Objective To explore the application effect of prone position ventilation combined with veno-venous extracorporeal membrane oxygenation (VV-ECMO) in the treatment of severe primary graft dysfunction (PGD) after lung transplantation. Methods The clinical data of 75 lung transplant recipients who developed severe PGD after lung transplantation and were treated with VV-ECMO from January 2021 to June 2024 at Wuxi People's Hospital Affiliated to Nanjing Medical University were collected. The patients with severe graft dysfunction after lung transplantation were divided into VV-ECMO group (control group, 45 cases) and prone position ventilation combined with VV-ECMO group (treatment group, 30 cases). The general data of the two groups of patients were compared, including the donors' clinical data (age, gender and oxygenation index, etc) and the recipients' clinical data [gender, age and body mass index (BMI), etc]. Cox regression analysis was used to analyze the influencing factors of the recipients' 30-day, 90-day and 180-day survival after surgery. The survival curves of the two groups of recipients were drawn using Kaplan-Meier method and compared using the log-rank test. Results The intensive care unit (ICU) stay time, ECMO application time and ventilator use time of control group were longer than those of treatment group. The proportion of male recipients and the BMI of control group were lower than those of treatment group. The 30-day, 90-day and 180-day survival of control group was worse than that of treatment group, and the differences were statistically significant (all P<0.05). The univariate Cox regression analysis of the recipients' 30-day survival after surgery showed that the recipients' BMI, history of diabetes, enlargement of the right atrium and right ventricle, intraoperative blood transfusion volume and intraoperative red blood cell transfusion volume were statistically significant (all P<0.05). The multivariate Cox regression analysis showed that the history of diabetes and enlargement of the right atrium and right ventricle were risk factors affecting the 30-day survival of lung transplant recipients (all P<0.05). The univariate Cox regression analysis of the recipients' 90-day survival after surgery showed that the recipients' BMI, history of diabetes, enlargement of the right atrium and right ventricle, intraoperative blood transfusion volume, intraoperative red blood cell transfusion volume and group variable were statistically significant (all P<0.05). The multivariate Cox regression analysis showed that the history of diabetes, enlargement of the right atrium and right ventricle and group variable were risk factors affecting the 90-day survival of lung transplant recipients (all P<0.05). The univariate Cox regression analysis of the recipients' 180-day survival after surgery showed that the recipients' BMI, history of diabetes, right atrium and right ventricle enlargement, intraoperative blood transfusion volume, intraoperative red blood cell transfusion volume and group variable were statistically significant (all P<0.05). The multivariate Cox regression analysis showed that the history of diabetes, enlargement of the right atrium and right ventricle and group variable were risk factors affecting the 180-day survival of lung transplant recipients (all P<0.05). The 30-day, 90-day and 180-day survival rates of control group were lower, and the differences between the two groups were statistically significant (all P<0.05), with a median survival time of 100 days in control group. Conclusions In the clinical treatment of severe PGD after lung transplantation, prone position ventilation combined with VV-ECMO may shorten ECMO application time, invasive ventilation time and ICU stay time, and improve the short-term prognosis of lung transplantation.

[Objective] To establish a new scoring system to predict the perioperative outcomes (operation time, intraoperative blood loss, and trifecta achievement) in patients undergoing robot-assisted partial nephrectomy (RAPN) by integrating the RENAL and Mayo adhesive probability (MAP) scores. [Methods] Clinical data of 178 patients with renal cell carcinoma who underwent RAPN performed by the same surgeon in our hospital during Jan.2015 and Jan.2022 were retrospectively analyzed.The RENAL and MAP scores of all patients were calculated.Linear regression and logistic regression were used to evaluate the associations between the components of the RENAL and MAP scores (a total of 6 variables) and perioperative outcomes.The factors with significant associations were then included into logistic regression analysis to identify independent predictors for constructing an assessment system for perioperative outcomes, and the receiver operating characteristic (ROC) curve was plotted to calculate the area under the curve (AUC) to predict its efficacy. [Results] Multivariate linear regression analysis showed that tumor size (β=6.14, 95%CI: 1.93—10.34, P=0.004), exophytic rate (β=10.60, 95%CI: 3.44—17.76, P=0.004), and perinephric fat thickness (β=16.48, 95%CI: 8.52—24.45, P<0.001) were significantly associated with operation time.Tumor size (β=10.55 95%CI: 5.60—15.49, P<0.001) was associated with both intraoperative blood loss and trifecta achievement (OR=1.73, 95%CI: 1.26—2.36, P=0.001). Multivariate logistic regression analysis of these 3 factors identified tumor size (OR=9.07, 95% CI: 1.18—69.45, P=0.03) and perinephric fat thickness (OR=2.28, 95%CI: 1.86—6.04, P=0.01) as independent predictors of perioperative outcomes.Based on these findings, the tumor size and perinephric fat thickness (RP) scoring was constructed, which demonstrated better predictive ability than RENAL score or MAP score alone (RP vs.RENAL vs.MAP: 0.766 vs.0.548 vs.0.684). [Conclusion] The RP score includes fewer variables than the RENAL and MAP scores but outperforms them.

