Abstract:The clinical data of a patient with recurrent fever,diagnosed with Mycobacterium avium infection complicated with multiple bone destruction via bone marrow metagenomic next-generation sequencing at The First Affiliated Hospital of Hainan Medical University on July 29,2025,were analyzed,and a literature review was conducted.The patient was a 58-year-old female admitted due to"fever for more than 2 months".She had been previously hospitalized in our department for fever;Mycobacterium intracellulare was detected in the alveolar lavage fluid collected via bronchoscope,and fever subsided after anti-nontuberculous mycobacterium treatment.Half a year later,the patient developed recurrent fever,and was re-admitted due to aggravated fever.She also had repeated significant elevation of white blood cell count,but chest CT on admission showed resolution of lesions compared with previous findings.Whole-body bone scan revealed multiple bone destruction throughout the body.Bone marrow aspiration biopsy was performed,which detected Mycobacterium avium and viral infection.The patient received anti-nontuberculous mycobacterium and antiviral treatment again,and fever subsided after treatment.For patients with nontuberculous mycobacterium pulmonary disease,when systemic bone destruction occurs while pulmonary lesions resolve,the possibility of other nontuberculous mycobacterium infections complicated by bone destruction should not be ignored.

Abstract:Objective To compare the clinical efficacy and safety of unilateral biportal endoscopy(UBE)and percutaneous endoscopic transforaminal discectomy(PETD)in the treatment of prolapsed and sequestered lumbar disc herniation.Methods A total of 202 patients with prolapsed and sequestered lumbar disc herniation who underwent surgical treatment in the Fourth Hospital of Changsha from September 2020 to January 2024 were enrolled.According to the surgical method received,the patients were divided into two groups,including 113 cases in the UBE group and 89 cases in the PETD group.The basic clinical data of the two groups were collected,and the operation time,intraoperative blood loss,number of intraoperative X-ray fluoroscopies and postoperative hospital stay were recorded respectively.The pain degree and functional recovery of the two groups were evaluated before surgery as well as at 1 d,3 months and 12 months after surgery,and the evaluation results were statistically analyzed using the visual analogue scale(VAS)score and oswestry disability index(ODI)score.The clinical efficacy of patients was evaluated and graded using the modified Macnab criteria at 3 months and 12 months after surgery.The incidence of postoperative complications in the two groups was recorded and statistically analyzed.Results The operation time and intraoperative blood loss in the UBE group were significantly less than those in the PETD group[(57±10)min vs(64±11)min;(29±8)ml vs(36±9)ml](both P＜0.05).At 3 months after surgery,the excellent and good rate in the UBE group was significantly higher than that in the PETD group[84.1％(95/113)vs 74.2％(66/89)](P=0.033).At 12 months after surgery,there was no statistically significant difference in the excellent and good rate between the two groups(P=0.173).The results of repeated measures analysis of variance showed that there were statistically significant time effects on VAS scores and ODI scores in both groups(both P＜0.001),indicating that overall,the postoperative pain of patients gradually decreased and the function continuously improved with the extension of time.The total incidence of postoperative complications in the UBE group was significantly lower than that in the PETD group[7.1％(8/113)vs 18.0％(16/89)](P=0.038).Conclusion In the treatment of prolapsed and sequestered lumbar disc herniation,UBE has more satisfactory short-term efficacy and higher surgical safety than PETD,while the two surgical methods have similar long-term clinical efficacy.

