Abstract:Objective To construct and validate a prognostic prediction model for T1/T2 stage renal carcinoma patients treated with robot-assisted laparoscopic partial nephrectomy(RALPN).Methods A total of 400 patients with T1/T2 stage renal carcinoma who underwent RALPN at the Affiliated Hospital of Nanjing University Medical School from August 2018 to July 2019 were retrospectively enrolled.A nomogram prediction model for prognosis was constructed,and internal validation was performed using the Bootstrap method,with calibration curves drawn for consistency verification.Results Among the 400 patients,22 were lost to follow-up at 5 years,and 378 completed effective follow-up.The 5-year cumulative survival rate was 90.5％(342/378),including 342 in the survival group and 36(9.5％)deaths in the death group.Cox regression analysis showed that increased differentiation degree was an independent protective factor for the prognosis of RALPN patients,while older age,presence of clinical symptoms,elevated World Health Organization(WHO)/International Society of Urological Pathology(ISUP)grade,advanced T stage,and regional lymph node metastasis were independent risk factors(all P＜0.05).A prognostic risk prediction model was constructed based on the above results.Hosmer-Lemeshow goodness-of-fit test showedx2=6.762,degree of freedom=8,P=0.578.The nomogram prediction model revealed that the influencing factors on prognosis ranked as age,WHO/ISUP grade,differentiation degree,T stage,clinical symptoms,and regional lymph node metastasis.When the total score reached 156,the 5-year mortality rate could reach 85.0％.The concordance index of the nomogram model was 0.956,indicating good consistency between predicted prognostic risk and actual risk in RALPN patients.The Brier score was 0.076,and the calibration slope was 0.820.Conclusion Prognostic factors for T1/T2 stage renal carcinoma patients treated with RALPN include differentiation degree,age,clinical symptoms,WHO/ISUP grade,T stage,and regional lymph node metastasis.The prediction model constructed based on these factors shows favorable discrimination and calibration.

Abstract:Objective To investigate the effect of modified Ponseti technique combined with external application of Chinese herbs for"promoting blood circulation and removing blood stasis,relaxing sinews and activating collaterals"on skin complications during the casting period in children with clubfoot.Methods A total of 80 children with clubfoot treated at the First Affiliated Hospital of Xinjiang Medical University from January 2022 to January 2025 were enrolled.The children were randomly divided into control group and observation group by random number table method,with 40 cases in each group.According to the dropout criteria,3 cases dropped out in each group,and 37 cases were finally included in each group.The control group received traditional Ponseti technique with vaseline gauze for skin protection,and the observation group was treated with modified Ponseti technique combined with external application of traditional Chinese medicine gel patches.The incidence of skin complications,skin condition,pain level,transforming growth factor-β1(TGF-β1),interleukin-6(IL-6),microcirculation evaluation,biomechanical monitoring and curative effect were compared between the two groups.Results The total incidence of skin complications in the observation group was significantly lower than that in the control group[8.1％(3/37)vs 40.5％(15/37)](x2=10.571,P=0.001).After treatment,the Braden Q scores in both groups were higher than those before treatment,and the score in the observation group was higher than that in the control group;the faces,legs,activity,cry,and consolability scale scores in both groups were lower than those before treatment,and the score in the observation group was lower than that in the control group(all P＜0.05).TGF-β,in both groups showed a continuous increasing trend before treatment,at 4 weeks of treatment and at cast removal;IL-6 in the control group showed a trend of first increasing and then decreasing,while that in the observation group showed a continuous decreasing trend;at 4 weeks of treatment and at cast removal,TGF-β1 in observation group were higher than those in the control group,and IL-6 were lower than those in the control group(all P＜0.05).After treatment,the blood perfusion in both groups was higher than that before treatment,and that in the observation group was higher than that in the control group;the contact pressure,shear force and pressure-time integral in both groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).The total effective rate of the observation group was significantly higher than that of the control group[94.6％(35/37)vs 75.7％(28/37)](x2=5.234,P=0.022).Conclusion Modified Ponseti technique combined with external application of traditional Chinese medicine gel patches for"promoting blood circulation and removing blood stasis,relaxing sinews and activating collaterals"can significantly reduce the incidence of skin complications during cast fixation in children with clubfoot,relieve skin pain,improve skin condition and significantly increase the total effective rate.Its mechanism is related to improving microcirculation,regulating inflammatory repair balance and optimizing biomechanical environment.

