Abstract:Objective To investigate the enthusiasm of medical staff to participate in accredited medical cooperation projects and its influencing factors,so as to provide reference for further encouraging medical staff to participate in such projects and improving their work enthusiasm.Methods This study used a questionnaire survey method,and it was expected that multivariate analysis would identify key factors to inform policy making.Based on the"medical staff deployment enthusiasm scale"developed earlier by the research group,335 medical staff from Beijing Anzhen Hospital,Capital Medical University were surveyed.Descriptive analysis,single factor analysis and multiple linear regression were used to study the medical staff's deployment enthusiasm and its influencing factors.Results A total of 335 questionnaires were distributed and 335 valid questionnaires were recovered,with an effective rate of 100％.The scoring rate of the"interpersonal relationship factor subscale"was the highest,while the scoring rates of the"objective factors of deployment projects"and"career planning"were relatively low.The scores of ≤ 30 years old,31-40 years old,41-50 years old and 51-60 years old were(110±20),(107±17),(103±16)and(68±18),respectively.The results of single factor analysis showed that there were significant differences in the scores of medical staff's deployment enthusiasm among different ages(P＜0.05).Conclusion Medical staff are generally willing to participate in the deployment project.It is recommended to take employees as the main body,and take goals,problems and needs as the guidance,formulate and improve policies and support measures for hospital assignment,enhance the enthusiasm of medical staff to participate in the assign-ment,and continue to promote the sinking of advantageous medical resources,so as to help the construction of healthy China.

Abstract:Objective To explore the combined effects of systemic immune-inflammation index(SII)and different obesity phenotypes on cardiometabolic comorbidity(CMM)in a physical examination population.Methods Based on the data of 5 036 participants who underwent physical examination in the Physical Examination Center of Xiyuan Hospital of CACMS from January 2020 to December 2024,their demographic data,physical examination and laboratory indicators were analyzed.SII was calculated and participants were divided into metabol-ically healthy non-overweight/obese(MHNO),metabolically healthy overweight/obese(MHO),metabolically healthy non-overweight/obese(MANO),and metabolically abnormal overweight/obese(MAO)according to metabolic status and body mass index.Multivariate Logistic regression analysis was used to explore the combined effect of SII and different obesity phenotypes on CMM.Restricted cubic spline(RCS)curve was used to explore the relationship between them,and odds ratio=1 was determined as the threshold.Results There were 395 CMM patients in 5 036 subjects(7.8％).The results of multivariate Logistic regression analysis showed that after fully adjusting for confounding factors,the MAO group had an increased risk of CMM compared with the MHNO group(P＜0.05),and the high SII group had an increased risk of CMM compared with the low SII group(P＜0.05).Compared with the low-SII combined MHNO group,both the low-SII combined MAO group and the high-SII combined MAO group showed a higher risk of CMM.After controlling for different confounding factors,the RCS curve showed a linear dose-response relationship between SII and the risk of CMM in MAO participants(P＜0.05),and the threshold of odds ratio=1 was 340.71.Conclusion High levels of SII and MAO are closely related to the risk of CMM.Special attention should be paid to MAO participants with SII＞340.71 to reduce the risk of CMM.

Abstract:The Ⅲ degree atrioventricular block refers to complete atrioventricular separation caused by the inability of the excitation from the atrium to downtransmit to the ventricle.The symptoms depend on the speed of the ventricular rate.If the ventricular rate is slow,there may be no obvious symptoms,but if the ventricular rate is very slow,dizziness,fatigue,syncope,and even cardiac arrest may occur.A 71-year-old male patient with a history of myocardial infarction was reported.After taking levamlodipine besylate tablets for 2 d,he developed amaurosis and Ⅲ degree atrioventricular block.The cause was considered to be adverse reactions caused by levam-lodipine besylate tablets.Sinus rhythm was restored 1 week after discontinuation of levamlodipine besylate tablets.The clinical data of the patient were analyzed,and the correlation of adverse reactions was evaluated.It was considered that levamlodipine besylate tablets caused Ⅲ degree atrioventricular block.It is suggested that we should be alert to the occurrence of adverse reactions of Ⅲ degree atrioventricular block in clinical application of this drug and improve the safety of medication.

