Abstract:Objective To explore the predictive value of the longitudinal change pattern of leptin to adiponectin ratio(LAR)on the progression of gestational diabetes mellitus(GDM)in pregnant women with borderline blood glucose.Methods A prospective study was conducted on 99 pregnant women with borderline blood glucose at 24 weeks of gestation admitted to the Third Affiliated Hospital of Xinxiang Medical University from September 2021 to June 2023.Fasting venous serum LAR was measured at 24 weeks,26 weeks and 28 weeks of gestation.Fasting venous serum LAR was measured at 24,26,and 28 weeks of gestation.The changes in LAR among all pregnant women during follow-up were observed.A latent class trajectory model(LCTM)was used to establish a trajectory model for LAR changes.The changes in LAR and baseline data among different trajectory groups were compared.Logistic regression analysis was conducted to investigate the relationship between LAR trajectory and progression to gestational diabetes mellitus(GDM).Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive performance of LAR trajectory for progression to GDM.Results During the follow-up of all pregnant women,the leptin levels were(7.56±2.50)μg·L-1,(8.80±2.74)μg·L-1,and(9.63±2.95)μg·L-1,respectively,and the LAR values were 1.21±0.30,1.56±0.44,and 1.97±0.51,respectively,all showing a significant upward trend.The adiponectin levels were(6.25±0.90)μg·L-1,(5.63±0.87)μg·L-1,and(4.89±0.75)μg·L-1,respectively,showing a significant downward trend,with statistical significance(P＜0.05).LCTM analysis identified three LAR trajectory models:low-to-slow increase(T1 group,30.30％),low-to-moderate-to-rapid increase(T2 group,35.35％),and high-to-rapid increase(T3 group,34.34％).Significant differences were observed in body mass index(BMI),low-density lipoprotein cholesterol(LDL-C),and fasting blood glucose(FBG)among the three trajectory groups(P＜0.05).Logistic regression analysis showed that both before and after adjustment,compared with the T1 group,the T2 and T3 groups increased the risk of developing GDM.The T2 and T3 trajectories were independently associated with the development of GDM(P＜0.05).ROC analysis indicated that when LAR followed a high-to-rapid increase trajectory(T3),the area under the curve for predicting the progression to GDM was 0.808(95％CI:0.717-0.881).Conclusion There are different longitudinal change trajectories of LAR in the follow-up of pregnant women with borderline blood glucose.The high-rapid increase trajectory has certain predictive value for the progression to GDM,which can be used as an auxiliary index for clinical prediction of GDM,so as to guide individualized and stratified intervention.

Abstract:Objective To investigate the types and proportions of basic diets and therapeutic diets prescribed to inpatients at a tertiary Grade A cancer specialty hospital,and to provide a reference for optimizing the provision of basic and therapeutic diets in cancer specialty hospitals and oncology departments of general hospitals.Methods Dietary orders for inpatients hospitalized from January to December 2024 were extracted from the Neusoft electronic medical record system.SPSS 22.0 was used for statistical analysis.The x2 test was applied to compare the proportion of therapeutic dietary orders between the cancer specialty hospitals and general hospitals,as well as to compare differences in the issuance and implementation of therapeutic dietary orders across different months within the hospital.Results In 2024,the average daily number of dietary orders at the cancer specialty hospital was(3 651.56±33.08)patients,among which therapeutic diet orders accounted for(951.30±87.01)patients,representing 25.98％of all dietary orders.Specifically,diabetic diets accounted for(288.55±2.81)patients(7.90％),low-salt and low-fat diets for(603.28±5.72)patients(16.52％),enteral tube feeding diets for(16.48±0.22)patients(0.45％),low-iodine diets for(15.64±0.33)patients(1.01％),and other therapeutic diets for(24.86±0.29)patients(0.68％).The proportion of therapeutic diet orders in this cancer specialty hospital(25.98％)was lower than that in general hospitals(32.35％)(P＜0.01).Among therapeutic diets,low-salt and low-fat diets ranked first,followed by diabetic diets.Moreover,the meal consumption rate of therapeutic diets(2.47％)was lower than that in general hospitals(75.30％)(P＜0.01).Conclusion Low-salt and low-fat diets and diabetic diets constitute the largest proportions of therapeutic dietary orders in the cancer specialty hospitals.However,their meal consumption rates remain low.The clinical nutrition department and the hospital cafeteria may enhance the diabetic and low-salt low-fat diets by aligning them with the regular and soft diet recipes,and may improve tube-feeding regimens by incorporating liquid diets,thereby increasing patient meal participation rates in cancer-focused hospitals or general hospital oncology units.

