Abstract:Objective To compare and analyze the value of magnetic resonance hysterosalpingography(MR-HSG)and hysterosalpingo-contrast sonography(HyCoSy)in evaluating tubal patency.Methods A total of 165 infertility patients treated in Baishan Central Hospital,Jilin Province from March 2022 to December 2024 were retrospectively enrolled,including 76 cases in the MR-HSG group undergoing MR-HSG examination and 89 cases in the HyCoSy group undergoing HyCoSy examination.Tubal examination results and consistency with laparoscopic findings were compared between the two groups.Receiver operating characteristic(ROC)curves were drawn to compare the diagnostic efficacy of the two methods.Pain during contrast examination and incidence of intraoperative and postoperative adverse reactions were also evaluated.Results In the MR-HSG group(76 patients,152 fallopian tubes),51 tubes were patent,36 were partially obstructed,and 65 were obstructed,with a positive rate of 57.2％(87/152).In the HyCoSy group(89 patients,178 fallopian tubes),65 tubes were patent,44 were partially obstructed,and 69 were obstructed,with a positive rate of 61.2％(109/178).Taking laparoscopic chromopertubation as the gold standard,the sensitivity,specificity and Youden index of MR-HSG in judging tubal patency were 90.32％,94.92％and 0.852,respectively,with an AUC of 0.926(95％confidence interval:0.878-0.974,P＜0.001),showing good consistency with laparoscopic results(Kappa=0.837).The sensitivity,specificity and Youden index of HyCoSy were 90.18％,87.88％and 0.781,respectively,with an AUC of 0.890(95％confidence interval:0.835-0.946,P＜0.001),also showing good consistency(Kappa=0.773).The VAS score in the MR-HSG group was higher than that in the HyCoSy group[(2.1±0.5)vs(1.9±0.4),P＜0.05].The incidence of adverse reactions was 10.5％(8/76)in the MR-HSG group and 5.6％(5/89)in the HyCoSy group,with no statistically significant difference between groups(P=0.243).Conclusion Both MR-HSG and HyCoSy have high accuracy and reliability in evaluating tubal patency.MR-HSG has outstanding imaging advantages,while HyCoSy provides better patient experience.Appropriate examination methods should be selected clinically based on patient conditions.

Abstract:Objective To investigate the changes and clinical significance of lysyl oxidase-like protein 2(LOXL2),chemokine ligand-18(CCL-18)and chitinase-like protein 40(YKL-40)levels in patients with connective tissue disease complicated with interstitial lung disease(CTD-ILD)before and after treatment.Methods A total of 90 patients with CTD-ILD admitted to the outpatient and inpatient Departments of Rheumatology and Immunology of The First Affiliated Hospital of Hebei North University from January 2022 to January 2023 were enrolled as observation group.Meanwhile,30 patients with simple connective tissue disease were set as case control group and 30 healthy subjects as healthy control group.According to pulmonary high-resolution CT(HRCT)scores before and after treatment,the 90 patients in the observation group were divided into improved group(38 cases),stable group(31 cases)and deteriorated group(21 cases).The levels of LOXL2,CCL-18,YKL-40 and HRCT scores were compared among all groups before treatment and 12 months after treatment.Spearman correlation analysis was used to analyze the correlation between serum LOXL2,CCL-18,YKL-40 levels and HRCT scores.Receiver operating characteristic(ROC)curve was established to analyze the predictive value of LOXL2,CCL-18 and YKL-40 levels before and after treatment for disease deterioration in CTD-ILD patients.Results Before treatment,the levels of LOXL2,CCL-18,YKL-40,SP-D and KL-6 in the observation group were higher than those in the case control group and healthy control group;the levels of the above indicators in the case control group were higher than those in the healthy control group(all P＜0.05).Before treatment and 12 months after treatment,the levels of LOXL2,CCL-18,YKL-40,SP-D,KL-6 and HRCT scores in the deteriorated group were higher than those in the stable group and improved group,and those in the stable group were higher than those in the improved group(all P＜0.05).In the improved group,the levels of LOXL2,CCL-18,YKL-40,SP-D,KL-6 and HRCT scores at 12 months after treatment were lower than those before treatment(all P＜0.05).Before treatment,LOXL2,CCL-18 and YKL-40 were positively correlated with HRCT scores(r=0.872,0.705,0.617,all P＜0.05).At 12 months after treatment,LOXL2,CCL-18 and YKL-40 were also positively correlated with HRCT scores(r=0.462,0.507,0.481,all P＜0.05).Before treatment,the area under the curve(AUC)of LOXL2,CCL-18 and YKL-40 for predicting disease deterioration in CTD-ILD patients was 0.871,0.880 and 0.792 respectively,and the AUC of combined prediction was 0.960,which was higher than that of single indicator prediction.At 12 months after treatment,the AUC of LOXL2,CCL-18 and YKL-40 for predicting disease deterio-ration was 0.862,0.869 and 0.761 respectively,and the AUC of combined prediction was 0.960,superior to single indicator prediction.Conclusions Serum LOXL2,CCL-18 and YKL-40 are highly expressed in CTD-ILD patients,which are among the pathogenic factors of ILD.Serum LOXL2,CCL-18 and YKL-40 are conducive to the early diagnosis of CTD-ILD and have important value in evaluating disease changes after treatment.

