Objective:To investigate the value of triglyceride glucose index(TyG)and monocyte to high-density lipoprotein choles-terol ratio(MHR)in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by heart fail-ure(HF),as well as the correlation of TyG and MHR with cardiac function in AECOPD patients.Methods:A retrospective analysis was performed for the clinical data of 298 AECOPD patients who were admitted to The First Hospital of Lanzhou University from January 2020 to December 2021,and according to the clinical manifestation,B-type natriuretic peptide/N-terminal B-type natriuretic peptide precursor,and echocardiography,the 298 AECOPD patients were divided into HF group with 127 patients and non-HF group with 171 patients.Related clinical indicators were compared between the two groups,and a regression analysis was used to identify the pos-sible risk factors for HF in AECOPD patients.The receiver operat-ing characteristic(ROC)curve analysis was used to investigate the value of TyG and MHR alone or in combination in the diagnosis of AECOPD complicated by HF,and a correlation analysis was used to investigate the correlation of TyG and MHR with cardiac function parameters(ejection fraction,ventricular wall thickness,cardiac chamber size,and valve regurgitation velocity)and pulmonary artery pressure in AECOPD patients.Results:The binary logistic regres-sion analysis showed that fasting blood glucose,absolute monocyte count,high-density lipoprotein cholesterol(HDL-C),arrhythmia,TyG,and MHR were independent risk factors for HF in AECOPD patients,and the HF group had significantly higher levels of TyG and MHR than the non-HF group(P<0.001).TyG had an area under the ROC curve(AUC)of 0.805(95%CI=0.754-0.856,P<0.001)in the diagnosis of AECOPD complicated by HF,and MHR had an AUC of 0.762(95%CI=0.707-0.817,P<0.001),while TyG combined with MHR had an AUC of 0.870(95%CI=0.828-0.912,P<0.001).The correlation analysis showed that TyG was negatively correlated with left ventricular ejection fraction and left ventricular fractional shortening and was positively correlated with end-diastolic interven-tricular septal thickness,mitral regurgitation velocity,and left ventricular end-diastolic posterior wall thickness,while MHR was nega-tively correlated with left ventricular stroke volume and left ventricular fractional shortening and was positively correlated with end-diastolic interventricular septal thickness,right ventricular anteroposterior diameter,right ventricular superior-inferior diameter,right ventricular transverse diameter,tricuspid regurgitation velocity,left ventricular end-diastolic posterior wall thickness,and pulmonary artery pressure.Conclusion:Fasting blood glucose,absolute monocyte count,HDL-C,arrhythmia,TyG,and MHR are independent risk factors for AECOPD complicated by HF.Both TyG and MHR have a certain value in the diagnosis of HF,and the combination of TyG and MHR has a better efficacy than each indicator alone in the diagnosis of AECOPD complicated by HF.TyG is correlated with the cardiac function parameters such as left ventricular ejection fraction,ventricular wall thickness,and mitral regurgitation velocity in patients with AECOPD and may have a stronger correlation with the left ventricle;MHR is correlated with right ventricular chamber size,tricuspid regurgitation velocity,and pulmonary artery pressure and may have a stronger correlation with the right ventricle.

Lysine methyltransferase 2A( KMT2A) rearrangement (KMT2A-r) is a high-risk gene subtype of acute lymphoblastic leukemia (ALL) in children with a high relapse rate, poor prognosis and suboptimal response to conventional chemotherapy.Improving the treatment and prognosis of childhood KMT2A-r ALL is an urgent problem.In recent years, with an in-depth understanding of the mechanism of KMT2A-r, more accurate risk stratification of KMT2A-r ALL has been carried out, and great progress has also been made in its immune and targeted therapy.In this article, the genetic and biological characteristics, risk stratification, treatment strategies and prognosis of children KMT2A-r ALL were reviewed in order to provide theoretical support for clinical work and future research.

