Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammatory index(SII),systemic inflammation response index(SIRI),and aggregate index of systemic inflammation(AISI)in chronic kidney disease(CKD)patients complicated with heart failure.Methods This study enrolled 190 CKD patients complicated with heart failure(case group)and 30 CKD patients without heart failure(control group)who treated in the outpatient and inpatient departments of Wenling Hospital of Traditional Chinese Medicine from January 2022 to December 2024.Differences in NLR,SII,SIRI,and AISI between the two groups were compared,and the relationship between these inflammatory markers and traditional Chinese medicine(TCM)syndrome types in CKD patients complicated with heart failure was analyzed.Logistic regression analysis and receiver operating characteristic(ROC)curve were used for evaluating the predictive efficacy of NLR,SII,SIRI,and AISI for illness severity of CKD complicated with heart failure.Results(1)The levels of NLR,SII,SIRI,and AISI in the case group were significantly higher than those in the control group(P＜0.01).(2)In CKD patients complicated with heart failure,NLR,SII,SIRI,and AISI were positively correlated with N-terminal pro-brain natriuretic peptide(NT-proBNP)levels(P＜0.01).(3)Among the CKD patients complicated with heart failure of fundamentally deficiency syndromes,spleen-kidney yang deficiency syndrome was the most prevalent,followed by spleen-kidney qi-yin deficiency syndrome,spleen-kidney qi deficiency syndrome,and yin-yang deficiency syndrome.Among the CKD patients complicated with heart failure of incidentally excess syndromes,blood stasis syndrome was the most common,followed by damp-heat syndrome,urinary toxin retention syndrome,and water-damp syndrome.(4)In CKD patients complicated with heart failure of fundamentally deficiency syndromes,NLR,SII,SIRI,and AISI levels ranked in the decreasing sequence in the syndromes of yin-yang deficiency,spleen-kidney yang deficiency,spleen-kidney qi-yin deficiency,and spleen-kidney qi deficiency;in the patients with incidentally excess syndromes,the levels ranked in the decreasing sequence in urinary toxin retention,damp-heat syndrome,blood stasis syndrome,and water-damp syndrome(P＜0.05).(5)Multivariate logistic regression identified NLR,SII,SIRI,and AISI as independent risk factors for illness severity of CKD complicated with heart failure(P＜0.01).(6)ROC curve analysis demonstrated high values of NLR,SII,SIRI,and AISI in differentiating illness severity of CKD complicated with heart failure(P＜0.01).Conclusion Inflammatory markers of NLR,SII,SIRI,and AISI exhibit significant correlation with illness severity of CKD complicated with heart failure,suggesting their potentiality as biological markers for TCM syndrome differentiation and disease progression assessment in this population.

Objective To investigate the correlation between insulin resistance markers[triglyceride-glucose(TyG)index],inflammatory indicators[neutrophil-to-lymphocyte ratio(NLR),C-reactive protein(CRP)],and traditional Chinese medicine(TCM)syndromes in patients with diabetic kidney disease(DKD)complicated by carotid atherosclerosis(CAS).Methods This retrospective study enrolled 300 DKD patients with CAS(case group)and 30 DKD patients without CAS(control group).Differences in TyG index,NLR,and CRP levels were compared between groups.The relationships between these markers and carotid intima-media thickness(IMT)/plaque area were analyzed,along with their variations across TCM syndromes.Logistic regression and receiver operating characteristic(ROC)curve analyses were performed to evaluate the predictive value of TyG index,NLR,and CRP for plaque stability and prognosis.Results(1)The TyG index,NLR,and CRP levels in patients with DKD and CAS were significantly higher than those in patients with DKD alone(P＜0.01).(2)The TyG index,NLR,and CRP were significantly positively correlated with IMT and plaque area(P＜0.01).(3)In patients with DKD combined with CAS,the TyG index,NLR,and CRP levels in those with unstable plaques were significantly higher than those with stable plaques(P＜0.01).(4)Among the distribution of TCM syndromes in patients with DKD combined with CAS,the qi and yin deficiency syndrome had the highest proportion(33.33％),followed by spleen and kidney yang deficiency syndrome(28.67％),yin and yang deficiency syndrome(22.00％),and turbid toxin and stasis obstruction syndrome(16.00％).(5)Among patients with DKD and CAS,the TyG index,NLR,and CRP levels in patients with different TCM syndromes decreased in the following order:turbid toxin and stasis obstruction syndrome,yin and yang deficiency syndrome,spleen-kidney yang deficiency syndrome,and qi and yin deficiency syndrome.(6)Logistic regression analysis results showed that TyG index,NLR,and CRP levels were closely associated with plaque stability in patients with DKD combined with CAS(P＜0.05 or P＜0.01).(7)ROC analysis showed that these markers have high prognostic value in DKD-CAS(P＜0.01).Conclusion TyG index,NLR,and CRP may serve as potential biomarkers for TCM syndrome differentiation and prognosis assessment in DKD-CAS.

