ObjectiveTo compare the effectiveness and mechanism of Xiangzhu Fanggan Formula （香术防感方） by sniffing and nasal drops for preventing influenza A H1N1flu. MethodsFifty-six BALB/c mice were randomly divided into normal group， model group， zanamivir group， high-concentration sachet group， low-concentration sachet group， high-concentration nasal drops group， and low-concentration nasal drops group， with 8 mice in each group. In the low- and high-concentration sachet groups， 15 g and 30 g of Xiangzhu Fanggan Formula sachet were used for sniffing for 24 h per day； while in the low- and high-concentration nasal drops groups， nasal drops of Xiangzhu Fanggan Formula were given at a concentration of 0.11 and 0.22 g/ml， 20 μl each time， twice a day； in the zanamivir group， zanamivir was given at a concentration of 1.025 mg/ml of 20 μl each time， twice a day； in the normal group and the model group， nasal drops of normal saline were given at 20 μl each time， twice a day. Each group was given prophylactic intervention for 5 days. On day 5， 1 h after the administration of the drug， the mice in all groups except the normal group received 35 μl of 50 LD₅₀ A/PR/8/34/H1N1 viral solution as nasal drops to prepare influenza A H1N1 model mice. The body mass of the mice was recorded and the rate of change of body mass was calculated daily from day 5 to day 9 of the experiment， and the general status was observed. The mice were sampled on day 9， and the lung index and the inhibition rate of lung index were calculated； HE staining was used to detect pathological changes in lung tissues and to score lung tissue lesions； RT-qPCR was used to detect viral load in lung tissues； and ELISA was used to detect secretory immunoglobulin A （sIgA） and serum tumour necrosis factor α （TNF-α） and interleukin 2 （IL-2）， interleukin 6 （IL-6）， and interferon γ （IFN-γ） in the lavage fluid of the upper respiratory tract. ResultsOn days 7， 8 and 9 of the experiment， the rate of change in body mass of mice in the model group significantly lower than that in the normal group at the same time points （P＜0.05 or P＜0.01）. On days 8 and 9 of the experiment， the rate of change in body mass of mice in the zanamivir group and the high-concentration nasal drops group increased when compared with the model group （P＜0.05 or P＜0.01）. Compared with the normal group， mice in the model group had significantly higher lung index， lung tissue lesion score， lung tissue viral load， significantly higher serum TNF-α， IL-6， IL-2， IFN-γ levels， and significantly lower sIgA levels in the upper respiratory lavage fluid （P＜0.01）. Compared with the model group， the lung index and lung tissue viral load reduced， serum IFN-γ， TNF-α， IL-2， IL-6 levels reduced， and sIgA levels increased in the zanamivir group and the high-concentration nosal drops group （P＜0.05 or P＜0.01）； except for low-concentration sachet group， lung tissue lesion scores of the drug intervention groups reduced compared with those of the model group （P＜0.01）. Compared with the zanamivir group， the lung index increased in the low-concentration sachet group and the low- and high-concentration nasal drops groups， and the serum TNF-α and IL-2 levels increased in all Xiangzhu Fanggan Formula intervention groups （P＜0.05 or P＜0.01）. Compared with high-concentration nasal drops group， serum TNF-α and IFN-γ levels elevated in the high-concentration increased group， and lung tissue viral load elevated in the low-concentration nasal drops group （P＜0.05 or P＜0.01）. The lung index inhibition rate was 80.84% in the zanamivir group， 41.61% and 17.90% in the high- and low-concentration sachet groups， and 35.40% and 25.40% in the high- and low-concentration nasal drops groups， respectively. HE staining showed that the lung tissues of the model group showed thickening of alveolar septa， alveolar collapse， and infiltration of inflammatory cells； whereas， in each drug intervention group， the inflammation of the lung tissues of the mice and the damage reduced， and the most obvious improvement was in the zanamivir group and the high-concentration nasal drops group. ConclusionXiangzhu Fanggan Formula by sniffing and nasal drops could both prevent influenza A H1N1 virus infection， with antiviral and anti-inflammatory effects， also could improve the pathological damage of lung tissue， and improve the immunity of respiratory mucosa. The nasal drops may be better than sachets in inhibiting inflammatory response， especially the high-concentration nasal drops showed more effective.

