Objective To observe the expression changes of micro RNA-23a(miR-23a)and apoptotic protease-activating factor-1(APAF-1)in endometrial carcinoma tissues and analyze its clinical significance.Methods 123 specimens of endometrial carcinoma in our hospital from May 2018 to May 2020 were selected as endometrial carcinoma group,and the para cancerous tissue was selected as the normal group.Expression of miR-23a and APAF-1 were examined in endometrial tissues;the relationship between miR-23a and APAF-1 and the clinicopathology of patients and the correlation between the two were analyzed;Kaplan-Meier method was used to analyze the survival of patients with endometrial cancer.Results Compared with the normal group,the expression level of miR-23a in endometrial carcinoma group was significantly increased,the expressions of APAF-1 mRNA and protein decreased significantly(P<0.05);miR-23a and APAF-1 were significantly correlated with clinical stage,histological differentiation and myometrial invasion(P<0.05);Pearson analysis showed that miR-23a was nega-tively correlated with APAF-1(P<0.05);Kaplan-Meier curves showed that PFS and OS were significantly higher in the miR-23a low-expression group as well as the APAF-1-positive expression group than in the miR-23a high-expression group and the APAF-1-negative expression group(P<0.05).Conclusion The expression level of miR-23a is increased and APAF-1 expression is decreased in endometrial carcinoma,both of which correlate with endometrial cancer progression and patient prognosis,are expected to be biomarkers for clinical assessment of disease progression and prognosis in early-stage patients.

Objective Exploring the predictive value of blood lipid variability for adverse cardiovascular events in patients with acute ST segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods A total of 235 STEMI patients who underwent emergency PCI in our hospital from October 2020 to October 2022 were selected as the research objects.According to whether target lesion failure(TLF)occurred,the patients were divided into TLF group and control group Lipid variability[stan-dard deviation(SD),coefficient of variation(CV)and mean-independent coefficient of variation(VIM)]of the two groups were compared.Multivariate Cox regression analysis was used to explore the related factors of TLF in STEMI patients after emergency PCI,and receiver operating characteristic curve(ROC)was used to analyze the predictive value.Results Variability indexes of low-density lipoprotein(LDL),high-density lipoprotein(HDL)and lipoprotein a[LP(a)]in TLF group:LDL(SD),LDL(CV),LDL(VIM),HDL(SD),HDL(CV),HDL(VIM),LP(a)(SD),LP(a)(CV),LP(a)(CV)a)(VIM)were higher than those in control group,and the differences were statistically significant(P<0.05).The results of multivariate Cox regression analysis showed that LDL(SD),LDL(CV),LDL(VIM),HDL(SD),HDL(CV),HDL(VIM),LP(a)(SD),LP(a)(CV),LP(a)(VIM)were all risk factors for TLF in STEMI patients after emergency PCI(P<0.05).ROC curve analysis results showed that,LDL(SD),LDL(CV),LDL(VIM),HDL(SD),HDL(CV),HDL(VIM),LP(a)(SD),LP(a)(CV),LP(a)(VIM)have certain predictive value for TLF in STEMI patients after emergency PCI(AUC:0.790,0.805,0.833,0.766,0.795,0.816,0.773,0.782,0.798).Conclusion Lipid variability is associated with adverse cardiovascular events in STEMI patients after emergency PCI,and is an independent risk factor for TLF in STEMI patients after emergency PCI.

