Abstract:Objective：B-cell specific moloney leukemia virus insertion site 1（Bmi-1）has been extensively documented for its role in stem cell proliferation and differentiation，but its role in the brain of aged mice remains unclear. The study aimed to investigate the pathophysiological role of Bmi-1 in brain aging. Methods：Seventeen-month-old Bmi-1 heterozygous（Bmi-1 ^+/-）mice and wild-type （WT）mice were selected as experimental subjects. Behavioral testing，immunohistochemistry，and Masson staining techniques were used to compared the overall health status and long-term memory abilities of Bmi-1 ^+/- mice with WT mice. HE staining，electron microscopy，and Western blot were emplyed to investigate the potential effects of Bmi-1 gene haploinsufficiency on the brain aging in mice. Results：Compared with the WT mice，Bmi-1 ^+/- mice showed a diminished long-term spatial memory function（P ＜ 0.05）， accompanied by a reduction in neurogenesis in the hippocampal dentate gyrus（DG，P ＜ 0.05），a decrease in neuronal numbers（P ＜ 0.05），and a reduction in the grey matter volume（P ＜ 0.05）. Further studies revealed that compared with the WT mice，Bmi-1^+/- mice exhibited enlarged and swollen mitochondria in DG neurons，with an increased proportion of reduced mitochondrial cristae（P ＜ 0.05）， and a significant increase in the number of lipofuscin in the cytoplasm of DG neurons（P ＜ 0.05）. Additionally，the expression levels of mitochondrial energy metabolism-related proteins，such as NADH dehydrogenase（ubiquinone）flavoprotein 2（NDUFV2）and NADH dehydrogenase（ubiquinone）ferrithionein 3（NDUFS3），were down-regulated in the DG region of Bmi-1^+/- mice（P ＜ 0.05），and the key catalytic enzyme dihydrolipoyl S-succinyltransferase（DLST）in the tricarboxylic acid cycle was also significantly down-regulated（P ＜ 0.01）. Meanwhile，among the cell cycle factors regulated by Bmi -1，the cyclin -dependent kinase inhibitor p27 and oncoprotein p53 were significantly up-regulated（P ＜ 0.05）. Conclusion：Half dose deletion of the Bmi-1 gene inhibits the generation of new neurons in the hippocampal region of aged mice，leading to a specific reduction in the volume of the hippocampal DG region and impairments in long -term memory function. The underlying mechanism may be related to the abnormal expression of aging-related proteins p27 and p53，as well as neuronal mitochondrial degeneration.

Abstract:Objective：To verify whether mfat - 1 transgenic mice participate in the repair of hypoxic - ischemic brain damage by promoting the proliferation of adult neural stem cells. Methods：In vitro experiments，adult neural stem cells from wild-type and mfat-1 transgenic mice were isolated and cultured，subjected to oxygen - glucose deprivation/reoxygenation（OGD/R）modeling，and the proliferation of neural stem cells was assessed；in vivo experiments，mfat - 1 transgenic mice and their littermates were subjected to hypoxic-ischemic brain damage（HIBD）modeling，and the proliferation capacity of adult neural stem cells was evaluated. Results：The mouse HIBD model and the neural stem cell in vitro culture system were established successfully. The proliferation ability of adult neural stem cells derived from mfat - 1 transgenic mice was higher than that from wild - type mice；mfat - 1 transgenic mice showed significantly enhanced proliferation capacity of neural stem cells compared to wild - type mice and displayed better behavioral performance. Conclusion：mfat-1 transgenic mice participate in the repair of HIBD by promoting the proliferation of mouse neural stem cells.

