Abstract:With the increasing proportion of aging population in China,the incidence of Alzheimer's disease is also increasing.Alzheimer's disease,the most common neurodegenerative disease,shows irreversible cognitive dysfunction.A number of studies have shown that insulin resistance is associated with the pathogenesis of Alzheimer's disease,such as abnormal accumulation of amyloid-β-protein,abnormal tau protein,and neuroinflam-mation.This article systematically reviews the association between insulin resistance and Alzheimer's disease and its possible mechanisms.

Abstract:Objective To investigate the risks and benefits of extended dual antiplatelet therapy(DAPT)in patients with previous hypertensive cerebral hemorrhage undergoing percutaneous coronary intervention(PCI).Methods This study was an observational clinical study.A total of 128 patients with a history of hypertensive cerebral hemorrhage who underwent PCI in Beijing Anzhen Hospital,Capital Medical University from January 2005 to December 2014 were enrolled as observation group,and 153 patients with hypertension but no history of cerebral hemorrhage were enrolled as control group.All patients were administered aspirin 100 mg/d and clopidogrel 75 mg/d after PCI,and the follow-up ranged from 12 to 48 months.The efficacy endpoint was major adverse cardiovascular and cerebrovascular events(MACCE),while the safety endpoint were cerebral hemorrhage and major bleeding.The duration of DAPT＞12 months was defined as extended DAPT,and the duration of DAPT 12 months was defined as non-extended DAPT.Univariate and multivariate Cox regression analysis were used to analyze the factors affecting the endpoint events.Results Previous history of hypertensive cerebral hemorrhage(P=0.029)and acute myocardial infarction(P=0.027)were independent risk factors for MACCE in hypertensive patients undergoing PCI,while extended DAPT(hazard ratio=0.351,P＜0.001)was an independent protective factor.In subgroup analysis,extended DAPT increased the risk of major bleeding in PCI patients with previous hypertensive cerebral hemorrhage(hazard ratio=6.650,P=0.036),but did not decrease the risk of MACCE(P=0.349).Extended DAPT did not increase the risk of major bleeding in PCI patients with previous hypertensive(P=0.538),but significantly reduced the risk of MACCE(hazard ratio=0.356,P=0.044).Conclusions Extended DAPT increases the risk of major bleeding in PCI patients with a history of hypertensive cerebral hemorrhage,and DAPT should be controlled within 12 months.Extended DAPT can reduce the risk of MACCE and does not increase the risk of major bleeding in patients with hypertension before PCI.It is recommended to extend the DAPT appropriately.

Abstract:Objective To investigate the effect of colchicine on atherosclerosis induced by high-fat diet in apolipoprotein E gene knockout(ApoE-/-)mice.Methods Twelve C57BL/6J wild-type mice were selected as the control group,24 ApoE-/-mice were completely randomized into model group and colchicine group,with 12 mice in each group.The control group was fed with regular feed;the model group and colchicine group were fed with high-fat diet to establish atherosclerosis model,at the same time colchicine group was also given colchicine 2 mg/(kg·d)by gavage for 8 weeks.The blood and aortic tissue samples were collected to detect the levels of blood lipids and C-reactive protein in each group.The pathological changes of aorta were observed by staining.The nuclear/cap ratio and vulnerability index of atherosclerotic plaques were compared among the groups.Results After intervention,the total cholesterol,triglycerides,low-density lipoprotein cholesterol,and C-reactive protein in the model group and colchicine group were higher than those in the control group,but those in the colchicine group were lower than those in the model group,and the high-density lipoprotein cholesterol was lower than that in the control group,but those in the colchicine group were higher than those in the model group(all P＜0.05).The number of apoptotic endothelial cells,collagen fiber content,and CD68,α-smooth muscle actin positive expression in the aortic tissue of mice in the colchicine group were significantly lower than those in the model group(all P＜0.05).The ratio of nucleus to cap and vulnerability index of atherosclerotic plaque in colchicine group were signif-icantly lower than those in model group[(3.24±0.49)vs(9.54±1.49),(2.84±0.39)vs(8.64±1.29)](both P＜0.05).Conclusion Colchicine can significantly reduce aortic atherosclerotic in ApoE-/-mice induced by high-fat diet.

