It is believed that Shengyang Yiwei Decoction （升阳益胃汤， SYD） is effective in regulating the flow of Qi （气）， and can treat various diseases caused by the disorder of the spleen and stomach Qi. In clinical practice， based on the pathological characteristics of children often having insufficient spleen， and adhering to the principle of treating different diseases with the same method， the focus is placed on the core pathogenesis of spleen and stomach Qi disharmony. We use SYD in various pediatric conditions such as allergic rhinitis， post COVID-19 condition， urethral syndrome， and dysfunctional uterine bleeding in adolescence， and emphasize the treatment is flexibly tailored to the symptoms.

Objective To optimize the process conditions and analyze the components of alkaloids from Zanthoxylum bungeanum Maxim（Z. bungeanum）using macroporous resin. Methods Combining single factor tests and orthogonal tests, the content of hydroxy-α-sanshool（HAS）and hydroxy-β-sanshool（HBS）were considered as indexes to determine the best process parameters. Ultra-performance liquid chromatography-quadrupole tandem time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E）was used to identify the structures of alkaloids. Results The optimal conditions were Mitsubishi HP-20 macroporous resin, the loading solution concentration was 0.2 g crude drug/ml, the ratio of crude drug to resin volume was 1 g∶2.5 ml, the diameter/height ratio of resin column was 1∶7, the dynamic adsorption flow rate was 4 times of bed volume（BV）per hour, and the adsorption time was 1 h. Impurities were removed by using 2 BV of 20% ethanol, 5 BV of 80% ethanol was used to elution, and the content of HAS and HBS was 4.71% and 1.02%, respectively. A total of 20 alkaloids were identified from Z. bungeanum. Conclusion This method was stable and feasible, obtaining high purity and various kinds of alkaloids, which could be used for the enrichment and purification of alkaloids from Z. bungeanum.

ObjectiveTo explore the diagnostic value of plasma C-C motif chemokine ligand 3（CCL3） levels in infectious diseases. MethodsThe study enrolled patients in hospital or outpatient service and individuals undergoing health check-ups at Guangdong Provincial People's Hospital from July to October 2023. Patients clinically diagnosed with infectious diseases were assigned to the experimental group， while those who were healthy or diagnosed with non-infectious diseases were included in the control group. After non-qualifying samples were excluded， residual blood specimens from complete blood count （CBC） tests were collected to measure the plasma CCL3 levels.The CBC parameters including white blood cell count （WBC）， neutrophils count （NEUT）， eosinophils count （EOS），etc， and the plasma CCL3 levels were analyzed between the infectious and control groups to evaluate the clinical diagnostic value of CCL3 in infectious diseases. ResultsA total of 257 cases were enrolled， with 167 in the experimental group （active infections confirmed via clinical symptoms， CBC， inflammatory markers， or etiological examinations） and 90 in the control group （confirmed absence of active infections）. The experimental group exhibited higher levels of WBC， NEUT and CCL3 than the control group， while the lymphocytes count（LYMPH）， EOS in the experimental group were lower， with statistical significance （P<0.001） in univariate analysis. By using these significantly different indicators as independent variables， logistics regression modeling identified WBC， NEUT and CCL3 as independent risk factors for infection. Receiver operating characteristic（ROC） curve analysis revealed superior diagnostic performance of CCL3 over WBC and NEUT， while LYMP and EOS showed no diagnostic performance. The area under the curve （AUC） for CCL3 was 0.844 （95% CI： 0.795， 0.892）， with a sensitivity of 84.4%， a specificity of 69.8%， and an optimal threshold of 106.405 ng/mL. ConclusionPlasma CCL3 levels have clinical diagnostic value in predicting infectious diseases and may serve as a potential clinical biomarker for detecting infectious diseases.

