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

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

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

Abstract:Objective To understand the nutritional status of malnutrition in elderly patients with hip fractures and to analyze its correlation with frailty status and quality of life.Methods A cross-sectional study was conducted.A total of 300 elderly inpatients with hip fractures admitted to the Orthopedics Department of Xiamen Hongai Hospital from February 2022 to June 2025 were selected by convenience sampling.According to the Mini Nutritional Assessment-Short Form(MNA-SF)scores,patients were divided into a malnutrition group(236 cases)and a non-malnutrition group(64 cases).Baseline data questionnaire,MNA-SF,FRAIL Scale,and WHO Quality of Life-BREF(QOL-BREF)Scale were used to investigate nutritional status,frailty status,and quality of life.Point-biserial correlation analysis was used to analyze the correlation between nutritional status and frailty status as well as quality of life.Binary logistic regression analysis was used to analyze the influencing factors of malnutrition in elderly patients with hip fractures.Results In the malnutrition group,the proportion of patients aged≥65 years,the proportion with≥2 comorbidities,body mass index(BMI),and FRAIL scores were higher than those in the non-malnutrition group,while QOL-BREF scores were lower than those in the non-malnutrition group,with statistically significant differences(P<0.05).Point-biserial correlation analysis showed that malnutrition was positively correlated with FRAIL scores(r=0.567,P<0.001)and negatively correlated with QOL-BREF scores(r=-0.538,P<0.001).Multivariate logistic regression analysis showed that comorbidities,FRAIL scores,and BMI were independent risk factors for malnutrition in elderly patients with hip fractures,while QOL-BREF scores were an independent protective factor(OR=1.754,95%CI:1.044-2.949,P=0.035;OR=1.872,95%CI:1.163-3.014,P=0.010;OR=1.826,95%CI:1.071-3.112,P=0.027;OR=0.510,95%CI:0.311-0.837,P=0.008).Conclusion The detection rates of malnutrition and malnutrition risk are high in elderly patients with hip fractures,which leads to frailty and affects patients'quality of life.Medical staff should identify patients with malnutrition as early as possible,intervene timely,and improve patient prognosis.

Abstract:Objective To investigate the effect of bilateral repetitive transcranial magnetic stimulation(rTMS)combined with swallowing and feeding training on the Functional Oral Intake Scale(FOIS)score and swallowing safety in patients with post-stroke dysphagia(PSD).Methods The clinical data of 120 PSD patients treated at Nanjing Tongren Hospital from March 2021 to April 2025 were retrospectively collected and divided into a single-intervention group(basic swallowing and feeding training intervention,n=53)and a combined-intervention group(bilateral rTMS combined with individualized swallowing and feeding training intervention,n=67)according to the treatment methods.Swallowing function[FOIS score,standardized swallowing assessment(SSA)score,videofluoroscopic swallowing study(VFSS)score],swallowing safety[penetration-aspiration scale(PAS)score,water swallowing test(WST)score],and clinical efficacy were compared between the two groups.Results After the intervention,FOIS and VFSS scores increased compared with those before the intervention in both groups,while SSA scores decreased.Moreover,the combined-intervention group had significantly higher FOIS and VFSS scores and a lower SSA score than the single-intervention group,with all differences being statistically significant(P<0.05).After the intervention,PAS and WST scores decreased compared with those before the intervention in both groups,and the scores in the combined-intervention group were significantly lower than those in the single-intervention group,with statistically significant differences(P<0.05).The total effective rate in the combined-intervention group was 95.52%(64/67),which was significantly higher than that in the single-intervention group(77.36%,41/53),and the difference was statistically significant(χ2=8.926,P=0.003).Conclusion Bilateral rTMS combined with swallowing and feeding training intervention can significantly improve FOIS scores and swallowing safety in PSD patients,enhance swallowing function,and achieve marked therapeutic effects.

