Abstract:Objective To observe the efficacy of cinacalcet combined with calcitriol in the treatment of secondary hyperparathyroidism(SHPT)in maintenance hemodialysis patients and its impact on the nutritional status of patients.Methods Chronic kidney disease patients who experienced SHPT and malnutrition during hemodialysis at Linquan County People's Hospital from February 2023 to March 2024 were selected as the research subjects,96 patients were randomly divided into two groups,with 48 patients in each group.Patients were given standardized nutritional management,with the control group receiving calcitriol capsules and the cinacalcet group receiving oral cinacalcet therapy in addition to the control group.Compare the serum calcium,phosphorus,and iPTH levels between the two groups at the time of enrollment,6 months of treatment,and 12 months of treatment.Upper arm circumference(MAC),triceps skinfold thickness(TSF),upper arm muscle circumference(AMC),and malnutrition inflammation score(MIS)were calculated.Compare two groups of adverse reactions.Results After 6 and 12 months of treatment,both groups had serum phosphorus and iPTH levels lower than baseline(t=3.239、3.469、6.853、4.852,P<0.05).The serum phosphorus and iPTH levels in the 6-month and 12-month cinacalcet groups were lower than those in the control group(P<0.05).At 6 and 12 months of treatment,both groups demonstrated a progressive upward trend in MAC,TSF and AMC.At 12 months,the AMC in the cinacalcet group was significantly higher than that in the control group,with a statistically significant between-group difference(t=2.979,P<0.05).Similarly,the MIS showed a gradual decline in both groups.The cinacalcet group exhibited lower MIS scores compared to the control group at both 6 months(12.72±3.19 vs.14.35±2.81)and 12 months(9.67±2.89 vs.11.94±3.73),with statistically significant differences(P<0.05 for both time points).There was no statistically significant difference in the incidence of adverse reactions between the two groups,χ2=0.489,P=0.484.Conclusion For patients with secondary hyperparathyroidism after maintenance hemodialysis,the combination of cinacalcet can effectively reduce parathyroid hormone and serum phosphorus levels,improve nutritional status,and enhance muscle function.

Abstract:Objective To investigate the effect analysis of transcranial magnetic stimulation(TMS)combined with swallowing training on swallowing function,surface electromyography and nutritional status in patients with dysphagia after cerebral infarction with swallowing dysfunction.Methods A prospective study was conducted on 102 patients with dysphagia after cerebral infarction who were treated in our hospital from March 2021 to March 2024,and they were divided into control group(51 cases)and observation group(51 cases)by random single blind method.Both groups were given routine intervention,the control group was given swallowing training on the basis of routine intervention,and the observation group was given TMS on the basis of the control group.Both groups were treated continuously for 8 weeks.The efficacy,water swallowing test(WST)grading,videofluoroscopic swallowing study(VFSS)score,standardized swallowing assessment(SSA)score,surface electromyography index[surface electromyography signal(amplitude,duration,median frequency)of mandibular hyoid muscle],nutritional status index[serum prealbumin(PAB),serum albumin(ALB),hemoglobin(HB)],and generic quality of life inventory-74(GQOLI-74)were compared between the two groups.Each dimension(physical function,material life,social function,psychological function)score.Results After treatment,the total effective rate of the observation group was 92.16%,which was higher than 74.51%in the control group(χ2=5.718,P<0.05).The WST grading,SSA score,amplitude,and duration in the observation group were lower than those in the control group after treatment(t=3.529,9.549,9.344,5.349,P<0.05).The VFSS score,median frequency,PAB,Alb,HB,and each dimension score of GQOLI-74 in the observation group were higher than those in the control group(t=6.607,5.436,2.116,3.469,2.357,9.056,5.443,5.647,5.883,P<0.05).Conclusion TMS combined with swallowing training has a significant effect on swallowing in patients with dysphagia after cerebral infarction,which can effectively improve their swallowing function,improve the surface electromyography activity characteristics(amplitude,time course,median frequency),nutritional indicators and quality of life of mandibular hyoid muscle.

