Abstract:Erythema nodosum(EN)is an inflammatory skin condition characterized by symmetrical,painful subcutaneous nodules primarily on the lower limbs.Its etiology is complex.Modern medicine often employs treatments such as hormones and non-steroidal anti-inflammatory drugs,which can provide short-term symptomatic relief but are associated with numerous adverse effects and a high recurrence rate.Traditional Chinese medicine(TCM)offers unique advantages in treating EN,demonstrating significant potential,particularly in regulating the overall constitution and reducing recurrence.Based on the"heat toxin damaging the collaterals"theory and incorporating clinical case studies,this paper explores the clinical approach of using a modified Simiao Yong'an Decoction with stage-based pattern differentiation for EN.It highlights the treatment strategy of"administering medicine based on disease stage and simultaneously addressing toxin and stasis,"aiming to provide a new clinical reference for TCM in the treatment of this disease.

Abstract:Objective To evaluate the clinical study of traditional Chinese medicine virtual and real hanging technique combined with anal washing No.1 fumigation in the treatment of high anal fistula.Methods Retrospective analysis.A total of 120 patients with high anal fistula treated in Baotou 291 Hospital from January 2022～January 2024 was selected by random number table method.The specific methods were divided into control group(60 cases)and observation group(60 cases),and the observation group used traditional Chinese medicine virtual and real thread hanging combined with hospital formula.Anal wash No.1 fumigation,and the control group used traditional Chinese medicine virtual and real thread hanging technique combined with povidone-iodine solution sitz bath,and the treatment efficiency and postoperative performance of the two groups were compared Visual analogue score(VAS)of pain at 3,7 and 14 days,anal incontinence severity score(Wexne)at 1 month,3 months and 6 months after surgery,anorectal dynamics examination index,and the incidence of postoperative adverse reactions in the two groups.Results The total effective rate of treatment in the observation group was higher than that in the control group(95.00％vs.76.67％),and the difference was statistically significant(χ2=8.292,P<0.05).With the progression of treatment,the VAS score,Wexner score and anorectal dynamics indexes anal canal resting pressure(ARP),anal canal maximum systolic pressure(MSP)and anal canal maximum systolic time(ALCT)all showed a downward trend in the two groups.In the comparison of each treatment time point,the VAS score,Wexner score,ARP,MSP,and ALCT of the observation group were lower than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in postoperative adverse reactions(wound infection,fall,anal incontinence,wound edema)between the two groups(P>0.05).Conclusion Traditional Chinese medicine virtual and real thread hanging technique combined with anal wash No.1 fumigation can help treat the recovery of sphincter muscle and reduce pain in patients with high anal fistula,and has good safety.

Abstract:Objective To evaluate the effect of pain management led by clinical pharmacists on pain treatment in patients with cancer pain.Methods From October 2022 to October 2024,306 patients with cancer pain were prospectively selected and randomly divided into routine group(153 cases)and intervention group(153 cases).The routine group received routine pharmaceutical intervention,while the intervention group adopted the pain management mode led by clinical pharmacists,both of which intervened for one month.The total effective rate of pain,qualified doctor's advice,medication compliance and equivalent morphine consumption during the intervention period were counted,and the pain improvement,quality of life and knowledge-belief-behavior scores before and after the intervention were compared between the two groups.Results After 1 month of intervention,the total effective rate of the intervention group(86.93％)was higher than that of the conventional group(77.12％,χ2=4.987,P<0.05).After 1 month of intervention,the score of pain and the number of outbreaks of pain in the two groups were lower than those before intervention,and the intervention group was lower than the conventional group[(1.98±0.51)point vs.(3.36±1.04)point,(0.97±0.25)time∕d vs.(1.98±0.61)time∕d,t=14.737,18.951,respectively,P<0.05].The scores of quality of life,knowledge,belief and behavior were higher than those before intervention,and the intervention group were higher than those of the conventional group[(45.02±4.23)point vs.(40.72±3.78)point,(30.71±2.61)point vs.(22.46±3.28)point,(28.90±3.02)point vs.(24.18±2.83)point,(16.33±1.12)point vs.(13.57±1.86)point,t=9.376,24.345,14.106,15.724,respectively,P<0.05].The total consumption of equivalent morphine in the intervention group was lower than that in the conventional group[(667.40±103.48)mg vs.(788.73±123.02)mg,t=9.336,P<0.05],and the qualified rate of medical orders and the total medication compliance rate after 1 month of intervention were higher than those in the conventional group(66.01％and 83.01％,χ2=13.724,5.889,respectively,P<0.05).Conclusion The pain management led by clinical pharmacists could effectively relieve the pain of patients with cancer pain,improve the qualified rate of medical orders,reduce morphine consumption,improve the quality of life,knowledge-belief-behavior score and medication compliance of patients,and had a good intervention effect.

