Abstract:Objective:To investigate the mechanism of DOK1 recombinant adenovirus(Ad-DOK1)on the regulation of insulin sensitivity in palmitic acid(PA)-induced insulin-resistant hepatocytes(BRL-3A).Methods:The control,solvent and model groups were treated with normal medium,ethanol and palmitic acid to establish a cellular insulin resistance model of BRL-3A cells and to iden-tify the cellular model using cellular glucose uptake assay.The control,null and adenovirus DOK1 overexpression groups were transfect-ed with normal serum,negative virus and Ad-DOK1(51257-1)in insulin-resistant BRL-3A cells,and the transfection efficiency of ade-novirus was detected by flow cytometry,and the Western blot method was used to detect DOK1,IRSI,IRSII,p-PI3K,PI3K,p-AKT,AKT,SREBP1c protein expression levels.Results:Palmitic acid induction for 6 hours resulted in a decrease in intracellular 2-deoxyglu-cose(P＜0.05),down-regulation of DOK1 protein expression level(P＜0.05),no significant change in IRSI and IRSII protein ex-pression level(P>0.05),no change in p-PI3K/PI3K ratio(P>0.05),down-regulation of p-AKT/AKT ratio(P＜0.05),and SREBP1c protein expression expression levels were upregulated(P＜0.05).After transfection of cells with DOK1 recombinant adeno-virus of optimal MOI 60,compared with the normal control group,intracellular 2-deoxyglucose was elevated(P＜0.05),DOK1 protein expression level was up-regulated(P＜0.05),there was no significant change in the expression level of IRSI and IRSII proteins(P>0.05),no significant change in the p-PI3K/PI3K ratio(P>0.05),the p-AKT/AKT ratio was upregulated(P＜0.05),and the ex-pression level of SREBP1c protein expression was downregulated(P＜0.05).Conclusion:Ad-DOK1 may enhance insulin sensitivity of BRL-3A cells by regulating AKT and SREBP1c.

Abstract:Objective:To develop a robust and widely applicable predictive model to improve the accuracy of diagnosing the ma-lignancy risk of pulmonary nodules.Methods:This study retrospectively collected clinical data from 1,414 patients with pulmonary nod-ules diagnosed and treated at the Affiliated Hospital of North Sichuan Medical College and the Guang'an People's Hospital.Meta-analy-sis and Least Absolute Shrinkage and Selection Operator(LASSO)regression were used to identify predictors related to the malignancy risk of pulmonary nodules.These factors were further optimized by multivariable Logistic regression(LR)to determine key features.Based on these features,8 machine learning models were constructed and evaluated for performance using Receiver Operating Character-istic(ROC)curves,calibration curves,and Decision Curve Analysis(DCA)in the training set and internal validation set.The best-performing model was used to develop a nomogram for risk stratification of patients.Results:Through the combined screening process of Meta-analysis,LASSO regression,and multivariable LR,10 key predictive factors were identified and integrated into eight different ma-chine learning models.Model evaluation demonstrated that the LR model performed best,achieving an Area Under the Curve(AUC)of 0.843 in the internal validation cohort.Additionally,the nomogram derived from this model exhibited strong predictive ability in the ex-ternal validation cohort,with an AUC of 0.770.Risk scores calculated from the nomogram stratified patients into four risk groups,with malignancy rates ranging from 0%in the low-risk group to 100%in the very high-risk group.Conclusion:The prediction model devel-oped in this study effectively assesses the malignancy risk of pulmonary nodules,providing a valuable risk stratification tool for clinical use.

Abstract:Objective:To investigate whether there was a potential two-way causal relationship between sleep disorder(SD)and the incidence of gastric ulcer(GU)by two sample Mendelian randomization(MR)analysis.Methods:The data sets of exposure and outcome were obtained from IEU database,from which suitable Single Nucleotide Poly Morphisms(SNPs)were selected as instrumental variables(IVs),and then inverse variance weighting(IVW),MR-Egger regression,weighted median(WME),simple model and weigh-ted model were used for two-way MR Analysis.Cochran's Q test and MR-Egger intercept test were used for sensitivity analysis.Results:The IVW method showed that there was a significant unidirectional causal relationship between SD and the incidence of GU.When SD were used as exposure factors,the positive MR Analysis had significant statistical significance(OR=1.009,95%CI:1.004～1.015,P=0.001).When GU used as an exposure factor,reverse MR Analysis was not statistically s-ignificant(OR=1.197,95%CI:0.425～3.371,P=0.734).Further sensitivity analysis showed no significant heterogeneity and horizontal pleiotropy.Conclusion:Mendelian randomization analysis found that there is a potential one-way causal relationship between SD and the risk of GU,and SD are risk factors for GU.

Abstract:Objective:To explore the clinical efficacy of dapagliflozin combined with metoprolol extended-release tablet treatment of senile chronic heart failure(CHF)with atrial fibrillation(AF)and influence on patients with myocardial damage.Methods:122 elderly patients with CHF and AF were divided into combined group and control group according to different treatment methods,with 61cases in each group.The control group was treated with metoprolol sustained release tablets,and the combined group was treated with daglizin in addition to the control group.Both groups were treated for 3 months.The efficacy and safety,myocardial injury and cardiac function indexes before and after treatment were observed.Results:The total effective rate in the combined group was higher than that in the control group(95.08%vs.81.97%,P＜0.05).After treatment,the levels of cTnI and NT-proBNP in both groups decreased com-pared to before treatment(P＜0.05),and combined group was lower than the control group(P＜0.05).Thelevelsof LVESD,LVEDD in both groups decreased compared to before treatment(P＜0.05),and combined group was lower than the control group(P＜0.05),LVEF increased compared to before treatment(P＜0.05),and the combined group was higher than the control group(P＜0.05).There was no statistically significant difference in the overall incidence of adverse reactions between the two groups(P>0.05).Con-clusion:Dapagliflozin combined with metoprolol extended-release tablet has difinite therapeutic effect on elderly CHF patients with AF,which is beneficial for reducing myocardial injury,improving heart function,and has good security.

