Abstract:Fetal premature ductus arteriosus is associated with a risk of poor prognosis.In this paper,the color Doppler ultrasound manifestations,clinical management and neonatal prognosis of a case of fetal ductus arteriosus suggested by prenatal ultrasound are analyzed,and the relevant literature at home and abroad is reviewed to explore and analyze the cause,clinical management and prognosis of the disease.In this case,two times of color Doppler ultrasound showed progressive deterioration of fetal heart,and the pregnancy was terminated by cesarean section in time.The newborn had a good prognosis.The neonatal prognosis of premature ductus arteriosus is related to the degree of fetal heart damage,gestational age at termination and etiology.Before fetal cardiac decompensation,close observation and careful extension of gestational age,monitoring of fetal cardiac function by ultrasound and other means,and timely termination of pregnancy can lead to good prognosis of most neonates.In addition,genetic testing can be considered for idiopathic cases to determine the etiology.

Abstract:Objective To investigate the effect of plerixafor combined with granulocyte colony stimulating factor(G-CSF)on systemic light chain amyloidosis(AL amyloidosis)by autologous peripheral blood for stem cell transplantation(ASCT).Methods A total of 46 patients diagnosed with AL amyloidosis and undergoing ASCT from July 2021 to July 2023 in General Hospital of Eastern Theater Command,National Clinical Research Center for Kidney Disease were enrolled retrospectively.Among them,23 patients with G-CSF mobilization regimen alone were included in the control group,and 23 patients with plerixafor combined G-CSF mobilization regimen were included in the observation group.The incidence of adverse reactions of stem cell mobilization,stem cell collection and reinfusion,transplantation complications and hematopoietic reconstitution were compared between the two groups.Results The incidence of diarrhoea related to stem cell mobilization in the observation group was higher than that in the control group(P＜0.01).The number of CD34 cells before collection and CD34 cells in the collection in the observation group were higher than those in the control group[(135±97)cells/μl vs(42±21)cells/μl,(6.9±3.5)x 106/kg vs(3.2±1.7)x 106/kg],and the collection cost was lower than that of the control group(all P＜0.01).The amount and cost of stem cell reinfusion in the observation group were lower than those in the control group(both P＜0.01).There was no significant difference in the incidence of complications in the neutropenia period between the two groups(all P＞0.05).The duration of granule deficiency,vertical implantation time,platelet implantation time and length of hospital stay in the observation group were shorter than those in the control group,and the hospitalization cost was lower than that in the control group(all P＜0.05).Conclusions Plerixafor combined with G-CSF mobilization regimen is safe and effective in ASCT for AL amyloidosis.It can reduce the frequency of collection,improve the quality of collection,effectively promote hematopoietic reconstitution,shorten the length of hospital stay,and reduce the cost of hospitalization.

Abstract:Objective To investigate the prevalence of Helicobacter pylori(Hp)infection in elderly patients with coronary atherosclerotic heart disease(CHD)and the correlation between their serum antibody types and the degree of coronary artery disease.Methods A total of 217 patients with CHD who were admitted to Western Theater General Hospital from April 2021 to June 2023 were selected as the research objects.The patients were divided into mild group(72 cases),moderate group(74 cases)and severe group(71 cases)according to the Gensini score tertiles.The general data of patients in each group were collected,the serum biochemical indexes,inflammatory factor indexes[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and Hp serum antibody classification of patients in each group were detected,and the plaque status of patients was evaluated.The related factors affecting the severity of coronary artery disease in elderly patients with CHD were analyzed.The correlation between Hp subtypes and levels of inflammatory factors was analyzed.Results There were significant differences in the proportion of Hp infection,high-risk plaque,and multi-vessel coronary artery disease among the three groups(all P＜0.05).The detection rates of cytotoxin-associated gene A product(CagA)/toxic vacuolated cytotoxin(VacA)in patients with multi-vessel lesions and high-risk plaque were higher than those in patients with single-vessel lesions and non-high-risk plaque[40.7％(35/86)vs 19.8％(26/131),48.5％(32/66)vs 19.2％(29/151)],and the detection rate of CagA/VacA increased in the mild group,moderate group and severe group[8.3％(6/72),28.4％(21/74)and 47.9％(34/71)](all P＜0.05).The levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol(LDL-C),hs-CRP,IL-6 and TNF-α in the moderate and severe groups were higher than those in the mild group,and those in the severe group were higher than those in the moderate group(all P＜0.05).Ordinal Logistic regression analysis showed that the levels of CagA/VacA subtype,total cholesterol,triglyceride,LDL-C,hs-CRP,IL-6 and TNF-α were all the independent risk factors for the severity of coronary artery disease in elderly patients with CHD(all P＜0.05).The levels of hs-CRP,IL-6 and TNF-α in patients with CagA/VacA infection were higher than those with UreA/UreB infection in the mild,moderate and severe groups(all P＜0.05).The levels of hs-CRP,IL-6 and TNF-αwere positively correlated with the CagA/VacA subtype(all P＜0.05),and negatively correlated with the UreA/UreB subtype(all P＜0.05).Conclusions Hp infection is closely related to the degree of coronary artery lesions in elderly CHD patients.The degree of coronary artery lesions is more serious in elderly CHD patients with Hp positive and CagA/VacA antibody type.

