Objective To explore whether there is a causal relationship between intestinal flora and esophageal cancer. Methods Summary statistics of intestinal flora and esophageal cancer were obtained from the Genome-wide Association Studies (GWAS) database. Five methods, including inverse variance weighted (IVW), weighted median estimation, Mendelian randomization (MR)-Egger regression, single mode, and weighted mode, were used for analysis, with IVW as the main analysis method. Sensitivity analysis was used to evaluate the reliability of MR results. Results In the IVW method, Oxalobacteraceae [OR=1.001, 95%CI (1.000, 1.002), P=0.023], Faecalibacterium [OR=1.001, 95%CI (1.000, 1.002), P=0.028], Senegalimassilia [OR=1.002, 95%CI (1.000, 1.003), P=0.006] and Veillonella [OR=1.001, 95%CI (1.000, 1.002), P=0.018] were positively correlated with esophageal cancer, while Burkholderiales [OR=0.999, 95%CI (0.998, 1.000), P=0.002], Eubacterium oxidoreducens [OR=0.998, 95%CI (0.997, 0.999), P=0.038], Romboutsia [OR=0.999, 95%CI (0.998, 1.000), P=0.048] and Turicibacter [OR=0.998, 95%CI (0.997, 0.999), P=0.013] were negatively correlated with esophageal cancer. Sensitivity analysis showed no evidence of heterogeneity, horizontal pleiotropy and reverse causality. Conclusion Oxalobacteraceae, Faecalibacterium, Senegalimassilia and Veillonella increase the risk of esophageal cancer, while Burkholderiales, Eubacterium oxidoreducens, Romboutsia and Turicibacter decrease the risk of esophageal cancer. Further studies are needed to explore how these bacteria affect the progression of esophageal cancer.

[Objective] To analyze the infection status of hepatitis E virus (HEV) among blood donors in Zhengzhou, so as to provide data support for formulating local blood screening strategies. [Methods] Random samples from blood donors from January to December 2022 were tested for HEV RNA using PCR technology. Reactive samples were sequenced for gene analysis, and the donors were followed up. [Results] Among 21 311 samples, 3(0.14‰) were reactive for HEV RNA, all of whom were male. Genetic sequencing results revealed that one strong positive sample was genotype 4, while sequencing failed for the other two due to low viral load. A follow-up of 25 strong positive donors showed that ALT significantly increased on day 7 after donation, anti-HEV IgM and anti-HEV IgG turned positive. On day 21, ALT returned to normal, and on day 35, HEV RNA turned negative. Notably, anti-HEV IgM and anti-HEV IgG persisted until day 482. [Conclusion] There is HEV infection among blood donors in Zhengzhou, and it is necessary to expand the screening scope to comprehensively explore the prevalence and genotype distribution of HEV among blood donors.

The pathological changes of myocardial infarction （MI） are mainly characterized by progressive myocardial ischemic necrosis， decline in cardiac diastolic function， thinning of the ventricular wall， and enlargement of the ventricles. The clinical manifestations include myocardial ischemia， heart failure， arrhythmia， shock， and even sudden cardiac death， rendering MI one of the most perilous cardiovascular diseases. Currently， the clinical treatment for MI primarily involves interventional procedures and drug therapy. However， due to their significant side effects and high complication rates associated with these treatments， they fail to ensure a satisfactory quality of life and long-term prognosis for patients. On the other hand， traditional Chinese medicine has demonstrated remarkable potential in improving patient prognosis while reducing side effects. Research has elucidated that various signaling pathways such as nuclear transcription factor-κB （NF-κB）， adenosine 5̒-monophosphate-activated protein kinase （AMPK）， transforming growth factor-β （TGF-β）/Smads， mitogen-activated protein kinase （MAPK）， Wnt/β-catenin （β-catenin）， and phosphatidylinositol 3-kinase （PI3K）/protein kinase B（Akt） play crucial roles in regulating the occurrence and development of MI. Effectively modulating these signaling pathways through its therapeutic interventions， traditional Chinese medicine can enhance MI management by inhibiting apoptosis， providing anti-inflammatory properties， alleviating oxidative stress levels， and resisting myocardial ischemia. Due to its notable efficacy and favorable safety， it has become an area of focus in clinical practice.