Abstract:Objective:To explore the effects of intermittent theta burst magnetic stimulation(iTBS)and 1 Hz repetitive tran-scranial magnetic stimulation(rTMS)on depressive symptoms and cognitive function in elderly patients with depression.Methods:Eld-erly patients with depression were divided into iTBS group(n=30)and 1 Hz rTMS group(n=43)according to the treatment regi-men.On the basis of antidepressant treatment for both groups,the left dorsolateral prefrontal lobe of the iTBS group was given a stimula-tion frequency of 50 Hz from the internal frequency,5 Hz from the inter-frequency and stimulation strength of 110%RMT,with a stimu-lation time of 2 s,an intermission of 8 s,and a repetition of 20 times,with a total of 600 pulses lasting for 200 s.The 1 Hz rTMS group was given a stimulation frequency of 1.0 Hz and a stimulation intensity of 110%RMT in the dorsolateral right prefrontal lobe,and was treated for 20 min per day,with a total of 1,200 pulses per treatment.Patients in both groups were treated 5 times per week at the same fixed time for 4 weeks for a total of 20 treatments.The Hamilton Depression Scale 24(HAMD-24),Geriatric Depression Scale(GDS),Beck Suicidal Ideation Inventory-Chinese Version(BSI-CV),Wisconsin Card Sorting Test,and Part A of the Connection Test were used for assessment before and after treatment,and adverse reactions during treatment were recorded.Results:With the prolongation of treat-ment time,the HAMD-24 and GDS scores of the two groups gradually decreased(P＜0.05),and the HAMD-24 and GDS scores of the iTBS group were lower than those of the 1 Hz rTMS group,and the difference was statistically significant(P＜0.05).After4 weeks of treatment,the number of correct responses of the patients in the iTBS group was higher than that of the 1 Hz rTMS group,and the num-ber of incorrect responses,BSI-CV score suicidal ideation intensity and suicide risk were lower than those of the 1 Hz rTMS group,and the TMT-A time was shorter than that of the 1 Hz rTMS group,with a statistically significant difference between the groups(P＜0.05).During the treatment period,there was no statistically significant difference in the incidence rate of adverse reactions between the two groups(P>0.05).Conclusion:There are significant advantages of iTBS over1 Hz rTMS in treating elderly patients with depression in terms of improving depressive symptoms,reducing suicidal ideation,and improving cognitive performance,and there was no increased treatment safety risk.

Abstract:Objective:To investigate the effect of intravenous esketamine combined with erector spinae plane block(ESPB)on the postoperative recovery quality in patients undergoing thoracoscopic lobectomy with general anesthesia.Methods:A total of 97 pa-tients who underwent thoracoscopic lobectomy were divided into two groups:group K(n=49)and group C(n=48),according to whether or not they were given esketamine.Patients in K group were given slow intravenous injection of 0.2 mg/kg ketamine after anes-thesia induction and 5 minutes before surgical skin incision,and patients in group C received intravenous injection of physiological sa-line equivalent to group K drugs.Comparison of general indicators,quality of recovery at 24 h postoperatively[40-item Quality of Re-covery Rating Scale(QoR-40)score],cellular immune function before and after 24 h of treatment(NK cells,CD4+T cells,and CD8+T cells),hemodynamics at each time point,and the occurrence of postoperative adverse events between the two groups.Results:Intrao-perative remifentanil dosage was lower in group K than in group C(P＜0.05).The overall QoR-40 score,as well as the subscores for pain,emotional state,and physical comfort in group K were higher than those in group C at 24 hours postoperatively(P＜0.05).Addi-tionally,levels of NK cells,CD4+T cells,and CD8+T cells were higher in the group K than those in group C at 24 hours postoperative-ly(P＜0.05).There were no statistically significant differences in hemodynamics and total incidence of adverse effects between the two groups(P>0.05).Conclusion:The intravenous application of esketamine combined with ESPB for thoracoscopic lobectomy under general anesthesia reduces intraoperative remifentanil dosage,improves the quality of postoperative recovery and improves postoperative cellular immune function in patients without increasing adverse effects.

Abstract:Objective:To analyze the diagnostic value of multimodal magnetic resonance imaging(MRI)in grading and Sub-type of meningiomas.Methods:A total of 98 patients with meningiomas were reviewed.They were divided into benign group(n=78)and malignant group(n=20)according to the pathological examination results.All of them underwent conventional MRI scan and mul-timodal MRI examination upon admission.The multimodal MRI parameters[apparent diffusion coefficient(ADC),local cerebral blood flow(rCBF),magnetic sensitive signal intensity(ITSS),N-acetylaspartate(NAA)/choline(Cho),NAA/creatine(Cr),Cho/Cr]of patients with benign and malignant meningiomas,and patients with different subtypes of benign meningiomas were compared.The diag-nostic value of multimodal MRI for meningioma classification and grading were analyzed by receiver operating characteristic(ROC)curves.Results:The ADC,NAA/Cho ratio and NAA/Cr ratio of meningiomas in the malignant group were lower than those in the be-nign group(P＜0.05).The rCBF,ITSS and Cho/Cr ratio were higher than those in the benign group(P＜0.05).The AUC values of three-dimensional arterial spin labeling(3D-ASL),diffusion-weighted imaging(DWI),susceptibility-weighted imaging(SWI)and proton magnetic resonance spectroscopy(1 H-MRS)for grading of meningiomas were 0.723,0.735,0.777 and 0.870.The AUC of com-bined diagnosis was 0.957.There were significant differences in rCBF,ITSS,NAA/Cho ratio,NAA/Cr ratio and Cho/Cr ratio among patients with different subtypes of benign meningiomas(P＜0.05).Conclusion:Multimodal MRI is helpful in clinical grading and Subtype of meningiomas.