Abstract:Objective To analyze the related factors affecting the pregnancy outcome of patients with unexplained recurrent abortion.Methods A total of 100 patients with unexplained recurrent abortion admitted to Pingdingshan Maternal and Child Health Hospital from January 2022 to October 2023 were selected and divided into pregnant group and non-pregnant group according to their pregnancy conditions.In addition,the pregnancy group was divided into live birth group and non-live birth group according to the birth conditions,and the clinical data of the patients were compared respectively.At the same time,logistic regression model was used to analyze the related factors affecting the pregnancy and childbirth of the patients.Results There were significant differences in age,body mass index(BMI),cycle schedule,anti-Mullerian hormone(AMH)and basal follicle stimulating hormone(FSH)between the pregnant group and the non-pregnant group(P＜0.05).There were no significant differences in infertility years,infertility factors,total forward sperm movement,endometrial thickness,basal luteinizing hormone(LH)and basal estradiol(E2)on insemination day between two groups(P＞0.05).There were significant differences in BMI and cycle schedule between live birth group and non-live birth group(P＜0.05).There were no significant differences in age,infertility years,infertility factors,total forward sperm movement,endometrial thickness,AMH,basal FSH,basal LH and basal E2 on insemination day between the two groups(P＞0.05).Logistic regression analysis showed that age,BMI,cycle schedule,AMH and basal FSH were all independent factors influencing the pregnancy status of patients with unexplained recurrent abortion(P＜0.05).BMI and cycle schedule were the independent influencing factors of artificial insemination in patients with unexplained recurrent abortion(P＜0.05).Conclusion Age,BMI,cycle schedule,AMH and basal FSH were all independent factors influencing the pregnancy status of patients with unexplained recurrent abortion,and BMI and cycle schedule were also independent factors influencing the birth status of patients.

Abstract:Objective To explore the influence of refined labor nursing management on the maternal and infant outcomes of pregnant women with gestational hypertension.Methods From January 2024 to June 2025,98 pregnant women with gestational hypertension admitted to Pingdingshan Maternal and Child Health Hospital were randomly divided into an observation group and a control group,with 49 cases in each group.The control group adopted the conventional labor nursing mode,and the observation group adopted the refined labor nursing mode on this basis.The blood pressure fluctuations during labor,the scores of the support and control in birth(SCIB),the maternal and infant outcomes,and the satisfaction with midwifery work were compared between the two groups.Results The fluctuation values of systolic blood pressure and diastolic blood pressure in the first and second stages of labor in the observation group were lower than those in the control group(P＜0.05).At 24 h and 72 h after delivery,the scores of the dimensions of internal control,external control and professional support in the SCIB in the observation group were higher than those in the control group(P＜0.05).The incidences of preeclampsia exacerbation during labor and postpartum hemorrhage in the observation group were both lower than those in the control group,and the Apgar scores of newborns after birth were higher than that in the control group(P＜0.05).The midwifery satisfaction scores of professional ability,work attitude,nursing process,and communication efficiency in the observation group were higher than those in the control group(P＜0.05).Conclusion The application of refined labor nursing management in the delivery process of pregnant women with gestational hypertension can prevent abnormal fluctuations in blood pressure during labor,enhance the sense of support and control during delivery,reduce the incidence of adverse outcomes for both mothers and infants,and make them more accepting of nursing work.

Abstract:Objective To observe the analgesic effects of multi-point nerve block combined with patient controlled intravenous analgesia(PCIA)after radical surgery for breast cancer in women.Methods A total of 60 patients who underwent radical surgery for breast cancer in Puyang People's Hospital from January 2020 to May 2024 were selected and divided into a combined group(multi-point nerve block combined with postoperative PCIA)and a PCIA group(postoperative PCIA)using a computer-generated random number table,with 30 cases in each group.The pain scores at 2,8,12,24,and 48 hours postoperatively,the first PCIA compression time,sufentanil dosage,PCIA compression frequency,analgesic satisfaction,and analgesic adverse reactions were compared between the two groups.Results There were no breakthrough pain or patients requiring rescue analgesia in both groups.Repeated measures analysis of variance showed that there was an interaction between the groups in terms of visual analogue scale(VAS)scores over time(P＜0.05).The VAS scores at 2,8,12,and 24 hours postoperatively in the combined group were lower than those in the PCIA group(P＜0.05).There was no significant difference in VAS scores at 48 hours postoperatively between the two groups(P＞0.05).Compared with 2 h after surgery,VAS scores at 8 h,12 h and 24 h were increased in both groups(P＜0.05),VAS scores at 48 h after surgery in the combined group was increased(P＜0.05),and VAS scores at 48 h after surgery in the PCIA group were decreased(P＜0.05).Compared with 8 h after surgery,VAS scores at 12 h were increased in both groups(P＜0.05),and VAS score at 48 h after surgery in the PCIA group was decreased(P＜0.05).Compared with 12 h after surgery,VAS scores at 24 h and 48 h were decreased in both groups(P＜0.05).Compared with 24 h after surgery,VAS scores at 48 h were decreased in both groups(P＜0.05).The first PCIA compression time in the combined group was longer than that in the PCIA group(P＜0.05),and the sufentanil dosage and PCIA compression frequency were lower than those in the PCIA group(P＜0.05).The analgesic satisfaction in the combined group was higher than that in the PCIA group(P＜0.05).There were no significant differences in the incidence of headache,nausea and vomiting,hallucinations,rash,and respiratory depression and the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Multi-point nerve block combined with PCIA can alleviate postoperative pain in women undergoing radical breast cancer surgery,reduce the dosage of PCIA,improve analgesic satisfaction,and does not significantly increase adverse reactions.

