Abstract:Objective To analyze the influencing factors of intra-abdominal hypertension(IAH)in patients with severe acute pancreatitis(SAP),and to construct a nomogram model based on these factors,and to evaluate the predictive efficacy of the nomogram model.Methods The clinical data of 160 SAP patients admitted to the Department of Critical Care Medicine,Shenzhen University General Hospital and Intensive Care Unit,Nansha Hospital,Guangzhou First People's Hospital,Guangdong Province from February 2022 to June 2024 were retrospectively analyzed.According to the presence or absence of IAH during hospitalization,SAP patients with IAH were included in the occurrence group(82 cases),and SAP patients without IAH were included in the non-occurrence group(78 cases).The clinical data of the two groups within 24 hours after admission were compared.Logistic regression analysis was used to screen the risk factors of SAP patients with IAH.A nomogram model was constructed,and the receiver operating characteristic curve,Hosmer-Lemeshow test,and decision analysis curve were used to evaluate the discrimination,calibration,and clinical benefits of the nomogram model.Results There were significant differences in body mass index(BMI),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,24 h fluid load,positive end-expiratory pressure,procalcitonin and C-reactive protein levels between the two groups(all P＜0.05).Logistic regression analysis showed that,BMI(odds ratio=1.122),APACHE Ⅱ score(odds ratio=1.342),24 h fluid load(odds ratio=1.229),positive end-expiratory pressure(odds ratio=1.224),procalcitonin(odds ratio=1.164)and C-reactive protein(odds ratio=1.182)were all risk factors for IAH in SAP patients(all P＜0.05).A risk nomogram model for SAP patients with IAH was constructed based on BMI,APACHE Ⅱ score,24 h fluid load,positive end-expiratory pressure,procalcitonin and C-reactive protein.Hosmer-Lemeshow test results showed that there was no significant difference between the predicted value of the nomogram model and the actual value(x2=2.015,P=0.377).The results of receiver operating characteristic curve analysis showed that the sensitivity,specificity,and area under the curve of the nomogram model for predicting SAP patients with IAH were 89.9％,74.8％,and 0.885,respectively.The results of decision curve analysis showed that the nomogram model had high predictive value and clinical validity.Conclusions The nomogram model based on BMI,APACHE Ⅱ score,24 h fluid load,positive end-expiratory pressure,procalcitonin and C-reactive protein has a good predictive efficacy for SAP patients complicated with IAH.

Abstract:Objective To investigate the effect of esketamine on perioperative delirium and depression in patients with breast cancer.Methods A total of 114 patients who planned to undergo radical mastectomy in the First Affiliated Hospital of Xinjiang Medical University from June 2022 to July 2024 were prospectively enrolled.They were divided into control group and observation group by random number table method,with 57 cases in each group.The observation group was given a single dose of esketamine 0.5 mg/kg during anesthesia induction,and continued to pump at 0.25 mg/(kg·h)until 0.5 h before the end of surgery.The control group was given the same dose of normal saline.The incidence of depression,delirium,pain degree,patient-controlled intravenous analgesia(PCIA),inflammatory indicators and adverse reactions were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss,postoperative extubation time,and residence time in post-anesthesia monitoring and treatment room between the two groups(all P＞0.05).The Hamilton Depression Scale scores of the two groups at different time points after operation increased with time,and the scores of the observation group were lower than those of the control group(all P＜0.05).Compared with the control group,the total incidence of postoperative delirium in the observation group was lower[8.8％(5/57)vs 22.8％(13/57)](P＜0.05).At different time points after operation,the pain numerical rating scale scores of the two groups showed a decreasing trend with time,and those in the observation group were lower than those in the control group(all P＜0.05).The proportion of PCIA self-control in the observation group was less than that in the control group[5.3％(3/57)vs 19.3％(11/57),P=0.022].At different time points 1 and 3 d after operation,the levels of interleukin-6 and tumor necrosis factor-α in the two groups increased first and then decreased,and those in the observation group were lower than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(all P＞0.05).Conclusion Esketamine can significantly relieve the depression of breast cancer patients after surgery,reduce the occurrence of delirium,enhance the analgesic effect,inhibit inflammatory response,and has good safety.

