Objective: To investigate the effect of ganoderic acid A (GA-A) on apoptosis and autophagy in human lung cancer cells by mediating the adenosine 5'-monophosphate-activated protein kinase (AMPK)/unc-51-like autophagy-activating kinase (ULK1)/mammalian target of rapamycin (mTOR) pathway. Methods: The Cell Counting Kit (CCK-8) was used to detect the toxicity of GA-A (0-160 μM) on A549 cells. A549 cells were assigned into control group (Ctrl), low-dose GA-A group (GA-A-L, 40 μM), high-dose GA-A group (GA-A-H, 80 μM), and high-dose GA-A+AMPK inhibitor group (GA-A-H+compound C). The colony formation experiment was used to detect cell proliferation ability. Flow cytometry was used to detect apoptosis in A549 cells. MTT method was used to detect cell proliferation; Western blot was used to detect the expression levels of apoptosis, autophagy, and AMPK/ULK1/mTOR pathway-related proteins in A549 cells. Results: Compared with the 0 μM group, the proliferation inhibition rate of A549 cells in the GA-A treatment groups was prominently higher (P<0.05), and the IC50 of GA-A on A549 cells was 81.44 μM. Compared with the control group, the A549 cell survival rate, colony formation rate, Bcl-2 and p62 protein expression, and p-mTOR/mTOR level were prominently lower in the GA-A-L and GA-A-H groups (P<0.05), while the apoptosis rate, number of autophagosomes, Bax protein expression, and LC3B-II/I, p-AMPK/AMPK, and p-ULK1/ULK1 levels were prominently higher (P<0.05). Compared with the GA-A-H group, the cell survival rate, colony formation rate, Bcl-2 and p62 protein expression, and p-mTOR/mTOR level were prominently higher in the GA-A-H+compound C group (P<0.05), while the apoptosis rate, number of autophagosomes, Bax protein expression, and LC3B-II/I, p-AMPK/AMPK, and p-ULK1/ULK1 levels were prominently lower (P<0.05). Conclusion: GA-A may induce apoptosis and autophagy in human lung cancer cells and inhibit cell proliferation by regulating the expression of key proteins in the AMPK/ULK1/mTOR pathway.

Objective: To investigate the effects of miR-425-5p on heart failure in rats and preliminarily explore its potential mechanism of action. Methods: A rat model of heart failure was established through multiple intraperitoneal injections of doxorubicin hydrochloride. After successful modeling, healthy male SD rats were randomly divided into five groups: model group, NC-Inhibitor group, miR-425-5p Inhibitor group, NC-agomir group, and miR-425-5p agomir group, with 10 rats in each group. An additional 10 healthy SD rats were used as the control group. After 4 weeks of intervention, cardiac function indicators including left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), and left ventricular fractional shortening (LVFS) were measured in each group. HE staining was used to observe morphological changes in myocardial tissue. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) in myocardial tissue were determined by enzyme-linked immunosorbent assay (ELISA). Reactive oxygen species (ROS) levels in myocardial tissue were detected by flow cytometry. qRT-PCR was used to detect the levels of miR-425-5p, ERK, and Nrf2 mRNA in myocardial tissue. Western Blot was performed to detect the protein levels of p-ERK and Nrf2. Results: Compared with the control group, rats in the model group showed significantly increased LVEDD, LVESD, and MDA levels, while LVEF, LVFS, SOD, GSH-Px, and ROS levels were significantly decreased. Pathological damage to myocardial tissue was increased, and miR-425-5p mRNA levels were significantly reduced. Additionally, ERK mRNA, Nrf2 mRNA, p-ERK, and Nrf2 protein expression levels were significantly decreased. Compared with the model group, rats in the miR-425-5p Inhibitor group exhibited further increases in LVEDD, LVESD, and MDA levels, with decreases in LVEF, LVFS, SOD, GSH-Px, and ROS levels. Pathological damage to myocardial tissue was exacerbated, and ERK mRNA, Nrf2 mRNA, p-ERK, and Nrf2 protein expression levels were significantly reduced. In contrast, rats in the miR-425-5p agomir group showed significant decreases in LVEDD, LVESD, and MDA levels, with increases in LVEF, LVFS, SOD, GSH-Px, and ROS levels. Pathological damage to myocardial tissue was alleviated, and ERK mRNA, Nrf2 mRNA, p-ERK, and Nrf2 protein expression levels were significantly increased. Conclusion: miR-425-5p inhibits heart failure in rats by regulating oxidative damage mediated by the ERK/Nrf2 signaling pathway.

Objective: To investigate the effect of metoprolol on myocardial energy metabolism in rats with chronic heart failure (CHF) by regulating the peroxisome proliferator-activated receptor coactivator 1α (PGC1α)-peroxisome proliferator-activated receptor α (PPARα)-mammalian target of rapamycin (mTOR) signaling pathway. Methods: CHF rat models were established by coronary artery ligation. Rats were randomly divided into sham operation group (only sutured without ligation), model group, captopril group (2.57 mg/kg captopril gavage), low-dose metoprolol group (10 mg/kg), and high-dose metoprolol group (20 mg/kg), with 15 rats in each group. After 4 weeks of continuous treatment, cardiac function was evaluated by echocardiography; serum myocardial injury-related indicators were detected using ELISA kits; myocardial histopathological changes were observed by hematoxylin-eosin (HE) and Masson trichrome staining; myocardial cell apoptosis was observed by TUNEL staining; myocardial energy metabolism-related indicators were detected by colorimetry; and the expression of proteins related to the PGC1α-PPARα-mTOR signaling pathway was analyzed by Western blot. Results: Compared with the sham operation group, the model group showed massive inflammatory infiltration and blue collagen fiber deposition in myocardial cells, significantly decreased levels of LVEF, LVFS, glycogen mass fraction, ATP concentration, PGC1α, PPARα, and p-mTOR (P<0.05), and significantly increased LVESD, LVEDD, CK-MB, cTnT, myocardial cell apoptosis ratio, fatty acid (FA), and lactate levels (P<0.05). Compared with the model group, the low-dose and high-dose metoprolol groups and the captopril group exhibited varying degrees of alleviated myocardial cell injury, reduced collagen deposition in myocardial cells, significantly increased LVEF, LVFS, glycogen mass fraction, ATP concentration, PGC1α, PPARα, and p-mTOR levels (P<0.05), and significantly decreased LVESD, LVEDD, CK-MB, cTnT, myocardial cell apoptosis ratio, FA, and lactate levels (P<0.05). Compared with the low-dose metoprolol group and the captopril group, the high-dose metoprolol group had less collagen deposition in myocardial cells, significantly higher LVEF, LVFS, glycogen mass fraction, ATP concentration, PGC1α, PPARα, and p-mTOR levels (P<0.05), and significantly lower LVESD, LVEDD, CK-MB, cTnT, myocardial cell apoptosis ratio, FA, and lactate levels (P<0.05). Conclusion: Metoprolol mediates myocardial cell energy metabolism by activating the PGC1α-PPARα-mTOR signaling pathway, alleviates pathological damage of myocardial cells in CHF rats, and thus improves cardiac function in CHF rats.

Objective: To investigate the impacts of long non-coding RNA (LncRNA) non-coding RNA activated by DNA damage (NORAD) on migration and invasion of acute myeloid leukemia (AML) cells by adjusting microRNA-136-5p (miR-136-5p)/chromobox protein homolog 4 (CBX4) axis. Methods: Human AML cell line KG1a was used as the research subject and divided into control group, sh-NC group, sh-NORAD group, sh-NORAD+NC-inhibitor group, and sh-NORAD+miR-136-5p-inhibitor group, with six replicates in each group. The expressions of LncRNA NORAD, miR-136-5p, and CBX4 mRNA in KG1a cell lysate were detected by qRT-PCR. Plate cloning, scratch assay, and Transwell assay were performed to detect the impacts of knocking down LncRNA NORAD on proliferation, migration, and invasion of KG1a cells. Moreover, Western blot was used to detect protein expression. Results: Compared with sh-NC group and control group, the clone number, scratch healing rate, invasion number, LncRNA NORAD, CBX4 mRNA and protein, MMP-9 were decreased in sh-NORAD group, and the expression of miR-136-5p was increased (P<0.05). Compared with sh-NORAD group and sh-NORAD+NC-inhibitor group, the clone number, scratch healing rate, invasion number, CBX4 mRNA and protein and MMP-9 of sh-NORAD+miR-136-5p-inhibitor group were increased. The expression of miR-136-5p was decreased (P<0.05). LncRNA NORAD could target the negative regulation of miR-136-5p, and miR-136-5p could target the negative regulation of CBX4. Conclusion: LncRNA NORAD can regulate the miR-136-5p/CBX4 axis to promote migration and invasion of AML cells.

