Abstract:Objective:　To investigate the effect of microRNA-132-5p (miR-132-5p) targeting S100 calcium-binding protein A9 (S100A9) on the apoptosis and inflammatory of mesangial cells induced by high glucose. Methods:　Human mesangial cells were cultured in DMEM normal glucose medium as control group, and cultured in DMEM high glucose medium as high glucose group.miR-NC, miR-132-5p, anti-miR-NC, anti-miR-132-5p were transfected into normal cultured mesangial cells and recorded as miR-NC group, miR-132-5p group, anti-miR-NC group, anti-miR-132-5p group; miR-NC, miR-132-5p, si-NC, si-S100A9 were transfected into mesangial cells and cultured in a high glucose medium, and recorded as high glucose+miR-NC group, high glucose+miR-132-5p group, high glucose+si-NC group, high glucose+si-S100A9 group; miR-132-5p was transfected with pcDNA and pcDNA-S100A9 into mesangial cells and cultured with high glucose medium, and recorded as high glucose+miR-132-5p pcDNA group, high glucose+miR-132-5p+pcDNA-S100A9 group. Real-time quantitative PCR (RT-qPCR) was used to detect miR-132-5p and S100A9 mRNA expressions. Western blot was used to detect S100A9, Bcl-2 associated X protein (Bax), and B cells lymphoma/leu-kemia-2 protein (Bcl-2) expression; dual luciferase assay was used to verify the targeting relationship between miR-132-5p and S100A9; flow cytometry was used to detect apoptosis; enzyme-linked immu-nosorbent assay (ELISA) detected the levels of tumor necrosis factor-α (TNF-α), interleukin (IL) -8 and IL-6. Results:　The expression of miR-132-5p in mesangial cells induced by high glucose was decreased, and the expression of S100A9 was increased (P<0.05).miR-132-5p targetedS100A9, overexpressedmiR-132-5porinhibited S100A9 expression. Apoptosis was reduced in high glucose-induced mesangial cells, Bax expression was reduced, Bcl-2 expression was increased, and TNF-α, IL-8, IL-6 levels were decreased (P<0.05). S100A9 overexpression reversed the inhibitory effect of miR-132-5p overexpression on apoptosis and inflammatory of mesangial cells induced by high glucose. Conclusion:　Overexpression of miR-132-5p can inhibit apoptosis and inflammatory of high glucose-induced mesangial cells by down-regulating S100A9.

Abstract:Objective:　To observe the therapeutic effect and mechanism of lactoferrin on glucocorticoid-induced osteoporosis (GIOP) in rats. Methods:　Sixty female SPF Wistar rats were randomly divided into control group, model group, low-dose lactoferrin group, medium-dose group, high-dose group and alendronate group. Dexamethasone sodium phosphate injection was intramuscularly injected to establish GIOP model rats. After the molding being completed, drug intervention was given to them by gavage. The bone morphology and bone mineral density (BMD) were detected by radiological examinations. The levels of procollagen type 1 amino-terminal propeptide (P1NP), bone alkaline phosphatase (bALP), osteocalcin (OC), β-crosslaps (β-CTX), insulin like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3), IGFBP-4, and IGFBP-5 in serum were detected by enzyme linked immunosorbent assay (ELISA). Western blot was used to detect the expression of IGF-1 receptor (IGF-1R) and phosphatidylinositol 3-kinase/mammalian target of rapamycin (PI3K/mTOR) signal-related proteins in femoral tissue. Results:　Compared with control group, the BMD value of rats in the model group was decreased (P=0.000) and bone morphology was destroyed. The serum levels of P1NP, bALP, OC, β-CTX, IGF-1, IGFBP-3, IGFBP-4 and IGFBP-5 were increased significantly (P=0.000). There was no significant difference in the protein expression of IGF-1R, p-PI3K/PI3K, p-Akt/Akt, and p-mTOR in femoral tissue (P>0.05). Compared with those of model group, the BMD (P=0.030, P=0.008) and bone morphology of rats in middle and high-dose of lactoferrin groups increased; serum levels of P1NP (P=0.009, P=0.000), bALP (P=0.002, P=0.000), OC (P=0.007, P=0.000) and β-CTX (P=0.020, P=0.009) decreased; serum levels of IGF-1 (P=0.007, P=0.003), IGFBP-3 (P=0.030, P=0.007), IGFBP-4 (P=0.020, P=0.009), and IGFBP-5 (P=0.040, P=0.008) increased dose-dependently; the protein expression of IGF-1R (P=0.020, P=0.006), p-PI3K/PI3K (P=0.040, P=0.005), p-Akt/Akt (P=0.003, P=0.007) and p-mTOR (P=0.010, P=0.000) was significantly up-regulated in middle and high-dose lactoferrin groups in femoral tissues. Conclusion:　Lactoferrin can improve the bone metabolism of GIOP in rats, and it is related to the regulation of IGFBP and IGF-1-mediated PI3K/mTOR signal activation. Lactoferrin has potential anti-osteoporosis activity.

