Abstract:Objective To construct an interpretable machine learning model to predict the short-term mortality risk of elderly patients with severe heart failure,and to explore the predictive value of the new inflammatory index.Methods A retrospective analysis was conducted on elderly patients with heart failure diagnosed in the MIMIC-IV 3.1 database.The study participants were randomly assigned to either the training cohort(70%)or the validation cohort(30%).Six algorithms including logistic regression(LR),decision tree(DT),random forest(RF),adaptive boosting(AdaBoost),light gradient boosting machine(LightGBM),and gaussian naive bayes(NB)were used to construct the prediction model.The discriminatory ability of the predictive algorithm was assessed through analysis of ROC curves,precision-recall(P-R)curves,and calibration curves.SHAP was used for model interpretation and to select the core inflammatory index.The optimal cutoff value was determined using the ROC curve.Results A total of 1994 elderly patients with severe heart failure were included.Among them,253 patients died within 28 days(12.7%),and 1741 patients survived(87.3%).After initial screening,65 clinical features were included in the construction of the machine learning model.The LightGBM model showed the best predictive performance,with an Area Under the Curve(AUC)of[0.897(0.881-0.909)],an average precision(AP)of 0.86 on the P-R curve,and a calibration curve showing that the predicted probability was consistent with the actual observation results.SHAP value analysis revealed that acute physiology score III(APS III),Glasgow coma scale(GCS),monocyte to lymphocyte ratio(MLR),respiratory rate(RR),age,blood urea nitrogen,Oxford acute severity of illness score(OASIS),ACEI,neutrophil-to-lymphocyte ratio(NLR),and nutritional risk index(NRI)were important influencing factors.The AUC of MLR and NLR on the ROC curve were 0.682 and 0.667,respectively.With a cutoff value of 0.426 and 7.083,the sensitivity was 0.747 and 0.751,and the specificity was 0.529 and 0.503.Conclusion The LightGBM model can better predict the short-term mortality risk of elderly patients with severe heart failure.The new inflammatory indices,such as NLR and MLR,have potential clinical application value for the short-term mortality risk stratification of elderly patients with heart failure.

Abstract:Objective To investigate the relationship between heart rate variability(heart rate variability,HRV)and postoperative arrhythmia in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(percutaneous coronary intervention,PCI).Methods Retrospectively,128 patients with acute myocardial infarction who received standardized drug therapy at Beijing Tongren Hospital from May 2022 to May 2024 were assigned to the control group.The other 128 patients who received combined percutaneous coronary intervention(PCI)in addition to standard drug therapy were assigned to the observation group.The study compared the general characteristics,efficacy,HRV-related indicators[RR interval standard deviation(standard deviation of normal-to-normal RR intervals,SDNN),RR interval mean value standard deviation(standard deviation of the average normal-to-normal RR intervals,SDANN),root mean square of successive RR interval differences(root mean square of successive RR interval differences,RMSSD),percentage of consecutive RR intervals with a difference of≥50 ms(percentage of successive RR intervals differing by≥50 ms,PNN50)],and the risk of arrhythmia between the two groups.ANOVA and Spearman correlation were used to analyze the relationship between preoperative HRV and postoperative arrhythmia.Results The overall effective rate of clinical outcomes in the observation group was 91.41%,significantly higher than the 76.56%in the control group(P<0.05);after treatment,the SDNN(125.66±16.92)ms,SDANN(110.34±15.75)ms,RMSSD(37.38±5.32)ms,and PNN50(14.14±3.53)%in the observation group were significantly higher than those in the control group(P<0.05);37.50%of patients in the observation group experienced arrhythmias after treatment,which was higher than that of(28.13%)(P>0.05);Spearman analysis showed that SDNN,SDANN,RMSSD,and PNN50 were significantly negatively correlated with postoperative arrhythmias.Conclusion PCI treatment can effectively restore coronary artery blood flow in patients with acute myocardial infarction and reduce the long-term risk of arrhythmias by improving HRV parameters.However,early postoperative arrhythmias remain relatively high due to reperfusion injury and unstable autonomic nervous regulation.The higher the HRV index,the lower the incidence of arrhythmias after PCI.Clinicians should be particularly vigilant about patients with elevated HRV indices.

