Objective To investigate the relationship of triglyceride-glucose(TyG)index and atherogenic index of plasma(AIP)with positive remodeling of coronary arteries in elderly coro-nary heart disease(CHD)patients with concomitant type 2 diabetes mellitus(T2DM).Methods A total of 120 elderly CHD patients with concomitant T2DM admitted to our department from January 2022 to June 2023 were continuously recruited,and according to the remodeling index,they were divided into positive remodeling group(47 cases)and non-positive remodeling group(73 cases).The clinical data were compared between the two groups.Multivariate logistic analysis was used to identify the risk factors for positive remodeling of coronary artery.Spearman correla-tion analysis was employed to analyze the correlation of TyG and AIP with positive remodeling.ROC curve was plotted to analyze the predictive value of TyG and AIP for the remodeling.Results The positive remodeling group had larger ratio of smoking,higher TG and HbA1c levels,and in-creased TyG index and AIP,but lower HDL-C and blood calcium levels than the non-positive re-modeling group(P＜0.05,P＜0.01).Univariate logistic regression analysis showed that smoking,TG,HDL-C,HbA1c,blood calcium,TyG and AIP were risk factors for positive coronary artery remodeling in elderly patients with CHD and T2DM(P＜0.05,P＜0.01).Multivariate logistic re-gression analysis showed that TyG index(OR=7.253,95％CI:2.458-13.364,P=0.035)and AIP(OR=6.017,95％CI:2.205-12.025,P=0.030)were independent risk factors for positive coronary artery remodeling in elderly patients with CHD and T2DM(P＜0.05).The AUC value of TyG index and AIP in predicting positive coronary artery remodeling in elderly CHD patients with T2DM was 0.783 and 0.766,respectively,and the value of their combination in the prediction was 0.868,which was significantly better than the indicator alone(P＜0.05).Conclusion TyG in-dex and AIP are closely associated with positive coronary artery remodeling in elderly CHD pa-tients with T2DM,and can be used as effective indicators in the prediction of positive remodeling,which is of great significance for early clinical identification of high-risk patients and formulation of individual intervention strategies.

Objective To explore the efficacy of progressive exercise training based on the modified Medical Research Council dyspnea scale (mMRC) grading in respiratory rehabilitation for patients with chronic obstructive pulmonary disease (COPD) at a primary healthcare setting. Methods A total of 106 patients with COPD admitted to Zhuanqiao Community Health Service Center in Shanghai from Aug.1, 2022 to Jul. 30, 2024 were selected as research subjects. They were randomly divided into a study group and a control group in a 1∶1 ratio, with 53 patients in each group. The control group received conventional treatment, while the study group received conventional treatment combined with progressive exercise training. After 4 weeks of continuous treatment, the changes in the 6-minute walk test (6MWT), COPD assessment test (CAT) score, mMRC grading, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading and pulmonary function were compared between the two groups. Results Patients in both groups showed improvements in 6MWT distance, CAT score, mMRC grading, GOLD grading, and pulmonary function compared to baseline (P＜0.05). Moreover, the study group had better improvements in 6MWT distance, CAT score, mMRC grading, GOLD grading, and pulmonary function than the control group (P＜0.05). Conclusions Conventional treatment combined with progressive exercise training based on mMRC grading can enhance the effect of respiratory rehabilitation in patients with COPD, particularly in improving pulmonary function and exercise tolerance.