Abstract:Objective To analyze the predictive value of homocysteine(Hcy)combined with thrombelastogram(TEG)for recurrent preeclampsia(PE).Methods A total of 60 patients with recurrent PE(recurrent PE group),68 patients with first-onset PE(first-onset PE group),and 80 healthy pregnant women(normal group)admitted to the 81st Group Army Hospital of the People's Liberation Army from January 2022 to December 2024 were enrolled.Hcy levels and TEG parameters[coagulation index(CI),maximum amplitude(MA),α-angle(Angle),reaction time(R),coagulation time(K)]were compared among the three groups at 11-15 weeks,16-20 weeks,and 24-28 weeks of gestation.All subjects were followed up until after delivery.According to perinatal outcomes,they were divided into a good perinatal outcome group(n=164)and a poor perinatal outcome group(n=44).Hcy levels and TEG parameters at different gestational periods were compared between the two groups.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of Hcy combined with TEG fitting values at 11-15 weeks,16-20 weeks,and 24-28 weeks of gestation for recurrent PE and poor perinatal outcomes.Results Compared with the normal group,the first-onset PE group and the recurrent PE group had higher Hcy,CI,MA,and Angle(P<0.05),and lower R and K(P<0.05)at 11-15 weeks,16-20 weeks,and 24-28 weeks of gestation.The recurrent PE group showed higher Hcy,CI,MA,and Angle(P<0.05),and lower R and K(P<0.05)than the first-onset PE group.ROC curve analysis showed that the areas under the curve of Hcy combined with TEG fitting values at 11-15 weeks,16-20 weeks,and 24-28 weeks of gestation for predicting recurrent PE were 0.942,0.979,and 0.941,respectively.Compared with the good perinatal outcome group,the poor perinatal outcome group had higher Hcy,CI,MA,and Angle(P<0.05),and lower R and K(P<0.05)at 11-15 weeks,16-20 weeks,and 24-28 weeks of gestation.ROC curve analysis showed that the areas under the curve of Hcy combined with TEG fitting values at 11-15 weeks,16-20 weeks,and 24-28 weeks of gestation for predicting poor perinatal outcomes were 0.856,0.944,and 0.959,respectively.Conclusion Combined detection of Hcy and TEG at 16-20 weeks of gestation can effectively predict the occurrence of recurrent PE,while combined detection at 24-28 weeks of gestation has the highest value for predicting adverse perinatal outcomes caused by recurrent PE.

Abstract:Objective To study the status quo and influencing factors of quality of life in patients with cholangiocarcinoma receiving chemotherapy combined with immunotherapy,and to construct a prediction model.Methods A total of 180 patients with cholangiocarcinoma admitted to the First Affiliated Hospital of Nanjing Medical University from February 2023 to December 2024 were selected as study subjects.All patients received chemotherapy combined with immunotherapy.The quality of life score of patients was investigated after treatment.The influencing factors of quality of life were analyzed by univariate analysis and multivariate linear regression analysis,and a prediction model was constructed based on the influencing factors.Receiver operating characteristic(ROC)curve was used to evaluate the performance of the model.Results The quality of life score of the 180 patients was(93.72±5.38)points,with the physiological dimension,functional dimension,social/family dimension,and emotional dimension scoring(26.49±4.24)points,(24.80±4.13)points,(22.67±3.71)points,and(19.76±3.52)points,respectively.Univariate analysis showed that there were statistically significant differences in quality of life scores among patients with different ages,education levels,family monthly incomes,marital statuses,lesion diameters,stages,and differentiation degrees(P<0.05).Multivariate linear regression analysis indicated that education level,family monthly income,marital status,lesion diameter,and stage were influencing factors of quality of life in patients with cholangiocarcinoma undergoing chemotherapy combined with immunotherapy(P<0.05).ROC curve analysis showed that the area under the curve of the model was 0.786(95%CI:0.705-0.848).The Hosmer-Lemeshow test suggested that the model had good calibration(χ2=5.119,P=0.147).Conclusion The quality of life in patients with cholangiocarcinoma undergoing chemotherapy combined with immunotherapy is at an upper-middle level.Education level,family monthly income,marital status,lesion diameter,and stage are factors affecting the quality of life of patients.The prediction model constructed based on the above influencing factors has high predictive performance.