Abstract:Objective To investigate the effect of early intensive rehabilitation on lower urinary tract symptoms and discharge readiness after flexible ureteroscopic lithotripsy.Methods A total of 150 patients with renal calculi who underwent flexible ureteroscopic laser lithotripsy in our hospital from March 2024 to March 2025 were prospectively selected and divided into intensive rehabilitation group(75 cases)and routine group(75 cases)according to the random number table method.Both groups of patients were treated with enhanced recovery after surgery(ERAS)during the perioperative period,and the intensive rehabilitation group was treated with early intensive rehabilitation on this basis.The pain visual analogue scale(VAS),self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,lower urinary tract symptoms,readiness for hospital discharge scale(RHDS)each dimension(adaptability,personal status,expected support)score,discharge guidance quality scale(QDTS)each dimension(required content,guidance skills and effects,obtained content)score were compared between the two groups.Results After intervention,the VAS score,SAS score and SDS score of the intensive rehabilitation group were lower than those of the conventional group(t=12.830,8.873,6.779,P<0.05);the incidence of lower urinary tract symptoms in the intensive rehabilitation group was lower than that in the conventional group at 7 and 14 days after operation.(χ2=5.720,4.807,P<0.05).After intervention,the scores and total scores of RHDS and QDTS in the intensive rehabilitation group were higher than those in the conventional group(t=5.221,5.365,6.931,6.667,5.590,6.749,5.934,10.221,P<0.05).Conclusion Early intensive rehabilitation intervention for patients undergoing flexible ureteroscopic laser lithotripsy based on ERAS can significantly alleviate the degree of pain,negative emotions of anxiety and depression,and the incidence of postoperative infection,and improve the readiness for discharge and the quality of discharge guidance.

Abstract:With the acceleration of global aging,the demand for elderly health services is increasingly prominent.The integration of traditional Chinese medicine(TCM)and Western medicine,a model that is based on"TCM health preservation,syndrome differentiation and TCM techniques"has enriched the connotation of elderly health services,added dimensions to disease diagnosis,and broadened the treatment methods for geriatric diseases.This integrative approach emphasizes holistic principles as a guide and,through syndrome differentiation and physical constitution adjustment,significantly enhances the physiological functions,chronic disease prevention,and quality of life for the elderly population.However,current practices face challenges such as the imbalance between the inheritance and innovation of TCM and insufficient integration within the primary health services.In the future,it is necessary to strengthen the standardized application of TCM theories and promote the deep integration of TCM and Western medicine in diagnosis,treatment,and long-term health management to help achieve the goal of healthy aging.

Abstract:Objective To explore the factors influencing the occurrence of pain in patients with peripheral neuropathy caused by type 2 diabetes.Methods From March 2025 to July 2025,a total of 578 patients meeting the diagnostic criteria for diabetic peripheral neuropathy(DPN)were selected from those treated at the Air Force Hangzhou Special Service Sanatorium Center(non-PDPN group=351 cases,PDPN group=227 cases).General clinical data,VAS scores,Toronto Clinical Scoring System scores,electromyography measurements of motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the median and common peroneal nerves were collected.Biochemical indicators including glycated hemoglobin(HbA1c)and fasting plasma glucose(FPG)were also gathered.Using SPSS 24.0 statistical software,a multivariate binary logistic regression model was constructed to analyze factors influencing PDPN.Subgroup forest plots were generated using R version 4.3.2.Results The effects of three factors—white blood cell count,fasting plasma glucose(FPG),and chronic disease comorbidities—on painful diabetic peripheral neuropathy(PDPN)were positively correlated(OR=1.174,2.848,3.094,P<0.05).PDPN patients had higher VAS scores,averaging(7.11±1.11).The motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the median nerve and common peroneal nerve in the PDPN group were significantly lower than those in the non-PDPN group(P<0.001).PDPN pain was significantly modulated by glycemic control levels(HbA1c and FPG),with HbA1c≥6.8%and∕or FPG≥9.05 mmol∕L identified as critical thresholds for pain.Conclusion Patients with PDPN experience high levels of pain.Clinically actionable approaches include strict control of high blood glucose thresholds,proactive management and monitoring of inflammatory status,systematic screening and comprehensive management of comorbidities,and emphasis on neurological function assessment and protection.

