Abstract:Objective To explore the mechanism of 5-fluorouracil(5-FU)combined with oxaliplatin(L-OHP)on cisplatin(DDP)resistance in non-small cell lung cancer through microRNA-92a(miR-92a)/Wnt/β-catenin pathway.Methods Cultivate human non-small cell lung cancer cells(A549)in vitro and construct the DDP resistance model.The experimental groups are as follows:A549 group was the normal A549 cells,A549/DDP group was the DDP resistant model cells,A549+DDP group was the A549 group co-cultured with DDP,A549/DDP+DDP group was the A549/DDP group co-cultured with DDP,A549/DDP+miR-92a inhibitor group was the A549/DDP group transfected with miR-92a inhibitor,5-FU+L-OHP group was the A549/DDP group co-cultured with 5-FU+L-OHP,5-FU+L-OHP+miR-92a mimics group was the 5-FU+L-OHP group transfected with miR-92a mimics,5-FU+L-OHP+miR-92a mimics+Wnt/β-catenin inhibitor group was the 5-FU+L-OHP+miR-92a mimics group transfected with Wnt/β-catenin inhibitor.5-Ethynyl-2'-deoxyuridine experiment was used to detect cell proliferation rate,wounding healing assay was used to detect cell migration rate,Transwell experiment was used to detect cell invasion ability,fluorescence in situ hybridization was used to detect the expression of miR-92a;quantitative real-time polymerase chain reaction was used to detect the expression of miR-92a,Wnt4,and β-catenin;Western Blot was used to detect protein expression of Wnt4,β-catenin and CD44.Results Compared with A549 group,the expression level of miR-92a in A549/DDP group was significantly increased(P＜0.05).Compared with A549/DDP group,the migration rate and cells invasion number in A549/DDP+miR-92a inhibitor group were significantly reduced(both P＜0.05).Compared with A549/DDP group,the cell proliferation rate,cell invasion number and expression levels of miR-92a,Wnt4,β-catenin,and CD44 proteins in 5-FU+L-OHP group were significantly reduced(all P＜0.05).Compared with 5-FU+L-OHP group,5-FU+L-OHP+miR-92a mimics group showed a significant increase(all P＜0.05).Compared with 5-FU+L-OHP+miR-92a mimics group,5-FU+L-OHP+miR-92a mimics+Wnt/β-catenin inhibitor group showed a significant decrease[miR-92a:(0.49±0.07)vs(0.97±0.14),Wnt4:(0.37±0.05)vs(1.19±0.16),β-catenin:(0.27±0.04)vs(1.54±0.20)](all P＜0.05).Conclusion The combination of 5-FU and L-OHP can effectively improve the DDP resistance of A549 cells,inhibit cell proliferation and invasion,which may be related to downregulating the expression of proteins related to the miR-92a/Wnt/β-catenin signaling pathway.

Abstract:Objective To analyze the influencing factors of bleeding after endoscopic submucosal dissection(ESD)in patients with early gastric cancer treated with antithrombotic therapy.Methods The clinical data of 40 patients with early gastric cancer who underwent ESD in the background of antithrombotic therapy in Zhangjiakou First Hospital,Hebei Province from January 2016 to December 2023 were retrospectively analyzed.According to the occurrence of bleeding after ESD,the patients were divided into non-bleeding group(34 cases)and bleeding group(6 cases).The incidence of bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy was counted.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of bleeding.Results The incidence of bleeding after ESD was 15.0％(6/40)in 40 patients with early gastic cancer treated with antithrombotic therapy.Univariate analysis showed that tumor size,lesion depth and intraoperative blood loss were associated with postoperative bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy(all P＜0.05).Age,gender,diabetes mellitus and pathological type were not associated with postoperative bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy(all P＞0.05).The statistically significant factors(lesion depth,tumor size,intraoperative blood loss)in univariate analysis were included in Logistic multivariate analysis.The results showed that tumor size≥3 cm,submucosal lesions,intraoperative blood loss≥800 ml were risk factors for bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy(the odds ratios were 7.001,6.802,11.101;and the 95％confidence intervals were 1.502-32.592,1.464-31.615,and 1.931-63.852,respectively;all P＜0.05).Conclusion The bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy is affected by tumor size,lesion depth and intraoperative blood loss,which should be paid attention to in clinical practice.In order to reduce the risk of bleeding,careful consideration of antithrombotic therapy should be given in the preoperative evaluation and postoperative management.

