Abstract:As a classic nonsteroidal anti-inflammatory drug,aspirin has attracted increasing attention in the field of colorectal cancer prevention and treatment in addition to its antipyretic,analgesic,anti-inflammatory and cardiovascular protective effects.Numerous epidemiological and clinical studies have confirmed that long-term regular use of aspirin can significantly reduce the risk of colorectal cancer incidence and mortality,and has clear chemopreventive value especially for populations with specific genetic background and tumor molecular subtypes.This paper systematically reviews the research progress of aspirin in the prevention and treatment of colorectal cancer,focusing on its possible multi-target anticancer mechanism network,aiming to provide a theoretical basis for the clinical"repurposing of old drugs"and expand new approaches for individualized prevention and treatment of colorectal cancer.

Abstract:Objective To investigate the effects of probiotic preparations on glucose and lipid metabolism and cytokines in obese patients with polycystic ovary syndrome(PCOS).Methods A total of 63 PCOS patients who visited Beijing Anzhen Hospital,Capital Medical University from April 2023 to December 2024 were enrolled.Patients were divided into observation group(42 cases)and control group(21 cases)by random number table method.The observation group received oral probiotic preparations,while the control group received oral maltodextrin,and both groups were treated for 12 weeks.General data,glucose metabolism indicators,lipid metabolism indicators and cytokine levels were compared between the two groups.Results Among the 63 enrolled patients,3 withdrew from the study midway due to personal reasons.Finally,60 patients completed the study,including 40 in the observation group and 20 in the control group.After treatment,body weight and body mass index in the observation group were lower than those before treatment and lower than those in the control group[(81.3±2.0)kg vs(85.3±2.1)kg,(29.4±0.6)kg/m2 vs(30.3±0.5)kg/m2](all P＜0.05).After treatment,fasting insulin and homeostasis model assessment of insulin resistance in the observation group were lower than those before treatment and lower than those in the control group(all P＜0.05).After treatment,triglyceride,total cholesterol and low-density lipoprotein cholesterol in the observation group were lower than those before treatment and lower than those in the control group(all P＜0.05).After treatment,interleukin-6(IL-6),IL-8 and tumor necrosis factor-α in the observation group were lower than those before treatment and lower than those in the control group,while IL-10 was higher than that before treatment and higher than that in the control group(all P＜0.05).Conclusion Probiotic preparations can regulate glucose and lipid metabolism in obese PCOS patients to a certain extent,which may be achieved by regulating the levels of related cytokines,improving the inflammatory microenvi-ronment,and further modulating metabolic indicators in obese PCOS patients.

Abstract:Objective To explore the association between triglyceride-glucose body mass index(TyG-BMI)and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients.Methods A total of 2 981 middle-aged and elderly hypertensive patients aged ≥45 years from the 2011 wave of the China health and retirement longitudinal study database were enrolled.During follow-up until 2015,233 patients developed new-onset adverse cardiovascular events(cardiovascular event group),and 2 748 patients remained free of adverse cardiovascular events(non-cardiovascular event group).Cox proportional hazards models were used to analyze the relationship of continuous TyG-BMI and categorized TyG-BMI[stratified by the median TyG-BMI of the study population(212.1)as the cut-off value;participants were divided into low-value group(102.4-212.1)and high-value group(＞212.1-432.1)]with the risk of adverse cardiovascular events.Restricted cubic splines were plotted to analyze the dose-response relationship between TyG-BMI and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients.Subgroup analyses were performed stratified by age(＜60 years vs ≥ 60 years),gender,diabetes history,smoking history and drinking history.Results The levels of body mass index,low-density lipoprotein cholesterol,serum uric acid,C-reactive protein,glycated hemoglobin and TyG-BMI in the cardiovascular event group were higher than those in the non-cardiovascular event group(all P＜0.05).In addition,the preva-lence rates of hyperlipidemia,diabetes mellitus and renal diseases were significantly higher,while high-density lipo-protein cholesterol and systolic blood pressure levels were lower in the cardiovascular event group compared with the non-cardiovascular event group(all P＜0.05).When TyG-BMI was included as a continuous variable in Cox proportional hazards regression analysis for the overall population,it was positively associated with the risk of adverse cardiovascular events across all models.In the fully adjusted Model 3 stratified by the median TyG-BMI,the high-value group had a 36％increased risk of adverse cardiovascular events relative to the low-value group(hazard ratio=1.36,95％confidence interval:1.05-1.76,P=0.020).The risk estimates of TyG-BMI(the second quartile versus the first quartile)were consistent with those of the overall population across all subgroups(i.e.,higher TyG-BMI corresponded to elevated risk),with no significant heterogeneity observed within each subgroup(the P values for interaction tests stratified by age,diabetes history,drinking status,gender and smoking history were 0.157,0.518,0.679,0.803 and 0.807,respectively).The elevated risk of adverse cardiovascular events indicated by increased TyG-BMI remained relatively stable across subgroups.Conclusions Elevated TyG-BMI is a risk factor for adverse cardiovascular events in middle-aged and elderly hypertensive patients.This indicator is easy to calculate and cost-effective,and can serve as a potential simple tool for evaluating cardiac risk in hypertensive patients.

