Table of Content

30 October 2025, Volume 40 Issue 10

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Changes in cathepsin C expression in peripheral blood monocyte subsets of RA patients

LUO Jing, YUAN Jiayi, YAO Xiaoyan, FAN Lieying

2025, 40(10):  933-940.  DOI: 10.3969/j.issn.1673-8640.2025.10.001

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Objective To investigate the relationship between cathepsin C（CTSC） expression in peripheral blood monocytes of patients with rheumatoid arthritis（RA） and RA. Methods A total of 78 RA patients（RA group），40 osteoarthritis（OA） patients（OA group），38 gout patients（gout group），33 systemic lupus erythematosus（SLE） patients（SLE group），34 Sjögren's syndrome（SS） patients（SS group），35 ankylosing spondylitis（AS） patients（AS group），9 psoriatic arthritis（PsA） patients（PsA group） and 42 healthy subjects（healthy control group） were enrolled from May 2023 to August 2024 at Shanghai East Hospital of Tongji University. The clinical data，including age，gender，rheumatoid factor（RF） and anti-cyclic citrullinated peptide（CCP） antibody determination results，were collected. Flow cytometry was used to determine the expression of CTSC in different cells of peripheral blood in 30 healthy subjects，37 RA patients，21 OA patients and 25 gout patients. Enzyme-linked immunosorbent assay（ELISA） was used to determine serum CTSC levels and the CTSC levels in the synovial fluid of 3 RA patients and 3 OA patients. Results The expression of CTSC in peripheral blood monocytes of RA patients was higher than that in neutrophils and lymphocytes（P<0.05）. The expression of CTSC in monocytes of RA group was higher than those in healthy control group，gout group and OA group（P<0.05）. In RA group，OA group，gout group and healthy control group，the expression of CTSC in intermediate monocytes（IM） and non-classical monocytes（NCM） was higher than that in classical monocytes（CM）（P<0.05），while there was no statistical significance between IM and NCM（P>0.05）. The expression of CTSC in CM，IM and NCM of RA patients was higher than those in OA group，gout group and healthy control group（P<0.05）. The CTSC levels in the synovial fluid of 3 RA patients（167，106 and 215 ng·mL^-1） were higher than those of 3 OA patients（28，53 and 6 ng·mL^-1）. The serum CTSC level of RA group was higher than those of OA group，SLE group，AS group and healthy control group（P<0.05）. Conclusions CTSC is highly expressed in pro-inflammatory monocytes of RA patients，and it may play a role in the pathogenesis of RA.

Consistency between calculation results of ionized calcium formula method and direct determination results of ion-selective electrode method

LIN Weiwei, XU Jingsong, ZHANG Lele, LI Min, WANG Hua

2025, 40(10):  941-945.  DOI: 10.3969/j.issn.1673-8640.2025.10.002

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Objective To investigate the consistency between the results of the formulas for calculating ionized calcium（formula method） and the direct determination results using ion-selective electrode（ISE） method. Methods The determination results of total calcium，ionized calcium，total carbon dioxide（TCO₂），bicarbonate ion（HCO₃^-），total protein（TP），albumin（Alb） and chloride ion（Cl^-） for 6 148 patients in the outpatient and inpatient departments of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July to December 2023 were collected. The ionized calcium determination results were calculated using 4 formulas [self-built formula 1（multivariate linear stepwise regression method），self-built formula 2（automatic linear modeling），Forster 1985 formula，Nordin 1989 formula] and compared with ISE method. Results The ionized calcium determination results of self-built formula 1，self-built formula 2，Forster 1985 formula and Nordin 1989 formula were all positively correlated with ISE method（r values were 0.660，0.659，0.478 and 0.222，respectively，P<0.05）. Taking the ISE method's ionized calcium determination results as the reference，the compliance threshold of formula method was set as ±10%. When the ISE method's ionized calcium determination results were 0.99-1.40 mmol·L^-1，the consistency of formula method was the highest，from high to low，they were self-built formula 1（95.93%），self-built formula 2（95.52%），Forster 1985 formula（90.78%） and Nordin 1989 formula（52.91%）. When the ISE method's ionized calcium determination results were ≤0.98 mmol·L^-1，the cosistency of formula method was <40%，and the formula method results were higher than that of ISE method（P<0.001）. When the ISE method's ionized calcium determination results were ≥1.41 mmol·L^-1，the consistency of formula method from high to low were Forster 1985 formula（76.19%），self-built formula 2（58.73%），self-built formula 1（41.27%） and Forster 1985 formula（41.27%），and the formula method results were lower than that of ISE method（P<0.001）. Conclusions When the ionized calcium level was 0.99-1.40 mmol·L^-1，except for Nordin 1989 formula，the consistency rates of the other formulas with ISE method are all relatively high. When the ionized calcium was ≤0.98 mmol·L^-1 or ≥1.41 mmol·L^-1，the differences between formula method and ISE method were significant，and the actual level of ionized calcium would be overestimated or underestimated.

