ObjectiveTo investigate the possible mechanism of Shenqi Jianxin Formula （参芪健心方） in the treatment of chronic heart failure （CHF） from the perspective of pyroptosis. MethodsFifty-two rats were randomly divided into sham operation group （n=8） and modeling group （n=44）. In the modeling group， the anterior descending branch of the left coronary artery was ligated to construct CHF rat model. Forty successfully-modelled rats were randomly divided into model group， Entresto group， Shenqi Jianxin Formula group， MCC950 group and the combination group （Shenqi Jianxin Formula plus MCC950）， with 8 rats in each group. In Shenqi Jianxin Formula group， 7.4 g/（kg·d） of Shenqi Jianxin Formula was given by gavage， while in Entresto group， 68 mg/（kg·d） of Entresto suspension was given by gavage； in MCC950 group， MCC950 was injected intraperitoneally with 10 mg/kg once every other day， and in the combination group， 7.4 g/（kg·d） of Shenqi Jianxin Formula was given by gavage， and MCC950 was injected intraperitoneally with 10 mg/kg once every other day； 10 ml/（kg·d） of saline was given by gavage in the sham operation group and the model group. After 3 weeks of continuous intervention， serum brain B-type natriuretic peptide （BNP）， creatine kinase isoenzyme MB （CK-MB）， interleukin 1β （IL-1β）， and interleukin 18 （IL-18） levels were detected by ELISA； HE staining and MASSON staining were used to observe pathological changes in rat myocardium. Except for the Entresto group， western blot technique was used to detect the expression of NOD-like receptor protein 3 （NLRP3）， caspase-1， and apoptosis-associated speck-like protein possessing a caspase-recruiting domain （ASC）； RT-PCR was used to detect the expression of NLRP3 and caspase-1 mRNA. ResultsCompared with the sham operation group， HE staining of rats in the model group showed obvious myocardial injury， while MASSON staining showed increased area of collagen fibrosis， and serum BNP， CK-MB， IL-1β， IL-18， myocardial tissue NLRP3， caspase-1， ASC protein expression and NLRP3， caspase-1 mRNA expression were all elevated （P＜0.05）. Compared with those in the model group， cardiomyocyte injury of rats and collagen fibrosis area were reduced， and serum BNP， CK-MB， IL-1β， and IL-18 contents were all reduced in Shenqi Jianxin Formula group， Entresto group， MCC950 group， and the combination group； except for Entresto group， myocardial tissue NLRP3， caspase-1， ASC protein expression and NLRP3， caspase-1 mRNA expression were reduced in the remaining three medication group （P＜0.05）. Compared with Shenqi Jianxin Formula group， the MCC950 group and the combination group showed decreased serum IL-1β and IL-18 content， collagen fibrosis area， myocardial tissue NLPR3， caspase-1 protein expression， and caspase-1 mRNA expression， and decreased ASC and NLRP3 mRNA expression was shown in the combination group （P＜0.05）. Compared with MCC950 group， collagen fibrosis area was reduced， and serum IL-18 content， NLRP3， caspase-1 mRNA expression were reduced in the combination group （P＜0.05）. ConclusionShenqi Jianxin Formula can effectively improve the myocardial injury and heart failure in rats with CHF， and its mechanism may be related to the inhibition of cardiomyocyte pyroptosis through NLPR3/Caspase-1 pathway to reduce the level of intramyocardial inflammation. The combined use of MCC950 with Shenqi Jianxin Formula could more effectively inhibite myocardial pyroptosis， with better therapeutic result than single use of each part.

