Abstract:Objective To explore the risk factors for failure in unilateral upper ureteral calculi treated with ureteroscopic holmium laser lithotripsy.Methods Totally 852 patients with upper ureteral calculi treated by rigid ureteroscopy holmium laser lithotripsy were retrospectively chosen in Inner Mongolia People's Hospital from January 2012 to September 2021 were enrolled,including 72 cases with lithotripsy failure evaluated a week after operation(lithotripsy failure group),and other patients with lithotripsy success(lithotripsy successful group).The clinical characteristics were analyzed and the independent risk factors of lithotripsy failure were evaluated by multivariate Logistic regression methods.Results The proportions of stones located on the left side,multiple stones,difficulty in entering the endoscope and stone dwell time ≥ 6 weeks in the lithotripsy failure group were higher than those in the lithotripsy successful group;the CT value of stones and stone dwell time≥2 weeks in the lithotripsy failure group were lower than those in the lithotripsy successful group(all P＜0.05).The multivariate Logistic regression analysis showed that difficulty in ureteroscopy was an independent risk factor for the failure of ureteroscopic holmium laser lithotripsy(odds radio=2.64,95％confidence interval:1.75-3.64,P=0.02).Conclusion The success rate of ureteroscopic holmium laser lithotripsy for the treatment of unilateral upper ureteral stones is high,and difficulty in entering the ureteroscope is an independent risk factor for lithotripsy failure.

Abstract:Objective To investigate the expression of glucose transporter 1(GLUT1)and topoisomerase Ⅱ A(TOP2A)in adrenal pheochromocytoma(PPGL)and their correlation with clinical features and prognosis.Methods A total of 120 cases of PPGL tissues that underwent surgical resection in Xinjiang Uygur Autonomous Region People's Hospital from March 2014 to June 2020 were selected as the experimental group.The adrenal tissues of 100 cases of non-functional adrenal adenoma who underwent surgical resection during the same period were collected as control group.Immunohistochemical staining was used to detect the expression of GLUT1 and TOP2A in tissues.Cox regression was used to analyze the prognostic factors of PPGL patients.Results The low expression rate of GLUT1 and the high expression rate of TOP2A in the experimental group were higher than those in the control group[51.7％(62/120)vs 14.0％(14/100),52.5％(63/120)vs 19.0％(19/100)](x2=34.225,31.829,both P＜0.001).The expression levels of GLUT1 and TOP2A were correlated with histological infiltration and Ki-67(both P＜0.05).The proportions of GLUT1 high expression and TOP2A low expression in the good prognosis group were higher than those in the poor prognosis group(both P＜0.001).Univariate analysis showed that histological infiltration,Ki-67,GLUT1 and TOP2A were prognostic factors(all P＜0.001).Cox multivariate regression analysis showed that TOP2A,histological infiltration and Ki-67 were all risk factors for poor prognosis of PPGL patients,and GLUT1 was a protective factor(all P＜0.001).Conlusion GLUT1 is low expression and TOP2A is high expression in PPGL tissues,which is related to poor prognosis of PPGL patients.

Abstract:Objective To investigate the predictive value of serum proprotein convertase subtilisin/kexin type 9(PCSK9)and lipopolysaccharide(LPS)for cardiovascular and cerebrovascular disease mortality in elderly patients with non-valvular atrial fibrillation(NVAF).Methods A total of 575 elderly patients with NVAF admitted to Haikou People's Hospital,Hainan Province from October 2016 to December 2020 were selected and followed up for 3 years.They were divided into death group(74 cases)and survival group(501 cases)according to whether they died of cardiovascular and cerebrovascular diseases.The serum levels of PCSK9 and LPS were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the risk factors for cardio-vascular and cerebrovascular disease mortality in elderly NVAF patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PCSK9 and LPS levels for cardiovascular and cerebrovascular disease mortality in elderly NVAF patients.Results After 3 years of follow-up,the cardiovascular and cerebro-vascular disease mortality of 575 elderly NVAF patients was 12.9％(74/575).The serum levels of PCSK9 and LPS in the death group were higher than those in the survival group(all P＜0.001).Multivariate Logistic regres-sion analysis showed that increasing age,increased CHA2DS2-VASc score,acute myocardial infarction,stroke/transient ischemic attack,increased heart failure,increased PCSK9,and increased LPS were the independent risk factors for cardiovascular and cerebrovascular disease death in elderly NVAF patients(all P＜0.05).The ROC curve showed that the area under the curve of serum PCSK9 and LPS levels combined to predict the death of cardio-vascular and cerebrovascular disease in elderly NVAF patients was 0.873,which was larger than 0.781 and 0.795 predicted by serum PCSK9 and LPS levels alone(both P＜0.001).Conclusion Elevated serum PCSK9 and LPS levels are independent risk factors for cardiovascular death in elderly patients with NVAF,and the combination of serum PCSK9 and LPS levels has a high predictive value for cardiovascular death in elderly patients with NVAF.

