Abstract:Coronary artery disease is a serious threat to human health,and its histopathological basis is atherosclerotic plaque.Early detection of coronary artery lesions is essential for the diagnosis of coronary athero-sclerotic heart disease.In current guidelines,coronary CT angiography(CCTA)is a class Ⅰ recommendation for initial diagnosis of coronary atherosclerotic heart disease but has limitations.Artificial intelligence has great potential in health care to improve diagnostic efficiency and precision.There is a lack of studies on the comparison between artificial intelligence-guided CCTA and intravascular ultrasound(IVUS)in coronary plaque burden.This article introduces the application of artificial intelligence in the daily cardiology practice of CCTA.This article first summarizes the characteristics of deep learning technology and its application in interventional cardiology,and then discusses the feasibility and future development prospects of artificial intelligence-based CCTA technology compared with IVUS in the field of interventional cardiology.

Abstract:Objective To investigate the relationship between neuron-specific enolase(NSE)level and the effect of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced small cell lung cancer(SCLC).Methods The clinical data of 108 patients with advanced SCLC treated with sintilimab combined with platinum-based doublet-chemotherapy in Zhujiang Hospital,Southern Medical University from February 2022 to February 2024 were retrospectively analyzed.According to the clinical efficacy,the patients were divided into effective group(66 cases)and ineffective group(42 cases).The clinical data,T cell subsets,immu-noglobulin(Ig),pro-gastrin-releasing peptide(Pro-GRP)and NSE level were compared between the two groups.Multivariate Logistic regression was used to analyze the independent risk factors of ineffectiveness,and the independent correlation between NSE level and the ineffectiveness risk of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC was analyzed,and the sensitivity analysis was performed using the E-value method.Restricted cubic spline(RCS)model was established to analyze the dose-response relationship between serum NSE level and the ineffective risk of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC.Results There were significant differences in smoking history,tumor stage,CD3+,CD4+,CD8+,IgA,IgG,IgM,Pro-GRP level between the two groups(P＜0.05).There were significant differences in NSE level and ΔNSE1,ΔNSE2,ΔNSE3 and ΔNSE4 level after the first,second,third and fourth cycles of chemotherapy between the two groups(all P＜0.05).In the same group,the NSE level after each chemotherapy were significantly different from those after the last chemotherapy(all P＜0.05).Hierarchical regression analysis showed that CD3+,CD4+and CD8+had a significant positive effect on NSE level(all P＜0.05),and IgA and IgM had a significant positive effect on NSE level(both P＜0.05).After adjusting for smoking history,tumor stage and Pro-GRP,serum NSE level was still an independent risk factor for the inefficacy of sintil-imab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC(odds ratio=2.620,95％confidence interval:1.538-4.580,P＜0.001).The trend test of NSE from low to high quintile groups was statistically significant(Ptrend＜0.001),and sensitivity analysis showed that the E-value was 2.619.RCS model analysis showed that there was a linear dose-response relationship between NSE level and the inefficacy risk of sindilizumab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC(Pfor non linear=0.195).Subgroup analysis showed that the correlation between NSE and sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC was stable in patients with different tumor stages,Pro-GRP,CD3+,CD4+,CD8+,IgA,IgG and IgM level,and there was no interaction between subgroups(all Pfor interaction＞0.05).Conclusion NSE level can significantly affect the clinical efficacy of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC.Patients with lower NSE level have better clinical efficacy.

Abstract:Mitochondria plays an important role in cellular activities and metabolic processes,and insulin resistance(IR)exists in the early stage of a variety of metabolic diseases.Many studies have shown that mitochondrial dysfunction affects insulin signaling through a variety of mechanisms,leading to the occurrence and development of IR.In addition,reduced insulin function inactivates signaling pathways,resulting in IR that affects mitochondrial biogenesis and dynamics and impairs mitochondrial function.However,it remains unclear whether mitochondrial dysfunction is primary or secondary to disturbances of glucose metabolism,IR,and insulin secretion defects early in the disease.This article reviews the causal relationship between mitochondrial dysfunction and IR,reveals the pathological mechanism of mitochondrial dysfunction in metabolic diseases,and reviews a variety of methods to improve mitochondrial function and IR,so as to provide reference for clinical practice.