Abstract:Objective To study the clinical effect and safety of Jiejing Suoquan decoction combined with mirabegron in the treatment of bladder spasm after transurethral resection of the prostate(TURP).Methods A total of 70 patients with bladder spasm after TURP in the Department of Urology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University from January to October 2024 were selected retrospectively.According to the postoperative treatment methods,the patients were divided into the control group(only treated with mirabegron,35 cases)and the observation group(treated with mirabegron combined with Jiejing Suoquan decoction,35 cases).The bladder spasm during catheterization,international prostate symptom score,overactive bladder score and quality of life score before and after treatment,the total effective rate of treatment and the incidence of adverse reactions were compared between the two groups.Results The number of bladder spasm,the duration of spasm,the score of spasm pain,the number of urgency and the number of abnormal manifestations related to urinary catheter in the observation group were less than those in the control group(all P＜0.05).After treatment,the international prostate symptom score,overactive bladder symptom score and quality of life score 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 total effective rate of the observation group was significantly higher than that of the control group[94.3％(33/35)vs 74.3％(26/35)](x2=5.285,P=0.022).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Jiejing Suoquan decoction combined with mirabegron is effective in the treatment of bladder spasm after TURP,which can reduce the frequency of bladder spasm to a greater extent,shorten the duration of spasm,relieve discomfort symptoms,and has high safety.

Abstract:Pulmonary arterial hypertension(PAH)is a kind of cardiovascular disease characterized by progressive proliferation of small pulmonary arteries leading to increased pulmonary vascular pressure and resistance,which leads to right heart failure and even global heart failure.Currently,PAH-targeted drugs used in clinical practice mainly include endothelin receptor antagonists,phosphodiesterase 5 inhibitors,guanylate cyclase agonists,prostacyclin analogues and their receptor agonists,etc.Clinically,for patients with negative acute vasodilator tests,single or two or more targeted drugs are selected for treatment according to the course of disease and risk stratification.A number of studies at home and abroad have shown that the combination therapy of targeted drugs has significant value for improving the existing symptoms and delaying the progression of the disease,but the relevant research data in children with PAH are still limited.This review will discuss the prognosis and limitations of combination therapy with targeted drugs for PAH in children.

Abstract:The incidence of heart failure with preserved ejection fraction(HFpEF)is increasing year by year,accounting for nearly 50％of the total number of patients with heart failure,and it has become a hot and difficult research topic in the cardiovascular field.Currently,diuretic,sodium-glucose cotransporter 2 inhibitor,aldosterone-receptor antagonist,renin-angiotensin system inhibitor and etiological screening are the main drug treatments for HFpEF,while the traditional drug evidence for the treatment of heart failure is limited.HFpEF has strong heterogeneity,complex pathogenesis,and few effective drugs.Therefore,it is of great clinical significance to actively strengthen the treatment of HFpEF.This article reviews the clinical trials of drugs recommended by the guidelines and research hotspots in the treatment of HFpEF in recent years,in order to provide reference for the treatment and future research of HFpEF.

Abstract:Rheumatoid arthritis(RA)is a chronic,systemic autoimmune disease characterized by erosive arthritis.With the application of biological agents and targeted synthetic disease-modifying antirheumatic drugs,as well as the promotion of"treatment to target"strategy,the treatment of RA has made significant progress,and most patients can achieve disease remission or low disease activity.However,there are still a significant number of patients with persistent disease activity or refractory symptoms despite receiving multiple drug therapies with different mechanisms of action,which are called refractory RA or refractory inflammatory arthritis.In recent years,the European League against Rheumatism has proposed the concept and definition of refractory RA,which provides a clearer definition for this patient group.The refractory RA patient population is heterogeneous.The causes of persistent symptoms may include persistent inflammatory activity,and may also involve non-inflammatory factors,such as central sensitization,concurrent fibromyalgia,and psychological factors.In order to guide clinical diagnosis and treatment more accurately,some scholars have proposed that refractory RA should be further divided into persistent inflammatory refractory RA(PIRRA)and non-inflammatory refractory RA(NIRRA).The aim of this review is to systematically review the progress in the diagnosis and treatment of refractory RA,with a focus on the definition,characteristics,diagnosis,treatment and future research directions of PIRRA and NIRRA subtypes.

