Abstract:The development of rheumatoid arthritis(RA)is a multi-step process and the disease is active before clinical arthritic symptoms appear.Preclinical rheumatoid arthritis(Pre-RA)refers to the period of disease development from the onset of the disease to the onset of clinical arthritis.It has been demonstrated that preclinical intervention can reduce the severity of RA and delay the onset of RA.The purpose of this review is to explore the risk factors for developing into RA from Pre-RA,so as to achieve the best therapeutic effect through appropriate pre-clinical intervention in high-risk groups of RA.

Abstract:Multiple myeloma(MM)cannot be cured at present.With the rapid development of new drugs combined with autologous transplantation,the median overall survival of patients is nearly 10 years.However,due to the high heterogeneity of MM,there are still some patients with poor prognosis and short survival.Bone marrow microenvironment plays an important role in MM.The formation of invasive vessels,regulatory immune cells,exosomes and autophagy,etc.can all affect the bone marrow microenvironment and promote the progression and drug resistance of MM.This review focuses on the interaction of components in the immune microenvironment of MM and immunotherapy,in order to provide more new treatment strategies.

Abstract:Objective To investigate the application effect of dexmedetomidine combined with remifentanil in patients with stroke undergoing interventional thrombectomy and its influence on cerebral metabolism and antioxi-dation.Methods A total of 96 patients with ischemic stroke admitted to Affiliated Hospital of Hebei University of Engineering from January 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 48 cases in each group.All patients received interventional thrombectomy.The control group was given remifentanil anesthesia,and the observation group was given dexmedetomidine anesthesia on the basis of the control group.The cerebral metabolic indexes immediately after anesthesia and 1 h after anesthesia,serum indexes and intracranial pressure before and 1 h after operation,postoperative eye opening time,Ramsay score,and adverse reactions were compared between the two groups.Results The blood oxygen difference of internal jugular vein bulb,blood oxygen content of internal jugular vein,cerebral metabolic rate and oxygen saturation of internal jugular vein bulb in the observation group were higher than those in the control group at 1 hour after anesthesia(all P＜0.05).The serum levels of malondialdehyde,endothelin and superoxide dismutase 1 hour after operation in the two groups were higher than those before operation,but those in the observation group were lower than those in the control group(all P＜0.05).One day after operation,the intracranial pressure levels of the two groups were lower than those before operation,and that of the observation group was lower than that of the control group[(167±20)mmH2O vs(182±22)mmH2O](t=3.524,P=0.001).The postoperative eye opening time of the observation group was shorter than that of the control group[(9.3±1.2)min vs(12.2±2.8)min](t=6.570,P=0.001),and the Ramsay score was higher than that of the control group[(4.3±0.5)vs(4.0±0.6)](t=3.127,P=0.002).Conclusions Dexmedetomidine combined with remifentanil anesthesia in interventional thrombectomy for stroke can improve brain metabolism and antioxidant capacity,reduce oxidative stress and inflammatory reaction,reduce intracranial pressure,promote postoperative recovery,and has certain safety.

