Abstract:Objective To investigate the safety and efficacy of minimally invasive left atrial appendage closure(LAAC)combined with catheter ablation(CA)in one-stop treatment of non-valvular atrial fibrillation(NVAF).Methods From August 2022 to July 2023,patients with NVAF who underwent one-stop minimally invasive LAAC combined with CA(one-stop group,20 cases)and only CA(single ablation group,22 cases)in the Department of Cardiology,Maoming People's Hospital,Guangdong Province were retrospectively analyzed.The baseline data,surgical procedures,perioperative complications,postoperative medications and 12-month follow-up results were collected and analyzed.Results The proportion of ischemic stroke history,CHA2DS2-VASc score,HAS-BLED score,left atrial anteroposterior diameter in the one-stop group were higher than those in the single ablation group(all P＜0.05).In terms of perioperative complications,there was 1 case of pseudoaneurysm vascular complication and 2 cases of epistaxis in the one-stop group,and no pericardial effusion and stroke events occurred in the two groups.There was significant difference in the oral administration of single drug between the two groups(P=0.038).In the one-stop group,there were 3 cases of recurrent atrial fibrillation,1 case of bleeding event,and no stroke.There were no recurrent atrial fibrillation,bleeding events and stroke in the single ablation group.Three patients had a residual shunt less than 3 mm at 3 months after surgery,and no patient had a residual shunt greater than 5 mm.Conclusions Minimally invasive LAAC combined with CA one-stop procedure is suitable for patients with high risk of thromboembolism and bleeding.One-stop procedure simplifies the procedure,reduces the risk,does not rely on transesophageal echocardiography,improves operability and safety,and is equivalent to simple CA surgery,and may be more effective in high-risk patients.

Abstract:Objective To investigate the current situation of differences in bleeding risk and risk perception in elderly patients with atrial fibrillation during anticoagulant therapy in the community,so as to provide reference for precise prevention of bleeding in patients.Methods A total of 487 elderly patients with atrial fibrillation who were accepted diagnosis and treatment guidance in Guangdong Provincial People's Hospital from June 2018 to July 2023 were selected as the research objects.The bleeding risk score and disease risk perception level at enrollment were investigated.Multiple linear regression method was used to analyze the influencing factors of bleeding risk and disease risk perception in elderly patients with atrial fibrillation receiving anticoagulant therapy in the community.Results Multivariate linear regression analysis showed that age,etiology of atrial fibrillation and medication were independent influencing factors for bleeding risk of community anticoagulant therapy in elderly patients with atrial fibrillation(standardized regression coefficients were 0.558,0.140,and 0.096,respectively,all P＜0.05).Age,family per capita monthly income,medication,comorbidity of hypertension and comorbidity of hyperglycemia were independent influencing factors of disease risk perception of community anticoagulation therapy in elderly patients with atrial fibrillation(standardized regression coefficients were 0.341,-0.482,0.064,0.059,and 0.100,respectively,all P＜0.05).Conclusion Elderly patients with atrial fibrillation have a high risk of bleeding during anticoagulant therapy in the community,and there is a bias in disease risk perception.The patients are affected by age,medication and comorbidities,which increase the risk of bleeding and reduce the ability of disease risk perception.

Abstract:Objective To explore whether psychological intervention can effectively reduce the incidence of postoperative depression in patients undergoing percutaneous coronary intervention(PCI)during the perioperative period.Methods A total of 266 patients with coronary atherosclerotic heart disease who underwent daytime PCI in Beijing Anzhen Hospital,Capital Medical University from September to October 2023 were enrolled.The patients were randomly divided into the psychological intervention group(136 cases)and the control group(130 cases).Patients in the control group were only given routine nursing during the perioperative period,while patients in the psychological intervention group were given perioperative psychological intervention in addition to routine nursing.The Hamilton Depression Rating Scale(HAMD)24-item version was used to assess patients'depressive mood postoperatively.Patients with HAMD score ≥21 were defined as having postoperative depression.Results The proportion of patients with HAMD score ≥ 21 at discharge in the psychological intervention group was lower than that in the control group[11.8％(16/136)vs 20.8％(27/130)](P＜0.05).The results of multivariate Logistic regression showed that after adjusting for potential confounding factors,psychological intervention was an independent influencing factor for the occurrence of postoperative depression in patients,and had a protective effect(odds ratio=0.41,95％confidence interval:0.20-0.85,P=0.017).Conclusion Perioperative psycho-logical intervention can reduce the incidence of postoperative depression in patients with daytime PCI.