Objective To explore the effect of different post-processing methods of total spinal CT angiography(CTA)for displaying spinal dural arteriovenous fistula(SDAVF).Methods Total spinal CTA data of 55 patients with SDAVF were retrospectively analyzed.Traditional post-processing of original CTA images(modified tissue growth boneless volume rendering[VR]and full-range axial maximum intensity projection[MIP])were performed,while the axial,sagittal and coronal MIP reconstructions,axial,sagittal and coronal VR reconstructions,as well as axial,sagittal and coronal MIP+VR reconstructions of original CTA images on lesion layers were completed,respectively.Taken digital subtraction angiography(DSA)as the gold standards,a 5-point scale was used to subjectively evaluate the effect of displaying the location,the range and feeding artery of fistula shown on CTA images based on different post-processing methods.Results No significant difference of subjective score of location nor feeding artery of fistula was found among axial MIP,VR and MIP+VR images(all P＞0.05),which were all higher than that of CTA images reconstructed using other post-processing methods(all P＜0.05).Meanwhile,no significant difference of subjective scores of the range of SDAVF was detected among sagittal MIP,VR and MIP+VR images(all P＞0.05),which were all higher than that of CTA images obtained using other post-processing methods(all P＜0.05).Conclusion The location and feeding artery of SDAVF could be observed based on axial MIP,VR and MIP+VR reconstructions of the total spinal CTA,while sagittal MIP,VR and MIP+VR reconstructions were conducive to display the range of SDAVF.Combination of multiple post-processing methods was helpful for comprehensive understanding the composition and range of SDAVF.

Objective To explore the effect of different post-processing methods of total spinal CT angiography(CTA)for displaying spinal dural arteriovenous fistula(SDAVF).Methods Total spinal CTA data of 55 patients with SDAVF were retrospectively analyzed.Traditional post-processing of original CTA images(modified tissue growth boneless volume rendering[VR]and full-range axial maximum intensity projection[MIP])were performed,while the axial,sagittal and coronal MIP reconstructions,axial,sagittal and coronal VR reconstructions,as well as axial,sagittal and coronal MIP+VR reconstructions of original CTA images on lesion layers were completed,respectively.Taken digital subtraction angiography(DSA)as the gold standards,a 5-point scale was used to subjectively evaluate the effect of displaying the location,the range and feeding artery of fistula shown on CTA images based on different post-processing methods.Results No significant difference of subjective score of location nor feeding artery of fistula was found among axial MIP,VR and MIP+VR images(all P＞0.05),which were all higher than that of CTA images reconstructed using other post-processing methods(all P＜0.05).Meanwhile,no significant difference of subjective scores of the range of SDAVF was detected among sagittal MIP,VR and MIP+VR images(all P＞0.05),which were all higher than that of CTA images obtained using other post-processing methods(all P＜0.05).Conclusion The location and feeding artery of SDAVF could be observed based on axial MIP,VR and MIP+VR reconstructions of the total spinal CTA,while sagittal MIP,VR and MIP+VR reconstructions were conducive to display the range of SDAVF.Combination of multiple post-processing methods was helpful for comprehensive understanding the composition and range of SDAVF.

