Objectives:To systematically evaluate the effectiveness and safety of sacubitril valsartan in the treatment of heart failure with mildly reduced ejection fraction(HFmrEF).Methods:Computer searches were conducted on PubMed,Embase,China National Knowledge Infrastructure(CNKI),VIP,and Wanfang Data,all from the time of database establishment until December 31,2023.Randomized controlled trials(RCT)of sacubitril valsartan(experimental group)compared to conventional drugs such as renin angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists(control group)for the treatment of HFmrEF were collected.After screening literature and extracting data,meta-analysis was conducted using Stata 15.0 and Rev Man 5.3 software,and bias and sensitivity analyses were published in parallel.Results:A total of 13 RCTs were included,with a total of 1 150 patients.The meta-analysis results showed that all-cause mortality risk of patients(RR=0.63,95%CI:0.45-0.86,P=0.004),and the risk of elevated blood creatinine(RR=0.65,95%CI:0.50-0.84,P=0.001)in the experimental group were significantly lower than those in the control group.The level of six-minute walk test post therapy was significantly higher in the experimental group patients than that in the control group(weighted mean differences[WMD]=66.33 m,95%CI:11.77-120.90,P=0.02).There was no statistically significant difference in the comparison on the readmission rate of heart failure(RR=0.87,95%CI:0.61-1.24,P=0.43),NT-proBNP levels(WMD=319.67 pg/ml,95%CI:-823.36 to 1 462.70,P=0.58),soluble suppression of tumorigenicity 2(sST2)levels(WMD=4.48 μg/L,95%CI:-0.58 to 9.54,P=0.08),incidence of hypotension(RR=1.03,95%CI:0.61-1.76,P=0.90),and incidence of hyperkalemia(RR=0.95,95%CI:0.67-1.33,P=0.75)between the two groups of patients after treatment.The results of publication bias and sensitivity analysis both indicated a high possibility of publication bias,and some indicators had unstable results.Conclusions:Sacubitril valsartan may effectively reduce all-cause mortality,and the risk of elevated blood creatinine in HFmrEF patients,improving their long-term prognosis.However,the incidence of hypotension and hyperkalemia remains unclear.

Objective:To investigate the relationship between gut microbiota characteristics and inflammatory factors with immune recovery in HIV-infected individuals，and to explore the role and clinical significance of gut microbiota in HIV immune recovery.Methods:Sixty HIV-infected individuals and twenty healthy controls（HC）were enrolled. Among them，twenty ones were HIV-infected individuals who had not received antiretroviral therapy（ART），and forty ones were HIV-infected individuals who had received ART for more than two years，including twenty immune responders（IR）and twenty immune non-responders（INR）. Fecal and blood samples were collected from participants. The gut microbiota in fecal samples was analyzed using 16 S rRNA sequencing，while plasma inflammatory factors were detected using Olink proteomics. The correlations between these factors and CD4 + T cell counts，CD4/CD8 ratios，as well as HIV DNA and HIV RNA were analyzed. Results:Compared with the HC group，gut microbiota α diversity in HIV-infected group was reduced，and the microbiota composition changed，with decreased abundance of Firmicutes and related genera，while the abundance of Bacteroidetes and Proteobacteria related genera increased. Compared with the IR group，the INR group showed increased abundance of the Bacteroidetes phylum and decreased abundance of the Firmicutes phylum. LEfSe analysis revealed enrichment of the Flavonifractor genus in the INR group and the Allisonella genus in the IR group. Flavonifractor was positively correlated with HIV DNA and HIV RNA ；Allisonella was positively correlated with CD4? T cell counts and negatively correlated with IL-6，CD8A，and TNF-α expression；and pro-inflammatory factors were positively correlated with the HIV viral reservoir. Conclusions:Reduced gut microbiota diversity and altered composition，as well as increased pro-inflammatory factors，are closely associated with immune recovery and disease progression in HIV-infected individuals.

