Abstract:Objective To evaluate the efficacy of catheter ablation for atrial fibrillation in elderly patients.Methods Patients aged 75 years or older were enrolled from the China Atrial Fibrillation Registry Study from August 2011 to December 2022.Patients were divided into ablation group and non-ablation group according to whether they received ablation at baseline.The primary endpoint was the composite endpoint of cardiovascular death and cardiovascular hospitalization.The secondary endpoints included cardiovascular death,cardiovascular hospitalization,embolic events and recurrence of atrial fibrillation.The Kaplan-Meier method was used to draw the survival curve.Multivariate Cox regression and overlapping weighted analysis were used to evaluate the relationship between ablation and endpoint.Results A total of 2 912 patients were enrolled,including 976 in the ablation group and 1 936 in the non-ablation group.Survival curve analysis showed that the risk of cardiovascular death or cardiovascular hospitalization in the ablation group was lower than that in the non-ablation group(hazard ratio=0.68,95％confidence interval:0.60-0.76,Log-rank P＜0.001).During the follow-up of 35.2(14.7,64.5)months,1 418 patients had cardiovascular death or cardiovascular hospitalization,and the incidence was 13.7/100 patient-years.The incidence was 10.4/100 patient-years in the ablation group and 15.2/100 patient-years in the non-ablation group.Catheter ablation was associated with a significantly lower composite risk of cardiovascular death or cardio-vascular hospitalization after adjustment for confounders(hazard ratio=0.82,95％confidence interval:0.72-0.93,P=0.003),with similar results in overlap-weighted analyses.In addition,catheter ablation was signifi-cantly associated with reduced risks of cardiovascular death(hazard ratio=0.38,overlap-weighted hazard ratio=0.35,both P＜0.001)and recurrence of atrial fibrillation(hazard ratio=0.30,overlap-weighted hazard ratio=0.28,both P＜0.001).Conclusion In older patients with atrial fibrillation,catheter ablation is associated with a lower risk of cardiovascular death or cardiovascular hospitalization and a lower risk of atrial fibrillation recurrence.

Abstract:Objective To investigate the influencing factors of macrophage accumulation in culprit lesions in patients with premature coronary atherosclerotic heart disease.Methods A total of 143 patients(≤45 years old)with premature coronary atherosclerotic heart disease who underwent coronary angiography and optical coherence tomography(OCT)in Qingdao Municipal Hospital,Shandong Province from October 2021 to October 2024 were retrospectively enrolled.Univariate and multivariate Logistic regression methods were used to analyze the independent predictors of macrophage accumulation under OCT in patients with premature coronary atherosclerotic heart disease.Results Among 143 patients with premature coronary atherosclerotic heart disease who underwent OCT examination,macrophage accumulation was found in 83(58.0％)culprit lesions.The positive influencing factors of macrophage aggregation in culprits lesions included smoking(P=0.002),hypertension(P＜0.001)and hypercholesterolemia(P=0.003),and the negative influencing factors included aspirin(P=0.024)and statins(P=0.007).Factors with P＜0.1 in univariate analysis were included in multivariate analysis.After adjusting for other risk factors,hypertension(odds ratio=4.555,95％confidence interval:2.058-10.084,P＜0.001),smoking(odds ratio=3.479,95％confidence interval:1.537-7.873,P=0.003)and hypercholesterolemia(odds ratio=5.364,95％confidence interval:1.634-17.608,P=0.006)were still independent predictors of macrophage accumulation in patients with premature coronary atherosclerotic heart disease,while diabetes had a related trend although the difference was not statistically significant(P=0.057).Conclusion Hypertension,smoking and hypercholesterolemia are independent predictors of macrophage accumulation in culprit lesions in patients with premature coronary atherosclerotic heart disease.

