Objective:To investigate the effect of roxadustat combined with levocarnitine in the treatment of renal anemia in hemodialysis patients with diabetic kidney disease (DKD), and its effects on iron metabolism, microinflammation status and microvascular complications.Methods:The clinical data of 89 hemodialysis renal anemia patients with DKD from January 2020 to October 2021 in Beijing Geriatric Hospital were retrospectively analyzed. Among them, 44 patients (control group)were treated with recombinant human erythropoietin and levocarnitine for renal anemia, and 45 patients (study group) were treated with recombinant human erythropoietin, levocarnitine and roxadustat for renal anemia. Both groups were treated for 3 months. The efficacy was compared between two groups. The laboratory indexes were measured before treatment and after 1, 3 months of treatment, including anemia related indexes such as hemoglobin, red blood cell count and mean corpuscular volume (MCV); iron metabolism indexes such as serum iron, ferritin and transferrin saturation (TSAT); inflammatory indexes such as interleukin-8 (IL-8), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α). The adverse reactions were recorded. The patients were followed up for 1 year after treatment, the incidence of diabetic microvascular complications, including diabetic peripheral neuropathy (DPN) and diabetic retinopathy (DR), was recorded.Results:The total effective rate in study group was significantly higher than that in control group: 93.33% (42/45) vs. 77.27% (34/44), and there was statistical difference ( χ2 = 4.60, P<0.05). There were no statistical differences in the laboratory indexes before treatment between two groups ( P<0.05); the hemoglobin, red blood cell count, MCV, serum iron, ferritin and TSAT after 1 and 3 months of treatment in study group were significantly higher than those in control group, the IL-8, CRP and TNF-α were significantly lower than those in control group, and there were statistical differences ( P<0.01 or <0.05). There was no significant difference in the incidence of adverse reactions between two groups ( P>0.05). After 1 year follow-up, 2 cases were lost in study group and 3 cases in the control group. The incidence of DR and DPN in study group were significantly lower than those in control group: 0 vs. 14.63% (6/41) and 2.33% (1/43) vs. 19.51% (8/41), and there were statistical differences ( χ2 = 4.75 and 4.81, P<0.05). Conclusions:Roxadustat combined with levocarnitine in the treatment of renal anemia in hemodialysis patients with DKD is reliable and safe, and can effectively relieve anemia symptoms, improve iron metabolism, reduce inflammatory response, and reduce the risk of diabetic microvascular complications.

Objective:To develop the Economic Toxicity Scale for Kidney Transplantation Patients, and to test the reliability and validity of the scale.Methods:Drawing upon Coleman′s social capital theory and the six subfields associated with economic toxicity put forward by European scholars, the initial version of the scale was developed via expert correspondence consultation and a preliminary survey. This was accomplished by building upon existing literature and conducting semi-structured interviews. A total of 261 cases of kidney transplantation patients from March to October 2022 admitted to the First Affiliated Hospital of Shandong First Medical University were investigated for reliability and validity test.Results:The Economic Toxicity Scale for Kidney Transplantation Patients included 6 dimensions, 31 entries. The total scale had a Cronbach alpha coefficient of 0.910 and the subscale had Cronbach alpha coefficient ranging from 0.798 to 0.943. The retest reliability coefficient for the total scale was 0.948, while the six dimensions ranged from 0.732 to 0.942.Conclusions:The scale demonstrates strong reliability and validity, making it a reliable tool for objectively evaluating the economic toxicity of kidney transplantation patients.

Objective To study the effect of IL-22 on the colonic barrier and its relationship with Nrf2 pathway in liver fibrosis mice.Methods The mice were divided into four groups:the control group(CON group),the model group(MOD group),the interleukin-22 group(IL-22 group),and the IL-22+ML385 group(ML385,an inhibitor of Nrf2),with 10 mice in each group,and the modeling cycle was 8 weeks.Liquid feed containing alcohol and carbon tetrachloride olive oil were given intraperitoneally in all groups except the CON group;IL-22 was given on top of this in the IL-22 group;and ML385 was injected intraperitoneally in the IL-22+ML385 group one hour before IL-22 treatment.At the end of modeling,the livers were stained with HE and Masson staining to clarify whether fibrosis occurred in the mice;the feces were collected to detect the cocci to bacillus ratio and observe the growth of intestinal flora;the colons were stained with HE staining,immunofluorescence and immunohistochemistry,and analyzed for the expression of tight junction proteins ZO-1,Occludin,and the Nrf2 pathway proteins(Nrf2,HO-1,and NQO1).The expression of these proteins was analyzed by immunohistochemistry.Results Compared with the CON group,mice in the MOD group showed significant fibrosis in the liver tissue,inflammatory cell infiltration in the colon tissue,and decreased expression of tight junction proteins(P<0.05).No overgrowth of various pathogenic bacteria was seen in fecal media.And there was no significant difference in the bulb-to-bar ratio.Compared with the MOD group,both liver and colon histopathologic damage were reduced in the IL-22 group,and tight junction protein expression was elevated,in addition,the expression levels of Nrf2,NQO1,and HO-1 were also elevated(P<0.05),whereas there was no significant change in the IL-22+ML385 group.Conclusion IL-22 improved the colonic barrier function in liver fibrosis mice,and the mechanism was related to the activation of Nrf2 anti-oxidative stress pathway.