Abstract:Objective To explore the relationship between the gene expression levels of TET methylcy-tosine dioxygenase 2(TET2)and DNA methyltransferase 3 A(DNMT3A)and the clinical classification and prognosis of patients with myelodysplastic syndromes(MDS).Methods A total of 97 patients with MDS admitted to Shijiazhuang People's Hospital,Heibei Province from January 2015 to December 2022 were retrospectively selected as the observation group,and 90 people without blood system diseases in the same hospital during the same period of physical examination were selected as the control group,and 87 patients with aplastic anemia were selected as the similar control group.The expression levels of TET2 and DNMT3A genes in the three groups were compared,and the differences of gene expression levels in patients with different MDS types and prognostic grades were compared.Results The expression level of TET2 gene in the observation group was lower than those in the control group and similar control group,and the expression level of DNMT3A gene was higher than those in the control group and similar control group(all P＜0.001).However,there was no significant difference between patients with different types of MDS(all P＞0.05).With the increase of prognosis risk,the expression level of TET2 gene showed an overall downward trend,and the expression level of DNMT3A gene showed an overall upward trend(all P＜0.001).The expression level of TET2 gene was negatively correlated with the poor prognosis of MDS(r=-0.664,P＜0.001),and the expression level of DNMT3A gene was positively correlated with the poor prognosis of MDS(r=0.639,P＜0.001).Conclusion The expression levels of TET2 and DNMT3A genes are not significantly different among different types of MDS,but are significantly related to the prognosis of MDS,and have reference significance for the prognosis of patients in clinic.

Abstract:Objective To investigate the clinical effect of Wenpi Chuzhang decoction in the treatment of gastrointestinal dysfunction of spleen Yang deficiency type.Methods According to the random number table method,50 patients with gastrointestinal dysfunction of spleen Yang deficiency type who were hospitalized in the Department of Critical Care Medicine,Hebei Provincial Hospital of Traditional Chinese Medicine from January 2021 to September 2022 were divided into observation group and control group,with 25 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with Wenpi Chuzhang decoction on the basis of the control group.Both groups were treated for 7 d.The clinical efficacy,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,traditional Chinese medicine(TCM)syndrome score,gastroin-testinal function related indicators,inflammatory factor levels and adverse reactions were compared between the two groups before and after treatment.Results The total effective rate of the observation group was significantly higher than that of the control group[96.0％(24/25)vs 72.0％(18/25)](P＜0.05).After treatment,the APACHE Ⅱscore and TCM syndrome score of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group(all P＜0.05).After treatment,the gastrointestinal dysfunction score,intra-abdominal pressure,abdominal circumference,and average gastric retention in the two groups were lower/less than those before treatment,and the above indexes in the observation group were lower/less than those in the control group(all P＜0.05).After treatment,the white blood cell count,tumor necrosis factor-α,and procalcitonin levels of the two groups were lower than those before treatment,and the levels of inflammatory factors in the observation group were lower than those in the control group(all P＜0.05).During the treatment period,there were no adverse reactions in the two groups,and the routine indexes of blood,urine,and stool remained normal.Conclusion Wenpi Chuzhang decoction is effective in the treatment of gastrointestinal dysfunction of spleen Yang deficiency type,which can improve gastrointestinal function and inhibit inflammatory factors.