Objective: To investigate the protective effects of tanshinone on heart and lung injury induced by severe sepsis and its association with the Toll-like receptor (TLRs) signaling pathway. Methods: A total of 80 male C57BL/6 mice were randomly divided into four groups: normal control group, sepsis model group, low-dose tanshinone (low-tan) group, and high-dose tanshinone (high-tan) group. Sepsis was induced in the model group by intraperitoneal injection of lipopolysaccharide (LPS). The low-tan and high-tan groups were treated with low and high doses of tanshinone, respectively, 1 hour before model induction. After 24 hours of modeling, heart and lung function, oxidative stress markers, TLRs signaling pathway-related protein expression, and pathological changes were assessed. Results: Compared with the control group, the airway resistance in the model group was significantly increased (P<0.01), and the lung compliance was significantly reduced (P<0.01); compared with the model group, the airway resistance in the low-tan group and high-tan group was reduced (P<0.01), and the lung compliance was increased (P<0.01), and the improvement in the high-tan group was more significant. The MDA level in heart and lung tissues of the model group was increased (P<0.01), and the SOD level was reduced (P<0.01); compared with the model group, the MDA level in the low-tan group and high-tan group was decreased (P<0.01), and the SOD level was increased (P<0.01), and the improvement in the high-tan group was more significant. The expression levels of TLR4, MyD88, and NF-κB proteins in heart and lung tissues of the model group were higher than those in the control group (P<0.001); the expression levels of these proteins in the low-tan group and high-tan group were lower than those in the model group (P<0.01 or P<0.001), and the reduction in the high-tan group was more obvious. In the control group, cardiomyocytes were arranged neatly and the structure was normal without obvious pathological changes; in the model group, cardiomyocytes were edematous and degenerated, and there were inflammatory cell infiltrations in the interstitium, and myocardial fibrosis may occur; in the low-tan group, the degree of cardiomyocyte damage was reduced compared with the model group, and the infiltration of inflammatory cells was reduced; in the high-tan group, the morphology of cardiomyocytes was close to normal and the inflammatory reaction was mild. In the control group, the alveolar structure was complete and there was no obvious inflammatory cell infiltration; in the model group, the alveolar wall was thickened, inflammatory cell infiltration was obvious, and the alveolar structure was damaged; in the low-tan group, alveolar inflammation was reduced and structural damage was improved; in the high-tan group, the alveolar structure was basically restored to normal and there was very little inflammatory cell infiltration. Conclusion: Danshentone significantly reduced cardiopulmonary injury caused by severe sepsis by inhibiting TLRs signaling pathway and reducing oxidative stress response.

Objective: To investigate the effect of MAC30 on breast cancer cell apoptosis through the regulation of ferroptosis mediated by JNK/Nrf2/HO-1 pathway. Methods: The mRNA and protein expression levels of MAC30 were detected in normal breast cells and various breast cancer cell lines. MCF-7 cells were divided into four groups: the control group, the NC-shRNA group (MCF-7 cells transfected with MAC30-NC-shRNA), the MAC30-shRNA group (MCF-7 cells transfected with MAC30-shRNA), and the MAC30-shRNA+SP600125 group (MCF-7 cells transfected with MAC30-shRNA and treated with JNK inhibitor). RT-qPCR and Western blot were used to detect the mRNA and protein expression levels of MAC30 in each group of MCF-7 cells to verify the transfection efficiency. CCK-8 assay, clone formation experiment, and flow cytometry were used to detect cell viability, clone number, and apoptosis in each group. Kits were utilized to measure the levels of ROS, MDA, GSH, and Fe²⁺ within cells of each group. RT-qPCR and Western blot were conducted to detect the mRNA and protein expression levels of iron death-related genes (GPX4, SLC7A11) in cells of each group. Western blot was also used to detect the expression levels of apoptosis-related proteins (Caspase-3, Bax, Bcl-2) and proteins related to the JNK/Nrf2/HO-1 signaling pathway (JNK, p-JNK, Nrf2, HO-1) in cells of each group. Results: Compared to the control group and the NC-shRNA group, the MAC30-shRNA group exhibited decreased mRNA and protein expression levels of MAC30, cell viability, and clone number in MCF-7 cells (P<0.05). Additionally, the apoptosis rate of MCF-7 cells, expression levels of Caspase-3 protein and Bax/Bcl-2, mRNA and protein expression levels of ferroptosis-related genes, as well as the expression levels of p-JNK/JNK and Nrf2 (cytoplasmic) were increased (P<0.05). Conversely, the expression levels of Nrf2 (nuclear) and HO-1 were decreased (P<0.05). Compared to the MAC30-shRNA group, the MAC30-shRNA+SP600125 group exhibited increased levels of MAC30 mRNA and protein expression, cell viability, and clone number within MCF-7 cells (P<0.05). Additionally, there were decreases in the apoptosis rate, Caspase-3 protein levels, Bax/Bcl-2 expression ratios, mRNA and protein expression levels of ferroptosis-related genes, and expression levels of p-JNK/JNK and Nrf2 (cytoplasmic) (P<0.05). Conversely, the expression levels of Nrf2 (nuclear) and HO-1 increased (P<0.05). Conclusion: Knockdown of MAC30 may promote apoptosis in breast cancer cells by regulating iron death mediated through the JNK/Nrf2/HO-1 signaling pathway.

Objective: To detect pathogens in elderly patients with persistent inflammation immunosuppression catabolism syndrome (PICS) using targeted next-generation sequencing (tNGS) technology, and to evaluate the diagnostic and therapeutic value of tNGS in screening for this disease. Methods: A total of 107 sputum samples from general inflammatory elderly patients and 107 sputum samples from PICS elderly patients admitted to our hospital from Jul. 2023 to Jul. 2024 were collected. tNGS was used to detect pathogens in both groups of patients and to compare the microbial characteristics between the two groups. Results: Using tNGS technology, 45 types of pathogens were identified in the control group, including 20 bacteria, 14 viruses, and 11 fungi; while 48 types of pathogens were identified in the observation group, including 24 bacteria, 12 viruses, and 12 fungi. Among the pathogens isolated using tNGS technology, the top three bacteria detected in the control group were Fusobacterium nucleatum (n=43), Streptococcus anginosus group (n=40), and Haemophilus influenzae (n=34); while in the observation group, they were Fusobacterium nucleatum (n=44), Pseudomonas aeruginosa (n=44), and Acinetobacter baumannii (n=32). The most detected fungi and viruses in both groups were Candida albicans and Epstein-Barr virus, respectively. Conclusion: tNGS is a potential tool for detecting pathogens in elderly patients with PICS, which can be used to detect pathogens in the patients and preliminarily confirm clinical diagnostic candidate markers for PICS.

