Objective To explore risk factors for cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients and evaluate its impact on cardiovascular events and mortality. Methods Retrospective selection of 223 patients with MHD admitted to the Department of Nephrology of Jinshan Hospital, Fudan University from June 30, 2019 to June 30, 2024, and enrollment completed within one week of June 30, 2019. Patients were divided into CVC and non-CVC groups. Baseline data and 5-year follow-up data were collected. The binary logistic regression analysis was performed to explore the risk factors for CVC. Kaplan-Meier survival curve was used to analyze the survival rate of patients. Cox proportional hazard regression model was applied to evaluate the impact of CVC on the survival rates of MHD patients. Results Totally, 223 MHD patients with an average age of (58.4±13.5) years and an average dialysis duration of (64.0±55.4) months were involved. Among them, 136(61.0%) were males, 117(52.5%) were complicated with CVC. Age, dialysis duration, diabetic kidney disease (DKD), the serum corrected total calcium and phosphate, intact parathyroid hormone (iPTH), high-sensitive C-reactive protein (hsCRP), and homocysteine (Hcy) were independent related factors for CVC (P＜0.05). Both all-cause mortality (46.6% vs 28.7%) and cardiovascular mortality (33.3% vs 16.0%) were significantly higher in the CVC group than those in the non-CVC group (P＜0.01). Conclusions Age, dialysis duration, the primary disease, calcium and phosphate, and inflammation- and nutrition-related serum indicators are associated with CVC in MHD patients. CVC significantly increases mortality risk of MHD patients.

Objective:To explore the effect of cathepsin L (CTSL) inhibitor on apoptosis of retinal pigment epithelial (RPE) cells and mitochondrial oxidative stress.Methods:RPE cells were cultured in vitro and divided into control group, hydrogen peroxide (H 2O 2) group, and H 2O 2+CTSL inhibitor group. The cells of H 2O 2 group and H 2O 2+CTSL inhibitor group were incubated in the medium containing 400 μmol/L H 2O 2 for 24 hours and 10 μmol/L CTSL inhibitor was added in H 2O 2+CTSL inhibitor group at the same time. The cells of normal group were routinely cultured cells. The follow-up experiment was carried out 24 hours after modeling. The rate of apoptosis was detected by flow cytometry. The expression of CTSL was detected by immunofluorescence staining, Western blot and real time-polymerase chain reaction. The level of mitochondrial super oxide was detected by MitoSOX fluorescent probe, and the mitochondrial structure was observed after MitoTracker staining, the average area, form factors, and branch of mitochondria were quantitatively analyzed. The two groups were compared using two-tailed Student t test, while numerous groups were compared using one-way ANOVA. Results:Compared with control group, the rate of apoptosis in H 2O 2 group was significantly higher ( t=3.307, P=0.029 7), the expression level of CTSL was significantly increased ( t=19.950, 6.916, 14.220; P<0.05). Compared with H 2O 2 group, the expression level of CTSL, the rate of apoptosis and the mitochondrial ROS level in H 2O 2+CTSL inhibitor group were significantly lower ( t=11.940, 4.718, 16.680; P<0.05). The mitochondria of H 2O 2+CTSL inhibitor group were elongated, oval-shaped or rod-shaped, while the mitochondria of H 2O 2 group lost their continuous contour shape and complete structure. The differences of the average area, form factors, and brach of mitochondria among 4 groups were statistically significant ( F=251.700, 34.010, 60.500; P<0.000 1). Conclusions:H 2O 2 can significantly induce apoptosis in RPE cells and increase CTSL expression. CTSL inhibitor can inhibit the H 2O 2-induced apoptosis of RPE cells, lower the mitochondrial super oxide level, and successfully repair the mitochondrial structure.

With the continuous evolution and refinement of the healthcare insurance system,there arises a heightened de-mand for the standardization and efficacy of healthcare insurance management.This paper takes a prominent public hospital in Guangzhou City as a case study to delve into the establishment and enhancement of an intelligent monitoring system for healthcare insurance.Initially,an analysis is conducted from the perspectives of the national,policy,and institutional levels to underscore the imperative and urgency of constructing an intelligent monitoring system for healthcare insurance.Subsequently,a comprehen-sive review of the current research landscape,both domestically and internationally,is presented,highlighting the challenges faced by domestic intelligent auditing systems in terms of their level of intelligence,the sophistication of hospital-level intelligent monitoring,and the standardization of rule libraries.Following this,the paper elaborates on the practical endeavors undertaken by large public hospitals in Guangzhou City regarding the construction and optimization of the intelligent monitoring system for healthcare insurance.This encompasses aspects such as the structure of the intelligent monitoring system,collaborative manage-ment in operational modes,and the standardization of rule libraries.Finally,the paper concludes by summarizing the positive im-pact of these practices on the regulation of medical service behaviors and the enhancement of efficiency in healthcare insurance quality management,while also offering insights into future research directions.