Abstract:Objective：To evaluate the effects of low-glutelin（LG）rice feeding on renal function in a chronic kidney disease（CKD） mouse model，and to provide a new dietary and nutritional intervention approach for CKD patients. Methods：The CKD mouse model induced by doxorubicin and diabetic nephropathy（DKD）mouse model induced by high fat and high sugar diet combined with streptozotocin were studied. Mice in each model were fed either LG rice（glutelin 2.43 g/100 g，non-absorbed albumin 4.47 g/100 g， total protein 8.15 g/100 g）or normal-glutelin（NG）rice（glutelin 4.85 g/100 g，albumin 1.78 g/100 g，total protein 7.79 g/100 g），and were divided into LG-CKD group，NG-CKD group，LG-DKD group，and NG-DKD group. Normal mice were fed with LG rice or NG rice as controls. The mice in each group were continuously fed for 16 weeks，and parameters including food intake，body weight，24-hour urinary protein（24 h UPro），urinary albumin -to-creatinine ratio（mAlb/Cr），fasting blood glucose（FBG），total cholesterol（TC）， triglyceride（TG），blood urea nitrogen（BUN），serum creatinine（sCr），and cystatin C（Cys C）were regularly monitored. Renal histopathological changes and degree of renal interstitial fibrosis were examined. Results：At week 16，there was no statistically significant difference in food intake and weight changes between LG-CKD and NG-CKD groups，and between LG-DKD and NG-DKD groups. At 16 weeks，the levels of BUN，sCr，and Cys C were significantly lower in LG -CKD than in NG -CKD（P=0.004，0.030 and 0.010，respectively）；the quantity of mAlb/Cr and 24 h UPro in LG-CKD group was significantly decreased（P=0.040 and 0.001， respectively），but the urine volume was significantly increased（P=0.043），compared with those indexes at 8 weeks. The urine volume in NG-CKD group was significantly decreased，compared with the LG-CKD group at 16 weeks（P=0.002）. FBG was significantly lower in LG-DKD than in NG-DKD at 16 weeks（P=0.002）. Renal histological study indicated that the kidney pathological injury degree of LG feeding mice was less than that of NG feeding mice，in both CKD and DKD mice，with statistical significance（P ＜0.05）. The transcriptome analysis revealed the JAK -STAT pathway was involved in regulating CKD related kidney injury. Conclusion：LG rice feeding may control blood glucose fluctuations in DKD，delay the progression of renal dysfunction and fibrosis in CKD and DKD mouse models.

Abstract:Objective：To investigate the expression patterns and underlying mechanisms of lysyl oxidase（LOX）in ovarian cancer， and to explore the correlation between its expression level and the clinical characteristics and therapeutic outcomes of the disease. Methods：The correlations of high LOX expression with the clinicopathological features，treatment outcomes，and prognosis of ovarian cancer were analyzed by the Cancer Genome Atlas（TCGA）. The expression characteristics of LOX mRNA in different ovarian cancer cells in the tumor microenvironment were explored by the TISCH2 database. The expression pattern of LOX in ovarian cancer tissues were confirmed through immunohistochemistry. We used siRNA transfection technology to silence the expression and LOX，and then aralyzed the differentially expressed genes between LOX-silencing and control fibroblasts through RNA sequencing，followed by Gene Set Enrichment Analysis（GSEA）to identify the signaling pathways that were differentially enriched between the LOX-silenced and the control groups，with subsequent validation through qRT - PCR. The effect of knocking down LOX in fibroblast on the sensitivity of ovarian cancer to paclitaxel was analyzed by determining the half-maximal inhibitory concentration（IC₅₀）. Furthermore，Western blot and qRT-PCR were performed to analyze the expression levels of LOX in human fibroblasts and mouse fibroblasts（L929）induced by paclitaxel. Results：High expression of LOX was significantly associated with the presence of tumors，poor treatment outcomes，and venous invasion in ovarian cancer. LOX was highly expressed in cancer associated fibroblasts in ovarian cancer. Silencing LOX led to the downregulation of cell adhesion molecule expression. Paclitaxel induced upregulation of LOX expression in fibroblasts. Knocking down LOX in fibroblasts increased the sensitivity of co-cultured fibroblasts and tumor cells to paclitaxel. Conclusion：High expression of LOX is associated with a poor prognosis in ovarian cancer，knocking down LOX in fibroblast may enhance the sensitivity of ovarian cancer to paclitaxel；the mechanism of LOX may linked to alterations in the expression of cell adhesion molecules in cancer-associated fibroblasts. Paclitaxel may upregulate the expression of LOX in fibroblasts.

