Objective:To explore the correlation between hyperuricemia (HUA) and chronic kidney disease (CKD) in the individuals undergoing physical examinations.Methods:It was a retrospective cohort study. The study selected 6 910 individuals who received health check-ups at the Xiangya Hospital Health Management Center of Central South University in 2012 and 2022, with none of them having developed CKD in 2012. Using the presence of HUA in 2012 as the independent variable and the occurrence of CKD in 2022 as the outcome variable, four Cox proportional hazards regression models were constructed, with baseline age, gender, body mass index, waist circumference, glomerular filtration rate, presence of hypertension, presence of diabetes, presence of dyslipidemia, white blood cell count, hemoglobin level, direct bilirubin level, alanine aminotransferase level, and blood uric acid level in 2013 as confounding variables. These models were used to analyze the correlation between HUA and CKD, and sensitivity analyses were conducted. The percentile bootstrap method was employed to conduct mediation effect testing, analyzing the intermediary risk factors that influence the correlation between HUA and CKD.Results:Among the 6 910 participants included in the study, the overall baseline detection rate of HUA was 8.78% (607/6 910). In 2022, the incidence of CKD was 7.2% (498/6 910). Cox regression analysis showed a positive correlation between HUA and the occurrence of CKD in the overall population ( HR=1.586, 95% CI: 1.224-2.055). However, after gradually adjusting for confounding factors, the correlation between HUA and CKD was not statistically significant. Stratified by gender, the occurrence of HUA was positively correlated with the incidence of CKD in women ( HR=2.599, 95% CI: 1.069-6.316), but the correlation became non-significant after adjusting for confounding factors. In contrast, there was no significant correlation between HUA and CKD in men. In sensitivity analysis, When uric acid levels were analyzed by grouping participants into two categories based on thresholds of>420 μmol/L for men and>360 μmol/L for women, or as a continuous variable, the results showed a positive correlation between HUA and CKD in the overall population and in women, the HR (95% CI) value was 1.627 (1.282-2.064), 2.465 (1.552-3.914), 1.004 (1.003-1.005) and 1.006 (1.004-1.008), respectively. However, after adjusting for confounding factors, the correlation between HUA and CKD became non-significant in both cases. In the males, there was no correlation between uric acid and the occurrence of CKD, regardless of whether uric acid was treated as a categorical or continuous variable. Mediation analysis revealed that diabetes and hypertension were full mediators between HUA/blood uric acid levels and CKD in the overall population. Among males, diabetes and hypertension were full mediators between blood uric acid levels and CKD. In females, hypertension was a full mediator between HUA/blood uric acid levels and CKD, with an effect proportion of 100%. Conclusion:HUA is positively correlated with the risk of CKD, particularly in females, but HUA is not an independent predictor of CKD. HUA influences the occurrence of CKD through conditions such as diabetes and hypertension.

Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5％vs.15.2％)and segmental renal vein involvement(42.4％vs.20.8％),but lower rates of renal sinus invasion(RSI,21.2％vs.73.6％)and renal vein tumor thrombus(0％vs.15.2％)compared with the RN group(n=394,all P＜0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P＞0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P＜0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P＞0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P＜0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.