Abstract:As the main artery of human blood circulation,the aorta undertakes the key function of trans-porting and distributing the blood pumped by the heart to various organs of the whole body.During blood flow,mechanical stresses are generated in the aorta,mainly including shear stress and mechanical stretch.Physiological mechanical stress maintains the physiological state of blood vessels,while pathological mechanical stress is closely related to the pathological changes of aortic diseases and is one of the risk factors for vascular events.Abnormal mechanical stress disrupts the normal function of endothelial cells and smooth muscle cells through a variety of mechanisms,thereby mediating the initiation and evolution of aortic diseases.This article reviews the latest progress in aortic mechanobiology,aiming to provide new ideas and directions for the prevention and treatment of aortic diseases.

Abstract:A 58-year-old man suffered from bilateral submaxillary swelling and pain with limited mouth opening.Physical examination showed that the opening degree was about a cross finger,and multiple ulcers were found in the oral mucosa,with no obvious swelling and slight tenderness in the bilateral submaxillary area,and no wounds were found in the whole body.During the treatment,the patient developed sudden lockjaw,dyspnea,stiffness of limbs,clinical diagnosis of tetanus infection,treatment of open airway,mechanical ventilation,anti-infection,neutralization of toxins,relief of spasm,nutritional support,correction of autonomic nervous disorders,etc.,the patient improved and was discharged.This paper summarizes the clinical manifestations and treatment of severe systemic tetanus infection in order to improve the level of diagnosis and treatment of this disease.

Abstract:Rheumatoid arthritis(RA)is a chronic systemic immune disease characterized by synovial inflammation and progressive joint destruction.Disorders of cell metabolism are closely related to the pathology of RA.At the site of inflammation,due to the limitation of energy sources,inflammatory cells adapt to perform their homeostatic functions through metabolism.Metabolic abnormalities in immune cells and stromal cells are considered to be important drivers of chronic inflammation in RA.Metabolites such as lactate play a key role in regulating immune cell function.This article reviews the important role of glycolysis,mitochondrial metabolism,lipid and amino acid metabolism in RA and the current status of metabolic-targeted therapy,in order to provide new ideas for the treatment of RA.

Abstract:Objective To investigate the predictive value of leptin and irisin for left ventricular systolic function(LVSF)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A retrospective analysis was conducted on 96 STEMI patients admitted to the Second Affiliated Hospital of Hebei North University from January 2021 to January 2024.Patients with left ventricular ejection fraction(LVEF)＜50％were included in the observation group(n=42),and those with LVEF≥50％were included in the control group(n=54).The correlation between leptin,irisin,and circumferential end-systolic stress(cESS)as well as myocardial energy expenditure(MEE)in patients with STEMI was analyzed.The independent correlations between leptin,irisin,and the risk of LVSF impairment were analyzed.A restricted cubic spline model was established to analyze the dose-response relationship between leptin,irisin,and the risk of LVSF impairment in STEMI patients.Results The results of multivariate Logistic regression analysis showed that a significant positive correlation was observed between leptin and cESS,MEE,while a significant negative correlation was found between irisin and cESS,MEE(all P＜0.001).Leptin exhibited an independent positive correlation,while irisin showed an independent negative correlation with LVSF impairment(both P＜0.05).There was a nonlinear dose-response relationship between leptin,irisin,and the risk of LVSF impairment.When leptin was ≤15 μg/L,the risk of LVSF impairment in STEMI patients increased with increasing leptin levels[odds ratio(OR)=1.517,95％confidence interval(CI):1.118-1.735,P＜0.001].When irisin was ≥0.89 mg/L,the risk of LVSF impairment in STEMI patients increased with decreasing irisin levels(OR=-1.593,95％CI:-2.818 to-1.326,P＜0.001).Conclusions Leptin has an independent positive correlation with LVSF impairment,while irisin shows an independent negative correlation.There exists a nonlinear dose-response relationship between leptin,irisin,and the risk of LVSF impairment.Specifically,when leptin is ≤15 μg/L,the risk of LVSF impairment in STEMI patients increases with increasing leptin levels;conversely,when irisin is ≥0.89 mg/L,the risk of LVSF impair-ment increases with decreasing irisin levels.

