Objective To reveal the effect of periplocymarin (PPM) on the proliferation and invasion of human pancreatic cancer cell lines, and to analyze whether it exerts anti-cancer effects by regulating signal transducer and activator of transcription 3 (STAT3). Methods (1) In vitro experiments: SW1990 cells were divided into the control group, the 0.05 PPM group, the 0.1 PPM group and the 0.2 PPM group (cultured with 0.05, 0.1 and 0.2 μmol/L PPM for 48 h, respectively), the control lentivirus (NC-oe)+0.2 PPM group (NC-oe+0.2 PPM) and the STAT3 overexpression lentivirus (STAT3-oe)+0.2 PPM group (STAT3-oe+0.2 PPM). The control group was cultured with DMEM medium for 48 h. The NC-oe+0.2 PPM group and the STAT3-oe+0.2 PPM group were first transfected with NC-oe and STAT3-oe into SW1990 cells using Lipofectamine 3000, and then the cells were cultured with 0.2 μmol/L PPM for 48 h. Cell viability was detected by MTT, cell proliferation was detected by EdU staining, cell apoptosis was detected by TUNEL, and cell invasion was detected by Transwell assay. (2) In vivo experiments: Nude mice were randomly divided into the model group, the low (L-PPM) group, the high-dose PPM group (H-PPM), the NC-oe+H-PPM group and the STAT3-oe+H-PPM group, with 6 mice in each group. The model group, the L-PPM group and the H-PPM group were subcutaneously injected with normal SW1990 cells. The NC-oe+H-PPM group and the STAT3-oe+H-PPM group were subcutaneously injected with SW1990 cells transfected with NC-oe and STAT3-oe lentivirus, respectively. After 10 days of inoculation, the model group was intraperitoneally injected with normal saline at a dose of 0.1 mL/10 g, the L-PPM and H-PPM groups were intraperitoneally injected with 1.0 and 3.0 mg/(kg·d) PPM solution, respectively. And the NC-oe+H-PPM group and the STAT3-oe+H-PPM group were intraperitoneally injected with 3.0 mg/(kg·d) PPM solution. The administration cycle was 28 days. The morphology of tumor tissue was observed by HE staining. The expressions of p-STAT3, Ki-67 and Bcl-2 in tumor tissue were detected by immunohistochemistry, and the levels of STAT3 mRNA in cells and tumor tissue were detected by qRT-PCR. The protein expression of p-STAT3 (Tyr705), STAT3, Bcl-2, Bax, matrix metalloproteinase (MMP)-2 and MMP-9 in SW1990 cells and tumor tissue were detected by Western blot assay. Results (1) In vitro experiments: compared with the control group, the levels of STAT3 mRNA and p-STAT3 (Tyr705) protein were all decreased in SW1990 cells in the 0.05, 0.1 and 0.2 PPM groups (P<0.05). Relative cell viability, EdU positive rate, the number of invasion cells and the protein levels of Bcl-2, MMP-2 and MMP-9 decreased (P<0.05), while the positive rate of TUNEL and the protein level of Bax both increased (P<0.05). Compared with the NC-oe+0.2 PPM group, the levels of STAT3 mRNA and p-STAT3 (Tyr705) protein in SW1990 cells were increased in the STAT3-oe+0.2 PPM group (P<0.05). Relative cell viability, EdU positive rate, the number of invasion cells and the protein levels of Bcl-2, MMP-2 and MMP-9 increased (P<0.05), while the positive rate of TUNEL and the protein level of Bax both decreased (P<0.05). (2) In vivo experiments: compared with the model group, the tumor volume, STAT3 mRNA level, p-STAT3 (Tyr705) protein level and the positive rates of p-STAT3, Ki-67 and Bcl-2 in nude mice of the L-PPM group and the H-PPM group were all decreased (P<0.05). Compared with the NC-oe+H-PPM group, the tumor volume, STAT3 mRNA level, p-STAT3 (Tyr705) protein level and the positive rates of p-STAT3, Ki-67 and Bcl-2 in nude mice of the STAT3-oe+H-PPM group were all increased (P<0.05). Conclusion PPM has anti-pancreatic cancer activity, which inhibits the proliferation and invasion of pancreatic cancer cells by regulating STAT3.

Objective To investigate the regulatory effect of tripterine on hepatocellular carcinoma (HCC) cells under oxidative stress and senescence conditions. Methods The Huh-7 human HCC cell line was routinely cultured in vitro. The cells were treated with different concentrations (0, 0.25, 0.5, 1, 2 and 4 μmol/L) of tripterine. The highest drug concentration that did not affect cell viability was determined by CCK-8 cell viability assay. The experiment was divided into four groups: the control group, the H₂O₂ group, the H₂O₂ + DMSO group and the H₂O₂ + tripterine group. The degree of cell senescence was assessed by β-galactosidase staining. The intracellular reactive oxygen species (ROS) level was detected by the DCFH-DA fluorescence probe method. The intracellular ATP level was detected by the luciferase catalysis method. The superoxide level in mitochondria was detected by the MitoSO Red fluorescence probe method. The mitochondrial membrane potential level was assessed by the JC-1 fluorescence probe method. Results The highest drug concentration of tripterine that did not affect the viability of the HCC cell line Huh-7 was 0.5 μmol/L, and this optimal drug concentration was used for the subsequent experiments. Compared with the control group, the cell senescence was enhanced in the H₂O₂ group, intracellular reactive oxygen species (ROS) level was increased, ATP level decreased, mitochondrial superoxide level increased and mitochondrial membrane potential level decreased (all P<0.05). Compared with the H₂O₂ + DMSO group, the H₂O₂ + tripterine group showed alleviated cell senescence, decreased intracellular ROS level, increased ATP level, decreased mitochondrial superoxide level and elevated mitochondrial membrane potential level (all P<0.05). Conclusion Tripterine can alleviate oxidative stress and subsequent senescence and mitigate mitochondrial damage in HCC cells.

