Objective:To investigate the incidence and risk factors associated with poor healing in closed drainage incisions among elderly lung cancer patients(aged ≥65 years)undergoing thoracoscopic pulmonary resection.Methods:A retrospective cohort study was conducted involving 471 elderly lung cancer patients who underwent single utility port video-assisted thoracic surgery(VATS)pulmonary resection at Beijing Hospital from January 1, 2022, to December 31, 2023.Patients were categorized into'healed’and'poor healing’groups based on the development of grade B/C healing following the removal of the closed drainage tube.A comparative analysis of demographic characteristics, medical history, and perioperative parameters between the groups was performed.Multivariate logistic regression analysis was employed to identify independent risk factors for poor incision healing.Results:A total of 471 elderly lung cancer patients who underwent VATS lobectomy were enrolled, with a mean age of 71.16 ± 3.44 years. Among them, 200(42.46%)were male and 271(57.54%)were female.Among 471 patients, 101(21.44%)developed poor healing, all classified as grade B. Univariate analysis revealed statistically significant differences between the two groups regarding BMI( χ2=1.632, P=0.004), diabetes mellitus( χ2=1.558, P=0.004), prolonged drainage duration ( χ2=1.829, P=0.002), and the extent of pulmonary resection( χ2=2.571, P=0.042).Multivariate logistic regression analysis indicated that a BMI of ≥24 kg/m 2( OR=1.534, 95% CI: 1.191-3.289, P=0.033), drainage tube indwelling time exceeding 4 days postoperatively( OR=1.712, 95% CI: 1.014-3.791, P=0.036), and diabetes mellitus( OR=1.855, 95% CI: 1.418-4.015, P=0.002)were significant factors influencing poor wound healing, with statistically significant differences noted( P<0.05). Conclusions:BMI, prolonged drainage duration, diabetes mellitus, and the extent of pulmonary resection are independent risk factors for poor healing of closed drainage incisions in elderly lung cancer patients following VATS.Clinical strategies should prioritize the control of BMI, perioperative glycemic management, real-time monitoring of drainage, and timely removal of tubes to mitigate complications.

A bladder cancer patient underwent intravesical Bacillus Calmette-Guérin (BCG) instillation in Xiamen Branch, Zhongshan Hospital, Fudan University in April 2023. Following 8 instillations the patient presented with fever, cough and dyspnea, and was diagnosed as interstitial pneumonia (IP). Symptoms resolved after anti-tuberculosis and methylprednisolone treatment, with subsequent successful discharge. Using the keywords ′Bacillus Calmette-Guérin, ′ ′intravesical instillation, ′ ′pneumonia, ′ Wanfang Data, China National Knowledge Infrastructure(CNKI), Weipu(VIP), and PubMed databases were searched for relevant literature published between January 2014 and June 2024, and 20 cases of BCG instillation-induced pneumonia were retrieved, including 10 IP cases and 10 miliary pneumonia cases. Among 10 IP cases, 7 received corticosteroids combined with anti-tuberculosis therapy. Two cases unresponsive to combination therapy resulted in mortality, while others showed therapeutic efficacy. Miliary pneumonia demonstrated better prognosis, with 6 cases achieving complete remission through anti-tuberculosis monotherapy. The results indicate that severe BCG-related pneumonia generally necessitates combined anti-tuberculosis and corticosteroid therapy.

Portal hypertensive biliopathy is a secondary condition of intrahepatic and extrahepatic bile duct abnormalities caused by portal hypertension, especially in extrahepatic portal venous obstruction. Most patients may remain asymptomatic for a long time, while a few may present with symptomatic portal hypertensive biliopathy, such as obstructive jaundice, cholelithiasis with or without cholangitis, gastrointestinal bleeding, and others. Such disease is rare in clinical practice and is prone to misdiagnosis and missed diagnosis. Improper treatment can lead to serious adverse consequences. We report a case of unexpected discovery of bile duct dilation due to abdominal pain, which was ultimately diagnosed as portal hypertensive biliopathy based on the medical history, manifestations of portal hypertension, and imaging examinations, especially intraductal ultrasonography.

Malignant tumor metastasis is the key factor leading to poor prognosis of patients， and it is a difficult problem to be overcome in the field of tumor therapy. Metabolic reprogramming， as a key link in the regulation of tumor metastasis activity， affects the growth， invasion， and metastasis of tumor cells by changing the metabolic pathways of intracellular substances （such as glucose， amino acids， lipids， and nucleotides）. In particular， metabolic reprogramming plays a key role in the multistage linked steps related to tumor metastasis and can play a crucial role in several key stages of tumor tissue dissociation in situ， hematogenous metastasis， and remote colonization. Malignant tumor cells can selectively adjust their own metabolic state to adapt to the growth conditions of different metastatic microenvironments and colonization sites and then choose the most favorable growth and metabolism strategy. According to the holistic concept of traditional Chinese medicine （TCM）， the metastasis of malignant tumors is generally closely related to the metabolic state of the whole body. One of the advantages of TCM in the treatment of malignant tumors is systemic regulation. With its multi-pathway， multi-target， and multi-component therapeutic characteristics， TCM can effectively control the metastasis of malignant tumors by regulating the degradation of tumor epithelial mesenchymal transformation （EMT） and extracellular matrix （ECM）， anchoring the independent growth of tumor cells and the tumor microenvironment. In this paper， the potential regulatory effects of metabolic reprogramming on the metastasis of malignant tumors were discussed， and the latest research progress of the regulation of metabolic reprogramming by TCM on tumor metastasis was reviewed. At the same time， the key targets of TCM and its bioactive components in the process of tumor metastasis intervention were reviewed. This study aims to provide a more valuable basis and clearer idea for the treatment of malignant tumor metastasis by regulating metabolic reprogramming with TCM.

