Abstract:Coronary atherosclerotic heart disease is one of the major diseases threatening human health.There is a mutual promoting relationship between the decline of renal function and the occurrence and development of coronary atherosclerotic heart disease.The ratio of serum creatinine to cystatin C(CCR)is a new marker for evaluating renal function.Compared with a single index,CCR has obvious advantages.In recent years,CCR has also attracted much attention in the study of coronary atherosclerotic heart disease.Domestic and foreign studies have found that the reduction of CCR is related to the risk of coronary atherosclerotic heart disease and the severity of coronary artery disease,the risk of adverse cardiovascular events,the risk of adverse events during and after coronary artery reconstruction,and aortic sclerosis.Therefore,it can be used as an effective index for the early diagnosis,condition evaluation and prognosis of coronary atherosclerotic heart disease.This article summarizes the relationship between CCR and the occurrence and development of coronary atherosclerotic heart disease,and reviews its research progress in coronary atherosclerotic heart disease,in order to provide a new direction for the diagnosis and treatment of coronary atherosclerotic heart disease.

Abstract:Objective To explore the risk factors of thrombosis in patients with essential thrombocythemia(ET)and to construct a visual risk prediction model.Methods The clinical data of 156 ET patients admitted to Xiyuan Hospital,China Academy of Chinese Medical Sciences from January 2022 to December 2024 were retro-spectively analyzed.According to the presence or absence of thrombosis,the patients were divided into thrombosis group(44 cases)and non-thrombosis group(112 cases).Univariate and multivariate Logistic regression methods were used to analyze the risk factors of thrombosis,and a risk prediction model was constructed.Results The proportion of age ≥60 years,hypertension and hyperlipidemia,JAK2 mutation,white blood cell count,neutrophil count(NEUT),and neutrophil-to-lymphocyte ratio in the thrombosis group were significantly higher than those in the non-thrombosis group(all P＜0.05).Multivariate Logistic regression analysis showed that age ≥ 60 years(odds ratio=3.08,95％confidence interval:1.20-7.92),splenomegaly(odds ratio=3.04,95％confidence interval:1.06-8.71),hyperlipidemia(odds ratio=3.06,95％confidence interval:1.20-7.80)and high NEUT(odds ratio=1.35,95％confidence interval:1.20-1.52)were independent risk factors for thrombosis in ET patients(all P＜0.05).Based on the results of multivariate Logistic regression analysis,a nomogram model was constructed to predict the risk of thrombosis in ET patients.The area under the receiver operating characteristic curve was 0.922(95％confidence interval:0.834-0.971),the specificity was 81.3％,the sensitivity was 93.2％,and the Youden index was 0.744.The Hosmer-Lemeshow goodness of fit testx2=6.32,P=0.612.The calibration curve showed that the predicted probability of the model was in good agreement with the observed frequency.Conclusion Elevated NEUT,age ≥60 years,hyperlipidemia and splenomegaly are independent risk factors for thrombosis in ET patients.The nomogram model based on these factors has a good predictive ability and can be used as an important tool for thrombosis risk stratification and clinical decision-making in ET patients.

Abstract:Objective To investigate the relationship between D-dimer to fibrinogen ratio(DFR),fibrinogen to albumin ratio(FAR)and the outcome of fetal protection in patients with recurrent spontaneous abortion(RSA).Methods A total of 100 patients with RSA in the First Affiliated Hospital of Zhengzhou University from May 2022 to November 2024 were selected as the observation group,and 100 healthy pregnant women in the same period were selected as the control group according to 1∶1 matching.The DFR and FAR of the two groups were compared,and the clinical data,DFR and FAR of patients with different tocolysis outcomes in the observation group were compared.Logistic regression was used to analyze the influencing factors of tocolysis outcomes in RSA patients,and restricted cubic spline was used to analyze the nonlinear relationship between DFR,FAR and tocolysis outcomes in RSA patients.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of DFR and FAR for the outcome of RSA.Results The DFR and FAR of the observation group were higher than those of the control group[(0.29±0.06)vs(0.15±0.04),(0.25±0.05)vs(0.12±0.03)](t=19.415,22.295,both P＜0.05).The previous history of induced abortion,the proportion of abortion times＞3,DFR and FAR of patients with failed tocolysis were higher than those of patients with successful tocolysis,and the proportion of more previous abortion time was lower than that of patients with successful tocolysis(all P＜0.05).Before and after propensity score matching method was used to adjust the variables such as previous history of induced abortion,number of abortions,and time of tocolation,Logistic regression analysis showed that DFR and FAR were the influencing factors of tocolation outcome in RSA patients(both P＜0.05).The levels of DFR and FAR had a nonlinear relationship with the risk of failed tocolysis in RSA patients(both P＜0.05).When DFR≥0.25 and FAR≥0.20,the risk of failed tocolysis in RSA patients increased with the increase of DFR and FAR levels(both P＜0.05).The results of ROC analysis showed that the area under the curve of DFR,FAR alone and in combination to predict the tocolysis outcomes in RSA patients was 0.752,0.745 and 0.881,respectively.Conclusion DFR and FAR have a nonlinear relationship with the outcome of fetal protection in RSA patients.When DFR≥0.25 and FAR≥0.20,the risk of fetal protection failure in RSA patients increases,and the two can be used to assist in evaluating the outcome of fetal protection in patients.

