Objective To observe the influence of dapagliflozin tablets on myocardial enzymes,mitral valve blood flow and major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)complicated with type 2 diabetes mellitus(T2DM)after interventional therapy.Methods AMI patients with T2DM were divided into control group and treatment group by cohort method.The control group was given aspirin tablets 300 mg and ticagrelor 180 mg orally,qd,until the day of interventional treatment.After interventional therapy,aspirin tablets 100 mg,qd,oral ticagrelor tablets 90 mg each time,once in the morning and once in the evening.On the basis of the treatment in the control group,the patients in the treatment group were given dapagliflozin tablets 5-10 mg,qd,every morning after admission.After 3 months of continuous treatment,the clinical efficacy,blood glucose control effect[fasting plasma glucose(FPG),2 hour postprandial blood glucose(2 h PG)],myocardial enzymes indicators[creatine kinase(CK),creatine kinase isoenzyme-MB(CK-MB)],ventricular remodeling indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)],adverse drug reactions and MACE were compared between the two groups.Results There were 55 cases in the control group and 59 cases in the treatment group.After treatment,the total effective rates of the treatment group and the control group were 88.14％(52 cases/59 cases)and 72.73％(40 cases/55 cases),respectively,the difference was statistically significant(P＜0.05).After treatment,the FPG of the treatment group and the control group were(7.29±0.71)and(7.81±0.75)mmol·L-1,respectively;the 2 h PG were(8.66±1.33)and(9.59±1.38)mmol·L-1,respectively;the CK were(145.68±29.82)and(163.68±42.16)U·L-1,respectively;the CK-MB were(8.21±2.37)and(10.33±3.08)U·L-1,respectively;the LVEF were(57.63±8.74)％and(51.41±6.49)％,respectively;LVESD were(33.26±5.33)and(39.51±5.38)mm,respectively.The above indexes in the treatment group were significantly different from those in the control group(all P＜0.05).During the treatment,the adverse drug reactions in the treatment group mainly included nausea and vomiting,diarrhea,constipation.The adverse drug reactions in the control group mainly included hypoglycemia,diarrhea,headache.The total incidence of adverse drug reactions in the treatment group and the control group was 6.68％(4 cases/59 cases)and 9.09％(5 cases/55 cases),respectively,and the difference was not statistically significant(P＞0.05).After 3 months of follow-up,the total incidence of MACE in the treatment group and the control group was 5.08％and 18.18％,respectively,the difference was statistically significant(P＜0.05).Conclusion Dapagliflozin has a significant efficacy in the treatment of AMI patients with T2DM,and it can enhance the effect of blood glucose control,reduce the myocardial injury,inhibit the ventricular remodeling,and reduce the risk of MACE,with high safety.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Objective To explore and analyze the expression and prognostic value of serum vitamin D(VitD),fer-ritin(FRT)and heparin-binding epidermal growth factor(HB-EGF)in sepsis patients.Methods 86 sepsis patients who were admitted to the intensive care unit(ICU)of a hospital from January 2021 to January 2022 were selected as the case group,and 60 non-sepsis patients in the ICU were selected as the control group.According to the prognosis of sepsis patients one month later,patients were divided into survival group and death group.Patient's serum upon admission was taken,levels of serum VitD,FRT and HB-EGF were detected,the correlation with the prognosis of sepsis patients was analyzed,and the prognostic value was evaluated by area under curve(AUC)of receiver opera-ting characteristic curve.Results Levels of white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-1β and FRT of case group were all higher than those of non-sepsis patients in the control group,while the VitD and HB-EGF levels were lower than those of non-sepsis patients in the control group,differences were all statistically significant(all P＜0.05).One month follow-up on the prognosis of sepsis patients showed that 55 patients survived and 31 died.Acute physiology and chronic health evaluationⅡ(APACHE IⅡ)score,sequential organ failure assessment(SOFA)score,PCT,TNF-α,L-1βand FRT score in patients in the death group were all higher than those in patients in the survival group,while VitD and HB-EGF were lower than patients in the survival group,differences were all statistically significant(all P＜0.05).The Pearson correlation analysis results showed that VitD were negatively correlated with APACHE Ⅱ score,SOFA score,WBC,CRP,PCT and TNF-α(all P＜0.05),HB-EGF was negatively correlected with APACHE Ⅱ,score,CRP,PCT,TNF-α,IL-6 and IL-1β(all P＜0.05);while FRT was positively correlated with APACHE Ⅱscores,CRP,PCT,TNF-α,IL-6 and IL-1β(all P＜0.05).The AUC,sensitivity,and specificity of combined de-tection of serum VitD,FRT and HB-EGF in predicting the prognosis of sepsis patients were 0.82(95％CI:0.72-0.86),84.39％,and 69.35％,respectively.Conclusion Serum levels of VitD and HB-EGF are lower and FRT is higher in sepsis patients,their expression levels are closely related to patient prognosis,and have good predictive value for predicting the prognosis of sepsis patients.

