Abstract:Objective To investigate the efficacy and safety of Oselidine in patient-controlled intravenous analgesia(PCIA)for elderly patients after total knee arthroplasty(TKA).Methods A prospective,double-blind,single-center,randomized controlled study design was employed.A total of 84 patients who were undergoing elective TKA under general anesthesia were recruited and randomly allocated to either the oseltidine group or the sufentanil group,with 42 cases in each group.All patients received PCIA 48 hours after the operation.The primary endpoint was the static visual analogue scale(VAS)score 24 hours after the operation,while the secondary end-points were the static and dynamic VAS scores at 6,12,24,and 48 hours after the operation.The time of the first PCIA pressing after operation,the effective number of PCIA pressings within 48 h after operation(D1),the total number of PCIA pressings within 48 h after operation(D2),the ratio of D1 to D2,and the incidence of remedial analgesia.The Ramsay sedation scores at 5,10,20,and 30 min after extubation,the Quality of Recovery-15(QoR-15)scores at 24 h before operation,24 h,and 48 h after operation,the Athens Insomnia Scale(AIS)scores on the night before operation,the first night,and the second night after operation,the satisfaction score,and the postoperative hospital stay.Adverse events(such as nausea and vomiting,respiratory depression,urinary retention,dizziness,etc.)that occurred within 48 h after surgery.Results There were no significant differences in VAS score,Ramsay score,analgesia pump pressing-related indexes,and the incidence of remedial analgesia between the two groups at all time points(P>0.05).The D1/D2 ratio,QoR-15 scores at 24 and 48 h after opera-tion,and the satisfaction score in the oseltidine group were higher than those in the sufentanil group(P<0.05).The AIS score on the first night after operation and the incidence of nausea and vomiting in the oseltidine group were lower than those in the sufentanil group(P<0.05).Conclusions This study systematically compared the analgesic efficacy and safety of oxycodone and sufentanil as PCIA drugs in patients with TKA.Results indicate that oxycodone not only provides analgesia comparable to sufentanil but also demonstrates significant advantages in terms of safety and patient comfort.Oxycodone significantly reduced the incidence of postoperative nausea and vom-iting,while enhancing the quality of postoperative recovery,sleep quality,and overall patient satisfaction.

Abstract:Objective This study aimed to compare the effects of hypotension prediction index(HPI)-guided hemodynamic management(HPI group)versus traditional haemodynamic management(control group)on intraoperative hypotensive events and postoperative recovery in elderly patients undergoing major abdominal surgery.Methods Elderly patients aged≥65 years undergoing major abdominal surgery under general anesthesia were enrolled.Patients were randomly divided into HPI group or control group using a random number table.In the HPI group,when the HPI exceeded 85,the HemoSphere monitor would trigger an alarm,the anesthesiologist formulated treatment plan based on advanced hemodynamic parameters,including administration of vasoconstrictors,fluid resuscitation,inotropic agents,or observation.In the control group,when MAP dropped below 65 mmHg,anesthesiologists managed hemodynamics based on the commonly used parameters of the HemoSphere monitor.Outcome measures recorded in both groups included the incidence of intraoperative hypotensive events,fluid intake and output,dosage of vasoactive drugs,postoperative mechanical ventilation duration,length of ICU stay,postop-erative hospital stay,and incidence of postoperative complications.Results A total of 64 elderly patients undergo-ing major abdominal surgery under general anesthesia were included in this study,comprising 39 males and 25 females,with ages ranging from 65 to 86 years and a body mass index(BMI)of 16.65～29.22 kg/m2.The HPI group had a significantly lower incidence of intraoperative hypotension than the control group(37.5%vs.65.6%,respectively;relative risk=0.558;95%confidence interval:0.325～0.957,P=0.024).Additionally,the HPI group exhibited lower values for time-weighted average MAP<65 mmHg(TWA-MAP<65 mmHg),area under the curve of MAP<65 mmHg(AUC-MAP<65 mmHg),and duration of MAP<65 mmHg compared with the con-trol group(all P<0.05).Compared with the control group,the HPI group had significantly reduced intraoperative colloid fluid infusion and total fluid input(P=0.037 and P=0.039,respectively)and a shorter postoperative mechanical ventilation duration(P=0.031).No statistically significant difference were observed between the two groups in the dosage of vasoactive drugs or incidence of postoperative complications(both P>0.05).Conclusions Compared with control group,HPI-guided hemodynamic management significantly reduces the incidence of intraop-erative hypotension events in elderly patients undergoing major abdominal surgery.Furthermore,HPI-guided hemo-dynamic management offers additional clinical benefits,including alleviating the duration and severity of intraop-erative hypotension,reducing intraoperative colloid and total fluid infusion,and shortening postoperative mechanical ventilation duration.