Abstract:Postoperative cognitive dysfunction(POCD)is one of the major postoperative complications in the elderly.Many studies have reported the risk factors of POCD,among which perioperative hypothermia is not only a common risk factor for surgery,but also a high risk factor for inducing POCD.Hypothermia can lead to an increase in perioperative blood loss,which increases the probability of infection.Especially in urology surgery,the use of a large amount of low temperature irrigation fluid during the operation,patients often have hypothermia during and after the operation.This will greatly affect the patient's postoperative recovery and prolong the length of hospital stay.There is still no satisfactory solution to solve the problem of intraoperative hypothermia and reduce the incidence of POCD.This article describes the research status of POCD and the changes of intraoperative body temperature,especially the relationship between intraoperative hypothermia and POCD,suggesting the importance of intraoperative body temperature protection,and it is expected to improve the prognosis of patients through a good body temperature protection strategy.

Abstract:Plexiform neurofibroma(pNF)is a rare benign schwannoma,which occurs in 30％-50％of patients with neurofibromatosis type 1.pNF can involve the head and neck,orbit,limbs,chest,abdomen,pelvic cavity,spinal canal,nerve roots,peripheral nerves and other parts,which may lead to severe pain and disfigupation,and even endanger organ function.Surgery is the main treatment for pNF.In recent years,with the joint develop-ment of oncology,neuroscience,genetics and pharmacology,medical treatment has also shown great application prospects.This article reviews the progress of drug and gene therapy in the medical treatment of pNF.

Abstract:Objective To investigate the mechanism of high-altitude pulmonary hypertension(HAPH)and the intervention effect of human embryonic stem cell exosomes(hESC-exo)on HAPH.Methods Thirty 8-week-old C57BL/6 male mice were randomly divided into three groups:control group,hypobaric hypoxia group(HH group),hypobaric hypoxia hESC-exo intervention group(HH-exo group),with 10 mice in each group.The mice in the control group were fed in the normobaric and normoxic environment for 35 d.The mice in HH and HH-exo groups were exposed to hypobaric hypoxia for 28 d and then exposed to normobaric and normoxic environment for another 7 d.On day 29,30 and 31 of the experiment,the HH-exo group was injected with 20 μg hESC-exo via the tail vein,and the control group and the hypobaric hypoxia group were injected with the same volume of phosphate buffer solution.Right ventricular systolic pressure(RVSP),right ventricular hypertrophy index(RVHI)and pulmonary arterial wall thickness(PA thickness)were evaluated on day 35.The mRNA and protein expression levels of α-smooth muscle actin(α-SMA),α-1 collagen(Col1-a1)and fibronectin(FN)were detected by real-time fluorescent quantitative polymerase chain reaction and Western blotting.Results After successful modeling,RVSP,RVHI and PA thickness in HH group were significantly higher/larger than those in control group(all P＜0.05).Four days after the last exosome injection,the pulmonary vascular resistance and pulmonary vascular morphology of mice in each group were re-evaluated.The results showed that the RVSP,RVHI and PA thickness of the HH-exo group were significantly lower/smaller than those of the HH group[(21.0±3.8)mmHg vs(26.8±3.6)mmHg,(0.256±0.016)vs(0.361±0.018),(0.54±0.11)vs(0.79±0.13)](all P＜0.05).The mRNA and protein expression levels of α-SMA,Col1-a1,and FN in the HH-exo group were signifi-cantly lower than those in the HH group(all P＜0.05).Conclusions Pulmonary adventitial fibrosis is the main histopathological feature of hypoxia-induced pulmonary hypertension in mice.hESC-exo can effectively alleviate HAPH induced by hypobaric hypoxia in mice by reducing pulmonary adventitial fibrosis.