Abstract:Objective To compare the clinical characteristics among patients with rheumatic autoimmune diseases(RADs)complicated with congenital heart disease(CHD),patients with isolated CHD and patients with isolated RADs,and to preliminarily explore the safety of immunosuppressants in the complicated population.Methods A total of 34 patients diagnosed with RADs complicated with CHD in The Second Hospital,Lanzhou University from March 2022 to June 2025 were retrospectively enrolled as the complicated group.According to a 1∶2 matching(based on age,gender,type of RADs and time of diagnosis),68 patients with isolated RADs without structural heart disease were selected as the control group(isolated RADs group)from the same period.Another 71 patients with isolated CHD(isolated CHD group)were enrolled in the same period.Baseline data,clinical symptoms,cardiac structure and function parameters,and adverse events were collected and compared among the three groups.Results Patients in the complicated group had diverse types of CHD but generally mild defects,and 91.2％(31/34)of them did not require cardiac intervention,which was in sharp contrast to the isolated CHD group,showing significant phenotypic differences.Cardiac structure and function evaluation showed that patients in the complicated group had more significant cardiac remodeling.The left ventricular end-diastolic diameter and main pulmonary artery diameter in the complicated group were significantly larger than those in the isolated CHD group[45.0(43.0,48.0)mm vs 44.0(41.0,46.0)mm,22.0(22.0,26.0)mm vs 22.0(20.0,23.0)mm](both P＜0.05).Meanwhile,the ejection fraction was significantly lower than that in the isolated CHD group 65％(63％,65％)vs 66％(64％,69％)](P＜0.05),and pulmonary artery systolic pressure was significantly higher than that in the isolated RADs group[27.5(25.0,35.0)mmHg vs 25.0(22.0,25.0)mmHg](P＜0.001).Among 30 patients in the complicated group treated with immunosuppressants,cardiac function indicators remained stable after a median follow-up of 15 months.The incidence of severe infection was 3.3％(1/30),and there were no treatment-related heart failure,thromboembolism or death events.Conclusion Cardiac defects in patients with RADs complicated with CHD are usually milder,and the vast majority do not require cardiac intervention.This is significantly different from the isolated CHD population admitted due to symptoms.In this context,immunosuppressive therapy for controlling RADs shows acceptable safety under close monitoring.A treatment strategy focusing on rheumatic immune disease management and individualized evaluation of cardiac intervention needs should be adopted for this special population.

Abstract:Objective To analyze the correlation between preoperative low-density lipoprotein cholesterol(LDL-C)and triple-negative breast cancer(TNBC),and to explore its predictive value for disease-free survival(DFS)and survival status of TNBC patients.Methods A total of 120 patients with TNBC,136 patients with benign breast tumors and 155 healthy physical examinees admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2010 to December 2020 were enrolled.General data of each group were compared.Receiver operating characteristic curve was used to determine the predictive value and optimal cut-off value of LDL-C for TNBC.Univariate and multivariate Cox regression analyses were applied to analyze the influencing factors of DFS and overall survival in TNBC patients.Results The LDL-C level in the TNBC group was significantly higher than those in the healthy examination group and benign breast tumor group[2.97(2.46,3.45)mmol/L vs 2.48(2.03,2.82),2.48(2.09,2.98)mmol/L](both P＜0.05).The area under the receiver operating characteristic curve of LDL-C for predicting TNBC was 0.711,and the optimal cut-off value was 2.83 mmol/L.TNBC patients were divided into low concentration group(＜2.83 mmol/L,50 cases)and high concentration group(≥2.83 mmol/L,70 cases)according to the cut-off value.LDL-C level was significantly correlated with age,menopausal and lymph node metastasis(all P＜0.05).Multivariate analysis showed that lymph node metastasis and LDL-C were independent risk factors for DFS and overall survival in TNBC patients(all P＜0.05).The survival rate of TNBC patients decreased with the increase of LDL-C level(P＜0.05).Conclusions TNBC patients have relatively elevated LDL-C levels.Both LDL-C and lymph node metastasis affect DFS and overall survival of TNBC patients,and LDL-C possesses important predictive value for the prognosis of TNBC.

Abstract:Objective To explore the value of serum intestinal fatty acid binding protein(IFABP)combined with D-lactate and ultrasonic score in evaluating the severity of acute gastrointestinal injury(AGI).Methods A prospective study was conducted on 106 patients with AGI admitted to Nanping First Hospital Affiliated to Fujian Medical University from December 2023 to December 2025.The patients were divided into mild group(grade Ⅰ and Ⅱ)and moderate-severe group(grade Ⅲ and Ⅳ)according to the injury degree.All patients underwent detection of serum IFABP and D-lactate as well as abdominal ultrasonography,with ultrasonic scores recorded.Logistic regression analysis and receiver operating characteristic(ROC)curve were used to explore the evaluation value of serum IFABP,D-lactate combined with ultrasonic score for AGI severity.Results Among 106 AGI patients,there were 45 cases(42.4％)of grade Ⅰ,37 cases(34.9％)of grade Ⅱ,22 cases(20.7％)of grade Ⅲ,and 2 cases(1.9％)of grade Ⅳ.The levels of serum IFABP and D-lactate in the moderate-severe group were higher than those in the mild group[(156±42)ng/L vs(106±37)ng/L,(9.6±3.9)mg/L vs(6.3±2.6)mg/L](all P＜0.001),and the proportion of ultrasonic score＞2 was higher than that in the mild group[70.8％(17/24)vs 35.4％(29/82)](P=0.002).The sequential organ failure assessment(SOFA)score and proportion of vasoactive drug use in the moderate-severe group were higher,while the albumin level was lower than those in the mild group(all P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of serum IFABP,D-lactate,ultrasonic score alone and their combination for evaluating AGI severity were 0.816,0.748,0.677 and 0.908 respectively.The AUC of the combined three indicators was higher than that of D-lactate and ultrasonic score(Z=2.280,P=0.011;Z=3.177,P=0.001),and there was no significant difference compared with the AUC of serum IFABP(Z=1.503,P=0.067).Multivariate Logistic analysis showed that SOFA score,albumin,vasoactive drugs,serum IFABP,D-lactate and ultrasonic score were independent influencing factors of AGI severity(P＜0.05).Conclusion Serum IFABP combined with D-lactate and ultrasonic score has high value in evaluating the severity of AGI.

