Abstract:Objective To investigate the relationship between the expression of serum microRNA(miR)-330-5p and Toll-like receptor 4(TLR4)and neuroinflammatory response and prognosis in children with status epilepticus(SE).Methods A total of 98 children with SE admitted to 3201 Hospital from January 2021 to November 2023 were selected as the SE group.According to the prognosis 28 days after admission,they were divided into poor prognosis group(37 cases)and good prognosis group(61 cases),and 40 healthy children in the same period were selected as the control group.The levels of serum miR-330-5p,TLR4 and neuroinflammatory markers[interleukin 1 β(IL-1β),IL-6 and tumor necrosis factor α(TNF-α)]were detected.The binding sites of miR-330-5p and TLR4 were predicted by online websites.The correlation between serum miR-330-5p and TLR4 was analyzed by Pearson correlation coefficient.The prognosis of children with SE was used as the dependent variable,and multivariate Logistic regression analysis was used to determine the influencing factors.The receiver operating characteristic curve was used to analyze the predictive value of serum miR-330-5p and TLR4 in the poor prognosis of children with SE.Results Compared with the control group,the expression of serum miR-330-5p in the SE group was decreased,and the expressions of TLR4,IL-1β,IL-6 and TNF-α were increased(all P＜0.001).There was a binding site between miR-330-5p and TLR4 3′-untranslated region 5310-5317.The expression of serum miR-330-5p was negatively correlated with the expression of TLR4,IL-1β,IL-6,TNF-α in children with SE(r=-0.686,-0.672,-0.646,-0.687,all P＜0.001),the expression of TLR4 was positively correlated with the expression of IL-1β,IL-6 and TNF-α(r=0.711,0.679,0.701,all P＜0.001).The onset time of SE≥1 h[odds ratio(OR)=4.317,95％confidence interval(CI):1.011 to 18.435],the increased severity score of SE(OR=2.749,95％CI:1.392 to 5.428),and the increased levels of IL-1 β(OR=1.067,95％CI:1.010 to 1.127),IL-6(OR=1.137,95％CI:1.014 to 1.275),TNF-α(OR=1.343,95％CI:1.051 to 1.716)and TLR4(OR=2.375,95％CI:1.133 to 4.978)were independent risk factors for poor prognosis of SE children,and the increased level of miR-330-5p was an independent protective factor(OR=0.933,95％CI:0.888 to 0.980)(all P＜0.05).The area under the curve(AUC)of serum miR-330-5p and TLR4 expression alone and in combination for predicting poor prognosis in children with SE were 0.794(95％CI:0.700 to 0.869),0.797(95％CI:0.703 to 0.871),and 0.881(95％CI:0.800 to 0.938)in order,and the binomial joint prediction AUC was the largest(both P＜0.05).Conclusion Low expression of serum miR-330-5p and high expression of TLR4 are closely related to increased neuroinflammation and poor prognosis in children with SE.The combination of serum miR-330-5p and TLR4 has a high predictive value for poor prognosis in children with SE.

Abstract:Objective To investigate the efficacy and safety of Xinkeshu capsule combined with low-dose ticagrelor in the treatment of unstable angina pectoris(UAP).Methods A total of 136 UAP patients who were treated in Characteristic Medical Center of Rocket Army from March 2021 to January 2024 were selected.According to the random number table method,they were divided into the control group and the observation group,with 68 cases in each group.The control group was treated with aspirin enteric-coated tablets and low-dose ticagrelor tablets.The observation group was treated with Xinkeshu capsule on the basis of the control group.Both groups were treated for 6 months.The clinical efficacy,traditional Chinese medicine syndrome score,serum levels of interleukin-6(IL-6),C-reactive protein(CRP),malondialdehyde,and glutathione peroxidase(GSH-Px)before and after treatment were compared between the two groups.Bleeding events,cardiovascular events and adverse drug reactions were compared between the two groups.Results The total effective rate of the observation group was significantly higher than that of the control group[95.6％(65/68)vs 85.3％(58/68)](P=0.041).After 6 months of treatment,the scores of chest pain,chest tightness and palpitation in the two groups were lower than those before treatment,and the scores of traditional Chinese medicine syndromes in the observation group were lower than those in the control group(all P＜0.05).After 6 months of treatment,the serum levels of IL-6,CRP and malondialdehyde in the two groups were lower than those before treatment,and the serum level of GSH-Px was higher than that before treatment(all P＜0.05).The serum levels of IL-6,CRP and malondialdehyde in the observation group were lower than those in the control group,and the serum level of GSH-Px was higher than that in the control group(all P＜0.05).There were no moderate bleeding,severe bleeding and cardiovascular events in the two groups.There was no significant difference in the incidence of mild bleeding and adverse reactions between the two groups(both P＞0.05).Conclusion Xinkeshu capsule combined with low-dose ticagrelor has a good clinical effect in the treatment of UAP,which can effectively improve the inflammatory response and oxidative stress response in patients with good safety.