Abstract:Objective:　To observe the distribution of pathogenic bacteria of moderate to severe diabetic foot infection (DFI) and the clinical effect of vancomycin-loaded bone cement combined with vacuum sealing drainage (VSD) on the treatment of moderate to severe DFI. Methods:　There were 71 patients with moderate to severe DFI admitted from March 2017 to March 2020 who were collected retrospectively in the study. According to the patient’s condition, 34 cases were treated with VSD only after thorough debridement (traditional group), and 37 cases were treated with vancomycin-loaded bone cement combined with VSD after thorough debridement (combined group). The distribution of pathogenic bacteria in patients were analyzed, and the wound healing rate, wound healing time, total hospitalization time and depression rating scale (PHQ-9) and anxiety screening scale (GAD-7) scores 3 months after first treatment were compared between the two groups. Results:　The results showed that 29 cases of pathogenic bacteria were detected in the traditional group, of which 17 cases of gram-negative bacteria accounted for 58.62%, and 12 cases of gram-positive bacteria accounted for 41.38%; the combined group detected 32 cases of pathogenic bacteria, of which 19 cases of gram-negative bacteria accounted for 59.38%, and 13 cases of positive bacteria accounted for 40.62%. There was no significant difference in the distribution of pathogenic bacteria detected between the two groups, and most of them were gram-negative bacteria. After 3 months of treatment, the healing rate was 94.59% (35/37) in the combined group and 76.47% (26/34) in the traditional group. Compared with the traditional group, the wound healing time, the total length of hospitalization and PHQ-9 and GAD-7 scores 3 months after the first treatment of patients in the combined group were significantly reduced, with statistically significant differences (P<0.05). Conclusion:　Patients with moderate to severe DFI are mainly infected by gram-negative bacteria. Vancomycin-loaded bone cement combined VSD has achieved good results in the treatment of moderate to severe DFI.

Abstract:Objective:　To explore the application value of thyroid TI-RADS classification combined with ultrasound-guided fine needle aspiration (FNA) cell smear in the identification and diagnosis of benign and malignant thyroid nodules. Methods:　A total of 1 038 patients with thyroid nodules who were treated in our hospital and The First Affiliated Hospital of Chengdu Medical College from June 2018 to February 2020 were selected in the study. Patients were randomly divided into 2 groups, with 519 patients in each group (control group and observation group). The control group underwent thyroid TI-RADS classification guided FNA cell smear examination, and the observation group underwent contrast-enhanced ultrasound examination on this basis. The success rate of the two groups of materials and the diagnostic efficiency of the two methods of guiding materials in the differentiation of benign and malignant thyroid nodules were compared. Results:　The success rate of sampling in the observation group was 93.45%, which was higher than 75.34% in the control group (P<0.05). The consistency of FNA cell smear detection and histopathological diagnosis under the guidance of thyroid TI-RADS classification was poor, with Kappa value of 0.365 (P<0.05), and the diagnostic sensitivity, specificity and accuracy were 74.42% (64/86), 71.80% (219/305) and 72.38% (283/391), respectively. FNA cell smear detection and histopathological diagnosis under the guidance of thyroid TI-RADS classification combined with contrast-enhanced ultrasound were in good agreement with histopathological diagnosis, with Kappa value of 0.785 (P<0.05), and the diagnostic sensitivity, specificity and accuracy were 91.80% (112/122), 90.63% (329/363) and 90.93% (441/485), respectively. The sensitivity, specificity and accuracy of the observation group were higher than those of the control group (P<0.05). Conclusion:　Thyroid TI-RADS classification combined with contrast-enhanced ultrasound to guide FNA cell smears can effectively improve the success rate of identifying benign and malignant thyroid nodules compared with thyroid TI-RADS classificationalone. This method is simple to operate with higher diagnostic sensitivity, specificity and accuracy, and of great clinical value.

