Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients. Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function， the writing group of the "Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration" has formulated elaborate guidelines regarding indications and contraindications， preoperative evaluation， anesthesia implementation， common complications， and treatment strategies. This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements. The objective is to standardize the rational application of this anesthesia method.

The treatment landscape for metastatic renal cell carcinoma （mRCC） has evolved rapidly over the past two decades with the introduction of targeted therapies and novel immune checkpoint inhibitors. Among these developments， cytoreductive nephrectomy （CN） remains a controversial and unresolved issue， with its survival benefits being questioned compared to systemic therapy （ST）. The role and optimal timing of CN in the context of modern systemic treatment for mRCC remain unclear. Additionally， there is still no well-defined consensus on patient selection for CN. Therefore， this article provides a concise review of current evidence regarding CN in mRCC， incorporating the latest renal cancer management guidelines. We focus particularly on optimal surgical timing， candidate patient selection， and the therapeutic value of metastasectomy. Furthermore， we examine the current role of CN in metastatic non-clear cell renal cell carcinoma and explore its evolving clinical applications and future prospects in mRCC treatment.

This paper systematically reviews the relevant literature to elaborate the mechanism of OSA-related kidney injury， aiming to explore how OSA and CKD promote each other through common mechanisms， and exacerbate or delay the occurrence and development of the disease through mutual influence. It also provides a reference for the clinical prevention and treatment of the disease and the future research directions.

Objective To analyze the evaluation value of dynamic monitoring of changes in serum brain natriuretic peptide （BNP）， urinary kidney injury molecule-1 （KIM-1）， and serum cystatin C （CysC） levels in acute kidney injury （AKI） after pediatric heart surgery. Methods 138 children who underwent cardiopulmonary bypass for congenital heart disease correction in our hospital from January 2023 to June 2024 were selected. The incidence of postoperative AKI in children was counted and they were divided into the AKI group and the non-AKI group accordingly. The changing levels of serum BNP， KIM-1， and CysC in the two groups of children were dynamically monitored and compared. The receiver operating characteristic curve （ROC） was used to evaluate the occurrence and severity of AKI after pediatric heart surgery. Results Among the 138 children， 81 did not develop AKI and 57 developed AKI， with an incidence rate of 41.30%. In the AKI group， there were a mild group （n = 20） and a moderate-severe group （n = 37）. Regarding the AKI group and the non-AKI group： there were differences in the levels of BNP， KIM-1， and CysC at 6 h， 12 h， 24 h， and 48 h after surgery （P < 0.05）. The levels of BNP， KIM-1， and CysC in the AKI group were higher than those in the non-AKI group （P < 0.05）， and there were differences in the changing trends of BNP， KIM-1， and CysC levels between the two groups （P < 0.05）. The results of multivariate Logistic regression analysis showed that BNP， KIM-1 and CysC were all factors influencing the occurrence of AKI after pediatric cardiac surgery （P < 0.05）. The ROC curve showed that the AUC of the three combined to predict the occurrence of AKI after pediatric heart surgery was 0.893， which was significantly higher than 0.723， 0.812， and 0.761 of BNP， KIM-1， and CysC respectively. Regarding the mild group and the moderate-severe group： there were differences in the levels of BNP， KIM-1， and CysC at 6 h， 12 h， 24 h， and 48 h after surgery （P < 0.05）. The levels of BNP， KIM-1， and CysC in the mild group were lower than those in the moderate-severe group （P < 0.05）， and there were differences in the changing trends of BNP， KIM-1， and CysC levels between the two groups （P < 0.05）. The results of multivariate Logistic regression analysis indicated that BNP， KIM-1 and CysC were all factors influencing the severity of AKI after pediatric cardiac surgery （P < 0.05）. The ROC curve showed that the AUC of the three combined to evaluate the severity of AKI was 0.908， which was significantly higher than 0.780， 0.762， and 0.720 of BNP， KIM-1， and CysC respectively. Conclusion Dynamic monitoring of changes in serum BNP， KIM-1， and CysC levels has a high evaluation value for the occurrence and severity of AKI after pediatric heart surgery， and the combined detection has a higher evaluation value.

Objective Patients with acute coronary syndrome （ACS） combined with chronic kidney disease （CKD） are at high risk of major adverse cardiovascular events （MACE）， and early prediction is crucial for improving prognosis. Non-invasive detection methods， due to their simplicity and safety， have become important tools for assessing risks in such patients. This study aims to evaluate the application value of non-invasive detection indicators in predicting MACE in ACS patients with CKD. Methods The study included 216 ACS patients with CKD， divided into a Non-MACE group （n = 149） and a MACE group （n = 67）. General patient data， non-invasive detection indicators， electrocardiogram （ECG）， and cardiac function indicators were collected. Univariate and multivariate logistic regression analyses were performed to explore the relationship between these indicators and MACE. A nomogram prediction model was constructed， and its performance was evaluated using ROC curve analysis， calibration curve， and decision curve analysis. Results Univariate analysis showed that age， BMI， SVR， SVRI， HRV， QTd， SDNN， LVEF， LVEDd， SCOPA-AUT score， and GRACE score were significantly associated with MACE. Multivariate analysis identified SVRI， QTd， SDNN， LVEF， LVEDd， SCOPA-AUT score， and GRACE score as independent risk factors for MACE. ROC curve analysis revealed that the model had an AUC value of 0.979， sensitivity of 0.925， specificity of 0.966， and accuracy of 0.9537， indicating high diagnostic accuracy. Calibration curve and decision curve analyses further confirmed the model's reliability. Conclusion Non-invasive detection indicators， including SVRI， QTd， SDNN， LVEF， LVEDd， SCOPA-AUT score， and GRACE score， have significant value in predicting MACE in ACS patients with CKD. The constructed prediction model provides an effective tool for clinical risk assessment.