Abstract:Objective To analyze the factors related to the occurrence of intrauterine adhesions after hysteroscopic surgery versus curettage in the treatment of early missed abortion.Methods A total of 60 patients with missed abortion admitted to the Third People's Hospital of Yunnan Province from January 2024 to June 2025 were selected as the research objects.They were divided into group A and group B by random number table method,with 30 cases in each group.Group A underwent routine curettage,and group B underwent hysteroscopic removal of gestational products.The surgical indicators,postoperative human chorionic gonadotropin(HCG)levels,menstrual recovery,endometrial thickness,pulsatility index(PI)and resistance index(RI)of subendometrial blood flow,and intrauterine adhesions were compared between the two groups.Results The operation time,intraoperative blood loss,hospital stay,and postoperative vaginal bleeding time in group B were significantly shorter/less than those in group A[(10.2±2.1)min vs(14.7±2.0)min,(35.3±5.6)mlvs(46.6±5.3)ml,(5.1±0.6)d vs(6.3±0.7)d,(6.0±0.9)d vs(7.8±1.0)d](t=8.227,8.005,6.481,7.272,all P＜0.001).With the passage of time,the HCG values in both groups showed a downward trend,and the HCG values in group B at 24 h,1 week,and 1 month after surgery were significantly lower than those in group A(all P＜0.05).The menstrual recovery time and the proportion of reduced menstrual volume in group B were significantly shorter/lower than those in group A(all P＜0.05).At 3 months after surgery,the endometrial thicknesses in both groups were significantly greater than those at 1 month after surgery,and the endometrial thicknesses in group B at 1 and 3 months after surgery were significantly greater than those in group A[(5.8±0.8)mm vs(4.4±0.7)mm,(8.0±0.9)mm vs(6.2±0.8)mm](t=7.859,8.094,all P＜0.001).At 3 months after menstrual resumption,the PI and RI values in both groups were significantly lower than those at 1 month after menstrual resumption,and those in group B were significantly lower than those in group A[(1.52±0.29)vs(2.17±0.41),(0.62±0.06)vs(0.75±0.09)](t=7.089,6.583,all P＜0.001).The incidence of intrauterine adhesions in group B was significantly lower than that in group A[6.7％(2/30)vs 26.7％(8/30)](x2=4.320,P=0.038).Conclusion Compared with routine curettage,hysteroscopic surgery can reduce the occurrence of intrauterine adhesions after early missed abortion,promote endometrial repair,improve uterine hemodynamics,and is conducive to protecting patients' reproductive function.It can be used as the preferred surgical method for missed abortion.

Abstract:Ischemic stroke(IS)is one of the most important diseases leading to death and long-term disability worldwide.In recent years,microRNA(miR),as an important gene expression regulator,has attracted extensive attention in its role in IS.MiR plays a variety of roles in stroke pathology and repair by regulating inflam-mation,apoptosis,blood-brain barrier permeability,neuronal survival and synaptic plasticity.Studies have shown that miR has bidirectional regulatory properties,which can not only aggravates ischemic brain damage(for example,miR-155,miR-34a),but also reduce brain damage and promote repair(for example,miR-21,miR-124,miR-132).In addition,miR plays a dynamic role in different stages and different pathological mechanisms of stroke,which provides a new perspective for the diagnosis and treatment of stroke.This review systematically summarized the mechanism of miR in IS,focusing on its regulatory role in inflammatory response,oxidative stress,apoptosis,blood-brain barrier injury and brain edema,and neural network repair.In addition,the limitations of current research were analyzed and future development directions were prospected.

Abstract:Objective To investigate the effects of dexmedetomidine combined with oxycodone on mean arterial pressure(MAP),heart rate,inflammatory response and oxidative stress in patients undergoing percutaneous transforaminal endoscopic lumbar discectomy(PELD).Methods A total of 100 patients with lumbar disc herniation(LDH)who underwent PELD in The First Affiliated Hospital of Xinjiang Medical University from January 2024 to January 2025 were randomly selected.According to the random number table method,they were divided into the control group and the observation group,with 50 cases in each group.The control group was intravenously injected with oxycodone before anesthesia induction,and the observation group was intravenously injected with oxycodone combined with dexmedetomidine before anesthesia induction.MAP,heart rate,visual analogue scale(VAS)score,inflammatory response indicators[interleukin-1 β(IL-1β),IL-8,IL-6,tumor necrosis factor-α(TNF-α)],oxidative stress indicators[malondialdehyde,superoxide dismutase(SOD)]and adverse reactions were compared between the two groups at different time points.Results The MAP and heart rate of the observation group during T2 to T5 were significantly lower than those of the control group(all P＜0.05).The VAS scores of the observation group at 1,12,and 24 h after surgery were significantly lower than those of the control group[(3.0±0.5)vs(3.7±0.5),(2.1±0.4)vs(2.6±0.5),(1.5±0.3)vs(2.2±0.5)](all P＜0.05).The inflammatory response indexes of the observation group at 1,2 and 3 d after operation and the malondialdehyde levels at 1 and 2 d after operation were significantly lower than those of the control group,and the SOD levels at 1 and 2 d after operation were significantly higher than those of the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.674).Conclusion Dexmedetomidine combined with oxycodone has a good anesthetic effect in PLED surgery of LDH patients,which can effectively improve the MAP and heart rate of patients,reduce postoperative pain,and inhibit inflammatory response and oxidative stress.

