Objective To analyze the relationship of protein intake level with high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in patients with diabetic kidney disease (DKD) and its influence on prognosis. Methods A total of 325 patients with DKD admitted from June 2021 to June 2024 were included and classified into a low protein group and a high protein group. The levels of hs-CRP, IL-6, and TNF-α were compared between the two groups of patients before follow-up and after 1 year of follow-up. The correlation was analyzed by linear mixed model. The incidence of endpoint events during follow-up and disease progression-free survival time were compared between the two groups. Results The inflammatory indicators exhibited no statistical differences between the two groups before follow-up (P>0.05). After 1 year of follow-up, the levels of hs-CRP, IL-6, and TNF-α in the two groups were higher than those before follow-up, and the levels in the high protein group were higher than those in the low protein group (P<0.05). Linear mixed model analysis suggested that the protein intake level, time, and the interaction term of protein intake level × time were correlated with the changes of hs-CRP, IL-6 and TNF-α levels (P<0.05). The incidence rate of endpoint events in the high-protein group during follow-up was 24.84% (40/161), which was significantly higher than 12.80% (21/164) in the low-protein group (χ²=7.724, P=0.005). The disease progression-free survival time was longer in the low-protein group than that in the high-protein group (Log Rank χ²=9.007, P=0.003). Conclusion The level of protein intake in patients with diabetic kidney disease is closely related to inflammatory response and prognosis.

Dietary interventions such as fasting are gaining increasing attention for their synergistic effects in anti-tumor therapy, yet the precise underlying mechanisms remain incompletely understood. Recent research has unveiled a novel mode of cell death named “mitoxyperilysis”, providing a fresh perspective on the molecular mechanisms by which fasting may interfere with tumor treatment. This form of death is primarily triggered by the synergy between metabolic dysfunction and innate immune activation. Its mechanism involves the mTORC2 signaling pathway mediating prolonged abnormal contact between damaged mitochondria and the plasma membrane. This leads to massive local release of reactive oxygen species (ROS), which further induces lipid peroxidation of the plasma membrane, ultimately resulting in the physical rupture and death of the cell. The most significant distinction between mitoxyperilysis and classical cell death pathways lies in its independence from caspases and GSDMD. This comment aims to systematically elucidate the process, molecular mechanisms, and differences from other classical cell death pathways of mitoxyperilysis, while also exploring its potential for clinical translation in oncological diseases. Targeting induction of mitoxyperilysis may enhance the efficacy of existing anti-tumor drugs and overcome chemotherapy resistance. However, intervention protocols require further optimization to achieve an optimal balance between safety and therapeutic effectiveness in clinical application.

Objective To investigate the correlation of serum human epididymis protein 4(HE4)and lung injury Prediction(LIPS)score with sepsis-associated acute respiratory distress syndrome(ARDS)and 28 d mortality.Methods A total of 207 patients with sepsis admitted to the hospital from January 2021 to January 2024 were selected.According to the presence or absence of ARDS,the patients were divided into ARDS group(73 cases)and non-ARDS group(134 cases).According to the 28 d survival,the ARDS group was further di-vided into death group(26 cases)and survival group(47 cases).HE4 level was detected by electrochemilumi-nescence,and LIPS score was calculated.Multivariate Logistic regression model was used to analyze the influ-encing factors of death in ARDS patients.Point biserial correlation was used to analyze the correlation between serum HE4,LIPS score and 28 d death in ARDS patients.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum HE4 and LIPS score in the diagnosis of sepsis-associated ARDS and predicting 28 d mortality.Results Compared with non-ARDS group,the serum HE4 level and LIPS score were significantly increased in ARDS group(P<0.05).The independent risk factors for sepsis-associated ARDS were increased SOFA score,increased blood lactic acid,increased HE4 and increased LIPS score(P<0.05).The 28 d mortality of 73 patients with sepsis-associated ARDS was 35.62%(26/73).Compared with the survival group,the serum HE4 and LIPS scores were increased in the death group(P<0.05).Serum HE4 and LIPS scores were positively correlated with 28 d mortality in patients with sepsis-associated ARDS(r=0.605,0.579,P<0.05).The area under the curve(AUC)of serum HE4 combined with LIPS score in the di-agnosis of sepsis-associated ARDS was 0.909,which was larger than 0.828 and 0.806 of serum HE4 and LIPS score alone(Z=3.360,3.387,all P<0.05).The AUC of serum HE4 combined with LIPS score in predicting 28 d mortality of patients with sepsis-associated ARDS was 0.891,which was larger than 0.808 and 0.779 of by serum HE4 and LIPS score alone(Z=2.028,2.017,all P<0.05).Conclusion The elevated serum HE4 level and LIPS score are independent risk factors for sepsis-associated ARDS,and are closely related to 28 d mortality.The combination of serum HE4 and LIPS score has a high value in the diagnosis of sepsis-associated ARDS and the prediction of 28 d mortality.