Abstract:Objective To investigate the correlation between neutrophil to lymphocyte ratio(NLR),systemic immune inflammation index(SII)and carotid atherosclerosis(CAS),and their predictive value for CAS.Methods A total of 400 patients who were treated in the heart center of the First Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2023 were selected,and they were divided into CAS group(157 cases)and non-CAS group(243 cases)according to the results of carotid ultrasound.The CAS group was further divided into carotid intima-media thickening group,single plaque group and multiple plaque group according to the carotid plaque.The basic clinical data,blood routine and blood biochemical indexes of each group were compared,and the correlation between the number of plaques and Crouse score in CAS group was analyzed.Multivariate Logistic regression was used to analyze the independent risk factors of CAS.The receiver operating characteristic(ROC)curve was used to analyze the value of NLR,SII alone and combined in predicting CAS.Results The age,systolic blood pressure,Crouse score,smoking history,history of hypertension,history of coronary atherosclerotic heart disease,history of diabetes mellitus,and proportion of recent use of lipid-lowering drugs in the CAS group were higher than those in the non-CAS group(all P＜0.05).NLR and SII in CAS group were higher than those in non-CAS group[(2.2±0.9)vs(1.8±0.7),(506±229)vs(418±157)](both P＜0.05).Triglyceride,low-density lipoprotein cholesterol(LDL-C),fasting blood glucose and glycosylated hemoglobin(HbA1c)in the CAS group were higher than those in the non-CAS group(all P＜0.05).Crouse score of multiple plaque group was higher than that of single plaque group(P＜0.05).Multivariate Logistic regression analysis showed that coronary atherosclerotic heart disease,NLR,SII,triglyceride,LDL-C and HbA1c were independent risk factors for CAS(all P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR for predicting CAS was 0.62(95％confidence interval:0.57-0.68),and the AUC of SII for predicting CAS was 0.60(95％confidence interval:0.54-0.65),and the AUC for predicting CAS increased to 0.72(95％confidence interval:0.67-0.77)when the two were combined.Conclusion NLR and SII are closely related to the occurrence of CAS,and both have certain predictive value for CAS.The predictive value of CAS can be improved when NLR and SII are combined.

Abstract:Objective To investigate the efficacy and safety of ceftazidime avibactam sodium for injection in the treatment of pneumonia caused by carbapenem-resistant Klebsiella pneumoniae(CRKP)infection.Methods Clinical data of 38 patients with pneumonia caused by CRKP admitted to the intensive care unit of Aviation General Hospital from January 1,2022 to October 31,2024 were retrospectively analyzed.According to different treatment regimens,they were divided into monotherapy group(16 cases,treated with intravenous infusion of ceftazidime avibactam sodium for injection on the basis of conventional treatment)and combined treat-ment group(22 cases,treated with intravenous infusion of ceftazidime avibactam sodium for injection combined with meropenem or tigecycline or epiracycline or polymyxin B on the basis of conventional treatment).Relevant data were collected,and the clinical treatment effects(clinical effective rate,microbial cure rate,bacterial clearance time,body temperature normalization time,inflammatory index changes,28-day mortality,total hospital mortality)and adverse reactions were compared between the two groups.Results The acute physiology and chronic health evaluation Ⅱ score of the combined treatment group was slightly higher than that of the monotherapy group(P＜0.05).There were no significant differences in clinical efficacy,28-day mortality and total in-hospital mortality between the two groups(all P＞0.05).The microbial cure rate of the combined treatment group was slightly higher than that of the monotherapy group,and the bacterial clearance time and body temperature normali-zation time were slightly shorter than those of the monotherapy group,but the differences were not statistically significant(all P＞0.05).There was no significant difference in white blood cell count,procalcitonin and C-reactive protein levels between the two groups before and after treatment(all P＞0.05).The incidence of kidney injury,liver injury and gastrointestinal symptoms in the combined treatment group was slightly higher than that in the monotherapy group[13.6％(3/22)vs 12.5％(2/16),18.2％(4/22)vs 12.5％(2/16),18.2％(4/22)vs 12.5％(2/16)],but the differences were not statistically significant(all P＞0.05).Conclusion For patients with pneumonia caused by CRKP infection,there is no significant difference in the overall efficacy between ceftazi-dime avibactam sodium injection monotherapy and combination therapy with other drugs,and there is no significant difference in adverse reactions.

