Abstract:Objective To compare the effects of Propofol versus Remazolam combined with low-dose Esketamine anesthesia on hemodynamics and stress response in patients undergoing hysteroscopic surgery.Methods A total of 140 patients undergoing hysteroscopic surgery from October 2022 to October 2023 were prospectively selected and divided into group P(n=70)and group R(n=70)using a sealed-envelope method.Group P was treated with Esketamine combined with Propofol during the induction period,and group R was treated with Esketamine combined with Remazolam during the induction period.The duration of anesthesia induction and time to postoperative emergence,hemodynamic parameters[systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse oxygen saturation(SpO2),heart rate]upon entering the room(T0),at 2 min after anesthetic administration(T1),after examination(T2),after vaginal dilator withdrawal(T3),and at emergence(T4),stress response indicators[adrenaline,cortisol]before operation and at 30 m after operation,degree of sedation and agitation during the recovery period[Ramsay sedation scale(RSS)score,postoperative emergence agitation/delirium(PEAD)score],and occurrence of adverse reactions during the recovery period were compared between the two groups.Results There was no significant difference in duration of anesthesia induction and time to postoperative emergence between the two groups(P＞0.05),nor significant difference in SBP,DBP,SPO2 and heart rate between the two groups at T0,T1,T2,T3 and T4(P＞0.05).At 30 min after operation,epinephrine and cortisol in group R were lower than those in group P(P＜0.05),and there was no significant difference in RSS score between group R and group P during the recovery period(P＞0.05).The PAES score of group R was lower than that of group P(P＜0.01),and there was no significant difference in the incidence of SpO2 reduction,nausea and vomiting,and drowsiness between the two groups(P＞0.05).The incidence of agitation in group R was lower than that in group P(P＜0.05).Conclusion The anesthetic effects of Remazolam combined with low-dose Esketamine and Propofol combined with low-dose Esketamine are comparable,both stabilizing intraoperative hemodynamics.However,the former is more effective in alleviating perioperative stress response and decreasing the incidence of emergence agitation.

Abstract:Objective To analyze the high-frequent ultrasonic characteristics of early joint lesions in patients with psoriatic arthritis(PsA)without skin lesions and the causes of misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 2 patients with PsA without skin lesions who were admitted from March 2023 to October 2024.Results Both of the two patients presented with knee joint pain,accompanied by pain in the joints of both hands.At the initial examination,no rashes were observed.The high-frequency ultrasound examination results showed one case of synovitis with effusion in both knee joints,and osteophyte formation in both knees,and one case of bilateral knee joint effusion,with the right side being more prominent,with thickening of the right knee synovium and a cyst inferolateral to the right popliteal fossa.Both patients were initially misdiagnosed as having arthritis and received corresponding treatments but without any improvement.In one patient,a red rash and scales appeared on the scalp,accompanied by itching;in the other patient,the fingernails of ten fingers showed varying degrees of thimble-like changes and longitudinal ridges,and a strip-like rash was observed at the 9-10 o'clock position around the umbilicus.No rashes were found in other areas.After relevant examinations,they were diagnosed with PsA.After adjusting the treatment,the joint pain of the patients was relieved,and the rash completely disappeared after 6 months.Conclusion In the early stage of PsA without skin lesion manifestations,there are no typical skin lesions.However,high-frequency ultrasound can reveal changes such as synovitis,joint effusion,thickening of the synovium,and popliteal cysts.The main reason for misdiagnosis is that patients have no obvious skin lesion symptoms.Clinicians should enhance their understanding of this disease and pay attention to skin and nail examinations for patients with unexplained joint pain.Combined with auxiliary methods such as high-frequency ultrasound,the rate of misdiagnosis can be reduced.

Abstract:Objective To investigate the effect of minimally invasive endoscopic channel system for spine-assisted thoracoscopic lumbar interbody fusion(TLIF)on intervertebral foramen morphology,lumbar pain and function in patients with lumbar disc herniation(LDH).Methods A prospective study was conducted on 76 patients with LDH who were admitted from January to December 2023.According to the random number table method,they were divided into minimally invasive group and traditional group,with 38 patients in each group.The traditional group underwent open TLIF,while the minimally invasive group underwent TLIF assisted by minimally invasive endoscopic channel system for spine.Perioperative indicators and postoperative complications were compared between the two groups,as well as changes in lumbar pain,lumbar function,intervertebral foramen,paraspinal muscles,and spinal pelvic morphology parameters before and after surgery.Results The intraoperative blood loss and postoperative drainage volume in the minimally invasive group were less than those in the traditional group,and the duration of operation and time to the first postoperative ambulation were shorter than those in the traditional group(P＜0.01).The visual analogue scale(VAS)pain score in the minimally invasive group was lower than that in the traditional group at 7 d,1 month,3 months and 6 months after operation(P＜0.05).At 3 and 6 months after operation,the intervertebral space height,intervertebral foramen height,intervertebral foramen area,cross-sectional area of multifidus muscle and lumbar lordosis angle in the minimally invasive group were larger than those in the traditional group,while the distance from multifidus muscle to lamina and pelvic tilt angle were smaller than those in the traditional group(P＜0.05).The Oswestry disability index of the minimally invasive group was lower than that of the traditional group at 3 and 6 months after operation,and the scores of the Japanese Orthopaedic Association and the health survey summary evaluation scale were higher than those of the traditional group(P＜0.05).The overall incidence of complications was lower in the minimally invasive group than that in the traditional group(P＜0.05).Conclusion Minimally invasive endoscopic channel system for spine-assisted TLIF in the treatment of LDH has less trauma,faster postoperative recovery,and can relieve pain,which is conducive to the improvement of intervertebral foramen,paraspinal muscle,spine and pelvis morphology,early recovery of lumbar function and improvement of quality of life.