Abstract:Objective To evaluate the correlation between triglyceride glucose(TyG)index and recur-rence of atrial fibrillation after catheter ablation in heart failure patients with preserved ejection fraction(HFpEF),and to explore a new risk stratification index for atrial fibrillation recurrence.Methods This study is based on a prospective,multicenter Chinese atrial fibrillation registry,which included 413 atrial fibrillation patients who underwent catheter ablation for the first time between August 2011 and December 2020 and met the diagnostic criteria for HFpEF.TyG index was calculated by comparing baseline triglycerides with fasting plasma glucose.The primary outcome was recurrence of atrial fibrillation after a 90d blank-period.Patients were stratified according to the first and third quartiles of TyG index(Q,:8.44,Q3:8.96)and divided into low TyG index group(TyG index＜8.44,137 cases),medium TyG index group(TyG index 8.44-8.96,139 cases),and high TyG index group(TyG index＞8.96,137 cases).Kaplan-Meier survival analysis and multivariate adjusted Cox proportional hazards regression model were used to evaluate the association between TyG index and atrial fibrillation recurrence.Results The average age of 413 patients was(61±11)years old,and 253 cases(61.3％)were male.During a median follow-up of 810 d,256 cases(62.0％)developed recurrent atrial fibrillation events.Each one-standard-deviation increase in the TyG index was associated with a 29％higher risk of atrial fibrillation recurrence[adjusted hazard ratio(HR)=1.29,95％confidence interval(CI):1.07-1.55,P=0.007].Restricted cubic spline model analysis showed that TyG index had a dose-response relationship with the risk of recurrence.Compared with the low TyG index group,patients in the medium and high TyG index group had a 74％(adjusted HR=1.74,95％CI:1.21-2.50,P=0.003)and 106％(adjusted HR=2.06,95％CI:1.36-3.13,P=0.001)increased risk of recurrence,respectively(P for trend=0.001).Conclusions In atrial fibrillation patients with HFpEF,elevated TyG index is associated with a significantly increased risk of atrial fibrillation recurrence after catheter ablation,and there is a dose-response relationship.TyG index,as an economic and practical indicator of insulin resistance,can be used to guide the risk stratification and individualized management of recurrence in this population.

Abstract:Objective To investigate the effect of camrelizumab assisted drug-loaded microspheres in the treatment of primary liver cancer and theirimpacts on serum Golgi glycoprotein 73(GP73),alpha fetoprotein,and alpha fetoprotein heterogeneity-L3(AFP-L3)in patients.Methods A total of 92 patients with primary liver cancer admitted to Baoding No.1 Central Hospital,Hebei Province from January 2022 to January 2024 were selected as the research objects.According to the random number table method,they were divided into combination group and drug-loaded microspheres group,with 46 cases in each group.The drug-loaded microspheres group was treated with drug-loaded microspheres,and the combined group was treated with camrelizumab adjuvant drug-loaded microspheres.Both groups were treated for 12 weeks.The clinical efficacy,levels of tumor markers,liver function indexes,nuclear factor-κB,hypoxia inducible factor-1α(HIF-1α),T lymphocyte subsets and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the objective response rate of the combined group was higher than that of the drug-loaded microspheres group[89.1％(41/46)vs 67.4％(31/46)](P＜0.05).After treatment,the levels of GP73,alpha fetoprotein,AFP-L3,carcinoembryonic antigen,alanine transaminase,aspartate transaminase,total bilirubin,nuclear factor-κB and HIF-1α in the two groups were lower than those before treatment,and those in the combined group were lower than those in the drug-loaded microspheres group;the CD3+,CD4+,and CD4+/CD8+ratio were significantly higher than those before treatment,and those in the combined group were higher than those in the drug-loaded microspheres group(all P＜0.05).There was no significant difference in adverse reactions between the two groups(all P＞0.05).Conclusion Compared with drug-loaded microspheres alone,camrelizumab combined with drug-loaded microspheres has a better short-term effect in the treatment of primary liver cancer,which is helpful to the recovery of liver function,reduces the level of serum tumor markers,and has a certain safety.

