Abstract:Exosomes are nanoscale vesicles and mediators of intercellular communication.Exosomes have attracted much attention due to their special biological effects and composition.Many studies have shown that exosomes regulate immune response,cell migration,cell differentiation,and tumor invasion.This article focuses on its anti-inflammatory and anti-aging mechanisms,because its complex mechanism can not only be used to eliminate inflammation,but also can reverse the aging of tissues and organs to a certain extent.Its clinical application prospect is very promising,and it can be applied to the brain,skin,heart and other fields,and is expected to solve many difficult and complicated diseases.

Abstract:Objective To explore the risk factors of cardiogenic shock(CS)in patients with acute exacer-bation of chronic heart failure(ACHF),and to construct and verify a Nomogram prediction model.Methods A total of 216 ACHF patients admitted to Second Affiliated Hospital of Naval Medical University from June 2022 to June 2024 were retrospectively selected.According to the presence or absence of CS,the patients were divided into CS group(38 cases)and non-CS group(178 cases).Multivariate Logistic regression was used to analyze the risk factors of ACHF patients with CS,and a Nomogram prediction model was constructed based on the risk factors.Consistency index,calibration curve and decision curve analysis were used to evaluate the prediction accuracy,fit degree and clinical utility of the Nomogram prediction model.Results Multivariate Logistic regression analysis showed that atrial fibrillation,tricuspid regurgitation,deteriorating renal function and high level of N-terminal pro-brain natriuretic peptide(NT-proBNP)were risk factors for CS in ACHF patients(all P＜0.05).The Nomogram prediction model was constructed based on Logistic regression risk factors,and it was verified that the prediction model showed good discrimination(the area under the curve was 0.893,with 95％confidence interval of 0.844 to 0.931,P＜0.05)and calibration(C-index was 0.902,mean absolute error was 0.003).Decision curve analysis showed that the net benefit of the prediction model was high,suggesting high clinical applicability.Conclusion Deterioration of renal function,atrial fibrillation,tricuspid regurgitation and high level of NT-proBNP are risk factors for CS in ACHF patients.The prediction model based on the above risk factors has high prediction accuracy and clinical applicability.

Abstract:Objective To investigate the effect of luteolin,the active ingredient in the alcohol extract of Prunella vulgaris,on the proliferation and migration of optic nerve glioma(ONG)cells,and to reveal its potential mechanism of action for tumor treatment.Methods The cultured U87-MG glioma cells were grouped for treat-ment.The control group was treated with dimethyl sulfoxide,and the 10,20,40 and 60 μmol/L luteolin treatment groups were treated with 10,20,40 and 60 μmol/L luteolin,respectively.The temozolomide treatment group was treated with 100 μmol/L temozolomide.The proliferation,migration and colony formation ability of U87-MG cells in different treatment groups were detected by scratch assay,colony formation assay and cell counting kit-8 assay.Real-time fluorescent quantitative polymerase chain reaction and Western blotting were used to detect the mRNA and protein expression of phosphatidylinositol-3-kinase(PI3K)/protein kinase B(AKT)pathway-related genes,PI3K catalytic subunit γ(PIK3CG),AKT,vimentin and N-cadherin.Results Luteolin could significantly inhibit the migration,clonogenesis and proliferation of U87-MG glioma cells,and the differences were statistically significant compared with the control group(all P＜0.05).With the increase of luteolin concentration,the inhibitory effect was gradually enhanced,and the inhibitory effect of temozolomide group was significantly lower than that of luteolin group(all P＜0.05).The PI3K/AKT pathway gene PIK3CG mRNA expressions in glioma U87-MG cells treated with 10,20,40,60 μmol/L luteolin and temozolomide for 24 h were significantly lower than those in the control group[(0.236±0.016),(0.199±0.016),(0.143±0.058),(0.103±0.014),(0.458±0.014)vs(0.977±0.023)](all P＜0.05).With the increase of luteolin concentration,the expression of PIK3CG mRNA decreased gradually.Although the decrease of temozolomide group was not as great as that of luteolin group,the difference between temozolomide group and control group was more than 2 times.However,the expressions of AKT,vimentin and N-cadherin mRNA were not affected.Western blot results showed that compared with the control group,the expression level of PIK3CG protein in luteolin groups was also significantly decreased.The expression of PIK3CG protein in luteolin group was gradually decreased with the increase of luteolin concentration,and the expression of PIK3CG protein in temozolomide group was also decreased,but the reduction ratio was not as obvious as that in luteolin group.The results of this protein detection were consistent with the results of mRNA.Conclusion This study confirmed that luteolin can effectively inhibit the proliferation and migration of glioma cells,and may regulate the PI3K/AKT pathway through the low expression of PIK3CG,thereby affecting the proliferation and migration of ONG cells.This study provides an experimental basis for the treatment of ONG with luteolin from the alcohol extract of Prunella vulgaris,reveals the application value of luteolin as a potential drug for the treatment of ONG,and provides a solid theoretical basis for its clinical transformation.

