Abstract:Objective To explore the effect of piperacillin tazobactam combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary(AECOPD)disease and its impact on patients'serum soluble CD40 ligand(sCD40L)and matrix metalloproteinase 9(MMP-9)levels.Methods A total of 95 AECOPD patients admitted to the 909th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2022 to April 2023 were selected.According to the random number table method,patients were divided into observation group(48 cases)and control group(47 cases).The control group received intravenous infusion of piperacillin tazobactam on the basis of routine treatment,while the observation group received intravenous infusion of ammonium bromide hydrochloride combined with piperacillin tazobactam on the basis of routine treatment,both of which were treated continuously for 7 d.The clinical efficacy of the two groups,changes in lung function,blood gas indicators,serum sCD40L and MMP-9 levels before and after treatment,and incidence of adverse reactions after treatment were compared.Results The total effective rate of the observation group was higher than that of the control group[95.8％(46/48)vs 80.9％(38/47)](P＜0.05).After treatment,the lung function indicators forced expiratory volume in the first second(FEV1),FEV,to forced vital capacity ratio,FEV,as a percentage of expected value,and blood gas analysis indicators arterial partial pressure of oxygen and pH in the observation group were significantly higher than those in the control group,while arterial carbon dioxide partial pressure was significantly lower than that in the control group(all P＜0.05).After treat-ment,the average levels of serum sCD40L and MMP-9 in the observation group were significantly lower than those in the control group(all P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusions The combination of piperacillin tazobactam and ambr-oxol hydrochloride has a significant therapeutic effect on AECOPD patients.It can improve lung function and blood gas analysis results,reduce serum sCD40L and MMP-9 levels,and its mechanism is related to effective control of inflammatory response and inhibition of airway remodeling.

Abstract:Tumor-associated macrophages are an important part of the tumor microenvironment.The mononuclear macrophage system has plasticity.Under different inducing conditions and stimulating factors,tumor-associated macrophages can be polarized into Ml-type and M2-type macrophages.M2-type macrophages play an important role in the occurrence and development of tumors.Macrophages can fight against tumor therapy by regulating the activation of tumor cells,promote angiogenesis,inhibiting the proliferation of autologous T cells and the production of interferon-y,so that T cells lose their anti-tumor activity,and promote tumor cell metastasis by releasing cytokines.Targeted therapy of tumor-associated macrophage,mainly through inhibiting the recruitment of macrophages,inhibiting the survival of tumor macrophages,modulating the polarization of macrophages,and modulating the macrophages in the tumor microenvironment,thus affecting the survival and metastasis of the tumor.

Abstract:Objective To explore the sedative effect of remazolam and midazolam on pulmonary function in patients with invasive mechanical ventilation.Methods A total of 90 patients who underwent invasive mechanical ventilation in the Affiliated Hospital of Chengde Medical College from February to September 2023 were selected.The patients were divided into control group(44 cases)and observation group(46 cases)by random number table method.The control group was given midazolam for sedation on the basis of conventional remifentanil.The observation group was given remazolam tosilate for sedation on the basis of conventional remifentanil.The degree of sedation,pulmonary function,blood gas analysis indexes,oxidative stress and inflammatory response indexes,and adverse events were compared between the two groups.Results The Richmond restlessness sedation scores in the observation group were lower than those in the control group at 30 min,4 h,12 h and 24 h after administration[(-0.93±0.11)vs(-0.88±0.12),(-1.08±0.08)vs(-0.99±0.12),(-1.11±0.09)vs(-1.06± 0.11),and(-1.18±0.07)vs(-1.10±0.09)](all P＜0.05).After sedation,the platform pressure,heart rate,mean arterial pressure,levels of malondialdehyde,and interleukin-6 in the observation group were lower than those in the control group,and the pulmonary static compliance,pulse oxygen saturation,and superoxide dismutase levels were higher than those in the control group(all P＜0.05).The total incidence of adverse events in the observation group was lower than that in the control group,but the difference was not statistically significant(x2=0.973,P=0.324).Conclusion The application of remazolam or midazolam in patients with invasive mechanical ventilation can improve the sedative effect,which is conducive to the promotion and smooth progress of invasive mechanical ventilation,improve the pulmonary function of patients,reduce oxidative stress and inflammatory response,and the anesthetic and sedative effect of remazolam is better than midazolam.