Abstract:Objective To investigate the clinical characteristics and predictors of heart failure in elderly patients with diabetes mellitus.Methods This study constitutes a retrospective analysis,wherein 22 patients diagnosed with type 2 diabetes mellitus complicated by heart failure,who were treated at the Second Medical Center of PLA General Hospital between January and December 2022,were designated as the observation group.A control group was established by age-and sex-matched selection of 37 diabetes patients without cardiac structural or functional abnormalities who underwent routine health examinations during the same period.Clinical data and stool specimens were collected from both groups.Concentrations of S-adenosylmethionine and glucose-1-phosphate were measured by liquid chromatography-mass spectrometry(LC-MS).Potential predictors were analyzed by univariate comparisons between groups and multivariate logistic regression.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of individual and combined predictors for heart failure in elderly patients with diabetes.Results Compared with the control group,the observation group had lower levels of S-adenosylmethionine[2.26(0.19,3.15)nmol∕g vs.61.51(14.83,99.02)nmol∕g]and glucose-1-phosphate[0.67(0.47,2.39)nmol∕g vs.2.85(2.01,8.15)nmol/g],respectively(Z=-4.655,-4.702,P<0.001).In multivariate analysis,S-adenosylmethionine(odds ratio OR=0.975,95％CI:0.952～0.998,P=0.036)and Glucose-1-phosphate(OR=0.262,95％CI:0.094～0.727,P=0.010)were independent predictors of heart failure in elderly patients with diabetes.ROC analysis showed that the combined prediction using both markers yielded an area under the curve(AUC)of 0.937(P<0.001),with a sensitivity of 95.5％and a specificity of 83.8％.Conclusion S-adenosylmethionine and glucose-1-phosphate are independent predictors of heart failure in elderly patients with diabetes.The combined use of these two markers has high predictive value.

Abstract:Objective To investigate the occurrence status and influencing factors of sarcopenia in middle-aged and elderly patients with type 2 diabetic nephropathy.Methods A total of 116 middle-aged and elderly patients with type 2 diabetic nephropathy admitted from June 2024 to February 2025 were enrolled.According to whether they had sarcopenia,participants were divided into the sarcopenia group(n=27)and the non-sarcopenia group(n=89).The distribution conditions of different genders and ages in patients with sarcopenia were statistically analyzed.The clinical data were compared between the two groups.Pearson analysis was used to analyze the correlation between sarcopenia and clinical data.Multivariate Logistic regression analysis was applied to analyze the influencing factors of sarcopenia in elderly patients with type 2 diabetic nephropathy.Results There was a statistical difference in the occurrence of sarcopenia among different age groups(P<0.05),and the proportion of patients>75 years old was the highest,and the proportion of women was statistically different(P<0.05),and the proportion of female patients>75 years old was the highest.In the age range of 75 years and older,the proportion of female patients was significantly higher than that of male patients(P<0.05).Compared with non-sarcopenia group,the sarcopenia group had significantly higher proportion of women,age,duration of diabetes mellitus,HDL-C,and time to sit up for 5 times(P<0.05),and significantly lower BMI,bone mineral density,25-(OH)D,body fat,bone mineral content,visceral fat area,and fat-free circumference of upper arm(P<0.05).Pearson analysis showed that BMI,bone mineral density,body fat,bone mineral content,visceral fat area and upper arm fat-free circumference were negatively correlated with type 2 diabetic nephropathy with sarcopenia(P<0.05).Logistic regression analysis(dependent variable assignment:sarcopenia group=1,non-sarcopenia group=0)after correcting baseline data showed that BMI,bone mineral density,body fat,bone mineral content,visceral fat area,and upper arm fat-free circumference were the influencing factors of type 2 diabetic nephropathy with sarcopenia(P<0.05).Conclusion Elderly patients with type 2 diabetic nephropathy complicated with sarcopenia are mainly elderly and female.The related indicators of body composition are related to type 2 diabetic nephropathy with sarcopenia.

Abstract:Objective To evaluate the impact of perioperative nutritional management on patients undergoing daytime laparoscopic cholecystectomy(LC)and establish an evidence-based protocol for perioperative nutritional support.Methods Eighty LC patients were prospectively enrolled and randomly assigned to either a control group(n=40,standard care)or an observation group(n=40,perioperative nutritional management).Postoperative outcomes were compared.Results Compared with the control group,the observation group demonstrated significantly earlier initiation of oral intake(water∕food),ambulation,and return to normal activities∕work(P<0.05).The pain scores at postoperative days 1 and 7 were lower in the observation group(P<0.05).The energy intake recovery ratios on day 1(t=11.63,P<0.05),protein intake recovery ratios on day 1(t=12.90,P<0.05)and activities of daily living(ADL)scores were greater in the observation group(P<0.05).The incidences of postoperative hunger(20.0％vs.42.5％)and wound complications(e.g.,exudate/hemorrhage;12.5％vs.32.5％)were significantly reduced(χ2=4.71、4.59,P<0.05).No between-group differences were observed in time to first flatus,abdominal pain,bloating,or thirst(P>0.05).Conclusion Early oral hydration and oral nutritional supplementation(ONS)post-LC do not increase gastrointestinal adverse effects.This approach mitigates postoperative hunger,accelerates functional recovery,reduces pain,enhances wound healing,and improves ADLs.

