AIM To explore the clinical effects of Tongfu Jiangzhuo Formula on ICU delirium patients with Internal Accumulation of Turbid Toxins.METHODS Based on Turbid Toxins theory,two hundred and ten patients were randomly assigned into control group(105 cases)for intervention of conventional treatment,and observation group(105 cases)for intervention of both Tongfu Jiangzhuo Formula and conventional treatment.The changes in clinical effects,delirium scores(CAM-ICU,ICDSC),TCM syndrome score,inflammatory factors(IL-1β,IL-6,IL-8),Raf-1,MEK-2,ERK-1 mRNA and incidence of adverse reactions were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased delirium scores,TCM syndrome score,inflammatory factors and Raf-1,MEK-2,ERK-1 mRNA(P＜0.05),especially for the observation group(P＜0.05).No significant difference in incidence of adverse reactions was found between the two groups(P＞0.05).CONCLUSION For the patients with ICU delirium due to Internal Accumulation of Turbid Toxins,Tongfu Jiangzhuo Formula can safely and effectively improve symptoms,and reduce inflammation levels and Raf-1,MEK-2,ERK-1 mRNA expressions.

AIM To explore the clinical effects of Tongfu Jiangzhuo Formula on ICU delirium patients with Internal Accumulation of Turbid Toxins.METHODS Based on Turbid Toxins theory,two hundred and ten patients were randomly assigned into control group(105 cases)for intervention of conventional treatment,and observation group(105 cases)for intervention of both Tongfu Jiangzhuo Formula and conventional treatment.The changes in clinical effects,delirium scores(CAM-ICU,ICDSC),TCM syndrome score,inflammatory factors(IL-1β,IL-6,IL-8),Raf-1,MEK-2,ERK-1 mRNA and incidence of adverse reactions were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased delirium scores,TCM syndrome score,inflammatory factors and Raf-1,MEK-2,ERK-1 mRNA(P＜0.05),especially for the observation group(P＜0.05).No significant difference in incidence of adverse reactions was found between the two groups(P＞0.05).CONCLUSION For the patients with ICU delirium due to Internal Accumulation of Turbid Toxins,Tongfu Jiangzhuo Formula can safely and effectively improve symptoms,and reduce inflammation levels and Raf-1,MEK-2,ERK-1 mRNA expressions.

Objective To explore the characteristics and influencing factors of complicated intra-abdominal infection in ICU patients after abdominal surgery.Methods A retrospective study was performed on ICU patients(n=92,observation group)developing complicated intra-abdominal infection after abdominal surgery versus patients(n=104,control group)without complicated intra-abdominal infection after abdominal surgery in our hospital from January 2020 to December 2023.The characteristics of patients who developed complicated intra-abdominal infections were analyzed and the relevant influencing factors were identified using multivariate Logistic regression analysis.Results A total of 124 strains of pathogenic bacteria were isolated and identified in 92 infected patients,with 64.52％(80/124)of Gram-negative strains comprising mainly 29.03％(36/124)of Escherichia coli,25.81％(32/124)of Gram-positive strains comprising mainly 12.90％(16/124)of Enterococcus faecalis,and 9.68％(12/124)of fungi comprising mainly 6.45％(8/124)of Candida albicans.Multivariate Logistic regression results showed that preoperative underlying disease,surgical methods,duration of surgery,invasive procedures,antibiotic use,and length of ICU stay,enteral nutrition were the influencing factors of complicated intra-abdominal infection in ICU patients after abdominal surgery(P＜0.0 5).Conclusion Patients with complicated intra-abdominal infection are infected with a variety of pathogenic bacteria,predominantly Gram-negative.The patient's preoperative underlying disease,surgical approach,duration of surgery,invasive procedures,use of antibiotics,length of ICU stay,and early enteral nutrition all affect the risk of complicated intra-abdominal infection in ICU patients after abdominal surgery.