Abstract:Objective:To investigate the efficacy of dapagliflozin combined with enalapril in the treatment of diabetic nephropa-thy(DN).Methods:A total of 160 patients with DN were divided into control group and observation group according to different treat-ment methods,with 80 cases in each group.The two groups were treated with enalapril and dapagliflozin combined with enalapril respec-tively for 12 weeks.Before and after treatment,the levels of 24 h urinary protein quantification(24 h UAE),urinary albumin to creati-nine ratio(ACR),serum creatinine(Scr),urea nitrogen(BUN)and estimated glomerular filtration rate(eGFR)were detected,and the levels of urine membrane protein(Podocin),podocyte slit diaphragm protein(Nephrin)and serum interleukin 6(IL-6),tumor necrosis factor α(TNF-α)were measured.The efficacy and adverse reactions of the two groups were compared.Results:The total ef-fective rate of the observation group was higher than that of the control group(P＜0.05).After treatment,compared with the control group,the 24 h UAE level,ACR value,Scr and BUN in the observation group decreased(P＜0.05),and the eGFR level increased(P＜0.05).The levels of urinary Podocin,Nephrin,serum IL-6,and TNF-α in the observation group were lower than those in the con-trol group(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Dapagliflozin combined with enalapril can more effectively reduce proteinuria,improve renal function and im-prove the efficacy of DN.The mechanism may be related to inhibiting inflammation and alleviating podocyte injury.

Abstract:Objective:To analyze surface electrocardiogram features of patients with ventricular arrhythmias arising from different outflow tracts.Methods:102 patients with ventricular arrhythmias were enrolled in this study.All of them underwent standard 12-lead electrocardiography.Electrocardiogram features and parameters of patients with ventricular arrhythmias arising from different ventricular outflow tracts and different positions of pulmonary valve in the right ventricular outflow tract were recorded.Results:All patients in-cluded in this study showed positive R waves in inferior wall leads on surface electrocardiograms,and QS pattern in aVL and aVR.A-mong the 102 patients,there were 19 cases with left ventricular outflow tract arrhythmias and 83 cases with right ventricular outflow tract arrhythmias,including ventricular arrhythmias arising above pulmonary valve(n=44)and below pulmonary valve(n=39).R wave amplitude,shortest RS(SRS),and intrinsicoid deflection time(IDT)in the right ventricular outflow tract group were smaller and shor-ter than those in the left ventricular outflow tract group(P<0.05).For patients with ventricular arrhythmias arising from different posi-tions of pulmonary valve in the right ventricular outflow tract group,R wave amplitude in lead II and lead aVF in the above pulmonary valve group was greater than that in the below pulmonary valve group,while RⅢ/RⅡwas lower than that in the below pulmonary valve group(P<0.05).There were statistically significant differences in QRS duration,R wave amplitude in lead III and aVF,Q wave am-plitude in lead aVL,and RⅢ/RⅡ among patients with ventricular arrhythmias originating from different anatomical parts of pulmonary valve(P<0.05).QRS duration in the right sinus group was longer than that in the left sinus group.The R wave amplitude in lead Ⅲ and aVF,Q wave amplitude in lead aVL and RⅢ/RⅡwere smaller than those in the left sinus group and the anterior sinus group.The Q wave amplitude in lead aVL was smaller than that in the left and right sinus junction group(P<0.05).R wave amplitude in lead Ⅲ and aVF in the left sinus group was greater than that in the left sinus junction group(P<0.05).Conclusion:Patients with ventricular arrhythmias arising from different outflow tracts have different surface electrocardiogram features and parameters.Clinically,the outflow tract where ventricular arrhythmias originate can be determined by relevant surface electrocardiogram parameters.

Abstract:Objective:To investigate the influence of transvaginal cervical cerclage during pregnancy on maternal-infant out-comes under different anesthesia conditions.Methods:Patients with cervical incompetence(CIC)who underwent McDonald's surgery were selected as the research subjects,71 patients were selected from the anesthesia state and included in the anesthesia group,and 113 patients were selected from the non-anesthesia state and included in the non anesthesia group.Each group was selected based on cervi-cal length≥10 mm and＜10 mm for data analysis.The differences in surgical related indicators,maternal complications,pregnancy outcomes,and neonatal outcomes were recorded.Results:For patients with cervical length＜10 mm,the non anesthesia group had lower hospitalization costs than the anesthesia group(P＜0.05),shorter surgical time than the anesthesia group(P＜0.05),and greater neonatal body weight than the anesthesia group(P＜0.05).For patients with cervical length≥10 mm,the non anesthesia group had a shorter surgical time than the anesthesia group(P＜0.05),a higher rate of vaginal delivery than the anesthesia group(P＜0.05),a lower rate of premature delivery than the anesthesia group(P＜0.05),and a lower rate of transferring to NICU after delivery than the anesthesia group(P＜0.05).Conclusion:For patients undergoing McDonald surgery,non-anesthesia state has certain advantages,and can shorten the surgical time,reduce the expense,and help to reduce the incidence rate of premature birth and improve the neonatal out-comes.

Abstract:Objective:To investigate the clinical effect of periodontal therapy+orthodontic+implant in the treatment of denti-tion defect.Methods:84 patients with dentition defect were included and divided into two groups according to different treatment meth-ods,with 42 cases in each group.The control group received conventional treatmen,and the observation group was treated with periodon-tal therapy+orthodontic+implant multidisciplinary treatment.The clinical efficacy,lateral skull X-ray measurement results[the dis-tance from the upper dental groove seat point to the maxillary plane(A-PFP),the distance from the lower dental groove seat point to the maxillary plane(B-PFP),the angle between the anterior skull base plane and the mandibular plane(SN-OP),the angle between the orbital ear plane and the mandibular plane(FH-MP),the distance from the upper dental groove edge point to the submental point(ANS Me),the distance from the upper lip protrusion point to the aesthetic line(Ls-E line),and the distance from the lower lip pro-trusion point to the aesthetic line(Li-E line)]and tooth function(self-made dental function score)were compared between the two groups.Results:The total effective rate of observation group was higher than that of control group(P＜0.05).After treatment,there was a statistically significant difference in the changes of A-PFP,SN-OP,FH-MP,ANS-Me and Ls-E lines between the two groups(P＜0.05),and the scores of mastication,pronunciation and swallowing in the observation group were higher than those in the control group(P＜0.05).Conclusion:The combination of periodontal therapy+orthodontic+implant can improve the clinical effect and improve the dental function of patients with dental defects.

