Abstract:Objective To investigate the pregnancy outcomes of puerperae with pulmonary arterial hypertension(PAH)after congenital heart disease(CHD)surgery.Methods A retrospective cohort study was conducted on 83 puerperae with PAH after CHD surgery admitted to the Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University from June 2012 to June 2022.According to the systolic pulmonary artery pressure estimated by echocardiography,the patients were divided into mild-moderate PAH group(＜80 mmHg,66 cases)and severe PAH group(≥80 mmHg,17 cases).Differences in gestational week at delivery,mode of delivery,neonatal outcomes and adverse cardiovascular events were analyzed between groups.Patients were further divided into non-adverse cardiovascular event group(54 cases)and adverse cardiovascular event group(29 cases)based on the occurrence of adverse cardiovascular events during pregnancy and puerperium.Univariate and multivariate Logistic regression analyses were used to identify risk factors for adverse cardiovascular events during pregnancy and puerperium.Results All 66 patients with mild-moderate PAH terminated pregnancy in the third trimester(after 28 gestational weeks)under multidisciplinary management.Among 17 patients with severe PAH,2 underwent cesarean termination of pregnancy due to deteriorated cardiac function in the second trimester,and the rest delivered live births after 28 gestational weeks.The mean gestational week of all live births was(36.5±2.5)weeks,ranging from 31 to 40 weeks.Compared with the mild-moderate PAH group,the severe PAH group had earlier gestational week at delivery,lower neonatal birth weight,and higher incidences of preterm birth and adverse cardiovascular events(all P＜0.05).A total of 3 maternal deaths occurred,all in the severe PAH group,with PAH crisis as the main cause of death.Multivariate Logistic regression analysis showed that cardiac function grade Ⅲ-Ⅳ(odds ratio=3.156,95％confidence interval:1.419-7.017,P=0.005)and brain natriuretic peptide ≥ 100 ng/L(odds ratio=11.221,95％confidence interval:2.418-12.659,P＜0.001)were risk factors for adverse cardiovascular events during pregnancy and puerperium in patients with PAH after CHD surgery.Conclusions Standardized multidisciplinary management during pregnancy yields favorable pregnancy outcomes in patients with mild-moderate PAH after CHD surgery.Increased pulmonary artery pressure significantly raises the incidences of preterm birth,small-for-gestational-age infants and adverse cardiovascular events.Cardiac evaluation is recommended for patients with PAH after CHD surgery before pregnancy.

Abstract:Objective To investigate the influencing factors of bleeding after peripherally inserted central catheter(PICC)placement in patients with cardiovascular diseases,and to clarify the causal association and mediating effect.Methods Medical records of 319 cardiovascular disease patients who underwent PICC placement in Beijing Anzhen Hospital,Capital Medical University from October 2024 to August 2025 were retrospectively collected.Patients were divided into bleeding group(61 cases)and non-bleeding group(258 cases)according to bleeding status.Demographic data,disease diagnosis,medication and other information were collected.With bleeding after PICC placement as the outcome variable,independent risk factors and pathways were identified by multivariate Logistic regression,causal association and mediation analysis.Results There were significant differences in puncture site,proportion of atrial fibrillation,thrombocytopenia,proportion of combined rheumatic heart disease,history of valve replacement surgery,platelet count,D-dimer and fibrinogen levels between the two groups(all P＜0.05).Multivariate Logistic regression analysis showed that thrombocytopenia,atrial fibrillation and history of valve replacement surgery were independent risk factors for PICC-related bleeding,while elevated D-dimer level and puncture at basilic vein were protective factors(all P＜0.05).Mediation analysis showed that platelet count was an important mediator between thrombocytopenia and PICC-related bleeding.Thrombocytopenia could indirectly increase bleeding risk by reducing platelet count,with an indirect effect value of 0.065(95％confidence interval:0.008-0.126).There was a non-linear association between platelet count and bleeding risk after PICC placement,and the bleeding risk increased significantly when platelet count was lower than 200 × 109/L.Conclusions Thrombocytopenia,atrial fibrillation,history of valve replacement surgery,lower D-dimer level and non-basilic vein puncture are closely related to bleeding risk after PICC placement in cardiovascular disease patients.Platelet count plays a partial mediating role in the association between thrombocytopenia and PICC-related bleeding,and a level below 200 × 109/L increases the bleeding risk.