Objective:To observe the changes of small airway parameters in patients with coal workers' pneumoconiosis in different disease stages by high resolution computed tomography (HRCT) , and analyze the correlation between them and the severity of the disease.Methods:From June 2016 to June 2023, 25 healthy volunteers and 71 untreated patients with coal worker's pneumoconiosis in the Fifth People's Hospital of Ningxia were selected as the research objects. The clinical and imaging data of the patients were collected, and the disease stages were performed according to the dust exposure history and high-kilovolt chest X-ray. The patients were divided into 4 groups: control group (25 cases) , coal workers' pneumoconiosis stage Ⅰ group (17 cases) , coal workers' pneumoconiosis stage Ⅱ group (32 cases) and coal workers' pneumoconiosis stage Ⅲ group (22 cases) . Quantitative chest HRCT parameters of each group were collected, including the square root of wall area at 10 mm inner perimeter (AWT-Pi10, Pi10) , airway wall thickness, airway wall volume, airway wall area percentage of the whole lung and the 5th, 6th, 7th and 8th level airways, and low attenuation area percentage (LAA%) of the whole lung. Pulmonary function indicators were collected, including forced expiratory volume in 1 second (FEV 1) and the percentage of its projected value [FEV 1 (%pred) ], the ratio of FEV 1 to forced vital capacity (FEV 1/FVC) and the percentage of its projected value[FEV 1/FVC (%pred) ]. One-way ANOVA or Kruskal-Wallis H test and Spearman rank correlation were used to analyze the difference and correlation. Results:Compared with control group, FEV 1, FEV 1 (%pred) , FEV 1/FVC and FEV 1/FVC (%pred) in stage Ⅱ and Ⅲ coal workers' pneumoconiosis groups were lower ( P<0.05) . In addition, the FEV 1 and FEV 1 (%pred) of the stage Ⅲgroup were lower than those of the stageⅡ group ( P<0.05) , and the FEV 1/FVC and FEV 1/FVC (%pred) of the stage Ⅲgroup were lower than those of the stage Ⅰgroup ( P<0.05) . Compared with stage Ⅰ group, Pi10 in stage Ⅲ group were increased ( P < 0.05) at the 6th and 8th level airways, and airway wall thickness and airway wall volume in the 6th, 7th and 8th level airways of stage Ⅲgroup increased ( P<0.05) . Correlation analysis showed that all pulmonary function indexes were negatively correlated with Pi10 of whole lung and the 6th, 7th and 8th level airways ( P<0.05) , all pulmonary function indexes were negatively correlated with airway wall thickness of the 7th and 8th level airways ( P<0.05) , and FEV 1/FVC (%pred) was negatively correlated with airway wall volume of the 7th and 8th level airways ( P<0.05) . FEV 1, FEV 1 (%pred) , FEV 1/FVC (%pred) were negatively correlated with percentage of airway wall area of whole lung and the 6th, 7th and 8th level airways ( P<0.05) . Conclusion:The quantitative airway parameters of coal workers' pneumoconiosis based on HRCT are correlated with pulmonary function indexes, which can reflect the severity of coal workers' pneumoconiosis.

Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5％vs.15.2％)and segmental renal vein involvement(42.4％vs.20.8％),but lower rates of renal sinus invasion(RSI,21.2％vs.73.6％)and renal vein tumor thrombus(0％vs.15.2％)compared with the RN group(n=394,all P＜0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P＞0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P＜0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P＞0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P＜0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.

Objective:To explore the correlation between hyperuricemia (HUA) and chronic kidney disease (CKD) in the individuals undergoing physical examinations.Methods:It was a retrospective cohort study. The study selected 6 910 individuals who received health check-ups at the Xiangya Hospital Health Management Center of Central South University in 2012 and 2022, with none of them having developed CKD in 2012. Using the presence of HUA in 2012 as the independent variable and the occurrence of CKD in 2022 as the outcome variable, four Cox proportional hazards regression models were constructed, with baseline age, gender, body mass index, waist circumference, glomerular filtration rate, presence of hypertension, presence of diabetes, presence of dyslipidemia, white blood cell count, hemoglobin level, direct bilirubin level, alanine aminotransferase level, and blood uric acid level in 2013 as confounding variables. These models were used to analyze the correlation between HUA and CKD, and sensitivity analyses were conducted. The percentile bootstrap method was employed to conduct mediation effect testing, analyzing the intermediary risk factors that influence the correlation between HUA and CKD.Results:Among the 6 910 participants included in the study, the overall baseline detection rate of HUA was 8.78% (607/6 910). In 2022, the incidence of CKD was 7.2% (498/6 910). Cox regression analysis showed a positive correlation between HUA and the occurrence of CKD in the overall population ( HR=1.586, 95% CI: 1.224-2.055). However, after gradually adjusting for confounding factors, the correlation between HUA and CKD was not statistically significant. Stratified by gender, the occurrence of HUA was positively correlated with the incidence of CKD in women ( HR=2.599, 95% CI: 1.069-6.316), but the correlation became non-significant after adjusting for confounding factors. In contrast, there was no significant correlation between HUA and CKD in men. In sensitivity analysis, When uric acid levels were analyzed by grouping participants into two categories based on thresholds of>420 μmol/L for men and>360 μmol/L for women, or as a continuous variable, the results showed a positive correlation between HUA and CKD in the overall population and in women, the HR (95% CI) value was 1.627 (1.282-2.064), 2.465 (1.552-3.914), 1.004 (1.003-1.005) and 1.006 (1.004-1.008), respectively. However, after adjusting for confounding factors, the correlation between HUA and CKD became non-significant in both cases. In the males, there was no correlation between uric acid and the occurrence of CKD, regardless of whether uric acid was treated as a categorical or continuous variable. Mediation analysis revealed that diabetes and hypertension were full mediators between HUA/blood uric acid levels and CKD in the overall population. Among males, diabetes and hypertension were full mediators between blood uric acid levels and CKD. In females, hypertension was a full mediator between HUA/blood uric acid levels and CKD, with an effect proportion of 100%. Conclusion:HUA is positively correlated with the risk of CKD, particularly in females, but HUA is not an independent predictor of CKD. HUA influences the occurrence of CKD through conditions such as diabetes and hypertension.