Abstract:Objective To observe the clinical efficacy of Xiaoke Jianpi decoction combined with conven-tional treatment and ketogenic diet management in patients with type 2 diabetes mellitus(T2DM)with Qi and Yin deficiency syndrome.Methods A total of 120 T2DM patients with Qi and Yin deficiency syndrome admitted to Beijing Rehabilitation Hospital,Capital Medical University from March 2021 to March 2023 were enrolled,and they were divided into control group and observation group according to the random number table method,with 60 cases in each group.The control group was given routine treatment and ketogenic diet management,and the observation group was treated with Xiaoke Jianpi decoction on the basis of the control group.Both groups were treated for 12 weeks.The blood glucose index,blood lipid index,inflammatory index,intestinal flora index,clinical efficacy and adverse reactions were compared between the two groups before and after treatment.Results There were 2 cases dropped off in the control group and 1 case dropped off in the observation group.Finally,58 cases in the control group and 59 cases in the observation group completed this study.After treatment,the levels of fasting plasma glucose,2 h postprandial plasma glucose,hemoglobin A1c,tri acylglycerol,total cholesterol,low-density lipoprotein cholesterol,hypersensitive C-reactive protein,tumor necrosis factor-α,interleukin-6,and Enterococcus abundance in the observation group were lower than those in the control group,and the contents of Bifidobacterium abundance and Lactobacillus abundance in the observation group were higher than those in the control group(all P＜0.05).The total effective rate of the observation group was better than that of the control group[93.2％(55/59)vs 77.6％(45/58)],the total incidence of adverse reactions in the observation group was lower than that in the control group[8.5％(5/59)vs 27.6％(16/58)](both P＜0.05).Conclusion Xiaoke Jianpi decoction combined with conventional treatment and ketogenic diet management can effectively improve glucose and lipid metabolism,reduce inflammatory response and regulate intestinal flora in T2DM patients with Qi and Yin deficiency syndrome,with good efficacy and high safety.

Abstract:Myasthenia gravis(MG)is an acquired autoimmune disease,the main symptom of which is the weakness of skeletal muscle contraction caused by neuromuscular transmission disorders.Common treatment methods for MG include anticholinesterase drug therapy,corticosteroid therapy,immunosuppressive therapy,plasma exchange therapy,surgical therapy,etc.Among them,there are various drugs commonly used for MG,such as glucocorticoids,azathioprine,immunosuppressants,etc.,which have been confirmed to have certain curative effects.With the in-depth research of MG mechanism and drugs in the medical community and the development of biotechnology,especially the birth of antibody drugs such as neonatal Fc receptor target antibody drugs,anti-complement 5 antibody drugs and surface antigen-antibody drugs,drug regimen of MG has brought more scientific and effective treatment options.This paper provides an overview of the incidence and treatment of MG,and reviews the research progress of antibody drugs in MG therapy.

