Objective To investigate the relationship between serum sclerostin(SOST), pentosidine(PTD) and patients with type 2 diabetic nephropathy(T2DN) complicated with sarcopenia. Methods 277 patients with T2DN admitted to the Department of Endocrinology of Changzhi People's Hospital of Shanxi Province, from January 2021 to January 2023 were selected and patients were divided into sarcopenia group(85 cases) and non-sarcopenia group(192 cases) according to whether or not they were complicated with sarcopenia. ELISA was used to detect serum SOST and PTD levels; Spearman's correlation was used to analyze the correlation between serum SOST and PTD levels and the indicators of sarcopenia[appendicular skeletal muscle mass index(ASMI), grip strength, stride speed, and 5 sit-up time]in patients with T2DN complicated with sarcopenia; the factors affecting sarcopenia were analyzed by multifactorial Logistic regression; the diagnostic value of serum SOST and PTD levels for T2DN patients complicated with sarcopenia was analyzed by using receiver operating characteristic(ROC) curves. Results Serum SOST and PTD levels were higher in the sarcopenia group than in the non-sarcopenia group(t=7.777,7.854, all P<0.001). Serum SOST and PTD levels were negatively correlated with ASMI, grip strength, and step speed in patients with T2DN complicated with sarcopenia(SOST:rs=-0.734,-0.725,-0.762; PTD:rs=-0.720,-0.732,-0.755, all P<0.001), and positively correlated with the 5 sitting times(rs=0.722, 0.729, all P<0.001); Multifactorial Logistic regression analysis showed that increased bone mineral density, increased ASMI, increased grip strength, and accelerated step speed were independent protective factors for the patients with T2DN complicated with sarcopenia [OR(95%CI)=0.875(0.779-0.982), 0.716(0.598-0.857), 0.509(0.366-0.707), 0.824(0.780-0.870)], and that increased time to 5 sitting times, increased SOST, and increased PTD were independent risk factors[OR(95%CI)=1.427(1.159-1.757), 1.056(1.023-1.090), 1.019(1.006-1.031)]; The area under the curve(AUC) for serum SOST, PTD and the combination of the two for the diagnosis of patients with T2DN complicated with sarcopenia was 0.793, 0.796, and 0.897, respectively, and the AUC for the combination of the two was greater than that for the serum SOST and PTD levels alone(Z=4.277, 3.825, all P<0.001). Conclusion The serum SOST and PTD levels are closely relate to T2DN complicated with sarcopenia, and elevated levels of both are independent risk factors for patients with T2DN complicated with sarcopenia. The combined detection of serum SOST and PTD levels have high diagnostic value for patients with T2DN complicated with sarcopenia.

Objective To construct and evaluate a nomogram prediction model of influencing factors of carotid atherosclerosis(CAS) in patients with type 2 diabetes mellitus(T2DM) base on serum microribonucleic acid(miR)-351 and miR-638 levels. Methods One hundred and eighty-two T2DM patients admitted to the Department of Endocrinology of The First Affiliated Hospital of Xinjiang Medical University from March 2021 to December 2022 were selected as observation group, and 91 healthy cases who underwent physical examination in the hospital during the same period were selected as healthy control group. The expression levels of serum miR-351 and miR-638, as well as differences in blood glucose and blood lipid were compared between two groups. T2DM patients were divided into CAS subgroup and non-CAS subgroup according to whether they were combined with CAS, and the differences in clinical characteristics in two subgroups were compared. The risk factors of T2DM combined with CAS were analyzed by multivariate Logistic regression. The risk nomogram prediction model of T2DM combined with CAS was constructed according to the risk factors. The predictive efficacy was analyzed by receiver operating characteristic(ROC) curve, and the calibration and decision-making ability of the model were analyzed by Bootstrap method and decision curve. Results The serum miR-638 level in observation group was lower than that in control group, and the serum miR-351 level was higher than that in control group(t/P=9.999/<0.001, 12.051/<0.001). The level of high-density lipoprotein cholesterol(HDL-C) in observation group was lower than that in control group(t/P=11.060/<0.001), and the levels of