Abstract:Objective To investigate the prescription status of long-term prescriptions containing may heart failure-exacerbating medications(HFEM)in outpatients with heart failure in cardiology department and analyze its influencing factors.Methods A retrospective analysis was conducted on the prescription data of 1 559 outpatients with heart failure who visited the cardiology department of Beijing Tongren Hospital,Capital Medical University from January to December 2022.Prescriptions containing HFEM were screened according to the HFEM catalog released by the American Heart Association in 2016.The patients were divided into the HFEM group and non-HFEM group according to the presence or absence of HFEM in the prescriptions.The clinical characteristics,number of complicated diseases,main comorbidities,number of medications used and professional titles of prescribing physicians were compared between the two groups,and the influencing factors for prescribing HFEM-containing prescriptions were analyzed.Results A total of 1 559 patients with heart failure or cardiac insufficiency in the diagnosis of long-term prescriptions were included in this study,among whom 168 patients(10.8％)were prescribed HFEM(HFEM group).The number of complicated diseases in the HFEM group was higher than that in the non-HFEM group.The proportions of comorbid hypertension,diabetes mellitus,anxiety-depressive state and medication use≥5 kinds in the HFEM group were higher than those in the non-HFEM group,while the proportion of comorbid arrhythmia was lower than that in the non-HFEM group(all P<0.05).Multivariate Logistic regression analysis showed that the number of complicated diseases,comorbid diabetes mellitus,comorbid anxiety-depressive state and number of medications used were independent influencing factors for prescribing HFEM-containing prescriptions(odds ratio=0.848,6.343,5.502,1.372)(all P<0.05).Conclusions HFEM are present in 10.8％of long-term prescriptions for outpatients with heart failure in cardiology department.The number of complicated diseases,comorbid diabetes mellitus,anxiety-depressive state and number of medications used are independent influencing factors for prescribing HFEM-containing prescriptions.

Abstract:Objective To analyze the etiological distribution and prognosis of pulmonary hypertension(PH)in children without congenital heart disease.Methods A total of 34 children with PH unrelated to congenital heart disease,aged<14 years,who were admitted to the Department of Cardiology,Hebei Children's Hospital from November 2017 to May 2024 were enrolled.According to the etiologies,the patients were divided into three groups:Group A(Group 1 pulmonary arterial hypertension),Group B(Group 3 PH due to lung diseases and/or hypoxia),and Group C(Group 5 PH due to unclear or multifactorial causes).Clinical data of the children were collected,the etiological distribution was described,and survival curves were plotted to analyze the differences in survival rates.Results A total of 34 children were enrolled in this study,including 15 cases of arterial PH(Group A),14 cases of lung disease and/or hypoxia-related PH(Group B),and 5 cases in Group C,all of whom were diagnosed with methylmalonic acidemia.In Group B,the age,transcutaneous oxygen saturation,and pulmo-nary artery systolic pressure were lower than those in Group A,while the proportion of preterm infants and arterial partial pressure of carbon dioxide level were higher than those in Group A(all P<0.05).Twenty-one children were admitted to the intensive care unit for treatment due to critical conditions at admission,while the remaining children with relatively stable conditions were treated in general wards.The 1-year,3-year,and 5-year survival rates were 72.7％,72.7％,and 54.5％in Group A,49.0％,39.2％,and 39.2％in Group B,and 100.0％,75.0％,and 75.0％in Group C,respectively.The 1-year,3-year,and 5-year survival rates of children admitted to the intensive care unit were 55.7％,50.1％,and 37.6％,respectively,while those of children not admitted to the intensive care unit were 100.0％,75.0％,and 56.3％,with a statistically significant difference between the two groups(Log-rank χ2=4.700,P=0.030).For children aged 2 years and above,the 1-year,3-year,and 5-year survival rates were 87.4％,77.7％,and 64.7％,respectively,compared with 58.2％,41.4％,and 41.4％for children under 2 years of age,and the difference between the groups was statistically significant(Log-rank χ2=4.793,P=0.029).Conclusions The etiologies of PH in children are widely distributed.Children with PH often present with poor cardiac function at admission;some are critically ill and require intensive care,with an unfavorable prognosis.Lung disease or hypoxia-related PH,critical condition requiring intensive care unit admission at presentation,and young age at diagnosis are associated with poor prognosis.