Roles of GDF-15，NT-proBNP and NLR in diagnosis，severity assessment and prognosis evaluation of chronic heart failure

ZOU Zhenyang, YU Jinshu, HE Rendong, XIE Ning, GUO Bin

2025, 40(10):  946-953.  DOI: 10.3969/j.issn.1673-8640.2025.10.003

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Objective To investigate the roles of growth differentiation factor-15（GDF-15），N-terminal pro-B-type natriuretic peptide（NT-proBNP） and neutrophil-to-lymphocyte ratio（NLR） in the diagnosis，severity assessment and prognosis evaluation of chronic heart failure（CHF）. Methods A total of 113 patients with CHF（CHF group） and 43 healthy subjects（control group） were enrolled from the Affiliated Hospital of North Sichuan Medical College from July 2023 to March 2024. The clinical data were collected，and related laboratory indicators and plasma levels of GDF-15 and NT-proBNP were determined. NLR was calculated. The patients were classified into mild group [31 cases，New York Heart Association（NYHA） classification Ⅰ-Ⅱ）] and moderate-severe group（82 cases，NYHA classification Ⅲ-Ⅳ）. All the patients were followed up for 3 months，and they were classified into endpoint event group and non-endpoint event group based on whether an endpoint event（cardiogenic death or rehospitalization due to heart failure） occurred. Logistic regression analysis was used to evaluate the influencing factors of CHF occurrence，severity and endpoint event occurrence. Receiver operating characteristic（ROC） curves were used to evaluate the efficacy of single and combined determinations in diagnosing CHF，assessing the severity of CHF，and predicting endpoint events. Results The levels of GDF-15，NT-proBNP，NLR，systemic immune-inflammation index（SII），the absolute value of neutrophils（NEUT#），the absolute value of monocytes（MO#） and red blood cell volume distribution width coefficient of variation（RDW-CV） in CHF group were all higher than those in control group（P<0.05），and the absolute value of lymphocytes（LYMPH#） was lower （P<0.05）. The levels of GDF-15，NT-proBNP，NLR and NEUT# in moderate-severe group were higher than those in mild group（P<0.05）. The levels of GDF-15，NT-proBNP，NLR，RDW-CV and red blood cell distribution width-to-platelet count ratio（RPR） in endpoint event group were higher than those in non-endpoint event group（P<0.05）. GDF-15，NT-proBNP and NLR were all risk factors for the occurrence of moderate-severe CHF and endpoint events（P<0.05）. The areas under curves（AUC） of single determinations of NT-proBNP，GDF-15 and NLR for diagnosing CHF were 0.917，0.829 and 0.764，respectively. For diagnosing moderate-severe CHF，the AUC were 0.633，0.705 and 0.715，respectively. For predicting endpoint events，the AUC were 0.689，0.799 and 0.752，respectively. The AUC of combined determinations of NT-proBNP+NLR，GDF-15+NT-proBNP and GDF-15+NLR for diagnosing CHF were 0.928，0.914 and 0.827，the AUC were 0.713，0.703 and 0.761 for diagnosing moderate-severe CHF，and the AUC were 0.773，0.795 and 0.843 for predicting endpoint events，respectively. The AUC of combined determination of the 3 indicators for diagnosing CHF was 0.906. For diagnosing moderate-severe CHF，the AUC was 0.758. For predicting endpoint events，the AUC was 0.843. Conclusions GDF-15，NT-proBNP and NLR have certain value in the diagnosis，severity assessment and prognosis evaluation of CHF.

Efficiency evaluation of prostate cancer screening based on prostate-specific antigen and prostate healthy index

SHI Meifang, WU Jiong, HU Jiahua, LIU Tao, CHEN Zhenyan, DAI Jie, HUA Bao, ZOU Zheng