Abstract:Objective To investigate the effects of Shugan Hewei decoction combined with mosapride on the levels of gastrointestinal hormones and inflammatory factors and quality of life in patients with functional dyspepsia(FD)of incoordination between the liver and stomach type.Methods A total of 120 FD patients with liver-stomach dif-ferment who were treated in Hubei Provincial Hospital of Traditional Chinese Medicine from October 2021 to October 2023 were selected.They were randomly divided into western medicine group and traditional Chinese and western medicine group,with 60 cases in each group.The western medicine group was treated with mosapride,and the Chinese and western medicine group was treated with Shugan Hewei decoction on the basis of the western medicine group.The patients in both groups were treated for 1 month.The clinical efficacy,gastrointestinal hormone,somatostatin,pepsinogen(PG),inflammatory factor levels,traditional Chinese medicine syndrome scores,quality of life,anxiety and depression scores were compared between the two groups.Results After treatment,the total effective rate of the Chinese and western medicine group was significantly higher than that of the western medicine group[93.3％(56/60)vs 78.3％(47/60)](P=0.018).After treatment,the levels of motilin,gastrin and PG Ⅰ in the two groups were significantly higher than those before treatment,and the levels in the Chinese and western medicine group were significantly higher than those in the western medicine group;The levels of somatostatin and PG Ⅱ,chest and flank pain,belching,abdominal fullness,upset scores,interleukin-6,tumor necrosis factor-αand C-reactive protein in the Chinese and western medicine group were significantly lower than those before treatment,and those in the Chinese and western medicine group were significantly lower than those in the western medicine group(all P＜0.05).After treatment,the FD quality of life scale scores of the two groups were signifi-cantly higher than those before treatment,and that in the Chinese and western medication group was significantly higher than that in the western medication group,while the self-rating anxiety scale and self-rating depression scale scores were significantly lower than those before treatment,and those in the Chinese and western medication group was significantly lower than those in the western medication group(all P＜0.05).Conclusion Shugan Hewei decoction combined with mosapride in the treatment of patients with FD of incoordination between the liver and stomach type can improve the clinical effect,relieve clinical symptoms,regulate the levels of gastrointestinal hormones and PG,reduce the level of inflammation,improve the quality of life,and relieve depression and anxiety.

Abstract:Resistant hypertension(RH)and refractory hypertension(RfH)refer to the failure or resistance of antihypertensive treatment.The prevalence of RH and RFH is difficult to quantify,but patients are at significantly increased cardiovascular risk.Standardized office blood-pressure measurements,confirmation of medical adherence,search for drug-or substant-induced blood-pressure elevations,drug-drug interactions,genetic polymor-phisms,pharmacometabolomics,ambulatory or home blood-pressure monitoring,and rule out pseudoresistance are warranted.Secondary hypertension was excluded on the basis of further investigations appropriate to clinical data.Lifestyle intervention and reasonable antihypertensive drug therapy are the cornerstone of RH management.If blood pressure is still not under control,device therapy,such as renal artery sympathetic radiofrequency ablation,should be considered.Device therapy such as renal artery sympathetic radiofrequency ablation can be considered,but the indications and safety need to be strictly evaluated.In practice,the management of RH and RfH should be individ-ualized according to the characteristics of patient.

Abstract:Objective To investigate the effect of proprotein convertase subtilisin/Kexin type 9 inhibitor as primary preventive treatment on the occurrence and progression of atherosclerotic plaque in rabbits.Methods Thirty healthy male New Zealand white rabbits were selected and randomly divided into control group,model group and evolocumab group,with 10 rabbits in each group.The control group was fed with normal diet.The model group was fed with high-fat diet and the right carotid artery intima was injured.The evolocumab group was given subcuta-neous injection of evolocumab on the basis of the model group.The peripheral blood of rabbits was collected to detect the lipid levels in each group.The pathological sections of blood vessels in each group were compared.Immunohistochemical staining was used to evaluate the expression of CD68,CD147 and matrix metalloproteinase 9 in the plaques.Results After 13 weeks of high-fat diet,the levels of low-density lipoprotein cholesterol,total cholesterol,and triglyceride in the model group and evolocumab group were higher than those before intervention,and were higher than those in the control group.The levels of low-density lipoprotein cholesterol,total cholesterol,and triglyceride in the model group were higher than those in the evolocumab group[(19.1±1.6)mmol/L vs(11.2±1.3)mmol/L,(22.2±2.4)mmol/L vs(13.1±2.7)mmol/L,(5.8±0.9)mmol/L vs(4.7±0.5)mmol/L](all P＜0.05).There was no plaque formation in the control group,while carotid plaque formation was observed in the model group and the evolocumab group.Macrophages and foam cells were abundant in the intima of the plaque in the model group,large lipid core was seen in the plaque,and the fibrous cap was thin,forming a typical vulnerable plaque.Compared with the model group,the evolocumab group showed more intimal hyperplasia,smaller plaque volume and stenosis,and lower expression of CD 147 and matrix metalloproteinase 9.Conclusions The early intervention of evolocumab can effectively control the levels of low-density lipoprotein cholesterol,total cholesterol and triglyceride,significantly reduce the volume of atherosclerotic plaque and the degree of stenosis,reduce the lipid deposition in the plaque,reduce the inflammatory reaction,and make the plaque more stable.It has the significance of primary prevention and treatment in the formation of coronary athero-sclerotic heart disease.