Abstract:Objective To investigate the effects of memory updating training combined with cognitive intervention on cancer-related fatigue(CRF),fear of recurrence(FoR),and chemotherapy adherence in lung cancer patients undergoing chemotherapy.Methods A prospective study was conducted on 120 lung cancer patients receiving chemotherapy from June 2022 to March 2025.Patients were randomized into control(n=60)and intervention(n=60)groups using number table method.Both groups received cognitive intervention,while the intervention group additionally underwent memory updating training.Outcomes were assessed using the Cancer Fatigue Scale(CFS),Fear of Progression Questionnaire-Short Form(FoP-Q-SF),chemotherapy adherence,and Brief Illness Perception Questionnaire(B-IPQ).Results Repeated-measures ANOVA revealed significant time,group,and interaction effects for physical fatigue,emotional fatigue,cognitive fatigue,total fatigue score,FoP-Q-SF,and B-IPQ(P<0.05).Simple effects analysis demonstrated significant between-group differences at 2 and 4 weeks post-intervention(P<0.05).The intervention group showed significantly higher chemotherapy adherence than controls(P<0.05).Conclusion Memory updating training combined with cognitive intervention significantly improves CRF and FoR in lung cancer patients,with progressive enhancement over time.This integrated cognitive-behavioral approach provides a clinically viable strategy for symptom management.

Abstract:Urinary retention is one of the most common complications after stroke,and this complication could not only lead to patients'physical discomforts,e.g.,urinary tract infection,hydronephrosis,etc.,but also cause patients'mental disorders such as anxiety,depression,etc.,that even seriously hindered patients'rehabilitation recovery progress in the recent years.In the past few years,TCM rehabilitation therapy has been proven by a number of studies to present the clear advantages for improving urinary retention recovery after stroke by multiple targets and pathways through interventions.In this article,we summarize systematically the mechanisms and clinical effect of characteristic TCM intervention therapy such as acupuncture,moxibustion,and herbal medicine,and reflect on the vital value for psychological intervention,so as to provide evidence-based clinical reference.

Abstract:Objective To systematically analyze the current status,trends,and care quality of dementia disease burden in China,providing scientific evidence for precision prevention and control strategies.Methods Based on the Global Burden of Disease Study 2021 database,we analyzed the spatiotemporal distribution and trends of dementia disease burden among adults aged≥40 years in 204 countries and regions,constructed Bayesian models to predict future trends,and established a quality of care index to assess care levels.Results In 2021,China's age-standardized incidence rate,prevalence rate,and years lived with disability rate were 151.47∕100,000,900.82∕100,000,and 185.63∕100,000 respectively,all significantly higher than global averages.From 1990 to 2021,these rates increased by 25.05%,28.11%,and 27.34%respectively,far exceeding global average increases.Disease burden was generally higher in females than males,with the most significant gender differences in the 70-79 age group.High fasting glucose,smoking,and high body mass index were the main risk factors.Projections indicated continued growth in disease burden from 2022 to 2036,with greater increases in females.China's quality of care index was 39.5%,positioned at theinflection point,indicating acritical transitional phase in care.Conclusion China's dementia disease burden exhibits a continuous upward trend and care quality urgently needs improvement.Primary prevention measures should be strengthened,long-term care systems should be improved,and integrated care systems adapted to an aging society should be constructed.

Abstract:Objective To analyze the correlation between serum levels of transforming growth factor-β1(TGF-β1),Golgi protein-73(GP73),C-C Motif Chemokine Ligand 11(CCL11),Toll-Like Receptor 4(TLR4)and platelet-albumin-bilirubin(PALBI)score in patients with hepatitis B virus(HBV)infection-related cirrhosis.Methods A total of 265 patients with chronic HBV infection admitted to our hospital from January 2021 to December 2024 were prospectively selected and divided into cirrhosis group and non-cirrhosis group according to whether cirrhosis occurred.All patients underwent serological tests,and the PALBI score was calculated.Spearman was used to analyze the correlation between serum TGF-β1,GP-73,CCL11,TLR4 levels and PALBI score in patients with HBV infection-related cirrhosis.Univariate and multivariate logistic regression were used to analyze the influencing factors of cirrhosis in patients with chronic HBV infection.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to analyze the predictive value of the above serological indicators for cirrhosis in patients with chronic HBV infection.Results Among the 265 patients with chronic HBV infection,84(31.70%)were in the cirrhosis group and 181(68.30%)were in the non-cirrhosis group.Spearman correlation analysis showed that the levels of serum TGF-β1,GP-73,CCL11 and TLR4 in the cirrhosis group were positively correlated with PALBI score(r=0.633,0.669,0.581,0.659,P<0.05).Multivariate logistic regression analysis showed that drinking history,antiviral treatment or not,ALT,Child-Pugh classification,PALBI score,TGF-β1,GP-73,CCL11 and TLR4 were the influencing factors of cirrhosis in patients with HBV infection.ROC results showed that the AUC of the combined detection of the above factors was 0.913(95%CI:0.876～0.950).The AUC was significantly higher than that of each single test[0.587(95%CI:0.512～0.662),0.648(95%CI:0.576～0.721),0.754(95%CI:0.693～0.814),0.578(95%CI:0.506～0.651),0.732(95%CI:0.673～0.791),0.779(95%CI:0.715～0.843),0.734(95%CI:0.665～0.804),0.781(95%CI:0.721～0.842),0.745(95%CI:0.680～0.810)],and the differences were statistically significant(Z=8.532,7.280,4.351,8.080,4.836,3.504,4.998,5.672,P<0.001).Conclusion The serum levels of TGF-β1,GP-73,CCL11 and TLR4 in patients with chronic HBV infection-related cirrhosis were positively correlated with PALBI score.The combined detection of the above factors can effectively predict the risk of cirrhosis and the degree of disease progression in patients with chronic HBV infection.

