ObjectiveTo investigate the intervention effects of modified Linggui Zhugan Tang （LGZGT） on patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） of the spleen deficiency and dampness obstruction with blood stasis type， reveal its possible mechanisms， and provide a theoretical basis for the clinical treatment of OSAHS with traditional Chinese medicine （TCM）. MethodsEighty OSAHS patients with spleen deficiency and dampness obstruction with blood stasis were randomly assigned to a control group and an observation group （1∶1） using a random number table， with 40 patients in each group. The control group received standard basic treatment combined with oral Doxofylline tablets， while the observation group received standard basic treatment combined with modified LGZGT. Serum levels of macrophage migration inhibitory factor （MIF）， microRNA-223 （miR-223）， and interleukin-18 （IL-18） were measured by enzyme-linked immunosorbent assay （ELISA）， and the mRNA expression levels of MIF， miR-223， and IL-18 were measured by real-time quantitative polymerase chain reaction （Real-time PCR）. After two months of treatment， the total clinical efficacy， apnea-hypopnea index （AHI）， lowest nocturnal oxygen saturation （LSpO₂）， body mass index （BMI）， TCM syndrome scores， and expression levels of MIF， miR-223， and IL-18 before and after treatment were compared between the two groups. Correlations between MIF， miR-223， IL-18 and AHI and LSpO₂ were also analyzed. ResultsCompared with the control group， the observation group showed a significantly higher total clinical effective rate （P<0.01， Z=-3.49）. Within the control group， no significant changes were observed in AHI， LSpO₂， BMI， TCM syndrome scores， or MIF， miR-223， IL-18 levels and their mRNAs after treatment. In the observation group， AHI， BMI， TCM syndrome scores， and MIF and IL-18 levels and their mRNAs decreased significantly， while LSpO₂ increased significantly （P<0.01）. After treatment， compared with the control group， the observation group exhibited significantly lower AHI， BMI， TCM syndrome scores， and MIF and IL-18 levels and their mRNAs， and significantly higher LSpO₂ （P<0.01）. Correlation analysis showed that MIF and IL-18 were positively correlated with AHI （P<0.01） and negatively correlated with LSpO₂ （P<0.01）， whereas miR-223 was negatively correlated with AHI （P<0.01） and positively correlated with LSpO₂ （P<0.01）. ConclusionModified LGZGT may improve OSAHS of the spleen deficiency and dampness obstruction with blood stasis type by reducing airway inflammatory factors， alleviating airway inflammation， relieving airway edema and stenosis， and improving airway obstruction.

Liver fibrosis is a key pathological stage in the progression of chronic liver diseases to liver cirrhosis， and effective etiological control or therapeutic interventions can help to achieve varying degrees of liver fibrosis regression in some patients. Accordingly， accurate assessment of the degree of liver fibrosis regression has gradually become an important concern in clinical management and the development of novel therapeutic agents. Conventional assessment methods mainly focus on fibrosis staging and have certain limitations in reflecting structural remodeling and dynamic changes of the liver. This article systematically reviews the recent research advances in the assessment of liver fibrosis regression from various aspects such as histological and digital pathology， serological and multi-omics biomarkers， and functional and molecular imaging modalities and discusses their respective advantages and limitations in assessing liver fibrosis regression. On this basis， this article discusses a multimodal integrated evaluation strategy based on artificial intelligence， in order to provide new ideas for accurate assessment of liver fibrosis regression， individualized therapeutic monitoring， and optimization of clinical trial endpoints.

ObjectiveTo evaluate the predictive value of six surrogate indices of insulin resistance （IR） for cardiovascular disease （CVD） risk in adults with cardiovascular-kidney-metabolic syndrome （CKM） stages 0-3. MethodsRelated data of 6 813 participants from the China health and retirement longitudinal study （CHARLS） were analyzed. Cox proportional hazards models and restricted cubic spline （RCS） analyses were performed to evaluate the associations between six insulin resistance surrogate indices （TyG， TyG-BMI， TyG-WC， TyG-WHtR， TyG-CVAI， CVAI） and CVD incidence. Predictive performance of 6 indices was comprehensively compared from 3 dimensionalities， using receiver operating characteristic （ROC） curves for discriminative ability， net reclassification improvement （NRI） for incremental predictive value， and decision curve analysis （DCA） for clinical utility. ResultsAll six IR surrogate indices significantly predicted CVD in the CKM population. RCS analysis revealed linear associations between each index and CVD incidence. ROC analysis showed that CVAI had the highest AUC （0.628，95%CI： 0.611-0.646）， significantly outperforming the single TyG index （P=0.001 6）. NRI analysis indicated significant reclassification improvement for the event group with CVAI （event NRI=0.042 8）. DCA demonstrated that CVAI achieved the highest net benefit across most thresholds. Subgroup analysis confirmed stronger associations between CVAI and CVD risk in CKM stages 2-3. ConclusionsThese six IR surrogate indices serve as valuable tools for predicting CVD incidence in individuals with CKM stages 0-3. Among them， CVAI exhibits optimal predictive value for future CVD risk in adults with CKM stages 1-3.

