Abstract:In the field of immunology,pregnancy is equivalent to a successful semi-allograft phenomenon,and the maternal immune tolerance to the semi-allograft fetus is related to the outcome of pregnancy.Helper T cells 17(Th17)and regulatory T cell(Treg)are newly discovered subsets of CD4+T lymphocytes.The expression levels of related transcription factor retinoic acid-related orphan receptor γt and forkhead box transcription factor P3 are closely related to the balance between Th17/Treg.The Th17/Treg immune imbalance can lead to abnormal maternal attack on the fetus,resulting in maternal-fetal tolerance disorder,and is related to recurrent miscarriage,preeclampsia,gestational diabetes mellitus and other pathological pregnancy.

Abstract:Acute lung injury often leads to the death of critically ill patients with acute respiratory distress syndrome(ARDS),and immune cell infiltration is regarded as an important sign of ARDS.Alveolar macrophages(AMs)are immune cells that play a role in the pathogenesis of ARDS.AMs participate in the development of diseases mainly by interacting with alveolar epithelial cells(AECs).AMs participate in the development of diseases mainly by interacting with alveolar epithelial cells(AECs).In the early stages of ARDS,activated AMs secrete proinflammatory cytokines to remove pathogens that may disrupt the cellular structure of AECs and cause cell death.In the late stage of ARDS,alternatively activated macrophages secrete anti-inflammatory cytokines that inhibit inflammatory responses and promote epithelial regeneration and alveolar structural remodeling.This article mainly reviews the functions and characteristics of AMs and AECs in ARDS,and describes the interaction between AMs and AECs.

Abstract:Objective To explore the correlation between grip strength and prognosis of patients with heart failure.Methods A total of 560 patients with heart failure in Tangshan Traditional Chinese Medicine Hospital,Hebei Province from June 2015 to June 2017 were selected.According to the tertile of grip strength,the patients were divided into three groups,group 1:grip strength＜18.9 kg(184 cases),group 2:18.9 kg≤ grip strength＜23.5 kg(188 cases),and group 3:grip strength≥23.5 kg(188 cases).The median follow-up time was 3 years.The main end points were all-cause death and heart failure rehospitalization.Kaplan-meier survival analysis was used to determine the relationship between grip strength level and endpoint events.Multivariate Cox regression was used to analyze the correlation between grip strength and prognosis of patients with heart failure.Subgroup analysis was used to explore the effect of grip strength on the outcomes of rehospitalization for heart failure in patients with different heart failure types.Locally weighted scatterplot smoothing(Lowess)curve was drawn to evaluate the relationship between grip strength and the risk of rehospitalization for heart failure.Results A total of 560 patients with heart failure were followed up for 3 years,and 28 cases(5.0％)died from any cause and 113 cases(20.2％)were rehospitalized for heart failure.There was no statistically significant difference in the incidence of all-cause death among the three groups(P=0.074),and the incidence of rehospitalization for heart failure was statistically different[25.0％(46/184),21.3％(40/188),and 14.4％(27/188)](P=0.034).Survival analysis result showed that with the increase of grip strength during follow-up,the incidence of rehospitalization for heart failure was significantly reduced(Log-rank P=0.034).Multivariate Cox regression analysis result showed that after more confounding factors were included,the risk of heart failure rehospitalization in patients with high grip strength was still significantly reduced(group 3 vs group 1,P=0.004).Subgroup analysis of different types of heart failure showed that patients with high grip strength had a significantly lower risk of heart failure rehospitalization in heart failure with reduced ejection fraction and heart failure with preserved ejection fraction(both P＜0.05).There were no significant interactions between heart failure type and grip strength group(interaction P=0.568).Lowess curve showed that grip strength,as a continuous variable,was inversely associated with the risk of heart failure rehospitalization.Conclusion In patients with heart failure,patients with high grip strength have a significantly lower risk of heart failure rehospitalization.