Abstract:Objective To explore the influence of ultrasound guided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia on perioperative stress and occurrence of postoperative delirium in elderly patients with hip fractures.Methods A total of 266 elderly patients with hip fracture admitted to Yan'an University Affiliated Hospital from January 2020 to June 2023 were prospectively selected and divided into group A and group B by envelope method,with 133 cases in each group.Group A was given laryngeal mask ventilation and sevoflurane inhalation general anesthesia,while group B was given ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia.The changes in stress indicators levels[cortisol,superoxide dismutase(SOD),angiotensin-Ⅱ(Ang-Ⅱ)]and visual analogue scale(VAS)scores at 5 min before operation and 2,12,24 h after operation,and Mini-Mental State Examination(MMSE)score and delirium occurrence on the 1st,2nd and 3rd day after operation were compared between the two groups.The occurrence of perioperative adverse reactions was recorded.Results The levels of cortisol,Ang-Ⅱ and SOD at 2,12 and 24 h after operation in both groups were higher than those at 5 min before operation but the levels in group B were lower than those in group A in each time point(all P＜0.05).At 2,12 and 24 h after operation,the VAS scores of the two groups were lower than those at 5 min before operation,and the VAS scores of group B were lower than those of group A at each time point(all P＜0.05).The MMSE scores of group B were higher than those of group A on the 1st,2nd and 3rd day after operation[(20±5)vs(18±4),(21±5)vs(19±4),(24±4)vs(21±5)],and the incidences of delirium were lower than those of group A(all P＜0.05).The incidences of intraoperative hypotension,restlessness during recovery and respiratory depression in group B were lower than those in group A(all P＜0.05).Conclusion Ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia is more conducive to reducing postoperative stress and pain in elderly patients with hip fracture,and has positive significance in reducing the incidence of postoperative delirium,intraoperative hypotension and restlessness during recovery.

Abstract:Objective To explore the effect of traditional Chinese medicine acupoint massage combined with contralateral controlled functional electrical stimulation(CCFES)on the recovery situation of motor function in patients with upper limb dysfunction after stroke.Methods A total of 220 patients with upper limb dysfunction after ischemic stroke admitted to West China Hospital,Sichuan University from July 2021 to July 2023 were selected as the research objects.According to the random number table method,the patients were divided into the control group and the observation group,with 110 cases in each group.The control group was treated with CCFES,and the observation group was treated with traditional Chinese medicine acupoint massage on the basis of the control group.Both groups were treated for 1 month.The clinical efficacy,traditional Chinese medicine syndrome score,wrist range of motion,motor function,daily living ability and quality of life were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[86.4％(95/110)vs 74.5％(82/110)](x2=4.885,P=0.027).After treatment,the traditional Chinese medicine syndrome scores of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group(all P＜0.05).After treatment,the scores of wrist range of motion,Fugl-Meyer scale,upper limb action study scale,functional independence rating scale and stroke quality of life scale in the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P＜0.05).Conclusion CCFES combined with traditional Chinese medicine acupoint massage can achieve significant curative effect in patients with upper limb dysfunction after stroke,which is helpful to the recovery of motor function.