Abstract:Post-infarction ventricular septal rupture(PIVSR)is a rare but fatal mechanical complication of acute myocardial infarction(AMI).In the reperfusion era,its incidence has decreased to below 1％,yet once it occurs,the mortality rate remains extremely high(ranging from 40％to 90％).The core pathophysiology is the rupture of the transmural infarct zone,leading to left-to-right shunt and rapid hemodynamic deterioration.The clinical manifestation is mostly sudden exacerbation of the condition after AMI,accompanied by a new-onset cardiac murmur,and bedside echocardiography is the preferred diagnostic method.Treatment requires multidisciplinary collaboration,with individualized selection of medications,mechanical circulatory support(such as intra-aortic balloon pump,extracorporeal membrane oxygenation),and ultimately surgical repair or transcatheter closure as the definitive treatments.The timing of surgery is controversial and requires balancing hemodynamic stability and the degree of tissue fibrosis.The prognosis is extremely poor,affected by multiple factors such as advanced age,cardiogenic shock,rupture location and surgical timing.This paper summarizes and discusses the epidemiology,pathophysiology,diagnosis,treatment and prognosis of PIVSR to guide clinical practice.

Abstract:Objective To evaluate and analyze the rationality of clinical application of Kanglaite injection,in order to provide reference for the rational use of Kanglaite injection.Methods From the electronic medical record system of Chaohu Hospital of Anhui Medical University,120 medical records using Kanglaite injection from January to April(before the special review)and 120 medical records from September to December 2023(after the special review)were randomly selected for retrospective analysis.The gender,age,clinical department,clinical diagnosis,treatment course,usage and dosage of the patients were statistically analyzed,the use rule was analyzed,and the rationality of clinical use was evaluated.The rationality data of the drug application before and after the special review were compared.Results Before the special review,the oncology department had the highest number of 120 hospitalized patients who received Kanglaite injection,with 77 cases(64.2％),followed by the respiratory department with 41 cases(34.2％);non-small cell lung cancer was the most commonly diagnosed disease(77 cases,accounting for 64.2％),followed by primary liver cancer(10 cases,accounting for 8.3％).The indications for use were consistent with the drug instructions.The route of administration of Kanglaite injection was intravenous drip,and the frequency of administration was once a day,which was in line with the recommendation of the instructions.There were 108 cases(90.0％)with a single dose of 200 ml,which met the recommendation of the manufacturer's instructions.Four patients(3.3％)had abnormal fat metabolism,which was a contraindication.The proportion of off-label use without indications in 120 patients after the special review was significantly lower than that before the special review,and the proportion of reasonable medication course was significantly higher than that before the special review[13.3％(16/120)vs 27.5％(33/120),25.0％(30/120)vs 1.7％(2/120)](both P＜0.05).No contraindications were found after the special review.Conclusions There are some unreasonable phenomena in the clinical use of Kanglaite injection,mainly manifested as off-label indication,short course of medication,and small single dose.Clinicians should strictly follow the drug instructions and relevant guidelines to improve the rationality of clinical use of Kanglaite injection.

Abstract:Objective To evaluate the clinical efficacy and safety of Zhenzhu Tongluo pill in the treatment of pain caused by spinal cord,root nerve and cauda equina nerve compression.Methods A randomized,double-blind,placebo-controlled trial was conducted to select 160 patients aged 25-65 years who were diagnosed with pain caused by spinal cord,root nerve,or cauda equina nerve compression and treated at the First Affiliated Hospital of Zhengzhou University from August to October 2024.The patients were randomly divided into the observation group and the control group by computer randomization method,with 80 cases in each group.The observation group was given Zhenzhu Tongluo pill on the basis of conventional medication,and the control group was given placebo on the basis of conventional medication.The course of treatment was 12 weeks for both groups.The visual analogue scale(VAS)score,modified Japanese Orthopaedic Association Evaluation of Treatment Score(mJOA),Short Form Health Survey(SF-36)scores,pain relief time,efficacy and safety were compared between the two groups before and after treatment.Results After 4,8 and 12 weeks of treatment,the VAS scores of the two groups were lower than those before treatment,the mJOA scores were higher than those before treatment,the VAS scores of the obser-vation group at each time point were significantly lower than those of the control group,and the mJOA scores were higher than those of the control group(all P＜0.05).After 12 weeks of treatment,the SF-36 scores of the two groups were higher than those before treatment,and the SF-36 score of the observation group was significantly higher than that of the control group(all P＜0.05).The pain relief time of the observation group was significantly shorter than that of the control group(P＜0.001).The total effective rate of the observation group was significantly higher than that of the control group[83.8％(67/80)vs 38.8％(31/80)](P＜0.001).Before and after treatment,the blood routine,urine routine,liver and kidney function,and coagulation function of patients in the two groups were within the normal range.Conclusion Zhenzhu Tongluo pill has significant effect and good safety in the treatment of pain caused by spinal cord,root nerve or cauda equina nerve compression,which provides a strong basis for clinical treatment.

