ObjectiveTo investigate the potential differences in cardiac lesions between the patients with viral， alcoholic or biliary cirrhosis. MethodsA retrospective analysis was performed for the clinical data of 512 patients who were hospitalized in Hunan Provincial People’s Hospital due to liver cirrhosis from January 2020 to December 2023， and according to the etiology， the patients were divided into viral cirrhosis group with 275 patients， alcoholic cirrhosis group with 70 patients， and biliary cirrhosis group with 167 patients. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test or the Tamhane’s T2 test was used based on homogeneity of variance for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the chi-square test was used for comparison of categorical data between groups. ResultsThere was a significant difference in sex distribution between the three groups， and the male patients accounted for 71.3% in the viral cirrhosis group and 95.7% in the alcoholic cirrhosis group， while the female patients accounted for 64.7% in the biliary cirrhosis group. The biliary cirrhosis group had an age of 61.67±9.59 years， which was significantly higher than that in the other two groups （P<0.05）. Compared with the viral cirrhosis group and the biliary cirrhosis group， the alcoholic cirrhosis group had significantly higher Child-Pugh score （H=30.598， P<0.05）， globulin （H=13.350， P<0.05）， and QTc interval （F=9.956， P<0.05） and significantly lower hemoglobin （F=4.529， P<0.05）， prothrombin activity （F=36.293， P<0.05）， and albumin （F=15.744， P<0.05）. There were no significant differences in each echocardiography parameter between the viral cirrhosis group and the alcoholic cirrhosis group （P>0.05）； compared with the biliary cirrhosis group， the viral cirrhosis group and the alcoholic cirrhosis group had significantly larger left atrial anterior-posterior diameter （H=19.197， P<0.05）， left ventricular end-diastolic diameter （LVEDD） （H=15.660， P<0.05）， right atrial transverse diameter （H=22.854， P<0.05）， mid-right ventricular transverse diameter （H=10.936， P<0.05）， interventricular septal thickness in diastole （IVSd） （H=13.539， P<0.05）， and left ventricular posterior wall thickness in diastole （LVPWd） （H=14.139， P<0.05）； compared with the biliary cirrhosis group， the viral cirrhosis group had a significantly higher mitral ratio of peak early to late diastolic filling velocity （E/A） （P<0.05）. Left ventricular diastolic dysfunction was observed in 170 patients （61.8%） in the viral cirrhosis group， 45 patients （64.3%） in the alcoholic cirrhosis group， and 125 patients （74.9%） in the biliary cirrhosis group， with a significant difference between the three groups （χ²=8.074， P=0.018）. The patients were divided into grade A， B， and C groups based on Child-Pugh score， and comparisons of echocardiography findings between the three groups showed no significant differences in LVEDD， IVSd， LVPWd， E/A， and left ventricular ejection fraction （all P>0.05）. ConclusionThere are differences in cardiac structure and function between patients with different etiologies of liver cirrhosis， and in clinical practice， individualized cardiac assessment and intervention should be performed based on different etiologies.

