Intraoperative hemodynamic monitoring and management are essential components of perioperative care for adult patients undergoing non?cardiac surgery， as they are critical for maintaining adequate tissue perfusion and preventing organ dysfunction. In June 2025， the European Society of Anaesthesiology and Intensive Care （ESAIC） published the “Statement on Intraoperative Hemodynamic Monitoring and Management in Adult Non? Cardiac Surgery.” Developed by a panel of 25 international multidisciplinary experts using an evidence?based approach， this statement addresses six key domains： arterial blood pressure management， heart rate regulation， stroke volume and cardiac output monitoring， assessment of cardiac preload and fluid responsiveness， application of microcirculation monitoring techniques， and integrated management of anesthesia depth with cerebral oxygen saturation monitoring. This article provides a comprehensive interpretation of the statement′s core recommendations， including guidance on the selection and limitations of monitoring modalities， as well as specific management targets for instance， recommending a mean arterial pressure of at least 60 mmHg as a threshold for intervention and explicitly advising against the use of arterial pressure as a surrogate for cardiac output. The objective is to offer practical clinical guidance for anesthesiologists and to enhance the precision and effectiveness of intraoperative hemodynamic management in adult non?cardiac surgical patients.

The China Cardiovascular Health and Disease Report 2024 has recently been released， offering a comprehensive and detailed assessment of the current status of cardiovascular diseases （CVD） and their associated risk factors in China. The report reveals that the number of CVD cases， as well as the overall and age-standardized incidence rates， continue to increase. Among these conditions， atherosclerotic cardiovascular disease （ASCVD） constitutes a major contributor to CVD-related mortality. Although ASCVD is largely preventable and controllable， the management of key modifiable risk factors?such as smoking， obesity， hypertension， dyslipidemia， and diabetes?remains suboptimal. This article systematically summarizes the prevalence， current management practices， and evidence-based prevention strategies for each major ASCVD risk factor， aiming to reinforce for clinicians the importance of not only treating established ASCVD but also proactively guiding patients in the prevention and control of its underlying risk factors， thereby reducing the overall burden of ASCVD in terms of both prevalence and mortality.

Immune checkpoint inhibitors （immune checkpoint inhibitors， ICIs）， as new anti-tumour drugs， have significantly improved the prognosis of tumour patients by blocking the endogenous immune inhibitory signals and activating the immune response of T cells against tumours. However， the immune-related adverse events （irAEs） they cause have become a significant concern. irAEs can affect multiple organ systems， including the kidneys.Among these， immune checkpoint inhibitor-associated acute kidney injury （ICI-AKI） represents the most common renal toxicity manifestation. The most common pathological type is acute interstitial nephritis （AIN）. Non-AIN types， such as glomerular diseases and thrombotic microangiopathy， can also occur. The pathogenesis of ICI-AKI is complex， involving immune tolerance imbalance， abnormal activation of autoreactive T cells， autoantibody production， and inflammatory cytokines. ICI-AKI typically responds well to early corticosteroid therapy， with most patients achieving partial or complete renal recovery. Therefore， the timely evaluation， precise diagnosis， and standardized management of suspected cases hold crucial clinical value. A deep understanding of the clinical and pathological features and immunological mechanisms of ICI-related renal injury is the key to optimizing early identification， accurate diagnosis， and effective management. This review aims to systematically summarize the key pathological findings of current ICI-related kidney injury and deeply explore its immunological mechanisms of occurrence and development， providing theoretical basis and guidance for clinical practice.

Objective To investigate the association between remnant cholesterol （RC） and clinicopathological parameters in patients with IgA nephropathy （IgAN）， and to assess the clinical significance of RC in the progression and management of IgAN. Methods A total of 366 patients with a biopsy?proven diagnosis of IgAN were consecutively enrolled in this retrospective study. Clinical and pathological data were systematically collected， and RC was calculated. Participants were stratified into two groups according to the median RC value. Baseline characteristics were compared between these groups. The association between RC and the presence of tubular atrophy/interstitial fibrosis （T1/2 lesions） in IgAN patients was evaluated using binary logistic regression， restricted cubic spline （RCS） analysis， receiver operating characteristic （ROC） curve analysis， and subgroup analyses. Results In this study， the high?RC group exhibited significantly higher levels of body weight， body mass index （BMI）， systolic blood pressure （SBP）， diastolic blood pressure （DBP）， triglycerides （TG）， total cholesterol （TC）， non?high?density lipoprotein cholesterol （non?HDL?C）， uric acid （UA）， complement 3 （C3）， and 24?hour urinary protein， as well as lower levels of albumin （ALB）， estimated glomerular filtration rate （eGFR）， and high?density lipoprotein cholesterol （HDL?C）， compared to the low?RC group. Patients with T1/2 lesions showed elevated levels of SBP， DBP， TC， non?HDL?C， UA， 24?hour urinary protein， and RC， along with reduced levels of hemoglobin （Hb）， ALB， and eGFR， relative to those with T0 lesions. Multivariate logistic regression analysis indicated that increased RC and decreased eGFR were independent risk factors for the presence of T1/2 lesions in patients with IgAN （P < 0.05）. RCS analysis revealed a linear association between RC and the likelihood of T1/2 lesions （non?linearity P = 0.343）. The area under the receiver operating characteristic curve （AUC） for a predictive model incorporating RC， Hb， UA， and eGFR was 0.833， indicating good discriminative ability. Subgroup analyses consistently demonstrated a significant association between RC and the risk of T1/2 lesions， with no statistically significant interactions observed across subgroups （all P > 0.05）. Conclusion RC can reflect the severity of both clinical and pathological manifestations in patients with IgAN， making RC monitoring a potentially valuable tool for assessing disease progression in clinical practice.

