Abstract:Objective:To explore the expression and significance of interleukin(IL)-22 and IL-17A mRNA in vaginal secretions in patients with reproductive tract infections after intrauterine adhesions(IUA)separation.Methods:A retrospective study was conducted.A total of 108 patients with IUA who underwent adhesive separation surgery in the General Hospital of Jinshui District Zhengzhou City from January 2022 and January 2024 were selected and followed up for more than 6 months.The postoperative efficacy and reproductive tract infection of the patients were evaluated,and the pathogen identification was conducted for the infected patients.Vaginal secretions of patients were collected.The levels of IL-22 and IL-17A mRNA were detected by reverse transcription-polymerase chain reaction,and the detection results were analyzed.Results:After excluding 14 cases lost to follow up,94 patients were included.Among 94 patients with IUA,there were 23 cases of postoperative reproductive tract infection(infected group)and 71 cases without infection(non-infected group).A total of 34 pathogenic bacteria were detected in the infected patients,of which Gram-negative bacteria accounted for the highest proportion,67.65%(23/34),mainly Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae,with 9,7 and 5 strains respectively.The improvement rate of American Fertility Society(AFS)score in the infected group was lower than that in the non-infected group[69.57%(16/23)vs.88.73%(63/71);χ2=4.759,P＜0.05],while the moderate to severe re-adhesion rate was higher than that in the non-infected group[39.13%(9/23)vs.16.90%(12/71);χ2=4.948,P＜0.05].The mRNA expression levels of IL-22 and IL-17A in vaginal secretions were higher than those in the non-infected group[IL-22 mRNA:1.67±0.32 vs.0.51±0.13;IL-17A mRNA:1.92±0.38 vs.0.34±0.09;t=25.019 and 32.646 respectively,P＜0.001].In the infected group,the mRNA expression levels of IL-22 and IL-17A in vaginal secretions of patients with no improvement in AFS were significantly higher than those with effective improvement in AFS[IL-22 mRNA:2.20±0.27 vs.1.44±0.31;IL-17A mRNA:2.24±0.33 vs.1.78±0.42;t=5.607 and 2.561 respectively,P＜0.05].Conclusions:After separation of intrauterine adhesion,reproductive tract infection in patients will affect the surgical effects and cause the increase in mRNA expression of IL-22 and IL-17A in vaginal secretions,thus detection of IL-22 and IL-17A mRNA expression levels can provide information for infection and efficacy judgment to a certain extent.

Abstract:Objective:To investigate the effect of trans-urethral ureteroscopic laser lithotripsy combined with vacuum-assisted stone extraction sheath for renal pelvis calculi.Methods:This study enrolled 83 patients with renal pelvis or ureteropelvic junction calculi treated at Kaifeng People's Hospital from December 2020 to January 2024.Participants were randomly allocated via a random number table into:control group(n=38),received conventional trans-urethral ureteroscopic laser lithotripsy;observation group(n=45):underwent trans-urethral ureteroscopic laser lithotripsy combined with vacuum-assisted stone extraction sheath.The operation indicators,stone-free rate and recurrence rate,quality of life,and complications between the two groups were compared.Results:The operation duration and postoperative recovery hospital stay in the observation group were both shorter than those in the control group[operation duration:(71.48±8.37)min vs.(87.62±10.14)min;postoperative recovery hospital stay:(3.47±0.91)d vs.(4.23±1.16)d,and intraoperative blood loss of the observation group was less than that of the control group[(43.17±5.89)mL vs.(55.82±7.16)mL],and the difference was statistically significant(P＜0.001).The stone-free rate of the observation group was higher than that of the control group[100.00%(45/45)vs.89.47%(34/38)],and the difference was statistically significant(P＜0.05).There was no significant difference in the recurrence between the two groups[2.22%(1/45)vs.7.89%(3/38)](P＞0.05).After operation,the scores of bodily pain,general health,mental health and quality of life in the observation group were all higher than those in the control group,and the difference was statistically significant(P＜0.001).Lower complication rate in the observation group[8.89%(4/45)vs.31.58%(12/38 cases)](P＜0.01).Conclusions:Trans-urethral ureteroscopic laser lithotripsy combined with vacuum-assisted stone extraction sheath for renal pelvis calculi demonstrates significant clinical effect for renal pelvis calculi,effectively improving stone-free rates while reducing postoperative complications,with an acceptable safety profile.

