Abstract:Objective To investigate the effects of modified fascia iliaca compartment block combined with general anesthesia on intraoperative hemodynamics and recovery quality in children with femoral fracture at medium and high altitudes.Methods A total of 80 children undergoing elective femoral fracture surgery admitted to Qinghai Province Women & Children's Hospital from May 2023 to May 2025 were selected and divided into control group and observation group by random number table method,with 40 cases in each group.The control group received tracheal intubation general anesthesia,and the observation group received combined fascia iliaca compartment block on the basis of the control group.The intraoperative dosage of anesthetics,awakening time,extubation time and length of stay in post-anesthesia care unit(PACU)were recorded in both groups.Hemody-namic indicators(systolic blood pressure,diastolic blood pressure and heart rate)at different time points[before anesthesia(T0),5 min after intubation(T1),skin incision(T2),30 min after operation start(T3),end of operation(T4)]were compared between the two groups.The behavioral pain scale for children(FLACC)scores at different time points(transfer out of PACU,2 h,4 h and 12 h after operation)were compared between the two groups.The incidence of adverse reactions was statistically analyzed.Results With time extension,the changing trends of systolic blood pressure,diastolic blood pressure and heart rate were different between the two groups,and the observation group showed a smaller changing trend(all P＜0.05).Compared with the control group,the dosages of propofol and remifentanil in the observation group were lower[(287±29)mg vs(311±32)mg,(10.4±2.4)μgvs(12.8±2.5)μg](allP＜0.05).Compared with the control group,the FLACC scores in the observation group were lower at transfer out of PACU,2 h,4 h and 12 h after operation(all P＜0.05);with time extension,the FLACC scores in both groups first increased and then decreased,and the observation group showed a smaller changing trend(P＜0.05).Compared with the control group,the awakening time,extubation time and PACU stay time in the observation group were shorter[(53±5)min vs(57±5)min,(9±3)min vs(12±3)min,(31±5)min vs(35±5)min](all P＜0.05).There were no significant differences in the incidence of adverse reactions between the two groups(all P＞0.05).Conclusions Modified fascia iliaca compartment block combined with general anesthesia has significant effects on children with femoral fracture at medium and high altitudes,which is conducive to maintaining hemodynamic stability,reducing the dosage of anesthetics,promoting postoperative recovery,shortening awakening time,with high safety.

Abstract:Objective To evaluate the therapeutic effect of sivelestat sodium,a neutrophil elastase(NE)inhibitor,on sepsis-associated acute respiratory distress syndrome(ARDS)at high altitude areas.Methods A total of 56 patients with sepsis-associated ARDS at high altitudes admitted to the Department of Critical Care Medicine,Qinghai Provincial People's Hospital from August 2023 to August 2024 were enrolled and randomly divided into observation group(27 cases)and control group(29 cases)by random number table method.Both groups received standard ARDS treatment as needed,and the observation group was additionally treated with sivelestat sodium on the basis of standard treatment.Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,sequential organ failure assessment(SOFA)score,oxygenation index,procalcitonin,interleukin-6(IL-6),white blood cell count,high-sensitivity C-reactive protein(hs-CRP)levels on day 1 and day 7 after admission were compared between the two groups.NE level was detected by enzyme-linked immunosorbent assay.Results There were no significant differences in APACHE Ⅱ and SOFA scores between the two groups on day 1(both P＞0.05).On day 7,APACHE Ⅱ and SOFA scores in both groups were lower than those on day 1,and SOFA score in the observation group was lower than that in the control group(all P＜0.05).There was no signifi-cant difference in oxygenation index between the observation group and the control group on day 1[130(107,174)vs 159(113,190)](Z=-1.369,P=0.171).Onday7,oxygenation index in both groups were higher than those on day 1(both P＜0.001),and that in the observation group was higher than that in the control group[286(240,316)vs 230(197,264)](Z=-3.281,P＜0.001).On day 1,there were no significant differences in white blood cell count,procalcitonin,IL-6 and hs-CRP levels between the two groups(all P＞0.05).On day 7,the above indicators 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).On day 1,there was no significant difference in NE level between the observation group and the control group[(56±4)μg/L vs(56±5)μg/L](t=-0.364,P=0.717).On day 7,NE levels in both groups were lower than those on day 1(both P＜0.05),and that in the observation group was lower than that in the control group[(48±4)μg/L vs(54±5)μg/L](t=4.620,P＜0.001).Conclusion Sivelestat sodium can significantly improve oxygenation index,alleviate organ injury and inhibit excessive inflammatory response in patients with sepsis-associated ARDS at high altitudes.

