Objective To explore the correlation between serum Dephosphorylation uncarboxylated matrix Gla protein(dp-ucMGP), osteocalcin(OC) levels and intracranial calcification of internal carotid artery in patients with ischemic stroke. Methods One hundred and seventy-two patients with ischemic stroke who were admitted to the Neurology, the Second Hospital of Baoding City, Hebei Province from December 2020 to October 2022 were selected as the research objects. The vascular wall calcification score was divided into 37 cases of no calcification group, 95 cases of mild calcification group, and 40 cases of severe calcification group. Collect clinical data of patients; Detect serum biochemical indicators and levels of dp-ucMGP and OC in patients; Analyze the correlation between serum levels of dp-ucMGP and OC with age, smoking history, and 25-hydroxyvitamin D [25(OH) D] in patients with ischemic stroke. Logistic regression analysis is used to identify the risk factors for intracranial carotid artery calcification in patients with ischemic stroke. The receiver operating characteristic curve(ROC) is used to analyze the predictive value of serum levels of dp-ucMGP and OC for mild and severe intracranial carotid artery calcification in patients with ischemic stroke. Results Compared with the non calcification group, the mild calcification group and the severe calcification group showed an increase in age, smoking history, and a decrease in 25(OH) D levels(F=5.901,P=0.003,χ2=8.963, P=0.011, F=33.403, P<0.001); Compared with the mild calcification group, the severe calcification group showed a decrease in 25(OH) D levels(P<0.05). The levels of serum dp-ucMGP and OC in the non calcification group, mild calcification group, and severe calcification group increased sequentially(F/P=101.057/<0.001, 11.668/<0.001). The serum dp ucMGP level was significantly positively correlated with OC(r/P=0.563/<0.001). High levels of dp-ucMGP and OC are risk factors for intracranial carotid artery calcification in ischemic stroke patients [OR(95% CI)=2.329(1.510-3.591), 1.735(1.010-2.980)]. The serum levels of dp-ucMGP and OC, as well as their combined prediction of AUC for mild calcification in the intracranial segment of the internal carotid artery in patients with ischemic stroke, were 0.857, 0.825, and 0.913, respectively. The combined AUC of the two was greater than the AUC predicted separately(Z/P=2.869/0.004, 2.861/0.004). The serum levels of dp-ucMGP, OC, and their combined prediction of severe calcification in the intracranial segment of the internal carotid artery in patients with ischemic stroke were 0.876, 0.809, and 0.945, respectively. The combined AUC of the two was greater than the AUC predicted separately(Z/P=2.314/0.021, 3.012/0.003). Conclusion The serum levels of dp-ucMGP and OC in patients with ischemic stroke increase with the degree of calcification in the intracranial segment of the internal carotid artery, which has certain predictive value for the degree of calcification in the intracranial segment of the internal carotid artery.

Objective To analyze the value of various qualitative and quantitative new indicators of lung ultrasound A-line in the differential diagnosis of Emphysema patients and healthy lungs. Methods From December 2021 to August 2022, 26 patients diagnosed as Emphysema in the People's Hospital of Hebei Province were included in the Emphysema group, and 30 subjects with similar age and no lung disease in the same period were selected as the healthy control group. Two groups of subjects were examined by lung ultrasound, and the vertical distance between the pleural line at the right front chest wall and the first A-line(dP-A1), and the vertical distance between the first and second A-lines(dA1-A2) were measured, Measure the pleural sliding degree(PSD) and diaphragm movement degree(DD) of the right midaxillary line; Switch the M mode to observe whether it is a "coastal sign" or "stratospheric sign". Draw the receiver operating characteristic curve(ROC) to analyze the diagnostic efficacy of each ultrasonic index for Emphysema. Results The dP-A1, dA1-A2,PSD and DD in the Emphysema group were significantly lower than those in the healthy control group(t/U=4.631, 4.435, 4.264, 2.038,P<0.01 or 0.05), with a higher proportion of stratospheric signs compared to the control group(χ2=9.231, P=0.002); The cutoff values of dP-A1, dA1-A2, PSD and DD were 17.7 mm, 16.7 mm, 12.13 mm and 14.05 mm respectively, and the AUC values for diagnosis of Emphysema were 0.790, 0.787, 0.833 and 0.659 respectively. Conclusion Lung ultrasound has a good diagnostic value for Emphysema. The A-line spacing and pleural slip index of lung ultrasound are better than the index of diaphragm mobility.