Abstract:Objective To explore the application effect of home exercise program based on digitized management in elderly patients with chronic atrophic gastritis(CAG)and frailty.Methods A total of 106 elderly patients with CAG frailty who were treated in the First Affiliated Hospital of Zhengzhou University from January 2023 to December 2024 were selected and divided into study group and control group according to the random number table method,with 53 cases in each group.The control group was given traditional home exercise program,and the study group was given home exercise program based on digitized management.Both groups were intervened for 3 months.The degree of frailty[Tilburg frailty inventory(TFI)],grip strength,physical activity ability[short physical performance battery(SPPB)],balance ability[Berg balance scale(BBS)],self-management ability[adult health self-management scale rating scale(AHSMSRS)],quality of life[short form 12 questionnaire(SF-12)]before intervention and 3 months after intervention(after intervention)and the incidence of falls during 3-month follow-up after intervention were compared between the two groups.Results After intervention,the TFI score of the study group was lower than that of the control group,and the grip strength was higher than that of the control group(P＜0.05).After intervention,the SPPB,BBS and AHSMSRS scores of the study group were higher than those of the control group(P＜0.05).After intervention,the scores of physical function,psychological function and total score of SF-12 in the study group were higher than those in the control group(P＜0.05).There was no significant difference in the incidence of falls during 3-month follow-up after intervention between the two groups(P＞0.05).Conclusion The home exercise program based on digital management can improve the frailty of elderly patients with CAG,enhance their grip strength,improve their physical activity ability,balance ability and self-management ability,and improve their quality of life.

Abstract:Objective To analyze the relationship between peripheral blood eosinophils(EOS),matrix metalloproteinase(MMP)-2,and postoperative recurrence of sinonasal inverted papilloma(SNIP).Methods A prospective study was conducted on 103 patients with SNIP who were diagnosed and received surgical treatment at Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2018 to July 2022.All patients were tested for peripheral blood EOS and MMP-2 upon admission,and underwent nasal endoscopic surgery.The endpoint was recurrence events within 2 years of follow-up,and the included patients were divided into a recurrence group and a non recurrence group.Cox regression was used to investigate the relationship between postoperative recurrence and peripheral blood EOS and MMP-2 in SNIP patients.The predictive value of peripheral blood EOS and MMP-2 for postoperative recurrence in SNIP patients was analyzed by receiver operating characteristic(ROC)curve.Results Among the 103 patients,27 relapsed within 2 years,with a recurrence time of 17.00(15.00,19.00)months and a recurrence rate of 26.21％.The proportion of Krouse grade Ⅲ-Ⅳ in the recurrence group,as well as the percentage of peripheral blood EOS,MMP-2,interleukin-6,and squamous cell carcinoma antigen(SCC)expression,were higher than those in the non recurrence group(P＜0.05).Cox regression analysis was used,recurrence in SNIP patients within 2 years after surgery was associated with Krouse grade Ⅳ,peripheral blood EOS percentage,increased expression of MMP-2,IL-6,and SCC(P＜0.05).ROC curves were drawn,and the area under the curve for predicting recurrence within 2 years after SNIP using peripheral blood EOS and MMP-2 was 0.785 and 0.791,respectively.The optimal cutoff values for predicting recurrence within 2 years after SNIP were 7.795 and 204.820,with sensitivities of 0.704 and 0.741,and specificities of 0.776 and 0.771,respectively.Conclusion The recurrence of SNIP patients after nasal endoscopic surgery is related to the increase of peripheral blood EOS and MMP-2.Detection of EOS and MMP-2 can early identify high-risk populations for recurrence and has certain predictive value for recurrence within 2 years.

Abstract:Objective To analyze the effectiveness of drug intervention based on Caprini risk assessment model for the prevention and treatment of venous thromboembolism(VTE)in orthopedic patients.Methods A total of 120 orthopedic patients admitted to Jiaozuo Coal Industry(Group)Limited Liability Company Central Hospital from April 2023 to April 2024 were randomly divided into two groups by drawing lots:a control group and an observation group,with 60 patients in each group.The control group received VTE management according to the department's previous mode.The observation group strictly followed the Caprini risk assessment scale and carried out reasonable prevention according to the risk level.High-risk and extremely high-risk patients were treated with dabigatran etexilate.The clinical outcomes of the two groups were compared.Results Compared with the control group,the incidence of VTE in the observation group was significantly lower(P＜0.05).After treatment,the observation group had higher levels of activated partial thromboplastin time(APTT),prothrombin time(PT),and thrombin time(TT)(P＜0.05),and lower levels of fibrinogen(FIB)and D-dimer(P＜0.05).There was no significant difference in blood routine indicators between the two groups before and after treatment(P＞0.05).No significant difference was found in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Drug intervention based on the Caprini risk assessment model can reduce the risk of VTE and improve the coagulation function in orthopedic patients.Its safety is acceptable,and the effect is ideal.