Objective To analyze the characteristics and evolution path of resources in different development stages of specialties,and to study the construction of the operation strategy of clinical specialties in public hospitals that match the development stage.Methods According to the organizational life cycle theory,the hospital specialty development in-terpretation model was constructed from three aspects:clinical,scientific research and teaching,and its operation strategy was analyzed.Results The development stage of the specialty was divided into initial stage,growth stage,promotion stage and plateau stage,and the progressive operation strategy was used to promote the development of the specialty to a higher stage.Conclusion It is necessary to design strategies according to local conditions,and ex-plore the resource development characteristics of public hospital specialties and the corresponding operation manage-ment strategies according to the explanatory model.

Objective:To explore the influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage and construct a corresponding risk prediction nomogram. The screening effects of the constructed model and different hematoma enlargement risk assessment tools were compared and analyzed.Methods:Two hundred and thirty-two patients with hypertensive intracerebral hemorrhage from the Department of Neurosurgery, Lianyungang First People's Hospital from April 2021 to February 2022 were selected as the research subjects. Multivariate Logistic regression was used to analyze the risk factors of hematoma expansion in patients with hyperhemamic intracerebral hemorrhage, and R software was used to construct a nomo diagram. The receiver operating characteristic curve (ROC) and Hosmer-Lemeshow (H-L) goodness-of-fit were used to evaluate the discrimination and calibration of the model, and the decision curve was used to analyze the clinical validity of the model. The constructed Nomo diagram, nine-point method and BRAIN score were used to assess the risk of hematoma enlargement in the included patients and used them as test variables, and the ROC curve was plotted to compare and analyze the area under the ROC curve, sensitivity and specificity of the constructed Nomo diagram, nine-point method and BRAIN score. The Kappa test was used to analyze the consistency between the Nomo diagram, the nine-point method, and the BRAIN score and the hematoma expansion results.Results:The results of multivariate logistic regression analysis showed that blood pressure was poorly controlled ( OR=13.290, 95% CI: 3.676-48.049), ventricular penetration ( OR=4.825, 95% CI: 1.458-15.975), early neurological deterioration ( OR=27.740, 95% CI: 8.713-88.314), Glasgow Coma Scale(GCS)≤8 points ( OR=25.883, 95% CI: 6.542-102.404) was the main influencing factor for hematoma expansion in patients with hypertensive intracerebral hemorrhage (The P values were <0.001, 0.010, <0.001, and <0.001, respectively). The H-L test results of Nomogram for predicting hematoma enlargement were χ2=3.20, P=0.525, the calibration curve was close to the ideal curve, and the mean absolute error was 0.015, and the decision curve analysis showed that the model had good clinical validity. The ROC results showed that the area under the ROC curve of the constructed Neumo diagram, nine-point method and BRAIN score were 0.971 (95% CI: 0.941-0.989), 0.696 (95% CI: 0.632-0.755), and 0.778 (95% CI: 0.719-0.830)(all P<0.001). The sensitivities were 94.37%, 71.83%, and 84.51%, and the specificities were 90.68%, 58.39%, and 65.84%, respectively. The results of Kappa test showed that the Kappa values of Nuomo diagram, nine-point method and BRAIN score were 0.806 , 0.264 and 0.429 (all P<0.001). Conclusion:The main influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage were poor blood pressure control, intraventricular hemorrhage, early neurological deterioration, and GCS score. The effect of the constructed Nuomo diagram model in predicting hematoma expansion in patients with hypertensive intracerebral hemorrhage is better than that of the nine-point method and the BRAIN score, which has clinical application value.

Objective:To analyze the clinical characteristics and gene variations of children with cystic fibrosis (CF), and to improve the understanding of pediatrician on CF.Methods:The data of 7 children with CF admitted to Xi'an Children 's Hospital from July 2018 to January 2024 were retrospectively analyzed. Results:The 7 patients (2 males and 5 females) were diagnosed at a median age of 3 years and 9 month(ranging from 1 year and 1 month to 10 years).The main clinical manifestations included recurrent respiratory tract infection (7 cases), bronchiectasis (3 cases), malnutrition (5 cases), steatosis (5 cases), false Bartter syndrome(2 cases), cirrhosis (1case),infantile vomiting (1 case),and meconium intestinal obstruction (1 case). A total of 14 mutation sites were found in 7 cases by whole exon sequencing and Sanger sequencing verification, including 7 missense mutations, 4 nonsenses mutations, 2 shear mutations, and 1 frameshift mutation which was a new mutation. After symptomatic treatment including anti-infection, chest physical therapy, hypertonic saline atomization, fat-soluble vitamin supplementation and pancreatic enzyme supplementation, the respiratory symptoms were controlled, the number of hospitalization due to respiratory infection was significantly reduced. However，the nutritional status of the 7 children did not reach the expected improvement.Conclusion:The clinical manifestations of CF are varied, among which recurrent respiratory tract infection, bronchiectasis and malnutrition are common.Timely targeted anti-infection and other symptomatic treatments can improve the prognosis. The compliance of the confirmed children with nutritional support is poor, and it is still necessary to strengthen the intervention of nutritional support.