Abstract:Objective To investigate the value of combined detection of serum tumor markers carbohy-drate antigen 125(CA125),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA19-9)in the diagnosis and prognosis evaluation of colon cancer.Methods A total of 116 patients with colon cancer who were first diagnosed and treated in People's Hospital of Rizhao,Shandong Province from January 2017 to June 2018 were selected as the observation group,and 50 patients with benign colon lesions who came to the hospital for diagnosis and treatment during the same period were selected as the control group.The serum levels of CA125,CEA and CA19-9 were detected and compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of colon cancer.Kaplan-Meier method and Log-rank test were used for survival analysis.With pathological diagnosis as the gold standard,the diagnostic value of single and combined examination for colon cancer was calculated by four-fold table method.Results The levels of serum CA125,CEA and CA19-9 in the observation group were higher than those in the control group[(96±15)kU/L vs(24±4)kU/L,(56.8±6.2)μg/Lvs(2.6±0.6)μg/L,(118±19)kU/L vs(25±6)kU/L](t=23.551,62.560,34.712,all P＜0.01).The serum levels of CA125,CEA and CA19-9 in patients with high clinical stage(Ⅲ-Ⅳ),low differentia-tion and distant metastasis in the observation group were significantly higher than those in patients with low clinical stage(Ⅰ-Ⅱ),high differentiation/moderate differentiation and no distant metastasis(all P＜0.001).Multivariate Logistic regression analysis showed that elevated serum levels of CA125,CEA and CA19-9 were independent risk factors for colon cancer.After 5 years of follow-up,the 5-year event-free survival rate of the high expression group of serum CA1 25,CEA and CA1 9-9 was significantly lower than that of the low expression group(all P＜0.01).The sensitivity,accuracy and negative predictive value of combined detection of serum CA125,CEA and CA19-9 in the diagnosis of colon cancer were significantly higher than those of single detection and the combination of two detection(all P＜0.05).Conclusion Serum CA125,CEA and CA19-9 can be used as biological indicators for the diagnosis of colon cancer,and the combined detection of the three can significantly improve the diagnostic value of colon cancer.

Abstract:Objective To observe the clinical effect of adalimumab injection combined with Fengshi Gutong capsule in the treatment of ankylosing spondylitis(AS)of kidney deficiency and governor cold.Methods A total of 77 AS patients diagnosed in the Department of Rheumatology and Immunology,the First Affiliated Hospital of Anhui Medical University from May 2021 to April 2023 were selected.All patients were randomly divided into control group(39 cases)and observation group(38 cases).The control group was treated with adalimumab combined with imrecoxib,and the observation group was treated with adalimumab combined with Fengshi Gutong capsule.The data before treatment,laboratory examination results,disease activity index,clinical compliance rate before and after treatment and safety indicators were compared between the two groups.Results There were no statistically significant differences in all indicators between the two groups before treatment(all P＞0.05).After 6 months of treatment,the physician global assessment(PGA)score,BathAS disease activity index(BASDAI),AS disease activity score(ASDAScrp),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in the control group were lower than those before treatment,BASDAI,ESR and CRP in the observation group were lower than those before treatment,and the clinical compliance rate was higher than that before treatment(all P＜0.05).After 12 months of treatment,the finger-ground distance,PGA score,BASDAI,ASDAScrp,ESR and CRP in the control group were lower than those before treatment,and the chest expansion and clinical compliance rate were higher than those before treatment,the finger-ground distance,PGA score,BASDAI,ASDAScrp,ESR and CRP in the observation group were lower than those before treatment,and the lumbar activity and clinical standard rate were higher than those before treatment,and the differences were statistically significant(all P＜0.05).After 12 months of treatment,the incidence of gastrointestinal discomfort in the observation group was lower than that in the control group[0(0/22)vs 16.7％(4/24),x2=4.016,P=0.045].Conclusion Adalimumab injection combined with Fengshi Gutong capsule in the treatment of AS patients with kidney deficiency and governor cold has the same effect as adalimumab injection combined with imrecoxib,which can provide a new choice for the treatment of AS.