Abstract:Objective：To investigate the expression levels of miR-199a-5p in the liver under various nutritional conditions and its effects on hepatic triacylglyceride（TAG）content，as well as the underlying mechanisms. Methods：RT -qPCR was used to detect the expression levels of miR-199a-5p in liver tissues of high fat diet mice. Hepa1-6 and AML12 cells were transfected with miR-199a-5p mimics，inhibitors，negative controls and pcDH-CD36-flag plasmid，respectively. The changes in biomarker expression related to lipid metabolism were detected by RT-qPCR and Western blot，and TAG content was detected by kit. The target gene of miR-199a-5p was predicted by microRNA Target Prediction Database（miRDB）and verified by the dual luciferase reporting assay. Results：The expression levels of miR - 199a - 5p in the liver of C57BL/6J mice were elevated under high - fat diet and fasting conditions. Overexpression of miR - 199a -5p reduced TAG levels in hepatocytes，while inhibition of miR - 199a -5p increased intracellular TAG content. miR-199a-5p decreased the protein expression of the fatty acid translocase CD36 by interacting with its 3′ untranslated region （3′ UTR）. Conclusion：The expression level of miR -199a -5p increases during hepatic lipid accumulation，and miR -199a -5p may reduce TAG content in hepatocytes by targeting CD36.

Abstract:Objective：To constract the Rv2647-deleted strain and Rv2647-complemented strain of Mycobacterium tuberculosis（M. tb） and Rv2647-overexpressing Mycobacterium smegmatis（Ms：：Rv2647）by phage recombination technique，and to evaluate the effect of M. tb Rv2647 protein on lung injury in model mice. Methods：A homologous exchange site was constructed and integrated into the phage genomes of M. tb，producing phagemids that were introduced into Mycobacterium smegmatis（Ms）to create a recombinant phage with a homologous exchange site. High-titer recombinant phages were amplified in vitro and transfected into M. tb（H37Rv），followed by static culture at 37 ℃ for 28 d. The single clone was selected and verified by PCR，yeilding the Rv2647 - deleted strain （H37RvΔRv2647）. The Rv2647 gene was amplified by PCR and was integrated into the multiple clone sites of vector pMV361 and pMV261 through seamless cloning to obtain the positive plasmids，which were transfected into H37RvΔRv2647 and Ms to obtain the Rv2647 - complemented strain（H37RvΔRv2647：：Rv2647）and Rv2647 - overexpressing Ms（Ms：：Rv2647），respectively. The suspension of H37Rv，H37RvΔRv2647，H37RvΔRv2647：：Rv2647，Ms，and Ms：：Rv2647 were used to infect C57BL/6 mice via tracheal injection. The survival rates，lung tissue bacterial load，and pathological damage of lung tissue in model mice were compared at 7 d and 30 d，respectively. Results：The PCR showed that Rv2647 gene was missing in the H37RvΔRv2647，while it was present in the H37RvΔRv2647：：Rv2647 and Ms：：Rv2647. The 30-day survival rates of model mice infected with H37RvΔRv2647，H37Rv，and H37RvΔRv2647：：Rv2647 were 100.00%，83.33%，and 83.33%，respectively；The 7-day survival rates of model mice infected with Ms and Ms：：Rv2647 were 100.00% and 83.33%，respectively. The lung bacterial load（lgCFU）of model mice in the H37RvΔRv2647 group（3.40±0.18）was significantly lower than that of the H37Rv group（3.86±0.15），P ＜ 0.001）and the H37RvΔRv2647：：Rv2647 group（3.80±0.16），P ＜ 0.01）；The inflammation area（%）in lung tissues of the H37RvΔRv2647 group（4.37±3.06）was significantly lower than that of the H37Rv group（62.76±14.24），P ＜ 0.001）and the H37RvΔRv2647：：Rv2647 group（67.37±0.45），P ＜ 0.001）. The lung bacterial load（lgCFU）of the Ms group（2.53±0.16）was significantly lower than that of the Ms：：Rv2647 group（2.81±0.13）， P ＜ 0.01）；The inflammation area（%）in lung tissue of the Ms group（5.71±1.29）was significantly lower than that of the Ms：：Rv2647 group（33.13 ± 13.84），P ＜ 0.05）. Conclusion：The Rv2647 - deleted strain（H37RvΔRv2647）and Rv2647 - complementary strain （H37RvΔRv2647：：Rv2647）of M. tb and Rv2647-overexpressing Ms（Ms：：Rv2647）were successfully constructed. Rv2647 protein may aggravate lung injury via inhibiting host clearance of M. tb.