Objective To explore the risk factors of the stone-free rate after flexible ureteroscopy for lower pole calculi， develop a predictive model based on these identified factors， with subsequent validation and evaluation of the established model. Methods A retrospective analysis was conducted on 154 patients with lower pole renal calculi who underwent flexible ureteroscopy （FURS） at Guangdong Provincial Hospital of Traditional Chinese Medicine from 2020 to 2024. Based on postoperative stone clearance status， patients were categorized into a stone-free group and a residual stone group. Univariate analysis was performed to screen potential risk factors， while Pearson correlation coefficients and variance inflation factor （VIF） were employed to assess multicollinearity， retaining the indicator with the highest area under the curve （AUC）. Independent predictors were identified through multivariate logistic regression analysis， and a nomogram model was constructed. Internal validation was conducd using the bootstrap resampling method. The predictive performance and clinical utility of the model were evaluated using receiver operating characteristic （ROC） curves and decision curve analysis （DCA）. Results Univariate analysis demonstrated that largest stone diameter （LSD）， cumulative stone diameter （CSD）， stone volume （SV）， stone surface area （SA）， mean stone density （MSDE）， and infundibular pelvic angle （IPA） were significantly associated with stone-free rate （SFR） following flexible ureteroscopy （FURS） for lower pole calculi （all P < 0.05）. After collinearity diagnostics， LSD （area under the curve ［AUC］= 0.724） was retained as the optimal stone burden parameter. Multivariate logistic regression analysis confirmed LSD， MSDE， and IPA as independent predictors of postoperative SFR. The nomogram model exhibited robust predictive performance with an AUC of 0.786 （sensitivity： 79.6%， specificity： 71.0%）. Internal validation via 1000 bootstrap resamples yielded an AUC of 0.792， and decision curve analysis （DCA） confirmed clinical utility with net benefit across threshold probabilities of 4% — 75%. Conclusions The nomogram model developed in this study， which incorporates both stone characteristics and renal anatomical parameters， demonstrates effective prediction of stone-free rate （SFR） following flexible ureteroscopy for lower pole calyceal stones. With stable predictive performance and high clinical applicability， this model provides a reliable tool for preoperative personalized decision-making in endourological management.

Objective To explore the function and molecular mechanisms of matrix metalloproteinase 19 （MMP-19） in colorectal cancer （CRC） and liver metastasis of CRC （CRLM）. Methods This study comprehensively analyzed transcriptomic data， single-cell data， and clinical information of CRC and CRLM patients retrieved from public databases， namely The Cancer Genome Atlas （TCGA） and Gene Expression Omnibus （GEO）. RNA sequencing analysis was carried out to identify biological functions associated with MMP-19 expression. The differential expression of MMP-19 between primary lesions and liver metastatic lesions was evaluated using quantitative real-time polymerase chain reaction （qRT-PCR）， Western blotting， and immunohistochemistry. In vitro functional assays were performed to validate the impact of MMP-19 on the proliferation， invasion， and migration of colorectal cancer cells. Results MMP-19 was highly expressed in CRC tissues and was significantly correlated with poor prognosis in both CRC and CRLM patients. Sequencing results and functional enrichment analysis demonstrated that MMP-19 is involved in epithelial-mesenchymal transition， amino acid and protein transport， cell proliferation， extracellular matrix organization， and the mitogen-activated protein kinase （MAPK） signaling pathway. Single-cell analysis revealed that the expression of MMP-19 in macrophages and dendritic cells was higher in both CRC primary tumors and liver metastases compared to normal tissues. In vitro experiments confirmed that MMP-19 enhances the proliferation， invasion， and migration capabilities of colorectal cancer cells. Conclusion MMP-19 has been shown to play a crucial role in promoting the development and progression of CRC. It increases the risk of postoperative recurrence and liver metastasis through inducing epithelial-mesenchymal transition and remodeling the immune microenvironment. Given these findings， MMP-19 emerges as a promising novel target for the diagnosis and treatment of both CRC and CRLM.

Objective To explore the alterations in the numbers of cortical neurons and synapses in type 1 diabetic rats and their correlation with cognitive dysfunction. Methods A type 1 diabetes model was induced by intraperitoneal injection of streptozotocin （STZ）. Four-month-old specific pathogen-free （SPF）-grade Sprague-Dawley （SD） rats were randomly allocated into a control group and a diabetic group， with five rats in each group. After three months of continuous feeding， optical fractionator stereology was employed to quantitatively analyze the volume of the cerebral cortex， the number of neurons， and the number of synapses. Results In comparison with the control group， the volume of the cerebral cortex in the diabetic group decreased by 6.00%， and the number of neurons decreased by 14.09%. However， these differences were not statistically significant （P > 0.05）. Never theless， the density of synapses significantly decreased by 70.14% （P < 0.05）， and there was a significant difference in the number of Spinophilin/Neurabin-positive synaptic boutons per neuron in the cortex （P < 0.05）. Conclusion Although early-stage type 1 diabetes does not lead to a significant loss of cortical neurons， the substantial reduction in synaptic numbers might be a crucial pathological basis for cognitive dysfunction.

