Objective To explore risk factors of sodium-dependent glucose transporters 2 （SGLT2） inhibitor-associated euglycemic diabetic ketoacidosis （euDKA） and to construct a risk prediction model. Methods A retrospective analysis was performed on the clinical data of type 2 diabetes patients treated with SGLT2 inhibitors in Dongnan Hospital of Xiamen University from January 2020 to December 2023, including age, gender and course of diabetes. The risk factors of SGLT2 inhibitor-associated euDKA were analyzed by univariate analysis and multivariate Logistic regression, and a prediction model was established. According to the receiver's operating characteristic （ROC） curve, the area under the curve （AUC） and the optimal critical value of the prediction model were determined. The prediction model was subjected to both internal and external validation. Results A total of 119 patients with type 2 diabetes treated with SGLT2 inhibitors were included in this study. Among them, there were 98 cases without euDKA （non-euDKA group）and 21 cases with euDKA （euDKA group）. Multivariate Logistic regression analysis showed the DKA history (OR=114.153), appetite or diet decreased three days before admission (OR=21.774), elevated neutrophil count (OR=2.056) and pre-hospital adjustment of hypoglycemic agents (OR=45.745) were independent factors to increase risks of euDKA associated with SGLT2 inhibitors （P<0.05）. Surgical history before admission was an independent factor to reduce this risk （OR=0.007, P<0.05）. By establishing the calculation formula of the prediction model = neutrophil count+6.571 （DKA history）−6.874 （surgical history before admission）+4.273 （appetite or diet decreased three days before admission）+5.302 （pre-hospital adjustment of hypoglycemic drugs）, the ROC curve was drawn. The AUC of the ROC of the prediction model was 0.982 （95%CI: 0.961-1.000, P<0.001）, with accuracy of 94.96%, sensitivity of 0.905, specificity of 0.959 and a critical value of 7.405. The AUC of ROC curve after the model’s ten-fold cross validation was 0.930. And the accuracy of the external validation of the prediction model was 85.29%. Conclusion The DKA history, appetite or diet decreased three days before admission, elevated neutrophil count and pre-hospital adjustment of hypoglycemic agents increased the risk of SGLT2 inhibitor-associated euDKA, while the surgical history before admission reduced this risk. The risk prediction model constructed on this basis could better predict the risk of SGLT2 inhibitor-associated euDKA.

Objective:To investigate the inflammatory indicator levels and influencing factors on middle-aged and elderly male residents at different residential distances from a uranium mine in Guangdong, so as to provide scientific data for the health risk assessment of the residents therein.Methods:With stratified sampling method, two groups of the permanent middle-aged and elderly male residents were randomly sampled within < 10 km and 10-20 km of the uranium mine, along with the basic demographic characteristics and lifestyle information collected through face-to-face questionnaire survey. Both height and weight of the respondents were measured using standard method and their body mass indexes (BMI) were calculated. Through collection of the venous blood, the levels of a wide range of inflammatory indicators were measured, such as C-reactive protein (CRP), complement C3, complement C4, leukocytes, lymphocytes, neutrophils, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and others. Multiple linear regression was used to analyze the influencing factors on the levels of inflammation indicators.Results:A total of 867 middle-aged and elderly male residents were included in this study, including one group of 431 residents within the 10-20 km at an average age of 51.54±5.37, and a second group of 436 residents within <10 km at an average age of 52.05±5.24. The result of multiple linear regression showed a positive correlation of the distance groups with complement C4 level ( β=0.014, 95% CI: 0.001-0.027) and lymphocyte number ( β=0.086, 95% CI: 0.003-0.168) ( t=2.07, 2.04, P<0.05). The ages of middle-aged and elderly male residents around the uranium mine was positively correlated ( t=2.50, P<0.05) with the levels of complement C4 ( β=0.018, 95% CI: 0.004-0.031), and negatively correlated ( t=-3.25, -2.97, P<0.05) with the levels of TNF-α ( β=-63.022, 95% CI: -101.114 to -24.929) and IL-6 ( β=-14.694, 95% CI: -24.396 to -4.992). Smoking was positively correlated ( t=4.29, 4.81, 3.19, P<0.05) with leukocytes number ( β=0.630, 95% CI: 0.341-0.918), lymphocytes number ( β=0.226, 95% CI: 0.134-0.319) and neutrophils number ( β=0.372, 95% CI: 0.143-0.601), and negatively correlated ( t=-2.07, -1.98, P<0.05) with the levels of TNF-α ( β=-43.551, 95% CI: -84.778 to -2.324) and IL-6 ( β=-10.603, 95% CI: -21.103 to -0.102). BMI was positively correlated ( t=8.60, 3.62, 3.18, 4.01, 2.10, P<0.05) with complement C3 level ( β=0.108, 95% CI: 0.084-0.133), complement C4 level ( β=0.026, 95% CI: 0.012-0.039), leukocytes number ( β=0.433, 95% CI: 0.166-0.699), lymphocyte number ( β=0.175, 95% CI: 0.089-0.261), and neutrophil number ( β=0.226, 95% CI: 0.014-0.438). Fruit consumption ( β=0.017, 95% CI: 0.001-0.034) was positively correlated with complement C4 levels ( t=2.10, P<0.05). Conclusions:This study showed no significant correlation between the inflammatory index levels of middle-aged and elderly male residents around the uranium mine and uranium mining. Age, smoking, BMI and fruit consumption were the influencing factors on the levels of inflammatory indicators of middle-aged and elderly male residents.