Objective:To investigate the relationship between gut microbiota characteristics and inflammatory factors with immune recovery in HIV-infected individuals，and to explore the role and clinical significance of gut microbiota in HIV immune recovery.Methods:Sixty HIV-infected individuals and twenty healthy controls（HC）were enrolled. Among them，twenty ones were HIV-infected individuals who had not received antiretroviral therapy（ART），and forty ones were HIV-infected individuals who had received ART for more than two years，including twenty immune responders（IR）and twenty immune non-responders（INR）. Fecal and blood samples were collected from participants. The gut microbiota in fecal samples was analyzed using 16 S rRNA sequencing，while plasma inflammatory factors were detected using Olink proteomics. The correlations between these factors and CD4 + T cell counts，CD4/CD8 ratios，as well as HIV DNA and HIV RNA were analyzed. Results:Compared with the HC group，gut microbiota α diversity in HIV-infected group was reduced，and the microbiota composition changed，with decreased abundance of Firmicutes and related genera，while the abundance of Bacteroidetes and Proteobacteria related genera increased. Compared with the IR group，the INR group showed increased abundance of the Bacteroidetes phylum and decreased abundance of the Firmicutes phylum. LEfSe analysis revealed enrichment of the Flavonifractor genus in the INR group and the Allisonella genus in the IR group. Flavonifractor was positively correlated with HIV DNA and HIV RNA ；Allisonella was positively correlated with CD4? T cell counts and negatively correlated with IL-6，CD8A，and TNF-α expression；and pro-inflammatory factors were positively correlated with the HIV viral reservoir. Conclusions:Reduced gut microbiota diversity and altered composition，as well as increased pro-inflammatory factors，are closely associated with immune recovery and disease progression in HIV-infected individuals.

Objective:To investigate the effects of CO2 intracavitary laser combined with pelvic floor magnetic stimulation on surface electromyography(sEMG)values and pelvic floor three-dimensional ultrasound parameters in female patients with stress urinary incontinence(SUI).Methods:A prospective study was conducted on 92 female SUI patients treated at the outpatient department of Meizhou People's Hospital from October 2021 to July 2023.The patients were randomly divided into an observation group and a control group(n=46 each)using a random number table.Both groups received home-based pelvic floor muscle training.The control group additionally received pelvic floor magnetic stimulation,while the observation group was treated with CO2 intracavitary laser combined with pelvic floor magnetic stimulation.The urinary leakage status,treatment efficacy,pelvic floor muscle sEMG,pelvic floor three-dimensional ultrasound parameters,quality of life,and sexual quality of life were compared between the two groups.Assessments included the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF),the Incontinence Impact Questionnaire-Short Form(IIQ-7),and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12).Results:1-hour leakage volume:0 g(observation group)vs.3 g(control group),24-hour leakage episodes:0 times(observation group)vs.0 times(control group),the observed differences were statistically significant(Z=-2.866,-2.355,P<0.05).Total effective rate:95.65%(observation)vs.58.70%(control),the observed differences were statistically significant(x2=4.083,P<0.05).Pelvic floor muscle sEMG(after treatment):Maximal fast contraction:(40.78±3.28)μV(observation)vs.(35.17±5.10)μV(control),Mean tonic contraction:(31.56±4.20)μV(observation)vs.(25.87±3.82)μV(control),Mean endurance contraction:(29.34±2.58)μV(observation)vs.(25.37±2.67)μV(control),all differences between the two groups were statistically significant(t=2.736,19.919,3.025,15.426,P<0.05).After treatment,both groups showed reductions in bladder neck descent(BND)during Valsalva maneuver,bladder-symphysis distance(BSD),urethral rotation angle(URA),and posterior vesicourethral angle(RVA).However,the observation group demonstrated significantly greater reductions compared to the control group(post-treatment data:observation group(24.30±3.21)mm,(2.34±0.23)mm,(56.40±5.87)°,(89.54±9.21)°;control group(26.21±3.48)mm,(3.57±0.35)mm,(60.29±6.45)°,(126.71±13.50)°.These differences were statistically significant(t=2.736,19.919,3.025,15.426,P<0.05).Similarly,both groups exhibited decreased scores on the ICIQ-SF and IIQ-7 scales,along with increased scores on the PISQ-12.Again,the observation group showed superior improvement,with statistically significant differences(t=11.478,13.168,6.631,P<0.05).Conclusion:On the basis of pelvic floor muscle training,CO2 intracavitary laser therapy combined with pelvic floor magnetic stimulation can effectively alleviate urinary incontinence symptoms in patients with female stress urinary incontinence(FSUI),enhance therapeutic efficacy,improve pelvic floor muscle strength and the stability of pelvic support structures,and promote quality of life and sexual function.