Abstract:The most common persistent type of atrial tachycardia is atrial fibrillation,and cardiac dysfunc-tion and stroke are the major risks for patients.In recent years,with the continuous monitoring of atrial electrical activity by cardiac implantable electronic devices(CIEDs),an early asymptomatic atrial fibrillation,called subclinical atrial fibrillation,has been found,which leads to an increased risk of thromboembolism.It was previ-ously only found after the occurrence of complications such as ischemic stroke or congestive heart failure.This review will discuss the definition,incidence,risk factors,stroke relationship,and anticoagulation of subclinical atrial fibrillation associated with CIEDs,and summarize its progress.

Abstract:Objective To investigate the correlation between serum peroxisome proliferator-activated receptor γ coactivator 1α(PGC-1α)and soluble CD40 ligand(sCD40L)levels with cognitive impairment and their predictive value in patients with acute cerebral infarction(ACI)complicated with cerebral microbleeds.Methods A total of 291 patients with ACI complicated with cerebral microbleeds admitted to the Department of Neurology,363 Hospital from June 2021 to March 2025 were enrolled as research subjects.According to the presence or absence of cognitive impairment,the patients were divided into the cognitive impairment group(124 cases)and non-cognitive impairment group(167 cases).Serum levels of PGC-1α and sCD40L were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was used to identify the influencing factors for cognitive impairment in patients with ACI complicated with cerebral microbleeds.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the combined prediction model constructed based on PGC-1α and sCD40L for cognitive impairment in patients with ACI complicated with cerebral microb-leeds.Results The serum PGC-1α level in the cognitive impairment group was significantly lower than that in the non-cognitive impairment group[(0.58±0.12)μg/L vs(0.85±0.10)μg/L],while the serum sCD40L level was significantly higher than that in the non-cognitive impairment group[(330±59)ng/L vs(226±21)ng/L](both P＜0.001).Multivariate Logistic regression analysis showed that high National Institutes of Health Stroke Scale(NIHSS)score and high sCD40L level were risk factors for cognitive impairment in patients with ACI complicated with cerebral microbleeds,while high PGC-1α level was a protective factor(all P＜0.05).A combined prediction model for cognitive impairment in patients with ACI complicated with cerebral microbleeds was constructed based on the probability risk model derived from the above multivariate regression:Logit[P/(1-P)]=-0.166+0.141 × NIHSS score-0.536 × PGC-1α+0.716 × sCD40L.ROC analysis with the model value as the predictive effect size showed that the area under the curve of the combined prediction model was 0.828(95％confidence interval:0.673-0.988),with a sensitivity of 84.7％and specificity of 82.0％.Conclusion Decreased serum PGC-1α level and increased sCD40L level are associated with cognitive impairment in patients with ACI complicated with cerebral microbleeds.The combined prediction model constructed based on PGC-1α and sCD40L can well evaluate the risk of cognitive impairment in these patients.

Abstract:Objective To investigate the correlation between serum long-chain acyl-CoA synthetase 4(ACSL4)and inter-alpha-trypsin inhibitor heavy chain 4(ITIH4)levels with neurological deficit severity and prognosis in patients with acute intracerebral hemorrhage(ICH).Methods A total of 200 ICH patients admitted to North China University of Science and Technology Affiliated Hospital from January 2020 to June 2024 were retro-spectively enrolled as the ICH group,and 150 healthy subjects who underwent physical examination during the same period were selected as the control group.According to the National Institutes of Health Stroke Scale(NIHSS)score at admission,ICH patients were divided into the mild group(36 cases),moderate group(90 cases)and severe group(74 cases).According to the modified Rankin Scale(mRS)score during follow-up,ICH patients were divided into the good prognosis group(131 cases)and poor prognosis group(69 cases).The differences in serum ACSL4 and ITIH4 levels among the above subgroups were compared.Pearson correlation analysis was used to analyze the correlation between serum ACSL4,ITIH4 levels and NIHSS,mRS scores.Multivariate Logistic regression model was used to analyze the influencing factors for poor prognosis in ICH patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum ACSL4,ITIH4 levels and their combination for the prognosis of ICH patients.Results The serum ACSL4 level in the ICH group was significantly higher than that in the control group,while the serum ITIH4 level was significantly lower than that in the control group(both P＜0.05).With the aggravation of neurological deficit in ICH patients,the serum ACSL4 level showed a gradient increase,while the serum ITIH4 level showed a gradient decrease(all P＜0.05).The serum ACSL4 level in the poor prognosis group was significantly higher than that in the good prognosis group,while the serum ITIH4 level was significantly lower than that in the good prognosis group(both P＜0.05).The NIHSS score and mRS score at admission in the poor prognosis group were significantly higher than those in the good prognosis group(all P＜0.05).Serum ACSL4 level was positively correlated with NIHSS score and mRS score(r=0.428,0.438,both P＜0.001),while serum ITIH4 level was negatively correlated with NIHSS score and mRS score(r=-0.512,-0.455,both P＜0.001).Multivariate Logistic regression analysis showed that NIHSS score,mRS score,serum ACSL4 level and serum ITIH4 level were all influencing factors for the prognosis of ICH patients(all P＜0.05).ROC curve analysis showed that the areas under the curve(AUC)of ACSL4 and ITIH4 alone for predicting poor prognosis in ICH patients were 0.753 and 0.825 respectively,and the AUC of their combination was increased to 0.874,which was superior to that of single index prediction(both P＜0.05).Conclusion The serum ACSL4 level is abnormally increased and the serum ITIH4 level is abnormally decreased in ICH patients,both of which are closely related to the severity of neurological deficit.The combination of the two has a good predictive value for the prognosis of ICH patients.