Abstract:Objective To analyze the correlations of the expression levels of CXC chemokine receptor 3(CXCR3),CXC chemokine ligand 10(CXCL10)and CXCL11 with CD8+T cell differentiation and disease severity in patients with pulmonary tuberculosis.Methods A total of 107 patients with pulmonary tuberculosis treated in Hebei Chest Hospital from December 2022 to October 2023 were enrolled and divided into mild group(42 cases),moderate group(35 cases)and severe group(30 cases)according to disease severity.General clinical data were collected.Within 48 h after enrollment,the levels of CXC chemokines including CXCR3,CXCL10 and CXCL11,as well as CD8+T cell differentiation subset indicators such as naive T cells(Tn),central memory T cells(Tcm),effector memory T cells(Tem)and terminally differentiated effector T cells(Temra)were detected.Multiple linear regression,generalized additive model(GAM),ordered Logistic regression,receiver operating characteristic(ROC)curve,restricted cubic spline(RCS)and mediation effect analysis were adopted for correlation analysis.Results With the increase of disease severity in pulmonary tuberculosis patients,the levels of CXCR3,CXCL10,CXCL11,Temra,programmed cell death protein 1,T cell immunoglobulin and mucin domain-containing molecule 3,lymphocyte activation gene 3,tumor necrosis factor-α and interferon-γ increased gradually,while body mass index,Tn and Tcm levels decreased correspondingly(all P＜0.05).Multiple linear regression analysis showed that CXCR3,CXCL10 and CXCL11 were positively correlated with Temra levels(all P＜0.05),and negatively correlated with Tn and Tcm levels(all P＜0.05).Mediation effect analysis indicated that CXCR3,CXCL10 and CXCL11 exerted significant positive total effects on disease severity of pulmonary tuberculosis patients.Tn and Temra played partial mediating roles between CXCR3,CXCL10,CXCL11 and disease severity(all P＜0.05),and Tcm had a partial mediating effect between CXCR3 and disease severity(P＜0.05).ROC curve analysis revealed that CXCR3,CXCL10 and CXCL11 had good predictive efficacy for the progression from mild to moderate-severe pulmonary tuberculosis and from mild-moderate to severe pulmonary tuberculosis,and the combined detection of the three indicators achieved better predictive performance.RCS curve analysis showed that the risk of progressing to severe pulmonary tuberculosis increased linearly with the elevation of CXCR3,CXCL10 and CXCL11 levels(all P＜0.05).Conclusions The levels of CXCR3,CXCL10 and CXCL11 in pulmonary tuberculosis patients are closely correlated with CD8+T cell differentiation and disease severity.CXC chemokines have high predictive value for the severe progression of pulmonary tuberculosis,which are expected to serve as potential biomarkers and provide a new direction for immunotherapy of pulmonary tuberculosis.

Abstract:Objective To explore the value of TWIST1 gene methylation level in the diagnosis and recurrence detection of bladder cancer patients.Methods A total of 119 patients with bladder cancer and other non-neoplastic diseases admitted to Beijing Anzhen Hospital,Capital Medical University from February to July 2025 were randomly enrolled.The preoperative urinary TWIST1 gene methylation level was compared with postop-erative pathological results,and the value of TWIST1 gene methylation level in the diagnosis and recurrence monitoring of clinical bladder cancer patients was analyzed.Results Among the 119 enrolled patients,65 cases were pathologically confirmed as bladder cancer and 54 cases were non-neoplastic patients.The comparison between postoperative pathological results and urinary TWIST1 gene methylation results showed that urinary TWIST1 gene methylation could reflect the tumor status in most patients.The sensitivity,specificity,positive predictive value and negative predictive value for the diagnosis of bladder cancer were 76.9％,81.5％,83.3％and 74.6％respectively.The diagnostic sensitivity and specificity were 73.5％and 86.5％in male patients,and 87.5％and 70.6％in female patients.In recurrence monitoring,TWIST1 gene methylation detection showed a specificity of 96.0％,a positive predictive value of 92.9％and a sensitivity of 72.2％.The area under the curve of TWIST1 gene methylation detection for diagnosing bladder cancer was 0.864(95％confidence interval:0.796-0.930).Conclusion Urinary TWIST1 gene methylation detection has important value for the diagnosis and recurrence monitoring of bladder cancer.