Objective To investigate the clinical characteristics and risk factors of the occurrence of hypoxic hepatitis(HH)in children with shock.Methods Clinical data(general situation,clinical situation and prognosis)of 234 children with different types of shock admitted to the pediatrics department of Hainan Women and Children's Medical Center from January 2016 to December 2023 were collected.Serum biochemical indexes on day 1(d1),day 2(d2),day 3(d3),day 5(d5),day 7(d7)of children with shock were collected,including serum alanine aminotransferase(ALT),glutamate aminotransferase(AST),lactate dehydrogenase(LDH),alkaline phosphatase(ALP),albumin(ALB),total bilirubin(TBIL),urea nitrogen(BUN),C reactive protein(CRP),international standardized time(INR)and lactate.And the clinical characteristics and risk factors of the occurrence of HH in children with shock were analyzed.Results A total of 234 cases(150 cases of males)of different types of shock in children were enrolled,ages ranged from 1 month to 16 years old.According to whether developed HH,the children with shock were divided into HH group(32 cases)and non-HH group(202 cases).The total incidence of HH was 13.7%(32/234).Septic shock was the main disease of the occurrence of HH in children with shock,accounting for 65.63%(21/32).According to the prognosis,children with shock combined HH were divided into survival group(17 cases)and death group(15 cases).The case fatality rate of children with shock combined HH was 46.9%.The ALT and AST values in children with shock combined HH were more than 20 times of the upper limits of normal ranges.The peak values of enzymatic indexes in the survival group appeared at the onset time d 1 to d 2,they were close to the normal ranges at the onset time d7,while the enzymatic indexes in the death group were higher than the normal ranges during the whole disease stage.Compared with the survival group,the peak values of ALT,AST,ALP,TBIL,CRP,BUN,and INR in the death group were obviously higher(P<0.05,both).The lowest value of ALB in the death group was lower than that in the survival group(P<0.05).The results of multivariate Logistic regression analysis showed that pediatric critical illness score(PCIS),lactate,multiple organ dysfunction syndrome(MODS),decompensated shock and cardiogenic shock were the risk factors for the occurrence of HH in children with shock(P<0.05 or 0.01),and left ventricular ejection fraction(LVEF)and mean arterial pressure(MAP)were the risk factors of the death of HH in children with shock(P<0.01).Conclusions Children with shock who have the risk factors as decreased PCIS,increased lactate level,MODS,decompensated shock and cardiogenic shock are apt to suffer from HH.Poor prognosis in the chil-dren with shock combined HH is associated with worse condition and lower LVEF.There is a high fatality rate of shock combined HH in children,so that liver function indicators should be closely monitored to early detect HH,and reasonable treatment should be given.

Objective Exploring the relationship between pain recurrence after percutaneous radiofre-quency thermocoagulation and the degree of trigeminal nerve atrophy and pontine angle in patients with primary trigeminal neuralgia(INT).Methods A retrospective analysis was conducted on 297 patients with INT admitted to Qingdao Haici Hospital Affiliated to Qingdao University(Qingdao Traditional Chinese Medicine Hospital)from January 2020 to December 2021.All patients received percutaneous radiofrequency thermocoagulation surgery in our hospital.They were followed up for 24 months,during which 56 patients experienced pain recurrence after sur-gery(recurrence group),while 241 patients did not experience postoperative pain recurrence(non-recurrence group).Results The length of the trigeminal nerve root,degree of trigeminal nerve atrophy,and the combined application of the two were used to draw ROC curves.The AUC values predicted for pain recurrence in INT patients after percutaneous radiofrequency thermocoagulation were 0.553,0.750,and 0.861,respectively.The results of the logistic regression model showed that shortened trigeminal nerve root length(OR=0.624,P=0.038),increased degree of trigeminal nerve atrophy(OR=2.257,P=0.000),multi vessel compression(OR=1.842,P=0.019),and severe baseline pain(OR=1.714,P=0.000)were independent risk factors for pain recurrence in INT patients after percutaneous radiofrequency thermocoagulation(P<0.05).Conclusions INT patients undergo thin-layer MRI scans before surgery,and the degree of trigeminal nerve atrophy has a higher predictive value for pain recur-rence after radiofrequency thermocoagulation.The length of trigeminal nerve roots and degree of trigeminal nerve atrophy are correlated with postoperative pain recurrence in patients.

Objective To explore the impact of HR-HPV infection on pregnancy outcomes and vaginal microbiota.Methods 128 pregnant women who underwent prenatal examinations at Mingshan Branch of the First Affiliated Hospital of Chengdu Medical College were selected as the research subjects.Both vaginal microbiota and HR-HPV testing were conducted,and single factor analysis and multiple linear regression analysis were used to identify the relevant factors of HR-HPV infection in pregnant women.The impact of HR-HPV infection on preg-nancy outcomes and vaginal microbiota was studied.Results Among the 49 cases in the infection group,30 cases contracted with type 16 HPV,accounting for 61.22%,13 type 18 HPV,accounting for 26.53%,and 1 type 31,33,51,52,53,and 58,respectively.Univariate analysis showed that HR-HPV infections were significantly correlated with age of first sexual activity,condom use,number of sexual partners,reproductive tract inflammation,and smoking history(P<0.05).Multivariate analysis showed that age of first sexual activity≤20 years,concurrent reproductive tract inflammation,multiple sexual partners,and smoking history were independent risk factors for HR-HPV infection,while condom use was an independent protective factor for HR-HPV infection.There were significant differences in the number of lactobacilli,candida infections,and vaginal cleanliness between the two groups(P<0.05).The incidence of spontaneous abortion and fetal growth restriction in the HR-HPV-infected group was significantly higher than that in the HR-HPV-uninfected group(P<0.05).Conclusions Pregnant women with HR-HPV infections are closely related to factors such as premature sexual conduct,number of sexual partners,reproductive tract inflammation,and smoking.Infections with HR-HPV during pregnancy can cause changes in the vaginal microenvironment and lead to adverse pregnancy outcomes.

