Abstract:Objective To discuss the risk factors of short-term death in elderly patients in emergency department with Gram-negative bloodstream infection.Methods Totally 227 patients over 65 years old with Gram-negative bloodstream infections,admitted to the Department of Emergency,Beijing Jishuitan Hospital,Capital Medical University from January 1,2015 to December 31,2019,were selected retrospectively.Based on whether they survived after 90 d of treatment,the patients were divided into death group(41 cases)and survival group(186 cases).The independent risk factors affecting the survival were studied by Cox regression model.Results The most common infection bacteria were Escherichia coli[140 cases(61.7％)]and Klebsiella pneumoniae[39 cases(17.2％)].As for the sites of infections,the most common were urinary system infections[93 cases(41.0％)]and pulmonary infections[51 cases(22.5％)].The proportions of solid tumors,cerebrovascular disease,acute renal failure,acute liver failure,septic shock,indwelling central venous catheter,indwelling urinary catheter and invasive operation in the survival group were lower than those in the death group,while the proportion of rational use of antimicrobial drugs in the early stage was higher than that in the death group(all P＜0.05).The survival group's length of hospital stay,heart rate,respiration,D-dimer quantification,blood urea nitrogen,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,and Charleson comorbidity index score were shorter than/lower than those in the death group,while the mean arterial pressure,platelet count,hemoglobin,and troponin I were higher than those in the death group(all P＜0.05).Multivariate Cox regression analysis showed that solid tumor[hazard ratio(HR)=3.109,95％confidence interval(CI):1.133-8.530,P=0.028],acute liver failure(HR=2.430,95％CI:1.072-5.511,P=0.033)and APACHE Ⅱ score(HR=1.216,95％CI:1.149-1.286,P＜0.001)were the independent risk factors.However,early appropriate use of antibiotics could reduce the mortality rate,and it was an independent protective factor(HR=0.269,95％CI:0.123-0.590,P=0.001).Conclusions Solid tumor,acute liver failure and APACHE Ⅱ score are the independent risk factors for the elderly emergency patients with Gram-negative bacteria bloodstream infection,and early appropriate use of antibiotics can reduce the mortality rate.

Abstract:Acute chest pain is one of the common symptoms in the emergency department.Early and accurate identification of high-risk and low-risk chest pain is beneficial to timely diagnosis and treatment of high-risk patients and reduce over-treatment of low-risk patients.At the same time,it can improve the prognosis and alleviate the severity of pre-hospital care and emergency department medical resources.In recent years,early risk stratifica-tion tools for patients with acute chest pain have been developed,and their sensitivity and specificity are different.This article reviews the current research progress of early risk assessment in patients with acute chest pain.

Abstract:Objective To investigate the correlation between serum uric acid level and atrial fibrillation in patients with non-alcoholic fatty liver disease(NAFLD).Methods A total of 565 patients diagnosed with NAFLD in the Second Hospital of Shanxi Medical University from January 2020 to December 2022 were retrospectively selected.According to whether they were complicated with atrial fibrillation,they were divided into atrial fibrillation group(224 cases)and non-atrial fibrillation group(341 cases).The clinical data of the two groups were analyzed.Multivariate Logistic regression analysis was used to determine the related factors for the occurrence of atrial fibrillation in NAFLD patients.A trend test was used to analyze the linear trend between serum uric acid level and atrial fibrillation.The nomogram model was constructed to predict the risk of atrial fibrillation,and the calibration curve was drawn to evaluate the accuracy of the nomogram.Finally,the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum uric acid and the nomogram model for the occurrence of atrial fibrillation in NAFLD patients.Results Multivariate Logistic regression analysis showed that age[odds ratio(OR)=1.096,95％confidence interval(CI):1.071-1.121,P＜0.001],serum creatinine(OR=1.021,95％CI:1.003-1.039,P=0.025)and serum uric acid(OR=1.008,95％CI:1.005-1.011,P＜0.001)were independent risk factors for the occurrence of atrial fibrillation in NAFLD patients,and high-density lipoprotein(P=0.010)was an independent protective factor.The risk of atrial fibrillation increased with the increase of serum uric acid level(P＜0.001 for trend test).The C-index of the nomogram predicted atrial fibrillation was 0.827(95％CI:O.793-0.861),and the Hosmer-Lemeshow test and calibration plots showed that the model was well calibrated.ROC analysis showed that the area under the curve of the nomogram model was 0.827,which was better than that of serum uric acid(0.683).Conclusion Elevated serum uric acid level is an independent risk factor for atrial fibrillation in patients with NAFLD.

