Abstract:Objective To investigate the expression changes of spectrin beta non-erythrocytic 2(SPTBN2)and me-thionine adenosyltransferase 1A(MAT1A)in non-small-cell lung cancer(NSCLC)tissues and their associations with pa-tients'prognosis,and to provide references for prognostic evaluation and potential therapeutic target screening in NSCLC.Methods A total of 112 patients with NSCLC were enrolled.The relative mRNA expression levels of SPTBN2 and MAT1A in NSCLC tumor tissues and adjacent non-tumorous tissues were detected by real-time quantitative polymerase chain reaction(RT-qPCR),and the protein expression of SPTBN2 and MAT1A was assessed by immunohistochemistry.Patients were followed up every 3-6 months after surgery until the study endpoint or death.Survival analysis was performed using the Kaplan-Meier method,and multivariate Cox proportional hazards regression models were used to analyze the im-pact of SPTBN2 and MAT1A expression on prognosis.Results The expression levels of SPTBN2 and MAT1A mRNA in the NSCLC tissues were 3.11±0.61 and 2.76±0.46,respectively,which were significantly higher than those in adja-cent non-cancerous tissues(1.02±0.23 and 0.94±0.27,both P<0.01).The number of SPTBN2-and MAT1A-posi-tive cases in the NSCLC tissues were 66 cases(58.93%)and 68 cases(60.71%),which were significantly higher than those in the adjacent tissues[6 cases(5.35%)and 8 cases(7.14%),both P<0.01].Patients with lymph node metasta-sis and TNM stage Ⅲa disease exhibited significantly higher positive expression rates of SPTBN2 and MAT1A in NSCLC tissues(both P<0.05).The 3-year overall survival rates of patients with positive SPTBN2 and MAT1A expression were 57.57%(38/66)and 55.88%(38/68),respectively,which were significantly lower than those of the SPTBN2-negative group(86.96%,40/46)and the MAT1A-negative group(90.91%,40/44)(Log-Rank χ²=12.020 and 13.350,both P<0.01).Multivariate analysis demonstrated that TNM stage Ⅲa,lymph node metastasis,positive SPTBN2 expression,and positive MAT1A expression were independent risk factors for poor prognosis in patients with NSCLC(all P<0.01).Conclusion SPTBN2 and MAT1A are highly expressed in NSCLC tissues and are closely associated with malignant tu-mor progression and poor prognosis,suggesting that they may serve as potential biomarkers for prognostic prediction.

Abstract:Objective To investigate the application effect of Mawangdui Daoyin Exercise in the rehabilitation pro-gram for patients with stable chronic obstructive pulmonary disease(COPD).Methods Eighty-eight COPD patients were divided into the control group and experimental group using a random number table,with 44 participants in each group.Patients in both groups received conventional pharmacological treatment.Patients in the control group additionally underwent breathing training,while patients in the experimental group did Mawangdui Daoyin Exercise alongside the same breathing training.We measured pulmonary function parameters[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),and FEV1/FVC],6-minute walking distance(6MWD),the Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS),St George's Respiratory Questionnaire(SGRQ),and recorded safety events before and after 8 weeks of treatment.Results Compared with the baseline,both groups showed significant improvements in FVC,FEV1,FEV1/FVC,and 6MWD(all P<0.05),with significantly greater improvement observed in the experimental group(all P<0.05).SAS and SDS scores,as well as all SGRQ domain scores(symptoms,activity,and impacts),were significantly reduced in both groups(all P<0.05),with the experimental group demonstrating lower scores than the control group(all P<0.05).Only one adverse event occurred in the control group,which resolved after pharmacological manage-ment.Conclusion Mawangdui Daoyin Exercise can effectively improve lung function and exercise tolerance in patients with stable COPD,and it also helps alleviate anxiety and depression,thereby enhancing their quality of life.

