Objective To investigate the predictive value of pH-corrected calcium concentration combined with immature platelet fraction(IPF) for disseminated intravascular coagulation(DIC) in elderly patients with acute upper gastrointestinal bleeding(AUGIB). Methods A total of 126 elderly patients with AUGIB who visited the Emergency Department of Beijing Jishuitan Hospital, Capital Medical University from January 2022 to January 2025 were enrolled as study subjects.They were divided into a DIC group(40 cases) and a non-DIC group(86 cases) based on the presence or absence of DIC. Serum pH-corrected calcium concentration was measured using an automatic biochemical analyzer, and IPF and other coagulation-related indicators were detected using an automatic hematology analyzer. Multivariate logistic regression analysis was used to identify independent risk factors for DIC in elderly AUGIB patients. Relative risk analysis was conducted to evaluate the impact of different levels of pH-corrected calcium concentration and IPF on DIC. The predictive value of the two indicators alone and in combination was assessed using receiver operating characteristic(ROC) curves. Results The pH-corrected calcium concentration was significantly lower, while the IPF level was significantly higher, in the DIC group compared to the nonDIC group(t = 8.963, 12.365, both P <0.001). Pearson correlation analysis showed that in elderly AUGIB patients, pH-corrected calcium concentration was significantly negatively correlated with the APACHEⅡ score(r =-0.723, P <0.001), whereas IPF was significantly positively correlated with the APACHEⅡ score(r = 0.756, P <0.001). Elevated IPF, elevated APACHEⅡscore, and elevated D-dimer were independent risk factors for DIC in elderly AUGIB patients [OR(95%CI) = 3.486(1.675-7.200), 1.752(1.198-2.568), 2.785(1.463-5.298)], while elevated pH-corrected calcium concentration and high platelet count(PLT) were protective factors [OR(95%CI) = 0.312(0.158-0.612), 0.311(0.196-0.621)]. The areas under the ROC curve(AUC) for pH-corrected calcium concentration, IPF, and their combination in predicting DIC in elderly AUGIB patients were0.828, 0.845, and 0.915, respectively. The AUC of the combined prediction was significantly higher than that of either indicator alone(Z = 2.985, 3.216;P = 0.003, <0.001). Conclusion Decreased pH-corrected calcium concentration and increased IPF are independent risk factors for DIC in elderly AUGIB patients. Combined detection of these two factors can improve predictive efficiency and provide a reference for early identification of high-risk patients.

Objective To explore the expression of serum micro RNA-26b(miR-26b), micro RNA-145(miR-145),and micro RNA-122(miR-122) in patients with liver cirrhosis(LC)-esophageal and gastric varices bleeding(EGVB) and their relationship with rebleeding. Methods A total of 173 patients with LC-EGVB who were treated in the Department of Gastroenterology of the Second Affiliated Hospital of Guilin Medical University from October 2022 to October 2024 were selected as the EGVB group. They were divided into a rebleeding group and a non-rebleeding group based on the rebleeding status during the 12-month follow-up. Another 168 patients with LC without EGVB who received concurrent treatment were designated as the control group. The q RT-PCR method was used to determine the expression levels of serum miR-26b, miR-145,and miR-122. Factors influencing rebleeding in patients with LC-EGVB and the diagnostic efficiency were explored and internally validated. Moreover, relative risk analysis was conducted to evaluate the effects of different serum miR-26b, miR-145,and miR-122 levels on rebleeding in patients with LC-EGVB. Results Compared with the control group, serum levels of miR-26b and miR-145 were significantly lower, while serum miR-122 level was significantly higher in the EGVB group(t =14.617, 9.481, 11.604, all P <0.001). According to the follow-up results, 58 cases of rebleeding occurred and 115 cases did not.The proportion of patients with severe esophageal varices, portal vein diameter, and serum miR-122 level in the rebleeding subgroup were significantly higher than those in the non-rebleeding subgroup, while serum miR-26b and miR-145 levels were significantly lower(χ2/t = 13.499, 3.031, 6.830, 7.597, 7.298;P <0.001, 0.003, <0.001, <0.001, <0.001). Severe esophageal varices, large portal vein diameter, and high serum miR-122 level were independent risk factors for rebleeding in LC-EGVB patients, while high miR-26b and high miR-145 levels were independent protective factors [OR(95%CI) = 2.856(1.155-7.064),2.106(1.067-4.157), 0.623(0.457-0.849), 0.372(0.174-0.794), 2.163(1.120-4.179)]. The AUC values for predicting rebleeding in LC-EGVB patients using serum miR-26b, miR-145, miR-122, and their combination were 0.809, 0.794, 0.812, and0.932, respectively. The combined use of these three markers significantly outperformed individual predictions(Z combinationmiR-26b = 3.966,P <0.001;Z combination-miR-145 = 4.618,P <0.001;Z combination-miR-122 = 2.950,P = 0.003). Relative risk analysis showed that patients with low expression of serum miR-26b and miR-145 had a risk of rebleeding approximately4.3 and 5.5 times higher than those with high expression, respectively. Meanwhile, patients with high expression of serum miR-122 had a risk of rebleeding approximately 5.5 times higher than those with low expression. Internal validation analysis of the predictive efficacy showed that the calibration curve closely aligned with the ideal curve, and the Hosmer-Lemeshow goodness-of-fit test result was χ2= 9.510, P = 0.393. Conclusion Serum miR-26b and miR-145 levels are decreased, while serum miR-122 level is increased in patients with LC-EGVB. Combined detection of these three markers shows higher diagnostic efficiency for rebleeding in LC-EGVB patients and may have certain clinical practicability.

