Abstract:Mitochondria plays an important role in cellular activities and metabolic processes,and insulin resistance(IR)exists in the early stage of a variety of metabolic diseases.Many studies have shown that mitochondrial dysfunction affects insulin signaling through a variety of mechanisms,leading to the occurrence and development of IR.In addition,reduced insulin function inactivates signaling pathways,resulting in IR that affects mitochondrial biogenesis and dynamics and impairs mitochondrial function.However,it remains unclear whether mitochondrial dysfunction is primary or secondary to disturbances of glucose metabolism,IR,and insulin secretion defects early in the disease.This article reviews the causal relationship between mitochondrial dysfunction and IR,reveals the pathological mechanism of mitochondrial dysfunction in metabolic diseases,and reviews a variety of methods to improve mitochondrial function and IR,so as to provide reference for clinical practice.

Abstract:Objective To explore the relationship between ischemic stroke with phlegm and blood stasis blocking collaterals and biochemical indexes.Methods Totally 71 patients with ischemic stroke with phlegm and blood stasis blocking collaterals(group A)and 55 patients with non-phlegm and blood stasis ischemic stroke(group B)treated in the Department of Acupuncture and Moxibustion,Beijing Hospital of Traditional Chinese Medicine(TCM),Capital Medical University from January to December 2021 were collected retrospectively.Another 70 healthy subjects who took part in physical examination in the same period were selected(group C).The serum biochemical indexes of subjects were measured and analyzed.The diagnostic value of each test index was analyzed and evaluated by drawing the receiver operating characteristic curve.Results The top five areas under the curve(AUC)indexes for diagnosing ischemic stroke of phlegm and blood stasis type were total protein,albumin,apolipoprotein A1(ApoA1),high density lipoprotein cholesterol(HDL-C)and cystatin C,and AUC were 0.930,0.912,0.811,0.802 and 0.754,respectively.The top five AUC indexes for diagnosis of non-phlegm and blood stasis type ischemic stroke were albumin,total protein,ApoA1,small and dense low density lipoprotein cholesterol(sdLDL-C)and cystatin C,which the AUCs were 0.962,0.908,0.879,0.831 and 0.830,respectively.The diagnostic value of total cholesterol,low density lipoprotein cholesterol(LDL-C),sdLDL-C and total bilirubin in ischemic stroke of non-phlegm and blood stasis type was significantly higher than that of phlegm and blood stasis type(Z=-2.083,P=0.037;Z=-2.705,P=0.007;Z=-3.056,P=0.002;Z=-2.264,P=0.024).Conclusions The detection of total cholesterol,HDL-C,LDL-C,ApoA1,sdLDL-C,cystatin C,total bilirubin,total protein and albumin has a certain reference value for TCM syndrome differentiation of ischemic stroke,but it is not recommended to use total cholesterol and other lipids as the basis of TCM syndrome differentiation of ischemic stroke.Total bilirubin may provide help and medication reference for the dialectical classification of phlegm and blood stasis blocking collaterals in ischemic stroke.

Abstract:Objective To investigate the value of 24 h dynamic electrocardiogram in predicting the recurrence of atrial fibrillation in patients with pre-excitation syndrome(WPW)and atrial fibrillation after radiofrequency ablation.Methods Fifty-one WPW patients with atrial fibrillation recurrence 6 months after radiofrequency ablation(recurrence group)and 51 WPW patients without atrial fibrillation recurrence(non-recurrence group)were selected from August 2021 to September 2023 in the Department of Electrocardiogram Function,the First People's Hospital of Kashgar,Xinjiang Uygur Autonomous Region.The 24 h dynamic electrocardiogram[P wave amplitude,maximum P wave duration(Pmax),P wave dispersion(Pd)and P wave terminal potential(Ptf),PR interval,QT interval corrected for heart rate(QTc)and Tp-Te interval]were compared between the two groups before operation.Multivariate Iogistic regression model was used to analyze the influencing factors of atrial fibrillation recurrence after radiofrequency ablation in patients with WPW and atrial fibrillation.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of postoperative atrial fibrillation recurrence.Results The values of QTc,P wave amplitude,Pmax and Pd in recurrence group were higher than those in non-recurrence group,while Ptf was lower than that in non-recurrence group(all P＜0.05).The age,duration of disease,left atrial diameter and atrial fibrillation attack frequency before ablation in the recurrence group were higher than those in the non-recurrence group,and left ventricular ejection fraction(LVEF)was lower than that in the non-recurrence group(all P＜0.05).Logistic regression analysis showed that older age,high Pmax and Pd values,and low LVEF were independent risk factors for atrial fibrillation recurrence after radiofrequency ablation in WPW patients with atrial fibrillation(all P＜0.05).ROC curve showed that the areas under the curve(AUC)of Pmax and Pd alone to predict the recurrence of atrial fibrillation after radiofrequency ablation in WPW patients with atrial fibrillation were 0.809(95％confidence interval:0.769-0.838)and 0.811(95％confidence interval:0.770-0.875),the AUC of combined prediction was 0.918(95％confidence interval:0.878-0.949),and the combined prediction efficiency is better than the individual prediction efficiency(both P＜0.05).Conclusion The 24 h dynamic electrocardiogram is related to the recurrence of atrial fibrillation after radiofrequency ablation in patients with WPW and atrial fibrillation.The Pmax and Pd values of P-wave potential are the risk factors for recurrence of atrial fibrillation after radiofrequency ablation in patients with WPW and atrial fibrillation,and the combination of the two has high efficacy in predicting recurrence of atrial fibrillation after radiofrequency ablation.