Abstract:Objective To compare the clinical efficacy of different minimally invasive small incisions in aortic valve replacement.Methods The clinical data from 187 patients with aortic valve disease who underwent aortic valve replace-ment were retrospectively analyzed.And they were divided into the full sternotomy(FS)group(50 cases),the partial up-per sternotomy(PUS)group(50 cases),the right parasternal longitudinal incision(RPLI)group(39 cases),and the right parasternal transverse incision(RPTI)group(48 cases)according to different surgical methods.The types and mod-els of artificial heart valves,types of accompanying surgery,operation time,cardiopulmonary bypass time,aortic occlu-sion time,postoperative blood loss,transfusion volume,ventilator use time,ICU stay time,24 h postoperative drainage,drain retention time,incidence of postoperative complications,postoperative hospital stay time,length of thoracic inci-sion,and degree of thoracic incision pain[visual analogue scale(VAS)score]at discharge were compared between the four groups.Results There were no significant differences between the four groups in terms of artificial valve replace-ment type,valve model,operative time,intraoperative blood transfusion volume,ventilator use time,ICU stay time,or in-cidence of postoperative complications(all P>0.05).Significant differences were observed in the following parameters:type of accompanying surgery,cardiopulmonary bypass time,aortic occlusion time,postoperative blood loss,24 h postop-erative drainage,drain retention time,postoperative hospital stay time,length of thoracic incision,and VAS score at dis-charge(all P<0.05).Further comparisons revealed that the FS group had the highest proportion of concomitant left atrial appendage ligation,the shortest cardiopulmonary bypass and aortic occlusion time,and the highest postoperative blood loss and 24 h postoperative drainage;this group also exhibited the longest drain retention time,postoperative hospital stay time,and thoracic incision length,alongside the highest VAS score at discharge(all P<0.05).The PUS group generally fell between the FS group and the other two groups;the RPLI group and RPTI group demonstrated significantly lower val-ues for the aforementioned indicators compared with the FS and PUS groups(all P<0.05).Furthermore,the RPTI group exhibited a lower VAS score at discharge than the RPLI group(P>0.05).Conclusions Minimally invasive aortic valve replacement is safe and effective,offering advantages such as minimal trauma,mild pain,and rapid recovery.Patients un-dergoing aortic valve replacement through a right parasternal transverse incision will enjoy even more benefits

Abstract:Objective To evaluate the efficacy and safety of doxycycline and levofloxacin in the treatment of macro-lide-unresponsive Mycoplasma pneumoniae pneumonia in children.Methods A retrospective analysis was performed on 200 children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia,including 100 cases treated with doxycy-cline(doxycycline group)and 100 cases treated with levofloxacin(levofloxacin group).The length of hospital stay,dura-tion of drug use,time to cough relief,the number of cases with defervescence within 24 h,and the levels of inflammatory markers[white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)]on admission and before discharge were recorded and compared between the two groups.Clinical efficacy and adverse reac-tions during treatment were also analyzed.Results The hospitalization duration in the doxycycline group was(7.96±1.34)days,while that in the levofloxacin group was(7.49±1.21)days(P>0.05).The number of days of medication use in the doxycycline group was(6.43±1.43)days,the number of days until cough improvement was(8.44±3.41)days,and 65 cases achieved fever resolution within 24 hours,while the levofloxacin group had(6.55±1.35)days,(8.78±4.26)days,and 54 cases,respectively.No statistically significant differences were found between the two groups(all P>0.05).Both groups showed significant decreases in WBC,CRP,PCT,and IL-6 levels post-treatment com-pared with those before treatment(all P<0.05).There were no statistically significant differences in pre-and post-treat-ment levels of WBC,CRP,PCT,or IL-6 between the levofloxacin and doxycycline groups(all P>0.05).The doxycy-cline group showed marked improvement in 63 cases,improvement in 34 cases,and no improvement in 3 cases.The levo-floxacin group showed marked improvement in 61 cases,improvement in 33 cases,and no improvement in 6 cases.There was no statistically significant difference in clinical efficacy between the two groups(P>0.05).During treatment,the dox-ycycline group had 2 cases of maculopapular rash,1 case of mild abdominal pain,and 10 cases of injection site pain.In the levofloxacin group,4 patients developed maculopapular rash,2 experienced mild abdominal pain,and 2 reported calf pain on the third day of infusion.No statistically significant difference was found in the incidence of adverse reactions be-tween the two groups(P>0.05).No new adverse reactions were reported during follow-up at 2 weeks and 1 month after dis-charge.Conclusions For children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia,treatment with doxycycline or levofloxacin can achieve good therapeutic effects and is relatively safe.