Objective To construct a cancer risk prediction model for patients with chronic atrophic gastritis(CAG)complicated with Helicobacter pylori(HP) infection based on the levels of carbohydrate antigen 72-4(CA72-4), alpha-fetoprotein(AFP), and serum uric acid(SUA), and to verify its predictive efficacy. Methods A total of 122 patients with CAG combined with HP infection from January 2022 to January 2025 were prospectively enrolled, including 61 cases in the canceration group(CAG combined with gastric cancer) and 61 cases in the non-canceration group. All patients underwent testing for serum indicators including CA72-4, AFP, and SUA. Clinical data of the two groups were analyzed. Multivariate logistic regression analysis was used to identify factors influencing canceration in patients with CAG combined with HP infection. A nomogram model for predicting canceration was constructed based on the influencing factors. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive efficacy of the model. The nomogram prediction model was validated using decision curve analysis and calibration curves. Results Compared with the non-canceration group, the canceration group had a higher proportion of Kimura-Takeshimoto type O(χ2= 4.946) and HP type Ⅰ(χ2= 4.127), as well as higher levels of CA72-4(t = 5.032), carbohydrate antigen 19-9(CA19-9)(t = 4.112), AFP(t = 5.592), SUA(t = 4.017), pepsinogen Ⅰ(PGⅠ)(t =3.479), pepsinogen Ⅱ(PGⅡ)(t =2.070), carcinoembryonic antigen(CEA)(t =3.078), and aspartate aminotransferase(AST)(t = 2.412), with statistically significant differences(all P <0.05). Multivariate logistic regression analysis showed that CA72-4(OR = 1.606, 95%CI :1.182-2.183), CA19-9(OR = 1.088, 95%CI : 1.028-1.152), AFP(OR = 1.171, 95%CI :1.070-1.283), SUA(OR = 1.018, 95%CI : 1.006-1.031), and CEA(OR = 1.524, 95%CI :1.043-2.225) were independent risk factors for canceration in patients with CAG combined with HP infection(all P <0.05), while a high level of PGⅠ(OR = 0.946, 95%CI : 0.906-0.988) was an independent protective factor(P <0.05). ROC curve analysis showed that the nomogram model had an AUC of 0.926(95%CI : 0.881-0.972) for predicting canceration. Calibration curve analysis showed that the predicted curve was highly consistent with the ideal line. Decision curve analysis demonstrated that the nomogram model provided a positive net benefit within a threshold range of 0-0.92. Conclusion The nomogram model constructed based on serum indicators including CA72-4, AFP, and SUA has high predictive value for canceration in patients with CAG combined with HP infection,and can provide a scientific basis for early identification of high-risk CAG patients with HP infection and for formulating individualized intervention strategies in clinical practice.

