ObjectiveTo investigate the risk factors for post-acute pancreatitis diabetes mellitus （PPDM-A） in patients with acute pancreatitis （AP）， to construct a nomogram prediction model， and to provide a reference for the development of individualized treatment regimens. MethodsA total of 351 patients with AP who were admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from June 2021 to January 2025 were prospectively enrolled， and they were randomly divided into modeling group with 246 patients and validation group with 105 patients at a ratio of 7∶3. According to the presence or absence of PPDM-A in the patients with AP， the modeling group was further divided into PPDM-A group with 86 patients and non-PPDM-A group with 160 patients. Clinical data were collected from all patients. The least absolute shrinkage and selection operator （LASSO） regression analysis was used to determine independent variables， and a Logistic regression analysis was used to investigate the influencing factors for PPDM-A. R software was used to construct a nomogram model. The receiver operating characteristic curve was used to assess the discriminatory ability of the model， and the Hosmer-Lemeshow test was used to test the model fitting degree， and the calibration curve was used to evaluate the model consistency； and decision curve analysis （DCA） was used to assess its clinical application value. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. ResultsAmong the 246 patients， 86 developed PPDM-A， resulting in an incidence rate of 34.96%. There were significant differences between the PPDM-A group and the non-PPDM-A group in the proportion of patients with an age of ≥60 years （65.12% vs 40.62%， P<0.05）， male sex （75.58% vs 55.63%， P<0.05）， a body mass index （BMI） of ≥24 kg/m² （63.95% vs 37.50%， P<0.05）， alcoholic AP （56.98% vs 36.87%， P<0.05）， moderate-to-severe AP （54.65% vs 35.00%， P<0.05）， or a computed tomography severity index （CTSI） score of ≥4 points （48.84% vs 28.75%， P<0.05）， as well as significant differences in the levels of blood calcium （1.46±0.35 mmol/L vs 1.89±0.37 mmol/L， P<0.05） and random blood glucose （Glu） （17.68±4.12 mmol/L vs 11.68±4.27 mmol/L， P<0.05）. The LASSO regression analysis obtained 8 independent variables. The Logistic regression analysis showed that age， sex， BMI， alcoholic AP， moderate-to-severe AP， CTSI score， and Glu were risk factors for PPDM-A （all P<0.05）， while blood calcium was a protective factor （P<0.05）. The model had an area under the ROC curve （AUC） of 0.932 （95% confidence interval ［CI］： 0.903 — 0.962） in the modeling group， and the Hosmer-Lemeshow goodness-of-fit test yielded χ²=7.346 （P=0.728）， the accuracy of model fitting was good； the calibration curve showed that the predicted probability was consistent with the actual probability， indicating that the consistency was good. The model had an AUC of 0.835 （95%CI： 0.753 — 0.917） in the validation group， and the Hosmer-Lemeshow goodness-of-fit test yielded χ²=7.014 （P=0.711）， the accuracy of model fitting was good； the calibration curve showed that the predicted probability was consistent with the actual probability， indicating that the consistency was good. The DCA results of the modeling group showed that the model exhibited a high clinical value in evaluating PPDM-A when the threshold probability was 0.13 — 0.94. ConclusionAge， sex， BMI， alcoholic AP， moderate-to-severe AP， blood calcium， CTSI score， and Glu are influencing factors for PPDM-A. The nomogram model constructed based on the above influencing factors shows good performance in predicting the risk of PPDM-A and can thus provide a reference for developing prevention strategies for PPDM-A in clinical practice.

