Objective:To investigate the serum sodium level and its fluctuation in patients with hospitalized acquired acute kidney injury (AKI) and explore their impacts on in-hospital mortality.Methods:It was a single-center retrospective study. The adult patients developing hospital-acquired AKI and receiving at least twice serum sodium tests admitted to Peking University First Hospital from January 1, 2018, to December 31, 2020 were included. Dysnatremia included hyponatremia (< 135 mmol/L) and hypernatremia (>145 mmol/L). The patients were divided into hyponatremia group, normal serum sodium group and hypernatremia group, and the differences of clinical data among the three groups were compared. The fluctuation of serum sodium level was evaluated by coefficient of variation. A restricted cubic spline was applied to investigate the association between serum sodium level at AKI onset and mortality. Poisson regression analysis was used to explore the mortality risk of dysnatremia at AKI onset, dysnatremia at admission, and coefficient of variation of serum sodium, respectively.Results:Among the enrolled 1 475 AKI patients, the age was 66.0 (55.0, 78.0) years, and 850 patients (57.6%) were males. The estimated glomerular filtration rate was 77.3 (50.4, 97.6) ml·min -1·(1.73 m 2) -1. The time from admission to AKI onset was 8 (4, 15) days. The incidence of hyponatremia and hypernatremia at admission were 19.6% (289/1 475) and 2.6% (39/1 475), respectively, while the incidence at AKI onset was 24.0% (354/1 475) and 12.7% (188/1 475), respectively. There was statistically significant difference in terms of age, the initial classification distribution of AKI, serum sodium at admission, serum sodium at the occurrence of AKI, the lowest serum sodium at hospitalization, the highest serum sodium at hospitalization, the coefficient of variation of serum sodium, and the proportions of heart failure, stroke, disseminated intravascular coagulation, sepsis, acute respiratory distress syndrome, shock, prerenal causes, circle diuretics and aldosterone antagonists among hyponatremia group, normal serum sodium group and hypernatremia group (all P<0.05). The restricted cubic spline analysis showed a "U"-shaped correlation between serum sodium level at AKI onset and in-hospital mortality. Poisson regression analysis showed that after adjusting for age, gender, number of chronic comorbidities, initial classification of AKI, basal estimated glomerular filtration rate and number of acute disease state, with normal serum sodium as the reference, hyponatremia ( RR=1.56, 95% CI 1.14-2.13) and hypernatremia ( RR=1.71, 95% CI 1.23-2.39) at AKI onset were correlated with an increased risk of in-hospital mortality. Hyponatremia at admission was correlated with an increased risk of in-hospital mortality ( RR=2.13, 95% CI 1.62-2.79), while there was no statistically significant association between hypernatremia and in-hospital mortality ( RR=1.22, 95% CI 0.62-2.44). After further adjusting serum sodium levels at admission and at the occurrence of AKI, the coefficient of variation of serum sodium level was still correlated with an increased risk of in-hospital mortality ( RR=1.23, 95% CI 1.14-1.33). Conclusions:Dysnatremia is common in patients with hospital-acquired AKI. The serum sodium level at AKI onset is correlated with in-hospital death in a "U" shape. Dysnatremia and serum sodium fluctuation are associated with an increased risk of in-hospital mortality.