Objective To survey conflict occurrence in surrogate decision makers for respiratory intensive care unit(RICU)patients with mechanical ventilation and explore its influencing factors.Methods A total of 101 surrogate decision-makers of mechanical ventilation patients in RICU were subjected from the Second Affiliated Hospital of Army Medical University from June 2024 to December 2024 by convenience sampling.General data questionnaire,Preparation for Decision Making Scale and Decisional Conflict Scale were used to conduct questionnaire survey.One-way ANOVA,Pearson correlation analysis and multiple linear regression analysis were employed to identify the influencing factors.Results The total score of decision readiness was 64.14±22.35,the total score of decision conflict was 35.18±26.47,and the incidence of decision conflict was 69.31%in the participants.Univariate analysis showed that there were statistically differences in whether knowing about prognosis,relationship with patients,awareness of patients'ideas about treatment,and understanding of information related to mechanical ventilation among the participants(P<0.05).Pearson correlation analysis indicated that decision readiness was negatively correlated with decision conflict and its 3 dimensions(P<0.001).The results of multiple linear regression analysis revealed that understanding of information related to mechanical ventilation and decision readiness were influencing factors for the decision conflict of the participants(P<0.001).Conclusion The decision conflict level is quite higher in the surrogate decision makers for RICU patients with mechanical ventilation,and the level is negatively correlated with the understanding of mechanical ventilation related information and decision readiness.

Objective To explore the clinical characteristics of patients with heat illness and the related factors for progression to heatstroke so as to provide a basis for early clinical intervention.Methods A case-control study design was adopted.A total of 164 patients with heat illness admitted to a hospital in Hainan Province from January 2018 to December 2023 were included,and divided into a heatstroke group(21 cases)and a non-heatstroke group(143 cases).Univariate and multivariate logistic regression analyses were used to evaluate the associations of body temperature,heart rate and mean arterial pressure at admission with the progression to heatstroke.Results The incidence of organ dysfunction in the patients with heat illness was 45.12％(74/164),and 12.80％(21/164)progressed to heatstroke.Multivariate logistic regression analysis showed that at admission,body temperature＞40 ℃(OR=10.11,95％CI:2.86～35.78),heart rate＞100 beats/min(OR=9.07,95％CI:2.75～29.94),and mean arterial pressure＜70 mmHg(OR=9.05,95％CI:2.75～29.75)were the related factors affecting the progression of heat illness patients to heatstroke.Conclusion The incidence of organ dysfunction in heat illness patients is relatively high.Body temperature,heart rate and mean arterial pressure at admission may be the related factors for predicting the progression of heat illness to heatstroke.

Objective To investigate the situation of unconformity of positive and reverse ABO blood typ-ing between outpatient and inpatient patients in the hospital,and explore the reasons for unconformity of posi-tive and reverse ABO blood typing detected by microcolumn gel method.Methods A retrospective analysis was conducted on the medical records of totally 425 patients with ABO blood type mismatch who underwent ORTHO VISION Max testing in the hospital from August 2023 to December 2024.Comprehensive analysis was conducted using various methods including the saline tube method,irregular antibody screening,increas-ing plasma volume,4 ℃ enhancement test,absorption elution,and gene sequencing,etc.Results Among 128 192 cases of ABO blood type tests,425 cases showed unconformity of positive and reverse ABO blood typ-ing,accounting for 0.33％.The causes were as follows:antibody weakening in 316 cases(74.35％),bone mar-row transplantation in 40 cases(9.41％),interference from irregular antibodies in 34 cases(8.00％),antigen weakening in 13 cases(3.06％),subgroups in 10 cases(2.35％),cold agglutinins in 6 cases(1.41％),inter-ference from irregular and autoantibodies in 4 cases(0.94％),auto-sensitization of red blood cells in 1 case(0.24％),and other reasons in 1 case(0.24％).Among 316 cases with antibody weakening,239 cases(75.63％)involved type A(anti-B weakening),61 cases(19.30％)involved type B(anti-A weakening),8 ca-ses(2.53％)involved type O(anti-A weakening),6 cases(1.91％)involved type O(anti-B weakening),and 2 cases(0.63％)involved type O(both anti-A and anti-B weakening).In patients with antibody weakening,the disease distribution was mainly cardiovascular disease in 127 cases(40.19％),a history of tumors in 67 ca-ses(21.20％),kidney diseases in 11 cases(3.48％),and orthopedic diseases in 10 cases(3.16％).Conclusion The main reason for the unconformity of positive and reverse ABO blood typing in the hospital is the weakening of the antibodies,especially the predominance of type A(anti-B weakening).Weakened anti-bodies are predominantly in the distribution of cardiovascular disease.For subtype-induced disturbances,a comprehensive analysis combining serology and gene sequencing is recommended.For disease-induced uncon-formity of positive and reverse ABO blood typing,monitoring the patients should be strengthened.

