Objective To explore the risk factors of clopidogrel resistance in elderly patients with acute myocardial infarction(AMI)in order to provide personalized medication plans.Methods A prospective trial was conducted on 472 elderly AMI patients undergoing coronary stent placement in No.901 Hospital of Joint Logistics Support Force of PLA and Hangzhou Special Service Conva-lescent Center of Air Force from January 2018 to December 2022.All patients received clopidogrel for antiplatelet postoperatively,and after 7 consecutive days of administration,peripheral venous blood samples were collected to observe whether the patient had resistance to clopidogrel and to measure the concentration of active metabolites of clopidogrel and the maximum platelet aggrega-tion ratio(MARAA)of arachidonic acid induced platelets.According to MARAA,they were divid-ed into a clopidogrel resistant group(MARAA≥55％,142 cases)and a clopidogrel sensitive group of(＜55％,330 cases).The clinical characteristics were compared between the two groups,and multivariate logistic regression analysis was used to identify the risk factors for clopidogrel resistance.The impact of clopidogrel resistance on major adverse cardiovascular events was ana-lyzed.Results The clopidogrel resistant group had significantly higher MARAA level,decrease in the concentration of clopidogrel active metabolites,higher BMI,and larger ratios of obesity,CYP2C19*2 mutation,diabetes,hyperlipidemia and administration of hypoglycemic drugs when compared with the clopidogrel sensitive group(P＜0.01).Obesity,diabetes,hyperlipidemia and CYP2C19*2 mutation were risk factors for clopidogrel resistance in elderly AMI patients(OR=2.036,95％CI:1.282-3.235;OR=2.795,95％CI:1.803-4.334;OR=2.125,95％CI:1.355-3.331;OR=4.881,95％CI:2.807-8.486).The incidence of major adverse cardiovascular events was notably higher in the clopidogrel resistant group than the sensitive group(11.27％vs 4.55％,P＜0.01).After a prediction model was constructed with R4.0.3 statistical software,330 cases randomly selected from the dataset were assigned into a training set,and the remaining 142 cases into a validation set.The AUC value of the training set and the validation set was 0.750 and 0.780,respectively.Hosmer-Lemeshow Goodness of Fit test indicated that the model had good re-liability and predictive value(Chi-square=18.907,P=0.215).Conclusion Obesity,diabetes,hy-perlipidemia and CYP2C19*2 mutation are risk factors of clopidogrel resistance in elderly AMI patients,and clopidogrel resistance may lead to poor prognosis.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

Objective To explore the risk factors of clopidogrel resistance in elderly patients with acute myocardial infarction(AMI)in order to provide personalized medication plans.Methods A prospective trial was conducted on 472 elderly AMI patients undergoing coronary stent placement in No.901 Hospital of Joint Logistics Support Force of PLA and Hangzhou Special Service Conva-lescent Center of Air Force from January 2018 to December 2022.All patients received clopidogrel for antiplatelet postoperatively,and after 7 consecutive days of administration,peripheral venous blood samples were collected to observe whether the patient had resistance to clopidogrel and to measure the concentration of active metabolites of clopidogrel and the maximum platelet aggrega-tion ratio(MARAA)of arachidonic acid induced platelets.According to MARAA,they were divid-ed into a clopidogrel resistant group(MARAA≥55％,142 cases)and a clopidogrel sensitive group of(＜55％,330 cases).The clinical characteristics were compared between the two groups,and multivariate logistic regression analysis was used to identify the risk factors for clopidogrel resistance.The impact of clopidogrel resistance on major adverse cardiovascular events was ana-lyzed.Results The clopidogrel resistant group had significantly higher MARAA level,decrease in the concentration of clopidogrel active metabolites,higher BMI,and larger ratios of obesity,CYP2C19*2 mutation,diabetes,hyperlipidemia and administration of hypoglycemic drugs when compared with the clopidogrel sensitive group(P＜0.01).Obesity,diabetes,hyperlipidemia and CYP2C19*2 mutation were risk factors for clopidogrel resistance in elderly AMI patients(OR=2.036,95％CI:1.282-3.235;OR=2.795,95％CI:1.803-4.334;OR=2.125,95％CI:1.355-3.331;OR=4.881,95％CI:2.807-8.486).The incidence of major adverse cardiovascular events was notably higher in the clopidogrel resistant group than the sensitive group(11.27％vs 4.55％,P＜0.01).After a prediction model was constructed with R4.0.3 statistical software,330 cases randomly selected from the dataset were assigned into a training set,and the remaining 142 cases into a validation set.The AUC value of the training set and the validation set was 0.750 and 0.780,respectively.Hosmer-Lemeshow Goodness of Fit test indicated that the model had good re-liability and predictive value(Chi-square=18.907,P=0.215).Conclusion Obesity,diabetes,hy-perlipidemia and CYP2C19*2 mutation are risk factors of clopidogrel resistance in elderly AMI patients,and clopidogrel resistance may lead to poor prognosis.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

