Abstract:Chinese patent medicine is an important part of clinical treatment drugs in China.Scientific evaluation and replacement of Chinese patent medicine shortage can provide a good guarantee for clinical diagnosis and treatment and standardized supply of drugs in medical institutions.In this paper,literature review was used to systematically review the process,dimensions and methods of clinical evaluation of Chinese patent medicine,to construct the evaluation process and index system of shortage varieties reflecting the characteristics of Chinese patent medicine,and to initially form an index pool.Delphi method was used to select and optimize the evaluation indicators,and the analytic hierarchy process was used to assign weights to the indicators of each dimension and level.Finally,the evaluation process of"Urgency evaluation of clinical use of CPM shortage-Evaluation of determining equivalent substitutable varieties-Comprehensive evaluation of equivalent substitutable varieties"was formed.From the different dimensions of clinical application,effectiveness,safety,economy,innovation,suitability and accessi-bility,the evaluation system was constructed,including 15 first-level indicators,30 second-level indicators and 65 third-level indicators.It provides a scientific and operational tool for medical institutions to replace or evaluate the shortage of Chinese patent medicine,and promotes medical institutions to continuously optimize the drug use list and drug use structure,and improves the level of clinical rational use of Chinese patent medicine and the quality of pharmaceutical services.

Abstract:Objective The purpose of this study is to explore the changes of brain structure in mice with heart failure with preserved ejection fraction(HFpEF)using high-resolution magnetic resonance imaging(MRI),in order to provide scientific basis for understanding the pathophysiological mechanism of the disease and developing new treatment methods.Methods Sixty specific pathogen free male C57BL/6J mice were selected and divided into control group and HFpEF group by body weight stratification,with 30 mice in each group.The control group was given normal diet and drinking ordinary water freely.In HFpEF group,HFpEF model was established by high-fat diet combined with L-nitroarginine methyl ester double hit.The brain structure of mice was assessed by high-resolution MRI combined with the voxel-based morphometry technique,and significant regions were identified by statistical analysis.Results Compared with the control group,the HFpEF group had a significant increase in gray matter volume in the right parahippocampal gyrus at 36 and 60 weeks of intervention[(0.92±0.08),(1.05±0.09)mm3 vs(0.78±0.06)mm3](both P＜0.05).The peak MNI coordinates were X=-11.4,Y=-14.1,Z=16.2,F value was 47.62,and the cluster size was 2 060 voxels.The gray matter volume of arcuate nucleus and paraventricular nucleus of the HFPEF group in the 36 week and 60 week were significantly greater than those of the control group,and the gray matter volume of ventromedial nucleus and dorsolateral nucleus of the HFPEF group also showed a significant increase in the 60 week(P＜0.05 or P＜0.01).In addition,the gray matter volume of the anterior thalamus of the HFPEF group was also significantly greater in the 60 week than that of the control group(P＜0.01).Conclusion HFpEF can lead to significant changes in brain structure in mice,especially in the parahippocampal gyrus and some nuclei of the hypothalamus.These structural changes may be closely related to the pathophysiological mechanism of HFpEF.

