Abstract:Inflammation and immune problems are important mechanisms that cause many diseases.Drug therapy is the main approach,which has the advantages of convenient use,low cost,and obvious therapeutic effects,but also has risks of organ damage,such as liver and kidney,and adverse drug reactions.Other treatment methods need to be explored.Lidocaine is a commonly used local anesthetic,which has recently received attention in the research of inflammatory and immune diseases.Studies have shown that lidocaine can alleviate inflammation and pain symptoms and regulate immune system function to improve inflammatory diseases and inhibit the development of immune diseases.This review summarizes the pharmacological mechanisms,clinical applications(especially in inflammatory and immune diseases),and safety and effectiveness of lidocaine,providing reference for further research and application of lidocaine.

Abstract:Fractures often result in broken blood vessels and soft tissue damage,ischemia,hypoxia,and oxidative stress.Reactive oxygen species act as second messengers to activate signal transduction pathways during oxidative stress.In the presence of reactive oxygen species,Abnormal mitochondrial oxidative stress,Kelch-like epichlorohydrin related protein 1/nuclear factor E2-related factor 2/antioxidant response element signaling pathway,nuclear factor-κB signaling pathway and silent mating type information regulator 2 homologous protein 1 forkhead box transcription factor O signaling pathway can regulate the proliferation and apoptosis of osteoblasts and osteoclasts.It can affect the process of fracture healing.In recent years,the research on mitochondrial function has been on the rise,and the related research on oxidative stress-related signaling pathways and fracture healing has been progressing.Further study on the targets and mechanisms of mitochondrial oxidative stress and related signal transduction can further understand the osteogenic differentiation,osteoblast activity and osteoclast apoptosis of bone marrow mesenchymal stem cells,and provide theoretical basis for the treatment of clinical fractures.

Abstract:Objective To investigate the clinical effect of Tongguan Yixin decoction in the treatment of vasospastic angina(VSA).Methods Totally 96 patients with VSA visited to Hangzhou Traditional Chinese Medicine Hospital,Zhejiang Province from September 2022 to September 2023 were selected and divided into the observation group and the control group adopting a simplified random grouping method,both 48 cases.The control group was treated with western treatment and the observation group was treated with Tongguan Yixin decoction.Both groups were treated for 2 months.During the treatment,2 cases were dropped out of the control group and 2 cases were dropped out of the observation group.Angina pectoris attack,traditional Chinese medicine(TCM)syndrome score,vascular endothelial function,Seattle Angina Pectoris Scale(SAQ)score,myocardial microcircu-lation index(corrected time flow frame count of left circumflex branch,anterior descending branch and right crown)and clinical effect were observed in the two groups before and after treatment.Results After treatment,TCM syndrome score,serum malondialdehyde level,angina pectoris attack frequency,angina pectoris duration,left circumflex branch correction time flow frame count,anterior descending branch correction time flow frame count,right crown correction time flow frame count levels in the two groups were lower/less/shorter than before treatment,and the observation group was lower than the control group(all P＜0.05).After treatment,the levels of serum nitric oxide,superoxide dismutase and SAQ scores in the two groups were higher than those before treatment,and the observation group was higher than the control group(all P＜0.05).After treatment,the total effective rate in the observation group was higher than that in the control group[95.6％(44/46)vs 82.6％(38/46)](P＜0.05).Conclusion Tongguan Yixin decoction can improve vascular endothelial function and myocardial microcirculation in patients with coronary spastic angina.