Abstract:Objective To investigate the effects of dexmedetomidine anesthesia on hemodynamics and satisfaction in hemodialysis patients with renal insufficiency.Methods A total of 80 hemodialysis patients with renal insufficiency admitted to Tangshan Central Hospital,Hebei Province from November 2020 to November 2023 were selected,and they were divided into control group and observation group according to the random number table method,with 40 cases in each group.The control group was given routine treatment,and the observation group was given intravenous infusion of dexmedetomidine hydrochloride on the basis of the treatment of the control group.Blood pressure,heart rate and pulse oximetry(SpO2)were compared between the two groups before and 20 min and 30 min after anesthesia.The renal function indicators β2-microglobulin(β2-MG),serum creatinine,serum uric acid,blood urea nitrogen,and blood phosphorus levels in both groups were compared.The self-designed satisfaction questionnaire was used to compare the satisfaction of patients in the two groups.Results The systolic blood pressure,diastolic blood pressure and heart rate of the observation group were lower than those of the control group 20 min and 30 min after anesthesia(all P＜0.05);there was no significant difference in SpO2 between the two groups(all P＞0.05).The levels of β2-MG,serum creatinine,serum uric acid,blood urea nitrogen,and blood phosphorus in the observation group were lower than those in the control group[(30±5)mg/L vs(35±6)mg/L,(120±14)μmol/L vs(181±21)μmol/L,(257±32)mmol/L vs(295±34)mmol/L,(10±3)mmol/L vs(18±5)mmol/L,(1.1±0.3)mmol/L vs(1.4±0.4)mmol/L](all P＜0.05).The total satisfaction rate of patients in the observation group was significantly higher than that in the control group[100.0％(40/40)vs 82.5％(33/40)](P＜0.05).Conclusion The application of dexmedetomidine in hemodialysis patients with renal insufficiency can stabilize the hemodynamic indexes of patients and improve patient satisfaction,which has good clinical application value.

Abstract:Objective To investigate the changes of cardiac indexes and cardiac function in pregnant women with pulmonary hypertension associated with congenital heart disease(CHD-PAH)during pregnancy and 6 months after delivery.Methods A total of 75 pregnant women with CHD-PAH who delivered in Beijing Anzhen Hospital,Capital Medical University from August 2018 to December 2022 were selected as the research objects.The pregnant women with CHD-PAH were grouped according to the results of prenatal echocardiography.According to pulmonary artery systolic pressure(SPAP),the patients were divided into mild group(41 cases),moderate group(22 cases)and severe group(12 cases).The pregnancy outcomes of the three groups were observed,and the changes of cardiac indexes and cardiac function during pregnancy and 6 months after delivery were analyzed.Results The gestational weeks of termination of pregnancy in the moderate group and the severe group were less than those in the mild group,the proportion of cesarean section and premature delivery were higher than those in the mild group,and the amount of postpartum hemorrhage in the severe group was more than that in the mild group(all P＜0.05).The birth weight of neonates in the severe group was lower than that in the mild group,the proportions of low birth weight infants in the moderate and severe groups was higher than that in the mild group,and the proportion of neonatal asphyxia in the severe group was higher than that in the mild group(all P＜0.05).The SPAP of the moderate and severe groups before pregnancy/early pregnancy,prenatal and 6 months after delivery were higher than those of the mild group(all P＜0.05),but there was no significant difference in SPAP among different time points within each group(all P＞0.05).There were no significant differences in left ventricular end-diastolic diameter,right atrial area and brain natriuretic peptide level among the three groups at each time point(all P＞0.05).The follow-up results showed that the cardiac function of 1 case in the moderate group and 4 cases in the severe group changed from grade Ⅲ-Ⅳ to grade Ⅰ-Ⅱ,and there was no significant difference in the proportion of grade Ⅰ-Ⅱ of cardiac function in the mild,moderate,and severe groups[100.0％(41/41),100.0％(22/22)and 91.7％(11/12)](P=0.70).The long-term follow-up proportion of cardiac function grade Ⅲ-Ⅳ in the severe group was lower than that in the prenatal period[91.7％(11/12)vs 41.7％(5/12)](P＜0.05).Conclusions The SPAP of pregnant women with severe CHD-PAH increases during pregnancy and decreases at 6 months after delivery,but it is still higher than the SPAP level of pregnancy/early pregnancy,and the cardiac function recovers well in long-term follow-up.The incidence of adverse maternal and fetal outcomes in pregnant women with severe CHD-PAH is high.The comprehensive use of cardiac diuretics,vasoactive agents and targeted drugs can effectively reduce the mortality of pregnant women with CHD-PAH,but patients with severe PAH are still contraindications to pregnancy,and it is recommended to avoid pregnancy.