2025, 40(10):  954-958.  DOI: 10.3969/j.issn.1673-8640.2025.10.004

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Objective To establish a prostate cancer screening strategy based on prostate-specific antigen（PSA） and prostate healthy index（PHI），and to investigate its diagnostic efficacy. Methods A total of 112 patients with suspected prostate cancer who underwent prostate biopsy at the North Branch of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from August 2021 to July 2022 were enrolled. The patients were classified into prostate cancer group（42 cases） and benign disease group（70 cases，benign prostatic hyperplasia） based on the results of prostate biopsy. The clinical data were collected，and PSA，free prostate-specific antigen（f-PSA） and PHI were determined，and the f-PSA/PSA ratio was calculated. Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic efficacy of each indicator for prostate cancer. Results There was statistical significance in age，PSA，f-PSA，PHI，rectal examination abnormal rate and prostate volume between prostate cancer group and benign disease group（P<0.05）. The areas under curves（AUC） for PHI，PSA，f-PSA and the f-PSA/PSA ratio in diagnosing prostate cancer were 0.820，0.771，0.728 and 0.621，respectively. The cut-off value of PSA was 4 ng·mL^-1 when the negative predictive value was the highest（1.000），and the cut-off value of 10 ng·mL^-1 resulted in a positive predictive value of 0.538. The cut-off value of PHI was 55 when the positive predictive value was the highest（0.750）. Based on different cut-off values of PHI，PSA and f-PSA，prostate cancer screening strategies were constructed. The AUC of screening strategy A（PSA 4 ng·mL^-1+ PHI 55），screening strategy B（PSA 4 ng·mL^-1+PHI 27） and screening strategy C（PSA 4，10 ng·mL^-1+f-PSA 1 ng·mL^-1） for diagnosing prostate cancer were 0.710，0.757 and 0.667，respectively. The positive predictive value of screening strategy A was the highest（0.833），and the negative predictive value of screening strategy C was the highest（0.882）. Conclusions PSA combined with PHI and f-PSA can effectively improve the efficacy of prostate cancer screening.

Prognosis assessment role of monocyte-to-high-density lipoprotein cholesterol ratio in patients with myocardial infarction with non-obstructive coronary artery

ZHANG Yan, WEI Tengfei, TU Sheng

2025, 40(10):  959-964.  DOI: 10.3969/j.issn.1673-8640.2025.10.005

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Objective To investigate the role of monocyte-to-high-density lipoprotein cholesterol ratio（MHR）in the prognosis assessment of patients with myocardial infarction with non-obstructive coronary artery（MINOCA）. Methods A total of 158 MINOCA patients from the People's Hospital of Bozhou from June 1，2018 to December 31，2021 were enrolled. The clinical data and laboratory determination results were collected，and the MHR was calculated. All the patients were followed up for at least 18 months，with the longest follow-up period being 60 months. The occurrence of major adverse cardiovascular events（MACE）within 18 months after coronary arteriography was recorded. Multivariate Logistic regression analysis was used to evaluate the influencing factors of MACE occurrence in MINOCA patients for 18 months after surgery. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of MHR in predicting MACE occurrence in MINOCA patients for 18 months after surgery. The survival status of MINOCA patients was analyzed by Kaplan-Meier survival curve. Results According to the median MHR（0.47），MINOCA patients were classified into MHR≤0.47 group（79 cases）and MHR>0.47 group（79 cases）. The smoking history and triglyceride（TG），the absolute value of monocytes（MO#）in MHR>0.47 group were higher than those in MHR≤0.47 group（P<0.05），and high-density lipoprotein cholesterol（HDL-C）was lower than that in MHR≤0.47 group（P<0.01）. There was no statistical significance in the other indicators between the 2 groups（P>0.05）. The incidence of MACE within 18 months after surgery in MHR>0.47 group was higher than that in MHR≤0.47 group（P<0.05）. MHR>0.47，TG and low-density lipoprotein cholesterol（LDL-C）were independent risk factors for MACE occurrence in MINOCA patients for 18 months after surgery [odds ratios（OR）were 2.275，1.137 and 1.119，95% confidence intervals（CI）were 1.022-5.065，1.002-1.290 and 1.016-1.304，respectively，P<0.05]. The area under curve（AUC）of MHR in predicting MACE occurrence in MINOCA patients for 18 months after surgery was 0.745. The 5-year survival rate without MACE after surgery in MHR≤0.47 group was higher than that in MHR>0.47 group（Log-rank χ2= 6.905，P=0.009）. Conclusions A high MHR is related to the occurrence of MACE in MINOCA patients. MHR has certain predictive value for MACE occurrence in MINOCA patients within 18 months after surgery，and may be used as a marker for predicting poor prognosis in MINOCA patients.