Abstract:Objective To analyze the clinical effect of aripiprazole combined with galantamine in the treatment of senile dementia patients with behavioral and psychological symptoms.Methods A total of 106 senile dementia patients with behavioral and psychological symptoms admitted to Tongde Hospital of Zhejiang Province from May 2024 to March 2025 were selected.According to the block random method,they were divided into the observation group and the control group,with 53 cases in each group.The control group was treated with oral galantamine hydrobromide tablets on the basis of conventional treatment,and the observation group was treated with aripiprazole tablets on the basis of the control group.Both groups were treated for 3 months.Before and after treatment,the scores of psychological and behavioral symptoms and cognitive function,the levels of nerve factors,and the incidence of adverse reactions during treatment were compared between the two groups.Results After treatment,the scores of dementia pathological behavior rating scale,Alzheimer's disease assessment scale-cognitive part and clinical dementia rating scale 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 levels of brain-derived neuro-trophic factor in the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group[(32±6)μg/L vs(28±5)μg/L];the levels of visinin-like protein 1 and neuron specific enolase 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).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Aripiprazole combined with galantamine is effective in the treatment of senile dementia patients with mental and behavioral symptoms,which can improve the patients'mental and behavioral symptoms,cognitive function and nerve factors,and does not increase the risk of adverse reactions,with good safety.

Abstract:Objective To investigate the efficacy of tirofiban at different time points in the endovascular treatment of atherosclerotic acute cerebral infarction(AIS)and its relationship with prognosis.Methods A total of 98 patients with atherosclerotic AIS who needed endovascular treatment in Shanxi Province Fenyang Hospital from June 2024 to May 2025 were selected as the research objects.All of the patients were divided into observation group[49 cases,tirofiban 0.4 μg/(kg·min)intravenous infusion for 0.5 h followed by 0.1 μg/(kg·min)intravenous infusion for 24 h+endovascular treatment]and control group[49 cases,tirofiban 0.2-1 mg during operation and 0.1 μg/(kg·min)intravenous infusion for 24 h after operation plus endovascular treatment]by random number table method.The platelet aggregation rate,platelet adhesion rate,platelet volume distribution width(PDW),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and National Institutes of Health Stroke Scale(NIHSS)scores were compared between the two groups at admission,24 h,7 d and 14 d after treatment.The rate of complications and good prognosis were compared between the two groups.Cox regression analysis was used to analyze the effect of tirofiban application time on the poor prognosis of patients.Results On admission,there were no significant differences in platelet aggregation rate,platelet adhesion rate,PDW,hs-CRP,IL-6,and NIHSS score between the two groups(all P＞0.05).After treatment,the platelet aggregation rate,platelet adhesion rate,PDW,hs-CRP,IL-6 and NIHSS score of the two groups were significantly decreased,and the observation group decreased more significantly at 7 d and 14 d after treatment(all P＜0.05).The incidence of reocclusion and the total incidence of adverse reactions in the observation group were significantly lower than those in the control group(all P＜0.05),and the rate of good prognosis was higher than that in the control group[73.5％(36/49)vs 51.0％(25/49)](P＜0.05).The timing of tirofiban administration in the observation group was a protective factor for the poor prognosis(hazard ratio=0.782,95％confidence interval:0.289-0.897,P=0.008),and the results were consistent in different subgroups.Conclusion The application of tirofiban before endovascular treatment can reduce the risk of poor prognosis of patients,and help to improve the neurological function,platelet function and inflammatory state of patients.

Abstract:Objective To explore the risk factors of early enteral nutrition(EEN)intolerance in elderly patients with severe pneumonia,and to construct and verify a nomogram model.Methods A total of 209 elderly patients with severe pneumonia in The Second Affiliated Hospital of Naval Medical University of Chinese People's Liberation Army from January 2023 to January 2025 were selected.EEN tolerance of patients was recorded.According to the presence or absence of EEN intolerance symptoms,the patients were divided into tolerance group and intolerance group.The risk factors of EEN intolerance were analyzed and a nomogram was drawn.The receiver operating characteristic curve was used to test the predictive efficacy of the nomogram model.Results Among 209 elderly patients with severe pneumonia,86 cases had EEN intolerance.The incidence was 41.1％(86/209).Among the patients with EEN intolerance,74.4％(64/86)had single symptom,mainly diarrhea,gastric retention and abdominal distension,25.6％(22/86)had two or more symptoms,and EEN intolerance mainly occurred on the first and second day of the implementation of EEN.Old age,late start of enteral nutrition,high clinical pulmonary infection score(CPIS),long duration of mechanical ventilation and intermittent injection were independent risk factors for EEN intolerance in elderly patients with severe pneumonia(all P＜0.05).The prediction model of EEN intolerance in elderly patients with severe pneumonia was constructed according to the influencing factors screened from the results of Logistic regression analysis.Logit(P)=-15.541+0.923 × age+0.966 × initiation time of enteral nutrition+0.854 × CPIS+0.338 × mechanical ventilation time-0.959 × feeding mode.Hosmer-Lemeshow goodness of fit test showed that x2=4.138,degree of freedom=8,P=0.830.The nomogram showed that when the sum of the scores of each influencing factor was more than 144,the risk of EEN intolerance was more than 80％.The consistency index of the nomogram model was 0.888,and the area under the curve for predicting EEN intolerance in elderly patients with severe pneumonia was 0.888(95％confidence interval:0.837-0.927).Conclusion The risk factors of EEN intolerance in elderly patients with severe pneumonia include old age,late start time of enteral nutrition,high CPIS,long duration of mechanical ventilation and intermittent injection.The nomogram model based on the above influencing factors has a high predictive efficiency for EEN intolerance in elderly patients with severe pneumonia,which is helpful for medical staff to accurately identify high-risk groups.It has guiding significance for the improvement of nutrition management strategy.

