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Fei Zhou,1,2 Liyuan Liu,1,2 Fei Wang,1,2 Lixiang Yu,1,2 Yujuan Xiang,1,2 Chao Zheng,1,2 Shuya Huang,1,2 Zhen Yang,1 Zhigang Yu1,2 1Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 2Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of ChinaCorrespondence: Zhigang Yu, Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China, Tel +86-531-85875048, Email yzg@medmail.com.cnPurpose: Periductal mastitis (PDM) is a chronic inflammatory lesion of the breast with an unknown etiology, and it is difficult for clinicians to differentiate it from granulomatous lobular mastitis (GLM), although they have different treatment strategies and prognosis. This study aimed to investigate the differences in their clinicopathologic features to inform treatment strategies.Patients and Methods: Between 2011 and 2020, 121 patients diagnosed with PDM and 57 patients with GLM were retrospective analysis. Patient data were extracted on demographics, clinical presentation, pathologic characteristics, treatments and clinical response. Histopathological evaluations were performed on core needle biopsy specimens. Immunohistochemical stains using antibodies against CD3, CD4, CD8, CD20, and CD138 was performed to define immune cell infiltration.Results: PDM patients had a higher median age compared to GLM patients (38 vs 32, p< 0.001). PDM was primarily located in the areolar area, while GLM predominantly affected the peripheral quadrant of the breast (56.20% vs 75.44%, p< 0.001). Histopathologically, more ductal dilatation (90.08% vs 3.51%, p< 0.001), ductal wall thickening (47.93% vs 1.75%, p< 0.001), and ductal rupture (44.63% vs 5.26%, p< 0.001) were observed in PDM. GLM presented with significantly more granuloma (94.74% vs 10.74%, p< 0.001), microabscess (68.42% vs 28.93%, p< 0.001), and lipid vacuole (40.35% vs 8.26%, p< 0.001) formation than PDM. Immunohistochemical analysis revealed a significant presence of CD20+ B lymphocytes in PDM and a higher prevalence of CD8+ T lymphocytes in GLM, indicating differing immune responses. Treatment outcomes varied, with PDM patients responding well to surgery and anti-mycobacterial therapy, while GLM patients showed favorable responses to steroid therapy.Conclusion: PDM is a specific entity with a similar clinical presentation but distinct histopathological features and immune profiles to GLM. Further research is needed to elucidate the pathogenesis and optimize therapeutic approaches for these breast inflammatory conditions.Keywords: etiology, granulomatous lobular mastitis, immunology, pathology, periductal mastitis

Liuping Cui,1,2 Ran Liu,1 Fubo Zhou,1 Yumei Liu,1 Bing Tian,1 Ying Chen,2,&ast; Yingqi Xing1,3,4,&ast; 1Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Neurology, The First Hospital of Jilin University, Changchun, People’s Republic of China; 3Beijing Diagnostic Center of Vascular Ultrasound, Beijing, People’s Republic of China; 4Center of Vascular Ultrasound, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yingqi Xing, Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, 45 Changchun Road, Beijing, Xicheng District, 100053, People’s Republic of China, Tel +86-18610047846, Email xingyq2009@sina.comPurpose: Intraplaque neovascularization, assessed using contrast-enhanced ultrasound (CEUS), is associated with ischemic stroke. It remains unclear whether detection of intraplaque neovascularization combined with color Doppler ultrasound (CDUS) provides additional value compared with CDUS alone in assessing ischemic stroke risk. Therefore, we investigated the clinical value of combined CEUS, CDUS, and clinical features for ischemic stroke risk stratification.Patients and Methods: We recruited 360 patients with ≥ 50% carotid stenosis between January 2019 and September 2022. Patients were examined using CDUS and CEUS. Covariates associated with ischemic stroke were identified using multivariate logistic regression analysis. The discrimination and calibration were verified using the C-statistic and Hosmer–Lemeshow test. The incremental value of intraplaque neovascularization in the assessment of ischemic stroke was analyzed using the Delong test.Results: We analyzed the data of 162 symptomatic and 159 asymptomatic patients who satisfied the inclusion and exclusion criteria, respectively. Based on multivariate logistic regression analysis, we constructed a nomogram using intraplaque neovascularization, degree of carotid stenosis, plaque hypoechoicity, and smoking status, with a C-statistic of 0.719 (95% confidence interval [CI]: 0.666– 0.768) and a Hosmer–Lemeshow test p value of 0.261. The net reclassification index of the nomogram was 0.249 (95% CI: 0.138– 0.359), and the integrated discrimination improvement was 0.053 (95% CI: 0.029– 0.079). Adding intraplaque neovascularization to the combination of CDUS and clinical features (0.672; 95% CI: 0.617– 0.723) increased the C-statistics (p=0.028).Conclusion: Further assessment of intraplaque neovascularization after CDUS may help more accurately identify patients at risk of ischemic stroke. Combining multiparametric carotid ultrasound and clinical features may help improve the risk stratification of patients with ischemic stroke with ≥ 50% carotid stenosis.Plain Language Summary: We studied whether using contrast-enhanced ultrasound (CEUS) to detect intraplaque neovascularization could help better determine the risk of ischemic stroke. We compared the combined use of color Doppler ultrasound (CDUS) and CEUS with CDUS alone in patients with more than 50% carotid narrowing. Our findings showed that combining clinical details, CDUS, and CEUS was more effective (0.719 vs 0.672). This means that CEUS provides extra insight when gauging ischemic stroke risk compared with CDUS alone. This could help in accurately identifying patients at high risk of stroke. However, more extensive studies are needed to fully understand the role of these tests in the evaluation of stroke risk. Keywords: atherosclerosis, contrast-enhanced ultrasound, vulnerable plaque, carotid ultrasound

