Objective To explore the relationship of metabolic comorbidities and insulin resistance(IR)with chronic kidney disease(CKD)among elderly individuals undergoing health exam.Methods A cross-sectional observational study was conducted on 8358 older adults who took health exam in Chinese PLA General Hospital between December 2009 and May 2021.According to the guidelines for CKD diagnostic criteria,they were divided into CKD group(983 cases)and non-CKD(7375 cases).Clinical data was collected,and the eGDR was calculated.Quasi-Bayesian method was used for causal mediation analysis.Results The prevalence of metabolic comorbidi-ties including hypertension,CHD,DM,hyperlipidemia,and hyperuricemia was significantly higher in the CKD group than the non-CKD group(P＜0.01).The eGDR was obviously lower in the CKD group than the non-CKD group[6.88±2.09 mg/(kg·min)vs 8.41±2.12 mg/(kg·min),P＜0.01].Logistic regression analysis revealed that,without adjusting covariates,each 1-unit increase in eGDR was associated with a 29％reduction in the risk of developing CKD(OR=0.714,95％CI:0.691-0.738,P＜0.01),and after adjusting covariates,eGDR remained signifi-cantly negatively association with the risk of CKD(P＜0.01).Mediation analysis indicated that DM and brachial-ankle pulse wave velocity accounted for the highest proportions of the mediating effect in the relationship between eGDR and CKD(14.2％and 12.5％,respectively).Conclusion In the elderly population undergoing health exam,reduced insulin sensitivity is significantly asso-ciated with the development of CKD.Diabetes and arteriosclerosis exert mediating effect in this association.

Objective:To evaluate the role of uncoupling protein 2 in dexmedetomidine-induced alleviation of myocardial ischemia-reperfusion (I/R) injury in diabetic mice.Methods:SPF C57BL/6 male mice, aged 6-8 weeks, weighing 20-25 g, in which the model of type 2 diabetes mellitus was established by high-fat feeding combined with intraperitoneal injection of streptozotocin, were used in this study. Ninety diabetic mice were divided into 5 groups ( n=18 each) by a random number table method: sham operation group (S group), myocardial I/R group, myocardial I/R+ UCP2 inhibitor genipin group (I/R+ G group), myocardial I/R+ dexmedetomidine group (I/R+ D group) and myocardial I/R+ dexmedetomidine+ UCP2 inhibitor genipin group (I/R+ DG group). Myocardial I/R injury model was established by ligating the left anterior descending coronary artery of diabetic mice for 60 min followed by 120 min of reperfusion. Dexmedetomidine 20 μg/kg was intraperitoneally injected at 5 min prior to reperfusion in I/R+ D group. Genipin 100 mg/kg was intraperitoneally injected at 14 h prior to ischemia, and dexmedetomidine 20 μg/kg was intraperitoneally injected at 5 min prior to reperfusion in I/R+ D+ G group. The concentrations of cardiac troponin I (cTnI), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10 in serum were detected by enzyme-linked immunosorbent assay at 120 min of reperfusion. The myocardial tissue was obtained for determination of the myocardial infarct size, the level of reactive oxygen species (ROS) (by flow cytometry), and the expression of UCP2, nuclear factor kappa B (NF-κB) inhibitory protein α (IκBα), phosphorylated IκBα (p-IκBα), NF-κB p65 and phosphorylated NF-κB p65 (p-NF-κB p65) (by Western blot) and for observation of the morphological structure of the myocardial tissue. The cardiac function was evaluated by echocardiography at 24 h of reperfusion. Results:Compared with group S, the percentage of myocardial infarct size and level of ROS were significantly increased, the concentrations of cTnI, TNF-α, IL-6 and IL-10 were increased, the expression of UCP2 was up-regulated, the p-IκBα/IκBα ratio and p-NF-κB p65/NF-κB p65 ratio were increased, the stroke volume (SV), ejection fraction (EF), and left ventricular fractional shortening (FS) were decreased ( P<0.05), and the myocardial structure was severely damaged in group I/R. Compared with group I/R, the percentage of myocardial infarct size and level of ROS were significantly decreased, the concentrations of cTnI, TNF-α and IL-6 were decreased, the concentration of IL-10 was increased, the expression of UCP2 was up-regulated, the p-IκBα/IκBα ratio and p-NF-κB p65/NF-κB p65 ratio were decreased, the SV, EF and FS were increased ( P<0.05), and the pathological damage was significantly attenuated in group I/R+ D. Compared with group I/R+ D, the percentage of myocardial infarct size and level of ROS were significantly increased, the concentrations of cTnI, TNF-α and IL-6 were increased, the concentration of IL-10 was decreased, the expression of UCP2 was down-regulated, the p-IκBα/IκBα ratio and p-NF-κB p65/NF-κB p65 ratio were increased, the SV, EF and FS were decreased ( P<0.05), and the pathological damage was aggravated in group I/R+ D+ G. Conclusions:Dexmedetomidine may ameliorate myocardial I/R injury by up-regulating UCP2 expression in the myocardium and inhibiting mitochondrial ROS-mediated inflammatory responses in diabetic mice.