Abstract:Objective To investigate the relationship between serum levels of interleukin-17(IL-17)and matrix metalloproteinase-13(MMP-13)and progression-free survival(PFS)and overall survival in patients with multiple myeloma in partial remission.Methods A total of 105 patients with multiple myeloma who achieved partial remission after clinical treatment in Zhejiang Provincial People's Hospital from June 2019 to May 2021 were selected as the research objects.The clinical data of the patients were collected,and the serum levels of IL-17 and MMP-13 were detected.All patients were followed up regularly after discharge to calculate survival,PFS and overall survival.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum IL-17 and MMP-13 levels for the prognosis of patients with partial remission.According to the optimal cut-off value of ROC,the patients were divided into high IL-17 group and low IL-17 group,high MMP-13 group and low MMP-13 group.PFS and overall survival were compared between groups.Cox regression analysis model was used to analyze the influencing factors of PFS and overall survival in patients with multiple myeloma.Results At the end of the follow-up,77 of 105 patients survived and 28 died,with an overall survival rate of 73.3％(77/105)and a mortality rate of 26.7％(28/105).ROC curve analysis showed that the best cut-off value of IL-17 to predict the prognosis of death in patients with multiple myeloma at partial remission was 30.85 ng/L,the area under the curve(AUC)=0.780,and the best cut-off value of MMP-13 to predict the prognosis of death in patients with multiple myeloma was 10.68 ng/L,AUC=0.738.The PFS and overall survival of the high IL-17 group were shorter than those of the low IL-17 group[(19±4)months vs(29±5)months,(36±6)months vs(50±6)months](t=12.000,11.545,both P＜0.001).The PFS and overall survival of the high MMP-13 group were shorter than those of the low MMP-13 group[(21±4)months vs(27±5)months,(38±6)months vs(47±7)months](t=7.719,7.128,both P＜0.001).Multivariate Cox regression analysis showed that lactate dehydrogenase,β2-microglobulin,IL-17,MMP-13,age,1q amplification,and 17p-were the influencing factors of PFS in patients with multiple myeloma(all P＜0.05).β2-microglobulin,IL-17,MMP-13,age,1q amplification,and 17p-were the influencing factors of overall survival(all P＜0.05).Conclusion The serum levels of IL-17 and MMP-13 in patients with multiple myeloma during partial remission are related to PFS and overall survival,which can be used as an intermediate stage indicator to evaluate the prognosis of patients.

Abstract:Objective To investigate the relationship between soluble growth stimulation-expressed gene 2 protein(sST2)and multi-slice spiral CT(MSCT)features and prognosis in patients with acute type B aortic dissection(ATBAD).Methods A total of 135 ATBAD patients diagnosed and admitted to Nanjing First Hospital by MSCT from July 2021 to July 2023 were selected and divided into the good prognosis group(105 cases)and poor prognosis group(30 cases)according to the 2-year follow-up results.The clinical data,serum biomarkers and MSCT imaging features of the patients were collected.Binary Logistic regression analysis was used to explore the correlation between serum sST2 level and MSCT features of ATBAD patients,LOWESS analysis was adopted to analyze the nonlinear relationship between sST2 level and inflammatory factors,and Cox regression analysis was used to identify the influencing factors of poor prognosis.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum sST2 level for the prognosis of ATBAD patients.Restricted cubic spline and threshold effect analysis were used to explore the dose-response relationship between sST2 level and the risk of poor prognosis.Stepwise regression and Bootstrap methods were used to test and analyze the mediating effect of inflammatory factors between sST2 and prognosis.Kaplan-Meier method and Log-rank test were used to analyze the effect of serum sST2 level on the 2-year survival rate of patients.Results The main MSCT features of the 135 ATBAD patients were aortic dilatation(77 cases,57.0％),true and false lumens(58 cases,43.0％)and intimal tear(55 cases,40.7％).The serum levels of sST2,D-dimer,C-reactive protein,cardiac troponin I(cTnI),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the poor prognosis group were significantly higher than those in the good prognosis group,while the level of anti-inflammatory factor IL-4 was significantly lower(all P＜0.05).The incidences of aortic dilatation,aortic dissection rupture,true and false lumens,thrombus spread and intimal tear in the poor prognosis group were significantly higher than those in the good prognosis group(all P＜0.05).Binary Logistic regression showed that sST2 was positively correlated with aortic dilatation,dissection rupture,true and false lumens and thrombus spread(all odds ratio＞1,P＜0.05).LOWESS analysis revealed a nonlinear relationship between serum sST2 level and the levels of D-dimer,C-reactive protein,cTnI,IL-4,IL-6 and TNF-α in ATBAD patients.Cox regression indicated that sST2,D-dimer,C-reactive protein,cTnI,IL-6 and TNF-α were independent risk factors for poor prognosis in ATBAD patients,and IL-4 as a protective factor(all P＜0.05).ROC curve showed that the area under the curve of sST2 for predicting the prognosis of ATBAD patients was 0.814(95％confidence interval:0.779-0.854).Restricted cubic spline analysis demonstrated a nonlinear relationship between sST2 level and prognostic risk in ATBAD patients(P＜0.001),and when the sST2 level was＞29.64 μg/L,the risk of poor prognosis increased gradually with the elevation of sST2 level.Mediation effect analysis showed that IL-4,IL-6 and TNF-α had a mediating regulatory effect between sST2 level and poor prognosis in ATBAD patients.Survival curve indicated that patients with lower sST2 concentration had a higher 2-year survival rate(Log-rank P＜0.05).Conclusion Serum sST2 level is positively correlated with MSCT features such as aortic dilatation,dissection rupture and thrombus spread in ATBAD patients,and also positively correlated with the risk of poor prognosis in ATBAD patients.It can serve as an important biomarker for evaluating ATBAD patients and provide an important basis for clinical treatment.