Abstract:Chronic mucus hypersecretion(CMH)is a significant pathophysiological feature of elderly respiratory chronic diseases such as chronic obstructive pulmonary disease,bronchial asthma,and bronchiectasis,severely impacting patients'quality of life and prognosis.Currently,there is still a lack of unified guidance for the systematic management of CMH in elderly patients.Therefore,the Geriatric Respiratory and Critical Care Medicine Branch of the China Association of Gerontology and Geriatrics organized experts in related fields to develop this consensus,systematically elaborating on the pathogenesis,clinical assessment methods,pharmacological and non-pharmacological treatment strategies for CMH in the elderly.The consensus covers assessment tools such as the Cough and Sputum Assessment Questionnaire(CASAQ)and Peak Cough Flow(PCF),as well as the rational use of medications including expectorants,mucoregulators,mucokinetics,and mucolytics.It also details non-pharmacological interventions such as chest physiotherapy,airway humidification and nebulization therapy,and mechanical airway clearance techniques.This consensus puts forward six recommendations,aiming to provide clinicians with standardized and actionable guidance for the management of CMH in elderly patients,thereby improving the overall treatment level of elderly respiratory chronic diseases and patients'quality of life.

Abstract:Objective To observe the efficacy of non-rescue intraprocedural use of tirofiban in elderly patients with atherosclerotic acute large vessel occlusion ischemic stroke undergoing mechanical thrombectomy.Methods A total of 116 elderly patients with atherosclerotic ischemic stroke were divided into a control group and a tirofiban group based on treatment approach.The control group received dual antiplatelet therapy(aspirin and clopidogrel).The tirofiban group received an intraprocedural microcatheter injection of tirofiban followed by continuous intravenous infusion for 24～48 hours postoperatively.Vascular recanalization was assessed using the modified Thrombolysis in Cerebral Infarction(mTICI)scale.Rates of reocclusion at 48 hours,platelet counts,and NIHSS scores were compared between groups.Additionally,symptomatic intracranial hemorrhage(sICH),intracranial hemorrhage,gastrointestinal bleeding,mortality within 3 months,and 90-day functional outcomes(assessed by the modified Rankin Scale[mRS])were evaluated.Results No significant differences in platelet counts or NIHSS scores were observed between the control and tirofiban groups preoperatively or postoperatively.While the degree of vascular recanalization did not differ significantly,the tirofiban group exhibited a lower 48-hour reocclusion rate(5.26％vs.17.24％,χ2=4.113,P<0.05)and a higher proportion of favorable mRS outcomes(mRS≤2)at 90 days(56.14％vs.36.21％,χ2=4.597,P<0.05).There were no significant differences in sICH,intracranial hemorrhage,gastrointestinal bleeding,or 3-month mortality between the two groups.Conclusion For elderly patients with atherosclerotic acute large vessel occlusion ischemic stroke,the non-rescue use of tirofiban during mechanical thrombectomy reduces the risk of reocclusion and improves functional outcomes without increasing safety concerns.

Abstract:Objective To analyze the influencing factors of meibomian gland dysfunction dry eye,and construct the related regression equation to analyze its predictive value.Methods The clinical data of 115 patients with meibomian gland dysfunction dry eye admitted to Jiangning Hospital affiliated to Nanjing Medical University from January 2022 to January 2025 were retrospectively collected as the case group,and the physical examination data of 115 patients who came to the hospital for physical examination or had a history of eyes but recovered as the control group at the same time.The general data of the two groups were compared,the influencing factors of meibomian gland dysfunction dry eye were analyzed,and a regression equation was constructed to analyze the relationship between meibomian gland dysfunction dry eye.Results The proportion of patients with thyroid diseases,working in an air-conditioned environment,engaging in fine eyesight work,wearing contact lenses,using computers or mobile phones for more than 6 hours every day,the height of lacrimal river,the score of meibomian gland loss area,the score of abnormal meibomian morphology,the score of corneal fluorescein staining,the levels of serum immunoglobulin(Ig)A,IgM and IgG were higher than those in the control group,and the time of non-contact tear film rupture was shorter than that in the control group.Multivariate analysis showed that thyroid disease,wearing corneal contact lens,average daily use of computer or mobile phone time>6 h,scores of meibomian gland loss area,eyelid margin morphological abnormality,corneal fluorescein staining,levels of serum IgA,IgM and IgG were all risk factors for meibomian gland dysfunction dry eye(OR=1.711,1.636,1.597,1.723,1.889,1.800,1.548,1.735,1.828,P<0.05).Regression equation:logit(P)=-9.637+thyroid disease×0.537+wearing corneal contact lens×0.492+average daily use of computer or mobile phone time×0.468+score of meibomian gland loss area×0.544+score of eyelid margin morphological abnormality×0.636+score of corneal fluorescein staining×0.588+level of serum IgA×0.437+level of serum IgM×0.551+level of serum IgG×0.603.The regression equation of meibomian gland dysfunction dry eye was evaluated,and the likelihood ratio was χ2=137.11,DF=9,P<0.001.Receiver operating characteristic curve(ROC)analysis showed that when logit(P)>12.97,the area under the curve(AUC)was 0.874,sensitivity was 86.96％,and specificity was 78.26％.Conclusion The risk factors of meibomian gland dysfunction dry eye included thyroid disease,wearing corneal contact lens,average daily use of computer or mobile phone>6 h,scores of meibomian gland loss area,eyelid margin morphological abnormality,corneal fluorescein staining,levels of serum IgA,IgM and IgG.The regression equation constructed based on this had good predictive value.

