Objective:To investigate the relationship between soluble vascular cell adhesion molecule-1 (sVCAM-1), high mobility group protein B1 (HMGB1), and heart failure after percutaneous coronary intervention (PCI) in patients with unstable angina (UA).Methods:This study was a retrospective study. The data of 196 UA patients who underwent PCI treatment in Xi′an Daxing Hospital from January 2019 to December 2023 were collected through the hospital′s electronic medical record system. The patients were followed up for 6 months after PCI, and the follow-up data were completed. According to the occurrence of heart failure during the follow-up period, they were divided into the occurrence group (35 cases) and the non occurrence group (161 cases). The general data, serum sVCAM-1, HMGB1 and other laboratory indicators before PCI were compared between the two groups, and the relationship between serum sVCAM-1, HMGB1 and the occurrence of heart failure in UA patients after PCI was analyzed.Results:Compared with the non occurrence group, the occurrence group had higher proportion of diabetes mellitus and multi-vessel disease : 28.57% (10/35) vs. 13.66% (22/161), 62.86% (22/35) vs. 32.30% (52/161); larger left ventricular diameter : (4.73 ± 0.54) cm vs (4.52 ± 0.51) cm; higher levels of serum cardiac troponin I (cTnI), creatine kinase MB isoenzyme (CK-MB), sVCAM-1 and HMGB1: 0.07 (0.05, 0.08) μg/L vs. 0.05 (0.04, 0.06) μg/L, (8.16 ± 1.58) μg/L vs. (7.08 ± 1.21) μg/L, (458.26 ± 41.23) μg/L vs. (422.19 ± 37.41) μg/L, (6.39 ± 1.44) μg/L vs. (5.24 ± 1.45) μg/L, there were statistical differences ( P<0.05). Logistic regression analysis showed that the occurrence of heart failure in UA patients after PCI may be related to a larger left ventricular diameter, abnormal levels of serum cTnI, sVCAM-1, and HMGB1 ( P<0.05). Restrictive cubic spline (RCS) analysis revealed a non-linear dose-response relationship between serum sVCAM-1, HMGB1, and the occurrence of heart failure in UA patients after PCI ( P<0.05). When serum sVCAM-1 ≥ 422.37 μg/L and HMGB1 ≥ 5.26 μg/L, the risk of heart failure in patients after PCI increased with the level of both. Serum sVCAM-1 and HMGB1 had a positive interactive effect on the occurrence of heart failure in UA patients after PCI. Decision curves and column charts were drawn to measure the model, it was found that the predictive model constructed with serum sVCAM-1 and HMGB1 assisted serum cTnI had certain predictive efficacy for the occurrence of heart failure in UA patients after PCI. Conclusions:The occurrence of heart failure in UA patients after PCI may be related to abnormally high levels of sVCAM-1 and HMGB1. As the levels of both increase, the risk of heart failure in patients increases. Using both to assist in predicting the risk of heart failure in patients has certain value.

