Abstract:Objective To explore the predictive value of serum protein/nucleic acid decarboxylase 1(DJ-1)and sol-uble cluster of differentiation 93(sCD93)for poor prognosis in patients with acute exacerbation of chronic obstructive pulmo-nary disease(AECOPD).Methods A total of 220 patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine at Yixing People's Hospital from November 2023 to March 2025 were enrolled in the AECOPD group.Patients were assessed and categorized into mild(n=75),moderate(n=61),and severe(n=84)subgroups.Based on prognosis,patients were further categorized into a favorable subgroup(n=136)and an unfavorable subgroup(n=84).Concur-rently,137 stable-phase COPD patients treated at the hospital formed the stable-phase group,while 169 healthy individuals un-dergoing routine health examinations served as the healthy control group.ELISA was used to detect serum levels of DJ-1 and sCD93.Multivariate logistic regression analysis was performed to identify factors influencing poor prognosis in patients with AECOPD.ROC curve analysis was used to evaluate the predictive value of serum DJ-1 and sCD93 for poor prognosis in AECOPD patients.Decision curve analysis(DCA)was used to assess the clinical applicability of the predictive model.Results Serum DJ-1 and sCD93 levels were higher in the AECOPD group than in the stable-phase group and the healthy control group(F/P=705.358/＜0.001,594.916/＜0.001).Among AECOPD patients,serum DJ-1 and sCD93 levels were highest in the severe subgroup,followed by the moderate subgroup,and lowest in the mild subgroup(F/P=60.385/＜0.001,49.865/＜0.001).Patients with poor prognosis exhibited a higher proportion of severe disease,as well as elevated levels of WBC,DJ-1,and sCD93 compared to those with favorable prognosis(t/x2/P=43.100/＜0.001,8.398/＜0.001,7.916/＜0.001,8.687/＜0.001),while FEV1and FVC were lower(t/P=16.158/＜0.001,18.091/＜0.001).Severe disease and elevated serum DJ-1 and sCD93 levels were risk factors for poor prognosis[OR(95％CI)=2.073(1.267-3.390),2.192(1.378-3.488),2.435(1.503-3.944)],while elevated FEV,and FVC levels were protective factors[OR(95％CI)=0.731(0.571-0.936),0.694(0.533-0.904)].The AUC values for predicting poor prognosis in AECOPD patients using serum DJ-1,sCD93 individually,and their combination were 0.810,0.801,and 0.944,respectively.The combined prediction outperformed the individual predictions of DJ-1 and sCD93(Z=3.785,4.218;both P＜0.001).The risk threshold probability ranged from 0.01 to 0.83,and the net benefit of the joint mod-el in predicting poor prognosis was higher than that of serum DJ-1 or sCD93 alone.Conclusion Serum DJ-1 and sCD93 levels are elevated in AECOPD patients with poor prognosis,and their combination has high predictive value for poor progno-sis in AECOPD patients.

Abstract:Objective To investigate the clinical manifestations,pathological features and prognosis of anti-glomerular basement membrane(anti-GBM)disease with membranous nephropathy(MN),and to provide a reference for the diagnosis and treatment of this rare disease.Methods A retrospective analysis was conducted on 58 patients diagnosed with anti-GBM disease via renal biopsy at our center between January 2016 and December 2024.Enrolled subjects included 34 patients with anti-GBM glomerulonephritis,16 with anti-GBM disease and concurrent anti-neutrophil cytoplasmic antibody-as-sociated vasculitis(anti-GBM+ANCA)and 8 with anti-GBM disease and MN(anti-GBM+MN).Laboratory tests and patho-logical information were analyzed among the three groups,and prognosis was assessed through continuous follow-up.Renal survival rates were calculated using the Kaplan-Meier method.Results The average age of enrolled subjects was over 45 years,and no significant gender differences were observed.Hemoptysis occurred in 14.7％(5/34)of the anti-GBM group and 18.7％(3/16)of the anti-GBM+ANCA group,while no hemoptysis was exhibited in the anti-GBM+MN group.Compared with patients with classical anti-GBM and anti-GBM+ANCA disease,those with anti-GBM disease with MN presented a lower incidence of acute kidney injury(AKI),no hemoptysis,and higher hemoglobin levels(P=0.011).The proportion of glomerular crescents in the anti-GBM+MN group was significantly lower than in the other two groups(P＜0.001).75％(6/8)of cases were positive for circulating anti-PLA2R and 87.5％(7/8)of cases showed positive PLA2R staining in renal tis-sue.Survival curve analysis revealed that renal outcomes in the anti-GBM+MN group were better than those in the anti-GBM and anti-GBM+ANCA groups(P=0.049).Conclusion Patients with both anti-GBM disease and MN showed atypical anti-GBM disease.They had a lower proportion of glomerular crescents and a better renal function prognosis than patients with classical anti-GBM.Early identification and treatment of anti-GBM disease associated with MN are needed to improve renal recovery.

