Abstract:Objective To construct and validate a prognostic prediction model for T1/T2 stage renal carcinoma patients treated with robot-assisted laparoscopic partial nephrectomy(RALPN).Methods A total of 400 patients with T1/T2 stage renal carcinoma who underwent RALPN at the Affiliated Hospital of Nanjing University Medical School from August 2018 to July 2019 were retrospectively enrolled.A nomogram prediction model for prognosis was constructed,and internal validation was performed using the Bootstrap method,with calibration curves drawn for consistency verification.Results Among the 400 patients,22 were lost to follow-up at 5 years,and 378 completed effective follow-up.The 5-year cumulative survival rate was 90.5％(342/378),including 342 in the survival group and 36(9.5％)deaths in the death group.Cox regression analysis showed that increased differentiation degree was an independent protective factor for the prognosis of RALPN patients,while older age,presence of clinical symptoms,elevated World Health Organization(WHO)/International Society of Urological Pathology(ISUP)grade,advanced T stage,and regional lymph node metastasis were independent risk factors(all P＜0.05).A prognostic risk prediction model was constructed based on the above results.Hosmer-Lemeshow goodness-of-fit test showedx2=6.762,degree of freedom=8,P=0.578.The nomogram prediction model revealed that the influencing factors on prognosis ranked as age,WHO/ISUP grade,differentiation degree,T stage,clinical symptoms,and regional lymph node metastasis.When the total score reached 156,the 5-year mortality rate could reach 85.0％.The concordance index of the nomogram model was 0.956,indicating good consistency between predicted prognostic risk and actual risk in RALPN patients.The Brier score was 0.076,and the calibration slope was 0.820.Conclusion Prognostic factors for T1/T2 stage renal carcinoma patients treated with RALPN include differentiation degree,age,clinical symptoms,WHO/ISUP grade,T stage,and regional lymph node metastasis.The prediction model constructed based on these factors shows favorable discrimination and calibration.

Abstract:Objective To explore the correlations of microRNA-214-3p(miR-214-3p)and long non-coding RNA MT1JP(lncRNA MT1JP)with clinicopathological features and prognosis in patients with cervical cancer.Methods A total of 116 patients with cervical cancer(cervical cancer group)and 100 healthy physical examinees(control group)admitted to Affiliated Hospital of Guangdong Medical University from June 2018 to June 2022 were retrospectively enrolled.The serum levels of miR-214-3p and lncRNA MT1JP were compared between the two groups,and their associations with clinicopathological parameters were analyzed.According to 3-year follow-up outcomes,enrolled patients were divided into death group(34 cases)and survival group(82 cases).Clinical data as well as miR-214-3p and lncRNA MT1JP levels were compared between subgroups.Multivariate Cox regression was performed to analyze the independent correlation of the two indicators with all-cause mortality risk.Restricted cubic spline(RCS)combined with threshold effect analysis was used to assess dose-response relationships.Pearson correlation test was adopted to evaluate the correlation between miR-214-3p and lncRNA MT1JP.Kaplan-Meier survival curves were plotted to compare survival rates stratified by different expression levels of the two biomarkers.Results Serum miR-214-3p was significantly upregulated while lncRNA MT1JP was downregulated in cervical cancer group relative to control group(both P＜0.05).The expression levels of miR-214-3p and lncRNA MT1JP were significantly correlated with depth of tumor invasion,lymph node metastasis,International Federation of Gynecology and Obstetrics(FIGO)stage,pathological grade,vascular invasion and tumor differentiation(all P＜0.05).Compared with survival group,death group presented higher proportion of patients with invasive depth over half of myometrium,lymph node metastasis,FIGO stage Ⅲ-Ⅳ,pathological grade G3 and poor differentiation,accompanied by elevated miR-214-3p and reduced lncRNA MT1JP(all P＜0.05).After adjusting for confounding factors,miR-214-3p and lncRNA MT1JP were independently correlated with mortality risk(both P＜0.001).miR-214-3p was negatively correlated with lncRNA MT1 JP(r=-0.426,P＜0.05).RCS analysis revealed a non-linear association between the two indicators and patient prognosis(both P＜0.001).The overall 3-year survival rate was 70.69％.Patients with miR-214-3p ≥1.23 had poorer 3-year survival than those with miR-214-3p＜1.23;patients with lncRNA MT1JP≤1.58 showed lower survival versus those with lncRNA MT1JP＞1.58(both P＜0.05).Conclusion Serum miR-214-3p is overexpressed and lncRNA MT1JP is underexpressed in cervical cancer patients.Both molecules are closely linked to multiple clinicopathological features related to tumor invasion and metastasis,and can serve as potential biomarkers for disease onset prediction and prognostic evaluation of cervical cancer.