Objective:To investigate the application value of sevoflurane combined with remifentanil in interventional thrombectomy of ischemic stroke patients and its influence on neurological and cognitive function.Methods:The clinical data of 84 patients with ischemic stroke treatment in the Xining Third People′s Hospital from September 2020 to September 2022 were selected retrospectively, and they were divided into the conventional group (42 cases) and experimental group (42 cases) according the treatment methods. Interventional thrombectomy was performed in both groups. Propofol combined with remifentanil was used in the conventional group, and sevoflurane combined with remifentanil was used in the experimental group. The excellent and good rate of anesthesia was compared between the two groups; the hemodynamic indexes before anesthesia induction (T 1), at the beginning of surgery (T 2), after thrombectomy and extubation (T 3) and at the end of surgery (T 4) were compared between the two groups; the brain injury indexes were compared before and 12, 24 and 48 h after surgery were compared between the two groups; the National Institutes of Health Stroke Scale (NIHSS) score, Simple Mental State Examination Scale (MMSE) score, postoperative cognitive dysfunction (POCD) and anesthesiation-related adverse reactions were compared between the two groups. Results:The excellent and good rate of anesthesia in the experimental group was higher than that in the conventional group:100.00% (42/42) vs. 83.33% (35/42), there was statistical difference ( χ2 = 5.61, P<0.05). The mean arterial pressure (MAP), heart rate (HR), and pulse oxygen saturation (SpO 2) in the two groups at T 2, T 3 and T 4 were higher than those at T 1 ( P<0.05); the MAP, HR and SpO 2 in the experimental group at T 2, T 3 and T 4 were lower than those in the conventional group ( P<0.05). The serum neuron-specific enolase (NSE) and S100β protein were significantly increased at 12 and 24 h after surgery in both groups ( P<0.05); serum NSE and S100β proteins in the experimental group at 12, 24 and 48 h were lower than those in the conventional group: (30.12 ± 4.26) μg/L vs. (35.64 ± 5.70) μg/L, (22.69 ± 4.01) μg/L vs. (26.81 ± 5.53) μg/L, (18.71 ± 2.92)μg/L vs. (21.34 ± 4.02) μg/L, (1.19 ± 0.20) μg/L vs. (1.37 ± 0.24) μg/L, (0.96 ± 0.13) μg/L vs. (1.13 ± 0.16) μg/L, (0.80 ± 0.11) μg/L vs. (0.94 ± 0.15) μg/L, there were statistical differences ( P<0.05). The NIHSS score was significantly higher and the MMSE score was significantly lower in both groups at 12 and 24 h after surgery ( P<0.05); the NIHSS score and MMSE score in both groups recovered to preoperative level at 48 h after the operation ( P>0.05). The NIHSS score in the experimental group at 12 and 24 h after surgery was lower than that in the conventional group, and the MMSE score was higher than that in the conventional group ( P<0.05). The incidence of anesthesia-related adverse reactions in the experimental groups was lower than that in the control group: 4.76%(2/42) vs. 21.43%(9/42); and the incidence of POCD was lower than that in the conventional group: 19.05%(8/42) vs. 2.38%(1/42), there were statistical differences ( χ2 = 5.13, 4.48, P<0.05). Conclusions:Sevoflurane combined with remifentanil has a significant anesthetic effect in interventional thrombectomy of ischemic stroke patients, which can stabilize hemodynamics, reduce the degree of brain injury, promote cognitive function recovery, and reduce POCD and adverse reactions.

Objective:To investigate the effect of local food-source enteral nutrition(EN) to improve the nutritional status of stroke patients.Methods:The clinical data of 180 patients with ischemic stroke admitted to the First People′s Hospital of Chengdu and the Second People′s Hospital of Chengdu during the period from June 2021 to June 2023 were selected retrospectively, patients in both groups received EN at 24 to 48 h after admission, and total energy intake was evaluated 7 d later, which was divided into the standard calorie group (90 cases) and the low- calorie group (90 cases) according to total energy intake. The total energy intake of patients in the standard calorie group increased to 125 -146 kJ/ (kg·d) after 7 d. Patients in the low-calorie group gradually increased to 105 kJ/ (kg·d) after 7 d. The changes in inflammatory factors and nutritional indexes before and after treatment were compared between the two groups, and the incidence of malnutrition and neurological function deficit before and after treatment were compared between the two groups.Results:After treatment, the levels of serum interleukin 1β, tumor necrosis factor-α, ultrasensitive C-reactive protein in the low-calorie group were lower than those in the standard calorie group: (16.74 ± 4.33) ng/L vs. (20.15 ± 5.68) ng/L, (25.58 ± 5.09)ng/L vs. (30.04 ± 6.46) ng/L, (12.41 ± 3.29) mg/L vs.(15.24 ± 4.18) mg/L, there were statistical differences ( P<0.05); the levels of serum total protein, albumin, transferrin were higher than those in the standard calorie group: (66.42 ± 8.32) g/L vs. (60.58 ± 8.32) g/L, (46.32 ± 6.39) g/L vs. (41.42 ± 5.34) g/L, (3.44 ± 0.65) g/L vs. (3.12 ± 0.31) g/L, there were statistical differences ( P<0.05). The incidence of malnutrition in the low-calorie group was lower than that in the standard calorie group: 3.33%(3/90) vs. 12.22%(11/90), there was statistical difference ( χ2 = 9.05, P<0.05). After 1 month and 3 months of treatment, the scores of National Institute of Health stroke scale (NIHSS) scores in the low-calorie group were lower than that in the standard calorie group: (15.76 ± 3.54) scores vs. (22.34 ± 6.24) scores, (8.65 ± 2.74) scores vs. (11.76 ± 4.83) scores, there were statistical differences ( P<0.05). Conclusions:Early local food-borne EN can improve the nutritional status of stroke patients, reduce the expression of inflammatory factors, and facilitate the improvement of neurological damage.