Abstract:Objective To investigate the rehabilitation effect and its influencing factors in patients with cervical spondylotic radiculopathy(CSR)after anterior cervical discectomy and fusion(ACDF).Methods Clinical data of 142 CSR patients treated with ACDF in the Second Affiliated Hospital of Naval Medical University from June 2020 to June 2024 were retrospectively analyzed.All patients were followed up for 3 months postoperatively.The rehabilitation effect was evaluated using the rehabilitation evaluation scale for cervical spondylotic radiculopathy(RES-CSR).Multiple linear regression was used to analyze the influencing factors of postoperative rehabilitation effect,and the product term test in multiple linear regression was used to analyze the interaction between factors.Results The RES-CSR score of 142 CSR patients at 3 months after ACDF was 77±15,indicating a moderate rehabilitation level.Multiple linear regression analysis showed that age ≥65 years(β=-0.160,P=0.001),diabetes mellitus(β=-0.120,P=0.002),exercise intensity＜3 times/week(β=-0.229,P＜0.001),comorbid anxiety/depression(β=-0.199,P＜0.001),Japanese Orthopaedic Association(JOA)score＜12 at 1 month postoperatively(β=-0.268,P＜0.001),and postoperative dysphagia(β=-0.197,P＜0.001)were independent risk factors affecting the rehabilitation effect after ACDF.There was no significant interaction effect of these risk factors on rehabilitation outcome.Conclusion The overall rehabilitation effect of CSR patients after ACDF is moderate.Age,diabetes mellitus,exercise intensity,anxiety/depression,JOA score at 1 month postop-eratively,and dysphagia are core factors affecting postoperative rehabilitation.Targeted intervention strategies based on these factors can help improve the quality of postoperative rehabilitation.

Abstract:Objective To evaluate the utilization rate of key evidence-based treatments in hospitalized patients with acute myocardial infarction(AMI)based on electronic medical record data,and to verify the accuracy of the evaluation results.Methods This cross-sectional study was conducted based on routine clinical diagnosis and treatment data.A total of 900 AMI cases from 5 hospitals in Beijing were enrolled.Taking manually extracted medical record data for evaluating diagnosis and treatment quality as the reference standard,the accuracy of the utilization rate of key evidence-based treatments evaluated by electronic medical record data was compared and verified.Results The baseline age of 900 enrolled AMI patients from 5 hospitals was(65±14)years old,including 663 males(73.7％).Analysis of AMI medical quality indicators in each hospital showed that electronic medical record data were consistent with manually recorded data in seven key indicators.For reperfusion therapy indicators,Hospital A(both 65.3％)and Hospital B(84.6％vs 86.8％,both ranked first)presented consistent results.The overall standardized mean difference of reperfusion therapy indicators was only 0.06,further confir-ming the tiny difference from the perspective of effect size.It indicated that electronic medical record data have high reliability in recording clearly defined and standardized diagnosis and treatment items.Conclusion The evaluation of the utilization rate of key evidence-based treatments in hospitalized AMI patients based on electronic medical record data has good consistency with medical quality evaluation based on manual data entry,which can be used as an information source to assess the medical quality of hospitalized AMI patients.

Abstract:Diabetic peripheral neuropathy(DPN)is one of the most common and severe complications in diabetic patients,which significantly affects patients' quality of life and prognosis.The pathogenesis of DPN involves metabolic disorder,oxidative stress,inflammatory response and nerve injury,and its molecular mecha-nism remains not fully clarified.Caveolin-1 is a key structural protein of cell membrane caveolae,which is widely involved in cell signal transduction,membrane structure regulation and metabolic processes.Accumulating studies have demonstrated that caveolin-1 plays an important role in neuroprotection,inflammatory regulation and metabolic homeostasis,and its abnormal expression and function are closely associated with the occurrence and progression of DPN.This article systematically reviews the mechanism and regulatory signaling pathways of caveolin-1 in DPN,and analyzes its research progress and value as a potential therapeutic target,aiming to provide new theoretical basis and strategic reference for mechanism exploration and clinical intervention of DPN.

