Objective:To develop and validate a predictive model for septic shock using noninvasive left ventricular pressure-strain loop myocardial work parameters combined with clinical indicators.Methods:In this retrospective study, 105 septic patients admitted to the intensive care unit of Zhangzhou Hospital between January and December 2023 were analyzed after screening (initial cohort: 124 patients). Participants were stratified into non-shock ( n=38) and shock ( n=67) groups based on septic shock occurrence within 48 hours of admission. Demographic characteristics, laboratory parameters, clinical variables, and myocardial work indices were compared between groups. Independent risk factors were identified through multivariate logistic regression, and a predictive model was constructed. Results:Five independent predictors of septic shock were identified: Left ventricular global longitudinal strain (GLS) ≥ -16% (X 1).Global work index (GWI) <1 196.5 mmHg% (X 2).Brain natriuretic peptide (BNP) ≥299.81 pg/mL (X 3).Lactate (Lac) ≥4.75 mmol/L (X 4).Mean arterial pressure (MAP) <68.5 mmHg (X 5).The derived model equation was:Y = -21.104 + 3.517×X 1 + 2.066×X 2 + 1.941×X 3 + 3.440×X 4 + 3.526×X 5.ROC analysis determined an optimal diagnostic cutoff of -13.6185 points (rounded to -14 for clinical practicality). Scores≥-14 indicated high septic shock risk. The model demonstrated excellent discrimination (AUC=0.960, 95% CI=0.919-0.998) and goodness-of-fit (Hosmer-Lemeshow test, P=0.804). Conclusions:This novel predictive model integrating myocardial work parameters and clinical indicators exhibits outstanding diagnostic performance for early septic shock detection, potentially enabling timely therapeutic intervention.

Objective To investigate the predictive value of platelet reactivity,RhoC and Rho kinase 1(ROCK1)combined with the electrocardiogram performance for slow flow/no reflow(SF/NRF)after the percutaneous coronary intervention(PCI)in elderly patients.Methods A retrospective analysis was conducted on the clinical data of 263 elderly PCI patients admitted to our hospital from January 2021 to July 2024.According to TIMI flow classification after PCI,they were divided into SF/NRF group(grade 0-II of TIMI flow classification,42 cases)and the control group(grade III of TIMI flow classification,221 cases).The baseline data and platelet reactivity,ROCK1,and ECG performance were compared between the two groups and the factors influencing SF/NRF after PCI in the elderly were analyzed.The value of joint predictors,each original covariate to predict SF/NRF after PCI in the elderly was evaluated.Results The proportion of patients with HPR,ROCK1,QTc,and T-wave inversion in SF/NRF group was higher than that in the control group(P<0.05);increased HPR,ROCK1,QTc,and T-wave inversion were independent risk factors for SF/NRF after PCI in the elderly(P<0.05);the AUC of the combined predictors for predicting SF/NRF after PCI in the elderly was significantly higher than that of the original covariates HPR(X1),ROCK1(X2,QTc(X3),and T-wave inversion(X4)(Z=5.112,3.688,4.368,5.697,P<0.05).Conclusion The increase of HPR,ROCK1,QTc and T wave inversion are independent risk factors for SF/NRF after PCI in the elderly.The combined detection of these indicators has certain predictive value for the occurrence of SF/NRF after PCI in the elderly.

OBJECTIVE To rapidly analyze the chemical constituents of Rubus sachalinensis Leveille by HPLC-Q-Exactive-MS/MS. METHODS Chromatographic separation was carried out on CAPCELL PAK MGII C18(4.6 mm×250 mm, 5 μm) column at the temperature of 30 ℃. The mobile phase was acetonitrile-0.1% formic acid by gradient elution, with a flow rate of 1.0 mL∙min−1, and the injection volume of 20 µL. The MS spectrum was acquired in negative ion modes using HESI ion source. RESULTS The molecular and structural formulae of the compounds were determined based on the exact mass number and ChemSpider and PubChem databases. By comparing the retention time of the corresponding reference standards and those reported in the literature, primary mass spectra, and secondary mass spectrometry pyrolysis fragments, combined with fragmentation regularity of such compounds, a total of 71 compounds were identified from Rubus sachalinensis Leveille, including 30 organic acids, 22 flavonoids, 7 triterpenoid saponins, 5 coumarins, 1 lignan, 1 gallotannin and 2 aromatic compounds. CONCLUSION This method can quickly and accurately identify the complex chemical constituents in Rubus sachalinensis Leveille, and provide scientific basis for the basic research on the medicinal substances of Rubus sachalinensis Leveille.

