OBJECTIVE To compare the efficacy and safety of evolocumab and probucol in patients with ultra-high-risk atherosclerotic cardiovascular disease （ASCVD） following percutaneous coronary intervention （PCI）. METHODS A retrospective analysis was conducted on 156 ultra-high-risk ASCVD patients who underwent PCI in our institution between January 1， 2023 and December 31， 2024. According to the lipid-lowering regimen， the patients were categorized into evolocumab group （ n ＝86） and probucol group （ n ＝70）. Changes in lipid parameters [total cholesterol （TC）， low-density lipoprot ein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， triglycerides， lipoprotein （a）， and lipid goal achievement rate ] ， inflammatory markers [interleukin-6 （IL-6） and C-reactive protein （CRP） ] ， and cardiac function indices （left ventricular ejection fraction， left ventricular end-systolic diameter， left ventricular end-diastolic diameter， and N-terminal pro-B-type natriuretic peptide） were compared between two groups at baseline and after 6 months of treatment. The incidence of adverse clinical events during treatment， including acute myocardial infarction， in-stent restenosis， acute heart failure， cerebral hemorrhage， and stroke， was also evaluated. RESULTS No statistically significant differences were observed between the two groups at baseline （ P ＞0.05）. After 6 months of treatment， both groups demonstrated significant improvements in lipid profiles （except HDL-C） and inflammatory markers compared to those at baseline （ P ＜0.05）. The evolocumab group exhibited greater reductions in TC， LDL-C， IL-6， and CRP， along with a higher lipid target achievement rate， compared with the probucol group （ P ＜0.05）. There were no statistically significant differences in the cardiac function-related indicators before and after treatment between the two groups， nor in the incidence of adverse events during the treatment （ P ＞0.05）. CONCLUSIONS For ultra-high-risk ASCVD patients after PCI， both of the above treatment options are associated with improvements in blood lipid and inflammatory response， with good safety during short-term follow-up. Evolocumab shows superior efficacy in TC， LDL-C and inflammatory markers reduction and lipid target achievement， compared to probucol.

In modern society， the comorbidity of insomnia with amnesia has shown a significantly increasing incidence and become increasingly severe， emerging as a public health issue that endangers people's physical and mental health and quality of life. Anmei Dan （AMD）， originally recorded in the Shishi Milu by CHEN Shiduo in the Qing Dynasty， possesses profound theoretical foundations and distinct clinical advantages in ameliorating insomnia with amnesia. Basic research has unequivocally confirmed its definite therapeutic effects on insomnia with amnesia and revealed partial mechanisms. AMD is therefore a veritable classic prescription embodying the principle of treating different diseases with the same method for insomnia and amnesia. However， few researchers have reviewed the related research progress. This article systematically summarized the theoretical connotations of traditional Chinese medicine in treating insomnia with amnesia， delineated the multi-component material basis of AMD in ameliorating insomnia with amnesia （including various chemical components such as ginsenosides， jujubosides， and salvianolic acids）， and evaluate its multi-dimensional clinical efficacy （e.g.， prolonging total sleep time， improving sleep efficiency， and enhancing memory）. Moreover， it systematically summarizes the multi-pathway mechanisms of action. The results indicate that AMD has a clear material basis， definite clinical efficacy， and a favorable safety profile in ameliorating insomnia and amnesia. AMD may exert the therapeutic effect by regulating sleep-wake rhythms， enhancing synaptic plasticity， inhibiting neuroimmune inflammation， and modulating autophagy， oxidative stress， and energy metabolism. In conclusion， AMD exerts synergistic effects through multi-component， multi-dimensional， and multi-pathway approaches， serving as an important prescription for enriching and developing the theory of treating different diseases with the same method for insomnia with amnesia.