Abstract:Objective To study the effect of robot-assisted internal fixation in the treatment of femoral neck fractures and analyze the related factors of postoperative infection.Methods A total of 93 patients with femoral neck fracture admitted to the First Affiliated Hospital of Air Force Military Medical University from April 2019 to April 2022 were selected.They were randomly divided into control group(46 cases)and observation group(47 cases).The control group was treated with traditional freehand positioning method for internal fixation,and the observation group was treated with robot-assisted internal fixation.The operation related indicators,angle between cannulated screw and femoral neck axis,fracture healing time,Harris hip function score and complications were compared between the two groups.According to the postoperative infection,the patients were divided into infection group and non-infection group.Logistic regression model was used to analyze the influencing factors of postoperative infection.Results The intraoperative fluoroscopy time,intraoperative blood loss and the number of guide pin implantation in the observation group were shorter/less than those in the control group[(14±5)s vs(21±5)s,(8.0±3.5)ml vs(10.1±2.4)ml,(4.8±0.8)times vs(11.8±2.4)times](all P＜0.05).The angle between the cannulated screw and the femoral neck axis on the positive and lateral positions in the observation group was smaller than that in the control group,the fracture healing time was shorter than that in the control group,and the Harris hip function score was higher than that in the control group(all P＜0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).There were 34 patients with postoperative infection and 59 patients without infection.The age ≥60 years,preoperative anemia,perioperative allogeneic blood transfusion rate,operation time and drainage tube indwelling time in the infection group were greater/longer than those in the non-infection group(all P＜0.05).Logistic regression analysis results showed that preoperative anemia,perioperative allogeneic blood transfusion,operation time and drainage tube indwelling time were independent influencing factors for postoperative infection in patients with femoral neck fracture(all P＜0.05).Conclusion Robot-assisted internal fixation for femoral neck fractures can achieve more accurate cannulated screw placement and improve the prognosis of patients.Close attention to anemia and allogeneic blood transfusion during the perioperative period can reduce postoperative infection.

Abstract:Objective To investigate the correlation between the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor(sFlt-1/PLGF)and vitamin D level with disease severity and pregnancy outcome in preg-nant women with late-onset preeclampsia.Methods The clinical data of 121 patients with late-onset preeclampsia who underwent prenatal examination and delivery in Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University from July 2021 to December 2023 were collected for a retrospective study.According to the severity of the disease,they were divided into severe group(61 cases)and non-severe group(60 cases).After 34 weeks of pregnancy,serum sFlt-1/PLGF and 25-(OH)-D level were measured,and the pregnancy outcomes of the study subjects,including 24 h urine protein levels,gestational weeks of delivery,and newborn weight,were tracked and recorded.Results The serum sFlt-1/PLGF in the severe group was higher than that in the non-severe group[38.20(21.66,69.22)vs 25.59(16.74,51.54)](P＜0.05).The serum 25-(OH)-D level in the severe group was lower than that in the non-severe group(P＞0.05).The serum sFlt-1/PLGF in severe group was negatively correlated with neonatal weight(r=-0.267,P=0.038)and positively correlated with 24 h urine protein level(r=0.377,P=0.003),but not significantly correlated with gestational age at delivery(P=0.645).Conclusion Compared with patients with non-severe preeclampsia,serum sFlt-1/PLGF in patients with severe preeclampsia is significantly higher,but there is no significant difference in serum vitamin D level between the two groups.In addition,serum sFlt-1/PLGF in patients with severe preeclampsia is positively correlated with 24 h urinary protein level and negatively correlated with neonatal weight,suggesting that serum sFlt-1/PLGF may play a role in the prediction of adverse pregnancy outcomes.This study may provide new ideas and methods for early diagnosis and early treatment of preeclampsia.

