Abstract:Objective To analyze the causes of aortic dissection with atypical chest pain as the initial symptom misdiagnosed as acute coronary syndrome(ACS).Methods A retrospective analysis was conducted on the clinical data of 2 patients with aortic dissection who were misdiagnosed as ACS from January 2022 to January 2024.Results One patient presented with sudden onset of crushing retrosternal pain for 2 h.The electrocardiogram showed ST segment elevation of 0.2-0.3 mV in leads V1 to V4,and troponin I was 1.5 ng/mL.The preliminary diagnosis was acute anterior ST segment elevation myocardial infarction.Emergency coronary angiography revealed 50％stenosis in the middle segment of the left anterior descending artery,but during the operation,the ascending aorta was found to be dilated with contrast agent retention.Further aortic CT angiography(CTA)confirmed Stanford type A aortic dissection,with a misdiagnosis duration of 12 h.Aortic ascending artery replacement+full arch replacement+Frozen Elephant Trunk procedure was performed.The patient recovered well after the operation,and there were no complications or new aortic dissection during the 6-month follow-up.Another case presented with intermittent chest pain accompanied by cold sweats for 3 d.The electrocardiogram showed ST segment depression of 0.1 mV in leads Ⅱ,Ⅲ,and aVF,and troponin T was 0.8 ng/mL.The diagnosis was non-ST segment elevation myocardial infarction.Coronary angiography showed 30％stenosis at the proximal right coronary artery,but a dissection flap shadow was detected in the aortic root.Emergency aortic CTA confirmed Stanford type B aortic dissection,with a misdiagnosis duration of 48 h.After consultation with Department of Vascular Medicine,a thoracic endovascular aortic repair was performed.The chest pain disappeared after the operation,and the patient recovered well at 12-month follow-up.Conclusion In patients with aortic dissection,coronary angiography may present with non-obstructive lesions accompanied by abnormal aortic morphology.When coronary lesions cannot account for the severe clinical symptoms,the possibility of aortic dissection should be suspected,and timely aortic imaging examination is the key to avoiding misdiagnosis.

Abstract:Acute cerebral infarction(ACI)is a common severe cerebrovascular disease in clinical practice,with extremely high rates of disability and mortality.In recent years,with the acceleration of population aging and changes in lifestyle,the incidence of ACI has been increasing year by year and showing a trend of occurrence at younger ages.Therefore,strengthening the clinical prevention and treatment of this disease is of great significance.Currently,traditional Chinese medicine(TCM)treats ACI by following the principles of syndrome differentiation and treatment and overall regulation;Western medicine mainly adopts various treatment methods and drugs based on its physiological and pathological processes,aiming to save patients'lives and improve the prognosis of the disease.Integration of TCM and Western medicine in the treatment of ACI can take the advantages of both medical methods,improve clinical efficacy,promote functional recovery,and has become the focus of clinical research on ACI.This article reviews the classification patterns of ACI treated by integrated TCM and Western medicine,providing a reference for improving the diagnosis and treatment level of ACI and improving the prognosis of patients.

Abstract:Objective To investigate the expression of long non-coding RNA homologous antisense gene A11(LncRNA HOXA11-AS)and microRNA-766-3p(miR-766-3p)in pancreatic cancer tissues,and their relationship with the prognosis of patients.Methods From April 2018 to December 2020,96 patients with pancreatic cancer were selected as the pancreatic cancer group,and 96 healthy individuals undergoing physical examination during the same period were selected as the healthy group.The expressions of LncRNA HOXA11-AS and miR-766-3p in serum,pancreatic cancer tissues,and adjacent tissues were measured,and the relationship between the two indicators and the pathological characteristics of the patients was analyzed.Pearson correlation analysis was conducted to investigate the correlation between the expression of LncRNA HOXA11-AS in pancreatic cancer tissues and miR-766-3p,and Kaplan-Meier survival curve analysis was used to examine the relationship between the expressions of LncRNA HOXA11-AS and miR-766-3p in pancreatic cancer tissues and the prognosis of the patients.Cox regression analysis was performed to identify the factors influencing the prognosis of pancreatic cancer patients,and receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of LncRNA HOXA11-AS and miR-766-3p in pancreatic cancer tissues for the prognosis of the patients.Results The expression of LncRNA HOXA11-AS in the serum of pancreatic cancer patients was higher than that in the healthy group,while the expression of miR-766-3p was lower(P<0.05).The expression of LncRNA HOXA11-AS in pancreatic cancer tissues was higher than that in adjacent tissues,while the expression of miR-766-3p was lower(P<0.05).The expression of LncRNA HOXA11-AS and miR-766-3p in pancreatic cancer tissues was related to vascular invasion,differentiation degree,and TNM stage of patients(P<0.05).The expression of LncRNA HOXA11-AS was negatively correlated with miR-766-3p(P<0.05).The 3-year cumulative survival rate of pancreatic cancer patients in the high LncRNA HOXA11-AS expression group and the low miR-766-3p expression group was lower than that in the low LncRNA HOXA11-AS expression group and the high miR-766-3p expression group(P<0.01).TNM stage Ⅲ,high expression of LncRNA HOXA11-AS and low expression of miR-766-3p were independent risk factors affecting the prognosis of pancreatic cancer patients(P<0.05).The area under the ROC curve of the combined prediction of LncRNA HOXA11-AS and miR-766-3p for the prognosis of pancreatic cancer patients was 0.942,which was better than that of each indicator alone(P<0.05).Conclusion Pancreatic cancer tissues exhibit upregulation of LncRNA HOXA11-AS expression and downregulation of miR-766-3p expression,with a negative correlation between the two.Furthermore,both LncRNA HOXA11-AS and miR-766-3p show potential as prognostic biomarkers for evaluating the prognosis of pancreatic cancer patients.