Abstract:Objective To investigate the effects of Mediterranean diet(MD)combined with continuous subcutaneous insulin infusion(CSII)on glycemic control,pancreatic β-cell function,and quality of life in type 2 diabetes mellitus(T2DM)patients with abdominal obesity.Methods A prospective study was conducted on 160 T2DM patients with abdominal obesity admitted to our hospital from January 2023 to January 2025.Participants were randomly assigned to control group(n=80,receiving CSII plus conventional diabetic diet)or intervention group(n=80,receiving CSII plus MD).Parameters including glucose metabolism(fasting plasma glucose[FPG],2-hour postprandial glucose[2hPG],glycated hemoglobin[HbA1c]),lipid profiles(low-density lipoprotein cholesterol[LDL-C],high-density lipoprotein cholesterol[HDL-C]),pancreatic function(HOMA-β,HOMA-IR),anthropometric indices(BMI,waist circumference,waist-to-hip ratio),Diabetes-Specific Quality of Life Scale(DSQL)scores and complication rates were compared.Results Repeated measures ANOVA showed significant time,group and interaction effects for 2hPG,HbA1c,LDL-C,HDL-C,HOMA-β and HOMA-IR(P<0.05),and significant time and group effects for FPG(P<0.05).After 3-month intervention,both groups showed significant improvements in BMI,waist circumference and waist-to-hip ratio compared to baseline,with greater improvements in the intervention group(t=4.508、5.074、3.614,P<0.05).The intervention group also demonstrated superior DSQL scores across all dimensions(t=4.206、4.025、5.007、4.303,P<0.05).Conclusion MD combined with CSII synergistically ameliorates glucolipid metabolism through β-cell function enhancement and insulin resistance reduction,while significantly ameliorating abdominal obesity and quality of life in T2DM patients.

Abstract:Objective To analyze the changes and clinical significance of serum neutrophil to lymphocyte ratio(NLR),interleukin-17(IL-17),and macrophage inflammatory protein-1alpha(MIP-1α)in elderly patients with chronic pulmonary heart disease(CPHD)and heart failure.Methods A total of 236 patients with CPHD who visited the hospital from January 2022 to December 2024 were selected as the research subjects.According to the diagnostic criteria for heart failure,they were assigned to the heart failure group(with heart failure,n=78)and the pure CPHD group(without heart failure,n=158).The patients'clinical data(gender,age,body mass index(BMI),smoking history,drinking history,course of CPHD,etc.)and various laboratory examination data(serum creatinine,blood urea nitrogen,serum NLR,IL-17,MIP-1α,etc.)upon admission were collected.Pearson's correlation was used to investigate the relationship between serum NLR,IL-17,MIP-1α and cardiac function indicators.The receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of serum NLR,IL-17,and MIP-1α for heart failure in elderly patients with CPHD.Results The levels of NLR,LVEF and SV in the heart failure group were lower than those in the pulmonary heart disease group,while the levels of IL-17 and MIP-1α were higher than those in the pulmonary heart disease group(P<0.05).Pearson correlation analysis found that serum NLR,IL-17,and MIP-1α were negatively correlated with left ventricular ejection fraction(LVEF)and stroke volume(SV)in elderly patients with CPHD and heart failure(P<0.05).Logistic regression analysis found that LVEF and SV were protective factors for heart failure in elderly patients with CPHD,while serum NLR,IL-17,and MIP-1α were risk factors(P<0.05).ROC curve analysis showed that area under the curve(AUC)and sensitivity of combination of serum NLR,IL-17 and MIP-1α for diagnosing heart failure in elderly patients with CPHD were relatively higher(P<0.05).Conclusion The changes in serum NLR,IL-17,and MIP-1α play an important role in the pathological process CPHD with heart failure in the elderly.These indicators exhibit high diagnostic value.