Objective To explore the relationship of metabolic comorbidities and insulin resistance(IR)with chronic kidney disease(CKD)among elderly individuals undergoing health exam.Methods A cross-sectional observational study was conducted on 8358 older adults who took health exam in Chinese PLA General Hospital between December 2009 and May 2021.According to the guidelines for CKD diagnostic criteria,they were divided into CKD group(983 cases)and non-CKD(7375 cases).Clinical data was collected,and the eGDR was calculated.Quasi-Bayesian method was used for causal mediation analysis.Results The prevalence of metabolic comorbidi-ties including hypertension,CHD,DM,hyperlipidemia,and hyperuricemia was significantly higher in the CKD group than the non-CKD group(P＜0.01).The eGDR was obviously lower in the CKD group than the non-CKD group[6.88±2.09 mg/(kg·min)vs 8.41±2.12 mg/(kg·min),P＜0.01].Logistic regression analysis revealed that,without adjusting covariates,each 1-unit increase in eGDR was associated with a 29％reduction in the risk of developing CKD(OR=0.714,95％CI:0.691-0.738,P＜0.01),and after adjusting covariates,eGDR remained signifi-cantly negatively association with the risk of CKD(P＜0.01).Mediation analysis indicated that DM and brachial-ankle pulse wave velocity accounted for the highest proportions of the mediating effect in the relationship between eGDR and CKD(14.2％and 12.5％,respectively).Conclusion In the elderly population undergoing health exam,reduced insulin sensitivity is significantly asso-ciated with the development of CKD.Diabetes and arteriosclerosis exert mediating effect in this association.

ObjectiveTo evaluate the clinical efficacy of Fuzheng Huaji Formula （扶正化积方） for chronic hepatitis B to reduce the incidence of liver cirrhosis and hepatocellular carcinoma. MethodsA retrospective cohort study was conducted， collecting medical records of 118 patients with chronic hepatitis B and 234 patients with hepatitis B-related cirrhosis who visited the hospital between January 1， 2014， and December 31， 2018. The use of Fuzheng Huaji Formula was designated as the exposure factor. Patients receiving antiviral treatment for hepatitis B without concurrent Fuzheng Huaji Formula therapy were included in the western medicine group， while those receiving antiviral treatment combined with Fuzheng Huaji Formula for a cumulative treatment lasting longer than 3 months were included in the combined treatment group. The follow-up observation period was five years. Kaplan-Meier survival analysis was used to assess the cumulative incidence of cirrhosis in patients with chronic hepatitis B and the cumulative incidence of hepatocellular carcinoma in patients with hepatitis B-related cirrhosis. Univariate and multivariate Cox regression analyses were employed to examine the factors influencing the occurrence of cirrhosis and hepatocellular carcinoma. ResultsAmong patients with chronic hepatitis B， there were 55 cases in the combined treatment group and 63 cases in the western medicine group； among patients with hepatitis B-related cirrhosis， there were 110 cases in the combined treatment group and 124 cases in the western medicine group. Five-year follow-up outcomes for chronic hepatitis B patients showed that the cumulative incidence of cirrhosis was 5.45% （3/55） in the combined treatment group and 17.46% （11/63） in the western medicine group， with a statistically significant difference between groups （Z = 2.003， P = 0.045）. Five-year follow-up outcomes for hepatitis B-related cirrhosis patients showed that the cumulative incidence of hepatocellular carcinoma was 8.18% （9/110） in the combined treatment group and 22.58% （28/124） in the western medicine group， also showing a statistically significant difference （Z = 3.007， P = 0.003）. Univariate and multivariate Cox regression analyses indicated that treatment with Fuzheng Huaji Formula is an independent protective factor in preventing the progression of chronic hepatitis B to cirrhosis and the progression of hepatitis B-related cirrhosis to hepatocellular carcinoma （P＜0.05）. ConclusionCombining Fuzheng Huaji Formula with antiviral therapy for hepatitis B can effectively intervene in the disease progression of chronic hepatitis B， reducing the incidence of cirrhosis and hepatocellular carcinoma.