Abstract:Objective To investigate the causes of misdiagnosis of interstitial pneumonia(IP)in the elderly as chronic bronchitis(CB)and the imaging characteristics.Methods A retrospective analysis was conducted on the clinical data of 2 elderly patients who were misdiagnosed as having CB instead of IP during the period from January 2020 to June 2023.Results One patient presented with recurrent cough,white sputum expectoration,and shortness of breath.Chest X-ray showed increased pulmonary markings in both lungs.The initial diagnosis was acute exacerbation of CB,and symptomatic treatment was given for 2 weeks.However,the symptoms did not improve and shortness of breath worsened.Further high-resolution CT(HRCT)revealed grid shadows in the lower lungs and honeycomb-like changes under the pleura.Pulmonary function tests indicated restrictive ventilation disorder,and elevated serum sialic acid glycan antigen-6 level.The final diagnosis was IP in the elderly(idiopathic pulmonary fibrosis type).The misdiagnosis period was 2 weeks.Nintedanib for anti-fibrotic treatment and long-term home oxygen therapy were administered.Follow-up for 6 months showed stable condition.Another patient presented with post-exercise breathing difficulty and dry cough,with a history of Sjögren's syndrome.Pulmonary function tests showed mild obstructive changes.The initial diagnosis was CB,and symptomatic treatment was given for 1 month,but the symptoms did not improve.HRCT showed diffuse ground-glass opacities in both lungs with traction bronchiectasis.Anti-nuclear antibody was positive(at a titer of 1∶320),and the diagnosis was IP in the elderly(Sjögren's syndrome-related IP).The misdiagnosis period was 1 month.Prednisone combined with Cyclophosphamide was used for treatment,and the patient was followed up for 1 year.The patient's condition remained stable.Conclusions The clinical manifestations of IP in the elderly are prone to confusion with those of CB.In clinical practice,a comprehensive analysis involving HRCT,pulmonary function tests,and serological markers is necessary to avoid misdiagnosis solely relying on chest X-rays or pulmonary function tests.

Abstract:Objective To investigate the incidence and risk factors of postoperative nausea and vomiting(PONV)in patients with obesity who underwent laparoscopic sleeve gastrectomy(LSG).Methods A retrospective analysis was conducted on the clinical data of 156 obese patients who underwent LSG from April 2019 to April 2024.The occurrence of PONV was statistically analyzed,and multivariate logistic regression was used to investigate the risk factors for PONV in obese patients treated with LSG.Results Among the 156 obese patients who underwent LSG,41 patients(26.28%)developed PONV.These patients were included in the PONV group,while the remaining patients were included in the non-PONV group.The PONV group had more females,a higher proportion of intraoperative Sufentanil use,and higher preoperative levels of alanine aminotransferase(ALT),aspartate aminotransferase,and C-reactive protein(CRP)compared with the non-PONV group,but a lower proportion of intraoperative Dexmedetomidine use and preoperative follicle-stimulating hormone(FSH)levels,as compared with those in the non-PONV group(P<0.05).Female gender,intraoperative Sufentanil use,and elevated preoperative ALT levels were all risk factors for PONV in obese patients treated with LSG,while intraoperative Dexmedetomidine use was a protective factor(P<0.01).Conclusion In clinical practice,for high-risk populations(especially women and those with abnormal liver function),the anesthesia plan should be optimized to reduce the dosage of Opioids,appropriately apply Dexmedetomidine,and combine multimodal antiemetic strategies to lower the risk of PONV in obese patients undergoing LSG and improve the quality of postoperative recovery.