Roles of serum cholinesterase，galectin-3 combined with cardiac function indicators for the prognosis evaluation of ADHF patients

ZHAO Haixia, AN Yingbo

2025, 40(10):  965-971.  DOI: 10.3969/j.issn.1673-8640.2025.10.006

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Objective To evaluate the prognosis of patients with acute decompensated heart failure （ADHF） by the combination of serum cholinesterase，galectin-3 and cardiac function indicators. Methods From August 2020 to August 2022，133 patients with ADHF at West China Hospital of Sichuan University and Beijing Haidian Hospital were enrolled. The 3-month and 1-year post-treatment periods were set as time points for short-term and long-term prognosis assessment. The patients were classified into poor short-term prognosis group，poor long-term prognosis group and good prognosis group. The differences of serum cholinesterase，galectin-3，N-terminal B-type natriuretic peptide （NT-proBNP），cardiac troponin I（cTnI）and left ventricular ejection fraction（LVEF）were compared. Multivariate Logistic regression analysis was used to evaluate the risk factors for poor short-term prognosis and poor long-term prognosis of the patients. Receiver operating characteristic（ROC）curve was used to analyze the role of combined determination of serum cholinesterase，galectin-3，NT-proBNP，cTnI and LVEF in predicting poor short-term and long-term prognosis in patients with ADHF. Results The serum cholinesterase levels and LVEF in short-term poor prognosis group and long-term poor prognosis group were both lower than those in good prognosis group（P<0.001），while the levels of galectin-3，NT-proBNP and cTnI were all higher than those in good prognosis group （P<0.001）. Renal function insufficiency，liver function insufficiency and acute coronary syndrome were independent risk factors for poor short-term prognosis（P<0.01），while renal function insufficiency and liver function insufficiency were independent risk factors for poor long-term prognosis（P<0.05）. Decreased serum cholinesterase，decreased LVEF，elevated galectin-3，elevated NT-proBNP and elevated cTnI were independent risk factors for poor short-term prognosis and poor long-term prognosis，respectively（P<0.05）. The areas under curves（AUC） for the single determinations of serum cholinesterase and galectin-3 in predicting poor short-term prognosis of patients with ADHF was 0.858 and 0.752，respectively，while the AUC for predicting poor long-term prognosis were 0.693 and 0.690，respectively. The AUC for the combined determination of serum cholinesterase，galectin-3，NT-proBNP，cTnI and LVEF in predicting poor short-term and long-term prognosis were 0.909 and 0.869，respectively. Conclusions The determination of serum cholinesterase，galectin-3，NT-proBNP，cTnI and LVEF is helpful for predicting the poor short-term and long-term prognosis of patients. The combined determination has a higher predictive value and a higher evaluation value for short-term prognosis than long-term prognosis.

Roles of serum CA125，TRAP1 and HO-1 in efficacy evaluation of targeted therapy combined with chemotherapy for patients with advanced non-small cell lung cancer

LU Xiuming, CHAI Baoying, CAO Yingqi, LIU Xin, YANG Lin

2025, 40(10):  972-977.  DOI: 10.3969/j.issn.1673-8640.2025.10.007

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Objective To investigate the roles of serum carbohydrate antigen（CA） 125，tumor necrosis factor receptor-associated protein 1（TRAP1） and heme oxygenase-1（HO-1） in the efficacy evaluation of targeted therapy combined with chemotherapy in patients with advanced non-small cell lung cancer（NSCLC）. Methods A total of 100 patients with advanced NSCLC in the Second Hospital of Qinhuangdao from June 2021 to June 2023 were enrolled. All the patients were given erlotinib（squamous carcinoma）/gefitinib（adenocarcinoma） targeted therapy combined with pemetrexed+cisplatin chemotherapy. The patients were classified into effective group（53 cases） and ineffective group（47 cases） according to therapeutic effect. The clinical data were collected，and the levels of serum CA125，TRAP1 and HO-1 were determined. Spearman correlation analysis was used to evaluate the correlation between the levels of CA125，TRAP1 and HO-1 and therapeutic effect. Logistic regression analysis was used to evaluate the influencing factors of the therapeutic effect of targeted therapy combined with chemotherapy in patients with advanced NSCLC. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of serum CA125，TRAP1 and HO-1 in judging the therapeutic effect of targeted therapy combined with chemotherapy in patients with advanced NSCLC. Results There was statistical significance in the degree of differentiation between ineffective group and effective group（P<0.05），and there was no statistical significance in age，gender，smoking history，pathological type and TNM stage（P>0.05）. The levels of serum CA125，TRAP1 and HO-1 in ineffective group were higher than those in effective group（P<0.05）. The levels of serum CA125，TRAP1 and HO-1 in patients with advanced NSCLC were negatively correlated with the therapeutic effect of targeted therapy combined with chemotherapy（r_s values were -0.522，-0.467 and -0.493，respectively，P<0.05）. The degree of differentiation，CA125，TRAP1 and HO-1 were all risk factors for the ineffectiveness of targeted therapy combined with chemotherapy in advanced NSCLC [odds ratios（OR） were 3.664，4.307，4.139 and 3.458，95% confidence intervals（CI） were 1.838-7.304，1.883-9.849，1.985-8.632 and 1.426-8.386，respectively，P<0.05]. The areas under curves（AUC） of single and combined determinations of CA125，TRAP1 and HO-1 for judging the ineffectiveness of targeted therapy combined with chemotherapy in patients with advanced NSCLC were 0.756，0.784，0.770 and 0.878，respectively. Conclusions Serum CA125，TRAP1 and HO-1 have certain predictive value in the efficacy evaluation of targeted therapy combined with chemotherapy in patients with advanced NSCLC，which may be used as the indicators for therapeutic effect prediction.