Abstract:Objective To investigate the efficacy of levosimendan and recombinant human brain natriuretic peptide in patients with acute myocardial infarction(AMI)complicated with heart failure and its effect on brain natriuretic peptide(BNP)and cardiac function.Methods A total of 120 patients with AMI complicated with heart failure admitted to the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to January 2025 were selected,and they were divided into single-drug group(levosimendan treatment)and combination group(levosimendan combined with recombinant human brain natriuretic peptide treatment)by random number table method,with 60 cases in each group.The therapeutic effects,levels of cardiac troponin I(cTnI),BNP,soluble tumor suppressor protein 2(sST2),urotensin Ⅱ,interleukin-1β(IL-1β),matrix metalloproteinase 9(MMP-9),high sensitive C-reactive protein(hs-CRP),cyclophilin A,left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were compared between the two groups.The adverse drug reactions of the two groups were analyzed.Results The total effective rate of the combination group was significantly higher than that of the single-drug group[93.3％(56/60)vs 80.0％(48/60)](P=0.032).After treatment,the levels of BNP,cTnI and sST2 in the two groups decreased,and the level of urotensin Ⅱ increased,and the comparison between the two groups showed that the combination group was better(all P＜0.05).After treatment,the levels of LVEDD and LVESD in the two groups reduced,and the level of LVEF increased,and the comparison between the two groups showed that the combination group was better(all P＜0.05).The levels of IL-1 β,MMP-9,hs-CRP and cyclophilin A in the two groups decreased after treatment,and the comparison between the two groups showed that the combination group was lower(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Levosi-mendan combined with recombinant human brain natriuretic peptide in the treatment of AMI complicated with heart failure can significantly reduce the level of BNP,improve the cardiac function of patients,alleviate the inflammatory response,improve the clinical efficacy,and has good safety.

Abstract:Objective To compare the clinical efficacy and safety of the VDPAP regimen(vincristine+daunorubicin+pegaspargase+prednisone)and the VDLP regimen(vincristine+daunorubicin+L-asparaginase+prednisone)in the treatment of children with acute lymphoblastic leukemia(ALL).Methods A total of 146 children with ALL who received chemotherapy at Hainan General Hospital from March 2019 to March 2024 were enrolled.They were divided into a control group and an observation group using a random number table,with 73 cases in each group.The control group was treated with the VDLP regimen,while the observation group was treated with the VDPAP regimen.The treatment response rate,blood routine parameters[white blood cell count(WBC),platelet count(PLT),red blood cell count(RBC),and hemoglobin],coagulation function indices[activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),and fibrinogen(FIB)],fibrinolytic indices[plasminogen,tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),and fibrin degradation products(FDP)],serum inflammatory factors[interleukin-6(IL-6),IL-8,high-sensitivity C-reactive protein(hs-CRP),and interferon-γ],serum tumor-specific growth factor(TSGF),vascular endothelial growth factor(VEGF),and incidence of adverse reactions were compared between the two groups.Results There was no statistically significant difference in the treatment response rate between the two groups(P＞0.05).After treatment,the levels of PLT,RBC,APTT,t-PA,PAI-1,and interferon-γ in the observation group were significantly higher than those in the control group,while the levels of WBC,FIB,IL-6,IL-8,hs-CRP,TSGF,and VEGF were significantly lower than those in the control group(all P＜0.05).The incidence of allergies in the observation group was significantly lower than that in the control group[1.4％(1/73)vs 11.0％(8/73)](P＜0.05).Conclusion Both the VDLP and VDPAP regimens are effective in the treatment of children with ALL.Compared with the VDLP regimen,the VDPAP regimen can improve blood routine parameters,inhibit the inflammatory response,and downregulate the serum levels of TSGF and VEGF,with higher safety.However,the VDPAP regimen has a more significant impact on the coagulation function and fibrinolytic indices of children with ALL,so clinicians should select an appropriate regimen based on the children's specific conditions.

