Aim To investigate the related influencing factors of major adverse cardiovascular events(MACE)in coronary heart disease(CHD)patients with type 2 diabetes mellitus(T2DM)based on prognostic nutritional index(PNI),and to construct a prediction model.Methods The clinical data of 391 patients with CHD combined with T2DM who were hospitalised in the Department of Cardiovascular Medicine of Hebei Provincial People's Hospital from Janu-ary 2022 to January 2023 were collected and followed up for 1 year,and were divided into the MACE group(n=99)and the non-MACE group(n=292)according to the presence or absence of the occurrence of MACE,and were divided into the training set(n=273)and the validation set(n=118)in a ratio of 7:3 by using the computer-generated random number method,and the patients in the training set were divided into the MACE(n=67)group and the non-MACE group(n=206)according to whether they had MACE or not.Lasso regression was used to screen the relevant influencing factors and to construct the prediction model of the column-line diagram,and the prediction model was validated by plotting receiv-er operating characteristic(ROC)curve,calibration curve,decision curve analysis(DCA),and clinical impact curve(CIC).Results Lasso regression showed that the use of angiotensin receptor neprilysin inhibitor(ARNI),fasting blood glucose(FBG),C-reactive protein(CRP),platelet to lymphocyte ratio(PLR),lipoprotein(a)(Lp(a)),and PNI were the predictors of the occurrence of MACE in patients with CHD combined with T2DM.A column-line graph pre-diction model was constructed and validated based on the above predictors,and the area under the ROC curve(AUC)was 0.838(95％CI:0.778～0.898)in the training set and0.872(95％CI:0.803～0.942)in the validation set,with a good discriminatory degree of the model,and the C-values of the calibration curves in the training set and the validation set were 0.838 and 0.872,respectively,with good fit.The results of the decision curve analysis and the clinical impact curve showed that the column-line graph prediction model had a higher net yield of MACE in patients with CHD combined with T2DM,with high clinical utility.Conclusion PNI is an influential factor in the occurrence of MACE in patients with CHD combined with T2DM,and the column-line graphical model constructed on the basis of predictors such as PNI is con-venient for clinical use and has high predictive value in predicting the occurrence of MACE in patients with CHD combined with T2DM.

Objective To explore the predictive value of dose surface histogram(DSH)in image guided radiotherapy(IGRT)for radiotherapy-induced acute radiation proctitis(ARP)in cervical cancer(CCA).Methods Totally 380 patients with CCA IGRT admitted to some hospital from May 2019 to May 2023 were selected prospectively and randomly divided into a control group(n=1 80)and an experimental group(n=200).The patients in the 2 groups were followed up and the incidence rates of ARP were counted,and rectal dose distribution was evaluated using dose volume histogram(DVH)in the control group and DSH in the experimental group.The predictive values of DVH and DSH for ARP were evaluated and compared using ROC curves.Statistical analysis was performed using SPSS 21.0 software.Results The two groups did not have statistically significant difference in the incidence rate of ARP(P＞0.05),while there were significant differences in the evaluation indicators of the rectal dose distribution(P＜0.05).V40,V50,S40 and S50 proved to have low predictive values for grade Ⅰ-Ⅳ ARP with AUC 0.700(P＜0.05);V60 and S60 had moderate predictive values for grade Ⅰ-Ⅳ ARP with AUC greater than 0.700 and less than or equal to 0.900(P＜0.05);V70,V78,S70 and S7s showed high predictive values for grade Ⅰ-Ⅳ ARP with AUC higher than 0.900(P＜0.05).Delong's test results indicated that DVH and DSH had no significant differences in AUC when used to predict gradeⅠ-Ⅳ ARP(allP＞0.05).Conclusion DSH is essentially the same as DVH when used for the prediction of grade Ⅰ-Ⅳ ARP due to CCA IGRT,and thus can be used for the supplementation and optimization of radiotherapy planning systems.[Chinese Medical Equipment Journal,2025,46(3):48-53]

