To investigate the risk factors for acute kidney injury (AKI) following the use of amphotericin B deoxycholate and to develop a predictive model to guide clinical monitoring and intervention.

Purpose: The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. Methods: This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. Results: Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). Conclusion Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.

Objective:To investigate the clinical characteristics and cardiac magnetic resonance (CMR) features of cardiac sarcoidosis (CS).Methods:This retrospective study included 8 consecutive patients with pathologically confirmed CS by endomyocardial biopsy from Fuwai Hospital, Chinese Academy of Medical Sciences, between January 2012 and September 2024. All patients underwent comprehensive CMR examinations including cine imaging and late gadolinium enhancement (LGE) imaging. Clinical data, including electrocardiographic findings, were collected. CMR phenotyping was performed based on imaging characteristics, and cardiac structure and function parameters were evaluated. LGE analysis was conducted using the American Heart Association 17-segment model to assess the distribution patterns and involvement sites.Results:The most common clinical symptoms were chest tightness (4 patients), palpitations (4 patients), and shortness of breath (6 patients). Electrocardiographic abnormalities included atrioventricular block in 4 patients, right bundle branch block in 2 patients, left bundle branch block in 2 patients, frequent premature ventricular contractions in 4 patients, and non-sustained ventricular tachycardia in 5 patients. CMR phenotyping revealed hypertrophic cardiomyopathy pattern in 3 patients, with 2 patients maintaining normal biventricular function and 1 patient showing significantly reduced biventricular systolic function. Dilated cardiomyopathy pattern was identified in 4 patients, all demonstrating significantly impaired biventricular systolic function. One patient exhibited another phenotype with preserved biventricular systolic function. LGE analysis demonstrated that the anterior wall and anterior septum (segments 1, 2, 7, 8) were the most frequently involved regions, followed by the lateral and inferior walls (segments 5, 6, 11, 12). Subepicardial involvement was the predominant pattern of myocardial enhancement.Conclusions:Cardiac sarcoidosis exhibits diverse clinical manifestations and heterogeneous imaging characteristics. CMR not only provides a comprehensive assessment of cardiac structure and function but also reveals distinctive myocardial tissue characteristics, particularly the extent and distribution patterns of LGE involvement. These findings have significant reference value for early identification of CS and differential diagnosis from other cardiomyopathies.

This review aims to analyze the current applications of open surgery, laparoscopic surgery, and robotic surgery in the treatment of colorectal cancer, particularly in elderly patients.It compares the differences among these three surgical methods in terms of surgical indicators, as well as short-term and long-term outcomes.Studies have shown that laparoscopic surgery has become the standard treatment for colorectal cancer, resulting in fewer postoperative complications and faster recovery times.While robotic surgery offers advantages in surgical precision and maneuverability, it is associated with longer surgical times and higher costs.For elderly patients, laparoscopic surgery has demonstrated fewer surgical complications and shorter hospital stays, with no significant difference in long-term survival rates compared to open surgery.However, there is limited research on the application of robotic surgery in elderly patients.Future studies should involve larger-scale, multi-centre randomized controlled trials to provide higher-level evidence and scientific guidance for the individualized treatment of elderly colorectal cancer patients.