Abstract:Objective To observe the effects of adjunctive treatment regimen of bacterial lysates and Budesonide nasal spray on the clinical symptoms,T lymphocyte subsets and inflammatory response of children with acute infectious rhinosinusitis.Methods A total of 100 children,aged 6～12 years,with acute infectious rhinosinusitis who were admitted from January 2023 to March 2024 were selected and divided into the observation group(n=50)and the control group(n=50)according to the random number table method.The control group was treated with Budesonide nasal spray in addition to anti-infection and symptomatic treatment,while the observation group was supplemented with the combination of bacterial lysates on the basis of the control group for 2 weeks.The efficacy[revised Wong-Baker facial pain scale(FPS-R),Lund-Kennedy endoscopic scoring system score],the time required for improvement of clinical symptoms(nasal congestion,rhinorrhea,olfactory disorder,headache),T lymphocyte subsets,inflammatory-related proteins[eosinophil cationic protein(ECP),immunoglobulin E(IgE),aquaporin-3(AQP-3)],blood routine indicators[white blood cell count(WBC),neutrophil percentage]and drug safety were compared between the two groups.Results After treatment,the FPS-R and Lund-Kennedy endoscopic scoring system scores of the observation group were lower than those of the control group(P<0.05).The time required for improvement of the main clinical symptoms(nasal congestion,runny nose,olfactory disorder,headache)of the observation group was shorter than that of the control group(P<0.05).After treatment,the levels of CD4+,CD4+/CD8+and serum AQP-3 in the observation group were higher than those in the control group,while CD8+,WBC,neutrophil percentage,and serum ECP and IgE levels were lower than those in the control group(P<0.05).During the treatment process,the total incidence of adverse reactions such as nosebleeds,gastrointestinal disorders(nausea,vomiting,and abdominal pain),rashes,coughs,and high fever in the observation group was not statistically different from that in the control group(P>0.05).Conclusion The adjunctive treatment regimen of bacterial lysates and Budesonide nasal spray has a favorable effect on children aged 6 to 12 years with acute infectious rhinosinusitis.It can shorten the time for symptom improvement,promote the recovery of T lymphocyte subsets,alleviate inflammatory responses,improve blood routine indicators,and has high safety.

Abstract:Objective To explore the clinical and pathological characteristics,causes of misdiagnosis,and preventive measures of ovarian borderline clear cell tumor(CCBOT),and to improve the level of clinical diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical and pathological data of one patient with CCBOT who was admitted in June 2022,and relevant literature was reviewed.Results In this study,a middle-aged female patient visited the hospital due to a pelvic mass detected during physical examination.The ultrasound examination revealed a cystic-solid lesion in the left ovary,and during the operation,a right ovarian cystic-solid mass was also identified;therefore,a laparoscopic bilateral salpingo-oophorectomy(BSO)was performed.The pathological examination of intraoperative frozen section suggested a sex cord-stromal tumor.Postoperative pathological and immunohistochemical examinations confirmed the diagnosis of CCBOT(right adnexa),with focal carcinomatous transformation,associated with endometriosis in the adjacent ovarian tissue.The pathological misdiagnosis lasted one week.Based on the pathological examination results,the patient was readmitted for a second operation for additional treatment(laparoscopic total hysterectomy+greater omentum resection+bilateral pelvic lymph node dissection).The postoperative pathological examination confirmed that the greater omentum and pelvic lymph nodes did not show tumor involvement.The patient recovered well after the operation,and the condition was stable.Follow-up for 34 months showed no tumor recurrence or metastasis.Conclusion CCBOT is a rare borderline tumor that originates in the ovary.Its morphology is prone to confusion with various ovarian tumors,making clinical diagnosis quite challenging.Enhancing awareness of clinical assessment,optimizing pathological diagnostic procedures,and strengthening multidisciplinary collaboration can reduce clinical misdiagnosis.However,a definitive diagnosis still requires combined pathological and immunohistochemical examinations.

Abstract:Objective To investigate the efficacy and risk factors for poor therapeutic effect of bronchoalveolar lavage(BAL)at different timings for the treatment of refractory Mycoplasma pneumoniae pneumonia(RMPP)in children.Methods A total of 200 children with RMPP who were admitted from April 2023 to October 2024 were selected.They were divided into the early intervention group(with a disease course of 8 to 14 d),the mid-term intervention group(with a disease course of 15 to 21 d),and the late intervention group(with a disease course of more than 21 d)based on the timing of the first treatment with BAL.The clinical efficacy,duration of fever,duration of cough,time to radiographic resolution,length of hospital stay,and incidence of adverse events after BAL therapy in RMPP children at different timings were compared.Multivariate logistic regression analysis was used to identify the risk factors affecting the poor therapeutic effect of BAL treatment in RMPP children.Results The total effective rate of the early intervention group was 89.36%(84/94),which was higher than that of the mid-term intervention group(77.46%,55/71)and the late intervention group(71.43%,25/35)(P<0.05).The duration of fever,cough,time to radiographic resolution and length of hospital stay in the early intervention group were shorter than those in the mid-term intervention group and the late intervention group(P<0.05).The proportion of shortness of breath,duration of fever,duration of use of Macrolide drugs,proportion of atelectasis,proportion of positive mycoplasma resistance gene loci,proportion of inflammatory stenosis of bronchial lumen under microscopic observation,white blood cell count,C-reactive protein,and duration of disease during BAL treatment were all higher or longer in poor therapeutic effect group than in the good therapeutic effect group(P<0.05).Long duration of fever,high proportion of positive mycoplasma resistance gene loci and long duration of BAL treatment were all independent risk factors affecting the poor therapeutic effect of BAL therapy in children with RMPP(P<0.05).No significant difference was observed in the overall incidence of postoperative adverse events among the three groups(P>0.05).Conclusion Early application of bronchoscopy for BAL therapy can effectively improve the clinical outcomes of children with RMPP.The poor therapeutic effect with BAL is related to the duration of the disease,the presence of positive mycoplasma resistance gene loci,and the disease duration during BAL administration.