Abstract:Objective To analyze the predictive value of serum chemerin level trajectory in the second and third trimesters for pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 210 GDM patients admitted to the Affiliated Hospital of Guizhou Medical University from January 2023 to July 2024 were enrolled as the GDM group,and 105 healthy pregnant women as the control group.Serum chemerin levels at 24 weeks,32 weeks of gestation and before delivery were compared between the two groups.Latent class trajectory modeling(LCTM)was used to identify subgroups with different serum chemerin trajectories in the GDM group.All GDM patients were followed up until delivery to record adverse pregnancy outcomes.Serum chemerin levels,baseline characteristics and incidence of adverse pregnancy outcomes were compared among different trajectory subgroups.Logistic regression was used to analyze the correlation between chemerin trajectory and adverse pregnancy outcomes.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of chemerin trajectory for adverse pregnancy outcomes.Results Serum chemerin levels showed no significant change at 24 weeks,32 weeks and before delivery in the control group(P＞0.05),but decreased gradually in the GDM group(P＜0.001).Serum chemerin levels in the GDM group were significantly higher than those in the control group at all three time points(all P＜0.001).LCTM identified three optimal trajectory subgroups:T1(low to relatively low chemerin level,n=65),T2(moderately high to low level,n=92),and T3(persistently high level,n=53).The overall incidence of adverse pregnancy outcomes in the GDM group was 24.8％(52/210).Pre-pregnancy body mass index,2 h 75 g oral glucose tolerance test(OGTT)blood glucose,glycated hemoglobin(HbA1c),homeostasis model assessment of insulin resistance,serum chemerin levels at all time points and adverse pregnancy outcome rate were highest in T3,followed by T2 and then T1(all P＜0.05).OGTT 2 h glucose,HbA1c and chemerin trajectory were independent risk factors for adverse pregnancy outcomes(all P＜0.05).After adjustment for OGTT 2 h glucose and HbA1c,chemerin trajectory remained an independent risk factor(P＜0.05).The area under the curve of persistently high chemerin trajectory for predicting adverse pregnancy outcomes was 0.852,with a sensitivity of 80.77％,specificity of 84.81％and Youden index of 0.656.Conclusions Serum chemerin trajectory in the second and third trimesters is significantly correlated with pregnancy outcomes in GDM patients.A persistently high chemerin level trajectory has high predictive efficacy for adverse pregnancy outcomes.

Abstract:Objective To explore the clinical characteristics and surgical treatment of ovarian torsion in children and adolescents,and to evaluate the changing trend of surgical strategies.Methods A retrospective analysis was performed on the clinical features,surgical modalities and pathological findings of children and adoles-cents with a confirmed diagnosis of ovarian torsion who underwent surgical treatment in Shanxi Children's Hospital from January 2017 to December 2024.Results A total of 158 surgically confirmed cases of ovarian torsion in children and adolescents were enrolled.The age distribution presented a bimodal pattern,with peaks in infancy and menarche period.The main clinical manifestations included abdominal pain,nausea and vomiting,accounting for 88.0％(139/158),38.6％(61/158)and 31.0％(49/158)respectively.Most neonatal cases were identified as abdominal masses during prenatal examination and confirmed surgically after birth.Ultrasound was the primary imaging modality;among 151 patients receiving ultrasound examination,117 cases(77.5％)were preoperatively diagnosed with ovarian torsion.The application rate of laparoscopy increased from 27.3％(3/11)in 2017 to 87.0％(20/23)in 2024,while the oophorectomy rate decreased from 72.7％(8/11)in 2017 to 26.1％(6/23)in 2024.Most cases of ovarian torsion complicated with adnexal masses were of benign pathological types.Conclusion Ovarian torsion in children and adolescents is more common in early infancy and around puberty with non-specific clinical symptoms.Transabdominal and pelvic ultrasound serves as the main diagnostic method.Ovarian torsion combined with ovarian masses is frequently encountered in this population,and most associated masses are benign lesions.The intraoperative oophorectomy rate has gradually declined,while the application rate of laparoscopy has remained at a relatively high and stable level in recent years.

Abstract:Objective To establish and evaluate a rat model simulating the mechanism of heart failure in maintenance hemodialysis(MHD).Methods A total of 26 SD rats were selected and divided into two groups by random number table method:6 rats in the control group were given edible oil by gavage;20 rats in the model group were treated with adenine edible oil solution by gavage to simulate uremic factors,intraperitoneal injection of doxorubicin to simulate heart failure and uremic factors,and potassium bromate solution instead of drinking water to simulate microinflammatory factors.The observation period lasted 6 weeks.General conditions including mental state,response,body weight and food intake,renal function,C-reactive protein(CRP),blood pressure and heart rate were observed.Echocardiographic parameters included left ventricular ejection fraction(LVEF),fractional shortening,interventricular septal end-systolic thickness(IVSS),left ventricular posterior wall end-systolic thickness(LVPWS),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV).Heart mass indexes included whole heart mass index(HM/BM)and left ventricular mass index(LVM/BM).Myocardial pathology was observed by transmission electron microscope.Results Ten rats in the model group survived at the end of the sixth week,with a mortality rate of 50％.The body weight of the model group was significantly lower than that of the control group starting from the end of the first week(all P＜0.001)and decreased slightly and slowly since the third week.Food intake was significantly lower than that of the control group from the second week onward(all P＜0.001).Serum urea nitrogen and creatinine in the model group were signifi-cantly higher than those in the control group starting from the first week and increased obviously at subsequent time points(all P＜0.001).At the end of the sixth week,CRP level in the model group was significantly higher than that in the control group[(17.27±1.88)mg/L vs(0.99±0.09)mg/L](P＜0.01).Meanwhile,systolic blood pressure,diastolic blood pressure,mean arterial pressure and heart rate in the model group were markedly lower than those in the control group;LVEF,fractional shortening,IVSS and LVPWS were significantly decreased;LVEDD,LVESD,LVEDV,LVESV,HM/BM and LVM/BM were significantly increased(all P＜0.001).Severe myocardial pathological damage was observed under electron microscope in the model group.Conclusions The established rat model simulating MHD-related heart failure meets the evaluation criteria of uremic toxin,heart failure and microinflammation modeling.It can truly and completely simulate the clinical and pathological progres-sion of MHD complicated with heart failure with good clinical similarity,and is suitable for in-depth experimental research of the disease.