Abstract:Objective To investigate the relationship of amplitude-integrated electroencephalogram(aEEG)signals and ferritin levels with vascular cognitive impairment in patients with ischemic cerebral small vessel disease(iCSVD).Methods A total of 126 patients with iCSVD treated in Qinhuangdao First Hospital from June 2023 to December 2024 were retrospectively selected and divided into a vascular cognitive impairment group(39 cases)and a non-impaired group(87 cases)according to the presence of vascular cognitive impairment.aEEG signals(continuity of background activity,sleep cycle,upper and lower boundary voltages),serum ferritin levels,and clinical data were compared between the two groups.Multivariate Logistic regression was used to analyze independent influencing factors for vascular cognitive impairment in iCSVD patients.Results Compared with the non-impaired group,the vascular cognitive impairment group showed higher proportions of abnormal background activity continuity and abnormal sleep cycle,lower upper and lower boundary voltage levels,higher serum ferritin level,higher homocysteine level,a higher proportion of high cerebrovascular disease load,and a higher white matter lesion severity score,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that aEEG background activity continuity(OR=1.264,95%CI:1.017-1.571),sleep cycle(OR=1.420,95%CI:1.092-1.847),serum ferritin level(OR=1.028,95%CI:1.008-1.049),and high cerebrovascular disease load(OR=1.441,95%CI:1.101-1.884)were associated with vascular cognitive impairment in iCSVD patients(P<0.05).Conclusion aEEG background activity continuity,sleep cycle,serum ferritin level,and high cerebrovascular disease load are associated with vascular cognitive impairment in patients with iCSVD.

Abstract:Respiratory syncytial virus(RSV)is a leading pathogen causing lower respiratory tract infections in infants,young children,the elderly,and immunocompromised individuals.It is primarily transmitted through droplets,contact with contaminated surfaces,or direct contact with secretions from infected persons.Currently,modern medicine offers no specific antiviral drugs for RSV,and management mainly relies on supportive care.Consequently,the active components of traditional Chinese medicine(TCM)extracts have emerged as a research hotspot for RSV treatment,with significant progress being achieved.Recent studies have found that extracts from Gardeniae Fructus,Andrographis paniculata,Artemisia annua,and Lonicera japonica can exert therapeutic effects against RSV through mechanisms such as direct viral inhibition,immune response regulation,and alleviation of oxidative damage,which greatly contributes to the clinical management of this disease.This article reviews the research progress on the efficacy and mechanisms of action of TCM extracts in treating RSV.

Abstract:Objective To observe the effect of esketamine on postoperative sleep quality in patients undergoing thoracoscopic surgery.Methods From January 2024 to June 2025,100 patients undergoing thoracoscopic surgery at Suqian First People's Hospital Affiliated to Nanjing Medical University were selected and divided into group A(conventional general anesthesia+postoperative analgesia)and group B(conventional general anesthesia+esketamine for postoperative analgesia)according to the random number table method,with 50 patients in each group.The analgesic and sedative effects,sleep quality and insomnia severity,inflammatory markers[procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin 6(IL-6)],stress indicators(epinephrine,norepinephrine,and fasting blood glucose),and adverse reactions were compared between the two groups.Results At 12 h,24 h,and 48 h after surgery,the Visual Analogue Scale(VAS)scores of both groups gradually decreased over time(P<0.05),while the Ramsay sedation scores gradually increased over time(P<0.05).The VAS scores of group B were lower than those of group A at the same time points(P<0.05),and the Ramsay scores were higher than those of group A(P<0.05).At 48 h after surgery,the Pittsburgh Sleep Quality Index(PSQI)scores decreased(P<0.05)and the Insomnia Severity Index(ISI)scores increased in both groups(P<0.05),with group B showing lower PSQI and ISI scores than group A(P<0.05).At 48 h after surgery,the levels of PCT,hs-CRP,TNF-α,IL-6,epinephrine,norepinephrine,and fasting blood glucose increased in both groups(P<0.05),but were lower in group B than in group A(P<0.05).The incidence of adverse reactions in group A(18.00%)was comparable to that in group B(22.00%),with no statistically significant difference(P>0.05).Conclusion The application of esketamine in thoracoscopic surgery can produce significant analgesic and sedative effects,improve patients'sleep quality,reduce postoperative inflammatory and stress responses,and has a high safety profile.