Abstract:Objective To observe the effect of proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors combined with atorvastatin on angina pectoris after percutaneous coronary intervention(PCI).Methods A total of 225 patients with angina pectoris after PCI in the Department of Cardiology,The Second People's Hospital of Hengshui,Hebei Province from April 2022 to April 2024 were selected.According to the random number table method,they were divided into the control group(112 cases)and the observation group(113 cases).The control group was treated with atorvastatin,and the observation group was treated with atorvastatin combined with PCSK9 inhibitors evolocumab.Both groups were treated for 24 weeks.Blood lipids,cardiac function,inflammatory factors,Seattle angina questionnaire(SAQ)score,adverse drug reactions(ADR)and follow-up were compared between the two groups.Results There were 2 cases in the control group and 3 cases in the observation group who dropped out,respectively.After 4,12 and 24 weeks of treatment,the levels of low-density lipoprotein cholesterol(LDL-C),lipoprotein(a),left ventricular end-systolic diameter(LVESD),interleukin-1β(IL-1β)and IL-6 in the two groups were lower than those before treatment.After 12 and 24 weeks of treatment,the levels of LDL-C,lipoprotein(a),LVESD,IL-1β and IL-6 in the two groups were lower than those after 4 weeks of treatment and 24 weeks of treatment.The levels of LDL-C,lipoprotein(a),LVESD,IL-1β and IL-6 in both groups were lower than those in 12 weeks(all P＜0.05).The levels of LDL-C,lipoprotein(a),LVESD,IL-1β and IL-6 in the observation group were lower than those in the control group at 4,12 and 24 weeks after treatment(all P＜0.05).After 4,12 and 24 weeks of treatment,stroke volume(SV),left ventricular ejection fraction(LVEF)and SAQ scores of the two groups were higher than those before treatment.After 12 and 24 weeks of treatment,the SV,LVEF and SAQ scores of the two groups were higher than those after 4 weeks of treatment.After 24 weeks of treatment,the SV,LVEF and SAQ scores of both groups were higher than those after 12 weeks of treatment(all P＜0.05).The SV,LVEF and SAQ scores of the observation group were higher than those of the control group at 4,12 and 24 weeks of treatment(all P＜0.05).There was no significant difference in the total incidence of ADR between the two groups(P＞0.05).After 12 weeks of follow-up,the incidences of secondary stent implantation and readmission in the observation group were lower than those in the control group[10.0％(11/110)vs 21.8％(24/110),9.1％(10/110)vs 19.1％(21/110)](x2=5.742,P=0.017;x2=4.543,P=0.033).After 24 weeks of follow-up,the incidence of secondary stent implantation and readmission in the observation group was lower than that in the control group[14.6％(16/110)vs 27.3％(30/110),12.7％(14/110)vs 24.6％(27/110)](x2=5.387,P=0.020;x2=5.066,P=0.024).Conclusion PCSK9 inhibitors combined with atorvastatin is effective in the treatment of angina pectoris after PCI,which can improve blood lipid and cardiac function,regulate inflammatory factors,increase SAQ score,reduce secondary stent implantation,and also reduce readmission of patients with angina pectoris after PCI,and does not increase ADR.

Abstract:Traditional endoscopic submucosal dissection is limited in clinical use due to long preoperative examination time,slow dissection speed,high incidence of complications,and differences in the level of surgeons.Artificial intelligence can provide accurate diagnosis and evaluation of lesions,accurate preoperative preparation and decision-making,intelligent traction,etc.,to assist clinicians in fast and safe surgical operations.At the same time,artificial intelligence can also assist in pathological diagnosis,teaching and training,prediction of complications and postoperative management.This article reviews the application status and research progress of artificial intelligence in endoscopic submucosal dissection,aiming to change the current clinical diagnosis and treatment mode and provide a new paradigm for intelligent endoscopic submucosal dissection.

Abstract:Objective To investigate the effect of Zhuyu Huoxue decoction combined with butylphthalide in the treatment of elderly patients with cerebral infarction in the recovery period.Methods A total of 120 elderly patients with cerebral infarction in recovery period admitted to Huadong Hospital Affiliated to Fudan University from March 2023 to February 2025 were selected as the research objects.According to the random number table method,they were divided into the observation group and the control group,with 60 cases in each group.The control group was treated with butylphthalide on the basis of conventional treatment.The observation group was treated with Zhuyu Huoxue decoction on the basis of the control group.Both groups were treated for 1 month.The clinical efficacy,traditional Chinese medicine syndrome scores,hemorheology indexes,brain injury markers,self-care ability of daily life,quality of life,and adverse reactions during treatment were compared between the two groups.Results After 1 month of treatment,the clinical efficacy of the observation group was better than that of the control group(P＜0.05).The scores of traditional Chinese medicine main symptom score,secondary symptoms and total syndrome in the observation group were lower than those in the control group(all P＜0.05).After treatment,the plasma viscosity and hematocrit of the two groups were lower than those before treatment,and those of the observation group was lower than those of the control group(all P＜0.05).After treatment,the levels of serum neuron-specific enolase in the two groups were lower than those before treatment,and the levels of brain-derived neurotrophic factor were higher than those before treatment,and the improvement of the two indexes in the observation group was better than that in the control group(all P＜0.05).After treatment,the modified Barthel index scores and stroke specific quality of life scale scores of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group[(79±8)vs(71±10),(163±22)vs(150±20)](all P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Zhuyu Huoxue decoction combined with butylphthalide soft capsule in the treatment of elderly patients with cerebral infarction in the recovery period can improve the clinical efficacy,further improve the clinical symptoms of patients,more effectively improve hemorheology and nerve function,improve the self-care ability of daily life and quality of life of patients,and has good safety.

