Objective:To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer.Methods:A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 (58.2%) were male and 415 (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until June 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models.Results:Among 992 patients,open surgery was the predominant approach (89.1%, 884/992), and radical antegrade modular pancreatosplenectomy (RAMPS) was performed in 317 patients (32.0%). Combined organ resection,venous resection,and arterial resection were performed in 23.5%, 9.3%,and 11.2% of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992),41.5% (412/992), and 8.7% (86/992),respectively. Stage ⅡB was the most common TNM stage (32.2%,319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period was 32.0(8.8) months(range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. In the recent five years (from 2020 to 2024), the median OS improved significantly to 34.1 months compared to 20.0 months from 2016 to 2019 ( P<0.01). Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC, n=855),58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC, n=32),and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) ( P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months, P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months),the difference was not statistically significant ( P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors ( P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for ⅠB, 25.5 months for ⅡA, 23.7 months for ⅡB, 23.0 months for Ⅲ, and 14.4 months for Ⅳ. The median OS time for R0,R1-1 mm,and R1-direct resections was 34.1,24.7,and 15.7 months,respectively ( P<0.01). Conclusion:Adjuvant chemotherapy,R0 resection,tumor stage,and differentiation are independent prognostic factors for pancreatic body and tail cancer.

Objective:To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer.Methods:A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 (58.2%) were male and 415 (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until June 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models.Results:Among 992 patients,open surgery was the predominant approach (89.1%, 884/992), and radical antegrade modular pancreatosplenectomy (RAMPS) was performed in 317 patients (32.0%). Combined organ resection,venous resection,and arterial resection were performed in 23.5%, 9.3%,and 11.2% of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992),41.5% (412/992), and 8.7% (86/992),respectively. Stage ⅡB was the most common TNM stage (32.2%,319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period was 32.0(8.8) months(range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. In the recent five years (from 2020 to 2024), the median OS improved significantly to 34.1 months compared to 20.0 months from 2016 to 2019 ( P<0.01). Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC, n=855),58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC, n=32),and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) ( P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months, P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months),the difference was not statistically significant ( P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors ( P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for ⅠB, 25.5 months for ⅡA, 23.7 months for ⅡB, 23.0 months for Ⅲ, and 14.4 months for Ⅳ. The median OS time for R0,R1-1 mm,and R1-direct resections was 34.1,24.7,and 15.7 months,respectively ( P<0.01). Conclusion:Adjuvant chemotherapy,R0 resection,tumor stage,and differentiation are independent prognostic factors for pancreatic body and tail cancer.