Abstract:With the continuous rise in the incidence of cardiovascular diseases,exploring biomarkers with higher comprehensive predictive value has become a hotspot in clinical research.The serum uric acid to high-density lipoprotein cholesterol ratio(UHR)is a novel composite serological indicator that combines serum uric acid with high-density lipoprotein cholesterol.Compared with traditional single indicators,UHR not only overcomes the limitations of individual indexes,but also can more comprehensively and dynamically reflect the complex glucose and lipid metabolism imbalance and systemic chronic inflammatory state in the human body.This paper systematically integrates clinical research evidence on the correlation between UHR and various cardiovascular diseases,and analyzes the underlying pathophysiological basis.By exploring the correlation of UHR in cardiovascular event risk stratification,early clinical screening and disease progression monitoring,this paper evaluates its clinical feasibility as a non-invasive,low-cost and easily accessible biomarker,so as to provide evidence-based support for further optimizing the management strategy and early intervention targets of cardiovascular diseases.

Abstract:Objective To observe the clinical efficacy of spring pediatric growth plaster combined with lifestyle regulation in the treatment of short stature children.Methods A randomized controlled trial was conducted.A total of 440 children with short stature admitted to The First Affiliated Hospital of Anhui Medical University North District,Qingyang County Hospital of Traditional Chinese Medicine,Anhui Province and Huangshan Huaze Hospital of Integrated Traditional Chinese and Western Medicine,Anhui Province from January to March 2023 and January to March 2024 were enrolled.The subjects were divided into control group and treatment group by random number table method,with 220 cases in each group.The control group received lifestyle regulation including exercise,sleep and nutritional intervention;on this basis,the treatment group was additionally treated with spring pediatric growth plaster.The total effective rate,height growth,monthly growth rate,traditional Chinese medicine syndrome score and adverse reactions were compared between the two groups.Results The total effective rate of the treatment group was significantly higher than that of the control group[62.7％(138/220)vs 47.2％(104/220)](P＜0.001),with obviously better curative effect(P=0.004).The height growth and monthly growth rate in the treatment group were significantly higher than those in the control group[(1.34±0.71)cm vs(0.82±0.56)cm,(0.67±0.36)cm/month vs(0.41±0.28)cm/month](both P＜0.001).After treatment,the traditional Chinese medicine syndrome score of the treatment group was markedly lower than that of the control group(P＜0.001).In the treatment group,10 children presented skin redness accompanied by pruritus at the initial stage of treatment,which was quickly relieved by external application of desonide cream without affecting subsequent application.No adverse reactions occurred in the control group.Conclusion Spring pediatric growth plaster combined with lifestyle regulation has definite curative effect on short stature children with spleen and kidney deficiency syndrome,which can significantly improve traditional Chinese medicine symptoms and increase height growth and monthly growth rate.