Objective To investigate the relationship of triglyceride-glucose(TyG)index and atherogenic index of plasma(AIP)with positive remodeling of coronary arteries in elderly coro-nary heart disease(CHD)patients with concomitant type 2 diabetes mellitus(T2DM).Methods A total of 120 elderly CHD patients with concomitant T2DM admitted to our department from January 2022 to June 2023 were continuously recruited,and according to the remodeling index,they were divided into positive remodeling group(47 cases)and non-positive remodeling group(73 cases).The clinical data were compared between the two groups.Multivariate logistic analysis was used to identify the risk factors for positive remodeling of coronary artery.Spearman correla-tion analysis was employed to analyze the correlation of TyG and AIP with positive remodeling.ROC curve was plotted to analyze the predictive value of TyG and AIP for the remodeling.Results The positive remodeling group had larger ratio of smoking,higher TG and HbA1c levels,and in-creased TyG index and AIP,but lower HDL-C and blood calcium levels than the non-positive re-modeling group(P＜0.05,P＜0.01).Univariate logistic regression analysis showed that smoking,TG,HDL-C,HbA1c,blood calcium,TyG and AIP were risk factors for positive coronary artery remodeling in elderly patients with CHD and T2DM(P＜0.05,P＜0.01).Multivariate logistic re-gression analysis showed that TyG index(OR=7.253,95％CI:2.458-13.364,P=0.035)and AIP(OR=6.017,95％CI:2.205-12.025,P=0.030)were independent risk factors for positive coronary artery remodeling in elderly patients with CHD and T2DM(P＜0.05).The AUC value of TyG index and AIP in predicting positive coronary artery remodeling in elderly CHD patients with T2DM was 0.783 and 0.766,respectively,and the value of their combination in the prediction was 0.868,which was significantly better than the indicator alone(P＜0.05).Conclusion TyG in-dex and AIP are closely associated with positive coronary artery remodeling in elderly CHD pa-tients with T2DM,and can be used as effective indicators in the prediction of positive remodeling,which is of great significance for early clinical identification of high-risk patients and formulation of individual intervention strategies.

Objective This study aimed to explore the effect of the combined Danzhi Jiangtang Capsule with dapagliflozin on the blood lipid profile and related inflammatory markers in patients with type 2 diabetes mellitus with peripheral vascular disease. Methods 72 patients with type 2 diabetes mellitus with peripheral vascular disease who met the inclusion criteria were admitted to the Department of Endocrinology,The First Affiliated Hospital of Anhui University of Chinese Medicine,from April 2021 to April 2023. The patients were assigned to the experimental group and the control group using the random number table method (36 cases in each group). The control group was treated with dapagliflozin in addition to standard treatment,while the experimental group received the Danzhi Jiangtang Capsule for 12 weeks. Clinical efficacy,glucose and lipid metabolism indicators,hypersensitive C-reactive protein (hs-CRP),body mass index (BMI) levels,and traditional Chinese medicine (TCM) syndrome scores were observed pre-and post-treatment.Results In post-treatment,the clinical efficacy was higher in the experimental group than in the control group. Significant reductions in fasting blood glucose (FPG),2 h postprandial glucose (2 hPG),triglycerides (TG),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),hs-CRP,BMI,and increased high-density lipoprotein cholesterol (HDL-C) were observed. Scores for TCM syndrome and individual items also decreased (P<0.05). Comparisons within the groups for pre-and post-treatment showed reductions in FPG,2 hPG,TG,TC,LDL-C,hs-CRP,and an increase in HDL-C,along with a decrease in total scores of TCM syndrome (P<0.05). Conclusion The Danzhi Jiangtang Capsule combined with dapagliflozin in the treatment of type 2 diabetes mellitus with peripheral vascular disease can regulate the blood lipid profile,reduce inflammatory factors,and improve patient's symptoms. Integrated traditional Chinese and Western medicine treatment are more conducive to controlling the disease,and TCM can be used in clinical practice as a combination treatment.