Abstract:Objective To summarize the clinical characteristics of heavy chain deposition disease(HCDD)in an el-derly patient presenting with nephrotic syndrome as the initial manifestation so as to provide a reference for the early clini-cal identification and timely symptomatic treatment of HCDD.Methods A retrospective analysis was conducted on the clinical manifestations,physical examination,laboratory examination,imaging examination and treatment process of an el-derly patient with HCDD who presented with nephrotic syndrome as the initial manifestation.Results A 76-year-old fe-male was admitted to the hospital with cough,shortness of breath,and edema.Laboratory tests revealed anemia,massive proteinuria(24-hour urine protein 4,142 mg),elevated serum creatinine(159 μmol/L),and hypocomplementemia(C3 0.46 g/L,C4 0.06 g/L).Serum immunofixation electrophoresis detected IgGλ-type M protein,and flow cytometry of bone marrow showed 1.48%monoclonal plasma cells.Light microscopy of renal biopsy revealed mesangial nodular sclerosis,and immunofluorescence showed IgG3 deposition along the capillary loops and mesangial areas,while κ and λ light chains were negative.Electron microscopy confirmed granular electron-dense deposits in the mesangial area and the inner side of the glomerular basement membrane,which was consistent with the pathological diagnosis of HCDD.After two courses of bortezomib combined with dexamethasone(BD regimen)treatment,the M protein turned negative,24-hour urine protein decreased to 395.9 mg,serum creatinine returned to 86 μmol/L,and complement C3 and C4 levels increased to 0.57 g/L and 0.17 g/L,respectively.During a 3-year follow-up,the patient's condition remained stable without edema or shortness of breath,and she was able to perform daily activities normally.Conclusion For elderly patients with nephrotic syn-drome,if they have hypocomplementemia and positive M protein,renal biopsy should be performed as soon as possible to confirm HCDD,and a regimen containing proteasome inhibitors should be initiated promptly,which can significantly im-prove long-term prognosis.

Abstract:Objective To investigate whether triiodothyronine(T3)is involved in the immune dysregulation mecha-nism of Graves'disease(GD)by modulating CD4+T lymphocytes.Methods Fasting peripheral venous blood was col-lected from 3 GD patients and 6 healthy controls(HCs).CD4+T lymphocytes were isolated and cultured.CD4+T lympho-cytes from 6 HCs were stimulated in vitro with 10 nmol/L T3 for 12 h.Whole-transcriptome RNA sequencing was per-formed on CD4+T lymphocytes from GD patients,unstimulated HCs,and T3-stimulated HCs to screen for differentially ex-pressed genes(DEGs).Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Ge-nomes(KEGG)pathway enrichment analysis were employed to elucidate the biological functions of the identified DEGs.Results A total of 2,449 DEGs(1,797 up-regulated and 652 down-regulated)were identified between GD patients and unstimulated HCs.Compared with unstimulated HCs,T3 stimulation induced 49 DEGs(47 up-regulated and 2 down-regu-lated)in HC-derived CD4+T lymphocytes.The intersection of these two DEG sets yielded 33 overlapping genes,including C5AR1,ITGAX,VEGFA,KLRD1,BTK,PLAUR,and NEU4.GO and KEGG analyses revealed that the signaling path-ways enriched for DEGs in GD patients and T3-stimulated HCs were highly similar,showing significant enrichment in path-ways such as the complement and coagulation cascade,nuclear factor-κB signaling pathway(NF-κB),and autoimmune thyroid disease.Conclusion High levels of T3 may contribute to the immune dysregulation in GD by regulating the ex-pression of genes such as C5AR1,ITGAX,and VEGFA in CD4+T lymphocytes,thereby activating pathways including the complement and coagulation cascade,NF-κB signaling pathway,and autoimmune thyroid disease.

Abstract:Objective To investigate the predictive value of serum long non-coding RNA zinc finger protein anti-sense chain 1(lncRNA ZFAS1)and long non-coding RNA homologous box gene transcription antisense RNA(lncRNA HOTAIR)in the early diagnosis and prognosis of patients with polycystic ovary syndrome(PCOS).Methods Totally 198 PCOS patients(research group)and 198 healthy women of reproductive age who underwent physical examination dur-ing the same period(control group)were selected.Fasting venous blood was drawn from the subjects of the two groups.Real-time fluorescent quantitative PCR(qRT-PCR)was used to detect serum lncRNA ZFAS1 and lncRNA HOTAIR.Pa-tients received the standardized treatment for 3 months,and the prognosis was determined based on the ultrasound re-exam-ination results.Multivariate Logistic regression was applied to analyze the factors affecting the prognosis of PCOS.Receiv-er operating characteristic(ROC)curve was used to evaluate the value of serum lncRNA ZFAS1 and lncRNA HOTAIR in the diagnosis and prognosis prediction of PCOS.Results Compared with the control group,the research group had high-er relative expression levels of serum lncRNA ZFAS1 and lncRNA HOTAIR(both P<0.05).Among 198 patients with PCOS,there were 107 patients with good prognosis and 91 patients with poor prognosis.Compared with patients with poor prognosis,patients with good prognosis had lower relative expression levels of serum lncRNA ZFAS1 and lncRNA HO-TAIR(both P<0.05).Multivariate Logistic regression showed that elevated levels of serum lncRNA ZFAS1,lncRNA HO-TAIR and AMH were risk factors affecting the prognosis of PCOS patients(all P<0.05),and elevated levels of FSH and ES were protective factors affecting the prognosis of PCOS patients(both P<0.05).ROC curve showed that the area under the curve(AUC)of serum lncRNA ZFAS1,lncRNA HOTAIR alone and in combination for the diagnosis of PCOS were 0.712,0.750,and 0.813,respectively.The AUC for predicting poor prognosis of PCOS using serum lncRNA ZFAS1 and lncRNA HOTAIR alone and in combination were 0.765,0.819,and 0.867,respectively.Conclusions The serum lev-els of lncRNA ZFAS1 and lncRNA HOTAIR in patients with PCOS are elevated.The levels of serum lncRNA ZFAS1 and lncRNA HOTAIR have certain value in the early diagnosis and poor prognosis evaluation of PCOS.