Abstract:Objective To investigate the effect of segmental constant pressure bladder function training on patients with spinal cord injury complicated with neurogenic bladder.Methods A total of 134 patients with spinal cord injury patients and neurogenic bladder who were treated in our hospital from January 2024 to April 2025 were prospectively selected for the study and divided into control group(67 cases)and observation group(67 cases)according to the random number table method.The control group was treated with conventional bladder function training and transcranial-peripheral bidirectional feedback magnetic stimulation,and the observation group was treated with segmental constant pressure bladder function training on this basis.Both groups were treated continuously for 4 weeks.The clinical efficacy,neurogenic bladder symptom score(NBSS),urodynamic parameters,bladder function and occurrence of complications were compared between the two groups.Results A significant difference in clinical efficacy was observed between the two groups,with the observation group outperforming the control group(χ2=6.351,P<0.05).After treatment,the observation group showed significantly lower NBSS score[(15.32±2.27)points vs.(19.61±2.67)points],residual urine volume[(62.69±10.54)mL vs.(83.61±12.56)mL],daily urinary frequency[(7.35±2.47)times vs.(9.19±2.83)times],and daily urinary leakage frequency[(3.18±1.17)times vs.(5.42±2.28)times]compared to the control group,with statistically significant differences(t=10.020,10.444,4.010,7.155,all P<0.05).Meanwhile,the observation group demonstrated significantly higher maximum urinary flow rate[(12.63±1.76)mL∕s vs.(10.59±1.54)mL∕s],maximum bladder capacity[(368.54±40.76)mL vs.(337.51±37.86)mL],and daily urinary volume[(254.18±29.37)mL vs.(212.72±22.89)mL]than the control group,with statistically significant differences(t=7.140,4.566,9.114,all P<0.05).No significant difference was observed in the incidence of occurrence of complications between the two groups(χ2=0.764,P>0.05).Conclusion The effect of segmented constant pressure bladder function training assisted transcranial-peripheral bidirectional feedback magnetic stimulation on spinal cord injury patients with neurogenic bladder is definite,which can effectively improve the symptoms of dysuria and urodynamic parameters,and promote the recovery of urination function.