Abstract:Objective To measure the medical resource redundancy status in public hospitals and its impact on medical expenses,so as to provide theoretical and practical basis for managers to effectively measure and utilize redundant resources to reasonably control medical expenses.Methods Based on the organizational redun-dancy theory,a total of 34 tertiary public general hospitals in Beijing from 2018 to 2022 were selected as the research objects.The ratio method was used to measure the redundancy status of bed,doctor and nurse resources,and a panel model was constructed to empirically analyze the impact of medical resource redundancy on medical expenses.Results 44.12％-58.82％of the hospitals were in a non-redundant state,20.59％-47.06％were in a low-redundant state,and 5.88％-23.53％were in a high-redundant state.There was a positive linear relationship between redundant resources and average cost per visit.The redundant resources of doctors and beds had a U-shaped relationship with average cost per case,while the redundant resources of nurses had an inverted S-shaped relationship with average cost per case.Conclusions Some tertiary public general hospitals in Beijing have medical resource redundancy,and when the redundant resources increase to a certain range,medical expenses will increase.Public hospitals should adhere to their public welfare,scientifically allocate resources on the basis of fully measuring medical needs,prevent excessive growth of medical resources,reasonably control medical expenses,and assume corresponding social responsibilities.

Abstract:Primary gastrointestinal stromal tumor(GIST)of the liver is extremely rare,and accurate diagnosis is challenging.A 52-year-old female patient with primary hepatic GIST was reported.The patient was admitted to the hospital due to a liver mass detected by physical examination without obvious clinical symptoms.She had a history of duodenal surgery and neurofibromatosis type 1(NF1).Laboratory tests showed normal tumor markers and liver function,and imaging showed a solid mass in the right lobe of the liver.Preoperative gastrointestinal endoscopy was normal.After elective partial hepatectomy under general anesthesia,the patient was pathologically diagnosed with spindle cell type GIST.Immunohistochemical staining showed c-Kit,CD34,CD117 and DOG-1 were positive.Imatinib was given as adjuvant therapy after surgery,and the drug was stopped after 1 year.There was no recurrence during the follow-up of 10 years.Primary hepatic GIST should be diagnosed by imaging,pathology and immunohistochemistry,and the possibility of metastasis should be excluded.Surgical resection combined with imatinib adjuvant therapy is effective.In addition,the relationship between NF1 and primary hepatic GIST needs to be further studied.This article reviews the relevant literature to provide some reference value for the clinical diagnosis,treatment and prognosis of this disease.

Abstract:In modern lifestyles,physical inactivity and changes in dietary structure have led to an increasing prevalence of obesity.As an independent chronic disease and a pathogenic factor for various chronic conditions,obesity has become a major public health issue in China.Inflammatory bowel disease(IBD)is a chronic nonspe-cific inflammatory intestinal disorder with a rising prevalence,which parallels the epidemiological trend of obesity.Therefore,this review summarizes the research progress on the relationship between obesity and IBD,aiming to better understand the role of obesity in the pathogenesis and progression of IBD and provide a theoretical basis for clinical diagnosis and treatment.

Abstract:Objective To investigate the correlation of serum long non-coding RNA(lncRNA)PSMB8-AS1 and myokine 53(MG53)levels with coronary lesion severity and prognosis in patients with acute coronary syndrome(ACS).Methods A prospective cohort study was conducted,enrolling 352 ACS patients admitted to People's Hospital of Shigatse City,Tibet Autonomous Region and Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2021 to April 2023(ACS group)and 100 healthy volunteers who underwent physical examination during the same period(control group)in People's Hospital of Shigatse City,Tiet Autonomous Region.According to the Gensini score of coronary angiography,ACS patients were divided into mild group(Gensini score≤40,120 cases),moderate group(Gensini score 41-79,162 cases)and severe group(Gensini score≥80,70 cases).The occurrence of major adverse cardiovascular events(MACEs)was followed up for 1 year.Serum lncRNA PSMB8-AS1 expression and MG53 levels were detected in all subjects within 24 h of enroll-ment.Multivariate Logistic regression was used to analyze the influencing factors of prognosis in ACS patients.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of lncRNA PSMB8-AS1 and MG53 for prognosis in ACS patients.Results The serum lncRNA PSMB8-AS1 expression and MG53 levels in the ACS group were significantly higher than those in the control group[(2.96±0.71)vs(1.36±0.33),(456±96)ng/L vs(108±20)ng/L](both P<0.05).The serum lncRNA PSMB8-AS1 expression and MG53 levels in the severe group were significantly higher than those in the moderate and mild groups(all P<0.05).During the 1-year follow-up,2 patients were lost to follow-up and 63 patients developed MACEs.The serum lncRNA PSMB8-AS1 expression and MG53 levels in the poor prognosis group were significantly higher than those in the good prognosis group(all P<0.05).High N-terminal pro-brain natriuretic peptide(NT-proBNP),high lncRNA PSMB8-AS1 expression and high MG53 level were risk factors for poor prognosis in ACS patients(all P<0.05),while high left ventricular ejection fraction(LVEF)was a protective factor(P<0.05).The areas under the curve(AUC)of lncRNA PSMB8-AS1 and MG53 for predicting prognosis in ACS patients were 0.806 and 0.862,respectively,which were higher than that of LVEF(both P<0.05),and showed no significant difference compared with that of NT-proBNP(P>0.05).The AUC of combined detection of lncRNA PSMB8-AS1 and MG53 for predicting prognosis in ACS patients was 0.953,which was higher than that of each single index(both P<0.05).Conclusion The increased serum lncRNA PSMB8-AS1 expression and MG53 levels in ACS patients are associated with severe coronary lesions and poor prognosis.Combined detection of lncRNA PSMB8-AS1 and MG53 is helpful for predicting the risk of poor prognosis in ACS patients.

