Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

Objective: To explore the impact of household tobacco smoke exposure on adolescents attempted smoking behavior, so as to provide a reference for tobacco control policy formulation and evaluation. Methods: From September to November 2023, a stratified cluster random sampling method was employed to select 7 841 middle and high school students from 10 monitoring sites (districts/counties) in Beijing for a questionnaire survey. Rao-Scott Chi square test was used to assess differences in proportions across subgroups, and complex sampling design based multivariate Logistic regression analysis was conducted to explore the influence of parental smoking and secondhand smoke (SHS) exposure at home on adolescents attempted smoking behavior. Results: About 47.17% of adolescents reported to have at least one parent smoked, with 42.36% reported of having only the father smoked, 0.73% reported of having only the mother smoked, and 4.08% reported of having both parents smoked. About 34.66% of middle and high school students were reported SHS exposure at home in the past 7 days, with 10.98%, 4.79% and 18.89% reported SHS exposure for 1-2, 3-4 and 5-7 days. Compared to adolescents with non smoking parents, those with a smoking father or both smoking parents had higher rates of attempted smoking [ OR (95% CI )=1.45(1.06-1.98), 3.73(2.18-6.37), P < 0.05 ]. Compared to adolescents without SHS exposure at home in the past 7 days, those exposed for 3-4 or 5- 7 days had higher rates of attempted smoking [ OR (95% CI )=2.21(1.27- 3.84 ), 2.46(1.58-3.83), P <0.01]. Conclusions Household tobacco smoke exposure is associated with adolescent attempted smoking behavior. Parents should quit smoking and prohibit smoking at home to create a smoke free environment for adolescents.

Objective:To investigate the application value of indocyanine green videoangiography (ICG-VA) in microsurgical clipping of ruptured posterior communicating artery aneurysms (PCoAA).Methods:Patients with ruptured PCoAA underwent microsurgical clipping and intraoperative ICG-VA at the Department of Neurosurgery, Lianyungang First People's Hospital from January 2020 to July 2022 were included retrospectively. Head CT was reviewed 3 days after operation to determine perioperative complications. CT angiography (CTA) or digital subtraction angiography (DSA) were used to evaluate the monitoring effect of ICG-VA. Glasgow Outcome Scale (GOS) was used to evaluate the clinical outcomes.Results:Thirty-two patients with ruptured PCoAA (a total of 38 aneurysms) were enrolled, including 7 males (21.9%), aged 57.97±8.91 years (range, 40~73). Twenty-seven patients (84.4%) had single aneurysm and 5 (15.6%) had multiple aneurysms (4 patients with 2 aneurysms and 1 with 3 aneurysms). Twenty-four patients (75.0%) had no or mild consciousness disorder, and 8 (25.0%) had moderate to severe consciousness disorder. The aneurysms of all patients were successfully clipped and ICG-VA was performed for a total of 40 times. Five patients with multiple aneurysms underwent precise localization of the parent artery and aneurysmal body using ICG-VA before clipping. After initial clipping, ICG-VA found 3 cases of residual aneurysms. After adjusting or adding aneurismal clips, ICG-VA showed that the residues were eliminated. Three days after the surgery, CT scan showed that 1 patient had right subdural effusion with periventricular infarction, and 1 had subdural effusion. At the final follow-up, CTA or DSA showed no residual aneurysms; the GOS score of 18 patients (56.3%) were 5, 5 patients (15.6%) were 4, and 9 (28.1%) were 3. There were no cases of vegetative state or death.Conclusion:ICG-VA assisted microsurgical clipping of ruptured PCoAA can effectively avoid residual aneurysms and the clinical application value is significant.