Abstract:Objective Observation of the effect of Brunnstrom staged training in neurological and physical rehabilitation of elderly patients recovering from stroke.Methods A total of 102 elderly stroke patients in the recovery phase admitted to Mengcheng County First People's Hospital from January 2021 to February 2024 were enrolled and randomly assigned to two groups using the envelope method.Both groups received conventional Western medical treatments including glycemic control,lipid regulation,anticoagulation,and neuroprotection.The conventional group underwent standard rehabilitation therapy,while the staged training group additionally received Brunnstrom-staged training intervention.Pre-and post-treatment levels of interleukin-6(IL-6),brain-derived neurotrophic factor(BDNF),interleukin-10(IL-10),IL-10),and neuron-specific enolase(NSE)levels before and after treatment.The Fugl-Meyer assessment score,the National Institutes of Health Stroke Scale(NIHSS),the modified fall efficacy scale(MFES),the Stroke-specific Quality of Life(SS-QOL),and the modified Barthel index(MBI)before and after treatment in both groups to statistically evaluate clinical efficacy.Results There were no significant differences in pre-treatment levels of IL-6,IL-10,BDNF,and NSE between the two groups(P>0.05).Post-treatment,both IL-6 and NSE levels decreased compared to pre-treatment in both groups,while BDNF and IL-10 levels increased(Conventional group:t=16.832,-18.214,-21.247,11.286;P<0.05;Staged training group:t=27.491,-25.632,-21.894,13.572;P<0.05).Post-treatment IL-6 levels in the staged training group were lower than those in the conventional group,while IL-10 levels were higher.BDNF and NSE levels showed no significant difference compared to the conventional group(P>0.05).Pre-treatment scores showed no significant differences between groups(P>0.05).Post-treatment Fugl-Meyer upper∕lower limb scores,MFES scores,MBI scores,and SS-QOL scores increased in both groups compared to pre-treatment levels(conventional group:t=-15.732,-16.284,-10.284,-20.4991,-15.732;P<0.05;phased training group t=-23.491,-20.163,-13.894,-24.163,-18.732;P<0.05).Post-treatment scores were higher in the phased training group than in the conventional group(P<0.05).NIHSS scores decreased in both groups post-treatment compared to pre-treatment(conventional group:t=16.832;P<0.05;phased training group:t=18.491;P<0.05),with the phased training group showing lower scores than the conventional group post-treatment(P<0.05).Pre-treatment three-dimensional gait spatiotemporal parameters showed no significant differences between groups(P>0.05);Post-treatment,both groups showed increased gait velocity,cadence,and stride length compared to pre-treatment,while the percentage of double-support phase and the ratio of support time between the unaffected and affected sides decreased(Conventional group:t=-18.491,-12.832,-16.284,10.491,3.894;P<0.05;Staged training group:t=-20.163,-15.732,-21.491,16.832,6.491;P<0.05).Post-treatment gait speed,cadence,and stride length were higher in the staged training group than in the conventional group,while the percentage of double-support phase and the ratio of support time between the unaffected and affected sides were lower than in the conventional group(P<0.05).The total effective rate in the phased training group[92.16％(47∕51)]showed no significant difference compared to the conventional group[80.39％(41∕51)](P>0.05).Conclusion Brunnstrom staged training reduces neurological impairment,improves limb motor function and prevents falls in elderly patients recovering from stroke.

Abstract:Objective To investigate the effect of the clinical efficacy and prognostic impact of FFR-based deferred revascularization in CCS patients with grade Ⅱ myocardial bridging of the LAD and proximal borderline lesions.Methods This retrospective analysis included 120 patients with chronic coronary syndrome(CCS)who were admitted to the Department of Cardiology,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,between June 2023 and June 2024.All patients underwent coronary angiography(CAG)and fractional flow reserve(FFR)assessment,which revealed a grade Ⅱ myocardial bridge(compression degree 50％-75％)in the left anterior descending artery(LAD)accompanied by a proximal borderline lesion(stenosis 50％-70％).Patients with FFR values in the gray zone(0.75≤FFR<0.80)were enrolled and randomly assigned via a random number table to either an interventional therapy group(observation group,n=60)or a medication therapy group(control group,n=60).All patients were followed for 12 months.The primary endpoints included all-cause death,cardiac death,non-fatal myocardial infarction,and unplanned target vessel revascularization(TVR).Secondary endpoints consisted of recurrent angina,positive exercise treadmill test results,and improvement in exercise tolerance.Results Results indicated no significant differences in baseline characteristics between the two groups(all P>0.05).There were also no statistically significant differences in the incidence of primary or secondary endpoint events(P>0.05).In the observation group,Seattle Angina Questionnaire(SAQ)scores improved from baseline in the domains of physical limitation(PL),treatment satisfaction(TS),angina stability(AS),and disease perception(DP).Similarly,the control group showed improvements in PL,TS,angina frequency(AF),and DP.Notably,the observation group achieved significantly higher scores in disease perception(DP)compared to the control group(t=-2.65,P<0.05).Conclusion FFR-guided delayed revascularization is safe and effective for patients with borderline proximal lesions in the left anterior descending artery accompanied by grade Ⅱ myocardial bridging,while conservative medical therapy can avoid unnecessary stent implantation.Conclusion FFR-guided delayed revascularization is relatively safe and effective for patients with borderline proximal lesions in the left anterior descending artery accompanied by grade Ⅱ myocardial bridging,while conservative medical therapy can avoid unnecessary stent implantation.