Abstract:Acute respiratory distress syndrome(ARDS)poses a severe challenge to the treatment of mechanical ventilation due to its complex pathophysiological characteristics.Optimization of lung protective ventilation strategy is considered to be the key to reduce the incidence of ventilation-induced lung injury and improve the prognosis of patients.However,due to the regional heterogeneity of lung lesions in ARDS patients,a single ventilation parameter setting is difficult to meet individual needs.In recent years,monitoring techniques based on respiratory mechanics,such as respiratory electromyography and esophageal manometry,have made it possible to accurately regulate personalized ventilation parameters.Respiratory electromyography can quantify diaphragm activity and respiratory muscle fatigue in real time,so as to optimize ventilator synchrony.By assessing the transpulmonary pressure gradient,esophageal manometry can guide the reasonable setting of positive end-expiratory pressure and tidal volume to reduce the risk of alveolar overdistension and repeated opening.The combination of these technologies can not only significantly reduce the incidence of ventilation-induced lung injury in patients with ARDS,but also improve oxygenation level and lung compliance.This article systematically reviews the research progress of lung protective ventilation strategy optimization in ARDS patients based on respiratory mechanics,focusing on the application advantages and future development direction of respiratory electromyography and pressure monitoring technology in individualized treatment.

Abstract:Objective To compare the clinical effects of craniotomy hematoma evacuation and frameless stereotactic puncture and drainage guided by neuronavigation in the treatment of severe brain stem hemorrhage.Methods Ninety patients with severe brain stem hemorrhage treated in Shijiazhuang People's Hospital,Hebei Province from May 2019 to May 2024 were selected.The patients were divided into control group(42 cases)and observation group(48 cases)according to different treatment methods.The control group was treated with craniotomy hematoma evacuation.The observation group was treated with frameless stereotactic puncture and drainage guided by neuronavigation.The effective rate,hematoma clearance,modified Rankin scale(mRS)score,Glasgow outcome scale(GOS)score and survival were compared between the two groups.Results At 3 months after operation,the significant effective rate of the observation group was higher than that of the control group[79.2％(38/48)vs 50.0％(21/42)](P=0.004).One week after operation,the hematoma clearance of the observation group was significantly higher than that of the control group[(5.4±1.1)ml vs(3.2±0.7)ml](P＜0.001).At 3 months after operation,the GOS score of the observation group was significantly higher than that of the control group[(4.2±1.0)vs(3.3±0.7)](P＜0.001).The incidence of complications in the observation group was significantly lower than that in the control group[8.3％(4/48)vs 31.0％(13/42)](P=0.006).At 3 months after operation,the mRS grade of the observation group was better than that of the control group(P＜0.05),and the mortality rate of the observation group was significantly lower than that of the control group(P＜0.05).Conclusion Compared with craniotomy hematoma evacuation,frameless stereotactic puncture and drainage guided by neuronavigation in the treatment of severe brain stem hemorrhage can further increase the amount of hematoma removed,reduce postoperative complications,and be beneficial to the prognosis of patients.

Abstract:Objective To explore the effect of standardized management of one of the core links in teaching process management on improving the competency of clinical medical undergraduates.Methods Three undergraduate students majoring in clinical medicine from Capital Medical University,namely the 2018,2019,and 2020 grades,were selected as the research subjects,with 15 students in each grade.The traditional teaching and examination management methods were adopted in 2018 grade.The reformed standardized teaching management and graduation assessment methods of 2019 and 2020 grades were adopted.Aiming at the lack of standardization and missing feedback in traditional assessment,a standardized system was constructed from three aspects,including assessment requirements,evaluation criteria and implementation path,combined with the basic require-ments of global medical education and the theory of plan-do-check-act cycle.The scores of medical and surgical examination in different grades were compared.Results In terms of surgical examination scores,the scores of inquiry,physical examination,auxiliary examination,oral examination,medical record writing and the total scores of 2019 grade students were significantly higher than those of 2018 grade students[total scores:(86.6±3.2)vs(79.2±3.0)](all P＜0.05).The scores of inquiry,auxiliary examination,medical record writing and the total score of grade 2020 students(89.9±3.7)were significantly higher than those of grade 2019(all P＜0.05).The scores of inquiry,physical examination,auxiliary examination,oral examination,medical record writing and total scores of grade 2019 students were significantly higher than those of grade 2018 students[total scores:(83.7±2.2)vs(77.4±2.3)](all P＜0.05).The scores of inquiry,auxiliary examination,medical record writing and the total score of grade 2020 students(88.5±3.8)were significantly higher than those of grade 2019(all P＜0.05).Conclusions Through standardized process,multi-dimensional evaluation and closed-loop feedback,standardized examination can effectively improve medical students'clinical skills,communication skills and other post competency.

