Objective:To explore the association between sublingual microcirculatory perfusion vessel proportion (PPV), high mobility group protein B1 (HMGB1), and sepsis-induced coagulopathy (SIC), and to identify early predictive markers for clinical intervention.Methods:A total of 66 septic patients admitted to the Respiratory Intensive Care Unit (RICU) between November 2021 and May 2024 were enrolled. Based on SIC diagnosis within 24 hours of admission, patients were categorized into SIC ( n=36) and non-SIC ( n=30) groups. Clinical parameters, including prothrombin time (PT), activated partial thromboplastin time (APTT), sublingual PPV, and serum HMGB1 levels (measured at 0 h and 6 h), were analyzed. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors. Results:Compared with the non-SIC group, the SIC group demonstrated significantly prolonged PT ( P<0.05) and APTT ( P<0.05), elevated 0 h lactate levels, and increased 6 h HMGB1. Spearman analysis revealed a positive correlation between 6 h PPV and platelet count ( P<0.05), while an inverse correlation was observed with 6 h PT ( P<0.05). Multivariate regression identified APTT, 6 h PPV, and 6 h HMGB1 as independent predictors of SIC. ROC analysis yielded AUC values of 0.732 for APTT, 0.802 for 6 h PPV, and 0.765 for 6 h HMGB1. The combination of 6 h PPV and HMGB1 further improved predictive accuracy (AUC=0.873). Conclusions:Prolonged APTT, decreased 6 h PPV, and elevated 6h HMGB1 are key indicators of SIC. Integrated assessment of these markers enhances early risk stratification in septic patients, facilitating timely clinical intervention.

Objective To investigate the relationship between serum orexin-A(OXA)and aspartate amin-otransferase(AST)levels and the disease severity and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 167 AIS patients(AIS group)treated at Hebei Provincial People's Hospital from January 2021 to January 2024 and 84 healthy individuals undergoing physical examinations(control group)were selected as the research objects.AIS patients were categorized by severity into mild AIS group[National Institutes of Health Stroke Scale(NIHSS)score＜5,42 cases],moderate AIS group(NIHSS score 5—＜16,56 cases),moderate-to-severe AIS group(NIHSS score 16—＜21,36 cases),and severe AIS group(NIHSS score ≥21,33 cases).Based on 3-month prognosis(modified Rankin scale),patients were divided into poor prognosis group(＞2 grade,54 cases)and good prognosis group(≤2 grade,113 cases).Spearman correlation analysis was used to assess the relationship between NIHSS scores and serum OXA and AST levels in AIS pa-tients.Multivariate unconditional Logistic regression was used to determine the relationship between serum OXA and AST levels and the prognosis of AIS patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum OXA and AST levels for prognosis.Results Compared with the control group,serum OXA level in the AIS group was lower,while AST level was higher(P＜0.05).Ser-um OXA level progressively decreased,and AST level progressively increased across the mild,moderate,mod-erately severe,and severe AIS groups(P＜0.05).NIHSS score was negatively correlated with serum OXA level and positively correlated with AST level in AIS patients(P＜0.05).High OXA level was an independent protective factor for poor prognosis in AIS patients,while high AST level was an independent risk factor(P＜0.05).The area under the curve(AUC)of the combined assessment of serum OXA and AST levels in predic-ting poor prognosis in AIS patients was 0.873,which was greater than the AUC of OXA(0.793)and AST(0.770)alone(P＜0.05).Conclusion In AIS patients,lower serum OXA level and higher AST level are as-sociated with disease severity and poor prognosis.The combined evaluation of serum OXA and AST levels has higher predictive value for AIS prognosis.