Objectives:To systematically evaluate the effectiveness and safety of sacubitril valsartan in the treatment of heart failure with mildly reduced ejection fraction(HFmrEF).Methods:Computer searches were conducted on PubMed,Embase,China National Knowledge Infrastructure(CNKI),VIP,and Wanfang Data,all from the time of database establishment until December 31,2023.Randomized controlled trials(RCT)of sacubitril valsartan(experimental group)compared to conventional drugs such as renin angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists(control group)for the treatment of HFmrEF were collected.After screening literature and extracting data,meta-analysis was conducted using Stata 15.0 and Rev Man 5.3 software,and bias and sensitivity analyses were published in parallel.Results:A total of 13 RCTs were included,with a total of 1 150 patients.The meta-analysis results showed that all-cause mortality risk of patients(RR=0.63,95%CI:0.45-0.86,P=0.004),and the risk of elevated blood creatinine(RR=0.65,95%CI:0.50-0.84,P=0.001)in the experimental group were significantly lower than those in the control group.The level of six-minute walk test post therapy was significantly higher in the experimental group patients than that in the control group(weighted mean differences[WMD]=66.33 m,95%CI:11.77-120.90,P=0.02).There was no statistically significant difference in the comparison on the readmission rate of heart failure(RR=0.87,95%CI:0.61-1.24,P=0.43),NT-proBNP levels(WMD=319.67 pg/ml,95%CI:-823.36 to 1 462.70,P=0.58),soluble suppression of tumorigenicity 2(sST2)levels(WMD=4.48 μg/L,95%CI:-0.58 to 9.54,P=0.08),incidence of hypotension(RR=1.03,95%CI:0.61-1.76,P=0.90),and incidence of hyperkalemia(RR=0.95,95%CI:0.67-1.33,P=0.75)between the two groups of patients after treatment.The results of publication bias and sensitivity analysis both indicated a high possibility of publication bias,and some indicators had unstable results.Conclusions:Sacubitril valsartan may effectively reduce all-cause mortality,and the risk of elevated blood creatinine in HFmrEF patients,improving their long-term prognosis.However,the incidence of hypotension and hyperkalemia remains unclear.