Objective To explore the feasibility and precautions of small incision bile duct stone removal in primary hospitals in extremely high-altitude areas.Methods The experience of small incision biliary exploration and cholecystectomy under general anesthesia at primary hospitals during the author's medical aid to Xizang in the high-altitude areas of northern Xizang was summarized(from June 2022 to December 2022).Results A total of 11 cases of small incision common bile duct stone removal were completed.Abdominal drainage was performed in all patients,including 6 cases with T-shaped tubes and 5 cases with primary closure of the common bile duct.The patients recovered well after surgery and was discharged.Conclusion In extreme high-altitude areas,under the guidance of medical aid doctors,it is completely feasible for primary hospitals to carry out small incision bile duct stone removal by selecting appropriate cases,training surgical skills,and performing detailed preoperative preparation.

Objective To investigate the diarrhea after minilaparotomy cholecystectomy among Tibetan residents in extremely high-altitude areas.Methods A retrospective analysis was conducted on the clinical data of 71 patients who underwent small incision cholecystectomy at the County People's Hospital during the period of medical aid(from June 2022 to December 2022).There were 38 patients(53.52%)with postoperative diarrhea and 33 patients(46.48%)without diarrhea.Results The duration of diarrhea was less than 1 week in 8 patients,ranged from 1 week to 3 months in 21 patients,and lasted for more than 3 months in 9 patients.There were significant differences between the two groups in terms of age(P<0.000 1),body mass index(P<0.000 1),proportions of patients with liver cirrhosis(P=0.012 9),history of acute cholecystitis(P=0.002 1),history of coronary heart disease(P=0.040 7),and presence of tenderness in the right upper abdomen during admission(P<0.000 1),white blood cell count(P=0.007 0),alanine aminotransferase(P=0.047 3),gallbladder diameter(P=0.003 4),gallbladder wall thickness(P=0.000 4),surgical duration(P=0.004 7),postoperative antibiotic use(P=0.000 6),postoperative hospital stay(P=0.000 2),and immediate resumption of butter tea(P<0.000 1).Age and immediate resumption of butter tea after surgery were independent risk factors for diarrhea after minilaparotomy cholecystectomy.Conclusion There is a higher incidence of diarrhea following small incision cholecystectomy in the residents of extremely high-altitude areas,which is associated with various factors such as the environment and lifestyle of the region.It is essential to enhance health education on gallstone and cultivate good personal health habits.Clinicians should conduct a detailed preoperative assessment.Patients should avoid drinking butter tea during perioperative period to avoid postoperative diarrhea.

Objective To construct an aptamer-functionalized carboxylated graphene oxide(CGO)fluo-rescent sensor to achieve highly sensitive and specific detection of ketamine(KET)and its metabolite norketamine(NK)using an aptamer capable of simultaneously recognizing KET and NK.Methods A specific aptamer for simultaneous recognition of KET and NK was screened using graphene oxide-sys-tematic evolution of ligand by exponential enrichment(GO-SELEX)and molecular docking tech-niques.The aptamer,labeled with Cy5 fluorescence,was chemically conjugated to CGO to construct an aptamer-functionalized CGO fluorescent sensor.By optimizing detection conditions,including the mass concentration of CGO,aptamer concentration,reaction temperature,and incubation time,quantita-tive analysis of the target analytes was achieved using the ratio of fluorescence intensity changes be-fore and after target addition.The stability of the sensor in biological matrices was evaluated by moni-toring fluorescence intensity changes over incubation time in blank blood and urine,in comparison with the traditional physical adsorption-based CGO fluorescent sensor.Spiked recovery experiments in blank blood and urine were conducted to compare performance with that of HPLC-MS/MS.Results A specific aptamer A5 was selected and chemically conjugated with CGO to construct the aptamer-functionalized CGO fluorescent sensor.Under optimized conditions,the proposed fluorescent sensor ex-hibited a linear detection range of 1.0-5.0 ng/mL for KET,with a limit of detection(LOD)of 0.86 ng/mL;while for NK,the linear detection range was 1.0-5.0 ng/mL,with an LOD of 0.70 ng/mL.Com-pared with the CGO fluorescent sensor constructed via physical adsorption,this sensor demonstrated greater stability in blood and urine.The spiked recovery rates of KET and NK in blank blood and urine ranged from 81.50%to 110.03%,exhibiting detection performance comparable to that of HPLC-MS/MS.Conclusion The aptamer screening method offers a novel approach for selecting aptamers tar-geting drugs and their metabolites.The constructed aptamer-functionalized CGO fluorescent sensor pro-vides an efficient and reliable strategy for the high-performance detection of KET and NK.