This paper introduces the concept of natural language processing, summarizes the status quo and advantages of the application of natural language processing based on electronic health records in symptom management of cancer patients, points out the existing shortcomings, and puts forward corresponding suggestions, aiming to provide reference for further improving the quality of nursing services for cancer patients in China and promoting the informatization and digitization of hospice care.

Objective To observe the value of 18F-FDG PET/CT semi-quantitative parameters for predicting spread through air spaces(STAS)of clinical stage Ⅰa—Ⅲa lung adenocarcinoma.Methods Data of 85 patients with clinical stage Ⅰa—Ⅲ a lung adenocarcinoma who underwent preoperative 18F-FDG PET/CT were retrospectively analyzed.The patients were divided into positive group(n=23)or negative group(n=62)according to whether pathology showed STAS or not.Clinical and PET/CT data were compared between groups,and logistic analysis was performed to explore the efficacy of each parameter for predicting STAS.Results Significant differences of gender,carcinoma embryonic antigen,clinical stage,pathological grade,micropapillary growth and proportion were found between groups(all P＜0.05).The maximum,the mean,the peak standard uptake value(SUVmax,SUVmean,SUVpeak),as well as the maximum,the mean and the peak standard uptake value normalized by lean body mass(SULmax,SULmean,SULpeak),also the total lesion glycolysis(TLG)in positive group were all significantly higher than those in negative group(all P＜0.05).Patients'gender,proportion of micropapillary growth,SUVmax and SULmax were all independent risk factors of STAS of clinical stage Ⅰa—Ⅲa lung adenocarcinoma.The area under the curve(AUC)of the above parameters for predicting STAS was 0.666,0.912,0.839 and 0.842,respectively,and of the combination was 0.957.Conclusion 18 F-FDG PET/CT semi-quantitative parameters SUVmax and SULmax were helpful for predicting STAS of clinical stage Ⅰa—Ⅲ a lung adenocarcinoma,and further combination of gender and proportion of micropapillary growth could improve diagnostic efficacy.

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is characterized by diffuse alveolar injury primarily caused by an excessive inflammatory response. Regrettably, the lack of effective pharmacotherapy currently available contributes to the high mortality rate in patients with this condition. Xuebijing (XBJ), a traditional Chinese medicine recognized for its potent anti-inflammatory properties, exhibits promise as a potential therapeutic agent for ALI/ARDS. This study aimed to explore the preventive effects of XBJ on ALI and its underlying mechanism. To this end, we established an LPS-induced ALI model and treated ALI mice with XBJ. Our results demonstrated that pre-treatment with XBJ significantly alleviated lung inflammation and increased the survival rate of ALI mice by 37.5%. Moreover, XBJ substantially suppressed the production of TNF-α, IL-6, and IL-1β in the lung tissue. Subsequently, we performed a network pharmacology analysis and identified identified 109 potential target genes of XBJ that were mainly involved in multiple signaling pathways related to programmed cell death and anti-inflammatory responses. Furthermore, we found that XBJ exerted its inhibitory effect on gasdermin-E-mediated pyroptosis of lung cells by suppressing TNF-α production. Therefore, this study not only establishes the preventive efficacy of XBJ in ALI but also reveals its role in protecting alveolar epithelial cells against gasdermin-E-mediated pyroptosis by reducing TNF-α release.
Animals ; Mice ; Alveolar Epithelial Cells ; Pyroptosis ; Gasdermins ; Lipopolysaccharides/adverse effects* ; Tumor Necrosis Factor-alpha ; Acute Lung Injury/drug therapy* ; Respiratory Distress Syndrome