ObjectiveTo evaluate the clinical effectiveness and safety of Modified Zhigancao Granules （炙甘草汤加味颗粒） for preventing the early recurrence following radiofrequency ablation in patients with atrial fibrillation （AF） of qi-yin deficiency syndrome. MethodsA multi-center， randomized， double-blind， placebo-controlled trial was designed. A total of 116 patients with atrial fibrillation of qi-yin deficiency syndrome who underwent radiofrequency ablation for the first time were enrolled from 3 centers， and they were randomly divided into a treatment group （59 cases） and a control group （57 cases）. Both groups received basic western medicine treatment after surgery. In addition， the treatment group was given oral Modified Zhigancao Granules， while the control group was given oral placebo granules. The dosage for both groups was 20 g each time， twice a day， with continuous treatment for 12 weeks. The recurrence of atrial fibrillation in both groups was recorded at 24 hours， 4 weeks， 8 weeks， and 12 weeks after surgery. The serum levels of B-type natriuretic peptide （BNP）， interleukin-6 （IL-6）， high-sensitivity C-reactive protein （hs-CRP）， and tumor necrosis factor-α （TNF-α） were detected before treatment and 12 weeks after treatment in both groups. The scores of Atrial Fibrillation Effect on QualiTy-of-life （AFEQT） Questionnaire （including scores of the daily life dimension， symptom dimension， treatment worry dimension， treatment satisfaction dimension， and total score） and traditional Chinese medicine （TCM） syndrome scores were compared before treatment and at 4 weeks， 8 weeks， and 12 weeks between groups. Safety indicators such as blood routine， urine routine， liver function， and renal function were monitored before and after treatment. ResultsNine of the treatment group and seven of the control group dropped out. Finally， 50 patients in each group were included in the statistical analysis. At 24 hours， 4 weeks， 8 weeks， and 12 weeks after surgery， the recurrence rates of AF in the treatment group were 2.0% （1/50）， 2.0% （1/50）， 4.0% （2/50）， and 10.0% （5/50）， respectively； while those in the control group were 2.0% （1/50）， 26.0% （13/50）， 28.0% （14/50）， and 34.0% （17/50）， respectively. Compared with the control group at the same time points， the early recurrence rates of AF in the treatment group were significantly lower at 4 weeks， 8 weeks， and 12 weeks after surgery （P＜0.01）. Compared with the baseline within group， BNP， hs-CRP， IL-6， and TNF-α in the treatment group all decreased after 12 weeks of treatment （P＜0.05）； the difference in hs-CRP levels （before vs. after treatment） in the treatment group was higher than that in the control group （P＜0.01）. Compared with the baseline within group， both groups showed decreases in the total score of AFEQT Questionnaire， scores of the daily life dimension， treatment worry dimension， symptom dimension， and TCM syndrome scores at 4 weeks， 8 weeks， and 12 weeks after treatment. Meanwhile， the score of the treatment satisfaction dimension of AFEQT increased in both groups （P＜0.01）， and the improvements in all the above scores in the treatment group were superior to those in the control group at all time points （P＜0.05 or P＜0.01）. All safety indicators of patients in both groups were within the normal range before treatment and at 12 weeks after treatment， and no adverse reactions or adverse events occurred in either group. ConclusionModified Zhigancao Granules can reduce the early recurrence rate following radiofrequency ablation in AF patients with qi-yin deficiency syndrome， improve clinical symptoms and quality of life， suppress inflammatory response， and show good safety.

