to whether PIVH occurred. The incidence and time of PIVH were described, and the differences in basic clinical features, perinatal conditions, postnatal treatment and complications between the two groups were compared. The risk factors of PIVH in ELBWI were further explored by multivariate binary logistic regression analysis.

Among 238 ELBWI (146 males and 92 females), 82 cases (34.5%) developed PIVH, including 28 cases (11.8%) of severe PIVH and 54 cases (22.7%) of mild PIVH. Among the 82 cases of PIVH, 68 cases occurred within 3 days after birth. Gestational age [(27.4±1.5) weeks vs (27.8±1.5) weeks, P=0.012], gestational diabetes mellitus [0 vs 9.0%(14/156), P=0.005], fibrinogen (FIB) [(1.8±0.5) g/L vs (2.7±0.9) g/L, P=0.012] were lower in PIVH group than in non-PIVH group. However, intrauterine distress [46.3%(38/82) vs 11.5%(18/156), P<0.001], birth asphyxia [85.4%(70/82) vs 62.8%(98/156), P<0.001], patent ductus arteriosus (PDA) [65.9%(54/82) vs 51.3%(80/156）, P=0.017], failure to withdraw invasive ventilator within 1 week [82.9%(14/82) vs 67.3%(105/156), P=0.010], use of vasoactive drugs within 1 week [28.0%(23/82) vs 15.4%(24/156), P=0.020], acidosis [28.0%(23/82) vs 12.2%(19/156), P=0.002], and hemorrhagic disease [18.3%(15/82) vs 7.1%(11/156), P=0.008] were higher in PIVH group than in non-PIVH group. Multivariate binary logistic regression analysis found that the risk factors for PIVH in ELBWI were acidosis (OR=2.257, 95%CI: 1.104-4.614, P=0.026), use of vasoactive drugs within 1 week (OR=2.274, 95%CI: 1.148-4.504, P=0.018), bleeding disorders (OR=2.583, 95%CI: 1.075-6.206, P=0.034) use of vasoactive drugs within 1 week (OR=2.301, 95%CI: 1.153-4.591, P<0.001).

The incidence of PIVH in ELBWI is high, which mostly occurs within 3 days after birth. Acidosis, hemorrhagic disease, use of vasoactive agents within 1 week and failure to evacuate invasive ventilators within 1 week may increase the risk of PIVH in ELBWI.

To evaluate the value of clear cell likelihood score (ccLS) in identifying renal oncocytoma (RO) and clear cell renal cell carcinoma (ccRCC).

Retrospective data of pathologically confirmed 43 RO patients [24 men and 19 women, aged 22-77 (54±14) years] between February 2008 and September 2021 and 43 ccRCC patients [30 men and 13 women, aged 29-78 (56±12) years] between May and July 2021 were consecutively included in the department of radiology, Chinese PLA General Hospital. Two radiologists used ccLS to assess each case independently, and disagreements were resolved by consensus. The ability of ccLS to identify RO and ccRCC was examined by the receiver operating characteristic (ROC) curve which identified the best optimal diagnostic cut-off values, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value.

The mean tumor diameter was 3.8 cm in RO patients and 3.7 cm in ccRCC patients. Central scar and segmental enhancement inversion (SEI) were more frequently observed in the RO group compared to the ccRCC group [53.5% (23∶43) versus 11.6% (5∶43) and 41.9% (18∶43) versus 7.0% (3∶43), respectively], with statistical differences (P<0.001). The ccLS scores in the RO group ranged from 1 to 4, while 79.0% of the cases were 3. The ccLS scores in the ccRCC group ranged from 2 to 5, while 72% of the cases were 4. The scores of the two groups were statistically different (P<0.001). The ccLS showed the best performance when the threshold was 4 according to the ROC curve. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ccLS for distinguishing RO from ccRCC were 83.7%, 90.7%, 87.2%, 90.0%, and 84.8%, respectively, and the area under the ROC curve value was 0.879.