Objective:To investigate differential gene expression, enriched biological processes, and pathway differences between residents of a high-background radiation area (HBRA), Yangjiang, and a control area—Enping.Methods:Seven residents were selected from the HBRA (the HBRA group) and seven from the control area (the control group) using the two-stage random sampling method. The cumulative radiation dose for each individual was calculated based on the ambient gamma exposure levels. Peripheral blood samples were collected and analyzed via high-throughput sequencing to identify differentially expressed genes. Subsequent analyses included gene ontology (GO) for biological process (BP), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and gene set enrichment analysis (GSEA).Results:The median ages of the HBRA and control groups had no statistically significant difference ( P = 0.370). The cumulative external doses for the HBRA and control groups were (99.59±20.07) and (33.82±10.61) mSv, respectively. This difference was statistically significant ( t = -5.88, P = 0.001). High-throughput sequencing identified 1 224 differentially expressed genes in the HBRA group, including 32 senescence-related genes, compared to the control group. The result of GO-BP analysis showed that these genes were predominantly enriched in cell signaling, biosynthesis, localization, cell cycle regulation, and cellular stress responses. KEGG analysis revealed significant enrichment in the chemokine and MAPK signaling pathways, as well as in pathways related to the cell cycle, autophagy, and mitophagy. Furthermore, GSEA analysis confirmed that the differentially expressed genes were mainly related to cell cycle regulation and mitochondrial functions. Conclusions:Differentially expressed mRNAs are found in the peripheral blood of residents in the HBRA. These mRNAs are predominantly associated with key biological processes and pathways, including cell cycle regulation, chemokine and MAPK signaling pathways, and mitophagy.

Objective To summarize the clinical efficacy of robotic-assisted left thoracic small-incision minimally invasive direct coronary artery bypass grafting(MIDCAB).Methods A retrospective analysis was conducted on the procedures and treatment outcomes of robotic-assisted MIDCAB in the Army Medical Center of PLA from October 2016 to June 2023.Baseline clinical information,MIDCAB-related data,perioperative conditions and data during follow-up were collected and analyzed.Results There were 23 patients subjected,including 21 males and 2 females,with a mean age of 58.17±7.49 years,and a body mass index(BMI)of 23.99±3.25 kg/m2.All of them experienced angina pectoris,and 1 had a history of myocardial infarction,1 had dilated cardiomyopathy,2 patients had chronic obstructive pulmonary disease(COPD),and 10 had a history of percutaneous coronary intervention(PCI).Robotic-assisted MIDCAB procedure was successfully completed.No internal mammary artery injury or transformation of the procedure occurred in these cases,and excellent bridging vessel flow was achieved after anastomosis of the internal mammary artery to left anterior descending branch.The incision length in the left chest was 8(8,8)cm,the operation time was 380(300,465)min,the intraoperative bleeding volume was 300(100,400)mL,the length of ICU stay was 3(2,3)d,the amount of thoracic drainage was 780(525,1 040)mL,and the postoperative length from surgery to discharge was 11.17±2.38 d.No mortality was observed during or within 30 d of hospitalization,and 1 patient was readmitted due to pericardial effusion within 30 d,and was discharged after symptomatic treatment including pericardiocentesis and drainage.No deaths,major adverse cardiovascular and cerebrovascular events(MACCE),or re-revascularization occurred in all patients during outpatient and telephone follow-up.Conclusion Robotic-assisted internal mammary artery dissection is a delicate and safe technique,and coronary artery bypass grafting in minimally invasive small-incision off-pump is effective,safe and feasible,with satisfactory short-and mid-term outcomes.The technique is suitable for minimally invasive coronary artery disease surgery and is worthy of popularization and application.

