Objective To investigate the 30-day mortality risk factors in elderly patients with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly (≥70 years) HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024 was performed. Simple random sampling in R software was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. Results A total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training set, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065-11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269-67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057-46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997-6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000-2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: area under the curve (AUC) in the training set was 0.898 (95%CI 0.831-0.966) and in the validation set was 0.912 (95%CI 0.805-1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.

ObjectiveTo investigate the application of central auditory testing combined with electroencephalographic features in the early screening of mild cognitive impairment due to Alzheimer's disease. MethodsA convenience sampling method was used to conduct a field survey in the Qixia District of Nanjing City, Jiangsu Province, from July to September, 2025. A total of 40 older adults diagnosed as mild cognitive impairment due to Alzheimer's disease and 23 cognitively normal older adults were recruited. Auditory N-back and dichotic listening paradigms were employed for assessment, while the scores of Montreal Cognitive Assessment Beijing Version (MoCA-BJ) and 32-channel electroencephalogram (EEG) data were simultaneously collected. Binary logistic regression analysis was applied to identify predictive indicators, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated. ResultsThe total score of dichotic listening was positively correlated with overall cognitive function (r = 0.475, P < 0.01), while right-ear advantage showed negative correlations with overall cognition, visuospatial ability, abstract reasoning, and delayed recall (r < -0.276, P < 0.05). Task performance across all conditions of the N-back task was positively correlated with overall cognitive function (r > 0.249, P < 0.05). Regarding EEG features, δ and θ band power and power peaks were positively correlated with delayed recall (r > 0.258, P < 0.05), whereas (α+θ)/(α+β) and θ/(α+β) were positively correlated with naming ability and visuospatial executive function, respectively (r > 0.261, P < 0.05). The results of the binary logistic regression analysis showed that the total score of binaural dichotic listening, the accuracy of 1-back task, the average power of δ waves, and the ratio of θ/(α+β) were independent influencing factors for mild cognitive impairment due to Alzheimer's disease (P < 0.05). The ROC analysis indicated that the AUC for auditory task performance and EEG features were 0.845 and 0.735 respectively, and when combined, the AUC increased to 0.862. ConclusionThe screening model based on the integration of auditory task performance and EEG features can be used in the early identification of mild cognitive impairment due to Alzheimer's disease.

Clinically， the occurrence of the breaking bad news is inevitable. For patients， they not only need to accept and cope with bad news， but also need to inform the bad news to their families with clear thinking and appropriate language， seeking their support and cooperation. This paper analysed the connotation and informing dilemma of bad news， investigated patients’ informing tendencies， as well as evaluated the advantages and disadvantages of three disclosure methods， including concealment， immediate informing， and staged informing. On these bases， a detailed response strategy for patients to inform their families was proposed in three parts， including pre-preparation， mid-articulation， and post-summary. In the initial phase， thorough preparation is essential. During the middle stage， when delivering bad news， use plain language and help family members adjust their emotions. In the final phase， ensure that all information and viewpoints have been fully communicated. In addition， the roles and analysis steps that doctors should play were analysed from their perspective and combined with the degree of doctor-patient trust. Effective informing of bad news is not only about communication skills， but also involves a deep understanding and respect for the psychological needs of patients and their families. Through meticulous preparation， appropriate expression， emotional support， and clear confirmation， communication and trust are promoted to face and overcome difficulties together.

Objective:To assess the safety and efficacy of thiotepa, busulfan, and etoposide (TBE) conditioning followed by autologous hematopoietic stem-cell transplantation (TBE auto-HSCT) in primary central nervous system lymphoma (PCNSL) patients.Methods:Clinical data from 27 PCNSL patients who received TBE auto-HSCT at the Fifth Medical Center of PLA General Hospital between November 1, 2021, and April 30, 2024, were retrospectively analyzed.Results:Twenty-seven patients [16 males, 11 females; median age 57 (23–72) years] were included, with 12 (44.4%, 12/27) over 60. Twenty-five had newly diagnosed PCNSL and 2 were relapsed. Median time from diagnosis to transplantation was 6.9 (5.0–10.0) months. TBE auto-HSCT increased complete remission (CR) rate from 63.0 to 96.3% ( P= 0.005), and 9 of 10 patients in partial remission achieving CR post-transplant. Median follow-up was 24.5 months (range 2.0–36.0). Two-year progress-free and OS rates were (87.2±6.9) % and (88.6±6.2) %, respectively. Common grade 3 nonhematologic adverse events were diarrhea (18.5%, 5/27) and bacterial infections (14.8%, 4/27). One patient (64 years old) died from carbapenem-resistant Enterobacteriaceae infection within 2 months post-transplant, yielding a 100-day treatment-related mortality of 3.7% (1/27) . Conclusion:TBE-conditioned high-dose chemotherapy with auto-HSCT is effective, safe, and well-tolerated in PCNSL patients, including the elderly.