Abstract:Objective To investigate the causes of chronic obstructive pulmonary disease(COPD)misdiagnosed as atrial septal defect(ASD),and to summarize the echocardiographic characteristics and differential points of misdiagnosed cases.Methods The clinical data of 2 patients with COPD misdiagnosed as ASD from March 2022 to May 2024 were retrospectively analyzed.Results One male patient presented with exertional dyspnea for 4 years,which was worsened in the past week.Echocardiography revealed right heart enlargement and tricuspid regurgitation,leading to a misdiagnosis of secundum ASD with a planned interventional occlusion procedure.Further pulmonary function tests demonstrated severe obstructive ventilatory impairment[forced expiratory volume in one second/forced vital capacity ratio(FEV1/FVC)52％].Chest CT showed diffuse emphysema and centrilobular bullae.A right-heart contrast echocardiogram excluded an intracardiac shunt.The final diagnosis was"acute exacerbation of COPD,chronic pulmonary heart disease combined with type Ⅱ respiratory failure."The duration of misdiagnosis was 4 years.After prompt adjustment of the treatment plan to standardized COPD management,the patient's dyspnea significantly improved,and coughing decreased within 3 days.Upon discharge on the 10th day of hospitalization,pulmonary function FEV1/FVC had improved to 56％.During the 6-month follow-up,the patient adhered to inhaled bronchodilator therapy and home oxygen therapy,with no recurrence of acute exacerbations.One female patient was admitted with"recurrent palpitations and lower limb edema for 2 years."Echocardiography showed right ventricular hypertrophy,pulmonary hypertension,and an interrupted atrial septal echo,leading to a misdiagnosis of secundum ASD with right heart overload and chronic right heart failure.Intensive diuretic therapy was initiated.After 3 days of treatment,the patient's resting dyspnea showed no significant improvement.Further right-heart contrast echocardiography revealed no intracardiac shunt.Blood gas analysis indicated hypoxemia and hypercapnia.Combined with a long-term smoking history,pulmonary function(FEV1/FVC 65％),and CT findings of emphysema,the final diagnosis was Global Initiative for Chronic Obstructive Lung Disease(GOLD)grade 3 COPD,chronic pulmonary heart disease combined with type Ⅱ respiratory failure.The duration of misdiagnosis was 2 years.The ASD-related treatment plan was immediately discontinued and switched to comprehensive management for COPD and pulmonary heart disease.At 5 d after treatment,lower limb edema subsided to the ankle level,and palpitations were relieved.The patient was discharged at 14 d after hospitalization,with a discharge pulmonary function FEV1/FVC of 67％.During the 1-year follow-up,the patient adhered to inhaled bronchodilator therapy and home oxygen therapy and was not re-hospitalized for heart failure.Conclusion In COPD patients with abnormal right heart function,the ultrasonographic manifestations are easily confused with ASD.Clinical analysis should be combined with pulmonary function,chest CT and right heart echocardiography to avoid misdiagnosis caused by cardiac ultrasound alone.

Abstract:Ginkgo biloba has various active ingredients,primarily including flavonoid glycosides,terpene lactones,and ginkgolic acids.The extracts of Ginkgo biloba have various pharmacological effects such as antioxidant,anti-aging,antidepressant,antibacterial,antiviral and anti-tumor activities.Malignant tumors are related to numerous factors such as environment,living habits,chronic inflammation and genetic susceptibility.At present,the treatment of malignant tumors is still a challenge to be overcome in clinical practice.The optimization of relevant diagnosis and treatment strategies and individualized treatment programs are the focus of medical attention.This article describes the pharmacological effects and application prospects of active ingredients of Ginkgo biloba,and analyzes its potential mechanism of efficacy in the treatment of malignant tumors,so as to provide ideas for clinical optimization of malignant tumor treatment programs and exploration of feasible adjuvant treatment methods.