AIM: To investigate the global research status, hotspots, and trends of exosome studies in ophthalmology, providing a theoretical foundation and constructive references for future research, and promoting in-depth development in this field.METHODS: Relevant literature on exosomes in ophthalmology published up to May 20, 2024, was retrieved from the China National Knowledge Infrastructure(CNKI), Web of Science Core Collection, and PubMed databases. Visual analyses of publication countries, institutions, authors, high-frequency keywords, burst keywords, and timelines were performed using CiteSpace 6.3.R1 and VOSviewer software.RESULTS: A total of 37 Chinese articles and 548 English articles were included. The top five countries in terms of publication volume were the United States(130 articles), China(80 articles), South Korea(24 articles), the United Kingdom(20 articles), and Japan(19 articles). The leading foreign institutions were the University of California System, Duke University, and Harvard University, while the top domestic institutions were Qingdao University, the Department of Ophthalmology at the First Affiliated Hospital of Jinan University, and the School of Physical Education and Sports Science at Beijing Normal University. Analysis of Chinese and English high-frequency and burst keywords indicated that global research hotspots on exosomes in ophthalmology primarily focus on dry eye, extracellular vesicles, mesenchymal stem cells and their derived exosomes, ocular surface diseases, ocular surface inflammation, biomarkers, retinal protection, immune eye diseases, uveitis, degenerative eye diseases, macular degeneration, diabetic retinopathy, neovascularization, thyroid-associated ophthalmopathy, and glaucoma, while English high-frequency words mainly were dry eye, dry eye disease, delivery, regenerative medicine, uveal melanoma, protein, and transplantation. Research has evolved from initial basic biological studies to exploring the pathogenesis of ocular diseases and advancing toward novel diagnostic and therapeutic approaches.CONCLUSION: Over the past 5 a, research on exosomes in ophthalmology has grown rapidly. Exosomes, as novel biomarkers and potential therapeutic targets, have become central to studies on the pathogenesis and clinical applications of ophthalmic diseases. Their roles in the diagnosis, treatment, and prevention of these diseases represent promising directions for future research.

Objective:To investigate the primary causes of hospitalization, comorbidities, hospitalization costs, and the factors influencing hospitalization expenses in gouty arthritis patients at a tertiary hospital in Haikou, Hainan Province, with the aim of providing a theoretical basis for optimizing medical resource allocation.Methods:We collected hospitalization data from gouty arthritis patients diagnosed between January and December 2021 at a tertiary hospital in Haikou. The main causes of hospitalization, the types and proportions of comorbidities, and their associations with hospitalization costs were analyzed. Patients were categorized into groups based on the primary cause of hospitalization: non-surgical gout, surgery for gout tophiformation, cardiovascular disease, cerebrovascular disease, renal disease, digestive system disease, and type 2 diabetes with complications. Chi-square tests were used for categorical variables, one-way ANOVA or Mann-Whitney U test for continuous variables, and multivariate linear regression for identifying factors influencing hospitalization costs. Spearman′s correlation analysis was conducted to explore associations between variables. Results:A total of 851 patients were included, with 721 males (84.7%) and 130 females (15.3%). The mean age was (65.3±14.1) years, and the average length of stay was (11.5±8.5)days. Among the 833 patients with comorbidities (97.9%), the most prevalent comorbid conditions were hypertension (539 cases, 63.3%), cerebral infarction (378 cases, 44.4%), and type 2 diabetes along with its complications (346 cases, 40.7%). The total cost for the non-surgical gout tophi group was 1.01 (0.72, 1.26) ten thousand yuan, which was significantly lower than that for the gout tophi surgery group [2.04(1.37, 3.42)ten thousand yuan( Z=-4.94, P<0.001)], the cardiovascular disease group [1.30(0.71, 2.29) ten thousand yuan( Z=-4.31, P<0.001)], and the cerebrovascular disease group [1.29(0.98, 2.07) ten thousand yuan, Z=-4.68, P<0.001)]. The total cost for the gout tophi surgery group was 2.04 (1.37, 3.42) ten thousand yuan, which was significantly higher than that for the non-surgical gout tophi group [1.01(0.72, 1.26) ten thousand yuan, Z=-4.94, P<0.001)], the cardiovascular disease group [1.30(0.71, 2.29) ten thousand yuan, Z=-2.40, P=0.020)], the cerebrovascular disease group [1.29(0.98, 2.07) ten thousand yuan, Z=-2.50, P=0.010)], the digestive system disease group [1.04(0.67, 1.97) ten thousand yuan, Z=-2.73, P=0.010)], the renal system disease group [1.01(0.78, 1.53)ten thousand yuan, Z=-3.62, P<0.001)], and the type 2 diabetes and its complications group [(0.88(0.67, 1.25) ten thousand yuan, Z=-4.13, P<0.001)]. Spearman correlation analysis showed a strong positive correlation between length of hospital stay and total hospitalization cost ( r=0.71, P<0.001), as well as a strong positive correlation between total cost and insurance reimbursement ( r=0.87 , P<0.001). The results from multiple linear regression analysis indicated that the length of hospital stay ( B=2 670.36, P<0.001), cardiovascular diseases ( B=12 266.28, P<0.001), digestive system diseases ( B=11 251.76, P=0.001), and cerebrovascular diseases ( B=7 318.79, P=0.020) were significantly positively associated with hospitalization costs. Conclusion:Tophus surgery incurred the highest hospitalization costs, with cardiovascular and cerebrovascular diseases being the primary reasons for gout-related hospitalizations. Standardizing gout treatment may reduce the disease burden by potentially lowering the incidence of comorbidities.