Objective:To evaluate the incidence, clinical features, factors affecting initial diagnosis, efficacy, and safety of therapy and prognosis of small intestinal Dieulafoy lesions (DL).Methods:Clinical data including clinical background, diagnosis, and treatment details of patients who were admitted to the Department of Gastroenterology, Air Force Medical Center, for suspected small bowel bleeding, diagnosed as having small bowel DL and treated with balloon-assisted enteroscopy (BAE) were retrospectively analyzed from November 2017 to March 2024.Results:Among 800 patients, 30 cases (3.75%, 30/800, 17 males and 13 females) were diagnosed as having small intestine DL with the mean age of 60.90 years. Clinical symptoms included melena (56.67%, 17/30), hematochezia (43.33%, 13/30), and hemodynamic instability (30.00%, 9/30). Active bleeding occurred in 23 (76.67%) patients. Comorbidities existed in 70.00% (21/30) and 33.33% (10/30) used long-term antithrombotic agents. Diagnosis was confirmed after a single BAE in 63.33% (19/30) and after multiple BAEs (mean 1.6 procedures) in 36.67% (11/30). Lesions were predominantly located at jejunal. All patients achieved successful treatment with a single BAE procedure. The median follow-up period was 12.25 months (range: 5.25-23.00 months). Five cases (16.67%) experienced recurrent bleeding, with one case transfered to surgical intervention. Two cases (6.67%) reported post-operative symptoms of dizziness and fatigue, which resolved after symptomatic management. Multivariate analysis showed that long-term oral anticoagulant therapy ( OR=0.06, 95% CI: 0.01-0.73) was an independent predictor of single-session diagnosis. Conclusion:Small intestinal DL is rare and challenging to diagnose. Antithrombotic therapy may facilitate the diagnosis of DL at the first BAE. Jejunal localization is common, and combined endoscopic therapy (including clipping) is effective and safe.

The structure and function of mitochondria and endoplasmic reticulum(ER)are important for maintaining cellular homeostasis.It has been found that the interaction between mitochondria and ER is involved in the occurrence and development of a variety of diseases.The mitochondria-associated ER membrane(MAM)is a membrane contact site between the ER and mitochondria,and is an important communication center between organelles in eukaryotic cell.Calcium channels on the ER side and the mitochondrial side are crucial in the calcium transport process in MAM.The interaction between ER and mitochondria controls mitochondrial biological function and cell survival through calcium transport regula-tion,and are involved in the occurrence and development of various pathologic process.On the one hand,MAM regulates calcium transport,which is involved in the modulation of various cellular survival and death processes.It plays a profound regulatory role in the damage of tumor cells,neuronal cells,car-diomyocytes,endothelial cells and nucleus pulposus cells through different key molecules within MAM.On the other hand,the regulation of MAM in calcium transport is crucial in the development of mitochon-drial dysfunction in Hepa 1-6 cells,the synthesis and secretion of pancreatic β-cells and amyotrophic lat-eral sclerosis.In addition,MAM also affects cellular transcription processes by regulating calcium trans-port,thereby exerting significant regulatory effects on angiogenesis and breast cancer.This paper reviews the structural features and pathophysiologic role of calcium transport regulation of MAM,and expects to provide new horizons for prevention and treatment of related diseases targeting MAM.