Abstract:Coronary artery disease is a serious threat to human health,and its histopathological basis is atherosclerotic plaque.Early detection of coronary artery lesions is essential for the diagnosis of coronary athero-sclerotic heart disease.In current guidelines,coronary CT angiography(CCTA)is a class Ⅰ recommendation for initial diagnosis of coronary atherosclerotic heart disease but has limitations.Artificial intelligence has great potential in health care to improve diagnostic efficiency and precision.There is a lack of studies on the comparison between artificial intelligence-guided CCTA and intravascular ultrasound(IVUS)in coronary plaque burden.This article introduces the application of artificial intelligence in the daily cardiology practice of CCTA.This article first summarizes the characteristics of deep learning technology and its application in interventional cardiology,and then discusses the feasibility and future development prospects of artificial intelligence-based CCTA technology compared with IVUS in the field of interventional cardiology.

Abstract:Diabetic nephropathy(DN)is an important cause of end-stage renal disease,but its mechanism is not fully understood.At present,it is considered to be the result of the interaction of genetics,immunity,inflammation,insulin resistance,oxidative stress and other factors.Recent studies have found that there are differences in intestinal flora between DN patients and healthy people,and intestinal flora can participate in the progression of DN by releasing endotoxin and its harmful metabolites to mediate systemic and renal inflammation.Therefore,exploring the role of intestinal flora in renal lesions of DN patients is expected to provide new ideas for the diagnosis and treatment of DN.

Abstract:Continuous renal replacement therapy(CRRT)is a widely used blood purification technique in extracorporeal circulation,and coagulation in the extracorporeal circulation circuit is one of its common complications.Heparin is commonly used as a circulating anticoagulant in clinical practice,but the higher risk of bleeding makes this regimen not suitable for patients with abnormal coagulation function.Nafamostat has a strong anticoagulant effect and a low risk of bleeding,which is more suitable for patients with high bleeding risk.This article reviews the clinical research progress of nafamostat in CRRT,in order to provide some reference value for the selection of anticoagulants for CRRT.

Abstract:Objective To analyze the effect of radiofrequency ablation combined with foam sclerotherapy injection on the quality of life and postoperative complications in patients with lower extremity varicose veins.Methods A total of 100 patients with lower extremity varicose veins admitted to the Affiliated Hospital of Northwest University,Xi'an No.3 Hospital from January 2022 to December 2023 were selected as the research objects.The patients were randomly(red and white ball)divided into control group(50 cases)and observation group(50 cases).The control group was treated with traditional high ligation and punctate stripping,and the observation group was treated with intracavitary radiofrequency ablation combined with foam sclerotherapy injection.The therapeutic effects,surgical indicators,pain stress level,hemodynamics,coagulation function indicators and the incidence of complications were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[98.0％(49/50)vs 82.0％(41/50)](P＜0.05).The operation time and hospitalization time of the observation group were shorter than those of the control group,and the intraoperative blood loss was less than that of the control group(all P＜0.05).After treatment,the visual analogue scale score,the levels of bradykinin and substance P in the observation group were lower than those in the control group,the hemodynamics and coagulation function were improved more significantly than those in the control group,and the score of chronic venous insufficiency questionnaire 14 was lower than that in the control group(all P＜0.05).The incidence of complications in the observation group was lower than that in the control group[2.0％(1/50)vs 12.0％(6/50)](P＜0.05).Conclusions Radiofrequency ablation combined with foam sclerotherapy injection in the treatment of lower extremity varicose veins can reduce the pain and stress of patients,improve their hemodynamics,coagulation function and quality of life,and has high application value.