Abstract:Objective To analyze the effect of peritoneal dialysis(PD)on intestinal mucosal barrier function,volume load and residual kidney function in patients with uremia.Methods A total of 100 patients with uremia were selected as study subjects from June 2023 to May 2024.They were divided into PD group(n=50)and non-PD group(n=50)according to the use of PD.Meanwhile,40 healthy individuals who received health check-ups in the hospital were selected as the control group.The levels of intestinal mucosal barrier function indicators[bacterial endotoxin,diamine oxidase(DAO),D-lactic acid and secretory immunoglobulin A(SIgA)]in the three groups were measured.The volume load indicator[inferior vena cava diameter(IVCD)]was detected by ultrasound,and the residual kidney function indicator[glomerular filtration rate(GFR)]was calculated.Spearman correlation analysis was conducted to explore the relationship of PD with intestinal mucosal barrier function,volume load,and residual renal function in patients with uremia.Results Compared with the control group,the PD group showed higher levels of bacterial endotoxin and D-lactic acid,larger IVCD,lower sIgA levels,and lower GFR(P＜0.05).Compared with the non-PD group,the PD group exhibited higher bacterial endotoxin levels and lower GFR(P＜0.05).In patients with uremia,PD was positively correlated with bacterial endotoxin(r=-0.372,P＜0.001),D-lactic acid(r=-0.396,P＜0.001)and IVCD(r=-0.331,P＜0.001),and positively correlated with sIgA(r=0.296,P=0.007)and GFR(r=0.405,P＜0.001).Conclusion There is a significant correlation of PD with intestinal mucosal barrier function,volume load,and residual kidney function in patients with uremia.Clinically,corresponding measures should be taken to reduce the influence of PD on intestinal mucosal barrier function,residual kidney function and volume load.

Abstract:Objective To investigate the influencing factors of major adverse cardiovascular events(MACE)in non-obstructive hypertrophic cardiomyopathy(NHCM)and to construct and validate a nomogram prediction model.Methods A total of 200 NHCM patients admitted from September 2021 to September 2022 were selected as the modeling set.According to the ratio of 7∶3,86 NHCM patients admitted from October 2022 to October 2023 were selected as the validation set.Patients in the modeling set were divided into MACE group(n=55)and non-MACE group(n=145)according to whether MACE occurred within 2 years.The general data and myocardial work parameters measured by echocardiography were compared between MACE group and non-MACE group.Logistic regression was used to analyze the influencing factors of MACE in NHCM patients,and the rms package of R software(version 4.3.0)was used to construct the nomogram prediction model.Calibration curve was drawn to evaluate the calibration of the prediction model;the receiver operating characteristic(ROC)curve was drawn to evaluate the discrimination of the prediction model,and the validation set data was used for external verification.Results The age,proportion of patients with unexplained syncope,atrial fibrillation,heart failure,and fragmented QRS waves(fQRS),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in the MACE group were higher than those in the non-MACE group,while the left ventricular ejection fraction(LVEF),global work index(GWI),gross conbustible work(GCW),and global work efficiency(GWE)were lower than those in the non-MACE group(P＜0.05,P＜0.01).Age,unexplained syncope,atrial fibrillation,heart failure,fQRS,and NT-proBNP were risk factors for MACE in patients with NHCM,while LVEF,GWI,GCW,and GWE were protective factors.After adjusting for age,unexplained syncope,atrial fibrillation,heart failure,fQRS,NT-proBNP,and LVEF,GWI,GCW,and GWE remained protective factors for MACE in patients with NHCM(P＜0.05,P＜0.01).The area under the curve(AUC)of the new nomogram prediction model established by combining conventional influencing factors with GWI,GCW,and GWE was 0.940(95％CI:0.902,0.977).Calibration curve and ROC curve showed that the new nomogram prediction model had high calibration and predictive performance for MACE.Conclusion GWI,GCW and GWE are still protective factors for MACE in NHCM patients after adjusting for conventional influencing factors.The nomogram prediction model established by the combination of GWI,GCW and GWE with conventional influencing factors has good predictive ability and high accuracy in the validation set,which can provide reference for clinical MACE prevention and treatment decisions.

Abstract:Objective To analyze the misdiagnosis causes and preventive measures of posterior circulation cerebral infarction(PCCI)as schizophrenia,vestibular neuritis,or Meniere's disease.Methods Clinical data of 3 patients with PCCI that had been misdiagnosed and then treated from June 2020 to June 2023 were retrospectively analyzed.Results One patient presented with visual hallucinations and speech-behavioral disorders for 7 d.The patient was initially diagnosed with schizophrenia,and treated accordingly,but the symptoms were not improved.After admission,according to the clinical symptoms,specialized examination and cranial magnetic resonance imaging(MRI),cerebellar infarction was diagnosed.The misdiagnosis lasted 7 d.One patient presented with paroxysmal vertigo with nausea,vomiting and tinnitus for 6 h.According to the clinical symptoms and specialized examination,it was considered as Meniere's disease.On the second day after symptomatic treatment,the vertigo showed progressive aggravation.The second physical examination and transcranial MRI T2 Flair sequence showed the high-signal shadow in the right cerebellar nodule,suggesting the ischemic lesion in the right cerebellar nodule(the right posterior inferior cerebellar artery supply area),which was diagnosed as acute cerebellar infarction.The misdiagnosis lasted 2 d.One patient was treated for sudden headache,dizziness and fever for 2 d.According to the clinical symptoms and signs,elevated white blood cell count,neutrophil count and lymphocyte count,and the cranial CT scan showing no obvious abnormality,vestibular neuritis was initially considered.At 3 d after treatment with anti-inflammatory,analgesic drugs and vestibular function improvement,the patient still experienced persistent pulsatile pain in the posterior occipital region,with rebound nystagmus and gaze-evoked nystagmus.Additional T2-weighted cranial MRI revealed ischemic foci in the left cerebellar vermis,paravermis,and cerebellar base(the blood supply area of the left posterior inferior cerebellar artery),confirming the diagnosis of acute cerebellar infarction.The misdiagnosis lasted 5 d.After the diagnosis,all the 3 patients were given Aspirin for antiplatelet aggregation,Atorvastatin to stabilize plaque,Ginkgo Biloba Ketone Ester dispersible tablets to improve cerebral circulation,Vitamin B12 for nerve nutrition and other symptomatic treatment,and they were discharged after improvement.Two patients were followed up for 6 months with good prognosis and no sequelae,except one patient who had residual mild hemiparesis on one side.Conclusion The complex anatomy and physiological structure of the posterior circulation lead to diverse and intricate symptoms and signs of PCCI,which is prone to misdiagnosis.In clinical practice,patients suspected of PCCI should undergo neuroimaging examinations such as cranial CT or MRI to reduce the early misdiagnosis rate of this disease.