Abstract:Objective To investigate the expression and clinical significance of multidrug resistance protein 4(MRP4)in serum of patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH).Methods A total of 150 COPD patients hospitalized in Guizhou Provincial People's Hospital from February 13,2023 to February 13,2024 were selected.According to the results of echocardiography,COPD patients were divided into COPD group(50 cases)and COPD combined with PH group(COPD+PH group,100 cases).In addition,50 healthy subjects in the same period were selected as the control group.According to pulmonary artery systolic pressure(PASP),the COPD+PH group was divided into mild group(36 mmHg≤PASP≤50 mmHg),moderate group(51 mmHg≤PASP≤70 mmHg)and severe group(PASP＞70 mmHg).MRP4,pulmonary function,blood gas analysis,red cell volume distribution width(RDW),mean platelet volume(MPV),brain natriuretic peptide(BNP)and albumin levels were measured.Pearson correlation model was used for correlation analysis.The receiver operating characteristic(ROC)curve was used to evaluate the value of MRP4 in predicting COPD combined with PH.Results The level of MRP4 in COPD group was lower than that in control group,while the level of MRP4 in COPD+PH group was higher than that in control group and COPD group(both P＜0.05).The level of albumin in COPD+PH group was lower than that in COPD group,and the levels of RDW,MPV and BNP were higher than those in COPD group(all P＜0.05).The levels of MRP4,RDW,MPV and BNP in moderate group and severe group were higher than those in mild group,and those in severe group were higher than those in moderate group;the albumin level was lower in the mild group than in the severe group,and that in the severe group was lower than that in the moderate group(all P＜0.05).The level of MRP4 in COPD+PH group was positively correlated with BNP,PASP,RDW and MPV(r=0.72,0.85,0.70,0.62,all P＜0.01),and negatively correlated with albumin(r=-0.60,P＜0.01).ROC curve analysis showed that when the cut-off value of MRP4 was 2.895 μg/L,the area under the curve for predicting COPD combined with PH was 0.917(95％confidence interval:0.865-0.970),the sensitivity was 93.00％,and the specificity was 88.00％.Conclusion MRP4 is highly expressed in serum of patients with COPD complicated with PH,which may be a potential biomarker.

Abstract:Objective To investigate the clinical effect of phloroglucinol combined with somatostatin in the treatment of acute pancreatitis(AP).Methods Forty patients with AP who received treatment with combination therapy of phloroglucinol and somatostatin at the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2020 to November 2023 were included as the combination group,while 40 AP patients treated with somatostatin during the same period were included as the control group.Patients'data were collected for retrospective analysis.The clinical efficacy,clinical symptom relief time,the recovery time of blood amylase,inflammatory factors and blood amylase levels before and after treatment,adverse reaction incidence and mortality rate were compared between the two groups.Results The total effective rate of the combined group was higher than that of the control group[95.0％(38/40)vs 82.5％(33/40)],and the difference was statistically significant(x2=-3.181,P=0.001).The relief time of abdominal pain,nausea and vomiting,peritoneal irritation sign,and the recovery time of blood amylase in the combination group were shorter than those in the control group[4.00(2.00,4.25)d vs 6.00(5.00,7.00)d,4.00(2.00,5.00)d vs 6.00(5.00,7.00)d,2.00(2.00,3.00)d vs 4.00(3.00,5.00)d,4.00(2.00,6.00)d vs 6.00(2.75,9.00)d],and the differences were statistically significant(all P＜0.05).After treatment,the levels of tumor necrosis factor-α,interleukin-6,C-reactive protein,and blood amylase in two groups were all lower than before treatment,and those in combination group were lower than those in control group(all P＜0.05).There was no statistically significant difference in the incidence and mortality rates of adverse reactions between the two groups[10.0％(4/40)vs 15.0％(6/40),2.5％(1/40)vs 5.0％(2/40)](both P＞0.05).Conclusion Phloroglucinol combined with somatostatin is effective in the treatment of AP,which can effectively relieve clinical symptoms and inflammatory reaction,and will not cause serious adverse reactions.

