Abstract:Objective To investigate the therapeutic effect of intrapulmonary oscillation and lung expansion(OLE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 108 AECOPD patients admitted to the Department of Critical Care Medicine,Sir Run Run Hospital,Nanjing Medical University from April 2022 to December 2023 were selected as the research objects.The patients were divided into observation group and control group by random number table method,with 54 cases in each group.The control group was given conventional chest physical therapy.The observation group was treated with OLE.Sputum volume,partial pressure of oxygen,partial pressure of carbon dioxide,respiratory rate,heart rate,forced expiratory volume in the first second(FEV1),ratio of FEV1to forced vital capacity(FEV1/FVC)and percentage of FEV,to predicted value(FEV1％)were compared between the two groups at the 1,3 and 5 d after treatment.The utilization rate of non-invasive ventilator(NIV),length of stay in intensive care unit(ICU)and 28 d mortality were compared between the two groups.Results The sputum volume of the observation group was higher than that of the control group 1 and 3 d after treatment,and was lower than that of the control group 5 d after treatment(all P＜0.05).At the 1,3 and 5 d after treatment,the partial pressure of oxygen in the two groups increased,and in the observation group was higher than that in the control group,and the partial pressure of carbon dioxide,respiratory rate and heart rate in the two groups decreased,and in the observation group were lower than those in the control group.At the 1,3 and 5 d after treatment,FEV1,FEV1/FVC and FEV1％in the two groups increased,and those in the observation group were higher than those in the control group at each time point(all P＜0.05).The utilization rate of NIV and the length of ICU stay in the observation group were lower/shorter than those in the control group[11.1％(6/54)vs 24.1％(13/54),(6.2±2.2)dvs(8.5±3.8)d](both P＜0.05).There was no significant difference in 28 d mortality between the observation group and the control group[1.9％(1/54)vs3.7％(2/54)](x2=1.025,P=0.074).Conclusion OLE can promote sputum excretion,improve oxygenation and ventilation function,reduce the utilization rate of NIV and shorten the length of ICU stay in patients with AECOPD.

Abstract:Osteoporosis(OP)is one of the common chronic diseases in orthopedics,which is characterized by bone loss and bone structure destruction.Fracture is its most serious complication,which greatly affects the quality of life of patients.The physiological mechanism involved in the occurrence and development of OP is extremely complex,and the increase of oxidative stress level caused by age and estrogen deficiency is an important reason for the occurrence of OP.Although there are many drugs for the treatment of osteoporosis,they all have mild or severe adverse reactions,and may even aggravate the suffering of patients.Resveratrol,a naturally occurring plant compound with antioxidant properties,can reduce oxidative stress in the body through a variety of pathways,and silent information regulator 1 is one of the targets.This article reviews the research progress of resveratrol in the treatment of OP by activating silent information regulator 1 and exercising its anti-oxidative stress effect through different mechanisms,in order to provide new ideas for researchers and new directions for clinicians in the treatment of OP.

Abstract:Objective To investigate the changes in the local myocardial oxygen and nutrient metabolism in patients with microvascular angina.Methods A total of 22 patients with primary microvascular angina pectoris admitted to Fuwai Central China Vascular Hospital from January 2020 to June 2022 were selected as the observation group,and 18 patients without clinical symptoms of angina pectoris who underwent radiofrequency ablation due to parsmal supraventricular tachycardia during the same period were selected as the control group.The changes of local oxygen,substance metabolism,internal environment and myocardial microvascular function before and after myocardial microcirculation were observed in the two groups.Results The pH value and blood glucose level of the ostium of the coronary artery in observation group were lower than those in control group,and the lactic acid,oxygen partial pressure and oxygen saturation were higher than those in control group(all P＜0.05).The levels of pH value,lactic acid,blood glucose and oxygen saturation in blood of coronary sinus were lower than those of control group,and the PCO2 was higher than that of control group(all P＜0.05).The glucose uptake rate,lactate production rate,frame number of corrected thrombolysis test(TCFC),coronary sinus filling time(CSFT),micro-circulation resistance index(IMR)and plasma endothelin-1 level in observation group were higher than those in control group,and the level of nitric oxide was lower than that in control group(all P＜0.05).Pearson correlation analysis showed that microvascular angina pectoris was positively correlated with coronary TCFC(r=0.327,P=0.040),CSFT(r=0.435,P=0.006),IMR(r=0.826,P＜0.001)and endothelin-1(r=0.517,P=0.001).There was a negative correlation with nitric oxide(r=-0.504,P＜0.001).In addition,IMR was positively correlated with endothelin-1(r=0.480,P=0.002)and negatively correlated with nitric oxide(r=-0.505,P=0.001).Conclusion The overall myocardial oxygen supply and metabolism are normal in patients with micro vascular angina pectoris.Regional myocardial hypoperfusion,local hypoxia,internal environment acidification,myocardial glucose anaerobic colysis enhancement,microvasomotor dysfunction.