Abstract:Objective To investigate the value of echocardiography in the diagnosis of leaflet thrombosis after transcatheter aortic valve replacement(TAVR).Methods A total of 115 patients who successfully underwent TAVR in Beijing Anzhen Hospital,Capital Medical University from January 1,2023 to July 1,2023 were selected as the research objects.According to the presence or absence of subclinical leaflet thrombosis(SLT)after TAVR,the patients were divided into normal group(85 cases)and thrombosis group(30 cases).According to the degree of SLT,the thrombosis group was divided into mild SLT group(17 cases)and moderate to severe SLT group(13 cases).Left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),aortic valve peak velocity(Vmax),mean pressure gradient(MPG),aortic valve orifice area(AVA),amount of change in Vmax(△Vmax),amount of change in MPG(△MPG),amount of change in AVA(△AVA),rate of change in Vmax(△Vmax％),rate of change in MPG(△MPG％),and rate of change in AVA(△AVA％)were compared between the two groups.Receiver operating characteristic curve was used to analyze the influencing factors of moderate to severe SLT.Results There were no significant differences in LVEDD,LVEF,Vmax,MPG and AVA between the thrombosis group and the normal group(all P＞0.05).The △Vmax,△MPG,△Vmax％and △MPG％in the thrombosis group were higher than those in the normal group,while the △ AV A and △AVA％were lower than those in the normal group(all P＜0.05).There were no significant differences in LVEDD,LVEF,Vmax,MPG and AVA among the moderate to severe SLT group,mild SLT group and normal group(all P＞0.05).There were significant differences in △Vmax,△MPG,△AVA,△Vmax％and △MPG％among the moderate to severe SLT group,mild SLT group and normal group(all P＜0.05).The △Vmax,△MPG,△Vmax％and △MPG％in the moderate to severe SLT group were higher than those in the mild SLT group and the normal group,△AVA and△AVA％were lower than those in the normal group,and △AVA was lower than that in the mild SLT group(all P＜0.05).The results of receiver operating characteristic curve analysis showed that the areas under the curve of△Vmax＞77 cm/s,△MPG＞6 mmHg,△AVA≤-0.01 cm2,△Vmax％＞35％,and △MPG％＞143％for predicting moderate to severe SLT after TAVR were 0.754,0.733,0.726,0.784 and 0.788,respectively,and the specificity were 80.4％,73.5％,65.7％,70.6％and 90.2％,and the sensitivity were 61.5％,61.5％,76.9％,76.9％and 61.5％,respectively(all P＜0.05).Conclusion Echocardiography has a certain diagnostic value for the formation of moderate to severe SLT after TAVR.△Vmax,△MPG,△AVA,△Vmax％and △MPG％can provide a reference for the identification of moderate to severe SLT after TAVR with certain accuracy.

