To investigate the risk factors for acute kidney injury (AKI) following the use of amphotericin B deoxycholate and to develop a predictive model to guide clinical monitoring and intervention.

Objective To investigate the role and potential mechanism of secreted phosphoprotein 1 (SPP1)⁺ macrophages in the formation of chronic renal allograft fibrosis. Methods The expression features of SPP1⁺ macrophages in renal allografts of chronic allograft dysfunction (CAD) patients were analyzed based on single-cell transcriptome data of renal tissues from patients with CAD. Transcription factor VIPER analysis and DoRothEA transcription factor activity analysis were performed on the single-cell transcriptome data. Renal tissue samples were collected from kidney transplant recipients, including the CAD group (n=5) and the non-renal allograft fibrosis group (CTL group, n=5). A mouse model of chronic allograft rejection was established and divided into the allogeneic kidney transplantation group (CAD group, n=3) and the syngeneic kidney transplantation group (SYN group, n=3). Hematoxylin-eosin staining was used to detect renal tissue injury in mice, and Masson staining was used to detect renal tissue fibrosis. Immunofluorescence staining was performed to detect SPP1 expression in renal tissues of transplant recipients and mouse renal allografts. Bone marrow-derived macrophages (BMDMs) were extracted from mice and subjected to hypoxia stimulation. The expression of hypoxia-inducible factor (HIF)-1α and SPP1 was detected by Western blot, and SPP1 expression was detected by flow cytometry. BMDMs were transfected with HIF-1α overexpression plasmid and HIF-1α small interfering RNA (siRNA) followed by hypoxia intervention, and the expression of HIF-1α and SPP1 was detected by Western blot. Mouse aortic endothelial cells (MAECs) were co-cultured with the supernatant of BMDMs, and the expression of endothelial-mesenchymal transition (EndMT)-related markers was detected by Western blot and immunofluorescence. Results Single-cell transcriptome analysis showed that the proportion of SPP1⁺ macrophages in renal allograft tissues was significantly higher in the CAD group than in the CTL group (P<0.05). The renal injury score and the percentage of interstitial fibrotic area in the CAD group were significantly higher than those in the SYN group (both P<0.05). Immunofluorescence staining showed that the proportion of SPP1⁺ macrophages was increased in the CAD group compared with the CTL group, and also increased in the CAD group compared with the SYN group (both P<0.05). VIPER analysis and DoRothEA transcription factor activity analysis revealed activation of the hypoxia pathway and upregulated expression of transcription factors such as HIF-1α in SPP1⁺ macrophages. SPP1 expression was elevated in BMDMs under hypoxic conditions. Knockdown of HIF-1α inhibited hypoxia-induced SPP1 protein expression, whereas overexpression of HIF-1α upregulated SPP1 protein levels. After co-culture of hypoxia-induced BMDMs with MAECs, the expression levels of EndMT-related markers were increased. Conclusions SPP1⁺ macrophages differentiated under hypoxia are significantly infiltrated in the formation of chronic renal allograft fibrosis, and may promote renal allograft fibrosis by inducing EndMT in renal vascular endothelial cells.

To systematically synthesize evidence on multiple KRAS G12C inhibitors(KRAS G12C inhibitors, KRAS G12Ci) as monotherapy within a unified population and recommended-dose framework, establish a comparable benchmark range of efficacy and safety for previously treated patients with advanced or metastatic KRAS G12C-mutant non-small cell lung cancer(NSCLC), and explore potential effect modifiers.

Objectives:To investigate the clinical efficacy of the distal tension-offloading cosmetic suture technique in reducing hypertrophic scar formation following open thyroidectomy.Methods:Clinical data and postoperative incision appearance of 138 patients undergoing open thyroidectomy at the Department of Thyroid and Neck Oncology of Tianjin Medical University Cancer Institute and Hospital, as well as the Department of Head and Neck Oncology of Tianjin Cancer Hospital Airport Hospital, from Aug 2023 to Jan 2024 was enrolled. Patients were devided into two groups based on the incision closure method: the distal tension-offloading cosmetic suture group (tension reduction group, 37 cases) and ordinary intradermal suture group (control group A, 55 cases evaluated 3 months post-surgery; control group B, 46 cases evaluated 6 months post-surgery). The Vancouver Scar Scale (VSS) was employed to assess the appearance of the wounds at 3 and 6 months post-surgery .Results:On 3 and 6 months post-surgery, the total VSS scores for patients in the tension reduction group were 2.8 ± 2.3 and 2.5 ± 2.5, respectively,while that in control group A on 3 months was 5.2 ± 3.0, and in group B on 6 months was 5.3 ± 3.4. The differences were statistically significant (all P<0.001). On 3 and 6 months post-surgery, the proportions of hypertrophic scars in the tension reduction group were 14% (5/37) and 11% (4/37), respectively , while in control group A it was 35% (19/55) , and in control group B was 35% (16/46) at 6 months, with differences being statistically significant ( P=0.024, 0.011 ). On 6 months post-surgery, 51 % (19/37) of patients in the tension reduction group achieved 'socially invisible aesthetic incisions', while only 15% (7/46) of patients in control group B achieved the same outcome ( P<0.01). Conclusion:Distal tension-offloading cosmetic suture significantly reduces the incidence of incision hypertrophic scars in open thyroid surgery.