Abstract:Objective To analyze the influencing factors of pneumothorax after thoracoscopic resection in lung cancer patients and construct a nomogram prediction model.Methods A total of 224 patients with lung cancer admitted to the First Affiliated Hospital of Nanjing Medical University from August 2024 to May 2025 were selected as the study subjects.They were divided into a pneumothorax group(n=20)and a non-pneumothorax group(n=204)based on the occurrence of postoperative pneumothorax.Multivariate logistic stepwise regression analysis was used to identify the influencing factors of postoperative pneumothorax after thoracoscopic resection in lung cancer patients.A nomogram model was constructed and validated.Results The pneumothorax group had a higher proportion of patients aged≥60 years,body mass index≥24 kg/m²,clinical stage Ⅱa-Ⅱb,operation time≥1.5 h,preoperative neoadjuvant therapy,and comorbid emphysema,along with higher white blood cell counts,lower albumin levels,and lower peak expiratory flow compared to the non-pneumothorax group.All differences were statistically significant(P<0.05).Age≥60 years(OR=1.976,95%CI:1.419-2.752),operation time≥1.5 h(OR=2.212,95%CI:1.527-3.204),preoperative neoadjuvant therapy(OR=2.732,95%CI:1.785-4.180),comorbid emphysema(OR=2.330,95%CI:1.587-3.422),and low albumin level(OR=0.393,95%CI:0.259-0.597)were risk factors for postoperative pneumothorax in lung cancer patients(P<0.05).The consistency index of the nomogram model was 0.885(95%CI:0.832-0.938).The calibration curve closely aligned with the ideal curve.The area under the curve(95%CI)of the nomogram for predicting postoperative pneumothorax was 0.904(0.851-0.957),with a specificity of 0.682 and a sensitivity of 0.918.Conclusion The influencing factors of postoperative pneumothorax after thoracoscopic resection in lung cancer patients include age,operation time,preoperative neoadjuvant therapy,comorbid emphysema,and albumin level.The constructed nomogram model has high application value in predicting pneumothorax.

Abstract:Objective To explore the predictive value of the D-dimer to platelet ratio(DPR)for venous thromboembolism(VTE)in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 150 elderly patients with COPD admitted to Sichuan Xiandai Hospital from January 2023 to September 2025 were selected and divided into two groups based on the occurrence of VTE:the VTE group(36 cases)and the non-VTE group(114 cases).The general clinical data of the two groups were compared;multivariate logistic stepwise regression analysis was used to identify the influencing factors for VTE in elderly COPD patients;and receiver operating characteristic curve analysis was applied to evaluate the predictive value of DPR for VTE in elderly COPD patients.Results In the VTE group,age,bed rest duration≥7 days,fibrinogen,D-dimer,and DPR were higher than those in the non-VTE group,while forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC),oxygen saturation,and platelet count were lower than those in the non-VTE group(all P<0.05).Multivariate logistic stepwise regression analysis showed that bed rest duration≥7 days(OR=3.501,95%CI:1.595-7.683),elevated fibrinogen(OR=2.776,95%CI:1.392-5.534),and DPR≥0.62×10-2(OR=3.059,95%CI:1.502-6.231)were independent risk factors for VTE in elderly COPD patients,while a higher FEV1/FVC(OR=0.510,95%CI:0.321-0.809)was an independent protective factor(all P<0.05).The area under the curve(AUC)of DPR for predicting VTE in elderly COPD patients was 0.912,which was significantly superior to the AUC of D-dimer(0.779)and platelet count(0.863)alone(Z=9.362,8.025;both P<0.001).Conclusion Elevated DPR is closely related to the occurrence of VTE in elderly COPD patients and has good predictive value.