Background: s/Aims: Sarcomatoid hepatocellular carcinoma (HCC) is a rare histological subtype of HCC characterized by extremely poor prognosis; however, its molecular characterization has not been elucidated. Methods: In this study, we conducted an integrated multiomics study of whole-exome sequencing, RNA-seq, spatial transcriptome, and immunohistochemical analyses of 28 paired sarcomatoid tumor components and conventional HCC components from 10 patients with sarcomatoid HCC, in order to identify frequently altered genes, infer the tumor subclonal architectures, track the genomic evolution, and delineate the transcriptional characteristics of sarcomatoid HCCs. Results: Our results showed that the sarcomatoid HCCs had poor prognosis. The sarcomatoid tumor components and the conventional HCC components were derived from common ancestors, mostly accessing similar mutational processes. Clonal phylogenies demonstrated branched tumor evolution during sarcomatoid HCC development and progression. TP53 mutation commonly occurred at tumor initiation, whereas ARID2 mutation often occurred later. Transcriptome analyses revealed the epithelial–mesenchymal transition (EMT) and hypoxic phenotype in sarcomatoid tumor components, which were confirmed by immunohistochemical staining. Moreover, we identified ARID2 mutations in 70% (7/10) of patients with sarcomatoid HCC but only 1–5% of patients with non-sarcomatoid HCC. Biofunctional investigations revealed that inactivating mutation of ARID2 contributes to HCC growth and metastasis and induces EMT in a hypoxic microenvironment. Conclusions We offer a comprehensive description of the molecular basis for sarcomatoid HCC, and identify genomic alteration (ARID2 mutation) together with the tumor microenvironment (hypoxic microenvironment), that may contribute to the formation of the sarcomatoid tumor component through EMT, leading to sarcomatoid HCC development and progression.

Background: s/Aims: Sarcomatoid hepatocellular carcinoma (HCC) is a rare histological subtype of HCC characterized by extremely poor prognosis; however, its molecular characterization has not been elucidated. Methods: In this study, we conducted an integrated multiomics study of whole-exome sequencing, RNA-seq, spatial transcriptome, and immunohistochemical analyses of 28 paired sarcomatoid tumor components and conventional HCC components from 10 patients with sarcomatoid HCC, in order to identify frequently altered genes, infer the tumor subclonal architectures, track the genomic evolution, and delineate the transcriptional characteristics of sarcomatoid HCCs. Results: Our results showed that the sarcomatoid HCCs had poor prognosis. The sarcomatoid tumor components and the conventional HCC components were derived from common ancestors, mostly accessing similar mutational processes. Clonal phylogenies demonstrated branched tumor evolution during sarcomatoid HCC development and progression. TP53 mutation commonly occurred at tumor initiation, whereas ARID2 mutation often occurred later. Transcriptome analyses revealed the epithelial–mesenchymal transition (EMT) and hypoxic phenotype in sarcomatoid tumor components, which were confirmed by immunohistochemical staining. Moreover, we identified ARID2 mutations in 70% (7/10) of patients with sarcomatoid HCC but only 1–5% of patients with non-sarcomatoid HCC. Biofunctional investigations revealed that inactivating mutation of ARID2 contributes to HCC growth and metastasis and induces EMT in a hypoxic microenvironment. Conclusions We offer a comprehensive description of the molecular basis for sarcomatoid HCC, and identify genomic alteration (ARID2 mutation) together with the tumor microenvironment (hypoxic microenvironment), that may contribute to the formation of the sarcomatoid tumor component through EMT, leading to sarcomatoid HCC development and progression.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective To evaluate the value of coronary CT angiography(CCTA)radiomics machine learning(ML)model combined with pericoronary fat attenuation index(FAI)for predicting coronary plaques progression.Methods Totally 194 patients with CCTA showing coronary plaques and received at least one CCTA review afterwards were retrospectively collected.The annual change value of total plaque burden(△TPB/y)was calculated based on the first and last CCTA to assess plaque progression.All patients were categorized into non-progressive(△TPB/y＜median △TPB/y)and progressive(△ TPB/y≥median △ TPB/y)groups.The patients were divided into training set(n=155)and validation set(n=39)at the ratio of 8∶2.Univariate and multivariate logistic regression analyses were used to screen clinical and primary CCTA related factors for plaque progression,and CCTA model was constructed.Radiomics features were extracted and screened based on primary CCTA to build ML models using random forest(RF),Gaussian process(GP),partial least squares discriminant analysis(PLS-DA),quadratic discriminant analysis(QDA)and support vector machine(SVM)algorithms.The effectiveness of all models was verified in validation set and the optimal ML model was selected.And its combination with CCTA model constructed combined model.The efficacy of each model for predicting coronary plaques progression was evaluated.Results Of 194 cases,97 were in progressive group and 97 were in non-progressive group.The training set included 77 cases of plaques progression and 78 of plaques non-progression,and the validation set included 20 of plaques progression and 19 of plaques non-progression.FAI was the independent predictor of plaque progression(OR=1.08,P＜0.001)and CCTA model was constructed.Ten optimal radiomics features based on training set were selected to build RF,GP,PLS-DA,QDA and SVM models.The area under the curve(AUC)of RF model in training set and validation set were both high,was considered as the optimal ML model.The AUC of CCTA,RF and combined models in training set was 0.684,0.847 and 0.861,respectively,while was 0.629,0.768 and 0.821 in validation set,respectively.Conclusion CCTA radiomics ML model combined with FAI could effectively predict coronary plaques progression.