Objective : To analyze the current status of anti-PD-1 combined with chemotherapy in advanced gastric cancer. Methods: The clinical data of 120 patients with advanced gastric cancer treated with chemotherapy or anti-PD-1 plus chemotherapy were retrospectively analyzed. The efficacy [measures include objective response rate(ORR), disease control rate(DCR), and progression-free survival(PFS)]and the occurrence of adverse reactions in patients was monitored. Univariate and multivariate Cox were used to analyze the relationship between clinicopathologic data [including age, gender, body mass index(BMI), differentiation degree, and related hematological indexes], specific treatment conditions and PFS, and to analyze the influence of treatment plan and line number on the curative effect. Results : The PFS of chemotherapy plus immunotherapy was significantly better than that of chemotherapy alone(P<0.05), and the median PFS of the two was 7.17 months(95%CI5.85-8.49) and 5.33 months(95%CI3.96-5.70), respectively. In the combination group, the overall ORR was 27.5% and DCR was 94.8%. In the chemotherapy group alone, the overall ORR was 9.7% and DCR was 69.4%.In the chemotherapy plus anti-PD-1 group, a high prognostic nutritional index(PNI) level also provided superior PFS in patients with a 47% reduction in the risk of progression versus a low PNI level [HR0.53(95%CI0.30-0.96);P<0.05]. The median PFS was 7.47 months(95%CI5.83-9.11) with a high PNI level versus 6.00 months(95%CI4.45-7.55) with a low PNI level. The overall incidence of adverse reactions of chemotherapy combined with anti-PD-1 was slightly higher than that of chemotherapy alone, and the incidence of adverse reactions of grade 3-4 was similar, within a controllable range, and could be improved after clinical treatment. Conclusion The efficacy of anti-PD-1 combined with chemotherapy in patients with advanced gastric cancer is better than that of chemotherapy, and the adverse reactions are controllable. In the chemotherapy plus anti-PD-1 group, patients with high PNI levels achieved a higher PFS.

Objective:To analyze the differences in determination of fluoride level in drinking water by ion-selective electrode method and high-throughput rapid determination method.Methods:The precision test was carried out by using the two methods to measure two kinds of fluoride standard substances, water samples of external quality control assessment from 2021 to 2023 (two kinds each year) and the fluoride level in three drinking water samples (for 5 times/each sample). Accuracy testing was conducted by measuring the external quality control assessment water samples and the spiked recovery rates drinking water, and water samples were grouped (water fluoride ≤1.00, > 1.00 mg/L) and analyzed according to the "Hygienic Standards for Drinking Water" (GB 5749-85). SPSS 23.0 software was used for statistical analysis of the measurement results.Results:(1) The correlation coefficients ( r) of the working curves of the two methods were both > 0.990, meeting the quality control requirements. (2) In the precision test, when comparing the results of the two methods for detecting two kinds of fluoride standard substances, there was no statistically significant difference ( F = 0.36, 0.15, P = 0.564, 0.707), and the coefficients of variation ( CV) were all < 5%. The CV of the detection results of the external quality control assessment water samples and drinking water samples were < 5%. (3) In the accuracy test, when the fluoride concentration in water was ≤1.00 mg/L, there was no statistically significant difference in the spiked recovery rates between the two methods ( F = 0.49, P = 0.504). When the fluoride concentration in water was > 1.00 mg/L, there was a statistically significant difference in the spiked recovery rates between the two methods ( F = 24.75, P = 0.003). Conclusions:The ion-selective electrode method has the advantages of wide detection range and wide adaptability, while the high-throughput rapid determination method has high accuracy. Testing personnel can weigh and choose the appropriate determination method based on the actual laboratory conditions and sample concentration range.