Colorectal cancer stands as a leading cause of cancer-related morbidity and mortality globally,with liver metastases being a significant determinant of patient prognosis.Conventional diagnostic methods,includ-ing imaging studies and biomarker testing,frequently exhibit inadequate sensitivity and specificity,underscoring the necessity for more advanced technologies.Recent advancements in genomics,transcriptomics,proteomics,me-tabolomics,and epigenomics have revolutionized our understanding of the biological mechanisms driving colorectal cancer.These methodologies enable comprehensive analyses of genetic mutations,gene expression profiles,protein modifications,and metabolic reprogramming,all of which are pivotal to the metastatic process.This article high-lights the advanced capabilities of artificial intelligence(AI)technologies in processing complex multi-omics data,thereby enhancing diagnostic accuracy and supporting personalized treatment strategies.It also addresses the challenges AI encounters in multi-omics analyses,such as ensuring data quality,improving model interpretability,and facilitating clinical translation.Additionally,it explores the potential integration of emerging technologies like single-cell sequencing and spatial omics into large-scale,multicenter studies to further enhance the clinical utility of these tools.

Objective To compare and find an optimal model for predicting the risk of DKD occurrence in patients with type 2 diabetes mellitus(T2DM).Methods A total of 2005 patients with T2DM were enrolled in this study from The Second Hospital of Shijiazhuang City during December 2017 to December 2022.All the subjects were divided into a training set(n=1403)and a validation set(n=602)according to the ratio of 3∶1 by simple random sampling.With the occurrence of DKD as the outcome variablein the training set,important feature variables were screened by LASSO regression.Six different machine learning models were established according to the feature variables,thenthe optimal model was determined by comparison,and anonlinerisk predictor for DKD occurrence was constructed in patients with T2DM.Results Taking the occurrence of DKD as the outcome variable in the training set,the results of LASSO regression analysis showed that the optimal value of the model was 10-fold cross validation lambda.1se=0.01662473,and 15 characteristic variables with nonzero coefficient were screened out to be related to the occurrence of DKD.The data included sex,age,family history of DM,DM duration,LDL-C,HbA1c,WBC,PDW,Scr,urine α1-microglobulin,urine β2-microglobulin,urine microalbumin,hypertension,hypokalemia,and DR.In the training set and validation set,the prediction performance of XGBoost model was better than that of other models(AUC=0.872,0.893,95%CI 0.853～0.891,0.865～0.921),the sensitivity was 0.779,0.863,and the specificity was 0.721,0.758,respectively.The F1 scores were 0.774 and 0.787.DCA analysis showed that the XGBoost model had a greater net benefit and threshold probability.According to the XGBoost model,the online predictor of DKD risk in T2DM patients was laid out,and two patients were selected for application,the results showed that the predictive value of the model was 0.185 in non-DKD patients,and the predictive value was 0.510 in DKD patients.Conclusions The XGBoost model is the best model for predicting the occurrence of DKD in T2DM patients,and an online predictor was successfully built.

