[Objective] To explore the predictive value of HALP score for prognosis in patients with multiple myeloma (MM). [Methods] A retrospective analysis was conducted on laboratory indicators and related clinical data of newly diagnosed multiple myeloma (NDMM) patients, treated at the Affiliated Hospital of North Sichuan Medical College from January 2016 to October 2023, prior to their first treatment. The HALP score was calculated, and the optimal cutoff value for HALP was determined using X-tile software. Survival analysis was performed using Kaplan-Meier curves for high HALP and low HALP groups. Univariate and multivariate analyses were conducted using the Cox regression model, and a forest plot was generated using Graphpad Prism to illustrate factors that may impact patient prognosis. The predictive ability of HALP score combined with β2-microglobulin and ECOG score for prognosis in MM patients was evaluated using receiver operating characteristic curve (ROC) analysis. [Results] A total of 203 MM patients were included, with the optimal cutoff value for HALP score being 29.15 (P<0.05). Among them, 101 patients were in the low HALP score group, and 102 patients were in the high HALP score group. The results of univariate and multivariate analysis using the Cox regression model showed that a HALP score <29.15 was an independent risk factor for progression-free survival (PFS) and overall survival (OS) (P<0.05). ROC curve analysis indicated that the combination of HALP score with β2-microglobulin and ECOG score had a higher predictive value for prognosis in MM patients compared to using HALP score alone. [Conclusion] The HALP score is closely related to the prognosis of patients with NDMM. A low HALP score indicates a poorer prognosis, while the combination of HALP score with β2-microglobulin and ECOG score provides a higher predictive value when assessed together.

OBJECTIVE To optimize the simmering technology of Rheum palmatum from Menghe Medical School and compare the difference of chemical components before and after processing. METHODS Using appearance score， the contents of gallic acid， 5-hydroxymethylfurfural （5-HMF）， sennoside A+sennoside B， combined anthraquinone and free anthraquinone as indexes， analytic hierarchy process （AHP）-entropy weight method was used to calculate the comprehensive score of evaluation indicators； the orthogonal experiment was designed to optimize the processing technology of simmering R. palmatum with fire temperature， simmering time， paper layer number and paper wrapping time as factors； validation test was conducted. The changes in the contents of five anthraquinones （aloe-emodin， rhein， emodin， chrysophanol， physcion）， five anthraquinone glycosides （barbaloin， rheinoside， rhubarb glycoside， emodin glycoside， and emodin methyl ether glycoside）， two sennosides （sennoside A， sennoside B）， gallic acid and 5-HMF were compared between simmered R. palmatum prepared by optimized technology and R. palmatum. RESULTS The optimal processing conditions of R. palmatum was as follows: each 80 g R. palmatum was wrapped with a layer of wet paper for 0.5 h， simmered on high heat for 20 min and then simmered at 140 ℃， the total simmering time was 2.5 h. The average comprehensive score of 3 validation tests was 94.10 （RSD＜1.0%）. After simmering， the contents of five anthraquinones and two sennosides were decreased significantly， while those of 5 free anthraquinones and gallic acid were increased to different extents； a new component 5-HMF was formed. CONCLUSIONS This study successfully optimizes the simmering technology of R. palmatum. There is a significant difference in the chemical components before and after processing， which can explain that simmering technology slows down the relase of R. palmatum and beneficiate it.