Role of combined determination of MTB-specific IFN-γ and IL-2 in auxiliary diagnosis of renal tuberculosis and differential diagnosis from urinary tract infection

SUN Qianqian, XIAO Hua, YANG Yue, MA Haolin, LI Lingzhao, LÜ Pengju

2025, 40(10):  978-981.  DOI: 10.3969/j.issn.1673-8640.2025.10.008

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Objective To investigate the role of combined determination of Mycobacterium tuberculosis（MTB）-specific interferon-gamma（IFN-γ） and interleukin（IL）-2 in the auxiliary diagnosis of renal tuberculosis and its differential diagnosis from urinary tract infection. Methods Totally，59 patients diagnosed as renal tuberculosis in clinical or laboratory settings（renal tuberculosis group） and 63 patients with urinary tract infection（control group） were enrolled from Zhengzhou Central Hospital from June 2023 to May 2024. The clean midstream urine samples were collected for MTB culture and GeneXpert MTB/RIF testing，and venous blood samples were collected for MTB-specific IFN-γ and IL-2 determinations. The efficacy of IFN-γ+IL-2 combined determination，MTB culture and GeneXpert MTB/RIF in differentiating renal tuberculosis from urinary tract infection was evaluated using receiver operating characteristic（ROC） curve. Results The secretion levels of IFN-γ and IL-2 in renal tuberculosis group were higher than those in control group（P<0.05）. The sensitivity of IFN-γ+IL-2 combined determination was 89.8%，which was higher than those of MTB culture and GeneXpert MTB/RIF testing（11.9% and 47.5%，respectively，P<0.001）. The areas under curves for differentiating renal tuberculosis from urinary tract infection by IFN-γ+IL-2 combined determination，MTB culture and GeneXpert MTB/RIF testing were 0.987，0.559 and 0.737，respectively. When the optimal cut-off values of IFN-γ and IL-2 were 4.76 and 15.375 pg·mL^-1，the sensitivity for diagnosing renal tuberculosis was 93.2%，and the specificity was 95.2%. Conclusions The combined determination of MTB-specific IFN-γ and IL-2 has high clinical value in the auxiliary diagnosis of renal tuberculosis and its differential diagnosis from urinary tract infection，providing a reference for the diagnosis of renal tuberculosis.

Influence of serum HMGB1 and IL-6 levels on pregnancy outcomes of pregnant women with periodontal disease

WEI Yuexiao, YANG Lili, GUO Fengtong

2025, 40(10):  982-986.  DOI: 10.3969/j.issn.1673-8640.2025.10.009

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Objective To investigate the influence of serum high mobility group protein B1（HMGB1） and interleukin-6（IL-6） levels on the pregnancy outcomes of pregnant women with periodontal disease. Methods From February 2022 to February 2024，200 pregnant women with periodontal disease（periodontal disease group） and 100 pregnant women with healthy periodontal status（control group） who underwent prenatal examinations at Cangzhou People's Hospital and had a gestational age <26 weeks were enrolled. The clinical data and high-sensitivity C-reactive protein（hs-CRP）determination results were collected，and serum HMGB1 and IL-6 levels were determined. The subjects were classified into favorable and adverse outcome groups. Multivariate Logistic regression analysis was used to evaluate the influencing factors of adverse pregnancy outcomes in pregnant women with periodontal disease. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of each indicator in judging the adverse pregnancy outcomes of pregnant women with periodontal disease. Results Serum HMGB1 and IL-6 levels in periodontal disease group were higher than those in control group（P<0.001）. The proportions of preterm infants，low birth weight infants and small for gestational age infants in periodontal disease group were all higher than those in control group（P<0.05），and the new born weight was lower than that in control group（P<0.001）. The proportions of complications（gestational diabetes，gestational hypertension，gestational anemia，preeclampsia） and the levels of hs-CRP，HMGB1 and IL-6 in adverse outcome group were higher than those in favorable outcome group（P<0.05）. Gestational diabetes，gestational hypertension，gestational anemia，preeclampsia and elevated hs-CRP，HMGB1 and IL-6 were all risk factors for adverse pregnancy outcomes in pregnant women with periodontal disease（P<0.05）. Based on the results of multivariate Logistic regression analysis，a combined prediction model for judging the adverse pregnancy outcomes of pregnant women with periodontal disease was constructed. The areas under curves（AUC） of serum HMGB1，IL-6 single determinations and the combined prediction model for judging the adverse pregnancy outcomes of pregnant women with periodontal disease were 0.768，0.766 and 0.839，respectively. Conclusions Elevated levels of HMGB1 and IL-6 can increase the risk of adverse pregnancy outcomes in pregnant women with periodontal disease. Serum HMGB1 and IL-6 may serve as biomarkers for evaluating the pregnancy outcomes of pregnant women with periodontal disease.

