Abstract:As an important supplement to commercially available drugs,medical institution preparations have a wide range of needs in clinical application.Among them,traditional Chinese medicine granules have become an important part of preparations in medical institutions because of their advantages of rapid absorption and convenient administration.However,with the rapid development of medical technology,there are still obvious deficiencies in the intelligence and standardization of existing traditional Chinese medicine equipment.As a result,traditional Chinese medicine preparations in medical institutions are generally faced with problems such as backward preparation process,unstable equipment performance,and poor quality uniformity,which restrict the clinical efficacy.This article systematically analyzes the research progress of clinical application and preparation process of traditional Chinese medicine granules in recent years,and deeply discusses its development status,key issues and future trends,in order to provide theoretical basis and practical guidance for the process improvement,innovation and development of preparations in medical institutions.

Abstract:Objective To explore the risk factors for reduction in branch opening area during coronary stent implantation immediate by combining high-precision intracavitary imaging techniques with functional studies.Methods Patients who underwent coronary angiography and stent interventional therapy at Beijing Jishuitan Hospital,Capital Medical University from October 22,2022 to June 1,2023 were selected.Based on the criterion that the reduction ratio of the postoperative branch opening area measured by endovascular imaging exceeded 50％,the lesions were divided into the postoperative branch opening area reduction group(53 cases)and the postoperative branch opening area normal group(113 cases).The differences in various angiographic features and endovascular imaging indicators of the two groups of lesions were compared,and the virtual coronary flow reserve fraction(Angio-FFR)at each point of the main branch of the bifurcated lesion was measured.The independent risk factors for the reduction of branch opening area were analyzed.The receiver operating characteristic(ROC)curve was established to evaluate the predictive value of intracavitary imaging for the reduction of branch opening area.Results There was no significant difference in coronary angiography data between the two groups(all P＞0.05).The proportion of plaque rupture/erosion,healing plaque and calcification in the opening area reduction group were lower than those in the opening area normal group,and the bifurcation angle and the minimum lumen area of the bifurcation nucleus were lower than those in the opening area normal group(all P＜0.05).The results of ROC curve analysis showed that the area under the curve predicted by ΔAngio-FFR for the reduction of branch opening area was 0.80(P＜0.001).The results of multivariate Logistic regression analysis showed that healing plaque,bifurcation calcification and cross bifurcation ΔAngio-FFR were the risk factors for the reduction of branch opening area(all P＜0.05).Conclusion The healing plaque,bifurcation calcification and cross bifurcation ΔAngio-FFR in the bifurcation junction area are the risk factors for the reduction of branch opening area after surgery.ΔAngio-FFR≥0.04 across the bifurcated vascular segment can better predict the reduction of the branch opening area after stent implantation.

Abstract:Objective To investigate the effect of gastric volume on the recovery of spontaneous circulation(ROSC)during cardiopulmonary resuscitation in patients with out of hospital cardiac arrest(OHCA).Methods The clinical data of 106 OHCA patients admitted to the Resuscitation Room of the Department of Emergency Medicine,Eastern Theater General Hospital of the Chinese People's Liberation Army from July 2021 to January 2023 were retrospectively analyzed.Patients were divided into a gastric distension group(28 cases)and a non gastric distension group(78 cases)based on the median percentage of gastric contents(including gas)in the negative pressure suction tray of the gastric tube after arrival at the hospital(defined as gastric distension if ≥ 75％).Baseline clinical data,ROSC and 30 d survival were compared between the two groups.The relationship between related clinical factors and ROSC,and the relationship between gastric volume and related clinical factors were analyzed.Results There was no significant difference in age,gender distribution,pre-hospital emergency care and pre-hospital time between the two groups(all P＞0.05).There was no significant difference in ROSC rate and 30 d survival rate between gastric distension group and nongastric distension group[28.6％(8/28)vs 25.6％(20/78),7.1％(5/28)vs 3.8％(3/78)](P=0.441,0.993).Multivariate Logistic regression analysis showed that cardiopulmonary resuscitation,airway management and epinephrine management were independent risk factors for death events in OHCA patients(all P＜0.05).Gastric volume was not associated with ROSC outcome(P=0.280).Conclusion Excessive gastric contents do not affect ROSC during cardiopulmonary resuscitation.