Abstract:Objective To investigate the correlation between brachial-ankle pulse wave velocity(baPWV),cardio-ankle vascular index(CAVI),ankle-brachial vascular index(ABI)and early disease progression of acute cerebral infarction(ACI).Methods A total of 280 consecutive ACI patients hospitalized in the Department of Neurology,North China University of Science and Technology Affiliated Hospital from October 2023 to September 2024 were enrolled.According to the disease progression within 7 days of onset,the patients were divided into progression group(84 cases)and non-progression group(196 cases).The values of baPWV,CAVI and ABI were detected by arteriosclerosis monitoring device.The relationship between the three indexes and the early progression of ACI was analyzed,and the predictive value of the three indexes was discussed.Results The age,body mass index,fibrinogen,low-density lipoprotein cholesterol and lipoprotein associated phospholipase A2 in the progression group were higher/higher than those in the non-progression group(all P＜0.05).The baPWV and CAVI in the progression group were higher than those in the non-progression group,and ABI was lower than that in the non-progression group[(1 275±221)cm/s vs(919±124)cm/s,(10.8±0.8)vs(9.1±1.1),(0.82±0.10)vs(1.02±0.13)](t=13.901,14.729,13.076,all P＜0.001).Multivariate Logistic regression analysis showed that baPWV,CAVI,ABI,fibrinogen and lipoprotein-associated phospholipase A2 were independent influencing factors for early disease progression in patients with ACI(all P＜0.05).Among them,baPWV and CAVI were risk factors for the early progression of ACI,and ABI was a protective factor.Correlation analysis showed that baPWV and CAVI were positively correlated with the early progression of ACI(r=0.645,0.612,both P＜0.001),while ABI was negatively correlated with it(r=-0.621,P＜0.001).The area under the curve of baPWV,CAVI,ABI and their combination in predicting early disease progression were 0.906,0.886,0.891 and 0.946,respectively,and the combined detection of the three had higher predictive value.Conclusion The baPWV,CAVI and ABI are closely related to the early progression of ACI.The baPWV,CAVI and ABI all have predictive value for early disease progression in ACI patients,and the combined detection of the three has higher predictive value.

Abstract:Objective This study aimed to select the critical parameters for prenatal screening of atrioven-tricular septal defect(AVSD)through analyzing the quantitative parameters of fetal echocardiography(FE).Methods Totally 112 FE quantitative parameters of 96 AVSD fetuses and 370 normal fetuses diagnosed in our center between January 2016 and December 2021 were retrospectively analyzed.Based on the area under the receiver operating characteristic curve(AUC),the top six with the best screening effect were selected and the effectiveness of six parameters was analyzed.Results Among the 112 parameters,the top six with the largest AUC were the end diastolic atrioventricular length ratio,the quantile score(Q score)of the end diastolic atrioven-tricular length ratio,the Q score of the end systolic atrioventricular length ratio,the end systolic atrioventricular length ratio,Q score of the end diastolic ventricular length,and the end-diastolic ventricular length.The AUC were 0.92,0.92,0.86,0.84,0.84 and 0.81,respectively.Within the range of false positive rate of 20％,the sensitivities of six parameters for prenatal screening of AVSD were 82％,82％,75％,67％,65％and 71％,respectively.Conclusion The ratio of the end diastolic atrioventricular length and its Q score could be used as the critical parameters for prenatal screening of AVSD,with the former being easier to calculate and remember.

Abstract:Objective To understand the basic knowledge level of congenital heart disease in early pregnancy women,use internet technology to conduct health education on congenital heart disease,and evaluate the effect of health education.Methods The research group was imported to formulate the propaganda and education content and the examination paper by using the Wechat small program.From August 2021 to August 2022,pregnant women at 11-13 weeks of gestation who were registered in Beijing Haidian Maternal and Child Health Hospital were selected and divided into the control group and the intervention group according to the random number table method.The control group was given the test before the education,and the intervention group was given the test after the education.The answers to the questionnaire were counted.Results The three items with the highest awareness rate were"awareness rate of the concept of congenital heart disease"(97.5％),"know the role of fetal echocardiography and are willing to take the initiative to rule out congenital heart disease"(92.0％)and"hope doctors specializing in congenital heart disease to conduct knowledge education"(84.0％).The three items with the lowest score:"congenital heart disease is divided into two types:'cyan'and'non-cyan'"(22.4％awareness rate),"received health education about congenital heart disease by doctors specializing in congenital heart disease"(23.4％),and"know of at least one health care facility that screens fetuses for congenital heart disease"(33.1％).Except for items of"awareness rate of the concept of congenital heart disease"and"knowing the role of fetal echocardiography and being willing to take the active examination to rule out congenital heart disease",the awareness rate of other items in the intervention group were higher than those in the control group(all P＜0.05).In the intervention group,pregnant women with older age and lower education level had lower awareness rate of some items(all P＜0.05).Conclusion Women in early pregnancy are more concerned about congenital heart disease,but there are cognitive blind areas and misunderstandings.Network technology can be used to publicize and educate them,and achieve satisfactory results.The pregnant women with older age and lower education level should be given special attention and guidance.