Methods: Preoperatively, all 115 patients underwent BMD assessments using both CT-derived HUs and dual-energy X-ray absorptiometry and were administered multiple questionnaires, including the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Index (BDI). Both pain intensity and pain-related disability were assessed before and after lumbar fusion surgery. Results: Postoperatively, 14 patients (14/115, 12.2%) experienced FBSS. Multivariate logistic regression was used to examine all preoperative covariates with significant differences between the patients with and without FBSS. The numeric rating pain scale score at rest, BAI score, PCS score, and HU value were found to be independently associated with FBSS (p<0.05). Conclusions This study revealed that preoperative BMD, as quantified by CT-derived HU values, may be associated with FBSS. Preoperative assessments of CT-derived HU values might provide additional details for identifying patients susceptible to FBSS, which could help prevent this complication.

Objective To investigate the clinical efficacy of our self-designed sight used to guide thoracic vertebroplasty.Methods A retrospective analysis was conducted of the 52 patients (70 thoracic vertebrae) who had undergone percutaneous vertebroplasty (PVP) (n =36)or percataneous kyphoplasty (PKP) (n =34) of T1-T4 vertebral bodies at Department of Orthopaedics,The First Affiliated Hospital to Zhengzhou University form August 2012 to October 2013.The operation time,intraoperative bleeding,intraoperative radiation by C-arm roentgenography,and visual analogue scale (VAS) were compared between the patients whose surgery had been guided by our self-designed sight and those whose surgery had been not.Results All the patients were followed up for 18 to 36 months (average,22.3 months).Compared with those who had not used the sight,the patients who had used the sight incurred significantly shorter operation time (16.5 ± 3.2 min versus 26.5 ± 3.7 min),significantly less intraoperative bleeding (2.8 ± 1.3 mL versus 6.3 ± 1.7 mL) and significantly less radiation by C-arm roentgenography (5.6 ± 3.3 times versus 9.4 ± 3.1 times) (P ＜0.05).The VAS scores at postoperative 3 days and final follow-up were significantly decreased than the preoperative values in all the patients (P ＜ 0.05).There were no significant differences between the patients who had used the sight and those who had not in the the VAS scores at postoperative 3 days or final follow-up (P ＞ 0.05).Conclusions The upper thoracic PVP or PKP guided by our self-designed sight has theadvantages of short operation time,less intraoperative bleeding and less frequency of C-arm radiation.The sight is suitable for various vertebroplasties.

