Objective To summarize the clinical efficacy of modified Morrow surgery in the treatment of hypertrophic obstructive cardiomyopathy. Methods A retrospective analysis was conducted on the clinical data of patients with hypertrophic obstructive cardiomyopathy treated with modified Morrow surgery at Zhongshan Hospital Affiliated to Fudan University from 2020 to 2023. Results A total of 318 patients were enrolled, including 156 males and 162 females, with an average age of (55.6±13.1) years. Preoperative echocardiography showed a mean interventricular septal thickness of (18.1±3.8) mm, peak left ventricular outflow tract pressure difference of (86.4±24.9) mm Hg. The surgery time was (162.3±51.0) min, extracorporeal circulation time was (80.9±31.0) min, and aortic occlusion time was (44.8±20.8) min. After the surgery, transesophageal echocardiography showed that the interventricular septal thickness was (11.0±1.8) mm and left ventricular outflow tract peak pressure difference was (9.4±5.1) mm Hg. The incidence rate of postoperative complete left bundle branch block was 45.3%, Ⅲ° atrioventricular block was 3.8%, and postoperative newly developed atrial fibrillation was 3.1%. The postoperative hospital stay was (6.6±4.9) days, and one perioperative death occurred, with a mortality rate of 0.3%. The follow-up time was (10.3±9.4) months, during which the transthoracic echocardiography revealed a ventricular septal thickness of (12.9±2.9) mm and a peak left ventricular outflow tract pressure difference of (13.9±10.0) mm Hg. Conclusion The modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy is safe and effective, with good results in the short and medium term.

Objective To explore the pro-inflammation resolution and protective effects of reactive oxygen species (ROS)-responsive liposomes modified with a cardiac-targeted peptide and loaded with resolvin D1 (RvD1, C-LP-RvD1) on myocardial ischemia-reperfusion (MI/R) injury. Methods The C-LP-RvD1 nanoliposomes were constructed, characterized physically and chemically, and evaluated for in vitro release. Non-targeting peptide-modified drug-loaded liposomes (LP-RvD1) were served as controls. Apoptotic adult mouse cardiomyocytes (AMCMs) were used to verify in vitro targeted binding capacity of C-LP-RvD1. In MI/R mice models, the in vivo distribution and cardiac enrichment of C-LP-RvD1 were assessed. Levels of specialized pro-resolving mediator (SPM) and inflammatory factors in cardiac tissue homogenates and cell culture supernatants were measured using enzyme-linked immunosorbent assay (ELISA). Cardiac function and fibrosis remodeling were evaluated via echocardiography and Masson staining four weeks after treatment. Biosafety was evaluated in healthy mice injected by C-LP-RvD1. Results The C-LP-RvD1 exhibited good nanoscale uniformity and stability, with ROS-triggered accelerated release characteristics. In vitro experiments showed that C-LP-RvD1 had higher binding capacity to apoptotic AMCMs than LP-RvD1, with significantly higher SPM levels (P＜0.01) and lower inflammatory factor levels (P＜0.05). In vivo experiments indicated enhanced cardiac enrichment of C-LP-RvD1 in MI/R injured hearts, with higher local myocardial SPM levels and lower inflammatory factor levels compared to LP-RvD1 (P＜0.05). Four weeks after treatment, compared with LP-RvD1, the C-LP-RvD1 mice group showed improved cardiac function indicators and reduced ventricular fibrosis remodeling ratio (P＜0.05). Safety evaluation revealed no significant systemic inflammation, immunogenicity, or coagulation abnormalities in healthy mice, with liver and kidney function and major organ histology showing no notable damage. Conclusions C-LP-RvD1 improves effective delivery of RvD1 to MI/R injured hearts through injury-targeted enrichment and ROS-responsive release, promoting inflammation resolution and suppressing excessive inflammation, thereby improving cardiac function and reducing adverse remodeling, with favorable biosafety.