Abstract:Objective To explore the SMOTE algorithm based epilepsy risk prediction model after successful resuscitation of cardiac arrest.Methods A total of 200 patients with successful resuscitation of cardiac arrest admitted to the 910th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army from October 2016 to October 2023 were retrospectively collected as observation objects.According to whether epilepsy occurred after successful resuscitation,the patients were divided into epilepsy group(50 cases)and non-epilepsy group(150 cases).Data of the subjects were collected and analyzed.Univariate and multivariate Logistic regression analysis were used to screen the risk factors of epilepsy after successful resuscitation of cardiac arrest,and then the SMOTE algorithm was used to reconstruct the original data set of influencing factors to obtain the risk early warning model and verify its predictive efficiency.Results There were 50 cases of epilepsy after successful resuscitation in 200 cases of cardiac arrest,and the incidence was 25.0％.Multivariate Logistic regression analysis showed that age,history of epilepsy,intracranial infection,cardiovascular and cerebrovascular diseases,and hypoxic-ischemic brain injury were risk factors for epilepsy after successful resuscitation of cardiac arrest(all P＜0.05).The original early warning model P1=1.107X1+1.221X2+1.025X3+1.227X4+1.162X5-3.909 was obtained.Hosmer-Lemeshow test results showed that the model had a good fit(coefficient of determination R2=0.418,P=0.599).The early warning model based on the SMOTE algorithm was P2=1.212X1+1.351X2+1.208X3+1.357X4+1.271X5-4.241.The Hosmer-Lemeshow test results indicated that the model had a good fit(coefficient of determination R2=0.617,P=0.833).The results of receiver operating characteristic curve analysis showed that the area under the curve of the original warning model P1 was 0.791,and the area under the curve of the early warning model P2 was 0.825.Conclusion The SMOTE early warning model is better than the original warning model,and can accurately predict epilepsy after successful resuscitation of cardiac arrest.

Abstract:Objective To observe the effect of proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors combined with atorvastatin on angina pectoris after percutaneous coronary intervention(PCI).Methods A total of 225 patients with angina pectoris after PCI in the Department of Cardiology,The Second People's Hospital of Hengshui,Hebei Province from April 2022 to April 2024 were selected.According to the random number table method,they were divided into the control group(112 cases)and the observation group(113 cases).The control group was treated with atorvastatin,and the observation group was treated with atorvastatin combined with PCSK9 inhibitors evolocumab.Both groups were treated for 24 weeks.Blood lipids,cardiac function,inflammatory factors,Seattle angina questionnaire(SAQ)score,adverse drug reactions(ADR)and follow-up were compared between the two groups.Results There were 2 cases in the control group and 3 cases in the observation group who dropped out,respectively.After 4,12 and 24 weeks of treatment,the levels of low-density lipoprotein cholesterol(LDL-C),lipoprotein(a),left ventricular end-systolic diameter(LVESD),interleukin-1β(IL-1β)and IL-6 in the two groups were lower than those before treatment.After 12 and 24 weeks of treatment,the levels of LDL-C,lipoprotein(a),LVESD,IL-1β and IL-6 in the two groups were lower than those after 4 weeks of treatment and 24 weeks of treatment.The levels of LDL-C,lipoprotein(a),LVESD,IL-1β and IL-6 in both groups were lower than those in 12 weeks(all P＜0.05).The levels of LDL-C,lipoprotein(a),LVESD,IL-1β and IL-6 in the observation group were lower than those in the control group at 4,12 and 24 weeks after treatment(all P＜0.05).After 4,12 and 24 weeks of treatment,stroke volume(SV),left ventricular ejection fraction(LVEF)and SAQ scores of the two groups were higher than those before treatment.After 12 and 24 weeks of treatment,the SV,LVEF and SAQ scores of the two groups were higher than those after 4 weeks of treatment.After 24 weeks of treatment,the SV,LVEF and SAQ scores of both groups were higher than those after 12 weeks of treatment(all P＜0.05).The SV,LVEF and SAQ scores of the observation group were higher than those of the control group at 4,12 and 24 weeks of treatment(all P＜0.05).There was no significant difference in the total incidence of ADR between the two groups(P＞0.05).After 12 weeks of follow-up,the incidences of secondary stent implantation and readmission in the observation group were lower than those in the control group[10.0％(11/110)vs 21.8％(24/110),9.1％(10/110)vs 19.1％(21/110)](x2=5.742,P=0.017;x2=4.543,P=0.033).After 24 weeks of follow-up,the incidence of secondary stent implantation and readmission in the observation group was lower than that in the control group[14.6％(16/110)vs 27.3％(30/110),12.7％(14/110)vs 24.6％(27/110)](x2=5.387,P=0.020;x2=5.066,P=0.024).Conclusion PCSK9 inhibitors combined with atorvastatin is effective in the treatment of angina pectoris after PCI,which can improve blood lipid and cardiac function,regulate inflammatory factors,increase SAQ score,reduce secondary stent implantation,and also reduce readmission of patients with angina pectoris after PCI,and does not increase ADR.