Abstract:Objective To investigate the clinical effect of sintilimab plus bevacizumab combined with transcatheter arterial chemoembolization(TACE)in the treatment of advanced liver cancer.Methods A total of 60 patients with advanced liver cancer admitted to the Affiliated Hospital of Guilin Medical University from November 2022 to December 2023 were selected.According to the random number table method,they were divided into the control group and the observation group,with 30 cases in each group.The control group was treated with TACE and bevacizumab,and the observation group was treated with sintilimab on the basis of the control group.The clinical efficacy,tumor markers,lymphocyte levels,prognosis and survival time and safety were compared between the two groups.Results The objective remission rate and disease control rate of the observation group were higher than those of the control group[66.7％(20/30)vs 40.0％(12/30),83.3％(25/30)vs 60.0％(18/30)](both P＜0.05).After treatment,the levels of tumor markers alpha-fetoprotein,carcinoembryonic antigen and carbohy-drate antigen 199 in the two groups were lower than those before treatment,and the levels of tumor markers in the observation group were lower than those in the control group(all P＜0.05).After treatment,the CD3+,CD4+,and CD4+/CD8+ratios in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group;the CD8+level 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 disease progression time,progression-free survival time and overall survival time of the observation group were higher than those of the control group[(6.1±1.4)months vs(4.9±1.4)months,(7.9±1.7)months vs(6.5±1.4)months,(11.2±2.1)months vs(9.7±2.0)months](all P＜0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P=0.739).Conclusion Sintilimab combined with bevaci-zumab combined with TACE has a good application in the treatment of advanced liver cancer,which can improve the short-term efficacy level,inhibit the level of tumor markers,improve the immune function of patients,prolong the prognosis and survival time of patients,and the treatment safety is good.

Abstract:Continuous renal replacement therapy(CRRT)is a widely used blood purification technique in extracorporeal circulation,and coagulation in the extracorporeal circulation circuit is one of its common complications.Heparin is commonly used as a circulating anticoagulant in clinical practice,but the higher risk of bleeding makes this regimen not suitable for patients with abnormal coagulation function.Nafamostat has a strong anticoagulant effect and a low risk of bleeding,which is more suitable for patients with high bleeding risk.This article reviews the clinical research progress of nafamostat in CRRT,in order to provide some reference value for the selection of anticoagulants for CRRT.

Abstract:Objective To analyze the effect of radiofrequency ablation combined with foam sclerotherapy injection on the quality of life and postoperative complications in patients with lower extremity varicose veins.Methods A total of 100 patients with lower extremity varicose veins admitted to the Affiliated Hospital of Northwest University,Xi'an No.3 Hospital from January 2022 to December 2023 were selected as the research objects.The patients were randomly(red and white ball)divided into control group(50 cases)and observation group(50 cases).The control group was treated with traditional high ligation and punctate stripping,and the observation group was treated with intracavitary radiofrequency ablation combined with foam sclerotherapy injection.The therapeutic effects,surgical indicators,pain stress level,hemodynamics,coagulation function indicators and the incidence of complications were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[98.0％(49/50)vs 82.0％(41/50)](P＜0.05).The operation time and hospitalization time of the observation group were shorter than those of the control group,and the intraoperative blood loss was less than that of the control group(all P＜0.05).After treatment,the visual analogue scale score,the levels of bradykinin and substance P in the observation group were lower than those in the control group,the hemodynamics and coagulation function were improved more significantly than those in the control group,and the score of chronic venous insufficiency questionnaire 14 was lower than that in the control group(all P＜0.05).The incidence of complications in the observation group was lower than that in the control group[2.0％(1/50)vs 12.0％(6/50)](P＜0.05).Conclusions Radiofrequency ablation combined with foam sclerotherapy injection in the treatment of lower extremity varicose veins can reduce the pain and stress of patients,improve their hemodynamics,coagulation function and quality of life,and has high application value.