Abstract:Objective To investigate the relationship between the levels of serum sirtuin 1(Sirt1)and sirtuin 6(Sirt6)and diabetes in patients with diabetic cataract(DC)and its diagnostic value.Methods A total of 113 patients with DC admitted to the Ophthalmology Department of Shunyi District Maternal and Child Health Hospital,Beijing,from January 2024 to June 2025 were prospectively enrolled(DC group).In addition,113 patients with type 2 diabetes mellitus(T2DM group)and 113 healthy individuals(control group)matched at a 1∶1 ratio were included.Serum Sirt1 and Sirt6 levels were measured using enzyme-linked immunosorbent assay.According to the stage of cataract,DC patients were divided into early(n=34),middle(n=43),and late(n=36)subgroups.Spearman correlation analysis was used to assess the association between serum Sirt1,Sirt6 levels and DC stage.Multivariate logistic regression was performed to identify factors influencing DC occurrence.Receiver operating characteristic(ROC)and decision curve analyses were used to evaluate the diagnostic performance and clinical benefit of serum Sirt1 and Sirt6 levels.Results Serum Sirt1 and Sirt6 levels decreased progressively across the con-trol,T2DM,and DC groups(F/P=312.468/＜0.001;257.992/＜0.001),and further declined with advancing DC stage(F/P=240.406/＜0.001;158.124/＜0.001).Serum Sirt1 and Sirt6 levels were negatively correlated with DC stage(rs/P=-0.653/＜0.001;-0.680/＜0.001).Longer T2DM duration and higher HbA1c were independent risk factors for DC,while increased Sirt1 and Sirt6 levels were independent protective factors[OR(95％CI)=1.741(1.329-2.282),2.217(1.241-3.960),0.692(0.606-0.791),0.720(0.636-0.815)].The areas under the ROC curve for serum Sirt1,Sirt6,and their combination in diagnosing DC were 0.808,0.796,and 0.901,respectively.The combined diagnostic model performed better than either marker alone(Z/P=3.692/＜0.001;4.428/＜0.001).Decision curve analysis showed that within a threshold probability range of 0.15-0.95,the com-bined model yielded greater net clinical benefit than individual Sirt1 or Sirt6 levels.Conclusion Serum Sirt1 and Sirt6 levels are significantly decreased in DC patients and are associated with disease occurrence and progression.The combined detection of Sirt1 and Sirt6 provides superior diagnostic performance and clinical benefit,suggesting potential value for early diagnosis and risk assessment of diabetic cataract.

Abstract:Objective To investigate the expression and clinical significance of peripheral blood soluble triggering receptor expressed on myeloid cells 2(sTREM2)and platelet-derived growth factor receptor-β(PDGFR-β)in patients with coronary microvascular dysfunction(CMD).Methods A total of 126 patients with non-obstructive angina pectoris(ANOCA)admitted to the First Affiliated Hospital of Shihezi University from January 2022 to December 2024 were prospec-tively selected and divided into CMD group(61 cases)and non-CMD group(65 cases)according to coronary flow reserve(CFR)and/or microcirculation resistance index(IMR).The caliper matching method was used to match the CMD group and the non-CMD group by 1∶1(matching tolerance 0.03),and 46 pairs of balanced samples of variables between groups were fi-nally obtained.The levels of sTREM2 and PDGFR-β in peripheral blood were detected by enzyme-linked immunosorbent as-say.Pearson correlation analysis was used to analyze the correlation between sTREM2 and PDGFR-β levels in peripheral blood of CMD patients after PSM and CFR and IMR.Multivariate Logistic regression and ROC curve were used to analyze the relationship between peripheral blood sTREM2,PDGFR-β levels and CMD occurrence and diagnostic value.Results Compared with the non-CMD group,the serum sTREM2 and PDGFR-β levels in the CMD group were increased(t=5.447,4.906,P＜O.00l);the levels of sTREM2 and PDGFR-β in peripheral blood of CMD patients were negatively correlated with CFR and positively correlated with IMR(r=-0.734,-0.725;0.739,0.714;all P＜0.001);After adjusting for confounding fac-tors,high sTREM2 and high PDGFR-β were independent risk factors for CMD[OR(95％CI)=1.006(1.003-1.010),1.601(1.232-2.081)];The area under the curve of sTREM2 and PDGFR-β levels in peripheral blood and the combined diagnosis of CMD were 0.784,0.768 and 0.870,respectively.The combined diagnosis value was better than that of the single diagnosis val-ue(Z=2.297,2.615,P=0.022,0.009).Conclusion The elevated levels of sTREM2 and PDGFR-β in peripheral blood of ANOCA patients are closely related to CMD.The combination of sTREM2 and PDGFR-β levels in peripheral blood has a high diagnostic value for CMD.