Abstract:Objective:To explore the clinical effect of rigid neuroendoscopy and traditional drilling irrigation and drainage in the treatment of chronic subdural hematoma(CSDH).Methods:The clinical data of CSDH patients were retrospectively analyzed.Accord-ing to different treatment methods,they were divided into traditional group(treated with traditional drilling irrigation and drainage)and endoscopic group(treated with rigid neuroendoscopy),48 cases in each group.The differences in perioperative indicators,GCS score,Markwalder grading and NIHSS score were compared between groups,and the complications and recurrence rate in the two groups were counted.Results:The intraoperative blood loss,hospitalization time and immediate postoperative hematoma clearance rate in endoscopic group were better than those in traditional group(P＜0.05),and the total surgical time in traditional group was shorter than that in en-doscopic group(P＜0.05).At 7 days after surgery,the GCS score and Markwalder neurological function grading in the two groups were improved(P＜0.05),but there were no obvious differences between the two groups(P>0.05).Different time points after surgery,the NIHSS score in both groups was reduced compared to before surgery(P＜0.05),and the score was lower in endoscopic group than that in traditional group(P＜0.05).The complications showed no significant differences(P>0.05),and the recurrence rate of hematoma was lower than that in traditional group(P＜0.05).Conclusion:Both rigid neuroendoscopy and traditional drilling irrigation and drainage can effectively treat CSDH,but neuroendoscopy has higher hematoma clearance rate,shorter hospitalization time and lower postoperative recurrence rate,which is worthy of clinical promotion.

Abstract:Objective:To investigate the associated factors of bone marrow suppression in elderly patients with colorectal cancer(CRC)undergoing chemotherapy,construct a risk prediction model to identify key determinants of bone marrow suppression,and pro-vide data-driven support for personalized clinical treatment strategies.Methods:The clinical data of 32 elderly CRC patients who expe-rienced bone marrow suppression(study group)and 70 patients who did not experience bone marrow suppression(control group)were retrospectively analyzed.Univariate and multivariate Logistic regression analyses were conducted to identify the factors influencing bone marrow suppression in elderly CRC patients undergoing chemotherapy.A risk prediction model was subsequently developed and valida-ted.Results:The results of the Logistic regression analysis indicated that advanced age,prolonged duration of chemotherapy,a Nutrition-al Risk Screening-2002(NRS-2002)score of≥3,combined chemotherapy,and low serum levels of white blood cell count(WBC),he-moglobin(HGB),and platelet count(PLT)were risk factors for bone marrow suppression in elderly CRC patients(P＜0.05).Based on these findings,an XGBoost model was developed.The top five most influential features identified by the model were prolonged chem-otherapy duration,NRS-2002 score≥3,combined chemotherapy,low serum WBC and HGB levels,followed by advanced age and low PLT levels.Evaluation using the ROC curve demonstrated that the AUC of the XGBoost model for predicting myelosuppression following chemotherapy in elderly CRC patients was 0.905,with a sensitivity of 83.36%and specificity of 92.35%.The Hosmer-Lemeshow test revealed no significant difference between the predicted and actual observed values(P>0.05).Conclusion:Advanced age,prolonged duration of chemotherapy,NRS-2002 score≥3,combined chemotherapy regimen,and low expression levels of serum WBC,HGB,and PLT are independent risk factors for myelosuppression in elderly CRC patients undergoing chemotherapy.The XGBoost model construc-ted based on these factors demonstrates excellent predictive performance.

Abstract:Objective:Combination therapy with percutaneous endoscopic foraminal approach for discectomy,core muscle train-ing,The treatment effect in patients with lumbar intervertebral disc herniation was analyzed.Methods:108 patients with lumbar disc herniation were selected and divided into control group and study group according to different treatment methods,54 cases in each group.The control group underwent discectomy,and the study group underwent core muscle training after surgery.The pain level,pain mediators,inflammatory factor level,lower limb nerve conduction function,lumbar spine function,and clinical efficacy were tested and compared.Results:Compared with the preoperative period,the visual analogue scale(VAS),low back pain ODI scale The Oswestry Disability Index(ODI),5-hydroxytryptamine(5-HT),prostaglandin E2(PGE2),tumor necrosis factor ɑ(TNF-ɑ),interleukin 6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)levels were reduced at 1,3,and 6 months postoperatively,and the study group was lower than the control group(P＜0.05).Compared with the preoperative period,β-endorphin(β-EP)levels,lower limb nerve conduction velocity,and JOA scores(Japanese Orthopaedic Association Scores JOA)were elevated at 1,3,and 6 months postoperative-ly,and the study group was higher than the control group(P＜0.05).The total effective rate of treatment in the study group was higher than that in the control group(P＜0.05).Conclusion:For patients with lumbar disc herniation,percutaneous endoscopic foraminal ap-proach combined with core muscle training can promote the recovery of lumbar function and reduce the degree of pain,and the clinical effect is good.