Abstract:Objective To investigate the effect of Jinqi Jiangtang tablets combined with liraglutide injection in the treatment of type 2 diabetes mellitus.Methods A total of 100 patients with type 2 diabetes mellitus who were treated in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2021 to October 2023 were included in this study.According to the random number table method,they were divided into the control group and the observation group,with 50 cases in each group.The control group was treated with liraglutide injection,and the observation group was treated with Jinqi Jiangtang tablets combined with liraglutide injection.Both groups were treated for 3 months.The therapeutic effects,and glucose metabolism indexes before and after treatment,vascular endothelial function indexes and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was significantly higher than that of the control group[96.0％(48/50)vs 82.0％(41/50)](P=0.025).After treatment,the levels of fasting blood glucose,glycated albumin and glycated hemoglobin in the two groups were lower than those before treatment,and the levels of fasting blood glucose,glycated albumin and glycated hemoglobin in the observation group were lower than those in the control group(all P＜0.05).After treatment,the levels of endothelin-1 in the two groups were lower than those before treatment,and the levels of calcitonin gene-related peptide(CGRP)and nitric oxide were higher than those before treatment.After treatment,the level of endothelin-1 in the observation group was lower than that in the control group,and the levels of CGRP and nitric oxide were higher than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.712).Conclusion Jinqi Jiangtang tablets combined with liraglutide injection has a good effect in the treatment of type 2 diabetes mellitus,which can improve the glucose metabolism and vascular endothelial function of patients,and has good safety.

Abstract:Objective To investigate the clinical characteristics,effective diagnosis and treatment methods and possible high risk factors of ovarian pregnancy,and to reduce misdiagnosis and missed diagnosis.Methods The clinical data of 32 patients with ovarian pregnancy diagnosed by surgery in Beijing Friendship Hospital,Capital Medical University from January 2013 to December 2023 were collected and analyzed.The related risk factors,surgical and pathological characteristics of the cases were analyzed,and the experience of diagnosis and treatment of ovarian pregnancy was summarized.Results Ovarian pregnancy could occur in all ages of childbearing age.The main clinical manifestations were amenorrhea,abdominal pain and vaginal bleeding.The preoperative clinical accurate diagnosis rate was low,and there were some cases of misdiagnosis.Eight cases were diagnosed with diseases other than ectopic pregnancy,such as intrauterine device displacement,pelvic inflammatory disease,and gastroenteritis,after visiting external hospitals or internal medicine departments.Before operation,only one case was clinically diagnosed as ovarian pregnancy,and the rest were diagnosed as tubal pregnancy.Thirty-one cases(96.9％)underwent gynecological ultrasound examination before operation.Only 2 cases described that the lesion was located in the ovary,and 3 cases suggested that the lesion was closely related to the ovary.There were also difficulties in intraoperative diagnosis:23 cases(71.9％)underwent laparoscopic exploration surgery,and 9 cases(28.1％)underwent laparotomy surgery.Twenty-one cases(65.6％)were clinically and pathologically consistent with ovarian pregnancy during and after surgery.Four cases(12.5％)showed no obvious villi during surgery,but corpus luteum was visible,suggesting ovarian corpus luteum rupture with pregnancy.Postoperative pathology suggested ovarian pregnancy,and the diagnosis of ovarian pregnancy was revised after surgery.Three cases(9.4％)showed ovarian rupture during surgery,with corpus luteum tissue visible around the rupture and no obvious chorionic tissue.Postoperative pathology suggested the presence of chorionic villi in abdominal hematoma,and both intraoperative and postoperative diagnoses considered ovarian pregnancy.Four cases(12.5％)underwent intraoperative exploration of both fallopian tubes,all of which were intact and showed ovarian rupture.No obvious corpus luteum rupture was observed during the operation,and the intraoperative diagnosis considered ovarian pregnancy rupture.All postoperative pathology showed no placental villi or trophoblast cells,and the postoperative chorionic gonadotropin(hCG)decreased satisfactorily.Ovarian pregnancy was still considered in the postoperative diagnosis.All patients underwent wedge resection of the affected ovary,and the patient's blood hCG decreased satisfactorily after surgery.No patients underwent secondary surgery.Conclusion Ovarian pregnancy is a rare type of emergency in obstetrics and gynecology,but intra-abdominal bleeding can endanger the life of pregnant women.Improving awareness and combining medical history,ultrasound examination,and blood hCG can improve preoperative diagnosis and treatment rates,so as to develop effective diagnosis and treatment plans more quickly.Laparoscopic ovarian wedge resection is safe and effective,and postoperative follow-up of blood hCG is necessary.