Abstract:Diabetic foot ulcer(DFU)is a common chronic refractory ulcer,which is also the main cause of amputation and even death in diabetic patients.DFU has become a social public health problem that needs to be solved urgently,which brings a huge economic and psychological burden to patients because of its delayed and difficult cure and easy to relapse.DNA methylation is one of the most intensively studied epigenetic mechanisms in the field of epigenetics,which plays a key role in the occurrence and development of diseases.The regulatory mechanism of many key genes in the development of DNA methylation on DFU is still unclear.This article reviews the role of five DNA methylation-regulated genes in DFU healing,aiming to provide a reference for further guiding the application of DNA methylation in DFU.

Abstract:Severe acute respiratory syndrome coronavirus 2 has caused a global pandemic of novel corona-virus infection.Although the main manifestation of viral infection is respiratory disease,an increasing number of studies have shown that novel coronavirus can cause a variety of nervous system damage,such as encephalitis,encephalopathy,Guillain-Barre syndrome and"long novel coronavirus infection"syndrome.The exact mechanism of neurological complications caused by the novel coronavirus is still unclear.This article reviews the clinical manifestations and possible pathological mechanisms of nervous system injury caused by novel coronavirus infec-tion,which is helpful to identify neurological symptoms and prevent critical illness in advance.

Abstract:Objective To investigate the sedative effect of remazolam on ultrasound-guided medial branch of superior laryngeal nerve block in elderly patients.Methods A total of 60 patients with early-stage laryngeal cancer who were treated in Beijing Tongren Hospital,Capital Medical University from May to September 2023 and underwent laryngoscopic carbon dioxide laser resection were selected.They were divided into midazolam group and remazolam group according to the random number table method,with 30 cases in each group.The patients in the midazolam group were sedated with 0.08 μg/kg sufentanil and 0.02 mg/kg midazolam,and the patients in the remazolam group were sedated with the same dose of sufentanil and 0.04 mg/kg remazolam.The success rate of sedation,sedation onset time,recovery time,mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO2),sedation level[evaluated using modified observer's assessment of alert/sedation score(MOAA/S)],patient state index(PSI)at different time points,satisfaction score of patient and anesthesiologist with sedation,and the incidence of adverse events such as bradycardia and hypoxemia during the patient's nerve block period were recorded and compared.Results The success rate of sedation in the remazolam group was significantly higher than that in the midazolam group[83.3％(25/30)vs 53.3％(16/30)],the onset time and recovery time of sedation were significantly shorter than those in midazolam group,and the satisfaction scores of patients and anesthesiologists with sedation were significantly higher than those in the midazolam group(all P＜0.05).The changes of MAP were similar between the two groups during sedation,and the heart rate was more stable than that in the midazolam group.The SpO2 in the remazolam group was lower than that in the midazolam group at 2 min after administration,and those were higher than those in the midazolam group at 6,10,and 15 min after adminis-tration(all P＜0.05).The MOAA/S of the remazolam group was lower than that of the midazolam group at 4,6 and 10 min after administration,while the PSI was higher than that of the midazolam group.At the same time,the PSI of the remazolam group was higher than that of the midazolam group at 15 min after administration(all P＜0.05).There was no significant difference in the incidence of bradycardia,hypoxemia,nausea and vomiting between the remazolam group and the midazolam group during nerve block sedation(all P＞0.05).Conclusion The sedation of remazolam for nerve block in elderly patients with early-stage laryngeal cancer has rapid onset and recovery,and it has better hemodynamic stability,less respiratory depression and better safety than midazolam.