Objective To investigate the predictive value of the atherogenic index of plasma(AIP)and systemic inflammatory re-sponse index(SIRI)for contrast-induced acute kidney injury(CI-AKI)in patients with hypertension complicated by acute ST-seg-ment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods A total of 964hypertensive patients with acute STEMI who underwent PCI treatment at the Affiliated Hospital of Xuzhou Medical University from Jan-uary 2021 to April 2025 were retrospectively enrolled.Using a randomized grouping method,the sample was divided into the training group(n=771)and the validation group(n=193)in a ratio of 8∶2.According to the diagnostic criteria for CI-AKI,the training group was further divided into the CI-AKI group(n=151)and the non-CI-AKI group(n=620),with baseline characteristics compared between the two groups.Multivariate Logistic regression models were constructed to identify independent predictors of postoperative CI-AKI,followed by receiver operating characteristic(ROC)curve analysis to evaluate the predictive efficacy of AIP,SIRI,and their combined detection for CI-AKI occurrence after PCI treatment.Results Left ventricular ejection fraction(LVEF),urea metabolism level,high-density lipoprotein cholesterol(HDL-C),diuretics,SIRI,and AIP showed significant correlations with the occurrence of CI-AKI in hypertensive patients with acute STEMI after PCI(P＜0.05).Multivariate Logistic regression analysis revealed that SIRI(OR=1.148,95％CI:1.060-1.244)and AIP(OR=5.946,95％CI:3.250-10.879)were independent risk factors for CI-AKI.The results of ROC curve analysis demonstrated that the combined detection of SIRI and AIP yielded an area under the curve of 0.805(95％CI:0.774-0.835),with the sensitivity of 70.8％and the specificity of 75.0％,which was significantly better than that of indi-vidual indicators(P＜0.001).The results of restricted cubic spline(RCS)indicated that when SIRI ≥ 2.773 or AIP ≥2.089,the risk of CI-AKI increased with rising levels of SIRI and AIP.Conclusion AIP and SIRI are independent risk factors for CI-AKI in hyperten-sive patients with acute STEMI after PCI,and their combined detection can improve the predictive efficacy of CI-AKI in hypertensive pa-tients with acute STEMI following PCI.