Objective To investigate the effects of insulin therapy on the mechanical behavior of solids,characteristics of fluid flow,and bone marrow stromal cells(BMSCs)differentiation in the distal femoral cancellous bone of type 2 diabetic rats under normal activity and vigorous exercise conditions.Methods The finite element models of cancellous bones and fluids in the distal femurs of rats in the control,diabetes,treatment,and placebo groups in 4-week and 8-week insulin treatment experiments under normal activity and vigorous exercise conditions were established based on micro-CT scanning images.The mechanical and cell differentiation parameters of the models in each group were analyzed using the fluid-solid interaction numerical simulation method.Correlations between mechanical,cell differentiation,and microstructural morphology parameters were also analyzed.Results Insulin therapy under normal activity and vigorous exercise conditions improved the solid and fluid mechanical parameters and BMSC differentiation parameters in type 2 diabetic rats.In the 4-week experiment,insulin treatment under normal activity and vigorous exercise conditions increased the differentiation areas of bone in type 2 diabetic rats from 64.024%to 69.372%and from 73.225%to 75.336%,respectively;in the 8-week experiment,insulin treatment under normal activity and vigorous exercise conditions increased the differentiation areas of bone in type 2 diabetic rats from 67.239%to 72.910%and from 76.147%to 78.291%,respectively.Morphological parameters BV/TV,Tb.N,Tb.Th,Tb.Sp,and structure model index were significantly correlated with the differentiation areas of the bone and cartilage(P<0.05).Conclusions Under vigorous exercise conditions,BMSCs on the surface of cancellous bone in the 8-week insulin treatment group were more likely to differentiate into bone tissue.This study is of great significance for further understanding the effects of insulin on the bone under normal activity and vigorous exercise conditions,and provides theoretical guidance for the selection of the insulin therapy cycle and exercise mode in the clinical treatment of type 2 diabetes.

Purpose To evaluate the value of shear wave elastic imaging of liver and spleen in predicting high risk esophageal and gastric varices in cirrhosis.Materials and Methods Sixty-four patients with cirrhosis in the First Hospital of Lanzhou University from November 2019 to April 2022 were enrolled prospectively,and underwent gastroscopy,elastography and serological examination.According to gastroscopy,patients were divided into high-risk varices(HRV,30 cases)and non-HRV group(34 cases),the differences of each clinical index and shear wave elastic imaging parameter between the groups were compared.The diagnostic efficacy of liver and spleen stiffness measurement for HRV was analyzed.And the diagnostic models were established for exploring the diagnostic effectiveness of different models with respect to excluding HRV in compensated liver cirrhosis.Results There were significant differences in platelet[(74±24)×109/L vs.(124±50)×109/L],liver stiffness[(16.1±5.6)kPa vs.(13.6±5.5)kPa]and spleen stiffness[(41.7±8.9)kPa vs.(28.1±8.6)kPa]between HRV and non-HRV groups(t/Z/χ2=5.136,-1.832,-6.206,all P<0.05).The areas under the curve of liver stiffness and spleen stiffness for predicting HRV were 0.660 and 0.858,respectively.The Baveno Ⅵ combined with the spleen stiffness model had the best performance(30.0％)for excluding HRV.Conclusion The measurement of liver and spleen stiffness by shear wave elastography has great diagnostic value for predicting HRV in cirrhosis,and spleen stiffness is better than liver stiffness.