Abstract:Medical academic journals are the platforms for the dissemination and promotion of related scientific research achievements in the field of medicine and health in China,and their high-quality development is an important embodiment of national medical academic strength and international influence.After the founding of the People's Republic of China,the achievements of medical academic journals in China have attracted wide attention.Medical academic journals serve the country and society,and have made outstanding contributions in the dissemination of knowledge,talent cultivation,academic exchange,leading innovation,achievement transformation,and foreign exchanges.With the new requirements of the new era,the scientific and technological periodicals in China are constantly strengthening their influence,communication power and reputation.The majority of scientific and technological workers and medical academic journal publishers shoulder the mission,and there is a long way to go on how to keep the integrity and innovation,and produce new results.This paper summarizes and discusses the relevant elements involved in the high-quality development of medical academic journals.

Abstract:Objective To explore the willingness of cardiovascular disease patients with mild cognitive impairment(MCI)to use computerized cognitive training(CCT),so as to provide a reference for promoting the use of CCT in cardiovascular disease patients with MCI.Methods Using the method of descriptive qualitative research,a total of 16 cardiovascular disease patients with MCI who were hospitalized in Beijing Anzhen Hospital,Capital Medical University from June to September 2023 and met the inclusion criteria were selected as the interview objects by purposive sampling for semi-structured interviews.Colaizzi phenomenological data analysis method was used to analyze the data and refine the theme.Results This study identified the needs of 16 patients with cardiovascular disease and MCI for the use of CCT,and three themes were extracted:the patients'attitudes towards CCT;the factors that hinder the use of CCT;and the factors that promote the use of CCT.Conclusion Enhancing the awareness and training of cardiovascular disease patients with MCI on the use of CCT,providing more policy support,and offering assistance in using CCT can help increase the use of CCT among cardiovascular disease patients with MCI,thereby improving their cognitive function and quality of life.

Abstract:Objective To investigate the clinical application value of detachable string magnetically controlled capsule endoscopy(ds-MCE)in patients with a positive fecal occult blood test(FOBT)and underlying cardiovascular disease(CVD).Methods CVD patients with positive FOBT who underwent MCE at the Depart-ment of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University from October 2023 to October 2024 were retrospectively enrolled.The patients who underwent ds-MCE were included in the string group,while those who underwent wireless magnetically controlled capsule endoscopy were included in the wireless group.The general information,complications,antithrombotic drug use,visualization of magnetically controlled capsule endoscopy,detected lesions,adverse reactions and adverse events related to the examination were collected.The primary outcome was the visual difference between the two groups,and the secondary outcome was the safety of ds-MCE.Results Finally,158 patients were included,including 53 cases in the string group and 105 cases in the wireless group.The visualization rates of the 4 quadrants and ≥3 quadrants for the upper,middle,and lower esophagus,as well as the dentate line,were significantly higher in the string group compared to the wireless group(all P＜0.01).In terms of gastric visualization,the visualization rate of gastric cardia in the string group was higher than that in the wireless group(P＜0.05).There was no significant difference in the detection rate of gastric and small intestinal lesions between the two groups(P＞0.05).In the string group,31(58.5％)patients did not experience any discomfort,21 cases(39.6％)reported mild pharyngeal discomfort,17 cases(32.1％)reported mild nausea,10 cases(18.9％)reported mild cough,and 1 case(1.9％)reported moderate nausea,all of which were tolerated.None of the patients had any adverse events such as capsule retention and aspiration etc.Conclusions The ds-MCE can be used to examine the esophagus,stomach and small intestine simultaneously in CVD patients with positive FOBT.It is safe and can provide accurate evidence for clinical diagnosis.