Abstract:Objective To investigate the mechanism of C-C motif chemokine receptor-2 positive(CCR2+)exosomes in regulating myocardial ischemia reperfusion(IR)injury in mice.Methods Twelve C57 mice were divided into wild-type(WT)sham-operated group,WT operated(IR model)group,CCR2-exosome operated group and CCR2+exosome operated group using a completely randomized method,with the last three groups constructing myocardial IR injury model and provide corresponding treatment.Ultrasound was used to examine the cardiac structure and function.Masson trichrome special staining method was used to detect the collagen deposition in cardiac tissues.Cardiomyocyte apoptosis was detected by transferase-mediated deoxyuridine triphosphate nick-end labeling method.The expressions of C-C motif chemokine ligand-2(CCL2)and CCR2 on the surface of monocytes were detected by immunohistochemical staining and real-time fluorescent quantitative polymerase chain reaction method.Flow cytometry was used to detect lymphocyte antigen 6 complex C(Ly6C)and CD43 monocytes in the infarct site after myocardial IR.Results At 7 d after myocardial IR surgery,the area of cardiac fibrosis in CCR2+exosome operated group was smaller than that in IR model group[(16.8±8.1)％vs(45.7±3.8)％];the ejection fraction was significantly lower than that of the WT sham-operated group but higher than that of the IR model group;the number of apoptotic cardiomyocytes in mice was less than that in IR model group.The relative expression of CCR2 protein in the heart of mice was lower than that of the IR model group;the area of CCR2 positive cells in the reperfusion area of the mice was smaller than that of the IR model group;the number of Ly6C+monocytes at the reperfusion site in mice was significantly lower than that in the IR model group;the number of monocytes in CD43 was significantly higher than that in IR model group;the relative expression of CCL2 mRNA and protein in the mouse heart was lower than that in the IR model group(all P＜0.05).Conclusions CCR2+exosomes show a significant anti-myocardial IR injury effect.The mechanism is that reduced CCL2 expression inhibits monocyte infiltration,thereby reducing myocardial injury and inhibiting heart failure.

Abstract:Objective To investigate the efficacy and safety of Xinkeshu capsules combined with enalapril maleate folic acid tablets in the treatment of patients with H-type hypertension with left ventricular hypertrophy(LVH).Methods Totally 168 patients with H-type hypertension with LVH admitted to Wuhan University of Science and Technology Affiliated Geriatric Hospital from January 2021 to October 2022 were selected.According to the random number table method,patients were divided into control group(84 cases)and observation group(84 cases).The control group patients were treated with enalapril maleate folic acid tablets,while the observation group patients were treated with Xinkeshu capsules on the basis of the control group.Both groups were treated for 6 months.The treatment efficacy,the systolic blood pressure(SBP),diastolic blood pressure(DBP),homocysteine,and cardiac function indicators before and after 6 months of treatment of two groups were compared.The occurrence of adverse reactions in two groups were counted.Results The total effective rate of the observation group was higher than that of the control group[94.0％(79/84)vs 83.3％(70/84)](P=0.028).After 6 months of treatment,levels of SBP,DBP,and homocysteine in the two groups were significantly reduced,and the levels in the observation group were lower than those in the control group(all P＜0.05).After 6 months of treatment,the left ventricular posterior wall thickness and interventricular septal thickness in the two groups slightly decreased,but there was no statistically significant difference between the groups and within the group(all P＞0.05).After 6 months of treatment,the left ventricular mass index(LVMI)and left ventricular end diastolic diameter(LVEDD)in the two groups significantly decreased,and LVMI and LVEDD in the observation group were greater than those in the control group(all P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the control group and observation group[7.1％(6/84)vs 8.3％(7/84)](P=0.773).Conclusions The combination of Xinkeshu capsules and enalapril maleate folic acid tablets has a good antihypertensive effect on patients with H-type hypertension complicated with LVH.It can also significantly improve left ventricular function,reduce serum homocysteine level,and has high safety.