Abstract:Objective To investigate the effects of probiotic preparations on glucose and lipid metabolism and cytokines in obese patients with polycystic ovary syndrome(PCOS).Methods A total of 63 PCOS patients who visited Beijing Anzhen Hospital,Capital Medical University from April 2023 to December 2024 were enrolled.Patients were divided into observation group(42 cases)and control group(21 cases)by random number table method.The observation group received oral probiotic preparations,while the control group received oral maltodextrin,and both groups were treated for 12 weeks.General data,glucose metabolism indicators,lipid metabolism indicators and cytokine levels were compared between the two groups.Results Among the 63 enrolled patients,3 withdrew from the study midway due to personal reasons.Finally,60 patients completed the study,including 40 in the observation group and 20 in the control group.After treatment,body weight and body mass index in the observation group were lower than those before treatment and lower than those in the control group[(81.3±2.0)kg vs(85.3±2.1)kg,(29.4±0.6)kg/m2 vs(30.3±0.5)kg/m2](all P＜0.05).After treatment,fasting insulin and homeostasis model assessment of insulin resistance in the observation group were lower than those before treatment and lower than those in the control group(all P＜0.05).After treatment,triglyceride,total cholesterol and low-density lipoprotein cholesterol in the observation group were lower than those before treatment and lower than those in the control group(all P＜0.05).After treatment,interleukin-6(IL-6),IL-8 and tumor necrosis factor-α in the observation group were lower than those before treatment and lower than those in the control group,while IL-10 was higher than that before treatment and higher than that in the control group(all P＜0.05).Conclusion Probiotic preparations can regulate glucose and lipid metabolism in obese PCOS patients to a certain extent,which may be achieved by regulating the levels of related cytokines,improving the inflammatory microenvi-ronment,and further modulating metabolic indicators in obese PCOS patients.

Abstract:Objective To summarize the experience of multidisciplinary collaborative anticoagulation management for patients undergoing simultaneous coronary endarterectomy(CE)during coronary artery bypass grafting(CABG),so as to provide reference for clinical medical staff.Methods A total of 90 patients receiving combined CABG and CE in Guangdong Provincial People's Hospital from September 2017 to June 2024 were retrospectively enrolled.The patients were divided into multidisciplinary collaborative anticoagulation group(45 cases)and routine anticoagulation group(45 cases)according to postoperative anticoagulation regimens.Postoperative total incidence of bleeding events and early graft patency rate were compared between the two groups.Results Among the 90 surgical patients,7 cases required postoperative intra-aortic balloon pump support.The intensive care unit stay was 97.0(59.7,163.0)h,and the mechanical ventilation duration was 20.0(17.0,48.2)h.Perioperative myocardial infarction occurred in 3 patients,gastrointestinal bleeding in 1 patient,other bleeding events in 5 patients,and cerebrovascular accidents in 5 patients.The average hospital stay was(27±11)d.Three patients and their families chose self-discharge after surgery,1 patient died during follow-up,and 1 patient received secondary coronary stent implantation for restenosis of a target vessel at non-endarterectomy site at the second month after operation.The proportions of patients with New York Heart Association cardiac function class 3-4 before and after surgery were 67.8％(61/90)and 16.7％(15/90),respectively.The 24 h postoperative drainage volume,total incidence of bleeding events and postoperative blood transfusion rate in the multidisciplinary collaborative anticoagulation group were lower than those in the routine anticoagulation group[(347±52)ml vs(451±61)ml,0(0/45)vs 13.3％(6/45),4.4％(2/45)vs 17.8％(8/45)],while the early graft patency rate was higher[95.6％(43/45)vs 82.2％(37/45)](all P＜0.05).There were no statistically significant differences in the incidence of graft occlusion and graft stenosis ≥50％between the two groups(both P＞0.05).Conclusion Multidisciplinary collaborative anticoagulation management after combined CABG and CE can signifi-cantly reduce bleeding risk and improve early graft patency rate.