Abstract:Objective To explore the therapeutic effect of Duzhong Jiangu granules combined with teriparatide on osteoporosis(OP)in elderly women.Methods Totally 100 elderly female OP patients who were treated in Tangshan Central Hospital,Hebei Province from June 2021 to October 2022 were selected as research subjects.According to the random number table method,they were divided into western medicine group and traditional Chinese and western medicine group,with 50 cases in each group.All patients were treated with basic treatment,and the western medicine group was treated with teriparatide subcutaneous injection on the basis of basic treatment,and the traditional Chinese and western medicine group was treated with oral Duzhong Jiangu granules on the basis of the western medicine group.The bone density,bone metabolism indicators[C-telopeptide of type Ⅰcollagen(CTX-Ⅰ),intact parathyroid hormone(iPTH),tartrate resistant acid phosphatase 5b(TRACP-5b)],traditional Chinese medicine syndrome scores,and serum chemerin levels before treatment and 6 months after treatment were compared between the two groups.At the same time,the efficacy and occurrence of adverse drug reactions(ADR)were compared between the two groups.Results During the study period,2 and 3 cases dropped out in the western medicine group and the traditional Chinese and western medicine group,respectively,48 and 47 cases were finally included in the evaluation,respectively.After 6 months of treatment,the bone density of the 2nd to 4th lumbar vertebrae,femoral neck,and greater trochanter in both groups were higher than those before treatment,and those in the traditional Chinese and western medicine group were significantly higher than those in the western medicine group;the levels of CTX-Ⅰ,iPTH,TRACP-5 b,traditional Chinese medicine syndrome scores and serum chemerin level were lower than those before treatment,and those in the traditional Chinese and western medicine group were significantly lower than those in the western medicine group(all P＜0.05).The total effective rate of the traditional Chinese and western medicine group was significantly higher than that of the western medicine group[95.7％(45/47)vs 81.2％(39/48)](x2=4.873,P=0.027).There was no significant difference in the total incidence of ADR between the two groups(x2=0.080,P=0.777).Conclusion The application of Duzhong Jiangu granules combined with teriparatide in the treatment of elderly female OP patients can improve the anti-OP effect,obviously alleviate symptoms,increase bone density,effectively reduce bone metabolism indicators and serum chemerin level,and has high safety.