Objective:To evaluate spinal-pelvic mobility and sagittal spinal-pelvic alignment characteristics in patients with developmental dysplasia of the hip (DDH), and to investigate differences in sagittal spinal-pelvic parameters between patients with DDH and those with osteonecrosis of the femoral head (ONFH).Methods:A total of 55 patients with DDH who underwent primary total hip arthroplasty (THA) at the Affiliated Hospital of Xuzhou Medical University between April 2021 and March 2024 were retrospectively analyzed. The cohort included 8 males and 47 females, with a mean age of 56.16±10.82 years (range: 26-76 years). Among them, 18 patients had bilateral DDH and 37 had unilateral DDH. Fifty-five age- and sex-matched patients with ONFH were selected as the control group. Unilateral DDH cases were classified according to the Hartofilakidis classification: 18 cases of type A, 13 cases of type B, and 6 cases of type C. Lateral spinal-pelvic radiographs were used to measure pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) in both standing and sitting positions. Changes in sagittal spinal-pelvic parameters between standing and sitting positions were analyzed to assess spinal-pelvic mobility. Spinal-pelvic mobility was considered abnormal if △SS was outside the range of 10°-30°. Abnormal mobility was further categorized as stiffness (△SS<10°) or hypermobility (△SS>30°).Results:The PI (52.37°±12.43°), standing PT (12.13°±9.50°), and sitting PT (36.49°±13.43°) of DDH patients were significantly higher than those of ONFH patients (44.88°±11.38°, 7.80°±11.36°, and 28.91°±11.38°, respectively), with statistically significant differences ( P<0.05). Abnormal spinal-pelvic mobility, including both stiffness and hypermobility, was observed in 53% of DDH patients, with stiffness accounting for 20%. These proportions were significantly higher than those in ONFH patients, which were 24% and 6%, respectively ( P<0.05). The prevalence of abnormal spinal-pelvic mobility in Hartofilakidis type C DDH patients was 83%, significantly higher than the 30.8% observed in type B patients (χ 2=4.550, P=0.033). The standing LL (54.37°±11.59°) and sitting LL (28.56°±15.51°) in unilateral DDH patients were significantly greater than those in bilateral DDH patients (46.88°±15.30° and 20.42°±9.77°, respectively), with statistically significant differences ( P< 0.05). Conclusions:Compared with patients with ONFH, those with DDH demonstrate a higher prevalence of abnormal spinal-pelvic mobility, particularly a greater incidence of spinal stiffness. Among DDH subtypes, Hartofilakidis type C patients exhibit a higher proportion of abnormal mobility compared to types A and B. Additionally, patients with unilateral DDH present with greater lumbar lordosis than those with bilateral involvement.

Objective:To evaluate the clinical characteristics and prognosis of transcatheter closure of secundum atrial septal defect (ASD) in infants.Methods:A retrospective analysis was conducted on 83 cases with secundum ASD who underwent transcatheter closure at the Women and Children′s Hospital of Qingdao University from January 2010 to December 2021. The clinical data included general information, pre- and post-operative echocardiography and electrocardiography, surgery records, and follow-up outcomes. The children who underwent successful occlusion were divided into two groups based on the presence or absence of pulmonary hypertension: the normal group and the pulmonary hypertension group. Differences between the two groups in terms of age, weight, right ventricular end-diastolic diameter, maximum ASD diameter, occluder size, and pulmonary-to-systemic flow ratio (Qp/Qs) were compared. Intergroup comparisons were performed using the Wilcoxon test.Results:Among the 83 infants with secundum ASD, 12 were males and 71 were females, with the age of (10.8±1.6) months. There were 29 cases (35%) with weight-for-age below the median level (less than the 25th percentile), 19 cases (23%) with recurrent or refractory pulmonary infections, and 40 cases (48%) with pulmonary hypertension. In this study, 81 cases (97%) successfully completed the procedure, while 2 cases failed due to soft defect margins. Postoperative arrhythmias occurred in 12 cases, of which 11 were transient arrhythmia; one case of atrioventricular block returned to normal rhythm after surgical removal of the occluder. The 81 infants who underwent successful occlusion were divided into normal group (41 cases) and pulmonary hypertension group (40 cases). The pulmonary artery systolic pressure, maximum diameter of ASD, the size of the occluder, and the cardiothoracic ratio were higher in the pulmonary hypertension group compared to those in the normal group, while the Qp/Qs value was lower (all P<0.05). Follow-up results indicated that infants with ASD who underwent transcatheter closure had no new arrhythmias, residual shunts, or intervention-related mortality. Within one year postoperatively, all infants exhibited normalization of right ventricular dimensions and pulmonary artery pressure. During a 3-year follow-up, all 29 cases that originally had a weight-for-age below the median level exhibited catch-up growth, reaching above the median level. Conclusions:Transcatheter closure for secundum ASD in infants is safe and feasible. Follow-up indicates that early transcatheter closure may be necessary for larger ASD diameters combined with pulmonary hypertension, with significant clinical improvement postoperatively.