Abstract:From a historical perspective and within the context of inheritance and innovation in the theory of collateral disease,this paper systematically analyzes the academic and clinical values of the systematic research on the theory of visceral collateral disease.Although the history of research on collateral disease in traditional Chinese medicine has wit-nessed the development of"three milestones,"a comprehensive theoretical system has never been fully established.This limita-tion has constrained the in-depth development of visceral syndrome differentiation in traditional Chinese medicine and the fur-ther improvement of clinical efficacy in treating refractory diseases.In the breakthrough achievement of the"fourth milestone"in contemporary research on collateral disease,the uniqueness of collateral vessel physiology,pathogenesis,and treatment is systematically studied based on the temporal and spatial differences between collateral vessels and meridians.This work sys-tematically constructs the theoretical system of collateral disease and establishes the new discipline of collateral disease theory in traditional Chinese medicine.It provides an important theoretical foundation for guiding clinical treatment based on syn-drome differentiation of visceral diseases,reveals the inherent laws governing the commonality of qi and blood circulation in collateral vessels and the unique functional structures of viscera,promotes the systematization of the theory of visceral collater-al disease,and enhances the clinical efficacy in treating refractory diseases.This paper also presents phased achievements in the research on the rules of syndrome differentiation and treatment of lung collateral disease and cardiovascular continuum,ai-ming to initiate discussion and promote systematic research on the theory of visceral collateral disease.

Abstract:Cancer recurrence and metastasis remain a difficult problem in current treatment,and cancer transmission is a necessary pathway for cancer recurrence and metastasis.Chinese medical master Professor Li Diangui put forward"turbid toxicity of malignant tumor"on the basis of"turbid toxicity theory"and combined with clinical experience,put forward that"turbid toxicity of malignant tumor"is the key to the pathogenesis of malignant tumor.Based on this,this article is based on passing away,and deeply explores the mechanism of"turbid toxicity of malignant tumor"in the progression of cancer recur-rence and metastasis.It applies passing away theory and"turbid toxicity of malignant tumor"to prevent cancer recurrence and metastasis,enriching the oncological connotation of turbidity theory,and providing ideas for clinical prevention and treatment of cancer recurrence and metastasis.

Abstract:Objective To investigate the correlation of serum myeloperoxidase(MPO)and lactate dehydrogenase(LDH)levels with the treatment response to standard chemotherapy regimens in patients with acute myeloid leukemia(AML).Methods A total of 118 AML patients admitted to the Department of Hematology,Yifu Hospital Affiliated to Nanjing Medi-cal University from February 2022 to January 2025 were enrolled.All patients received standard chemotherapy.Treatment re-sponse was assessed between 21 and 28 days after chemotherapy completion.Patients achieving complete remission were as-signed to the good response group(n=70),and the remaining to the poor response group(n=48).Serum MPO and LDH lev-els were measured by enzyme linked immunosorbent assay.Multivariate logistic regression was used to analyze factors influ-encing treatment response and to construct a predictive model.The predictive performance of serum MPO,LDH,and the com-bined model was evaluated using receiver operating characteristic(ROC)curves.The interaction between MPO and LDH on treatment response was assessed by relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy in-dex(SI).Results Of the 118 AML patients,70(59.32％)achieved complete remission after standard chemotherapy and were included in the good response group.The poor response group showed lower serum MPO levels and higher LDH levels than the good response group(t/P=4.791/＜0.001,4.585/＜0.001).Additionally,the poor response group had higher age,a greater proportion of extramedullary infiltration,and a higher percentage of bone marrow blasts(t/x2/P=3.905/＜0.001,3.648/＜0.001,4.810/0.028).Logistic regression indicated that older age,extramedullary infiltration,higher bone marrow blast percentage,and elevated LDH were risk factors for poor treatment response[OR(95％o CI)=1.197(1.086-1.318),7.756(1.477-40.724),1.160(1.058-1.272),1.021(1.010-1.032)],while higher serum MPO was a protective factor[OR(95％CI)=0.985(0.976-0.994)].The areas under the ROC curve(AUCs)for serum MPO alone,LDH alone,their combination,and the predictive model were 0.744,0.704,0.787,and 0.911,respectively.The predictive model showed the highest value(Z/P=3.161/0.002,3.616/＜0.001,2.426/0.015).A positive interaction was observed between serum MPO and LDH on treatment response.Conclusion Serum MPO and LDH levels are associated with the response of AML patients to standard chemotherapy.Patients with lower MPO and higher LDH levels before chemotherapy are at increased risk of poor treatment response.