Chaoe Zhou,1,&ast; Jun Li,2,&ast; Fude Zhou,3 Lei Huang,4 Xinmin Liu,1 Haichao Li5 1Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China; 3Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 4Department of Clinical Laboratory, Peking University First Hospital, Beijing, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xinmin Liu, Department of Geriatrics, Peking University First Hospital, Tel +86-10-8357-2128, Beijing, 100034, People’s Republic of China, Email lxm2128@163.com Haichao Li, Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Tel +86-10-8357-2128, Beijing, 100034, People’s Republic of China, Email lhch91767@sina.comAbstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an acute, rare and potentially fatal drug reaction. To date, limited studies have reported secondary Pneumocystis jirovecii pneumonia (PJP) infection during the treatment of DRESS syndrome. A 53-year-old man was admitted to the hospital due to a persistent fever lasting for 5 days. He had a medical history of hypertension, psoriasis, urticaria, and had recently been treated with carbamazepine for nerve spasm two weeks ago. After admission, the patient presented with a high fever accompanied by chills, abdominal pain, bilateral upper limb muscle pain, and generalized lymph nodes enlargement. Laboratory tests revealed elevated eosinophils and atypical lymphocytes. Subsequently, the patient developed multiple internal organ complications, including oliguria, elevated serum creatinine, liver enzymes, and cardiac troponin I. Based on diagnostic criteria, the patient was diagnosed with DRESS syndrome. To manage the DRESS syndrome, the patient was successively or simultaneously prescribed methylprednisolone, cyclosporin and intravenous immunoglobulin, resulting in an improvement of the condition. However, during the treatment, the patient was infected with Pneumocystis jirovecii. Despite targeted therapy with trimethoprim/sulfamethoxazole, primaquine and clindamycin successively, no remission was observed. Chest CT scans exhibited multiple exudations in both lungs, indicative of interstitial pneumonia. Unfortunately, the patient’s oxygenation progressively declined, leading to his untimely demise. This rare case further highlights the need for clinicians to be aware of the risk of Pneumocystis jirovecii infection in DRESS syndrome patients treated with long-term and high-dose glucocorticoid therapy.Keywords: DRESS syndrome, Pneumocystis jirovecii pneumonia, carbamazepine, glucocorticoid therapy, case report

Hongxia Wang,1,&ast; Fating Zhou,2,&ast; Zhilin Li,1 Yulan Ding,1 Qian Wen,1 Quanxing Tang1 1Department of General Practice, People’s Hospital of Deyang City, Deyang, Sichuan, People’s Republic of China; 2Emergency Department, Chongqing Emergency Medical Center, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongxia Wang, Department of General Practice, People’s Hospital of Deyang City, Deyang, Sichuan, People’s Republic of China, Email HongXia.W@hotmail.comBackground: Streptococcus constellatus rarely causes pyopneumothorax, which is a serious state and requires a surgery. However, not every patient can tolerate surgery and individualized solutions are needed. Furthermore, many known situations are risk factors of S. constellatus infection, but S. constellatus pyopneumothorax associated with Hashimoto’s thyroiditis has not been reported.Case Presentation: We present the case of a 74-year-old male with multiple encapsulated pyopneumothorax caused by S. constellatus. Given his respiratory failure, we provided two-stage percutaneous right empyema radiography for catheter drainage in the radiology interventional department instead of surgery. Moreover, an occult Hashimoto’s thyroiditis was discovered in the patient, which was possibly associated with S. constellatus pyopneumothorax. Levothyroxine was administered to improve his situation.Conclusion: To our knowledge, it is the first case described in this context. We provided an alternative treatment for S. constellatus encapsulated pyopneumothorax in patient who might not tolerate surgery. We also revealed the possible relationship between S. constellatus pyopneumothorax and Hashimoto’s thyroiditis.Keywords: radiology interventional, Streptococcus constellatus, pyopneumothorax, Hashimoto’s thyroiditis

Ju Kuang, Zhihai Luo, Fu Zhou Department of Respiratory and Critical Care Medicine, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Fu Zhou, Tel +86-17702395630, Email 1163629567@qq.comAbstract: A 66-year-old male patient diagnosed with small-cell lung cancer received chemotherapy and immunotherapy, resulting in successful tumor control. However, the patient subsequently experienced a fever and rapid progression of the pulmonary cavity. Despite sampling bronchoscopic bronchoalveolar lavage fluid for targeted next-generation sequencing (tNGS), the cause remained unidentified. Adding bronchoalveolar lavage fluid to sense metagenomic next-generation sequencing (mNGS) confirmed the infection caused by actinomycetes. The patient’s condition improved after active anti-infection treatment. This case was further analyzed and discussed through a comprehensive literature review, focusing on molecular microbiological diagnosis and treatment processes. The points outlined were as follows: the advancement of molecular microbiology has gradually reduced the challenges associated with diagnosing rare infectious diseases such as pulmonary actinomycosis. Additionally, in immunodeficient individuals, certain infectious diseases with a chronic course may exhibit acute and aggressive characteristics, which is of concern to all colleagues. Currently, tNGS and mNGS are widely employed in clinical settings as practical tools for diagnosing infectious diseases. Notably, these two methods are not substitutes for each other but complement each other.Keywords: pulmonary actinomycosis, lung cancer, targeted next-generation sequencing, metagenomic next-generation sequencing