Objective: To investigate the correlation between the levels of serum interleukin-12P70 (IL-12P70), 4-hydroxynonenal (4-HNE), and Calcium-binding protein (S100A12) in elderly patients with community-acquired pneumonia (CAP) and the severity and prognosis of the disease. Methods: A total of 158 elderly patients with CAP admitted to Hebei Chest Hospital from Apr. 2022 to Jun. 2024 were selected as the study group, and another 158 healthy physical examination subjects were selected as the control group. the levels of serum IL-12P70, 4-HNE, S100A12, pulmonary infection score (CPIS), acute physiology and chronic health evaluation II (APACHE II)score and pulmonary function indices [force expiratory volume in the first second (FEV1), and forceful lung capacity (FVC)] were compared in patients with different disease severity of the study group and control group. The correlation between serum levels of IL-12P70, 4-HNE, and S100A12 and the severity score of the disease was analyzed. The study group was followed up for 28 days and assigned to a good prognosis subgroup and a poor prognosis subgroup based on prognosis. The clinical data, serum levels of IL-12P70, 4-HNE, and S100A12 were compared between the two subgroups. The correlation and predictive efficacy of serum IL-12P70, 4-HNE, and S100A12 with prognosis were analyzed. Results: The levels of serum IL-12P70, 4-HNE, and S100A12 in the study group were higher than those in the control group (P<0.05). The levels of CPIS, APACHE II score, serum IL-12P70, 4-HNE, and S100A12 in severe patients were higher than those in non-severe patients, FEV1 and FVC were lower than non-severe patients (P<0.05). Pearson correlation analysis showed that serum IL-12P70, 4-HNE, and S100A12 were positively correlated with CPIS and APACHE II scores, negatively correlated with FEV1 and FVC(P<0.05). After a follow-up of 28 days, 33 patients in the study group had a poor prognosis and 125 patients had a good prognosis, which were included in the poor prognosis subgroup and the good prognosis subgroup, respectively. The age, proportion of severe cases, proportion of diabetes, CPIS, APACHE II score, serum IL-12P70, 4-HNE, and S100A12 levels in the poor prognosis subgroup were higher than those in the good prognosis subgroup,while FEV1 and FVC were lower than good prognosis subgroup (P<0.05). Logistic regression analysis showed that serum IL-12P70, 4-HNE, and S100A12 were independent factors affecting prognosis for elderly CAP patients before and after adjusting for age, diabetes, and other factors (P<0.05). ROC curve analysis showed that the AUC of serum IL-12P70, 4-HNE, and S100A12 for predicting the prognosis of elderly CAP was 0.796, 0.730, and 0.783, respectively. The optimal cutoff values were 5.24 pg/mL, 21.23 mg/L, and 23.70 ng/mL, with sensitivities of 66.67%, 63.64%, and 81.82%, and specificities of 82.40%, 74.40%, and 68.80%, respectively. The AUC of the combined prediction of the prognosis of elderly CAP was 0.911, with a sensitivity of 84.85% and a specificity of 80.80%, which was significantly improved compared with the prediction performance of individual factors (Z=2.377, 2.850, 2.685, P=0.018, 0.004, 0.007). Another 68 cases of elderly CAP patients in the same period were selected as the sample of external validation data set, of which 46 cases were severe and 22 cases were non-severe, with 28 days of follow-up, and 13 cases of poor prognosis and 55 cases of good prognosis. Serum IL-12P70, 4-HNE, and S100A12 combined to predict the prognosis of the 68 patients in the external validation data set sample was 11 cases of poor prognosis and 57 cases of good prognosis, with an accuracy of 97.06%, suggesting that the prediction efficiency was good. Conclusion: Serum IL-12P70, 4-HNE, and S100A12 are positively correlated with the severity of disease in elderly patients with CAP and are independent factors affecting prognosis. Combined detection can accurately predict the prognosis.

Objective: To investigate the etiological characteristics of pulmonary infection in patients undergoing chemotherapy for advanced lung cancer and the predictive value of high mobility group box 1 (HMGB1) combined with matrix metalloproteinase-9 (MMP-9). Methods: A total of 118 patients who underwent chemotherapy for advanced lung cancer in the Second Affiliated Hospital of Air Force Medical University from June 2023 to June 2024 were selected, and divided into the infected group (n=51) and the uninfected group (n=67) based on whether they developed pulmonary infection after chemotherapy. Sputum samples were collected from the infected group for etiological examination. The levels of HMGB1 and MMP-9 in the two groups were compared. Logistic regression analysis was performed to identify factors influencing pulmonary infection in patients undergoing chemotherapy for advanced lung cancer. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of HMGB1 combined with MMP-9 levels for pulmonary infection. Results: In this study, 51 patients developed pulmonary infection. A total of 64 strains of pathogenic bacteria were isolated, including 39 strains (60.94%) of Gram-negative bacteria, 20 strains (31.25%) of Gram-positive bacteria, and 5 strains (7.81%) of fungi. The levels of HMGB1 and MMP-9 in the infected group were higher than those in the uninfected group (P<0.05). Logistic regression analysis showed that HMGB1 and MMP-9 levels were risk factors for pulmonary infection (P<0.05). The area under the curve (AUC), sensitivity and specificity of HMGB1 were 0.806, 56.86% and 94.03% (P<0.05). The AUC, sensitivity and specificity of MMP-9 were 0.838, 62.75% and 92.54% (P<0.05). The AUC, sensitivity and specificity of HMGB1 combined with MMP-9 were 0.905, 72.55% and 92.54% (P<0.05). Conclusion: Gram-negative bacteria are main pathogenic bacteria of pulmonary infection in patients undergoing chemotherapy for advanced lung cancer. The levels of HMGB1 and MMP-9 are significantly elevated in patients with pulmonary infection. Combination of HMGB1 and MMP-9 can improve clinical diagnostic efficacy for pulmonary infection in patients undergoing chemotherapy for advanced lung cancer.

Objective: To analyze the correlation between coagulation indexes and homocysteine (Hcy), β2-microglobulin (β2-MG) and occurrence of end-stage renal disease (ESRD) in patients with hypertensive nephropathy (HN). Methods: A total of 138 patients with HN in the hospital from August 2019 to August 2021 were selected as the study group. According to the occurrence of ESRD after 3 years of follow-up, the above patients were divided into ESRD group (n=26) and non-ESRD group (n=112). In addition, 102 hypertensive patients without nephropathy who received examination in the hospital during the same period were included in the control group. The levels of coagulation indexes [D-dimer (D-D), fibrinogen (Fib), fibrinogen degradation product (FDP)], Hcy and β2-MG were measured among all study subjects. The correlation between D-D, Fib and FDP levels and Hcy and β2-MG levels in hypertensive nephropathy patients was analyzed by Pearson correlation, and the correlation between D-D, Fib and FDP levels and the occurrence of end-stage nephropathy in hypertensive nephropathy patients was analyzed by Logistic regression. Results: The levels of serum D-D, Fib, FDP, Hcy and β2-MG in the study group were higher than those in the control group (P<0.05). Serum D-D, Fib, FDP, Hcy and β2-MG levels were higher in the ESRD group than those in the non-ESRD group (P<0.05). Correlation analysis indicated that serum D-D, Fib and FDP levels were positively correlated with Hcy and β2-MG levels in patients with HN (r=0.771, 0.795; 0.568, 0.619; 0.545,0.591, P<0.05). The levels of D-D, Fib and FDP in hypertensive nephropathy patients were independent risk factors for end-stage nephropathy (P<0.05). Conclusion: The levels of D-D, Fib and FDP in hypertensive nephropathy patients were positively correlated with the levels of Hcy, β2-MG and end-stage nephropathy.

Objective: To study the value of combined detection of urinary insulin-like growth factor binding protein 7 (IGFBP7) and matrix metalloproteinase inhibitor 2 (TIMP-2) in the early risk prediction of severe acute pancreatitis (SAP) complicated with acute kidney injury (AKI). Methods: A total of 89 SAP patients admitted from January 2022 to January 2024 were retrospectively selected. According to the presence or absence of AKI, they were divided into a complicated group (complicated with AKI, 24 cases) and a single group (without AKI, 65 cases). The levels of urinary IGFBP7 and TIMP-2 in the two groups were determined by enzyme-linked immunosorbent assay (ELISA). The influencing factors of AKI in SAP patients were selected by multivariate Logistic regression analysis. The value of the bedside index for severity in acute pancreatitis (Bisap) score and the product of urinary IGFBP7 and TIMP-2 were selected by receiver operating characteristic (ROC) curve analysis. Results: The serum calcium level of the concurrent group was lower than that of the single group, and the product of urinary IGFBP7 and TIMP-2, high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), D-dimer, and Bisap score were higher, and the differences were statistically significant (P<0.05). The product of urinary IGFBP7 and TIMP-2 also increased with the increase of AKI grade in AKI patients (P<0.05). Pearson analysis showed that serum calcium level and urinary IGFBP7 and TIMP-2 product were negatively correlated in AKI patients (P<0.05), and hs-CRP, PCT, D-dimer and Bisap score were positively correlated with TIMP-2 product (P<0.05). Multivariate logistic regression analysis showed that the product of urinary IGFBP7 and TIMP-2 and Bisap score was the influencing factor of SAP complicated with AKI (P<0.05). ROC curve showed that the area under the curve (AUC) of the product of urinary IGFBP7 and TIMP-2 in the prediction of SAP complicated with AKI was higher than that of Bisap score (P<0.05). Conclusion: The significantly increased product of urinary IGFBP7 and TIMP-2 is an influencing factor of AKI in SAP patients and can assist in predicting the occurrence of AKI.