Abstract:Objective To investigate the changes and clinical significance of serum lymphotoxin-like,exhibits inducible expression,competes with herpes simplex virus glycoprotein D for herpesvirus-entry mediator,a receptor expressed by T lymphocytes(LIGHT)and chitinase 3-like protein 1(CHI3L1)levels in children with severe Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 110 children with severe MPP(SMPP group)and 55 children with general MPP(GMPP group)admitted to the Department of Pediatrics,the First Hospital of Yulin,Shaanxi Province from January 2021 to February 2024 were selected.The children with SMPP were divided into non-critical group(41 cases),critical group(38 cases)and extremely critical group(31 cases)according to pediatric critical illness score.According to the outcome 28 days after admission,the children were further divided into poor prognosis group(40 cases)and good prognosis group(70 cases).The serum levels of LIGHT and CHI3L1 at admission were detected by enzyme-linked immunosorbent assay.With the poor prognosis of children with SMPP as the dependent variable,multivariate unconditional Logistic regression analysis was used to determine its influencing factors.The receiver operating characteristic curve was drawn to evaluate the efficacy of serum LIGHT and CHI3L1 levels in predicting the poor prognosis of children with SMPP.Results The serum levels of LIGHT and CHI3L1 in the SMPP group were higher than those in the GMPP group[(8.2±1.8)ng/L vs(4.3±0.8)ng/L,(2 917±732)ng/L vs(1 825±388)ng/L](both P＜0.001).The serum levels of LIGHT and CHI3L1 in extremely critical group were higher than those in critical group and non-critical group,and those in critical group were higher than those in non-critical group(all P＜0.05).High pediatric critical illness score was an independent protective factor for poor prognosis in children with SMPP,and high procalcitonin,LIGHT,and CHI3L1 were independent risk factors for poor prognosis(all P＜0.05).The area under the curve of the combination of serum LIGHT and CHI3L1 levels for predicting the poor prognosis of children with SMPP was 0.868,which was larger than 0.781 and 0.784 of serum LIGHT and CHI3L1 levels alone(both P＜0.05).Conclusions Children with SMPP have elevated serum levels of LIGHT and CHI3L1,which are closely related to disease severity and poor prognosis.The combination of serum levels of LIGHT and CHI3L1 has a high predictive value for poor prognosis in children with SMPP.

Abstract:Objective To analyze the expression of moesin and paired related homeobox protein 1(PRRX1)in elderly patients with non-small cell lung cancer(NSCLC)and their correlation with the efficacy of osimertinib targeted therapy.Methods A total of 60 elderly patients with NSCLC admitted to the 920th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2021 to June 2024 were selected as the research objects.The expression levels of moesin and PRRX1 in cancer tissues and adjacent tissues were detected,and the correlation between the expression changes of moesin and PRRX1 and the efficacy of osimertinib targeted therapy was analyzed.According to the efficacy of osimertinib targeted therapy,the patients were divided into the effective treatment group(42 cases)and the ineffective treatment group(18 cases).The expression levels of moesin and PRRX1 were compared between the two groups.The predictive value of moesin and PRRX1 expressions for clinical efficacy in elderly patients with NSCLC was analyzed.Results The positive expression rates of moesin and PRRX1 in cancer tissues were 70.0％(42/60)and 83.3％(50/60),respectively.The staining area of cells was enlarged and the staining intensity was high.There were statistically significant differences in pathological type,tumor diameter,TNM stage,degree of differentiation,lymph node metastasis,capsule invasion,positive expression of moesin and PRRX1,and incidence of epidermal growth factor receptor gene mutation between the two groups(all P＜0.05).The positive rate of moesin in epidermal growth factor receptor(EGFR)gene wild-type patients was higher than that in EGFR mutant patients,and the positive expression rate of PRRX1 was lower than that of mutant patients(both P＜0.05).Spearman correlation analysis showed that the expression of moesin and PRRX1 was positively correlated with clinical efficacy(r=0.339,P＜0.001;r=0.558,P＜0.001).Multivariate Logistic regression analysis showed that pathological tissue type,maximum tumor diameter,TNM stage,degree of differentiation,lymph node metastasis,capsule invasion,mosin and PRRX1 expression were all risk factors affecting the efficacy of osimertinib targeted therapy(all P＜0.001).Receiver operating characteristic curve analysis showed that the predictive value of combined detection of moesin and PRRX1 for clinical efficacy in elderly patients with NSCLC was higher than that of moesin or PRRX1 alone.Conclusion The expressions of moesin and PRRX1 are related to the efficacy of osimertinib targeted therapy in elderly NSCLC patients,which can be predicted by combined detection,so as to provide reference for clinical treatment plan adjustment.