Abstract:Objective To explore the value of magnetocardiography in the evaluation of coronary artery in patients with coronary atherosclerotic heart disease.Methods A total of 165 patients who were hospitalized with chest tightness and/or chest pain in the Department of Cardiology,Beijing Jishuitan Hospital,Capital Medical University from April 1,2024 to December 30,2024 and were suspected of coronary atherosclerotic heart disease were collected.Finally,55 patients were diagnosed with coronary heart disease and 110 patients were excluded from coronary heart disease.All the selected patients completed magnetocardiogram,coronary CT angiography(CTA)and coronary angiography.Taking the results of coronary angiography as the gold standard,the efficacy of magnetocardiogram and coronary CTA in the diagnosis of coronary atherosclerotic heart disease was compared.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of magneto-cardiogram in the diagnosis of coronary atherosclerotic heart disease were 86.7％,83.3％,81.2％,88.2％and 84.8％,respectively;the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of coronary CTA in the diagnosis of coronary atherosclerotic heart disease were 69.9％,65.6％,65.6％,63.6％and 57.7％,respectively.Conclusion Magnetocardiography may become a new method to judge the severity of coronary atherosclerotic heart disease,which can provide more reliable information for patients before coronary angiography.

Abstract:Objective To explore the influencing factors of electronic health literacy and pulmonary nodule detection in health check-up population.Methods A total of 730 healthy people who underwent chest CT examination in the Department of Health Management,the First Affiliated Hospital of Guangxi Medical University from February to August 2023 were selected as the research objects.The general situation and the electronic health literacy scale(eHEALS)questionnaire survey were conducted to obtain research data,and the data of the two groups of people with or without eHEALS scores were compared to analyze the related influencing factors of pulmonary nodule detec-tion.Results The eHEALS qualified group was younger and had higher education level than the unqualified group.The proportions of being single,paying great attention to physical and mental health,exercising occasionally or often and searching online health information were higher than those in the unqualified group(all P＜0.05).The results of univariate binary Logistic regression analysis suggested that age[odds ratio(OR)=1.02,95％confidence interval(CI):1.01-1.03,P=0.001]and married(OR=1.71,95％CI:1.11-2.64,P=0.015)were the risk factors for pulmonary nodule detection.The results of multivariate binary Logistic regression analysis suggested that age was an independent risk factor for pulmonary nodule detection(OR=1.02,95％CI=1.01-1.03,P=0.001).Conclusion The overall age of the eHEALS score eligible population was younger and the education level was relatively higher.Age is an independent risk factor for the detection of pulmonary nodule.

Abstract:Primary biliary cholangitis can combine other immune system diseases,when the two diseases appear at the same time,easily to cause complicated complications.This paper reports a case of a 66-year-old female patient with primary biliary cholangitis in the stage of liver cirrhosis who was admitted to the hospital due to unexplained fever and recurrent thrombocytopenia.After excluding infection,tumor,drug and other causes,the final diagnosis was primary biliary cholangitis,systemic lupus erythematosus,infective endocarditis,and the diagnosis and treatment process was analyzed.On the basis of anti-infection treatment,the patient was given avatrobopag maleate to increase platelet.Systemic lupus erythematosus was treated with corticosteroids,cyclosporine and hydroxychloroquine,and the patient's condition improved and was discharged.Half a year later,no aortic valve vegetation was found by echocardiography in the outpatient follow-up,which was good for clinical reference.