Abstract:Objective To analyze the clinical effect of aripiprazole combined with galantamine in the treatment of senile dementia patients with behavioral and psychological symptoms.Methods A total of 106 senile dementia patients with behavioral and psychological symptoms admitted to Tongde Hospital of Zhejiang Province from May 2024 to March 2025 were selected.According to the block random method,they were divided into the observation group and the control group,with 53 cases in each group.The control group was treated with oral galantamine hydrobromide tablets on the basis of conventional treatment,and the observation group was treated with aripiprazole tablets on the basis of the control group.Both groups were treated for 3 months.Before and after treatment,the scores of psychological and behavioral symptoms and cognitive function,the levels of nerve factors,and the incidence of adverse reactions during treatment were compared between the two groups.Results After treatment,the scores of dementia pathological behavior rating scale,Alzheimer's disease assessment scale-cognitive part and clinical dementia rating scale in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).After treatment,the levels of brain-derived neuro-trophic factor in the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group[(32±6)μg/L vs(28±5)μg/L];the levels of visinin-like protein 1 and neuron specific enolase in the two groups were lower than those before treatment,and those in the observation group were lower 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(P＞0.05).Conclusion Aripiprazole combined with galantamine is effective in the treatment of senile dementia patients with mental and behavioral symptoms,which can improve the patients'mental and behavioral symptoms,cognitive function and nerve factors,and does not increase the risk of adverse reactions,with good safety.

Abstract:Objective To investigate the clinical value of coronary CT angiography(CCTA)and CT fractional flow reserve(CT-FFR)in the evaluation of myocardial ischemia caused by coronary artery disease.Methods A total of 106 patients with coronary atherosclerotic heart disease who underwent coronary angiography and fractional flow reserve(FFR)measurement at Peking University First Hospital from January 2018 to December 2022 were enrolled retrospectively.A total of 114 coronary vessels with 50％to 89％stenosis were included.All patients underwent CCTA examination within 3 months before surgery to obtain coronary disease reporting and data system(CAD-RADS)grades and CT-FFR values,and quantitative flow ratio(QFR)was calculated based on coronary angiography images.FFR≤0.80 was used as the diagnostic criterion for myocardial ischemia,and the diagnostic efficacy of each index was evaluated,and Spearman correlation and subgroup analysis were performed.Results The area under the curve(AUC)of CAD-RADS classification for the diagnosis of myocardial ischemia was 0.663(95％confidence interval:0.569-0.749).There was no correlation between CT-FFR and FFR(r=0.18,P=0.054),and the overall diagnostic efficacy of CT-FFR for myocardial ischemia was limited(AUC=0.562,95％confidence interval:0.466-0.655),but it showed better diagnostic performance in female patients(AUC=0.845)than in male patients(AUC=0.504,P＜0.001).QFR was highly correlated with FFR(r=0.82,P＜0.001),and the AUC for diagnosing myocardial ischemia was 0.965(95％confidence interval:0.913-0.991).Conclusion In patients with coronary artery stenosis ranging from 50％to 89％,QFR has high diagnostic consistency and accuracy,which can be used as a reference index to verify the accuracy of non-invasive assessment.CAD-RADS classification and CT-FFR alone have limited diagnostic value for functional myocardial ischemia.CT-FFR has a better diagnostic performance in female patients,suggesting that it may have certain application value in specific population.

