Abstract:Objective: To explore the effect of the K283R mutation in JE/Zika chimeric virus envelope protein on neurovirulence in mice. Methods: Using the full-length cDNA clone of JE/ZIKV (MR766) as the template, the infectious clone carrying E-K283R substitution was constructed via overlap extension PCR-mediated site-directed mutagenesis and molecular cloning, followed by restriction enzyme (XhoⅠ) linearization and in vitro transcription. The mutant virus JE/ZIKV (MR766) (K283R) was rescued by electroporation into BHK21 cells. Viral characteristics were validated through serial passage, sequencing, plaque assay, growth kinetics, and indirect immunofluorescence. Neurovirulence was quantitatively assessed by intracranial challenge in 3-week-old female Kunming mice, with LD50 as the endpoint metric. Results: Restriction analysis confirmed successful construction of the JE/ZIKV (MR766) (K283R) infectious clone. Plaque assays, sequencing, and immunofluorescence verified viral rescue, showed larger plaque diameters (0.20 ± 0.04) cm for the mutant compared to the parental strain JE/ZIKV (MR766) (0.14 ± 0.03) cm, P < 0.05. The growth curve showed that both strains reached peak titers at 60 h post-infection. Animal experiments revealed an intracranial LD50 of 1.35 pfu/0.03 mL for JE/ZIKV (K283R), slightly lower than the parental strain (2.21 pfu/0.03 mL). Conclusion: The K283R substitution in ZIKV E protein did not significantly attenuate murine neurovirulence, suggesting its non-critical role in viral pathogenicity regulation.

Abstract:Objective: To explore the change and its significance of the numbers of neurons and synapses in the rat spinal dorsal horn at 7 and 28 days after L5 spinal nerve ligation (SNL). Methods: 29 male SD rats aged 3 months were randomly divided into two groups: L5 unilateral SNL group (10 animals) and sham-operated group (13 animals). The mechanical withdrawal thresholds (PWT) of bilateral hind paws were measured every 4 days, starting from 1 day before the operation until 28 days post-operation. At 7 and 28 days post-operation, the L5 segment of the spinal cord was removed. Paraffin-embedded sections were prepared and stained with Nissl’s method and synaptophysin immunohistochemistry to mark neurons and synapses (presynaptic axon terminals). The numbers of neurons and synapses (per unit length of the spinal cord) in the L5 spinal cord dorsal horn were estimated with the stereological optical disector. Results: The percentage reductions of PWT on the operation side were significantly lower in the SNL group than in the sham-operated group. Compared with the contralateral non-operated side, the number of synapses and the numerical ratio of synapses to neurons were unchanged on the operation side in the SNL group at 7 days, and significantly increased by 23.5% and 17.4%, respectively, at 28 days. Conclusion: SNL-induced changes in synaptic plasticity associated with neuropathic pain (NP) require prolonged development. This delayed neural remodeling may constitute the structural underpinnings of chronic pain maintenance.

Abstract:Objective: To investigate the effects of different macrophage polarization phenotypes on the proliferation and metastasis of hepatocellular carcinoma (HCC) cells and their underlying mechanisms. Methods: THP-1 suspension cells were induced to adhere and differentiate into M0 macrophages by treatment with phorbol 12-myristate 13-acetate (PMA). Subsequently, polarization into M1 and M2 macrophages was achieved by stimulation with lipopolysaccharide (LPS) and interferon-γ (IFN-γ), or interleukin-4 (IL-4) and interleukin-13 (IL-13), respectively. Quantitative real-time polymerase chain reaction (qPCR) was performed to analyze the mRNA expression levels of specific marker genes related to M1 and M2 macrophage phenotypes. The Cell Counting Kit-8 (CCK-8) assay was used to evaluate the effect of macrophage culture supernatants on the growth of hepatocellular carcinoma (HCC) cells. The effect of macrophage culture supernatant on the metastatic ability of liver cancer cells was analyzed by Transwell assay. Western blot analysis was carried out to determine the expression and activation levels of key proteins involved in relevant signaling pathways. Results: qPCR analysis demonstrated that the mRNA expression levels of M1-associated markers, including HLA-DR, TNF-α, and CXCL-9, were upregulated in vitro-induced M1 macrophages (P < 0.05). In contrast, the expression levels of MRC1 and HGF, markers associated with M2 macrophages, were increased in vitro-induced M2 macrophages (P < 0.05), with distinct morphological features validating successful polarization. CCK-8 assay results indicated that, in both SMMC7721 and Sk-hep1 cell lines, co-culture with M2 macrophage supernatants enhanced cell proliferation compared with M1 groups and the blank control group (P < 0.05). Co-culture with M1 macrophage supernatants reduced SMMC7721 proliferation (P < 0.05) but showed no significant effect on Sk-hep1 compared to the control. Transwell migration assays further confirmed that M2 macrophage supernatants markedly promoted the migration capacity of both SMMC7721 and Sk-hep1 cell lines compared to M1 (P < 0.05), with M1 showing no pro-migratory effect. Western blot analysis indicated that M2 macrophages likely promote the growth and metastasis of HCC cells by activating the ERK and AKT signaling pathways, whereas M1 macrophages suppress these pathways. Conclusion: M2 macrophages may promote the proliferation and metastasis of HCC cells, potentially through activation of the ERK and AKT signaling pathways, while M1 macrophages may inhibit these processes by suppressing ERK/AKT signaling.