Abstract:Vitamin D is a steroid derivative that plays an important role in a variety of metabolic processes.Vitamin D deficiency is common in the population.The latest research evidence shows that vitamin D deficiency may be related to the pathogenesis of insulin resistance(IR)-related diseases.In addition to the benefits of vitamin D supplementation for bone health,its role in improving IR should not be ignored.This review summarizes the reported effects of vitamin D on IR,supplements the mechanisms of vitamin D improving IR through various pathways,and concludes that maintaining vitamin D at an adequate level has a certain effect on improving IR and is helpful for blood glucose control in patients with type 2 diabetes.In the future treatment of type 2 diabetes,Vitamin D supplementation combined with currently known hypoglycemic regimens may be a comprehensive and individualized treatment in the future.

Abstract:Dizziness and vertigo are one of the most common causes and symptoms of patients seeking medical advice.Although they are not life-threatening,they are closely related to the quality of life and work efficiency of patients,and are also early warning signals for many diseases.Vertigo related diseases have the characteristics of high difficulty in diagnosis and treatment,recurrent conditions and persistent symptoms.The combination of traditional Chinese and western medicine has obvious advantages in treating this disease.Guangxi is located in South China.It is located in low latitudes,bordering the Nanling Mountain Mountains in the north,and the south of the Five Ridges is located in the subtropical monsoon climate zone.Under the combined effect of geographical environ-ment,solar radiation,atmospheric circulation and other factors,it has formed the climate characteristics of warm climate,rich heat and abundant precipitation.The climate characteristics of hot,humid and rainy in the south of the Five Ridges are closely related to phlegm dampness,and fire heat syndrome.The majority of people are humid and hot.Currently,there are few guidelines,norms and consensus on the diagnosis and treatment of dizziness based on the combination of traditional Chinese and western medicine,and regional expert consensus targeting ethnic minority areas in Guangxi is even rarer.Therefore,combining with the geographical conditions,climate,physical characteristics of the population,and diagnosis and treatment techniques with Zhuang medical character-istics in Guangxi,an experts consensus in the diagnosis and treatment of dizziness based on traditional Chinese and western medicine,is compiled to provide reference for the clinical diagnosis and treatment of this disease.We have compiled an expert consensus on the diagnosis and treatment of vertigo in accordance with the geographical conditions of Guangxi,with a view to providing reference for the clinical diagnosis and treatment of the disease.

Abstract:Objective To investigate the changes of mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)scores in patients with silent brain infarction(SBI)and their relationship with the effect of dual antiplatelet aggregation therapy.Methods A total of 110 SBI patients admitted to North China University of Science and Technology Affiliated Hospital from August 2022 to October 2023 were retrospectively analyzed.According to the treatment regimen,the patients were divided into conventional group(50 cases)and dual antibody group(60 cases).The conventional group was treated with bay aspirin,and the dual antibody group was treated with dual antiplatelet aggregation therapy(aspirin and clopidogrel bisulfate).The general data of the patients were collected,and the levels of nervous system markers,cognitive function,and coagulation function were detected before treatment,1 and 3 months after treatment,and the clinical effect of the patients after 3 months of treatment was evaluated.Logistic regression equation was used to analyze the risk factors affecting the clinical efficacy of SBI patients.Receiver operating characteristic curve analysis was used to evaluate the predictive value of cognitive function before treatment for clinical efficacy.Results After 1 and 3 months of treatment,the levels of nerve growth factor and brain-derived neurotrophic factor(BDNF),MMSE and MoCA scores in both groups showed an upward trend,and the scores in the dual antibody group were higher than those in the conventional group at each time point(all P＜0.05).After 1 and 3 months of treatment,the levels of neuron-specific enolase(NSE),glial fibrillary acidic protein factor,fibrinogen(FIB),maximum platelet aggregation rate,and D-dimer in the two groups showed a decreasing trend compared with those before treatment,and those in the dual antibody group were lower than those in the conventional group at each time point(all P＜0.05).After 3 months of treatment,the effective rate of the dual antibody group was higher than that of the conventional group[86.7％(52/60)vs 70.0％(35/50)](x2=4.581,P=0.032).Logistic regression analysis showed that past history,smoking history,drinking history,BDNF,NSE,FIB,D-dimer levels before treatment,MMSE and MoCA scores were the influencing factors of clinical efficacy in patients with SBI(all P＜0.05).The receiver operating characteristic curve analysis showed that the area under the curve of MMSE and MoCA combined to predict the clinical efficacy of SBI patients was 0.848.Conclusions Dual antiplatelet aggregation therapy can effectively improve the level of neurological markers,cognitive level and coagulation function in patients with SBI.At the same time,the level of cognitive function after the onset of SBI has a significant impact on the long-term clinical prognosis of patients.In the process of clinical treatment,in addition to monitoring the clinical symptoms of patients,The cognitive function of patients should be evaluated in time to obtain the best treatment effect.