Abstract:This article reports the 8-year follow-up and therapeutic observation of one elderly patient with type 2 diabetic nephropathy.The patient was diagnosed with diabetic nephropathy[chronic kidney disease(CKD)stage G3a and A2]at the initial visit,accompanied by hypertension,dyslipidemia,hyperuricemia and obesity.Insulin combined with dipeptidyl peptidase Ⅳ inhibitor was initially administered to control blood glucose,which was later adjusted to canagliflozin,a sodium-glucose cotransporter 2 inhibitor(SGLT2i);the antihypertensive regimen was adjusted to perindopril,an angiotensin-converting enzyme inhibitor(ACEI),combined with sustained-release nifedipine,a calcium channel blocker(CCB);lipid-lowering therapy was adjusted to atorvastatin combined with ezetimibe;allopurinol was used to reduce serum uric acid.In accordance with the recommendations of the Chinese guidelines for the prevention and treatment of type 2 diabetes mellitus,the comprehensive control targets for this patient were glycated hemoglobin(HbA1c)＜7.5％,blood pressure＜130/80 mmHg and low-density lipoprotein cholesterol(LDL-C)＜1.8 mmol/L,so as to halt renal function deterioration.During the continuous 8-year follow-up treatment from 2018 to 2025,the patient's disease indicators were significantly improved:HbA1c decreased from 9.2％to 7.9％,blood pressure dropped from 140/80 mmHg to 131/73 mmHg,LDL-C declined from 2.7 mmol/L to 1.4 mmol/L,serum uric acid returned to normal,and the urinary albumin/creatinine ratio fell from 33.2 mg/g to 14.4 mg/g,with the CKD stage improved from A2 to A1.The estimated glomerular filtration rate(eGFR)remained stable at 37.1-38.8 ml/(min·1.73 m2)in the recent 3 years,reaching 38.0 ml/(min·1.73 m2)in 2025.The eGFR only decreased by 16.7 ml/(min·1.73 m2)over the 8 years,with an average annual decline of merely 2.1 ml/(min·1.73 m2),indicating that renal function deterioration was markedly halted.The comprehensive therapeutic regimen of this patient based on SGLT2i for hypoglycemia,ACEI combined with CCB for hypertension,and statin combined with cholesterol absorption inhibitor for dyslipidemia significantly improved multiple indicators including HbA1c,blood pressure and LDL-C,and retarded the deterioration of renal function caused by diabetic nephropathy.

Abstract:Objective To explore the short-term prognosis and clinical characteristics of patients with acute myocardial infarction(AMI)complicated with upper gastrointestinal bleeding after endoscopic therapy,and to identify the safe conditions for endoscopic treatment and key prognostic factors.Methods A total of 64 patients admitted to Beijing Anzhen Hospital,Capital Medical University from January 2012 to August 2025 with AMI combined with upper gastrointestinal bleeding who received successful endoscopic hemostasis were retrospectively enrolled.Clinical data including general information,medical history,laboratory examinations,cardiac and bleeding characteristics,and clinical outcomes were collected.The primary endpoint was all-cause mortality within 30 d after successful endoscopic hemostasis.Patients were divided into survival group(44 cases)and death group(20 cases)for comparative analysis.Results The age of the 64 patients was(63±13)years old,among whom 79.7％(51/64)were male.Non-ST-segment elevation myocardial infarction accounted for 60.9％(39 cases),and ST-segment elevation myocardial infarction accounted for 39.1％(25 cases).Cardiac insufficiency was present in 53.1％(34 cases)on admission.All patients achieved successful endoscopic hemostasis without intraoperative complications.During the 30 d follow-up period,44 patients(68.8％)survived and 20 patients(31.2％)died,among whom 95.0％(19/20)died of cardiac causes after successful hemostasis.Due to severe underlying cardiac diseases in the death group,the proportions of patients receiving mechanical ventilation,intra-aortic balloon pump,extracorporeal membrane oxygenation and continuous renal replacement therapy were significantly higher than those in the survival group[80.0％(16/20)vs 25.0％(11/44),35.0％(7/20)vs 9.1％(4/44),45.0％(9/20)vs 4.5％(2/44),40.0％(8/20)vs 0(0/44)](all P＜0.05).Conclusions Most patients with AMI combined with upper gastrointestinal bleeding undergoing endoscopic hemostasis are complicated with cardiac insufficiency.The application of advanced life support contributes to hemodynamic stability and guarantees the safe implementation of endoscopic hemostasis,while it also reflects critical illness severity.The prognosis of patients is determined by the severity of underlying cardiac lesions.

