Objective:To explore the risk factors for severe acute kidney injury (AKI) in children with sepsis in the pediatric intensive care unit (PICU) and construct a prediction model to assist early clinical identification.Methods:A retrospective analysis was performed on clinical data of 987 children with sepsis admitted to the PICU of Hunan Children′s Hospital from July 1, 2018 to January 31, 2021. Children who developed severe AKI during hospitalization were included in the AKI stage 2-3 group ( n=228), and the remaining were included in the No-AKI/AKI stage 1 group ( n=759). General information and biochemical indicators were compared between the two groups. Logistic regression analysis was used to identify risk factors for severe AKI in children with sepsis, and a prediction model and nomogram were established. Results:The mortality rate in the AKI stage 2-3 group was 2.49 times that of the No-AKI/AKI stage 1 group [31.1%(71/228) vs 12.5%(95/759), P<0.05]. Compared with the No-AKI/AKI stage 1 group, the AKI stage 2-3 group had lower levels of platelet count (PLT), total protein (TP), albumin (ALB), antithrombin Ⅲ (AT3), and fibrinogen (FIB), but higher levels of lactate dehydrogenase (LDH), serum creatinine (SCr), blood urea nitrogen (BUN), magnesium ion (Mg 2+ ), activated partial thromboplastin time (APTT), fibrinogen degradation products (FDP), and D-dimer (D-D) (all P<0.05), with no significant difference in total bile acid (TBAC) ( P>0.05). Multivariate logistic regression analysis showed that decreased AT3 ( OR=0.989, 95% CI: 0.980-0.997, P=0.007), increased LDH ( OR=1.001, 95% CI: 1.000-1.001, P<0.001), increased SCr ( OR=1.051, 95% CI: 1.037-1.066, P<0.001), and increased BUN ( OR=1.099, 95% CI: 1.028-1.174, P=0.005) were risk factors for severe AKI in children with sepsis. The prediction model was Logist Pr=-3.184-0.012 X1+ 0.001 X2+ 0.050 X3+ 0.094 X4 ( X1=AT3, X2=LDH, X3=SCr, X4=BUN), with the optimal cut-off value of 0.374 (Youden index=0.560). A nomogram was constructed by binary assignment of predictive variables, with an area under the curve of 0.826 (95% CI: 0.790-0.861, P<0.001). Conclusions:The mortality rate of septic children with severe AKI in PICU is significantly increased. Decreased AT3, and increased LDH, SCr, and BUN are risk factors for severe AKI in children with sepsis. Clinicians should be alert to severe AKI when the predicted probability of the early warning model exceeds 0.374.

Objective:To analyze the liver histological characteristics and clinically related factors in inactive hepatitis B surface antigen (HBsAg) carriers (IHC), and also explore whether antiviral treatment is necessary for IHC, as defined in the 2022 version of the hepatitis B prevention and treatment guidelines.Methods:A multicenter, retrospective cohort study was conducted. Two hundred and thirty-one IHC cases who underwent liver biopsy histopathological examination in nine medical institutions, including Beijing Youan Hospital affiliated with Capital Medical University, from January 2018 to December 2023 were included. General informative data, clinical serological markers, and transient elastography (TE) examination results were collected. Patients were divided into a positive (148 cases) and a negative group (83 cases) according to the results of hepatitis B virus (HBV) DNA detection. The differences in liver pathological inflammatory activity (G) and liver fibrosis stage (S) were analyzed between the two groups to explore the correlation between liver tissue conditions and clinically related factors. Comparsions of normally distributed continwous data, skeukd continuous data, and categorical data between groups are performed using t tests, Mann-Whitney U tests and χ2 tests, respectively. Results:The age of 231 IHC cases was 43 (38, 51) years old, with 95.2% (220/231) aged ≥30 years, and males accounted for 64.9% (150/231). HBsAg and HBV DNA levels were 131.9 (20.8, 400.9) IU/mL and 94.0 (0, 448.5) IU/mL, respectively, of which 35.9% (83/231) were HBV DNA negative (<20 IU/mL). The remarkable proportions of G≥2, S≥2, and liver injury (G≥2 and/or S≥2) in liver tissue were 16.5% (38/231), 29% (67/231), and 35.9% (83/231), respectively. The S≥2 proportion was significantly higher in the HBV DNA-negative group than the positive group (42.2% vs. 21.6%, P<0.001), and it mainly occurred in the population cohort over 30 years old (44.9% vs. 31.0%, P=0.04). The liver stiffness measurement (LSM), aspartate transaminase to platelet ratio index (APRI), and platelet (PLT) were significantly higher in the S≥2 group than the S<2 group ( P<0.05). Conclusion:Clinicians can comprehensively evaluate the degree of liver fibrosis in IHC based on clinical factors such as age, PLT, APRI, and LSM, even if the liver histological results are lacking. The China 2022 version guidelines define that nearly half of IHC has histological indications for antiviral therapy, and liver biopsy and prompt treatment can be recommended.