0bjective:To confirm the role of decreased chemerin on aerobic exercise-induced improvement of glucose and lipid metabolism using exogenous chemerin in obese,diabetic and atherosclerotic rats,and to explore whether the mechanisms is related to the key enzymes or proteins of glucose and lipid metabolism mediated by peroxi-some proliferator-activated receptor γ(PPARγ)in the peripheral metabolic organs(liver,muscle and fat),includ-ing lipoprotein triglyceride lipase(ATGL)and lipoprotein lipase(LPL)and glucose transporter 4(GLUT4). Method:①Animal experiments:Total of 130 male rats aged 6 weeks were included in this study.In addition to the normal control(Con,n=17)rats,the model rats with obesity(OB),atherosclerosis(AS)and diabetes mellitus(DM)were established by 8-week high-fat diet,8-week high-fat diet combined with intraperitoneal injection of Vitamin D3 or of low dose of streptozotocin,respectively.All the successfully established model rats were ran-domly divided into:the control[AS(n=8),OB(n=8)and DM(n=10)and the exercise(EAS(n=8),EOB(n=8)and EDM(n=10)]rats.All exercise groups were participated in the 4-week moderate-intensity treadmill running exercise with gradually increased load,six days per week and one time per day.Serum chemerin were detect-ed by ELISA.Protein levels of chemerin,CMKLR1,PPARγ,ATGL,LPL and GLUT4 in tissues(liver,gastrocne-mius and perirenal fat)were detected by Western blot.In order to confirm the mediation role of PPARγ,diabet-ic rats were randomly divided into 4 groups:DM(n=10),EDM(n=10),EDM plus PPARγ agonist pioglitazone(EDP,n=10)and EDM plus PPARγ antagonist GW9662(EDG,n=10),and the protein levels of ATGL,LPL and GLUT4 were detected.②Cell experiments:3T3-L1 cells were treated with exogenous chemerin(200 ng/ml)for 48 h,then the cells were collected to detect the protein levels of PPARγ,ATGL,LPL and GLUT4. Result:①The serum chemerin and the protein levels of chemerin and CMKLR1 in tissues(liver,gastrocnemius and perirenal fat)of EAS,EOB and EDM groups rats were significantly decreased after 4-week aerobic exer-cise,with the improvement of blood glucose and lipid.The protein levels of PPARγ,ATGL,LPL in liver,gas-trocnemius and perirenal fat,and GLUT4 in gastrocnemius were significantly increased in the EAS,EOB and EDM rats after 4-week aerobic exercise.② In DM rats,the increase of ATGL,LPL and GLUT4 induced by aerobic exercise were partially reversed by PPARγ inhibitor GW9662 and further enhanced by PPARγ agonist pioglitazone.(3)The protein levels of PPARγ,ATGL,LPL and GLUT4 in 3T3-L1 cells were significantly re-duced after treating the cells with exogenous chemerin. Conclusion:The improved effect of 4 weeks of aerobic exercise on blood glucose and blood lipid in rats with obesity,diabetic and atherosclerosis is related to the reduction of chemerin,thereby upregulating key en-zymes and proteins of glycolipid metabolism(including ATGL,LPL and GLUT4).The effect of chemerin on the above key enzymes and protein is mediated by PPARγ in diabetes rats.

Objective To develop"guideline for risk assessment and prevention of noninvasive ventilation related facial pressure injuries in adults"and to provide a reference for clinical medical staff to evaluate and prevent noninvasive ventilation related facial pressure injuries.Methods Referring to the"WHO Guideline Development Manual",clinical problems were formed through 3 rounds of Delphi expert consultation.The relevant recommendation opinions and evidence were screened,extracted,integrated and evaluated to form a draft consensus.Through a round of Delphi expert consultation and a round of expert consensus meeting,expert opinions were combined to modify and improve the content of each item to form a final draft of the expert consensus.Results Recommendations for the constructed guideline included 7 aspects of risk factors,high-risk sites,assessment tools,assessment timing and content,selection of non-invasive ventilation equipment,selection of dressings,and preventive measures,including 7 clinical questions and 15 recommendations.Conclusion The"guideline for risk assessment and prevention of noninvasive ventilation related facial pressure injuries in adults"was an evidence-based guideline based on the best evidence,Chinese clinical reality,and professional judgment,and it can provide practice bases for scientific clinical decisions making by clinical medical staff and managers.

