Objective To establish the construction and validation of a nomogram model for predicting the risk of early diabetic kidney disease(DKD)based on blood pressure and blood glucose variability.Methods Patients with early DKD were selected as the DKD group(n=247)and patients with T2DM alone as the T2DM group(n=150)from the Department of Endocrinology of our hospital during April 2020 to December 2023.All subjects were randomly divided into a training set(n=278)and a validation set(n=119)according to a ratio of 7∶3.The general data and biochemical indicators were compared between the two groups,and Cox proportional risk regression analysis was performed on the influencing factors for DKD in the training set.The risk nebulogram prediction model was constructed.The receiver operating characteristic(ROC)curve and consistency index(C-index)were used to analyze the effectiveness of the model in the training set and verification set,and Bootstrap internal verification was carried out.The calibration curve was drawn to evaluate the prediction calibration degree and discrimination validity of the model.Clinical decision curve(DCA)was applied to evaluate the clinical utility of the nomogram model.Results SBP,DBP,BUN,blood uric acid,24 h systolic blood pressure variation coefficient(24 hSBPCV),24 h diastolic blood pressure variation coefficient(24 h hDBPCV),coefficient of variation in daytime systolic blood pressure(dSBPCV),coefficient of variation in daytime diastolic blood pressure(dDBPCV),coefficient of variation in nighttime systolic blood pressure(nSBPCV),coefficient of Variation in nighttime diastolic blood pressure(nDBPCV),maximum daytime blood glucose fluctuation range(LAGE),average blood glucose throughout the day(MBG),and standard deviation of blood glucose throughout the day(SDBG),fasting blood glucose coefficient of variation(FBG-CV)and mean blood glucose fluctuation range(MAGE)were higher in DKD group than in T2DM group(P＜0.05).eGFR was lower in DKD group than in T2DM group(P＜0.05).Cox proportional risk regression analysis showed that 24 hSBPCV,24 hDBPCV,dSBPCV,dDBPCV,nSBPCV,nDBPCV,LAGE,MBG,SDBG,FBG-CV and MAGE were the influencing factors for the early occurrence of DKD.Accordingly,the prediction model of early DKD was established.ROC curve analysis showed that the area under the curve of the early DKD nomogram model were 0.834 and 0.805 in the training set and verification set,with the sensitivity 85.20%and 80.60%,and the specificity 71.40%and 72.40%,respectively.Calibration curve analysis showed that the C-index of the early DKD neomorph model were 0.839 and 0.801 in the training set and the verification set,respectively.The goodness of fit test results showed that the actual observed values are in good agreement with the predicted results.The results of DCA curve showed that when the threshold probability of early DKD occurrence was between 0 and 1,the net benefit value of this model was better.Conclusions In this study,the nomogram model constructed by BP and BG variability parameters can effectively predict the occurrence of early DKD,and provide a basis for clinical screening and evaluation.

Objective To investigate the relationship between serum Rho-associated coiled coil containing protein kinase 2(ROCK2),syndecan-1(SDC-1),Apelin-13 and renal function and prognosis in patients with diabetes nephropathy.Methods From November 2019 to November 2021,153 patients with diabetic nephrop-athy admitted to the hospital were selected as the study group,and 153 patients with simple diabetes were se-lected as the simple diabetes group.Another 153 healthy individuals who underwent physical examinations during the same period were selected as the healthy control group.The levels of serum ROCK2,SDC-1 and Apelin-13 were determined by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlations between the levels of serum ROCK2,SDC-1,and Apelin-13 and the clinical data of pa-tients with urinary nephropathy.Univariate and multivariate Logistic regression analyses were conducted to analyze the influencing factors of poor prognosis in patients with diabetic nephropathy.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum ROCK2,SDC-1 and Apelin-13 for poor prognosis of patients with diabetes nephropathy.Results Compared with the healthy control group,the levels of serum ROCK2 and SDC-1 in the simple diabetes group and the study group increased,the level of Apelin-13 decreased,the estimated glomerular filtration rate(eGFR)decreased,and the ratio of urinary albu-min to creatinine(UACR)increased,and the differences were statistically significant(P＜0.05).The levels of serum ROCK2,SDC-1,Apelin-13 and UACR in the study group were higher than those in the simple diabe-tes group,while eGFR was lower than that in the simple diabetes group,and the differences were statistically significant(P＜0.05).Pearson correlation analysis indicated that the levels of serum ROCK2,SDC-1,and Apelin-13 in the study group were negatively correlated with eGFR(P＜0.05),and positively correlated with renal disease stage,creatinine,24-hour proteinuria,and UACR index(P＜0.05).Compared with the good prognosis group,the levels of serum ROCK2,DCC-1,Apelin-13 and UACR in the poor prognosis group in-creased(P＜0.05),and eGFR decreased(P＜0.05).Univariate and multivariate Logistic regression analyses indicated that the levels of serum ROCK2,SDC-1,and Apelin-13 were all influencing factors for the prognosis of patients(P＜0.05).ROC curve analysis indicated that the area under the curve(AUC)for the combined prediction of poor prognosis in patients by serum ROCK2,DCC-1,and Apelin-13 levels was significantly grea-ter than that by ROCK2(Z=2.854,P=0.004)and DCC-1(Z=2.426,P=0.015)and Apelin-13(Z=2.172,P=0.030)were predicted separately.Conclusion The serum ROCK2,DCC-1 and Apelin-13 levels in patients with diabetic nephropathy increase and are related to renal function.The combination of the three has a relatively high predictive efficacy for the prognosis of patients.

