Objective To explore the clinical efficacy of robot-assisted coronary artery bypass grafting through a small incision in the left intercostal space in the treatment of multivessel coronary disease. Methods A retrospective analysis was conducted on the clinical data of patients who underwent coronary artery bypass grafting through a small incision in the left intercostal space at Central China Fuwai Hospital of Zhengzhou University from January 1, 2023 to October 15, 2024. Patients were divided into a robotic group and a minimally invasive group based on whether the surgery was assisted by the Da Vinci robot. Results A total of 81 patients were included, with 57 in the minimally invasive group, including 41 males and 16 females, with a median age of 65.0 (57.5, 69.5) years; and 24 in the robotic group, including 17 males and 7 females, with a median age of 61.0 (56.0, 69.0) years. There was no statistically significant difference in baseline data between the two groups (P>0.05). The robotic group had less intraoperative bleeding [300 (200, 438) mL vs. 500 (375, 600) mL, P=0.006], shorter postoperative mechanical ventilation time [15.0 (13.3, 23.5) h vs. 22.0 (15.5, 39.5) h, P=0.037], and lower incidence of postoperative pain [8 (33.3%) vs. 33 (57.9%), P=0.043]. The hospitalization cost in the robotic group was higher than that in the minimally invasive group [130491 (123298, 135691) yuan vs. 123892 (115543, 133449) yuan, P=0.023]. There was no statistical difference in postoperative laboratory indicators between the two groups (P>0.05). There was also no statistical difference in the duration of surgery, postoperative 24 h drainage volume, ICU stay time, postoperative hospital stay or incidences of perioperative compications including pleural effusion, transfusion, new-onset atrial fibrillation, acute kidney injury, non-union of incision, major cardiovascular and cerebrovascular adverse events, and reoperation between the two groups (P>0.05). Conclusion Compared with the minimally invasive group, the robotic group shows satisfactory efficacy and can effectively reduce postoperative pain and intraoperative bleeding, and shorten postoperative mechanical ventilation time.

Objective:To investigate the effect of levosimendan combined with dual antiplatelet therapy on heart failure in elderly patients with ischemic cardiomyopathy and its effect on ventricular remodeling, serum growth stimulating gene 2 protein (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.Methods:A total of 158 elderly patients with ischemic cardiomyopathy admitted to Yan 'an People 's Hospital from December 2021 to December 2023 were selected as the research objects. Under the principle of balanced and comparable baseline characteristics between groups, they were divided into observation group ( n=79) and control group ( n=79) by random number table method. The patients in the control group received dual antiplatelet and conventional treatment, and patients in the observation group were treated with levosimendan on the basis of the treatment plan of the control group. After treatment, the effective rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), serum sST2 level, NT-proBNP level and the incidence of disease-related adverse reactions after treatment were compared between the two groups. Measurement data with normal distribution were expressed as xˉ± s, and the mean comparison between groups was performed by independent sample t test. Counting data were expressed as case(%), comparison between groups was performed by χ2 test. P<0.05 was considered statistically significant. Results:After treatment, the effective rate of the observation group was 97.47% (77/79), which was significantly higher than 82.28% (65/79) of the control group ( χ2=10.01, P=0.002); at the same time, the LVEF level of the observation group after intervention was (49.26±3.98)%, which was significantly higher than that of the control group (46.13±4.02)%, and the difference was statistically significant ( t=4.92, P<0.001), and the levels of LVEDV and LVESV in the observation group after intervention were (104.25±18.36)mL and (49.24±6.37)mL, respectively, which were significantly lower than (118.97±19.25)mL and (55.12±6.28)mL in the control group, and the differences were statistically significant ( t values were 4.92 and 5.84, respectively; all P<0.01). In addition, the levels of sST2 and NT-proBNP in the observation group after intervention were (37.25±15.48)μg/L and (825.37±86.24)ng/L, respectively, which were significantly lower than those in the control group (66.35±16.37)μg/L and (1136.24±121.75)ng/L, and the differences were statistically significant ( t values were 11.48 and 18.52, respectively; all P<0.001); the total incidence of adverse drug reactions in the observation group and the control group was 17.72% (14/79) and 18.90% (15/79), respectively, and the difference was not statistically significant ( χ2=0.04, P=0.837). Conclusion:The combination of levosimendan and dual antiplatelet therapy can effectively improve the efficacy of ischemic cardiomyopathy in heart failure, improve ventricular remodeling, and regulate sST2 and NT proBNP levels, with high application value.