Objective:To analyze the correlation between 24-hour urinary sodium excretion and early renal function impairment in patients with primary hypertension.Methods:This cross-sectional study included patients with primary hypertension who were admitted to the Department of Cardiology of the Chinese People′s Liberation Army General Hospital between January 2021 and October 2024. Patients were divided into low-sodium, medium-sodium, and high-sodium groups based on their 24-hour urinary sodium excretion. General clinical data were collected using the electronic medical record system. Urinary sodium, protein, and microalbumin excretion were analyzed from 24-hour urine samples. Spearman correlation analysis was used to explore the relationship between 24-hour urinary sodium excretion and urinary microalbumin excretion. A multiple linear regression model was used to further assess the independent association between these variables. Subgroup analyses were conducted based on age were performed to determine whether age influenced the relationship between urinary sodium excretion and renal function impairment.Results:A total of 1 065 patients with primary hypertension were included, with a mean age of (55.26±14.06) years, including 568(53.33%) males. The low-sodium, medium-sodium, and high-sodium groups included 223, 579, and 263 patients, respectively. The 24-hour urinary microalbumin excretion in the high-sodium group was significantly higher than in the medium-sodium and low-sodium groups, and this trend remained consistent across different age groups (all P<0.05). Spearman correlation analysis showed a positive correlation between 24-hour urinary sodium excretion and urinary microalbumin excretion ( r=0.220, P<0.001), and this relationship was observed in all age groups (all P<0.05). Multiple linear regression analysis confirmed an independent association between 24-hour urinary sodium excretion and urinary microalbumin excretion (all P<0.001), which persisted across different age groups (all P<0.05). Conclusion:In patients with primary hypertension, 24-hour urinary sodium excretion is closely associated with microalbumin excretion, suggesting a potential link to early renal function impairment.

Objective:To validate the accuracy of three-dimensional anatomical models reconstructed from cone beam CT (CBCT) using micro-CT as the gold standard, and to evaluate the feasibility of performing anatomical analyses on such models.Methods:A total of 13 isolated deciduous teeth with intact roots were collected, including 5 anterior teeth and 8 molars, with a total of 34 root canals. The teeth were extracted from children aged 3-9 years who visited Peking University Hospital of Stomatology from January 2019 to April 2022 due to trauma or periapical disease, and were then scanned by micro-CT (with a voxel size of 0.018 mm) and CBCT (with a voxel size of 0.125 mm), respectively. Using a threshold-based semi-automated region segmentation method, anatomical models of these isolated teeth were reconstructed from the two CTs. Subsequently, the two CT reconstructed models were registered based on the iterative closest point algorithm, followed by deviation analysis. The key anatomical parameters were measured on the micro-CT and CBCT models, respectively, and the differences were calculated.Results:The CBCT reconstruction models were relatively accurate in the hard tissue morphology, and 97.1% (33/34) of the root canals were identified accurately. When it comes to the deviation analysis, the average distance between the matched points on the CBCT reconstruction models and the micro-CT models was (0.01±0.03) mm for the hard tissue, and (0.00±0.03) mm for the pulp chambers and canals, which did not affect clinical observation. The hard tissue and root canal length of CBCT models were both smaller than those of micro-CT models ( P<0.05), with a 95% limits of agreement of (-0.70, 0.14) mm for the hard tissue, and a 95% limits of agreement of (-1.93, 1.00) mm for the pulp chambers and canals. The impact of these differences on clinical operations was all within the acceptable range. Conclusions:Using micro-CT as a validate standard, CBCT with a voxel size of 0.125 mm was proved to be an effective tool for the reconstruction of deciduous teeth. Therefore, the reconstructed models were appropriate for studying deciduous teeth anatomy.

A recombinant adenovirus(rAd)for expression of Mycobacterium tuberculosis(M.tb)c-di-AMP phosphodiesterase CnpB was constructed,and its induced humoral immune response was detected.The codon-optimized gene of M.tb CnpB was cloned into the adenoviral plasmid pcADV.The recombinant plasmid pcADV-CnpB was transfected into HEK293T cells,and expression was detected with Western blot.The recombinant plasmid pcADV-CnpB and the backbone plasmid were co-transfected into HEK293T cells to obtain the recombinant adenovirus rAd-CnpB.rAd-CnpB was amplified in HEK293T cells,and the target protein expression of rAd-CnpB was detected with Western blot and immunofluorescence.Mice were immunized with rAd-CnpB intranasally,and their sera and bronchoalveolar lavage fluid(BALF)were collected.ELISA was used to detect levels of antigen-specific antibodies.Restriction enzyme digestion and sequencing indicated that the recombinant plasmid pcADV-CnpB was successfully constructed and led to protein expression in eukaryotic cells.rAd-CnpB was packaged and produced in HEK293T cells.After amplification and purification,rAd-CnpB with a titer of 5.53×1010 PFU/mL was obtained.rAd-CnpB led to CnpB expression in HEK293T cells.Intranasal immunization with rAd-CnpB increased levels of IgG and secretory IgA in BALF and led to high levels of IgG in sera.rAd-CnpB,the recombinant adenovirus for expression of c-di-AMP phosphodiesterase CnpB was successfully constructed,and was found to induce antigen-specific humoral and mucosal immune responses through mucosal immunization.Thus,rAd-CnpB may be used in further research on new TB vaccine strategies.