Abstract:Objective To explore the correlation between serum interleukin-8(IL-8)and serum amyloid A(SAA)levels and treatment outcomes in children with Streptococcus pneumoniae pneumonia.Methods A retrospective analysis was performed on the clinical data of 126 children with Streptococcus pneumoniae pneumonia admitted to Anhui Children's Hospital from January 2022 to December 2024,who were enrolled in the case group.In addition,relevant data of 63 children who underwent health check-ups in the hospital during the same period were collected at a ratio of 1∶2 to the case group,and they were included in the control group.According to the clinical efficacy at 1 week after treatment,the children in the case group were divided into the effective treatment group(105 cases)and the ineffective treatment group(21 cases).The serum IL-8 and SAA levels of the case group before treatment and the control group during physical examination were compared,as well as the changes in serum IL-8 and SAA levels of the ineffective treatment group and the effective treatment group before and after treatment.The correlation between the treatment outcomes of children with Streptococcus pneumoniae pneumonia and the serum IL-8 and SAA levels before treatment was analyzed.Results The serum IL-8 and SAA levels in the case group before treatment were significantly higher than those in the control group(both P＜0.05).The serum IL-8 and SAA levels in the ineffective treatment group were higher than those in the effective treatment group at the same time points both before and after treatment[before treatment:(86±13)ng/L vs(66±11)ng/L,(18.8±3.1)mg/L vs(15.1±2.8)mg/L;after treatment:(85±12)ng/L vs(33±6)ng/L,(17.3±3.0)mg/L vs(9.1±2.6)mg/L](all P＜0.05).After treatment,the serum IL-8 and SAA levels in the effective treatment group were significantly lower than those before treatment(both P＜0.05).Before treatment,the clinical pulmonary infection score,C-reactive protein,IL-8,and SAA levels,as well as the proportions of complicated pleural effusion and malnutrition in the ineffective treatment group were all higher than those in the effective treatment group(all P＜0.05).Logistic regression analysis showed that the treatment outcome of children with Streptococcus pneumoniae pneumonia may be associated with complicated pleural effusion,complicated malnutrition,and pre-treatment serum IL-8 and SAA levels(all P＜0.05).Restricted cubic spline analysis revealed a non-linear dose-response relationship between pre-treatment serum IL-8 and SAA levels and the risk of treatment failure in children with Streptococcus pneumoniae pneumonia(both P＜0.05).Pre-treatment serum IL-8 and SAA had a positive interactive effect on the risk of treatment failure in these children.Conclusion The treatment outcome of children with Streptococcus pneumoniae pneumonia is closely related to the pre-treatment serum IL-8 and SAA levels,and the risk of treatment failure increases with the elevation of these two indicators.

Abstract:Objective To explore the clinical effect of governor vessel moxibustion combined with Bushen Huoxue acupuncture in the treatment of postmenopausal osteoporosis of kidney deficiency and blood stasis type.Methods A total of 120 patients with postmenopausal osteoporosis of kidney deficiency and blood stasis type admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2022 to December 2023 were selected,and they were divided into control group and study group according to the two-color ball method,with 60 cases in each group.Both groups received basic treatment and conventional western medicine treatment.The control group was additionally treated with Bushen Huoxue acupuncture,and the study group was additionally treated with governor vessel moxibustion on the basis of the control group.The clinical efficacy,quality of life,bone mineral density,bone metabolism,traditional Chinese medicine syndrome score,clinical symptoms and adverse reactions were compared between the two groups.Results The total effective rate of the study group was higher than that of the control group[91.7％(55/60)vs 76.7％(46/60)](x2=5.065,P=0.024).After treatment,the short form health survey scores,bone mineral density values of axial bone and distal 1/3 radius,serum total N-terminal propeptide of type Ⅰ collagen,bone morphogenetic protein and osteocalcin levels were higher than those before treatment in both groups,and those in the study group were higher than those in the control group(all P＜0.05).After treatment,the visual analogue scale score,Oswestry disability index score,β-collagen special sequence level and traditional Chinese medicine syndrome score of the two groups were lower than those before treatment,and those of the study group were lower than those of the control group(all P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusions The combined application of governor vessel moxibustion and Bushen Huoxue acupuncture in the treatment of postmenopausal osteoporosis with kidney deficiency and blood stasis can effectively increase bone mineral density,improve bone metabolism,improve their quality of life,and reduce clinical symptoms.

