ObjectiveTo clarify the associations between plasma fibrinogen （Fbg） and volumetric bone mineral density （vBMD） as well as osteoporosis measured by quantitative computed tomography （QCT）， and to explore the role of plasma Fbg in early screening and diagnosis of osteoporosis. MethodsPatients with hypertension who were hospitalized in the Department of Endocrinology of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to June 2022 and underwent QCT examinations were included for cross-sectional analysis. The study analyzed the correlation between plasma Fbg and osteoporosis in patients. The diagnostic efficacy of plasma Fbg for osteoporosis was evaluated by the area under the receiver operating characteristic （ROC） curve （AUC）. ResultsTotally 441 subjects were included in the analysis， with an average age of 46.0±14.5 years and a prevalence of osteoporosis of 6.4% （28/441）. As the level of plasma fibrinogen increased， the incidence of osteoporosis significantly increased （P<0.000 1）while the average bone mineral density of L1 and L2 were significantly decreased （P<0.05）. Compared with the first quartile of plasma Fbg（1.99g/L -2.37g/L）， the risk of osteoporosis in the fourth quartile of plasma Fbg （3.67g/L-4.46g/L） increased by 8.85 times after adjusting for related confounding factors. ConclusionThis study found a negative correlation between plasma fibrinogen levels and bone density in patients with hypertension. Plasma fibrinogen levels may serve as a potential screening indicator for osteoporosis， aiding in early diagnosis and therapeutic monitoring. This discovery offers a new perspective for the study of bone metabolic diseases and warrants further investigation.

Objective To investigate the predictive value of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and the simplified pulmonary embolism index(sPESI)score for 30-day death in patients with acute pulmonary embolism(APE).Methods The clinical data of 291 APE patients admitted to Xuanwu Hospital of Capital Medical University from January 2017 to December 2021 were retrospectively analyzed.White blood cell count(WBC),NLR,PLR,sPESI score,and other indicators were calculated at admission.The patients were followed up within 30 days and were divided into the death group and the survival group accord-ing to the prognosis.The differences in the above indexes between the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors for 30-day mortality in APE patients.The area under the receiver operating characteristic(ROC)curve of NLR,PLR,and combined sPESI scores in predicting mortality was compared.Results Among the APE patients,11 cases(3.78％)died and 280 cases(96.22％)survived within 30 days.The WBC,NLR,PLR,and sPESI score in the death group were sig-nificantly higher than those in the survival group(P＜0.05).Multivariate Logistic regression analysis showed that PLR,NLR,and sPESI score were independent risk factors for 30-day mortality in APE patients(P＜0.05).The area under ROC curve(AUC)of PLR in pre-dicting the 30-day death of APE patients was 0.799(P=0.001).The AUC of NLR was 0.827(P=0.001).The AUC of sPESI score was 0.874(P=0.001).There was no significant difference in the AUC of PLR,NLR,and sPESI score in predicting death(P=0.181,0.340);the AUC of NLR combined with sPESI score was 0.925(P=0.001),which was greater than that of NLR(P=0.004).The AUC of PLR combined with sPESI score was 0.901(P=0.001),which was greater than that of PLR(P=0.002).Conclusion NLR,PLR,and sPESI score are independent risk factors for 30-day mortality in APE patients,and all of them have certain prognostic values.The prognostic value of PLR and NLR combined with sPESI score was higher than that of PLR and NLR alone.

Objective:To compare the positioning errors in tracing the body surface markers between radiotherapy placement with or without using the laser positioning coordination system in post-breast conservative surgery patients, and to verify the clinical value of the laser positioning coordination system.Methods:A total of 45 post-breast-conservative surgery patients who underwent radiotherapy in Department of Radiation Oncology of the Affiliated Hospital of Inner Mongolia Medical University from January 2022 to September 2023 were prospectively collected. In the experimental group 1 ( n=15), the initial version of the laser positioning coordination system was employed to trace the body surface markers. In the experimental group 2 ( n=15), the upgraded version of the laser positioning coordination system was adopted to draw the body surface markers. In the control group ( n=15), the body surface markers were traced with conventional approach. All patients were treated with spiral tomotherapy (TOMO), and the error values in the left and right directions ( X), head and foot directions ( Y), ventral and dorsal directions ( Z), and rotation angles (ROLL) before each radiotherapy were recorded. The differences in the positioning errors among the three groups were analyzed by t-test. Results:The positioning errors in the X, Y, Z directions and ROLL in the experimental group 1 were (3.10±2.43) mm, (4.36±3.45) mm, (2.29±2.49) mm and 0.95°±0.88°, and (2.88±2.28) mm, (3.58±2.95) mm, (2.40±2.54) mm, and 0.70°±0.70° in the experimental group 2, and (4.32±3.48) mm, (5.49±4.74) mm, (2.61±3.38) mm and 1.22°±1.16° in the control group, respectively. Statistical significance was observed in the differences of positioning errors in the X, Y directions and ROLL between the experimental group 1 and control group ( t=4.32, 2.89, 2.78, P < 0.001, =0.004, =0.006), respectively. Statistical significance was detected in the differences of positioning errors in the X, Y directions and ROLL between the experimental group 2 and control group ( t=5.20, 5.14, 5.82, all P<0.001). Statistical significance was noted in the differences of positioning errors in the Y direction and ROLL between the experimental group 1 and 2 ( t=2.58, 3.41, P=0.010, 0.001). Conclusion:The laser positioning coordination system-assisted tracing the body surface marking line can significantly reduce the positioning errors in the X and Y directions and ROLL, and the upgraded version of the laser positioning coordination system can further reduce the positioning errors in the Y direction and ROLL compared with the initial version, which is of high clinical application value.