Abstract:Objective To explore the independent risk factors for hypertension in patients in the post-anesthesia care unit(PACU)after ophthalmic surgery under general anesthesia.Methods A total of 908 patients who underwent elective ophthalmic surgery under general anesthesia in Beijing Tongren Hospital,Capital Medical University from September 2024 to May 2025 were retrospectively enrolled as research subjects.The patients were divided into hypertension group(560 cases)and non-hypertension group(348 cases)according to blood pressure status.Baseline data,preoperative medical history,surgical procedures,vital signs and eye pain scores of patients in the two groups were collected.Univariate and multivariate Logistic regression analyses were used to screen the independent influencing factors of postoperative hypertension in PACU.Results There were statistically significant differences in age,proportions of hypertension history,diabetes history and distribution of postoperative ocular pain scores between the two groups(all P＜0.05).The heart rate of patients in the hypertension group was higher than that in the non-hypertension group(P＜0.05).Univariate analysis showed that age(odds ratio=1.035,95％confidence interval:1.024-1.045),preoperative hypertension history(odds ratio=9.549,95％confidence interval:6.104-14.937),preoperative diabetes history(odds ratio=2.282,95％confidence interval:1.638-3.180),heart rate(odds ratio=1.020,95％confidence interval:1.008-1.031)and postoperative eye pain score 1-3(odds ratio=0.646,95％confidence interval:0.485-0.861)were significantly correlated with postoperative hypertension(all P＜0.05).Multivariate Logistic regression analysis indicated that increased age,preoperative hypertension history,preoperative diabetes history,accelerated heart rate and severe eye pain were independent risk factors for hypertension upon admission to PACU after operation(all P＜0.05).Conclusion Patients with advanced age,preoperative history of hypertension or diabetes,rapid heart rate and severe eye pain are more susceptible to hypertension in PACU.

Abstract:As the most aggressive subtype of breast cancer,triple-negative breast cancer(TNBC)poses great challenges to clinical treatment due to the lack of clear molecular targets and high heterogeneity.As an emerging three-dimensional cell culture model,organoid technology can highly simulate the tissue structure,genetic characteristics and microenvironmental interaction of tumors in vitro,providing a revolutionary tool for basic research,drug screening and clinical transformation of TNBC.This paper systematically reviews the basic principles and development process of organoid technology,focusing on the application potential of organoids in drug sensitivity,novel drug screening and mechanism research of TNBC.Meanwhile,this paper also summarizes the controversies and challenges faced by organoids and prospects their future development directions.By integrating existing research evidence,this paper aims to clarify how organoid technology promotes the research of TNBC and provide theoretical basis and practical guidance for its clinical application.

Abstract:Objective To explore the potential value of serum kidney injury molecule-1(KIM-1)in the early risk stratification of acute kidney injury(AKI)within 72 h after onset in patients with acute myocardial infarction(AMI).Methods A total of 30 consecutive AMI patients hospitalized in Beijing Anzhen Hospital,Capital Medical University from November 2025 to January 2026 were enrolled in this single-center prospective preliminary study.Patients were divided into AKI group(10 cases)and non-AKI group(20 cases)according to the occurrence of AKI.Serum samples were collected at admission immediately(T0),6-12 h after admission(T1),24 h after admission(T2),48 h after admission(T3),and 72 h after admission(T4)to detect the levels of KIM-1 and serum creatinine.Receiver operating characteristic curve was used to analyze its value in predicting AKI within 72 h.As an exploratory study with a limited sample size,the results were only used to generate hypoth-eses and report confidence intervals.Results The level of KIM-1 at T0 in the AKI group was significantly higher than that in the non-AKI group[0.150(0.095,0.305)μg/L vs 0.080(0.058,0.132)μg/L](P=0.019).The area under the curve(AUC)of KIM-1 at T0 for predicting AKI within 72 h was 0.77(95％confidence interval:0.52-0.94),which was superior to serum creatinine at the same time point(AUC=0.66,95％confidence interval:0.45-0.88).Taking 0.100 μg/L as the cut-off value,the sensitivity of KIM-1 for predicting AKI was 100％(95％confidence interval:69％-100％)and the specificity was 60％(95％confidence interval:36％-81％).With the consistent median time from symptom onset to admission between the two groups,KIM-1 showed intergroup differences at T0,while serum creatinine did not show significant differences until T2,with a time difference of approximately 24 h.Conclusions Serum KIM-1 at admission has potential value for early risk stratification of AKI after AMI,with an earlier detection time than serum creatinine.However,these exploratory findings need external verification by large-sample and multicenter studies as well as clinical practicability evaluation before clinical transformation and application.

