ObjectiveTo investigate the value of liver stiffness measurement （LSM） and spleen stiffness measurement （SSM） measured by two-dimensional shear wave elastography （2D-SWE） in the diagnosis of severe portal hypertension （SPH） and high-risk varices （HRV）， and to provide a basis for noninvasive assessment of portal hypertension. MethodsA prospective study was conducted among 78 patients with cirrhotic portal hypertension who were treated in Liver Research Center of Beijing Friendship Hospital， Capital Medical University， from December 2019 to April 2023. According to hepatic venous pressure gradient （HVPG）， the patients were divided into 6 mmHg≤HVPG<12 mmHg group， 12 mmHg≤HVPG<20 mmHg group， and HVPG ≥20 mmHg group. All patients underwent gastroscopy and 2D-SWE within 1 week after HVPG measurement， and SWE-LSM and SWE-SSM measured by 2D-SWE were recorded. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. With HVPG and gastroscopy findings as the gold standard， the receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to evaluate diagnostic performance， while the DeLong test was used for comparison of AUC. The Pearson or Spearman correlation analysis was used to investigate the correlation between variables， and the linear regression analysis and the Logistic regression analysis were used to investigate the influencing factors for HVPG and HRV. ResultsThe mean HVPG was 18.1±6.4 mmHg for the patients enrolled in this study， and HRV was observed in 62 patients （79.5%）. Both SWE-LSM and SWE-SSM were significantly positively correlated with HVPG （r=0.413 and 0.633， both P<0.001）， with an AUC of 0.812 and 0.902， respectively， in the diagnosis of HVPG≥12 mmHg and an AUC of 0.804 and 0.789， respectively， in the diagnosis of HVPG≥20 mmHg （all P>0.05）. The multivariate linear regression analysis showed that SWE-SSM was an independent influencing factor for HVPG （β=0.17， P<0.001）. In the diagnosis of HRV， only SWE-SSM showed a significant positive correlation with HRV （r=0.432， P<0.001）， with a better diagnostic performance than SWE-LSM in terms of AUC （0.808 vs 0.642， Z=2.775， P=0.006）. The multivariate Logistic regression analysis showed that platelet count was an independent influencing factor for HRV （odds ratio=0.97， P=0.014）. ConclusionSWE-SSM is closely correlated with both HVPG and HRV， showing a good performance in the diagnosis of SPH and HRV， and therefore， it is expected to become an effective noninvasive tool for assessing portal hypertension.

Objective:To investigate the association between different sleep patterns and anxiety and depression in hemodialysis patients, thereby providing a reference for improving their psychological and sleep conditions.Methods:This study was a cross-sectional survey.A convenience sampling method was used to select patients undergoing regular dialysis at a hemodialysis centre in the Sixth People's Hospital of Huizhou from May 2023 to May 2024. Sleep quality, anxiety and depression symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale for (SAS) and Self-rating Depression Scale (SDS). Potential profiles were analyzed using Mplus 8.3 and mixed-effects Logistic regression was used to explore the association between sleep pattern category and anxiety-depression.Results:A total of 264 valid questionnaires were returned, of which 142 were males and 122 were females, aged (56.61 ± 12.69) years old. The sleep patterns of hemodialysis patients were divided into three potential categories:patients with overall better sleep quality31.4%(83/264), patients with poor sleep using hypnotic medication12.9%(34/264), and patients with poor sleep without hypnotic medication 55.7%(147/264). Significant differences were found in age, education, anxiety and depression across different sleep categories ( χ2 values were 9.75-25.72, all P<0.05). Compared with the group with overall better sleep quality, the risk of anxiety was higher in the group with sleep difficulties without hypnotic medication ( OR=5.409, P<0.05), and the risk of anxiety and depression ( OR=5.010, 6.488, both P<0.05) was higher in the group with sleep disorders using hypnotic medication. Compared with patients with poor sleep without hypnotic medication, patients with poor sleep using hypnotic medication had a higher risk of depression ( OR=6.501, P<0.05). Conclusions:There are three potential categories of sleep patterns in hemodialysis patients and significant correlations between them and anxiety and depression, and precise screening and individualized interventions need to be implemented in the clinic to improve patients' quality of life.