Abstract:Objective Left atrial appendage occlusion(LAAO)has emerged as an effective alternative for atrial fibrillation(AF)patients with contraindications to anticoagulation therapy.The impact of LAAO on the structure and function of the left atrium(LA)remains controversial.Based on cardiac computed tomography angiography(CCTA),this study quantitatively analyzed the effects of LAAO on left atrial volume and left atrial ejection fraction(LAEF)in patients with AF.Methods A single-center retrospective cohort of 185 non-valvular AF patients(67 paroxysmal,118 persistent)undergoing LAAO without concomitant ablation from January 2021 to December 2024 was analyzed.LA maximal volume(LAVmax),minimal volume(LAVmin),and LA ejection fraction(LAEF)were measured by CCTA at baseline and 3-month follow-up.Paired Wilcoxon tests compared pre-and post-procedural changes.Results The baseline LAVmax in the persistent atrial fibrillation group was higher than that in the paroxysmal atrial fibrillation group[166.91(140.475,196.07)vs.141.72(118.865,169.635);Z=0.668,P<0.001].The baseline LAVmin was also higher in the persistent atrial fibrillation group than in the paroxysmal atrial fibrillation group[145.6(123.185,174.99)vs.125.35(101.35,153.6);Z=0.629,P<0.001].At the 3month followup after operation,LAVmax[161.12(136.032,189.183)]and LAVmin[143.12(120.005,174.098)]in the persistent atrial fibrillation group were significantly decreased compared with preoperative baseline,respectively[LAVmax:166.91(140.475,196.07),Z=9.189,P<0.001;LAVmin:145.6(123.185,174.99),Z=8.472,P=0.008].Conclusion LAAO induces early LA reverse remodeling(volume reduction)in persistent AF but not in paroxysmal AF,without improving systolic function.This"structure-function dissociation"supports personalized AF management strategies.

Abstract:The younger onset of gynecological malignancies and the improvement of diagnosis and treatment levels have significantly enhanced the survival rate of early-stage patients.Preserving fertility has become a key focus in clinical practice,driving a shift in the treatment philosophy from"survival first"to"balancing quality of life".This article systematically reviews the fertility preservation strategies for early-stage cervical cancer,endometrial cancer,and ovarian-related malignancies:clarifying the core indications for fertility preservation in each tumor,elaborating on the core surgical and drug treatment plans for fertility preservation,and the oncological safety and pregnancy outcomes confirmed by related clinical studies;emphasizing the core supporting role of assisted reproductive technology.The clinical implementation of fertility preservation requires multidisciplinary collaboration among gynecological oncology,reproductive medicine,and pathology to achieve an individualized balance between oncological safety and fertility needs.However,it also faces challenges such as uneven technology dissemination and complex decision-making.In the future,through the promotion of standardized diagnosis and treatment,technological innovation,and the improvement of social support systems,more young patients will be able to realize their fertility wishes after tumor treatment,highlighting the profound evolution of the medical model towards a"patient-centered"approach.

Abstract:Objective To explore the efficacy and long-term outcomes of combining vericiguat with a"new quadruple therapy"in patients diagnosed with heart failure with reduced ejection fraction.Methods Prospectively select 150 patients with chronic heart failure and left ventricular ejection fraction below 40％,who are divided into a control group and an experimental group using block randomization.A total of 137 patients completed the follow-up,with 67 in the control group and 70 in the experimental group.The control group received standard therapy,including sacubitril∕valsartan,β-blockers,mineralocorticoid receptor antagonists,and SGLT2 inhibitors.The experimental group received vericiguat in addition to the standard therapy of the control group.Follow-up was performed before treatment,at 1 month,3 months and 6 months,respectively,to observe the efficacy of drug use,and to detect N-terminal B-type natriuretic peptide precursor(NT-proBNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and 6-minute walking distance.The differences in the incidence of adverse reactions and cardiovascular events during drug use were compared.Results The experimental group demonstrated a total effective rate of 90.0％(An improvement of 1 level or more in the NYHA classification compared with before treatment is considered effective),significantly surpassing the control group's rate of 74.63％(χ2=6.216,P<0.05).Both groups showed improvements in NT-proBNP,LVEF,and 6MWD after treatment compared to before treatment(F=84.316、96.827、317.142,P<0.05),with the experimental group demonstrating a superior trend of improvement over the control group,and the difference was statistically significant(F=4.593、21.891、5.334,P<0.05).Intergroup comparisons at different treatment times revealed no significant differences in NT-proBNP and LVEF between the control and experimental groups after 1 month of treatment(P>0.05).At 1 month of treatment,there was no statistically significant difference in NT-proBNP and LVEF between the control group and the experimental group(P>0.05).At 3 and 6 months of treatment,the experimental group showed more significant improvement in NT-proBNP(t=-2.741,-5.787,P<0.05)and LVEF(t=2.045,3.037,P<0.05).The 6MWD of the experimental group increased more significantly at 1,3,and 6 months(t=2.142,2.370,2.725,P<0.05).Both groups of patients showed improvement in LVEDD and LVESD over time(F=120.231、62.031,P<0.05),but there was no statistically significant difference in the magnitude of improvement between the groups(P>0.05).Similarly,the frequency of adverse effects and cardiovascular complications did not differ meaningfully between the groups(P>0.05).However,patients in the intervention group demonstrated a notable decrease in heart failure-related readmission rates(χ2=4.023,P<0.05).Conclusion On the basis of conventional quadruple drug therapy for heart failure,combined with vericiguat and long-term use can effectively improve the cardiac function of patients and reduce the readmission rate of patients with heart failure.