Distinct from the complementary inhibition mechanism through binding to the target with three-dimensional conformation of small molecule inhibitors, targeted protein degradation technology takes tremendous advantage of endogenous protein degradation pathway inside cells to degrade plenty of “undruggable” target proteins, which provides a novel route for the treatment of many serious diseases, mainly including proteolysis-targeting chimeras, lysosome-targeting chimeras, autophagy-targeting chimeras, antibody-based proteolysis-targeting chimeras, etc. Unlike proteolysis-targeting chimeras first found in 2001, which rely on ubiquitin-proteasome system to mainly degrade intracellular proteins of interest, lysosome-targeting chimeras identified in 2020, which was act as the fastly developing technology, utilize cellular lysosomal pathway through endocytosis mediated by lysosome-targeting receptor to degrade both extracellular and membrane proteins. As an emerging biomedical technology, nucleic acid-driven lysosome-targeting chimeras utilize nucleic acids as certain components of chimera molecule to replace with ligand to lysosome-targeting receptor or protein of interest, exhibiting broad application prospects and potential clinical value in disease treatment and drug development. This review mainly introduced present progress of nucleic acid-driven lysosome-targeting chimeras technology, including its basic composition, its advantages compared with antibody or glycopeptide-based lysosome-targeting chimeras, and focused on its chief application, in terms of the type of lysosome-targeting receptors. Most research about the development of nucleic acid-driven lysosome-targeting chimeras focused on those which utilized cation-independent mannose-6-phosphonate receptor as the lysosome-targeting receptor. Both mannose-6-phosphonate-modified glycopeptide and nucleic aptamer targeting cation-independent mannose-6-phosphonate receptor, even double-stranded DNA molecule moiety can be taken advantage as the ligand to lysosome-targeting receptor. The same as classical lysosome-targeting chimeras, asialoglycoprotein receptor can also be used for advance of nucleic acid-driven lysosome-targeting chimeras. Another new-found lysosome-targeting receptor, scavenger receptor, can bind dendritic DNA molecules to mediate cellular internalization of complex and lysosomal degradation of target protein, suggesting the successful application of scavenger receptor-mediated nucleic acid-driven lysosome-targeting chimeras. In addition, this review briefly overviewed the history of lysosome-targeting chimeras, including first-generation and second-generation lysosome-targeting chimeras through cation-independent mannose-6-phosphonate receptor-mediated and asialoglycoprotein receptor-mediated endocytosis respectively, so that a clear timeline can be presented for the advance of chimera technique. Meantime, current deficiency and challenge of lysosome-targeting chimeras was also mentioned to give some direction for deep progress of lysosome-targeting chimeras. Finally, according to faulty lysosomal degradation efficiency, more cellular mechanism where lysosome-targeting chimeras perform degradation of protein of interest need to be deeply explored. In view of current progress and direction of nucleic acid-driven lysosome-targeting chimeras, we discussed its current challenges and development direction in the future. Stability of natural nucleic acid molecule and optimized chimera construction have a great influence on the biological function of lysosome-targeting chimeras. Discovery of novel lysosome-targeting receptors and nucleic aptamer with higher affinity to the target will greatly facilitate profound advance of chimera technique. In summary, nucleic acid-driven lysosome-targeting chimeras have many superiorities, such as lower immunogenicity, expedient synthesis of chimera molecules and so on, in contrast to classical lysosome-targeting chimeras, making it more valuable. Also, the chimera technology provides new ideas and methods for biomedical research, drug development and clinical treatment, and can be used more widely through further research and optimization.