Abstract:Objective To observe the clinical efficacy of budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets in the treatment of patients with bronchiectasis complicated with severe chronic obstructive pulmonary disease(BCOS),and to explore its effect on improving dyspnea and small airway function in BCOS patients.Methods A total of 90 BCOS patients admitted to Hainan Hospital of Chinese PLA General Hospital from January 2023 to January 2024 were enrolled as research subjects.According to different treatment regimens,the patients were divided into the control group(45 cases,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol alone)and the observation group(45 cases,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets).The clinical data and therapeutic efficacy were compared between the two groups.A difference-in-differences model was established to evaluate the changes in comprehensive scores before and after treatment in the two groups.Repeated measures analysis of variance was used to analyze the changes in maximal expiratory flow at 25％of forced vital capacity(MEF25)and maximal expiratory flow at 50％of forced vital capacity(MEF50).The effects of MEF25 and MEF50 on therapeutic efficacy during treatment were analyzed.Results There were no statistically significant differences in clinical data between the two groups(all P＞0.05).After treatment,the scores of chronic obstructive pulmonary disease assessment test(CAT),St.George's respiratory questionnaire(SGRQ)and modified medical research council dyspnea scale(mMRC)in both groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group(all P＜0.05).The results of the difference-in-differences model showed that the CAT,SGRQ and mMRC scores decreased by 9.782,5.462 and 8.102 on average after treatment.The interac-tion coefficient of group × time had a significant effect on the comprehensive scores.The reduction amplitude of comprehensive scores in the observation group after treatment was higher than that in the control group,with an increase of 7.631,3.019 and 6.932 respectively.There were statistically significant differences in the inter-group effect,time effect and interaction effect of MEF25 and MEF50 levels in patients(all P＜0.05).The total effective rate of treatment in the observation group was significantly higher than that in the control group[95.6％(43/45)vs 82.2％(37/45)](x2=6.133,P=0.047).The results of stratified analysis showed that at each stratified level of MEF25 and MEF50 at 12 weeks of treatment,the therapeutic effect of the observation group was stronger than that of the control group(both P＜0.001).Conclusion Budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets can improve the clinical efficacy of BCOS patients,alleviate dyspnea and improve small airway function.

Abstract:Gallbladder cholesterol cholelithiasis is a complex disease caused by the combined effects of genetic and environmental factors.This article systematically elaborates its cascading pathogenesis,which initiates with the imbalance of hepatic cholesterol metabolism and abnormal bile composition,leading to cholesterol super-saturation in bile.Subsequently,cholesterol in supersaturated bile nucleates in the mucin gel matrix to form cholesterol monohydrate crystals.Meanwhile,the dysfunction of gallbladder smooth muscle cells induced by excessive cholesterol uptake results in impaired gallbladder motility and bile stasis,which provides a"breeding ground"for crystal growth and aggregation.Notably,intestinal factors such as intestinal dysbiosis are also key links in the pathogenesis of gallbladder cholesterol stones.This article focuses on analyzing the core roles of key genes including adenosine triphosphate-binding cassette transporter genes,mucin genes and cholecystokinin receptor genes in multiple pathological steps,revealing that genetic susceptibility runs through the entire process of initiation,nucleation,growth and regulation in gallbladder cholesterol stone formation.

Abstract:Objective To investigate the association between C-reactive protein-triglyceride-glucose index(CTI)and hypertension based on data from the China health and retirement longitudinal study(CHARLS).Methods Participants aged ≥ 45 years recorded in the CHARLS database from 2011 to 2015 were enrolled.Cox regression was used to analyze the relationships of continuous CTI and CTI subgroups with the risk of incident hypertension.Restricted cubic spline(RCS)analysis was performed to explore the dose-response relationship between CTI and hypertension risk.Subgroup analyses were conducted according to age(≥ 60 years or not),gender,residence,smoking,and drinking status.Results A total of 5 210 participants were included,among whom 1 579 developed incident hypertension(hypertension group)and the remaining 3 631 were included in the non-hypertension group.Compared with the non-hypertension group,participants in the hypertension group were older,had a higher proportion of males,a lower proportion of married individuals,higher percentages of smokers and drinkers,higher prevalence rates of heart disease,diabetes,stroke,dyslipidemia,and lung disease,as well as higher levels of low-density lipoprotein cholesterol,body mass index,and CTI(all P＜0.05).Participants were divided into three groups by tertiles of CTI:T1(5.99≤CTI≤8.27),T2(8.27＜CTI ≤8.96),andT3(8.96＜CTI ≤ 12.79).In model 3,CTI was significantly associated with an increased risk of incident hypertension(hazard ratio=1.16,95％confidence interval:1.08-1.25,P＜0.001).Compared with T1,both T2 and T3 were signifi-cantly related to an increased risk of incident hypertension(T2:hazard ratio=1.20,95％confidence interval:1.04-1.38,P=0.015;T3:hazard ratio=1.35,95％confidence interval:1.17-1.57,P＜0.001).Trend test indicated that the risk of incident hypertension was significantly associated with elevated CTI subgroups(Pfor trend＜0.001).RCS analysis showed a linear relationship between CTI and the risk of hypertension in middle-aged and elderly Chinese individuals(Poverall＜0.001,Pnonlinear=0.254).Subgroup analyses revealed that the positive association between CTI and hypertension risk was significant in males and rural residents,and was not affected by age,smoking,or drinking status.Conclusion CTI increase is a risk factor for hypertension in middle-aged and elderly individuals.