Objective:To explore the application value of renal artery resistance index in the diagnosist of intra-abdominal hypertension (IAH) in critically ill patients.Methods:89 patients with risk factors of IAH in the intensive care unit of Zhangzhou Hospital Affiliated to Fujian Medical University from February 2022 to June 2022 were retrospective analyzed. The intra-abdominal pressure (IAP) were measured by bladder, and patients divided into IAH group (IAP≥12 mmHg) and non-IAH group (IAP <12 mmHg). The resistance index (RI) of the right renal aorta, segment artery and interlobar artery were measured by color Doppler ultrasound. The difference between the measurement indicators of patients in the IAH and non-IAH groups and the correlation with IAP were analyzed. As for different indicators to predict the diagnostic efficacy of IAH, ROC curve analysis was used to evaluate the effect. And further multivariate logistic regression analysis was to find independent risk predictor.Results:A total of 89 patients were included in the study, including 44 patients with normal IAP and 45 patients diagnosed IAH. There were significant differences in the right renal aorta, segmental artery and interlobar artery RI (all P<0.01). The interlobar artery RI≥0.698 was the highest diagnostic cut-off,area under the curve was 0.914, sensitivity was 82.2%, specificity was 97.7%, and Jordon index was 0.799. The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between right renal interlobar artery RI and IAP ( r=0.741, P<0.01). The multivariate logistic regression analysis showed that the right renal interlobar artery RI ( OR= 24.472, 95% CI:5.122~116.919, P<0.01) was an independent risk predictor of IAH ( P<0.01). Conclusion:Right renal interlobar artery RI had better diagnostic efficacy of IAH,renal ultrasound could be used as an alternative, non-invasive technique for the diagnosis and follow-up of IAH.

A retrospective analysis of the clinical data of seven acute B-lymphoblastic leukemia (B-ALL) patients with TCF3-HLF fusion gene-positive admitted to the First Affiliated Hospital of Soochow University from June 2017 to August 2022 was conducted to summarize their clinical features and prognoses. The seven B-ALL patients comprised four males and three females, with a median age of 18 (11-33) years. Five patients tested positive for CD33 expression, and four patients had a normal karyotype. Two patients had hypercalcemia at the initial diagnosis, and one patient developed hypercalcemia at relapse. Six patients presented with coagulation dysfunction at diagnosis. After induction chemotherapy, five out of seven patients achieved complete remission, of which four subsequently relapsed. Two patients did not achieve remission even after two rounds of induction chemotherapy, with one achieving complete remission after treatment with blinatumomab immunotherapy. Three patients underwent chimeric antigen receptor T cell therapy, whereas three patients subsequently underwent hematopoietic stem cell transplantation. Five patients died, while two patients survived with sustained complete remission. TCF3-HLF-positive B-ALL is rare and has a high relapse rate and poor prognosis.

Objective To explore the effects of Shaoyao Gancao granule on hair growth,behavior,and the hypothalamic pituitary adrenal(HPA)axis in mice with alopecia areata(AA).Methods Forty-two C3H/HeJ mice were randomly divided into control,model,Shaoyao Gancao granule high-,middle-,low-dose,corticotropin-releasing hormone receptor 1(CRHR1)antagonist,and compound glycyrrhizin tablet(CGT)groups.Photography,dermoscopy,weight analysis,and behavioral measurement were performed.Corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),cortisol,glucocorticoid receptor(GR),and brain-derived neurotrophic factor(BDNF)were also assessed.Results Compared with the model group,high-dose Shaoyao Gancao granules improve hair regeneration and weight gain(P＜0.05),increased the percentage of total exercise distance and central area exercise distance in an open field test(P＜0.05),reduced the immobility time in the forced swimming and tail suspension experiments(P＜0.05),reduced peripheral blood levels of CRH,ACTH,and cortisol(P＜0.05),and increased expression of GR and BDNF in the hippocampus(P＜0.05).Conclusions Shaoyao Gancao granule promotes hair growth and improves behavioral performance in mice with AA.These effects may be related to downregulating CRH,ACTH,and cortisol expression,upregulating GR and BDNF expression,and inhibiting excessive activation of the HPA axis.