Abstract:Objective To describe the electrophysiological characteristics and ablation strategies of epicardial mitral isthmus-dependent atrial flutter(AFL)mediated by the Marshall ligament.Methods A retrospective study was conducted on 38 patients who underwent atrial fibrillation ablation and developed recurrent AFL radiofre-quency ablation between January 2022 and June 2023 at the Arrhythmia Center,Beijing Anzhen Hospital,Capital Medical University.All patients were diagnosed intraoperatively with epicardial mitral isthmus-dependent AFL mediated by the Marshall ligament through high-density mapping.Intraoperative mapping characteristics,ablation method and follow-up results were analyzed.Results The 38 patients in this study included 30 cases of counter-clockwise reentry around the mitral valve,5 cases of clockwise,and 3 cases of bi-atrial reentry.In all cases,activation mapping demonstrated a"pseudo-focal"activation pattern,with breakthrough points typically located at the ridge between the left pulmonary veins and the left atrial appendage or posterior to the previous endocardial mitral isthmus ablation line.Twenty patients(52.6％)had AFL terminated by ethanol infusion of the vein of Marshall.During a follow-up period of(18±9)months,4 patients(10.5％)experienced recurrences of atrial fibrillation or atrial tachycardia post blanking period.Conclusion Epicardial mitral isthmus-dependent AFL mediated by the Marshall ligament often presents with counterclockwise rotation and has a characteristic activation pattern.ablation can effectively terminate this type of AFL,with a low long-term recurrence rate.

Abstract:Objective To investigate the dynamic changes of macrophage subpopulations and the expressions of CD59 and P2X7 during the process of myocardial infarction in mice.Methods A total of 36 adult male C57BL/6J mice were randomly divided into control group(6 mice without any treatment)and myocardial infarction group(30 mice).A mouse model of acute myocardial infarction was established by ligating the left anterior descending coronary artery,and 30 mice in the myocardial infarction group were randomly divided into groups A,B,C,D,and E,and the samples were collected at 1,3,5,7,and 14 d after myocardial infarction,respectively.The peripheral blood and heart tissues of mice were collected.The dynamic changes of macrophage subpopulations and the expressions of CD59 and P2X7 were detected by flow cytometry.Results The numbers of monocytes in peripheral blood on the 1 and 3 d after myocardial infarction were higher than those in the control group[(9.5±1.7),(10.3±3.7)x 104/ml vs(3.2±3.1)x 104/ml](all P＜0.05).The white blood cell counts and macrophage counts of heart tissue at 1,3 and 5 d after myocardial infarction were higher than those of the control group(all P＜0.05).The Ly6Chigh macrophage count in cardiac tissue peaked at 3 d after myocardial infarction,while the Ly6Clow subset reached a peak at 5 d after myocardial infarction,both of which were higher than those in the control group(all P＜0.05).The percentage of P2X7-CD59-cells in Ly6Chigh cells was higher than that in the control group on 1 d after myocardial infarction,while the proportion of P2X7+CD59+macrophages was lower than that in the control group(all P＜0.05).The percentages of P2X7+CD59+cells in Ly6Clow macrophages at 1,3,and 5 d after myocardial infarction were lower than those in the control group,while the proportion of P2X7-CD59+cells was higher than that in the control group(all P＜0.05).Conclusion At different stages of acute myocardial infarction in mice,the subpopulations of cardiac tissue macrophages show dynamic changes,accompanied by dynamic changes in the expressions of CD59 and P2X7.