Abstract:Objective To investigate the changes and clinical significance of peripheral blood lymphocyte subsets in vivo in children with Kawasaki disease(KD).Methods A total of 99 children with KD admitted to the Department of Pediatric Medicine,Weifang People's Hospital,Shandong Province from October 2021 to December 2022 were selected as the observation group,and 64 children with common respiratory tract infection with fever as the main manifestation during the same period were selected as the control group.The lymphocyte subsets were detected and compared by flow cytometry.Receiver operating characteristic curve was used to evaluate the diagnostic efficacy of different lymphocyte subsets.Results The levels of CD4+,CD4+/CD8+ratio and B cells in the observation group were higher than those in the control group,and the levels of CD3+,CD8+and natural killer cells were lower than those in the control group(all P＜0.05).In the observation group,the levels of CD4+,CD4+/CD8+ratio and B cells in the acute stage were lower than those in the non-acute stage,and the levels of CD3+,CD8+and natural killer cells were higher than those in the non-acute stage(all P＜0.05).The area under the curve of CD3+,CD4+,CD8+,CD4+/CD8+ratio,B cells,and natural killer cells in the diagnosis of acute KD were 0.494,0.776,0.277,0.924,0.731,and 0.451,respectively.CD4+/CD8+ratio had the highest diagnostic efficiency,followed by CD4+.Conclusion The levels of T lymphocyte subsets in children with KD are abnormal,which can be used as an auxiliary basis for the identification of KD,and can also be used as a reference index to evaluate the development and recovery of KD.

Abstract:Objective To explore the effects of ultrasonographic characteristics of the second stage of labor on delivery mode and pregnancy outcome of pregnant women with hypertensive disorders complicating pregnancy(HDCP).Methods A total of 106 pregnant women with HDCP who were hospitalized and delivered in Shaanxi Provincial People's Hospital from January 2023 to September 2024 were retrospectively selected as the research objects.The angle of fetal head progression(AOP),the distance between fetal head and perineum(HPD),and the distance between fetal head and pubic symphysis(HSD)were measured by intrapartum ultrasound during the second stage of labor.The delivery mode and pregnancy outcome were recorded.Multivariate Logistic regression was used to analyze the related factors affecting natural delivery in pregnant women with HDCP.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of AOP,HPD,and HSD for the delivery mode of pregnant women with HDCP.The differences of ultrasonographic characteristics of the second stage of labor among different delivery methods and different pregnancy outcomes were compared.Results A total of 67 women had natural delivery,15 women had assisted delivery,and 24 women converted to cesarean section.The AOP of the midwifery or cesarean section group was lower than that of the natural delivery group[(102±9)° vs(138±14)°],and the HPD and HSD were higher than those of the natural delivery group[(5.6±1.4)cm vs(3.1±0.6)cm,(2.52±0.42)cm vs(1.21±0.26)cm](all P＜0.05).The prolonged duration of the second stage of labor,large HPD and large HSD were risk factors for midwifery or cesarean section,and large AOP was a protective factor for natural delivery in pregnant women with HDCP(all P＜0.05).The critical values of AOP,HPD,and HSD in predicting the delivery mode of HDCP pregnant women were 125°,4 cm,and 1.5 cm,respec-tively,and the area under the curve was 0.780,0.761,and 0.744,respectively.The area under the curve of the combined prediction of the three was 0.915,which was greater than that of the individual prediction(all P＜0.05).The natural delivery rate of AOP＜125° group,HPD ≥4 cm group and HSD≥ 1.5 cm group was lower than that of AOP≥125° group,HPD＜4 cm group and HSD＜1.5 cm group,respectively(all P＜0.05).There were 12 cases of adverse pregnancy outcomes.The AOP of the poor pregnancy outcome group was lower than that of the good pregnancy outcome group,and the HPD and HSD were higher than that of the good pregnancy outcome group(all P＜0.05).Conclusion The reduce of AOP and the increase of HPD and HSD during the second stage of labor are related to the midwifery or cesarean section and adverse pregnancy outcomes of HDCP pregnant women.The combination of AOP,HPD and HSD can effectively predict the delivery mode of HDCP pregnant women.