Abstract:Recent years,the incidence of gastric cancer has decreased but the rate of gastric signet ring cell carcinoma(GSRCC)has distinctly increased by year.Compared with non-GSRCC,the prognosis of patient with GSRCC is extremely poor,which is closely related to its special pathological and molecular features and poor sensibility of chemotherapy drugs.Moreover,some molecular expressions may be potential therapeutic targets and biomarkers.Now we have reviewed the progress of GSRCC.

Abstract:Breast cancer is one of the most common malignant tumors in women,which directly affects women's physical and mental health and quality of life.As an important part of breast cancer treatment,endocrine therapy can significantly improve the survival rate and quality of life of patients.However,in the process of endocrine therapy,the follow-up management of patients is often neglected,resulting in insufficient evaluation of treatment effect and lack of psychological support.At present,although some studies have explored the strategies of endocrine therapy for breast cancer,there is still a lack of systematic summary and analysis of the specific points of follow-up.This article introduces the role of estrogen in breast cancer and the mechanism of endocrine therapy,and comprehensively reviews the key points of follow-up in breast cancer patients with endocrine therapy,including therapeutic effect evaluation,complications monitoring,quality of life evaluation and psychological support.Through a comprehensive analysis of the relevant literature,this paper aims to provide clinicians with effective follow-up strategies to improve the prognosis and quality of life of patients,so as to provide a reference for the comprehensive management of breast cancer.

Abstract:Objective To analyze the risk factors for delayed extubation after radical surgery in children with tetralogy of Fallot(TOF).Methods A total of 287 children diagnosed with TOF in the Pediatric Heart Center,Beijing Anzhen Hospital,Capital Medical University from January 2018 to December 2021 were enrolled in this study.Based on whether mechanical ventilation time was greater than or equal the median(49 h),they were divided into normal extubation group(144 cases)and delayed extubation group(143 cases).The perioperative clinical data of the two groups were collected for comparative analysis,to explore the single factor affecting the duration of mechanical ventilation,and then multivariate Logistic regression analysis was performed.Results All children underwent radical surgery,and the median mechanical ventilation time was 49(24,93)h.The age,body mass,body surface area,preoperative blood oxygen saturation,Mcgoon ratio,pulmonary artery index measured by ultrasound,proportion of preoperative lateral branch occlusion,proportion of cross valve ring patch surgery,cardiopulmonary bypass time,ascending aorta occlusion time,length of intensive care unit hospital stay,proportion of postoperative capillary leakage syndrome(CLS),and the proportion of serious adverse events in two groups after surgery showed statistically significant differences(all P＜0.05).Multivariate Logistic regression analysis showed that preoperative lateral branch occlusion(odds ratio=2.896),postoperative CLS(odds ratio=6.610),cross valve ring patch surgery(odds ratio=1.800),and lower body mass(odds ratio=0.959)were independent risk factors for postoperative delayed extubation in children with TOF(all P＜0.05).Conclusion Preoperative lateral branch occlusion,postoperative CLS,cross valve ring patch surgery and lower body mass are independent risk factors for postoperative delayed extubation in children with TOF.