Abstract:Objective To investigate the expression of serum type Ⅰ collagen α1 chain(COL1A1)and cellular communication network factor 1(CCN1)in patients with chronic heart failure(CHF)and their correlation with prognosis.Me-thods 158 patients with CHF(CHF group)and 79 healthy subjects(control group)who were treated in the Second Affiliated Hospital of Nanjing Medical University from January 2022 to August 2024 were prospectively selected according to the ratio of 2∶1.The levels of serum COL1A1 and CCN1 were detected by enzyme-linked immunosorbent assay.According to the risk stratification,CHF patients were divided into low-risk CHF group(52 cases),medium-risk CHF group(60 cases)and high-risk CHF group(46 cases).The correlation between serum COL1A1,CCN1 levels and risk stratification in CHF patients was analyzed by Spearman rank correlation.CHF patients were divided into poor subgroup and good subgroup according to the 6-month prognosis.The prognostic factors of CHF patients and the predictive efficacy of serum COL1A1 and CCN1 levels were analyzed.Results Compared with the control group,the levels of serum COL1A1 and CCN1 in the CHF group were increased(t/P=24.185/＜0.001,18.129/＜0.001);The levels of serum COL1A1 and CCN1 in patients with low-risk CHF,medi-um-risk CHF and high-risk CHF increased in turn(F/P=64.321/＜0.001,63.243/＜0.001);Compared with the good subgroup,the patients in the poor subgroup were older,the proportion of NYHA cardiac function grade Ⅳ was higher,the proportion of high-risk stratification was higher,the level of NT-proBNP was higher,the level of COL1A1 was higher,and the level of CCN1 was higher(x2/t/U/P=3.176/0.002,1165.000/＜0.001,704.000/＜0.001,5.815/＜0.001,6.913/＜0.001,7.267/＜0.001);the levels of serum COL1A1 and CCN1 in CHF patients were positively correlated with risk stratification(rs/P=0.653/＜0.001,0.649/＜0.001);the 6-month poor prognosis rate of 158 CHF patients was 32.91％(52/158);Age increase,NYHA cardiac function grade Ⅳ,high risk stratification,elevated NT-proBNP,elevated COL1A1,and elevated CCN1 were independent risk factors for poor prognosis in CHF patients[OR(95％CI)=1.102(1.026-1.184),9.301(2.221-38.943),7.074(1.352-36.995),1.001(1.001-1.002),1.027(1.010-1.045),1.051(1.023-1.079)];The AUC of serum COL1A1,CCN1 levels and the combination of the two in predicting the poor prognosis of CHF patients were 0.790,0.806 and 0.880,respectively.The AUC of the combi-nation of the two in predicting the poor prognosis of CHF patients was greater than that of the two alone(Z/P=3.002/0.003,2.757/0.006).Conclusion The levels of serum COL1A1 and CCN1 in patients with CHF are increased,which is related to the aggravation of risk stratification and poor prognosis.The combination of the two has a higher predictive efficiency for prognosis.

Abstract:Objective To investigate the therapeutic effects of endovascular repair with covered stent graft on Stan-ford type B aortic dissection(AD)and its impact on serum endothelin-1(ET-1)and uric acid levels using propensity score matching(PSM).Methods From July 2021 to March 2024,a total of 160 patients with Stanford type B aortic dissection(AD)admitted to the Department of Cardiovascular Surgery at the Seventh People's Hospital of Zhengzhou were enrolled in this study.These patients were randomly divided into a study group and a control group using a random number table.The control group received conventional medical conservative treatment,while the study group received endovascular repair with a covered stent graft in addition to the treatment given to the control group.The clinical data of the two groups of patients were matched at a ratio of 1∶1,and ultimately,58 pairs of patients were successfully matched.The study compared the in-hospital mortality rate,the rate of reoperation or reintervention,and the incidence of complications between the two groups.Additional-ly,liver and kidney function,serum ET-1 and uric acid levels were assessed before and 2 weeks after treatment.The Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)scores,SF-36 scale scores,and follow-up results were also com-pared between the two groups.Results There was no significant difference in in-hospital mortality rate and the rate of reop-eration or reintervention between the two groups(P＞0.05).However,the incidence of postoperative complications was higher in the study group than in the control group(x2=4.921,P=0.027).Compared with pre-treatment levels,post-treatment levels of ALT,AST,BUN,and SCr in the study group were decreased and were lower than those in the control group(t=9.296,14.561,4.473,11.468,P＜0.001).Similarly,post-treatment levels of ET-1 and serum uric acid in the study group were decreased and lower than those in the control group(t=5.182,7.411,P＜0.001).After treatment,APACHE Ⅱ scores were decreased and SF-36 scores were increased in both groups,with greater changes observed in the study group(t=5.898,7.982,4.525,P＜0.001).Follow-up results showed that the rates of reoperation or reintervention and mortality were lower in the study group than in the control group(x2=8.700,5.902,P=0.003,0.015).Conclusion The combination of medical treatment and endo-vascular repair with covered stent graft for Stanford type B AD patients can improve the quality of life,enhance liver and kid-ney function,reduce the incidence of complications and re-treatment,and improve the prognosis.The therapeutic effect is su-perior to that of medical treatment alone,and this may be related to the reduction in serum ET-1 and uric acid levels.