Objective:To compare the assay and related substance detection methods of erythromycin lactobionate in the Chinese Pharmacopoeia 2020(ChP),USP 2023(USP),JP18(JP),BP2023(BP)and EP 11.0(EP),investigate the differences between the test results obtained from 7 batches of erythromycin lactobionate for injection samples by using ChP and BP methods and thus provide a reference for the improvement of specification of erythromycin lactobionate.Methods:The differences of test methods and limits under the items of assay and related substances of erythromycin lactobionate in the above five pharmacopoeias were listed and compared.The related substances and contents of erythromycin lactobionate for injection samples from different manufactures were tested with methods stated in ChP and BP,and then compared and analyzed.Results:The items of related substances were determined by high performance liquid chromotographic methods in the ChP,EP and BP.The test methods and limits in the EP and BP were the same,which were different from that in ChP.The related substances were not determined in the USP and JP.There are obvious differences between the chromatographic methods and limits for the items of related substances in the ChP and BP,i.e.,BP contains 7 specific impuri-ties,while ChP contains only 2 specific impurities.The limits for any other impurity and the total amount of impurities were lower in the BP than those in the ChP.The antibiotic microbiological assay was used as the test method for the item of assay in the ChP,USP and JP based on different bacterial strains,which was different from the chromatographic method used in the BP.Based on the different methods of the ChP and BP,the related substances and content determination results of 7 batches of erythromycin lactobionate for injection samples met the acceptance criteria.The detection efficiency of BP related substances inspection method for specific impurities and total impurities were significantly higher than that of the ChP method.Conclusion:The BP method is superi-or to the ChP method in the detection of erythromycin lactobionate and erythromycin lactobionate for injection related substances.In terms of content determination,the external standard method adopted by BP is feasible to replace the antibiotic microbiological assay adopted by the ChP.Related substances and content determination methods adopted by the BP can provide an important reference for the revision and improvement of erythromycin lactobionate standard in the ChP.

Taking the micro-course The Connection Between Vertebrae as an example, this paper discusses the teaching design, production process and practical application of the anatomy micro-course, analyzes the existing problems and puts forward corresponding suggestions. The micro-course design integrates knowledge points with ideological and political elements, and applies a variety of teaching methods to make the teaching content interesting, enlightening and applicable. In the production process, using anatomical specimens, models and 3D software demonstration structure can make abstract knowledge intuitive and perceptual. Moreover, the artistry of micro-course is increased appropriately, and the misunderstanding of emphasizing appearance and neglecting design is avoided. The application of micro-course integrates the micro-course and online education platform to realize the intelligent education of information teaching. In addition, college teachers should improve the awareness of micro-course production and carry out systematic construction and application of micro-course resources.