Objective: To analyze the predictive value of serum chemokine ligand 19 (CCL19), high mobility protein-1 (HMGB1), and interferon - γ (IFN - γ) for perinatal outcomes in patients with systemic lupus erythematosus (SLE) during pregnancy. Methods: A total of 180 pregnant SLE patients treated in our hospital from January 2022 to January 2024 were selected and divided into an adverse group (n=41) and a good group (n=139) according to perinatal outcomes. Another 41 non-pregnant SLE patients treated in our hospital during the same period were selected as the control group. Serum levels of CCL19, HMGB1 and IFN-γ were compared between the three groups. logistic regression analysis was conducted to analyze the influencing factors of adverse perinatal outcomes in SLE patients during pregnancy, and the predictive efficacy of serum CCL19, HMGB1, and IFN-γ in SLE patients during pregnancy was analyzed by receiver operating curve (ROC). Results: Serum levels of CCL19, HMGB1 and IFN-γ in adverse group were higher than those in good group and control group (F=1184.610, 180.557, 487.362, P<0.05). Serum levels of CCL19, HMGB1 and IFN-γ in the good group were higher than those in the control group (P<0.05). Logistic regression analysis showed that, CCL19 [OR (95%CI): 2.036 (1.037~4.317)], HMGB1 [OR (95%CI): 1.982 (1.130~3.592)], IFN - γ [OR (95%CI): 3.936 (1.392~5.284)], Raynaud's phenomenon [OR (95%CI): 1.818 (1.057~3.269)], SLE disease activity score (SLEDAI)[OR (95%CI): 2.387 (1.047~4.082)] are risk factors for adverse perinatal outcomes in pregnant SLE patients (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of the combined detection of serum CCL19, HMGB1, and IFN - γ for predicting adverse perinatal outcomes in pregnant SLE patients was 0.873, with a 95% confidence interval of 0.816~0.931. The AUC of the combined detection of serum CCL19, HMGB1, and IFN - γ was higher than that of single detection (Z/P=2.402/0.013, 2.598/0.009, 2.710/0.006). Conclusion: Overexpression of serum CCL19, HMGB1, and IFN - γ in pregnant SLE patients is closely associated with adverse perinatal outcomes. Combined detection of serum CCL19, HMGB1, and IFN - γ can improve the predictive power of adverse perinatal outcomes in pregnant SLE patients.

Objective: To explore the interactive effect and combined predictive value of serum sex hormone binding globulin (SHBG) and fatty acid binding protein 4 (FABP4) levels in the risk of premature delivery in patients with gestational diabetes mellitus (GDM). Methods: 209 GDM patients from Yuncheng Central Hospital Affiliated to Shanxi Medical University from June 2021 to June 2024 were selected as the research subjects. They were assigned to premature group (65 cases) and full-term group (144 cases) according to whether premature delivery occurred. Serum SHBG and FABP4 levels were detected in fasting peripheral venous blood drawn early in the morning of the day following the diagnosis of GDM (before any glucose-lowering intervention) in all patients, the levels of serum SHBG and FABP4 were compared between the two groups, serum SHBG and FABP4 levels were classified into high and low levels based on the median and accordingly divided into four subgroups. The clinical data and premature delivery rates of the four subgroups were compared. The relationship and interactive effect between serum SHBG, FABP4 and the risk of premature delivery were analyzed. The predictive value of serum SHBG and FABP4 for the risk of premature delivery was evaluated. Results: The serum SHBG level in the preterm group was (332.61±75.93) nmoL/L, significantly lower than that in the full-term group [(428.38±108.74) nmoL/L], while the FABP4 level [(28.55±8.13) μg/L] was significantly higher than that in the full-term group [(20.93±6.52) μg/L] (P<0.05). There were statistically significant differences in pre-pregnancy BMI, gestational weight gain, history of adverse pregnancy, fasting blood glucose (FBG), 1-hour postprandial blood glucose (1h PBG), 2-hour postprandial blood glucose (2h PBG), and preterm birth rate among the four subgroups (P<0.05). Before and after adjusting for other factors, serum SHBG and FABP4 levels were independent influencing factors for preterm birth risk in GDM patients (P<0.05). Before adjusting for other factors, compared with the Q1 subgroup, the odds ratios (OR) [95% confidence interval (CI)] for preterm birth risk in GDM patients in the Q2, Q3, and Q4 subgroups were 3.125 (1.186~8.234), 3.114 (1.224~7.920), and 6.024 (2.451~14.806), respectively. After adjusting for other factors, the OR (95%CI) for preterm birth risk in the Q2, Q3, and Q4 subgroups were 2.929 (1.152~7.449), 2.785 (1.103~7.031), and 5.428 (2.216~13.297), respectively. Interaction analysis showed a positive interaction between low SHBG levels and high FABP4 levels in the risk of preterm birth in GDM patients (P<0.05). The area under the receiver operating characteristic curve (AUC) for serum SHBG and FABP4 in predicting preterm birth risk in GDM patients was 0.760 and 0.755, with sensitivity of 80.00% and 83.08%, and specificity of 65.28% and 60.42%, respectively. The combined prediction model had an AUC of 0.887, sensitivity of 84.62%, and specificity of 85.42%, which was significantly better than the individual predictive values of the two markers (Z=3.011, 2.781; P=0.003, 0.005). Conclusion: Low serum SHBG expression and high FABP4 expression exhibit a positive interaction in the risk of preterm birth in GDM patients, serving as independent influencing factors. The combined prediction model demonstrates reliable predictive value for preterm birth risk in GDM patients.

Objective: To analyze the correlation between neutrophil count (NC), coagulation parameters and deep venous thrombosis (DVT) after total knee arthroplasty (TKA). Methods: Totally 364 patients who received TKA in the hospital from September 2022 to September 2023 were divided into thrombosis group (n=42) and non-thrombosis group (n=322) according to whether DVT occurred after surgery. Peripheral blood NC, D-D, Fib, APTT, PT and TT of all study subjects were measured at 3 days after surgery. Logistic regression analysis was adopted to explore the relationship between NC and coagulation parameters with the occurrence of DVT after TKA. The predictive value of NC and coagulation parameters on the occurrence of postoperative DVT was investigated by receiver operating characteristic curve (ROC). Results: At 3 days after surgery, the levels of NC, D-D, and Fib in the thrombosis group were higher than those in the non-thrombosis group (P<0.05), but there were no obvious differences in APTT, PT and TT between groups (P>0.05). Logistic regression analysis suggested that the levels of NC, D-D, and Fib were independent risk factors of DVT occurrence after TKA (P<0.05). ROC curve showed that 3 days after surgery, the area under the curve (AUC) of NC, D-D, and Fib independently predicted the occurrence of deep vein thrombosis after total knee replacement was 0.636, 0.724 and 0.664, respectively, and the sensitivity was 45.24%, 47.62% and 66.67%, respectively. The specificity was 81.68%, 88.82%, 64.60%, respectively. The AUC of the combined prediction was 0.905, the sensitivity was 85.71%, and the specificity was 80.43%. The combined prediction efficiency was better than that of each index alone (P<0.05). Conclusion: The occurrence of DVT after TKA is closely related to the postoperative NC and coagulation parameters. The determination of NC and coagulation parameters after surgery can be used to understand the risk of lower extremity DVT, to guide clinical early prevention and treatment measures.