Abstract:Objective: To construct a prognostic model for ovarian cancer based on endoplasmic reticulum stress-related genes (ERSRGs) and systematically evaluate its ability to predict patient survival outcomes and response to immunotherapy. Methods: Transcriptomic data and clinical information of ovarian cancer patients were integrated, and machine learning algorithms were applied to identify ERSRGs associated with prognosis. A risk score model was developed based on the selected key genes, and its predictive performance and robustness were assessed in independent training, validation, and overall cohorts. Single-cell transcriptomic data were further utilized to explore the expression patterns and potential regulatory mechanisms of these key genes within immune cells. Results: Nine key ERSRGs (ERBB2, NHLRC1, CREB3L4, CALR3, MAPK13, OSBPL3, HSD11B2, SLC4A11, GJB1) were identified (P < 0.05). The constructed model effectively stratified patients into high- and low-risk groups, demonstrating a 5-year AUC of 0.663 in the overall cohort. The high-risk group exhibited characteristics of T cell dysfunction and immune escape (P < 0.05). Single-cell RNA sequencing analysis revealed specific expression of these genes in certain immune cell subtypes and tumor cells, suggesting their potential role in modulating the immune microenvironment. Conclusion: A novel prognostic model based on nine ERSRGs was successfully constructed and validated for ovarian cancer, demonstrating robust performance in predicting both prognosis and immunotherapy response. This model provides a theoretical foundation and a potential clinical tool for individualized treatment strategies, showing promising translational value.

Abstract:Objective: To explore the clinical application value of Da Vinci robot or traditional laparoscopic distal radical resection in the treatment of gastric cancer based on propensity score matching. Methods: The medical records of patients with gastric cancer who received distal radical resection of gastric cancer were collected. According to the different surgical methods, they were divided into robot group (Da Vinci robotic surgery, n = 85) and laparoscopic group (traditional laparoscopic surgery, n = 81). Propensity score matching (1:1 nearest neighbor matching, caliper value of 0.2) was used to balance the baseline data. Finally, 63 pairs of data in each group were obtained. Both groups were followed up for 6 months after surgery. The perioperative indexes (surgical time, number of lymph node dissection, postoperative first liquid diet time, abdominal drainage volume, postoperative first anal exhaust time, postoperative ambulation time, postoperative hospital stay), inflammatory factors [C-reactive protein (CRP), procalcitonin (PCT), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), white blood cell count (WBC)], tumor markers [cancer antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA)], postoperative complications, and recurrence rate were compared between the two groups. Results: After treatment, the number of lymph node dissection, postoperative first anal exhaust time, abdominal drainage volume, and postoperative ambulation time in the robot group were better than those in the laparoscopic group (P 0.05). Conclusion: Da Vinci robot surgery can improve surgical efficiency and lymph node dissection efficacy, and reduce the postoperative inflammatory response, and it does not increase postoperative risk.

Abstract:Objective: Leveraging mobile health (mHealth) technology, to examine the risk factors of type Ⅱ diabetes mellitus to painful diabetic peripheral neuropathy (PDPN). Methods: Based on the presence of PDPN, the 102 type 2 diabetic patients were split into two groups: 30 were lesioned and 72 were not. Age, gender, duration of diabetes, body mass index (BMI), fasting blood glucose, glycated hemoglobin, and triglycerides were among the clinical data gathered. Patient satisfaction with the mHealth intervention, adherence to the mHealth intervention, frequency of use, and duration of use were among the data pertaining to mHealth applications. The independent risk factors of PDPN in type 2 diabetes patients were analyzed by comparing the differences of various indicators between the two groups. ROC prediction curves were plotted to evaluate each risk factor’s predictive value for PDPN. Results: Significant between-group disparities were observed in fasting plasma glucose, glycosylated hemoglobin, triglycerides, mHealth usage frequency, and duration (P 0.75, especially glycosylated hemoglobin (0.887) and mHealth usage frequency (0.879) with prominent efficiency. Conclusion: Controlling the levels of glycosylated hemoglobin and triglycerides and increasing the frequency and duration of mHealth usage can reduce the risk of PDPN.

Abstract:Objective: To analyze whether the subcutaneous lumbar spine index (SLSI) is a risk factor for low back pain (LBP) in patients with osteoporotic vertebral compression fractures (OVCF) following percutaneous balloon kyphoplasty (PKP). Methods: A total of 80 OVCF patients were selected. Based on the Visual Analogue Scale (VAS) score 1 month post-PKP, patients were divided into two groups: LBP group (VAS ≥ 4, n = 35) and non-LBP group (VAS 0.05). However, the LBP group had higher VAS and ODI scores than the non-LBP group at 3, 6, and 12 months postoperatively (P < 0.05). Univariate and multivariate logistic regression analyses showed that SLSI was significantly higher in the LBP group compared to the non-LBP group (P < 0.05), indicating it as a risk factor for LBP after PKP. ROC curve analysis indicated that the area under the curve (AUC) for SLSI was 0.769 (95% CI: 0.667–0.871), with a cutoff value of 0.765 determined by the Youden index (sensitivity: 88.6%, specificity: 57.8%). Conclusion: A higher SLSI is associated with LBP following PKP. It is recommended that SLSI assessment be performed prior to PKP in OVCF patients as a potential effective predictor for postoperative LBP.