Ziyun Wang,1,2,&ast; Yao Wang,1,2,&ast; Yuqi Ji,1,2 Ziwei Yang,1,2 Yixiu Pei,3 Jiankun Dai,4 Yong Zhang,5 Fuqing Zhou1,2 1Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, 330006, People’s Republic of China; 2Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, People’s Republic of China; 3Department of Radiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, People’s Republic of China; 4MR Advanced Application, GE Healthcare, Beijing, 100176, People’s Republic of China; 5Department of Pain Clinic, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, 330006, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yong Zhang, Department of Pain Clinic, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +86 791 8869 5036, Email zy830226@163.com Fuqing Zhou, Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng, Street, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +86 791 8869 5132, Email ndyfy02301@ncu.edu.cnPurpose: To explore resting-state functional connectivity (rsFC) of the amygdala in patients with low-back-related leg pain (LBLP).Patients and Methods: For this prospective study, a total of 35 LBLP patients and 30 healthy controls (HCs) were included and underwent functional MRI and clinical assessments. Then, patients with LBLP were divided into acute LBLP (aLBLP) and chronic LBLP (cLBLP) subgroups. We further evaluated the between-group rsFC differences using left and right amygdala seeds in a whole-brain voxel analysis strategy. Finally, we performed correlation analysis between the rsFC values of altered regions and clinical indices.Results: Compared to HCs, hypoconnectivity of the amygdala was observed in LBLP patients (P < 0.01, with correction). The amygdala’s rsFC pattern was different between aLBLP and cLBLP patients: decreased the amygdala’s FC to the right putamen, to the right paracentral lobule (PCL), or to the right posterior temporal lobe in aLBLP patients, while right amygdala to the bilateral anterior cingulate cortex (ACC) and the left postcentral gyrus (PoCG) in cLBLP patients. Correlation analysis showed that lower rsFC of the left amygdala to the right PCL was correlated with the von Frey filament (vF) test values of the left lumbar (p = 0.025) and right lumbar (p = 0.019) regions, and rsFC of the right amygdala to the left PoCG was correlated with lower vF test values of the left lumbar (p = 0.017), right lumbar spine (p = 0.003); to right PoCG was correlated with calf (p = 0.015); the rsFC of the right amygdala to bilateral ACC was negatively correlated with the pain rating index (p = 0.003).Conclusion: LBLP patients showed amygdala hypoconnectivity, and the altered pattern of amygdala rsFC was different in the acute and chronic phases. Moreover, the amygdala hypoconnectivity was related to individual mechanical sensitivity (vF test) in LBLP patients.Keywords: amygdala, resting-state functional MRI, low-back-related leg pain, acute pain, chronic pain

Qiuying Qin,1,2,&ast; Xiaoxuan Kou,1,2,&ast; Yuanyuan Zheng,1,2 Fei Zhou,1,2 Xiaoyong Zhang,1,2 Hongyan Liu1,2 1State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China; 2Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaoyong Zhang; Hongyan Liu, Email xiaoyzhang@smu.edu.cn; liuhongyan205628@163.comPurpose: In recent years, a new therapeutic approach, known as immune checkpoint blockade (ICB), has been proposed as approach to improve outcomes in patients with intermediate stage (Barcelona Clinic Liver Cancer, BCLC B) or advanced stage (BCLC C) hepatocellular carcinoma (HCC). Unfortunately, only a select patients can benefit from ICB. Hence, biomarkers that can predict the success and survival of treatment are still necessary.Patients and Methods: Between 2018 to 2021, 132 patients received ICB treatment for intermediate or advanced stage HCC. Based on the early kinetics of C-reactive protein (CRP), the patients were classified into three groups. The study endpoints were progression-free survival (PFS) and overall survival (OS).Results: Our findings support the predictive power of early CRP kinetics in determining immunotherapy response for intermediate or advanced HCC. Objective response rates (ORR) were found in 41.2% of CRP flare-responders, 13.3% of CRP responders, and 3.5% of CRP non-responders (p< 0.001). Disease control rates (DCR) in the three groups were substantially different (p< 0.001). The improved PFS and OS were strongly correlated with the early kinetics of CRP. Compared to CRP non-responders, CRP responders, especially CRP flare-responders, had significantly longer PFS (median PFS: CRP flare-responders: 11.6 months vs CRP responders: 5.2 months vs CRP non-responders: 2.3 months, p< 0.001).Conclusion: The CRP flare response robustly predicts the immunotherapy response and outcomes in patients with HCC. Early CRP kinetics may be an inexpensive, easily implemented and non-invasive biomarker to anticipate response to ICB therapy in intermediate or advanced HCC, with the potential to optimize treatment monitoring.Keywords: hepatocellular carcinoma, C‐reactive protein kinetics, CRP flare response, immune checkpoint blockade, biomarker, immunotherapy