Abstract:Objective To evaluate the association between anti-factor Xa activity(AXA)and rivaroxaban blood concentration in elderly patients over 60 years old treated with rivaroxaban,and to establish a linear regression model for the relationship between AXA and blood concentration.Methods This study was a prospective cohort study.Fifty patients aged ≥60 years with complete clinical data and indications for anticoagulant therapy who were hospitalized in the Department of Geriatric Medicine,Peking University First Hospital from March 2022 to March 2023 and received rivaroxaban were enrolled.After continuous administration of rivaroxaban for at least 3 days,blood samples were drawn to detect the trough and peak values of AXA and the trough and peak values of blood drug concentration.Linear regression models were used to evaluate the relationship between AXA and blood concentration.Results In the study population,there was a linear correlation between the trough value of AXA and the trough value of blood concentration.Taking the AXA trough value of rivaroxaban 3 days after administration as the independent variable and the trough value of blood drug concentration as the dependent variable,the linear regression model was constructed,and the following results were obtained:①(y)=10.378+160.185 × trough value of AXA.That was,for every 1 kIU/L increase in the trough value of AXA,the trough value of blood concentration increased by 170.563 μg/L.The determination coefficient was 0.730,the Durbin-Watson test value was 1.845,the model statistical test F=129.538,P＜0.001,and the residual was in accordance with normal distribution.There was a linear correlation between the peak value of AXA and the peak value of blood concentration.Taking the peak value of AXA after taking rivaroxaban for 3 days as the independent variable and the peak value of blood drug concentration as the dependent variable,the linear regression model was constructed,and the following results were obtained:②y=33.600+119.449 × peak value of AXA.That was,when the peak value of AXA increased by 1 kIU/L,the peak blood concentration increased by 153.049 μg/L.The determination coefficient was 0.656,the Durbin-Watson test value was 2.083,the model statistical test F=91.655,P＜0.001,and the residual was in accordance with normal distribution.Conclusion There is a linear regression model between AXA and blood concentration of rivaroxaban.In clinical practice,the predicted bleeding concentration can be calculated by the linear regression model between AXA and blood concentration,which can be compared with the target value to evaluate the anticoagulant strength and guide further treatment.

Abstract:Objective To investigate the relationship of serum lipocalin 2(LCN2)and angiopoietin-like protein 2(ANGPTL2)with pathological features and prognosis in patients with papillary thyroid carcinoma(PTC).Methods A total of 83 PTC patients admitted to Shanxi Province Cancer Hospital from January 2017 to June 2020 were selected as the PTC group,and 83 healthy volunteers were selected as the control group during the same period.The serum levels of LCN2 and ANGPTL2 were detected by enzyme-linked immunosorbent assay.According to the mean levels of serum LCN2 and ANGPTL2 in PTC patients,they were divided into high/low LCN2 and ANGPTL2 groups.The disease-free survival curves of PTC patients with high/low levels of LCN2 and ANGPTL2 were drawn by Kaplan-Meier method.The prognostic factors of PTC patients were analyzed by Cox regression.Results The serum levels of LCN2 and ANGPTL2 in PTC group were higher than those in control group[(193±84)μg/L vs(87±22)μg/L,(5.8±0.7)μg/L vs(4.1±0.4)μg/L](both P＜0.001).The serum levels of LCN2 and ANGPTL2 in PTC patients were significantly different in patients with different TNM stages,lymph node metastasis and distant metastasis(all P＜0.05).The 3-year disease-free survival rate of 83 patients with PTC was 77.1％(64/83).Kaplan-Meier curve analysis showed that the 3-year disease-free survival rate of the high LCN2 group was lower than that of the low LCN2 group,and the 3-year disease-free survival rate of the high ANGPTL2 group was lower than that of the low ANGPTL2 group(all P＜0.05).Multivariate Cox regression analysis showed that TNM stage Ⅲ to Ⅳ,lymph node metastasis,distant metastasis,elevated LCN2 and ANGPTL2 were independent risk factors for poor prognosis of PTC patients(all P＜0.05).Conclusion The serum levels of LCN2 and ANGPTL2 in PTC patients are increased,which are closely related to TNM stage,lymph node metastasis,distant metastasis and prognosis,and may become new markers for evaluating the progression and prognosis of PTC.