OBJECTIVE: To observe the characteristics of changes in non-invasive hemodynamic parameters in neonates with septic shock so as to provide clinical reference for diagnosis and treatment. METHODS: A observational study was conducted. The neonates with sepsis complicated with septic shock or not admitted to neonatal intensive care unit (NICU) of the First Affiliated Hospital of Shantou University Medical College were enrolled as the study subjects, who were divided into preterm infant (< 37 weeks) and full-term infant (≥ 37 weeks) according to the gestational age. Healthy full-term infants and hemodynamically stable preterm infants transferring to NICU after birth were enrolled as controls. Electronic cardiometry (EC) was used to measure hemodynamic parameters, including heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI), before treatment in the septic shock group, at the time of diagnosis of sepsis in the sepsis without shock group, and before the discharge from the obstetric department or on the day of transferring to NICU in the control group. RESULTS: Finally, 113 neonates with complete data and parental consent for non-invasive hemodynamic monitoring were enrolled, including 32 cases in the septic shock group, 25 cases in the sepsis without shock group and 56 cases in the control group. In the septic shock group, there were 17 cases at the compensated stage and 15 cases at the decompensated stage. There were 21 full-term infants (20 cured or improved and 1 died) and 11 premature infants (7 cured or improved and 4 died), with the mortality of 15.62% (5/32). There were 18 full-term infants and 7 premature infants in the sepsis without shock group and all cured or improved without death. The control group included 28 full-term infants and 28 premature infants transferring to NICU after birth. Non-invasive hemodynamic parameter analysis showed that SV, SVI, CO and CI of full-term infants in the septic shock group were significantly lower than those in the sepsis without shock group and control group [SV (mL): 3.52±0.99 vs. 5.79±1.32, 5.22±1.02, SVI (mL/m²): 16.80 (15.05, 19.65) vs. 27.00 (22.00, 32.00), 27.00 (23.00, 29.75), CO (L/min): 0.52±0.17 vs. 0.80±0.14, 0.72±0.12, CI (mL×s^-1×m^-2): 40.00 (36.67, 49.18) vs. 62.51 (56.34, 70.85), 60.01 (53.34, 69.68), all P < 0.05], while SVR and SVRI were significantly higher than those in the sepsis without shock group and control group [SVR (kPa×s×L^-1): 773.46±291.96 vs. 524.17±84.76, 549.38±72.36, SVRI (kPa×s×L^-1×m^-2): 149.27±51.76 vs. 108.12±12.66, 107.81±11.87, all P < 0.05]. MAP, SV, SVI, CO and CI of preterm infants in the septic shock group were significantly lower than those in the control group [MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 38.55±10.48 vs. 47.46±2.85, SV (mL): 2.45 (1.36, 3.58) vs. 3.96 (3.56, 4.49), SVI (mL/m²): 17.60 (14.20, 25.00) vs. 25.50 (24.00, 29.00), CO (L/min): 0.32 (0.24, 0.63) vs. 0.56 (0.49, 0.63), CI (mL×s^-1×m^-2): 40.01 (33.34, 53.34) vs. 61.68 (56.68, 63.35), all P < 0.05], while SVR and SVRI were similar to the control group [SVR (kPa×s×L^-1): 1 082.88±689.39 vs. 656.63±118.83, SVRI (kPa×s×L^-1×m^-2): 126.00±61.50 vs. 102.37±11.68, both P > 0.05]. Further analysis showed that SV, SVI and CI of neonates at the compensation stage in the septic shock group were significantly lower than those in the control group [SV (mL): 3.60±1.29 vs. 4.73±1.15, SVI (mL/m²): 19.20±8.33 vs. 26.34±3.91, CI (mL×s^-1×m^-2): 46.51±20.34 vs. 61.01±7.67, all P < 0.05], while MAP, SVR and SVRI were significantly higher than those in the control group [MAP (mmHg): 52.06±8.61 vs. 48.54±3.21, SVR (kPa×s×L^-1): 874.95±318.70 vs. 603.01±111.49, SVRI (kPa×s×L^-1×m^-2): 165.07±54.90 vs. 105.09±11.99, all P < 0.05]; MAP, SV, SVI, CO and CI of neonates at the decompensated stage in the septic shock group were significantly lower than those in the control group [MAP (mmHg): 35.13±6.08 vs. 48.54±3.21, SV (mL): 2.89±1.17 vs. 4.73±1.15, SVI (mL/m²): 18.50±4.99 vs. 26.34±3.91, CO (L/min): 0.41±0.19 vs. 0.65±0.15, CI (mL×s^-1×m^-2): 43.34±14.17 vs. 61.01±7.67, all P < 0.05], while SVR and SVRI were similar to the control group [SVR (kPa×s×L^-1): 885.49±628.04 vs. 603.01±111.49, SVRI (kPa×s×L^-1×m^-2): 114.29±43.54 vs. 105.09±11.99, both P > 0.05]. CONCLUSIONS Full-term infant with septic shock exhibit a low cardiac output, high vascular resistance hemodynamic pattern, while preterm infant with septic shock show low cardiac output and normal vascular resistance. At the compensated stage the hemodynamic change is low output and high resistance type, while at the decompensated stage it is low output and normal resistance type. Non-invasive hemodynamic monitoring can assist in the identification of neonatal septic shock and provide basis for clinical diagnosis and treatment.
Humans ; Shock, Septic/physiopathology* ; Infant, Newborn ; Hemodynamics ; Female ; Male ; Case-Control Studies ; Infant, Premature