Abstract:Objective To explore the effect of high-density lipoprotein cholesterol(HDL-C)composition on the risk of multiple types of coronary atherosclerotic heart disease based on Mendelian randomization(MR)method.Methods In accordance with the assumptions of relevance,independence,and exclusivity of MR Studies,instrumental variables were extracted from publicly available genome-wide association study data to predict the lipid composition of HDL-C,such as the phospholipids in HDL-C.Causal inference between HDL-C lipid composition and coronary atherosclerosis and various types of coronary atherosclerotic heart disease was carried out by using the random effects model pseudo-variance weighting method,MR-Egger method and MR-PRESSO method.Cochran's Q method and MR-Egger intercept method were used for sensitivity analysis.Results The increased levels of peripheral HDL-C,as well as the levels of total lipids,cholesterol esters,cholesterol,and phospholipids in HDL-C,were significantly associated with a reduced risk of coronary atherosclerotic heart disease,myocardial infarction,unstable angina,and coronary atherosclerosis(all P＜0.05).In contrast,increased triglyceride levels in HDL-C were significantly associated with increased risk of coronary atherosclerotic heart disease,unstable angina,and coronary atherosclerosis(all P＜0.05),but not myocardial infarction(P＞0.05).The results reported by the MR-Egger and MR-PRESSO methods support those reported by the pseudo-variance weighting method described above.Although the Cochran's Q method reported significant heterogeneity in these analyses,the random-effects model pseudo-variance weighting method used in this study can overcome this limitation and provide reliable results.No significant level pleiotropy was found by the MR-Egger intercept method in any of the above analyses.Conclusion The total lipid,phospholipid and cholesterol components of HDL-C play a protective role in the pathogenesis of multiple types of coronary atherosclerotic heart disease at the genetic level,while the triglyceride component of HDL-C plays a pathogenic role in the pathogenesis of many kinds of coronary atherosclerotic heart disease except myocardial infarction at the genetic level.

Abstract:Objective To analyze the distribution and drug resistance of common pathogens in critically ill patients with lower respiratory tract infection in emergency department.Methods The bacterial culture-positive strains in sputum,pleural effusion and lung lavage fluid samples from the Department of Emergency,Shengjing Hospital of China Medical University from January 2017 to December 2018 were collected through the laboratory information system of the Department of Laboratory,Shengjing Hospital of China Medical University.A total of 432 strains that met the inclusion criteria were screened through the electronic medical record and imaging system software of our hospital.The distribution of bacteria was analyzed and the drug resistance was analyzed by drug sensitivity test.Results Among the 432 strains,411 were Gram negative bacteria and 19 were Gram positive cocci.Among the Gram negative bacteria,the main one was Acinetobacter baumannii(172 strains,accounting for 39.81％of the total bacterial strains),followed by Pseudomonas aeruginosa(97 strains,accounting for 22.45％of the total bacterial strains).Acinetobacter baumannii had a sensitivity rate of over 80％to amikacin and tigecycline.Pseudomonas aeruginosa had a sensitivity rate of over 80％to amikacin,gentamicin,cefoperazone/sulbactam,and tobramycin.Conclusion Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogenic bacteria in critically ill patients with lower respiratory tract infection in emergency department.Amikacin and tigecy-cline are sensitive to Acinetobacter baumannii which can be included in empirical treatment.

Abstract:Objective To investigate the mechanism of C-C motif chemokine receptor-2 positive(CCR2+)exosomes in regulating myocardial ischemia reperfusion(IR)injury in mice.Methods Twelve C57 mice were divided into wild-type(WT)sham-operated group,WT operated(IR model)group,CCR2-exosome operated group and CCR2+exosome operated group using a completely randomized method,with the last three groups constructing myocardial IR injury model and provide corresponding treatment.Ultrasound was used to examine the cardiac structure and function.Masson trichrome special staining method was used to detect the collagen deposition in cardiac tissues.Cardiomyocyte apoptosis was detected by transferase-mediated deoxyuridine triphosphate nick-end labeling method.The expressions of C-C motif chemokine ligand-2(CCL2)and CCR2 on the surface of monocytes were detected by immunohistochemical staining and real-time fluorescent quantitative polymerase chain reaction method.Flow cytometry was used to detect lymphocyte antigen 6 complex C(Ly6C)and CD43 monocytes in the infarct site after myocardial IR.Results At 7 d after myocardial IR surgery,the area of cardiac fibrosis in CCR2+exosome operated group was smaller than that in IR model group[(16.8±8.1)％vs(45.7±3.8)％];the ejection fraction was significantly lower than that of the WT sham-operated group but higher than that of the IR model group;the number of apoptotic cardiomyocytes in mice was less than that in IR model group.The relative expression of CCR2 protein in the heart of mice was lower than that of the IR model group;the area of CCR2 positive cells in the reperfusion area of the mice was smaller than that of the IR model group;the number of Ly6C+monocytes at the reperfusion site in mice was significantly lower than that in the IR model group;the number of monocytes in CD43 was significantly higher than that in IR model group;the relative expression of CCL2 mRNA and protein in the mouse heart was lower than that in the IR model group(all P＜0.05).Conclusions CCR2+exosomes show a significant anti-myocardial IR injury effect.The mechanism is that reduced CCL2 expression inhibits monocyte infiltration,thereby reducing myocardial injury and inhibiting heart failure.