Abstract:Objective To investigate the factors influencing the occurrence of urinary tract infections in patients with renal calculi treated with thulium-doped laser combined with a head-flexible negative pressure sheath.Methods The clinical data of 198 patients with kidney stones admitted to Beijing Friendship Hospital Pinggu Campus between January 2023 and January 2025 were retrospectively analysed,and the patients were divided into the infected group(n=25)and the uninfected group(n=173)according to whether they suffered from urinary tract infection.The clinical data of the patients were collected to compare the differences of each clinical data between the infected and uninfected groups,and the main influencing factors of postoperative urinary tract infection were analysed by Logistic multiple regression model.Results The operating time(76.24±21.43)min and hospital stay(9.88±2.99)d were longer in the infected group than in the uninfected group(68.03±18.51)min and(8.11±2.06)d(t=2.031,3.769,P<0.05).The 2 groups had urinary tract infections in the preoperative period,Combined diabetes mellitus,prophylactic application of antimicrobial drugs,stone residue,indwelling time of double-J tube,history of urinary tract infection,degree of hydronephrosis,type of antimicrobial drugs used,stone diameter,white blood cell count(WBC)count,serum albumin(ALB)showed significant differences in the comparisons between the 2 groups(χ2=5.239,26.062,4.074,3.968,5.639,30.495,12.991,6.967,4.138,6.924,11.411,P<0.05).Logistic multiple regression model analysis showed that diabetes mellitus(OR=1.582,95%CI:1.366～1.798,P=0.041),prophylactic use of antibiotics<2(OR=0.495,95%CI:0.278～0.712,P=0.019),(95%CI:1.291～1.983,P=0.025),stone residue(P=0.018,OR=2.108,95%CI:1.832～3.384)and the types of antibacterial drugs used(OR=1.879,95%CI:1.628～2.130).Conclusion After patients with renal calculi were treated with thulium-doped laser combined with head bendable negative pressure sheath,combined diabetes mellitus,non-preventive application of antimicrobial drugs,prolonged indwelling of double J-tubes,and the use of multiple antimicrobial drugs were the main risk factors for postoperative urinary tract infections;therefore,corresponding preventive strategies should be adopted in time to reduce the incidence of postoperative urinary tract infections and to improve the patient's prognosis.

Abstract:Objective To compare the lipid-lowering efficacy of policosanol combined with ezetimibe,Xuezhikang(red yeast rice)combined with ezetimibe,and moderate-intensity statin(pravastatin)monotherapy in a high-risk population with Atherosclerotic Cardiovascular Disease(ASCVD).The study evaluated the effects and safety of these three regimens on reducing Total Cholesterol(TC)and Low-Density Lipoprotein Cholesterol(LDL-C)levels,providing a reference for lipid management in primary care.Methods A prospective,randomized controlled trial(RCT)was conducted.A computer-generated random number table was used for allocation;the random sequence was generated by a statistician independent of the research team.Allocation concealment was achieved using sealed,opaque envelopes.Group assignment was sealed in envelopes beforehand and opened by a research assistant not involved in enrollment after patients completed baseline assessments and met inclusion criteria.Neither investigators nor participants were involved in the allocation process to avoid selection bias.124 ASCVD patients diagnosed in our outpatient department from 2023 to 2025 with hypertension,hypercholesterolemia,and classified as high-risk were enrolled and randomly divided into three groups:Group A(pravastatin monotherapy,40 mg∕day,n=41),Group B(policosanol 5 mg∕day+ezetimibe 10 mg∕day,n=43),and Group C(Xuezhikang 0.6 g twice daily+ezetimibe 10 mg∕day,n=40).Baseline characteristics were comparable(P>0.05).Efficacy indicators included:TC and LDL-C levels(mmol∕L)and their reductions from baseline,LDL-C target achievement rate(proportion of patients with post-treatment LDL-C<2.6 mmol∕L),and incidence of adverse reactions(including muscle pain,gastrointestinal reactions,abnormal liver∕kidney function,elevated creatine kinase).All patients received treatment alongside dietary control and moderate exercise,with follow-up lasting 8-12 weeks.Results Post-treatment TC levels were(4.30±0.30)mmol∕L,(4.27±0.28)mmol∕L,and(4.70±0.40)mmol∕L for Groups A,B,and C,respectively.LDL-C levels were(2.53±0.25)mmol∕L,(2.45±0.24)mmol∕L,and(2.59±0.30)mmol∕L,respectively.ANOVA with post-hoc testing(LSD method)showed that Group B had significantly lower TC levels than Group C(t=5.82,P<0.05),and significantly lower LDL-C levels than Group C(t=2.56,P<0.05).The difference between Group B and Group A was not statistically significant(P>0.05).LDL-C target achievement rates were 58.5%,62.8%,and 42.5%for Groups A,B,and C,respectively,with no statistically significant difference among groups(P=0.151).The adverse reaction rates were 24.4%,4.7%,and 10.0%for Groups A,B,and C,respectively,with a statistically significant difference observed(χ2=7.104,P<0.05).Conclusion The policosanol combined with ezetimibe group showed the greatest numerical reduction in LDL-C levels and the lowest adverse reaction rate.