Objective To explore the perioperative therapeutic effects and follow-up manage-ment in 16 patients with left ventricular assist device(LVAD)implantation.Methods A retrospec-tive analysis was conducted in data of 16 patients who underwent LVAD implantation in the depart-ment of cardiovascular surgery.Data of 6-minute walk test(6MWT),European Quality of Life-5 Di-mension-5 Levels(EQ-5D-5L),New York Heart Association(NYHA)classification,echocardio-graphy,chest radiography,cardiothoracic ratio,and occurrence of complications(infection,bleed-ing,thrombosis,right heart failure,neurological issues)were collected via the electronic medical re-cord system before surgery and at 30,60,and 90 days postoperatively.Results All patients sur-vived with the pump at 90 days postoperatively.One patient with preoperative renal insufficiency un-derwent dialysis and received a heart transplant after 8 months.One patient developed a sterile granu-loma at the percutaneous lead site on the abdominal wall,which improved after treatment,no complica-tions occurred in other patients.At 90 days postoperatively,there was no statistically significant differ-ence in the right ventricular area change fraction and tricuspid annular plane systolic excursion com-pared with preoperative values(P＞0.05).The left ventricular ejection fraction,left ventricular end-diastolic diameter,and cardiothoracic ratio showed significant improvement compared with preoperative levels(P＜0.05).At 30 days postoperatively,30％of patients recovered to NYHA class Ⅰ and 70％to class Ⅱ;at 60 days,80％of patients to class Ⅰ and 20％to class Ⅱ;at 90 days,90％to classⅠ and 10％to class Ⅱ.The 6MWT and EQ-5D-5L scores of patients significantly increased within 90 days postoperatively(P＜0.01).Conclusion Through rigorous preoperative assessment by a multidisciplinary LVAD team,refinement of surgical techniques,and comprehensive management during hospitalization,self-management before discharge,daily follow-up after discharge,and fol-low-up management upon returning to the hospital for patients with LVAD implantation,the cardiac function and quality of life of patients are significantly improved at 90 days postoperatively.

Objective:To explore the application of photoplethysmography (iPPG) for contactless vital signs monitoring in the intensive care unit (ICU).Methods:Ten tracheostomy patients in intensive care had their heart rate, oxygen saturation, and diastolic and systolic pressures monitored using iPPG technology and a 24-hour bedside monitor. The readings included periods at rest, during turning, during suctioning, and when undergoing vigorous physical therapy and occupational therapy. The monitoring lasted 3 consecutive days. The data collected by the two methods were compared to analyze the accuracy of the contactless vital signs monitoring system.Results:The oxygen saturation readings of the two systems showed no significant differences. The heart rates, diastolic pressures, and systolic pressures did, however, differ significantly.Conclusions:In the situations tested, contactless monitoring of oxygen saturation is effective, but there is still significant room for improvement in the three indicators of heart rate, systolic pressure, and diastolic pressure.