Abstract:Objective To investigate the expression of long non-coding RNA(lncRNA)SH3BP5-AS1 and microRNA(miR)-6838-5p in patients with hepatocellular carcinoma and their relationship with clinicopathological features and prognosis.Methods A total of 110 patients with hepatocellular carcinoma who underwent surgical treatment in The Second Affiliated Hospital of Xi'an Jiaotong University and XD Group Hospital from January 2018 to December 2020 were selected.The expressions of lncRNA SH3BP5-AS1 and miR-6838-5p in surgically resected cancer tissues and adjacent tissues were detected,and the survival of patients was followed up after discharge.The correlation between lncRNA SH3BP5-AS1 and miR-6838-5p in cancer tissues was analyzed,and Kaplan-Meier curve was drawn to compare the survival difference of hepatocellular carcinoma patients with different lncRNA SH3BP5-AS1 and miR-6838-5p expression.Univariate and multivariate Cox proportional hazards regression methods were used to analyze the prognostic factors of patients with hepatocellular carcinoma.Results The expression of lncRNA SH3BP5-AS1 in hepatocellular carcinoma tissues was higher than that in adjacent tissues,and the expression of miR-6838-5p was lower than that in adjacent tissues[(2.7±0.4)vs(1.5±0.3),(1.9±0.5)vs(3.1±0.7)](both P＜0.001).High expression of lncRNA SH3BP5-AS1 and low expression of miR-6838-5p were associated with poor differentiation,TNM stage Ⅲ,intrahepatic metastasis and vascular invasion(all P＜0.05).There was a negative correlation between lncRNA SH3BP5-AS1 and miR-6838-5p expression in hepatocellular carcinoma tissues(r=-0.524,P＜0.001).The 3-year overall survival rate of hepatocellular carcinoma patients with high expression of lncRNA SH3BP5-AS1 was lower than that of patients with low expression of lncRNA SH3BP5-AS1,and the 3-year overall survival rate of hepatocellular carcinoma patients with low expression of miR-6838-5p was lower than that of patients with high expression of miR-6838-5p(both P＜0.05).TNM stage Ⅲ,intrahepatic metastasis and high expression of lncRNA SH3BP5-AS1 were risk factors for poor prognosis of patients with hepatocellular carcinoma,and high expression of miR-6838-5p was a protective factor(all P＜0.05).Conclusion Up-regulation of lncRNA SH3BP5-AS1 expression and down-regulation of miR-6838-5p expression in hepatocellular carcinoma tissues are related to clinical malignant pathological characteristics and poor prognosis.

Abstract:Objective To investigate the protective effect of Yixiao decoction on sciatic nerve in mice with diabetic peripheral neuropathy.Methods Twenty-four KKAy mice aged 8 weeks were completely random divided into model group,lipoic acid group and Yixiao decoction group,with 8 mice in each group.Eight C57BL/6J mice of the same age were used as the control group.The lipoic acid group was given lipoic acid 60 mg/(kg·d)by gavage,the Yixiao decoction group was given Yixiao decoction 7.7 g/(kg·d)by gavage,and the control and model groups were given distilled water by gavage.The drug was administered once daily for 12 weeks.The fasting blood glucose,body weight and neurological function of mice in each group were compared before and 4,8,12 weeks after intervention.Results The fasting blood glucose and body weight of the model group,lipoic acid group and Yixiao decoction group were higher than those of the control group at 8 and 12 weeks after intervention(all P＜0.05).The fasting blood glucose of the lipoic acid group was lower than that of the model group at 12 weeks after intervention.The fasting blood glucose and body weight of the Yixiao decoction group were lower than those of the model group at 8 and 12 weeks after intervention.The body weight at 12 weeks after intervention in the Yixiao decoction group was lower than that in the lipoic acid group(all P＜0.05).The mechanical pain thresholds of the model group,the lipoic acid group and the Yixiao decoction group were lower than those of the control group at before and 8,12 weeks after intervention(all P＜0.05).The tail flick times of before and 4,8,12 weeks after intervention in the model group,lipoic acid group and Yixiao decoction group were higher than those in the control group(all P＜0.001).The mechanical pain thresholds of the lipoic acid group and the Yixiao decoction group were higher than those of the model group at 8 and 12 weeks after intervention,and the tail flick times of the lipoic acid group and the Yixiao decoction group were lower than those of the model group at 4,8 and 12 weeks after intervention.The mechanical pain threshold at 12 weeks after intervention in the Yixiao decoction group was higher than that in the lipoic acid group[(2.54±0.24)g vs(1.95±0.28)g],and the tail flick times at 4,8 and 12 weeks after intervention were lower than those in the lipoic acid group(all P＜0.001).Conclusion Yixiao decoction can reduce sciatic nerve injury in mice with diabetic peripheral neuropathy,and its mechanism may be related to the regulation of Keap1-Nrf2-ARE signaling pathway and the downstream expression of superoxide dismutase and catalase.