Objective:To analyze the clinical characteristics and gene variations of children with cystic fibrosis (CF), and to improve the understanding of pediatrician on CF.Methods:The data of 7 children with CF admitted to Xi'an Children 's Hospital from July 2018 to January 2024 were retrospectively analyzed. Results:The 7 patients (2 males and 5 females) were diagnosed at a median age of 3 years and 9 month(ranging from 1 year and 1 month to 10 years).The main clinical manifestations included recurrent respiratory tract infection (7 cases), bronchiectasis (3 cases), malnutrition (5 cases), steatosis (5 cases), false Bartter syndrome(2 cases), cirrhosis (1case),infantile vomiting (1 case),and meconium intestinal obstruction (1 case). A total of 14 mutation sites were found in 7 cases by whole exon sequencing and Sanger sequencing verification, including 7 missense mutations, 4 nonsenses mutations, 2 shear mutations, and 1 frameshift mutation which was a new mutation. After symptomatic treatment including anti-infection, chest physical therapy, hypertonic saline atomization, fat-soluble vitamin supplementation and pancreatic enzyme supplementation, the respiratory symptoms were controlled, the number of hospitalization due to respiratory infection was significantly reduced. However，the nutritional status of the 7 children did not reach the expected improvement.Conclusion:The clinical manifestations of CF are varied, among which recurrent respiratory tract infection, bronchiectasis and malnutrition are common.Timely targeted anti-infection and other symptomatic treatments can improve the prognosis. The compliance of the confirmed children with nutritional support is poor, and it is still necessary to strengthen the intervention of nutritional support.

Objective To evaluate the predictive value of patent ductus arteriosus(PDA)for the incidence and mortality of neonatal pulmonary hemorrhage(NPH)in infants with a gestational age(GA)of≤32 weeks.Methods Retrospective analysis of clinical data from premature infants with GA≤32 weeks consecutively admitted between January 2021 and June 2024.The analyzed clinical characteristics included GA,birth weight(WT),mode of delivery,diseases experienced by the infants,and maternal perinatal factors.Infants were categorized based on the presence or absence of NPH,and the clinical features of both groups were compared.Furthermore,infants with NPH and hemodynamically significant patent ductus arteriosus(hsPDA)were subdivided according to in-hospital mortality for additional analysis.Results The study included a total of 511 pediatric patients,of whom 92 cases were diagnosed with NPH.NPH was strongly correlated with mechanical ventilation(MV),high-frequency oscil-lation(HFO),hsPDA,disseminated intravascular coagulation(DIC),and intraventricular hemorrhage(IVH)(r=0.443,0.407,0.352,0.325,0.310,respectively;all P<0.001).Neonatal respiratory distress syndrome(NRDS)(grades 3-4),IVH,MV,HFO,DIC,and hsPDA were identified as independent risk factors for NPH in infants≤32 weeks of GA(OR=2.641,2.097,1.065,2.298,5.550,3.820,respectively;all P<0.05).GA,WT,PDA diameter,PDA velocity,left ventricular output(LVO),velocity of the late diastolic a'wave in the left ventricle(LV a'),and neonatal asphyxia(NA)were significant factors influencing NPH combined with hsPDA(all P<0.05).The PDA severity score(PDAsc)was determined to be a risk factor for mortality in infants≤32 weeks of GA with NPH and hsPDA(OR=1.265,95%CI 1.031-1.553,P=0.024).A strong correlation was observed between the predicted probability of death in infants with NPH and PDA and PDAsc(r=0.901,P=0.001).The ROC curve analysis demonstrated that PDAsc served as an ideal predictor of mortality in infants with NPH and PDA(AUC=0.687,P=0.002).Conclusions hsPDA is an independent risk factor for the development of NPH in infants≤32 weeks of GA.Additionally,PDAsc serves as a significant risk factor for mortality in infants≤32 weeks of GA who have both NPH and PDA,indicating a strong correlation and potential predictive value.