Abstract:Objective: To explore the therapeutic efficacy of combining rupatadine tablets with mometasone furoate nasal spray in the treatment of allergic rhinitis (AR) and its effect on serum inflammation-related indicators. Methods: A total of 118 AR patients were enrolled. The patients were divided into two groups according to different treatment regimens: a control group (n = 59) or an observation group (n = 59). The control group received mometasone furoate nasal spray alone, while the observation group received both mometasone furoate nasal spray and rupatadine tablets. Treatment duration was 4 weeks for both groups. Before and after treatment, nasal symptom scores (TNSS), total nasal accompanying symptom scale (TNNSS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) were assessed. Serum levels of immunoglobulin E (IgE), interleukin (IL)-4, IL-6, and IL-10, as well as peripheral blood eosinophil (EOS) counts, were measured. Results: The total effectiveness rate was higher in the observation group (96.61%) compared to the control group (83.05%) (P < 0.05). After treatment, TNSS, TNNSS, and RQLQ scores were lower in the observation group than in the control group (P < 0.05). Serum IgE, EOS counts, and IL-4 and IL-6 levels were also lower in the observation group (P < 0.05), while IL-10 levels were higher (P < 0.05). Conclusion: The combination of rupatadine tablets and mometasone furoate nasal spray alleviates nasal symptoms, reduces IgE and EOS levels, mitigates inflammatory responses, and enhances therapeutic outcomes in AR patients.

Abstract:Objective: To evaluate the early predictive value of serum ferritin (SF), C-reactive protein (CRP), and D-dimer (D-D) in children with refractoryMycoplasma pneumoniae pneumonia (RMPP). Methods: A total of 107 children withMycoplasma pneumoniae pneumonia (MPP) were selected and classified into general group (GMPP group, n = 51) and refractory group (RMPP group, n = 56) according to treatment response and disease progression. The differences in serum SF, CRP, and D-D levels in the acute phase were compared between groups. Logistic regression analysis was adopted to screen the influencing factors of RMPP. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive efficiency of serum SF, CRP, D-D, and combined detection of the three indicators on RMPP. Results: There was no statistically significant difference in general information such as age, gender, and admission time between the two groups (P > 0.05). The RMPP group had a longer duration of fever and more involvement of lung lobes (P < 0.05). The levels of serum SF, CRP, and D-D in the RMPP group were higher than those in the GMPP group (P < 0.05). Multivariate Logistic regression revealed that the increases of SF, CRP, and D-D were the influencing factors of RMPP occurrence (P < 0.05). ROC curve analysis suggested that the area under the ROC curve (AUC) of the combination of SF, CRP, and D-D in predicting RMPP was 0.849, which was better than that of any single indicator (P < 0.05). Conclusion: Serum SF, CRP, and D-D levels are closely related to the disease severity and refractory progression of children with MPP. The three levels can be used as independent predictors of RMPP. Combined detection can provide an important basis for early warning of RMPP in children.

Abstract:Objective: To explore the clinical application value of vasoactive-inotropic score (VIS) in predicting veno-arterial extracorporeal membrane oxygenation (VA-ECMO) assisted weaning in patients with cardiogenic shock. Methods: This study was a retrospective single-center cohort study, including patients who received VA-ECMO treatment for cardiogenic shock. A total of 495 patients received ECMO treatment, and 150 patients met the criteria and were included in the analysis. The demographic characteristics, underlying diseases, etiology, clinical conditions, APACHE II score, lactic acid level, and VIS score of the patients were collected, and the differences between the two groups were compared. Independent predictors were analyzed by multivariate Logistic regression, and the ROC curve and subgroup analysis were further drawn to evaluate the predictive efficacy of VIS. Results: A total of 150 patients with cardiogenic shock (CS) receiving VA-ECMO were included, of whom 84 (56.0%) were successfully weaned and 66 (44.0%) failed. The proportion of acute myocardial infarction was higher in the failure group, while myocarditis was more common in the success group. The rates of concomitant CRRT and APACHE II scores were higher in the failure group (P 1, P < 0.05). ROC curve analysis demonstrated that the 24-hour VIS reduction rate had the highest predictive value for weaning outcome (AUC = 0.780). A combined prediction model incorporating the 24-hour VIS reduction rate, APACHE II score, VIS, and lactate indicators further improved predictive performance (AUC = 0.820). Subgroup analyses indicated that this prediction model maintained consistent predictive value across different etiologies, CPR statuses, and CRRT conditions. Conclusion: VIS, especially the VIS value at 24 hours after ECMO initiation, is an important index to predict the outcome of VA-ECMO weaning in patients with cardiogenic shock, and can be used as a powerful tool for clinical evaluation of the possibility of successful weaning.