Abstract:Objective To investigate the current status and influencing factors of frailty in hospitalized elderly patients with atrial fibrillation.Methods A total of 106 elderly inpatients with atrial fibrillation diagnosed and treated in Bazhong Central Hospital,Sichuan Province from May 2021 to May 2024 were collected as the research objects,and their clinical data were recorded.According to the occurrence of frailty,they were divided into non-frailty group(56 cases)and frailty group(50 cases).Multivariate Logistic regression analysis was used to screen the influencing factors of frailty in hospitalized elderly patients with atrial fibrillation.And construct a nomogram prediction model.The Bootstrap method was used for internal verification,the Hosmer-Lemeshow test was used to analyze the consistency of the nomogram prediction model,the receiver operating characteristic(ROC)curve was drawn to analyze the discrimination of the model,and the calibration curve was used to analyze the calibration of the model.Results Among 106 hospitalized elderly patients with atrial fibrillation,50 patients developed frailty,with an incidence of 47.2％.The 30-day and 90-day readmission rates in the frailty group were higher than those in the non-frailty group[14.0％(7/50)vs 1.8％(1/56),20.0％(10/50)vs 5.4％(3/56)](both P＜0.05).The age and the proportion of Barthel index score＜60 in the frailty group were greater/higher than those in the non-frailty group,and the hemoglobin and albumin were lower than those in the non-frail group(all P＜0.05).Increasing age and Barthel index score＜60 were independent risk factors for frailty in hospitalized elderly patients with atrial fibrillation,and increasing hemoglobin and albumin were protective factors for frailty in hospitalized elderly patients with atrial fibrillation(all P＜0.05).The Hosmer-Lemeshow test results of internal validation of the nomogram showed x2=5.983,P=0.649.The ROC curve results showed that the area under the curve was 0.864(95％confidence interval:0.794-0.934).The calibration curve results showed that the actual probability was basically consistent with the predicted probability,and the slope of the curve was close to 1.Conclusion The incidence of frailty in hospitalized elderly patients with atrial fibrillation is high.Patients with older age,Barthel index score＜60,lower hemoglobin and lower albumin are more likely to have frailty.

Abstract:Objective To evaluate the predictive value of myocardial perfusion imaging(MPI)for all-cause mortality risk in patients with compound heterozygous familial hypercholesterolemia(CHFH).Methods Patients with CHFH diagnosed by genetic testing who underwent stress and rest MPI in the Department of Nuclear Medicine,Beijing Anzhen Hospital,Capital Medical University from June 2010 to March 2022 were retrospectively followed up.Total summed stress score(SSS),total summed rest score(SRS)and summed difference score(SDS)of left ventricular myocardial perfusion parameters were obtained by 17-segment 5-point method.The patients were followed up for all-cause mortality,and Cox regression was used to analyze the predictors of all-cause mortality.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of the predictors.Kaplan-Meier analysis and Log-rank test were used to compare the incidence of all-cause mortality in different groups.Results Forty-five patients with CHFH were enrolled and followed up for a median of 6(4,9)years.A total of 11(24.4％)patients died during the follow-up period.The left ventricular myocardial perfusion parameters SSS,SRS and SDS were significantly different between the death group and the survival group(all P＜0.05).Cox regression analysis showed that SRS(Hazard ratio=1.362,95％confidence interval:1.029-1.802,P=0.031)was an independent predictor of all-cause mortality in patients with CHFH.ROC analysis determined that the best cut-off value for predicting death was SRS ≥2.5,and the area under the curve was 0.749.Kaplan-meier survival curve analysis showed that the incidence of all-cause death in SRS≥2.5 group was significantly higher than that in SRS＜2.5 group(Log-rankx2=14.991,P＜0.001).Conclusion MPI is an important imaging method for the risk assessment of all-cause mortality in patients with CHFH,and parameter SRS is an important factor for predic-ting death in such patients.

