1.Regulation of natural killer cell subtypes and functions by programmed cell death protein 1 and its receptor at the maternal-fetal interface in mice infected with Toxoplasma gondii during the second trimester
Jiayue SUN ; Qiuhua BAI ; Xiaodan CHEN ; Jiayin LÜ ; Shanshan HE ; Lili TANG ; Dejun LIAO ; Dengyu LIU ; Xiaoyin FU
Chinese Journal of Schistosomiasis Control 2025;37(5):465-474
Objective To investigate the regulatory role of the programmed cell death protein 1 (PD-1) and its ligand programmed cell death protein ligand 1 (PD-L1) signaling on the subtypes and functions of natural killer (NK) cells at the maternal-fetal interface during the second trimester in mice following Toxoplasma gondii infection during the first trimester. Methods Twelve 6- to 8-week-old female mice of the C57BL/6J strain were divided into a control group and an infection group, of 6 mice in each group. On the 6.5th day of pregnancy (Gd6.5), each pregnant mouse in the infection group was intraperitoneally injected with 150 tachyzoites of the Toxoplasma gondii PRU strain, while mice in the control group were injected with an equal volume of physiological saline. On the 12.5th day of pregnancy (Gd12.5), uterus and placenta tissues were sampled from pregnant mice for pathological observations, and the mRNA expression levels of PD-1, PD-L1, and tumor necrosis factor-α (TNF-α) were quantified in uterus and placenta tissues. The PD-1 and DX5 expression was measured on NK cells at the maternal-fetal interface using flow cytometry. In addition, the in vitro JEG-3 trophoblast cells and NK-92MI cells co-culture system was established as the control group, and the addition of T. gondii tachyzoites in the co-culture system served as the infection group. The PD-1, PD-L1, and DX5 mRNA expression was quantified in cells using real-time fluorescence quantitative reverse transcription PCR (RT-qPCR) assay, and the TNF-α concentration was measured in the cell culture supernatant using enzyme-linked immunosorbent assay (ELISA). Results On Gd12.5, clear and intact cellular structures of placental decidual tissues were seen in pregnant mice in the control group, with no remarkable abnormal changes found in the uterine columnar epithelial cells, and inflammatory cell infiltration and blood stasis at varying degrees were found in uterine and placental tissues from pregnant mice in the infection group. The relative PD-1, PD-L1, and TNF-α mRNA expression was (1.004 ± 0.004), (1.001 ± 0.001), and (1.001 ± 0.001) in uterine tissues from pregnant mice in the control group and (2.480 ± 0.720), (3.355 ± 0.920), and (2.391 ± 0.073) in the infection group, respectively. The relative PD-1, PD-L1, and TNF-α mRNA expression was (1.007 ± 0.010), (1.006 ± 0.006), and (1.001 ± 0.001) in the uterine tissues in the control group and (6.948 ± 1.918), (3.225 ± 1.034), and (1.536 ± 0.150) in the infection group, respectively. The relative PD-1, PD-L1, and TNF-α mRNA expression was higher in both the uterine (t = 3.55, 4.43 and 33.02, all P values < 0.05) and placental tissues (t = 5.36, 3.72 and 6.18, all P values < 0.05) in the infection group than in the control group. Flow cytometry showed that the proportions of PD-1+ NK cells, PD-1+ DX5+ NK cells, and DX5+ NK cells were (12.200 ± 1.082)%, (9.373 ± 7.728)%, and (44.000 ± 4.095)% in uterine tissues from pregnant mice in the control group, and (21.733 ± 1.630)%, (18.767 ± 1.242)%, and (73.367 ± 0.611)% in the infection group, respectively. The proportions of PD-1+ NK cells, PD-1+ DX5+ NK cells, and DX5+ NK cells were (1.100 ± 0.510)%, (2.277 ± 1.337)%, and (96.167 ± 2.831)% in placental tissues from mice in the control group, and (26.867 ± 9.722)%, (23.433 ± 6.983)%, and (82.467 ± 2.248)% in the infection group, respectively. The