fasting blood glucose(FPG), 2-hour postprandial blood glucose(2hPG), glycosylated hemoglobin(HbA1c), total cholesterol(TC), triglyceride(TG) and low-density lipoprotein cholesterol(LDL-C) were higher than those in control group(t=18.034, 20.355, 21.744, 7.991, 20.682,13.256, P<0.001); Multivariate Logistic regression analysis showed that, elevated HbA1c, TC, TG, LDL-C and miR-351 were independent risk factors for T2DM combined with CAS[OR(95%CI)=8.129(3.377-19.567), 1.444(1.093-1.908), 7.868(2.254-27.459), 2.728(1.241-5.997), 1.337(1.039-1.721)],and elevated miR-638 was protective factor [OR(95%CI)=0.046(0.006-0.337)]. ROC analysis showed that the area under the curve(AUC) of the levels of HbA1c, TC, TG, LDL-C, miR-351, miR-638 and the prediction model were 0.863, 0.670, 0.693, 0.726, 0.776, 0.655 and 0.936 respectively, the AUC of the prediction model was the largest(Z=3.468, 6.602, 5.832, 5.599, 5.064, 6.674,P<0.001); 1000="" the="" nomogram="" model="" internally="" was="" verified="" by="" bootstrap="" repeated="" sampling="" of="" b="1" showed="" that="" c-index="" suggesting="" had="" better="" predictive="" ability.="" decision="" analysis="" shows="" threshold="" probability="" and="" net="" return="" rate="">0, which was higher than two invalid lines. Conclusion The levels of serum miR-351 and miR-638 in T2DM patients are abnormally express, which are involve in the occurrence and progression of patients with CAS combine with T2DM. Elevated HbA1c, TC, TG, LDL-C, miR-351, and decreased miR-638 are independent risk factors for T2DM combine with CAS, nomogram prediction model base on miR-351, miR-638 and other independent risk factors has good predictive value for T2DM combine with CAS, which could be used to evaluate the risk of patients with CAS combine with T2DM.

Objective To establish a risk prediction model for enteral nutrition feeding intolerance(ENFI) in children with acute pancreatitis(AP) by analyzing the influencing factors. Methods A purposive sampling method was used to collect 401 children with acute pancreatitis admitted to Department of Gastroenterology, Children's Hospital Affiliated to Nanjing Medical University from June 2017 to June 2020 as the research subjects. They were divided into 280 cases in modeling groups and 121 cases in validation groups using a random number table method. The modeling group was separated into ENFI subgroup(n=113) and non-ENFI subgroup(n=167) based on whether ENFI occurred. Clinical data were collected, univariate and multivariate Logistic regression were applied to analyze the influencing factors of ENFI in children with AP; R software was applied to construct a column chart model for predicting ENFI in children with AP, and the predictive performance of the model was evaluated. Results The proportions of infants with IAP≤20 cmH2O, APACHEⅡ score≤20, serum Alb level >25 g/L, enteral nutrition start time ≤72 h, and CVP≤12 cmH2O in the ENFI subgroup were lower than those in the non-ENFI subgroup(χ2/P=8.450/0.004, 7.453/0.006, 8.717/0.003, 8.551/0.003, 6.771/0.009),while the proportion of no addition of soluble fiber was higher than non-ENFI subgroup(χ2/P=7.448/0.006); multivariate Logistic regression analysis showed that abdominal pressure>20 cmH2O, no addition of soluble fiber, serum Alb level ≤ 25 g/L, enteral nutrition start time>72 hours, and central venous pressure>12 cmH2O were independent risk factors for ENFI in AP children[OR(95%CI)=2.111(1.139-3.913), 2.019(1.036-3.935), 1.989(1.081-3.660), 1.907(1.032-3.524), 2.112(1.170-3.812)]; the validation results of the modeling group showed that the area under the ROC curve(AUC) was 0.886(95%CI 0.850-0.922), indicated good consistency between the predicted risk of ENFI in AP patients and the actual risk. The AUC for external validation was 0.890(95%CI 0.853-0.926), and the model predicted a good consistency between the risk of ENFI in AP patients and the actual risk(χ2=6.130, P=0.419). Conclusion Abdominal pressure>20 cmH2O, no addition of soluble fiber, serum Alb level ≤ 25 g/L, enteral nutrition start time>72 hours, and central venous pressure>12 cmH2O are independent risk factors affecting the occurrence of ENFI in children with AP. The prediction model constructed based on this has good predictive value and can provide reference for early prediction of the risk of ENFI in children with AP.