Abstract:Objective To explore the mechanism by which erianin remodels chemotherapeutic response in colorectal cancer.Methods Human colorectal cancer cell lines HCT116 and SW480 were used as research objects and divided into blank control group(only normal medium added),oxaliplatin group(10 μmol/L oxaliplatin added),erianin groups(0,25,50 nmol/L erianin added),and combination group(10 μmol/L oxaliplatin+50 nmol/L erianin added).Cell counting kit assay was used to detect cell viability and calculate half-maximal inhibitory concentration(IC50);colony formation assay was performed to evaluate cell proliferation ability;flow cytometry was used to assess cell apoptosis rate and cell cycle distribution;relevant kits were employed to determine lipid peroxidation level,glutathione and malondialdehyde levels;Western blot was used to detect the expression of ferroptosis-related proteins[glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11),long-chain acyl-CoA synthetase 4(ACSL4)].Results For HCT116 and SW480 cells,increased erianin concentration and prolonged treatment time both gradually reduced cell viability,and the cell viability in the 50 nmol/L erianin treatment group was significantly lower than that in the 25 nmol/L treatment group(P＜0.05).The 48 h IC50 values of erianin for HCT116 and SW480 cells were 30.2 nmol/L and 101.4 nmol/L,respectively.The colony formation rate,glutathione content,and protein levels of GPX4 and SLC7A11 in the single-drug treatment groups(oxaliplatin group and erianin group)were significantly lower than those in the blank control group,and the relevant indicators in the combination group were the lowest,which were further decreased compared with the single-drug treatment groups(all P＜0.05).The cell apoptosis rate,lipid peroxidation level,malondialdehyde content,and ACSL4 protein level in the single-drug treatment groups were significantly higher than those in the blank control group,and the relevant indicators in the combination group were the highest,which were further increased compared with the single-drug treatment groups(all P＜0.05).Compared with the blank control group,both the oxaliplatin group and the erianin group induced G2/M phase arrest;the proportion of G2/M phase cells in the combination group was further increased,while the proportions of S phase and G0/G1 phase cells were decreased(all P＜0.05).Conclusion Erianin can inhibit the viability of colorectal cancer cells,and its combination with oxaliplatin can enhance the inhibitory effect.The mechanism may be related to inducing cell apoptosis,arresting cell cycle,and promoting ferroptosis.

Abstract:Intermuscular adipose tissue(IMAT)is an ectopic fat deposited between skeletal muscles.It causes mitochondrial dysfunction by secreting a variety of bioactive substances,interferes with insulin signaling pathway,and eventually leads to insulin resistance(IR).A large number of studies have shown that IMAT is considered as a key factor affecting skeletal muscle and whole body insulin sensitivity due to its unique anatomical location and active metabolic function.The association is affected by many factors,such as age,gender,race and lifestyle.Lifestyle intervention,drug therapy and surgery can reduce IMAT and affect the occurrence and development of IR.Future studies need to further analyze the differentiation and secretion regulation mechanism of IMAT cells,promote its application in individualized efficacy prediction and non-invasive evaluation,and provide new targets for the prevention and treatment of IR.

Abstract:Exosomes are nanoscale membrane vesicles secreted by cells,which play a crucial role in cell communication and are involved in various physiological and pathological processes of the human body.Among them,exosomal microRNA-148 exerts an important regulatory effect on the occurrence and development of gastric diseases.This review summarizes the research on the regulatory mechanisms of exosomal microRNA-148 in common gastric diseases such as gastritis,gastric ulcer and gastric cancer,as well as the intervention effects of traditional Chinese medicine on it.It is found that exosomes can transfer biomolecules including DNA,coding RNA,non-coding RNA,lipids and proteins between cells,regulate related signaling pathways,and exert important values in the occurrence,development,diagnosis,treatment,prognosis and other aspects of various gastric diseases.In the prevention and treatment of gastric diseases,traditional Chinese medicine can also regulate the physiological and pathological processes of the body by affecting the secretion of exosomes and the expression of biomolecules such as non-coding RNA carried by them.This review aims to provide new ideas and theoretical basis for the treatment of gastric diseases.