Liver fibrosis is a chronic liver injury resulting from factors like viral hepatitis, autoimmune hepatitis, non-alcoholic steatohepatitis, fatty liver disease, and cholestatic liver disease. Liver transplantation is currently the gold standard for treating severe liver diseases. However, it is limited by a shortage of donor organs and the necessity for lifelong immunosuppressive therapy. Mesenchymal stem cells (MSCs) can differentiate into various liver cells and enhance liver function when transplanted into patients due to their differentiation and proliferation capabilities. Therefore, it can be used as an alternative therapy for treating liver diseases, especially for liver cirrhosis, liver failure, and liver transplant complications. However, due to the potential tumorigenic effects of MSCs, researchers are exploring a new approach to treating liver fibrosis using extracellular vesicles (exosomes) secreted by stem cells. Many studies show that exosomes released by stem cells can promote liver injury repair through various pathways, contributing to the treatment of liver fibrosis. In this review, we focus on the molecular mechanisms by which stem cell exosomes affect liver fibrosis through different pathways and their potential therapeutic targets. Additionally, we discuss the advantages of exosome therapy over stem cell therapy and the possible future directions of exosome research, including the prospects for clinical applications and the challenges to be overcome.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To explore the effect of step frequency-controlled walking exercise on vascular endothelial injury in postmenopausal patients with essential hypertension.Methods According to the screening criteria,postmenopausal women aged 55～60 years with essential hypertension and age-matched healthy women with normal blood pressure were recruited.The hypertensive patients were fur-ther divided into an exercise training group(ET)(n=23)that received step frequency-based walking intervention,and a positive control group(PC)(n=23)without exercise intervention.The normotensive healthy subjects were assigned to a negative control group(NC)(n=23).The exercise training lasted 45 to 60 minutes every other day,at least three times a week,for 12 weeks.Before and after the in-tervention,the following parameters were measured:morphological indices[body fat percentage and waist-to-hip ratio(WHR)],blood pressure indicators[systolic blood pressure(SBP)and diastolic blood pressure(SDP)],lipid metabolism markers consisting of the total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-c),and high-density lipoprotein cholesterol,and vascular en-dothelial injury parameters such as endothelial microparticles(EMPs),high-sensitivity C-reactive pro-tein(hs-CRP),and superoxide dismutase(SOD).Results After the intervention,the ET group exhibit-ed significant improvements compared to baseline(P<0.05).Specifically,reductions were observed in body fat percentage,WHR,SBP,TC,TG,LDL-c,EMPs,and hs-CRP(P<0.05).Meanwhile,HDL-c and SOD levels increased significantly(P<0.05).Most of the above indicators demonstrated sig-nificant improvements in the ET group compared to the PC group after the intervention(P<0.05).Con-clusion A 12-week step frequency-controlled walking exercise at moderate intensity improves body com-position,SBP,lipid metabolism,and vascular endothelial function in postmenopausal patients with hy-pertension,suggesting its potentialto reduce cardiovascular risk in this population.