Abstract:As a key multifunctional adaptor protein in cells,sequestosome-1(p62)is not only a substrate receptor in the autophagy pathway,but also a hub connecting signal transduction and metabolic regulation.Although studies have shown that p62 is abnormally highly expressed in various malignant tumors such as hepato-cellular carcinoma,pancreatic cancer,renal cancer and colorectal cancer,the molecular mechanism by which it drives tumor metabolic reprogramming remains incompletely clear.This article systematically reviews the molecular mechanism by which p62 integrates mammalian target of rapamycin complex 1,nuclear factor erythroid 2-related factor 2,and nuclear factor-κB signaling axes through non-canonical autophagy pathways to coordinately regulate the stability of glucose transporters,glycolytic rate-limiting enzymes,and glutamine transporters,thereby remodeling the glycolipid metabolic network of tumor cells.In addition,this article further discusses metabolic intervention therapeutic strategies targeting p62 signaling nodes,providing a theoretical basis for the development of novel combined anti-tumor therapies.

Abstract:Objective To summarize the experience of multidisciplinary collaborative anticoagulation management for patients undergoing simultaneous coronary endarterectomy(CE)during coronary artery bypass grafting(CABG),so as to provide reference for clinical medical staff.Methods A total of 90 patients receiving combined CABG and CE in Guangdong Provincial People's Hospital from September 2017 to June 2024 were retrospectively enrolled.The patients were divided into multidisciplinary collaborative anticoagulation group(45 cases)and routine anticoagulation group(45 cases)according to postoperative anticoagulation regimens.Postoperative total incidence of bleeding events and early graft patency rate were compared between the two groups.Results Among the 90 surgical patients,7 cases required postoperative intra-aortic balloon pump support.The intensive care unit stay was 97.0(59.7,163.0)h,and the mechanical ventilation duration was 20.0(17.0,48.2)h.Perioperative myocardial infarction occurred in 3 patients,gastrointestinal bleeding in 1 patient,other bleeding events in 5 patients,and cerebrovascular accidents in 5 patients.The average hospital stay was(27±11)d.Three patients and their families chose self-discharge after surgery,1 patient died during follow-up,and 1 patient received secondary coronary stent implantation for restenosis of a target vessel at non-endarterectomy site at the second month after operation.The proportions of patients with New York Heart Association cardiac function class 3-4 before and after surgery were 67.8％(61/90)and 16.7％(15/90),respectively.The 24 h postoperative drainage volume,total incidence of bleeding events and postoperative blood transfusion rate in the multidisciplinary collaborative anticoagulation group were lower than those in the routine anticoagulation group[(347±52)ml vs(451±61)ml,0(0/45)vs 13.3％(6/45),4.4％(2/45)vs 17.8％(8/45)],while the early graft patency rate was higher[95.6％(43/45)vs 82.2％(37/45)](all P＜0.05).There were no statistically significant differences in the incidence of graft occlusion and graft stenosis ≥50％between the two groups(both P＞0.05).Conclusion Multidisciplinary collaborative anticoagulation management after combined CABG and CE can signifi-cantly reduce bleeding risk and improve early graft patency rate.

Abstract:Objective To explore the short-term prognosis and clinical characteristics of patients with acute myocardial infarction(AMI)complicated with upper gastrointestinal bleeding after endoscopic therapy,and to identify the safe conditions for endoscopic treatment and key prognostic factors.Methods A total of 64 patients admitted to Beijing Anzhen Hospital,Capital Medical University from January 2012 to August 2025 with AMI combined with upper gastrointestinal bleeding who received successful endoscopic hemostasis were retrospectively enrolled.Clinical data including general information,medical history,laboratory examinations,cardiac and bleeding characteristics,and clinical outcomes were collected.The primary endpoint was all-cause mortality within 30 d after successful endoscopic hemostasis.Patients were divided into survival group(44 cases)and death group(20 cases)for comparative analysis.Results The age of the 64 patients was(63±13)years old,among whom 79.7％(51/64)were male.Non-ST-segment elevation myocardial infarction accounted for 60.9％(39 cases),and ST-segment elevation myocardial infarction accounted for 39.1％(25 cases).Cardiac insufficiency was present in 53.1％(34 cases)on admission.All patients achieved successful endoscopic hemostasis without intraoperative complications.During the 30 d follow-up period,44 patients(68.8％)survived and 20 patients(31.2％)died,among whom 95.0％(19/20)died of cardiac causes after successful hemostasis.Due to severe underlying cardiac diseases in the death group,the proportions of patients receiving mechanical ventilation,intra-aortic balloon pump,extracorporeal membrane oxygenation and continuous renal replacement therapy were significantly higher than those in the survival group[80.0％(16/20)vs 25.0％(11/44),35.0％(7/20)vs 9.1％(4/44),45.0％(9/20)vs 4.5％(2/44),40.0％(8/20)vs 0(0/44)](all P＜0.05).Conclusions Most patients with AMI combined with upper gastrointestinal bleeding undergoing endoscopic hemostasis are complicated with cardiac insufficiency.The application of advanced life support contributes to hemodynamic stability and guarantees the safe implementation of endoscopic hemostasis,while it also reflects critical illness severity.The prognosis of patients is determined by the severity of underlying cardiac lesions.