Abstract:Objective To explore correlation between oral debility and postoperative delirium in elderly ICU patients.Methods 220 cases of ICU elderly postoperative patients admitted to Hai'an People's Hospital from January 2023 to December 2024 were selected.The ICU Ambiguity Assessment Scale for Consciousness(CAM-ICU)was used to assess whether delirium occurred or not in the patients at 7 days postoperatively.It was separated into a group of occurrences of postoperative delirium and a group of non-occurrences of postoperative delirium according to the occurrence of delirium.Their demographic and clinically relevant data were collected,and influencing factors of postoperative delirium in elderly patients in ICU were analyzed by univariate and multivariate analyses,and the predictive value was analyzed by using the subject's work characteristic curve(ROC);and the correlation between the patient's score on the Oral Failure Inventory(OFI-8)and the score on the Assessment of Ambiguity of Consciousness Scale for ICU(CAM-ICU-7)was analyzed by using the Pearson correlation analysis.Results Among 220 elderly ICU patients,83 patients(37.73%)had postoperative delirium and 137 patients(62.27%)did not have postoperative delirium.The results of univariate analysis showed that invasive mechanical ventilation,American Society of Anesthesiologists(ASA)grading,duration of surgery,postoperative Acute Physiology and Chronic Health Status Ⅱ(APACHE Ⅱ)scores,intraoperative hypothermia,benzodiazepine use,opioid use,oral debility and length of ICU stay were all statistically significant when comparing the two groups of patients(P<0.05).Logistic regression analysis showed that invasive mechanical ventilation,ASA classification,postoperative APACHE Ⅱ score,intraoperative hypothermia,benzodiazepine use,opioid use,oral debility and length of ICU stay were all influential factors for postoperative delirium in elderly patients in the ICU(P<0.05).The results of the ROC analysis showed that oral weakness and the combination of all the indexes predicted the occurrence of postoperative delirium in elderly patients,and the area under the curve(AUC)was 0.937(95%CI:0.904～0.969),which was higher than the AUC predicted by each indicator alone(P<0.05),with a sensitivity of 86.7%and a specificity of 89.1%.The results of the Pearson correlation analysis showed that OFI-8 scores of elderly patients in the ICU were positively correlated with CAM-ICU-7 scores(P<0.05).Conclusion There is a correlation between oral debility and the occurrence of postoperative delirium in elderly patients in ICU,which can provide a basis for early screening and intervention of postoperative delirium in elderly patients in ICU.

Abstract:Objective To explore the right-to-left shunt(RLS)of patent foramen ovale(PFO)in patients with migraine by contrast-enhanced transthoracic echocardiography(c-TTE)evaluation,and to analyze the relationship with cryptogenic stroke(CS).Methods Seventy-four patients with migraine who received treatment in Anqing Shihua Hospital of Nanjing Drum Tower Hospital Group from August 2022 to November 2024 were selected as study subjects for retrospective analysis.According to whether the patients were complicated with CS,they were divided into CS group(n=35)and non-CS group(n=39).All subjects received c-TTE to detect PFO and RLS.RLS was evaluated by contrast-enhanced ultrasound in the resting state and after Valsalva maneuver.According to the microbubble count grading,it was divided into no shunt(grade 0),small shunt(grade I),medium shunt(gradeⅡ)and large shunt(grade Ⅲ).The presence of PFO,RLS grading(gradeⅠ,Ⅱor Ⅲ),PFO aperture,PFO length,valve activity and atrial septal aneurysm(ASA)were recorded in the two groups of patients,and the correlation with CS was explored by Logistic regression analysis.Results c-TTE test revealed that the detection rate of PFO in the CS group was 62.86%(22/35))and that in the non-CS group was 51.28%(20/39),and there was no statistical significance between the two groups(P>0.05).There were 13,7,10 and 5 cases of RLS grade 0,Ⅰ,Ⅱ and Ⅲ in the CS group,and there were 19,14,4 and 2 cases in the non-CS group respectively(P=0.062).The comparison of PFO diameter,length,and valve mobility among patients with RIS grades 0,Ⅰ,Ⅱ and Ⅲ showed statistically significant differences(F=1131.107,281.964,416.390,P<0.001).Multivariate logistic regression analysis revealed that PFO aperture and valve activity were independent risk factors of CS occurrence,and were positively correlated with CS(P<0.05).Conclusion Simple PFO may not be sufficient to cause CS.The anatomical and functional characteristics of PFO are the key factors leading to CS.The larger the diameter of PFO and the range of motion of the valve,the higher the risk of CS occurrence.For migraine patients with combined CS,c-TTE can be used as an effective screening tool to provide a basis for early diagnosis and clinical intervention.

Abstract:With the popularization of vitamin D testing,it has been found that the phenomenon of vitamin D deficiency is higher in China(about 90%)and widespread worldwide.Modern research suggests that vitamin D not only plays a significant role in bone health but also in a variety of chronic diseases.As an important nutrient,it has irreplaceable physiological support functions in human growth,pregnancy and health in old age.The widespread deficiency of vitamin D is influenced by a combination of multiple factors such as pathology,physiology,natural environment,living conditions and health awareness.This article,in combination with literature review,sorts out the current situation and health risks of vitamin D deficiency,as well as how to supplement and apply vitamin D preparations to improve the current situation,for clinical reference.