Objective To investigate the clinical significance of serum B cell activating factor （BAFF） and complement lytic factor Bb in patients with idiopathic membranous nephropathy （IMN）， as well as their correlation with the urinary albumin?to?creatinine ratio （UACR）. Methods A total of 204 IMN patients were enrolled as the study group， and 100 healthy individuals undergoing physical examinations during the same period served as the control group. Serum levels of BAFF， Bb， and UACR were measured and compared between the two groups. Pearson correlation analysis was performed to assess the associations among serum BAFF， Bb， and UACR. The patients in the study group were followed up for 12 months and stratified into a favorable prognosis group and a poor prognosis group （defined as no remission） based on disease remission status. Demographic and clinical characteristics， as well as serum BAFF and Bb levels， were compared between the two outcome groups. Multivariate logistic regression analysis was conducted to identify independent predictors of poor prognosis in IMN patients. Receiver operating characteristic （ROC） curve analysis was employed to evaluate the predictive value of these indicators for poor prognosis. Results The levels of BAFF， Bb， and UACR in the research group were significantly higher than those in the control group （P < 0.05）. Pearson correlation analysis revealed that both BAFF and Bb were positively correlated with UACR （r = 0.716 and 0.543， respectively； P < 0.05）. After one year of follow?up， a total of 200 patients completed the study， among whom 46 experienced poor prognosis. Based on the follow?up outcomes， patients were categorized into a poor prognosis group （n = 46） and a good prognosis group （n = 154）. The poor prognosis group exhibited significantly higher levels of serum creatinine， 24?hour urinary protein， BAFF， and Bb， as well as lower eGFR values， compared to the good prognosis group （P < 0.05）. Multivariate regression analysis identified 24?hour urinary protein， BAFF， and Bb as independent risk factors for poor prognosis in patients with IMN， whereas eGFR was identified as a protective factor （P < 0.05）. ROC curve analysis demonstrated that the combined assessment of 24?hour urinary protein， eGFR， BAFF， and Bb yielded a higher AUC value for predicting poor prognosis in IMN patients than any single indicator alone （Z = 4.145， 3.908， 4.308， 3.864； P < 0.05）. Conclusions The serum levels of BAFF and Bb in patients with IMN are significantly elevated and positively correlated with the UACR. The combination of 24?hour urinary protein excretion and eGFR demonstrates high predictive value for poor prognosis in these patients. These findings suggest that BAFF and Bb may serve as potential biomarkers for prognostic assessment in IMN， and the integrated measurement of multiple parameters could provide a more comprehensive clinical basis for disease management.

Objective To investigate the association between nutritional status and serum hepcidin and pentraxin 3 （PTX3） levels in patients undergoing maintenance hemodialysis （MHD）. Methods A total of 76 patients with MHD who met the inclusion criteria were recruited from the hemodialysis center at the Affiliated Hospital of Chengde Medical University. Nutritional status was assessed using the Subjective Global Assessment （SGA）， which categorizes patients into three grades： SGA?A， SGA?B， and SGA?C. Serum levels of PTX3 and hepcidin were measured by enzyme?linked immunosorbent assay （ELISA）. Statistical analyses were conducted using SPSS software. One?way analysis of variance （ANOVA） was applied to compare differences across the three SGA groups. Logistic regression analysis was performed to identify influencing factors， and receiver operating characteristic （ROC） curve analysis was used to evaluate diagnostic value. Among the participants， 45 patients were classified as malnourished based on SGA?B and SGA?C scores， while those with SGA?A constituted the well?nourished control group. Results Among the 76 MHD patients， 59.2% were malnourished. We then compared clinical characteristics across the three groups. The results showed that the malnourished group was older and exhibited significantly higher levels of hs?CRP， PTX3， and hepcidin （P < 0.05）， while serum albumin， creatinine， and phosphorus levels were significantly lower （P < 0.05）. Pearson correlation analysis revealed positive correlations between SGA grades and hs?CRP， PTX3， and hepcidin levels （all P < 0.05）. Logistic regression analysis with “malnutrition” as the dependent variable indicated that elevated hs?CRP， PTX3， and hepcidin levels， along with age and male gender， were associated with increased risk of malnutrition in MHD patients， whereas higher serum phosphorus and creatinine levels were protective factors. Further multivariate logistic regression analysis demonstrated that serum PTX3 level was an independent risk factor for malnutrition （P = 0.032）， while higher creatinine level was an independent protective factor （P = 0.047）. ROC curve analysis showed that the combination of serum PTX3 and creatinine levels had a high diagnostic value for identifying malnutrition in MHD patients， yielding an AUC of 0.789 （P < 0.001）， a Youden index of 0.448， sensitivity of 77.8%， and specificity of 71.0%. Conclusions Elevated levels of PTX3 and hepcidin， along with reduced serum creatinine levels， are associated with an increased risk of malnutrition in patients undergoing MHD. Notably， elevated serum PTX3 and decreased serum creatinine independently predict malnutrition in this population and demonstrate high predictive value.

Objective To investigate the effect of vitamin B12 （VB12） on the expression of zonula occludens?1 （ZO?1） in house dust mite （HDM）?treated human airway epithelial cell line （Beas?2b） and its underlying mechanism. Methods Beas?2b cells were cultured in DMEM high?glucose medium containing 10% fetal bovine serum. The cells were divided into four groups： control， VB12， HDM， and VB12 + HDM. Beas?2b cells were transfected with lentiviruses carrying NC?siRNA， ATG5?siRNA， BECN1?siRNA， and mCherry?EGFP?LC3. After 12 hours of transfection （MOI = 20）， the medium was replaced with fresh medium， and stable transfected cell lines were selected using puromycin （1 μg/mL）. Cells were stimulated with VB12 （20 μg/mL） and HDM （50 μg/mL） for 24 hours. The protein levels of ZO?1， autophagy?related protein 5 （ATG5）， BECN1 and microtubule?associated protein light chain 3 （LC3） were detected by immunofluorescence and Western blot. Autophagy in human airway epithelial cells was observed using confocal microscopy. Results Compared with the control group， the expression of ZO?1 in the HDM group was lower （P < 0.05）， while the expressions of ATG5， BECN1， and LC3 were higher （P < 0.05）. Compared with the HDM group， the VB12 + HDM group showed increased ZO?1 expression （P < 0.05）， decreased expressions of ATG5， BECN1， and LC3 （P < 0.01）， and reduced autophagosome formation （P < 0.05）. In ATG5? and BECN1?knockdown cell lines， ZO?1 expression increased after HDM treatment （P < 0.05）. Conclusion Vb12 can enhance ZO?1 expression in HDM?treated human airway epithelial cells by down?regulating autophagy， and its mechanism is associated with the ATG5 and BECN1 signaling pathways.