Objective:To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) combined with platelet-to-lymphocyte ratio (PLR) in early stage of systemic inflammatory response syndrome (SIRS) in children.Methods:A total of 136 children with SIRS (SIRS group) and 120 healthy children (control group) diagnosed and treated in the Eighth People′s Hospital of Hefei from January 2021 to February 2023 were retrospectively selected as the study objects. Inflammatory response indicators and peripheral blood NLR and PLR levels were compared between the two groups. Pearson test was used to analyze the correlation between NLR and PLR and other inflammatory response indicators in children with SIRS. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR and PLR alone and combined detection for SIRS.Results:The levels of serum procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) in the SIRS group were higher than those in the control group: (1.56 ± 0.41) μg/L vs. (0.57 ± 0.15) μg/L, (56.04 ± 17.71) mg/L vs. (4.50 ± 1.38) mg/L, (8.54 ± 1.95) ng/L vs. (0.95 ± 0.21) ng/L, there were statistical differences ( P<0.05). The levels of NLR and PLR of peripheral blood in the SIRS group were higher than those in the control group: 4.08 ± 1.32 vs. 2.01 ± 0.58, 269.15 ± 80.09 vs. 194.01 ± 62.41, there were statistical differences ( P<0.05). The results of Pearson test showed that the levels of NLR and PLR of peripheral blood were positively correlated with the levels of serum PCT, CRP and IL-6 ( r = 0.245, 0.540, 0.492, 0.282, 0.365, 0.721, P<0.05). The ROC curve analysis results showed that the area under the curve of the combined NLR and PLR detection to predict SIRS was 0.747(95% CI 0.650 -0.828), which was higher than the single index. Conclusions:The levels of NLR and PLR of peripheral blood are related to the incidence of SIRS in children. The combined prediction of the two index can further improve the accuracy of early prediction.

Objective:To analyze the correlation between serum chitinase 1 (CHIT1), secreted crimp-associated protein 5 (SFRP5) and renal function in patients with diabetic kidney disease (DKD).Methods:Two hundred patients with DKD (observation group) and 180 patients with simple diabetes (control group) diagnosed and treated in Beijing Rehabilitation Hospital Affiliated to Capital Medical University from July 2022 to July 2024 were retrospectively selected. Oxidative stress indexes, glucose and lipid metabolism indexes, renal function indexes, CHIT1 and SFRP5 levels of the two groups were detected. Multivariate Logistic regression was used to analyze the risk factors of DKD in diabetic patients, and Pearson test was used to analyze the correlation between serum CHIT1 and SFRP5 levels and renal function indexes.Results:The levels of CHIT1 and SFRP5 in the observation group were higher than those in the control group : (1.25 ± 0.29) μg/L vs. (0.90 ± 0.22) μg/L, (10.91 ± 3.21) μg/L vs. (5.70 ± 1.17) μg/L, there were statistical differences ( P<0.05). The results of Multivariate Logistic regression analysis showed that fasting blood glucose, glycated hemoglobin, postprandial 2 h blood glucose, total cholesterol, low density lipoprotein cholesterol, triacylglycerol, high density lipoprotein cholesterol, steady-state model insulin resistance index, steady-state model islet beta cell function index, advanced oxidized protein products, malondialdehyde, superoxide dismutol, total antioxidant capacity, cystatin C (CysC), urea nitrogen (BUN), serum creatinine (SCr), isotype cysteine (Hcy), glomerular filtration rate (GFR), CHIT1 and SFRP5 were all risk factors for DKD ( P<0.05). Pearson test results showed that serum CHIT1 and SFRP5 levels in DKD patients were positively correlated with CysC, BUN, SCr and Hcy levels ( r = 0.669, 0.708, 0.558, 0.537 and 0.619, 0.559, 0.639, 0.555, P<0.01), and there were negative correlation with GFR level ( r = - 0.558, -0.363, P<0.01). Conclusions:Serum CHIT1 and SFRP5 levels in DKD patients are significantly increased, which are related to renal function indicators. Changes in serum CHIT1 and SFRP5 levels can reflect the degree of renal function injury and can be used as auxiliary clinical indicators for disease monitoring.

