OBJECTIVE To investigate the effects of sacubitril/valsartan on renal function in patients with primary hypertension. METHODS A retrospective study was conducted among patients with primary hypertension who were admitted to PLA Strategic Support Force Characteristic Medical Center from January 2018 to June 2023. Based on their medication， they were divided into two groups： sacubitril/valsartan group and valsartan group. Propensity score matching was used to match baseline data between the two groups. Patients were treated with antihypertensive drugs based on improving their lifestyle. Sacubitril/valsartan group additionally received oral administration of 200 mg Sacubitril/valsartan tablets once daily， while valsartan group additionally received oral administration of 80 mg Valsartan capsules once daily. The increase amplitude of serum creatinine from baseline， the proportion of patients with elevated serum creatinine ＞30%-50% or ＞50%， and the proportion of patients with hyperkalemia （serum potassium ≥5.5 mmol/L） were compared between two groups at 2 months and 6 months after treatment. The trends of changes in serum creatinine， serum potassium and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment （at baseline）， 2 months and 6 months after treatment. RESULTS After propensity score matching， there were 62 patients in sacubitril/valsartan group and 61 patients in valsartan group； there were no significant differences in baseline characteristics between the two groups before treatment （P＞0.05）， indicating comparability. After 6 months of treatment， the increase of serum creatinine in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.003）； the proportion of patients with elevated serum creatinine ＞30%-50% in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.045）. None of the patients experienced hyperkalemia events after 2 months and 6 months of treatment. Repeated measures analysis of variance showed significantly statistical differences in serum creatinine and eGFR between the two groups within 6 months of treatment （P＜0.001）. Patients taking valsartan experienced a continuous increase in serum creatinine levels and a decrease in eGFR， while patients taking sacubitril/valsartan showed a first increase and then a decrease in serum creatinine levels， and a first decrease and then an increase in eGFR with a prolonged duration of medication. CONCLUSIONS Sacubitril/valsartan can delay or even reverse the decline in renal function levels， and limit the deterioration of renal function in patients with primary hypertension， without increasing the risk of hyperkalemia.

Existing epidemiologic and clinical studies have demonstrated that obesity is associated with the risk of a variety of cancers. In recent years, an increasing number of experimental and clinical studies have unraveled the complex relationship between obesity and cancer risk and the underlying mechanisms. Obesity-induced abnormalities in immunity and biochemical metabolism, including chronic inflammation, hormonal disorders, dysregulation of adipokines, and microbial dysbiosis, may be important contributors to cancer development and progression. These contributors play different roles in cancer development and progression at different sites. Lifestyle changes, weight loss medications, and bariatric surgery are key approaches for weight-centered, obesity-related cancer prevention. Treatment of obesity-related inflammation and hormonal or metabolic dysregulation with medications has also shown promise in preventing obesity-related cancers. In this review, we summarize the mechanisms through which obesity affects the risk of cancer at different sites and explore intervention strategies for the prevention of obesity-associated cancers, concluding with unresolved questions and future directions regarding the link between obesity and cancer. The aim is to provide valuable theoretical foundations and insights for the in-depth exploration of the complex relationship between obesity and cancer risk and its clinical applications.
Humans ; Adipokines/metabolism* ; Bariatric Surgery ; Inflammation/therapy* ; Neoplasms/prevention & control* ; Obesity/therapy* ; Risk Factors

Objective To explore the value of Fast Dixon in improving the quality of thyroid turbo spin echo(TSE)T2WI images via comparing the quality of thyroid MR T2WI images based on Fast Dixon,Dixon,and BLADE sequences.Methods The prospective study included 11 healthy volunteers,who underwent neck MR scanning.The evaluation of image quality was performed via a combination of objective measures and subjective ratings.Objective measures included signal-to-noise ratio(SNR)of bilateral thyroid and muscles,and contrast-to-noise ratio(CNR).Subjective measures included overall image quality,uniformity of fat suppression,sharpness of thyroid margins and muscles surrounding the thyroid,image noise in the neck region,image background noise,and image quality of the nasopharynx.Two diagnostic physicians with over 10 years of thyroid diagnostic experience independently evaluated the images via a 5-point scale.Inter-observer agreement was analyzed via Spearman correlation coefficient.Statistical analysis was performed using SPSS 22.0 software,including normality and homogeneity of variance tests for continuous data.Kruskal-Wallis one-way ANOVA was used for statistical analysis of subjective measures,followed by post hoc pairwise comparisons.A significance level of P<0.05 was considered statistically significant.Results Eleven healthy volunteers,the SNR of bilateral thyroid and muscles was significantly higher in Fast Dixon sequence than that in Dixon and BLADE sequences.For bilateral CNR,Fast Dixon sequence was also significantly higher than that of Dixon and BLADE sequences.Fast Dixon sequence also had significant advantages in seven subjective ratings indicators(P<0.001).Conclusion The Fast Dixon sequence shows the highest image quality and important application value in the display and evaluation of thyroid lesions.