Abstract:Objective To investigate the application value of monocyte to high-density lipoprotein choles-terol ratio(MHR),neutrophil to high-density lipoprotein cholesterol ratio(NHR)and lymphocyte to high-density lipoprotein cholesterol ratio(LHR)in risk prediction and risk stratification of coronary atherosclerotic heart disease(CHD).Methods A total of 200 patients who underwent coronary angiography in the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to June 2024 were selected.According to the results of coronary angiography,the patients were divided into CHD group(120 cases)and non-CHD group(80 cases),and the CHD group was further divided into low-risk group(80 cases)and medium-high-risk group(40 cases)according to SYNTAX score.The clinical data of patients were collected,and the relationship between MHR,NHR,LHR and the degree of coronary artery stenosis was analyzed.Multivariate Logistic regression was used to analyze the independent risk factors of CHD,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each index for CHD.Results The MHR,NHR and LHR of the CHD group were significantly higher than those of the non-CHD group[(0.42±0.15)vs(0.28±0.11),(3.79±1.62)vs(2.45±0.88),(1.49±0.58)vs(1.29±0.50)](all P＜0.05).Spearman correlation analysis showed that MHR,NHR and LHR were significantly positively correlated with SYNTAX score(r=0.460,0.496,0.156,all P＜0.05).Multivariate Logistic regression analysis showed that history of hypertension,history of diabetes,history of smoking,MHR,NHR and low-density lipoprotein cholesterol were independent risk factors for CHD(all P＜0.05).ROC curve results showed that the area under the curve of MHR,NHR and combined detection for predicting CHD were 0.785,0.790 and 0.826,respectively;the sensitivity were 81.7％,75.0％and 74.2％,and the specificity were 68.7％,73.8％and 81.2％,respectively.Conclusion Both MHR and NHR are independent risk factors for CHD,and are significantly positively correlated with the degree of coronary artery stenosis.The predictive value of combined detection for CHD is better than that of single detection,which has important clinical application value.

Abstract:Objective To analyze the changes and clinical significance of peripheral blood endothelial progenitor cell microparticles(EPC-MPs)and microRNA-126(miR-126)expression in patients with acute ST-segment elevation myocardial infarction(STEMI)before and after ischemia-reperfusion.Methods Fifty patients with acute STEMI who received percutaneous coronary intervention(PCI)treatment at People's Hospital of Xinjiang Uygur Autonomous Region from December 2023 to November 2024 were selected.Based on whether myocardial ischemia-reperfusion injury(MIRI)occurred after PCI,they were divided into non-MIRI group and MIRI group.The clinical data of the patients were collected,and the peripheral blood of the patients was collected before PCI,immediately after PCI,and 4,12,24 h after PCI.Flow cytometry was used to identify and quantify EPC-MPs.Real-time fluorescent quantitative polymerase chain reaction was used to detect the expression level of miR-126 in microparticles.Logistic regression was used to analyze the correlation between relevant indicators and MIRI,and the receiver operating characteristic(ROC)curve was used to evaluate its diagnostic value for MIRI.Results During the study period,a total of 21 patients(42.0％)developed MIRI after PCI and were included in the MIRI group,and the remaining 29 patients were included in the non-MIRI group.The levels of EPC-MPs in peripheral blood of all patients showed a gradual increase trend after PCI.Between the two groups,the level of non-MIRI group was higher than that of MIRI group before 12 h after PCI,and lower than that of MIRI group after 12 h(all P＞0.05).The level of miR-126 in all patients increased gradually after PCI,reached the peak at 12 h,and then decreased.Between the two groups,the non-MIRI group was always higher than the MIRI group,and the difference was statistically significant at 12 h and 24 h after PCI(both P＜0.05).Multivariate Logistic regression analysis showed that the level of miR-126 at 24 h after PCI was independently associated with MIRI(odds ratio=0.20,95％confidence interval:0.04-0.87,P=0.031),and the area under the ROC curve was 0.810,with a sensitivity of 77.8％and a specificity of 76.2％.Conclusion The level of EPC-MPs in peripheral blood of patients with acute STEMI increases gradually after reperfusion,while the level of miR-126 increases first and then decreases.MiR-126 can be used as a potential diagnostic indicator for MIRI at 24 h after PCI.

