Objective To construct and verify a risk prediction model of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and to screen the optimal model by using machine learning algorithm,so as to provide references for clinical formulation of a nursing risk management plan.Methods The convenience sampling method was used to retrospectively select 476 patients who underwent thoracoscopic radical resection of lung cancer in a tertiary hospital in Hangzhou,Zhejiang Province from January to December 2023 as a construction group.Logistic regression,decision tree,random forest and naive Bayesian model were constructed by SPSS 29.0 and R 4.3.0 software.The prediction performance of each model was compared by accuracy,precision,recall,F1 score and area under the receiver operating characteristic curve,and the optimal model was screened.From January to June 2024,204 patients in the unit were prospectively selected as the research subjects of an external validation group.The discrimination and calibration of the optimal model were evaluated by AUC value and calibration curve.Results A total of 680 patients completed the survey.All 4 models showed that multimodal analgesia,thoracic drainage tube type,pain score,tracheal intubation type,state anxiety and catheter indwelling time were the influencing factors of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer(P＜0.05).The 4 risk prediction models showed that the random forest prediction model had the best comprehensive performance.The external verification results showed that the AUC value was 0.913,and the calibration curve fitted well with the 45° ideal line.Conclusion Among the 4 risk prediction models,the random forest prediction model has the best performance,which is more suitable for the assessment of the risk of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and has good generalization and clinical application value.

Objective:To measure the cerebral cortical activity by the functional near-infrared spectroscopy,fNIRS during the bilateral single-leg standing in population with chronic ankle instability(CAI)and healthy controls.Method:Sixteen healthy participants without any sprains and 16 participants with unilateral CAI were recruit-ed.The fNIRS was used to collect the brain function signals during the bilateral single-leg standing task.Based on the concentration of oxyhemoglobin(HbO2),the functional activation(β value)of each brain region of the two groups was calculated,and the differences between the groups during the tasks were compared in nine brain regions,including the dorsolateral prefrontal cortex(DLPFC),primary sensory area(S1),supplemen-tary motor area(SMA),and middle temporal gyrus(MTG).Result:Compared to healthy participants,CAI participants exhibited significantly increased cortical activity based on the β value in right SMA(ch28)and left Wernicke's area(ch51)during the single-leg standing on the injured side.During the single-leg standing on the uninjured side,CAI participants exhibited significantly increased cortical activity in the right side of DLPFC(ch15),S1(ch33)and MTG(ch40).Conclusion:The cerebral cortex activation in patients with CAI is different from that in healthy people,ac-cording to the neural mechanism of posture control.There is a higher activation of DLPFC,S1,MTG,SMA,and Wernicke's area in CAI patients during the state of postural control.

The incomplete degradation of tumour cells by macrophages(Mφ)is a contributing factor to tumour progression and metastasis,and the degradation function of Mφ is mediated through phagosomes and lysosomes.In our preliminary experiments,we found that overactivation of NADPH oxidase 2(NOX2)reduced the ability of Mφ to degrade engulfed tumour cells.Above this,we screened out liquiritin from Glycyrrhiza uralensis Fisch,which can significantly inhibit NOX2 activity and inhibit tumours,to elucidate that suppressing NOX2 can enhance the ability of Mφ to degrade tumour cells.We found that the tumour environment could activate the NOX2 activity in Mφ phagosomes,causing Mφ to produce excessive reactive oxygen species(ROS),thus prohibiting the formation of phagolysosomes before degradation.Conversely,inhibiting NOX2 in Mφ by liquiritin can reduce ROS and promote phagosome-lysosome fusion,therefore improving the enzymatic degradation of tumour cells after phagocytosis,and subse-quently promote T cell activity by presenting antigens.We further confirmed that liquiritin down-regulated the expression of the NOX2 specific membrane component protein gp91 phox,blocking its binding to the NOX2 cytoplasmic component proteins p67 phox and p47 phox,thereby inhibiting the activity of NOX2.This study elucidates the specific mechanism by which Mφ cannot degrade tumour cells after phagocytosis,and indicates that liquiritin can promote the ability of Mφ to degrade tumour cells by suppressing NOX2.