Abstract:Objective To explore the efficacy of alteplase intravenous thrombolysis combined with tirofiban in preventing acute cerebral infarction(ACI)from progressing to progressive cerebral infarction(PCI),and to construct a random forest model for predicting the risk of PCI.Methods A total of 106 ACI patients admitted to Nanping First Hospital Affiliated to Fujian Medical University from January 2022 to December 2024 were selected and divided into control group(alteplase intravenous thrombolysis alone,26 cases)and observation group(alteplase intravenous thrombolysis combined with tirofiban,80 cases)according to different treatment regimens.The incidence of PCI,national institutes of health stroke scale(NIHSS)scores,coagulation indicators,and adverse reactions were compared between the two groups.Furthermore,the observation group was divided into progression group and non-progression group.Clinical data and laboratory indicators were compared between the two subgroups.Logistic regression analysis was used to screen the risk factors for PCI,and a random forest model was established to predict the risk of PCI.Results Among the 26 patients in the control group,17 patients(65.4％)progressed to PCI after treatment,while 34 of the 80 patients(42.5％)in the observation group developed PCI,with a statistically significant difference between the two groups(P=0.042).The post-treatment NIHSS score in the observation group was lower than that in the control group(P＜0.05).After treatment,thrombin time,activated partial thromboplastin time,and prothrombin time in the observation group were all longer than those in the control group(all P＜0.05).Multivariate Logistic regression analysis showed that diabetes mellitus(odds ratio=20.530,P=0.004),admission NIHSS score(odds ratio=1.368,P=0.018),admission systolic blood pressure(odds ratio=1.053,P=0.041),fibrinogen(FIB)(odds ratio=29.931,P＜0.001),and serum amyloid A(SAA)(odds ratio=1.116,P=0.033)were influencing factors for PCI.In the random forest model,the order of factor importance was FIB,SAA,systolic blood pressure,NIHSS score,and diabetes mellitus.The area under the curve(AUC)of the random forest model was 0.957,with a sensitivity of 94.12％and specificity of 86.96％,which was superior to the Logistic model(AUC=0.909,P=0.042).Conclusion Alteplase combined with tirofiban can effectively reduce the risk of PCI,improve neurological function and coagulation status without increasing adverse reactions.Diabetes mellitus,high NIHSS score,high systolic blood pressure,elevated FIB,and high SAA are independent risk factors for PCI.The random forest model exhibits higher predictive performance,which is conducive to early identification of high-risk patients and guidance of individualized interventions.

Abstract:Objective To investigate the effect of leuprolide acetate sustained-release microspheres on ovarian reserve function in girls with idiopathic central precocious puberty(ICPP)by monitoring the levels of anti-Mullerian hormone and inhibin B.Methods Sixty-one girls aged 6-9 years who were diagnosed with ICPP and complained of premature breast development or early menarche in Beijing Jishuitan Hospital,Capital Medical University from January 2021 to December 2023 were selected as the ICPP group.Another 50 girls with normal adolescent development aged 6-9 years who underwent physical examination in the pediatric outpatient department of our hospital during the same period were selected as the healthy control group.The general data and sex hormone levels before and after treatment were compared between the two groups.Results In the general data,the standard deviation scores of weight,height,body mass index,bone age biological age difference,and inhibin B levels of 61 girls in the ICPP group were significantly higher than those of 50 healthy control group girls(all P＜0.05).Among the 50 girls in the ICPP group,5 girls were excluded because they did not follow the doctor's advice and regularly monitored the relevant clinical and biochemical indicators,and the remaining 45 girls were included.There was no significant difference in AMH level between the ICPP group and the healthy control group after 6 and 12 months of treatment(all P＞0.05).Luteinizing hormone and follicle-stimulating hormone were significantly lower than before treatment in this group[0.44(0.30,0.81),0.34(0.24,0.57)IU/L vs 2.70(1.09,4.19)IU/L;1.7(1.1,2.3),1.7(1.3,2.2)IU/L vs 6.1(4.0,7.2)IU/L](all P＜0.05).Inhibin B transiently decreased after 6 months of treatment and was lower than that before treatment[39(29,61)ng/L vs 76(50,88)ng/L](P＜0.05),and there was no significant difference after 12 months of treatment[71(53,99)ng/L]compared with that before treatment(P＞0.05).Conclusion Leuprolide acetate sustained-release microspheres have no significant effect on ovarian reserve function in girls with ICPP.

