1.Therapeutic potential of ion channel modulation in Alzheimer's disease.
Bing HUANG ; Cheng-Min YANG ; Zhi-Cheng LU ; Li-Na TANG ; Sheng-Long MO ; Chong-Dong JIAN ; Jing-Wei SHANG
Acta Physiologica Sinica 2025;77(2):327-344
Alzheimer's disease (AD), a prototypical neurodegenerative disorder, encompasses multifaceted pathological processes. As pivotal cellular structures within the central nervous system, ion channels play critical roles in regulating neuronal excitability, synaptic transmission, and neurotransmitter release. Extensive research has revealed significant alterations in the expression and function of ion channels in AD, implicating an important role of ion channels in the pathogenesis of abnormal Aβ deposition, neuroinflammation, oxidative stress, and disruptions in calcium homeostasis and neural network functionality. This review systematically summarizes the crucial roles and underlying mechanisms of ion channels in the onset and progression of AD, highlighting how these channel abnormalities contribute to AD pathophysiology. We also discuss the therapeutic potential of ion channel modulation in AD treatment, emphasizing the importance of addressing multifactorial nature and heterogeneity of AD. The development of multi-target drugs and precision therapies is proposed as a future direction of scientific research.
Alzheimer Disease/therapy*
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Humans
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Ion Channels/physiology*
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Oxidative Stress
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Animals
;
Amyloid beta-Peptides/metabolism*
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Synaptic Transmission
;
Calcium/metabolism*
2.Relationship between frailty and acute kidney injury after hip fracture surgery in the elderly
Shu-Jun YE ; Kai-Hong ZHANG ; Xiao-Man SUN ; Huan-Kai ZHANG ; Zhi-Liang HUANG ; Duo YANG ; Long-Sheng ZHANG
Medical Journal of Chinese People's Liberation Army 2025;50(7):831-838
Objective To analyze the relationship between frailty and acute kidney injury(AKI)after hip fracture surgery in the elderly.Methods A total of 405 elderly patients who underwent hip fracture surgery in Jieyang People's Hospital from August 2021 to January 2023 were retrospectively analysed.According to the modified frailty index(mFI),they were divided into frail group(mFI≥0.27,n=112)and non-frail group(mFI<0.27,n=293).Postoperative AKI was defined according to the Kidney Disease:Improving Global Outcomes(KDIGO)criteria.After 1:1 propensity score matching(PSM),100 cases in each group were successfully matched.Univariable and multivariable logistic regression models,propensity score adjustment,PSM,inverse probability of treatment weighting(IPTW),standardized mortality ratio weighting(SMRW),pairwise algorithm(PA)weighting,and overlap weighting(OW)methods were used to analyze the relationship between frailty and postoperative AKI.Stratified analyses were performed according to age(≥80 or<80 years),gender,whether angiotensin-converting enzyme inhibitors(ACEI)/angiotensin Ⅱreceptor antagonists(ARB)were used,and whether intraoperative hypotension occurred.Results After PSM,there were no significant differences between the two groups in age,sex,surgical type,ACEI/ARB,blood urea nitrogen,serum creatinine,intraoperative blood loss,and intraoperative hypotension[standardized mean difference(SMD)<0.1].In both the original cohort and the matched cohort,the incidence of AKI was higher in frail group than in non-frail group(25.9%vs.8.9%,P<0.001;28.0%vs.11.0%,P=0.002).Analysis of the risk of postoperative AKI in elderly hip fracture patients in frail group found that compared with the non-frail group,in the univariate logistic regression model the odds ratio(OR)and a 95%confidence interval(CI)for the frail group was 3.59(2.00-6.43),P<0.001,and in the multivariable logistic regression model,the OR(95%CI)for frail group was 3.04(1.55-5.95),P=0.001.After adjustment for propensity score,the OR(95%CI)for frail group was 2.85(1.52-5.34),P=0.001,and the OR(95%CI)for frail group after PSM was 3.15(1.47-6.75),P=0.003.After IPTW,SMRW,PA weighting,and OW,the OR(95%CI)for frail group were 2.48(1.37-4.50),2.43(1.41-4.19),2.63(1.25-5.54),and 2.69(1.07-6.78),respectively,with P<0.05.The interaction tests were not statistically significant for age,sex,use of ACEI/ARB,and intraoperative hypotension(P>0.05).Conclusion In elderly patients with hip fractures,preoperative frailty may be a risk factor for postoperative AKI.
