Objective To investigate the clinical prognostic value of the prognostic nutritional index (PNI) in patients with renal cell carcinoma (RCC) undergoing partial nephrectomy.Methods A retrospective analysis was conducted on the clinical data of RCC patients who underwent partial nephrectomy at our hospital during 2020 and 2024.The optimal cutoff value of PNI was determined based on the maximum Youden index from the receiver operating characteristic (ROC) curve.The clinicopathological characteristics, overall survival (OS), and progression-free survival (PFS) between patients with different PNI levels were compared.Cox regression analysis was used to explore the independent prognostic factors for RCC patients. Results Based on the ROC curve, the optimal cutoff value corresponding to the maximum Youden index was calculated to be 46.675, at which point the sensitivity was 65.3% and the specificity was 62.2%.Of the 815 patients included in the study, 293 (36.0%) patients had a PNI＜46.675.Cox regression analysis confirmed that preoperative PNI, tumor diameter, ISUP classification, and ECOG score were independent risk factors for postoperative OS in patients with RCC who underwent PN (P＜0.05).In addition, preoperative PNI, tumor diameter, ISUP classification and ECOG score were independent risk factors for postoperative PFS (P＜0.05).After covariates in the multivariable Cox regression model were adjusted, patients in the low PNI group demonstrated significantly shorter overall survival (HR=2.392, P＜0.001) and significantly poorer progression-free survival (HR=2.076, P＜0.001) compared to those in the high PNI group.Conclusion Preoperative PNI has significant clinical value in evaluating the prognosis of RCC patients undergoing partial nephrectomy.An elevated preoperative PNI is associated with a better prognosis.

ObjectiveTo investigate the effects of Liuwei Dihuangwan on mammalian target of rapamycin （mTOR）-mediated synaptic plasticity in the prefrontal cortex-hippocampus circuit in the rat model of valproic acid （VPA）-induced autism spectrum disorder （ASD） and to explore its potential mechanism for reducing behavioral abnormalities in ASD rats. MethodsThirteen SD pregnant rats were randomized into the VPA group （10 rats） and the control group （3 rats）. On gestational day 13， the VPA group was intraperitoneally injected with VPA solution （600 mg·kg^-1）， while the control group was injected with an equal volume of normal saline. Male pups of 21 days old from both groups underwent behavioral tests to screen the ASD model rats （32 rats）. These rats were then randomly assigned to the model （distilled water）， vitamin D （1 480 U·kg^-1）， low-dose （0.75 g·kg^-1） Liuwei Dihuangwan， and high-dose （1.5 g·kg^-1） Liuwei Dihuangwan groups， and normal male pups were selected as the blank group （distilled water）， with 8 rats in each group. Each group was treated with the corresponding drug or an equal volume of distilled water via gavage daily. After drug administration， behavioral tests were conducted again， followed by anesthesia and tissue collection. Nissl staining was carried out to observe the morphological changes of neurons in the prefrontal cortex and hippocampus. Transmission electron microscopy was used to observe changes in hippocampal synaptic structure. Immunohistochemistry and Western blot were employed to determine the expression of mTOR， phosphatidylinositol 3-kinase （PI3K）， and protein kinase B （Akt） in the prefrontal cortex， as well as synaptophysin-1 （SYP-1）， postsynaptic density 95 （PSD95）， and N-methyl-D-aspartate receptors （NMDARs） in the hippocampus. ResultsCompared with the control group， the model group exhibited severe growth retardation and developmental deformities， with abnormal behavioral performance and pathological damage to neurons and synapses in the prefrontal cortex and hippocampus. Compared with the model group， all treatment groups showed reduced behavioral abnormalities and pathological damage to neurons and synapses in the prefrontal cortex and hippocampus， with the most significant effects in the high-dose Liuwei Dihuangwan group. Immunohistochemistry and Western blotting results showed that compared with the