Objective To investigate the expression levels of platelet activating factor and rhythm nuclear receptor Rev-erbα in patients after ischemic stroke on different onset times.Methods A total of 158 patients after ischemic stroke admitted from June 2022 to May 2023 were divided into four groups according to the onset time T1(0-6 o'clock),T2(6-12 o'clock),T3(12-18 o'clock),and T4(18-24 o'clock).Matched to the ischemic stroke groups,126 patients hospitalized at the same time with non-ischemic stroke were divided into four groups.General data and serum samples of the subjects were collected,and the expression levels of CD62P,CD40L and Rev-erbα were detected with enzyme-linked immunosorbent assay(ELISA).Results The expressions of platelet activating factor CD62P,tumor necrosis factor CD40L,and rhythm nuclear receptor Rev-erbα in T2 group after ischemic stroke were significantly higher than that in the other groups(P＜0.05),whilst no significant difference were observed in other three groups(P＞0.05).The expression of CD62P,CD40L and rev-erbα in ischemic stroke groups were significantly higher than that in control groups.Conclusion The expression levels of the rhythm nuclear receptor Rev-erbα,CD62P,and CD40L in ischemic stroke groups is higher than that in control groups,and the expression of these cytokines is more significant in T2 group(i.e.early in the morning)than other time slot.On the other hand,the expressions of CD62P and CD40L are consistent with Rev-erbα on the time slots,indicating a clear correlation.It is indicated Rev-erbα and platelet activation play a key role on attacking of ischemic stroke.

Objective To establish the construction and validation of a nomogram model for predicting the risk of early diabetic kidney disease(DKD)based on blood pressure and blood glucose variability.Methods Patients with early DKD were selected as the DKD group(n=247)and patients with T2DM alone as the T2DM group(n=150)from the Department of Endocrinology of our hospital during April 2020 to December 2023.All subjects were randomly divided into a training set(n=278)and a validation set(n=119)according to a ratio of 7∶3.The general data and biochemical indicators were compared between the two groups,and Cox proportional risk regression analysis was performed on the influencing factors for DKD in the training set.The risk nebulogram prediction model was constructed.The receiver operating characteristic(ROC)curve and consistency index(C-index)were used to analyze the effectiveness of the model in the training set and verification set,and Bootstrap internal verification was carried out.The calibration curve was drawn to evaluate the prediction calibration degree and discrimination validity of the model.Clinical decision curve(DCA)was applied to evaluate the clinical utility of the nomogram model.Results SBP,DBP,BUN,blood uric acid,24 h systolic blood pressure variation coefficient(24 hSBPCV),24 h diastolic blood pressure variation coefficient(24 h hDBPCV),coefficient of variation in daytime systolic blood pressure(dSBPCV),coefficient of variation in daytime diastolic blood pressure(dDBPCV),coefficient of variation in nighttime systolic blood pressure(nSBPCV),coefficient of Variation in nighttime diastolic blood pressure(nDBPCV),maximum daytime blood glucose fluctuation range(LAGE),average blood glucose throughout the day(MBG),and standard deviation of blood glucose throughout the day(SDBG),fasting blood glucose coefficient of variation(FBG-CV)and mean blood glucose fluctuation range(MAGE)were higher in DKD group than in T2DM group(P＜0.05).eGFR was lower in DKD group than in T2DM group(P＜0.05).Cox proportional risk regression analysis showed that 24 hSBPCV,24 hDBPCV,dSBPCV,dDBPCV,nSBPCV,nDBPCV,LAGE,MBG,SDBG,FBG-CV and MAGE were the influencing factors for the early occurrence of DKD.Accordingly,the prediction model of early DKD was established.ROC curve analysis showed that the area under the curve of the early DKD nomogram model were 0.834 and 0.805 in the training set and verification set,with the sensitivity 85.20%and 80.60%,and the specificity 71.40%and 72.40%,respectively.Calibration curve analysis showed that the C-index of the early DKD neomorph model were 0.839 and 0.801 in the training set and the verification set,respectively.The goodness of fit test results showed that the actual observed values are in good agreement with the predicted results.The results of DCA curve showed that when the threshold probability of early DKD occurrence was between 0 and 1,the net benefit value of this model was better.Conclusions In this study,the nomogram model constructed by BP and BG variability parameters can effectively predict the occurrence of early DKD,and provide a basis for clinical screening and evaluation.