Objective:To investigate the effect and mechanism of total glucosides of paeony(TGP)on intestinal ischemia reperfusion(IIR)injury in rats based on Ras homolog gene family member A(RhoA)/Rho-related coiled-coil protein kinase 1(Rock1)pathway.Method:The IIR rat models were established by clamping the superior mesenteric artery for 1 h,and the rats were randomly divided into Sham group,Model group,TGP group,TGP+Rhosin(RhoA inhibi-tor)group and TGP+LPA(RhoA agonistor)group,with 8 rats in each group.After 4 weeks of continuous administration once a day,the activity or level of intestinal barrier indexes[diamine oxidase(DAO),d-lactic acid(D-LA)and endotoxin(ET)]in plasma were detected by ELISA method,the wet/dry weight(W/D)ratio was calculated to evaluate the intestinal water content.The intestinal histopathological changes was observed by HE stainning,and the the degree of intestinal injury was evaluated by Chiu's score.The intestinal cells apoptosis was observed by TUNEL method.The inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-18(IL-18)and interleukin-1β(IL-1β)]in serum were detected by ELISA method.The oxidative stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD)and catalase(CAT)]in serum were measured by spectrophotometry method.The expression of RhoA,ROCK1,nuclear factor-κB p65(NF-κB p65),hypoxia induciblefactor-1α(HIF-1α),zonula occludens protein-1(ZO-1),Occludin proteins were detected by Western blot method.Result:Compared with Model group,the activity of DAO and the content of D-LA,ET in plasma of TGP group and TGP+Rhosin group were significantly decreased,the W/D of intestinal were significantly decreased(P<0.05).The intestinal histopathological changes were significantly improved,the Chiu's score and cell poptosis index were significantly decreased(P<0.05).The content of TNF-α,IL-18,IL-1β,MDA in serum were significantly decreased,the activity of SOD,CAT were significantly increased(P<0.05).The expression of RhoA,ROCK1,NF-κB p65 proteins in in-testine tissue were significantly decreased,the expression of HIF-1α,ZO-1,Occludin proteins were significantly in-creased(P<0.05).Compared with TGP group,Rhosin significantly enhanced the effects of TGP on various detection indi-cators in IIR rats(P<0.05),while LPA significantly weakened the aforementioned effects of TGP(P<0.05).Conclusion:TGP could inhibiting inflammation,oxidative stress and improving intestinal barrier function by down-regulating RhoA/ROCK1 pathway,thus playing protective role against IIR injury in rats.

Objective:To investigate the association between serum thyroid-stimulating hormone(TSH) level and the 10-year risk of atherosclerotic cardiovascular disease(ASCVD) in men over 50 years old with type 2 diabetes mellitus(T2DM).Methods:This study included male T2DM patients aged≥50 years, diagnosed at the First Hospital of Lanzhou University between July 2021 and March 2022. Patients were categorized into three groups based on serum TSH level: elevated TSH group(T3, TSH>5.91 mIU/L) and normal TSH group, which was further divided into T1(0.56 mIU/L≤TSH<3.24 mIU/L) and T2(3.24 mIU/L≤TSH≤5.91 mIU/L) group. The 10-year ASCVD risk index was compared across groups. Spearman correlation and multiple linear regression analyses were used to assess the independent association between TSH level and 10-year ASCVD risk index. Results:A total of 490 male T2DM patients aged≥50 years were included(T1: 310, T2: 131, T3: 49). The 10-year ASCVD risk index was significantly higher in T3 group than that in T1 group(18.40% vs 13.90%, χ2=9.47, P<0.05). Serum TSH level showed a positive correlation with the 10-year ASCVD risk( r=0.144, P<0.05). After adjusting for confounders such as age, hypertension, lipid profile, diabetes duration, aspartate aminotransferase, albumin, lactate dehydrogenase, estimated glomerular filtration rate, creatinine, and phosphorus, multiple linear regression confirmed that TSH level was independently associated with the 10-year ASCVD risk index( β=0.23, 95% CI 0.02-0.45). Conclusions:Higher serum TSH level is independently associated with an increased 10-year ASCVD risk in men over 50 years old with T2DM. Regular TSH monitoring may aid in cardiovascular risk stratification in this population.