Abstract:Objective To explore the implementation of risk assessment and prevention effect of lower limb deep venous thrombosis(DVT)in intensive care unit(ICU)patients.Methods The clinical data of 148 patients admitted to the ICU of Aviation General Hospital from July 1,2022 to June 30,2023 were collected and retrospectively analyzed.According to whether DVT occurred within 24 h of ICU admission,the patients were divided into DVT group(45 cases)and non-DVT group(103 cases).The patients in the non-DVT group were further divided into new-onset DVT group(16 cases)and non-new-onset DVT group(87 cases)according to the evaluation results within 2 weeks of ICU admission(after 24 h).The evaluation of DVT in ICU patients was summarized through DVT risk score,D-dimer,and fibrinogen levels,and the effectiveness of relevant preventive measures for DVT was observed.Results Acute physiology and chronic health status scoring system 11 score in DVT group was higher than that in non-DVT group(P＜0.05).There was no significant difference in DVT risk score between medical and surgical patients in DVT group,non-DVT group,non-new-onset DVT group and new-onset DVT group(all P＞0.05).The levels of D-dimer and fibrinogen in the DVT group were significantly higher than those in the non-DVT group[(10.7±3.4)mg/L vs(3.8±1.7)mg/L,(486±133)g/L vs(376±133)g/L](both P＜0.05).In the non-DVT group,the rates of hospital-acquired DVT were 70.0％(7/10),8.9％(4/45),14.3％(2/14),and 8.8％(3/34)for basic prophylaxis,mechanical prophylaxis,pharmacological prophylaxis alone and mechanical and pharmacological prophylaxis,respectively.The incidences of DVT in patients with mechanical prevention,simple drug prevention and mechanical prevention combined with drug prevention were significantly lower than those in patients with simple basic prevention.The incidence of DVT in patients with mechanical prevention and mechanical prevention combined with drug prevention is lower than that in patients with drug prevention alone(all P＜0.05).Conclusions The incidence of lower limb DVT in ICU patients is high.D-dimer,fibrinogen level and DVT risk score can be used to assess the risk of DVT in patients and guide the corresponding preventive measures.The occurrence of DVT can be effectively avoided by using positive preventive measures for ICU patients.

Abstract:Antihypertensive drug therapy is an important intervention for hypertensive patients with heart failure.Angiotensin converting enzyme inhibitor,angiotensin Ⅱ receptor blocker,angiotensin receptor neprilysin inhibitor,diuretic,calcium channel blocker and β-receptor blocker are commonly used as first-line antihypertensive drugs in clinical practice.For high-risk patients with hypertension and heart failure,multi-drug combination therapy is generally adopted in clinical practice,and the efficacy of antihypertensive drugs is different in patients with different left ventricular ejection fraction grades.Therefore,the stratification of cardiovascular disease in hypertensive patients before the use of antihypertensive drugs will be helpful to guide clinical rational drug use.This article reviews the therapeutic effect and research progress of the latest first-line antihypertensive drugs for hypertension complicated with heart failure.

Abstract:Objective To observe the clinical effect of modified Huanglian Wendan decoction in the treatment of obesity-related hypertension and its effect on homocysteine level.Methods A total of 68 patients with obesity-related hypertension treated in First Affiliated Hospital,Heilongjiang University of Chinese Medicine from March 2023 to March 2024 were selected as research objects.According to the random number table method,they were divided into the control group and the observation group,with 34 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with modified Huanglian Wendan decoction on the basis of the control group.Both groups were treated for 8 weeks.The Traditional Chinese Medicine syndrome curative effect,blood pressure,physique index,blood lipid and homocysteine level before and after treatment,and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[85.3％(29/34)vs 58.8％(20/34)](x2=5.916,P=0.015).After treatment,the systolic blood pressure,diastolic blood pressure,body mass index and abdominal circumference of the two groups were lower than those before treatment,and the above indexes of the observation group were lower than those of the control group(all P＜0.05).After treatment,the levels of triglyceride,total cholesterol,low-density lipoprotein cholesterol and homocysteine in the two groups were lower than those before treatment,and the high-density lipoprotein cholesterol was higher than that before treatment.The levels of low-density lipoprotein cholesterol and homocysteine in the observation group were lower than those in the control group,and the level of high-density lipoprotein cholesterol in the observation group was higher than that in the control group(all P＜0.05).There were no obvious adverse reactions in the two groups during treatment.Conclusion Modified Huanglian Wendan decoction can improve the therapeutic effect of obesity-related hypertension by regulating the level of homocysteine.