Abstract:Objective:To investigate the effect of esketamine(ESK)on inflammatory markers in patients with sepsis.Methods:A retrospective analysis was conducted on clinical data of 96 sepsis patients who received analgesia and sedation treatments in the Intensive Care Unit of the Third Affiliated Hospital of Southern Medical University from June 1,2021 to April 30,2023.Based on whether esketamine was administered,patients were divided into an ESK group(n=48)and a Non-ESK group(n=48).The ESK group received continuous infusion of esketamine combined with other sedative and analgesic drugs for 48 hours,while the Non-ESK group received other sedative and analgesic drugs without esketamine.Clinical data include collected included gender,age,underlying disease,infection sites,Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,etc.The following indicators were collected before sedative and analgesic drugs infusion(0 h)and at 24 h,48 h,and 72 h after infusion:(1)Inflammatory indicators,including interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and white blood cell(WBC)count;(2)Sedation and analgesia scores,including the Non-verbal Adult Pain Assessment scale(NVPS)score and the Richmond Agitation-sedation Scale(RASS)score;(3)Details of drug therapy,prognostic indicators and adverse reactions.Results:No significant differences were observed between the two groups in the usage rates or dosages of sedatives,analgesics,antibiotics,vasoactive drugs,or hormones within 48 hours of sedation and analgesia treatment(P＞0.05).At baseline(0 h),median levels of IL-6,PCT,CRP and WBC were 146.00 pg/mL,2.33 ng/mL,134.17 mg/L,and 12.63×109/L in the ESK group,and 271.35 pg/mL,6.14 ng/mL,160.10 mg/L,and 13.31×109/L in the Non-ESK group.In both groups,all inflammatory markers showed a decreasing trend over time at 24 h,48 h,and 72 h after treatment.In the ESK group(IL-6:96.40 pg/mL,67.01 pg/mL,42.83 pg/mL;PCT:3.79 ng/mL,2.16 ng/mL,1.78 ng/mL;CRP:113.92 mg/L,95.91 mg/L,97.82 mg/L;WBC count:13.08×109/L,11.74×109/L,9.72×109/L).In the Non-ESK group(IL-6:113.65 pg/mL,125.00 pg/mL,107.20 pg/mL;PCT:5.51 ng/mL,3.72 ng/mL,3.64 ng/mL;CRP:155.60 mg/L,135.79 mg/L,107.55 mg/L;WBC:12.78×109/L,12.68×109/L,12.29×109/L).Wald χ² values were 20.905,16.465,28.317,and 16.291 respectively(P＜0.01).The improvement of PCT and CRP in the ESK group was better than that in the Non-ESK group(Wald χ² values were 16.956 and 10.262,P＜0.01),and the improvement of WBC in the Non-ESK group was better than that in the ESK group(Wald χ² value was 13.275,P＜0.001).The 28-day successful extubation rate in the ESK group was higher than the Non-ESK group[61.9%(26/42)vs.25.8%(8/31),χ²=9.340,P＜0.01].Conclusions:The decreased level of IL-6,PCT,CRP and WBC in patients with sepsis and the increased success rate of extubation at 28 days are associated with the use of esketamine.

Abstract:Objective:To study the correlation between cardiac function and serum inflammatory factors in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods:A retrospective analysis was conducted on 126 AMI patients admitted to Henan Provincial People's Hospital from August 2022 to April 2024.Compare the levels of inflammatory factors and the changes of cardiac function indicators in AMI patients before and after the operation,as well as the levels of inflammatory factors and cardiac function among different types of AMI patients after PCI,and explore the correlation between them.Results:The levels of interleukin-6(IL-6),tumor necrosis-α(TNF-α)and C-reactive protein(CRP)in 126 AMI patients 1 day after surgery[(19.56±5.10)ng/L,(29.15±5.54)ng/L and(27.75±7.56)mg/L,respectively]were lower than those before surgery[(30.14±5.62)ng/L,(39.15±5.62)ng/L and(48.74±8.07)mg/L,respectively;t=14.652,13.200 and 20.640 respectively,P＜0.001].One day after surgery,levels of IL-6,TNF-α and CRP in non-ST segment elevation myocardial infarction(NSTEMI)patients[(17.38±4.33)ng/L,(26.67±4.59)ng/L and(25.04±6.68)mg/L,respectively]were lower than those in ST segment elevation myocardial infarction(STEMI)patients[(22.37±4.67)ng/L,(32.35±5.01)ng/L and(31.25±7.24)mg/L,respectively;t=6.201,6.620 and 4.991,respectively;P＜0.001].Three months postoperatively,left ventricular ejection fraction(LVEF)of AMI patients was higher than that before operation(0.528 3±0.070 4 vs.0.407 4±0.052 9,t=15.796,P＜0.001);left ventricular end-diastolic diameter(LVEDD)was lower than before operation[(43.13±6.45)mm vs.(57.34±7.23)mm,t=15.860,P＜0.001].Three months postoperatively,compared with STEMI patients[LVEF:0.485 1±0.054 5;LVEDD:(46.85±5.82)mm],the LVEF level of NSTEMI patients(0.561 8±0.062 9)was higher(t=7.194,P＜0.001),and the LVEDD level[(40.25±5.37)mm]was lower(t=6.593,P＜0.001).Pearson analysis showed that serum IL-6,TNF-α and CRP levels were positively correlated with LVEDD(r=0.339,0.391,and 0.417 respectively,P＜0.001),and negatively correlated with LVEF(r=-0.328,-0.386,and-0.401 respectively,P＜0.001).Conclusions:The levels of IL-6,TNF-α and CRP are related to the cardiac function in AMI patients after PCI.The cardiac function can be determined by monitoring the levels of these three factors.