control group， the model group exhibited significantly increased protein levels and phosphorylation ratios of p-mTOR， p-Akt， and p-PI3K in the prefrontal cortex （P<0.05， P<0.01）， and decreased protein levels of SYP-1 and PSD95 and increased protein level of NMDARs in the hippocampus （P<0.01）. Compared with those in the model group， the protein levels of p-mTOR， p-Akt， and p-PI3K in the prefrontal cortex decreased in the vitamin D and high-dose Liuwei Dihuangwan groups （P<0.05）， and the p-mTOR/mTOR， p-Akt/Akt， and p-PI3K/PI3K ratios in the prefrontal cortex declined in the vitamin D group （P<0.05）. The high-dose Liuwei Dihuangwan group showed a reduction in p-PI3K/PI3K ratio （P<0.05）. The protein level of SYP-1 and PSD95 in the hippocampus increased in the vitamin D， low-dose Liuwei Dihuangwan， and high-dose Liuwei Dihuangwan groups （P<0.05， P<0.01）， while the protein level of NMDARs decreased in the vitamin D and high-dose Liuwei Dihuangwan groups （P<0.01）. ConclusionLiuwei Dihuangwan significantly reduces VPA-induced ASD-like behaviors and enhances the regeneration and repair of neurons in the prefrontal cortex and synaptic structures in the hippocampus by downregulating of PI3K/Akt/mTOR expression in the prefrontal cortex， upregulating SYP-1 and PSD95 expression in the hippocampus， and inhibiting NMDARs expression.

ObjectiveTo explore the target of Erzhiwan in reducing myocardial injury in ovariectomized mice through non-targeted myocardial metabolomics combined with experimental verification. MethodsOvariectomized mouse model was selected， 40 female C57BL/6 mice were randomly divided into sham operation group， model group， estrogen group（estradiol valerate， 1.3×10^-4 g·kg^-1）， Erzhiwan low and high dose groups（3.12， 9.36 g·kg^-1）， with 8 mice in each group. Each administration group was given the corresponding dose of Erzhiwan by gavage， and the sham operation group and model group were given equal volume of distilled water by gavage for 12 weeks. Echocardiography was used to detect cardiac function， hematoxylin-eosin（HE） staining was used to observe myocardial morphological changes， and enzyme-linked immunosorbent assay（ELISA） was used to detect the levels of estrogen， N-terminal pro-brain natriuretic peptide（NT-proBNP）， hypersensitive troponin T（hs-TnT）， total cholesterol（TC）， triglyceride（TG）， low density lipoprotein cholesterol（LDL-C）， high density lipoprotein cholesterol（HDL-C）， interleukin（IL）-1β， IL-18 and tumor necrosis factor-α（TNF-α）. The non-targeted metabolomics of mouse myocardium were analyzed by ultra performance liquid chromatography-quadrupole-electrostatic field orbital trap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap MS）， and the differential metabolites and corresponding metabolic pathways were obtained. The mRNA expression levels of phosphatidylinositol 3-kinase（PI3K） and protein kinase B（Akt） in mouse myocardial tissues were detected by real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）， and the protein expression levels of PI3K， Akt， phosphorylated（p）-Akt were detected by Western blot. ResultsCompared with the sham operation group， the model group showed abnormal cardiac function， increased myocardial fiber space， cardiomyocyte atrophy， sarcoplasmic aggregation， and occasional dissolution or rupture of muscle fiber， the level of estrogen in the serum was decreased， the levels of NT-proBNP， hs-TnT， IL-1β， IL-18， TNF-α， TG， TC and LDL-C were increased， and the level of HDL-C was decreased（P<0.01）. Compared with the model group， Erzhiwan could increase the level of estrogen， improve the abnormal cardiac function， reduce the pathological injury of myocardial tissue， decrease the levels of myocardial injury markers（NT-proBNP， hs-TnT） and inflammatory factors（IL-1β， IL-18， TNF-α）， decrease the levels of TG， TC， LDL-C， and increased the level of HDL-C（P<0.01）. The results of non-targeted myocardial metabolomics showed that 31 of the 162 differential metabolites between the model group and sham operation group were significantly adjusted after administration of Erzhiwan， which were mainly glycerol phospholipid metabolites. Pathway enrichment results showed that Erzhiwan mainly affected