Abstract:Objective To investigate the impact of radiotherapy on cardiovascular disease mortality in patients with different gastrointestinal malignant tumors.Methods A total of 621 324 patients with gastrointestinal malignant tumors were screened from the large cohort of the Surveillance,Epidemiology,and End Results database of the National Cancer Institute.Poisson regression analysis and Fine-Gray competing risk regression analysis were used to evaluate the impact of radiotherapy on cardiovascular disease mortality in patients with different gastrointestinal malignant tumors.Subgroup analysis was conducted simultaneously to identify the predictive factors of radiotherapy-related cardiovascular disease mortality.Results A total of 621 324 patients with gastrointestinal malignant tumors were enrolled,including 30 453 cases(4.9％)of esophageal cancer,53 282 cases(8.6％)of gastric cancer,452 464 cases(72.8％)of colorectal cancer,37 630 cases(6.1％)of hepatocellular carcinoma,7 979 cases(1.3％)of gallbladder cancer,and 39 516 cases(6.3％)of pancreatic cancer.Among the 106 110 patients with gastrointestinal tumors who received radiotherapy,the risk of cardiovascular disease mortality was significantly increased in patients with esophageal cancer and gastric cancer[relative risk(RR)=1.15,95％confidence interval(CI)=1.03-1.28,adjusted hazard ratio(HR)=1.15,95％CI=1.06-1.29;RR=1.19,95％CI=1.08-1.31,adjusted HR=1.11,95％CI=1.02-1.21].Compared with the general population in the United States,patients with esophageal cancer who received radiotherapy had the highest standardized mortality ratio of cardiovas-cular disease mortality.Advanced age,long disease course,male gender,and concurrent chemotherapy were associated with a higher risk of cardiovascular mortality.Conclusions Among patients with gastrointestinal malignant tumors,those with esophageal cancer and gastric cancer who receive radiotherapy have an increased risk of cardiovascular disease mortality.Advanced age,long disease course,male gender,and concurrent chemotherapy may be potential predictive factors for radiotherapy-related cardiovascular disease mortality in patients with gastroin-testinal malignant tumors.

Abstract:The establishment of intestinal microbiota in early life is a complex and critical process,which exerts a profound impact on the immune system development,metabolic function regulation and long-term health of neonates.In recent years,an increasing number of studies have shown that maternal health status,metabolic status and antibiotic use during pregnancy have important effects on the composition and function of neonatal intestinal microbiota.These maternal diseases affect the initial colonization of neonatal flora through various pathways(such as placenta,amniotic fluid,breast milk and delivery mode),and may lead to flora imbalance,thereby increasing the risk of neonatal diseases.This article reviews the recent research progress on the effects of maternal diseases during pregnancy on neonatal intestinal microbiota,introduces the research methods,main findings and long-term effects on the host,and discusses future research directions.

Abstract:Objective To explore how to help trainees quickly master the technique of tri-arm clip for wound closure after endoscopic submucosal dissection(ESD)of colorectal lesions.Methods Eight trainees who received standardized ESD training in the Department of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University from September 2024 to September 2025 were selected as subjects.A stepwise training model including theoretical lectures,video teaching,on-site observation,animal model practice and hands-on tutoring was adopted.The ability of trainees to independently complete wound closure with tri-arm clips was evaluated.The operation time of wound closure using tri-arm clips combined with ordinary metal clips and the incidence of postop-erative complications such as bleeding,perforation and infection were recorded.After training,questionnaires were used to collect trainees' evaluation and feedback.Results A total of 8 trainees were enrolled and all completed the whole stepwise training process.All trainees could independently complete wound closure with tri-arm clips after ESD.The diameter of the included wounds was(21±8)mm,and the average operation time for trainees to complete wound closure with tri-arm clips combined with ordinary metal clips was(20±11)min.No postoperative complications such as bleeding,perforation or infection occurred in any patient.All trainees reported that the training effect was significant,and the tri-arm clip wound closure technique could effectively improve their ability to manage wounds after ESD.The overall value score of the training in the Likert scale questionnaire was(4.8±0.5).Conclusion The stepwise training model can help trainees quickly master the tri-arm clip wound closure technique after endoscopic surgery.Tri-arm clip is efficient and safe for ESD wound closure,especially suitable for wounds with large area,special anatomical location,intraoperative muscular layer injury or suspected perforation,and high bleeding risk.