Objective To discuss the effects of glutamine fructose-6-phosphate transaminase 1 (GFPT1) on the proliferation, apoptosis and immune escape of non-small cell lung cancer cells by adjusting the programmed cell death ligand 1 (PD-L1) pathway. Methods Cancer and adjacent tissue samples of 80 patients with non-small cell lung cancer who underwent surgical treatment were collected, and the expression of GFPT1 was detected by immunohistochemistry. Human non-small cell lung cancer cell line A549 was cultured and divided into the CK group, the sh-NC group, the sh-GFPT1 group, the sh-GFPT1+oe-NC group and the sh-GFPT1+oe-PD-L1 group. EdU staining was performed to detect cell proliferation. Cell apoptosis was measured by flow cytometry. Protein expression levels were measured by Western blot assay. Primary human CD8?T cells were isolated and purified from peripheral blood of healthy volunteers and co-cultured with A549 cells from each group for 48 h. The co-culture supernatant was collected, and CD8?T cells were purified and recovered via Ficoll density-gradient centrifugation. Trypan blue staining was used to detect the survival rate of the recovered CD8? T cells from co-culture. Enzyme-linked immunosorbent assay was performed to measure the levels of transforming growth factor-β (TGF-β), interleukin-10 (IL-10), interferon-γ (IFN-γ) and PD-L1 in the co-culture medium. Results The positive rate of GFPT1 was higher in cancer tissue than that in adjacent non-cancerous tissue, and the positive rate of GFPT1 was also higher in cancer tissue from stage Ⅲ—Ⅳ patients compared to those of stage Ⅰ—Ⅱ patients (P<0.01). The positive rate of EdU, the expressions of proliferating cell nuclear antigen (PCNA), Ki-67 proliferation antigen (Ki-67), B-cell lymphoma 2 (Bcl-2) and PD-L1 were lower in the sh-GFPT1 group than those in the CK group and the sh-NC group, while the apoptosis rate and the expression of Bcl-2-associated X protein (Bax) were higher (P < 0.05). The above indicators showed the opposite changes in the sh-GFPT1+oe-PD-L1 group compared with the sh-GFPT1 group and the sh-GFPT1+oe-NC group. After co-culture with CD8⁺T cells, the survival rate of CD8?T cells and IFN-γ level were higher in the sh-GFPT1 group than those in the CK group and the sh-NC group, while the levels of TGF-β, IL-10 and PD-L1 were lower (P<0.05). The survival rate of CD8?T cells and IFN-γ level were lower in the sh-GFPT1+oe-PD-L1 group than those in the sh-GFPT1 group and the sh-GFPT1+oe-NC group, while the levels of TGF-β, IL-10 and PD-L1 were higher (P < 0.05). Conclusion GFPT1 is highly expressed in non-small cell lung cancer tissue. Silencing the expression of GFPT1 can inhibit PD-L1 expression, thereby inhibiting the proliferation and immune escape of non-small cell lung cancer cells and promoting their apoptosis.

Objective To evaluate the effects of tanshinone ⅡA (Tan-ⅡA) on glymphatic system function in Alzheimer's disease (AD) rats using multimodal MRI techniques. Methods Twelve male SD rats were randomly divided into the control group (healthy controls), the AD model group, the AD+Tan-ⅡA group and the AD+Tgn-073 group, with 3 rats in each group. Except for the control group, all remaining three groups underwent stereotaxic injection of Aβ1-40 to establish the AD model. Following modeling, the AD+Tan-ⅡA group and the AD+Tgn-073 group received four weeks of intervention with Tan-ⅡA and the AQP4 agonist Tgn-073, respectively. Multi-b-value diffusion-weighted imaging (DWI) was used to analyze water molecule diffusion characteristics in rat brain tissue, with calculation of the apparent diffusion coefficient (ADC), distributed diffusion coefficient (DDC) and heterogeneity index α. Dynamic contrast-enhanced MRI (DCE-MRI) and immunofluorescence were employed to assess signal intensity changes and aquaporin-4 (AQP4) expression in the hippocampal, striatal and cortical regions. Results Compared with the control group, the ADC, DDC and heterogeneity index α values were significantly decreased in the AD group (all P<0.01). Compared with the AD group, there were no statistically significant differences in ADC, DDC or α values in the AD+Tan-ⅡA group after drug intervention. In contrast, all three parameters were elevated in the AD+Tgn-073 group (P<0.05). DCE-MRI revealed that in the hippocampal and cortical regions, the signal intensity ratio was higher in the AD+Tgn-073 group than that of the AD group in the early post-contrast phase (40 or 60 min, P<0.05), whereas the AD+Tan-ⅡA group showed elevated signal intensity in the cortical region during the mid-to-late phase (100, 120, and 150 min, P<0.05). Immunofluorescence demonstrated that compared with the control group, AQP4 expression was elevated exclusively in the hippocampus of AD rats. Compared with the AD group, AQP4 expression was downregulated in both hippocampal and striatal regions of the AD+Tgn-073 group and the AD+Tan-ⅡA group. Conclusion Tan-ⅡA can improve glymphatic transport function in brain of AD rats, and the underlying mechanism may involve pathways that are not directly dependent on AQP4.