Zhaobing Pan,1– 3,&ast; Qiaoshan Yang,1– 3,&ast; Xiaojing Zhang,1– 3 Xiaoqing Xu,1– 3 Yao Sun,1– 3 Fusheng Zhou,1– 4 Leilei Wen1– 3 1Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, People’s Republic of China; 2Institute of Dermatology, Anhui Medical University, Hefei, Anhui, People’s Republic of China; 3Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People’s Republic of China; 4Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fusheng Zhou; Leilei Wen, Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei, 230000, Anhui, People’s Republic of China, Tel +86-138-5698-5934 ; +86-183-5609-9275, Fax +86-0551-63633742, Email biozhoufs@163.com; wenleilei_2012@163.comPurpose: Systemic lupus erythematosus (SLE) is a typical autoimmune disease characterized by the involvement of multiple organs and the production of antinuclear antibodies. This study aimed to investigate the molecular mechanism of SLE.Patients and Methods: We retrieved genome-wide gene expression levels from five public datasets with relatively large sample sizes from the Gene Expression Omnibus (GEO), and we compared the expression profiles of peripheral blood mononuclear cells (PBMCs) from SLE patients and healthy controls (HCs). The expression of seven target genes in PBMCs from 25 cases and 3 HCs was further validated by reverse-transcription quantitative PCR (RT‒qPCR). Flow cytometry was used for verifying the proportion of naive CD4(+) T cells and M2 macrophages in PBMCs from 5 cases and 4 HCs.Results: We found 14 genes (TRIM5, FAM8A1, SHFL, LHFPL2, PARP14, IFIT5, PARP12, DDX60, IRF7, IF144, OAS1, OAS3, RHBDF2, and RSAD2) that were differentially expressed among all five datasets. The heterogeneity test under the fixed effect model showed no obvious heterogeneity of TRIM5, FAM8A1, and SHFL across different populations. TRIM5 was positively correlated with the remaining 13 genes. By separating patient samples into TRIM5-high and TRIM5-low groups, we found that up-regulated genes in the TRIM5-high group were mainly enriched in virus-related pathways. Immune cell proportion analysis and flow cytometry revealed that naive CD4(+) T cells were significantly decreased while M2 macrophages were increased in the SLE group. TRIM5 expression levels were negatively correlated with naive CD4(+) T cells but positively correlated with M2 macrophages.Conclusion: Our data indicated that TRIM5 might be a key factor that modulates SLE etiology, possibly through naive CD4(+) T cells and M2 macrophages.Keywords: differential gene expression analysis, gene, virus, autoimmune disease

Hongtao Cheng,1,2,&ast; Xingwen Deng,3,&ast; Jieyao Li,4,&ast; Yonglan Tang,1,2 Shiqi Yuan,5 Xiaxuan Huang,5 Zichen Wang,1 Fuling Zhou,6 Jun Lyu1,7 1Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 2School of Nursing, Jinan University, Guangzhou, People’s Republic of China; 3Department of Medical Information, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 4Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 6Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China; 7Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Lyu, Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China, Email lyujun2020@jnu.edu.cn Fuling Zhou, Department of Hematology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan, 430071, People’s Republic of China, Email zhoufuling@whu.edu.cnBackground: Dysphagia is common in elderly patients with dementia and is one of the common clinical geriatric syndromes. It imposes a heavy burden on patients and their caregivers and is becoming an important public health problem. This study examined the association between dysphagia in older dementia patients in the ICU and the subsequent adverse health outcomes they experience.Patients and Methods: A retrospective analysis of adults (≥ 65 years) with dementia in ICUs of a Boston tertiary academic medical center was conducted. Using the International Classification of Diseases’ Ninth and Tenth Revisions, dementia patients were identified. The study cohort comprised 1009 patients, median age 84.82 years, 56.6% female, predominantly White (72.9%). Patients were grouped based on swallowing function: dysphagia (n=282) and no-dysphagia (n=727). Dysphagia was identified via positive bedside swallowing screening. Primary outcomes were 90- and 180-day mortality, secondary outcomes included aspiration pneumonia, pressure injury, and delirium. Cohort characteristics were compared using the Wilcoxon rank-sum and chi-square tests. Dysphagia and outcomes correlations were examined via Kaplan-Meier survival analysis, Cox proportional-hazards regression models, logistic regression models, and subgroup analysis.Results: After adjusting for covariates, the results from multivariate Cox proportional-hazards regression indicated that dysphagia was significantly associated with increased 90-day (HR=1.36, 95% CI=1.07– 1.73, E-value=1.78) and 180-day (HR=1.47, 95% CI=1.18– 1.82, E-value=1.94) mortality; the multifactorial logistic regression results indicated that dysphagia was associated with significant increases in pressure injury (OR=1.58, 95% CI=1.11– 2.23, E-value=1.83) and aspiration pneumonia occurrence (OR=4.04, 95% CI=2.72– 6.01, E-value=7.54), but was not significantly associated with delirium prevalence (OR=1.27, 95% CI=0.93– 1.74).Conclusion: Dysphagia is likely to increase the risk of adverse health outcomes in older adults with dementia in ICU, and these adverse outcomes mostly include 90- and 180-day mortality, aspiration pneumonia, and pressure injury.Keywords: dysphagia, dementia, older adults, mortality, intensive care unit, delirium

Kaili Li, Xiaoxue Hu, Quanyi Lu, Heng Zhang, Jiayi Zhou, Shijing Tian, Fachun Zhou Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Shijing Tian; Fachun Zhou, Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical, University, 1 Youyi Road, Yuzhong Qu, 3rd Floor, Building 1, Chongqing, People’s Republic of China, Tel +23-89011756, Email doctortianshijing@163.com; cyzfc1966@126.comBackground: To evaluate the risk factors and prognosis of patients with acute cholangitis recurrence.Methods: A total of 503 patients with acute cholangitis admitted to the First Affiliated Hospital of Chongqing Medical University between July 2013 and January 2022 were included in this retrospective observational study, who were followed up for 360 days and divided into relapse group and non-recurrence group according to the recurrence of acute cholangitis. Risk factors and prognosis of patients with acute cholangitis recurrence were analyzed by univariate, multivariate analyses and proportional hazards model.Results: A total of 161 patients with recurrent acute cholangitis were identified. Recurrent acute cholangitis usually occurred within 125 days; Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterococcus faecium was the most common positive record both in blood and bile culture. In the multivariate analysis, abdominal pain (OR = 2.448, 95% CI = 1.196– 5.010, P = 0.014), bile stones (OR = 2.429, 95% CI = 1.024– 5.762, P = 0.044), diabetes (OR = 1.790, 95% CI = 1.007– 3.182, P = 0.047), pathogen (OR = 3.305, 95% CI = 1.932– 5.654, P< 0.001), and chronic kidney disease (OR = 2.500, 95% CI = 1.197– 5.221, P = 0.015) may be ascertained as the risk factors of acute cholangitis recurrence. The recurrence of acute cholangitis was identified as an independent risk factor for patient death (HR = 4.524, 95% CI = 1.426– 14.357, P = 0.010) by Cox proportional-hazards regression.Conclusion: Abdominal pain, bile stones, diabetes and chronic kidney disease may be risk factors of acute cholangitis recurrence. Patients with recurrent acute cholangitis have poor prognosis and high mortality. Early control of recurrent risk factors and active intervention are beneficial to high-risk patients.Keywords: recurrence, acute cholangitis, risk factors, prognosis