Objective:To explore the association between cognitive function and the level of gamma-amino-butyric acid(GABA)in anterior cingulate cortex(ACC)before and after treatment in patients with major depres-sion disorder.Methods:Totally 31 medication-naive patients with major depression disorder meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)and 33 normal controls were col-lected.Each eligible patient received treatment with selective serotonin reuptake inhibitor agents for 8 weeks.The MATRICS Consensus Cognitive Battery(MCCB)was used to evaluate the cognitive function.By means of 1H magnetic resonance spectroscopy,anterior cingulate cortex GABA concentrations were measured.Results:At base-line,the concentration of ACC GABA relative to water(GABA+/W)was lower in the patient group than in the control group(P＜0.05)and increased after treatment(P＜0.05).ACC GABA+/W was negatively associated with verbal learning and visual memory score in patient group at baseline(correlation coefficient and P value were r=-0.40,P＜0.05;r=-0.42,P＜0.05,respectively).The ACC GABA+/W difference resulted of treatment in patient group was positively associated with the difference of working memory score and the difference of reasoning and problem-solving score(correlation coefficient and P value were r=0.58,P＜0.05;r=0.66,P＜0.05,respec-tively).Conclusion:The cognitive dysfunction of patients with major depression disorder may not be related to the degree of depression and anxiety.And improvement of cognitive function may be associated with increase of ACC GABA concentrations.

Objective To explore the mediation effect of emotional intelligence in social support and subjective happiness,and to provide practical guidance for scientific management of nursing talents in hemodialysis center.Methods Using a cross-sectional study,by a proportional stratified sampling method,from October 2022 to January 2023,800 hemodialysis nurses in Guangzhou area were selected as the respondents,using the general data adjustment table,general well-being schedule(GWB),social support rating scale(SSRS),and wong law emotional intelligence scale(WLEIS-C).The pearson correlation was used to analyze the correlation between emotional intelligence,social support and subjective happiness of hemodialysis nurses in Guangzhou;the process macro program was used to explore the mediation effect of emotional intelligence in social support and subjective happiness in Guangzhou.Results 707 valid questionnaires were collected,and the effective recovery rate was 88.38%.The total score of subjective well-being of hemodialysis nurses in Guangzhou was(75.67±8.17),the total score of emotional intelligence(82.29±16.20),and the total score of social support(38.76±8.40).The total score of social support was positively associated with the total score of subjective well-being(r=0.517,P<0.01)and the total score of emotional intelligence(r=0.633,P<0.01),the total score of emotional intelligence was positively related to the total score of subjective well-being(r=0.634,P<0.01).Social support had a direct effect on subjective well-being(β=0.165,95%CI:0.103-0.261),and indirectly affected it through the partial mediation effect of emotional intelligence(β=0.095,95%CI:0.069-0.142),and the indirect mediation effect accounted for 36.54%of the total effect.Conclusion Guangzhou area hemodialysis nurses subjective well-being is in upper level,and emotional intelligence in hemodialysis nurses social support and subjective happiness plays intermediary effect,managers should focus on hemodialysis nurses emotional intelligence,take various measures to improve their emotional intelligence level,enhance social support,so as to improve hemodialysis nurses subjective well-being.