Objective:To investigate the clinicopathological characteristics and prognostic factors of gastrointestinal stromal tumor (GIST) with initial surgical resection.Methods:The retro-spective cohort study was conducted. The clinicopathological data of 847 GIST patients who under-went initial surgical resection in Tianjin Medical University Cancer Institute & Hospital from January 2011 to December 2020 were collected. There were 405 males and 442 females, aged (60±10)years. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the nonparameter rank sum test. The Kaplan-Meier method was used to calculate survival rates. Univariate analysis was conducted using the Log-rank test. Multivariate analysis was conducted using the COX regression model. Results:(1) Clinicopatholo-gical characteristics. Of 847 patients, the tumor primary location was stomach in 585 cases, jejunum and ileum in 142 cases, duodenum in 76 cases, colorectum in 10 cases, esophagus in 3 cases, and extra-gastrointestinal in 31 cases. There were 13 cases with liver metastasis and 22 cases with abdominal metastasis. The tumor maximum diameter was (7±5)cm, and the number of nuclear divisions was 4(range, 0-60) cells/50 high-power field or 5 mm 2. According to risk classification of National Institutes of Health (NIH), 31 cases were of extremely low risk, 238 cases were of low risk, 213 cases were of moderate risk, 365 cases were of high risk. There were 839 of 847 patients positive for CD117, 788 cases positive for Dog-1, 710 cases positive for CD34, respectively. There were 272 cases with Ki-67 <5%, 214 cases with Ki-67 of 5%- 9%, 198 cases with Ki-67 ≥10%, 163 cases with missing data. R 0 resection was in 814 cases and non-R 0 resection was in 33 cases. (2) Gene testing and postoperative adjuvant therapy of GIST patients. ① Gene testing. Of 847 patients, 424 underwent genetic testing. The proportion of genetic testing was 1.89%(1/53) in 2011, 9.76%(8/82) in 2012, 8.45%(6/71) in 2013, 15.66%(13/83) in 2014, 50.00%(40/80) in 2015, 55.26%(42/76) in 2016, 73.86%(65/88) in 2017, 68.27%(71/104) in 2018, 80.65%(75/93) in 2019, 88.03%(103/117) in 2020, respectively. Of 424 with genetic testing, 338 cases had KIT mutation, 31 cases had PDGFRA mutation, 55 cases were wild type. ② Adjuvant therapy. Of 847 patients, 253 patients underwent postoperative adjuvant therapy. The proportions of postoperative adjuvant therapy were 8.82%(21/238), 41.78%(89/213), 39.18%(143/365) in patients of low risk, moderate risk, high risk. Of 578 patients with moderate to high risk, the proportion of postoperative adjuvant therapy was 15.15%(5/33) in 2011, 14.71%(10/68)in 2012, 22.45%(11/49) in 2013, 29.09%(16/55) in 2014, 41.38%(24/58) in 2015, 46.15%(24/52) in 2016, 32.81%(21/64)in 2017, 60.00%(45/75) in 2018, 60.42%(29/48) in 2019, 61.84%(47/76) in 2020, respectively. Of 253 patients underwent postoperative adjuvant therapy, 247 cases received imatinib had 6 cases received sunitinib. (3) Comparison of clinicopathological characteristics of GIST with non-gastric origin and gastric origin. Of 847 patients, 262 cases had non-gastric origin and 585 cases had gastric origin. There were significant differences in gender, the number of tumor, tumor maximum diameter, Ki-67 index, risk classification of NIH, and R 0 resection between the two groups ( χ2=8.62, 8.40, 12.97, 6.57, Z=-6.15, χ2=17.19, P<0.05). (4) Analysis of influencing factors for recurrence-free survival rate in GIST patients. Results of multivariate analysis showed that the year of initial diagnosis, primary site, tumor maximum diameter, mitotic image, risk classification of NIH, R 0 resection, genetic testing and postoperative