Abstract:Objective To investigate the efficacy and safety of Xinkeshu capsules combined with enalapril maleate folic acid tablets in the treatment of patients with H-type hypertension with left ventricular hypertrophy(LVH).Methods Totally 168 patients with H-type hypertension with LVH admitted to Wuhan University of Science and Technology Affiliated Geriatric Hospital from January 2021 to October 2022 were selected.According to the random number table method,patients were divided into control group(84 cases)and observation group(84 cases).The control group patients were treated with enalapril maleate folic acid tablets,while the observation group patients were treated with Xinkeshu capsules on the basis of the control group.Both groups were treated for 6 months.The treatment efficacy,the systolic blood pressure(SBP),diastolic blood pressure(DBP),homocysteine,and cardiac function indicators before and after 6 months of treatment of two groups were compared.The occurrence of adverse reactions in two groups were counted.Results The total effective rate of the observation group was higher than that of the control group[94.0％(79/84)vs 83.3％(70/84)](P=0.028).After 6 months of treatment,levels of SBP,DBP,and homocysteine in the two groups were significantly reduced,and the levels in the observation group were lower than those in the control group(all P＜0.05).After 6 months of treatment,the left ventricular posterior wall thickness and interventricular septal thickness in the two groups slightly decreased,but there was no statistically significant difference between the groups and within the group(all P＞0.05).After 6 months of treatment,the left ventricular mass index(LVMI)and left ventricular end diastolic diameter(LVEDD)in the two groups significantly decreased,and LVMI and LVEDD in the observation group were greater than those in the control group(all P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the control group and observation group[7.1％(6/84)vs 8.3％(7/84)](P=0.773).Conclusions The combination of Xinkeshu capsules and enalapril maleate folic acid tablets has a good antihypertensive effect on patients with H-type hypertension complicated with LVH.It can also significantly improve left ventricular function,reduce serum homocysteine level,and has high safety.

Abstract:Ginkgo biloba extract(GBE),as a traditional Chinese medicine,has the functions of anti-inflammation,anti-oxidation,maintaining cell survival,inhibiting platelet activation,dilating blood vessels and regulating metabolism.It is widely used in clinical treatment of a variety of cardiovascular diseases,especially atherosclerosis.In the treatment of atherosclerosis,GBE can play a protective effect by acting on multiple pathways including 5'-adenosine monophosphate-activated protein kinase/protein kinase B,mitogen-activated protein kinase,phosphatidylinositol-3-kinase/protein kinase B,nuclear factor E2-related factor/heme oxygenase-1.This article reviews the mechanism and clinical application of GBE in the treatment of atherosclerosis.