Abstract:Objective To explore the application effect of internal dental floss traction assisted technique in endoscopic submucosal dissection(ESD)for early colorectal cancer and precancerous lesions.Methods Clinical data of 98 patients with early colorectal cancer and precancerous lesions who underwent ESD in Department of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University from January 2022 to December 2023 were selected to retrospective analysis,and they were divided into the dental floss group(51 cases)and the control group(47 cases)according to endoscopic treatment methods.The control group received standard ESD,while the dental floss group received additional internal dental floss traction during ESD.The ESD procedure time,incidence of intraoperative bleeding,lesion resection effect,incidence of postoperative complications,and length of hospital stay were compared between the two groups.Results Compared to the control group,ESD procedure time and the incidence of intraoperative bleeding in the dental floss group were shorter/lower[25.0(17.3,30.0)min vs 45.0(32.0,64.0)min,39.2％(20/51)vs 53.2％(25/47)](both P＜0.05).There were no significant differences in overall resection rate,complete resection rate,postoperative and length of hospital stay between the two groups(all P＞0.05),and no delayed perforation occurred.Conclusion The application of internal floss traction in ESD for the treatment of early colorectal cancer and precancerous lesions can shorten the procedure time,reduce the incidence of intraoperative bleeding.

Abstract:Objective To explore the independent correlation between sequential organ failure assessment maximum(SOFA Maximum)≥ 11 and heart,brain,lung,kidney and liver dysfunction at 30 d after acute type A aortic dissection(ATAAD)repair,and to evaluate the sensitivity and independence of SOFA Maximum in guiding organ care after ATAAD repair.Methods A total of 114 patients with ATAAD who underwent surgical repair in Beijing Anzhen Hospital,Capital Medical University from August to December 2023 were retrospectively selected.Multiple Logistic regression was used to explore the independent correlation between SOFA Maximum≥11 and the representative end point of organ dysfunction at 30 d after ATAAD repair.Results SOFA Maximum ≥ 11 was independently associated with cardio-cerebral insufficiency(major cardiovascular and cerebrovascular adverse events),pulmonary insufficiency(postoperative pulmonary complications),renal insufficiency(acute kidney injury/failure),and liver insufficiency(acute liver injury/failure)at 30 d after ATAAD repair(odds ratio=5.61,3.94,9.44,2.89,respectively,allP＜0.05).Conclusion SOFA Maximum≥ 11 has good independence and sensitivity in guiding organ nursing after ATAAD repair.In the future,SOFA Maximum≥ 11 will be included in the standardized perioperative management system of ATAAD repair,which has broad application prospects.

Abstract:Objective To explore the effect of probucol combined with atorvastatin in the treatment of acute cerebral infarction and its effect on patients' blood lipids.Methods A total of 96 patients with acute cerebral infarction admitted to the Shandong Provincial Third Hospital from January 2022 to January 2024 were selected.They were divided into observation group and control group according to the random number table method,with 48 cases in each group.The control group was given conventional treatment based on atorvastatin,and the observation group was treated with probucol tablets on the basis of the control group.All patients were treated for 12 weeks.The clinical efficacy,blood lipid indexes,ultrasound parameters of carotid plaque,inflammatory factors,and treatment safety were compared between the two groups.Results The total effective rate of the obser-vation group was higher than that of the control group[91.7％(44/48)vs 72.9％(35/48)](P=0.016).After treatment,the blood lipid indexes of the two groups were better than those before treatment,and the blood lipid indexes of the observation group were better than those of the control group(all P＜0.05).After treatment,the carotid intima-media thickness and vascular resistance index of the observation group were less than those of the control group,and the maximum systolic velocity and the maximum end-diastolic velocity were higher than those of the control group(all P＜0.05).After treatment,the levels of inflammatory factors matrix metalloproteinase-2,nucleotide-binding oligomerization domain-like receptor protein 3 and interleukin-1 β in the observation group were lower than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Probucol combined with atorvastatin has a good application effect on acute cerebral infarction,which can improve the blood lipid level of patients,stabilize the carotid plaque of patients,improve the carotid blood flow velocity,reduce the level of inflammatory factors,and has good treatment safety.

Abstract:Acute ethylene glycol poisoning is one of the common causes of poisoning.Due to the lack of rapid and accurate diagnostic methods and safe and effective drugs,it is very difficult in the clinical diagnosis and treatment process,and delayed diagnosis and treatment will directly lead to serious organ damage and even death.Full understanding of the metabolic process in vivo,clinical manifestations,the accuracy and limitations of laboratory tests,and the applicability of treatment regimens are of great significance for rapid diagnosis and improved prognosis.This article reviews the metabolism of ethylene glycol in the body,the clinical manifestations after poisoning,and the research status of the latest diagnosis and treatment methods at home and abroad,so as to provide methods and ideas for early identification and effective treatment of acute ethylene glycol poisoning.