ObjectiveThis study aims to investigate the effect of Liuwei Dihuangwan on the autophagy function in the hippocampus of senescence-accelerated mouse prone 8 （SAMP8） by regulating the expression of glycoprotein non-metastatic melanoma protein B （GPNMB）. Furthermore， it is designed to explore the mechanism of the method of tonifying the kidneys and replenishing essence in the treatment of Alzheimer's disease （AD）. MethodsIn experiment 1， 24 5-month-old SAMP8 mice were randomly and equally divided into the model group， and the low-， middle- and high-dose（0.59，1.18，2.36 g·kg^-1） Liuwei Dihuangwan groups. At the same time， six 5-month-old senescence accelerated mouse resistant 1 （SAMR1） mice were used as the control group. The learning and memory ability was evaluated through novel object recognition experiment. Serum cortisol （Cort）， adrenocorticotropic hormone （ACTH） and urine 17-hydroxycorticosteroid （17-OHCS） levels were detected by enzyme-linked immunosorbent assay （ELISA）. The ultrastructure of hippocampal neurons was observed by transmission electron microscope （TEM）， and the expression levels of hippocampal GPNMB， a disintegrin and metalloproteinase 10 （ADAM10） and autophagy-related proteins were detected by Western blot. In experiment 2， 18 SAMP8 mice were randomly and equally divided into the model group， vector control group （Vector）， and GPNMB overexpression group （GPNMB^OE）. Lentiviral vectors were stereotactically injected into the brain （2 μL per side in the GPNMB^OE group）. Western blot was used to detect the expression of the above target proteins in the hippocampus； In Experiment 3， 24 SAMP8 mice were randomly and equally divided into the model group， Liuwei Dihuangwan group， Liuwei Dihuangwan+negative control （NC） group， and Liuwei Dihuangwan+GPNMB silencing group （shGPNMB）. Before drug treatment， the Liuwei Dihuangwan+NC group and the Liuwei Dihuangwan+shGPNMB group were injected with negative control and GPNMB silencing lentivirus， respectively. Western blot was used to detect the expression of the above target proteins in the hippocampus. ResultsThe novel object discrimination index of mice in the model group was significantly lower than that of mice in the control group （P<0.01）. The novel object discrimination index of mice in the medium- and high-dose Liuwei Dihuangwan groups was significantly higher than that of mice in the model group （P<0.01）. Aggregated autolysosomes were observed in the normal hippocampus tissue by TEM. In the model group， mitochondria were dominant， and no typical characteristic autophagosomes were observed. In the low- and medium-dose Liuwei Dihuangwan groups， a small number of autolysosomes and autophagosomes with double-membrane structures were observed. In the high-dose Liuwei Dihuangwan group， the number of autophagosomes and autolysosomes was greater than that in the low- and medium-dose groups. The results of ELISA and Western blot showed that compared with the control group， the levels of serum Cort， ACTH， and urine 17-OHCS in the model group were substantially increased， while the expression of hippocampal ADAM10， Beclin1， and microtubule associated-protein light chain 3-Ⅱ/Ⅰ （LC3 Ⅱ/Ⅰ） was significantly decreased. The expression of GPNMB and ubiquitin binding protein p62 was significantly increased （P<0.05， P<0.01）. Compared with the model group， the serum Cort and ACTH levels in the low-， medium-， and high-dose Liuwei Dihuangwan groups were significantly reduced， while only the urine 17-OHCS level in the high-dose group was significantly reduced. The hippocampal GPNMB， ADAM10， Beclin1， and LC3 Ⅱ/Ⅰ expression levels in the medium-， and high-dose groups of Liuwei Dihuangwan were significantly increased compared to the model group， whereas the expression of p62 was significantly reduced （P<0.01）. The above indicators showed a progressive trend among the three groups. Compared with the model group， the GPNMB^OE group showed a significant increase in GPNMB， ADAM10， Beclin1， LC3 Ⅱ/Ⅰ expression， and a significant decrease in p62 expression （P<0.01）. Compared with the model group， the expression of GPNMB， ADAM10， Beclin1， and LC3 Ⅱ/Ⅰ in the hippocampus of the Liuwei Dihuangwan group significantly increased， while the expression of p62 significantly decreased （P<0.01）. Compared with the Liuwei Dihuangwan group， the Liuwei Dihuangwan+shGPNMB group showed a significant decrease in GPNMB， ADAM10， Beclin1， LC3 Ⅱ/Ⅰ， and a significant increase in p62 expression （P<0.01）. ConclusionLiuwei Dihuangwan can enhance hippocampal autophagy function and improve AD by upregulating GPNMB expression.