Objective To investigate the effect of remifentanil (Rem) on cartilage damage in osteoarthritis (OA) rats by regulating the hypoxia-inducible factor-1α (HIF-1α)/adenovirus E1B19kD interaction protein 3 (BNIP3) pathway. Methods A total of 50 SPF-grade SD male rats were randomly divided into the sham group, the OA group, the Rem low-dose (Rem-L) group, the Rem high-dose (Rem-H) group and the Rem-H +YC-1 (HIF-1α inhibitor) group. OA model was established. Serum levels of monocyte chemotactic protein-1 (MCP-1), interleukin (IL) -18, IL-10, type I collagen carboxy-terminal peptide (CTX-Ⅰ) and type Ⅱ collagen carboxy-terminal peptide (CTX-Ⅱ) were detected by enzyme-linked immunosorbent assay (ELISA). Hematoxylin-eosin (HE) staining and transmission electron microscopy were used to observe pathological changes and structural alterations in cartilage tissue. Chondrocyte apoptosis was detected by TUNEL staining. The content of nitric oxide (NO), malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) were detected by test kit. Matrix metalloproteinase 3 (MMP-3), matrix metalloproteinase 13 (MMP-13), microtubule-associated protein 1 light chain 3-Ⅱ (LC3Ⅱ)/microtubule-associated protein 1 light chain 3-Ⅰ (LC3Ⅰ), p62 and HIF-1α/BNIP3 pathway protein expression were detected by Western blot analysis. Results Compared with the OA group, cartilage tissue morphology of rats was significantly improved in the Rem-L group and the Rem-H group, and the extent of chondrocyte nuclear and mitochondrial structural damage was reduced, the serum IL-18, MCP-1, CTX-Ⅰ, CTX-Ⅱ, Mankin score, apoptosis rate of chondrocytes, content of NO and MDA in cartilage tissue, MMP-3, MMP-13 and p62 protein expression levels were reduced, while the serum IL-10 level, SOD activity in cartilage tissue, LC3 Ⅱ/LC3 Ⅰ, HIF-1α and BNIP3 protein expression levels were increased (P<0.05). YC-1 could reduce the improvement effect of Rem on cartilage damage in OA rats (P<0.05). Conclusion Rem can improve cartilage injury in OA rats, which may be related to the activation of HIF-1α/BNIP3 pathway.

Objective To analyze the expression and clinical significance of metastasis-associated gene 1 (MTA1), ADP ribosylation factor-like protein 2 (ARL2) and vascular endothelial growth factor C (VEGF-C) in non-small cell lung cancer (NSCLC) tissue. Methods From 170 patients with NSCLC admitted to Zhangjiakou First Hospital received surgical treatment were prospectively included. Cancer tissue and adjacent tissue were collected, and the pathological positive status was evaluated through Immunohistochemical staining. The patients were followed up for one year after the operation. Eight cases were lost to follow-up, and 162 cases were finally included in the study, including 44 cases of recurrence and metastasis. The positive expression of MTA1, ARL2 and VEGF-C protein in cancerous tissue, para-cancerous tissue of patients with NSCLC were compared. The differences in the expression levels of the three in cancer tissue of patients with different clinicopathological characteristics and different prognoses were analyzed. Spearman correlation analysis was used to analyze the correlation between the expression levels of MTA1, ARL2 and VEGF-C in cancer tissue. Multivariate Cox regression analysis was used to analyze the influencing factors of prognosis for NSCLC. Results The positive rates of MTA1, ARL2 and VEGF-C protein were higher in NSCLC tissue than those in para-cancerous tissue (P<0.05). In patients with the maximum diameter of tumor ≥3 cm, the depth of invasion ≥1 cm, the TNM classification (TNM) stage of tumor Ⅲ/Ⅳ, lymph node metastasis, low degree of differentiation and the histological type of adenocarcinoma, the positive expression rates of MTA1, ARL2 and VEGF-C were higher than those in the corresponding control groups (P<0.05). The results of multivariate Cox analysis showed that TNM stage Ⅲ/Ⅳ, lymph node metastasis, low degree of differentiation, MTA1 positive, ARL2 positive and VEGF-C positive were risk factors for the prognosis of NSCLC patients (P<0.05). The results of Spearman correlation analysis showed that the expression of MTA1 in cancer tissue was strongly positively correlated with the expression of ARL2 (r_s=0.575, P<0.001), the expression of MTA1 was strongly positively correlated with the expression of VEGF-C (r_s=0.443, P<0.001), and the expression of ARL2 was strongly positively correlated with the expression of VEGF-C (r_s=0.351, P<0.001). Conclusion The positive expression rates of MTA1, ARL2 and VEGF-C in patients with NSCLC increase. The expressions of the three are positively correlated and closely related to the pathological characteristics of the tumor and poor prognosis.

