Objective To explore the correlation between serum nickel striated protein(Metrnl), epithelial fatty acid binding protein(E-FABP) levels and myopenia in elderly patients with type 2 diabetes(T2DM). Methods Two hundred and forty-one patients with T2DM treated in the geriatric department of Hanyang Hospital in Wuhan from May 2020 to July 2023 were selected as the research subjects. They were divided into a sarcopenia group of 55 cases and a non sarcopenia group of 186 cases based on whether they were complicated with sarcopenia. Enzyme linked immunosorbent assay was used to detect serum Metrnl levels, and chemiluminescence immunoassay was used to detect serum E-FABP levels; Compare the serum Metrnl and E-FABP levels between two groups of patients; Pearson correlation analysis of the correlation between serum Metrnl, E-FABP levels and the characteristics of T2DM with sarcopenia; The value of Receiver Operating Characteristic(ROC) curve analysis of serum Metrnl and E-FABP levels in predicting T2DM with sarcopenia; Logistic multiple regression analysis of the influencing factors of T2DM with sarcopenia. Results The serum E-FABP, T2DM course, HOMA-IR, and SARC-F scores in the sarcopenia group were higher than those in the non sarcopenia group, while serum Metrnl, body mass index(BMI), gait speed, grip strength, and limb skeletal muscle mass index(ASMI) were lower than those in the non sarcopenia group(t/P=8.839/<0.001, 5.723/<0.001, 6.116/<0.001, 28.237/<0.001, 8.825/<0.001, 3.605/<0.001, 2.814/0.005, 15.449/<0.001, 8.111/<0.001). The serum Metrnl level is positively correlated with BMI, walking speed, grip strength, and ASMI in patients with sarcopenia(r/P=0.512/<0.001, 0.509/<0.001, 0.524/<0.001, 0.498/<0.001); It is negatively correlated with the course of T2DM, HOMA-IR, and SARC-F scores(r/P=-0.486/<0.001,-0.497/<0.001,-0.527/<0.001); The level of E-FABP is negatively correlated with BMI, walking speed, grip strength, and ASMI(r/P=-0.510/<0.001,-0.519/<0.001,-0.496/<0.001,-0.494/<0.001); There is a positive correlation between the course of T2DM, HOMA-IR, and SARC-F scores(r/P=0.501/<0.001, 0.504/<0.001, 0.492/<0.001). The AUC of T2DM with sarcopenia evaluated by serum Metrnl, E-FABP, and their combination were 0.816, 0.822, and 0.896, respectively. The combined prediction of AUC was higher than that of Metrnl and E-FABP alone(Z=1.960, 1.976, P=0.015, 0.022). Elevated E-FABP is an independent risk factor for sarcopenia in T2DM, while elevated Metrnl is a protective factor for sarcopenia in T2DM [OR(95%CI)=2.932(1.347-6.384), 0.755(0.623-0.915), all P<0.01].Conclusion The serum Metrnl levels decrease and E-FABP levels increase in elderly T2DM patients with sarcopenia, which are closely related to the occurrence of sarcopenia.

Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Hebei North University
Abstract：
Objective To study the correlation and clinical significance between the expression of EMSY transcription inhibitor(EMSY), p53 induced death domain protein 1(PIDD), and homologous recombination repair genes in non-small cell lung cancer(NSCILC) tissues. Method Eighty patients with NSCLC were treated by the Respiratory and Critical Care Medicine Department of the First Affiliated Hospital of Hebei North University from January 2022 to April 2023. Real time fluorescent quantitative PCR was used to detect the expression of EMSY, PIDD and homologous recombination repair gene human breast cancer susceptibility gene 1(BRCA1), excision repair cross complementary gene 1(ERCC1), ribonucleotide reductase subunit 1(RRM1) in cancer tissues and adjacent tissues. Pearson correlation analysis of the correlation between EMSY, PIDD expression and homologous recombination repair gene expression; Analyze the relationship between EMSY, PIDD expression and clinical pathological parameters related to NSCLC, and their value in the diagnosis of NSCLC. Results The relative expression levels of EMSY, PIDD, BRCA1, ERCC1, and RRM1 mRNA in NSCLC cancer tissues were higher than those in adjacent tissues(t/P=30.176/<0.001, 27.821/<0.001, 25.075/<0.001, 16.680/<0.001, 25.610/<0.001). The expression of EMSY and PIDD mRNA in NSCLC cancer tissue is positively correlated with BRCA1, ERCC1, and RRM1 mRNA(r/P=0.654/<0.001, 0.712/<0.001, 0.584/<0.001; 0.724/<0.001, 0.661/<0.001, 0.563/<0.001). The expression of EMSY and PIDD mRNA in low differentiation, lymph node metastasis, and TNM stage III NSCLC cancer tissues was higher than that in high differentiation, no lymph node metastasis, and TNM stage I-II NSCLC cancer tissues(t/P=13.693/<0.001, 13.380/<0.001, 12.197/<0.001; 10.289/<0.001, 11.130/<0.001, 9.405/<0.001). The AUC of EMSY, PIDD mRNA, and two combined diagnoses for NSCLC were 0.834, 0.802, and 0.906, respectively. The AUC of the two combined diagnoses was greater than that of a single indicator(Z=4.751, 5.257, P<0.001). Conclusion The increased expression of EMSY and PIDD in NSCLC cancer tissue is related to the expression of homologous recombination repair genes and adverse clinical and pathological features. The combination of the two is helpful for the diagnosis of NSCLC.

Objective To observe the clinical efficacy of blood perfusion combined with naloxone hydrochloride in the treatment of patients with acute severe sedative drug poisoning. Methods One hundred and twenty patients with acute severe sedative drug poisoning treated in the Emergency Department of Changzhi People's Hospital from July 2019 to July 2023 were selected as the study subjects. Divide into a control group and a study group using a random number table method, with 60 cases in each group. The control group received intravenous infusion of naloxone hydrochloride, while the study group received hemoperfusion treatment on the basis of the control group. Compare the clinical efficacy, wakefulness time, disappearance time of toxic symptoms, length of hospital stay, blood gas index levels [pH, arterial oxygen pressure(PaO2), arterial carbon dioxide pressure(PaCO2)], serum inflammatory factor levels [interleukin-4(IL-4), IL-6, tumor necrosis factor-α(TNF-α)] And the incidence of complications. Results The total clinical effective rate of the research group was 93.33%, higher than 76.67% in the control group(χ2/P=6.536/0.011). After treatment, the patients in the study group had shorter periods of consciousness, disappearance of toxic symptoms, and hospital stay compared to the control group(t/P=6.675/<0.001, 6.004/<0.001, 7.174/<0.001). Compared with before treatment, the PaCO2, IL-4, IL-6, TNF-α of patients after treatment were decreased, and pH, PaO2 increased(P<0.05), and the decrease/increase amplitude in the study group was greater than that in the control group(t/P=6.745/<0.001, 5.729/<0.001, 6.922/<0.001, 6.169/<0.001, 2.419/0.017, 4.291/<0.001). The total incidence of complications in the study group after treatment was 3.33%, lower than the 15.00% in the control group(χ2/P=4.904/0.027). Conclusion Hemoperfusion combined with naloxone hydrochloride can effectively improve blood gas status, reduce inflammatory reactions, and promote patient recovery in patients with acute severe sedative drug poisoning.