Abstract:Objective To compare the effects of glucocorticoid sustained-release sinus stents and conventional surgical cavity debridement on nasal ventilation function and inflammation levels after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps(CRSwNP).Methods A total of 104 patients with CRSwNP admitted to The Second Affiliated Hospital of Luohe Medical College from February 2022 to February 2024 were enrolled and divided into two groups according to the odd and even numbers of their hospital admission numbers.Both groups underwent functional endoscopic sinus surgery,and received antibiotics,nasal irrigation and mometasone furoate nasal spray for 2 weeks postoperatively.The control group only received conventional surgical cavity debridement at the 2-week postoperative follow-up,while the observation group received implantation of glucocorticoid sinus stents into bilateral ethmoid sinuses at the same follow-up time point.The differences in nasal endoscopy scores,symptom scores,neutrophil-to-lymphocyte ratio(NLR),interleukin-17(IL-17),and nasal ventilation function indicators[including distance from the minimal cross-sectional area to the nostril(DCAN),nasal airway resistance,nasal minimal cross-sectional area(NMCA)and nasal cavity volume(NCV)]were compared between the two groups,and the incidence of complications was statistically analyzed.Results At 12 weeks postoperatively,the ethmoid sinus obstruction score and ethmoid sinus scab/coagulum score in both groups were lower than those at 2 weeks postoperatively,and the scores in the observation group were lower than those in the control group(P＜0.05).The symptom scores in both groups improved compared with those at 2 weeks postoperatively,but there was no significant difference between the two groups(P＞0.05).The levels of NLR and IL-17 in both groups at 12 weeks postoperatively were lower than those at 2 weeks postoperatively,and the levels in the observation group were lower than those in the control group(P＜0.05).At 12 weeks postoperatively,DCAN and nasal airway resistance decreased,while NMCA and NCV increased in both groups,and all the above ventilation indicators in the observation group were superior to those in the control group(P＜0.05).The incidence rates of middle turbinate lateral displacement and adhesion in the observation group were lower than those in the control group(P＜0.05),and there was no significant difference in the incidence of other complications between the two groups.Conclusion The application of glucocorticoid sustained-release sinus stents after endoscopic sinus surgery for CRSwNP can improve patients' nasal ventilation function,inhibit inflammation,reduce the occurrence of middle turbinate lateral displacement and adhesion,and promote the benign outcome of the surgical cavity.

Abstract:Objective To analyze the correlations among clinical manifestations,molecular subtypes and prognosis in patients with diffuse large B-cell lymphoma(DLBCL),verify the prognostic value of the traditional international prognostic index(IPI)and its individual components in the era of rituximab plus CHOP(R-CHOP)regimen,and explore a modified risk stratification model incorporating extranodal involvement and molecular subtypes,so as to provide evidence for clinical prognostic evaluation and individualized treatment.Methods A retrospective analysis was conducted on the clinical data of 120 previously untreated DLBCL patients admitted to the First Affiliated Hospital of Henan Medical University from January 2020 to January 2023.Patients' demographic characteristics,Ann Arbor staging,number of extranodal involvement,lactate dehydrogenase(LDH)level,Eastern Cooperative Oncology Group(ECOG)score,IPI score,immunohistochemical molecular typing[germinal center B-cell-like(GCB),non-germinal center B-cell-like(non-GCB)],and survival follow-up information were systematically collected.The Kaplan-Meier method was used to calculate the 3-year overall survival(OS)and progression-free survival(PFS),and the log-rank test was used for inter-group comparison.Variables with P＜0.1 in univariate analysis were included in the Cox proportional hazards regression model,and multivariate models including the total IPI score(model 1)and individual IPI components(model 2)were constructed,respectively,with proportional hazards hypothesis testing.Subgroup analysis was further conducted based on molecular typing,and a simple prognostic score incorporating independent risk factors was preliminarily constructed.Results The median follow-up time for the entire group of 120 patients was 36 months.The 3-year OS was 69.2％,and the 3-year PFS was 62.5％.Univariate analysis showed that age(＜40 years,40-＜60 years,≥60 years),Ann Arbor stages Ⅲ and Ⅳ,IPI score ≥ 3,elevated LDH,≥2 extranodal involvements,and non-GCB molecular subtypes were significantly associated with poorer OS and PFS(P＜0.05).Multivariate analysis(model 1)revealed that an IPI score of ≥3(HR=3.448,95％CI:1.820-6.352,P＜0.001),≥2 extranodal involvements(HR=2.759,95％CI:1.480-5.146,P=0.001),and non-GCB subtype(HR=1.986,95％CI:1.132-3.485,P=0.017)were independent poor prognostic factors for OS.Model 2(individual components of IPI)indicated that only ≥2 extranodal involvements(HR=2.815,95％CI:1.513-5.237,P=0.001)and elevated LDH levels(HR=1.892,95％CI:1.056-3.391,P=0.032)maintained independent prognostic significance.Subgroup analysis found that the impact of age on prognosis was primarily concentrated in the non-GCB subtype(HR=2.436,95％CI:1.284-4.622,P=0.007).The initially constructed simplified prognostic model incorporating three factors(IPI score≥3,≥ 2 extranodal involvements,and non-GCB subtype)showed a trend toward better discrimination for 3-year overall survival compared with the traditional IPI score.Conclusion High IPI score,multiple extranodal involvements,and non-GCB subtype are independent poor prognostic factors for DLBCL patients;the contribution of traditional IPI components has decreased,with extranodal involvement and elevated LDH levels gaining more prominence;there is a significant interaction between age and molecular typing.The simplified modified model constructed based on these factors exhibits superior discriminatory power compared to the traditional IPI.This study provides a scientific basis for individualized prognostic assessment and identification of high-risk patients in DLBCL.