Objective To observe the therapeutic effect of hoop circumference drug,Hongzhongxiao tincture,on the treatment of skin abscess in rats under the guidance of defended field theory.Methods Forty SpragueDawley (SD) rats were randomly divided into normal control group,model group,western medicine control group,Hongzhongxiao pretreatment group and Hongzhongxiao treatment group according to the computer generated random number.Subcutaneous abscesses models were reproduced by subcutaneous injection of 1 mL (3-5 × 109 cfu/mL) of staphylococcus aureus,and the normal control group was subcutaneously injected with the same amount of normal saline.After molding,the rats in the model group were treated with normal saline for change of dressing;the western medicine control group was treated with mupirocin ointment for external use;Hongzhongxiao pretreatment group was treated with 2 mL of Hongzhongxiao for dressing 4 hours after the modeling;in Hongzhongxiao treatment group,2 mL dressing was given after the emergence of hard swelling,and the Hongzhongxiao drug range applied was 1 cm over the swelling range.Each group was dressed once daily.The changes of mental state,body weight,skin temperature,range and time of abscess formation,wound ulceration and healing time,transcutaneous oxygen pressure (TcPO2) at the periphery of abscess were observed in each group.Results ① After modeling,the activity of the rats was decreased,the appetite became worse,and the food intake less.Except the normal control group,the rats in other groups had different degrees of mental listlessness.② After 3 days of treatment,the body weight gain of the model group was significantly lower than that of the normal control group (g:8.75 ± 9.85 vs.31.67 ± 7.92,P ＜ 0.01),and continued to 18 days after treatment (g:27.13± 11.70 vs.98.00 ± 8.94);after treatment for 18 days,the body weight gain in the western medicine control group,Hongzhongxiao pretreatment group and Hongzhongxiao treatment group was significantlyhigher than those of model group (g:53.28 ± 19.69,49.12 ± 7.23,44.71 ± 12.42 vs.27.13 ± 11.70,all P ＜ 0.05).③ After 3 days of treatment,the body temperature of the model group was obviously lower than that of the normal control group (℃:33.75 ± 0.68 vs.35.03 ± 0.41,P ＜ 0.01) and continued to 10 days (℃:34.30 ± 0.35 vs.35.03 ± 0.41,P ＜ 0.01).The body temperature of the rats in Hongzhongxiao pretreatment group was significantly lower than that in the normal control group,the model group and the western medicine control group on the 14th day after treatment (℃:33.97 ± 0.83 vs.35.10 ± 0.57,35.01 ± 0.68,35.25 ± 0.23,all P ＜ 0.05).The body temperature of Hongzhongxiao treatment group was significantly higher than that of the Hongzhongxiao pretreatment group (℃:34.87 ± 0.94 vs.33.97 ± 0.83,P ＜0.05).④ After treatment for 13,15,17 days,the contraction rates of swollen area in western medicine control group,hongzhongxiao pretreatment group and hongzhongxiao treatment group were greater than the rate in model group,and the change was most significant on the 17th day after treatment [(96.37 ± 5.09)％,(92.76 ± 13.56)％,(98.41 ± 3.85)％ vs.(77.46 ± 19.07)％,all P ＜ 0.05].⑤ Compared with the model group,the times of abscess localization in the western medicine control group,the Hongzhongxiao pretreatment group and the Hongzhongxiao treatment group was shorter than that in the model group (days:9.28 ± 1.38,7.33 ± 1.97,7.67 ± 1.63 vs.12.63 ± 1.99,all P ＜ 0.05);the time of wound healing in Hongzhongxiao pretreatment group aud Hongzhongxiao treatment group were significantly shorter than those of the model group (days:17.67 ± 1.03,16.83 ± 1.51 vs.19.92 ± 2.33,P ＜ 0.05).⑥ TcPO2 in the Hongzhongxiao pretreatment group was significantly higher than that in the model group on the 7th day after treatment [mmHg (1 mmHg =0.133 kPa):63.33 ± 9.77 vs.39.51 ± 8.42],and the Hongzhongxiao treatment group (44.25 ± 6.41) was significantly lower than that of the Hongzhongxiao pretreatment group,and the Hongzhongxiao treatment group was significantly higher than that of the model group (59.50 ± 7.34 vs.49.52 ± 10.17) on the 14th day after drug application,and the western medicine control group was significantly lower than that of the model group (37.71 ± 5.63 vs.54.33 ± 7.74),the Hongzhongxiao pretreatment group and Hongzhongxiao treatment group were significantly higher than those of the western medicine control group,the difference being statistically significant (all P ＜ 0.05).Conclusions The Hongzhongxiao tincture applied on top and circumferentially around the periphery of the abscess can reduce the local inflammatory response,improve the body weight and mental state,increase the blood supply around wound periphery for anti-infection and anti-inflammation in order to promote the formation of defending field of nursing.Although the early application of Hongzhongxiao tincture cannot reduce the local infectious symptoms and kill the Staphylococcus aureus,it can make skin abscess localization as soon as possible and shorten the wound healing time.

