Objective To explore the correlation between serum levels of miR-193a-3p,activated transcription factor 5(ATF5),clinicopathological characteristics and chemotherapy efficacy in patients with triple negative breast cancer(TNBC).Methods A total of 120 patients with TNBC admitted to our hospital were collected as the research group.In the same period,120 cases with benign breast disease in our hospital were selected as the control group.Serum levels of miR-193a-3p and ATF5 were detected,and the relationship between them and clinicopathological characteristics were detected in two groups.According to the therapeutic effect,TNBC patients were divided into the treatment ineffective group(n=50)and the treatment effective group(n=70).The expression levels of miR-193a-3p and ATF5 were compared between the two groups,and factors affecting the chemotherapy efficacy of TNBC patients were analyzed.Results Compared with before chemotherapy,the serum miR-193a-3p level increased and ATF5 level decreased in TNBC patients after chemotherapy(P＜0.05).Compared with the control group,the serum miR-193a-3p level of TNBC patients decreased in the research group before chemotherapy,and ATF5 level increased(P＜0.05).The expression level of miR-193a-3p was lower and the expression level of ATF5 was higher in patients with tumor diameter≥3 cm,lymph node metastasis,low histological grade,clinical stage Ⅲ and Ki-67＞30%(P＜0.05).In TNBC patients,compared with the treatment effective group,patients in the treatment ineffective group showed a decreased serum miR-193a-3p level and an increased ATF5 level(P＜0.05).Lower level of miR-193a-3p,higher level of ATF5,lymph node metastasis,tumor diameter≥3 cm,low histological grade,and TNM stage Ⅲ were risk factors affecting the efficacy of chemotherapy in TNBC patients(P＜0.05).Conclusion Low level of miR-193a-3p and high level of ATF5 in the serum of TNBC patients are risk factors for chemotherapy efficacy.

Objective:To investigate the efficacy of alveolar lavage combined with montelukast in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its effect on oxidative stress and inflammatory factors in patients.Methods:A prospective study was conducted involving 90 patients with AECOPD who were admitted to the Intensive Care Unit of Shan County Central Hospital from December 2021 to December 2022. The patients were randomly divided into a control group and an observation group, with 45 patients in each group, using the random number table method. The control group received conventional treatment, while the observation group was additionally treated with alveolar lavage combined with montelukast. Symptom score, Acute Physiology and Chronic Health Evaluation II score, overall response rate, serum levels of oxidative stress markers (malondialdehyde, 4-hydroxynonenal, and superoxide dismutase), and serum levels of inflammatory factors (C-reactive protein, tumor necrosis factor-α, interleukin-6, and procalcitonin) were compared between the two groups before and after treatment.Results:After treatment, the symptom scores for both groups decreased significantly compared with their respective scores before treatment ( t = 6.68, 11.32, both P < 0.05). After treatment, the symptom score in the observation group was significantly lower than that in the control group [(8.69 ± 0.84) points vs. (15.39 ± 1.18) points, t = 8.75, P < 0.05]. After treatment, the Acute Physiology and Chronic Health Evaluation II score in the observation group was significantly lower than that in the control group ( t = 9.19, P < 0.05). The overall response rate in the observation group was significantly higher than that in the control group [93.33% (42/45) vs. 75.56% (34/45), t = 4.56, P < 0.05]. After treatment, serum levels of 4-hydroxynonenal and malondialdehyde in the observation group were significantly lower than those in the control group ( t = 4.20, 5.15, both P < 0.05), while serum level of superoxide dismutase in the observation group was significantly higher than that in the control group ( t = 5.23, P < 0.05). After treatment, serum levels of C-reactive protein, tumor necrosis factor-α, interleukin-6, and procalcitonin in the observation group were significantly lower than those in the control group ( t = 6.86, 5.60, 8.75, 4.89, all P < 0.05). Conclusion:Alveolar lavage combined with montelukast can reduce clinical symptoms in patients with AECOPD, promote recovery, enhances clinical efficacy, decreases oxidative stress responses, increases the body's antioxidant capacity, lowers the expression of inflammatory factors, and reduces inflammatory responses.