Abstract:Objective To investigate the level of cardiac rehabilitation(CR)disorder in patients with unstable angina(UA)and analyze its influencing factors.Methods A total of 210 patients with UA who were treated in Jieshou People's Hospital from January 2021 to March 2024 were retrospectively selected as the study subjects.The Chinese version of the cardiac rehabilitation disorder scale(CRBS-C/M)revised by Duan Juan et al.,was used to evaluate the level of CR disorder in patients.Univariate analysis and multiple linear regression analysis were used to analyze the related factors affecting the level of CR disorder in UA patients.Results The total average score of CRBS-C/M in 210 UA patients was(3.12±0.42)points,among which the average score of logistics factor dimension was the highest(3.46±0.43)points,and the other three dimensions were:perceived need dimension(3.05±0.46)points,work/time conflict dimension(3.08±0.45)points,complications/functional status dimension(3.15±0.35)points.Multivariate linear regression analysis revealed that age(β=0.170,P<0.05),education level(β=-0.117,P<0.05),social support level(β=-0.602,P<0.05),angina attack frequency(β=-0.101,P<0.05),dyspnea(β=-0.141,P<0.05),exercise habit(β=0.156,P<0.05),and GRACE score(β=-0.168,P<0.05)were associated factors influencing the level of cardiac rehabilitation(CR)barriers in UA patients,explaining 60.8%of the total variance.Conclusions The level of CR disorder in UA patients is high,and logistic factors are the main influencing factors.Age>60 years old,low education level,low level of social support,angina attack frequency≥3 times/month,higher degree of dyspnea,absence of exercise habits,and high GRACE score are influencing factors for high CR barrier levels in UA patients.

Abstract:Objective To investigate the effects of progressive relaxation training combined with gastrointestinal exercise on gastrointestinal function,negative emotions,and sleep quality in elderly patients with functional dyspepsia(FD).Methods Eighty elderly FD patients admitted to our hospital from March 2024 to March 2025 were enrolled and randomly divided into a control group(n=40)and an observation group(n=40).Both groups received conventional treatment and gastrointestinal exercise intervention,while the observation group additionally underwent progressive relaxation training.Therapeutic efficacy,symptom scores,self-rating anxiety scale(SAS),self-rating depression scale(SDS),quality of life index(QL-Index),pittsburgh sleep quality index(PSQI),and adverse reactions were compared between the two groups.Results The total effective rate was significantly higher in the observation group than in the control group(χ2=4.021,P<0.05).Before treatmen,no significant differences were observed in symptom scores,SAS,SDS,QL-Index,or PSQI between the two groups(all P>0.05).After treatment,symptom scores,SAS,SDS,and PSQI decreased in both groups,with lower values in the observation group(t=7.861,13.015、12.201、10.815、8.735,all P<0.05),while QL-Index improved,with higher scores in the observation group(P<0.05).No significant difference in adverse reaction rates was found between the groups(P>0.05).Conclusion Progressive relaxation training combined with gastrointestinal exercise effectively enhances clinical efficacy,reduces anxiety and depression,improves sleep quality and quality of life,and demonstrates good safety in elderly FD patients,suggesting significant clinical applicability.

Abstract:Objective To evaluate the diagnostic value of synchronous 12 lead dynamic electrocardiogram(DCG)for myocardial ischemia in elderly patients with coronary heart disease.Methods Clinical data of 80 elderly patients with coronary heart disease who visited the hospital from August 2023 to December 2024 were collected.All patients underwent synchronous 12 lead DCG and coronary angiography examinations.According to the results of coronary angiography examination,patients were divided into myocardial ischemia group and non-myocardial ischemia group.The differences in synchronous 12 lead DCG parameters and related data between myocardial ischemia and non-myocardial ischemia patients were compared,with a focus on analyzing the diagnostic value of synchronous 12 lead DCG parameters for myocardial ischemia in elderly coronary heart disease.Results Through coronary angiography examination,myocardial ischemia was detected in 36 of 80 elderly patients with coronary heart disease,with a detection rate of 45.00%.The synchronous 12 lead DCG parameters(duration of ST segment depression,amplitude of ST segment depression,P-wave dispersion,and T-peak to terminal interval)in the myocardial ischemia group were higher than those in the non-myocardial ischemia group(t=6.054、5.564、3.156、3.504,P<0.05).Receiver operating characteristic(ROC)curve was drawn for the subjects,and the results showed that the duration of ST segment depression,amplitude of ST segment depression,P-wave dispersion,and the area under the curve(AUC)of single and combined diagnosis of myocardial ischemia in elderly coronary heart disease were all greater than 0.7,indicating certain diagnostic value.Moreover,the combined diagnostic value was higher than the single diagnostic value of the above indicators(Z=2.270、2.078、3.893、3.841,P<0.05).Conclusion Synchronous 12 lead DCG has certain value in diagnosing myocardial ischemia in elderly coronary heart disease and can provide important reference information for clinical diagnosis and treatment.