Abstract:Objective To explore latent classification characteristics of cognitive function,sleep quality and emotional status in patients with coronary atherosclerotic heart disease,and analyze relevant influencing factors.Methods A total of 5 413 patients with coronary atherosclerotic heart disease admitted to Beijing Anzhen Hospital,Capital Medical University from December 2021 to April 2023 were enrolled.Latent profile analysis was performed to identify latent subgroups based on cognitive function,sleep quality and emotional status.Montreal cognitive assessment,pittsburgh sleep quality index,self-rating anxiety scale and self-rating depression scale were applied to evaluate cognitive function,sleep quality,anxiety and depression respectively.Multinomial Logistic regression was used to analyze influencing factors of each subgroup.Results All subjects were divided into three latent subgroups:stable adaptation group(2 800 cases,51.7％),transitional risk group(2 371 cases,43.8％)and high-symptom-burden group(242 cases,4.5％).There were statistically significant differences in gender,educational attainment,history of cerebrovascular disease,smoking status,drinking status,body mass index and age among the three groups(all P＜0.05).There were significant differences in the total scores of the Montreal cognitive assessment,pittsburgh sleep quality index,self-rating anxiety scale and self-rating depression scale,as well as the proportions of mild cognitive impairment,abnormal sleep quality,anxiety and depression among the three groups(all P＜0.05).Multivariate Logistic regression revealed that advanced age,female sex,cerebrovascular disease history and low body weight were independent predictors for classification into the high-symptom-burden group;increased age(odds ratio=1.014,95％confidence interval:1.008-1.020,P＜0.001),female gender(odds ratio=0.766,95％confidence interval:0.662-0.886,P＜0.001)and non-drinking habit(odds ratio=1.267,95％confidence interval:1.053-1.526,P=0.012)were independent influencing factors for inclusion in the transitional risk group.Conclusion Obvious heterogeneity exists in cognitive function,sleep quality and emotional status among coronary atherosclerotic heart disease patients.Clinical nursing should screen high-risk populations including elderly,female,low body mass index and patients complicated with cerebrovascular diseases,and carry out individualized precise interventions corresponding to different profile characteristics so as to improve clinical prognosis.

Abstract:Objective To explore the impact of active telephone follow-up within 1 month after catheter ablation for atrial fibrillation(AF)on perioperative medication adherence,incidence of clinical outcome events and rehospitalization rates based on routine follow-up.Methods A retrospective cohort study was conducted.A total of 547 patients who underwent elective AF surgery at Beijing Anzhen Hospital,Capital Medical University in January 2025 were enrolled as the intervention group,receiving one active telephone follow-up within 1 month after surgery;893 patients who underwent elective surgery at our hospital in February 2025 were included as the control group,only receiving routine first outpatient follow-up at 3 months after surgery.The telephone follow-up included verifying understanding of medical advice,guiding medication administration,answering questions,evaluating postoperative recovery,identifying abnormal symptoms and providing medical guidance,and offering psychological support.The primary outcome was medication adherence at 6 months post operatively,and secondary outcomes included thromboembolic events,bleeding events and rehospitalization within 6 months postoperatively.Results In terms of medication adherence at 6 months postoperatively,the proportion of patients in the intervention group who continuously adhered to anticoagulant medication according to the CHA2DS2-VASc score was significantly higher than that in the control group[53.9％(295/547)vs 42.9％(383/893)](x2=16.598,P＜0.001);the propor-tion of patients in the intervention group who discontinued antiarrhythmic drugs as directed was significantly higher than that in the control group[82.8％(453/547)vs 77.5％(692/893)](x2=6.274,P=0.012).There was no significant difference in the incidence of thromboembolic and bleeding events between the two groups(both P＞0.05).In terms of rehospitalization,the incidence of outpatient visits for cardiovascular diseases in the intervention group was significantly higher than that in the control group[8.4％(46/547)vs 4.9％(44/893)](P=0.008).There were no significant differences between the two groups in the incidence of emergency visits for cardiovascular diseases(P=0.174),hospitalization for cardiovascular diseases(P=0.627),and re-visits or hospitalization for cardiovascular reasons(P=0.053).Conclusion Early active telephone follow-up after radiofrequency ablation for AF can significantly improve patients' adherence to anticoagulant and antiarrhythmic medications without increasing the risk of short-term adverse events.This follow-up model can serve as a supple-mentary method to routine outpatient follow-up.