Abstract:Pulmonary thromboembolism(PTE)is one of the common causes of sudden unexpected death,with a high morbidity and mortality rate,seriously threatening patients' lives and health seriously.Trauma and genetic factors can lead to lower limb deep vein thrombosis(LDVT)secondary to PTE,and the mechanism of its occurrence has been a hot topic of research at home and abroad.In this article,we summarize trauma and genetic variation leading to LDVT secondary to PTE and sudden unexpected death by focusing on vascular endothelial damage,venous stasis and hypercoagulable state of the blood,so as to provide references for clinical prevention,treatment and forensic identification.

Abstract:Objective To investigate the changes of non-high-density lipoprotein cholesterol(non-HDL-C)and apolipoprotein B/apolipoprotein A1 ratio(ApoB/ApoA1)levels during highly active antiretroviral therapy(HAART)in patients with human immunodeficiency virus(HIV)infection/acquired immunodeficiency syndrome(AIDS)and their predictive value for cardiovascular system damage.Methods The clinical data of 400 HIV/AIDS patients admitted to the Fifth People's Hospital of Anyang from January 1,2015 to January 1,2021 were retrospectively analyzed.According to whether HIV/AIDS patients had cardiovascular system damage,they were divided into the occurrence group and the non-occurrence group.The clinical data and the levels of non-HDL-C and ApoB/ApoA1 during treatment were compared between the two groups.Logistic regression analysis was used to analyze the effects of non-HDL-C and ApoB/ApoA1 changes on cardiovascular system damage in HIV/AIDS patients.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of non-HDL-C and ApoB/ApoA1 changes on cardiovascular system damage in HIV/AIDS patients.Results Among the 400 HIV/AIDS patients,112 cases(28.00％)had cardiovascular system damage within 4 years.The main type of damage was abnormal electrocardiogram(86 cases,76.79％),among which non-specific ST-T changes(45 cases)and various arrhythmias(41 cases)were the most common.Imaging abnormalities(18 cases,16.07％)were the second.The proportion of abnormal laboratory tests(8 cases,7.14％)was the lowest,mainly the increase of troponin Ⅰ(5 cases)or creatine kinase isoenzyme(3 cases).The proportion of smoking history and opportunistic infections during treatment in the occurrence group were higher than those in the non-occurrence group.The HAART time was longer than that in the non-occurrence group,and the differences were statistically significant(P＜0.05).The changes of non-HDL-C and ApoB/ApoA1(Δ6 months,Δ12 months)in the occurrence group were higher than those in the non-occurrence group,the differences were statistically significant(P＜0.05).Logistic regression analysis showed that non-HDL-C and ApoB/ApoA1 changes(Δ6 months,Δ12 months)were independently associated with cardiovascular system damage in HIV/AIDS patients(P＜0.05).The area under the curve(AUC)value of non-HDL-C and ApoB/ApoA1(Δ6 months)combined prediction of cardiovascular system damage in HIV/AIDS patients was greater than that of single index prediction(P＜0.05).The AUC value of non-HDL-C and ApoB/ApoA1(Δ12 months)combined prediction of cardiovascular system damage was greater than that of single index prediction(P＜0.05).The AUC value of combined prediction of non-HDL-C and ApoB/ApoA1 change value(Δ12 months)was higher than that of combined prediction of non-HDL-C and ApoB/ApoA1 change value(Δ6 months)(P＜0.05).Conclusion The increase of non-HDL-C and ApoB/ApoA1 levels in HIV/AIDS patients during HAART treatment is related to cardiovascular system damage,and the combination of the changes before and after treatment has a good effect on predicting cardiovascular system damage,which is helpful for clinicians to optimize cardiovascular risk management in time to reduce the occurrence of cardiovascular system damage.