Abstract:Objective To investigate the clinical efficacy and safety of the Jiedu Shugan Huoxue formula as an adjuvant therapy for patients with primary liver cancer undergoing microwave ablation.Methods A total of 120 patients with primary liver cancer(from September 2023 to December 2024)were included and randomly divided into the observation group and the control group using a random number table.The control group received only microwave ablation therapy,while the observation group was given Jiedu Shugan Huoxue formula before and after the microwave ablation therapy.The therapeutic effects and adverse reactions of the two groups were compared,and the changes in traditional Chinese medicine(TCM)syndrome scores,Karnofsky scores,tumor markers,liver function indicators,and immune function indicators before and after treatment were observed in both groups.Results The total effective rate of treatment in the observation group was 83.33%(50/60),which was higher than that of the control group[66.67%(40/60)](P<0.05).After treatment,the TCM syndrome score,alpha-fetoprotein,carbohydrate antigen 19-9,carcinoembryonic antigen,aspartate aminotransferase,alanine aminotransferase,total bilirubin,gamma-glutamyl transferase,and CD8+level in the observation group were lower than those in the control group,while the Karnofsky score,CD3+,CD4+,and CD4+/CD8+levels were higher(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Jiedu Shugan Huoxue formula can enhance the clinical efficacy of patients undergoing microwave ablation for primary liver cancer,significantly improve liver function and immune function,and have good safety.

Abstract:Objective investigate the application effect of low-intensity pulsed ultrasound(LIPUS)stimulation on patients with Parkinson's disease complicated with cognitive impairment.Methods A total of 109 patients with Parkinson's disease and cognitive impairment who visited the hospital from March 2022 to December 2024 were selected as the research subjects.They were randomly divided into the LIPUS group(n=55)and the Sham group(n=54)using the random number table method.Both groups received conventional drug treatment.The LIPUS group was given LIPUS stimulation therapy,while the Sham group received Sham stimulation.The treatment lasted for 16 weeks.The therapeutic effects,cognitive and mental status[Montreal Cognitive Assessment Scale(MoCA),Mini-Mental State Examination(MMSE)],neurotransmitters,psychological status[Beck Anxiety Inventory(BAI),Beck Depression Inventory(BDI)],quality of life[Unified Parkinson's Disease Rating Scale(UPDRS)],and adverse reactions were compared between the two groups.Results The total effective rate of LIPUS group was 94.55%(52/55),which was higher than that of the Sham group[(81.48%(44/54)](P<0.05).Compared with those before treatment,the scores of MMSE and MoCA,as well as the levels of serum 5-hydroxytryptamine,norepinephrine,and dopamine,gradually increased after 8 and 16 weeks of treatment in both groups,which were higher in the LIPUS group than in the Sham group(P<0.05).Compared with those before treatment,the scores of BAI,BDI,and UPDRS gradually decreased after 8 and 16 weeks of treatment in both groups,which were lower in the LIPUS group than in the Sham group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion LIPUS stimulation is effective in the treatment of Parkinson's disease with cognitive impairment.It can effectively improve the cognition,mental state and psychological state and enhance the quality of life of patients,which may be related to the regulation of neurotransmitter expression level by LIPUS stimulation,with good safety.