Advances in genomics,biochemistry,and genetics have deepened our understanding of epigenetic mechanisms.These mechanisms play a crucial role in life,heredity,and evo-lution.Their growing significance is driving biomedical research toward personalized and precise medicine.Renal diseases,par-ticularly chronic kidney disease and acute kidney injury,require new treatment strategies.Their subtle clinical symptoms and challenges in early diagnosis limit current therapeutic options.Research on epigenetic modifications in renal diseases is expan-ding rapidly.This field is emerging as a promising approach for kidney disease treatment.The transition from basic mechanistic studies to clinical applications is underway.Epigenetic modifica-tions hold great potential for improving early diagnosis,enabling personalized treatment,and advancing precision medicine in re-nal diseases.

Objective:To investigate the association between serum thyroid-stimulating hormone(TSH) level and the 10-year risk of atherosclerotic cardiovascular disease(ASCVD) in men over 50 years old with type 2 diabetes mellitus(T2DM).Methods:This study included male T2DM patients aged≥50 years, diagnosed at the First Hospital of Lanzhou University between July 2021 and March 2022. Patients were categorized into three groups based on serum TSH level: elevated TSH group(T3, TSH>5.91 mIU/L) and normal TSH group, which was further divided into T1(0.56 mIU/L≤TSH<3.24 mIU/L) and T2(3.24 mIU/L≤TSH≤5.91 mIU/L) group. The 10-year ASCVD risk index was compared across groups. Spearman correlation and multiple linear regression analyses were used to assess the independent association between TSH level and 10-year ASCVD risk index. Results:A total of 490 male T2DM patients aged≥50 years were included(T1: 310, T2: 131, T3: 49). The 10-year ASCVD risk index was significantly higher in T3 group than that in T1 group(18.40% vs 13.90%, χ2=9.47, P<0.05). Serum TSH level showed a positive correlation with the 10-year ASCVD risk( r=0.144, P<0.05). After adjusting for confounders such as age, hypertension, lipid profile, diabetes duration, aspartate aminotransferase, albumin, lactate dehydrogenase, estimated glomerular filtration rate, creatinine, and phosphorus, multiple linear regression confirmed that TSH level was independently associated with the 10-year ASCVD risk index( β=0.23, 95% CI 0.02-0.45). Conclusions:Higher serum TSH level is independently associated with an increased 10-year ASCVD risk in men over 50 years old with T2DM. Regular TSH monitoring may aid in cardiovascular risk stratification in this population.

Objective:To understand the incidence rate of herpes zoster (HZ) and postherpetic neuralgia (PHN) in Beijing, and analyze the incidence trend of HZ and PHN from 2015 to 2022.Methods:Cases of HZ and PHN from 2015 to 2022 were retrieved from the Hospital Information Systems (HIS) of all primary and above hospitals/clinics in three districts representing the urban, inner suburban, and outer suburban areas of Beijing. After duplication screening, the first visit cases were screened, and the incidence characteristics were described. The incidence rate of HZ and PHN in each year by sex and age group and the age-standardized incidence rate were calculated. The annual percentage increase (APC) of incidence rate was calculated using the Joint regression model, and the change trend was analyzed.Results:The age-standardized incidence rate of HZ in Beijing from 2015 to 2022 ranged from 7.44‰ to 10.05‰, with an average annual incidence rate of 8.95 ‰, significantly increasing with age ( P<0.001). The Joinpoint regression model showed that the overall age-standardized incidence of HZ remained relatively stable, with no significant difference (APC=2.28%, t=1.56, P=0.170). However, the incidence rate among the 0-19-year-old group exhibited a trend of decrease (APC=-10.70%, t=-6.29, P<0.001). For PHN, the age-standardized incidence in Beijing ranged from 0.77‰ to 2.67‰, with an average annual incidence rate of 1.59‰ and a proportion of 9.48% to 26.86% among HZ cases. Both the incidence of PHN and its proportion among HZ cases increased with age ( P<0.001). The age-standardized incidence of PHN increased annually (APC=18.56%, t=9.02, P<0.001). Conclusion:The incidence rate of HZ and PHN in Beijing continues to be at a high level, and PHN shows an increasing trend over time.