Objective:To explore the psychological vulnerability characteristics of patients after percutaneous coronary intervention (PCI) based on symptom network analysis, and to provide evidence for maintining their psychological health.Methods:Using a cross-sectional survey method, from October 2023 to March 2024, a convenience sampling approach was employed to conduct a questionnaire survey among patients who underwent percutaneous coronary intervention (PCI) in the general ward of the Cardiology Department at Peking University Third Hospital. The survey involved a general information questionnaire and Mental Vulnerability Questionnaire. The R language was used to construct a symptom network to describe the relationship between each symptom of patients′psychological vulnerability, and its centrality index was calculated.Results:A total of 260 post-PCI patients were enrolled, including191 males and 69 females, with a mean age of (62.38 ± 12.91) years and a total psychological vulnerability score of (47.25 ± 13.18). Multiple linear regression analysis showed that the level of mental vulnerability was higher in patients with female gender ( β = 0.207, P = 0.001) and higher number of comorbidities/past history ( β = 0.126, P = 0.039). In the symptom network analysis, the symptoms with the highest node strength, tight centrality, and mediator centrality were "You often feeling unwell" ( rs = 1.25, rc = 0.003 45, rb = 2.61), "You always in a bad mood" ( rs = 1.15) and "You often have anxiety attacks" ( rs = 1.13) were second only to "You often feeling unwell" in the center of intensity. Conclusions:The core symptom of psychological vulnerability in post-PCI patients is "You often feeling unwell", and mental symptoms are in a more central position. Nursing staff should take mental symptoms as the target of intervention, and strengthen the holistic care for patients′physical-psychological-mental symptoms, so as to effectively reduce the level of psychological vulnerability of the patients, and to maintain their psychological health.

Objective To investigate the correlation of SII with occurrence of short-term MI in eld-erly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with con-comitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atheroscle-rosis were risk factors for MI occurrence(OR=1.001,95％CI:1.000-1.001,P=0.001;OR=1.106,95％CI:1.016-1.203,P=0.020;OR=4.798,95％CI:2.621-8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95％CI:0.073-0.895,P=0.033;OR=0.474,95％CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P＜0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the high-level group was significantly lower than that in the low-level group(Plog rank＜0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independ-ent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.

Objective:To analyze the relationship between blood urea nitrogen (BUN)/albumin (ALB) ratio (B/A) and prognosis of patients undergoing percutaneous coronary intervention (PCI) guided by ultrasound before operation.Methods:A total of 116 patients who underwent PCI under the guidance of intra-coronary ultrasound in Xianyang Central Hospital from February 2020 to December 2022 were retrospectively selected as the observation group, and 120 healthy people in the same period were selected as the control group. All patients were followed up for 1 year after surgery, and 116 patients were divided into poor prognosis group ( n=33) and good prognosis group ( n=83), taking major adverse cardiovascular events (MACE) as the end point during follow-up. The levels of BUN and ALB in peripheral blood of all subjects were detected after admission, and B/A was calculated. The basic data, biochemical indexes and B/A of each group were analyzed and compared. The predictive value of preoperative BUN, ALB and B/A on postoperative MACE in patients with PCI guided by intra-coronary ultrasound was analyzed by receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was used to evaluate the related influencing factors of postoperative MACE in patients with PCI guided by intra-coronary ultrasound. Results:The left ventricular end-diastolic inner diameter (LVEDD), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), BUN and B/A in the observation group were higher than those in the control group, and left ventricular ejection fraction (LVEF) and ALB were lower than those in the control group (all P<0.05). NT-proBNP, CK-MB, BUN and B/A in the poor prognosis group were higher than those in the good prognosis group, and LVEF and ALB were lower than those in the good prognosis group (all P<0.05). ROC curve results showed that the AUC of peripheral blood BUN, ALB and B/A predicting postoperative MACE in patients with PCI guided by intra-coronary ultrasound were 0.833(95% CI: 0.783-0.883), 0.859(95% CI: 0.809-0.909) and 0.922(95% CI: 0.872-0.972). Multivariate logistic regression analysis showed that LVEF [ OR(95% CI)=1.952(1.317-2.895)], NT-proBNP [ OR(95% CI)=2.625(1.643-4.193)], BUN [ OR(95% CI)=3.353(1.922-5.851)], ALB [ OR(95% CI)=3.792(2.049-7.018)] and B/A [ OR(95% CI)=3.277(2.000-5.370)] were all the influencing factors of postoperative MACE in patients undergoing PCI guided by intra-coronary ultrasound ( P<0.05). Conclusions:The level of B/A in patients with PCI guided by intra-coronary ultrasound increased before surgery, and the high level of B/A is a risk factor for postoperative MACE, which can be used as a biological index to evaluate the postoperative MACE in patients with PCI guided by intra-coronary ultrasound.