Abstract:Objective To observe the clinical effect of Buxin Ningshen decoction in the treatment of angina pectoris complicated with generalized anxiety disorder.Methods A total of 180 patients with angina pectoris and generalized anxiety disorder admitted to the Department of Emergency,Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2021 to January 2023 were selected,and they were divided into observation group and control group according to the random number table method,with 90 cases in each group.In the control group,conventional western medicine was used for standardized treatment of angina pectoris,but no medication targeting anxiety.The observation group was treated with Buxin Ningshen decoction for anxiety on the basis of the control group.Both groups were treated for 4 weeks.The generalized anxiety disorder 7-item(GAD-7)scale,patient health questionnaire 15(PHQ-15)scale scores,frequency and duration of angina pectoris,left ventricular ejection fraction,the score of traditional Chinese medicine syndrome,and occurrence of adverse reactions during treatment were compared between the two groups before and after treatment.Results After treatment,the scores of GAD-7 and PHQ-15,the frequency and duration of angina pectoris,and the score of traditional Chinese medicine syndrome in the observation group were significantly lower than those in the control group,and the left ventricular ejection fraction was higher than that in the control group[(0.9±0.7)vs(3.4±1.4),(1.1±1.0)vs(3.7±2.1),(2.1±0.9)times/week vs(4.1±1.2)times/week,(2.2±1.2)minutes/time vs(4.8±2.2)minutes/time,(2.6±1.9)vs(8.9±2.9),(55±6)％vs(51±7)％](all P＜0.05).There were no obvious adverse reactions in the two groups during the whole treatment.Conclusion Buxin Ningshen decoction can effectively relieve the symptoms of patients with angina pectoris and generalized anxiety disorder with good safety.

Abstract:In recent years,with the widespread use of carbapenem antibacterial agents,the drug resistance rate of Klebsiella pneumonia(KP)to carbapenem antibacterial agents has been increasing.Carbapenem-resistant KP(CRKP)has been widely spread around the world,and the detection rate is increasing,which has become a major global public health problem.The mechanism of CRKP resistance is complex,involving carbapenemase production,abnormal expression of outer membrane porin,and overexpression of active efflux pump system.For the infection caused by CRKP strains,the clinical treatment of antibiotics is limited,the infection control is difficult,and the patient mortality is high.Therefore,it is necessary to actively prevent CRKP,early detect infection and clarify the mechanism of drug resistance,optimize the clinical use of antibiotics and infection prevention and control,and find new antibiotics and new combination therapy to actively deal with CRKP.This article reviews the current status of CRKP infection,drug resistance mechanisms,and treatment strategies,so as to provide evidence for the effective prevention and treatment of CRKP.

Abstract:Objective To investigate the effect of ultrasound-guided paravertebral nerve block(TPVB)combined with intrathoracic vagus nerve block on rapid recovery after thoracoscopic surgery.Methods A total of 66 patients with lung cancer who underwent thoracoscopic surgery in Quzhou City People's Hospital from February 2022 to January 2023 were selected as the research objects,and they were divided into the control group and the observation group by random number table method,with 33 cases in each group.Both groups received video-assisted thoracoscopic surgery for lung cancer.The control group was given general anesthesia with double-lumen bronchial intubation,and the observation group was given non-intubation intravenous anesthesia with ultrasound-guided TPVB combined with intrathoracic vagus nerve block.The postoperative recovery,mean arterial pressure,heart rate,degree of pain and incidence of postoperative complications were observed between the two groups.Results The first feeding time and hospital stay of the observation group were shorter than those of the control group,and the partial pressure of carbon dioxide in arterial blood 30 min after the operation was higher than that of the control group(all P＜0.001).The heart rate and mean arterial pressure in the control group were higher than those before anesthesia induction 30 min after operation and immediately after operation(both P＜0.05);but there were no significant differences in heart rate and mean arterial pressure before and after anesthesia induction in the obser-vation group(all P＞0.05);and the heart rate and mean arterial pressure in the observation group were lower than those in the control group[heart rate:(75±8)times/min vs(81±7)times/min,(76±8)times/min vs(83±10)times/min;mean arterial pressure:(81±9)mmHg vs(90±9)mmHg,(82±8)mmHg vs(93±10)mmHg](all P＜0.05).There was no significant difference in visual analogue scale score between the two groups at 30 min before operation(P＞0.05).At 1,6,12,24 and 48 h after operation,the visual analogue scale scores of the observation group were lower than those of the control group(all P＜0.05).The incidence of complications in the observation group was lower than that in the control group[6.1％(2/33)vs 15.2％(5/33)](x2=4.243,P=0.039).Conclusion Compared with the double-lumen endotracheal intubation general anesthesia method,for patients undergoing video-assisted thoracoscopic surgery,ultrasound-guided TPVB combined with intrapleural vagus nerve block can avoid fluctuations in blood pressure and heart rate,reduce postoperative pain,accelerate postoperative recovery,and reduce the incidence of postoperative complications.