Objective:To investigate the effect of levosimendan combined with dual antiplatelet therapy on heart failure in elderly patients with ischemic cardiomyopathy and its effect on ventricular remodeling, serum growth stimulating gene 2 protein (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.Methods:A total of 158 elderly patients with ischemic cardiomyopathy admitted to Yan 'an People 's Hospital from December 2021 to December 2023 were selected as the research objects. Under the principle of balanced and comparable baseline characteristics between groups, they were divided into observation group ( n=79) and control group ( n=79) by random number table method. The patients in the control group received dual antiplatelet and conventional treatment, and patients in the observation group were treated with levosimendan on the basis of the treatment plan of the control group. After treatment, the effective rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), serum sST2 level, NT-proBNP level and the incidence of disease-related adverse reactions after treatment were compared between the two groups. Measurement data with normal distribution were expressed as xˉ± s, and the mean comparison between groups was performed by independent sample t test. Counting data were expressed as case(%), comparison between groups was performed by χ2 test. P<0.05 was considered statistically significant. Results:After treatment, the effective rate of the observation group was 97.47% (77/79), which was significantly higher than 82.28% (65/79) of the control group ( χ2=10.01, P=0.002); at the same time, the LVEF level of the observation group after intervention was (49.26±3.98)%, which was significantly higher than that of the control group (46.13±4.02)%, and the difference was statistically significant ( t=4.92, P<0.001), and the levels of LVEDV and LVESV in the observation group after intervention were (104.25±18.36)mL and (49.24±6.37)mL, respectively, which were significantly lower than (118.97±19.25)mL and (55.12±6.28)mL in the control group, and the differences were statistically significant ( t values were 4.92 and 5.84, respectively; all P<0.01). In addition, the levels of sST2 and NT-proBNP in the observation group after intervention were (37.25±15.48)μg/L and (825.37±86.24)ng/L, respectively, which were significantly lower than those in the control group (66.35±16.37)μg/L and (1136.24±121.75)ng/L, and the differences were statistically significant ( t values were 11.48 and 18.52, respectively; all P<0.001); the total incidence of adverse drug reactions in the observation group and the control group was 17.72% (14/79) and 18.90% (15/79), respectively, and the difference was not statistically significant ( χ2=0.04, P=0.837). Conclusion:The combination of levosimendan and dual antiplatelet therapy can effectively improve the efficacy of ischemic cardiomyopathy in heart failure, improve ventricular remodeling, and regulate sST2 and NT proBNP levels, with high application value.