Objective To analyze the level and clinical significance of serum Rho associated Coiled coil protein kinase 1(ROCK1) and agouti associated neuropeptide(AgRP) in patients with chronic obstructive pulmonary disease(COPD) and pulmonary hypertension(PH). Methods One hundred and fifty COPD patients admitted to the Department of Respiratory and Critical Care of the Fifth Affiliated Hospital of Xinjiang Medical University from January 2020 to July 2022 were selected as the COPD group, and were divided into 39 cases of PH subgroup and 111 cases of non PH subgroup according to whether PH was combined or not; Another 60 healthy volunteers who underwent physical examination during the same period were selected as the healthy control group. Detection of serum ROCK1, AgRP, and inflammatory factors [interleukin(IL-1)-1β, IL-6, IL-8, tumor necrosis factor-α(TNF-α)] level and pulmonary function(FEV1% and FEV1/FVC). Pearson/Spearman correlation analysis was used to analyze the correlation between serum ROCK1, AgRP, lung function indicators, and inflammatory factors in patients with COPD combined with PH. Multivariate logistic regression analysis was used to analyze the influencing factors of COPD combined with PH. The evaluation value of serum ROCK1, AgRP levels on COPD combined with PH was evaluated by ROC. Results Compared with the healthy control group, the serum levels of ROCK1 and IL-1β, IL-6, IL-8, TNF-α was higher in the COPD group, the AgRP level and FEV1%, FEV1/FVC was lower(t=26.657, 26.350, 15.690, 12.567, 15.987, 17.235, 27.639, 26.348, all P<0.001). Compared with non PH subgroups, the serum levels of ROCK1 and IL-1β, IL-6, IL-8, TNF-α was higher in the PH subgroup, the AgRP level and FEV1%, FEV1/FVC was lower(t=5.858, 4.503, 5.045, 4.455, 4.472, 6.048, 4.207, 5.206, all P<0.001). Serum ROCK1 in COPD patients with PH is negatively correlated with FEV1%, FEV1/FVC, there is a positive correlation with IL-1 β, IL-6, IL-8, TNF-α(r=-0.647,-0.689, 0.672, 0.656, 0.710, 0.624, all P<0.001); AgRP is positively correlated with FEV1%, FEV1/FVC, and there is a negative correlation with IL-1 β, IL-6, IL-8, TNF-α(r=0.627, 0.705,-0.607,-0.601,-0.661,-0.610, all P<0.001). High FEV1%, FEV1/FVC, and AgRP are independent protective factors for COPD patients with concomitant PH, IL-1 β high, IL-6 high, IL-8 high, TNF-α high and high ROCK1 are independent risk factors [OR(95% CI)=0.877(0.770-0.999), 0.820(0.710-0.946), 0.552(0.359-0.850), 1.156(1.025-1.303), 2.011(1.160-3.485), 1.161(1.032-1.307), 1.107(1.025-1.197), 1.487(1.102-1.875)]. The area under the curve of serum ROCK1, AgRP levels, and binomial combination prediction for COPD combined with PH were 0.777, 0.769, and 0.853, respectively. The AUC of binomial combination was higher than that of single prediction(Z=2.410, 2.598, P=0.016, 0.009). Conclusion The decrease in serum ROCK1 levels and the increase in AgRP levels in patients with COPD combined with PH are related to decreased lung function and inflammatory response. The combination of ROCK1 and AgRP has high value in evaluating COPD combined with PH and may become an auxiliary diagnostic indicator.