Abstract:Immune thrombocytopenia(ITP)is an autoimmune disease characterized by thrombocytopenia and bleeding tendency,and clinical platelet transfusion refractoriness(PTR)is a crucial factor affecting therapeutic efficacy.This study aimed to explore the immune mechanisms of PTR in ITP and their impacts on clinical manage-ment,with a focus on analyzing the distinct mechanisms of antibody-mediated and T cell-mediated PTR.Through literature review,we found that antibody-mediated PTR is mainly induced by specific antibodies such as human leukocyte antigen and anti-platelet membrane glycoprotein Ⅱ b/Ⅲ a antibodies.These antibodies clear transfused platelets via complement activation and phagocytosis by macrophages,significantly increasing the risk of bleeding.In contrast,T cell-mediated PTR involves the abnormal activation of CD8+T cells,which inhibits megakaryocyto-poiesis and leads to a chronic disease course.Based on these mechanisms,this study proposed a strategy of"mechanism-oriented classified diagnosis and treatment".It is suggested that human leukocyte antigen-matched transfusion combined with immunoglobulin therapy be adopted for antibody-mediated PTR,while the combined intervention of thrombopoietin receptor agonists and immunosuppressants be applied for T cell-mediated PTR.Future research should focus on the application of dynamic immune monitoring technologies,the development of bifunctional biological agents and the realization of individualized precision medicine,so as to significantly improve the therapeutic efficacy and quality of life of ITP patients.This study provides an important theoretical basis and practical guidance for the individualized treatment of ITP.

Abstract:In recent years,the global incidence of obesity and related metabolic diseases[such as type 2 diabetes mellitus and metabolic dysfunction-associated fatty liver disease(MASLD)]has increased significantly.MASLD involves a continuous disease progression towards metabolic dysfunction-associated steatohepatitis and fibrosis,which can ultimately lead to liver cirrhosis and hepatocellular carcinoma.Exploring its pathogenic mecha-nisms is conducive to developing novel preventive,diagnostic,and therapeutic strategies for the disease.As the mainstream theory of the disease's pathogenesis,the"multiple hit hypothesis"has been gradually verified by clinical and experimental studies regarding the subsequent hits on the basis of hepatic steatosis.This article summarizes and discusses multidimensional mechanisms including lipid metabolism,inflammation,and endocrine-related axes,aiming to provide new insights for the systematic diagnosis and treatment of MASLD.

Abstract:Objective To investigate the changes and clinical significance of peripheral blood lymphocyte subsets in vivo in children with Kawasaki disease(KD).Methods A total of 99 children with KD admitted to the Department of Pediatric Medicine,Weifang People's Hospital,Shandong Province from October 2021 to December 2022 were selected as the observation group,and 64 children with common respiratory tract infection with fever as the main manifestation during the same period were selected as the control group.The lymphocyte subsets were detected and compared by flow cytometry.Receiver operating characteristic curve was used to evaluate the diagnostic efficacy of different lymphocyte subsets.Results The levels of CD4+,CD4+/CD8+ratio and B cells in the observation group were higher than those in the control group,and the levels of CD3+,CD8+and natural killer cells were lower than those in the control group(all P＜0.05).In the observation group,the levels of CD4+,CD4+/CD8+ratio and B cells in the acute stage were lower than those in the non-acute stage,and the levels of CD3+,CD8+and natural killer cells were higher than those in the non-acute stage(all P＜0.05).The area under the curve of CD3+,CD4+,CD8+,CD4+/CD8+ratio,B cells,and natural killer cells in the diagnosis of acute KD were 0.494,0.776,0.277,0.924,0.731,and 0.451,respectively.CD4+/CD8+ratio had the highest diagnostic efficiency,followed by CD4+.Conclusion The levels of T lymphocyte subsets in children with KD are abnormal,which can be used as an auxiliary basis for the identification of KD,and can also be used as a reference index to evaluate the development and recovery of KD.