Abstract:Objective To evaluate the utilization rate of key evidence-based treatments in hospitalized patients with acute myocardial infarction(AMI)based on electronic medical record data,and to verify the accuracy of the evaluation results.Methods This cross-sectional study was conducted based on routine clinical diagnosis and treatment data.A total of 900 AMI cases from 5 hospitals in Beijing were enrolled.Taking manually extracted medical record data for evaluating diagnosis and treatment quality as the reference standard,the accuracy of the utilization rate of key evidence-based treatments evaluated by electronic medical record data was compared and verified.Results The baseline age of 900 enrolled AMI patients from 5 hospitals was(65±14)years old,including 663 males(73.7％).Analysis of AMI medical quality indicators in each hospital showed that electronic medical record data were consistent with manually recorded data in seven key indicators.For reperfusion therapy indicators,Hospital A(both 65.3％)and Hospital B(84.6％vs 86.8％,both ranked first)presented consistent results.The overall standardized mean difference of reperfusion therapy indicators was only 0.06,further confir-ming the tiny difference from the perspective of effect size.It indicated that electronic medical record data have high reliability in recording clearly defined and standardized diagnosis and treatment items.Conclusion The evaluation of the utilization rate of key evidence-based treatments in hospitalized AMI patients based on electronic medical record data has good consistency with medical quality evaluation based on manual data entry,which can be used as an information source to assess the medical quality of hospitalized AMI patients.

Abstract:Objective To evaluate right ventricular function in patients with left ventricular noncompaction(LVNC)by speckle tracking imaging(STI),and to investigate the predictive efficiency of right ventricular global longitudinal strain(RVGLS)/pulmonary artery systolic pressure(PASP)ratio for adverse outcomes in LVNC patients.Methods A total of 42 LVNC patients admitted to Affiliated Hospital of Qingdao University from November 2023 to June 2025 were prospectively enrolled.According to the median left ventricular ejection fraction(LVEF),the patients were divided into group A(LVEF ≤43％,21 cases)and group B(LVEF＞43％,21 cases).Meanwhile,42 healthy adults were enrolled as control group(group C).STI was used to measure RVGLS and calculate RVGLS/PASP ratio.Linear regression analysis was performed to analyze the correlation between RVGLS/PASP ratio and other ultrasonic parameters.Receiver operating characteristic(ROC)curve was applied to analyze the value of RVGLS/PASP ratio in evaluating adverse prognosis of LVNC patients.Results Compared with group A,left ventricular global longitudinal strain(LVGLS),RVGLS,right ventricular free wall longitudinal strain(RVFWLS)and RVGLS/PASP ratio were increased in group B and group C(all P＜0.05).Compared with group C,LVGLS,RVGLS and RVGLS/PASP ratio were decreased in group B(all P＜0.05).Multiple linear regression analysis showed that medial early diastolic mitral annular velocity,left atrial volume index and RVFWLS were independently correlated with RVGLS/PASP ratio(all P＜0.05).ROC curve analysis indicated that RVGLS/PASP ratio had the highest predictive efficiency for adverse prognosis of LVNC patients,with an area under the curve of 0.856(95％confidence interval:0.744-0.967).Conclusion Right ventricular function is decreased in LVNC patients.RVGLS/PASP ratio can be used to evaluate right ventricular function and predict adverse prognosis in LVNC patients,which has important clinical significance.

Abstract:Objective To analyze the related factors of substandard concentration of cefoperazone sulbactam(SCF)in patients with ventilator-associated pneumonia(VAP)and to evaluate the dosing regimen of SCF in the treatment of VAP by Monte Carlo simulation(MCS).Methods A total of 172 VAP patients admitted to Renji Hospital,Shanghai Jiao Tong University School of Medicine from April to September 2021 were selected as the research objects.According to the steady-state trough concentration of SCF in VAP patients,the patients were divided into substandard group(64 cases)and standard group(108 cases),and the related factors of substandard SCF concentration in VAP patients were analyzed.MCS was used to analyze the compliance of each regimen at different infusion times.Results Multivariate Logistic regression analysis showed that age,craniocerebral injury,creatinine clearance rate(CCr)level and continuous renal replacement therapy(CRRT)were independent influencing factors for substandard SCF plasma concentration in VAP patients(all P＜0.05).The area under the curve of Logistic regression model for predicting substandard SCF plasma concentration in VAP patients before and after internal verification was 0.873(95％confidence interval:0.839-0.898)and 0.875(95％confidence interval:0.844-0.901),respectively,which had a good prediction efficiency.The results of MCS analysis showed that with the increase of drug infusion time,the target achievement probability(PTA)showed an upward trend under different administration regimens and infusion time.However,each dosing regimen had a specific minimum inhibitory concentration(MIC)threshold.When the pathogen MIC was below this threshold,the infusion time could be adjusted to achieve the desired pharmacodynamic goal of PTA＞90％.When the pathogen MIC was ≤16 μg/ml,PTA＞90％could be achieved by optimizing the dosing regimen and prolonging the infusion time.However,when the pathogen MIC was ≥ 32 μg/ml,the therapeutic goal of PTA＞90％could not be achieved regardless of the dosing regimen or infusion time.For empirical treatment,the cumulative response rate reached more than 90％when only 3 g(q6 h)regimen was infused for 4 h.Conclusion The age,CRRT,craniocerebral injury and CCr level should be fully considered when selecting SCF dosing regimen for VAP patients.The pharmacokinetic/pharmacodynamic synergism induced by SCF infusion dosing regimen shows a selective characteristic for MIC.For the pathogens at the upper or borderline high sensitivity threshold,the administration strategy can be optimized,including adjusting the administration interval,increasing the drug dose,and prolonging the infusion time,so as to achieve the maintenance of effective blood drug concentration.