Abstract:Objective To explore the expression and clinical significance of serum ephrin type A receptor 2(EphA2)and activating transcription factor 3(ATF3)levels in children with Mycoplasma pneumoniae pneumonia(MPP)complicated with asthma.Methods A total of 120 children with MPP complicated with asthma(MPP+asthma group),120 children with simple MPP(MPP group),and 120 healthy children who underwent physical examination during the same period(control group)admitted to Shanxi Children's Hospital from January 2022 to February 2025 were selected.Children in the MPP+asthma group were divided into mild group(30 cases),moderate group(42 cases),and severe group(48 cases)according to the disease severity.Serum EphA2 and ATF3 levels,pulmonary function indices[peak expiratory flow(PEF),forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC),FEV1 as a percentage of predicted value(FEV1％)],airway inflammation indices[eosinophil(EOS)count,fractional exhaled nitric oxide(FeNO),total immunoglobulin E(IgE)],and airway remodeling indices[transforming growth factor β,(TGF-β1),matrix metalloproteinase 2(MMP-2),MMP-9]were detected.The correlations between serum EphA2 and ATF3 levels and clinical indicators in children with MPP complicated with asthma were analyzed;the relationship between serum EphA2 and ATF3 levels and the disease severity of these children was explored;and the value of serum EphA2 and ATF3 levels in assessing the disease severity was evaluated using receiver operating characteristic curve analysis.Results The PEF,FEV1/FVC ratio,and FEV1％in the simple MPP group and MPP+asthma group were significantly lower than those in the control group,with the MPP+asthma group showing even lower values than the simple MPP group.The EOS count,total IgE,FeNO,TGF-β1,MMP-2,MMP-9,EphA2,and ATF3 levels in the simple MPP group and MPP+asthma group were significantly higher than those in the control group,and the MPP+asthma group had higher levels than the simple MPP group(all P＜0.05).The PEF,FEV1/FVC ratio,and FEV1％in the moderate and severe subgroups were significantly lower than those in the control group,with the severe subgroup having lower values than the moderate subgroup.The EOS count,total IgE,FeNO,TGF-β1,MMP-2,MMP-9,EphA2,and ATF3 levels in the moderate and severe subgroups were significantly higher than those in the control group,and the severe subgroup had higher levels than the moderate subgroup(all P＜0.05).In children with MPP complicated with asthma,serum EphA2 and ATF3 levels were positively correlated with disease severity,EOS count,total IgE,FeNO,TGF-β1,MMP-2,and MMP-9 levels,while negatively correlated with PEF,FEV1/FVC ratio,and FEV1％ (all P＜0.05).Results of ordinal multinomial Logistic regression analysis showed that EphA2(odds ratio=1.022,95％confidence interval:1.006-1.039)and ATF3(odds ratio=1.489,95％confidence interval:1.292-1.716)were independent risk factors for disease progression in children with MPP complicated with asthma(all P＜0.001).The areas under the curve of serum EphA2,ATF3 levels,and their combination for evaluating moderate-to-severe MPP complicated with asthma were 0.830,0.817,and 0.895,respectively,with the combined evaluation being superior to either single indicator.Conclusion Serum EphA2 and ATF3 levels are elevated in children with MPP complicated with asthma,which are associated with disease severity,aggravated airway inflammation,enhanced airway remodeling,and decreased pulmonary function.These two indicators may serve as biomarkers for assessing the disease severity in such children.