Abstract:Objective To investigate the effect of camrelizumab assisted drug-loaded microspheres in the treatment of primary liver cancer and theirimpacts on serum Golgi glycoprotein 73(GP73),alpha fetoprotein,and alpha fetoprotein heterogeneity-L3(AFP-L3)in patients.Methods A total of 92 patients with primary liver cancer admitted to Baoding No.1 Central Hospital,Hebei Province from January 2022 to January 2024 were selected as the research objects.According to the random number table method,they were divided into combination group and drug-loaded microspheres group,with 46 cases in each group.The drug-loaded microspheres group was treated with drug-loaded microspheres,and the combined group was treated with camrelizumab adjuvant drug-loaded microspheres.Both groups were treated for 12 weeks.The clinical efficacy,levels of tumor markers,liver function indexes,nuclear factor-κB,hypoxia inducible factor-1α(HIF-1α),T lymphocyte subsets and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the objective response rate of the combined group was higher than that of the drug-loaded microspheres group[89.1％(41/46)vs 67.4％(31/46)](P＜0.05).After treatment,the levels of GP73,alpha fetoprotein,AFP-L3,carcinoembryonic antigen,alanine transaminase,aspartate transaminase,total bilirubin,nuclear factor-κB and HIF-1α in the two groups were lower than those before treatment,and those in the combined group were lower than those in the drug-loaded microspheres group;the CD3+,CD4+,and CD4+/CD8+ratio were significantly higher than those before treatment,and those in the combined group were higher than those in the drug-loaded microspheres group(all P＜0.05).There was no significant difference in adverse reactions between the two groups(all P＞0.05).Conclusion Compared with drug-loaded microspheres alone,camrelizumab combined with drug-loaded microspheres has a better short-term effect in the treatment of primary liver cancer,which is helpful to the recovery of liver function,reduces the level of serum tumor markers,and has a certain safety.

Abstract:Infants with critical congenital heart disease face life-threatening conditions immediately after birth.Once the condition worsens,the prognosis is extremely poor.In view of the serious adverse consequences that may result from this critical condition after surgery,in the diagnosis and treatment of a pregnant woman with abnormal cardiac structure of infant admitted to Beijing Anzhen Hospital,Capital Medical University,we chose the multidisci-plinary treatment mode starting surgery immediately after delivery of neonate for the first time to avoid the high risk before surgery.The infant was diagnosed with total anomalous pulmonary venous connection during the mother's pregnancy.After delivering the fetus through cesarean section in our hospital,she was immediately transferred to the cardiac operating room to confirm the diagnosis,complete the necessary preoperative examination,start anesthesia,complete surgical correction,and the operation process and postoperative recovery were smooth.This treatment approach,involving early postnatal surgery,holds the promise of improving the prognosis of infants with critical congenital heart disease,reducing mortality,and enhancing long-term health outcomes.

Abstract:Objective To investigate the efficacy and safety of Xinkeshu capsule combined with low-dose ticagrelor in the treatment of unstable angina pectoris(UAP).Methods A total of 136 UAP patients who were treated in Characteristic Medical Center of Rocket Army from March 2021 to January 2024 were selected.According to the random number table method,they were divided into the control group and the observation group,with 68 cases in each group.The control group was treated with aspirin enteric-coated tablets and low-dose ticagrelor tablets.The observation group was treated with Xinkeshu capsule on the basis of the control group.Both groups were treated for 6 months.The clinical efficacy,traditional Chinese medicine syndrome score,serum levels of interleukin-6(IL-6),C-reactive protein(CRP),malondialdehyde,and glutathione peroxidase(GSH-Px)before and after treatment were compared between the two groups.Bleeding events,cardiovascular events and adverse drug 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[95.6％(65/68)vs 85.3％(58/68)](P=0.041).After 6 months of treatment,the scores of chest pain,chest tightness and palpitation in the two groups were lower than those before treatment,and the scores of traditional Chinese medicine syndromes in the observation group were lower than those in the control group(all P＜0.05).After 6 months of treatment,the serum levels of IL-6,CRP and malondialdehyde in the two groups were lower than those before treatment,and the serum level of GSH-Px was higher than that before treatment(all P＜0.05).The serum levels of IL-6,CRP and malondialdehyde in the observation group were lower than those in the control group,and the serum level of GSH-Px was higher than that in the control group(all P＜0.05).There were no moderate bleeding,severe bleeding and cardiovascular events in the two groups.There was no significant difference in the incidence of mild bleeding and adverse reactions between the two groups(both P＞0.05).Conclusion Xinkeshu capsule combined with low-dose ticagrelor has a good clinical effect in the treatment of UAP,which can effectively improve the inflammatory response and oxidative stress response in patients with good safety.