Objective To evaluate the effect of exosomes from different sources on the growth, metastasis and immune microenvironment of hepatocellular carcinoma ( HCC ) in a mouse model of orthotopic transplanted hepatoma so as to provide new insight into the clinical immunotherapy of hepatocellular carcinoma. Methods The serum-derived exosomes were obtained by ultracentrifugation from Hepa1-6 cells and 3-week orthotopically tumor-bearing HCC mice. The morphology and size of exosomes were identified by transmission electron microscopy. One-week tumor-bearing HCC C57BL/6 mice were randomly divided into 3 groups ( 3 mice for each group ) , and respectively treated with tail vein injection of 120 μl PBS(control group), 120 μl Hepa1-6 cell-derived exosomes (1μg/μl, TEXcel group), and serum-derived exosomes (1μg/μl) (TEXserum group). The treatments were conduced once a week for 3 consecutive weeks. The mice were sacrificed on the 4th day after the treatments, and the liver tissue and lung tissues were dissected. The volumes of the liver cancer tissues were measured. The expression of PD-L1 protein and CD3+and FoxP3+T lymphocytes infiltration in the liver cancer tissues were respectively detected by Western Blot and immunohistochemical staining. The lung metastasis of the liver cancer was detected by hematoxylin-eosin staining. Results The diameters of the Hepa1-6 cell- and serum-derived exosomes both were about 100 nm, and were uniform vesicles with complete membrane structure. Compared with the control group, Hepa1-6 cell-derived exosomes had a certain inhibitory effect on the growth and lung metastasis of HCC, while there was no significant difference for the TEXserum group. Western Blot results showed that compared with the control group, PD-L1 protein expression was significantly up-regulated in both TEXcel group and TEXserum group. Immunohistochemical staining showed that compared with the control group, the infiltration number of Foxp3+-labeled regulatory T cells (Treg) had no significant changes in TEXcel group and the TEXserum group, and the differences were no statistically significant (all P>0.05). However, the infiltration number of CD3+-labeled T lymphocytes was significantly reduced in the two groups, and the differences were statistically significant (all P<0.05). Conclusion The Hepa1-6 cell-derived exosomes have a certain inhibitory effect on the growth and lung metastasis of HCC, and have no obvious regulation effects on the immune microenvironment of HCC. The serum-derived exosomes from orthotopically tumor-bearing HCC mice can promote the growth and lung metastasis of HCC and immunosuppress the microenvironment. The Hepa1-6 cell-derived exosomes are expected to be used for immunotherapy studies of liver cancer.

Objective To detect the expression and function of ZNRF3 in different kinds of thyroid cancer tissues and cells.Methods Immunohistochemistry was used to detect the expressions of ZNRF3 protein in 35 cases of papillary thyroid carcinoma and 10 cases of poorly differentiated thyroid carcinoma.The expressions of ZNRF3 gene in TPC-1 and 8505C were detected by RT-PCR,and the cell lines were derived from papillary thyroid carcinoma and poorly differentiated thyroid carcinoma respectively.After silenced ZNRF3 gene expression with lentivirus,the proliferation ability of TPC-1 cells were detected with CCK-8,the invasion and metastasis ability of TPC-1 cells were detected with Transwell.Results According to results of immunohistochemistry and RT-PCR,the expressions of ZNRF3 in papillary thyroid carcinoma cells and tissues were higher than those in poorly differentiated thyroid carcinoma cells and tissues,the differences were statistically significant (4.83±0.44 vs.3.13 ±0.59,t =2.20,P ＜0.05;1.01±0.06 vs.0.21±0.04,t =11.80,P＜0.01).After ZNRF3 geng silencing,according to the results of CCK8,the proliferation ability of TPC-1 cells was significantly enhanced in 72 h,the difference was statistically significant (0.96 ± 0.10 vs.0.64 ± 0.05,t =3.19,P ＜ 0.05);and according to the results of Transwell,the TPC-1 cell's invasion (0.12 ± 0.01 vs.0.09 ±0.00,t =5.48,P＜0.01) and migration (0.22 ±-0.01 vs.0.17 ±0.01,t =4.58,P ＜0.05) also increased,the differences were statistically significant.Conclusion The expression of ZNRF3 in papillary thyroid carcinoma is higher than that in poorly differentiated thyroid cancer.ZNRF3 is tumor suppressor gene in the thyroid tumors.