Abstract:Objective To investigate the risk factors of frailty in elderly patients with unstable angina pectoris(UA)and its effect on prognosis.Methods A total of 255 elderly patients with UA admitted to Inner Mongolia Autonomous Region People's Hospital from January 2021 to December 2023 were selected.According to the presence or absence of frailty,the patients were divided into frailty group and non-frailty group,and the incidence of major adverse cardiovascular events(MACE)was recorded during 1-year follow-up.The clinical data of elderly UA patients were collected,and the risk factors for frailty in elderly UA patients were analyzed by multivariate Logistic regression method and a nomogram model was constructed.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Receiver operating characteristic(ROC)curve was used to calculate the area under the curve to evaluate the predictive ability of the model.C-index was used to evaluate the discrimination ability of the model.The calibration curve was used to evaluate the consistency of the model.The decision curve was used to evaluate the net benefit of the model.The Kaplan-Meier survival curve was used to compare the incidence of MACE between the frailty group and the non-frailty group.Results The incidence of frailty in 255 elderly patients with UA was 45.1％(115/255).Age,Canadian Cardiovascular Society(CCS)grade Ⅲ-Ⅳ,comorbidity,polypharmacy,sleep disorders,decreased activities of daily living,nutritional risk and cardiac troponin T(cTnT)were independent risk factors for frailty in elderly patients with UA(all P＜0.05).A nomogram model was constructed based on the above independent risk factors,and the Hosmer-Lemeshow test showed P＞0.05.ROC curve and model evaluation showed that the area under the curve of the nomogram model for predicting frailty in elderly UA patients was 0.891,and the consistency index was 0.891.The calibration curve and decision curve showed that the prediction probability of the nomogram model fitted the ideal curve,and the net clinical benefit was greater than 0 when the threshold probability was greater than 0.11.The Kaplan-Meier survival curve showed that the incidence of MACE in the frail group was higher than that in the non-frail group(P＜0.05).Conclusion Age,CCS classification,comorbidity,polypharmacy,sleep disorders,reduced activities of daily living,nutritional risk,and cTnT are risk factors for frailty in elderly UA patients,which have a significant adverse impact on the prognosis.The nomogram prediction model based on risk factors has high predictive value,discrimination ability,consistency and clinical applicability for elderly UA patients complicated with frailty.

Abstract:Objective To analyze the relevant factors affecting the instability of international normalized ratio(INR)in patients with pulmonary embolism,and to construct a nomogram prediction model and verify it.Method A retrospective analysis was performed on 562 patients with pulmonary embolism admitted to Beijing Anzhen Hospital,Capital Medical University from January 2017 to August 2022.Patients were divided into INR instability group(47 cases)and INR stability group(515 cases).The clinical data of the two groups were compared.The influencing factors of INR instability in patients with pulmonary embolism were analyzed by Logistic regression method and verified by receiver operating characteristic(ROC)curve.Results There were significant differences in gender ratio,body mass index,total bilirubin level and the proportions of active tumor,infection,heart failure,lower limb swelling,rheumatic heart disease,hypertension and anemia between the two groups(all P＜0.05).Logistic regression analysis showed that male(odds ratio=2.94,95％confidence interval:1.41-6.13,P＜0.01),rheumatic heart disease(odds ratio=17.70,95％confidence interval:2.78-112.64,P＜0.01),anemia(odds ratio=7.76,95％confidence interval:3.37-17.87,P＜0.01)were risk factors for INR instability in patients with pulmonary embolism.ROC curve analysis showed that the area under the curve of male,rheumatic heart disease and anemia to predict INR instability was 0.787.Conclusions Gender,rheumatic heart disease and anemia are independently correlated with INR instability in patients with pulmonary embolism,and the combined prediction of INR instability is better than that of a single index,which is a good reference value for medical staff in clinical practice.