Abstract:Objective To compare the application effects of vibratory positive end expiratory pressure(oscillatory positive expiratory pressure,OPEP)and active circulation breathing technique(active cycle of breathing techniques,ACBT)in airway clearance of patients with acute exacerbation of chronic obstructive pulmonary disease(chronic obstructive pulmonary disease,COPD).Methods 120 COPD patients admitted between January and December 2024 were included in the study.Randomly divided into two groups,with 60 cases in the ACBT group and 60 cases in the OPEP group.Both groups underwent continuous airway clearance with ACBT and OPEP for 7 days.Compare the daily sputum volume and sputum viscosity between two groups of patients.The Modified Dyspnea Index(modified Medical Research Council scale,mMRC)was used to evaluate the respiratory changes of patients at the time of enrollment and on the 3rd and 7th day of treatment,and to compare the adverse reactions and length of hospital stay between the two groups.Results On days 2-5,the sputum output of the OPEP group was higher than that of the ACBT group,with P values<0.05.On days 6-7,there was no statistically significant difference in sputum output between the two groups(P>0.05).On the 3rd and 7th day,although the proportion of grade I in the OPEP group was higher than that in the ACBT group,there was no statistically significant difference between the groups(P>0.05).There was no statistically significant difference in mMRC scores between the two groups at the time of enrollment and on day 7.On day 3,the OPEP group had lower scores than the ACBT group(t=2.814,P=0.006).The average hospitalization time in the ACBT group was(9.12±2.06)days,while in the OPEP group it was(8.53±1.89)days,with a statistically significant difference(t=1.614,P=0.109).There was no statistically significant difference in adverse reactions between the two groups(P>0.05).Conclusion The use of vibratory positive expiratory pressure for airway clearance in AECOPD patients can more effectively promote earlier sputum clearance,alleviate earlier clinical symptoms,and is safe and easy to learn.It can be used as an adjuvant treatment for patients with acute exacerbation of chronic obstructive pulmonary disease.

Abstract:Objective To explore the effects of mindfulness training combined with active respiratory and circulatory training on cancer-related fatigue,anxiety and pulmonary function rehabilitation in patients with non-small cell lung cancer(NSCLC)undergoing chemotherapy.Methods A total of 88 patients with NSCLC chemotherapy who were treated in our hospital from January 2022to December 2024 were prospectively selected and divided into treatment group(44 cases)and combined group(44 cases)according to the random number table method.Both groups were given routine nursing intervention,the treatment group was treated with active respiratory and circulatory technology,and the combined group was treated with mindfulness training intervention on the basis of the treatment group.Both groups were treated continuously for 8 weeks.The scores of each dimension of Piper Fatigue Scale(PFS)(body,emotion,cognition and behavior),Hamilton Anxiety Scale(HAMA)score,Hamilton Depression Scale(HAMD)score,lung function index[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),peak expiratory flow(PEF)],Pittsburgh Sleep Quality Index(PSQI)score and 36-item Short Form Health Survey(SF-36)score were compared between the two groups.Results After intervention,the scores of physical,emotional,cognitive and behavioral dimensions in the combined group were lower than those in the treatment group(t=9.753,12.746,11.032,10.673,P<0.05).After intervention,the scores of FVC,FEV1,PEF and SF-36 in the combined group were higher than those in the treatment group(t=2.698,2.938,2.394,5.581,P<0.05),and the HAMA score,HAMD score and PSQI score were lower than those in the treatment group(t=15.431,18.170,2.618,P<0.05).Conclusion The use of mindfulness training combined with active respiratory and circulatory training in patients with NSCLC chemotherapy can effectively improve their cancer-related fatigue and sleep quality,relieve anxiety and depression,and improve lung function and quality of life.