Objective:To investigate the effect of high-dose vitamin D combined with insulin on serum homocysteine (HCY), glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus.Methods:From June 2020 to May 2023, 120 patients with gestational diabetes mellitus in Yan'an People's Hospital were selected as the research object, and they were randomly divided into observation group and control group with 60 cases in each group. The control group was treated with insulin aspart, while the observation group was treated with insulin aspart and large dose of vitamin D. The levels of serum HCY, glucose metabolism, serum 25-hydroxyvitamin D3 and blood lipid metabolism were compared between the two groups before and after treatment. The pregnancy outcomes of the two groups were compared and analyzed through follow-up.Independent sample t-test is used for comparison between two groups of econometric data that conform to normal distribution, while paired t-test is used for comparison within groups. The comparison between the groups was performed by χ2 test. Results:After treatment, fasting blood glucose ((4.67±0.52) mmol/L vs (5.46±0.68) mmol/L), 2-hour postprandial blood glucose ((6.67±0.56) mmol/L vs (8.42±0.78) mmol/L) and homeostasis model insulin resistance index (2.45±0.45 vs 3.87±0.34) in the observation group were significantly lower than those in the control group, and homeostasis model assessment of islets in pre diabetes patients β cell function index (HOMA-β) in the observation group was significantly higher than that in the control group (87.15±10.45 vs 75.92±10.06). The differences were statistically significant (t values were 7.15, 14.12, 19.50, and 6.00; all P<0.001). After treatment, the serum HCY level ((8.72±1.27) μmol/L vs (10.18±1.65) μmol/L), in the observation group was lower than that in the control group and the serum 25-OH-D3 level ((15.05±2.41) μg/L vs (11.25±2.37) μg/L) in the observation group was higher than that in the control group. The differences were statistically significant ( t=5.43, 8.71, P<0.001). After treatment, the serum triglyceride, total cholesterol and low density lipoprotein cholesterol (LDL-C) in the observation group were compared with those in the control group. LDL-C levels were lower than those in the control group ((2.15±0.15) mmol/L vs (3.23±0.18) mmol/L, (5.23±0.14) mmol/L vs (6.34±0.17) mmol/L, (1.53±0.21) mmol/L and (2.21±0.22) mmol/L), serum high density lipoprotein cholesterol (HDL-C), HDL-C levels were significantly higher than those in the control group ((1.18±0.11) mmol/L vs (0.98±0.12) mmol/L), and the differences were statistically significant (t-values were 35.70, 39.04, 17.32, and 9.52, respectively, all P<0.001). The incidence of adverse pregnancy outcome in the observation group was lower than that in the control group (10% (6/60) vs 40% (24/60)), and the difference was statistically significant ( χ2=14.28, P<0.001). Conclusion:High-dose vitamin D combined with insulin therapy can not only effectively improve glucose and lipid metabolism, but also reduce the HCY level and improve the adverse pregnancy outcome in patients with gestational diabetes mellitus.

The protein kinase B(Akt)pathway can regulate the growth,proliferation,and metabolism of tumor cells and stem cells through the activation of multiple downstream target genes,thus affecting the development and treatment of a range of diseases.Thioesterase superfamily member 4(THEM4),a member of the thioesterase superfamily,is one of the Akt kinase-binding proteins.Some studies on the mechanism of cancers and other diseases have shown that THEM4 binds to Akt to regulate its phosphorylation.Initially,THEM4 was considered an endogenous inhibitor of Akt,which can inhibit the phosphorylation of Akt in diseases such as lung cancer,pancreatic cancer,and liver cancer,but subsequently,THEM4 was shown to promote the proliferation of tumor cells by positively regulating Akt activity in breast cancer and nasopharyngeal carcinoma,which contradicts previous findings.Considering these two distinct views,this review summarizes the important roles of THEM4 in the Akt pathway,focusing on THEM4 as an Akt-binding protein and its regulatory relationship with Akt phosphorylation in various diseases,especially cancer.This work provides a better understanding of the roles of THEM4 combined with Akt in the treatment of diseases.