Objective To investigate the impact of Epstein-Barr virus(EBV)infection on immune responses among systemic lupus erythematosus(SLE)patients.Methods AA total of 103 SLE patients(SLE group),50 rheumatoid arthritis(RA)patients(RA group),and 120 healthy physical examinees(control group)were enrolled from May 2022 to April 2024.Anti-EBV CA IgG,IgA,IgM,anti-EBV EA IgM,and anti-EBV NA IgG,IgA antibody levels were measured using direct chemiluminescent magnetic particle-based indirect immunoassay,and positive rates were compared among groups.SLE patients were further divided into reactivated infection and past infection groups based on anti-EBV antibody profiles.Non-specific and specific immune response markers were assessed.Peripheral blood T lymphocytes from two groups were isolated via fluorescence-activated cell sorting(FACS)for transcriptomic sequencing.Results The positive rate of anti-EBV CA IgA antibody in the SLE group[22.30％(23/103)]was higher than that in the RA group[6.00％(3/50)]and the control group[5.00％(6/120)],showing significant difference(P＜0.05).In SLE patients,anti-EBV EA IgM antibody was positively correlated with interferon-α(IFN-α)(r=0.1984,P＜0.05);anti-EBV CA IgM antibody was positively correlated with interleukin(IL)-2,IL-5,and IL-1β(r=0.1980,0.2553,0.1797,P＜0.05);anti-EBV CA IgG antibody was positively correlated with IL-5(r=0.2769,P＜0.05),IL-2(r=0.1820,P＜0.05),IL-8(r=0.1920,P＜0.05),and interferon-γ(IFN-γ)(r=0.1807,P＜0.05).Anti-EBV NA IgG antibody was positively correlated with IL-4(r=0.2015,P＜0.05),IL-8(r=0.2395,P＜0.05),and IL-17(r=0.1795,P＜0.05),and negatively correlated with IL-5(r=-0.2212,P＜0.05).Anti-EBV NA IgG antibody in SLE patients was positively correlated with IgG(r-0.2731,P＜0.05),and anti-EBV CA IgM antibody was positively correlated with IgM(r=0.2614,P＜0.05);anti-EBV EA IgM antibody was negatively correlated with white blood count(r=-0.2742,P＜0.05),neutrophil count(r=-0.2249,P＜0.05),lymphocyte count(r=-0.2723,P＜0.05),and monocyte count(r=-0.2275,P＜0.05),and anti-EBV NA IgA antibody was positively correlated with IgA results(r=0.3231,P＜0.05).The anti-EBV CA IgA antibody-positive SLE group showed elevated levels of the nonspecific immune response marker IgA and decreased levels of C3 and C4,as compared with the anti-EBV CA IgA antibody-negative SLE group,RA group,and control group(P＜0.05).Additionally,when compared with the RA group and control group,the anti-EBV CA IgA antibody-positive SLE group had reduced specific immune response parameters,including CD16+56+,CD 19,and the CD4/CD8 ratio(P＜0.05).Results from transcriptomic sequencing of peripheral blood T lymphocytes revealed upregulation of IL-2,IL-5,IL-8 and IFN-γ in reactivated infection group,as compared with the past infection group(P＜0.05).Results of the differential gene enrichment analysis between the two groups revealed that the differentially expressed genes were primarily associated with inflammatory signaling pathways,such as"inflammatory response activation,""inflammasome formation,"and"inflammatory cytokine release."Conclusion SLE patients demonstrate higher EBV activity.EBV infection may exacerbate SLE's inflammatory microenvironment by activating Th1/Th2 immune responses and promote humoral immune activation.

Objective:To investigate the efficacy of high-flux hemodialysis combined with hemoperfusion in patients with uremia.Methods:Eighty patients with uremia who received treatment at the Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital) from January 2020 to December 2022 were selected for this prospective randomized controlled trial. Participants were grouped using a random number table method, with 40 patients in the study group receiving high-flux hemodialysis combined with hemoperfusion, and 40 patients in the control group receiving high-flux hemodialysis alone. Toxicity clearance, calcium-phosphate metabolism, immune function, and vascular endothelial function were assessed using competitive enzyme-linked immunosorbent assay, immunofluorescence assay, fully automated biochemical analyzers, and immunoturbidimetric assay. The differences in toxicity clearance, calcium-phosphate metabolism, immune function, and vascular endothelial function were compared between the two