Objective:To investigate the impact of air pollution on dynamic changes in lung function and further explore the association between genetic factors and lung function and its changes.Methods:Research data were from 14 506 participants in the United Kingdom Biobank with two complete baseline and follow-up lung function tests. Particulate matter [including particulate matter with aerodynamic diameter ≤2.5 μm and ≤10 μm (PM 2.5 and PM 10)], nitrogen dioxide (NO 2), and nitrogen oxides (NO x) concentrations were estimated using land-use regression models. Annual changes in lung function were calculated based on baseline and follow-up lung function tests. Polygenic risk scores (PRS) of lung function [forced expiratory volume in the first second (FEV 1), forced vital capacity (FVC), and the ratio of FEV 1 to FVC (FEV 1/FVC)] were constructed by genetic variations. The association between air pollution concentrations and lung function changes was analyzed by multiple linear regression models, and the impact of genetic factors on lung function and its changes was also assessed. Results:PM 2.5, PM 10, NO 2, and NO x showed a negative correlation with FVC changes [PM 2.5: -6.66 (95% CI: -9.92- -3.40) ml/year; PM 10: -0.40 (95% CI: -0.77- -0.03) ml/year; NO 2: -1.84 (95% CI: -2.60- -1.07) ml/year; NO x: -1.37 (95% CI: -2.27- -0.46) ml/year]. Additionally, PM 2.5, PM 10and NO 2 were also negatively correlated with changes in FEV 1 [PM 2.5: -3.19 (95% CI: -5.79- -0.59) ml/year; PM 10: -3.00 (95% CI: -5.92- -0.08) ml/year; NO 2: -0.95 (95% CI: -1.56- -0.34) ml/year]. PRS of lung function were positively correlated with baseline lung function (FVC, FEV 1, and FEV 1/FVC) and lung function changes (all β>0, all P<0.001). In different PRS stratification analyses, the effect of air pollution on lung function changes remained significant, and there was no apparent heterogeneity. Conclusions:PRS of lung function are significantly associated with baseline and lung function changes. Long-term exposure to air pollution accelerates the decline of lung function indicators such as FVC and FEV 1. The effects of air pollution are consistent in individuals with different genetic risk scores.

Objective To explore the effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer.Methods Ninety-three patients undergoing thoracoscopic surgery for lung cancer in our hospital from November 2022 to April 2023 were selected,and randomly assigned into three groups according to different postoperative analgesic protocols.Group P(n=30)was given patient-controlled intravenous analgesia,group T(n=31)received patient-controlled intravenous analgesia combined with thoracic paravertebral block,while group S(n=32)received patient-controlled intravenous analgesia combined with serratus intercostal plane block.Then the Visual Analogue Scale(VAS)score,Ramsay sedation scores,the press times of analgesic pump,the use of sedative drugs and adverse effects were compared among all three groups,and the sensory block plane,performance time,onset time and duration of the block were compared between group T and S.Results VAS scores in the resting state at postoperative 2 h,24 h and 48 h were(3.09±0.69),(2.83±0.59)and(2.07±0.51)in group P,which were higher than group T[(1.22±0.33),(2.51±0.54)and(1.57±0.45)]and group S[(1.01±0.30),(2.23±0.51)and(1.22±0.25)],group T was higher than group S.VAS scores in the coughing state at postoperative 2 h,24 h and 48 h were(3.63±0.55),(3.24±0.67)and(2.61±0.51)in group P,which were higher than the group T[(1.45±0.29),(2.71±0.56)and(2.33±0.53)]and group S[(1.14±0.28),(2.40±0.57)and(2.03±0.52)],group T was higher than group S.VAS scores in the resting and coughing states at postoperative 2 h,24 h and 48 h yielded statistical difference among three groups(all P＜0.05).Ramsay sedation scores at postoperative 2 h,24 h and 48 h were(2.21±0.51),(2.34±0.56)and(2.31±0.55)in group P,(2.23±0.53),(2.35±0.55)and(2.33±0.54)in group T and(2.22±0.52),(2.36±0.57)and(2.32±0.55)in group S,with no statistical difference(all P＞0.05).The press times of analgesic pump at postoperative 24 h and 48 h were(10.18±2.42)and(14.51±3.20)in group P,which were higher than the group T[(3.32±0.79)and(6.84±1.62)]and group S[(1.17±0.28)and(2.63±0.62)],group T was higher than group S,with statistical difference(all P＜0.05).The additional dose of sufentanil and the total amount of sufentanil used in postoperative period were(8.05±1.99)μg and(71.53±6.91)μg in group P,which were more than the group T[(3.77±0.93)pg and(65.82±5.77)μg]and the group S[(2.23±0.55)μg and(47.54±4.56)μg],group T was higher than group S,with statistical difference(all P＜0.05).Group S had shorter performance time[(5.32±1.77)min]and longer block duration time[(12.51±2.14)h]than those of group T[(12.41±3.42)min and(10.31±2.01)h],with statistical difference(all P＜0.05).The incidence of adverse reactions was 6.25％in group S,which was lower than the group P(30.00％,P＜0.05),and no statistical difference was reported among three groups in the occurrence rate of comparisons(all P＞0.05).Conclusion The sedation effects of the three different patient-controlled analgesia protocols are comparable,but patient-controlled intravenous analgesia combined with serratus intercostal plane block provides better postoperative analgesia for patients undergoing thoracoscopic surgery for lung cancer,which has less analgesic pump presses and lower dose of postoperative analgesic drugs used,and fewer adverse effects.