Abstract:Objective Based on the database of China National Cancer Center,this study constructed and verified a nomogram model of osteosarcoma prognosis integrating clinical features and molecular markers(Ki67,SATB2).Methods The data of 1 817 patients with osteosarcoma from 2013 to 2023 were retrospectively analyzed and randomly divided into training group(1 271 cases)and verification group(546 cases)according to the ratio of 7∶3.The threshold of grouping continuous variables was determined by restricted cubic spline(RCS)curve,and independent prognostic factors were screened by univariate and multivariate Cox regression analysis,and nomogram model was constructed.Model performance is evaluated using the concordance index(C-index),receiver operating characteristic curve(ROC),and calibration curves.Finally,the critical value of risk stratification is determined and Kaplan-Meier survival analysis is carried out.Results The baseline characteristics of the training group and verification group were balanced.Univariate and multivariate Cox regression analysis screened out seven independent prognostic factors such as age,tumor diameter,M stage,surgery,chemotherapy,Ki67 index and SATB2.The nomogram model shows good prediction efficiency in both the training group and the verification group.The C-index of the training group was 0.721(95%CI:0.692～0.749),and that of the verification group was 0.712(95%CI:0.665～0.747).The predicted AUC of 1-year,3-year and 5-year survival rates in the training group were 0.826,0.704 and 0.694 respectively.In the validation group,the predicted AUC of 1-year,3-year and 5-year survival rates were 0.757,0.721 and 0.702 respectively.The calibration curve indicates that the prediction results of the model are highly consistent with the actual observation data.Conclusion The nomogram model shows a good prediction efficiency in the internal verification of the current research cohort,which can help identify high-risk patients and provide reference for clinical prediction.

Abstract:Objective To observe the clinical value of Krebs von den Lungen-6(KL-6)and surfactant protein D(SP-D)in the early diagnosis and assessment of idiopathic pulmonary fibrosis(IPF)in patients.Methods 38 patients with idiopathic fibrosis who received treatment from January 2022 to October 2024 and 25 healthy adults recruited during the same period and matched with IPF patients in terms of age and gender were selected as the research subjects.Compare the serum KL-6 and SP-D levels between IPF group and the healthy control group,analyze the correlation between serum KL-6 and SP-D levels and lung function,HRCT scores in IPF patients.Results The serum KL-6 and SP-D levels in the IPF group were significantly higher than those in the healthy control group(t=7.889,7.245,P<0.05).KL-6 and SP-D are significantly positively correlated with CT scores(r=0.703,0.632,P<0.05).KL-6 is negatively correlated with FVC%pred,DLco%pred,and FEV1/FVC,the correlation coefficients are-0.314,-0.415,and-0.388,while SP-D is negatively correlated with FVC%pred,FEV1%pred,and DLco%pred,the correlation coefficients are-0.279,-0.322,and-0.384.The areas under the curves for KL-6,SP-D,and their combined diagnosis of IPF are 0.906,0.899,and 0.940,respectively.The cut-off value for diagnosing IPF with KL-6 is 527.3 U/mL,and the cut-off value for SP-D is 89.2 ng/mL.Conclusion The detection of serum KL-6 and SP-D levels holds certain value for the early detection of idiopathic pulmonary fibrosis.Monitoring changes in their levels may aid in evaluating treatment efficacy and adjusting therapeutic plans,thereby contributing to the management of IPF patients.

Abstract:Objective To investigate the pulmonary complications after thoracoscopic radical resection of lung cancer in elderly patients with lung cancer,analyze the influencing factors,and construct a prediction model.Methods The data of elderly patients with non-small cell lung cancer who received thoracoscopic radical resection of lung cancer in the hospital from December 2021 to December 2024 were collected by the electronic medical record system.The data of 130 patients were screened by inclusion and exclusion criteria for the study.The data of patients were collected,and the postoperative pulmonary complications were counted,and the patients were divided into the complication group and the non-complication group.The clinical data were compared between groups,and univariate and multivariate regression analyses were carried out,and the nomogram was used to construct the prediction model,and receiver operating characteristic curve was used for verification.Results Among the 130 elderly patients with non-small cell lung cancer receiving thoracoscopic radical resection of lung cancer,27 cases had postoperative pulmonary complications,with an incidence rate of 20.77%.The complications mainly included 19 cases of pulmonary infection,7 cases of pleural effusion and 5 cases of atelectasis,with incidence rates of 14.61%,5.38%and 3.85%respectively.Univariate comparison revealed that smoking,pulmonary lobectomy,proportion of surgical time>2 h and intraoperative blood loss in the complication group were higher(χ2=4.243,4.918,4.248,t=7.146,P=0.039,0.027,0.039,<0.001)while albumin(ALB),forced expiratory volume in the first second(FEV1)and forced vital capacity(FVC)were lower than those in the non-complication group(t=5.980,5.678,3.866,3.727,all P<0.001).Univariate analysis and multivariate regression analysis indicated that intraoperative blood loss,pulmonary lobectomy,ALB,FEV1,FVC and FEV1/FVC were the influencing factors of postoperative pulmonary complications(P<0.05).The prediction model based on the above influencing factors had an area under the curve of 0.970,which indicated that the predictive efficiency was good.Conclusion The incidence rate of pulmonary complications after thoracoscopic radical resection of lung cancer is high in elderly patients with lung cancer,and pulmonary infection is more common.Postoperative pulmonary complications can be affected by intraoperative blood loss,resection method,ALB,FEV1,FVC and FEV1/FVC.The model based on the above indicators has good predictive efficiency.