Abstract:Objective To investigate the protective effect of apigenin on cardiac function in rats with myocardial infarction and its possible mechanism through deacetylase 3/β-catenin/peroxisome proliferator-activated receptor y(PPARγ)signaling pathway.Methods Forty healthy adult male specific pathogen-free SD rats were randomly divided into sham operation group,myocardial infarction group,apigenin group and apigenin+GW9662(a PPARγ antagonist)group,with 10 rats in each group.Myocardial infarction models were established in all groups except the sham operation group.Then the myocardial infarction group received no other intervention.The apigenin group was intraperitoneally injected with apigenin 5 mg/kg daily for 7 days,and the apigenin+GW9662 group was intraperitoneally injected with GW9662 2 mg/kg daily for 7 days on the basis of the apigenin group.The levels of myocardial enzymes,myocardial morphology,levels of inflammatory factors,apoptosis rate of myocardial cells,and the expression levels of deacetylase 3,β-catenin and PPARγ in myocardial tissue were compared among the groups.Results After the dead rats were removed,6 rats from each group were randomly selected for each test.The levels of creatine kinase isoenzymes and cardiac troponin Ⅰ in myocardial infarction group were significantly higher than those in sham operation group(both P＜0.001).However,the levels of both in apigenin group were significantly lower than those in myocardial infarction group[(41±6)U/L vs(118±14)U/L,(4.6±1.8)ng/L vs(14.2±2.2)ng/L](both P＜0.001).The levels of both in the apigenin+GW9662 group were significantly higher than those in the apigenin group(both P＜0.01).Compared with the myocardial infarction group,the apigenin group had better cell morphology and arrangement,clearer stripes,and less cell necrosis.The levels of interleukin-1β and interleukin-6 in apigenin group were significantly lower than those in myocardial infarction group(both P＜0.01),while the levels of interleukin-1 β and interleukin-6 in apigenin+GW9662 group were significantly higher than those in apigenin group(both P＜0.05).The apoptosis rates of myocardial cells in shamoperation group,myocardial infarction group,apigenin group,and apigenin+GW9662 group were 2.95％,38.78％,12.56％,and 22.33％,respectively.The levels of deacetylase 3 and PPARγ in apigenin group were significantly higher than those in myocardial infarction group,and the level of β-catenin was significantly lower in apigenin group than that in myocardial infarction group(all P＜0.001).The levels of deacetylase 3 and PPARγ in apigenin+GW9662 group were significantly lower than those in apigenin group(P＜0.05 or P＜0.01),and the level of β-catenin in apigenin+GW9662 group was significantly higher than that in apigenin group(P＜0.05).Conclusion Apigenin can significantly improve cardiac function and reduce cardiomyocyte apoptosis after myocardial infarction by activating deacetylase 3/β-catenin/PPARγ signaling pathway.The protective mechanism of apigenin may involve the regulation of this signaling pathway.Activation of PPARγ is essential for the cardioprotective effects of apigenin.

Abstract:Objective To explore the value of perfluorobutyane for injection contrast-enhanced ultrasound combined with serum αL-fucosidase(AFU),forkhead box A1(FOXA1)and clusterin in the differentiation of small hepatocellular carcinoma(SHCC)and focal nodular hyperplasia(FNH)of the liver.Methods A total of 264 suspected patients with SHCC or FNH admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from March 2021 to March 2024 were selected and divided into SHCC group(87 cases)and FNH group(177 cases)according to the results of pathological examination.The perfluorobutyane for injection contrast-enhanced ultrasound was used to compare the related parameters.Enzyme-linked immunosorbent assay was used to detect and compare the expression of serum AFU,FOXA1 and clusterin.The receiver operating characteristic curve was drawn to analyze the diagnostic value of serum AFU,FOXA1 and clusterin for SHCC and FNH.The differential value of perfluorobutane for injection contrast-enhanced ultrasound combined with serum AFU,FOXA1 and clusterin in SHCC and FNH was analyzed by four-grid table.Results The proportion of contrast agent arriving earlier than the surrounding area,contrast agent perfusion defect,and enhancement expansion＞10％in arterial phase in the SHCC group were higher than those in the FNH group,and the proportion of high-enhancement rings in Kupffer phase was lower than that in the FNH group(all P＜0.05).The serum levels of AFU,FOXA1 and clusterin in SHCC group were higher than those in FNH group[(64±6)U/L vs(36±5)U/L,(18.4±2.5)μg/L vs(13.3±2.2)μg/L,(120±16)μg/L vs(84±14)μg/L](t=38.944,16.829,18.925,all P＜0.001).The results of receiver operating characteristic curve analysis showed that the area under the curve of serum AFU,FOX A1 and clusterin in the diagnosis of SHCC and FNH were 0.895(95％confidence interval:0.857-0.934),0.900(95％confidence interval:0.861-0.940)and 0.866(95％confidence interval:0.820-0.913),respectively.The area under the curve of the combination of the three markers for the diagnosis of SHCC and FNH was 0.979(95％confidence interval:0.965-0.994).The accuracy of perfluorobutane for injection contrast-enhanced ultrasound in the detection of SHCC and FNH is higher than that of AFU,FOXA1 and clusterin alone,and slightly lower than that of the combined detection of the four.Conclusion Perfluorobutane for injection contrast-enhanced ultrasound combined with serum AFU,FOXA1 and clusterin can improve the differentiation value of SHCC and FNH.