Objective To investigate differences in postoperative analgesia efficacy,inflammatory response,and recovery between intraplanar(in-plane)and extraplanar(out-of-plane)thoracic paravertebral block(TPVB)techniques under ultrasound guidance in patients undergoing thoracoscopic radical resection for lung cancer,thereby providing evidence for selecting the optimal block technique in clinical practice.Methods Eighty patients undergoing thoracoscopic radical resection for lung cancer between March and September 2022 were randomly assigned to an intraplanar group(n=40)or an extraplanar group(n=40).Before induction of anesthesia,both groups received 10 mL of 0.33％ropivacaine injected into the T4 and T6 paravertebral spaces under ultrasound guidance,using their respective in-plane or out-of-plane techniques.The following parameters were compared between the groups:nerve block procedure duration,onset time of block,visual analogue scale(VAS)pain scores within 48 hours postoperatively,incidence of postoperative nausea and vomiting(PONV),and serum inflammatory and stress markers including C-reactive protein(CRP),interleukin-6(IL-6),cortisol(Cor),and norepinephrine(NE).Results No significant differences were observed between the groups in block procedure duration,onset time,or analgesic duration(P＞0.05).Compared with the extraplanar group,the intraplanar group demonstrated a significantly reduced incidence of PONV(15.0％vs.35.0％,P=0.039)and significantly lower serum levels of CRP,IL-6,and Cor at 24 hours postoperatively(P＜0.05).No pleural punctures occurred in the intraplanar group(0％),whereas the extraplanar group had a 15.0％incidence rate.However,the overall complication rate in both groups showed no statistically significant difference(P=0.060).Conclusion Both ultrasound-guided in-plane and out-of-plane TPVB techniques provide effective postoperative analgesia for thoracoscopic radical lung cancer surgery.However,the in-plane technique significantly reduces the incidence of PONV and postoperative inflammatory responses while demonstrating higher operational safety,making it the preferred clinical choice.

Chronic obstructive pulmonary disease (COPD) is a common and frequently-occurring respiratory disease, which has imposed a huge burden on society. Moreover, the pathogenesis of COPD remains unclear. Ferroptosis is a newly discovered pattern of programmed cell death, characterized by excessive iron accumulation and lipid peroxidation. Studies have shown that ferroptosis and abnormal iron metabolism play an indispensable role in COPD. This article reviews the relationship between ferroptosis and COPD, elaborates on the impact of iron metabolism imbalance in the body on the occurrence and development of COPD, in order to stimulate the thinking of a large number of researchers and reveal the crucial role of iron in COPD.

Objective:To apply combined serological diagnostic methods for anti-BP180-type and anti-laminin 332 (Ln332) -type mucous membrane pemphigoid (MMP), and to summarize their clinical and immunoserological characteristics.Methods:A retrospective analysis was conducted on the data from 52 patients clinically suspected of having MMP at the Hospital of Dermatology, Chinese Academy of Medical Sciences from January 2017 to February 2022. Serum samples were collected, and combined serological tests, including indirect immunofluorescence on salt-split skin, enzyme-linked immunosorbent assay, and immunoblotting, were performed to analyze the immunoserological and clinical characteristics of the patients. The Fisher′s exact test was used to compare the lesion occurrence rates between groups.Results:Among the 52 patients clinically suspected of MMP, 32 (61.5%) were diagnosed with anti-BP180-type MMP, 10 (19.2%) with anti-Ln332-type MMP, and 4 (7.7%) with anti-BP180- and anti-Ln332-type MMP due to the presence of both anti-BP180 and anti-Ln332 antibodies; 2 tested positive for IgG on the epidermal side of salt-split skin, but no target antigens were identified by serological tests, and they were diagnosed with MMP (subtype pending) ; 4 tested negative by immunoserological tests. Ocular involvement was observed in 6 out of 10 patients with anti-Ln332-type MMP, whereas only 6 out of 32 anti-BP180-type MMP patients (18.8%) had ocular symptoms, and there was a significant difference in the occurrence rate of ocular involvement between the two groups ( P = 0.02) ; the occurrence rates of nasal involvement and multi-mucosal involvement were significantly higher in the anti-Ln332-type MMP patients (50%[5/10], 90%[9/10], respectively) than in the anti-BP180-type MMP patients (0, 25%[8/32], respectively, both P < 0.001). Scar formation occurred in 6 out of 10 anti-Ln332-type MMP patients, but occurred in only 6 out of 32 anti-BP180-type patients (18.8%, P = 0.02) . Conclusion:The combination of indirect immunofluorescence on salt-split skin, enzyme-linked immunosorbent assay, and immunoblotting could effectively identify anti-BP180 and anti-Ln332 autoantibodies in MMP patients, with BP180 being the most common target antigen; compared with anti-BP180-type MMP, anti-Ln332-type MMP appeared to be more frequently involve the ocular and nasal mucosae, associated with the involvement of multiple mucosal sites, carrying a higher risk of scar formation.