Objective To analyze the spectrum of poisoning diseases in the Tongliao area,and provide the scientific basis for standardized treatment of acute poisoning and formulation of toxin control strategies in this area.Methods A retrospective cross-sectional study method was conducted,clinical data of acute poisoning patients admitted to the emergency center(department of emergency)of Inner Mongolia University for Nationalities Affiliated Hospital from January 1,2018 to December 31,2022,were collected through the hospital information system(HIS),including gender,age,marital status,regional distribution,poisoning routes,cultural level,poisoning cause,seasonal distribution,occupation,past medical history,types of toxic drugs,and number of patients undergoing blood purification treatment.Analyze the disease spectrum characteristics of patients with different prognosis,gender,age,region,seasonal distribution and occupational poisoning,and observe the changes in treatment costs for acute poisoning patients of different types of poisoning.Pearson correlation analysis were used to analyze the correlation between gender,age,occupation,past medical history,poisoning routes,cause of poisoning,treatment methods(gastric lavage,blood purification),season,and total hospitalization expenses.Results A total of 701 patients with acute poisoning were enrolled,including 335 outpatients and 366 inpatients.The ratio of males to females was 1∶1.49,and the average age was(43.23±19.39)years old.①Gender characteristics:there was no significant difference in the growth rate of male and female cases of sexual poisoning over the past 5 years(P＞0.05).There was a statistically significant difference in the acute poisoning spectrum between males and females(χ2 = 39.75,P = 0.000);②In terms of age:acute poisoning patients were concentrated in those over 30 years old,with an average age of(52.41±14.47)years.Among them,169 cases(24.11%)over 60 years old were the most common.There was statistical significance in the comparison of poisoning spectra among patients of different age groups(χ2 = 87.57,P = 0.000);③ Past medical history:previous medical history has a significant impact on acute poisoning.In this study,244 cases(34.81%)had a previous medical history,of which 85 cases(34.84%)had a history of mental illness.Among the 47 cases of poisoning caused by psychotropic drugs;④Regional distribution:Horqin District had the highest number of acute poisoning patients(340 cases),while Huolingol City had the lowest number(5 cases).There were statistically significant differences in the number of acute poisoning patients in different regions(χ2 = 74.820,P = 0.034);⑤Seasonal characteristics:poisoning months were concentrated in May,June,July,August,and September,pesticide poisoning was concentrated in May,July,and August,and therapeutic drug poisoning was concentrated in June,July,August,and October;food poisoning mainly occurs in August and September;⑥ Occupational characteristics:farmers and herdsmen had the highest incidence of acute poisoning(63.33%),while retirees had the lowest incidence of poisoning(1.71%).There were statistically significant differences in the spectrum of occupational poisoning among different professions(χ2 = 86.130,P = 0.000);⑦ Treatment cost:pesticide poisoning and food poisoning have the highest per capita cost;⑧ Correlation analysis:correlation analysis showed that the total cost of treatment was significantly positively correlated with toxic drugs and blood purification(r = 0.105,0.678,P = 0.044,0.000),and negatively correlated with seasons(r =-0.125,P = 0.017).It was not correlated with gender,age,occupation,history,poisoning routes,poisoning cause,and gastric lavage(r values were 0.077,0.078,-0.025,0.036,0.069,-0.073,0.004,all P＞0.05);⑨Types and prognosis of toxins:therapeutic drugs(54.07%)and pesticides(37.95%)were the most common types of toxins.The main therapeutic drugs were sedatives and hypnotics(32.72%)and antipyretic analgesics(22.69%);pesticide poisoning was mainly caused by herbicides(31.20%),rodenticides(27.44%),and organophosphorus insecticides(24.81%).Poisoning routes mainly due to gastrointestinal intake(97.43%);545 cases(77.75%)were cured and improved,146 cases(20.83%)were not cured,and 10 cases(1.42%)died.There is no statistically significant difference in overall prognosis among different types of poisoning(χ2 = 10.380,P = 0.239).The blood purification treatment rate was 27.39%.Conclusion Acute poisoning in the Tongliao area has regional characteristics.The main causes were emergency stimuli such as arguments and alcohol consumption,as well as intentional poisoning caused by mental and neurological diseases such as anxiety,depression,sleep disorders,and cerebrovascular diseases.Reducing accessibility is crucial for the control of local toxins.

Objective:To evaluate the outcome of the patients receiving dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) delivered by first-responders who witnessed the out-of-hospital cardiac arrest (OHCA) before the Emergency Medical Service (EMS) arrived.Methods:We performed a search of the relevant literature exploring major scientific databases. We assessed the quality of the included cohort study according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Meta-analysis was performed on three outcome indicators (recovery of spontaneous circulation survival to hospital discharge and survival with favourable neurologic outcome) using the Revman5.3 software.Results:A total of 21 studies with 349 822 patients were selected for the meta-analysis, including 182 125 patients in the DA-CPR group and 167 697 in the CPR-only group. The meta-analysis showed no significant difference between the DA-CPR and CPR-only groups in ROSC [ RR=1.10, 95% confidence interval ( CI): 0.94-1.29, P=0.24], survival to hospital discharge ( RR=1.10, 95% CI: 0.90-1.34, P=0.34) and survival with favourable neurologic outcome ( RR=1.01, 95% CI: 0.79-1.28, P=0.97) of the patients in America, Japan and Korea. However, there was a significant difference between the DA-CPR and the CPR-only groups in ROSC ( RR=2.61, 95% CI:1.53-4.46, P=0.0005), survival to hospital discharge( RR=6.08, 95% CI: 1.84-20.04, P=0.003), and survival with favourable neurologic outcome( RR=9.76, 95% CI: 1.87-51.02, P=0.007) of the patients in China. Conclusions:The overall effect of DA-CPR is significantly different for each country. In detail, DA-CPR offers a survival advantage (Return of spontaneous circulation, survival to hospital discharge and survival with favourable neurologic outcome) over CPR alone in China but no advantage in developed countries.