groups.Results:Compared with before treatment, both groups showed a significant decrease in parathyroid hormone (PTH), blood creatinine, β 2-microglobulin, blood urea nitrogen, blood phosphorus, advanced glycation end products (AGEs), intercellular adhesion molecule-1 (ICAM-1), and homocysteine (Hcy) after treatment. Specifically, PTH levels decreased from (353.28 ± 50.26) ng/L to (235.26 ± 31.51) ng/L in the control group and from (357.17 ± 52.18) ng/L to (174.16 ± 26.35) ng/L in the study group; blood creatinine decreased from (969.47 ± 110.44) μmol/L to (511.57 ± 91.96) μmol/L in the control group and from (957.58 ± 121.99) μmol/L to (414.37 ± 87.41) μmol/L in the study group; β 2-microglobulin decreased from (40.27 ± 7.98) mg/L to (22.06 ± 3.26) mg/L in the control group and from (41.65 ± 8.40) mg/L to (17.70 ± 3.43) mg/L in the study group; blood urea nitrogen decreased from (30.64 ± 5.63) mmol/L to (14.02 ± 2.80) mmol/L in the control group and from (30.04 ± 5.90) mmol/L to (10.07 ± 1.94) mmol/L in the study group; blood phosphorus decreased from (2.23 ± 0.49) mmol/L to (1.80 ± 0.36) mmol/L in the control group and from (2.26 ± 0.53) mmol/L to (1.53 ± 0.31) mmol/L in the study group ; Hcy decreased from (35.87 ± 5.34) μmol/L to (30.93 ± 4.65) μmol/L in the control group and from (36.21 ± 5.27) μmol/L to (20.26 ± 4.53) μmol/L in the study group; ICAM-1 decreased from (574.96 ± 56.81) ng/L to (419.87 ± 40.76) ng/L in the control group and from (569.84 ± 52.37) ng/L to (384.51 ± 35.12) ng/L in the study group; AGEs levels decreased from (330.41 ± 43.69) mg/L to (297.64 ± 38.59) mg/L in the control group and from (326.98 ± 41.25) mg/L to (165.42 ± 15.74) mg/L in the study group. Conversely, compared with before treatment,blood calcium, immunoglobulin G, immunoglobulin M, immunoglobulin A, CD 4+, CD 4+/CD 8+ ratio, complement 3, and complement 4 all increased after treatment. Specifically, blood calcium increased from (1.90 ± 0.43) mmol/L to (2.27 ± 0.32) mmol/L in the control group and from (1.93 ± 0.46) mmol/L to (2.61 ± 0.36) mmol/L in the study group; IgG increased from (7.73 ± 1.56) g/L to (9.21 ± 2.04) g/L in the control group and from (7.82 ± 1.62) g/L to (10.7 ± 2.02) g/L in the study group; IgM increased from (0.42 ± 0.07) g/L to (1.29 ± 0.11) g/L in the control group and from (0.40 ± 0.08) g/L to (1.52 ± 0.08) g/L in the study group; IgA increased from (0.44 ± 0.16) g/L to (1.54 ± 0.25) g/L in the control group and from (0.48 ± 0.19) g/L to (1.93 ± 0.38) g/L in the study group; CD 4+ increased from (32.77 ± 5.71)% to (38.18 ± 4.92)% in the control group and from (32.11 ± 5.34)% to (46.07 ± 4.95)% in the study group; the CD 4+/CD 8+ ratio increased from (1.07 ± 0.14) to (1.29 ± 0.15) in the control group and from (1.07 ± 0.17) to (1.61 ± 0.26) in the study group; C3 increased from (0.80 ± 0.12) g/L to (1.01 ± 0.20) g/L in the control group and from (0.79 ± 0.14) g/L to (1.19 ± 0.23) g/L in the study group; and C4 increased from (0.32 ± 0.15) g/L to (0.67 ± 0.17) g/L in the control group and from (0.33 ± 0.14) g/L to (0.86 ± 0.12) g/L in the study group. All these differences were statistically significant between the two groups ( t = 12.01, 19.47, 33.98, 33.72, 17.64, 20.36, 22.75, 24.28, 19.25, 22.77, 4.71, 29.54, 32.01, 27.39, -5.06, -11.39, -4.79, -9.65, -61.55, -97.13, -36.63, -32.21, -7.71, -16.90, -5.78, -11.34, -9.21, -13.28, -13.25, -33.73, all P < 0.05). Additionally, when compared with the control group, the study group showed superior results ( t = -9.40, -4.84, -5.82, -7.33, -3.59, -10.40, -4.16, -20.07, 4.47, 3.28, 5.43, 7.14, 6.73, 3.73, 5.76, all P < 0.05). Conclusions:High-flux hemodialysis combined with hemoperfusion for the treatment of uremia can effectively improve calcium and phosphorus metabolism and vascular endothelial function, as well as enhance immune function and toxicity clearance rate.