Abstract:Objective To evaluate right ventricular function in patients with left ventricular noncompaction(LVNC)by speckle tracking imaging(STI),and to investigate the predictive efficiency of right ventricular global longitudinal strain(RVGLS)/pulmonary artery systolic pressure(PASP)ratio for adverse outcomes in LVNC patients.Methods A total of 42 LVNC patients admitted to Affiliated Hospital of Qingdao University from November 2023 to June 2025 were prospectively enrolled.According to the median left ventricular ejection fraction(LVEF),the patients were divided into group A(LVEF ≤43％,21 cases)and group B(LVEF＞43％,21 cases).Meanwhile,42 healthy adults were enrolled as control group(group C).STI was used to measure RVGLS and calculate RVGLS/PASP ratio.Linear regression analysis was performed to analyze the correlation between RVGLS/PASP ratio and other ultrasonic parameters.Receiver operating characteristic(ROC)curve was applied to analyze the value of RVGLS/PASP ratio in evaluating adverse prognosis of LVNC patients.Results Compared with group A,left ventricular global longitudinal strain(LVGLS),RVGLS,right ventricular free wall longitudinal strain(RVFWLS)and RVGLS/PASP ratio were increased in group B and group C(all P＜0.05).Compared with group C,LVGLS,RVGLS and RVGLS/PASP ratio were decreased in group B(all P＜0.05).Multiple linear regression analysis showed that medial early diastolic mitral annular velocity,left atrial volume index and RVFWLS were independently correlated with RVGLS/PASP ratio(all P＜0.05).ROC curve analysis indicated that RVGLS/PASP ratio had the highest predictive efficiency for adverse prognosis of LVNC patients,with an area under the curve of 0.856(95％confidence interval:0.744-0.967).Conclusion Right ventricular function is decreased in LVNC patients.RVGLS/PASP ratio can be used to evaluate right ventricular function and predict adverse prognosis in LVNC patients,which has important clinical significance.

Abstract:Acute pancreatitis is a common acute abdomen in clinical practice.Most patients have a good prognosis,while a small number of patients suffer from a severe and life-threatening condition with a certain risk of death,and the mortality rate caused by this disease ranges from 5％to 10％.One important cause of death in these patients is secondary peripancreatic infection.This article reviews the research progress on the etiology,common clinical manifestations,clinical diagnostic criteria,and subsequent prevention and treatment of secondary intra-abdominal infection in acute pancreatitis,so as to improve our understanding of secondary intra-abdominal infection,provide ideas for clinical prevention and treatment,and thereby reduce patient mortality.

Abstract:As a classic nonsteroidal anti-inflammatory drug,aspirin has attracted increasing attention in the field of colorectal cancer prevention and treatment in addition to its antipyretic,analgesic,anti-inflammatory and cardiovascular protective effects.Numerous epidemiological and clinical studies have confirmed that long-term regular use of aspirin can significantly reduce the risk of colorectal cancer incidence and mortality,and has clear chemopreventive value especially for populations with specific genetic background and tumor molecular subtypes.This paper systematically reviews the research progress of aspirin in the prevention and treatment of colorectal cancer,focusing on its possible multi-target anticancer mechanism network,aiming to provide a theoretical basis for the clinical"repurposing of old drugs"and expand new approaches for individualized prevention and treatment of colorectal cancer.

Abstract:Acute myeloid leukemia(AML)is a highly heterogeneous malignant hematologic neoplasm,and its occurrence and development are closely related to abnormal regulation of gene expression.In recent years,the role of epitranscriptomics,especially RNA modification,in the pathogenesis of AML has attracted increasing attention.This review focuses on three key RNA chemical modifications-N6-methyladenosine(m6A),5-methyl-cytosine(m5C)and 7-methylguanosine(m7G),and systematically elaborates their regulatory networks,biological functions and clinical significance in AML.This paper summarizes the basic characteristics of m6A,m5C and m7G modifications,and focuses on how these modifications and their regulators affect the stability,splicing,nuclear export and translation efficiency of target messenger RNAs,thereby regulating the expression of oncogenes,tumor suppressor genes and signaling pathways related to AML,and ultimately driving the proliferation,self-renewal,differentiation arrest and chemoresistance of leukemia cells.In conclusion,this review aims to reveal the complex regulatory role of RNA modifications in AML,discuss the value of related regulators as novel molecular markers and potential therapeutic targets,and provide new perspectives for understanding the pathogenesis of the disease and developing new diagnosis and treatment strategies.