Objective To evaluate the predictive value of serum total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C), triglyceride-glucose index (TyG), cystatin C (CysC) and left atrial diameter (LAD) in patients with coronary heart disease (CHD) complicated with ischemic stroke. Methods One hundred patients with CHD complicated with ischemic stroke were enrolled as the comorbidity group, while another 100 CHD patients without a history of ischemic stroke were selected as the control group. Baseline characteristics and laboratory parameters were retrospectively collected in both groups. Echocardiography was performed to measure left ventricular end-diastolic diameter (LVEDd), LAD and left ventricular ejection fraction (LVEF). Binary Logistic regression analysis was performed to identify factors influencing ischemic stroke in CHD patients. Based on the identified factors, a nomogram prediction model was constructed. The predictive value of the nomogram model was then assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis. Results The proportion of hypertension, TC/HDL-C ratio, TyG, CysC and LAD were higher in the comorbidity group compared to those of the control group (P<0.05). Logistic regression analysis identified that elevated TC/HDL-C, TyG, CysC and LAD were independent risk factors for ischemic stroke in patients with CHD. A nomogram prediction model was subsequently constructed based on these four indicators. The model exhibited good discriminative ability, with a concordance index of 0.880. ROC curve analysis showed an area under the curve of 0.880 (95% CI: 0.834-0.927) for predicting ischemic stroke. The optimal cut-off value was 51.80 points, with a specificity of 0.760, sensitivity of 0.880 and the Youden's index of 0.640. Decision curve analysis revealed that the nomogram model provided a higher net benefit than any single indicator when the prediction probability threshold was set between 10% and 30%. Conclusion TC/HDL-C, the TyG, CysC and LAD are significant factors influencing ischemic stroke in patients with CHD. The nomogram model constructed based on these factors demonstrates potential utility for predicting this risk.

Objective To analyze the predictive value of serum ceruloplasmin (CP) and kidney injury molecule-1 (KIM-1) levels for the progression of elderly patients with chronic kidney disease (CKD) to end-stage renal disease (ESRD). Methods A total of 208 elderly CKD patients were enrolled and divided into the progression group (56 cases) and the non-progression group (152 cases) according to whether they progressed to ESRD. Baseline demographic and clinical data at admission were collected. Serum CP levels were measured by immunoturbidimetry, and KIM-1 levels were detected by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of CP and KIM-1 levels for CKD progression to ESRD. Cox regression analysis was used to assess the relationship between CP and KIM-1 levels and ESRD. Kaplan-Meier (K-M) survival curves were constructed to evaluate the risk correlation. Results Compared with the non-progression group, there were significantly higher age, proportion of CKD stages G4/G5, 24-hour urinary protein quantification (24h-UP), serum creatinine (Scr), urinary albumin-to-creatinine ratio (UACR), blood urea nitrogen (BUN), uric acid (UA), systolic blood pressure (SBP), CP and KIM-1 levels in the progression group, while the estimated glomerular filtration rate (eGFR) was lower (P<0.05). ROC curve analysis showed that when CP and KIM-1 were set at 346.86 mg/L and 3.26 μg/L, respectively, the area under the ROC curve (AUC) was 0.670 (95% CI: 0.601-0.733) for CP and 0.700 (95% CI: 0.633-0.762) for KIM-1. When CP and KIM-1 were combined for prediction, the AUC increased to 0.804 (95% CI: 0.744-0.856), with a sensitivity of 71.43% and specificity of 75.66%. Multivariate Cox regression analysis indicated that both CP and KIM-1 were independent risk factors for progression to ESRD in elderly CKD patients (P<0.05). Kaplan-Meier curve results showed that the 3-year cumulative incidence of ESRD progression in the CP>346.86 mg/L group was significantly higher than that in the CP≤346.86 mg/L group [40.96% (34/83) vs. 17.60% (22/125), Log-rank χ2=22.076, P<0.01]. Similarly, the 3-year cumulative incidence of ESRD in the KIM-1>3.26 μg/L group was significantly higher than that in the KIM-1≤3.26 μg/L group [50.85% (30/59) vs. 17.45% (26/149), Log-rank χ2=46.518, P<0.01]. Conclusion Serum CP and KIM-1 levels are significantly associated with the risk of progression to ESRD in elderly CKD patients. Elevated levels of CP and KIM-1 indicate a higher risk of disease progression.

Objective To explore the characteristics of perinatal thyroid diseases and analyze the risk factors for neonatal thyroid dysfunction. Methods A total of 1 237 pregnant women who underwent prenatal examination and delivered at Yinchuan Maternal and Child Health Care Hospital, Ningxia Medical University, from March 2022 to March 2025, along with their neonates, were enrolled as study subjects. According to the presence or absence of perinatal thyroid diseases, the participants were divided into the observation group (358 cases) and the control group (879 cases). Clinical data of the pregnant women were collected, and levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) were measured during the first, second and third trimesters as well as postpartum. Neonatal thyroid function was followed up to analyze the characteristics of perinatal thyroid diseases. Multivariate Logistic regression analysis was used to identify independent risk factors for neonatal thyroid dysfunction. Results Among the 1 237 pregnant women, the overall prevalence of perinatal thyroid disorders was 28.9%. The prevalence rates of overt hypothyroidism, subclinical hypothyroidism, thyrotoxicosis, positivity for TPOAb or TgAb, thyroid nodules and postpartum thyroiditis were 5.6% (69 cases), 9.3% (115 cases), 4.9% (61 cases), 12.8% (158 cases), 6.7% (83 cases) and 7.2% (89 cases), respectively. Multivariate Logistic regression analysis showed that elevated first-trimester TSH level (OR=2.387, 95%CI: 1.593-3.572), TPOAb positivity (OR=1.915, 95%CI: 1.232-2.998), non-use of iodine supplementation (OR=2.145, 95%CI: 1.378-3.352) and advanced maternal age (≥35 years, OR=1.792, 95%CI: 1.121-2.885) were independent risk factors for neonatal thyroid dysfunction. Conclusion Elevated first-trimester TSH level, TPOAb positivity, iodine deficiency and advanced maternal age are independent risk factors for neonatal thyroid dysfunction.