Abstract:Objective To investigate the effects of preoperative carbohydrate intake on perioperative stress response and postoperative cognitive function in elderly patients undergoing high-risk orthopedic surgery.Methods A total of 221 elderly patients who underwent high-risk orthopedic surgery in Haikou People's Hospital,Hainan Province from January 2022 to December 2024 were enrolled.According to the preoperative treatment methods,the patients were divided into observation group(94 cases,drinking carbohydrate beverage 2 h before surgery),drinking water group(62 cases,drinking the same amount of warm water 2 h before surgery)and control group(65 cases,fasting and water deprivation before surgery).The physiological metabolic indexes[blood glucose,insulin,insulin resistance index,adrenocorticotropic hormone(ACTH)],postoperative cognitive function[mini-mental state examination(MMSE)score],postoperative quality of recovery(QoR-40 score),complications and gastric volume changes were compared among the three groups at different time points.Results There were significant differences in blood glucose and ACTH levels among the three groups at T3 time point(8:00 the next day after surgery)(all P＜0.001).There was no significant difference in MMSE scores among the three groups before and after operation(all P＞0.05).The incidence of postoperative cognitive dysfunction(POCD)in the observation group was significantly lower than that in the control group(P＜0.01).Multivariate Logistic regression analysis showed that age,preoperative MMSE score and grouping were independent influencing factors for the occurrence of POCD(all P＜0.05).The QoR-40 scores of the observation group,drinking water group and control group were 192(189,196),180(173,186)and 162(156,169),and the difference was statistically significant(P＜0.001).There was no significant difference in the incidence of reflux,aspiration,nausea and vomiting among the groups(all P＞0.05).Conclusion Preoperative carbohydrate supplementation can effectively reduce the perioperative stress response of elderly patients undergoing high-risk orthopedic surgery,improve the quality of postoperative recovery,and reduce the incidence of POCD without increasing the risk of postoperative complications.

Abstract:Objective To investigate the clinical effect and safety of modified Buyang Huanwu decoction combined with chemotherapy in the treatment of advanced triple negative breast cancer(TNBC).Methods The clinical data of 162 hospitalized patients diagnosed with advanced TNBC and received chemotherapy in China-Japan Friendship Hospital from January 2021 to January 2024 were retrospectively analyzed.According to the different treatment regimens,the patients were divided into simple chemotherapy group(treated with albumin-bound paclitaxel,eutidrone or capecitabine standard chemotherapy)and integrated traditional Chinese and western medicine treatment group(treated with modified Buyang Huanwu decoction combined with standard chemotherapy),with 81 cases in each group.The clinical efficacy,adverse reactions and quality of life in terms of pain were observed after treatment.Results The proportion of stable disease and disease control rate in the integrated traditional Chinese and western medicine treatment group were higher than those in the simple chemotherapy group[24.5％(19/81)vs 12.3％(10/81),69.1％(56/81)vs 50.6％(41/81)](both P＜0.05).The progression-free survival of the integrated traditional Chinese and western medicine treatment group was longer than that of the simple chemotherapy group[(4.6±1.9)months vs(4.0±1.6)months](P＜0.05).After 3 months of treatment,the total effective rate of peripheral neurotoxicity in the integrated traditional Chinese and western medicine treatment group was higher than that in the simple chemotherapy group[91.8％(45/49)vs 90.8％(59/65)](P＜0.05).After the last chemotherapy and at the 3-month follow-up,the pain numerical rating scale score of the integrated traditional Chinese and western medicine treatment group was lower than that of the simple chemotherapy group[(1.2±0.8)vs(2.9±1.0),(1.4±0.7)vs(2.5±1.2)](both P＜0.05).Conclusion Buyang Huanwu decoction combined with chemotherapy has a good clinical effect in the treatment of advanced TNBC,and it can significantly reduce chemotherapy-related peripheral neurotoxicity and improve the quality of life of patients with advanced TNBC.