Abstract:Primary Immune Thrombocytopenia(ITP)is an autoimmune disease mediated by platelet autoantibodies.Most ITP patients have antiplatelet antibodies against the immunoglobulin G(IgG)subtype,which interact with glycoproteins on platelets and megakaryocytes to increase platelet destruction and inhibit platelet production.Neonatal Fc receptor(FcRn)is used to maintain the homeostasis of IgG levels in the human body.Targeting FcRn by FcRn inhibitors can reduce pathogenic IgG in the blood,proving its efficacy in the treatment of ITP and other autoimmune diseases,and improving platelet counts in ITP patients to some extent.Both efgartigimod and Rozanolixizumab can bind to FcRn and lead to the reduction of circulating IgG.FcRn inhibitors can also indirectly prolong the half-life of romiplostim to improve the therapeutic effect.This review briefly summarizes the mechanism of inhibition of platelet destruction and production in ITP,the molecular mechanism of FcRn and FcRn inhibitors,the application of FcRn inhibitors in ITP,and the association of FcRn with romiplostim and intravenous Ig.

Abstract:Objective To investigate the changes of serum markers after patent foramen ovale(PFO)closure and its clinical significance.Methods A total of 210 patients who underwent PFO closure in Fuwai Hospital,Chinese Academy of Medical Sciences from December 2019 to October 2022 were included retrospectively.The levels of serum markers before and after occlusion were compared,including the neutrophil/lymphocyte(NLR),the platelet/lymphocyte(PLR),mean platelet volume(MPV),homocysteine(Hey),albumin,total cholesterol,and high-density lipoprotein cholesterol levels.PFO patients with stroke were selected as the observa-tion group(151 cases),and 149 patients with atrial septal defect in our hospital during the same period were selected as the control group.The Hey levels were compared between the observation group and the control group before and after occlusion.Results The levels of NLR,PLR,and MPV in patients after occlusion were higher than those before occlusion,while the levels of Hey,albumin,total cholesterol,and high-density lipoprotein cholesterol were lower than those before occlusion(all P＜0.05).The Hey level in the observation group before PFO closure was significantly higher than that in the control group[(13.11±10.15)μmol/L vs(10.38±3.44)μmol/L](P＜0.01).There was no significant difference in Hcy level between the observation group[(11.12±9.68)μmol/L]after occlusion and the control group(P＞0.05).Conclusion The level of Hey significantly decreased after PFO closure,and high level of Hey may be closely related to PFO-associated crypto-genic stroke.In conclusion,it is clinically meaningful to monitor the Hey level in patients with PFO.

Abstract:Objective To investigate the clinical diagnosis and prognostic value of serum growth arrest specific protein 6(Gas6),plasminogen activator inhibitor-1(PAI-1)and serum cholinesterase(S-ChE)in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary infection.Methods A total of 106 COPD patients with pulmonary infection admitted to Beijing Tiantan Hospital,Capital Medical University from January 2021 to January 2023 were selected as the infection group,and 111 COPD patients without pulmonary infection during the same period were included as the non-infection group.According to the prognosis,the patients in the infection group were divided into survival group(83 cases)and death group(23 cases).The serum Gas6,PAI-1 and S-ChE levels were compared between the non-infection group and the infection group.The general data of the survival group and the death group were compared.Receiver operating characteristic curve was used to analyze the predictive value of serum Gas6,PAI-1 and S-ChE for pulmonary infection and death in elderly COPD patients.Multivariate Logistic regression was used to analyze the factors affecting the prognosis of elderly COPD patients with pulmonary infection.Results The levels of serum Gas6 and PAI-1 in the infection group were higher than those in the non-infection group,and the level of S-ChE was lower than that in the non-infection group(all P＜0.001).The results of receiver operating characteristic curve showed that the area under the curve of serum Gas6,PAI-1,S-ChE and their combination in the diagnosis of pulmonary infection was 0.787,0.797,0.782,0.889,respectively.The area under the curve of the combined diagnosis of the three was higher than that of their individual diagnosis(Z=4.527,5.435,4.167;all P＜0.001).The proportions of patients with GOLD grade Ⅲand diabetes mellitus,and the levels of serum Gas6 and PAI-1 in the death group were higher than those in the survival group;the levels of ratio of forced expiratory volume in the first second to percentage of expected value,forced expiratory volume in the first second/forced vital capacity ratio and S-ChE were lower than those in the survival group(all P＜0.05).Multivariate Logistic regression analysis showed that Gas6 and PAI-1 were risk factors for death in elderly patients with COPD complicated with pulmonary infection,and S-ChE was a protective factor(all P＜0.05).The receiver operating characteristic curve showed that the area under the curve of the combined diagnosis of serum Gas6,PAI-1 and S-ChE was higher than that of their individual detection(all P＜0.05).Conclusion The levels of serum Gas6 and PAI-1 are increased and S-ChE is decreased in elderly COPD patients with pulmonary infection,which has certain value in the clinical diagnosis and prognosis evaluation of the disease.