Abstract:Objective To explore the prognostic value of blood urea nitrogen to albumin ratio in patients with sepsis in the emergency department.Methods The basic information and laboratory examination data of 313 patients with sepsis treated in the emergency room of Beijing Chao-Yang Hospital,Capital Medical University from March 2021 to March 2022 were collected by retrospective observation method.The patients were divided into survival group(229 cases)and death group(84 cases)according to whether they died during the treatment in the hospital.The clinical and laboratory data of the two groups were compared,and the risk factors of death during hospitalization were analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of BAR in patients with sepsis.Results The age,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,heart rate,and proportion of cerebral infarction in the death group were significantly higher than those in the survival group,while systolic blood pressure,diastolic blood pressure,and proportion of chronic obstructive pulmonary diseasein the death group were lower than those in the survival group(all P＜0.05).The white blood cell count,absolute value of neutrophils,CRP,procalcitonin,blood urea nitrogen,aspartate aminotransferase,and BAR in the death group were higher than those in the survival group,while the absolute value of lymphocytes and albumin levels were lower than those in the survival group(all P＜0.05).Multivariate Logistic regression analysis showed that BAR(P=0.025)and APACHE Ⅱ score(P＜0.001)were independent risk factors for in-hospital death of sepsis patients.The ROC curve analysis results showed that the area under the curve(AUC)of BAR for predicting the death of sepsis patients during hospitalization was 0.728,the AUC for APACHE Ⅱ score was 0.814,and the AUC for BAR+APACHE Ⅱ score was 0.824.The combined predictive effect was better than BAR alone.The combination of BAR and APACHE Ⅱ scores had good sensitivity and specificity(sensitivity of 77.4％and specificity of 75.5％).Conclusions BAR,APACHE Ⅱ scores are independent risk factors for the prognosis of patients with sepsis.BAR has moderate predictive power and high specificity for the prognosis of patients with sepsis in the emergency department.Compared with BAR alone,BAR combined with APACHE Ⅱ score has better predictive power,with better sensitivity and higher specificity.

Abstract:Objective To explore the predictive value of reverse shock index and Glasgow Coma Scale score product(rSIG)index combined with serum fibrinogen(FIB)and C-reactive protein(CRP)levels in the prognosis of patients with multiple injuries.Methods A total of 140 patients with multiple injuries admitted to Department of Emergency,North China University of Science and Technology Affiliated Hospital from February 2022 to March 2023 were selected as the main observation objects.The patients were divided into survival group(120 cases)and death group(20 cases)according to their survival status 28 d after injury.Another 100 healthy people were selected as control subjects.The level of serum FIB was detected by automatic coagulation analyzer,and the level of CRP was detected by immune scattering turbidimetry.Pearson method was used to analyze the correlation between rSIG index and serum FIB and CRP levels.Cox regression method was used to analyze the influencing factors of death in patients with multiple injuries.The receiver operating characteristic curve was used to analyze the predictive value of rSIG index combined with serum FIB and CRP levels for the prognosis of patients with multiple injuries.Results The serum FIB level of patients with multiple injuries was lower than that of healthy people[(2.2±0.4)g/L vs(2.9±0.5)g/L],and the CRP level was higher than that of healthy people[(36±8)mg/L vs(7±3)mg/L](both P＜0.001).The serum FIB level of the survival group was higher than that of the death group[(2.3±0.4)g/L vs(1.6±0.4)g/L],and the CRP level was lower than that of the death group[(34±8)mg/L vs(47±8)mg/L](both P＜0.001).The rSIG index of the survival group were higher than those of the death group(P＜0.05).Pearson analysis showed that serum FIB was negatively correlated with CRP level(r=-0.446,P＜0.001)and positively correlated with rSIG index(r=0.473,P＜0.001),and serum CRP level was negatively correlated with rSIG index(r=-0.536,P＜0.001).Cox regression analysis showed that FIB,CRP and rSIG index were the influencing factors of death in patients with multiple injuries(all P＜0.05).The area under the curve of rSIG index combined with serum FIB and CRP levels in predicting the prognosis of patients with multiple injuries was 0.972,which was significantly higher than that of single detection(all P＜0.05).The sensitivity of combined detection was 95.00％and the specificity was 88.33％.Conclusion The serum FIB level is decreased and CRP level is increased in patients with multiple injuries.The combination of FIB and CRP with rSIG index has certain predictive value for the prognosis of patients with multiple injuries.