Abstract:Primary sclerosing cholangitis(PSC)is a chronic cholestatic disease of the biliary tract,which is often accompanied by inflammatory bowel disease(IBD).PSC coexisting with IBD shows different clinical phenotypes,disease outcome and tumor risk from independent diseases,which affects the treatment and manage-ment of the disease.This article reviews the pathogenesis of PSC complicated with IBD,the interaction between the course of disease,and the risk and monitoring of related malignant tumors,in order to enhance clinicians'understanding of the disease and provide new ideas for the clinical research and diagnosis and treatment of PSC complicated with IBD.

Abstract:Objective To analyze the clinical risk factors of lead dislocation in cardiac implantable electronic devices(CIED).Methods A total of 78 patients with lead dislocation after CIED implantation due to arrhythmia from January 2013 to June 2024 in Beijing Anzhen Hospital,Capital Medical University were selected as the lead dislocation group.During the same period,137 patients with arrhythmia who did not have lead dislocation after CIED implantation were randomly selected as the non-dislocation group.The baseline characteristics,laboratory test results and ultrasound results of the two groups were compared.Logistic regression was used to analyze the clinical risk factors of lead dislocation.Results The patients in the lead dislocation group were younger than those in the non-dislocation group[(67±12)years vs(73±10)years],and the proportion of patients with atrioventricular block and cardiac interventional procedure history was higher in the dislocation group than in the non-dislocation group[46.2％(36/78)vs 10.9％(15/137),23.1％(18/78)vs 7.3％(10/137)](all P＜0.05).There were no significant differences in laboratory test results except alanine transaminase between the two groups(all P＞0.05).The left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the lead dislocation group were larger than those in the non-dislocation group,and the left ventricular ejection fraction in the lead dislocation group was lower than that in the non-dislocation group(all P＜0.05).Multivariate binary Logistic regression analysis showed that higher left ventricular end-diastolic diameter(odds ratio=1.43),lower left ventricular ejection fraction(odds ratio=1.07)and history of atrioventricular block(odds ratio=16.74)were independently associated with increased risk of lead dislocation events(all P＜0.01).Conclusion Higher left ventricular end-diastolic diameter,lower left ventricular ejection fraction,and a history of atrioventricular block are independently associated with an increased risk of CIED lead dislocation events.

Abstract:Myocardial infarction remains a major public health challenge,and despite advances in acute treatment and long-term management,the search for innovative therapies to enhance outcomes and improve patient outcomes and quality of life continues.Even though surgical treatment has been quite mature,the incidence of postoperative complications in patients with myocardial infarction is still high,which prompts the medical commu-nity to begin to seek adjuvant treatment options.Oxygen therapy was considered the cornerstone of the treatment of myocardial infarction in the 20th century,but emerging evidence has revealed its limited effectiveness and potential adverse effects in patients with normal oxygen saturation,and this approach is no longer recommended for routine use.Therefore,hypoxia therapy has become a highly anticipated emerging method.Hypoxic adjuvant therapy is to induce adaptive response by exposing patients to hypoxic environment in a controlled and intermittent manner,so as to improve myocardial metabolism,enhance vascular function,and improve exercise endurance.The underlying mechanisms of this therapy involve stabilizing hypoxia-inducible factors,stimulating angiogenesis,and reducing oxidative stress,thereby protecting against ischemic injury and promoting cardiac repair.In conclusion,adjuvant hypoxic therapy provides a promising new approach for the management of myocardial infarction,but more studies are needed to optimize its application and ensure its safety and efficacy.

