Objective To explore the independent risk factors for complicated coronary heart disease (CHD) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to construct a risk prediction model. Methods A retrospective study was performed to analyze the clinical data of 308 OSAHS patients who visited Jiangsu Provincial People's Hospital from January 2021 to June 2025. The patients were divided into the CHD group (n=80) and non-CHD group (n=228) according to the presence or absence of complicated CHD. Independent risk factors were identified using univariate analysis and multivariate logistic regression, and a nomogram prediction model was constructed. The model was evaluated using the calibration curve, Hosmer-Lemeshow test, Decision Curve Analysis (DCA) curve, and Receiver Operating Characteristic (ROC) curve. Results The incidence of CHD in OSAHS patients was 25.97%. Age, history of hypertension, oxygen desaturation index (ODI), severe polysomnography (PSG) grade, decreased high-density lipoprotein cholesterol, elevated homocysteine, and elevated troponin I were independent risk factors for OSAHS complicated with CHD (P<0.05). The nomogram model demonstrated good calibration (Hosmer-Lemeshow test, P=0.995), and the DCA curve showed high clinical net benefit. The area under the ROC curve was 0.940 (95% CI: 0.908~0.972), with a sensitivity of 0.842 and a specificity of 0.900. Conclusion Age, history of hypertension, ODI, PSG grade, high-density lipoprotein cholesterol, homocysteine, and troponin I are independent risk factors for CHD in OSAHS patients. The prediction model constructed based on these factors can provide a reliable tool for clinical nurses to early identify high-risk individuals and formulate targeted intervention strategies.

OBJECTIVE: To explore whether hydrocortisone can improve the prognosis of patients with severe community-acquired pneumonia (sCAP) by Meta-analysis. METHODS: Randomized controlled trial (RCT) on hydrocortisone in the treatment of sCAP were extracted from the database including PubMed, Cochrane library, Web of Science, and Embase, and the search time was up to April 29, 2023. The patients in the standard treatment group received standard treatment such as antibiotics and supportive care, while those in the hydrocortisone group received hydrocortisone treatment on the basis of standard treatment. Meta-analysis was used to compare the mortality, duration of mechanical ventilation, mechanical ventilation rate and incidence of adverse reactions (hyperglycemia, gastrointestinal bleeding, secondary infection) between the two groups. The risk of literature bias was assessed. The studies that might have publication bias were corrected by the subtraction and complementation method. At the same time, trial sequential analysis (TSA) was conducted. RESULTS: A total of 5 RCTs involving 1 031 patients were finally enrolled, including 494 patients in the standard treatment group and 537 patients in the hydrocortisone group. Among the 5 studies, the research site of 2 studies was in the mixed ward. Considering the inclusion characteristics of the study population, there was doubt whether its research object was sCAP patients, which might have a certain impact on the results and introduce potential bias. Meta-analysis showed that the mortality in the hydrocortisone group was significantly lower than that in the standard treatment group [6.0% vs. 14.0%; odds ratio (OR) = 0.38, 95% confidence interval (95%CI) was 0.25-0.59, P < 0.01; I² = 9%]. The studies that were asymmetric were corrected by the reduction and supplementation method. Even after filling the missing studies, hydrocortisone could still reduce the death risk of the patient (OR = 0.49, 95%CI was 0.32-0.73, P < 0.01; I² = 31%). TSA showed that the average mortality of the standard treatment group was about 14.0%, and that of the hydrocortisone group was about 6.0%, with a relative risk reduction (RRR) = 57%. The calculated sample size was 699 cases, and the actual sample size was 1 031 cases. The actual sample size exceeded the required sample size, and the Z-curve crossed the O'Brien-Fleming boundary and the curve corresponding to P = 0.05, it meant that hydrocortisone could effectively reduce the mortality of sCAP. Compared with the standard treatment group, no statistical difference in the duration of mechanical ventilation was found in the hydrocortisone group [mean difference (MD) = -3.26, 95%CI was -6.72-0.21, P = 0.07; I² = 0%], but the 8-day mechanical ventilation rate was significantly lowered (19.5% vs. 55.4%; OR = 0.24, 95%CI was 0.12-0.45, P < 0.01; I² = 0%), and also no significantly difference was found in the incidence of hyperglycemia (54.3% vs. 44.6%, OR = 1.26, 95%CI was 0.56-2.84, P = 0.58; I² = 61%), gastrointestinal bleeding (2.5% vs. 3.6%; OR = 0.70, 95%CI was 0.34-1.46, P = 0.34; I² = 0%) and secondary infection (9.2% vs. 11.5%; OR = 0.46, 95%CI was 0.06-3.35, P = 0.45; I² = 53%). CONCLUSION Hydrocortisone can reduce the mortality rate of sCAP patients, decrease their need for mechanical ventilation, and does not increase the risk of hyperglycemia, gastrointestinal bleeding, or secondary infections.
Humans ; Hydrocortisone/therapeutic use* ; Community-Acquired Infections/drug therapy* ; Pneumonia/drug therapy* ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; Community-Acquired Pneumonia