ObjectiveTo observe the clinical efficacy of Danzhi Jiangtang capsules with the functions of replenishing Qi， nourishing Yin， and dredging collaterals on patients with type 2 diabetes mellitus （T2DM） combined with lower-extremity macroangiopathy and serum levels of homocysteine （Hcy） and cystatin C （Cys C）. MethodA total of 80 eligible patients who were treated in the department of endocrinology of the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2017 to December 2019 were randomized into the treatment group （40 cases） and control group （40 cases）. Both groups received the basic therapies for diabetes and Danzhi Jiangtang capsules （oral） was added to the treatment group. The levels of glycosylated hemoglobin A1c （HbA1c）， fasting plasma glucose （FPG）， 2-hour postprandial glucose （2 hPG）， fasting C-peptide （C-P）， and 2-hour postprandial C-peptide （2 hC-P）， triglycerides （TG）， total cholesterol （TC）， high density lipoprotein cholesterol （HDL-C）， and low density lipoprotein cholesterol （LDL-C） and serum levels of Hcy and Cys C were measured and the traditional Chinese medicine（TCM） syndrome scores were calculated before and after treatment in the two groups. ResultAfter 12 weeks of treatment， levels of HbA1c， FPG， and 2 hPG were lower than those before treatment in the two groups （P<0.05）. Levels of C-P （P<0.05） and 2 hC-P were higher than those before treatment in the two groups. After treatment， levels of HbA1c， FPG， and 2 hPG in the treatment group were lower than those in the control group （P<0.05）， while levels of C-P and 2 hC-P showed no significant difference between two groups. After treatment， the levels of TG， TC， and LDL-C were lower than those before treatment （P<0.05） and HDL-C level was higher than that before treatment （P<0.05） in both groups. After treatment， levels of TG and LDL-C in the treatment group were lower than those in the control group （P<0.05）， and levels of TC and HDL-C demonstrated no significant difference between two groups. After the treatment， the TCM syndrome score was lower than that before the treatment in both groups （P<0.05） and lower in the treatment group than in the control group （P<0.05）. The overall effective rate of the treatment group was higher than that of the control group （χ^２=7.585， P<0.05）. The levels of Cys C and Hcy were lower than those before treatment in the two groups （P<0.05） and lower in the treatment group than in the control group （P<0.05）. Doppler echocardiography of the lower limbs showed no obvious improvement in the control group after treatment. However， for the treatment group， slight decrease in intima-media thickness of the lower limb arteries and a slight reduction in the plaque area were observed， but the difference was not statistically significant. ConclusionDanzhi Jiangtang capsules has definite therapeutic effect on T2DM combined with lower-extremity macroangiopathy， which can improve glucolipid metabolism and reduce serum levels of Hcy and Cys C. This study can serve a reference for the prevention and treatment of T2DM combined with macroangiopathy.

Objective:To observe the differences of macular microvascular structure between recurrent and non-recurrent macular edema (ME) secondary to central retinal vein occlusion (CRVO) after intravitreal injection of ranibizumab (IVR), and to preliminarily analyze the correlation between recurrence and ME.Methods:A prospective clinical observational study. Forty-five patients (45 eyes) diagnosed as CRVO with ME were included in this study in Tianjin Medical University Eye Hospital from January 2020 to December 2021. There were 22 males (22 eyes) and 23 females (23 eyes). All cases were unilateral. The average age was 61.11±10.88 years old. All patients received IVR treatment once a month for 3 consecutive months. ME were regressive after the initial three treatments. The patients were divided into recurrent group (21 cases, 21 eyes) and non-recurrent group (24 cases, 24 eyes) based on ME recurrence at 6 months after ME resolution. All patients underwent best corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography angiography (OCTA). OCTA was used to scan the macula in the area of 3 mm×3 mm, and the vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), fovea and parafovea before and after treatment was measured. Foveal retinal thickness, foveal avascular zone (FAZ) area, perimeter of FAZ (PERIM), avascular index of FAZ (AI), VD within 300 μm width of FAZ range (FD-300). Foveal VD included superficial and deep retinal VD (SFVD, DFVD); parafoveal VD included superficial and deep retinal VD (SPFVD, DPFVD). Taking the initial three treatments as the observation time point, the changes of the parameters of the two groups were compared. Comparison between the recurrent and non-recurrent group was performed by two independent sample t-tests. Receiver operating characteristic (ROC) curve analysis was used to measure the area under the curve (AUC) of VD for predicting the recurrence of ME. Results:There were no significant differences in age ( t=1.350), IOP ( t=1.929), SFVD ( t=-1.716), DFVD ( t=-1.143), CRT ( t=-1.207) and AI ( t=1.387) between the recurrent and non-recurrent group ( P>0.05). There were significant differences in times of anti-VEGF therapy ( t=5.912), BCVA ( t=5.003), SVD ( t=-4.617), SPFVD ( t=-4.110), DVD ( t=-5.503), DPFVD ( t=-4.772), FAZ area ( t=2.172), PERIM ( t=2.606) and FD-300 ( t=-3.501) between the recurrent and non-recurrent group ( P<0.05). ROC curve analysis showed that the AUC of DVD in predicting the recurrence of ME was highest, with 0.921, and the threshold was 37.65%. The sensitivity and specificity were 91.7% and 85.7%, respectively. Conclusions:The SVD, SPFVD, DVD, DPFVD and FD-300 in the recurrence group are significantly lower than those in the non-recurrence group, while the FAZ area and PERIM are significantly higher than those in the non-recurrence group. DVD≤37.65% can be used as the best threshold for predicting the recurrence of ME.