Abstract:Objective: To explore the efficacy of autologous emulsified fat grafting in the treatment of early proliferative scarring leading to joint dysfunction. Methods: 84 patients with early proliferative scarring leading to joint dysfunction were included in the prospective study, and were divided into the control group (n = 42) and the treatment group (n = 42) according to different treatment methods. The control group was treated with conventional scar surface topical application of silicone gel (scarin), and the treatment group was treated with intra-proliferative scar injection of autologous adipose tissue. Both groups were followed up for 2 months. The efficacy, scar condition [Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS) scores], joint function recovery, inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8)], scar index, scar hardness, thickness, width, and pathological indicators of scar tissue [fibroblast density, collagen fiber surface density, type I collagen, type III collagen], as well as the occurrence of complications between the two groups were recorded and compared. Results: The treatment group showed higher effective treatment rates and excellent joint function recovery rates compared to the control group (P 0.05). Conclusion: The efficacy of using intra-proliferative scar injection of autologous adipose tissue for the treatment of early proliferative scarring resulting in joint dysfunction is precise, which helps to reduce the inflammatory response, improve the degree of scarring, inhibit scar proliferation, enhance the aesthetic effect, and facilitate joint function recovery.

Abstract:Objective: To evaluate the therapeutic effectiveness ofBaitouweng decoction enema for ulcerative colitis (UC) and assess its impact on oxidative stress levels. Methods: A total of 85 UC patients were divided into an observation group (n = 43, mesalazine enteric-coated tablets orally +Baitouweng decoction enema) and a control group (n = 42, mesalazine enteric-coated tablets orally) according to different treatment methods. The treatment course was 20 days. The clinical efficacy, Traditional Chinese Medicine (TCM) syndrome score, endoscopic severity index (UCEIS) score, modified Mayo score, Inflammatory Bowel Disease Questionnaire (IBDQ) score, serum oxidative stress indicators [glutathione peroxidase (GSH-Px) and catalase (CAT) activity], serum inflammatory indicators [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) levels], and incidence of adverse reactions were compared between the two groups. Results: The overall efficacy rate in the observation group was higher than that in the control group (93.02% vs. 80.95%, P 0.05). Conclusion:Baitouweng decoction enema reduces symptoms, promotes mucosal healing, and improves quality of life in UC patients with damp-heat syndrome. Its mechanism of action may be associated with enhanced antioxidant enzyme activity and inhibition of the inflammatory response.

Abstract:Objective: To investigate the effect of interaction between serum uric acid (UA) level and carotid intima-media thickness (IMT) on carotid plaque in elderly patients with hypertension. Methods: A total of 133 hypertensive patients were retrospectively analyzed, and the patients were grouped according to the presence or absence of carotid plaque. The clinical data of patients in the plaque group and the non-plaque group were compared, and the influencing factors of carotid plaque formation were analyzed by Logistic regression. The interaction of serum UA level with IMT and its effect on carotid plaque in elderly patients with hypertension were analyzed. Results: Age, IMT, UA, and low-density lipoprotein cholesterol (LDL-C) in the plaque group were higher than those in the non-plaque group (P < 0.05). The results of multivariate analysis showed that age, UA, LDL-C, and IMT were all influencing factors on the formation of carotid plaque in elderly patients with hypertension (P < 0.05). The area under the curve (AUC) of serum UA level in the diagnosis of carotid plaque was 0.838 (95% CI: 0.764–0.896), with a sensitivity of 73.26% and specificity of 82.98%, indicating certain diagnostic value for carotid plaque formation. There was an additive interaction between UA level and IMT, and the risk of carotid plaque formation was higher when high UA level and increased IMT were present simultaneously than when either factor was present alone (RERI = 1.71, 95% CI: 0.22–3.41). The synergistic effect was 1.60 times the sum of the effects produced by the two factors alone (SI = 1.60, 95% CI: 1.12–2.35). Conclusion: Both high serum UA levels and increased IMT are independent risk factors for carotid plaque formation in elderly patients with hypertension, and they exhibit an additive interaction effect. Their simultaneous presence leads to a significantly higher risk of carotid plaque formation.