Abstract:Objective To investigate the efficacy of ozone combined with low-temperature plasma radiofrequency thermocoagulation on discogenic lumbodynia and its impact on patients'inflammatory factor levels.Methods A total of 104 patients with discogenic lumbodynia who were treated in the Department of Pain Management,Beijing Anzhen Hospital,Capital Medical University from May 2022 to May 2023 were selected.According to the random number table method,they were divided into control group and observation group,with 52 cases in each group.The control group was treated with low-temperature plasma radiofrequency thermocoagulation,and the observation group was treated with ozone combined with low-temperature plasma radiofrequency thermocoagulation.Clinical efficacy,pain visual analogue scale(VAS)score,Oswestry dysfunction index questionnaire(ODI)score,levels of interleukin-1 β(IL-1β),IL-6,1L-8 and tumor necrosis factor-α(TNF-α)before and after treatment,and incidence of adverse reactions after treatment were compared.Results The excellent rate of the observation group was higher than that of the control group[94.2％(49/52)vs 78.8％(41/52)](P＜0.001).After 2 weeks of treatment,the VAS and ODI scores of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group[between two groups:(1.4±1.2)vs(2.4±1.0),(13±4)vs(23±5)](both P＜0.001).After 2 weeks of treatment,the levels of serum IL-1 β,IL-6,IL-8 and TNF-α 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＜0.001).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P=1.000).Conclusion Ozone combined with low-temperature plasma radiofrequency thermocoagulation is a safe and effective method for the treatment of discogenic lumbodynia,which can significantly reduce the levels of inflammatory factors.

Abstract:Objective To investigate the effect and safety of modified Xiakucao decoction combined with metformin in the treatment of type 2 diabetes mellitus(T2DM)with thyroid nodules.Methods Totally 122 patients with T2DM complicated with thyroid nodules admitted to the Hebei Medical University Third Hospital from March 2021 to June 2022 were selected as the research objects.According to the random number table method,they were divided into combination group(61 cases)and western medication group(61 cases).The western medication group was given metformin on the basis of routine intervention,and the combination group was given modified Xiakucao decoction on the basis of the western medication group.Both groups were continuous treated for 3 months.The clinical efficacy of thyroid,the number and volume of thyroid nodules,blood glucose level,and thyroid function indexes before and after treatment were compared between the two groups,and the incidence of adverse reactions was compared.Results After treatment,the total effective rate of thyroid efficacy in the combination group was significantly higher than that in the western medicine group[95.1％(58/61)vs 83.6％(51/61)](P=0.040).After treatment,the number and volume of thyroid nodules,fasting blood glucose and 2 h postprandial blood glucose of the combination group were less/smaller/lower than those of the western medication group(all P＜0.001).There was no significant difference in the levels of thyroid stimulating hormone,free triiodothyronine and free thyroxine between the two groups before and after treatment(all P＞0.05).No serious adverse reactions occurred in the two groups,and there was no significant difference in the incidence of mild adverse reactions between the combination group and the western medication group[1.6％(1/61)vs 6.6％(4/61)](x2=0.834,P=0.361).Conclusion The combination of traditional Chinese and western medicine for patients with T2DM complicated with thyroid nodules has significant clinical effect and high application value.