Abstract:Objective To investigate the effect of vidian neurectomy(VN)combined with anterior ethmoidal neurotomy(AEN)on olfaction and clinical efficacy in patients with chronic sinusitis complicated with allergic rhinitis(CRSwAR).Methods The medical records of 54 patients with moderate to severe CRSwAR with olfactory dysfunction who were treated in the Department of Otolaryngology,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from December 2022 to December 2023 were retrospectively collected.The patients were divided into observation group(26 cases)and control group(28 cases)according to the specific operation conditions.The control group was treated with functional endoscopic sinus surgery,while the observation group was treated with unilateral VN and bilateral AEN on the basis of the control group.The percentage of eosinophils in peripheral blood(EOS％),the total score of Sniffin' sticks olfactory test,subjective symptom score[sinonasal outcome test(SNOT-22),rhinoconjunctivitis quality of life questionnaire(RQLQ)score],Lund-Kennedy score of nasal endoscopy and Lund-Mackay score of nasal cavity and paranasal sinus CT were compared between the two groups before and after surgery,and the changes of olfactory and nasal symptoms before and after operation were evaluated and analyzed.The factors affecting the total score of Sniffin' sticks olfactory test were analyzed by generalized mixed linear model,and the postoperative recurrence rate was compared between the two groups.Results Both groups of EOS％decreased over time(Pwithin group＜0.01),but no significant interaction was observed(Pinteraction=0.33).The analysis of within subject effects showed that the total score of Sniffin'sticks olfactory test changed over time(Pwithin group＜0.01),and the observation group showed a faster increase in scores compared to the control group(Pinteraction＜0.01).Both SNOT-22 and RQLQ scores had a temporal trend and interactive effects,and there was a significant difference in the treatment effect between the two groups in terms of the above scores(both Pinter group＜0.05).One year after surgery,the Lund-Kennedy scores of nasal endoscopy and nasal sinus CT in both groups were lower than before surgery,and the observation group had lower Lund-Kennedy scores of nasal endoscopy than the control group[(3.3±0.3)vs(4.7±3.0)](both P＜0.05).The results of general-ized linear mixed model analysis showed that the Lund-Kennedy score of nasal endoscopy had an effect on the total score of Sniffin' sticks olfactory test(P=0.001).The recurrence rate of the observation group was lower than that of the control group[7.7％(2/26)vs 32.1％(9/28)](P=0.026).Conclusion VN and AEN combined with functional endoscopic sinus surgery is beneficial to restore the olfactory function and nasal mucosal function of CRSwAR patients,and reduce the postoperative recurrence rate.

Abstract:Objective To investigate the effect of Lingyang Qingfei pill combined with piperacillin sodium and tazobactam sodium in the treatment of patients with severe pneumonia.Methods A total of 125 patients with severe pneumonia admitted to the General Hospital of the Northern Theater Command of Chinese People's Liberation Army from October 2020 to October 2023 were selected as the research objects.According to the random number table method,they were divided into the control group(62 cases)and the observation group(63 cases).All patients were given conventional treatment.The control group was treated with piperacillin sodium and tazobactam sodium,and the observation group was treated with Lingyang Qingfei pill on the basis of the control group.Both groups were treated for 14 days.The clinical efficacy,symptom disappearance time,pulmonary function index,inflammatory factor index and safety of the two groups were compared.Results The total effective rate of the observation group was significantly higher than that of the control group[96.8％(61/63)vs 74.2％(46/62)](x2=12.985,P＜0.001).After treatment,the antipyretic time,shortness of breath disappearance time,cough disappearance time and wet rales disappearance time of the observation group were shorter than those of the control group(all P＜0.05).After treatment,the forced vital capacity,forced expiratory volume in the first second and partial expiratory flow-volume of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group(all P＜0.05).After treatment,the levels of serum C-reactive protein,interleukin-6 and procalcitonin 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).There was no significant difference in the incidence of adverse reactions between the observation group and the control group[7.9％(5/63)vs 4.8％(3/62)](x2=0.501,P=0.479).Conclusion Lingyang Qingfei pill combined with piperacillin sodium and tazobactam sodium has a good effect on severe pneumonia,which can relieve clinical symptoms,improve lung function,reduce inflammatory factors,and has good safety.