Abstract:Objective To investigate the efficacy of herombopag olamine tablet in the treatment of chemo-therapy-induced thrombocytopenia(CIT)after breast cancer surgery.Methods A total of 120 patients with CIT caused by chemotherapy after breast cancer surgery diagnosed in Affiliated Hospital of Hebei University from December 2021 to December 2023 were selected.According to the random number table method,the patients were divided into recombinant human thrombopoietin(rhTPO)group and combined group,with 60 cases in each group.The rhTPO group was treated with rhTPO,and the combination group was treated with rhTPO and herombopag olamine tablets.Both groups were treated for 4 weeks.The clinical efficacy,platelet parameters,thrombopoietin(TPO),inflammatory factors,platelet count(PLT),immune function indexes and adverse reactions were compared between the two groups after treatment.Results The total effective rate in the combined group was significantly higher than that in the rhTPO group[91.7％(55/60)vs 75.0％(45/60)](P=0.014).After treatment,the platelet volume distribution width and mean platelet volume in the two groups were lower than those before treatment,and those in the combined group were lower than those in the rhTPO group,and the platelet crit was higher than that before treatment,and those in the combined group were higher than those in the rhTPO group(all P＜0.05).After treatment,the levels of IL-6,TPO and tumor necrosis factor-α in the two groups were lower than those before treatment,and those in the combined group were significantly lower than those in the rhTPO group(all P＜0.05).After 3,7 and 14 days of treatment,the PLT levels of the two groups were higher than those before treatment,and the PLT levels of the combined group were higher than those of the rhTPO group(all P＜0.05).Compared with before treatment,the levels of CD3+,CD4+,and CD4+/CD8+ratio in the two groups after treatment were significantly increased,and those in the combined group were higher than those in the rhTPO group(all P＜0.05).After treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P=0.488).Conclusion Herombopag olamine tablet combined with rhTPO in the treatment of CIT caused by chemotherapy after breast cancer surgery can improve the clinical efficacy of patients,reduce the levels of serum interleukin-6,TPO and tumor necrosis factor-α,improve PLT and immune function,and has high safety.

Abstract:Objective To investigate the relationship between the levels of serum nuclear factor erythroid 2-related factor 2(Nrf2),hepcidin 25(Hepc-25)and insulin-like growth factor 1(IGF-1)and anemia in cancer patients undergoing chemotherapy.Methods A total of 142 tumor patients admitted to the Affiliated Hospital of Yangzhou University from January 2022 to January 2024 were selected.According to whether anemia occurred after chemotherapy,they were divided into observation group(anemia occurred,89 cases)and control group(no anemia occurred,53 cases).According to the severity of anemia,the patients in the observation group were divided into mild group(23 cases),moderate group(44 cases)and severe group(22 cases).The levels of Nrf2,Hepc-25 and IGF-1 were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the influencing factors of anemia in patients during tumor chemotherapy.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of Nrf2,Hepc-25 and IGF-1 in anemia.Results The hemoglobin and red blood cell count of the observation group were significantly lower than those of the control group,and the proportions of female and gastric cancer patients were significantly higher than those of the control group(all P＜0.05).The serum levels of Nrf2 and IGF-1 in the observation group were lower than those in the control group[(1.36±0.24)μg/L vs(2.98±0.53)μg/L,(166±20)μg/L vs(192±27)μg/L],and the serum levels of Hepc-25 were higher than those in the control group[(49±6)μg/L vs(23±4)μg/L](all P＜0.05).The serum levels of Nrf2 and IGF-1 in the mild group,the moderate group and the severe group decreased in turn,and the serum levels of Hepc-25 increased in turn(all P＜0.05).The results of multivariate Logistic regression analysis showed that Hepc-25,female,gastric cancer were the risk factors for anemia(all P＜0.05),while Nrf2,IGF-1,hemoglobin and red blood cell count were protective factors for anemia induced by tumor chemotherapy(all P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of Nrf2,Hepc-25 and IGF-1 in predicting anemia was 0.867,0.841 and 0.797,respectively.When combined,the AUC increased to 0.954.Conclusion The serum levels of Nrf2 and IGF-1 are decreased and Hepc-25 is increased in the cancer patients with anemia after chemotherapy.The serum levels of Nrf2 and IGF-1 are related to the occurrence of anemia in the cancer patients with anemia after chemotherapy,and the combined use of the three factors can effectively predict the occurrence of anemia in the cancer patients with anemia after chemotherapy.