Objective:To explore the related factors and independent risk factors of radiation pneumonitis (RP) in breast cancer patients after radiotherapy, and to guide the optimization of treatment plan for BC and reduce the incidence of RP.Methods:A retrospective analysis was conducted on 770 female breast cancer patients who received postoperative radiotherapy at Deyang People's Hospital between July 2021 and September 2024. The occurrence of RP was observed, and potential clinical and dosimetric factors were analyzed. Continuous variables were assessed using the t-test, categorical variables with the chi-square test, and univariate analysis was used to identify factors associated with RP. Multivariate logistic regression analysis was used to find out the independent risk factors of RP, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor. Results:Among 770 patients, 46 developed RP (34 grade 1, 12 grade 2). Univariate analysis showed that surgical method, chemotherapy regimen, interval between chemotherapy and radiotherapy, age, planning target volume, and maximum dose of the ipsilateral lung were not associated with RP (all P>0.05). Clinical stage ( χ2=7.84, P=0.020), chest wall + supraclavicular + internal mammary lymph node irradiation ( χ2=104.50, P<0.001), supraclavicular + internal mammary lymph node irradiation ( χ2=8.90, P=0.003), number of chemotherapy cycles ( t=9.88, P<0.001), and ipsilateral lung V 5 Gy( t=16.47, P<0.001), V 10 Gy( t=18.70, P<0.001), V 15 Gy( t=20.23, P<0.001), V 20 Gy( t=23.39, P<0.001), V 25 Gy( t=21.68, P<0.001), V 30 Gy( t=21.67, P<0.001), V 35 Gy( t=20.67, P<0.001), V 40 Gy( t=19.96, P<0.001), V 45 Gy( t=18.59, P<0.001), V 50 Gy( t=11.69, P<0.001), D mean( t=30.76, P<0.001) were significantly correlated with the occurrence of RP. Multivariate analysis revealed that ipsilateral lung V 5 Gy ( OR=1.258, 95% CI: 1.143-1.384, P<0.001), number of chemotherapy cycles ( OR=2.767, 95% CI: 1.781-4.299, P<0.001), and chest wall + supraclavicular + internal mammary lymph node irradiation ( OR=7.926, 95% CI: 2.943-21.349, P<0.001) were independent risk factors for RP. Using V 5 Gy=51.65% as the diagnostic cutoff, the sensitivity and specificity for predicting RP were 0.870 and 0.804, respectively. Taking the number of chemotherapy cycles=6.50 as the cutoff, the sensitivity and specificity of predicting RP were 0.891 and 0.586, respectively. Taking 0.50 as the diagnostic cutoff point, the sensitivity and specificity of chest wall + supraclavicular + internal mammary lymph node irradiation for RP were 0.870 and 0.797, respectively. Conclusions:The number of chemotherapy cycles, ipsilateral lung V 5 Gy, and chest wall + supraclavicular + internal mammary lymph node irradiation are independent risk factors for RP in postoperative female breast cancer patients.

Objective To explore the regularity of prescriptions for epidemic disease in Taiping Huimin Heji Ju Fang based on the latent structure model and association rules analysis,and to provide references for modern epidemic treatment.Methods Prescriptions for epidemic diseases were extracted from Taiping Huimin Heji Ju Fang.A high-frequency herb matrix(frequency≥10)was constructed,and high-frequency herbs were analyzed using MicrosoftExcel 2016,Lantern 5.0,and IBM SPSS Modeler 18.0 for efficacy classification,property/flavor/channel tropism statistics,latent structure modeling,and association rule analysis.Results Among the 200 collected herbal prescriptions,46 high-frequency medicinal materials were identified,such as licorice,fresh ginger,dried ginger,poriae,and ginseng.The top 3 drugs efficacy were tonifying deficiency,relieving surface and warming inner.The medicinal properties were mainly warm,and the medicinal flavors were pungent,bitter,and sweet.The meridian tropisms mainly included the spleen meridian,lung meridian and stomach meridian.The analysis of latent structure model suggested that there were 8 types of common symptoms of epidemic disease,such as wind evil attack exterior,wind-cold-dampness,wind-heat,excess-heat in triple energizer,dampness inhibits qi stagnation,yang deficiency,blockage and spleen-qi deficiency.Theanalysis of association rules obtained licorice-ephedra and licorice-atractylodes,which with a core of licorice medicine,and the 16 association rules such as dried ginger-cinnamon,pericarpium citri reticulatae-mangnolia officinalis and poriae-ginseng-atractylodes macrocephala after eliminating ginger,jujube and licorice.Conclusion Most of the medicines used in the treatment of epidemic diseases in Taiping Huimin Heji Ju Fang are pungent,bitter and dispelling evil,the treatment should follow the principle of dispelling evil,warming yang to dissipate cold,dispelling dampness,clearing heat and expelling fire,inducing resuscitation,supporting the right and supplementing deficiency,which embodies the treatment principle of dispelling evil and supporting right,and provides reference and ideas for the treatment of clinical diseases based on syndrome differentiation.