Abstract:Objective To investigate the effects of esmketamine combined with butorphanol tartrate on pain mediators and inflammatory stress response in elderly patients with femoral neck fracture undergoing total hip replacement.Methods A total of 112 elderly patients with femoral neck fracture who underwent total hip arthro-plasty in the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from September 2022 to September 2024 were selected as the research objects.A total of 112 patients were divided into observation group and control group by random number table method,with 56 cases in each group.The control group was given butorphanol tartrate patient-controlled intravenous analgesia,while the observation group was given esketamine combined with butorphanol tartrate patient-controlled intravenous analgesia.The postoperative analgesia and seda-tion scores,pain mediators,inflammatory factors,stress response and the total incidence of adverse reactions were compared between the two groups.Results The Visual Analogue Scale scores of the two groups at 2,6,12 and 24 h after operation were gradually decreased,and those in the observation group were lower than those in the control group at each time point.The Ramsay sedation scores of the observation group were gradually increased,and those in the observation group were higher than those in the control group at each time point(all P＜0.001).The levels of prostaglandin E2,substance P,and β-endorphin in the two groups 24 h after operation were higher than those before operation,but those in the observation group were lower than those in the control group[(49±6)μg/Lvs(52±5)μg/L,(61±6)μg/L vs(65±6)μg/L,(130±13)μg/L vs(138±15)μg/L](all P＜0.05).The levels of tumor necrosis factor-α,interleukin-6,epinephrine,norepinephrine and cortisol in the two groups at 24 h after operation were higher than those before operation,but those in the observation group were lower than those in the control group.The level of interleukin-10 in the observation group was higher than that in the control group(all P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Esmketamine combined with butorphanol tartrate has a good analgesic and sedative effect on elderly patients with femoral neck fracture undergoing total hip replacement.It can reduce the levels of pain mediator,tumor necrosis factor-α and interleukin-6,increase the level of interleukin-10,and reduce the stress response.

Abstract:Objective To investigate the efficacy of Da Vinci robotic surgical system in the treatment of adenomyosis complicated with deep endometriosis.Methods The clinical data of patients with adenomyosis complicated with deep endometriosis who underwent total hysterectomy and resection of endometriotic lesions in the First Affiliated Hospital of Xinxiang Medical University from December 2020 to March 2024 were retrospectively collected.A total of 53 patients were enrolled,including 20 patients undergoing Da Vinci robot-assisted laparo-scopic surgery(Da Vinci group)and 33 patients undergoing traditional laparoscopic surgery(laparoscopic group).The operation time,intraoperative blood loss,blood transfusion rate,postoperative exhaust time,abdominal drainage volume,and postoperative infection rate were compared between the two groups.Results The intraoperative blood loss,abdominal drainage volume,drainage tube placement time,postoperative exhaust time and postoperative infection rate in the Da Vinci group were lower than those in the laparoscopic group[(65±25)ml vs(110±53)ml,(62±18)ml vs(108±17)ml,(1.7±0.3)d vs(2.3±0.5)d,(1.6±0.4)d vs(2.3±0.5)d,0(0/20)vs 18.2％(6/33)](all P＜0.05).Conclusion Da Vinci robotic surgical system is superior to traditional laparoscopy in shortening postoperative hospital stay,reducing intraoperative blood loss,reducing postoperative infection rate,and promoting the recovery of gastrointestinal function.The treatment effect is better and the safety is higher.

Abstract:Objective To compare the therapeutic effect of plasma exchange and blood transfusion with leukocyte-removing red blood cell suspension on children with autoimmune hemolytic anemia(AIHA).Methods A prospective study was conducted on 97 children with AIHA admitted to Hainan Women and Children's Medical Center from July 2021 to July 2023.According to the random number table method,they were divided into the control group(48 cases)and the observation group(49 cases).The control group was treated with plasma exchange,and the observation group was treated with leukocyte-removing red blood cell suspension.The clinical efficacy,blood indexes,coagulation function indexes,fibrinolysis function,and adverse reactions were compared between the two groups.Results There was no significant difference in the total effective rate between the observation group and the control group[98.0％(48/49)vs 93.8％(45/48),x2=1.087,P=0.297].After treatment,the red blood cell count,hemoglobin,thrombin time,prothrombin time,activated partial thromboplastin time and plasminogen in the two groups were higher/longer than those before treatment,and those in the observation group were higher/longer than those in the control group.The reticulocyte,serum bilirubin,fibrinogen,D-dimer and plasminogen activator inhibitor-1 in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group[4.1％(2/49)vs 16.7％(8/48)](x2=4.153,P=0.042).Conclusion Both plasma exchange and leukocyte-removing red blood cell suspension have good effects on children with AIHA,but the latter is more conducive to improving the hemogram,coagulation function and fibrinolysis function of children,and has higher safety.