Abstract:Heart failure is a complex and common endpoint of many cardiovascular diseases,caused by various types of heart disease.MicroRNA(miR)is a class of endogenous non-coding small RNA molecules with a length of about 22 nucleotides,which can regulate the growth,differentiation,proliferation,apoptosis and other life activities of cells.A large number of studies have shown that miR is involved in the occurrence and development of a variety of heart failure,such as cardiomyocyte hypertrophy,myocardial fibrosis,and abnormal cardiac energy metabolism,and miR has a specific expression profile in various cardiovascular diseases,indicating that miR is expected to become a new biomarker for cardiovascular diseases.In addition,more than 60 miR-based therapeutic drugs are currently in different stages of development,such as targeting miR mimics or antagonists,miR inhibitors and other ways to regulate endogenous miR levels.The miR may be a potential target for new therapeutic strategies.This review summarizes the relationship between miR and the diagnosis,treatment and prognosis of heart failure.

Abstract:Diabetic kidney disease is a common clinical chronic complication of diabetes mellitus,which has become the main cause of chronic kidney disease and end-stage renal disease.Traditional Chinese medicine believes that the core of the disease is the kidney,which is caused by the damage of the kidney body,the loss of kidney use,and the failure of the nephron.In Huangdi Neijing,it is recorded that"the kidney is bitter and dry,and the acute food is bitter to moisten it","the kidney wants to be strong,and the acute food is bitter to strengthen it,and it is bitter to tonify it,and the salt reduces it".This article investigated the connotation of the theory of"bitter to fill and reduce"of kidney in Huangdi Neijing,and combined with the current mainstream treatment of diabetic kidney disease in traditional Chinese medicine,it is proposed that the differentiation and treatment of diabetic kidney disease in traditional Chinese medicine should focus on the kidney.The kidney dryness should be moistened by spicy,the kidney deficiency should be strengthened by bitterness,and the kidney is solid should be salty and reduced.In order to provide theoretical origin for the treatment of diabetic kidney disease with integrated traditional Chinese and western medicine,and provide new ideas and methods for the differentiation and treatment of diabetic kidney disease with traditional Chinese medicine.

Abstract:Phosphodiesterase 4 is the main enzyme that metabolizes cyclic adenosine monophosphate in inflammatory cells and plays a crucial role in regulating the balance of second messengers.As the key signal transduction regulation factor,phosphodiesterase 4 in a variety of diseases shows a promising pharmacological target,the inhibitors have been used as a treatment drug.This article reviews the mechanism,efficacy and adverse reactions of phosphodiesterase 4 inhibitors in the treatment of dermatosis.

