Abstract:Pulmonary tuberculosis is a common respiratory infectious disease.In recent years,a growing number of studies have highlighted the importance of the gut-lung axis in the occurrence and development of pulmonary tuberculosis.Gut microbiota and its metabolites influence immunity and inflammation in pulmonary diseases such as tuberculosis via the gut-lung axis.Conversely,pulmonary tuberculosis infection can also cause ecological imbalance of the gut microbiota through the gut-lung axis.This review summarizes the mechanism of the gut microbiota-immune axis regulation in the occurrence and progression of Mycobacterium tuberculosis infection,as well as the potential of biotherapeutics in the treatment of pulmonary tuberculosis,aiming to provide new strategies for its management.

Abstract:Objective To explore the efficacy and safety of remimazolam besylate for continuous mechanical ventilation in intensive care unit(ICU)patients.Methods Fifty critically ill patients who required continuous mechanical ventilation and were admitted to Anqing Municipal Hospital from May 2021 to June 2022 were selected.They were divided into a remimazolam group and a midazolam group using a random number table,with 25 cases in each group.Sedation dose was titrated based on the Richmond Agitation-Sedation Scale and the Bispectral Index.The time to achieve satisfactory sedation,the time from discontinuation of sedation to full alertness,adverse reactions during sedation,delirium,and sedation failure events were recorded.Results The drug infusion dose for maintaining light sedation was(0.22±0.07)mg/(kg·h)in the remimazolam group and(0.06±0.01)mg/(kg·h)in the midazolam group.The time to achieve satisfactory sedation was significantly shorter in the remimazolam group than in the midazolam group[8.00(7.00,11.00)min vs 16.00(10.50,19.00)min,P<0.001].The time to regain full alertness after discontinuation of sedation was significantly shorter in the remimazolam group than in the midazolam group[18.00(14.25,21.00)min vs 32.00(27.00,43.00)min,P<0.001].In the remimazolam group,there was 1 case of sedation failure,2 cases of hypotension,and 1 case of delirium.In the midazolam group,all cases achieved successful sedation,with 4 cases of hypotension and 6 cases of delirium.The differences were not statistically significant(P>0.05).Conclusion Remimazolam besylate can be safely and effectively used for continuous mechanical ventilation in ICU patients.

Abstract:Objective To investigate the relationship of coagulation,inflammation and other indicators with ABCD2 score and short-term prognosis in patients with transient ischemic attack(TIA).Methods A total of 372 patients with TIA admitted to Qionglai Medical Center Hospital from August 2024 to August 2025 were selected.According to the ABCD2 score,they were divided into a low-risk group(145 cases),a medium-risk group(161 cases),and a high-risk group(66 cases).The general clinical data of the three groups of TIA patients were compared.Spearman correlation analysis was used to analyze the correlations between ABCD2 score and D-dimer(D-D),fibrinogen(FIB),chemokine ligand 12(CXCL12),high-sensitivity C-reactive protein(hs-CRP),and homocysteine(Hcy)in TIA patients.Based on whether acute cerebral infarction(ACI)occurred within 7 days,the patients were divided into an ACI group(87 cases)and a non-ACI group(285 cases).The general clinical data between the two groups were compared.Multivariate logistic regression analysis was employed to identify the influencing factors for short-term ACI occurrence in TIA patients.A prediction model was constructed,and receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of each indicator for short-term ACI occurrence in TIA patients.Results The levels of D-D,FIB,CXCL12,hs-CRP,and Hcy in the medium-risk and high-risk groups were higher than those in the low-risk group(P<0.05);the levels of D-D,FIB,CXCL12,hs-CRP,and Hcy in the high-risk group were higher than those in the medium-risk group(P<0.05).Spearman correlation analysis showed that D-D,FIB,CXCL12,hs-CRP,and Hcy were positively correlated with ABCD2 score in TIA patients(r=0.436,0.451,0.508,0.515,0.482,all P<0.001).The ACI group had a higher proportion of diabetes and higher levels of ABCD2 score,D-D,FIB,CXCL12,hs-CRP,and Hcy than the non-ACI group(P<0.05).Multivariate Logistic regression analysis showed that diabetes,ABCD2 score,D-D,FIB,CXCL12,hs-CRP,and Hcy were independent risk factors for short-term ACI in TIA patients(OR=1.564,95%CI:1.044-2.341,P=0.031;OR=1.811,95%CI:1.179-2.782,P=0.007;OR=1.587,95%CI:1.068-2.358,P=0.023;OR=1.496,95%CI:1.148-1.950,P=0.003;OR=1.534,95%CI:1.150-2.046,P=0.004;OR=1.480,95%CI:1.152-1.902,P=0.002;OR=1.618,95%CI:1.080-2.422,P=0.020).A prediction model was constructed based on the multivariate logistic regression results.The Hosmer-Lemeshow goodness-of-fit test showed a good fit for the model(P<0.05).ROC curve analysis showed that the area under the curve of the model was 0.922,with a sensitivity and specificity of 82.80%and 90.90%at the optimal cutoff value.ROC curve analysis showed that the areas under the curve for D-D,FIB,CXCL12,hs-CRP,and Hcy in predicting short-term ACI in TIA patients were 0.846,0.838,0.868,0.896,and 0.730,with sensitivities of 74.70%,78.20%,77.00%,75.90%,and 72.40%,and specificities of 91.90%,77.90%,89.50%,93.70%,and 62.80%,respectively.The area under the curve for combined prediction was 0.926,with a sensitivity of 82.80%and a specificity of 90.90%.The efficacy of combined prediction was superior to that of D-D,FIB,or Hcy alone(Z=-2.062,-3.096,-5.544,P<0.05).Conclusion The levels of D-D,FIB,CXCL12,hs-CRP,and Hcy in TIA patients are related to ACI risk and prognosis.Higher levels of D-D,FIB,CXCL12,hs-CRP,and Hcy are associated with a higher risk of future ACI in TIA patients.Measures should be taken as early as possible to prevent ACI in high-risk patients.