Abstract:Objective：To investigate the predictive value of three-dimensional speckle tracking echocardiography（3D-STE）and myocardial work（MW）on major adverse cardiovascular events（MACE）in patients with acute ST-segment elevation myocardial infarction（STEMI）who underwent primary percutaneous coronary intervention（PPCI）. Methods：Ninety patients with first concurrence of STEMI and treated with PPCI were enrolled. 3D-STE，MW assessments were performed within 24 hours following PPCI，and cardiac magnetic resonance late gadolinium enhancement imaging（CMR-LGE）was completed within 7 days post-procedure. The patients were followed up for 12 months after PPCI to track the occurrence of MACE，which inclueded recurrent angina pectoris，revascularization due to acute coronary syndrome，acute heart failure attack，and sudden cardiac death. Results：Twenty patients（22.2%）experienced MACE. Univariate and multivariate COX regression analysis showed infarction size（IS），global longitudinal strain（GLS），and global work index（GWI）as independent predictors of MACEs. The area under the curve（AUC）values for these indicators from the receiver operating characteristic（ROC）curves were 0.886，0.846 and 0.830，respectively，and pairwise comparison by Delong method showed no statistically significant difference in AUC values（all P ＞ 0.05）. The AUC value of the combined GLS and GWI in predicting MACE was 0.939，which was significantly better than either parameter alone（P ＜ 0.05），and comparable to IS（P ＞ 0.05）. Kaplan-Meier curve showed that patients with GLS＜ -10.5%，GWI ＞ 1 298.5 mmHg% and IS ＜ 26.05% had higher survival rate（P ＜ 0.05）. Conclusion： 3D-STE and MW can better predict MACE after PPCI in STEMI patients.GLS and GWI have similar diagnostic value，and their combination provides superior predictive power compared to either parameter alone，and is comparable to IS in terms of diagnostic efficiency.

Abstract:Objective：To analyze the epidemiological characteristics of brucellosis patients，and to explore the diagnostic value of lipopolysaccharide（LPS）testing for brucellosis and the therapeutic effect of LPS combined with blood culture on brucellosis. Methods： A total of 61 clinical patients with brucellosis was collected and divided into the current brucellosis group（n=39）and the brucellosis treatment effective group（n=22），the current brucellosis group consisted of 32 cases in the initial diagnosis group and 7 cases in the treatment ineffective group，twenty healthy subjects were used as the normal control group. The clinical characteristics of the patients were retrospectively analyzed，and LPS content was examined quantitatively. The results of blood culture，rose Bengal plate agglutination test（RBT）and LPS level were analyzed. The positive rates of the three detection methods were compared，and the diagnostic sensitivity，specificity，accuracy，negative/positive predictive values，and the diagnostic efficacy of combined diagnosis were evaluated. Results：Among 39 present patients，and the positive rate of LPS test was 100%，higher than those of blood culture（82.05%） and RBT test（97.44%）. In 22 patients with effective treatment，the blood culture results were all negative. The false positive rates of LPS and RBT tests were 45.45% and 90.91%，respectively. The LPS level in the treatment effective group were significantly lower than those in the initial diagnosis group and the treatment ineffective group，and there was no statistically significant difference compared to the normal control group. The area under curve（AUC）values of blood culture combined with RBT，blood culture combined with LPS， RBT combined with LPS，and the combination of all three were 0.914，0.957，0.779，and 0.959，respectively. Since the AUC value for the combination of all three did not show a significant increase compared to the combination of blood culture with LPS，we choose the combination of blood culture with LPS as the indicator for evaluating the efficacy of brucellosis treatment. Conclusion：LPS detection has a high value in the diagnosis of present brucellosis and the evaluation of therapeutic effect of brucellosis. It can be used for the diagnosis of brucellosis in key population，improve the diagnosis rate and predict the outcome of the disease.