Chengbo Lu,1,&ast; Fanghui Zhou,2,&ast; Huimin Xian,3,&ast; Siyuan Sun,4 Jingkun Yue,4 Ying Zhang,5 Qi Zhao,6 Xing Luo,3 Yang Li7 1Department of Cardiology, 1st Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, People’s Republic of China; 2Department of Hematology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 3Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 4Department of Cardiology, People’s Hospital of Taihe County, Taihe, Anhui, People’s Republic of China; 5Department of Gynaecology and Obstetrics, 1st Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, People’s Republic of China; 6Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 7Department of Cardiology, 4th Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xing Luo; Yang Li, Email luoxing321@163.com; jacksonbiotechlab@gmail.comBackground: The relationship between serum IL-38 and major adverse cardiovascular events (MACE) in patients with ST elevation myocardial infarction (STEMI) remains unclear.Methods: In the present study, 589 STEMI patients were included, the serum level of IL-38 was measured. The median follow-up time was 720 days, the STEMI patients were divided into high IL-38 (IL-38> 6.49ng/mL) and low IL-38 groups (IL-38≤ 6.49ng/mL) to compare the probability of MACE.Results: Plasma IL-38 levels were significantly lower in STEMI patients than in SAP patients (4.0± 2.2 vs 6.9± 3.2 ng/mL, P < 0.001). Ninety-three STEMI patients met the defined MACE study endpoint. The incidence of MACE was significantly lower in patients with high IL-38 group than in patients with low IL-38 group (7.8% vs 23.7%, P < 0.001). Low plasma IL-38 levels were independently associated with the occurrence of MACE (OR = 0.90, P < 0.001).Conclusion: We get a conclusion that low plasma levels of IL-38 are independently associated with the occurrence of MACE.Graphical Abstract: Keywords: inflammatory response, SAP, IL-38, STEMI, MACE

Qi Zhao,1,&ast; Siyuan Sun,2,&ast; Fanghui Zhou,3,&ast; Jingkun Yue,2 Xing Luo,4 Xiufen Qu1 1Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, 150086, People’s Republic of China; 2Department of Cardiology, People’s Hospital of Taihe County, Taihe, Anhui, 236600, People’s Republic of China; 3Department of Hematology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China; 4Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xing Luo; Xiufen Qu, Email luoxing321@163.com; quxiufenhmu@126.comPurpose: The effects of combing evolocumab and statin on the clinical outcome and physiological function of coronary arteries in STEMI patients with non-infarct-related artery (NIRA) disease are still unclear.Methods: A total of 355 STEMI patients with NIRA were enrolled in this study, who underwent combined quantitative flow ratio (QFR) at baseline and after 12 months of treatment with statin monotherapy or statin plus evolocumab.Results: Diameter stenosis and lesion length were significantly lower in the group undergoing statin plus evolocumab. While the group exhibited significantly higher minimum lumen diameter (MLD), and QFR values. Statin plus evolocumab (OR = 0.350; 95% CI: 0.149– 0.824; P = 0.016) and plaque lesion length (OR = 1.223; 95% CI: 1.102– 1.457; P = 0.033) were independently associated with rehospitalization for unstable angina (UA) within 12 months.Conclusion: Evolocumab combined with statin therapy can significantly improve the anatomical and physiological function of the coronary arteries and downregulate the re-hospitalization rate due to UA in STEMI patients with NIRA.Keywords: PCSK9 inhibition, C-reactive protein, inflammation, physiological assessment, quantitative flow ratio, non-infarct-related artery

Yeting Zhou, Leiming Wang, Fei Zhou Xuzhou Medical University Jiangsu Key Laboratory of Tumor Biotherapy, Shuyang People’s Hospital, Suqian, 221000, People’s Republic of ChinaCorrespondence: Leiming Wang; Fei Zhou, Xuzhou Medical University Jiangsu Key Laboratory of Tumor Biotherapy, Shuyang People’s Hospital, Shuyang, Suqian, 221000, People’s Republic of China, Email wangleiming89@21cn.com; zhoufei67a@126.comObjective: Various studies have shown an association between the anti-cancer drug 5-fluorouracil and matrix metalloproteinase 7 (MMP7). The expression of MMP7 in the serum of colorectal cancer patients, as well as their sensitivity to chemotherapy, were examined using the FOLFOX4 chemotherapy treatment.Methods: Serum samples were taken from 216 colorectal cancer patients who had undergone four cycles of gemcitabine and cisplatin treatment. The sera of 216 healthy persons were used as controls. MMP7 levels in the serum were measured by ELISA. Demographic and survival data were collected.Results: MMP7 levels were not associated with sex, age, peritoneal dissemination, liver metastasis, lymph node metastasis, lymphatic invasion, or venous invasion in CRC patients, but were associated with histological grade, tumor size, TNM stage, and depth of tumor invasion. Patients’ serum MMP7 expression reduced after treatment. MMP7 expression was significantly lower chemotherapy-sensitive patients compared with chemotherapy-resistant patients. Elevated MMP7 expression was associated with worse prognosis and chemotherapy-sensitive patients had markedly better overall survival compared with chemotherapy-resistant patients.Conclusion: MMP7 expression was potentially associated with the development of colorectal cancer and elevated levels were associated with chemoresistance in CRC patients. Serum MMP7 levels can be used to screen for drug resistance during FOLFOX4 chemotherapy treatment.Keywords: MMP7, colorectal cancer, FOLFOX4 chemotherapy, chemotherapy-resistant