Abstract:Objective To investigate the effects of IL-33 on social deficits and repetitive stereotyped behaviors in the BTBR T+Itpr3tf/J(BTBR)mouse model of autism.Methods The experiment will be conducted at the Children's Hospital Affiliated to Soochow University from January 2025 to June 2025.Ten 6-week-old male BTBR mice were selected and ran-domly divided into the BTBR+Vehicle group(n=5)and the BTBR+IL-33 group(n=5)according to the random number table method.Five C57BL/6(B6)mice were selected as the B6+Vehicle group.The BTBR+IL-33 group received daily intraperito-neal injections of IL-33(300 ng/mouse)for 7 consecutive days,while the B6+Vehicle and BTBR+Vehicle groups were admin-istered an equivalent volume of saline.Following treatment,behavioral tests were conducted,including self-grooming,social interaction,three-chamber social test,and novel object recognition.After the behavioral experiments,brain tissue samples were collected.Dendrites were detected by Golgi staining,the pathological morphology of brain tissue was observed by transmission electron microscopy,and protein expression was detected by Western blot.Results The interaction time of mice in the B6+Vehicle group and the BTBR+IL-33 group was longer than that in the BTBR+Vehicle group(t=10.523,7.201,all P＜0.001),and the self-grooming time was shorter than that in the BTBR+Vehicle group(t=4.750,14.114,all P＜0.001).The TS1 of mice in the B6+Vehicle group and the BTBR+IL-33 group was greater than that of TOb(t=14.992,14.521,all P＜0.001).The social preference index of mice in the B6+Vehicle group and the BTBR+IL-33 group was greater than that of mice in the BTBR+Ve-hicle group(t=10.570,10.48,all P＜0.001).The social novelty preference index of mice in the B6+Vehicle group and the BT-BR+IL-33 group was greater than that of mice in the BTBR+Vehicle group(t=16.768,14.162,all P＜0.001).There was no sta-tistically significant difference in the novel object recognition index between the B6+Vehicle group mice and the BTBR+Vehi-cle group mice,or between the BTBR+Vehicle group mice and the BTBR+IL-33 group mice(t=0.485,0.527,P=0.640,0.612).The dendritic spine density and dendrite complexity of mice in the BTBR+Vehicle group were both higher than those in the B6+Vehicle group and the BTBR+IL-33 group(t=2.944,2.734,P=0.021,0.032).The expression level of ULK1 in the brains of mice in the B6+Vehicle group and the BTBR+IL-33 group was higher than that in the BTBR+Vehicle group(t=3.324,3.687,P=0.011,0.007).The expression level of ATG12 in the B6+Vehicle group and the BTBR+IL-33 group was higher than that in the BTBR+Vehicle group(t=3.792,3.174,P=0.005,0.013).There was no difference in the expression levels of Beclin1,ATG5,and ATG16L1 between the BTBR+Vehicle group and the BTBR+IL-33 group(t=1.083,0.300,1.857,P=0.312,0.771,0.101).Conclusion IL-33 ameliorates repetitive stereotyped behaviors and social deficits in BTBR mice by upregulating ULK1 and ATG12 expression,thereby improving neuronal structure and function.

Abstract:To report the clinical and genetic characteristics of a child with progressive familial intrahepatic cholestasis type 3(PFIC3),and review the literature.

Abstract:Objective To explore the correlation between serum histone deacetylase 4(HDAC4),Rho-associated coiled-coil containing protein kinase 2(ROCK2),and growth arrest-specific gene 6(Gas6)levels with acute kidney injury(AKI)in patients with preeclampsia(PE).Methods A total of 150 patients diagnosed with PE admitted to the Obstetrics De-partment of Shanxi Children's Hospital(Shanxi Maternal and Child Health Hospital)between March 2022 and March 2025 were selected as the disease group.Based on the presence or absence of AKI,they were further divided into an AKI subgroup(n=71)and a non-AKI subgroup(n=79).Additionally,94 healthy pregnant women without gestational hypertension identified during obstetric examinations at the hospital during the same period were selected as the control group.ELISA was used to de-tect serum levels of HDAC4,ROCK2,and Gas6.Pearson correlation analysis was performed to assess the relationship between serum HDAC4,ROCK2,and Gas6 levels and renal injury markers.Multivariate logistic regression analysis was con-ducted to identify factors influencing the development of AKI in patients with PE.ROC curve analysis was used to evaluate the predictive value of serum HDAC4,ROCK2,and Gas6 levels for AKI in patients with PE.Furthermore,the bootstrap meth-od was employed for internal validation of the joint prediction model.Results The disease group had higher serum HDAC4,ROCK2,and Gas6 levels than the control group(t=22.552,22.632,12.355,all P＜0.001).SBP,DBP,SCr,BUN,and serum HDAC4,ROCK2,and Gas6 levels were significantly higher in the AKI subgroup than in the non-AKI subgroup(t=2.412,6.320,16.167,11.268,8.602,7.719,8.157;P=0.017,＜0.001,＜0.001,＜0.001,＜0.001,＜0.001,＜0.001).Serum HDAC4,ROCK2,and Gas6 were positively correlated with SCr(r=0.493,0.527,0.504,all P＜0.001)and BUN(r=0.482,0.539,0.526,all P＜0.001).Elevated SBP,DBP,SCr,BUN,HDAC4,ROCK2,and Gas6 were all risk factors for AKI in PE patients[OR(95％CI)=1.613(1.036-2.512),1.542(1.056-2.251),1.879(1.162-3.037),1.924(1.223-3.026),2.581(1.529-4.356),2.396(1.381-4.156),2.015(1.279-3.175)].The risk of AKI in PE patients with high serum levels of HDAC4,ROCK2,and Gas6 was 1.604,1.536,and 1.593 times higher,respectively,than in patients with low levels.The AUC values for predicting AKI in PE patients using serum HDAC4,ROCK2,Gas6 alone and their combination were 0.824,0.805,0.809,and 0.934,respectively.The combined prediction outperformed the individual predictions of serum HDAC4,ROCK2,and Gas6(Z=3.404,3.380,3.335;all P=0.001).Internal validation results indicated that the calibration curve between the model's predicted probabilities and actual occurrence rates closely aligned with the ideal reference line,demonstrating the model's strong calibration capability and internal consistency.Conclusion Serum HDAC4,ROCK2,and Gas6 levels are all elevated in PE patients with concurrent AKI.The combined detection of these three biomarkers can provide a reference for predicting concurrent AKI in PE patients.