Abstract:Objective To explore the association between triglyceride-glucose body mass index(TyG-BMI)and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients.Methods A total of 2 981 middle-aged and elderly hypertensive patients aged ≥45 years from the 2011 wave of the China health and retirement longitudinal study database were enrolled.During follow-up until 2015,233 patients developed new-onset adverse cardiovascular events(cardiovascular event group),and 2 748 patients remained free of adverse cardiovascular events(non-cardiovascular event group).Cox proportional hazards models were used to analyze the relationship of continuous TyG-BMI and categorized TyG-BMI[stratified by the median TyG-BMI of the study population(212.1)as the cut-off value;participants were divided into low-value group(102.4-212.1)and high-value group(＞212.1-432.1)]with the risk of adverse cardiovascular events.Restricted cubic splines were plotted to analyze the dose-response relationship between TyG-BMI and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients.Subgroup analyses were performed stratified by age(＜60 years vs ≥ 60 years),gender,diabetes history,smoking history and drinking history.Results The levels of body mass index,low-density lipoprotein cholesterol,serum uric acid,C-reactive protein,glycated hemoglobin and TyG-BMI in the cardiovascular event group were higher than those in the non-cardiovascular event group(all P＜0.05).In addition,the preva-lence rates of hyperlipidemia,diabetes mellitus and renal diseases were significantly higher,while high-density lipo-protein cholesterol and systolic blood pressure levels were lower in the cardiovascular event group compared with the non-cardiovascular event group(all P＜0.05).When TyG-BMI was included as a continuous variable in Cox proportional hazards regression analysis for the overall population,it was positively associated with the risk of adverse cardiovascular events across all models.In the fully adjusted Model 3 stratified by the median TyG-BMI,the high-value group had a 36％increased risk of adverse cardiovascular events relative to the low-value group(hazard ratio=1.36,95％confidence interval:1.05-1.76,P=0.020).The risk estimates of TyG-BMI(the second quartile versus the first quartile)were consistent with those of the overall population across all subgroups(i.e.,higher TyG-BMI corresponded to elevated risk),with no significant heterogeneity observed within each subgroup(the P values for interaction tests stratified by age,diabetes history,drinking status,gender and smoking history were 0.157,0.518,0.679,0.803 and 0.807,respectively).The elevated risk of adverse cardiovascular events indicated by increased TyG-BMI remained relatively stable across subgroups.Conclusions Elevated TyG-BMI is a risk factor for adverse cardiovascular events in middle-aged and elderly hypertensive patients.This indicator is easy to calculate and cost-effective,and can serve as a potential simple tool for evaluating cardiac risk in hypertensive patients.

Abstract:Ovarian cancer is the leading cause of death among malignant tumors of the female reproductive system,which seriously threatens the health of women.Based on the principles of evidence-based medicine,the guideline development group referred to the latest international and domestic clinical practice guidelines to formulate methods,objectively evaluate the evidence of integrated traditional Chinese and western medicine in the diagnosis and treatment of ovarian cancer,and extensively consulted experts from various disciplines such as Chinese medicine,clinical medicine,and methodology.The final result is this guideline,aiming to provide guidance for the clinical practice of integrated traditional Chinese and western medicine in the diagnosis and treatment of ovarian cancer.

Abstract:The rate of in-stent restenosis in patients with coronary atherosclerotic heart disease and diabetes mellitus is significantly higher than that in patients without diabetes mellitus.It is characterized by abnormal glucose metabolism,blood glucose fluctuation,insulin resistance as the core,and is often accompanied by hyperlipidemia,hyperuricemia,abnormal coagulation and fibrinolysis indicators,chronic inflammation,etc.These factors directly or indirectly affect vascular endothelial function,promote smooth muscle proliferation,abnormal coagulation,and ultimately lead to the occurrence of restenosis.This review mainly summarizes and discusses the research on the risk factors of in-stent restenosis after percutaneous coronary intervention in patients with diabetes mellitus and coronary atherosclerotic heart disease,in order to provide a reference for reducing the incidence of in-stent restenosis and preventing the occurrence of adverse cardiovascular events.