Abstract:Objective To investigate the relationship between D-dimer/fibrinogen ratio(DFR)and C-reactive protein/fibrinogen ratio(CFR)and clinical prognosis in elderly patients with acute exacerbation of chronic heart failure(AECHF).Methods The clinical data of 157 patients with AECHF admitted to Chongqing University Fuling Hospital from May 2020 to May 2024 were retrospectively collected.DFR and CFR were calculated,and the death and rehospitalization due to heart failure within 90 days after admission of AECHF patients were counted.According to the prognosis of AECHF patients,they were divided into good prognosis group(105 cases)and poor prognosis group(52 cases).The risk factors for the poor prognosis of patients with AECHF were analyzed,and the value of DFR and CFR in predicting the poor prognosis of patients with AECHF was analyzed.Results DFR and CFR in the poor prognosis group were higher than those in the good prognosis group[(0.20±0.05)vs(0.18±0.03),(3.3±0.7)vs(2.6±0.4)](both P＜0.05).New York Heart Association class Ⅳ,N-terminal pro-brain natriuretic peptide(NT-proBNP),DFR and CFR were risk factors for poor prognosis in patients with AECHF(all P＜0.05).The area under the ROC curve of combined DFR,CFR and NT-proBNP for predicting poor prognosis in AECHF patients was higher than that of DFR,CFR or NT-proBNP alone(Z=3.861,3.452,2.853,all P＜0.05).Conclusion Increased DFR and CFR are associated with poor prognosis in patients with AECHF.The combination of DFR,CFR and NT-proBNP has a high prognostic value in patients with AECHF.

Abstract:Objective To analyze the effect of dexmedetomidine combined with laryngeal mask general anesthesia on cerebral oxygen supply and demand balance in patients undergoing acute anterior circulation large vessel occlusion thrombectomy.Methods A total of 95 patients who underwent acute anterior circulation large vessel occlusion thrombectomy in Lishui People's Hospital,Zhejiang Province from December 2022 to December 2024 were included.According to the random number table method,they were divided into an observation group(47 cases)and a control group(48 cases).The control group received general anesthesia with laryngeal mask,while the observation group received intravenous infusion of dexmedetomidine hydrochloride injection at the beginning of the surgery on the basis of general anesthesia with laryngeal mask.The intraoperative clinical indexes of the two groups were compared,such as the mean arterial pressure(MAP),heart rate and pulse oxygen saturation(SpO2)levels of the two groups were recorded before anesthesia induction(T0),after anesthesia induction(T1),15 min during surgery(T2)and after surgery(T3).The blood oxygen saturation(SjvO2),cerebral oxygen uptake rate(CERO2),arterial oxygen content(CaO2)and internal carotid vein oxygen content(CjvO2)of the two groups were compared at T0,T3 and 24 h after surgery(T4).The national institutes of health stroke scale(NIHSS)scores of the two groups before and after surgery were analyzed.Results The time from puncture to vascular recanalization and the number of thrombectomy in the observation group were shorter/less than those in the control group,and the first recanalization rate was higher than that in the control group(all P＜0.05).The MAP and heart rate of T,,T2 and T3 in the two groups decreased first and then increased,but the MAP and heart rate of T1 and T2 in the observation group were higher than those in the control group(all P＜0.05).There were no time,group and interaction effects on SpO2 of patients in the two groups(all P＞0.05).The SjvO2,CaO2 and CjvO2 of T0,T3 and T4 in the two groups decreased first and then increased,and CERO2 increased first and then decreased,but the SjvO2,CaO2,and CjvO2 of T3 in the observation group were higher than those in the control group,and CERO2 was lower than that in the control group(all P＜0.05).There was no significant difference in NIHSS score between the observation group and the control group before operation[(17.2±2.6)vs(17.2±2.8)](t=0.145,P=0.885).The NIHSS scores of the two groups at 48 h after operation were lower than those before operation,and the NIHSS scores of the observation group were lower than those of the control group[(9.6±1.2)vs(12.4±1.5)](t=10.208,P＜0.001).Conclusion The combination of dexmedetomidine and laryngeal mask general anesthesia can improve intraoperative clinical indicators,stabilize hemodynamics,balance cerebral oxygen supply and demand,and reduce neurological damage in patients undergoing acute anterior circulation large vessel occlusion thrombectomy.

