Objective To compare the differences in clinical characteristics between persistent atrial fibrillation(PsAF)combined with heart failure with preserved ejection fraction(HFpEF)and heart failure with reduced ejection fraction(HFrEF),and to clarify the influencing factors and predictive efficacy of PsAF combined with heart failure(HF).Methods A total of 117 inpatients with PsAF admitted to Laiyang Hospital of Traditional Chinese Medicine from February 2023 to February 2025 were selected and divided into PsAF+HFpEF group(n=42),PsAF+HFrEF group(n=34),and PsAF group(n=41)according to the type of HF.The baseline data,serum uric acid(UA)levels and echocardiographic parameters[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left atrium diameter(LAD),right ventricular diameter(RVD),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),stroke volume(SV)and pulmonary artery systolic pressure(PASP)]of three groups of patients were compared.Multivariate Logistic regression analysis was used to identify the independent influencing factors of PsAF combined with HF,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive efficacy.Results The proportions of New York Heart Association(NYHA)cardiac function grade Ⅲ-Ⅳ and hyperuricemia,and heart rate,N-terminal pro-brain natriuretic peptide(NT-proBNP),UA in patients of PsAF+HFpEF group and PsAF+HFrEF group were significantly higher than those in PsAF group(P＜0.05).The serum creatinine level of patients in PsAF+HFrEF group was significantly higher than that in PsAF+HFpEF group and PsAF group(P＜0.05).The levels of LVESD,LVEDD,LAD,RVD,PASP,LVEDV and LVESV in PsAF+HFrEF group were significantly higher than those in PsAF group(P＜0.05).The LVESD,LVEDD,LAD,LVEDV and LVESV of patients in PsAF+HFpEF group were significantly lower than those in PsAF+HFrEF group(P＜0.05),LAD and PASP were significantly higher than those in PsAF group(P＜0.05).There was a statistically significant difference in LVEF among three groups of patients(P＜0.05),in sequence:PsAF group＞PsAF+HFpEF group＞PsAF+HFrEF group.Multivariate Logistic regression analysis showed that NT-proBNP,UA,and NYHA cardiac function grade Ⅲ-Ⅳ were all independent risk factors for PsAF complicated with HF,and LVEF was an independent protective factor(P＜0.05).The area under the curve for combined prediction of PsAF combined with HF by NT-proBNP+UA+LVEF was 0.967.Conclusion NT-proBNP,UA and LVEF are all independent predictors of PsAF complicated with HF.The combination of three has highly efficient predictive value and provides an efficient tool for clinical risk stratification.

Objective To compare the differences in clinical characteristics between persistent atrial fibrillation(PsAF)combined with heart failure with preserved ejection fraction(HFpEF)and heart failure with reduced ejection fraction(HFrEF),and to clarify the influencing factors and predictive efficacy of PsAF combined with heart failure(HF).Methods A total of 117 inpatients with PsAF admitted to Laiyang Hospital of Traditional Chinese Medicine from February 2023 to February 2025 were selected and divided into PsAF+HFpEF group(n=42),PsAF+HFrEF group(n=34),and PsAF group(n=41)according to the type of HF.The baseline data,serum uric acid(UA)levels and echocardiographic parameters[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left atrium diameter(LAD),right ventricular diameter(RVD),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),stroke volume(SV)and pulmonary artery systolic pressure(PASP)]of three groups of patients were compared.Multivariate Logistic regression analysis was used to identify the independent influencing factors of PsAF combined with HF,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive efficacy.Results The proportions of New York Heart Association(NYHA)cardiac function grade Ⅲ-Ⅳ and hyperuricemia,and heart rate,N-terminal pro-brain natriuretic peptide(NT-proBNP),UA in patients of PsAF+HFpEF group and PsAF+HFrEF group were significantly higher than those in PsAF group(P＜0.05).The serum creatinine level of patients in PsAF+HFrEF group was significantly higher than that in PsAF+HFpEF group and PsAF group(P＜0.05).The levels of LVESD,LVEDD,LAD,RVD,PASP,LVEDV and LVESV in PsAF+HFrEF group were significantly higher than those in PsAF group(P＜0.05).The LVESD,LVEDD,LAD,LVEDV and LVESV of patients in PsAF+HFpEF group were significantly lower than those in PsAF+HFrEF group(P＜0.05),LAD and PASP were significantly higher than those in PsAF group(P＜0.05).There was a statistically significant difference in LVEF among three groups of patients(P＜0.05),in sequence:PsAF group＞PsAF+HFpEF group＞PsAF+HFrEF group.Multivariate Logistic regression analysis showed that NT-proBNP,UA,and NYHA cardiac function grade Ⅲ-Ⅳ were all independent risk factors for PsAF complicated with HF,and LVEF was an independent protective factor(P＜0.05).The area under the curve for combined prediction of PsAF combined with HF by NT-proBNP+UA+LVEF was 0.967.Conclusion NT-proBNP,UA and LVEF are all independent predictors of PsAF complicated with HF.The combination of three has highly efficient predictive value and provides an efficient tool for clinical risk stratification.

