In patients with heart failure with reduced ejection fraction(HFrEF),some individuals demonstrate significant improvement in left ventricular ejection fraction(LVEF)during subsequent evaluations after treatment.The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America(AHA/ACC/HFSA)heart failure management guidelines introduced the term"heart failure with improved ejection fraction(HFimpEF)"to describe patients with prior LVEF≤40%that subsequently increased above 40%during follow-up.Studies indicate that HFimpEF patients exhibit lower all-cause mortalities and heart failure rehospitalization rates,with a significantly better prognosis compared to HFrEF patients,establishing HFimpEF as a staged therapeutic target for HFrEF.Current discussion on HFimpEF primarily focuses on two aspects:characteristics of the target population and effective methods for LVEF improvement,and maintenance strategies for cardiac function preservation in HFimpEF patients;particularly the latter lacks clear clinical-guideline recommendations.Therefore,reviewing existing research to systematically summarize therapeutic strategies that promote the HFrEF-to-HFimpEF transition and effective maintenance approaches for HFimpEF becomes crucial.This article comprehensively reviews the LVEF-improving effects of current pharmacological,device-based,and surgical interventions,along with monitoring and management strategies for HFimpEF patients.In HFrEF patients,clinical evidence suggests that β-blockers and cardiac resynchronization therapy can significantly improve LVEF beyond 40%.Regarding HFimpEF management,sodium-glucose cotransporter-2 inhibitors(SGLT2i)and renin-angiotensin system inhibitors(RASi)demonstrate efficacy in maintaining LVEF and cardiac function.Additionally,this review identifies current research limitations in HFimpEF and proposes potential future research directions.

In patients with heart failure with reduced ejection fraction(HFrEF),some individuals demonstrate significant improvement in left ventricular ejection fraction(LVEF)during subsequent evaluations after treatment.The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America(AHA/ACC/HFSA)heart failure management guidelines introduced the term"heart failure with improved ejection fraction(HFimpEF)"to describe patients with prior LVEF≤40%that subsequently increased above 40%during follow-up.Studies indicate that HFimpEF patients exhibit lower all-cause mortalities and heart failure rehospitalization rates,with a significantly better prognosis compared to HFrEF patients,establishing HFimpEF as a staged therapeutic target for HFrEF.Current discussion on HFimpEF primarily focuses on two aspects:characteristics of the target population and effective methods for LVEF improvement,and maintenance strategies for cardiac function preservation in HFimpEF patients;particularly the latter lacks clear clinical-guideline recommendations.Therefore,reviewing existing research to systematically summarize therapeutic strategies that promote the HFrEF-to-HFimpEF transition and effective maintenance approaches for HFimpEF becomes crucial.This article comprehensively reviews the LVEF-improving effects of current pharmacological,device-based,and surgical interventions,along with monitoring and management strategies for HFimpEF patients.In HFrEF patients,clinical evidence suggests that β-blockers and cardiac resynchronization therapy can significantly improve LVEF beyond 40%.Regarding HFimpEF management,sodium-glucose cotransporter-2 inhibitors(SGLT2i)and renin-angiotensin system inhibitors(RASi)demonstrate efficacy in maintaining LVEF and cardiac function.Additionally,this review identifies current research limitations in HFimpEF and proposes potential future research directions.