Abstract:Objective:　To analyze the clinical characteristics and current status of diagnosis and treatment of adrenal incidentaloma (AI). Methods:　Clinical data of 488 patients admitted to Peking University First Hospital who met the AI diagnostic criteria from January 2012 to December 2018 were retrospectively analyzed. Results:　① Of the 488 AI patients, 326 cases (66.80%) were found during physical examination, 409 cases (83.81%) were non-functional lesion. ② There were 180 cases received surgical treatment, among which 27 patients (15.00%) were pathologically diagnosed as pheochromocytoma. The area under curve of blood normetane-phrine (NMN) in the diagnosis of pheochromocytoma was 0.906, with the sensitivity of 92.9%, the specificity of 81.6%, and the Youden’s index of 0.745. The area under curve of the joint test by computed tomography (CT), blood norepinephrine (NE) and urine NE was 0.828, with the sensitivity of 77.8%, the specificity of 85.3%, and the Youden’s index of 0.631. ③ To evaluate the diagnostic value of overnight 1 mg dexamethasone inhibition test for subclinical Cushing’s syndrome (SCS), the area under curve of the 1 mg overnight dexamethasone inhibition test in diagnosis of SCS was 0.967, the optimal cut-off point was 2.1 μg/dL, with the sensitivity of 93.3%, the specificity of 92.4%, and the Youden’s index of 0.857. ④ A total of 65 patients of non-functional AI were followed up for 6 months to 7 years, and only 2 cases progressed to SCS. ⑤ There were 31 additional cases of adrenal mass<1 cm, and only 2 cases (6.45%) were primary aldosteronism. Conclusion:　① Two thirds of AI was found by routine physical examination, which was the main reason for the increase of incidence of accidental tumor, and 84% of which was non-functional lesions. ② The value of CT combined with blood NE and urine NE in the diagnosis of pheochromocytoma is lower than that of blood NMN. ③ The optimal cut-off point for the 1 mg overnight dexamethasone inhibition test diagnosis of SCS is 2.1 μg/dL, which is better than 1.8 μg/dL. ④ Non-functional AI may progress to SCS. ⑤ The clinical significance of adrenal lesions<1 cm function evaluation is unlikely to require, while imaging follow-up may be only required.

Abstract:Objective:　To evaluate whether¹³¹I combined with lithium carbonate is better than¹³¹I alone in the treatment of hyperthyroidism. Methods:　The literature published before April 2020 in PubMed, Web of Science, the Cochrane Library, CNKI, CBM and Wanfang databases was retrieved. Randomized controlled trials (RCTs) of¹³¹I combined with lithium carbonate and¹³¹I alone in the treatment of hyperthyroidism were searched. The risk bias evaluation tool recommended by Cochrane system evaluation manual was used to evaluate the quality of the included literature, and Review Manager 5.3 was used to perform Meta-analysis on the extracted data, while descriptive analysis was used for those that could not be combined. Results:　This study included 14 RCTs for analysis, including 1 567 patients, 808 in the experimental group and 759 in the control group. The results showed that there was significant difference in the cure rate of hyperthyroidism between¹³¹I combined with lithium carbonate and¹³¹I alone at the third month (RR=1.24, 95% CI=1.09-1.41, P=0.001) and 12th month (RR=1.18, 95% CI=1.04-1.34, P=0.010). There was significant difference in the recurrence rate of hyperthyroidism at the third month (RR=0.39, 95% CI=0.18-0.85, P=0.02), and the incidence of hypothyroidism in one month (RR=1.39, 95% CI=1.06-1.84, P=0.02), and no significant difference in the total effective rate of hyperthyroidism treatment at the third month (RR=1.02, 95% CI=0.97-1.08, P=0.48) and sixth month (RR=1.06, 95% CI=0.86-1.30, P=0.60). There was no significant difference in thyroid size at 1 month (SMD=-0.26, 95% CI=-0.61-0.09, P=0.15). Conclusion:　The results of systematic review show that¹³¹I combined with lithium carbonate in the treatment of hyperthyroidism, the cure rate, recurrence rate of hyperthyroidism in the third and 12th month and the incidence of hypothyroidism in the 12th month are better than those of¹³¹I alone, but there is no significant difference in the total effectiverateandthyroidsizeof hyperthyroidism treatment. However, due to the low quality of the included literature, its results and conclusions still need to be verified by more RCTs with large samples, multi centers, and test design specifications.

Abstract:Renal hyperparathyroidism (rHPT) is an adaptive response of human body based on the disorder of calcium and phosphorus metabolism in chronic kidney disease (CKD) and the progressive aggravation of vitamin D hypofunction, characterized by hyperparathyroidism and excessive synthesis and secretion of parathyroid hormone (PTH). It occurs in the early stage of renal failure and is associated with increased risk of fracture, cardiovascular disease and death. The vitamin D supplementation and reduction of phosphorus intake can be used in the early stage of CKD, while calcium mimetic agent can be used in the end-stage of CKD. For the refractory secondary hyperparathyroidism (SHPT) with poor drug treatment, parathyroidectomy can be performed. Renal transplantation can improve rHPT, but can’t cure that. In this review, we summarized the pathophysiology, diagnosis and drug treatment of rHPT, elaborated the effect of renal transplantation, and discussed the indication and strategy on SHPT.