Aim To analyze the correlation between serum retinol-binding protein 4(RBP4),low density lipo-protein cholesterol to albumin ratio(LDLC/Alb),monocyte to high density lipoprotein ratio(MHR)and plaque stability in carotid atherosclerosis population and their predictive value for acute ischemic stroke(AIS).Methods A total of 197 patients with asymptomatic carotid atherosclerosis admitted to our hospital from September 2021 to January 2023 were selected for a prospective cohort study,and they were categorized into occurred group and non-occurred group according to whether AIS occurred within 12 months.Baseline information at time of visit,results of the cervical ultrasonography and serum RBP4,LDLC/Alb,MHR levels were compared between the two groups.Spearman/Pearson and receiver operating characteristic(ROC)curve were used to analyze the corr-elation of RBP4,LDLC/Alb and MHR with carotid atherosclerosis and plaque stability,and the value of predicting AIS in carotid atherosclerosis population.Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration ability of serum RBP4,LDLC/Alb and MHR to jointly predict AIS in carotid atherosclerosis population.Results The carotid intima-media thickness(IMT)was higher in occurred group than that in non-occurred group.There were more soft plaques and mixed plaques in occurred group than in non-occurred group(P＜0.05).Serum levels of RBP4,LDLC/Alb and MHR were higher in occurred group than those in non-occurred group(P＜0.05).The correlation analysis showed that the levels of serum RBP4,LDLC/Alb and MHR were positively correla-ted with IMT(r=0.803,0.740,0.710)and plaque properties(r=0.736,0.685,0.703)(P＜0.001).ROC curve a-nalysis showed that the AUC of serum RBP4,LDLC/Alb and MHR in predicting AIS in carotid atherosclerosis population was 0.796,0.821 and 0.828,respectively,and the AUC of MHR was the largest;the AUC of the combination of serum RBP4,LDLC/Alb and MHR was 0.936,which was higher than that of MHR(Z=2.978,P＜0.05),the predictive sensi-tivity and specificity were 88.24％and 87.40％.Hosmer-Lemeshow goodness of fit test showed that there was no signifi-cant difference between serum RBP4,LDLC/Alb and MHR in predicting AIS and the actual observation value in carotid atherosclerosis population(P＞0.05),and the prediction model had good calibration ability.Conclusion Serum RBP4,LDLC/Alb,and MHR are positively correlated with carotid atherosclerosis and plaque stability,and can predict the occurrence of AIS.Combined detection of the three can be used as a method for early identification of potential high-risk populations for AIS,providing a new,quantifiable guidance scheme for the prevention and treatment of AIS in carotid ath-erosclerotic population.

Objective:To explore the relationship between serum soluble myeloid cell trigger receptor-1(sTREM-1)messenger RNA(mRNA),high mobility group protein B1(HMGB1)mRNA levels and intestinal flora and the occurrence of preterm premature rupture of membranes(PPROM)in gestational diabetes mellitus(GDM)patients.Methods:98 GDM pregnant women with GDM combined with PPROM who underwent regular prenatal check ups and delivered at the First Hospital Affiliated to Hebei North University from June 2022 to May 2024 were selected as the GDM combined with PPROM group,102 GDM pregnant women without PPROM were selected as the GDM without PPROM group,and 108 normal pregnant women were selected as the control group.Intestinal flora,serum sTREM-1 mRNA,HMGB1 mRNA levels of the three groups of pregnant women were collected and compared;the correlation between serum sTREM-1 mRNA and HMGB1 mRNA levels and intestinal flora in GDM pregnant women,the factors affecting the occurrence of PPROM in pregnant women with GDM,and the predictive value of serum sTREM-1 mRNA and HMGB1 mRNA in the occurrence of PPROM in GDM pregnant women were analyzed.Results:Compared with control group,colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM without PPROM group and GDM combined with PPROM group(P＜0.05),the colony number of Bifidobacterium and Lactobacillus was significantly de-creased(P＜0.05).The gestational age at delivery of GDM combined with PPROM group was significantly lower than that of control group and GDM without PPROM group(P＜0.05).Compared with GDM without PPROM group,the colony number of Bifidobacterium and Lactobacillus were significantly decreased(P＜0.05),colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM com-bined with PPROM group(P＜0.05).The serum levels of sTREM-1 mRNA and HMGB1 mRNA in control group,GDM without PPROM group,GDM combined with PPROM group were increased sequentially(P＜0.05).Serum sTREM-1 mRNA was positively correlated with HMGB1 mRNA in GDM pregnant women(r＞0,P＜0.05);serum sTREM-1 mRNA and HMGB1 mRNA were positively correlated with the colony numbers of Enterococcus,Enter-obacter,Bacteroides and Fusobacterium(r＞0,P＜0.05),and negatively correlated with the colony numbers of Bifidobacterium and Lactobacillus(r＜0,P＜0.05).Enterococcus,Enterobacter,Bacteroides,Fusobacterium,sTREM-1 mRNA and HMGB1 mRNA were independent risk factors for PPROM in GDM pregnant women(OR＞1,P＜0.05),while Bifidobacterium and Lactobacillus were independent protective factors for PPROM in GDM pregnant women(OR＜1,P＜0.05).The area under curve(AUC)of predicting PPROM in GDM pregnant women by combining serum sTREM-1 mRNA and HMGB1 mRNA(0.922)was higher than the AUC predicted by serum sTREM-1 mRNA and HMGB1 mRNA alone(0.829,0.841)(P＜0.05).Conclusions:Serum sTREM-1 mRNA and HMGB1 mRNA were highly expressed in GDM pregnant women,and the increase trend of serum both was more obvious in GDM pregnant women with PPROM,both of which were related to intestinal flora imbalance and the occurrence of PPROM.The combination of sTREM-1 mRNA and HMGB1 mRNA has high efficacy in predicting the occurrence of PPROM.