Abstract:Objective To investigate the characteristics of immune reconstitution in patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and its correlation with clinical prognosis.Methods The clinical data of 208 patients who underwent allo-HSCT in the Department of Hematology,the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2022 were collected.Peripheral blood lymphocyte subsets and immunoglobulin(Ig)levels were measured before transplantation and at 30th,60th and 90th days after transplantation.The correlation between immune reconstitution and acute graft-versus-host disease(aGVHD)and overall survival was analyzed.Results The reconstitution of B cells and natural killer cells(NK cells)after allo-HSCT was faster,and the reconstitution of CD8+T cells was the second.The reconstitution of CD3+,CD4+T and Ig cells was slower than that after allo-HSCT.On the 30th day after allo-HSCT,the counts of CD4+T lymphocytes in the aGVHD group were higher than those in the non-aGVHD group[209(151,265)× 106/L vs 67(37,121)×106/L],while the counts of CD8+T lymphocytes and NK cells in the aGVHD group were lower than those in the non-aGVHD group[94(50,137)×106/L vs 185(104,280)× 106/L、158.0(113.8,306.8)×106/L vs 321.0(165.0,421.0)×106/L](all P＜0.05).The counts of CD3+T,CD8+T lymphocytes,B cells and NK cells in aGVHD group were lower than those in non-aGVHD group on the 60th day after allo-HSCT(all P＜0.05).On the 90th day after allo-HSCT,the counts of CD3+T,CD4+T,CD8+T lymphocytes and B cells in the aGVHD group were lower than those in the non-aGVHD group(all P＜0.05).The median time to aGVHD was the 41 st day after transplantation.The incidence of aGVHD was positively correlated with the counts of CD4+T lymphocytes,and negatively correlated with the counts of CD8+T lymphocytes,NK cells,IgG and IgA before the occurrence of aGVHD(all P＜0.05).The incidence of aGVHD was negatively correlated with the counts of CD3+T,CD8+T lymphocytes and B cells(all P＜0.05).The patients with higher peripheral blood CD4+cell counts(≥130.5 × 106/L)before the 41st day after transplantation had a better survival rate than those with lower peripheral blood CD4+cell counts(＜130.5 × 106/L)(P=0.016).Conclusion The immune reconstitution after allo-HSCT is correlated with the occurrence of aGVHD and overall survival,and the high CD4+T lymphocyte counts(≥130.5 × 106/L)in the early stage after allo-HSCT is associated with a better prognosis.

Abstract:Objective To investigate the etiology,clinical characteristics,diagnosis and treatment of small intestinal diseases with chronic diarrhea as the main symptom,and to improve the understanding and timely diagnosis and treatment of related small intestinal diseases.Methods From January 2016 to January 2020,patients hospitalized in the Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences with chronic diarrhea as the first and main symptom,without evidence of esophageal,gastric or colorectal involvement by imaging and endoscopy,and with small intestinal lesions were retrospectively enrolled.The general information,etiology,clinical manifestations,nutritional and inflammatory status of the patients were analyzed.Results A total of 23 patients were enrolled,including 17 males and 6 females,with the most patients aged 19-44 years[12 cases(52.2％)].The median time from the onset of symptoms to the final diagnosis was 1 year.The main cause was immune-related diseases[17 cases(73.9％)],followed by small intestinal malabsorption syndrome[4 cases(17.4％)]and infectious diseases[2 cases(8.7％)].In addition to chronic diarrhea,the symptoms of digestive system were often accompanied by abdominal pain[17 cases(73.9％)],hematochezia[5 cases(21.7％)],nausea and vomiting[6 cases(26.1％)].Most patients were at risk of malnutrition,mainly manifested as emaciation,anemia and hypoalbuminemia.Conclusions There is a wide spectrum of diseases with chronic diarrhea as the main manifestation and small intestinal involvement alone.Most of them are rare small intestinal diseases,such as autoimmune enteritis,which are difficult to diagnose.For patients with unexplained chronic diarrhea,we should pay attention to the etiology of small intestinal diseases and make timely diagnosis and treatment.