Objective:To explore the sequential chemotherapy efficacy of different chemotherapeutic regimens in ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma.Methods:A retrospective analysis was conducted on clinical and pathological data of 100 patients with platinum-sensitive ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma treated at Peking University Peopel′s Hospital from January 1992 to January 2019. All patients underwent staging surgery or cytoreductive surgery followed by adjuvant chemotherapy. Based on different postoperative adjuvant chemotherapy regimens, patients were divided into the sequential chemotherapy group (70 cases) and the conventional chemotherapy group (30 cases). Clinical and pathological characteristics, chemotherapy efficacy, adverse reactions, and prognosis were compared between the two groups.Results:(1) Clinical and pathological characteristics: the age, tumor types (including ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma), pathological types, International Federation of Gynecology and Obstetrics (FIGO) stage, postoperative residual disease size, presence of neoadjuvant chemotherapy, and total number of chemotherapy cycles were compared between the sequential chemotherapy group and the conventional chemotherapy group. There were no statistically significant differences observed in these characteristics between the two groups (all P>0.05). (2) Chemotherapy efficacy: the median sum of complete response (CR)+partial response (PR) duration in the sequential chemotherapy group was 80.0 months (range: 39 to 369 months), whereas in the conventional chemotherapy group, it was 28.0 months (range: 13 to 52 months). A statistically significant difference was observed between the two groups ( Z=-7.82, P<0.001). (3) Chemotherapy adverse reactions: in the sequential chemotherapy group, 55 cases (79%, 55/70) experienced bone marrow suppression and 20 cases (29%, 20/70) had neurological symptoms. In the conventional chemotherapy group, these adverse reactions occurred in 11 cases (37%, 11/30) and 2 cases (7%, 2/30), respectively. Statistically significant differences were observed between the two groups for both bone marrow suppression and neurological symptoms (all P<0.05). For the other chemotherapy adverse reactions compared between the two groups, no statistically significant differences were observed (all P>0.05). (4) Prognosis: during the follow-up period, the recurrence rate in the sequential chemotherapy group was 73% (51/70) and in the conventional chemotherapy group was 100% (30/30). The median sum of recurrence-free interval was 70.5 months (range: 19 to 330 months) in the sequential chemotherapy group and 15.0 months (range: 6 to 40 months) in the conventional chemotherapy group. Statistically significant differences were observed between the two groups for both recurrence rate and median recurrence-free interval (all P<0.01).In the sequential chemotherapy group, the median progression-free survival (PFS) time was 84.0 months (range: 34 to 373 months), and the median overall survival (OS) time was 87.0 months (range: 45 to 377 months). In contrast, in the conventional chemotherapy group, the median PFS time was 30.5 months (range: 14 to 60 months), and the median OS time was 37.5 months (range: 18 to 67 months). Statistically significant differences were observed between the two groups for both PFS and OS (all P<0.001). In the sequential chemotherapy group, the 3-year, 5-year, and 10-year OS rates were 100% (70/70), 93% (65/70), and 21% (15/70), respectively. In contrast, in the conventional chemotherapy group, the OS rates were 50% (15/30) at 3 years, 3% (1/30) at 5 years, and 0 at 10 years, respectively. The two groups were compared respectively, and the differences were statistically significant (all P<0.05). Conclusions:Sequential chemotherapy significantly prolongs PFS and OS in patients with ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma. The efficacy is superior to that of the conventional chemotherapy, with manageable adverse reactions. The use of sequential chemotherapy as first-line treatment for patients with ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma is recommended.