Abstract:Objective To explore the application of serum interleukin-7(IL-7),lactate dehydrogenase/albumin(LDH/ALB),and soluble leukocyte differentiation antigen subtype 14(sCD14-ST)in the diagnosis and disease assessment of chronic obstructive pulmonary disease(COPD)with pulmonary infection(PI).Methods A total of 109 patients with COPD complicated by PI admitted to the hospital from June 2022 to June 2024 were included in the infection group.Additionally,100 patients with uncomplicated COPD who visited the outpatient department during the same period were included in the control group.Both groups were incorporated into the training set.We compared the general characteristics,IL-7 levels,LDH/ALB ratios,and sCD14-ST levels between the infection group and the control group.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic value of these indicators in COPD complicated with PI.Patients in the Infection Group were divided into mild(n=27),moderate(n=49)and severe(n=33)subgroups based on the pneumonia severity index(PSI).The IL-7,LDH/ALB,sCD14-ST levels and PSI of the three subgroups were compared,and Pearson's correlation analysis was conducted to analyze the relationship between IL-7,LDH/ALB,and sCD14-ST levels and PSI.Additionally,59 patients with COPD complicated by PI and 50 patients with COPD alone admitted to the hos-pital between July 2024 and December 2024 were selected for the validation set to construct a nomogram model.Results The age,duration of COPD,history of diabetes,long-term use of antibiotics,mechanical ventilation status and length of hospital stay in the infection group were all higher than those in the conventional group(P<0.05).The levels of IL-7,LDH/ALB and sCD14-ST in the infection group were all higher than those in the conventional group(t=4.551,4.510,4.329,P<0.05).The results of multivariate logistic regression analysis showed that IL-7,LDH/ALB,and sCD14-ST were all independent risk factors for COPD combined with PI(P<0.05).The com-bined diagnostic value of IL-7,LDH/ALB,and sCD14-ST for COPD combined with PI is higher than that of a single indicator diagnosis.The AUCs of serum IL-7,LDH/ALB,and sCD14-ST for COPD combined with PI alone and in combination are 0.711,0.666,0.700,and 0.856,respectively.The AUC of combined diagnosis was higher than that of individual diagnosis(ZIL-7～combined=4.877,ZLDH/ALB～combined=5.279,ZsCD14-ST～combined=4.371,P<0.05).The Kappa test showed that the Kappa values of IL-7,LDH/ALB,sCD14-ST and the combined diagnosis were 0.405,0.265,0.311 and 0.551 respectively.Levels of IL-7,LDH/ALB,and sCD14-ST in the severe subgroup were significantly higher than those in the moderate and mild subgroups,and levels in the moderate subgroup were sig-nificantly higher than those in the mild subgroup(P<0.05).PSI was higher in the severe group than in the mild and moderate groups,and was higher in the moderate group than in the mild group(P<0.05).Pearson correlation analysis revealed positive correlations between the levels of IL-7,LDH/ALB,sCD14-ST and disease severity in COPD patients with PI(r=0.390,0.444,0.372,P<0.001).The risk factor selection model based on multifactor logistic regression demonstrated good predictive value for COPD with pulmonary infection.The AUC values for the training and validation sets were 0.82(0.75～0.88)and 0.78(0.66～0.90),respectively.Calibration curves indicated that predicted values closely matched actual outcomes(P>0.05).The decision curve indicated a high positive net benefit at thresholds ranging from 50%to 100%.Conclusions The combination of IL-7,LDH/ALB,and sCD14-ST has high diagnostic value for COPD complicated with pulmonary infection.Furthermore,the levels of these three indicators are positively correlated with disease severity,which may provide a basis for clinical assessment of patient condition.

Abstract:Objective To investigate the clinical value of circular RNAs(circRNAs)in the diagnosis and disease activity assessment of ankylosing spondylitis(AS)by measuring the expression levels of hsa_circ_0001707 and hsa_circ_0075522 in peripheral blood mononuclear cells(PBMCs)of AS patients.Methods A case-control study was conducted,enrolling 88 newly diagnosed AS patients and 80 healthy controls(HCs)with matched baseline characteristics.The expression of hsa_circ_0001707,hsa_circ_0075522,and HLA-B27 was detected via quantitative polymerase chain reaction(qPCR).Disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index(BASDAI).Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and complete blood count parameters were measured using automated analyzers.Novel inflammatory indices,including the lymphocyte-to-monocyte ratio(LMR),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),derived NLR(dNLR),and systemic immune-inflammation index(SII),were calculated.Results circRNA analysis revealed significantly upregulated hsa_circ_0001707 and downregulated hsa_circ_0075522 in AS patients(both P<0.05).Receiver operating characteristic(ROC)curve analysis demonstrated that hsa_circ_0001707 exhibited moderate diagnostic efficacy for distinguishing AS from HCs(AUC=0.677,P<0.001),which significantly improved when combined with dNLR(AUC=0.835,P<0.001).In disease activity assess-ment,hsa_circ_0001707 levels were significantly higher in active AS(BASDAI≥4)than in inactive patients and correlated with CRP.Its discriminative power for active AS surpassed that of CRP(AUC:0.684 vs.0.674).Correlation analysis further supported the potential role of hsa_circ_0001707 in AS pathogenesis,showing positive associations with inflammatory markers(NLR,SII,CRP)and BASDAI(P<0.05),but negative correlations with lymphocyte percentage(L%)and LMR.In contrast,hsa_circ_0075522 showed no significant clinical correla-tions.Conclusion Hsa_circ_0001707 may serve as a promising peripheral blood biomarker for AS diagnosis and disease activity monitoring.