Objective:To evaluate the therapeutic effectiveness of adult patients with Kashin-Beck disease (KBD) in Gansu Province, and provide guidance for rational and effective treatment of KBD patients.Methods:The KBD patients who participated in the "2021 Basic Public Health Service Subsidy Key Endemic Disease Prevention and Control Project" in Gansu Province were selected as the research subjects. Gender, age, clinical grading characteristics, and treatment plan selection of all subjects were analyzed, and the treatment effectiveness of KBD patients in different regions was evaluated.Results:A total of 6 711 KBD patients were included in the treatment program, including 3 139 males (46.8%) and 3 572 females (53.2%), 3 157 cases (47.0%) of patients aged 60 and 3 554 cases (53.0%) over 60 years old. There were 3 921, 2 166, and 624 patients with grades Ⅰ, Ⅱ, and Ⅲ, respectively, accounting for 58.4%, 32.3%, and 9.3%, respectively. The gender, age composition, and clinical grading among KBD patients included in different regions were compared, and the differences were statistically significant (χ 2 = 194.34, 47.44, 408.61, P < 0.001). In the distribution of treatment schemes, the number of patients who selected "drug treatment", "drug treatment combined with physical therapy", "drug treatment combined with acupuncture and moxibustion/massage", "drug treatment combined with acupuncture and moxibustion/massage combined with physical therapy", and "other treatment schemes" were 4 084 (60.9%), 726 (10.8%), 672 (10.0%), 443 (6.6%), and 786 (11.7%), respectively. The distribution of treatment plans in different regions was compared, and the difference was statistically significant (χ 2 = 1 088.38, P < 0.001). The total effective rate of KBD patients was 84.5% (5 668/6 711). The total effective rates of KBD patients with different clinical grades were ranked from high to low as grade Ⅲ (87.3%, 545/624), grade Ⅱ (86.4%, 1 871/2 166), and grade Ⅰ (82.9%, 3 252/3 921). The total effective rate of KBD patients with different treatment schemes from high to low was "drug treatment combined with acupuncture and moxibustion/massage combined with physical therapy" (91.0%, 403/443), "drug treatment combined with physical therapy" (87.1%, 632/726), "drug treatment" (86.7%, 3 539/4 084), "drug treatment combined with acupuncture and moxibustion/massage" (82.3%, 553/672), and "other treatment schemes" (68.8%, 541/786). The total effective rate of KBD patients in different regions, from high to low, was as follows: Linxia Hui Autonomous Prefecture (100%, 144/144), Qingyang City (88.7%, 3 562/4 017), Pingliang City (85.0%, 1 327/1 562), Gannan Tibetan Autonomous Prefecture (83.9%, 78/93), Dingxi City (70.9%, 151/213), Tianshui City (62.5%, 125/200), and Longnan City (58.3%, 281/482). The total effective rate of KBD patients in different clinical grades, treatment schemes, and regions was compared, and the differences were statistically significant (χ 2 = 16.95, 181.72, 435.80, P < 0.001). Conclusions:The overall effective rate of treatment for KBD patients in Gansu Province is relatively high, but there are significant differences in therapeutic outcomes among cities (prefectures); it is related to the treatment scheme and the clinical grading of patients. The scheme of "drug treatment combined with acupuncture and moxibustion/massage combined with physical therapy" has better efficacy.