Abstract:Objective To investigate the association between serum uric acid(SUA)level and albuminuria in elderly patients with type 2 diabetes mellitus(T2DM).Methods A consecutive case series of 588 elderly patients with T2DM hospitalized in the Department of Geriatricology at Henan Provincial People's Hospital from January to December 2023 was included in this cross-sectional analysis.According to urinary albumin/creatinine(UACR),588 patients were divided into normoalbuminuria group(UACR＜30 mg·g-1)and albuminuria group(UACR ≥30 mg·g-1),and clinical characteristics were compared between groups.Patients were divided into Q1 group(＜255 μmol·L-1),Q2 group(255 to＜303 μmol·L-1),Q3 group(303 to＜359.23 μmol·L-1)and Q4 group(≥359.23 μmol·L-1)according to the SUA quartile.The probability of albuminuria among quartiles was analyzed.Multivariable logistic regression was used to evaluate the association between SUA and risk of albuminuria.Receiver operating characteristic(ROC)curves were constructed to assess the predictive value of SUA for albuminuria.Results Compared with the normoalbuminuria group,patients in the albuminuria group had longer disease duration(P＜0.05),higher prevalence of primary hypertension and diabetic retinopathy(P＜0.05).The albuminuria group also showed significantly higher levels of systolic blood pressure(SBP),glycated hemoglobin(HbA1c),blood urea nitrogen,SUA,serum creatinine and fasting blood glucose(FBG),while estimated glomerular filtration rate(eGFR)and high-density lipoprotein cholesterol were significantly lower(P＜0.05).After adjusting for confounding factors,multivariable logistic regression analysis showed that the risks of macroalbuminuria in Q3 and Q4 groups were 6.356-fold(95％CI:1.000-40.359,P＜0.05)and 10.881-fold(95％CI:1.685-70.067,P＜0.05)higher than Q1 group,respectively.ROC curve analysis demonstrated that SUA had better predictive value for macroalbuminuria than microalbuminuria,with an optimal cutoff value of 329.8 μmol·L-1.Conclusion SUA levels are closely associated with albuminuria in elderly T2DM patients,particularly showing an independent correlation with macroalbuminuria.SUA level ≥ 329.8 μmol·L-1 may serve as an important indicator for predicting the risk of macroalbuminuria in elderly T2DM patients.

Abstract:Objective To explore the effects of ultrasound-guided pericapsular nerve group(PENG)block combined with combined intravenous and inhalation anesthesia on hemodynamics and delirium in elderly patients undergoing hip replacement.Methods Data of elderly patients who underwent hip replacement in the Second Affiliated Hospital of Zhengzhou University from February 2022 to February 2024 were collected.They were divided into two groups based on anesthesia methods,and a 1∶1 propensity score matching was used to balance the data between the two groups.Finally,43 patients who underwent surgery under combined intravenous and inhalation anesthesia were included as the control group,and 43 patients who underwent ultrasound-guided PENG block combined with combined intravenous and inhalation anesthesia were included as the observation group.Hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)]were recorded at 5 minutes before anesthesia induction(To),at skin incision(T1),at prosthesis implantation(T2),and at the end of surgery(T3).The dosage of anesthetic drugs,postoperative recovery,and the incidence of delirium within 72 hours postoperatively were also compared between the two groups.Results Compared with To,MAP and HR decreased at T,and increased at T2 and T3 in both groups(P＜0.05).The observation group showed higher MAP and HR than the control group at T1 and T2(P＜0.05).The dosages of main intraoperative anesthetics and postoperative patient-controlled intravenous analgesia(PCIA)drugs in the observation group were lower than those in the control group.The recovery time of orientation and the first time to get out of bed were shorter,and the incidence of delirium within 72 hours postoperatively was lower in the observation group than in the control group(P＜0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group(P＜0.05).Conclusion The combination of ultrasound-guided PENG block and combined intravenous and inhalation anesthesia during hip replacement in elderly patients is more conducive to stabilizing hemodynamics,reducing the dosage of anesthetics,decreasing the incidence of postoperative delirium,and promoting early recovery.