Abstract:Objective To evaluate the efficacy and health economics of different minocycline-containing quadruple regimens in newly treated patients with Helicobacter pylori(Hp)infection.Methods From January 1,2022 to July 31,2023,the clinical data of 554 Hp infection patients who received eradication treatment with a quadruple regimen containing minocycline in Beijing Jishuitan Hospital,Capital Medical University were retrospectively analyzed.According to different eradication treatment plans,they were divided into MAPB group(166 cases),MMPB group(81 cases),and MLPB group(307 cases).The MAPB group received minocycline-amoxicillin-proton pump inhibitor(PPI)-bismuth regimen,the MMPB group received minocycline-metronidazole-PPI-bismuth regimen,and the MLPB group received minocycline-levofloxacin-PPI-bismuth regimen,All three groups were treated for 14 d.Outcome measures included Hp eradication rate and incidence of adverse reactions.Using the results of the above studies as parameters,multi-strategy comparison and net benefit method were used to evaluate all treatment strategies and screen the superior one,respectively.Sensitivity analysis was performed to evaluate the stability of the results.Results The Hp eradication rates of patients in the MAPB group,MMPB group,and MLPB group were 92.8％(154/166),84.0％(68/81),and 94.1％(289/307)(x2=9.382,P=0.009).Adverse drug reactions were reported in 185 of 554 patients(33.4％)during eradication therapy.The incidence of adverse events(46.9％)was highest in MMPB group(x2=38.545,P＜0.001).The results of multi-scheme comparison showed that none of the above three schemes was absolutely inferior.The multi-scheme comparison method and the net benefit method results showed that minocycline-levofloxacin-PPI-bismuth regimen might be advantage intervention.Sensitive analysis showed that eradication rate of minocycline-amoxicillin-PPI-bismuth regimen had significant impact on stability of such result.Conclusions Minocycline-containing quadruple therapies showed satisfactory efficacy in the eradication treatment of newly treated patients with Hp infection.Minocycline-levofloxacin-PPI-bismuth regimen might stand optimal health economic value.

Abstract:Objective To investigate the therapeutic effect of glutamine on small intestinal mucosal injury in patients taking aspirin.Methods Patients who were taking aspirin and had small intestinal mucosal injury screened by capsule endoscopy in Beijing Anzhen Hospital,Capital Medical University from January 2022 to January 2024 were selected as the study subjects.They were divided into intervention group and control group by computer random sequence method.The intervention group continued to take aspirin and compound glutamine enteric-coated capsules,while the control group continued to take aspirin without other interventions for aspirin damage.Capsule endoscopy was performed again after 2 months of treatment.The small intestinal mucosal injury of the two groups was evaluated by the small intestinal endoscopic 5-point scale.The primary endpoint of the study was the change in the small intestinal mucosal injury score of the two groups.Results A total of 43 patients were successfully enrolled and completed the whole clinical trial,including 22 cases in the intervention group and 21 cases in the control group.The small intestinal mucosal injury score of the intervention group after treatment was significantly lower than that before treatment[1.0(0.0,1.3)vs 2.0(2.0,3.0),P＜0.001].There was no significant difference in small intestinal mucosal injury score before and after treatment in the control group[2.0(2.0,2.0)vs 2.0(2.0,2.0),P=0.317].Compared with the control group,the small intestinal mucosal injury score of the intervention group decreased more[1.0(1.0,2.0)vs0.0(0.0,0.0),P＜0.001].Conclusion Glutamine can be used to reduce associated small intestinal mucosal injury in patients who are taking aspirin.