Objective:To observe the changes of small airway parameters in patients with coal workers' pneumoconiosis in different disease stages by high resolution computed tomography (HRCT) , and analyze the correlation between them and the severity of the disease.Methods:From June 2016 to June 2023, 25 healthy volunteers and 71 untreated patients with coal worker's pneumoconiosis in the Fifth People's Hospital of Ningxia were selected as the research objects. The clinical and imaging data of the patients were collected, and the disease stages were performed according to the dust exposure history and high-kilovolt chest X-ray. The patients were divided into 4 groups: control group (25 cases) , coal workers' pneumoconiosis stage Ⅰ group (17 cases) , coal workers' pneumoconiosis stage Ⅱ group (32 cases) and coal workers' pneumoconiosis stage Ⅲ group (22 cases) . Quantitative chest HRCT parameters of each group were collected, including the square root of wall area at 10 mm inner perimeter (AWT-Pi10, Pi10) , airway wall thickness, airway wall volume, airway wall area percentage of the whole lung and the 5th, 6th, 7th and 8th level airways, and low attenuation area percentage (LAA%) of the whole lung. Pulmonary function indicators were collected, including forced expiratory volume in 1 second (FEV 1) and the percentage of its projected value [FEV 1 (%pred) ], the ratio of FEV 1 to forced vital capacity (FEV 1/FVC) and the percentage of its projected value[FEV 1/FVC (%pred) ]. One-way ANOVA or Kruskal-Wallis H test and Spearman rank correlation were used to analyze the difference and correlation. Results:Compared with control group, FEV 1, FEV 1 (%pred) , FEV 1/FVC and FEV 1/FVC (%pred) in stage Ⅱ and Ⅲ coal workers' pneumoconiosis groups were lower ( P<0.05) . In addition, the FEV 1 and FEV 1 (%pred) of the stage Ⅲgroup were lower than those of the stageⅡ group ( P<0.05) , and the FEV 1/FVC and FEV 1/FVC (%pred) of the stage Ⅲgroup were lower than those of the stage Ⅰgroup ( P<0.05) . Compared with stage Ⅰ group, Pi10 in stage Ⅲ group were increased ( P < 0.05) at the 6th and 8th level airways, and airway wall thickness and airway wall volume in the 6th, 7th and 8th level airways of stage Ⅲgroup increased ( P<0.05) . Correlation analysis showed that all pulmonary function indexes were negatively correlated with Pi10 of whole lung and the 6th, 7th and 8th level airways ( P<0.05) , all pulmonary function indexes were negatively correlated with airway wall thickness of the 7th and 8th level airways ( P<0.05) , and FEV 1/FVC (%pred) was negatively correlated with airway wall volume of the 7th and 8th level airways ( P<0.05) . FEV 1, FEV 1 (%pred) , FEV 1/FVC (%pred) were negatively correlated with percentage of airway wall area of whole lung and the 6th, 7th and 8th level airways ( P<0.05) . Conclusion:The quantitative airway parameters of coal workers' pneumoconiosis based on HRCT are correlated with pulmonary function indexes, which can reflect the severity of coal workers' pneumoconiosis.