Abstract:Objective To explore the value of color Doppler ultrasound in the differential diagnosis of renal cell carcinoma and renal angiomyolipoma(RAML).Methods A retrospective analysis was conducted on the clinical data of 102 patients with renal cancer diagnosed by pathological examination at Henan Electric Power Hospital from March 2021 to March 2024,and the clinical data of 86 patients with RAML diagnosed by pathological examination during the same period were selected as the RAML group.All patients underwent color Doppler ultrasound examination,and the efficacy of color Doppler ultrasound in distinguishing renal cell carcinoma from RAML was analyzed and compared.The consistency between its differentiation of renal cell carcinoma from RAML and pathological examination results was also analyzed,and the ultrasound image characteristics of the two groups were compared.Results The results of color Doppler ultrasound examination showed that 103 cases were renal cancer and 85 cases were RAML.Among them,17 cases of renal cancer were misdiagnosed as RAML,and 18 cases of RAML were misdiagnosed as renal cancer.The accuracy of color Doppler ultrasound differential diagnosis was 81.38％(153/188),sensitivity was 83.33％(85/102),specificity was 79.07％(68/86),positive predictive value was 82.52％(85/103),and negative predictive value was 80.00％(68/85).The consistency between color Doppler ultrasound diagnosis of renal cell carcinoma,RAML,and pathological examination results was strong(Kappa value=0.625,P＜0.05).The proportion of low echo and rich blood supply in the renal cancer group was higher than that in the RAML group,and the proportion of clear boundaries was lower than that in the RAML group(P＜0.05).Conclusion Color Doppler ultrasound has certain clinical value in the differential diagnosis of renal cell carcinoma and RAML,and the consistency between its differential diagnosis of renal cell carcinoma,RAML,and pathological examination results is strong.

Abstract:Objective To investigate the application value of esketamine pre-treatment combined with dexmedetomidine intravenous anesthesia in precision radiotherapy for pediatric tumors.Methods A total of 156 children with tumors who received precision radiotherapy at the Third People's Hospital of Zhengzhou City from January 2021 to September 2024 were retrospectively enrolled.According to the anesthesia regimen,they were divided into a pre-treatment anesthesia group(78 cases)and a conventional anesthesia group(78 cases).The conventional anesthesia group received dexmedetomidine intravenous anesthesia,while the pre-treatment anesthesia group received esketamine pre-treatment combined with dexmedetomidine intravenous anesthesia.Anesthesia efficacy was compared between the two groups.Hemodynamic parameters[diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR)]and anesthesia depth[University of Michigan sedation scale(UMSS)score]were recorded at four time points:before anesthesia(T0),5 min after anesthesia induction(T1),5 min after the start of radiotherapy(T2),and 5 min after radiotherapy completion(T3).Anesthesia-related indicators and adverse reactions were also compared between the two groups.Results The excellent anesthesia rate in the pre-treatment anesthesia group was higher than that in the conventional anesthesia group(P＜0.05).At T0-T3,DBP,SBP,and HR in both groups showed a trend of initial decrease followed by a gradual increase.Notably,the fluctuation magnitudes of DBP,SBP,and HR at T1 and T2 in the pre-treatment anesthesia group were smaller than those in the conventional anesthesia group(P＜0.05).The UMSS scores in both groups exhibited an initial increase followed by a decrease over T0-T3,with significantly higher scores at T,and T2 in the pre-treatment anesthesia group(P＜0.05).The onset time of anesthesia in the pre-treatment anesthesia group was shorter than that in the conventional anesthesia group(P＜0.05).However,no significant differences were observed between the two groups in total sedation time,recovery time,orientation recovery time,or the incidence of anesthesia-related adverse reactions(P＞0.05).Conclusion Esketamine pre-treatment combined with dexmedetomidine intravenous anesthesia in precision radiotherapy for pediatric tumors can better stabilize hemodynamic parameters,enhance anesthesia depth,and improve anesthesia efficacy,while also shortening the onset time.This regimen demonstrates favorable anesthesia recovery quality and a satisfactory safety profile.

Abstract:Objective To investigate the efficacy of arthroscopic medial patellar plica resection combined with acupotomy release in the treatment of knee osteoarthritis(KOA).Methods KOA patients in the 988 Hospital of Joint Logistic Support Force of PLA from May 2022 to April 2025 were selected and grouped according to the treatment plan.Patients who underwent arthroscopic debridement combined with plica resection were assigned to the control group,and patients who underwent arthroscopic debridement combined with plica resection plus acupotomy release were assigned to the observation group.Propensity score matching(PSM)with a 1∶1 nearest neighbor matching method was used for matching.After PSM,42 cases in the observation group and 42 cases in the control group were successfully matched.The efficacy of the two groups,as well as the Knee Society score(KSS),visual analogue scale(VAS),and Western Ontario and McMaster Universities osteoarthritis index(WOMAC)scores before and at 1,3,and 6 months after surgery,and the imaging indicators before and at 6 months after surgery were compared.Adverse events and overall satisfaction were also recorded.Results At 6 months after surgery,the total effective rate in the observation group(90.48％)was higher than that in the control group(73.81％)(P＜0.05).The VAS scores at rest and during activity in the observation group were lower than those in the control group at 1,3,and 6 months after surgery(P＜0.05).The Lysholm knee score(LKS)and KSS scores in the observation group were higher than those in the control group,while the WOMAC score was lower than that in the control group at 1,3,and 6 months after surgery(P＜0.05).The thickness of medial patellar plica and the depth of joint effusion in the observation group were lower than those in the control group at 6 months after surgery(P＜0.05).There was no statistically significant difference in the incidence of adverse events between the two groups(P＞0.05).The overall satisfaction in the observation group(90.48％)was higher than that in the control group(71.43％)(P＜0.05).Conclusion Arthroscopic debridement combined with plica resection followed by acupotomy release of extracapsular soft tissue can more effectively relieve pain,improve knee joint function,and enhance satisfaction in KOA patients than arthroscopic surgery alone.