Abstract:Objective To analyze the influencing factors of cardiovascular composite endpoint events in patients with chronic heart failure(CHF).Methods The clinical data of 108 patients with CHF in Anqing First People's Hospital of Anhui Medical University from January 2022 to January 2025 were retrospectively analyzed.According to the occurrence of cardiovascular composite endpoint events,the patients were divided into the occurrence group and the non-occurrence group,and the clinical data of the two groups were collected and compared.Logistic regression analysis was used to analyze the influencing factors of cardiovascular composite endpoint events in CHF patients,and a nomogram was drawn to evaluate the predictive value of related influencing factors in the occurrence of cardiovascular composite endpoint events in CHF patients.Results Of the 108 CHF patients,87 cases(80.6％)had no cardiovascular composite endpoint events and were enrolled in the non-occurrence group,15 cases(13.9％)had repeat revascularization,5 cases(4.6％)died from any cause,1 case(0.9％)had myocardial infarction,and a total of 21 cases(19.4％)were enrolled in the occurrence group.Logistic regression analysis showed that age,baseline circulating endothelial cell specific molecule 1(Endocan),free fatty acid(FFA)level,self-perceived burden scale(SPBS)and Mental vulnerability questionnaire(MVQ)scores were the influencing factors of cardio-vascular composite endpoint events in CHF patients(all P＜0.05).By drawing the nomogram,it was found that the above influencing factors had a high value in predicting the occurrence of cardiovascular composite endpoint events in CHF.The consistency index of the nomogram was 0.85(95％confidence interval:0.74-0.95),which showed good consistency and predictive ability and high accuracy of the model.Conclusion Age,baseline Endocan,FFA levels,SPBS and MVQ scores can affect the risk of cardiovascular composite endpoint events in patients with CHF,and their combined prediction has high application value.

Abstract:Objective To investigate the value of echocardiography in the preoperative diagnosis of primary right ventricular tumors.Methods The clinical manifestations and echocardiographic features of 30 patients with primary right ventricular tumors diagnosed by surgical pathology in Beijing Anzhen Hospital,Capital Medical University from April 2016 to January 2024 were retrospectively analyzed.With the pathological results as the gold standard,the coincidence rate of echocardiography in the pathological diagnosis of primary right ventricular tumors was analyzed.Results Among 30 patients with primary right ventricular tumors,postoperative pathological results showed that 24 cases(80.0％)were benign tumors and 6 cases(20.0％)were malignant tumors.Benign tumors included 11 cases of myxoma,6 cases of fibroma,4 cases of rhabdomyoma,1 case of mature teratoma,1 case of papillary elastofibroma and 1 case of lipoleiomyoma.Malignant tumors included undifferentiated pleomorphic sarcoma,angiosarcoma,synovial sarcoma,myxofibrosarcoma,leiomyosarcoma,and malignant hemangioendothelioma in 1 case each.The coincidence rate between preoperative ultrasound diagnosis and postoperative pathological diagnosis was 36.7％(11/30).The ultrasound features of myxoma were highly specific,and the coincidence rate of ultrasound diagnosis was 9/11.The characteristic manifestations of myxoma included:moderate echo,irregular shape,lobulated shape,pedicle attachment,loose structure,large activity,shape changes with the rhythm cycle,and the tumor was embedded into the valve orifice to varying degrees during diastole,and secondary stenosis.There were no pedicles in 6 cases of malignant tumors,while 15 cases(62.5％)of benign tumors had pedicles.There was significant difference between the two groups(P=0.017).The ultrasound echocardiographic features were compared between the benign and malignant tumor groups.In the malignant tumor group,there were 5 cases of irregular morphology,4 cases of pericardial effusion,5 cases of poor mobility,5 cases of unclear boundaries,4 cases of tricuspid regurgitation,and 2 cases of right ventricular outflow tract obstruction.In the benign tumor group,there were 6 cases(25.0％)with irregular morphology,4 cases(16.7％)with pericardial effusion,7 cases(29.2％)with poor mobility,5 cases(20.8％)with unclear boundaries,11 cases(45.8％)with tricuspid regurgitation,and 7 cases(29.2％)with right ventricular outflow tract obstruction.There were statistically significant differences in the proportion of irregular morphology,concomitant pericardial effusion,poor mobility,and unclear boundaries between the two groups(P=0.016,0.029,0.026,0.009).There was no statistically significant difference in the proportion of tricuspid regurgitation and right ventricular outflow tract obstruction(P=0.651,1.000).Conclusion Primary right ventricular tumors are mostly benign tumors.Echocardiography can find the space-occupying lesions in the cardiac cavity,provide the location,size,shape and boundary of the tumor,and also indicate whether the cardiac tumor has an impact on hemodynamics.Combined with the clinical characteristics of patients and echocardiography characteristics,preliminary pathological nature can be determined.It has a certain value in preoperative diagnosis of primary right ventricular tumors.