Objective To explore the relationship between of endothelial activation and stress index (EASIX) and the course and survival ending of sepsis. Methods A retrospective analysis of 197 patients meeting the definition of sepsis 3.0 were admitted to the Tongzhou Campus,Dongzhimeng Hospital of Beijing University of Chinese Medicine from March 2019 to March 2023,and grouped according to the course of disease and prognosis. The SOFA score and APACHE Ⅱ score were used to assess the severity of sepsis. The EASIX index consists of lactate dehydrogenase,creatinine,and platelets. Multivariate COX regression model analysis of factors affecting poor prognosis in sepsis. The receiver operator characteristic (ROC ) curve was drawn to investigate the predictive value of EASIX,SOFA and APACHE Ⅱ scores for the course and 30-day mortality in patients with sepsis. Patient subgroup analysis was performed according to the best cut-off value,and Kaplan-Meier survival curves were drawn. Results Compared with the sepsis group,the EASIX (2.55±0.54 vs 2.30±0.49),APACHE Ⅱ (16.47±4.10 vs 11.81±4.89),SOFA(8.66±3.00 vs 5.48±3.92) scores of the septic shock group were significantly in creased,and EASIX also increased significantly with the progression of the disease,with statistically significant differences(t=-3.293,-7.255,-6.431,all P<0.001). The 30-day mortality rates in the sepsis and septic shock groups were 11.96％ and 29.52％,respectively. EASIX was positively correlated with SOFA scores and APACHE Ⅱ scores (r=0.662,0.425,all P<0.05),and increased with the progression of the disease course(t=3.293,P=0.001). Multivariate COX regression analysis showed that elevated EASIX was an independent risk factor for 30-day death in septic shock[OR(95％CI):1.282(1.135～1.449),P=0.001]. The ROC curve analysis showed that the predictive performance of EASIX for 30-day mortality in septic patients compared with APACHE Ⅱ and SOFA scoring,with no statistically significant difference (Z=1.208,0.538,P=0.227,0.591). The Kaplan-Meier survival curve analysis showed that the 30-day mortality of sepsis patients in the EASIX>2.43 group was significantly higher than that in the EASIX≤ 2.43 group (Log-Rank x2=18.76,P<0.001). Conclusion EASIX is a potential biomarker for predicting poor short-term prognosis in sepsis.

Objective:To separate and purify the polysaccharides from Polygonatum filipes,characterize their primary structure and investigate the immunomodulatory effects on RAW264.7 macrophages.Methods:Crude polysaccharides from Polygonatum filipes were extracted by ultrasound assisted method,then Polygonatum filipes polysaccharides(CSPFPs)were obtained after elimination of the proteins with combined papain-Sevag method.The total sugar content was determined by phenol-sulfuric acid method.Structures of CSPFPs were analyzed by fourier transform infrared spectroscopy(FT-IR),high performance gel permeation chromatography(HPGPC)and high performance liquid chromatography(HPLC).Effects of CSPFPs on cell viability,pinocytic activity,TNF-α secretion,MAPK and NF-κB signaling pathways of RAW264.7 cells were explored by MTT,Neutral red,ELISA and Western blot,respectively.Results:Extraction rate of CSPFPs by ultrasound-assisted method was 41.61%,which contained total sugar content of 94.00%.CSPFPs with Mw of 3 125 Da was composed of arabinose(1.85%),galactose(6.14%),glucose(56.41%)and mannose(35.60%).The in vitro experiments showed that CSPFPs were non-cytotoxic and enhanced the pinocytic activity,TNF-α secretion and phosphorylation levels of p38,ERK,JNK,p65,IκB and IKK,indicating the activation of MAPK and NF-κB signaling pathways under the concentra-tion of 2.5～200 μg/ml.Conclusion:The ultrasound-assisted method can efficiently isolate CSPFPs with immunomodulatory activity,which provides basic data for the development and application of CSPFPs as an immunostimulant.