Abstract:Objective To investigate the effect of different antiplatelet therapy on the prognosis of patients with epistaxis.Methods The clinical data of 243 patients with epistaxis who were admitted to Beijing Anzhen Hospital,Capital Medical University from January 2020 to December 2023 were retrospectively analyzed.According to the use of antiplatelet drugs before epistaxis,78 patients with coronary atherosclerotic heart disease who took aspirin combined with ticagrelor or clopidogrel were divided into dual antibody group,83 patients who took single antiplatelet drugs were divided into single antibody group,and 82 patients who did not use antiplatelet drugs were divided into control group.The clinical and laboratory indexes,therapeutic effects and complications of epistaxis were compared among the three groups,and the related factors affecting the prognosis of epistaxis were analyzed.Results The proportions of multiple epistaxis(≥3 times within 1 month)and persistent epistaxis(≥30 minutes within 24 hours)in the dual antibody group were higher than those in the single antibody group and the control group(all P＜0.05).The cure rate of the double antibody group was lower than those of the control group and the single antibody group,and the recurrence rate was significantly higher than that of the control group[67.9％(53/78)vs 91.5％(75/82),81.9％(68/83);9.0％(7/78)vs 1.2％(1/82)](all P＜0.05).The total incidence of complications in the dual antibody group was higher than those in the control group and the single antibody group[25.6％(20/78)vs 8.5％(7/82),10.8％(9/83)](both P＜0.05).Logistic regression analysis showed that the possibility of healing of epistaxis within 1 month after dual antiplatelet therapy was significantly lower than that of the control group(odds ratio=1.759,95％confidence interval:1.032-5.925,P=0.034).Conclusions Dual antiplatelet therapy significantly increases the risk of severe epistaxis and has adverse effects on the prognosis of patients with epistaxis,which should be paid more attention.

Abstract:Objective To investigate the clinical effect of Jianpi Wenyang decoction in the treatment of epigastric pain syndrome(EPS)of spleen and stomach weakness in grassroots training participants.Methods A total of 84 patients with functional dyspepsia of spleen and stomach weakness admitted to the First Medical Center of Chinese PLA General Hospital from February to August 2023 were selected as the research objects.According to the random number table method,they were divided into the control group(42 cases)and the observation group(42 cases).The control group was treated with omeprazole magnesium enteric-coated tablets on the basis of basic treatment,and the observation group was treated with external application of Jianpi Wenyang decoction on the basis of basic treatment.The gastrointestinal symptom scores,gastric motor function,traditional Chinese medicine syndrome scores,efficacy and safety were compared between the two groups.Results During the experiment,2 cases of control group dropout occurred.After treatment,the gastrointestinal symptom scores of the two groups were significantly lower than those before treatment,and the scores of postprandial fullness and early satietythe in the observation group were lower than those in the control group(all P＜0.05).After treatment,the antral contraction amplitude,antral contraction frequency and antral motility index of the two groups were higher than those before treatment,and the antral motility index of the observation group was higher than that of the control group(all P＜0.05).After treatment,the traditional Chinese medicine syndrome scores of the two groups were lower than those before treatment,and the traditional Chinese medicine syndrome scores of poor appetite,fatigue,and aggravation after eating 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 higher than that of the control group[95.2％(40/42)vs 72.5％(29/40)(x2=7.940,P=0.005).During the treatment,no adverse reactions occurred in the two groups.Conclusion Jianpi Wenyang decoction can not only significantly improve the clinical symptoms of EPS such as abdominal distension and early satiety,but also relieve the accompanying symptoms such as fatigue and poor appetite,so as to improve the quality of life of the training participants.

Abstract:Epilepsy is a group of chronic brain diseases.This article summarizes the clinical data,whole exome sequencing test results,diagnosis and treatment process of a 4-month-old boy with epilepsy with SCN8A gene variation who was admitted to Shaanxi Provincial People's Hospital and presented with seizures as the first symptom.The child was admitted to the hospital due to"paroxysmal seizures for half a day".After admission,the child still had recurrent seizures,and the brain magnetic resonance imaging and video electroencephalogram were normal.The whole exome sequencing test report shows that:SCN8A,chr12:52184185;c.4223G＞A(p.Gly1475Arg)variation.After the treatment with antiepileptic drugs,the symptoms were relieved.Combined with the relevant literature review,we believe that for infants less than 6 months of age with unexplained seizures,routine examination results can not identify the cause,gene sequencing should be actively improved to help the diagnosis,to provide ideas for the development of precise treatment plans,and to provide help for family genetic counseling.