Abstract:Objective To investigate the relationship between left atrial strain and N-terminal pro-brain natriuretic peptide(NT-proBNP)level in ST-segment elevation myocardial infarction(STEMI)patients with mildly reduced or preserved left ventricular ejection fraction(LVEF).Methods Patients who were first diagnosed with acute STEMI and underwent percutaneous coronary intervention(PCI)within 24 h from March to December 2022 in Department of Cardiology,Beijing Jishuitan Hospital,Capital Medical University,with LVEF＞40％in the acute phase,were enrolled.The left atrial strain parameters were analyzed by two-dimensional speckle tracking imaging.According to the value of left atrial strain during reservoir phase(LASr),patients were divided into reduced LASr group and normal LASr group.The clinical data and ultrasound data of the two groups were compared.Multiple linear regression model was used to analyze the relationship between LASr and serum NT-proBNP peak value in STEMI patients with mildly reduced or preserved LVEF.Results Among 51 patients with acute STEMI and LVEF＞40％who underwent PCI,there were 22 cases(43.1％)in reduced LASr group and 29 cases(56.9％)in normal LASr group.Age and NT-proBNP peak value in the reduced LASr group were higher than those in the normal LASr group[(60±12)years vs(50±12)years,1 679.0(811.4,2 133.2)ng/L vs 584.2(201.5,1 524.0)ng/L](both P＜0.05).The longitudinal strain during left atrial channel phase and strain during left atrial systolic phase in the reduced LASr group were higher than those in the normal LASr group(both P＜0.05).Multiple linear regression analysis showed that after adjusting for anterior myocardial infarction,peak value of creatine kinase isoenzyme and LVEF,LASr was an independent predictor of serum NT-proBNP peak value in STEMI patients with mildly reduced or preserved LVEF(P=0.039).Conclusion LASr is an independent predictor of NT-proBNP peak value in STEMI patients with mildly reduced or preserved LVEF undergoing PCI.

Abstract:With the aggravation of population aging,coronary atherosclerotic heart disease(CHD)combined with cognitive impairment has gradually attracted attention.Epidemiological data show that there is a significant positive correlation between CHD and the risk of cognitive impairment.Patients with CHD show worse cognitive ability,and patients with cognitive impairment combined with CHD have a faster rate of cognitive decline.CHD combined with cognitive impairment not only seriously damages the physical and mental health of patients,but also increases the social burden.The causes of CHD combined with cognitive impairment are complex and the pathogenesis is diverse,including physiological mechanisms such as vascular endothelial dysfunction,cholesterol-25-hydroxylase mediated immune inflammation,and excessive activation of ceramide by platelets,as well as behavioral and psychological mechanisms such as education level,cardiac invasive surgery,and decreased perceived activity ability.This article aims to review the latest research progress on the physiological and behavioral psychological mechanisms of CHD combined with cognitive impairment,so as to provide ideas for the clinical diagnosis,treatment and prevention of CHD combined with cognitive impairment.

Abstract:Objective To observe the effect of biomimetic electrical stimulation combined with cognitive-behavioral therapy on female patients with stress urinary incontinence(SUI).Methods This study was a prospective randomized controlled study.A total of 160 patients with female SUI admitted to Peking University Third Hospital from March 2019 to June 2023 were selected as the research objects,and they were divided into observation group and control group by random number table method,with 80 cases in each group.The control group was treated with cognitive-behavioral therapy(CBT),and the observation group was given bionic electrical stimulation of pelvic floor on the basis of the control group.The intervention lasted for 8 weeks.The pelvic floor functional ultrasound indicators,pelvic floor electromyography values,scores of urinary incontinence questionnaire brief form(ICI-Q-SF),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)were compared between the two groups before and after the intervention.The total effective rate was compared between the two groups after the intervention.Results During the research process,one case in the control group and three cases in the study group were lost.Finally,79 cases in the control group completed the study,and 77 cases in the observation group completed this research.After intervention,bladder urethral posterior angle and bladder neck mobility,scores of ICI-Q-SF,SAS and SDS in both groups were Iess/lower than before intervention,and those in the observation group were less/lower than those in the control group,the electromyographic values during the rapid contraction stage,sustained contraction stage,and endurance contraction stage of the pelvic floor were all higher than before intervention,and those in the observation group were higher than those in the control group(all P＜0.05).After intervention,the total effective rate of the observation group was significantly higher than that of the control group[97.4％(75/77)vs 88.6％(70/79)](P＜0.05).Conclusion The combination of biomimetic electrical stimulation and cognitive-behavioral therapy can effectively improve pelvic floor function,reduce urinary incontinence symptoms and negative emotions in female patients with SUI.