Objective To investigate the effect of PCSK9 inhibitors on the level of inflammation and ven-tricular remodeling after PCI in ST-elevation acute myocardial infarction.Methods A total of 220 patients with acute ST-segment elevation myocardial infarction who received percutaneous coronary artery intervention in the Emergency Center of Qingdao Central Hospital from April 2021 to July 2023 were randomly divided into two groups,110 patients in the control group were treated with conventional treatment,and 110 patients in the PCSK9i group were treated with PCSK9 inhibitors on the basis of conventional treatment.Compared before and after treatment left ventricular endsystolic diameter(LVESD)and left ventricular ejection fraction(LVEF)and triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),total cholesterol(TC).C-reactive protein(CRP),interleukin 6(IL-6),tumor necrosis factor α(TNF-α).The incidence of major adverse cardiovascular events(MACE)(including myocardial infarction,recurrence of heart failure,malignant arrhythmia,and cardiovascular death)was compared.Results After 6 months of treatment and follow-up,LVEDD(mm),LVESD(mm),TG(mmol/L),TC(mmol/L),LDL-C(mmol/L),CRP(mg/L),TNF-α(pg/mL)and JL-6(ng/mL)after PCSK9i treatment were significantly lower than those in the control group,and the difference was statistically significant[(51.32±5.84)vs.(54.43±2.91);(34.88±2.69)vs.(36.96±3.19);(1.41±0.61)vs.(2.13±1.26);(3.53±1.06)vs.(3.98±0.93);(0.95±0.36)vs.(1.79±0.27);(5.18±1.92)vs.(7.69±2.61);(36.43±9.41)vs.(57.79±14.43);(17.4±0.68)vs.(28.55±8.92),All P<0.01],and the LVEF(%)and HDL-C(mmol/L)in the PCSK9i group were higher than patients in the control group,and the difference was statistically significant[(46.69±3.63)vs.(41.34±3.42),P<0.05,(1.35±0.29)vs.(1.29±0.27),P<0.01].The incidence of MACE events in the PCSK9i group was obviously lower than patients in the control group(5.2%vs.13.6%,P<0.05).Conclusion The application of PCSK9 inhibitors after PCI in patients with ST-segment elevation acute myocardial infarction can better reduce blood lipids,stabilize coronary plaque,reduce local and circula-tory inflammatory responses after myocardial infarction,improve ventricular adverse remodeling after myocardial infarction,inhibit ventricular remodeling,and reduce the total incidence of MACE,worthing promoting use.

Objective To investigate the value of magnetic resonance image-diffusion weighted imaging(MRI-DMI)combined with attenuation imaging(ATI)in the diagnosis of focal nodular lesions<2 cm in the back-ground of fatty liver.Methods The clinical data of 68 patients with fatty liver complicated with focal nodular lesions<2 cm were retrospectively analyzed from June 2022 to June 2023 in Huaihe Hospital of Henan University.All patients underwent MRI,pathology and ATI examination.According to the degree of fatty liver disease,68 patients were divided into severe group(n=24),moderate group(n=27)and mild group(n=17).The apparent diffusion coefficient(ADC)and acoustic attenuation coefficient(AC)values of patients with different focal lesions were compared with clinical data,and the ADC values and AC values of patients with different fatty liver lesions were compared with clinical data,and the correlation was analyzed by Pearson.To analyze the value of MRI-DWI combined with AC value in the diagnosis of malignant fatty liver disease with focal nodular disease<2 cm.Results Pathological diagnosis showed that 41 of the 68 patients were benign and 27 were malignant.There were no significant differences in low density lipoprotein cholesterol(LDL-C),age,triglyceride(TG),sex,total cholesterol(TC)and high density lipoprotein cholesterol(HDL-C)between benign nodule group and malignant nodule group(P>0.05).There was no difference in TG,age,HDL-C,sex,TC and LDL-C among mild,moderate and severe groups(P>0.05).The ADC value of malignant nodule group was lower than benign nodule group under different b values(P<0.05),and the AC value of malignant nodule group was higher than that of benign nodule group(P<0.05).ADC value under different b values in the severe group was lower than mild and moderate groups(P<0.05),ADC value under different b values in the moderate group was lower than mild group(P<0.05),AC value in the severe group was higher than mild and moderate groups(P<0.05),and AC value in the moderate group was higher than mild group(P<0.05).ADC values at different b values were negatively correlated with the degree of fatty liver disease(P<0.05),but not with TG,HDL-C,TC and LDL-C(P>0.05).AC was positively correlated with the degree of fatty liver disease(P<0.05),negatively correlated with HDL-C(P<0.05),but not with TG,TC and LDL-C(P>0.05).The area under the curve(AUC)values of MRI-DWI,AC and their combi-nation in the diagnosis of fatty liver complicated with focal nodule disease<2 cm into malignancy were 0.775,0.773 and 0.909,respectively(P<0.05),and the AUC value of the combination was higher(P<0.05).Conclusion MRI-DWI and ATI have important value in the differential diagnosis of benign and malignant lesions of focal nodular lesions<2 cm in the background of fatty liver,and the combination of MRI-DWI and ATI has higher diagnostic value.