Objective:To evaluate the application effect of a wearable visual field meter based on extended reality (XR) glasses for patients with macular disease.Methods:A self-controlled study was conducted.A total of 41 consecutive patients (41 eyes) with macular disease were recruited at Renmin Hospital of Wuhan University from October 2022 to October 2024.All patients underwent 10-2 center visual field test using a self-developed wearable visual field meter (XRVF), and the results were compared with those obtained using a traditional Humphrey field analyzer (HFA).The comparison parameters included mean retinal sensitivity (MS), false positive rate (FPR), false negative rate (FNR), and testing duration.A subject satisfaction questionnaire was administered.This study followed the Declaration of Helsinki.The study protocol was approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2024-K263), and all subjects signed the informed consent form.Results:The retinal sensitivity of patients measured by HFA was (23.24±3.71)dB, which was higher than (22.01±3.45)dB by XRVF, showing a statistically significant difference ( t=4.924, P=0.036).The FPR measured by HFA and XRVF were (2.39±2.51)% and (2.59±3.29)%, respectively, and the FNR were (3.49±6.05)% and (3.74±5.38)%, respectively, showing no statistically significant difference ( t=-3.624, P=0.948; t=-1.241, P=0.519).The median test duration for HFA and XRVF was 6.15 (5.78, 6.65) and 5.98 (5.71, 6.69)minutes, respectively, without statistically significant difference ( Z=-1.987, P=0.953).92.6% of the subjects thought the device was comfortable, simple and practical. Conclusions:The XRVF has good consistency with the HFA, can effectively and reliably evaluate the visual field function of patients with macular disease, and is easily accepted by patients.

Objective:To construct a preoperative prehabilitation program for prostate cancer based on evidence-based and Delphi method, so as to provide theoretical basis for medical staff to carry out preoperative prehabilitation research for prostate cancer patients.Methods:From June 2023 to March 2024, the first draft of the prehabilitation plan for prostate cancer before surgery was formed through evidence summary, semi-structured interviews and expert meetings. The experts in related fields were selected for two rounds of Delphi expert consultation. The items were revised according to the expert consultation opinions to establish the final plan.Results:Totally 16 experts were included, aged (43.19 ± 7.57) years. Five were males and 11 were females. The response rates of the two rounds of expert consultation were both 16/16, and the authority coefficients of the two rounds expert consultation were both 0.85. The Kendall coordination coefficients of the importance and feasibility of the items in the second round of consultation were 0.213 and 0.224, both P<0.05. In the second round of consultation, the value of importance assignment of items at all levels was 4.19-4.94 points, and the full score rate was 43.75%-93.75%. The final scheme included 5 first-level items, 13 second-level items, and 34 third-level items. Conclusions:The preoperative prehabilitation program for prostate cancer is scientific, importanceand applicable, which provides a theoretical basis for clinical preoperative prehabilitation for prostate cancer patients.