Objective To investigate the expression levels of platelet activating factor and rhythm nuclear receptor Rev-erbα in patients after ischemic stroke on different onset times.Methods A total of 158 patients after ischemic stroke admitted from June 2022 to May 2023 were divided into four groups according to the onset time T1(0-6 o'clock),T2(6-12 o'clock),T3(12-18 o'clock),and T4(18-24 o'clock).Matched to the ischemic stroke groups,126 patients hospitalized at the same time with non-ischemic stroke were divided into four groups.General data and serum samples of the subjects were collected,and the expression levels of CD62P,CD40L and Rev-erbα were detected with enzyme-linked immunosorbent assay(ELISA).Results The expressions of platelet activating factor CD62P,tumor necrosis factor CD40L,and rhythm nuclear receptor Rev-erbα in T2 group after ischemic stroke were significantly higher than that in the other groups(P＜0.05),whilst no significant difference were observed in other three groups(P＞0.05).The expression of CD62P,CD40L and rev-erbα in ischemic stroke groups were significantly higher than that in control groups.Conclusion The expression levels of the rhythm nuclear receptor Rev-erbα,CD62P,and CD40L in ischemic stroke groups is higher than that in control groups,and the expression of these cytokines is more significant in T2 group(i.e.early in the morning)than other time slot.On the other hand,the expressions of CD62P and CD40L are consistent with Rev-erbα on the time slots,indicating a clear correlation.It is indicated Rev-erbα and platelet activation play a key role on attacking of ischemic stroke.

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Objective:To investigate the correlation between plasma microRNA (miR)-122, miR-33a and the severity of coronary artery disease in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease.Methods:The clinical data of 196 patients with T2DM from January 2019 to October 2021 in Xuzhou First People′s Hospital were retrospectively analyzed. Among them, 81 cases were complicated with coronary heart disease (combined group), 115 cases were not complicated with coronary heart disease (control group). The plasma levels of miR-122 and miR-33a were detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction, the plasma level of N-terminal B-type natriuretic peptide precursor (NT-proBNP) was detected by enzyme-linked immunosorbent assay. In combined group, the number of coronary artery lesions was determined according to the results of coronary angiography, and Gensini score was evaluated. Linear regression model was used to analyze the relationship between plasma miR-122, miR-33a and NT-proBNP levels with the incidence of coronary heart disease in patients with T2DM. Receiver operating characteristic (ROC) curve was used to analyze the plasma miR-122 and miR-33a in predicting efficiency of coronary heart disease in patients with T2DM. In combined group, Spearman correlation method was used to analyze the relationship between plasma miR-122, miR-33a and the number of coronary artery lesions, and Pearson correlation method was used to analyze the relationship between plasma miR-122, miR-33a and plasma NT proBNP, Gensini score.Results:The plasma miR-122, miR-33a and NT-proBNP in combined group were significantly higher than those in control group: 5.76 ± 1.35 vs. 1.18 ± 0.33, 1.39 ± 0.37 vs. 0.65 ± 0.11 and (786.87 ± 156.39) ng/L vs. (103.45 ± 19.27) ng/L respectively, and there were statistical differences ( P<0.01). Linear regression result showed that plasma miR-122, miR-33a, and NT-proBNP were positive correlation with occurrence of coronary heart disease in patients with T2DM ( P<0.01); ROC curve analysis result showed that the area under curve of plasma miR-122, miR-33a and combination in predicting coronary heart disease in patients with T2DM were 0.816, 0.845 and 0.912 respectively (95% CI 0.744 to 0.865, 0.768 to 0.892 and 0.836 to 0.967). Coronary angiography result showed that there were 46 cases of single vessel lesions, 25 cases of double vessel lesions and 10 cases of three vessel lesions. The plasma miR-122, miR-33a, NT-proBNP and Gensini score in patients with three vessel lesions were significantly higher than those in patients with double vessel lesions and patients with single vessel lesions: 6.52 ± 0.96 vs. 4.95 ± 0.85 and 3.74 ± 0.52, 1.45 ± 0.31 vs. 1.06 ± 0.25 and 0.81 ± 0.13, (829.78 ± 62.59) ng/L vs. (627.48 ± 47.12) and (502.64 ± 38.24) ng/L, (63.89 ± 12.71) scores vs. (42.18 ± 6.03) and (22.36 ± 2.41) scores, the indexes in patients with double vessel lesions were significantly higher than those in patients with single vessel lesions, and there were statistical differences ( P<0.05). In combined group, Spearman correlation analysis result showed that the plasma miR-122 and miR-33a were positive correlation with the number of coronary artery lesions ( r = 0.879 and 0.825, P<0.05); Pearson correlation analysis result showed that the plasma miR-122 and miR-33a were positive correlation with the plasma NT-proBNP and Gensini score (miR-122: r = 0.896 and 0.788, miR-33a: r = 0.871 and 0.765; P<0.05). Conclusions:The plasma levels of miR-122 and miR-33a are related to the occurrence of coronary heart disease and severity of coronary artery disease in patients with T2DM, which may be used to guide the prevention and treatment of coronary heart disease in patients with T2DM.