Abstract:Objective To investigate the clinical effect of Yanghe decoction combined with acupuncture in the treatment of diabetic lower extremity arteriosclerosis obliterans.Methods A total of 106 patients with diabetes mellitus combined with arteriosclerosis obliterans of lower limbs were selected from April 2022 to September 2023 at Panlong District People's Hospital in Kunming,Yunnan Province,and First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine were enrolled.Patients were divided into observation group and control group according to the random number table method,with 53 cases in each group.The control group was given basic western medicine treatment,and the observation group was given combined acupuncture treatment with Yanghe decoction on the basis of the control group.Both groups were treated for 1 month.Clinical symptom score of the affected limb,color ultrasound indexes of lower limb arteries,ankle brachial index and claudication distance,hemorheology indexes,Vascular endothelial function and safety status were observed.Results Two patients in each of the two groups were excluded from treatment,and 51 patients were finally included.After treatment,the total effective rate of observation group was higher than that of control group[92.2％(47/51)vs 76.5％(39/51)](x2=6.805,P=0.033).After treatment,scores of lower limb arterial blood flow velocity,brachial ankle index and claudication distance as well as the peak blood flow velocity of femoral artery,popliteal artery and dorsalis pedis artery in both groups were higher than before treatment,and the levels of observation group were higher than those of control group(all P＜0.05).After treatment,the levels of whole blood low-cut viscosity,whole blood high-cut viscosity,plasma viscosity,serum mononuclear cell chemotine-1 and endothelin-1 in the two groups were lower than those before treatment,and the observation group was lower than that in the control group(all P＜0.05).Conclusion Yanghe decoction combined with acupuncture is effective in the treatment of patients with diabetic lower extremity arteriosclerosis occlusion.

Abstract:Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death worldwide.With the aging of population,the incidence and mortality of cardiovascular disease in China continue to increase.Currently,there are still great challenges in non-invasive screening and effective treatment for ASCVD high-risk population.In the past decade,innovative therapies such as monoclonal antibodies and RNA interference drugs have entered clinical application,providing more effective interventions for ASCVD targeted lipid-lowering and anti-inflammatory treatment.At the same time,biomimetic drugs and nano-agents for ASCVD diagnosis and treatment have successively entered clinical research and made breakthrough progress.This article reviews the clinical application progress of innovative drugs such as monoclonal antibodies and RNA interference in the targeted lipid-lowering and anti-inflammatory treatment of ASCVD in recent years,and summarizes the research progress of innovative drug preparations based on nano-delivery systems for the targeted diagnosis and treatment of ASCVD.

Abstract:Objective To study the effect of different doses of urokinase on elderly patients with hypertensive cerebral hemorrhage during CT-guided hematoma puncture and drainage.Methods A total of 60 elderly patients with hypertensive cerebral hemorrhage who underwent CT-guided hematoma puncture and drainage in Zhangjiakou First Hospital,Hebei Province from June 2021 to October 2023 were selected as the research objects.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 low-dose urokinase,with a dose of 20 000 U.The observation group was treated with high-dose of urokinase,with a dose of 50 000 U.Both groups were treated for 2 weeks.The treatment effect,complications,neurological disability score(NDS),activities of daily living scale(ADL),Glasgow outcome scale(GOS)and inflammatory factor levels were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[96.7％(29/30)vs 73.3％(22/30)](x2=7.862,P＜0.001).There was no significant difference in the incidence of complications between the two groups(x2=0.532,P=0.765).After treatment,the NDS scores of the two groups were lower than those before treatment,and that of the observation group was lower than that of the control group;the ADL and GOS scores of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group(all P＜0.05).After treatment,the levels of tumor necrosis factor-α,C-reactive protein and interleukin-6 in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).Conclusions The application of high-dose urokinase in CT-guided hematoma puncture and drainage in the treatment of elderly hypertensive cerebral hemor-rhage has a definite effect,which can improve the living ability and prognosis of patients,reduce the degree of inflammatory reaction and nerve function damage,and has high safety,which is worthy of clinical application.