Abstract:Objective To investigate the association between dietary index of gut microbiota(DI-GM)and heart failure in a cross-sectional study.Methods The data of this study were collected from the United States National Health and Nutrition Examination Survey database 2007-2020.The inclusion criteria were 20-80 years old,33 665 subjects were included after excluding those missing information on heart failure,incomplete 2 d 24 h dietary recall,and missing data required for DI-GM calculation.DI-GM was calculated based on the data from two dietary retrospective interviews.Multivariate Logistic regression analysis was used to explore the relationship between DI-GM and heart failure.A restricted cubic spline model was constructed to determine the non-linear relationship between DI-GM and heart failure.Subgroup analysis by age,sex,etc.,and interaction was evaluated.Results A total of 33 665 participants were included in this study.The prevalence of heart failure was 3.3％(1 122 cases)and the weighted DI-GM score was 5(4,6).According to the presence or absence of heart failure,the patients were divided into heart failure group and non-heart failure group.There were significant differences in age,gender,race,education level,marital status,family income/poverty line,body mass index,health behavior,and disease history between the heart failure group and the non-heart failure group(all P＜0.05),and the weighted score of DI-GM in the heart failure group was lower than that in the non-heart failure group(P=0.002).The results of weighted multivariate Logistic regression analysis showed that after adjusting for covariates in different models,the increase in DI-GM was associated with a reduced risk of heart failure(all P＜0.05).The DI-GM subgroup analysis showed that the risk of heart failure decreased with the increase of scores(the P-values for trend were all less than 0.001).The restricted cubic spline model showed a linear association between DI-GM and the risk of heart failure(nonlinearity test P=0.522).Subgroup analysis showed no significant interaction between DI-GM and heart failure in each subgroup(all P＞0.05).Conclusion DI-GM is independently associated with the risk of heart failure,and high level of DI-GM has a protective effect on heart failure.

Abstract:Objective To analyze the value of magnetic resonance imaging(MRI)three-dimensional ultra-short echo time(UTE)sequence in the prognosis evaluation of non-small cell lung cancer(NSCLC).Methods A total of 220 patients with NSCLC admitted to Hengshui Second People's Hospital,Hebei Province from January 2020 to February 2024 were selected.All patients underwent conventional MRI and three-dimensional UTE sequence MRI.The results of pathological biopsy were used as the standard to analyze the diagnostic efficacy of conventional MRI and three-dimensional UTE sequence MRI in the clinical staging of NSCLC.After a 1-year follow-up,patients were divided into a good prognosis group(141 cases)and a poor prognosis group(79 cases).Data such as lung function,signal intensity(SIN)of UTE during full expiration,and UTE-T2* were compared between the two groups.The relationship between clinical indicators and prognosis of patients and the diagnostic value of UTE sequence in the prognosis of NSCLC were analyzed.Results Among 220 NSCLC patients,34 cases were diagnosed as TNM stage Ⅰ,70 cases as TNM stage Ⅱ and 116 cases as TNM stage Ⅲ A by pathological biopsy.The consistency between conventional MRI and pathological biopsy was 0.824(P＜0.05),and the con-sistency between the three-dimensional UTE sequence and pathological biopsy was 0.945(P＜0.05).SIN showed a downward trend and UTE-T2* showed an upward trend in TNM stage Ⅰ,Ⅱ and Ⅲ patients(all P＜0.001).Age,proportion of TNM stage Ⅲ A,tumor diameter,proportion of lymph node metastasis and UTE-T2* in the poor prognosis group were higher than those in the good prognosis group(all P＜0.01),and SIN was lower than that in the good prognosis group(P＜0.05).Binary Logistic regression analysis showed that age,TNM stage,tumor diameter,lymph node metastasis and UTE-T2*were risk factors for poor prognosis of NSCLC patients,and high SIN was a protective factor for poor prognosis of NSCLC patients(all P＜0.05).The receiver operating characteristic curve analysis showed that the area under the curve of the combination of SIN and UTE-T2*was 0.828,and the sensitivity and specificity were 89.97％and 80.14％,respectively.Conclusion MRI three-dimensional UTE sequence can effectively identify the clinical stage of NSCLC,and its quantitative parameters are related to the prognosis of NSCLC patients,which can be used for clinical diagnosis of NSCLC.