adjuvant therapy were independent factors influencing recurrence-free survival rate in GIST patients with initial surgical resection ( hazard ratio=0.58, 0.61, 2.00, 1.71, 5.81, 2.56, 0.65, 0.38, 95% confidence interval as 0.39-0.85, 0.45-0.83, 1.46-2.74, 1.24-2.35, 3.16-10.69, 1.63-4.02, 0.46-0.94, 0.25-0.56, P<0.05). Conclusions:GIST with initial surgical resection is common located in stomach, with high positive rate in CD117 and Dog-1. The number of people undergoing genetic testing and targeted therapy for GIST is increasing year by year. There are significant differ-ences in clinicopathological characteristics between GIST with non-gastric origin and gastric origin. The year of initial diagnosis, primary site, tumor maximum diameter, mitotic image, risk classifica-tion of NIH, R 0 resection, genetic testing and postoperative adjuvant therapy are independent factors influencing recurrence-free survival rate in GIST patients with initial surgical resection.

Objective To investigate the effect of Tongsheng Prescription on trimethylamine N-oxide(TMAO)and related metabolites substrate in patients with acute cerebral infarction after intervention and to evaluate its clinical efficacy.Methods A prospective randomized controlled study was conducted in 48 patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)who had received endovascular treatment(EVT).The patients were divided into an observation group(25 cases)and a control group(23 cases).After emergency EVT,the control group was treated with routine western medicine,and the observation group was treated with nasogastric feeding or oral use of Tongsheng Prescription on the basis of treatment for the control group.The course of treatment lasted for seven days,and then the patients were followed up for three months.Before operation,7 days and 90 days after operation,National Institutes of Health Stroke Scale(NIHSS)scores in the two groups were observed.The functional prognosis evaluated with Modified Rankin Scale(MRS)scores was compared between the two groups,and the effects of Tongsheng Prescription on serum TM AO and related metabolites choline,betaine and L-carnitine were investigated.Results(1)On the postoperative day 7 and 90,the NIHSS scores of the two groups were decreased compared with those before operation(P＜0.01),and the decrease of NIHSS scores on the postoperative day 7 and 90 in the observation group was significantly superior to that in the control group(P＜0.01).(2)On the postoperative day 90,the rate of good functional outcome in the observation group was 96.00％(24/25),which was significantly higher than 69.57％(16/23)in the control group,and the difference was statistically significant(P＜0.05).(3)On the postoperative day 7 and 90,the levels of TMAO,L-carnitine and betaine in the observation group tended to decrease compared with those before operation,but the difference was not statistically significant(P＞0.05).However,the levels of TMAO,L-carnitine and betaine in the control group were significantly increased compared with those before operation(P＜0.01).On the postoperative day 7,the levels of TMAO,L-carnitine and betaine in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P＜0.05).(4)Spearman correlation analysis showed that TMAO was positively correlated with NIHSS score,L-carnitine and choline(P＜0.05 or P＜0.01).Conclusion Tongsheng Prescription has a significant effect on AIS-LVO patients seven days after EVT.The Prescription is beneficial to obtain a good functional outcome,and its mechanism may be related to the decrease of TMAO level through L-carnitine and betaine pathways,so as to improve the neurological deficit symptoms of stroke patients.