Abstract:Objective To investigate the correlation between TIR and cognitive impairment in elderly patients with T2DM.Methods A total of 80 elderly patients with T2DM admitted to Linquan People's Hospital from May 2023 to July 2024 were reviewed.They were divided into cognitive impairment group(n=36)and normal cognition group(n=44)according to whether they had cognitive impairment.General information,Montreal Cognitive Assessment Scale(MoCA)scores,fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2 h PG),glycated hemoglobin(HbA1c)and TIR were compared.The correlation between blood glucose indicators and MoCA score was analyzed.Results Compared with the normal cognition group,the course of T2DM in the cognitive impairment group was longer[(11.47±2.85)years vs(8.39±2.06)years],and total MoCA score was lower[(21.71±3.19)scores vs(27.92±2.85)scores],and HbA1c level was higher[(8.43±1.85)%vs(7.26±1.44)%],and TIR was shorter[(53.72±13.86)%vs(67.93±16.75)%](t=5.603,9.188,3.181,4.074,P<0.05).There was no significant difference in FPG or 2hPG between the two groups(t=0.575,1.174,P>0.05).HbA1c level was negatively correlated with MoCA score(r=-0.302,P=0.006).TIR was positively correlated with MoCA score(r=0.410,P<0.001).FPG and 2 h PG levels were not correlated with MoCA score(P>0.05).Long course of T2DM(OR=1.146,95%CI:1.035～1.269)and high HbA1c level(OR=1.188,95%CI:1.013～1.392)were risk factors for cognitive impairment in elderly patients with T2DM(P<0.05),while high TIR level(OR=0.976,95%CI:0.959～0.994)was a protective factor(P<0.05).Conclusion Cognitive impairment is closely related to TIR in elderly patients with T2DM.The longer the TIR,the better the blood glucose control throughout the day,and the lower the risk of cognitive impairment.

Abstract:Objective This study aimed to investigate the roles of Atrogin-1 and body mass index(BMI)in the clinical prediction of sarcopenia,evaluate their independent influencing factors and combined predictive efficacy,and provide scientific evidence for early diagnosis and risk assessment of sarcopenia.Methods A retrospective cohort study was conducted,enrolling 114 eligible patients between August 2022 and October 2024,including 63 sarcopenia cases and 51 non-sarcopenia controls.Demographic and clinical characteristics were collected,and multivariate binomial logistic regression was performed to explore the effects of BMI and Atrogin-1 on sarcopenia.Trend analysis was used to validate the stability of Atrogin-1 and BMI across different models,and receiver operating characteristic(ROC)curve analysis was applied to assess their predictive performance.Results Baseline data revealed significant differences between sarcopenia and non-sarcopenia groups in age,weight,BMI,appendicular skeletal muscle mass index(ASM),calf circumference,Atrogin-1 levels,diabetes history,and frailty status.Multivariate logistic regression identified BMI and Atrogin-1(OR=0.68,1.08,P<0.001)as independent influencing factors for sarcopenia.Risk factor validation models demonstrated that Atrogin-1 exhibited an upward risk trend with increasing values,while BMI showed a downward risk trend with higher values,regardless of adjustments for age,sex,smoking,alcohol consumption,diabetes,hypertension,or metabolic indicators.ROC analysis revealed that the AUC for BMI in predicting sarcopenia was 0.83(0.75～0.90),while Atrogin-1 had an AUC of 0.84(0.74～0.94).The combined predictive model achieved a higher AUC of 0.91(0.85～0.98),outperforming individual indicators.Conclusion Both Atrogin-1 and BMI are independent predictors of sarcopenia and can effectively assess its risk.The combined predictive model demonstrates superior accuracy compared to individual indicators,suggesting that integrating Atrogin-1 and BMI may enhance early identification of sarcopenia,offering valuable insights for clinical screening and intervention.