Abstract:Objective：To investigate the correlation of baseline serum adiponectin and leptin levels with target organ damage and postoperative clinical outcomes of patients with primary aldosteronism（PA）. Methods：A total of 68 PA patients who underwent unilateral adrenalectomy and had follow-up information for at least 6 months after surgery were included. Serum adiponectin and leptin concentrations were detected at baseline. Postoperative clinical outcomes were evaluated according to primary aldosteronism surgical outcome（PASO）criteria. The correlation of serum adiponectin and leptin levels with target organ damage and postsurgical clinical outcome was analyzed. Results：After surgery，28 patients（41.2%）with PA were clinically cured and 40 patients（58.8%）were not clinically cured. The levels of baseline adiponectin and estimated glomerular filtration rate（eGFR）in the clinically cured group were higher than those in the clinically uncured group（all P ＜ 0.05），while body mass index（BMI），the daily defined dose value of hypertension medications，the proportion of hyperlipidemia and diabetes were lower（all P ＜ 0.05）. No difference in leptin levels was detected between the two groups. Leptin levels were negatively correlated with the E/A ratio and ankle-brachial pressure index（all P ＜ 0.05）. Adiponectin levels were not correlated with target organ damage indicators. Multivariate stepwise logistic regression analysis showed that lower BMI（OR=0.422，95%CI：0.272-0.653，P ＜ 0.001）and higher adiponectin levels（OR=1.359，95%CI：1.004-1.840， P=0.047）were independently associated with postoperative clinical cure. We further stratified patients based on BMI，and identified that higher eGFR（OR=1.074，95%CI：1.023-1.127，P=0.004）and adiponectin levels（OR=1.816，95%CI：1.261-2.616，P=0.001） were associated with postoperative clinical cure in non - obese patients with PA. Conclusion：Baseline serum adiponectin and leptin detection is helpful to evaluate PA target organ damage，predict postoperative clinical outcomes，and assist in guiding the accurate management of PA.

Abstract:Objective：To evaluate the accuracy of the SurePath - liquid based cytology（SurePath - LBC）technique in the cytopathological dignosis of fine needle aspiration（FNA）for thyroid nodules. Methods：A retrospective study was conducted on 352 patients（363 thyroid nodules）from the Thyroid and Breast Surgery Department of the First Affiliated Hospital of Nanjing Medical University，who underwent thyroidectomy and had complete preoperative cytopathological and postoperative pathological data. The SurePath -LBC was used for cytological diagnosis before surgery，and the cytopathological diagnoses were compared with the surgical pathology results. 363 independent cytology reports were obtained from these patients. BRAF^V600E mutation testing was also performed on 264 cases. Results：Cytopathology suggested suspicious for malignancy（SM）in a total of 112 cases，including 110 cases of suspected papillary thyroid carcinoma（PTC）and 2 cases of suspected medullary thyroid carcinoma（MTC）. Among the 110 suspected PTC cases，surgical pathology confirmed 106 cases as PTC，1 case as atypical adenoma，1 case as follicular thyroid carcinoma（FTC）， and 2 cases as well differentiated tumors of uncertain malignant potential（WT-UMP），with a diagnosis accuracy of 96.4%. Both cases suspicious for MTC were confirmed as MTC by surgical pathology，with an accuracy of 100.0%. The overall accuracy for SM cases with surgical pathology was 97.3%. 211 nodules were reported as“malignant，M”（210 PTC and 1 case MTC）. Among 210 PTC cases，209 cases were confirmed by histology，and 1 case was confirmed to be atypical adenoma，yielding a diagnosis accuracy of 99.5%. The case diagnosed as MTC by cytology was also confirmed as MTC by surgical pathology，with a diagnosis accuracy of 100.0%. The overall diagnosis accuracy for suspected M cases with surgical pathology was 99.5%. The BRAF^V600E mutation rates of SM and M cases were 82.3% and 95.5%，respectively. Among the seven nodules cytologically diagnosed as benign，final surgical pathology revealed 3 cases of nodular goiter，2 cases of follicular tumors，and 2 cases of PTC. There were 23 thyroid nodules reported as atypia of undetermined significance（AUS），19 cases of which were classified ase TI-RADS 4B or higer，with a BRAF^V600E mutation rate of 62.5%（10/16）and an overall malignancy rate of 87.0%. In the 10 cases with nondiagnostic（ND）results，the BRAF^V600E mutation rate was 57.1%（4/7）， with an overall malignancy rate of 50.0%. Conclusion：The SurePath -LBC method for preparing cytological specimens from thyroid FNA for the diagnosis of SM or M showed high concordance with surgical pathological diagnosis. It is also accurately indicated specific malignancy types. This technique has significant reference value for the preoperative diagnosis of thyroid nodules and is worth further promotion and application.