Abstract:Objective: To investigate the risk factors for secondary acute traumatic coagulopathy (ATC) in children with severe traumatic brain injury (sTBI), providing reference for early identification of the risk of ATC and development of related intervention strategies. Methods: A total of 115 children with sTBI were enrolled in this study. They were divided into the secondary ATC group (n = 38) and the non-secondary ATC group (n = 77) according to whether ATC occurred within 24 h post-injury. Coagulation parameters were dynamically monitored at 6, 12, and 24 h post-injury. Univariate and logistic regression analyses were used to identify the risk factors for secondary ATC, and a nomogram was constructed on this basis. Results: The incidence of secondary ATC among the 115 children with sTBI was 33.04% (38/115). Compared with the non-secondary ATC group, the secondary ATC group demonstrated significant increases in ISS score at admission, the proportions of children with hypothermia at admission, surgery within 24 h after admission, platelet count 2 mmol/L at admission, and a significantly decreased GCS score at admission (P < 0.05). Compared with levels at 6 h post-injury, APTT, PT, and D-D were increased, and FIB was decreased at 12 and 24 h post-injury only in the secondary ATC group (P < 0.05). Compared with the non-secondary ATC group, the secondary ATC group presented significant increases in APTT, PT, and D-D levels, and a significant decrease in FIB level (P < 0.05). Multivariate logistic regression analysis identified the following independent influencing factors for secondary ATC in children with sTBI: ISS score at admission (OR = 1.670, 95% CI: 1.126–2.477), lactate level at admission (OR = 1.340, 95% CI: 1.091–1.647), FIB at 12 h post-injury (OR = 0.695, 95% CI: 0.544–0.888), and D-D at 12 h post-injury (OR = 1.480, 95% CI: 1.067–2.053) (all P < 0.05). The nomogram model indicated that these four factors had high predictive value for the occurrence of secondary ATC. Conclusion: Higher injury severity score (ISS) and lactate level at admission, as well as lower FIB level and higher D-D level at 12 h post-injury, are independent risk factors for secondary ATC in children with sTBI. The nomogram prediction model constructed based on these four key indicators demonstrates good predictive efficacy, providing an intuitive and practical quantitative tool for early identification of children at high risk of ATC.

Abstract:Objective: To investigate the application value of rivaroxaban combined with mechanical prophylaxis in primary prevention of venous thromboembolism (VTE) in malignant tumor patients with high Khorana score. Methods: 128 patients with malignant tumors and a high risk of VTE (Khorana score ≥ 2) were selected and divided into three groups according to the intervention plan: namely, the combined prevention group (n = 42, rivaroxaban + mechanical prophylaxis), the rivaroxaban group (n = 43, rivaroxaban), and the mechanical prophylaxis group (n = 43, mechanical prophylaxis), with an intervention period of 6 months. The incidence of VTE, femoral superficial vein diameter (FSV), popliteal vein diameter (POPV), peak velocity (PV), average velocity (MV), plasma viscosity, whole blood high-shear viscosity, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D), 6-keto-prostaglandin F1α (6-K-PGF1α), endothelin-1 (ET-1), C-reactive protein (CRP), interleukin-6 (IL-6), and the incidence of bleeding events were compared among the three groups. Results: After 6 months of intervention, the incidence of VTE in both the combined prevention group and the rivaroxaban group was lower than that in the mechanical prophylaxis group (P 0.05). Conclusion: Rivaroxaban combined with mechanical prophylaxis can reduce the risk of VTE in malignant tumor patients with high Khorana scores, optimize the structural morphology and hemodynamic status of lower extremity veins, regulate hemorheological characteristics and coagulation function, and reduce the body’s inflammatory response.

Abstract:Objective: To study the role of remifentanil in improving coagulation function by regulating the inflammatory response mediated by the NF-κB signaling pathway in adult cardiopulmonary bypass cardiac surgery. Methods: The research subjects were 204 adult patients who underwent cardiopulmonary bypass cardiac surgery. They were divided into two groups based on different intervention methods. The patients in the study group received targeted remifentanil infusion anesthesia, while those in the control group received intermittent sufentanil infusion anesthesia. The differences in hemodynamic indicators, surgical indicators, inflammatory response, stress response, coagulation function, NF-κB signaling pathway activity, and complications were compared between the two groups. Results: The differences in heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), cardiac contractility index (CCI), stroke volume variation (SVV), pulmonary artery pressure (PAP), peripheral capillary oxygen saturation (SpO?), and bispectral index (BIS) at different time points between the two groups were statistically significant (P 0.05). Conclusion: Remifentanil regulates the NF-κB signaling pathway by modulating the expression of P65, P50, Act1, and IκBα proteins, thereby reducing the release of inflammatory factors and improving coagulation function. This demonstrates the advantages of remifentanil not only in analgesia but also in its significant role in postoperative immune regulation and recovery of coagulation function.