Abstract:Objective:To explore the predictive value of ultrasound three-dimensional speckle tracking imaging(3D-STI)pa-rameters combined with serum N-terminal pro brain natriuretic peptide(NT proBNP)levels for adverse cardiovascular events(MACE)in patients with acute myocardial infarction after percutaneous coronary intervention(PCI).Methods:82 patients with acute myocardial infarction(AMI)were divided into MACE group(n=18)and non MACE group(n=64)based on the occurrence of MACE during the 6-month follow-up.Collected clinical data of all patients,postoperative ultrasound 3D-STI parameters,and serum NT proBNP levels,compared the differences between the two groups of the above parameters,used Logistic regression analysis to identify independent risk factors for MACE,and drawed receiver operating characteristic(ROC)curves to verify the predictive value of each indicator individual-ly and in combination for MACE.Results:18 out of 82 patients developed MACE(21.95%).The LDL,cTnT,and serum NT proBNP levels in the MACE group were higher than those in the non MACE group(P＜0.05),while LVEF,GLS,GCS,GRS,GAS,rotation an-gle,and rotation angle were lower than those in the non MACE group(P＜0.05).Logistic regression analysis showed that GLS(OR=3.102),GCS(OR=2.989),GRS(OR=3.053),and serum NT proBNP(OR=2.956)were independent risk factors for MACE after PCI in AMI patients(P＜0.05).The ROC curve showed that when all indicators were used in combination,the AUC was 0.976,and the sensitivity and specificity were 94.44%and 95.31%,respectively.Conclusion:Ultrasound 3D-STI related parameters GLS,GCS,GRS combined with serum NT proBNP levels can further improve the predictive value of MACE occurrence in AMI patients after PCI.

Abstract:Objective:To analyze the prognostic value of QTc in electrocardiogram and related indicators in patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods:106 patients with NSTEMI were selected as the research subjects.They were divided into poor prognosis group(n=41)and good prognosis group(n=65)according to the prognosis at 3 months after treatment.Univariate or multivariate Logistic regression analysis was conducted to identify factors affecting the prognosis of NSTEMI pa-tients,the ROC curve analyzed the prognostic value of dynamic electrocardiogram indicators for NSTEMI patients.Results:Univariate a-nalysis showed that the levels of creatine kinase isoenzyme and cardiac troponin T,QRS duration,corrected QT(QTc)interval,the pro-portions of ST-segment depression and T wave flattening or inversion in the good prognosis group were lower and shorter than those in the poor prognosis group(P＜0.05).Multivariate Logistic regression analysis showed that creatine kinase isoenzyme,QRS duration,QTc interval,the proportion of ST-segment depression,and T wave flattening or inversion were independent prognostic factors for pa-tients with NSTEMI(P＜0.05).ROC curve analysis showed that the areas under the curve(AUC)of QRS duration,QTc interval,the proportion of ST-segment depression,and T wave flattening or inversion for prognosis evaluation of patients with NSTEMI were 0.832,0.827,0.634,and 0.690.The AUC of combined use of the four was the largest,which was 0.922.Conclusion:QTc,QRS,ST-segment depression,and T wave flattening or inversion on electrocardiogram all can be used to evaluate short-term prognosis of NSTEMI.Be-sides,combined use of them can achieve better evaluation results.

Abstract:Objective:To explore the effect of piperacillin sodium and tazobactam sodium for injection combined with ambroxol hydrochloride on sputum characteristics,pulmonary inflammation,and respiratory mechanics in patients with severe pneumonia(SP).Methods:A total of 106 patients with SP were divided into the control group and the observation group according to different treatment methods,with 53 cases in each group.On the conventional treatment basis,the control group was treated with piperacillin sodium and tazobactam sodium for injection,and the observation group was treated with ambroxol hydrochloride on the basis of the treatment of con-trol group.After 14 d of treatment,the two groups were compared on clinical efficacy,clinical indicators,sputum characteristic scores,inflammatory indicators,and respiratory mechanics indicators.The occurrence of adverse reactions was recorded.Results:After 14 d of treatment,the total effective rate,bacterial clearance rate,sputum volume score,and dynamic lung compliance of the observation group were higher compared with the control group(P＜0.05).The duration of fever,duration of mechanical ventilation,sputum change time,cough and sputum characteristic scores,C-reactive protein,tumor necrosis factor,procalcitonin,work of breathing and peak airway pres-sure were lower than those of the control group(P＜0.05).The incidence rates of adverse reactions in the two groups during treatment were 7.55%and 11.32%,with no significant difference(P>0.05).Conclusion:Piperacillin sodium and tazobactam sodium for in-jection combined with ambroxol hydrochloride is effective in the treatment of SP,which can effectively improve sputum characteristics and respiratory mechanics,and alleviate pulmonary inflammation,with good safety.

Abstract:Objective:To investigate the predictive factors of prognosis in patients with septic cardiomyopathy and building pre-diction model.Methods:A retrospective study was conducted on 156 patients with purulent pericarditis,and they were divided into a model set and a validation set in a 7∶3 ratio.The patients in the model set were divided into survival and death groups according to dif-ferent outcomes.The influence factors on the prognosis of the model set patients were evaluated by multivariate Cox regression analysis,and a ROC curve and decision curve analysis(DCA)were used to validate the model using R software.Results:Multiple COX regres-sion analysis indicated that lactic acid,D-dimer,interleukin-6,APACHE-Ⅱscore and SOFA score were independent risk factors for 28 deaths in hospital with septic cardiomyopathy.ROC curve analysis results showed that the predictive value curve area(AUC)of the model set was 0.90,and the AUC of the validation set was 0.83,indicated that the model has good value in the prognosis of patients with septic cardiomyopathy.The results of the clinical decision curve(DCA curve)suggested that the clinical benefit of the validation set and the model set in this model was superior to the"assume all patients die"(all)and"assume all patients die"(none)curves.Conclusion:The prediction model has a good fit to the actual and correction curves,approaching the ideal curve,and has certain clini-cal practical value for patients with septic cardiomyopathy.