The ccLS has credible sensitivity and specificity in differentiating renal oncocytoma from clear cell carcinoma, which may be helpful for the preoperative diagnosis.

Herein, the clinical data of 20 patients with pontine hemorrhage were retrospectively analyzed. All the patients underwent surgery via infratemporal-prepetrosal approach between January 2013 and June 2021 in the Department of Neurosurgery from the First Affiliated Hospital of Soochow University. There were 15 males and 5 females. The age ranged from 32 to 69 years, with an average age of 47.9 years. The course of disease was 3.5-16.0 h, with an average of 6.7 h. All the patients underwent surgery successfully. The hematomas of 17 patients were completely removed while the hematomas of the other 3 patients were partially removed. One patient died of multiple organ dysfunction syndrome during 30 days follow-up after surgery. The other patients were evaluated by Glasgow outcome scale (GOS), and the results showed that 1 patient was in Grade 5, 7 patients were in Grade 4, 6 patients were in Grade 3, 4 patients were in Grade 2, and 2 patients were in Grade 1. The surgery via infratemporal-prepetrosal approach is a safe, reasonable and feasible treatment for pontine hemorrhage. Especially for the patients who were younger than 50 years old, with high preoperative Glasgow Coma Scale (GCS) grade and surgical indications. This surgical technique can effectively reduce the mortality and improve the prognosis of patients with pontine hemorrhage. Moreover, patients should be operated within 6 hours after pontine hemorrhage as soon as possible.

This paper reports the diagnosis and treatment of a patient with abdominal distension, hepatosplenomegaly, increased polyclonal immunoglobulin and pancytopenia as clinical characteristics. The patient, a 38-year-old male, was admitted to the Department of Hematology, Peking University People's Hospital in December 2021 due to "abdominal distension and fatigue for more than 2 months". The patient was misdiagnosed as multiple myeloma in a foreign hospital. After being admitted to Peking University People's Hospital, after detailed laboratory examination and pathological examination, as well as multidisciplinary consultation and discussion, the evidence of autoimmune hepatitis was considered insufficient. As the patient was from Yangquan, Shanxi Province, the screening of protozoa infection was further improved, and the results showed that Leishmania IgG antibody (serum rK39 antibody) was positive, and peripheral blood metagenomic sequencing confirmed that it was infantile Leishmania infection, and it was diagnosed as visceral leishmaniasis. After being transferred to a specialist hospital in January 2022, he received the "six-day regimen" of antimony sodium gluconate, and the patient's symptoms of fatigue and abdominal distension gradually improved. At the last follow-up in May 2022, the patient's abdominal physical examination showed no palpation of liver and spleen subcostal, and no subsequent bone marrow etiology was reviewed. In recent years, the incidence of this disease in China has been significantly reduced, and it is easy to be ignored. Moreover, this patient lacks characteristic clinical manifestations, so we should be vigilant in the process of clinical diagnosis and treatment.

This study reported a 65-year-old male with programmed death receptor-1 (PD-1) inhibitor-related neuroimmune overlap syndrome. The main manifestations were eyelid ptosis, general limb weakness, and sensory impairment. After auxiliary examination, the lesions were considered to involve intracranial, spinal cord and peripheral nerves. The symptoms improved after discontinuation of PD-1 inhibitor and glucocorticoid treatment. For immune checkpoint inhibitor (ICIs) -related neurological adverse reactions (NirAEs), hormonal therapy can be given at the same time as ICIs are stopped, and follow-up evaluation can be made.

Diabetic retinopathy (DR) is a preventable and controllable blinding eye disease. At present, the prevalence of DR is increasing, and its prevention and treatment are facing significant challenges. Recent studies have shown that DR is related to negative psychology, and some progress has been made in the research of DR accompanied by anxiety and depression, but the specific mechanism of the interaction between DR and anxiety and depression has not been clarified. This article reviews the recent research progress of DR and anxiety and depression in clinical, mechanism and influencing factors, and provides new ideas for exploring the multi-factor regulation mechanism of DR, early screening and prevention, and strengthening the health management of diabetes.