Abstract:The occurrence and development of atherosclerosis are closely related to the phenotypic hetero-geneity of vascular smooth muscle cells(VSMCs).Studies have shown that VSMCs exhibit remarkable plasticity and can transdifferentiate into multiple phenotypes in the plaque microenvironment,participating in plaque forma-tion.This process is regulated at multiple levels,including transcription factors,epigenetics,and signaling path-ways.During plaque progression,VSMCs play a dual role:they can either stabilize plaques or exacerbate plaque instability.Therefore,targeted regulation of VSMC phenotypic transition has become a novel therapeutic strategy.In the future,it is necessary to combine spatial omics and other technologies to further clarify their dynamic evolu-tion and promote clinical translation.

Abstract:Objective To investigate the correlation of serum microRNA-760(miR-760)and cytoplasmic polyadenylation element binding protein 2(CPEB2)expression with clinicopathological features and prognosis in children with acute lymphoblastic leukemia(ALL).Methods A total of 205 children with ALL admitted to Shaanxi Provincial People's Hospital from January 2020 to June 2022 were prospectively enrolled as the ALL group,and 103 healthy children during the same period were selected as the control group.The serum expression levels of miR-760 and CPEB2 mRNA were detected.The binding site between miR-760 and CPEB2 was predicted through an online database.Pearson correlation analysis was used to analyze the correlation between serum miR-760 and CPEB2 mRNA expression in children with ALL,and their relationship with clinicopathological features was also analyzed.The progression-free survival rate was compared among children with different serum expression levels of miR-760 and CPEB2 mRNA.Multivariate Cox regression analysis and receiver operating characteristic(ROC)curve were used to analyze the influencing factors for the prognosis of children with ALL and the predictive efficacy of serum miR-760 and CPEB2 mRNA expression for prognosis.Results The serum expression level of miR-760 in the ALL group was lower than that in the control group[(0.64±0.11)vs(1.01±0.17)],and the expression level of CPEB2 mRNA was higher than that in the control group[(1.33±0.30)vs(0.83±0.14)](all P＜0.001).A binding site of miR-760 was found at positions 2855-2861 of the 3'untranslated region of CPEB2.Serum miR-760 expression was negatively correlated with CPEB2 mRNA expression in children with ALL(r=-0.655,P＜0.001).There were statistically significant differences in the serum expression levels of miR-760 and CPEB2 mRNA among ALL children with different risk stratifications(all P＜0.001).The 3-year event-free survival rate of ALL children in the miR-760 high expression group was higher than that in the miR-760 low expression group,and the 3-year event-free survival rate in the CPEB2 mRNA high expression group was lower than that in the CPEB2 mRNA low expression group(all P＜0.05).Mixed lineage leukemia gene rearrangement,high-risk stratification and CPEB2 mRNA≥1.33 were independent risk factors for poor prognosis in children with ALL,while miR-760 ≥0.64 was an independent protective factor(all P＜0.05).The areas under the curve of serum miR-760,CPEB2 mRNA and their combination in predicting poor prognosis of children with ALL were 0.796,0.790 and 0.896,respectively.The combined detection was superior to the single detection of serum miR-760 or CPEB2 mRNA in predictive efficacy(all P＜0.05).Conclusion Serum miR-760 low expression and CPEB2 mRNA high expression are associated with adverse clinicopathological features and poor prognosis in children with ALL,and the combined detection of serum miR-760 and CPEB2 expression has a high predictive efficacy for the prognosis of these children.

Abstract:Objective To investigate the efficacy of Shenxiong glucose injection combined with benidipine in the treatment of angina pectoris of coronary atherosclerotic heart disease and its effects on serum levels of pentraxin 3(PTX-3)and inducible nitric oxide synthase(iNOS).Methods A total of 148 patients with angina pectoris of coronary atherosclerotic heart disease admitted to Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2021 to December 2022 were selected and divided into the control group and the combined group with 74 cases in each group by random number table method.The control group was treated with benidipine,and the combined group was treated with Shenxiong glucose injection on the basis of the control group.Both groups were treated for 14 d.The therapeutic efficacy,cardiac function,quality of life,levels of inflammatory markers and adverse reactions were compared between the two groups after treatment.Results The total effective rate of the combined group was higher than that of the control group[96.0％(71/74)vs 82.4％(61/74)](P=0.008).After treatment,the cardiac output,left ventricular ejection fraction and cardiac index of the combined group were all higher than those of the control group(all P＜0.05).After treatment,the Seattle angina question-naire(SAQ)scores of both groups were higher than those before treatment,and the SAQ score of the combined group was higher than that of the control group[(428±57)vs(391±49)](all P＜0.05).After treatment,the serum levels of PTX-3,iNOS and interleukin-6 in the combined group were all 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(P=0.547).Conclusion Shenxiong glucose injection combined with benidipine has a significant efficacy in the treatment of angina pectoris of coronary atherosclerotic heart disease,which can obviously improve cardiac function and quality of life of patients,effectively regulate the levels of inflammatory markers,and has few adverse reactions.