Abstract:Objective To investigate the effect of treadmill aerobic training combined with butylphthalide on hemorheology and limb function in patients with cerebral ischemic stroke(CIS)during rehabilitation.Methods A total of 116 patients with CIS who were treated in Hai an People's Hospital from June 2023 to June 2024 were prospectively selected and divided into contrast group and study group by random number table method,with 58 cases in each group.The contrast group was treated with routine rehabilitation therapy+oral butylphthalide soft capsule,and the study group was treated with treadmill aerobic training on this basis.Both groups were treated continuously for 4 weeks.The efficacy,neurological function[National Institutes of Health Stroke Scale(NIHSS)score],cardiopulmonary function[left ventricular ejection fraction(LVEF),exercise duration(ED),peak oxygen consumption(VO2 max)],hemorheology indexes[plasma viscosity(PV),whole blood viscosity(WBV)],Fugl-Meyer Rating Scale for Lower Extremity(FMA-LE)score,modified Barthel index(MBI)score,Berg Balance Scale(BBS)score.Results After treatment,the total effective rate of the study group was 94.83%,which was higher than that of the contrast group(79.31%)(χ2=5.352,P<0.05).After the treatment,the levels of the NIHSS score,WBV,and PV in the observation group were all lower than those in the control group(t=11.401,8.177,7.452,P<0.05).Meanwhile,the LVEF,ED,VO2max,FMA-LE score,BBS score,and MBI score in the observation group were all higher than those in the control group(t=3.930,4.926,3.617,5.383,6.709,4.377,P<0.05).Conclusion The use of treadmill aerobic training combined with butylphthalide in CIS patients has a significant effect,which can effectively improve their cardiopulmonary function and hemorheology,improve neurological function,lower limb motor ability and daily living ability.

Abstract:Objective To observe the effects of aerobic and resistance exercise interventions combined with personalized ambulatory glucose monitoring instructions on the control of blood glucose levels in patients with type 2 diabetes mellitus(T2DM).Methods This study was prospectively designed,124 cases of T2DM patients admitted from January 2023 to December 2024 were selected and divided into 62 cases in the conventional group and 62 cases in the personalized group using the envelope method.Both groups were given aerobic and resistance exercise interventions,routine dynamic glucose monitoring in the conventional group and personalized dynamic glucose monitoring guidance in the personalized group.The differences in glucose and lipid metabolism between the two groups were compared before and after the intervention,and the changes in self-management behavior scores,medical coping questionnaire(MCMQ)scores,and diabetes specific quality of survival scale(DSQL)scores were assessed before and after the intervention in both groups.Results After intervention,the levels of high-density lipoprotein cholesterol(HDL-C)in the personalized group was higher than that in the conventional group,and the levels of triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),blood glucose(FBG),and 2-hour postprandial blood glucose(2 h PBG)were lower than those the conventional group.The differences were statistically significant(t=-2.169,2.066,2.537,2.52,5.634,8.808,P<0.05).The scores of all aspects of self-behavior in the two groups of patients were higher than those before intervention,and the personalized group was higher than the conventional group.The differences were statistically significant(t=-4.51,-5.506,-3.089,-9.296,-9.975,P<0.5).The face score of MCMQ in the personalized group was higher than that in the conventional group,and the avoidance score and compliance score were lower than those in the conventional group(t=-4.964,3.197,5.656,P<0.05).The scores of DSQL in the two groups of patients were lower,and those in the personalized group were lower than those in the conventional group(t=5.526,5.042,4.976,5.669,P<0.05).Conclusion Aerobic and resistance exercise interventions combined with personalized ambulatory glucose monitoring guidance and exercise alone in T2DM are both beneficial to glycemic control,improve lipid metabolism,improve self-management ability,correct poor psychological status,and improve quality of life,but aerobic and resistance exercise interventions combined with personalized ambulatory glucose monitoring guidance are more preferable.

Abstract:Objective To analyze the effects of aerobic combined with resistance exercise on blood glucose regulation and liver fat content in patients with type 2 diabetes mellitus(T2DM)and non-alcoholic fatty liver disease(NAFLD).Methods In this study,a single-blind randomized controlled trial design was used to select 80 patients with T2DM and NAFLD who were admitted to Bozhou People's Hospital from August 2024 to January 2025 as the research objects.Random sequences were generated by computer software and hidden by the sealed envelope method.The patients were randomly divided into control group and observation group,with 40 cases in each group.The control group received routine interventions,while the observation group received aerobic combined with resistance exercise intervention on the basis of the control group's treatment.Both groups were intervened continuously for 12 weeks.The blood glucose indexes,body weight,blood lipid indexes,adipokines,liver fat content,visceral fat area,liver function indexes,and insulin function indexes were compared between the two groups before and after the intervention.Results After 12 weeks of intervention,the fasting blood glucose level,glycosylated hemoglobin level,body mass index,triglyceride level,low-density lipoprotein cholesterol level,leptin level,liver fat content,visceral fat area,alanine aminotransferase level,aspartate aminotransferase level,and fasting C-peptide level of the observation group were all lower than those of the control group,and the differences were statistically significant(t=4.137,8.087,2.626,8.280,4.870,5.313,7.614,12.594,7.797,6.944,2.005,P<0.05).The high-density lipoprotein cholesterol level,adiponectin level,and islet function of the observation group were all higher than those of the control group,and the differences were statistically significant(t=3.049,4.459,4.102,P<0.05).After intervention,liver fat content and visceral fat area were positively correlated with FPG and HbA1c in both groups(r=0.323,0.411,0.453,0.586,0.351,0.407,0.557,0.375,P<0.05).Conclusion Aerobic combined with resistance exercise has a good clinical effect on patients with T2DM and NAFLD.It can effectively regulate the blood glucose level and adipokine level of patients,reduce liver fat content,and improve liver function and insulin resistance.Therefore,clinical nurses can enhance the enthusiasm of patients to participate in exercise for a long time through individualized evaluation and precise education,so as to improve the therapeutic effect.