Abstract:Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of cough variant asthma(CVA).Methods A retrospective analysis was conducted on the data of 10 patients with misdiagnosed CVA that were admitted from June 2022 to June 2024.Results Among the 10 patients,there were 6 males and 4 females,aged from 18 to 45 years.Three patients presented with persistent cough with scant white sticky sputum.Physical examination revealed no obvious rales in both lungs,and chest X-ray examination showed thickened lung markings.The initial diagnosis was chronic bronchitis,but anti-infection and cough relief treatments were ineffective.Afterwards,the diagnosis of CVA was confirmed by bronchial provocation test.Three patients presented with recurrent cough,runny nose and nasal congestion as the main symptoms.The initial diagnosis was upper respiratory tract infection,but antiviral and symptomatic treatments did not relieve the symptoms.They were diagnosed with CVA through pulmonary function tests and allergen tests.Four patients presented mainly with irritating dry cough accompanied by throat itching.Laryngoscopy showed congestion of the pharyngeal mucosa,and the initial diagnosis was chronic pharyngitis.After treatment,the symptoms recurred.Eventually,they were diagnosed with CVA through bronchial provocation tests and other examinations.The misdiagnosis of the 10 patients in this group lasted 1 to 3 months.After diagnosis,the patient was treated with inhaled glucocorticoids combined with Bronchodilators,and all symptoms improved significantly.Conclusion The clinical manifestations of CVA lack specificity and are easily confused with chronic bronchitis,upper respiratory tract infections and chronic pharyngitis.Clinicians should enhance their understanding of CVA,attach importance to the differential diagnosis of chronic cough,and conduct timely tests such as pulmonary function and bronchial provocation tests to reduce misdiagnosis and mistreatment.

Abstract:Objective To observe the effect of external-use eczema decoction on the degree of skin inflammation in rats with eczema and its therapeutic mechanism,and to evaluate the efficacy and safety of external-use eczema decoction combined with Corticosteroid ointment in the treatment of mild to moderate eczema in children through clinical trials.Methods Forty 5-week-old clean-grade male SD rats were randomly divided into Chinese herbal medicine group,positive drug group,the model group,the Glucocorticoid group and the blank control group,with 8 rats in each group.The rat model of eczema was constructed by 2,4-dinitrochlorobenzene,and the blank control group was not modeled.After successful modeling,the Chinese herbal medicine group,the positive drug group and the Glucocorticoid group were treated with external-use eczema decoction,Binghuangfule ointment and Hydrocortisone Butyrate cream respectively,while the model group and the blank control group were not given any drug treatment.The experiment lasted until the 30th day,the changes of ear thickness and the severity of skin lesions in each group were recorded.Transepidermal water loss(TEWL)and water content of stratum corneum(WCSC)were measured.Blood samples were collected to determine the levels of immunoglobulin E(IgE)and interleukin(IL)-4.From January 2018 to December 2019,60 children with mild to moderate eczema were selected and divided into the control group(n=30)and the intervention group(n=30)according to random number table method.The control group was treated with conventional Glucocorticoid ointment,and the intervention group was treated with external-use eczema decoction on this basis.The therapeutic effect,re-visit rate,eczema area and severity index(EASI)score,serum IL-4,IL-18 and IL-23 levels and adverse reactions were observed in the two groups.Results Compared with the blank control group,the observation indexes of the model group were statistically different(P＜0.05).Compared with the model group,the ear thickness,skin lesion severity score and serum IL-4 level of the Chinese herbal medicine group,the positive drug group and the Glucocorticoid group decreased after the experiment,which was the lowest in the Chinese herbal medicine group,followed by the positive control drug group and the Glucocorticoid group(P＜0.05).Compared with the model group,TEWL decreased and WCSC increased in the Glucocorticoid group,positive control drug group and Chinese herbal medicine group(P＜0.05).The TEWL of the positive control drug group and the Chinese herbal medicine group was lower than that of the Glucocorticoid group,and the WCSC was higher than that of the Glucocorticoid group(P＜0.05).There was no significant difference in serum IgE levels between the Chinese herbal medicine group,the positive control drug group,the Glucocorticoid group and the model group(P＞0.05).After treatment,the EASI score and serum levels of IL-4,IL-18 and IL-23 in the intervention group were lower than those in the control group,and the eczema area was smaller than that in the control group(P＜0.05).The cure rate of the intervention group was higher than that of the control group,while the re-visit rate was lower than that of the control group(P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion External-use eczema decoction can reduce the inflammatory response and improve the skin lesion,eczema symptoms and skin barrier function of eczema rats.External-use eczema decoction can improve the clinical efficacy of children with mild to moderate eczema,reduce serum inflammatory factors and re-visit rate,and has good safety.