Objective:To compare the effect of prognosis between drug-coated balloon (DCB) and drug eluting stent (DES) interventional therapy in patients with coronary heart disease.Methods:The clinical data of 346 coronary heart disease patients underwent interventional therapy because of small vessel lesion, in-stent restenosis and bifurcation lesion in Xuanwu Hospital, Capital Medical University from December 2018 to July 2021 were retrospectively analyzed. Among them, 179 patients were treated with DES (DES group), including small vessel lesion 81 cases, in-stent restenosis 35 cases, and bifurcation lesion 63 cases; 167 patients were treated with DCB (DCB group), including small vessel lesion 69 cases, in-stent restenosis 62 cases, and bifurcation lesion 36 cases. The major adverse cardiac and cerebrovascular event (MACCE) within 1 year after discharge was compared between two groups. Non-inferiority was analyzed, and non-inferiority margin was set to be 4%.Results:There was no statistical difference in the incidence of MACCE between DCB group and DES group: 3.59% (6/167) vs. 7.26% (13/179), P>0.05. There were no statistical differences in the incidences of MACCE in patients with small vessel lesion, in-stent restenosis and bifurcation lesion between DCB group and DES group: 1.45% (1/69) vs. 4.94% (4/81), 8.06% (5/62) vs. 14.29% (5/35) and 0 vs. 6.35% (4/63); P>0.05. Non-inferiority analysis result showed that DCB was non-inferior to DES on the prognosis in patients with coronary heart disease (95% CI - 8.41% to 1.07%). Conclusions:Non-inferiority of DCB versus DES is shown in coronary heart disease patients with small vessel lesion, in-stent restenosis and bifurcation lesion.

Objective:To analyze the relationship between stress hyperglycemia (SHG) and the prognosis of acute myocardial infarction (AMI) without diabetes mellitus (DM).Methods:Using a retrospective cohort study method, 396 AMI patients without DM or impaired glucose tolerance (IGT) and admitted glycated hemoglobin A 1c (HbA 1c)≤6.0% from January 2018 to December 2020 in Xuanwu Hospital, Capital Medical University were selected. Among them, 238 patients did not have SHG at admission (group A), 85 patients had SHG at admission but their blood glucose level did not reach the diagnostic criteria for DM (group B), and 73 patients had SHG at admission and their blood glucose level reached the diagnostic criteria for DM (group C). The baseline data and the incidence of main adverse cardiovascular and cerebrovascular events (MACCE) were recorded. Multivariate Cox regression was used to analyze the independent risk factors of MACCE after discharge in AMI patients without DM. Results:The incidence of MACCE after discharge in group B and group C was significantly higher than that in group A: 29.4% (25/85) and 35.6% (26/73) vs. 18.5% (44/238), the incidence in group C was significantly higher than that in group B, and there was statistical difference ( P<0.05). Multivariate Cox regression analysis result showed that SHG on admission was an independent risk factor for MACCE after discharge in AMI patients without DM ( P<0.05), and LVEF on admission was an independent protective factor for MACCE after discharge in AMI patients without DM ( P<0.01). Conclusions:SHG on admission is the independent risk factor of MACCE in AMI patient without DM. Early detection, assessment and proper intervention measures based on clinical reality should be advocated for the AMI patients with SHG to further improve the prognosis.

