Objective To discuss the clinical application of coronary CT angiography(CCTA)-derived fractional flow reserve(CT-FFR)in evaluating the risk stratification of the coronary artery stenosis and atherosclerotic plaque quantitative parameters.Methods A total of 122 patients,who received CCTA examination at the Xuzhou Municipal Central Hospital of China,were enrolled in this study.The patients were divided into non-ischemia group(CT-FFR＞0.8,n=66)and ischemia group(CT-FFR0.8,n=56).The characteristics of atherosclerotic plaque were compared between the two groups.Logistic regression analysis was used to analyze the correlation between plaque characteristics and ischemic lesions.Results There were 218 vessels having a CT-FFR＞0.8 and 174 vessels having a CT-FFR ≤0.8.Statistically significant differences in the total plaque volume,calcified plaque volume,plaque length,and stenosis ratio＞50％existed between the two groups(all P＜0.05).Logistic regression analysis indicated that the total plaque volume,calcified plaque volume,plaque length,and stenosis ratio＞50％were the risk factors for myocardial ischemia.Conclusion CT-FFR can be used for the risk stratification of coronary stenosis and atherosclerotic plaque characteristics,which can evaluate the local myocardial blood supply condition from the anatomical stenosis and functional level so as to optimize the diagnosis and treatment measures.

Objective:To compare the efficacy of programmed death-1(PD-1)inhibitors combined with chemotherapy with that of bevaci-zumab combined with chemotherapy as first-line treatments for advanced non-squamous non-small cell lung cancer(nsNSCLC).Methods:Retrospective collection of 237 patients with advanced nsNSCLC who received first-line treatment at the Fourth Hospital of Hebei Medical University from November 2014 to March 2024.According to the treatment plan,119 cases were assigned into PD-1 inhibitor com-bined with chemotherapy(IC group)and 118 cases were assigned into bevacizumab combined with chemotherapy(BC group).Propensity score matching(PSM)was used to balance covariates.The primary endpoint was progression-free survival(PFS),and the secondary end-points were objective response rate(ORR),disease control rate(DCR),and overall survival(OS).Results:Among 237 patients with PSM,87 were assigned to the IC group and 87 to the BC group,with respective ORRs of 31.0%(27/87)and 43.7%(38/87)(P=0.085)and respective DCRs of 96.6%(84/87)and 95.4%(83/87)(P=1.000).No significant difference in the median PFS was observed between the two groups,with a PFS value of 9.3 months in the IC group and 9.1 months in the BC group(P=0.053).In addition,the two groups also showed no significant difference in OS(neither group reached the median OS;P=0.116).Conclusions:There was no significant difference in the short-term efficacy between chemotherapy combined with PD-1 inhibitor and that combined with bevacizumab as first-line treatments for advanced nsNSCLC.

Objective To search and integrate relevant evidence of Traditional Chinese Medicine rehabilitation care during recovery of stroke patients with limb dysfunction,and to provide the evidence for clinical practice.Methods We systematically search domestic and foreign guideline websites,professional association websites,and databases such as Cochrane Library,PubMed,Embase,CNKI,CBM for evidence on Chinese medicine rehabilitation care for limb dysfunction following stroke.The search included guidelines,clinical decisions,evidence summaries,systematic reviews,expert consensuses,and randomized controlled trials,with the search timeframe spanning from the inception of the respective databases to May 2023.The literature was evaluated and rated for quality by 2 researchers independently.Results A total of 17 articles,including 7 guidelines,4 systematic reviews,1 evidence summary and 5 randomized controlled trials were included to summarize 28 pieces of evidence on Traditional Chinese Medicine rehabilitation care for stroke patients with limb dysfunction.The evidence can be categorized into 4 areas,including evaluation,Traditional Chinese Medicine nursing technology,health education and precautions.Conclusion Traditional Chinese Medicine nursing technology for stroke patients with limb dysfunction have various forms and rich contents.Appropriate Traditional Chinese Medicine nursing techniques should be selected according to the actual situation and the willingness of patients to promote the rehabilitation of their limb functions.