Abstract:Objective To investigate the efficacy and safety of enteral nutrition combined with biological agents(infliximab or ustekinumab)in the induction of remission in adults with moderate to severe Crohn's disease.Methods The clinical data of Crohn's disease patients diagnosed in the Second Affiliated Hospital of Guilin Medical College and the Second Affiliated Hospital of Guangxi Medical University from October 2018 to October 2024 were retrospectively selected.They were divided into observation group(14 cases)and control group(15 cases)according to whether they were combined with enteral nutrition.The observation group was treated with enteral nutrition and biological agents,and the control group was treated with less residue diet and biological agents.The general clinical data,laboratory indexes before and after treatment,body mass index and Crohn's disease activity index(CDAI)score were compared between the two groups to evaluate the disease activity,and the occurrence of adverse reactions was recorded.Results After treatment,the body mass index and albumin level of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group[body mass index:(21.2±2.1)kg/m2 vs(19.3±2.9)kg/m2],and the erythrocyte sedimentation rate and CDAI of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group(all P＜0.05).All patients had a clinical response.There were 12 cases(85.7％)of clinical remission in the observation group and 11 cases(73.3％)in the control group(x2=0.132,P=0.716).During the treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Enteral nutrition combined with biological agents is beneficial to induce remission of moderate to severe Crohn's disease in adults with good safety.

Abstract:Objective To investigate the efficacy and safety of mini-percutaneous nephrolithotomy(Mini-PCNL)and retrograde intrarenal surgery(RIRS)in the treatment of renal stones with 10-20 mm high hardness in children.Methods The clinical data of 62 children with renal calculi who underwent Mini-PCNL or RIRS at Beijing Friendship Hospital,Capital Medical University from June 2021 to June 2024 were retrospectively analyzed.The patients were divided into Mini-PCNL group(29 cases)and RIRS group(33 cases).The general data,intraoperative and postoperative data of the two groups were compared.Results There were no significant differences in general data between the two groups(all P＞0.05).The length of postoperative hospital stay and the decrease of hemoglobin in Mini-PCNL group were longer/greater than those in RIRS group[(4.7±1.7)d vs(2.9±1.5)d,6(4,10)g/L vs 2(0,4)g/L].The number of anesthesia and operation time in the Mini-PCNL group were less/shorter than those in the RIRS group[(1.9±0.3)times vs(2.8±0.4)times,(58±19)min vs(69±21)min](all P＜0.05).Conclusions Mini-PCNL and RIRS have good stone-free effect and safety in the treatment of renal stones with 10-20 mm high hardness in children.Although Mini-PCNL has longer hospital stay,it has the advantages of shorter operation time and fewer times of anesthesia.

Abstract:Objective To investigate the effect of gabapentin on preoperative anxiety and intubation reaction in patients with human immunodeficiency virus(HIV)infection.Methods A total of 68 HIV-infected patients who underwent elective general anesthesia and non-cardiac surgical treatment at Beijing Ditan Hospital,Capital Medical University from May 2023 to November 2024 were selected.According to the random number table method,they were divided into the observation group and the control group,with 34 cases in each group.The control group received placebo orally the night before surgery,and the observation group was given gabapentin capsules orally the night before surgery.The visual analogue scale(VAS)score and state-trait anxiety questionnaire(STAI-S)score were compared between the two groups at the preoperative and immediately after entering the operating room.The heart rate and mean arterial pressure(MAP)were compared between the two groups before anesthesia induction,during tracheal intubation and 1,3,5,10 min after intubation.The occurrence of adverse reactions in the two groups was recorded.Results There was no significant difference in VAS scores between the two groups before operation,immediately into the operating room,and at the time of anesthesia recovery room(all P＞0.05).The STAI-S score in the observation group was lower than that before operation and that in the control group at the same time point[(39±5)vs(43±5)](all P＜0.05).The heart rate and MAP levels of the observation group were lower than those of the control group at the time of tracheal intubation and 1,3,10 min after intubation(all P＜0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(all P＞0.05).Conclusions Gabapentin can reduce preoperative anxiety and intubation reactions in HIV-infected patients,without prolonging the duration of stay in the anesthesia recovery room.