Abstract:Objective:To compare the effects and complications of ventriculoperitoneal shunt at different puncture points in the treatment of secondary communicating hydrocephalus.Methods:The clinical data of 122 patients with secondary communicating hydro-cephalus were retrospectively analyzed.According to different surgical methods,the patients were divided into 57 cases in frontal horn group(puncture via frontal horn of lateral ventricle)and 65 cases in occipital horn group(puncture via occipital horn of lateral ventri-cle).The surgical related indicators,preoperative and 1-week postoperative cognitive function[Glasgow Coma Scale(GCS)]and inci-dence rates of complications were compared between the two groups of patients.Results:There were no significant differences in surgical time,intraoperative blood loss,hospitalization time and adjustment rate of secondary surgery between groups(P>0.05).The good rate of postoperative shunt tube position in frontal horn group was higher than that in occipital horn group(P＜0.05).The total incidence rate of complications in frontal horn group was lower compared to occipital horn group(P＜0.05).No obvious difference was observed in GCS score between groups before surgery and on the day and about 1 week after surgery(P>0.05).Conclusion:Both surgical methods can improve the cognitive function of patients.Compared with ventriculoperitoneal shunt through occipital horn puncture for pa-tients with secondary communicating hydrocephalus,frontal horn puncture can more effectively enhance the good rate of postoperative shunt tube position and reduce the incidence rates of complications,it is worthy of application and promotion.

Abstract:Objective:To explore the clinical efficacy of recombinant human interferon α-1b combined with budesonide and sin-gle budesonide aerosol inhalation in the treatment of acute bronchitis in children.Methods:106 children with acute bronchitis were se-lected as study samples,and were divided into control group and study group by adopting different treatment methods,with 53 cases in each group.The children in the control group were treated with budesonide aerosol inhalation inhalation in addition to conventional treatment,while the children in the study group were combined with budesonide and recombinant human interferon α-1b aerosol inhala-tion inhalation on the basis of conventional treatment,both groups were treated for 1 week.The regression times of clinical symptoms,changes in serum inflammatory factors levels[procalcitonin(PCT),serum C-reactive protein(CRP)],blood routine[white blood cell count(WBC),neutrophil percentage(NEU%)]and lung function indexes[maximum expiratory volume in one second(FEV1),FEV1 to forced vital capacity ratio(FEV1/FVC),and maximum expiratory flow(PEF)]before treatment and after 1 week of treatment and adverse reactions during treatment were compared.Results:The regression times of clinical symptoms in study group were shorter than those in control group(P＜0.05).After 1 week of treatment,the levels of serum PCT,CRP,WBC and NEU%were lower in study group than those in control group(P＜0.05).The FEV1/FVC,PEF and FEV1 in study group were higher compared with those in con-trol group(P＜0.05).During treatment,there were no statistical differences in the incidence rates of adverse reactions between both groups(P>0.05).Conclusion:Recombinant human interferon α-1b combined with budesonide aerosol inhalation inhalation for chil-dren with acute bronchitis can quickly relieve the clinical symptoms,and improve the inflammation level,and it has high safety.

Abstract:Objective:To investigate the effects of different immunosuppressant therapy on the efficacy and immune function of patients with generalized myasthenia gravis(MG).Methods:Retrospective analysis of clinical data of 86 patients with systemic MG,they were divided into control group(n=42,thiopyurine+glucocorticoid)and observation group(n=44,tacrolimus+glucocorticoid)according to different treatment methods.Both groups were treated for 1 year.The clinical efficacy,immune function index[Anti-acetyl-choline receptor antibodies(AchR-Ab),serum immunoglobulin A(IgA),immunoglobulin G(IgG)and complement(C4)],muscle function[QMGS scale,myasthenia gravis composite scale(MGC)],daily living scale(ADL)and adverse reactions were compared be-tween the two groups.Results:The total clinical effective rate after treatment was 93.18%in the observation group and 92.86%in the control group,and there was no difference in comparison(P>0.05).After treatment 3 month and 1 year,the QMGS score,MGC score and AchR-Ab,C4 levels of the two groups were lower than those before treatment(P＜0.05),and the ADL score and IgA,IgG levels increased(P＜0.05).The QMGS score and MGC score of the observation group were lower than those of the control group(P＜0.05),and the ADL score was higher than those of the control group at3 months after treatment(P＜0.05).There was no signif-icant difference in the comparison of the remaining indicators(P>0.05).There was no statistically significant difference in the inci-dence of adverse reactions between the two groups(P>0.05).Conclusion:Both azathioprine and tacrolimus can effectively treat sys-temic MG,restore normal muscle activity,improve immune function,and have low adverse drug reactions,but tacrolimus can be effective faster in the short term,and can be reasonably selected according to the needs and specific conditions of patients.

Abstract:Objective:To explore the effects of batroxobin injection combined with enteric-coated aspirin on coagulation func-tion,inflammatory response,and symptoms in patients with deep vein thrombosis following lower limb fractures during the acute phase.Methods:A total of 108 patients with lower limb fractures complicated by deep vein thrombosis were divided into a control group and an observation group according to different treatment methods,with 54 cases in each group.The control group received treatment with enter-ic-coated aspirin,while the observation group received batroxobin injection in addition to aspirin treatment,lasting for 7 days.Both groups continued treatment with enteric-coated aspirin for 7 months to consolidate the therapeutic effect.After 7 days of treatment,the efficacy,coagulation function,blood rheology,inflammation,venous blood flow velocity,lower limb circumference,pain[Visual Analog Scale(VAS)],lower limb symptoms,and incidence of adverse reactions were recorded and compared between the two groups.Results:The effective rate of treatment in the observation group was higher than that in the control group(92.59%vs.77.78%,P＜0.05).Af-ter treatment,the activated partial thromboplastin time(APTT)in the observation group was higher than that in the control group(P＜0.05),while fibrinogen(FIB),prothrombin time(PT),whole blood high shear viscosity,and whole blood low shear viscosity levels were all lower than those in the control group(P＜0.05).Additionally,levels of hypersensitive C-reactive protein(hs-CRP),procalci-tonin(PCT),and interleukin-6(IL-6)in the observation group were lower than those in the control group(P＜0.05).The venous blood flow velocity in the observation group was higher than that in the control group(P＜0.05),and the lower limb circumference,VAS score,lower limb swelling,skin color,and cord-like or nodular scoring were all lower than those in the control group(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:For pa-tients with deep vein thrombosis following lower limb fractures,the short-term efficacy of batroxobin injection combined with enteric-coated aspirin is significant,beneficial for improving coagulation function and blood rheology indicators during the acute phase,and helps reduce inflammation and pain levels,effectively improving lower limb symptoms.It is worthy of clinical promotion and application.

