Background:Duodenal papillary adenoma is a benign tumor with relatively low incidence but significant carcinogenesis potential.Despite the minimal invasiveness and low complication rate,endoscopic papillectomy is associated with a definite risk of recurrence for duodenal papillary adenoma.Investigating the driver genes of duodenal papillary adenoma and establishing predictive models for recurrence and malignant progression could facilitate the precision medicine.Aims:To identify the key driver genes for tumor occurrence,carcinogenesis and recurrence in duodenal papillary adenoma by integrating multi-dimensional bioinformatics approaches based on transcriptomics data,and validate clinically.Methods:Expression profiles of duodenal papillary adenoma and adenocarcinoma were obtained from the GEO database(including data sets GSE189035,GSE94919,GSE111156,and GSE102208).Differentially expressed genes(DEGs)between adenomatous and normal tissues were screened.Weighted gene co-expression network analysis(WGCNA)and pseudo-time analysis were combined to identify the core genes exhibiting an"initial rise followed by decline"expression pattern during the dynamic progression from normal tissue to adenoma and adenocarcinoma.Functional annotation,immune microenvironment profiling,and protein-protein interaction network analysis were performed to explore the tumor-promoting mechanisms of these core genes.Clinical validation was conducted using immunohistochemistry to estimate the gene expression level and its relationship with tumor recurrence.Results:A total of 469 common DEGs were identified.WGCNA revealed that the blue module(including 1 051 genes)was associated with adenoma development and progression(Cor=-0.29,0.15,and 0.11 for normal tissue,adenoma,and adenocarcinoma,respectively).Intersection with DEGs pinpointed four key genes:SLC12A2,BEST4,SLC37A2,and SOAT2.Pseudo-time analysis demonstrated that only SLC12A2 maintained sustained high expression in both adenoma and adenocarcinoma tissues.KEGG enrichment analysis indicated that SLC12A2 was linked to various malignant pathways(e.g.,PD-1/PD-L1 signaling pathway),and its high expression correlated with the reduced immune cell infiltration(e.g.,γδ T cells,CD8+T cells,etc.).Clinical validation by immunohistochemistry confirmed the trend of initial upregulation and subsequent downregulation of SLC12A2 expression in normal,adenoma,and adenocarcinoma tissues.Patients with tumor recurrence showed higher SLC12A2 expression level(P=0.004);likewise,SLC12A2 high expression was associated with an elevated recurrence risk(P=0.034).Conclusions:SLC12A2 serves as a critical driver of tumorigenesis and progression for duodenal papillary adenoma,and might be a promising biomarker for recurrence prediction.

Irritable bowel syndrome(IBS)is a kind of gastrointestinal dysfunction disease characterized by abdominal pain and abnormal defecation accompanied by changes in frequency or fecal character as the main clinical symptoms,and diarrhea-type irritable bowel syndrome(IBS-D)is the most common.It has been found that Chinese medicine therapy has achieved good results in the treatment of IBS-D through multi-component,multi-target and multi-pathway targeted regulation of intestinal flora.Therefore,based on intestinal flora,this paper reviews the relationship between intestinal flora and IBS-D,the understanding of Chinese medicine on IBS-D and intestinal flora,and the role of Chinese medicine therapy on intestinal flora.

Objective:To observe the application effect of nursing risk management based on PDCA (plan, do, check, action) cycle quality control concept on patients with diabetic ketoacidosis, and provide reference for improving the nursing quality of diabetic ketoacidosis.Methods:A historical control study was adopted. Using simple random sampling method, patients with diabetic ketoacidosis admitted to Emergency Intensive Care Unit of Lishui Central Hospital from January 2019 to March 2020 were selected as the research subjects, patients admitted from January to September 2019 were treated as the control group and received routine care, while patients admitted from October 2019 to March 2020 were treated as the experimental group and received nursing risk management based on PDCA cycle quality control concept. Blood glucose control time, urine ketone negative conversion time, acidosis correction time, hospital stay, occurrence of complications, depression and anxiety scores, nursing quality and nursing satisfaction were compared between the two groups after intervention.Results:A total of 89 patients were included. There were 43 patients in the control group, including 16 males and 27 females, aged (64.37 ± 15.85) years old; 46 patients in the experimental group, including 23 males and 23 females, aged (59.28 ± 13.66) years old. Before intervention, there were no significant differences in depression and anxiety scores between 2 groups (both P<0.05). After intervention, the blood glucose control time, urine ketone negative conversion time, acidosis correction time and hospital stay were (9.24 ± 1.26), (38.39 ± 3.28), (12.23 ± 1.39) h and (11.34 ± 2.28) d in the experimental group, shorter than (9.94 ± 1.40), (40.12 ± 3.67), (13.66 ± 2.47) h and (13.62 ± 3.40) d in the control group, the differences were statistically significant ( t values were 2.35-3.74, all P<0.05). The occurrence of complications, depression and anxiety scores in the experimental group were 13.04% (6/46), (3.18 ± 0.37) points, (4.69 ± 1.33) points, lower than 30.23% (13/43), (3.72 ± 0.96) points, (5.77 ± 1.60) points in the control group, the differences were statistically significant ( χ2=3.91, t=3.55, 3.47, all P<0.05). The total score of nursing quality and nursing satisfaction in the experimental group were (82.91 ± 4.22), (89.02 ± 4.95) points, higher than (76.86 ± 5.01), (81.14 ± 7.89) points in the control group, the differences were statistically significant ( t=6.18, 5.68, both P<0.05). Conclusions:Nursing risk management based on PDCA cycle quality control concept can shorten the treatment time of patients with diabetic ketoacidosis, reduce the risk of complications, ensure the nursing quality, relieve the negative emotions during hospitalization, and improve satisfaction of patients.