Objective To investigate the correlation between serum osteoblastin(OPN)and angiopoietin-like protein 8(ANGPTL8)levels and hepatic fibrosis(HF)after interventional therapy-transcatheter arterial chemoembolisation(TACE)in patients with primary hepatocellular carcinoma(PHC).Methods 166 patients with PHC admitted between March 2021 and June 2023 were selected and divided into 92 cases with HF(observation group)and 74 cases without HF(control group)according to whether or not HF occurred after interventional therapy;enzyme-linked immunosorbent assay(ELISA)was used to determine the serum OPN and ANGPTL8 levels and to analyse the predictive value of the OPN and ANGPTL8 levels on HF.Pearson correlation was used to analyze the correlation between OPN and ANGPTL8 levels and biochemical indexes.The factors influencing the occurrence of HF were analyzed by multi-factor Logistics regression.ROC curve was used to analyze the predictive value of OPN and ANGPTL8 for HF.Results Serum OPN[(74.56±11.56)ng/ml],ANGPTL[(42.78±5.23)ng/ml],ALT[(62.24±9.56)U/L],AST[(42.88±8.23)U/L],HA[(252.98±52.44)ng/L],LN[(152.64±26.45)ng/L],PC Ⅲ[(16.54±3.46)ng/L]and Ⅳ-C[(152.78±21.23)ng/L]in observation group were significantly higher than the control group[(57.89±9.68)ng/ml,(35.46±4.78)ng/ml,(49.46±7.46)U/L,(31.48±7.26)U/L,(192.56±23.88)ng/L,(124.48±11.23)ng/L,(11.26±2.23)ng/L and(126.45±18.56)ng/L].The differences between the two groups were statistically significant(P＜0.05).The AUC of serum OPN,ANGPTL8 and the combination of the two in predicting the occurrence of HF were 0.914,0.920 and 0.978,respectively,and the AUC of OPN combined with ANGPTL8 in predicting the occurrence of HF was higher than the AUC of the two separately(P＜0.05).Conclusion The levels of serum OPN and ANGPTL8 of patients with PHC are closely associated with the occurrence of HF,and the two are HF occurrence influencing factors and can be used as indicators to predict the occurrence of HF.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Background::Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.Methods::This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied.Results::At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs. placebo, 95% CI 31%–69%) and 45% (low vs. placebo, 95% CI 26%–64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator’s Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310. Conclusion::CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.Trial Registration::ClinicalTrials.gov, NCT04805411.

Objective:To investigate the clinicopathological characteristics, and prognosis of appendiceal goblet cell adenocarcinoma(GCA).Methods:The clinical and pathological data of 21 GCA cases were retrospectively analyzed, and their pathological morphology, immunohistochemical phenotype, genetic alteration and clinical treatment and prognosis were studied.Results:Most of the 21 patients showed appendicitis, with appendectomy alone or extensive resection of the tumor, followed by chemotherapy. There were 12 low-grade and 9 moderate and high-grade patients by pathological examination, and tumor cells express CEA, CK20, SATB-2, Syn(19/21), CgA(18/21), CD56(18/21), Ki67(+,10%-50%),and one patient had mutations in the BRAF gene.Depth of tumor infiltration ( r=0.716, P<0.001), and TNM stage ( r=0.816, P<0.001) were all positively correlated with the grade of GCA. After 19 to 98 months of follow-up, one patient relapsed and one patient died. Conclusions:Appendiceal GCA is a kind of tumor with bidirectional differentiation characteristics. Its morphology and biological behavior lineage are relatively broad, especially the high level is more aggressive, hence more active treatment should be adopted.