Abstract:Objective To investigate the effect of bevacizumab combined with Huaier granule in the treat-ment of non-small cell lung cancer.Methods A total of 84 patients with non-small cell lung cancer who were treated in Yan'an University Affiliated Hospital from January 2021 to October 2023 were included in this study.According to the random number table method,they were divided into the control group and the observation group,with 42 cases in each group.On the basis of conventional treatment,the control group was treated with bevacizumab injection,and the observation group was treated with bevacizumab injection combined with Huaier granule.Both groups were treated for 12 weeks.The clinical efficacy,traditional Chinese medicine symptom score,tumor markers,quality of life and adverse reactions were compared between the two groups.Results The disease control rate of the observation group was significantly higher than that of the control group[85.7％(36/42)vs 66.7％(28/42)](P=0.040).After treatment,the scores of chest tightness,cough,dry stool and chest pain 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 levels of carbohydrate antigen 125,pro-gastrin-releasing peptide and carcinoembryonic antigen 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 scores of physical function,social function,mental psychology and general feeling of the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P＜0.05).There was no significant difference in the incidence of nausea and vomiting,abnormal liver and kidney function,alopecia,skin reaction and toxic myelosuppression between the two groups(all P＞0.05).Conclusion Bevacizumab combined with Huaier granule in the treatment of non-small cell lung cancer has a good therapeutic effect,which can improve the traditional Chinese medicine symptoms,serum tumor markers and quality of life of patients.

Abstract:The morbidity and mortality of cardiovascular disease in patients with rheumatoid arthritis are significantly higher than those in the general population,and coronary atherosclerotic heart disease is one of the main causes of death in patients with rheumatoid arthritis.There are many reasons for rheumatoid arthritis complicated with coronary atherosclerotic heart disease,including traditional risk factors for coronary atherosclerotic heart disease and rheumatoid factor-mediated immune damage.This article mainly reviews the related research on the pathogenesis of rheumatoid arthritis complicated with coronary atherosclerotic heart disease,in order to provide ideas for the effective intervention of patients with rheumatoid arthritis complicated with coronary atherosclerotic heart disease.

Abstract:Objective To investigate the expression and clinical significance of multidrug resistance protein 4(MRP4)in serum of patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH).Methods A total of 150 COPD patients hospitalized in Guizhou Provincial People's Hospital from February 13,2023 to February 13,2024 were selected.According to the results of echocardiography,COPD patients were divided into COPD group(50 cases)and COPD combined with PH group(COPD+PH group,100 cases).In addition,50 healthy subjects in the same period were selected as the control group.According to pulmonary artery systolic pressure(PASP),the COPD+PH group was divided into mild group(36 mmHg≤PASP≤50 mmHg),moderate group(51 mmHg≤PASP≤70 mmHg)and severe group(PASP＞70 mmHg).MRP4,pulmonary function,blood gas analysis,red cell volume distribution width(RDW),mean platelet volume(MPV),brain natriuretic peptide(BNP)and albumin levels were measured.Pearson correlation model was used for correlation analysis.The receiver operating characteristic(ROC)curve was used to evaluate the value of MRP4 in predicting COPD combined with PH.Results The level of MRP4 in COPD group was lower than that in control group,while the level of MRP4 in COPD+PH group was higher than that in control group and COPD group(both P＜0.05).The level of albumin in COPD+PH group was lower than that in COPD group,and the levels of RDW,MPV and BNP were higher than those in COPD group(all P＜0.05).The levels of MRP4,RDW,MPV and BNP in moderate group and severe group were higher than those in mild group,and those in severe group were higher than those in moderate group;the albumin level was lower in the mild group than in the severe group,and that in the severe group was lower than that in the moderate group(all P＜0.05).The level of MRP4 in COPD+PH group was positively correlated with BNP,PASP,RDW and MPV(r=0.72,0.85,0.70,0.62,all P＜0.01),and negatively correlated with albumin(r=-0.60,P＜0.01).ROC curve analysis showed that when the cut-off value of MRP4 was 2.895 μg/L,the area under the curve for predicting COPD combined with PH was 0.917(95％confidence interval:0.865-0.970),the sensitivity was 93.00％,and the specificity was 88.00％.Conclusion MRP4 is highly expressed in serum of patients with COPD complicated with PH,which may be a potential biomarker.