Objective To investigate the correlation between serum semaphorin 6B(SEMA6B), E26 transformationspecific factor 2(ETS2) and inflammatory response and prognosis in patients with hepatitis B virus(HBV)-related acute-onchronic liver failure(ACLF). Methods A total of 139 patients with HBV-ACLF who were admitted to the Department of Hepatology, the First Hospital of Hunan University of Chinese Medicine from January 2023 to August 2025 were selected as the case group. According to the stage of liver failure, HBV-ACLF patients were divided into early subgroup(58 cases), middle subgroup(44 cases), and late subgroup(37 cases). In addition, 139 healthy individuals who underwent physical examination in the hospital during the same period were selected as the healthy control group at a 1:1 ratio. Serum levels of SEMA6B,ETS2, and inflammatory factors [interleukin(IL)-1β, IL-6, tumor necrosis factor-α(TNF-α)] were detected and compared between groups. The correlation between serum SEMA6B and ETS2 levels and inflammatory indexes and liver failure stage in patients with HBV-ACLF was analyzed. Based on 90-day outcomes, HBV-ACLF patients were divided into a death subgroup and a survival subgroup. Factors influencing poor prognosis and the predictive efficacy of serum SEMA6B and ETS2 levels for poor prognosis were analyzed. Results Compared with the healthy control group, serum levels of SEMA6B, IL-1β, IL-6,and TNF-α were significantly increased, while ETS2 level was significantly decreased in the case group(t = 10.021, 18.332,24.142, 32.238, 13.053, all P <0.001). Serum levels of SEMA6B, IL-1β, IL-6, and TNF-α progressively increased across the early, middle, and late subgroups, while ETS2 level progressively decreased(F = 196.132, 132.220, 273.083, 232.329, 299.660,all P <0.001). Serum SEMA6B level was positively correlated with IL-1β, IL-6, TNF-α, and liver failure stage in HBV-ACLF patients(r/rs= 0.769, 0.736, 0.800, 0.802, all P <0.001). ETS2 level was negatively correlated with IL-1β, IL-6, TNF-α, and liver failure stage(r/rs=-0.734,-0.796,-0.761,-0.883, all P <0.001). The 90-day mortality rate of the 139 patients with HBV-ACLF was 43.88%(61/139). Advanced ACLF stage, upper gastrointestinal bleeding, increased INR, increased MELD score, increased IL-6, and increased SEMA6B were independent risk factors for death in HBV-ACLF patients, while elevated ETS2 was a protective factor [OR(95%CI) = 2.328(1.077-5.031), 3.717(1.026-13.470), 4.991(1.663-14.982), 1.239(1.093-1.404), 1.155(1.024-1.303), 2.166(1.421-3.302), 0.284(0.149-0.540)]. The areas under the ROC curve for serum SEMA6B, ETS2, and their combination in predicting poor prognosis were 0.805, 0.796, and 0.898, respectively. The combined prediction demonstrated superior predictive efficacy(Z = 3.358, 3.295, both P <0.001). Conclusion Increased serum SEMA6B and decreased ETS2 levels are associated with aggravated inflammatory response and advanced liver failure stage, and are independent influencing factors for mortality. The combination of serum SEMA6B and ETS2 levels provides high predictive efficacy for prognosis.

目的 研究胃癌组织中N-乙酰基转移酶10(NAT10)、N6-甲基腺苷RNA结合蛋白1(YTHDF1)表达，分析两者与幽门螺杆菌(Hp)感染的相关性及临床预后价值。方法 选取2020年4月—2022年4月中国人民解放军总医院第四医学中心肿瘤内科治疗的胃癌患者132例，根据是否存在Hp感染分为Hp阳性组92例和Hp阴性组40例。采用免疫组织化学法检测NAT10、YTHDF1蛋白表达;分析Hp阳性胃癌组织NAT10、YTHDF1蛋白表达和胃癌患者临床病理特征的关系; Spearman等级相关分析NAT10与YTHDF1蛋白表达的相关性;采用Kaplan-Meier曲线和Cox回归分析胃癌患者预后不良的影响因素。结果 NAT10、YTHDF1蛋白阳性率比较，Hp阳性癌组织>Hp阴性癌组织>癌旁组织(χ2/P=85.881/<0.001、90.338/<0.001); Hp阳性癌组织中NAT10与YTHDF1蛋白表达呈正相关(rs/P=0.678/<0.001); TNM分期Ⅲ期的胃癌患者NAT10、YTHDF阳性率高于TNM分期Ⅰ～Ⅱ期的胃癌患者(χ2/P=8.986/0.003、8.772/0.003); Hp阳性组NAT10、YTHDF蛋白阳性率均显著高于Hp阴性组(χ2/P=39.602/<0.001,33.608/<0.001); NAT10+YTHDF1共阳性胃癌患者3年总生存率显著低于非共阳性胃癌患者(Log-Rankχ2=22.470,P<0.001);TNM分期Ⅲ期、NAT10阳性、YTHDF1阳性是胃癌患者预后不良的独立危险因素[HR(95%CI)=1.568(1.235～1.992)、1.254(1.014～1.549)、1.244(1.012～1.529)]。结论 Hp阳性胃癌组织中NAT10、YTHDF1表达上调，与TNM分期密切相关，是评估Hp阳性胃癌预后的危险因素。