AIM To investigate the effects of Yunpi Tongchang Formula on intestinal mucosal barrier damage in rats with opioid-induced constipation(OIC)of Spleen-Kidney Yang Deficiency Syndrome.METHODS In contrast to the 10 rats of the blank group,the 50 rats of the modeling group were induced into models of OIC of Spleen-Kidney Yang Deficiency Pattern by 7 days consecutive administration of both subcutaneous loperamide injection and alternating gavage of activated carbon ice water and vinegar.Following successful modeling,rats were randomly allocated into the model group,the mosapride citrate tablet group(1.35 mg/kg),and the high-dose,medium-dose,and low-dose Yunpi Tongchang Formula groups(15.12,7.56,3.78 g/kg),with 8 mice in each group.Upon the completion of the 14 days treatment,the rats had their TCM Syndrome scores assessed;their fecal water content,initial black stool excretion time,and small intestine propulsion rate measured;their colon tissue morphology observed by HE staining;their serum levels of IL-6,TNF-α,and IL-1β detected by ELISA;their expressions of occludin and zonula occludens-1(ZO-1)in colon tissues detected by immunohistochemistry;their mRNA expressions of MyD88,TLR4 and NF-κB p65 in the colon tissues detected by RT-qPCR;and their protein expressions of MyD88,TLR4 and NF-κB p65 in the colon tissues detected by Western blot.RESULTS Compared to the blank group,the model group had higher TCM Syndrome scores(P＜0.01);lower fecal water content and small intestine propulsion rate(P＜0.05,P＜0.01);longer initial black stool excretion time(P＜0.01);more mucosal edema in colon tissue,obvious inflammatory infiltration,and glandular disorder;increased serum levels of IL-6,TNF-α and IL-1 β(P＜0.05);decreased colon expressions of ZO-1 and occludin(P＜0.01);and increased mRNA and protein expressions of TLR4,MyD88 and NF-κB p65(P＜0.01).Compared to the model group,both the medium-dose Yunpi Tongchang Formula group and the mosapride citrate tablet group demonstrated effectively reduced TCM syndrome scores(P＜0.01);increased fecal water content and small intestine propulsion rate(P＜0.05,P＜0.01);and shorter initial black stool excretion time(P＜0.01);improved colon mucosal edema and inflammatory infiltration;decreased serum levels of IL-6,TNF-α and IL-1β(P＜0.01);upregulated protein expressions of ZO-1 and occludin(P＜0.01);and downregulated mRNA and protein expressions of TLR4,MyD88 and NF-κB p65(P＜0.05,P＜0.01).CONCLUSION Yunpi Tongchang Formula significantly ameliorates constipation symptoms in OIC rat models of Spleen-Kidney Yang Deficiency Syndrome because of its efficacy in attenuating intestinal inflammation and preserving the integrity of intestinal epithelial barrier structure,with its mechanistic action in downregulating TLR4/MyD88/NF-κB signaling pathway activation.

Objective:To explore and compare the effect and prognosis of small bone window surgery at different timings in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods:Using a retrospective analysis, HICH patients admitted to department of neurosurgery of Guihang Guiyang Hospital were selected from May 2021 to May 2023. According to the different surgical timings, the patients were divided into ultra-early group (time from onset to surgery <6 h) and early group (onset to surgery time ≥6~<24 h). Propensity score was used to match 51 cases in each group. The perioperative indicators (surgical time, intraoperative blood loss, hospital stay, hematoma clearance rate), incidence rates of complications, neurological function (National Institute of Health Stroke Scale (NIHSS), Barthel index), endothelin and arginine vasopressin (AVP) before surgery and after 7 days of surgery, clinical efficacy (Glasgow Outcome Scale (GOS)) at 1 month after surgery, rebleeding rate and mortality rate within 1 year after surgery were compared between both groups. Chi-square test was used for between-group comparison of enumeration data, t test was adopted for between-group comparison of measurement data with normal distribution, and non-parametric rank sum test was adopted for comparison of ranked data between groups.Results:The intraoperative blood loss and hospital stay in ultra-early group with (186.54±20.15) mL and (14.45±2.04) d were significantly less or shorter than (220.10±24.61) mL and (16.79±2.52) d in early group, the difference was statistically significant ( t values were 7.54 and 5.15; both P<0.001). At 7 days after surgery, the NIHSS ((14.55±1.57) and (16.14±2.13) points), endothelin ((69.14±6.37) and (73.48±6.83) mg/L) and AVP ((12.81±2.02) and (14.35±2.23) μg/L) in ultra-early group and early group were significantly lower than before ((32.67±3.81) and (32.38±3.53) points, (89.67±7.25) and (88.24±6.38) mg/L, (18.47±2.41) and (18.04±2.37) μg/L) while the Barthel index ((72.35±10.14) and (67.45±9.78) points) was significantly higher than before ((49.45±7.41) and (47.87±7.37) points),and the difference was statistically significant ( t values were 31.40, 28.13, 15.19, 11.28, 12.85, 8.10, 13.02, and 11.42, respectively; all P<0.001) and the NIHSS, endothelin and AVP in ultra-early group were significantly lower than in early group, while the Barthel index was significantly higher than early group, the difference was statistically significant ( t values were 4.29, 3.32, 3.66, and 2.48 respectively; P values were <0.001, 0.001, <0.001, and 0.015, respectively ). GOS grading (grade I-grade V: 1, 3, 9, 22, 16 cases) in ultra-early group at 1 month after surgery was significantly better than that in early group (grade I-V: 3, 5, 10, 26, 7 cases) ( Z=1.97, P=0.049). Conclusion:Both ultra-early and early small bone window surgery have good results in the treatment of HICH, but ultra-early surgery is more beneficial to the recovery of patients' neurological function and has better prognosis, which can be used as a reference.