Abstract:Objective To observe and compare the efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB)ver-sus laparoscopic sleeve gastrectomy(LSG)in the treatment of severe obesity complicated with type 2 diabetes mellitus(T2DM).Methods Sixty patients with severe obesity and T2DM were divided,according to the surgical procedure,in-to the LSG group(underwent LSG)and the LRYGB group(underwent LRYGB),with 30 cases in each group.The follow-ing parameters were compared between the two groups:surgery-related indicators(operation time,intraoperative blood loss,and length of hospital stay),obesity-related indicators(body weight,body mass index,and percentage of excess weight loss),glucose metabolism parameters(fasting blood glucose,glycated hemoglobin,and fasting C-peptide),and lipid metabolism parameters(cholesterol and triglycerides)at 6 months and 1 year postoperatively.The clinical efficacy for T2DM and the incidence of complications within 30 days after surgery were also compared.Results Compared with the LSG group 1,the LRYGB group had longer surgical time and length of hospital stay(both P<0.05).Compared with the preoperative levels,both groups showed lower levels of obesity indicators,glucose metabolism indicators and lipid me-tabolism indicators at 6 months and 1 year after surgery(all P<0.05).There were no statistically significant differences be-tween the two groups in intraoperative blood loss,postoperative obesity-related indicators,glucose metabolism indicators,lipid metabolism indicators,remission rate of T2DM,or incidence of complications within 30 days after surgery(all P>0.05).Conclusions Both LSG and LRYGB,as bariatric and metabolic surgeries,are effective in intervening against obesity and regulating glucose and lipid metabolism in patients with severe obesity and T2DM,demonstrating similar clini-cal efficacy.The LSG procedure offers slight advantages in terms of operation time and length of hospital stay.

Abstract:Objective To investigate the expression changes of discoid domain receptor 2(DDR2)in the liver tis-sues of mice with metabolic-associated fatty liver disease(MAFLD).Methods Ten 8-week-old male C57BL/6J mice were randomly divided into the normal chow diet group(NC group,n=5)and high-fat diet group(HFD group,n=5).The HFD group was fed a high-fat diet,while the NC group received a standard diet for 16 weeks.After 12-hour fasting,we weighed all mice and collected blood samples through orbital venipuncture to detect serum liver function indicators[ala-nine aminotransferase(ALT)and aspartate aminotransferase(AST)]and lipid profiles[total cholesterol(TC)and triglyc-erides(TG)].Liver weight and the liver index were recorded.Enzymatic assays measured hepatic TG and free fatty acids(FFA).Hepatic histopathology was examined using HE staining and Oil Red O staining.DDR2 mRNA and protein levels in the liver tissues were detected by qPCR and Western blotting.Results Compared with the NC group,the HFD group exhibited significantly higher body weight after 16 weeks(P<0.05).Serum ALT,AST,TC,and TG levels were higher in the HFD group than in the NC group(all P<0.05).The liver weight,liver index,and content of liver TG and FFA in the HFD group were all higher than those in the NC group(all P<0.01).Compared with the NC group,the HFD group exhibit-ed marked hepatic steatosis.Both DDR2 mRNA and protein expression levels in the liver tissues were higher in the HFD group than in the NC group(both P<0.01).Conclusion DDR2 mRNA and protein expression are up-regulated in the liver tissues of MAFLD mice,suggesting that DDR2 may play a significant role in the development and progression of MAFLD.