Objective:To investigate the effects of warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets on the function of autologous arteriovenous fistula (AVF) and hemodynamics in patients with uremia. Methods:A prospective study was conducted involving 90 patients with uremia who underwent AVF creation at Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital), from January 2018 to December 2023. The patients were randomly divided into a control group (45 patients receiving aspirin enteric coated tablets) and a study group (45 patients receiving warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets). The internal diameter and blood flow of the fistula, vascular endothelial function, hemodynamics, the presence of vascular murmurs, elasticity, fistula patency and function, and the occurrence of complications were compared between the two groups. Results:After 1 month of treatment, the internal diameter of AVF increased in each group [study group: (6.69 ± 1.93) mm vs. (5.02 ± 1.56) mm; control group: (5.69 ± 1.78) mm vs. (4.93 ± 1.30) mm] compared with before treatment ( t = 8.29, 2.63, both P < 0.05). The blood flow of AVF increased in each group [study group: (530.49 ± 91.88) mL/min vs. (236.51 ± 21.84) mL/min; control group: (418.16 ± 53.87) mL/min vs. (242.36 ± 22.33) mL/min] compared with before treatment ( t = 23.85, 28.69, both P < 0.05). After 1 month of treatment, the internal diameter and blood flow of AVF in the study group were greater compared with those in the control group ( t = 2.55, 7.07, both P < 0.05). After 1 month of treatment, the levels of endothelin-1 in each group significantly decreased compared with before treatment [control group: (64.83 ± 11.80) μmol/L vs. (102.48 ± 16.60) μmol/L; study group: (49.48 ± 12.15) μmol/L vs. (104.60 ± 16.52) μmol/L] compared with before treatment ( t = -19.13, -23.51, both P < 0.05). The levels of nitric oxide [control group: (95.65 ± 14.87) ng/L vs. (78.56 ± 13.47) ng/L; study group: (86.36 ± 14.68) ng/L vs. (76.59 ± 13.56) ng/L], vascular diameter [control group: (7.20 ± 0.63) mm vs. (2.53 ± 0.50) mm; study group: (5.42 ± 0.66) mm vs. (2.47 ± 0.55) mm], vascular wall thickness [control group: (0.82 ± 0.05) mm vs. (0.28 ± 0.07) mm; study group: (0.60 ± 0.05) mm vs. (0.29 ± 0.10) mm], and blood flow [control group: (825.00 ± 65.00) mL/min vs. (314.84 ± 72.75) mL/min; study group: (623.71 ± 74.19) mL/min vs. (321.24 ± 71.62) mL/min] in each group significantly increased compared with before treatment ( t = 9.50, 4.99, 48.94, 26.89, 48.33, 22.11, 55.92, 29.50, all P < 0.05). Additionally, after 1 month of treatment, the levels of endothelin-1 in the study group were significantly lower than those in the control group ( t = 6.08, P < 0.05). The levels of nitric oxide, vascular diameter, vascular wall thickness, and blood flow in the study group were greater than those in the control group ( t = 2.98, 13.15, 21.99, 13.69, all P < 0.05). After 1 month of treatment, the shear stress of the radial artery in each group decreased significantly compared with before treatment [control group: (42.96 ± 6.54) dyne/cm2 vs. (47.62 ± 7.36) dyne/cm2; study group: (34.31 ± 6.71) dyne/cm2 vs. (46.71 ± 7.56) dyne/cm2, t = -13.30, -4.67, both P < 0.05]. The blood flow velocity at the venous end of the anastomosis significantly increased in both groups compared with pre-treatment levels [control group: (85.51 ± 8.48) cm/s vs. (74.60 ± 10.80) cm/s; study group: (119.18 ± 10.27) cm/s vs. (73.27 ± 10.37) cm/s, t = 35.92, 10.03, both P < 0.05]. The shear stress of the radial artery in the study group was lower ( t = -6.18, P < 0.05), while the blood flow velocity at the venous end of the anastomosis was higher ( t = 16.95, P < 0.05) compared with