Abstract:Objective To explore the effect of Bushen Yiqi recipe on bone marrow suppression and immune function after breast cancer chemotherapy.Methods A total of 110 breast cancer patients treated with epirubicin and cyclophosphamide sequential Docetaxel(EC-T)scheme in the Sixth Medical Center of Chinese PLA General Hospital from January 2023 to January 2024 were selected as the research objects.They were randomly divided into the control group and the observation group,with 55 cases in each group.The control group was treated with the EC-T scheme.The observation group was treated with Bushen Yiqi recipe on the basis of the control group.The changes of blood routine indexes,cellular immune function,traditional Chinese medicine symptom score and quality of life score(QLQ-C30)in patients were observed before and after treatment.Results After treatment,the white blood cell count,absolute neutrophil count,hemoglobin and platelet count levels of the two groups were lower than those before treatment,but those in the observation group were higher than those in the control group(all P＜0.05).After the treatment,levels of CD3+,CD4+and CD4+/CD8+ratio of the two groups were lower than those before the treatment,but those in the observation group were higher than those in the control group;the CD8+level was higher than that before the treatment,but that in the observation group was lower than that in the control group(all P＜0.05).After treatment,the scores of shortness of breath,fatigue,palpitation,insomnia,dizziness,complexion,cold limbs,waist and knee soreness in the two groups were higher than those before treatment,but those in the observation group were lower than those in the control group(all P＜0.05).After 7 and 20 d of treatment,the QLQ-C30 scores of the two groups were lower than those before treatment,but the scores in the observation group were higher than those in the control group[(75.2±2.1)vs(74.1±1.9),(78.9±2.2)vs(75.9±2.1)](all P＜0.05).Conclusions Bushen Yiqi recipe can effectively prevent bone marrow suppression after breast cancer chemotherapy,correct the immune dysfunction after chemotherapy,improve the secondary clinical symptoms of patients after chemotherapy,and significantly improve the quality of life.It can be used as an adjuvant and supplementary treatment for breast cancer patients undergoing chemotherapy.

Abstract:Objective To investigate the short-term effect of Guyuling capsules combined with calcitriol in the treatment of osteoporosis.Methods A total of 90 patients with osteoporosis admitted to Shaanxi Provincial People's Hospital from April 2022 to October 2023 were selected.They were divided into control group and observation group using the random number table method,with 45 cases in each group.The control group received treatment with calcitriol on the basis of routine symptomatic support,and the observation group was given treatment of Guyuling capsules on the basis of the control group.Both groups were treated continuously for 6 months.The total effective rate,pain visual analogue scale(VAS)score,brief health status survey scale(SF-36)score,lumbar spine anteroposterior(L1-4)and left femoral neck bone density,bone metabolism indicators[osteoprotegerin,osteocalcin,C-telopeptide of type Ⅰ collagen(CTX-Ⅰ),and bone alkaline phosphatase(BALP)]levels before and after treatment were compared,as well as the incidence of adverse reactions during treatment was compared.Results The total effective rate of the observation group was higher than that of the control group[95.6％(43/45)vs 75.6％(34/45)],and the difference was statistically significant(P=0.007).After treatment,the SF-36 score,serum osteoprotegerin,osteocalcin,and BALP levels,lumbar vertebrae(L1-4)and left femoral neck bone density in the observation group were higher than those in the control group,while VAS score and CTX-Ⅰ level 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 observation group and control group[8.9％(4/45)vs 4.4％(2/45)](P=0.398).Conclusions The combination of Guyuling capsules and calcitriol has a significant short-term effect on the treatment of osteoporosis,which may be achieved by improving bone density and bone metabolism levels,and has good safety.