Objective:To explore the mechanism of curcumin (Cur) in intervening leukemia based on transcriptomics and network pharmacology.Methods:(1) Cell proliferation experiment: Leukemia MV-4-11 cells were cultured in vitro and divided into the control group (DMSO), 15 μmol/L curcumin group (Cur 15 μmol/L), and 20 μmol/L curcumin group (Cur 20 μmol/L). The CFSE method by flow cytometry was used to determine the inhibitory effect of curcumin on the growth of leukemia MV-4-11 cells at 0, 24, and 48 hours. (2) Network pharmacology analysis: the Smiles number of curcumin was obtained using the PubChem database. The targets of curcumin were retrieved from SwissTargetPrediction, SEA, TTD, and CTD platforms. Leukemia-related targets were screened using Genecards, OMIM, TTD, and CTD databases, and the intersection targets of curcumin-leukemia were further collected. (3) Transcriptomics and network pharmacology analysis: RNA from MV-4-11 cells in the control group and Cur group was collected, transcriptome sequencing was performed, and the common targets of differential genes in network pharmacology and transcriptomics were collected. The STRING website and Cytoscape software were used to construct a protein-protein interaction (PPI) network for the intersection targets. The David database and micro-bioinformatics were used for enrichment analysis based on gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. Finally, the core targets and main pathways of curcumin in anti-leukemia were screened out.Results:(1) Compared with the control group, 15 μmol/L and 20 μmol/L curcumin significantly inhibited the proliferation of MV-4-11 cells (all P<0.05). (2) Network pharmacology analysis showed 1 209 curcumin drug targets and 7 702 leukemia-related targets, with 901 intersection targets for curcumin′s anti-leukemia effect. (3) Transcriptome sequencing showed 14 714 genes expressed in the curcumin group and 13 689 genes in the control group, with a total of 3 064 differentially expressed genes, including 2 189 up-regulated genes and 875 down-regulated genes. There were 182 intersection targets between network pharmacology and transcriptomics. KEGG enrichment results indicated that the anti-leukemia targets of curcumin were mainly related to cancer signaling pathways, phosphatidylinositol-3-kinase signaling pathway (PI3K-Akt) signaling pathway, and mitogen-activated protein kinase (MAPK) signaling pathway. Conclusions:This study obtained the gene expression profile of curcumin acting on leukemia and elaborated the molecular mechanism of inhibiting leukemia cell proliferation, which is mainly involved in cancer signaling pathways, PI3K-Akt signaling pathway, MAPK signaling pathway, etc., indicating that the inhibitory effect of curcumin on leukemia is multi-faceted and multi-level.

Objective:This study aimed to construct a prediction model for diagnosis of proliferative lupus nephritis based on a machine learning algorithm. Additionally, a user-friendly platform was developed to propose a non-invasive method to assist the pathologic classification of lupus nephritis.Methods:A retrospective analysis was conducted on clinical and pathological data of lupus nephritis patients confirmed by renal biopsy at Zhengzhou University People′s Hospital from January 2017 to August 2023. The study population was randomly divided into training and testing sets in a 7∶3 ratio. Utilizing six machine learning algorithms, classification models were developed. The predictive performance of each model was assessed using metrics such as accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). The optimal model, once identified, was deployed as a web-based calculator for convenient model application. SPSS 25.0 and R 4.2.2 were used to analyze the data.Results:The study included a total of 212 patients, with 138 cases with proliferative lupus nephritis and 74 cases with non-proliferative lupus nephritis. The AUC values for the six models, namely logistic regression, decision tree, random forest, support vector machine, extreme gradient boosting, and light gradient boosting machine, were 0.79, 0.62, 0.79, 0.88, 0.81, and 0.77, respectively; the accuracy rates were 82.54%, 65.08%, 74.60%, 85.71%, 69.84%, 71.43%, respectively. Among them, the support vector machine model demonstrated the optimal performance. This model had deployed as a web-based calculator. Based on feature importance scores, the top 10 influencing factors were identified, including anti URNP antibody, immunoglobulin G, serum globulin, estimated glomerular filtration rate, anti Smith antibody, BMI index, anti dsDNA antibody, uric acid, anti-Rib.p antibody, and gender.Conclusion:A prediction model based on machine learning algorithms was successfully established, and a web calculator was developed to offer a simple and non-invasive method for diagnosing proliferative lupus nephritis. This can assist clinicians in evaluating the risk-benefit ratio of kidney biopsy in patients with lupus nephritis.