Objective To investigate the association between intestinal microbiota dysbiosis and colonic polyps， Helicobacter pylori （Hp） infection， and intestinal metaplasia. Methods A total of 200 patients diagnosed with colonic polyps， Hp infection， or both conditions. These patients were classified into three groups： the colonic polyp group （n = 90）， the Hp infection with intestinal metaplasia group （n = 49）， and the colonic polyp combined with Hp infection and intestinal metaplasia group （n = 61）. Additionally， 62 individuals who underwent routine health examinations at our hospital during the same period were enrolled as a control group. The study compared gut microbiota imbalances across these groups to investigate the association between intestinal dysbiosis and colonic polyps， Hp infection， and the co?occurrence of colonic polyps with Hp?related intestinal metaplasia. Logistic regression analysis was performed to identify risk factors associated with the development of intestinal metaplasia due to Hp infection in patients with colonic polyps. Results Compared to the control group， intestinal flora imbalance was significantly more prevalent in the colorectal polyp group， the Hp infection with intestinal metaplasia group， and the colorectal polyp combined with Hp infection and intestinal metaplasia group （P < 0.05）. Moreover， intestinal flora imbalance in the colorectal polyp with Hp infection and intestinal metaplasia group was significantly higher than that in both the colorectal polyp group and the Hp infection with intestinal metaplasia group （P < 0.05）. Regarding exhaled gas levels， H₂ and CH₄ concentrations were significantly elevated in the groups with colorectal polyps accompanied by Hp infection and intestinal metaplasia， those with colorectal polyps alone， and those with Hp infection and intestinal metaplasia， compared to the control group （P < 0.05）. Similarly， exhaled H₂S levels were significantly higher in the group with colorectal polyps complicated by Hp infection and intestinal metaplasia than in the control group （P < 0.05）. Furthermore， exhaled H₂ and CH₄ levels showed positive correlations with the presence of colorectal polyps， Hp infection with intestinal metaplasia， and colorectal polyps combined with Hp infection and intestinal metaplasia （P < 0.05）. Exhaled H₂S levels were positively correlated with colorectal polyps complicated by Hp infection and intestinal metaplasia （P < 0.05）. Logistic regression analysis indicated that a history of smoking， atrophic gastritis， peptic ulcer， and intestinal flora imbalance are independent risk factors for Hp infection-associated intestinal metaplasia in patients with colorectal polyps （P < 0.05）. Conclusion Intestinal flora imbalance is associated with colorectal polyps and Hp?induced intestinal metaplasia， suggesting that microbial dysbiosis may represent a potential risk factor for the development of these conditions.

Objective To analyze the incidence of cardiovascular events among patients with comorbid chronic obstructive pulmonary disease （COPD） and hypertension （HTN）， as well as to identify the associated influencing factors. Methods A retrospective analysis was conducted on patients diagnosed with primary hypertension （HTN group， n = 64）， chronic obstructive pulmonary disease （COPD group， n = 64）， and concomitant primary hypertension and COPD （combined group， n = 64） at our hospital between December 2021 and January 2025. Cardiovascular event incidence， pulmonary function parameters?including forced vital capacity （FVC）， forced expiratory volume in 1 second （FEV1）， peak expiratory flow （PEF）， and percent predicted FEV1 （FEV1% pred）?and blood pressure levels （systolic blood pressure ［SBP］， diastolic blood pressure ［DBP］） were compared across the three groups. Kaplan?Meier curves were constructed to illustrate and compare the cumulative incidence of cardiovascular events. Covariance analysis was performed to assess the impact of hypertension on pulmonary function， and Cox proportional hazards regression was employed to identify factors associated with cardiovascular outcomes. Results The total incidence rate of cardiovascular events in the HTN group was 14.06%， which was significantly lower than that in the COPD group （29.69%） and the combined HTN?COPD group （48.44%） （P<0.05）. A highly significant difference was observed in the cumulative incidence rates across the three groups （P < 0.05）. Specifically， the COPD group exhibited a higher cumulative incidence than the HTN group （P < 0.05）， while the combined group showed the highest incidence， exceeding both the COPD and HTN groups （P < 0.05）. Pulmonary function parameters?including FVC， FEV1， PEF， and FEV1% pred?were significantly higher in the HTN group compared to both the COPD and combined groups （P < 0.05）. Moreover， these indices were also higher in the COPD group than in the combined group （P < 0.05）. Systolic and diastolic blood pressure （SBP and DBP） levels in the combined group were significantly elevated compared to both the HTN and COPD groups （P < 0.05）， and SBP and DBP in the HTN group were higher than those in the COPD group （P < 0.05）. After adjusting for potential confounders， the intergroup difference in FVC remained statistically significant （P < 0.05）， and the effect of group on FEV1% pred was particularly robust （partial η2 = 0.754， P < 0.05）. Compared with patients without cardiovascular events， those who experienced events differed significantly by disease type （P < 0.05）. The proportions of patients with HTN alone and HTN combined with COPD were higher in the event group than in the non?event group （P < 0.05）. Additionally， FVC and FEV1% pred were lower in the event group， whereas SBP and DBP were higher （all P < 0.05）. Multivariate analysis identified disease type， FEV1% pred， and SBP as independent predictors of cardiovascular events （P < 0.05）. Decision tree analysis further highlighted that the coexistence of HTN and COPD constitutes a critical determinant in cardiovascular risk stratification. Conclusions The incidence of cardiovascular events in patients with COPD combined with HTN was significantly higher than in those with either condition alone. Furthermore， the coexistence of these diseases， along with impaired lung function （as indicated by reduced FEV1% predicted） and increased SBP， were independent risk factors for cardiovascular events.