Objective:To explore the brain activation intensity changes of depressed patients in the phase of expected value (EV), positive prediction error (+ PE) and negative prediction error (-PE) under uncertain (risky, ambiguous) decision-making.Methods:From July 2018 to February 2021, a total of 48 depressed patients in the Affiliated Hospital of Qingdao University were collected (depression group), and 69 sex-, age-, and educational level-matched healthy people were recruited as the control group. All participants completed risky and ambiguous decision-making tasks under the E-Prime system.SA-9800 brain functional audio-visual stimulation system and GE3.0 T functional magnetic resonance imaging (fMRI) scanners were used to conduct synchronous scanning and data acquisition. Using Xjview software to analyze the activation intensity of related brain areas to compare the activity intensity of the two groups.SPSS 16.0 software was used for chi square test, independent sample t-test. Results:Under risky decision-making, compared with the control group, the brain areas with reduced activation during EV phase in depression group were bilateral prefrontal cortex (PFC)(MNI coordinate: left x=-45, y=21, z=-6; right x=0, y=69, z=-3), left para hippocampal gyrus(PHG)(MNI coordinate: x=-9, y=0, z=-22), bilateral occipital lobe(OL)(MNI coordinate: left x=-51, y=-81, z=-3; right x=48, y=-84, z=-9)( P<0.05). The brain areas with reduced activation during + PE phase were bilateral PFC, left hippocampus (HIP), bilateral temporal lobe (TL), left middle occipital gyrus( P<0.05). The brain areas with reduced activation were bilateral PFC, right putamen, bilateral TL( P<0.05) during -PE phase. Under ambiguous decision-making, compared with the control group, the brain areas with reduced activation during EV phase in depression group were bilateral PFC, right OL( P<0.05); the brain areas with reduced activation during + PE phase were bilateral PFC, right putamen and hippocampus, bilateral TL, bilateral OL( P<0.05); and the brain areas with reduced activation were bilateral PFC, bilateral TL( P<0.05) during -PE phase. Conclusion:The study shows that the activities of reward brain areas such as PFC, limbic system and OL system are reduced during EV and PE phase under uncertain decision-making in depressed patients.

Objective To evaluate the efficacy of Schroth PSSE combined with 3D printing braces in the treatment of adolescent idiopathic scoliosis.Method Forty patients were included and divided into a support group(3D printing support group)and a support+exercise therapy group(3D printing support+Schroth PSSE group).Excluding outliers and lost follow-up data,32 patients were ultimately included,with 16 patients in each group.Wearing time≥18 h for both groups of 3D printing supports.The intervention period of Schroth PSSE is 12 weeks,and exercise is maintained after 12 weeks until the end of follow-up.The longest follow-up time for the brace group was 25 months,with an average follow-up time of(15.00±1.29)months.The longest follow-up time for the brace+exercise therapy group was 24 months,with an average follow-up time of(16.59±1.01)months.Relevant indicators were evaluated after follow-up.Results The support and exercise therapy group showed better improvement in Cobb angle and trunk rotation angle(ATR)than the support group,with statistically significant differences(P<0.05);The distance between the midpoint of the C7 vertebral body and the midline of the sacrum(C7-CSVL)in the support and exercise therapy group showed a statistically significant difference before and after treatment(P<0.05),while there was a significant difference before and after Apical Vertebral Translation(AVT)treatment(P<0.01).There was no statistically significant difference compared to the support group(P<0.05);In terms of SRS-22 score,the brace+exercise therapy group can comprehensively improve the SRS-22 score.Conclusion The combination of Schroth PSSE and 3D printing braces has a better effect on improving Cobb angle and torso rotation angle,improving coronary imbalance,increasing patient satisfaction,and improving quality of life compared to using 3D printing braces alone.

Background: To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database. Methods: Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected. Results: As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries. Conclusions The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.

Objective To study the protective effect and mechanism of adenosine A2a receptor(A2aR)activation in the pathogenesis of systemic sclerosis associated interstitial lung disease(SSc-ILD).Methods A total of 24 healthy female Balb/c mice were randomly divided into three groups:wild normal control(WN)group,wild model(WM)group,WM with CGS21680(WMC)group.Two weeks after the end of injections,the lung samples and serum of mice were collected.A part of lung tissues were obtained for hematoxylin eosinstaining,Masson staining and determination of hydroxyprolineto observe the degree of inflammation and fibrosis.Enzyme linked immunosorbent assay(ELISA)was used to detect advanced oxidative protein products in mouse serum and lung tissue,reduced glutathione in lung tissue,and oxidative stress levels in serum and lung tissue.Results①Underhematoxylin eosinstaining and Masson staining,the lungs of mice in WM group showed inflammation infiltration and fibrosis,while mice in WMC group showed a reduction compared to mice in WM group;②The content of hydroxyproline in lung tissue,serum and late stage oxidative protein products in lung tissue of WM group mice increased compared to WN group mice(P<0.01),while the content of WMC group mice decreased compared to WM group mice(P<0.01);③The reduced glutathione content in lung tissue of WM group mice was lower than that of WN group mice(P<0.01),while WMC group mice were higher than WM group mice(P<0.05).Conclusion The activation of A2aR ameliorated the degree of inflammation and fibrosis in SSc-ILD,possibly through the antioxidant mechanism.