Abstract:Objective To investigate the effects of enteral nutrition suspension combined with bifidobacterium triple viable capsules on intestinal flora and T helper cell 17/regulatory T cell(Th17/Treg)cytokines in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with type Ⅱ respiratory failure.Methods A total of 205 elderly patients with AECOPD complicated with type Ⅱ respiratory failure admitted to Nanjing Hospital Affiliated to Nanjing Medical University from August 2023 to March 2025 were enrolled.They were divided into control group(102 cases)and treatment group(103 cases)by random envelope method.The control group received early enteral nutrition,while the treatment group was additionally given bifidobacterium triple viable capsules on the basis of early enteral nutrition.Both groups were treated continuously for 10 d.The clinical efficacy of the two groups was observed,and the nutritional indicators,intestinal flora,serum Th17/Treg cytokines and adverse reactions before and after treatment were compared.Results The total clinical effective rate of the treatment group was significantly higher than that of the control group[95.1％(98/103)vs 85.3％(87/102)](P＜0.05).In terms of nutritional indicators,the levels of albumin,total protein and hemoglobin in both groups were significantly increased after treatment compared with those before treatment,and the levels in the treatment group were significantly higher than those in the control group(all P＜0.05).Intestinal flora analysis showed that compared with before treatment,the abundance of beneficial bacteria(Bifidobacterium,Lactobacillus acidophilus)in both groups was significantly increased after treatment,while the abundance of harmful bacteria(Escherichia coli,Enterococcus)showed an opposite change;comparison between groups further confirmed that the treatment group was significantly better than the control group in optimizing flora structure(all P＜0.05).Compared with before treatment,the serum levels of interleukin-17(IL-17)and tumor necrosis factor-α(TNF-α)in both groups were significantly decreased after treatment,while the levels of IL-10 and IL-35 were significantly increased.Meanwhile,the serum levels of IL-17 and TNF-α in the treatment group were significantly lower than those in the control group,and the levels of IL-10 and IL-35 were significantly higher than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P＞0.05).Conclusion Early enteral nutrition combined with bifidobacterium triple viable capsules can effectively improve the clinical efficacy of elderly patients with AECOPD complicated with type Ⅱ respiratory failure,improve nutritional indicators and intestinal flora,regulate Th17/Treg cytokines,with good safety.

Abstract:Objective To analyze the effects of the interaction between serum nucleotide-binding oligome-rization domain-like receptor protein 3(NLRP3)and heat shock protein 70(Hsp70)on cognitive impairment in elderly patients with minor ischemic stroke(MIS).Methods A total of 219 elderly MIS patients admitted to the First Affiliated Hospital of Hebei North University from December 2024 to May 2025 were enrolled.Cognitive func-tion was assessed using the Montreal cognitive assessment scale 3 months after onset.Patients were divided into cognitive impairment group and non-cognitive impairment group.Serum NLRP3 and Hsp70 levels were compared between the two groups.Pearson correlation was used to analyze the correlation between serum NLRP3 and Hsp70.Logistic regression was used to analyze the relationship between serum NLRP3,Hsp70 and cognitive impairment.The interaction between NLRP3 and Hsp70 on cognitive impairment was analyzed.Receiver operating characteristic(ROC)curve and decision curve analysis were used to evaluate the predictive value of serum NLRP3 and Hsp70 for cognitive impairment in elderly MIS patients.Results Serum NLRP3 level in the cognitive impairment group was significantly higher than that in the non-cognitive impairment group[(137±13)ng/L vs(109±9)ng/L],and Hsp70 level was significantly lower[(22±4)μg/L vs(30±6)μg/L](both P＜0.05).Pearson correlation analysis showed that serum NLRP3 level was negatively correlated with serum Hsp70 level(r=-0.843,P＜0.05).Logistic regression analysis showed that age and serum NLRP3 were risk factors for cognitive impairment in elderly MIS patients,while education years and Hsp70 were protective factors(all P＜0.05).Interaction analysis showed that after adjusting for confounding factors,compared with low NLRP3+high Hsp70 group,the risk of cognitive impairment in high NLRP3+low Hsp70 group increased to 10.326 times.Serum NLRP3 and Hsp70 had a syner-gistic interaction effect on the risk of cognitive impairment(P＜0.05).ROC curve showed that the area under the curve of combined serum NLRP3 and Hsp70 prediction was 0.895,which was higher than that of single indicator(all P＜0.05).Decision curve showed that within the risk threshold of 0.01-0.99,the net benefit rate of combined detection of serum NLRP3 and Hsp70 was higher than that of single detection.Conclusion Serum NLRP3 is a risk factor and Hsp70 is a protective factor for cognitive impairment in elderly MIS patients.They have a synergistic interaction effect on cognitive impairment,and combined detection can improve the predictive value for the risk of cognitive impairment.