Objective To investigate the early diagnostic value of combined detection of serum TIR?domain?containing adapter?inducing interferon?β （TRIF）， cyclophilin A （CyPA）， ubiquitin carboxyl?terminal hydrolase L1 （UCH?L1）， and hepcidin （Hepc） in brain injury among premature infants （BIPI）. Methods Clinical data from 105 infants with brain injury following perinatal asphyxia （BIPI） admitted to our hospital between January 2022 and December 2024 were retrospectively collected and assigned to the case group， which was further subdivided into a severe subgroup （n = 31） and a mild subgroup （n = 74） based on the extent of brain injury. As controls， clinical data from 105 healthy preterm infants born in our hospital during the same period were retrospectively enrolled in a 1∶1 ratio. Serum levels of TRIF， CyPA， UCH?L1， and Hepc， along with clinical characteristics， were compared between the groups. Pearson correlation analysis was performed to evaluate the association between serum biomarker levels and neonatal behavioral neurological assessment （NBNA） scores. The diagnostic performance of these biomarkers for early detection of BIPI was assessed by constructing receiver operating characteristic （ROC） curves and calculating the area under the curve （AUC）. Results Serum levels of TRIF， CyPA， UCH?L1， and Hepc were significantly higher in the case group than in the control group （P < 0.05）， while NBNA scores were significantly lower in the case group （P < 0.05）. Similarly， serum levels of these biomarkers were significantly elevated in the severe group compared to the mild group （P < 0.05）， accompanied by significantly lower NBNA scores in the severe group （P < 0.05）. Pearson correlation analysis revealed that serum levels of TRIF， CyPA， UCH?L1， and Hepc were negatively correlated with NBNA scores （r = -0.579， -0.514， -0.609， -0.588； all P < 0.05）. ROC analysis demonstrated that the combined detection of these four markers yielded an AUC of 0.927 for early diagnosis of BIPI， which was significantly higher than the AUCs of individual markers （0.819， 0.803， 0.776， and 0.767， respectively； P < 0.05）. Conclusions The serum levels of TRIF， CyPA， UCH?L1， and Hepc in children with BIPI were significantly elevated. These biomarkers were closely associated with disease progression and neurological development， and their combined measurement demonstrated superior performance in the early diagnosis of BIPI.

Objective To investigate the association between novel evaluation indicators of IR and LEAD in patients with T2DM. Methods A total of 1，164 T2DM patients hospitalized in the Department of Endocrinology and Metabolism of Heze Mudan People's Hospital from January 2022 to April 2025 were enrolled. They were divided into the non-LEAD group （694 cases） and the LEAD group （470 cases） according to the presence of LEAD. General data and biochemical indicators were collected， and the triglyceride-glucose index （TyG）， triglyceride-glucose-body mass index （TyG-BMI）， estimated glucose disposal rate （eGDR）， triglyceride-to-high-density lipoprotein cholesterol ratio （TG/HDL-C）， and Metabolic Syndrome Insulin Resistance index （METS-IR） were calculated. Logistic regression analysis was performed to analyze the influencing factors for the development of LEAD in T2DM patients， as well as the correlation between novel IR assessment indices grouped by different quartiles and the risk of LEAD onset. Receiver operating characteristic （ROC） curve analysis was performed to evaluate the predictive value of these indicators for LEAD. Results Compared with non-LEAD group， the LEAD group had significantly higher TyG， TyG-BMI， TG/HDL-C， and METS-IR， but lower eGDR （all P < 0.05）. Logistic regression analysis showed that TyG， TyG-BMI， and METS-IR were identified as risk factors for the development of LEAD in patients with T2DM， while eGDR was a protective factor against it. After adjusting for confounders， compared with the Q1 group， the Q4 groups of TyG （OR = 3.647， 95%CI： 1.082 ~ 7.972， P < 0.001）， TyG-BMI （OR = 3.027， 95%CI： 1.275 ~ 9.753， P < 0.001）， and METS-IR （OR = 4.032， 95%CI： 1.242 ~ 12.385， P < 0.001） had a significantly increased LEAD risk， while the Q4 group of eGDR had a significantly decreased risk （OR = 0.225， 95%CI： 0.118 ~ 0.429， P < 0.001）. ROC curve analysis showed that METS-IR， TyG， TyG-BMI， and eGDR all exhibit predictive value for LEAD， with areas under the curve being 0.823， 0.758， 0.773， and 0.737， respectively. Subgroup analysis indicated that METS-IR was more strongly correlated with LEAD in subgroups of age ≥ 60 years， disease duration ≥ 5 years， HbA?C ≥ 7.0%， smoking history， and hypertension. Conclusion Elevated levels of TyG， TyG-BMI， and METS-IR， along with decreased levels of eGDR， are associated with an increased risk of LEAD onset in patients with T2DM. METS-IR exhibits high predictive efficacy for the development of LEAD in T2DM patients and may serve as a tool for its screening and risk assessment.

