Objective To investigate the expression of soluble leukocyte differentiation antigen 14 subtype(sCD14-ST) and activator of activated cellular triggering agent A(ACTA) in the sera of elderly patients with chronic heart failure(CHF) combined with pulmonary infection(PI), as well as its correlation with the patients' conditions and prognosis. The correlation with the patient's condition and prognosis. Methods Ninety-eight elderly patients with CHF combined with PI treated in the Geriatrics Department of the First Affiliated Hospital of Naval Medical University from January 2019 to March 2023 were the study subjects(PI group), and they were categorized into mild subgroups according to the severity of PI(n=41), moderate subgroup(n=32), and severe subgroup(n=25); and then according to the survival of patients discharged from the hospital for 28 d, they were categorized into the survival subgroup(n=66) and death subgroup(n=32); another 98 cases of elderly CHF patients with uncomplicated PI who had the same basic clinical data as the PI group in the same period were selected as controls(non-PI group). We compared the expression levels of serum sCD14-ST and ACTA in each group; analyzed the influencing factors on the prognosis of elderly CHF patients with PI by multifactorial logistic regression; and analyzed the predictive value of serum sCD14-ST and ACTA levels on the prognosis of elderly CHF patients with PI by ROC curve. Results Serum sCD14-ST and ACTA levels were elevated in the PI group compared with the non-PI group(t/P=34.065/<0.001, 38.096/<0.001). Serum sCD14-ST, ACTA levels were increased in the mild subgroup, moderate subgroup, and severe subgroup of elderly patients with CHF combined with PI in that order(F/P=130.716/<0.001, 152.476/<0.001). The proportion of patients with cardiac function class IV, sCD14-ST, and ACTA levels were higher in the death subgroup than in the survival subgroup(χ2/t/P=13.399/0.001, 7.867/<0.001, 7.297/< 0.001). The results of multifactorial logistic regression analysis showed that high cardiac function class, high sCD14-ST, and high ACTA were prognostic risk factors for elderly patients with CHF combined with PI [OR(95%CI)=2.723(1.355-5.471), 3.154(1.626-6.117), 3.425(1.678-6.990)]. The AUCs of serum sCD14-ST, ACTA and the combination of the two for predicting prognosis in elderly patients with CHF combined with PI were 0.898, 0.893 and 0.964, respectively, and the combination of the two was superior to their respective individual predictive efficacy(Z=2.281, 2.882,P=0.023, 0.004).Conclusion Serum sCD14-ST and ACTA levels were significantly elevated in elderly patients with CHF combined with PI, in order of severity, and the expression levels in the death subgroup were significantly higher than those in the survival subgroup, and the combination of the two had a high predictive value for the prognosis of elderly patients with CHF combined with PI.

Objective To analyze the changes of serum interleukin-12p70(IL-12p70) and amyloid A(SAA) levels in patients with chronic obstructive pulmonary disease(COPD) and their relationship with concomitant coronary heart disease(CHD).Methods One hundred and fifty COPD patients diagnosed and treated in the Department of Respiratory and Critical Care Medicine, Fenyang Hospital, Shanxi Medical University, were selected from May 2019 to May 2023, among which 58 patients with concurrent CHD were included in the COPD-CHD group, and 92 patients without concurrent CHD were included in the COPD group. Serum IL-12p70 and SAA levels were detected; the incidence of concurrent CHD in COPD patients with different serum IL-12p70 and SAA levels was compared; logistic regression modeling was used to analyze the independent relationship between serum IL-12p70 and SAA and concurrent CHD in COPD patients, and subjects' work characteristic curves(ROC curves) were used to analyze serum IL-12p70, the value of SAA in predicting the complication of CHD in COPD patients. Results The proportion of smoking history, proportion of diabetes, fibrinogen and serum IL-12p70, SAA levels in COPD-CHD group were higher than those in COPD group [χ2(t)/P=4.696/0.030, 4.801/0.029, 2.629/0.010, 6.111/<0.001, 5.744/<0.001]; with the increase of serum IL-12p70 and SAA levels, the incidence of concomitant CHD in patients with COPD showed a trend of increasing(χ2/P=27.864/<0.001, 31.346/<0.001); elevated serum IL-12p70 and SAA were both independent risk factors for the complication of CHD in patients with COPD [OR(95%CI)=3.350(2.002-5.607), 3.658(2.268-5.899)]; ROC curve analysis showed that the AUC of serum IL-12p70 and SAA combined in predicting concurrent CHD in patients with COPD was 0.835, which was better than their respective individual predictive efficacy(Z/P=2.180/0.029, 2.244/0.025).Conclusion Serum IL-12p70 and SAA levels were elevated in patients with COPD, especially in the presence of CHD, and both of them are independent risk factors for CHD in patients with COPD, and the risk of CHD in patients with COPD can be determined by the levels of these two indexes in clinical practice.