Objective:To excplore the risk factors for myocardial damage in patients with systemic lupus erythematosus (SLE) and the value of application of resting gated nuclear myocardial imaging.Methods:A total of 64 lupus patients who were hospitalized in Wuxi People′s Hospital from January 2021 to December 2022 were included, and the patients′ clinical data, imaging data, and test reports were retrospectively analyzed using paired χ2 test, t test, Wilcoxon rank-sum test, Mann-Whitney U test, and binary logistic regression analysis. Results:①Among the 64 patients with lupus, 19(29.7%) had abnormal radionuclide myocardial imaging, 23 (35.9%) had elevated BNP, and 6 (9.4%) had myocardial involvement on echocardiography. There was no statistical difference between radionuclide myocardial imaging and BNP ( Kappa=0.294, P=0.503), but there was a significant difference between radionuclide myocardial imaging and echocardiography ( Kappa=0.394, P<0.001). ②There was no statistical difference in the EF values measured by resting gated myocardial radionuclide imaging and echocardiography [(64.9±9.6)% vs. (63.2±5.6)%, Z=-1.73, P=0.083]. ③Compared with the normal myocardial group, the myocardial damage group had higher BNP value [(912±1729)pg/ml vs. (297±572)pg/ml, t=-3.05, P=0.002], ESR[(56±42)mm/1 h vs. (34±27)mm/1 h, t=-2.17, P=0.030], and SDI scores[2.16±1.30 vs. 1.04±0.85, t=-3.43, P=0.002], more patients with a course of disease≥10 years [57.9% vs. 28.9%, Z=2.17, P=0.030], and anti-U1RNP antibody[52.6% 24.4%, Z=-2.18, P=0.029] and anti-SSB antibody[31.6% vs. 11.1% Z=-1.97, P=0.049] were statistically different. ④Through binary logistic regression analysis, SDI score [ OR ( 95%CI)=2.444 (1.195, 4.998), P=0.014], anti-U1RNP antibody [ OR ( 95%CI)=4.569 (1.036, 20.150), P=0.045] and disease duration≥10 years [ OR ( 95%CI)=5.218 (1.210, 22.496), P=0.027] were independent risk factors for myocardial damage in SLE patients. Conclusion:Resting gated radionuclide myocardial imaging can accurately provide ventricular motion parameters and can detect myocardial damage in SLE patients at early stage. Disease duration ≥10 years, high SDI score, and positive anti-U1RNP antibodies are independent risk factors for myocardial damage in SLE patients.

Objective To observe the correlations of image manifestations of organ damage and clinical characteristics of heat stroke.Methods Totally 46 patients with heat stroke were retrospectively enrolled.Based on the presence or absence of image manifestations of heat stroke related organ damage on head MRI and chest-abdominal CT and combined with sequential organ failure assessment(SOFA),the patients were divided into organ damage positive group(positive A,images showed clear manifeatations of organ damage and the corresponding SOFA≥2)and organ damage negative group(negative B,images showed no obvious organ damage or the corresponding SOFA＜2).Clinical data,laboratory indicators and treatment outcomes were compared between groups.Univariate and multivariate logistic analyses were used to explore the correlations of image manifestations of organ damage and clinical characteristics of heat stroke.Results Among 46 cases,26 were classified as positive group A and 20 as negative group.There were significant differences of patients' age,gender,Glasgow coma scale(GCS)and heart rate at admission,thrombin time,D-dimer,lactate dehydrogenase,partial pressure of carbon dioxide,lactic acid,myoglobin,platelet count(PLC),interleukin-6 and serum creatinine before treatment,as well as time of hospital stay and post-treatment outcomes between groups(all P＜0.05).GCS score,PLC levels and time of hospital stay of heat stroke patients were all correlated with image manifeations of organ damage(OR=0.592,0.729,1.532,all P＜0.05),among which GCS score and time of hospital stay were independently associated with image manifeations of organ damage(OR=0.607,1.448,both P＜0.05).Conclusion Image manifeations of organ damage was correlated with GCS score and time of hospital stay in patients with heat stroke.