Objective:To explore the value of quantitative susceptibility mapping (QSM) in evaluating renal injury in patients with early diabetic nephropathy (DN).Methods:From October 2019 to December 2020, 32 patients with early DN were prospectively enrolled in the Third Affiliated Hospital of Soochow University. According to the estimated glomerular filtration rate (eGFR), they were divided into three groups: DN1 (eGFR≥90 ml·min -1·1.73 m -2, 11 cases), DN2 (60-<90 ml·min -1·1.73 m -2, 11 cases) and DN3 (30-<60 ml·min -1·1.73 m -2, 10 cases). At the same time, 32 normal volunteers were recruited as the control group. Both kidneys were scanned by QSM to measure the susceptibility of renal cortex and medulla. Paired samples t-test was used to compare the differences of the susceptibility between left and right kidneys and between cortex and medulla. One-way analysis of variance was performed to compare the differences of corresponding susceptibility values among different groups, and LSD- t was used for the pairwise comparison. Pearson correlation test was performed between the susceptibility value of the medulla and eGFR. The ROC curve was used to analyze the diagnostic efficacy of QSM parameters in the diagnosis of DN and different degrees of severity of DN. Results:The susceptibility values of bilateral renal medulla in normal volunteers and patients with DN were lower than those of renal cortex (all P<0.001). There was no significant difference in the susceptibility value between left and right renal cortex (all P>0.05). There was significant difference in the susceptibility value between left and right medulla (all P<0.05). There was no significant difference in the susceptibility value of bilateral renal cortex among the control group and the DN1－DN3 groups (both P>0.05). The susceptibility values of left renal medulla in control group, DN1, DN2 and DN3 groups were (-4.46±1.16)×10 -2, (-5.96±0.97)×10 -2, (-7.97±1.25)×10 -2, (-9.58±1.45)×10 -2 ppm, of right renal medulla were (-3.70±0.65)×10 -2, (-5.06±1.28)×10 -2, (-7.33±1.46)×10 -2, (-9.09±2.22)×10 -2 ppm, respectively. The overall difference of the susceptibility value of bilateral renal medulla was statistically significant (both P<0.05), and there were significant differences between each two groups (all P<0.05). The linear positive correlation were found between the susceptibility values of renal medulla and the corresponding eGFR (left kidney r=0.732, P<0.001; right kidney r=0.684, P<0.001). The areas under the ROC curve (AUC) of left and right renal medulla susceptibility value in diagnosis of normal and DN were 0.931 and 0.943, of DN1 and DN (2 and 3) were 0.952 and 0.883, of DN (1 and 2) and DN3 were 0.888 and 0.831, respectively. Conclusion:The susceptibility value of QSM quantitative parameter has a certain value in the staging and differential diagnosis of early DN, among which the susceptibility value of renal medulla has higher diagnostic efficiency.

Objective:To investigate the clinical efficacy of hemoperfusion in the treatment of severe organophosphorus poisoning and its effect on diaphragm function.Methods:Eighty-five patients with severe organophosphorus poisoning who received treatment in Affiliated Huxi Hospital of Jining Medical University (Shanxian Central Hospital), China between January 2018 and January 2020 were included in this study. They were randomly divided into treatment ( n = 43)and control ( n = 42) groups. The control group was given conventional treatment including gastric lavage, catharsis, and application of reactivators and anticholinergic drugs. The treatment group was subjected to three times of hemoperfusion, with an interval of 24 hours between two hemoperfusion interventions based on the conventional treatment used in the control group. Before and after three times of hemoperfusion, serum levels of cholinesterase (CHE), interleukin-6 (IL-6), arterial partial pressure of oxygen (PaO 2), and arterial partial pressure of carbon dioxide (PaCO 2) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE) II score and oxygenation index (OI) in each group were calculated. Right diaphragmatic activity, diaphragmatic thickness at the end of inspiration (DTei) and diaphragmatic thickness at the end of expiration were measured by bedside ultrasound. The diaphragmatic thickening rate (DTF) and diaphragmatic rapid shallow breathing index (D-RSBI) were calculated. Serum CHE and IL-6 levels, OI, diaphragmatic activity, DTF and D-RSBI were compared between the treatment and control groups. The incidence of intermediate syndrome, tracheal intubation rate, 28-day mortality rate, and hospital stay were compared between the two groups. Results:Before hemoperfusion, there were no significant differences in serum levels of CHE and IL-6, OI, right diaphragmatic activity, DTF, and D-RSBI between the treatment and control groups (all P > 0.05). After three times of hemoperfusion, serum IL-6 level and D-RSBI in the treatment group were (37.9 ± 6.2) ng/L and (0.77 ± 0.20) times /min/mm, which were significantly lower than those in the control group [(45.9 ± 5.3) ng/L, (0.90 ± 0.16) times/min/mm ( t = -6.295, -3.382, P < 0.001, P = 0.001)]. Serum CHE level, OI, DE and DTF in the treatment group were (2.29 ± 0.52) kU/L, (264.5 ± 24.3) mmHg, (16.5 ± 1.9) mm, (27.2 ± 4.7) %, respectively, which were significantly higher than those in the control group [(1.96 ± 0.39) kU/L, (252.6 ± 27.2) mmHg, (14.3 ± 1.6) mm, (23.5 ± 4.1) %, t = 3.258, 2.141, 5.598, 3.877, all P < 0.05]. The incidence of intermediate syndrome, tracheal intubation rate, hospital stay in the treatment group were [4.7% (2/43)], [2.3% (1/43)] and [(11.8 ± 1.8) days], respectively, which were significantly lower than those in the control group [23.8% (10/42), 19.0% (8/42) and (12.9 ± 1.8) days, χ2 = 6.432, P = 0.011; χ2 = 6.276, P = 0.012; t = -2.932, P = 0.004]. There was no significant difference in 28-day mortality rate between the two groups ( P > 0.05). Conclusion:Hemoperfusion can improve diaphragmatic function, reduce inflammatory reaction and shorten hospital stay in patients with severe organophosphorus poisoning.