Objective To observe the effect of Shuxuetong combined with tirofiban in the treatment of acute cerebral infarction. Methods Eighty-six patients with acute cerebral infarction treated in the Department of Neurology of Xuzhou Municipal Hospital affiliated to Xuzhou Medical University from March 2021 to April 2023 were included in the study, and they were divided into single-medicine group(43 cases, tirofiban) and combined-medicine group(43 cases, Shuxuetong +tirofiban) by randomized numerical table, and the patients of the two groups underwent conventional basic treatment, and the cerebral hemodynamics was measured and compared before and after the treatment. Cerebral hemodynamic indexes(mean blood flow velocity of common carotid artery, cerebrovascular peripheral resistance), oxidative stress indexes [superoxide dismutase(SOD), malondialdehyde(MDA), glutathione peroxidase(GSH-Px)], inflammatory factors [interleukin(IL)-4, IL-6, tumor necrosis factor-alpha(TNF-alpha)], and vascular endothelial function indexes [vascular pseudohaemophilic factor(VPF)] were measured before and after treatment[vascular pseudohemophilic factor(vWF), endothelin-1(ET-1), intercellular adhesion molecule-1(ICAM-1)], to assess the patients' self-care ability, neurological impairment improvement, and to count the adverse reactions such as nausea, gingival bleeding, rash during the drug administration. Results After treatment, the mean blood flow velocity of the common carotid artery in the combination group was higher than that in the single-drug group, and the peripheral vascular resistance was lower than that in the single-drug group(t/P=4.991/<0.001, 2.898/0.005); the levels of serum SOD and GSH-Px were higher than that in the single-drug group, and the level of MDA was lower than that in the single-drug group(t/P=4.991/<0.001, 2.898/0.005). were lower than those in the single-drug group(t/P=5.711/<0.001,4.305/<0.001, 7.927/<0.001); serum IL-4, IL-6, and TNF-α levels were significantly lower than those in the single-drug group(t/P=8.886/<0.001, 9.312/<0.001, 6.984/<0.001); serum vWF, ET-1, and ICAM-1 levels were significantly lower than those in the single-drug group(t/P=8.314/<0.001, 9.824/<0.001, 11.054/<0.001); scores of self-care ability in daily life were higher than those of the single-drug group, and scores of neurological deficits were significantly lower than those of the single-drug group(t/P=9.188/<0.001, 10.946/<0.001); 2="" there="" was="" no="" statistically="" significant="" difference="" in="" the="" comparison="" of="" total="" incidence="" adverse="" such="" as="" gingival="" bleeding="" and="" between="" p="">0.05).Conclusion The application of Shuxuetong combined with tirofiban in the treatment of acute cerebral infarction can restore cerebral hemodynamics, reduce oxidative stress injury and improve inflammation, improve the endothelial function of the patients, and restore their ability of self-care, and the combination of treatments did not significantly increase the adverse reactions.