Abstract:Objective To analyze the causes of clinical misdiagnosis and mistreatment of heart failure with preserved ejection fraction(HFpEF)in the elderly and the methods for correcting misdiagnosis,in order to improve the diagnosis and treatment level of clinicians.Methods A retrospective analysis was conducted on the clinical data of one patient misdiagnosed as pneumonia and one patient misdiagnosed as malignant pleural effusion and eventually diagnosed as HFpEF in the elderly from January 2021 to January 2023.The causes of misdiagnosis were summarized,and preventive measures were proposed.Results Two patients visited the hospital due to respiratory symptoms and pleural effusion respectively.Based on clinical symptoms and related examination findings,they were initially misdiagnosed as pneumonia and malignant pleural effusion respectively,and symptomatic treatment yielded unsatisfactory outcomes.After admission,further echocardiographic examinations revealed that all patients had structural or functional abnormalities of the heart.Laboratory tests indicated an increase in N-terminal pro-brain natriuretic peptide.Combined with clinical manifestations,they were diagnosed with HFpEF.The misdiagnosis lasted 7 d and 2 months respectively.After targeted treatment,the symptoms were alleviated significantly and cardiac function recovered.Conclusion The clinical symptoms of HFpEF in the elderly are atypical and prone to misdiagnosis.Enhancing clinicians' understanding and vigilance of this disease,conducting thorough physical examinations,completing relevant tests and closely observing the changes in the condition are the keys to reducing misdiagnosis of HFpEF in the elderly.

Abstract:Objective To investigate the influencing factors of volume overload status in patients undergoing continuous ambulatory peritoneal dialysis(CAPD)and its relationship with micro-inflammatory markers and nutritional status.Methods A total of 109 CAPD patients admitted from June 2021 to December 2023 were selected as the research subjects.According to occurrence of volume overload,the patients were divided into the normal volume group(n=59)and the volume overload group(n=50).The general information,dialysis-related indicators,micro-inflammatory markers[interleukin-6(IL-6),C reactive protein(CRP),tumor necrosis factor-α(TNF-α)],and nutritional status[serum albumin,total protein,transferrin(TRF),retinol binding protein(RBP),total cholesterol(TC),triglyceride(TG)]of the two groups were compared.The correlation between micro-inflammation markers and nutritional status indicators in CAPD patients was analyzed,binary logistic regression was used to analyze the influencing factors of volume load in patients,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of micro-inflammation and nutritional status indicators for volume overload status in CAPD patients.Results The systolic blood pressure(SBP),extracellular fluid,extracellular fluid/total fluid,and extracellular fluid/intracellular fluid levels in the volume overload group were higher than those in the normal volume group,and the weekly urea clearance index was lower than that in the normal volume group(P＜0.01).The levels of serum IL-6,CRP and TNF-α in the volume overload group were higher than those in the normal volume group,while the albumin level was lower than that in the normal volume group(P＜0.01).There was no significant difference in the levels of total serum protein,TRF,RBP,TC and TG between the two groups(P＞0.05).Pearson correlation analysis showed that the micro-inflammatory markers IL-6,CRP,and TNF-α in patients with volume-overloaded CAPD were significantly negatively correlated with albumin(P＜0.05).SBP,weekly urea clearance index,extracellular fluid,extracellular fluid/total fluid,extracellular fluid/intracellular fluid,CRP,and albumin were all independent risk factors for volume overload in CAPD patients(P＜0.01).ROC curve analysis showed that the areas under the ROC curve of IL-6,CRP,TNF-α and albumin for diagnosing volume overload in CAPD patients were 0.697,0.946,0.750 and 0.866 respectively,with sensitivities of 48.00％,86.00％,66.00％and 70.00％respectively and specificities of 89.83％,100.00％,81.36％and 93.22％respectively.Conclusion The albumin level of CAPD patients is related to IL-6,CRP and TNF-α.SBP,weekly urea clearance index,extracellular fluid,extracellular fluid/total fluid,extracellular fluid/intracellular fluid,CRP,and albumin are independent risk factors for volume overload in CAPD patients.In clinical practice,volume overload in patients can be improved through measures such as strengthening adequate dialysis,controlling blood pressure,enhancing nutritional management,and anti-infection.