AIM:To investigate the effects of total flavonoids of Pterocarya hupehensis Skan(PHSTF)on dex-tran sulfate sodium(DSS)-induced ulcerative colitis(UC)mouse model and lipopolysaccharide(LPS)-stimulated RAW264.7 macrophages.METHODS:Thirty-six male C57BL/6J mice(6 to 8 weeks old,SPF grade)were randomly di-vided into 6 groups:negative control(NC)group,3%DSS-induced model group,mesalazine(300 mg·kg-1·d-1)group,and low-dose(62.5 mg·kg-1·d-1),medium-dose(125 mg·kg-1·d-1)and high-dose(250 mg·kg-1·d-1)PHSTF treatment groups,with 6 mice in each group.The mice in NC group received distilled water,while those in other groups were treated with a 3%DSS solution for 7 d to induce the UC model.On the 1st day of DSS administration,the mice in treatment groups received the corresponding agents via oral gavage for 10 d,while those in NC and model groups were gavaged with distilled water.Throughout the study,the effects of PHSTF on body weight,fecal blood,and colon length were measured and recorded daily.Histopathological changes in colon tissues were assessed using hematoxylin-eosin staining.The levels of the pro-inflammatory cytokine interleukin-1β(IL-1β)and the anti-inflammatory cytokine IL-10 in colon tissues were quantified using ELISA.The LPS-induced RAW264.7 macrophage model was employed to evaluate the cellular effects of PHSTF.Cell viability was assessed by CCK-8 assay,and cell morphology was observed under a microscope.The mRNA expression of inflammatory markers[IL-1β,inducible nitric oxide synthase(iNOS),IL-10 and arginase-1(Arg-1)]was measured by RT-qPCR.Western blot and immunofluorescence double labeling were used to detect the protein expression of macrophage polarization markers(iNOS,CD206 and Arg-1).Finally,immunohistochemistry(IHC)was utilized to as-sess protein expression of iNOS in colon tissues.RESULTS:Compared to the DSS-induced UC model group,PHSTF sig-nificantly improved several parameters,including weight loss(P<0.05),rectal bleeding,and colon shortening in DSS-treated mice.PHSTF also reduced histopathological damage and inflammatory cell infiltration in the colon.It decreased IL-1β levels(P<0.05)and increased IL-10 levels(P<0.05)in colon tissues.In LPS-induced RAW264.7 cells,PHSTF reduced the mRNA expression of IL-1β and iNOS(P<0.01),while upregulating the mRNA expression of IL-10 and Arg-1(P<0.01).Additionally,PHSTF decreased iNOS protein expression(P<0.01)and elevated the expression of Arg-1 and CD206 proteins(P<0.01).IHC analysis further confirmed that PHSTF downregulated iNOS protein expression in colon tissues.CONCLUSION:Treatment with PHSTF promotes the polarization of macrophages from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype,thereby alleviating inflammation in colon tissue and ameliorating ulcer-ative colitis in mice.