Hua Wu,1 Xiaojun Zhou,1 Fan Zhou,2 Dongliang Huang,3 Tao Huang1 1Department of Laboratory Medicine, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, Haikou, People’s Republic of China; 2International School of Public Health and One Health, Hainan Medical University, Haikou, People’s Republic of China; 3Emergency Department, Armed Police Hospital of Hainan, Haikou, People’s Republic of ChinaCorrespondence: Tao Huang, Department of Laboratory Medicine, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, No. 19, Xiuhua Road, Xiuying District, Haikou, 570311, People’s Republic of China, Tel +868986842560, Email 13005080993@163.comAbstract: DL96 Microbial Identification/Antimicrobial Susceptibility Testing (ID/AST) System (Zhuhai DL, Guangdong, China) is one of the most commonly used commercial ID/AST System in China. This study aims to evaluate the performance of DL 96E for Antimicrobial Susceptibility Testing (AST) of 270 Enterobacterales isolates from Hainan general hospital using the broth microdilution method (BMD) as reference method. CLSI M52 criteria was followed when analyzing the evaluation results. Twenty antimicrobial agents were evaluated, and categorical agreement (CA) ranged from 62.8% to 96.5%. Imipenem had the lowest CA (63.9%) and highest very major errors (VME) (52.8%). A total of 103 carbapenem-resistant Enterobacterales were evaluated; DL 96E miss identified 22 isolates, including six carbapenemase-producing Enterobacteriaceae. DL 96E must adjust the Minimum Inhibitory Concentration (MIC) ranges of ciprofloxacin, levofloxacin, and piperacillin-tazobactam to cover Clinical and Laboratory Standards Institute (CLSI) breakpoints, adjust the formulation of some antimicrobial, such as imipenem, and increase the MIC detection range to cover the Quality control (QC) strains’ MIC range.Keywords: antimicrobial susceptibility testing, broth microdilution method, minimum inhibitory concentration, categorical agreement

Wenwen Sun,1,2 Yuling Xing,2 Fei Zhou,2,3 Yingao Ma,2,3 Xiaozheng Wan,2,4 Huijuan Ma3,5 1Graduate School of North China University of Science and Technology, Tangshan, People’s Republic of China; 2Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China; 3Graduate School of Hebei Medical University, Shijiazhuang, People’s Republic of China; 4Graduate School of Hebei North University, Zhangjiakou, People’s Republic of China; 5Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital, Shijiazhuang, People’s Republic of ChinaCorrespondence: Huijuan Ma, Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China, Tel +86 18032838686, Email huijuanma76@163.comObjective: In view of the high prevalence of osteoporosis in diabetic patients, this study aimed to investigate the correlation between TyG-BMI, which represents insulin resistance, and bone loss markers, which represent bone metabolism, in an attempt to provide new ideas for the early prevention and diagnosis of osteoporosis in patients with T2DM.Patients and Methods: A total of 1148 T2DM were enrolled. The clinical data and laboratory indicators of the patients were collected. TyG-BMI was calculated based on fasting blood glucose (FBG), triglycerides (TG), and body mass index (BMI) levels. Patients were divided into Q1-Q4 groups according to TyG-BMI quartiles. According to gender, two groups were divided into men and postmenopausal women. Subgroup analysis was performed according to age, course of disease, BMI, TG level and 25(OH)D3 level. The correlation between TyG-BMI and BTMs was investigated by correlation analysis and multiple linear regression analysis using SPSS25.0 statistical software.Results: 1. Compared with Q1 group, the proportion of OC, PINP and β-CTX in Q2, Q3 and Q4 groups decreased significantly. 2. Correlation analysis and multiple linear regression analysis showed that TYG-BMI was negatively correlated with OC, PINP and β-CTX in all patients and male patients. In postmenopausal women, TyG-BMI was negatively correlated with OC and β-CTX, but not with PINP. 3. Subgroup analysis of male patients and postmenopausal female patients according to age, course of disease, BMI, TG and 25(OH)D3 showed that TyG-BMI had a stronger negative correlation with BTMs in male patients with age < 65, disease duration < 10, BMI≥ 24, TG < 1.7, and 25(OH)D3≥ 20.Conclusion: This study was the first to show an inverse association between TyG-BMI and BTMs in T2DM patients, suggesting that high TyG-BMI may be associated with impaired bone turnover.Keywords: type 2 diabetes mellitus, triglyceride glucose-body mass index, bone turnover markers, inflammation

For the Linac Coherent Light Source II (LCLS-II) project at SLAC, a 1.3 GHz superconducting rf (SRF) linac is being constructed that will generate 4 GeV electron bunches at a high repetition rate to drive x-ray free electron lasers. The LCLS-II electron source, which comprises the first three meters of the electron injector, includes two normal-conducting, continuous-wave rf cavities: a one-cell, 185.7 MHz gun and a two-cell, 1.3 GHz buncher. It also includes a gun load-lock system that allows photocathodes to be changed under vacuum. The components in this beam-line section were designed and built by Lawrence Berkeley National Laboratory based on experience from their advanced photoinjector experiment program. In combination with the SLAC UV laser system, the electron source is designed to produce beam rates up to 1 MHz with average currents up to initially. The source was installed in mid-2018, well in advance of the SRF linac, which is now nearing completion. The source was commissioned over a two-year period, and this paper presents results including electron beam and dark current characterization.