The paper reports a case of 2,8-dihydroxyadenine (2,8-DHA) crystalline nephropathy caused by mutation of adenine phosphoribosyltransferase ( APRT) gene. The female patient was 60 years old, and sought medical advice due to "foaming urine increased for half a year". Renal biopsy result showed irregular yellowish brown 2,8-DHA crystals with refraction under polarized light. 2,8-DHA crystals were found by urine sediment detection, and homozygous deletion of c.521_523delTCT on exon 5 of APRT gene was found by genetic testing. Finally this patient was diagnosed as 2,8-DHA crystalline nephropathy. Renal function improved after treatment with allopurinol. The case report aims to improve the clinician's understanding of 2,8-DHA crystalline nephropathy. Early recognition, correct diagnosis, and early drug intervention may delay the progression of renal failure and improve the prognosis.

Objective:To investigate the role of hepatitis B virus X protein (HBx) in glomerular podocyte immune disorder and its regulatory mechanism.Methods:Fourteen 6-week-old male hepatitis B virus (HBV) transgenic (HBV-Tg) mice were selected, and age-matched wild type (WT) mice were as controls. They were fed to different weeks, and 24 h urinary protein, blood biochemistry, renal pathology and podocyte changes under electron microscope were detected. The expression of HBx and the infiltration of immune cells in kidney tissue of HBV-Tg mice were observed by immunohistochemistry. Human podocyte cell line was transfected with pcDNA3.1/myc-HBx plasmid, and the localization of HBx and Nephrin in podocytes was detected by immunofluorescence. The expression of major histocompatibility complex Ⅱ (MHC-Ⅱ) and co- stimulatory molecule CD40 on the cell surface was detected by flow cytometry. The contents of multiple cytokines in cell culture supernatants were determined by enzyme-linked immunosorbent assay. Transcriptome sequencing (RNA-seq) was used to screen the downstream related genes regulated by HBx, and real-time quantitative PCR was used to verify their expressions. After overexpression or silencing of Notch1 gene with overexpressed plasmids or short hairpin RNA (shRNA) in podocytes, the effects on the expression of immune molecules and cytokines secretion was observed. The Notch receptor inhibitor N-[N-(3, 5-difluorophenyl-l- alanyl)]-(s)-phenylglycine tert-butyl ester (DAPT) was used to block Notch1 signaling pathway in HBV-Tg mice, and then blood biochemistry, renal pathological changes and infiltration of immune cells in kidney tissue were observed. Results:Twenty-four-hour urine protein, serum creatinine and urea nitrogen levels were markedly increased (all P<0.05) and renal pathological injury was significantly aggravated in HBV-Tg mice than those in WT mice. Also, HBx was up-regulated and immune cells infiltrated in the glomerulus of HBV-Tg mice. After transfection with HBx in podocytes, the expression of MHC-Ⅱ and CD40 on the cellular surface was up-regulated (all P<0.05), the contents of monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor -α (TNF-α) and interleukin (IL)-1β in the supernatants were increased (all P<0.05), and the secretion of IL-4 and interferon γ (IFN-γ) was unbalanced. RNA-seq screened downstream genes of HBx, such as Notch1, PLA2R, TLR4, etc; and further confirmed that HBx could promote the up-regulation of Notch1 mRNA and protein (all P<0.05). After over-expression of Notch1 gene, HBx-induced expression of MHC-Ⅱ and CD40 on the cellular surface was significantly up-regulated (all P<0.05), and the contents of MCP-1, TNF-α and IL-1β in the supernatants were obviously increased (all P<0.05), and the imbalance of IL-4/IFN-γ was further aggravated. After Notch1 gene silencing, the above results showed the opposite changes. In vivo, the results indicated that serum creatinine levels were obviously decreased (all P<0.05), renal pathological injury and immune cell infiltration were significantly alleviated in HBV-Tg+DAPT group than those in HBV-Tg+DMSO group. Conclusions:HBx protein can promote the up-regulation of Notch1 signaling pathway in podocytes. And Notch1 signaling pathway promotes the expression of immune molecules on the surface of podocytes and regulates the imbalance of cytokines, then causes glomerular injury and dysfunction of immune microenvironment.