Objective:To investigate the serum sodium level and its fluctuation in patients with hospitalized acquired acute kidney injury (AKI) and explore their impacts on in-hospital mortality.Methods:It was a single-center retrospective study. The adult patients developing hospital-acquired AKI and receiving at least twice serum sodium tests admitted to Peking University First Hospital from January 1, 2018, to December 31, 2020 were included. Dysnatremia included hyponatremia (< 135 mmol/L) and hypernatremia (>145 mmol/L). The patients were divided into hyponatremia group, normal serum sodium group and hypernatremia group, and the differences of clinical data among the three groups were compared. The fluctuation of serum sodium level was evaluated by coefficient of variation. A restricted cubic spline was applied to investigate the association between serum sodium level at AKI onset and mortality. Poisson regression analysis was used to explore the mortality risk of dysnatremia at AKI onset, dysnatremia at admission, and coefficient of variation of serum sodium, respectively.Results:Among the enrolled 1 475 AKI patients, the age was 66.0 (55.0, 78.0) years, and 850 patients (57.6%) were males. The estimated glomerular filtration rate was 77.3 (50.4, 97.6) ml·min -1·(1.73 m 2) -1. The time from admission to AKI onset was 8 (4, 15) days. The incidence of hyponatremia and hypernatremia at admission were 19.6% (289/1 475) and 2.6% (39/1 475), respectively, while the incidence at AKI onset was 24.0% (354/1 475) and 12.7% (188/1 475), respectively. There was statistically significant difference in terms of age, the initial classification distribution of AKI, serum sodium at admission, serum sodium at the occurrence of AKI, the lowest serum sodium at hospitalization, the highest serum sodium at hospitalization, the coefficient of variation of serum sodium, and the proportions of heart failure, stroke, disseminated intravascular coagulation, sepsis, acute respiratory distress syndrome, shock, prerenal causes, circle diuretics and aldosterone antagonists among hyponatremia group, normal serum sodium group and hypernatremia group (all P<0.05). The restricted cubic spline analysis showed a "U"-shaped correlation between serum sodium level at AKI onset and in-hospital mortality. Poisson regression analysis showed that after adjusting for age, gender, number of chronic comorbidities, initial classification of AKI, basal estimated glomerular filtration rate and number of acute disease state, with normal serum sodium as the reference, hyponatremia ( RR=1.56, 95% CI 1.14-2.13) and hypernatremia ( RR=1.71, 95% CI 1.23-2.39) at AKI onset were correlated with an increased risk of in-hospital mortality. Hyponatremia at admission was correlated with an increased risk of in-hospital mortality ( RR=2.13, 95% CI 1.62-2.79), while there was no statistically significant association between hypernatremia and in-hospital mortality ( RR=1.22, 95% CI 0.62-2.44). After further adjusting serum sodium levels at admission and at the occurrence of AKI, the coefficient of variation of serum sodium level was still correlated with an increased risk of in-hospital mortality ( RR=1.23, 95% CI 1.14-1.33). Conclusions:Dysnatremia is common in patients with hospital-acquired AKI. The serum sodium level at AKI onset is correlated with in-hospital death in a "U" shape. Dysnatremia and serum sodium fluctuation are associated with an increased risk of in-hospital mortality.

Objective:To separate and purify the polysaccharides from Polygonatum filipes,characterize their primary structure and investigate the immunomodulatory effects on RAW264.7 macrophages.Methods:Crude polysaccharides from Polygonatum filipes were extracted by ultrasound assisted method,then Polygonatum filipes polysaccharides(CSPFPs)were obtained after elimination of the proteins with combined papain-Sevag method.The total sugar content was determined by phenol-sulfuric acid method.Structures of CSPFPs were analyzed by fourier transform infrared spectroscopy(FT-IR),high performance gel permeation chromatography(HPGPC)and high performance liquid chromatography(HPLC).Effects of CSPFPs on cell viability,pinocytic activity,TNF-α secretion,MAPK and NF-κB signaling pathways of RAW264.7 cells were explored by MTT,Neutral red,ELISA and Western blot,respectively.Results:Extraction rate of CSPFPs by ultrasound-assisted method was 41.61%,which contained total sugar content of 94.00%.CSPFPs with Mw of 3 125 Da was composed of arabinose(1.85%),galactose(6.14%),glucose(56.41%)and mannose(35.60%).The in vitro experiments showed that CSPFPs were non-cytotoxic and enhanced the pinocytic activity,TNF-α secretion and phosphorylation levels of p38,ERK,JNK,p65,IκB and IKK,indicating the activation of MAPK and NF-κB signaling pathways under the concentra-tion of 2.5～200 μg/ml.Conclusion:The ultrasound-assisted method can efficiently isolate CSPFPs with immunomodulatory activity,which provides basic data for the development and application of CSPFPs as an immunostimulant.