Abstract:Hyperuricemia is a common metabolic disease,mainly caused by factors such as purine metabolism disorders in the human body,reduced or excessive excretion of uric acid,etc.Long-term high uric acid levels not only can lead to gout attacks but also may cause chronic damage to the kidney,affecting the quality of life of patients.Drug therapy remains the preferred treatment for hyperuricemia.Although clinical therapeutic drugs can control some conditions,there are still many deficiencies.This article reviews the research progress of drugs related to the treatment of hyperuricemia,and introduces and discusses new uric acid-lowering drugs,hoping to provide references for clinical medication and new drug development.

Abstract:Objective To investigate the influencing factors and action path of postoperative exercise volume in patients with acute type A aortic dissection,so as to provide a reference for formulating targeted exercise intervention programs.Methods From December 2022 to June 2024,convenience sampling was used to select 268 patients with acute type A aortic dissection after operation in Beijing Anzhen Hospital,Capital Medical University as the research object.The general information questionnaire,fear of heart disease exercise scale,exercise self-efficacy scale,brief illness perception questionnaire and physical activity rating scale were used for investigation.Univariate analysis and Spearman correlation analysis were used to test the chain mediating effect between variables by Mplus7.4 software.Results Among 268 patients with acute type A aortic dissection after surgery,the total score of exercise volume was(18.0±7.0),which was at a low level.There were 40 patients(14.9％)with low exercise volume and 228 patients(85.1％)with moderate/high exercise volume.The patient's score on the cardiac disease exercise fear scale was(36.3±5.4),the score on the exercise self-efficacy scale was(62.1±15.8),and the score on the simple disease perception questionnaire was(41.2±8.5).Univariate analysis showed that age,education level,occupational status,history of hypertension,cardiac function classification and body mass index were the influencing factors of exercise volume in patients with acute type A aortic dissection after surgery(all P＜0.05).The direct effects of illness perception,exercise self-efficacy and exercise fear on the amount of exercise in patients with acute type A aortic dissection after surgery were established,with effect values of-0.339,0.636 and-0.241,respectively.Exercise self-efficacy indirectly affected the amount of exercise(moderate/high exercise)of patients through the mediating effect of illness perception,and the effect value was 0.097,accounting for 13.23％of the total effect.Exercise fear indirectly affected the amount of exercise(moderate/high exercise)through the single mediating effect of exercise self-efficacy and the chain mediating effect of exercise self-efficacy illness perception,and the effect value was-0.701,accounting for 74.41％of the total effect.Conclusion Clinical medical and nursing staff should pay attention to the influence of illness perception,exercise self-efficacy and exercise fear on the exercise volume of patients with acute type A aortic dissection after surgery,and develop scientific and accurate intervention programs to improve the exercise volume of patients with acute type A aortic dissection after surgery.

Abstract:Objective To investigate the clinical effect of Shengui capsule combined with sacubitril/valsartan sodium in the treatment of chronic heart failure and its effect on serum angiotensin Ⅱ(Ang Ⅱ)and brain natriuretic peptide(BNP)levels.Methods A total of 128 patients with chronic heart failure admitted to Hebei Chest Hospital from July 2023 to May 2024 were selected.They were divided into single drug group and combined group by simple random method,with 64 cases in each group.The single drug group was treated with sacubitril/valsartan sodium,and the combined group was treated with Shengui capsule on the basis of the single drug group.The treatment effect,Ang Ⅱ,BNP,cardiac function,oxidative stress level,Lee's heart failure score and heart failure self-care index(SCHFI)score were compared between the two groups.Results After treatment,the total effective rate of the combined group was higher than that of the single drug group[92.2％(59/64)vs 78.1％(50/64)](P=0.025).After treatment,the serum levels of Ang Ⅱ and BNP in the two groups were lower than those before treatment,and those in the combined group were lower than those in the single drug group[(25.1±2.7)ng/L vs(28.7±3.0)ng/L,(143±15)ng/L vs(169±17)ng/L](all P＜0.05).After treatment,the left ventricular ejection fraction,superoxide dismutase,glutathione peroxidase and SCHFI score of the two groups were higher than those before treatment,and those of the combined group were higher than those of the single drug group(all P＜0.05).The left ventricular posterior wall thickness,malondialdehyde level and Lee's heart failure score in the two groups were lower than those before treatment,and those in the combined group were lower than those in the single drug group(all P＜0.05).Conclusion Shengui capsule combined with Sacubitril/valsartan sodium is effective in the treatment of chronic heart failure,which can effectively improve cardiac function and dyspnea.