Abstract:Diabetic nonhealing wounds are closely related to glycometabolism, which is a common clinical and intractable complication. Due to its complicated pathogenesis, safe and efficient treatments are still in needs. This article described its relevant pathogenesis, including "microenvironmental contamination", excessive oxidative stress, "hidden damage", and intestinal microbiological disorder, etc. In addition, the research progress of cytokines, hyperbaric oxygen, new materials and application of new drug were reviewed, in order to provide a theoretical basis for research and development of drugs and clinical treatment in this field.

Abstract:Obesity related metabolic diseases seriously affect human health all over the world. It's found that the disorder of gut microbiota leads to the increase of conditional pathogenic bacteria and harmful bacterial metabolites, which is involved in the occurrence and development of obesity related metabolic diseases. Diet is one of the important factors affecting gut microbiota. Caloric restriction as one of dietary intervention, a lot of evidence have proven that it can significantly improve the symptoms of metabolic diseases such as obesity, diabetes and nonalcoholic fatty liver disease. Gut microbiota may be one of its targets. Therefore, this paper reviews from such following three aspects as the changes of gut microbiota in obesity, diabetes and nonalcoholic fatty liver disease, the therapeutic effect of caloric restriction on these three metabolic diseases and the mediating role of gut microbiota in the process.

Abstract:Non-alcoholic fatty liver disease (NAFLD) is the manifestation of the metabolic syndrome in the liver. Currently, there is no effective treatment program. Bile acids (BAs), as metabolites and signaling molecules of the intestinal flora, are involved in the pathogenesis of NAFLD from different levels. This article summarizes the mechanism of intestinal flora-bile acid axis in NAFLD and related drug treatment progress.

Abstract:Diabetes is a chronic metabolic disease characterized by chronic hyperglycemia, which is a serious threat to human health. Good blood glucose control is the key to prevent diabetic complications. Blood glucose monitoring is not only an important means to guide blood glucose to reach the standard, but also an accepted method to evaluate the state of blood glucose control. Blood glucose monitoring includes spot blood glucose, glycated albumin, glycosylated hemoglobin, 1, 5-anhydrous glucose alcohol and continuous blood glucose monitoring. In recent years, big data, artificial intelligence, non-invasive monitoring and other new technologies have been integrated into the management of diabetes, in order to provide a more scientific and reliable basis for clinical selection of blood glucose monitoring technology.

Abstract:Objective:　To study the effect of 1, 25-(OH)₂-VitD₃ on the proliferation of bladder cancer cells and explore its mechanism. Methods:　Bladder cancer cells T24 were cultured in vitro. The effects of 1, 25-(OH)₂-VitD₃ at different concentrations on cell viability were detected by MTT assay. The optimal time and half inhibitory concentration of 1, 25-(OH)₂-VitD₃ on bladder cancer cells were screened. Cells were divided into four groups: control group, glucose transporter-1 (GLUT1) inhibitor group, 1, 25-(OH)₂-VitD₃ group and 1, 25-(OH)₂-VitD₃+GLUT1 inhibitor group. Hoechst 33258 staining was used to observe the morphological changes of cells in each group. The levels of glucose uptake, adenosine triphosphate (ATP) production and lactate formation were detected by kits. The mRNA and protein expression levels of GLUT1, hexokinase 2 (HK2), 6-phosphofructo-2-kinase/fructose-2, 6-biphosphatase 3 (PFKFP3), pyruvate kinase isozyme type M2 (PKM2), lactate dehydrogenase A (LDHA) and hypoxia-inducible factor-1α (HIF-1α) were detected by real-time PCR and Western blot. Results:　1, 25-(OH)₂-VitD₃ could reduce the proliferation of T24 cells in a dose-dependent manner. The number of apoptotic cells in 1, 25-(OH)₂-VitD₃ group, GLUT1 inhibitor group and 1, 25-(OH)₂-VitD₃+GLUT1 inhibitor group were higher than that in control group, while the mRNA and protein expression levels of GLUT1, HK2, PFKFP3, PKM2, LDHA and HIF-1α were significantly lower than those in control group. Compared with GLUT1 inhibitor group, the mRNA (all P=0.000) and protein (all P=0.000) expression levels of GLUT1, HK2, PFKFP3, PKM2, LDHA and HIF-1α were significantly lower in 1, 25-(OH)₂-VitD₃+GLUT1 inhibitor group. Conclusion:　1, 5-(OH)₂-VitD₃ can inhibit the proliferation and induce apoptosis of bladder cancer cells. Its mechanism may be related to down-regulation of GLUT1 expression to inhibit cell glucolusis.