A 61-year-old male patient with coronary heart disease was treated with dual antiplatelet therapy, lipid-lowering therapy (atorvastatin) and other symptomatic drugs after coronary interventions. Because the patient was at ultra-high-risk of cardiovascular events, had multiple in-stent restenosis, and had uncontrolled blood lipids, subcutaneous injection of evolocumab 140 mg was added once every 2 weeks. The platelet count (PLT) of the patient was within the reference range before evolocumab application. After 2 injections of evolocumab, he developed bloody sputum, blood blisters on the lips and scattered bleeding points around the body, with PLT 19×10 9/L. The dual antiplatelet therapy and evolocumab were suspended, but the bleeding was aggravated. According to the results of bone marrow puncture and biopsy, the patient was diagnosed with idiopathic thrombocytopenic purpura. Glucocorticoid, human immunoglobulin, recombinant human thrombopoietin and platelet transfusion were given but not effective. Subsequently, herombopag was added and PLT gradually increased. After 25 days, the PLT was 109×10 9/L.

A 61-year-old male patient with coronary heart disease was treated with dual antiplatelet therapy, lipid-lowering therapy (atorvastatin) and other symptomatic drugs after coronary interventions. Because the patient was at ultra-high-risk of cardiovascular events, had multiple in-stent restenosis, and had uncontrolled blood lipids, subcutaneous injection of evolocumab 140 mg was added once every 2 weeks. The platelet count (PLT) of the patient was within the reference range before evolocumab application. After 2 injections of evolocumab, he developed bloody sputum, blood blisters on the lips and scattered bleeding points around the body, with PLT 19×10 9/L. The dual antiplatelet therapy and evolocumab were suspended, but the bleeding was aggravated. According to the results of bone marrow puncture and biopsy, the patient was diagnosed with idiopathic thrombocytopenic purpura. Glucocorticoid, human immunoglobulin, recombinant human thrombopoietin and platelet transfusion were given but not effective. Subsequently, herombopag was added and PLT gradually increased. After 25 days, the PLT was 109×10 9/L.

Objective:To establish an animal model of acute systemic cold injury in mice.Methods:There were 98 C57BL/6 mice, half male and half female, with body weight of 22-27 g and age of 10 weeks. The mice were randomly divided into 7 groups ( n=14) according to the changes of anal temperature in cold environment, namely, group A (38.5 ± 1) ℃, group B (35 ± 1) ℃, group C (30 ± 1) ℃, group D (25 ± 1) ℃, group E (20 ± 1) ℃, group F (15 ± 1) ℃, and group G (10 ± 1) ℃, among which, group A was the blank control group, and the rest groups were the experimental group. The mice in the blank control group were placed in the normal environment (20 ± 5) ℃, and the mice in the experimental group were placed in the low temperature artificial climate box at - 20℃. The anal temperature of the mice was measured intermittently (as the core temperature), and the time required for the core temperature of the mice to drop to groups B, C, D, E, F and G was recorded. The righting reflex was used to evaluate the consciousness state, the action ability and the general state of each organ of mice were observed, and the blood routine and HE staining of each organ were detected. Results:The lower the core temperature of the experimental group, the longer the time required. The consciousness state, action ability, general state of organs, blood routine, and HE staining of organs in groups B, C, and D were basically the same as those in group A, and there was no acute systemic cold injury. Therefore, the blood routine, general observation of organs, and HE staining of organs in groups B, C, and D were no longer displayed compared with those in group A. Compared with group A, mice in group E began to suffer from disturbance of consciousness and action ability. With the decrease of core body temperature, the damage was aggravated, and mice in group G died. Compared with group A, the indices of blood routine test (WBC, RBC, HGB, PLT) of mice in group E began to decrease, and the univariate variance calculation showed that only WBC changes had statistical significance ( P<0.05). Compared with groups A and E, the indices of blood routine test (WBC, RBC, HGB, PLT) of mice in group F were further reduced, and the changes of each index in univariate variance calculation were statistically significant ( P<0.05). The general observation results showed that compared with group A, the lung, liver and spleen surfaces of mice in group E began to darken, and compared with groups A and E, the lung, liver, spleen, kidney and heart of mice in group F were further deepened and darkened, with irregular edges. HE staining results of various organs showed that compared with group A, the mice in group E began to have partial alveolar structure destruction and a small amount of inflammatory cell infiltration, the central vein of the liver was slightly congested, and the red and white pulp of the spleen were indistinct. Compared with groups A and E, the pathological structure damage of the lung, liver, spleen, kidney, heart and brain tissues of the mice in group F was further aggravated. Conclusions:Detection of consciousness state, action ability, general state of organs, blood routine and HE staining indices of organs in mice under low temperature can simulate the progress of clinical acute cold injury, and the animal model of acute systemic cold injury was successfully prepared.