Abstract:Objective To investigate the clinical effect of remimazolam alone or combined with remifentanil for sedation in awake fiberoptic bronchoscopic tracheal intubation(AFOI).Methods Sixty patients who underwent elective AFOI surgery in Beijing Friendship Hospital,Capital Medical University from August 2021 to February 2023 were selected as the research objects.The patients were divided into remimazolam alone group(RM group)and remimazolam combined with remifentanil group(RR group)by random number table method,with 30 cases in each group.Patients in the RM group received only a continuous infusion of remimazolam 0.6 mg/(kg·h).RR group received remimazolam 0.6 mg/(kg·h)and remifentanil 0.05 µg/(kg·min)combined infusion.AFOI operation-related evaluation,sedation level and hemodynamic indexes at different time points[drug infusion at 1 min(T1)and 3 min(T2),before fiberoptic bronchoscope entering the glottis(T3),and after tracheal tube entering the trachea(T4)]were compared between the two groups.Results The response to fiberoptic bronchoscopy intubation,cough severity and post-intubation tolerance score,intubation time,awareness and willingness to accept AFOI score in RR group were lower/shorter than those in RM group(all P＜0.001).The Modified Observer's Assessment of Alertness/Sedation score and bispectral index at T2,T3 and T4 in RR group were lower than those in RM group(all P＜0.05).The incidence of hypoxemia and deep sedation was higher and the incidence of hypertension and tachycardia was lower in the RR group than in the RM group[44.8％(13/29)vs 0(0/30),48.3％(14/29)vs 3.3％(1/30),31.0％(9/29)vs 63.3％(19/30),34.5％(10/29)vs 73.3％(22/30)](all P＜0.05).Conclusions Remimazolam alone can provide effective sedation for AFOI and is safe and reliable.Remimazolam combined with remifentanil can provide better intubation conditions and comfort,but may increase the risk of respiratory depression.

Abstract:Cardiovascular disease remains a high incidence disease worldwide and the largest cause of mortality among populations and severely affects the health of elderly.At present,the trend of population aging has become a major global problem.With the physiological changes of aging,the elderly are more likely to suffer from cardiovascular diseases.At the same time,the elderly often have multimorbidity,which is an important reason for the increase in the prevalence of heart failure.Therefore,it is urgent to adopt new strategies to develop personalized health care programs suitable for the elderly,delay the progression of cardiovascular disease in the aging population,and gradually improve the healthy life expectancy of the elderly.Enhanced external counterpulsation(EECP)is a non-invasive treatment suitable for cardiovascular rehabilitation and secondary prevention.As a passive aerobic exercise,EECP provides a safe,effective and non-invasive rehabilitation treatment for elderly patients with cardio-vascular disease.In order to standardize the application and prescription management of EECP in elderly patients with cardiovascular disease,effectively increase coronary artery reserve,improve cardiac function,improve exercise tolerance,improve their quality of life and obtain the best prognosis,Cardiac Intensive Care Professional Committee of Chinese Medical Doctor Association,Critical Care Medicine Professional Committee of Chinese Medical Education Association,and etc.have developed the consensus by mutiple seminars and screened a large number of evidence-based medical evidence.This consensus focuses on clinical practice,is demand-oriented,and summarizes the process,including the working principle of EECP,the mechanism of action on cardiovascular diseases,the application of EECP in elderly cardiovascular diseases,and the operating procedures.The consensus aims to help clinicians to carry out standardized and systematic EECP treatment,so as to improve the effectiveness and safety of treatment,and to provide reference and basis for the application of EECP in elderly patients with cardiovascular disease.