ObjectiveTo investigate the characteristics of cardiac structure and function in patients with liver cirrhosis and the correlation of cardiac ultrasound parameters and cardiac function parameters with esophageal varices （EV）， and to provide a theoretical basis for identifying high-risk patients in the early stage， optimizing clinical management， and improving prognosis. MethodsA retrospective analysis was performed for the clinical data of 359 patients who were hospitalized in Hunan Provincial People’s Hospital and were diagnosed with liver cirrhosis from January 2020 to December 2023， among whom there were 176 patients in the non-EV group and 183 patients in the EV group. The two groups were compared in terms of general data， laboratory test results， and examination findings， and the characteristics of cardiac lesions were analyzed for liver cirrhosis patients with EV. The independent samples t-test was used for comparison between the two groups， a one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test or the Tamhane’s T2 test was used for further comparison between two groups based on homogeneity of variance； The Mann-Whitney U test was used for comparison between the two groups， the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the chi-square test was used for comparison of categorical data between groups； the Spearman’s rank correlation coefficient was used for correlation analysis. ResultsThere were no significant differences in sex and age between the two groups （all P >0.05）. Compared with the non-EV group， the EV group had significantly lower levels of red blood cell， hemoglobin， platelet， prothrombin activity， albumin， and albumin/globulin ratio （all P<0.05） and significantly higher values of total bilirubin， total bile acid， cardiac creatine kinase， fibrosis-4 index， LOK index， aspartate aminotransferase-to-platelet ratio index， and aspartate aminotransferase-to-alanine aminotransferase ratio （all P <0.001）. For the non-EV group， 58.0% of the patients had Child-Pugh class A disease， while in the EV group， 48.1% of the patients had Child-Pugh class B disease. Compared with the non-EV group， the EV group had significantly greater left atrial anterior-posterior diameter （LA-ap）， left ventricular end-diastolic diameter （LVEDD）， right atrial transverse diameter （RA-t）， early diastolic filling velocity at the mitral valve orifice （E）， early diastolic filling velocity/late diastolic filling velocity （E/A） ratio， peak systolic velocity of pulmonary valve （PV）， peak systolic velocity of aortic valve （AV）， and QTc interval （all P<0.05）. The Spearman correlation analysis showed that LA-ap， LVEDD， RA-t， E， E/A， PV， AV and QTc interval were positively correlated with EV （all P<0.05）， among which LA-ap， E， and PV had an r-value of 0.297， 0.223， and 0.311， respectively. Comparison of the patients with different Child-Pugh classes showed that compared with the Child-Pugh class B and C groups， the Child-Pugh class A group had significantly smaller LA-ap， mid-right ventricular transverse diameter， E， PV， AV， HR， and QTc interval （all P<0.05）； compared with the Child-Pugh class B group， the Child-Pugh class A group had significantly lower values of LVEDD， RA-t， and E/A ratio （all P<0.05）； there were significant differences in A and PV between the Child-Pugh class B group and the Child-Pugh class C group （all P<0.05）. ConclusionLiver cirrhosis patients with EV have significant cardiac lesions， and routine echocardiography should be performed to assess cardiac function.

Objective To explore the changes in trace elements and amino acid profiles in serum of patients with hepatocellular carcinoma(HCC) providing a reference for clinical diagnosis and treatment.Methods A total of 104 patients with HCC who underwent surgical treatment in the Department of Hepatobiliary Surgery of our hospital from January 2024 to April 2024 were selected as the study group, and 139 patients with benign biliary diseases during the same period were selected as the control group. Atomic absorption spectrometry was used to detect the levels of six trace elements (copper, zinc, calcium, magnesium, iron, and lead) in the serum of both groups, and liquid chromatography-tandem mass spectrometry was used to measure the concentrations of 21 amino acids.Results Compared with the control group, the serum copper level in the HCC group was significantly increased (P<0.05), while the levels of zinc and iron were significantly decreased (P<0.05). Amino acid profile analysis revealed that, compared with the control group, the concentrations of tyrosine, methionine, and phenylalanine in the HCC group were increased (P<0.05), while the concentrations of valine, leucine, isoleucine, glutamine, and arginine were decreased (P<0.05). Further analysis of the correlation between trace elements and amino acids with statistical differences between the groups showed that copper was negatively correlated with valine and leucine (P<0.05), while zinc and iron were positively correlated with valine, leucine, and isoleucine (P<0.01).Conclusions Imbalances in trace elements and amino acid metabolism changes are common in patients with HCC, and there may be an intrinsic connection between the two.