AIM:To investigate the effects of total flavonoids of Pterocarya hupehensis Skan(PHSTF)on dex-tran sulfate sodium(DSS)-induced ulcerative colitis(UC)mouse model and lipopolysaccharide(LPS)-stimulated RAW264.7 macrophages.METHODS:Thirty-six male C57BL/6J mice(6 to 8 weeks old,SPF grade)were randomly di-vided into 6 groups:negative control(NC)group,3%DSS-induced model group,mesalazine(300 mg·kg-1·d-1)group,and low-dose(62.5 mg·kg-1·d-1),medium-dose(125 mg·kg-1·d-1)and high-dose(250 mg·kg-1·d-1)PHSTF treatment groups,with 6 mice in each group.The mice in NC group received distilled water,while those in other groups were treated with a 3%DSS solution for 7 d to induce the UC model.On the 1st day of DSS administration,the mice in treatment groups received the corresponding agents via oral gavage for 10 d,while those in NC and model groups were gavaged with distilled water.Throughout the study,the effects of PHSTF on body weight,fecal blood,and colon length were measured and recorded daily.Histopathological changes in colon tissues were assessed using hematoxylin-eosin staining.The levels of the pro-inflammatory cytokine interleukin-1β(IL-1β)and the anti-inflammatory cytokine IL-10 in colon tissues were quantified using ELISA.The LPS-induced RAW264.7 macrophage model was employed to evaluate the cellular effects of PHSTF.Cell viability was assessed by CCK-8 assay,and cell morphology was observed under a microscope.The mRNA expression of inflammatory markers[IL-1β,inducible nitric oxide synthase(iNOS),IL-10 and arginase-1(Arg-1)]was measured by RT-qPCR.Western blot and immunofluorescence double labeling were used to detect the protein expression of macrophage polarization markers(iNOS,CD206 and Arg-1).Finally,immunohistochemistry(IHC)was utilized to as-sess protein expression of iNOS in colon tissues.RESULTS:Compared to the DSS-induced UC model group,PHSTF sig-nificantly improved several parameters,including weight loss(P<0.05),rectal bleeding,and colon shortening in DSS-treated mice.PHSTF also reduced histopathological damage and inflammatory cell infiltration in the colon.It decreased IL-1β levels(P<0.05)and increased IL-10 levels(P<0.05)in colon tissues.In LPS-induced RAW264.7 cells,PHSTF reduced the mRNA expression of IL-1β and iNOS(P<0.01),while upregulating the mRNA expression of IL-10 and Arg-1(P<0.01).Additionally,PHSTF decreased iNOS protein expression(P<0.01)and elevated the expression of Arg-1 and CD206 proteins(P<0.01).IHC analysis further confirmed that PHSTF downregulated iNOS protein expression in colon tissues.CONCLUSION:Treatment with PHSTF promotes the polarization of macrophages from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype,thereby alleviating inflammation in colon tissue and ameliorating ulcer-ative colitis in mice.

Objective:To evaluate the therapeutic effectiveness of adult patients with Kashin-Beck disease (KBD) in Gansu Province, and provide guidance for rational and effective treatment of KBD patients.Methods:The KBD patients who participated in the "2021 Basic Public Health Service Subsidy Key Endemic Disease Prevention and Control Project" in Gansu Province were selected as the research subjects. Gender, age, clinical grading characteristics, and treatment plan selection of all subjects were analyzed, and the treatment effectiveness of KBD patients in different regions was evaluated.Results:A total of 6 711 KBD patients were included in the treatment program, including 3 139 males (46.8%) and 3 572 females (53.2%), 3 157 cases (47.0%) of patients aged 60 and 3 554 cases (53.0%) over 60 years old. There were 3 921, 2 166, and 624 patients with grades Ⅰ, Ⅱ, and Ⅲ, respectively, accounting for 58.4%, 32.3%, and 9.3%, respectively. The gender, age composition, and clinical grading among KBD patients included in different regions were compared, and the differences were statistically significant (χ 2 = 194.34, 47.44, 408.61, P < 0.001). In the distribution of treatment schemes, the number of patients who selected "drug treatment", "drug treatment combined with physical therapy", "drug treatment combined with acupuncture and moxibustion/massage", "drug treatment combined with acupuncture and moxibustion/massage combined with physical therapy", and "other treatment schemes" were 4 084 (60.9%), 726 (10.8%), 672 (10.0%), 443 (6.6%), and 786 (11.7%), respectively. The