Objective:To construct an prediction model based on magnetic resonance imaging (MRI) machine learning algorithm and radiomics and investigate its application value in predicting lymphovascular invasion (LVI) status of rectal cancer without lymph node metastasis.Methods:The retrospective cohort study was conducted. The clinicopathological data of 204 rectal cancer patients without lymph node metastasis who were admitted to Gansu Provincial Hospital from February 2016 to January 2024 were collected. There were 123 males and 81 females, aged (61±7)years. All 204 patients were randomly divided into the training dataset of 163 cases and the testing dataset of 41 cases by a ratio of 8∶2 using the electronic computer randomization method. The training dataset was used to construct the prediction model, and the testing dataset was used to validate the prediction model. The clinical prediction model, radiomics model and joint prediction model were constructed based on the selected clinical and/or imaging features. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and the chi-square test or Fisher exact probability were used for comparison between the groups. Comparison of ordinal data was conducted using the nonparameter rank sum test. The inter-class correlation coefficient (ICC) was used to evaluate the consistency of the radiomics features of the two doctors, and ICC >0.80 was good consistency. Univariate analysis was conducted by corres-ponding statistic methods. Multivariate analysis was conducted by Logistic stepwise regression model. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC), Delong test, decision curve and clinical impact curve were used to evaluate the diagnostic efficiency and clinical utility of the model. Result:(1) Analysis of factors affecting LVI status of patients. Of the 204 rectal cancer patients without lymph node metastasis, there were 71 cases with positive of LVI and 133 cases with negative of LVI. Results of multivariate analysis showed that gender, platelet (PLT) count and carcinoembryonic antigen (CEA) were independent factors affecting LVI status of rectal cancer without lymph node metastasis in training dataset [ odds ratio=2.405, 25.062, 2.528, 95% confidence interval ( CI) as 1.093-5.291, 2.748-228.604, 1.181-5.410, P<0.05]. (2) Construction of clinical prediction model. The clinical prediction model was conducted based on the results of multivariate analysis including gender, PLT count and CEA. Results of ROC curve showed that the AUC, accuracy, sensitivity and specificity of clinical prediction model were 0.721 (95% CI as 0.637-0.805), 0.675, 0.632 and 0.698 for the training dataset, and 0.795 (95% CI as 0.644-0.946), 0.805, 1.000 and 0.429 for the testing dataset. Results of Delong test showed that there was no significant difference in the AUC of clinical prediction model between the training dataset and the testing dataset ( Z=-0.836, P>0.05). (3) Construction of radiomics model. A total of 851 radiomics features were extracted from 204 patients, and seven machine learning algorithms, including logistic regression, support vector machine, Gaussian process, logistic regression-lasso algorithm, linear discriminant analysis, naive Bayes and automatic encoder, were used to construct the prediction model. Eight radiomics features were finally selected from the optimal Gaussian process learning algorithm to construct a radiomics prediction model. Results of ROC curve showed that the AUC, accuracy, sensitivity and specificity of radiomics prediction model were 0.857 (95% CI as 0.800-0.914), 0.748, 0.947 and 0.642 for the training dataset, and 0.725 (95% CI as 0.571-0.878), 0.634, 1.000 and 0.444 for the testing dataset. Results of Delong test showed that there was no significant difference in the AUC of radiomics prediction model between the training dataset and the testing dataset ( Z=1.578, P>0.05). (4) Construction of joint prediction model. The joint prediction model was constructed based on the results of multivariate analysis and the radiomics features. Results of ROC curve showed that the AUC, accuracy, sensitivity and specificity of radiomics prediction model were 0.885 (95% CI as 0.832-0.938), 0.791, 0.912 and 0.726 for the training dataset, and 0.857 (95% CI as 0.731-0.984), 0.854, 0.714 and 0.926 for the testing dataset. Results of Delong test showed that there was no significant difference in the AUC of joint prediction model between the training dataset and the testing dataset ( Z=0.395, P>0.05). (5) Performance comparison of three prediction models. Results of the Hosmer-Lemeshow goodness-of-fit test showed that all of the clinical prediction model, radiomics prodiction model and joint prediction model having good fitting degree ( χ2=1.464, 12.763, 10.828, P>0.05). Results of Delong test showed that there was no signifi-cant difference in the AUC between the clinical prediction model and the joint prediction model or the radiomics model ( Z=1.146, 0.658, P>0.05), and there was a significant difference in the AUC between the joint prediction model and the radiomics model ( Z=2.001, P<0.05). Results of calibra-tion curve showed a good performance in the joint prediction model. Results of decision curve and clinical impact curve showed that the performance of joint prediction model in predicting LVI status of rectal cancer without lymph node metastasis was superior to the clinical prediction model and the radiomics model. Conclusions:The clinical prediction model is constructed based on gender, PLT count and CEA. The radiomics predictive model is constructed based on 8 selected radiomics features. The joint prediction model is constructed based on the clinical prediction model and the radiomics predictive model. All of the three models can predict the LVI status of rectal cancer with-out lymph node metastasis, and the joint prediction model has a superior predictive performance.