Abstract:Objective To explore the influencing factors of length of hospital stay(LOS)in patients with hypertensive intracerebral hemorrhage(HICH)after intracranial hematoma removal and to construct a risk prediction model.Methods A total of 122 patients with HICH admitted to the Second Affiliated Hospital of Fuyang Normal University from April 2022 to May 2025 were retrospectively selected.All patients were treated with intracranial hematoma removal.Patient demographic and disease-related data were collected.According to the median postoperative LOS,patients were divided into a high LOS group(﹥15 d,n=61)and a low LOS group(≤15 d,n=61).Multivariate Logistic regression analysis was used to analyze the influencing factors of postoperative LOS,and a nomogram prediction model was constructed using R software.A receiver operating characteristic curve was drawn to evaluate the predictive value of the nomogram model for postoperative LOS.Results The high LOS group showed higher proportions of patients aged≥60 years,brain herniation,Glasgow Coma Scale(GCS)score<9,preoperative aspiration pneumonia,systolic blood pressure≥180 mmHg at admission,and higher preoperative white blood cell count compared to the low LOS group(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years(OR=2.795,95%CI:1.312-5.957),GCS score<9(OR=2.765,95%CI:1.275-5.997),preoperative aspiration pneumonia(OR=2.795,95%CI:1.137-6.873),systolic blood pressure at admission≥180 mmHg(OR=2.770,95%CI:1.188-6.461),and elevated preoperative white blood cell count(OR=1.135,95%CI:1.011-1.275)were independent risk factors for prolonged postoperative LOS in HICH patients(P<0.05).A nomogram model was constructed to predict prolonged postoperative LOS in HICH patients,and the consistency index was 0.824(95%CI:0.725-0.886).The area under the curve of the nomogram model for predicting postoperative LOS was 0.887(95%CI:0.816-0.939),with a specificity of 87.64%and a sensitivity of 91.52%.Conclusion Age≥60 years,GCS score<9,preoperative aspiration pneumonia,systolic blood pressure at admission≥180 mmHg,and elevated preoperative white blood cell count are independent risk factors for prolonged LOS in HICH patients after surgery.The nomogram model constructed based on these factors has good predictive value.

Abstract:Objective To observe the efficacy of unilateral biportal endoscopic technique(UBET)compared with traditional uniportal endoscopic technique(SET)in assisting spinal fusion for degenerative lumbar diseases.Methods A prospective study was conducted on 268 patients with degenerative lumbar diseases admitted to Ziyang Traditional Chinese Medicine Hospital from April 2020 to April 2023.They were randomly divided into a control group and an observation group using a random number table,with 134 patients in each group.The control group underwent traditional SET-assisted spinal fusion,while the observation group received UBET-assisted spinal fusion.The two groups were compared in terms of operative time,intraoperative blood loss,postoperative drainage volume,hospital stay,Visual Analog Scale(VAS)score,Japanese Orthopaedic Association(JOA)score,Oswestry Disability Index(ODI)score at different time points,serum inflammatory factor levels(tumor necrosis factor-α,interleukin-6,interleukin-4),imaging parameters(intervertebral space height,lumbar lordosis angle,foraminal area),Bridwell interbody fusion grade at 6 months postoperatively,and the incidence of cage subsidence and endplate injury during a two-year follow-up.Results The observation group had shorter operative time and hospital stay than the control group(P<0.05),and less intraoperative blood loss and postoperative drainage volume(P<0.05).At 1 week,1 month,3 months,and 6 months postoperatively,the observation group had lower VAS and ODI scores but higher JOA scores than the control group(P<0.05).At 1 month,3 months,and 6 months postoperatively,the observation group showed significantly greater intervertebral space height,lumbar lordosis angle,and foraminal area than the control group(P<0.05).At 6 months postoperatively,the Bridwell interbody fusion grade in the observation group was significantly better than that in the control group(P<0.05),with a Grade I fusion rate of 89.55%,higher than 74.63%in the control group(χ2=10.152,P<0.05).During the two-year follow-up,the incidences of cage subsidence and endplate injury in the observation group were lower than those in the control group(P<0.05).Conclusion UBET-assisted spinal fusion is effective and safe in treating degenerative lumbar diseases.It shortens operative time,reduces intraoperative blood loss,promotes postoperative functional recovery,alleviates inflammatory responses,and,due to its superior visualization and operational space,achieves a higher interbody fusion rate and better mid-to long-term lumbar stability.