Abstract:Objective To compare the changes in serum Toll-like receptor 4(TLR4),interleukin-35(IL-35),and C-reactive protein(CRP)/albumin(ALB)levels in children with bronchial asthma with or without Mycoplasma pneumoniae(MP)infection,and to analyze their impact on severe airway responsiveness.Methods A total of 140 children with bronchial asthma admitted to Qingdao Central Hospital of Rehabilitation University from May 2021 to December 2024 were retrospectively selected.All children underwent MP IgM antibody testing and were divided into two groups based on MP infection status:the MP-infected group(65 cases)and the non-MP-infected group(75 cases).The levels of TLR4,IL-35,and CRP/ALB were compared between the two groups.Children in the MP-infected group all underwent quantitative aerosol inhalation bronchial provocation testing using methacholine as the provoking agent.The cumulative dose of the provocant required to induce a 20%decrease in baseline forced expiratory volume in 1 second(PD20-FEV1)was used as the indicator of airway responsiveness.Spearman correlation analysis was used to analyze the correlations between serum TLR4,IL-35,CRP/ALB levels and airway responsiveness in asthmatic children with MP infection.Using PD20-FEV1<0.035 mg as the criterion for severe airway responsiveness,multivariate logistic regression analysis was performed to analyze the relationships between TLR4,IL-35,CRP/ALB levels and severe airway responsiveness.Results The levels of TLR4 and CRP/ALB in the MP-infected group were significantly higher than those in the non-MP-infected group,while the IL-35 level was significantly lower than that in the non-MP-infected group(P<0.001).Spearman correlation analysis showed that PD20-FEV1 was significantly negatively correlated with TLR4 and CRP/ALB levels,and significantly positively correlated with IL-35 level(r=-0.634,-0.592,0.516,respectively;P<0.001).Children with severe airway responsiveness had significantly higher TLR4 and CRP/ALB levels and significantly lower IL-35 levels compared to those with moderate airway responsiveness(P<0.001).Multivariate logistic regression analysis showed that TLR4 and CRP/ALB were independent risk factors for severe airway responsiveness in asthmatic children with MP infection,while IL-35 was an independent protective factor(OR=3.408,95%CI:1.526-7.611,P=0.003;OR=4.212,95%CI:1.491-11.903,P=0.007;OR=0.418,95%CI:0.197-0.886,P=0.023).Conclusion Serum TLR4,IL-35,and CRP/ALB levels in children with bronchial asthma and MP infection are significantly altered compared to those without MP infection.These indicators are correlated with airway responsiveness.High TLR4,high CRP/ALB,and low IL-35 levels influence severe airway responsiveness in children,and clinical further screening should be considered for children with these manifestations.

Abstract:Objective To investigate the expression of special AT-rich sequence-binding protein 2(SATB2)and mismatch repair proteins[MutS homolog 2(MSH2),MSH6]in colorectal cancer tissues,and to analyze the predictive value of single and combined detection of the three for prognosis.Method A total of 124 colorectal cancer patients admitted to Fuyang People's Hospital from January 2022 to November 2024 were selected as research subjects.The expression of SATB2,MSH2,and MSH6 in colorectal cancer tissues and paracancerous tissues was compared,and the differences in their expression among patients with different pathological characteristics and different prognoses were analyzed.Spearman correlation analysis was used to analyze the correlation between the expression of SATB2,MSH2,MSH6 and colorectal cancer prognosis.Receiver operating characteristic(ROC)curves were created to analyze the predictive value of SATB2,MSH2,and MSH6 for colorectal cancer prognosis.Results The positive expression rate of SATB2 in colorectal cancer tissues was 54.84%,significantly lower than the 90.32%in paracancerous tissues(P<0.05).The loss rates of MSH2 and MSH6 expression in colorectal cancer tissues were 9.68%and 7.26%,respectively,significantly higher than the 2.42%and 0.81%in paracancerous tissues(P<0.05).The positive expression rate of SATB2 in patients with TNM stage Ⅰ-Ⅱ colorectal cancer was significantly higher than in patients with stage Ⅲ-Ⅳ(P<0.05).The positive expression rate of SATB2 in the poor prognosis group was significantly lower than in the good prognosis group(P<0.05),while the loss rates of MSH2 and MSH6 were significantly higher than in the good prognosis group(P<0.05).Spearman rank correlation analysis showed that SATB2 positive expression was inversely correlated with poor prognosis(r=-0.246,P=0.006),while MSH2 and MSH6 loss were positively correlated with poor prognosis(rMSH2=0.476,PMSH2<0.001;rMSH6=0.369,PMSH6<0.001).ROC curve analysis showed that the combined detection of SATB2,MSH2,and MSH6 had a sensitivity,specificity,and area under the curve(AUC)of 89.29%,64.58%,and 0.852,respectively,significantly better than single detection of the three(ZSATB2=3.517,PSATB2<0.001;ZMSH2=3.937,PMSH2<0.001;ZMSH6=5.206,PMSH6<0.001).Conclusion SATB2 shows low expression in colorectal cancer tissues,while MSH2 and MSH6 have high loss rates in colorectal cancer tissues.All three are significantly correlated with the prognosis of colorectal cancer patients and can be used for predicting colorectal cancer prognosis.