Objective To construct machine learning(ML)model for predicting early neurologi-cal deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS),and to analyze risk factors of END using Shapley additive explanations(SHAP).Methods A total of 97 AIS patients who received IVT were enrolled.Patients were divided into END group(18 cases)and non-END group(79 cases)based on whether they experienced END within 24 hours post-IVT.All patients were randomly divided into training set(n=68)and validation set(n=29)at ra-tio of 7 to 3.Univariate and least absolute shrinkage and selection operator(LASSO)analyses were performed to screen important feature variables associated with END from clinical data.Six ML algo-rithms,including random forest,light gradient boosting machine,decision tree,support vector ma-chine,k-nearest neighbors and extreme gradient boosting,were employed to construct predictive mod-els.Receiver operating characteristic(ROC)curves,calibration curves and clinical decision curve analysis(DC A)were used to evaluate the performance of each ML model.The SHAP method was introduced to interpret the optimal ML model.Results Among the six ML algorithm models,the random forest model was identified as best predictive model.In the training set,it achieved area un-der the curve(AUC)of 0.909,with specificity,precision,recall and F1 score being 0.873,0.856,0.910 and 0.825,respectively.In the validation set,its AUC was 0.915,with correspond-ing values of 0.824,0.800,0.945 and 0.834.Calibration curves and DC A demonstrated that the random forest model had higher prediction accuracy and clinical net benefit.SHAP variable impor-tance plots revealed that the top six contributing imaging factors to END were large-area cerebral in-farction,pre-thrombolysis National Institutes of Health Stroke Scale(NIHSS)score,door-to-needle time(DNT),history of atrial fibrillation,white blood cell(WBC)levels and history of diabetes.Conclusion ML models can effectively predict the risk of END in IVT patients,with the random forest model demonstrating the best predictive performance.Combining SHAP for model visualization interpretation aids clinicians in understanding the contribution of each feature variable to the predic-tion results,thereby facilitating targeted preventive treatment strategies.

Objective This study aims to systematically evaluate the evidence-based medicine of traditional Chinese medicine(TCM)in the treatment of dry eye,analyze its efficacy and differences compared with modern Western medicine treatments,and provide a scientific basis for clinical application.Methods By searching Chinese and English databases(including CNKI,Wanfang Data,PubMed,Cochrane Library,etc.),we included meta-analyses and systematic reviews of TCM treatments for dry eye.Literature was screened according to strict inclusion and exclusion criteria,and relevant data were extracted and integrated for analysis.The Mantel-Haenszel fixed-effects model was used to calculate the relative risk(RR)and mean difference(WMD),with the effect size expressed as a 95％confidence interval,to analyze the efficacy in-dicators of TCM treatment for dry eye.Results A total of 21 articles were finally included,involving various TCM inter-ventions for dry eye(such as Chinese herbal medicine,acupuncture,and TCM external therapies).The results showed that TCM treatment was superior to Western medicine alone in improving the overall clinical efficacy[RR=1.63,95％CI(1.46,1.81),P＜0.05],prolonging tear film break-up time[MD=2.23,95％CI(1.85,2.60),P＜0.05],and increasing tear secretion[MD=1.49,95％CI(1.04,1.94),P＜0.05].In addition,acupuncture,the combination of Chinese herbal medicine and Western medicine,and TCM external therapies all demonstrated unique advantages in improving dry eye symptoms and tear function.Conclusion TCM treatment for dry eye shows significant efficacy in key indicators such as overall clinical efficacy,tear film break-up time,and tear secretion,with a high level of safety.