Objective To explore the relationship between of endothelial activation and stress index (EASIX) and the course and survival ending of sepsis. Methods A retrospective analysis of 197 patients meeting the definition of sepsis 3.0 were admitted to the Tongzhou Campus,Dongzhimeng Hospital of Beijing University of Chinese Medicine from March 2019 to March 2023,and grouped according to the course of disease and prognosis. The SOFA score and APACHE Ⅱ score were used to assess the severity of sepsis. The EASIX index consists of lactate dehydrogenase,creatinine,and platelets. Multivariate COX regression model analysis of factors affecting poor prognosis in sepsis. The receiver operator characteristic (ROC ) curve was drawn to investigate the predictive value of EASIX,SOFA and APACHE Ⅱ scores for the course and 30-day mortality in patients with sepsis. Patient subgroup analysis was performed according to the best cut-off value,and Kaplan-Meier survival curves were drawn. Results Compared with the sepsis group,the EASIX (2.55±0.54 vs 2.30±0.49),APACHE Ⅱ (16.47±4.10 vs 11.81±4.89),SOFA(8.66±3.00 vs 5.48±3.92) scores of the septic shock group were significantly in creased,and EASIX also increased significantly with the progression of the disease,with statistically significant differences(t=-3.293,-7.255,-6.431,all P<0.001). The 30-day mortality rates in the sepsis and septic shock groups were 11.96％ and 29.52％,respectively. EASIX was positively correlated with SOFA scores and APACHE Ⅱ scores (r=0.662,0.425,all P<0.05),and increased with the progression of the disease course(t=3.293,P=0.001). Multivariate COX regression analysis showed that elevated EASIX was an independent risk factor for 30-day death in septic shock[OR(95％CI):1.282(1.135～1.449),P=0.001]. The ROC curve analysis showed that the predictive performance of EASIX for 30-day mortality in septic patients compared with APACHE Ⅱ and SOFA scoring,with no statistically significant difference (Z=1.208,0.538,P=0.227,0.591). The Kaplan-Meier survival curve analysis showed that the 30-day mortality of sepsis patients in the EASIX>2.43 group was significantly higher than that in the EASIX≤ 2.43 group (Log-Rank x2=18.76,P<0.001). Conclusion EASIX is a potential biomarker for predicting poor short-term prognosis in sepsis.

Objective To compare the lipid-lowering efficacy and safety of fixed-dose combination and free combination of rosuvastatin and ezetimibe in hypercholesterolemia patients who fail to achieve low-density lipoprotein cholesterol(LDL-C)goal with statin monotherapy.Methods A total of 45 hypercholesterolemia patients who switched from statin monotherapy to fixed-dose combination of rosuvastatin and ezetimibe after failing to achieve target LDL-C goal admitted at cardiological departments of First Affiliated Hospital of Sun Yat-sen University,Nanhai Fourth People's Hospital,Foshan First People's Hospital,and Guangdong Provincial People's Hospital between March and June 2024 were enrolled and served as the study group.Another 120 hyper-cholesterolemia patients who treated with free combination of rosuvastatin and ezetimibe were se-lected from Xiamen Regional Health Medical Big Data Platform with propensity score matching and served as control group.The LDL-C level,LDL-C reduction,and changes in TC,HDL-C and TG levels in 4-6 weeks after the medication switch,as well as the safety indicators(AST,ALT,CK,Cre and eGFR)were compared between the two groups.Results In 4-6 weeks after the medication switch,the patients in the study group exhibited a significant decrease in LDL-C level(1.70±0.44 mmol/L vs 2.12±0.87 mmol/L,P＜0.01),obvious LDL-C reduction[(43.17±16.11)％vs(29.14±29.13)％,P＜0.01]when compared to those of the control group.The LDL-C goal attainment rate was significantly higher in the study group than the control group(71.11％vs 45.00％,P=0.003).In addition,there were no statistical differences in the levels of HDL-C and TG and the reductions of HDL-C and TG between the two groups in 4-6 weeks after treatment(P＞0.05).The study group obtained notably lower TC level and TC reduction than the control group in the time(P＜/0.05,P＜0.01).After treatment,no statistical differences were observed between the two groups in terms of AST,ALT,CK,Cre and eGFR(P＞0.05).Conclusion Com-pared to free combination of rosuvastatin and ezetimibe,fixed-dose combination can further reduce LDL-C level in hypercholesterolemia patients who have not achieved LDL-C goal with statin monotherapy,with higher LDL-C goal attainment rate and good safety.