Abstract:Objective To explore the effect of air pollution exposure on the incidence of stroke.Methods From January 1,2023 to December 31,2024,time series data from four community surveillance points in Beijing were used for analysis,with urban and rural residents of Beijing as the research population.Daily air pollutant concentrations(PM2.5,PM10,sulfur dioxide,carbon monoxide,ozone,nitrogen dioxide)and meteoro-logical data were collected.A time-stratified case-crossover design and a Poisson-like regression model were used to estimate the association between air pollutants and stroke events.Results A total of 1 100 stroke patients were registered during the study period.Concentrations of PM2.5 and PM10 varied significantly between monitoring sites and between days.The results showed that the exposure to PM2.5 and PM10 significantly increased the risk of stroke events.The peak effect of PM2.5 appeared in the lag period of 3-5 d,and the peak effect of PM10 appeared in the lag period of 4-7 d.For every 10 μg/m3 increase in PM2.5 concentration,the relative risk of stroke was 1.022(95％confidence interval:1.008-1.039),and the lag period was 0-7 d.For every 10 μg/m3 increase in PM10 concentration,the relative risk of stroke was 1.027(95％confidence interval:1.008-1.055),and the lag period was 0-12 d.Conclusion The results of this study showed that environmental pollutants,especially PM2.5 and PM10,were significantly associated with stroke events.These findings suggest the impor-tance of air quality management in reducing the risk of stroke.

Abstract:Objective To observe the effects of remimazolam on stress response,serum inflammatory factors and postoperative short-term quality of recovery in elderly patients with one-lung ventilation.Methods Sixty patients who underwent thoracoscopic radical lung cancer surgery in the First Affiliated Hospital of Hebei North University from August 2023 to August 2024 were selected.The patients were divided into group P and group R according to the random number table method,with 30 cases in each group.Group P was given propofol and remifentanil anesthesia,group R was given remimazolam and remifentanil anesthesia.The heart rate,mean arterial pressure(MAP),blood oxygen saturation,and bispectral index(BIS)were monitored and recorded before anesthesia(T1),intubation(T2),skin incision(T3),at the end of operation(T4),and extubation(T5).The occurrence of hypotension,bradycardia,hypertension and the use of vasoactive drugs during operation were recorded.The pain mediators were compared between the two groups before operation and 24 h after operation.Inflammatory mediators and stress response indexes were measured before operation,at the end of operation,and at 6 and 24 h after operation.The quality of recovery 15-item(QoR-15)scale scores were recorded before induction of anesthesia and at 24 and 72 h after operation.Results The heart rate and MAP at T4 in group R were higher than those in group P,and BIS at T5 was lower than that in group P(all P＜0.05).The incidence of hypotension,bradycardia and the use of vasoactive drugs in group R were lower than those in group P[10.0％(3/30)vs 50.0％(15/30),0(0)vs 26.6％(8/30),26.6％(8/30)vs 83.3％(25/30)](all P＜0.05).At 24 h after operation,the levels of high-mobility protein B1 protein in the two groups were lower than those before operation,and those in group R were lower than those in group P.The levels of prostaglandin E2 and 5-hydroxytryptamine in the two groups were higher than those before operation,and those in group R were higher than those in group P(all P＜0.05).The levels of C-reactive protein and interleukin-6 in the two groups were higher than those before operation immediately after operation and at 6 and 24 h after operation,but those in group R were lower than those in group P at each time point(all P＜0.05).The cortisol levels immediately after operation and 6 h after operation were higher than those before operation in both groups,but those in group R were lower than those in group P at each time point(all P＜0.05).The total QoR-15 scores at 24 h and 72 h after operation were lower than those before anesthesia induction in both groups,but those in group R were higher than those in group P(all P＜0.05).Conclusion Remimazolam can maintain hemodynamic stability and reduce the incidence of adverse cardiovascular events in elderly patients undergoing thoracoscopic radical resection of lung cancer.At the same time,it can inhibit the release of pain mediators and inflammatory factors,which is beneficial to reduce the postoperative stress response of elderly patients and improve the quality of postoperative recovery.

Abstract:Objective To investigate the effect of dexamethasone combined with intraoperative gastroin-testinal decompression on postoperative nausea and vomiting in patients with Baska laryngeal mask airway positive pressure ventilation.Methods A total of 240 patients undergoing laparoscopic cholecystectomy with Baska laryn-geal mask positive pressure ventilation in Panzhihua Central Hospital,Sichuan Province from December 2023 to June 2024 were selected.They were randomly divided into blank control group(group A),dexamethasone group(group B),gastrointestinal decompression group(group C)and dexamethasone combined with gastrointestinal decompression group(group D),with 60 cases in each group.Before anesthesia induction,dexamethasone 4 mg was injected intravenously in group B and D.after laryngeal mask implantation,sputum suction tubes were placed in group C and D for gastrointestinal decompression.The areas of gastric antrum were measured and calculated by ultrasound before anesthesia induction(T0),after successful laryngeal mask implantation(T1),and after removal of laryngeal mask(T2).The general information and anesthesia operation,the changes of antral area at T0,T1,and T2,and the occurrence of flatulence,nausea,vomiting,sore throat,and hoarseness at 1,6,and 24 h after operation were observed and compared among the four groups.Results There were no statistically significant differences in general information,operation conditions,and antral areas at T0 and T1 among the four groups(all P＞0.05).At T2,the areas of gastric antrum in group A and B were significantly larger than those in group C and D.The incidences of flatulence,nausea and vomiting at 1 and 6 h after operation and the incidence of nausea at 24 h after operation were significantly different among the four groups(all P＜0.05).The incidences of nausea and vomiting at 1 and 6 h after surgery,gastric distension at 6 h after surgery[1 h after surgery:15.0％(9/60)vs 36.7％(22/60),10.0％(6/60)vs 30.0％(18/60);6 h after surgery:10.0％(6/60)vs 51.7％(31/60),8.3％(5/60)vs 51.7％(31/60)],and nausea at 24 h after surgery[6.7％(4/60)vs 26.7％(16/60)]in Group D were all lower than those in Group A(all P＜0.05).Conclusion Dexamethasone combined with intraoperative gastrointestinal decompression can reduce the incidence of nausea and vomiting at 1 and 6 h after Baska laryngeal mask airway positive pressure ventilation,gastric bloating at 6 h after surgery,and nausea at 24 h after surgery.