Abstract:Cardiovascular disease has become the leading cause of death in China.Malnutrition is a common complication in patients with cardiovascular disease,which seriously affects the occurrence,development and prognosis of the disease.Formulated foods for special medical purpose(FSMP)are prepared for people with specific diseases or nutritional status to help improve nutritional status and enhance immunity.Research has shown that FSMP can improve the prognosis of cardiovascular disease patients,especially in those at risk of malnutrition.This article reviews previous studies on the relationship between cardiovascular disease and malnutrition,and summarizes the research progress of FSMP in patients with cardiovascular disease at home and abroad,aiming to provide a basis for the development and application of FSMP in cardiovascular disease.

Abstract:The difficulty of diabetic wound healing is an important public health problem.Such wounds are affected by multiple factors such as ischemia and hypoxia,infection,inflammation,and neuropathy,which seriously hinder the healing process.As a new biotherapeutic tool,exosomes not only retain the biological activity of parental cells,but also have low immunogenicity and good biocompatibility.It can carry bioactive molecules such as growth factors,genes,and proteins,as well as non-bioactive substances such as metal ions,oxygen,and nitric oxide.It can promote wound healing by multiple mechanisms such as regulating inflammatory response,promoting angiogenesis,inhibiting oxidative stress,and reconstructing extracellular matrix.This article reviews the research progress of exosomes in diabetic wound repair,focusing on their mechanism of action and delivery strategies,and prospects the future development direction combined with the existing limitations.

Abstract:Objective To understand the basic knowledge level of congenital heart disease in early pregnancy women,use internet technology to conduct health education on congenital heart disease,and evaluate the effect of health education.Methods The research group was imported to formulate the propaganda and education content and the examination paper by using the Wechat small program.From August 2021 to August 2022,pregnant women at 11-13 weeks of gestation who were registered in Beijing Haidian Maternal and Child Health Hospital were selected and divided into the control group and the intervention group according to the random number table method.The control group was given the test before the education,and the intervention group was given the test after the education.The answers to the questionnaire were counted.Results The three items with the highest awareness rate were"awareness rate of the concept of congenital heart disease"(97.5％),"know the role of fetal echocardiography and are willing to take the initiative to rule out congenital heart disease"(92.0％)and"hope doctors specializing in congenital heart disease to conduct knowledge education"(84.0％).The three items with the lowest score:"congenital heart disease is divided into two types:'cyan'and'non-cyan'"(22.4％awareness rate),"received health education about congenital heart disease by doctors specializing in congenital heart disease"(23.4％),and"know of at least one health care facility that screens fetuses for congenital heart disease"(33.1％).Except for items of"awareness rate of the concept of congenital heart disease"and"knowing the role of fetal echocardiography and being willing to take the active examination to rule out congenital heart disease",the awareness rate of other items in the intervention group were higher than those in the control group(all P＜0.05).In the intervention group,pregnant women with older age and lower education level had lower awareness rate of some items(all P＜0.05).Conclusion Women in early pregnancy are more concerned about congenital heart disease,but there are cognitive blind areas and misunderstandings.Network technology can be used to publicize and educate them,and achieve satisfactory results.The pregnant women with older age and lower education level should be given special attention and guidance.