Abstract:Objective To investigate the differences of intraoperative related indicators,clinical efficacy,safety,postoperative quality of life and patient satisfaction between low-dose(0.2-＜0.5 ml)and standard-dose(0.5-1.5 ml)lauromacrogol sclerotherapy in the treatment of hemorrhagic internal hemorrhoids,in order to provide scientific basis and reference for clinical practice.Methods A total of 137 patients with hemorrhagic internal hemorrhoids who received lauromacrogol sclerotherapy in Xiangyang Central Hospital,Hubei Province from January 2021 to November 2024 were selected.According to the single injection dose,they were divided into standard-dose group(99 cases)and low-dose group(38 cases).The intraoperative indicators,postoperative complications,clinical efficacy,quality of life and patient satisfaction were compared between the two groups.Results The operation time,average dose of single injection point and total injection volume in the low-dose group were shorter/less than those in the standard-dose group[(23±3)min vs(25±4)min,(0.46±0.08)ml vs(0.95±0.33)ml,(1.8±0.6)ml vs(4.4±1.9)ml](all P＜0.05).The incidences of postoperative dirt and anal distension in the low-dose group were significantly lower than those in the standard-dose group(both P＜0.05).At least 8 weeks of follow-up,the incidences of bleeding and prolapse in the standard-dose group were higher than those in the low-dose group(both P＜0.05).There was no significant difference in the total effective rate between the standard-dose group and the low-dose group[99.0％(98/99)vs 100.0％(38/38)](P=0.303).The low-dose group performed better than the standard-dose group in mobility,self-care ability,and daily activities(all P＜0.05).Patients in the low-dose group were more satisfied than those in the standard-dose group(P=0.02).Conclusion For patients with hemorrhagic internal hemorrhoids,endoscopic single-point injection of low-dose and standard-dose lauromacrogol has the same effect,and has fewer postoperative complications,better quality of life,and higher patient satisfaction.

Abstract:Objective To observe the pathological types and distribution of abnormal uterine bleeding in postmenopausal women,analyze the relationship between different pathological types and clinical characteristics,and explore the risk factors of endometrial malignant and precancerous lesions in postmenopausal women with abnormal uterine bleeding.Methods The clinical data of 894 patients with postmenopausal abnormal uterine bleeding who underwent hysteroscopy and endometrial localization biopsy in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from May 1,2018 to May 1,2023 were retrospectively analyzed.The pathological and clinical characteristics of the patients were summarized.Multivariate Logistic regression was used to analyze the risk factors of endometrial malignant and precancerous lesions in postmenopausal women with abnormal uterine bleeding.Results Among 894 patients with abnormal uterine bleeding after menopause,the pathological types were mainly benign lesions,accounting for 710 cases(79.4％),of which endometrial polyps accounted for the largest proportion,269 cases(30.1％),malignant and precancerous lesions accounted for 184 cases(20.6％),and endometrial cancer was the most common,accounting for 151 cases(16.9％).There were significant differences between the two groups in age,menopausal years,fertility,diabetes mellitus,endometrial echo uniformity,endometrial thickness ≥0.5 cm,duration of abnormal uterine bleeding,normal coagulation function and normal proportion of tumor markers(all P＜0.05).Multivariate Logistic regression analysis showed that long menopausal years(6-10 years,＞10 years),non-childbearing,endometrial thickness ≥0.5 cm,abnormal tumor markers were the risk factors for endometrial malignant and precancerous lesions in postmenopausal patients(all P＜0.05).Conclusion The main cause of abnormal uterine bleeding after menopause is benign lesions,and the occurrence of malignant and precancerous lesions is related to the years of menopause,fertility,endometrial thickness and tumor markers.

Abstract:Objective To explore the efficacy of alteplase intravenous thrombolysis combined with tirofiban in preventing acute cerebral infarction(ACI)from progressing to progressive cerebral infarction(PCI),and to construct a random forest model for predicting the risk of PCI.Methods A total of 106 ACI patients admitted to Nanping First Hospital Affiliated to Fujian Medical University from January 2022 to December 2024 were selected and divided into control group(alteplase intravenous thrombolysis alone,26 cases)and observation group(alteplase intravenous thrombolysis combined with tirofiban,80 cases)according to different treatment regimens.The incidence of PCI,national institutes of health stroke scale(NIHSS)scores,coagulation indicators,and adverse reactions were compared between the two groups.Furthermore,the observation group was divided into progression group and non-progression group.Clinical data and laboratory indicators were compared between the two subgroups.Logistic regression analysis was used to screen the risk factors for PCI,and a random forest model was established to predict the risk of PCI.Results Among the 26 patients in the control group,17 patients(65.4％)progressed to PCI after treatment,while 34 of the 80 patients(42.5％)in the observation group developed PCI,with a statistically significant difference between the two groups(P=0.042).The post-treatment NIHSS score in the observation group was lower than that in the control group(P＜0.05).After treatment,thrombin time,activated partial thromboplastin time,and prothrombin time in the observation group were all longer than those in the control group(all P＜0.05).Multivariate Logistic regression analysis showed that diabetes mellitus(odds ratio=20.530,P=0.004),admission NIHSS score(odds ratio=1.368,P=0.018),admission systolic blood pressure(odds ratio=1.053,P=0.041),fibrinogen(FIB)(odds ratio=29.931,P＜0.001),and serum amyloid A(SAA)(odds ratio=1.116,P=0.033)were influencing factors for PCI.In the random forest model,the order of factor importance was FIB,SAA,systolic blood pressure,NIHSS score,and diabetes mellitus.The area under the curve(AUC)of the random forest model was 0.957,with a sensitivity of 94.12％and specificity of 86.96％,which was superior to the Logistic model(AUC=0.909,P=0.042).Conclusion Alteplase combined with tirofiban can effectively reduce the risk of PCI,improve neurological function and coagulation status without increasing adverse reactions.Diabetes mellitus,high NIHSS score,high systolic blood pressure,elevated FIB,and high SAA are independent risk factors for PCI.The random forest model exhibits higher predictive performance,which is conducive to early identification of high-risk patients and guidance of individualized interventions.