Abstract:Objective To explore the risk factors for recurrence and progression of locally advanced cervical cancer after radical chemoradiotherapy and to construct a nomogram prediction model,so as to provide references for treatment optimization and prognosis evaluation.Methods A total of 331 patients with locally advanced cervical cancer who received radical chemoradiotherapy in Yuncheng Central Hospital Affiliated to Shanxi Medical University from January 2019 to January 2022 were retrospectively included.Their clinicopathological characteristics and follow-up data were analyzed.Univariate and multivariate analyses were performed to identify risk factors for recurrence and progression of locally advanced cervical cancer after radical chemoradiotherapy.A nomogram prediction model was constructed and its predictive performance was analyzed.Results The median follow-up time of the 331 patients was 27.0(5.0-36.0)months.The 1-year and 3-year progression-free survival rates were 83.99%(278/331)and 67.67%(224/331),respectively.The 1-year and 3-year overall survival rates were 95.47%(316/331)and 77.34%(256/331),respectively.Univariate analysis showed that there were statistically significant differences in 3-year progression-free survival among subgroups in terms of histopathological differentiation,maximum primary tumor diameter,pelvic lymph node metastasis,depth of invasion,type of pelvic radiotherapy,squamous cell carcinoma antigen(SCC-Ag)level,and D-dimer level(P<0.05).Multivariate analysis showed that moderately to poorly differentiated histology,maximum primary tumor diameter≥4 cm,pelvic lymph node metastasis,depth of invasion over 1/2,whole pelvic radiotherapy,SCC-Ag>2.0 μg/L,and D-dimer>0.8 mg/L were independent risk factors for recurrence and progression of locally advanced cervical cancer after radical chemoradiotherapy(P<0.05).A nomogram model for recurrence and progression of locally advanced cervical cancer after radical chemoradiotherapy was constructed based on the multivariate analysis results.The areas under the ROC curve of this model for predicting 1-year,2-year,and 3-year progression-free survival were 0.729,0.761,and 0.773,respectively.Conclusion The recurrence and progression of locally advanced cervical cancer after radical chemoradiotherapy may be associated with multiple factors,including histopathological differentiation,maximum tumor diameter,pelvic lymph node metastasis,depth of invasion,pelvic radiotherapy type,SCC-Ag level,and D-dimer level.The nomogram model constructed based on these factors demonstrates good predictive performance for 1-year,2-year,and 3-year progression-free survival.

Abstract:Objective To explore the predictive value of peripheral blood anti-Müllerian hormone(AMH)and thyroid-specific antibody levels on pregnancy outcomes in patients with polycystic ovary syndrome(PCOS).Methods A total of 120 patients with PCOS admitted to Jiangjin District Maternal and Child Health Hospital of Chongqing from January 2022 to January 2024 were included for retrospective analysis.All patients underwent detection of peripheral blood AMH,thyroid-stimulating hormone(TSH),and thyroid-specific antibodies[thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb)].According to pregnancy outcomes,patients were divided into a pregnancy group(73 cases)and a non-pregnancy group(47 cases).The levels of peripheral blood AMH,TSH,TPOAb,and TGAb were compared between the two groups.The pregnant patients were followed up and further divided into a good pregnancy outcome group(44 cases)and a poor pregnancy outcome group(29 cases)based on their pregnancy outcomes.The predictive value of peripheral blood AMH,TSH,and thyroid-specific antibody levels on pregnancy outcomes and their influence on pregnancy outcomes were analyzed.Results The levels of AMH,TPOAb,and TGAb in the non-pregnancy group were higher than those in the pregnancy group(P<0.05).The levels of AMH,TPOAb,and TGAb in the poor pregnancy outcome group were higher than those in the good pregnancy outcome group(P<0.05).The area under the curve(AUC)of the combination of AMH,TPOAb,and TGAb for predicting pregnancy outcomes in PCOS patients was greater than that of each indicator alone(P<0.05).The proportions of patients with pre-pregnancy BMI≥25.00 kg/m²,gestational hypertension,gestational diabetes mellitus,AMH≥7.07 ng/mL,TPOAb≥70.89 IU/mL,and TGAb≥58.88 IU/mL in the poor pregnancy outcome group were higher than those in the good pregnancy outcome group(P<0.05).Gestational hypertension,gestational diabetes mellitus,AMH≥7.07 ng/mL,TPOAb≥70.89 IU/mL,and TGAb≥58.88 IU/mL were identified as independent influencing factors for pregnancy outcomes in PCOS patients(P<0.05).Conclusion Abnormally elevated levels of peripheral blood AMH,TPOAb,and TGAb are independent influencing factors for poor pregnancy outcomes in PCOS patients,and the combined detection of these indicators has good predictive value for pregnancy outcomes.