proportions of PD-1+ NK cells (t = 8.45, P < 0.05) and DX5+ NK cells (t = 12.29, P < 0.05) were higher in uterine tissues from pregnant mice in the infection group than in the control group, and no significant difference was seen in the proportion of PD-1+ DX5+ NK cells (Z = -1.09, P > 0.05). The proportions of PD-1+ NK cells (t = 4.58, P < 0.05) and PD-1+ DX5+ NK cells (t = 5.15, P < 0.05) were higher in placental tissues from pregnant mice in the infection group than in the control group, while the proportion of DX5+ NK cells was lower in the infection group than in the control group (t = -6.56, P < 0.05). RT-qPCR assay revealed that the relative PD-1, PD-L1, and DX5 mRNA expression was (1.010 ± 0.005), (1.002 ± 0.003), and (1.001 ± 0.001) in the JEG-3 cells and NK92MI cells co-culture system and (3.638 ± 1.258), (0.397 ± 0.158), and (4.267 ± 1.750) in the control group, and ELISA measured that the TNF-α concentration was higher in the cell culture supernatant in the infection group [(22.056 ± 3.205) pg/mL] than in the control group [(12.441 ± 0.001) pg/mL] (t = 5.20, P < 0.05). The PD-1(t = 3.62, P < 0.05) and DX5 mRNA expression (t = 3.23, P < 0.05) was higher in the infection group than in the control group, and the PD-L1 mRNA expression was lower in the infection group than in the control group (t = -6.63, P < 0.05). Conclusions Following T. gondii infection, both PD-L1 expression and PD-1 expression on DX5+ NK cells at the maternal-fetal interface are upregulated in mice during the second trimester; however, the proportion of DX5+ NK cells decreases. These findings suggest that PD-1/PD-L1 signaling may suppress NK cell functions by modulating DX5+ NK cell subsets.
2.ATF3 regulates inflammatory response in atherosclerotic plaques in mice through the NF-κB signaling pathway.
Bing XIA ; Jin PENG ; Jiuyang DING ; Jie WANG ; Guowei TANG ; Guojie LIU ; Yun WANG ; Changwu WAN ; Cuiyun LE
Journal of Southern Medical University 2025;45(6):1131-1142
OBJECTIVES:
To investigate the role of activating transcription factor 3 (ATF3) in atherosclerotic plaques for regulating inflammatory responses during atherosclerosis (AS) progression.
METHODS:
Human coronary artery specimens from autopsy cases were examined for ATF3 protein expression and localization using immunofluorescence staining and Western blotting. Apolipoprotein E-deficient (ApoE-/-) mouse models of AS induced by high-fat diet (HFD) feeding for 12 weeks were subjected to tail vein injection of adeno-associated virus serotype 9 (AAV9) to knock down ATF3 expression. After an additional 5 weeks of HFD feeding, the mice were euthanized for analyzing structural changes of the aortic plaques, and the expression levels of ATF3, inflammatory factors (CD45, CD68, IL-1β, and TNF-α), and NF-κB pathway proteins (P-IKKα/β and P-NF-κB p65) were detected. In the cell experiment, THP-1-derived foam cells were transfected with an ATF3-overexpressing plasmid or an ATF3-specific siRNA to validate the relationship between ATF3 and NF‑κB signaling.
RESULTS:
In human atherosclerotic plaques, ATF3 expression was significantly elevated and partially co-localized with CD68. ATF3 knockout in ApoE-/- mice significantly increased aortic plaque volume, upregulated the inflammatory factors, enhanced phosphorylation of the NF‑κB pathway proteins, and increased the expressions of VCAM1, MMP9, and MMP2 in the plaques. In THP-1-derived foam cells, ATF3 silencing caused activation of the NF‑κB pathway, while ATF3 overexpression suppressed the activity of the NF-κB pathway.
CONCLUSIONS
AS promotes ATF3 expression, and ATF3 deficiency exacerbates AS progression by enhancing plaque inflammation via activating the NF-κB pathway, suggesting the potential of ATF3 as a therapeutic target for AS.