Abstract:Objective To investigate the correlation between pan-immune inflammation value(PIIV)and left ventricular remodeling and poor prognosis in elderly patients with chronic heart failure.Methods This study was a retrospective analysis.A total of 150 elderly patients with chronic heart failure admitted to the 908th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from January 2020 to December 2021 were collected as the chronic heart failure group.In addition,150 relatively healthy elderly volunteers who under-went physical examination in our hospital during the same period were collected as the control group.The chronic heart failure group was further divided into subgroups according to the level of PIIV.The differences in clinical data between the different groups were compared,and the correlation between PIIV and related indicators of ventricular remodeling and its efficacy in predicting left ventricular remodeling in elderly patients with chronic heart failure were analyzed.At the same time,the related factors of left ventricular remodeling in elderly patients with chronic heart failure were analyzed.Results The PIIV of patients in the chronic heart failure group was significantly higher than that in the control group[687.4(472.1,856.9)vs 305.1(185.4,440.6)](P＜0.05).According to the median of PIIV in the chronic heart failure group,the patients in the chronic heart failure group were divided into low PIIV group(PIIV≤687.4,n=75)and high PIIV group(PIIV＞687.4,n=75).The incidence of left ventricular remodeling,left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)in the high PIIV group were higher/greater than those in the low PIIV group,and left ventricular ejection fraction(LVEF)in the high PIIV group was lower than that in the low PIIV group[61.3％(46/75)vs 41.3％(31/75),(198±17)ml vs(186±12)ml,(230±15)ml vs(219±14)ml,(42±11)％vs(47±8)％](all P＜0.05).The rates of recurrent heart failure and cardiac rehospitalization in the high PIIV group were higher than those in the low PIIV group[54.7％(41/75)vs 33.3％(25/75),41.3％(31/75)vs 22.7％(17/75)](both P＜0.05).PIIV was significantly positively correlated with LVESV and LVEDV(r=0.502,0.542,both P＜0.001),and negatively correlated with LVEF(r=-0.533,P＜0.001).The area under the receiver operating characteristic curve of PIIV for predicting left ventricular remodeling in elderly patients with chronic heart failure was 0.869,with a 95％confidence interval of 0.822-0.916.Multivariate COX regression analysis showed that PIIV,New York Heart Association functional class and N-terminal pro-brain natriuretic peptide were the influencing factors of left ventricular remodeling in patients with chronic heart failure(all P＜0.05).Conclusion PIIV has a good predictive value for left ventricular remodeling in elderly patients with chronic heart failure.

Abstract:Objective To observe serum angiopoietin-2(Ang-2)and stress-induced protein 2(Sesn2)levels in patients with acute ischemic stroke(AIS)after intravenous thrombolysis and their correlation with clinical prognosis.Methods A total of 105 AIS patients who received intravenous thrombolytic therapy in Baiyun Hospital Affiliated to Guizhou Medical University from August 2022 to March 2024 were prospectively selected.Serum Ang-2 and Sesn2 levels were measured at admission,and the prognosis was evaluated 3 months after thrombolysis.The levels of serum Ang-2 and Sesn2 in patients with different severity and prognosis were compared,and the relationship between serum Ang-2 and Sesn2 and the clinical prognosis of AIS patients was analyzed.Results The serum Ang-2 and Sesn2 in the severe group(30 cases)were higher than those in the moderate-severe group(46 cases)and the moderate group(29 cases)[(32±6)ng/L vs(29±5),(24±5)ng/L,(16±3)μg/L vs(12±4),(10±3)μg/L],and the moderate-severe group were higher than the moderate group(all P＜0.05).At 3 months after thrombolysis,45 of 105 patients had poor prognosis.The levels of serum Ang-2,Sesn2 and D-dimer and the proportion of patients with severe disease severity in the poor prognosis group were higher than those in the good prognosis group(all P＜0.05).Multivariate Logistic regression analysis showed that severe disease,D-dimer,Ang-2 and Sesn2 were independent prognostic factors(all P＜0.05).The restricted cubic spline analysis showed that the serum Ang-2 and Sesn2 levels were positively correlated with the prognosis of AIS patients in a non-linear dose-response relationship(both P＜0.05),and there was a positive interaction between serum Ang-2 and Sesn2 on the prognosis of AIS patients(the cut-off values were 28.18 ng/L and 12.61 μg/L,respectively).The nomogram showed that the concordance index of the model with serum Ang-2,Sesn2,D-dimer and disease severity was 0.975(95％confidence interval:0.951-0.999),and the discrimination was good.When the decision curve was drawn,the net earning rate of the decision curve drawn by serum Ang-2,Sesn2,and D-dimer level was higher,and the maximum net earning rate was 0.429.Conclusions The more severe the disease,the higher the serum Ang-2 and Sesn2 levels.When the serum Ang-2 and Sesn2 levels were higher than 28.18 ng/L and 12.61 μg/L respectively before treatment,the clinical prognosis might be poor and high risk.The serum Ang-2 and Sesn2 levels combined with disease severity and D-dimer levels can improve the predictive value for the clinical prognosis of AIS.