This review is based on the research progress and challenges of immune checkpoint inhibitors (ICIs) in the treatment of hepatocellular carcinoma (HCC). ICIs block the PD-1/PD-L1 and CTLA-4 pathways; thereby reactivate the body’s anti-tumor immune response, providing a new therapeutic option for patients with advanced HCC. However, the effect of ICIs is still compromised by factors such as primary and acquired resistance, immune-related adverse events and tumor microenvironment inhibition. This reveiw deeply analyzes these key mechanisms that affect the efficacy of ICIs, and proposes strategies to optimize the treatment, including combination with targeted therapy, chemotherapy and radiotherapy, modulation of tumor microenvironment, and the development of novel biomarkers. Future research should focus on personalized treatment that integrates the molecular and immunological characteristics of patients to enhance the precision and efficacy of ICIs therapy for patients with HCC.

Objective:To explore the relationship between serum complement levels at diagnosis and prognosis in patients with aggressive non-Hodgkin lymphoma(NHL).Methods:The clinical data of 102 patients with aggressive non-Hodgkin lymphoma diagnosed in the First Hospital of Lanzhou University from February 2017 to March 2023 were selected to analyze the correlation between serum complement C3 and C4 levels and prognosis of patients with aggressive NHL at the time of initial diagnosis.The optimal cut-off point of C3 and C4 were obtained by calculating the Jorden index through the receiver operating characteristic(ROC)curve,and 102 patients were divided into low C3 group(C3＜1.07)and high C3 group(C3≥1.07),low C4 group(C4＜0.255)and high C4 group(C4 ≥0.255).The effects of serum C3 and C4 levels on the prognosis of these patients were analyzed.Results:ROC curve analysis showed that the area under the curve(AUC)of C3 and C4 in predicting the prognosis of aggressive NHL patients was 0.634(95％CI:0.525-0.743;P=0.025)and 0.651(95％CI:0.541-0.761;P=0.012),respectively.The optimal cut-off points for C3 and C4 were 1.07 and 0.255,respectively.K-M survival analysis showed that groups with high C3 and C4 levels had shorter progression-free survival(PFS)(P=0.0079;P=0.0092)and overall survival(OS)(P=0.021;P=0.021).Multivariate Cox analysis showed that high level serum complement C3(HR=2.37,95％CI:1.07-5.24,P=0.034)and age ≥60 years(HR=2.34,95％CI:1.11-4.95,P=0.025)were independent risk factors for PFS in patients with aggressive NHL.High level complement C3(HR=2.37,95％CI:1.09-5.13,P=0.029)and age ≥60 years at diagnosis(HR=2.40,95％CI:1.13-5.13,P=0.024)were independent risk factors for OS in patients with aggressive NHL.Conclusion:The level of serum complement C3 at diagnosis is one of the prognostic factors in patients with aggressive NHL.

Objective:To investigate the genetic causal relationship of leukocyte telomere length(LTL)with prostatitis,orchi-tis and epididymitis by two-sample Mendelian randomization(MR).Methods:Using LTL as the exposure factor and prostatitis,or-chitis and epididymitis as outcome factors,we mined the Database of Genome-Wide Association Studies(GWAS).Then,we analyzed the causal relationship of LTL with prostatitis,orchitis and epididymitis by Mendelian randomization using inverse variance weighting(IVW)as the main method and weighted median and MR-Egger regression as auxiliary methods,determined the horizontal multiplicity by MR-Egger intercept test,and conducted sensitivity analysis using the leaving-one-out method.Results:A total of 121 related sin-gle nucleotide polymorphisms(SNPs)were identified in this study.IVW showed LTL to be a risk factor for prostatitis(OR=1.383,95％CI:1.044-1.832,P=0.024),and for orchitis and epididymitis as well(OR=1.770,95％CI:1.275-2.456,P=0.000 6).Conclusion:Genetic evidence from Mendelian randomized analysis indicates that shortening of LTL reduces the risk of prostatitis,orchitis and epididymitis.