Abstract:Objective To explore the effects of precise intervention in operating room and whole-course companionship on anxiety and depression in patients undergoing glioma resection in eloquent areas.Methods A total of 88 patients who underwent intraoperative awake functional area glioma resection in Beijing Tiantan Hospital,Capital Medical University from January 2020 to June 2021 were selected.The control group was given routine intervention of intraoperative wake-up surgery,and the observation group was given precise intervention and whole-process accompany on this basis.Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to evaluate patients'anxiety and depression,satisfaction questionnaire was used to evaluate patients'satisfaction with operating room work,and the above indicators were compared between the two groups.Results The SAS and SDS scores of the two groups 3 d after operation were lower than those of the same group 1 d before operation,and the scores of the observation group were lower than those of the control group[between groups:(33.0±3.6)vs(37.8±1.5),(33.9±2.1)vs(35.5±2.2)](all P＜0.05).The total satisfaction of the observation group was higher than that of the control group[97.7％(43/44)vs 86.4％(38/44)](P＜0.001).Conclusion Operating room precise intervention and whole-course companishment can help to reduce the postoperative anxiety and depression of patients with glioma resection in functional area,and improve the satisfaction of patients with operating room related work.

Abstract:Objective To investigate the curative effect of Wenyang Busui decoction combined with Ludangshen oral liquid on cancer-related fatigue(CRF).Methods A total of 146 patients with CRF admitted to Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2021 to January 2023 were selected.According to the random number table method,they were divided into the observation group and the control group,with 73 cases in each group.The control group was treated with Ludangshen oral liquid on the basis of conventional cancer treatment,and the observation group was treated with Wenyang Busui decoction on the basis of the control group.Both groups were treated for 1 month.The Piper fatigue scale score,fatigue degree classification,traditional Chinese medicine syndrome score and curative effect were compared between the two groups before and after treatment.Results After treatment,the scores of behavior,emotion,feeling and cognition of the two groups were lower than those before treatment,and the scores of the observation group were lower than those of the control group(all P＜0.05).After treatment,the degrees of fatigue in the observation group and the control group were lower than those before treatment(all P＜0.001),and that in the observation group was lower than that in the control group(P=0.004).After treatment,the traditional Chinese medicine syndrome scores of the two groups were lower than those before treatment(all P＜0.05),and that in the observation group was lower than that in the control group[(14.4±2.3)vs(19.7±3.4)](P＜0.001).The total effective rate of the observation group was higher than that of the control group[91.8％(67/73)vs 75.3％(55/73)](P=0.007).Conclusion Wenyang Busui decoction combined with Ludangshen oral liquid can effectively improve the clinical symptoms of patients with CRF,reduce the degree of fatigue,and has a definite clinical effect.

Abstract:Carotid artery dissection is a relatively rare disease in clinical practice,and reports of serious adverse cardiovascular events during this procedure are even rarer.Carotid artery stenting(CAS)is widely used in the treatment of carotid artery dissection because of its small trauma and few complications.Once acute circulatory failure occurs,the implementation of effective anesthesia management is particularly key to save the patient's life.This article reports a case of carotid artery dissection patient with complex underlying diseases.Anesthesia management plan for sudden malignant arrhythmia,cardiac arrest,and acute circulatory failure during CAS was implemented.Through the implementation of goal-directed individualized anesthesia management program,the patient was finally rescued and discharged.