Abstract:Objective To investigate the effect of gastrodin on hypoxia tolerance in the central nervous system of mice and its molecular mechanism.Methods Forty healthy BALB/c mice were randomly divided into four groups(n=10 per group):control group,hypoxia preconditioning group,low-dose gastrodin group(20 mg/kg),and high-dose gastrodin group(100 mg/kg).The experimental groups received intraperitoneal injections twice daily for 7 consecutive days.Hypoxia tolerance time and oxygen consumption were compared among the groups.The mRNA and protein expression levels of phosphoinositide 3-kinase(PI3K),protein kinase B(AKT),and hypoxia-inducible factor-1α(HIF-1α)in brain tissues were detected using RT-qPCR and Western blotting.In vitro experiments using primary cultured rat cortical neurons included the following groups:gastrodin control,acute hypoxia,hypoxia preconditioning,and different concentrations of gastrodin treatment(0.1 mmol/L and 0.4 mmol/L).Neuronal viability was assessed using the CCK-8 assay.Results Compared with the control group,both the hypoxia preconditioning group and the high-dose gastrodin group showed significantly prolonged hypoxia tolerance time(P<0.05),but only the high-dose gastrodin group exhibited a significant decrease in oxygen consumption(P<0.05).Molecular analysis revealed that the high-dose gastrodin group had significantly upregulated mRNA and protein expression of PI3K,AKT,and HIF-1α(P<0.05),while only HIF-1α expression was significantly increased in the low-dose gastrodin group(P<0.05).In vitro experiments confirmed that 0.4 mmol/L gastrodin significantly improved neuronal viability under hypoxic conditions(P<0.05).Conclusion Gastrodin can effectively enhance hypoxia tolerance in the central nervous system,and its mechanism is closely associated with activation of the PI3K/AKT/HIF-1α signaling pathway.Hypoxia preconditioning shares the same molecular regulatory mechanism.

Abstract:Objective To investigate the risk factors for severe progression in patients with chronic liver insufficiency with hepatitis E virus(HEV)infection and to construct a risk prediction model based on laboratory indicators.Methods A total of 177 patients with chronic liver insufficiency and HEV infection who were diagnosed and treated at Linfen Central Hospital from January 2016 to January 2024 were retrospectively enrolled.They were divided into groups based on whether they progressed to severe hepatitis(severe group:107 patients;non-severe group:70 patients).Univariate and multivariate Logistic regression analyses were used to screen for risk factors associated with severe progression in these patients,and a nomogram prediction model was constructed.The predictive performance of the model was evaluated.Results Among the 177 patients included in this study,107 experienced severe progression,with an incidence of 60.45%.Univariate analysis showed that total bile acid(TBA)level,high-density lipoprotein cholesterol(HDL-C)level,apolipoprotein A1 level,and blood uric acid level were associated with severe progression in patients with chronic liver insufficiency and HEV infection(P<0.05).Multivariate Logistic regression analysis revealed that TBA level and blood uric acid level were independent risk factors for severe progression(P<0.05),while HDL-C level and apolipoprotein A1 level were independent protective factors(P<0.05).The predictive performance of the four independent influencing factors(TBA,HDL-C,apolipoprotein A1,and blood uric acid)and the nomogram model probability for severe progression in these patients was analyzed.The results showed that the areas under the receiver operating characteristic curve were 0.743,0.725,0.729,0.713,and 0.887,the area under the curve predicted by the nomogram model was higher than that predicted by any single indicator(P<0.05).Conclusion The risk of severe progression in patients with chronic liver insufficiency and HEV infection is closely related to laboratory indicators such as TBA,HDL-C,apolipoprotein A1,and blood uric acid levels.The nomogram model constructed using these four factors demonstrates good predictive performance for severe progression in these patients.