Abstract:Epstein syndrome is a non-muscle myosin heavy chain 9(MYH9)-related disease with throm-bocytopenia.It is caused by defects in the MYH9 gene,which encodes the non-muscle myosin heavy chain Ⅱ A protein.The common clinical manifestation is bleeding caused by thrombocytopenia,and the platelet recovery is not obvious after blood transfusion and immunotherapy.In the process of diagnosis and treatment,the diagnosis should be made as soon as possible according to the cell morphology and gene detection results to avoid delayed diagnosis and misdiagnosis.In this paper,the clinical data and genetic test results of a child with Epstein syndrome were retrospectively analyzed,and the related literature was reviewed to further improve the understanding of Epstein syndrome.The patient was a 2-year-old boy with no clinical manifestations of bleeding.Routine blood test showed thrombocytopenia,and the peripheral blood smear and bone marrow cytology showed giant platelets without neutrophil inclusion bodies.Gene sequencing showed a MYH9 gene mutation,exon c.287C＞T(p.Ser96Leu).The patient was clinically diagnosed with Epstein syndrome,and his parents were normal wild type.For patients with incomplete clinical symptoms at the time of diagnosis,relevant complications and comorbidities should be clearly informed.At present,there is no clear and effective treatment for this disease,and unrelated hematopoietic stem cell transplantation has been used in clinical treatment,but the efficacy is not clear.Most children need to be followed up regularly.

Abstract:Plexiform neurofibroma(pNF)is a rare benign schwannoma,which occurs in 30％-50％of patients with neurofibromatosis type 1.pNF can involve the head and neck,orbit,limbs,chest,abdomen,pelvic cavity,spinal canal,nerve roots,peripheral nerves and other parts,which may lead to severe pain and disfigupation,and even endanger organ function.Surgery is the main treatment for pNF.In recent years,with the joint develop-ment of oncology,neuroscience,genetics and pharmacology,medical treatment has also shown great application prospects.This article reviews the progress of drug and gene therapy in the medical treatment of pNF.

Abstract:Postoperative cognitive dysfunction(POCD)is one of the major postoperative complications in the elderly.Many studies have reported the risk factors of POCD,among which perioperative hypothermia is not only a common risk factor for surgery,but also a high risk factor for inducing POCD.Hypothermia can lead to an increase in perioperative blood loss,which increases the probability of infection.Especially in urology surgery,the use of a large amount of low temperature irrigation fluid during the operation,patients often have hypothermia during and after the operation.This will greatly affect the patient's postoperative recovery and prolong the length of hospital stay.There is still no satisfactory solution to solve the problem of intraoperative hypothermia and reduce the incidence of POCD.This article describes the research status of POCD and the changes of intraoperative body temperature,especially the relationship between intraoperative hypothermia and POCD,suggesting the importance of intraoperative body temperature protection,and it is expected to improve the prognosis of patients through a good body temperature protection strategy.