Abstract:Objective This study aimed to select the critical parameters for prenatal screening of atrioven-tricular septal defect(AVSD)through analyzing the quantitative parameters of fetal echocardiography(FE).Methods Totally 112 FE quantitative parameters of 96 AVSD fetuses and 370 normal fetuses diagnosed in our center between January 2016 and December 2021 were retrospectively analyzed.Based on the area under the receiver operating characteristic curve(AUC),the top six with the best screening effect were selected and the effectiveness of six parameters was analyzed.Results Among the 112 parameters,the top six with the largest AUC were the end diastolic atrioventricular length ratio,the quantile score(Q score)of the end diastolic atrioven-tricular length ratio,the Q score of the end systolic atrioventricular length ratio,the end systolic atrioventricular length ratio,Q score of the end diastolic ventricular length,and the end-diastolic ventricular length.The AUC were 0.92,0.92,0.86,0.84,0.84 and 0.81,respectively.Within the range of false positive rate of 20％,the sensitivities of six parameters for prenatal screening of AVSD were 82％,82％,75％,67％,65％and 71％,respectively.Conclusion The ratio of the end diastolic atrioventricular length and its Q score could be used as the critical parameters for prenatal screening of AVSD,with the former being easier to calculate and remember.

Abstract:Objective To investigate the sedative effect of remazolam on ultrasound-guided medial branch of superior laryngeal nerve block in elderly patients.Methods A total of 60 patients with early-stage laryngeal cancer who were treated in Beijing Tongren Hospital,Capital Medical University from May to September 2023 and underwent laryngoscopic carbon dioxide laser resection were selected.They were divided into midazolam group and remazolam group according to the random number table method,with 30 cases in each group.The patients in the midazolam group were sedated with 0.08 μg/kg sufentanil and 0.02 mg/kg midazolam,and the patients in the remazolam group were sedated with the same dose of sufentanil and 0.04 mg/kg remazolam.The success rate of sedation,sedation onset time,recovery time,mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO2),sedation level[evaluated using modified observer's assessment of alert/sedation score(MOAA/S)],patient state index(PSI)at different time points,satisfaction score of patient and anesthesiologist with sedation,and the incidence of adverse events such as bradycardia and hypoxemia during the patient's nerve block period were recorded and compared.Results The success rate of sedation in the remazolam group was significantly higher than that in the midazolam group[83.3％(25/30)vs 53.3％(16/30)],the onset time and recovery time of sedation were significantly shorter than those in midazolam group,and the satisfaction scores of patients and anesthesiologists with sedation were significantly higher than those in the midazolam group(all P＜0.05).The changes of MAP were similar between the two groups during sedation,and the heart rate was more stable than that in the midazolam group.The SpO2 in the remazolam group was lower than that in the midazolam group at 2 min after administration,and those were higher than those in the midazolam group at 6,10,and 15 min after adminis-tration(all P＜0.05).The MOAA/S of the remazolam group was lower than that of the midazolam group at 4,6 and 10 min after administration,while the PSI was higher than that of the midazolam group.At the same time,the PSI of the remazolam group was higher than that of the midazolam group at 15 min after administration(all P＜0.05).There was no significant difference in the incidence of bradycardia,hypoxemia,nausea and vomiting between the remazolam group and the midazolam group during nerve block sedation(all P＞0.05).Conclusion The sedation of remazolam for nerve block in elderly patients with early-stage laryngeal cancer has rapid onset and recovery,and it has better hemodynamic stability,less respiratory depression and better safety than midazolam.

Abstract:Although liposomal doxorubicin is an effective anti-cancer drug,their induced hand foot syndrome(HFS)has a significant impact on the quality of life and treatment compliance of patients.In recent years,in-depth research on its mechanisms and the development of new management strategies have provided new hope for improving the treatment experience of patients.The aim of this study is to explore the mechanism,treatment methods,and the latest progress in future research directions of HFS.