Objective To comprehensively analyze the clinical characteristics and risk factors of children with refractory mycoplasma pneumonia （RMPP）， precisely identify the joint predictors in these children， and construct a prediction model. This aims to offer a scientific foundation for the early identification of RMPP and the formulation of accurate treatment and medication strategies. Methods A retrospective analysis was performed on the clinical data of 282 children diagnosed with mycoplasma pneumoniae pneumonia （MPP） who were admitted to the Pediatric Department of the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between August 1， 2023， and February 29， 2024. Among these children， 119 with RMPP were classified into the RMPP group， while the remaining 163 with general MPP （GMPP） were assigned to the GMPP group. The clinical data of both groups， encompassing age， gender， duration of fever， symptoms， laboratory test indices， chest imaging data， complications， etc.， were compared. A logistic probability model （LogP model） for joint application was constructed. The discriminatory ability of the model was evaluated using the area under the receiver operating characteristic （ROC） curve， and the calibration of the model was assessed by means of a calibration curve. Results In comparison with the GMPP group， children in the RMPP group exhibited a significantly longer duration of fever （P = 0.002）. Moreover， they had a higher incidence of complications， including myocardial damage and coagulation dysfunction （P < 0.05）. Regarding inflammatory markers， the levels of C-reactive protein （CRP）， procalcitonin （PCT）， and lactate dehydrogenase （LDH） were notably elevated in the RMPP group （P < 0.05）， whereas the level of albumin （Alb） was lower （P = 0.001）. In the RMPP group， the levels of interleukin-2 （IL-2）， interleukin-5 （IL-5）， interleukin-8 （IL-8）， interleukin-1β （IL-1β）， and D-Dimer were increased， while the levels of interleukin-6 （IL-6） and interleukin-17 （IL-17） were decreased （P < 0.05）. Chest computed tomography （CT） scans revealed a higher proportion of lung consolidation， pleural effusion， and atelectasis in the RMPP group （P < 0.05）. Multivariate logistic regression analysis demonstrated that CRP， total bilirubin （T-BIL）， LDH， IL-17， and prothrombin time （PT） were independent risk factors for RMPP （P < 0.05）. The receiver operating characteristic （ROC） predictive model established based on these factors had an area under the curve （AUC） of 0.787 （95% confidence interval ［CI］： 0.693 ~ 0.880）， with a cutoff value of 0.421， a sensitivity of 0.786， and a specificity of 0.660. The calibration curve indicated that the predicted probability matched well with the reference probability， and there was no statistical difference in the results of the Hosmer-Lemeshow test （P > 0.05）. Conclusions The clinical features of children with RMPP are predominantly characterized by prolonged fever， moderate lung lesions， other organ injuries， and high inflammatory markers. CRP， T-BIL， LDH， IL-17， and PT can act as independent risk factors for RMPP.

Objective To investigate the therapeutic efficacy of inspiratory muscle training （IMT） combined with external diaphragm pacing （EDP） in elderly patients with chronic heart failure （CHF）. Methods 147 patients with CHF admitted to the Department of Cardiology of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2024 to October 2024 were selected， of which 38 patients were in the conventional drug therapy group （standard care group）， 52 patients were in the conventional drug therapy + EDP therapy （dual therapy group）， and 57 patients were in the conventional drug therapy + EDP therapy + IMT therapy （triple therapy group）. Comparative analyses were performed for maximum inspiratory pressure （MIP）， maximum expiratory pressure （MEP）， handgrip strength， 6-minute walk distance （6MWD）， modified Medical Research Council （mMRC） scores， resting heart rate， and blood pressure before treatment and 4 weeks post-intervention. Results After treatment， The dual therapy group demonstrated higher MIP， 6MWD， and lower mMRC scores than the standard care group （P < 0.05）. The triple therapy group exhibited superior improvements in MIP， MEP， handgrip strength， 6MWD， and lower mMRC scores compared to both standard care and dual therapy groups （P < 0.05）， with additional benefits including lower resting systolic blood pressure versus dual therapy group （P < 0.05） and reduced resting heart rate compared to standard care group （P < 0.05）. Conclusion The combined IMT and EDP significantly enhances respiratory and upper limb muscle strength in CHF patients， effectively improves cardiopulmonary function， alleviates dyspnea， and reduces resting heart rate and blood pressure，thus improving the quality of life.It is worthy of clinical promotion and application.

Objective To investigate the appropriate indicators for monitoring pediatric nociceptive stimulation， this study compared the SPI and NOX， two dual-parameter nociceptive stimulation monitors based on different principles， in terms of their effects on remifentanil consumption and postoperative recovery in pediatric adenotonsillectomy. Methods Children aged 3 ~ 12 years who were scheduled to undergo adenotonsillectomy under general anesthesia with endotracheal intubation were randomly assigned to the conventional group （Group R， n = 19）， the SPI group （Group S， n = 19）， and the NOX group （Group N， n = 18） according to the type of nociceptive stimulation monitor used. All children were subjected to routine fasting. The depth of anesthesia was monitored using a BIS monitor， and the remifentanil infusion rate was adjusted according to heart rate， SPI， or NOX values to maintain the index within the range of 30 ~ 50. After surgery， all children were transferred to the Post-Anesthesia Care Unit （PACU） with the tracheal catheter in place until they recovered. During the operation， the consumption of anesthetics such as remifentanil was recorded. Postoperatively， pain and agitation scores， the incidence of agitation at different time points， the duration of anesthesia， the surgical time， the time to extubation， and the length of stay in the recovery room were measured. Additionally， postoperative adverse reactions and perioperative vital signs were documented. Results In comparison with Group R， in Group N， the intraoperative consumption of remifentanil and the agitation score during the recovery period were significantly reduced. Conversely， in Group S， both of these two indicators were significantly elevated （P < 0.05）. Among the three groups， the residence time in the Post-Anesthesia Care Unit （PACU） was the shortest in Group N， and this difference was statistically significant （P < 0.05）. There were no significant disparities in the FLACC score， the incidence of agitation， and the extubation time among the three groups. Conclusions The NOX index can serve as a quantitative metric for monitoring nonciceptive stimulation during pediatric adenotonsillectomy. This index has the potential to decrease the intraoperative consumption of opioids and the residence time in the recovery room.