glycerophospholipid metabolic pathway， PI3K-Akt pathway， cyclic guanosine monophosphate（cGMP）-protein kinase G（PKG） pathway and other metabolic pathways. Compared with the sham operation group， the levels of phosphatidylcholine（PC， 11 types） and phosphatidylethanolamine（PE， 5 types） in mouse myocardial tissue of the model group were increased（P<0.05， P<0.01）， and the mRNA and protein expressions of PI3K and p-Akt were decreased（P<0.05， P<0.01）. Compared with the model group， the levels of PC（11 types） and PE（5 types） were decreased（P<0.05， P<0.01） in myocardial tissue of Erzhiwan group， the mRNA and protein expressions of PI3K and p-Akt were elevated（P<0.01）. ConclusionErzhiwan can alleviate the pathological injury of myocardium in ovariectomized mice， improve the abnormal cardiac function， improve lipid metabolism disorder， and reduce the levels of myocardial injury markers and inflammatory factors， which involves a number of signaling and metabolic pathways in the heart， among which glycerophospholipid metabolism pathway and PI3K/Akt pathway may have key roles.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To explore the correlation between the ratio of serum free triiodothyronine/free thyroxine (FT3/FT4) and carotid atherosclerosis in a population undergoing physical examination.Methods:This retrospective cross-sectional study consecutively enrolled 4 031 adult healthy examinees who underwent both carotid ultrasound and serum thyroid hormone level testing at the Health Management Center of Shengjing Hospital Affiliated to China Medical University from January 2017 to December 2023. The general information, anthropometric measurements, and related laboratory indicators were collected. Based on carotid ultrasound results, the participants were divided into carotid atherosclerosis group (2 382 cases) and non-carotid atherosclerosis group (1 649 cases). According to the median FT3/FT4 ratio (0.35), participants were further categorized into a high FT3/FT4 ratio group (1 998 cases) and a low FT3/FT4 ratio group (2 033 cases). Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic value of serum FT3/FT4 levels for carotid atherosclerosis. Additionally, the carotid atherosclerosis group was subdivided into carotid intima-media thickness (CIMT) thickening group (1 006 cases) and plaque formation group (1 376 cases). Stepwise logistic regression analysis was used to assess the correlation between FT3/FT4 levels and different severity of carotid artery stiffness.Results:Among the 4 031 health examinees included in the study, the detection rate of carotid atherosclerosis was 59.09% (2 382/4 031). The FT3/FT4 ratio in the carotid atherosclerosis group was significantly lower than that in the non-carotid atherosclerosis group (0.34 vs 0.39, Z=-19.958, P<0.001). The incidence rate of carotid atherosclerosis in the high FT3/FT4 ratio group was significantly lower than that in the low FT3/FT4 ratio group (46.7% vs 71.3%, Z=251.797, P<0.001). Multivariate regression analysis revealed that the FT3/FT4 ratio was an independent protective factor for carotid atherosclerosis ( OR=0.493, 95% CI: 0.458-0.529), with a protective effect comparable to high-density lipoprotein cholesterol ( OR=0.659, 95% CI: 0.543-0.801), while fasting blood glucose ( OR=1.566) and low-density lipoprotein cholesterol ( OR=1.164) were risk factors. ROC curve analysis showed that the area under the curve (AUC) of the FT3/FT4 ratio for diagnosing carotid atherosclerosis was 0.685 (sensitivity 79.3%, specificity 50.2%, cutoff value 0.39). In the analysis of carotid atherosclerosis subtypes, the FT3/FT4 ratio in the plaque formation group (0.328) was significantly lower than that in the CIMT thickening group (0.360) and the non-stiffness group (0.391)(all P<0.001), and it exhibited a stronger protective effect against plaque formation ( OR=0.297, 95% CI: 0.256-0.344). Conclusion:The FT3/FT4 ratio shows a dose-response relationship with the severity of carotid artery sclerosis and can serve as an auxiliary screening indicator for individuals at high cardiovascular risk. To enhance diagnostic efficacy, it is recommended to integrate this measure with other metabolic indicators.