Predictive value of preoperative NLR combined with serum UA and PGE2 levels in elderly patients with hip fractures for postoperative delirium

WANG Mengru, ZHOU Lin, XING Xiqian, CUI Qianqian

2025, 40(10):  987-991.  DOI: 10.3969/j.issn.1673-8640.2025.10.010

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Objective To investigate the predictive value of preoperative neutrophil-to-lymphocyte ratio（NLR），uric acid（UA）and prostaglandin E2（PGE2） combined determination for postoperative delirium in elderly patients with hip fractures. Methods A total of 120 elderly patients with hip fractures who underwent surgical treatment at Shijiazhuang Third Hospital from April to December 2023 were enrolled. The clinical data were collected，and preoperative NLR and serum UA and PGE2 levels were determined. Within 3 d after surgery，all the patients were scored using the confusion assessment method-severity（CAM-S） delirium scale，and they were classified into delirium group（27 cases） and non-delirium group（93 cases）. Spearman analysis was used to evaluate the correlation between NLR，UA，PGE2 and American Society of Anesthesiologists（ASA） grades. Multivariate Logistic regression analysis was used to evaluate the influencing factors of postoperative delirium in elderly patients with hip fractures. The efficacy of NLR，UA and PGE2 in judging postoperative delirium in elderly patients with hip fractures was evaluated using receiver operating characteristic（ROC） curve. Results The proportion of ASA grade Ⅲ-Ⅳ，NLR and serum UA and PGE2 levels in delirium group were higher than those in non-delirium group（P<0.05）. NLR，UA and PGE2 were positively correlated with ASA grades（r_s values were 0.447，0.424 and 0.487，respectively，P<0.001）. Elevated NLR，UA and PGE2 were all risk factors for postoperative delirium in elderly patients with hip fractures（P<0.05）. The areas under curves for single and combined determinations of NLR，UA and PGE2 in judging postoperative delirium in elderly patients with hip fractures were 0.834，0.823，0.861 and 0.968，respectively. Conclusions Elevated preoperative NLR and serum UA and PGE2 levels are risk factors for postoperative delirium in elderly patients with hip fractures. The combined determination of NLR，UA and PGE2 can improve the predictive efficacy of postoperative delirium in elderly patients with hip fractures.

Roles of serum β-Klotho and nestin-1 in auxiliary diagnosis and clinical staging of endometrial cancer