Objective To understand the epidemiological characteristics of severe congenital heart dis-ease in Chongqing City during 2007-2023 to provide a basis for its comprehensive prevention and control measures.Methods Based on hospital monitoring data,453 children patients with severe congenital heart dis-ease monitored by the birth defects monitoring institutions in Chongqing city from January 2007 to December 2023 were included in the study.They were grouped by year,perinatal infants gender,maternal permanent res-idence(urban/rural),maternal age,different regions and other categories.The χ2 test was used to analyze the difference in the incidence rate of different categories of severe congenital heart diseases,and the Joinpoint re-gression model was used to analyze the change trend.Results A total of 1 468 005 perinatal neonates were monitored in Chongqing City during 2007-2023 and 453 cases of severe congenital heart disease were found,with an incidence rate of 3.09/10 000,in which the incidence rate of atrioventricular septal defect was 2.16/10 000,the incidence rate of tetralogy of fallot was 0.66/10 000 and the incidence rate of transposition of great ar-teries was 0.27/10 000.The total incidence rate of cities and towns was higher than that in the countryside(χ2=64.08,P<0.001),the urban area was higher than the Chongqing southeast and Chongqing northeast towns cluster(χ2=49.34,P<0.001),the female was higher than the male(χ2=5.63,P=0.018).The inci-dence rates in different ages groups showed the U shape distribution(χ2=31.63,P<0.001).The incidence rate of the pregnant women<20 years old group and pregnant women≥35 years old group was higher,which of the 25-29 years old group was lower.The incidence rate of severe congenital heart disease in Chongqing City during 2007-2023 appeared the turning point,which during 2007-2016 was gradually increased(APC=-15.95),and which during 2016-2023 was gradually decreased(APC=-15.36).Conclusion The incidence rate of severe congenital heart disease in Chongqing city during 2007-2023 was increased first and then de-creased,moreover there were differences in time,region and population.

Objective:To investigate the clinical characteristics of patients with high-myopia macular hole retinal detachment (MHRD) combined with choroidal detachment and to preliminarily analyze factors associated with postoperative hole closure.Methods:A retrospective clinical case series study. A total of 68 patients with high myopia (68 eyes) with MHRD diagnosed by Department of Ophthalmology, Peking University People’s Hospital from January 2019 to April 2024 were included in this study. Among them, there were 14 males (14 eyes) and 54 females (54 eyes). The mean age was (61.10±9.66) years. All eyes were treated with pars plana vitrectomy (PPV) combined with silicone oil or gas filling. Best corrected visual acuity (BCVA), intraocular pressure, and B-mode ultrasonography were performed. The BCVA test was performed using the Snellen visual acuity chart, which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The range of choroidal detachment was defined according to the number of involved quadrants observed in B-mode ultrasound or surgery, which was divided into 1 to 4 quadrants. Axial length (AL) was measured under retinal reattachment. In 68 eyes, there were 17 eyes with choroidal detachment and 51 eyes without choroidal detachment, respectively. There were 17 eyes with choroidal detachment, and the detachment range involved 1, 2, 2 and 12 eyes in 1, 2, 3 and 4 quadrants, respectively. During operation, 13% C 3F 8 was filled in 2 eyes, all of which were not complicated with choroidal detachment. 66 eyes were filled with silicone oil. According to whether the patients were complicated with choroidal detachment, the patients were divided into the group without choroidal detachment and the group with choroidal detachment. Independent sample t test, Welch two-sample t test or Mann-Whitney U test were used for comparison between groups. Generalized linear regression and logistic regression were used to analyze the relationship between the aperture size of postoperative unclosed holes and the closed hole after surgery and clinical factors. Results:At 3 months after surgery, the logMAR BCVA of the affected eye was 1.29±0.43, with a preoperative to postoperative difference ranging from -1.60 to 0.70 (-0.51±0.51) logMAR units. The AL ranged from 26.6 to 34.3 (29.60±2.12) mm. Among 68 eyes, macular hole of 37 (54.4%, 37/68) eyes were open and 31 (45.6%, 31/68) eyes were closed, respectively. The hole diameter of the open eye was (753±424) μm. There was no significant difference in age, course of disease and AL between the two groups ( W=412.0, 477.5, 427.0; P>0.05). Before operation, BCVA in patients with choroidal detachment was worse ( W=257.5) and intraocular pressure was lower ( t=4.051) in patients with choroidal detachment compared with those without choroidal detachment, with statistical significance ( P<0.05). At 3 months after surgery, BCVA in patients with choroidal detachment was significantly worse than that in patients without choroidal detachment, with statistical significance ( W=284.0, P<0.05). There were no significant differences in logMAR BCVA difference ( t=0.616) and macular hole closure rate ( χ 2=0.000) before and after surgery ( P>0.05). The reoperation rate of retinal detachment due to persistent or recurrent retinal detachment was significantly higher in the group with choroid detachment than in the group without choroid detachment, and the difference was statistically significant (odds ratio=6.424, P<0.05). Logistic regression analysis showed that young age was significantly correlated with macular hole closure failure after surgery ( β=0.077, P=0.015). There was no correlation between AL, duration of disease, BCVA before surgery, intraocular pressure, wether combined with choroid detachment range and postoperative hole closure ( β=-0.072, 0.000, 0.672, -0.085, -0.391; P>0.05). Conclusions:Concomitant choroidal detachment adversely affected on both pre-operative and post-operative visual acuity in high myopia MHRD. It is closely associated with the risk of recurrent retinal detachment and the needs of multiple operations, but has no significant effect on hole closure rate. Lower age of onset may be a risk factor for macular hole closure.

Objective:To observe and analyze the correlation between ectopic foveal inner layer (EIFL) and the EIFL-based idiopathic epiretinal membrane (ERM) staging system and the anatomic and functional prognosis of ERM eyes post pars plana vitrectomy (PPV).Methods:A retrospective study. From January 1, 2020 to October 30, 2023, 345 eyes of 330 patients diagnosed with idiopathic ERM in Department of Ophthalmology of Peking University People's Hospital and treated with standard transciliary flat three-channel 25G PPV combined with ERM and internal limiting membrane exfoliation were included in the study. Among them, 96 were males (111 eyes) and 234 were females (234 eyes). The mean age was (66.8±7.7) years. All study eyes received standard three-port 25G PPV combined with ERM and internal limiting membrane peeling. All study eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. BCVA was performed using a standard logarithmic visual acuity chart and converted to logarithm of the minimum angle of resolution visual acuity for statistical analysis. EIFL thickness and central foveal thickness (CFT) on OCT were measured. ERM eyes were grouped into stage Ⅰ, Ⅱ, Ⅲ and Ⅳ according to ERM staging scheme based on EIFL; disorganization of the retinal inner layers (DRIL) of study eyes were assessed and grouped into no, mild and severe groups. The correlation between ERM staging as well as EIFL thickness and the anatomical and functional prognosis 6 months post-PPV were analyzed.Results:Among 345 study eyes, 12, 87, 174 and 72 eyes were stage Ⅰ-Ⅳ ERM respectively, 63 with no DRIL, 216 with mild DRIL and 66 with severe DRIL. Among the 153 eyes with macular edema, the edema subsided in 66 eyes (43.1%, 66/153) 6 months after the operation. Eighty-seven eyes (56.9%, 87/153) did not regress. The edema subsided 6 months after the operation was not significantly correlated with the ERM stage before the operation ( χ2=3.331, R=?0.145, P=0.304) or the degree of DRIL ( χ2=0.655, R=?0.108, P=0.445). The results of the correlation analysis showed that logMAR BCVA 6 months after the surgery was positively correlated with the degree of DRIL before the surgery ( Tau-b=0.236), ERM stage ( Tau-b=0.194), CFT ( r=0.383), and EIFL thickness ( r=0.317) ( P<0.05). There was no significant correlation with the thickness of the outer nuclear layer before the operation ( r=0.004, P>0.05). Preoperative ERM stage ( Tau-b=0.303, P<0.001) and DRIL severity ( Tau-b= 0.238, P=0.001) were positively correlated with CFT at 6 months after surgery. Conclusion:The ERM stage and EIFL thickness before the operation are positively correlated with logMAR BCVA and CFT 6 months after the operation.