Objective:To explore the risk factors of blood pressure fluctuations during the dialysis period in maintenance hemodialysis (MHD) patients and their impact on long-term survival.Methods:A total of 100 cases of MHD patients admitted to Anhui Linquan People′s Hospital from September 2020 to May 2022 were selected and divided into high fluctuation group (coefficient of variation in systolic blood pressure>8.64%) and non-high fluctuation group (coefficient of variation in systolic blood pressure ≤ 8.64%). The clinical data of the two groups were compared, and the LASSO model was used to conduct the preliminary screening for each risk factor. The nomogram prediction model of blood pressure fluctuation during the dialysis period was drawn, and the receiver operating characteristic (ROC) curve and calibration curve was drawn to obtain the prediction efficiency and calibration degree of the nomograph model. Kaplan-Meier survival curve was drawn to compare the 1-year survival status of the two groups.Results:The results of single factor analysis showed that body mass index, dialysis age, urea clearance index, ultrafiltration volume, serum calcium, serum albumin, serum phosphorus, serum sodium, total parathyroid hormone (iPTH), serum uric acid, serum creatinine, C-reactive protein, alkaline phosphatase, early diastolic maximum blood flow in the left ventricle (peak E)/atrial systolic maximum blood flow of mitral valve (peak A), and left ventricular ejection fraction (LVEF) were risk factors for blood pressure fluctuation during dialysis ( P<0.05). The prediction model of nomograph was drawn, and the consistency index (C-index) was 0.941, the prediction sensitivity was 88.40%, and the specificity was 91.20%. Kaplan-Meier survival curve analysis showed that the 1-year survival rate in the high fluctuation group was lower than that in the non-high fluctuation group ( P<0.05). Conclusions:Blood pressure fluctuation during dialysis in MHD patients is related to blood sodium, calcium and phosphorus, iPTH, blood uric acid, albumin, peak E/peak A, and LVEF, and can affect the prognosis of patients, and attention should be paid to the monitoring and control of above indexes of the patients in order to improve the prognosis.

Objective:To investigate the predictive value of the triglyceride-high-density lipoprotein cholesterol-glucose-body mass index (TyHGB) and triglyceride-glucose-body mass index (TyG-BMI) in early pregnancy for gestational diabetes mellitus (GDM) and pregnancy outcomes.Methods:A retrospective analysis was conducted, a total of 600 pregnant women who underwent prenatal examinations at North China Medical and Health Group Xingtai General Hospital from August 2020 to August 2023 were collected. Participants were divided into GDM group (76 cases) and non-GDM group (524 cases) based on GDM occurrence, and further categorized into adverse pregnancy group (101 cases) and favorable pregnancy group (499 cases) based on outcomes. Multivariate Logistic regression was used to identify risk factors for GDM and adverse pregnancy. The predictive performance of TyHGB and TyG-BMI was evaluated using receiver operating characteristic (ROC) curves.Results:After adjusting for confounders, TyHGB and TyG-BMI were independent risk factors for GDM ( OR = 1.569, 95% CI 1.259 -1.955; OR = 1.109, 95% CI 1.029 - 1.038) and adverse pregnancy ( OR = 1.438, 95% CI 1.193 - 1.734; OR = 1.021, 95% CI 1.014 - 1.029). The area under the curve (AUC) for TyHGB and TyG-BMI alone in predicting GDM was 0.677 and 0.731, respectively. Combined prediction of GDM yielded an AUC of 0.793, with sensitivity of 72.37% and specificity of 65.81%. For adverse pregnancy, the AUC of TyHGB and TyG-BMI alone were 0.666 and 0.692, respectively, while their combination achieved AUC of 0.746, with specificity of 69.34% and sensitivity of 65.35%. Conclusions:TyHGB and TyG-BMI in early pregnancy are risk factors for GDM and adverse pregnancy outcomes. Their combination can enhance predictive efficacy for both conditions.