Objective:To predict the 3-year cancer-specific survival(CSS)of patients with non-meta-static T3a renal cell carcinoma after surgery.Methods:A total of 336 patients with pathologically con-firmed T3a N0-1M0 renal cell carcinoma(RCC)who underwent surgical treatment at the Department of Urology,Peking University Third Hospital from March 2013 to February 2021 were retrospectively collect-ed.The patients were randomly divided into a training cohort of 268 cases and an internal validation co-hort of 68 cases at an 4∶1 ratio.Using two-way Lasso regression,variables were selected to construct a nomogram for predicting the 3-year cancer-specific survival(CSS)of the patients with T3aN0-1M0 RCC.Performance assessment of the nomogram included evaluation of discrimination and calibration ability,as well as clinical utility using measures such as the concordance index(C-index),time-dependent area un-der the receiver operating characteristic curve[time-dependent area under the curve(AUC)],calibra-tion curve,and decision curve analysis(DCA).Risk stratification was determined based on the nomo-gram scores,and Kaplan-Meier survival analysis and Log-rank tests were employed to compare progres-sion-free survival(PFS)and cancer-specific survival(CSS)among the patients in the different risk groups.Results:Based on the Lasso regression screening results,the nomogram was constructed with five variables:tumor maximum diameter,histological grading,sarcomatoid differentiation,T3a feature,and lymph node metastasis.The baseline data of the training and validation sets showed no statistical differences(P＞0.05).The consistency indices of the column diagram were found to be 0.808(0.708-0.907)and 0.903(0.838-0.969)for the training and internal validation sets,respectively.The AUC values for 3-year cancer-specific survival were 0.843(0.725-0.961)and 0.923(0.844-1.002)for the two sets.Calibration curves of both sets demonstrated a high level of consistency between the actual CSS and predicted probability.The decision curve analysis(DCA)curves indicated that the column dia-gram had a favorable net benefit in clinical practice.A total of 336 patients were included in the study,with 35 cancer-specific deaths and 69 postoperative recurrences.According to the line chart,the patients were divided into low-risk group(scoring 0-117)and high-risk group(scoring 119-284).Within the low-risk group,there were 16 tumor-specific deaths out of 282 cases and 36 postoperative recurrences out of 282 cases.In the high-risk group,there were 19 tumor-specific deaths out of 54 cases and 33 post-operative recurrences out of 54 cases.There were significant differences in progression-free survival(PFS)and cancer-specific survival(CSS)between the low-risk and high-risk groups(P＜0.000 1).Conclusion:A nomogram model predicting the 3-year CSS of non-metastatic T3a renal cell carcinoma patients was successfully constructed and validated in this study.This nomogram can assist clinicians in accurately assessing the long-term prognosis of such patients.

Objective:To understand the relationship between lipid accumulation product (LAP) and hyperuricemia in physical examination population.Methods:This was a cross-sectional study. The analysis was based on baseline data from a retrospective cohort study. Total of 44 294 people who received physical examination in the Health Management Center of Xiangya Hospital of Central South University from January to December 2012 were selected as subjects with whole-group sampling method. All the subjects aged ≥18 years with complete study variables. The minimum waist circumference of the subjects was calculated to determine the criteria for calculating LAP in those population. With LAP as the observed variable and hyperuricemia as the outcome variable, LAP was divided into four groups according to the interquartile interval (Q 1-Q 4 groups): group Q 1<10.56 cm·mmol/L, 10.56 cm·mmol/L≤Q 2<20.79 cm·mmol/L, 20.79 cm·mmol/L≤Q 3<38.94 cm·mmol/L, Q 4≥38.94 cm·mmol/L. Five models were constructed with logistic regression analysis. No confounding factors was adjusted in Model 1, model 2 was adjusted for age and gender; and model 3 was further adjusted for body mass index, hypertension, hyperlipidemia, creatinine and glomerular filtration rate; model 4 was further adjusted education level, occupation, health insurance, smoking, drinking, diet scores and physical exercise; model 5 was further adjusted the family history of gout, diabetes and hypertension. And the relationship between different LAP levels and hyperuricemia was analyzed. Results:In this study, the minimum waist circumference in the physical examination population was 58 cm and 53 cm for men and women, respectively. The total incidence of hyperuricemia was 13.4% in this population, 5.94% for women and 19.40% for men. When the confounding factors were not adjusted (model 1), the risk of hyperuricemia in women′s LAP Q 2 to Q 4 groups was 1.76 times (95% CI: 1.42-2.17), 5.08 times (95% CI: 4.20-6.14) and 12.58 times (95% CI: 10.43-15.18), and it was 1.68 times (95% CI: 1.43-1.96), 2.74 times (95% CI: 2.36-3.18), and 5.32 times (95% CI: 4.62-6.14) in men, respectively. After gender stratification and adjustment for confounding factors (model 5), the risk still existed, compared with that in Q 1 group of LAP, the risk of hyperuricemia in women in Q 4 group was 8.28 times higher (95% CI: 2.50-27.38) and 3.31 times higher in men (95% CI: 1.57-6.95). Conclusion:The risk of hyperuricemia in health examination population increases with LAP, especially in women.