Abstract:Objective To investigate the clinical significance of positive anti-nuclear antibody(ANA)in patients with Takayasu arteritis(TA)and its impact on the risk of coronary artery disease.Methods A total of 158 patients with TA and without other immune diseases who were hospitalized in Beijing Anzhen Hospital,Capital Medical University from January 2014 to February 2022 were enrolled.According to the results of ANA,the patients were divided into ANA positive group(46 cases)and ANA negative group(112 cases).The general data,laboratory examination and imaging data of the subjects were collected,and the correlation analysis between the groups was performed.Logistic regression method was used to analyze the related risk factors,and the prediction model was established.Receiver operating characteristic(ROC)curve was used to compare the area under the curve(AUC)of different prediction models,and the clinical significance of positive ANA in patients with TA was analyzed.Results The incidence of hyperlipidemia was higher in ANA positive group than in ANA negative group[23.9％(11/46)vs 7.1％(8/112)](P=0.003).The incidence of coronary artery lesions in ANA positive group was significantly higher than that in ANA negative group[50.0％(23/46)vs 22.3％(25/112)](P=0.001).Multivariate Logistic regression analysis showed that positive ANA and hyperlipidemia were independent risk factors for coronary artery lesions in patients with TA(both P＜0.05).The ROC curve analysis showed that the AUC of the model based on age of onset,gender,course of disease,body mass index,National Institutes of Health(NIH)score and hyperlipidemia history was 0.713(P=0.001),and the AUC of the prediction model increased to 0.761 when ANA was added as a risk factor(P＜0.001).For patients without a history of hyperlipidemia(139 cases),the prediction model was constructed based on multivariate Logistic regression analysis,including age,gender,course of disease,body mass index and NIH score,and the AUC of the baseline model was 0.645(P=0.046),and the AUC increased to 0.709 when positive ANA was added as a risk factor(P=0.004).Conclusion Coronary artery disease should be alert to patients with TA combined with positive ANA,especially in patients without hyperlipidemia.

Abstract:Objective To investigate the inhibitory effect of telmisartan(TEL)on the proliferation of scirrhous gastric cancer(SGC)cells and to explore its mechanism.Methods Routine culture of gastric cancer cells MKN1 and SGC cells HSC45,Cells Count Kit-8 experiment to detect the effect of TEL on the proliferation ability of MKN1 and HSC45 cells.Flow cytometry was used to detect the effects of TEL on apoptosis and cell cycle of HSC45 cells.Western blotting was used to detect the effects of TEL on autophagy and phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/mammalian target of rapamycin(mTOR)signaling pathway related protein expression in HSC45 cells.HSC45 cells were treated with the PI3K/AKT/mTOR signaling pathway activator SC79 and TEL.The effects of TEL on HSC45 cell proliferation,apoptosis,autophagy,and cell cycle were detected,respectively,after activating the PI3 K/AKT/mTOR signaling pathway.Results TEL inhibited the proliferation ability of MKN1 and HSC45 cells in a concentration and time dependent manner(both P＜0.001),and had a significant inhibitory effect on HSC45 cell proliferation(P＜0.05).Compared with the control group,apoptosis rat in HSC45 cells,LC3 Ⅱ/Ⅰ protein expression cell cycle arrest in G0/G1 phase rate in TEL group were higher[(26.2±2.6)％vs(1.3±0.4)％,(1.02±0.09)vs(0.29±0.04),(53.4±3.4)％vs(38.1±2.9)％],and phosphorylated PI3K,AKT and mTOR expressions in TEL group were lower(all P＜0.05).Compared with the control group,proliferation rate,apoptotic rate,LC3 Ⅱ/Ⅰ protein expression,and cell cycle arrest in G0/G1 phase rate in TEL group and TEL+SC79 group were higher,while those in the TEL+SC79 group were lower than the TEL group(all P＜0.05).Conclusion TEL downregulates the PI3K/AKT/mTOR signaling pathway,and promotes SGC cell apoptosis,autophagy,and cycle arrest,thereby inhibiting SGC cell proliferation ability.