Objective: To explore the correlation between the expression levels of serum insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), and thyroid-stimulating hormone (TSH) index, and the progression of cognitive impairment to dementia in cerebral small vessel disease (CSVD), to provide a reference for clinical prevention and treatment. Methods: A total of 210 CSVD patients with cognitive impairment admitted to the hospital from May 2020 to May 2023 were selected and treated with symptomatic treatment. They were followed up for 1 year and assigned to a dementia group and a non-dementia group based on whether their cognitive impairment progressed to dementia. Clinical data were collected from all patients, and 5 mL of fasting venous blood was collected early in the morning of the day following the admission of all patients to detect the levels of serum IGF-1, VEGF, and TSH indices. The clinical data, serum levels of IGF-1, VEGF, and TSH indices were compared between the two groups, the correlation between serum levels of IGF-1, VEGF, and TSH indices and the severity of cognitive impairment and dementia was analyzed, the predictive value of each serum marker for the progression of CSVD cognitive impairment to dementia was evaluated. Results: Compared with the non-dementia group, the dementia group had higher proportions of alcohol consumption, family history of dementia, and total CSVD imaging burden scores at baseline, as well as lower MoCA scores and proportions of regular anti-cognitive impairment treatment at baseline (all P<0.05). Compared with the non-dementia group (97.28±14.15) ng/mL, (248.77±40.61) ng/L, and (133.27±13.58) mIU/L, the dementia group had lower serum IGF-1 and VEGF levels [(83.65±10.40) ng/mL and (210.49±35.23) ng/L, respectively], and a higher TSH index level (151.45±18.72) mIU/L (t=5.471, 5.762, 6.791, all P<0.05); serum IGF-1 and VEGF were negatively correlated with the total burden score of CSVD imaging at baseline, and positively correlated with MoCA score; the TSH index was positively correlated with the total burden score of CSVD imaging at baseline, and negatively correlated with MoCA score (P<0.05). Before and after correcting other factors, serum IGF-1, VEGF, and TSH indices were still independently associated with the progression of CSVD cognitive impairment to dementia (P<0.05). The AUCs of serum IGF-1, VEGF, and TSH index for predicting the progression of CSVD cognitive impairment to dementia were 0.776 (95%CI: 0.713~0.831), 0.812 (95%CI: 0.752~0.863), and 0.821 (95%CI: 0.762~0.871), respectively; the AUC of the three combined predictors for the progression of CSVD cognitive impairment to dementia was 0.932 (95%CI: 0.888~0.962), with a sensitivity of 88.89% and a specificity of 84.71%; the predictive value was significantly higher than that of each predictor (P<0.05). Conclusion: The serum levels of IGF-1, VEGF, and TSH indices are significantly correlated with the condition of patients with CSVD cognitive impairment, which are independent factors contributing to the progression to dementia, and their combined predictive value is reliable.

Objective: To investigate the expression levels of angiopoietin like protein 8 (ANGPTL8) and CXC chemokine ligand 16 (CXCL16) in serum of patients undergoing total knee replacement, and their correlation with lower extremity deep vein thrombosis. Methods: A total of 110 patients who underwent total knee arthroplasty at our hospital between December 2016 and June 2022 were enrolled. Serum ANGPTL8 and CXCL16 levels were measured by enzyme-linked immunosorbent assay (ELISA) preoperatively and 7 days postoperatively for comparison. Patients were divided into non-deep vein thrombosis (non-DVT) group (n=76) and deep vein thrombosis (DVT) group (n=34) based on whether they developed lower extremity DVT. General characteristics were compared between the two groups. Pearson correlation analysis was performed to examine: 1) the correlation between serum ANGPTL8 and CXCL16 levels, and 2) their association with DVT occurrence. Multivariate logistic regression analysis was conducted to identify risk factors for DVT in TKA patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of serum ANGPTL8 and CXCL16 levels for DVT development. Results: 7 days after the surgery of total knee replacement, Serum ANGPTL8 and CXCL16 were significantly lower than preoperative (t=9.189,5.773, P=0.000) and serum ANGPTL8 and CXCL167d in lower extremity deep veinthrornbosis group was higher than that in non lowere extremity deep vein thrombosis group (t=1.96 1,7.580,1.029,8.095,P=0.052,0.000,0.306,0.000); there were obvious differences in age, hypertension history, operation time, bed rest time and body mass index between lower extremity deep vein thrombosis group and non lower extremity deep vein thrombosis group (P<0.05); the levels of serum ANGPTL8 and CXCL16 were obviously and positively correlated with the occurrence of lower extremity deep vein thrombosis (r=0.728, 0.856, P=0.001, 0.000); there was a obvious positive correlation between serum ANGPTL8 level and CXCL16 level in patients with total knee replacement (r=0.538, P=0.000); serum ANGPTL8, CXCL16, history of hypertension, operation time and bed rest time after operation were the influencing factors of lower extremity deep vein thrombosis in patients undergoing total knee replacement (P<0.05); the AUC predicted by the combination of serum ANGPTL8 and CXCL16 in patients undergoing total knee replacement was 0.986, with a sensitivity of 94.12% and a specificity of 95.37%, which was better than their separate prediction (Zcombination-ANGPTL8=2.193, Zcombination-CXCL16=2.343, P=0.028, 0.019). Conclusion: The levels of serum ANGPTL8 and CXCL16 in patients with total knee replacement 7 days after operation are obviously lower than those before operation, in addition, patients with lower extremity deep vein thrombosis have higher levels of serum ANGPTL8 and CXCL16, the combined detection of the two can better evaluate the occurrence of lower extremity deep vein thrombosis in patients undergoing total knee replacement.

Objective: To explore the value of ABCD2 score combined with peripheral blood homocysteine (Hcy) and glutathione peroxidase (GSH-Px) levels on predicting the prognosis of patients with transient ischemic attack (TIA). Methods: A total of 126 patients with TIA from December 2022 to August 2024 were retrospectively analyzed and included in TIA group. According to whether acute cerebral infarction occurred within 7 days, the patients in TIA group were divided into ACI group (n=29) and non-ACI group (n=97). The baseline data, ABCD2 score and peripheral blood indexes (Hcy, GSH-Px) were compared between ACI group and non-ACI group. ABCD2 score and peripheral blood indexes (Hcy, GSH-Px) were compared between ACI group and non-ACI group. Pearson correlation analysis was used to explore the correlation between each index and clinical data. Binary logistic equation was adopted to analyze the related influencing factors of acute cerebral infarction in patients. ROC curve was drawn to analyze the diagnostic value of ABCD2 score combined with peripheral blood Hcy and GSH-Px levels on the prognosis in TIA group. Results: Hypertension, diabetes, attack duration, attack frequency, TC and TG in ACI group were significantly higher than those in non ACI group (P<0.05). The ABCD2 scores and peripheral blood Hcy levels in the ACI group were significantly higher than those in the non ACI group (P<0.05), while GSH Px was significantly lower than those in the non ACI group (P<0.05). ABCD2 score and Hcy were significantly positively correlated with attack duration, attack frequency, TC and TG (P<0.05), and GSH-Px was significantly negatively correlated with each index (P<0.05). The ABCD2 score and peripheral blood Hcy level in ACI group were significantly higher (P<0.05) while the GSH-Px was significantly lower compared to non-ACI group (P<0.05). ABCD2 score and levels of Hcy and GSH-Px in peripheral blood were correlated with acute cerebral infarction (P<0.05). The AUCs of ABCD2 score, peripheral blood Hcy and GSH-Px in predicting the poor prognosis of patients were 0.638, 0.677 and 0.701 respectively. The AUC of the combination of the three indexes for poor prognosis of patients was 0.770, and the combined diagnostic value was higher. Conclusion: ABCD2 score and levels of peripheral blood Hcy and GSH-Px are correlated with transient ischemic attack and poor prognosis, which are expected to be used as reference indexes.

Objective: To observe the relationship between elderly sarcopenia and swallowing dysfunction and analyze the effect of hyperbaric oxygen (HBO) adjuvant therapy. Methods: Totally 120 elderly patients with sarcopenia in the hospital from January 2022 to December 2023 were selected as the research subjects, and they received water swallow test. The occurrence of swallowing dysfunction was observed. The elderly patients with sarcopenia complicated with swallowing dysfunction were randomized into two groups. The control group adopted neuromuscular electrical stimulation, whereas the observation group received HBO adjuvant therapy on the basis of the control group. The levels of serum nutritional indexes [albumin (ALB), transferrin (TF)], modified Mann assessment of swallowing ability (MMASA), functional oral intake scale (FOIS) and swallowing-quality of life questionnaire (SWAL-QOL) were compared between groups at different time points. Results: Among the 120 elderly patients with sarcopenia, 66 cases were combined with dysphagia, the detection rate was 55.00%. 66 elderly patients with sarcopenia complicated with swallowing dysfunction were divided into control group (n=33) and observation group (n=33) by simple randomization method. At 3 weeks of treatment and at the end of treatment, serum ALB and TF levels in both groups were risen compared with those before treatment (P<0.05). The level of serum ALB in the observation group was higher than that in the control group at 3 weeks of treatment (P<0.05), and serum TF level was not statistically different from that in the control group (P>0.05), and the levels of serum ALB and TF at the end of treatment were higher compared with those in the control group (P<0.05). The swallowing function-related scores (MMASA, FOIS, SWAL-QOL) in both groups were enhanced at 3 weeks of treatment and at the end of treatment compared with those before treatment, and the observation group had higher scores (P<0.05). Conclusion: Elderly patients with sarcopenia are prone to swallowing dysfunction. After HBO adjuvant therapy, the swallowing function and nutritional status of elderly sarcopenia patients with swallowing dysfunction are significantly improved.