Objective:To explore the association between thyroid function and chronic kidney disease (CKD) in adults.Methods:A cross-sectional study was conducted in adults who received health checkup in the First Affiliated Hospital of Shandong First Medical University from January to December in 2021. Clinical data were collected, including age, gender, height, weight, blood pressure, etc. And blood glucose, blood lipid, blood creatinine, blood uric acid, routine urine function, thyroid function (free triiodine, free thyroxine, thyroid stimulating hormone) were measured. Multivariate logistic regression model was used to investigate the correlation between thyroid function indicators and the onset of CKD; and receiver operator characteristic (ROC) curve was used to explore the ability of thyroid function indicators in evaluating CKD.Results:In the study, 46 342 adults with an average age of (47.6±14.3) years were enrolled, of which 56.2% were males. The prevalence of DeGFR (eGFR<60 ml·min -1·(1.73 m 2) -1), proteinuria and CKD was 1.15%, 0.53% and 1.58%, respectively. The TSH subgroup analysis showed that the prevalence of DeGFR, albuminuria and CKD in the hypothyroidism group was significantly increased to 1.07%, 2.36% and 3.20%, respectively (all P<0.05). After adjusting for confounding factors, multivariate logistic regression analysis showed that FT3 was negatively associated with CKD ( OR=0.63, 95% CI: 0.54-0.74), however FT4 ( OR=1.05, 95% CI: 1.03-1.07) and TSH ( OR=1.03, 95% CI: 1.01-1.04) were positively correlated with CKD. Similar results were obtained in the subgroup without hypertension and diabetes ( P<0.05). The ROC analysis indicated that FT3 had a better capability for evaluating CKD than FT4 and TSH, with an area under the curve of 0.63, a cut-off value of 4.18 pmol/L, and a sensitivity and specificity of 57.5% and 62.6%, respectively. Conclusions:Thyroid function status is closely associated with the onset of CKD in the adult population receiving health check-up. FT3 is a risk factor for the onset of CKD.

Goniotomy (GT) is a safe and effective type of minimally invasive glaucoma surgery (MIGS) extensively utilized in China.It is particularly suited for treating primary open-angle glaucoma and advanced primary angle-closure glaucoma.Although GT is generally safe, hyphema and postoperative intraocular pressure (IOP) spikes remain common complications after GT.Currently, there is no standardized protocol for managing these issues, which can impact clinicians' assessment of surgical outcomes and potentially affect the prognosis.Therefore, it is crucial to establish comprehensive and detailed management protocols for perioperative hyphema and IOP spike following GT.This will guide clinical practitioners in managing complications appropriately and systematically, thereby promoting the further development and refinement of MIGS.To address these concerns, several domestic glaucoma treatment experts along with members of the Glaucoma Society of Ophthalmology, Guangdong Medical Association reviewed existing literature and held recommendation meetings to develop a guideline for managing perioperative hyphema and IOP spikes following GT.It includes defining perioperative hyphema in GT, discussing its high-risk factors and outcomes, exploring methods for prevention prior to surgery and techniques to reduce bleeding during the procedure, and managing postoperative hemorrhage.Additionally, it covers defining IOP spikes after GT, investigates their causes and contributing factors, and outlines management strategies and anticipated outcomes to provide a valuable resource for clinicians.