Abstract:Objective To investigate the clinical effect of Nocardia rubrum cell wall skeleton(Nr-CWS)topical treatment on women with cervical high-risk human papillomavirus(HR-HPV)persistent infection.Methods A total of 120 female patients with persistent cervical HR-HPV infection(≥ 1 year)who visited the gynecological clinic of Beijing Anzhen Hospital,Capital Medical University from January 2021 to August 2023 were collected,and the clinical data of the patients were collected for retrospective analysis.According to the patients'preferred treatment method,they were divided into observation group and control group,with 60 cases in each group.The control group was given lifestyle intervention,including healthy lifestyle,appropriate exercise,enhance body resistance;the patients in the observation group were treated with external application of Nr-CWS on the basis of immunity intervention,10 times as a course of treatment.The efficacy of the two groups was evaluated at 6 and 12 months after treatment.Results At 6 and 12 months after treatment,the total effective rate of the observation group was significantly higher than that of the control group[63.3％(38/60)vs 18.3％(11/60),73.3％(44/60)vs 35.0％(21/60)](all P＜0.05).There was no statistically significant difference in the efficacy(total effective rate)of different subtypes of persistent HR-HPV patients in the observation group at 6 and 12 months after treatment(all P＞0.05).Conclusion Topical Nr-CWS is effective in the treatment of persistent cervical HR-HPV infection in women.

Abstract:Acute myocardial infarction complicated by cardiogenic shock is a serious and life-threatening condition with high mortality.In recent years,emergency percutaneous coronary intervention(PCI)assisted by extracorporeal membrane oxygenation(ECMO)has made some progress in the treatment of these patients.ECMO can provide effective cardiopulmonary support for patients,maintain circulatory stability,and create conditions for emergency PCI.Recently,multidisciplinary cooperation has been strengthened in clinical practice,and several medical centers have successfully carried out ECMO-assisted emergency PCI,which has significantly improved the survival rate and prognosis of patients.In addition,with the continuous development of technology,there are more in-depth studies and understandings on the treatment timing,indications and postoperative complications manage-ment of ECMO-assisted emergency PCI.However,this treatment mode still faces many challenges,such as high treatment cost,technical complexity and possible complications,which still need to be further solved.This review summarizes the recent studies on ECMO combined with PCI in the treatment of acute myocardial infarction compli-cated with cardiogenic shock,in order to further improve the effectiveness and safety of this treatment mode,and bring more survival hope for patients.