Objective:To explore the clinical characteristics and prognosis of children with chronic myeloid leukemia in the blast phase (CML-BP) .Methods:The clinical characteristics, treatment measures, and survival outcomes of 28 children with CML-BP were analyzed in our hospital from January 2008 to November 2022.Results:The male to female ratio of the 28 children with CML-BP was 1.15∶1. The median age of diagnosis of CML-BP was 10 years, and the median follow-up time was 79 months. During the diagnosis of CML, four children were in the BP, one was in the accelerated phase (AP) and 23 children were in the chronic phase (CP). Among the 23 children with CML-CP, 75% had progressed directly from CP to BP without experiencing the AP. Among the children diagnosed with CML-BP, 71.4% were classified as chronic myeloid leukemia lymphoid blast phase (CML-LBP), 25.0% belonged to the chronic myeloid leukemia myeloid blast phase (CML-MBP), and 3.6% belonged to the chronic myeloid leukemia mixed phenotype acute leukemia (CML-MPAL). Treatment with hemaopoietic stem cell transplantation (HSCT) after tyosine kinase inhibitor (TKI) combined with chemotherapy was administered to 19 children, two children received HSCT after TKI alone, and seven children received TKI combined with chemotherapy but without HSCT. The 5-year overall survival of the 28 children with CML-BP was 59.3%.Conclusion:The direct progression of BP from CP is greater in children with CML-BP compared with adults, and the overall prognosis of children with CML-BP is poor.

Objective To analyze the pathological types and causes of misdiagnosis of thyroglossal duct cyst(TGDC).Methods The clinical data of 173 patients diagnosed with TGDC before operation in Tangdu Hospital of Air Force Medical University from January 2013 to January 2023 were retrospectively analyzed.Combined with postoperative pathology,a total of 15 patients were found to be misdiagnosed before operation,and the causes of misdiagnosis were summarized.Results The pathological types of 14 misdiagnosed cases in-cluded seven cases of dermoid cyst,three cases of thyroglossal duct papillary carcinoma,one case of accessory thyroid gland,one case of nodular goiter with intracapsular hemorrhage,one case of cervical lymphadenitis and one case of inflammatory nodule.All the 14 patients underwent standard Sistrunk surgery,and regular follow-up after surgery showed no hypothyroidism,recurrence or metastasis.Preoperative static thyroid imaging proved that the neck mass was vago thyroid in one patient,and surgery was not performed to avoid hypothy-roidism or parathyroidism caused by surgery.Conclusion Misdiagnosis of TGDC as other diseases is rare,cli-nicians should raise awareness to avoid the adverse consequences caused by blind operation.

Objective:To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection.Methods:A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study.Results:The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months.Conclusions:MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.

Gastric cancer is a common malignant tumor in China. Most gastric cancer patients are already in the locally advanced stage when they seek medical treatment. Radical surgery is the main treatment for gastric cancer. The quality control of postoperative perioperative management is of great significance in improving the surgical treatment effect and the quality of life of patients. This article systematically summarizes seven aspects, including diet and nutrition management, antimicrobial drug management, pain management, prophylactic anticoagulation management, airway management, postoperative complication management, and discharge and follow-up management, establishes clear quality standards, and achieves the goals of reducing postoperative complications, standardizing perioperative medication use, reducing hospitalization time and costs, thereby reducing patient burden and improving the economic and social benefits of medical institutions.