Abstract:Objective To investigate the effects of nicotinamide ribose(NR)supplementation on mitochondrial synthesis and sarcopenia in Marfan syndrome(MFS)mice.Methods Ten 3-month-old male wild type and 10 FBN1C1039G/+transgenic(FBN1 TG)mice were selected to establish a skeletal muscle injury model by intramuscular injection of cardiotoxin into the tibial anterior muscle.The area of neonatal muscle fiber,the number and volume of mitochondria were analyzed,and the expression levels of mitochondrial function-related genes were detected.NR(NR group)or equal volume of phosphate buffer(control group)was added to the culture medium of induced C2C12 myoblasts.The expression of myogenin gene,the area of muscle fiber and the content of mitochondria in cells were observed.The area of newly formed muscle fibers was analyzed on the 15th day after operation.Results The ratios of gastrocnemius muscle mass to muscle length and tibialis anterior muscle mass to muscle length of FBN1 TG mice were lower than those of wild type mice,and the cross-sectional areas of muscle fibers before and after cardiac toxin injury were smaller than those of wild type mice(all P＜0.001).It was manifested as sarcopenia.On day 10 after surgery,the number of mitochondria and the expression of mitochondria-related genes in the newborn skeletal muscle of FBN1 TG mice were less/lower than those of wild type mice(all P＜0.001).The expression of myogenin,the positive area of myofibers and the content of mitochondria in C2C12 myoblasts in NR group were higher than those in control group(all P＜0.001).On postoperative day 15,the cross-sectional area of muscle fibers in skeletal muscle of NR-treated FBN1 TG mice was larger than that of FBN1 TG mice treated with 0.9％sodium chloride injection[(836±52)μm2 vs(550±36)μm2](t=9.017,P＜0.001).Conclusion NR can improve the phenotype of sarcopenia in MFS mice by promoting mitochondrial synthesis and muscle fiber formation.

Abstract:Objective To compare the occurrence of recurrent laryngeal nerve injury after different types of aortic hybrid surgery.Methods A total of 175 patients who underwent aortic hybrid surgery(aortic branch artificial vascular bypass surgery+thoracic aortic endovascular repair)in Beijing Anzhen Hospital,Capital Medical University from December 2019 to December 2021 were selected to analyze the causes of recurrent laryngeal nerve injury after aortic hybrid surgery.The occurrence of postoperative recurrent laryngeal nerve injury and other postop-erative complications in different surgical types were compared and analyzed.Results According to the type of surgery,the 175 patients were divided into the left common carotid artery-left subclavian artery bypass group(77 cases),the left axillary artery-right axillary artery-right carotid artery bypass group(35 cases),the left axillary artery-right axillary artery- left common carotid artery bypass group(20 cases),and the ascending aorta-brachioce-phalic artery bypass group(43 cases).The incidence of postoperative recurrent laryngeal nerve injury in the four groups was 16.9％(13/77),0(0/35),10.0％(2/20)and 18.6％(8/43),respectively,and the difference between the groups was statistically significant(P=0.023).Another 175 patients had cerebral infarction in 6 cases(3.4％),paraplegia in 5 cases(2.9％),acute kidney injury in 3 cases(1.7％),arrhythmia in 3 cases(1.7％),and pulmonary infection in 5 cases(2.9％).Conclusion Recurrent laryngeal nerve injury is one of the postoperative complications of aortic hybrid surgery.There are significant differences in the incidence of recurrent laryngeal nerve injury among different types of hybrid surgery.

Abstract:Objective To investigate the clinical characteristics and gender differences in patients with degenerative mitral regurgitation undergoing mitral valve repair.Methods A total of 639 consecutive patients with degenerative mitral regurgitation who underwent mitral valve repair in Beijing Anzhen Hospital,Capital Medical University from January 1,2018 to December 31,2022 were enrolled.The patients were grouped according to gender,and the differences in clinical characteristics and echocardiographic parameters between the two groups were compared.Results Of the 639 enrolled patients,195(30.5％)were female.Compared with male patients,female patients were older[58(47,66)years vs 54(45,62)years]and had higher levels of brain natriuretic peptide and D-dimer before surgery(all P＜0.05).There was no significant difference in the location of valve prolapse and chordae tendineae rupture between male and female patients(all P＞0.05).The left atrial antero-posterior diameter,right atrial diameter,left ventricular end-diastolic diameter and left ventricular end-systolic diameter of female patients were smaller than those of male patients(all P＜0.001).However,after adjusting for body surface area,the above imaging parameters were larger in female than in male,and the corrected left ventricular end-diastolic diameter and corrected left ventricular end-systolic diameter were significantly different(all P＜0.001).Conclusion For female patients with degenerative mitral regurgitation,ultrasound parameters without body surface area correction may underestimate the severity of cardiac compensation caused by valvular regurgitation.