Abstract:Objective To investigate the expression of cyclin-dependent kinase inhibitor 2 A(CDKN2A)and B lymphocyte-induced mature protein 1(Blimp-1)in cervical high-grade squamous intraepithelial lesion(HSIL)and their relationship with the progression of HSIL.Methods A total of 815 patients with HSIL who underwent cervical conization in Shanxi Children's Hospital from January 2019 to January 2022 were selected.According to the postoperative pathological results,the patients were divided into progressive group and non-progressive group.The surgically resected cervical tissues were taken to detect the expression of CDKN2A mRNA and Blimp-1 mRNA.Pearson method was used to analyze the correlation between CDKN2A mRNA and Blimp-1 mRNA.Multivariate Logistic regression was used to analyze the risk factors for the progression of HSIL.Receiver operating characteristic curve was used to analyze the value of CDKN2A mRNA and Blimp-1 mRNA in the diagnosis of HSIL progression.Results Among 815 patients with HSIL,97 cases(11.9％)were confirmed to progress to cervical cancer by postoperative pathology,which was the progressive group,and the remaining 718 cases(88.1％)were the non-progressive group.The expression level of CDKN2A mRNA in cervical tissue of progressive group was lower than that of non-progressive group[(0.53±0.13)vs(1.43±0.27)],and the expression level of Blimp-1 mRNA was higher than that of non-progressive group[(2.65±0.71)vs(1.27±0.24)](all P＜0.001).The expression of CDKN2A mRNA was negatively correlated with the expression of Blimp-1 mRNA in cervical tissues(r=-0.650,P＜0.05).Human papillomavirus 16/18 infection,cervical intraepithelial neoplasia grade 3 and high expression of Blimp-1 mRNA were risk factors for HSIL progression to cervical cancer(all P＜0.05),and high expression of CDKN2A mRNA was a protective factor(P＜0.05).The area under the curve of CDKN2A mRNA and Blimp-1 mRNA in the diagnosis of HSIL progression was 0.777 and 0.759,respectively.The area under the curve of combined diagnosis was 0.920,which was higher than that of single diagnosis(both P＜0.05).Conclusion Low expression of CDKN2A mRNA and high expression of Blimp-1 mRNA in cervical tissues are risk factors for the progression of HSIL to cervical cancer.The combination of CDKN2A mRNA and Blimp-1 mRNA can predict the risk of HSIL progression.

Abstract:Objective To investigate the clinical effect of Shenkang injection combined with levosimendan on patients with early acute kidney injury(AKI)after coronary artery bypass grafting(CABG).Methods A total of 110 patients with early AKI after CABG admitted to General Hospital of Northern Theater Command of Chinese People's Liberation Army from February 2023 to September 2024 were selected.According to the random number table method,they were divided into control group and observation group,with 55 cases in each group.The control group was treated with levosimendan injection on the basis of conventional comprehensive treatment,and the observation group was treated with Shenkang injection on the basis of the control group.The clinical efficacy,cardiac function,renal function,inflammatory indicators and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[94.5％(52/55)vs 80.0％(44/55)](P=0.022).After treatment,the left ventricular fractional shortening,left ventricular ejection fraction,and glomerular filtration rate of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group.The levels of 24 h urine protein,urine microprotein,serum creatinine,blood urea nitrogen,interleukin-6(IL-6),IL-8,and IL-18 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).There was no significant difference in the total incidence of adverse reactions between the two groups(P=1.000).Conclusion Shenkang injection combined with levosimendan in the treatment of patients with early AKI after CABG is effective,which can improve the heart and kidney function of patients,effectively inhibit the inflammatory response in the body,and is safe and reliable in clinical application.

Abstract:Cardiovascular disease is a major threat to human health.Its core pathophysiological features are endothelial dysfunction,which is manifested as decreased vasodilation ability,hemodynamic abnormalities,and accelerated progression of atherosclerosis.Trimetazidine can effectively improve endothelial dysfunction by optimizing energy metabolism,improving hemodynamics,reducing oxidative stress,inhibiting inflammatory response,and regulating angiogenesis,and is widely used in the treatment of a variety of cardiovascular diseases.This article reviews the mechanism of trimetazidine and its latest research progress in improving endothelial dysfunction related to cardiovascular disease,so as to provide new strategies and evidence for better clinical application of trimetazidine.