Hypercholesterolemia is a significant risk factor for the development of atherosclerosis. 2',3',5'-Tri-O-acetyl-N ⁶-(3-hydroxyphenyl) adenosine (IMM-H007), a novel AMPK agonist, has shown protective effects in metabolic diseases. However, its impact on cholesterol and triglyceride metabolism in hypercholesterolemia remains unclear. In this study, we aimed to elucidate the effects and specific mechanisms by which IMM-H007 regulates cholesterol and triglyceride metabolism. To achieve this goal, we used Apoe ^-/- and Ldlr ^-/- mice to establish a hypercholesterolemia/atherosclerosis model. Additionally, hepatocyte-specific Ampka1/2 knockout mice were subjected to a 5-week high-cholesterol diet to establish hypercholesterolemia, while atherosclerosis was induced via AAV-PCSK9 injection combined with a 16-week high-cholesterol diet. Our results demonstrated that IMM-H007 improved cholesterol and triglyceride metabolism in mice with hypercholesterolemia. Mechanistically, IMM-H007 modulated the AMPKα1/2-LDLR signaling pathway, increasing cholesterol uptake in the liver. Furthermore, IMM-H007 activated the AMPKα1-FXR pathway, promoting the conversion of hepatic cholesterol to bile acids. Additionally, IMM-H007 prevented hepatic steatosis by activating the AMPKα1/2-ATGL pathway. In conclusion, our study suggests that IMM-H007 is a promising therapeutic agent for improving hypercholesterolemia and atherosclerosis through the activation of AMPKα.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Numerous c-mesenchymal-epithelial transition (c-MET) inhibitors have been reported as potential anticancer agents. However, most fail to enter clinical trials owing to poor efficacy or drug resistance. To date, the scaffold-based chemical space of small-molecule c-MET inhibitors has not been analyzed. In this study, we constructed the largest c-MET dataset, which included 2,278 molecules with different structures, by inhibiting the half maximal inhibitory concentration (IC₅₀) of kinase activity. No significant differences in drug-like properties were observed between active molecules (1,228) and inactive molecules (1,050), including chemical space coverage, physicochemical properties, and absorption, distribution, metabolism, excretion, and toxicity (ADMET) profiles. The higher chemical diversity of the active molecules was downscaled using t-distributed stochastic neighbor embedding (t-SNE) high-dimensional data. Further clustering and chemical space networks (CSNs) analyses revealed commonly used scaffolds for c-MET inhibitors, such as M5, M7, and M8. Activity cliffs and structural alerts were used to reveal "dead ends" and "safe bets" for c-MET, as well as dominant structural fragments consisting of pyridazinones, triazoles, and pyrazines. Finally, the decision tree model precisely indicated the key structural features required to constitute active c-MET inhibitor molecules, including at least three aromatic heterocycles, five aromatic nitrogen atoms, and eight nitrogen-oxygen atoms. Overall, our analyses revealed potential structure-activity relationship (SAR) patterns for c-MET inhibitors, which can inform the screening of new compounds and guide future optimization efforts.

Objective To evaluate the impact of intensified infection control measures on the incidence of health-care-associated infection(HAI)under the background of the reform of diagnosis-intervention packet(DIP)payment,and provide decision-making basis for HAI management under the reform of medical insurance payment.Methods The interrupted time series research design was used to collect the monitoring data of HAI in a tertiary first-class hospital from October 2021 to September 2024.The changing trend of HAI incidence was analyzed by piecewise li-near regression,and the intervention effect was evaluated by standardized infection ratio(SIR).Results From Oc-tober 2021 to September 2022,the incidence of HAI was 2.17％(95％CI:2.08％-2.26％),which dropped to 1.87％(95％CI:1.82％-1.92％)after the intervention.Piecewise linear regression analysis showed that the inci-dence of HAI decreased by 0.324％immediately after the intervention(95％CI:-0.481％--0.167％,P＜0.001),and the trend after the intervention changed significantly compared with that before the intervention(95％CI:-0.033％--0.009％,P=0.001).SIR analysis showed that the actual incidence during the entire intervention period was equivalent to 74.56％of the incidence in intervention period,gradually stabilized from 88.39％-93.81％at the beginning of the intervention to 67.03％-71.22％at the end of the study,and the intervention effect was sustained.Conclusion Intensified infection control measures under the background of the reform of DIP significantly reduce the incidence of HAI and improve the stability of infection control management,which provide new insights into the synergistic improvement of medical insurance payment and HAI management quality.