Abstract:Objective To investigate the expression of plasma S100 calcium-binding protein A8/A9(S100A8/A9)and soluble OX40 ligand(sOX40L)in children with primary immune thrombocytopenia(ITP)and their relationship with bleeding severity and prognosis.Methods A total of 120 children with ITP(ITP group)and 60 healthy children(control group)admitted to Affiliated 3201 Hospital of Xi'an Jiaotong University School of Medicine from October 2021 to February 2024 were prospectively selected.Based on bleeding grade,ITP children were divided into non-bleeding subgroup(19 cases),minor bleeding subgroup(32 cases),mild bleeding subgroup(32 cases),moderate bleeding subgroup(26 cases),and severe bleeding subgroup(11 cases).According to 1-year prognosis,they were categorized into poor prognosis and good prognosis subgroups.Enzyme-linked immunosorbent assay was used to detect plasma S100A8/A9 and sOX40L levels.Multivariate Lo-gistic regression and ROC analysis were employed to analyze the relationship between plasma S100A8/A9 and sOX40L levels and poor prognosis in children with ITP,and to evaluate predictive efficacy.Results Compared with the control group,plas-ma levels of S100A8/A9 and sOX40L in the ITP group were significantly increased(t/P=36.784/＜0.001,32.693/＜0.001).Plasma S100A8/A9 and sOX40L levels progressively increased across the non-bleeding,minor bleeding,mild bleeding,mod-erate bleeding,and severe bleeding subgroups(F/P=265.204/＜0.001,344.140/＜0.001).After 1 year of follow-up,the poor prognosis rate among 120 ITP children was 17.50％(21/120).Compared with the good prognosis subgroup,the poor progno-sis subgroup showed higher bleeding grade,lower platelet count(PLT),lower absolute lymphocyte value,and higher S100A8/A9 and sOX40L levels(t/P=7.226/＜0.001,5.537/＜0.001,3.745/＜0.001,4.951/＜0.001,5.084/＜0.001).Increased bleeding grade,high S100A8/A9,and high sOX40L were independent risk factors for poor prognosis in ITP children,while high plate-let count was an independent protective factor[OR(95％CI)=3.952(1.062-14.703),1.137(1.043-1.241),1.557(1.158-2.093),0.839(0.730-0.965)].The area under the curve(AUC)of plasma S100A8/A9,sOX40L levels,and their combination for predicting poor prognosis in ITP children were 0.798,0.817,and 0.897,respectively.The combined detection was superior to either marker alone(Z/P=2.478/0.013,2.145/0.032).Conclusion Plasma levels of S100A8/A9 and sOX40L are elevated in children with ITP,correlating with increased bleeding severity and poorer prognosis.The combination of plasma S100A8/A9 and sOX40L levels demonstrates high predictive efficacy for prognosis.

Abstract:The clinical data of five patients with Tropheryma whipplei pneumonia were reported and a literature re-view was conducted.

Abstract:Stress urinary incontinence(SUI)is a common urinary system disorder in women.Traditional treatment methods mainly include pelvic floor muscle training,biofeedback therapy,and oral medication,which have certain limitations.Electroacupuncture,as a traditional Chinese medicine therapy combined with modern medical techniques,has demonstrated good efficacy in treating SUI,though its mechanisms have not yet reached clinical consensus.This paper introduces the devel-opment and advantages of electroacupuncture therapy,elaborates on its mechanisms in treating female SUI-including neural regulation,muscle strengthening and regeneration,and microcirculation improvement-and analyzes its current clinical appli-cation status.It emphasizes the need to develop personalized treatment plans,providing new directions for clinical diagnosis,treatment,and basic research.