Objective:To investigate the predictive value of serum homocysteine (Hcy), neutrophil to lymphocyte ratio (NLR) and total imaging load score on cognition disorders in patients with small cerebral vascular disease (CSVD).Methods:A total of 106 CSVD patients treated in Shanxi Hongdong County People's Hospital from June 2021 to June 2024 were retrospectively selected as the study objects. The Montreal Cognitive Assessment Scale (MoCA) was used to assess cognitive function. Among them, 43 patients with cognition disorders and 63 patients without cognition disorders were evaluated. Another 30 healthy subjects over 60 years old were selected as control group. General data and serum Hcy, NLR and other indicators of the three groups were compared, MRI examination was performed, and the total imaging load score was calculated. Logistic regression was used to analyze the risk factors of cognition disorders in CSVD patients, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of Hcy, NLR and radiographic total load score for cognition disorders in CSVD patients.Results:The levels of Hcy, NLR and total imaging load scores in the CSVD group were higher than those in the CSVD group and the control group : (20.32 ± 3.24) μmol/L vs. (17.75 ± 2.81), (14.96 ± 3.84) μmol/L; 2.77 ± 0.75 vs. 2.27 ± 0.68, 1.93 ± 0.47; (1.28 ± 0.73) scores vs. (0.92 ± 0.55), (0.36 ± 0.21) scores, there were statistical differences ( P<0.05). The results of Logistic regression showed that Hcy, NLR and total load score were risk factors for cognition disorders ( P<0.05). The results of ROC curve showed that the area under the curve (AUC) of Hcy, NLR, total imaging load score combined prediction of cognition disorders was 0.798. Conclusions:Hcy, NLR and total imaging load score are risk factors for cognition disorders in CSVD, and have certain predictive value for cognition disorders.

Objective:To investigate the short-term clinical efficacy of two fixation methods, mini-titanium plate fixation and suture suspension, in cervical posterior unilateral laminoplasty, and to explore the relationship between changes in the cervical sagittal sequence and therapeutic outcomes.Methods:A retrospective analysis was conducted on 55 patients who underwent cervical posterior unilateral laminoplasty with mini-titanium plate fixation and 50 patients with suture suspension at the First People's Hospital of Lianyungang from September 2020 to January 2023. All patients were followed up for 12 months, and the axial symptoms was recorded. The main clinical efficacy evaluations included before surgery and 12 months after surgery visual analog score (VAS) for neck pain, Japanese Orthopaedic Association score (JOA) and neck disability index (NDI). Four parameters were recorded before surgery and 12 months after surgery to assess the sagittal sequence: C 2-7 sagittal vertical axis (C 2-7SVA), T 1 slope angle (T 1s), C 2-7Cobb angle and cervical range of motion. Results:The mini-titanium plate fixation group had 5 cases of axial symptoms, while the traditional suture suspension group had 16 cases; the postoperative VAS, JOA and C 2-7Cobb angle in the mini-titanium plate fixation group were all less than those in the suture suspension group, with statistically significant differences ( P<0.05). Specifically, the postoperative VAS in the mini-titanium plate fixation group was (1.93 ± 1.42) points, and (2.67 ± 2.15) points in the suture suspension group ( P = 0.049); the JOA was (10.39 ± 2.20) points in the mini-titanium plate fixation group and (9.62 ± 1.52) points in the suture suspension group ( P = 0.012); the C 2-7Cobb angle was (21.087 ± 3.564)° in the mini-titanium plate fixation group and (23.092 ± 1.265)° in the suture suspension group ( P = 0.003). There was no statistical difference in operation time and blood loss between two groups ( P>0.05). The postoperative C 2-7SVA, T 1s and range of motion in the traditional suture suspension group were less than those in the mini-titanium plate fixation group, with statistically significant differences ( P<0.05). Specifically, the postoperative C 2-7SVA was (25.700 ± 3.035) mm in the mini-titanium plate fixation group and (23.946 ± 3.079) mm in the suture suspension group ( P = 0.004); the postoperative T 1s was (28.770 ± 2.361)° in the mini-titanium plate fixation group and (26.746 ± 3.198)° in the suture suspension group ( P = 0.004); the postoperative range of motion was (32.651 ± 4.995)° in the mini-titanium plate fixation group and (28.672 ± 5.874)° in the suture suspension group ( P = 0.003). Conclusions:Cervical posterior unilateral laminoplasty with mini-titanium plate fixation can effectively improve VAS, JOA, and restore neurological function, maintaining the cervical spine's sagittal balance, stability, and maximum range of motion.