Abstract:Objective:　To investigate the effect of plant extract resveratrol on autophagy of the granulosa cells in rat model with polycystic ovary syndrome and to explore its regulation on SIRT1/AMPK pathway. Methods:　Ovarian granulosa cells of Sprague Dawley rats with polycystic ovary syndrome (PCOS) were cultured in vitro and treated with different concentrations of resveratrol (5, 10, 20, 40 μmol/L) for different times (24, 48, 72 h). The proliferation rate of ovarian granulosa cells was observed by MTT method, the changes of intracellular autophagy were observed by electron microscope, and the expression changes of silent information regulator T1 (SIRT1), adenosine monophosphate-activated protein kinase (AMPK), phosphorylated AMPK (pAMPK), Beclin1 and p62 were detected by Western blot. Finally, the expression of the above proteins in the cells was detected after the application of EX527, as a specific SIRT1 inhibitor. Results:　MTT results showed that resveratrol promoted the proliferation rates of the granulosa cells of PCOS rats (P<0.05), and it was in a concentration-time dependent manner (P<0.05). Electron microscope showed that resveratrol could reduce the number of autophagosome in cells (P<0.05). Western blot results showed that resveratrol could enhance the protein expression levels of SIRT1 and pAMPK in ovarian granulosa cells (P<0.05), inhibit the expression of Beclin1 (P<0.05), and increase the expression of p62. After combined with SIRT1 specific inhibitor EX527, the protein expression levels of SIRT1 and pAMPK in granulosa cells decreased significantly, the expression of Beclin1 increased significantly (P<0.05), while p62 decreased significantly (P<0.05). Conclusion:　Resveratrol could inhibit the level of autophagy and promote the proliferation of ovarian granulosa cells of the rats with PCOS, which is closely related to the activation of SIRT1/AMPK pathway by resveratrol.

Abstract:Objective:　To investigate the effect and mechanism of miR-217 on proliferation and apoptosis of non-small cell lung cancer cells. Methods:　The expression levels of miR-217 and E2F3 mRNA in non-small cell lung cancer tissues and cells were detected by RT-qPCR.miR-NC, miR-217 mimic, miR-217 inhibitor, pc-NC, pc-E2F3 plasmids were transfected into non-small cell lung cancer SK-MES-1 or A549 cells, respectively or in combination, using Lipofectamine 2000. Cell proliferation was detected by clone formation experiments, apoptosis was detected by flow cytometry, targeting relationship was detected by dual luciferase report, and the relative expression level of E2F3 protein was detected by Western blot. Results:　miR-217 was significantly down-regulated in non-small cell lung cancer tissues and cells (P<0.01). Compared with Control group, the number of cloned cells of SK-MES-1 or A549 cells in miR-217 mimic group significantly decreased, and the apoptosis rate increased significantly (P<0.01); the number of cloned cells of SK-MES-1 or A549 cells of non-small cell lung cancer in miR-217 inhibitor group significantly increased and the apoptosis rate decreased (P<0.01).miR-217 targeted down-regulation of E2F3. Co-transfection of pc-E2F3 reversed the effects of miR-217 on proliferation and apoptosis of non-small cell lung cancer SK-MES-1 or A549 cells. Conclusion:　Overexpression of miR-217 inhibits the proliferation and induces apoptosis of non-small cell lung cancer SK-MES-1 or A549 cells by targeting E2F3.