Abstract:Objective To investigate the efficacy of dexamethasone combined with dexmedetomidine in postoperative analgesia for elderly patients with hip fracture.Methods A total of 128 elderly patients with hip fracture admitted to the Eighth Affiliated Hospital of Southern Medical University from December 2023 to December 2024 were selected as the research objects.They were divided into the control group and the observation group according to the random number table method,with 64 cases in each group.The control group was pumped with dexmedetomidine before anesthesia induction;the observation group was pumped with dexmedetomidine combined with dexamethasone before anesthesia induction.The postoperative analgesia,awakening time,cognitive function,cerebral oxygen metabolism,renal function and adverse reactions were compared between the two groups.Results The time of the first pump pressing in the observation group was longer than that in the control group,the number of pump pressings and sufentanil dosage within 24 h after operation,and the VAS scores at 12 h,24 h and 48 h after operation were less/lower than those in the control group(all P＜0.05).The mini-mental state examination scores of both groups decreased at 24 h after operation and increased at 48 h and 72 h after operation,and the mini-mental state examination scores of the observation group at 24 h and 48 h after operation were higher than those of the control group(all P＜0.05).The levels of arterial oxygen content and jugular venous oxygen content in both groups decreased at 24 h after operation,and those in the observation group were higher than those in the control group(all P＜0.05).The levels of serum creatinine and blood urea nitrogen in both groups increased at 24 h after operation,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 observation group and the control group[14.1％(9/64)vs 9.4％(6/64)](x2=0.680,P=0.410).Conclusion Dexamethasone combined with dexmedetomidine can improve the postoperative analgesic effect in elderly patients with hip fracture,reduce postoperative cognitive impairment,improve cerebral oxygen metabolism,alleviate renal damage,and has good safety.

Abstract:In recent years,the global incidence of obesity and related metabolic diseases[such as type 2 diabetes mellitus and metabolic dysfunction-associated fatty liver disease(MASLD)]has increased significantly.MASLD involves a continuous disease progression towards metabolic dysfunction-associated steatohepatitis and fibrosis,which can ultimately lead to liver cirrhosis and hepatocellular carcinoma.Exploring its pathogenic mecha-nisms is conducive to developing novel preventive,diagnostic,and therapeutic strategies for the disease.As the mainstream theory of the disease's pathogenesis,the"multiple hit hypothesis"has been gradually verified by clinical and experimental studies regarding the subsequent hits on the basis of hepatic steatosis.This article summarizes and discusses multidimensional mechanisms including lipid metabolism,inflammation,and endocrine-related axes,aiming to provide new insights for the systematic diagnosis and treatment of MASLD.

Abstract:Myocardial ischemia-reperfusion injury(MIRI)is a common and severe pathological process in cardiovascular diseases,which often leads to cardiomyocyte damage and dysfunction.In recent years,mitophagy,an important cellular autophagic mechanism,has attracted extensive attention in academic circles.Mitophagy not only plays a key role in maintaining intracellular mitochondrial homeostasis,but also affects cell survival,energy metabolism and oxidative stress response during MIRI.Existing studies have shown that mitophagy promotes cardiomyocyte survival and functional recovery by clearing damaged mitochondria,but its specific mechanism still needs further exploration.This article aims to review the latest research progress of mitophagy in MIRI,analyze its effects on cardiomyocyte survival and metabolism as well as its role in oxidative stress,so as to provide reference and guidance for future research.