This study assessed the role and mechanism of the recombinant Bacillus Calmette-Gue?rin vaccine(rBCG)with c-di-AMP adjuvant in regulating metabolism and immunity in epididymal white adipose(eWAT)in mice.Male C57BL/6 mice were intravenously immunized with BCG and rBCG,and their body weights were monitored.eWAT was isolated from the mice,and the stromal vascular fractions(SVFs)cell number was counted with a hemocytometer.Sections of mouse adipose tissue were prepared,and the size,number,and morphology of eWAT adipocytes and crown-like structure(CLS)formation were compared under a microscope after HE staining.The transcription levels of lipid metabolism-associated factors,cytokines and aging-associated genes in each group were determined with qRT-PCR.The body weights of mice gradually increased after immunization with BCG and rBCG.The proportions of eWAT increased,and the SVFs cell number decreased,in rBCG immunized mice.HE staining indicated that BCG immunization promoted hyperplasia,whereas rBCG immunization promoted hypertrophy of eWAT adipocytes;moreover,both BCG and rBCG immunization induced CLS formation in eWAT.The qRT-PCR results indicated that rBCG immunization inhibited the expression of genes associated with lipolysis and energy expenditure in eWAT.BCG immunization had little effect on cytokine transcription,whereas rBCG significantly induced the transcription of IFN-γ and IL-1Ra,and inhibited that of IL-15 and IL-2,but did not induce the expression of aging-associated genes.Thus,rBCG immunization induced eWAT adipocyte hypertrophy,which was associated with the inhibition of eWAT lipolysis and the regulation of cytokine expression.

This study aims to investigate the characteristics of chitosan-loaded miR-146a nanoparti-cles and explore their protective effect against acute liver cell injury induced by LPS in vitro.Galac-tosylated arginine chitosan(GCA)nanoparticles were successfully synthesized,prepared and used to further prepare GCA-miR-146a nanoparticles with different mass ratios by ion cross-linking method.The binding efficiency of miR-146a by GCA nanoparticles was detected by gel retardation experiment.Particle size,morphology and potential were observed and detected by transmission e-lectron microscopy and Zetasizer NanoZS90 respectively.The cytotoxicity of GCA nanoparticles on HepG2 cells was detected by CCK-8 kit.Cellular uptake was assayed by fluorescence microscopy to select the optimum ratio for the further study.The LPS induced acute liver cell injury were evalua-ted by real-time fluorescence quantitative PCR.The results showed that the mass ratio of GCA-miR-146a was 5∶1.Encapsulation efficiency and drug loading efficiency of the nanoparticles reached 97.11％and 20.08％,respectively.The 100 nm nanoparticles with 1.15 mV surface charge showed uniform morphology.The GCA-miR-146a nanoparticles had no cytotoxicity and had high transfection efficiency on HepG2 cells.The study demonstrated that GCA-miR-146 ananoparticles could significantly increase the expression of miR-146a in HepG2 cells and reduce the mRNA ex-pression levels of IL-6 and TNF-α in vitro.The prepared GCA nanoparticles loaded with miR-146a had high loading efficiency and could protect LPS-induced acute liver cell injury in vitro.

Objective:To validate the accuracy of three-dimensional anatomical models reconstructed from cone beam CT (CBCT) using micro-CT as the gold standard, and to evaluate the feasibility of performing anatomical analyses on such models.Methods:A total of 13 isolated deciduous teeth with intact roots were collected, including 5 anterior teeth and 8 molars, with a total of 34 root canals. The teeth were extracted from children aged 3-9 years who visited Peking University Hospital of Stomatology from January 2019 to April 2022 due to trauma or periapical disease, and were then scanned by micro-CT (with a voxel size of 0.018 mm) and CBCT (with a voxel size of 0.125 mm), respectively. Using a threshold-based semi-automated region segmentation method, anatomical models of these isolated teeth were reconstructed from the two CTs. Subsequently, the two CT reconstructed models were registered based on the iterative closest point algorithm, followed by deviation analysis. The key anatomical parameters were measured on the micro-CT and CBCT models, respectively, and the differences were calculated.Results:The CBCT reconstruction models were relatively accurate in the hard tissue morphology, and 97.1% (33/34) of the root canals were identified accurately. When it comes to the deviation analysis, the average distance between the matched points on the CBCT reconstruction models and the micro-CT models was (0.01±0.03) mm for the hard tissue, and (0.00±0.03) mm for the pulp chambers and canals, which did not affect clinical observation. The hard tissue and root canal length of CBCT models were both smaller than those of micro-CT models ( P<0.05), with a 95% limits of agreement of (-0.70, 0.14) mm for the hard tissue, and a 95% limits of agreement of (-1.93, 1.00) mm for the pulp chambers and canals. The impact of these differences on clinical operations was all within the acceptable range. Conclusions:Using micro-CT as a validate standard, CBCT with a voxel size of 0.125 mm was proved to be an effective tool for the reconstruction of deciduous teeth. Therefore, the reconstructed models were appropriate for studying deciduous teeth anatomy.