Abstract:Sleep disorders and cognitive impairment have become non-negligible public health issues.Epidemiological data indicate that sleep disorders are an important risk factor for cognitive impairment,but the underlying mechanism remains unclear.Comprehensive studies have shown that sleep disorders may regulate synapse-related signaling pathways,interfere with the synaptic pruning function of glial cells,induce an imbalance in neurotransmitter and receptor systems,disrupt normal neural oscillations,and impair synaptic plasticity.These effects further weaken the information processing and circuit integration capabilities of cognition-related brain regions such as the hippocampus and prefrontal cortex,ultimately manifesting as cognitive deficits dominated by memory impairment.Therefore,clarifying how sleep disorders affect synaptic plasticity is a key link in revealing the mechanism of sleep disorder-induced cognitive impairment.This review will discuss the aforementioned aspects,aiming to provide a comprehensive perspective for understanding the synaptic plasticity mechanism under-lying cognitive impairment caused by sleep disorders.

Abstract:This paper explores the roles of lactic acid and its derived lactylation modification in macro-phage polarization and bone healing.It elaborates on how lactic acid regulates the transformation of macrophages from the M1 to M2 phenotype through metabolic reprogramming and signaling pathways,and further discusses the important significance of this process in the inflammatory,reparative and remodeling phases of fracture healing.In addition,the paper describes the special manifestations of macrophage polarization under pathological conditions such as hypoxia in the fracture microenvironment and osteoporosis.At the mechanistic level,it not only summarizes histone lactylation modification,but also reveals how non-histone lactylation modification(e.g.,pyruvate kinase M2)directly regulates the expression of bone healing-related genes,including the regulation of osteoclast resorption and osteoblast differentiation.This paper emphasizes the potential of lactic acid and lactylation modification as therapeutic targets for bone healing,and proposes future research directions for improving bone repair efficacy by regulating macrophage polarization,providing an innovative strategy for the treatment of non-union fractures.

Abstract:Objective To investigate the correlation between the optimization of emergency timeliness and survival outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation(ECPR),and to provide evidence-based medical evidence for the establishment of an efficient ECPR rapid response system.Methods The clinical data of 167 critically ill patients who underwent ECPR treatment at Beijing Anzhen Hospital,Capital Medical University from January 2017 to December 2024 were retrospectively analyzed.Key indicators including the extracorporeal membrane oxygenation(ECMO)initiation time(the time from the ECMO team receiving the emergency call to start the emergency process to the successful initiation of ECMO),installation location and catheterization method were recorded,and their relationships with clinical outcomes such as in-hospital mortality and weaning success rate were analyzed.Results The in-hospital mortality rate was 71.9％(120/167)and the weaning success rate was 41.9％(70/167)among the 167 ECPR patients.The ECMO initiation time was shorter in the operating room and intensive care unit,and the longest in the emergency department,with no statistically significant difference(P=0.131).The initiation time of pre-catheterization and percutaneous puncture was signifi-cantly shorter than that of incision,puncture combined with incision(all P＜0.05).The initiation time of in-hos-pital survivors was significantly shorter than that of in-hospital non-survivors[30.00(21.00,40.00)min vs 35.00(26.00,48.00)min](Z=-2.275,P=0.023).The initiation time of successful weaning patients was also significantly shorter than that of unsuccessful weaning patients[30.00(21.00,40.50)min vs 35.00(28.00,49.00)min](Z=-2.223,P=0.026).Multivariate Logistic regression analysis showed that catheterization method was the only independent risk factor affecting ECPR initiation time(hazard ratio=2.273,95％confidence interval:1.354-3.815,P=0.002).Logistic regression model analysis showed that when the initiation time was 40 min,the risk of death in patients increased significantly and the weaning success rate decreased significantly(all P＜0.05).Conclusion Initiation time is a key factor affecting the prognosis of ECPR patients.The application of percutaneous puncture catheterization technology and optimization of initiation time(controlled within 40 min)can significantly improve the survival outcomes of patients.Medical institutions should establish a professional ECPR rapid response team,formulate standardized emergency processes,and improve the rescue success rate of patients with refractory cardiac arrest.

Abstract:Inverted formin 2(INF2),a member of the formin family with dual functions of actin polymeri-zation and depolymerization,has attracted increasing attention in tumorigenesis and development in recent years.By regulating mitochondrial dynamics,cytoskeleton remodeling,organelle interaction and other processes,INF2 exerts complex roles in various malignant tumors.This paper reviews the functional mechanisms of INF2 in different types of tumors and its potential clinical application value,and also discusses the research status and future development direction of INF2 as a potential therapeutic target,aiming to provide new ideas and strategies for clinical treatment.