Abstract:Cervical cancer is the most common malignant tumor of the female reproductive system.Persistent infection of high-risk human papillomavirus(HR-HPV)is the main cause of cervical precancerous lesions and cervical cancer,and the main cause of female death worldwide.Despite the continuous updates in prevention,screening,and treatment methods for cervical cancer,significant progress has been made.However,for patients with advanced recurrent and metastatic cervical cancer,the treatment effect is not ideal.Therefore,it is of great significance to explore the molecular mechanism of cervical cancer and find new prevention and treatment strategies and targeted therapies.This article focuses on the molecular regulatory mechanism of HR-HPV,the regulatory mechanism of estrogen,progesterone and immune regulation on HR-HPV in the occurrence and development of cervical cancer,and the molecular mechanism of ferroptosis involved in cervical cancer occurrence and development,which will open up a new perspective for the prevention and treatment of cervical cancer.

Abstract:Objective To investigate the effect of dapagliflozin combined with metformin on visceral fat and serum chemokine-like receptor 1(CMKLR1)levels in patients with type 2 diabetes mellitus(T2 DM)compli-cated with non-alcoholic fatty liver disease(NAFLD).Methods A total of 80 patients with T2DM and NAFLD who were diagnosed and treated in Cangzhou People's Hospital,Hebei Province from January 2020 to January 2023 were selected and divided into metformin group and dapagliflozin group by random number table method,with 40 cases in each group.The metformin group was treated with metformin hydrochloride sustained release tablets,and the dapagliflozin group was treated with dapagliflozin tablets on the basis of the metformin group.The clinical efficacy,glucose and lipid metabolism related indicators,inflammation related indicators,serum CMKLR1 level,body fat indicators,and adverse reactions were compared between the two groups.Results The total effective rate of dapagliflozin group was higher than that of metformin group[97.5％(39/40)vs 80.0％(32/40)](x2=4.507,P=0.034).After treatment,the levels of fasting blood glucose,glycosylated hemoglobin,total cholesterol,triglyceride,low-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance index in the two groups were lower than those before treatment,and those in the dapagliflozin group were lower than those in the metformin group(all P＜0.05).The levels of interleukin-6,tumor necrosis factor-α and CMKLR1 in the two groups were lower than those before treatment,and those in the dapagliflozin group were lower than those in the metformin group(all P＜0.05).The visceral fat area,subcutaneous fat area,body weight and body mass index of the two groups were lower than those before treatment,and those of the dapagliflozin group were lower than those of the metformin group(all P＜0.05).During the treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Dapagliflozin combined with metformin in the treatment of T2DM with NAFLD can effectively reduce visceral fat and serum CMKLR1 level.

Abstract:In recent years,the formulation of medical talent training strategies by public hospitals in conjunction with hospital development strategies and actual conditions has emerged as a pivotal factor influencing the high-quality advancement of hospitals.However,there is uncertainty within original personnel management systems of Beijing Anzhen Hospital,Capital Medical University regarding personnel training,and improvements are necessary in human resource evaluation,salary management systems,and information platform management.To address this issue,our hospital has implemented a series of policies and all departments have collaborated to collectively promote the establishment and development of talent training projects within the hospital.The optimization and integration of resources,such as award applications,funding and platform support,and performance incentives,has enhanced the construction of a talent training system to enhance hierarchical training modes,establish an evaluation and management system,and propose personalized training strategies.Promote the reform of resource based relative value scale talent performance remuneration,categorized evaluation of medical,nursing and technical talents.Strengthening the information-based talent training platform aims to build a database,enhance online management capabilities.The implementation of a series of measures has steadily improved the hospital's advantageous disciplines and comprehensive strength.