Abstract:Objective To investigate the effect of leuprolide acetate sustained-release microspheres on ovarian reserve function in girls with idiopathic central precocious puberty(ICPP)by monitoring the levels of anti-Mullerian hormone and inhibin B.Methods Sixty-one girls aged 6-9 years who were diagnosed with ICPP and complained of premature breast development or early menarche in Beijing Jishuitan Hospital,Capital Medical University from January 2021 to December 2023 were selected as the ICPP group.Another 50 girls with normal adolescent development aged 6-9 years who underwent physical examination in the pediatric outpatient department of our hospital during the same period were selected as the healthy control group.The general data and sex hormone levels before and after treatment were compared between the two groups.Results In the general data,the standard deviation scores of weight,height,body mass index,bone age biological age difference,and inhibin B levels of 61 girls in the ICPP group were significantly higher than those of 50 healthy control group girls(all P＜0.05).Among the 50 girls in the ICPP group,5 girls were excluded because they did not follow the doctor's advice and regularly monitored the relevant clinical and biochemical indicators,and the remaining 45 girls were included.There was no significant difference in AMH level between the ICPP group and the healthy control group after 6 and 12 months of treatment(all P＞0.05).Luteinizing hormone and follicle-stimulating hormone were significantly lower than before treatment in this group[0.44(0.30,0.81),0.34(0.24,0.57)IU/L vs 2.70(1.09,4.19)IU/L;1.7(1.1,2.3),1.7(1.3,2.2)IU/L vs 6.1(4.0,7.2)IU/L](all P＜0.05).Inhibin B transiently decreased after 6 months of treatment and was lower than that before treatment[39(29,61)ng/L vs 76(50,88)ng/L](P＜0.05),and there was no significant difference after 12 months of treatment[71(53,99)ng/L]compared with that before treatment(P＞0.05).Conclusion Leuprolide acetate sustained-release microspheres have no significant effect on ovarian reserve function in girls with ICPP.

Abstract:Objective To investigate the effect of hypercapnia ventilation mode on elderly patients undergoing laparoscopic radical resection of colorectal cancer on the basis of goal-directed fluid therapy,and to observe the changes of intraoperative regional cerebral oxygen saturation and postoperative cognitive function.Methods A total of 60 elderly patients scheduled for elective laparoscopic radical resection of colorectal cancer in the First Affiliated Hospital of Hebei North University from July 2023 to June 2024 were selected.They were divided into a control group and an observation group by random number table method,with 30 cases in each group.Both groups received fluid replacement under the guidance of goal-directed fluid therapy.Respiratory parameters were adjusted to maintain intraoperative arterial partial pressure of carbon dioxide(PaCO2)at 35-45 mmHg and pH 7.35-7.45 in the control group,while in the observation group,PaCO2 was maintained at 46-55 mmHg and pH 7.25-7.35.The general data,PaCO2 at different time points[preoperatively(T0),5 min before pneumoperitoneum(T1),20 min after pneumoperitoneum(T2),1 h after pneumoperitoneum(T3),2 h after pneumoperitoneum(T4),and 20 min after the end of pneumoperitoneum(T5)],intraoperative regional cerebral oxygen saturation(rSO2),results of arterial blood gas analysis,cerebral oxygen metabolism indicators,serum cognitive function indicators,and early postoperative cognitive function indicators were compared between the two groups.Results There were no statistically significant differences in general data between the two groups(all P＞0.05).Compared with T0,PaCO2 and rSO2 in the observation group increased,while pH decreased at T2-T5(all P＜0.05).PaCO2 and rSO2 at T2-T4 in the observation group were higher than those in the control group;pH at T2-T5 in the observation group were lower than those in the control group(all P＜0.05).At 1 h after pneumoperitoneum,the internal jugular venous oxygen saturation in the observation group was higher than that in the control group,while the arterial-internal jugular venous oxygen content difference and cerebral oxygen extraction rate were lower than those in the control group(all P＜0.05).The level of brain-derived neurotrophic factor on the first day after surgery in the observation group was higher than that in the control group,and the levels of neuron-specific enolase and homocysteine were lower than those in the control group(all P＜0.05).Compared with the day before surgery,the Mini-Mental State Examination(MMSE)scores of both groups decreased on the first day after surgery;the MMSE score of the observation group on the first day after surgery was higher than that of the control group(all P＜0.05).The incidence of postoperative cognitive dysfunction in the observation group was lower than that in the control group[10.0％(3/30)vs 36.7％(11/30)](P＜0.05).Conclusion On the basis of goal-directed fluid therapy,the application of permissive hypercapnia ventilation mode in elderly patients undergoing laparoscopic radical resection of colorectal cancer can increase cerebral blood flow,elevate rSO2,reduce cerebral oxygen metabolism level,mitigate cognitive function impairment,and contribute to the rapid postoperative recovery of patients.