Abstract:Ginkgo biloba extract(GBE),as a traditional Chinese medicine,has the functions of anti-inflammation,anti-oxidation,maintaining cell survival,inhibiting platelet activation,dilating blood vessels and regulating metabolism.It is widely used in clinical treatment of a variety of cardiovascular diseases,especially atherosclerosis.In the treatment of atherosclerosis,GBE can play a protective effect by acting on multiple pathways including 5'-adenosine monophosphate-activated protein kinase/protein kinase B,mitogen-activated protein kinase,phosphatidylinositol-3-kinase/protein kinase B,nuclear factor E2-related factor/heme oxygenase-1.This article reviews the mechanism and clinical application of GBE in the treatment of atherosclerosis.

Abstract:Objective To investigate the clinical effect of sintilimab plus bevacizumab combined with transcatheter arterial chemoembolization(TACE)in the treatment of advanced liver cancer.Methods A total of 60 patients with advanced liver cancer admitted to the Affiliated Hospital of Guilin Medical University from November 2022 to December 2023 were selected.According to the random number table method,they were divided into the control group and the observation group,with 30 cases in each group.The control group was treated with TACE and bevacizumab,and the observation group was treated with sintilimab on the basis of the control group.The clinical efficacy,tumor markers,lymphocyte levels,prognosis and survival time and safety were compared between the two groups.Results The objective remission rate and disease control rate of the observation group were higher than those of the control group[66.7％(20/30)vs 40.0％(12/30),83.3％(25/30)vs 60.0％(18/30)](both P＜0.05).After treatment,the levels of tumor markers alpha-fetoprotein,carcinoembryonic antigen and carbohy-drate antigen 199 in the two groups were lower than those before treatment,and the levels of tumor markers in the observation group were lower than those in the control group(all P＜0.05).After treatment,the CD3+,CD4+,and CD4+/CD8+ratios in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group;the CD8+level was lower than that before treatment,and that in the observation group was lower than that in the control group(all P＜0.05).The disease progression time,progression-free survival time and overall survival time of the observation group were higher than those of the control group[(6.1±1.4)months vs(4.9±1.4)months,(7.9±1.7)months vs(6.5±1.4)months,(11.2±2.1)months vs(9.7±2.0)months](all P＜0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P=0.739).Conclusion Sintilimab combined with bevaci-zumab combined with TACE has a good application in the treatment of advanced liver cancer,which can improve the short-term efficacy level,inhibit the level of tumor markers,improve the immune function of patients,prolong the prognosis and survival time of patients,and the treatment safety is good.

Abstract:Objective To analyze the distribution and drug resistance of common pathogens in critically ill patients with lower respiratory tract infection in emergency department.Methods The bacterial culture-positive strains in sputum,pleural effusion and lung lavage fluid samples from the Department of Emergency,Shengjing Hospital of China Medical University from January 2017 to December 2018 were collected through the laboratory information system of the Department of Laboratory,Shengjing Hospital of China Medical University.A total of 432 strains that met the inclusion criteria were screened through the electronic medical record and imaging system software of our hospital.The distribution of bacteria was analyzed and the drug resistance was analyzed by drug sensitivity test.Results Among the 432 strains,411 were Gram negative bacteria and 19 were Gram positive cocci.Among the Gram negative bacteria,the main one was Acinetobacter baumannii(172 strains,accounting for 39.81％of the total bacterial strains),followed by Pseudomonas aeruginosa(97 strains,accounting for 22.45％of the total bacterial strains).Acinetobacter baumannii had a sensitivity rate of over 80％to amikacin and tigecycline.Pseudomonas aeruginosa had a sensitivity rate of over 80％to amikacin,gentamicin,cefoperazone/sulbactam,and tobramycin.Conclusion Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogenic bacteria in critically ill patients with lower respiratory tract infection in emergency department.Amikacin and tigecy-cline are sensitive to Acinetobacter baumannii which can be included in empirical treatment.