Objective To evaluate the intravascular volume at different levels of edema and disease course by the fractional excretion of filtered sodium(FeNa)of children with primary nephrotic syndrome(PNS).Methods A total of 172 children with newly diagnosed PNS who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from September 2022 to September 2024 were selected and divided into non-e-dema group(n=51),mild edema group(n=43),moderate edema group(n=46)and severe edema group(n=32)according to the degree of edema at the time of admission.A total of 40 healthy children who underwent physical examination during the same period were selected as the healthy control group.Serum creatinine,ser-um sodium were detected before and after treatment.Urine samples were collected to detect urine creatinine,urine sodium,FeNa was calculated and compared according to the results,and the degree of edema was recor-ded.24 h urine samples were collected on the same day to detect 24 h urine protein quantification and 24 h u-rine volume.Results On day 1 to 2 of the course of the disease,about 12%of the PNS children had FeNa<0.2%,indicating insufficient intravascular volume,which was mainly concentrated in the severe edema group.The moderate,severe edema group had a significantly lower FeNa level than the non-edema group,mild edema group,and healthy control group(P<0.01).The moderate edema group had a significant increase in FeNa on days 6 to 7 of the course of the disease,and the severe edema group had a significant increase in Fena on days 11 to 12 of the course of the disease(P<0.01).Conclusion Intravascular volume of PNS children with mod-erate to severe edema is often reduced,and intravascular volume may be insufficient in severe edema.PNS chil-dren with moderate to severe edema have increased intravascular volume with the extension of the course of disease and the improvement of the condition.

Intellectual disability (ID) is a kind of neurodevelopmental disorder with high clinical and genetic heterogeneity, which seriously endangers the physical and mental health of children. Its etiology is complex, many genetic and environmental factors can participate in the pathogenesis, and metabolic disorders are one of the important etiology. Targeted assays such as plasma amino acids and acylcarnitine and urinary organic acids are of limited use in helping to diagnose and manage these patients. Non-targeted metabolomics has become a tool to explore changes in the metabolites of organisms and a means to study possible biomarkers of such diseases. In recent years, metabolomics technology has made some progress in the etiology and mechanism of ID, providing new ideas and methods for its early recognition, treatment and improvement of prognosis. This paper reviews the progress of non-targeted metabolomics in ID.

Intellectual disability (ID) is a kind of neurodevelopmental disorder with high clinical and genetic heterogeneity, which seriously endangers the physical and mental health of children. Its etiology is complex, many genetic and environmental factors can participate in the pathogenesis, and metabolic disorders are one of the important etiology. Targeted assays such as plasma amino acids and acylcarnitine and urinary organic acids are of limited use in helping to diagnose and manage these patients. Non-targeted metabolomics has become a tool to explore changes in the metabolites of organisms and a means to study possible biomarkers of such diseases. In recent years, metabolomics technology has made some progress in the etiology and mechanism of ID, providing new ideas and methods for its early recognition, treatment and improvement of prognosis. This paper reviews the progress of non-targeted metabolomics in ID.

Objective This study aims to systematically evaluate the evidence-based medicine of traditional Chinese medicine(TCM)in the treatment of dry eye,analyze its efficacy and differences compared with modern Western medicine treatments,and provide a scientific basis for clinical application.Methods By searching Chinese and English databases(including CNKI,Wanfang Data,PubMed,Cochrane Library,etc.),we included meta-analyses and systematic reviews of TCM treatments for dry eye.Literature was screened according to strict inclusion and exclusion criteria,and relevant data were extracted and integrated for analysis.The Mantel-Haenszel fixed-effects model was used to calculate the relative risk(RR)and mean difference(WMD),with the effect size expressed as a 95％confidence interval,to analyze the efficacy in-dicators of TCM treatment for dry eye.Results A total of 21 articles were finally included,involving various TCM inter-ventions for dry eye(such as Chinese herbal medicine,acupuncture,and TCM external therapies).The results showed that TCM treatment was superior to Western medicine alone in improving the overall clinical efficacy[RR=1.63,95％CI(1.46,1.81),P＜0.05],prolonging tear film break-up time[MD=2.23,95％CI(1.85,2.60),P＜0.05],and increasing tear secretion[MD=1.49,95％CI(1.04,1.94),P＜0.05].In addition,acupuncture,the combination of Chinese herbal medicine and Western medicine,and TCM external therapies all demonstrated unique advantages in improving dry eye symptoms and tear function.Conclusion TCM treatment for dry eye shows significant efficacy in key indicators such as overall clinical efficacy,tear film break-up time,and tear secretion,with a high level of safety.