Abstract:Objective To analyze the reasons for misdiagnosis of aortic dissection as acute myocardial infarction(AMI),and to summarize the methods for correcting such misdiagnosis,so as to improve the diagnostic skills of clinical physicians.Methods A retrospective analysis was conducted on the clinical data of 2 patients with aortic dissection who were misdiagnosed as having AMI from June 2020 to June 2023.Results One patient presented with chest pain and vomiting for 3 h.Based on the clinical symptoms,the physical examination upon admission,and the electrocardiogram(ECG)results indicating sinus rhythm with T-wave changes in the chest leads(flattened in V3-V4 and shallow inversion in V5-V6),the initial diagnosis was AMI and grade 3 hypertension(extremely high risk),and symptomatic treatment was given.On the second day of treatment,the patient's chest pain suddenly worsened to an unbearable level.Subsequently,ECG examination,laboratory tests,and a CT angiography of the aorta were performed,and the final diagnosis was descending aortic dissection of DeBakey type Ⅲ,accompanied by bilateral pleural effusion.The misdiagnosis lasted 24 h.After one week of internal medical treatment,the patient's condition improved and was transferred to another hospital for aortic stent-graft implantation.The operation was successful,and the patient recovered well.Another patient presented with a tearing-like severe pain behind the sternum for 1 h.Based on the clinical symptoms,physical examination,and bedside ECG results,the diagnosis was acute inferior wall ST-segment elevation myocardial infarction.Symptomatic treatment was immediately administered.During the treatment period,further laboratory tests were conducted,and an expert consultation was organized.The family declined to undergo coronary angiography and signed an informed consent form.Intravenous thrombolysis was given for 2 h,but the patient's chest pain did not significantly relieve.Bedside full-channel ECG,bedside echocardiography,aortic ultrasound,and enhanced CT of the aorta were performed again to correct the diagnosis as aortic dissection(Stanford type A).The misdiagnosis lasted 2 h.The patient and the family declined to undergo surgical treatment at another hospital and received conservative treatment for 14 d.The patient's condition improved and was discharged.At seven months after discharge,the patient died due to ineffective rescue from heart failure.Conclusion Patients with aortic dissection are prone to misdiagnosis of AMI and receive inappropriate treatment accordingly.Clinicians should be vigilant,pay attention to the key points for differentiating the two conditions,conduct detailed inquiries and thorough physical examinations,and promptly carry out targeted imaging examinations to reduce or avoid misdiagnosis and mistreatment of aortic dissection.

Abstract:Objective To analyze the relationship between the number of lung ultrasound B-lines and body weight changes,extracellular water(ECW)/total body water(TBW)ratio in patients undergoing peritoneal dialysis,as well as its value in evaluating the volume load.Methods A total of 100 patients with end-stage renal disease(ESRD)undergoing peritoneal dialysis admitted from September 2021 to August 2023 were selected as the research subjects.The changes in the number of lung ultrasound B-lines,ECW/TBW ratio,and body weight before and after dialysis were compared,and the correlation between the number of lung ultrasound B-lines and body weight change,ultrafiltration volume,ECW/TBW,as well as the consistency of lung ultrasound and body composition analysis in volume load assessment,was analyzed.Results The number of B-lines,ECW/TBW ratioand body weight changes in peritoneal dialysis patients after dialysis were less or lower than those before dialysis(P<0.05).The number of B-lines before dialysis was positively correlated with the increase of body weight(P<0.05),and the number of B-lines after dialysis was positively correlated with the remaining body weight(P<0.05).The percentage change of B-line number before and after dialysis was positively correlated with body weight loss and ultrafiltration volume(P<0.05).The number of B lines before and after dialysis was positively correlated with ECW/TBW(P<0.05),and the percentage change in the number of B-lines before and after dialysis was positively correlated with the percentage change in ECW/TBW ratio(P<0.05).The consistency of lung ultrasound and body composition analysis in evaluating the volume load of peritoneal dialysis patients was 97.00%,and the Kappa value was 0.955(95%CI:0.831,0.999).Conclusion The number of B-lines before and after peritoneal dialysis in patients with ESRD is closely related to ECW/TBW ratio and body weight changes.Furthermore,lung ultrasound and body composition analysis have good consistency in evaluating patients'volume load,which can provide guidance for the treatment of peritoneal dialysis patients.

Abstract:Objective To explore clinical features of pulpitis caused by cracked teeth and to analyze the causes of misdiagnosis.Methods A retrospective analysis was performed on clinical data of 3 patients who had pulpitis caused by cracked teeth and were admitted to the hospital from January 2021 to March 2025.Results All of the three patients visited the hospital due to paroxysmal maxillofacial pain and were initially diagnosed with trigeminal neuralgia,without response to treatment with oral Carbamazepine.They were diagnosed with pulpitis caused by cracked teeth after analysis of detailed medical history and oral examination combined with X-ray and staining with 2.5％tincture of iodine.The duration of misdiagnosis ranged from 2 weeks to 3 months.After confirmed diagnosis,pain symptoms completely disappeared after root canal therapy and full crown restoration.During the 3-6 months of follow-up,affected teeth functioned well,with no recurrence of pain but stable restoration.Conclusion Early symptoms of pulpitis caused by cracked teeth are not typical,which is more likely to be misdiagnosed as trigeminal neuralgia.Features of the disease,limitations in clinical diagnosis,and patient factors are reasons for misdiagnosis of pulpitis caused by cracked teeth.Generating a systematic prevention strategy,standardizing the differential diagnosis process,and carrying out interdisciplinary collaboration are key to timely and clear diagnosis,reducing or avoiding misdiagnosis and mistreatment.