Abstract:Liver fibrosis is a key stage in the progression of chronic liver injury to cirrhosis.Its pathological mechanism mainly involves excessive deposition of extracellular matrix and abnormal activation of hepatic stellate cells.As an important homeostatic regulatory mechanism in cells,autophagy maintains cell function by degradation of abnormal components,but it shows cell type dependence in liver fibrosis.Inhibition of autophagy in hepatocytes leads to lipotoxicity,while excessive activation of autophagy in hepatic stellate cells promotes fibrosis.The phosphatidylinositol-3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR)pathway is a key regulatory axis of autophagy,and its abnormal activation can destroy autophagic homeostasis and accelerate the process of fibrosis.Guishao Wujia decoction,as a traditional Chinese medicine compound,has shown multi-target regulatory potential in anti-liver fibrosis by its therapeutic principle of"fixing the middle Jiao,tonifying the liver and kidney,and removing blood stasis".Studies have shown that the compound can inhibit the activity of PI3K/Akt/mTOR pathway,up-regulate the expression of autophagy-related proteins(such as Beclin-1),enhance hepatocyte autophagy and inhibit the activation of hepatic stellate cells,thereby reducing extracellular matrix deposition.In addition,its components(such as panax notoginseng saponins,oyster oligopeptide and total gluco-sides of paeony)can reduce oxidative stress and inflammatory injury and improve liver pathological changes through anti-oxidation,anti-inflammation and multi-pathway synergistic action.This review systematically elaborated the dual role of autophagy homeostasis imbalance in liver fibrosis,and revealed the mechanism of autophagy regulation mediated by Guishao Wujia decoction through the PI3K/Akt/mTOR pathway.This review provides a molecular theoretical basis for the treatment of liver fibrosis with traditional Chinese medicine compound,which has important clinical transformation value.

Abstract:Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in sputum culture of patients with chronic obstructive pulmonary disease(COPD)complicated with respir-atory tract infection.Methods COPD patients with respiratory tract infection who were diagnosed and treated in Northern Jiangsu People's Hospital,Jiangsu Province and the First Affiliated Hospital of Soochow University from January 2023 to December 2024 were selected as the research objects.The clinical data and sputum samples of the patients were collected,and the pathogen detection and drug resistance analysis were performed after sputum culture.Results A total of 628 patients were enrolled in this study.According to sputum samples,the patients were divided into sputum culture positive group(416 cases)and sputum culture negative group(212 cases).There were no significant differences in gender,age,year,infection month,and COPD course between the two groups(all P＞0.05).The results of pathogen detection showed that 177 strains(33.6％)were Gram-positive bacteria,324 strains(61.5％)were Gram-negative bacteria,and 26 strains(4.9％)were fungi.The main Gram-positive bacteria were Staphylococcus aureus(81 strains,45.8％),Streptococcus pneumoniae(54 strains,30.5％)and Staphylococcus epidermidis(28 strains,15.8％).Gram-negative bacteria were mainly Klebsiella pneumoniae(112 strains,34.6％),Acinetobacter baumannii(96 strains,29.6％),and Pseudomonas aeruginosa(83 strains,25.6％).The main Gram-positive bacteria showed high resistance rates to penicillin,azithromycin and levofloxacin,but were completely sensitive to vancomycin,teicoplanin and linezolid.Among the main Gram-negative bacteria,Klebsiella pneumoniae and Acinetobacter baumannii had high resistance rates to ampicillin,amoxicillin/clavulanic acid,ciprofloxacin,gentamicin,levofloxacin,tobramycin and cephalosporins,and low resistance rates to carbapenems such as imipenem and meropenem.Pseudomonas aeruginosa had high resistance rates to ampicillin,ceftriaxone,amoxicillin/clavulanic acid,and low resistance to gentamicin,tobramycin,imipenem,meropenem and most cephalosporins.Conclusion The pathogens in COPD patients with respiratory tract infection are complex and diverse,and the resistance rate to clinical first-line antibiotics is high.During the treatment,sputum culture and drug sensitivity test should be performed in time to guide clinical rational drug use.

