From the natural-philosophical model of medicine in ancient Greece to the modern bio-psycho-social par-adigm,the evolution of medical models has always been shaped by philosophy.In classical antiquity,medicine and philosophy were closely intertwined;the natural-philosophical model,exemplified by Hippocrates,emphasized the human body as an integrated whole.During the Renaissance,the rise of experimental science challenged traditional philosophical systems and pushed medicine toward empirical investigation.In the late twentieth century,the bio-psycho-social model emerged to address the limitations of the purely biomedical approach.In the twenty-first centu-ry,the advent of artificial intelligence is driving a new transformation in medicine and continually prompting reflec-tion on the future direction of medical models and their underlying philosophical significance.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Objective To explore the correlation of red cell distribution width/albumin ratio(RAR)and fibrinogen/albumin ratio(FAR)with severity of coronary artery disease(CAD)in patients with coronary heart disease(CHD),and to further explore the relationship of RAR and FAR with CAD severity in different glucose metabolic states.Methods A total of 577 CHD patients undergoing coronary angiography(CAG)in Department of Cardiology of Tianjin People's Hospital from January 2021 to December 2022 were enrolled,and according to the results of CAG,412 patients were diagnosed with multi-vessel CAD and the other 165 patients with single-vessel CAD.Their baseline data and results of laboratory tests were collected,and RAR and FAR values were calculated.Univariate and multivariate logistic regression analyses were performed with RAR and FAR as independent variables,and ROC curve was plotted to evaluate the predic-tive values of the 2 indicators for the severity of CAD.Spearman correlation analysis was applied to analyze the occurrence of major adverse cardiovascular events(MACEs)in the patients.Results Logistic regression analysis showed that RAR and FAR were independent risk factors for CAD(OR=1.974,95％CI:1.348-2.593,P=0.000;OR=1.737,95％CI:1.486-2.377,P=0.000).Un-der different glucose metabolic states,RAR had the highest correlation with the risk of CAD in diabetic patients(OR=2.828,95％CI:1.157-7.145),while FAR was associated with a relatively low risk of CAD in diabetic patients(OR=2.217,95％CI:1.533-5.570).ROC curve analysis showed that RAR(AUC=0.776,95％CI:0.731-0.821,P=0.000)and FAR(AUC=0.725,95％CI:0.676-0.774,P=0.000)had predictive value for the severity of CAD in CHD patients.Spearman correlation analysis indicated that RAR and FAR were positively correlated with occur-rence of MACEs in CHD patients(P＜0.001).Conclusion RAR and FAR are independent pre-dictors for CHD patients.RAR has a stronger predictive value for lesion severity in CHD patients with concomitant abnormal glucose metabolism.