Animals
;
Activating Transcription Factor 3/metabolism*
;
Signal Transduction
;
NF-kappa B/metabolism*
;
Humans
;
Mice
;
Plaque, Atherosclerotic/metabolism*
;
Inflammation/metabolism*
;
Apolipoproteins E
;
Atherosclerosis/metabolism*
;
Diet, High-Fat
3.Regulatory role and mechanism of mitochondrial ribosomal protein S35 in proliferation,invasion,and migration of colon cancer cells
Jiameng ZHU ; Longhe SUN ; Qiannan SUN ; Jun REN ; Bin LIU ; Liuhua WANG ; Daorong WANG
Journal of Clinical Medicine in Practice 2025;29(2):24-31,37
Objective To investigate the regulatory role and mechanism of mitochondrial riboso-mal protein S35(MRPS35)in the proliferation,invasion,and migration of colon cancer cells.Meth-ods A total of 120 colon cancer tissues and adjacent normal tissues from patients undergoing radical resection for colon cancer were collected.Human colon cancer cell lines(HCT116,SW480,SW620)and a human normal colon epithelial cell line(NCM460)were cultured.Bioinformatics analysis,real-time quantitative polymerase chain reaction,Western blot,immunohistochemical(IHC)analysis,and cellular functional experiments(plate clone formation assay,scratch test,Transwell migration assay,CCK-8 cell viability assay)were conducted to evaluate the expression and regulatory mechanism of MRPS35 in colon cancer.Results Bioinformatics analysis showed that the expression level of the MRPS35 gene was higher in colorectal cancer tissues than in adjacent normal tissues(P<0.05).The relative expression levels of MRPS35 mRNA and MRPS35 protein were higher in human colon cancer cell lines(HCT116,SW480,SW620)than in NCM460 cells(P<0.05).The relative ex-pression level of MRPS35 protein was higher in colon cancer tissues than that in adjacent normal tis-sues(P<0.05).The expression level of MRPS35 was significantly correlated with tumor diameter,tumor differentiation,and T stage(P=0.002,0.021,0.036).Patients with high MRPS35 expres-sion had a higher overall survival rate than those with low MRPS35 expression(Log-rank P=0.015).After knockdown of MRPS35,the abilities of colon cancer cell cloning,proliferation,invasion,and migration were significantly enhanced.Furthermore,the expression of Wnt1,β-Catenin,and their downstream target proteins increased significantly after MRPS35 knockdown.Conclusion MRPS35 is significantly overexpressed in both colon cancer tissues and colon cancer cells,and it may inhibit the occurrence and development of colon cancer by regulating the Wnt/β-Catenin signaling pathway.Therefore,MRPS35 has the potential to become a novel biomarker and therapeutic target for colon cancer.
4.Risk factors and nomogram construction of permanent hypoparathyroidism after total thyroidectomy
Pengyong LIU ; Mengyou LIU ; Yu ZHOU ; Hai GUAN ; Zhen TIAN ; Hao HU ; Xiaosong YUE ; Qiannan GUAN
Tianjin Medical Journal 2025;53(8):850-855
Objective To analyze the risk factors of permanent hypoparathyroidism(pHPP)after total thyroidectomy in patients with thyroid cancer and establish a nomogram prediction model.Methods A total of 245 patients with thyroid cancer who received total thyroidectomy in our hospital were enrolled between January 2020 and January 2024.According to presence or absence of postoperative pHPP,patients were divided into the pHPP group and the non-pHPP group.The influencing factors of postoperative pHPP in patients with thyroid cancer were analyzed by univariate and multivariate Logistic regression analysis.The nomogram prediction model for postoperative pHPP in patients with thyroid cancer was constructed and varified,and efficiency of the model was evaluated.Results In 245 patients with thyroid cancer,the incidence of pHPP within 6 months after surgery was 10.20%(25/245).Univariate analysis showed that there were significant differences in tumor size,surgical method,central lymph node dissection,use of nano carbon tracer,envelope invasion,parathyroid excision by mistake,Hashimoto thyroiditis,serum calcium and parathyroid hormone at 1 d after surgery between the two groups(P<0.05),but there were no significant differences in gender,age,smoking,drinking,extraglandular invasion,parathyroid autologous transplantation,preoperative vitamin D or serum phosphorus at 1 d after surgery between the two groups(P>0.05).Multivariate analysis showed that maximum tumor diameter≥4 cm,routine and open total thyroidectomy,central lymph node dissection,no use of nano carbon tracer and parathyroid excision by mistake were all independent risk factors for postoperative pHPP in patients with thyroid cancer(P<0.05).Results of nomogram prediction model showed that C-index was 0.921,the corrected curve was close to ideal curve,and AUC of nomogram model for predicting postoperative pHPP was 0.926(95%CI:0.871-0.981).Conclusion The nomogram prediction model constructed based on independent risk factors of postoperative pHPP has good predictive efficiency in patients with thyroid cancer.