Objective:To investigate the primary causes of hospitalization, comorbidities, hospitalization costs, and the factors influencing hospitalization expenses in gouty arthritis patients at a tertiary hospital in Haikou, Hainan Province, with the aim of providing a theoretical basis for optimizing medical resource allocation.Methods:We collected hospitalization data from gouty arthritis patients diagnosed between January and December 2021 at a tertiary hospital in Haikou. The main causes of hospitalization, the types and proportions of comorbidities, and their associations with hospitalization costs were analyzed. Patients were categorized into groups based on the primary cause of hospitalization: non-surgical gout, surgery for gout tophiformation, cardiovascular disease, cerebrovascular disease, renal disease, digestive system disease, and type 2 diabetes with complications. Chi-square tests were used for categorical variables, one-way ANOVA or Mann-Whitney U test for continuous variables, and multivariate linear regression for identifying factors influencing hospitalization costs. Spearman′s correlation analysis was conducted to explore associations between variables. Results:A total of 851 patients were included, with 721 males (84.7%) and 130 females (15.3%). The mean age was (65.3±14.1) years, and the average length of stay was (11.5±8.5)days. Among the 833 patients with comorbidities (97.9%), the most prevalent comorbid conditions were hypertension (539 cases, 63.3%), cerebral infarction (378 cases, 44.4%), and type 2 diabetes along with its complications (346 cases, 40.7%). The total cost for the non-surgical gout tophi group was 1.01 (0.72, 1.26) ten thousand yuan, which was significantly lower than that for the gout tophi surgery group [2.04(1.37, 3.42)ten thousand yuan( Z=-4.94, P<0.001)], the cardiovascular disease group [1.30(0.71, 2.29) ten thousand yuan( Z=-4.31, P<0.001)], and the cerebrovascular disease group [1.29(0.98, 2.07) ten thousand yuan, Z=-4.68, P<0.001)]. The total cost for the gout tophi surgery group was 2.04 (1.37, 3.42) ten thousand yuan, which was significantly higher than that for the non-surgical gout tophi group [1.01(0.72, 1.26) ten thousand yuan, Z=-4.94, P<0.001)], the cardiovascular disease group [1.30(0.71, 2.29) ten thousand yuan, Z=-2.40, P=0.020)], the cerebrovascular disease group [1.29(0.98, 2.07) ten thousand yuan, Z=-2.50, P=0.010)], the digestive system disease group [1.04(0.67, 1.97) ten thousand yuan, Z=-2.73, P=0.010)], the renal system disease group [1.01(0.78, 1.53)ten thousand yuan, Z=-3.62, P<0.001)], and the type 2 diabetes and its complications group [(0.88(0.67, 1.25) ten thousand yuan, Z=-4.13, P<0.001)]. Spearman correlation analysis showed a strong positive correlation between length of hospital stay and total hospitalization cost ( r=0.71, P<0.001), as well as a strong positive correlation between total cost and insurance reimbursement ( r=0.87 , P<0.001). The results from multiple linear regression analysis indicated that the length of hospital stay ( B=2 670.36, P<0.001), cardiovascular diseases ( B=12 266.28, P<0.001), digestive system diseases ( B=11 251.76, P=0.001), and cerebrovascular diseases ( B=7 318.79, P=0.020) were significantly positively associated with hospitalization costs. Conclusion:Tophus surgery incurred the highest hospitalization costs, with cardiovascular and cerebrovascular diseases being the primary reasons for gout-related hospitalizations. Standardizing gout treatment may reduce the disease burden by potentially lowering the incidence of comorbidities.