Objective:To explore the therapeutic effect of multi-mode sequential combination of artificial liver in the treatment of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data of HBV-ACLF patients treated with artificial liver in Wuxi Fifth People′s Hospital from January 2018 to June 2021 were retrospectively analyzed. Eighty-six patients were divided into artificial liver multi-mode sequential combination therapy group (sequential combination group) and conventional treatment group. The cytokine level changes and model for end-stage liver disease (MELD) score were analyzed at 14 days of disease duration. The survival outcome and complications of artificial liver were analyzed after 30 days of follow-up. Two independent samples t test and chi-square test were used for statistical analysis. Cox regression analysis was used to analyze the risk factors of death, and Kaplan-Meier method was used to analyze the survival rate of patients. Results:A total of 86 patients were enrolled, including 48 patients in sequential combination group with the average number of artificial liver of 4.68 times/person, and 38 patients in conventional treatment group with the average number of artificial liver of 3.17 times/person. At 14 days of disease duration, interleukin (IL)-6, IL-8, interferon γ-inducible protein (IP)-10 level and MELD score in sequential combination group decreased significantly than those in the conventional treatment group ( t=3.80, 3.62, 4.95 and 1.11, respectively, all P<0.050). After 30 days of follow-up, 63 patients survived and 23 patients died. Cox regression analysis showed that baseline international normalized ratio (hazard ratio ( HR)=0.558, 95% confidence interval ( CI) 0.193 to 0.856, P=0.027), baseline antithrombin Ⅲ activity ( HR=0.876, 95% CI 0.824 to 0.932, P<0.001), artificial liver mode ( HR=0.819, 95% CI 0.236 to 0.992, P=0.005), spontaneous peritonitis ( HR=0.170, 95% CI 0.045 to 0.647, P=0.009) and hepatic encephalopathy ( HR=0.004, 95% CI 0.001 to 0.030, P<0.001) were independent influencing factors for 30-day survival outcome. The cumulative survival rate of sequential combination group was higher than that of conventional treatment group, and the difference was statistically significant ( χ2=5.45, P=0.020). There were no significant differences in the proportions of bleeding, deep vein thrombosis, heart rate and blood pressure instability between the two groups ( χ2=0.63, 1.20 and 0.54, respectively, all P>0.050). The platelet decline of patients in sequential combination group was slighter than that in conventional treatment group, and the difference was statistically significant ( t=-4.17, P=0.002). Conclusions:Multi-mode sequential combination therapy of artificial liver could eliminate cytokines and reduce MELD score more effectively in patients with HBV-ACLF, and prolong the survival time of patients and have little effect on platelet count.