Abstract:Objective To clarify the clinical characteristics of patients with gestational diabetes mellitus(GDM)complicated by group B streptococcus(GBS)infection and its impact on pregnancy outcomes,and to analyze the predictive value of glycated hemoglobin(HbA1c),neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)in GDM patients complicated by GBS infection and its complication,chorioamnionitis.Methods A retrospective selection was conducted on 277 inpatients diagnosed with GDM who were admitted to the Nanhai Maternal and Child Health Hospital,Foshan City from January 2023 to December 2024.Among these patients,those with GDM combined with GBS infection were assigned to the positive group(n=75),while those with GDM but without GBS infection were assigned to the control group(n=202).The differences in clinical data,including age,and pregnancy outcomes between the two groups of pregnant women were compared.Multivari-ate logistic regression analysis was employed to explore the risk factors for GBS infection in GDM patients and the risk factors for chorioamnionitis in GDM patients with GBS infection.The predictive value of the relevant indicators was assessed using the receiver operating characteristic curve(ROC).Results In the positive group,the levels of HbA1c,NLR,and PLR were significantly elevated.Moreover,the incidences of premature rupture of membranes and intrauterine distress also showed a significant increase,and these differences were statistically significant(all P<0.05).The results of multivariate logistic regression analysis indicated that HbA1c(OR=2.574,95%CI:1.355～4.889)and NLR(OR=1.545,95%CI:1.318～1.811)were independent risk factors for GBS infection in patients with GDM(all P<0.05).Meanwhile,NLR(OR=1.694,95%CI:1.242～2.190)was identified as an independent risk factor for chorioamnionitis in GDM patients with GBS infection.The ROC curve results demon-strated that the area under the curve(AUC)of the combined prediction model constructed based on HbA1c and NLR for predicting GBS infection in GDM patients was 0.800(95%CI:0.741～0.859),and the AUC of NLR for predicting chorioamnionitis was 0.855(95%CI:0.760～0.951).The PLR had no significant correlation with GBS infection and its complications(P>0.05).Conclusions GBS infection in patients with GDM elevates the risk of adverse pregnancy outcomes among pregnant women.Elevated levels of glycated HbA1c and NLR are independent risk factors for GBS infection in GDM patients.The NLR holds predictive value for chorioamnionitis in GDM patients with GBS infection.It is advisable to enhance the management of high-risk pregnancies to prevent adverse pregnancy outcomes and mitigate the risk of maternal and infant infections during the perinatal period.

Abstract:Objective To explore the efficacy of gestrinone combined with leuprolide in the treatment of endometriosis(EMs)and its effects on sex hormones,inflammatory indicators and peripheral blood carbohydrate antigen 125(CA125),endometrial antibody(EMAb)and anti-Müllerian hormone(AMH).Methods 120 patients with EMs admitted to our hospital from November 2019 to November 2022 were selected.All patients were divided into control group and study group according to the random number table method,with 60 cases in each group.Control group was treated with gestrinone,and study group was additionally given leuprolide on the basis of control group.The clinical efficacy after 6 months of treatment,sex hormones indicators[estradiol(E2),luteinizing hor-mone(LH),follicle stimulating hormone(FSH)],inflammatory indicators[interleukin-6(IL-6),IL-8,tumor necrosis factor α(TNF-α),hypersensitivity C-reactive protein(hs-CRP)]and serum-related indicators(CA125,EMAb,AMH)before treatment and after 6 months of treatment were compared between the two groups,and the occurrence of adverse drug reactions during medication.Results After 6 months of treatment,the total effective rate of treatment in study group was significantly higher than that in control group(91.67%vs.76.67%)(P<0.05).After 6 months of treatment,the levels of E2,LH,FSH,IL-6,IL-8,TNF-α,hs-CRP,CA125 and EMAb in the two groups were significantly decreased compared with those before treatment while the level of AMH was increased(P<0.05),and the above indexes in study group were significantly different from those in control group during the same period(P<0.05).During 6 months of medication,there were no differences in the incidence rates of adverse drug reactions between the two groups(P>0.05).Conclusion Gestrinone combined with leupro-lide has a significant effect in the treatment of patients with endometriosis,and it can significantly improve the endocrine,relieve inflammatory response and improve serum-related indicators,and it has high safety and good application value.

Abstract:Objective To investigate the application effect of graded intervention based on Rockall risk score in patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods A total of 218 patients with ANVUGIB admitted to the hospital between January 2021 and January 2025 were selected,and randomly assigned to the study group(n=110)and the control group(n=108).The control group received conventional treatment and intervention measures.On this basis,the study group was given graded intervention based on Rockall risk score.Comparisons were made between the two groups on rebleeding rates under different Rockall risk levels,hemoglobin(Hb)levels,platelet count(PLT),clinical symptom improvement time,ANVUGIB self-management scores,Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores,and clinical outcomes.Results After intervention,the rebleeding rates of patients at intermediate Rockall risk and high risk in the study group(12.90%and 17.65%)were lower than those in the control group(28.57%and 53.85%)(P<0.05).The total rebleeding rate in the study group(10.00%)was lower than that in the control group(25.93%)(P<0.05).After 1 week and 1 month of intervention,Hb levels and PLT in the study group were higher than those in the control group(P<0.05).The time to stopping bleeding,hematemesis or melena disappearing,blood pressure returning to normal,and heart rate returning to normal was shorter in the study group than in the control group(P<0.05).After 1 week and 1 month of intervention,ANVUGIB self-management scores of the study group were higher than those of the control group.The SAS and SDS scores were lower than those of the control group(P<0.05).The blood transfusion rate and complication rate during hospitalization were comparable between the two groups of patients(P>0.05).Hospital stay of the study group was shorter than that of the control group(P<0.05).Conclusion Graded intervention based on Rockall risk score can improve bleeding symptoms,reduce rebleeding rate,enhance self-management ability,alleviate anxiety,and improve clinical outcomes in patients with ANVUGIB.