Objective:To investigate the risk factors for kidney injury during anti-retroviral therapy (ART) with zidovudine (AZT) or tenofovir disoproxil fumarate (TDF) in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients, and to construct and validate a prediction model for the risk of kidney injury in HIV/AIDS patients based on a nomogram.Methods:A total of 923 HIV/AIDS patients admitted to Liuzhou People′s Hospital between January 1st, 2004 and December 31st, 2020 were included in this study. The modeling set (647 cases) and the validation set (276 cases) were divided in a 7∶3 ratio. Risk factors were screened using the least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram prediction model for renal impairment risk in HIV/AIDS patients was constructed based on the selected variables. The model′s predictive performance was assessed by calculating the area under the curve (AUC) using the receiver operating characteristics curve (ROC curve). The performance of this model was evaluated using calibration curves. The clinical utility of the model was assessed using decision curve analysis (DCA).Results:Among 923 HIV/AIDS patients, there were 91 cases with kidney injury, including 67 in the modeling set and 24 in the validation set. AZT was used in 29 cases, and TDF was used in 62 cases. LASSO regression analysis was employed to screen seven non-zero variables, including age, ART regimen, baseline estimated glomerular filtration rate (eGFR), baseline CD4 + T lymphocyte count, baseline human immunodeficiency virus (HIV) RNA, baseline hemoglobin, and baseline aspartate aminotransferase (AST), their LASSO regression coefficient were 1.296, 0.250, 1.443, 0.240, 0.120, 0.395, and 0.002, respectively. Based on these variables, a visual nomogram model was constructed and subsequently validated. Through ROC curve analysis, the AUC for the modeling set was 0.826 (95% confidence interval ( CI) 0.767 to 0.884), with a sensitivity of 0.731 and a specificity of 0.809. For the validation set, the AUC was 0.872 (95% CI 0.807 to 0.956), with a sensitivity of 0.875 and a specificity of 0.778. The calibration curve results for the modeling set showed a mean absolute error (MAE) of 0.012 and a consistency index of 0.826, while the validation set had an MAE of 0.021 and a consistency index of 0.872. These results indicated that the model had a high goodness-of-fit, excellent calibration performance, and was reliable and stable. When the risk threshold for the modeling set ranged from 2% to 73%, the model demonstrated favorable net benefits, indicating its excellent clinical utility. Conclusion:The nomogram-based risk prediction model for kidney injury in HIV/AIDS patients is constructed using seven variables including age, ART regimen, baseline eGFR, baseline CD4 + T lymphocyte count, baseline HIV RNA, baseline hemoglobin, and baseline AST, which provides a valuable tool for early identification of individuals at risk of kidney injury and supports timely clinical interventions.

Objective:To investigate changes of CD4+T/CD8+T ratio in children with mycoplasma pneumoniae pneumonia(MPP)at different ages and to predict outcome.Methods:A total of 150 children aged 1～12 with MPP admitted to The Second People's Hospital of Hefei from March 2021 to September 2023 were selected as study group,and were divided into improved group(n=112)and deteriorated group(n=38)according to clinical outcomes after treatment.According to age,patients were divided into in-fant group(≤3 years old)38 cases,preschool group(4～6 years old)57 cases,school age group(>6 years old)55 cases.General information,biochemical test indicators and other related data were collected,CD4+T/CD8+T was calculated,and statistical analysis was performed by SPSS23.0 software.Through univariate and multifactor Logistics regression analysis,changes of CD4+T/CD8+T and other indicators in MPP children of different ages were compared,and independent factors affecting outcome of MPP children were screened.ROC curve was used to analyze efficacy of selected independent influencing factors in predicting outcome of MPP children of different ages.Log-binomial model was used to analyze risk effect of age on CD4+T/CD8+T and different outcomes in MPP children.Dose-response relationship between CD4+T/CD8+T and risk of disease progression in MPP children was analyzed by Logistic regression model combined with restricted cubic spline(RCS)model.P<0.05 was