Abstract:Objective：To investigate the clinical characteristics and identify the associated factors in patients with atrial fibrillation （AF）and moderate to severe atrial functional mitral regurgitation（AFMR）. Methods：This was a single - center and cross - sectional study，which recruited a total of 313 patients with AF and AFMR hospitalized in the cardiovascular department of the Affiliated Jiangning Hospital of Nanjing Medical University from July 2023 to March 2024. Patients were categorized into two groups based on the severity of mitral regurgitation：the less than moderate AFMR group（Group A，n=249）and the moderate to severe AFMR group （Group B，n=64）. Baseline data were compared，and correlation analysis and logistic regression were employed to determine the factors associated with moderate to severe AFMR in AF patients. Results：Significant differences（P ＜ 0.05）were observed between the groups in age，CHA2DS2-VASc score，type of atrial fibrillation，history of renal insufficiency，heart failure with preserved ejection fraction （HFpEF），N-terminal pro-brain natriuretic peptide（NT-proBNP），tricuspid regurgitation severity，left atrial diameter，left ventricular end diastolic diameter，and left ventricular ejection fraction. Multivariate logistic regression analysis revealed that left atrial diameter （OR=1.067，95% CI：1.002-1.137，P ＜ 0.05），left ventricular end diastolic diameter（OR=1.153，95% CI：1.052-1.264，P ＜ 0.05）， mild-to-moderate tricuspid regurgitation（OR=6.571，95% CI：1.362-31.705，P ＜ 0.05），moderate tricuspid regurgitation（OR=10.795， 95%CI：3.816-30.543，P ＜ 0.05），moderate -to -severe tricuspid regurgitation（OR=19.525，95% CI：4.593-82.999，P ＜ 0.05），and severe tricuspid regurgitation（OR=20.701，95% CI：5.799-73.896，P ＜ 0.05）were independent risk factors for moderate to severe AFMR in AF patients. Conclusion：Compared with AF patients with AFMR less than moderate severity，those with moderate to severe AFMR show the discrepancy in clinical characteristics，and they tend to exhibit a more complex clinical comorbidities. Left atrial diameter enlargement，left ventricular end diastolic diameter enlargement，and the presence of more than mild severity of tricuspid regurgitation are independent predictors of moderate to severe AFMR in AF patients.

Abstract:Objective：To evaluate the efficacy and safety of tislelizumab combined with chemotherapy as first -line treatment for locally advanced or metastatic squamous non - small - cell lung cancer in the real -world. Methods：A total of 109 patients with lung squamous cell carcinoma were included in the Affiliated Hospital of Inner Mongolia Medical University from January 2021 to December 2023，of whom 66 patients in the tislelizumab combined with chemotherapy group and 43 patients in the chemotherapy group. The objective response rate（ORR），progression-free survival（PFS），overall survival（OS）and the incidence of treatment-related adverse events（TRAEs）of the two groups were evaluated. Results：At a median follow-up of 20.2 months，the ORR of the tislelizumab combined with chemotherapy group was significantly higher than that of the chemotherapy group（75.8% vs. 51.2%）. The median PFS prolonged significantly in the tislelizumab combined with chemotherapy group compared to the chemotherapy group（17.3 months vs. 9.3 months）. OS data were not reached in the tislelizumab combined with chemotherapy group，which was significantly longer than the chemotherapy group（19.3 months，HR=0.38，95%CI：0.19-0.68，P=0.002）. The incidence of overall TRAEs and TRAEs above grade 3 in the two groups was similar. The incidence of immune-related adverse events（irAEs）in the tislelizumab combined chemotherapy group was 28.8%，including one case（1.5%）of grade 3 and above immune-associated pneumonia. Conclusion：Tislelizumab combined with chemotherapy as first-line treatment significantly improves the efficacy and manageable safety/tolerability profile in patients with locally advanced or metastatic lung squamous cell carcinoma.