distribution of treatment plans in different regions was compared, and the difference was statistically significant (χ 2 = 1 088.38, P < 0.001). The total effective rate of KBD patients was 84.5% (5 668/6 711). The total effective rates of KBD patients with different clinical grades were ranked from high to low as grade Ⅲ (87.3%, 545/624), grade Ⅱ (86.4%, 1 871/2 166), and grade Ⅰ (82.9%, 3 252/3 921). The total effective rate of KBD patients with different treatment schemes from high to low was "drug treatment combined with acupuncture and moxibustion/massage combined with physical therapy" (91.0%, 403/443), "drug treatment combined with physical therapy" (87.1%, 632/726), "drug treatment" (86.7%, 3 539/4 084), "drug treatment combined with acupuncture and moxibustion/massage" (82.3%, 553/672), and "other treatment schemes" (68.8%, 541/786). The total effective rate of KBD patients in different regions, from high to low, was as follows: Linxia Hui Autonomous Prefecture (100%, 144/144), Qingyang City (88.7%, 3 562/4 017), Pingliang City (85.0%, 1 327/1 562), Gannan Tibetan Autonomous Prefecture (83.9%, 78/93), Dingxi City (70.9%, 151/213), Tianshui City (62.5%, 125/200), and Longnan City (58.3%, 281/482). The total effective rate of KBD patients in different clinical grades, treatment schemes, and regions was compared, and the differences were statistically significant (χ 2 = 16.95, 181.72, 435.80, P < 0.001). Conclusions:The overall effective rate of treatment for KBD patients in Gansu Province is relatively high, but there are significant differences in therapeutic outcomes among cities (prefectures); it is related to the treatment scheme and the clinical grading of patients. The scheme of "drug treatment combined with acupuncture and moxibustion/massage combined with physical therapy" has better efficacy.

Objective:To analyze the liver histological characteristics and clinically related factors in inactive hepatitis B surface antigen (HBsAg) carriers (IHC), and also explore whether antiviral treatment is necessary for IHC, as defined in the 2022 version of the hepatitis B prevention and treatment guidelines.Methods:A multicenter, retrospective cohort study was conducted. Two hundred and thirty-one IHC cases who underwent liver biopsy histopathological examination in nine medical institutions, including Beijing Youan Hospital affiliated with Capital Medical University, from January 2018 to December 2023 were included. General informative data, clinical serological markers, and transient elastography (TE) examination results were collected. Patients were divided into a positive (148 cases) and a negative group (83 cases) according to the results of hepatitis B virus (HBV) DNA detection. The differences in liver pathological inflammatory activity (G) and liver fibrosis stage (S) were analyzed between the two groups to explore the correlation between liver tissue conditions and clinically related factors. Comparsions of normally distributed continwous data, skeukd continuous data, and categorical data between groups are performed using t tests, Mann-Whitney U tests and χ2 tests, respectively. Results:The age of 231 IHC cases was 43 (38, 51) years old, with 95.2% (220/231) aged ≥30 years, and males accounted for 64.9% (150/231). HBsAg and HBV DNA levels were 131.9 (20.8, 400.9) IU/mL and 94.0 (0, 448.5) IU/mL, respectively, of which 35.9% (83/231) were HBV DNA negative (<20 IU/mL). The remarkable proportions of G≥2, S≥2, and liver injury (G≥2 and/or S≥2) in liver tissue were 16.5% (38/231), 29% (67/231), and 35.9% (83/231), respectively. The S≥2 proportion was significantly higher in the HBV DNA-negative group than the positive group (42.2% vs. 21.6%, P<0.001), and it mainly occurred in the population cohort over 30 years old (44.9% vs. 31.0%, P=0.04). The liver stiffness measurement (LSM), aspartate transaminase to platelet ratio index (APRI), and platelet (PLT) were significantly higher in the S≥2 group than the S<2 group ( P<0.05). Conclusion:Clinicians can comprehensively evaluate the degree of liver fibrosis in IHC based on clinical factors such as age, PLT, APRI, and LSM, even if the liver histological results are lacking. The China 2022 version guidelines define that nearly half of IHC has histological indications for antiviral therapy, and liver biopsy and prompt treatment can be recommended.