Objective To investigate the differences in renal pathological features between nephrotic syndrome (NS) type and non-NS type in children with IgA vasculitis nephritis (IgAVN). Methods The renal pathological data of 349 children with IgAVN presenting with nephrotic-range proteinuria were retrospectively analyzed. According to the presence or absence of NS, patients were divided into the NS group (n=56) and the non-NS group (n=293). The clinical characteristics and pathological types were compared between the two groups. Results Among the 349 children with IgAVN, the majority showed ISKDC grade Ⅲ or higher lesions (78.2%, 273/349). Immunofluorescence was dominated by IgA deposition (74.8%, 261/349), and 41.0% (143/349) of the patients had concomitant C3 deposition. The 24-hour urinary protein quantification was positively correlated with pathological grading, mesangial proliferation degree and crescent proportion (all P<0.05). Compared with the non-NS group, the NS group had significantly higher proportions of gross hematuria, ISKDC gradeⅡb and Ⅳ lesions, severe mesangial proliferation, crescent proportion (≥25%) and tubulointerstitial injury (all P<0.05). Conclusion NS-type IgAVN is more severe in terms of crescent formation, severe mesangial proliferation and renal tubulointerstitial injury.

Objective To explore the predictive value of serum chitinase-3-like protein 1 (CHI3L1) and Sestrin2 for recurrent ischemic stroke (IS) in patients with symptomatic carotid artery stenosis (SCAS). Methods A total of 82 SCAS patients were prospectively enrolled and divided into the recurrence group (27 cases) and the non-recurrence group (55 cases) based on whether they experienced recurrent IS. The ultrasound diagnostic instrument was used to conduct the carotid artery ultrasound examination. Serum CHI3L1 and Sestrin2 levels were detected by ELISA method. General information of patients were collected. Pearson method was used to analyze the correlations between serum CHI3L1, Sestrin2 and ultrasound indicators. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum CHI3L1 and Sestrin2 for the recurrence of IS in patients with SCAS. Results The proportion of hyperlipidemia, severe stenosis, levels of CHI3L1 and Sestrin2, arterial stenosis rate, area under the time-intensity curve (AUCTC) and peak intensity were higher in the recurrent group compared to the non-recurrent group (P<0.05). Serum CHI3L1 and Sestrin2 were positively correlated with carotid artery stenosis rate, AUCTC and peak intensity (r=0.496, 0.547, 0.529, 0.489, 0.535, 0.511, P<0.05). The risks of recurrent IS in SCAS patients with high CHI3L1 and Sestrin2 levels were 3.618-fold (95%CI: 1.518-8.620) and 2.591-fold (95%CI: 1.232-5.451), which was higher compared to those with corresponding low levels. The area under the curve (AUC) for serum CHI3L1 and Sestrin2 individually and combined in predicting recurrent IS was 0.811 (95%CI: 0.700-0.922), 0.737 (95%CI: 0.622-0.852) and 0.879 (95%CI: 0.790-0.969), respectively, with the combined prediction being superior to each individual prediction (all P<0.05). Conclusion In SCAS, the serum levels of CHI3L1 and Sestrin2 in patients with recurrent IS are both abnormally elevated, and combined detection can improve the predictive effectiveness for recurrent IS in SCAS patients.

Objective To explore the predictive value of plasma oxidized low-density lipoprotein (ox-LDL) combined with high-resolution vascular wall imaging (HRMR-VWI) hyperintensity features for the stability of atherosclerotic plaques in patients with cerebral infarction. Methods A total of 147 patients with cerebral infarction were selected and divided into the stable group (n=61) and the unstable group (n=86) based on plaque stability. Baseline data were collected from both groups, and plaque characteristic indicators were obtained through HRMR-VWI examination. Pearson correlation analysis was used to explore the relationship between ox-LDL and HRMR-VWI indicators. ROC curve analysis was conducted to evaluate the predictive efficacy of individual and combined indicators for plaque instability. Multivariate Logistic regression analysis was performed to identify the influencing factors of plaque instability. Results Compared with the stable group, there were significantly increased levels of triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), lipoprotein related phospholipase A2 (LP-PLA2), C-reactive protein (CRP), cystatin C (CysC), homocysteine (HCY) and ox-LDL in the unstable group (P<0.05). The plaque burden, incidence of intraplaque hemorrhage, incidence of fibrous cap damage and incidence of large lipid necrosis core were also significantly increased (P<0.05). Spearman correlation analysis showed that ox-LDL was positively correlated with plaque burden (r_s=0.174), plaque bleeding (r_s=0.241) and fibrous cap damage (r_s=0.352) (P<0.05). ROC curve analysis revealed that the AUCs for ox-LDL, plaque burden, intraplaque hemorrhage, fibrous cap rupture and combined prediction were 0.802 (0.728-0.863), 0.798 (0.723-0.859), 0.754 (0.676-0.821), 0.774 (0.698-0.839) and 0.957 (0.910-0.983), respectively, with combined prediction demonstrating the highest efficacy. Multivariate Logistic regression analysis indicated that ox-LDL (OR=1.137,95%CI: 1.070-1.208), plaque burden (OR=1.292, 95%CI: 1.151-1.450), intraplaque hemorrhage (OR=2.843, 95%CI: 2.239-3.611) and fibrous cap rupture (OR=3.200, 95%CI: 2.494-4.104) were risk factors for plaque in stability in patients with cerebral infarction (P<0.05). Conclusion The levels of plasma ox-LDL and related indicators of HRMR-VWI (plaque burden, intraplaque hemorrhage and fibrous cap damage) are closely related to plaque stability in patients with cerebral infarction. Combined detection can significantly improve the predictive efficacy of plaque instability.