Abstract:Objective To investigate the relationship between electrocardiographic parameters T-wave peak-end interval(Tp-Te)and corrected QT interval(QTc)and the risk of malignant arrhythmia in patients with hypertrophic cardiomyopathy(HCM).Methods A total of 333 patients with HCM admitted to the 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2020 to May 2024 were retrospectively selected.According to the results of 24 h ambulatory electrocardiography,patients with malignant arrhythmia were included in the observation group(102 cases),and those without malignant arrhythmia were included in the control group(231 cases).Clinical data and electrocardiographic parameters of the patients were collected.Multivariate regression models were used to adjust for confounding factors and analyze the independent correlations of Tp-Te and QTc with malignant arrhythmia;LOWESS smoothing curves were applied to explore their relationships with heart rate variability;stratified regression was performed to evaluate the associations in different subgroups.Results The proportion of males,age,left ventricular end-systolic diameter,left atrial volume index,left atrial diameter,and interventricular septum thickness in the observation group were all higher than those in the control group,while the left ventricular end-diastolic diameter and left ventricular ejection fraction were lower than those in the control group(all P＜0.05).The Tp-Te[(109±16)ms vs(77±15)ms]and QTc[(438±36)ms vs(412±34)ms]in the observation group were significantly higher than those in the control group,and the standard deviation of normal-to-normal R-R intervals(SDNN),standard deviation of average R-R intervals(SDANN),and root mean square of successive differences in adjacent R-R intervals(RMSSD)were lower than those in the control group(all P＜0.05).Results of independent correlation analysis showed that after adjusting for confounding factors,patients with lower levels of SDNN,SDANN,and RMSSD,as well as higher levels of Tp-Te and QTc,had a higher risk of developing malignant arrhythmia(all P＜0.05).Stratified analysis showed that Tp-Te and QTc were correlated with the risk of malignant arrhythmia in all subgroups stratified by gender,age,and cardiac structure(all P＜0.05).Threshold analysis indicated that the inflection points of Tp-Te and QTc affecting the occurrence of malignant arrhythmia were 92.66 ms and 424.66 ms,respectively.Below the thresholds,the risk decreased with the increase of these parameters,while above the thresholds,the risk increased with the elevation of these parameters.Conclusions Tp-Te and QTc are independent predictors of malignant arrhythmia in patients with HCM,with clear threshold effects.Combined with reduced heart rate variability,these parameters can provide key evidence for risk stratification and early intervention in HCM patients,optimizing clinical manage-ment strategies.

Abstract:Objective To observe the effect of proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitor on lipoprotein(a)level in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 60 STEMI patients admitted to Liuzhou Workers'Hospital,Guangxi Zhuang Autonomous Region from January to July 2024 were enrolled.The patients were divided into the control group and the observation group according to the random number table method,with 30 cases in each group.Both groups received standard treatment,and the observation group was subcutaneously injected with evolocumab 140 mg immediately after primary percutaneous coronary intervention(PPCI)on the basis of standard treatment.The levels of peripheral blood PCSK9 and lipoprotein(a)were measured before PPCI as well as on the 3rd,7th and 14th days after PPCI.The differences between the two groups were compared,and the correlation between PCSK9 and lipoprotein(a)was analyzed.Results On the 3rd,7th and 14th days after surgery,the serum PCSK9 concentrations in both groups were lower than those before surgery.Compared with the control group,the serum PCSK9 concentration in the observation group showed a faster and more significant downward trend,and the PCSK9 concentrations in the observation group were lower than those in the control group on the 3rd,7th and 14th days after surgery(all P＜0.05).On the 14th day after surgery,the lipoprotein(a)level in the observation group was significantly lower than that in the control group[169.5(108.3,194.7)mg/L vs 224.7(140.1,308.5)mg/L](Z=-4.482,P＜0.001).Spearman correlation analysis showed that serum PCSK9 concentration was significantly positively correlated with lipoprotein(a)concentration in STEMI patients(r=0.248,P＜0.001).Conclusion Administration of PCSK9 inhibitor within 24 hours after PPCI can significantly accelerate lipoprotein(a)metabolism,with a 33.8％reduction on the 14th day after surgery,which is significantly superior to standard treatment alone.The decrease of lipoprotein(a)presents a delayed acceleration mode and is closely related to the degree of PCSK9 inhibition,which provides a new path reference for precise residual risk management in patients with STEMI.