Abstract:Although liposomal doxorubicin is an effective anti-cancer drug,their induced hand foot syndrome(HFS)has a significant impact on the quality of life and treatment compliance of patients.In recent years,in-depth research on its mechanisms and the development of new management strategies have provided new hope for improving the treatment experience of patients.The aim of this study is to explore the mechanism,treatment methods,and the latest progress in future research directions of HFS.

Abstract:Objective To compare the efficacy of different preoperative neoadjuvant chemotherapy regimens in high-risk neuroblastoma(HR-NB).Methods The clinical data of 50 children with HR-NB diagnosed and treated in Shanxi Children's Hospital from January 2016 to January 2019 were collected and retrospectively analyzed.Patients were divided into group A(30 cases)and group B(20 cases)according to different preoperative neoadjuvant chemotherapy regimens.Group A was treated with CAV(cyclophosphamide+adriamycin+vincristine)and CVP(cyclophosphamide+etoposide+cisplatin)before surgery.Group B was treated with CAV(the same drug as group A)and VIP(etoposide+ifosfamide+cisplatin)chemotherapy before surgery.The chemotherapy effect,complete resection rate,adverse reactions and survival were compared between the two groups.Results The effective rate of chemotherapy in group B was significantly higher than that in group A[90.0％(18/20)vs 63.3％(19/30)](P＜0.05).There was no significant difference in the complete resection rate between group B and group A[85.0％(17/20)vs 63.3％(19/30)](P=0.148).The children in both groups tolerated well.The incidences of leukopenia,thrombocytopenia,vomiting,diarrhea,and liver and kidney function damage in group B were lower than those in group A(all P＜0.05).Kaplan-meier survival analysis showed that the 3-year overall survival rate in group B was higher than that in group A(67.2％vs 49.9％,Log-rank x2=3.986,P=0.046).Conclusions Preoperative CAV and VIP alternating chemotherapy regimen may be effective in children with HR-NB,and the adverse reactions can be tolerated.

Abstract:Objective To discuss the differential value of CD4+/CD8+ratio combined with cytokines in active and inactive pulmonary tuberculosis.Methods Totally 107 patients with pulmonary tuberculosis treated in Hebei Chest Hospital from January 2021 to August 2023 were selected as research objects.They were divided into inactive pulmonary tuberculosis group(53 cases)and active pulmonary tuberculosis group(54 cases)according to the condition.The levels of serum cytokines and CD4+/CD8+ratio were compared between the two groups.The relationship between serum cytokine level and CD4+/CD8+ratio in patients with pulmonary tuberculosis was analyzed by stratified regression analysis.Multivariate Logistic regression analysis was used to analyze the factors affecting the occurrence of active pulmonary tuberculosis.The effect of the interaction between serum cytokines and CD4+/CD8+ratio on the occurrence of active pulmonary tuberculosis was analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum cytokines and CD4+/CD8+ratio alone and in combination in the differential diagnosis of active and inactive pulmonary tuberculosis.Results The levels of serum interleukin-6(IL-6),interferon-γ(INF-γ),IL-8 and CD4+/CD8+ratio in active pulmonary tuberculosis group were significantly higher than those in inactive pulmonary tuberculosis group(all P＜0.05).The results of stratified regression analysis showed that IL-6,INF-y and IL-8 all had significant positive effects on CD4+/CD8+ratio(all P＜0.05).The results of multivariate Logistic regression analysis showed that the increased levels of serum IL-6,INF-γ,IL-8 and CD4+/CD8+ratio were the risk factors of active pulmonary tuberculosis(all P＜0.05).The results of interaction analysis showed that there was no multiplicative or additive interaction between serum IL-6,INF-γ,IL-8 and CD4+/CD8+ratio before and after adjusting sex and age(all P＞0.05).The areas under the ROC curve of IL-6,INF-γ,IL-8,CD4+/CD8+ratio and their combination were 0.746,0.771,0.805,0.707 and 0.850,respectively,the combination of the four has the highest efficacy in distinguishing active and inactive pulmonary tuberculosis.Conclusion The levels of serum IL-6,INF-γ,IL-8 and peripheral blood CD4+/CD8+ratio in patients with active pulmonary tuberculosis were higher than those in patients with inactive pulmonary tuberculosis.The level of serum cytokines can affect the cellular immunity of patients with pulmonary tuberculosis,based on this,active and inactive pulmonary tuberculosis can be distinguished.