Objective To analyze the risk factors for survival in patients with hematological malignancies after hematopoietic stem cell transplantation (HSCT), to establish a risk prediction and survival prediction model, and to provide a reference for clinical diagnosis and treatment. Methods A total of 237 patients with malignant hematological diseases who underwent HSCT at West China Hospital of Sichuan University from January 2017 to April 2019 were selected as the study subjects. The survival of all patients after HSCT was statistically analyzed. The influencing factors of survival were analyzed by multivariate regression analysis, and the prediction model was constructed. Results A total of 237 patients with hematological malignancies were included in this study. After 3 years of follow-up, 85 patients died, with a mortality rate of 35.86%. Multivariate logistic analysis showed that diabetes mellitus (OR=4.358, P=0.007), infection (OR=3.522, P=0.000), neutropenia time >7d (OR=2.734, P=0.009), incomplete HLA matching (OR=5.688, P=0.000), cGVHD (OR=2.593, P=0.007) and HCT-CI (OR=6.701, P=0.000) were independent risk factors affecting the survival of patients with hematological malignancies after HSCT (P<0.05). The risk prediction model for survival was P=1/(1 + e ^{(3.192 + 01.259 + 1.472 ×(diabetes mellitus) + 1.259×(infection) + 1.006 ×(neutropenia time) + 1.738 ×(HLA matching) + 0.953 ×(cGVHD) + 1.902 ×(HCT-CI)}), Hosmer-Lemeshow χ²=6.692, P=0.462. AUC and 95%CI of the model for predicting survival were 0.836 and 0.783-0.888, showing good fit and predictive efficiency. Conclusion Diabetes mellitus, infection, neutropenia time >7d, incomplete HLA matching, cGVHD and HCT-CI are all high-risk factors of survival in patients with malignant hematologic disease after HSCT. Clinically, attentions should be paid to these patients and intervention measures should be taken to improve their survival after HSCT.

Gastrointestinal motility disorder is an important cause of digestive system diseases. Patients often suffer from nausea， vomiting， gastric retention， gastroparesis， constipation， and many other symptoms， and their quality of life is seriously reduced. Prokinetic agents are routinely used in clinical practice， but their long-term use is prone to problems such as reduced efficacy and increased adverse reactions. Since the incidence of gastrointestinal diseases has continued to rise globally in recent years， there is an urgent need for clinical development of safe and effective treatment strategies. Aurantii Fructus， a traditional Chinese medicine， has the effect of smoothing Qi and eliminating distention， and it has been used to treat gastrointestinal diseases for thousands of years. In modern clinical practice， it is mainly used for the treatment and auxiliary treatment of various gastrointestinal diseases such as functional dyspepsia， functional constipation， and irritable bowel syndrome. The efficacy is remarkable， and no adverse reactions have been reported at conventional doses. Therefore， it can greatly improve the symptoms of patients with gastrointestinal diseases and improve their quality of life. Modern research has revealed that there are many active components in Aurantii Fructus， among which flavonoids have the highest content and the most types. Flavonoids are the main active components in Aurantii Fructus to regulate gastrointestinal motility. Aurantii Fructus and its active components can affect gastrointestinal hormones， neural pathways， Cajal mesenchymal cells， and other multiple mechanisms. They can adjust gastrointestinal motility and correct gastrointestinal motility disorders， showing potential application value in the treatment of gastrointestinal motility disorders. However， a comprehensive analysis of Aurantii Fructus in this aspect is still lacking. This study summarized the pharmacological activities of active components of Aurantii Fructus extract and its flavonoids， volatile oils， alkaloids， and coumarin on the regulation of gastrointestinal motility and explored the latest research progress on its mechanism. Finally， the adverse reactions of Aurantii Fructus were summarized. It aims to provide a scientific basis for the research and clinical application of Aurantii Fructus and its active components in the regulation of gastrointestinal motility.

Objective To investigate the nutritional status in patients with aplastic anemia (AA), and to analyze the influencing factors. Methods A retrospective analysis was performed on the clinical data of 152 patients with AA admitted to West China Hospital between March 2019 and March 2022. The nutritional status of all patients was screened by Nutritional Risk Screening 2002 (NRS2002). According to the screening criteria, the patients were divided into control group (46 cases, total NRS2002 score <3 points) and malnutrition risk group (106 cases, total NRS2002 score ≥3 points). The body mass index (BMI), disease grading [severe AA (SAA), non-severe AA (NSAA)], levels of hemoglobin (Hb), serum albumin (Alb), serum ferritin (SF), total protein (TP), folic acid (FA), vitamin B12 (VB12), serum iron (SI), unsaturated iron binding capacity (UIBC) and transferrin saturation (TSAT) were recorded and compared between the two groups. The risk factors of malnutrition were analyzed by logistic regression analysis, and levels of the related influencing factors were compared. The association between nutritional risk and prognosis in patients with AA was analyzed. Results Among the 152 patients with AA, 69.74% of them were at risk of malnutrition. There was no significant difference in the BMI, TP, FA and VB12 between the malnutrition risk group and the control group (P>0.05). The proportion of SAA cases in the malnutrition risk group was significantly higher than that in the control group. The levels of Alb and UIBC in the malnutrition risk group were significantly lower than those in the control group, while the levels of SF, SI and TSAT were higher than those in the control group. In addition, the levels of SF, SI and TSAT in SAA patients were higher than those in NSAA group (P<0.05). Logistic regression analysis showed that high levels of SF, SI and TSAT, and high proportion of SAA cases were risk factors of malnutrition in AA patients (P<0.05). The incidence of adverse prognosis in the malnutrition risk group was significantly higher than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion Patients with AA have a higher risk of malnutrition, and high levels of SF, SI and TSAT are risk factors for malnutrition. The greater the risk of malnutrition, the more severe the poor prognosis.