Objective:To explore the clinical value of nasal high flow oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods:From June 2017 to June 2018, 61 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) admitted to the Huxi Hospital (Shanxian Central Hospital) Affiliated to Jining Medical College were taken as the clinical research objects. The patients were divided into control group and treatment group by using the random number table method with 31 patients in control group and 30 patients in treatment group. They all treated with anti-infection, anti-inflammation, expectoration, spasmolysis, asthma relief, anticoagulation and nutritional support. The control group was given conventional low flow oxygen therapy, while the treatment group was given nasal high flow oxygen therapy. The changes of partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), pulmonary artery systolic pressure (PSAP), right ventricular pressure maximum rise rate (dp/dt) and the application rate of non-invasive and invasive mechanical ventilation within 7 d were observed before and 12, 24, 48 and 72 h after treatment. Results:Before treatment, PaO 2, PaCO 2, PSAP and dp/dt of patients in the two groups showed no statistical difference, indicating comparability between groups. Compared with the control group, the PaO 2 in the treatment group decreased at all time points after treatment [(54.37 ± 5.39) mmHg (1 mmHg=0.133 kPa) vs. (57.77 ± 6.06) mmHg, (61.87 ± 5.20) mmHg vs. (65.03 ± 4.91) mmHg, (66.93 ± 6.59) mmHg vs. (72.58 ± 7.13) mmHg, (70.20 ± 8.18) mmHg vs. (75.55 ± 7.37) mmHg, P<0.05]. PaCO 2 decreased [(57.97 ± 6.18) mmHg vs. (61.84 ± 6.20) mmHg, (51.27 ± 4.53) mmHg vs. (55.77 ± 5.87) mmHg, (48.57 ± 5.37) mmHg vs. (51.55 ± 4.62) mmHg, (44.70 ± 5.40) mmHg vs. (47.68 ± 5.86) mmHg, P<0.05]. PSAP all decreased [(50.80 ± 6.94) mmHg vs. (54.55 ± 6.58) mmHg, (48.70 ± 6.22) mmHg vs. (52.55 ± 6.91) mmHg, (45.33 ± 7.51) mmHg vs. (49.19 ± 6.40) mmHg, (41.23 ± 9.22) mmHg vs. (45.94 ± 7.35) mmHg, P<0.05]. Dp/dt all increased [(403.77 ± 109.43) mmHg/s vs. (345.39 ± 112.50) mmHg/s, (429.83 ± 102.56) mmHg/s vs. (369.77 ± 110.55) mmHg/s, (483.43 ± 105.20) mmHg/s vs. (426.48 ± 107.27) mmHg/s, (532.43 ± 107.01) mmHg/s vs. (473.74 ± 105.00) mmHg/s. P<0.05]. The application rate of non-invasive/invasive mechanical ventilation in the treatment group was lower than that in the control group within treated for 7 d ( P<0.05). Conclusions:Transnasal high-flow oxygen therapy has a better clinical effect on patients with chronic obstructive pulmonary disease and is helpful to improve the right heart function.