Objective To train an automatic recognition and classification model of ulcerative colitis colonoscopy image based on ResNet,and to test its accuracy,in order to help doctors improve the clinical detection rate and classification accuracy of ulcerative colitis.Methods A total of 4000 colonoscopy images were retrospectively collected from the Colonoscopy Center of Hebei Hospital of Traditional Chinese Medicine from January 2018 to October 2023,and were divided into normal group,mild group,moderate group and severe group according to Mayo endoscopic scoring criteria,with 1000 images for each group.After pre-processing such as brightness adjustment and Angle rotation,the number of images was expanded to 20,000,and the data set was randomly divided into training set,verification set and test set according to the ratio of 7∶2∶1.The training set and verification set are input into the ResNet model to learn and test its stability.After all training is completed,the accuracy of the model is recorded through the test set,and the accurate regression curve is made to evaluate the classification effect of the model.Results In the test set,the accuracy of classification of ulcerative colitis was 99.8％in normal group,98.8％in mild group,95.6％in moderate group and 97.8％in severe group.Conclusion ResNet has good performance in image recognition and classification of ulcerative colitis,can improve the clinical accuracy of ulcerative colitis,and can assist doctors to identify and classify the disease,which has a more reliable clinical application value.

Objective To train an automatic recognition and classification model of ulcerative colitis colonoscopy image based on ResNet,and to test its accuracy,in order to help doctors improve the clinical detection rate and classification accuracy of ulcerative colitis.Methods A total of 4000 colonoscopy images were retrospectively collected from the Colonoscopy Center of Hebei Hospital of Traditional Chinese Medicine from January 2018 to October 2023,and were divided into normal group,mild group,moderate group and severe group according to Mayo endoscopic scoring criteria,with 1000 images for each group.After pre-processing such as brightness adjustment and Angle rotation,the number of images was expanded to 20,000,and the data set was randomly divided into training set,verification set and test set according to the ratio of 7∶2∶1.The training set and verification set are input into the ResNet model to learn and test its stability.After all training is completed,the accuracy of the model is recorded through the test set,and the accurate regression curve is made to evaluate the classification effect of the model.Results In the test set,the accuracy of classification of ulcerative colitis was 99.8％in normal group,98.8％in mild group,95.6％in moderate group and 97.8％in severe group.Conclusion ResNet has good performance in image recognition and classification of ulcerative colitis,can improve the clinical accuracy of ulcerative colitis,and can assist doctors to identify and classify the disease,which has a more reliable clinical application value.

Objective:To study the healthcare level (HCL) in China and its influencing factors.Methods:By using the data reported in the China statistical yearbook published by the National Bureau of Statistics and in other public literature, HCL was calculated in terms of the number of population and physicians in the whole country and various provinces. Multiple regression was used to analyze the relationship between HCL and regional population, area, number of administrative divisions and gross domestic product (GDP). Pearson correlation analysis was applied to analyze the relationship between healthcare level and medical radiation frequency. Results:Since 2015, Chinese HCL value was lower than 1 000, but there were two provinces with HCL value greater than 1 000 in 2019. Population and GDP were the influencing factors for the HCL, with correlation coefficients of 0.416 and -0.583, respectively. There was a correlation between HCL and medical exposure frequency of Chinese population( r= -0.620, P=0.028). Conclusions:Chinese HCL value was 542 in 2020, but there has been great differences between various provinces. HCL as an indicator of medical exposure assessment needs further research in China.