Objective To identify risk factors associated with lymphatic leakage after laparoscopic radical prostatectomy （LRP） and to develop a machine learning?based nomogram for predicting such outcomes to support clinical prevention strategies. Methods We retrospectively analyzed perioperative data from 248 patients who underwent radical prostatectomy for prostate cancer between January 2020 and January 2024. Independent risk factors were identified through univariate and multivariate logistic regression analyses. A predictive model was developed， and its diagnostic performance was assessed by the area under the receiver operating characteristic curve （AUC）. Five?fold cross?validation was performed to evaluate the model′s generalizability. A nomogram was subsequently constructed to facilitate individualized risk quantification. Results Among the 248 patients， 89 （35.9%） developed lymphatic leakage， while 159 （64.1%） did not. Independent risk factors for lymphatic leakage included intraoperative lymph node dissection （OR = 5.415， 95%CI： 2.167 ~ 13.532， P < 0.001）， intraoperative plasma transfusion （OR = 2.952， 95%CI： 1.524 ~ 5.718， P = 0.001）， and postoperative fasting duration of ≥ 2 days （OR = 1.412， 95%CI： 1.089 ~ 1.829， P = 0.009）. The predictive model showed good discrimination and calibration （AUC = 0.711， 95%CI： 0.647 ~ 0.776， P < 0.001； sensitivity： 0.764； specificity： 0.597）. Model robustness was confirmed through five?fold cross?validation （training set AUC = 0.822； test set AUC = 0.829）. The nomogram provided a clinically useful tool for quantifying individual risk of lymphatic leakage. Conclusions Intraoperative lymph node dissection， plasma transfusion， and postoperative fasting lasting ≥ 2 days are independent risk factors for lymphatic leakage following radical prostatectomy. The validated predictive model demonstrates favorable clinical utility.

Objective To investigate the effects of goal-directed fluid therapy （GDFT） combined with ultrasound-guided erector spinae plane block （ESPB） on perioperative stress response and postoperative recovery in patients undergoing robot-assisted pedicle screw fixation surgery. Methods Eighty patients scheduled for elective surgery were randomly divided into two groups： control （general anesthesia + conventional fluid management， n = 40） and intervention （general anesthesia + GDFT + ESPB， n = 40）. Heart rate （HR）， mean arterial pressure （MAP）， serum cortisol （Cor）， norepinephrine （NE）， blood glucose （GLU） levels， and resting VAS scores were measured and compared between the two groups preoperatively （T?）， at screw placement （T?）， at end of surgery （T?）， 30 minutes after extubation （T?）， at 24 hours （T?）， and 48 hours （T?） postoperatively. Intraoperative fluid volume， remifentanil consumption， postoperative rescue analgesia frequency， time to first ambulation， length of stay， and complications （agitation， nausea and vomiting， respiratory depression） were recorded. Results There were no differences in baseline （T?） indicators between the two groups （P > 0.05）. The intervention group exhibited significantly lower levels of HR， MAP， Cor， NE， and GLU at T?， T?， and T? compared with the control group （P < 0.05）， with Cor， NE， and GLU reduced by > 30% at T? （P < 0.05）. Intraoperative fluid volume and remifentanil dosage were significantly reduced （both P < 0.05）. VAS scores and the number of rescue analgesia requests were lower at T?， T?， and T? （P < 0.01）. Time to first ambulation time and postoperative hospital stay were shortened （both P < 0.01）. The incidence of agitation， nausea/vomiting and overall complications was lower in the intervention group （P < 0.05）， whereas respiratory depression rates did not differ （P > 0.05）. Conclusion GDFT plus ESPB can effectively suppress perioperative stress response in robot-assisted spinal surgery， significantly reduce intraoperative opioid dosage and fluid volume， optimize postoperative analgesia， enhance recovery， and lower complication risk. This combination provides an effective ERAS strategy for improving surgical safety and recovery quality.

Objective To investigate the relationship between serum melatonin and prostaglandin E₂ （PGE2） levels with disease severity and prognosis of necrotizing enterocolitis （NEC） in premature infants. Methods A total of 215 premature infants diagnosed with NEC （NEC group） admitted to our hospital between January 2022 and February 2025 and 80 healthy premature infants （control group） were prospectively enrolled. NEC cases were stratified by Bell′s staging divided into mild （n = 67）， moderate （n = 90）， and severe （n = 58） subgroups. Serum levels of melatonin and PGE2 were measured by enzyme-linked immunosorbent assay. Spearman correlation analysis was used to assess the relationship between serum melatonin， PGE2 levels and Bell staging. According to the 28-day prognosis assessment， NEC infants were divided into a poor prognosis group and a good prognosis group. Multivariate logistic regression and ROC analysis were used to explore the association and predictive value of serum melatonin and PGE2 levels in NEC prognosis， and decision curve analysis （DCA） was used to evaluate clinical net benefit. Results Compared with the control group， the NEC group had significantly lower serum melatonin levels and higher PGE2 levels （P < 0.05）. Among the NEC subgroups， serum melatonin levels decreased and PGE2 levels increased progressively from mild to severe NEC （P < 0.05）. Serum melatonin was negatively correlated with Bell stage， while PGE2 was positively correlated （P < 0.05）. The 28-day poor prognosis rate in NEC infants was 18.60% （40/215）. Severe disease and elevated PGE2 were independent risk factors for poor prognosis， while higher birth weight and increased melatonin were independent protective factors （P < 0.05）. The area under the ROC curve （AUC） for predicting prognosis using melatonin， PGE2， and their combination was 0.797， 0.780， and 0.880， respectively， with the combined prediction performing significantly better than either biomarker alone （P < 0.05）. DCA indicated that when the threshold probability exceeded 0.1， the net benefit of the combined model was greater than that of either marker alone. Conclusion In premature infants with NEC， reduced serum melatonin and elevated PGE2 levels are associated with increased disease severity and poor prognosis. The combination of serum melatonin and PGE2 levels provides high predictive value for prognosis.