Abstract:Objective To investigate the etiological distribution of multidrug-resistant organism(MDRO)infection and its relationship with Th1/Th2 cytokine levels in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Two hundred patients with AECOPD admitted from April 2022 to July 2024 were selected as the research subjects.The MDRO infection and etiological distribution were recorded.According to presence of MDRO infection,they were divided into MDRO group and non-MDRO group.The general data and Th1/Th2 cytokine level of the two groups were compared,to analyze the correlation between Th1/Th2 cytokines and clinical characteristics.Multivariate logistic regression was used to analyze the influencing factors of MDRO infection,and the prediction model was constructed accordingly.Its value for predicting MDRO infection was evaluated using receiver operating characteristic curves.Results A total of 60 patients with MDRO infection occurred in 200 patients with AECOPD,and 137 strains of MDRO were isolated.There were significant differences in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,forced expiratory volume in one second to forced vital capacity ratio(FEV1/FVC),FEV1 percentage of predicted value(FEV1％),use of antibiotics in the past 3 months,invasive mechanical ventilation and serum interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleukin(IL)-4 and IL-13 levels between the two groups(P＜0.05).The serum levels of IFN-γ,TNF-α,IL-4 and IL-13 in patients with MDRO infection were positively correlated with APACHE Ⅱ score,use of antibiotics in the past 3 months,and invasive mechanical ventilation,and negatively correlated with FEV1/FVC and FEV1％(P＜0.05).The use of antibiotics in the past 3 months,invasive mechanical ventilation and serum IFN-γ,TNF-α,IL-4 and IL-13 levels were the influencing factors of MDRO infection in AECOPD patients(P＜0.05).Delong test showed that the area under the receiver operating characteristic(ROC)curve(AUC)of Th1/Th2 cytokine model and combined model in predicting MDRO infection was better than that of clinical model(P＜0.05).Conclusion MDRO infection in AECOPD patients is closely related to the changes of Th1/Th2 cytokines.The use of antibiotics in the past 3 months,invasive mechanical ventilation and serum IFN-γ,TNF-α,IL-4 and IL-13 levels are the influencing factors of MDRO infection in AECOPD patients.The prediction model based on the above factors has a higher predictive value for MDRO infection.

Abstract:Objective To investigate the clinical manifestations,causes of misdiagnosis and preventive measures of gastritis cystica profunda(GCP).Methods A retrospective analysis was conducted on the clinical data and imaging manifestations of a patient with GCP who was misdiagnosed as having simple gastric cysts at the initial diagnosis in January 2025.Results The patient was admitted to the hospital due to the detection of a gastric mass during physical examination.Endoscopic ultrasound(EUS)and CT examinations were performed,and the initial diagnosis was a simple gastric cyst.After admission,endoscopic submucosal dissection of the fundus gastric mass was performed.Eventually,the patient was diagnosed with GCP through postoperative pathological examination.The misdiagnosis lasted 5 d.At 3 months after the operation,a gastroscopy reexamination of the patient showed that postoperative scars could be seen at the original lesion site,with smooth mucosa and no signs of residue or recurrence.Conclusion GCP is a relatively rare submucosal lesion of the stomach in clinical practice.Due to the lack of specificity of its clinical manifestations and the high similarity of endoscopic and imaging features with other gastric diseases,it may lead to a significant increase in the probability of misdiagnosis.For suspected submucosal cystic lesions of the stomach,GCP should be considered in the differential diagnosis.CT combined with EUS examination can facilitate the diagnosis and treatment of GCP.

Abstract:Objective To investigate the application value of Prourokinase combined with Nicorandil in emergency percutaneous coronary intervention(PCI)for elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 126 elderly patients with acute STEMI who underwent emergency PCI from December 2020 to December 2023 were selected as the research subjects for retrospective analysis.The patients were divided into two groups based on whether Prourokinase treatment was performed during PCI.The control group was treated with Nicorandil(n=82),and the research group was supplemented with Prourokinase on this basis(n=44).The myocardial injury markers[creatine kinase(CK),cardiac troponin I(cTnI),myocardial creatine kinase isoenzyme(CK-MB)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume index(LVESVI),left ventricular end-diastolic volume index(LVEDVI)],and no-reflow/slow blood flow,as well as incidence of major adverse cardiovascular events(MACE)and adverse reactions were compared between the two groups.Results The incidence of no-reflow/slow blood flow during PCI in the research group was 18.19％(8/44),which was lower than that[35.36％(29/82)]in the control group(P＜0.05).At 1 week after the operation,the levels of CK,cTnI,CK-MB,LVESVI and LVEDVI in both groups decreased compared with those before the operation,which were lower in the research group than in the control group(P＜0.05).At 1 week after the operation,the LVEF levels in both groups increased compared with those before the operation,and the levels in the research group were higher than those in the control group(P＜0.05).Within 6 months after the operation,there was no significant difference in the incidence of MACE between the two groups(P＞0.05),No significant difference in the incidence of adverse reactions between the two groups from the initiation of medication to 7 d after surgery(P＞0.05).Conclusion Prourokinase combined with Nicorandil can effectively prevent the phenomenon of no-reflow/slow blood flow in elderly patients with acute STEMI during emergency PCI,effectively improve myocardial perfusion,enhance cardiac function,and has high safety.