Abstract:Objective:To study the influence of placental morphology and pathological changes on neonatal outcome in patients with premature rupture of membranes(PROM).Methods:100 parturients with PROM were selected as the study group,and 100 nor-mal parturients without PROM during the same period were selected as the control group.HE staining was used to observe the Placental pathological changes and monitor pregnancy outcome.The Placental pathological changes and pregnancy outcome were compared be-tween the two groups.The influencing factors of premature rupture of membranes were analyzed by Single factor and multiple factor Lo-gistic regression analysis.Results:The incidence of placental pathological changes in the study group was higher(P＜0.05).The inci-dence of adverse pregnancy outcome in the study group was higher than that in the control group(23.00%vs.5.00%,P＜0.05).Uni-variate analysis showed that there were no statistically significant difference in the incidence of uterine malformations,cervical dysfunc-tion,polyhydramnios,anemia during pregnancy,placenta previa,and history of induced labor or miscarriage between the two groups(P>0.05).In the study group,gestational diabetes,hypertension,abnormal fetal position,multiple births,reproductive tract infection and unknown causes were all higher(P＜0.05).Logistic regression analysis showed that the abnormal fetal position,multiple births,and reproductive tract infection were all independent risk factors for premature rupture of membranes(P＜0.05).Conclusion:Prema-ture rupture of membranes is affected by abnormal fetal position,multiple pregnancies,and reproductive tract infections,and the placenta of patients with premature rupture of membranes has pathological changes,which will lead to poor neonatal outcome.

Abstract:Objective:To analyze the clinical efficacy of Edaravone combined with teneplase in the treatment of vascular demen-tia(VD)after cute ischemic cerebral infarction(AICI).Methods:A total of 210 patients with AD after AICI were included in this study,and were divided into the experimental group and the control group according to different treatment methods,with 105 cases in each group.Both groups received conventional treatment after admission,while the control group received teneplase thrombolytic therapy in the conventional treatment.Based on the experimental group in the control group used the adr in intravenous drip treatment.After 4 weeks of treatment,the clinical efficacy,cognitive function[Mini Mental State Examination(MMSE)and Montreal Cognitive Assess-ment(MoCA)scores],neurological function[National Institutes of Health Stroke Scale(NIHSS)],daily living ability(ADL scores)and related laboratory indexes[levels of vascular endothelial growth factor(VEGF)and hypoxia inducible factor-1α(HIF-1α)]of the two groups were compared.Results:The total effective rate in experimental group was higher than that in the control group(95.24%vs.81.90%,P＜0.05).After 4 weeks of treatment,MMSE,MoCA,VEGF,HIF-1α were increased in both group,and the experimental group was higher than the control group(P＜0.05).The NIHSS scores and ADL were reduced,the and the experimental group was lower than the control group(P＜0.05).Conclusion:Edaravone combined with teneplase is effective in the treatment of VD after AI-CI,which can effectively improve the cognitive and neurological functions of patients,promote vascular repair,inhibit hypoxia,and im-prove patients'ability of daily life.

Abstract:Objective:To analyze the effects of different approaches of omental sac approach and intermediate approach in lapa-roscopic radical resection on inflammatory factors and stressindicatorsin patients with left colon cancer.Methods:80 patients with left-sided colon cancer scheduled for laparoscopic radical surgery were selected as the study subjects.According to different surgical approa-ches,they were divided into a study group(omental bursa approach)and a control group(intermediate approach),with 40 cases in each group.The surgical-related indicators and postoperative recovery of the two groups were compared,and serum inflammatory factors and stress indicators were measured preoperatively and on the third postoperative day.Results:There were no statistically significant differences in surgical time and number of lymph nodes dissected between the two groups(P>0.05),but the study group had lower laparoscopic free time and postoperative drainage volume compared to the control group(P＜0.05).There were no statistically signifi-cant differences in first exhaust time,first defecation time,and feeding time between the two groups(P>0.05),but the study group had a shorter hospital stay compared to the control group(P＜0.05).There were no statistically significant differences in inflammatory factors and stress levels before surgery between the two groups(P>0.05),and the levels of hs-CRP,IL-6,TNF-α,norepinephrine,epi-nephrine,and cortisol in both groups were higher after surgery compared to before surgery(P＜0.05),and the study group was lower than the control group(P＜0.05).Conclusion:Laparoscopic radical surgery with different approaches has different effects on patients with left colon cancer.Compared with the middle approach,omental sac approach can effectively shorten the laparoscopic free time and hospital stay of patients,and has less impact on inflammatory factors and stressindicatorsof patients,which is conducive to early postop-erative rehabilitation of patients.

Abstract:Objective:To explore the clinical value of microscopic clipping and endovascular interventional embolization in the treatment of cerebral aneurysms.Methods:A retrospective analysis was conducted on the clinical data of 90 patients with cerebral aneu-rysms.The patients were divided into clipping group and intervention group according to different surgical techniques,with 45 cases in each group.The perioperative indexes,vascular endothelial function and inflammatory factors before surgery and at 1 week after surgery,nerve function[National Institutes of Health Stroke Scale(NIHSS),Glasgow Outcome Scale(GOS)]at 6 months after surgery in the two groups were compared.Results:The perioperative indexes in intervention group were lower than those in clipping group(P＜0.05).At 1 week after surgery,levels of VEGF and ET-1 in intervention group were lower than those in clipping group(P＜0.05),while CGRP was higher than that in clipping group(P＜0.05).At 1 week after surgery,levels of MMP-9,TNF-α and HIF-1α in inter-vention group were lower than those in clipping group(P＜0.05).At6 months after surgery,NIHSS score in intervention group was lower than that in clipping group,while GOS score was higher than that in clipping group(P＜0.05).Conclusion:Endovascular inter-ventional embolization has advantages such as simple operation and fast postoperative recovery,which can effectively repair vascular and cerebral nerve injury,and reduce inflammatory response in patients with cerebral aneurysms.