ObjectiveTo investigate the effects of the combination of components from Tripterygii Radix et Rhizoma and Chuanxiong Rhizoma on rheumatoid arthritis fibroblast-like synoviocytes （RA-FLSs） and the underlying mechanism. MethodsRA-FLSs were grouped as follows： blank control， positive control （methotrexate）， Tripterygii Radix et Rhizoma components， Chuanxiong Rhizoma components， and components from Tripterygii Radix et Rhizoma+Chuanxiong Rhizoma. The cell-counting kit-8 （CCK-8） assay was employed to the cell proliferation， invasion， and apoptosis. The levels of tumor necrosis factor （TNF）-α， interleukin （IL）-6， reactive oxygen species （ROS）， and malondiadehyde （MDA） in cells were measured. Western blot was employed to determine the protein levels of nuclear factor erythroid 2-related factor 2 （Nrf2）， heme oxygenase-1 （HO-1）， nuclear factor-kappa B （NF-κB） p65， phosphorylated inhibitory subunit of NF-κBα （p-IκBα）， cysteinyl aspartate-specific protease-3 （Caspase-3）， and B-cell lymphoma 2 （Bcl-2）. Real-time PCR was employed to determine the mRNA levels of Nrf2， HO-1， and NF-κB p65. ResultsThe cells in the groups of positive control， Tripterygii Radix et Rhizoma components， Chuanxiong Rhizoma components， and components from Tripterygii Radix et Rhizoma+Chuanxiong Rhizoma were treated with 2.50 mg·L^-1 methotrexate， 0.20 mg·L^-1 triptolide + 0.20 mg·L^-1 celastrol， 5.00 mg·L^-1 ferulic acid + 20.00 mg·L^-1 ligustrazine， 0.20 mg·L^-1 triptolide + 0.20 mg·L^-1 celastrol + 5.00 mg·L^-1 ferulic acid + 20.00 mg·L^-1 ligustrazine， respectively. Compared with the blank control group， drug administration reduced the proliferation and invasion and increased the apoptosis of cells （P<0.01）， lowered the levels of TNF-α， IL-6， ROS， and MDA （P<0.01）， up-regulated the mRNA and protein levels of Caspase-3， Nrf2， and HO-1 （P<0.01）， and down-regulated the mRNA and protein levels of Bcl-2， NF-κB p65， and p-IκBα （P<0.01）. Compared with the Tripterygii Radix et Rhizoma components group， the combination of components from Tripterygii Radix et Rhizoma+Chuanxiong Rhizoma inhibited the proliferation and invasion （P<0.05） and promoted the apoptosis of RA-FLSs， up-regulated the mRNA levels of Nrf2 and HO-1 and protein levels of Nrf2 and Caspase-3 （P<0.05）， and down-regulated the protein levels of NF-κB p65 and p-IκBα （P<0.05）. ConclusionThe combination of components from Chuanxiong Rhizoma and Tripterygii Radix et Rhizoma can inhibit the proliferation and invasion and promote the apoptosis of RA-FLSs and alleviate oxidative stress and inflammation by inhibiting the NF-κB signaling pathway， activating the Nrf2/HO-1 pathway， and regulating the expression of Bcl-2/Caspase-3.