3.Predictive value of caliceal pelvic height-to-infundibular length ratio for stone-free rate in lower calyx stone treatment with flexible ureteroscopic lithotripsy
Shiwei HUANG ; Sheng ZHONG ; Guangming YIN ; Long WANG ; Zhiqiang JIANG ; Kai HUANG ; Jing TAN
Chinese Journal of Urology 2025;46(8):600-606
Objective:This study aims to explore the predictive value of the ratio of caliceal pelvic height to infundibular length(CPH/IL)for the stone-free rate(SFR)in the treatment of lower calyx stones using flexible ureteroscopic lithotripsy(FURL)combined with a distally bendable negative pressure suction sheath.Methods:A retrospective analysis was conducted on the clinical data and anatomical parameters of 312 patients with lower calyx stones or combined lower calyx stones admitted to the Third Xiangya Hospital of Central South University from September 2022 to December 2023,all of whom were treated with FURL combined with a distally bendable negative pressure suction sheath. Stone clearance was defined as no residual stones or residual stones with a diameter of ≤3 mm without any symptoms. Patients were divided into the clearance group(265 cases,84.90%)and the non-clearance group(47 cases,15.10%). There were no significant differences in gender(male/female:173/92 cases vs. 29/18 cases),age[(44.69 ± 13.14)years vs.(42.60 ± 10.93)years],degree of hydronephrosis(no hydronephrosis/mild hydronephrosis/moderate to severe hydronephrosis:122/85/58 cases vs. 21/12/14 cases),side of lower calyx stones(left/right:157/108 cases vs. 31/16 cases),maximum diameter of stones(MDS)[(19.23 ± 6.41)mm vs.(17.77 ± 6.18)mm],and CT value of stones[(993.46 ± 249.12)Hu vs.(1013.43 ± 300.90)Hu]between the two groups( P > 0.05),indicating comparability between groups. There was no significant difference in the distance from the midpoint of the lower lip of the renal pelvis to the ureter at the lowest plane of the lower calyx(K-A line)between the clearance and non-clearance groups[(26.16 ± 5.18)mm vs.(25.70 ± 8.66)mm, P > 0.05]. However,significant differences were observed in the infundibulopelvic angle(IPA)[(53.97 ± 15.72)° vs.(37.43 ± 15.39)°],infundibular length(IL)[(27.26 ± 5.11)mm vs.(33.04 ± 7.38)mm],infundibular width(IW)[(8.27 ± 2.82)mm vs.(7.09 ± 3.20)mm],caliceal pelvic height(CPH)[(19.96 ± 4.63)mm vs.(30.32 ± 7.56)mm],ureter-lower calyx distance(ULD)[(23.00 ± 5.59)mm vs.(18.78 ± 6.31)mm],CPH/IL ratio[(0.73 ± 0.11)vs.(0.92 ± 0.09)],and curvature of the lower calyx of the renal pelvis[(0.06 ± 0.01)mm -1 vs.(0.08 ± 0.03)mm -1]between the two groups( P <0.05). Univariate and logistic multivariate regression analyses were used to identify the independent risk factors affecting the postoperative SFR of FURL-treated lower calyx stones and to assess the value of CPH/IL for SFR in the treatment of lower calyx stones using FURL combined with a distally bendable negative pressure suction sheath. A logistic multivariate regression model and a corresponding nomogram were constructed,and