Objective To screen the risk factors leading to poor prognosis of elderly patients with mechanical intestinal obstruction, and to evaluate the efficacy of different risk factors in predicting the poor prognosis of patients. Methods Retrospectively analyzed 98 cases of elderly patients with mechanical intestinal obstruction admitted to the Department of Gastrointestinal(Oncology) Surgery of the First Affiliated Hospital of Xinjiang Medical University from February 2021 to February 2023, which were divided into a good prognosis group(n=76) and a poor prognosis group(n=76) according to the prognosis of the patients. poor prognosis group(n=22). We compared the differences in clinical data, symptoms and signs, inflammation-related indexes, and treatment-related characteristics between the 2 groups; analyzed the correlation between clinical data, symptoms and signs, inflammation-related indexes, and treatment-related characteristics of elderly patients with mechanical intestinal obstruction and poor prognosis; and screened the risk factors for poor prognosis of elderly patients with mechanical intestinal obstruction by multifactorial logistic regression and evaluated their predictive efficacy by the subjects' work characterization curve(ROC). ROC) to evaluate their predictive efficacy.Results The mean BMI, PG-SGA grade and prevalence of diabetes mellitus in the poor prognosis group were statistically different from those in the good prognosis group(t/χ2/P=2.486/0.015,8.164/0.017,4.382/0.036); statistically significant differences in the proportion of patients in the poor prognosis group who experienced loss of bowel sounds and progressive exacerbation of abdominal pain compared with patients in the good prognosis group(χ2/P=4.025/0.045, 4.248/0.039); prognostication The mean CRP, PCT, IL-6, and NLR levels of patients in the poor prognosis group were significantly higher than those of patients in the good prognosis group(t/P=2.653/0.009, 2.478/0.015, 2.391/0.019, 2.636/0.010); the difference between the average length of surgery, the proportion of glucocorticoid application and the average length of hospitalization of the patients in the poor prognosis group compared with the patients in the good prognosis group was statistically significant(t/χ2/P=2.373/0.020, 5.002/0.025, 2.366/0.020); Spearman's correlation analysis showed that PG-SGA classification, prevalence of diabetes mellitus, serum CRP, PCT, IL-6, and NLR levels in elderly patients with mechanical intestinal obstruction were significantly and positively correlated with poor prognosis(r/P=0.202/0.040, 0.211/0.037, 0.213/0.036, 0.229/0.023, 0.211/0.037, 0.207/0.039), and the mean BMI level was significantly negatively correlated with poor prognosis(r=-0.242/0.016); multifactorial logistic regression analysis showed that lower BMI, higher PG-SGA grading, serum PCT, IL-6 and IL-2 levels in elderly patients with painful mechanical intestinal obstruction were all risk factors for poor prognosis [OR(95%CI)=0.377(0.196-0.724), 9.893(5.087-16.043), 2.835(1.742-10.840), 1.415(1.044-1.919), 2.990(1.905-9.884)]; BMI, PCT, IL-6 and NLR levels predicted adverse prognosis in elderly patients with mechanical intestinal obstruction with AUCs of 0.668, 0.659, 0.646, and 0.630, respectively, and the differences in the predictive efficacy of each of the four individually were not statistically significant when compared by DeLong's method(Z=1.321,P=0.357). Conclusion Changes in BMI and serum PCT, IL-6 and NLR levels in elderly patients with mechanical intestinal obstruction are of great value in predicting poor prognosis, suggesting that nutritional status and inflammatory response level are related to the treatment effect of mechanical intestinal obstruction in elderly patients, and that changes in the above indexes should be closely monitored in clinical practice to assess the prognosis of the patients.