Abstract:Salt-sensitive hypertension,as a kind of hypertension,is more common in northwest and north-east China,and its pathogenesis is quite complex.Currently,there are explanations for salt-sensitive hypertension that result from long-term use of salt leading to disorders in the renin-angiotensin-aldosterone system,as well as studies from a genetic perspective and those that investigate the activation of receptor signaling pathways.This review will focus on the newly discovered sodium channel of renal subdorsal membrane cells to discuss salt-sensitive hypertension.

Abstract:Objective To investigate the efficacy and safety of programmed cell death protein 1(PD-1)inhibitor combined with chemotherapy in elderly patients with advanced esophageal squamous cell carcinoma.Methods This study was a retrospective cohort study.A total of 95 elderly patients with unresectable locally advanced or metastatic esophageal squamous cell carcinoma diagnosed and treated in Beijing Hospital from October 2019 to December 2022 were consecutively enrolled.The patients were divided into PD-1 inhibitor group(30 cases)and control group(65 cases)according to whether PD-1 inhibitors were used.Both groups were given paclitaxel and cisplatin chemotherapy,and PD-1 inhibitor group was also given PD-1 inhibitor.Paclitaxel and cisplatin chemotherapy and PD-1 inhibitor were given every 3 weeks.The patients were treated until disease progression or intolerance or death.The follow-up ended on December 31,2023.The overall survival,progression-free survival and objective response rate of the two groups were compared,and the important factors affecting overall survival were evaluated by multivariate Cox regression analysis.Results Patients in the PD-1 inhibitor group were relatively older than those in the control group,but the difference was not statistically significant(P＞0.05).During the follow-up period,65 patients died,including 16 cases(53.3％)in the PD-1 inhibitor group and 49 cases(75.4％)in the control group.The overall survival[15.1(12.4,18.9)months vs 11.3(9.2,15.7)months,P=0.002]and progression-free survival[6.6(5.0,7.4)months vs 5.0(3.8,6.6)months,P=0.004]of the PD-1 inhibitor group were longer than those of the control group,and the objective response rate was higher than that of the control group[56.7％(17/30)vs 40.0％(26/65),x2=4.196,P=0.041].There was no significant difference in the incidence of grade ≥3 adverse reactions between the PD-1 inhibitor group and the control group[56.7％(17/30)vs 50.8％(33/65),x2=0.793,P=0.261].Multivariate Cox regression analysis showed that body mass index,Eastern Cooperative Oncology Group score,distant metastasis at enrollment,programmed cell death ligand 1 combined positive score≥1 and PD-1 inhibitor treatment were important factors affecting overall survival(hazard ratio=0.893,0.779,1.730,0.693,0.772;all P＜0.05).Conclusion PD-1 inhibitor combined with chemotherapy has good efficacy and safety in elderly patients with advanced esophageal squamous cell carcinoma.