Objective:To investigate the value of proteinuria in evaluating the severity of pre-eclampsia (PE) and assessing the maternal and neonatal outcomes of PE.Methods:The clinical records of 265 pregnant women who were diagnosed with PE at Peking Union Medical College Hospital from January 2011 to June 2021 were retrospectively analyzed. According to 24-hour urine protein (24-hUPro) results, pregnant women were divided into two groups: the non-proteinuric group (24-hUPro<0.3 g, n=10) and proteinuric group (24-hUPro≥0.3 g, n=255). The proteinuric group was further divided into 3 subgroups based on proteinuria levels: mild group (0.3 g≤24-hUPro<2.0 g, n=119), moderate group (2.0 g≤24-hUPro<5.0 g, n=59), and severe group (24-hUPro≥5.0 g, n=77). The demographic and clinical data, laboratory indicators, pregnancy complications, maternal and neonatal outcomes were compared between different groups. Results:In proteinuric subgroups, increased proteinuria was associated with earlier onset gestations, higher incidence of headache, peripheral tissue edema, serosal effusion, intrauterine growth restriction, and abnormal umbilical cord blood flow (all P<0.05). There were no significant differences in the incidence of placental abruption, eclampsia and maternal mortality among the three subgroups, but there were significant differences in the incidence of neonatal birth weight and multiple neonatal complications (all P<0.05). Compared with the proteinuric group, the non-proteinuric group showed later onset gestation (median:34.7 vs 37.6 weeks) and gestational age of delivery (median:36.0 vs 38.4 weeks), lower proportion of ocular vascular lesions [56.7% (135/238) vs 2/9], higher birth weight (median: 2 325 vs 2 750 g), and lower rate of neonatal intensive care unit occupancy [54.3%(127/234) vs 1/10;all P<0.05]. Conclusions:The proteinuria plays an important role in assessing the severity of PE and maternal and neonatal outcomes, but it is not the only indicator. The non-proteinuric PE pregnant women might still lead to severe maternal and neonatal outcomes.

Objective:To investigate the effect of stroke center on the treatment time and short-term prognosis in patients with ultra-early acute cerebral infarction (ACI) within 6 h treated with intravenous thrombolysis.Methods:The clinical data of 113 patients with ultra-early ACI treated with intravenous thrombolysis from July 2017 to July 2019 in Chaoyang City Central Hospital, Liaoning Province were retrospectively analyzed. Among them, 40 patients who received intravenous thrombolysis before the establishment of the stroke center (from July 2017 to July 2018) were enrolled as control group, and 73 patients who received intravenous thrombolysis after the establishment of the stroke center (from August 2018 to July 2019) were as study group. The treatment time nodes were recorded, including the time of onset, time of ACI initial diagnosis, time of completing blood collection and index reporting, time of completing CT examination and diagnosis, time of informed consent and time of onset of intravenous thrombolysis. The short-term prognosis indexes were recorded, including the mortality rate, effective rate of intravenous thrombolysis, improvement rate of neurological deficit at discharge and length of stay.Results:The time of ACI initial diagnosis, time of informed consent and time of onset of intravenous thrombolysis in study group were significantly shorter than those in control group: (5.16 ± 1.97) min vs. (10.23 ± 7.80) min, (36.26 ± 21.89) min vs. (56.23 ± 40.97) min and (85.12 ± 35.46) min vs. (126.28 ± 50.14) min, and there were statistical differences ( P<0.01); there were no statistical difference in the time of onset, time of completing blood collection and index reporting and time of completing CT examination and diagnosis between 2 groups ( P>0.05). The mortality rate in study group was significantly lower than that in control group: 1.4% (1/73) vs. 12.5% (5/40), the effective rate of intravenous thrombolysis and improvement rate of neurological deficit at discharge were significantly higher than those in control group: 84.9% (62/73) vs. 67.5% (27/40) and 76.7% (56/73) vs. 55.0% (22/40), and there were statistical differences ( P<0.05); there was no statistical difference in length of stay between 2 groups ( P>0.05). Conclusions:The establishment of standard stroke center can shorten the treatment time and improve the prognosis of patients with ultra-early ACI.

With the extension of human life expectancy, the threat of cancer to human beings has become increasingly prominent. Cancer has become the first cause of death for urban and rural residents in China. As the disease progresses, many patients have metastases in other sites besides the primary malignant tumors. Hence, it is of significance to choose effective treatment methods. Body gamma knife treatment is an accurate stereotactic radiotherapy that can render higher doses to the tumors and better protect surrounding normal tissues. A large number of clinical trials have demonstrated that body gamma knife treatment of lung metastases, liver metastases and adrenal metastases can obtain relatively high local control rates. In this article, the application of body gamma knife in the treatment of metastatic tumors was reviewed.