LIU Yingjie, YU Qian, LI Xinyu, GUO Jia, YANG Xiaojie, DONG Xianping

2025, 40(10):  992-997.  DOI: 10.3969/j.issn.1673-8640.2025.10.011

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Objective To investigate the clinical application roles of serum β-Klotho and nestin-1 in the auxiliary diagnosis and clinical staging of endometrial cancer. Methods A total of 140 patients with endometrial cancer（endometrial cancer group），140 patients with benign uterine diseases（benign disease group） and 140 healthy females（healthy control group） were enrolled from Tangshan Maternal and Child Health Hospital from March 2019 to March 2020. According to the International Federation of Gynecology and Obstetrics staging criteria，they were classified into stage Ⅰ-Ⅱ group（88 cases） and stage Ⅲ-Ⅳ group（52 cases）. The clinical data were collected，and the levels of serum β-Klotho and nestin-1 were determined in endometrial cancer group before and after surgery，benign disease group and healthy control group. Pearson correlation analysis was used to evaluate the correlation between serum β-Klotho and nestin-1 in patients with endometrial cancer. Multivariate Logistic regression analysis was used to evaluate the influencing factors of clinical staging in patients with endometrial cancer. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of serum β-Klotho and nestin-1 in the auxiliary diagnosis of endometrial cancer and the judgment of clinical staging. Results The levels of serum β-Klotho in endometrial cancer group before surgery，benign disease group and healthy control group were increased successively（P<0.001），and the levels of serum nestin-1 were decreased successively（P<0.001）. The levels of serum β-Klotho in endometrial cancer group after surgery were higher than those before surgery（P<0.05），and the levels of serum nestin-1 were lower than those before surgery（P<0.05）. Compared with the stage Ⅰ-Ⅱ group，the proportions of poorly differentiation，lymphatic metastasis and myometrial invasion depth>1/2 and the level of serum nestin-1 in the stage Ⅲ-Ⅳ group were increased（P<0.05），and the level of serum β-Klotho was decreased（P<0.05）. There was no statistical significance in the other data between the 2 groups（P>0.05）. Poorly differentiation，myometrial invasion depth>1/2，elevated nestin-1 and decreased β-Klotho were all risk factors for stage Ⅲ-Ⅳ endometrial cancer（P<0.05）. The areas under curves（AUC） of serum β-Klotho and nestin-1 for the auxiliary diagnosis of endometrial cancer were 0.744，0.822 and 0.870，respectively，and the AUC for the judgment of clinical stage Ⅲ-Ⅳ in endometrial cancer patients were 0.714，0.800 and 0.861，respectively. Conclusions The levels of serum β-Klotho and nestin-1 in patients with endometrial cancer are abnormal，which may be used as indicators for the auxiliary diagnosis and clinical staging of endometrial cancer.

Acute promyelocytic leukemia diagnosis assisted by YOLOV8 deep learning model

LUO Yuanmei, LIU Chang, CHEN Lilong, LI Zhenzhang, YUE Yubiao, LI Yang, XU Lingqing

2025, 40(10):  998-1003.  DOI: 10.3969/j.issn.1673-8640.2025.10.012

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Objective To analyze the feasibility of using the YOLOV8 deep learning（DL） model to rapidly identify cell images of acute promyelocytic leukemia（APL）. Methods Bone marrow smears from 56 untreated patients diagnosed with APL at the Affiliated Qingyuan Hospital of Guangzhou Medical University from 2004 to 2023 were collected. Medical image capture software was used to take pictures，and 1 551 clear images were collected and labeled with cell types（ZYLXB and Other） by Make Sense software. A total of 5 041 abnormal promyelocyte images and 1 606 other-type cell images were labeled. Totally，4 033 abnormal promyelocyte images and 1 330 other-type cell images were randomly selected as the training set，and the remaining images after training were included in the validation set. A YOLOV8 DL model was established to evaluate the model's ability to rapidly identify APL cell images. Results The accuracy of the YOLOV8 DL model in identifying abnormal promyelocytes reached 91%，and the precision gradually increased with the increase of the confidence threshold，reaching a peak at approximately 0.9. Conclusions The YOLOV8 DL model can rapidly and accurately identify APL images.

Evaluation of prognosis prediction effects in acute ischemic stroke patients based on machine learning algorithms

LI Mingchao, SHEN Tong, ZHOU Binghe, DOU Xin, HU Liang, CHANG Dong, ZHANG Ze

2025, 40(10):  1004-1009.  DOI: 10.3969/j.issn.1673-8640.2025.10.013

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Objective To evaluate the roles of random forest，extreme gradient boosting，LightGBM machine learning algorithms and Logistic regression analysis in predicting the prognosis of patients with acute ischemic stroke（AIS）. Methods The demographic and clinical data of 670 AIS patients from Fudan University Pudong Medical Center from February 2022 to June 2024 were collected. The 670 patients were randomly divided into a training set（469 cases） and a test set（201 cases） at a ratio of 7∶3. Totally，4 prediction models for AIS prognosis were established using Logistic regression analysis，random forest，extreme gradient boosting and LightGBM machine learning algorithm. The prognosis predictive effects were evaluated based on receiver operating characteristic（ROC） curve，accuracy，sensitivity，specificity，F1 score，positive predictive value and negative predictive value. Results The areas under curves（AUC） of Logistic regression analysis，random forest，extreme gradient boosting and LightGBM machine learning algorithms for predicting the prognosis of AIS patients were 0.908，0.915，0.908 and 0.896，respectively. Among the 4 algorithms，the random forest algorithm had the optimal accuracy and F1 score，Logistic regression analysis had the highest specificity and positive predictive value，and LightGBM machine learning algorithm had the optimal negative predictive value. The extreme gradient boosting algorithm performed poorly in all evaluation indicators. Conclusions The AIS prognosis prediction algorithms constructed based on machine learning can early identify the prognosis of patients，but an appropriate machine learning model should be selected.