Objective To investigate the correlation of SII with occurrence of short-term MI in eld-erly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with con-comitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atheroscle-rosis were risk factors for MI occurrence(OR=1.001,95％CI:1.000-1.001,P=0.001;OR=1.106,95％CI:1.016-1.203,P=0.020;OR=4.798,95％CI:2.621-8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95％CI:0.073-0.895,P=0.033;OR=0.474,95％CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P＜0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the high-level group was significantly lower than that in the low-level group(Plog rank＜0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independ-ent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.

Objective:To analyze the relationship between blood urea nitrogen (BUN)/albumin (ALB) ratio (B/A) and prognosis of patients undergoing percutaneous coronary intervention (PCI) guided by ultrasound before operation.Methods:A total of 116 patients who underwent PCI under the guidance of intra-coronary ultrasound in Xianyang Central Hospital from February 2020 to December 2022 were retrospectively selected as the observation group, and 120 healthy people in the same period were selected as the control group. All patients were followed up for 1 year after surgery, and 116 patients were divided into poor prognosis group ( n=33) and good prognosis group ( n=83), taking major adverse cardiovascular events (MACE) as the end point during follow-up. The levels of BUN and ALB in peripheral blood of all subjects were detected after admission, and B/A was calculated. The basic data, biochemical indexes and B/A of each group were analyzed and compared. The predictive value of preoperative BUN, ALB and B/A on postoperative MACE in patients with PCI guided by intra-coronary ultrasound was analyzed by receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was used to evaluate the related influencing factors of postoperative MACE in patients with PCI guided by intra-coronary ultrasound. Results:The left ventricular end-diastolic inner diameter (LVEDD), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), BUN and B/A in the observation group were higher than those in the control group, and left ventricular ejection fraction (LVEF) and ALB were lower than those in the control group (all P<0.05). NT-proBNP, CK-MB, BUN and B/A in the poor prognosis group were higher than those in the good prognosis group, and LVEF and ALB were lower than those in the good prognosis group (all P<0.05). ROC curve results showed that the AUC of peripheral blood BUN, ALB and B/A predicting postoperative MACE in patients with PCI guided by intra-coronary ultrasound were 0.833(95% CI: 0.783-0.883), 0.859(95% CI: 0.809-0.909) and 0.922(95% CI: 0.872-0.972). Multivariate logistic regression analysis showed that LVEF [ OR(95% CI)=1.952(1.317-2.895)], NT-proBNP [ OR(95% CI)=2.625(1.643-4.193)], BUN [ OR(95% CI)=3.353(1.922-5.851)], ALB [ OR(95% CI)=3.792(2.049-7.018)] and B/A [ OR(95% CI)=3.277(2.000-5.370)] were all the influencing factors of postoperative MACE in patients undergoing PCI guided by intra-coronary ultrasound ( P<0.05). Conclusions:The level of B/A in patients with PCI guided by intra-coronary ultrasound increased before surgery, and the high level of B/A is a risk factor for postoperative MACE, which can be used as a biological index to evaluate the postoperative MACE in patients with PCI guided by intra-coronary ultrasound.

Objective:To explore the psychological vulnerability characteristics of patients after percutaneous coronary intervention (PCI) based on symptom network analysis, and to provide evidence for maintining their psychological health.Methods:Using a cross-sectional survey method, from October 2023 to March 2024, a convenience sampling approach was employed to conduct a questionnaire survey among patients who underwent percutaneous coronary intervention (PCI) in the general ward of the Cardiology Department at Peking University Third Hospital. The survey involved a general information questionnaire and Mental Vulnerability Questionnaire. The R language was used to construct a symptom network to describe the relationship between each symptom of patients′psychological vulnerability, and its centrality index was calculated.Results:A total of 260 post-PCI patients were enrolled, including191 males and 69 females, with a mean age of (62.38 ± 12.91) years and a total psychological vulnerability score of (47.25 ± 13.18). Multiple linear regression analysis showed that the level of mental vulnerability was higher in patients with female gender ( β = 0.207, P = 0.001) and higher number of comorbidities/past history ( β = 0.126, P = 0.039). In the symptom network analysis, the symptoms with the highest node strength, tight centrality, and mediator centrality were "You often feeling unwell" ( rs = 1.25, rc = 0.003 45, rb = 2.61), "You always in a bad mood" ( rs = 1.15) and "You often have anxiety attacks" ( rs = 1.13) were second only to "You often feeling unwell" in the center of intensity. Conclusions:The core symptom of psychological vulnerability in post-PCI patients is "You often feeling unwell", and mental symptoms are in a more central position. Nursing staff should take mental symptoms as the target of intervention, and strengthen the holistic care for patients′physical-psychological-mental symptoms, so as to effectively reduce the level of psychological vulnerability of the patients, and to maintain their psychological health.