Abstract:Objective To explore the risk factors for reduction in branch opening area during coronary stent implantation immediate by combining high-precision intracavitary imaging techniques with functional studies.Methods Patients who underwent coronary angiography and stent interventional therapy at Beijing Jishuitan Hospital,Capital Medical University from October 22,2022 to June 1,2023 were selected.Based on the criterion that the reduction ratio of the postoperative branch opening area measured by endovascular imaging exceeded 50％,the lesions were divided into the postoperative branch opening area reduction group(53 cases)and the postoperative branch opening area normal group(113 cases).The differences in various angiographic features and endovascular imaging indicators of the two groups of lesions were compared,and the virtual coronary flow reserve fraction(Angio-FFR)at each point of the main branch of the bifurcated lesion was measured.The independent risk factors for the reduction of branch opening area were analyzed.The receiver operating characteristic(ROC)curve was established to evaluate the predictive value of intracavitary imaging for the reduction of branch opening area.Results There was no significant difference in coronary angiography data between the two groups(all P＞0.05).The proportion of plaque rupture/erosion,healing plaque and calcification in the opening area reduction group were lower than those in the opening area normal group,and the bifurcation angle and the minimum lumen area of the bifurcation nucleus were lower than those in the opening area normal group(all P＜0.05).The results of ROC curve analysis showed that the area under the curve predicted by ΔAngio-FFR for the reduction of branch opening area was 0.80(P＜0.001).The results of multivariate Logistic regression analysis showed that healing plaque,bifurcation calcification and cross bifurcation ΔAngio-FFR were the risk factors for the reduction of branch opening area(all P＜0.05).Conclusion The healing plaque,bifurcation calcification and cross bifurcation ΔAngio-FFR in the bifurcation junction area are the risk factors for the reduction of branch opening area after surgery.ΔAngio-FFR≥0.04 across the bifurcated vascular segment can better predict the reduction of the branch opening area after stent implantation.

Abstract:Objective To investigate the clinical effect of Bufei decoction and Liujunzi decoction in the treatment of chronic cough with deficiency of lung-spleen Qi after Mycoplasma pneumoniae infection in children.Methods A total of 102 children with chronic cough of lung-spleen Qi deficiency after Mycoplasma pneumoniae infection in Wuhan Hospital of Traditional Chinese Medicine,Hubei Province from March 2023 to April 2024 were selected.According to the random number table method,they were divided into the control group and the observation group,with 51 cases in each group.The control group was treated with oral azithromycin.The observation group was treated with Bufei decoction and Liujunzi decoction on the basis of the control group.Both groups were treated for 14 d.The cough score,serum inflammatory factors,disappearance time of clinical symptoms or signs,traditional Chinese medicine syndrome score,laboratory test indexes and clinical efficacy were compared between the two groups.Results After treatment,the cough scores,serum inflammatory factor levels,traditional Chinese medicine syndrome scores and laboratory test indexes of the two groups were lower than those before treatment,and those of the observation group were lower than those of the control group(all P＜0.05).The disappearance times of clinical symptoms or signs in the observation group were shorter than those in the control group(all P＜0.05).The total effective rate of the observation group was higher than that of the control group[94.1％(48/51)vs 84.3％(43/51)](x2=11.537,P=0.009).Conclusion Modified Bufei decoction and Liujunzi decoction combined with azithromycin has significant clinical effect in the treatment of chronic cough after Mycoplasma pneumoniae infection in children.

Abstract:Objective To investigate the relationship between D-dimer/fibrinogen ratio(DFR)and C-reactive protein/fibrinogen ratio(CFR)and clinical prognosis in elderly patients with acute exacerbation of chronic heart failure(AECHF).Methods The clinical data of 157 patients with AECHF admitted to Chongqing University Fuling Hospital from May 2020 to May 2024 were retrospectively collected.DFR and CFR were calculated,and the death and rehospitalization due to heart failure within 90 days after admission of AECHF patients were counted.According to the prognosis of AECHF patients,they were divided into good prognosis group(105 cases)and poor prognosis group(52 cases).The risk factors for the poor prognosis of patients with AECHF were analyzed,and the value of DFR and CFR in predicting the poor prognosis of patients with AECHF was analyzed.Results DFR and CFR in the poor prognosis group were higher than those in the good prognosis group[(0.20±0.05)vs(0.18±0.03),(3.3±0.7)vs(2.6±0.4)](both P＜0.05).New York Heart Association class Ⅳ,N-terminal pro-brain natriuretic peptide(NT-proBNP),DFR and CFR were risk factors for poor prognosis in patients with AECHF(all P＜0.05).The area under the ROC curve of combined DFR,CFR and NT-proBNP for predicting poor prognosis in AECHF patients was higher than that of DFR,CFR or NT-proBNP alone(Z=3.861,3.452,2.853,all P＜0.05).Conclusion Increased DFR and CFR are associated with poor prognosis in patients with AECHF.The combination of DFR,CFR and NT-proBNP has a high prognostic value in patients with AECHF.