Abstract:Objective To investigate the correlation between rectus femoris cross-sectional area(RFCSA),nutritional status dynamics,caloric intake,and in-hospital mortality in the intensive care unit(ICU).Methods This prospective study enrolled 190 ICU patients from June 2022 to June 2024 as the derivation cohort.Participants were stratified into survival and non-survival groups based on in-hospital mortality.RFCSA was measured by ultrasonography;nutritional status was assessed using the NUTRIC score;caloric intake was quantified from medical records.An additional 82 patients(July-December 2024)constituted the validation cohort at a 7∶3 ratio.Univariate and binary logistic regression identified independent predictors,with ROC curves evaluating model performance.Results Univariate analysis revealed significant differences in age,BMI,RFCSA,rectus femoris atrophy rate,NUTRIC score,caloric intake,plasma albumin,PaCO2,and oxygenation index between groups(P<0.05).Binary logistic regression identified higher RFCSA and greater caloric intake as independent protective factors,while advanced age,elevated muscle atrophy rate,and higher NUTRIC score were independent risk factors.The predictive model achieved an AUC of 0.989(95%CI:0.979～0.999)a sensitivity of 98.1%and a specificity of 93.5%.Validation cohort results showed an AUC of 0.983(95%CI:0.960～1.000),sensitivity of 95.0%,and specificity of 95.2%.Conclusion Age,RFCSA,rectus femoris atrophy rate,NUTRIC score,and caloric intake are critical determinants of ICU mortality.The developed model demonstrates excellent predictive accuracy for clinical prognosis assessment.

Abstract:Objective To observe the efficacy and safety of pulmonary rehabilitation in chronic obstructive pulmonary disease(COPD)patients with severe hypoxemia receiving long-term oxygen therapy(LTOT).Methods 88 stable COPD patients on LTOT were randomly divided into two groups.The control group received standard care without pulmonary rehabilitation,while the rehabilitation group underwent a 12-week pulmonary rehabilitation program.Lung function,blood gas parameters,6-minute walk distance(6MWD)results,and COPD Assessment Test(CAT)scores were compared at baseline and after 12 weeks.Adverse events were recorded.Results No significant differences existed between groups at baseline.After 12 weeks,the rehabilitation group showed higher FEV1,FEV1∕FVC,FEV1%predicted,and PaO2 levels compared with the control group,with slightly lower PaCO2(statistically non-significant).After 12 weeks,the 6MWD in the pulmonary rehabilitation group was higher than the control group's(t=3.472,P=0.001).The CAT score in the pulmonary rehabilitation group was lower than the control group's(t=3.241,P=0.002).No falls,syncope,or cardio∕cerebrovascular events occurred during the study.Conclusion Pulmonary rehabilitation improves exercise tolerance and quality of life and has good safety profile in LTOT-dependent COPD patients.