Objective To explore the factors affecting the occurrence of transient arrhythmia after percutaneous coronary intervention （PCI） in patients with acute coronary syndromes （ACS）， to establish a risk prediction model， and to test the prediction effect. Methods 480 ACS patients who underwent PCI in Western Theater Air Force Hospital of PLA from August 2022 to February 2024 were selected as study subjects and were divided into 336 cases in the construct group and 144 cases in the validation group according to the ratio of 7：3. The data of the construct group were used to construct the model， and the validation group was used to validate the model. The patients in the constructed group were divided into 84 cases in the occurrence group and 252 cases in the non-occurrence group according to whether they had experienced postoperative transient arrhythmia， and the validation group was divided into 36 cases in the occurrence group and 108 cases in the non-occurrence group. The baseline data of the study subjects in the two groups were observed， and the predictive value of continuous variables was analyzed using the ROC experiment； the influencing factors of the occurrence of transient arrhythmia after PCI in ACS patients were analyzed using multifactorial logistic regression； the Nomogram prediction model was constructed using the R language； and the model was evaluated and validated using calibration curves and decision curves. Results The results of a one-way analysis of the constructed group showed that older age， the presence of a history of diabetes mellitus， the time from onset to admission ≥ 6 h， and higher BNP levels were the main risk factors for the occurrence of transient arrhythmia after PCI in patients with ACS （P < 0.05）， and the prediction model established accordingly had an AUC of 0.865 and a 95% CI of 0.804 ~ 0.927， which was effective in predicting the occurrence of transient arrhythmia after PCI in patients with ACS. The model performed well in predicting the occurrence of transient arrhythmia after PCI， with a C-index of 0.858 （0.753 ~ 0.865）， and provided a good standardized net benefit when its risk threshold was between 0.10 to 0.96. The validation group ROC curve and calibration curve results are good， with an AUC of 0.846 and a C-index of 0.840 （0.737 ~ 0.851）， suggesting that the model has a good external predictive efficacy. The results of the validation group decision curve analysis indicated that the model could provide better standardized net returns when the risk threshold was between 0.06 and 0.94. Conclusion The results of univariate analysis showed that older age， the presence of a history of diabetes mellitus， onset-to-admission time ≥6 h， and higher BNP levels were the main risk factors for the occurrence of transient arrhythmia after PCI in patients with ACS， and the Nomogram model constructed on the basis of these four influencing factors could effectively predict the risk of transient arrhythmia after PCI in patients with ACS.

Objective To explore the expression of serine/threonine protein kinase 1 （AKT1） and Isochorismatase Domain-Containing 1 （ISOC1） in gastric cancer tissues and evaluate their diagnostic utility. Methods A total of 90 patients with gastric cancer who were diagnosed and treated in our hospital between March 2023 and September 2024 were recruited as the study subjects. The positive expression rates and positive scores of AKT1 and ISOC1 in cancer tissues and adjacent tissues were compared. The AKT1 and ISOC1 positive scores of gastric cancer patients with diverse characteristics were also compared. The Spearman correlation analysis was employed to examine the relationship between the expression of AKT1 and ISOC1 in cancer tissues and the clinical features of gastric cancer patients. A diagnostic model for gastric cancer， integrating AKT1 and ISOC1， was established using the Logistic regression model. Receiver operating characteristic （ROC） curves were plotted to analyze the area under the curve （AUC） value， sensitivity， and specificity of AKT1， ISOC1， and their combined diagnosis for gastric cancer. Results The positive expression rates and positive scores of AKT1 and ISOC1 in cancer tissues were significantly higher than those in paracancerous tissues （P < 0.05）. In gastric cancer patients， the expressions of AKT1 and ISOC1 were notably higher in patients with low differentiation， clinical stage Ⅰ~Ⅱ， invasion depth T_1-2， absence of lymph node metastasis， and no distant metastasis compared to those with moderate differentiation， clinical stage Ⅲ~Ⅳ， invasion depth T_3-4， and presence of lymph node metastasis and distant metastasis （P < 0.05）. Spearman's correlation analysis indicated that AKT1 and ISOC1 were positively correlated with the degree of differentiation， clinical stage， lymph node metastasis， invasion degree， and distant metastasis （P < 0.05）. The area under the curve （AUC） values of AKT1， ISOC1， and their combined diagnosis for gastric cancer were 0.735， 0.726， and 0.875 respectively （P < 0.05）. The sensitivities were 60.00%， 56.70%， and 75.60%， while the specificities were 85.60%， 83.30%， and 87.80%. The AUC value of the combined detection of AKT1 and ISOC1 in the diagnosis of gastric cancer was higher than that of AKT1 or ISOC1 alone （Z = -3.003， -3.196， P < 0.05）. Conclusions AKT1 and ISOC1 are highly expressed in gastric cancer tissues， and their expressions are upregulated with the progression of the disease. The combined detection of their expression levels holds great significance for the diagnosis and prognosis assessment of gastric cancer.

Objective To evaluate the utility of the liver-spleen volume ratio and fibrinogen in predicting the risk of esophagogastric variceal bleeding in patients with cirrhosis. Methods A total of 130 cirrhotic patients with esophagogastric variceal bleeding were recruited from among those admitted to Nantong Third People's Hospital between January 2020 and December 2022. Clinical data， blood test results， biochemical assay findings， coagulation test outcomes， and computed tomography （CT） scan results were collected. Based on their 1-year prognosis， the patients were classified into a non-bleeding group （n = 71） and a re-bleeding group （n = 59）. For normally distributed continuous variables， an independent samples t-test was employed； for non-normally distributed continuous variables， the Mann-Whitney U test was used； and for categorical variables， the chi-square test or Fisher's exact probability test was applied. Multivariable analysis was conducted to identify independent risk factors for esophageal and gastric variceal bleeding （EGVB） in cirrhotic patients. A predictive model integrating the liver-to-spleen volume ratio （LSVR） and fibrinogen （FIB） was then established. The clinical effectiveness of LSVR， FIB alone， and their combination was evaluated using receiver operating characteristic （ROC） curve analysis. The optimal cut-off value of the combined LSVR and FIB for predicting the prognosis of EGVB was calculated， and survival curves were plotted using the Kaplan-Meier method. Results Clinically relevant differences were observed in AST， FIB， D-dimer， MELD， ALBI scores， spleen volume， and the liver-to-spleen volume ratio between the two groups （P < 0.05）. Multivariable analysis indicated that LSVR （OR = 3.347， 95%CI： 1.624 ~ 6.899， P = 0.001） and FIB （OR =0.206， 95% CI： 0.078 ~ 0.544， P = 0.001） were independent risk factors for the prognosis of EGVB. The area under the receiver operating characteristic curve （AUC） was the largest when LSVR was combined with FIB （AUC = 0.825， 95% CI： 0.751 ~ 0.899）， which was higher than that of LSVR alone （AUC = 0.731， 95%CI： 0.639 ~0.822） and FIB alone （AUC = 0.683， 95%CI： 0.589 ~ 0.777）. The optimal cutoff value of the combination of LSVR and FIB was -2.741， with a specificity of 81.7% and a sensitivity of 74.6%. Kaplan-Meier survival analysis demonstrated that patients with LSVR combined with FIB < -2.741 had a 1-year non-bleeding rate of 53.4% （39/73）， which was significantly higher than the 7.0% （4/57） in patients with LSVR combined with FIB ≥ -2.741， and the difference was statistically significant （P < 0.001）. Conclusions Compared with using LSVR or FIB alone， combining LSVR with FIB enhances the predictive efficacy for 1-year re-bleeding in EGVB patients. This model could serve as an objective and straightforward tool for better clinical implementation.