Abstract:Objective To explore the effects of remimazolam and sevoflurane on postoperative agitation after daytime adenoidectomy in children with adenoid hypertrophy under general anesthesia,and to evaluate their application effect in children undergoing general anesthesia.Methods A total of 50 children with adenoid hyper-trophy who underwent daytime surgery in Beijing Tongren Hospital,Capital Medical University from August to December 2023 were selected.According to the random number table method,they were divided into sevoflurane group and remimazolam group,with 25 cases in each group.The sevoflurane group and remimazolam group received sevoflurane and remimazolam for maintenance of anesthesia,respectively.The general data,intraoperative conditions,pediatric anesthesia emergence delirium(PAED)scale score,incidence of agitation during recovery period,recovery time of spontaneous breathing,recovery time,extubation time,postoperative pain intensity,and adverse events were compared between the two groups.Results The scores of PAED scale at 5,10,20 min after extubation and at the time of leaving the postanesthesia care unit in the remimazolam group were lower than those in the sevoflurane group(all P＜0.05).The incidence of agitation in remimazolam group was lower than that in sevoflurane group[12.0％(3/25)vs 44.0％(11/25)](x2=6.340,P=0.012).The recovery time of spontaneous breathing,recovery time and extubation time in the remimazolam group were shorter than those in the sevoflurane group(all P＜0.05).There was no significant difference in the incidence of adverse events between the two groups(P=0.733).There was no significant difference in pain intensity between the two groups at 5,10,20 min after extubation,at the time of leaving the postanesthesia care unit,and 6 h after extubation(all P＞0.05).Conclusion Remimazolam can effectively reduce the incidence of postoperative agitation after daytime adenoidec-tomy in children,and can promote the postoperative rehabilitation of children.

Abstract:Under physiological conditions,the metabolism of energy substances such as lipids,glucose,ketone bodies and amino acids in the heart maintains a dynamic balance to meet the energy needs of the heart.During sepsis,the inflammatory responses caused by some chemical mediators such as endotoxin and nitric oxide,as well as the activation or inhibition of certain signaling pathways,will lead to changes in cardiac energy metabolism,which is both a compensatory process and the cause of organ dysfunction.This review will focus on the changes in energy metabolism during sepsis,especially the energy metabolism of the heart,aiming to provide new research directions and strategies for the future treatment of cardiac dysfunction caused by sepsis.

Abstract:Objective To investigate the effect of moist exposed burn ointment combined with concentrated growth factor in the treatment of diabetic foot.Methods A total of 90 patients with diabetic foot admitted to Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2022 to January 2024 were selected as the research objects.They were divided into control group 1,control group 2 and combined group by random number table method,with 30 cases in each group.On the basis of basic comprehensive treatment,the control group 1 was treated with moistexposed burn ointment,the control group 2 was treated with concentrated growth factor,and the combined group was treated with moistexposed burn ointment combined with concentrated growth factor.The clinical efficacy,wound healing indicators,growth factor levels,inflammatory factor levels,and treatment safety were compared among the three groups.Results The total effective rate of the combined group was higher than those of the control group 1 and the control group 2[93.3％(28/30)vs 73.3％(22/30),70.0％(21/30)](both P＜0.05).After treatment,the wound healing area of combined group was larger than those of control group 1 and control group 2,while the growth time of new granulation tissue,healing time,and treatment cost of combined group were shorter/lower than those of control group 1 and control group 2(all P＜0.05).After treatment,the levels of vascular endothelial growth factor,basic fibroblast growth factor and epidermal growth factor in the combined group were higher than those in the control group 1 and the control group 2,and the levels of high-sensitivity C-reactive protein,tumor necrosis factor-α and interleukin-6 in the combined group were lower than those in the control group 1 and the control group 2(all P＜0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P＞0.05).Conclusion Moist exposed burn ointment combined with concentrated growth factors has a good effect in the treatment of diabetic foot,which can promote wound healing,reduce treatment cost,improve the level of growth factors,reduce the level of inflammatory factors,and has good safety.