Objective:To investigate the clinical efficacy of Di'ao Xinxuekang Capsules combined with injectable pancreatic kallidinogenase in the treatment of diabetic retinopathy. Methods:This study was a prospective research. A total of 90 patients with diabetic retinopathy treated at The People's Hospital of Liaoning Province from September 2021 to March 2024 were included in this study. The patients were randomly assigned to an observation group and a control group, with 45 patients in each group, using the random number table method. The control group received treatment with injectable pancreatic kallidinogenase, while the observation group underwent treatment with Di'ao Xinxuekang Capsules in addition to injectable pancreatic kallidinogenase. Both groups were treated for 14 days. The clinical efficacy, changes in visual acuity after treatment compared with before treatment, ocular hemodynamic indicators (peak systolic velocity and resistance index), and the incidence of adverse reactions were compared between the two groups. Results:The response rate in the observation group was significantly higher than that in the control group [90.91% (40/45) vs. 73.33% (33/45), χ2 = 8.61, P<0.05]. Before treatment, there were no significant differences between the two groups regarding visual acuity values, retinal thickness, and ocular hemodynamic parameters ( t = 0.11, 0.05, 0.47, 1.08, all P>0.05). After 14 days of treatment, the visual acuity in the observation group was significantly higher than that in the control group [(1.06 ± 0.11) vs. (0.81 ± 0.06), t = 12.62, P<0.001]. The peak systolic velocity in the observation group was significantly greater than that in the control group [(31.85 ± 1.92) cm/s vs. (27.01 ± 1.33) cm/s, t = 8.01, P<0.001]. The retinal thickness in the observation group was significantly lower than that in the control group [(311.5 ± 45.2) μm vs. (350.3 ± 59.3) μm, t = -3.49, P<0.001]. The resistance index in the observation group was significantly lower than that in the control group [(0.59 ± 0.02) vs. (0.68 ± 0.04), t = -12.57, P<0.001]. There was no significant difference in the incidence of adverse reactions between the observation and control groups [8.89% (4/45) vs. 6.67% (3/45), χ2 = 0.16, P>0.05]. Conclusions:Di'ao Xinxuekang Capsules combined with injectable pancreatic kallidinogenase for the treatment of diabetic retinopathy can effectively enhance clinical efficacy, improve patients' visual acuity and ocular hemodynamic indicators, and is considered safe.

Objective:To investigate the clinical efficacy of Zhibitai capsules combined with liraglutide in the treatment of type 2 diabetes mellitus (T2MD) complicated by metabolic-associated fatty liver disease (MAFLD). Methods:This study used a prospective design. A total of 92 patients with T2DM complicated by MAFLD who were admitted to The People's Hospital of Liaoning Province from September 2023 to September 2024 were included in this study. They were randomly divided into an observation group and a control group, with 46 patients in each group. Both groups received lifestyle intervention and standard antidiabetic treatment. The control group received subcutaneous injections of liraglutide, while the observation group was treated with liraglutide combined with Zhibitai capsules. All patients were treated for 3 months. Blood glucose levels, glycated hemoglobin, blood lipid levels, liver function, and hemodynamic parameters were compared between the two groups both before and after treatment. The controlled attenuation parameter of liver fat was measured using Fibro Touch. Results:After treatment, there were no statistically significant differences in fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin levels between the two groups (all P > 0.05). The high-density lipoprotein cholesterol level in the observation group was significantly higher than that in the control group [(1.31 ± 0.40) mmol/L vs. (0.90 ± 0.30) mmol/L, t = -5.56, P < 0.001]. The levels of total cholesterol [(3.70 ± 0.80) mmol/L vs. (4.40 ± 0.90) mmol/L], triglycerides [(1.50 ± 0.40) mmol/L vs. (2.60 ± 0.50) mmol/L], and low-density lipoprotein cholesterol [(1.80 ± 0.50) mmol/L vs. (2.60 ± 0.60) mmol/L] in the observation group were significantly lower than those in the control group ( t = 3.94, 11.65, 6.39, all P < 0.001). The controlled attenuation parameter of liver fat in the observation group was significantly lower than that in the control group [(249.20 ± 7.60) dB/m vs. (264.70 ± 8.70) dB/m, t = 9.10, P < 0.001]. The level of total bilirubin in the observation group was significantly higher than that in the control group [(16.40 ± 1.50) μmol/L vs. (15.00 ± 1.40) μmol/L, t = -4.63, P < 0.05], while the levels of other liver function indicators in the observation group were significantly lower than those in the control group ( t = 4.83, 9.57, 3.66, all P < 0.001). After treatment, whole blood viscosity at high shear rates, whole blood viscosity at lower shear rates, plasma viscosity, and platelet aggregation levels were all significantly lower in the observation group compared with the control group ( t = 2.13, 2.62, 2.97, 6.15, 4.00, all P < 0.05). Conclusions:Zhibitai capsules combined with liraglutide can improve blood glucose levels, lipid profiles, and liver function, while also decreasing blood viscosity in patients with T2MD complicated by MAFLD.