Abstract:Objective To explore the association between serum 25-hydroxyvitamin D[25(OH)D]and parathyroid hormone(PTH)and their influencing factors in the physical examination population in Beijing.Methods A cross-sectional study was conducted on 39,365 adults who underwent their first physical examination in Second Medical Center of Chinese PLA General Hospital from 2017 to 2021.Serum 25(OH)D and PTH were measured by chemiluminescence.Vitamin D was classified into sufficient(>30 ng/mL),insufficient(20～30 ng/mL),and deficient(<20 ng/mL)groups.Multivariate linear regression analysis was performed after adjusting for age,gender,BMI,blood calcium,blood phosphorus,and eGFR.Results(1)Vitamin D deficiency was common:92.8%had insufficient or deficient levels(deficient:55.2%,insufficient:37.6%),and only 7.2%were sufficient.(2)Population differences:Age:The deficiency rate was highest in the 18-39 age group(63.8%),and the sufficient rate was higher in the≥60 age group(10.9%);Gender:The deficiency rate was higher in females(65.6%)than in males(50.2%),and females were an independent risk factor for elevated PTH(β=2.670,P<0.001);BMI:The dificient rate was highest in the BMI<18.5 kg/m2(62.7%)and>32 kg/m2(59.9%)groups.(3)25(OH)D was negatively correlated with PTH:the median PTH increased stepwise with decreasing 25(OH)D(sufficient group:38.08 pg/mL,insufficient group:40.82 pg/mL,deficient group:44.0 pg/mL);25(OH)D was an independent negative predictor of PTH(β=-0.383,P<0.001);70.3%of the high PTH group(>65 pg/mL)were vitamin D deficient,but there was no statistically significant difference in PTH levels within the group(P>0.05).Conclusion The rate of vitamin D insufficiency/deficiency in the physical examination population in Beijing is over 90%,and it is independently associated with elevated PTH.Females and individuals with low/high BMI are at higher risk.It is recommended to routinely test 25(OH)D and PTH in physical examinations,especially for the above high-risk groups,to provide a basis for improving vitamin D nutritional status and potential parathyroid dysfunction.

Abstract:Objective To explore the clinical value of ultrasound combined with electrocardiogram(ECG)-guided puncture and tip localization technology in the placement of peripherally inserted central catheters(PICC).Methods A total of 102 patients requiring PICC catheterization for tumors or long-term infusion,admitted between January 2021 and December 2024,were enrolled and randomly divided into an observation group and a control group,with 51 cases in each.The control group received traditional ultrasound-guided puncture and positioning,while the observation group underwent ultrasound combined with ECG-guided tip localization.Clinical data were collected,including accuracy of catheter tip placement and catheterization time.Pain was assessed using the Visual Analog Scale(VAS)immediately after puncture.Bleeding volume and puncture site oozing within 24 hours were recorded,catheter-related complications were monitored,and patient satisfaction was evaluated.Results There was no significant difference in catheterization time between the control and observation groups(P=0.695).The proportion of optimal catheter tip position was significantly higher in the observation group compared to the control group(χ2=11.054,P=0.004).No significant differences were found between the two groups in terms of immediate puncture VAS pain score,puncture site oozing at 24 hours post-procedure,immediate bleeding volume,or 24-hour bleeding volume(P>0.05).The incidence of complications was significantly lower in the observation group than in the control group(χ2=4.320,P=0.038).Patient satisfaction scores for doctor-patient relationship and treatment attitude were significantly higher in the observation group(t=-5.726,-4.551,P<0.05),while no significant differences were observed between the groups in satisfaction with catheter comfort,puncture technique,or catheterization technique(P>0.05).Conclusion The combination of ultrasound and ECG-guided technology in PICC catheterization significantly improves tip placement accuracy,reduces complication rates,and enhances patient satisfaction,demonstrating high clinical application value.

Abstract:Objective To explore the effect of stratified intervention model based on modified version of the DORSSSP scoring system in elderly hip fracture patients with heart disease.Methods 183 elderly patients with hip fracture complicated by heart disease from July 2021 to December 2023 were selected as the study subjects and divided into 2 groups,with 92 cases in the study group and 91 cases in the control group.The control group was given a routine orthopedic intervention,and the study group was given a stratified intervention based on the modified version of the DORSSSP scoring system.The two groups were compared with postoperative complications and death,postoperative kinesiophobia,risk to fall,balance ability and daily living ability.Results After the intervention,two patients in the study group had complications with an incidence of 21.74%,and the concurrent incidence in the control group was 40.66%.Comparing the two groups,the difference was significant(P<0.05).The complications were mainly congestive heart failure,deep vein thrombosis of lower limbs,and lung infection.There was no statistically significant difference in postoperative mortality between the two groups of patients(P>0.05).The study group had significantly lower risk than the control group,while the balance ability was significantly better than the control group(P<0.05).The daily living ability of the two groups was significantly improved,and the study group was significantly better than the control group(P<0.05).Conclusion The stratified intervention model,based on the modified version of the DORSSSP scoring system,can significantly reduce the risk of postoperative phobia,and improve the balance and daily living ability.