Abstract:Objective To explore the role of circ_0001126 in homocysteine(Hcy)-induced ferroptosis of Mouse Podocyte Cell line-5(MPC-5)cells.Methods MPC-5 cells were cultured in vitro and divided into a control group(0 µmol/L Hcy)and an Hcy group(80 µmol/L Hcy).After 48 hours of cell intervention,the expressions of glutathione peroxidase 4(GPX4)and solute carrier family 7 member 11(SLC7A11)proteins were detected by Western blot.The levels of malondialdehyde(MDA)and glutathione(GSH)were measured using a kit,and the level of Fe²⁺ was observed using a fluorescence assay kit.High-throughput sequencing was employed to screen specific circular RNA(circRNA)in podocytes from the control group and the Hcy group,and quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used for validation.Bioinformatics was used to predict chromosome location and conservation.After transfection with si-circ_0001126 and its negative control(si-NC),the expressions of GPX4 and SLC7A11 proteins and their mRNAs were detected by Western blot and qRT-PCR,respectively.The intracellular MDA level was measured by a malondialdehyde assay kit,the intracellular GSH level was measured by a GSH assay kit,and the intracellular Fe²⁺ level was observed by a fluorescence assay kit.Results Compared with the Control group,the Hcy group exhibited a significant decrease in the expression of ferroptosis related proteins GPX4 and SLC7A11(P<0.001),a notable increase in the expression levels of Fe2+and MDA(P<0.001),and a marked decrease in GSH levels(P<0.001);High throughput sequencing revealed a total of 12 circRNAs with differential expression in the Hcy group,including 8 up-regulated and 4 down-regulated.Based on|log2foldchange|(≥2)and P value(P<0.05),circ_0001126 was screened out,and qRT-PCR was used to verify its upregulation in the Hcy group,which is consistent with the sequencing results(P<0.001).Analysis using the UCSC Genome Browser Gateway and circbase showed that circ_0001126 is primarily located at chr3:51659420-51660998,formed by the cyclization of the second exon of the Maml3 gene and is highly conserved.Transfection of si-circRNAs demonstrated that si-circ_0001126-309 had the optimal interference efficiency(P<0.001).Compared with the Hcy+si-NC group,the Hcy+si-circ_0001126 group showed a significant increase in the expression of ferroptosis-related proteins GPX4 and SLC7A11(P<0.001),a notable decrease in Fe2+and MDA expression levels(P<0.001),and an marked increase in GSH levels(P<0.001).Conclusion circ_0001126 shows a significant up-regulation in MPC-5 cells treated with Hcy,and down-regulating its expression can inhibit Hcy-induced ferroptosis in MPC-5 cells.

Abstract:Objective To investigate the expression correlation of PD-L1 and Her-2 in invasive urothelial carcinoma(IUC)and their impact on patient prognosis,providing a basis for precise stratified treatment and prog-nostic evaluation.Methods A total of 60 IUC patients were included from May 2021 to May 2024.Immunohisto-chemistry was used to detect the expression levels of Her-2 and PD-L1 in tumor tissues.The correlation between their expressions and clinicopathological parameters(tumor differentiation grade,TNM stage,lymph node metastasis,etc.)was analyzed.Kaplan-Meier method and Log-rank test were used to compare progression-free survival(PFS)and overall survival(OS)among patients with different expression statuses.Cox proportional hazard regression model was applied to identify independent prognostic risk factors.Additionally,the diagnostic efficacy of combined Her-2 and PD-L1 detection for poor prognosis was evaluated.Results The positive rate of Her-2 was 38.33%(23/60),and the high expression rate of PD-L1 was 41.67%(25/60).Both expressions were positively correlated with low tumor differentiation(r=0.360/0.280,P<0.05)and clinical stage Ⅲ—Ⅳ(r=0.395/0.325,P<0.05).Multi-variate analysis revealed that Her-2 positivity(HR=1.878,P=0.042)and high PD-L1 expression(HR=1.822,P=0.039)were independent risk factors for poor prognosis.The AUC of combined Her-2 and PD-L1 detection was 0.830(P<0.001),with a sensitivity of 82.14%and specificity of 81.25%,which was significantly better than single indicators(P<0.05).Conclusions Her-2 positivity and high PD-L1 expression are independent risk factors for tumor progression and poor prognosis in IUC patients.Combined detection of the two can improve the efficacy of prognostic evaluation and provide a new biomarker combination for precise stratified treatment of IUC.

Abstract:Objective To investigate the value of acupuncture therapy in restoring immune homeostasis,reducing the levels of inflammatory markers,and improving the activities of daily living in patients recovering from ischemic stroke.Methods This research is a single-center,randomized controlled clinical trial.A total of 100 patients with ischemic stroke who were undergoing rehabilitation between August 2023 and January 2025 were enrolled.By using a random number table,the participants were randomly allocated to either a rehabilitation control group(n=50),which received integrated Chinese-Western rehabilitation therapy,or an acupuncture experimental group(n=50),which received acupuncture in addition to the standard integrated rehabilitation.The immune parameters(T,B,NK cell counts and CD4+/CD8+ratio),inflammatory markers,Barthel Index(BI),and Fugl-Meyer Assessment(FMA)scores were compared before and after treatment.A cohort of 50 healthy individuals served as the healthy control group for assessing the baseline immune and inflammatory status.Results At baseline,the patient groups exhibited significant immune dysregulation when compared to the healthy control group.This was manifested by lower counts of total T cells,CD4+cells,and CD8+cells,as well as higher levels of B cells and NK cells(P<0.05).After the intervention,the acupuncture experimental group demonstrated a substantial increase in total T cells,CD4+cells,and the CD4+/CD8+ratio.Moreover,there was a more marked reduction in B and NK cell levels in the acupuncture experimental group compared to the rehabilitation control group.Inflammatory markers decreased in both groups after treatment,but the reduction amplitude was significantly greater in the acupuncture experimental group.Similarly,although both groups exhibited enhanced BI and FMA scores before and after treatments,the improvements were statistically more significant in the acupuncture experimental group(P<0.05).The acupuncture group showed significantly higher overall therapeutic efficacy compared to the rehabilitation control group,with overall therapeutic efficacy rates of 96.0%and 72.0%,respectively(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Adjunctive acupuncture significantly promotes immune rebalancing,alleviates inflammation,and enhances functional independence in rehabilitation patients with ischemic stroke.