Objective To explore the correlation between helicobacter pylori （Hp） infection and inflammatory factors， as well as its association with the progression of liver fibrosis in patients with metabolically associated fatty liver disease （MAFLD） and type 2 diabetes mellitus （T2DM）. Methods A total of 300 patients diagnosed with MAFLD and T2DM who were admitted to the Hepatology Department of Hebei Hospital of Traditional Chinese Medicine between April 2023 and March 2024 were recruited. Based on Hp infection status， these patients were classified into an Hp-positive group and an Hp-negative group. Subsequently， the clinical data， inflammatory factors， and liver fibrosis indices of the two groups were comprehensively compared. Furthermore， the patients in the Hp-positive group were randomly assigned to an intervention group and a control group. The intervention group received standard Hp eradication therapy， whereas the control group was administered placebo therapy. Pearson correlation analysis was employed to investigate the associations among Hp infection， inflammatory factors， and liver fibrosis indices. Binary logistic regression analysis was utilized to identify the independent risk factors influencing the progression of liver fibrosis. Results In both the Hp-positive and Hp-negative groups， parameters including age， fasting blood glucose （FPG）， glycosylated hemoglobin （HbA1c）， total bilirubin （TBIL）， direct bilirubin （DBIL）， indirect bilirubin （IBIL）， tumor necrosis factor-α （TNF-α）， and interleukin-6 （IL-6）， along with C-reactive protein （CRP） and liver stiffness measurement （LSM）， were meticulously measured. Statistical analysis revealed that the differences in these parameters between the two groups were significant （P < 0.05）. Specifically， within the experimental setup， the levels of TNF-α， IL-6， CRP， and LSM in the intervention group were notably lower than those in the control group （P < 0.05）. Pearson correlation analysis was employed to explore the relationships among variables， and the results indicated a positive correlation between the Hp detection value （DPM） and the levels of TNF-α， IL-6， CRP， and LSM （P < 0.05）. Furthermore， binary logistic regression analysis was conducted to identify independent risk factors. The findings demonstrated that positive Hp infection， elevated TNF-α， elevated IL-6， and elevated CRP were independent risk factors for the progression of liver fibrosis （P < 0.05）. To evaluate the diagnostic performance， the receiver operating characteristic （ROC） curve analysis was carried out. The areas under the curve （AUC） for HP infection， TNF-α， IL-6， and CRP were 0.800， 0.786， 0.769， and 0.783， respectively. These values were significantly lower than the AUC of 0.896 obtained from the combined detection （P < 0.05）. Conclusions In MAFLD patients with T2DM， DPM is closely associated with inflammatory factors （such as TNF-α， IL-6， and CRP） and the advancement of liver fibrosis. The combined detection of these factors holds significant value in predicting the progression of liver fibrosis. It can offer a reliable foundation for the clinical assessment of the risk of liver fibrosis progression.

Objective To investigate the impact of closed negative pressure drainage in combination with Ilizarov transverse tibial bone transport on oxidative stress and inflammatory response in patients with severe diabetic foot. Methods A total of 60 patients with severe diabetic foot who were admitted to the hospital from July 2019 to March 2023 were recruited as the research subjects. These patients were randomly allocated into a control group （n = 30） and an observation group （n = 30）. The control group received Ilizarov tibial transverse bone transport alone， whereas the observation group was treated with closed negative pressure drainage in conjunction with Ilizarov tibial transverse bone transport. The following parameters were compared between the two groups of patients： the reduction rate of wound size， the healing rate， growth factors ［Epidermal Growth Factor （EGF）， Transforming Growth Factor （TGF）， Vascular Endothelial Growth Factor （VEGF）］， oxidative stress indicators ［Advanced Protein Oxidation Products （AOPP）， Malondialdehyde （MDA）， Superoxide Dismutase （SOD）］， inflammatory factors ［Procalcitonin （PCT）， Interleukin-18 （IL-18）， C-reactive Protein （CRP）］， adverse reactions， and the amputation rate. Results The shrinkage rate and healing rate of patients in the observation group were both significantly higher than those in the control group （P < 0.05）. Post-treatment， the improvement in growth factor levels， including EGF， TGF， and VEGF， in the observation group was more pronounced compared to that in the control group （P < 0.05）. Regarding serum AOPP， MDA， and SOD levels， the improvement in the observation group was superior to that in the control group （P < 0.05）. Moreover， the improvement in inflammatory factor levels such as serum PCT， IL-18， and CRP in the observation group was more notable than that in the control group （P < 0.05）. The incidence of adverse reactions such as redness， swelling， pain， and bleeding in the observation group was 6.67%. When compared with the incidence of 11.67% in the control group， no statistically significant difference was observed （P > 0.05）. The amputation rate of patients in the observation group was 3.33%， which was significantly lower than 23.33% in the control group （P < 0.05）. Conclusions Closed negative pressure drainage combined with Ilizarov tibial transverse bone transport demonstrates better efficacy in the treatment of severe diabetic foot. This treatment modality can effectively promote wound healing， enhance oxidative stress regulation， and inhibit the inflammatory response， presenting a relatively high safety profile. Therefore， the application of closed negative pressure drainage combined with Ilizarov tibial transverse bone transport in the treatment of severe diabetic foot merits clinical reference and promotion.