Objective To verify the performance of an non competitive immune sandwich method(candidate method)in detecting 25(OH)D,and evaluate the measurement agreement of candidate method with liquid chromatography tandem mass spectrometry(LC-MS/MS,reference method).Methods According to the comparison of documents such as China National Accreditation Service for Conformity Assessment(CNAS)-GL037,the precision,linear interval,lower limit of quantitation(LOQ)and accuracy of the method for detecting 25(OH)D were verified.1 073 residual serum samples were collected from March to July 2021 and 25(OH)D was detected by the two methods.Passing-bablok regression,concordance correlation coefficient(CCC),Bland altman plots and Kappa test were used to analyze the consistency and bias.Weighted Kappa test was conducted to evaluate the consistency of two methods for clinical assessment of vitamin D nutritional status.Results The performance of candidate method:the within-run CV was lower than 5%and the in laboratory CV were lower than 10%;test results between 2.88～52.45 ng/ml showed good linear relationship;the lower limit of quantitation was 2.26 ng/ml,the bias of candidate method measuring standard reference materials were within±6%and within 15%measuring vitamin D external quality assessment scheme(DEQAS)samples.The comparison method and the reference method showed good correlation(r=0.965,CCC=0.946)with an average deviation of-1.54 ng/ml(-7.42%).The two methods coincidence rate in judging vitamin D status was 85.96%(918/1 068),and the weighted kappa value was 0.801.Conclusions The candidate method measurement performance met the clinical requirements,and showed good correlation and consistency with the reference method.

Objective:To investigate the sleep status of conscious patients in the ICU, their perception of ICU environmental stressors, and the correlation between the two, providing a basis for nursing interventions.Methods:A convenience sampling method was used to recruit 120 conscious patients admitted to Zhongshan Hospital, Fudan University for the first time to the ICU from August 2022 to January 2023 for the study. Data were collected using a general information questionnaire, the Intensive Care Unit Environmental Stressor Scale (ICUESS), and the Richards-Campbell Sleep Questionnaire (RCSQ). Multiple linear regression analysis was performed to identify factors influencing sleep quality in conscious ICU patients.Results:The total RCSQ and ICUESS scores of 120 conscious ICU patients were 36.0 (12.3, 60.8) and 76.0 (69.0±84.0), respectively. The primary stressors identified by patients were "inability to fall asleep" "thirst" and "restraint by medical tubing". Multiple linear regression analysis showed that the treatment environment, one's own experience and noise were significant factors affecting sleep quality in conscious ICU patients ( P<0.05) . Conclusions:The overall sleep quality of conscious ICU patients was poor and closely related to their perceived level of ICU environmental stressors. ICU medical staff should focus on optimizing the treatment environment, noise and patients' own experience to improve their sleep quality.

Objective To verify the performance of an non competitive immune sandwich method(candidate method)in detecting 25(OH)D,and evaluate the measurement agreement of candidate method with liquid chromatography tandem mass spectrometry(LC-MS/MS,reference method).Methods According to the comparison of documents such as China National Accreditation Service for Conformity Assessment(CNAS)-GL037,the precision,linear interval,lower limit of quantitation(LOQ)and accuracy of the method for detecting 25(OH)D were verified.1 073 residual serum samples were collected from March to July 2021 and 25(OH)D was detected by the two methods.Passing-bablok regression,concordance correlation coefficient(CCC),Bland altman plots and Kappa test were used to analyze the consistency and bias.Weighted Kappa test was conducted to evaluate the consistency of two methods for clinical assessment of vitamin D nutritional status.Results The performance of candidate method:the within-run CV was lower than 5%and the in laboratory CV were lower than 10%;test results between 2.88～52.45 ng/ml showed good linear relationship;the lower limit of quantitation was 2.26 ng/ml,the bias of candidate method measuring standard reference materials were within±6%and within 15%measuring vitamin D external quality assessment scheme(DEQAS)samples.The comparison method and the reference method showed good correlation(r=0.965,CCC=0.946)with an average deviation of-1.54 ng/ml(-7.42%).The two methods coincidence rate in judging vitamin D status was 85.96%(918/1 068),and the weighted kappa value was 0.801.Conclusions The candidate method measurement performance met the clinical requirements,and showed good correlation and consistency with the reference method.