5.Clinical value of extraperitoneal stoma in laparoscopic Mile′s procedure
Hualin XIE ; Liuhua WANG ; Bin LIU ; Qiannan SUN ; Jin JI ; Daorong WANG
International Journal of Surgery 2025;52(1):44-50
Objective:To compare the clinical efficacy of laparoscopic Miles surgery through extraperitoneal stoma and intraperitoneal stoma.Methods:The medical records of 140 patients with low rectal cancer after laparoscopic Miles surgery admitted to Gastrointestinal Surgery of Northern Jiangsu People′s Hospital of Jiangsu Province from January 2018 to December 2022 were retrospectively analyzed. Among them, 80 were males and 60 were females, aged 50 to 75 years old, with an average age of 63.95 years old. They were divided into observation group (extraperitoneal stoma, n=70) and control group (intraperitoneal stoma, n=70) based on the stoma method. Through telephone, WeChat, outpatient follow-up and other contact methods, the intraoperative and postoperative recovery, the incidence of perioperative complications (stoma edema, stoma ischemia, peristoma inflammation, perineal/pelvic infection, lung infection) and the incidence of complications at 6 months and 1 year after surgery (stoma stricture, parastoma hernia/internal hernia, stoma prolapse/retraction), and the difference in the ability of artificial anus to control defecation at 1 year after surgery were compared between the two groups. SPSS27.0 statistical software was used for data analysis and processing. Results:(1) Incidence of individual complications such as lung infection between the two groups of patients during the perioperative period (4.3% vs 4.3%, χ2=0.17, P=0.676), stoma edema (25.7% vs 21.4%, χ2=0.36, P=0.550), stoma ischemia (7.1% vs 7.1%, χ2=0.00, P=1.000), peristomal inflammation (20.0% vs. 18.6%, χ2=0.05, P=0.830), perineal/pelvic infection (15.7% vs 27.1%, χ2=2.72, P=0.099), there was no difference between the two groups. There was still no difference in the overall complication rate between the two groups (72.9% vs 78.6%, χ2=0.62, P=0.430). (2) After follow-up to 6 months after surgery, the overall complication rate was 5.7% in the observation group compared with 22.9% in the control group ( χ2=7.06, P=0.008). In particular, the incidence of post-operative parastomal hernia/internal hernia did not occur in the observation group, while 8.6% of patients in the control group occurred (18.6% vs 42.9%, χ2=4.35, P=0.037). (3) After follow-up to 1 year after surgery, the overall complication rate in the observation group was lower than that in the control group ( χ2=8.59, P=0.003). The incidence of parastomal hernia/internal hernia after operation in the observation group was lower than that in the control group (2.9% vs 14.3%, χ2=4.47, P=0.034). (4) At the one-year follow-up, the overall excellent and good rate in the evaluation of bowel function in the observation group was higher than that in the control group (71.4% vs 48.6%, χ2=7.62, P=0.006). Conclusions:In laparoscopic Miles surgery for patients with rectal cancer, choosing extraperitoneal stoma has achieved good results, which can reduce the risk of complications 6 months or even 1 year after surgery, especially in preventing and controlling parastomal hernia/internal hernia. It has significant advantages, and at the same time, it can also promote the recovery of patients′ bowel function and reduce other related complications, thereby ensuring patient safety.
6.Mismatch analysis of individual identity alignments from STRtyper-21G DNA-typing database
Jiahui SONG ; Zhenping LIU ; Xiaoxia ZHANG ; Jingkai YANG ; Xudong LV ; Qiannan XU ; Xiandun ZHAI
Chinese Journal of Forensic Medicine 2025;40(4):434-437
Objective To investigate the loci in the STRtyper-21G kit that are prone to tolerance mismatches when compared with the GlobalFilerTM kit and the PowerPlex? 21 kit,and to analyze the underlying causes.Methods A total of 5,870 database comparison reports involving STRtyper-21G profiles and other autosomal STR kits were examined for identity alignment.Samples showing mismatched loci were re-tested using the STRtyper-21G,GlobalFilerTM,and PowerPlex? 21 kits.For loci with mismatches,primers were redesigned and sequencing was performed.Results Eight mismatched samples(8/5 870)were identified,involving the loci D18S51,D8S1179,and D2S1338.Sequencing revealed that the allele dropout at D18S51 was due to a G→A mutation at the 79th base upstream of the core sequence;at D8S1179,a C→A mutation at the 4th base upstream;and at D2S1338,a C→T mutation at the 22nd base downstream.Conclusion All mismatches were attributable to mutations in primer binding regions.These findings provide reference for interpreting mismatch results in the STRtyper-21G database.When mismatches occur at these loci and the profiles are homozygous,exclusion conclusions should be made with caution.