Objective To investigate the expression of ALKBH3-AS1 in peripheral blood CD4+T cells of patients with systemic lupus erythematosus(SLE)and its correlation with T helper cell 17/regulatory T cells(Th17/Treg)and disease activity.Methods A total of 60 patients diagnosed with SLE in Leshan Hospital of Traditional Chinese Medicine from July 2020 to March 2024 were retrospectively collected.According to SLEDAI score,they were divided into active group(n=33,SLEDAI ≥ 10 score)and stable group(n=27,SLEDAI＜10 score).At the same time,52 healthy subjects were selected as control group.The general data of three groups were collected and peripheral blood mononuclear cell(PBMC)was obtained by centrifugation in peripheral blood.CD4+T cells were isolated by immunomagnetic beads,and Th17/Treg ratio was detected by flow cytometry.The relative expression levels of ALKBH3-AS1 and retinoid-related orphan receptor γ t(ROR γ t)in CD4+T cells were detected by fluorescence quantitative PCR.The contents of transforming growth factor(TGF)-β and interleukin(IL)-17 in serum were determined by enzyme-linked immunosorbent assay(ELISA).The levels of C3 and C4 were determined by rate scattering immunoturbidimetry.Pearson analyzed the correlation between ALKBH3-AS1,Th17 and various clinical indicators in SLE patients.Logistic regression analysis of the influencing factors in patients with severe SLE showed that the difference was statistically significant.Results Hb,ALB,ALKBH3-AS1 mRNA,CD4+T,complement C3 and C4 in the control group were significantly higher than those in SLE group(t/Z=3.245,-11.169,-12.675,-17.829,-15.240,-19.212),RDW,TGF-β,RORγ t,Th17/Treg,IL-17,and CRP in the control group were lower than that in SLE group(t/Z=4.206,10.054,19.869,37.942,50.463,3.115),and the differences were statistically significant(all P＜0.05).ALB,ALKBH3-AS1 mRNA,CD4+T in the active group were significantly lower than those in the stable group(t/Z=-8.918,-2.483,-11.694),CRP,TGF-β,RORγt,Th17/Treg,and IL-17 were significantly higher than those in the stable group(t/Z=3.121,5.671,1.787,14.720,12.044),and the differences were statistically significant(all P＜0.05).Pearson analysis showed that ALKBH3-AS1 was positively correlated with CD4+T(r=0.663),and negatively correlated with Th17/Treg,IL-17,TGF-β,ROR γ t,SLED AIindex(r=-0.687,-0.715,-0.705,-0.678,-0.671),Th17/Treg was negatively correlated with CD4+T(r=-0.817),and positively correlated with IL-17,TGF-β,ROR γ t,SLED AI index with statistical significance(r=0.687,0.767,0.598,0.704).Logistics regression analysis,showed that increased CD4+T[OR(95％CI):0.715(0.304～0.904)]proportion and up-regulated ALKBH3-AS1[OR(95％CI):0.654(0.320～0.987)]expression were protective factors affecting disease activity in SLE patients.The contents of TGF-β[OR(95％CI):1.487(1.120～1.814)]and IL-17[OR(95％CI):1.294(1.217～1.887)]were up-regulated,the proportion of Th17/Treg[OR(95％)CI:1.674(1.361～1.679)]was up-regulated,and the relative expression of ROR γ t[OR(95％)CI:1.547(1.252～1.941)]was increased as risk factors affecting disease activity in SLE patients.Conclusion The down-regulated expression of ALKBH3-AS1 and up-regulated expression of TGF-β,ROR γ t and IL-17 in CD4+T cells of SLE patients are all correlated with disease activity,and can be potential biomarkers for diagnosis,disease activity and efficacy evaluation in SLE patients.