Abstract:Objective To investigate the value of interleukin-2(IL-2),interleukin-10(IL-10),human β-defensin 2(HBD-2),and heparin-binding protein(HBP)in the condition and prognostic assessment of patients with active tuberculosis(ATB),and to provide a reference basis for early diagnosis and treatment and prognostic assessment of this disease.Methods 212 cases of patients with ATB admitted to the Heilongjiang Infectious Disease Control Hospital from January 2022 to April 2024 were selected as the ATB group,and were divided into the mild group(67 cases),the moderate group(113 cases),and the severe group(32 cases)according to the condition of the patients,and the patients in the ATB group all received standardized treatment for 6 months(2 HREZ∕4 HR regimen),and there were no cases of lost visits.They were divided into the group with good prognosis(61 cases)and the group with poor prognosis(151 cases)by the prognosis of the patients.The levels of serum IL-2,IL-10,HBD-2,HBP of each group were compared,and the good and poor prognosis groups were included as negative and positive,respectively,and the predictive value of serum IL-2,IL-10,HBD-2,and HBP alone and in combination on the prognosis of patients with ATB was analyzed by plotting the subjects'work characteristic curves(ROC)to obtain the area under the curve(AUC).Results Serum levels of IL-2,IL-10,HBD-2,and HBP showed a gradual incremental trend among the three groups:mild group,moderate group,and severe group(P<0.05).Serum levels of IL-2,IL-10,HBD-2,and HBP were higher in the poor prognosis group compared to the good prognosis group(P<0.05).ROC analysis showed that the AUC value of serum IL-2,IL-10,HBD-2,and HBP combined test for predicting a poor prognosis in patients with ATB was 0.929,which was higher than the AUC value of each index alone(0.795,0.728,0.762,0.767,P<0.05).Conclusion Serum levels of IL-2,IL-10,HBD-2 and HBP were related to the condition and prognosis of patients with ATB,and the combined detection of these four indicators yields a higher predictive value for the prognosis of patients with active pulmonary tuberculosis.

Abstract:Objective To analyze the correlation between cardiopulmonary resuscitation(CPR)duration,platelet count and end-tidal carbon dioxide partial pressure(PETCO2)monitoring and short-term prognosis after return of spontaneous circulation(ROSC)in hospitalized patients with cardiac arrest.Methods A total of 202 cardiac arrest patients with return of spontaneous circulation(ROSC)treated at Yuncheng Central Hospital Affiliated to Shanxi Medical University from January 2023 to December 2024 were enrolled.They were divided into groups based on clinical indicators:long resuscitation group(n=122,≥15 min)and short resuscitation group(n=80,<15 min);high platelet group(n=79,≥100×109∕L)and low platelet group(n=123,<100×109∕L);high PETCO2 group(n=77,≥27.5 mmHg)and low PETCO2 group(n=125,<27.5 mmHg).Kaplan-Meier curves were used to analyze the relationship between overall survival and different groups of CPR duration,platelet count,and PETCO2,with Log-Rank test for survival differences between groups.Univariate Cox regression was applied to screen short-term prognostic factors,followed by multivariate Cox regression for independent predictors.The predictive value of single and combined indicators for poor short-term prognosis in ROSC patients was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),with Delong test for statistical comparison.Results Kaplan-Meier analysis showed that the median survival time in the long resuscitation group,low platelet group,and low PETCO2 group was significantly lower than that in the short resuscitation group,high platelet group,and high PETCO2 group,with statistically significant differences(P<0.05).Multivariate Cox regression analysis indicated that the Acute Physiology and Chronic Health Evaluation Ⅱ score on admission,Glasgow Coma Scale score on admission,CPR duration,platelet count,and PETCO2 were independent influencing factors for poor short-term prognosis in cardiac arrest patients with ROSC(P<0.05).The ROC curve results showed that the areas under the curve(AUC)for combined detection of CPR duration,platelet count,and PETCO2,as well as single indicators,were 0.873(95%CI:0.822～0.924),0.712(95%CI:0.638～0.787),0.763(95%CI:0.680～0.845),0.787(95%CI:0.720～0.854),0.733(95%CI:0.662～0.804),and 0.645(95%CI:0.564～0.726),respectively.Delong test showed that the AUC of combined detection was significantly higher than that of each single indicator(Z=4.245,3.347,3.165,3.109,4.863;P<0.05).Conclusion CPR duration,platelet count,and PETCO2 monitoring can effectively predict the short-term prognosis of cardiac arrest patients with ROSC,providing an objective basis for early identification of high-risk patients.This finding helps optimize post-resuscitation management strategies and lays a data foundation for establishing a multi-index combined prognostic assessment model.