Objective:To explore the value of susceptibility-weighted imaging (SWI) in quantitative evaluation of iron load in diabetic kidneys.Methods:Thirty two healthy New Zealand white rabbits were randomly divided into diabetic group (DM, n = 20) and control group (NC, n = 12). DM model was established by injecting 5% alloxan solution (100 ml/kg) through ear vein. 12 rats were finally enrolled into the group. NC group was injected with the same dose of normal saline. DM group and NC group were intramuscularly injected with 60 mg/kg iron dextran. The left kidney was scanned by MRI immediately after iron injection (0 weeks) and 12 weeks after feeding. The left kidney was killed after 12 weeks of scanning. The left kidney was examined by Prussian blue staining and atomic absorption spectrophotometer. The value of SWI in quantitative evaluation of renal iron content was evaluated by using the iron content measured by atomic absorption spectrophotometer as the gold standard. On SWI phase diagram, the region of interest (ROI) was manually drawn along the renal cortical vagal area, and the measured phase values were converted into angular radians. Mann Whitney U test was used to compare the blood glucose value and the angle radian value at 0 week and 12 week between the two groups; independent sample t test was used to compare the difference of iron content between the two groups; nonparametric Wilcoxon signed rank test was used to compare the difference of angle radian between DM group and NC group at 0 and 12 weeks; Spearman correlation analysis was used to study the correlation between angle radian value and atomic absorption spectrophotometer results. Results:The blood glucose level in DM group [28.0 (10.6) mmol/L] was significantly higher than that in NC Group [6.5 (1.9) mmol/L], and the difference was statistically significant (U = 0, P<0.001). At week 0, there was no significant difference between DM group [-0.04 (-0.02)] and NC Group [-0.02 (0.06)] in angle radian value (U=105.50, P>0.05); at 12 weeks, the angle radian value of DM group [0.22 (0.17)] was higher than that of NC Group [0.17 (0.05)], the difference was statistically significant (U=35.50, P<0.05). The angle radian of DM group and NC group at 12 weeks were higher than that of 0 weeks, and the differences were statistically significant ( P<0.05). Prussian blue staining showed that iron was mainly deposited in renal cortex, and the blue staining in DM group was more obvious than that in NC group. The signal intensity of renal cortex on SWI images in DM group was significantly lower than that in 0 week group at 12 weeks, and slightly decreased in NC group. The iron content of DM group and NC group were (171.39±20.13) mg/kg and (116.21±28.90) mg/kg, respectively, and the difference was statistically significant ( t=5.428, P<0.001). Spearman correlation analysis showed that the angle radian was positively correlated with iron content ( r=0.67, P<0.001). Conclusions:Diabetic kidneys have more iron deposits than normal kidneys. As a non-invasive, simple and convenient examination technique, SWI has the potential to quantitatively evaluate the iron load of diabetic kidneys.

Objective:To explore the efficacy and safety of domestic RECO flow restoration device in acute intracranial large-vessel occlusion (LVO).Methods:This study was a multicenter, prospective, randomized, open, controlled trial; 136 patients with acute intracranial LVO at 7 Chinese stroke centers from February 2014 to August 2016 were randomly assigned into an experimental group (thrombectomy by RECO device, n=67) and a control group (thrombectomy by Solitaire device, n=69). The efficacy and safety of patients from the two groups were compared and analyzed. The primary efficacy end point was set as achievement of good recanalization (modified thrombolysis in cerebral infarction [mTICI] grading≥2); the secondary efficacy end points included good prognosis (modified Rankin scale scores≤2 90 d after thrombectomy), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained, or mortality within 90 d of thrombectomy. The safety end points included any device-related serious adverse events, symptomatic intracerebral hemorrhage or serious adverse events within 24 of thrombectomy. Results:There was no statistically significant difference between the experimental group and the control group in successful rate of good recanalization (91.0% vs. 86.9%), good prognosis rate (62.7% vs. 46.4%), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained([85.4±47.0] min vs. [89.9±53.3] min), and mortality within 90 d of thrombectomy (13.4% vs. 23.2%, P>0.05). There were no device-related serious adverse events in all patients. No significant differences were found in the incidences of symptomatic intracranial hemorrhage (1.5% vs. 7.4%) or serious adverse events (death [1.5% vs. 1.4%] and brain hernia [4.5% vs. 0.0%]) between the two groups ( P>0.05). Conclusion:The domestic RECO flow restoration device is an effective and safe mechanical thrombectomy stent retriver for acute intracranial LVO.