Abstract:Depressive disorder and anxiety disorder are closely related to insomnia,which is the most common cause of insomnia and brings serious trouble to patients' family,society,work or study.It is very impor-tant to accurately evaluate the sleep status of patients with depression and anxiety disorders and give corresponding treatment measures in time.This article reviews the latest research progress on the pathogenesis of depression,anxiety disorder and insomnia,in order to deepen the clinicians' understanding of depression,anxiety disorder and insomnia,and provide references for clinical diagnosis and treatment.

Abstract:Objective To evaluate the correlation between triglyceride glucose(TyG)index and recur-rence of atrial fibrillation after catheter ablation in heart failure patients with preserved ejection fraction(HFpEF),and to explore a new risk stratification index for atrial fibrillation recurrence.Methods This study is based on a prospective,multicenter Chinese atrial fibrillation registry,which included 413 atrial fibrillation patients who underwent catheter ablation for the first time between August 2011 and December 2020 and met the diagnostic criteria for HFpEF.TyG index was calculated by comparing baseline triglycerides with fasting plasma glucose.The primary outcome was recurrence of atrial fibrillation after a 90d blank-period.Patients were stratified according to the first and third quartiles of TyG index(Q,:8.44,Q3:8.96)and divided into low TyG index group(TyG index＜8.44,137 cases),medium TyG index group(TyG index 8.44-8.96,139 cases),and high TyG index group(TyG index＞8.96,137 cases).Kaplan-Meier survival analysis and multivariate adjusted Cox proportional hazards regression model were used to evaluate the association between TyG index and atrial fibrillation recurrence.Results The average age of 413 patients was(61±11)years old,and 253 cases(61.3％)were male.During a median follow-up of 810 d,256 cases(62.0％)developed recurrent atrial fibrillation events.Each one-standard-deviation increase in the TyG index was associated with a 29％higher risk of atrial fibrillation recurrence[adjusted hazard ratio(HR)=1.29,95％confidence interval(CI):1.07-1.55,P=0.007].Restricted cubic spline model analysis showed that TyG index had a dose-response relationship with the risk of recurrence.Compared with the low TyG index group,patients in the medium and high TyG index group had a 74％(adjusted HR=1.74,95％CI:1.21-2.50,P=0.003)and 106％(adjusted HR=2.06,95％CI:1.36-3.13,P=0.001)increased risk of recurrence,respectively(P for trend=0.001).Conclusions In atrial fibrillation patients with HFpEF,elevated TyG index is associated with a significantly increased risk of atrial fibrillation recurrence after catheter ablation,and there is a dose-response relationship.TyG index,as an economic and practical indicator of insulin resistance,can be used to guide the risk stratification and individualized management of recurrence in this population.

Abstract:Objective To investigate the risk factors of frailty in elderly patients with unstable angina pectoris(UA)and its effect on prognosis.Methods A total of 255 elderly patients with UA admitted to Inner Mongolia Autonomous Region People's Hospital from January 2021 to December 2023 were selected.According to the presence or absence of frailty,the patients were divided into frailty group and non-frailty group,and the incidence of major adverse cardiovascular events(MACE)was recorded during 1-year follow-up.The clinical data of elderly UA patients were collected,and the risk factors for frailty in elderly UA patients were analyzed by multivariate Logistic regression method and a nomogram model was constructed.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Receiver operating characteristic(ROC)curve was used to calculate the area under the curve to evaluate the predictive ability of the model.C-index was used to evaluate the discrimination ability of the model.The calibration curve was used to evaluate the consistency of the model.The decision curve was used to evaluate the net benefit of the model.The Kaplan-Meier survival curve was used to compare the incidence of MACE between the frailty group and the non-frailty group.Results The incidence of frailty in 255 elderly patients with UA was 45.1％(115/255).Age,Canadian Cardiovascular Society(CCS)grade Ⅲ-Ⅳ,comorbidity,polypharmacy,sleep disorders,decreased activities of daily living,nutritional risk and cardiac troponin T(cTnT)were independent risk factors for frailty in elderly patients with UA(all P＜0.05).A nomogram model was constructed based on the above independent risk factors,and the Hosmer-Lemeshow test showed P＞0.05.ROC curve and model evaluation showed that the area under the curve of the nomogram model for predicting frailty in elderly UA patients was 0.891,and the consistency index was 0.891.The calibration curve and decision curve showed that the prediction probability of the nomogram model fitted the ideal curve,and the net clinical benefit was greater than 0 when the threshold probability was greater than 0.11.The Kaplan-Meier survival curve showed that the incidence of MACE in the frail group was higher than that in the non-frail group(P＜0.05).Conclusion Age,CCS classification,comorbidity,polypharmacy,sleep disorders,reduced activities of daily living,nutritional risk,and cTnT are risk factors for frailty in elderly UA patients,which have a significant adverse impact on the prognosis.The nomogram prediction model based on risk factors has high predictive value,discrimination ability,consistency and clinical applicability for elderly UA patients complicated with frailty.

