Type Ⅰ neurofibromatosis(NF1) is a genetic disease caused by mutations in the NF1 gene. It is characterized by neurofibromatosis and can affect multiple systems throughout the body, often accompanied by scoliosis and neurological abnormalities. The clinical manifestations are complex and there is a risk of malignancy. As a clinically difficult disease, its diagnosis and treatment are difficult. Following the consensus among experts in the clinical diagnosis and treatment of type Ⅰ neurofibromatosis in China in 2021, the China Rare Disease Alliance has recently written and published a multidisciplinary diagnosis and treatment guide for type I neurofibromatosis in 2023. The article provides an interpretation of its genetic diagnosis, surgical considerations, and orthopedic related clinical symptoms, with the aim of promoting its clinical application.

Objective To explore the effect of cardiopulmonary rehabilitation training on motor function and cardiopulmonary adaptability in stroke patients with coronary heart disease.Methods One hundred and fifty-six stroke patients with coronary heart disease admitted to the Rehabilitation Medicine Department of the Second Hospital of Hebei Medical University from June 2021 to December 2022 were selected as the research subjects. The random number table method is divided into a combined group(n=78) and a single group(n=78). The single group received routine rehabilitation treatment, while the combined group received cardiopulmonary rehabilitation training on the basis of routine rehabilitation treatment. Both groups continued for 8 weeks. Compare the changes in motor function(FMA, MBI scores), mental health scores(SAS, SDS scores), heart function(LVEF, LVESD, VO2 max, AT, VE/VO2), lung function(FVC, FEV1, FEV1/FVC), and blood lipids between the two groups before and after treatment. Results Compared with before treatment, after 8 weeks of treatment, the FMA score and MBI score of both groups increased, and the combined group was higher than the single group(t/P=4.147/<0.001, 2.718/0.007); After 8 weeks of treatment, the SAS and SDS scores of both groups decreased compared to before treatment, and the combined group was lower than the single group(t=13.773, 29.086, P<0.001); After 8 weeks of treatment, the levels of LVEF, VO2 max, and AT in both groups increased compared to before treatment, while the levels of LVESD and VE/VO2 decreased. The increase/decrease amplitude in the combination group was greater than that in the single group(t=6.472, 10.453, 7.746, 28.078, 2.276, P<0.05); After 8 weeks of treatment, FVC, FEV1, and FEV1/FVC in both groups increased, and the combined group was higher than the single group(t=13.245, 8.530, 5.169, P<0.001); After 8 weeks of treatment, the levels of TC, TG, and LDL-C in both groups decreased, while the levels of HDL-C increased, and the decrease/increase amplitude in the combination group was greater than that in the single group(t=4.960, 11.665, 13.366, 10.360, P<0.001). Conclusion Cardiopulmonary rehabilitation training can significantly improve the cardiopulmonary function of stroke patients with coronary heart disease, enhance the body's motor function, improve living conditions, and accelerate patient recovery.

Objective To analyze the correlation and predictive value of plasma atherosclerotic index(AIP) and apnea hypopnea index(AHI) in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) complicated with coronary heart disease. Methods Collection of clinical data from 136 OSAHS patients who underwent their first coronary angiography examination at Huangshi Central Hospital from January 2018 to January 2023. Patients were divided into a coronary heart disease group of 59 cases and a non coronary heart disease group of 77 cases based on whether coronary heart disease was diagnosed. The differences between AHI and AIP between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between AHI and AIP, and logistic regression analysis was used to analyze the influencing factors of OSAHS combined with coronary heart disease, Predictive value analysis was conducted using the receiver operating characteristic curve(ROC). Results The AHI and AIP of OSAHS patients in the coronary heart disease group were higher than those in the non coronary heart disease group(t=7.393, 4.314, P<0.001). AHI is positively correlated with AIP(r=0.254, P=0.003). Long disease course, high BMI, AHI, and AIP are independent risk factors for OSAHS complicated with coronary heart disease [OR(95%CI)=1.264(1.044-1.532), 1.577(1.174-2.119), 1.199(1.107-1.298), 3.165(1.039-5.312)],high LDL-C is independent protective factor[OR(95%CI)=0.724(0.605-0.873)]; The AUC of OSAHS predicted by AHI, AIP, and their combination were 0.835, 0.838, and 0.891, respectively. The AUC of the combination of the two was greater than that detected by the two alone(Z=2.498, 2.108, P=0.013, 0.035). Conclusion High levels of AIP and AHI are independent risk factors for coronary heart disease in OSAHS patients, and their combination can effectively improve the predictive value of coronary heart disease in OSAHS patients.