Abstract:Objective To investigate the relationship between elevated thyroid stimulating hormone(TSH)level and elevated blood pressure in women of childbearing age in a community of Urumqi.Methods In this study,cluster random sampling method was used to select 866 women of childbearing age with complete data from 2 561 subjects who participated in an epidemiological survey of chronic diseases in a community of Urumqi in May 2020,and the age ranged from 20 to 49 years.The height,body mass,abdominal circumference,hip circum-ference,blood pressure,fasting blood glucose and TSH levels were measured.Logistic regression method was used to analyze the relationship between elevated TSH level and elevated blood pressure.Results A total of 866 women of childbearing age were included in this study.According to the blood pressure status before pregnancy,they were divided into normal blood pressure group(424 cases,49.0％)and elevated blood pressure group(442 cases,51.0％).Age,abdominal circumference,hip circumference,waist-hip ratio,body mass index and TSH level[(3.4±2.8)mIU/L vs(2.9±2.1)mIU/L]in the elevated blood pressure group were significantly higher than those in the normal blood pressure group(all P＜0.05).The blood pressure level(0=normal,1=elevated)was used as the dependent variable,and age,abdominal circumference,hip circumference,body mass index,fasting blood glucose,and TSH were used as independent variables.Model 1(without controlling other variables)and model 2(controlling age,waist circumference,hip circumference,body mass index and fasting blood glucose)were used to explore the relationship between TSH level and elevated blood pressure.The results showed that elevated TSH level was associated with elevated blood pressure regardless of whether other factors were controlled.Elevated TSH level may be a risk factor for elevated blood pressure(model 1:odds ratio=1.53,95％confidence interval:1.09-2.13,P=0.012;model 2:odds ratio=1.45,95％confidence interval:1.03-2.04,P=0.030).Conclusion Elevated TSH level is associated with elevated blood pressure in women of childbearing age,and elevated TSH level may be a risk factor for elevated blood pressure.

Abstract:Objective To evaluate the efficacy and safety of live combined bacillus subtilis enteric-coated capsules in the treatment of irritable bowel syndrome(IBS)by Meta-analysis.Methods PubMed,Embase,CBM,CNKI,Wanfang,VIP,Cochrane Library and other databases were systematically searched until June 2023.The observation group was treated with live combined bacillus subtilis enteric-coated capsules alone or combined with other drugs,and the control group was treated with other drugs alone or combined.RevMan 5.4.1 software was used for Meta-analysis.Results Meta-analysis showed that the total effective rate of the observation group was better than that of the control group(relative risk=1.20,P＜0.001),and the incidences of abdominal pain and diarrhea symptoms were lower than those of the control group(all P＜0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(odds ratio=0.80,P=0.28).Subgroup analysis showed that the total effective rates of the observation group were higher than those of the control group in diarrhea-predominant IBS and constipation-predominant IBS(both P＜0.05).Conclusion Based on the current literature evidence,live combined bacillus subtilis enteric-coated capsules are effective and safe in the treatment of IBS.

Abstract:Objective To investigate the correlation between preoperative serum bile acid level and clinical indicators and prognosis in patients with colorectal cancer.Methods A total of 253 patients diagnosed with colorectal cancer in Tianjin Union Medical Center from January 2018 to August 2022 were collected as the observation group.During the same period,248 cases of mixed hemorrhoids without other serious diseases were collected as the control group for retrospective study.According to the clinical data of these patients,Logistic regression method was used to analyze the influencing factors of colorectal cancer occurrence.The changes of serum bile acid levels before and after surgery were compared.Spearman correlation analysis was used to analyze the correlation between preoperative serum bile acid level and tumor markers,lymphocyte subsets,interleukin-6(IL-6),as well as tumor necrosis factor α(TNF-α).The Kaplan-Meier method was used to draw survival curves and compare the prognostic differences of patients with different levels of serum bile acid.The differences of lesion location and pathology in patients with different serum bile acid levels were compared.Results Logistic regression analysis showed that higher serum bile acid level was a risk factor for colorectal cancer(odds ratio=1.102,95％confidence interval:1.022-1.189,P=0.012).The postoperative serum bile acid level was lower than that before operation(P＜0.05).The preoperative serum bile acid levels were positively correlated with carcinoembryonic antigen,IL-6,and TNF-α levels(all P＜0.05).Survival analysis showed that patients with higher levels(≥4.7 μmol/L)of serum bile acid had shorter recurrence free survival time than those with lower levels(＜4.7 µmol/L)(Log-rank x2=9.711,P=0.002),recurrence and metastasis rate was higher[55.6％(15/27)vs 25.8％(17/66)](P＜0.05).The proportion of low and moderate differentiation was higher and the proportion of lesions located in the right colon was lower in the high level of serum bile acid group than those in the low level of serum bile acid group(all P＜0.05).Conclusions Preoperative high level of serum bile acid is a risk factor for colorectal cancer,which is positively correlated with some tumor markers and inflammatory factors,and is related to tumor location,pathology and prognosis of patients.It has certain value in guiding the clinical diagnosis and treatment of patients with colorectal cancer.