Abstract:Objective To investigate the effect of compound Xueshuantong capsule combined with sodium hyaluronate eye drops in the treatment of dry eye.syndrome.Methods A total of 98 patients with dry eye syndrome treated in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2021 to December 2023 were selected.According to the random number table method,they were divided into the control group(49 cases)and the observation group(49 cases).The control group was treated with sodium hyalur-onate eye drops(1 drop/time,3 times/d).The observation group was treated with compound Xueshuantong capsule combined with sodium hyaluronate eye drops,and the usage of sodium hyaluronate eye drops was the same as that of the control group;compound Xueshuantong capsule was 3 capsules/time,3 times/day orally.Both groups were treated for 4 weeks.After treatment,the therapeutic effect was evaluated,and the improvement times of eye dryness,visual acuity fluctuation,burning sensation and foreign body sensation were compared between the two groups.The levels of nucleotide-binding oligomerization domain-like receptor 1(NOD-1),C-reactive protein(CRP)and interleukin-6(IL-6)in tear were compared between the two groups before and after treatment.The adverse reactions were recorded.Results The total effective rate of the observation group was significantly higher than that of the control group[95.9％(47/49)vs 81.6％(40/49)](P=0.025).The improvement times of eye dryness,visual acuity fluctuation,burning sensation and foreign body sensation in the observation group were shorter than those in the control group(all P＜0.05).After treatment,the concentrations of NOD-1,CRP and IL-6 in the two groups were lower than those before treatment(all P＜0.05).The concentrations of NOD-1,CRP and IL-6 in the observation group were lower than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.558).Conclusion The combined use of compound Xueshuantong capsule and sodium hyaluronate eye drops in the treatment of dry eye syndrome can quickly improve the clinical symptoms of patients,and has a significant improvement in the eye inflammation of patients,with good safety.

Abstract:Objective To investigate the prevalence of Helicobacter pylori(Hp)infection in elderly patients with coronary atherosclerotic heart disease(CHD)and the correlation between their serum antibody types and the degree of coronary artery disease.Methods A total of 217 patients with CHD who were admitted to Western Theater General Hospital from April 2021 to June 2023 were selected as the research objects.The patients were divided into mild group(72 cases),moderate group(74 cases)and severe group(71 cases)according to the Gensini score tertiles.The general data of patients in each group were collected,the serum biochemical indexes,inflammatory factor indexes[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and Hp serum antibody classification of patients in each group were detected,and the plaque status of patients was evaluated.The related factors affecting the severity of coronary artery disease in elderly patients with CHD were analyzed.The correlation between Hp subtypes and levels of inflammatory factors was analyzed.Results There were significant differences in the proportion of Hp infection,high-risk plaque,and multi-vessel coronary artery disease among the three groups(all P＜0.05).The detection rates of cytotoxin-associated gene A product(CagA)/toxic vacuolated cytotoxin(VacA)in patients with multi-vessel lesions and high-risk plaque were higher than those in patients with single-vessel lesions and non-high-risk plaque[40.7％(35/86)vs 19.8％(26/131),48.5％(32/66)vs 19.2％(29/151)],and the detection rate of CagA/VacA increased in the mild group,moderate group and severe group[8.3％(6/72),28.4％(21/74)and 47.9％(34/71)](all P＜0.05).The levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol(LDL-C),hs-CRP,IL-6 and TNF-α in the moderate and severe groups were higher than those in the mild group,and those in the severe group were higher than those in the moderate group(all P＜0.05).Ordinal Logistic regression analysis showed that the levels of CagA/VacA subtype,total cholesterol,triglyceride,LDL-C,hs-CRP,IL-6 and TNF-α were all the independent risk factors for the severity of coronary artery disease in elderly patients with CHD(all P＜0.05).The levels of hs-CRP,IL-6 and TNF-α in patients with CagA/VacA infection were higher than those with UreA/UreB infection in the mild,moderate and severe groups(all P＜0.05).The levels of hs-CRP,IL-6 and TNF-αwere positively correlated with the CagA/VacA subtype(all P＜0.05),and negatively correlated with the UreA/UreB subtype(all P＜0.05).Conclusions Hp infection is closely related to the degree of coronary artery lesions in elderly CHD patients.The degree of coronary artery lesions is more serious in elderly CHD patients with Hp positive and CagA/VacA antibody type.