Abstract:This article reports a case of autosomal dominant optic atrophy to provide a reference for the clinical diagnosis of this type of disease.The patient had poor vision in both eyes without any obvious cause,and was diagnosed with autosomal dominant optic atrophy after combining auxiliary examinations and genetic testing.There is currently no effective treatment for this disease,and the key to treatment is to improve the patient's visual quality.Lifestyle changes and regular follow-up examinations are usually recommended.

Abstract:Linezolid is an oxazolidinone antibacterial drug whose mechanism of action is mainly to inhibit bacterial growth by targeting bacterial ribosomes and interfering with bacterial protein synthesis,and is mainly used for the treatment of gram-positive bacteria,including Enterococcus faecalis,Staphylococcus aureus,and Staphylococcus aureus resistant to vancomycin.Although linezolid is an effective antimicrobial drug,its potential to cause lactic acidosis is a rare and fatal side effect.Current treatment guidelines have some recommendations.First,monitor blood linezolid and lactate levels while linezolid is being administered.Second,linezolid should not be combined with drugs that affect mitochondrial function.Third,patients with hepatic and renal insufficiency or linezolid therapy for＞1 month should be monitored for hyperlactatemia.Fourth,if hyperlactic acidosis occurs,it is recommended to stop linezolid and correct the acidosis as soon as possible.This article reports a case of lactic acidosis after taking linezolid for tuberculous pleurisy,which was confirmed to be a side effect of linezolid after exclusion of other causes such as metabolism,hypoxia or organ damage.It aims to improve clinicians'knowledge of the diagnosis and treatment of lactic acidosis caused by linezolid.

Abstract:Objective To investigate the effect and safety of perioperative hydration therapy combined with furosemide on contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI).Methods A total of 556 patients who underwent PCI in the Department of Cardiology,the First People's Hospital of Kashi,Xinjiang Uygur Autonomous Region from January to December 2023 were collected.All patients were divided into control group and observation group by random number table method,with 278 cases in each group.The observation group was treated with hydration and furosemide during the perioperative period,and the control group was treated with hydration alone.The basic clinical data of the two groups were compared.The renal function and the incidence of CIN were compared before and after operation.The influencing factors of CIN were analyzed by binary Logistic regression.The incidence of adverse reactions during hospitalization was compared between the two groups.Results The proportion of male in the observation group was lower than that in the control group,and the proportion of hypertension history,contrast agent dosage,and proportion of taking β-blockers were higher than those in the control group(all P＜0.05).The levels of serum creatinine,cystatin C and serum uric acid in the two groups were significantly higher than those before operation(all P＜0.05).The incidence of CIN in the observation group was lower than that in the control group[19.4％(54/278)vs 27.3％(76/278)](P=0.027).Binary Logistic regression analysis showed that contrast agent dosage was an independent risk factor for CIN after PCI(odds ratio=1.016,95％confidence interval:1.009-1.024,P=0.019).Furosemide was a protective factor for CIN after PCI(odds ratio=0.359,95％confidence interval:0.143-0.904,P=0.030).There was no significant difference in the incidence of adverse reactions between the two groups during hospitalization(P=0.102).Conclusion Perioperative hydration combined with furosemide can reduce the incidence of CIN after PCI,and does not increase the incidence of adverse reactions during hospitalization,with high safety.