Abstract:Objective To investigate the relationship between the levels of serum neurotransmitters,5-hydroxytryptamine(5-HT),norepinephrine(NE),neuron-specific enolase(NSE),neurofilament heavy chain protein(NfH),S100β protein and sleep disorders in patients with acute ischemic stroke.Methods A total of 358 patients with acute ischemic stroke hospitalized in the Department of Neurology,North China University of Science and Technology Affiliated Hospital from November 2022 to October 2023 were selected.The Pittsburgh Sleep Quality Index(PSQI)scale was completed within 3 days after admission to evaluate the sleep condition of patients.According to PSQI score and results,the patients were divided into sleep disorder group(276 cases)and non-sleep disorder group(82 cases).The sleep disorder group was further divided into mild sleep disorder group(147 cases),moderate sleep disorder group(96 cases)and severe sleep disorder group(33 cases).The serum levels of 5-HT,NE,NSE,NfH and S100β were compared among the groups.Logistic regression method was used to analyze the risk factors of sleep disorders after acute ischemic stroke.Spearman correlation method was used to analyze the correlation between serum 5-HT,NE,NSE,NfH,S100β protein and the severity of sleep disorder in patients with acute ischemic stroke.Results The serum levels of 5-HT and NE in sleep disorder group were lower than those in non-sleep disorder group[(248±90)ng/L vs(422±48)ng/L,(147±50)ng/L vs(270±46)ng/L],and the levels of NSE,NfH and S100β protein in the sleep disorder group were higher than those in the non-sleep disorder group[(9.2±3.0)μg/L vs(5.2±1.6)μg/L,(85±24)ng/L vs(51±12)ng/L,(798±174)ng/L vs(480±98)ng/L](all P＜0.001).Logistic regression analysis showed that 5-HT,NE,NSE,NfH and S100βprotein were independent risk factors for sleep disorders after acute ischemic stroke(all P＜0.05).Among them,5-HT and NE were protective factors,and NSE,NfH and S100β protein were risk factors.Spearman correlation analysis showed that the severity of sleep disorders was negatively correlated with the levels of 5-HT and NE in patients with acute ischemic stroke(r=-0.902,-0.942,both P＜0.001),and positively correlated with the levels of NSE,NfH and S100β(r=0.774,0.775,0.878,all P＜0.001).Conclusions The serum levels of 5-HT,NE,NSE,NfH and S100β protein were correlated with sleep disorders and their severity in patients with acute ischemic stroke.The severity of sleep disorders was negatively correlated with serum levels of 5-HT and NE,and positively correlated with serum levels of NSE,NfH and S100β protein.

Abstract:The development process of cardiac rehabilitation for coronary atherosclerotic heart disease is full of constant negations and doubts.It has experienced the transformation from"rest"to"dynamic rehabilitation",from the program with exercise rehabilitation as the core to comprehensive intervention,and from the program with exercise rehabilitation as the core to the comprehensive intervention.Its benefits have been supported by a large number of evidence-based medical evidence,and have been recommended by many countries and organizations.It is closely integrated with the primary and secondary prevention of coronary atherosclerotic heart disease,and has become an indispensable part of the medical practice of cardiovascular disease,which determines the treatment,prognosis and quality of life of patients with cardiovascular disease.This review aims to summarize the origin and historical background of cardiac rehabilitation at home and abroad,help clinical understand cardiac rehabilitation and its future potential,and provide a reference for promoting the development of cardiac rehabilitation in China.

