ObjectiveTo explore the relationship between serum sCD40L level and coronary stenosis degree in acute coronary syndromes(ACS) patients with different glucose tolerance conditions.Methods154 patients with ACS were divided into normal glucose tolerance group ( NGT),impaired glucose tolerance group (IGT) and type 2 diabetes group (T2DM) according to the OGTT.The levels of serum sCD40L were detected by ELISA,and all patients underwent coronary angiography in order to calculate their Gensini score.Then the relationship between serum sCD40L level and coronary stenosis was analyzed by statistics.ResultsThe Gensini scores of IGT[(41.8 ± 19.8)score] and T2DM groups [(40.1 ± 18.7)score] were higher than NGT group [(21.9 ± 15.3)score] ( P ＜0.01 ),but there was no statistical difference between IGT and T2DM ( P ＞ 0.05 ) group.The serum sCD40L levels of IGT[(2.46 ± 0.79 )ng/ml]were higher than NGT group [(2.12 ± 0.81 )ng/ml] ( P ＜ 0.05 ),and the serum sCD40L levels in T2DM group [( 2.57 ± 0.68) ng/ml] were obviously higher than NGT group [( 2.12 ± 0.81 ) ng/ml] ( P ＜ 0.01 ).The serum sCD40L levels in T2DM group were higher IGT group,but there was no statistical difference between T2DM and IGT groups( P ＞0.05).Statistical analysis revealed that serum sCD40L levels had no statistical difference among the three groups and it had no relationship with coronary stenosis ( r =-0.147,P ＞0.05).ConclusionsCD40/CD40L activation would occur in the patients of ACS with wildly abnormal blood sugar,not only in those who had diabetes with much higher blood sugar.The serum sCD40L level in the ACS patients with abnormal glucose tolerance had no relationship with the severity of coronary stenosis.

Objective:This paper is to evaluate the curative effect of Self-made Jishen prescription combined with conventional western medicine in the treatment of type 2 diabetic kidney disease (DKD) with both deficiency of both qi and yin and blood stasis.Methods:A total of 80 patients from February 2019 to July 2020 with the syndrome of deficiency of both Qi and Yin with blood stasis in the DKD Ⅲ stage of Ruzhou Jiren Diabetes Hospital were selected. Those patients who met the diagnostic criteria were randomly divided into 2 groups, the control group and the treatment group, according to registration orders, with 40 in each group. The control group was treated with conventional western medicine therapy, and the treatment group was treated with modified self-made Jishen prescription on the basis of the control group. The treatment of both groups lasted for 3 months. Traditional Chinese Medicine (TCM) symptoms were scored before and after the treatment; hexokinase method was used to detect FPG, sarcosine oxidase method was used to detect SCr and eGFR were calculated, latex enhanced turbidimetric inhibition immuno assay method was used to detect hypersensitive C-reactive protein (hs-CRP), the sandwich ELISA was used to detect transforming growth factor-β1 (TGF-β1), and HbA1c was detected by high performance liquid chromatography; 24 h urine was collected, and 24 hUTP was detected by pyrogallol red-molybdenum method; and the clinical efficacy was evaluated.Results:The total effective rate was 87.5% (35/40) in the treatment group and 67.5% (27/40) in the control group. The difference between the two groups was statistically significant ( Z=-2.72, P=0.006). After treatment, hs-CRP [(2.52±1.02) mg/L vs. (3.21±1.22) mg/L, t=2.74], TGF-β1 [(32.2±6.52) mg/L vs. (38.3±6.8) mg/L, t=-4.97], 24 hUTP [(120.91±38.84) mg vs. (144.84 ±49.69) mg, t=-5.94] in the treatment group were significantly lower than those in the control group ( P<0.05); eGFR [(66.23±4.91)ml?min -1?1.73m -2vs. (59.69 ±4.51) ml?min -1?1.73m -2, t=6.61] in the treatment group was significantly higher than that of the control group ( P<0.05). The TCM Symptom Score after treatment in the treatment group was significantly lower than that of the control group ( P<0.01). Conclusion:For the patients with T2DM kidney disease of Phase Ⅲ with Deficiency of both Qi and Yin and Blood Stasis, the treatment of self-made Jishen prescription combined with conventional western medicine can inhibit the inflammatory reaction and renal interstitial fibrosis, improve the glomerular filtration rate, and reduce the excretion of urine protein.