Weikang Shi,1,2,&ast; Yuwen Lu,1,&ast; Fangyan Zhou,1 Huiyi He,3 Jicong Jiang,1 Ximao Xue1 1Department of Dermatology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Dermatology, Jinhua Maternal & Child Health Care Hospital, Jinhua, People’s Republic of China; 3Department of Dermatology, Ruian People’s Hospital, Wenzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ximao Xue, Email xueximao2021@163.comAbstract: Eosinophilic pustular folliculitis (EPF) is a rare, chronic, itchy, aseptic disease. Although most cases of infantile EPF (I-EPF) are detected in infants, we found that a 7-year-old child with I-EPF, who received treatment with oral azithromycin in combination with topical narrow bound Ultra Violet B light (NB-UVB) irradiation, with no recurrence at follow-up. Our experience with the successful treatment of this patient can provide a reference for more pediatric patients.Keywords: infantile eosinophilic pustular folliculitis, case report, treatment, dermatopathology

Wei Ju,1,2,&ast; Guan-fa Luo,1,&ast; Yuan-yuan Shi,3 Fei-jun Zhou,1 Meng-qi Li,1 Jian-hui Xu,1 Zhi-xin Yan,2 Xi-hu Yang1 1Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, People’s Republic of China; 2Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, People’s Republic of China; 3Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xi-hu Yang, Email yangxihu1981@126.comObjective: Sebaceous carcinoma (SC) of the submandibular gland is extremely rare. Owing to the low morbidity and nonspecific clinical manifestations, diagnosis is commonly delayed, which increases metastasis and mortality. To date, there have been five reported cases of SC of the submandibular gland. Here, we present a new case and review the relevant literature.Methods and Results: A 36-year-old woman presented with an enlarged left submandibular gland. Clinical features included a non-tender solitary nodular mass with normal overlying skin. There were no special findings on computed tomography or ultrasound examination except for a swollen mass in the left submandibular gland. The patient underwent surgical resection. Pathological examination confirmed the diagnosis of SC with nerve infiltration. Immunohistochemical examination of this case showed positive staining for P63, P40, CK7, CK8/18, MLH1, MSH2, MSH6, and PMS2. The specimen was negative for androgen receptor, CEA, S-100, CK5/6, SOX-10, SOX-11, SMA, and GCDFP-15. The KI-67 labeling index was determined to be 15%. PAS and anti-epithelial membrane antigen were positive in partial area. The patient is still undergoing follow-up, and no metastasis or recurrence has been observed for 2 months.Conclusion: This case highlighted the fact that despite its rarity, SC should be considered as a differential diagnosis for masses located in the head and face. Early and accurate diagnosis, followed by wide surgical excision, has a favorable prognosis. Therefore, clinicians should be familiar with the clinical and pathological features of this disease.Keywords: sebaceous carcinoma, salivary gland neoplasms, submandibular gland, androgen receptor, P63, P40

Yuwen Lu, Fangyan Zhou, Yu Gao, Wanwan Jin Department of Dermatology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of ChinaCorrespondence: Yu Gao; Wanwan Jin, Email gaoyu0570@sina.com; jinwanwan0604@163.comPurpose: We used color Doppler ultrasound to conduct an objective evaluation of the 595-nm Pulsed Dye Laser (PDL) combined with 755-nm long-pulse alexandrite sequential laser treatment for hybrid IH.Patients and Methods: A total of 116 cases of hybrid IH were selected for this study. The interval between laser treatments was around 4 weeks, and 6 laser treatments or complete removal of the tumor was the end point. All children underwent color Doppler ultrasonography at the 0th, 1st, 6th months of treatment. Children were grouped by gender, age (< 6 months, ≥ 6 months), thickness (< 8 mm, ≥ 8 mm), and location (face and neck, trunk, and extremities). Calculate the volume of IHs according to color Doppler ultrasound. The volume ratio before and after treatment was defined as the A-value. Treatment outcomes were defined as effective when the A-value < 75%.Results: In total, 74 cases (63.79%) had effective outcomes. Overall, the samples showed a statistically significant difference in the reduction of IH volume after 6 months of laser treatment (P < 0.001). The treatment of < 6 months group had better efficacy than the ≥ 6 months group (P < 0.001), the treatment of thickness < 8 mm group had better efficacy than the thickness ≥ 8 mm group (P < 0.001) and there was no significant difference in efficacy between the three different location groups (P > 0.05). Greater reduction in blood flow in the group with the effective outcome than in the group with the ineffective outcome (P < 0.001).Conclusion: Color Doppler ultrasound can be applied to the diagnosis of hybrid IH and to the evaluation of treatment time and outcomes, and it can help clinicians recognize hybrid IH with greater accuracy. The earlier intervention for hybrid IH we perform, the better outcomes will be.Keywords: hybrid infantile hemangioma, color Doppler ultrasound, treatment, pulsed dye laser, alexandrite laser