Abstract:Objective To investigate the impacts of esmolol combined with carvedilol on the heart rate-systolic blood pressure product(RPP)and serum Sestrin2 level in patients with coronary atherosclerotic heart disease(CHD)and myocardial ischemia.Methods A total of 106 patients with CHD and myocardial ischemia admitted to Yulin Hospital,First Affiliated Hospital of Xi'an Jiaotong University from March 2021 to March 2023 were selected.According to the random number table method,they were divided into the observation group and the control group,with 53 cases in each group.The control group was treated with carvedilol,and the observation group was treated with esmolol on the basis of the control group.Both groups were treated for 8 weeks.The total effective rate,electrocardiogram examination results,myocardial oxygen supply related indicators,serum Sestrin2 levels and adverse reactions were compared between the two groups.Results The total effective rate of observation group was higher than that of control group[90.6％(48/53)vs 75.5％(40/53)](P=0.038).After treatment,the total myocardial ischemic load,the number and duration of ST segment depression within 24 h,heart rate,systolic blood pressure and RPP levels 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).After treatment,the serum Sestrin2 levels in both groups were lower than those before treatment,and the serum Sestrin2 level in the observation group was lower than that in the control group[(8.1±1.0)μg/L vs(10.1±1.6)μg/L](all P＜0.001).The total incidence of adverse reactions in the observation group was lower than that in the control group[11.3％(6/53)vs 47.2％(25/53)](P＜0.001).Conclusion The combination of esmolol and carvedilol is effective in the treatment of patients with CHD and myocardial ischemia,which can effectively improve the myocardial ischemia status of patients,regulate heart rate and blood pressure levels,reduce myocardial oxygen consumption,and has fewer adverse reactions.

Abstract:Objective To discuss the differential value of CD4+/CD8+ratio combined with cytokines in active and inactive pulmonary tuberculosis.Methods Totally 107 patients with pulmonary tuberculosis treated in Hebei Chest Hospital from January 2021 to August 2023 were selected as research objects.They were divided into inactive pulmonary tuberculosis group(53 cases)and active pulmonary tuberculosis group(54 cases)according to the condition.The levels of serum cytokines and CD4+/CD8+ratio were compared between the two groups.The relationship between serum cytokine level and CD4+/CD8+ratio in patients with pulmonary tuberculosis was analyzed by stratified regression analysis.Multivariate Logistic regression analysis was used to analyze the factors affecting the occurrence of active pulmonary tuberculosis.The effect of the interaction between serum cytokines and CD4+/CD8+ratio on the occurrence of active pulmonary tuberculosis was analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum cytokines and CD4+/CD8+ratio alone and in combination in the differential diagnosis of active and inactive pulmonary tuberculosis.Results The levels of serum interleukin-6(IL-6),interferon-γ(INF-γ),IL-8 and CD4+/CD8+ratio in active pulmonary tuberculosis group were significantly higher than those in inactive pulmonary tuberculosis group(all P＜0.05).The results of stratified regression analysis showed that IL-6,INF-y and IL-8 all had significant positive effects on CD4+/CD8+ratio(all P＜0.05).The results of multivariate Logistic regression analysis showed that the increased levels of serum IL-6,INF-γ,IL-8 and CD4+/CD8+ratio were the risk factors of active pulmonary tuberculosis(all P＜0.05).The results of interaction analysis showed that there was no multiplicative or additive interaction between serum IL-6,INF-γ,IL-8 and CD4+/CD8+ratio before and after adjusting sex and age(all P＞0.05).The areas under the ROC curve of IL-6,INF-γ,IL-8,CD4+/CD8+ratio and their combination were 0.746,0.771,0.805,0.707 and 0.850,respectively,the combination of the four has the highest efficacy in distinguishing active and inactive pulmonary tuberculosis.Conclusion The levels of serum IL-6,INF-γ,IL-8 and peripheral blood CD4+/CD8+ratio in patients with active pulmonary tuberculosis were higher than those in patients with inactive pulmonary tuberculosis.The level of serum cytokines can affect the cellular immunity of patients with pulmonary tuberculosis,based on this,active and inactive pulmonary tuberculosis can be distinguished.