Objective:To investigate the influencing factors of major adverse cardiovascular events (MACE) in maintenance hemodialysis (MHD) patients, and to construct and verify the nomogram.Methods:The clinical data of 240 patients with MHD admitted to the First Affiliated Hospital of Hebei North University from July 2022 to October 2023 were retrospectively analyzed. According to whether the patients had MACE, they were divided into two groups, namely the occurrence group (with MACE, n=55) and the non-occurrence group (without MACE, n=185). After comparing the clinical data of the two groups, The independent risk factors of MHD patients with MACE were screened by binary logistic regression analysis, and the risk nomogram prediction model was constructed according to the risk factors, and the prediction efficiency of the model was analyzed by Bootstrap method. Results:There were significant differences in age, dialysis age, hyperlipidemia, hyperuricemia and hemodialysis flux between the two groups (all P<0.05). Binary logistic regression model analysis showed that dialysis age >12 months, combined with hyperlipidemia, combined with hyperuricemia, and low throughput hemodialysis were independent risk factors for MHD patients with MACE (all P<0.05). The neomorph risk prediction model was constructed based on independent risk factors. The area under the curve (AUC) of the prediction model was 0.842(95% CI: 0.789-0.896), the specificity was 69.1%, the sensitivity was 89.7%, the cutoff value was 13.128, and the Yoden index was 0.588, suggesting that the accuracy of the model was good. Conclusions:Dialysis age >12 months, combined with hyperlipidemia, combined with hyperuricemia and low throughput hemodialysis are independent risk factors for MACE in MHD patients. Intervention and control of risk factors can reduce the incidence of MACE.

Objective:To discuss the effect of DEAD-box RNA helicase 39A(DDX39A)gene silencing on the proliferation,migration and invasion of the esophageal cancer TE-1 cells,and to clarify its possible mechanism.Methods:For bioinformatics analysis,GSE63941,GSE77861,GSE20347,and GSE16153 chip data were downloaded from the GEO database.The esophagel cancer-related data were selected from the TCGA Database.R software was used to analyze the differentially expressed genes.STRING Database was used to construct the protein-protein interaction(PPI)network.Identification of key genes of high relevance was achieved using the MCODE plugin in Cytoscape.The expression of key genes in normal esophageal tissue and esophageal cancer tissue were analyzed with the GEPIA 2 database.Kaplan-Meier Plotter was used to perform survived analysis and plotting for the screened key genes.Cytological experiments were carried out on esophageal cancer TE-1 cells,and small interfering RNA(siRNA)technology was used to silence the expression of DDX39A gene.The TE-1 cells in the logarithmic growth phase were selected and divided into blank(MOCK)group,negative control(si-NC)group,and silencing(si-DDX39A)group.Real-time fluorescence quantitative PCR(RT-qPCR)and Western blotting methods were used to detect the expression levels of DDX39A mRNA and protein in the TE-1 cells in various groups;CCK-8 assay was conducted to detect the proliferation activity of cells in various groups,and the cell scratch assay was used to measure the migration rate of cells in various groups;Transwell chamber assay was used to detect the number of invasion cells in various groups;Western blotting method was used to detect the expression levels of β-catenin,glycogen synthase kinase-3β(GSK3β),phosphorylated glycogen synthase kinase-3β(p-GSK3β),c-MYC,Cyclin D1 and nuclear β-catenin proteins in the cells in various groups.Results:Analyses using TCGA database combined with the GEO Database yielded a total of 56 differentially expressed genes.MCODE plugin in Cytoscape software identified 41 key genes of high relevance;DDX39A was screened by analyzing 41 genes through the GEPIA 