Objective:To develop a risk prediction model of acute cerebral infarction (ACI) in patients with type 2 diabetes mellitus (T2DM).Methods:It was a cross-sectional study. The clinical data of 798 patients with T2DM hospitalized in the Department of Endocrinology and Neurology of Shanxi Bethune Hospital from August 2021 to October 2023 were collected. Based on whether they had concurrent ACI, the patients were divided into T2DM with ACI group (case group) and pure T2DM group (control group). The patients were then allocated to a training set ( n=558) and a validation set ( n=240) in a 7∶3 ratio by the sample functions in R software. LASSO regression was employed to screen and optimize variables, and a multivariate logistic regression analysis was used to establish the nomogram prediction model. The discriminative ability, calibration, and clinical usefulness of the risk prediction model were assessed with receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis, respectively. Results:LASSO regression identified gender, age, systolic blood pressure, fasting plasma glucose (FPG), albumin (ALB), and carotid vascular condition as the variables for prediction. The multivariable logistic regression analysis showed that female ( OR=0.489, 95% CI: 0.308-0.778) and ALB ( OR=0.846, 95% CI: 0.795-0.901) were protective factors for ACI occurrence in T2DM patients, while age ( OR=1.051, 95% CI:1.025-1.077), systolic blood pressure ( OR=1.047, 95% CI: 1.034-1.059), FPG ( OR=1.185, 95% CI: 1.089-1.288), and carotid plaque ( OR=7.359, 95% CI: 3.050-17.756) were risk factors. The area under the ROC curve (AUC) for risk of ACI in the training set was 0.863(95% CI: 0.833-0.893), and it was 0.846(95% CI: 0.797-0.896) for the validation set. Calibration curves and the Hosmer-Lemeshow goodness-of-fit test indicated good model fit (training set χ2=8.311, P=0.404; validation set χ2=3.957, P=0.861). Decision curve analysis showed that the clinical effectiveness of the model was higher when the threshold probabilities of the training set and the validation set was 0.02-0.93 and 0.12-0.99, respectively. Conclusion:In this study, a prediction model of ACI risk in T2DM patients was successfully established.