Objective:To investigate the efficacy of Modified Banxia Xiexin Decoction on patients with functional dyspepsia (FD) and its impact on gastric function.Methods:From June 2021 to December 2022, at the Department of Gastroenterology, Wenzhou Central Hospital, a total of 56 patients with FD who met the diagnostic criteria of Rome Ⅳ were prospectively enrolled. The patients were treated with Modified Banxia Xiexin Decoction for 4 weeks. The clinical efficacy was evaluated by the upper gastrointestinal symptom severity index score. The gastric function was assessed by standard gastric loading test of liquid nutrient meal and standard gastric emptying test of solid meal. The total scores of dyspeptic symptoms, the maximal satiety threshold of proximal stomach, the initial satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were compared before and after the treatment. During the treatment and in 4-week follow-up after treatment, the adverse events (such as nausea, diarrhea, dizziness and rash) were observed. Wilcoxon rank sum test and paired sample t-test were used for statistical analysis. Results:After the treatment, 14 FD patients were cured, 22 patients showed significant improvement, 12 patients had response, and 8 patients showed no improvement. The total efficacy rate was 85.71%(48/56). The total score of dyspepsia symptoms after the treatment was lower than that before treatment (3.00(1.00, 4.00) vs. 13.00(8.00, 18.00)), and the difference was statistically significant ( Z=-7.96, P<0.001). After the treatment, the maximal satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were both higher than those before treatment ( (897.45±98.82) mL vs. (588.46±60.26) mL, (87.59±12.74)% vs. (36.59±15.95)%), and the differences were statistically significant ( t=19.98 and 18.70, both P<0.001). The initial satiety threshold of proximal stomach before and after treatment was compared((131.84±52.91) mL vs. (130.0±47.61) mL), and the difference was not statistically significant( P>0.05). No adverse events related to this study were observed during treatment period and in the 4-week follow-up. Conclusions:The Modified Banxia Xiexin Decoction can improve proximal gastric compliance and gastric emptying function in patients with FD. Additionally, it can alleviate dyspeptic symptoms and have good clinical efficacy and high safety.

Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.

Objective:To correlate serum levels of neuron specific enolase (NSE) and inflammatory factors with recovery of neurological function in patients with severe traumatic brain injury.Methods:Ninety-six patients with severe traumatic brain injury who received treatment from January 2018 to January 2020 in Taizhou Hospital were included in this study. These patients were divided into a mild-to-moderate group ( n = 51) and a severe group ( n = 45). Additional 60 healthy controls who concurrently received health examination were included in the healthy control group. Serum NSE level was detected by enzyme-linked immunosorbent assay, serum C-reactive protein (CRP) level by immunoturbidimetry, serum procalcitonin (PCT) level by chemiluminescent assay, and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels by enzyme-linked immunosorbent assay. All patients were followed up for 3 months. Recovery of neurological function was evaluated by modified Rankin Scale. Results:Serum NSE level was (50.42 ± 13.25) μg/L and (36.79 ± 10.28) μg/L in the severe and mild-to-moderate groups, respectively, which was significantly higher than that in the healthy control group [(6.13 ± 1.78) μg/L, t = 25.641, 22.688, both P < 0.05). Serum NSE level in the severe group was significantly higher than that in the mild-to- moderate group ( t = 5.576, P < 0.05). Serum CRP, PCT, IL-6 and TNF-α levels were (78.95 ± 15.46) mg/L, (3.46 ± 0.75) μg/L, (432.15 ± 78.29) μg/L and (36.57 ± 8.98) μg/L] respectively in the severe group, (34.65 ± 7.48) mg/L, (1.68 ± 0.51) μg/L, (285.41 ± 36.75) μg/L and (17.54 ± 5.26) μg/L] respectively in the mild-to-moderate group and (3.25 ± 0.86) mg/L, (0.08 ± 0.02) μg/L, (73.52 ± 13.89) μg/L and (1.64 ± 0.50) μg/L, respectively in the healthy control group. Serum CRP, PCT, IL-6 and TNF-α levels in the severe and mild-to-moderate groups were significantly higher than those in the healthy control group ( t = 37.890, 34.922, 34.870, 30.099, 32.284, 24.315, 40.980, 23.312, all P < 0.05). Serum levels of these indicators in the severe group were significantly higher than those in the mild-to-moderate group ( t = 17.493, 13.414, 11.500, 12.451, all P < 0.05). In the severe group, neurological function recovered well in 34 patients and poorly in 17 patients. Serum NSE level in patients with poor neurological function recovery was significantly higher than that in patients with good recovery [(68.93 ± 14.25) μg/L vs. (34.61 ± 12.36) μg/L, t = 8.457, P < 0.05). Serum CRP [(113.24 ± 27.39) mg/L], PCT [(4.57 ± 0.87) μg/L], IL-6 [(598.90 ± 43.52) μg/L] and TNF-α [(58.78 ± 12.13) μg/L] levels in patients with poor recovery were significantly higher than those in patients with good recovery [(32.19 ± 6.90) mg/L, (2.23 ± 0.65) μg/L, (261.39 ± 26.56) μg/L and (14.53 ± 4.26) μg/L, t = 11.956, 9.788, 29.280 and 14.537, all P < 0.05). Serum NSE, CRP, PCT, IL-6 and TNF-α were positively correlated with poor prognosis ( r = 0.849, 0.743, 0.795, 0.683, 0.701, all P < 0.05). Conclusion:In patients with severe traumatic brain injury, serum NSE, CRP, PCT, IL-6 and TNF-α levels increase, which are positively correlated with poor prognosis.