Objective:To investigate the effects of CO2 intracavitary laser combined with pelvic floor magnetic stimulation on surface electromyography(sEMG)values and pelvic floor three-dimensional ultrasound parameters in female patients with stress urinary incontinence(SUI).Methods:A prospective study was conducted on 92 female SUI patients treated at the outpatient department of Meizhou People's Hospital from October 2021 to July 2023.The patients were randomly divided into an observation group and a control group(n=46 each)using a random number table.Both groups received home-based pelvic floor muscle training.The control group additionally received pelvic floor magnetic stimulation,while the observation group was treated with CO2 intracavitary laser combined with pelvic floor magnetic stimulation.The urinary leakage status,treatment efficacy,pelvic floor muscle sEMG,pelvic floor three-dimensional ultrasound parameters,quality of life,and sexual quality of life were compared between the two groups.Assessments included the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF),the Incontinence Impact Questionnaire-Short Form(IIQ-7),and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12).Results:1-hour leakage volume:0 g(observation group)vs.3 g(control group),24-hour leakage episodes:0 times(observation group)vs.0 times(control group),the observed differences were statistically significant(Z=-2.866,-2.355,P<0.05).Total effective rate:95.65%(observation)vs.58.70%(control),the observed differences were statistically significant(x2=4.083,P<0.05).Pelvic floor muscle sEMG(after treatment):Maximal fast contraction:(40.78±3.28)μV(observation)vs.(35.17±5.10)μV(control),Mean tonic contraction:(31.56±4.20)μV(observation)vs.(25.87±3.82)μV(control),Mean endurance contraction:(29.34±2.58)μV(observation)vs.(25.37±2.67)μV(control),all differences between the two groups were statistically significant(t=2.736,19.919,3.025,15.426,P<0.05).After treatment,both groups showed reductions in bladder neck descent(BND)during Valsalva maneuver,bladder-symphysis distance(BSD),urethral rotation angle(URA),and posterior vesicourethral angle(RVA).However,the observation group demonstrated significantly greater reductions compared to the control group(post-treatment data:observation group(24.30±3.21)mm,(2.34±0.23)mm,(56.40±5.87)°,(89.54±9.21)°;control group(26.21±3.48)mm,(3.57±0.35)mm,(60.29±6.45)°,(126.71±13.50)°.These differences were statistically significant(t=2.736,19.919,3.025,15.426,P<0.05).Similarly,both groups exhibited decreased scores on the ICIQ-SF and IIQ-7 scales,along with increased scores on the PISQ-12.Again,the observation group showed superior improvement,with statistically significant differences(t=11.478,13.168,6.631,P<0.05).Conclusion:On the basis of pelvic floor muscle training,CO2 intracavitary laser therapy combined with pelvic floor magnetic stimulation can effectively alleviate urinary incontinence symptoms in patients with female stress urinary incontinence(FSUI),enhance therapeutic efficacy,improve pelvic floor muscle strength and the stability of pelvic support structures,and promote quality of life and sexual function.

The long-term efficacy and complications of implantable diaphragm pacer (IDP) in a child with cervical spinal cord injury (CSCI) in the Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center in September 2022 were retrospective analyzed.A male child had quadriplegia without an obvious cause at the age of 12 years, and he was then lived completely with the assistance of mechanical ventilation.At the age of 14 years, he could wean off the ventilator in unilateral diaphragmatic pacing mode.However, mechanical ventilation was re-given for months after 5 years due to pneumonia, and then the IDP was re-given with the self-felt decreased pacing effect.After hospitalization, the patient was examined with mild diaphragmatic atrophy, secondary flat chest, and mild scoliosis.After optimization of the transdiaphragmatic pacing threshold and rehabilitation, his respiratory function improved.IDP can be used in CSCI for long time, while flat chest and scoliosis that limited the expansion of the lungs should be considered.At the meantime, the increased abdominal spasm affected the abdominal compliance, leading to the decrease in the efficiency of the diaphragm.

Background Currently,the diagnosis of depressive disorder relies on symptomatology,which is greatly influenced by subjective factors such as clinicians' experience.Finding more accurate and reliable quantitative diagnostic methods is currently an urgent problem.Objective To explore the value of Fisher discriminant function based on inflammatory cytokines in the diagnosis of depressive disorder,so as to provide references for clinical diagnosis.Methods A total of 136 patients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria,who underwent inpatient treatment at Hebei Mental Health Center from April 2020 to November 2020,were enrolled as study group.67 healthy participants matched for age and gender,was recruited during the same period.Serum levels of inflammatory cytokine were measured using enzyme-linked immunosorbent assay(ELISA).Fisher discriminant model was employed to establish a discriminant function for inflammatory cytokines exhibiting significant statistical differences between study group and control group,which was then validated.Results The levels of pro-inflammatory cytokines interleukin-1β(IL-1β),interleukin-6(IL-6),interferon-γ(INF-γ)and tumor necrosis factor-α(TNF-α)were higher in the study group compared with control group,with statistically significant differences(U=9.115,5.239,4.431,5.428,P<0.01).Conversely,the levels of anti-inflammatory cytokines interleukin-4(IL-4),interleukin-10(IL-10)and interleukin-13(IL-13)were lower in the study group compared with control group,with statistically significant differences(U=7.398,7.331,7.614,P<0.01).The retrospective test in Fisher discriminant function achieved a correct discrimination rate of 89.66%,and the cross validation achieved a correct discrimination rate of 88.67%.Conclusion The Fisher discriminant function developed in this study may serve as a valuable auxiliary method in the diagnosis of depressive disorder.