Abstract:Objective To investigate the longitudinal dynamic changes in cerebral gray matter volume in patients with persistent olfactory loss after upper respiratory tract infection(PURIPOL).Methods A total of 20 PURIPOL patients(8 males and 12 females,aged 41±11 years)with olfactory loss lasting more than 2 years who were treated at the olfactory and gustatory disorders diagnosis and treatment center of Beijing Anzhen Hospital,Capital Medical University from January 2018 to December 2024 were enrolled.Another 20 age-,gender-and education-matched healthy volunteers were recruited as the control group.Subjective and objective olfactory functions were evaluated by the Sniffin'sticks test(TDI score)and olfactory event-related potentials(oERPs),and cognitive function was screened by the mini-mental state examination(MMSE).Retrospective analysis was performed on the 3D-T1-weighted brain structural magnetic resonance imaging of PURIPOL patients at three stages:3-12 months,＞12-24 months and＞24 months after the onset of olfactory loss.Voxel-based morphometry(VBM)was used to compare the differences in gray matter volume between PURIPOL patients and the control group,and to observe the evolutionary law over time.Results The TDI score of the PURIPOL group was significantly lower than that of the control group[(5.7±3.1)vs(34.6±2.6)](P＜0.01).The oERPs of the PURIPOL group showed longer latencies and lower amplitudes of N1 and P2 waves than those of the control group(all P＜0.01).VBM analysis revealed that compared with the control group,the PURIPOL group had a significant reduction in gray matter volume in the right orbitofrontal cortex and left gyrus rectus at 3-12 months after olfactory loss;the gray matter volume in the right orbitofrontal cortex and bilateral gyrus rectus further decreased at＞12-24 months;and the scope of gray matter atrophy extended to the bilateral orbitofrontal cortex,bilateral gyrus rectus and right insula at＞24 months(FDR corrected,all P＜0.001).Conclusion Progressive reduction in gray matter volume exists in olfactory-related brain regions of PURIPOL patients,suggesting that long-term lack of olfactory input may lead to structural remodeling in the corresponding brain regions,which may be one of the important central mechanisms of persistent olfactory loss.

Abstract:Objective To investigate the risk factors for mortality within 30 d after gastrointestinal bleeding(GIB)in patients undergoing thoracotomy in cardiac surgery.Methods A total of 271 adult patients who under-went thoracotomy in the Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University and developed GIB within 30 d after surgery from January 2017 to January 2024 were retrospectively enrolled.All-cause mortality within 30 d after GIB was set as the primary endpoint.According to the occurrence of the primary endpoint event,the patients were divided into the survival group(149 cases)and the death group(122 cases).Univariate Logistic analysis was performed between the two groups,and then covariates were included to construct a multivariate Logistic model to identify the risk factors for mortality within 30 d after GIB.Results The proportions of female patients,peripheral vascular disease,European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ),rethoracotomy before bleeding,cerebrovascular disease before bleeding,pulmonary infection before bleeding,shock before bleeding,vasoactive drug support before bleeding,mechanical ventilation before bleeding,continuous renal replacement therapy before bleeding,intra-aortic balloon pump or extracorporeal membrane oxygenation before bleeding,red blood cell transfusion volume before bleeding,stable international normalized ratio(INR)before bleeding,and the first INR after bleeding in the death group were significantly higher than those in the survival group,while the proportion of hypertension,stable platelet count before bleeding,systolic blood pressure at the time of bleeding,and the first platelet count after bleeding in the death group were significantly lower than those in the survival group(all P＜0.05).Multivariate Logistic regression analysis showed that peripheral vascular disease was an independent risk factor for mortality within 30 d after GIB in patients undergoing thoracotomy in cardiac surgery(odds ratio=2.77,95％confidence interval:1.28-6.19,P=0.011).Every 10 mmHg increase in systolic blood pressure at the time of bleeding(1 mmHg=0.133 kPa,odds ratio=0.74,95％confidence interval:0.63-0.85,P＜0.001)and every 50 × 109/L increase in the first platelet count after bleeding(odds ratio=0.73,95％confidence interval:0.61-0.86,P＜0.001)were associated with a decreased risk of mortality.Conclusion In patients undergoing thoracotomy in cardiac surgery complicated with GIB,peripheral vascular disease is independently associated with an increased risk of mortality within 30 d after GIB,while higher systolic blood pressure at the time of bleeding and higher first platelet count after bleeding are associated with a decreased risk of mortality within 30 d after GIB.