Objective:To explore predictive value of pericoronary fat attenuation index(FAI)of the assessment of computed tomography(CT)for coronary restenosis post the surgery of percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD).Methods:A total of 100 elderly patients with CHD who admitted to Harbin 242 Hospital and underwent PCI from August 2021 to August 2024 were prospectively selected,and they were divided into stenosis group(46 cases)and non-stenosis group(54 cases)based on whether occurred coronary artery restenosis after the surgery.Multivariate logistic regression was used to analyze the influence factors of occurring restenosis in elderly patients with CHD after PCI surgery,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of FAI for restenosis post PCI surgery in patients with CHD.Results:The differences in lipoprotein a,fibrinogen(FIB),total bilirubin(TBIL),total cholesterol(TC),triglyceride(TG),Coronary artery Lesion Complexity Scoring System(SYNTAX)score and FAI were significant between the stenosis group and the non-stenosis group,and the differences were all statistically significant(t=11.819,27.088,38.363,2.632,4.106,7.773,3.231,P<0.05).There were no statistically significant difference in gender,age,body mass index(BMI),blood pressure,basically medical history,and the diameter of implanted stents between the two groups(P>0.05).Multivariate logistic regression analysis showed that lipoprotein a FIB TBIL,TC,TG,SYNTAX score,and FAI index were all influence factors for restenosis post PCI surgery in patients with CHD[OR=4.578(95%CI:2.645～7.932),3.850(95%CI:2.048～7.237),0.145(95%CI:0.052～0.405),6.133(95%CI:1.382～27.219),0.019(95%CI:0.002～0.158),1.264(95%CI:1.150～1.389),1.062(95%CI:1.024～1.102),P<0.05].The ROC curve analysis showed that the area under curve(AUC)value of the ROC curve of the FAI index was 0.760(95%CI:0.666～0.854)in predicting restenosis post PCI surgery,and the sensitivity,specificity,the maximum Youden index and the best cut-off value of that were respectively 89.1%,59.3%,0.484,-79.79,P<0.001.Conclusion:FAI has significant value in predicting restenosis post PCI surgery in elderly patients with CHD,and it can be used as basis of assessing clinical risk.

Objective:To investigate the relationship between oxygen consumption (VO 2), carbon dioxide production (VCO 2), and Oxygen Consumption/lactate (VO 2/Lac) with risk of death in patients with severe ARDS. Methods:A retrospective cohort study method was used, and the study subjects were hospitalized for >5 days adult patients with severe ARDS in the central intensive care unit of Henan Provincial People's Hospital from 1 March 2020 to 30 June 2023. The following patients were excluded: IC test was not completed on the 4th day of ICU admission, IC test results were unreliable, mechanical ventilation duration had exceeded 48 h at the time of ICU transfer or admission, palliative care patients and pregnant and parturient women. Using indirect calorimetry to determine VO 2 and VCO 2 values on the 4th day of admission, reviewing medical records to obtain general condition, disease information, blood gas analysis (including lactate value), diagnostic and therapeutic measures, and following up deaths by telephone and time of death. The primary outcome measure was death at 90 days, and the secondary outcome measure was death at 28 days, length of stay in ICU, total length of stay, and total hospitalization cost. Cox regression analysis and linear regression analysis were used to investigate the relationship between VO 2, VCO 2, VO 2/Lac and primary and secondary outcome indexes. Results:A total of 216 patients were enrolled, 78 patients (36.1%) died and 138 patients (63.9%) survived at 90 days. After correction for confounders, the results of multifactorial Cox regression analysis suggested that compared with the Q4 group, HR (95% CI) for 90-day risk of death in the VO 2 Q1 and Q2 groups was 3.21 (1.38, 7.49) and 3.24 (1.42, 7.38), and HR (95% CI) for 90-day risk of death in the VCO 2 Q1, Q2 and Q3 groups was 5.88 (2.33, 14.84), 4.26 (1. 60, 11.34) and 3.54 (1.34, 9.35), respectively, and the HR (95% CI) for 90-day risk of death in the VO 2/Lac Q1, Q2 and Q3 groups were 8.72 (3.01, 25.25), 8.43 (2.91, 24.47) and 4.04 (1.34, 12.17) respectively. P-trends were all <0.05, indicating that VO 2, VCO 2 and VO 2/Lac were linearly and negatively associated with the risk of 90-day mortality. In addition, VO 2, VCO 2, and VO 2/Lac were negatively associated with 28-day risk of death and higher VO 2/Lac was negatively associated with length of ICU stay. Conclusions:VO 2, VCO 2 and VO 2/Lac were negatively associated with 90-day mortality risk and 28-day mortality risk in patients with severe ARDS and may be independent risk factors predicting mortality risk of such patients.