Abstract:Hyperuricemia(HUA)is common in patients with cardiovascular disease,and aspirin is the most widely used antiplatelet drug in cardiovascular disease.HUA is closely related to the occurrence and development of cardiovascular diseases.Aspirin may interfere with the production and excretion of uric acid,thereby affecting the level of serum uric acid.This paper reviews the effect of aspirin on HUA and blood uric acid level,to further explore the mechanism of action of aspirin affect uric acid generation and discharge,implement merge HUA individualized,accurate treatment of cardiovascular disease in patients with aspirin,improve cardiovascular disease prevention effect is of great significance.

Abstract:Mitophagy is an autophagy process in cells that can remove damaged mitochondria and maintain the health of cells.Kidney is an organ with high energy consumption.Mitochondria plays an important role in kidney function,and kidney diseases are usually associated with mitochondrial dysfunction.Recent studies have shown that mitochondrial damage and dysfunction in renal tubular cells may lead to renal tubular injury and decreased glomerular filtration rate,and mitophagy can remove these damaged mitochondria,thereby protecting renal cells from autophagy.In addition,mitophagy is also involved in the occurrence and development of kidney diseases,such as glomerulosclerosis and renal tubulointerstitial fibrosis.Therefore,mitophagy plays an important role in the prevention and treatment of kidney diseases.This article reviews the role of mitophagy in kidney diseases,and provides new ideas and strategies for mitochondrial targeted therapy in the future.

Abstract:Objective To investigate the diagnostic value of inflammatory markers in peripheral blood for hepatocellular carcinoma(HCC).Methods A total of 431 patients with HCC who were admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2019 to April 2022 were collected as the research objects(HCC group),and 153 patients with hepatic hemangioma were enrolled as the control group.The peripheral blood neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),lymphocyte to C-reactive protein ratio(LCR),C-reactive protein to albumin ratio(CAR),albumin to total bilirubin ratio(ABR),fibrinogen to albumin ratio(FAR),fibrinogen to prealbumin ratio(FPR)were calculated.Logistic regression analysis was used to evaluate the risk factors and protective factors for distinguishing HCC from hepatic hemangioma.The receiver operating characteristic(ROC)curve was drawn to analyze the auxiliary diagnostic value of the above indicators in the differential diagnosis of HCC and hepatic hemangioma.Results Logistic regression analysis showed that male,age,NLR,CAR and FPR were risk factors for the development of hepatic hemangioma into HCC(odds ratios=11.710,1.110,1.998,1.035,7.989,all P＜0.05);ABR,PLR,LMR and FAR were protective factors for the development of hepatic hemangioma into HCC(odds ratios=0.686,0.978,0.670,0.798,all P＜0.05).The results of ROC curve analysis showed that LMR,CAR,ABR,and FPR showed good diagnostic efficacy in the differential diagnosis of HCC and hepatic hemangioma[area under the curve(AUC)＞0.7],among which the protective factor LMR had the highest diagnostic efficacy,with an AUC of 0.761.The AUC of combined detection of NLR,PLR,LMR,LCR,CAR,ABR,FAR,and FPR was 0.946,which had the highest diagnostic efficiency.Conclusions NLR,PLR,LMR,LCR,CAR,ABR,FAR and FPR have certain value in the diagnosis of HCC.Among them,NLR,CAR and FPR are risk factors of HCC,and ABR,PLR,LMR and FAR are protective factors of HCC.The combined detection of the above indicators can improve the diagnostic efficiency of HCC.

Abstract:Objective To investigate the effect of Keluoxin capsule combined with dapagliflozin in the treatment of diabetic nephropathy.Methods A total of 90 patients with diabetic nephropathy admitted to Shaanxi Provincial People's Hospital from April 2022 to October 2023 were selected.According to the random number table method,the patients were divided into control group and observation group,with 45 cases in each group.Patients in both groups received routine symptomatic and supportive treatment.The control group was treated with dapagli-flozin,and the observation group was treated with Keluoxin capsule on the basis of the control group.Both groups were treated for 3 months.The clinical efficacy,islet function indexes,renal function indexes,blood glucose indexes,inflammatory indexes before and after treatment and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[88.9％(40/45)vs 71.1％(32/45)](x2=4.395,P=0.036).After treatment,the insulin resistance index,serum creatinine,urea nitrogen,24 h urine protein,fasting blood glucose,postprandial 2 h blood glucose,glycosylated hemoglobin,high-sensitivity C-reactive protein,interleukin-1 β,interleukin-6 and tumor necrosis factor-α levels in the observation group were smaller than/lower than those in the control group,and the islet β cell function index was higher than that in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.398).Conclusion Keluoxin capsule combined with dapagliflozin is effective in the treatment of diabetic nephropathy,which can improve islet function and renal function,reduce the level of inflammation,and has good safety.