Abstract:Objective To construct a long-term prognosis score in patients with pediatric dilated cardio-myopathy(PDCM)based on clinical risk factors and verify its risk stratification ability.Methods The clinical data of children with dilated cardiomyopathy(DCM)admitted to Beijing Anzhen Hospital,Capital Medical University from September 2015 to December 2019 were retrospectively analyzed.Children with DCM from September 2015 to March 2017 were enrolled as the discovery set(87 cases),and children with DCM from April 2017 to December 2019 were enrolled as the validation set(51 cases).According to the presence or absence of adverse events,the children with DCM were divided into event group and non-event group.Univariate Cox regression was used to screen clinical risk factors related to adverse events,and multivariate Cox regression coefficients was further used to assign weights to clinical risk factors to construct a prognostic score.Kaplan-Meier curves was used to assess the risk stratification ability of the scores.Results In the discovery set,the left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)in the event group were lower than those in the non-event group.The levels of blood urea nitrogen,serum uric acid and B-type natriuretic peptide(BNP)in the event group were higher than those in the non-event group(all P＜0.05).In the validation set,the age,serum creatinine and BNP in the event group were higher than those in the non-event group(all P＜0.05).Univariate Cox regression analysis showed that age,LVEF,LVFS,left ventricular end-diastolic diameter z score,BNP,blood urea nitrogen,serum uric acid and C-reactive protein were significantly correlated with adverse events(all P＜0.05).Multivariate Cox regression analysis finally included LVEF,BNP and C-reactive protein to construct the prognostic score.In validation set,after the use of prognostic score for layered,low-risk and high-risk children with DCM non-event survival rates were 81.2％and 51.1％respectively(Log-rank P=0.049).Conclusion The prognostic score of PDCM long-term adverse events based on clinical risk factors is construct,it can be used for risk stratification.

Abstract:Objective To investigate the clinical characteristics and prognosis of patients with hematogenous disseminated tuberculosis(HDTB)admitted to intensive care unit(ICU),and to improve clinicians'understanding of the disease.Methods A total of 130 patients with severe tuberculosis admitted to the tuberculosis ICU of Changsha Central Hospital,Hunan Province from June 2019 to June 2023 were retrospectively analyzed.According to the presence or absence of hematogenous spread and lesion involvement,the patients were divided into HDTB group(42 cases)and local tuberculosis group(88 cases).The clinical characteristics and prognosis of the two groups were compared.Results The proportions of underlying diseases and autoimmune diseases in the HDTB group were higher than those in the local tuberculosis group,while the proportions of cough and expectoration were signif-icantly lower than those in the local tuberculosis group(all P＜0.05).The white blood cell count,hemoglobin and albumin levels of the HDTB group were lower than those of the local tuberculosis group,and the procalcitonin and C-reactive protein levels and the proportions of liver and renal insufficiency were higher than those of the local tuberculosis group(all P＜0.05).The proportion of hematogenous disseminated tuberculosis in the HDTB group was significantly higher than that in the local tuberculosis group,while the proportion of invasive tuberculosis was lower than that in the local tuberculosis group[54.8％(23/42)vs 9.5％(8/84),21.4％(9/42)vs 54.8％(46/84)](both P＜0.05).There was no significant difference in the proportion of cavitary tuberculosis between the two groups(P＞0.05).The positive rate of acid-fast bacilli in HDTB group was significantly lower than that in local tuberculosis group(P＜0.05).The incidences of multiple organ dysfunction syndrome,sepsis and adverse reactions to anti tuberculosis drugs in the HDTB group were significantly higher than those in the local tuberculosis group,and the length of ICU stay and total hospital stay were longer than those in the local tuberculosis group(all P＜0.05).Totally 27 patients(64.3％)in HDTB group were successfully transferred out of ICU after treatment,and 15 patients(35.7％)died in hospital.In the local tuberculosis group,74 patients(84.1％)were discharged from ICU and 14 patients(15.9％)died in hospital.The mortality rate in the HDTB group was significantly higher than that in the local tuberculosis group(P＜0.05).Conclusion HDTB mostly occurs in patients with immunocompromised underlying diseases.The clinical manifestations of HDTB are mainly systemic symptoms,such as lack of specificity,pulmonary imaging is mainly hematogenous disseminated tuberculosis,the positive rate of acid-fast bacilli in sputum is low,the co-infection is more serious,the incidence of multiple organ dysfunction syndrome and sepsis is high,the adverse drug reactions in the process of anti-tuberculosis is easy to occur,the length of hospital stay is long,and the mortality is high.