the control group. The incidence of vascular murmurs [11.11% (5/45) vs. 28.89% (13/45)] and the failure/reconstruction rate of the fistula [4.44% (2/45) vs. 24.44% (11/45)] were significantly lower compared with the control group ( Z = -2.10, -2.68, both P < 0.05). The rate of good vascular elasticity [93.33% (42/45) vs. 71.11% (32/45)] and the patency rate of the AVF [93.33% (42/45) vs. 73.33% (33/45) in the study group were significantly higher compared with the control group ( Z = 2.74, 2.53, both P < 0.05). The total incidence of complications in the study group was significantly higher than that in the control group [2.22% (1/45) vs. 20.00% (9/45), χ2 = 7.20, P < 0.05). Conclusions:Warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets can increase the internal diameter and blood flow of AVF in patients with uremia, improve endothelial function and hemodynamics, reduce thrombus formation, enhance fistula function and patency rates, and decrease the incidence of fistula failure/reconstruction and complications.

Objective:To explore the impact of adolescent mental health status on smartphone addiction, and construct a predictive model for smartphone addiction based on the eXtreme Gradient Boosting(XGBoost) algorithm and multivariate Logistic regression.Methods:In April 2023, a cross-sectional survey was conducted among 14 666 adolescents.All participants were systematically evaluated using a self-developed general information questionnaire, the middle school student mental health scale(MSSMHS), the adolescents self-harm scale(ASHS), the interaction anxiousness scale(IAS), the mobile phone addiction index(MPAI), the middle school students shame scale(MSSS), the UCLA loneliness scale(UCLA-LS), the multidimensional peer victimization scale(MPVS), and the basic psychological needs scale(BPNS).R software version 4.3.2 was used for data analysis. Participants were randomly divided into training set and validation set at the ratio of 7∶3.The XGBoost model and multivariate logistic regression model were constructed to predict the risk of smartphone addiction, and a nomogram was plotted.Model performance was evaluated using the Hosmer-Lemeshow test, area under the curve(AUC), and accuracy(ACC).Results:(1) A total of 14 036 high school students were included in the study, with 5 069(36.1%) exhibited smartphone addiction.The training set comprised 9 826 students, with 3 549(36.1%) being smartphone addicts.The validation set included 4 210 students, with 1 520(36.1%) being smartphone addicts.(2) The XGBoost model identified shame-proneness and social anxiety as the two main predictors of smartphone addiction.(3) Multivariate Logistic regression analysis revealed that anxiety( B=0.328, OR(95% CI)=1.39(1.07-1.81), P=0.015), interpersonal sensitivity( B=0.311, OR(95% CI)=1.36(1.05-1.77), P=0.018), learning pressure( B=0.606, OR(95% CI)=1.83(1.46-2.31), P<0.001), mood swings( B=0.775, OR(95% CI)=2.17(1.70-2.78), P<0.001), social anxiety( B=0.024, OR(95% CI)=1.02(1.01-1.04), P<0.001), shame-proneness( B=0.049, OR(95% CI)=1.05(1.04-1.06), P<0.001), and peer victimization( B=0.037, OR(95% CI)=1.04(1.02-1.06), P<0.001) were significant predictors of smartphone addiction.(4) The ACC and AUC values of the XGBoost model were 0.890 and 0.929 in the training set, and 0.865 and 0.864 in the validation set, respectively.The multivariate Logistic regression model achieved ACC and AUC values of 0.870 and 0.854 in the training set, and 0.867 and 0.859 in the validation set, respectively. Conclusion:Anxiety, interpersonal sensitivity, learning pressure, mood swings, social anxiety, shame-proneness, and peer victimization are identified risk predictors of smartphone addiction in high school adolescents.