Administration, Intravenous ; Ascorbic Acid/therapeutic use* ; COVID-19 ; Humans ; Pneumonia ; SARS-CoV-2

Objective To investigate the clinical value of combined detection of glycoprotein 125 (CA125) and human epididymis protein 4 (HE4).Methods 46 patients with ovarian malignant tumor (malignant tumor group) and 48 patients with benign ovarian tumors (benign tumor group) treated in our hospital from June 2013 to August 2015 were selected.The serum levels of CA125 and HE4 were detected in all the patients and its diagnostic value was evaluated by ROC curve.The levels of CA125 and HE4 in patients with different pathological types were compared.Results The best diagnostic value of CA125 was 47.9 U/L,The serum level of CA125 ≥47.9 U/L predicted the specificity of ovarian malignant tumor was 87.34% and that the sensitivity was 76.69%.The best diagnostic value of HE4 was 55.68 pmol/L.The serum level of HE4 ≥ 55.68 pmol/L predicted the specificity of ovarian malignant tumor was 90.34% and that the sensitivity was 83.01%.There was significant difference in CA125 and HE4 between the patients with benign and malignant ovarian tumors (P<0.05).No significant difference in the diagnosis of malignant ovarian tumor and the specificity by using combined detection of HE4 and CA125 (P>0.05)However,the sensitivity was significantly higher than that of single detection,the difference was statistically significant (P<0.05).The levels of CA125 and HE4 in patients with epithelial ovarian tumors were higher than those with non epithelial ovarian tumors,and the difference was statistically significant (P<0.05).The levels of CA125 and HE4 in patients with mucinous ovarian cancer were significantly lower than those in patients with serous ovarian cancer (P<0.05).Conclusion The combined detection of serum CA125 and HE4 can significantly improve the value of differential diagnosis of ovarian tumors,and CA125 and HE4 may play an important role in the pathological classification of malignant ovarian tumors.

Background and purpose:Bladder cancer is the most common urological tumor, and its pathogen-esis is still not fully understood. The study was aimed to observe the expressions of key genes in many tumor-associated signaling pathways in normal bladder tissue and bladder carcinoma, and to provide further evidence for the subsequent study of bladder cancer recurrence and metastasis.Methods:Twenty-seven cases of bladder cancer specimens were col-lected, and normal bladder tissues and bladder cancer tissues were distinguished by frozen section. Then, the expressions of 84 genes of cancer-related signaling pathways in bladder cancer tissues and normal bladder tissues were screened by Cancer Pathway Finder PCR Array produced by QIAGEN company.Results:Compared with the normal bladder tissues, the bladder carcinoma tissues had 8 up-regulated genes and 19 down-regulated genes. In this study, the impact of epithe-lial-mesenchymal transition (EMT) signaling pathway was selected as a research direction in which theGSC,KRT14,DSP were up-regulated,SNAI2,SNAI3 were down-regulated. ThereforeGSC,KRT14,DSP,SNAI2 andSNAI3 were chosen as target genes, and verified by qRT-PCR in many examples. The result showed that the expressions ofGSC gene in bladder cancer tissues were up-regulated, but with no statistical significance;KRT14,DSP expressions in bladder cancer were higher than those in normal bladder tissues (P<0.05);SNAI2,SNAI3 expressions in bladder cancer were lower than those in normal bladder tissues (P<0.05), andSNAI3 showed the most obvious expression differences.Conclusion:KRT14,DSP andSNAI3 may play an important role in bladder cancer’s occurrence, development and metastasis.

Objective To investigate the effect of notch signaling pathway on drug resistance and invasiveness of bladder cancer .Methods We observed the changes of growth and morphology of bladder cancer T 24 , 5637 and J82 cells which treated for 48 hours using γ-secretase inhibitor by inverted microscope .The mRNA and protein lev-els of the EMT molecular markers , including E-cadherin , N-cadherin , vimentin and Alpha-smooth muscle actin were examined by RT-PCR and Western blot in bladder cancer cells;Detected the changes of drug resistance and invasion respectively by MTT and Transwell in bladder cancer cells .Results After completely blocking the Notch signaling pathway , the inverted microscope showed that bladder cancer cells became smaller and more disperse ;RT-PCR and Western blot showed the mRNA and protein levels of E-cadherin were up-regulated ( P<0.05 ) , contrast , N-cadherin , vimentin and Alpha-smooth muscle actin were down-regulated ( P<0.05 ); The prolifera-tion of bladder cancer cells were significantly inhibited by MTT test;The number of through microporous membrane cells significantly decreased ( P<0.05 ) shown by Transwell test .Conclusions The Notch signaling pathway is completely blocked that nhibites proliferation and EMT of bladder cancer cells , reduces drug resistance and inva-sion in bladder cancer cells .It suggests that drug resistance and invasiveness of bladder cancer can be changed through EMT which is regulated through notch signaling pathway .