Objective:To explore the clinical manifestations and characteristics of serum adrenal cortex hormone spectrum in patients with adrenocortical hypercortisolism with different pathological types of adrenal adenoma.Methods:A retrospective analysis was conducted on 68 patients with adrenal Cushing's syndrome who underwent surgical treatment in the Department of Endocrinology and/or Urology, Peking University First Hospital from January 2018 to June 2022. Among them, 12 patients had obvious eosinophilic changes in pathology(eosinophilic group), and 56 patients had no obvious eosinophilic changes(non-eosinophilic group). Among eosinophilic group, one male and 11 females, age(49.83±9.87) years old, body mass index (BMI)(25.86±3.21) kg/m 2, systolic blood pressure (140.25±20.72)mmHg(1 mmHg=0.133 kPa), diastolic blood pressure(91.00±14.87)mmHg, 7 cases were overt Cushing's syndrome. Among non-eosinophilic group, 14 males and 32 females, age(52.91±10.82) years old, BMI (26.06 ± 3.57) kg/m 2; ystolic blood pressure (142.13±16.71) mmHg, diastolic blood pressure (83.63±11.41) mmHg; 16 cases of overt Cushing's syndrome. There was no statistically significant difference in the above indicators between the two groups ( P>0.05).In terms of laboratory tests, 0: 00 cortisol levels in the eosinophilic group and non-eosinophilic groups were 14.95(5.93, 23.2) ng/dl and 6.69(4.07, 11.35) ng/dl ( P=0.044), the cortisol levels after 1mg dexamethasone inhibition test were 20.19(11.29, 26.92) ng/dl and 5.94(2.68, 12.90) ng/dl ( P=0.005), and 8: 00, 16: 00, and 0: 00, ACTH levels were 2.08 (1.02, 2.90) pg/ml and 8.37(2.30, 11.67) pg/ml ( P=0.006), 1.22(1.00, 3.20) pg/ml, and 4.22(1.80, 6.33) pg/ml ( P=0.012), 0.65 (0, 2.63) pg/ml, and 2.76(1.44, 5.57) pg/ml( P=0.023), serum triglyceride were 1.92(1.31, 2.50) mmol/L and 1.31(1.04, 1.80) mmol/L ( P=0.026), and the differences were statistically significant. In terms of target organ damage, there were 6 cases and 10 cases ( P=0.017) in the eosinophilic group and non eosinophilic group with ventricular wall hypertrophy, 1 case and 0 cases( P=0.030) in the aortic dissection group, and 4 cases and 5 cases ( P=0.024) with four or more types of target organ damage, respectively, with statistically significant differences. Two groups of preoperative serum adrenal cortex hormone profiles were detected by liquid chromatography tandem mass spectrometry. The differences in adrenal cortex hormone profiles and hormone ratios between the two groups were compared. Age, gender, and statistically significant indicators were included in a multivariate logistic regression model to analyze the correlation between each indicator and eosinophilic changes. Results:Adrenal cortical hormone profile of the two groups showed that the serum estrone levels in the eosinophilic group and non-eosinophilic group were 20.27(13.49, 39.81) pg/ml and 12.59(8.08, 21.18) pg/ml ( P=0.034), and 11-hydroxyandrostenedione levels were 692.34(536.19, 1 049.66) pg/ml and 1 157.60(710.78, 1 539.30) pg/ml( P=0.026), with statistically significant differences; There were no statistically significant difference in the expression levels of other hormones ( P>0.05). In terms of hormone ratio, the estradiol/testosterone ratios in the eosinophilic and non eosinophilic groups were 0.14(0.08, 0.62) and 0.04(0.01, 0.09)( P=0.008), the estrone/androstenedione ratios were 0.06(0.05, 0.12) and 0.04(0.03, 0.06)( P=0.007), the 11-hydroxyandrostenedione/androstenedione ratios were 2.26(1.30, 2.69) and 4.03(2.48, 5.25)( P=0.008), the estriol/estrone ratios were 0.10(0.03, 0.29) and 0.25(0.12, 0.51)( P=0.016), the estriol/estradiol were 0.22(0.03, 0.30) and 0.33(0.12, 0.73)( P=0.032), and the differences were statistically significant. The results of multivariate analysis showed that estrone ( OR=1.04, 95% CI 1.01-1.07, P=0.009) and estrone/androstenedione ( OR=25 008 670.29, 95% CI 8.45-74 015 852 572 024.10, P=0.025) were independently associated with eosinophilic pathology. Conclusions:Adrenocortical hypercortisolism patients with eosinophilic pathology have higher levels of serum cortisol secretion, more pronounced inhibition of the hypothalamic pituitary adrenal axis, more significant metabolic disorders and target organ damage, and higher production of estrone.

Objective To discuss the correlation of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with type 2 diabetic nephropathy (T2DN),and to analyze the value of NLR and PLR independent and combined detection in predicting T2DN.Methods A total of 300 patients with type 2 diabetes mellitus from Department of Endocrinology,Shanxi Bethune Hospital from December 2021 to September 2023 were analyzed retrospectively.According to the urinary albumin-creatinin ratio (ACR),patients were divided into the normal albuminuria group (A1 group,n=100),microalbuminuria group (A2 group,n=100) and the macroalbuminuria group (A3 group,n=100).The clinical and biochemical data (blood routine,blood biochemistry,glycosylated hemoglobin A1c,etc) were collected by fasting blood.Results NLR and PLR of patients in A3 group and A2 group were higher than those in A1 group ( P<0.05).NLR and PLR of patients in A3 group were higher than those in A2 group (P<0.05).Logistic regression analysis displayed that NLR (OR=1.702,95％CI:1.290-2.247,P<0.001]and PLR (OR=1.007,95％CI:1.001-1.014,P=0.033) were risk factors for T2DN.According to the analysis of receiver operating characteristic curve,the value of NLR for predicting T2DN was higher than PLR[area under the curve (AUC):0.715 vs.0.655].The cut-off values of NLR and PLR for predicting T2DN were 1.975 and 126.135,the corresponding sensitivity and specificity were 72.0％,64.0％ and 53.0％,74.0％ respectively.When NLR was combined with PLR,the AUC was 0.714,the sensitivity of combined prediction was 68.0％,and the specificity was 68.5％.Conclusion NLR and PLR are both risk factors for T2DN,and both can be used to predict T2DN.NLR has the greatest predict value for T2DN.The combined predictive value of NLR and PLR were not improved compared with NLR alone.