Abstract:Cardiogenic shock(CS)is characterized by rapid progression and high mortality,which requires rapidly identification and management of the high-risk patients.The detection of plasma biomarkers is helpful for early risk identification of CS patients,so as to optimize treatment measures.In recent years,the role of new CS biomarkers in shock progression,disease course monitoring and death risk prediction has attracted clinical attention.These biomarkers include markers related to inflammation,immunity,endothelial function,and markers based on proteomics screening.This article reviews the research progress of several novel biomarkers of CS in shock risk assessment and prognosis prediction.

Abstract:Objective To explore the mechanism of Yiqi Huoxue Jiedu decoction in the treatment of platinum-resistant ovarian cancer(PROC).Methods A total of 12 patients with PROC in the Department of Oncology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences from September 2022 to March 2023 were selected.According to different treatment methods,the patients were divided into traditional Chinese medicine group and control group,with 6 cases in each group.The control group was treated with the regimen selected by the doctor,and the traditional Chinese medicine group was treated with the Yiqi Huoxue Jiedu decoction on the basis of the regimen selected by the doctor.Peripheral blood was collected,RNA was extracted from peripheral blood,reverse transcribed and cDNA was purified after qualified quality control,and transcriptome sequencing was performed using Illumina sequencing platform.DESeq2 software was used to screen differential long-chain non-coding RNA(lncRNA)and differential expression gene(DEG)between the two groups.The target genes of lncRNA were predicted by cis-regulation,and the results of predicted target genes and sequenced DEG were intercrossed to obtain important target genes and lncrnas regulating them.Gene ontology,Kyoto Encyclopedia of Genes and Genomes and protein interaction network(PPI)analyses were performed.Results Solute carrier family 3 member 2(SLC3A2)and BCL2-like protein 11(BCL2L11)were the important target genes regulated by Yiqi Huoxue Jiedu decoction,and they were regulated by lncRNA SNHG1,MIR4435-2HG and AC108463.3.The DEG regulated by Yiqi Huoxue Jiedu decoction was enriched in the functions of cell metabolism,cell autophagy and protein-DNA binding.Vascular endothelial growth factor receptor signaling pathway,apoptosis,autophagy,choline metabolism in cancer,and mammalian target of rapamycin signaling pathway were enriched.PPI showed that Yiqi Huoxue Jiedu decoction mainly regulated proteins with apoptosis,cell metabolism,DNA repair function,as well as classic oncogene sarcoma gene,mitogen-activated protein kinase 3,etc.Conclusion The targets of Yiqi Huoxue Jiedu decoction in the treatment of PROC patients are SLC3A2 and BCL2L11 regulated by lncRNA SNHG1,MIR4435-2HG and AC 108463.3,thereby regulating the biological behavior of cancer cells such as programmed cell death and the classical pathway of cancer.

Abstract:Objective To investigate the efficacy and safety of new double-tube laryngeal mask airway in the treatment of esophageal and gastric varices sclerotherapy combined with tissue glue injection in patients with liver cirrhosis.Methods A prospective study was conducted on 80 patients with liver cirrhosis who were treated with esophagogastric varices sclerotherapy combined with tissue glue injection under gastroscopy in Beijing Ditan Hospital,Capital Medical University from August 2021 to July 2023.The patients were divided into observation group and control group by random number table method,with 40 cases in each group.The control group was given oxygen inhalation with the mask after the mouth opener placement,and the observation group was given oxygen inhalation with the new double-tube laryngeal mask inserted and connected with the breathing tube.The mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO2),and bispectral index(BIS)were recorded and compared before anesthesia(T1),after laryngeal mask/bite placement(T2),5 min after placement(T3)and at the time of exit from the endoscope(T4).The incidence of adverse reactions and postoperative satisfaction of patients and doctors were compared between the two groups.Results There were no statistically significant differences in age,gender,body mass index,American Society of Anesthesiologists classification,operation time,anesthesia time,and propofol dosage between the two groups(all P＞0.05).There were no significant differences in MAP,heart rate and BIS value between the two groups at each time point(all P＞0.05).At T2,T3,and T4 time points,the SpO2 in the observation group were higher than those in the control group[(96.6±2.4)％vs(94.3±3.3)％,(97.1±2.1)％vs(92.2±3.9)％,(96.1±1.5)％vs(95.3±1.9)％](all P＜0.05).The incidence of hypoxemia in the observation group was significantly lower than that in the control group[2.5％(1/40)vs 20.0％(8/40)](P＜0.05).There were no statistically significant differences in the incidences of other adverse reactions between the two groups(both P＞0.05).The satisfaction of doctors in the observation group was significantly higher than that in the control group[97.5％(39/40)vs 52.5％(21/40)](P＜0.001).There was no statistically significant difference in patient satisfaction between the two groups(P=0.709).Conclusion The new double-tube laryngeal mask airway can ensure oxygenation and has good safety in the treatment of esophageal and gastric varices sclerotherapy combined with tissue adhesive injection in patients with liver cirrhosis.