Abstract:Objective To investigate the expression of long non-coding RNA(lncRNA)SH3BP5-AS1 and microRNA(miR)-6838-5p in patients with hepatocellular carcinoma and their relationship with clinicopathological features and prognosis.Methods A total of 110 patients with hepatocellular carcinoma who underwent surgical treatment in The Second Affiliated Hospital of Xi'an Jiaotong University and XD Group Hospital from January 2018 to December 2020 were selected.The expressions of lncRNA SH3BP5-AS1 and miR-6838-5p in surgically resected cancer tissues and adjacent tissues were detected,and the survival of patients was followed up after discharge.The correlation between lncRNA SH3BP5-AS1 and miR-6838-5p in cancer tissues was analyzed,and Kaplan-Meier curve was drawn to compare the survival difference of hepatocellular carcinoma patients with different lncRNA SH3BP5-AS1 and miR-6838-5p expression.Univariate and multivariate Cox proportional hazards regression methods were used to analyze the prognostic factors of patients with hepatocellular carcinoma.Results The expression of lncRNA SH3BP5-AS1 in hepatocellular carcinoma tissues was higher than that in adjacent tissues,and the expression of miR-6838-5p was lower than that in adjacent tissues[(2.7±0.4)vs(1.5±0.3),(1.9±0.5)vs(3.1±0.7)](both P＜0.001).High expression of lncRNA SH3BP5-AS1 and low expression of miR-6838-5p were associated with poor differentiation,TNM stage Ⅲ,intrahepatic metastasis and vascular invasion(all P＜0.05).There was a negative correlation between lncRNA SH3BP5-AS1 and miR-6838-5p expression in hepatocellular carcinoma tissues(r=-0.524,P＜0.001).The 3-year overall survival rate of hepatocellular carcinoma patients with high expression of lncRNA SH3BP5-AS1 was lower than that of patients with low expression of lncRNA SH3BP5-AS1,and the 3-year overall survival rate of hepatocellular carcinoma patients with low expression of miR-6838-5p was lower than that of patients with high expression of miR-6838-5p(both P＜0.05).TNM stage Ⅲ,intrahepatic metastasis and high expression of lncRNA SH3BP5-AS1 were risk factors for poor prognosis of patients with hepatocellular carcinoma,and high expression of miR-6838-5p was a protective factor(all P＜0.05).Conclusion Up-regulation of lncRNA SH3BP5-AS1 expression and down-regulation of miR-6838-5p expression in hepatocellular carcinoma tissues are related to clinical malignant pathological characteristics and poor prognosis.

Abstract:Rheumatoid arthritis is an autoimmune disease,which can cause the involvement of multiple organs and systems such as bones and joints.Elderly patients with rheumatoid arthritis have the characteristics of organ dysfunction,low immune system function,and more complications,which lead to an increased incidence of infection.Patients with infection are difficult to treat,have a poor prognosis,and have a high mortality rate.Therefore,it is of great clinical significance to explore the relationship between elderly rheumatoid arthritis and infection.This article reviews the risk factors of elderly rheumatoid arthritis complicated with infection,in order to improve the understanding of elderly rheumatoid arthritis complicated with infection.

Abstract:Objective To investigate the impact of chronic obstructive pulmonary disease(COPD)on the occurrence of thrombotic events and recurrence after radiofrequency ablation in patients with atrial fibrillation.Methods Totally 80 atrial fibrillation patients with COPD(COPD group)and 80 atrial fibrillation patients without COPD(control group)admitted to Qinghai Red Cross Hospital from January 2020 to January 2024 were selected.The occurrence of thrombotic events and the score of atrial fibrillation thrombosis risk-VASc(CHA2DS2-VASc)in the two groups were recorded.All patients underwent radiofrequency ablation.The patients were divided into recurrence group and non-recurrence group according to the recurrence of atrial fibrillation after radiofrequency ablation.The factors affecting the recurrence of atrial fibrillation after radiofrequency ablation were analyzed.Results The total incidence of thrombotic events,the proportion of CHA2DS2-VASc score ≥2,and the postoper-ative recurrence rate in the COPD group were higher than those in the control group[20.0％(16/80)vs 8.8％(7/80),22.5％(18/80)vs 10.0％(8/80),53.8％(43/80)vs 26.2％(21/80)](all P＜0.05).A total of 64 patients had recurrence and 96 patients had no recurrence.The body mass index,the proportion of type 2 diabetes mellitus and COPD in the recurrence group were higher than those in the non-recurrence group.The duration of atrial fibrillation and the left atrial anteroposterior diameter were longer than those in the non-recurrence group,and the left ventricular ejection fraction was lower in the recurrence group than that in the non-recurrence group(all P＜0.05).A longer course of atrial fibrillation and COPD were the risk factors for recurrence of atrial fibrilla-tion after radiofrequency ablation(odds ratio=3.762,2.656,both P＜0.001).Conclusions The incidence of thrombotic events and the recurrence rate after radiofrequency ablation of atrial fibrillation in patients with COPD are higher.COPD is a risk factor for the recurrence of atrial fibrillation after radiofrequency ablation.