Objective To explore the diagnostic value of transesophageal echocardiography(TEE) in the morphology and function of left atrial appendage(LAA) in patients with patent foramen ovale and atrial fibrillation(AF). Methods Ninety-six patients with patent foramen ovale admitted to the First Hospital of Handan City from December 2019 to January 2022 were selected as the research subjects. They were divided into two groups based on whether they were complicated with atrial fibrillation: the patent foramen ovale combined with atrial fibrillation group(48 cases in the atrial fibrillation group) and the patent foramen ovale combined with atrial fibrillation group(48 cases in the non-atrial fibrillation group). 30 healthy individuals in the same period were selected as the healthy control group, all of whom underwent TEE examination. Compare the morphology and function of LAA with different degrees of spontaneous development in the left atrium among three groups of ultrasound detection indicators. Compare the morphology and function of LAA in patients with patent foramen ovale and different types of atrial fibrillation, and analyze its diagnostic value. Results The left atrial diameter(LAD) of the atrial fibrillation group was higher than that of the non-atrial fibrillation group and the healthy control group(t/P=13.422/<0.001, 10.675/<0.001), and the left ventricular ejection fraction(LVEF) of the atrial fibrillation group and non-atrial fibrillation group was lower than that of the healthy control group(t/P=25.263/<0.001, 17.918/<0.001). At the same time, the atrial fibrillation group was lower than that of the non-atrial fibrillation group(t/P=5.577/<0.001). The length and diameter of LAA in the atrial fibrillation group were higher than those in the non-atrial fibrillation group and the healthy control group(t=5.975, 5.209, P<0.05). The LAA ejection fraction(LAAEF) and LAAPEV of the atrial fibrillation group and non-atrial fibrillation group were lower than those of the healthy control group, while the LAA end diastolic volume(LAAEDV) was higher than that of the healthy control group(P<0.01). At the same time, the LAAEF and LAAPEV of the atrial fibrillation group were lower than those of the non-atrial fibrillation group(P<0.01). The LAAEF and LAAPEV in the permanent subgroup were lower than those in the paroxysmal and persistent subgroups(P<0.05). The area under the curve(AUC) of LAA, LAAEF, LAAPEV, and their combination in diagnosing patent foramen ovale with atrial fibrillation were 0.758, 0.906, 0.788, and 0.955, respectively. The AUC of the combination diagnosis was higher than that of the single diagnosis(Z/P=4.455/<0.001, 2.364/0.018, 4.047/<0.001). Conclusion TEE examination of LAA morphology and function in patients with patent foramen ovale combined with atrial fibrillation has diagnostic value, and the combined diagnosis has high specificity and sensitivity.

Objective To explore the value of serum homologous phosphatase tensin(PTEN), leukocyte differentiation antigen 34(CD34), and amino terminal brain natriuretic peptide(NT-proBNP) in the early diagnosis and prognosis of elderly heart failure(HF).Methods One hundred and twenty-six elderly HF patients admitted to the Emergency Department of Cangzhou People's Hospital from September 2020 to November 2022 were selected as the study subjects(HF group). According to the New York Heart Association(NYHA) cardiac function classification, they were divided into a Class I subgroup(n=29), a Class II subgroup(n=40), a Class III subgroup(n=32), and a Class IV subgroup(n=25). Patients were divided into a Good Prognostic subgroup(n=76) and a Poor Prognostic subgroup(n=50) based on their prognosis; Another 50 healthy individuals who underwent physical examination in the hospital during the same period were selected as the healthy control group. Compare the serum PTEN, CD34, and NT-proBNP levels in each group; Logistic regression analysis of the influencing factors of poor prognosis in elderly HF patients; The evaluation value of receiver operating characteristic curve(ROC) analysis of serum PTEN, CD34, and NT-proBNP in the prognosis of elderly HF patients.Results Compared with the healthy control group, the serum PTEN levels in the HF group decreased(t/P=13.809/<0.001), while the levels of CD34 and NT-proBNP increased(t/P=10.462/<0.001, 24.509/<0.001). The levels of serum PTEN, CD34, and NT-proBNP gradually decrease with the increase of NYHA grading(F/P=57.753/<0.001), while the levels of CD34 and NT-proBNP gradually increase(F/P=27.626/<0.001,111.566/<0.001). there="" was="" no="" significant="" difference="" in="" and="" lvedd="" between="" the="" patients="" with="" good="" prognosis="" those="" poor="" p="">0.05). The LVEF and PTEN levels in the patients with good prognosis were higher than those in the patients with poor prognosis(t/P=29.827/<0.001, 7.566/<0.001), and the CD34 and NT-proBNP levels were lower than those in the patients with poor prognosis(t/P=9.846/<0.001, 12.801/<0.001). Logistic regression analysis showed that NYHA grade III-IV, low PTEN, high CD34, and high NT-proBNP were risk factors for poor prognosis in elderly HF patients [OR(95% CI)=2.011(1.251-3.232), 1.986(1.278-3.087), 2.022(1.271-3.218), 1.533(1.075-2.186)]. The ROC curve results showed that the AUC of serum PTEN, CD34, NT-proBNP, and their combined evaluation for the prognosis of elderly HF patients were 0.849, 0.915, 0.825, and 0.979, respectively. The AUC of the three combined evaluations was relatively large(Z/P=3.479/0.001, 2.462/0.014, 2.077/0.038).Conclusion The serum PTEN levels in elderly HF patients were significantly reduced, while the levels of CD34 and NT-proBNP were increased, which were correlated with NYHA cardiac function grading and prognosis in elderly HF patients.