Objective To investigate the expression levels of mucin 5B(MUC5B) and matrix metalloproteinase-9(MMP-9) in patients with cholangiocarcinoma, analyze their relationship with the clinical characteristics and prognosis of the patients, and explore their clinical application value. Methods The clinical data of 160 patients with cholangiocarcinoma who were diagnosed and treated in our hospital and completed follow-up from March 2022 to October 2023 were retrospectively collected. The expression levels of MUC5B and MMP-9 were compared between cancer tissues and adjacent tissues, and were also compared among patients with different clinical characteristics. The COX regression model was used to analyze the factors influencing the prognosis of cholangiocarcinoma patients. The ROC curve was established to analyze the predictive va-lue of MUC5B and MMP-9 expression for the prognosis of cholangiocarcinoma patients. Results The expression levels of MUC5B and MMP-9 in cancer tissues were significantly higher than those in adjacent tissues(t/P=26.193/<0.001, 24.772/<0.001). The expression levels of MUC5B and MMP-9 in cancer tissues were significantly higher in patients with a family history, low differentiation, submucosal infiltration, tumor diameter >3 cm, pathological stage Ⅲ–Ⅳ, and lymph node metastasis than in those without a family history, with moderate to high differentiation, mucosal infiltration, tumor diameter ≤3 cm, pathological stage Ⅰ–Ⅱ, and without lymph node metastasis(MUC5B: t/P=3.946/<0.001, 2.924/0.004, 3.203/0.002, 5.155/<0.001, 2.816/0.005, 4.576/<0.001; MMP-9: t/P=3.348/<0.001, 2.865/<0.001, 4.642/<0.001, 6.069/<0.001, 3.062/0.003, 4.365/<0.001). Spearman correlation analysis showed that MUC5B and MMP-9 were significantly positively correlated with family history, infiltration depth, tumor diameter, pathological stage, and lymph node metastasis(MUC5B: rs/P=0.282/<0.001, 0.241/0.002, 0.374/<0.001, 0.216/0.006, 0.340/<0.001; MMP-9: rs/P=0.241/0.002, 0.329/<0.001, 0.434/<0.001, 0.218/0.006, 0.324/<0.001), and significantly negatively correlated with differentiation degree(P<0.01). Follow-up results showed that 101 out of 160 cholangiocarcinoma patients had endpoint events, with an incidence rate of 63.13%. Based on the occurrence of endpoint events, patients were divided into a favorable prognosis group(n=59) and an unfavorable prognosis group(n=101). Multivariate COX regression analysis showed that tumor diameter >3 cm, pathological stage Ⅲ–Ⅳ, elevated MUC5B, and elevated MMP-9 were independent risk factors for poor prognosis in cholangiocarcinoma patients(all P<0.05). Using the Cut-off value as the standard, the AUCs of MUC5B, MMP-9, and their combination were 0.879, 0.886, and 0.922, respectively. At the Cut-off value, the sensitivities of MUC5B, MMP-9, and their combination were 0.772, 0.752, and 0.881, respectively; the specificities were 0.831, 0.898, and 0.797, respectively. Conclusion Both MUC5B and MMP-9 are highly expressed in patients with cholangiocarcinoma, and are associated with family history, differentiation degree, infiltration depth, tumor diameter, pathological stage, and lymph node metastasis. Tumor diameter >3 cm, pathological stage Ⅲ–Ⅳ, elevated MUC5B, and elevated MMP-9 are independent risk factors for poor prognosis. MUC5B and MMP-9 demonstrate good predictive value for the prognosis of cholangiocarcinoma patients, and their combined use can improve the sensitivity of auxiliary diagnosis.

Department of Critical Care Medicine,the Second Affiliated Hospital of Hainan Medical University

Objective To investigate the predictive value of machine learning(ML) models that integrate aortic computed tomography angiography(CTA) parameters and clinical variables for re-dilation in patients with residual aortic dissection(rAD) after ascending aortic replacement. Methods A total of 156 patients with aortic dissection(AD) who underwent ascending aortic replacement at Beijing Anzhen Hospital between September 2017 and October 2020 were retrospectively included. Patients were randomly and stratifiedly divided into a training set and a validation set at a 7:3 ratio. Aortic CTA-derived parameters were manually measured, and clinical variables were collected. Feature selection was performed using univariate logistic regression and least absolute shrinkage and selection operator(LASSO) regression. Subsequently, prediction models were constructed using random forest(RF), extreme gradient boosting(XGBoost), and support vector machine(SVM). Model performance was evaluated using the area under the receiver operating characteristic curve(AUC). Results After a median follow-up of 4.7 years, re-dilation events occurred in 36 patients(23.1%). Following feature selection, height, history of hypertension, number of entry tears, maximum true lumen diameter at the iliac bifurcation level, and false lumen area at the iliac bifurcation level were included in the ML models. In the training set, the AUCs of the RF, SVM, and XGBoost models were 1.000(1.000-1.000), 0.932(0.865-0.984), and 1.000(1.000-1.000), respectively. In the validation set, the corresponding AUCs were 0.865(0.703-0.978), 0.855(0.706-0.967), and 0.795(0.598-0.936), respectively. Conclusion The ML models developed in this study demonstrate potential utility for prognostic prediction in patients with rAD after ascending aortic replacement. Among them, the RF model showed the best performance in the validation set, which may contribute to improved clinical management of patients with rAD.

Department of Neurology,The 901st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army

Objective To explore the efficacy of self-designed Xingnao Fuyuan Decoction combined with piracetam in patients with vascular dementia(VD) after cerebral infarction(CI), and to investigate its effects on serum neuregulin-1(NRG-1) and angiopoietin-like protein 4(ANGPTL4) levels. Methods A total of 100 patients with VD after CI were selected and randomly divided into a control group and an observation group according to a random number table, with 50 cases in each group. The control group was treated with piracetam, while the observation group received self-designed Xingnao Fuyuan Decoction combined with piracetam. Therapeutic efficacy and changes in serum NRG-1 and ANGPTL4 levels were compared between the two groups. Results The total effective rate in the observation group was significantly higher than that in the control group(96.0% vs. 80.0%, χ2=6.061, P=0.014). After treatment, the scores of the Mini-Mental State Examination(MMSE), Montreal Cognitive Assessment(MoCA), and Modified Hasegawa Dementia Scale(HDS-R) in the observation group were significantly higher than those in the control group(t=7.171, 4.262, 5.891; all P<0.05), while the Clinical Dementia Rating(CDR) score was significantly lower(t=4.596, P<0.05). After treatment, whole blood high-shear viscosity, whole blood low-shear viscosity, and plasma viscosity in the observation group were significantly lower than those in the control group(t=2.965, 3.570, 3.242; all P<0.05). After treatment, serum NRG-1 and ANGPTL4 levels in the observation group were significantly higher than those in the control group(t=5.949, 3.904; both P<0.05). Conclusion The combination of self-designed Xingnao Fuyuan Decoction and piracetam demonstrates good clinical efficacy in patients with VD after CI. It can improve cognitive function, reduce the severity of dementia, and lower blood viscosity. The mechanism may be related to the regulation of serum NRG-1 and ANGPTL4 levels.