Objective Exploring the relationship between changes in serum Golgi apparatus transmem-brane glycoprotein 73(GP73)and chitosanase 3-like protein 1(CHI3L1)levels and liver fibrosis and lesion sever-ity in patients with hepatitis B(CHB).Methods Using a case-control study,80 patients diagnosed with CHB infection and developing liver fibrosis in the Infectious Disease Department of Changsha First Hospital from June 2020 to June 2023 were selected as the liver fibrosis group,while 120 patients diagnosed with CHB infection but not developing liver fibrosis in the Infectious Disease Department of our hospital were selected as the control group.The serum GP3,CHI3L1,liver function,and fibrosis indicators of the two groups of patients were compared,and the liver fibrosis group was divided into mild according to Scheuer system standards Perform stratified analysis on patients with significant liver fibrosis.Results The serum GP3 and CHI3L1 levels in the liver fibrosis group were significantly higher than those in the control group,with statistical significance(P＜0.05);The ROC curves were plotted using serum GP3,CHI3L1,and GP3+CHI3L1,respectively.The sensitivity for diagnosing liver fibrosis in CHB patients was 62.81%,60.94%,and 96.33%,with specificity of 80.66%,80.05%,and 75.30%.The AUC values under the curves were 0.792,0.756,and 0.908,respectively;The levels of ALT,AST,HA,LN,PC III NP,C IV,and CG in the liver fibrosis group were higher than those in the control group,and the PLT measurement values were lower than those in the control group,with statistical significance(P＜0.05);49 patients with moderate to severe liver fibrosis(33 in S2 phase and 16 in S3 phase)and 31 patients with mild liver fibrosis(all in S1 phase)had significantly higher serum GP3 and CHI3L1 levels than mild patients,with statistical significance(P＜0.05);The levels of DBIL,ALT,AST,HA,LN,PC III NP,C IV,and CG in patients with moderate to severe liver fibrosis were higher than those in the mild group,and the PLT measurement values were lower than those in the mild group,with statistical significance(P＜0.05).Conclusion The serum GP3 and CHI3L1 levels in CHB patients with liver fibrosis are significantly elevated,and there is a certain correlation with the degree of liver fibro-sis.The combination of these two indicators is beneficial for diagnosing liver fibrosis in CHB patients.