Abstract:Objective To investigate the effect of esketamine on trigeminal cardiac reflex(TCR)in patients with trigeminal neuralgia undergoing percutaneous balloon compression(PBC).Methods A total of 80 patients with trigeminal neuralgia who underwent PBC in Hebei General Hospital from January to August 2023 were selected,and they were divided into esketamine group and control group according to the random number table method,with 40 cases in each group.The control group was induced with midazolam,sufentanil,benzenesulfonate cisatracurium,and propofol.The esketamine group was induced with midazolam,sufentanil,benzenesulfonate cisatracurium,propofol,and esketamine.The heart rate and mean arterial pressure(MAP)before induction of anesthesia(T0),before the start of surgery(T1)and at the time of foramen ovale puncture(T2),the incidence of TCR at the time of foramen ovale puncture,and the incidence of perioperative adverse reactions were compared between the two groups.Results The heart rate and MAP of patients in the two groups at time points T1 and T2 were significantly lower than those at time point T0,and the heart rate and MAP of the esketamine group at time points T1 and T2 were significantly higher than those of the control group(all P＜0.05).The incidence of TCR was significantly lower in the esmketamine group than that in the control group[15.0％(6/40)vs 45.0％(18/40)](P＜0.05).There was no significant difference in the total incidence of adverse reactions between the esmketamine group and the control group[22.5％(9/40)vs 12.5％(5/40)](P＞0.05).Conclusion Esketamine can reduce the incidence of TRC in patients with trigeminal neuralgia undergoing PBC,and improve the perioperative safety of patients.

Abstract:Vitamin D is a steroid derivative that plays an important role in a variety of metabolic processes.Vitamin D deficiency is common in the population.The latest research evidence shows that vitamin D deficiency may be related to the pathogenesis of insulin resistance(IR)-related diseases.In addition to the benefits of vitamin D supplementation for bone health,its role in improving IR should not be ignored.This review summarizes the reported effects of vitamin D on IR,supplements the mechanisms of vitamin D improving IR through various pathways,and concludes that maintaining vitamin D at an adequate level has a certain effect on improving IR and is helpful for blood glucose control in patients with type 2 diabetes.In the future treatment of type 2 diabetes,Vitamin D supplementation combined with currently known hypoglycemic regimens may be a comprehensive and individualized treatment in the future.

Abstract:Irritable bowel syndrome with constipation(IBS-C)is a subtype of irritable bowel syndrome(IBS).Because its exact pathogenesis is not clear,there is no specific method in terms of treatment,mainly based on laxatives,but it is difficult to achieve satisfactory efficacy in completely relieving symptoms and preventing recurrence.In recent years,the continuous development of new drugs and the update of relevant clinical guidelines have further developed the diagnosis and treatment of IBS-C.Based on this,this review focuses on the current research progress in the treatment of IBS-C,in order to provide evidence and support for clinical practice.

Abstract:Objective To explore the value of suboccipital muscle group fascial block in the treatment of cervicogenic headache(CEH).Methods A total of 100 CEH patients who were treated in Beijing Anzhen Hospital,Capital Medical University from January to December 2023 were selected as the research objects.According to the random number table method,they were divided into the observation group and the control group,50 cases in each group.The control group was treated with ibuprofen sustained-release capsules,and the observation group was treated with suboccipital muscle group fascial block.The visual analogue scale(VAS)score,pain rating index(PRI)score,neck disability index(NDI)score,efficacy and safety indexes were compared between the two groups.Results After treatment,the VAS,PRI and NDI 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).In the control group,0 case was cured,2 cases were markedly effective,38 cases were improved,and 10 cases were ineffective,with a total effective rate of 80.0％(40/50);in the observation group,0 case was cured,13 cases were markedly effective,35 cases were improved,and 2 cases were ineffective,with a total effective rate of 96.0％(48/50);the efficacy of the observation group was better than that of the control group(Z=-3.649,P＜0.001).There were no adverse events such as bleeding and infection in the treatment area in the observation group.Three patients in the control group complained of nausea and vomiting after oral medication,and the symptoms were mild and relieved by themselves.Conclusion Fascial block of suboccipital muscle group has certain value in the treatment of CEH.It can significantly reduce the frequency and intensity of headache,improve the quality of life of patients,and has good safety.