Abstract:Objective:　To investigate the expression of Toll-like receptor 2 (TLR2) in the serum of patients with obstructive sleep apnea syndrome (OSAS) and its effect on lung injury. Methods:　Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression level of TLR2 in the patients’serum. Wistar rats were divided into Control group, chronic intermittent hypoxia group (CIH group) and TLR2 antagonist T2.5 group (T2.5 group), the hypoxic chamber was used to establish the CIH model and it was identified. The animal lung function analysis system was used to measure the lung function indexes changes of each group of rats[inspiratory capacity (IC), volume after forced exhalation in 0.3 s (FEV0.3), breath volume per minute (MV) and peak expiratory flow (PEF) ]. HE staining was used to detect the pathological changes of lung tissue in each group of rats; qRT-PCR and Western blot were used to detect the expression level of TLR2 in the lung tissue of each group of rats; ELISA was used to detect the expression changes of superoxidedismutase (SOD) activity, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the lung tissue of each group and ELISA was used to de tect changes in the expression of TLR2, TNF-α and IL-6 in serum of rats in each group. Results:　With the aggravation of OSAS, the TLR2 content in the serum of OSAS patients increased (P<0.05). The physiological characteristics of the model rats were close to the pathophysiological characteristics of OSAHS, so the CIH rat model was successfully established. Compared with CIH group (IC: 4.71±0.28, FEV0.3:4.48±0.31, MV:156.78±6.11, PEF:20.89±1.37), T2.5 increased the IC (6.01±0.32), FEV0.3 (5.51±0.38), MV (187.56±5.53) and PEF (29.75±1.43) of rats (all P<0.05); T2.5 inhibited lung tissue damage in rats, neutrophil infiltration was less, and capillaries only expanded slightly; the expression level of TLR2 protein in lung tissue of T2.5 group was down-regulated (P<0.05), the SOD activity increased (P<0.05), the MDA content decreased (P<0.05), and the TNF-α and IL-6 levels decreased (all P<0.05) in the lung tissue; the serum levels of TLR2, TNF-α and IL-6 in the T2.5 group decreased (all P<0.05). Conclusion:　OSAS can cause lung damage, oxidative stress and inflammatory response, while TLR2 antagonists can improve lung function in rats and reduce the expression of oxidative stress and inflammatory factors.

Abstract:Objective:　To assess the feasibility of textural feature analysis of Cine-cardiac magnetic resonance (CMR) as a tool to evaluate heart failure grades in patients with hypertrophic cardiomyopathy (HCM). Methods:　Eighty-two patients with HCM that underwent CMR examination at The Southwest Hospital of Army Medical University from 2013 to 2016 were enrolled in this retrospective study. All of the patients were divided into two groups according to the New York Heart Association (NYHA) classification of heart failure. Patients with NYHAⅠ-Ⅱwere selected as the mild heart failure group, and the other patients with NYHAⅢ-Ⅳwere selected as the severe heart failure group. The textures of left ventricular myocardium at the end of diastasis were extracted manually by MATLAB software twice from Cine sequence, and the Bland-Altman analysis was used to calculate the features consistency of the two times. The convolutional neural networks (CNN) calculated the area under the curve (AUC) of the features after optimization. Chi-square test was used to compare the difference of gender distribution between the two groups. The percentage of late gadolinium enhancement (LGE) in the left ventricle was calculated by Circle Cardiovascular Imaging (CVI, Canada) software. Argus software was used to calculate the left ventricular ejection fraction (EF), cardiac output (CO) and cardiac index (CI). Mann-Whitney U test was performed to compare the difference of the age, body mass index (BMI) and left ventricular function parameters between the two groups, and the receiver operating characteristic (ROC) was used to analyze the AUC of those function parameters. Results:　The gender distribution, age and BMI were not significantly different between the two groups (P=0.407, 0.338, 0.120). The EF, LGE, CO and CI cardiac function parameters of left ventricles between the mild and severe heart failure groups were of no significant difference (P=0.860, 0.072, 0.944, 0.568). The AUC calculated by CNN was 91.31%, which was significantly larger than that of EF, LGE, CO and CI (51.22%, 62.53%, 49.51%, 48.91%). Conclusion:　Textural feature analysis algorithm can effectively identify the difference of NYHAⅠ-Ⅱand NYHAⅢ-Ⅳgrades in patients with HCM, and with higher sensitivity than that of CMR function parameters.

Abstract:Objective:　To investigate the independent risk factors of ischemic stroke in patients with acute myocardial infarction and atrial fibrillation in 1 year, and to construct a risk prediction model. Methods:　We retrospectively enrolled 383 patients diagnosed with acute myocardial infarction and atrial fibrillation in the Department of Cardiology of Xinqiao Hospital of Army Medical University. Telephone follow-up for ischemic stroke within 1 year. According to the sequence of follow-up events, they were divided into groups by 7∶3. There were 268 cases in the modeling group and 115 cases in the verification group. According to whether patients in the modeling group had an ischemic stroke, they were divided into a stroke group and a non-stroke group. The risk factors of the two groups were compared and a risk prediction model was established. A total of 115 patients in the verification group verified the efficacy of the ischemic stroke risk prediction model. Results:　Advanced age (age>65 years), smoking, drinking, hypertension, D-dimer, low-density lipoprotein, and left atrial diameter, neutrophils-lymphocytes ratio (NLR), and C-reactive protein-albumin ratio (CAR) increased the risk of ischemic stroke in patients with acute myocardial infarction and atrial fibrillation. The final model established in this study was P=e^x/ (1+e^x), where e was the natural logarithm, X=-22.547+0.044×Age+0.653×Smoking+1.277×Drinking+1.134×Drinking hypertension+0.867×D-dimer+0.702×LDL+0.297×Left atrium ID+0.421×NLR+0.665×CAR. The ROC curve area of the modeling group was 0.866 (95% CI=0.820-0.911, P<0.001), the sensitivity was 87.50%, and the specificity was 73.11%. The predictive power of this model was at a moderate level. The area under the ROC curve of the verification group was 0.913 (95% CI=0.854-0.973, P<0.001), the sensitivity was 85.71%, and the specificity was 87.36%. Conclusion:　This model has good predictive ability and can be used for the screening of ischemic stroke in patients with acute myocardial infarction and atrial fibrillation within 1 year, and can provide a reference for timely identification and intervention of ischemic stroke.