the predictive ability of the model for SFR was evaluated using the receiver operating characteristic(ROC)curve. The calibration curve and the Hosmer -Lemeshow test were used to assess the consistency and accuracy of the model. The clinical utility of the model was evaluated using decision curve analysis(DCA). Results:Univariate analysis revealed that seven anatomical parameters differed significantly between the clearance and non-clearance groups(all P < 0.05):infundibulopelvic angle(IPA, OR = 0.27,95% CI 0.17-0.42, P < 0.01),infundibular length(IL, OR = 2.52,95% CI 1.83-3.47, P < 0.01),infundibular width(IW, OR = 0.64,95% CI 0.45-0.90, P = 0.011),caliceal pelvic height(CPH, OR = 5.78,95% CI 3.67-9.10, P < 0.01),ureter-lower calyx distance(ULD, OR = 0.43,95% CI 0.30-0.63, P < 0.01),CPH/IL ratio( OR = 13.62,95% CI 6.86-27.03, P < 0.01),and curvature of the lower calyx of the renal pelvis( O = 3.15,95% CI 2.08-4.78, P < 0.01). Multivariate logistic regression further identified CPH/IL( OR = 9.87,95% CI 4.92-19.79, P < 0.01),IPA( OR = 0.41,95% CI 0.23-0.71, P = 0.001),and ULD( OR = 0.50,95% CI 0.29-0.87, P = 0.014)as independent risk factors influencing the stone-free rate after flexible ureteroscopic lithotripsy combined with a distally bendable negative-pressure suction sheath. The area under the ROC curve(AUC)of the univariate regression model showed that for IPA,the AUC was 0.788(95% CI 0.711-0.864);for IL,it was 0.731(95% CI 0.643-0.819);for ULD,it was 0.677(95% CI 0.586-0.767);for CPH,it was 0.867(95% CI 0.804-0.929);for IW,it was 0.628(95% CI 0.535-0.721);for CPH/IL,it was 0.906(95% CI 0.850-0.961)with an optimal cutoff value of 0.882,corresponding to a sensitivity of 83.02% and a specificity of 92.08%;and for curvature of the lower calyx of the renal pelvis,it was 0.744(95% CI 0.662-0.827). The AUC of the multivariate regression model was 0.929(95% CI 0.884-0.974)with an optimal cutoff value of 0.364,corresponding to a sensitivity of 82.98% and a specificity of 95.09%. Calibration curves demonstrated close agreement between the predicted and actual stone-free rates after FURL(C-index = 0.921). The Hosmer-Lemeshow goodness-of-fit test indicated no significant discrepancy between predicted and observed probabilities( P = 0.135,>0.05). Decision-curve analysis further revealed that basing clinical decisions on the model ,s predicted probability yields a higher net clinical benefit than either withholding FURL for all patients or treating all patients regardless of risk,and it also outperforms strategies guided by any single independent predictor alone. Conclusions:IPA,IL,IW,CPH,ULD,CPH/IL ratio,and curvature of the lower calyx of the renal pelvis can all predict the postoperative SFR of FURL combined with a distally bendable negative pressure suction sheath for the treatment of lower calyx stones to varying degrees. Among them,CPH/IL has the highest predictive value. When CPH/IL >0.88,it may be difficult to use FURL to treat lower calyx stones.