Objective:To investigate the treatment and prognosis of acute carotid artery occlusion during perioperative period of carotid endarterectomy (CEA).Methods:The clinical data of 112 carotid artery stenosis patients who underwent CEA from January 2017 to December 2021 in Lianyungang Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed. The patients were followed up at 6 to 9 months after surgery, the clinical prognosis was evaluated by Glasgow outcome score (GOS), and the head and neck CT angiography (CTA) was performed.Results:Among the 112 patients, 5 patients underwent acute carotid artery occlusion during the perioperative period, including 1 case of intraoperative acute occlusion of internal carotid artery and 1 case of intraoperative internal carotid artery combined with external carotid artery cute occlusion, both of them were re-sutured, and multi-mode monitoring showed that each carotid artery was unobstructed; 2 cases of intraoperative external carotid artery occlusion, no re-suture was performed during the operation; 1 case of intraoperative monitoring showed no obvious abnormality, and the contralateral limb hemiplegia was observed after surgery, and the muscle strength was grade 1, the carotid color Doppler ultrasound showed the occlusion of the internal carotid artery on the operation side. The CT and CTA examination showed focal infarction and common carotid artery on the operation side, and drugs and conservative treatment were given. The follow-up result: GOS 5 scores was in 4 cases, and 4 scores in 1 case; the muscle strength of hemiplegia patient recovered to grade 4; head and neck CTA examination, except for 1 case of common arterial occlusion, the other 4 cases showed no special abnormality.Conclusions:Intraoperative acute carotid artery occlusion can be detected timely by intraoperative multi-mode hemodynamic monitoring during CEA. Vascular recanalization after acute occlusion is possible by adopting active and effective treatment methods, the occurrence of postoperative ischemic stroke can be effectively prevented and the prognosis of patients can be improved.

Objective To observe the effects of hemoperfusion(HP)combined with hemodialysis on cholinesterase(ChE)activity and inflammatory factors in patients with acute organophosphorus pesticide poisoning(AOPP).Methods A retrospective cohort study was conducted.Seventy-three AOPP patients admitted to the department of emergency of Yingshang People's Hospital from January 2020 to December 2022 were enrolled.The patients were divided into HP group(31 cases)and HP+continuous renal replacement therapy(CRRT)group(42 cases)according to different treatment regimens.All patients were given supportive treatment according to the standard protocol after admission.HP was given to the patients as soon as possible after admission,and the treatment time was between 2 hours and 3 hours,with an interval of 24 hours.Patients in HP+CRRT group were treated with continuous veno-venous hemodiafiltration(CVVHDF)after HP.The serum ChE,tumor necrosis factor-α(TNF-α),and interleukins(IL-1,IL-6)levels were compared between the two groups after admission(T0),at the end of the first HP/HP+CRRT(T1),at the end of the second HP/HP+CRRT(T2),and at the end of the third HP/HP+CRRT(T3).The ChE recovery time,the incidence of intermediate syndrome(IMS),the length of hospital stay,and the rate of admission to ICU were also compared.Results With the extension of treatment time,the ChE activity at T1,T2,and T3 in the two groups was significantly higher than that at T0,and the levels of TNF-α,IL-1,and IL-6 were significantly lower than those at T0,reaching the trough value at T3,and the changes in HP+CRRT group were more significant than those in HP group[ChE activity(U/L):2 903.26±164.43 vs.2 292.98±350.96,TNF-α(ng/L):78.24±10.75 vs.100.55±15.58,IL-1(ng/L):95.98±22.56 vs.127.94±18.74,IL-6(ng/L):34.36±8.66 vs.58.74±10.46,all P<0.05].The recovery time of ChE activity and length of hospital stay in HP+CRRT group were significantly shorter than those in HP group[ChE activity recovery time(days):4.42±1.17 vs.7.31±1.46,length of hospital stay(days):9.25±2.14 vs.12.75±2.30,both P<0.05],the incidence of IMS and ICU admission rate were significantly lower than those in HP group[the incidence of IMS:33.33%(14/42)vs.61.29%(19/31),ICU admission rate:9.52%(4/42)vs.29.03%(9/31),both P<0.05].Conclusion For AOPP patients,HP+CRRT is superior to HP alone in the clearance of inflammatory factors,restoring ChE activity,reducing the incidence of IMS,and shortening the length of hospital stay,making it a valuable option for clinical application.