Objective To analyze the risk factors of gastrointestinal dysfunction in patients with acute respiratory failure(ARF) and build a prediction model. Methods Four hundred and fifty-two elderly patients with ARF who were admitted to the Emergency Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2018 to August 2022 were selected. The gastrointestinal function of the patients was evaluated with acute gastrointestinal dysfunction(AGI) score and divided into 136 cases in the non-obstacle group and 316 cases in the obstacle group. Collect clinical data from patients, use binary logistic regression to analyze the risk factors for gastrointestinal dysfunction in elderly ARF patients, and construct a predictive model for gastrointestinal dysfunction in elderly ARF patients based on these risk factors. The Hosmer Lemeshow(H-L) test and the Receiver Operating Characteristic Curve(ROC) test are used to test the calibration and discrimination of the predictive model. Results There were 136 cases with AGI grade 1, 152 cases with AGI grade 2, 101 cases with AGI grade 3, and 63 cases with AGI grade 4. A total of 316 cases developed gastrointestinal dysfunction, with an incidence rate of 69.91%. There was a statistically significant difference in age, ARF etiology, abdominal infection, nutritional support, ICU hospitalization time, APACHE II score, SOFA score, PCT, CRP, DAO, D-lactate, and IFABP between the two groups(P<0.05). Age, sepsis, high SOFA score, high D-lactate, and high IFABP are risk factors for gastrointestinal dysfunction in elderly ARF patients [OR(95%CI)=2.273(1.480-3.491), 2.175(1.467-3225), 1.900(1.294-2.790), 1.540(1.173-2.023), and 1.489(1.158-1.913)]. The predictive model predicts that the area under the curve for gastrointestinal dysfunction in elderly ARF patients is 0.840(95% CI 0.803-0.873, P<0.05), and the H-L test P=0.109. According to the regression coefficient, the predicted score of risk factors was calculated, and the optimal critical value was 2 points. The area under the curve was 0.848(95% CI 0.811-0.880, P<0.05). Conclusion Age, sepsis, high SOFA score, high D-lactate, and high IFABP are risk factors for gastrointestinal dysfunction in elderly ARF patients. Based on this, establishing a predictive model has good predictive power.

Objective To analyze the early predictive value of urinary insulin-like growth factor binding protein-7(IGFBP-7) and tissue inhibitor of metalloproteinase-2(TIMP-2) in acute renal injury(AKI) in sepsis.Methods Fifty-eight patients with sepsis admitted to the Emergency Department of Shanxi Provincial People's Hospital from January 2020 to December 2021 were selected and divided into a sepsis AKI group of 22 cases and a non AKI group of 36 cases according to KDIGO's diagnostic criteria. Collect urine and blood samples from patients at 0 h, 24 h, 48 h, and 72 h after enrollment, and detect levels of urine creatinine(SCr), IGFBP-7, and TIMP-2. Analyze the correlation between SCr, urinary IGFBP-7, TIMP-2, and sepsis AKI. The diagnostic value of receiver operating characteristic curve(ROC) analysis of SCr, urinary IGFBP-7, and TIMP-2 in early acute kidney injury in sepsis.Results Compared with the non AKI group, the levels of SCr, urinary IGFBP-7, and urinary TIMP-2 in the AKI group increased at all time points, with statistically significant differences(F/P=147.848/<0.001, 330.849/<0.001, 136.777/<0.001). SCR was positively correlated with urinary IGFBP-7 and urinary TIMP-2(r/P=0.680/<0.001, 0.392/0.002), while urinary IGFBP-7 was positively correlated with urinary TIMP-2(r/P=0.618/<0.001). ROC curve analysis showed that the area under the curve(AUC) of SCr, urinary IGFBP-7, urinary TIMP-2, and urinary IGFBP-7/TIMP-2 in predicting sepsis AKI were 0.586, 0.907, 0.738, and 0.914, respectively. Urinary IGFBP-7 and urinary IGFBP-7/TIMP-2 were superior to SCr(Z/P=4.117/<0.001, 4.196/<0.001). Urinary IGFBP-7 and urinary IGFBP-7/TIMP-2 are better than urinary TIMP-2(Z/P=2.663/0.008, 3.378/0.008).Conclusion Urinary IGFBP-7, urinary TIMP-2, and urinary IGFBP-7/TIMP-2 can all be used as indicators for early prediction of acute kidney injury in sepsis, and the predictive value of urinary IGFBP-7 and urinary IGFBP-7/TIMP-2 is superior to urinary TIMP-2.