Objective:To investigate the efficacy of anatomical resection (AR) in the early stages of treating solitary hepatocellular carcinoma (HCC) combined with liver cirrhosis with a diameter of ≤5 cm in comparison to different surgical methods of preferential hepatic parenchymal preservation (non-anatomical liver resection, NAR).Methods:The clinical data of 1 390 cases with solitary HCC combined with liver cirrhosis at an early stage who underwent liver resection at Mengchao Hepatobiliary Hospital of Fujian Medical University and six other medical centers from September 2013 to May 2019 were retrospectively analyzed. Patients were divided into the AR group (486 cases) and the NAR group (904 cases) and the wide surgical margin (WSM) group (745 cases) and the narrow surgical margin (NSM) group (645 cases) according to whether they received AR and the width of the surgical margin (1 cm). The basic information of the patients, preoperative evaluation index data, and postoperative follow-up (follow-up every 3 months) were collected. The Kaplan-Meier method was used to plot the survival curve.The log-rank test was used to compare the difference in survival between the two groups. The Cox proportional hazards regression model was used to analyze the factors affecting the prognosis. Propensity score matching (PSM) was applied to reduce intergroup bias.Results:The overall survival (OS) rates for all patients at 1, 3, and 5 years were 95.5%, 79.9%, and 63.5%, respectively. The recurrence-free survival (RFS) rates were 81.5%, 59.0%, and 43.7%, respectively. There was a statistically significant difference in RFS rate between the AR group and the NAR group prior to PSM, but no statistically significant difference in OS rate (RFS rate: 47.0% vs. 41.9%, P<0.05; OS rate: 64.4% vs. 62.9%, P>0.05). The postoperative RFS rate and OS rate were significantly superior in the WSM group than those of the NSM group (RFS rate: 47.8% vs. 37.2%, P<0.001; OS rate: 69.0% vs. 57.3%, P<0.001). There was no statistically significant difference in OS rate and RFS rate between the AR group and the NAR group following PSM (RFS: 46.3% vs. 45.1%, P>0.05; OS rate: 64.0% vs. 64.3%, P>0.05).The 5-year OS and RFS rates in the WSM group were 66.8% and 60.2%, respectively. The 5-year OS and RFS rates for the NSM group were 48.7% and 41.4%, respectively, with a statistically significant difference ( P<0.05). Cox multivariate analysis indicated that serum albumin, tumor diameter, microvascular invasion, and surgical margin were independent prognostic factors affecting OS and RFS. The Child-Pugh grade and satellite lesions were independent prognostic factors affecting OS. Conclusion:Anatomical liver resection is not an independent risk factor for prognosis, but the state of the resection margin determines the prognosis of patients with solitary HCC combined with cirrhosis. Therefore, hepatic resection margins should be prioritized in such patients.

Objective:To evaluate the application effect of intelligent management of health management (examination) institutions in Shanxi Province.Methods:In this study, a cross-sectional study was adopted. In October 2023, through convenient sampling, 300 health management (examination) institutions in Shanxi Province were investigated according to the four regions of northern Shanxi, central Shanxi, southern Shanxi and southeastern Shanxi, and the application information of intelligent management in the whole process from January to December 2022 was collected. According to the evaluation indicators in the documents of the National Health and Wellness Commission, six indicators were analyzed, including the completion rate of health questionnaire, the integrity of physical examination files, the filing rate of physical examination cycle, the evaluation rate of cardiovascular risk diseases, the re-examination rate of patients with chronic diseases (blood pressure, blood lipid and blood glucose indicators) and the follow-up rate of important abnormal results.Results:The completion rates of health questionnaires in northern Shanxi, central Shanxi, southern Shanxi and southeastern Shanxi were 54.9%, 84.2%, 93.2% and 98.2% ( χ 2=225 050.17, P<0.001), and the filing rates of health checkups in various regions were 89.1%, 94.7%, 94.0% and 94.5% ( χ 2=10 254.02, P<0.001). The filing rates of physical examination cycles in each region were 21.8%, 23.4%, 24.3% and 24.7% ( χ 2=734.15, P<0.001), and the assessment rates of cardiovascular risk diseases in each region were 84.5%, 85.4%, 80.2% and 86.2% ( χ 2=4 627.99, P<0.001). The reexamination rates of patients with chronic diseases (blood pressure, blood lipid and blood glucose indicators) in different regions were 38.8%, 39.7%, 39.3% and 39.5% ( χ 2=24.24, P<0.001), and the follow-up rates of important abnormal results were 81.7%, 84.1%, 82.9% and 83.9% ( χ 2=255.02, P<0.001). Conclusion:Shanxi health management (examination) institutions have achieved certain results in the application of intelligent management in the whole process, but there is still much room for improvement in the filing of physical examination cycle and re-examination of chronic diseases.