Abstract:Objective:　To explore the differences in serum metabolic profiles of patients with hepatitis B virus (HBV) -related liver fibrosis and chronic hepatitis B (CHB), and to search for potential biomarkers of HBV-related liver fibrosis. Methods:　High-performance liquid chromatography-mass spectrometry was used to analyze the serum metabolic profiles of 16 HBV-related liver fibrosis and 16 CHB patients. By using statistical analysis and database search, the differential metabolites between the two groups were identified. Metabolic pathway analysis and enrichment analysis of differential metabolites using MetaboAnalyst 4.0 software screened out the primary metabolic pathways and differential metabolites on pathways. Finally, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of major differential metabolites. Results:　A total of 54 different metabolites were identified in the two groups. Metabolic pathways and enrichment analysis found that sphingolipid metabolism pathway[-log (P) =9.75, impact=0.42]and glycerophospholipid metabolism pathway[-log (P) =10.90, impact=0.06]were related to HBV-related liver fibrosis mainly enriched in metabolic pathways, including sphingomyelin, 1-phosphate-sphingosine, sphingosine, ceramide and other four different metabolites enriched in sphingolipid metabolism pathways, while phosphatidylcholine, phosphatidyl serine, phosphatidylinositol, phosphatidic acid, phosphatidylglycerol and other five different metabolites were enriched in the glycerophospholipid metabo-lism pathway. ROC analysis showed that the areas under the ROC curve of the nine different metabolites were all greater than 0.700, and all had a good diagnostic performance. Conclusion:　Sphingomyelin, 1-phospho-sphingosine, sphingosine, ceramide, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidic acid, and phosphatidyl all have a high diagnostic accuracy of HBV-related liver fibrosis, which may be a potential metabolic biomarker for HBV-related liver fibrosis.

Abstract:Objective:　To investigate the effects of different administration routes of intravenous drip and aerosol inhalation of penehyclidine hydrochloride (PCHE) on respiratory mechanics of patients undergoing gynecological laparoscopic surgery. Methods:　A total of 150 patients undergoing gynecological laparoscopic surgery in Sichuan Provincial People's Hospital were randomized into intravenous drip group, aerosol inhalation group and blank control group, with 50 cases in each group. The three groups of patients were given intravenous drip with PCHE 1 mL, aerosolinhalation with PCHE 1 mL and intravenous drip with saline 1 mL 15 min before induction of anesthesia, respectively. Respiratory mechanics indexes (Peak, Raw, Plat, PetCO₂), circulatory mechanics indexes (HR, BP) and blood gas analysis indexes (PaO₂, PaCO₂, PaO₂/FiO₂) were collected before artificial pneumoperitoneum (T₁), 30 min after pneumoperitoneum (T₂), 60 min after pneumoperitoneum (T₃) and 10 min after extubation (T₄). Results:　At T₂ and T₃, the Peak, Plat and Raw values of intravenous drip group and aerosol inhalation group were significantly lower than those of blank control group (P<0.05), and the respiratory mechanics indexes of aerosol inhalation group were significantly lower than those of intravenous drip group (P<0.05). At T₂, T₃ and T₄, the PaO₂ and PaO₂/FiO₂ values of aerosol inhalation group and intra venous drip group were significantly higher than those of blank control group (P<0.05), PaO₂ and PaO₂/FiO₂ values of aerosol inhalation group at T₂ and T₃ were significantly higher than those of intravenous drip group (P<0.05). PaCO₂ values of aerosol inhalation group and intravenous drip group at T₂, T₃ and T₄ were significantly lower than those of blank control group (P<0.05). And there was no significant difference in PaCO₂ values between intravenous drip group and aerosol inhalation group (P>0.05). There was no significant difference in HR and BP values among the three groups (P>0.05). There was no significant difference in respiratory mechanics index, circulatory mechanics index and blood gas analysis index among the three groups after the change of body position (P>0.05). Conclusion:　Artificial pneumoperitoneum during gynecological laparoscopic surgery could cause changes in respiratory tract mechanics and blood gas analysis. PCHE can effectively improve the airway pressure and internal respiratory environment of patients, which provides a scientific basis for clinical administration and anesthesia management in gynecological laparoscopic surgery.