Abstract:Objective To investigate the effect of ABBV-744,a novel small molecule inhibitor of the bromo-domain and extra-terminal domain(ABBV-744)on cardiac fibrosis in mice with heart failure.Methods Twenty-four male C57BL/6J mice aged 8-10 weeks were randomly divided into sham-operated group,model group,JQ1 intervention group and ABBV-744 intervention group,with 6 mice in each group.Heart failure model was not established in the sham operation group,and the heart failure model was established by transverse aortic constriction(TAC)in the other three groups.The success of the model was determined by detecting the flow velocity of the aortic arch.After 18 d TAC surgery,JQ1 intervention group were administered by intraperitoneal injection,and ABBV-744 was administered by gavage once a day for 30 d.Cardiac function was detected by echocardiography.Cardiac hypertrophy was analyzed by cardiac related index.Hematoxylin eosin(HE)staining was used to analyze the infiltration of inflammatory cells in the heart and kidney.Sirius red staining was used to evaluate the degree of cardiac fibrosis in mouse heart tissue.Western blotting and quantitative polymerase chain reaction were used to detect the expression of α-smooth muscle actin(α-SMA),type α1-Ⅰ collagen(COL1A1),and type α1-Ⅲ collagen(COL3A1).Aspartate aminotransferase,total bilirubin,serum creatinine and blood urea nitrogen were detected to evaluate the effect of drugs on liver and kidney function.Results Echocardiography showed that the left ventricular ejection fraction and fractional shortening were significantly increased in the ABBV-744 intervention group as compared with the model group[(55±4)％vs(45±4)％,(28.0±2.6)％vs(22.4±2.4)％],and both left ventricular endsystolic diameter and left ventricular enddiastolic diameter were significantly reduced(P＜0.05 or P＜0.01).Compared with the model group,the ratio of heart weight to body weight and the ratio of heart weight to tibia length were significantly decreased in the ABBV-744 intervention group(P＜0.05 or P＜0.001).HE staining showed that ABBV-744 reduced the infiltration of inflammatory cells in cardiac microvessels.Sirius red staining showed that ABBV-744 could reduce collagen deposition and cardiac fibrosis in heart failure after TAC.Compared with the model group,the protein expression of α-SMA and the mRNA expression of COL1A1 and COL3A1 in the ABBV-744 intervention group was significantly down-regulated(P＜0.05 or P＜0.01).Compared with the JQ1 intervention group,HE staining of the kidney and biochemical analysis of the plasma showed that ABBV-744 had less damage to the liver and kidney.Conclusion ABBV-744 can effectively improve TAC mice heart failure and reduce cardiac fibrosis,which may be related to the inhibition of fibroblast activation protein.Compared with JQ1 intervention group,ABBV-744 has less effect on liver and kidney function.

Abstract:Objective To investigate the relationship between serum omentin-1 and prostate specific antigen(PSA)and polycystic ovary syndrome(PCOS),and to provide new ideas for the diagnosis and treatment of PCOS.Methods A total of 40 PCOS patients who visited the Department of Reproductive Medicine,the Second Affiliated Hospital of Shandong First Medical University from February to December 2021 were selected as the PCOS group.During the same period,40 infertility patients with regular menstruation due to tubal factors or male factors were selected as the control group.Liver function,renal function,fasting blood glucose,fasting insulin,blood lipids,reproductive endocrine hormones,omentin-1 and PSA levels were detected in all patients.The differences of the above indicators between the two groups were compared.Results The levels of luteinizing hormone,luteinizing hormone/follicle-stimulating hormone,testosterone,waist circumference,waist-hip ratio,triglyceride,fasting insulin,homeostasis model assessment of insulin resistance index(HOMA-IR)and PSA in PCOS group were significantly higher than those in control group,while the level of omentin-1 was significantly lower than that in control group(all P＜0.05).Correlation analysis showed that omentin-1 was negatively correlated with testosterone,HOMA-IR and alanine aminotransferase(r=-0.479,P=0.033;r=0.450,P=0.046;r=-0.679,P=0.001).PSA was positively correlated with testosterone,fasting insulin and HOMA-IR(r=0.562,P=0.010;r=0.472,P=0.035;r=0.574,P=0.008),and negative correlated with omentin-1(r=-0.472,P=0.036).Conclusion Serum omentin-1 and PSA are closely related to insulin resistance and hyperandro-genism in PCOS patients.