Objective To investigate the effects of different hemodiafiltration （HDF） frequencies combined with high-flux hemodialysis （HFHD） on renal function， micro-inflammatory status， and left ventricular function in patients with diabetic nephropathy who have undergone maintenance hemodialysis （MHD）. Methods A total of 120 patients with diabetic nephropathy undergoing MHD between January 2022 and December 2024 were enrolled in the study and randomly divided into a study group and a control group using a random number table method， with 60 patients in each group. Both groups received HFHD. The control group received hemodiafiltration （HDF） once a month， whereas the study group received HDF once a week. The study evaluated the two groups in terms of therapeutic efficacy， renal function indices， calcium-phosphorus metabolism indices， micro-inflammatory status， left ventricular function indices， and the incidence of adverse reactions. Results The total response rate in the study group was significantly higher than that in the control group （P < 0.05）. Following treatment， the levels of serum creatinine （Scr）， cystatin C （Cys C）， and 24-hour urine protein quantification （24hUP） in the study group were significantly lower than those in the control group （P < 0.05）. After treatment， the blood calcium level in the study group was higher， whereas the blood phosphorus level was lower compared to the control group （P < 0.05）. Additionally， post-treatment levels of interleukin-8 （IL-8）， IL-6， and tumor necrosis factor-α （TNF-α） in the study group were significantly reduced in comparison to the control group （P < 0.05）. The study group also exhibited improved cardiac function after treatment， as evidenced by a higher left ventricular ejection fraction （LVEF）， and reduced left ventricular end-diastolic diameter （LVDD） and left ventricular end-systolic diameter （LVSD） compared to the control group （P < 0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups ［8.33% （5/60） vs. 11.67% （7/60）， P > 0.05］. Conclusion Combining once-weekly HDF with HFHD can enhance therapeutic outcomes and renal function， promote the recovery of calcium-phosphorus metabolism， alleviate the micro-inflammatory state， and improve left ventricular function in MHD patients with diabetic nephropathy.

Objective To investigate the effects of different administration times on the efficacy and safety of subcutaneous immunotherapy using dual mite extracts in patients with allergic rhinitis （AR）. Methods This study was designed as a retrospective cohort analysis. Thirty-nine mite-sensitized AR patients who completed three years of standardized dual-mite subcutaneous immunotherapy （SCIT） were included. Based on self-selected and consistently maintained injection schedules， patients were non-randomly assigned to either a morning dosing group （MD group， 8：00—12：00， n = 19） or an afternoon dosing group （AD group， 14：00—18：00， n = 20）， with further subgroup stratification conducted at 2-hour intervals. Nasal and ocular symptoms were evaluated before and after treatment using the visual analog scale （VAS）， and all adverse reactions were systematically recorded. Results The AD group exhibited significantly greater improvement in nasal itching compared to the MD group （median difference： -2 vs. 0， U = 118.5， P = 0.04， effect size r = 0.33）. The AD group also demonstrated favorable trends toward improved sneezing， nasal congestion， rhinorrhea， and total VAS score， although these differences did not reach statistical significance. In the subgroup analysis by 2-hour intervals， the 16：00—18：00 subgroup showed greater symptom relief than the 8：00—10：00 subgroup， though the difference was not statistically significant. No significant differences were observed between the two groups in the incidence of total， local， or systemic adverse reactions （P > 0.05）， and no moderate or severe systemic adverse events occurred. Conclusions This preliminary retrospective analysis indicates that afternoon administration of dual-mite SCIT， particularly between 16：00 and 18：00， may enhance the improvement of nasal symptoms without elevating safety concerns. The timing of SCIT administration could therefore represent a promising avenue for treatment optimization.

Objective To explore the impact of the number of negative lymph node resections on the overall survival and recurrence rate of patients with ovarian cancer. Methods A retrospective selection was made of 150 ovarian cancer patients admitted to our hospital from October 2021 to October 2023 as the research subjects. According to the standard of the number of negative lymph nodes removed， they were divided into three groups： T1 group （≤ 17）， T2 group （18 ~ 27）， and T3 group （≥ 28）. Clinical characteristics and surgical indicators were collected， and the recurrence and survival situations were analyzed. Results The clinical characteristic analysis results showed that there were no statistically significant differences among the three groups in terms of age， menopausal status， BMI， CCI， family history of tumors， etc. （P > 0.05）. There were no significant differences in surgical methods， residual lesion size， postoperative complications among the three groups （P > 0.05）. In terms of operation time， T1 group < T2 group < T3 group （P < 0.05）， and the bleeding volume in T3 group was more than that in T1 group （P < 0.05）. There was no significant difference in the overall recurrence rate among the three groups （P > 0.05）， but with the increase in the number of lymph node resections （from T1 group to T3 group）， the recurrence rate showed a statistically significant downward trend （P < 0.05）. Cox regression analysis showed that the univariate analysis indicated that for each additional negative lymph node， the risk of death decreased by 4.7% （HR = 0.953， P < 0.05）； the multivariate analysis （after adjusting for confounding factors） showed that the risk decreased by 5.8% （HR = 0.942， P < 0.05）. Restricted cubic spline （RCS） analysis confirmed a significant linear association between the two （P < 0.05）. With 5 lymph nodes as the reference， the risk ratios for 10， 20， and 30 resections were 1.003， 0.760， and 0.317， respectively， and the trend showed that the risk of death continued to decrease as the number of lymph nodes increased. Multivariate Cox analysis showed that the risk of death in T3 group was 68% lower than that in T1 group （P < 0.05）， the risk in FIGO stage Ⅲ was 3.11 times higher （P < 0.05）， and the risk in high-grade tumors was 2.80 times higher （P < 0.05）. Conclusions The number of negative lymph nodes removed in patients with ovarian cancer is linearly correlated with prognosis. The more lymph nodes removed， the lower the risk of death for the patients. Adequate lymph node removal should be an important part of the surgical treatment for ovarian cancer.