Abstract:Sepsis is a systemic inflammatory response syndrome triggered by infection,and it is also one of the main factors leading to the death of critically ill patients.Coagulopathy caused by sepsis is not only a life-threatening complication,but also a key factor for the deterioration of patients with sepsis.Therefore,in-depth study of the mechanism of sepsis coagulopathy and related biomarkers will help clinicians to identify these problems earlier,so as to improve the prognosis of patients and provide clinicians with new treatment directions.

Abstract:The incidence and mortality of chronic kidney disease are increasing worldwide,which threatens the physical and mental health of patients.Moreover,the complications of the disease involve multiple organs and multiple systems,and the medical costs are expensive.If the disease is not well controlled,it will progress rapidly.By reading and sorting out the relevant domestic and international literature,this paper analyzes and demonstrates the mechanism and clinical efficacy of a variety of traditional Chinese medicine intestinal therapy in the treatment of chronic kidney disease from different perspectives.It was found that intestinal therapy with traditional Chinese medicine could improve intestinal flora imbalance,reduce the accumulation of uremic toxins,correct calcium and phosphorus imbalance,inhibit hyperparathyroidism and improve micro-inflammatory state.As one of the commonly used external treatment methods in clinical practice,intestinal therapy of traditional Chinese medicine is delivered through the intestine,which connects the lung and large intestine on the outside and inside.Under the transmission of the lung,the effect of the drug is fully played and reaches the site of the disease,which also coincides with the theory of"intestine-kidney axis"in modern medicine.

Abstract:Objective To analyze the risk factors for lymphovascular space invasion(LVSI)in patients with low-grade endometrial carcinoma,construct a nomogram prediction model,and evaluate its effectiveness.Methods The clinical data of 167 patients with low-grade endometrial carcinoma who underwent initial treatment in the Department of Gynecology,Beijing Friendship Hospital,Capital Medical University from January 2015 to May 2023 were retrospectively analyzed.The patients were divided into non-vascular invasion group(143 cases)and vascular invasion group(24 cases)according to vascular invasion.Logistic regression analysis was used to determine the risk factors of LVSI in low-grade endometrial carcinoma.A nomogram model for predicting the risk of LVSI in low-grade endometrial carcinoma was established,and the consistency coefficient and calibration curve were used to evaluate the predictive performance and conformity of the model.Results Multivariate Logistic regression model(stepwise selection method)was used to analyze the independent risk factors of LVSI in patients with low-grade endometrial carcinoma.The results showed that long vaginal bleeding time,triglycerides 1.7 mmol/L,carbohydrate antigen 125 ≥35 kU/L,International Federation of Gynecology and Obstetrics clinical stage Ⅱ and above were independent risk factors for LVSI in patients with low-grade endometrial carcinoma(odds ratios=1.000,1.070,1.820,7.700,all P＜0.05).The independent risk factors screened by multivariate Logistic regression analysis were used to establish a nomogram model for predicting the risk of LVSI in low-grade endometrial carcinoma.After calibration and verification,the predicted risk was close to the actual risk,and the concordance index was 0.843.Conclusion Clinical high staging,serum high triglycerides,high carbohydrate antigen 125,and long preoperative vaginal bleeding time are risk factors for LVSI in patients with low-grade endometrial carcinoma.The nomogram model based on these indicators can be used to evaluate the risk of LVSI in these patients before surgery.

Abstract:Microangiopathy,a common and specific complication of diabetes mellitus,significantly impairs the functioning of various organs in patients.Extensive research has demonstrated the crucial role of gut microbiota in human metabolism and immune regulation.Alterations in gut microbiota composition can disrupt the gastrointestinal environment,leading to abnormal production of metabolites,inflammatory conditions,disturbances in glucose metabolism,and even insulin resistance.Type 2 diabetes mellitus(T2DM)patients often experience metabolic disorders and chronic inflammation accompanied by disruptions in intestinal microbiota.Changes in the stable community of intestinal microbiota have a profound impact on the prognosis of diabetic microvascular compli-cations.This review aims to summarize the characteristics and pathogenesis of intestinal microbiota in diabetic microangiopathy,providing a solid theoretical foundation for regulating intestinal microbiota as an approach for preventing and treating T2DM and related microangiopathic conditions.