Abstract:Objective To investigate the effects of Xinshuaikang Shenque acupoint application combined with standardized treatment regimen of western medicine on the results of echocardiography and the distance of 6 min walk test(6MWT)in patients with chronic heart failure(CHF).Methods A total of 98 patients with CHF admitted to Inner Mongolia Autonomous Region Traditional Chinese Medicine Hospital from June 2022 to June 2023 were selected as the research objects,and they were divided into combined group and standard treatment group by random number table method,with 49 cases in each group.The standard treatment group was treated with standardized western medicine,and the combined treatment group was treated with Xinshuankang Shenque acupoint application.The clinical efficacy,traditional Chinese medicine syndrome scores,echocardiographic indicators[left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)],serological indicators[N-terminal pro-B-type natriuretic peptide(NT-proBNP),cardiac troponin Ⅰ(cTnⅠ),angiotensin Ⅱ(AngⅡ)],exercise tolerance and quality of life indicators[6MWT distance,Minnesota Living with Heart Failure Questionnaire(MLHFQ)],and adverse reactions were compared between the two groups.Results After treatment,the total effective rate of the combined group was significantly higher than that of the standard treatment group[71.4％(35/49)vs 51.0％(25/49)](P=0.038).After treatment,the scores of fatigue,shortness of breath,heavy limbs,palpitation and night sweat in the two groups were lower than those before treatment,and those in the combined group were significantly lower than those in the standard treatment group(all P＜0.05).After treatment,LVEF,SV and 6MWT distance in both groups were significantly higher than those before treatment,and those in the combined group were significantly higher than those in the standard treatment group.LVEDD,LVESD,NT-proBNP,cTnⅠ,AngⅡ and MLHFQ were significantly lower than those before treatment,and those in the combined group were significantly lower than those in the standard treatment group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.505).Conclusion Xinshuaikang Shenque acupoint application combined with standardized western medicine treatment has better clinical effect on CHF patients,which can effectively improve the cardiac function of patients,increase exercise endurance and improve the quality of life of patients.

Abstract:Ovarian cancer is a gynecological malignant tumor with the highest mortality rate.Exploring effective treatment methods to prevent metastasis has become an urgent clinical problem to be solved.Immunotherapy is a new field of cancer treatment.However,ovarian cancer is not sensitive to immunotherapy because of the lack of infiltration of cytotoxic T cells and the inability of infiltrated T cells to recognize all tumor antigens.It belongs to the category of"cold tumor"and is not sensitive to immunotherapy.Traditional Chinese medicine believes that qi deficiency,blood stasis and toxic turbidity are the key pathogenesis of ovarian cancer,and the Yiqi Huoxue Jiedu method is an important treatment,which needs to be further clarified on the basis of theoretical research.Immuno-suppression and chronic inflammation constitute the two core characteristics of the tumor microenvironment,which jointly promote the occurrence,development and metastasis of tumors.In this paper,the immune-inflammatory microenvironment is highly consistent with the theory of"Yin and Yang"and"poison-pathogenic factors"of traditional Chinese medicine.The deficiency of Yang transforming qi is like the deficiency of positive immune cells such as cytotoxic T cells.On the one hand,it is like infiltration of too many immunosuppressive cells,factors,and metabolites.On the other hand,it is like poison caused by deficiency in the human body,which maintains and amplifies the inflammatory microenvironment.Inflammation promotes tumor progression,and inflammation in turn promotes immunosuppression.The therapeutic idea of this method is clarified from the perspective of immune inflammation:"warming Yang,strengthening positive,balancing Yin and Yang"to activate positive immunity."Activating blood circulation,dissipating phlegm,dispersing cold and clearing heat"can disperse Yin and pathogenic factors,detoxify toxic stagnation,thereby alleviating immunosuppression and regulating inflammatory microenvironment.The anti-inflammatory treatment by"Fighting poison with poison"improves the theoretical basis for the transformation of"cold"and"hot"immunogenicity by this method,and provides theoretical basis for further material research.