OBJECTIVE：To study the ef fects of Gegen qinlian decoction （GGQLD）on blood lipid and blood glucose of hyperlipidemia（HLP）model rats ，and to explore its mechanism from the perspective of intestinal flora. METHODS ：Totally 48 rats were randomly divided into blank control group （n＝8）and modeling group （n＝40）. For consecutive 5 weeks，model group was given high-lipid diet to induce HLP model ；blank control group was given routine diet. After modeling ，30 modeling rats were randomly divided into model group ，simvastatin group （positive control ，10 mg/kg），GGQLD high-dose ，medium-dose and low-dose groups （14.85，4.95，1.65 g/kg，by crude drug ），with 6 rats in each group. Blank control group and model group were given constant volume of normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day，for consecutive 11 weeks. At the same time ，each group was continuously given corresponding diet. After the last medication ， body mass and body length of rats were determined ，and Lee ’s index was calculated. Serum levels of TG ，TC，HDL-C，LDL-C and fasting blood glucose （FBG）were determined in rats. DNA of rat caecum content was extracted for 16S rRNA V 3-V4 region sequencing. The Two-part model was used to analyze the correlation between intestinal flora with lipids and blood glucose. RESULTS：After 11 weeks of administration ，compared with blank control group ，the body mass ，body length ，Lee’s index ， serum levels of TC ，TG，HDL-C and FBG of model group were increased significantly （P＜0.05 or P＜0.01），while the level of HDL-C was decreased significantly （P＜0.05）. Compared with model group ，body mass and Lee ’s index and serum levels of TG ， FBG of rats in GGQLD high-dose group ，and serum levels of TC ，TG in GGQLD medium-dose group ，as well as serum level of TG of rats in GGQLD low-dose group was decreased significantly （P＜0.05 or P＜0.01）. Correlation analysis with intestinal flora showed that TC and TG shared 3 operational taxonomic units （OTU），including OTU 559，OTU701 and OTU 135（OTU135 was also shared with FBG ），which were all positively correlated with the level of TC ，TG and FBG （P＜0.01）. The three OTU were annotated as Tyzzerella of Spirillaceae ，Anaerotruncus of Verrucaceae and Peptoclostridium of Streptococcidae ，respectively. High-dose and low-dose GGQLD had a down-regulating effect on Tyzzerella and Anaerotruncus（P＜0.05 or P＜0.01），while had up-regulating effect on Peptoclostridium（P＜0.01）. CONCLUSIONS ：High-dose GGQLD （14.85 g/kg）can effectively reduce the body mass and blood lipid of HLP model rats ，and can prevent the abnormal increase of blood glucose of model rats. The mechanism may be associated with that the reduction of intestinal flora （Tyzzerella，Anaerotruncus）content.

Objective:To evaluate the airway and voice quality improvement in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery.Methods:From January 2012 to December 2016, a retrospective study was conducted in 39 patients with BVFP who underwent selective laryngeal reinnervation surgery in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Navy Medical University. All patients were examined by videostroboscopy, vocal function assessment, laryngeal electromyography and pulmonary function test before and after the surgery, and followed up for at least 2 years to evaluate the efficacy and safety of the surgery.Wilcoxon signed rank test was used to analyze the G score and VHI-10 score data. Paired t-test was used to analyze acoustic parameters, MPT values and pulmonary function parameters. Results:Postoperative infection and hemorrhage occurred in one patient separately.Videostroboscopic videos showed that at 4-8 months postoperatively, vocal folds in 35 patients achieved moderate or severe abduction during inspiration, 2 patients only achieved mild abduction, 2 patients showed no abduction,while all patients achieved adduction in bilateral vocal cords during phonation. The recovery rate of moderate-to-severe abduction was 89.7% (35/39), and these patients were decannulated successfully. At 12 months after operation, G score and VHI-10 score were significantly lower than those before operation ( P<0.05), and the acoustic parameters jitter, shimmer, HNR and MPT were significantly improved ( P<0.05). Most of the parameters of the pulmonary function test at 3 months postoperatively returned to the normal reference level, while the maximum inspiratory pressure (PImax) at 12 months after operation was still slightly lower than the normal level, but it was significantly improved compared with preoperative value ( P<0.05). The EMG data at 12 months postoperatively showed full interference potentials in 37 patients in bilateral posterior cricoarytenoid muscles during inspiration, and full interference potentials in bilateralthyroarytenoid muscles during phonation. Obvious misdirected regeneration electric activitieswere found in two of them. Potentials in posterior cricoarytenoid muscle were weak in 2 cases with poor abduction. During long-term follow-up, only one case showed decreased abduction, but did not affect respiratory function. Conclusions:The selective laryngeal reinnervation procedure applied in the present study can restore physiological motion of vocal cords. The success rate was high, the curative effect was stable, and the complications were rare. It is worth of promotion.