Abstract:Objective To explore the clinical effect of Yifei Qinghua ointment combined with TP chemo-therapy regimen in the treatment of patients with advanced non-small cell lung cancer(NSCLC).Methods A total of 96 patients with advanced NSCLC who were treated in Shanxi Cancer Hospital from January 2023 to September 2024 were selected.According to the random number table method,they were divided into the control group and the observation group,with 48 cases in each group.The control group was treated with TP chemotherapy regimen(paclitaxel and cisplatin)by intravenous drip,and the observation group was treated with Yifei Qinghua ointment orally on the basis of the control group,21 d as a course of treatment.Patients in both groups were treated for 2 consecutive courses.The efficacy,serum tumor markers,immune function indexes and adverse reactions were compared between the two groups.Results The disease control rate and objective remission rate of the observation group were higher than those of the control group[70.8％(34/48)vs 45.8％(22/48),41.7％(20/48)vs 20.8％(10/48)](both P＜0.05).After treatment,the levels of cytokeratin 19 fragment antigen,carcinoembryonic antigen and neuron specific enolase in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).After treatment,the natural killer cells,CD3+,CD4+and CD4+/CD8+ratio of the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group,and the CD8+ratio was lower than that before treatment,and that in the observation group was lower than that in the control group(all P＜0.05).The incidences of bone marrow suppression,digestive tract reaction and alopecia in the observation group were lower than those in the control group[6.2％(3/48)vs 22.9％(11/48),10.4％(5/48)vs 37.5％(18/48),20.8％(10/48)vs 54.2％(26/48)](all P＜0.05).Conclusion On the basis of TP chemotherapy regimen,Yifei Qinghua ointment can enhance the immunity of patients with advanced NSCLC,improve the anti-tumor effect,significantly reduce the levels of serum tumor markers and reduce adverse reactions,indicating that integrated traditional Chinese and western medicine treatment has unique advantages in"increasing efficiency and reducing toxicity".

Abstract:Objective To investigate the changes of low-density lipoprotein receptor-related protein with 11 ligand-binding repeats(LR11)and protein tyrosine phosphatase receptor O(PTPRO)in peripheral blood before and after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI)and their relationship with in-stent restenosis(ISR).Methods A total of 312 elderly AMI patients who underwent PCI in Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to December 2023 were prospectively selected,and they were divided into ISR group and non-ISR group according to whether ISR occurred after 1 year.The levels of LR11 and PTPRO in peripheral blood were detected by enzyme-linked immu-nosorbent assay.Spearman correlation was used to analyze the correlation between the levels of peripheral blood LR11 and PTPRO and the rate of luminal diameter stenosis at 1 year after PCI in AMI patients,and the relationship between the levels of peripheral blood LR11 and PTPRO and ISR in AMI patients after PCI and its predictive efficacy were analyzed.Results The levels of LR11 and PTPRO in peripheral blood of AMI patients after PCI were higher than those before PCI[(195±48)mg/L vs(153±43)mg/L,(20±4)μg/L vs(16±4)μg/L](both P＜0.05).The levels of LR11 and PTPRO in peripheral blood of AMI patients after PCI were positively correlated with the lumen diameter stenosis rate at 1 year after PCI(rs=0.617,0.602,both P＜0.001).After 1-year follow-up,the incidence of ISR after PCI was 16.7％(52/312)in 312 AMI patients.High low-density lipoprotein cholesterol,high postoperative LR11 and high postoperative PTPRO were independent risk factors for ISR in AMI patients after PCI(all P＜0.05).The area under the curve of postoperative peripheral blood LR11,PTPRO and their combination to predict ISR in AMI patients after PCI was 0.824,0.797 and 0.904,respectively,and the combination of the two was better than each single prediction(both P＜0.05).Conclusion The increased levels of LR11 and PTPRO in peripheral blood of elderly AMI patients after PCI are related to ISR after PCI.The combination of LR11 and PTPRO has a high predictive effect on ISR after PCI.

Abstract:Objective To investigate the clinical application value of magnetically controlled capsule endoscopy in patients with antithrombotic therapy.Methods The clinical data of 1 215 patients who underwent magnetically controlled capsule endoscopy at the Department of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University from January 2019 to December 2023 were retrospectively analyzed.The patients were divided into antithrombotic therapy group(413 cases)and control group(802 cases,without antithrombotic drugs)according to whether they took antithrombotic drugs or not.The general data and endoscopic findings were compared between the two groups and between the patients with gastrointestinal bleeding.Results The proportion of gastrointestinal bleeding in the antithrombotic therapy group was significantly higher than that in the control group[49.4％(204/413)vs 6.1％(49/802)],and the proportions of overt bleeding and occult bleeding were also higher than those in the control group(all P＜0.001).The proportions of gastric ulcer,small intestinal ulcer,jejunoileum ulcer,modified Lanza score of gastric mucosal injury and grading score of small intestinal mucosal injury in antithrombotic therapy group were significantly higher than those in control group(all P＜0.05).The proportion of small intestinal bleeding,Lanza score of gastric mucosal injury and small intestinal mucosal injury grading score in antithrombotic therapy group were significantly higher than those in control group[52.0％(106/204)vs 18.4％(9/49),2.0(1.0,4.0)vs 1.0(1.0,2.0),2.0(1.0,4.0)vs 1.0(1.0,2.0)](all P＜0.05).The proportion of oral proton pump inhibitors in the antithrombotic therapy group was significantly higher than that in the control group[27.0％(55/204)vs 6.1％(3/49)](P＜0.001).Conclusion Gastric and small intestinal mucosal injuries were significantly increased in patients with antithrombotic therapy compared with those without antithrombotic therapy.The proportion of small intestinal bleeding in bleeding patients increased signifi-cantly.Magnetically controlled capsule endoscopy can be used to observe gastric and small intestinal mucosal injury and lesions in patients with antithrombotic therapy.