Ring finger protein 43 (RNF43) is a ring-type E3 ubiquitin ligase.As a negative regulater of Wnt signaling pathway, RNF43 has an important anti-tumor effect.The mutation of RNF43 may cause abnormal activation of Wnt signaling pathway, and then promote invasion, metastasis and proliferation of tumor cell.In addition, the act of RNF43 protein in the Wnt signal pathway is expected to be a molecular target in the therapy of cancer.In recent years, with the gradual deepening of related research, the molecular structure of RNF43 protein and its mechanism of action with the Wnt pathway-related proteins have been gradually clear.In clinical, RNF43 protein analogs and related vaccine also show the important position in the therapy of cancer.

Objective To investigate the heat effects of the high-frequency electric knife on the recurrent laryngeal nerve ( RLN) in pigs and the safety margin in which electric knife can be used .Methods Totally 12 pigs for experiment were randomly divided into 3 groups by the distance between the head of the electric knife and the nerve(2 mm, 1 mm, 0 mm).The application time of the electric knife touching RLN was set to be 3 s and the application energy of the electric knife was 90 W.The data of electromyogram were measured by means of nerve detector before and after operation .Statistical analysis was made based on those data .The nerve tissues were taken to make paraffin sections so that the histological change can be observed and compared before and after damage.Results The data from electromyogram by nerve detector indicated that the difference of the amplitude of group 2(1 mm)and group 3(0 mm)had statistical significance(P<0.05)within group.There were significant difference of the amplitude between the 3 groups.Histological study showed that the tissues of group 3(0 mm)had obvious injury .Conclusions In thyroid surgery , the safety range of high frequency electrical knife used around RLN is:the distance from electrical knife head to nerve should be no less than 2 mm.

Recurrent laryngeal nerve injury is one of the serious complications after thyroidectomy.Unilateral injury causes hoarseness,while bilateral injury causes difficulty in breathing or even life-threatening glottis obstruction.Analyzing the root cause of the thyroid injury,firstly it is the anatomical factors of recurrent laryngeal nerve,namely the close and complex relationship between the recurrent laryngeal nerve and the inferior thyroid artery,the existence of branches of recurrent laryngeal nerve and its variation,and the presence of non recurrent laryngeal nerve and Zuckerkandl nodules.Those are all made the recurrent laryngeal nerve easy to be damaged.Secondly it is because of the vulnerability of the recurrent laryngeal nerve itself.Last improper using of energy operation instrument will cause heat injury on nerves.Below counter measures can be implemented to prevent recurrent laryngeal nerve injury.Dissect to show recurrent laryngeal nerve or make it ‘ visualization’ during thyroidectomy.Elaborately anatomize recurrent laryngeal nerve to appropriate degree.Be familiar with the property of energy operation instrument and thus safely use them to reduce the heat injury of recurrent laryngeal nerve.Reasonably use the intraoperative nerve monitoring in the surgery,which assist to reduce the risk of injury of recurrent laryngeal nerve.

Objective To investigate the effect of heat stress on organ indices, intestinal morphology, gastric mu-cosal HSP70 mRNA expression and glucose metabolic hormones in mice.Methods A single-factor experiment was de-signed for the present research.Eighteen KM mice of the similar age and weight were randomly divided into control group and heat stress group.The weight of the heart, liver, spleen, lung and kidney, as well as the expression of HSP70 mRNA in the mouse gastric mucosa were measured.The plasma concentration of insulin and glucagon, the villus height and crypt depth of the duodenum and jejunum were detected.The histological changes of the liver, duodenum and jejunum were also examined.Results There was no effect of heat stress on the organ indices.It significantly increased the expression of HSP70 mRNA in the gastric mucosa, reduced the plasma insulin level and caused serious injury to the liver, duodenum and jejunum in the mice.Conclusions Heat stress does not significantly affect the organ indices in mice, but can significantly increase the expression of HSP70 mRNA in the gastric mucosa, cause apparent damages in the liver, duodenum and jeju-num, reduce the villus height, crypt depth and villus height/crypt depth ratio of the duodenum and jejunum, and also de-crease the blood insulin concentration in the mice.