Objective To investigate the mechanism of Guizhi Tongluo Tablets(GZTLP)on improving atherosclerosis in APOE knockout mice by regulating neutrophil extracellular trapping nets(NETs).Methods After modeling,24 APOE knockout mice aged 8 weeks were randomly divided into 4 groups:GZTLP high-dose group,low-dose group,model control group and normal control group,with 6 mice in each group.GZTLP was given 1.87 mg·g-1 and 0.47 mg·g-1 intragastric administration in high-dose group and low-dose group,respectively.The normal control group and model control group were given 0.9%sodium chloride solution intragastric administration for 6 weeks,and the lipid plaque deposition in aorta was observed by gross oil red O staining.Lipid deposition in aortic root was observed by oil red O staining.The pathological changes of lipid plaques in aortic root were observed by HE staining.The levels of interleukin-1β(IL-1β)and tumor necrosis factor α(TNF-α)in peripheral blood of mice were detected by enzyme-linked immunosorbent assay(ELISA).The expression of lymphocyte antigen 6G(Ly6G),myeloperoxidase(MPO)and citrulinated histone(Cit-H3)in plaques of the aortic arch and the colocalization of Ly6G,MPO and Cit-H3 were detected by immunofluorescence assay.Results Compared with the normal control group,the aorta of mice in the model control group showed serious lipid plaque deposition,morphological damage,and a large number of inflammatory cells infiltration,the contents of serum inflammatory factors IL-1β and TNF-α were increased,and the protein expressions of Ly6G,Cit-H3 and MPO were significantly increased.Compared with model control group,GZTLP group reduced the amount of lipid plaque deposition in aorta,the arrangement of aortic cells was more regular,the inflammatory cell infiltration was improved,and the contents of serum inflammatory factors IL-1β and TNF-α were significantly decreased(P<0.05).The colocalization and the protein expression of Ly6G,MPO and Cit-H3 were significantly decreased in aortic tissues(P<0.01).Conclusions GZTLP can improve atherosclerosis,and its mechanism may be related to the inhibition of neutrophil extracellular trapping nets.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To construct a predictive model of radiomics based on laparoscopic grayscale ultrasound features and investigate its value in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) during laparoscopic liver resection.Methods:A total of 74 patients (74 lesions)with HCC confirmed by postoperative pathology, who underwent a laparoscopic ultrasonography during laparoscopic hepatectomy were prospectively enrolled in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2022 to August 2023. The general clinical information of the patients was recorded, and the features were extracted and screened from tumor regions in gray-scale ultrasound images, and eventually the radiomics prediction models were constructed, respectively. Pathological results were used as gold standard to compare the effectiveness of different models in predicting MVI.Results:In the 74 HCC lesions, 12 lesions were MVI positive.The MVI imaging prediction model of HCC lesions was constructed from the screened clinical features, laparoscopic gray scale ultrasound image features, as well as combined screened clinical features, respectively. The obtained data sets were randomly divided into 5 parts (4 parts with 15 lesions, 1 part with 14 lesions), and the effectiveness of the model was trained and tested by the method of 5 folds interaction validation. The performance of support vector machine(SVM) radiomics model based on the characteristics of laparoscopic gray scale ultrasound in predicting the MVI of HCC was the best. Compared with clinical model and combined Adaboost model, the SVM, radiomics model had higher area under ROC curve (0.836 vs 0.696, 0.804), accuracy (0.852 vs 0.687, 0.838), sensitivity (0.900 vs 0.900, 0.833) and specificity (0.837 vs 0.644, 0.838). Conclusions:The radiomics model based on the characteristics of laparoscopic gray-scale ultrasound is an innovative potential approach to predict the MVI status of HCC lesions during laparoscopic hepatectomy.

OBJECTIVE To observe the short-term efficacy and safety of venetoclax combined with homoharringtonine and cytarabine in the treatment of acute myeloid leukemia （AML）. METHODS The data of 40 newly diagnosed AML patients admitted to our hospital from October 2022 to November 2023 were retrospectively collected and divided into observation group and control group according to treatment plan， with 20 cases in each group. The patients in the control group were given Daunorubicin hydrochloride for injection+Cytarabine for injection， and the patients in the observation group were given Venetoclax tablets+ Homoharringtonine injection+Cytarabine for injection. The patients in both groups were given relevant medicine， with 28 days as one cycle. The short-term efficacy， negative rate of minimal residual disease （MRD）， duration of granulocyte deficiency， duration of platelet （PLT） ＜20×109 L－1， transfusion volume of suspended red blood cells and platelet， and the occurrence of adverse drug reactions were evaluated in both groups after 1 cycle of induction chemotherapy. RESULTS The complete remission or complete remission with incomplete hematologic recovery （CR/CRi） rate in the observation group was significantly higher than control group （P＜0.05）， and the negative rate of MRD in the observation group was also significantly higher than control group （P＜0.05）. However， in low-， medium- and high-risk patients， there was no statistical significance in CR/CRi rates between the two groups （P＞0.05）. There were no significant differences in the duration of agranulocytosis， the duration of PLT ＜20×109 L－1， the amount of suspended red blood cell transfusion， the amount of platelet transfusion， the incidence of hematologic toxicity and the incidence of non-hematologic toxicity between 2 groups （P＞0.05）. CONCLUSIONS Venetoclax combined with homoharringtonine and cytarabine show good short-term efficacy and safety in the treatment of AML.