Objective To discuss the correlation between serum miR-155-5p, miR-17-5p, miR-375 and the degree of macular edema (ME) in patients with retinal vein occlusion (RVO). Methods A total of 103 patients with RVO combined with ME admitted to our hospital from January 2020 to November 2024 were selected as the observation group. According to the severity of ME, patients with RVO combined with ME were divided into 47 cases of mild, 34 cases of moderate and 22 cases of severe. Based on the prognosis, patients were classified into the poor prognosis group (38 cases) and the good prognosis group (65 cases). Another 103 patients with simple RVO in our hospital during the same period were selected as the control group. The levels of serum miR-155-5p, miR-17-5p and miR-375 were detected in the control group and the observation group. The correlation of serum miR-155-5p, miR-17-5p, miR-375 and the degree of ME were analyzed by Spearman correlation analysis method. Logistic analysis was performed to identify the influencing factors of prognosis in patients with RVO complicated with ME. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of serum miR-155-5p, miR-17-5p and miR-375 for the prognosis of patients with RVO complicated with ME. Results Compared with the control group, serum miR-155-5p and miR-17-5p were higher in the observation group, and miR-375 level was lower (P<0.05). As the degree of ME increased, the serum miR-155-5p and miR-17-5p increased sequentially, while the miR-375 decreased sequentially (P<0.05). The degree of ME in patients with RVO and concurrent ME was positively correlated with serum miR-155-5p and miR-17-5p (r_s=0.536, 0.524, P<0.05), and negatively correlated with serum miR-375 (r_s=-0.488, P<0.05). Compared with the good group, serum miR-155-5p and miR-17-5p were higher in the poor group, and miR-375 level was lower (P<0.05). The increased miR-155-5p and miR-17-5p levels, and the decreased miR-375 were risk factors affecting the poor prognosis of patients with RVO complicated with ME (P<0.05). The AUC of the union of serum miR-155-5p, miR-17-5p and miR-375 in predicting the prognosis of patients with RVO and concurrent ME was 0.983, which was better than the individual prediction of miR-155-5p, miR-17-5p and miR-375 (Z _{union - miR-155-5p}=2.854, P=0.004, Z _{union - miR-17-5p}=3.133, P=0.002, Z _{union - miR-375}=4.297, P<0.001). Conclusion The serum miR-155-5p, miR-17-5p and miR-375 levels in patients with RVO complicated with ME are closely related to the degree of macular edema, and the combination of the three has a high predictive efficacy for the prognosis of patients.

Objective To evaluate the characteristic factors for retinal pigment epithelial (RPE) tears in patients with fibrovascular retinal pigment epithelial detachment (fv-RPED) after anti-vascular endothelial growth factor (VEGF) therapy. Methods A total of 76 patients (76 eyes) diagnosed with fv-RPED and received anti-VEGF treatment were enrolled. Patients were divided into the tear group (9 cases) and the non-tear group (67 cases) according to the occurrence of RPE tears. Data of types of anti-VEGF drugs received by patients with RPE tear, the number of injections before the tear and the interval time from the last injection to the RPE tear were collected. Best-corrected visual acuity (BCVA) was recorded at the last visit before the tear and at the first visit after the tear. Optical coherence tomography (OCT) was used to measure the height and maximum horizontal diameter of fv-RPED in all patients before treatment, and the imaging features of patients with RPE tear before treatment were analyzed. Results Age, fv-RPED height and maximum horizontal diameter were significantly higher in the tear group than those in the non-tear group (all P<0.05). Among the 9 patients with RPE tears, the anti-VEGF agents administered included ranibizumab 0.5 mg (3 cases), conbercept 0.5 mg (4 cases), aflibercept 2 mg (1 case) and aflibercept 8 mg (1 case). The mean number of injections before the tear was 3.5±1.2. Six tears occurred during the initial three loading doses, and three occurred during the reactivation phase. The median interval from the last injection to the RPE tear was 21 days. The mean ETDRS letter score decreased from 59.1±4.4 before the tear to 37.6±8.4 after the tear (P<0.05). All 9 cases showed obvious RPE folds. A hyporeflective cleft beneath the RPE-choroidal neovascularization (CNV) complex was observed in 5 cases, and RPE microrips were present in 2 cases. Conclusion Risk factors for RPE tears in fv-RPED patients after anti-VEGF treatment include advanced age, larger fv-RPED dimensions, and OCT features such as RPE folds, a hypo-reflective cleft beneath the RPE-CNV complex and RPE micro-rips.