statistically significant.Results:CRP,IgA,IgG,IgM and CD8+T were the highest in infant group,followed by preschool group,the lowest in school-age group(P<0.05),CD4+T and CD4+T/CD8+T were the lowest in infant group,followed by preschool group,and the highest in school-age group(P<0.05).MPP children with≤3 years old accounted for the lowest proportion of improvement(18.76%)and the worst improvement,followed by MPP children with 4～6 years old,MPP children with>6 years old accounted for the highest proportion of improvement(43.75%),and the best im-provement(P<0.001).Improvement of children with disease course≤7 days was significantly better than disease course>7 days(P<0.001).CRP,DD,ESR,LDH,IgA,IgG,IgM and CD8+T levels in children with MPP deterioration were significantly higher than children with MPP improvement(P<0.001),and CD4+T and CD4+T/CD8+T levels were significantly lower than children with MPP im-provement(P<0.001).Multi-factor Logistics regression analysis showed that age,IgA,IgG,IgM and CD4+T/CD8+T were independent influencing factors for outcome of MPP children(P<0.05).ROC curve analysis showed that when cut-off value was 1.50,AUC of CD4+T/CD8+T to predict outcome of MPP children was 0.86(95%CI:0.75～0.94),sensitivity and specificity were 83.76%and 84.60%,respectively.Log-binomial model showed that MPP children with CD4+T/CD8+T≤1.50%had the highest risk of worsening out-come.Risk scores before and after adjustment were 2.05(1.41～3.75),2.07(1.46～3.88)and 2.14(1.50～4.02)times of those in im-provement group.School-age children with CD4+T/CD8+T>1.50%had the lowest risk of worsening,and risk before and after adjust-ment was 1.07(1.00～1.87),1.13(1.04～1.98),1.18(1.07～2.01)times higher than improved group.RCS model analysis of relation-ship between CD4+T/CD8+T and different outcomes in MPP children showed that regardless of whether confounders were adjusted,CD4+T/CD8+T was negatively correlated with outcome of MPP children.Conclusion:CD4+T/CD8+T in MPP children of different ages is significantly different.CD4+T/CD8+T is the lowest in infant group,followed by preschool group,and the highest in school-age group.CD4+T/CD8+T in children with worsening MPP is significantly lower than improved MPP,and CD4+T/CD8+T is negatively correlated with outcome of MPP children,which has certain value in predicting outcome of MPP children.

Objective:To construct a lentiviral interference plasmid targeting collapse response regulatory protein 1(CRMP1)gene,to establish a human neuroblastoma cell line(SH-SY5Y)with stable CRMP1 knockdown,and to investigate its impact on expression of NLRP3 inflammasome protein.Methods:Double-stranded shRNA was designed and synthesized targeting h-CRMP1 mRNA sequence,and cloned into PLKO.1 vector.Recombinant shCRMP1 plasmids were constructed correctly,which was transfected into HEK-293T cells for lentiviral packaging.Obtained lentivirus supernatant was concentrated and then infected into SH-SY5Y cells.The interference effect of shCRMP1 plasmid and protein expressions of NLRP3 inflammasome components in SH-SY5Y cells were detected by Western blot.Results:DNA sequencing results showed that insertion sequences of recombinant interference plasmids pLKO.1-shCRMP1 were consistent with designed sequences,which confirmed successful construction of shCRMP1 lentivirus interfering plasmids and transfected into HEK-293T cells for lentivirus packaging,and protein level of CRMP1 in HEK-293T cells were decreased.SH-SY5Y cells were infected with lentivirus concentrate obtained from packaging and screened with puromycin.Western blot results showed that shCRMP1 recombinant lentiviral plasmids could significantly down-regulate CRMP1 protein expression in SH-SY5Y cells.It was also found that in SH-SY5Y cell line with stable CRMP1 knockdown,inhibition of CRMP1 expression could effectively inhibit NLRP3 inflammasome activation under MPP+induction.Conclusion:pLKO.1-shCRMP1 lentiviral interfering plas-mids have been successfully constructed,and interference with CRMP1 can inhibit activation of NLRP3 inflammasome in MPP+-in-duced SH-SY5Y cells.This study provides guidance for further research on mechanism of CRMP1 in neurodegenerative diseases such as Parkinson's disease.