Abstract:Objective To investigate the efficacy and safety of esketamine combined with sufentanil in patients undergoing liver cancer resection.Methods A total of 108 patients with primary liver cancer who under-went liver cancer resection in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Hebei Province from November 2021 to November 2023 were divided into sufentanil group and combination group by simple random method,with 54 cases in each group.Patients in both groups were treated with patient-controlled intravenous analgesia(PCIA)after operation.The sufentanil group was treated with sufentanil and ondansetron.The combination group was treated with esketamine on the basis of sufentanil group.The perioperative indexes,visual analogue scale(VAS)scores,respiratory and circulatory function indexes at 6,24 and 48 hours after operation were compared between the two groups.The occurrence of adverse reactions was recorded.Results The first ambulation time and the dosage of PCIA in the combined group were shorter/lower than those in the sufentanil group[(33±4)h vs(39±4)h,(56±5)ml vs(79±6)ml](both P＜0.001).The VAS scores of the two groups showed a decreasing trend at 6,24 and 48 hours after operation,and the VAS scores of the combined group were lower than those of the control group at each time point(all P＜0.001).The mean arterial pressure and heart rate of the two groups showed a decreasing trend,and the levels of the combined group were lower than those of the control group at each time point(all P＜0.001).The pulse oxygen saturation of the combined group was higher than that of the sufentanil group at each time point(all P＜0.05).The incidence of adverse reactions in the combined group was lower than that in the sufentanil group(P＜0.05).Conclusion PCIA with esketamine combined with sufentanil has definite analgesic effect in patients undergoing liver cancer resection,can improve perioperative indicators,and has little effect on respiratory and circulatory function of patients,with high safety.

Abstract:Objective To analyze the risk factors of carotid artery restenosis after interventional therapy in patients with ischemic stroke.Methods The clinical data of 110 patients with ischemic stroke who underwent endovascular interventional therapy in Hengshui People's Hospital,Hebei Province from December 2020 to December 2022 were collected and retrospectively analyzed.All patients were followed up for 1 year.According to the results of re-examination of carotid ultrasound,the patients were divided into the non-restenosis group(42 cases)and the restenosis group(68 cases).Logistic regression was used to analyze the risk factors of carotid artery restenosis af-ter endovascular intervention in patients with ischemic stroke.The nomogram prediction model was constructed by R software,internal validation was performed by Bootstrap method,goodness of fit test was performed by Hosmer-Lemeshow test,and the predictive efficacy of the nomogram was evaluated by receiver operating characteristic(ROC)curve.Results The proportion of smoking history,hyperhomocysteinemia(HHcy),postoperative proximal carotid artery diameter＜6.8 mm,postoperative proximal internal carotid artery diameter＜4.8 mm,and postoper-ative serum C-reactive protein(CRP)＞10 mg/L in the restenosis group were higher than those in the non-restenosis group(all P＜0.05).The results of univariate Logistic regression analysis showed that smoking history,HHcy,small postoperative proximal diameter of the common carotid artery,small postoperative proximal diameter of the internal carotid artery,and high postoperative serum CRP were all risk factors for carotid artery restenosis after intravascular intervention(odds ratios=4 158.246,31.064,140.768,295.064,and 8 286.344,all P＜0.05).The nomogram prediction model and calibration curve based on the incidence of carotid restenosis after endovascular intervention had a good consistency with the actual incidence,and the concordance index was 0.913.The ROC curve analysis showed that the area under the curve was 0.913(95％confidence interval:0.821-0.942),indicating that the prediction model had high discrimination power and predictive value.Conclusion The occurrence of carotid artery restenosis after endovascular intervention in patients with ischemic stroke is related to smoking history,HHcy,small postoperative proximal diameter of common carotid artery,small postoperative proximal diameter of internal carotid artery,and high postoperative serum CRP,which should be paid attention to in clinical practice.