Objective Study the advantages and disadvantages of hospital information outsourcing projects,strengthen the management of outsourcing services,and enhance the capability for the construction of smart hospitals.Methods Utilize the SWOT mode to comprehensively analyze the outsourcing services of hospital information projects,combine practical outsourcing experience in hospitals,and research on relevant issues regarding outsourcing services.Results The SWOT method can compre-hensively analyze information outsourcing services,fully utilize the advantages of outsourcing,and strengthen the process and se-curity management of outsourcing services.Conclusion The outsourcing service of hospital information project can reduce the cost,make up for the technical shortcoming,release the information department's ability,and improve the operation and mainte-nance level.

Objective:To explore the impact of diabetes mellitus on perioperative myocardial injury and cardiac function recovery in patients undergoing off-pump coronary artery bypass grafting (CABG).Methods:The clinical data of 40 patients with coronary heart disease who underwent off-pump CABG in Changsha Central Hospital from 2015 to 2025 were retrospectively included. They were divided into the diabetes group (20 cases) and the control group (20 cases) according to whether they had type 2 diabetes mellitus. Myocardial injury markers (creatine kinase isoenzyme, troponin I, lactate dehydrogenase) before surgery, on the 1st and 3rd days after surgery and before discharge, as well as cardiac function indicators (B-type natriuretic peptide, left ventricular ejection fraction) before surgery and before discharge were compared between the two groups. The postoperative recovery speed (mechanical ventilation time, intensive care unit stay, vasoactive drug use time, postoperative hospital stay) was also compared between the two groups.Results:Before surgery, there were no statistically significant differences in myocardial injury markers and cardiac function indicators between the two groups (all P>0.05). On the 3rd day after surgery, lactate dehydrogenase in the diabetes group was significantly higher than that in the control group ( P<0.05), while there were no statistically significant differences in creatine kinase isoenzyme and troponin I between the two groups (all P>0.05). Before discharge, the levels of creatine kinase isoenzyme and B-type natriuretic peptide in the diabetes group were significantly higher than those in the control group (all P<0.05), and the left ventricular ejection fraction was significantly lower than that in the control group ( P<0.05). Compared with the control group, the diabetes group had significantly longer mechanical ventilation time, intensive care unit stay, and postoperative hospital stay (all P<0.05), but there was no statistically significant difference in the use time of vasoactive drugs ( P>0.05). Conclusions:For patients with coronary heart disease complicated with diabetes mellitus, their preoperative cardiac status is comparable to that of patients without diabetes mellitus, but they show a characteristic dynamic injury pattern after surgery: early elevation of lactate dehydrogenase suggests susceptibility to subcellular injury, and long-term abnormalities of creatine kinase isoenzyme, B-type natriuretic peptide, and decrease in left ventricular ejection fraction indicate myocardial repair disorders. Compared with patients without diabetes mellitus, those with diabetes mellitus require a longer recovery time after off-pump CABG, and targeted perioperative management strategies are urgently needed.