Objective To investigate the clinical characteristics and prognostic risk factors in elderly patients with acute myeloid leukemia(AML).Methods A retrospective analysis was conducted on the clinical data of 101 elderly AML patients admitted to Affiliated Hospital of Jiaxing University from January 2022 to December 2024.All patients were treated with azacitidine+venetoclax regimen.The clinical characteristics of patients and the risk factors related to prognosis were explored.Results The median follow-up was 14 months.Among the 101 patients,74 achieved complete remission or complete remission with incomplete hematological recovery.The median overall survival(OS)of patients with aged ≥70 years,white blood cell count＞50 × 109/L,TP53 mutation,complex chromosomes,and high-risk European leukemia net(ELN)risk stratification was significantly shortened(P＜0.05).Multivariate analysis showed that age(HR=0.125,95％CI:0.023-0.662,P=0.015),white blood cell count(HR=0.145,95％CI:0.032-0.662,P=0.013),and ELN risk stratification(HR=100.397,95％CI:14.395-700.207,P＜0.001)were all independent influencing factors for OS in elderly AML patients.Conclusion Age,white blood cell count and ELN risk stratification are all independent influencing factors affecting OS in elderly AML patients.

AIM To evaluate the chemical constituent consistency in formula granules and traditional decoctions of Gouteng Jiangya Formula.METHODS HPLC characteristic chromatograms were established,the analysis was performed on a 30 ℃ thermostatic YMC-Triart C18 column(4.6 mm× 250 mm,5 μm),with the mobile phase comprising of acetonitrile-0.2％phosphoric acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 240 nm.Puerarin was used as an internal standard to calculate the relative correction factors of 3'-methoxy puerarin,puerarin apioside,magnolflorine,paeoniflora,daidzin,baicalin,palmatine,berberine,wogonoside and benzoylpaeoniflorin,after which the content detemination was made by quantitative analysis of multi-components by single-marker(QAMS).RESULTS The characteristic chromatograms of 9 batches of formula granules and 15 bacthes of traditional decoctions demonstrated the similarities of more than 0.90 at the detection wavelengths of 192,210,240,260,280,300,320,360 nm,along with similar total peak areas.Eleven constituents showed good linear relationships within their own ranges(r＞0.999 0),whose average recoveries were 97.27％-101.64％with the RSDs of 0.36％-1.11％,the result obtained by QAMS and external standard method demonstrated no significant differences(P＞0.05).The contents of various constituents in the formula granules approximated those in the traditional decoctions.CONCLUSION The consistent kinds and contents of various constituents are obversable in formula granules and traditional decoctions of Gouteng Jiangya Formula,which can provide a reference for the reasonable clinical application of this formula.