Objective:To investigate the relationship between cardiometabolic index (CMI) and hyperuricemia (HUA) in the health examination population.Methods:It was a cross-sectional study. A total of 21 720 individuals who received health examinations in Xiangya hospital, Central South University between 2020 and 2021 were recruited in this study. Multivariate logistic regression analysis was used to determine the independent correlation between CMI and HUA, and stratified analysis was applied to check whether there were population differences. Then the predictive value of CMI for hyperuricemia in the health examination population was evaluated with the area under the receiver operator characteristic (ROC) curve.Results:Among the 21 720 subjects, 4 418 (20.34%) were detected with HUA. In the HUA group, the body mass index (BMI), waist-to-hip ratio, CMI, total cholesterol, triglyceride, systolic blood pressure, diastolic blood pressure, fasting blood glucose, 2-hour postprandial blood glucose, and blood creatinine levels were all significantly higher than those in the normal uric acid group, while high-density lipoprotein and epidermal growth factor receptor (eGFR) were significantly lower (all P<0.05). Multiple logistic regression analysis showed that after adjusting for relevant factors, CMI was significantly positively correlated with HUA ( OR=1.16, 95% CI: 1.129-1.192); and with the increase of CMI, the risk of HUA increased gradually. Stratified analysis and interaction test according to gender, age, BMI, hypertension, abnormal blood glucose and glomerular filtration rate indicated that CMI was positively associated with the occurrence of HUA in all populations. Compared with that in people with abnormal blood glucose, the correlation between CMI and HUA was more obvious in people with normal blood glucose. The area under the ROC curve (AUC) for CMI to predict HUA was 0.723(95% CI: 0.715-0.731), with a specificity of 0.636 and a sensitivity of 0.698, and the cut-point was 0.693. Conclusion:There was a significant positive correlation between CMI and HUA in the health examination population, which has good predictive value for HUA.

OBJECTIVE To investigate the role of clinical pharmacists in the treatment of a patient with Epstein-Barr （EB） virus encephalitis. METHODS Clinical pharmacist participated in drug diagnosis and therapy for a patient with EB virus encephalitis. According to the physiological characteristics of the disease and the pharmacokinetic-pharmacodynamic characteristics of antibiotics， clinical pharmacists suggested that the dose should be adjusted as ceftriaxone 2 g， q12 h+meropenem 2 g， q8 h. Based on the uncontrolled infection of the patient， pharmacists suggested that ceftriaxone should be stopped and vancomycin 1 million U and q12 h should be used as alternative therapy. According to the results of etiology， pharmacists suggested that acyclovir should be discontinued and replaced with ganciclovir 5 mg/kg， q12 h. The electrolyte disturbance of the patient may be adverse drug reactions caused by Mannitol injection， it was recommended to stop the drug. RESULTS The clinician followed the advice of the clinical pharmacists. After treatment， the patient improved and was discharged. CONCLUSIONS Clinical pharmacists can carry out pharmaceutical care for patients with EB virus encephalitis， assist physicians in optimizing the treatment plan of patients， and ensure the effectiveness and safety of drug treatment.