Objective:To compare the analgesic effect of femoral triangle block and adductor canal block after total knee arthroplasty.Methods:Clinical studies comparing the analgesic efficacy of femoral triangle block and adductor canal block after total knee arthroplasty were retrieved from CNKI, Wanfang Data Knowledge Service Platform, VIP, Chinese Medical Journal Full-text Database, PubMed, Embase, and the Cochrane Library, with the retrieval time ranging from the establishment of the databases to October 2024. Data on knee pain scores, morphine consumption, quadriceps muscle strength, postoperative timed up-and-go test (TUGT), and postoperative complications were extracted. The modified Jadad scale was used to evaluate the methodological quality of the included literature. Meta-analysis was performed using Stata 18.0 statistical software.Results:A total of 670 patients from 9 randomized controlled trials were included in the meta-analysis. There were 333 patients in the femoral triangle block group, with an average age of 60.6-72.3 years, and there were 337 patients in the adductor canal block group, with an average age of 61.7-73.5 years. All the 7 English articles were of high quality, and the modified Jadad score was 6-7 points. Two Chinese articles were of low quality and the modified Jadad score was 3. The results of meta-analysis showed that there were no statistically significant differences between the two groups in postoperative morphine consumption [ SMD=0.13, 95% CI(-0.45, 0.71), P=0.658], postoperative 24h knee resting pain score [ SMD=-0.35, 95% CI(-1.48, 0.78), P=0.545], postoperative 48h knee resting pain score [ SMD=-0.56, 95% CI(-1.71, 0.60), P=0.347], postoperative 24h TUGT [ SMD=0.01, 95% CI(-0.27, 0.30), P=0.933], postoperative 48h TUGT [ SMD=0.04, 95% CI(-0.61, 0.69), P=0.905], and incidence of postoperative complications [ RR=1.17, 95% CI(0.56, 2.45), P=0.669]. The quadriceps strength of the adductor canal block group was greater than that of the femoral triangle block group at 24 h after operation, and the difference was statistically significant [ WMD=-0.73, 95% CI(-0.93, -0.53), P<0.001]. Conclusions:Both femoral triangle block and adductor canal block can effectively relieve pain after total knee arthroplasty. Patients with adductor canal block have better muscle strength recovery in the early postoperative period.

To analyze the epidemiological characteristics of COVID-19 in Fujian Province from the 49th week of 2022 to the 5th week of 2023,after further optimization of China's COVID-19 prevention and control measures on December 7,2022(the 49th week of 2022),this study used multi-dimensional surveillance data to dynamically assess population infection levels and their changing trends.The aim of the study was to provide a scientific basis for early warning of epidemic risk,medical resource allocation,and evalu-ation of socio-economic impact.A multi-source data surveillance system was constructed,encompassing surveillance of fever clinics at medical institutions(weekly collection of visits,positive nucleic acid and antigen test results,inpatients,and severe cases in sec-ondary or above hospitals),population nucleic acid test monitoring(weekly person-times and positivity rates of single-tube tests from the provincial system),sentinel hospital monitoring(weekly proportion of influenza-like illness visits at 18 sentinel hospitals and re-lated viral testing data),and monitoring of novel coronavirus variants(weekly systematic collection of genomic sequences of local and imported cases).Line charts were plotted weekly,and time series analysis,molecular epidemiological methods,and an improved SEIAR model were used to simulate epidemic spread.During the study period,the COVID-19 epidemic in Fujian Province exhibited three distinct stages.In the infection peak stage(52nd week of 2022),the provincial fever clinic visits reached 606 893 person-times,and a 49.2%positivity rate in population single-tube nucleic acid tests and 63.8%positivity rate in sentinel hospital monitoring were observed.In the medical load peak stage(2nd week of 2023),274 460 inpatients and 28 487 severe cases were recorded.In the epidemic decline stage(4th to 5th weeks of 2023),fever clinic visits decreased by 96.3%with respect to the peak,the single-tube nucleic acid test positivity rate decreased to 6.3%,and the sentinel hospital COVID-19 nucleic acid test positivity rate was 6.4%.All 508 sequenced local cases were Omicron variants,predominantly BA.5.2 and its sub-lineages(67.4%).Among 56 imported se-quenced cases,BA.5.2 and its sub-lineages accounted for 50.0%,and 16.1%comprised nine variants of interest including XBB and BQ.The model predicted the infection peak in the 52nd week of 2022,whereas the hospitalization peak lagged by approximately 10.6 days.Multi-source data monitoring revealed a three-stage development of the COVID-19 epidemic in Fujian.The BA.5.2 strain was dominant during the epidemic.The combination of multi-source monitoring data and modeling provides important references for epi-demic prevention and control,and highlights the need to improve the monitoring system in follow-up.