Abstract:Objective To observe the efficacy of the bioceramic material iRoot BP Plus in vital pulpotomy for irreversible pulpitis of mature permanent teeth.Methods A total of 100 patients(100 affected teeth)with irreversible pulpitis of mature permanent teeth admitted to the School of Stomatology,Xi'an Jiaotong University from March 2022 to March 2024 were selected as the study subjects.They were divided into a control group and an experimental group by simple randomization,with 50 cases in each group(50 affected teeth each).The control group underwent pulpotomy using mineral trioxide aggregate(MTA)as the pulp capping agent,while the experimental group underwent pulpotomy using the bioceramic material iRoot BP Plus as the pulp capping agent.Pain level,clinical efficacy,radiographic efficacy,and tooth discoloration rate were compared between the two groups.Results On the first and seventh days after surgery,the visual analog scale(VAS)scores of both groups decreased compared with those before surgery(P<0.05),and the scores on day 7 were lower than those on day 1(P<0.05).The VAS scores of the experimental group were lower than those of the control group on both day 1 and day 7 after surgery(P<0.05).At 3,6,and 12 months after surgery,the clinical success rates of the experimental group were 96.00%,94.00%,and 94.00%,respectively,while those of the control group were 94.00%,92.00%,and 90.00%,respectively,with no statistically significant differences between the two groups(P>0.05).At 3,6,and 12 months after surgery,the radiographic success rates of the experimental group were 96.00%,92.00%,and 92.00%,respectively,while those of the control group were 92.00%,90.00%,and 90.00%,respectively,with no statistically significant differences between the two groups(P>0.05).At 12 months after surgery,the tooth discoloration rate of the experimental group was 2.00%(1/50),which was lower than that of the control group at 46.00%(23/50)(χ²=26.535,P<0.05).Conclusion In vital pulpotomy for irreversible pulpitis of mature permanent teeth,the short-term and long-term efficacy of iRoot BP Plus is comparable to that of MTA,but it shows advantages in reducing postoperative pain and preventing tooth discoloration.

Abstract:Objective To analyze the predictive value of blood routine-derived inflammatory indicators combined with the triglyceride-glucose(TyG)index for atherosclerosis in patients with rheumatoid arthritis(RA).Methods A total of 208 RA patients treated at Jiangyou People's Hospital between February 2019 and February 2024 were enrolled and divided into an atherosclerosis group(68 cases)and a non-atherosclerosis group(140 cases)based on the presence of atherosclerosis.General clinical data,blood routine-derived inflammatory indicators[neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),monocyte-to-lymphocyte ratio(MLR),systemic immune-inflammation index(SII)],and the TyG index were compared between the two groups.Multivariate Logistic regression was used to analyze influencing factors for atherosclerosis in RA patients.Receiver operating characteristic(ROC)curve analysis was applied to evaluate the predictive value of NLR,PLR,MLR,SII,and TyG for atherosclerosis in RA patients.Results There were no significant differences in age,sex,body mass index,RA duration,RA severity,education level,smoking history,or alcohol consumption between the two groups(P>0.05).The atherosclerosis group had significantly higher NLR,PLR,MLR,SII,and TyG levels compared to the non-atherosclerosis group(P<0.05).Multivariate logistic regression analysis indicated that elevated NLR,PLR,MLR,SII,and TyG were independent risk factors for atherosclerosis in RA patients(OR=2.535,95%CI:1.412-4.549,P=0.002;OR=1.020,95%CI:1.009-1.031,P<0.001;OR=1.742,95%CI:1.159-2.619,P=0.008;OR=1.112,95%CI:1.046-1.181,P=0.001;OR=1.232,95%CI:1.030-1.474,P=0.023).ROC curve analysis showed that the combined prediction of NLR,PLR,MLR,SII,and TyG yielded an AUC of 0.836 for atherosclerosis in RA patients,which was superior to each indicator alone(Z=4.266,4.063,4.399,3.936,5.055,all P<0.05).Conclusion NLR,PLR,MLR,SII,and TyG have certain predictive value for atherosclerosis in RA patients,and their combined use improves predictive performance.

Abstract:Objective To explore the ameliorative effect of Tongxinluo Capsules on myocardial fibrosis in rats with radiation-induced heart disease(RIHD)via the transforming growth factor-β1(TGF-β1)/Smad signaling pathway.Method Forty-eight 8-week-old male SPF-grade SD rats were randomly divided into the following groups:blank control group,model group,low-dose Tongxinluo group(0.14 g/kg),medium-dose Tongxinluo group(0.28 g/kg),high-dose Tongxinluo group(0.56 g/kg),and atorvastatin calcium group(0.90 mg/kg),8 per group.Except for the blank control group,the remaining five groups received radiotherapy.Starting from the day after irradiation,the blank control group and model group were administered 0.9%sodium chloride solution by gavage,while the other drug groups received their respective medications by gavage,once daily for 12 weeks.Cardiac ultrasound was used to measure left ventricular ejection fraction(LVEF)and left ventricular shortening fraction(LVFS).Serum levels of cardiac troponin I(cTnI)and creatine kinase-MB(CK-MB)were detected by enzyme-linked immunosorbent assay.Histopathological changes in myocardial tissue were observed using hematoxylin-eosin staining and Masson's trichrome staining.Western blotting was employed to detect the protein expression of TGF-β1,Smad3,p-Smad3,Smad2,p-Smad2,and Smad7 in cardiac tissue.Results Compared with the blank control group,the model group showed decreased LVEF and LVFS at weeks 6 and 12 after administration(P<0.05);increased serum cTnI and CK-MB levels(P<0.05);HE staining revealed significant myocardial cell edema with extensive inflammatory infiltration and elevated pathological scores(P<0.05);Masson staining showed marked myocardial fibrosis and increased collagen volume fraction(CVF)(P<0.05);cardiac tissue exhibited increased expression of TGF-β1,p-Smad3,and p-Smad2 proteins(P<0.05),while Smad7 protein expression was decreased(P<0.05).Compared with the model group,the low-,medium-,and high-dose Tongxinluo groups and the atorvastatin calcium group showed increased LVEF and LVFS at weeks 6 and 12(P<0.05);decreased serum cTnI and CK-MB levels(P<0.05);myocardial cell morphology returned to normal with regular arrangement,inflammatory infiltration was significantly reduced,fibrosis was alleviated,and pathological scores and CVF were decreased(P<0.05);cardiac tissue showed decreased expression of TGF-β1,p-Smad3,and p-Smad2 proteins(P<0.05),while Smad7 protein expression was increased(P<0.05).Conclusion Tongxinluo Capsules ameliorate cardiac injury and reduce myocardial fibrosis in RIHD rats by regulating the TGF-β1/Smad signaling pathway.