Abstract:Klinefelter syndrome(KS)is a common sex chromosome abnormality in males and the most common cause of congenital male hypogonadism.This paper reports a case of KS combined with dermatomyositis with positive anti-melanoma differentiation-associated gene 5(MDA5)antibody.The patient was a 44-year-old male who presented with bilateral shoulder and knee joint swelling and pain with limb weakness,bilateral periorbital purple rash,sparse pubic hair,short penis,no laryngeal,low testosterone level,elevated follicle-stimulating hormone and luteinizing hormone levels,elevated serum lactate dehydrogenase,positive anti-MDA5 antibody,and a chromosome karyotype of 47,XXY.The patient was diagnosed with KS combined with dermatomyositis with positive anti-MDA5 antibody,and had bilateral femoral head necrosis and osteoporosis.This article reviews the diagnosis and treatment process of the patients,focuses on the potential risk of bone metabolic diseases in these patients,and reminds the first doctor to prevent and monitor the occurrence of bone metabolic diseases,so as to prevent disease before disease and prevent disease from becoming worse,which is very important to improve the quality of life of patients.

Abstract:Gastroesophageal reflux disease(GERD)is a common digestive system disease with complex etiology and recurrent episodes,which has brought great trouble to clinicians.As a surgical method for the treat-ment of gastric cancer and other diseases,proximal gastrectomy destroys the physiological structure of the cardia and its surrounding area,which may lead to the occurrence of acid reflux and reflux phenomenon in the residual stomach after surgery,which may cause GERD.This situation seriously affects the quality of life of patients.This article mainly summarizes the pathogenesis,treatment methods and the progress of anti-reflux surgery for GERD after proximal gastrectomy,aiming to provide a reference for the selection of treatment options for GERD after proximal gastrectomy.

Abstract:Triple-negative breast cancer(TNBC)is a highly heterogeneous subtype of breast cancer.Due to its lack of specific treatment markers,its recurrence rate,mortality rate,and aggressiveness are all higher than other types of breast cancer.In recent years,the focus of tumor research has been on the tumor microenvironment,and tumor-associated macrophages(TAM)account for more than 50％of the stromal cells in breast cancer and are the most abundant immune cells in the tumor microenvironment.A large number of studies on the relationship between TAM and tumor-related mechanisms have found that TAM play an important role in tumor development and progression,making them a promising biomarker for TNBC treatment and prognosis prediction.This review summa-rizes the role of TAM in TNBC and potential treatment strategies.

Abstract:Objective To evaluate the predictive value of myocardial perfusion imaging(MPI)for all-cause mortality risk in patients with compound heterozygous familial hypercholesterolemia(CHFH).Methods Patients with CHFH diagnosed by genetic testing who underwent stress and rest MPI in the Department of Nuclear Medicine,Beijing Anzhen Hospital,Capital Medical University from June 2010 to March 2022 were retrospectively followed up.Total summed stress score(SSS),total summed rest score(SRS)and summed difference score(SDS)of left ventricular myocardial perfusion parameters were obtained by 17-segment 5-point method.The patients were followed up for all-cause mortality,and Cox regression was used to analyze the predictors of all-cause mortality.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of the predictors.Kaplan-Meier analysis and Log-rank test were used to compare the incidence of all-cause mortality in different groups.Results Forty-five patients with CHFH were enrolled and followed up for a median of 6(4,9)years.A total of 11(24.4％)patients died during the follow-up period.The left ventricular myocardial perfusion parameters SSS,SRS and SDS were significantly different between the death group and the survival group(all P＜0.05).Cox regression analysis showed that SRS(Hazard ratio=1.362,95％confidence interval:1.029-1.802,P=0.031)was an independent predictor of all-cause mortality in patients with CHFH.ROC analysis determined that the best cut-off value for predicting death was SRS ≥2.5,and the area under the curve was 0.749.Kaplan-meier survival curve analysis showed that the incidence of all-cause death in SRS≥2.5 group was significantly higher than that in SRS＜2.5 group(Log-rankx2=14.991,P＜0.001).Conclusion MPI is an important imaging method for the risk assessment of all-cause mortality in patients with CHFH,and parameter SRS is an important factor for predic-ting death in such patients.