Abstract:Objective To investigate the clinical effect of Linaoxin capsule combined with tirofiban in the treatment of acute myocardial infarction.Methods A total of 118 patients with acute myocardial infarction admitted to the Affiliated Hospital of Qingdao University from September 2023 to September 2024 were selected.They were divided into the observation group and the control group by envelope lottery method,with 59 cases in each group.The control group was treated with tirofiban,and the observation group was treated with Linaoxin capsule on the basis of the control group.The effects of the two groups were evaluated after 7 d of treatment.The clinical efficacy,cardiac function,myocardial injury markers,oxidative stress,vascular endothelial function and adverse reactions of the two groups were evaluated.Results The total effective rate of the observation group was higher than that of the control group[91.5％(54/59)vs 76.3％(45/59)](P＜0.05).After treatment,the cardiac function indexes of left ventricular ejection fraction,stroke volume,cardiac output,and cardiac index in the observation group were higher than those in the control group,and the levels of serum creatine kinase isoenzyme,cardiac troponin Ⅰ,and myoglobin in the observation group were lower than those in the control group(all P＜0.05).After treatment,the levels of serum malondialdehyde and myeloperoxidase in the observation group were lower than those in the control group,and the level of superoxide dismutase was higher than that in the control group(all P＜0.05).After treatment,the vascular endothelial function indexes of nitric oxide,vascular endothelial growth factor and vascular endothelin-1 in the observation group were better than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The clinical effect of Linaoxin capsule combined with tirofiban in the treatment of acute myocardial infarction is significant,which can improve the cardiac function of patients,reduce the level of myocardial injury markers,inhibit the body's oxidative stress response,improve the vascular endothelial function of patients,and the treatment safety is good.

Abstract:Objective To investigate the clinical effect and safety of Mongolian medicine Sandthorn Wuwei powder combined with conventional treatment on patients with hypoxic pulmonary hypertension(HPH).Methods A total of 89 patients with HPH admitted to the Department of Cardiovascular Medicine,Inner Mongolia Autonomous Region People's Hospital from August 2022 to August 2024 were retrospectively analyzed.According to the treatment method,the patients were divided into the control group(44 cases)and the observation group(45 cases).The control group received conventional treatment such as oxygen therapy,diuretics,and calcium channel blockers,and the observation group was treated with Sandthorn Wuwei powder on the basis of the control group.Both groups were treated for 6 months.The exercise endurance,cardiopulmonary function,blood gas indexes,inflammatory factors,oxidative stress markers,imaging,vascular endothelial function,and quality of life were compared between the two groups before and after treatment.The clinical efficacy was compared between the two groups.Results After treatment,6 min walking distance,forced expiratory volume in one second,forced expiratory volume in one second/forced vital capacity,peak expiratory flow,arterial oxygen partial pressure,superoxide dismutase,nitric oxide metabolites,and right ventricular ejection fraction levels in the observation group were significantly longer/higher than those in the control group;Borg score,pulmonary artery systolic pressure,arterial partial pressure of carbon dioxide,hemoglobin,interleukin-6,tumor necrosis factor α,8-isoprostan-F2α,malondialdehyde,right ventricular end diastolic volume,endothelin-1,pulmonary hypertension specific scale score,and Mongolian medicine syndrome score were significantly lower than those in the control group(all P＜0.05).The total effective rate of the observation group was significantly higher than that of the control group[80.0％(36/45)vs 61.4％(27/44)](P=0.008).Conclusion Sandthorn Wuwei powder combined with conventional treatment can significantly improve pulmonary hemodynamics,exercise endurance and quality of life in patients with HPH,and its mechanism may be achieved by anti-inflammation,anti-oxidation,regulation of vascular endothelial function and inhibition of pulmonary vascular remodeling,with good safety.