Abstract:Objective To explore the changes in dynamic parameters of diffusion-weighted imaging(DWI)and fluid-attenuated inversion recovery(FLAIR)sequences in patients with ischemic stroke(IS)undergoing emergency intravenous thrombolysis and to evaluate their application value for the efficacy of intravenous thrombolysis and clinical outcomes.Methods A total of 134 IS patients admitted to Shunyi District Hospital,Beijing between April 2022 and April 2025 were retrospectively enrolled.All patients received emergency intravenous thrombolysis and underwent DWI and FLAIR sequence scans at admission and 24 hours after thrombolysis respectively.The relationship between dynamic changes in imaging parameters and 24-hour thrombolysis efficacy(assessed by △NIHSS)and 90 d clinical outcomes(assessed by the modified Rankin scale)was analyzed.Based on ΔNIHSS scores,patients were divided into a good efficacy group(≥2 points,53 cases)and a poor efficacy group(<2 points,81 cases)at 24 hours post-thrombolysis.According to Modified Rankin Scale scores,they were further categorized into an unfavorable outcome group(>2 points,61 cases)and a favorable outcome group(≤2 points,73 cases).Results The poor 24-hour intravenous thrombolysis efficacy group had higher lesion volume,△rSI-FLAIR,age,admission NIHSS score,and onset-to-door time than the good efficacy group,while △rADC was lower(P<0.05).Spearman correlation analysis showed that △rSI-FLAIR was positively correlated with △NIHSS(r=0.238,P<0.05),and △rADC was negatively correlated with △NIHSS(r=-0.387,P<0.05).Logistic regression analysis indicated that lesion volume,△rSI-FLAIR,age,admission NIHSS score,and onset-to-door time were independent risk factors for 24-hour thrombolysis efficacy,while △rADC was a protective factor(P<0.05).ROC curve analysis showed that the AUC of lesion volume,△rSI-FLAIR,and △rADC for evaluating 24-hour thrombolysis efficacy were 0.669,0.787,and 0.778,respectively.The poor 90 d outcome group had a higher proportion of posterior circulation ischemia,as well as higher lesion volume,△rSI-FLAIR,age,admission NIHSS score,and onset-to-door time than the good outcome group,while △rADC was lower(P<0.05).Logistic regression analysis showed that posterior circulation ischemia,onset-to-door time,lesion volume,△rSI-FLAIR,age,and admission NIHSS score were risk factors for 90 d outcomes,while △rADC was a protective factor(P<0.05).ROC curve analysis showed that the AUC of lesion volume,△rSI-FLAIR,and △rADC for predicting 90 d outcomes were 0.614,0.793,and 0.739,respectively.Conclusion Parameters of DWI and FLAIR sequences and their dynamic changes within 24 hours after thrombolysis can be used for quantitative assessment of short-term efficacy of intravenous thrombolysis in IS patients and have certain predictive value for 90 d clinical outcomes.

Abstract:Objective To investigate the correlation between key lymphatic development genes prospero homeobox 1(PROX1),forkhead box protein C2(FOXC2),and vascular endothelial growth factor receptor 3(VEGFR3)in spontaneous chylous disorders.Methods A retrospective study was conducted from January 2019 to December 2023.Twenty-five patients with spontaneous chylous disorders were selected as the patient group,and 20 healthy volunteers undergoing physical examination during the same period were selected as the control group from Shanghai Pudong New Area Punan Hospital.Protein and mRNA expression levels of PROX1,FOXC2,and VEGFR3 in whole blood were compared between the two groups.Results Among the 25 patients with spontaneous chylous disorders,there were 11 cases of chyluria,6 cases of chylous ascites,and 8 cases of chylothorax.No statistically significant difference was found in whole blood protein expression levels of PROX1,FOXC2,and VEGFR3 between the control group and the patient group(P>0.05);However,mRNA expression levels of PROX1,FOXC2,and VEGFR3 were significantly higher in the patient group than in the control group(P<0.05).There were no statistically significant differences in PROX1 and FOXC2 expressions among patients with chyluria,chylothorax and chylous ascites(P>0.05).Conclusion The upregulation of PROX1,FOXC2,and VEGFR3 gene expression in spontaneous chylous diseases suggests that these genes may be involved in the occurrence and development of the disease by affecting lymphatic structure and function.