Abstract:Objective To investigate the effect of gastric volume on the recovery of spontaneous circulation(ROSC)during cardiopulmonary resuscitation in patients with out of hospital cardiac arrest(OHCA).Methods The clinical data of 106 OHCA patients admitted to the Resuscitation Room of the Department of Emergency Medicine,Eastern Theater General Hospital of the Chinese People's Liberation Army from July 2021 to January 2023 were retrospectively analyzed.Patients were divided into a gastric distension group(28 cases)and a non gastric distension group(78 cases)based on the median percentage of gastric contents(including gas)in the negative pressure suction tray of the gastric tube after arrival at the hospital(defined as gastric distension if ≥ 75％).Baseline clinical data,ROSC and 30 d survival were compared between the two groups.The relationship between related clinical factors and ROSC,and the relationship between gastric volume and related clinical factors were analyzed.Results There was no significant difference in age,gender distribution,pre-hospital emergency care and pre-hospital time between the two groups(all P＞0.05).There was no significant difference in ROSC rate and 30 d survival rate between gastric distension group and nongastric distension group[28.6％(8/28)vs 25.6％(20/78),7.1％(5/28)vs 3.8％(3/78)](P=0.441,0.993).Multivariate Logistic regression analysis showed that cardiopulmonary resuscitation,airway management and epinephrine management were independent risk factors for death events in OHCA patients(all P＜0.05).Gastric volume was not associated with ROSC outcome(P=0.280).Conclusion Excessive gastric contents do not affect ROSC during cardiopulmonary resuscitation.

Abstract:Objective To explore the clinical effect of warming acupuncture combined with Yiqi Tongluo recipe in the treatment of stroke of Qi deficiency and blood stasis type patients in the recovery stage and its influence on cerebral hemodynamics,serum phospholipase A2(PLA2)and homocysteine(Hcy)levels.Methods A total of 125 patients with stroke of Qi deficiency and blood stasis type in the recovery stage admitted to the First Hospital of Hunan University of Chinese Medicine from May 2022 to May 2024 were selected.According to the random number table method,they were divided into the control group(62 cases)and the observation group(63 cases).The control group was given routine treatment,and the observation group was treated with warming acupuncture combined with Yiqi Tongluo recipe on the basis of the control group.After two weeks of treatment,the efficacy of the two groups was evaluated,and the cerebral hemodynamic indexes,PLA2,Hey levels,neurological function-related factor levels and national institutes of health stroke scale(NIHSS)scores before and after treatment were compared.Results The total effective rate of the observation group was higher than that of the control group[93.6％(59/63)vs 80.6％(50/62)](P=0.030).After treatment,the cerebral vascular peripheral resistances of the two groups were lower than those before treatment,and that of the observation group was lower than that of the control group.The minimum blood flow and minimum blood flow velocity of the two groups were higher/faster than those before treatment,and those of the observation group were higher/faster than those of the control group(all P＜0.05).After treatment,the levels of serum PLA2 and Hey in the two groups were lower than those before treatment(both P＜0.05),and those in the observation group were lower than those in the control group[(16±4)mmol/L vs(19±5)mmol/L,(14.3±2.1)μmol/L vs(17.5±3.3)μmol/L](all P＜0.05).After treatment,the glial fibrillary acidic protein,neuron-specific enolase,myelin basic protein,brain-specific protein,heart-type fatty acid binding protein and NIHSS scores of the two groups after treatment were lower than those before treatment,and those of the observation group were lower than those of the control group(all P＜0.05).Conclusion Warming acupuncture combined with Yiqi Tongluo recipe can improve the curative effect of patients with stroke of Qi deficiency and blood stasis type in the recovery period,improve cerebral hemodynamics and neurological function,and reduce serum PLA2 and Hey levels.