Objective:To analyze the differentially expressed messenger RNA(mRNA), microRNA(miRNA), and long non-coding RNA(lncRNA)during the browning of mouse subcutaneous adipose tissue, construct a competitive endogenous RNA(ceRNA)network, and provide a theoretical basis for investigating the regulatory mechanisms of white adipose tissue browning.Methods:A cold-stimulated mouse model was established for transcriptome sequencing.Bioinformatics tools were employed to screen for differentially expressed mRNAs, miRNAs, and lncRNAs.An integrated mRNA-miRNA-lncRNA analysis was performed to construct a ceRNA network.Gene Ontology(GO), Kyoto Encyclopedia of Genes and Genomes(KEGG), and Gene Set Enrichment Analysis(GSEA)were conducted on the differentially expressed mRNAs and ceRNA networks to explore transcriptional regulation during the cold-induced browning of subcutaneous adipose tissue.Results:Transcriptomic analysis of the cold-stimulated model identified 4, 256 differentially expressed RNAs, which include 3, 600 mRNAs, 588 lncRNAs, and 68 miRNAs.GO and KEGG analyses revealed that the browning of white adipose tissue involves immune-related processes, such as immune system processes, immune responses, adaptive and innate immune responses, and the positive regulation of T-cell activation.A ceRNA network associated with browning regulation was constructed, comprising 233 nodes(188 mRNAs, 34 miRNAs, and 11 lncRNAs)and 351 edges.Protein-protein interaction(PPI)analysis of the mRNAs within the ceRNA network highlighted pathways including apoptosis, intracellular signaling transduction, hypoxia-inducible factor-1(HIF-1), AMP-activated protein kinase(AMPK), Janus kinase-signal transducer and activators of transcription(JAK-STAT)signaling, carbon metabolism, glycolysis, and thyroid hormone pathways, all of which regulate lipid metabolism, hypoxia, and glycolysis.Cytohubba analysis identified the top 10 hub genes: Bcl2, Src, Cebpb, Creb1, Runx1, Foxo3, Ets1, Socs3, Slc2 a4, and Pkm. Conclusions:The ceRNA network that regulates the browning of white adipose tissue is involved in various pathways, including carbon metabolism, glycolysis, thyroid hormone signaling, growth hormone signaling, prolactin signaling, as well as the HIF-1, AMPK, and JAK-STAT pathways.Key regulatory miRNAs in this context include miR-30e-5p, miR-182-5p, miR-20b-5p, miR-144-3p, miR-363-3p, miR-141-3p, miR-203-3p, and miR-107-3p.These miRNAs may serve as critical targets for inducing browning in response to cold exposure.