Objective To investigate the biological functions of IncRNA-BG on the radiosensitivity of normal human bronchial epithelial cell line Beas-2B.Methods Three IncRNA-BG siRNAs were designed,synthesized and traasfected into Beas-2B cells via lipofectamine.The RNA transcription level of BG was detected by quantitative real time-PCR to confirm the siRNA transfection efficiency.The experiment was divided into control group,control siRNA transfected group,and BG transfected group.Cell survival was detected by clonogenic assay,and the cell cycle distribution was determined by flow cytometry assay.The γ-H2AX foci formation after irradiation was visualized via immunofluorescence.Western blot assay was performed to detect the protein expressions of RAD50,p-P53,KU70,KU80,MDM2,CDK2 and RB.Results BG-siRNA transfection significantly reduced the BG transcription level (t =8.32-15.29,P ＜0.05) and increased cell survival after irradiation at 0.5,1,2,4 and 6 Gy.Analyzed with the multi-target model,the SERD0 of Beas-2B cells and control siRNA transfected cells were calculated to be 0.80 and 0.82,respectively.In addition,BG-siRNA transfection enhanced radiation-induced cell cycle arrest at G2 phase so that,after 4 Gy irradiation,the cells in G2 phase was increased from (37.37 ±0.63) ％ of control siRNA cells to (64.19 ± 1.01) ％ (t =30.65,P ＜ 0.05).Meanwhile,the γ-H2AX foci of BG-siRNA transfected cells was decreased from 76 ± 1.78 per 100 cells to 59-± 3.49 per 100 cells (t =13.72,P ＜0.05).The expressions of DNA damage related proteins including KU70,KUS0,CDK2 and RB were increased,but the expressions of p-P53 and RAD50 were decreased.Conclusions LncRNA-BG could regulate the radiosensitivity of the normal human bronchial epithelial cells,probably through inducing cell cycle G2 phase arrest and promoting DNA damage repair after irradiation.

Objective To observe the effect of Shengji corium elephatis mastic in treating chronic refractory skin ulcer, and analyze its preliminary mechanism. Methods Totally 62 patients with chronic refractory skin ulcer in granulation stage were randomly divided into two groups, 32 cases of treatment group were treated with Shengji corium elephatis mastic, and 30 cases of control group were treated with Vaseline gauze. All patients were treated for 4 weeks. The rate of wound healing, wound reduction ratio and wound secretion level of VEGF were observed. Results The cure rate and the total effective rate between the two groups had significant difference (P<0.05). After 2 weeks treatment, the mean wound reduction area of treatment group and control group was 82.31%and 66.32%respectively. After 4 weeks treatment, the mean wound reduction area of treatment group and control group was 90.35%and 78.7%respectively, the difference was statistically significant (P<0.05). After 1, 2 and 3 weeks treatment, the treatment group had significant difference with the control group in wound secretion VEGF level (P<0.05). Conclusion Shengji corium elephatis mastic can promote wound healing of chronic refractory skin ulcer. The possible mechanism is that Shengji corium elephatis mastic promotes the generation of VEGF in wound thus promotes wound repair.

Objective To detect the expression of scleroderma-related autoantibodies, such as anti-Scl-70, anli-centromere antibody ( ACA)and anti-RNA polymerase Ⅲ ( ARA) , and their relationship with clinical features in Chinese systemic sclerosis (SSc) patients. Methods One hundred and thirty-five Chinese SSc patients from the clinical database of the Scleroderma Trials and Research Group proposed by European League Against Rheumatism's Scheroderma Trial and Research Group( EUSTAR) were consecutively enrolled. The expression of ARA, anti-Scl-70 and ACA were detected through linear immunoblotting, double immunodiffusion and indirect irnmunofluorescence, respectively. The relevance between the existing of autoantibodies and clinical manifestations was analyzed statistically. Results Among the 135 Chinese SSc patients, the prevalence of anti-Scl-70, ACA, ARA were 49. 6% , 13.3 % and 8.9% respectively. Patients with anti-Scl-70 antibody had significantly shorter disease course [(71 ±59) month vs (90 ± 103) month, P = 0.041] , higher proportion of interstitial lung disease ( P = 0. 031) but lower of pulmonary arterial hypertension (P =0.042). Modified Rodnan's skin score (P=0.008) and prevalence of facial and cervical cutaneous sclerosis (P = 0. 002) , distal (to elbow/knee ) cutaneous sclerosis ( P = 0. 004 ) and digital pitting scarring/disappear of digital pad were all significantly higher in anti-Scl-70 positive group. Patients with AC A had longer disease course ( P = 0. 036) , lower IgM level ( P = 0. 045) and were less prevalent of interstitial lung disease ( P =0. 045). Patients with ARA had higher serum creatinine and urea nitrogen level ( P ＜ 0.001) although otherwise features had unremarkable differences. Conclusion Scleroderma-related autoantibodies have relevance with different clinical manifestation and detection of these autoantibodies may be helpful to the diagnosis of SSc, organ involvement evaluation and predicting outcomes. The clinical relevances of autoantibodies in Chinese SSc patients may differ from other areas or races.