【Objective】 To investigate the anemia status of infants and toddlers aged 6 - 24 months in Linxia Hui Autonomous Prefecture, Gansu Province, and to comprehensively evaluate the differences in feeding behaviors between anaemic and normal children through the infant and child feeding index (ICFI) and feeding knowledge scores, so as to provide reference for the guidance of infants and young children feeding in ethnic minority areas and the promotion of children′s growth and development. 【Methods】 Taking infants and young children aged 6 - 24 months in Linxia Prefecture as the study subjects, a multi-stage random sampling method was used to select children who met the requirements from 5 townships and 5 villages in 7 counties in 2019 and 2020.Periphral blood samples were collected to test the level of hemoglobin, so as to determine the anemia status.Meanwhile, physical examination was performed and a questionnaire survey of guardians was conducted to analyze the association betweenanaemia and feeding patterns 【Results】 A total of 3 901 infants and children were included in this study, of whom 729 (18.70%) were anaemic, with a mean ICFI score of 12.56±2.70 and a mean feeding knowledge score of 1.97±1.01.There was no statistically significant association of low feeding knowledge score and low ICFI with anaemia after adjusting for confounders (P>0.05), Unqualified meat addition in ICFI was a risk factor for anaemia (OR=1.355, P=0.042), while non-bottle feeding in the past 24 hours (OR=0.762, P=0.021), and breastfeeding in the past 24 hours of infants and toddlers aged 12 - 24 months (OR=0.228, P=0.018) were protective factor for anemia in infants and toddlers aged 12 - 24 months. 【Conclusions】 The average prevalence of anemia in infants and toddlers aged 6 - 24 months in Linxia Hui Autonomous Prefecture of Gansu Province is high, but the level of infant feeding and the level of feeding knowledge of caregivers are low.Early adherence to breastfeeding, timely addition of supplementary food, and more comsumpution of meat for children are conducive to preventing anemia.

OBJECTIVE To evaluate the efficacy of intranasal branches neurotomy of vidian nerve in the treatment of persistent moderate to severe allergic rhinitis. METHODS Cases diagnosed as persistent moderate-severe allergic rhinitis in our department were collected. those treated with branches neurotomy of vidian nerve were selected as the treatment group,and those treated with conservative medicine were selected as the control group. The visual analogue scale(VAS),rhinoconjunctivitis quality of life questionnaire(RQLQ),Nitric oxide in nose(nNO) and medication score evaluation of two groups of cases were evaluated respectively short-term(<1 year),medium-term(1 to 3 years) and long-term prognosis of outcome(3 to 5 years). RESULTS The short-term,mid-term and long-term postoperative VAS(2.26±0.75,2.30±0.63,2.49±0.57),RQLQ(0.55±0.11,0.55±0.11,1.00±0.12),nNO[(464.62±75.84)ppb,(378.63±110.21)ppb,(368.23±104.25)ppb]and medication scores (2.50±1.03,2.54±0.99,2.95±0.93) were significantly lower than those before operation[6.76±0.58,3.35±0.40,(696.64±132.69)ppb,5.17±1.50)]. The VAS,RQLQ,nNO and medication scores of the control group were lower than those of the control group at the corresponding time points(all P<0.05). One patient developed blindness in the right eye after interventional treatment due to epistaxis 21 days after operation,but no serious complications directly related to intranasal branches neurotomy of vidian nerve occurred. CONCLUSION The branches neurotomy of vidian nerve have a positive outcome in short,medium and long-term for persistent moderate to severe allergic rhinitis,the operation is safe and effective.