BACKGROUND: In the interim analysis of MONARCH plus, adding abemaciclib to endocrine therapy (ET) improved progression-free survival (PFS) and objective response rate (ORR) in predominantly Chinese postmenopausal women with HR+/HER2- advanced breast cancer (ABC). This study presents the final pre-planned PFS analysis. METHODS: In the phase III MONARCH plus study, postmenopausal women in China, India, Brazil, and South Africa with HR+/HER2- ABC without prior systemic therapy in an advanced setting (cohort A) or progression on prior ET (cohort B) were randomized (2:1) to abemaciclib (150 mg twice daily [BID]) or placebo plus: anastrozole (1.0 mg/day) or letrozole (2.5 mg/day) (cohort A) or fulvestrant (500 mg on days 1 and 15 of cycle 1 and then on day 1 of each subsequent cycle) (cohort B). The primary endpoint was PFS of cohort A. Secondary endpoints included cohort B PFS (key secondary endpoint), ORR, overall survival (OS), safety, and health-related quality of life (HRQoL). RESULTS: In cohort A (abemaciclib: n  = 207; placebo: n  = 99), abemaciclib plus a non-steroidal aromatase inhibitor improved median PFS vs . placebo (28.27 months vs . 14.73 months, hazard ratio [HR]: 0.476; 95% confidence interval [95% CI]: 0.348-0.649). In cohort B (abemaciclib: n  = 104; placebo: n  = 53), abemaciclib plus fulvestrant improved median PFS vs . placebo (11.41 months vs . 5.59 months, HR: 0.480; 95% CI: 0.322-0.715). Abemaciclib numerically improved ORR. Although immature, a trend toward OS benefit with abemaciclib was observed (cohort A: HR: 0.893, 95% CI: 0.553-1.443; cohort B: HR: 0.512, 95% CI: 0.281-0.931). The most frequent grade ≥3 adverse events in the abemaciclib arms were neutropenia, leukopenia, anemia (both cohorts), and lymphocytopenia (cohort B). Abemaciclib did not cause clinically meaningful changes in patient-reported global health, functioning, or most symptoms vs . placebo. CONCLUSIONS: Abemaciclib plus ET led to improvements in PFS and ORR, a manageable safety profile, and sustained HRQoL, providing clinical benefit without a high toxicity burden or reduced quality of life. TRIAL REGISTRATION ClinicalTrials.gov (NCT02763566).
Humans ; Female ; Fulvestrant/therapeutic use* ; Breast Neoplasms/metabolism* ; Aminopyridines/therapeutic use* ; Benzimidazoles/therapeutic use* ; Middle Aged ; Aromatase Inhibitors/therapeutic use* ; Aged ; Receptor, ErbB-2/metabolism* ; Adult ; Letrozole/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Anastrozole/therapeutic use*

ObjectiveTo describe different non-alcoholic fatty liver disease （NAFLD） outcomes among community inhabitants， and further to explore the correlation between bio-indicator level variance and the outcomes. MethodsPhysical indicators （height， weight， waist circumstances， hip circumstances， blood pressure， etc）， biochemical indicators ［fasting plasma glucose， HbA1c， serum triglycerides（TG）， serum total cholesterol（TC）， low-density lipoprotein cholesterol（LDL-C）， high-density lipoprotein cholesterol（HDL-C）， liver related transaminase， etc］ and clinical imaging （B-scan ultrasonography） were collected during the follow-up from the Songjiang Natural Population Sub-cohort. The identification of NAFLD was supported by the definition criteria from Guidelines for the diagnosis and treatment of non⁃alcoholic fatty liver disease. Paired t-test and multifactorial logistic regression model were used to compare the difference between the indicator level of the subjects from different outcome subgroups and to further analyze the correlation between these indicator variance and different NAFLD outcomes. ResultsDuring a median follow-up time of 2.94 years， 12 076 subjects were involved. The cumulative NAFLD incidence and remission rate were 21.57% and 31.15%， respectively. The proportion of subjects who still had NAFLD was 27.96%. Among subjects with newly-developed NAFLD， indicators including blood pressure， BMI， fasting plasma glucose， and plasma lipid level increased， while in the remission subgroup， blood pressure， BMI（WHR）， waist-hip ratio（WHR）， and TG level were significantly decreased. Increased level of systolic pressure， WHR， BMI， HbA1c， and LDL-C might be the risk factors to the occurrence of NAFLD. While decreased level of WHR， BMI， TC and LDL-C level and elevated HDL-C level were likely to be the influencing factors of NAFLD remission process. ConclusionThe NAFLD morbidity in the community inhabitants is relatively high. BMI， WHR， fasting plasma sugar and plama lipid level variance may act as the influencing factors towards different NAFLD outcomes.

Objective This paper aims to address the challenges of hospital equipment management by implementing the life cycle management system in the medical laboratories of public hospitals.Methods Based on the three principles of standard-ization,refinement,and dynamism,this paper conducted data tracking and managed equipment analysis with specifications dur-ing the processes of planning,discussion,procurement,acceptance,operation,maintenance,performance evaluation,scrap-ping,and updating.Results After implementing life cycle management,the average risk level significantly decreased compared to pre-implementation(P＜0.05).Budget implementation efficiency increased by 14.53％from 2019 to 2023.The investment payback period was controlled within 2 years.Conclusion The application of the life cycle management system to equipment management in medical laboratories of public hospitals is of great significance for the high-quality development of hospitals.