4.Analysis of Risk Factors for Uremic Encephalopathy in Maintenance Hemodialysis Patients
Hai-yan KANG ; Zhi-yan TAN ; Liu-yu TAN ; Wei-guang LU ; Qiong HUANG ; Sheng-bao LONG
Progress in Modern Biomedicine 2025;25(16):2630-2635
Objective:To explore the independent risk factors for uremic encephalopathy(UE)in maintenance hemodialysis(MHD)patients and provide evidence for early clinical warning and intervention.Methods:A case-control study was conducted,enrolling 67 MHD patients diagnosed with UE(UE group)at Laibin People's Hospital from January 2010 to December 2024,and 67 non-UE patients during the same period(control group).Demographic characteristics,dialysis parameters,laboratory indicators,and infection events were collected.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for UE.Results:The UE group had significantly higher rates of infection(58.2%vs.29.9%),serum creatinine(789 vs.702 μmol/L),and iPTH levels(568 vs.385 pg/mL)compared to the control group(P<0.05).Multivariate analysis revealed that concurrent infection(OR=3.022,95%CI:1.312-6.958),elevated serum creatinine(OR=1.004,95%CI:1.000-1.008),and elevated iPTH(OR=1.002,95%CI:1.001-1.003)were independent risk factors for UE(P<0.05).The combined prediction model achieved an AUC of 0.878(95%CI:0.822-0.934),with 82.1%sensitivity and 80.6%specificity.Conclusion:Infection,elevated serum creatinine,and elevated iPTH significantly increase the risk of UE in MHD patients.Clinical management should emphasize infection prevention,toxin clearance optimization,and parathyroid function regulation to reduce UE incidence.
5.Bioequivalence of rivaroxabanpian in healthy Chinese subjects
Xu ZHU ; Xiao-ni WANG ; Chang LU ; Ran ZHANG ; Ning CHEN ; Jin-mei ZHOU ; Feng ZHANG ; Wen ZHANG ; Sheng-long ZHAO ; Shun-wang HUANG ; Huan ZHOU
Chinese Pharmacological Bulletin 2025;41(11):2194-2199
Aim To evaluate the bioequivalence of two oral preparations of rivaroxaban tablets(test preparation T and refe-rence preparation R)in fasting/postprandibular state in healthy Chinese subjects.Methods A randomized,open,single-dose,four-cycle,completely repeated crossover experiment was used in this study.A total of 70 healthy male and female subjects were enrolled,including 38 subjects in the fasting group and 32 sub-jects in the postprandial group.Rivaroxaban tablets(2.5 mg/tablet)were taken orally once per cycle and their reference preparations were tested.The plasma rivaroxaban concentration was determined by LC-MS/MS method.The pharmacokinetic parameters of rivaroxaban tablets were calculated by WinNonlin software,and the parameters were analyzed and processed.Re-sults The PK parameters of rivaroxaban tablets and reference preparations in fasting group were as follows:Cmax was(72.48±17.08)and(66.36±15.64)μg·L-1,respectively.AUC0-t were(383.49±101.06)and(370.43±102.16)h·ng·mL-1,and AUC0-inr were(389.58±102.28)and(375.84±103.01)h·μg·L-,respectively.Main PK parameters of subjects taking rivaroxaban tablets orally after meals:Cmax were(66.48±15.64 and 60.87±13.44)μg·L-1,AUC0-t were(404.44±72.58)and(381.80±79.93)h·μg·L-1,re-spectively.AUC0_inf was(410.88±73.55)and(393.64±69.71)h·μg·L-1,respectively.Under fasting and postmeal conditions,subjects took rivaroxaban test and reference prepara-tion orally,one tablet(2.5 mg/tablet)each time.The geometric mean of the main pharmacokinetic parameters of rivaroxaban in plasma(Cmax,AUC0-t,AUC0-inf)and their corresponding values had a 90%confidence interval ranging from 80.00%to 125.00%.No serious adverse events or unexpected adverse e-vents occurred in both groups.Conclusion Rivaroxaban tablets are bioequivalent and safe in vivo under fasting and postprandial conditions.