2 and Kaplan-Meier plotter Databases.The results of RT-qPCR and Western blotting methods showed that compared with si-NC group,the expression levels of DDX39A mRNA and protein in the cells in si-DDX39A group were decreased(P＜0.05).The CCK-8 results showed that the proliferation activity of the cells in si-DDX39A group was lower than that in si-NC group(P＜0.05).The cell scratch assay results showed that the cell migration rate in si-DDX39A group after 24 h was lower than that in si-NC group(P＜0.05).The results of Transwell chamber assay showed that the number of invasion cells in si-DDX39A group was lower than that in si-NC group(P＜0.05).Compared with si-NC group,the expression levels of β-catenin,p-GSK3β,c-MYC,Cyclin D1,and nuclear β-catenin in the TE-1 cells in si-DDX39A-1 group and si-DDX39A-3 group were decreased(P＜0.01),but the expression levels of GSK3β protein had no significant differences(P＞0.05).Conclusion:Silencing of DDX39A gene could inhibit the proliferation,migration and invasion of TE-1 cells,and the mechanism may be related to the regulation of Wnt/β-catenin signaling pathway.

Objective:To investigate the levels and clinical significances of miRNA-155-5p (miR-155-5p) and hypoxia inducible factor-1α (HIF-1α) in the bone marrow of patients with acute myeloid leukemia (AML)-M 5. Methods:A cross sectional study was conducted. The bone marrow samples were collected from 32 AML-M 5 patients who were admitted to the First Affiliated Hospital of Hebei North University from November 2023 to December 2024, and the bone marrow samples collected from 11 patients with megaloblastic anemia from November 2023 to May 2025 were used as controls. Reverse transcription real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to determine relative expression of miR-155-5p at the transcription level in bone marrow mononuclear cells, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of HIF-1α protein in bone marrow supernatant. The levels of miR-155-5p and HIF-1α in bone marrow were compared between AML patients and control group, as well as among AML patients with different prognostic risks. Spearman method was used to analyze the relationship between miR-155-5p level and HIF-1α level in bone marrow of AML patients and their levels with bone marrow and peripheral blood cell indicators. Results:Among the 32 AML-M 5 patients, 20 patients (62.5%) were male and 12 patients (37.5%) were female, with a median age [ M ( Q1, Q3)] of 63 (51, 70) years; according to the clinical response criteria recommended by the European Leukemia Network (ELN) in 2022, there were 12 cases (37.5%) of complete response (CR) and 8 cases (25.0%) of non-complete response (NCR); according to the risk stratification criteria recommended by ELN in 2022, there were 8 cases (25.0%) with good prognosis, 13 cases (40.6%) with moderate prognosis and 11 cases (34.4%) with poor prognosis. In the control group, there were 5 males and 6 females, with a median age of 68 (63, 72) years. There was no statistically significant difference in gender and age between the two groups (both P > 0.05). The transcription level relative expression of miR-155-5p in the bone marrow mononuclear cells of AML-M 5 patients [5.13 (2.83, 8.84) vs. 0.87 (0.56, 1.69)] and the concentration of HIF-1α protein in the bone marrow supernatant of AML-M 5 patients [(116±32) pg/ml vs. (58±22) pg/ml] were higher than those in the control group, and the differences were statistically significant (both P < 0.001). The relative expression of miR-155-5p at the transcription level in the initial diagnosis group and NCR group and the concentration of HIF-1α in the initial diagnosis group, NCR group and CR group were higher than those in the control group (all P < 0.01), the relative expression of miR-155-5p at the transcription level in the CR group was higher than that in the control group, but the difference was not statistically significant ( P > 0.05); the relative expression of miR-155-5p at the