Abstract:Objective To investigate the expression level of Stanniocalcin 2(STC2)in gastric cancer patients and its predictive value for resistance to immunotherapy.Methods A total of 148 gastric cancer patients admitted to the 909th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from April 2022 to April 2024 were enrolled as research subjects.Reverse transcription real-time fluorescent quantitative polymerase chain reaction was used to detect the relative expression of STC2 mRNA in gastric cancer tissues and paired paracancerous tissues(non-tumor gastric mucosal tissues ≥ 5 cm from the tumor edge).Immunohistochem-istry was performed to detect STC2 protein expression,and patients were divided into the high STC2 expression group(90 cases)and low STC2 expression group(58 cases)according to staining intensity and the proportion of positive cells.The clinicopathological data of patients were collected,and the occurrence of immunotherapy resist-ance was observed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of STC2 expression level for immunotherapy resistance.Correlation heatmap was used to analyze the association between STC2 expression and tumor immune microenvironment indicators,including the infiltration ratios of CD8+T cells,CD4+T cells and B cells,the positive rate of programmed cell death protein 1(PD-1)in T cells,the infiltration ratios of regulatory T cells(Treg,marked by FOXP3+)and macrophages(marked by C D68),as well as the positive rate of programmed cell death ligand 1(PD-L1)on the surface of tumor cells.Results The relative expression of STC2 mRNA in gastric cancer tissues was(2.7±0.7),which was significantly higher than that in paracancerous tissues(1.0±0.3),with a statistically significant difference(t=27.035,P＜0.001).The positive expression rate of STC2 in gastric cancer tissues(58.1％)was higher than that in paracancerous tissues(29.7％)(x2=24.196,P＜0.001).The proportions of patients with TNM stage Ⅳ,serosal and extra-serosal infiltration,and lymph node metastasis in the high expression group were all higher than those in the low expression group(all P＜0.05).Among the 148 patients,44 developed immunotherapy resistance,and the resistance rate in the high expression group was higher than that in the low expression group[36.7％(33/90)vs 19.0％(11/58)](x2=5.290,P=0.021).ROC curve analysis showed that the area under the curve of STC2 expression level for predicting immunotherapy resistance in gastric cancer patients was 0.908(95％confidence interval:0.850-0.949),with a sensitivity of 81.82％and a specificity of 92.30％.Correlation heatmap analysis revealed that STC2 expression level in gastric cancer tissues was significantly negatively correlated with the infiltra-tion ratios of CD8+T cells,CD4+T cells and B cells as well as the positive rate of PD-1 in T cells(all P＜0.001),and significantly positively correlated with the infiltration ratios of FOXP3+Treg cells and CD68+macrophages as well as the positive rate of PD-L1 on the surface of tumor cells(all P＜0.001).Conclusion The expression level of STC2 is significantly elevated in gastric cancer tissues,which is associated with tumor invasion depth,lymph node metastasis and advanced clinical stage.Gastric cancer patients with high STC2 expression have a higher rate of immunotherapy resistance,and STC2 can serve as an effective biomarker for predicting immunotherapy resistance,whose mechanism may be related to the regulation of tumor immune microenvironment.

Abstract:Objective To explore the predictive value of Caprini score combined with D-dimer for postoper-ative venous thromboembolism(VTE)in patients with gastrointestinal tumors.Methods A retrospective analysis was performed on the clinical data of 195 patients with gastrointestinal tumors who underwent surgical treatment in the Department of General Surgery,Beijing Anzhen Hospital,Capital Medical University from February 2023 to February 2025.According to the occurrence of postoperative VTE,the patients were divided into the VTE group(20 cases)and the control group(without VTE,175 cases).The clinical data,Caprini score and D-dimer levels were compared between the two groups.Logistic regression analysis was used to identify the risk factors for postop-erative VTE in patients with gastrointestinal tumors,and the predictive value of Caprini score and D-dimer for VTE was evaluated.Results There were statistically significant differences in age,operation duration and intraoperative blood transfusion rate between the two groups(all P＜0.05).The D-dimer levels of both groups after surgery were significantly higher than those before surgery,and the level in the VTE group was significantly higher than that in the control group[(467±155)μg/L vs(352±170)μg/L](all P＜0.01).The Caprini score of the VTE group after surgery was significantly higher than that of the control group[(7.6±1.3)vs(5.2±1.5)](P＜0.01).Logistic regression analysis showed that abnormally elevated D-dimer and Caprini score were independent risk factors for postoperative VTE in patients with gastrointestinal tumors(both P＜0.001).The areas under the curve(AUC)of D-dimer and Caprini score for predicting postoperative VTE in patients with gastrointestinal tumors were 0.713(95％confidence interval:0.593-0.832)and 0.875(95％confidence interval:0.801-0.949),respec-tively.The AUC of their combination was 0.892(95％confidence interval:0.827-0.957),which was higher than that of each single index(both P＜0.05).Conclusion Caprini score combined with D-dimer has high predictive value for postoperative VTE in patients with gastrointestinal tumors,which has important reference significance for clinical prevention of postoperative VTE.