Abstract:Objective To investigate the effect of Bifidobacterium quadruple live tablets on intestinal flora and the serum levels of forkhead box O3(FOXO3),autophagy-related gene 7(ATG7),and macrophage inflammatory protein-3α(MIP-3α)in elderly male patients with severe pneumonia.Methods A total of 80 elderly male patients with severe pneumonia admitted to the 980th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from February 2023 to August 2024 were selected as research subjects.They were divided into a control group and an observation group using the random number table method,with 40 cases in each group.The control group received conventional treatments such as nutritional support,oxygen inhalation,and expectoration.The observation group was given Bifidobacterium quadruple live tablets on the basis of the control group.Both groups were treated continuously for 2 weeks.The clinical efficacy,symptom improvement time,immune function,inflammatory factors,and intestinal flora were compared between the two groups.Results The total effective rate of treatment in the observation group was higher than that in the control group[95.0％(38/40)vs 77.5％(31/40)](x2=5.165,P=0.023).The times to clinical symptom improvement in the observation group were shorter than those in the control group(all P＜0.05).After treatment,the levels of CD3+,CD4+,and CD4+/CD8+ratio in both groups were higher than those before treatment,and the observation group had significantly higher levels than the control group(all P＜0.05).After treatment,the levels of procalcitonin,C-reactive protein,serum amyloid A,surfactant protein,FOXO3,ATG7,and MIP-3 α in both groups were lower than those before treatment,and the observation group had significantly lower levels than the control group(all P＜0.05).After treatment,the levels of Lactobacillus and Bifidobacterium in the observation group were higher than those before treatment,while Enterococcus was lower than that before treatment;the levels of Lactobacillus and Bifidobacterium in the observation group were higher than those in the control group,and Enterococcus was lower than that in the control group(all P＜0.05).Conclusion Bifidobacterium quadruple live tablets can significantly improve the clinical efficacy,reduce the inflammatory level,and modulate the intestinal flora in elderly patients with severe pneumonia.

Abstract:Gallbladder cholesterol cholelithiasis is a complex disease caused by the combined effects of genetic and environmental factors.This article systematically elaborates its cascading pathogenesis,which initiates with the imbalance of hepatic cholesterol metabolism and abnormal bile composition,leading to cholesterol super-saturation in bile.Subsequently,cholesterol in supersaturated bile nucleates in the mucin gel matrix to form cholesterol monohydrate crystals.Meanwhile,the dysfunction of gallbladder smooth muscle cells induced by excessive cholesterol uptake results in impaired gallbladder motility and bile stasis,which provides a"breeding ground"for crystal growth and aggregation.Notably,intestinal factors such as intestinal dysbiosis are also key links in the pathogenesis of gallbladder cholesterol stones.This article focuses on analyzing the core roles of key genes including adenosine triphosphate-binding cassette transporter genes,mucin genes and cholecystokinin receptor genes in multiple pathological steps,revealing that genetic susceptibility runs through the entire process of initiation,nucleation,growth and regulation in gallbladder cholesterol stone formation.

Abstract:Pulmonary infectious diseases are among the primary causes of high morbidity and mortality worldwide.Their occurrence and progression are closely associated with the complex inflammatory responses of the body.Traditionally,research on pulmonary infections has largely relied on the detection of inflammatory factors in circulating blood.However,a growing body of evidence indicates that the inflammatory factor profile in the local respiratory tract(e.g.,bronchoalveolar lavage fluid,sputum,etc.)can more directly reflect the status of the pulmonary immune microenvironment,and its expression levels are both correlated with and significantly different from those of inflammatory factors in the blood.This article aims to review the recent research progress on the expression characteristics,dynamic changes,clinical significance and interaction of local respiratory tract and circulating blood inflammatory factors in common pulmonary infectious diseases such as community-acquired pneumonia,coronavirus disease 2019,hospital-acquired pneumonia/ventilator-associated pneumonia,and to explore their potential values in disease diagnosis,severity assessment,prognosis judgment and individualized treatment.

Abstract:Uterine adenomyomatous polyp(AP),also known as polypoid adenomyoma,is a subtype of endometrial polyp characterized by the intermixture of smooth muscle fibers in the polyp stroma.Surgical resection is the mainstay of treatment.This article explores the clinical characteristics,diagnosis and treatment strategies,and fertility preservation of AP through a typical case.The patient was a 35-year-old female who first visited the hospital with the main complaints of"increased menstrual flow for 1 year and vaginal bleeding for 17 d".Hysteroscopy combined with pathological examination confirmed the diagnosis of AP.Later,she underwent multiple hysteroscopic surgeries,high-intensity focused ultrasound surgery,drug treatment,and uterine artery embolization,eventually developing severe intrauterine adhesions that significantly affected her fertility.The patient had no regular postoper-ative follow-up and experienced multiple recurrences.Literature review shows that AP lacks specific clinical symp-toms and has a high recurrence rate,which must be confirmed by hysteroscopy and pathological examination.