Objective:To screen the risk factors of acute kidney injury (AKI) in patients with multiple trauma, construct a prediction model accordingly, and evaluate its predictive value.Methods:A retrospective cohort study was performed to analyze the clinical data of 560 multiple trauma patients who were admitted to while Affiliated Hospital of Jiangsu University from January 2017 to June 2023, including 424 males and 136 females, aged 18-91 years [(55.5±15.0)years]. The patients were randomly divided into a training set ( n=392) and validation set ( n=168) with a ratio of 7∶3. Of all, 77 patients were combined with AKI in the training set, while 33 patients combined with AKI in the validation set. The AKI group and non-AKI group in the training set were compared in terms of gender, age, hypertension, diabetes, cause of injury, abbreviated injury scale (AIS) score of head and neck injury, AIS score of maxillofacial injury, AIS score of chest injury, AIS score of abdominal injury, AIS score of extremities and pelvic injury, AIS score of body surface injury, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, body temperature, red blood cell and plasma transfusion volume within 24 hours following admission, emergency surgery, mechanical ventilation, vasoactive drug therapy, Glasgow coma score (GCS) on admission, revised trauma score (RTS) on admission, acute physiology and chronic health assessment II (APACHE II) on admission, injury severity score (ISS) on admission, and laboratory test results on admission including white blood cell count, neutrophil count, lymphocyte count, C-reactive protein, hemoglobin, platelet count, activated partial thromboplastin time (APTT), prothrombin (PT), fibrinogen (FIB), thrombin time (TT), international normalized ratio (INR), D-dimer, blood lactate, base excess, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, globulin, urea nitrogen, serum creatinine, blood glucose, potassium, sodium and chloronium. In the training set, univariate analysis and Lasso regression analysis were used to screen the risk factors of AKI in patients with multiple trauma, which were then included into multivariate logistic regression analysis to identify the independent risk factors. A nomogram prediction model was constructed using the R software based on the above independent risk factors. Hosmer-Lemeshow (H-L) goodness-of-fit test was performed to evaluate the fitting degree of the prediction model in the training set and the validation set, and the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve (DCA) were plotted in the training set and the validation set to evaluate the predictive performance of the prediction model. Results:There were statistically significant differences in AIS score of abdominal injury, heart rate, body temperature, red blood cell and plasma transfusion volume within 24 hours following admission, emergency surgery, mechanical ventilation, vasoactive drug therapy, GCS on admission, RTS on admission, APACHE II on admission, ISS on admission as well as hemoglobin, platelet count, APTT, PT, FIB, TT, INR, blood lactate, base excess, AST, albumin, globulin, urea nitrogen, serum creatinine, blood glucose and sodium on admission between the AKI group and the non-AKI group ( P<0.05 or 0.01). The characteristic variables screened by Lasso regression analysis included AIS score of abdominal injury, red blood cell transfusion volume within 24 hours following admission, mechanical ventilation, vasoactive drugs therapy, blood lactate on admission, blood creatinine on admission, AST on admission, and blood sodium on admission. Multivariate logistic regression analysis