Abstract:Objective To explore the effect of high-density lipoprotein cholesterol(HDL-C)composition on the risk of multiple types of coronary atherosclerotic heart disease based on Mendelian randomization(MR)method.Methods In accordance with the assumptions of relevance,independence,and exclusivity of MR Studies,instrumental variables were extracted from publicly available genome-wide association study data to predict the lipid composition of HDL-C,such as the phospholipids in HDL-C.Causal inference between HDL-C lipid composition and coronary atherosclerosis and various types of coronary atherosclerotic heart disease was carried out by using the random effects model pseudo-variance weighting method,MR-Egger method and MR-PRESSO method.Cochran's Q method and MR-Egger intercept method were used for sensitivity analysis.Results The increased levels of peripheral HDL-C,as well as the levels of total lipids,cholesterol esters,cholesterol,and phospholipids in HDL-C,were significantly associated with a reduced risk of coronary atherosclerotic heart disease,myocardial infarction,unstable angina,and coronary atherosclerosis(all P＜0.05).In contrast,increased triglyceride levels in HDL-C were significantly associated with increased risk of coronary atherosclerotic heart disease,unstable angina,and coronary atherosclerosis(all P＜0.05),but not myocardial infarction(P＞0.05).The results reported by the MR-Egger and MR-PRESSO methods support those reported by the pseudo-variance weighting method described above.Although the Cochran's Q method reported significant heterogeneity in these analyses,the random-effects model pseudo-variance weighting method used in this study can overcome this limitation and provide reliable results.No significant level pleiotropy was found by the MR-Egger intercept method in any of the above analyses.Conclusion The total lipid,phospholipid and cholesterol components of HDL-C play a protective role in the pathogenesis of multiple types of coronary atherosclerotic heart disease at the genetic level,while the triglyceride component of HDL-C plays a pathogenic role in the pathogenesis of many kinds of coronary atherosclerotic heart disease except myocardial infarction at the genetic level.

Abstract:Multiple myeloma(MM)cannot be cured at present.With the rapid development of new drugs combined with autologous transplantation,the median overall survival of patients is nearly 10 years.However,due to the high heterogeneity of MM,there are still some patients with poor prognosis and short survival.Bone marrow microenvironment plays an important role in MM.The formation of invasive vessels,regulatory immune cells,exosomes and autophagy,etc.can all affect the bone marrow microenvironment and promote the progression and drug resistance of MM.This review focuses on the interaction of components in the immune microenvironment of MM and immunotherapy,in order to provide more new treatment strategies.

Abstract:Objective To investigate the correlation between neutrophil to lymphocyte ratio(NLR),systemic immune inflammation index(SII)and carotid atherosclerosis(CAS),and their predictive value for CAS.Methods A total of 400 patients who were treated in the heart center of the First Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2023 were selected,and they were divided into CAS group(157 cases)and non-CAS group(243 cases)according to the results of carotid ultrasound.The CAS group was further divided into carotid intima-media thickening group,single plaque group and multiple plaque group according to the carotid plaque.The basic clinical data,blood routine and blood biochemical indexes of each group were compared,and the correlation between the number of plaques and Crouse score in CAS group was analyzed.Multivariate Logistic regression was used to analyze the independent risk factors of CAS.The receiver operating characteristic(ROC)curve was used to analyze the value of NLR,SII alone and combined in predicting CAS.Results The age,systolic blood pressure,Crouse score,smoking history,history of hypertension,history of coronary atherosclerotic heart disease,history of diabetes mellitus,and proportion of recent use of lipid-lowering drugs in the CAS group were higher than those in the non-CAS group(all P＜0.05).NLR and SII in CAS group were higher than those in non-CAS group[(2.2±0.9)vs(1.8±0.7),(506±229)vs(418±157)](both P＜0.05).Triglyceride,low-density lipoprotein cholesterol(LDL-C),fasting blood glucose and glycosylated hemoglobin(HbA1c)in the CAS group were higher than those in the non-CAS group(all P＜0.05).Crouse score of multiple plaque group was higher than that of single plaque group(P＜0.05).Multivariate Logistic regression analysis showed that coronary atherosclerotic heart disease,NLR,SII,triglyceride,LDL-C and HbA1c were independent risk factors for CAS(all P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR for predicting CAS was 0.62(95％confidence interval:0.57-0.68),and the AUC of SII for predicting CAS was 0.60(95％confidence interval:0.54-0.65),and the AUC for predicting CAS increased to 0.72(95％confidence interval:0.67-0.77)when the two were combined.Conclusion NLR and SII are closely related to the occurrence of CAS,and both have certain predictive value for CAS.The predictive value of CAS can be improved when NLR and SII are combined.