Egypt’s medical insurance is mainly covered by government and commercial insurance. The low coverage of commercial insurance and the quality of medical services needs more improvement in Egypt. Recently, the incidence rate of diabetes, chronic kidney disease, hypertensive heart disease, COPD and liver cancer is rising. Traditional Egyptian medicine is similar to Traditional Chinese Medicine (TCM), and its modern traditional medicine is mainly Arabian medicine. Acupuncture, as the main form of TCM, was introduced into Egypt in the 1970s, but it has not been covered by the medical insurance system. The development of TCM in Egypt needs improvement. It is suggested that further explorated fields should be focused on the acupuncture therapy, TCM education and TCM treatment of keeping health in Egypt.

Objective To investigate the chlorhexidine acetate-resistance in Klebsiella pneumoniae ( K. pneumoniae) clinical isolates and to analyze the possible mechanisms and molecular epidemiology of re-sistant isolates. Methods A total of 332 K. pneumoniae clinical isolates were collected in the First Affilia-ted Hospital of Wenzhou Medical University in 2015. Standard agar dilution was used to screen chlorhexidine acetate-resistant isolates. The minimum inhibition concentrations ( MIC) of chlorhexidine acetate to resistant isolates with and without the presence of carbonyl cyanide m-chlorophenyl hydrazone ( CCCP) , which was an efflux pump inhibitor, were analyzed. Efflux pump genes of cepA, qacE and qacΔE1 that carried by and ex-pressed in those isolates were detected by polymerase chain reaction ( PCR) and quantitative real-time PCR ( RT-qPCR) , respectively. The biofilm formation ability was measured by crystal violet staining. The homol-ogy among the chlorhexidine acetate-resistant isolates was investigated with multilocus sequence typing ( MLST) and pulsed-field gel electrophoresis ( PFGE) . Results Twenty-five K. pneumoniae strains were re-sistant to chlorhexidine acetate. The MIC values of chlorhexidine acetate for them were reduced by at least four-fold in the presence of CCCP. Strains carrying the genes of cepA, qacE and qacΔE1 accounted for 100％, 40％ and 40％, respectively. The expression of the efflux pump genes in the chlorhexidine acetate-resistant isolates was higher than that in the susceptible isolates. The biofilm formation ability of the chlo-rhexidine acetate-resistant isolates was better than that of the susceptible isolates. Furthermore, negative, weak-positive and positive biofilm formation ability was observed in four ( 16％) , 20 ( 80％) and one (4％) strains, respectively. The results of MLST and PFGE showed that the 25 chlorhexidine acetate-resist-ant isolates belonged to 19 different sequence types ( ST) with diverse PFGE patterns. Conclusions This study suggested that active efflux was the main mechanism of chlorhexidine acetate resistance in K. pneumoni-ae. The 25 chlorhexidine acetate-resistant K. pneumoniae strains possessed different biofilm formation ability and shared low homology.

Objective To explore the expression and clinical significance of microRNA (miR)-155 and miR -222 in plasma of patients with ventricular septal defect(VSD),and to analyze the possible mechanism.Methods A total of 20 children with VSD who received treatment at the Department of Cardiovascular Surgery from August 2012 to June 2013 were enrolled (the VSD group)and 15 patients with fracture (the control group).The plasma miR -155 and miR -222 expression levels were measured by real -time quantitative reverse transcription -polymerase chain reaction (RT -qPCR).The potential target genes of miR -155 and miR -222 were predicted by using 3 current-ly available prediction programs,including TargetScan,mirbase and Miranda,and the signaling pathway of miRNA was predicted by Pathway -express analysis.Results Compared with the control group,the expression levels of miR -155 (P =0.033)and miR -222(P <0.001)in the VSD group decreased significantly;miR -155 and miR -222 predic-ted target genes included 74 and 50,respectively.The Pathway -express analysis indicated that 7 signaling pathways played important roles in the occurrence of fetal VSD,including signaling pathways for heart development,such as:mito-gen -activated protein kinase(MAPK)signaling pathway.Conclusions The expression levels of plasma miR -155 and miR -222 in VSD were significantly decreased.The target genes were related to signaling pathways for heart deve-lopment (MAPK signaling pathway),which indicates that miR -155 and miR -222 may be involved in the pathological process of VSD,and may serve as an independent evaluation indicator for the diagnosis of VSD.