Objective To explore the predictive value of the uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR), fasting blood glucose (FBG) and nighttime mean diastolic blood pressure (nDBP) for autonomic nervous imbalance in patients with essential hypertension (EH). Methods A total of 176 EH patients were divided into the EH normal autonomic nervous function group (normal group, 98 cases) and the EH combined with reduced autonomic nervous function regulation group (reduced group, 78 cases) according to the standard deviation of all sinus RR intervals (SDNN) in dynamic electrocardiography. General clinical data of the patients [age, gender, body mass index (BMI), history of hypertension, history of antihypertensive drug use, smoking history and drinking history] were collected. Laboratory indicators [creatinine (Cr), UA, FBG, glycated hemoglobin (HbA1c) and blood lipids] were detected. Ambulatory blood pressure parameters [daytime mean systolic blood pressure (dSBP), daytime mean diastolic blood pressure (dDBP), nighttime mean systolic blood pressure (nSBP) and nDBP] were recorded. UHR was then calculated. Binary Logistic regression analysis was used to identify independent risk factors for autonomic nervous imbalance, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of UHR, FBG and nDBP for autonomic nervous imbalance. Results Compared with the normal group, there were higher proportion of males, higher levels of BMI, FBG, UA, triglyceride (TG), UHR, dDBP, nSBP and nDBP in the reduced group, while the level of HDL-C was lower (all P<0.05). Binary Logistic regression analysis showed that elevated UHR, FBG and nDBP were independent risk factors for autonomic nervous imbalance (all P<0.05). ROC curve analysis indicated that the predictive value of UHR alone detection for autonomic nervous imbalance was superior to that of FBG or nDBP alone detection, and was equivalent to that of the combined detection of UHR, FBG and nDBP. Conclusion UHR, FBG and nDBP are all independent influencing factors for autonomic nervous imbalance in EH patients. Among them, UHR has higher predictive value and can be used as a reference indicator for early identification of high-risk patients.

Objective To evaluate the efficacy of interventional treatment of primary long-segment infrahepatic inferior vena cava (IIVC) occlusion. Methods The clinical data of 28 patients with primary long-segment IIVC occlusion were retrospectively analyzed, including 11 patients complicated with inferior vena cava or iliac vein thrombosis. All patients underwent digital subtraction angiography (DSA) to determine the extent of the lesion and subsequently received interventional treatment. Changes in the distal-to-proximal pressure gradient across the inferior vena cava, the venous clinical severity score (VCSS) and the clinical-etiology-anatomy-pathophysiology (CEAP) classification were compared before and after treatment. Results Interventional treatment was successfully completed in all patients, and recanalization of the inferior vena cava was achieved in every case. Balloon dilation alone was performed in 24 patients, and stent implantation was performed in 4 patients. Among the 11 patients with thrombosis, catheter-directed thrombolysis was performed before angioplasty, and no severe complications occurred. The distal-to-proximal pressure gradient across the inferior vena cava decreased significantly after treatment (P<0.01). One month after the procedure, both the CEAP classification and VCSS score were generally improved compared with those before treatment (both P<0.01). During follow-up, 19 patients maintained patency of the inferior vena cava, whereas 9 developed restenosis, all were successfully recanalized by repeat interventional treatment. Conclusion Interventional treatment for primary long-segment IIVC occlusion is safe and effective, and can significantly improve lower-extremity venous symptoms, providing evidence for minimally invasive treatment strategies in clinical practice.

Objective To explore the relationship between platelet-derived growth factor (PDGF), thickness of the lower uterine muscle wall and the delivery outcome in pregnant women with a scarred uterus. Methods A retrospective study was conducted on 196 pregnant women with scarred uterus who delivered at the First Affiliated Hospital of Zhengzhou University from October 2023 to October 2024. Clinical data were retrospectively collected through the medical record system. Venous blood sample was collected before delivery, and the serum PDGF level was detected by enzyme-linked immunosorbent assay. The thickness of the muscle wall at the thinnest part of the lower uterine segment was measured by abdominal ultrasound before delivery. Patients were divided into the good outcome group (n=132) and the poor outcome group (n=64) according to the delivery outcome. Multivariate Logistic regression analysis was conducted to identify the factors influencing the delivery outcome of women with scarred uterus. The receiver operating characteristic (ROC) curve analysis was used to evaluate the value of PDGF and the thickness of the myometrium in lower uterine segment in predicting the delivery outcome of women with scarred uterus who were planning to have another pregnancy. Results The age and the increase in gestational weight gain were both higher in the group with poor delivery outcome than those of the group with good outcome (P<0.05), while the time since the last cesarean section and the gestational age at delivery were lower in the group with poor delivery outcome than those of the group with good outcome (P<0.05). The PDGF level was higher in the poor delivery outcome group than that of the good outcome group (P<0.05), while the thickness of the lower uterine segment muscle wall was lower than that in the good outcome group (P<0.05). The results of Logistic regression analysis showed that older age, large increase in body weight during pregnancy and elevated PDGF levels were independent risk factors for adverse pregnancy outcomes in women with scarred uterus who were pregnant again (P<0.05), and the increase in the thickness of the muscular wall in the lower segment of the uterine was a protective factor (P<0.05). The ROC curve results showed that the area under the curve (AUC) for PDGF, the thickness of the myometrium in the lower uterine segment, and their combination in predicting the delivery outcome of women with scarred uterus who were pregnant again was 0.694 (95% CI: 0.586-0.802), 0.705 (95% CI: 0.604-0.807) and 0.893 (95% CI: 0.827-0.959), and the AUC predicted by the combination of the two was higher than that predicted by the individual indicators (P<0.05). Conclusion The increase in PDGF levels is a risk factor for poor pregnancy outcome in women with scarred uterus who are attempting another pregnancy, and the increase in the thickness of the uterine lower segment muscle wall is a protective factor. The combination of the two has a good predictive effect on the delivery outcome of pregnant women with a scarred uterus.