Abstract:Objective To investigate the effect of Naoxinqing capsule as an adjuvant to Trimetazidine in the treatment of coronary heart disease(CHD)with stable angina pectoris and blood stasis syndrome,and to analyze its impact on patients' blood lipids and hemorheology.Methods In total,124 patients with CHD with stable angina pectoris and blood stasis syndrome admitted from January 2022 to December 2024 were randomly divided into two groups(control group and research group)using a random number table method,with 62 patients in each group.Both groups received conventional treatment,with the control group receiving Trimetazidine and the research group receiving Naoxinqing capsules combined with Trimetazidine for two consecutive months.The therapeutic effects,occurrence of adverse reactions,improvement of symptoms before and after treatment,blood lipid levels,hemorheological indicators and serum levels of inflammatory factors were compared between the two groups.Results After treatment,the total effective rate of angina treatment in the research group was 93.55％(58/62),which was higher than that of the control group[79.03％(49/62)],with fewer angina attacks and shorter duration of attacks compared with the control group(P＜0.05).After treatment,the levels of serum total cholesterol,triglycerides,low-density lipoprotein cholesterol,high-sensitivity C-reactive protein,interleukin-6,and hemorheological indicators(plasma viscosity,whole blood low shear and high shear viscosity)in the research group were lower than those in the control group(P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups during treatment(P＞0.05).Conclusion The use of Naoxinqing capsules as an adjuvant to Trimetazidine is safe and effective for the treatment of CHD with stable angina pectoris and blood stasis syndrome.It can significantly improve patients' blood lipids and hemorheology,reduce levels of inflammatory factors,decrease the frequency of angina attacks,and shorten the duration of each attack.

Abstract:Objective To investigate the application value of prophylactic hemostatic clip placement in endoscopic cold snare polypectomy(CSP)for medium-sized colorectal polyps(CRP).Methods A total of 154 patients with medium-sized CRP(long diameter 6-10 mm)from July 2022 to July 2024 were selected as the research subjects and divided into two groups using the random number table method.Seventy-six patients in the control group underwent conventional painless endoscopic CSP,while 78 patients in the observation group received prophylactic hemostatic clip placement on the basis of endoscopic CSP.Surgery-related indicators(duration of intraoperative bleeding,procedure cost,duration of operation),and polyp resection(polypectomy time,en bloc resection rate)were compared,and the occurrence of postoperative complications(delayed bleeding,abdominal pain,abdominal distension),recovery and patient satisfaction were recorded.Results The duration of operation in the observation group was longer than that in the control group,and the procedure cost washigher than that of the control group,while the duration of intraoperative bleeding was shorter than that of the control group(P＜0.05).There was no significant difference in the polypectomy time and en bloc resection rate between the two groups(P＞0.05).The incidence of delayed postoperative bleeding in the observation group was lower than that in the control group(P＜0.05).There was no significant difference in the incidence of abdominal pain and abdominal distension between the two groups(P＞0.05).The recovery time of semi-liquid diet and normal diet in the observation group was shorter than that in the control group(P＜0.05).The satisfaction of patients in the observation group was higher than that in the control group(P＜0.05).Conclusion Prophylactic hemostatic clip placement in endoscopic CSP for medium-sized CRP can shorten duration of intraoperative bleeding and reduce the incidence of delayed postoperative bleeding,accelerate postoperative recovery of patients,and significantly increase patient satisfaction.However,it also leads to longer duration of procedure and higher costs.Therefore,prophylactic hemostatic clip placement should be individualized based on the patient's specific clinical circumstances.

Abstract:Objective To investigate the effect of the Shuxin Tiaogeng formula on nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome-related factors in perimenopausal patients with coronary heart disease(CHD)accompanied by anxiety or depression.Methods A total of 80 patients with perimenopausal CHD accompanied by anxiety or depression who were admitted from March 2023 to February 2024 were selected and divided into the conventional group(n=40)and the Shuxin Tiaogeng formula group(n=40)according to the random number table method.The conventional group was treated with conventional secondary prevention of CHD and Paroxetine Hydrochloride tablets,while the Shuxin Tiaogeng formula group was treated with a self-designed Shuxin Tiaogeng formula on the basis of the conventional group.The clinical efficacy and the occurrence of adverse reactions of the two groups were evaluated.The serum inflammatory indicators,TCM syndrome scores,and mRNA expression levels of NLRP3 inflammasome signaling pathology-related factors before and after treatment were compared between the two groups.The scores of angina pectoris,perimenopausal symptoms,psychological anxiety state,and psychological depression state were compared between the two groups before treatment and at 2 and 3 months after treatment.Results The total effective rate of clinical treatment in the Shuxin Tiaogeng formula group was 95.00％(38/40),which was higher than 85.00％(34/40)in the conventional group(P＜0.05).At 3 months after treatment,the primary symptom scores,secondary symptom scores,and the levels of serum tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-1 β in both groups were lower than those before treatment,and the levels in the Shuxin Tiaogeng formula group were lower than those in the conventional group(P＜0.05).At different time points after treatment,the Hamilton Anxiety Scale,Angina pectoris,Hamilton Depression Scale-17 and modified Kupperman scores of the two groups all showed a continuous downward trend over time.Moreover,the above scores of the Shuxin Tiaogeng formula group were significantly lower than those of the conventional group at 2 and 3 months after treatment(P＜0.05).At 3 months after treatment,the expression levels of NLRP3 and Caspase-1 mRNA in both groups decreased significantly compared with those before treatment,and the decrease in the Shuxin Tiaogeng formula group was greater than that in the conventional group(P＜0.05).No significant difference was observed in the incidence of adverse reactions during the treatment period between the two groups(P＞0.05).Conclusion The combination of Shuxin Tiaogeng formula and Western medicine can reduce the mRNA expression of NLRP3 inflammasome-related factors and the levels of downstream inflammatory factors in the serum of perimenopausal patients with CHD accompanied by anxiety or depression,improve TCM syndromes,alleviate the symptoms of perimenopausal syndrome,and effectively relieve the anxiety or depressive symptoms of patients,showing definite clinical efficacy and relatively high safety.