Abstract:Objective To investigate the effect of Bifidobacterium quadruple live tablets on intestinal flora and the serum levels of forkhead box O3(FOXO3),autophagy-related gene 7(ATG7),and macrophage inflammatory protein-3α(MIP-3α)in elderly male patients with severe pneumonia.Methods A total of 80 elderly male patients with severe pneumonia admitted to the 980th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from February 2023 to August 2024 were selected as research subjects.They were divided into a control group and an observation group using the random number table method,with 40 cases in each group.The control group received conventional treatments such as nutritional support,oxygen inhalation,and expectoration.The observation group was given Bifidobacterium quadruple live tablets on the basis of the control group.Both groups were treated continuously for 2 weeks.The clinical efficacy,symptom improvement time,immune function,inflammatory factors,and intestinal flora were compared between the two groups.Results The total effective rate of treatment in the observation group was higher than that in the control group[95.0％(38/40)vs 77.5％(31/40)](x2=5.165,P=0.023).The times to clinical symptom improvement in the observation group were shorter than those in the control group(all P＜0.05).After treatment,the levels of CD3+,CD4+,and CD4+/CD8+ratio in both groups were higher than those before treatment,and the observation group had significantly higher levels than the control group(all P＜0.05).After treatment,the levels of procalcitonin,C-reactive protein,serum amyloid A,surfactant protein,FOXO3,ATG7,and MIP-3 α in both groups were lower than those before treatment,and the observation group had significantly lower levels than the control group(all P＜0.05).After treatment,the levels of Lactobacillus and Bifidobacterium in the observation group were higher than those before treatment,while Enterococcus was lower than that before treatment;the levels of Lactobacillus and Bifidobacterium in the observation group were higher than those in the control group,and Enterococcus was lower than that in the control group(all P＜0.05).Conclusion Bifidobacterium quadruple live tablets can significantly improve the clinical efficacy,reduce the inflammatory level,and modulate the intestinal flora in elderly patients with severe pneumonia.

Abstract:Objective To explore the predictive value of early admission infection markers and T-cell subsets in children with severe Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 100 children with MPP admitted to the Affiliated Hospital of North Sichuan Medical College from January 2023 to December 2024 were enrolled as research subjects.According to the severity of the disease,the children were divided into the mild MPP group(70 cases)and the severe MPP group(30 cases).The general data,main clinical manifesta-tions,peripheral blood infection markers and T-cell subsets were compared between the two groups.Multivariate Logistic regression analysis was used to explore the correlation of C-reactive protein(CRP),procalcitonin,serum amyloid A(SAA),CD4+,CD8+and CD4+/CD8+ratio with severe MPP in children.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of each indicator alone or in combination.Results The duration of fever and the proportion of tachypnea in the severe MPP group were longer/higher than those in the mild MPP group(all P＜0.05).The serum levels of CRP,procalcitonin and SAA in the severe MPP group were higher than those in the mild MPP group,while CD4+,CD8+and CD4+/CD8+ratio were lower than those in the mild MPP group(all P＜0.05).Multivariate Logistic regression analysis showed that the increased levels of CRP,procalci-tonin and SAA,as well as the decreased levels of CD4+,CDg+and CD4+/CD8+ratio were closely associated with the occurrence of severe MPP in children(all P＜0.05).ROC curve analysis showed that the area under the curve of the combined detection of the six indicators(CRP,procalcitonin,SAA,CD4+,CD8+and CD4+/CD8+ratio)for predicting severe MPP in children was larger than that of each indicator alone(0.953 vs 0.756,0.852,0.861,0.777,0.724,0.719,all P＜0.05).Conclusion CRP,procalcitonin,SAA,CD4+,CD8+and CD4+/CD8+ratio all have certain predictive value for severe MPP in children,and the combined detection of the six indicators has higher predictive efficacy.

Abstract:Ovarian cancer is the leading cause of death among malignant tumors of the female reproductive system,which seriously threatens the health of women.Based on the principles of evidence-based medicine,the guideline development group referred to the latest international and domestic clinical practice guidelines to formulate methods,objectively evaluate the evidence of integrated traditional Chinese and western medicine in the diagnosis and treatment of ovarian cancer,and extensively consulted experts from various disciplines such as Chinese medicine,clinical medicine,and methodology.The final result is this guideline,aiming to provide guidance for the clinical practice of integrated traditional Chinese and western medicine in the diagnosis and treatment of ovarian cancer.