Abstract:Objective To investigate the relationship between the expression of serum microRNA(miR)-330-5p and Toll-like receptor 4(TLR4)and neuroinflammatory response and prognosis in children with status epilepticus(SE).Methods A total of 98 children with SE admitted to 3201 Hospital from January 2021 to November 2023 were selected as the SE group.According to the prognosis 28 days after admission,they were divided into poor prognosis group(37 cases)and good prognosis group(61 cases),and 40 healthy children in the same period were selected as the control group.The levels of serum miR-330-5p,TLR4 and neuroinflammatory markers[interleukin 1 β(IL-1β),IL-6 and tumor necrosis factor α(TNF-α)]were detected.The binding sites of miR-330-5p and TLR4 were predicted by online websites.The correlation between serum miR-330-5p and TLR4 was analyzed by Pearson correlation coefficient.The prognosis of children with SE was used as the dependent variable,and multivariate Logistic regression analysis was used to determine the influencing factors.The receiver operating characteristic curve was used to analyze the predictive value of serum miR-330-5p and TLR4 in the poor prognosis of children with SE.Results Compared with the control group,the expression of serum miR-330-5p in the SE group was decreased,and the expressions of TLR4,IL-1β,IL-6 and TNF-α were increased(all P＜0.001).There was a binding site between miR-330-5p and TLR4 3′-untranslated region 5310-5317.The expression of serum miR-330-5p was negatively correlated with the expression of TLR4,IL-1β,IL-6,TNF-α in children with SE(r=-0.686,-0.672,-0.646,-0.687,all P＜0.001),the expression of TLR4 was positively correlated with the expression of IL-1β,IL-6 and TNF-α(r=0.711,0.679,0.701,all P＜0.001).The onset time of SE≥1 h[odds ratio(OR)=4.317,95％confidence interval(CI):1.011 to 18.435],the increased severity score of SE(OR=2.749,95％CI:1.392 to 5.428),and the increased levels of IL-1 β(OR=1.067,95％CI:1.010 to 1.127),IL-6(OR=1.137,95％CI:1.014 to 1.275),TNF-α(OR=1.343,95％CI:1.051 to 1.716)and TLR4(OR=2.375,95％CI:1.133 to 4.978)were independent risk factors for poor prognosis of SE children,and the increased level of miR-330-5p was an independent protective factor(OR=0.933,95％CI:0.888 to 0.980)(all P＜0.05).The area under the curve(AUC)of serum miR-330-5p and TLR4 expression alone and in combination for predicting poor prognosis in children with SE were 0.794(95％CI:0.700 to 0.869),0.797(95％CI:0.703 to 0.871),and 0.881(95％CI:0.800 to 0.938)in order,and the binomial joint prediction AUC was the largest(both P＜0.05).Conclusion Low expression of serum miR-330-5p and high expression of TLR4 are closely related to increased neuroinflammation and poor prognosis in children with SE.The combination of serum miR-330-5p and TLR4 has a high predictive value for poor prognosis in children with SE.