Objective:To explore the risk factors for severe acute kidney injury (AKI) in children with sepsis in the pediatric intensive care unit (PICU) and construct a prediction model to assist early clinical identification.Methods:A retrospective analysis was performed on clinical data of 987 children with sepsis admitted to the PICU of Hunan Children′s Hospital from July 1, 2018 to January 31, 2021. Children who developed severe AKI during hospitalization were included in the AKI stage 2-3 group ( n=228), and the remaining were included in the No-AKI/AKI stage 1 group ( n=759). General information and biochemical indicators were compared between the two groups. Logistic regression analysis was used to identify risk factors for severe AKI in children with sepsis, and a prediction model and nomogram were established. Results:The mortality rate in the AKI stage 2-3 group was 2.49 times that of the No-AKI/AKI stage 1 group [31.1%(71/228) vs 12.5%(95/759), P<0.05]. Compared with the No-AKI/AKI stage 1 group, the AKI stage 2-3 group had lower levels of platelet count (PLT), total protein (TP), albumin (ALB), antithrombin Ⅲ (AT3), and fibrinogen (FIB), but higher levels of lactate dehydrogenase (LDH), serum creatinine (SCr), blood urea nitrogen (BUN), magnesium ion (Mg 2+ ), activated partial thromboplastin time (APTT), fibrinogen degradation products (FDP), and D-dimer (D-D) (all P<0.05), with no significant difference in total bile acid (TBAC) ( P>0.05). Multivariate logistic regression analysis showed that decreased AT3 ( OR=0.989, 95% CI: 0.980-0.997, P=0.007), increased LDH ( OR=1.001, 95% CI: 1.000-1.001, P<0.001), increased SCr ( OR=1.051, 95% CI: 1.037-1.066, P<0.001), and increased BUN ( OR=1.099, 95% CI: 1.028-1.174, P=0.005) were risk factors for severe AKI in children with sepsis. The prediction model was Logist Pr=-3.184-0.012 X1+ 0.001 X2+ 0.050 X3+ 0.094 X4 ( X1=AT3, X2=LDH, X3=SCr, X4=BUN), with the optimal cut-off value of 0.374 (Youden index=0.560). A nomogram was constructed by binary assignment of predictive variables, with an area under the curve of 0.826 (95% CI: 0.790-0.861, P<0.001). Conclusions:The mortality rate of septic children with severe AKI in PICU is significantly increased. Decreased AT3, and increased LDH, SCr, and BUN are risk factors for severe AKI in children with sepsis. Clinicians should be alert to severe AKI when the predicted probability of the early warning model exceeds 0.374.

Objective:To evaluate the safety and efficacy of domestically produced magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease.Method:This study is a prospective cohort study. Patients with typical heartburn and reflux symptoms (at least partial response to proton pump inhibitors), abnormal esophageal acid exposure and normal esophageal peristalsis were included, prospectively in the Department of Gastroesophageal Surgery, Rocket Force Characteristic Medical Center from June 2019 to September 2022. Patients with hiatal hernia >2 cm and severe esophagitis were excluded. The MSA was wrapped around the distal esophagus after esophageal hiatus repair by laparoscopy. A postoperative questionnaire survey was conducted to assess the relief of symptom, complications, the discontinuation rate of proton pump inhibitor, and surgical satisfaction. Gastroscopy, high-resolution esophageal pressure measurement, and pH value impedance monitoring were also reviewed. The pre- and postoperative rates were compared using the McNeinar χ2 test. Result:Currently, 23 patients with gastroesophageal reflux disease were enrolled and underwent MSA surgery. There were 20 males and 3 females, aged ( M (IQR)) 48 (14) years (range: 25 to 64 years). All cases were successfully implanted with MSA. Subjective indicators were followed for 17 (18) months (range: 14 to 53 months), while objective indicators were followed for 17 (1) months (range: 12 to 23 months). The postoperative gastrointestinal and extraesophageal symptom scores showed a significant decrease compared to preoperative levels as follows: the degree of subjective relief of overall digestive symptoms was 90 (20)% (range:0~100%), the