Abstract:As a highly prevalent gastrointestinal malignant tumor worldwide,colorectal cancer has a complex pathogenesis and poor prognosis.At present,conventional clinical treatment faces severe challenges such as multidrug resistance,high metastasis and recurrence rate,and serious toxic side effects.Nuclear factor erythroid 2-related factor 2(Nrf2)signaling pathway is the core regulatory hub of cellular antioxidant stress,which mediates tumor cell proliferation,invasion and metastasis in colorectal cancer and is a key target for reversing multidrug resistance in colorectal cancer.Traditional Chinese medicine has unique advantages in the prevention and treatment of colorectal cancer with multi-component,multi-target and overall regulation,and shows significant potential in inhibiting tumors,reversing drug resistance and improving prognosis.Recent studies have shown that a variety of active ingredients and compounds of traditional Chinese medicine can regulate the Nrf2 signaling pathway,induce ferroptosis and apoptosis,inhibit migration and reverse drug resistance.This paper systematically reviews the role of the Nrf2 signaling pathway in colorectal cancer,aiming to provide ideas and references for the prevention and treatment of colorectal cancer with traditional Chinese medicine.

Abstract:Metabolic-associated fatty liver disease(MAFLD)is the most common chronic liver disease worldwide,and Helicobacter pylori(Hp)is a highly prevalent intragastric colonizing bacterium.The correlation between their comorbidity has become a research hotspot.Several meta-analyses have confirmed a positive correla-tion between MAFLD and Hp infection.Basic and clinical studies suggest that Hp can aggravate MAFLD by inducing inflammatory response and insulin resistance.Early eradication of Hp can improve metabolic and inflam-matory status as well as hepatic steatosis in patients with MAFLD.Studies on traditional Chinese medicine(TCM)constitutions have confirmed that damp-heat constitution and phlegm-damp constitution are the common susceptible constitutions for both diseases.The core pathogenesis of spleen failing in transportation,damp-heat and phlegm-turbidity in comorbid patients provides a two-way confirmation of"pathogenesis-mechanism"with modern medical mechanisms.Therefore,Hp eradication therapy is expected to be a potential intervention strategy to delay the progression of MAFLD,and research on TCM constitutions of comorbid patients also provides a new direction for formulating individualized integrated TCM and western medicine diagnosis and treatment plans and improving the prevention and treatment level of comorbidity.

Abstract:Objective To investigate the clinical value of atherogenic index of plasma(AIP)in predicting lean metabolic-associated fatty liver disease(MAFLD).Methods Physical examinees who underwent health examination at The Affiliated Hospital of Inner Mongolia Medical University from January 2024 to January 2025 were enrolled.General and laboratory data were compared between patients with lean MAFLD(observation group)and lean healthy examinees(control group).Multivariate Logistic regression analysis was used to analyze factors associated with lean MAFLD in individuals with body mass index(BMI)＜23 kg/m2.Receiver operating charac-teristic curve was drawn to analyze the clinical value of each index in predicting lean MAFLD.The incidence of lean MAFLD was compared between high AIP group and low AIP group.Results A total of 56 patients with lean MAFLD(observation group)and 214 lean healthy examinees(control group)were screened.There were signifi-cant differences in age,gender,BMI,systolic blood pressure,diastolic blood pressure,alanine aminotransferase(ALT),aspartate aminotransferase,γ-glutamyl transferase,alkaline phosphatase,renal function,blood lipid,fasting blood glucose and AIP between the observation group and the control group(all P＜0.05).Multivariate Logistic regression analysis showed that age,gender,BMI,ALT and AIP were independent influencing factors for MAFLD in individuals with BMI＜23 kg/m2(all P＜0.05).The area under the curve(AUC)of combined prediction of lean MAFLD by BMI,ALT and AIP was 0.904,which was higher than that of single index prediction(Z=3.476,3.625,3.029;P=0.018,0.013,0.020).The incidence of lean MAFLD in high AIP group was higher than that in low AIP group[43.3％(42/97)vs 8.1％(14/173)](x2=46.863,P＜0.001).Conclusion AIP is an independent risk factor for MAFLD in individuals with BMI＜23 kg/m2.Combination of AIP,BMI and ALT has high clinical value in predicting MAFLD in individuals with BMI＜23 kg/m2.