Abstract:Objective To investigate the efficacy of levosimendan and recombinant human brain natriuretic peptide in patients with acute myocardial infarction(AMI)complicated with heart failure and its effect on brain natriuretic peptide(BNP)and cardiac function.Methods A total of 120 patients with AMI complicated with heart failure admitted to the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to January 2025 were selected,and they were divided into single-drug group(levosimendan treatment)and combination group(levosimendan combined with recombinant human brain natriuretic peptide treatment)by random number table method,with 60 cases in each group.The therapeutic effects,levels of cardiac troponin I(cTnI),BNP,soluble tumor suppressor protein 2(sST2),urotensin Ⅱ,interleukin-1β(IL-1β),matrix metalloproteinase 9(MMP-9),high sensitive C-reactive protein(hs-CRP),cyclophilin A,left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were compared between the two groups.The adverse drug reactions of the two groups were analyzed.Results The total effective rate of the combination group was significantly higher than that of the single-drug group[93.3％(56/60)vs 80.0％(48/60)](P=0.032).After treatment,the levels of BNP,cTnI and sST2 in the two groups decreased,and the level of urotensin Ⅱ increased,and the comparison between the two groups showed that the combination group was better(all P＜0.05).After treatment,the levels of LVEDD and LVESD in the two groups reduced,and the level of LVEF increased,and the comparison between the two groups showed that the combination group was better(all P＜0.05).The levels of IL-1 β,MMP-9,hs-CRP and cyclophilin A in the two groups decreased after treatment,and the comparison between the two groups showed that the combination group was lower(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Levosi-mendan combined with recombinant human brain natriuretic peptide in the treatment of AMI complicated with heart failure can significantly reduce the level of BNP,improve the cardiac function of patients,alleviate the inflammatory response,improve the clinical efficacy,and has good safety.

Abstract:Objective To investigate the changes of low-density lipoprotein receptor-related protein with 11 ligand-binding repeats(LR11)and protein tyrosine phosphatase receptor O(PTPRO)in peripheral blood before and after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI)and their relationship with in-stent restenosis(ISR).Methods A total of 312 elderly AMI patients who underwent PCI in Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to December 2023 were prospectively selected,and they were divided into ISR group and non-ISR group according to whether ISR occurred after 1 year.The levels of LR11 and PTPRO in peripheral blood were detected by enzyme-linked immu-nosorbent assay.Spearman correlation was used to analyze the correlation between the levels of peripheral blood LR11 and PTPRO and the rate of luminal diameter stenosis at 1 year after PCI in AMI patients,and the relationship between the levels of peripheral blood LR11 and PTPRO and ISR in AMI patients after PCI and its predictive efficacy were analyzed.Results The levels of LR11 and PTPRO in peripheral blood of AMI patients after PCI were higher than those before PCI[(195±48)mg/L vs(153±43)mg/L,(20±4)μg/L vs(16±4)μg/L](both P＜0.05).The levels of LR11 and PTPRO in peripheral blood of AMI patients after PCI were positively correlated with the lumen diameter stenosis rate at 1 year after PCI(rs=0.617,0.602,both P＜0.001).After 1-year follow-up,the incidence of ISR after PCI was 16.7％(52/312)in 312 AMI patients.High low-density lipoprotein cholesterol,high postoperative LR11 and high postoperative PTPRO were independent risk factors for ISR in AMI patients after PCI(all P＜0.05).The area under the curve of postoperative peripheral blood LR11,PTPRO and their combination to predict ISR in AMI patients after PCI was 0.824,0.797 and 0.904,respectively,and the combination of the two was better than each single prediction(both P＜0.05).Conclusion The increased levels of LR11 and PTPRO in peripheral blood of elderly AMI patients after PCI are related to ISR after PCI.The combination of LR11 and PTPRO has a high predictive effect on ISR after PCI.

Abstract:Objective To investigate the clinical value of coronary CT angiography(CCTA)and CT fractional flow reserve(CT-FFR)in the evaluation of myocardial ischemia caused by coronary artery disease.Methods A total of 106 patients with coronary atherosclerotic heart disease who underwent coronary angiography and fractional flow reserve(FFR)measurement at Peking University First Hospital from January 2018 to December 2022 were enrolled retrospectively.A total of 114 coronary vessels with 50％to 89％stenosis were included.All patients underwent CCTA examination within 3 months before surgery to obtain coronary disease reporting and data system(CAD-RADS)grades and CT-FFR values,and quantitative flow ratio(QFR)was calculated based on coronary angiography images.FFR≤0.80 was used as the diagnostic criterion for myocardial ischemia,and the diagnostic efficacy of each index was evaluated,and Spearman correlation and subgroup analysis were performed.Results The area under the curve(AUC)of CAD-RADS classification for the diagnosis of myocardial ischemia was 0.663(95％confidence interval:0.569-0.749).There was no correlation between CT-FFR and FFR(r=0.18,P=0.054),and the overall diagnostic efficacy of CT-FFR for myocardial ischemia was limited(AUC=0.562,95％confidence interval:0.466-0.655),but it showed better diagnostic performance in female patients(AUC=0.845)than in male patients(AUC=0.504,P＜0.001).QFR was highly correlated with FFR(r=0.82,P＜0.001),and the AUC for diagnosing myocardial ischemia was 0.965(95％confidence interval:0.913-0.991).Conclusion In patients with coronary artery stenosis ranging from 50％to 89％,QFR has high diagnostic consistency and accuracy,which can be used as a reference index to verify the accuracy of non-invasive assessment.CAD-RADS classification and CT-FFR alone have limited diagnostic value for functional myocardial ischemia.CT-FFR has a better diagnostic performance in female patients,suggesting that it may have certain application value in specific population.