Objective:To investigate the feasibility and safety of distal radial artery approach in emergency percutaneous coronary intervention(PCI) of elderly ST-segment elevation myocardial infarction(STEMI) patients.Methods:This study is a cross-sectional study. Elderly patients with acute myocardial infarction who received emergency PCI at the Third Central Hospital of Tianjin from January 2020 to December 2022 were selected. They were divided into the distal radial artery group and the classic radial artery group based on the puncture location. The success rate, puncture time, surgical success rate, and surgical time of the two groups were observed; The incidence of complications in patients, including radial artery occlusion rate, radial artery spasm rate, local hematoma rate, aneurysm incidence rate were recorded.Results:There were 70 cases in the distal radial artery group, including 33 males (47.1%), aged (65.6±6.7) years old; There were 70 cases in the classic radial artery group, including 35 males (50.0%), aged (66.4±6.9) years old. There was no statistically significant difference in puncture success rate, puncture time, surgical success rate, and surgical time between the distal radial artery group and the classical radial artery group ( P>0.05). The incidence of radial artery occlusion in the distal radial artery group was significantly lower than that in the classical radial artery group (1.4% vs. 8.6%, P=0.024). The postoperative compression time in the distal radial artery group was significantly shorter than that in the classical radial artery group ((291.6±10.5) min vs. (343.5±9.8) min, P=0.047). There was no statistically significant difference in the incidence of radial artery spasm, local hematoma, and aneurysm between the two groups ( P>0.05). Conclusions:The distal radial artery approach has a lower radial artery occlusion rate, shorter compression time, and better safety. It can be used as a new approach for emergency PCI in elderly patients with STEMI for clinical application.

Objective To determine the effect of thrombus aspiration combined with intracoronary injection of recombinant human TNK tissue type plasminogen activator(rhTNK-tPA)on micro-circulation and cardiac function during primary PCI in elderly patients with acute myocardial in-farction(AMI).Methods A retrospective study was conducted on 90 elderly patients with STEMI undergoing primary PCI in Tianjin Third Central Hospital from January 2021 to October 2023.According to their treatment strategies,they were divided into simple suction group(n=46)and combination group(n=44).The suction group received a suction catheter for thrombus aspiration within the coronary artery,while the combined group got a suction catheter for thrombus aspira-tion within the infarct related blood vessels,and then received a local injection of rhTNK-tPA into the lesion through the suction catheter.Their general data,proportion of ST segment resolution(STR)≥70％at 90 min after surgery,postoperative TIMI blood flow grade,postoperative TIMI myocardial perfusion grade(TMPG),corrected TIMI frame count(CTFC)and cardiac ultrasound indicators as well as the incidence of adverse cardiac events during hospitalization were compared between the two groups.Results Larger proportions of postoperative STR ≥70％,postoperative TIMI blood flow grade 3 and TMPG grade 3,and lower CTFC were observed in the combination group than the suction group(P＜0.05).In 1 week after surgery,the simple suction group had lower left ventricular ejection fraction[LVEF,(52.5±6.2)％vs(58.3±6.4)％,P＜0.05],but larger left ventricular diameter(LVD,44.1±3.9 mm vs 51.9±2.5 mm,P＜0.05)than the com-bined group.The incidence of MACE during hospitalization was obviously lower in the combined group than the suction group(20.5％vs 37.0％,P＜0.05).Conclusion Combined intracoronary injection of rhTNK-tPA based on thrombotic aspiration can effectively reduce the coronary thrombus burden,improve myocardial microcirculation perfusion,reduce the incidence of MACE during hospitalization,and not increase the risk of bleeding in elderly STEMI patients.

OBJECTIVE To analyze the factors influencing patient satisfaction in the outpatient pharmacy of tertiary maternity and child specialist hospitals in Chongqing， and provide a reference for improving the pharmaceutical management capability of tertiary maternity and child specialist hospitals and enhancing patients’ medical experience. METHODS Utilizing KANO model， a questionnaire was developed and data were analyzed. Key influencing factors were identified through the categorization of requirement attributes， Better values， Worse values， and two-dimensional matrix analysis. The impact of these categorized demand factors on overall satisfaction was further validated through Structural Equation Modeling （SEM）. RESULTS Cronbach’s α coefficient for the survey questionnaire was 0.855， exceeding the acceptable threshold of 0.7； Bartlett test for sphericality yielded a value of 5 538.56 with P＜0.01， indicating good reliability and validity of the survey results. Through the KANO model’s factor selection process， the top four key factors influencing patient satisfaction in outpatient pharmacies were determined to be： medication pick-up time （r＝0.45）， pharmacist service attitude （r＝0.45）， rational medication consultation （r＝0.41）， self-service calling system （r＝0.40）， all of which were subsequently validated through SEM. CONCLUSIONS The four factors of medication pick-up time， self-service calling system， pharmacist service attitude， and rational medication consultation significantly influence patient satisfaction in the outpatient pharmacies of tertiary maternity and child hospitals in Chongqing.