Integrase inhibitors (INSTIs) are the newest class of antiretroviral drug which are available to people living with the human immunodeficiency virus (HIV). Since 2007, five types of INSTIs have been marketed: Raltegravir, Elvitegravir, Dolutegravir, Bictegravir and Cabotegravir, all of which were approved by the US Food and Drug Administration (FDA) for use in the initiation of antiretroviral therapy (ART) in treatment-na?ve individuals. Compared with other types of antiretroviral drugs, INSTIs have better efficacy and tolerability, so many countries around the world have listed INSTIs-containing regimens as the preferred regimen for HIV ART. In recent years, with the widespread use of INSTIs, some research data suggest that INSTIs may have some adverse effects (AEs), such as central nervous system symptoms, abnormal lipid metabolism, weight gain, abnormal liver and kidney function, etc. This review summarizes the current use of INSTIs in people living with the HIV, and highlights the clinical efficacy and their AEs among the five types of INSTIs in China.

Objective:To investigate the short-term efficacy and safety of cardiac contractility modulation (CCM) in patients with heart failure.Methods:This was a cross-sectional study of patients with heart failure who underwent CCM placement at the First Affiliated Hospital of Xinjiang Medical University from February to June 2022. With a follow-up of 3 months, CCM sensation, impedance, percent output, and work time were monitored, and patients were compared with pre-and 3-month postoperative left ventricular ejection fraction (LVEF) values, and 6-minute walk test distance and New York Heart Association (NYHA) cardiac function classification, and the occurrence of complications was recorded.Results:CCM was successfully implanted in all 9 patients. Seven(7/9) of them were male, aged (56±14) years, 3 patients had ischaemic cardiomyopathy and 6 patients had dilated cardiomyopathy. At 3-month postoperative follow-up, threshold was stable, sense was significantly lower at follow-up than before (right ventricle: (16.3±7.0) mV vs. (8.2±1.1) mV, P<0.05; local sense: (15.7±4.9) mV vs. (6.7±2.5) mV, P<0.05), and impedance was significantly lower at follow-up than before (right ventricle (846±179) Ω vs. (470±65) Ω, P<0.05, local sense: (832±246) Ω vs. (464±63) Ω, P<0.05). The CCM output percentage was (86.9±10.7) %, the output amplitude was (6.7±0.4) V, and the daily operating time was (8.6±1.0) h. LVEF was elevated compared to preoperative ((29.4±5.2) % vs. (38.3±4.3) %, P<0.05), the 6-minute walk test was significantly longer than before ((96.8±66.7)m vs. (289.3±121.7)m, P<0.05). No significant increase in the number of NYHA Class Ⅲ-Ⅳ patients was seen (7/9 vs. 2/9, P>0.05). The patient was not re-hospitalised for worsening heart failure symptoms, had no malignant arrhythmic events and experienced significant relief of symptoms such as chest tightness and shortness of breath. No postoperative complications related to pocket hematoma, pocket infection and rupture, electrode detachment, valve function impairment, pericardial effusion, or cardiac perforation were found. Conclusions:CCM has better short-term safety and efficacy in patients with heart failure.