Abstract:Objective To investigate the correlation between serum syndecan-1(SDC-1)and peptidy-larginine deiminase 2(PAD2)levels and short-term poor prognosis in patients with sepsis.Methods A total of 150 patients with sepsis admitted to Anhui Provincial Hospital from January 2022 to December 2024 were selected as the observation group,and 150 healthy people in the same period were selected as the control group.The serum levels of SDC-1 and PAD2 were compared between the two groups.The patients with sepsis were divided into poor prognosis group and good prognosis group according to the 28 d survival.The correlation between serum SDC-1,PAD2 and the risk of short-term poor prognosis in patients with sepsis was analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of related indicators for short-term poor prognosis in patients with sepsis.Results The serum levels of SDC-1 and PAD2 in the observation group were higher than those in the control group[(240±50)μg/L vs(126±26)μg/L,(39±15)μg/L vs(10±4)μg/L](both P＜0.001).Among 150 patients with sepsis,46 patients(30.7％)died within 28 d and were classified into the poor prognosis group,and the remaining 104 patients were classified into the good prognosis group.The serum levels of SDC-1 and PAD2 in the poor prognosis group were higher than those in the good prognosis group[(274±46)μg/L vs(225±40)μg/L,(49±18)μg/L vs(35±12)μg/L](both P＜0.001).Restricted cubic spline analysis showed that the correlation strength between serum SDC-1 and PAD2 levels and the risk of short-term poor prognosis in patients with sepsis showed an approximate J-type non-linear dose-response relationship.Thiex2 Phi coefficient correlation and binomial correlation test showed that serum SDC-1 and PAD2 levels were positively correlated with the risk of short-term poor prognosis in patients with sepsis(all P＜0.001).ROC curve analysis showed that the area under the curve of SDC-1 and PAD2 in predicting the risk of short-term poor prognosis in patients with sepsis was 0.858 and 0.760,respectively.Conclusion The levels of serum SDC-1 and PAD2 in patients with sepsis are abnormally increased,and both of them are positively correlated with short-term poor prognosis of patients,which can be used to predict short-term poor prognosis of such patients.

Abstract:Uterine diverticulum is a rare uterine malformation,which is rarely reported in domestic and foreign literature.Its clinical manifestations lack specificity and can easily lead to misdiagnosis or missed diagnosis.This article explores the diagnostic strategy and individualized treatment mode of this disease through a typical case.The patient,a 32 year old female,presented with the main complaint of"prolonged menstrual period for more than 2 years and vaginal bleeding for 2 months".Transvaginal four-dimensional ultrasound and pelvic magnetic resonance imaging suggest a depression on the anterior wall of the cervix,which is further confirmed by hysteroscopy as cervical diverticulum.The patient underwent cervical diverticulectomy under laparoscopy,during which the diverticulum was completely removed and the cervical muscle layer defect was repaired.After a 6-month follow-up,the patient's menstrual cycle returned to normal.Congenital cervical diverticulum is a rare disease with non-specific clinical symptoms that require differential diagnosis through multimodal imaging combined with hyste-roscopy.Congenital cervical diverticulum is commonly characterized by abnormal uterine bleeding and infertility,which can be easily confused with other gynecological diseases.It is recommended to combine imaging and endoscopic examination to achieve accurate diagnosis,and choose personalized surgical plans based on the patient's reproductive needs.This case provides important reference for clinical treatment of such rare diseases.

Abstract:Objective To analyze the efficacy and safety of switching bevacizumab in patients with rat sarcoma(RAS)wild-type metastatic colorectal cancer(mCRC)who could not tolerate the skin toxicity of cetuximab in the first-line treatment.Methods A total of 143 patients with RAS wild-type mCRC who received two-drug chemotherapy combined with cetuximab as first-line treatment and completed at least one efficacy evaluation without disease progression in the Affiliated Hospital of Xuzhou Medical University from January 2018 to July 2023 were retrospectively selected.The observation group was the patients who could not tolerate the skin toxicity of cetuximab and switched to bevacizumab-based treatment,and the control group was the patients who could continue to receive cetuximab.The efficacy and safety of the two groups were compared.Results After propensity score matching,the median progression-free survival of the observation group and the control group were 10.5 months(95％confidence interval:9.3-11.7 months)and 10.8 months(95％confidence interval:9.4-12.2 months),respectively,and there was no significant difference between the two groups(P=0.28).The median overall survival was 27.1 months(95％confidence interval:22.9-31.3 months)and 33.5 months(95％confidence interval:25.9-4 1.0 months),respectively,and there was no significant difference between the two groups(P=0.17).During the treatment,the proportion of skin toxicity in the observation group was lower than that in the control group(P＜0.05),and there was no significant difference in the incidence of other adverse reactions between the two groups(all P＞0.05).Conclusion Switching to bevacizumab is also a treatment option for patients with RAS wild-type mCRC who cannot tolerate cetuximab skin toxicity during first-line therapy.