Abstract:Objective To explore the correlation between dietary inflammatory index(DII)and sarcopenia in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 122 elderly patients with COPD admitted to Santai Hospital Affiliated to North Sichuan Medical College from August 2024 to August 2025 were selected.They were divided into the sarcopenia group(34 cases)and the non-sarcopenia group(88 cases)based on the presence of sarcopenia.General clinical data were compared between the two groups;multivariate logistic stepwise regression analysis was used to analyze the influencing factors for sarcopenia in elderly COPD patients;receiver operating characteristic(ROC)curve analysis was adopted to evaluate the predictive value of DII for sarcopenia in elderly COPD patients.Results In the sarcopenia group,age,COPD duration,proportion of hypoproteinemia,proportion of airflow limitation at Grade Ⅲ-Ⅳ,fasting blood glucose,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin 6(IL-6),and DII were higher than those in the non-sarcopenia group,while body mass index and proportion of patients receiving exercise training were lower than those in the non-sarcopenia group(all P<0.05).Multivariate logistic stepwise regression analysis showed that prolonged COPD duration(OR=1.887,95%CI:1.243-2.865),hypoproteinemia(OR=2.404,95%CI:1.399-4.129),airflow limitation at Grade Ⅲ-Ⅳ(OR=2.784,95%CI:1.481-5.234),and DII≥3.32(OR=3.040,95%CI:1.501-6.157)were independent risk factors for sarcopenia in elderly COPD patients(all P<0.05).The area under the ROC curve(AUC)of DII for predicting sarcopenia in elderly COPD patients was 0.909,which was significantly superior to the AUC of CRP(0.686),TNF-α(0.755),and IL-6(0.846)when used alone(Z=10.621,9.527,8.336,respectively;all P<0.001).Conclusion An elevated DII is closely associated with sarcopenia in elderly COPD patients and has good predictive efficacy.

Abstract:Objective To investigate the relationship between interleukin-6(IL-6),human leukocyte antigen G(HLA-G),T-cell immunoglobulin and mucin domain 3(Tim-3)and clinicopathological indicators and prognosis in patients with acute myeloid leukemia(AML).Methods A total of 113 AML patients admitted to Linfen People's Hospital from March 2020 to November 2023 were selected as the study group,and 80 normal individuals during the same period were selected as the control group.Serum levels of IL-6,HLA-G,and Tim-3 were detected and compared between the two groups,and the relationship between the expression levels of IL-6,HLA-G,Tim-3 and clinicopathological indicators in AML patients was analyzed.According to the one-year prognosis,AML patients were divided into a survival group(85 cases)and a death group(28 cases),and serum levels of IL-6,HLA-G,and Tim-3 were compared between the two groups.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of serum IL-6,HLA-G,and Tim-3 levels for the prognosis of AML patients.Results Serum levels of IL-6,HLA-G,and Tim-3 in the AML patient group were significantly higher than those in the control group(P<0.05).Serum levels of IL-6,HLA-G,and Tim-3 in AML patients were related to peripheral blood white blood cell count and European Leukemia Net(ELN)risk stratification(P<0.05).Serum levels of IL-6,HLA-G,and Tim-3 in the death group were higher than those in the survival group(P<0.05).The areas under the curve(AUC)of serum IL-6,HLA-G,and Tim-3 for predicting the prognosis of AML patients were 0.829,0.840,and 0.787,respectively.The AUC for the combination of the three markers was 0.948,which was better than that of each individual predictor(Z combination vs IL-6=2.497,Z combination vs HLA-G=2.957,Z combination vs Tim-3=3.207,all P<0.05).Conclusion Serum levels of IL-6,HLA-G,and Tim-3 are significantly elevated in AML patients,and their expression levels are related to peripheral blood white blood cell count and ELN risk stratification.The combination of the three markers may assist in predicting the prognosis of AML patients.

Abstract:Objective To analyze the influencing factors of cognitive frailty(CF)in elderly patients with heart failure(HF)and construct a nomogram model.Methods A total of 246 elderly HF patients admitted to Luzhou People's Hospital from August 2023 to August 2025 were selected.The patients were divided into the CF group(n=86)and the non-CF group(n=160)based on the presence of CF.Multivariate Logistic regression analysis was used to explore the influencing factors of CF in elderly HF patients.A nomogram was drawn,and the predictive value was evaluated using the receiver operating characteristic curve.Results The proportion of patients with older age,living alone,diabetes,grade IV cardiac function,depression,sleep disorders,and poor nutritional status was significantly higher in the CF group than in the non-CF group(P<0.05).The proportion of patients with body mass index,being married,exercise frequency≥3 times/week,and engaging in weekly intellectual activities was significantly lower in the CF group than in the non-CF group(P<0.05).Multivariate analysis showed that older age(OR=1.088,95%CI:1.028-1.153),depression(OR=3.433,95%CI:1.694-6.954),and grade Ⅳ cardiac function(OR=2.084,95%CI:1.085-4.001)were independent risk factors for CF in elderly HF patients,while exercise frequency≥3 times/week(OR=0.335,95%CI:0.155-0.723)and weekly intellectual activities(OR=0.298,95%CI:0.149-0.594)were independent protective factors(P<0.05).The nomogram model showed a consistency index of 0.846(95%CI:0.797-0.895).The area under the curve of the nomogram model for predicting CF in elderly HF patients was 0.846(95%CI:0.797-0.895),with a specificity of 80.00%and a sensitivity of 77.91%.Conclusion Age,depression,cardiac function grade,exercise frequency,and weekly intellectual activities are independent influencing factors for CF in elderly HF patients.The nomogram model constructed based on these factors has high predictive value for CF in elderly HF patients.