Objective To investigate the influence of different disinfectants on the ultrasound-guided internal jugular vein puncture and adhesive application.Methods A total of 102 emergency patients with traumatic hemorrhage who underwent ultrasound-guided internal jugular vein puncture and catheterization were selected as the study subjects and randomly divided into the iodine group(51 cases)and the chlorhexidine-alcohol group(51 cases).Iodophor(0.5%effective iodine)and 2.0%chlorhexidine gluconate+70.0%ethanol were used for disinfection before puncture,respectively.The disinfection effect of the puncture site,puncture condition,ultrasound imaging,and adhesive force of the application of patients were statistically compared between the two groups.Results There was no significant difference in the bacterial count before disinfection,the bacterial count after disinfection or the qualified rate of disinfection at the puncture site of patients between the two groups(P>0.05).There were significant differences in the success rate of one-time puncture,the number of puncture and the time of puncture and catheterization between the two groups(P<0.05).There were significant differences in the rate of clear ultrasound images,adhesive force and rate of warping or shedding of the application between the two groups(P<0.05).Conclusion For emergency patients with traumatic hemorrhage,using iodophor(0.5%effective iodine)and 2.0%chlorhexidine gluconate+70.0%ethanol disinfection before ultrasound-guided internal jugular vein puncture can achieve good disinfection effects.Iodine disinfection can obtain clearer ultrasound images and a higher success rate of one-time puncture,but the adhesive force of the application is poor,making it prone to warping or shedding.

OBJECTIVE: To compare the clinical efficacy of acupuncture with yin-yang regulation method versus local acupuncture in treating chronic low back pain (CLBP) in elderly patients with lumbar disc herniation (LDH), and to evaluate the changes in the multifidus muscle before and after treatment using musculoskeletal ultrasound. METHODS: A total of 128 elderly patients with CLBP due to LDH were randomly assigned to an observation group (64 cases, 2 cases dropped out) and a control group (64 cases, 2 cases dropped out). The control group received local acupuncture at bilateral L₃-L₅ Jiaji points (EX-B2), Shenshu (BL23), Dachangshu (BL25), Weizhong (BL40), Yaoyangguan (GV3), and ashi points. The observation group received acupuncture with yin-yang regulation method, which included an abdominal protocol with Baihui (GV20), Zhongwan (CV12), Qihai (CV6), Guanyuan (CV4), bilateral Tianshu (ST25), and Dahe (KI12), etc., and a lumbar protocol with Baihui (GV20), Dazhui (GV14), Jizhong (GV6), Yaoyangguan (GV3), and ashi points, etc., alternated bilaterally. Both groups were treated once every other day, three times per week, for a total of 12 sessions. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and the indexs of musculoskeletal ultrasound multifidus muscle (resting and functional thickness and Young's modulus values) were observed before and after treatment, and the clinical efficacy was evaluated in the two groups. RESULTS: After 1 and 4 weeks of treatment, both groups showed lower VAS scores compared to baseline (P<0.05), the VAS scores in the observation group were lower than those in the control group (P<0.001). ODI scores in both groups were decreased after 1 and 4 weeks of treatment compared to baseline (P<0.05), with a further reduction at 4 weeks of treatment compared to 1 week of treatment (P<0.05); the observation group showed lower ODI score than the control group after 1 week of treatment (P<0.001). After treatment, both groups demonstrated increased resting and functional multifidus muscle thickness bilaterally compared to baseline (P<0.01), with an increased right-side thickness change rate (P<0.01), though no significant difference was observed between groups (P>0.05). Compared to baseline, after treatment, the observation group exhibited decreased Young's modulus values for bilateral resting and functional multifidus muscle (P<0.01), while the control group showed reductions only in bilateral resting and right-side functional Young's modulus values (P<0.01). After treatment, the bilateral functional Young's modulus values in the observation group were lower than that in the control group (P<0.05), and the bilateral resting and functional changes in Young's modulus values were greater in the observation group than those in the control group (P<0.01). The overall effective rate was 93.5% (58/62) in the observation group, which was higher than 79.0% (49/62) in the control group (P<0.05). CONCLUSION Acupuncture with yin-yang regulation method effectively alleviates pain, improves functional disability, increases multifidus muscle thickness, and reduces Young's modulus values in elderly patients with CLBP due to LDH, which has superior therapeutic effect compared to local acupuncture.
Humans ; Low Back Pain/physiopathology* ; Male ; Acupuncture Therapy ; Female ; Aged ; Intervertebral Disc Displacement/physiopathology* ; Middle Aged ; Yin-Yang ; Lumbar Vertebrae ; Acupuncture Points ; Treatment Outcome