Abstract:Objective To compare the effects of Castor single-branch stent(integrated single-branch covered stent delivery system)and Longuette chimney stent(aortic-branch artery covered skirt-type chimney stent system)techniques on aortic remodeling,false lumen thrombosis,and postoperative complications in the treatment of acute Stanford type B aortic dissection(TBAD)involving the left subclavian artery(LSA).Methods A retrospective study was conducted on the clinical data of 73 patients with TBAD involving the LSA in the acute phase who were admitted between June 2022 and June 2024.According to the treatment method,37 patients treated with Longuette chimney stent were assigned to the Longuette group,and 36 patients treated with Castor single-branch stent were assigned to the Castor group.The intraoperative indicators,length of hospital stay,aortic remodeling,false lumen thrombosis at 6 months post-operation,and short-and medium-term complications were compared between the two groups.Results The duration of operation and X-ray fluoroscopy time in the Castor group were longer than those in the Longuette group(P＜0.05).There was no significant difference in intraoperative blood loss and length of hospital stay between Castor group and Longuette group(P＞0.05).There was no significant difference in the increase rate of true lumen volume,the increase in the maximum diameter of the distal true lumen,and the area distal to the stent between the Castor group and the Longuette group at 2 weeks and 6 months after operation(P＞0.05).Compared with those at 2 weeks after operation,the increase rate of true lumen volume,the increase in the maximum diameter of the distal true lumen,and the area distal to the stent were increased in the two groups at 6 months after operation(P＜0.05).There was no significant difference in the rate of false lumen thrombosis between the two groups at 6 months after operation(P＞0.05).The total incidence of recent complications in Castor group[5.56％(2/36)]was lower than that in Longuette group[21.62％(8/37)](P＜0.05).There was no significant difference in the incidence of mid-term complications between the Castor group[2.78％(1/36)]and the Longuette group[8.11％(3/37)](P＞0.05).Conclusion Both Castor single-branch stent and Longuette chimney stent can achieve good efficacy and safety in the treatment of TBAD involving LSA in the acute stage.Both of them have the same effect in promoting aortic remodeling and false lumen thrombosis.However,although Castor single-branch stent technology has longer duration of operation and fluoroscopy time,it has advantages in reducing the risk of short-term complications such as endoleak and stent displacement,showing better early safety.

Abstract:Objective To investigate the association of triglycerides(TG)-total cholesterol-(TC)-body weight(BW)index(TCBI)with urinary albumin/creatinine ratio(UACR)in type 2 diabetes mellitus(T2DM)patients.Methods A total of 600 patients with T2DM who were treated between January 2018 and November 2023 were enrolled in this study.Clinical data and several parameters,such as TC,TG,TC,and UACR,were collected.According to calculated TCBI values,patients were divided into low TCBI(L-TCBI)group(n=200),medium TCBI(M-TCBI)group(n=200)and high TCBI(H-TCBI)group(n=201).According to UACR,patients were divided into normal albuminuria group(n=314),microalbuminuria group(n=232)and macroalbuminuria group(n=54).Pearson correlation analysis was applied to examine the correlation between TCBI and clinical characteristics in patients with T2DM.Multivariate logistic regression analysis was used to identify risk factors for albuminuria in T2DM patients and to evaluate the predictive value of TCBI for the risk of albuminuria onset.Results The logarithmically transformed UACR(lgUACR)was higher in the H-TCBI group than in the L-TCBI and M-TCBI groups,and higher in the M-TCBI group than in the L-TCBI group(P＜0.05).The TCBI level in the macroalbuminuria group was higher than that in both the normal albuminuria and microalbuminuria groups,and higher in the microalbuminuria group than in the normal albuminuria group(P＜0.05).TCBI showed negative correlations with age(r=-0.14,P＜0.01),disease duration(r=-0.11,P＜0.01),and high-density lipoprotein cholesterol(r=-0.12,P＜0.01),while it showed positive correlations with lgUACR(r=0.27,P＜0.01),body mass index(r=0.30,P＜0.01),glycated hemoglobin(r=0.12,P＜0.01),fasting blood glucose(r=0.19,P＜0.01),low-density lipoprotein cholesterol(r=0.23,P＜0.01),blood urea(r=0.09,P＜0.01),blood uric acid(r=0.25,P＜0.01),and the logarithmically transformed insulin resistance index(r=0.14,P＜0.01).Multivariate logistic regression analysis indicated that TCBI was an independent risk factor for albuminuria(P＜0.01).The area under the receiver operating characteristic curve of TCBI in predicting albuminuria was 0.715,with a sensitivity of 63.6％and a specificity of 71.0％.Conclusion In T2DM patients,increased TCBI is related to elevated UACR,increasing the risk of albuminuria and having certain predictive value for albuminuria.