Abstract:Objective To investigate the status quo of fear of progression(FoP)in patients with adenomatous polyps,and to explore its relationship with self-perceived burden and family hardiness.Methods A total of 190 patients with adenomatous polyps who were treated in Tangdu Hospital,Air Force Medical University from December 2023 to December 2024 were enrolled.The general information questionnaire,Fear of Progression Questionnaire-Short Form(FoP-Q-SF),Family Hardiness Index(FHI)and Self-Perceived Burden Scale(SPBS)were used for assessment.Pearson correlation analysis was utilized to analyze the relationship between FoP and self-perceived burden as well as family hardiness.Logistic regression analysis was conducted to identify the main influencing factors of FoP.Results A total of 190 patients with adenomatous polyps were included.The total score of FoP-Q-SF was(29.09±3.95)points,with 41 patients(21.58%)scoring≥34 points,indicating psychological dysfunction.There were statistically significant differences in FoP-Q-SF scores among patients with different education levels,family monthly incomes,disease courses,medical payment methods,FHI scores and SPBS scores(P<0.05).FHI score was negatively correlated with FoP-Q-SF total score(r=-0.523),while SPBS score was positively correlated with FoP-Q-SF total score(r=0.543)(P<0.05).Education level of high school or below/junior college(OR=1.863,95%CI:1.128-3.076),family monthly income≤5 000 yuan(OR=1.808,95%CI:1.077-3.033),out-of-pocket payment for medical expenses(OR=2.162,95%CI:1.378-3.392),FHI score≤40 points(OR=0.471,95%CI:0.234-0.951)and SPBS score≥20 points(OR=2.143,95%CI:1.591-2.886)were identified as influencing factors of FoP in patients with adenomatous polyps(P<0.05).Conclusion At present,patients with adenomatous polyps have a relatively low level of FoP.FoP increases patients'self-perceived burden,and improving family hardiness is beneficial for reducing FoP level.

Abstract:Objective This study employed RNA sequencing technology to analyze the peripheral blood of patients with high-altitude pulmonary hypertension(HAPH),aiming to identify core genes associated with HAPH's pathogenesis and to validate the expression changes of these genes using reverse transcription quantitative polymerase chain reaction(RT-qPCR).The study provides a theoretical basis for early diagnosis and the development of therapeutic targets for HAPH.Methods A total of 42 healthy males who underwent physical examinations at the 948th Hospital of the PLA(affiliated with the General Hospital of Xinjiang Military Region)from April to September 2023 and showed no abnormalities in cardiac ultrasound examinations were selected as study subjects.Following 5 months of high-altitude hypoxic exposure at elevations above 5 000 meters,they were divided into a healthy control group(24 cases)and an HAPH group(18 cases)based on Doppler ultrasound examinations.Blood samples were collected from both groups,and total RNA was extracted using TRIzol reagent.RNA sequencing was performed on the Illumina Novaseq 6000 platform.Differentially expressed genes(DEG)were identified using the limma package with thresholds of|log2FC|>1 and P<0.05.Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis was further conducted to identify pathways associated with the DEG.Protein-protein interaction(PPI)networks were constructed using the STRING database,and core genes were screened using the Maximum Neighborhood Component,Edge Percolated Component,and BottleNeck algorithms.The Xsum algorithm combined with the Cmap database was used to screen for potential compounds for HAPH treatment.Finally,RT-qPCR was performed to validate the expression changes of the core genes.Results Transcriptome sequencing identified 617 differentially expressed genes,including 326 upregulated and 291 downregulated genes.Pathway enrichment analysis revealed that the heme biosynthesis pathway was closely associated with HAPH.Based on PPI analysis,five core genes were identified:ferrochelatase(FECH),synuclein alpha(SNCA),actin beta,AKT serine/threonine kinase 1,and ubiquitin C.Screening via the Cmap database suggested arachidonyltrifluoromethane(ATFMK)as a potential compound that may inhibit the core genes.RT-qPCR validation results showed that FECH and SNCA were significantly upregulated in the HAPH group,indicating that these two genes may play important roles in the pathological process of HAPH.Conclusion This study identified differentially expressed core genes associated with HAPH through transcriptomic analysis.Among them,FECH and SNCA were further validated by RT-qPCR and may serve as potential biomarkers and therapeutic targets for HAPH.The compound ATFMK may have potential as a therapeutic agent.These findings provide new molecular insights for early diagnosis and targeted therapy of HAPH.