Abstract:Objective To evaluate the application efficacy of patient-controlled epidural analgesia(PCEA)com-bined with programmed intermittent epidural bolus(PIEB)for labor analgesia in primiparas with gestational diabetes melli-tus(GDM).Methods A total of 482 GDM primiparas planning vaginal delivery were enrolled and allocated into two groups:the PCEA group(n=240,receiving standard PCEA),and the PCEA+PIEB group(n=242,receiving the com-bined regimen of PCEA with PIEB).We compared the delivery mode,oxytocin use,duration of labor stages,intrapartum blood glucose levels,2-hour postpartum hemorrhage volume,incidence of adverse reactions,visual analogue scale(VAS)scores,and analgesic satisfaction of the two groups as well as neonatal height,weight,blood glucose,Apgar scores,umbili-cal artery blood gas parameters,and the proportion of admission to the neonatal intensive care unit(NICU).Results The PCEA+PIEB group demonstrated significantly lower VAS scores and reduced local anesthetic consumption at 1,2,and 3 h after analgesia initiation,at 7-8 cm cervical dilation,and at fetal delivery,compared to the PCEA group.Additionally,the combined regimen was associated with a shorter time to pain relief,a longer total analgesic duration,fewer patient-con-trolled bolus requests,and higher maternal satisfaction(all P<0.05).No significant intergroup differences were ob-served in delivery mode,oxytocin requirement,labor stage durations,maternal blood glucose levels,2-hour postpartum hemorrhage,or incidence of adverse reactions(all P>0.05).There was no statistically significant difference in height,weight,blood glucose,Apgar scores,umbilical artery blood gas values,or NICU admission rates between the two groups(all P>0.05).Conclusions For primiparas with GDM,the combined PCEA+PIEB regimen provides superior labor an-algesia,characterized by enhanced efficacy and higher maternal satisfaction,compared to PCEA alone.The impact of PCEA combined with PIEB on other maternal and infant outcomes is not significantly different from that of PCEA alone.

Abstract:Objective To observe the efficacy of three-dimensional image-guided Iridium-192(192Ir)interstitial brachytherapy in the treatment of locally advanced cervical cancer(LACC).Methods A total of 100 patients with LACC were divided into the study group(n=58)and the control group(n=42).Both groups received pelvic intensity-mod-ulated radiation therapy combined with concurrent chemotherapy.The study group was treated with three-dimensional im-age-guided ¹⁹²Ir interstitial brachytherapy,while the control group received conventional intracavitary brachytherapy.We compared the target volume dosimetric parameters[the minimum radiation dose received by 90%of the high-risk clinical target volume(HRCTV-D90),dose conformity index,homogeneity index,and the minimum radiation dose received by 2 cubic centimeters of the rectum,bladder,and colon(D2cc)],short-term efficacy[complete response(CR),partial re-sponse(PR),stable disease(SD),progressive disease(PD),and objective response rate(ORR)],quality of life(Kar-nofsky performance score),and incidence of adverse reactions between the two groups.Cox proportional hazards regres-sion model was used to analyze the independent influencing factors of progression-free survival(PFS).Results The HRCTV-D90 and dose conformity index in the study group were significantly higher than those in the control group,while the homogeneity index was significantly lower(all P<0.01).The rectal D2cc and bladder D2cc in the study group were signif-icantly lower than those in the control group(both P<0.01).At 3 months after treatment,the CR rate and ORR in the study group were significantly higher than those in the control group,and the improvement rate of Karnofsky score in the study group was also significantly higher than that in the control group(all P<0.05).During the 18-month follow-up,the PFS rate and overall survival rate in the study group were significantly higher than those in the control group(both P<0.05).The incidences of radiation proctitis and radiation cystitis in the study group were significantly lower than those in the control group(both P<0.05).Cox proportional hazards regression analysis showed that treatment method,parametrial infiltration depth,tumor size,and FIGO stage were independent influencing factors of PFS(all P<0.05).Conclusion Compared with conventional intracavitary brachytherapy,three-dimensional image-guided ¹⁹²Ir interstitial brachytherapy for LACC has better dosimetric parameters,higher short-term efficacy,and lower incidence of adverse reactions.

Abstract:Helicobacter pylori(H.pylori)infection is a significant causative factor in chronic gastritis,peptic ul-cers,and gastric cancer.With the widespread use of antibiotics in clinical practice,the resistance rates of H.pylori to clarithromycin,metronidazole,and levofloxacin have been progressively increasing.Antibiotic resistance in H.pylori has become a major challenge in clinical eradication therapy.The mechanisms of H.pylori resistance are complex and involve alterations in antibiotic target sites,efflux pump systems,drug-degrading enzyme systems,and biofilm formation,among others.A deeper understanding of the resistance mechanisms of H.pylori may provide new insights for the development of novel approaches to eradication therapy.