Abstract:Objective To observe the clinical effect of Buxin Ningshen decoction in the treatment of angina pectoris complicated with generalized anxiety disorder.Methods A total of 180 patients with angina pectoris and generalized anxiety disorder admitted to the Department of Emergency,Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2021 to January 2023 were selected,and they were divided into observation group and control group according to the random number table method,with 90 cases in each group.In the control group,conventional western medicine was used for standardized treatment of angina pectoris,but no medication targeting anxiety.The observation group was treated with Buxin Ningshen decoction for anxiety on the basis of the control group.Both groups were treated for 4 weeks.The generalized anxiety disorder 7-item(GAD-7)scale,patient health questionnaire 15(PHQ-15)scale scores,frequency and duration of angina pectoris,left ventricular ejection fraction,the score of traditional Chinese medicine syndrome,and occurrence of adverse reactions during treatment were compared between the two groups before and after treatment.Results After treatment,the scores of GAD-7 and PHQ-15,the frequency and duration of angina pectoris,and the score of traditional Chinese medicine syndrome in the observation group were significantly lower than those in the control group,and the left ventricular ejection fraction was higher than that in the control group[(0.9±0.7)vs(3.4±1.4),(1.1±1.0)vs(3.7±2.1),(2.1±0.9)times/week vs(4.1±1.2)times/week,(2.2±1.2)minutes/time vs(4.8±2.2)minutes/time,(2.6±1.9)vs(8.9±2.9),(55±6)％vs(51±7)％](all P＜0.05).There were no obvious adverse reactions in the two groups during the whole treatment.Conclusion Buxin Ningshen decoction can effectively relieve the symptoms of patients with angina pectoris and generalized anxiety disorder with good safety.

Abstract:In recent years,with the widespread use of carbapenem antibacterial agents,the drug resistance rate of Klebsiella pneumonia(KP)to carbapenem antibacterial agents has been increasing.Carbapenem-resistant KP(CRKP)has been widely spread around the world,and the detection rate is increasing,which has become a major global public health problem.The mechanism of CRKP resistance is complex,involving carbapenemase production,abnormal expression of outer membrane porin,and overexpression of active efflux pump system.For the infection caused by CRKP strains,the clinical treatment of antibiotics is limited,the infection control is difficult,and the patient mortality is high.Therefore,it is necessary to actively prevent CRKP,early detect infection and clarify the mechanism of drug resistance,optimize the clinical use of antibiotics and infection prevention and control,and find new antibiotics and new combination therapy to actively deal with CRKP.This article reviews the current status of CRKP infection,drug resistance mechanisms,and treatment strategies,so as to provide evidence for the effective prevention and treatment of CRKP.

Abstract:Objective To investigate the efficacy and safety of ceftazidime avibactam sodium for injection in the treatment of pneumonia caused by carbapenem-resistant Klebsiella pneumoniae(CRKP)infection.Methods Clinical data of 38 patients with pneumonia caused by CRKP admitted to the intensive care unit of Aviation General Hospital from January 1,2022 to October 31,2024 were retrospectively analyzed.According to different treatment regimens,they were divided into monotherapy group(16 cases,treated with intravenous infusion of ceftazidime avibactam sodium for injection on the basis of conventional treatment)and combined treat-ment group(22 cases,treated with intravenous infusion of ceftazidime avibactam sodium for injection combined with meropenem or tigecycline or epiracycline or polymyxin B on the basis of conventional treatment).Relevant data were collected,and the clinical treatment effects(clinical effective rate,microbial cure rate,bacterial clearance time,body temperature normalization time,inflammatory index changes,28-day mortality,total hospital mortality)and adverse reactions were compared between the two groups.Results The acute physiology and chronic health evaluation Ⅱ score of the combined treatment group was slightly higher than that of the monotherapy group(P＜0.05).There were no significant differences in clinical efficacy,28-day mortality and total in-hospital mortality between the two groups(all P＞0.05).The microbial cure rate of the combined treatment group was slightly higher than that of the monotherapy group,and the bacterial clearance time and body temperature normali-zation time were slightly shorter than those of the monotherapy group,but the differences were not statistically significant(all P＞0.05).There was no significant difference in white blood cell count,procalcitonin and C-reactive protein levels between the two groups before and after treatment(all P＞0.05).The incidence of kidney injury,liver injury and gastrointestinal symptoms in the combined treatment group was slightly higher than that in the monotherapy group[13.6％(3/22)vs 12.5％(2/16),18.2％(4/22)vs 12.5％(2/16),18.2％(4/22)vs 12.5％(2/16)],but the differences were not statistically significant(all P＞0.05).Conclusion For patients with pneumonia caused by CRKP infection,there is no significant difference in the overall efficacy between ceftazi-dime avibactam sodium injection monotherapy and combination therapy with other drugs,and there is no significant difference in adverse reactions.