Abstract:Objective To investigate the effect of gabapentin on preoperative anxiety and intubation reaction in patients with human immunodeficiency virus(HIV)infection.Methods A total of 68 HIV-infected patients who underwent elective general anesthesia and non-cardiac surgical treatment at Beijing Ditan Hospital,Capital Medical University from May 2023 to November 2024 were selected.According to the random number table method,they were divided into the observation group and the control group,with 34 cases in each group.The control group received placebo orally the night before surgery,and the observation group was given gabapentin capsules orally the night before surgery.The visual analogue scale(VAS)score and state-trait anxiety questionnaire(STAI-S)score were compared between the two groups at the preoperative and immediately after entering the operating room.The heart rate and mean arterial pressure(MAP)were compared between the two groups before anesthesia induction,during tracheal intubation and 1,3,5,10 min after intubation.The occurrence of adverse reactions in the two groups was recorded.Results There was no significant difference in VAS scores between the two groups before operation,immediately into the operating room,and at the time of anesthesia recovery room(all P＞0.05).The STAI-S score in the observation group was lower than that before operation and that in the control group at the same time point[(39±5)vs(43±5)](all P＜0.05).The heart rate and MAP levels of the observation group were lower than those of the control group at the time of tracheal intubation and 1,3,10 min after intubation(all P＜0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(all P＞0.05).Conclusions Gabapentin can reduce preoperative anxiety and intubation reactions in HIV-infected patients,without prolonging the duration of stay in the anesthesia recovery room.

Abstract:Objective To investigate the current status and influencing factors of frailty in hospitalized elderly patients with atrial fibrillation.Methods A total of 106 elderly inpatients with atrial fibrillation diagnosed and treated in Bazhong Central Hospital,Sichuan Province from May 2021 to May 2024 were collected as the research objects,and their clinical data were recorded.According to the occurrence of frailty,they were divided into non-frailty group(56 cases)and frailty group(50 cases).Multivariate Logistic regression analysis was used to screen the influencing factors of frailty in hospitalized elderly patients with atrial fibrillation.And construct a nomogram prediction model.The Bootstrap method was used for internal verification,the Hosmer-Lemeshow test was used to analyze the consistency of the nomogram prediction model,the receiver operating characteristic(ROC)curve was drawn to analyze the discrimination of the model,and the calibration curve was used to analyze the calibration of the model.Results Among 106 hospitalized elderly patients with atrial fibrillation,50 patients developed frailty,with an incidence of 47.2％.The 30-day and 90-day readmission rates in the frailty group were higher than those in the non-frailty group[14.0％(7/50)vs 1.8％(1/56),20.0％(10/50)vs 5.4％(3/56)](both P＜0.05).The age and the proportion of Barthel index score＜60 in the frailty group were greater/higher than those in the non-frailty group,and the hemoglobin and albumin were lower than those in the non-frail group(all P＜0.05).Increasing age and Barthel index score＜60 were independent risk factors for frailty in hospitalized elderly patients with atrial fibrillation,and increasing hemoglobin and albumin were protective factors for frailty in hospitalized elderly patients with atrial fibrillation(all P＜0.05).The Hosmer-Lemeshow test results of internal validation of the nomogram showed x2=5.983,P=0.649.The ROC curve results showed that the area under the curve was 0.864(95％confidence interval:0.794-0.934).The calibration curve results showed that the actual probability was basically consistent with the predicted probability,and the slope of the curve was close to 1.Conclusion The incidence of frailty in hospitalized elderly patients with atrial fibrillation is high.Patients with older age,Barthel index score＜60,lower hemoglobin and lower albumin are more likely to have frailty.