Abstract:Benign prostatic hyperplasia(BPH)is the most common urinary disorder in middle-aged and older men,significantly affecting patients'quality of life.There is an urgent need for effective and safe treatments.The Rezum water vapor thermal therapy is an emerging minimally invasive treatment that directly applies water vapor to prostate tissue to re-duce gland volume and improve urethral patency;it has recently gained more attention.Current studies indicate that the Rezum water vapor thermal therapy appears promising in terms of both effectiveness and safety;however,it requires more rigorous comparative studies with traditional treatments.Furthermore,additional research is needed to evaluate its long-term effects and potential complications.

Abstract:Objective To explore the application value of gastroscope-guided tracheal intubation in the diagnosis and treatment of digestive endoscopy.Methods A prospective selection of 140 patients undergoing gastrointestinal endo-scopic diagnosis and treatment with planned endotracheal intubation was conducted.These patients were divided into the observation group(n=70)and control group(n=70)using a random number table method.The experimental group under-went gastroscope-guided tracheal intubation,while the control group underwent video laryngoscope-guided intubation.The intubation time,first tracheal intubation success rate,hemodynamic indicators[heart rate(HR)and mean arterial pres-sure(MAP)],and incidence of complications were recorded and statistically analyzed.Results The success rate of first endotracheal intubation in the observation group was higher than that in the control group,but the difference was not statis-tically significant(P>0.05).Compared with the control group,the intubation time in the observation group was shorter,and both HR and MAP were lower immediately after intubation(T1)and 1 minute after intubation(T2)(both P<0.05).Compared with the control group,the incidence of choking cough and mucosal injury in the observation group was signifi-cantly lower(both P<0.05).Gastroscopy guidance was a protective factor for intubation complications(OR=0.642,P=0.008),while intubation time was an independent risk factor(OR=2.051,P=0.001).Conclusion Gastroscope-guid-ed tracheal intubation offers advantages such as shorter operation time,more stable hemodynamics,and fewer complica-tions,making it suitable for patients requiring combined diagnostic and therapeutic digestive endoscopy.

Abstract:Objective To evaluate the application effect of intravenous injection of remimazolam besylate on pain-less gastroscopy for pediatric patients.Methods Prospectively,60 pediatric patients aged 6-14 years scheduled for pain-less gastroscopy were prospectively enrolled and assigned into the remimazolam group and propofol group using a random number table,with 30 patients in each group.During preoperative anesthetic induction,both groups initially received fen-tanyl 1 μg/kg intravenously,followed by intravenous administration of remimazolam besylate 0.2 mg/kg in the remimazol-am group and propofol 2 mg/kg in the propofol group,with rescue sedation provided based on Modified Observer's Assess-ment of Alertness/Sedation(MOAA/S)scale scores.During gastroscopy procedures,both groups received multiple supple-mental doses of remimazolam besylate 0.05 mg/kg or propofol 0.5 mg/kg,respectively,based on the children's response.A comparison was made between the two groups regarding sedation success rate,times of remedial sedation,sedation onset time,awakening time,and recovery time,as well as changes in heart rate,pulse oxygen saturation,and blood pressure be-fore and after induction.Anesthesia-related adverse reactions were also documented for both groups.Results All 60 pe-diatric patients successfully completed anesthetic induction,achieving sedation success rate of 100%in both groups.Com-pared with the propofol group,the remimazolam group demonstrated a higher proportion of cases requiring≥2 remedial se-dation interventions and significantly shorter awakening time and recovery time.Compared with the propofol group,the remimazolam group exhibited significantly higher mean arterial pressure at 0 minute,1 minute and 5 minutes post-induc-tion(P<0.05).Compared with the propofol group,the remimazolam group showed significantly lower incidences of hypo-tension and injection pain(P<0.05).Conclusion Intravenous injection of remimazolam besylate demonstrates excel-lent sedative efficacy for painless gastroscopy in pediatric patients,effectively reduces awakening time and recovery time,and is associated with fewer adverse reactions.