Abstract:Objective To investigate the effect of different main nail lengths of the proximal femoral nail antirotation(PFNA)in the treatment of patients with type 31-A3.1-A3.3 intertrochanteric femoral fracture(IFF).Methods A prospective study was conducted on 150 patients with type 31-A3.1-A3.3 IFF admitted from September 2022 to October 2024.These patients were divided into a long nail group and a short nail group based on a random number table method,with 75 patients in each group.The long nail group received the extended-length main nail for PFNA,while the short nail group received the standard-length main nail for PFNA.The perioperative indicators,fracture healing time,duration of complete weight-bearing,duration of operation,reduction quality,postoperative stability,surgical trauma stress factors[superoxide dismutase(SOD),angiotensin Ⅱ(Ang Ⅱ),norepinephrine(NE)],hip joint mobility[hip flexion-extension range of motion(ROM),internal-external rotation ROM of the hip],hip joint function,and complications were compared between the two groups.Results Compared with the short nail group,the duration of operation,length of hospitalization,blood loss,and intraoperative fluoroscopy frequency of the long nail group were longer or more,while duration of complete weight-bearing and fracture healing time were shorter(P＜0.05).There was no significant difference in the quality of reduction between the two groups(P＞0.05).The postoperative stability of the long nail group was better than that of the short nail group(P＜0.05).On the 1st and 3rd day after operation,SOD in the long nail group was lower than that in the short nail group,while Ang Ⅱ and NE were higher than those in the short nail group(P＜0.05).There was no significant difference in hip flexion and hip internal-external rotation ROM between the two groups at 3 and 6 months after operation(P＞0.05).The excellent and good rate of hip joint function in long nail group[98.67％(74/75)]was higher than that in short nail group[89.33％(67/75)](P＜0.05).There was no significant difference in the total incidence of complications between the long nail group[1.33％(1/75)]and the short nail group[2.67％(2/75)](P＞0.05).Conclusion Compared with standard-length main nail for PFNA,the extended-length main nail for PFNA in the treatment of patients with type 31-A3.1-A3.3 type IFF can promote fracture healing,improve postoperative stability,improve hip function,and has good safety;however,it is associated with greater surgical trauma and a slower perioperative recovery.

Abstract:Objective To investigate the application effect of acupotomy combined with Chiropractic manipulative therapy in patients with cervical spondylotic radiculopathy(CSR).Methods A total of 80 patients with CSR admitted from November 2021 to October 2023 were selected.The patients were divided into observation group and conventional group by random number table method,with 40 patients in each group.The conventional group received Chiropractic manipulative therapy,and the observation group received acupotomy combined with Chiropractic manipulative therapy.The clinical efficacy of the two groups was observed,and the visual analogue scale(VAS)pain score,neck disability index(NDI)score,hemorheological indicators[plasma viscosity,whole blood viscosity(at low,medium,and high shear rate)],F-wave conduction velocities of the median and ulnar nerves,pain mediators[serum substance P,β-endorphin(β-EP),prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT)]levels before and after treatment and safety were compared between the two groups.Results The total effective rate of treatment in the observation group[95.00％(38/40)]was higher than that in the conventional group[77.50％(31/40)](P＜0.05),and after treatment,the VAS pain scores and NDI scores of the observation group were lower than those of the conventional group(P＜0.01).After treatment,the whole blood viscosity at low,medium and high shear rate and plasma viscosity in the observation group were lower than those in the conventional group,and the F-wave conduction velocities of the median and ulnar nerves was higher than that in the conventional group(P＜0.01).After treatment,compared with the conventional group,the serum PGE2,substance P,5-HT in the observation group were lower,while β-EP was higher(P＜0.01),and there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Acupotomy combined with Chiropractic manipulative therapy is effective and safe in the treatment of patients with CSR.It can promote nerve conduction,regulate hemorheological parameters,and accelerate the metabolism of pain mediators,thereby reducing the degree of pain and improving cervical spine function.

Abstract:Objective To analyze the status and influencing factors of intrinsic capacity in elderly patients with cerebrovascular disease,and to evaluate the efficacy of prediction model.Methods A total of 206 elderly patients with cerebrovascular disease admitted to the hospital from January to December 2024 were selected.The intrinsic capacity assessment method developed by the World Health Organization was used to investigate the status of intrinsic capacity.Patients with an intrinsic capacity scores ≥ 4 were included in the good intrinsic capacity group and those with an intrinsic capacity scores＜4 were included in the poor intrinsic capacity group.Meanwhile,general information and data such as grip strength,self-efficacy for rehabilitation,activity of daily living and hematological indexes of the two groups were collected.Multivariate logistic regression analysis was used to analyze factors influencing intrinsic capacity in elderly patients with cerebrovascular disease,and a prediction model was constructed.Hosmer-Lemeshow test was used for goodness-of-fit test of the model,and predictive efficacy of the model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).Results The overall intrinsic capacity score of the 206 patients with cerebrovascular disease enrolled in the study was(3.29±0.74)points.Among them,143(69.42％)patients with intrinsic capacity scores＜4 points and the remaining 63 patients were included in the poor intrinsic capacity group and the good intrinsic capacity group,respectively.There were significant differences in education level,marital status,grip strength,the Self-Efficacy for Rehabilitation Outcome Scale(SER)score,Barthel index(BI)score,and C-reactive protein(CRP)between the two groups(P＜0.05).Multivariate logistic regression analysis showed that education level,marital status,grip strength,SER score,BI score,and CRP were factors influencing intrinsic capacity decline in elderly patients with cerebrovascular disease(P＜0.05).Based on the above influencing factors,the model constructed for predicting intrinsic capacity in elderly patients with cerebrovascular disease achieved an area under the curve of 0.981(0.952,0.995),with a sensitivity of 92.31％and a specificity of 95.24％.Conclusion The intrinsic capacity of elderly patients with cerebrovascular disease is generally low.Educational level,marital status,grip strength,self-efficacy for rehabilitation,activity of daily living,and CRP level are factors influencing their intrinsic capacity.The risk prediction model constructed based on above influencing factors demonstrates certain predictive value for intrinsic capacity decline in patients.