Abstract:Objective To explore the effect of electroencephalogram biofeedback therapy combined with venlafaxine in the treatment of generalized anxiety disorder(GAD).Methods A total of 94 patients with GAD from Luoyang Fifth People's Hospital from March 2022 to March 2024 were randomly divided into control group(47 cases,treated with venlafaxine)and observation group(47 cases,treated with electroencephalogram biofeedback therapy combined with venlafaxine)according to the random number table method.After 8 weeks of treatment,the clinical efficacy of the two groups was evaluated.The anxiety symptoms[Hamilton anxiety scale(HAMA)and self-rating anxiety scale(SAS)]and sleep quality[Pittsburgh sleep quality index(PSQI)]before and after treatment were compared between the two groups.Adverse reactions during treatment were counted.Results The total effective rate of the observation group was higher than the control group(P＜0.05).After treatment,the HAMA scores,SAS scores and PSQI scores of both groups decreased,and the scores in the observation group were lower(P＜0.05).The difference in the incidence of adverse reactions between the two groups was not significant(P＞0.05).Conclusion The combination of electroencephalogram biofeedback therapy and venlafaxine has a good therapeutic effect on GAD,which can alleviate patients' anxiety symptoms,improve sleep quality,and has high safety.

Abstract:Objective To analyze the influencing factors of clinical outcomes in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary embolism(PE),and to construct a risk prediction model.Methods The clinical data of 132 patients with COPD combined with PE(modeling group)admitted to General Hospital of Hebi Coal Industry(Group)Co.,LTD from August 2019 to August 2022 were retrospectively analyzed.They were followed up for 2 years after treatment and divided into death group and survival group according to clinical outcome.The clinical data of the two groups were compared.Multivariate logistic regression was used to analyze the risk factors affecting the clinical outcome of COPD patients with PE,and the prediction model of clinical outcome of COPD patients with PE was constructed and verified internally.In addition,44 patients with COPD combined with PE(validation group)were selected as external validation of the prediction model according to a ratio of 3∶1.Results There was no significant difference in clinical data between the modeling group and the verification group(P＞0.05).Univariate analysis showed that age,pulmonary function grade,D-dimer,fibrinogen(FIB)level,platelet count and embolization degree were significantly associated with the clinical outcome of COPD patients with PE(P＜0.05).Multivariate logistic regression analysis showed that age,pulmonary function grade,D-dimer,FIB level,platelet count and embolization degree were independent risk factors affecting the clinical outcome of COPD patients with PE(P＜0.05).Internal and external verification showed that the average absolute error between the actual measured value of the calibration curve and the predicted value of the model was 0.030 and 0.025,respectively.The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)was 0.870 and 0.844,respectively.The decision analysis curve showed that when the predicted risk threshold was 0.01-0.90,the nomogram model showed significant clinical net benefit.Conclusion Age,pulmonary function grade,D-dimer,FIB level,platelet count and embolization degree are closely related to the clinical outcome of COPD patients with PE.The prediction model of clinical outcome of COPD patients with PE based on this model has good accuracy and differentiation,and has high clinical application value.

Abstract:Objective To investigate the effect of Neuman's concept of care on nursing in patients treated with peritoneal dialysis(PD).Methods A total of 86 patients treated with PD in the First Affiliated Hospital of Zhengzhou University from March 2023 to August 2024 were divided into 2 groups by random number table method(with 43 cases in each group).In addition to the control group,Neuman's concept of care on nursing was given to the observation group.The scores of hospital anxiety and depression scale(HADS),mindful attention awareness scale(MAAS)and kidney disease questionnaire(KDQ)were compared before and after the intervention.Results After intervention,the scores of anxiety and depression of HADS in both groups decreased,and the scores of anxiety and depression of HADS in the observation group were lower after intervention(P＜0.05).After intervention,the scores of MAAS and KDQ in both groups increased,and the scores of MAAS and KDQ in the observation group were higher after intervention(P＜0.05).Conclusion The nursing intervention based on Neuman's care concept can alleviate anxiety and depression of patients undergoing PD treatment,and improve mental awareness and quality of life.