Objective:To investigate the effect of physical activity on mortality risk in patients with chronic obstructive pulmonary disease (COPD) in Sichuan Province.Methods:Based on baseline data from 2004 to 2008 from the China Kadoorie Biobank project site in Pengzhou City, Sichuan Province, a total of 8 501 COPD patients aged 30-79 years were enrolled and followed up for a long period to determine mortality outcomes. Quartiles were used to group physical activity levels. The Cox proportional hazards regression model was used to analyze the effect of physical activity level on mortality outcomes.Results:As of December 31, 2017, the cumulative follow-up of the participants totaled 85 600.58 person-years (mean follow-up duration: 10.07 years). During this period, a total of 2 000 deaths were recorded, yielding a cumulative mortality rate of 23.53%. Among these deaths, 665 were attributed to COPD, corresponding to a cumulative mortality rate of 7.82%; and 1 116 were attributed to cardiovascular and cerebrovascular disease (CVD), corresponding to a cumulative mortality rate of 13.13%. The Cox proportional hazards regression model analysis revealed that, after adjusting for confounding factors, total physical activity was associated with a reduced risk of mortality from COPD, CVD, and all causes in patients with COPD. Compared with the low-level group of total physical activity, the medium-high-level group had the lowest risk of COPD mortality, with an HR of 0.39 (95% CI: 0.30-0.49). The high-level group had the lowest risk of CVD death and all-cause death, with HRs of 0.46 (95% CI: 0.37-0.56) and 0.55 (95% CI: 0.48-0.64), respectively. The lowest risk of COPD death and CVD death was found in the medium-high level of work-based physical activity group, with HRs of 0.36 (95% CI: 0.28-0.46) and 0.43 (95% CI: 0.36-0.51), respectively; the risk of all-cause mortality was lowest in the medium-high and high-level groups, with HRs values of 0.53 (95% CI: 0.46-0.61) and 0.53 (95% CI: 0.45-0.61). The risk of COPD death was lowest in the high-level transportation physical activity group, with an HR of 0.66 (95% CI: 0.53-0.83), and the risk of CVD and all-cause death was lowest in the medium-high level group, with HRs of 0.63 (95% CI: 0.53-0.76) and 0.73 (95% CI: 0.64-0.84), respectively. The risk of COPD death and CVD death was the lowest in the high-level domestic physical activity group, with HRs of 0.66 (95% CI: 0.49-0.89) and 0.76 (95% CI: 0.61-0.95), respectively, and the risk of all-cause death was the lowest in the medium-high level group, with an HR of 0.82 (95% CI: 0.72-0.94). There is no statistical association between leisure physical activity and the risk of death from three types of diseases. Conclusions:Total physical activity, including work-based, transportation-based, and domestic physical activity, reduced the risk of COPD, CVD, and all-cause mortality in patients with COPD in Sichuan Province. The magnitude of mortality risk was influenced by the type and level of physical activity.