Objective:We aimed to investigate the relationship between CYP2D6*10 gene polymorphisms and adverse reactions associated with tamoxifen treatment in breast cancer patients, and assess the value of CYP2D6*10 gene polymorphism testing in guiding the use of medications in endocrine therapy for breast cancer.Methods:177 breast cancer patients with HR-positive and postoperative tamoxifen were admitted to the First Affiliated Hospital of Nanjing Medical University from November 2012 to December 2021. Their clinicopathologic data were collected for follow-up observation of adverse reactions related to tamoxifen treatment. After two years of tamoxifen treatment, finger blood of these patients was taken for CYP2D6 gene polymorphism detection. Moreover, databases including RNAfold, QTLbase, 3DSNP v2.0, RegulomeDB 2.2, and HaploReg v4.2 were used to predict the annotation of proximal and distal interactions of CYP2D6 polymorphic sites between genes and regulatory elements.Results:Genotyping analysis revealed 40 patients (22.6%) with the CC genotype, 79 (44.6%) with the CT genotype, and 58 (32.8%) with the TT genotype. Common adverse reactions to tamoxifen included abnormal liver function (58), fatty liver (81), uterine fibroids (12), and endometrial surgery for endometrial thickening (17). Univariate and multivariate logistic regression analyses showed that there were no significant statistical differences between the CC and CT+TT genotypes in terms of liver damage, new-onset fatty liver, uterine fibroids, or tumor recurrence and metastasis ( P＞0.05). Notably, endometrial thickening was more significant in patients with the CT+TT genotype (4.37±3.82 mm) than in those with the CC genotype (2.43±2.96 mm), with a statistically significant difference between them ( P＜0.01). Bioinformatic analysis suggested that in breast tissues, the CYP2D6*10 polymorphic locus had a significant expression quantitative trait locus (eQTL) effect with CYP2D6, and its genetic variations could affect the binding of CYP2D6 to transcription factors, which might modulate the expression of CYP2D6 through changes in secondary structure and chromatin modifications, etc., and thus affect the tamoxifen drug sensitivity. Further eQTL analysis showed significant correlation between CYP2D6 expression levels with different genotypes of the CYP2D6 rs1065852 polymorphism in breast tissues ( P＜0.01). Conclusion:Tamoxifen remains a primary therapeutic agent for premenopausal HR-positive breast cancer patients, and its efficacy is influenced by polymorphisms in the CYP2D6*10. It is recommended that for breast cancer patients carrying the CYP2D6 CT and TT genotypes, endometrial monitoring should be strengthened during treatment with tamoxifen, and the medication should be adjusted in a timely manner.

Objective:To develop radiomics score (RS) based on 18F-FDG PET/CT, and construct the machine learning model combining clinical and other relevant factors for personalized prediction of 2-year event-free survival (2-EFS) in patients with diffuse large B-cell lymphoma (DLBCL), and to perform interpretability analysis of the model. Methods:A total of 91 patients (49 males, 42 females; age (57.8±12.8) years) with pathologically confirmed DLBCL from December 2017 to December 2020 at the First Hospital of Shanxi Medical University were retrospectively analyzed. According to the ratio of 7∶3, patients were randomly divided into training set ( n=63) and test set ( n=28), and divided into non-progression group and progression group according to the follow-up results. The whole-body PET semi-quantitative parameters were calculated from the PET/CT images before treatment, and 328 radiomics features were extracted from the largest target lesions of patients. The least absolute shrinkage and selection operator (LASSO) was used to develop the RS. Clinical and PET characteristic difference analysis was performed through χ2 test and Mann-Whitney U test. Extreme gradient boosting (XGBoost) models were constructed based on clinical, PET radiomics features and RS, and the prediction efficiency of each model was evaluated by ROC AUC. The model interpretability was analyzed by using shapely additive explanation (SHAP). Results:Of all patients, 32 had disease progression and 59 did not. There were no significant differences in baseline characteristics between the training set and the test set ( χ2 values: 0.06-1.84, U values: 665.00-763.00, all P>0.05). The comparison between the progression group and non-progression group in the training set showed statistical differences in the international prognostic index (IPI) score ( χ2=4.87, P=0.027), myelocytomatosis viral oncogene (MYC) protein expression ( χ2=4.29, P=0.038), and metabolic tumor volume (MTV; U=307.00, P=0.038). Seven radiomics features were screened by LASSO. Among XGBoost models with different feature combinations, IPI score, MYC protein expression, MTV combined with RS had the highest predictive efficiency (training set: AUC=0.73; test set: AUC=0.70). Through SHAP analysis, RS was the most predictive feature in the optimal model. Conclusion:The machine learning integrated model of IPI score, MYC protein expression and MTV combined with RS can effectively predict the prognosis of DLBCL patients, and baseline 18F-FDG PET/CT radiomics can be used as a potential means to evaluate the prognosis of DLBCL patients.