Abstract:Objective To analyze the trends in diabetes mellitus mortality rates and years of life lost(YLL)across China and its regions from 2008 to 2021,and to assess the burden of diabetes-related deaths.Methods Based on nation-al cause-of-death surveillance data from 2008 to 2021,Excel 2019 and Python 3.9 software were used to collate and ana-lyze the age-standardized mortality rate,age-standardized YLL rate,and estimated annual percentage change(EAPC)for diabetes across different genders,regions,and age groups.Results The standardized mortality rate for diabetes mellitus in China increased from 7.94 per 100 000 in 2008 to 9.12 per 100 000 in 2021,representing a 14.86%rise.From 2008 to 2016,the age-standardized mortality rate was higher in females than in males.However,the rate increased faster among males(EAPC:2.03 for males vs.0.64 for females),leading to higher male mortality from 2017 onward.From 2008 to 2010,females had the highest age-standardized YLL rate.Yet,as the male YLL rate showed sustained growth(EAPC:2.42)while the female rate declined(EAPC:0.11),males exhibited a higher YLL rate than females after 2011.From 2008 to 2021,both the age-standardized mortality rate and YLL rate for diabetes were higher in urban areas compared to rural areas.During 2008-2016,the eastern region had the highest age-standardized mortality rate,and during 2008-2011,the central region had the highest age-standardized YLL rate.However,the western region exhibited the fastest growth in both the mortality rate and YLL rate,gradually becoming the region with the highest age-standardized mortality rate(since 2017)and YLL rate(since 2012).The burden of diabetes-related deaths increased with age,being highest among individ-uals aged 75 and above,with a peak observed in the≥85 age group.Conclusions From 2008 to 2021,diabetes melli-tus-related mortality in China increased substantially.Diabetes mellitus remains a chronic disease requiring prioritized pre-vention and control.Males,the elderly,and populations in rural and western regions face relatively higher mortality risks.

Abstract:Objective To observe the effects of semaglutide,a glucagon-like peptide-1 receptor agonist(GLP-1RA),on abdominal fat distribution and brown adipose tissue(BAT)activity in the neck region of overweight/obese pa-tients with type 2 diabetes mellitus(T2DM).Methods Thirty-two overweight/obese patients with T2DM were divided into the observation group(n=18)and control group(n=14).The observation group received subcutaneous injections of semaglutide starting at 0.25 mg weekly,gradually titrated to 1.0 mg weekly.The control group was maintained on a hypo-glycemic regimen excluding GLP-1 receptor agonists(GLP-1RAs)and dipeptidyl peptidase-4(DPP-4)inhibitors.Both groups underwent a 3-month intervention period.Anthropometric parameters,including height,weight,waist circumfer-ence,and body mass index(BMI),were measured before and after treatment.We detected the fasting plasma glucose(FPG),fasting insulin(FINS),glycated hemoglobin(HbA1c),triglycerides(TG),and low-density lipoprotein choles-terol(LDL-C).Insulin resistance index(HOMA-IR),insulin sensitivity index(HOMA-IS),and pancreatic β-cell func-tion(HOMA-β)were assessed.Abdominal subcutaneous adipose tissue(SAT)area,visceral adipose tissue(VAT)area,and neck brown adipose tissue(BAT)activity were quantified by magnetic resonance imaging(MRI),with BAT activity represented by T2* values at the C3-4,C4-5,C5-6 vertebral levels.Results Compared with pre-treatment levels,the body weight,waist circumference,BMI,FPG,and both SAT and VAT areas following treatment decreased,while HOMA-β and T2* values at C3-4,C4-5,C5-6 intervertebral spaces increased in the observation group(all P<0.05).After treatment,the observation group exhibited lower body weight,waist circumference,BMI,and HOMA-IR than the control group,while HOMA-IS and HOMA-β were higher than those of the control group(all P<0.05).Conclusions In overweight/obese patients with type 2 diabetes,semaglutide treatment produces significant reductions in body weight and blood glucose along with improved pancreatic β-cell function.It also lowers abdominal visceral and subcutaneous fat content and elevates neck BAT activity.Semaglutide may exert its weight-loss and metabolic-improvement effects by decreasing abdominal fat distribution and enhancing BAT activity.

Abstract:Objective To investigate the impact of humidification via nebulization combined with preemptive analge-sia on postoperative recovery of laparoscopic patients.Methods Eighty patients who underwent laparoscopic surgery un-der general anesthesia were prospectively selected and were divided into the observation group of 39 cases and control group of 41 cases.Both groups received intravenous drip of flurbiprofen axetil(1.0 mg/kg)and esketamine(0.5 mg/kg)before anesthesia induction as preemptive analgesia.After surgery,once patients were fully awake,the observation group received humidification via nebulization with warm water,while the control group consumed the same volume of warm wa-ter in small amounts over multiple intakes.Pain and sedation levels were assessed at 5 min after extubation and 24 h post-operatively using the visual analogue scale(VAS)and the sedation agitation scale(SAS).The recovery time of gastrointes-tinal function,adverse events,and hospital stay were recorded.The QoR-40 scale was used to evaluate recovery outcomes at 48 h postoperatively,and the Likert scale was used to assess overall patient satisfaction.Results There were no signif-icant differences in VAS or SAS scores between the two groups at 5 min after extubation and 24 h postoperatively(both P>0.05).Compared with the control group,the observation group had shorter postoperative bowel sound recovery time,first flatus time,hospital stay and less episodes of coughing and choking(all P<0.05),and showed improved QoR-40 scores and higher overall satisfaction at 48 h after surgery(all P<0.05);while nausea and vomiting rates were comparable(both P>0.05).Conclusions Humidification via nebulization combined with preemptive analgesia on postoperative recovery of laparoscopic patients can promote postoperative recovery and improve patient satisfaction by shortening the hospital stay and reducing the episodes of coughing and choking.