Humans ; Early Detection of Cancer ; Endoscopy ; Esophageal Neoplasms/epidemiology* ; Risk Factors ; Mass Screening

OBJECTIVE To predict potential quality markers(Q-markers) in Yinhua Miyanling tablets based on fingerprinting and network pharmacology methods. METHODS HPLC fingerprints of 13 batches of Yinhua Miyanling tablets were established, and the similarity analysis was carried out using the "Chromatographic Fingerprint Evaluation System for Traditional Chinese Medicine" to identify the common peaks and attribute them. The fingerprints of Yinhua Miyanling tablets were investigated using chemometrics, cluster analysis, principal component analysis and orthogonal partial least squares discriminant analysis in combination with SPSS 26.0 and SIMCA 14.1 software to identify the major signature components responsible for the differences. The network pharmacology was used to screen and analyze the targets and pathways of Yinhua Miyanling tablets, construct a "drug-component-target-pathway" network diagram, and predict the Q-Marker and core targets of Yinhua Miyanling tablets. RESULTS HPLC fingerprint of Yinhua Miyanling tablets was established, and 27 common peaks including chlorogenic acid, mangostin, wild baicalin, lignocerin and quercetin were identified. Chemical pattern recognition analysis screened five components as differential markers for Yinhua Miyanling tablets. Five active ingredients, 20 core targets and 20 key pathways were screened by network pharmacology, showing that all five active ingredients could be used as potential Q-Markers. CONCLUSION The method is stable, accurate and feasible for screening five chemical components as potential Q-Markers for Yinhua Miyanling tablets. It provides a reference for the overall control of the quality of Yinhua Miyanling tablets, and also lays the foundation for further research on the mechanism of action of Yinhua Miyanling tablets.

Aristolochic acid (AA), extracted from Aristolochiaceae plants, plays an essential role in traditional herbal medicines and is used for different diseases. However, AA has been found to be nephrotoxic and is known to cause aristolochic acid nephropathy (AAN).AA-induced acute kidney injury (AKI) is a syndrome in AAN with a high morbidity that manifests mitochondrial damage as a key part of its pathological progression. Melatonin primarily serves as a mitochondria-targeted antioxidant. However, its mitochondrial protective role in AA-induced AKI is barely reported. In this study, mice were administrated 2.5 mg/kg AA to induce AKI. Melatonin reduced the increase in Upro and Scr and attenuated the necrosis and atrophy of renal proximal tubules in mice exposed to AA. Melatonin suppressed ROS generation, MDA levels and iNOS expression and increased SOD activities in vivo and in vitro. Intriguingly, the in vivo study revealed that melatonin decreased mitochondrial fragmentation in renal proximal tubular cells and increased ATP levels in kidney tissues in response to AA. In vitro, melatonin restored the mitochondrial membrane potential (MMP) in NRK-52E and HK-2 cells and led to an elevation in ATP levels. Confocal immunofluorescence data showed that puncta containing Mito-tracker and GFP-LC3A/B were reduced, thereby impeding the mitophagy of tubular epithelial cells. Furthermore, melatonin decreased LC3A/B-II expression and increased p62 expression. The apoptosis of tubular epithelial cells induced by AA was decreased. Therefore, our findings revealed that melatonin could prevent AA-induced AKI by attenuating mitochondrial damage, which may provide a potential therapeutic method for renal AA toxicity.