Abstract:Objective：To study the relationship between the stress hyperglycemia ratio（SHR）and patients with sepsis-related acute respiratory distress syndrome（ARDS）admitted to the intensive care unit（ICU）. Methods：A total of 375 patients with sepsis admitted to the ICU of the South Hospital of Oriental Hospital from October 2019 to February 2024 were retrospectively included. SHR was calculated based on the blood glucose and glycosylated hemoglobin（HbA1c）upon admission. The patients were divided into the ARDS group and the non -ARDS group according to whether ARDS occurred at the time of admission. The general clinical data of the two groups were compared. Multivariate logistic regression analysis was used to identify risk factors for the development of ARDS in sepsis patients. The predictive value of SHR for ARDS in sepsis was analyzed by receiver operating characteristic（ROC）curve. The performance of SHR was compared across different ARDS severity levels. Results：In this study，there were 293 patients with sepsis-related ARDS（78.1%），128 patients with mild ARDS（44.7%），116 patients with moderate ARDS（39.6%）and 49 patients with severe ARDS（16.7%）. Compared with the non-ARDS group，the ARDS group had lower P/F ratio，higer SOFA scores，SHR，admission blood glucose levels，and lactate levels，as well as longer duration of mechanical ventilation，vasopressor use，and ICU stay，with statistically significant differences. Multivariate logistic regression analysis showed that SOFA score（OR=1.307，95%CI：1.182-1.445）and SHR （OR=4.246，95% CI：1.940-9.296）were independent risk factors for ARDS（P ＜ 0.001）. ROC curve analysis showed that the area under the curve（AUC）value of SHR for predicting sepsis-associated ARDS was 0.682，with a sensitivity of 38.6% and a specificity of 91.4%. The combination of SHR and SOFA score had an AUC value of 0.791 for predicting sepsis-associated ARDS，with a sensitivity of 68.3% and a specificity of 80.2% . As the severity of sepsis - associated ARDS increased，SHR values were higher（P=0.002）. Conclusion：High SHR value is a risk factor for ARDS in sepsis patients. The level of SHR is related to the occurrence and severity of ARDS caused by sepsis and has predictive value. SHR can serve as a rapid warning indicator.

Abstract:Objective：To evaluate the efficacy and safety of laparoscopic microwave ablation for treating focal nodular hyperplasia （FNH）of the liver. Methods：A retrospective analysis was conducted on FNH patients treated at our center from November 2019 to March 2024. The subjects included 43 patients underwent laparoscopic microwave ablation（ablation group）and 65 patients received surgical resection（resection group）. Key indicators such as operation duration，intraoperative blood loss，postoperative hospital stay， costs，and postoperative complications were compared between the two groups. Results：All procedures in the ablation group were successfully completed，with an average operation duration of（1.1 ± 0.6）h，average intraoperative blood loss of（35.8 ± 6.7）mL， average postoperative hospital stay of（2.9 ± 1.5）d，and average hospitalization costs of（21 257.5 ± 3 059.2）yuan. These indicators were significantly better than those of the resection group. Postoperative complications included fever（4 cases，9.3%），hematuria （1 case，2.3%），and renal insufficiency（1 case with a serum creatinine level of 236 μmol/L，2.3%）. The incidence of postoperative complications showed no significant difference compared to the resection group. Follow - up results indicated that all lesions were completely ablated，with no lesion enlargement or recurrence observed within one -year follow - up period. Conclusion：Laparoscopic microwave ablation for FNH is safe，effective，and economical，and it merits clinical promotion and application.