Abstract:Objective To investigate the mechanism of influence of age and body mass index(BMI)on vascular endothelial function and coronary artery lesion(CAL)in children with Kawasaki disease(KD).Methods The clinical data of 200 children with KD admitted to Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from April 2024 to January 2025 were retrospectively collected.The patients were divided into an infant group(<1 year,n=84),a toddler group(1-3 years,n=57),and a preschool group(4-6 years,n=59)according to age.Based on the 85th and 95th percentile of BMI for children of the same age and sex,they were classified into a normal group(n=119),an overweight group(n=42),and an obesity group(n=39).According to the presence of CAL,they were divided into a CAL group(n=86)and a non-CAL group(n=114).Vascular endothelial function indices were compared among children with KD of different ages and BMI categories.Clinical data were compared between the CAL group and the non-CAL group.Multivariate logistic regression analysis was used to identify influencing factors for CAL in children with KD.Results The carotid intima-media thickness(IMT)and carotid stiffness index(SI)in the infant group were higher than those in the young children group and the preschool group(P<0.05),while the reactive hyperemia index(RHI),flow-mediated dilation(FMD),and nitroglycerin-mediated dilation(NMD)were significantly lower than those in the young children group and the preschool group(P<0.05).The IMT in the young children group was significantly higher than that in the preschool group(P<0.05).IMT and SI in the obese group were significantly higher than those in the overweight group and the normal group(P<0.05),while RHI,FMD,and NMD were significantly lower than those in the normal group(P<0.05).IMT in the overweight group was significantly higher than that in the normal group(P<0.05),while RHI,FMD,and NMD were significantly lower than those in the normal group(P<0.05).The proportion of children aged≤3 years,the proportion of overweight/obese children,and the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),IMT,and SI in the CAL group were significantly higher than those in the n-CAL group(P<0.05),while the levels of RHI,FMD,and NMD in the CAL group were significantly lower than those in the n-CAL group(P<0.05).Multivariate Logistic regression analysis showed that age,BMI,CRP,TNF-α,IMT,SI,RHI,FMD,and NMD were independent influencing factors for CAL in children with KD(P<0.05).Conclusion Vascular endothelial function differs in children with KD of different ages and BMI,and age,BMI,CRP,TNF-α,IMT,SI,RHI,FMD,and NMD are independent influencing factors for CAL occurrence in children with KD.

Abstract:Objective To observe the clinical efficacy of distal acupoint acupuncture combined with Xiaozhong Zhitong Ointment in treating acute rotator cuff injuries.Methods A total of 64 patients with acute rotator cuff injuries admitted to the Zibo Baohua Hospital of Traditional Chinese Medicine and Wangjing Hospital,China Academy of Chinese Medical Sciences from March 2023 to December 2024 were selected as study subjects.They were assigned random numbers by a central randomization system and divided into experimental group 1(n=22),experimental group 2(n=22),and control group(n=20).Experimental group 1 received distal acupoint acupuncture.Experimental group 2 received the same treatment as experimental group 1 with the addition of topical application of Xiaozhong Zhitong Ointment.The control group received acupuncture at points recommended in the textbook"Acupuncture and Moxibustion".All groups were treated for 10 days.Clinical efficacy,Visual Analog Scale(VAS)score,American Shoulder and Elbow Surgeons(ASES)score,shoulder range of motion(ROM),and adverse events were compared among the three groups.Results During treatment,one patient dropped out from experimental group 2 and one from the control group.The total effective rate in experimental group 2(100.00%)was significantly higher than that in the control group(73.68%)and experimental group 1(72.73%)(P<0.05).After treatment,VAS scores decreased in all three groups(P<0.05),and ASES scores increased(P<0.05).The VAS score in experimental group 2 was significantly lower than that in experimental group 1 and the control group(P<0.05),while the ASES score and the differences in VAS and ASES scores were significantly higher in experimental group 2 than in the other two groups(P<0.05).After treatment,flexion,abduction,and external rotation angles increased in all three groups compared with those before treatment(P<0.05),and these angles in experimental group 2 were greater than those in experimental group 1 and the control group(P<0.05).There was no statistically significant difference in the incidence of adverse events among the three groups(P>0.05).Conclusion Distal acupoint acupuncture combined with topical application of Xiaozhong Zhitong Ointment is clinically effective in treating acute rotator cuff injuries,significantly alleviating pain and promoting the recovery of shoulder joint function.