Objective:To evaluate the role of uncoupling protein 2 in dexmedetomidine-induced alleviation of myocardial ischemia-reperfusion (I/R) injury in diabetic mice.Methods:SPF C57BL/6 male mice, aged 6-8 weeks, weighing 20-25 g, in which the model of type 2 diabetes mellitus was established by high-fat feeding combined with intraperitoneal injection of streptozotocin, were used in this study. Ninety diabetic mice were divided into 5 groups ( n=18 each) by a random number table method: sham operation group (S group), myocardial I/R group, myocardial I/R+ UCP2 inhibitor genipin group (I/R+ G group), myocardial I/R+ dexmedetomidine group (I/R+ D group) and myocardial I/R+ dexmedetomidine+ UCP2 inhibitor genipin group (I/R+ DG group). Myocardial I/R injury model was established by ligating the left anterior descending coronary artery of diabetic mice for 60 min followed by 120 min of reperfusion. Dexmedetomidine 20 μg/kg was intraperitoneally injected at 5 min prior to reperfusion in I/R+ D group. Genipin 100 mg/kg was intraperitoneally injected at 14 h prior to ischemia, and dexmedetomidine 20 μg/kg was intraperitoneally injected at 5 min prior to reperfusion in I/R+ D+ G group. The concentrations of cardiac troponin I (cTnI), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10 in serum were detected by enzyme-linked immunosorbent assay at 120 min of reperfusion. The myocardial tissue was obtained for determination of the myocardial infarct size, the level of reactive oxygen species (ROS) (by flow cytometry), and the expression of UCP2, nuclear factor kappa B (NF-κB) inhibitory protein α (IκBα), phosphorylated IκBα (p-IκBα), NF-κB p65 and phosphorylated NF-κB p65 (p-NF-κB p65) (by Western blot) and for observation of the morphological structure of the myocardial tissue. The cardiac function was evaluated by echocardiography at 24 h of reperfusion. Results:Compared with group S, the percentage of myocardial infarct size and level of ROS were significantly increased, the concentrations of cTnI, TNF-α, IL-6 and IL-10 were increased, the expression of UCP2 was up-regulated, the p-IκBα/IκBα ratio and p-NF-κB p65/NF-κB p65 ratio were increased, the stroke volume (SV), ejection fraction (EF), and left ventricular fractional shortening (FS) were decreased ( P<0.05), and the myocardial structure was severely damaged in group I/R. Compared with group I/R, the percentage of myocardial infarct size and level of ROS were significantly decreased, the concentrations of cTnI, TNF-α and IL-6 were decreased, the concentration of IL-10 was increased, the expression of UCP2 was up-regulated, the p-IκBα/IκBα ratio and p-NF-κB p65/NF-κB p65 ratio were decreased, the SV, EF and FS were increased ( P<0.05), and the pathological damage was significantly attenuated in group I/R+ D. Compared with group I/R+ D, the percentage of myocardial infarct size and level of ROS were significantly increased, the concentrations of cTnI, TNF-α and IL-6 were increased, the concentration of IL-10 was decreased, the expression of UCP2 was down-regulated, the p-IκBα/IκBα ratio and p-NF-κB p65/NF-κB p65 ratio were increased, the SV, EF and FS were decreased ( P<0.05), and the pathological damage was aggravated in group I/R+ D+ G. Conclusions:Dexmedetomidine may ameliorate myocardial I/R injury by up-regulating UCP2 expression in the myocardium and inhibiting mitochondrial ROS-mediated inflammatory responses in diabetic mice.