Abstract:Objective: To explore the optimal timing of chemoimmunotherapy combined with radiotherapy for oligometastatic esophageal squamous carcinoma and analyze the prognostic factors. Methods: 71 patients with oligometastatic esophageal squamous carcinoma who received chemoimmunotherapy combined with radiotherapy were selected as research subjects, and were divided into three groups according to the timing of radiotherapy relative to chemoimmunotherapy: The first radiotherapy group (receiving radiotherapy before chemoimmunotherapy, n = 21), The synchronous radiotherapy group (receiving radiotherapy within four cycles from the start of chemoimmunotherapy, n = 29), The sequential radiotherapy group (receiving radiotherapy after four cycles from the start of chemoimmunotherapy, n = 21). Clinical efficacy [disease control rate (DCR), progression-free survival (PFS), overall survival (OS)] and incidence of adverse reactions were compared among the three groups. According to the neutrophil-to-lymphocyte ratio (NLR), patients were further divided into a low NLR group (NLR 2.33, n = 39), and their overall survival (OS) was compared. Univariate and multivariate Cox regression analyses were conducted to identify factors affecting the prognosis of patients with oligometastatic esophageal cancer. Results: The DCR for the first radiotherapy group, synchronous radiotherapy group, and sequential radiotherapy group were 33.3%, 44.8%, and 52.4%, respectively. There was no statistically significant difference in DCR among the three groups (P > 0.05). The median PFS for the first, synchronous, and sequential radiotherapy groups were 11.9, 17.6, and 17.5 months, respectively, with no statistically significant difference among the three groups (P > 0.05). The median OS for the first radiotherapy group, synchronous radiotherapy group, and sequential radiotherapy group was 18.4 months (95% CI: 13.1–23.7), 21.7 months (95% CI: 17.8–25.7), and 16.5 months (95% CI: 9.9–23.1), respectively. The differences in OS among the three groups were statistically significant (P 0.05). The OS for the low NLR group and the high NLR group was 23.3 months (95% CI: 19.6–27.0) and 16.6 months (95% CI: 15.1–18.1), respectively (P < 0.05). Both univariate and multivariate analyses indicated that NLR was an independent prognostic factor for patients with oligometastatic esophageal cancer (HR = 4.17, 95% CI: 2.17–8.00, P < 0.05). Conclusion: For patients with oligometastatic esophageal squamous carcinoma, initiating radiotherapy within four weeks of starting chemoimmunotherapy (i.e., concurrent chemoimmunotherapy and radiotherapy) prolongs overall survival without increasing treatment-related adverse effects. NLR is a valuable prognostic marker in this setting, and a high pretreatment NLR suggests a poorer prognosis.

Abstract:Objective: To investigate the predictive value of preoperative CT enterography (CTE) in evaluating the inflammatory activity of Crohn’s disease (CD) and early anastomotic recurrence (EAR) after primary enterectomy. Methods: 70 patients with CD who underwent initial intestinal resection were selected as research subjects and divided into an active group (n = 42) and a remission group (n = 28) based on inflammatory activity. Endoscopic examination was performed within 6 months after surgery; according to whether EAR occurred, patients were further classified into a recurrence group (n = 16) and a non-recurrence group (n = 54). Clinical characteristics, CTE signs, and SES-CD scores were compared between the different inflammatory activity groups and between the recurrence and non-recurrence groups, respectively. Receiver operating characteristic (ROC) curves were drawn to analyze the efficiency of CTE signs in evaluating CD inflammatory activity and predicting EAR after primary enterectomy in CD patients. Results: The thickness of the intestinal wall, CT value of the intestinal mucosa in the venous phase, ΔCT value, intestinal stenosis rate, mesenteric lymph node enlargement rate, mesenteric fibrofatty hyperplasia rate, comb sign rate, abscess/fistula rate, and the probability of intestinal wall stratified enhancement type A and type B were all significantly higher in the active group than in the remission group (P < 0.05). In the recurrence group, the thickness of the intestinal wall, CT value of the intestinal mucosa in the venous phase, ΔCT value, and rates of mesenteric lymph node enlargement, mesenteric fibrofatty hyperplasia, and abscess/fistula were significantly higher than those in the non-recurrence group (P < 0.05). ROC curve analysis indicated that the area under the curve (AUC) of the combination of CTE signs in predicting inflammatory activity of CD was 0.967. The AUC for predicting EAR after primary enterectomy in CD patients was 0.977, which was significantly higher than the AUC of any single CTE sign (P < 0.05). Conclusion: CTE signs and a comprehensive CTE-based scoring system have high value in the combined evaluation of inflammatory activity in Crohn’s disease and demonstrate excellent predictive performance for early anastomotic recurrence after primary enterectomy in CD patients.

Abstract:Objective: To explore the key risk factors influencing in-hospital mortality in elderly patients with sepsis and pulmonary infection, and to develop and validate a risk prediction model for in-hospital mortality based on the Least Absolute Shrinkage and Selection Operator (LASSO)-Logistic regression algorithm, integrating the lactate-to-albumin ratio (LAR) and other indicators, aiming to provide a quantitative tool for early identification of high-risk patients and optimization of intervention strategies. Methods: A retrospective analysis was conducted on 102 elderly patients (age ≥ 65 years) with sepsis and pulmonary infection admitted to the Intensive Care Unit (ICU). Based on in-hospital outcomes (within 28 days), patients were divided into a survival group (n = 65) and a death group (n = 37). Clinical data of all patients were collected. LASSO regression was used to screen predictive variables. The selected variables were incorporated into multivariate Logistic regression analysis to establish a risk prediction model. The Bootstrap method was employed for internal validation. The area under the receiver operating characteristic curve (AUC) and the Hosmer–Lemeshow goodness-of-fit test were used to evaluate the model’s discrimination and calibration. Results: Univariate and LASSO-Logistic regression analyses revealed that Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR = 1.202, 95% CI: 1.078–1.326), Sequential Organ Failure Assessment (SOFA) score (OR = 1.366, 95% CI: 1.142–1.590), lactate-to-albumin ratio (LAR) (OR = 1.581, 95% CI: 1.242–1.920), and mechanical ventilation (OR = 5.523, 95% CI: 1.892–9.155) were independent risk factors for in-hospital mortality (P 0.05). Decision curve analysis (DCA) showed that the prediction model had good clinical applicability when the probability threshold ranged from 0.3 to 0.7. Conclusion: The prediction model based on APACHE II score, SOFA score, LAR, and mechanical ventilation, constructed via LASSO-Logistic regression, demonstrates good predictive performance for in-hospital mortality risk in elderly ICU patients with sepsis and pulmonary infection. It aids in the early identification of high-risk patients and facilitates timely intervention.