Objective To analyze the risk factors of neurogenic bladder dysfunction （NB） in patients with spinal cord injury， and establish a risk prediction model of NB in patients with spinal cord injury by decision tree algorithm. Method Clinical data of 176 patients with spinal cord injury admitted from April 2022 to July 2024 were retrospectively analyzed. Patients with spinal cord injury were divided into disorder group and non-disorder group according to whether they were complicated by NB. Multivariate Logistic regression analysis was used to screen the risk factors of NB. Modeler software was used to construct the decision tree model of spinal cord injury patients with concurrent NB， and the 5-fold cross-validation method was used to internally verify the model， and the prediction efficiency of the model was compared. Results Among 176 patients with spinal cord injury， 42 patients had concurrent NB， the incidence of NB was 23.86%. Logistic regression analysis showed that the level of spinal cord injury （T₁₀—L₂）， degree of spinal cord injury （complete injury）， course of disease （≥ 6 months）， bladder compliance （abnormal）， urinary system infection （yes） and detrusor sphincter disorder （yes） were all independent risk factors for NB in patients with spinal cord injury （P < 0.05）. Probability forecasting model P = 1/［1 + e- ^{（-6.008+0.791*X1+3.117*X2+1.492*X3+1.270*X4+1.516*X5+2.158*X6）}］， models to predict the overall accuracy is 80.5%； The prediction accuracy of the model is 71.7% through the cross-verification of 5 fold. Decision tree model showed that the degree of spinal cord injury had the greatest effect on the complication of NB in patients with spinal cord injury， and the information gain was 0.46. ROC results showed that the AUC values of NB predicted by the two models were close （0.873 vs. 0.852， Z = 0.875， P = 0.469）. Conclusion The level of spinal cord injury， degree of spinal cord injury， course of disease， bladder compliance， urinary system infection， detrusor sphincter disorder can all predict the risk of NB. The decision tree model constructed in this study can effectively predict the risk probability of NB in patients with spinal cord injury， and medical staff can make targeted plans according to the above factors to reduce the risk of NB.

Objective To analyze the characteristics of spirometry and type 2 inflammation indicators of patients with CVA， ACO and CA to determine their clinical utility in identifying and distinguishing among CVA， ACO and CA patients. Methods Clinical data from 483 patients diagnosed with bronchial asthma， CVA， and bronchial asthma combined with chronic obstructive pulmonary disease in the outpatient department of the First Affiliated Hospital of Soochow University from July 2023 to June 2024 were collected and divided into CA， CVA and ACO groups according to diagnosis. Comparison of spirometry， fractional exhaled nitric oxide （FeNO）， blood eosinophil （EOS）， serum total immunoglobulin E （tIgE） and other tests between CA and CVA， CA and ACO groups. Perform logistic regression analysis on significant test results， then construct receiver operating characteristic （ROC） curves to compare the area under the curve and corresponding cut-off values. Result There was a statistically significant difference in tIgE between the CVA and CA groups （P = 0.018）， whereas no significant differences were observed in FeNO and EOS. Additionally， no notable differences were found between the ACO and CA groups in tIgE， FeNO， or EOS. Finally， FEV1%pred （OR = 1.086， P = 0.019）， FEV1/FVC （OR = 1.153， P = 0.023）， and MEF50%pred （OR = 0.922， P = 0.045） were used to construct the discriminative model between CA and CVA. ROC curves were plotted， with FEV1%pred showing an AUC of 0.680 （P < 0.001）， a Youden index of 0.358， and a corresponding cutoff value of 89.200. FEV1/FVC had an AUC of 0.684 （P < 0.001）， a Youden index of 0.334， and a cutoff value of 76.075. MEF50%pred had an AUC of 0.668 （P < 0.001）， a Youden index of 0.309， and a cutoff value of 59.800. The combined sensitivity of these three measures was 0.909， specificity was 0.514， positive predictive value was 0.600， negative predictive value was 0.873， and the AUC was 0.773 （P < 0.001）， with a Youden index of 0.423. FEV1 （OR = 0.002， P = 0.045）， FEV1%pred （OR = 1.490， P = 0.006）， and FEV1/FVC （OR = 0.749， P = 0.005） were used to construct the discriminative model between CA and ACO. ROC curves were plotted， with FEV1 showing an AUC of 0.819 （P < 0.001）， a Youden index of 0.532， and a corresponding cutoff value of 2.060. FEV1%pred had an AUC of 0.788 （P < 0.001）， a Youden index of 0.501， and a cutoff value of 75.000. FEV1/FVC had an AUC of 0.891 （P < 0.001）， a Youden index of 0.678， and a cutoff value of 68.620. The combined sensitivity of these three measures was 1.000， specificity was 0.904， positive predictive value was 0.771， negative predictive value was 1.000， and the AUC was 0.973 （P < 0.001）， with a Youden index of 0.904. Conclusions Differences exist in the spirometry among CVA， ACO and CA. The spirometry results incorporated into the discriminative models provide good discriminative value for distinguishing between CA and CVA patients with similar clinical symptoms， as well as for identifying ACO in the CA population.