Abstract:Objective To investigate the predictive value of left atrial pressure(LAP)on recurrence after catheter ablation in patients with atrial fibrillation complicated by heart failure with preserved ejection fraction(HFpEF).Methods A total of 233 patients with atrial fibrillation complicated by HFpEF who were hospitalized for the first time in Xiangyang Central Hospital,Hubei University of Arts and Science from January 2022 to August 2024,underwent successful catheter ablation and completed follow-up were retrospectively enrolled.According to whether atrial fibrillation recurred during follow-up,patients were divided into non-recurrence group(182 cases)and recurrence group(51 cases).Baseline data were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent predictors of recurrence,and receiver operating characteristic(ROC)curve was applied to evaluate the predictive efficacy of each indicator.Results There were significant differences in left atrial anterior-posterior diameter,left atrial volume,preoperative LAP and postoperative LAP between the two groups(all P＜0.05).Univariate analysis showed that left atrial anterior-posterior diameter,preoperative LAP,postoperative LAP and left atrial volume were significant predictors of atrial fibrillation recurrence(all P＜0.05).Multivariate analysis showed that preoperative LAP,postoperative LAP,left atrial anterior-posterior diameter and left atrial volume were independent predictors for atrial fibrillation recurrence(all P＜0.05).ROC curve analysis showed that the areas under the curve of preoperative LAP,postoperative LAP,left atrial anterior-posterior diameter,left atrial volume and the combination of the four indicators were 0.864,0.834,0.724,0.804 and 0.923,respectively,and the combined prediction of the four indicators was the best.Conclusion LAP is an independent predictor of atrial fibrillation recurrence after catheter ablation in patients with atrial fibrillation complicated by HFpEF.Combined with left atrial anterior-posterior diameter and left atrial volume,it can further improve the prediction accuracy,which is helpful to identify high-risk patients and guide postoperative management.

Abstract:Objective To explore the correlation of serum adipokine progranulin(PGRN)and resistin with inflammatory markers and nutritional indicators in elderly chronic heart failure(ECHF)patients complicated with frailty,and to analyze their diagnostic value.Methods A total of 203 ECHF patients admitted to The Second Hospital of Heilongjiang Province from March 2022 to June 2025 were enrolled as the ECHF group,and 184 age-and gender-matched community residents were selected as the control group.Levels of PGRN and resistin were detected.ECHF patients were further divided into frailty subgroup and non-frailty subgroup according to the complication of frailty.Serum levels of PGRN,resistin and inflammatory markers including interleukin-1 β(IL-1 β),IL-6 and tumor necrosis factor-α(TNF-α)were detected,and nutritional risk screening 2002(NRS 2002)score in the ECHF patients was calculated.Pearson correlation analysis was used to analyze the correlations of serum PGRN and resistin with inflammatory markers and nutritional indicators in ECHF patients complicated with frailty.The influencing factors of frailty in ECHF patients and the diagnostic value of serum PGRN and resistin were analyzed.Results Compared with the control group,serum levels of PGRN and resistin in the ECHF group were increased[(66±17)μg/L vs(44±9)μg/L,(8.1±2.7)μg/L vs(4.2±1.4)μg/L](all P＜0.001).Serum PGRN and resistin were positively correlated with IL-1 β,IL-6,TNF-α and NRS 2002 score in ECHF patients complicated with frailty(all P＜0.001).Advanced age(odds ratio=1.128,P=0.001),prolonged course of heart failure(odds ratio=1.302,P=0.009),New York Heart Association functional class Ⅳ(odds ratio=4.104,P=0.037),elevated PGRN(odds ratio=1.111,P＜0.001)and elevated resistin(odds ratio=1.775,P＜0.001)were independent risk factors for frailty in ECHF patients.The area under the curve of PGRN alone,resistin alone,and their combination for diagnosing frailty in ECHF patients was 0.794,0.807 and 0.898 respectively,and the combined diagnosis showed the optimal efficacy(all P＜0.05).Conclusion The elevated serum levels of PGRN and resistin in ECHF patients complicated with frailty are related to enhanced inflammatory response and malnutrition.The combined detection of serum PGRN and resistin has high diagnostic value for frailty complicated with ECHF.