Abstract:Objective To explore the predictive value of alanine aminotransferase(ALT)jump combined with hepatitis B surface antigen(HBsAg)decline for functional cure in chronic hepatitis B(CHB)patients treated with nucleotide analogues(NAs)sequential pegylated interferon(Peg-IFN)and establish a prediction model.Methods CHB patients who visited the Affiliated Hospital of Xuzhou Medical University from July 2019 to December 2022,were HBsAg positive for more than 6 months,hepatitis B virus(HBV)DNA≤3.3 log10IU/ml and received NAs antiviral therapy for at least 1 year,combined with Peg-IFN for 48 weeks,were retrospectively enrolled.The analysis was based on the baseline to 12 weeks alanine aminotransferase(ALT)jump(2-fold increase from baseline)and HBsAg decline(decrease from baseline).HBsAg response was defined as HBsAg＜3.2 and a decrease of＞1.0 log10IU/ml at 24 weeks.HBsAg＜2.0 log10IU/ml at 48 weeks was used as the efficacy evaluation index,and the predictive factors of HBsAg response were analyzed and a prediction model was constructed.The receiver operating characteristic curve was used to evaluate the model fitting effect.Results A total of 145 CHB patients treated with NAs followed by Peg-IFN were included in the study.Forty of 50 HBsAg responders at 24 weeks had HBsAg＜2.0 log10IU/ml at 48 weeks of treatment,with a positive predictive value(PPV)of 80.0％,and 19 of them(38.0％)achieved HBsAg loss.Multivariate Logistic regression analysis showed that baseline HBsAg(odds ratio=11.306,95％confidence interval:3.959-32.288,P＜0.001),baseline to week 12 ALT jump(odds ratio=3.435,95％confidence interval:1.107-10.659,P=0.033),and HBsAg decreased at 12 weeks(odds ratio=54.775,95％confidence interval:5.941-505.028,P＜0.001)were independent predictors of HBsAg response.The prediction model was established as follows:Logit P=2.425 × baseline HBsAg+4.003 × HBsAg decreased+1.234 × ALT flared-5.776(BHA model),its area under the curve was 0.843,the standard error was 0.037,95％confidence interval:0.769-0.916,according to the calculation formula of Jorden index,the cutoff value of P value was determined to be 0.51,and the sensitivity and specificity of its diagnosis were 86.70％and 67.30％.Conclusion Baseline HBsAg level,ALT jump combined with HBsAg decline at 12 weeks of treat-ment are associated with HBsAg response in CHB patients treated with NAs sequential Peg-IFN.The prediction model constructed by the above indicators can screen out patients who are likely to achieve functional cure at 48 weeks of combination therapy.

Abstract:Objective To investigate the eradication rate and safety of bismuth-based quadruple therapy containing minocycline and levofloxacin in newly diagnosed patients with Helicobacter pylori(Hp)infection.Methods A total of 280 patients with Hp infection who were initially treated in Beijing Jishuitan Hospital,Capital Medical University from January 2022 to October 2023 were enrolled.According to the random number table method,they were divided into minocycline and levofloxacin group(observation group)and amoxicillin and clarithromycin group(control group),with 140 cases in each group.Both groups were combined with rabeprazole and bismuth potassium citrate to form a quadruple regimen for 14 days.The medication safety and compliance of patients were followed up for 3 to 5 days after the end of medication.Hp eradication rate was determined by 13C urea breath test after 4 to 12 weeks.Results Intention-to-treat(ITT)analysis(One case was excluded in the study due to refusal to take medication,afterwards 139 cases in the observation group and 140 cases in the control group)and protocol-following(PP)analysis(after removing the subsequently excluded patients,both the observation group and the control group had 134 cases)showed that the eradication rates of the observation group were higher than those of the control group[ITT analysis:92.1％(128/139)vs 80.7％(113/140),x2=7.667,P=0.006;PP analysis:95.5％(128/134)vs 84.3％(113/134),x2=9.267,P=0.002].Age,sex,body mass index,endoscopic findings and smoking had no significant effect on the eradication rate(all P＞0.05).The proportion of abnormal taste in the observation group was lower than that in the control group(P＜0.05).There was no significant difference in other adverse reactions between the two groups(all P＞0.05).Conclusion The bismuth-based quadruple therapy containing minocycline and levofloxacin has an ideal eradication rate,safety and compliance in Hp naive patients.