Objective To investigate the effects of Tianma Jiannao Granules(derived from Banxia Baizhu Tianma Decoction)combined with hyperbaric oxygen on cognitive function,activities of daily living(ADL),and the expression levels of serum inflammatory factors,matrix metalloproteinase 9(MMP-9),homocysteine(Hcy)and superoxide dismutase(SOD)in patients with vascular dementia(VD).Methods A total of 100 VD patients with wind-phlegm and stasis obstruction type were randomly divided into a trial group and a control group,50 cases in each group.The patients in the two groups were given symptomatic treatment such as controlling blood pressure,lowering blood glucose and regulating blood lipid.Additionally,the control group was given Oxiracetam Capsules orally,and the trial group was given Tianma Jiannao Granules orally combined with hyperbaric oxygen therapy on the basis of treatment for the control group.The course of treatment covered 12 weeks.The changes of traditional Chinese medicine(TCM)syndrome scores,Mini-Mental State Examination(MMSE)scores,ADL scores,and the expression levels of serum inflammatory factors,neurotransmitters,apoptosis-related factors,MMP-9,Hcy and SOD in the two groups were observed before and after treatment.Results(1)The scale scoring showed that after treatment,the TCM syndrome scores and ADL scores of the two groups were significantly decreased compared with those before treatment(P＜0.05),and the MMSE scores were significantly increased compared with those before treatment(P＜0.05).The decrease of TCM syndrome scores and ADL scores and the increase of MMSE scores in the trial group were significantly superior to those in the control group(P＜0.01).(2)After treatment,the serum levels of inflammatory factors such as tumor necrosis factor α(TNF-α),C-reactive protein(CRP)and interleukin 6(IL-6)in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of serum TNF-α,CRP and IL-6 levels in the trial group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the serum levels of neurotransmitters such as norepinephrine(NE),dopamine(DA)and 5-hydroxytryptamine(5-HT)in the two groups were significantly increased compared with those before treatment(P＜0.05),and the increase of serum NE,DA and 5-HT levels in the trial group was significantly superior to that in the control group(P＜0.01).(4)After treatment,the serum level of apoptosis-related factor of heme oxygenase-1(HO-1)in the two groups was significantly increased compared with that before treatment(P＜0.05),and the levels of serum soluble apoptosis-related factors(sFAS)and their ligands(sFASL)were significantly decreased compared with those before treatment(P＜0.05).The increase of serum HO-1 level and the decrease of serum sFAS and sFASL levels in the trial group were significantly superior to those in the control group(P＜0.01).(5)After treatment,the serum SOD level in the two groups was significantly increased compared with that before treatment(P＜0.05),and the levels of serum MMP-9 and Hcy were significantly decreased compared with those before treatment(P＜0.05).The increase of serum SOD level and the decrease of serum MMP-9 and Hcy levels in the trial group were significantly superior to those in the control group(P＜0.01).Conclusion Tianma Jiannao Granules combined with hyperbaric oxygen is effective on improving the cognitive function and ADL of VD patients,and has certain effects on counteracting inflammatory response and oxidation and on regulating the expression of neurotransmitters.

Objective:To explore the therapeutic efficacy and prognostic factors of induction therapy for secondary central nervous system lymphoma(SCNSL).Methods:Clinical data of patients diagnosed with SCNSL from 2010 to 2021 at Guangdong Provincial People's Hospital were retrospectively collected.A retrospective cohort study was performed on all and grouped patients to analyze the efficacy and survival.Multivariate logistic regression analysis was used to explore the adverse prognostic factors.Results:Thirty-seven diffuse large B-cell lymphoma patients with secondary central involvement were included in the research.Their 2-year overall survival(OS)rate was 46.01％and median survival time was 18.1 months.The 2-year OS rates of HD-MTX group and TMZ group were 34.3％and 61％,median survival time were 8.7 and 38.3 months,and median progression-free survival time were 8.1 and 47 months,respectively.Multivariate logistic regression analysis showed that age,sex,IPI,Ann Arbor stage were correlated with patient survival time.The median survival time of patients with CD79B,KMT2D,CXCR4.ERBB2,TBL1XR1,BTG2,MYC,MYD88,and PIM1 mutations was 8.2 months,which was lower than the overall level.Conclusion:HD-MTX combined with TMZ as the first-line strategy may improve patient prognosis,and early application of gene sequencing is beneficial for evaluating prognosis.