Abstract:Rectal multiple neuroendocrine neoplasms is a rare malignant tumor of the rectum.The risk of lymph node metastasis is significantly increased,and the small lesions are occult.There is no consensus on the treatment and follow-up strategy.Herein,this paper reports a case of rectal multiple micro neuroendocrine neoplasms with lymph node metastasis,and reviews the relevant literature to discuss the clinicopathological features and diagnosis and treatment experience of the disease,in order to strengthen clinicians'understanding of rectal multiple micro neuroendocrine neoplasms.

Abstract:Objective To evaluate the diagnostic value of superb microvascular imaging(SMI),contrast-enhanced ultrasound(CEUS)and both combination in thyroid micropapillary carcinoma(TMC).Methods Totally 45 patients with suspected TMC were examined by ultrasound,SMI and CEUS,and then underwent surgical resection in Beijing Anzhen Hospital,Capital Medical University from July 2017 to September 2023.The pathological results were obtained.Pathological diagnosis was used as a golden indicator,and the diagnostic value of SMI,CEUS and SMI combined with CEUS in TMC was compared.Results Among 45 patients,55 thyroid nodules were detected.SMI found 44 malignant thyroid nodules and 11 benign thyroid nodules,and the SMI diagnosis of TMC had a conformity rate of 89.1％,sensitivity of 100％,specificity of 45.5％,misdiagnosis rate of 54.5％,missed diagnosis rate of 0,positive predictive value of 88％,negative predictive value of 100％,and Kappa value of 0.571.CEUS found 49 malignant nodules and 6 benign nodules,and the CEUS diagnosis of TMC had a coincidence rate of 94.5％,sensitivity of 98.0％,specificity of 66.7％,misdiagnosis rate of 33.3％,missed diagnosis rate of 2.0％,positive predictive value of 96％,negative predictive value of 80％,and Kappa value of 0.697.SMI combined with CEUS found 48 malignant thyroid nodules and 7 benign thyroid nodules,and SMI combined with CEUS diagnosis of TMC had a coincidence rate of 96.4％,sensitivity of 100％,specificity of 71.4％,misdiagno-sis rate of 28.6％,missed diagnosis rate of 0,positive predictive value of 96％,negative predictive value of 100％,and Kappa value of 0.814.Conclusion The diagnostic coincidence rate of SMI combined with CEUS is higher than that of single SMI and CEUS.SMI can be used as a preliminary screening method for TMC patients.

Abstract:Objective To explore the dilemma and breakthrough direction of the development of cardiac surgery professional database,hoping to bring beneficial reference for the construction of cardiac surgery professional database.Methods The operation database and follow-up system in Valve Surgery Center,Beijing Anzhen Hospital,Capital Medical University were extracted and compared,and the operation of the database and the existing problems were summarized and reviewed retrospectively.Results The operation information database had been running for more than 20 years since 2001,including 15 420 cases of valve surgery,and had become a part of clinical work.In the past 20 years,the age of patients undergoing valve surgery had changed in many aspects,such as age,diseased valves and surgical methods,indicated the changes of valve diseases and the progress of surgical techniques.The age of patients treated by valve surgery increased from(46±15)years old in 2001 to(58±13)years old in 2023.A total of 962 patients were enrolled in the follow-up system within 2 years since 2013,and 691 patients were followed up,with a follow-up rate of 71.8％.However,the bottleneck of sustainable development appeared later.Compared with the surgical database,there were differences in the follow-up system in terms of service subject orientation,information collection mode,and database working mode.Conclusion The construction of cardiac surgery database in the era of big data required the combination of national top-level design and practical exploration.The establishment of a patient-centered,national-level longitudinal database,combined with a disease-centered,professional-level horizontal database.Covering perfect basic and professional informa-tion,should be the future direction of professional database development.