Abstract:Irritable bowel syndrome with constipation(IBS-C)is a subtype of irritable bowel syndrome(IBS).Because its exact pathogenesis is not clear,there is no specific method in terms of treatment,mainly based on laxatives,but it is difficult to achieve satisfactory efficacy in completely relieving symptoms and preventing recurrence.In recent years,the continuous development of new drugs and the update of relevant clinical guidelines have further developed the diagnosis and treatment of IBS-C.Based on this,this review focuses on the current research progress in the treatment of IBS-C,in order to provide evidence and support for clinical practice.

Abstract:Objective To explore the value of suboccipital muscle group fascial block in the treatment of cervicogenic headache(CEH).Methods A total of 100 CEH patients who were treated in Beijing Anzhen Hospital,Capital Medical University from January to December 2023 were selected as the research objects.According to the random number table method,they were divided into the observation group and the control group,50 cases in each group.The control group was treated with ibuprofen sustained-release capsules,and the observation group was treated with suboccipital muscle group fascial block.The visual analogue scale(VAS)score,pain rating index(PRI)score,neck disability index(NDI)score,efficacy and safety indexes were compared between the two groups.Results After treatment,the VAS,PRI and NDI 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).In the control group,0 case was cured,2 cases were markedly effective,38 cases were improved,and 10 cases were ineffective,with a total effective rate of 80.0％(40/50);in the observation group,0 case was cured,13 cases were markedly effective,35 cases were improved,and 2 cases were ineffective,with a total effective rate of 96.0％(48/50);the efficacy of the observation group was better than that of the control group(Z=-3.649,P＜0.001).There were no adverse events such as bleeding and infection in the treatment area in the observation group.Three patients in the control group complained of nausea and vomiting after oral medication,and the symptoms were mild and relieved by themselves.Conclusion Fascial block of suboccipital muscle group has certain value in the treatment of CEH.It can significantly reduce the frequency and intensity of headache,improve the quality of life of patients,and has good safety.

Abstract:Objective To investigate the effect of intranasal dexmedetomidine on emergence agitation during general anesthesia in elderly patients with renal insufficiency.Methods A total of 100 elderly patients with renal insufficiency undergoing gastrointestinal surgery in Tangshan Central Hospital,Hebei Province from February 2023 to February 2024 were selected as the research objects,and were randomly divided into two groups,with 50 cases in each group.Patients in the observation group were given intranasal dexmedetomidine l h before the end of surgery.Patients in the control group were given the same volume of 0.9％sodium chloride injection nasal drops 1 h before the end of surgery.The anesthesia recovery index,pain degree,sedation effect,renal function index and adverse reactions were compared between the two groups.Results The recovery time of spon-taneous breathing and anesthesia recovery time in the observation group were shorter than those in the control group(both P＜0.05).The visual analogue scale scores of the observation group were lower than those of the control group at 6,12,24 h and 48 h after anesthesia recovery(all P＜0.001).The Ramsay scores of sedation immediately,5,30 and 60 min after extubation in the observation group were higher than those in the control group(all P＜0.001).The levels of blood urea nitrogen,serum creatinine,24 h urinary albumin and 24 h urinary microalbumin excretion rate in the observation group were lower than those in the control group(all P＜0.001).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group[8.0％(4/50)vs 46.0％(23/50),x2=18.316,P＜0.001].Conclusion The application of intranasal dexmedetomidine in patients with renal insufficiency undergoing general anesthesia has good anesthetic analgesic and sedative effects,which can effectively shorten the time of respiratory recovery and anesthesia recovery,reduce restlessness during anesthesia recovery,good recovery of renal function level,less adverse reactions,and is safe and effective.