Objective:To observe the inhibitory effect of lentivirus (LV)-mediated miR-191 on the proliferation and angiogenesis of human retinal vascular endothelial cells (hREC) cultured in vitro.Methods:The hREC cell lines were cultured in vitro and divided into control group, hypoxia group, LV-empty vector (LV-vector) group, and LV-miR-191 (LV-191) group. The LV-vector group and LV-191 group were transferred to the corresponding lentiviral vector respectively. Flow cytometry was used to detect cell transfection efficiency. Cell Counting Kit-8 (CCK-8) test was used to detect cell proliferation ability. Scarification test and invasion chamber (Transwell) test were used to detect cell migration ability. Matrigel test was used to detect cell lumen formation ability. Real-time quantitative polymerase chain reaction (qPCR) was used to detect the relative expression of miR-191 and relative mRNA expression of its downstream target genes p21, vascular endothelial growth factor (VEGF), cell division protein kinase (CDK) 6, cyclin-D1 (Cyclin D1). Independent sample t test was used for pairwise comparison. Results:The results of flow cytometry showed that the transfection efficiency of cells in the control group and the LV-191 group were 0.615% and 99.400%, respectively. The results of CCK-8, scarification, Transwell and Matrigel test showed that, compared with the control group, the number of cell proliferation ( t=6.130, 4.606), the cell mobility ( t=4.910, 6.702), the number of stained cells on the microporous membrane ( t=7.244, 6.724) and the lumen formation ability cells ( t=8.345, 9.859) were significantly increased in the hypoxia group and the LV-vector group ( P<0.01), while the LV-191 group showed completely opposite performance ( t=14.710, 6.245, 5.333, 5.892; P≤0.01). The qPCR test results showed that, compared with the control group and the LV-vector group, the relative expression of miR-191 mRNA in the cells of the LV-191 group was significantly up-regulated ( t=44.110, 42.680), the relative expression of Cyclin D1 mRNA ( t=29.940, 14.010) and CDK6 mRNA ( t=15.200, 7.645) decreased significantly, and the difference were statistically significant ( P<0.01); the relative expression of p21 mRNA increased, however, the difference was not statistically significant ( t=2.013, 2.755; P>0.05). There was no significant difference in the relative expression of VEGF mRNA in the 4 groups of cells ( F=0.966, P>0.05). Conclusions:LV-191 can inhibit the proliferation, migration and tubing of hREC by up-regulating p21 and down-regulating CDK6 and Cyclin D1.

Objective:To observe the value of optical coherence tomography (OCTA) in distinguishing ischemic and non-ischemic branch retinal vein occlusion (BRVO).Methods:A prospective clinical observational study. From January 2020 to January 2021, 44 eyes of 44 patients with BRVO diagnosed in Tianjin Medical University Eye Hospital were included in the study. Among them, there were 24 eyes of 24 males and 20 eyes of 20 females. The macular edema subsided after three consecutive anti-vascular endothelial growth factor (VEGF) drug treatments. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fluorescein fundus angiography (UWFFA), and OCTA examination. According to the results of UWFFA, the affected eyes were divided into ischemic group and non-ischemic group, with 22 eyes in 22 patients. The macular area of the affected eye with an OCTA instrument were scaned in the range of 3 mm× 3 mm to measure the blood flow density (SVD, DVD), foveal blood flow density (SFVD, DFVD), parafoveal blood flow density (SPFVD, DPFVD), affected hemilateral blood flow density (SHVD, DHVD) and affected quadrant blood flow density (SQVD, DQVD) of the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina, foveal retinal thickness (CRT), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), out-of-roundness index (AI), and blood flow density within 300 μm width of FAZ (FD-300). The two-sample independent t test was used to compare the parameters between the ischemic group and the non-ischemic group. Receiver operating characteristic (ROC) curve analysis was used to measure the area under the curve (AUC) of blood flow density to predict ischemic BRVO, determine the critical value for predicting ischemic BRVO and the corresponding sensitivity and specificity, with AUC> 0.9 as the prediction performance was good. Results:The differences of BCVA ( t=1.544), intraocular pressure ( t=-0.404), SFVD ( t=0.444), DFVD ( t=-0.812), CRT ( t=1.082), FAZ area ( t=-0.785), PERIM ( t=-0.685), AI ( t=1.047) of the eyes in the ischemic group and non-ischemic group were not statistically significant ( P>0.05). The differences of age ( t=2.194), SVD ( t=-3.796), SPFVD ( t=-4.181), SHVD ( t=-4.700), SQVD ( t=-3.594), DVD ( t=-2.324), DPFVD ( t=-2.476), DHVD ( t=-2.118), DQVD ( t=-6.529) and FD-300 ( t=-5.116) of the eyes in the ischemic group and non-ischemic group area were statistically significant ( P<0.05). ROC curve analysis results showed that DQVD predicted the AUC of ischemic BRVO the largest (0.917), the best cut-off value was 33.75%, and the sensitivity and specificity were 90.9% and 81.8%, respectively. Conclusion:OCTA can quantitatively assess the microvascular structure of SCP and DCP in the macular area of BRVO eyes, and contribute to distinguish ischemic and non-ischemic BRVO.