Abstract:Objective To investigate the relationship between the levels of Toll-like receptor 9(TLR9)and growth differentiation factor 15(GDF15)and the occurrence of acute kidney injury(AKI)in patients with sepsis.Methods A total of 106 patients with sepsis admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to June 2024 were retrospectively selected as the control group,and 160 patients with sepsis-associated AKI during the same period were selected as the study group.The clinical data and expression levels of TLR9 and GDF15 were compared between the two groups.Spearman correlation analysis was used to explore the correlation between TLR9 and GDF15 expression levels and the occurrence of AKI in sepsis patients.Receiver operating characteristic(ROC)curve analysis was applied to evaluate the predictive value of TLR9 and GDF15 expression levels for AKI.Results The levels of respiratory rate,heart rate,glucose,creatinine,lactate,along with the proportion of infection originating from an intra-abdominal source,in the study group were higher than those in the control group,while the levels of oxygen saturation,albumin,hemoglobin,platelet count,and mean arterial pressure(MAP)were lower(P<0.05).The expression levels of TLR9 and GDF15 in the study group were higher than those in the control group(P<0.05).Spearman correlation analysis showed that the expression levels of TLR9 and GDF15 were positively correlated with the occurrence of AKI(r=0.587,0.621,both P<0.05).lactate(OR=2.309,95%CI:1.184-4.506),MAP(OR=2.155,95%CI:1.066-4.356),creatinine(OR=2.077,95%CI:1.014-4.256),TLR9(OR=2.606,95%CI:1.471-4.620),and GDF15(OR=2.492,95%CI:1.437-4.322)were identified as independent risk factors for AKI in sepsis patients(P<0.05).The area under the curve of TLR9,GDF15,and their combination for predicting sepsis-associated AKI were 0.812,0.759,and 0.813,respectively.Conclusion The expression levels of TLR9 and GDF15 are closely associated with the occurrence of sepsis-associated AKI and may serve as predictive indicators for sepsis-associated AKI.

Abstract:Objective To explore the efficacy of vericiguat and its influence on cardiac and renal function and prognosis in elderly patients with heart failure with reduced ejection fraction(HFrEF).Methods A total of 104 elderly patients with HFrEF admitted to the Cardiology Department of Handan Central Hospital between November 2022 and January 2024 were selected and randomly divided into a conventional treatment group(n=52,receiving conventional therapy)and a vericiguat-combined group(n=52,receiving conventional therapy combined with vericiguat)according to the random number table method.After 6 months of treatment,the efficacy,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP),6-minute walk test(6MWT),blood urea nitrogen(BUN),and serum creatinine(SCr)before and after treatment were compared between the two groups.The occurrence of major adverse cardiovascular event(MACE)within 6 months was also observed.Results After treatment,the total effective rate in the vericiguat-combined group was 98.08%,which was higher than that in the conventional treatment group(84.62%,P<0.05).After treatment,LVEF[(59.28±5.24)%]and 6MWT[(447.92±72.75)m]in the vericiguat-combined group were significantly higher than those in the conventional treatment group[(51.87±4.37)%and(407.21±70.12)m,respectively],while LVEDD[(55.47±4.13)mm],LVESD[(34.19±3.24)mm],and NT-proBNP level[(361.24±28.26)pg/mL]in the vericiguat-combined group were significantly lower than those in the conventional treatment group[(64.91±5.84)mm,(38.52±3.71)mm,and(394.31±30.36)pg/mL,respectively],with statistically significant differences(P<0.001).Before and after treatment,there were no statistically significant differences in BUN and Scr levels between the two groups(P>0.05).The proportions of all-cause mortality,heart failure rehospitalization,myocardial infarction,and malignant arrhythmia in the vericiguat-combined group were all lower than those in the conventional treatment group(P<0.05).Conclusion Vericiguat has a definite curative effect in the treatment of HFrEF,can effectively improve cardiac function without negative effects on renal function,reduces the incidence of MACE,and improves prognosis.

Abstract:Objective To explore the related factors of acute respiratory distress syndrome(ARDS)in patients with severe trauma and to construct a nomogram prediction model.Methods A total of 212 patients with severe trauma admitted to The Second Affiliated Hospital of Xiamen Medical College from March 2023 to March 2025 were retrospectively selected.According to the occurrence of ARDS,they were divided into an ARDS group(83 cases)and a non-ARDS group(129 cases).General data,past medical history,injury characteristics,treatment conditions,and laboratory indicators were compared between the two groups.Multivariate Logistic regression analysis was used to identify independent risk factors for ARDS in severe trauma patients,and a nomogram prediction model was constructed based on these factors.The ROC curve was plotted to analyze the value of the nomogram prediction model in predicting ARDS in severe trauma patients.Results The ARDS group had higher proportions of Injury Severity Score≥25,pulmonary contusion,flail chest,admission hypoxemia,shock time≥4 h,laparotomy,aspiration of gastric contents,pulmonary infection,higher Abbreviated Injury Scale chest score,and higher serum tumor necrosis factor-α level at 24 h after admission compared to the non-ARDS group(P<0.05).Multivariate Logistic regression analysis showed that Injury Severity Score≥25,high Abbreviated Injury Scale chest score,pulmonary contusion,hypoxemia at admission,shock duration≥4 h,and high tumor necrosis factor-α level at 24 h after admission were independent risk factors for ARDS in severe trauma patients(OR=2.705,95%CI:1.631-4.485,P<0.01;OR=3.800,95%CI:2.310-6.252,P<0.01;OR=5.270,95%CI:3.038-9.141,P<0.01;OR=4.158,95%CI:2.483-6.962,P<0.01;OR=3.187,95%CI:2.058-4.934,P<0.01;OR=2.389,95%CI:1.433-3.985,P<0.01).ROC curve analysis showed that the nomogram prediction model had an AUC of 0.914,a sensitivity of 78.31%,and a specificity of 93.80%for predicting ARDS in severe trauma patients.Conclusion Injury Severity Score≥25,high Abbreviated Injury Scale chest score,pulmonary contusion,hypoxemia at admission,shock duration≥4 h,and high tumor necrosis factor-α level at 24 h after admission are independent risk factors for ARDS in severe trauma patients.The nomogram prediction model constructed based on these risk factors is an effective tool for predicting the occurrence of ARDS in severe trauma patients.