transcription level in the newly diagnosis group was higher than that in the CR group, and the difference was statistically significant ( P < 0.01). However, there was no statistically significant difference between the newly diagnosis group and the NCR group or between the NCR group and the CR group (all P > 0.05). The concentration of HIF-1α in the newly diagnosis group and NCR group was higher than that in the CR group, and the differences were statistically significant (both P < 0.05). However, there was no statistically significant difference between the newly diagnosis group and the NCR group ( P > 0.05). There was no statistically significant difference in the relative expression of miR-155-5p at the transcription level and HIF-1α concentration in bone marrow among AML-M 5 patients with poor prognosis, moderate prognosis and good prognosis (both P > 0.05). The level of miR-155-5p in the bone marrow of AML-M 5 patients was positively correlated with the level of HIF-1α ( r = 0.446, P = 0.010); the level of miR-155-5p in bone marrow was positively correlated with the proportion of bone marrow primitive cells ( r = 0.583, P < 0.001), peripheral blood leukocyte count ( r = 0.464, P = 0.008), peripheral blood monocyte count ( r = 0.464, P = 0.007), and peripheral blood monocyte-to-leukocyte ratio ( r = 0.457, P = 0.009). The concentration of HIF-1α in the bone marrow of AML-M 5 patients was positively correlated with the proportion of bone marrow primitive cells ( r = 0.568, P = 0.001) and peripheral blood mononuclear cells-to-white blood cells ratio ( r = 0.375, P = 0.034), but not with peripheral blood white blood cell count ( r = 0.159, P = 0.385) or peripheral blood mononuclear cell count ( r = 0.300, P = 0.095). Conclusions:The levels of miR-155-5p and HIF-1α in the bone marrow of AML-M 5 patients are relatively high, and the levels of both are lower in patients with remission. However, the levels of both may not be related to the risk of prognosis. The levels of miR-155-5p and HIF-1α in the bone marrow of AML-M 5 patients are positively correlated, and their levels are also positively correlated with major hematological indicators in the bone marrow and peripheral blood.

Objective To investigate the relationship between Klotho,insulin-like growth factor-1(IGF-1),and Irisin in the placentas of pregnant rats and the intrauterine development of fetuses.Methods Thirty SD rats were divided into the intrauterine growth restriction(IUGR)experimental animal model group(IUGR group),the macrosomia experimental animal model group(macrosomia fetal group),and the control group ac-cording to different feeding diets(low-protein diet,high-protein diet,and normal diet).All pregnant mice were subjected to laparotomy for tissue sampling on the 21st day of pregnancy.The birth weight,body length,and placental mass of fetal rats were recorded.The relative mRNA expression levels of Klotho,IGF-1,and Irisin in the placentas were detected by quantitative real-time fluorescent reverse transcription-PCR(qRT-PCR),and the correlations between various factors above were analyzed.Results Compared with the control group,the birth weight,body length and placental mass of fetal rats in the IUGR group were lower,while those in the macrosomia fetal group were higher,with statistically significant differences(P<0.05).Compared with the control group,the relative mRNA expression levels of Klotho,IGF-1,and Irisin in the IUGR group were de-creased,while those in the macrosomia fetal group were increased,with statistically significant differences(P<0.05).Correlation analysis showed that Klotho mRNA was positively correlated with the relative expres-sion levels of placental IGF-1 mRNA and Irisin mRNA,and IGF-1 mRNA were also positively correlated with the relative expression level of placental Irisin mRNA(P<0.05).Conclusion Klotho,IGF-1,and Irisin in the placenta are associated with fetal growth and possibly regulated through the Klotho/IGF-1/Irisin axis.