Objective To investigate the relationship between serum phosphorus and magnesium levels and disease severity/prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 158 elderly AECOPD patients admitted to our hospital from January 2022 to December 2024 were enrolled as the study subjects. Patients were divided into the mild group (n=52), the moderate group (n=46) and the severe group (n=60) based on disease severity. Serum phosphorus and magnesium levels, as well as pulmonary function indices, were compared between the groups. Pearson correlation analysis was performed to assess the relationship between serum phosphorus/magnesium levels and disease-related indicators. According to the prognosis after 6-month follow-up, patients were categorized into the good prognosis group (n=116) and the poor prognosis group (n=42). The general and clinical data of the two groups were collected and compared. Univariate and multivariate Logistic regression analyses were performed to identify prognostic factors. Receiver operating characteristic (ROC) curve analysis was used to evaluate the value of relevant factors in predicting poor prognosis in elderly patients with AECOPD. Results The serum phosphorus and magnesium levels, the percentage of forced expiratory volume in 1 second to the predicted value (FEV1% predicted) and the percentage of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) were lower in the severe group than those in the mild group and the moderate group, but the CURB-65 score was higher in the severe group compared to the mild group and the moderate group (P<0.05). Serum phosphorus and magnesium levels were negatively correlated with the CURB-65 score (r=-0.369 and -0.283, respectively, P<0.05) and positively correlated with FEV1% predicted value and FEV1/FVC (r=0.387, 0.281 for phosphorus; r=0.220, 0.171 for magnesium; P<0.05). Both univariate and multivariate Logistic regression analyses indicated that older age was an independent risk factor for poor prognosis in elderly AECOPD patients, whereas higher FEV1% predicted value, serum phosphorus and serum magnesium levels were independent prediction factors (all P<0.05). ROC curve analysis demonstrated that the area under the curve (AUC) of the combined prediction of age, FEV1% predicted value, serum phosphorus and serum magnesium was higher than that of the individual indicators (Z=4.643, 3.745, 4.411, 4.327, respectively; P<0.05). Conclusion Serum phosphorus and magnesium levels are correlated with the severity of AECOPD in elderly patients. Age, FEV1% predicted value, serum phosphorus and serum magnesium levels possess independent predictive value for prognosis, and their combined assessment enhances predictive efficacy.

Objective To systematically analyze the trends in disease burden of intracerebral hemorrhage (ICH) attributed to high systolic blood pressure among the elderly population aged ≥65 years in China from 1990 to 2023, apply the age-period-cohort (APC) model to reveal the independent effects of death risk and disease burden, and predict the disease burden of ICH attributed to high systolic blood pressure in China from 2024 to 2040. Methods Based on the data from the 2023 Global Burden of Disease (GBD) study, this study extracted the mortality and Disability-Adjusted Life Years (DALYs) data of ICH caused by high systolic blood pressure in elderly population in China. An APC model was constructed, and the study subjects were divided into 7 age groups, 7 period groups and 13 birth cohort groups. The relative risks (RR) of age, period and birth cohort on the mortality rate and DALYs rate were analyzed. The Bayesian age-period-cohort (BAPC) model was employed to forecast the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) of ICH patients caused by high systolic blood pressure in China from 2024 to 2040. Results In 2023, the number of death from ICH attributable to high systolic blood pressure in elderly population in China reached 518 845 cases, representing an increase of 8.25% compared with 1990, while DALYs decreased by 3.39%. However, the ASMR and ASDR decreased by 70.30% and 71.42%, respectively, with average annual percentage changes (AAPC) of -3.50% and -3.62%. The APC model indicated that the mortality and DALYs risk showed an initial increase and then decreased with age. The peak risk of death was between 90-94 years old, and the peak risk of DALYs was between 75-79 years old. The period effect demonstrated a sustained decline in mortality and DALYs risk from 2009. The cohort effect revealed an intergenerational improvement trend, with later-born cohorts exhibiting lower mortality and DALYs risk. The increase in the absolute number of death and the standardised rate of DALYs were increased in male than those in female, and the decrease in the absolute number and standardized rate were more significant in female. The prediction results of the BAPC model indicated that by 2040, the ASMR and ASDR of ICH in China due to high systolic blood pressure would decrease to 121.4 per 100 000 and 1 777.9 per 100 000, respectively. Conclusion From 1990 to 2023, the disease burden of ICH attributable to high systolic blood pressure in elderly population in China shows a relatively downward trend, while the aging of the population continuously increased its absolute burden. In the future, it is necessary to focus on the dual intervention of blood pressure and cerebrovascular risk for the elderly and male with hypertension.

Diabetic retinopathy (DR) is one of the common ocular complications in diabetic patients, which can cause severe impairment of visual function. Among DR patients, diabetic macular edema (DME) is the most common cause of central vision impairment. Anti-vascular endothelial growth factor (VEGF) therapy is currently the first-line treatment for DME. However, anti-VEGF therapy shows significant heterogenelty in treatment response, suggesting that ocular or systemic factors may be involved. At present, the analysis of relevant influencing factors has not been fully elucidated. This article reviews the ocular and systemic factors that contribute to the heterogeneous response to anti-VEGF treatment in DME patients.