ObjectiveTo investigate the possible mechanism of modified Gegen Qinlian Decoction （葛根芩连汤） in treatment of ulcerative colitis （UC） from the view of intestinal mucosal epithelial barrier damage and epithelial mesenchymal transition. MethodsSixty male C57BL/6J mice were divided into blank group， model group， western medicine control group， and low-， medium-， and high-dose modified Gegen Qinlian Decoction groups， with 10 mice in each group. Except for the blank group， 3% dextran sodium sulfate （DSS） was used to induce colitis model by free drinking for 7 days， and on the first day of modelling， 6， 12， and 24 g/（kg·d） of modified Gegen Qinlian Decoction were given to the low-， medium-， and high-dose groups respectively， 5-aminosalicylic acid （5-ASA） 100 mg/（kg·d） given by gavage to western medicine control group， and 10 ml/kg distilled water were given to blank and model group by gavage， once a day for 7 days. Body mass of mice was recorded and disease activity index （DAI） scores were performed daily. The mice were anesthetized after 24h of the last administration and the colon was taken to observe the length of colon， HE staining was applied to observe the damage of colonic mucosa and score pathological states， Masson staining to detect the deposition of colonic collagen fibers， immunofluorescence to observe the distribution of F-actin in colonic mucosal epithelium， and immunohistochemistry to detect the expression of tight junction protein ZO-1， Occludin， E-cadherin and Vimentin. ResultsCompared with the blank group at the same time， the percentage of body mass of mice in the model group on day 7 of modelling significantly reduced and the DAI score was significantly increased （P＜0.01）； compared with the model group at the same time， the body mass of mice in the western medicine control group and all of modified Gegen Qinlian Decoction groups decreased， and the DAI scores of mice in the western medicine control group and the high-dose modified Gegen Qinlian Decoction group decreased （P＜0.05 or P＜0.01）； compared with the same time of mice in the low-dos Gegen Qinlian Decoction group， the body mass of mice in the high-dose Gegen Qinlian Decoction group and the western medicine control group significantly elevated （P＜0.05）. Compared with the blank group， the length of the colon of mice in the model group was significantly shortened， the pathological score and the percentage of collagen area were significantly increased， the average fluorescence intensity of F-actin was reduced， the protein levels of ZO-1， Occludin and E-cadherin in the colon tissue decreased， and the protein level of Vimentin elevated （P＜0.01）. Compared with the model group， the length of colon significantly increased， patholo-gical score， collagen area percentage decreased， ZO-1， Occludin， E-cadherin protein levels increased and Vimentin levels decreased in all medicated groups； the average fluorescence intensity of F-actin increased in the western medicine control group and the middle- and high-dose Gegen Qinlian Decoction groups （P＜0.05 or P＜0.01）. Compared with the low-dose Gegen Qinlian Decoction group， the proportion of collagen fibre area in the middle-dose Gegen Qinlian Decoction group and the western medicine control group reduced； the mean fluorescence intensity of F-actin increased in the middle-dose Gegen Qinlian Decoction group； the protein levels of ZO-1 and E-cadherin increased in the western medicine control group， and the protein levels of ZO-1 increased in the high-dose Gegen Qinlian Decoction group （P＜0.05）. Compared with the medium-dose Gegen Qinlian Decoction group， the protein levels of ZO-1 elevated in the high-dose Gegen Qinlian Decoction group （P＜0.05）. Comapred with the high-dose Gegen Qinlian Decoction group， level of E-cadherin and Vimentin protein of the western medicine control group increased （P＜0.05）. ConclusionModified Gegen Qinlian Decoction was able to reduce colonic inflammation and mucosal barrier damage and inhibit the process of epithelial mesenchymal transition in mice models of ulcerative colitis， which may be one of its action mechanisms .

Objective To investigate the types of dyslipidemia with poor blood glucose control in patients with type 2 diabetes mellitus(T2DM)and their changes after intensive hypoglycemic therapy. Methods A total of 140 T2DM patients who were hospitalized in the Endocrinology Department of Ruijin Hospital Wuxi Branch Shanghai Jiao Tong University of Medicine were enrolled in this study from August 2022 to July 2023. All the participants were divided into no therapy(Con,n=50),oral medication therapy (OAD,n=41),and insulin therapy group (Ins,n=49). Results The age and DM duration were higher in OAD and Ins groups than in Con group (P<0.05). HOMA-IR and FC-P were lower in Ins group than in OAD group (P<0.05). Compared with baseline,FPG,TC,TG,LDL-C,and fructosamine decreased and FC-P increased after treatment in each group (P<0.05). Pearson correlation analysis showed that the changes in TG after treatment in the Con and Ins groups were positively correlated with △fructosamine (P<0.05). Conclusions TC,TG,and LDL-C are increased when blood glucose control is poor in T2DM patients. After intensified hypoglycemic treatment,TC,TG,and LDL-C are decreased. The change in TG after treatment is positively correlated with △fructosamine.

Objective To investigate the types of dyslipidemia with poor blood glucose control in patients with type 2 diabetes mellitus(T2DM)and their changes after intensive hypoglycemic therapy. Methods A total of 140 T2DM patients who were hospitalized in the Endocrinology Department of Ruijin Hospital Wuxi Branch Shanghai Jiao Tong University of Medicine were enrolled in this study from August 2022 to July 2023. All the participants were divided into no therapy(Con,n=50),oral medication therapy (OAD,n=41),and insulin therapy group (Ins,n=49). Results The age and DM duration were higher in OAD and Ins groups than in Con group (P<0.05). HOMA-IR and FC-P were lower in Ins group than in OAD group (P<0.05). Compared with baseline,FPG,TC,TG,LDL-C,and fructosamine decreased and FC-P increased after treatment in each group (P<0.05). Pearson correlation analysis showed that the changes in TG after treatment in the Con and Ins groups were positively correlated with △fructosamine (P<0.05). Conclusions TC,TG,and LDL-C are increased when blood glucose control is poor in T2DM patients. After intensified hypoglycemic treatment,TC,TG,and LDL-C are decreased. The change in TG after treatment is positively correlated with △fructosamine.

Objectives:To verify the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of its clinical application.Methods:A convenience sampling method was used to collect 129 geriatric patients who underwent inguinal hernia surgery from January 2018 to January 2023 in nine hospitals in Liaoning Province. There were 120 males and 9 females, of whom 89 patients were 60 to <75 years old, 33 patients were 75 to <85 years old and 7 patients were ≥85 years old. The 129 patients included 11 elderly patients with inguinal hernia who had recovered from preoperative infection with COVID-19. Statistical methods such as Cronbach′s coefficient, Kaiser-Meyer-Olkin test, Bartlett′s test, Pearson′s correlation analysis, etc. were calculated to verify the reliability indexes such as feasibility, content validity, structural validity, criterion-related validity, internal consistency reliability, and re-test reliability. Taking the 5-item modified frailty index (5-mFI) as the gold standard, the area under the curve was used to analyze the ability of the two scales to predict the occurrence of postoperative acute urinary retention, postoperative delirium, poor incision healing, operative hematoma seroma, and postoperative complications.Results:The frailty assessment scale for elderly patients with inguinal hernia showed good reliability and validity (valid completion rate of 99.2%; item content validity index of 1.000, and the scale content validity index of 1.000; exploratory factor analysis extracted a total of 1 principal component, and factor loadings of each item of 0.565 to 0.873; the AUC for frailty diagnosis using 5-mFI as the gold standard of 0.795 ( P<0.01) Cronbach′s coefficient of 0.916, retest reliability coefficient of 0.926), it could effectively predict postoperative acute urinary retention, delirium, hematoma seroma in the operative area and total complications (AUC of 0.746, 0.870, 0.806, and 0.738, respectively; all P<0.05), and prediction efficiency was higher than that of 5-mFI (AUC of 0.694, 0.838, 0.626 and 0.641, P<0.05 for delirium only), but both scales were inaccurate in predicting poor incision healing (AUC of 0.519, P=0.913 for the frailty assessment scale and 0.455, P=0.791 for the 5-mFI). Conclusions:The frailty assessment scale for elderly patients with inguinal hernia is reliable and significantly predicts the occurrence of postoperative adverse events in elderly inguinal hernia patients. The scale can also be used for preoperative frailty assessment in elderly patients with inguinal hernia after rehabilitation from COVID-19 infection.

Cancer is the leading cause of death in children. With the development of family participatory care, it has become a trend to use home chemotherapy for children with cancer in stable stages. Therefore, this article introduces the current situation of home chemotherapy medication safety, elaborates on the influencing factors of family chemotherapy medication safety for cancer children from two aspects including oral chemotherapy and intravenous chemotherapy, and proposes intervention measures to optimize the family chemotherapy medication process for cancer children, improve their home chemotherapy medication ability and effectively ensure the medication safety of cancer children.