Abstract:Objective To investigate the efficacy of Qingre Lifei oral liquid combined with recombinant human interferon α1b in the treatment of bronchiolitis in children and its effect on hemorheology.Methods A total of 296 children with bronchiolitis admitted to Beijing University of Chinese Medicine Third Affiliated Hospital from December 2022 to December 2023 were selected and randomly divided into the observation group and the control group with 148 cases in each group by computer random number method.The control group was treated with nebulized inhalation of recombinant human interferon α1b via oral or nasal route on the basis of supportive therapy,and the observation group was treated with oral Qingre Lifei oral liquid on the basis of the control group.Both groups were treated continuously for 7 d.The disappearance time of symptoms and signs,lung function,inflammatory factors,hemorheological indexes,therapeutic efficacy and adverse reactions were compared between the two groups.Results The disappearance time of cough,paroxysmal dyspnea,nasal flaring and three concave signs in the observation group was shorter than that in the control group(all P＜0.05).After treatment,the inspiratory to expiratory time ratio,time to peak tidal volume ratio and interferon-γ in the observation group were significantly higher than those in the control group,while respiratory resistance,interleukin-33,eosinophils,plasma viscosity,erythrocyte aggregation index and fibrinogen were significantly lower than those in the control group(all P＜0.05).The total effective rate of the observation group was higher than that of the control group[96.6％(143/148)vs 89.2％(132/148)](P=0.013).No severe adverse reactions were observed in both groups during the treatment period.Conclusion Qingre Lifei oral liquid combined with recombinant human interferon α1b in the treatment of bronchiolitis in children is helpful to alleviate respiratory symptoms,inhibit airway inflammation and regulate hemorheology,with good efficacy and safety.

Abstract:Xuezhikang is derived from red yeast rice and contains 13 natural statins(including non-crystalline lovastatin and its analogs)as well as a variety of bioactive components.It synergistically regulates the lipid profile and cholesterol metabolism by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase and activating peroxi-some proliferator-activated receptor-related signaling pathways.Meanwhile,it exerts anti-inflammatory,antioxidant and vascular endothelial protective effects in the treatment of cardiovascular diseases by inhibiting nuclear factor-κB activation and promoting the nuclear translocation of nuclear factor E2-related factor 2.Both clinical studies and practice have shown that Xuezhikang can significantly reduce the levels of low-density lipoprotein cholesterol and triglycerides in patients,and alleviate inflammatory status and oxidative stress.It helps to reduce the risk of cardi-ovascular events and improve prognosis in high-risk cardiovascular populations with a history of diabetes,myocardial infarction and other comorbidities.As a monotherapy,it has a definite lipid-lowering effect;it can also be combined with statins or non-statin lipid-lowering drugs(such as ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors)for synergistic lipid-lowering in the treatment of cardiovascular diseases.Based on its good overall tolerability and multi-target action characteristics,Xuezhikang provides a clinically valuable therapeutic option for the primary and secondary prevention of cardiovascular diseases.

Abstract:Objective To analyze the epidemiological characteristics of inpatients with ocular trauma admitted to a Grade A tertiary hospital in Beijing from 2015 to 2019.Methods A total of 621 patients with traumatic ocular diseases admitted to the Third Medical Center,Chinese PLA General Hospital from January 2015 to December 2019 were retrospectively enrolled.Data including gender,age,type of admission diagnosis and surgical treatment were recorded.Multivariate Logistic regression model was used to analyze the risk factors for traumatic ocular diseases.Result Among the 621 patients,483 were male and 138 were female.In terms of age distribution,there were 64 cases under 13 years old,221 cases aged 13-30 years,295 cases aged＞30-60 years and 41 cases over 60 years old.Regarding occupational distribution,172 were construction workers,105 were manufacturing workers and 89 were students.There were significant differences in the proportion of patients among different genders,ages and occupations(all P＜0.001).The top three admission diagnoses were orbital wall fracture(294 cases,47.3％,including 271 cases caused by blunt trauma),canaliculus laceration(142 cases,22.9％,including 96 cases caused by blunt instrument cutting)and lens dislocation(44 cases,7.1％,including 38 cases caused by high-velocity impact).There was a significant difference in the proportion of ocular trauma types among patients receiving different surgical methods(P＜0.001).Multivariate Logistic regression analysis showed that male sex(odds ratio=1.83,95％confidence interval:1.29-2.60),construction worker occupation(odds ratio=2.45,95％confidence interval:1.78-3.38)and blunt instrument injury(odds ratio=4.12,95％confidence interval:2.96-5.73)were independent risk factors for orbital wall fracture(all P＜0.05).The age of＞30-60 years old(odds ratio=4.21,95％confidence interval:2.89-6.13)and sharp instrument cutting(odds ratio=3.87,95％confidence interval:2.64-5.67)were independent risk factors for canaliculus laceration(both P＜0.001).Conclusions Young and middle-aged laborers are high-risk groups for ocular trauma,with occupa-tional exposure and daily activities as the main inducing factors,indicating that occupational protection and safety education on sports activities are urgently needed to be strengthened.Orbital wall fracture should be taken as a key direction for prevention and treatment,and surgical strategies should be individually designed based on age and injury type.