Objective To investigate the dosimetric differences between volumetric modulated arc therapy (VMAT) with a flattening filter (FF) and flattening filter-free (FFF) VMAT in fractionated stereotactic radiotherapy for brain metastases. Methods Seventeen patients with brain metastases were divided into FF-VMAT group (VMAT plans with the FF mode) and FFF-VMAT group (VMAT plans with the FFF mode). The two groups were compared in terms of target volume dose parameters (D_98%, D_2% and D_mean), the conformal index (CI), the gradient index (GI), the gradient, normal brain tissue dose parameters (V_5Gy, V_10Gy, V_12Gy and D_mean), monitor units, and beam-on time. Results Compared with the FF-VMAT group, the FFF-VMAT group had significantly lower GI (3.33 ± 0.37 vs 3.27 ± 0.35, P = 0.001), a significantly lower gradient [(0.85 ± 0.20) cm vs (0.84 ± 0.19) cm, P = 0.002], a significantly shorter beam-on time [(177.05 ± 62.68) s vs (142.71 ± 34.59) s, P = 0.001], and significantly higher D_2% [(65.69 ± 2.15) Gy vs (66.99 ± 2.03) Gy, P = 0.001] and D_mean [(58.77 ± 1.60) Gy vs (59.95 ± 1.43) Gy, P <0.001]. There were no significant differences in the CI, the D_98% of the target volume, the V_5Gy, V_10Gy, V_12Gy and D_mean of the normal brain tissue, and monitor units between FFF-VMAT and FF-VMAT. Conclusion FFF-VMAT can better protect the normal tissue around the target volume, reduce the beam-on time, and improve treatment efficiency.

Objective To investigate the dose calculation accuracy of two algorithms in Monaco TPS for self-made phantoms with different cavity thickness, and analyze the influence of phantoms with different cavity thickness on dose verification of upper esophageal cancer. Methods The phantoms with different cavity thickness were placed on the simulated CT positioning machine to scan and acquire images. In Monaco TPS, the irradiation fields with energy of 6 MV, 100 MU and different square field sizes were added to the acquired images. The dose of the cavity of the ionization chamber was calculated by two algorithms, and measured on the accelerator by dosimeter under the same conditions. At the same time, 20 patients with upper esophageal cancer who received dynamic intensity modulation in fixed field were randomly selected and included in the study, and two algorithms were used for dose verification on phantoms with different cavity thickness. The results were statistically analyzed by SPSS 22.0 software. Results The maximum deviations between the calculated values and the measured values were 0.66% and −1.8%, in the calculation of phantoms with different cavity thickness by algorithms of Monte Carlo and Pencil Beam. In Monte Carlo algorithm, the result of RD pair t test is P > 0.05. Paired t test of AD (0 mm, 10 mm), (5 mm, 10 mm) and (10 mm, 20 mm) groups showed no significant difference (P < 0.05). The maximum deviation was 1.1%, and the rest groups were not statisticely significant (P > 0.05); In Pencil Beam algorithm the t test results of RD (0 mm, 20 mm) and (5 mm, 20 mm) pairs were (P < 0.05), the maximum deviation was 0.58%, and the rest groups were (P > 0.05). In AD group, (P < 0.05), the maximum deviation was 2.78%; The paired t test between the two algorithms was (P < 0.05), and the maximum deviations in RD and AD groups were 2.49% and 4.14%, respectively. Conclusion Monte Carlo algorithm has accurate calculation and high gamma pass rate of dose verification, and there is no clinical difference in gamma pass rate of dose verification among phantoms with different cavity thickness, pencil Beam algorithm is not recommended in cavity phantom calculation.

Objective To investigate the rehabilitation effect of folic acid,intravenous and oral lipoic acid sequential therapy combined with plantar acupoint massage on treatment of patients with high-risk diabetic foot (DF).Methods A total of 120 patients with high-risk DF were randomly divided into 4 groups.The control group was given routine therapy of diabetes.Besides the basic treatment,folic acid was given in the folic acid group.On the basis of the folic acid group,lipoic acid was used in lipoic acid group with oral taken after two weeks of intravenous drip.The massage group was treated with plantar acupoint massage on the basis of the lipoic acid group,and the treatment course was 6 months.The Toronto symptom and sign score,the brachial ankle pulse wave velocity (baPWV),the ankle brachial ratio (ABI) and the score of life quality of four groups were compared before and after the intervention.Results The homocysteine and the baPWV in the folic acid group,the lipoic acid group and the massage group were significantly lower than those in the control group (P ＜0.01).Except for the folic acid group,The Toronto symptom and sign score in the other two groups was significantly lower than that in the control group (P ＜ 0.01).Except for the folic acid group,ABI of the lipoic acid group and the massage group was significantly higher than that of the control group (P ＜0.01).The score of life quality in the lipoic acid group and the massage group were significantly lower than that in the control group (P ＜ 0.01).The oxidized low density lipoprotein in the lipoic acid group and the massage group were significantly lower than that in other two groups (P ＜ 0.01).Conclusion Folic acid,intravenous and oral lipoic acid sequential therapy combined with plantar acupoint massage can improve the effect of DF patients.