Objective To investigate the association between the TyG index,its modified variants,and the risk of developing colorectal cancer(CRC).Methods This study included a total of 93,177 participants from the 2006 Kailuan Group health examination cohort.Participants were categorized into four quartiles(Q1-Q4)according to their TyG and modified TyG indices.Follow-up began at the baseline examination,with incident CRC as the primary outcome.Participants were censored at the time of CRC diagnosis,death,or the end of the study,whichever occurred first.The dose-response relationship between TyG and its modified indices and the risk of CRC was evalu-ated using restricted cubic splines(RCS)in conjunction with Cox proportional hazards regression models,yielding hazard ratios(HRs)and 95%confidence intervals(CIs).To compare the strength of associations between TyG and its modified versions(TyG-BMI,TyG-WC,TyG-WHR,TyG-WHtR,TyG-WWI)and CRC risk,HRs for CRC per one standard deviation increase in each index were calculated and compared.Results Both the TyG index and its modified variants demonstrated a significant dose-response relationship with the risk of CRC incidence.Specifically,for the TyG index,each 1-standard deviation(SD)increase was associated with a 1.17-fold(95%CI:1.09～1.27)higher risk of CRC.Compared with the first quartile(Q1),the third quartile(Q3)and fourth quartile(Q4)exhibited a 1.25-fold(95%CI:1.01～1.55)and 1.26-fold(95%CI:1.01～1.57)increased risk,respectively.For TyG-BMI,each 1-SD increase was linked to a 1.20-fold(95%CI:1.07～1.35)elevated CRC risk.Compared with Q1,Q3 and Q4 showed a 1.32-fold(95%CI:1.06～1.64)and 1.51-fold(95%CI:1.21～1.88)increase,respectively.Regarding TyG-WC,each 1-SD increment was associated with a 1.22-fold(95%CI:1.13～1.32)higher CRC risk,with Q3 and Q4 showing a 1.35-fold(95%CI:1.08～1.70)and 1.56-fold(95%CI:1.24～1.96)increased risk compared to Q1.For TyG-WHtR,each 1-SD increase was associated with a 1.24-fold(95%CI:1.08-1.42)higher CRC risk.Compared with Q1,Q2,Q3,and Q4 demonstrated a 1.31-fold(95%CI:1.03～1.66),1.55-fold(95%CI:1.23～1.95),and 1.60-fold(95%CI:1.27～2.02)increase,respectively.In the case of TyG-WHR,each 1-SD increase was associated with a 1.19-fold(95%CI:1.10～1.29)higher CRC risk,with Q4 showing a 1.42-fold(95%CI:1.14～1.77)increased risk compared to Q1.Finally,for TyG-WWI,each 1-SD increase was associated with a 1.22-fold(95%CI:1.13～1.32)elevated CRC risk,with both Q3 and Q4 showing a 1.58-fold increase(Q3:95%CI:1.26～1.98;Q4:95%CI:1.25～1.99).Stratified analyses by sex and age consistently revealed significant associations between the TyG index and its modified variants and CRC risk.Furthermore,these indices were independently associated with the incidence of both colon cancer and rectal cancer.Conclusions(1)Elevated levels of the TyG index and its modified variants are independent risk factors for CRC.(2)Both the TyG index and its modified forms demonstrate a significant dose-response association with the incidence of CRC.(3)Among the modified TyG indices,TyG-WWI,TyG-WHtR,TyG-BMI,TyG-WC,and TyG-WHR showed stronger correlations with CRC risk compared to the original TyG index.

Different insect drugs have their own characteristics in terms of efficacy,including removing blood stasis and promoting blood circulation,dispelling phlegm and dispersing lumps,and nourishing the body.This article discussed the use of insect medicines in the treatment of chronic heart failure(CHF)based on the theory of"collateral deficiency and tonifying".Taking the TCM theory of"collateral deficiency and tonifying"as the entry point,this article categorized the pathogenesis of CHF into deficiency of qi and yang,deficiency of collaterals,phlegm retention and dampness stagnation,and accumulation of collaterals,and believes that the treatment should be based on resolving blood stasis and promoting collaterals,eliminating phlegm and promoting collaterals,dispersing lumps and promoting collaterals,and tonifying heart collaterals,thus achieving the effect of"collateral deficiency and tonifying".It also summarized the efficacy and modern pharmacological mechanisms of insect drugs,providing medication ideas for the treatment of CHF.