Objective:To explore the dynamic effects of venous sinus stenting (VSS) implantation on the optic nerve structure and visual function in patients with idiopathic intracranial hypertension (IIH).Methods:Patients with IIH combined with venous sinus stenosis and optic disc edema who were admitted to the Beijing Tiantan Hospital and received VSS treatment from January 2019 to September 2023 were prospectively included. Before the operation, the general data of the patients were collected and lumbar puncture examination was performed to measure the cerebrospinal fluid pressure. Ophthalmic multimodal imaging examinations such as binocular best corrected visual acuity (BCVA), optic disc stereoscopic photography, visual field, and optical coherence tomography (OCT) were performed respectively before the operation, 3 months and 6 months after the operation. The BCVA of both eyes, the Frisén grade (FPG) of optic disc edema, the mean defect (MD) value of the visual field, the thickness of the retinal nerve fiber layer (RNFL) around the optic disc and the thickness of the optic ganglion cell complex (GCC) were collected respectively. The eye with poor preoperative visual field MD value was defined as the study eye, and the other eye was the contralateral eye. The Friedman rank sum test was used to statistically analyze the differences of various indicators before the operation, 3 months after the operation and 6 months after the operation. Further, the Wilcoxon signed rank test was used to pairwise compare the results at the three time points.Results:A total of 72 patients with IIH who met the criteria were included, among whom 61 were female (84.7%), and the baseline optic disc edema Frisén grade was 3(2-4). The FPG, BCVA, MD values and RNFL thickness of the study eye and the contralateral eye at 3 and 6 months after the operation were significantly improved compared with those before the operation (all P<0.017). At 6 months after the operation, the FPG, BCVA, MD value, RNFL thickness of the study eye and the FPG and RNFL thickness of the contralateral eye were further improved compared with those at 3 months, and the differences were statistically significant (all P<0.017). During the treatment and follow-up period, no serious adverse reactions occurred in all patients. Conclusions:VSS can effectively improve papillary edema and visual function impairment in patients with IIH combined with venous sinus stenosis. Ophthalmic multimodal imaging examination provides an objective basis for preoperative assessment of optic nerve structure and visual function, postoperative efficacy monitoring and visual function recovery, etc. In the diagnosis and treatment process of IIH, the collaborative cooperation between the neurology department and the ophthalmology department is very important.

Objective:To explore the dynamic effects of venous sinus stenting (VSS) implantation on the optic nerve structure and visual function in patients with idiopathic intracranial hypertension (IIH).Methods:Patients with IIH combined with venous sinus stenosis and optic disc edema who were admitted to the Beijing Tiantan Hospital and received VSS treatment from January 2019 to September 2023 were prospectively included. Before the operation, the general data of the patients were collected and lumbar puncture examination was performed to measure the cerebrospinal fluid pressure. Ophthalmic multimodal imaging examinations such as binocular best corrected visual acuity (BCVA), optic disc stereoscopic photography, visual field, and optical coherence tomography (OCT) were performed respectively before the operation, 3 months and 6 months after the operation. The BCVA of both eyes, the Frisén grade (FPG) of optic disc edema, the mean defect (MD) value of the visual field, the thickness of the retinal nerve fiber layer (RNFL) around the optic disc and the thickness of the optic ganglion cell complex (GCC) were collected respectively. The eye with poor preoperative visual field MD value was defined as the study eye, and the other eye was the contralateral eye. The Friedman rank sum test was used to statistically analyze the differences of various indicators before the operation, 3 months after the operation and 6 months after the operation. Further, the Wilcoxon signed rank test was used to pairwise compare the results at the three time points.Results:A total of 72 patients with IIH who met the criteria were included, among whom 61 were female (84.7%), and the baseline optic disc edema Frisén grade was 3(2-4). The FPG, BCVA, MD values and RNFL thickness of the study eye and the contralateral eye at 3 and 6 months after the operation were significantly improved compared with those before the operation (all P<0.017). At 6 months after the operation, the FPG, BCVA, MD value, RNFL thickness of the study eye and the FPG and RNFL thickness of the contralateral eye were further improved compared with those at 3 months, and the differences were statistically significant (all P<0.017). During the treatment and follow-up period, no serious adverse reactions occurred in all patients. Conclusions:VSS can effectively improve papillary edema and visual function impairment in patients with IIH combined with venous sinus stenosis. Ophthalmic multimodal imaging examination provides an objective basis for preoperative assessment of optic nerve structure and visual function, postoperative efficacy monitoring and visual function recovery, etc. In the diagnosis and treatment process of IIH, the collaborative cooperation between the neurology department and the ophthalmology department is very important.