Objective To conduct a retrospective analysis of the correlation among bedaquiline （BDQ） plasma concentrations， relevant clinical factors， and disease prognosis. Methods In this retrospective study， 22 patients diagnosed with rifampicin-resistant tuberculosis （RR-TB）， multidrug-resistant tuberculosis （MDR-TB）， or pre-extensively drug-resistant tuberculosis （pre-XDR-TB） were enrolled. These patients were admitted to the tuberculosis ward of our hospital between February 2022 and October 2024. All patients were administered a treatment regimen containing BDQ. The cohort comprised 6 RR-TB patients （27.27%）， 12 MDR-TB patients （54.55%）， and 4 pre-XDR-TB patients （18.18%）. Peripheral blood samples were collected 2 hours after the oral administration of Bedaquiline. The plasma concentration of Bedaquiline was measured using liquid chromatography-tandem mass spectrometry （LC-MS/MS）. Spearman correlation analysis was performed using R studio software with the ggplot2 and corrplot packages. The factors included the blood concentration of bedaquiline， electrocardiogram QTcF （QT interval corrected by the Fridericia method）， liver and kidney function parameters， weight， age， body mass index， sex， blood uric acid level， serum creatinine level， and other relevant indicators. Results In 22 patients treated with BDQ， the plasma concentration reached a peak after 1.5 weeks of administration， and gradually stabilized after 2 weeks. The plasma concentration was approximately 1-3 μg/mL. After 24 weeks of withdrawal of bedaquiline， patients were continued to monitor their bedaquiline concentration and found that BDQ blood concentration in peripheral blood was approximate 1 μg /mL up to 36 weeks. The serum concentration of BDQ was not correlated with age， body weight， BMI， ALT， AST， GGT， TDiL， urea， uric acid and QT interval， but correlated with sputum negative transformation and serum creatinine. The correlation analysis between serum concentration of BDQ and acid-fast staining of sputum smear showed， the difference was significant （r = 0.35， P < 0.05）. In addition， the correlation analysis between serum BDQ concentration and serum creatinine showed， the difference was significant （r = 0.34， P < 0.05）. The results of multiple linear regression analysis showed that BDQ blood concentration was positively correlated with Scr level， and Scr was an independent factor affecting BDQ blood concentration. 20 cases （90.9%， 20/22） were cured， 1 case died of Covid-19 virus infection， 1 case was recurrence. Conclusions Regimens containing bedaquiline seem to exhibit relatively high safety profiles and good tolerability among patients with rifampicin-resistant， multidrug-resistant， or pre-extensively drug-resistant tuberculosis， typically yielding favorable treatment outcomes. The BDQ shows a positive correlation with serum creatinine （SCr）. Consequently， close surveillance of BDQ levels and renal function remains of utmost importance throughout the treatment course.

Objective To explore the therapeutic effect of doubling the first dose of batroxobin in the treatment of sudden sensorineural hearing loss with reduced frequency. Methods A total of 96 patients diagnosed with sudden sensorineural hearing loss， who received treatment at the Department of Otolaryngology at the Second Affiliated Hospital of Guizhou Medical University between August 2022 and October 2024， were included in the study. Using the random number table method， the patients were assigned to two groups， an observation group and a control group， each comprising 48 cases. The control group was treated with Ginkgo biloba extract， methylprednisolone tablets， and a first dose of 10 BU of batroxobin， while the observation group was treated with Ginkgo biloba extract， methylprednisolone tablets， and a first dose of 20 BU of batroxobin. After one cycle of treatment， compare the pure tone hearing threshold， hemorheological indicators， coagulation function indicators， efficacy， and adverse reactions between the two groups. Follow up for 6 months and record the recurrence outcome. Results After treatment， the pure tone hearing threshold of both groups decreased， and the observation group was lower than the control group （P < 0.05）. After treatment， the effective rates of the observation group and the control group were 77.08% and 54.17%， respectively， and the whole blood low shear viscosity was （18.27 ± 1.63） （20.29 ± 1.41） mPa·s， the whole blood shear viscosity was （5.58 ± 0.64）， （6.01 ± 0.69） mPa·s， the whole blood high shear viscosity is （4.26 ± 0.38）， （4.54 ± 0.31） mPa·s， the plasma viscosity is （1.52 ± 0.26）， （1.71 ± 0.34） mPa·s， the red blood cell aggregation index is （0.60 ± 0.21）， （0.52 ± 0.17）， the red blood cell deformation index was （5.73 ± 0.61）， （6.20 ± 0.64）， and the fibrinogen （FIB） is （0.72 ± 0.18）. 0.95 ± 0.13） g/L， thrombin time （TT） were （23.51 ± 2.08） and （21.76 ± 2.13） s， prothrombin time （PT） were （12.71 ± 0.63） and （12.05 ± 0.65） s， respectively， and activated partial thromboplastin time （APTT） were （28.32 ± 3.07） and （29.51 ± 2.24） s， respectively， with the observation group showing more significant changes （P < 0.05）. The recurrence rate of the observation group was lower than that of the control group （P < 0.05）. Conclusion Doubling the first dose of batroxobin can help alleviate the symptoms of hearing impairment， improve inner ear microcirculation， and enhance treatment efficacy in patients with total frequency decline type sudden deafness.

Objective To explore the impacts of remimazolam on intraoperative intracranial pressure （ICP） and cerebral oxygenation in patients undergoing laparoscopic lower abdominal and pelvic surgery under CO₂ pneumoperitoneum combined with Trendelenburg position. Methods Eighty-eight patients scheduled to undergo laparoscopic lower abdominal and pelvic surgery were randomly assigned to the remimazolam group （n = 44） and the sevoflurane group （n = 44）. In the remimazolam group， continuous infusion of remimazolam at a rate of 1 mg/（kg·h） was administered for anesthesia maintenance. In contrast， the sevoflurane group inhaled 2% sevoflurane. Heart rate （HR）， mean arterial pressure （MAP）， peak airway pressure （Peak）， plateau airway pressure （Plat）， end-tidal CO₂ （P_ETCO₂）， regional cerebral oxygen saturation （rSO₂）， and optic nerve sheath diameter （ONSD）of both eyes were measured and recorded at the following time points： prior to anesthesia induction （T₀）， 5 minutes after induction （T₁）， 10 minutes （T₂）， 30 minutes （T₃）， and 60 minutes （T₄） after the establishment of pneumoperitoneum in Trendelenburg position， as well as 30 minutes after deflation in the supine position （T₅）. Results No significant intergroup differences were detected in HR， MAP， Peak， Plat， or P_ETCO₂ at any time point （P > 0.05）. In both groups， Peak and Plat values were significantly higher at T₂-T₄ compared to T₁ （P < 0.05）. Regarding the ONSD） no intergroup differences were noted at T₀ and T₁ （P > 0.05）. From T₂ to T₅， ONSD in both groups increased significantly relative to T_0.. It gradually rose with the prolongation of pneumoperitoneum and Trendelenburg positioning and showed a slight decrease at T₅ （P < 0.05）. Specifically， at T₃ and T₄， the remimazolam group exhibited significantly smaller ONSD values than the sevoflurane group （P < 0.05）. Throughout the study， no intergroup differences in rSO₂ were observed （P > 0.05）. Conclusion In laparoscopic lower abdominal and pelvic surgeries performed in the Trendelenburg position， intravenous anesthesia with remimazolam may be more effective in mitigating the elevation of intracranial pressure compared to sevoflurane inhalation.