Abstract:Objective To explore the impact of nutritional risk status on glycemic control and the occur-rence of cardiovascular events in elderly patients with type 2 diabetes mellitus(T2DM)complicated with coronary atherosclerotic heart disease(CAD).Methods A total of 111 elderly patients with T2DM complicated with CAD admitted to Guangdong Provincial Hospital of Chinese Medicine from June 2024 to June 2025 were selected as the research objects.The nutritional risk screening scale(NRS 2002)was used to assess the nutritional risk of patients,who were divided into nutritional risk group(28 cases)and non-nutritional risk group(83 cases)according to the assessment results.Baseline data of patients were collected,and blood glucose indicators of the two groups were detected;meanwhile,the occurrence of cardiovascular events was recorded.Spearman correlation analysis was used to evaluate the correlations between nutritional risk status and glycemic control as well as the occurrence of cardiovascular events.Multivariate Logistic regression analysis was applied to identify the risk factors influencing poor glycemic control and the occurrence of cardiovascular events.Results There were statistically significant differences in the number of complications,C-reactive protein(CRP)level,and albumin level between the two groups(all P＜0.05).The levels of glycated hemoglobin,fasting blood glucose,and 2 h postprandial blood glucose in the nutritional risk group were significantly higher than those in the non-nutritional risk group(all P＜0.05).The incidence of poor glycemic control in the nutritional risk group was 60.7％(17/28),which was significantly higher than 24.1％(20/83)in the non-nutritional risk group(P＜0.05).The total incidence of cardiovascular events in the nutritional risk group was 53.6％(15/28),which was significantly higher than 19.3％(16/83)in the non-nutritional risk group(P＜0.05).Spearman correlation analysis showed that nutritional risk status was positively correlated with poor glycemic control and cardiovascular events(r=0.386,P=0.005;r=0.425,P=0.002,respectively).Multivariate Logistic regression analysis revealed that nutritional risk status,number of complications ≥ 2,elevated CRP level,and decreased albumin level were independent risk factors for poor glycemic control and cardiovascular events in the patients(all P＜0.05).Conclusion Nutritional risk status significantly exacerbates the deterioration of glycemic control and increases the risk of cardiovascular events in elderly patients with T2DM complicated with CAD.Moreover,nutritional risk status is positively correlated with poor glycemic control and cardiovascular events.Multivariate analysis further confirms that nutritional risk status,number of complications ≥2,elevated CRP level,and decreased albumin level are independent risk factors for poor glycemic control and cardiovascular events,suggesting that clinical practice should strengthen nutritional screening and intervention to improve prognosis.

Abstract:Coronary atherosclerotic heart disease and malignant tumors,as two major common chronic diseases,have an increasingly prevalent comorbidity,which severely impacts patient prognosis.This article systematically reviews the research progress on intervention strategies for coronary atherosclerotic heart disease complicated with malignant tumors,covering three key aspects:primary prevention,assessment and optimization of cardiovascular risks associated with cancer treatment,and long-term management of cancer survivors.It focuses on lifestyle and pharmacological interventions,the application of biomarkers and multimodal imaging technologies,management of cardiovascular toxicity induced by radiotherapy,chemotherapy,and targeted therapy,as well as multidisciplinary collaboration and perioperative strategies.Despite significant advancements,high-quality evidence-based medicine and standardized management pathways remain lacking in this field.This review aims to provide a comprehensive clinical reference for physicians and promote the standardized and individualized development of comorbidity management.

Abstract:Objective To evaluate the efficacy and safety of cefoperazone sodium/sulbactam sodium(CPZ-SBT)combined with ulinastatin in the treatment of renal transplant recipients with severe pneumonia(RTSP).Methods A retrospective analysis was performed on the clinical data of 74 RTSP patients admitted to General Hospital of Northern Theater Command of the Chinese People's Liberation Army from January 2022 to May 2025.The patients were divided into control group(treated with CPZ-SBT)and combination group(treated with CPZ-SBT combined with ulinastatin)according to the treatment regimen,with 37 cases in each group.Both groups received continuous treatment for more than 7 d.The clinical efficacy,clinical indicators,respiratory function indicators,inflammatory factor levels before and after treatment,and adverse reactions during treatment were recor-ded and compared between the two groups.Results Both groups were sensitive to CPZ-SBT treatment.The total effective rate of the combination group was slightly higher than that of the control group[97.3％(36/37)vs 89.2％(33/37)],but the difference was not statistically significant(P=0.165).The time to body temperature recovery,wheezing resolution,and cough resolution in the combination group were significantly shorter than those in the control group(all P＜0.05).After treatment,the arterial oxygen saturation and arterial partial pressure of oxygen in both groups were significantly higher than those before treatment,with the combination group showing higher values than the control group.The arterial partial pressure of carbon dioxide,procalcitonin,and C-reactive protein levels in both groups were significantly lower than those before treatment,and the combination group had lower levels than the control group(all P＜0.05).The total incidence of adverse reactions in the combination group was slightly higher than that in the control group[10.8％(4/37)vs 5.4％(2/37)],but the difference was not statistically significant(P=0.394).Conclusion CPZ-SBT combined with ulinastatin in the treatment of RTSP patients can effectively promote symptom recovery,improve respiratory function,and regulate inflammatory factor levels,with mild adverse reactions,showing good safety and efficacy.