Abstract:Objective To investigate the relationship between soluble growth stimulation-expressed gene 2 protein(sST2)and multi-slice spiral CT(MSCT)features and prognosis in patients with acute type B aortic dissection(ATBAD).Methods A total of 135 ATBAD patients diagnosed and admitted to Nanjing First Hospital by MSCT from July 2021 to July 2023 were selected and divided into the good prognosis group(105 cases)and poor prognosis group(30 cases)according to the 2-year follow-up results.The clinical data,serum biomarkers and MSCT imaging features of the patients were collected.Binary Logistic regression analysis was used to explore the correlation between serum sST2 level and MSCT features of ATBAD patients,LOWESS analysis was adopted to analyze the nonlinear relationship between sST2 level and inflammatory factors,and Cox regression analysis was used to identify the influencing factors of poor prognosis.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum sST2 level for the prognosis of ATBAD patients.Restricted cubic spline and threshold effect analysis were used to explore the dose-response relationship between sST2 level and the risk of poor prognosis.Stepwise regression and Bootstrap methods were used to test and analyze the mediating effect of inflammatory factors between sST2 and prognosis.Kaplan-Meier method and Log-rank test were used to analyze the effect of serum sST2 level on the 2-year survival rate of patients.Results The main MSCT features of the 135 ATBAD patients were aortic dilatation(77 cases,57.0％),true and false lumens(58 cases,43.0％)and intimal tear(55 cases,40.7％).The serum levels of sST2,D-dimer,C-reactive protein,cardiac troponin I(cTnI),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the poor prognosis group were significantly higher than those in the good prognosis group,while the level of anti-inflammatory factor IL-4 was significantly lower(all P＜0.05).The incidences of aortic dilatation,aortic dissection rupture,true and false lumens,thrombus spread and intimal tear in the poor prognosis group were significantly higher than those in the good prognosis group(all P＜0.05).Binary Logistic regression showed that sST2 was positively correlated with aortic dilatation,dissection rupture,true and false lumens and thrombus spread(all odds ratio＞1,P＜0.05).LOWESS analysis revealed a nonlinear relationship between serum sST2 level and the levels of D-dimer,C-reactive protein,cTnI,IL-4,IL-6 and TNF-α in ATBAD patients.Cox regression indicated that sST2,D-dimer,C-reactive protein,cTnI,IL-6 and TNF-α were independent risk factors for poor prognosis in ATBAD patients,and IL-4 as a protective factor(all P＜0.05).ROC curve showed that the area under the curve of sST2 for predicting the prognosis of ATBAD patients was 0.814(95％confidence interval:0.779-0.854).Restricted cubic spline analysis demonstrated a nonlinear relationship between sST2 level and prognostic risk in ATBAD patients(P＜0.001),and when the sST2 level was＞29.64 μg/L,the risk of poor prognosis increased gradually with the elevation of sST2 level.Mediation effect analysis showed that IL-4,IL-6 and TNF-α had a mediating regulatory effect between sST2 level and poor prognosis in ATBAD patients.Survival curve indicated that patients with lower sST2 concentration had a higher 2-year survival rate(Log-rank P＜0.05).Conclusion Serum sST2 level is positively correlated with MSCT features such as aortic dilatation,dissection rupture and thrombus spread in ATBAD patients,and also positively correlated with the risk of poor prognosis in ATBAD patients.It can serve as an important biomarker for evaluating ATBAD patients and provide an important basis for clinical treatment.