Abstract:Objective To investigate the clinical effect of traditional Chinese medicine in the treatment of advanced colorectal cancer.Methods A total of 338 patients with advanced colorectal cancer who were treated in Suzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from January 2015 to December 2022 were retrospectively selected as the research objects.According to different treatment methods,the patients were divided into traditional Chinese medicine group(180 cases)and traditional Chinese and western medicine group(158 cases).The traditional Chinese medicine group was mainly treated with traditional Chinese medicine,without any chemotherapy,targeted therapy and immunotherapy.In the traditional Chinese and western medicine group,chemotherapy was given priority to,combined with traditional Chinese medicine comprehensive treatment.Two months was a cycle,and the two groups were treated for 2 consecutive cycles.The main clinical symptoms,Karnofsky performance status(KPS)score,clinical efficacy and progression free survival(PFS)were compared between the two groups.Results There was no significant difference in gender distribution,age,site of disease,pathological type,degree of differentiation,stage,metastatic site,KPS score and traditional Chinese medicine syndrome type between the two groups(all P＞0.05).After treatment,the incidences of fatigue,poor appetite,abdominal distension,abdominal pain,constipation and loose stool in the traditional Chinese medicine group were lower than those in the traditional Chinese and western medicine group(all P＜0.05).The improvement of KPS score in the traditional Chinese medicine group was better than that in the traditional Chinese and western medicine group(P＜0.001).The total effective rate of the traditional Chinese and western medicine group was higher than that of the traditional Chinese medicine group[84.8％(134/158)vs 73.3％(132/180)](P＜0.05).The PFS of the traditional Chinese and western medicine group was 3 months longer than that of the traditional Chinese medicine group(Log-rank x2=4.729,P=0.030).Conclusions Comprehensive treatment of traditional Chinese medicine or comprehensive treatment of traditional Chinese medicine combined with chemotherapy can improve the clinical effect,clinical symptoms and KPS score,and prolong PFS.Traditional Chinese medicine treatment alone can better improve clinical symptoms and KPS score,while the combination of traditional Chinese medicine and western medicine has advantages in prolonging PFS.

Abstract:Objective To investigate the correlation between the expression of kisspeptin and omentin-1 and bone age index and ovarian volume in girls with central precocious puberty.Methods A total of 85 girls with central precocious puberty who were treated in Maternal and Child Health Hospital of Tangshan City,Hebei Province from July 2022 to June 2023 were selected as the observation group,and another 70 healthy girls who underwent physical examination during the same period were selected as the control group.The levels of related clinical indexes,kisspeptin and omentin-1 were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of bone age index and ovarian volume.Pearson correlation analysis was used to analyze the correlation between the expression of kisspeptin and omentin-1 with bone age index and ovarian volume in girls with central precocious puberty.Results The levels of kisspeptin,bone age index and ovarian volume in the observation group were significantly higher/greater than those in the control group[(2.68±1.05)μg/L vs(0.60±0.20)μg/L,(1.67±0.25)vs(1.02±0.06),(3.68±0.58)cm3 vs(2.70±0.29)cm3],while the level of omentin-1 in the observation group was significantly lower than that in the control group[(27±4)μg/L vs(70±8)µg/L](all P＜0.001).Multivariate Logistic regression analysis showed that predicting adult height,estradiol,luteinizing hormone(LH),follicle stimulating hormone(FSH),bone-derived alkaline phosphatase,osteocalcin,insulin-like growth factor-1,kisspeptin and omentin-1 were the influencing factors of bone age index(all P＜0.001),while uterine volume,estradiol,LH,FSH,kisspeptin and omentin-1 were the influencing factors of ovarian volume(all P＜0.001).Kisspeptin in girls with central precocious puberty was positively correlated with bone age index(r=0.634,P=0.001)and ovarian volume(r=0.533,P=0.001),and the omentin-1 was negatively correlated with bone age index(r=-0.569,P=0.001)and ovarian volume(r=-0.459,P=0.001).Conclusion The expression of kisspeptin increases in girls with central precocious puberty,while the expression of omentin-1 decreases.Kisspeptin is positively correlated with the bone age index and ovarian volume of pediatric patients,while omentin-1 is negatively correlated with the bone age index and ovarian volume of pediatric patients.