Abstract:Objective To construct a prediction model for the risk of poor prognosis in non-small cell lung cancer(NSCLC)patients receiving immunotherapy based on a prospective longitudinal cohort.Methods An analysis was conducted on clinical data of 282 NSCLC patients treated with immune checkpoint inhibitor(ICIs)at Nanchong Mental and Physical Hospital from January 2022 to January 2025.Based on prognosis,patients were divided into a poor prognosis group(119 cases)and a good prognosis group(163 cases).Differences in general data and laboratory indicators before treatment and after 2 treatment cycles—including neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation index(SII),systemic inflammation response index(SIRI),and T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)—were compared between the two groups.Cox proportional hazards regression analysis was used to identify influencing factors for poor prognosis in NSCLC patients receiving immunotherapy.A nomogram was constructed to build a prediction model for the risk of poor prognosis.ROC curve analysis and the consistency index(C-index)were used to evaluate the model's discrimination.The Bootstrap method was used for repeated sampling for internal validation to assess the model's calibration.Results The poor prognosis group had a lower proportion of ICI as first-line therapy and lower CD4+/CD8+after 2 treatment cycles,but higher NLR,SII,SIRI,and CD8+after 2 treatment cycles compared to the good prognosis group(P<0.05).Multivariate Cox proportional hazards regression analysis showed that NLR and SII after 2 treatment cycles were independent risk factors for poor prognosis in NSCLC patients receiving immunotherapy,while ICI as first-line therapy and CD4+/CD8+after 2 treatment cycles were independent protective factors(HR=3.928,95%CI:2.198-6.015,P<0.001;HR=1.635,95%CI:1.018-2.427,P=0.012;HR=0.457,95%CI:0.239-0.871,P=0.017;HR=0.905,95%CI:0.851-0.986,P=0.010).ROC curve analysis showed that the AUC of the nomogram prediction model for poor prognosis in NSCLC patients receiving immunotherapy was 0.833(95%CI:0.745-0.920),and the C-index was 0.851(95%CI:0.770-0.931),indicating good model discrimination.Internal validation showed good model calibration.Conclusion The line of ICI therapy and CD4+/CD8+,NLR,and SII after 2 treatment cycles may influence the prognosis of advanced NSCLC patients receiving immunotherapy.The nomogram prediction model constructed from these four factors can assist in predicting the risk of poor prognosis.

Abstract:Objective To explore the relationship between serum uric acid(SUA),oxidized low-density lipoprotein(ox-LDL)and the disease condition and prognosis in elderly patients with vascular dementia(VaD).Methods A total of 120 elderly patients with VaD admitted to Xingtai People's Hospital from December 2022 to December 2024 were prospectively selected.According to the evaluation results of the Mini-Mental State Examination,the patients were divided into the mild group(43 cases),moderate group(51 cases)and severe group(26 cases),the levels of SUA and ox-LDL were compared among the three groups,and the correlation between SUA,ox-LDL levels and disease severity was analyzed by Point-biserial correlation analysis.Based on the evaluation results of the Barthel Index scale at 3 months of follow-up after discharge,the patients were divided into the good prognosis group(91 cases)and poor prognosis group(29 cases).The levels of SUA and ox-LDL were compared between the two groups,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of SUA and ox-LDL for poor prognosis in elderly VaD patients.Results The levels of SUA and ox-LDL in the severe group and moderate group were higher than those in the mild group(P<0.05);the levels of SUA and ox-LDL in the severe group were higher than those in the moderate group(P<0.05).Point-biserial correlation analysis showed that the levels of SUA and ox-LDL in elderly VaD patients were significant positively correlated with disease severity(r=0.506,0.518;P<0.001).The levels of SUA and ox-LDL in the poor prognosis group[(417.43±51.24)μmol/L,(78.66±14.18)U/L]were significantly higher than those in the good prognosis group[(351.95±43.58)μmol/L,(60.19±11.29)U/L](P<0.001).ROC curve analysis showed that the area under the curve(AUC)of the combination of SUA and ox-LDL for predicting poor prognosis in elderly VaD patients was 0.952,which was significantly better than the AUC of 0.812 for SUA and 0.898 for ox-LDL when used alone(Z=3.125,2.451;P<0.05).Conclusion The levels of SUA and ox-LDL are significantly elevated in elderly patients with VaD,and they are positively correlated with the severity of the disease.The combination of these two indicators has higher predictive value for poor prognosis in the patients.