Abstract:Objective To explore the mechanism by which erianin remodels chemotherapeutic response in colorectal cancer.Methods Human colorectal cancer cell lines HCT116 and SW480 were used as research objects and divided into blank control group(only normal medium added),oxaliplatin group(10 μmol/L oxaliplatin added),erianin groups(0,25,50 nmol/L erianin added),and combination group(10 μmol/L oxaliplatin+50 nmol/L erianin added).Cell counting kit assay was used to detect cell viability and calculate half-maximal inhibitory concentration(IC50);colony formation assay was performed to evaluate cell proliferation ability;flow cytometry was used to assess cell apoptosis rate and cell cycle distribution;relevant kits were employed to determine lipid peroxidation level,glutathione and malondialdehyde levels;Western blot was used to detect the expression of ferroptosis-related proteins[glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11),long-chain acyl-CoA synthetase 4(ACSL4)].Results For HCT116 and SW480 cells,increased erianin concentration and prolonged treatment time both gradually reduced cell viability,and the cell viability in the 50 nmol/L erianin treatment group was significantly lower than that in the 25 nmol/L treatment group(P＜0.05).The 48 h IC50 values of erianin for HCT116 and SW480 cells were 30.2 nmol/L and 101.4 nmol/L,respectively.The colony formation rate,glutathione content,and protein levels of GPX4 and SLC7A11 in the single-drug treatment groups(oxaliplatin group and erianin group)were significantly lower than those in the blank control group,and the relevant indicators in the combination group were the lowest,which were further decreased compared with the single-drug treatment groups(all P＜0.05).The cell apoptosis rate,lipid peroxidation level,malondialdehyde content,and ACSL4 protein level in the single-drug treatment groups were significantly higher than those in the blank control group,and the relevant indicators in the combination group were the highest,which were further increased compared with the single-drug treatment groups(all P＜0.05).Compared with the blank control group,both the oxaliplatin group and the erianin group induced G2/M phase arrest;the proportion of G2/M phase cells in the combination group was further increased,while the proportions of S phase and G0/G1 phase cells were decreased(all P＜0.05).Conclusion Erianin can inhibit the viability of colorectal cancer cells,and its combination with oxaliplatin can enhance the inhibitory effect.The mechanism may be related to inducing cell apoptosis,arresting cell cycle,and promoting ferroptosis.

Abstract:Objective To explore the correlation between serum interleukin-8(IL-8)and serum amyloid A(SAA)levels and treatment outcomes in children with Streptococcus pneumoniae pneumonia.Methods A retrospective analysis was performed on the clinical data of 126 children with Streptococcus pneumoniae pneumonia admitted to Anhui Children's Hospital from January 2022 to December 2024,who were enrolled in the case group.In addition,relevant data of 63 children who underwent health check-ups in the hospital during the same period were collected at a ratio of 1∶2 to the case group,and they were included in the control group.According to the clinical efficacy at 1 week after treatment,the children in the case group were divided into the effective treatment group(105 cases)and the ineffective treatment group(21 cases).The serum IL-8 and SAA levels of the case group before treatment and the control group during physical examination were compared,as well as the changes in serum IL-8 and SAA levels of the ineffective treatment group and the effective treatment group before and after treatment.The correlation between the treatment outcomes of children with Streptococcus pneumoniae pneumonia and the serum IL-8 and SAA levels before treatment was analyzed.Results The serum IL-8 and SAA levels in the case group before treatment were significantly higher than those in the control group(both P＜0.05).The serum IL-8 and SAA levels in the ineffective treatment group were higher than those in the effective treatment group at the same time points both before and after treatment[before treatment:(86±13)ng/L vs(66±11)ng/L,(18.8±3.1)mg/L vs(15.1±2.8)mg/L;after treatment:(85±12)ng/L vs(33±6)ng/L,(17.3±3.0)mg/L vs(9.1±2.6)mg/L](all P＜0.05).After treatment,the serum IL-8 and SAA levels in the effective treatment group were significantly lower than those before treatment(both P＜0.05).Before treatment,the clinical pulmonary infection score,C-reactive protein,IL-8,and SAA levels,as well as the proportions of complicated pleural effusion and malnutrition in the ineffective treatment group were all higher than those in the effective treatment group(all P＜0.05).Logistic regression analysis showed that the treatment outcome of children with Streptococcus pneumoniae pneumonia may be associated with complicated pleural effusion,complicated malnutrition,and pre-treatment serum IL-8 and SAA levels(all P＜0.05).Restricted cubic spline analysis revealed a non-linear dose-response relationship between pre-treatment serum IL-8 and SAA levels and the risk of treatment failure in children with Streptococcus pneumoniae pneumonia(both P＜0.05).Pre-treatment serum IL-8 and SAA had a positive interactive effect on the risk of treatment failure in these children.Conclusion The treatment outcome of children with Streptococcus pneumoniae pneumonia is closely related to the pre-treatment serum IL-8 and SAA levels,and the risk of treatment failure increases with the elevation of these two indicators.