Abstract:Objective To investigate the relationship between serum long non-coding RNA tumor necrosis factor related heterologous ribonucleoprotein L(lncRNA THRIL)and long non-coding RNA nuclear enriched abundant transcript 1(lncRNA NEAT1)and the severity and prognosis of neonatal pneumonia.Methods A total of 120 cases of neonatal pneumonia treated at the Fourth Hospital of Hebei Medical University from August 2022 to August 2024 were selected as the observation group.These cases were divided into the mild-disease group(42 cases),the moderate-disease group(40 cases),and the severe-disease group(38 cases)based on the severity of the disease.According to the prognosis after 2 weeks of treatment,the pediatric patients were classified into the good-prognosis group(86 cases)and the poor-prognosis group(34 cases).Meanwhile,120 healthy neonates who underwent physical examinations at the hospital during the same period were selected as the control group.The serum levels of lncRNA THRIL and lncRNA NEAT1 in the tested neonates were measured using real-time fluores-cence quantitative polymerase chain reaction(PCR).The clinical data of neonates with pneumonia were collected,and the immune inflammatory markers,namely soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and soluble interleukin-2 receptor(sIL-2R),were detected.Logistic regression analysis was employed to identify and verify the influencing factors associated with poor prognosis in neonates with pneumonia.Considering the predictive effect of serum lncRNA THRIL and lncRNA NEAT1 on the poor prognosis of these children,receiver operating characteristic(ROC)curve analysis was conducted to evaluate the clinical value of each lncRNA individually and their combined value.Results The serum levels of lncRNA THRIL and lncRNA NEAT1 in the observation group were significantly higher than those in the control group(P<0.05).The serum levels of lncRNA THRIL and lncRNA NEAT1 gradually increased as neonatal pneumonia worsened(P<0.05).When compared with the good-prognosis group,the proportion of cesarean section and the levels of serum sTREM-1,sIL-2R,lncRNA THRIL,and lncRNA NEAT1 in the poor-prognosis group were significantly elevated(P<0.05).Serum sIL-2R,lncRNA THRIL,and lncRNA NEAT1 were identified as independent risk factors for poor prognosis in neonates with pneumonia(P<0.05).The area under the curve(AUC)values of serum lncRNA THRIL,lncRNA NEAT1,and their combination in predicting the poor prognosis of neonatal pneumonia were 0.772,0.808,and 0.930,respectively.Moreover,the AUC of the combination of the two was significantly higher than that of each index alone(Zcombination-lncRNA THRIL=2.347,Zcombination-lncRNA NEAT1=2.217,P=0.019,0.027).Conclusion Serum levels of lncRNA THRIL and lncRNA NEAT1 are significantly elevated in neonates with pneumonia.Both lncRNA THRIL and lncRNA NEAT1 serve as risk factors for the poor prognosis of neonatal pneumonia,and their combination exhibits a favorable predictive effect on the prognosis of neonates with pneumonia.

Abstract:Objective To elucidate the mechanism by which tauroursodeoxycholic acid(TUDCA)alleviates oxygen-glucose deprivation(OGD)-induced cardiomyocyte injury through specific regulation of TBC1D15 protein expression and subcellular localization to restore mitophagy function.Methods Primary cardiomyocytes were subjected to OGD and treated with TUDCA at low(20 μmol/L),medium(40 μmol/L),or high(80 μmol/L)doses.TBC1D15 subcellular localization and expression were assessed by immunofluorescence.Cell apoptosis/necrosis was evaluated using YO-PRO-1/PI double staining.Lysosome staining is used to detect lysosome function.Autophagy dual-labeling adenovirus HBAD-mcherry-EGFP-LC3 is used to detect the efficiency of autophagy flow.Western blot was performed to analyze autophagy-related proteins(Beclin-1,LC3-Ⅱ/Ⅰ,p62)and the anti-apoptotic protein Bcl-2.Results Compared with the normal control group,the model group showed a significant decrease in TBC1D15 expression and disordered distribution.After TUDCA intervention,the expression of TBC1D15 was restored in a dose-dependent manner.In the high-dose group,the fluorescence intensity was close to that of the normal control group,and the localization at the cell membrane was significantly enhanced.Regarding autophagy-related indicators,the medium-and high-dose TUDCA groups significantly promoted autophagy activation,which was manifested as an increase in the LC3-Ⅱ/Ⅰ ratio,accelerated degradation of p62,and increased expression of Beclin-1.The results of cell apoptosis/necrosis detection showed that cell apoptosis/necrosis was significantly increased in the model group,while it was significantly alleviated after TUDCA intervention.Meanwhile,the expression of the anti-apoptotic protein Bcl-2 was up-regulated,and this ameliorative effect was most significant in the high-dose group.Conclusion TUDCA restores TBC1D15 membrane localization in a dose-dependent manner,subsequently activating the mitophagy pathway,and ultimately synergistically inhibits apoptosis/necrosis.