Abstract:Hederagenin is a pentyclic triterpenoid compound with a variety of biological activities and pharmacological effects such as anti-tumor,anti-depressant,anti-inflammatory and anti-bacterial.Hederagenin affects the progression of tumors by regulating apoptosis,autophagy and cell cycle,and has a certain improvement effect on depression,Alzheimer's disease,osteoarthritis and other diseases.The α-hederagenin,derivative of hederagenin,has also shown certain potential in anti-tumor research.It can induce apoptosis and ferroptosis of tumor cells,and play an anti-cancer role in inhibiting cell proliferation and metastasis.In this paper,the research results of hederagenin and its derivative in recent years are summarized and discussed.

Abstract:There were significant changes in the composition,function and metabolites of intestinal flora in patients with chronic heart failure.The abundance of Escherichia coli/Shigella,Veillonococcus and Enterobacter increased in the intestinal flora of patients with heart failure.The microbial functions such as tryptamine metabolism,lipid metabolism and lipolysaccharide synthesis were increased,the bacterial genes related to the production of beneficial metabolite butyrate were decreased,and the bacterial genes related to trimethylamine oxide production were significantly increased.Metabolites of intestinal flora,such as trimethylamine oxide,short-chain fatty acids,amino acid derivatives,and bile acids are one of the main ways in which intestinal flora interacts with the host.These metabolites can be absorbed directly into the host circulatory system and then migrate to different organs.Or they can be metabolized by host enzymes to produce signaling molecules that do their job.

Abstract:Objective To investigate the effect of modified Xinglou Chengqi decoction combined with butylphthalide in the treatment of cognitive impairment after cerebral infarction and its influence on serum brain-gut peptide factor,homocysteine(Hey)and β-amyloid protein 1-42(Aβ1-42).Methods A total of 120 patients with cognitive impairment after cerebral infarction admitted to the No.2 Hospital of Baoding,Hebei Province from January 2019 to November 2023 were selected.They were divided into combined group,Chengqi decoction group and butylphthalide group according to the random number table method,with 40 cases in each group.All the three groups were given conventional western medicine treatment,including cranial nerve nutrition,anti-platelet aggrega-tion,and improving circulation.Butylphthalide group was treated with butylphthalide.The Chengqi decoction group was treated with modified Xinglou Chengqi decoction.The combined group was treated with modified Xinglou Chengqi decoction and butylphthalide,and the three groups were treated for 4 weeks.The efficacy of traditional Chinese medicine,western medicine,neurological function,cognitive function,daily living ability,brain-gut peptide factor,Hcy,Aβ1-42,and the incidence of adverse reactions were compared among the three groups.Results The total effective rate of traditional Chinese and western medicine treatment in the combined group were higher than those in the butylphthalide group and the Chengqi decoction group,and the total effective rate of tradi-tional Chinese medicine treatment in the Chengqi decoction group was higher than that in the butylphthalide group(all P＜0.05).After treatment,the neurological function score of the combined group was lower than those of the Chengqi decoction group and the butylphthalide group,and the Montreal cognitive Assessment scale score and daily living ability score were higher than those of the Chengqi decoction group and the butylphthalide group(all P＜0.05).After treatment,the levels of CGRP,5-hydroxytryptamine and motilin in combined group were higher than those in Chengqi decoction group and butylphthalide group(all P＜0.05).After treatment,Hey in the combined group was lower than that in the Chengqi decoction group and butylphthalide group,and Aβ1-42 was higher than that in the Chengqi decoction group and butylphthalide group(all P＜0.05).There was no significant difference in the total incidence of adverse reactions among the combined group,Chengqi decoction group and butylphthalide group[5.0％(2/40)vs 2.5％(1/40),5.0％(2/40)](x2=0.417,P=0.812).Conclusion Modified Xinglou Chengqi decoction combined with butylphthalide is effective in the treatment of cognitive impairment after cerebral infarction,which can regulate the expression of brain-gut peptide factors,improve neurological function and cognitive function,and improve the ability of daily living of patients,with high safety.