Objective To evaluate the clinical value of 18F-fibroblast-activation protein inhibitor(18F-FAPI)PET/CT in malignant tumors exhibiting low uptake of 18F-fluorodeoxyglucose(18F-FDG).Methods We prospectively analyzed 62 patients with malignant tumors and low 18F-FDG uptake who underwent 18F-FAPI PET/CT in the Affiliated Cancer Hospital and Institute of Guangzhou Medical University from January 2021 to November 2022.Patient demographics information,clinical and radiological data were collected.Tumor lesions were categorized based on 18F-FAPI and 18F-FDG uptake relative to surrounding tissues into low-,moderate-,and high-uptake,with high uptake indicating positivity.The number and tracer uptake levels of primary tumors and metastatic lesions visualized by both 18F-FDG and 18F-FAPI were recorded and compared.Results Of the 62 primary tumors,18(29.0%)showed low-uptake and 44(71.0%)moderate-uptake on 18F-FDG PET,while 1(1.6%),6(9.7%),and 55(88.7%)showed low,moderate,and high uptake on 18F-FAPI,respectively.The maximum standardized uptake value(SUVmax)for primary tumors was significantly higher with 18F-FAPI than with 18F-FDG(7.5±5.6 vs.3.9±2.1,P<0.01).The number of positive lymph node foci revealed by 18F-FAPI was noticeably higher than that by 18F-FDG(77 vs.38,P<0.01).A total of 16 distant organ metastases were identified,with 11(68.8%)detected by 18F-FDG and 15(93.8%)by 18F-FAPI,showing no significant difference in detection rates(P>0.05).Conclusions 18F-FAPI PET/CT effectively visualizes primary and metastatic lesions in malignant tumors with low 18F-FDG uptake,suggesting its potential as a promising radiotracer for such malignancies.

Objective To investigate the effect of cordyceps sinensis(CS)on the activation of fibroblasts through IL-6 trans-signaling pathway and its specific mechanism in the treatment of renal fibrosis.Methods Renal fibrosis mouse model was established by unilateral ischemia/reperfusion(UIR),and the mice were administered intragastrically CS,soluble glycoprotein 130 Fc(sgp130Fc)or Hyper-IL-6.Masson's trichrome staining was utilized to identify tubulointerstitial fibrosis.PAS staining was utilized to assess the extent of renal injury.Western blot was employed to analyze the expression levels of fibrosis markers[alpha-smooth muscle actin(α-SMA),fibronectin(FN)]and proteins associated with IL-6 trans-signaling pathway[phosphorylated signal transducer and activator of transcription 3(p-STAT3),soluble interleukin-6 receptor(sIL-6R)].The expression and localization of proteins were additionally detected by immunohistochemistry,immunofluorescence and qPCR.The effect of cordyceps sinensis extract cordycepin on IL-6 trans-signaling in fibroblasts was further investigated in vitro.Results The results from in vivo experiments showed that administration of CS during the chronic phase demonstrated a beneficial protective impact on inflammation and fibrosis in the affected kidney,and serum creatinine levels and collagen deposition were decreased.Western blot analysis revealed a decrease in the expression levels of α-SMA,FN,as well as IL-6 trans-signaling pathway protein p-STAT3,sIL-6R in the treatment group.Additionally,the mRNA expression levels of chemokines monocyte chemoattractant protein-1(MCP-1)and C-X-C motif chemokine ligand 12(CXCL12)were also decreased in the CS treatment group.Additionally,Hyper-IL-6 can partially counteract the therapeutic effects of CS.In vitro experiments further demonstrated that cordycepin inhibited the secretion of IL-6 from NRK-52E.Combined treatment of recombinant IL-6 and sIL-6R protein activated NRK-49F,leading to a significant increase in α-SMA,FN,and p-STAT3 expression levels.Cordycepin or sgp130Fc treatment significantly inhibited the proliferation of fibroblasts induced by IL-6 trans-signaling pathway.Conclusion CS can significantly reduce IL-6 secretion by renal tubular epithelial cells and inhibit the activation of IL-6 trans-signaling pathway in fibroblasts,thereby ameliorating renal interstitial fibrosis.