Objective To investigate the application of liver three-dimensional (3D) visualized reconstruction technique in hepatectomy for children with complicated hepatoblastoma. Methods A retrospective analysis was performed for the clinical data of 30 children with hepatoblastoma who underwent hepatectomy for radical resection in PLA Rocket Force Characteristic Medical Center from January 2018 to October 2020, and according to whether liver 3D visualization with IQQA-Liver system was performed before surgery, the children were divided into 3D reconstruction group with 15 children and control group with 15 children. The two groups were compared in terms of perioperative parameters, short-term prognosis, and follow-up conditions. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Fisher's exact test was used for comparison of categorical data between two groups. Results Compared with the control group, the 3D reconstruction group had a significantly higher mean age (55.7±10.2 years vs 28.2±2.7 years, P < 0.05) and a significantly higher number of patients with POSTTEXT stage III/VI hepatoblastoma (12 vs 5, P < 0.05) or involvement of the hepatic vein or the inferior vena cava (11 vs 3, P < 0.05). All children completed the surgery successfully, and there were no significant differences between the two groups in blood loss, time of operation, number of times and duration of hepatic portal occlusion, and number of children receiving segmental hepatectomy or partial hepatectomy (all P > 0.05). The median follow-up after surgery was 9.5 months. In the 3D reconstruction group, 2 children experienced recurrence and were diagnosed at 10 and 12 months, respectively, after surgery, and they were treated with chemotherapy at the moment; in the control group, 4 children experienced recurrence, which was higher than that in the 3D reconstruction group ( P =0.651), and among these 4 children, 2 had recurrence at 7 months after surgery, received liver transplantation, and survived up to now, and the other 2 children died shortly after recurrence. Conclusion 3D visualized reconstruction technique helps to perform hepatectomy for children with complicated hepatoblastoma more safely and accurately, especially extended hepatectomy for patients with stage POST TEXT III/IV hepatoblastoma, thereby avoiding liver transplantation.

Radiotherapy is the most common treatment for nasopharyngeal carcinoma, and the radiotherapy technique is essential for the prognosis of nasopharyngeal carcinoma. Due to the complexity of the structure of the intensity-modulated device and the accuracy of the clinical requirements of radiotherapy, it is inevitable that higher requirements will be imposed on the process of intensity-modulated radiotherapy. Currently, gaps exist in the radiotherapy equipment and personnel qualification among radiotherapy units, and thus the homogenization in the radiotherapy remains to be strengthened in China. With the application of radiotherapy information management system, digital medicine and artificial intelligence technologies in the field of radiotherapy, the original process fails to meet the application needs of the new precise radiotherapy technology. Therefore, this process is designed based on the existing radiotherapy procedures for nasopharyngeal carcinoma in combination with the latest developments in the field of radiotherapy, aiming to establish a novel standard process recommendation, ensuring the standardization and homogenization of radiotherapy and achieve the individualized intensity-modulated radiotherapy for nasopharyngeal carcinoma patients.