Abstract:Objective To investigate the effect of aerobic interval exercise combined with rosuvastatin and other medications in preventing in-stent restenosis(ISR)after carotid artery stenting(CAS).Methods From February 2022 to January 2023,120 patients who underwent carotid artery stenting for carotid artery stenosis were enrolled.They were randomly divided into a medication group and a combined exercise group,with 60 patients in each group.The medication group received daily oral rosuvastatin postoperatively,while the combined exercise group initiated aerobic interval training 4 weeks after surgery.Each exercise session lasted 25 minutes,including 5 minutes of warm-up,15 minutes of aerobic interval exercise,and 5 minutes of cool-down∕stretching,performed 3 times weekly for over 48 weeks.Carotid artery CTA was used to assess intravascular restenosis.The incidence of ISR,target vessel revascularization,mortality,and other major adverse events were compared between the two groups at 12 months.Levels of C-reactive protein(CRP),interleukin-6(IL-6),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and adiponectin(APN)were measured before and after the intervention.Regularly monitor liver and kidney function,blood glucose,and other indicators to observe medication safety.Results In the medication group,one case was lost to follow-up.The in-stent restenosis rate in the combined exercise group was 1.67%,lower than that in the medication group(10.16%),with χ2=3.884 and P=0.048.There were no statistically significant differences in target vessel revascularization rate or mortality between the two groups.After intervention,the CRP and IL-6 levels in the combined exercise group were(6.8±2.2)mg∕L and(7.5±2.9)ng∕L,respectively,both lower than those in the medication group(7.9±2.8)mg∕L and(8.6±2.3)ng∕L.The APN level in the combined exercise group was higher than that in the medication group.For CRP and IL-6,the comparisons yielded(t=2.385,2.290,P<0.05),respectively.After intervention,the TC(3.9±0.4)mmol∕L,TG(1.3±0.4)mmol∕L,and LDL-C(2.4±0.4)mmol∕L levels in the combined exercise group were all lower than those in the medication group(4.6±0.6)mmol∕L,(1.5±0.3)mmol∕L,and(2.6±0.5)mmol∕L(t=7.499,3.081,2.411,P<0.05),respectively.No serious adverse reactions were observed during the monitoring period.Conclusion Compared to pharmacotherapy alone,the combination of intermittent exercise and pharmacotherapy exerts a more significant effect in reducing inflammatory responses,improves lipid profiles,and decreases the incidence of ISR following CAS.

Abstract:Objective This study aimed to compare the protective effects of volumetric modulated arc therapy(VMAT)versus 3D conformal radiotherapy(3D-CRT)on cardiac and pulmonary tissues in postoperative radiotherapy for radical mastectomy.Methods A retrospective analysis was conducted on 118 radical mastectomy patients treated in the Department of Oncology,Tongling People's Hospital,from January 2022 to December 2024.Among them,60 patients received VMAT,and 58 received 3D-CRT.All patients were treated using a Varian Clinac IX accelerator with a uniform prescription dose of 50 Gy in 25 fractions.Results Dosimetric analysis revealed that the VMAT group significantly reduced cardiac mean dose,cardiac V20,and maximum dose to the left anterior descending artery(t=5.12,4.78,6.33,P<0.001),respectively.For pulmonary protection,the VMAT group showed superior ipsilateral lung V20,mean lung dose,and contralateral lung V5(t=5.89,4.67,3.98,P<0.001).Treatment efficiency improved significantly with VMAT and enhancing homogeneity index(HI)(t=5.78,4.56,P<0.001).Conclusion VMAT significantly reduces cardiac and pulmonary radiation exposure compared to 3D-CRT,which is recommended as the optimal radiotherapy strategy for radical mastectomy patients.

Abstract:Objective To explore the relationship between the expression levels of serum toll-like receptor 4(TLR4)and myeloid differentiation factor 88(MyD88)and the occurrence of acute respiratory distress syndrome(ARDS)in patients with sepsis in ICU.Methods A retrospective analysis was performed on 160 patients with sepsis admitted to ICU of our hospital from July 2022 to October 2024,who were divided into ARDS group(n=100)and non-ARDS group(n=60)according to whether the oxygenation index was lower than 300 mmHg.Clinical data of the two groups were collected,and serum TLR4 and MyD88 expression levels were compared between the two groups.Multivariate Logistic regression model was used to analyze the risk factors of ARDS in sepsis patients.Results The oxygenation index in the ARDS group was lower than that in the non-ARDS group(t=18.109,P<0.05),while the SOFA score and PCT level were higher than those in the non-ARDS group(t=2.561、2.652,P<0.05).Serum TLR4 and MyD88 expression levels were higher in the ARDS group than those in the non-ARDS group(t=9.645,7.714,P<0.05).Logistic regression analysis showed that elevated serum TLR4(OR=1.670,P=0.001)and MyD88(OR=1.538,P=0.002)expression levels are independent risk factors for the occurrence of ARDS in ICU patients with sepsis(P<0.05).Conclusion The increased expression levels of serum TLR4 and serum MyD88 are the related influencing factors for the occurrence of ARDS in ICU patients with sepsis.