Objective:To construct a thyroid nodule segmentation model using ultrasound dynamic images and explore its potential for assisting in the screening of thyroid nodules.Methods:A total of 126 patients with thyroid nodules（comprising 150 nodules）who were diagnosed and treated at Xuzhou Cancer Hospital from April 2024 to December 2024 were prospectively enrolled. Two-dimensional ultrasound was performed to capture short-axis and long-axis video images of thyroid nodules，forming a dynamic ultrasound image dataset. The dataset was divided into training，validation，and test sets in a ratio of 6∶1∶3. After the training loss curve converged，the model that performed well on the validation set was selected for testing. Three-fold cross-validation was employed for training and testing. All 300 ultrasound videos were divided into three subsets. In each experiment，two subsets were used as the training set，and one subset was used as the test set to evaluate the model's generalization ability. A collaborative spatiotemporal diffusion model was established based on the dynamic trends and tissue texture details of thyroid nodules. Six widely used segmentation metrics were employed to evaluate the model's application capabilities.Results:The study included 126 patients with 150 thyroid nodules，300 dynamic ultrasound images，and video lengths of 3-4 seconds per nodule，resulting in 12 312 segmented images. The size of the thyroid nodules was（10.7 ± 10.6）mm（transverse diameter）×（8.4 ± 6.3）mm（anteroposterior diameter）. Among the nodules，62（41.3%）had clear boundaries，while 88（58.7%）had indistinct boundaries；61（40.7%）exhibited regular shapes，while 89（59.3%）were irregular；66（44.0%）had a taller-than-wide aspect ratio；and 70（46.7%）showed microcalcifications. The collaborative diffusion model based on dynamic ultrasound image segmentation achieved the following scores：a Jaccard score of（69.22 ± 0.03）%，a Dice score of（79.16 ± 0.18）%，a Precision score of（86.70 ± 0.17）%，a Recall score of（77.82 ± 0.04）%，an Sα score of（85.26 ± 0.01）%，and an Eθmn score of（90.58 ± 0.17）%. Compared to other models，this model demonstrated significant improvements across all evaluation metrics，achieving the highest values in each metric with increments of over 8% and 1%，respectively. Conclusions:The collaborative diffusion model with a dynamic controller，constructed based on dynamic ultrasound images of thyroid nodules，demonstrates excellent performance in ultrasound image segmentation. It improves the accuracy of thyroid nodule screening，thereby providing a valuable auxiliary diagnostic tool for clinical practice.

Objective:To investigate the clinical results of anteriorly displaced orbicularis oculi flap and autologous granular fat injections via sub-brow incision for correction of different degrees of sunken upper eyelid.Methods:From September 2021 to September 2022, a total of 80 patients with upper eyelid skin laxity and sunken upper eyelid were recruited prospectively from the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine. There were 18 males and 62 females, aged 28 to 60 years, with a mean age of (42.7±9.2) years. According to Park's method, 59 patients with grade Ⅰ and grade Ⅱ sunken upper eyelid were treated with eyebrow lifting and orbicularis oculi flap correction, and 21 patients with grade Ⅲ upper eyelid sunken were treated with eyebrow lifting combined with autologous particles fat filling. The patients were followed up for 6 months. The depth of sunken upper eyelid was measured before and after operation. The incidence of adverse reactions and patient satisfaction were recorded.Results:The mean depth of depression measured preoperatively was (6.01±2.25) mm in the grades Ⅰ and Ⅱ sunken upper eyelid, which was improved to (2.00±1.06) mm at the 6-month postoperative follow-up ( P=0.001), and the mean depth of depression was (13.15±1.75) mm in the group of grade Ⅲ, which was improved to (4.15±1.49) mm at the 6-month postoperative follow-up ( P=0.001). After 6-month follow-up, the incidence of complications was 6.3% (5/80) and the satisfaction rate was 90.0% (72/80). Conclusions:Different correction methods should be chosen according to the degree of sunken upper eyelid. Grades Ⅰand Ⅱ sunken upper eyelid are corrected with orbicularis muscle flap through sub-eyebrow incision, and grade Ⅲ is corrected with autologous fat injection. Both the clinical effect and patient satisfaction rate are higher.