Abstract:Objective To investigate the impacts of esmolol combined with carvedilol on the heart rate-systolic blood pressure product(RPP)and serum Sestrin2 level in patients with coronary atherosclerotic heart disease(CHD)and myocardial ischemia.Methods A total of 106 patients with CHD and myocardial ischemia admitted to Yulin Hospital,First Affiliated Hospital of Xi'an Jiaotong University from March 2021 to March 2023 were selected.According to the random number table method,they were divided into the observation group and the control group,with 53 cases in each group.The control group was treated with carvedilol,and the observation group was treated with esmolol on the basis of the control group.Both groups were treated for 8 weeks.The total effective rate,electrocardiogram examination results,myocardial oxygen supply related indicators,serum Sestrin2 levels and adverse reactions were compared between the two groups.Results The total effective rate of observation group was higher than that of control group[90.6％(48/53)vs 75.5％(40/53)](P=0.038).After treatment,the total myocardial ischemic load,the number and duration of ST segment depression within 24 h,heart rate,systolic blood pressure and RPP levels in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).After treatment,the serum Sestrin2 levels in both groups were lower than those before treatment,and the serum Sestrin2 level in the observation group was lower than that in the control group[(8.1±1.0)μg/L vs(10.1±1.6)μg/L](all P＜0.001).The total incidence of adverse reactions in the observation group was lower than that in the control group[11.3％(6/53)vs 47.2％(25/53)](P＜0.001).Conclusion The combination of esmolol and carvedilol is effective in the treatment of patients with CHD and myocardial ischemia,which can effectively improve the myocardial ischemia status of patients,regulate heart rate and blood pressure levels,reduce myocardial oxygen consumption,and has fewer adverse reactions.

Abstract:Objective To investigate the clinical characteristics,endoscopic findings and influencing factors of rebleeding in elderly patients with peptic ulcer complicated with bleeding.Methods A total of 182 elderly patients with peptic ulcer and bleeding who were hospitalized in Xuanwu Hospital,Capital Medical University from January 2022 to August 2024 were retrospectively collected.According to the prognosis,they were divided into rebleeding group(12 cases)and non-rebleeding group(170 cases).The general data,laboratory examination results and endoscopic manifestations of the two groups were compared.Logistic regression analysis was used to explore the influencing factors of rebleeding in elderly patients with peptic ulcer and bleeding.Results The incidence rate of regular abdominal pain in the rebleeding group was higher than that in the non-rebleeding group(P＜0.05).The albumin level in the rebleeding group was lower than that in the non-rebleeding group[(27±6)g/L vs(32±5)g/L](P=0.001).The proportions of Forrest grade Ⅰ a-Ⅱ b,ulcer diameter ≥2 cm and retrobulbar ulcer in the rebleeding group were higher than those in the non-rebleeding group(all P＜0.05).Logistic regression analysis showed that regular abdominal pain was an independent risk factor for rebleeding in elderly patients with peptic ulcer and bleeding(P＜0.05),and albumin was an independent protective factor(P＜0.05).Conclusion Regular abdominal pain is an independent risk factor for rebleeding in elderly patients with peptic ulcer and bleeding,and albumin level is an independent protective factor.