Objective:To analyze the differentially expressed messenger RNA(mRNA), microRNA(miRNA), and long non-coding RNA(lncRNA)during the browning of mouse subcutaneous adipose tissue, construct a competitive endogenous RNA(ceRNA)network, and provide a theoretical basis for investigating the regulatory mechanisms of white adipose tissue browning.Methods:A cold-stimulated mouse model was established for transcriptome sequencing.Bioinformatics tools were employed to screen for differentially expressed mRNAs, miRNAs, and lncRNAs.An integrated mRNA-miRNA-lncRNA analysis was performed to construct a ceRNA network.Gene Ontology(GO), Kyoto Encyclopedia of Genes and Genomes(KEGG), and Gene Set Enrichment Analysis(GSEA)were conducted on the differentially expressed mRNAs and ceRNA networks to explore transcriptional regulation during the cold-induced browning of subcutaneous adipose tissue.Results:Transcriptomic analysis of the cold-stimulated model identified 4, 256 differentially expressed RNAs, which include 3, 600 mRNAs, 588 lncRNAs, and 68 miRNAs.GO and KEGG analyses revealed that the browning of white adipose tissue involves immune-related processes, such as immune system processes, immune responses, adaptive and innate immune responses, and the positive regulation of T-cell activation.A ceRNA network associated with browning regulation was constructed, comprising 233 nodes(188 mRNAs, 34 miRNAs, and 11 lncRNAs)and 351 edges.Protein-protein interaction(PPI)analysis of the mRNAs within the ceRNA network highlighted pathways including apoptosis, intracellular signaling transduction, hypoxia-inducible factor-1(HIF-1), AMP-activated protein kinase(AMPK), Janus kinase-signal transducer and activators of transcription(JAK-STAT)signaling, carbon metabolism, glycolysis, and thyroid hormone pathways, all of which regulate lipid metabolism, hypoxia, and glycolysis.Cytohubba analysis identified the top 10 hub genes: Bcl2, Src, Cebpb, Creb1, Runx1, Foxo3, Ets1, Socs3, Slc2 a4, and Pkm. Conclusions:The ceRNA network that regulates the browning of white adipose tissue is involved in various pathways, including carbon metabolism, glycolysis, thyroid hormone signaling, growth hormone signaling, prolactin signaling, as well as the HIF-1, AMPK, and JAK-STAT pathways.Key regulatory miRNAs in this context include miR-30e-5p, miR-182-5p, miR-20b-5p, miR-144-3p, miR-363-3p, miR-141-3p, miR-203-3p, and miR-107-3p.These miRNAs may serve as critical targets for inducing browning in response to cold exposure.

Objective: Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology associated with venous sinus stenosis. This study aimed to develop a magnetic resonance venography (MRV)-based radiomics model for predicting a high trans-stenotic pressure gradient (TPG) in IIH patients diagnosed with venous sinus stenosis. Materials and Methods: This retrospective study included 105 IIH patients (median age [interquartile range], 35 years [27– 42 years]; female:male, 82:23) who underwent MRV and catheter venography complemented by venous manometry. Contrast enhanced-MRV was conducted under 1.5 Tesla system, and the images were reconstructed using a standard algorithm. Shape features were derived from MRV images via the PyRadiomics package and selected by utilizing the least absolute shrinkage and selection operator (LASSO) method. A radiomics score for predicting high TPG (≥ 8 mmHg) in IIH patients was formulated using multivariable logistic regression; its discrimination performance was assessed using the area under the receiver operating characteristic curve (AUROC). A nomogram was constructed by incorporating the radiomics scores and clinical features. Results: Data from 105 patients were randomly divided into two distinct datasets for model training (n = 73; 50 and 23 with and without high TPG, respectively) and testing (n = 32; 22 and 10 with and without high TPG, respectively). Three informative shape features were identified in the training datasets: least axis length, sphericity, and maximum three-dimensional diameter.The radiomics score for predicting high TPG in IIH patients demonstrated an AUROC of 0.906 (95% confidence interval, 0.836– 0.976) in the training dataset and 0.877 (95% confidence interval, 0.755–0.999) in the test dataset. The nomogram showed good calibration. Conclusion Our study presents the feasibility of a novel model for predicting high TPG in IIH patients using radiomics analysis of noninvasive MRV-based shape features. This information may aid clinicians in identifying patients who may benefit from stenting.