Objective:To analyze and explore the independent risk factors of 28-day mortality in patients with septic myocardial injury.Methods:A retrospective cohort study was conducted to collect clinical data of 505 patients diagnosed with sepsis related myocardial injury admitted to the intensive care unit (ICU) of the Affiliated Hospital of Jining Medical University from January 2015 to December 2020. According to the 28-day survival status of patients, they were divided into survival group and death group. COX multivariate regression analysis was used to analyze the influencing factors of the 28-day mortality rate of sepsis related myocardial injury patients, and receiver operating characteristic (ROC) curves were drawn to evaluate the effectiveness of independent risk factors in predicting the 28-day mortality rate of sepsis related myocardial injury patients.Results:A total of 505 patients with sepsis myocardial injury were included, of which 282 survived on 28 days and 223 died, with a mortality rate of 44.16%. COX multivariate regression analysis showed that Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, blood lactate (LAC), oxygenation index (PaO 2/FiO 2), admission heart rate, and albumin were independent risk factors for sepsis associated myocardial injury mortality at 28 days (all P<0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of SOFA score was 0.766 2, and the 95% confidence interval (95% CI) was 0.724 5-0.807 9; The predictive value of 28-day mortality in sepsis associated myocardial injury patients was superior to APACHE Ⅱ score, LAC, PaO 2/FiO 2, admission heart rate, and albumin [The AUC values were 0.754 1(0.711 5-0.796 7), 0.752 6(0.710 1-0.795 1), 0.697 0(0.649 7-0.744 2), 0.623 2(0.573 7-0.672 7), and 0.620 3(0.570 8-0.669 7), respectively]. Conclusions:SOFA score, APACHE Ⅱ score, LAC, PaO 2/FiO 2, admission heart rate, and albumin are independent risk factors for the 28-day mortality rate of sepsis related myocardial injury. Clinical practice should identify these factors early, intervene early, and improve patient prognosis.

Objective:To investigate the clinical value of different doses of paricalcitol combined with cinacalcet in the treatment of secondary hyperparathyroidism (SHPT) in patients with maintenance hemodialysis (MHD).Methods:The clinical data of 90 patients with MHD combined with SHPT from December 2020 to December 2022 in Beijing Geriatric Hospital were retrospectively analyzed. Among them, 30 patients were treated with cinacalcet (control group), 30 patients were treated with fixed dose paricalcitol combined with cinacalcet (experimental group A), and 30 patients were treated with adjusting dose of paricalcitol based on the level of intact parathyroid hormone (iPTH) combined with cinacalcet (experimental group B). All patients were continuously treated for 8 weeks. The blood calcium, blood phosphorus, iPTH, osteoprotegerin, osteocalcin, type Ⅰ collagen carboxy terminal peptide cross-linking (β-CTX), N-terminal medium molecule fragment of calcium (N-MID), fibroblast growth factor-23 (FGF-23) and Klotho protein before treatment and after 4 and 8 weeks of treatment were detected; coronary artery calcification (CAC) score and abdominal aortic calcification (AAC) score were evaluated. The adverse reactions were recorded.Results:There were no statistical differences in the indexes before treatment among three groups ( P>0.05). There were no statistical differences in blood calcium and blood phosphorus after 4 and 8 weeks of treatment among three groups ( P>0.05). After 4 and 8 weeks of treatment, the iPTH, β-CTX, osteoprotegerin, N-MID, osteocalcin and FGF-23 in experimental group A and experimental group B were significantly lower than those in control group, after 4 weeks of treatment: (936.99 ± 202.36) and (635.74 ± 135.44) ng/L vs. (1 028.56 ± 11.39) ng/L, (1.85 ± 0.32) and (1.50 ± 0.27) μg/L vs. (2.27 ± 0.69) μg/L, (71.18 ± 6.98) and (64.33 ± 7.87) ng/L vs. (80.15 ± 10.85) ng/L, (106.36 ± 14.42) and (92.64 ± 11.32) μg/L vs. (135.19 ± 15.18) μg/L, (66.17 ± 8.52) and (60.21 ± 7.85) μg/L vs. (73.15 ± 9.44) μg/L, (109.17 ± 11.24) and (98.50 ± 10.36) ng/L vs. (126.18 ± 15.64) ng/L; after 8 weeks of treatment: (632.17 ± 154.98) and (526.85 ± 98.45) ng/L vs. (819.85 ± 169.78) ng/L, (1.33 ± 0.15) and (1.15 ± 0.20) μg/L vs. (1.78 ± 0.27) μg/L, (65.78 ± 9.74) and (52.77 ± 7.18) ng/L vs. (74.26 ± 11.58) ng/L, (85.64 ± 11.62) and (70.25 ± 8.59) μg/L vs. (105.92 ± 19.17) μg/L, (48.17 ± 5.99) and (41.15 ± 6.44) μg/L vs. (59.24 ± 6.87) μg/L, (90.15 ± 11.25) and (82.58 ± 9.74) ng/L vs. (105.26 ± 14.35) ng/L, the indexes in experimental group B were significantly lower than those in experimental group A, and there were statistical differences ( P<0.05). After 4 and 8 weeks of treatment, the Klotho protein in experimental group A and experimental group B was significantly higher than that in control group, after 4 weeks of treatment: (124.25 ± 14.85) and (146.31 ± 16.85) U/L vs. (107.26 ± 11.36) U/L, after 8 weeks of treatment: (135.62 ± 16.87) and (150.24 ± 17.43) U/L vs. (115.56 ± 15.48) U/L, the Klotho protein in experimental group B was significantly higher than that in experimental group A, and there were statistical differences ( P<0.05). After 4 and 8 weeks of treatment, the CAC score and AAC score in experimental group A and experimental group B were significantly lower than those in control group, the indexes in experimental group B were significantly lower than those in experimental group A, and there were statistical differences ( P<0.05). There was no statistical difference in the incidence of adverse reactions among three groups ( P>0.05). Conclusions:Compared with the fixed dose of paricalcitol combined with cinacalcet therapy, the adjusting the dosage of paricalcitol combined with cinacalcet therapy based on iPTH level has more definite therapeutic effects in patients with MHD combined with SHPT, which can improve bone metabolism and reduce vascular calcification.