Abstract:Objective To investigate the efficacy and safety of enteral nutrition combined with biological agents(infliximab or ustekinumab)in the induction of remission in adults with moderate to severe Crohn's disease.Methods The clinical data of Crohn's disease patients diagnosed in the Second Affiliated Hospital of Guilin Medical College and the Second Affiliated Hospital of Guangxi Medical University from October 2018 to October 2024 were retrospectively selected.They were divided into observation group(14 cases)and control group(15 cases)according to whether they were combined with enteral nutrition.The observation group was treated with enteral nutrition and biological agents,and the control group was treated with less residue diet and biological agents.The general clinical data,laboratory indexes before and after treatment,body mass index and Crohn's disease activity index(CDAI)score were compared between the two groups to evaluate the disease activity,and the occurrence of adverse reactions was recorded.Results After treatment,the body mass index and albumin level of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group[body mass index:(21.2±2.1)kg/m2 vs(19.3±2.9)kg/m2],and the erythrocyte sedimentation rate and CDAI 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).All patients had a clinical response.There were 12 cases(85.7％)of clinical remission in the observation group and 11 cases(73.3％)in the control group(x2=0.132,P=0.716).During the treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Enteral nutrition combined with biological agents is beneficial to induce remission of moderate to severe Crohn's disease in adults with good safety.

Abstract:Objective To investigate the mechanism of high-altitude pulmonary hypertension(HAPH)and the intervention effect of human embryonic stem cell exosomes(hESC-exo)on HAPH.Methods Thirty 8-week-old C57BL/6 male mice were randomly divided into three groups:control group,hypobaric hypoxia group(HH group),hypobaric hypoxia hESC-exo intervention group(HH-exo group),with 10 mice in each group.The mice in the control group were fed in the normobaric and normoxic environment for 35 d.The mice in HH and HH-exo groups were exposed to hypobaric hypoxia for 28 d and then exposed to normobaric and normoxic environment for another 7 d.On day 29,30 and 31 of the experiment,the HH-exo group was injected with 20 μg hESC-exo via the tail vein,and the control group and the hypobaric hypoxia group were injected with the same volume of phosphate buffer solution.Right ventricular systolic pressure(RVSP),right ventricular hypertrophy index(RVHI)and pulmonary arterial wall thickness(PA thickness)were evaluated on day 35.The mRNA and protein expression levels of α-smooth muscle actin(α-SMA),α-1 collagen(Col1-a1)and fibronectin(FN)were detected by real-time fluorescent quantitative polymerase chain reaction and Western blotting.Results After successful modeling,RVSP,RVHI and PA thickness in HH group were significantly higher/larger than those in control group(all P＜0.05).Four days after the last exosome injection,the pulmonary vascular resistance and pulmonary vascular morphology of mice in each group were re-evaluated.The results showed that the RVSP,RVHI and PA thickness of the HH-exo group were significantly lower/smaller than those of the HH group[(21.0±3.8)mmHg vs(26.8±3.6)mmHg,(0.256±0.016)vs(0.361±0.018),(0.54±0.11)vs(0.79±0.13)](all P＜0.05).The mRNA and protein expression levels of α-SMA,Col1-a1,and FN in the HH-exo group were signifi-cantly lower than those in the HH group(all P＜0.05).Conclusions Pulmonary adventitial fibrosis is the main histopathological feature of hypoxia-induced pulmonary hypertension in mice.hESC-exo can effectively alleviate HAPH induced by hypobaric hypoxia in mice by reducing pulmonary adventitial fibrosis.

Abstract:Objective To investigate the efficacy and safety of mini-percutaneous nephrolithotomy(Mini-PCNL)and retrograde intrarenal surgery(RIRS)in the treatment of renal stones with 10-20 mm high hardness in children.Methods The clinical data of 62 children with renal calculi who underwent Mini-PCNL or RIRS at Beijing Friendship Hospital,Capital Medical University from June 2021 to June 2024 were retrospectively analyzed.The patients were divided into Mini-PCNL group(29 cases)and RIRS group(33 cases).The general data,intraoperative and postoperative data of the two groups were compared.Results There were no significant differences in general data between the two groups(all P＞0.05).The length of postoperative hospital stay and the decrease of hemoglobin in Mini-PCNL group were longer/greater than those in RIRS group[(4.7±1.7)d vs(2.9±1.5)d,6(4,10)g/L vs 2(0,4)g/L].The number of anesthesia and operation time in the Mini-PCNL group were less/shorter than those in the RIRS group[(1.9±0.3)times vs(2.8±0.4)times,(58±19)min vs(69±21)min](all P＜0.05).Conclusions Mini-PCNL and RIRS have good stone-free effect and safety in the treatment of renal stones with 10-20 mm high hardness in children.Although Mini-PCNL has longer hospital stay,it has the advantages of shorter operation time and fewer times of anesthesia.