Abstract:Objective To identify risk factors associated with renal impairment in early-onset type 2 diabe-tes mellitus(EOT2DM)through a multidimensional assessment,so as to provide a scientific basis for establishing an early warning system and optimizing clinical intervention strategies.Methods This retrospective study recruited 541 patients diagnosed with EOT2DM who were admitted to the Department of Endocrinology at the Jiangsu Provincial Hospital of Traditional Chinese Medicine from August 2024 to August 2025.The participants were stratified into two groups according to the presence of abnormal renal impairment indicators:an EOT2DM group with renal impair-ment(n=241)and an EOT2DM group without renal impairment(n=300).Clinical data were collected and underwent univariate analysis.Variables with a P-value<0.05 in the univariate analysis,as well as variables with established clinical significance according to previous literature(even if P≥0.05),were included in a least absolute shrinkage and selection operator(LASSO)logistic regression model to remove redundant variables.Subsequently,multivariate logistic regression analysis was carried out.The optimal cut-off values for significant continuous variables were identified by calculating the Youden's index.Based on these cut-offs,continuous variables were dichotomized into high-risk(≥cutoff)and low-risk(<cutoff)groups.After covariance adjustment,the adjusted odds ratios(ORs)and their 95%confidence intervals(CIs)were computed to accurately quantify the independent association between the level of each risk variable and the risk of renal impairment in EOT2DM.Receiver Operating Character-istic(ROC)curves were drawn,and the discriminatory ability of each risk factor was evaluated by the area under the ROC curve.Results Multivariate logistic regression analysis has identified six risk factors:sTM(OR=1.789,AUC=0.702),TG(OR=2.647,AUC=0.602),UA(OR=1.693,AUC=0.637),LDL-C(OR=1.942,AUC=0.562),WHR(OR=2.364,AUC=0.566),and carotid plaque(OR=1.872,AUC=0.607).After further refining the strength of the association by using cutoff values,the following four risk factors were determined:sTM,TG,WHR,and carotid plaque.Conclusions Elevated sTM,TG,WHR,and the presence of carotid plaque are independent risk factors for renal impairment in patients with EOT2DM.Among these,sTM demonstrated superior accuracy for renal impairment in EOT2DM and may be more suitable as a clinical assessment tool.

Abstract:Objective To investigate the impact of angiography-guided puncture on the initial success rates of arteriovenous fistula(AVF)punctures in hemodialysis patients and provide clinical evidence to enhance surgical outcomes.Methods A total of 98 hemodialysis patients who underwent AVF puncture at our hospital from September 2024 to August 2025 were randomly divided into the control group and the experimental group(49 cases in each group)using the randomized digital table method.The control group received conventional puncture techniques combined with health education,whereas the experimental group underwent angiography-guided punc-ture.A comparative analysis was carried out on the single-puncture success rates,complication incidence,pain scores,and dialysis adequacy between the two groups.Results The experimental group attained a single-puncture success rate of 95.92%,which was significantly higher than the 79.59%success rate of the control group(P<0.05).The total complication rate(including hematoma,oozing,and infection)in the experimental group was 10.20%,notably lower than the 30.61%rate of the control group(P<0.05).The average visual analog scores(VAS)in the experimental group were(2.1±0.8)points,significantly lower than the(3.8±1.2)points of the control group(P<0.05).The urea clearance index(Kt/V)in the experimental group reached(1.45±0.15),considerably higher than the(1.32±0.18)index of the control group(P<0.05).Conclusion Angiography-guided puncture exhibits remarkable advantages in enhancing the initial success rates of AVF puncture,minimizing complications,relieving patient pain,and improving dialysis adequacy,rendering it suitable for extensive clinical application.

Abstract:Objective To compare the oncological and functional outcomes between preserving the left colic artery(LCA)and high ligation of the inferior mesenteric artery(IMA)during laparoscopic D3 lymph node dissection for rectal cancer.Methods A total of 162 patients with rectal cancer who received surgical treatment in our hospital from July 2021 to February 2024 were selected.These patients were randomly assigned by computer randomization to the low-position group(preservation of the left colic artery(LCA)with low-position ligation com-bined with D3 lymph node dissection)and the high-position group(adopted the dassic total mesovectal excision for rectal cancer,and the inferior mesenteric artery was ligated at a high level),with 81 cases in each group.Surgical parameters,postoperative complications,tumor markers,and postoperative survival were compared between the two groups.Results The low-position group exhibited a longer operative time and a longer duration for lymph node dissection at the IMA root when compared to the high-position group(P<0.05).However,it required splenic flexure mobilization less frequently(P<0.05).Postoperatively,the serum levels of carcinoembryonic anti-gen(CEA),carbohydrate antigen 19-9(CA19-9),and carbohydrate antigen 125(CA125)decreased in both groups(P<0.05).In the postoperative period,both the low-position and high-position groups showed increases in LARS(low anterior resection syndrome)and residual urine volume(P<0.05),as well as decreases in single voided volume,maximum urinary flow rate,FSFI score,IIEF-5 score,resting anal pressure,and maximum anal sphincter pressure(P<0.05).The low-position group had lower LARS scores and residual urine volume than the high-position group(P<0.05),whereas the low-position group had higher resting anal pressure and maximum anal sphincter pressure than the high-position group(P<0.05).A comparative analysis between the two cohorts re-vealed that the incidence of anastomotic leakage was significantly lower in the low-position cohort than in the high-position cohort(P<0.05).During the 1-year follow-up,no deaths occurred in either group.The low-position group had 9 cases of local recurrence(11.11%)and 2 cases of distant metastasis(2.47%),while the high-position group had 5 cases of local recurrence(6.17%)and 2 cases of distant metastasis(2.47%).There was no statistically significant difference in progression-free survival between the two groups(P>0.05).Conclusion Under standardized D3 lymph node dissection,preserving the LCA yields oncological outcomes equivalent to those achieved by high IMA ligation.Meanwhile,it offers significant advantages in reducing the risk of anastomotic leakage and better preserving early postoperative defecation and urinary function.