Abstract:Objective To investigate the expression level of Stanniocalcin 2(STC2)in gastric cancer patients and its predictive value for resistance to immunotherapy.Methods A total of 148 gastric cancer patients admitted to the 909th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from April 2022 to April 2024 were enrolled as research subjects.Reverse transcription real-time fluorescent quantitative polymerase chain reaction was used to detect the relative expression of STC2 mRNA in gastric cancer tissues and paired paracancerous tissues(non-tumor gastric mucosal tissues ≥ 5 cm from the tumor edge).Immunohistochem-istry was performed to detect STC2 protein expression,and patients were divided into the high STC2 expression group(90 cases)and low STC2 expression group(58 cases)according to staining intensity and the proportion of positive cells.The clinicopathological data of patients were collected,and the occurrence of immunotherapy resist-ance was observed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of STC2 expression level for immunotherapy resistance.Correlation heatmap was used to analyze the association between STC2 expression and tumor immune microenvironment indicators,including the infiltration ratios of CD8+T cells,CD4+T cells and B cells,the positive rate of programmed cell death protein 1(PD-1)in T cells,the infiltration ratios of regulatory T cells(Treg,marked by FOXP3+)and macrophages(marked by C D68),as well as the positive rate of programmed cell death ligand 1(PD-L1)on the surface of tumor cells.Results The relative expression of STC2 mRNA in gastric cancer tissues was(2.7±0.7),which was significantly higher than that in paracancerous tissues(1.0±0.3),with a statistically significant difference(t=27.035,P＜0.001).The positive expression rate of STC2 in gastric cancer tissues(58.1％)was higher than that in paracancerous tissues(29.7％)(x2=24.196,P＜0.001).The proportions of patients with TNM stage Ⅳ,serosal and extra-serosal infiltration,and lymph node metastasis in the high expression group were all higher than those in the low expression group(all P＜0.05).Among the 148 patients,44 developed immunotherapy resistance,and the resistance rate in the high expression group was higher than that in the low expression group[36.7％(33/90)vs 19.0％(11/58)](x2=5.290,P=0.021).ROC curve analysis showed that the area under the curve of STC2 expression level for predicting immunotherapy resistance in gastric cancer patients was 0.908(95％confidence interval:0.850-0.949),with a sensitivity of 81.82％and a specificity of 92.30％.Correlation heatmap analysis revealed that STC2 expression level in gastric cancer tissues was significantly negatively correlated with the infiltra-tion ratios of CD8+T cells,CD4+T cells and B cells as well as the positive rate of PD-1 in T cells(all P＜0.001),and significantly positively correlated with the infiltration ratios of FOXP3+Treg cells and CD68+macrophages as well as the positive rate of PD-L1 on the surface of tumor cells(all P＜0.001).Conclusion The expression level of STC2 is significantly elevated in gastric cancer tissues,which is associated with tumor invasion depth,lymph node metastasis and advanced clinical stage.Gastric cancer patients with high STC2 expression have a higher rate of immunotherapy resistance,and STC2 can serve as an effective biomarker for predicting immunotherapy resistance,whose mechanism may be related to the regulation of tumor immune microenvironment.

Abstract:Chronic obstructive pulmonary disease(COPD)is a highly prevalent respiratory disease world-wide,and its treatment is faced with challenges such as a long course of disease and recurrent attacks.In recent years,improving the clinical efficacy of COPD patients by regulating intestinal function has become a research hotspot.As one of the traditional Chinese medicine(TCM)Zang-Fu organ theories,"the lung and large intestine are interior-exterior related"proposes a unique idea of"simultaneous treatment of lung and intestine".Modern medicine has put forward the"lung-gut axis"theory based on the crosstalk relationship between microorganisms and their metabolites between the lung and large intestine,which provides a scientific basis and research direction for the TCM treatment of COPD.Based on the theory of"simultaneous treatment of lung and intestine"and with the modern research on the"lung-gut axis"as the key,this paper intends to systematically sort out the application progress from"simultaneous treatment of lung and intestine"to the"lung-gut axis".It expounds the treatment of COPD by TCM compound prescriptions,TCM enema,acupoint application and other methods,which can regulate intestinal flora imbalance,restore immune balance and exert a synergistic therapeutic effect.This study aims to give full play to the advantages of classic TCM theories in the research field of respiratory diseases and provide new ideas for the TCM treatment of COPD.