Abstract:Objective To investigate the changes of serum microRNA-155(miR-155)and NOD-like receptor protein 3(NLRP3)levels and their diagnostic values for carotid atherosclerosis(CAS)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 142 patients with T2DM admitted to West China Hospital,Sichuan University from January 2021 to January 2023 were selected.According to the presence or absence of CAS,the patients were divided into CAS group(72 cases)and non-CAS group(70 cases).The general data of the two groups of patients were collected and compared,and the serum levels of miR-155 and NLRP3 were detected and compared between the two groups.Pearson corr-elation was used to analyze the correlation between serum miR-155 and NLRP3 levels in T2DM patients.Multivariate Logistic regression was used to analyze the influencing factors of CAS in T2DM patients.Receiver operating characteristic curve was used to analyze the diagnostic value of serum miR-155 and NLRP3 levels for CAS in T2DM patients.Results The duration of T2DM in the CAS group was longer than that in the non-CAS group,and the proportion of smoking history,glycosylated hemoglobin,home-ostasis model assessment of insulin resistance index,miR-155 and NLRP3 were higher than those in the non-CAS group(all P＜0.05).Pearson correlation analysis showed that serum miR-155 levels were positively correlated with NLRP3 levels in T2DM patients(r=0.765,P＜0.001).Multivariate Logistic regression model showed that the prolonged duration of T2 DM,smoking history,glycosylated hemoglobin,homeostasis model assessment of insulin resistance index,miR-155 and NLRP3 were independent risk factors for CAS in T2DM patients(all P＜0.05).Receiver operating characteristic curve analysis showed that the area under the curve of serum miR-155 and NLRP3 levels combined in the diagnosis of CAS in T2DM patients was larger than those of serum miR-155 and NLRP3 levels alone(0.900 vs 0.791,0.799,Z=3.436,3.381;both P=0.001).Conclusions The increase of serum miR-155 and NLRP3 levels is closely related to the occurrence of CAS in T2DM patients.The combina-tion of serum miR-155 and NLRP3 levels has a high diagnostic value for CAS in T2DM patients.

Abstract:Objective To analyze the expression of moesin and paired related homeobox protein 1(PRRX1)in elderly patients with non-small cell lung cancer(NSCLC)and their correlation with the efficacy of osimertinib targeted therapy.Methods A total of 60 elderly patients with NSCLC admitted to the 920th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2021 to June 2024 were selected as the research objects.The expression levels of moesin and PRRX1 in cancer tissues and adjacent tissues were detected,and the correlation between the expression changes of moesin and PRRX1 and the efficacy of osimertinib targeted therapy was analyzed.According to the efficacy of osimertinib targeted therapy,the patients were divided into the effective treatment group(42 cases)and the ineffective treatment group(18 cases).The expression levels of moesin and PRRX1 were compared between the two groups.The predictive value of moesin and PRRX1 expressions for clinical efficacy in elderly patients with NSCLC was analyzed.Results The positive expression rates of moesin and PRRX1 in cancer tissues were 70.0％(42/60)and 83.3％(50/60),respectively.The staining area of cells was enlarged and the staining intensity was high.There were statistically significant differences in pathological type,tumor diameter,TNM stage,degree of differentiation,lymph node metastasis,capsule invasion,positive expression of moesin and PRRX1,and incidence of epidermal growth factor receptor gene mutation between the two groups(all P＜0.05).The positive rate of moesin in epidermal growth factor receptor(EGFR)gene wild-type patients was higher than that in EGFR mutant patients,and the positive expression rate of PRRX1 was lower than that of mutant patients(both P＜0.05).Spearman correlation analysis showed that the expression of moesin and PRRX1 was positively correlated with clinical efficacy(r=0.339,P＜0.001;r=0.558,P＜0.001).Multivariate Logistic regression analysis showed that pathological tissue type,maximum tumor diameter,TNM stage,degree of differentiation,lymph node metastasis,capsule invasion,mosin and PRRX1 expression were all risk factors affecting the efficacy of osimertinib targeted therapy(all P＜0.001).Receiver operating characteristic curve analysis showed that the predictive value of combined detection of moesin and PRRX1 for clinical efficacy in elderly patients with NSCLC was higher than that of moesin or PRRX1 alone.Conclusion The expressions of moesin and PRRX1 are related to the efficacy of osimertinib targeted therapy in elderly NSCLC patients,which can be predicted by combined detection,so as to provide reference for clinical treatment plan adjustment.