Abstract:Objective: To investigate whether female patients with functional dyspepsia (FD) accompanied by abnormal urinalysis can be distinguished from those with genuine urinary tract infections (UTI), and to compare and analyze potential differences in urinalysis parameters between the two groups while developing a predictive model for differentiation. Methods: This study enrolled 120 female FD patients with abnormal urinalysis and 120 female UTI patients. The Mann–Whitney U test and chi-square test were employed to compare urinalysis parameters and the urinary inflammation index (UII) between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of urinalysis parameters in distinguishing FD from UTIs. Furthermore, logistic regression analysis was conducted to construct a nomogram-based predictive model. Results: Higher levels of leukocyte esterase (500 Leu/μL), positive urinary protein, occult blood (3+), higher red blood cell counts (RBCs ≥ 31/μL), and higher white blood cell counts (WBCs ≥ 71/μL) were associated with an odds ratio (OR < 1), suggesting a stronger association with UTI rather than FD (P < 0.05). In contrast, milder or lower-level abnormalities in urinalysis parameters were more indicative of FD. The optimal combined predictive model for UTI included occult blood, protein, and leukocyte esterase, achieving an AUC of 0.833 (95% CI: 0.778–0.888), with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 71.7%, 90.8%, 88.6%, 76.2%, and 81.3%, respectively. Conclusion: Abnormal urinalysis indicators in female FD patients exhibit distinct characteristics compared to those in UTI. The combination of urinary protein, leukocyte esterase, and occult blood demonstrates superior predictive value for differentiating between these two conditions. These findings provide a valuable foundation for further investigation into the pathogenesis and therapeutic approaches for FD accompanied by abnormal urinalysis indicators.

Abstract:Objective: To investigate the correlation between the triglyceride-glucose–body mass index (TyG-BMI) and the comorbidity of metabolic-associated fatty liver disease (MAFLD) in patients with chronic kidney disease (CKD). Methods: A total of 250 hospitalized CKD patients were enrolled. Patients were divided into two groups based on the presence or absence of MAFLD: the CKD-alone group (n = 125) and the CKD with MAFLD group (n = 125). Differences in baseline characteristics and TyG-BMI levels between groups were compared. TyG-BMI was stratified into four quartiles, and the incidence of MAFLD across these quartiles was analyzed. Pearson correlation analysis was used to assess the relationship between TyG-BMI and various clinical parameters. Logistic regression was performed to evaluate the independent association between TyG-BMI and MAFLD risk in CKD patients. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive value of TyG-BMI for MAFLD occurrence. Results: Compared to the CKD-alone group, the CKD with MAFLD group exhibited higher levels of diabetes prevalence, BMI, lymphocytes (LYM), monocytes (MONO), hemoglobin (HB), high-sensitivity C-reactive protein (Hs-CRP), total bilirubin (TBil), direct bilirubin (DBil), serum creatinine (Cr), triglycerides (TG), GGT/HDL, LDL-C/HDL-C, monocyte-to-HDL ratio (MHR), atherogenic index of plasma (AIP), TyG, TyG-BMI, and TyG-ALT. In contrast, albumin (ALB), estimated glomerular filtration rate (eGFR), and HDL levels were lower in the MAFLD group, with all differences being statistically significant (P < 0.05). As CKD staging progressed, the prevalence of MAFLD showed an increasing trend (P < 0.05). Stratification of TyG-BMI into quartiles revealed MAFLD incidence rates of 3.2%, 25.6%, 30.4%, and 40.8% in Q1 to Q4 groups, respectively, indicating a clear increasing trend with higher TyG-BMI levels; intergroup differences were statistically significant (P < 0.001). Pearson correlation analysis revealed positive correlations between TyG-BMI and BMI, HB, TG, Cr, LDL-C/HDL-C, AIP, TyG, and TyG-ALT (P < 0.05), and negative correlations with DBil, ALB, HDL-C, and eGFR (P < 0.05). After adjusting for confounders such as age, sex, hypertension, diabetes, HB, GGT/HDL-C, MHR, LDL-C/HDL-C, and TyG-ALT, logistic regression indicated that TyG-BMI was an independent risk factor for MAFLD in CKD patients (OR = 1.12, 95% CI: 1.07–1.16, P < 0.001). ROC analysis showed an area under the curve (AUC) of 0.720 (95% CI: 0.656–0.784) for TyG-BMI in predicting MAFLD, with an optimal cutoff value of 215.25, sensitivity of 63.0%, and specificity of 90.0%. Conclusion: In CKD patients, the risk of MAFLD may increase with rising TyG-BMI levels. TyG-BMI could serve as an independent risk factor and a valuable predictive biomarker for MAFLD in this population.