Objective:Based on the health ecological model, this paper systematically explores the influencing factors of mild cognitive impairment among the elderly herders in Nanshan pastoral area of Xinjiang, and provides the basis for local medical institutions to formulate prevention and control strategies for mild cognitive impairment among the elderly herders.Methods:A total of 1 145 valid questionnaires were collected, all of them were permanent herdsmen aged over 60 years in Nanshan pastoral area of Xinjiang were selected from June 2022 to February 2023 by stratified cluster random sampling method in a cross-sectional survey. Under the guidance of health ecological model, the research variables were included from five dimensions: physiology, psychology, behavioral lifestyle, social network and medical and health environment, and questionnaires were conducted. SPSS 23.0 was used for chi-square test and binary Logistic regression to analyze the influencing factors of mild cognitive impairment in elderly herders.Results:There were 564 males and 581 females with age of (70.84 ± 5.69) years old in the study. The prevalence rate of mild cognitive impairment among elderly herdsmen in Nanshan pastoral area of Xinjiang was 36.1%(413/1 145). Binary Logistic regression analysis showed that: personal monthly income (1 000-2 999 yuan)( OR = 0.583, 95% CI 0.366 - 0.926, P<0.05), education level (junior high school and above)( OR = 0.479, 95% CI 0.315 - 0.728, P<0.01) were the protective factors for mild cognitive impairment among the elderly herdsmen in Nanshan pastoral area. Hypertension ( OR = 1.842, 95% CI 1.256 - 2.702, P<0.01), dyslipidemia ( OR = 1.449, 95% CI 1.069 - 1.964, P<0.05) and chronic pain ( OR = 1.549, 95% CI 1.082 - 2.216, P<0.05) were the risk factors of mild cognitive impairment in elderly herders in Nanshan pastoral area. Conclusions:The prevalence rate of mild cognitive impairment among elderly herders in Nanshan pastoral area of Xinjiang is high, so it is necessary to carry out mild cognitive impairment screening as soon as possible, especially focusing on people suffering from hypertension, dyslipidemia and chronic pain, and making intervention plans to delay the occurrence and development of mild cognitive impairment and improve the quality of life of elderly herders.

Objective To summarize the experience of integrative palliative care at Peking Union Medi-cal College Hospital and provide a reference for promoting the integrative palliative care model.Methods Twenty cases receiving integrative palliative care at Peking Union Medical College Hospital were collected.The clinical characteristics,reasons for initiating integrative palliative care,the process of integrative palliative care,and feedback from these cases were summarized.Results Insomnia(11 cases,55％)and pain(9 cases,45％)were the most common symptoms requiring control in the 20 cases.The integrative palliative care team assisted in medical decision-making for 17 cases(85％),prepared end-of-life for 9 cases(45％),assisted in the transfer for 3 cases(15％),and provided comfort care for all the 20 cases(100％).Conclusions The integrative palliative care model can help alleviate suffering in end-of-life patients and provide support to patients'families and the original medical teams.This model is worth further promotion within class A tertiary hospitals.

Objective To investigate the application value of γ-glutamyltransferase(GGT),alkaline phosphatase(ALP)and peripheral blood neutrophil to lymphocyte ratio(NLR)in liver cancer.Methods 100 patients with liver cancer admitted to Wuming Hospital Affiliated to Guangxi Medical University from January 2012 to December 2020 were retrospectively selected to be included in liver cancer group,100 patients with cirrhosis to be included in cirrhosis group,100 patients with hepatitis to be included in hepatitis group,and 100 healthy physical examination subjects from our hospital during the same period were included in physical examination group.The GGT,ALP and NLR levels of the four groups were compared.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of each index for liver cancer.Results The levels of NLR,GGT and ALP in liver cancer group were significantly higher than those in cirrhosis group,hepatitis group and physical examination group(P<0.05).The NLR in cirrhosis group was significantly higher than that in physical examination group and hepatitis group(P<0.05).GGT and ALP in cirrhosis group and hepatitis group were significantly higher than those in physical examination group(P<0.05).Spearman correlation analysis showed that NLR was positively correlated with GGT and ALP,and GGT was positively correlated with ALP(P<0.05).When NLR,GGT and ALP were detected separately,area under the curve(AUC)of NLR was the largest(0.943,95％CI:0.901-0.971,P<0.001),and AUC of ALP was the smallest.The AUC of three combined detections was 0.987(95％CI:0.959-0.998),and the sensitivity was 99.0％.Conclusion The combined detection of NLR,GGT and ALP can significantly improve the detection rate of liver cancer,and the combined detection has better application value.