Objective To design a performance testing platform to evaluate the working status and performance characteristics of the ventilator proportional solenoid valve.Methods The performance testing platform had its hardware including a high-pressure gas source,a pressure regulating valve,sensors and etc,and its software designed based on PyQt5 and composed of several modules for data acquisition,parameter setting,image display,indicator computation,result output and etc.Two kinds of proportional solenoid valves(Valve 1、Valve2)were selected for static and dynamic tests to verify the performance of the platform.Results The platform developed facilitated the proportional solenoid valve to carry out accurate computation of static and dynamic indicators at real time and time domain and waveform feature extraction of sensor data by precision control and data acquisition for the proportional solenoid valve.Static tests showed that Valve 1 gained advantages over Valve 2 in static flow characteristics involving in lowered repeatability,return error and offset while enhanced stability;dynamic tests indicated Valve 2 had rapid flow variations and significant flow fluctuation impacts,Valve 1 showed smooth dynamic response changes,and Valve 2 behaved better than Valve 1 in dynamic performance.Conclusion The testing platform developed comprehensively demonstrates the performance characteristics and working performance of the ventilator proportional solenoid valve,which is of great significance to enhance the reliability and safety of the ventilator.[Chinese Medical Equipment Journal,2025,46(1):13-19]

Objective To analyze the molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP)in a hospital in Hainan Province,explore the differences in the distribution of resistance genes and virulence factors between hypervirulent CRKP(hv-CRKP)and non-hv-CRKP,analyze the clinical significance,and provide basis for optimizing treatment and prevention strategies.Methods CRKP strains isolated from a hospi-tal in Hainan Province from July 2023 to June 2024 were collected retrospectively.Their resistance phenotypes were detected by antimicrobial susceptibility testing.Carbapenemase genes(KPC-2,NDM-1,IPM)and virulence factors(rmpA/rmpA2,iucA,iroB,etc.)were detected by polymerase chain reaction(PCR).Department source,speci-men distribution,and resistance-virulence characteristics were analyzed.Results A total of 76 strains of CRKP were isolated,with an overall isolation rate of 7.7％(76/985).The strains were mainly distributed in the intensive care unit(ICU)(28.9％)and neurosurgery ICU(23.6％),with the highest proportion of strains isolated from re-spiratory tract specimens(60.5％).The resistance genes were mainly KPC-2(72.4％)and NDM-1(21.1％),and the virulence factors mrkD(type Ⅲ pili,85.5％)and fim H(type Ⅰ pili,84.2％)were commonly presented.Among 76 strains of CRKP,39 strains(51.3％)met the criteria for hv-CRKP and all carried KPC-2 gene(100％).The detection rates of resistance genes and virulence factors rmpA2(97.4％),iucA(100％),and iroB(89.7％)were all higher than those of non-hv-CRKP strains(KPC-2,43.2％;rmpA2,0;iucA,8.1％;iroB,13.5％).The main characteristics of hv-CRKP was the combination of KPC-2 resistance gene and rmpA2+iucA+iutA+iroB virulence factors(64.1％).Antimicrobial resistance phenotype of hv-CRKP was different from non-hv-CRKP.hv-CRKP presented higher susceptibility rates to aminoglycosides and compound sulfamethoxazole than non-hv-CRKP.Conclusion The proportion of hv-CRKP and non-hv-CRKP strains in this hospital is comparable.hv-CRKP is characterized by carrying the KPC-2 resistance gene in combination with rmpA2+iucA+iutA+iroB virulence factors,and the proportion of strains carrying multiple virulence factors is higher than that of non-hv-CRKP.Both are generally resistant to β-lactams and quinolones.hv-CRKP has lower resistance rates to aminoglycosides and com-pound sulfamethoxazole than non-hv-CRKP.Its advantage of aminoglycoside susceptibility provides a new treatment option.It is recommended to guide differential medication through molecular typing and strengthen infection control measures in ICU to curb the spread of antimicrobial-resistant bacteria.