degree of subjective relief of overall respiratory symptoms was 100(10)% (range: 10%~100%), the overall satisfaction rate was 83% (19/23), the proton pump inhibitor discontinuation rate was 70% (16/23). The proportion of esophagitis has decreased from 44% (10/23) to 9% (2/23) ( κ=0.169, P=0.039), The Hill grade of gastroesophageal valve morphology improved from 1 case of grade Ⅰ, 5 cases of grade Ⅱ, 10 cases of grade Ⅲ, and 7 cases of grade Ⅲ preoperative to 22, 1, 0, and 0 cases postoperative. The proportion of lower esophageal sphincter pressure below normal has decreased from 70% (16/23) to 35% (8/23) ( κ=0.170, P=0.012). There were 21 patients who restored normal esophageal acid exposure. Eleven patients had mild long-term dysphagia, but it didn′t affect their daily life. No postoperative device migration, erosion, or secondary surgical removal occurred. Conclusions:Laparoscopic implantation of the MSA device was safe and well tolerated. It can effectively control the symptoms of gastroesophageal reflux disease, reduce medication, restore normal cardia morphology and function, and esophageal acid exposure. The main postoperative complication was dysphagia, but it was relatively mild.

Objective To investigate the correlation between the ratio of lesion volume to uterine volume(T/U),the expression levels of Ki-67 and p16 proteins in lesion tissue,and the recurrence risk of endometrial cancer.Methods A total of 150 patients diagnosed with endometrial carcinoma through pathological examination at Qiandongnan Prefecture People's Hospital were enrolled for follow-up observation.Among them,28 patients experienced recurrence after a 2-year follow-up period,while 122 patients remained recurrence-free.The expression differences of Ki-67 protein and p16 protein in T/U and lesion tissues during surgery were compared between the two groups.Furthermore,these indexes were analyzed based on different pathological features,and the variation in relapse-free survival time was assessed among patients with distinct T/U status as well as Ki-67 and p16 protein expressions.Results The T/U value and the positive expression rate of Ki-67 protein were significantly higher in the relapsed group compared to the non-relapsed group,while the positive expression rate of p16 protein was significantly lower in the relapsed group(P＜0.05).Additionally,patients with T/U ≥ 0.18 had a significantly higher proportion of stage Ⅲ patients and patients with low histological differentiation compared to those with T/U＜0.18(P＜0.05).Furthermore,patients with positive expression of Ki-67 protein exhibited a significantly higher proportion of stage Ⅲ patients,patients with low histological differentiation,and lymph node metastasis compared to those with negative expression of Ki-67 protein(P＜0.05).The proportion of stage Ⅲ patients exhibiting positive p16 protein expression,low histological differentiation,and lymph node metastasis was significantly lower compared to those with negative p16 protein expression(P＜0.05).Patients with endometrial cancer having a T/U ≥0.18 experienced shorter recurrence-free survival time 2 years post-surgery in comparison to patients with T/U＜0.18(x2=6.962,P=0.008).Patients displaying positive Ki-67 expression had a shorter recurrence-free survival time 2 years after surgery than those with negative Ki-67 expression(x2=4.815,P=0.028).The recurrence-free survival time 2 years after surgery for patients expressing p 16 protein positively was longer than that for patients ex-pressing it negatively(x2=4.279,P=0.039).The presence of FIGO stage Ⅲ,lymph node metastasis,depth of myographic invasion ≥1/2,T/U value ≥ 0.18,and positive expression of Ki-67 protein were identified as significant risk factors for postoperative recurrence in endometrial cancer(P＜0.05).Conversely,the positive expression of p16 protein was found to be a protective factor against recurrence in endometrial carcinoma following surgery(P＜0.05).Conclusion The expression of T/U,Ki-67 protein,and p16 protein in endometrial cancer patients is as-sociated with tumor progression and may augment the risk of postoperative recurrence.