Objective To explore and analyze the clinical application effect of thymosin α1 combined with folfox regimen in the adjuvant treatment of patients after transabdominal radical resection of rectal cancer （RC）. Methods A total of 102 patients with RC in the hospital were included from January 2020 to January 2024， and were randomly and evenly classified into two groups by adopting random number table method. The conventional group received folfox regimen after radical resection， whereas the study group was added with thymosin α1. The levels of tumor-related factors， changes of immune function indicators， treatment safety， recurrence and metastasis， and tumor-related mortality were observed in the two groups after treatment. Results Compared with before treatment， the levels of carcinoembryonic antigen （CEA）， hypoxia-inducible factor-1α （HIF-1α）， matrix metalloproteinase-9 （MMP-9） and vascular endothelial growth factor （VEGF） in the two groups were significantly decreased， and the levels in the study group were significantly lower than those in the conventional group （P < 0.05）. After Bonferroni correction， CEA and MMP-9 were statistically different between groups （P < 0.010）. The CD83⁺， CD4⁺/CD8⁺ and NK cell activity were significantly enhanced in the two groups compared to before treatment， and the above indicators were significantly higher in the study group （P < 0.05）. After Bonferroni correction， there were statistical differences in CD83⁺， CD4⁺/CD8⁺ and NK cell activity between groups （P<0.010）. In terms of treatment safety， the total incidence rate of toxic and side effects in the study group was 23.53%， which was significantly lower than 43.14% in the conventional group （P < 0.05）. Logistic regression （stepwise forward method） analysis showed that nerve invasion， vascular tumor thrombus and folfox regimen were risk factors of tumor recurrence and metastasis （P < 0.05）. Kaplan-Meier curve revealed that patients in the study group showed a trend of survival benefit. However， Log-rank test suggested that the difference between the two groups did not reach statistical significance （P > 0.05）. COX regression analysis indicated that vascular tumor thrombus was a risk factor of tumor-related death （P < 0.05）. Conclusion The adjuvant therapy with thymosin α1 combined with folfox regimen after transabdominal radical resection of RC can effectively activate the functions of dendritic cell， NK cell and T cell， increase the killing effect of tumor cell， reduce the loads of tumor-related factors， and thus help to reduce the recurrence and metastasis rate.

Objective To explore the diagnostic value of deep learning image reconstruction （DLIR） combined with low?dose chest computed tomography （CT） with axial scan in the diagnosis of mycoplasma pneumoniae pneumonia （MPP） in children， and to provide reference for clinical practice. Methods 160 cases MPP children from February 2024 to June 2025 were selected as study subjects， and low?dose chest CT with axial scan was performed on all patients. DLIR and conventional adaptive iterative reconstruction?V （ASIR?V） were used for image reconstruction. The objective image quality ［background noise （SD）， signal?to?noise ratio （SNR）， and contrast?to?noise ratio （CNR）］， subjective image quality， and CT sign detection rate were compared， and the consistency of DLIR and ASIR?V in the diagnosis of MPP severity and clinical diagnosis was compared. Results As the intensity of DLIR and the weight of ASIR increasd， SD gradually decreased， while SNR and CNR gradually increased. The high?strength DLIR （DLIR?H） SD was lower than that of ASIR with a blending level of 80% （ASIR?V80%）. The SNR and CNR were higher than those of ASIR?V80%， showing statistical significance （P < 0.05）. Ridit test showed that DLIR?H had the best subjective image quality score under different DLIR intensities， and ASIR?V80% had the best subjective image quality score under different ASIR weights. Furthermore， the subjective image quality score of DLIR?H was higher that of ASIR?V80%， and the differences were statistically significant （P < 0.05）. Using DLIR?H， the detection rates of air bronchogram， pulmonary consolidation， and interstitial infiltration （69.38%， 86.88%， 20.63%， respectively） were higher than those using ASIR?V80% （50.00%， 71.88%， 7.50%， respectively）， and the differences were statistically significant （P < 0.05）. Consistency analysis showed that the Kappa value between the diagnostic results of MPP severity using DLIR?H and clinical diagnosis was 0.856 （95%CI： 0.771 ~ 0.996）， while that between the diagnostic results of MPP severity using ASIR?V80% and clinical diagnosis was 0.498（95%CI： 0.346 ~ 0.650）. ROC analysis showed that the area under the curve （AUC） for diagnosing MPP severity was 0.925 （95%CI： 0.872 ~ 0.960） for DLIR?H and 0.729 （95%CI： 0.653 ~ 0.796） for ASIR?V80%， and the diagnostic value of DLIR?H was superior to that of ASIR?V80% （Z = 3.952， P < 0.001）. Conclusion DLIR can effectively improve image quality. DLIR?H combined with low?dose chest CT with axial scan has high diagnostic value for the severity of MPP， and can serve as a feasible solution for clinical diagnosis of MPP severity and reducing radiation dose.

Objective To investigate the expression of HBV RNA in hepatitis B virus?associated hepatocellular carcinoma （HBV?HCC）. Methods A total of 259 patients with chronic hepatitis B （CHB） and 41 HBV?HCC patients treated in the outpatient or inpatient department of the Affiliated Hospital of Zunyi Medical University from December 2023 to January 2025 were enrolled as subjects. The differences in age， sex， and levels of HBV RNA， HBV DNA， ALT， AST， and TBIL between the two groups were compared. Differences in viral load between HBV RNA and HBV DNA within each group were compared. Correlations between HBV RNA and HBV DNA， ALT， AST， and TBIL within each group were analyzed. Diagnostic efficacy of HBV RNA for HBV?HCC was determined using receiver operating characteristic （ROC） curve analysis. Results The HBV?HCC group had significantly higher HBV RNA load， HBV RNA positivity rate， ALT， AST and TBIL levels and proportion of male patients and older age compared to the CHB group （P < 0.05）. Scatter plot analysis revealed a higher HBV DNA load compared to the HBV RNA load in the CHB group （P < 0.000 1）. Correlation analysis showed that HBV RNA was positively correlated with HBV DNA in both groups （P < 0.05）. In the CHB group， HBV RNA was positively correlated with ALT， AST and TBIL （P < 0.001）. The ROC curve showed that the area under the curve （AUC） for HBV RNA was 0.6923 （P < 0.000 1）， with an optimal cut?off value of ≥ 2.5 log₁₀ copies/mL for diagnosing HBV?HCC. Conclusion Serum HBV RNA levels demonstrate high sensitivity and specificity for identifying HBV?HCC and can serve as a reliable indicator for predicting the occurrence of HBV?HCC.