Objective: To investigate the occupational health status of medical radiation workers in Hangzhou City, so as to provide the basis for their occupational health risk assessment. Methods: Data on medical radiological workers who underwent occupational health examinations from 2021 to 2022 were collected through the Physical Examination Information Management System of the Hangzhou Occupational Disease Prevention and Control Hospital. The physical examination data including blood routine, eye lens, thyroid ultrasound, thyroid function, liver function, renal function and blood lipid were collected, and the abnormal rates of occupational health examinations among workers with different genders, working years and occupational exposure types were analyzed. Results: A total of 3 968 medical radiation workers were investigated, including 2 310 males (58.22%) and 1 658 females (41.78%). There were 2 039 (51.39%), 821 (20.69%) and 1 108 (27.92%) workers with 1-<6, 6-<10 years and 10 years and above of work, respectively. Diagnostic radiology was the predomenant type of exposure, with 2 240 workers accounting for 56.45%. The abnormal rates of thyroid ultrasound and blood lipid were 47.73% and 45.21%, respectively, which were relatively higher than other items. The abnormal rates of micronucleus rate, thyroid ultrasound, thyroid function and renal function were higher in females than in males, while the abnormal rates of lymphocyte count, liver function and blood lipid in males were higher in males than in females (all P<0.05). With the increase of working years, the abnormal rates of micronucleus rate and blood lipid showed upward trends (both P<0.05). There were statistically significant differences in the abnormal rates of thyroid ultrasound, liver function and blood lipid among different occupational exposure types (all P<0.05). Conclusion Long-term low-dose ionizing radiation environment affects the thyroid, micronucleus rate and blood lipid of medical radiation workers in Hangzhou City, with differences observed among workers with different genders and occupational exposure types.

Homo- or heterodimeric compounds that affect dimeric protein function through interaction between monomeric moieties and protein subunits can serve as valuable sources of potent and selective drug candidates. Here, we screened an in-house dimeric natural product collection, and panepocyclinol A (PecA) emerged as a selective and potent STAT3 inhibitor with profound anti-tumor efficacy. Through cross-linking C712/C718 residues in separate STAT3 monomers with two distinct Michael receptors, PecA inhibits STAT3 DNA binding affinity and transcription activity. Molecular dynamics simulation reveals the key conformation changes of STAT3 dimers upon the di-covalent binding with PecA that abolishes its DNA interactions. Furthermore, PecA exhibits high efficacy against anaplastic large T cell lymphoma in vitro and in vivo, especially those with constitutively activated STAT3 or STAT3^Y640F. In summary, our study describes a distinct and effective di-covalent modification for the dimeric compound PecA to disrupt STAT3 function.

Objective In response to issues such as the lagging informatization of internal auditing in public hospitals,this study aims to implement the"Technology-Empowered Auditing"strategy,construct an internal audit information system a-ligned with high-quality development,and advance the goal of comprehensive audit oversight.Methods Based on an analysis of the current situation,shortcomings are identified.Solutions are proposed,including strengthening data governance and intelligent analysis,establishing self-adaptive optimization mechanisms for models,and empowering the entire audit process with big data technologies.Results A four-layer architecture of"basic layer-data layer-application layer-user layer"is designed,integrating four major modules:intelligent analysis and early warning,audit management,audit operation,and rectification tracking.This system achieves the integration of multi-source heterogeneous data,real-time risk monitoring,and overcomes the limitations of rule-based models,thereby enhancing audit intelligence.Conclusion The proposed framework facilitates deep integration of big data technologies with audit practices,provides methodological support for addressing efficiency bottlenecks,and offers a refer-ence for industry-wide adoption.