Abstract:Objective To explore the expression and clinical significance of serum ephrin type A receptor 2(EphA2)and activating transcription factor 3(ATF3)levels in children with Mycoplasma pneumoniae pneumonia(MPP)complicated with asthma.Methods A total of 120 children with MPP complicated with asthma(MPP+asthma group),120 children with simple MPP(MPP group),and 120 healthy children who underwent physical examination during the same period(control group)admitted to Shanxi Children's Hospital from January 2022 to February 2025 were selected.Children in the MPP+asthma group were divided into mild group(30 cases),moderate group(42 cases),and severe group(48 cases)according to the disease severity.Serum EphA2 and ATF3 levels,pulmonary function indices[peak expiratory flow(PEF),forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC),FEV1 as a percentage of predicted value(FEV1％)],airway inflammation indices[eosinophil(EOS)count,fractional exhaled nitric oxide(FeNO),total immunoglobulin E(IgE)],and airway remodeling indices[transforming growth factor β,(TGF-β1),matrix metalloproteinase 2(MMP-2),MMP-9]were detected.The correlations between serum EphA2 and ATF3 levels and clinical indicators in children with MPP complicated with asthma were analyzed;the relationship between serum EphA2 and ATF3 levels and the disease severity of these children was explored;and the value of serum EphA2 and ATF3 levels in assessing the disease severity was evaluated using receiver operating characteristic curve analysis.Results The PEF,FEV1/FVC ratio,and FEV1％in the simple MPP group and MPP+asthma group were significantly lower than those in the control group,with the MPP+asthma group showing even lower values than the simple MPP group.The EOS count,total IgE,FeNO,TGF-β1,MMP-2,MMP-9,EphA2,and ATF3 levels in the simple MPP group and MPP+asthma group were significantly higher than those in the control group,and the MPP+asthma group had higher levels than the simple MPP group(all P＜0.05).The PEF,FEV1/FVC ratio,and FEV1％in the moderate and severe subgroups were significantly lower than those in the control group,with the severe subgroup having lower values than the moderate subgroup.The EOS count,total IgE,FeNO,TGF-β1,MMP-2,MMP-9,EphA2,and ATF3 levels in the moderate and severe subgroups were significantly higher than those in the control group,and the severe subgroup had higher levels than the moderate subgroup(all P＜0.05).In children with MPP complicated with asthma,serum EphA2 and ATF3 levels were positively correlated with disease severity,EOS count,total IgE,FeNO,TGF-β1,MMP-2,and MMP-9 levels,while negatively correlated with PEF,FEV1/FVC ratio,and FEV1％ (all P＜0.05).Results of ordinal multinomial Logistic regression analysis showed that EphA2(odds ratio=1.022,95％confidence interval:1.006-1.039)and ATF3(odds ratio=1.489,95％confidence interval:1.292-1.716)were independent risk factors for disease progression in children with MPP complicated with asthma(all P＜0.001).The areas under the curve of serum EphA2,ATF3 levels,and their combination for evaluating moderate-to-severe MPP complicated with asthma were 0.830,0.817,and 0.895,respectively,with the combined evaluation being superior to either single indicator.Conclusion Serum EphA2 and ATF3 levels are elevated in children with MPP complicated with asthma,which are associated with disease severity,aggravated airway inflammation,enhanced airway remodeling,and decreased pulmonary function.These two indicators may serve as biomarkers for assessing the disease severity in such children.

Abstract:Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in sputum culture of patients with chronic obstructive pulmonary disease(COPD)complicated with respir-atory tract infection.Methods COPD patients with respiratory tract infection who were diagnosed and treated in Northern Jiangsu People's Hospital,Jiangsu Province and the First Affiliated Hospital of Soochow University from January 2023 to December 2024 were selected as the research objects.The clinical data and sputum samples of the patients were collected,and the pathogen detection and drug resistance analysis were performed after sputum culture.Results A total of 628 patients were enrolled in this study.According to sputum samples,the patients were divided into sputum culture positive group(416 cases)and sputum culture negative group(212 cases).There were no significant differences in gender,age,year,infection month,and COPD course between the two groups(all P＞0.05).The results of pathogen detection showed that 177 strains(33.6％)were Gram-positive bacteria,324 strains(61.5％)were Gram-negative bacteria,and 26 strains(4.9％)were fungi.The main Gram-positive bacteria were Staphylococcus aureus(81 strains,45.8％),Streptococcus pneumoniae(54 strains,30.5％)and Staphylococcus epidermidis(28 strains,15.8％).Gram-negative bacteria were mainly Klebsiella pneumoniae(112 strains,34.6％),Acinetobacter baumannii(96 strains,29.6％),and Pseudomonas aeruginosa(83 strains,25.6％).The main Gram-positive bacteria showed high resistance rates to penicillin,azithromycin and levofloxacin,but were completely sensitive to vancomycin,teicoplanin and linezolid.Among the main Gram-negative bacteria,Klebsiella pneumoniae and Acinetobacter baumannii had high resistance rates to ampicillin,amoxicillin/clavulanic acid,ciprofloxacin,gentamicin,levofloxacin,tobramycin and cephalosporins,and low resistance rates to carbapenems such as imipenem and meropenem.Pseudomonas aeruginosa had high resistance rates to ampicillin,ceftriaxone,amoxicillin/clavulanic acid,and low resistance to gentamicin,tobramycin,imipenem,meropenem and most cephalosporins.Conclusion The pathogens in COPD patients with respiratory tract infection are complex and diverse,and the resistance rate to clinical first-line antibiotics is high.During the treatment,sputum culture and drug sensitivity test should be performed in time to guide clinical rational drug use.