Objective To observe the clinical efficacy and safety of carrelizumab combined with radiofrequency ablation in the treatment of patients with liver cirrhosis and liver cancer. Methods Ninety patients with primary liver cancer combined with liver cirrhosis were admitted to the General Surgery Center of Beijing You'an Hospital affiliated with Capital Medical University from January 2022 to February 2023, and were divided into the observation group(n=45) and the control group(n=45) by the method of randomized numerical table. Both groups were treated with radiofrequency ablation for hepatocellular carcinoma, and the patients in the observation group were treated with pre-operative and post-operative combined application of karelizumab on this basis. After 2 months of treatment, the clinical efficacy of the two groups was compared; liver function indexes(serum total bilirubin(TB), alanine aminotransferase(ALT) and aspartate aminotransferase(AST)), tumor markers(alpha-fetoprotein(AFP), glycoprotein antigen 199(CA199) and hepatocellular carcinoma high-expression gene 10(PEG10)) and immunity indexes(CD4, CD4 and CD4) were detected in the patients of both groups. We calculated the incidence rate of adverse events during the treatment period, including changes in the levels of CD4+T cells, CD8+T cells and CD4+/CD8+ ratio. Results Total effective rate of the observation group and the control group was not statistically significant(91.11% vs. 84.44%, χ2=0.932, P=0.334); Serum TB, ALT and AST levels of patients in the observation group were lower than those in the control group after treatment(t/P=1.993/0.049, 3.505/0.001, 2.520/0.014), and serum AFP, CA199 and PEG10 levels were lower than those in the control group(t/P=2.410/0.018, 3.076/0.003, 3.552/0.001), and the peripheral blood CD4+T cell ratio, CD8+T cell ratio and CD4+/CD8+ ratios were higher than those in the control group(t/P=5.621/<0.001, 3.438/0.001, 3.281/0.001); the incidence rate of total adverse events during the treatment period was higher in the observation group compared with the control group. control group was not statistically significant(17.78% vs. 13.33%,χ2=0.338,P=0.561). Conclusion Carelizumab combined with radiofrequency ablation can improve the clinical efficacy of hepatocellular carcinoma patients with combined cirrhosis to a certain extent, which may be related to the reduction of patients' tumor marker levels and improvement of immune function, and this combination treatment plan has certain clinical application prospects.

Objective To investigate the effects of liraglutide and selegiline on renal hemodynamics and neutrophil/lymphocyte ratio(NLR), serum cystatin C(CysC), and monocyte chemoattractant-1(MCP-1) in patients with early-onset type 2 diabetic nephropathy(T2DN). The effects of NLR, serum cystatin C(CysC), and monocyte chemokine-1(MCP-1). Methods One hundred and ten patients with early T2DN admitted to the Department of Endocrinology I of the First Hospital of Handan City from December 2020 to December 2022 were selected as study subjects. The patients were divided into observation group(n=55) and control group(n=55) according to random number ranking method. The control group was treated with selegiline and the observation group was treated with liraglutide combined with selegiline for 12 weeks. We compared the efficacy, glycemic indexes, renal hemodynamic indexes in both renal aorta(MRA) and interlobar artery(IRA), NLR, Cys-C, MCP-1, and the occurrence of adverse reactions between the two groups, and analyzed the relationship between urinary protein excretion rate(UAER) and serum NLR, CysC, and MCP-1.Results The total effective rate of the observation group was 90.91%, higher than that of the control group, which was 67.27%(χ2/P=9.290/0.002). After 12 weeks of treatment, the levels of HbA 1c, FPG, and 2 h PG in the 2 groups were lower than those before treatment, and the observation group was lower than the control group(t/P=4.222/<0.001, 6.064/<0.001, 6.648/<0.001); Vdmin and Vsmax of IRA and MRA in the 2 groups were elevated compared with those before treatment, and the elevation was more obvious in the observation group than the control group(t/P=3.733/<0.001, 6.800/0.001, 2.598/0.011, 2.043/0.043); the PI and RI of IRA and MRAof group 2 were reduced compared with those before treatment, and the reduction was more obvious in the observation group than in the control group(t/P=4.194/<0.001, 3.933/<0.001, 3.265/0.001, 6.171/<0.001); 2 group's UAER, NLR, Cys-C, and MCP-1levels were reduced compared with those before treatment, and the reduction was more obvious in the observation group than the control group(t/P=14.534/<0.001, 2.609/0.010, 9.795/<0.001, 6.618/<0.001); Pearson's analysis, NLR, Cys-C, and MCP-1 were positively correlated with UAER(r=0.513, 20.764, 0.685, all P<0.001). The difference in the incidence of adverse reactions between the 2 groups was not statistically significant when compared(χ2/P=0.910/0.340).Conclusions Liraglutide combined with selegiline has good efficacy in the treatment of early T2DN, which can effectively improve renal hemodynamics, regulate the levels of NLR, Cys-C and MCP-1, and protect renal function.