Abstract:Objective To analyze the efficacy of vascular and plaque characteristics of coronary computed tomography angiography(CCTA)in evaluating myocardial ischemia in patients with coronary atherosclerotic heart disease(CHD).Methods The clinical data of 70 patients with suspected or confirmed CHD who underwent invasive coronary angiography(ICA)in Zhangjiakou First Hospital,Hebei Province from November 2021 to October 2023 were retrospectively analyzed.All patients underwent CCTA,ICA and fractional flow reserve(FFR)examination in turn.Myocardial FFR measured by pressure guidewire under ICA guidance was used as the gold standard,and all diseased vessels were divided into the ischemia group(FFR≤0.8)and the non-ischemia group(FFR＞0.8),including 32 patients(37 diseased vessels)in the ischemia group and 38 patients(44 diseased vessels)in the non-ischemia group.The plaque characteristics(plaque burden,non-calcified plaque volume percentage,calcified plaque volume percentage,lesion length,high-risk signs of plaque)and the degree of arterial stenosis in left main coronary artery,anterior descending artery,right coronary artery were compared between the two groups.Logistic regression analysis was used to analyze the relationship between CCTA stenosis rate,plaque characteristics and myocardial ischemic lesions.The receiver operating characteristic curve was used to evaluate the diagnostic efficacy of different indicators for myocardial ischemic lesions.Results The incidences of CT high-risk plaque and napkin ring sign in the ischemia group were higher than those in the non-ischemia group,while the incidences of low-density plaque and positive remodeling were lower than those in the non-ischemia group(all P＜0.05).There was a significant difference in the degree of arterial stenosis between the two groups(Z=9.275,P＜0.001).Multivariate Logistic regression analysis showed that the risk factors of myocardial ischemia included CCTA stenosis rate,lesion length and CT high-risk plaque(odds ratio=3.796,1.029,2.463,respectively;all P＜0.05).The diagnostic efficacy of CCTA(≥50％stenosis)combined with CT high-risk plaque and lesion length was higher than that of CCTA(≥50％stenosis)or ICA(≥50％stenosis)alone(area under the curve:0.715 vs 0.626,0.665,both P＜0.05).Conclusion The predictive factors of myocardial ischemia in CHD include CCTA stenosis rate,lesion length and CT high-risk plaque.The combined application of the three can greatly improve the diagnostic efficiency of myocardial ischemia.

Abstract:Objective To investigate the effect of Xuesaitong dropping pills combined with clopidogrel in the treatment of medium-high risk transient ischemic attack and its influence on related inflammatory markers.Methods A total of 96 patients with moderate and high risk transient ischemic attack who were treated in Hebei General Hospital from December 2021 to August 2023 were selected.A total of 96 patients were divided into control group(48 cases)and observation group(48 cases)by random number table method.The control group was treated with clopidogrel bisulfate tablets,and the observation group was treated with Xuesaitong dropping pills combined with clopidogrel bisulfate tablets.Both groups were treated for 2 weeks.The total effective rate,ABCD-2 score,serum inflammatory markers,incidence of acute cerebral infarction,and incidence of adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[93.8％(45/48)vs 79.2％(38/48)](P＜0.05).After 2 weeks of treatment,the ABCD-2 scores of the two groups were lower than those before treatment,and the ABCD-2 score of the observation group was lower than that of the control group[(2.3±1.0)vs(3.2±1.0)](P＜0.05).After 2 weeks of treatment,the levels of serum interleukin-1 β,monocyte chemoattractant protein-1 and C-reactive protein in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).The incidence of acute cerebral infarction in the observation group at 6 months was lower than that in the control group[4.2％(2/48)vs 16.7％(8/48)](P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Xuesaitong dripping pills combined with clopidogrel in the treatment of medium-high risk transient ischemic attack can achieve good effect,reduce the ABCD-2 score,serum inflammatory index levels and the risk of acute cerebral infarction in the short time,and the adverse reactions are few and mild.