Abstract:Fetal premature ductus arteriosus is associated with a risk of poor prognosis.In this paper,the color Doppler ultrasound manifestations,clinical management and neonatal prognosis of a case of fetal ductus arteriosus suggested by prenatal ultrasound are analyzed,and the relevant literature at home and abroad is reviewed to explore and analyze the cause,clinical management and prognosis of the disease.In this case,two times of color Doppler ultrasound showed progressive deterioration of fetal heart,and the pregnancy was terminated by cesarean section in time.The newborn had a good prognosis.The neonatal prognosis of premature ductus arteriosus is related to the degree of fetal heart damage,gestational age at termination and etiology.Before fetal cardiac decompensation,close observation and careful extension of gestational age,monitoring of fetal cardiac function by ultrasound and other means,and timely termination of pregnancy can lead to good prognosis of most neonates.In addition,genetic testing can be considered for idiopathic cases to determine the etiology.

Abstract:Objective To investigate the preventive effect of Taohong Siwu decoction on deep vein throm-bosis after total knee arthroplasty.Method A total of 120 patients with knee osteoarthritis who underwent total knee arthroplasty in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2022 to August 2023 were selected.According to the random number table method,they were divided into the control group and the observation group,with 60 cases in each group.The control group was treated with total knee replacement,and the observation group was treated with Taohong Siwu decoction on the basis of the control group.The symptom scores,glycocalyx damage markers,inflammatory factors,coagulation index and the incidence of deep vein thrombosis were compared between the two groups.Results The scores of tongue coating and pulse,pain of affected limbs,skin color and skin temperature after operation in the two groups were lower than those before operation,and those in the observation group were lower than those in the control group(all P＜0.05).The leg circumferences of upper and lower 10 cm of patella in the two groups after operation were smaller than those before operation,and those in the observation group were smaller than those in the control group(all P＜0.05).The levels of syndecan 1,heparin sulfate,and hyaluronic acid after operation in the two groups were lower than those before operation,and those in the observation group were lower than those in the control group(all P＜0.05).The levels of tumor necrosis factor-α and interleukin-6 in the two groups after operation were lower than those before operation,and those in the observation group were lower than those in the control group.The activated partial thromboplastin times in the two groups were longer than those before operation,and that in the observation group was longer than that in the control group(all P＜0.05).The incidence of deep vein thrombosis was 3.3％(2/60)in the observation group and 13.3％(8/60)in the control group,and the difference between the groups was statistically significant(x2=3.927,P=0.048).Conclusion Taohong Siwu decoction for patients with total knee arthroplasty has a significant effect on improving the glycocalyx damage markers and alleviating the inflammatory response of the body,and the incidence of postoperative deep vein thrombosis of the lower extremities is effectively controlled.

Abstract:Cardiac surgery faces severe challenges in the perioperative management of patients due to its characteristics of deep trauma and high risk of postoperative complications.Rapid rehabilitation medicine,by integrating multidisciplinary collaboration programs such as preoperative pre-rehabilitation,application of minimally invasive techniques,and goal-oriented fluid management,constructs an optimized path covering the entire perioperative process.It can effectively regulate surgical stress responses,reduce complications such as pulmonary infections,and shorten the length of stay in the intensive care unit and the length of hospital stay.This article systematically reviews the latest progress of rapid rehabilitation medicine in the field of cardiac surgery,focusing on key technological breakthroughs such as the optimization of minimally invasive surgical approaches,extracorporeal circulation blood management,precise body temperature maintenance,and dynamic monitoring of coagulation function,providing a theoretical basis for promoting the standardized implementation of the concept of rapid rehabilitation medicine in cardiac surgery.