Objective To analyze the risks and related influencing factors of early screening for lung cancer,and to study prognostic factors based on survival conditions,in order to ultimately provide baseline data for the prevention and treatment of lung cancer.Methods A cluster sampling method was used to select 40 to 75 year old registered residence residents in 10 districts and 6 counties of Zhengzhou City in 2020 as screening objects.Through voluntary participation and filling in evaluation questionnaires,high-risk groups of lung cancer were evalu-ated,and then three screening tests(tumor markers,low-dose spiral CT and lung function)were performed on high-risk groups.Finally,we will adopt an active and passive follow-up approach to collect information on diag-nosed lung cancer patients.Statistically describe the screening data and describe the epidemiological results of different characteristic populations;Using multivariate logistic regression method for statistical analysis,compare the differences in various results of different factors.Results 50128 cases of early screening for lung cancer in Zhengzhou City were evaluated in 2020,with a completion rate of 100.26%.The average age of the survey was(59.86±17.67)years old,and the gender ratio was 0.81∶1.The high-risk detection rate is 30.15%.Multivariate logistic regression analysis showed that males(smoking)(OR=5.43,95%CI:5.20～5.67),individuals with a history of tobacco exposure(OR=3.82,95%CI:3.67～3.98),first-degree relatives who had previously suffered from lung cancer(OR=12.06,95%CI:11.02～13.20),and other populations were more susceptible to lung cancer(all P<0.05).Conclusion Male(smoking),exposure to secondhand smoke,cancer in first-degree relatives,previous diagnosis of other tumors,symptoms of lung infection,"chest tightness,shortness of breath,and difficulty breathing in daily life",and"significant psychological trauma in the past 3 years"are independent risk factors for lung cancer,which should be given special attention and effective intervention measures should be taken.

Objective To explore the clinical efficacy of arc-edge needle therapy based on Zaodian theory in the treatment of refractory tennis elbow.Methods 64 patients with refractory tennis elbow were collected and randomly divided into a control group and an observation group using a random number table method.Among them,32 cases in the control group were treated with local pain point injection.32 patients in the observation group were treated with arc-edge needle therapy once a week,with two treatments per group.The Number rating scale(NRS)Mayo,elbow joint performance score(MEPS)and Disabilities of the arm,shoulder and hand(DASH)score were recorded and compared between the two groups before treatment and at 1,2,4 and 24 weeks of follow-up after treatment,disease efficacy score(WDES)at 24 weeks of follow-up.Results During the treat-ment process,neither group of patients experienced serious adverse reactions.At each stage after treatment,two groups of NRS MEPS,DASH,and WDES at 24 weeks of follow-up all improved compared to before treatment.After one week of treatment,there was no statistically significant difference in NRS scores between the two groups(P>0.05).At follow-up visits at weeks 2,4,and 24,the NRS scores in the observation group were lower than those in the control group.After 1,2,4,and 24 weeks of follow-up after treatment,the DASH score was lower in the observation group than in the control group,and the MEPS score was higher in the observation group than in the control group,with statistically significant differences(P<0.05).After 24 weeks of treatment,the WDES of the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Local pain point injection and arc-edge Zaodian release can alleviate pain and improve elbow joint function in the early stage of refractory tennis elbow.However,the long-term effect of local pain point injection treatment is not good,and the treatment effect of the observation group gradually improves.

Lung cancer is the most fatal malignant tumor worldwide,with non-small cell lung cancer(NSCLC)being the predominant pathological subtype.The development of NSCLC is driven by mutations in the epidermal growth factor receptor(EGFR),and EGFR tyrosine kinase inhibitors(EGFR-TKIs)are employed as targeted therapies for first-line treatment of advanced NSCLC patients harboring EGFR mutations.However,varia-tions in molecular structures,concurrent mutations,and mechanisms of therapeutic resistance contribute to prog-nostic disparities among different EGFR subgroups.This review primarily summarizes the molecular structural basis and differential treatment responses associated with distinct types of EGFR mutations in NSCLC.