Objective: To study the efficacy of thoracoscopic surgery via lateral thoracic approach and subxiphoid approach in the treatment of mediastinal tumor (MT) and its influence on the levels of plasma pain-causing factors. Methods: Totally 118 patients with MT in the hospital from June 2020 to June 2023 were selected, and were divided into lateral thoracic group (thoracoscopic surgery via lateral thoracic approach, n=46) and xiphoid group (thoracoscopic surgery via subxiphoid approach, n=72) according to the surgical approaches. The propensity score method was used for 1∶1 matching, and 43 cases were included in each group. The surgical indicators, postoperative pain, pain-causing factors, incidence rates of postoperative complications, recurrence rate and survival status at 1 year after surgery were compared between groups. Results: The extubation time and analgesic days in xiphoid process group were shorter than those in lateral chest group, the differences were statistically significant (P<0.05). The scores of numerical rating scale (NRS) at T1, T2 and T3 in the xiphoid group with (3.53±0.86) points, (2.46±0.65) points and (1.67±0.41) points were lower than (4.26±1.18) points, (3.73±0.92) points and (2.18±0.54) points in the lateral thoracic group (P<0.05). Serum bradykinin (BK), neuropeptide Y (NPY) and prostaglandin E2 (PGE2) in the xiphoid group at T1, T2 and T3 were lower compared with those in the lateral thoracic group (P<0.05). There was no significant difference in total complications between xiphoid process group (6.99%) and lateral chest group (13.98%) (P>0.05). There was no significant difference in postoperative recurrence rate (2.33% vs 2.33%) and fatality rate (0% vs 2.33%) between the two groups (P>0.05). Conclusion: Thoracoscopic surgery via subxiphoid approach for patients with MT can effectively shorten the postoperative extubation time and analgesic use time, and reduce the levels of postoperative pain-causing factors, and it has high treatment safety.

Objective: To investigate the early warning efficacy and significance of renal resistance index (RRI), inferior vena cava respiratory variability index (IVC-RVI), and serum silent information regulator 3 (Sirtuin3 mRNA) in predicting acute kidney injury (AKI) secondary to septic shock. Methods: A total of 185 patients with septic shock admitted to our hospital from August 2020 to August 2023 were enrolled and divided into an AKI group (90 cases) and a non-AKI group (95 cases) based on whether AKI developed. Baseline data, RRI, IVC-RVI, and serum Sirtuin3 mRNA levels at 0 hours and 24 hours after fluid resuscitation were compared between the two groups. Multivariate logistic regression was used to analyze the effects of RRI reduction rate, IVC-RVI reduction rate, and serum Sirtuin3 mRNA on AKI secondary to septic shock. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of different models for AKI secondary to septic shock. Results: The APACHE II score and SOFA score in the AKI group were significantly higher than those in the non-AKI group (P<0.05). The RRI at 0h and 24h of fluid resuscitation in the AKI group was higher than that in the non-AKI group, and the decrease rate of RRI and Sirtuin3 mRNA were lower than those in the non-AKI group (P<0.05). The IVC-RVI at 0h and 24h of fluid resuscitation in the AKI group was lower than that in the non-AKI group, and the decrease rate of IVC-RVI was higher than that in the non-AKI group (P<0.05). Multivariate analysis showed that the reduction rate of RRI, the reduction rate of IVC-RVI, and Sirtuin3 mRNA were all independent factors associated with AKI secondary to septic shock. Each unit increase in these three factors increased the risk of AKI by 0.402, 1.365, and 0.398 times, respectively (P<0.05). ROC analysis showed that the AUC of traditional schemes: APACHE II score and SOFA score for predicting AKI secondary to septic shock were 0.729 and 0.744, respectively (P<0.001). New scheme: The AUC of RRI reduction rate, IVC-RVI reduction rate, Sirtuin3 mRNA, and the combination of the three for predicting AKI secondary to septic shock were 0.758, 0.766, 0.773, and 0.921, respectively (P<0.001). The RRI reduction rate + IVC-RVI reduction rate + AUC of Sirtuin3 mRNA were significantly greater than the APACHE II score, SOFA score, RRI reduction rate, IVC-RVI reduction rate, and Sirtuin3 mRNA (P<0.05). Sensitivity analysis showed that compared with the combination, the AUC values of Apache Ⅱ score+combination, SOFA score+combination, Apache Ⅱ score+SOFA score+combination were not significantly improved (P>0.05), suggesting that the prediction scheme including Apache Ⅱ score and SOFA score would not increase the prediction value, and had no significant impact on the joint prediction results after elimination. Conclusion: The reduction rate of RRI, IVC-RVI, and serum Sirtuin3 mRNA after 24 hours of fluid resuscitation are closely related to the occurrence of AKI secondary to septic shock. The combination of the three can provide early warning of the risk of AKI, and has higher predictive value than the traditional APACHE II score and SOFA score, providing a reference for clinical early warning of AKI and reducing the occurrence of AKI.

Objective: To analyze the correlation between serologic testing results and maternal immunoglobulin G (IgG) antibody titer in hemolytic disease of newborn (HDN) induced by ABO blood group incompatibility. Methods: A total of 142 children with HDN induced by ABO blood group antigen incompatibility in the hospital were enrolled as the research objects between May 2021 and May 2024. All children underwent blood group and related serology examinations. Results: In the 142 children with HDN induced by ABO blood group antigen incompatibility, positive rates in children with groups A and B were 55.63% and 44.37%, respectively. According to serologic testing, positive rates of direct anti-human globulin test, free IgG antibody test and antibody release test were 12.68%, 48.59% and 100%, respectively. The titer distribution of IgG anti-A (B) antibody was as follows: 1∶64, 1∶128, 1∶256, 1∶592, 1∶1024, and the corresponding number of cases was as follows: 64 cases(45.07%), 37 cases(26.06%), 22 cases(15.49%), 11 cases(7.75%), 8 cases(5.63%). There were significant differences in titer distribution of IgG antibody between mild HDN group and moderate to severe HDN group (P<0.05). Conclusion: The titer of IgG antibody is correlated with the severity of HDN.

Objective: To explore the clinical efficacy of traditional thoracotomy and minimally invasive cardiac surgery on patients with heart disease (HD) and influence on postoperative complications. Methods: The clinical data of 306 HD patients in the hospital from August 2021 to June 2024 were retrospectively analyzed. According to the surgical methods, the enrolled patients were divided into thoracotomy group (traditional thoracotomy, n=178) and minimally invasive group (minimally invasive cardiac surgery, n=128). The clinical effectiveness, surgery-related indexes, postoperative indexes, pulmonary artery and venous compliance immediately after surgery, occurrence of related complications and world health organization quality of life scale (WHO QOL-BREF) scores were compared between groups. Results: The total effective rates in the minimally invasive group and the thoracotomy group were 94.53% and 84.27% respectively, and the minimally invasive group had higher total effective rate than the thoracotomy group (P<0.05). The incision size in the minimally invasive group was smaller than that in the thoracotomy group, and the aortic occlusion time, cardiopulmonary shunt time, intensive care unit stay, ventilator assistance time and hospitalization time were shorter, and the total amount of thoracic drainage within 24 hours and the amount of bleeding during surgery were less, and the immediate performances of postoperative pulmonary artery and venous compliance were better than those in the thoracotomy group (P<0.05). The total incidence of complications in minimally invasive group and thoracotomy group was 10.94% and 29.21%, respectively, and the minimally invasive group was lower than the thoracotomy group, the difference was statistically significant (P<0.05). The increases of scores of aspects of WHOQOL-BREF scale were higher in the minimally invasive group than those in the thoracotomy group (P<0.05). Conclusion: Compared with traditional thoracotomy, minimally invasive surgery for HD has the advantages of slight surgical trauma, rapid recovery of patients, improvement of lung function compliance, reduction of complication risk, and improvement of quality of life, with important clinical application value.