Objective:To assess the current clinical application status of provocation/stress echocardiography in hypertrophic cardiomyopathy（HCM）among echocardiography physicians from large grade A tertiary hospitals，located in 24 provinces or directly administered municipalities，and to achieve a relatively clear and comprehensive overview of the current clinical application status of provocation/stress echocardiography in HCM. This study was conducted by the Chinese Society of Ultrasound in Medicine（CSUM）and Chinese Society of Echocardiography（CSE）.Methods:An online survey was anonymously conducted using Question Star application from 20 March to 30 September 2023. The survey covered the following topics including the echocardiographic diagnostic overview，the selection of views and measurement parameter of echocardiography，and the cognition and application，awareness and management of risk，and clinical demand of provocation/stress echocardiography.Results:A total of 337 valid responses were included in the final statistical analysis. The study revealed that the number of HCM patients seen by echocardiography physicians was very few（0-10%），with a low proportion of diagnosed obstructive HCM patients. There was incomplete mastery of the left ventricular outflow tract（LVOT）obstruction criteria（68.25%），insufficient awareness of the importance of LVOT pressure gradient measurement（7.12% echocardiographic doctors routinely performed LVOT gradient measurement for suspect HCM patients），non-standardized selection of echocardiographic views and measurement parameters for HCM，and significant deficiencies in knowledge and application of Valsalva provocation/stress echocardiography（17.21% and 79.23% doctors were quite aware of the principles of Valsalva provocation/stress echocardiography，respectively）. The risk awareness of provocation/stress echocardiography（13.65% physicians were fully aware of the potential risk）and the ability to manage associated risks（19.29% physicians were able to handle all emergencies）were lacking. Existing guidelines did not sufficiently standardize the clinical practice of provocation/stress echocardiography（23.44%），and there was diversity in learning formats requirements and unmet clinical needs.Conclusions:This survey revealed insufficient fundamental theoretical knowledge and a need for further standardization and training in the application of provocation/stress echocardiography for HCM among echocardiography physicians. Additionally，risk awareness and adequate response skills need improvement. There is a need for more practical and guiding guidelines for clinical practice，as well as numerous unmet clinical needs.

Objective:To compare the clinical outcomes and costs in arthroscopic repair of small and medium-sized supraspinatu tendon tears between double-pulley suture-bridge (DPSB) and traditional suture bridge (SB).Methods:A retrospective study was conducted at Department of Joint Surgery, The Second Hospital Affiliated to Hengyang Medical School to analyze the data of 26 patients with small and medium-sized supraspinatus tendon tears who had been treated by SB repair from May 2018 to December 2020 (SB group) and those of 35 patients with small and medium-sized supraspinatus tendon tears who had been treated by DPSB repair from January 2021 to December 2022 (DPSB group). There were 61 patients in the 2 groups, including 44 males and 17 females, with an age of (59.1±7.5) years. The left shoulder was affected in 26 patients and the right shoulder in 35 patients. The tear size was small in 25 cases and medium in 36 ones. The total number of anchors used, total anchoring costs, and surgical time were recorded and compared between the 2 groups. Visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score and shoulder range of motion were used to evaluate the clinical outcomes of the 2 groups before surgery and at the last follow-up. Comparisons were made within and between the 2 groups. Tendon integrity was assessed using MRI or ultrasound at 3, 6, 12 months or at the last follow-up.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). DPSB and SB groups were followed up for (28.1±3.5) and (27.1±1.8) months, respectively. There was no statistically significant difference between DPSB group and SB group in surgical time or total number of anchors ( P>0.05). The total costs of anchoring in DPSB group [(6,028.6±173.4) yuan] were significantly lower than those in SB group [(13,257.1±554.2) yuan] ( P<0.05). At the last follow-up, the anterior flexion, abduction, external rotation and internal rotation of the shoulder, as well as VAS pain score, ASES score and UCLA score, were significantly better in both DPSB group and SB group than their preoperative values ( P<0.05), but there were no statistically significant differences between DPSB group and SB group ( P>0.05). There was no significant difference either in tendon retear between DPSB group (2 cases) and SB group (1 case) ( P>0.05). No such complication as wound infection or nerve damage was found in either group. Conclusions:In arthroscopic repair of small and medium-sized supraspinatu tendon tears, both DPSB and SB techniques can achieve satisfactory and comparable clinical outcomes. However, DPSB leads to lower total costs of anchoring.