Abstract:Objective To observe the efficacy of comprehensive rehabilitation combined with enalapril maleate folic acid tablets and donepezil hydrochloride in the treatment of H-type hypertension with mild cognitive impairment(MCI).Methods Fifty-nine patients with H-type hypertension with MCI over 60 years of age admitted to Qixia District Hospital of Nanjing City from January 2023 to June 2024 were selected and randomly divided into two groups using a computer-generated randomization sequence in Microsoft Excel table.The control group was given enalapril maleate folic acid tablets with donepezil hydrochloride for treatment,and the comprehensive group added comprehensive rehabilitation therapy to the control group's program.The two groups were compared in terms of 24 h ambulatory blood pressure,homocysteine(Hcy),high-sensitivity-C-reactive protein(hs-CRP),the score of the Mini-Mental State Examination(MMSE),Wei-style Memory Scale(WMS-RC)score,Hasegawa Dementia Scale(HDS)score,and changes in the score of the ability to perform activities of daily living(ADL)to statistically measure the efficacy of the two groups in terms of blood pressure treatment.Results Comparison of the 24-hour dynamic blood pressure situation before treatment between the two groups was conducted;the difference is not statistically significant(P>0.05).The 24h dynamic blood pressure of both groups after treatment was lower than that before treatment,and the comprehensive group was lower than the control group after treatment(P<0.05).Comparison of Hcy and hs-CRP before treatment in the two groups showed no statistically significant difference(P>0.05).Hcy and hs-CRP were lower than before treatment in both groups after treatment,and were lower in the comprehensive group than in the control group after treatment(P<0.05).Comparison of WMS-RC scores before treatment between the two groups showed no statistically significant difference(P>0.05).Picture recall scores,associative learning scores,back-counting scores,and comprehension memory collocations were higher in both groups after treatment compared with before treatment,and were higher in the integrated group than in the control group after treatment(P<0.05).Comparison of HDS scores,MMSE scores,and ADL scores before treatment between the two groups showed no statistically significant difference(P>0.05).HDS scores,MMSE scores,ADL scores of both groups after treatment were higher than before treatment,and the comprehensive group was higher than the control group after treatment(P<0.05).The total effective rate of blood pressure in the composite group was 93.10%higher than 73.33%in the control group in comparison,and the difference was statistically significant(P<0.05).Conclusion Comprehensive rehabilitation combined with enalapril maleate folic acid tablets and donepezil hydrochloride for the treatment of H-type hypertension with MCI improves efficacy,blood pressure and cognitive function.

Abstract:Objective To observe the effects of hip lift breathing training combined with aerobic exercise on cardiopulmonary function,exercise tolerance and quality of survival in patients with chronic heart failure.Methods Prospectively 104 cases of chronic heart failure patients admitted to our hospital from January 2023 to December 2023 were randomly divided into two groups using the lottery method.The conventional group performed conventional rehabilitation exercises,and the hip-lifting group performed hip-lifting breathing training combined with conventional rehabilitation exercises.Cardiopulmonary function test,N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac function,and endpoint events during 6 months of follow-up.Results There was no difference in cardiac function between the two groups before training(P>0.05).The left ventricular ejection fraction(LVEF),stroke volume(SV),and cardiac output index(CI)were higher in the two groups after training than before treatment.And the LVEF,SV,CI were higher in the hip-lifting group than in the conventional group(t=3.190,5.881,5.663,P<0.05).There was no difference in the pre-training cardiorespiratory test parameters between the two groups(P>0.05).After training,the peak oxygen uptake,peak oxygen uptake%pred,anaerobic threshold,anaerobic threshold%pred,and peak oxygen pulse in the two groups were higher than before treatment,and the lowest value of carbon dioxide ventilation equivalent(VE/VCO2)was lower than before treatment.The peak oxygen uptake(t=4.491,P<0.05),peak oxygen uptake%pred(t=4.432,P<0.05),anaerobic threshold(t=5.087,P<0.05),anaerobic threshold%pred(t=5.505,P<0.05),and peak oxygen pulse(t=3.874,P<0.05)in the hip-lifting group were higher than those in the conventional group,while VE/VCO2 was lower than that in the conventional group(t=8.315,P<0.05).Comparison of pre-training NT-proBNP between the two groups showed no statistically significant difference(P>0.05).Post-training NT-proBNP was lower than pre-treatment in both groups.Post-training NT-proBNP in the hip-lifting group was lower than NT-proBNP in the conventional group(t=9.274,P<0.05).The readmission rate of cardiovascular events within 6 months of follow-up was lower in the hip-lifting group than in the conventional group(χ2=4.762,P<0.05),and the rates of nonfatal myocardial infarction,acute cerebrovascular events,sudden cardiac death,and all-cause mortality did not differ from those of the conventional group(P>0.05).Conclusion Hip lift breathing training combined with aerobic exercise improves cardiorespiratory fitness and reduces readmission for cardiovascular events in patients with chronic heart failure.