Abstract:1 clinical data patient, male, 46 years old. He was admitted to the hospital on June 29, 2023 because of "chest tightness with occasional chest pain for more than half a month". Before admission, chest enhanced CT showed a patchy mixed density shadow on the left side of the anterior upper mediastinum (Fig. 1), which was about 6.3 cm × 5.1 cm × 5.8 cm in size and irregular in shape. The enhancement scan showed uneven and continuous enhancement, and small patchy low-density without enhancement shadow was seen inside, which disappeared from the fat space of adjacent large vessels and closely seemed to have invasion with the pericardium. A patchy low enhancement filling defect (about 2.6 cm × 2.1 cm) was seen in the left brachiocephalic vein (Fig. 2). Consider malignant thymoma and left brachiocephalic vein tumor thrombus formation. After admission, we improved the relevant auxiliary examination and diagnosed malignant thymoma, ct3n0m0 stage Ⅲ a (ajcc/uicc 8th Edition). On July 11, 2023, open chest exploration thymectomy was performed: the median sternal incision was taken.

Abstract:Objective:To explore the effect of Ba Duan Jin combined with whole course nursing on cognitive function,medication compliance and disease recurrence of patients with schizophrenia in remission.Methods:124 patients with schizophrenia in remission were included as the research object.According to the intervention method,they were divided into two groups:the study group and the control group,with 62 cases in each group.The control group received a 4-month full course nursing intervention,while the study group patients received a full course nursing intervention combined with 30 minutes of Baduanjin exercise per day.Before and after the inter-vention,the patients'cognitive function was evaluated by MATRICS Consensus Cognitive Test(MCCB),and their medication compli-ance was evaluated by Frankl Treatment Compliance Scale(FCS).The adverse reactions and recurrence of the two groups were recor-ded during the intervention.Results:After intervention,the MCCB factor working memory scores,the operating speed,and wired test scores of the observation group were lower than those of the control group(P＜0.05).The compliance grade score of the observation group was higher than that of the control group(P＜0.05),and the recurrence rate was lower than that of the control group(P＜0.05).Neither group of patients experienced any adverse reactions during the treatment period.Conclusion:Ba Duan Jin com-bined with combined with whole-course nursing can effectively improve the cognitive level,of schizophrenia patients in remission,but al-so can improve patients'medication compliance and reduce the recurrence rate after discharge.

Abstract:Objective:To explore the effects of external counterpulsation(ECP)therapy combined with exercise intervention on cardiac function,exercise tolerance and negative sentiment in senile patients with coronary heart disease after percutaneous coronary in-tervention(PCI).Methods:110 senile patients with coronary heart disease who underwent PCI were divided into single exercise group(n=55)and combined ECP group(n=55)according to the different intervention methods.Both groups received routine intervention after PCI,on this basis,the single exercise group received exercise intervention,and the combined ECP group received ECP combined exercise intervention,all for 3 months.The levels of cardiac function[left ventricular ejection fraction(LVEF),maximum heart rate(HRmax),cardiac output(CO)],physical endurance[peak oxygen uptake(Peak VO2),perceived fatigue scale(RPE),6-minute walking distance(6-MWD)],Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD)and quality of life questionnaire(SF-36)were compared between the two groups before and after intervention.Results:The LVEF,HRmax,CO,Peak VO2,6-MWD and SF-36 scores of the combined ECP group after intervention were higher than those of the single exercise group(P＜0.05).The scores of RPE,HAMA and HAMD in the combined ECP group were lower than those in the single exercise group(P＜0.05).Conclusion:ECP therapy combined with exercise intervention can improve the cardiac function and physical endurance of senile patients with coro-nary heart disease after PCI,relieve anxiety and depression,and improve the quality of life.

Abstract:Objective:To explore the effects of different pneumoperitoneum pressures on intraoperative hypothermia,stress re-sponse and postoperative recovery in patients undergoing laparoscopic total hysterectomy.Methods:A total of 80 patients with laparo-scopic total hysterectom were divided into low pressure group and high pressure group accordingto to the given pneumoperitoneum pres-sure,with 40 cases in each group.The pneumoperitoneum pressure of the low pressure group and the high pressure group was 12 mmHg and 14 mmHg,respectively.The body temperature[core body temperature before pneumoperitoneum(T0),10 min after pneumoperito-neum(T1),20 min after pneumoperitoneum(T2),30 min after pneumoperitoneum(T3),5 min after operation(T4),incidence of hy-pothermia],postoperative recovery[anesthesia recovery time,extubation time],stress response[serum norepinephrine(NE),cortisol(Cor)levels at T0,T1,T2,T3 and T4]and postoperative recovery were compared between the two groups.Results:The core body tem-perature at T1～T4 in the low pressure group was higher than that in the high pressure group(P＜0.05).Theincidenceof hypothermia in the low pressure group was lower than that in the high pressure group(P＜0.05).The levels of NE and Cor in the low pressure group were lower than those in the high pressure group at T1～T4(P＜0.05).The anesthesia recovery time,extubation time,the first exhaust,defecation and hospitalization time in the low-pressure group were shorter than those in the high-pressure group(P＜0.05).Conclusion:The establishment of pneumoperitoneum with 12 mmHg and 14 mmHg pressure in laparoscopic total hysterectomy can en-sure the smooth development of the operation.When low CO2 pressure(12 mmHg)is used to establish pneumoperitoneum during oper-ation,it can slow down the decrease of body temperature,reduce the incidence of hypothermia,promote postoperative recovery,and have less stress response,which is more conducive to postoperative recovery.