ObjectiveTo observe the behavioral and pain threshold alterations， as well as the changes in indexes related to depression and pain in the serum and central system in mice stressed by maternal separation and chronic neuropathic pain， and explore the underlying mechanism of Wenyang prescription （WY）， Jieyu prescription （JY）， and Wenyang Jieyu prescription （WYJY） in improving depression and pain sensitivity. MethodThe birth date of mice was recorded as PD0. After birth， the mice were divided into a blank group and an experimental group. The neonatal mice in the experimental group underwent maternal separation in PD5-14 at 8 h·d^-1. After ablactation， the mice were divided into a maternal separation group， a WY group （Erxian decoction， 5.84 g·kg^-1）， a JY group （Xiaoyaosan， 12.00 g·kg^-1）， a WYJY group （16.68 g·kg^-1）， and a fluoxetine group （2.60 mg·kg^-1）， with 15 mice in each group. Meanwhile， 15 male mice of the same age without maternal separation were assigned to the normal control group. Mice in the blank group and the maternal separation group were fed on a regular chow diet in PD21-PD90， while the remaining groups were fed on the corresponding drugs. In PD91， sciatic nerve ligation was performed to induce a model of maternal separation and chronic neuropathic pain. The open field test was used to observe the depression-like behaviors of mice in each group， and the mechanical and temperature pain thresholds were measured to detect the pain sensitivity of mice in each group. The serum levels of corticosterone （CORT）， substance P， and β-endorphin （β-EP） were determined by enzyme-linked immunosorbent assay （ELISA）， and the expression of the glucocorticoid receptor （GR） in the amygdala and β-EP protein in the hypothalamus was detected by immunohistochemistry. The mRNA expression levels of amygdala GR gene （Nr3c1）， FK506 binding protein 5 gene （FKBP5）， metabolic glutamate receptor 5 gene （GRM5）， and brain-derived neurotrophic factor （BDNF） were detected by real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）. ResultCompared with the blank group， the maternal separation group showed reduced stay time and total distance traveled in the 5-min open field test （P<0.01）， reduced mechanical pain threshold （P<0.01）， increased serum CORT and β-EP （P<0.01）， declining FKBP5 mRNA expression （P<0.01）， and increased hypothalamic β-EP expression （P<0.05）. Compared with the maternal separation group， the groups with drug intervention showed prolonged stay time （P<0.05， P<0.01） and up-regulated pain thresholds to different degrees. The total distance traveled in the 5-min open field test increased in the WY group， the WYJY group， and the fluoxetine group （P<0.05， P<0.01）. The JY group showed decreased serum CORT （P<0.01）， reduced β-EP ， and increased BDNF mRNA （P<0.01）. Nr3c1 and GRM5 mRNA decreased in the WY group （P<0.05， P<0.01）. The WYJY group showed decreased serum CORT （P<0.05）and decreased Nr3c1， GRM5， and BDNF mRNA （P<0.05， P<0.01）. The levels of β-EP expression were elevated to different degrees in the groups with drug intervention， but the differences were not significant. The levels of GR expression in the WY group， the JY group， and the WYJY group increased （P<0.05）. ConclusionWYJY can inhibit central pain sensitization and regulate hypothalamic-pituitary-adrenal gland （HPA） axis function by enhancing the expression of GR in the amygdala and inhibiting neuroplasticity and excitability in the amygdala to relieve depression-like behaviors and improve somatic hyperalgesia.

Objective:To discuss the characteristics of common diseases of fighter pilots and provide evidence and support for improving the health level and combat capabilities of Chinese fighter pilots by the Meta-analysis of disease spectrum.Methods:The information of disease spectrum of Chinese fighter pilots was extracted from the literatures collected by SinoMed, China Academic Journal Network Publishing Database, China Scientific Journal Database, Wanfang Data and PubMed before December of 2020. STATA 16 and SPSS 26 software were used to make system evaluation for the constituent ratio of single disease, and the diseases were analyzed in subgroups by years.Results:Seventeen literatures, that published from 2002 to 2020, were collected for Meta-analysis and 9 431 persons were involved (aged from 20 to 60 years) based on the statistical analysis from 1965 to 2019. The results indicated metabolic diseases, spinal diseases, aviation occupational diseases, hepatobiliary diseases, etc.. The Meta-analysis showed that the proportion of spinal diseases was 29.5% (95 %CI was 20.8%~38.2%, I2=99.0%), metabolic diseases was 22.2% (95 %CI was 12.5%~31.8%, I2=99.5%), valvulopathy and arrhythmia was 15.1% (95 %CI was 7.3%~22.8%, I2=97.0%), aviation occupational diseases was 14.3% (95 %CI was 8.2%~20.4%, I2=94.4%), hepatobiliary diseases was 10.5% (95 %CI was 5.4%~15.5%, I2=98.9%) and gastrointestinal diseases was 8.4% (95 %CI was 5.5%~11.3%, I2=94.0%) in Chinese fighter pilots. Conclusions:The metabolic diseases, spinal diseases and hepatobiliary diseases are accounted for a relatively higher proportion among Chinese fighter pilots, and corresponding protective measures should be taken to improve the health level of pilots through the work of medical support departments at all levels.

Objective:To discuss the characteristics of common diseases of fighter pilots and provide evidence and support for improving the health level and combat capabilities of Chinese fighter pilots by the Meta-analysis of disease spectrum.Methods:The information of disease spectrum of Chinese fighter pilots was extracted from the literatures collected by SinoMed, China Academic Journal Network Publishing Database, China Scientific Journal Database, Wanfang Data and PubMed before December of 2020. STATA 16 and SPSS 26 software were used to make system evaluation for the constituent ratio of single disease, and the diseases were analyzed in subgroups by years.Results:Seventeen literatures, that published from 2002 to 2020, were collected for Meta-analysis and 9 431 persons were involved (aged from 20 to 60 years) based on the statistical analysis from 1965 to 2019. The results indicated metabolic diseases, spinal diseases, aviation occupational diseases, hepatobiliary diseases, etc.. The Meta-analysis showed that the proportion of spinal diseases was 29.5% (95 %CI was 20.8%~38.2%, I2=99.0%), metabolic diseases was 22.2% (95 %CI was 12.5%~31.8%, I2=99.5%), valvulopathy and arrhythmia was 15.1% (95 %CI was 7.3%~22.8%, I2=97.0%), aviation occupational diseases was 14.3% (95 %CI was 8.2%~20.4%, I2=94.4%), hepatobiliary diseases was 10.5% (95 %CI was 5.4%~15.5%, I2=98.9%) and gastrointestinal diseases was 8.4% (95 %CI was 5.5%~11.3%, I2=94.0%) in Chinese fighter pilots. Conclusions:The metabolic diseases, spinal diseases and hepatobiliary diseases are accounted for a relatively higher proportion among Chinese fighter pilots, and corresponding protective measures should be taken to improve the health level of pilots through the work of medical support departments at all levels.

Objective:To investigate the expressions and correlation of bcl-2, programmed death-1 (PD-1) and programmed death ligand-1(PD-L1) in diffuse large B-cell lymphoma (DLBCL) tissue specimens, and the relationship between chemotherapy efficacy and prognosis of DLBCL patients.Methods:The expressions of bcl-2, PD-1 and PD-L1 in 82 patients with DLBCL who were admitted to Chenzhou First People's Hospital of Hunan Province from May 2011 to April 2014 were detected by using immunohistochemistry, and the correlation of the expressions of bcl-2, PD-1 and PD-L1 with clinicopathological characteristics and prognosis was analyzed.Results:The positive rate of bcl-2, PD-L1 and PD-1 in cancer tissues of DLBCL patients was 53.7% (44/82), 56.1% (46/82) and 32.9% (27/82), respectively. There was a correlation between bcl-2 and PD-L1 expression ( r = 0.306, P = 0.005). Bcl-2 was highly expressed in patients with international prognosis index (IPI) score 3-4 points, non-germinal center B-cell-like (non-GCB) subtype and B symptoms (all P < 0.05); PD-1 was highly expressed in patients with IPI score 3-4 points ( P < 0.05); PD-L1 was highly expressed in patients with IPI score 3-4 points, tumor stage Ⅲ-Ⅳ, B symptoms, ≥60 years old, and non-GCB (all P < 0.05). The overall survival (OS) and progression-free survival (PFS) in bcl-2-negative group were better than those in the bcl-2-positive group, and the differences were statistically significant (both P < 0.05); OS and PFS in PD-L1-negative group were better than those in PD-L1-positive group, and the differences were statistically significant(both P < 0.01). There were no statistical differences in OS and PFS between PD-1-positive group and PD-1-negative group (both P > 0.05). OS and PFS in bcl-2 and PD-L1 co-expression group were worse than those in both negative or any negative group (all P < 0.01), and PFS in bcl-2 and PD-1 co-expression group was worse than those in both negative or any negative group ( P = 0.044). Cox multivariate analysis showed IPI score 3-4 points and B symptoms were the independent influencing factors of OS in DLBCL patients (both P < 0.01); IPI score 3-4 points, B symptoms and PD-L1-positive were the independent influencing factors of poor PFS in DLBCL patients (all P < 0.05). Conclusion:The positive expressions of bcl-2 and PD-L1 are the independent factors for the poor prognosis of DLBCL patients, which may become new targets for the treatment of DLBCL.

Objective To study the effect of thrombolysis of inta-arterial infusion of different concentrations of urokinase(UK) in dogs. Methods 25 healthy crossbreeding dogs were divided into five groups, with five dogs in each group. Every dog was injected with self-thrombus from carotis interna artery to embolize its distal part or branchers. Treatment with different concentrations of UK was initiated 2 hours after setting up the model of cerebral embolism by carotis interna artery. The dose of each group was: A(control group), 0.9% physiological sodium chloride solution; B,1 200U/ml UK; C,6 000U/mlUK; D, 12 000U/mlUK; E, 60 000U/mlUK. Angiography and CT scannings were performed before and after thrombolysis. Pathologic examination was performed 24 hours after embolism. Results The rate of recanalization of groups A,B were 0 but 100% for groups C,D and E, Judged by angiographies after thrombolysis, group C,D and E had significantly better reperfusion compared with group A,B(P