Abstract:Objective To investigate the relationship between the occurrence and development of coronary heart disease(CHD)and changes in autonomic nervous function.Methods 125 CHD patients in the hospital from July 2023 to October 2024 were retrospectively selected and included in the observation group,and 60 non-CHD patients with similar symptoms were enrolled as the control group.All patients received 24-hour dynamic electrocardiogram examination after admission.Heart rate variability indexes[standard deviation of NN intervals(SDNN),root mean square of successive differences(RMSSD),standard deviation of average normal to normal(SDANN),percentage of difference between consecutive N-N intervals>50 ms(PNN50)]were compared between groups.According to different clinical subtypes of CHD patients,34 patients with stable angina pectoris(SAP)were assigned into the SAP group,and 54 patients with unstable angina pectoris(UAP)were included in the UAP group,and 37 patients with acute myocardial infarction(AMI)were selected as the AMI group.The differences in SDNN,RMSSD,SDANN and PNN50 were analyzed among the three groups.Point-biserial correlation analysis was adopted to explore the relationship between SDNN,RMSSD,SDANN,PNN50 and occurrence and development of CHD.Results Compared with the control group,the SDNN,RMSSD,SDANN and PNN50 in the observation group were lower(t=17.306,8.414,16.975,5.044,P<0.05).Point-biserial correlation analysis found that CHD occurrence was significantly negatively correlated with SDNN,RMSSD,SDANN and PNN50(r=-0.524,-0.504,-0.516,-0.423,P<0.05).There were obvious differences in SDNN,RMSSD,SDANN and PNN50 among different CHD subtype groups(F=24.456,6.789,17.892,9.738,P<0.05).Compared with the SAP group and the UAP group,the above indexes were lower in the AMI group.Point-biserial correlation analysis revealed a significant negative correlation between AMI occurrence and the above indexes(r=-0.546,-0.508,-0.511,-0.436,P<0.05).Conclusion The autonomic nervous function of patients with different clinical subtypes of CHD is quite different,and the more severe the lesion is,the lower the heart rate variability related to autonomic nervous function is.Heart rate variability has certain value on judging the occurrence and development of CHD.

Abstract:Objective To analyze the relationship between oxidized low-density lipoprotein(Ox-LDL)levels and the severity of neurological impairment,prognosis,and cognitive dysfunction in patients with ischemic stroke.Methods A total of 179 ischemic stroke patients admitted to the stroke unit of Xingtai Central Hospital from January 2023 to June 2024 were enrolled.Serum Ox-LDL levels were measured at admission using a fully automated chemiluminescence analyzer via chemiluminescent immunoassay(CLIA),with a normal reference range of≤64.4 U/L.Neurological impairment severity was assessed using the National Institutes of Health Stroke Scale(NIHSS)at admission.Post-stroke cognitive impairment(PSCI)was evaluated at 6 months post-stroke using the Montreal Cognitive Assessment(MoCA),and daily living ability was assessed via the modified Barthel Index(MBI).Ox-LDL levels were compared across groups with varying neurological impairment severities,degrees of daily living ability recovery,and between PSCI and non-PSCI groups.Correlations between Ox-LDL levels and NIHSS scores,MBI,and MoCA scores were analyzed.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of Ox-LDL.Results Ox-LDL levels progressively increased with worsening neurological impairment:mild group[34 cases,(52.3±11.9)U/L],moderate group[81 cases,(79.6±18.2)U/L],and severe group[64 cases,(93.1±10.7)U/L].Admission NIHSS scores positively correlated with Ox-LDL levels(r=0.287,P<0.05).At 6 months,the Ox-LDL level in the PSCI group(97.3±16.8)U/L was significantly higher than in the non-PSCI group(62.4±15.1)U/L(t=14.633,P=0.000).MoCA scores negatively correlated with Ox-LDL levels(r=-0.489).The area under the ROC curve(AUC)for Ox-LDL in predicting PSCI was 0.697(95%CI:0.599～0.821).Conclusion Ox-LDL levels are associated with the severity of neurological impairment and the occurrence of post-stroke cognitive dysfunction in ischemic stroke patients.Early detection of Ox-LDL levels may help identify high-risk PSCI patients,enabling timely interventions to improve prognosis.