Objective To investigate the value of serum amyloid A4(SAA4)and suppressor of cytokine signaling 1(SOCS1)in the early differential diagnosis of spinal tuberculosis(STB)and pyogenic spondylitis(PS).Methods The clinical information from STB patients(STB group,n=62)and PS patients(PS group,n=52)who visited the First Affiliated Hospital of Xinxiang Medical College from January 2019 to June 2021 were collected,and anoth-er 50 healthy individuals from examinations clinic in the same period were taken as the control group.Enzyme linked immunosorbent assay(ELISA)was applied to measure the expression of serum SAA4 and SOCS1;Logistic regression was applied to analyze the influencing factors of identifying STB and PS;Receiver operating characteristic(ROC)curve was applied to analyze the differential value of serum SAA4 and SOCS1 for STB and PS.Results Compared with the control group,serum SAA4 level was increased and SOCS1 level decreased in patients from STB and PS groups(P＜0.05),while the level of SAA4 and SOCS1 in the STB group was higher than those in the PS group(P＜0.05);Logistic regression analysis showed that serum SAA4,and SOCS1 were predictive fac-tors for distinguishing STB from PS(P＜0.05);ROC curve results showed that the area under the curve(AUC)of SAA4 and SOCS1 for distinguishing STB and PS separately was 0.833 and 0.872 with sensitivity of 75.8%and 75.8%and specificity as 65.1%and 66.9%respectively.The AUC of the combination of STB and PS was 0.947,with sensitivity and specificity of 88.7%and 78.0%respectively and the AUC identified by the combination of the two was obviously higher than that identified by SAA4 and SOCS1 alone(Z=2.683,2.015,P＜0.05).Conclusions The serum levels of SAA4 and SOCS1 in STB patients are significantly higher than those in PS patients and both can be used as early differential indicators for STB and PS.Combined measurement can improve the effectiveness of differential diagnosis.

Objective To investigate the impact of type 2 inflammation markers blood eosinophils(EOS)and fractional exhaled nitric oxide(FeNO)on bronchodilator responsiveness(BDR)in patients with chronic obstructive pulmonary disease(COPD).Methods This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October,2019 to October,2023,who all underwent bronchial dilation test(BDT)of the large and small airways.Based on smoking history,blood EOS,and FeNO,these patients were divided group A(blood EOS<300/μL+FeNO<35 ppb+smoking history<20 pack-years),group B(blood EOS<300/μL+FeNO<35 ppb+smoking history≥20 pack-years),group C(blood EOS≥300/μL or FeNO≥35 ppb+smoking history≥20 pack-years),and group D(blood EOS≥300/μL or FeNO≥35 ppb+smoking history<20 pack-years)for analyzing the relationship between clinical indexes and BDR.Results BDR evaluation based on forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and maximum mid-expiratory flow(MMEF)yielded consistent results,all showing a younger mean age,higher FeNO levels,and higher blood EOS counts and percentages in patients positive for BDT(P<0.05).The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D.The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D.In the overall patients,age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF(P<0.05).Conclusion Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients,and their clinical significance needs further investigation.

Objective To investigate the impact of type 2 inflammation markers blood eosinophils(EOS)and fractional exhaled nitric oxide(FeNO)on bronchodilator responsiveness(BDR)in patients with chronic obstructive pulmonary disease(COPD).Methods This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October,2019 to October,2023,who all underwent bronchial dilation test(BDT)of the large and small airways.Based on smoking history,blood EOS,and FeNO,these patients were divided group A(blood EOS<300/μL+FeNO<35 ppb+smoking history<20 pack-years),group B(blood EOS<300/μL+FeNO<35 ppb+smoking history≥20 pack-years),group C(blood EOS≥300/μL or FeNO≥35 ppb+smoking history≥20 pack-years),and group D(blood EOS≥300/μL or FeNO≥35 ppb+smoking history<20 pack-years)for analyzing the relationship between clinical indexes and BDR.Results BDR evaluation based on forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and maximum mid-expiratory flow(MMEF)yielded consistent results,all showing a younger mean age,higher FeNO levels,and higher blood EOS counts and percentages in patients positive for BDT(P<0.05).The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D.The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D.In the overall patients,age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF(P<0.05).Conclusion Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients,and their clinical significance needs further investigation.