Objective To analyze the relationship between serum micro ribonucleic acid(miRNA)-27a, forkhead framing protein O3(FOXO3), and the severity of the disease and the prognosis of elderly patients with severe pneumonia complicated by acute respiratory distress syndrome(ARDS). Methods One hundred and eight elderly patients with severe pneumonia complicating ARDS(ARDS group) and 72 elderly patients with severe pneumonia not complicating ARDS(non-ARDS group) admitted to the Department of Intensive Care Medicine, Jing'an District Central Hospital, Shanghai, China, from October 2022 to September 2023 were selected, and the patients in the ARDS group were divided into a mild subgroup of 26 cases and a moderate subgroup of 34 cases according to the oxygenation index. The patients in the ARDS group were further divided into 26 cases in the mild subgroup, 34 cases in the moderate subgroup, and 48 cases in the severe subgroup according to the oxygenation index, and were divided into 33 cases in the death subgroup and 75 cases in the survival subgroup according to the prognosis at 28 d. In addition, 60 healthy volunteers who had medical checkups during the same period were selected as the healthy control group. Real-time fluorescence quantitative polymerase chain reaction was used to detect serum miR-27a and FOXO3 levels, and TargetScan database predicted the binding sites of miR-27a and FOXO3. The correlation between serum miR-27a and FOXO3 mRNA levels was analyzed by Pearson/Spearman correlation, multifactorial logistic regression was used to analyze the prognostic factors of elderly patients with severe pneumonia complicated by ARDS, and the subject work characteristics(ROC) curves were used to analyze the effects of serum miR-27a and FOXO3 mRNA levels on the prognosis of elderly patients with severe pneumonia complicated by The predictive value of death in patients with ARDS. Results Serum miR-27a level decreased and FOXO3 mRNA level increased in healthy control group, non-ARDS group and ARDS group(F/P=77.352/<0.001, 62.956/<0.001); serum miR-27a level decreased and FOXO3 mRNA level increased in mild, moderate and severe subgroups, and serum miR-27a level decreased and FOXO3 mRNA level increased in mild, moderate and severe subgroups. subgroups serum miR-27a level decreased and FOXO3 mRNA level increased sequentially(F/P=83.597/<0.001,111.833/<0.001); there was a binding site between miR-27a and the 3'-untranslated region of FOXO3 from 3257～3264 Sites. Serum miR-27a was negatively correlated with FOXO3 mRNA levels in elderly patients with severe pneumonia complicating ARDS(r/P=-0.736/<0.001), and oxygenation index was positively correlated with serum miR-27a levels and negatively correlated with FOXO3 mRNA levels(r/P=0.751/<0.001,-0.785/<0.001). The 28-d mortality rate of elderly patients with severe pneumonia complicated by ARDS was 30.56%(33/108). Increasing age, prolonged duration of mechanical ventilation, and elevated FOXO3 mRNA were independent risk factors affecting the prognosis of elderly patients with severe pneumonia complicating ARDS, and elevated oxygenation index and elevated miR-27a were independent protective factors [OR(95%CI)=1.199(1.033-1.393), 1.547(1.009-2.373), 1.108(1.040-1.180), 0.973(0.958-0.989), and 0.903(0.844-0.965)]; the areas under the curves of serum miR-27a, FOXO3 mRNA levels and the combination of the two in predicting death in elderly patients with severe pneumonia complicating ARDS were respectively was 0.784, 0.786, 0.879, and the AUC of the combination of the two was greater than that predicted by serum miR-27a and FOXO3 mRNA levels alone(Z/P=2.550/0.011, 2.963/0.003). Conclusions The decrease of serum miR-27a level and the increase of FOXO3 mRNA level in elderly patients with severe pneumonia complicating ARDS are closely related to the disease exacerbation and poor prognosis, and the combination of the two is of high value in predicting the death of elderly patients with severe pneumonia complicating ARDS.

Keyword：
Severe pneumonia; Acute respiratory distress syndrome; microRNA-27a; Forkhead box protein O3; Disease severity; Prognosis; Elderly;

Objective To explore the efficacy of thymopeptide combined with noninvasive ventilator-assisted ventilation in the treatment of patients with chronic obstructive pulmonary disease(COPD) combined with respiratory failure.Methods Eighty COPD patients with combined respiratory failure diagnosed and treated in the Department of Family Medicine of Zhengzhou First People's Hospital from January 2020 to January 2023 were divided into 2 groups according to the different treatment plans, and non-invasive ventilator-assisted ventilation was included in the control group(n=40), and non-invasive ventilator-assisted ventilation was included in the control group(n=40). Patients treated with noninvasive ventilator-assisted ventilation combined with thymidine were included in the observation group(n=40). The clinical efficacy of the 2 groups and the partial pressure of blood oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), arterial oxygen saturation(SaO2), tumor necrosis factor-alpha(TNF-α), C-reactive protein(CRP), and interleukin-8(IL-8) before and after treatment were compared, Interleukin-18(IL-18), dyspnea(MRC score), symptoms(CAT score), and quality of life(SGRQ score). Results The total effective rate of in the observation group were 95.00%(38/40) higher than 77.50%(31/40) in the control group(χ2=5.165,P=0.023); after the treatment, the total effective rate of clinical treatment in the observation group was 95.00%(38/40) higher than that in the control group. 0.023); after treatment, PaO2, SaO2, and IL-10 were higher in the observation group than in the control group, and PaCO2, TNF-α, CRP, and IL-18 were lower than in the control group(t=4.169, 4.173, 8.624, 6.572, 7.294, 10.320, 6.024,P<0.001); after treatment, the MRC score, CAT score, and SGRQ score of the observation group were lower than those of the control group(t/P=2.715/0.008, 5.440/<0.001, 12.501/<0.001).Conclusion Thymopeptide combined with noninvasive ventilator-assisted ventilation is effective in COPD patients with respiratory failure, which can regulate the process of immune-inflammatory reaction and restore blood gas indexes, thus improving clinical symptoms and promoting the quality of life.