Abstract:The rate of in-stent restenosis in patients with coronary atherosclerotic heart disease and diabetes mellitus is significantly higher than that in patients without diabetes mellitus.It is characterized by abnormal glucose metabolism,blood glucose fluctuation,insulin resistance as the core,and is often accompanied by hyperlipidemia,hyperuricemia,abnormal coagulation and fibrinolysis indicators,chronic inflammation,etc.These factors directly or indirectly affect vascular endothelial function,promote smooth muscle proliferation,abnormal coagulation,and ultimately lead to the occurrence of restenosis.This review mainly summarizes and discusses the research on the risk factors of in-stent restenosis after percutaneous coronary intervention in patients with diabetes mellitus and coronary atherosclerotic heart disease,in order to provide a reference for reducing the incidence of in-stent restenosis and preventing the occurrence of adverse cardiovascular events.

Abstract:Objective To investigate the clinical effect of remimazolam alone or combined with remifentanil for sedation in awake fiberoptic bronchoscopic tracheal intubation(AFOI).Methods Sixty patients who underwent elective AFOI surgery in Beijing Friendship Hospital,Capital Medical University from August 2021 to February 2023 were selected as the research objects.The patients were divided into remimazolam alone group(RM group)and remimazolam combined with remifentanil group(RR group)by random number table method,with 30 cases in each group.Patients in the RM group received only a continuous infusion of remimazolam 0.6 mg/(kg·h).RR group received remimazolam 0.6 mg/(kg·h)and remifentanil 0.05 µg/(kg·min)combined infusion.AFOI operation-related evaluation,sedation level and hemodynamic indexes at different time points[drug infusion at 1 min(T1)and 3 min(T2),before fiberoptic bronchoscope entering the glottis(T3),and after tracheal tube entering the trachea(T4)]were compared between the two groups.Results The response to fiberoptic bronchoscopy intubation,cough severity and post-intubation tolerance score,intubation time,awareness and willingness to accept AFOI score in RR group were lower/shorter than those in RM group(all P＜0.001).The Modified Observer's Assessment of Alertness/Sedation score and bispectral index at T2,T3 and T4 in RR group were lower than those in RM group(all P＜0.05).The incidence of hypoxemia and deep sedation was higher and the incidence of hypertension and tachycardia was lower in the RR group than in the RM group[44.8％(13/29)vs 0(0/30),48.3％(14/29)vs 3.3％(1/30),31.0％(9/29)vs 63.3％(19/30),34.5％(10/29)vs 73.3％(22/30)](all P＜0.05).Conclusions Remimazolam alone can provide effective sedation for AFOI and is safe and reliable.Remimazolam combined with remifentanil can provide better intubation conditions and comfort,but may increase the risk of respiratory depression.

Abstract:Cardiovascular disease remains a high incidence disease worldwide and the largest cause of mortality among populations and severely affects the health of elderly.At present,the trend of population aging has become a major global problem.With the physiological changes of aging,the elderly are more likely to suffer from cardiovascular diseases.At the same time,the elderly often have multimorbidity,which is an important reason for the increase in the prevalence of heart failure.Therefore,it is urgent to adopt new strategies to develop personalized health care programs suitable for the elderly,delay the progression of cardiovascular disease in the aging population,and gradually improve the healthy life expectancy of the elderly.Enhanced external counterpulsation(EECP)is a non-invasive treatment suitable for cardiovascular rehabilitation and secondary prevention.As a passive aerobic exercise,EECP provides a safe,effective and non-invasive rehabilitation treatment for elderly patients with cardio-vascular disease.In order to standardize the application and prescription management of EECP in elderly patients with cardiovascular disease,effectively increase coronary artery reserve,improve cardiac function,improve exercise tolerance,improve their quality of life and obtain the best prognosis,Cardiac Intensive Care Professional Committee of Chinese Medical Doctor Association,Critical Care Medicine Professional Committee of Chinese Medical Education Association,and etc.have developed the consensus by mutiple seminars and screened a large number of evidence-based medical evidence.This consensus focuses on clinical practice,is demand-oriented,and summarizes the process,including the working principle of EECP,the mechanism of action on cardiovascular diseases,the application of EECP in elderly cardiovascular diseases,and the operating procedures.The consensus aims to help clinicians to carry out standardized and systematic EECP treatment,so as to improve the effectiveness and safety of treatment,and to provide reference and basis for the application of EECP in elderly patients with cardiovascular disease.