Abstract:In modern lifestyles,physical inactivity and changes in dietary structure have led to an increasing prevalence of obesity.As an independent chronic disease and a pathogenic factor for various chronic conditions,obesity has become a major public health issue in China.Inflammatory bowel disease(IBD)is a chronic nonspe-cific inflammatory intestinal disorder with a rising prevalence,which parallels the epidemiological trend of obesity.Therefore,this review summarizes the research progress on the relationship between obesity and IBD,aiming to better understand the role of obesity in the pathogenesis and progression of IBD and provide a theoretical basis for clinical diagnosis and treatment.

Abstract:Objective To investigate the correlation of peripheral blood pro-nerve growth factor(proNGF)and GATA binding protein 3(GATA3)with severity and cognitive function in patients with Parkinson's disease(PD).Methods A total of 158 patients with PD(PD group)admitted to the Fourth Affiliated Hospital of Nanjing Medical University from January 2020 to March 2023 and 80 healthy volunteers(control group)who had recently visited the hospital for physical examination were retrospectively selected.PD patients were divided into early stage group(Hoehn-Yahr stage 1 to 2.5,32 cases),middle stage group(Hoehn-Yahr stage 3,76 cases)and late stage group(Hoehn-Yahr stage 4 to 5,50 cases)according to the severity of the disease.According to their cognitive function,they were divided into PD dementia(PDD)group[PD cognitive rating scale(PD-CRS)score ≤73,37 cases],PD mild cognitive impairment(PD-MCI)group(PD-CRS score 74 to 80,68 cases)and normal cognitive group(PD-CRS score＞80,53 cases).The levels of proNGF and GATA3 in peripheral blood were detected.The correlation between proNGF and GATA3 levels in peripheral blood of patients with PD and Hoehn-Yahr stage was analyzed.Unconditional ordinal multinomial Logistic regression was used to analyze the relationship between peripheral blood proNGF and GATA3 levels and the development of cognitive impairment in PD patients.The receiver operating characteristic curve was used to analyze the predictive efficiency of peripheral blood proNGF and GATA3 levels on cognitive impairment.Results The level of proNGF in PD group was higher than that in control group,and the the level of GAT A3 was lower than that in control group(both P＜0.001).The level of proNGF in the late stage group,the middle stage group and the early stage group showed a downward trend,and the level of GATA3 showed an upward trend(all P＜0.001).The Hoehn-Yahr scale was positively correlated with the level of proNGF(r=0.775,P＜0.001)and negatively correlated with the level of GATA3(r=-0.780,P＜0.001)in PD patients.proNGF was an independent risk factor for cognitive impairment in PD patients,and GATA3 was an independent protective factor(all P＜0.001).The area under the curve of peripheral blood proNGF and GATA3 levels combined to evaluate cognitive impairment and PDD in PD patients was 0.873 and 0.868,which was larger than those of peripheral blood proNGF and GAT A3 levels alone(both P＜0.05).Conclusions Elevated levels of proNGF and decreased levels of GAT A3 in peripheral blood of PD patients are closely related to disease severity and cognitive impairment.The combination of proNGF and GATA3 levels in peripheral blood has a high energy efficiency in evaluating cognitive impairment and PDD in PD patients.

Abstract:Objective To investigate the predictive value of low triiodothyronine(T3)syndrome(LT3S)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score for the prognosis of patients with Klebsiella pneumoniae pneumonia.Methods The medical records of 63 patients with Klebsiella pneumoniae pneumonia admitted to Beijing Chao-Yang Hospital,Capital Medical University from January 2020 to December 2024 were retrospectively analyzed.The patients were divided into the survival group(26 cases)and the death group(37 cases)according to 30 d survival status.The clinical indicators were compared between the LT3S group(44 cases)and the normal T3 group(19 cases).The area under the receiver operating characteristic(ROC)curve(AUC)and Logistic regression analysis were used to evaluate the predictive value of LT3S and APACHE Ⅱscore for the prognosis of patients with Klebsiella pneumoniae pneumonia.Results The incidence of LT3 S in the death group was higher than that in the survival group[83.8％(31/37)vs 50.0％(13/26)](P=0.004).Logistic regression analysis showed that LT3 S and APACHE Ⅱ score were independent risk factors for 30 d death in patients with Klebsiella pneumoniae pneumonia(both P＜0.05).ROC curve analysis showed that the AUCs of T3 and APACHE Ⅱ score for predicting 30 d death were 0.930 and 0.858,respectively(P＞0.05).Conclusion The incidence of LT3S is high in patients with Klebsiella pneumoniae pneumonia.Both LT3S and APACHE Ⅱ score are independent risk factors for 30 d death in these patients,and there is no significant difference in their predictive efficacy.