showed that red blood cell transfusion volume within 24 hour following admission ( OR=1.09, 95% CI 1.01, 1.18), mechanical ventilation ( OR=2.49, 95% CI 1.06, 5.85), vasoactive drug therapy ( OR=2.04, 95% CI 1.03, 4.03), blood lactate on admission ( OR=1.10, 95% CI 1.01, 1.21) and serum creatinine on admission ( OR=1.02, 95% CI 1.01, 1.03) were independent risk factors for AKI in patients with multiple trauma ( P<0.05). The regression equation was constructed: Logit[ P/(1- P)]=0.086 2×"red blood cell transfusion volume within 24 hour following admission"+0.912 7×"mechanical ventilation"+0.713 2×"vasoactive drug therapy"+0.098 9×"blood lactate on admission"+0.019 2×"serum creatinine on admission" -4.822 3. H-L goodness-of-fit test showed χ2 value of 9.50 in the training set ( P>0.05) and 6.43 in the validation set ( P>0.05). The results of the ROC curve indicated that the area under the curve (AUC) was 0.84 (95% CI 0.78, 0.89) in the training set and 0.80 (95% CI 0.72, 0.88) in the validation set. The calibration curves showed good agreement with the actual curves, with the predicted probability consistent with the actual probability in both training set and validation set. DCA analysis showed that the threshold probability ranged from 2% to 70% with the net benefit rate of the prediction model greater than 0 in the training set, while the threshold probability ranged from 3% to 69% with the net benefit rate of the prediction model greater than 0 in the validation set. Conclusions:Red blood cell transfusion volume within 24 hours following admission, mechanical ventilation, vasoactive drug therapy, lactate and serum creatinine on admission are independent risk factors for AKI in patients with multiple trauma. The nomogram prediction model based on the above 5 predictive variables of AKI in patients with multiple trauma shows good predictive efficacy and clinical application value.

This study retrospectively analyzed data from 25 patients with paroxysmal nocturnal hemoglobinuria (PNH) admitted to Peking Union Medical College Hospital and Dongfang Hospital of Beijing University of Chinese Medicine from January 2023 to June 2024. Patients receiving sufficient eculizumab treatment for at least 3 months and who completed hemolytic complex (CH50) level testing pre- and post-treatment for 3 and 6 months were selected. Blood routine, biochemistry, and the 50% CH50-related indicators were monitored pre- and post-treatment. Among these patients, 24 completed 6 months of treatment and CH50 testing. After 3 and 6 months of eculizumab treatment, all patients with PNH showed significant improvement in symptoms, with lactate dehydrogenase (LDH) levels decreasing from a baseline of (1 814.4 ± 924.8) U/L to (248.5 ± 61.0) U/L and (239.3 ± 44.8) U/L. Hemoglobin levels increased from a baseline of (73.9±14.4) g/L to (99.9 ± 21.3) g/L and (99.6 ± 19.8) g/L. The baseline CH50 level was (32.4±14.7) %, which decreased to 2.0% (1.0% –8.0% ) and 1.0% (1.0% –4.0% ) at 3 and 6 months posttreatment, respectively. At baseline, a linear correlation was found between CH50 and LDH levels ( P<0.001), and the trend of CH50 changes was significantly lower than LDH at 3 and 6 months post-treatment with eculizumab, with similar trends. However, no linear correlation was observed between CH50 and LDH levels or other parameters at 3 and 6 months of medication. Our case demonstrates that eculizumab is effective for PNH hemolysis treatment. The serum CH50 level may be a biomarker for complement blockade induced by eculizumab, which can, to some extent, reflect the intravascular hemolysis of PNH and the efficacy of eculizumab.