Abstract:Objective To investigate the characteristics of immune reconstitution in patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and its correlation with clinical prognosis.Methods The clinical data of 208 patients who underwent allo-HSCT in the Department of Hematology,the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2022 were collected.Peripheral blood lymphocyte subsets and immunoglobulin(Ig)levels were measured before transplantation and at 30th,60th and 90th days after transplantation.The correlation between immune reconstitution and acute graft-versus-host disease(aGVHD)and overall survival was analyzed.Results The reconstitution of B cells and natural killer cells(NK cells)after allo-HSCT was faster,and the reconstitution of CD8+T cells was the second.The reconstitution of CD3+,CD4+T and Ig cells was slower than that after allo-HSCT.On the 30th day after allo-HSCT,the counts of CD4+T lymphocytes in the aGVHD group were higher than those in the non-aGVHD group[209(151,265)× 106/L vs 67(37,121)×106/L],while the counts of CD8+T lymphocytes and NK cells in the aGVHD group were lower than those in the non-aGVHD group[94(50,137)×106/L vs 185(104,280)× 106/L、158.0(113.8,306.8)×106/L vs 321.0(165.0,421.0)×106/L](all P＜0.05).The counts of CD3+T,CD8+T lymphocytes,B cells and NK cells in aGVHD group were lower than those in non-aGVHD group on the 60th day after allo-HSCT(all P＜0.05).On the 90th day after allo-HSCT,the counts of CD3+T,CD4+T,CD8+T lymphocytes and B cells in the aGVHD group were lower than those in the non-aGVHD group(all P＜0.05).The median time to aGVHD was the 41 st day after transplantation.The incidence of aGVHD was positively correlated with the counts of CD4+T lymphocytes,and negatively correlated with the counts of CD8+T lymphocytes,NK cells,IgG and IgA before the occurrence of aGVHD(all P＜0.05).The incidence of aGVHD was negatively correlated with the counts of CD3+T,CD8+T lymphocytes and B cells(all P＜0.05).The patients with higher peripheral blood CD4+cell counts(≥130.5 × 106/L)before the 41st day after transplantation had a better survival rate than those with lower peripheral blood CD4+cell counts(＜130.5 × 106/L)(P=0.016).Conclusion The immune reconstitution after allo-HSCT is correlated with the occurrence of aGVHD and overall survival,and the high CD4+T lymphocyte counts(≥130.5 × 106/L)in the early stage after allo-HSCT is associated with a better prognosis.

Abstract:Objective To investigate the correlation between serum long-chain acyl-CoA synthetase 4(ACSL4)and inter-alpha-trypsin inhibitor heavy chain 4(ITIH4)levels with neurological deficit severity and prognosis in patients with acute intracerebral hemorrhage(ICH).Methods A total of 200 ICH patients admitted to North China University of Science and Technology Affiliated Hospital from January 2020 to June 2024 were retro-spectively enrolled as the ICH group,and 150 healthy subjects who underwent physical examination during the same period were selected as the control group.According to the National Institutes of Health Stroke Scale(NIHSS)score at admission,ICH patients were divided into the mild group(36 cases),moderate group(90 cases)and severe group(74 cases).According to the modified Rankin Scale(mRS)score during follow-up,ICH patients were divided into the good prognosis group(131 cases)and poor prognosis group(69 cases).The differences in serum ACSL4 and ITIH4 levels among the above subgroups were compared.Pearson correlation analysis was used to analyze the correlation between serum ACSL4,ITIH4 levels and NIHSS,mRS scores.Multivariate Logistic regression model was used to analyze the influencing factors for poor prognosis in ICH patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum ACSL4,ITIH4 levels and their combination for the prognosis of ICH patients.Results The serum ACSL4 level in the ICH group was significantly higher than that in the control group,while the serum ITIH4 level was significantly lower than that in the control group(both P＜0.05).With the aggravation of neurological deficit in ICH patients,the serum ACSL4 level showed a gradient increase,while the serum ITIH4 level showed a gradient decrease(all P＜0.05).The serum ACSL4 level in the poor prognosis group was significantly higher than that in the good prognosis group,while the serum ITIH4 level was significantly lower than that in the good prognosis group(both P＜0.05).The NIHSS score and mRS score at admission in the poor prognosis group were significantly higher than those in the good prognosis group(all P＜0.05).Serum ACSL4 level was positively correlated with NIHSS score and mRS score(r=0.428,0.438,both P＜0.001),while serum ITIH4 level was negatively correlated with NIHSS score and mRS score(r=-0.512,-0.455,both P＜0.001).Multivariate Logistic regression analysis showed that NIHSS score,mRS score,serum ACSL4 level and serum ITIH4 level were all influencing factors for the prognosis of ICH patients(all P＜0.05).ROC curve analysis showed that the areas under the curve(AUC)of ACSL4 and ITIH4 alone for predicting poor prognosis in ICH patients were 0.753 and 0.825 respectively,and the AUC of their combination was increased to 0.874,which was superior to that of single index prediction(both P＜0.05).Conclusion The serum ACSL4 level is abnormally increased and the serum ITIH4 level is abnormally decreased in ICH patients,both of which are closely related to the severity of neurological deficit.The combination of the two has a good predictive value for the prognosis of ICH patients.