Objective To explore the expression of peripheral blood Nod-like receptor protein 3 （NLRP3） inflammasomes， serum caveolin-1 （Cav-1）， and sphingosine 1-phosphate receptor 1 （S1P1） in children with Kawasaki disease （KD）， and to elucidate their associations with coronary artery lesion （CAL）. Methods A total of 223 children diagnosed with KD were recruited from our hospital between March 2023 and December 2024 and served as the KD study group. These children were classified into the CAL group （n = 71） and the non-CAL group （n = 152） based on their CAL status. Additionally， 223 healthy children who underwent physical examinations at our hospital were selected as the healthy control group. Clinical data， levels of routine laboratory test indices， peripheral blood NLRP3 inflammasomes， serum Cav-1， and S1P1 were compared among the groups. Risk factors for CAL in children with KD were analyzed， and the diagnostic value of peripheral blood NLRP3 inflammasomes， serum Cav-1， and S1P1 levels for CAL in children with KD was evaluated. Results The levels of NLRP3， caspase-1， ASC in peripheral blood and messenger ribonucleic acid （mRNA） of serum Cav-1 were significantly higher in the KD study group than in the healthy control group （P < 0.05）. Conversely， the serum level of S1P1 was significantly lower in the KD study group compared to the healthy control group （P < 0.05）. In the CAL group， the levels of peripheral blood white blood cell count （WBC）， NLRP3， caspase-1， ASC mRNA， serum C-reactive protein （CRP）， and Cav-1 were all higher than those in the non-CAL group （P < 0.05）， while the serum level of S1P1 was lower than that in the non-CAL group （P < 0.05）. The levels of NLRP3， caspase-1， ASC mRNA in peripheral blood， along with serum Cav-1 and S1P1， were identified as independent risk factors for CAL in children with KD （P < 0.05）. The results of receiver operating characteristic （ROC） analysis indicated that the combined test of the levels of NLRP3， caspase-1， ASC mRNA in peripheral blood， serum Cav-1， and S1P1 for diagnosing CAL in children with KD had an area under the curve （AUC） value of 0.926. This value was significantly higher than that of each individual index （0.844， 0.785， 0.821， 0.843， 0.833， P < 0.05）. Conclusions The levels of NLRP3 inflammatory vesicles in peripheral blood and serum Cav-1 were highly expressed in children with KD， whereas the serum S1P1 was poorly expressed. These indices may be involved in the development process of CAL in children with KD. Moreover， the combination of these indices is more beneficial for the diagnosis of CAL in children with KD.

The repeated administration of morphine frequently gives rise to tolerance， manifested by a reduction in analgesic efficacy and an elevation in adverse effects. These consequences significantly impinge upon its clinical utility. Synaptic functional plasticity governs long-term alterations in synaptic transmission efficiency through calcium signaling pathways， protein kinase cascade reactions， and glia-neuron interactions， thereby facilitating the development of morphine tolerance. Structural plasticity encompasses the dynamic remodeling of dendritic spine density and morphology， the establishment or elimination of synaptic connections， and the reconstitution of synaptic active zones. Morphine-induced synaptic plasticity within the central nervous system demonstrates region-specific alterations， which jointly drive the process of tolerance. This review comprehensively synthesizes the research advancements regarding the mechanisms of synaptic plasticity in morphine tolerance， with the aim of furnishing a theoretical foundation for the development of innovative analgesic medications and the optimization of clinical treatment strategies.

Sepsis， a systemic inflammatory disorder triggered by infection， is characterized by a complex pathophysiological mechanism that gives rise to high mortality rates and treatment bottlenecks. Short-Chain Fatty Acids （SCFAs）， as the core metabolites of the intestinal flora， exhibit potential in organ protection during sepsis via a multi-target regulatory mechanism. In the realm of immunomodulation， SCFAs achieve a balance between pro-inflammatory and anti-inflammatory responses by activating G protein-coupled receptors， inhibiting the activation of NLRP3 inflammasomes， and suppressing the cascade reaction of pro-inflammatory factors. At the metabolic regulation level， SCFAs optimize mitochondrial function， mitigate the hypercatabolic state associated with sepsis， and relieve organ energy failure. Furthermore， SCFAs exert an organ-protective effect in multiple ways. They enhance the integrity of the intestinal barrier， inhibit pathogen translocation， and impede the systemic spread of inflammation through the synergistic mechanisms of the intestinal-organ axis. Animal and preclinical studies have demonstrated that exogenous supplementation of SCFAs or dietary fiber intervention may interact with the intestinal flora， offering a novel strategy for sepsis treatment. In this review， we systematically summarize the multi-target regulatory network of SCFAs in sepsis and the research progress regarding their organ-protective effects in sepsis. Additionally， we propose therapeutic strategies targeting microbial metabolites， thereby providing a new perspective for overcoming the limitations of traditional anti-infection and immunomodulation.