Abstract:Objective To compare the efficacy and safety of percutaneous transluminal coronary angio-plasty(PTCA)alone,drug-eluting stents(DES)and drug-coated balloons(DCB)in patients with coronary atherosclerotic heart disease in the real world.Methods A retrospective cohort study was conducted.Patients with coronary heart disease who underwent interventional therapy in Baoding No.1 Central Hospital,Hebei Province from January 2022 to October 2024 were enrolled and divided into PTCA group,DES group and DCB group according to surgical methods.Propensity score matching was used to balance baseline data among groups at a ratio of 1∶1∶1,and finally 70 patients were included in each group.The primary efficacy endpoint was major adverse cardiovascular events(MACE,including cardiac death,non-fatal myocardial infarction and ischemia-driven target lesion revascularization)within 1 year after operation.Safety endpoints included bleeding academic research consortium type 2-5 bleeding and in-stent thrombosis.Results The surgical success rates were high in all three groups[92.9％(65/70)in PTCA group vs 97.1％(68/70)in DES group vs 98.6％(69/70)in DCB group,P=0.185].During follow-up,there was no significant difference in the incidence of MACE among PTCA group,DES group and DCB group[20.0％(14/70)vs 17.1％(12/70)vs 8.6％(6/70)](P=0.147).In terms of safety,the incidence of bleeding events was lower in PTCA group[10.0％(7/70)],and no in-stent thrombosis occurred.Multivariate Cox regression analysis showed that age(per 1-year increase),diabetes mellitus,acute coronary syndrome,lesion type(B2/C type)and target lesion vessel being left anterior descending artery were risk factors for MACE(all P＜0.05).Conclusion In real-world clinical practice,in a propensity score-matched cohort of coronary heart disease patients,PTCA alone,as a representative of the"intervention without implantation"concept,shows favorable application value in specific lesions.Its surgical success rate is comparable to that of DES and DCB,and it has safety advantages of lower bleeding risk and zero in-stent thrombosis.Revascularization strategies should be reasonably selected according to lesion characteristics and individual patient conditions,and PTCA remains an important treatment option for specific populations.

Abstract:Objective To investigate the value of different risk factors in health management for predicting the risk of atherosclerotic cardiovascular disease(ASCVD).Methods Data of 1 679 employees who underwent annual physical examination in a unit in Xi'an City,Shaanxi Province from February 1 to April 30,2023 were retrospectively analyzed.Relevant data were collected,and the included population was divided into low-risk,intermediate-risk,high-risk,very high-risk and ultra-high-risk groups according to the overall risk assessment process of ASCVD in Chinese adults.Low-risk and intermediate-risk were defined as non-high-risk,while high-risk,very high-risk and ultra-high-risk were defined as high-risk.General data were compared between high-risk and non-high-risk populations.Multivariate Logistic regression was used to analyze the relationship between emotional factors(anxiety/depression status),inflammatory indicators[systemic immune-inflammation index(SII),systemic inflammatory response index(SIRI)and systemic inflammation aggregation index(AISI)]and high ASCVD risk.Restricted cubic spline model was used to analyze the potential dose-response association between inflammatory indicators and high ASCVD risk.Receiver operating characteristic curve and De-long test were used to evaluate the diagnostic and predictive value of inflammatory indicators for high ASCVD risk.Results There were statistically significant differences between non-high-risk population(1 419 cases)and high-risk population(260 cases)in gender,age,SII,SIRI,AISI,anxiety score,depression score and other aspects(all P＜0.05).Multivariate Logistic regression analysis showed that after fully adjusting relevant variables,anxiety and depression scores were not associated with high ASCVD risk(all P＞0.05),while SII,SIRI and AISI were associated with high ASCVD risk(all P＜0.05).Restricted cubic spline model analysis showed a linear correlation between SII(Poverall＜0.001,Pnon-linear=0.074)and high risk,and nonlinear correlations between SIRI(Poverall＜0.001,Pnon-linear=0.024),AISI(Poverall＜0.001,Pnon-linear=0.006)and high risk.SII,SIRI and AISI all had predictive value for high ASCVD risk(all P＜0.05),with areas under the curve of 0.562,0.630 and 0.611,respectively.Conclusion The retrospective study of physical examination data suggests that emotional factors(to some extent)and complete blood cell-related inflammatory indexes have predictive value for high ASCVD risk.

Abstract:As a highly prevalent gastrointestinal malignant tumor worldwide,colorectal cancer has a complex pathogenesis and poor prognosis.At present,conventional clinical treatment faces severe challenges such as multidrug resistance,high metastasis and recurrence rate,and serious toxic side effects.Nuclear factor erythroid 2-related factor 2(Nrf2)signaling pathway is the core regulatory hub of cellular antioxidant stress,which mediates tumor cell proliferation,invasion and metastasis in colorectal cancer and is a key target for reversing multidrug resistance in colorectal cancer.Traditional Chinese medicine has unique advantages in the prevention and treatment of colorectal cancer with multi-component,multi-target and overall regulation,and shows significant potential in inhibiting tumors,reversing drug resistance and improving prognosis.Recent studies have shown that a variety of active ingredients and compounds of traditional Chinese medicine can regulate the Nrf2 signaling pathway,induce ferroptosis and apoptosis,inhibit migration and reverse drug resistance.This paper systematically reviews the role of the Nrf2 signaling pathway in colorectal cancer,aiming to provide ideas and references for the prevention and treatment of colorectal cancer with traditional Chinese medicine.