Abstract:Objective: To explore the efficacy of Seretide and Breztri Aerosphere inhalation in the treatment of patients with asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods: A total of 103 patients with ACOS were selected as study subjects and divided into the Seretide group (n = 52) and the Breztri Aerosphere group (n = 51) according to different treatment regimens. Patients in the Seretide group were treated with Seretide, while those in the Breztri Aerosphere group received Breztri Aerosphere treatment. The treatment course lasted 90 days. Clinical efficacy, disease control status [Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score, Asthma Control Test (ACT) score], improvement in lung function [forced expiratory volume in one second (FEV?), forced vital capacity (FVC), inspiratory capacity to total lung capacity ratio (IC/TLC)], immune changes in T lymphocytes [T helper 17 cells (Th17), regulatory T cells (Treg)], serum indicators [interleukin-17 (IL-17), eosinophil count (EOS)], incidence of adverse reactions, and disease progression were compared between the two groups. Results: The clinical efficacy in the Breztri Aerosphere group was significantly better than that in the Seretide group (P 0.05). However, the acute exacerbation rate and emergency visit rate in the Breztri Aerosphere group were significantly lower than those in the Seretide group (P < 0.05). Conclusion: Breztri Aerosphere can effectively improve pulmonary function and immune regulation in patients with ACOS, with a favorable safety profile. It is worthy of clinical promotion and application.

Abstract:Objective: To explore the correlation between coagulation indices and lymphocyte-derived indexes and the prognosis of patients with lung adenocarcinoma receiving combined therapy with platinum-based doublet chemotherapy and bevacizumab. Methods: A total of 43 patients with advanced lung adenocarcinoma who received platinum-based doublet chemotherapy combined with bevacizumab were included, and their clinical data were retrospectively analyzed. According to the levels of coagulation index [fibrinogen (Fib)] and lymphocyte-derived indexes [lymphocyte-to-fibrinogen ratio (LFR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR)], patients were divided into low-level and high-level groups. Progression-free survival (PFS) was compared between the low- and high-level groups for each index. Univariate analysis and multivariate Cox regression analysis were applied to identify factors influencing the prognosis of patients undergoing this combined treatment regimen. Results: PFS in the low-level Fib group was significantly higher than that in the high-level Fib group (P < 0.05). PFS in the high-level LFR group was significantly higher than that in the low-level LFR group (P < 0.05). PFS in the low-level PLR group was significantly higher than that in the high-level PLR group (P < 0.05). PFS in the low-level NLR group was significantly higher than that in the high-level NLR group (P < 0.05). Univariate analysis of baseline clinical characteristics revealed that PFS differed significantly among patients with different statuses of liver metastasis and maintenance treatment (P < 0.05). Multivariate Cox regression analysis indicated that PLR, NLR, and maintenance treatment were independent prognostic factors for patients with lung adenocarcinoma (P < 0.05). Conclusion: Fibrinogen (Fib), lymphocyte-to-fibrinogen ratio (LFR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), liver metastasis, and maintenance treatment are all associated with PFS in patients with lung adenocarcinoma treated with platinum-based doublet chemotherapy combined with bevacizumab. Specifically, low PLR, low NLR, and receipt of maintenance treatment are independent predictors of longer progression-free survival.

Abstract:1 Case data A male patient, 80 years old, was admitted to the hospital due to "epigastric pain for 10 days". The patient had no obvious inducement of epigastric pain 10+days ago, with intermittent distention and pain, accompanied by black stool, acid regurgitation, belching, and occasional dysphagia. No obvious abnormality was found on physical examination. Complete auxiliary examination: Abdominal CT showed that the gastric wall of the cardia lesser curvature was irregularly thickened, the tube wall was rigid, and the local area was in the form of a mass like process growing into the gastric cavity. The larger section size was about 4.1 cm × 3.2 cm, the CT value was about 35 HU, the density was uneven, the boundary was smooth, the focus involved the whole layer of the gastric wall, the serous surface was blurred, and the enhanced scanning showed progressive uneven enhancement in three stages (Figure 1).

Abstract:Objective: To analyze the application value of the Conceive–Design–Implement–Operate (CDIO) nursing mode in patients undergoing endoscopic surgery for chronic rhinosinusitis (CRS). Methods: A total of 186 patients who underwent surgery for CRS were selected as research subjects. According to different nursing methods, they were divided into the control group and the CDIO group, with 93 cases in each group. The control group received routine nursing care, while the CDIO group received nursing intervention based on the CDIO model. All patients received the assigned interventions until discharge. Pain intensity [Visual Analog Scale (VAS)], psychological status [Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)], quality of life [Sino-Nasal Outcome Test-20 (SNOT-20)], and postoperative complication rates were compared between the two groups. Results: Compared to the control group, the CDIO group had significantly lower VAS scores at 6 and 12 hours postoperatively, and lower SAS, SDS, and SNOT-20 scores at discharge (P < 0.05). The postoperative complication rate was also significantly lower in the CDIO group (P < 0.05). Conclusion: The CDIO nursing intervention model can effectively reduce postoperative pain and complication rates, and improve psychological well-being and quality of life in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery.