Objective To explore the predictive value of fat attenuation index(FAI)and fibrous plaque index(FPI)for the prognosis of patients with acute coronary syndrome(ACS).Methods A retrospective cohort study was conducted on 334 ACS patients undergoing percutaneous coronary intervention(PCI)in the First Affiliated Hospital of Army Military Medical University and Yongchuan Hospital of Chongqing Medical University from March 2021 to July 2023.All patients received coronary computed tomography angiography(CCTA)to measure FAI and FPI.According to the occurrence of major adverse cardiovascular events(MACE)with 1 year of follow-up,they were divided into MACE group(n=108)and non-MACE group(n=226).The baseline data,CCTA data and results of laboratory tests were collected and compared between the 2 groups.Multivariate logistic regression analysis was used to analyze the relationship of FAI and FPI with the prognosis of ACS patients,and ROC curve was drawn to evaluate its predictive efficiency.Results Among the 334 ACS patients,108(32.34%)experienced MACE.When compared with the non-MACE group,the MACE group exhibited significantly larger proportions of diabetes(72.22%vs 31.86%)and left main coronary artery disease(18.52%vs 7.08%),but lower success rate of operation(79.63%vs 93.81%,P<0.05).Radiologic results showed that the proportion of severe stenosis(20.37%vs 10.62%),FAI(-80.12±6.41 HU vs-72.34±7.09 HU)and FPI(0.58±0.41 vs 0.26±0.12)were obviously increased in the MACE group than the non-MACE group(P<0.05).Laboratory tests indicated that there were statistical differences between the 2 groups in high-density lipoprotein-cholesterol(HDL-C,1.20±0.15 vs 1.09±0.16 mmol/L),miR-126(0.91±0.12 vs 0.96±0.15)and SST2(38.45±5.67 vs 34.30±4.89 ng/mL,P<0.05).Multivariate Logistic regression analysis revealed that FAI(OR=1.200,95%CI:1.136～1.268),FPI(OR=63.157,95%CI:14.126～282.374),moderate stenosis(OR=1.332,95%CI:1.024～1.859),severe stenosis(OR=1.480,95%CI:1.074～2.039),miR-126(OR=0.007,95%CI:0.001～0.077),and sST2(OR=1.192,95%CI:1.113～1.277)were independent predictors of MACE(P<0.05).ROC curve analysis displayed that stenosis degree(AUC=0.622,95%CI:0.561～0.683,P=0.001),FAI(AUC=0.790,95%CI:0.741～0.839,P=0.001)and FPI(AUC=0.700,95%CI:0.638～0.761,P=0.001),miR-126(AUC=0.646,95%CI:0.584～0.707,P=0.001),sST2(AUC=0.700,95%CI:0.638～0.761,P=0.001)had certain predictive values for ACS prognosis.Conclusion Coronary FAI and FPI can be used as independent prognostic indicators of ACS patients,and their numerical changes are closely related to plaque stability and inflammatory state.

As one of the chronic diseases with high incidence in contemporary society, cervical spondylosis has increasing patient groups who gradually present a low age, and it seriously affects social and public health. Although modern medicine has made great progress in the pathological research and clinical treatment of cervical spondylosis, patients still face gastrointestinal side effects of nonsteroidal anti-inflammatory drugs(NSAIDs), neck pain, limited mobility, upper limb numbness, and other symptoms after conservative or surgical treatment. In the theory of traditional Chinese medicine(TCM), cervical spondylosis belongs to the categories of "Bi syndrome" "stiff neck" "stiff Bi", etc. With the change of the times, the change of lifestyle, and the application of western medicine treatment, the etiology and pathogenesis of TCM in cervical spondylosis also show new characteristics. In terms of etiology and pathogenesis, it involves the invasion of wind, cold, and dampness, long-term strain, liver and kidney deficiency, Qi and blood stasis, which are associated with factors such as cervical degeneration, muscle tension and spasm, intervertebral disc herniation, and nerve root compression in modern medicine. In terms of the evolution of pathogenesis, in the early stage, wind, cold, and dampness, were more common in Xuanfu, resulting in unfavorable muscles and bones, poor flow of Qi and blood, and cervical spondylosis and radiculopathy. Medium-term phlegm stasis and internal knots, sluggish muscles and veins, and long-term weathering and fire are more likely to occur in the vertebral artery and sympathetic radiculopathy. In the later stage, the positive Qi is depleted; the true Yin is damaged, and the viscera Qi and blood are deficient, which is most common in cervical myelopathy. The strategy of treating cervical spondylosis with TCM classic formulas applies Gegen Decoction, Wutou Decoction, Qianghuo Shengshi Decoction, Mahuang Jiazhu Decoction to patients with wind, cold, and dampness. Patients with phlegm dampness and blood stasis are treated with Huoxue Xiaoling Dan, Jinlingzi Powder, Siwu Decoction, Banxia Baizhu Tianma Decoction, Shuanghe Decoction, etc. For those patients with liver, spleen, and kidney deficiency, Huangqi Guizhi Wuwu Decoction, Tianma Gouteng Decoction, Guishao Dihuang Pills, Shenling Baizhu Powder, and Lizhong Decoction are used to invigorate the spleen, nourish Qi and blood, and tonify liver and kidney. In clinical practice, the authors advocate a safe and effective treatment plan of classic formulas based on deficiency and excess, the integration of formulas and syndromes, and the combination of modern research results, so as to relieve symptoms, reduce recurrence, and reduce medical burden.
Humans ; Spondylosis/drug therapy* ; Medicine, Chinese Traditional/methods* ; Drugs, Chinese Herbal/therapeutic use* ; Cervical Vertebrae/pathology*

Objective To explore and identify the nutritional/inflammatory indicator with the highest predictive potential for overall survival(OS)in postoperative tumor patients so as to provide guidance for postoperative rehabilitation of tumor patients.Methods Data from 3 191 surgical patients were collected,including 15 nutritional/inflammatory indicators.The maximum selection rank statistic method was used to calculate the optimal cut-off values for continuous indicators.The Kaplan-Meier method was used to assess OS,and Cox proportional hazards models were used to analyze the association between the aforementioned 15 indicators and survival.The predictive value of these 15 indicators was evaluated with receiver operating characteristic(ROC)curves and C-index.Results Multivariate analysis showed that all 15 indicators were significantly associated with poorer OS in surgical patients(P＜0.05 for all).Time-dependent area under the curve(AUC)and C-index analysis indicated that 3 indicators with the highest predictive potential in OS in postoperative tumor patients were the nutritional risk index(NRI)(C-index:0.597),C-reactive protein-to-albumin ratio(CAR)(C-index:0.587),and C-reactive protein-to-lymphocyte ratio(CLR)(C-index:0.587).The optimal cut-off value for NRI was determined to be 104.31(i.e.,NRI＜104.31 suggests malnutrition)with the maximum selection rank statistic method,the optimal cut-off value for CAR to be 0.05(i.e.,CAR≥0.05 suggests a strong inflammatory response,often accompanied by malnutrition),and the optimal cut-off value for CLR to be 1.18(i.e.,CLR≥1.18 suggests a strong inflammatory response).Subgroup analysis indicated that NRI,CAR,and CLR had good correlation with tumor staging,and there were significant differences between tumor node metastasis(TNM)Ⅲ/Ⅳ stage patients and TNM Ⅰ/Ⅱ stage patients when there was a strong inflammatory response or malnutrition.Conclusion In postoperative tumor patients,NRI,CLR,and CAR have high prognostic value.Combining these with the patient's clinical stage,it enables more precise guidance for clinical diagnosis and treatment strategies.

Objective To explore and identify the nutritional/inflammatory indicator with the highest predictive potential for overall survival(OS)in postoperative tumor patients so as to provide guidance for postoperative rehabilitation of tumor patients.Methods Data from 3 191 surgical patients were collected,including 15 nutritional/inflammatory indicators.The maximum selection rank statistic method was used to calculate the optimal cut-off values for continuous indicators.The Kaplan-Meier method was used to assess OS,and Cox proportional hazards models were used to analyze the association between the aforementioned 15 indicators and survival.The predictive value of these 15 indicators was evaluated with receiver operating characteristic(ROC)curves and C-index.Results Multivariate analysis showed that all 15 indicators were significantly associated with poorer OS in surgical patients(P＜0.05 for all).Time-dependent area under the curve(AUC)and C-index analysis indicated that 3 indicators with the highest predictive potential in OS in postoperative tumor patients were the nutritional risk index(NRI)(C-index:0.597),C-reactive protein-to-albumin ratio(CAR)(C-index:0.587),and C-reactive protein-to-lymphocyte ratio(CLR)(C-index:0.587).The optimal cut-off value for NRI was determined to be 104.31(i.e.,NRI＜104.31 suggests malnutrition)with the maximum selection rank statistic method,the optimal cut-off value for CAR to be 0.05(i.e.,CAR≥0.05 suggests a strong inflammatory response,often accompanied by malnutrition),and the optimal cut-off value for CLR to be 1.18(i.e.,CLR≥1.18 suggests a strong inflammatory response).Subgroup analysis indicated that NRI,CAR,and CLR had good correlation with tumor staging,and there were significant differences between tumor node metastasis(TNM)Ⅲ/Ⅳ stage patients and TNM Ⅰ/Ⅱ stage patients when there was a strong inflammatory response or malnutrition.Conclusion In postoperative tumor patients,NRI,CLR,and CAR have high prognostic value.Combining these with the patient's clinical stage,it enables more precise guidance for clinical diagnosis and treatment strategies.

Objective China is among the 30 countries with a high burden of tuberculosis(TB)worldwide,and TB remains a public health concern.Kashgar Prefecture in the southern Xinjiang Autonomous Region is considered as one of the highest TB burden regions in China.However,molecular epidemiological studies of Kashgar are lacking. Methods A population-based retrospective study was conducted using whole-genome sequencing(WGS)to determine the characteristics of drug resistance and the transmission patterns. Results A total of 1,668 isolates collected in 2020 were classified into lineages 2(46.0%),3(27.5%),and 4(26.5%).The drug resistance rates revealed by WGS showed that the top three drugs in terms of the resistance rate were isoniazid(7.4%,124/1,668),streptomycin(6.0%,100/1,668),and rifampicin(3.3%,55/1,668).The rate of rifampicin resistance was 1.8%(23/1,290)in the new cases and 9.4%(32/340)in the previously treated cases.Known resistance mutations were detected more frequently in lineage 2 strains than in lineage 3 or 4 strains,respectively:18.6%vs.8.7 or 9%,P<0.001.The estimated proportion of recent transmissions was 25.9%(432/1,668).Multivariate logistic analyses indicated that sex,age,occupation,lineage,and drug resistance were the risk factors for recent transmission.Despite the low rate of drug resistance,drug-resistant strains had a higher risk of recent transmission than the susceptible strains(adjusted odds ratio,1.414;95%CI,1.023-1.954;P = 0.036).Among all patients with drug-resistant tuberculosis(DR-TB),78.4%(171/218)were attributed to the transmission of DR-TB strains. Conclusion Our results suggest that drug-resistant strains are more transmissible than susceptible strains and that transmission is the major driving force of the current DR-TB epidemic in Kashgar.

OBJECTIVE: To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older. METHODS: We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older. Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer. Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis. RESULTS: We included 157,097 UK Biobank participants (78,151 women and 78,946 men) in our study, with mean age of 64 ± 2.9 years. During a median follow-up of 8.1 (7.4-8.8) years, 1543 (1.0%) participants developed incident aortic stenosis. Compared with those with the lowest handgrip strength (tertile 1), the adjusted hazard ratios (95% confidence interval) of incident aortic stenosis in the middle (tertile 2) and the highest (tertile 3) were 0.86 (0.77-0.97) and 0.76 (0.67-0.87), respectively. CONCLUSIONS Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults. Future studies warrant preventive strategies for older adults with lower handgrip strength.

Objective To investigate the therapeutic effects of proximal femoral nail antirotation(PFNA)assisted by robot navigation and PFNA guided by C-arm X-ray machine for the treatment of intertrochanteric fracture of femur(IFOF).Methods The 100 patients with unilateral IFOF in our hospital were selected as the study subjects.They were divided into the control group(50 cases)and the robot-assisted group(50 cases)according to random number table method.The control group was treated with PFNA internal fixation under C-arm X-ray machine fluoroscopy,and the robot-assisted group was treated with PFNA internal fixation assisted by robot navigation.Surgical indicators,fracture reduction and fracture healing,stress response indexes,hip joint function,quality of life score and incidence of surgery related complications were compared between the two groups.Results The operation time,total fluoroscopy time,nail placement time and fracture healing time of the robot-assisted group were shorter than those of the control group(P＜0.05);and the intraoperative blood loss,guide needle adjustment frequency,and fluoroscopy frequency of the robot-assisted group were less than those of the control group(P＜0.05).The fracture reduction and fracture healing in the robot-assisted group were better than those in the control group(P＜0.05).Two days after operation,the levels of serum norepinephrine(NE),angiotensin Ⅱ(Ang Ⅱ)and superoxide dismutase(SOD)in the two groups were higher than those before operation(P＜0.05),and the levels of serum NE,Ang Ⅱ and SOD in the robot-assisted group were lower than those in the control group(P＜0.05).The Harris score and 36-item short-form(SF-36)score of patients 7 days and 3 months after surgery in the two groups were higher than those before surgery(P＜0.05),and the above scores 3 months after surgery were higher than those 7 days after surgery(P＜0.05).Harris score and SF-36 score 7 days and 3 months after operation in the robot-assisted group were higher than those in the control group(P＜0.05).The incidence of complications in the robot-assisted group was lower than that in the control group(P＜0.05).Conclusion Compared with the C-arm X-ray machine fluoroscopy,the treatment of IFOF with PFNA assisted by robot navigation can further shorten the operation time,reduce the surgical trauma and the incidence of complications,achieve better effect of fracture reduction and healing,reduce stress response of the body,and improve hip joint function and quality of life for patients.

Objective:To explore whether Ph+acute lymphoblastic leukemia (ALL)cell line SUP-B15 treated with imatinib occurs a tolerant status charactered by cell proliferation suppression but apoptotic resistance,then evaluate whether IGF1-R inhibitor AEW541 can break this tolerance,and further explain its mechanisms.Methods:SUP-B15 cells were treated with different concentrations of imatinib or AEW541.Cell proliferation was assayed by Deep Blue,and apoptotic cells were determined by Annexin V/7-AAD staining.Apoptotic rate was measured by flow cytometry after co-treatment of imatinib and AEW541.Western blot was used to evaluate ABL downstream signals,including the phosphorylation of STAT5,ERK1/2,and AKT,as well as to detect cleaved caspase-3 and PARP1,the molecular signatures of apoptosis.Furthermore,an inhibitor of STAT5 or MEK-ERK1/2 was used to confirm the key mechanism of the combination of imatinib and AEW541 induced SUP-B15 cell apoptosis.Results:Imatinib monotherapy effectively suppressed the proliferation of SUP-B15 cells,but did not induce significant increase of apoptotic rate,leading to occurrence of tolerant status.AEW541 monotherapy did not dramatically affect the proliferation and apoptosis of SUP-B15 cells,but significantly increased apoptotic rate of SUP-B15 cells and cleavage of caspase-3 and PARP1 when combined with imatinib simultaneously. A combination of imatinib and AEW541 reduced STAT5 and ERK1/2 phosphorylation as compared with imatinib monotherapy in SUP-B15 cells,but had no impact on AKT phosphorylation.Apoptosis could be induced by STAT5 inhibitor AC-4-130,but not by MEK-ERK1/2 inhibitor trametinib in SUP-B15 cells.Conclusion:SUP-B15 cells treated with imatinib can establish drug tolerance.IGF1-R inhibitor AEW541 can further reduce STAT5 activation,thereby boosting the effect of apoptotic induction of imatinib on SUP-B15 cells.This research may provide a new idear to overcome imatinib tolerance.