Objective: To analyze the occurrence and related factors of different delirium subtypes in patients after cardiac valve surgery. Methods: Totally 103 patients who received cardiac valve surgery in the hospital from January 2021 to January 2024 were enrolled as the study subjects. Richmond Agitation-Sedation Score (RASS) and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) were adopted to evaluate the occurrence and subtypes of delirium on the 2nd day after surgery. According to the occurrence of postoperative delirium, the patients were divided into delirium group and non-delirium group. The clinical data of all patients were collected, and the influencing factors of delirium after cardiac valve surgery were analyzed by univariate analysis and multivariate Logistic regression analysis. Results: In this study, 31 cases of delirium occurred in 103 patients with cardiac valve surgery, with an incidence of 30.10%. Among the 31 cases, there were 15 cases of low-activity delirium [48.39% (15/31)], 6 cases of high-activity delirium [19.35% (6/31)] and 10 cases of mixed delirium [32.26% (10/31)]. Univariate analysis indicated that there were statistical differences in age, mechanical ventilation time, acute physiology and chronic health evaluation II (APACHE II) score, cardiopulmonary bypass time, concurrent anemia, atrial fibrillation, ICU stay and surgical time between groups (P<0.05). Logistic regression analysis found that age≥70 (OR=1.642, 95%CI: 1.030~2.618), mechanical ventilation duration≥6 h (OR=3.568, 95%CI: 2.037~6.250), APACHEⅡ score≥10 points (OR=2.683, 95%CI: 1.447~4.975), cardiopulmonary bypass time≥2 h (OR=2.166, 95%CI: 1.317~3.564), concurrent anemia (OR=2.971, 95%CI: 1.723~5.124), atrial fibrillation (OR=1.459, 95%CI: 1.014~2.101), ICU stay≥36 h (OR=2.401, 95%CI: 1.423~4.052), and surgical time≥5 h (OR=2.030, 95%CI: 1.271~3.243) were high risk factors for delirium after cardiac valve surgery (P<0.05). Conclusion: Patients after cardiac valve surgery have a high risk of delirium, and low-activity delirium is the main subtype. The age of patients, mechanical ventilation time, APACHE II score, cardiopulmonary bypass time, concurrent anemia, atrial fibrillation, ICU stay and surgical time are the main factors affecting the occurrence of delirium in postoperative patients. Clinically, it is necessary to actively screen the above factors and take targeted prevention and control measures to reduce the risk of delirium.

Objective: To observe the efficacy of SRM-IV vertigo diagnosis and treatment system in the treatment of benign paroxysmal positional vertigo (BPPV). Methods: A total of 154 patients with BPPV in the hospital were enrolled from July 2023 to July 2024, and were divided into control group (manipulative reduction treatment) and instrument reduction group (SRM-IV vertigo diagnosis and treatment system) by random number table method. The therapeutic effect, vertigo degree [Dizziness Handicap Inventory (DHI)], vestibular function [Vestibular Activities of Daily Living (VADL), Vestibular Symptom Index (VSI)] and balance function [Berg Balance Scale (BBS)] before and after treatment were compared between groups, and the incidence rate of adverse reactions and occurrence of residual dizziness (RD) within 1 month of follow-up were counted. Results: The total effective rate in instrument reduction group was higher than that in control group (P<0.05). After treatment, the scores of VADL,DHI and VSI scales in the two groups were decreased, the BBS score in both groups was risen, and the difference value before and after treatment in instrument reduction group was significantly greater than that in control group (P<0.05). there was no statistical difference in the incidence rate of adverse reactions between groups (P>0.05). Within 1 month of follow-up, the incidence rate and duration of RD in instrument reduction group were significantly lower or shorter compared to control group (P<0.05). Conclusion: SRM-IV vertigo diagnosis and treatment system has significant efficacy in the treatment of BPPV, and it can effectively improve the vertigo degree, vestibular function and balance function, and reduce the occurrence of RD symptoms, and it has good safety.

Objective: To analyze the influencing factors of early cardiovascular failure in patients with successful cardiopulmonary resuscitation (CPR). Methods: A total of 132 patients who achieved return of spontaneous circulation (ROSC) after CPR in our hospital from January 2022 to January 2024 were selected. Patients were divided into a cardiovascular failure group (occurred within 72 hours after resuscitation) and a non-cardiovascular failure group (not occurred) based on cardiovascular status changes after resuscitation. Demographic data, medical history, CPR-related parameters, and blood biochemical indices were compared between the two groups. Multivariate logistic regression analysis was used to identify independent risk factors for early cardiovascular failure in successfully resuscitated patients. Results: Among 132 successfully resuscitated patients, 91 developed early cardiovascular failure, with an incidence of 68.94%. The cardiovascular failure group had significantly older age, higher proportions of hypertension, diabetes, and smoking, longer CPR duration, higher proportion of epinephrine use before defibrillation, and higher levels of blood lactate, brain natriuretic peptide (BNP), and serum creatinine (SCr) after ROSC compared with the non-cardiovascular failure group (all P<0.05). Levels of endothelin-1 (ET-1), nitric oxide (NO), and von Willebrand factor (vWF) were also significantly higher in the cardiovascular failure group (P<0.05). Logistic regression analysis showed that hypertension, CPR duration, epinephrine use before defibrillation, and ET-1 were independent risk factors for early cardiovascular failure in successfully resuscitated patients (P<0.05). Conclusion: The occurrence of early cardiovascular failure in patients with successful CPR is closely related to hypertension, long duration of resuscitation, use of adrenaline before defibrillation and elevated ET-1 level. Clinical monitoring and management of high-risk patients should be strengthened.

Objective: To explore relationship between pre-thrombolic state (PTS) markers and repeated implantation failure (RIF) in patients undergoing in vitro fertilization-embryo transfer (IVF-ET), and to analyze their predictive value in RIF. Methods: A retrospective analysis was performed on the clinical data of 118 patients (RIF group) with RIF and 110 patients (control group) undergoing IVF-ET for the first cycle in the hospital between June 2019 and March 2024. The peripheral venous blood was collected before embryo transfer to detect PTS markers [antithrombin III (AT-III), human prothrombin fragment 1+2 (F1+2), platelet α-granular membrane protein-140 (GMP-140), Von willebrand factor (vWF)]. The relationship between PTS markers and RIF was analyzed by Logistic regression analysis, and their predictive value for RIF was analyzed by receiver operating characteristic (ROC) curves. Results: There were no significant differences in infertility duration, infertility factors, BMI, gonadotropin (Gn) dosage, or Gn treatment duration between the RIF group and the control group (P>0.05). The RIF group had a significantly older age, fewer oocytes retrieved, and fewer high-quality embryos than the control group (P<0.05). Levels of prethrombotic state markers F1+2, GMP-140, and vWF were significantly higher in the RIF group, while AT-Ⅲ expression was significantly lower (P<0.05). Logistic regression analysis showed that a higher number of oocytes retrieved, more high-quality embryos, higher fertilization rate, and higher AT-Ⅲ expression were protective factors against RIF in IVF-ET patients. Age, as well as high expression of F1+2, GMP-140, and vWF, were risk factors for RIF. The combined detection of prethrombotic state markers F1+2, GMP-140, vWF, and AT-Ⅲ had an area under the ROC curve (AUC) of 0.817 for predicting RIF in IVF-ET patients, which was significantly higher than the AUC values of individual markers (0.722, 0.713, 0.730, and 0.726, respectively; P<0.05). Conclusion: Age, number of retrieved oocytes, number of high-quality embryos and PTS are all influencing factors of RIF in IVF-ET patients. F1+2, GMP-140, vWF and AT-III can predict the occurrence of RIF to a certain extent.