Objective To explore the correlation between remnant cholesterol level and CI-AKI in elderly patients with ACS and concomitant T2DM following PCI.Methods A retrospective case-control study was conducted on 759 elderly T2DM patients with ACS undergoing PCI in the Affi-liated Hospital of Xuzhou Medical University between January 2020 and December 2023.The pa-tients were randomly allocated into a training group(n=608)and a validation group(n=151)in a ratio of 8∶2.Based on CI-AKI diagnostic criteria,the training group was further stratified into a CI-AKI subgroup(n=95)and a non-CI-AKI subgroup(n=513).Multivariate logistic regression analysis was used to identify the independent risk factors for CI-AKI.Results The remnant cho-lesterol level was significantly higher in the CI-AKI subgroup than the non-CI-AKI subgroup[0.78(0.51,1.07)mmol/L vs 0.57(0.40,0.81)mmol/L,P＜0.01].Red blood cell count,remnant cholesterol,age,uric acid,log-transformed systemic immune-inflammatory(SII)index,and cysta-tin C were identified as independent predictors for CI-AKI in T2DM patients with ACS after PCI(P＜0.01).ROC curve analysis demonstrated that the model combining remnant cholesterol with other independent predictors exhibited superior discriminative performance in both the training group(AUC=0.818,95％CI:0.773-0.863)and validation group(AUC=0.787,95％CI:0.686-0.889)when compared to the models excluding remnant cholesterol(P＜0.01).Conclusion Rem-nant cholesterol is an independent predictor of CI-AKI in elderly patients with ACS and T2DM af-ter PCI.A risk prediction model based on remnant cholesterol and other independent risk factors demonstrates enhanced predictive performance for postoperative CI-AKI in the patients.

Objective:To develop machine learning models for interpreting brain maturity in preterm infants based on electroencephalographic (EEG) features and analyze factors affecting interpretation accuracy.Methods:This prospective study enrolled preterm infants requiring bedside EEG monitoring in the Department of Neonatology at the First Hospital of Jilin University from January 2023 to March 2024. Data from each integer-corrected gestational age (GA) group were randomly split into training and testing sets (7∶3 ratio) using Python's sklearn.model_selection.train_test_split function. Three machine learning models, including support vector regression (SVR), random forest, and decision tree, were employed to analyze EEG signals. Model performance was evaluated against manually interpreted GA as the gold standard using prediction deviation, mean absolute error (MAE), root mean square error (RMSE), and correlation coefficient ( r). Accuracy was defined based on the difference between predicted and manually interpreted GA (categorized into accurate and inaccurate groups), with a difference less than one week considered accurate. Statistical analyses included Chi-square test (or Fisher's exact test), t-test, Mann-Whitney U test, and multivariate logistic regression. Results:Among 241 preterm infants (training set: n=168; testing set: n=73), the random forest model demonstrated optimal performance: concordance rate 90.4% (66/73) with MAE 0.378 weeks, RMSE 0.577 weeks, and r=0.932 ( P<0.001). The decision tree model achieved 87.7% concordance (64/73) with MAE 0.316 weeks, while SVR showed 64.2% concordance (47/73) and MAE 0.840 weeks. Stratified by GA, random forest performed best in the 34 weeks group [concordance 100.0% (52/52), MAE 0.269 weeks], followed by the 32-34 weeks group [89.0% (81/91), MAE 0.448 weeks] and <32 weeks group [88.8% (87/98), MAE 0.561 weeks]. Compared to the accurate group ( n=205), the inaccurate group ( n=36) had higher rates of vaginal delivery [41.7% (15/36) vs. 19.5% (40/205), χ2=8.53], grade ≥Ⅱ intracranial hemorrhage [11.1% (4/36) vs. 2.4% (5/205), χ2=4.22], and periventricular echogenicity [33.3% (12/36) vs. 7.8% (16/205), χ2=17.03] (all P<0.05). Multivariate analysis identified vaginal delivery ( OR=0.190, 95% CI: 0.068-0.527), lower corrected GA ( OR=0.678, 95% CI: 0.488-0.941), and periventricular echogenicity ( OR=11.339, 95% CI: 3.250-39.559) as independent factors affecting accuracy (all P<0.05). Conclusion:The random forest-based model shows optimal accuracy for predicting brain maturity in preterm infants. Vaginal delivery, lower corrected GA, and periventricular echogenicity reduce its predictive accuracy.