Objective:To investigate the effects of laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein surgery on postoperative early pain and mobility in patients with inguinal hernia.Methods:The retrospective cohort study was conducted. The clinical data of 184 pati-ents with unilateral inguinal hernia who were admitted to Shaanxi Provincial People's Hospital from June 2021 to December 2022 were collected. There were 152 males and 32 females, aged (64±8)years. Of the 184 patients, 92 cases undergoing TAPP were divided into the TAPP group, and 92 cases under-going Lichtenstein surgery were divided into the Lichtenstein group. Observation indicators: (1) surgical situations; (2) postoperative pain; (3) postoperative mobility. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Paired sample t test was used for comparison within group before and after surgery. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Results:(1) Surgical situations. Total duration of hospital stay, duration of postoperative hospital stay, expense of hospitalization were 1.70(1.00,2.00)days, 1.00(1.00,1.00)days, 14 808(14 385,15 292)yuan in the TAPP group, versus 2.12(2.00,3.00)days, 1.42(1.00,2.00)days, 10 590(9802,11 362)yuan in the Lichtenstein group, showing significant differences in the above indicators between the two groups ( Z=-3.23, -4.07, -11.72, P<0.05). (2) Postoperative pain. Score of verbal rating scale (VRS) were 1.36±0.75 and 3.22±0.66 before surgery and at 20-22 hours after surgery in the TAPP group, versus 1.34±0.80 and 3.42±0.80 in the Lichtenstein group, showing significant differences within the two groups ( t=-29.15, -31.46, P<0.05). (3) Postoperative mobility. The time from getting up to standing bedside of patients before surgery and at 20-22 hours after surgery were (5.47±1.08)seconds and (7.94±2.23)seconds in the TAPP group, versus (5.87±1.13)seconds and (11.59±1.88)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-11.99, -15.64, -27.26, P<0.05). The time for hip flexion 90° of patients before surgery and at 20-22 hours after surgery were (0.74±0.32)seconds and (1.23±0.54)seconds in the TAPP group, versus (0.81±0.19)seconds and (1.97±0.69)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-8.11, -16.53, -17.81, P<0.05). The time for walking 10 meters of patients before surgery and at 20-22 hours after surgery were (10.30±1.53)seconds and (12.80±1.67)seconds in the TAPP group, versus (10.38±1.35)seconds and (18.35±1.69)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-22.44, -33.66, -32.46, P<0.05). The time for walking 20 meters of patients before surgery and at 20-22 hours after surgery were (17.87±2.89)seconds and (24.16±2.54)seconds in the TAPP group, versus (18.02±2.82)seconds and (32.64±2.56)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-22.55, -38.75, -34.59, P<0.05). Conclusion:Compared to Lichtenstein surgery, patients with TAPP experience faster recovery of mobility, earlier discharge, and higher expense of hospitalization.

Objective:To investigate the effects of laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein surgery on postoperative early pain and mobility in patients with inguinal hernia.Methods:The retrospective cohort study was conducted. The clinical data of 184 pati-ents with unilateral inguinal hernia who were admitted to Shaanxi Provincial People's Hospital from June 2021 to December 2022 were collected. There were 152 males and 32 females, aged (64±8)years. Of the 184 patients, 92 cases undergoing TAPP were divided into the TAPP group, and 92 cases under-going Lichtenstein surgery were divided into the Lichtenstein group. Observation indicators: (1) surgical situations; (2) postoperative pain; (3) postoperative mobility. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Paired sample t test was used for comparison within group before and after surgery. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Results:(1) Surgical situations. Total duration of hospital stay, duration of postoperative hospital stay, expense of hospitalization were 1.70(1.00,2.00)days, 1.00(1.00,1.00)days, 14 808(14 385,15 292)yuan in the TAPP group, versus 2.12(2.00,3.00)days, 1.42(1.00,2.00)days, 10 590(9802,11 362)yuan in the Lichtenstein group, showing significant differences in the above indicators between the two groups ( Z=-3.23, -4.07, -11.72, P<0.05). (2) Postoperative pain. Score of verbal rating scale (VRS) were 1.36±0.75 and 3.22±0.66 before surgery and at 20-22 hours after surgery in the TAPP group, versus 1.34±0.80 and 3.42±0.80 in the Lichtenstein group, showing significant differences within the two groups ( t=-29.15, -31.46, P<0.05). (3) Postoperative mobility. The time from getting up to standing bedside of patients before surgery and at 20-22 hours after surgery were (5.47±1.08)seconds and (7.94±2.23)seconds in the TAPP group, versus (5.87±1.13)seconds and (11.59±1.88)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-11.99, -15.64, -27.26, P<0.05). The time for hip flexion 90° of patients before surgery and at 20-22 hours after surgery were (0.74±0.32)seconds and (1.23±0.54)seconds in the TAPP group, versus (0.81±0.19)seconds and (1.97±0.69)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-8.11, -16.53, -17.81, P<0.05). The time for walking 10 meters of patients before surgery and at 20-22 hours after surgery were (10.30±1.53)seconds and (12.80±1.67)seconds in the TAPP group, versus (10.38±1.35)seconds and (18.35±1.69)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-22.44, -33.66, -32.46, P<0.05). The time for walking 20 meters of patients before surgery and at 20-22 hours after surgery were (17.87±2.89)seconds and (24.16±2.54)seconds in the TAPP group, versus (18.02±2.82)seconds and (32.64±2.56)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups ( t=-22.55, -38.75, -34.59, P<0.05). Conclusion:Compared to Lichtenstein surgery, patients with TAPP experience faster recovery of mobility, earlier discharge, and higher expense of hospitalization.