Objective To explore the application value of sacubitril valsartan versus valsartan in the treatment of chronic heart failure(CHF)in the elderly patients based on the changes in serum heat shock protein 27(HSP27)and soluble glycoprotein 130(sgp130)levels.Methods A total of 204 CHF patients admitted to our hospital from June 2021 to December 2023 were retrospectively enrolled and divided into Group A(sacubitril valsartan,102 cases)and Group B(valsartan,102 cases).The clinical efficacy and cardiac function grade after 6 months of treatment were compared between the two groups.The changes in the serum levels of HSP27,sgp130,NT-ProBNP as well as echocardiographic indicators before and after treatment,and incidence of cardiovascular events were recorded and compared.Results After treatment,Group A obtained significantly higher total clinical efficacy and larger proportion of better NYHA grades than Group B(P＜0.05).After treatment,the serum levels of HSP27,sgp130 and NT-proBNP and values of LVEDD,LVPWT and IVST were significantly reduced in both groups,with more obviously decreased indi-cators in Group A(P＜0.01).What's more,LVEF and cardiac output were increased in both groups after treatment,and those in Group A were notably higher than those in Group B[(55.47±5.27)％vs(52.70±5.08)％,4.97±0.26 L/min vs 4.61±0.16 L/min,P＜0.01].The incidences of myocardial infarction and total cardiovascular events were remarkably lower in Group A than Group B(0.98％vs 6.86％,P=0.030;8.82％vs 18.63％,P=0.042).Conclusion In elderly CHF patients,sacubitril valsartan is superior to valsartan in more effectively regulating serum HSP27 and sgp130 levels,reversing the ventricular remodeling,and improving the cardiac function.

Objective To explore the application value of sacubitril valsartan versus valsartan in the treatment of chronic heart failure(CHF)in the elderly patients based on the changes in serum heat shock protein 27(HSP27)and soluble glycoprotein 130(sgp130)levels.Methods A total of 204 CHF patients admitted to our hospital from June 2021 to December 2023 were retrospectively enrolled and divided into Group A(sacubitril valsartan,102 cases)and Group B(valsartan,102 cases).The clinical efficacy and cardiac function grade after 6 months of treatment were compared between the two groups.The changes in the serum levels of HSP27,sgp130,NT-ProBNP as well as echocardiographic indicators before and after treatment,and incidence of cardiovascular events were recorded and compared.Results After treatment,Group A obtained significantly higher total clinical efficacy and larger proportion of better NYHA grades than Group B(P＜0.05).After treatment,the serum levels of HSP27,sgp130 and NT-proBNP and values of LVEDD,LVPWT and IVST were significantly reduced in both groups,with more obviously decreased indi-cators in Group A(P＜0.01).What's more,LVEF and cardiac output were increased in both groups after treatment,and those in Group A were notably higher than those in Group B[(55.47±5.27)％vs(52.70±5.08)％,4.97±0.26 L/min vs 4.61±0.16 L/min,P＜0.01].The incidences of myocardial infarction and total cardiovascular events were remarkably lower in Group A than Group B(0.98％vs 6.86％,P=0.030;8.82％vs 18.63％,P=0.042).Conclusion In elderly CHF patients,sacubitril valsartan is superior to valsartan in more effectively regulating serum HSP27 and sgp130 levels,reversing the ventricular remodeling,and improving the cardiac function.

Objective:To explore the curative effect and safety of cold snare polypectomy for colorectal adenoma of less than 15 mm.Methods:Data of 464 colorectal adenoma from 315 patients who were treated with cold snare polypectomy (CSP) and cold endoscopic mucosal resection (cold EMR) in the Third People′s Hospital of Jingdezhen from January 2018 to December 2019 were collected. Patients were divided into group A(3-5 mm), B (6-9 mm), and C (10-15 mm) according to the size of adenoma. Enbloc resection rate, immediate bleeding during polypectomy, delayed postpolypectomy bleeding, cold snare defect protrusions(CSDPs)and postoperative recurrence were analyzed.Results:The overall enbloc resection rate was 99.4%(461/464), and 100.0%(248/248), 98.8%(170/172), 97.7%(43/44) respectively in group A, B, and C without significant difference( P =0.126, 95% CI: 0.097-0.157). The overall incidence of immediate bleeding during polypectomy was 1.1%(5/464), and 0.4%(1/248), 1.7%(3/172), 2.3%(1/44) respectively in group A, B, and C without significant difference( P = 0.267, 95% CI: 0.227-0.308), showing an upward trend in the immediate postpolypectomy bleeding incidence with the increase of diameter of the polyps. No delayed postpolypectomy bleeding occurred. The overall incidence of CSDPs was 20.5%(95/464), 16.4%(63/384) and 40.0%(32/80) in the group of CSP and cold EMR respectively with significant difference( P<0.001, 95% CI: 0-0.006), showing an upward trend in the incidence of CSDPs with the increase of the diameter. A total of 286 adenomas in 195 patients were followed up. The median follow-up time was 9.7 months. Three patients relapsed. Conclusion:CSP is safe and effective for colorectal adenoma ≤15 mm with low incidence of immediate bleeding during polypectomy and recurrence, and no delayed postprocedural bleeding.

Objective To evaluate the efficiency of second trimester screenings for Down syndrome using alpha-fetoprotein and β-human chorionic gonadotropin duplex.MethodsPregnant women of south Zhejiang were screened for Down syndrome fetuses by maternal alpha-fetoprotein and β-human chorionic gonadotropin duplex during second trimester.The high-risk women underwent prenatal diagnosis by amniocentesis,cell culture and chromosome analysis.The newborns followed up by the maternal and child tertiary health care network and suspected to have Down syndrome were diagnosed by peripheral blood chromosome analysis.Statistical analysis was performed using two-sample t test and x2 test.Risk probability of Down Syndrome was calculated by random screening software. Results From Oct.2007 to May 2009,1130 of 32 188 singleton pregnant women in second trimester received prenatal screening were discovered with high risk(≥1 ∶ 270).Prenatal diagnosis was performed in 90.79％ cases (1026/1130) of high risk women and seven fetuses were diagnosed as Down syndrome by amniotic fluid chromosome analysis,and the pregnancies were terminated.Among the other 104 cases without prenatal diagnosis one Down syndrome baby was delivered.Six of 31 058 pregnancy women with low risk delivered Down syndrome babies with the incidence of Down syndrome of 0.19‰ (6/31 058).Detection rate of second trimester screenings for Down syndrome using alpha-fetoprotein and β-human chorionic gonadotropin duplex was 57.14％(8/14).False positive rate was 3.48％ (1122/32 188).Positive predictive value was 7.08‰(8/1130).During the same period,there were 23 813 pregnant women who didn't receive screening and 15 fetuses with Down syndrome were diagnosed after birth.There was no statistical difference in the prevalence rate of Down syndrome between those pregnant women who received prenatal screening or not [0.43‰ (14/32 188) vs 0.63‰ (15/23 813),x2 =1.004,P＞0.05].The prevalence of Down syndrome was 0.52‰ (29/56 001) in this area. ConclusionsThe prenatal screening and diagnosis could reduce the birth rate of Down syndrome patients.However,detection rate,false positive rate and positive predictive value of which were lower than reports in other studies.It's possible that the reference data might be not suitable for Chinese.