AIM:To investigate the immunosuppressive effects of M2-like tumor-associated macrophages(M2-TAMs)on CD8+T cells within the tumor microenvironment of esophageal cancer.METHODS:Multiplex fluores-cence immunohistochemistry was used to analyze the distribution of immune cells in esophageal cancer tissues.An in vitro co-culture system was established,and flow cytometry along with Calcein-AM/PI staining was employed to assess the im-pact of M2-TAMs on CD8+T cell function.The GEPIA database was utilized to evaluate the prognostic significance of PDCD1 expression in esophageal cancer patients and to analyze the correlations between gene expressions.Immunohisto-chemistry(IHC)was performed to detect the expression of TGF-β1 in esophageal cancer tissues.Flow cytometry and en-zyme-linked immunosorbent assay(ELISA)were used to measure PD-1,IFN-γ and TNF-α expression in CD8+T cells fol-lowing treatment with a TGF-β1 inhibitor.RESULTS:Compared with early-stage(stage I)esophageal cancer patients,the patients with advanced disease(stages Ⅱ to Ⅳ)exhibited dynamic changes in the infiltration of CD4+T cells,CD8+T cells,Tregs,and M2-TAMs within tumor tissues,with significant correlations observed among these cell populations(P<0.05).The distribution of M2-TAMs and Tregs was positively correlated with poor prognosis(P<0.05),while that of CD8+T cells was negatively correlated(P<0.05).In contrast,CD4+T cell infiltration showed no significant association with clinical outcomes(P>0.05).Co-culture of CD8+T cells with M2-TAMs resulted in significant downregulation of CD107a,granzyme B,IFN-γ and TNF-α expression(P<0.01).Additionally,M2-TAM-treated CD8+T cells co-cultured with esophageal cancer cells led to reduced apoptosis of cancer cells.High expression of PDCD1 was significantly associated with poor prognosis(P<0.05),and significant correlations were observed between CD8A and PDCD1 expression,as well as between TGF-β1 and CD274 gene expression(P<0.01).TGF-β1 was also significantly associated with CD163+macro-phage infiltration and the progression of esophageal cancer(P<0.05).Treatment with a TGF-β1 inhibitor in the M2-TAM and CD8+T cell co-culture system significantly down-regulated PD-1 expression and increased the secretion of IFN-γ and TNF-α(P<0.01).CONCLUSION:The TGF-β1 derived from M2-TAMs inhibits the antitumor activity of CD8+T cells in the esophageal cancer microenvironment,suggesting potential therapeutic targets for overcoming immunosuppression in esophageal cancer.

Objective:To compare the analgesic effect of femoral triangle block and adductor canal block after total knee arthroplasty.Methods:Clinical studies comparing the analgesic efficacy of femoral triangle block and adductor canal block after total knee arthroplasty were retrieved from CNKI, Wanfang Data Knowledge Service Platform, VIP, Chinese Medical Journal Full-text Database, PubMed, Embase, and the Cochrane Library, with the retrieval time ranging from the establishment of the databases to October 2024. Data on knee pain scores, morphine consumption, quadriceps muscle strength, postoperative timed up-and-go test (TUGT), and postoperative complications were extracted. The modified Jadad scale was used to evaluate the methodological quality of the included literature. Meta-analysis was performed using Stata 18.0 statistical software.Results:A total of 670 patients from 9 randomized controlled trials were included in the meta-analysis. There were 333 patients in the femoral triangle block group, with an average age of 60.6-72.3 years, and there were 337 patients in the adductor canal block group, with an average age of 61.7-73.5 years. All the 7 English articles were of high quality, and the modified Jadad score was 6-7 points. Two Chinese articles were of low quality and the modified Jadad score was 3. The results of meta-analysis showed that there were no statistically significant differences between the two groups in postoperative morphine consumption [ SMD=0.13, 95% CI(-0.45, 0.71), P=0.658], postoperative 24h knee resting pain score [ SMD=-0.35, 95% CI(-1.48, 0.78), P=0.545], postoperative 48h knee resting pain score [ SMD=-0.56, 95% CI(-1.71, 0.60), P=0.347], postoperative 24h TUGT [ SMD=0.01, 95% CI(-0.27, 0.30), P=0.933], postoperative 48h TUGT [ SMD=0.04, 95% CI(-0.61, 0.69), P=0.905], and incidence of postoperative complications [ RR=1.17, 95% CI(0.56, 2.45), P=0.669]. The quadriceps strength of the adductor canal block group was greater than that of the femoral triangle block group at 24 h after operation, and the difference was statistically significant [ WMD=-0.73, 95% CI(-0.93, -0.53), P<0.001]. Conclusions:Both femoral triangle block and adductor canal block can effectively relieve pain after total knee arthroplasty. Patients with adductor canal block have better muscle strength recovery in the early postoperative period.