6.Research progress of nano drug delivery system based on metal-polyphenol network for the diagnosis and treatment of inflammatory diseases
Meng-jie ZHAO ; Xia-li ZHU ; Yi-jing LI ; Zi-ang WANG ; Yun-long ZHAO ; Gao-jian WEI ; Yu CHEN ; Sheng-nan HUANG
Acta Pharmaceutica Sinica 2025;60(2):323-336
Inflammatory diseases (IDs) are a general term of diseases characterized by chronic inflammation as the primary pathogenetic mechanism, which seriously affect the quality of patient′s life and cause significant social and medical burden. Current drugs for IDs include nonsteroidal anti-inflammatory drugs, corticosteroids, immunomodulators, biologics, and antioxidants, but these drugs may cause gastrointestinal side effects, induce or worsen infections, and cause non-response or intolerance. Given the outstanding performance of metal polyphenol network (MPN) in the fields of drug delivery, biomedical imaging, and catalytic therapy, its application in the diagnosis and treatment of IDs has attracted much attention and significant progress has been made. In this paper, we first provide an overview of the types of IDs and their generating mechanisms, then sort out and summarize the different forms of MPN in recent years, and finally discuss in detail the characteristics of MPN and their latest research progress in the diagnosis and treatment of IDs. This research may provide useful references for scientific research and clinical practice in the related fields.
7.Propofol Promotes Anesthesia Through the Activation of Centrally-Projecting Edinger-Westphal Nucleus Urocortin 1-Positive Neurons.
Jing HUANG ; Yiwen HU ; Sheng JING ; Fuhai BAI ; Zonghong LONG ; Zhuoxi WU ; Liang FANG ; Lei CAO ; Youliang DENG ; Xiaohang BAO ; Hong LI
Neuroscience Bulletin 2025;41(6):1109-1114
8.Bioequivalence of rivaroxabanpian in healthy Chinese subjects
Xu ZHU ; Xiao-ni WANG ; Chang LU ; Ran ZHANG ; Ning CHEN ; Jin-mei ZHOU ; Feng ZHANG ; Wen ZHANG ; Sheng-long ZHAO ; Shun-wang HUANG ; Huan ZHOU
Chinese Pharmacological Bulletin 2025;41(11):2194-2199
Aim To evaluate the bioequivalence of two oral preparations of rivaroxaban tablets(test preparation T and refe-rence preparation R)in fasting/postprandibular state in healthy Chinese subjects.Methods A randomized,open,single-dose,four-cycle,completely repeated crossover experiment was used in this study.A total of 70 healthy male and female subjects were enrolled,including 38 subjects in the fasting group and 32 sub-jects in the postprandial group.Rivaroxaban tablets(2.5 mg/tablet)were taken orally once per cycle and their reference preparations were tested.The plasma rivaroxaban concentration was determined by LC-MS/MS method.The pharmacokinetic parameters of rivaroxaban tablets were calculated by WinNonlin software,and the parameters were analyzed and processed.Re-sults The PK parameters of rivaroxaban tablets and reference preparations in fasting group were as follows:Cmax was(72.48±17.08)and(66.36±15.64)μg·L-1,respectively.AUC0-t were(383.49±101.06)and(370.43±102.16)h·ng·mL-1,and AUC0-inr were(389.58±102.28)and(375.84±103.01)h·μg·L-,respectively.Main PK parameters of subjects taking rivaroxaban tablets orally after meals:Cmax were(66.48±15.64 and 60.87±13.44)μg·L-1,AUC0-t were(404.44±72.58)and(381.80±79.93)h·μg·L-1,re-spectively.AUC0_inf was(410.88±73.55)and(393.64±69.71)h·μg·L-1,respectively.Under fasting and postmeal conditions,subjects took rivaroxaban test and reference prepara-tion orally,one tablet(2.5 mg/tablet)each time.The geometric mean of the main pharmacokinetic parameters of rivaroxaban in plasma(Cmax,AUC0-t,AUC0-inf)and their corresponding values had a 90%confidence interval ranging from 80.00%to 125.00%.No serious adverse events or unexpected adverse e-vents occurred in both groups.Conclusion Rivaroxaban tablets are bioequivalent and safe in vivo under fasting and postprandial conditions.