Abstract:Objective To evaluate the diagnostic efficacy of targeted sequencing technology for tuberculosis in tissues and body fluids.Methods The positive detection rates of Mycobacterium tuberculosis(TB)using four traditional methods-seminested real-time fluorescence quantitative PCR(GeneXpert),fluorescent probe-based nucleic acid detection(TB-DNA),Mycobacterium tuberculosis culture,and acid-fast staining-in airway and extrapulmonary specimens were statisti-cally analyzed,and pairwise results were assessed for consistency.The positive rates of tNGS versus the four traditional meth-ods were compared across groups and subgroups in extrapulmonary specimens.ROC curves were plotted based on final diag-noses to evaluate the diagnostic performance of tNGS for proliferative pulmonary tuberculosis and extrapulmonary tuberculosis.Results Compared with TB-DNA,Mycobacterium tuberculosis culture,and acid-fast staining,GeneXpert dem-onstrated the highest positive rates in both extrapulmonary and airway specimen groups(airway:25.0％,extrapulmonary:32.0％).Pairwise comparisons of identical methods between groups showed poor consistency among the four traditional meth-ods(Kappa＜0.40).Among the five detection methods in extrapulmonary specimens,tNGS achieved a 76.0％positive rate(92/121),with tissue subgroups showing 73.0％(54/74)and body fluid subgroups 80.9％(38/47)—significantly higher than other methods within each subgroup(P＜0.001).No significant difference was observed between tissue and body fluid sub-groups using tNGS(P＞0.05).Based on the final diagnostic results,among the five methods,tNGS demonstrated the strongest comprehensive diagnostic performance in extrapulmonary specimens,with an AUC of 0.771 and a sensitivity of 83.6％,along with a Youden index of 54.2％—significantly higher than other methods.The specificity of tNGS reached 70.6％,while its positive predictive value was as high as 94.6％.Conclusion Among conventional methodologies,GeneXpert exhibits the highest positivity rate across various specimen types and demonstrates optimal consistency.The tNGS method outperformed traditional approaches in the comprehensive diagnosis of proliferative pulmonary tuberculosis and extrapulmonary tuberculosis,effectively reducing diagnostic discrepancies caused by variations in lesion locations and morphological characteristics.

Abstract:Objective To investigate the expression and clinical significance of serum insulin-like growth factor binding protein 5(IGFBP5)and soluble osteoclast-associated receptor(sOSCAR)in young and middle-aged patients with acute myocardial infarction(AMI).Methods A total of 105 young and middle-aged AMI patients admitted to the Department of Cardiology,Xingtai Central Hospital from January 2021 to June 2023 were prospectively selected as the AMI group.According to the degree of coronary stenosis(Gensini score),they were divided into mild stenosis(＜30 points,32 ca-ses),moderate stenosis(30-60 points,42 cases),and severe stenosis(＞60 points,31 cases).Additionally,60 healthy volunteers were selected as the healthy control group.The young and middle-aged AMI patients were further divided into poor and good prognosis subgroups based on their 24-month prognosis.Serum IGFBP5 and sOSCAR expression levels were detec-ted by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation between serum IGFBP5,sOSCAR expression,and Gensini score.The relationship between serum IGFBP5 and sOSCAR expression and the prognosis of young and middle-aged AMI patients,as well as their predictive efficacy,were analyzed.Results Compared with the healthy control group,serum IGFBP5 expression was increased and sOSCAR expression was decreased in the AMI group(t/P=15.073/＜0.001,16.141/＜0.001).Serum IGFBP5 expression increased sequentially,and sOSCAR expression de-creased sequentially,across mild,moderate,and severe stenosis groups(F/P=268.737/＜0.001,87.294/＜0.001).In young and middle-aged AMI patients,Gensini score was positively correlated with serum IGFBP5 expression and negatively correlated with sOSCAR expression(r/P=0.745/＜0.001,-0.732/＜0.001).The 12-month poor prognosis rate among the 105 young and middle-aged AMI patients was 40.00％(42/105).Gensini score,Killip grade ≥ Ⅱ,and elevated IGFBP5 were independent risk factors for poor prognosis,while elevated sOSCAR was an independent protective factor[OR(95％CI)=3.636(1.518-8.710),2.754(1.141-6.647),1.013(1.005-1.021),0.987(0.987-0.997)].The AUCs of serum IGFBP5 expression,sOSCAR expression,and their combination for predicting poor prognosis in young and middle-aged AMI patients were 0.784,0.786,and 0.857,respectively.The combined prediction showed a larger AUC(Z/P=2.141/0.032,2.348/0.019).Conclusion Serum IGFBP5 expression is increased and sOSCAR expression is decreased in young and middle-aged AMI patients,which is close-ly related to the aggravation of coronary stenosis and poor prognosis.The combined detection of serum IGFBP5 and sOSCAR has higher predictive efficacy for poor prognosis in young and middle-aged AMI patients.