Stroke is the second leading cause of death in the world and the first cause of adult death and disability in China.Post-stroke depression(PSD)is one of the most common and serious complications of stroke,affecting about one-third of stroke patients and seriously affecting the rehabilitation process of patients returning to social life.At present,oral psychotropic drugs and psychotherapy are commonly used in clinical treatment of PSD,but because of their safety and economy,the clinical effect is often not ideal.As a safe and effective treatment,physical therapy has been widely used in clinical practice.This article reviews transcranial magnetic stimulation and other physical therapy,in order to provide reference for clinical treatment of PSD and future research development.

Objective To explore the clinical efficacy and safety of azithromycin sequential therapy combined with risk management in the treatment of mycoplasmal pneumonia pneumonia(MPP)in children.Methods MPP children admitted to the Department of Pediatrics of Quzhou People's Hospital from March 2023 to November 2023 were retrospectively selected,and divided into a study group(azithromycin sequential therapy combined with risk management)and a control group(azithromycin sequential therapy combined with routine care)according to different intervention methods.The clinical efficacy,inflammatory cytokines[interleukin-6(IL-6),interleukin-17(IL-17),and tumor necrosis factor-α(TNF-α)],incidence of MPP-related complications,and incidence of drug-related adverse reactions(DRAR)in the two groups after treatment were observed and compared.Results A total of 119 children with MPP were included in the study,with 57 in the study group and 62 in the control group.The clinical efficacy of children with MPP in the study group was significantly higher than that in the control group(P＜0.05).There was no significant difference in IL-6,IL-17,and TNF-α between the two groups before treatment(P＞0.05);after treatment,both groups showed significant decreases in IL-6,IL-17,and TNF-α compared with before treatment,and these indicators of the study group were lower than thsoe of the control group(P＜0.05).The incidence of MPP-related complications in children in the study group was lower than that in the control group(P＜0.05),and there was no significant difference in the incidence of adverse drug reactions between the two groups(P＞0.05).In addition,the satisfaction of MPP children's family members in the study group with nursing care was significantly higher than that in the control group(P＜0.05).Conclusion The clinical efficacy of azithromycin sequential therapy combined with risk management in the treatment of pediatric MPP is significant,which can regulate the expression of inflammatory cytokines,reduce MPP-related complications,and improve clinical efficacy and family satisfaction with nursing care.

Objective:To summarize the best evidence for the management of ovarian hyperstimulation syndrome in patients undergoing assisted reproductive therapy.Methods:Evidence related to the management of ovarian hyperstimulation syndrome in patients undergoing assisted reproductive therapy,including guidelines,clinical decision,best clinical practice,systematic evaluation,expert consensus and evidence summary and related original research were systematically searched in UpToDate,BMJ Best Practice,World Health Organization(WHO)website,Guidelines International Network(GIN),National Institute for Health and Clinical Excellence(NICE)website,National Guidelines website,American Society for Reproductive Medicine(ASRM)website,New York Academy of Sciences(NYAS)website,Joanna Briggs Institute(JBI)database,Cochrane Library,CINAHL,PubMed,Wanfang database,CNKI,and China Biomedical Literature Database from inception to May 31,2024.Two researchers independently evaluated the quality of the literature,and a senior researcher made the final decision for literature inclusion.Results:A total of 15 articles were included in the study.Following quality assessment,one article was excluded.The remaining 14 articles included 5 practice guidelines,3 systematic reviews,2 expert consensuses,1 evidence summary,and 3 from UpToDate.Ultimately,27 pieces of evidence were identified across five key aspects:risk assessment,disease monitoring,early prevention,institutional management and health education.Conclusion:The updated evidence indicates that the monitoring and prevention of ovarian hyperstimulation syndrome should start early,personalized treatment plans should be provided for patients,and the rational allocation of treatment resources needs to be promoted to enhance effective management of ovarian hyper-stimulation syndrome.