Abstract:Objective To explore the risk factors of postoperative delirium in patients with severe multiple fracture trauma,and to establish and verify a nomogram model.Methods A total of 220 patients with severe multiple fracture trauma who were treated and operated in the 910th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army from January 2019 to December 2022 were selected as the modeling set.Another 94 patients with severe multiple fracture trauma from January to December 2023 were selected as the validation set.According to whether delirium occurred,the patients in the modeling set were divided into non-delirium group(147 cases)and delirium group(73 cases).The clinical data of non-delirium group and delirium group were compared.The risk factors of postoperative delirium were analyzed,and the accuracy of the nomogram model was established and verified.Results The age,injury severity(ISS)score,length of intensive care unit(ICU)stay,the proportions of patients with physical restraint,American Society of Anesthesiologists(ASA)gradeⅢ-Ⅳ,mechanical ventilation,and general anesthesia were significantly greater/higher in the delirium group than in the non-delirium group,and the preoperative albumin level was significantly lower in the delirium group than in the non-delirium group(all P＜0.05).Multivariate Logistic regression analysis showed that age ≥ 60 years,preoperative albumin ≤30 g/L,ASA grade Ⅲ-Ⅳ,ISS score ≥21,general anesthesia and ICU stay ≥9 days were independent risk factors for preoperative albumin(all P＜0.05).The receiver operating characteristic curve showed that the area under the curve of the modeling set and the validation set were 0.803(95％confidence interval:0.706-0.875)and 0.818(95％confidence interval:0.678-0.962),respectively,which showed good prediction accuracy.The calibration curve of the nomogram risk prediction model showed that the predictions of the modeling set and the validation set were in good agreement with the observations.The P values of Hosmer-Lemeshow test were 0.405 and 0.669,respectively,and the P values were not significant.Conclusion The nomogram risk prediction model based on age ≥60 years,preoperative albumin ≤30 g/L,ASA grade Ⅲ-Ⅳ,ISS score ≥21,general anesthesia and ICU stay ≥9 days has good accuracy in predicting postoperative delirium in patients with severe multiple fracture trauma,which can be used to guide clinical preventive intervention measures.

Abstract:Objective To explore the effects of levocarnitine combined with maintenance hemodialysis(MHD)on inflammatory factors levels and cardiac function in patients with chronic kidney disease(CKD).Methods A total of 106 CKD patients treated with dialysis in the First Affiliated Hospital of Hebei North University from June 2022 to September 2023 were prospectively selected as the research objects.According to the random number table method,they were divided into the control group and the observation group,with 53 cases in each group.The control group was treated with MHD,and the observation group was treated with levocarnitine combined with MHD.Both groups were treated for 3 months.The levels of inflammatory factors,renal function,cardiac function,Klotho protein and irisin before and after treatment were compared between the two groups,and the correlation between the levels of inflammatory factors and cardiac function indexes was analyzed.Results The improvement of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),left ventricular ejection fraction(LVEF),brain natriuretic peptide,cardiac output,Klotho protein and irisin levels in the observation group were better than those in the control group 3 months after treatment(all P＜0.05).At the same time,the levels of blood uric acid,blood urea nitrogen and serum creatinine in the observation group were lower than those in the control group at 1 month and 3 months after treatment(all P＜0.05).Pearson analysis showed that CRP was positively correlated with brain natriuretic peptide(all P＜0.05).TNF-α was negatively correlated with LVEF and cardiac output,and positively correlated with brain natriuretic peptide(all P＜0.05).IL-6 was negatively correlated with LVEF and cardiac output,and positively correlated with brain natriuretic peptide(all P＜0.05).The incidence of complications during dialysis in the observation group was lower than that in the control group[3.8％(2/53)vs 15.1％(8/53)](P=0.046).Conclusion Levocarnitine combined with MHD treatment in patients with CKD can better improve the inflammatory state,reduce the cardiac load,and reduce the incidence of dialysis-related complications.