9.Analysis of Risk Factors for Uremic Encephalopathy in Maintenance Hemodialysis Patients
Hai-yan KANG ; Zhi-yan TAN ; Liu-yu TAN ; Wei-guang LU ; Qiong HUANG ; Sheng-bao LONG
Progress in Modern Biomedicine 2025;25(16):2630-2635
Objective:To explore the independent risk factors for uremic encephalopathy(UE)in maintenance hemodialysis(MHD)patients and provide evidence for early clinical warning and intervention.Methods:A case-control study was conducted,enrolling 67 MHD patients diagnosed with UE(UE group)at Laibin People's Hospital from January 2010 to December 2024,and 67 non-UE patients during the same period(control group).Demographic characteristics,dialysis parameters,laboratory indicators,and infection events were collected.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for UE.Results:The UE group had significantly higher rates of infection(58.2%vs.29.9%),serum creatinine(789 vs.702 μmol/L),and iPTH levels(568 vs.385 pg/mL)compared to the control group(P<0.05).Multivariate analysis revealed that concurrent infection(OR=3.022,95%CI:1.312-6.958),elevated serum creatinine(OR=1.004,95%CI:1.000-1.008),and elevated iPTH(OR=1.002,95%CI:1.001-1.003)were independent risk factors for UE(P<0.05).The combined prediction model achieved an AUC of 0.878(95%CI:0.822-0.934),with 82.1%sensitivity and 80.6%specificity.Conclusion:Infection,elevated serum creatinine,and elevated iPTH significantly increase the risk of UE in MHD patients.Clinical management should emphasize infection prevention,toxin clearance optimization,and parathyroid function regulation to reduce UE incidence.
10.Predictive value of caliceal pelvic height-to-infundibular length ratio for stone-free rate in lower calyx stone treatment with flexible ureteroscopic lithotripsy
Shiwei HUANG ; Sheng ZHONG ; Guangming YIN ; Long WANG ; Zhiqiang JIANG ; Kai HUANG ; Jing TAN
Chinese Journal of Urology 2025;46(8):600-606
Objective:This study aims to explore the predictive value of the ratio of caliceal pelvic height to infundibular length(CPH/IL)for the stone-free rate(SFR)in the treatment of lower calyx stones using flexible ureteroscopic lithotripsy(FURL)combined with a distally bendable negative pressure suction sheath.Methods:A retrospective analysis was conducted on the clinical data and anatomical parameters of 312 patients with lower calyx stones or combined lower calyx stones admitted to the Third Xiangya Hospital of Central South University from September 2022 to December 2023,all of whom were treated with FURL combined with a distally bendable negative pressure suction sheath. Stone clearance was defined as no residual stones or residual stones with a diameter of ≤3 mm without any symptoms. Patients were divided into the clearance group(265 cases,84.90%)and the non-clearance group(47 cases,15.10%). There were no significant differences in gender(male/female:173/92 cases vs. 29/18 cases),age[(44.69 ± 13.14)years vs.(42.60 ± 10.93)years],degree of hydronephrosis(no hydronephrosis/mild hydronephrosis/moderate to severe hydronephrosis:122/85/58 cases vs. 21/12/14 cases),side of lower calyx stones(left/right:157/108 cases vs. 31/16 cases),maximum diameter of stones(MDS)[(19.23 ± 6.41)mm vs.(17.77 ± 6.18)mm],and CT value of stones[(993.46 ± 249.12)Hu vs.(1013.43 ± 300.90)Hu]between the two groups( P > 0.05),indicating comparability between groups. There was no significant difference in the distance from the midpoint of the lower lip of the renal pelvis to the ureter at the lowest plane of the lower calyx(K-A line)between the clearance and non-clearance groups[(26.16 ± 5.18)mm vs.(25.70 ± 8.66)mm, P > 0.05]. However,significant differences were observed in the infundibulopelvic angle(IPA)[(53.97 ± 15.72)° vs.(37.43 ± 15.39)°],infundibular length(IL)[(27.26 ± 5.11)mm vs.(33.04 ± 7.38)mm],infundibular width(IW)[(8.27 ± 2.82)mm vs.