Abstract:Objective To compare the efficacy of different preoperative neoadjuvant chemotherapy regimens in high-risk neuroblastoma(HR-NB).Methods The clinical data of 50 children with HR-NB diagnosed and treated in Shanxi Children's Hospital from January 2016 to January 2019 were collected and retrospectively analyzed.Patients were divided into group A(30 cases)and group B(20 cases)according to different preoperative neoadjuvant chemotherapy regimens.Group A was treated with CAV(cyclophosphamide+adriamycin+vincristine)and CVP(cyclophosphamide+etoposide+cisplatin)before surgery.Group B was treated with CAV(the same drug as group A)and VIP(etoposide+ifosfamide+cisplatin)chemotherapy before surgery.The chemotherapy effect,complete resection rate,adverse reactions and survival were compared between the two groups.Results The effective rate of chemotherapy in group B was significantly higher than that in group A[90.0％(18/20)vs 63.3％(19/30)](P＜0.05).There was no significant difference in the complete resection rate between group B and group A[85.0％(17/20)vs 63.3％(19/30)](P=0.148).The children in both groups tolerated well.The incidences of leukopenia,thrombocytopenia,vomiting,diarrhea,and liver and kidney function damage in group B were lower than those in group A(all P＜0.05).Kaplan-meier survival analysis showed that the 3-year overall survival rate in group B was higher than that in group A(67.2％vs 49.9％,Log-rank x2=3.986,P=0.046).Conclusions Preoperative CAV and VIP alternating chemotherapy regimen may be effective in children with HR-NB,and the adverse reactions can be tolerated.

Abstract:Objective To discuss the risk factors of short-term death in elderly patients in emergency department with Gram-negative bloodstream infection.Methods Totally 227 patients over 65 years old with Gram-negative bloodstream infections,admitted to the Department of Emergency,Beijing Jishuitan Hospital,Capital Medical University from January 1,2015 to December 31,2019,were selected retrospectively.Based on whether they survived after 90 d of treatment,the patients were divided into death group(41 cases)and survival group(186 cases).The independent risk factors affecting the survival were studied by Cox regression model.Results The most common infection bacteria were Escherichia coli[140 cases(61.7％)]and Klebsiella pneumoniae[39 cases(17.2％)].As for the sites of infections,the most common were urinary system infections[93 cases(41.0％)]and pulmonary infections[51 cases(22.5％)].The proportions of solid tumors,cerebrovascular disease,acute renal failure,acute liver failure,septic shock,indwelling central venous catheter,indwelling urinary catheter and invasive operation in the survival group were lower than those in the death group,while the proportion of rational use of antimicrobial drugs in the early stage was higher than that in the death group(all P＜0.05).The survival group's length of hospital stay,heart rate,respiration,D-dimer quantification,blood urea nitrogen,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,and Charleson comorbidity index score were shorter than/lower than those in the death group,while the mean arterial pressure,platelet count,hemoglobin,and troponin I were higher than those in the death group(all P＜0.05).Multivariate Cox regression analysis showed that solid tumor[hazard ratio(HR)=3.109,95％confidence interval(CI):1.133-8.530,P=0.028],acute liver failure(HR=2.430,95％CI:1.072-5.511,P=0.033)and APACHE Ⅱ score(HR=1.216,95％CI:1.149-1.286,P＜0.001)were the independent risk factors.However,early appropriate use of antibiotics could reduce the mortality rate,and it was an independent protective factor(HR=0.269,95％CI:0.123-0.590,P=0.001).Conclusions Solid tumor,acute liver failure and APACHE Ⅱ score are the independent risk factors for the elderly emergency patients with Gram-negative bacteria bloodstream infection,and early appropriate use of antibiotics can reduce the mortality rate.