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate the clinical characteristics and risk factors of airway mucus plugging in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:This was a retrospective cross-sectional study. A total of 322 hospitalized AECOPD patients admitted to the First Affiliated Hospital of Anhui Medical University from February 2023 to February 2025 were enrolled. Based on chest high-resolution computed tomography (HRCT) findings of airway mucus plugging, patients were classified into mucus plugging and non-mucus plugging groups. General and clinical data were collected, including age, sex, disease duration, smoking and alcohol history, comorbidities, number of acute exacerbations in the past year, routine blood tests, biochemical indices, pulmonary function, and pathogen detection. The incidence of airway mucus plugging in AECOPD patients was calculated, and differences in baseline characteristics, laboratory parameters, and pulmonary function between the two groups were compared. Logistic regression was used to identify independent risk factors for mucus plugging, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of relevant indicators.Results:Of the 322 enrolled patients, 87(27.02%) were found to have airway mucus plugging. Univariate analysis revealed statistically significant differences between the mucus plug group and the non-plug group in the following parameters (all P<0.05): body mass index (BMI), disease duration, smoking status, Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, modified British Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test (CAT) score, frequency of acute exacerbations, neutrophil percentage, absolute lymphocyte count, lymphocyte percentage, albumin, C-reactive protein (CRP), activated partial thromboplastin time, fibrinogen, fibrin(ogen) degradation products, D-dimer, Aspergillus infection rate, percentage of forced expiratory volume in 1 second to predicted value (FEV 1%pred), ratio of FEV 1 to forced vital capacity (FEV 1/FVC), and percentage of maximal mid-expiratory flow to predicted value (MMEF 75/25%pred). Multivariate logistic regression analysis identified the following as independent risk factors for airway mucus plugs (all P<0.05): elevated CRP ( OR=1.022, 95% CI: 1.013-1.036), decreased albumin ( OR=0.891, 95% CI: 0.825-0.959), Aspergillus infection ( OR=1.774, 95% CI: 1.366-2.317), and reduced MMEF 75/25%pred value ( OR=0.978, 95% CI: 0.964-0.990). ROC curve analysis showed that the combined predictive model incorporating CRP, albumin, Aspergillus infection, and MMEF 75/25%pred had an area under the ROC curve (AUC) of 0.776(95% CI: 0.714-0.838), which was superior to each individual indicator alone, with AUCs of 0.721 for CRP, 0.687 for albumin, 0.579 for Aspergillus infection, and 0.631 for MMEF 75/25%pred. Conclusions:AECOPD patients with airway mucus plugging exhibit higher inflammatory markers, poorer nutritional status, a higher likelihood of Aspergillus infection, worse pulmonary function, and poorer prognosis. Aspergillus infection, elevated CRP, decreased albumin, and reduced MMEF 75/25%pred are independent risk factors for mucus plugs in AECOPD.

Objective:To measure the cerebral cortical activity by the functional near-infrared spectroscopy,fNIRS during the bilateral single-leg standing in population with chronic ankle instability(CAI)and healthy controls.Method:Sixteen healthy participants without any sprains and 16 participants with unilateral CAI were recruit-ed.The fNIRS was used to collect the brain function signals during the bilateral single-leg standing task.Based on the concentration of oxyhemoglobin(HbO2),the functional activation(β value)of each brain region of the two groups was calculated,and the differences between the groups during the tasks were compared in nine brain regions,including the dorsolateral prefrontal cortex(DLPFC),primary sensory area(S1),supplemen-tary motor area(SMA),and middle temporal gyrus(MTG).Result:Compared to healthy participants,CAI participants exhibited significantly increased cortical activity based on the β value in right SMA(ch28)and left Wernicke's area(ch51)during the single-leg standing on the injured side.During the single-leg standing on the uninjured side,CAI participants exhibited significantly increased cortical activity in the right side of DLPFC(ch15),S1(ch33)and MTG(ch40).Conclusion:The cerebral cortex activation in patients with CAI is different from that in healthy people,ac-cording to the neural mechanism of posture control.There is a higher activation of DLPFC,S1,MTG,SMA,and Wernicke's area in CAI patients during the state of postural control.