Abstract:Objective To evaluate the accuracy of a backpropagation neural network(BPNN)model incorporating clinical and imaging features in predicting axillary lymph node burden among breast cancer patients with one to two positive sentinel lymph nodes.Methods We retrospectively analyzed clinical and imaging data from 386 female breast cancer patients who underwent axillary lymph node dissection at three medical centers between January 2021 and December 2024.Based on pathological findings,patients were categorized into a high axillary lymph node burden group(n=155)and a low burden group(n=231).Data from Center 1 and Center 2(Affiliated Hospital of Guangdong Medical University and Affiliated Yangjiang Hospital of Guangdong Medical University;n=295)were randomly divided into a training set(n=207)and an internal validation set(n=88),while data from Center 3(Second Affiliated Hospital of Guangdong Medical University;n=91)served as the exter-nal validation cohort.Univariate and multivariate logistic regression analyses were conducted in the training cohort to identify independent risk factors.Four machine learning algorithms,including logistic regression,support vector machine(SVM),random forest and BPNN were then used to construct predictive models,which were subse-quently evaluated in the internal and external validation cohorts.The Shapley additive explanation(SHAP)method was applied to assess and visualize feature importance.Results Univariate and multivariate logistic regression analyses identified the neutrophil-to-lymphocyte ratio(NLR),peritumoral edema,and axillary lymph node corti-cal thickening as independent predictors of nodal burden.The BPNN-based model demonstrated superior predictive performance,achieving an area under the receiver operating characteristic curve(AUC)of 0.793.SHAP analysis revealed that peritumoral edema contributed most significantly to model predictions,followed by lymph node cortical thickening and NLR.Conclusions An interpretable BPNN model integrating clinical and imaging characteristics provides reliable prediction of axillary lymph node burden in breast cancer patients.This approach offers valuable support for axillary management and personalized treatment planning.

Abstract:Objective To explore the association between serum omentin-1 and chemerin levels and the risk of major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease(CHD).Methods A total of 313 elderly patients with coronary heart disease(CHD)admitted to the Department of Cardi-ology,Tangshan Workers'Hospital between January 2023 and January 2025 were recruited as study subjects.After excluding 13 patients who were lost to follow-up,300 patients were ultimately included in the study.The patients were then classified into the major adverse cardiovascular events(MACE)group and the non-MACE group accord-ing to the occurrence of MACE.Baseline data,clinical data,and serum levels of omentin-1 and chemerin in the two groups were statistically analyzed.Spearman correlation analysis was employed to investigate the association between serum omentin-1 and chemerin levels and the risk of MACE in elderly CHD patients.LASSO regression and multivariate logistic regression were utilized to identify the risk factors for MACE in elderly CHD patients.Based on the results of multivariate logistic regression analysis,a nomogram prediction model was developed and internally validated using the calibration curve and receiver operating characteristic(ROC)curve.The clinical utility of the model was assessed through decision curve analysis.Results During the follow-up period,97 patients(32.33%)experienced Major Adverse Cardiovascular Events(MACE)(MACE group),whereas the remaining 203 patients(67.67%)did not(non-MACE group).The MACE group exhibited lower serum omentin-1 levels and higher chemerin levels compared to the non-MACE group(P<0.05).The results of Spearman correlation analysis indicated that the occurrence of MACE was negatively correlated with the serum omentin-1 level(r=-0.637,P<0.001)and positively correlated with the serum chemerin level(r=0.552,P<0.001)among elderly patients with Coronary Heart Disease(CHD).Multivariate logistic regression analysis demonstrated that omentin-1(95%CI:0.992～0.997),chemerin(95%CI:1.012～1.058),Gensini score(95%CI:1.012～1.165),C-reactive protein(CRP)(95%CI:1.711～3.627),and Left Ventricular Ejection Fraction(LVEF)(95%CI:0.756～0.895)were influencing factors for MACE in elderly CHD patients(P<0.05).ROC curve analysis revealed that the areas under the curve(AUCs)of omentin-1 and chemerin for predicting MACE in elderly CHD patients were 0.893(95%CI:0.852～0.926)and 0.841(95%CI:0.794～0.880),respectively.The AUC of the nomogram model constructed based on the results of multivariate logistic regression analysis for predicting MACE in elderly CHD patients was 0.979(95%CI:0.956～0.992).The calibration curve showed a good agreement between the predicted curve and the ideal curve,suggesting good model calibration.Decision curve analysis indicated that when the risk threshold probability ranged from 0.01 to 0.99,the model could yield better clinical benefits.Conclusions Omentin-1 and chemerin are intricately associated with the occurrence of Major Adverse Cardiovascular Events(MACE)in elderly patients with Coronary Heart Disease(CHD)and possess excellent predictive value.The nomogram model constructed based on indicators such as omentin-1 and chemerin exhibits superior predictive performance and can offer a reference for the clinical assessment of the risk of MACE in elderly patients with CHD.