Influence of freeze-thaw treatment on determination results of thrombophilia in routine laboratory specimens

WANG Shuaili, LIU Ying, WANG Li, YUAN Li

2025, 40(10):  1010-1013.  DOI: 10.3969/j.issn.1673-8640.2025.10.014

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Objective To analyze the influence of routine laboratory specimens subjected to freezing and thawing at -20 ℃ on the determination results of thrombophilia. Methods A total of 80 sodium citrate anticoagulant plasma specimens from the First Affiliated Hospital of Xi'an Jiaotong University were collected. The levels of antithrombin（AT），protein C（PC），lupus anticoagulant（LA）and protein S（PS） were determined at the immediate time point（0 d），immediately after thawing at -20 ℃ for 3 d（3 d） and 2 h（2 h） after thawing at 4 ℃. The differences in determination results at different time points were compared. Results The levels of AT，PC and LA remained stable within 2 h after thawing at -20 ℃ for 3 d，while the level of PS was significantly decreased，but the results remained stable within 2 h after thawing. Conclusions Freezing and thawing of sodium citrate anticoagulated plasma at -20 ℃ has an impact on the determination results of PS. Clinicians should pay attention to this situation when diagnosing thrombophilia.

Distribution characteristics and drug resistance analysis of fungi isolated from clinical samples from 2019 to 2023 in Heilongjiang

CUI Lanying, GUO Dawen, YU Xiaochen, WANG Xi

2025, 40(10):  1014-1018.  DOI: 10.3969/j.issn.1673-8640.2025.10.015

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Objective To analyze the distribution and drug resistance of clinical isolates of fungi in Heilongjiang from 2019 to 2023，and to provide references for infection prevention and control and treatment. Methods A total of 34 815 clinical isolates of yeast-like fungi from 42 general hospitals in Heilongjiang were collected from the National Fungal Disease Surveillance Network from 2019 to 2023. All the isolates were identified and subjected to in vitro drug susceptibility testing. The differences in isolation rates and drug resistance of yeast-like fungi in different types of samples were compared. Results Among the 34 815 yeast-like fungi，51.01% were isolated from the intensive care unit（ICU），and the isolation rate of yeast-like fungi in sputum samples was the highest（65.23%）. Among the sterile body fluids，the isolation rates of yeast-like fungi in pus（42.92%）and blood（30.41%）were the top 2. Among the clinical isolates of Candida，Candida albicans was the most common（63.28%），followed by Candida glabrata（13.81%），Candida parapsilosis and Pichia kudriavzevii with isolation rates of 4.22% and 2.77%，respectively. The in vitro drug susceptibility test results showed that Candida glabrata was susceptible dose dependent（SDD）or resistant to fluconazole，and Pichia kudriavzevii was naturally resistant to fluconazole. The sensitivity rates of Candida albicans and Candida parapsilosis to fluconazole were relatively high（>80%），while the sensitivity rate of Candida tropicalis to fluconazole was only 65.8%. The 70.5% of Candida tropicalis isolates were wild-type to itraconazole，which was lower than that of Candida glabrata（89.3%），Candida parapsilosis（88.5%）and Pichia kudriavzevii（93.5%）. The sensitivity rates of Candida albicans，Candida parapsilosis and Pichia kudriavzevii to voriconazole （>93%） were higher than that of Candida tropicalis（67.1%）. All isolated Candida species were wild-type to amphotericin B. Conclusions The resistance rate of Candida tropicalis to azole drugs is relatively high in Heilongjiang. Itraconazole，voriconazole and amphotericin B have strong antibacterial activity against Candida species.

Research progress in molecular diagnostic techniques for respiratory tract infections

XU Ben, FENG Zhangliang, SONG Xiaojun, JIN Dazhi, CHEN Yu

2025, 40(10):  1019-1024.  DOI: 10.3969/j.issn.1673-8640.2025.10.016

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In the recent years，the incidence of respiratory infectious diseases has been on the rise. However，traditional diagnostic techniques for respiratory pathogens have limitations，such as long processing time and low determination limit. Molecular diagnostic techniques，on the other hand，offer advantages of rapidity，sensitivity and automation. This review focuses on the role of molecular diagnostic techniques in the etiological diagnosis of respiratory tract infections，and it also looks forward to the future development and direction of molecular diagnostic techniques.