Abstract:Objective To explore the effect of YZG-331 on pain threshold and sleep quality in a mouse model of pain and its potential mechanism.Methods Thirty-six male specific pathogen-free 8-week-old C57BL/6J mice were selected.They were randomly divided into sham operation group,operation group and observation group,with 12 mice in each group.In the sham operation group,the skin was only cut and sutured after disinfection with iodophor.In the operation group and the observation group,L4/L5 dorsal root ganglion was cut and scraped under microscopic conditions to establish a pain mouse model.The mice in the observation group were intraperitoneally injected with YZG-331 at a concentration of 10 mg/kg on day 1,2,and 3 after operation,and the solvent was sodi-um carboxymethyl cellulose.The mice in the operation group and the sham operation group were given the same vol-ume of sodium carboxymethyl cellulose.Patch clamp was used to detect neuronal electrical signals,and proteomics analysis,molecular docking and kinetic simulation electrophysiological experiments were performed to evaluate the activity of N-methyl-D-aspartate(NMDA)receptor and the mechanism of YZG-331 on it.Results YZG-331 significantly increased the prickling and thermal pain thresholds,improved sleep quality,and inhibited pain-induced abnormalities in brain electrical activity in mice.Proteomics sequencing,molecular docking and electrophysiological experiments showed that YZG-331 stably bound to NMDA receptors.The docking score of YZG-331 with NMDA was-4.742,and the result of generalized Born surface area analysis was-33.08 kcal/mol.It penetrated deep into the receptor active pocket and formed a variety of interactions with key amino acid residues to inhibit NMDA receptor-mediated neurotoxicity and regulate cellular excitability balance.Conclusion The present findings provide strong experimental evidence for YZG-331 as a potential therapeutic agent for pain and sleep disorders.

Abstract:Candida albicans is the main pathogen causing invasive fungal infections in humans.Invasive fungal infections are of great clinical concern because of their high mortality.Fluconazole is the most commonly used antifungal drug in clinical practice.However,with the widespread use of fluconazole,the resistance to fluconazole has increased year by year,and the resistance mechanism shows diversity and complexity.Traditional Chinese medicine has the characteristics of low toxicity,broad spectrum,multi-target,low price and difficult to induce drug resistance.A large number of studies have shown that traditional Chinese medicine can regulate multiple fluconazole resistance targets to play a potential role in the treatment of Candida albicans resistant strains,and can also enhance the antibacterial effect of existing azole antifungal drugs and reverse drug resistance.This article reviews the mechanism of natural traditional Chinese medicine targeting fluconazole resistance in Candida albicans,in order to provide theoretical basis for the development of azole antifungal sensitization therapy based on the monomer components of traditional Chinese medicine.

Abstract:Objective To investigate the correlation and diagnostic value of plasma trimethylamine oxide(TMAO)and its precursors with heart failure with preserved ejection fraction(HFpEF).Methods A total of 66 patients with chronic heart failure in First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from August to December 2015 were selected as the research objects.According to the diagnostic criteria of heart failure,they were divided into HFpEF group(32 cases)and HFrEF group(34 cases).At the same time,40 patients with non-heart failure(NHF)admitted to our hospital during the same period were selected as the NHF group.The levels of TMAO,trimethylamine,choline,betaine and L-carnitine in plasma were detected by liquid chromatography-mass spectrometry.Combined with echocardiographic indicators and biomarkers,Pearson correlation analysis and receiver operating characteristic(ROC)curve were used to evaluate the diagnostic value of TMAO and its precursors for HFpEF.Results Compared with NHF group,the plasma levels of TMAO,trimethylamine and choline in HFpEF and HFrEF group were significantly increased,and those in HFpEF group were higher than HFrEF group(all P＜0.05).The level of L-carnitine in HFpEF group was significantly higher than that in NHF group(P＜0.05).There was no significant difference in betaine levels among the three groups(P＞0.05).Correlation analysis showed that TMAO level was positively correlated with tissue inhibitor of metalloproteinase-1(r=0.360,P＜0.05)and negatively correlated with estimated glomerular filtration rate(r=-0.449,P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of TMAO for the diagnosis of HFpEF was 0.812,the sensitivity was 90.6％,and the specificity was 67.5％.The AUC of trimethylamine in the diagnosis of HFpEF was 0.920,the sensitivity was 87.5％,and the specificity was 87.5％.The AUC of choline in the diagnosis of HFpEF was 0.941,the sensitivity was 87.5％,and the specificity was 97.5％.The AUC of L-carnitine in the diagnosis of HFpEF was 0.694,the sensitivity was 65.6％,and the specificity was 70.0％.Conclusion TMAO and its precursors(trimethylamine,choline,L-carnitine)are correlated with HFpEF and may be potential biomarkers for the auxiliary diagnosis of HFpEF,but their clinical application needs to be further verified.