Abstract:Objective To explore the temporal regularity of the progression of gastric mucosal precancerous conditions and optimize the endoscopic follow-up strategy for intestinal-type early gastric cancer screening.Methods A retrospective cohort study design was adopted in this study.Initially,5 655 patients with gastric mucosal lesions who underwent gastroscopy and pathological biopsy at the Digestive Endoscopy Center of Peking University Third Hospital from January 2005 to December 2024 were enrolled.A total of 659 patients with typical precancerous conditions before the following pathological endpoints[moderate dysplasia(MOD),severe dysplasia and intestinal-type early gastric cancer(SD/EGC)]were screened out,including 186 cases in the SD/EGC group and 473 cases in the MOD group.The temporal trajectory of the progression of precancerous conditions was analyzed based on endoscopic and pathological data.Results Among the 659 patients,the lesions were mainly distributed in the middle third of the stomach(299 cases,45.4％)and lower third(312 cases,47.3％),with the lesser curvature of the stomach(391 cases,59.3％)being the most common horizontal location.The detection rate of intestinal metaplasia(IM)in the background mucosa was 66.0％(435/659).The median time for chronic atrophic gastritis(CAG)to progress to moderate dysplasia(MOD)was 28(21,74)months(20 cases),and to severe dysplasia and intestinal-type early gastric cancer(SD/EGC)was 45(19,128)months(12 cases).The median progression times from IM,mild dysplasia(MD),and MOD to SD/EGC were 39(17,66)months(103 cases),38(18,75)months(97 cases),and 27(12,40)months(46 cases),respectively.Conclusion By analyzing the cascade progression sequence of CAG→IM→MD→MOD→ SD/EGC(arrows indicate progression to),this study confirmed that with the elevation of lesion grade,the time required for progression to the endpoint lesion generally shows a gradually shortening trend.Among them,the median time for MOD to progress to SD/EGC was 27 months.Combined with the recommendations of existing guidelines,it is considered that a high-definition chromoendoscopy follow-up strategy with an interval of at least 6-12 months should be adopted for MOD patients,thereby providing evidence-based basis for the early screening and intervention of intestinal-type gastric cancer based on the temporal trajectory of lesion progression.

Abstract:Objective To investigate the efficacy of tirofiban at different time points in the endovascular treatment of atherosclerotic acute cerebral infarction(AIS)and its relationship with prognosis.Methods A total of 98 patients with atherosclerotic AIS who needed endovascular treatment in Shanxi Province Fenyang Hospital from June 2024 to May 2025 were selected as the research objects.All of the patients were divided into observation group[49 cases,tirofiban 0.4 μg/(kg·min)intravenous infusion for 0.5 h followed by 0.1 μg/(kg·min)intravenous infusion for 24 h+endovascular treatment]and control group[49 cases,tirofiban 0.2-1 mg during operation and 0.1 μg/(kg·min)intravenous infusion for 24 h after operation plus endovascular treatment]by random number table method.The platelet aggregation rate,platelet adhesion rate,platelet volume distribution width(PDW),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and National Institutes of Health Stroke Scale(NIHSS)scores were compared between the two groups at admission,24 h,7 d and 14 d after treatment.The rate of complications and good prognosis were compared between the two groups.Cox regression analysis was used to analyze the effect of tirofiban application time on the poor prognosis of patients.Results On admission,there were no significant differences in platelet aggregation rate,platelet adhesion rate,PDW,hs-CRP,IL-6,and NIHSS score between the two groups(all P＞0.05).After treatment,the platelet aggregation rate,platelet adhesion rate,PDW,hs-CRP,IL-6 and NIHSS score of the two groups were significantly decreased,and the observation group decreased more significantly at 7 d and 14 d after treatment(all P＜0.05).The incidence of reocclusion and the total incidence of adverse reactions in the observation group were significantly lower than those in the control group(all P＜0.05),and the rate of good prognosis was higher than that in the control group[73.5％(36/49)vs 51.0％(25/49)](P＜0.05).The timing of tirofiban administration in the observation group was a protective factor for the poor prognosis(hazard ratio=0.782,95％confidence interval:0.289-0.897,P=0.008),and the results were consistent in different subgroups.Conclusion The application of tirofiban before endovascular treatment can reduce the risk of poor prognosis of patients,and help to improve the neurological function,platelet function and inflammatory state of patients.