Objective To investigate the expression changes in Rho-related associated-coil forming protein kinase 2(ROCK2) and renalase in serum of patients with idiopathic membranous nephropathy(IMN) and their diagnostic value for IMN. Methods From January 2019 to November 2020, 120 patients with IMN admitted to the Nephrology Department of Yiling Hospital in Hebei Province were selected as the IMN group, and another 120 volunteers who underwent physical examination in the hospital during the same period were selected as healthy control group. Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of serum ROCK2 and renalase in patients with IMN, the correlation between ROCK2 and renalase levels and some clinical indicators was analyzed by Pearson's method; the value of ROCK2, renalase and their combination in the diagnosis of IMN was analyzed by receiver operating characteristic(ROC) curve. Results The levels of ROCK2, renalase in the IMN group were greatly higher than those in healthy control group(t/P=12.837/<0.001, 11.066/<0.001). Serum ROCK2 was gradually increased in patients with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ IMN(F/P=77.154/<0.001); the level of serum renalase in stage Ⅰ, Ⅱ, and Ⅲ gradually increased, but the level of serum renalase in stage Ⅳ were lower than those in stage Ⅲ(F/P=163.042/<0.001). Alb was negatively correlated with ROCK2 and renalase levels(r/P=-0.302/0.009,-0.402/<0.001). PLA2R antibody, BUN, SCr and 24 h urinary protein were positively correlated with ROCK2 and renalase levels(r=0.336/0.359, 0.264/0.284, 0.315/0.420, 0.320/0.412, 0.359/<0.001,0.284/0.010,0.420/<0.001,0.412/<0.001); ROC curve showed that the AUC of ROCK2 for the diagnosis of IMN was 0.908, the AUC of renalase for the diagnosis of IMN was 0.907, the AUC of the two combined for the diagnosis of IMN was 0.965, which was greatly higher than that of the two alone(Z=3.597,3.755, P<0.001). Conclusion Both ROCK2 and renalase are highly expressed in the serum of patients with IMN, and the combination of the two has a high value in the diagnosis of IMN.

Objective To explore the difference of erythrocyte parameters such as serum ferritin, mean corpuscular volume(MCV) and mean corpuscular hemoglobin(MCH) in patients with iron deficiency anemia(IDA) and their correlation with disease severity.Methods Clinical data of 102 IDA patients treated in the Internal Medicine Department of Maternal and Child Health Hospital of Xinjiang Uygur Autonomous Region from October 2021 to March 2023 were Retrospective analyzed. According to the severity of the disease, the patients were divided into mild to moderate IDA group(n=64) and severe IDA group(n=38). The general clinical data, iron metabolism indexes such as ferritin, serum ferritin(SF) and total iron binding capacity(TIBC), erythrocyte parameters such as mean corpuscular volume(MCV), mean corpuscular hemoglobin(MCH) and erythrocyte distribution width(RDW), reticulocyte(RET) count, RET percentage and hemoglobin content of reticulocyte(RET-He) were compared between the two groups. The differences of various indexes among patients with different prognosis were analyzed, and the risk factors of serious condition in IDA patients were screened by Spearman correlation analysis and multivariate Logistic regression analysis.Results Serum ferritin, SF, MCV, MCH, RET percentage and RET-He in severe IDA group were significantly lower than those in mild to moderate IDA group(t/P=5.091/<0.001, 5.513/<0.001, 3.191/0.002, 5.338/<0.001, 5.244/<0.001, 5.745/<0.001), while serum TIBC level, RDW and RET count were significantly higher than those in mild to moderate IDA group(t/P=4.215/<0.001, 5.770/<0.001, 3.874/<0.001). The severity of IDA patients was positively correlated with serum TIBC, RDW and RET count, and negatively correlated with serum ferritin(r/P=0.390/<0.001, 0.496/<0.001, 0.386/<0.001), SF, MCV, MCH, RET percentage and RET-He(r/P=-0.477/<0.001,-0.506/<0.001,-0.302/0.002,-0.475/<0.001,-0.466/<0.001,-0.500/<0.001). Multivariate Logistic regression analysis showed that the increase of ferritin and the level of MCH in patients with IDA were the protective factors of severe illness[OR(95%CI)=0.780(0.631-0.965), 0.556(0.328-0.941)].Conclusion There are great differences in iron metabolism, erythrocyte parameters and reticulocyte parameters in IDA patients with different severity, in which the decrease of ferritin and MCH levels may indicate that the condition of IDA patients is more serious. Monitoring related indicators will more accurately evaluate the condition of IDA patients and provide a certain guiding value for clinical treatment.