Abstract:Objective To explore the clinical value of endoscopic ultrasonography combined with inflammatory markers in the differential diagnosis of gastric stromal tumor and gastric leiomyoma.Methods From January 2017 to April 2024,at the Department of Gastroenterology,the First Hospital of Lanzhou University,the clinical data of 152 patients who underwent endoscopic treatment and were confirmed as gastric stromal tumor or leiomyoma by postoperative pathology were retrospectively selected.There were 86 cases of gastric stromal tumor(gastric stromal tumor group)and 66 cases of gastric leiomyoma(gastric leiomyoma group).The baseline data,endoscopic ultra-sound characteristics and inflammation-related indicators of the two groups were compared.Binary Logistic regres-sion was used to analyze the independent diagnostic factors of gastric stromal tumor and gastric leiomyoma.The receiver operating characteristic curve was used to analyze the diagnostic efficacy of single index and combination for gastric stromal tumor and gastric leiomyoma.Results The age of patients in gastric stromal tumor group was significantly older than that in gastric leiomyoma group[58(53,64)years vs 54(47,59)years](Z=-3.438,P=0.001).There were significant differences in tumor size,tumor location,internal echo properties and echo uniformity between the two groups(all P＜0.05).The platelet to lymphocyte ratio(PLR)and neutrophil to lymphocyte ratio in gastric leiomyoma group were lower than those in gastric stromal tumor group,and the lympho-cyte to monocyte ratio(LMR)was higher than that in gastric stromal tumor group(all P＜0.05).Multivariate binary Logistic regression analysis showed that age,tumor size,tumor location,PLR and LMR were independent diagnostic factors(all P＜0.05).The results of receiver operating characteristic curve analysis showed that the area under the curve of age,tumor size,tumor location,PLR,LMR and the combination of the five indicators were 0.337,0.309,0.424,0.378,0.670,0.856,respectively.The diagnostic efficacy of the combination of the five indicators for gastric stromal tumor and gastric leiomyoma was significantly better than that of each single indicator.Conclusion The combined model of endoscopic ultrasonography features and inflammatory indicators can significantly improve the efficacy of preoperative differential diagnosis of gastric stromal tumors and gastric leiomyoma,and provide a reliable basis for clinical diagnosis.

Abstract:Objective To explore the predictive value of combining metabolic syndrome(MS),systemic inflammation index(SIRI)and fibrinogen/albumin ratio(FAR)in the prognosis of triple-negative breast cancer(TNBC),construct a scoring system and verify its predictive value for the prognosis of TNBC.Methods A total of 252 TNBC patients treated in the Affiliated Hospital of Chengde Medical University and the First Hospital of Hebei Medical University from January to December 2019 were selected as the training set,and 98 TNBC patients treated in the two hospitals from January to April 2020 were selected as the validation set.In the training set,48 patients with MS were included in the observation group,and 204 patients without MS were included in the control group.The patients were followed up for 3 years to record the occurrence of adverse events.MS,FAR and SIRI scoring systems were constructed and their predictive efficacy was evaluated.Results There were no significant differences in baseline data between the training set and the validation set(all P＞0.05).There were statistically significant differences in the levels of systolic blood pressure,diastolic blood pressure,body mass index,triglyceride,high-density lipoprotein,blood glucose,and the proportions of diabetes,hypertension,and adverse outcomes between the observation group and the control group(all P＜0.001).The results of univariate Cox regression analysis showed that SIRI and MS were risk factors for the poor outcome of TNBC patients,and FAR was a protec-tive factor for the poor outcome of TNBC patients(all P＜0.05).Receiver operating characteristic curve analysis results showed that the area under the curve of SIRI was 0.853,the area under the curve of FAR was 0.787,and the area under the curve of the scoring system was 0.886.Conclusion MS,FAR and SIRI are independent predictors of poor prognosis in TNBC,and the scoring system constructed by them can improve the prediction efficiency of poor prognosis.