Abstract:Objective To explore the independent risk factors for hypertension in patients in the post-anesthesia care unit(PACU)after ophthalmic surgery under general anesthesia.Methods A total of 908 patients who underwent elective ophthalmic surgery under general anesthesia in Beijing Tongren Hospital,Capital Medical University from September 2024 to May 2025 were retrospectively enrolled as research subjects.The patients were divided into hypertension group(560 cases)and non-hypertension group(348 cases)according to blood pressure status.Baseline data,preoperative medical history,surgical procedures,vital signs and eye pain scores of patients in the two groups were collected.Univariate and multivariate Logistic regression analyses were used to screen the independent influencing factors of postoperative hypertension in PACU.Results There were statistically significant differences in age,proportions of hypertension history,diabetes history and distribution of postoperative ocular pain scores between the two groups(all P＜0.05).The heart rate of patients in the hypertension group was higher than that in the non-hypertension group(P＜0.05).Univariate analysis showed that age(odds ratio=1.035,95％confidence interval:1.024-1.045),preoperative hypertension history(odds ratio=9.549,95％confidence interval:6.104-14.937),preoperative diabetes history(odds ratio=2.282,95％confidence interval:1.638-3.180),heart rate(odds ratio=1.020,95％confidence interval:1.008-1.031)and postoperative eye pain score 1-3(odds ratio=0.646,95％confidence interval:0.485-0.861)were significantly correlated with postoperative hypertension(all P＜0.05).Multivariate Logistic regression analysis indicated that increased age,preoperative hypertension history,preoperative diabetes history,accelerated heart rate and severe eye pain were independent risk factors for hypertension upon admission to PACU after operation(all P＜0.05).Conclusion Patients with advanced age,preoperative history of hypertension or diabetes,rapid heart rate and severe eye pain are more susceptible to hypertension in PACU.

Abstract:Objective To investigate the therapeutic effect of Shexiang Baoxin Pills combined with nicorandil on patients with coronary slow flow(CSF)and its influence on vascular endothelial function and levels of inflammatory factors.Methods A total of 100 CSF patients admitted to the Department of Cardiovascular Medicine,the Third People's Hospital of Hubei Province from June 2023 to December 2024 were selected as subjects.Patients were divided into control group and observation group by random number table method,with 50 cases in each group.The control group was treated with conventional basic drugs and nicorandil tablets;the observation group was additionally given Shexiang Baoxin pills on the basis of the control group.Both groups were treated for 6 months.Clinical efficacy,corrected TIMI frame count(CTFC)of main coronary branches,serum vascular endothelial function indexes,serum inflammatory factor indexes and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[96.0％(48/50)vs 84.0％(42/50)](x2=4.000,P=0.046).After treatment,the CTFC of main coronary branches in both groups was lower than that before treatment,and those in the observation group were significantly lower than those in the control group(all P＜0.05).After treatment,the serum endothelin-1 level in both groups was lower than that before treatment,and that in the observation group was lower than that in the control group;the nitric oxide level was higher than that before treatment,and that in the observation group was higher than that in the control group(all P＜0.05).After treatment,serum inflammatory factor indexes in both groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(x2=0.122,P=0.727).Conclusion Shexiang Baoxin pills combined with nicorandil has a definite effect in the treatment of CSF,which can regulate blood flow velocity of main coronary branches,improve vascular endothelial function,inhibit inflammatory response,and has high safety.

Abstract:Objective To evaluate the clinical outcomes and real-world pharmacoeconomic value of subcutaneous(SC)versus intravenous(Ⅳ)administration in the de-escalated dual-target non-anthracycline regimen combined with albumin-bound paclitaxel(nab-PHP regimen)for human epidermal growth factor receptor 2(HER2)-positive breast cancer.Methods A total of 72 female patients with HER2-positive early invasive breast cancer scheduled for neoadjuvant therapy admitted to Peking University International Hospital from January 2024 to December 2025 were retrospectively enrolled and divided into SC group(37 cases)and Ⅳ group(intravenous control group,35 cases)according to administration route.Inverse probability of treatment weighting(IPTW)was applied to balance baseline covariates between groups.The primary clinical endpoint was overall pathological complete response rate,with a prespecified non-inferiority margin of-10％.The primary economic endpoint was total direct medical cost.Time-driven activity-based costing(TDABC)was adopted to accurately calculate medical staff labor and time costs,and cost-minimization analysis was conducted.Results After IPTW weighting,baseline characteristics were well balanced between the two groups(standardized mean difference＜0.1).For clinical efficacy,the absolute difference in overall pathological complete response rate between the SC group and Ⅳ group was merely 0.6％(95％confidence interval:-4.8％-6.0％),which verified the absolute non-inferiority of subcutaneous administration(Pnon-inf＜0.001).In terms of safety,the incidence of all-grade infusion-related reactions in the SC group was lower than that in the Ⅳ group[2.7％(1/37)vs 17.1％(6/35)](P＜0.05).Medical resource accounting based on TDABC showed that per-cycle chair-side administration time,pharmacy preparation time in intravenous admixture service,drug delivery and monitoring time were all shorter in the SC group(all P＜0.001).Comprehensive statistical results demonstrated that the total cost for completing the full course of neoadjuvant therapy in the SC group was lower than that in the Ⅳ group(P＜0.001).Conclusions For de-escalated neoadjuvant therapy of HER2-positive early breast cancer,the SC-nab-PHP regimen is non-inferior to the conventional intravenous regimen in pathological complete response rate,with improved safety and reduced medical costs.