Objective To investigate the value of conventional radiological features and CT radiomics features to differentiate parotid adenolymphoma from malignant tumor. Methods Radiological data from 128 patients with adenolymphoma and 39 patients with parotid malignancy were collected between December 2018 and October 2023. Radiomics features were extracted to obtain Rad?score and construct a radiomics model. Conventional radiological features were analyzed to obtain independent predictors， and a conventional radiological model was constructed. Model performance was compared by the DeLong test， and the Rad?score was combined with radiological features to establish a comprehensive model and plot a nomogram. Results Based on CT venous phase images， 9 optimal radiomic features were selected. Conventional radiological features were analyzed by univariate and multivariate logistic regression analysis and found that shape and degree of enhancement were independent predictors of adenolymphoma and malignant parotid tumors. The CT radiomics model is superior to the conventional radiological model（P < 0.05）. The area under the curve （AUC） of the radiomics model was 0.938 （95% CI： 0.887 ~ 0.988）， and the specificity and sensitivity were 0.856 and 0.923， respectively. Conventional radiological features and Rad?score were analyzed by univariate and multivariate logistic regression analysis and found that Rad?score and degree of enhancement were independent predictors of adenolymphoma and malignant parotid tumors. The difference between the diagnostic efficacy of the comprehensive model created by the Rad?score combined with the degree of enhancement and the diagnostic efficacy of the radiomics model was not statistically significant （P > 0.05）. Conclusion The CT radiomics model performed better than the conventional radiological model in discriminating parotid gland adenolymphoma from malignant tumors. The diagnostic performance of the comprehensive model has improved， aiding in clinical decision?making.

Objective To evaluate the diagnostic value of dual?layer spectral CT （DLCT） virtual non?contrast （VNC） imaging combined with iodine maps in differentiating early post?endovascular therapy （EVT） intracranial hemorrhage from contrast extravasation. Methods Retrospective analysis of 97 patients who underwent DLCT immediately after EVT was conducted. Taking 24?hour follow?up CT/MRI as the gold standard， patients were divided into hemorrhage and non?hemorrhage groups， and their clinical data were compared. VNC CT values and iodine concentration （IC） were measured. Spearman's rank correlation was used to analyze the relationship between VNC CT and IC values， and ROC curve analysis using R software to evaluate the diagnostic performance of VNC， iodine maps， and their combination. Results Among 97 patients， 51 （52.6%） showed no intracranial hyperdense lesions， while 46 （47.4%） with abnormal densities were analyzed. Using 24?hour postoperative CT/MRI as reference standard， among the 46 patients ultimately included in the analysis， 38 cases （82.6%） were non?hemorrhagic and 8 cases （17.4%） hemorrhagic. No significant differences existed in age， sex， or treatment methods （all P > 0.05）. VNC CT values and IC showed significantly negative correlation （r = -0.537， P < 0.01）. ROC analysis revealed AUCs of 0.917 （95%CI： 0.786 ~ 0.999） for VNC， 0.878 （95%CI： 0.719 ~ 0.999） for IC， and 0.919 （95%CI： 0.812 ~ 0.999） for the combination of the two （P < 0.05 for combined vs. individual methods）. Optimal thresholds were 53.6 HU for VNC and 0.605 mg/ml for IC. Based on the final analysis of 46 enrolled patients， the sensitivity of VNC， iodine map， and their combination in differentiating early cerebral hemorrhage from contrast extravasation was 88.9%， 94.3%， and 91.4%， respectively； the specificity 94.3%， 77.8%， and 88.9%， respectively； and the accuracy 90.9%， 90.9%， and 93.2%， respectively. Conclusion The DLCT VNC?iodine map combination significantly improves differentiation between post?EVT hemorrhage and contrast extravasation， and it is recommended for routine clinical application.

Objective Using the theory of the “lung?intestinal axis” to analyze the therapeutic efficacy of acupuncture combined with modified Ginseng?Ling?Bai?Zhu?San in patients with ulcerative colitis and its effects on intestinal flora balance. Methods One hundred and fifty patients with ulcerative colitis who received treatment at our hospital between October 2022 and December 2024 were enrolled in this study. These patients were randomly assigned to either the combination group or the control group， with 75 patients in each group. The control group was treated with modified Shenling Baizhu San， while the combination group received acupuncture in addition to the same herbal formula. After four treatment cycles， changes in TCM symptom scores， intestinal mucosal barrier function， immune microenvironment， gut microbiota balance， and overall clinical efficacy were evaluated and compared between the two groups. Results Compared with the control group， the combination group showed significant improvements after treatment： TCM syndrome scores， IBDQ， DAI， Baron score， DAO， PCT， ET， IL?23， IL?6， IL?1β， CD8⁺， Enterobacteriaceae， Escherichia coli， Bifidobacterium bifidum， Th17/Treg ratio， and incidence of adverse reactions were significantly reduced； meanwhile， levels of Hb， ALB， PAB， TGF?β1， CD4⁺， CD4⁺/CD8⁺ ratio， and Lactobacillus， as well as clinical efficacy， were markedly increased. All differences were statistically significant （P < 0.05）. Conclusion Effective and safe treatment of ulcerative colitis can be achieved through the combination of acupuncture and a modified formula of Ginseng?Ling?Bai?Juju?San， which may improve intestinal mucosal lesions， reduce inflammation， and stabilize the balance of intestinal flora by modulating the endocrine network of the “lung?intestinal axis”.

Mesenchymal stem cells （MSCs） are multipotent stromal cells that possess the capacity for self-renewal and differentiation into multiple cell lineages. Due to the ease of procurement， robust expansion in vitro， the multipotency， they are recognized as a vital source of stem cells in the field of regenerative medicine. MSCs can be isolated from various tissues， including bone marrow， adipose tissue， and umbilical cord. Research indicates that Human umbilical cord mesenchymal stem cells （hUCMSCs） play an effective role in wound healing and tissue regeneration， and can be utilized for the repair of skin wounds. They are also considered to be the most promising seed cells for skin tissue engineering. This review aims to provide an overview of the biological characteristics of hUCMSCs， the mechanisms in promoting skin wound healing， and their clinical applications.