Objective:To analyze the application value of ultrasound Thyroid Imaging Reporting and Data System (TI-RADS) classification in the differential diagnosis of thyroid nodules and its correlation with patients' midkine, thymidine kinase 1, and thyroid function indicators.Methods:This study was a prospective study. A total of 108 patients with thyroid nodules (120 nodules) who visited Jinan 2 nd People's Hospital from December 2022 to February 2024 were included. Ultrasound examinations were conducted to complete the TI-RADS classification, and serum levels of midkine (MK) and thymidine kinase 1 (TK1), as well as thyroid function indicators, were measured. Based on the patients' pathological results, the consistency between the TI-RADS diagnostic results and the pathological findings was analyzed. The diagnostic efficacy of TI-RADS classification was calculated. The incidence of malignant nodules across various TI-RADS categories was assessed, and the differences in serum levels of MK, TK1, and thyroid function indicators between patients with benign and malignant nodules were compared. Additionally, a correlation analysis was performed to analyze the correlation between the TI-RADS classification of thyroid nodules and the serum levels of MK, TK1, and thyroid function indicators. Results:Pathological examination results revealed 38 malignant nodules and 82 benign nodules. The consistency between ultrasound TI-RADS classification diagnoses and pathological results was good ( Kappa = 0.90, P < 0.001), with diagnostic sensitivity, specificity, and accuracy of 86.84% (33/38), 97.56% (80/82), and 94.17% (113/120), respectively. Among the ultrasound TI-RADS classifications, the malignant rates for category Ⅳb and category Ⅴ thyroid nodules were the highest, at 92.00% (23/25) and 100.00% (10/10), respectively. Serum levels of MK, TK1, and thyroid-stimulating hormone (TSH) were significantly higher in patients with malignant thyroid nodules than in those with benign thyroid nodules (all P < 0.05). Correlation analysis indicated that TI-RADS classification was positively correlated with serum levels of MK, TK1, and TSH ( r = 0.56, 0.60, 0.52, all P < 0.05). Conclusions:Ultrasound TI-RADS classification can be used to differentiate the nature of thyroid nodules, demonstrating high accuracy with low risks of missed or misdiagnoses. It is also closely related to indicators such as MK, TK1, and TSH, providing a basis for the detection of thyroid cancer.

Objective:To explore the experience of emotion management and program needs of patients with vasovagal syncope (VVS) from the doctor-nurse-patient perspective.Methods:This study was a phenomenological study in qualitative research. Using purposive sampling method, four medical specialists, four nursing specialists, and 10 patients with VVS from the Syncope Center of Shanghai East Hospital, Tongji University were selected from March to May 2024 for semi-structured interviews. Colaizzi's phenomenological data analysis was used to analyze the data.Results:Theme 1 was the initial perception and experience of emotion management, in which the doctor-nurse perspective included two sub-themes of emotion management met the actual needs of clinical patients and the management program was too specialized and unknown, and the patient perspective included three sub-themes of differences in the ability of individuals to recognize their own emotional state, lack of knowledge related to emotion management, and lack of social support. Theme 2 was the need for emotion management programs, in which the doctor-nurse perspective involved two sub-themes of multidisciplinary cooperation, suitable for clinical operation and follow-up, and the combination of online and offline, and in-hospital and out-of-hospital linkage, and the patient perspective involved two sub-themes of the need for healthcare guidance, easy to operate, and the diversification of forms, personalization, and meeting the needs of different populations.Conclusions:The content of emotion management is relatively unknown to doctors, nurses and patients, and even more so to patients. VVS emotion management work is still in its infancy, and emotion management as a branch of rehabilitation needs to be emphasized for its development, and psychological assessment and intervention work should be incorporated into the routine of syncope rehabilitation.