Abstract:Objective To investigate the changes of serum microRNA-155(miR-155)and NOD-like receptor protein 3(NLRP3)levels and their diagnostic values for carotid atherosclerosis(CAS)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 142 patients with T2DM admitted to West China Hospital,Sichuan University from January 2021 to January 2023 were selected.According to the presence or absence of CAS,the patients were divided into CAS group(72 cases)and non-CAS group(70 cases).The general data of the two groups of patients were collected and compared,and the serum levels of miR-155 and NLRP3 were detected and compared between the two groups.Pearson corr-elation was used to analyze the correlation between serum miR-155 and NLRP3 levels in T2DM patients.Multivariate Logistic regression was used to analyze the influencing factors of CAS in T2DM patients.Receiver operating characteristic curve was used to analyze the diagnostic value of serum miR-155 and NLRP3 levels for CAS in T2DM patients.Results The duration of T2DM in the CAS group was longer than that in the non-CAS group,and the proportion of smoking history,glycosylated hemoglobin,home-ostasis model assessment of insulin resistance index,miR-155 and NLRP3 were higher than those in the non-CAS group(all P＜0.05).Pearson correlation analysis showed that serum miR-155 levels were positively correlated with NLRP3 levels in T2DM patients(r=0.765,P＜0.001).Multivariate Logistic regression model showed that the prolonged duration of T2 DM,smoking history,glycosylated hemoglobin,homeostasis model assessment of insulin resistance index,miR-155 and NLRP3 were independent risk factors for CAS in T2DM patients(all P＜0.05).Receiver operating characteristic curve analysis showed that the area under the curve of serum miR-155 and NLRP3 levels combined in the diagnosis of CAS in T2DM patients was larger than those of serum miR-155 and NLRP3 levels alone(0.900 vs 0.791,0.799,Z=3.436,3.381;both P=0.001).Conclusions The increase of serum miR-155 and NLRP3 levels is closely related to the occurrence of CAS in T2DM patients.The combina-tion of serum miR-155 and NLRP3 levels has a high diagnostic value for CAS in T2DM patients.

Abstract:Unruptured intracranial aneurysm is a buried time bomb in patients who often have concomitant hypertension.In addition to the pro-rupture risk factors confirmed by most studies,complex hemodynamics,inflammatory factors and uncontrolled hypertension also increase the risk of rupture.As a commonly used antihy-pertensive drug in clinic,calcium channel blockers have been found to play a protective role in the process of rupture,but some studies have found different or even contradictory results.This article reviews the risk factors of aneurysm rupture,the effect of calcium channel blockers on aneurysm rupture,and the dual effects of calcium channel blockers.

Abstract:Objective To investigate the risk factors of postoperative delirium after coronary artery bypass grafting(CABG)and to establish a risk prediction model.Methods The clinical data of 1 067 patients who underwent CABG at Coronary Heart Disease Surgery Center,Beijing Anzhen Hospital,Capital Medical University from January 2022 to June 2023 were retrospectively collected.The intensive care unit(ICU)confusion assessment method(CAM-ICU)was used to assess the occurrence of postoperative delirium.The patients were divided into delirium group and non-delirium group.The clinical characteristics of the two groups were compared.Univariate analysis and multivariate binary Logistic regression analysis were used to determine the independent risk factors affecting the occurrence of delirium,and a nomogram model for predicting the risk of delirium was established.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the delirium model.Results Among 1 067 patients,there were 133 patients in delirium group,the incidence of delirium was 12.5％,the age was(62±10)years,and 97 cases were male.There were 934 patients in the non-delirium group,the age was(62±9)years and 704 cases were male.SPSS 22.0 software was used to randomly select 747 patients as the experimental group,and the remaining 320 patients were used as the internal validation group.Multivariate Logistic regression analysis showed that education below junior high school,preoperative sleep disorders,history of diabetes mellitus,left ventricular ejection fraction(LVEF)≤45％,mild anemia,hypoproteinemia,cardiopulmonary bypass and ventilator use ≥48 h were independent risk factors for delirium after CABG in the experimental group(all P＜0.05).The ROC analysis showed that the area under the curve(AUC)of the experimental group was 0.736(95％confidence interval:0.682-0.739).The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit,and the P value was 0.748.The AUC of the scoring early warning system was 0.754(95％confidence interval:0.690-0.819).The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit,and the P value was 0.808.Conclusion Delirium is one of the common complications after CABG.Low education level,preoperative sleep disorders,cardiopulmonary bypass and long-term use of ventilator are independent risk factors for delirium after CABG.