Abstract:Objective To analyze the factors related to the occurrence of intrauterine adhesions after hysteroscopic surgery versus curettage in the treatment of early missed abortion.Methods A total of 60 patients with missed abortion admitted to the Third People's Hospital of Yunnan Province from January 2024 to June 2025 were selected as the research objects.They were divided into group A and group B by random number table method,with 30 cases in each group.Group A underwent routine curettage,and group B underwent hysteroscopic removal of gestational products.The surgical indicators,postoperative human chorionic gonadotropin(HCG)levels,menstrual recovery,endometrial thickness,pulsatility index(PI)and resistance index(RI)of subendometrial blood flow,and intrauterine adhesions were compared between the two groups.Results The operation time,intraoperative blood loss,hospital stay,and postoperative vaginal bleeding time in group B were significantly shorter/less than those in group A[(10.2±2.1)min vs(14.7±2.0)min,(35.3±5.6)mlvs(46.6±5.3)ml,(5.1±0.6)d vs(6.3±0.7)d,(6.0±0.9)d vs(7.8±1.0)d](t=8.227,8.005,6.481,7.272,all P＜0.001).With the passage of time,the HCG values in both groups showed a downward trend,and the HCG values in group B at 24 h,1 week,and 1 month after surgery were significantly lower than those in group A(all P＜0.05).The menstrual recovery time and the proportion of reduced menstrual volume in group B were significantly shorter/lower than those in group A(all P＜0.05).At 3 months after surgery,the endometrial thicknesses in both groups were significantly greater than those at 1 month after surgery,and the endometrial thicknesses in group B at 1 and 3 months after surgery were significantly greater than those in group A[(5.8±0.8)mm vs(4.4±0.7)mm,(8.0±0.9)mm vs(6.2±0.8)mm](t=7.859,8.094,all P＜0.001).At 3 months after menstrual resumption,the PI and RI values in both groups were significantly lower than those at 1 month after menstrual resumption,and those in group B were significantly lower than those in group A[(1.52±0.29)vs(2.17±0.41),(0.62±0.06)vs(0.75±0.09)](t=7.089,6.583,all P＜0.001).The incidence of intrauterine adhesions in group B was significantly lower than that in group A[6.7％(2/30)vs 26.7％(8/30)](x2=4.320,P=0.038).Conclusion Compared with routine curettage,hysteroscopic surgery can reduce the occurrence of intrauterine adhesions after early missed abortion,promote endometrial repair,improve uterine hemodynamics,and is conducive to protecting patients' reproductive function.It can be used as the preferred surgical method for missed abortion.

Abstract:Objective To compare the clinical efficacy and safety of unilateral biportal endoscopy(UBE)and percutaneous endoscopic transforaminal discectomy(PETD)in the treatment of prolapsed and sequestered lumbar disc herniation.Methods A total of 202 patients with prolapsed and sequestered lumbar disc herniation who underwent surgical treatment in the Fourth Hospital of Changsha from September 2020 to January 2024 were enrolled.According to the surgical method received,the patients were divided into two groups,including 113 cases in the UBE group and 89 cases in the PETD group.The basic clinical data of the two groups were collected,and the operation time,intraoperative blood loss,number of intraoperative X-ray fluoroscopies and postoperative hospital stay were recorded respectively.The pain degree and functional recovery of the two groups were evaluated before surgery as well as at 1 d,3 months and 12 months after surgery,and the evaluation results were statistically analyzed using the visual analogue scale(VAS)score and oswestry disability index(ODI)score.The clinical efficacy of patients was evaluated and graded using the modified Macnab criteria at 3 months and 12 months after surgery.The incidence of postoperative complications in the two groups was recorded and statistically analyzed.Results The operation time and intraoperative blood loss in the UBE group were significantly less than those in the PETD group[(57±10)min vs(64±11)min;(29±8)ml vs(36±9)ml](both P＜0.05).At 3 months after surgery,the excellent and good rate in the UBE group was significantly higher than that in the PETD group[84.1％(95/113)vs 74.2％(66/89)](P=0.033).At 12 months after surgery,there was no statistically significant difference in the excellent and good rate between the two groups(P=0.173).The results of repeated measures analysis of variance showed that there were statistically significant time effects on VAS scores and ODI scores in both groups(both P＜0.001),indicating that overall,the postoperative pain of patients gradually decreased and the function continuously improved with the extension of time.The total incidence of postoperative complications in the UBE group was significantly lower than that in the PETD group[7.1％(8/113)vs 18.0％(16/89)](P=0.038).Conclusion In the treatment of prolapsed and sequestered lumbar disc herniation,UBE has more satisfactory short-term efficacy and higher surgical safety than PETD,while the two surgical methods have similar long-term clinical efficacy.