Abstract:Objective To explore the clinical characteristics of hypertension in patients with myeloprolif-erative neoplasms(MPN).Methods The clinical data of 103 MPN patients[including 61 patients with polycy-themia vera(PV group)and 42 patients with essential thrombocythemia(ET group)]admitted to Beijing Anzhen Hospital,Capital Medical University from May 2010 to May 2020 were retrospectively collected.The prevalence of hypertension and age distribution of patients in PV group and ET group were analyzed,and the differences in clinical characteristics of hypertension patients in the two groups were compared.Results In this study,the overall prevalence of hypertension in MPN patients was 52.4％(54/103),and the relative proportion of hypertension was relatively high in patients aged 55-64 years and 75-84 years,which were 17/27 and 5/7,respectively.However,the hyper-tension patients in the 25-44 years old group were all secondary hypertension in MPN.Patients with hypertension in PV group were younger and had lower platelet count than those in ET group.The proportion of male patients,JAK2V617F gene mutation rate,serum creatinine,hemoglobin and hematocrit in both men and women were higher in PV group than those in ET group(all P＜0.05).Correlation analysis showed that systolic blood pressure was positively correlated with white blood cell count in hypertensive patients in PV group,and left ventricular ejection fraction was negatively correlated with white blood cell count in hypertensive patients in both groups(r=0.453,P=0.047;r=-0.448,P=0.019;r=-0.491,P=0.049).The history of MPN in secondary hypertension patients in PV group was longer than that in ET group.The diastolic blood pressure,serum creatinine in male and female,JAK2V617F gene mutation rate,hemoglobin and hematocrit in secondary hypertension patients in PV group were significantly higher than those in ET group,and the platelet count was lower than that in ET group(all P＜0.05).Conclusion The prevalence of hypertension in MPN patients is higher than that in the general popula-tion,and it is significantly younger.PV and ET patients have different clinical characteristics of hypertension.

Abstract:Objective To investigate the efficacy and safety of trastuzumab combined with apatinib in the treatment of advanced breast cancer.Methods A total of 128 patients with advanced breast cancer admitted to Cangzhou People's Hospital,Hebei Province from January 2022 to February 2024 were selected and divided into observation group and control group by random number table method,with 64 cases in each group.The control group was treated with trastuzumab,and the observation group was treated with apatinib on the basis of the control group.The clinical efficacy,biochemical indexes,serum tumor markers,quality of life and adverse reactions were compared between the two groups.Results The total effective rate and disease control rate of the observation group were higher than those of the control group[29.7％(19/64)vs 12.5％(8/64),60.9％(39/64)vs 34.4％(22/64)](x2=5.680,P＜0.001;x2=9.051,P=0.003).After treatment,the levels of platelet factor 4,midkine,carcinoembryonic antigen,tissue polypeptide specific antigen,carbohydrate antigen 125 and carbohydrate antigen 153 in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).After treatment,the quality of life scores of the two groups were higher than those before treatment,and that in the observation group was higher than that in the control group(all P＜0.05).During the treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Trastuzumab combined with apatinib is effective and safe in the treatment of advanced breast cancer,which can significantly reduce the level of tumor markers and improve the quality of life of patients.

Abstract:Objective To evaluate the bioequivalence and safety of dienogest tablets in Chinese healthy adult female subjects in fasting state.Methods A single center,randomized,open,two-period,double crossover trial design was designed.A total of 24 Chinese healthy adult female subjects were enrolled from February 21 to March 3,2022 in Beijing Anzhen Hospital,Capital Medical University.They were divided into two groups(refer-ence preparation-test preparation group and test preparation-reference preparation group)by random number table method,with 12 people in each group.The two groups took the reference formulation and the test formulation,or the test formulation and the reference formulation(2 mg of denogestrel tablets)in fasting state on the 1st and 8th day,respectively.By collecting biological samples and analyzing the blood drug concentration,the pharmacokinetic parameters of the two drugs were compared,and the bioequivalence was evaluated.At the same time,the clinical safety of the subjects was observed.Results The pharmacokinetic parameters of fasting oral test preparation and reference preparation:the peak plasma concentrations were(52±13)and(54±11)µg/L,respectively,the time to peak concentrations were 1.75(0.50,5.50)and 1.00(0.50,5.50)h,respectively,area under the curve of the blood drug concentration-time from 0 to t were(620±87)and(604±99)h·μg/L,respectively,the area under the curve of the blood drug concentration-time from 0 to infinity were(644±97)and(628±111)h·μg/L,respectively,and the plasma elimination half-life were(9.7±1.5)and(9.8±1.8)h,respectively.The geometric mean ratios of the main pharmacokinetic parameters were within the bioequivalent range of 80％to 125％.During the study period,there were no adverse events leading subjects withdrawal or serious adverse events in both groups.Conclusion The test preparation and reference preparation of dienogest tablets are bioequivalent and have high safety in Chinese healthy adult female subjects under fasting state.