Abstract:Objective To investigate the relationship between the levels of serum neurotransmitters,5-hydroxytryptamine(5-HT),norepinephrine(NE),neuron-specific enolase(NSE),neurofilament heavy chain protein(NfH),S100β protein and sleep disorders in patients with acute ischemic stroke.Methods A total of 358 patients with acute ischemic stroke hospitalized in the Department of Neurology,North China University of Science and Technology Affiliated Hospital from November 2022 to October 2023 were selected.The Pittsburgh Sleep Quality Index(PSQI)scale was completed within 3 days after admission to evaluate the sleep condition of patients.According to PSQI score and results,the patients were divided into sleep disorder group(276 cases)and non-sleep disorder group(82 cases).The sleep disorder group was further divided into mild sleep disorder group(147 cases),moderate sleep disorder group(96 cases)and severe sleep disorder group(33 cases).The serum levels of 5-HT,NE,NSE,NfH and S100β were compared among the groups.Logistic regression method was used to analyze the risk factors of sleep disorders after acute ischemic stroke.Spearman correlation method was used to analyze the correlation between serum 5-HT,NE,NSE,NfH,S100β protein and the severity of sleep disorder in patients with acute ischemic stroke.Results The serum levels of 5-HT and NE in sleep disorder group were lower than those in non-sleep disorder group[(248±90)ng/L vs(422±48)ng/L,(147±50)ng/L vs(270±46)ng/L],and the levels of NSE,NfH and S100β protein in the sleep disorder group were higher than those in the non-sleep disorder group[(9.2±3.0)μg/L vs(5.2±1.6)μg/L,(85±24)ng/L vs(51±12)ng/L,(798±174)ng/L vs(480±98)ng/L](all P＜0.001).Logistic regression analysis showed that 5-HT,NE,NSE,NfH and S100βprotein were independent risk factors for sleep disorders after acute ischemic stroke(all P＜0.05).Among them,5-HT and NE were protective factors,and NSE,NfH and S100β protein were risk factors.Spearman correlation analysis showed that the severity of sleep disorders was negatively correlated with the levels of 5-HT and NE in patients with acute ischemic stroke(r=-0.902,-0.942,both P＜0.001),and positively correlated with the levels of NSE,NfH and S100β(r=0.774,0.775,0.878,all P＜0.001).Conclusions The serum levels of 5-HT,NE,NSE,NfH and S100β protein were correlated with sleep disorders and their severity in patients with acute ischemic stroke.The severity of sleep disorders was negatively correlated with serum levels of 5-HT and NE,and positively correlated with serum levels of NSE,NfH and S100β protein.

Abstract:The development process of cardiac rehabilitation for coronary atherosclerotic heart disease is full of constant negations and doubts.It has experienced the transformation from"rest"to"dynamic rehabilitation",from the program with exercise rehabilitation as the core to comprehensive intervention,and from the program with exercise rehabilitation as the core to the comprehensive intervention.Its benefits have been supported by a large number of evidence-based medical evidence,and have been recommended by many countries and organizations.It is closely integrated with the primary and secondary prevention of coronary atherosclerotic heart disease,and has become an indispensable part of the medical practice of cardiovascular disease,which determines the treatment,prognosis and quality of life of patients with cardiovascular disease.This review aims to summarize the origin and historical background of cardiac rehabilitation at home and abroad,help clinical understand cardiac rehabilitation and its future potential,and provide a reference for promoting the development of cardiac rehabilitation in China.