Abstract:Objective To develop a model based on the Medical Information Mart for Intensive Care(MIMIC)database to predict in-hospital mortality in patients with congestive heart failure and cardiogenic shock(CS),and evaluate its clinical efficacy.Methods This retrospective study included 2 090 patients diagnosed as congestive heart failure complicated with CS from 2008 to 2019 from the MIMIC-Ⅳ database.All patients were divided into non-death group(1 434 cases)and death group(656 cases)according to whether there was in-hospital death.Data on clinical characteristics,vital signs,laboratory results,and system scores were collected.Lasso regression was used to select relevant variables,and multivariate logistic regression analysis was employed to identify independent predictors and construct a nomogram model for predicting in-hospital mortality.Internal validation was performed using the Bootstrap method.The model was evaluated using the receiver operating charac-teristic(ROC)curve and decision curve analysis(DCA).Results Multivariate Logistic regression analysis showed that peripheral oxygen saturation[odds radio(OR)=0.968,95％confidence interval(CI):0.949-0.987,P=0.001]and serum albumin(OR=0.764,95％CI:0.626-0.932,P=0.008)were independent protection factors for patients in-hospital death,and age(OR=1.043,95％CI:1.034-1.051,P＜0.001),female(OR=1.304,95％CI:1.052-1.615,P=0.015),body temperature＜36 ℃(OR=1.720,95％CI:1.284-2.304,P＜0.001),chronic obstructive pulmonary disease(OR=1.404,95％CI:1.131-1.744,P=0.002),hemodi-alysis(OR=2.210,95％CI:1.710-2.856,P＜0.001),serum lactate levels(OR=1.149,95％CI:1.100-1.200,P＜0.001)and sequential organs failure assessment(SOFA)score(OR=1.113,95％CI:1.080-1.146,P＜0.001)were independent risk factors.Based on multivariate Logistic regression analysis,a nomogram risk model of nosocomial death in patients with congestive heart failure complicated with CS was constructed.The nomogram model demonstrated an area under the ROC curve of 0.766,with a sensitivity of 72.6％and specificity of 66.9％.Internal validation showed good agreement between the predicted and actual values on the calibration curve.Decision curve analysis indicated that the model provided significant clinical net benefit.Conclusions Based on the MIMIC-Ⅳ database,this study developed a nomogram model incorporating age,gender,chronic obstructive pulmonary disease,peripheral oxygen saturation,body temperature＜36 ℃,hemodialysis,serum albumin,serum lactate,and SOFA score to predict in-hospital mortality in patients with CS complicated by congestive heart failure cardiogenic shock.The model demonstrated high discriminative ability,calibration,predictive performance,and clinical net benefit,enabling early identification of high-risk patients and optimization of treatment decisions.

Abstract:Hydroxychloroquine,as an antimalarial drug,has low toxicity,anti-inflammatory,immuno-modulatory,immunosuppressive and thromboprophylaxis effects.It is not only used in the treatment of malaria,but also in the treatment of rheumatic immune diseases.As the research progressed,it is discovered that hydroxychloro-quine can mitigate kidney damage by inhibiting the cascade of inflammatory signaling,suppressing autophagy,and preventing the formation of immune response complexes,thereby reducing or delaying the occurrence of proteinuria.Hence,it is utilized for the management of kidney diseases associated with inflammatory responses,such as IgA nephropathy and lupus nephritis.Moreover,hydroxychloroquine has demonstrated a superior safety profile in comparison to other immunosuppressants for treating kidney diseases.Furthermore,the therapeutic efficacy of hydroxychloroquine in additional kidney conditions like diabetic nephropathy and membranous nephropathy is highly esteemed,warranting further investigation into its mechanism of action and potential safety considerations.