Objective To investigate the therapeutic effect of dagliflozin combined with silymarin in patients with type 2 diabetes mellitus combined with non-alcoholic fatty liver disease(NAFLD). Methods One hundred and four patients with type 2 diabetes mellitus combined with NAFLD were collected and treated in the Department of Endocrinology of the Fifth Affiliated Hospital of Xinjiang Medical University from January 2021 to December 2022, and were divided into 52 patients in the control group and 52 patients in the study group according to the method of randomized numerical table, and the patients in the two groups were given conventional treatment and metformin hypoglycemic treatment, and the study group was given dagliflozin on top of this treatment. The study group was given dagliflozin combined with silymarin treatment on this basis. After 6 months of treatment, changes in glycemic and lipid metabolism indexes, liver function, liver hardness, tumor necrosis factor-alpha(TNF-alpha), superoxide dismutase(SOD), and adiponectin(APN) levels of the patients in the two groups were compared before and after treatment. Results glycated hemoglobin, fasting glucose, 2 h postprandial glucose, and insulin resistance index(HOMA-IR) decreased in the two groups after treatment compared with the pre-treatment level, and the study group was lower than the control group(t/P=3.411/<0.001, 2.926/0.005, 3.578/<0.001, 2.672/0.015), and body mass index(BMI), waist-to-hip ratio, visceral fat area, total cholesterol(TC), triacylglycerol(TG), and low-density lipoprotein cholesterol(LDL-C) were significantly lower than that before treatment in the study group and were lower than that in the control group after treatment(t/P=2.873/0.008, 2.435/0.013, 4.878/<0.001, 3.997/<0.001, 2.265/0.025, 1.997/0.038);aspartate aminotransferase(AST), alanine aminotransferase(ALT), and total bilirubin decreased significantly after treatment compared with pretreatment in patients in the study group, and patients in the study group were lower than those in the control group(t/P=5.737/<0.001, 4.971/<0.001, 3.258/<0.001); patients in the study group had lower TNF-α and higher SOD and APN after treatment, and the magnitude of decrease/elevation in the study group was greater than that in the control group(t/P=2.453/0.021, 3.842/<0.001, 3.927/<0.001); 2="" during="" the="" treatment="" incidence="" of="" adverse="" reactions="" such="" as="" nausea="" and="" abdominal="" increase="" in="" body="" hypoglycemia="" patients="" groups="" were="" differences="" not="" statistically="" p="">0.05). Conclusion Dagliflozin combined with silymarin on the basis of metformin glucose-lowering therapy can significantly improve insulin resistance and liver function, reduce inflammatory factor level and oxidative stress injury, and improve APN level in patients with type 2 diabetes mellitus combined with NAFLD.

目的 分析2～4期慢性肾脏病(CKD)患者血清血管非炎性因子(VNN1)、细胞交流网络因子2(CCN2)水平及对并发急性肾损伤(AKI)的预测价值。方法 选取2020年3月—2022年3月重庆医科大学附属第一医院梁平医院肾内科诊治2～4期CKD患者102例为CKD组，根据是否并发AKI,分为AKI亚组28例和非AKI亚组74例，以同期体检的健康者60例为健康对照组。Pearson相关分析血清VNN1、CCN2与肾疾病指标的相关性；多因素Logistic回归分析影响2～4期CKD患者并发AKI的因素；受试者工作特征曲线分析血清VNN1、CCN2及二者联合对2～4期CKD患者并发AKI的预测价值。结果 CKD组患者血清VNN1、CCN2水平高于健康对照组(t=34.043,16.383,P均<0.001)。AKI亚组血肌酐、血尿酸、血尿素氮、24 h尿蛋白定量及血清VNN1、CCN2水平均高于非AKI亚组(t/P=4.842/<0.001,3.578/0.001,5.268/<0.001,3.876/<0.001,20.046/<0.001,10.791/<0.001)。2～4期CKD患者血清VNN1、CCN2与血肌酐、血尿酸、血尿素氮、24 h尿蛋白定量呈显著正相关(VNN1:r/P=0.627/<0.001,0.624/<0.001,0.521/<0.001,0.705/<0.001;CCN2:r/P=0.646/<0.001,0.610/<0.001,0.536/<0.001,0.689/<0.001)。血肌酐、血尿素氮、血尿酸、24h尿蛋白定量、血清VNN1、CCN2升高是影响2～4期CKD患者并发AKI的独立危险因素[OR(95%CI)=1.602(1.268～2.022),1.652(1.263～2.161),1.594(1.252～2.028),1.579(1.196～2.086),1.568(1.131～2.176),1.673(1.124～2.385)]。血清VNN1、CCN2及二者联合预测2～4期CKD患者并发AKI的AUC为0.814、0.822、0.890,二者联合的AUC大于单一指标检测(Z=4.675、4.513,P均<0.001)。结论 2～4期CKD患者血清VNN1、CCN2升高，两者是影响2～4期CKD患者并发AKI的独立危险因素，且二者联合对2～4期CKD并发AKI具有较高的预测价值。