Objective: To discuss the influencing factors of survival outcomes in patients with epithelial ovarian cancer(EOC) after initial treatment. Methods: A total of 219 patients with EOC, who were eligible for follow-up,were admitted to Linyi Tumor Hospital from Jan. 2018 to Dec. 2020 Clinical datas, such as the age, height, weight, the time of diagnosis, surgery time, surgical scope, pathological results, changes in serum carbohydrate antigen 125(CA125), the frequency and time of chemotherapy, and the time of first recurrence after initial treatment, above of the subjects were recorded. Calculate and compare the survival outcomes of these patients. Results: The average age of the 219 newly treated patients with epithelial ovarian cancer is 56.0 years (25~81 years old). The median follow-up time was 71 months (4~99 months). The FIGO stage, degree of differentiation, tumor side, underwent cytoreductive surgery or not, pelvic lymphadenectomy or not, chemotherapy frequency in initial treatment, neoadjuvant chemotherapy (NACT) frequency, ascites or not, CA125 decreased to normal within three courses of chemotherapy postoperatively or not, the recurrence interval after initial treatment was less than 12 months or not, are statistically significant factors affecting the survival outcome of EOC patients after initial treatment (P＜0.05). According to the results of multivariate COX regression analysis, FIGO stage, underwent cytoreductive surgery or not, CA125 decreased to normal within three courses of chemotherapy postoperatively or not, and whether the recurrence interval after initial treatment was ≤ 12 months, are all independent risk factors affecting the survival outcome of EOC patients after initial treatment (P＜0.05). Conclusion: Most patients with EOC are diagnosed in advanced stages, with a low 5-year survival rate. Improving diagnostic rate of early ovarian cancer, executing satisfactory cytoreductive surgery as early as possible, and postponing the recurrence time after initial treatment can improve the prognosis of patients with ovarian cancer.

Objective: To study the influence of small scleral tunnel incision and clear corneal incision phacoemulsification (PHACO) on ocular surface function indexes and anterior chamber depth in patients with cataract. Methods: One hundred and fifty patients with cataract (monocular disease) who were scheduled to undergo PHACO treatment in the hospital from August 2022 to January 2024 were selected and divided into scleral group (small scleral tunnel incision PHACO, n=75) and corneal group (clear corneal incision PHACO, n=75) by adopting simple random grouping method (random number table method). The ocular surface function indexes, anterior chamber depth, corneal endothelial cell (CEC) loss rate, dry eye symptoms and postoperative complications were compared between groups. Results: The tear break-up time (BUT) in the two groups was decreased first and then increased, and the BUT in the scleral group at T1, T2 and T3 was longer than that in the corneal group (P<0.05). The corneal surface asymmetry index (SAI) and corneal surface astigmatism (CYL) were enhanced first and then reduced in both groups, and the SAI and CYL were lower in the scleral group than those in the corneal group at T1, T2 and T3 (P<0.05). The peripheral and central anterior chamber depth of the two groups showed an increasing trend, but the change trend of the two groups was the same, and the difference was not statistically significant (F interaction =2.384, 2.376, P>0.05).The scleral group had lower CEC loss rate at T1, T2 and T3 than the corneal group (P<0.05). The score of ocular surface Disease Index Scale (OSDI) of the two groups increased first and then decreased, but the change trend of the two groups was the same, and the difference was not statistically significant (F interaction =1.930, P>0.05). There was no statistical significance in postoperative complications between the scleral group (18.67%) and the corneal group (29.33%) (P>0.05). Conclusion: Compared with PHACO with clear corneal incision, PHACO with small scleral tunnel incision for cataract patients can promote the recovery of corneal surface morphology and reduce the loss of corneal endothelial cells, with good treatment safety.

Objective: To explore the lung-protective effect of low-dose esketamine in patients with single lung ventilation during radical lung cancer surgery. Methods: Prospectively, 78 patients aged ≥60 years who underwent elective radical resection for lung cancer from January 2022 to December 2023 were selected and divided into two groups (n=39 each) using a random number table method: the esketamine group and the control group. In the esketamine group, esketamine was intravenously injected at a dose of 0.2 mg/kg during anesthesia induction, and esketamine was intravenously pumped at a rate of 0.15 mg·kg^-1·h^-1 for anesthesia maintenance; the control group received an equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of admission (T0), immediately after successful double-lumen tube intubation (T1), at the start of one-lung ventilation (T2), at the start of surgery (T3), at the end of one-lung ventilation (T4), and at the end of surgery (T5). Bispectral index (BIS) was recorded at T2, T3, T4, and T5. Alveolar-arterial oxygen tension difference (A-aDO₂), respiratory index (RI), and dynamic lung compliance (Cdyn) were calculated immediately after intubation, 30 minutes after one-lung ventilation, and at the end of surgery. Peripheral venous blood samples were collected before surgery, at the end of surgery, and 24 hours after surgery to measure serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), malondialdehyde (MDA), and superoxide dismutase (SOD). Visual analog scale (VAS) scores were recorded at 2 hours (V1), 6 hours (V2), 12 hours (V3), 24 hours (V4), and 48 hours (V5) after surgery. Results: Compared with the control group, Cdyn was significantly higher in the esketamine group at 30 minutes of one-lung ventilation and at the end of surgery (P>0.05), while PA-aO₂ and RI were significantly lower (P<0.05).Compared with the control group, plasma levels of TNF-α and IL-10 in the esketamine group were significantly lower at the end of surgery and 24 hours after surgery (P<0.05); plasma IL-6 was significantly lower at the end of surgery (P<0.05); plasma MDA concentration was significantly lower at the end of surgery and 24 hours after surgery (P<0.05); plasma SOD activity was significantly higher (P>0.05). VAS scores at all time points after surgery and the effective pressing times and total times of patient-controlled intravenous analgesia (PCIA) within 48 hours after surgery were significantly lower in the esketamine group than in the control group (P<0.05). Conclusion: Intravenous induction and continuous intraoperative infusion of low-dose esketamine in patients undergoing one-lung ventilation for radical resection of lung cancer can maintain hemodynamic stability, inhibit inflammatory and oxidative stress responses, and have positive effects on pulmonary function and postoperative analgesia.

Objective: To observe the efficacy of CalliSpheres drug-eluting bead bronchial artery chemoembolization (DEB-BACE) combined with immunotherapy in advanced non-small cell lung cancer (NSCLC) patients. Methods: A retrospective analysis was performed on 142 advanced NSCLC patients admitted to our hospital from January 2020 to April 2023. Patients were divided into a control group (systemic chemotherapy combined with immunotherapy) and an observation group (CalliSpheres DEB-BACE combined with immunotherapy). Propensity score matching (caliper value set to 0.01, 1∶1 matching) was used, and 71 patients with comparable baseline data were finally included in each group. The efficacy on solid tumors, serum tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125), cytokeratin fragment antigen 21-1 (CYFRA21-1)] before and after treatment, T lymphocyte subsets (CD3⁺, CD4⁺, CD4⁺/CD8⁺), drug-related adverse reactions, and 1-year follow-up outcomes (progression-free survival, overall survival) were compared between the two groups. Results: The objective response rate (ORR) and disease control rate (DCR) in the observation group were 45.07% and 80.28%, respectively, significantly higher than 23.35% and 64.79% in the control group (P<0.05). Before treatment, there were no significant differences in CEA, CA125, and CYFRA21-1 levels between the two groups (P>0.05). After treatment, these markers decreased in both groups (P<0.05), with greater reductions observed in the observation group (P<0.05). Before treatment, CD4⁺, CD3⁺, and CD4⁺/CD8⁺ levels showed no significant differences (P>0.05). After treatment, CD4⁺, CD3⁺, and CD4⁺/CD8⁺ levels decreased in the observation group (P<0.05), with smaller changes compared to the control group (P>0.05). The incidence of bone marrow suppression was lower in the observation group (P<0.05). At 1-year follow-up, the observation group had a progression-free survival (PFS) of (10.12±0.31) months and an overall survival (OS) of (11.32±0.16) months, significantly better than the control group's PFS of (8.56±0.38) months and OS of (10.42±0.27) months (log rank χ²=6.416, P<0.05; log rank χ²=4.120, P=0.042). Conclusion: CalliSpheres DEB-BACE combined with immunotherapy is safe and effective for advanced NSCLC patients.