Objective:This study aimed to clarify clinicopathologic characteristics, postoperative complications, and related risk factors of elderly patients with gastric cancer.Methods:A total of 395 patients(≥65 years old)who underwent radical gastrectomy for gastric cancer in Beijing Hospital from January 2014 to December 2021 were enrolled in this study.The patients were divided into the common elderly group(age<80 years, n=340)and the high-age group(age ≥ 80 years, n=55). Postoperative complications were classified into medical and surgical types.The clinicopathological characteristics and complications were compared between the two groups.Logistic regression models(univariate and multivariate)were used to identify the risk factors for postoperative complications.Results:The common elderly group was 65-79 years old(mean age: 71.5±4.3 years), with 263 male(77.4%); The high-age group was 80-89 years old(mean age: 82.6±2.6 years), with 42 male(76.4%). The comorbidity rate and the number of comorbidities in the high-age group were significantly higher than those in the common elderly group.The American Society of Anesthesiologists(ASA)scores and nutritional risk screening(NRS)2002 scores in the high-age group were significantly higher than those in the common elderly group(both P<0.05), and the activities of daily living(ADL)scores in the high-age group were significantly lower than that in the common elderly group( P<0.001). There were no statistically significant differences in tumor location, degree of differentiation, pathological type, T stage, and N stage between the two groups(all P>0.05). The overall postoperative complication rate in the high-age group was significantly higher than that in the common elderly group(38.2% vs.24.7%, P=0.036); the medical complications were significantly increased in the high-age group(21.8% vs.10.9%, P=0.022), whereas the surgical complications did not increase significantly(25.5% vs.17.1%, P=0.135). Multivariate analysis revealed that the number of comorbidities ≥2( HR=2.502, 95% CI: 1.275-4.911, P=0.008), preoperative NRS 2002 scores ≥5( HR=2.714, 95% CI1.294-5.693, P=0.008), and preoperative ADL scores<100( HR=2.012, 95% CI1.010-4.009, P=0.047)were independent risk factors for medical complications.Additionally, ASA grade ≥ 3( HR=2.586, 95% CI: 1.444-4.632, P=0.001)and proximal or distal gastrectomy( HR=2.397, 95% CI: 1.237-4.574, P=0.009)were independent risk factors for surgical complications. Conclusions:The occurrence of postoperative medical complications in very elderly patients with gastric cancer undergoing radical surgery has increased, while the rate of surgical complications has not increased.Moreover, advanced age itself is not an independent risk factor for postoperative complications.More attention should be paid to medical complications, and the management of commodities and nutritional support should be strengthened during the perioperative period.

Objective:To analyze the efficacy of phantom-less quantitative computer tomography (PL-QCT) for the diagnosis of osteoporosis in patients with lumbar degenerative diseases.Methods:From October 2021 to October 2023, a total of 1 248 patients with lumbar degenerative disease who did not receive anti-osteoporosis treatment in the Department of Spine Surgery, Tianjin Hospital were retrospectively analyzed. There were 520 males and 728 females, aged 62.31±9.37 years (range, 40-87 years), height 1.66±0.08 m (range, 1.43-1.89 m), weight 69.04±8.27 kg (range, 49-93 kg). The mean body mass index was 26.11±3.67 kg/m 2 (range, 14.40-37.11 kg/m 2). Dual-energy X-ray absorptiometry (DXA) and PL-QCT were used to diagnose osteoporosis, and the detection rates of the two diagnostic methods were compared. The receiver operating characteristic (ROC) curve of PL-QCT for the diagnosis of osteoporosis was drawn, the area under the curve (AUC) and 95% confidence interval (CI), sensitivity and specificity were calculated. Results:Among 1 248 patients with lumbar degenerative diseases, 626 (50.2%) were diagnosed as osteoporosis by PL-QCT, 423(33.9%) were diagnosed by spine DXA, 488(39.1%) were diagnosed by hip DXA and 539 patients(43.2%) were diagnosed by dual-site DXA. The detection rate of osteoporosis of PL-QCT was higher than that of spine DXA (χ 2=193.557, P<0.001), hip DXA (χ 2=322.201, P<0.001) and dual-site DXA (χ 2=94.683, P<0.001), and the difference was statistically significant. Taking the diagnostic results of spinal DXA for osteoporosis as a reference, the ROC curve of PL-QCT for the diagnosis of osteoporosis showed a sensitivity of 79%, a specificity of 81%, and an AUC and 95% CI of 0.82(0.79, 0.85). Taking the diagnostic results of hip DXA for osteoporosis as a reference, the ROC curve of PL-QCT for the diagnosis of osteoporosis showed a sensitivity of 85%, a specificity of 55%, and an AUC and 95% CI of 0.75(0.71, 0.78). Taking the diagnostic results of two-site DXA for osteoporosis as a reference, the ROC curve of PL-QCT for the diagnosis of osteoporosis showed a sensitivity of 72%, a specificity of 75%, and an AUC and 95% CI of 0.81(0.78, 0.83). Conclusion:Compared with DXA, PL-QCT has a higher detection rate of osteoporosis in patients with degenerative lumbar spine disease and good diagnostic efficacy.