Abstract:Objective This study aimed to identify lipid metabolites associated with the risk of idiopathic pulmonary fibrosis(IPF)and investigate their upstream regulatory proteins.Methods Lipid metabolites were selected as candidates based on two published genome-wide association studies(GWAS)on metabolites along with the Lipid Maps,HMDB,and SwissLipids databases.The FinnGen cohort and UK Biobank cohort were used as the discovery cohort and replication cohort for IPF,respectively.Two-sample Mendelian randomization(MR)was utilized to assess the causal associations between lipid metabolites and IPF.Cochran's Q,MR-Egger,and colocalization analyses were performed to evaluate the robustness of the results.Overlapping proteins were screened by integrating IPF lung tissue proteomics data with transcriptomics data from the GEO dataset GSE70866.Subsequent MR was conducted to verify causal associations between candidate proteins and lipid me-tabolites.Results MR analysis identified two lipid metabolites significantly associated with IPF in the discovery cohort:1-oleoyl-2-linoleoyl-sn-glycerol(18∶1/18∶2)(OR=0.659,P=0.041)and isobutyrylcarnitine(C4)(OR=1.165,P=0.025).Cochran's Q and MR-Egger excluded heterogeneity and pleiotropy(P＞0.05),and the posterior probability of Bayesian colo-calization PPH4=92.2％.Multi-omics analysis screened a total of 132 candidate regulatory proteins with GWAS data,inclu-ding NT5E(OR=1.000,P=0.004),RNASET2(OR=1.000,P=0.013),MYL3(OR=0.998,P=0.003),SERPIND1(OR=0.999,P=0.035),PLG(OR=1.000,P=0.002),and CKAP4(OR=1.000,P=0.002).Conclusion A decreased level of 1-oleoyl-2-linoleoyl-sn-glycerol is associated with an elevated risk of IPF,and its level may be regulated by the following pro-teins:NT5E,RNASET2,MYL3,SERPIND1,PLG,CKAP4,and ITIH1.

Abstract:Objective To investigate the predictive value of albumin-corrected anion gap(ACAG)in hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke.Methods A total of 184 patients with acute ischemic stroke who received intravenous thrombolytic therapy in Mingji Hospital Affiliated to Nanjing Medical U-niversity from September 2021 to September 2024 were selected.They were divided into an HT group(n=39)and a non-HT group(n=145)based on whether HT occurred within 48 hours after thrombolytic therapy.Baseline data and relevant laborato-ry indicators on the first day of admission were collected.Multivariate logistic regression was used to analyze the influencing factors of HT occurrence in patients,and ROC curve analysis was employed to assess the predictive value of ACAG for HT occurrence in stroke patients.Results The levels of CRP,Cl-,HCO3-,and Alb in the HT group were lower than those in the non-HT group(P＜0.05),while the levels of AG and ACAG in the HT group were higher than those in the non-HT group(P＜0.05).Multivariate logistic regression analysis showed that ACAG[OR=14.145,95％CI:3.078-64.645],AG[OR=2.983,95％CI:1.859-4.758],CRP[OR=2.428,95％CI:1.101-12.082],and NIHSS score at admission[OR=3.147,95％CI:1.906-5.168]were all influencing factors for HT in stroke patients(P＜0.05).ROC curve analysis results showed that ACAG had higher predictive efficiency than other indicators,with an AUC of 0.872(95％CI:0.767-0.972),sensitivity of 0.725,spe-cificity of 0.973,Youden index of 0.698,and an optimal cutoff value of 18.010 mmol/L(P＜0.001).Conclusion ACAG has high efficacy in predicting HT after intravenous thrombolysis in stroke patients,outperforming other traditional indicators.A specific ACAG threshold(18.010 mmol/L)can be used clinically to effectively identify patients at high risk of hemorrhagic transformation.

Abstract:The management of relapsed/refractory multiple myeloma(RRMM)remains a formidable challenge due to disease heterogeneity and drug resistance.Recent years have witnessed a paradigm shift from conventional chemotherapy to tar-geted and immunotherapeutic strategies.This article comprehensively reviews the progress in drug therapy for RRMM.While traditional targeted agents,including proteasome inhibitors and immunomodulatory drugs,continue to evolve and break efficacy barriers through structural optimization and combination regimens,novel immunotherapies-such as monoclonal antibodies,anti-body-drug conjugates,bispecific antibodies,and chimeric antigen receptor T-cell(CAR-T)therapies-have demonstrated unprec-edented efficacy in achieving deep and durable responses,even in heavily pretreated patients.The future of RRMM clinical man-agement lies in biomarker-guided precision medicine,mechanism-driven combination therapies,and the forward deployment of the most effective treatments,ultimately aiming to transform RRMM into a chronic and controllable condition.