Objective:To evaluate the clinical efficacy and safety of fractional CO 2 laser combined with topical application of radix scutellariae ointment in the treatment of hyperplastic scar. Methods:This randomized controlled trial prospectively enrolled 90 patients with hyperplastic scar treated with fractional CO 2 laser at the Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine) from January 2020 to December 2021. Participants were randomly divided into a trial group and a control group using a random number table. The trial group ( n=45, 22 males, 23 females, aged 18-54 years) received topical radix scutellariae ointment post-laser treatment, while the control group ( n=45, 23 males, 22 females, aged 19-55 years) received recombinant bovine basic fibroblast growth factor gel. Both groups underwent treatment every 3 months, with scar assessments conducted at 1-month post-treatment. Outcomes included Vancouver scar scale (VSS) scores, scar cosmesis assessment and rating (SCAR) scores, adverse reaction rates, and patients' satisfaction. Results:After the first, second, and third treatments, the trial group showed significantly lower VSS and SCAR scores compared to the control group (all P<0.05). Patients' satisfaction in the trial group was 91.1% (41/45), significantly higher than 77.8% (35/45) in the control group ( P=0.036). The adverse reaction rate in the trial group was 15.6% (7/45), and 28.9% (13/45) in the control group, there was no statistical difference ( P=0.813). Conclusion:Fractional CO 2 laser combined with topical radix scutellariae ointment demonstrate superior clinical efficacy, higher patient satisfaction, and lower adverse reaction rates in the treatment of hyperplastic scar.

Aim To investigate the therapeutic effects of a newly developed Tadalafil tablets on pathological myocardial hypertrophy induced by abdominal aortic constriction(AAC)in rats,as well as its influence on the activation of the NF-κB signaling pathway in myo-cardial cells.Methods SD rats were randomly divid-ed into 4 groups:the sham operation group(Sham),the model group(AAC),the tadalafil new tablet treat-ment group(N-Tad,5 mg·kg-1),and the positive control drug treatment group(Cialis,10 mg·kg-1g).The AAC model group and treatment group rats under-went blunt dissection and constrictive ligation of the abdominal aorta at the left renal artery branch point during surgery,while the Sham group rats only had their arteries separated without any constrictive liga-tion.Rats in the treatment groups received either N-Tad or Cialis via gavage three days after modeling,while rats in the sham group and the model group re-ceived physiological saline daily for 8 weeks.Small an-imal ultra-high-resolution echocardiography and hemo-dynamic assessment were applied to evaluate left ven-tricular function in each group of rats,and the calcula-tion of the left ventricular mass index was conducted.By employing Western blot and RT-PCR.we assessed the impact of this treatment on the expression of the hy-pertrophy factor atrial natriuretic peptide(ANP),phosphorylated NF-κB p65 protein(p-NF-κB p65),and phosphorylated IκB-α in the left heart tissue of rats and in H9c2 cardiomyocytes.Results Compared to the Sham group,the AAC rats exhibited a significant decrease in left heart function,an increase in left ven-tricular mass index,and a notable increase in ANP and p-p65 expression in the left heart tissue(P＜0.05).Both N-Tad and Cialis treatments could significantly enhance left ventricular function,decrease left ventric-ular mass index,and inhibit the expression of ANP and phosphorylated NF-κB p65 in rats with myocardial hy-pertrophy(P＜0.05).Notably,the therapeutic effect of low-dose N-Tad was comparable to that of high-dose Cialis.At the cellular level,Tadalafil significantly in-hibited the activation of the NF-κB signaling pathway and reduced the expression of associated proteins in H9c2 cardiomyocytes.Conclusions N-Tad can sig-nificantly inhibit p65 and IκB-α phosphorylation,and the activation of the NF-κB signaling pathway,reduce ANP expression,and improve pathological myocardial hypertrophy,as well as mitigate left heart function damage caused by abdominal aortic constriction.