OBJECTIVETo explore the effects of oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury at early stage.

METHODSTwenty-four patients with severe burn injury admitted to our burn ward from August 2013 to September 2014, conforming to the study criteria, were divided into conventional therapy group (n = 12) and early enteral feeding group (n = 12) according to the random number table. Patients in conventional therapy group received conventional treatment immediately after admission, while those in early enteral feeding group were orally given 100 mL of a mixture of glutamine, probiotics, and prebiotics once a day besides conventional treatment for 7 days. Serum levels of diamine oxidase (DAO) and procalcitonin (PCT) and plasma level of LPS were determined by ELISA before treatment and on treatment day (TD) 1, 3, 7, 14, and 21. Wound secretion and blood samples were collected for bacterial culture within the 21 TD. The incidence of MODS within the 21 TD was observed. Data were processed with Fisher's exact test, rank sum test, analysis of variance for repeated measurement, and LSD-t test.

RESULTS(1) Serum levels of DAO in patients of early enteral feeding group on TD 7, 14, and 21 were respectively (14.9 ± 3.7), (12.4 ± 3.1), and (9.5 ± 0.7) ng/mL, which were significantly lower than those of conventional therapy group [(17.5 ± 4.0), (16.3 ± 3.3), and (13.0 ± 1.1) ng/mL, with t values from 2.913 to 15.304, P values below 0.01]. Serum levels of DAO at the other time points were close between the two groups (with t values from -0.598 to 0.139, P values above 0.05). (2) Compared with serum levels of PCT in patients of conventional therapy group [(11.7 ± 20.9) and (12.9 ± 23.9) ng/mL], those of early enteral feeding group were significantly lower on TD 7 and 14 [(2.7 ± 8.1) and (2.0 ± 5.6) ng/mL, with Z values respectively -2.919 and -2.139, P < 0.05 or P < 0.01]. Serum levels of PCT at the other time points were close between the two groups (with Z values from -1.833 to -0.346, P values above 0.05). (3) Plasma level of LPS in patients of early enteral feeding group on TD 7 was (33 ± 56) pg/mL, which was significantly lower than that of conventional therapy group [(102 ± 108) pg/mL, Z = -2.046, P < 0.05]. Plasma levels of LPS at the other time points between the two groups showed no significant difference (with Z values from -2.003~-0.526, P values above 0.05). (4) Positive results in bacterial culture of wound secretion were approximately the same between the two groups (P > 0.05). Bacterial culture of blood was positive in 7 patients of conventional therapy group and 1 patient of early enteral feeding group, showing significantly statistical difference (P < 0.05). MODS was observed in 1 patient of conventional therapy group, showing no significantly statistical difference with that of early enteral feeding group (no patient, P > 0.05).

CONCLUSIONSEarly intestinal feeding of mixed enteral nutritional agent in addition to conventional therapy can effectively promote repair of the impairment of intestinal mucosal barrier, protect integrity of intestinal mucosa, reduce damage to intestines, and alleviate inflammatory response in patients suffering from severe burn injury.

Administration, Oral ; Amine Oxidase (Copper-Containing) ; blood ; Burns ; metabolism ; therapy ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Enteral Nutrition ; methods ; Female ; Glutamine ; administration & dosage ; pharmacology ; Humans ; Intestinal Mucosa ; drug effects ; metabolism ; Protein Precursors ; blood ; Treatment Outcome ; Wound Healing

Objective To provide anatomical basis for elevating iliac tissue flap pedicled on the iliolumbar artery.Methods The course,number,outer diameter and distribution of iliolumbar artery were observed on 13 human cadavers.Results All the iliolumbar artery originated from the internal iliac artery.The iliolumbar artery gave off 2 branches (iliacus branch and lumbar branch) when passing between the obturator nerve and the lumbosacral trunk,posteriorly to the psoas major.The mean distance between origin of the iliolumbar artery and bifurcation point to iliacus and lumbar branches was 7.1 (7.1 ± 0.5) cm.The iliacus branch divided into two branches:one artery curved forward and anastomosed with the iliacus branch of deep circumflex iliac artery; the other artery supplied the tissue around the posterior superior iliac spine.The lumbar branch supplied the psoas major and the quadratus lumborum.Conclusion The iliolumbar artery and the iliacus branch is one of the most constant and reliable vessels supplying the iliac bone,and can be used as the pedicle of free or pedicled iliac tissue flaps.