Abstract:Objective To investigate the relationship between electrocardiographic parameters T-wave peak-end interval(Tp-Te)and corrected QT interval(QTc)and the risk of malignant arrhythmia in patients with hypertrophic cardiomyopathy(HCM).Methods A total of 333 patients with HCM admitted to the 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2020 to May 2024 were retrospectively selected.According to the results of 24 h ambulatory electrocardiography,patients with malignant arrhythmia were included in the observation group(102 cases),and those without malignant arrhythmia were included in the control group(231 cases).Clinical data and electrocardiographic parameters of the patients were collected.Multivariate regression models were used to adjust for confounding factors and analyze the independent correlations of Tp-Te and QTc with malignant arrhythmia;LOWESS smoothing curves were applied to explore their relationships with heart rate variability;stratified regression was performed to evaluate the associations in different subgroups.Results The proportion of males,age,left ventricular end-systolic diameter,left atrial volume index,left atrial diameter,and interventricular septum thickness in the observation group were all higher than those in the control group,while the left ventricular end-diastolic diameter and left ventricular ejection fraction were lower than those in the control group(all P＜0.05).The Tp-Te[(109±16)ms vs(77±15)ms]and QTc[(438±36)ms vs(412±34)ms]in the observation group were significantly higher than those in the control group,and the standard deviation of normal-to-normal R-R intervals(SDNN),standard deviation of average R-R intervals(SDANN),and root mean square of successive differences in adjacent R-R intervals(RMSSD)were lower than those in the control group(all P＜0.05).Results of independent correlation analysis showed that after adjusting for confounding factors,patients with lower levels of SDNN,SDANN,and RMSSD,as well as higher levels of Tp-Te and QTc,had a higher risk of developing malignant arrhythmia(all P＜0.05).Stratified analysis showed that Tp-Te and QTc were correlated with the risk of malignant arrhythmia in all subgroups stratified by gender,age,and cardiac structure(all P＜0.05).Threshold analysis indicated that the inflection points of Tp-Te and QTc affecting the occurrence of malignant arrhythmia were 92.66 ms and 424.66 ms,respectively.Below the thresholds,the risk decreased with the increase of these parameters,while above the thresholds,the risk increased with the elevation of these parameters.Conclusions Tp-Te and QTc are independent predictors of malignant arrhythmia in patients with HCM,with clear threshold effects.Combined with reduced heart rate variability,these parameters can provide key evidence for risk stratification and early intervention in HCM patients,optimizing clinical manage-ment strategies.

Abstract:The clinical data of a patient with recurrent fever,diagnosed with Mycobacterium avium infection complicated with multiple bone destruction via bone marrow metagenomic next-generation sequencing at The First Affiliated Hospital of Hainan Medical University on July 29,2025,were analyzed,and a literature review was conducted.The patient was a 58-year-old female admitted due to"fever for more than 2 months".She had been previously hospitalized in our department for fever;Mycobacterium intracellulare was detected in the alveolar lavage fluid collected via bronchoscope,and fever subsided after anti-nontuberculous mycobacterium treatment.Half a year later,the patient developed recurrent fever,and was re-admitted due to aggravated fever.She also had repeated significant elevation of white blood cell count,but chest CT on admission showed resolution of lesions compared with previous findings.Whole-body bone scan revealed multiple bone destruction throughout the body.Bone marrow aspiration biopsy was performed,which detected Mycobacterium avium and viral infection.The patient received anti-nontuberculous mycobacterium and antiviral treatment again,and fever subsided after treatment.For patients with nontuberculous mycobacterium pulmonary disease,when systemic bone destruction occurs while pulmonary lesions resolve,the possibility of other nontuberculous mycobacterium infections complicated by bone destruction should not be ignored.