Abstract:Takayasu arteritis is a systemic vasculitis characterized by chronic nonspecific inflammation of the aorta and its major branches.Current clinical guidelines recommend the use of high-dose glucocorticoids combined with immunosuppressants to achieve remission induction,dose reduction and disease control.Although the international and domestic guidelines for the diagnosis and treatment of Takayasu arteritis list a variety of immunosuppressive agents for the initial treatment stage,no clear drug preferred regimen has been established.This article systematically reviews the efficacy and safety characteristics of immunosuppressive agents commonly used in clinical practice in the treatment of Takayasu arteritis,in order to provide reference for clinical decision-making and reasonable selection of immunosuppressive agents.

Abstract:Objective To investigate the clinical effect and safety of Jianpi Xiaoji decoction combined with atorvastatin in the treatment of breast cancer patients with hyperlipidemia related to endocrine therapy.Methods The clinical data of 113 breast cancer patients with endocrine therapy related hyperlipidemia admitted to Guangxi Medical University Cancer Hospital from January 2022 to December 2024 were retrospectively analyzed.The patients were divided into observation group(57 cases,Jianpi Xiaoji decoction combined with atorvastatin treatment)and control group(56 cases,atorvastatin treatment alone)according to the different lipid-lowering treatment regimens on the basis of basic intervention.Both groups received 28 days of intervention.The blood lipids,liver and kidney function indexes,symptom scores,brief health status survey scale(SF-36),adverse reactions,and efficacy in blood lipids and traditional Chinese medicine syndromes were compared between the two groups before and after treatment.Results After treatment,the levels of total cholesterol,low-density lipoprotein cholesterol,apolipoprotein B and lipoprotein a in the observation group were lower than those in the control group,and the level of apolipoprotein A1 was higher than that in the control group[(4.12±0.68)mmol/L vs(5.89±0.71)mmol/L,(2.92±0.58)mmol/L vs(3.78±0.61)mmol/L,(0.68±0.15)g/L vs(0.92±0.16)g/L,(224±72)mg/L vs(278±75)mg/L,(1.62±0.25)g/L vs(1.48±0.23)g/L](all P＜0.05).After treat-ment,the level of alanine aminotransferase and the symptom scores of fatigue and insomnia in the observation group were lower than those in the control group,and the scores of the core dimensions of SF-36 such as physiological function,body pain,vitality and general health were higher than those in the control group(all P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P=0.420).The total effective rate of blood lipid and traditional Chinese medicine syndrome in the observation group was higher than that in the control group(both P＜0.05).Conclusion Compared with atorvastatin alone,Jianpi Xiaoji decoction combined with atorvastatin can further improve dyslipidemia in breast cancer patients with endocrine therapy related hyperlipidemia,reduce the potential risk of liver injury,and improve the quality of life.

Abstract:Objective To investigate the efficacy and cost-effectiveness of unilateral fully covered metal stents and bilateral plastic stents in endoscopic drainage for malignant hilar bile duct obstruction(HMBO).Methods Patients who underwent endoscopic retrograde cholangiopancreatography and biliary stent placement due to unresectable HMBO(Bismuth type Ⅱ-Ⅳ)in the Second Hospital,Lanzhou University from May 2020 to May 2024 were retrospectively collected.A total of 76 patients were enrolled and divided into unilateral fully covered metal stent group(group A,31 cases)and bilateral plastic stent group(group B,45 cases).The primary outcome was clinical success rate,and the secondary outcome was stent patency time,hospital stay,and surgery-related costs.Results There was no significant difference in clinical success rate and length of hospital stay between the two groups(all P＞0.05).The stent patency time of group A was longer than that of group B[Bismuth type Ⅱ-Ⅲ:(180±118)d vs(92±70)d;Bismuth type Ⅳ:(210±122)d vs(85±61)d],and the surgery-related cost was higher than that of group B[Bismuth type Ⅱ-Ⅲ:(49±15)thousand yuan vs(29±10)thousand yuan;Bismuth Ⅳ type:(50±16)thousand yuan vs(25±8)thousand yuan](all P＜0.05).Conclusions Endoscopic stent drainage is an effective palliative treatment for HMBO.Unilateral fully covered metal stent drainage has certain advantages in stent patency time,and bilateral plastic stent drainage has certain advantages in hospitalization cost,but more large sample clinical studies are needed to further confirm.