Abstract:Objective To investigate the relationship between the methylation levels of the CD4+T lymphocyte perforin gene promoter and the continuous progression of pulmonary emphysema in rats after smoking cessation,as well as the intervention effect of S-adenosylmethionine(SAM).Methods Twenty SD rats were randomly divided into 4 groups:normal control group,model group,4-week smoking cessation group,and 4-week smoking cessation with SAM intervention group,each comprising 5 rats,the last three groups rat emphysema model was established using cigarette smoke exposure method and taked corresponding measures.Right lower lung tissues were collected from each group for histopathological observation after staining with hematoxylin-eosin(HE),and mean linear intercept(MLI)and mean alveolar number(MAN)were measured.CD4+T lymphocytes were isolated from the spleens of rats in each group using immunomagnetic bead method,DNA was extracted,and the methylation level of the CD4+T lymphocyte perforin gene promoter region was detected.Results The model group,the 4-week smoking cessation group,and the 4-week smoking cessation with SAM intervention group all showed significant increases in MLI compared to the normal control group(all P＜0.05).Specifically,the 4-week smoking cessation group showed greater increases compared to the model group and the 4-week smoking cessation with SAM intervention group(both P＜0.05).Moreover,the model group,the 4-week smoking cessation group,and the 4-week smoking cessation with SAM intervention group demonstrated decrease in MAN compared to the normal control group(all P＜0.05),with the 4-week smoking cessation group showing a greater decrease compared to the model group(P＜0.05).Additionally,the methylation levels of CD4+T lymphocyte perforin gene promoter in the model group and the 4-week smoking cessation group were lower than those in the normal control group and the 4-week smoking cessation with SAM intervention group[(93.9±3.1)％and(93.1±1.8)％vs(97.1±1.1)％and(96.4±1.5)％](all P＜0.05).Conclusions The persistent low methylation levels observed in the perforin gene promoter of CD4+T lymphocytes in rats following smoking cessation may contribute to the ongoing deterioration of emphysema in this population.However,following intervention with SAM,the deterioration of pulmonary emphysema in smoking cessation rats could be reversed.

Abstract:Objective To investigate the changes of various indicators in elderly patients with pulmonary interstitial fibrosis combined with emphysema syndrome(CPFE),analyze the related influencing factors of the disease,and use the data to construct a nomogram prediction model and implement verification.Methods The clinical data of 120 elderly patients with CPFE(CPFE group)and 120 elderly patients with simple emphysema(simple emphysema group)who were treated in Inner Mongolia Autonomous Region People's Hospital from January 2018 to January 2023 were retrospectively analyzed.Univariate analysis was used to analyze the clinical characteristics of elderly CPFE patients,and multivariate analysis was used to analyze the influencing factors of CPFE.A nomo-gram prediction model for CPFE in elderly patients was constructed and its predictive efficiency was analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of relevant indicators for CPFE.Results The smoking index,proportion of reflux esophagitis,albumin,red blood cell volume distribution width,and percentage of carbon monoxide diffusion to predicted value(DLCO％)in the CPFE group were higher/greater than those in the simple emphysema group,while the percentage of total lung volume to predicted value(TLC％)was lower than that in the simple emphysema group(all P＜0.05).The results of Logistic multiple regression analysis showed that smoking index,reflux esophagitis,albumin,red blood cell volume distribution width,TLC％,and DLCO％were independent influencing factors for CPFE in elderly patients(all P＜0.05).A nomogram was constructed based on the variables selected by multivariate analysis.The concordance index was 0.756,and the mean absolute error of the calibration curve was 0.019.The ROC curve analysis results showed that the areas under the curve of independent influencing factors obtained from the above multiple factor analysis and the P-value prediction probability of the regression model predicting of CPFE in elderly patients were 0.713,0.600,0.739,0.674,0.702,0.729,and 0.893,respectively.Conclusion Compared with patients with simple emphysema,some clinical indicators of elderly patients with CPFE will show significant changes,and the prediction model based on these indicators can better predict the occurrence of CPFE in elderly patients.