Kaili Li, Sanle Jiang, Hongxue Fu, Yingting Hao, Shijing Tian, Fachun Zhou Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Shijing Tian; Fachun Zhou, Emergency Department, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Qu, 17th Floor, Building 1, Chongqing, People’s Republic of China, Tel +86 023-89011756, Email doctortianshijing@163.com; cyzfc1966@126.com; zfc88@126.comBackground: To identify the risk factors and prognosis of carbapenem-resistant organisms (CRO) in patients with acute cholangitis.Methods: This retrospective observational study was conducted to explore the risk factors and prognosis of CRO infection in 503 acute cholangitis patients diagnosed between July 2013 and January 2022 at the First Affiliated Hospital of Chongqing Medical University, who were divided into a CRO group and non-CRO group based on the presence or absence of CRO. Univariate, multivariate analyses, and the proportional hazards model were used to compare the risk factors and prognosis of CRO suffering in patients with acute cholangitis.Results: We identified 35 patients colonized with CRO from 503 acute cholangitis patients. In the multivariate analysis, tumor (OR=7.09, 95% CI=1.11– 45.30, P=0.038) and chronic kidney disease (OR=8.70, 95% CI=2.11– 35.88, P=0.003) were ascertained as the risk factors of the occurrence on CRO infection under the background of acute cholangitis. CRO infection was identified as an independent risk factor for acute cholangitis patient death (HR=5.147, 95% CI=1.475– 17.595, P=0.01) by Cox proportional-hazards regression.Conclusion: Tumor and chronic kidney disease may be risk factors for CRO infection. Patients diagnosed with acute cholangitis further infected with CRO had a poor prognosis and a more severe mortality. Active screening for CRO is expected to facilitate early prevention, diagnosis, and treatment of high-risk patients.Keywords: CRO, acute cholangitis, risk factors, prognosis

The dehydrogenation of 2,3-butanediol (BDO) to 3-hydroxybutanone (HBO) was studies over Li cation-doped CuZnAl catalysts. The catalyst samples were characterized by XRD, XPS, H -TPR and SEM techniques. The characterization results showing that doping with Li cation obviously modified the surface morphology of CuZnAl catalysts; decreased the reduction temperature of CuZnAl catalysts; and finally increased the amount of Cu active sites. The reaction results showing that, Li modified CuZnAl catalysts obviously enhanced the selectivity of the dehydrogenation of BDO to HBO by inhibiting the dehydration of BDO. The Li(2%)–Cu(44%)–Zn(38%)–Al(16%) exhibited the highest activity for dehydrogenation of BDO, with the conversion rate of BDO is 72.4% and the selectivity of HBO is 95.9% at 260 °C. This catalyst shows excellent stability for more than 100 h without significant deactivation. 2

Recently, alloys have been widely utilized as protection layers for homogenized Li growth. However, the protective mechanisms for different alloys are not clearly understood. Herein, guided by the binary phase diagrams, Mg, Au, Zn, Al, Fe, and Cu protective layers have been selected for study of their protective abilities and mechanisms. The selected metals can be classified into three categories according to the nature of their associated alloy protective layers: (1) metals with high solubility in Li while not forming any intermediate line compounds, e.g., Mg, which is good for fast Li stripping; (2) metals with limited solid solubility but forming stable line compounds with Li upon the lithiation, e.g., Au, Zn, and Al, where the formed stable line compounds LixAu, LixZn, and LixAl will hamper Li kinetics; (3) metals with negligible mutual solubility and no line compound formation with Li, e.g., Fe and Cu, which block the Li stripping path and therefore result in the highest polarization voltage.

Ling Zhang1 &ast;, Xinhua Xie2 &ast;, Yangyan Sun1 &ast;, Futao Zhou1 1School of Basic Medicine, Gannan Medical University, Ganzhou, People’s Republic of China; 2Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Futao Zhou, School of Basic Medicine, Gannan Medical University, Ganzhou, Jiangxi Province, 341000, People’s Republic of China, Email zhft522@163.comObjective: Hyperhomocysteinemia (HHcy), as an important risk factor for Alzheimer’s disease (AD), would aggravate cognitive dysfunction. This study aimed to investigate whether and to what degree the homocysteine (Hcy) levels in blood and cerebrospinal fluid (CSF) were elevated in AD patients compared with healthy controls and to explore the factors related to the elevated Hcy levels in AD patients.Methods: PubMed and Embase databases were searched to identify eligible studies, and study quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Ratio of mean (RoM) Hcy concentrations was used as a measure of fold-change between AD patients and healthy control subjects.Results: We identified 35 eligible studies, consisting a total of 2172 patients with AD and 2289 healthy controls. The pooled results showed that patients with AD had a significantly higher blood level of Hcy (RoM, 1.32; 95% CI, 1.25– 1.40; p< 0.001) than controls did, with large heterogeneity across studies (I2=81.4%, p< 0.001). Hcy level in CSF did not differ significantly between patients with AD than controls (RoM, 1.12; 95% CI, 0.90– 1.39, p=0.293; I2=69.4%, p=0.02). A random effects meta-regression analysis revealed that there was an inverse correlation between the blood levels of Hcy and folate (p=0.006). There was no link found between the blood levels of vitamin B12, or the Mini-Mental Status Examination scores reflecting the degree of cognitive impairment, and blood levels of Hcy.Conclusion: Regardless of dementia severity, there is an approximate one-third increase in blood Hcy in AD patients, which is robustly associated with a decreased level of blood folate in AD, but not with that of blood vitamin B12 nor the degree of dementia. Future investigation on the cause-and-effect link between Hcy and folate is warranted to clarify this issue.Keywords: homocysteine, Alzheimer’s disease, meta-regression