Abstract:Objective:　To investigate the clinical characteristics and prognostic risk factors of patients with connective tissue disorders associated pulmonary arterial hypertension (CTD-PAH). Methods:　In this study, 81 patients with CTD-PAH admitted to the Department of Rheumatology and Immunology and the Department of Dermatology in the First Affiliated Hospital of Hebei North University from January 2011 to December 2018 were selected as the research objects, among which, there were 36 cases of systemic lupus erythematosus associated pulmonary arterial hypertension (SLE-PAH), 24 cases of systemic sclerosis associated pulmonary arterial hypertension (SSc-PAH), and 21 cases of primary Sj?gren syndrome associated pulmonary arterial hypertension (pSS-PAH). Baseline demographic data, clinical features, transthoracic echocardiography related parameters and laboratory findings of these 81 CTD-PAH patients were collected and analyzed. Univariate and multivariate Cox regression models were used to analyze the related risk factors for survival and prognosis in patients with CTD-PAH. Results:　The mean age of 81 CTD-PAH patients was (38.54±9.76) years old, 57 cases (70.4%) with Raynaud’s phenomenon, and 77 cases (95.1%) of females. SLE-PAH was the most common type of CTD-PAH (44.4%), followed by SSc-PAH (29.6%) and pSS-PAH (25.9%). Autoantibodies were mainly anti-U1 ribonucleoprotein (U1RNP) (56.8%). The onset age of SLE-PAH patients was significantly earlier than that of pSS-PAH and SSc-PAH patients (P<0.05). All the 81 patients with CTD-PAH were followed up, and no one was lost. The overall 1-, 3-and 5-year survival rates were 86.2%, 77.9% and 65.7%, respectively. The 1-, 3-and 5-year overall survival rates of SLE-PAH patients were 94.4%, 88.5% and 78.5%, those of SSc-PAH patients were 74.1%, 63.9% and 47.3% respectively, and those of pSS-PAH patients were 85.7%, 74.6% and 62.6% respectively. Univariate Cox analysis showed: CTD type, cardiac index (CI) <2.0 L/ (mL·m²), combined with mild interstitial lung disease (ILD), 6-minute walking distance (6MWD) <440 m, red blood cell distribution width-coefficient of variation (RDW-CV) >15.0%, combined with hyperuricemia (HUA), World Health Organization (WHO) cardiac function classification ofⅢtoⅣ, combined with Raynaud’s phenomenon, N-terminal pro-B-type natriuretic peptide (NT-proBNP) >1 400 ng/L and endothelin-1 (ET-1) >0.55 ng/L were related factors affecting survival and prognosis of patients with CTD-PAH (P<0.05). After adjusting for age, right atrial pressure (RAP) and mean pulmonary artery pressure (mPAP), multivariate Cox analysis showed that the mortality in SSc-PAH patients was 3.728 times higher than that in SLE-PAH patients (P<0.05), that of 6 MWD<440 m CTD-PAH patients was 5.629 times than that of 6MWD≥440 m patients (P<0.05), that of RDW-CV>15.0% CTD-PAH patients was 2.785 times than that of RDW-CV≤15% patients (P<0.05), that of patients combined with HUA was 3.978 times higher than that of non-HUA patients (P<0.05), that of the CTD-PAH patients with ET-1 concentration>0.55 ng/L was 3.186 times higher than that of CTD-PAH patients with ET-1 concentration≤0.55 ng/L (P<0.05). Conclusion:　The majority of CTD-PAH patients are female, and the main clinical manifestations are combination of Raynaud’s phenomenon, and more than half of the patients with present anti-U1RNP antibody. SLE-PAH is the most common type of CTD-PAH and SSc-PAH has the worst prognosis. CTD type, 6 MWD<440 m, RDW-CV>15.0%, combined HUA and serum ET-1 level>0.55 ng/L are independent risk factors for poor prognosis in patients with CTD-PAH. Early identification of CTD-PAH patients with poor prognosis, early intervention and active and effective follow-up are helpful to improve the long-term prognosis of patients.