Abstract:Objective To construct a risk stratification prediction model for hip joint dysfunction following proximal femoral nail antirotation(PFNA)in elderly patients with intertrochanteric fractures,and to evaluate its performance.Methods A total of 208 elderly patients with intertrochanteric fractures admitted from January 2021 to June 2023 were selected as the research subjects.A questionnaire survey was conducted through the general data questionnaire,hospital electronic medical record system,Harris hip function scoring system,and Tampa Scale for Kinesiophobia.Univariate and multivariate logistic regression analyses were used to analyze the influencing factors of hip joint dysfunction after PFNA in elderly patients with intertrochanteric fractures.Significant variables from logistic regression analysis were included in the nomogram model,and the receiver operating characteristic(ROC)curve was used to verify its efficacy.According to the risk factors carried by individuals,the total risk score and risk probability of hip joint dysfunction after PFNA in elderly patients were calculated using a nomogram model,and the risk stratification was performed based on the total risk scores.Results The follow-up and data collection of 206 elderly patients with intertrochanteric fractures were finally completed.The Harris hip function score was(86.12±7.32)scores,the good prognosis rate of hip function was 75.24％(155/206),and the poor prognosis rate was 24.76％(51/206).Univariate and multivariate logistic regression analyses showed that overweight/obesity,unstable fracture,time to operation≥7 d,Clavien-Dindo classification,kinesiophobia,malnutrition,osteoporosis,serum N-terminal propeptide of type I collagen,and serum osteocalcin were all independent risk factors for hip dysfunction after PFNA in elderly patients with intertrochanteric fracture,while functional exercise compliance and serum 25-hydroxyvitamin D3 were protective factors(P＜0.01).Based on the above influencing factors,the area under the ROC curve of the nomogram model for predicting hip joint dysfunction after PFNA was 0.861(95％CI:0.793,0.928).According to the nomogram model,the total risk score and predicted risk probability of hip joint dysfunction were calculated.According to the total score,patients were stratified into three risk levels:low risk(≤ 160 scores),medium risk(＞160-200 scores)and high risk(＞200 scores),with the corresponding probabilities of ≤ 10％,＞10％-50％and＞50％,respectively.Conclusion Overweight/obesity,malnutrition and osteoporosis are the influencing factors of hip joint dysfunction after PFNA in elderly patients with intertrochanteric fracture.The nomogram model constructed on this basis has good clinical predictive utility and can guide the clinical establishment of risk warning model.

Abstract:Objective To analyze the efficacy of intravaginal live lactobacillus preparations-assisted recombinant human interferon alpha-2b(rhIFN-α2b)and Baofukang suppository in the treatment of human papillomavirus(HPV)-associated cervicitis,as well as their impact on HPV clearance rate,Th1/Th2 cytokines,vaginal microecology,adverse reactions,and recurrence rate.Methods A total of 130 patients with HPV-associated cervicitis admitted from May 2020 to May 2022 were divided into the research group and the control group by random number table method,with 65 patients in each group.The control group was treated with rhIFN-α2 b vaginal effervescent capsule+Baofukang suppository,and the research group was treated with rhIFN-α2 b vaginal effervescent capsule+Baofukang suppository+live lactobacillus capsule.The therapeutic effect,HPV clearance rate,Th1/Th2 cytokines[interleukin-2(IL-2),interferon-γ(IFN-γ),interleukin-4(IL-4),and interleukin-10(IL-10)],vaginal microecology,adverse effects,and recurrence rate were compared between the two groups.Results The total effective rate of the research group was 96.92％(63/65),which was higher than 84.62％(55/65)of the control group(P＜0.05).The HPV clearance rate in the research group was higher than that in the control group after 1,2 and 3 courses of treatment(P＜0.05).The levels of serum IL-2,IFN-γ,IL-4 and IL-10 in the research group were lower than those in the control group after 1,2 and 3 courses of treatment(P＜0.05).After 3 courses of treatment,the bacterial density,bacterial diversity and lactobacillus in the research group were better than those in the control group,and the negative rate of hydrogen peroxide and the normal rate of pH value were higher than those in the control group(P＜0.05).The recurrence rate of the research group was 4.62％(3/65),lower than that of the control group(15.38％,10/65)(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P＞0.05).Conclusion The combination of rhIFN-α2b,Baofukang suppository and live lactobacillus preparations in the treatment of HPV-associated cervicitis can significantly improve the clinical efficacy and HPV clearance rate,correct the imbalance of Th1/Th2 cytokines,improve the vaginal microecological environment,effectively reduce the recurrence rate,and has certain safety.