Objective:To explore the effect of intervention model based on comprehensive nutrition management on glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus (GDM).Methods:104 GDM patients admitted to Shanxi Bethune Hospital from February 2022 to March 2023 were randomly divided into control group and experimental group, with 52 cases in each group. The control group implemented routine management measures and nutrition guidance, while the experimental group implemented an intervention model based on comprehensive nutrition management on the basis of routine management. The indexes of glucose and lipid metabolism (glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, total cholesterol, triglyceride and low density lipoprotein cholesterol), pregnancy outcome, self-management ability and self-efficacy were compared between the two groups before and after intervention.Results:Before the intervention, there was no significant difference in general situation, glucose and lipid metabolism index, self-management ability and self-efficacy between the two groups ( P>0.05). After the intervention, the level of glucose and lipid metabolism index in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The incidence of adverse pregnancy outcome in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The scores of self-management ability and self-efficacy in the experimental group were significantly higher than those in the control group, with statistical significance ( P<0.05). Conclusion:The intervention model based on comprehensive nutrition management can effectively improve the glucose and lipid metabolism index and pregnancy outcome of GDM patients, and significantly improve their self-management ability and self-efficacy related to nutrition management, which has high clinical application and promotion value.

Objective:The purpose of this study is to explore the clinical characteristics of Coronavirus Disease 2019 (COVID-19) in patients with type 2 diabetes mellitus (T2DM), and analyze the risk factors for adverse outcomes.Methods:2 052 patients diagnosed with COVID-19 who were hospitalized in Shanxi Bethune Hospital between December 1, 2022 and March 20, 2023 were included. They were divided into diabetes group ( n=70) and non-diabetes group ( n=1 982) according to the presence or absence of comorbid T2DM. The two groups were matched at 1:1 via propensity score matching. Clinical characteristics and laboratory examination results of the two groups were compared. According to the outcomes during hospitalization, the two groups were further divided into two subgroups respectively. Univariate analysis and subsequent binary Logistic regression was used to analyze the risk factors of adverse outcomes in patients with COVID-19 and type 2 diabetes. Results:After the propensity score matching, the most common comorbid condition in diabetes group and non-diabetes group was hypertension. The proportion of patients with severe or critical disease in diabetes group was higher compared with non-diabetes group. The levels of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), blood urea, IL-4, IL-6, IL-10, IFN-γ and TNF-α were significantly higher in the diabetes group ( P<0.05). Logistic regression analysis within the diabetes group showed that hypertension ( OR=3.640, 95% CI: 3.156 to 4.290), FBG>11 mmol/L ( OR=3.283, 95% CI: 1.416 to 7.611), HbA1c>10% ( OR=2.718, 95% CI: 1.024 to 7.213) were independent risk factors for adverse outcomes in patients with COVID-19 and type 2 diabetes(all P<0.05). Conclusions:Compared with the non-diabetes group, patients with COVID-19 and T2DM have worse inflammatory response and higher levels of inflammatory cytokines. The elevated levels of FBG and HbA1c are related to the adverse outcome in patients with COVID-19 and T2DM.