Abstract:Objective To explore the predictive value of thyroid hormone sensitivity indicators for postop-erative recurrence and metastasis of differentiated thyroid cancer(DTC)in the elderly.Methods A total of 106 elderly patients with DTC after surgery admitted to Peking University First Hospital Taiyuan Hospital from June 2019 to April 2020 were retrospectively selected.The patients were divided into recurrence and metastasis group(observation group,19 cases)and non-recurrence and metastasis group(control group,87 cases)according to whether recurrence and metastasis occurred 3 years after operation.Logistic regression model was used to analyze the influencing factors,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of thyroid hormone sensitivity indicators for postoperative recurrence and metastasis in elderly DTC patients.Results There were significant differences in TNM staging,postoperative 131I treatment,surgical methods,the proportion of postoperative thyroid-stimulating hormone(TSH)therapy,the levels of free triiodothyronine,TSH,thyroid stimulating hormone index(TSHI),thyroid-stimulating hormone resistance index(TT4RI),and thyroid feedback Quantile-based index(TFQI)between the two groups(all P＜0.05).Binary Logistic regression analysis showed that stage Ⅲ-Ⅳ,TSH,TSHI,TT4RI,TFQI,postoperative 131I treatment,total thyroidectomy,and no postoperative TSH therapy were risk factors for postoperative recurrence and metastasis in elderly DTC patients(all P＜0.05).ROC curve analysis showed that the area under the curve of thyroid hormone sensitivity indicators TSHI,TT4RI and TFQI combined to predict postoperative recurrence and metastasis of DTC patients was 0.977(95％confidence interval:0.937-0.999).Conclusions The combination of thyroid hormone sensitivity indicators TSHI,TT4RI and TFQI has high accuracy and predictive value in predicting postoperative recurrence and metastasis in elderly DTC patients,which can be used as effective indicators for clinical prediction of postoperative recurrence and metastasis in elderly DTC patients.

Abstract:Objective To investigate the clinical effect of metformin combined with camrelizumab and transcatheter arterial chemoembolization(TACE)in the treatment of patients with advanced hepatocellular carcinoma complicated with type 2 diabetes mellitus(T2 DM).Methods The clinical data of 82 patients with advanced hepatocellular carcinoma and T2DM who were treated in the 940th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from January 2018 to December 2022 were retrospectively analyzed.According to different treatment methods,the patients were divided into metformin group(42 cases)and control group(40 cases).The control group was treated with camrelizumab and TACE combined with non-metformin hypoglycemic drugs.The metformin group was treated with camrelizumab and TACE combined with metformin.The differences in immune function,biochemical indexes,tumor markers,efficacy and safety between the two groups were compared.Results After treatment,the levels of CD3+,CD4+T lymphocytes,CD4+/CD8+ratio,natural killer cell ratio,Interferon-γ,tumor necrosis factor-α,and interleukin-2 in the metformin group were all higher than those in the control group;the proportion of CD8+T lymphocytes,expression levels of interleukin-6 and programmed cell death receptor-1,aspartate aminotransferase,total bilirubin,alkaline phosphatase,aspartate aminotransferase to platelet ratio index,alpha fetoprotein levels,and positive rate of circulating tumor DNA were all lower than those in the control group(all P＜0.05).The objective response rate and disease control rate were significantly higher in the metformin group than those in the control group[61.9％(26/42)vs 30.0％(12/40),90.5％(38/42)vs 67.5％(27/40)](both P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(all P＞0.05).Conclusion Metformin combined with camrelizumab and TACE can significantly improve the immune function,liver function and metabolic status of hepatocellular carcinoma patients with T2 DM,reduce tumor activity,and has good safety.

Abstract:Objective To investigate the clinical effect of Bufei decoction and Liujunzi decoction in the treatment of chronic cough with deficiency of lung-spleen Qi after Mycoplasma pneumoniae infection in children.Methods A total of 102 children with chronic cough of lung-spleen Qi deficiency after Mycoplasma pneumoniae infection in Wuhan Hospital of Traditional Chinese Medicine,Hubei Province from March 2023 to April 2024 were selected.According to the random number table method,they were divided into the control group and the observation group,with 51 cases in each group.The control group was treated with oral azithromycin.The observation group was treated with Bufei decoction and Liujunzi decoction on the basis of the control group.Both groups were treated for 14 d.The cough score,serum inflammatory factors,disappearance time of clinical symptoms or signs,traditional Chinese medicine syndrome score,laboratory test indexes and clinical efficacy were compared between the two groups.Results After treatment,the cough scores,serum inflammatory factor levels,traditional Chinese medicine syndrome scores and laboratory test indexes of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group(all P＜0.05).The disappearance times of clinical symptoms or signs in the observation group were shorter than those in the control group(all P＜0.05).The total effective rate of the observation group was higher than that of the control group[94.1％(48/51)vs 84.3％(43/51)](x2=11.537,P=0.009).Conclusion Modified Bufei decoction and Liujunzi decoction combined with azithromycin has significant clinical effect in the treatment of chronic cough after Mycoplasma pneumoniae infection in children.