Objective To analyze the risk factors for postoperative intra-abdominal infection in gastric cancer pa-tients,as well as construct and validate a nomogram prediction model.Methods 588 gastric cancer surgery pa-tients who admitted to the Department of General Surgery of the First Affiliated Hospital of Soochow University from April 2021 to March 2024 were selected as the study subjects.Clinical data of patients were collected and ran-domly divided into the training set and the validation set according to the ratio of 3∶1.Clinical data between two groups of patients were compared.Patients were divided into the infection group and non-infection group according to whether they had intra-abdominal infection after surgery.Univariate and multivariate analyses were conducted,and a nomogram prediction model was constructed and validated based on the results of multivariate analysis.Results Among the 588 patients,52(8.84％)had postoperative intra-abdominal infection.A total of 65 strains of patho-gens were detected from 52 peritoneal fluid specimens,out of which 47(72.31％)were Gram-negative bacteria,15(23.07％)were Gram-positive bacteria,and 3(4.62％)were fungi.Multivariate logistic regression analysis showed that the degree of eradication(microscopic residue),combined organ resection,hypertension,history of ab-dominal surgery,and duration of surgery were all independent risk factors for postoperative intra-abdominal infec-tion in gastric cancer patients(all P＜0.05).Based on multivariate analysis results,a nomogram prediction model for postoperative intra-abdominal infection in gastric cancer patients was constructed.The receiver operating charac-teristic(ROC)curve result showed that the areas under the ROC curve(AUCs)of the training set and validation set were 0.764(95％CI:0.677-0.852)and 0.712(95％CI:0.565-0.860,respectively,indicating that the model had good discriminability for postoperative intra-abdominal infection in gastric cancer patients.Hosmer-Lemeshow test showed a x2 value of 8.491 and a P value of 0.387,suggesting goodness fit of the model.The decision curve analysis(DCA)result showed that within the risk threshold ranges of the training set(0.05-0.4)and validation set(0.1-1.0,positive benefits may be obtained by using the model to intervene in patients with high risk of post-operative intra-abdominal infection.Clinical impact curve(CIC)analysis result showed that within the risk thresh-old ranges of the training set(0-0.4)and validation set(0-0.5),the number of infected cases predicted by the model was higher than the actual number,indicating good clinical practicality of the model.Conclusion Construc-tion of a nomogram prediction model based on independent risk factors for postoperative intra-abdominal infection in gastric cancer can provide a quantitative and intuitive reference for the early clinical assessment of postoperative in-tra-abdominal infection in gastric cancer.

Objective In response to issues such as the lagging informatization of internal auditing in public hospitals,this study aims to implement the"Technology-Empowered Auditing"strategy,construct an internal audit information system a-ligned with high-quality development,and advance the goal of comprehensive audit oversight.Methods Based on an analysis of the current situation,shortcomings are identified.Solutions are proposed,including strengthening data governance and intelligent analysis,establishing self-adaptive optimization mechanisms for models,and empowering the entire audit process with big data technologies.Results A four-layer architecture of"basic layer-data layer-application layer-user layer"is designed,integrating four major modules:intelligent analysis and early warning,audit management,audit operation,and rectification tracking.This system achieves the integration of multi-source heterogeneous data,real-time risk monitoring,and overcomes the limitations of rule-based models,thereby enhancing audit intelligence.Conclusion The proposed framework facilitates deep integration of big data technologies with audit practices,provides methodological support for addressing efficiency bottlenecks,and offers a refer-ence for industry-wide adoption.