Abstract:Objective To investigate the relationship between systolic pulmonary arterial pressure(SPAP)and prognosis in pregnant women with shunt-related congenital heart disease-associated pulmonary hyper-tension(PH).Methods The clinical data of 254 pregnant women with shunt-related congenital heart disease-associated PH in Beijing Anzhen Hospital,Capital Medical University from January 2010 to July 2020 were retro-spectively analyzed.The patients were divided into non-drug treatment group(131 cases)and drug treatment group(123 cases)according to whether they needed postoperative drug treatment.The basic characteristics and perioperative management data of the two groups were compared.SPAP was estimated by echocardiography,and the correlation between SPAP and postoperative medication was evaluated by regression model,curve fitting and threshold saturation effect analysis.Results The body mass index and gestational age of the drug treatment group were less than those of the non-drug treatment group,the intraoperative infusion volume was less than that of the non-drug treatment group,and the proportion of New York Heart Association heart function grades Ⅲ-Ⅳ,SPAP levels,and the proportion of tricuspid valve regurgitation were higher than those in the non-drug treatment group(all P＜0.001).After adjusting for possible confounding factors,there was a non-linear correlation between SPAP and postoperative medication,and the turning point of SPAP was 90 mmHg.When SPAP≤90 mmHg,the risk of postoperative drug therapy increased with the increase of SPAP(odds ratio=1.06,95％confidence interval:1.02-1.09,P=0.001).When SPAP＞90 mmHg,there was no significant correlation between SPAP and postoperative medication(odds ratio=0.99,95％confidence interval:0.96-1.02,P=0.478).Compared with women with SPAP≤90 mmHg,those with SPAP＞90 mmHg have a higher risk of postoperative drug therapy(odds ratio=3.06,95％confidence interval:1.14-8.06,P=0.023).Conclusions Puerperae with severe PH have a high risk of requiring drug therapy after surgery.For mild to moderate patients,it is necessary to be vigilant,prepare for drug treatment and improve pulmonary artery pressure as soon as possible to reduce the risk of pregnancy.For these patients,individualized assessment of multiple factors is more important.

Abstract:Objective To analyze the effect of role stress on work engagement of emergency physicians in specialized tertiary comprehensive hospitals by improving organizational justice.To summarize the main experiences and practices from the aspects of emergency medicine talent team construction,discipline construction,and performance distribution,and to provide some suggestions for improving the work engagement of emergency physi-cians in public hospitals.Methods A random cluster sampling method was used to select emergency physicians from Beijing Anzhen Hospital,Capital Medical University and 7 other public tertiary hospitals in Beijing as the research objects.The survey was conducted by means of network electronic questionnaire,and 221 respondents with valid questionnaires were collected as the research objects(hereinafter referred to as subjects).The role stress,work engagement and organizational Justice scale were used to investigate the subjects.SPSS 22.0 was used for descriptive analysis and correlation analysis,and structural equation model was used to verify the theoretical research hypothesis(the negative correlation between role stress and work engagement of emergency physicians,and the moderating effect of organizational justice on the three-dimensional relationship between role stress and work engagement).Results Most of the 211 subjects were female,totaling 128 people,accounting for 57.92％.Most of the emergency physicians had higher education,with master's degree accounting for 48.87％,followed by university,accounting for 29.86％,the two accounted for more than 50.00％,and 75.11％of the subjects were ordinary workers without duties.The proportion of emergency specialists in subjects was 66.06％,and they were the main force engaged in specific emergency work.The results of structural equation model validation showed that the hypotheses were all valid.There was a strong negative correlation between role stress and work engagement in emergency physicians,and organizational justice moderated the relationship between role stress and work engagement.The standardized fit index was 0.812,and the standardized fit index was 0.862,indicating that the model fit was good.Conclusion There is still room for improvement in the work engagement of emergency physi-cians in specialized tertiary comprehensive hospitals,and improving their sense of organizational justice is the key link.Managers can adjust the impact of role stress on work engagement of emergency physicians by increasing salary,improving working environment and other organizational justice measures,so as to improve their work engagement level.