Objective To explore the clinical value of transnasal high volume oxygen therapy in the treatment of patients with acute heart failure.Methods From January 2016 to January 2018,61 cases with acute heart failure in Huxi Hospital Affiliated to Jining Medical College were selected.The patients were randomly divided into control group and treatment group according to the digital table,31 cases in the control group and 30 cases in the treatment group.The two groups were routinely given control of fluid volume,analgesia,strong heart,diuresis,vasodilator,anti-platelet aggregation,camp support and so on.The control group was given conventional oxygen therapy,and the treatment group was treated with high flow oxygen through nose.Before treatment and 12h,24h,48h,72h after treatment,the left ventricular ejection fraction (LVEF),oxygen index (PaO2/FiO2),serum lactic acid (Lac),B type sodium and titanium (BNP) in serum,and the application rate of non-invasive mechanical ventilation and invasive mechanical ventilation in 7d were observed in the two groups.Results Compared with the control group,the LVEF of the treatment group in each time point increased [(35.58 ± 3.64) ％ vs.(37.77 ± 3.76) ％,(37.87 ± 3.58) ％ vs.(40.07 ±3.36)％,(44.94 ±3.19)％ vs.(46.83 ±3.21)％,(47.55 ±3.45％)％ vs.(40.07 ±3.36％)％,t =-2.308,-2.466,-2.316,-2.487,all P ＜ 0.05].The PaO2/FiO2 of the treatment group increased significantly at each time point after treatment [(177.39 ± 10.62) mmHg vs.(184.17 ± 10.49) mmHg,(188.00 ± 11.72) mmHg vs.(198.57 ± 18.47) mmHg,(204.06 ± 17.69) mmHg vs.(221.40 ± 23.80) mmHg,(265.23 ± 34.51) mmHg vs.(290.37 ± 26.72) mmHg,t =-2.507,-2.678,-3.236,-3.174,all P ＜ 0.05].The BNP level of the treatment group decreased significantly at each time point after treatment [(2 462.90 ± 288.00) ng/mL vs.(2 264.53 ± 366.44) ng/mL,(1 646.61 ± 377.19) ng/mL vs.(1 474.07 ± 214.03) ng/mL,(991.94 ± 242.95) ng/mL vs.(811.90 ±258.67) ng/mL,(653.77 ± 147.671) ng/mL vs.(526.47 ± 127.87) ng/mL,t =2.355,2.187,2.803,3.594,all P ＜ 0.05].The Lac level of the treatment group decreased significantly at 12h and 24h after treatment [(5.05 ± 0.69) mmol/L vs.(4.55 ± 0.80) mmol/L,(3.68 ± 0.89) mmol/L vs.(3.13 ± 0.77) mmol/L,t =2.610,2.601,all P ＜ 0.05],but there were no statistically significant differences between the two groups at 48h and 72h after treatment [(1.62 ± 0.65) mmol/L vs.(1.53 ± 0.65) mmol/L,(1.36 ± 0.64) mmol/L vs.(1.26 ± 0.46) mmol/L,all P ＞ 0.05].In the control group and the treatment group,the incidence rates of non-invasive mechanical ventilation in 7d were 35.48％ (11/31),13.33％ (4/30),respetively,the difference was statistically significant (x2 =4.034,P ＜ 0.05).In the control group and the treatment group,the incidence rates of invasive mechanical ventilation in 7d were 12.90％ (4/31),3.33％ (1/30),respetively,the difference was statistically significant (x2 =4.957,P ＜ 0.05).Conclusion Nasal high flow oxygen therapy has better clinical effect on patients with acute heart failure.It is a more active treatment measure,and is worthy of clinical application.