Abstract:Objective：To evaluate the effect of non-curative endoscopic submucosal dissection（ESD）on postoperative complications after additional thoraco-laparoscopic esophagectomy and to investigate the optimal interval between non-curative ESD and additional esophagectomy. Methods：A total of 831 patients with esophageal cancer who underwent thoraco -laparoscopic esophagectomy in our hospital between October 2019 and October 2022 were collected. Among them，52 patients underwent ESD prior to esophagectomy， while 779 patients did not. Propensity score matching（PSM）was performed at a 1∶3 ratio，dividing the patients into an ESD+OP group （52 cases）and a Non-ESD+OP group（149 cases）. The incidence of postoperative complications was compared between the two groups， and the outcomes of esophagectomy performed at different time points after ESD were evaluated. Results：The incidence of postoperative complications was higher in the ESD + OP group than the Non - ESD + OP group（59.6% vs. 33.6% ，P=0.001），with significantly increased rates of pulmonary infection（26.9% vs. 10.7%，P=0.001）and anastomotic leakage（13.5% vs. 4.7%，P=0.033）. The lowest complication rate（38.1% vs. 75.0%，P=0.033）and the safest outcomes were observed when esophagectomy was performed 2 to 4 weeks after ESD. Conclusion：The non - curative ESD may increased the postoperative complications and the risk of esophagectomy. Performing esophagectomy 2 to 4 weeks after ESD is relatively safer and can effectively reduce surgical risk.

Abstract:Mesenchymal stem cell（MSC）is one of the most significant sources of cell - based therapeutics for bone tissue regeneration. Investigations have demonstrated that MSC-derived exosomes can get beyond the restrictions of stem cell transplantation. Exosomes have been demonstrated to stimulate osteogenesis and osteogenic differentiation in the bone microenvironment both in vivo and in vitro. Exosomes play as a crucial role in intercellular communication by directly influencing the transcriptional level of their target cells. They carry DNA，mRNA，miRNA，protein，and lipids. The miRNAs are major regulators at various stages of cell differentiation，and modulate physiological and pathological processes through mRNA degradation or translation blockade. MSC - derived exosomes have advanced significantly in bone regeneration and repair recently. This article addresses the formation of MSC - derived exosomes，their application，and possible therapeutic procedures in the restoration of bone tissue defects.

Abstract:Pulmonary arterial hypertension（PAH）is a chronic progressive disease characterized by reduced exercise tolerance and right heart dysfunction，which can eventually lead to right heart failure. Cardiopulmonary exercise test（CPET）is a non - invasive assessment tool that comprehensively evaluates circulatory，respiratory，metabolic，and muscular functions under resting and exercise conditions. This article reviews the application and research progress of CEPT in PAH.

Abstract:Improving the prognosis of patients with peritoneal dialysis（PD）and developing standardized method for predicting PD clinical outcomes have been received widespread attention in recent years. The currently recognized core outcomes affecting PD prognosis are PD - associated infections，cardiovascular disease，death，reduced quality of life，and technical failure. Predicting and identifying high-risk patients with poor prognosis for PD clinical outcomes and intervening early are of great importance for improving survival rate and quality of life as well as improving prognosis of PD patients. This paper reviews the relevant research progress in recent years from three aspects：biological markers，risk prediction models，and artificial intelligence.

Abstract:Cirrhotic cardiomyopathy is a myocardial dysfunction that occurs in end-stage liver disease，characterized by systolic and diastolic dysfunction，cardiac structural changes，and electrophysiological abnormalities. It is a known but poorly understood complication of cirrhosis，with an adverse clinical effect on the overall health，survival，and prognosis of patients with cirrhosis. Liver dysfunction and systemic inflammatory response under portal hypertension are jointly involved in its pathogenesis. This article will review the research progress on the pathogenesis of liver cirrhosis cardiomyopathy in recent years from two aspects：elevated levels of circulating bile acids caused by liver dysfunction and systemic chronic inflammatory response under portal hypertension.