Abstract:Acute gastrointestinal injury in sepsis,due to its high incidence and mortality rate,directly affects the prognosis of sepsis patients and has attracted increasing attention from clinicians.As the pathogenesis and pathological process of sepsis are extremely complex and have not yet been fully clarified,the existing evaluation tools or methods for acute gastrointestinal dysfunction are difficult to comprehensively and accurately reflect the changes in gastrointestinal function,and there is a lack of reliable,real-time assessment methods and diagnostic criteria.Currently,the diagnosis of acute gastrointestinal injury in sepsis mainly relies on clinical manifestations such as loss of appetite,nausea,vomiting,abdominal distension,gastric retention and reflux of intestinal fluid.The intestinal barrier function is evaluated by detecting the content of specific biomarkers in blood or excreta,such as intestinal fatty acid-binding protein(I-FABP),citrulline,endotoxin,fecal calprotectin,and fecal secretory immunoglobulin A(sIgA).Gastrointestinal ultrasound,with its advantages of objectivity,dynamics,real-time performance,and convenience,has become a major auxiliary examination method for evaluating acute gastrointestinal injury.The treatment of gastrointestinal function injury emphasizes providing reasonable nutritional support,probiotic supplementation,and using prokinetic drugs on the basis of eliminating the cause,controlling infection,maintaining vital signs and the stability of important organ functions,which can achieve significant therapeutic effects.Traditional Chinese medicine has a unique role in improving gastrointestinal symptoms and restoring gastrointestinal function.The integrated approach of combining traditional Chinese and Western medicine presents a promising strategy for the prevention and treatment of septic gastrointestinal injury.

Abstract:Objective:To investigate the efficacy of the 304 retrospective analysis training method in enhancing the diagnostic accuracy of endoscopists for gastrointestinal submucosal tumors.Methods:Ten endoscopists from the Department of Gastroenterology of the Fourth Medical Center of the PLA General Hospital were selected.All the physicians had relatively rich endoscopic operation experience and had participated in the basic training of endoscopic ultrasound.They were randomly divided into a training group(n=5)and a control group(n=5)by the random number table method.The training group received"white light-ultrasound-pathology"retrospective training utilizing the 304 retrospective analysis training method.Another 92 patients underwent endoscopic ultrasound examination from January 2019 to January 2024 were selected and randomly allocated to the training group(n=47)and the control group(n=45).Endoscopists in the training group and the control group conducted the examinations respectively,with the pathological diagnosis results as the gold standard.The diagnostic accuracy of submucosal tumors of the digestive tract was analyze in the control group and the training group.Results:A total of 92 patients with gastrointestinal submucosal tumors were included in this study.The common locations of the lesions were the gastric body(n=19),gastric antrum(n=18),and rectum(n=16),and the prevalent lesion types included leiomyoma(n=22),gastrointestinal stromal tumor(GIST)(n=21),and neuroendocrine tumor(n=14).Both white-light endoscopy and endoscopic ultrasonography demonstrated high accuracy in assessing lesion size.Endoscopic ultrasound achieved an accuracy of 65.2%(60/92)in evaluating the layer of origin of the lesions.The training group showed an accuracy of 68.1%(32/47),which was higher than the control group's 62.2%(28/45),but the difference was not statistically significant(χ²=0.348,P＞0.05).As the diagnostic accuracy of endoscopists in the training group for determining the layer of origin of lesions improved year by year,the proportion of patients opting for endoscopic surgery also increased annually.Through the"304 retrospective analy-sis training",endoscopists significantly enhanced their diagnostic accuracy in determining the nature of lesions under endoscopic ultrasound.The accuracy of training group achieved 83.0%(39/47),which was significantly higher than that of the control group(57.8%,26/45),and the difference was statistically significant(χ²=7.041,P＜0.01).Conclusions:The 304 retrospective analysis training method significantly improves the diagnostic accuracy of endoscopists in identifying the patho-logical characteristics of gastrointestinal submucosal tumors and enhances the precision of lesion depth assessment,advocat-ing for its broader adoption,which is worthy of promotion.