Objective:To comparatively the efficacy of the combined external fixator and the Ilizarov in the treatment of open tibia-fibula fractures and their influence on postoperative infection.Methods:A total of 215 patients with open tibio-fibula fractures diagnosed and treated at Tianjin Medical University General Hospital Airport Site from January 2021 to January 2024 were retrospectively selected as the research subjects. They were divided into the observation group (110 cases, using the combined external frame) and the control group (105 cases, using theIlizarov) according to the types of external fixators adopted. The clinical efficacy, bone healing condition, X-ray callus score, and serological indicators, including the bone morphogenetic protein (BMP-2), vascular endothelial growth factor (VEGF), osteocalcin (OC), C-reactive protein (CRP) in the two groups were compared. The America Orthopedic Foot & Ankle Society(AOFAS) score, Hospital for Special Surgery (HSS) score, and Health Survey Scale (SF-36) score were applied to evaluate the recovery of patients, and the postoperative infection conditions in the two groups were compared.Results:At 12 months after the operation, the excellent and good rate of clinical efficacy in the observation group was higher than that in the control group:90.00%(99/110) vs. 80.00%(84/105), there was statistical difference ( χ2 = 4.24, P<0.05). The complete weight-bearing time, swelling elimination time, bone healing time and postoperative hospital stay in the observation group were shorter than those in the control group:(144.73 ± 15.48) d vs. (152.12 ± 15.55) d, (11.25 ± 1.34) d vs. (13.18 ± 1.37) d, (123.01 ± 12.53) d vs. (136.38 ± 13.45) d, (30.15 ± 3.24) d vs. (31.47 ± 3.48) d, there were statistical differences ( P<0.01). The X-ray callus scores in the observation group at 1 week and 1, 3 and 6 months after the operation were higher than those in the control group: (1.37 ± 0.15) scores vs. (1.28 ± 0.14) scores, (7.65 ± 0.83) scores vs. (5.64 ± 0.75) scores,(12.34 ± 1.25) scores vs. (10.78 ± 1.16) scores,(14.52 ± 1.56) scores vs.(12.11 ± 1.35) scores, there were statistical differences ( P<0.01). Six months after the operation, the levels of BMP-2, VEGF and OC in the observation group were higher than those in the control group: (84.23 ± 8.51) ng/L vs. (76.79 ± 7.82) ng/L, (17.26 ± 1.83) ng/L vs. (15.34 ± 1.67) ng/L, (18.34 ± 1.92) μg/L vs. (6.48 ± 1.75) μg/L; while CRP was lower than that in the control group: (6.49 ± 0.76) mg/L vs. (7.13 ± 0.78) mg/L; there were statistical differences ( P<0.01). The scores of AOFAS, HSS and SF-36 in the observation group at 6 months after the operation were higher than those in the control group: (76.34 ± 7.85) scores vs. (70.11 ± 7.49) scores,(70.12 ± 7.63) scores vs. (67.77 ± 6.68) scores, (93.57 ± 10.34) scores vs. (85.73 ± 8.65) scores, there were statistical differences ( P<0.01 or <0.05). The patients were followed up for 12 months after the operation. There was no statistical difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Compared with the Ilizarov, the combined external fixator has a better therapeutic effect in the treatment of open tibia-fibula fractures. It can promote the healing of bone wounds, improve joint function and quality of life, and has good safety.