Objective:To retrospectively analyze the clinical application of extracorporeal membrane oxygenation (ECMO) in severe adenovirus pneumonia, and to evaluate the application value of ECMO in children with severe adenovirus pneumonia.Methods:Children diagnosed with severe adenovirus pneumonia and intervened with ECMO in the Hunan Children′s Hospital from January 1, 2018 to December 31, 2019 were recruited in this study for analyzing.The gender, age, clinical manifestations, mechanical ventilation duration, ECMO duration, the length of hospital stay, complications and prognosis were collected and analyzed.Results:A total of 4 children were included in the study, involving 2 cases were successfully evacuated from ECMO.Finally, 3 children died, and 1 case survived.Three death cases had a longer than 18 days of duration from the onset to the start with ECMO.Their ventilator assist time before star-ting ECMO was 3-5 days, and ECMO intervention time was longer, with the maximum of 27.5 days.The survived case had an 11-day duration from the onset to the start with ECMO, and the ventilator assisted time and ECMO intervention time were 5 days, and less than 10 days, respectively.Conclusions:ECMO treatment for children with severe adenovirus pneumonia has a low success rate, but it is still the most important way to save children.Early application of ECMO can improve the prognosis of children with severe adenovirus pneumonia.

In the context of the "Belt and Road" initiative, We systematically analyzed the general education and training systems of 16 Western Pacific countries and regions, including general practitioner college education, post-graduation education, and faculty status. Developed countries and regions have a long-term medical education system, strong faculty, and a comprehensive training model for general practitioners. Underdeveloped countries and regions are relatively weak in educational institutions, faculty, and general practitioner training models. The underdeveloped countries and regions should develop a general medical education and training system in terms of strengthening the construction of general medical disciplines, strengthening the supervision and certification of general practitioners, improving the general medical training model, and strengthening the construction of teachers.

Objective To investigate the influence factors on length of ICU stay in cardiac rupture patients after surgical repair.Methods A retrospective study was conducted and enrolled survived cardiac rupture patients admitted to ICU of Wuxi People's Hospital from January 2009 to January 2017.Clinical data of patients were recorded including age,causes,complications,blood transfusion,duration of mechanical ventilation,duration of vasoactive agent employment,and length of ICU stay.At the same time,the laboratory findings were documented including hemoglobin(Hb),hematocrit (Hot),serum creatinine,blood lactic acid and creatine kinase muscle b(CK-MB).Patients were divided into two groups according to length of ICU stay(A group ＞3 d,B group ≤ 3 d).Data were analyzed using SPSS20.0 and MedCalc software.Pearson correlation test and ROC curve were taken to analyze the predicting factors for the prognosis.Results Twenty-two patients were referred to ICU after operation and survived.The length of ICU stay varied from 2 to 12 d.The statistical analysis showed the levels of Hb and Hct in group A were lower than those in group B (P＜0.05);the levels of CK-MB and lactic acid in group A were higher than those in group B (P＜0.05);and larger volume of blood transfusion (P=0.002),higher complications (P=0.024),longer duration of mechanical ventilation (P=0.001) and longer duration of vasopressor application (P=0.003) were found in group A.Pearson correlation test showed Hb and Hct had negative correlation with duration of mechanical ventilation,duration of vasoactive agent application and length of ICU stay (P＜0.05),whereas the CK-MB and lactic acid had positive correlation with duration of mechanical ventilation,duration of vasoactive agent employment and length of ICU stay (P＜0.05).ROC curve showed lactic acid,Hct,and CK-MB all had significance in prediction of prolonged ICU stay,and there were no statistically significant differences in areas under the curve(AUC) among these three biomarkers (P＞0.05).With the employment of ROC curve,the optimal cut-off points of three biomarkers for clinical diagnosis were lactic acid ≥ 3.4 mmol/L,Hct ≤ 39％,CK-MB ≥ 58 U/L.Conclusion Hb,Hct,lactic acid,CK-MB,blood transfusion,complications,duration of mechanical ventilation,duration of vasoactive agent employment were factors influencing on length of ICU stay in cardiac rupture patients after operations.The levels of lactic acid,Hct,and CK-MB had significance in prediction of prolonged ICU stay.