Abstract:This case report is of a patient with acute exacerbation of chronic obstructive pulmonary disease and multidrug resistant Pseudomonas aeruginosa infection.Moxalactam,ceftazidime and etimicin sulfate injection were given successively for anti-infective treatment,but the symptoms were not improved.Combined with the results of sputum culture suggesting Pseudomonas aeruginosa(mucoid type),the clinical pharmacist suggested adjusting the antibacterial drug to meropenem,and replacing sodium valproate sustained-release tablets with leveti-racetam tablets.Azithromycin tablets were added because the infection index of the patient was still high,although the infection index decreased after 3 d of treatment.After treatment,the symptoms and positive signs of the patient disappeared,and the patient was cured and discharged.Clinical pharmacists should actively communicate with clinicians according to the pharmacological effects,pharmacokinetics/pharmacodynamic characteristics of antibiotics,and auxiliary medication precautions in combination with the patient's condition and pathogenic characteristics,so as to develop personalized and accurate dosing regimens for patients and guide clinical rational drug use.

Abstract:Traditional Chinese medicine pediatrics play a great role in clinical work.It is of great signifi-cance to unearth the advantages and characteristics of traditional Chinese medicine pediatrics,sort out,select,and promote the advantage disease categories of traditional Chinese medicine pediatrics for clinical work.The Chinese Society of Traditional Chinese Medicine organizes a series of youth forums on the clinical advantage diseases to explore the advantages and features of traditional Chinese medicine diagnosis and treatment,condense the scientific problems related to traditional Chinese medicine solving clinical problems,and provide support for the precise development of traditional Chinese medicine.This expert discussion paper discusses the scope,significance,and suggestions for building the advantage disease categories of traditional Chinese medicine pediatrics from three perspectives.It is hoped that fellow practitioners and administrative departments will pay attention to and promote the progress of the advantage disease categories of traditional Chinese medicine pediatrics.This will greatly benefit the people's health and the revitalization and development of traditional Chinese medicine pediatrics.

Abstract:Objective To investigate the relationship between serum brain natriuretic peptide(BNP),ferritin and insulin-like growth factor-1(IGF-1)levels and bronchopulmonary dysplasia(BPD)in preterm infants,in order to provide a scientific basis for the diagnosis of BPD.Methods A total of 80 premature infants admitted to the First Affiliated Hospital of Hebei North University from May 2021 to May 2023 were selected.According to the presence or absence of BPD within 28 days after birth,the preterm infants were divided into BPD group(38 cases)and non-BPD group(42 cases).According to the severity of BPD,the infants in the BPD group were divided into mild group(14 cases),moderate group(13 cases),and severe group(11 cases).Blood samples were collected from each subject,and their basic clinical information was collected.Serum levels of BNP,ferritin and IGF-1 were measured by enzyme-linked immunosorbent assay.The differences between BPD group and non-BPD group and between different severity subgroups of BPD were compared.Logistic regression was used to analyze the risk factors for BPD in preterm infants.Results The levels of serum BNP and ferritin in BPD group were higher than those in non-BPD group[(1 429±408)mg/L vs(137±33)mg/L,(372±120)μg/L vs(160±50)μg/L],and the level of IGF-1 was lower than that in non-BPD group[(26±8)μg/L vs(37±12)μg/L](all P＜0.05).The serum levels of BNP and ferritin in preterm infants with different severity of BPD rised with the severity of the disease,with mild group＜moderate group＜severe group;the level of IGF-1 reduced with the severity of the disease,with mild group＞moderate group＞severe group,and the differences between any two groups were statistically significant(all P＜0.05).The duration of mechanical ventilation,length of hospital stay,duration of continuous positive airway pressure,and the proportion of neonatal pneumonia and neonatal asphyxia in BPD group were higher than those in non-BPD group(all P＜0.05).Logistic regression analysis showed that serum levels of BNP and ferritin,duration of mechanical ventilation,and duration of continuous positive airway pressure were risk factors for BPD in preterm infants,while IGF-1 level was a protective factor(all P＜0.05).Conclusions The levels of serum BNP and ferritin in preterm infants with BPD are increased,and the level of IGF-1 is decreased.The three levels can be used as indicators of BPD,which are of great significance in evaluating the condition of preterm infants with BPD.