Abstract:Objective To explore the clinical effects of oral treatment with finerenone combined with sacubitril/val-sartan and dapagliflozin on early diabetic kidney disease.Methods Sixty-eight patients with early type 2 diabetic ne-phropathy were selected as the study subjects.Under the principle of balanced and comparable baseline data such as age and gender,the subjects were divided into the control group of 33 cases and experimental group of 35 cases.The control group was treated with sacubitril/valsartan and dapagliflozin,while the experimental group was treated with finerenone in addition to the treatment of the control group for a total of 12 months.We compared the renal function indicators[serum creatinine(Cr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR),uric acid(UA),urinary micro-albumin(MALB),and urinary microalbumin-to-creatinine ratio(ACR)],blood glucose indicators[fasting blood glucose(FPG)and glycosylated hemoglobin A1c(HbA1c)],blood pressure indicators[systolic blood pressure(SBP)and diastol-ic blood pressure DBP],blood potassium and inflammation related indicators[white blood cells(WBC),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)]before and after treatment between two groups,and recorded and compared the occurrence of adverse reactions(headache,dizziness,nausea,vomiting,hyperkalemia,and hypotension)between the two groups.Results After treatment,BUN,MALB,ACR,HbA1c,FPG,SBP,DBP,WBC,IL-6,and TNF-α in both groups decreased in comparison with those before treatment(all P<0.05).The Cr level in the experimental group was lower than that in the control group after 12 months of treatment,while eGFR and blood potassium levels were higher than those in the control group after 12 months of treatment.BUN,MALB,and ACR levels were lower than those in the control group after 6 and 12 months of treatment.WBC,IL-6,TNF-α,and SBP levels were lower than those in the con-trol group after 3,6,and 12 months of treatment(all P<0.05).There were no statistically significant differences in the in-cidence of headache,dizziness,nausea and vomiting,hyperkalemia,or hypotension between the two groups(all P>0.05).Conclusions Oral treatment of early diabetic kidney disease with finerenone combined with sacubitril/valsartan and dapagliflozin can effectively reduce urinary protein,improve renal function,control blood sugar and inflammatory reac-tion,and help long-term blood pressure management.However,there is a risk of increasing blood potassium during the use of finerenone,and blood potassium levels need to be regularly measured.

Abstract:Objective To explore the effects of pioglitazone metformin combined with dapagliflozin on visceral fat ar-ea and serum lipid hydroperoxide(LHP)level in type 2 diabetes mellitus(T2DM)patients.Methods A total of 130 pa-tients with T2DM were enrolled and randomly assigned into the control group(65 cases)and observation group(65 cas-es).Patients in the control group received pioglitazone and metformin,while patients in the observation group received dapagliflozin in addition to pioglitazone and metformin.We compared the blood glucose levels[glycated hemoglobin(HbA1C),fasting plasma glucose(FPG),and 2-hour postprandial blood glucose(2 h PG)],pancreatic function[fasting insulin(FINS)and insulin resistance index(HOMA-IR)],visceral fat area(VFA),oxidative stress levels[LHP,malo-ndialdehyde(MDA),and superoxide dismutase(SOD)]before and after treatment in the two groups,as well as the inci-dence of adverse reactions.Results After treatment,both groups exhibited decreased levels of HbA1C,FPG,2 h PG,FINS,HOMA-IR,LHP,MDA,and VFA,and an increased level of SOD.Compared with the control group,the observa-tion group had significantly lower levels of HbA1c,2 h PG,FPG,HOMA-IR,FINS,MDA,LHP and VFA,and a higher level of SOD(all P<0.05).In the observation group,there were 2 cases of edema and 1 case of weight gain,with an ad-verse reaction incidence of 4.62%(3/65);in the control group,there was 1 case of edema and 1 case of digestive tract symptoms,with an incidence of 3.08%(2/65).No statistically significant difference was found in the incidence of ad-verse reactions between the two groups(P>0.05).Conclusion The combination of dapagliflozin and pioglitazone met-formin can not only reduce blood glucose and improve insulin resistance,but also decrease VFA and lower serum LHP lev-el in patients with T2DM.