Objective To analyze the risk factors for postoperative intra-abdominal infection in gastric cancer pa-tients,as well as construct and validate a nomogram prediction model.Methods 588 gastric cancer surgery pa-tients who admitted to the Department of General Surgery of the First Affiliated Hospital of Soochow University from April 2021 to March 2024 were selected as the study subjects.Clinical data of patients were collected and ran-domly divided into the training set and the validation set according to the ratio of 3∶1.Clinical data between two groups of patients were compared.Patients were divided into the infection group and non-infection group according to whether they had intra-abdominal infection after surgery.Univariate and multivariate analyses were conducted,and a nomogram prediction model was constructed and validated based on the results of multivariate analysis.Results Among the 588 patients,52(8.84％)had postoperative intra-abdominal infection.A total of 65 strains of patho-gens were detected from 52 peritoneal fluid specimens,out of which 47(72.31％)were Gram-negative bacteria,15(23.07％)were Gram-positive bacteria,and 3(4.62％)were fungi.Multivariate logistic regression analysis showed that the degree of eradication(microscopic residue),combined organ resection,hypertension,history of ab-dominal surgery,and duration of surgery were all independent risk factors for postoperative intra-abdominal infec-tion in gastric cancer patients(all P＜0.05).Based on multivariate analysis results,a nomogram prediction model for postoperative intra-abdominal infection in gastric cancer patients was constructed.The receiver operating charac-teristic(ROC)curve result showed that the areas under the ROC curve(AUCs)of the training set and validation set were 0.764(95％CI:0.677-0.852)and 0.712(95％CI:0.565-0.860,respectively,indicating that the model had good discriminability for postoperative intra-abdominal infection in gastric cancer patients.Hosmer-Lemeshow test showed a x2 value of 8.491 and a P value of 0.387,suggesting goodness fit of the model.The decision curve analysis(DCA)result showed that within the risk threshold ranges of the training set(0.05-0.4)and validation set(0.1-1.0,positive benefits may be obtained by using the model to intervene in patients with high risk of post-operative intra-abdominal infection.Clinical impact curve(CIC)analysis result showed that within the risk thresh-old ranges of the training set(0-0.4)and validation set(0-0.5),the number of infected cases predicted by the model was higher than the actual number,indicating good clinical practicality of the model.Conclusion Construc-tion of a nomogram prediction model based on independent risk factors for postoperative intra-abdominal infection in gastric cancer can provide a quantitative and intuitive reference for the early clinical assessment of postoperative in-tra-abdominal infection in gastric cancer.

Currently, the evaluation of keloids is mostly based on clinical observation and many clinical evaluation scales, and there is still a lack of a "gold standard" to objectively evaluate keloids. Imaging examinations are of great value to the diagnosis, differential diagnosis of and efficacy evaluation in keloids. This review summarizes the research progress in the application of imaging techniques in keloids, thereby helping clinicians choose the appropriate equipment.

Objectives:Fluid resuscitation is an important treatment for sepsis. However, the optimal choice of fluid is still controversial. This study aimed to investigate the effect of Sodium Bicarbonate Ringer’s Solution on the outcome of patients with sepsis.Methods:This was a single-center, prospective, randomized controlled clinical study, From July 2021 to June 2023, adult patients with Sepsis who met the diagnostic criteria of Sepsis 3.0 admitted to the Department of Critical Care Medicine of Jiangdu People's Hospital of Yangzhou were randomly assigned to the sodium bicarbonate ringer’s solution group or the normal saline group according to the random number table. Patients received either sodium bicarbonate ringer’s solution or normal saline as fluid for resuscitation and maintenance therapy. Clinicians determined the amount and rate of infusion based on volume assessment. The 30-day mortality, the degradation of endothelial glycocalyx degradation products at multiple time points, the mortality in intensive care unit (ICU), the incidence of major adverse renal events (MAKE30) within 30 days, and other clinical outcomes were compared between the two groups. Enzyme-Linked immunosorbent assay was used to determine the concentration of endothelial glycocalyx coating degradation products in peripheral blood. The count data were analyzed by χ 2 test, and the measurement data were analyzed by independent sample t test. Results:A total of 67 patients who met the inclusion criteria were enrolled during the study (32 patients in the sodium bicarbonate ringer’s solution group and 35 patients in the normal saline group). There were no significant differences in baseline data such as age, gender, underlying diseases, and SOFA score at enrollment between the two groups ( P>0.05).The 30-day mortality (28.1% vs. 40.0%), ICU mortality (15.6% vs. 20.0%) and MAKE30 (31.2% vs. 42.9%) in the sodium bicarbonate ringer’s solution group were lower than those in the normal saline group, but the differences were not statistically significant ( P>0.05). The levels of SCD-1(1317.3±206.9) pg/mL, HA (75.1±24.9) ng/mL and HS (75.6±13.8) ng/mL in the sodium bicarbonate ringer’s solution group were significantly lower than those in the normal saline group [(1514.6±264.9) pg/mL, (96.5±25.4) ng/mL, (85.8±15.8) ng/mL] on the third day (all P<0.05). Conclusion:Although the use of sodium bicarbonate ringer’s solution for resuscitation in sepsis patients cannot significantly reduce the 30-day mortality rate, but significantly reduce the degradation of polysaccharide coating, decrease the occurrence of hyperchloremia and acidosis.