Abstract:Objective To explore the impact of nutritional risk status on glycemic control and the occur-rence of cardiovascular events in elderly patients with type 2 diabetes mellitus(T2DM)complicated with coronary atherosclerotic heart disease(CAD).Methods A total of 111 elderly patients with T2DM complicated with CAD admitted to Guangdong Provincial Hospital of Chinese Medicine from June 2024 to June 2025 were selected as the research objects.The nutritional risk screening scale(NRS 2002)was used to assess the nutritional risk of patients,who were divided into nutritional risk group(28 cases)and non-nutritional risk group(83 cases)according to the assessment results.Baseline data of patients were collected,and blood glucose indicators of the two groups were detected;meanwhile,the occurrence of cardiovascular events was recorded.Spearman correlation analysis was used to evaluate the correlations between nutritional risk status and glycemic control as well as the occurrence of cardiovascular events.Multivariate Logistic regression analysis was applied to identify the risk factors influencing poor glycemic control and the occurrence of cardiovascular events.Results There were statistically significant differences in the number of complications,C-reactive protein(CRP)level,and albumin level between the two groups(all P＜0.05).The levels of glycated hemoglobin,fasting blood glucose,and 2 h postprandial blood glucose in the nutritional risk group were significantly higher than those in the non-nutritional risk group(all P＜0.05).The incidence of poor glycemic control in the nutritional risk group was 60.7％(17/28),which was significantly higher than 24.1％(20/83)in the non-nutritional risk group(P＜0.05).The total incidence of cardiovascular events in the nutritional risk group was 53.6％(15/28),which was significantly higher than 19.3％(16/83)in the non-nutritional risk group(P＜0.05).Spearman correlation analysis showed that nutritional risk status was positively correlated with poor glycemic control and cardiovascular events(r=0.386,P=0.005;r=0.425,P=0.002,respectively).Multivariate Logistic regression analysis revealed that nutritional risk status,number of complications ≥ 2,elevated CRP level,and decreased albumin level were independent risk factors for poor glycemic control and cardiovascular events in the patients(all P＜0.05).Conclusion Nutritional risk status significantly exacerbates the deterioration of glycemic control and increases the risk of cardiovascular events in elderly patients with T2DM complicated with CAD.Moreover,nutritional risk status is positively correlated with poor glycemic control and cardiovascular events.Multivariate analysis further confirms that nutritional risk status,number of complications ≥2,elevated CRP level,and decreased albumin level are independent risk factors for poor glycemic control and cardiovascular events,suggesting that clinical practice should strengthen nutritional screening and intervention to improve prognosis.

Abstract:Objective To evaluate the efficacy and safety of cefoperazone sodium/sulbactam sodium(CPZ-SBT)combined with ulinastatin in the treatment of renal transplant recipients with severe pneumonia(RTSP).Methods A retrospective analysis was performed on the clinical data of 74 RTSP patients admitted to General Hospital of Northern Theater Command of the Chinese People's Liberation Army from January 2022 to May 2025.The patients were divided into control group(treated with CPZ-SBT)and combination group(treated with CPZ-SBT combined with ulinastatin)according to the treatment regimen,with 37 cases in each group.Both groups received continuous treatment for more than 7 d.The clinical efficacy,clinical indicators,respiratory function indicators,inflammatory factor levels before and after treatment,and adverse reactions during treatment were recor-ded and compared between the two groups.Results Both groups were sensitive to CPZ-SBT treatment.The total effective rate of the combination group was slightly higher than that of the control group[97.3％(36/37)vs 89.2％(33/37)],but the difference was not statistically significant(P=0.165).The time to body temperature recovery,wheezing resolution,and cough resolution in the combination group were significantly shorter than those in the control group(all P＜0.05).After treatment,the arterial oxygen saturation and arterial partial pressure of oxygen in both groups were significantly higher than those before treatment,with the combination group showing higher values than the control group.The arterial partial pressure of carbon dioxide,procalcitonin,and C-reactive protein levels in both groups were significantly lower than those before treatment,and the combination group had lower levels than the control group(all P＜0.05).The total incidence of adverse reactions in the combination group was slightly higher than that in the control group[10.8％(4/37)vs 5.4％(2/37)],but the difference was not statistically significant(P=0.394).Conclusion CPZ-SBT combined with ulinastatin in the treatment of RTSP patients can effectively promote symptom recovery,improve respiratory function,and regulate inflammatory factor levels,with mild adverse reactions,showing good safety and efficacy.