Abstract:Objective To investigate the effect of ultrasound-guided paravertebral nerve block(TPVB)combined with intrathoracic vagus nerve block on rapid recovery after thoracoscopic surgery.Methods A total of 66 patients with lung cancer who underwent thoracoscopic surgery in Quzhou City People's Hospital from February 2022 to January 2023 were selected as the research objects,and they were divided into the control group and the observation group by random number table method,with 33 cases in each group.Both groups received video-assisted thoracoscopic surgery for lung cancer.The control group was given general anesthesia with double-lumen bronchial intubation,and the observation group was given non-intubation intravenous anesthesia with ultrasound-guided TPVB combined with intrathoracic vagus nerve block.The postoperative recovery,mean arterial pressure,heart rate,degree of pain and incidence of postoperative complications were observed between the two groups.Results The first feeding time and hospital stay of the observation group were shorter than those of the control group,and the partial pressure of carbon dioxide in arterial blood 30 min after the operation was higher than that of the control group(all P＜0.001).The heart rate and mean arterial pressure in the control group were higher than those before anesthesia induction 30 min after operation and immediately after operation(both P＜0.05);but there were no significant differences in heart rate and mean arterial pressure before and after anesthesia induction in the obser-vation group(all P＞0.05);and the heart rate and mean arterial pressure in the observation group were lower than those in the control group[heart rate:(75±8)times/min vs(81±7)times/min,(76±8)times/min vs(83±10)times/min;mean arterial pressure:(81±9)mmHg vs(90±9)mmHg,(82±8)mmHg vs(93±10)mmHg](all P＜0.05).There was no significant difference in visual analogue scale score between the two groups at 30 min before operation(P＞0.05).At 1,6,12,24 and 48 h after operation,the visual analogue scale scores of the observation group were lower than those of the control group(all P＜0.05).The incidence of complications in the observation group was lower than that in the control group[6.1％(2/33)vs 15.2％(5/33)](x2=4.243,P=0.039).Conclusion Compared with the double-lumen endotracheal intubation general anesthesia method,for patients undergoing video-assisted thoracoscopic surgery,ultrasound-guided TPVB combined with intrapleural vagus nerve block can avoid fluctuations in blood pressure and heart rate,reduce postoperative pain,accelerate postoperative recovery,and reduce the incidence of postoperative complications.

Abstract:Objective To investigate the application effect of dexmedetomidine combined with remifentanil in patients with stroke undergoing interventional thrombectomy and its influence on cerebral metabolism and antioxi-dation.Methods A total of 96 patients with ischemic stroke admitted to Affiliated Hospital of Hebei University of Engineering from January 2022 to December 2023 were selected.According to the random number table method,they were divided into the control group and the observation group,with 48 cases in each group.All patients received interventional thrombectomy.The control group was given remifentanil anesthesia,and the observation group was given dexmedetomidine anesthesia on the basis of the control group.The cerebral metabolic indexes immediately after anesthesia and 1 h after anesthesia,serum indexes and intracranial pressure before and 1 h after operation,postoperative eye opening time,Ramsay score,and adverse reactions were compared between the two groups.Results The blood oxygen difference of internal jugular vein bulb,blood oxygen content of internal jugular vein,cerebral metabolic rate and oxygen saturation of internal jugular vein bulb in the observation group were higher than those in the control group at 1 hour after anesthesia(all P＜0.05).The serum levels of malondialdehyde,endothelin and superoxide dismutase 1 hour after operation in the two groups were higher than those before operation,but those in the observation group were lower than those in the control group(all P＜0.05).One day after operation,the intracranial pressure levels of the two groups were lower than those before operation,and that of the observation group was lower than that of the control group[(167±20)mmH2O vs(182±22)mmH2O](t=3.524,P=0.001).The postoperative eye opening time of the observation group was shorter than that of the control group[(9.3±1.2)min vs(12.2±2.8)min](t=6.570,P=0.001),and the Ramsay score was higher than that of the control group[(4.3±0.5)vs(4.0±0.6)](t=3.127,P=0.002).Conclusions Dexmedetomidine combined with remifentanil anesthesia in interventional thrombectomy for stroke can improve brain metabolism and antioxidant capacity,reduce oxidative stress and inflammatory reaction,reduce intracranial pressure,promote postoperative recovery,and has certain safety.