Abstract:Objective To establish and evaluate a rat model simulating the mechanism of heart failure in maintenance hemodialysis(MHD).Methods A total of 26 SD rats were selected and divided into two groups by random number table method:6 rats in the control group were given edible oil by gavage;20 rats in the model group were treated with adenine edible oil solution by gavage to simulate uremic factors,intraperitoneal injection of doxorubicin to simulate heart failure and uremic factors,and potassium bromate solution instead of drinking water to simulate microinflammatory factors.The observation period lasted 6 weeks.General conditions including mental state,response,body weight and food intake,renal function,C-reactive protein(CRP),blood pressure and heart rate were observed.Echocardiographic parameters included left ventricular ejection fraction(LVEF),fractional shortening,interventricular septal end-systolic thickness(IVSS),left ventricular posterior wall end-systolic thickness(LVPWS),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV).Heart mass indexes included whole heart mass index(HM/BM)and left ventricular mass index(LVM/BM).Myocardial pathology was observed by transmission electron microscope.Results Ten rats in the model group survived at the end of the sixth week,with a mortality rate of 50％.The body weight of the model group was significantly lower than that of the control group starting from the end of the first week(all P＜0.001)and decreased slightly and slowly since the third week.Food intake was significantly lower than that of the control group from the second week onward(all P＜0.001).Serum urea nitrogen and creatinine in the model group were signifi-cantly higher than those in the control group starting from the first week and increased obviously at subsequent time points(all P＜0.001).At the end of the sixth week,CRP level in the model group was significantly higher than that in the control group[(17.27±1.88)mg/L vs(0.99±0.09)mg/L](P＜0.01).Meanwhile,systolic blood pressure,diastolic blood pressure,mean arterial pressure and heart rate in the model group were markedly lower than those in the control group;LVEF,fractional shortening,IVSS and LVPWS were significantly decreased;LVEDD,LVESD,LVEDV,LVESV,HM/BM and LVM/BM were significantly increased(all P＜0.001).Severe myocardial pathological damage was observed under electron microscope in the model group.Conclusions The established rat model simulating MHD-related heart failure meets the evaluation criteria of uremic toxin,heart failure and microinflammation modeling.It can truly and completely simulate the clinical and pathological progres-sion of MHD complicated with heart failure with good clinical similarity,and is suitable for in-depth experimental research of the disease.

Abstract:Objective To explore the potential value of serum kidney injury molecule-1(KIM-1)in the early risk stratification of acute kidney injury(AKI)within 72 h after onset in patients with acute myocardial infarction(AMI).Methods A total of 30 consecutive AMI patients hospitalized in Beijing Anzhen Hospital,Capital Medical University from November 2025 to January 2026 were enrolled in this single-center prospective preliminary study.Patients were divided into AKI group(10 cases)and non-AKI group(20 cases)according to the occurrence of AKI.Serum samples were collected at admission immediately(T0),6-12 h after admission(T1),24 h after admission(T2),48 h after admission(T3),and 72 h after admission(T4)to detect the levels of KIM-1 and serum creatinine.Receiver operating characteristic curve was used to analyze its value in predicting AKI within 72 h.As an exploratory study with a limited sample size,the results were only used to generate hypoth-eses and report confidence intervals.Results The level of KIM-1 at T0 in the AKI group was significantly higher than that in the non-AKI group[0.150(0.095,0.305)μg/L vs 0.080(0.058,0.132)μg/L](P=0.019).The area under the curve(AUC)of KIM-1 at T0 for predicting AKI within 72 h was 0.77(95％confidence interval:0.52-0.94),which was superior to serum creatinine at the same time point(AUC=0.66,95％confidence interval:0.45-0.88).Taking 0.100 μg/L as the cut-off value,the sensitivity of KIM-1 for predicting AKI was 100％(95％confidence interval:69％-100％)and the specificity was 60％(95％confidence interval:36％-81％).With the consistent median time from symptom onset to admission between the two groups,KIM-1 showed intergroup differences at T0,while serum creatinine did not show significant differences until T2,with a time difference of approximately 24 h.Conclusions Serum KIM-1 at admission has potential value for early risk stratification of AKI after AMI,with an earlier detection time than serum creatinine.However,these exploratory findings need external verification by large-sample and multicenter studies as well as clinical practicability evaluation before clinical transformation and application.