Abstract:Objective To analyze the clinical characteristics of pain in rheumatology outpatients.Methods A total of 739 outpatients from the Department of Rheumatology and Immunology,the First Affiliated Hospital of Anhui Medical University from January 2019 to June 2022 were selected for pain assessment question-naire survey.The distribution of pain degree,sleep disorders caused by pain,and pain location were analyzed.The differences of pain degree[visual analog scale(VAS)scores],pain location,and pain complications among different diseases were compared,and the related factors of moderate to severe pain were analyzed.Results Of the 739 patients,517 cases(70.0％)had pain,including 198 cases(26.8％)with mild pain(VAS score 1-3),215 cases(29.1％)with moderate pain(VAS score 4-6),and 104 cases(14.1％)with severe pain(VAS score 7-10).Among the 739 patients,245 cases(33.2％)had sleep disorders caused by pain,mainly included 129 cases(17.5％)had poor sleep quality,57 cases(7.7％)had difficulty falling asleep,and 54 cases(7.3％)woke up with pain or woke up early.Totally 197 patients(26.7％)were in the outpatient clinic due to pain in both hands,followed by 152 patients(20.6％)with knee pain.Among 517 patients with pain,73 cases(14.1％)were complicated with hypertension.There was a statistically significant difference in the proportion of hypertension among the diseases with pain(P＜0.001).There was a statistically significant difference in the degree of pain between patients with rheumatic diseases of different diseases(P＜0.001).There were statistically significant differences in the distribution proportions of low back pain,leg pain,hip pain,knee pain,upper limb pain,and shoulder pain among rheumatic patients with different diseases(all P＜0.05).Logistic regression analysis showed that knee pain,low back pain,leg and foot pain,cervical pain,shoulder pain,hip and hip pain,and upper limb pain were the relevant factors causing moderate to severe pain(all P＜0.05).Conclusion In this study,70.0％of outpatients in rheumatology and Immunology Department had pain,43.2％of patients had moderate to severe pain,and 33.2％of patients had sleep disorders due to pain,suggesting that we should pay attention to the pain of outpatients in rheumatology and Immunology Department.

Abstract:Objective To investigate the effect of methylprednisolone pulse therapy combined with mouse nerve growth factor on visual acuity and autoimmune antibodies levels in patients with acute optic neuritis.Methods A total of 122 patients with acute optic neuritis admitted to Affiliated Hospital of Hebei University from July 2023 to June 2024 were selected as the research objects.According to the random number table method,they were divided into the control group(61 cases)and the observation group(61 cases).Both groups were given conventional treatment first,the control group was given mouse nerve growth factor,and the observation group was given methylprednisolone pulse therapy on the basis of the control group,both groups were treated for 4 weeks.The curative effect,visual acuity,visual function index,visual field defect value,autoimmune antibody,visual evoked potential,incidence of adverse reactions and recurrence rate were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[91.8％(56/61)vs 77.0％(47/61)](x2=5.050,P=0.025).After treatment,the visual acuity,visual function index and P100 wave amplitude of the two groups were higher/greater than those before treatment,and those of the observation group were higher/greater than those of the control group;the visual field defect value,positive rate of myelin oligoden-drocyte glycoprotein,positive rate of aquaporin 4,and P100 wave latency in the two groups were lower/shorter than those before treatment,and those in the observation group were lower/shorter than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(x2=0.684,P=0.408).The recurrence rate of the observation group was lower than that of the control group[8.2％(5/61)vs 21.3％(13/61)](x2=4.171,P=0.041).Conclusion Methylprednisolone pulse therapy combined with mouse nerve growth factor has a significant effect on acute optic neuritis,which can effectively improve visual acuity,improve the function of the optic nerve,and reduce the immune response.

Abstract:Objective To evaluate the clinical efficacy of Tongxinluo capsule combined with enhanced external counterpulsation(EECP)in patients with ischemic cardiomyopathy and heart failure.Methods A total of 188 patients with ischemic cardiomyopathy and heart failure who were hospitalized in the Department of Cardiovascular Medicine,the First Affiliated Hospital of Hebei North University from May 2021 to June 2023 were selected.The patients were divided into control group and observation group by block randomization method,with 94 cases in each group.The control group was treated with conventional western medicine combined with EECP,and the observation group was treated with Tongxinluo capsule on the basis of the control group.Both groups were treated for 8 weeks.The traditional Chinese medicine syndrome scores,hemodynamic indicators(cardiac output,cardiac index,stroke volume),cardiac function indicators[left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)],and safety were compared between the two groups before and after treatment.Results The traditional Chinese medicine syndrome scores of the two groups at 8 weeks of treatment were lower than those before treatment,and those of the observa-tion group were lower than those of the control group[(9.4±2.3)vs(11.7±2.8)](all P＜0.05).The cardiac output,cardiac index and stroke volume of the two groups at 8 weeks of treatment were higher than those before treatment,and those of the observation group were higher than those of the control group(all P＜0.05).After 8 weeks of treatment,LVESD and LVEDD of the two groups were lower than those before treatment,and LVEF was higher than that before treatment,and LVESD and LVEDD of the observation group were lower than those of the control group,and LVEF was higher than that of the control group(all P＜0.05).During the treatment and observation period,there was no significant difference in the incidence of nausea and vomiting,insomnia,and abdominal discomfort between the two groups(all P＞0.05).Conclusion Tongxinluo capsule combined with EECP in the treatment of patients with ischemic cardiomyopathy and heart failure can improve the traditional Chinese medicine syndrome score,hemodynamics and cardiac function indexes,and has good safety.