7.Mismatch analysis of individual identity alignments from STRtyper-21G DNA-typing database
Jiahui SONG ; Zhenping LIU ; Xiaoxia ZHANG ; Jingkai YANG ; Xudong LV ; Qiannan XU ; Xiandun ZHAI
Chinese Journal of Forensic Medicine 2025;40(4):434-437
Objective To investigate the loci in the STRtyper-21G kit that are prone to tolerance mismatches when compared with the GlobalFilerTM kit and the PowerPlex? 21 kit,and to analyze the underlying causes.Methods A total of 5,870 database comparison reports involving STRtyper-21G profiles and other autosomal STR kits were examined for identity alignment.Samples showing mismatched loci were re-tested using the STRtyper-21G,GlobalFilerTM,and PowerPlex? 21 kits.For loci with mismatches,primers were redesigned and sequencing was performed.Results Eight mismatched samples(8/5 870)were identified,involving the loci D18S51,D8S1179,and D2S1338.Sequencing revealed that the allele dropout at D18S51 was due to a G→A mutation at the 79th base upstream of the core sequence;at D8S1179,a C→A mutation at the 4th base upstream;and at D2S1338,a C→T mutation at the 22nd base downstream.Conclusion All mismatches were attributable to mutations in primer binding regions.These findings provide reference for interpreting mismatch results in the STRtyper-21G database.When mismatches occur at these loci and the profiles are homozygous,exclusion conclusions should be made with caution.
8.Patent ductus arteriosus severity predicts the occurrence and mortality of pulmonary hemorrhage in pre-mature infants with gestational age≤32 weeks
Qiannan JIANG ; Tingting LIU ; Yingying LIU ; Kaijie CUI ; Xiuxiang LIU
The Journal of Practical Medicine 2025;41(10):1575-1583
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.
9.Risk factors and nomogram construction of permanent hypoparathyroidism after total thyroidectomy
Pengyong LIU ; Mengyou LIU ; Yu ZHOU ; Hai GUAN ; Zhen TIAN ; Hao HU ; Xiaosong YUE ; Qiannan GUAN
Tianjin Medical Journal 2025;53(8):850-855
Objective To analyze the risk factors of permanent hypoparathyroidism(pHPP)after total thyroidectomy in patients with thyroid cancer and establish a nomogram prediction model.Methods A total of 245 patients with thyroid cancer who received total thyroidectomy in our hospital were enrolled between January 2020 and January 2024.According to presence or absence of postoperative pHPP,patients were divided into the pHPP group and the non-pHPP group.The influencing factors of postoperative pHPP in patients with thyroid cancer were analyzed by univariate and multivariate Logistic regression analysis.The nomogram prediction model for postoperative pHPP in patients with thyroid cancer was constructed and varified,and efficiency of the model was evaluated.Results In 245 patients with thyroid cancer,the incidence of pHPP within 6 months after surgery was 10.20%(25/245).Univariate analysis showed that there were significant differences in tumor size,surgical method,central lymph node dissection,use of nano carbon tracer,envelope invasion,parathyroid excision by mistake,Hashimoto thyroiditis,serum calcium and parathyroid hormone at 1 d after surgery between the two groups(P<0.05),but there were no significant differences in gender,age,smoking,drinking,extraglandular invasion,parathyroid autologous transplantation,preoperative vitamin D or serum phosphorus at 1 d after surgery between the two groups(P>0.05).Multivariate analysis showed that maximum tumor diameter≥4 cm,routine and open total thyroidectomy,central lymph node dissection,no use of nano carbon tracer and parathyroid excision by mistake were all independent risk factors for postoperative pHPP in patients with thyroid cancer(P<0.05).Results of nomogram prediction model showed that C-index was 0.921,the corrected curve was close to ideal curve,and AUC of nomogram model for predicting postoperative pHPP was 0.926(95%CI:0.871-0.981).Conclusion The nomogram prediction model constructed based on independent risk factors of postoperative pHPP has good predictive efficiency in patients with thyroid cancer.
10.Patent ductus arteriosus severity predicts the occurrence and mortality of pulmonary hemorrhage in pre-mature infants with gestational age≤32 weeks
Qiannan JIANG ; Tingting LIU ; Yingying LIU ; Kaijie CUI ; Xiuxiang LIU
The Journal of Practical Medicine 2025;41(10):1575-1583
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.

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