Objective:To construct a foreign-funded medical safety risk review evaluation index system for the regulatory needs in the context of expanding the opening up of China's medical service industry,in order to achieve a dynamic balance between opening up and safety and prevent systemic risks.Methods:Using a combination of the Delphi method and hierarchical analysis method,21 senior experts from the fields of management of healthcare institutions,health policy,health jurisprudence and public safety were invited to participate in the construction of the indexes.Statistical quantities such as expert authority coefficient,coordination coefficient and content validity were used to ensure the specificity of the indicators,and the hierarchical analysis method was used to quantify the weights of the indicators and derive the analysis results.Results:the positive coefficients of the two rounds of expert consultation were greater than 95%,and the expert authority coefficient was 0.897;the expert Kendall coordination coefficients were 0.178 and 0.182,respectively,with P＜0.001,and the differences were all statistically significant.Through two rounds of expert correspondence,the evaluation index system of foreign-funded medical hospital safety risk review constructed by 4 first-level indicators,12 second-level indicator systems and 38 third-level indicators of functional safety,medical safety,bio-safety and information security was finalized.Conclusions:Through a multi-dimensional risk assessment framework,the system provides quantitative tools for the review and dynamic supervision of foreign medical access,which can support the policy synergy of"high level of openness and high level of security"and help modernize the governance capacity of China's medical service industry.

Objective To observe the origin and course of the obturator artery(OA),so as to provide anatomical reference for reducing hemorrhage during pelvic surgery and pubic fracture fixation.Methods A total of 65 human hemi-pelvises specimens with intact structure were dissected to observe the origin,course and other variations of OA.Measure the length of the inner section of OA basin and the outer diameter at the origin,etc.Results OA originated from the internal iliac artery in 57 cases(87.7%),including 3 cases(4.6%)of the superior gluteal artery,5 cases(7.7%)of the inferior gluteal artery,3 cases(4.6%)of the external iliac artery and 5 cases(7.7%)of the inferior epigastric artery.OA participated in the formation of the arterial trunk in 3 cases(4.6%).The length of the pelvic segment of the OA in male and female was(50.87±15.41)mm and(51.71±14.19)mm,respectively,with no statistically significant difference between them(P>0.05).The outer diameters at the origin of the OA in male and female were(2.79±1.05)mm and(2.35±0.86)mm,and there was no statistically significant difference between them(P>0.05).Conclusion OA mainly originated from the anterior trunk of the internal iliac artery,with a few OA originated from the branches of the posterior trunk or the inferior epigastric artery,or participated in the formation of the arterial trunk.In pelvic surgery involving OA area,attention should be paid to the length of its pelvic segment and the outer diameter at the origin of OA,so as to better locate and protect blood vessels during surgery.

Chronic kidney disease(CKD)is a chronic disease characterized by renal structural damage and dysfunction.At present,there is still a lack of effective therapeutic drugs and prevention and treatment methods for CKD in clinical practice.More and more studies have shown that necroptosis,as a new type of programmed cell death,plays a vital role in the onset and progression of CKD.Targeting key molecules in the necroptosis pathway,such as RIPK1,RIPK3 and MLKL,the development of small molecule inhibitors has become an emerging strategy for the treatment of CKD,and has shown significant potential to pro-tect the kidneys and alleviate renal fibrosis in a variety of in vitro and in vivo models.Therefore,this article summarizes the re-search progress of the mechanism of necroptosis in recent years,and focuses on the potential role of necroptosis in the pathogene-sis of CKD and the therapeutic potential of targeting this path-way,providing a new perspective and research direction for the prevention and treatment of CKD in the future.

Objective： The aim of this study is to explore the predictive value of biparametric magnetic resonance imaging(bpMRI)for pelvic lymph node metastasis in prostate cancer patients with PSA≤20 μg/L and establish a nomogram. Methods： The imaging data and clinical data of 363 patients undergoing radical prostatectomy and pelvic lymph node dissection in the First Affiliated Hospital of Nanjing Medical University from July 2018 to December 2023 were retrospectively analyzed. Univariate analysis and multivariate logistic regression were used to screen independent risk factors for pelvic lymph node metastasis in prostate cancer, and a nomogram of the clinical prediction model was established. Calibration curves were drawn to evaluate the accuracy of the model. Results： Multivariate logistic regression analysis showed extrocapusular extension (OR=8.08,95%CI=2.62－24.97, P<0.01), enlargement of pelvic lymph nodes (OR=4.45,95%CI=1.16－17.11,P=0.030), and biopsy ISUP grade(OR=1.97,95%CI=1.12－3.46, P=0.018)were independent risk factors for pelvic lymph node metastasis. The C-index of the prediction model was 0.834, which indicated that the model had a good prediction ability. The actual value of the model calibration curve and the prediction probability of the model fitted well, indicating that the model had a good accuracy. Further analysis of DCA curve showed that the model had good clinical application value when the risk threshold ranged from 0.05 to 0.70.Conclusion： For prostate cancer patients with PSA≤20 μg/L, bpMRI has a good predictive value for the pelvic lymph node metastasis of prostate cancer with extrocapusular extension, enlargement of pelvic lymph nodes and ISUP grade≥4.
Humans ; Male ; Prostatic Neoplasms/diagnostic imaging* ; Lymphatic Metastasis ; Retrospective Studies ; Nomograms ; Prostate-Specific Antigen/blood* ; Lymph Nodes/pathology* ; Pelvis ; Predictive Value of Tests ; Prostatectomy ; Lymph Node Excision ; Risk Factors ; Magnetic Resonance Imaging ; Logistic Models ; Middle Aged ; Aged