Infectious diseases are still one of the leading causes of morbidity and death globally, affecting public health and life, social and economic development, and even national security. Early detection focuses on detecting the abnormal information of infectious disease outbreaks or epidemics in a timely and sensitive way to conduct field investigation and verification. It is also a precursor to effective surveillance and early warning system. The effective surveillance and early warning system can fully and accurately understand the real conditions, driving forces, and transmission chain of the occurrence of a specific infectious disease outbreak and epidemic and put forward scientific and effective prevention and control strategies and measures. Due to the measurement of the resources support and the particular data collection value, it is not easy to obtain epidemiological, etiological, and other data information in a timely, complete and accurate manner. This paper summarized the theory and technology on early detection, effective surveillance, and early warning information on infectious diseases. It also integrated and utilized the multi-source data, including effective infectious disease surveillance and the country's early warning system, to better understand the outbreak epidemic, causes, risks, processes, and driving forces. Thus, it is possible to set up a sensitive, specific staging measurement innovative technical system to monitor, early warning, and timely respond to acute infectious diseases through multidisciplinary cooperation in China. It provides the basis for strengthening the surveillance and early warning of new emerging and major infectious diseases and public health emergencies, avoiding the spread of inadequate response to infectious disease, and preventing the resources waste of over-response.

Objective:To investigate the clinicopathological and molecular characteristics of pulmonary enteric adenocarcinoma (PEAC).Methods:The clinical and pathological data of 19 cases of PEAC in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively collected from 2015 to 2019. Immunohistochemistry (IHC) was used to detect the relevant immunophenotypes, amplification refractory mutation system (ARMS) and fluorescence in situ hybridization (FISH) were used to detect the expression of EGFR, KRAS and ALK genes. The patients were followed up, and the relevant literature was reviewed and analyzed.Results:There were 19 cases, including 10 males and 9 females, with a mean age of 58 years (range 33-71 years). Microscopically, the tumors showed moderately to highly differentiated adenoid and/or papillary growth patterns. The tumor cells were highly columnar and sometimes showed pseudostratification. Inflammatory necrosis and scattered nuclear fragmentation were seen in some glandular lumens. IHC showed variable expression of CK7 (19/19), TTF1 (8/19), Napsin A (6/19), villin (17/19), CK20 (16/19) and CDX2 (10/19). Molecular testing showed KRAS mutation in nine cases (9/19), EGFR mutation in one case (1/19), and positive ALK split signal in one case (1/19). In the literature, the reported mutation rate of KRAS in PEAC was much higher than that of EGFR and ALK. All 19 cases underwent surgical resection and 11 cases were subjected to chemotherapy or radiotherapy.Conclusions:PEAC is a rare variant of invasive pulmonary adenocarcinoma, and has similar histological and cytological features to that of colorectal adenocarcinoma. However, detailed medical history, histologic heterogeneity, an IHC combination of CK7 +/villin + and high KRAS mutation rate are the key points of diagnosis. The prognosis needs long-term follow-up and big data statistics.