Objective:To explore the effects of multidisciplinary pain management in patients with cesarean scar pregnancy (CSP) undergoing uterine artery embolization (UAE) .Methods:Totally 140 CSP patients who underwent UAE in Nantong Maternity and Child Health Care Hospital, Nantong University from January 2019 to March 2021 were selected by convenient sampling and divided into the observation group and control group according to the random number table, with 70 patients in each group. Patients in the control group received routine care, while patients in the observation group underwent multidisciplinary pain management. The stress response-related indicators, complication rates, and pain control satisfaction were compared between the two groups.Results:The heart rate, systolic blood pressure, visual analog pain score, and anxiety score of the observation group were lower than those of the control group, and the Brinell comfort score was higher than that of the control group, with statistically significant differences ( P<0.05) . The total incidence of complications in the observation group was 8.57% (6/70) , which was lower than 21.43% (15/70) in the control group, and the difference was statistically significant ( P<0.05) . The total satisfaction with pain control in the observation group was 91.43% (64/70) , which was higher than 75.71% (53/70) in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The multidisciplinary pain management is beneficial to relieve the degree of stress response of patients, reduce the occurrence of complications, and improve the satisfaction with pain control.

Background::The combination of high-frequency oscillations (HFOs) with single-mode imaging methods has been proved useful in identifying epileptogenic zones, whereas few studies have examined HFOs combined with multimodal imaging methods. The aim of this study was to evaluate the prognostic value of ripples, an HFO subtype with a frequency of 80 to 200 Hz is combined with multimodal imaging methods in predicting epilepsy surgery outcome.Methods::HFOs were analyzed in 21 consecutive medically refractory epilepsy patients who underwent epilepsy surgery. All patients underwent positron emission tomography (PET) and deep electrode implantation for stereo-electroencephalography (SEEG); 11 patients underwent magnetoencephalography (MEG). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting surgical outcome were calculated for ripples combined with PET, MEG, both PET and MEG, and PET combined with MEG. Kaplan-Meier survival analyses were conducted in each group to estimate prognostic value.Results::The study included 13 men and 8 women. Accuracy for ripples, PET, and MEG alone in predicting surgical outcome was 42.9%, 42.9%, and 81.8%, respectively. Accuracy for ripples combined with PET and MEG was the highest. Resection of regions identified by ripples, MEG dipoles, and combined PET findings was significantly associated with better surgical outcome (P < 0.05). Conclusions::Intracranial electrodes are essential to detect regions which generate ripples and to remove these areas which indicate good surgical outcome for medically intractable epilepsy. With the assistance of presurgical noninvasive imaging examinations, PET and MEG, for example, the SEEG electrodes would identify epileptogenic regions more effectively.