Abstract:Objective To investigate the effect of intranasal dexmedetomidine on emergence agitation during general anesthesia in elderly patients with renal insufficiency.Methods A total of 100 elderly patients with renal insufficiency undergoing gastrointestinal surgery in Tangshan Central Hospital,Hebei Province from February 2023 to February 2024 were selected as the research objects,and were randomly divided into two groups,with 50 cases in each group.Patients in the observation group were given intranasal dexmedetomidine l h before the end of surgery.Patients in the control group were given the same volume of 0.9％sodium chloride injection nasal drops 1 h before the end of surgery.The anesthesia recovery index,pain degree,sedation effect,renal function index and adverse reactions were compared between the two groups.Results The recovery time of spon-taneous breathing and anesthesia recovery time in the observation group were shorter than those in the control group(both P＜0.05).The visual analogue scale scores of the observation group were lower than those of the control group at 6,12,24 h and 48 h after anesthesia recovery(all P＜0.001).The Ramsay scores of sedation immediately,5,30 and 60 min after extubation in the observation group were higher than those in the control group(all P＜0.001).The levels of blood urea nitrogen,serum creatinine,24 h urinary albumin and 24 h urinary microalbumin excretion rate in the observation group were lower than those in the control group(all P＜0.001).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group[8.0％(4/50)vs 46.0％(23/50),x2=18.316,P＜0.001].Conclusion The application of intranasal dexmedetomidine in patients with renal insufficiency undergoing general anesthesia has good anesthetic analgesic and sedative effects,which can effectively shorten the time of respiratory recovery and anesthesia recovery,reduce restlessness during anesthesia recovery,good recovery of renal function level,less adverse reactions,and is safe and effective.

Abstract:Objective To investigate the risk factors of postoperative delirium after coronary artery bypass grafting(CABG)and to establish a risk prediction model.Methods The clinical data of 1 067 patients who underwent CABG at Coronary Heart Disease Surgery Center,Beijing Anzhen Hospital,Capital Medical University from January 2022 to June 2023 were retrospectively collected.The intensive care unit(ICU)confusion assessment method(CAM-ICU)was used to assess the occurrence of postoperative delirium.The patients were divided into delirium group and non-delirium group.The clinical characteristics of the two groups were compared.Univariate analysis and multivariate binary Logistic regression analysis were used to determine the independent risk factors affecting the occurrence of delirium,and a nomogram model for predicting the risk of delirium was established.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the delirium model.Results Among 1 067 patients,there were 133 patients in delirium group,the incidence of delirium was 12.5％,the age was(62±10)years,and 97 cases were male.There were 934 patients in the non-delirium group,the age was(62±9)years and 704 cases were male.SPSS 22.0 software was used to randomly select 747 patients as the experimental group,and the remaining 320 patients were used as the internal validation group.Multivariate Logistic regression analysis showed that education below junior high school,preoperative sleep disorders,history of diabetes mellitus,left ventricular ejection fraction(LVEF)≤45％,mild anemia,hypoproteinemia,cardiopulmonary bypass and ventilator use ≥48 h were independent risk factors for delirium after CABG in the experimental group(all P＜0.05).The ROC analysis showed that the area under the curve(AUC)of the experimental group was 0.736(95％confidence interval:0.682-0.739).The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit,and the P value was 0.748.The AUC of the scoring early warning system was 0.754(95％confidence interval:0.690-0.819).The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit,and the P value was 0.808.Conclusion Delirium is one of the common complications after CABG.Low education level,preoperative sleep disorders,cardiopulmonary bypass and long-term use of ventilator are independent risk factors for delirium after CABG.