Abstract:Objective To investigate the effects of Guizhi Xinjia decoction combined with Huici needling on cervical spine activity,pain mediators,traditional Chinese medicine(TCM)syndrome scores,and shear wave elastography(SWE)parameters in patients with neck and shoulder myofascial pain syndrome(MPS).Methods A total of 122 patients with neck and shoulder MPS admitted from January 2021 to January 2024 were selected.They were divided into the observation group(n=40),the control group 1(n=41)and the control group 2(n=41)according to random number table method,and the three groups were treated with conventional Western medicine.On this basis,the observation group was supplemented with Guizhi Xinjia decoction combined with Huici needling,the control group 1 was treated with Guizhi Xinjia decoction,and the control group 2 was treated with Huici needling;the treatment cycle was 2 weeks.The TCM therapeutic efficacy,TCM syndrome score,SWE parameters,pain mediators[cyclooxygenase-2(COX-2),5-Hydroxytryptamine(5-HT),prostaglandin E2(PGE2),β-endorphin(β-EP)],cervical mobility,neck disability index(NDI)score,and safety were statistically analyzed in the three groups.Results In the control group 1,1 patient was lost to follow-up,1 patient was excluded in the control group 2,and no patient was excluded in the observation group.At 2 weeks after treatment,the total effective rate of the observation group was 92.50％(37/40),which was higher than 72.50％(29/40)of the control group 1 and 70.00％(28/40)of the control group 2(P＜0.05).At 2 weeks after treatment,the TCM syndrome score,NDI score,Young's modulus and shear wave velocity on the affected side in the observation group were lower than those in the control group 1 and the control group 2,while cervical range-of-motion scores for flexion-extension,left-right rotation,and lateral flexion were higher than those in the control group 1 and the control group 2(P＜0.05).At 2 weeks after treatment,COX-2,5-HT and PGE2 in the observation group were lower than those in the control group 1 and the control group 2,while β-EP was higher than that in the control group 1 and the control group 2(P＜0.05).There were no obvious adverse reactions in the three groups.Conclusion The combined treatment of Guizhi Xinjia decoction and Huici needling is effective and safe for patients with neck and shoulder MPS.It can regulate the expression levels of pain mediators,effectively improve the muscle function of the neck and shoulder,alleviate clinical symptoms,and restore the mobility of the shoulder and neck.

Abstract:Objective To construct a risk prediction model for the oral mucosal membrane pressure injury(MMPI)in elderly patients with severe traumatic brain injury(TBI)admitted to the intensive care unit(ICU),and to evaluate its predictive value.Methods A total of 100 elderly patients who developed oral MMPI while admitted to the ICU for severe TBI from January 2019 to February 2024 were selected as the observation group,and another 100 elderly patients who were admitted to the ICU for severe TBI during the same period but did not develop oral MMPI were selected as the control group.Baseline data for both groups were collected to analyze the influencing factors of oral MMPI in elderly ICU patients with severe TBI,the risk prediction model was constructed,and its predictive value was evaluated.Results Compared with the control group,the observation group had older age,the longer ICU stay and endotracheal tube indwelling time,higher proportions of the modified Beck oral assessment scale(BOAS)score of 11-15,combined diseases,the types of medical devices used ≥ 3,prone position ventilation,elevated skin temperature,sputum suction frequency interval＜2 h,use of vasoactive drugs,poor nutritional state,use of sedative drugs and higher levels of TNF-α and IL-6(P＜0.05,P＜0.01).Lasso-logistic regression analysis showed that the influencing factors of oral MMPI in elderly patients with severe TBI in ICU were age,length of ICU stay,combined diabetes mellitus,prone position ventilation,tracheal tube indwelling time,types of medical devices used,modified BOAS score,sputum suction frequency,use of vasoactive drugs and sedatives,nutritional status,TNF-α and IL-6.The concordance index(C-index)of the risk prediction model based on the above influencing factors was 0.894,and the area under the curve(AUC)was 0.815.The decision curve analysis(DCA)showed that the model achieved a favorable net benefit value.Conclusion Age,length of ICU stay,diabetes mellitus,prone position ventilation,endotracheal tube indwelling time,types of medical devices used,modified BOAS score,sputum suction frequency,use of vasoactive drugs and sedatives,nutritional status,TNF-α and IL-6 are the influencing factors of oral MMPI in elderly patients with severe TBI in ICU.The risk prediction model based on this has high prediction efficiency,and clinical prevention and treatment measures can be formulated according to the above influencing factors.