Abstract:Objective To explore the effects of high-flow nasal cannula oxygen therapy(HFNC)on nerve ventilation drive and respiratory work in patients with chronic obstructive pulmonary disease(COPD)after mechanical ventilation extubation.Methods A total of 292 COPD patients who underwent mechanical ventilation and extubation in the Intensive Care Unit(ICU)and the Emergency Intensine Care Unit of People's Hospital of Quzhou,Zhejiang Province from January 2020 to June 2022 were selected and randomly divided into observation group and control group,with 146 cases in each group.The observation group received HFNC intervention,and the control group received Venturi mask oxygen therapy intervention.The general data of the two groups were compared.The respiratory parameters,blood gas analysis indexes,diaphragm electrical activity(EAdi)data and inspiratory effort index were compared between the two groups at the beginning of oxygen therapy and 30 min,60 min,24 h of oxygen therapy.The differences of clinical indicators between the two groups were compared.Results During the study period,7 and 5 patients were excluded from the control group and the observation group.After 60 min of oxygen therapy and 24 h of oxygen therapy,the respiratory rate and arterial partial pressure of carbon dioxide in the observation group were lower than those in the control group,and the oxygenation index and arterial oxygen partial pressure were higher than those in the control group(all P＜0.05).After 60 min of oxygen therapy and 24 h of oxygen therapy,the EAdi peak value,the EAdi valley value,the area under the EAdi curve,the product of diaphragmatic pressure-time,the product of diaphragmatic pressure-time per minute,and the product of diaphragmatic pressure-time per aspiration in the observation group were lower than those in the control group(all P＜0.05).The reintubation rate within 48 h,ICU hospitalization cost and ICU hospitalization time in the observation group were lower/shorter than those in the control group[6.4％(9/141)vs 18.7％(26/139),(43±8)thousand yuan vs(61±11)thousand yuan,(5.7±1.1)d vs(7.8±1.3)d](all P＜0.05).Conclusion Compared with traditional oxygen therapy,HFNC can effectively improve the neural ventilation drive and respiratory work of COPD patients after mechanical ventilation extubation,reduce the reintubation rate,shorten the length of ICU stay,and reduce the treatment cost.

Abstract:Gouty arthritis is a common crystal-related disease caused by the deposition of sodium urate crystals in articular and non-articular tissues,which can lead to inflammation and joint damage.It is mainly closely related to genetic,environmental and metabolic factors.Its occurrence is usually significantly associated with ele-vated serum uric acid levels.In the presence of persistent hyperuricemia,chronic deposition of sodium urate crys-tals in the joint and periarticular space and subsequent activation of the innate immune system are central mecha-nisms in the development of gouty arthritis.Among them,the exact molecular mechanism of NOD-like receptor family protein 3 inflammasome and some cytokines in the activation of gouty arthritis has not been elucidated.The treat-ment of recurrent gouty arthritis leading to the formation of tophus is limited.Therefore,it is particularly important to find effective drug targets for the treatment of goutv arthritis.

Abstract:Objective To investigate the effects of sacubitril/valsartan combined with basic therapy on hemorheology,cardiac function status and exercise tolerance in patients with chronic heart failure(CHF).Methods A total of 114 CHF patients admitted to the Third People's Hospital of Chengdu from April 2019 to April 2023 were selected and divided into observation group and control group by block randomization method,with 57 cases in each group.The control group received conventional CHF basic treatment,and the observation group was given sacubitril/valsartan combined treatment on this basis.The clinical effects of the two groups were compared after 6 months of treatment.Including heart function[left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)],hemorheology indexs[whole blood viscosity,plasma viscosity,erythrocyte deformation index(DI)],sports endurance[6 min walking distance test(6MWT)and peak oxygen uptake].The occurrence of adverse reactions of patients in the two groups during treatment was recorded.Results After 6 months of treatment,the total effective rate of the observation group was higher than that of the control group[84.2％(48/57)vs 68.4％(39/57)](P=0.047).After 6 months of treatment,the LVEDV and LVESV of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group[(222±4)ml vs(226±5)ml,(100±4)ml vs(102±5)ml](all P＜0.05).After 6 months of treatment,the hemorheological indexes of whole blood viscosity and plasma viscosity in the two groups were lower than those before treatment,and the observation group were lower than the control group[(3.1±1.0)mPa·s vs(3.7±1.1)mPa·s,(1.2±1.0)mPa·svs(1.9±1.1)mPa·s];DI was higher than that before treatment,and the observation group was higher than the control group[(0.51±0.23)vs(0.41±0.24)](all P＜0.05).After 6 months of treatment,the 6MWT distance and peak oxygen uptake in exercise tolerance of the two groups were longer/higher than those before treatment,and those in the observation group were longer/higher than those in the control group[(509±6)m vs(501±6)m,(22.4±2.9)ml/(kg·min)vs(20.7±3.8)ml/(kg·min)](all P＜0.05).During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients(P=0.297).Conclusion Sacubitril/valsartan combined with basic therapy has a significant effect on CHF,which makes the hemorheology of patients tend to be normal,and has a positive effect on the improvement of cardiac function and exercise endurance.