Abstract:With the increasing proportion of aging population in China,the incidence of Alzheimer's disease is also increasing.Alzheimer's disease,the most common neurodegenerative disease,shows irreversible cognitive dysfunction.A number of studies have shown that insulin resistance is associated with the pathogenesis of Alzheimer's disease,such as abnormal accumulation of amyloid-β-protein,abnormal tau protein,and neuroinflam-mation.This article systematically reviews the association between insulin resistance and Alzheimer's disease and its possible mechanisms.

Abstract:Objective To investigate the risks and benefits of extended dual antiplatelet therapy(DAPT)in patients with previous hypertensive cerebral hemorrhage undergoing percutaneous coronary intervention(PCI).Methods This study was an observational clinical study.A total of 128 patients with a history of hypertensive cerebral hemorrhage who underwent PCI in Beijing Anzhen Hospital,Capital Medical University from January 2005 to December 2014 were enrolled as observation group,and 153 patients with hypertension but no history of cerebral hemorrhage were enrolled as control group.All patients were administered aspirin 100 mg/d and clopidogrel 75 mg/d after PCI,and the follow-up ranged from 12 to 48 months.The efficacy endpoint was major adverse cardiovascular and cerebrovascular events(MACCE),while the safety endpoint were cerebral hemorrhage and major bleeding.The duration of DAPT＞12 months was defined as extended DAPT,and the duration of DAPT 12 months was defined as non-extended DAPT.Univariate and multivariate Cox regression analysis were used to analyze the factors affecting the endpoint events.Results Previous history of hypertensive cerebral hemorrhage(P=0.029)and acute myocardial infarction(P=0.027)were independent risk factors for MACCE in hypertensive patients undergoing PCI,while extended DAPT(hazard ratio=0.351,P＜0.001)was an independent protective factor.In subgroup analysis,extended DAPT increased the risk of major bleeding in PCI patients with previous hypertensive cerebral hemorrhage(hazard ratio=6.650,P=0.036),but did not decrease the risk of MACCE(P=0.349).Extended DAPT did not increase the risk of major bleeding in PCI patients with previous hypertensive(P=0.538),but significantly reduced the risk of MACCE(hazard ratio=0.356,P=0.044).Conclusions Extended DAPT increases the risk of major bleeding in PCI patients with a history of hypertensive cerebral hemorrhage,and DAPT should be controlled within 12 months.Extended DAPT can reduce the risk of MACCE and does not increase the risk of major bleeding in patients with hypertension before PCI.It is recommended to extend the DAPT appropriately.

Abstract:Objective To investigate the effect of colchicine on atherosclerosis induced by high-fat diet in apolipoprotein E gene knockout(ApoE-/-)mice.Methods Twelve C57BL/6J wild-type mice were selected as the control group,24 ApoE-/-mice were completely randomized into model group and colchicine group,with 12 mice in each group.The control group was fed with regular feed;the model group and colchicine group were fed with high-fat diet to establish atherosclerosis model,at the same time colchicine group was also given colchicine 2 mg/(kg·d)by gavage for 8 weeks.The blood and aortic tissue samples were collected to detect the levels of blood lipids and C-reactive protein in each group.The pathological changes of aorta were observed by staining.The nuclear/cap ratio and vulnerability index of atherosclerotic plaques were compared among the groups.Results After intervention,the total cholesterol,triglycerides,low-density lipoprotein cholesterol,and C-reactive protein in the model group and colchicine group were higher than those in the control group,but those in the colchicine group were lower than those in the model group,and the high-density lipoprotein cholesterol was lower than that in the control group,but those in the colchicine group were higher than those in the model group(all P＜0.05).The number of apoptotic endothelial cells,collagen fiber content,and CD68,α-smooth muscle actin positive expression in the aortic tissue of mice in the colchicine group were significantly lower than those in the model group(all P＜0.05).The ratio of nucleus to cap and vulnerability index of atherosclerotic plaque in colchicine group were signif-icantly lower than those in model group[(3.24±0.49)vs(9.54±1.49),(2.84±0.39)vs(8.64±1.29)](both P＜0.05).Conclusion Colchicine can significantly reduce aortic atherosclerotic in ApoE-/-mice induced by high-fat diet.