Abstract:Objective:To analyze the epidemiological characteristics and trends of human immunodeficiency virus(HIV)or acquired immune deficiency syndrome(AIDS)in Wujiang District,Suzhou from 2014 to 2023,providing evidence for targeted prevention strategies and resource allocation.Methods:Newly diagnosed HIV or AIDS cases were extracted from the Chinese Center for Disease and Prevention,filtered by"provincially verified"status and current residence in Wujiang District.Joinpoint Regression Program(v5.2.0)was used to analyze incidence trends.Results:From 2014 to 2023,652 new HIV or AIDS cases were confirmed in Wujiang District,with incidence increasing from 2.76 to 4.70 per 100,000 population.The proportion of cases aged≥50 years rose significantly from 34.09%(15/44)to 60.20%(59/98).Result of time trend analysis showed that the incidence of male,HIV-infected,heterosexual transmitted infection and divorced or widowed marital status in the 50 and above age group showed a significant upward trend,with the average annual change percentage(AAPC)being 5.55%(95%CI 2.68-8.50,P＜0.01),11.99%(95%CI 7.04-17.16,P＜0.01),7.42%(95%CI 3.29-11.72,P＜0.01),and 27.60%(95%CI 8.94-49.46,P=0.01),respectively.In terms of age group,the incidence of disease in people aged 60 years and above(60-69 years,70-79 years,and 80 years and above)showed a significant upward trend,and the AAPC was 32.29%(95%CI 19.94-45.92,P＜0.01),25.85%(95%CI 0.08-58.26,P=0.05),and 17.37%(95%CI 3.45-33.16,P＜0.05),respectively.The model analysis results showed that the incidence of heterosexual infections in the age group 50 years and older was divided into two phases,with a significant increase from 2017 to 2023,with an annual percentage change(APC)of 35.15%(95%CI 11.59-63.68,P=0.01).Conclusions:HIV or AIDS incidence in Wujiang District showed sustained growth from 2014 to 2023,particularly among older adults(≥50 years)via heterosexual transmission,underscoring the need for targeted geriatric interventions.

Abstract:Objective:To analyze the detection value of peripheral blood neutrophil to lymphocyte ratio(NLR),platelet count to lymphocyte ratio(PLR),apolipoprotein B/apolipoprotein A1(ApoB/ApoA1)and lipoprotein a[Lp(a)]on patients with varying degrees of acute pancreatitis(AP).Methods:Clinical data of 69 patients with AP admitted to the Second People's Hospital of Zhengzhou from January 2020 to December 2023 were retrospectively analyzed,and they were divided into three groups according to the severity of the disease.The levels of NLR,PLR,ApoB/ApoA1 and Lp(a)in peripheral blood of AP patients with different severity before treatment were compared.Spearman correlation analysis method was used to analyze the correlation between peripheral blood NLR,PLR,ApoB/ApoA1 and Lp(a)levels and AP severity.According to whether they developed organ failure or not,they were divided into good prognosis group(n=50)and poor prognosis group(n=13),and the peripheral blood NLR,PLR,ApoB/ApoA1 and Lp(a)were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of peripheral blood NLR,PLR,ApoB/ApoA1 and Lp(a)levels on predicting the prognosis of AP patients.Results:There were significant differences in the levels of NLR,PLR,ApoB/ApoA1 and Lp(a)in peripheral blood of AP patients with different disease severity(P＜0.05).Spearman correlation analysis showed that the levels of NLR,PLR,ApoB/ApoA1 and Lp(a)in peripheral blood were positively correlated with the severity of AP(P＜0.05).The levels of NLR,PLR,ApoB/ApoA1 and Lp(a)in peripheral blood of patients with poor prognosis were significantly higher than those of patients with good prognosis(P＜0.05).In ROC curve,areas under the curves(AUCs)of peripheral blood NLR,PLR,ApoB/ApoA1 and Lp(a)levels in predicting the prognosis of AP patients were 0.837,0.793,0.827 and 0.757,respectively,and the sensitivity was 92.31%,92.31%,84.62%and 76.92%,respectively.The specificity was 75.00%,66.07%,76.79%and 71.43%,respectively.Conclusions:The levels of NLR,PLR,ApoB/ApoA1 and Lp(a)in peripheral blood are closely related to the severity of AP,and have high value in predicting the prognosis of AP patients.