(7.09 ± 3.20)mm],caliceal pelvic height(CPH)[(19.96 ± 4.63)mm vs.(30.32 ± 7.56)mm],ureter-lower calyx distance(ULD)[(23.00 ± 5.59)mm vs.(18.78 ± 6.31)mm],CPH/IL ratio[(0.73 ± 0.11)vs.(0.92 ± 0.09)],and curvature of the lower calyx of the renal pelvis[(0.06 ± 0.01)mm -1 vs.(0.08 ± 0.03)mm -1]between the two groups( P <0.05). Univariate and logistic multivariate regression analyses were used to identify the independent risk factors affecting the postoperative SFR of FURL-treated lower calyx stones and to assess the value of CPH/IL for SFR in the treatment of lower calyx stones using FURL combined with a distally bendable negative pressure suction sheath. A logistic multivariate regression model and a corresponding nomogram were constructed,and the predictive ability of the model for SFR was evaluated using the receiver operating characteristic(ROC)curve. The calibration curve and the Hosmer -Lemeshow test were used to assess the consistency and accuracy of the model. The clinical utility of the model was evaluated using decision curve analysis(DCA). Results:Univariate analysis revealed that seven anatomical parameters differed significantly between the clearance and non-clearance groups(all P < 0.05):infundibulopelvic angle(IPA, OR = 0.27,95% CI 0.17-0.42, P < 0.01),infundibular length(IL, OR = 2.52,95% CI 1.83-3.47, P < 0.01),infundibular width(IW, OR = 0.64,95% CI 0.45-0.90, P = 0.011),caliceal pelvic height(CPH, OR = 5.78,95% CI 3.67-9.10, P < 0.01),ureter-lower calyx distance(ULD, OR = 0.43,95% CI 0.30-0.63, P < 0.01),CPH/IL ratio( OR = 13.62,95% CI 6.86-27.03, P < 0.01),and curvature of the lower calyx of the renal pelvis( O = 3.15,95% CI 2.08-4.78, P < 0.01). Multivariate logistic regression further identified CPH/IL( OR = 9.87,95% CI 4.92-19.79, P < 0.01),IPA( OR = 0.41,95% CI 0.23-0.71, P = 0.001),and ULD( OR = 0.50,95% CI 0.29-0.87, P = 0.014)as independent risk factors influencing the stone-free rate after flexible ureteroscopic lithotripsy combined with a distally bendable negative-pressure suction sheath. The area under the ROC curve(AUC)of the univariate regression model showed that for IPA,the AUC was 0.788(95% CI 0.711-0.864);for IL,it was 0.731(95% CI 0.643-0.819);for ULD,it was 0.677(95% CI 0.586-0.767);for CPH,it was 0.867(95% CI 0.804-0.929);for IW,it was 0.628(95% CI 0.535-0.721);for CPH/IL,it was 0.906(95% CI 0.850-0.961)with an optimal cutoff value of 0.882,corresponding to a sensitivity of 83.02% and a specificity of 92.08%;and for curvature of the lower calyx of the renal pelvis,it was 0.744(95% CI 0.662-0.827). The AUC of the multivariate regression model was 0.929(95% CI 0.884-0.974)with an optimal cutoff value of 0.364,corresponding to a sensitivity of 82.98% and a specificity of 95.09%. Calibration curves demonstrated close agreement between the predicted and actual stone-free rates after FURL(C-index = 0.921). The Hosmer-Lemeshow goodness-of-fit test indicated no significant discrepancy between predicted and observed probabilities( P = 0.135,>0.05). Decision-curve analysis further revealed that basing clinical decisions on the model ,s predicted probability yields a higher net clinical benefit than either withholding FURL for all patients or treating all patients regardless of risk,and it also outperforms strategies guided by any single independent predictor alone. Conclusions:IPA,IL,IW,CPH,ULD,CPH/IL ratio,and curvature of the lower calyx of the renal pelvis can all predict the postoperative SFR of FURL combined with a distally bendable negative pressure suction sheath for the treatment of lower calyx stones to varying degrees. Among them,CPH/IL has the highest predictive value. When CPH/IL >0.88,it may be difficult to use FURL to treat lower calyx stones.

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