Abstract:Objective To explore the effects of paravertebral space approach pedicle screw internal fixation combined with screw placement on the recovery and pain of injured vertebrae in patients with spinal fracture through paravertebral space approach.Method Fifty patients with spinal fracture admitted to Beijing Anzhen Hospital,Capital Medical University from May 2021 to May 2023 were selected.Patients were divided into control group and observation group by lottery method,with 25 cases each.The control group treated with lateral spinous approach pedicle screw internal fixation combined with screw placement of injured vertebrae;the observation group treated with pedicle screw internal fixation with paravertebral space approach combined with nail placement of injured vertebra.Perioperative indexes,pain degree,vertebral anterior margin height improvement,Cobb's angle,serum bone metabolism indexes and trauma factor levels were compared between the two groups.Results The intraoperative blood loss,operation time,postoperative bed rest time,postoperative drainage and postoperative hospital stay in the observation group were less/shorter than those in the control group,and the visual analog scale score of pain in the observation group was lower than that in the control group 3 d after operation(all P＜0.001).At 3 d and 3 months after operation,the height of the anterior edge of vertebral body in the observation group was higher than that in the control group[(14.0±1.3)cm vs(11.7±1.2)cm,(15.4±1.7)cm vs(12.8±1.3)cm],and the level of type Ⅰ procollagen amino terminal peptide was higher than that in the control group;the Cobb's angle was smaller than that in the control group,and the type Ⅰ collagen carboxyl terminal peptide was lower than that of the control group(all P＜0.001).Three days after operation,the levels of myoglobin,lactate dehydrogenase and creatine kinase in the observation group were lower than those in the control group(all P＜0.05).Conclusions The clinical efficacy of using the paravertebral muscle gap approach in the combination of pedicle screw internal fixation and vertebral fixation is better.It has the characteristics of small surgical incision,short time,and fast recovery,and helps patients recover from vertebral injuries,reduce pain,and promote bone healing.

Abstract:Objective To explore the effect of afatinib maleate tablets combined with cisplatin and paclitaxel in the treatment of advanced non-small cell lung cancer.Methods The clinical data of 80 patients with advanced non-small cell lung cancer admitted to the Affiliated Brain Hospital/Chest Hospital of Nanjing Medical University from January 2019 to September 2022 were retrospectively analyzed.According to different treatment methods,they were divided into control group and observation group,with 40 cases in each group.The control group was treated with cisplatin and paclitaxel chemotherapy,and the observation group was treated with afatinib maleate tablets on the basis of the control group.The efficacy,tumor marker level,the quality of life questionnaire-Chinese cancer chemotherapy patients(QLQ-CCC)score,incidence of adverse reactions,and 12-month survival rate were compared between the two groups.Results The disease control rate in the observation group was higher than that in the control group[82.5％(33/40)vs 62.5％(25/40)](x2=4.013,P=0.045).There was no statistically significant difference in objective response rate between the two groups(x2=0.503,P=0.478).After treatment,the average levels of carbohydrate antigen 125,cytokeratin 19 fragment,and carcinoembryonic antigen in the two groups were lower than before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).After treatment,the scores of general feeling,psychological function,social function and physical function of QLQ-CCC in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(x2=0.879,P=0.348).The 12-month survival rate of the observation group was higher than that of the control group[62.5％(25/40)vs 40.0％(16/40)](x2=4.053,P=0.044).Conclusion Afatinib maleate tablets combined with cisplatin and paclitaxel in the treatment of advanced non-small cell lung cancer can achieve a good effect,the disease control rate can reach a high level,and can effectively reduce the level of tumor markers,improve the quality of life of patients,and improve the short-term survival rate.

Abstract:Objective To explore the effect of traditional Chinese medicine acupoint massage combined with contralateral controlled functional electrical stimulation(CCFES)on the recovery situation of motor function in patients with upper limb dysfunction after stroke.Methods A total of 220 patients with upper limb dysfunction after ischemic stroke admitted to West China Hospital,Sichuan University from July 2021 to July 2023 were selected as the research objects.According to the random number table method,the patients were divided into the control group and the observation group,with 110 cases in each group.The control group was treated with CCFES,and the observation group was treated with traditional Chinese medicine acupoint massage on the basis of the control group.Both groups were treated for 1 month.The clinical efficacy,traditional Chinese medicine syndrome score,wrist range of motion,motor function,daily living ability and quality of life were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[86.4％(95/110)vs 74.5％(82/110)](x2=4.885,P=0.027).After treatment,the traditional Chinese medicine syndrome scores 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).After treatment,the scores of wrist range of motion,Fugl-Meyer scale,upper limb action study scale,functional independence rating scale and stroke quality of life scale in the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P＜0.05).Conclusion CCFES combined with traditional Chinese medicine acupoint massage can achieve significant curative effect in patients with upper limb dysfunction after stroke,which is helpful to the recovery of motor function.