Objective:To discuss the influence of mindfulness-based stress reduction plus micro-class education on the complications and knowledge mastery rate in surgical patients with diabetes mellitus.Methods:A total of 105 patients, diagnosed as diabetes mellitus complicated with appendicitis in the Affiliated Hospital of Chengde Medical College were selected from January 2019 to January 2020. They were hospitalized for laparoscopic appendectomy and were randomly divided into the control group ( n = 52) and the study group ( n = 53) in accordance with the random number table. The patients in the control group were given routine nursing care, and the patients in the study group were given mindfulness decompression therapy combined with micro-classroom education. The blood glucose control and psychological emotion of the two groups before and after operation, and the postoperative complications and the mastery rate of disease knowledge of the two groups were compared. Results:There was no significant difference in blood glucose indexes between the two groups at baseline ( P>0.05); FBG, HbA1c and other indicators in the two groups were improved during operation and 24h after operation, but FBG (7.38±0.54) mmol/L, HbA1c (6.39±0.21)% and FBG (6.90±0.52) mmol/L and HbA1c (6.10±0.39)% in the study group were lower than those in the control group [(8.16±1.21) mmol/L, (7.53±1.05)%, (7.60±0.57) mmol/L, (6.50±0.41)%], the difference was statistically significant ( t value was 6.789-13.264, P < 0.05); there was no significant difference in SAS and SDS scores between the two groups at baseline ( P > 0.05), until discharge, the SAS and SDS scores of the treatment group were 35.81±5.49 and 42.08±4.91 respectively, which were significantly lower than those of the control group (42.21±5.53, 6.51±4.72) respectively, compared with the corresponding scale scores of the control group, the difference between the two groups after treatment was statistically significant ( t value was 5.386, 4.265, P < 0.05). Compared with 17.31% (9/52) of the control group, the incidence of complications in the study group decreased to 5.66% (3/53), there was significant difference ( χ2 value was 6.789, P < 0.05). The qualified rate of disease knowledge mastery in the study group (98.11%,52/53) was significantly higher than that in the control group (86.53%, 45/52), and the difference was significant ( χ2 value was 5.062, P < 0.05). Conclusion:The mindfulness-based stress reduction plus micro-class education can effectively control the laparoscopic appendectomy patients blood glucose, stabilize the mental emotions, increase the illness knowledge mastery degree, keep in good mood, reduce the postoperative complications and promote the fast recovery.

Objective:To implement an intervention with community-dwelling middle-aged and elderly people through a new science promotion approach, and to evaluate changes in the level of bone health awareness.Methods:From April 2017 to June 2017, 200 community-dwelling middle-aged and elderly people aged 50 years and over were randomly included.They were divided into the intervention group receiving a new science promotion intervention(n=100, with 50 males and 50 females)and the control group(n=100, with 50 males and 50 females). Baseline and follow-up assessments of bone health awareness were performed before and after the one-year intervention.A questionnaire survey on preferences for different types of science promotion articles in WeChat accounts was conducted.Differences in scores for intervention effects before and after intervention were compared between the two groups.Potential influencing factors for the scale score were examined by a multi-factor analysis.Results:After one year of intervention, scores for intervention effects were higher in the intervention group than in the control group( P<0.001). In the intervention group, scores were higher after intervention than before intervention( P<0.001). In the control group, scores after follow-up were slightly higher than those at baseline(29.4±11.4 vs.27.9±10.1, P<0.001). The increase in scores before and after intervention was greater in the intervention group than in the control group( P<0.001). Baseline score, group designation, history of drinking and diabetes impacted the scores in middle-aged and elderly women, while other factors did not.Most middle-aged and older people preferred texts illustrated with pictures, and older people were more receptive to videos. Conclusions:The new science promotion method is beneficial to bone health management, can improve bone health awareness in middle-aged and elderly people.

Objective: To investigate the influencing factors of fertility outcome after laparoscopic conservative surgery for tubal pregnancy. Methods: From October 2010 to October 2016, 253 cases of tubal pregnancy treated by laparoscopic conservative surgery in General Hospital of Jizhong energy Fengfeng Group Hospital were analyzed retrospectively.All patients were followed up from 24 to 36 months after operation to observe the intrauterine pregnancy.Logistic regression was used to analyze the influencing factors of intrauterine pregnancy. Results: After 24-36 months follow-up, the patients were not contraception and pregnant under the guidance of doctors.Among the 253 cases, 182 (71.1%) were intrauterine pregnancy, 37 (14.6%) were ectopic pregnancy, and 34 (13.4%) were not pregnant.The results of logistic regression showed that high level of hCG, severe pelvic adhesions, obstruction of fallopian tube and history of ectopic pregnancy were the risk factors of intrauterine pregnancy (OR (95%CI) 1.982 (1.075-3.149), 2.410 (1.279-5.069), 2.485 (1.071-3.594), 5.071 (1.094-9.081), P<0.05 or P<0.01). Conclusion The reproductive outcome of laparoscopic conservative surgery for tubal pregnancy is influenced by many factors.The high level of hCG in preoperative blood, severe pelvic adhesions, obstruction of tubal and ectopic pregnancy history are the risk factors of postoperative pregnancy.