Abstract:Objective To explore the value of left ventricular contrast echocardiography and three-dimensional echocardiography Heart Model(3D-HM)parameters in predicting major adverse cardiovascular events(MACE)in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 197 patients with coronary heart disease,diagnosed by coronary angiography and treated with PCI in the Department of Cardiology of the First Hospital of Changsha from June 2023 to December 2024,were selected.Meanwhile,104 healthy volunteers during the same period were also recruited.The general data,3D-HM param-eters[left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF)],and myocardial contrast echocardiography(MCE)parameters[platform peak intensity(A),curve slope(β),myocardial blood flow(A×β),perfusion score index(PSI)]at the time of admission were compared between the two groups.All patients were followed up for 6 months after PCI.The occurrence of MACE after PCI in patients with coronary heart disease was recorded.Subsequently,the patients were divided into the MACE group(26 cases)and the non-MACE group(171 cases).The general data,3D-HM parameters,and MCE parameters before PCI and at 1 week,3 months,and 6 months after PCI were compared between the two groups of patients.The risk factors for the occurrence of MACE after PCI in patients with coronary heart disease and the predictive value of left ventricular contrast echocardiography and 3D-HM parameters for MACE after PCI in patients with coronary heart disease were evaluated by multivariate logistic regression analysis and receiver operat-ing characteristic curve(ROC),respectively.Results Compared with healthy volunteers,the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and pressure-strain index(PSI)of patients with coronary heart disease were higher,whereas the left ventricular ejection fraction(LVEF),A,β,and A×β were lower(P<0.05).The proportion of patients with fewer than 4 viable myocardial segments in the major adverse cardiovascular event(MACE)group was higher than that in the non-MACE group(P<0.05).When compared with the same group before surgery,in the two groups of patients with coronary heart disease,the LVEDV,LVESV,and PSI at 1 week,3 months,and 6 months after surgery gradually decreased,reaching the lowest levels at 6 months after surgery.Meanwhile,the LVEF,A,β,and A×β gradually increased,reaching the highest levels at 6 months after surgery(P<0.05).Compared with the non-MACE group,the LVEDV,LVESV,and PSI of patients in the MACE group were higher at 1 week,3 months,and 6 months after surgery,while the LVEF,A,β,and A×β were lower(P<0.05).Multivariate analysis indicated that a high level of PSI at 1 week after percutaneous coronary intervention(PCI)(OR=2.351)was a risk factor for MACE in patients with coronary heart disease after PCI.In contrast,high levels of LVEF(OR=0.381),A(OR=0.500),β(OR=0.521),and A×β(OR=0.538)at 1 week after PCI were protective factors(P<0.05).The results of receiver operating characteristic(ROC)analysis demonstrated that the area under the curve(AUC)of the combi-nation of LVEF,A,β,A×β,and PSI in predicting MACE in patients with coronary heart disease after PCI was 0.891,which was greater than that of LVEF(0.647),A(0.697),β(0.676),A×β(0.681),or PSI(0.709)(P<0.05).Conclusions Left ventricular contrast echocardiography and 3D-HM parameters(LVEF,A,β,A×β,PSI)are strongly associated with the occurrence of major adverse cardiovascular events(MACE)after per-cutaneous coronary intervention(PCI)in patients with coronary heart disease.The combination of left ventricular contrast echocardiography and 3D-HM parameters exhibits high predictive efficiency for the clinical prognosis of these patients.

Abstract:Objective The aim of this study was to investigate the effects and mechanisms of bone marrow mesenchymal stem cell exosomes on the mouse asthma models.Methods C57/6J mice were divided into control group,model group,exosome(5,10,and 20 μg),and exosome(20 μg)+RS09 TFA group.After administra-tion of the respective treatment,airway resistance was measured in each group of mice.Hematoxylin and eosin(HE)staining was used to detect airway damage in mice.Enzyme-linked immunosorbent assay(ELISA)was applied to detect the concentrations of inflammatory factors interleukin-4(IL-4),interleukin-5(IL-5),and inter-leukin-13(IL-13)in the alveolar fluid of mice.The colorimetric method was used to determine the concentrations of malondialdehyde(MDA),catalase(CAT),and superoxide dismutase(SOD)in the alveolar fluid.Western blot was used to detect the expression of Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor κB(NF-κB)in the lung tissues of mice.Results Compared with the model group,the airway resistance in the exosome 5,10,20 μg groups decreased significantly(P<0.05);the concentrations of IL-4,IL-5,IL-13,and MDA in the alveolar fluid of mice decreased significantly(P<0.05);while the concentrations of CAT and SOD increased significantly(P<0.05);additionally,the expression of TLR4,MyD88,and NF-κB were all significantly downregulated(P<0.05).Compared with the exosome 20 μg group,the airway resistance in the exosome 20 μg+RS09 TFA group increased significantly(P<0.05),the concentrations of IL-4,IL-5,IL-13,and MDA in the alveolar fluid of mice increased significantly(P<0.05),while the concentrations of CAT and SOD decreased significantly(P<0.05),the expression of TLR4,MyD88,and NF-κB were all significantly upregulated(P<0.05).Conclusion Bone marrow mesenchymal stem cell exosomes can alleviate mouse asthma by inhibiting the TLR4/MyD88/NF-κB signaling pathway.

Abstract:Objective To investigate the effect of the frequency of Foley balloon placement after hystero-scopic transcervical resection of adhesion(TCRA)on re-adhesion in patients with severe intrauterine adhesions(IUA).Methods The clinical data of 128 patients with severe IUA who underwent TCRA at the hospital from January 2022 to January 2025 were reviewed.According to the number of Foley balloon insertions after surgery,they were divided into a control group(single insertion,n=68)and an observation group(two insertions,n=60).The clinical efficacy,IUA scores before and after treatment,menstrual changes,postoperative re-adhesion,and pregnancy status were compared between the two groups.Results The total effective rate reached 90.00%(54/60)in the observation group,which was higher than 76.47%(52/68)in the control group(P<0.05).After treatment,the American Fertility Society(AFS)Score of the observation group(3.12±1.06)was lower than that of the control group(4.35±1.21).The improvement value of IUA score(6.70±1.57)was higher than that of the control group(5.26±1.62)(P<0.05).After treatment,menstrual blood volume of the observation group[(40.22±3.91)mL]was larger than that of the control group[(37.39±4.10)mL],and menstrual period[(5.06±1.12)d]was longer than that of the control group[(4.41±1.20)d](P<0.05).There was a statistically significant difference in the incidence of re-adhesion between the two groups(15.00%vs.32.35%,P>0.05).Conclusion The placement of Foley balloons twice after TCRA surgery in patients with severe IUA can effectively alleviate the degree of IUA,increase menstrual flow,improve menstruation,and reduce the risk of re adhesion.It is worthy of clinical research.