Abstract:Objective To explore the influence of ultrasound guided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia on perioperative stress and occurrence of postoperative delirium in elderly patients with hip fractures.Methods A total of 266 elderly patients with hip fracture admitted to Yan'an University Affiliated Hospital from January 2020 to June 2023 were prospectively selected and divided into group A and group B by envelope method,with 133 cases in each group.Group A was given laryngeal mask ventilation and sevoflurane inhalation general anesthesia,while group B was given ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia.The changes in stress indicators levels[cortisol,superoxide dismutase(SOD),angiotensin-Ⅱ(Ang-Ⅱ)]and visual analogue scale(VAS)scores at 5 min before operation and 2,12,24 h after operation,and Mini-Mental State Examination(MMSE)score and delirium occurrence on the 1st,2nd and 3rd day after operation were compared between the two groups.The occurrence of perioperative adverse reactions was recorded.Results The levels of cortisol,Ang-Ⅱ and SOD at 2,12 and 24 h after operation in both groups were higher than those at 5 min before operation but the levels in group B were lower than those in group A in each time point(all P＜0.05).At 2,12 and 24 h after operation,the VAS scores of the two groups were lower than those at 5 min before operation,and the VAS scores of group B were lower than those of group A at each time point(all P＜0.05).The MMSE scores of group B were higher than those of group A on the 1st,2nd and 3rd day after operation[(20±5)vs(18±4),(21±5)vs(19±4),(24±4)vs(21±5)],and the incidences of delirium were lower than those of group A(all P＜0.05).The incidences of intraoperative hypotension,restlessness during recovery and respiratory depression in group B were lower than those in group A(all P＜0.05).Conclusion Ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia is more conducive to reducing postoperative stress and pain in elderly patients with hip fracture,and has positive significance in reducing the incidence of postoperative delirium,intraoperative hypotension and restlessness during recovery.

Abstract:Objective To investigate the relationship between neuron-specific enolase(NSE)level and the effect of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced small cell lung cancer(SCLC).Methods The clinical data of 108 patients with advanced SCLC treated with sintilimab combined with platinum-based doublet-chemotherapy in Zhujiang Hospital,Southern Medical University from February 2022 to February 2024 were retrospectively analyzed.According to the clinical efficacy,the patients were divided into effective group(66 cases)and ineffective group(42 cases).The clinical data,T cell subsets,immu-noglobulin(Ig),pro-gastrin-releasing peptide(Pro-GRP)and NSE level were compared between the two groups.Multivariate Logistic regression was used to analyze the independent risk factors of ineffectiveness,and the independent correlation between NSE level and the ineffectiveness risk of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC was analyzed,and the sensitivity analysis was performed using the E-value method.Restricted cubic spline(RCS)model was established to analyze the dose-response relationship between serum NSE level and the ineffective risk of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC.Results There were significant differences in smoking history,tumor stage,CD3+,CD4+,CD8+,IgA,IgG,IgM,Pro-GRP level between the two groups(P＜0.05).There were significant differences in NSE level and ΔNSE1,ΔNSE2,ΔNSE3 and ΔNSE4 level after the first,second,third and fourth cycles of chemotherapy between the two groups(all P＜0.05).In the same group,the NSE level after each chemotherapy were significantly different from those after the last chemotherapy(all P＜0.05).Hierarchical regression analysis showed that CD3+,CD4+and CD8+had a significant positive effect on NSE level(all P＜0.05),and IgA and IgM had a significant positive effect on NSE level(both P＜0.05).After adjusting for smoking history,tumor stage and Pro-GRP,serum NSE level was still an independent risk factor for the inefficacy of sintil-imab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC(odds ratio=2.620,95％confidence interval:1.538-4.580,P＜0.001).The trend test of NSE from low to high quintile groups was statistically significant(Ptrend＜0.001),and sensitivity analysis showed that the E-value was 2.619.RCS model analysis showed that there was a linear dose-response relationship between NSE level and the inefficacy risk of sindilizumab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC(Pfor non linear=0.195).Subgroup analysis showed that the correlation between NSE and sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC was stable in patients with different tumor stages,Pro-GRP,CD3+,CD4+,CD8+,IgA,IgG and IgM level,and there was no interaction between subgroups(all Pfor interaction＞0.05).Conclusion NSE level can significantly affect the clinical efficacy of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC.Patients with lower NSE level have better clinical efficacy.