Abstract:Objective To investigate the effects of different concentrations of cyclosporine on metabolism of blood glucose,blood lipid,uric acid,etc and renal function in patients with aplastic anemia.Methods A total of 143 patients with aplastic anemia treated with cyclosporine in the First Affiliated Hospital of Harbin Medical University from January 2021 to January 2024 were selected.According to the different blood drug concentration monitoring time,they were divided into 1 month after treatment group(group A,31 cases),3 months after treatment group(group B,34 cases)and 6 months after treatment group(group C,42 cases)and 12 months after treatment group(group D,36 cases).The blood concentration of cyclosporine,blood glucose,blood lipid,serum creatinine and uric acid of patients in different groups were collected,and the correlation between the blood concentration of cyclosporine and each index was analyzed.Results The blood concentrations of cyclosporine in groups A,B,C,and D were(193±28),(214±19),(188±28),and(176±26)μg/L,respectively.The blood concentration of cyclosporine in group B was higher than those in groups A,C,and D(P＜0.05).There were statistically significant differences in the levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and creatinine among the four groups(all P＜0.05),and there was no statistically significant difference in the level of uric acid(P＞0.05).The results of correlation analysis showed that blood glucose,triglyceride,low-density lipoprotein cholesterol and creatinine were positively correlated with the blood concentration of cyclosporine,high-density lipoprotein cholesterol was negatively correlated with the blood concentration of cyclosporine(all P＜0.05),while total cholesterol and uric acid levels were not correlated with the blood concentration of cyclosporine(both P＞0.05).Conclusions The plasma concentration of cyclosporine has an effect on blood glucose,lipid metabolism and renal function in patients with aplastic anemia,but has no effect on uric acid metabolism.

Abstract:Objective To investigate the application value of profile blood lipid combined with CT angiography(CTA)in the diagnosis of carotid plaque in patients with cerebral infarction.Methods A total of 200 patients with cerebral infarction admitted to the Department of Neurology,Zhangjiakou First Hospital,Hebei Province from May 2021 to December 2022 were selected as the observation group,and 100 healthy people who underwent physical examination during the same period were selected as the control group.According to the results of digital subtraction angiography,the patients in the observation group were divided into plaque group(108 cases)and non-plaque group(92 cases).Gender,age,smoking history,hypertension,diabetes,heart disease history,kidney disease history,and blood lipid indexes were collected and compared.The results of digital subtraction angiography were used as the gold standard to evaluate the efficacy of CTA alone and combined with blood lipid indexes in the diagnosis of carotid plaque.Results There were no statistically significant differences in baseline data between the observation group and the control group(all P＞0.05).The levels of serum matrix metalloproteinase-9(MMP-9),total cholesterol,triglyceride and low-density lipoprotein cholesterol(LDL-C)in the observation group were higher than those in the control group,and the levels of tissue inhibitor of metalloproteinase-1(TIMP-1)and high-density lipoprotein cholesterol(HDL-C)were lower than those in the control group(all P＜0.05).The levels of serum MMP-9,total cholesterol,triglyceride and LDL-C in the plaque group were higher than those in the non-plaque group,and the levels of TIMP-1 and HDL-C in the plaque group were lower than those in the non-plaque group(all P＜0.05).Multivariate Logistic regression showed that MMP-9 and triglyceride were independent risk factors for carotid plaque,and TIMP-1 was protective factor(all P＜0.05).The area under the curve(AUC)of CTA combined with serum MMP-9,TIMP-1,total cholesterol,triglyceride,HDL-C and LDL-C in the diagnosis of carotid plaque was 0.993.The AUC of CTA combined with serum MMP-9 and TIMP-1 in the diagnosis of carotid plaque was 0.981.The AUC of CTA alone in the diagnosis of carotid plaque was 0.935,and the diagnostic efficacy of combined diagnosis was higher than that of CTA alone.Conclusion Blood lipid profile combined with CTA,MMP-9 and TIMP-1 can significantly improve the diagnostic efficiency of carotid plaque in patients with cerebral infarction,provide a more comprehensive and accurate diagnostic basis for clinical practice,and contribute to early intervention and individualized treatment of cerebral infarction.