Abstract:Objective To investigate the effect of plerixafor combined with granulocyte colony stimulating factor(G-CSF)on systemic light chain amyloidosis(AL amyloidosis)by autologous peripheral blood for stem cell transplantation(ASCT).Methods A total of 46 patients diagnosed with AL amyloidosis and undergoing ASCT from July 2021 to July 2023 in General Hospital of Eastern Theater Command,National Clinical Research Center for Kidney Disease were enrolled retrospectively.Among them,23 patients with G-CSF mobilization regimen alone were included in the control group,and 23 patients with plerixafor combined G-CSF mobilization regimen were included in the observation group.The incidence of adverse reactions of stem cell mobilization,stem cell collection and reinfusion,transplantation complications and hematopoietic reconstitution were compared between the two groups.Results The incidence of diarrhoea related to stem cell mobilization in the observation group was higher than that in the control group(P＜0.01).The number of CD34 cells before collection and CD34 cells in the collection in the observation group were higher than those in the control group[(135±97)cells/μl vs(42±21)cells/μl,(6.9±3.5)x 106/kg vs(3.2±1.7)x 106/kg],and the collection cost was lower than that of the control group(all P＜0.01).The amount and cost of stem cell reinfusion in the observation group were lower than those in the control group(both P＜0.01).There was no significant difference in the incidence of complications in the neutropenia period between the two groups(all P＞0.05).The duration of granule deficiency,vertical implantation time,platelet implantation time and length of hospital stay in the observation group were shorter than those in the control group,and the hospitalization cost was lower than that in the control group(all P＜0.05).Conclusions Plerixafor combined with G-CSF mobilization regimen is safe and effective in ASCT for AL amyloidosis.It can reduce the frequency of collection,improve the quality of collection,effectively promote hematopoietic reconstitution,shorten the length of hospital stay,and reduce the cost of hospitalization.

Abstract:Objective To investigate the efficacy and safety of programmed cell death protein 1(PD-1)inhibitor combined with chemotherapy in elderly patients with advanced esophageal squamous cell carcinoma.Methods This study was a retrospective cohort study.A total of 95 elderly patients with unresectable locally advanced or metastatic esophageal squamous cell carcinoma diagnosed and treated in Beijing Hospital from October 2019 to December 2022 were consecutively enrolled.The patients were divided into PD-1 inhibitor group(30 cases)and control group(65 cases)according to whether PD-1 inhibitors were used.Both groups were given paclitaxel and cisplatin chemotherapy,and PD-1 inhibitor group was also given PD-1 inhibitor.Paclitaxel and cisplatin chemotherapy and PD-1 inhibitor were given every 3 weeks.The patients were treated until disease progression or intolerance or death.The follow-up ended on December 31,2023.The overall survival,progression-free survival and objective response rate of the two groups were compared,and the important factors affecting overall survival were evaluated by multivariate Cox regression analysis.Results Patients in the PD-1 inhibitor group were relatively older than those in the control group,but the difference was not statistically significant(P＞0.05).During the follow-up period,65 patients died,including 16 cases(53.3％)in the PD-1 inhibitor group and 49 cases(75.4％)in the control group.The overall survival[15.1(12.4,18.9)months vs 11.3(9.2,15.7)months,P=0.002]and progression-free survival[6.6(5.0,7.4)months vs 5.0(3.8,6.6)months,P=0.004]of the PD-1 inhibitor group were longer than those of the control group,and the objective response rate was higher than that of the control group[56.7％(17/30)vs 40.0％(26/65),x2=4.196,P=0.041].There was no significant difference in the incidence of grade ≥3 adverse reactions between the PD-1 inhibitor group and the control group[56.7％(17/30)vs 50.8％(33/65),x2=0.793,P=0.261].Multivariate Cox regression analysis showed that body mass index,Eastern Cooperative Oncology Group score,distant metastasis at enrollment,programmed cell death ligand 1 combined positive score≥1 and PD-1 inhibitor treatment were important factors affecting overall survival(hazard ratio=0.893,0.779,1.730,0.693,0.772;all P＜0.05).Conclusion PD-1 inhibitor combined with chemotherapy has good efficacy and safety in elderly patients with advanced esophageal squamous cell carcinoma.