Abstract:As a mental disease that seriously endangers people's physical and mental health,the incidence of depression is increasing year by year.As one of the common complications after surgery and anesthesia,postoperative depression has a negative impact on the postoperative rehabilitation process and medical burden of patients.Conventional antidepressants have the problem of delayed efficacy,which cannot achieve rapid remission of severe depression after surgery.In recent years,breakthroughs in the research of ketamine and its related compounds in the field of anti-depression have provided hope for rapid relief of postoperative depressive symptoms.This article systematically summarizes and discusses the research progress of ketamine and its enantiomers in the treatment of postoperative depression.

Abstract:Objective To investigate the clinical effect of phloroglucinol combined with somatostatin in the treatment of acute pancreatitis(AP).Methods Forty patients with AP who received treatment with combination therapy of phloroglucinol and somatostatin at the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2020 to November 2023 were included as the combination group,while 40 AP patients treated with somatostatin during the same period were included as the control group.Patients'data were collected for retrospective analysis.The clinical efficacy,clinical symptom relief time,the recovery time of blood amylase,inflammatory factors and blood amylase levels before and after treatment,adverse reaction incidence and mortality rate were compared between the two groups.Results The total effective rate of the combined group was higher than that of the control group[95.0％(38/40)vs 82.5％(33/40)],and the difference was statistically significant(x2=-3.181,P=0.001).The relief time of abdominal pain,nausea and vomiting,peritoneal irritation sign,and the recovery time of blood amylase in the combination group were shorter than those in the control group[4.00(2.00,4.25)d vs 6.00(5.00,7.00)d,4.00(2.00,5.00)d vs 6.00(5.00,7.00)d,2.00(2.00,3.00)d vs 4.00(3.00,5.00)d,4.00(2.00,6.00)d vs 6.00(2.75,9.00)d],and the differences were statistically significant(all P＜0.05).After treatment,the levels of tumor necrosis factor-α,interleukin-6,C-reactive protein,and blood amylase in two groups were all lower than before treatment,and those in combination group were lower than those in control group(all P＜0.05).There was no statistically significant difference in the incidence and mortality rates of adverse reactions between the two groups[10.0％(4/40)vs 15.0％(6/40),2.5％(1/40)vs 5.0％(2/40)](both P＞0.05).Conclusion Phloroglucinol combined with somatostatin is effective in the treatment of AP,which can effectively relieve clinical symptoms and inflammatory reaction,and will not cause serious adverse reactions.

Abstract:Objective To investigate the predictive value of serum proprotein convertase subtilisin/kexin type 9(PCSK9)and lipopolysaccharide(LPS)for cardiovascular and cerebrovascular disease mortality in elderly patients with non-valvular atrial fibrillation(NVAF).Methods A total of 575 elderly patients with NVAF admitted to Haikou People's Hospital,Hainan Province from October 2016 to December 2020 were selected and followed up for 3 years.They were divided into death group(74 cases)and survival group(501 cases)according to whether they died of cardiovascular and cerebrovascular diseases.The serum levels of PCSK9 and LPS were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the risk factors for cardio-vascular and cerebrovascular disease mortality in elderly NVAF patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PCSK9 and LPS levels for cardiovascular and cerebrovascular disease mortality in elderly NVAF patients.Results After 3 years of follow-up,the cardiovascular and cerebro-vascular disease mortality of 575 elderly NVAF patients was 12.9％(74/575).The serum levels of PCSK9 and LPS in the death group were higher than those in the survival group(all P＜0.001).Multivariate Logistic regres-sion analysis showed that increasing age,increased CHA2DS2-VASc score,acute myocardial infarction,stroke/transient ischemic attack,increased heart failure,increased PCSK9,and increased LPS were the independent risk factors for cardiovascular and cerebrovascular disease death in elderly NVAF patients(all P＜0.05).The ROC curve showed that the area under the curve of serum PCSK9 and LPS levels combined to predict the death of cardio-vascular and cerebrovascular disease in elderly NVAF patients was 0.873,which was larger than 0.781 and 0.795 predicted by serum PCSK9 and LPS levels alone(both P＜0.001).Conclusion Elevated serum PCSK9 and LPS levels are independent risk factors for cardiovascular death in elderly patients with NVAF,and the combination of serum PCSK9 and LPS levels has a high predictive value for cardiovascular death in elderly patients with NVAF.