Abstract:Objective To explore the effects of high-flow nasal cannula oxygen therapy(HFNC)on nerve ventilation drive and respiratory work in patients with chronic obstructive pulmonary disease(COPD)after mechanical ventilation extubation.Methods A total of 292 COPD patients who underwent mechanical ventilation and extubation in the Intensive Care Unit(ICU)and the Emergency Intensine Care Unit of People's Hospital of Quzhou,Zhejiang Province from January 2020 to June 2022 were selected and randomly divided into observation group and control group,with 146 cases in each group.The observation group received HFNC intervention,and the control group received Venturi mask oxygen therapy intervention.The general data of the two groups were compared.The respiratory parameters,blood gas analysis indexes,diaphragm electrical activity(EAdi)data and inspiratory effort index were compared between the two groups at the beginning of oxygen therapy and 30 min,60 min,24 h of oxygen therapy.The differences of clinical indicators between the two groups were compared.Results During the study period,7 and 5 patients were excluded from the control group and the observation group.After 60 min of oxygen therapy and 24 h of oxygen therapy,the respiratory rate and arterial partial pressure of carbon dioxide in the observation group were lower than those in the control group,and the oxygenation index and arterial oxygen partial pressure were higher than those in the control group(all P＜0.05).After 60 min of oxygen therapy and 24 h of oxygen therapy,the EAdi peak value,the EAdi valley value,the area under the EAdi curve,the product of diaphragmatic pressure-time,the product of diaphragmatic pressure-time per minute,and the product of diaphragmatic pressure-time per aspiration in the observation group were lower than those in the control group(all P＜0.05).The reintubation rate within 48 h,ICU hospitalization cost and ICU hospitalization time in the observation group were lower/shorter than those in the control group[6.4％(9/141)vs 18.7％(26/139),(43±8)thousand yuan vs(61±11)thousand yuan,(5.7±1.1)d vs(7.8±1.3)d](all P＜0.05).Conclusion Compared with traditional oxygen therapy,HFNC can effectively improve the neural ventilation drive and respiratory work of COPD patients after mechanical ventilation extubation,reduce the reintubation rate,shorten the length of ICU stay,and reduce the treatment cost.

Abstract:Objective To investigate the effects of sacubitril/valsartan combined with basic therapy on hemorheology,cardiac function status and exercise tolerance in patients with chronic heart failure(CHF).Methods A total of 114 CHF patients admitted to the Third People's Hospital of Chengdu from April 2019 to April 2023 were selected and divided into observation group and control group by block randomization method,with 57 cases in each group.The control group received conventional CHF basic treatment,and the observation group was given sacubitril/valsartan combined treatment on this basis.The clinical effects of the two groups were compared after 6 months of treatment.Including heart function[left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)],hemorheology indexs[whole blood viscosity,plasma viscosity,erythrocyte deformation index(DI)],sports endurance[6 min walking distance test(6MWT)and peak oxygen uptake].The occurrence of adverse reactions of patients in the two groups during treatment was recorded.Results After 6 months of treatment,the total effective rate of the observation group was higher than that of the control group[84.2％(48/57)vs 68.4％(39/57)](P=0.047).After 6 months of treatment,the LVEDV and LVESV of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group[(222±4)ml vs(226±5)ml,(100±4)ml vs(102±5)ml](all P＜0.05).After 6 months of treatment,the hemorheological indexes of whole blood viscosity and plasma viscosity in the two groups were lower than those before treatment,and the observation group were lower than the control group[(3.1±1.0)mPa·s vs(3.7±1.1)mPa·s,(1.2±1.0)mPa·svs(1.9±1.1)mPa·s];DI was higher than that before treatment,and the observation group was higher than the control group[(0.51±0.23)vs(0.41±0.24)](all P＜0.05).After 6 months of treatment,the 6MWT distance and peak oxygen uptake in exercise tolerance of the two groups were longer/higher than those before treatment,and those in the observation group were longer/higher than those in the control group[(509±6)m vs(501±6)m,(22.4±2.9)ml/(kg·min)vs(20.7±3.8)ml/(kg·min)](all P＜0.05).During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients(P=0.297).Conclusion Sacubitril/valsartan combined with basic therapy has a significant effect on CHF,which makes the hemorheology of patients tend to be normal,and has a positive effect on the improvement of cardiac function and exercise endurance.

Abstract:Gouty arthritis is a common crystal-related disease caused by the deposition of sodium urate crystals in articular and non-articular tissues,which can lead to inflammation and joint damage.It is mainly closely related to genetic,environmental and metabolic factors.Its occurrence is usually significantly associated with ele-vated serum uric acid levels.In the presence of persistent hyperuricemia,chronic deposition of sodium urate crys-tals in the joint and periarticular space and subsequent activation of the innate immune system are central mecha-nisms in the development of gouty arthritis.Among them,the exact molecular mechanism of NOD-like receptor family protein 3 inflammasome and some cytokines in the activation of gouty arthritis has not been elucidated.The treat-ment of recurrent gouty arthritis leading to the formation of tophus is limited.Therefore,it is particularly important to find effective drug targets for the treatment of goutv arthritis.