Objective To investigate the relationship between serum microRNA-181a-5p and miR-132-5p levels and the 3-year prognosis of patients with chronic glomerulonephritis.Methods One hundred and twenty-eight patients with chronic glomerulonephritis admitted to the Nephrology Department of the 901 Hospital of the Chinese People's Liberation Army Joint Logistics Support Force from January 2018 to April 2020 were selected as the chronic glomerulonephritis group(nephritis group) and 130 healthy individuals who underwent physical examinations were selected as the healthy control group(control group). Detect two groups of renal function indicators, serum miR-181a-5p, and miR-132-5p levels; Analyze the correlation between serum miR-181a-5p, miR-132-5p and renal function indicators, identify factors affecting poor prognosis within 3 years in patients with chronic glomerulonephritis, and evaluate the value of serum miR-181a-5p, miR-132-5p, and their combination in predicting poor prognosis within 3 years in patients with chronic glomerulonephritis. Results Compared with the control group, the levels of serum miR-181a-5p and miR-132-5p in the nephritis group were significantly reduced(t/P=47.860/<0.001, 75.095/<0.001), while the levels of serum uric acid(UA), blood urea nitrogen(BUN), blood creatinine(SCR), and cystatin C(CysC) were significantly increased. The level of glomerular filtration rate(eGFR) was significantly reduced(t=27.103, 16.387, 37.145, 47.506, 28.550, all P<0.001). Serum miR-181a-5p is positively correlated with miR-132-5p levels, while serum miR-181a-5p and miR-132-5p are negatively correlated with UA, BUN, Scr, CysC levels, and positively correlated with eGFR levels(r=0.572,-0.506,-0.514,-0.493,-0.627, 0.605,-0.498,-0.546,-0.481,-0.609, 0.612, all P<0.001). Compared with the subgroup with good prognosis, the subgroup with poor prognosis showed a significant increase in serum UA, BUN, SCr, and CysC levels, while eGFR, serum miR-181a-5p, and miR-132-5p levels significantly decreased(t=6.730, 3.596, 10.629, 7.760, 12.657, 8.881, 13.932, all P<0.001). High levels of UA, BUN, SCr, CysC, eGFR, miR-181a-5p, and miR-132-5p are risk factors for poor prognosis within 3 years in patients with chronic glomerulonephritis [OR(95% CI)=2.239(1.256-3.992), 2.768(1.237-6.194), 2.173(1.195-3.950), 1.806(1.204-2.709), 3.022(1.620-5.637), 2.565(1.349-4.879), 3.350(1.226-9.157)]. The area under the curve(AUC) of serum miR-181a-5p, miR-132-5p, and their combined prediction of poor prognosis within 3 years in patients with chronic glomerulonephritis were 0.832, 0.801, and 0.904, respectively. The AUC predicted by the combination of the two was significantly higher than that predicted by each individual(Z/P=1.714/0.043, 2.050/0.020).Conclusions Patients with chronic glomerulonephritis have lower levels of serum miR-181a-5p and miR-132-5p, which are closely related to renal function. The combination of the two can help evaluate the patient's prognosis within 3 years.

Objective To analyze the relationship between the expression of polypyrimidine binding protein 3(PTBP3), ubiquitin specific protease 28(USP28) and postoperative recurrence and metastasis in elderly breast cancer.Methods From February 2017 to February 2020, 178 elderly breast cancer patients were diagnosed and treated in the Breast Surgery Department of Liaoning Cancer Hospital. Detect the expression of PTBP3 and USP28 in tissues using immunohistochemistry. Follow up for 3 years, Kaplan Meier survival analysis showed that different expressions of PTBP3 and USP28 had an impact on the recurrence and metastasis of elderly breast cancer after surgery. Cox regression analysis of factors influencing postoperative recurrence and metastasis of elderly breast cancer.Results The positive rates of PTBP3 and USP28 in breast cancer tissues were 65.17%(116/178) and 67.42%(120/178), higher than those in adjacent tissues 12.92%(23/178) and 11.24%(20/178), with a statistically significant difference(χ2=102.080, 117.725, both P<0.001). The positive rates of PTBP3 and USP28 in TNM stage Ⅲ and moderately and poorly differentiated breast cancer tissues were higher than those in TNM stage Ⅱ and highly differentiated breast cancer tissues, and the differences were statistically significant(χ2/P=9.822/0.002, 14.606/0.001, 8.337/0.004, 28.925/<0.001). The 3-year no recurrence and metastasis rate in the PTBP3 positive group was 70.43%(81/115), lower than the 93.55%(58/62) in the negative group(Log Rankχ2=12.521, P<0.001). The 3-year recurrence and metastasis free rate in the USP28 positive group was 72.27%(86/119), lower than the 91.38%(53/58) in the negative group(Log Rank χ2=8.511, P=0.003). Cox regression analysis showed that PTBP3 positive, USP28 positive, tumor stage III, and medium and low differentiation were independent risk factors for postoperative recurrence and metastasis of breast cancer patients [OR(95%CI)=1.502(1.054-2.142), 1.642(1.107-2.435), 1.523(1.147-2.024), 1.513(1.159-1.975), all P<0.05].Conclusion The increased expression of PTBP3 and USP28 in elderly breast cancer tissues, PTBP3 positive and USP28 positive are risk factors for postoperative recurrence and metastasis of elderly breast cancer patients.