ObjectiveBased on the concept of quality by design（QbD）， the processing process of calcined Pyritum was optimized， and its X-ray diffraction（XRD） fingerprint was established. MethodsThe safety， effectiveness and quality controllability of calcined Pyritum were taken as the quality profile（QTPP）， the color， hardness， metallic luster， phase composition， the contents of heavy metals and hazardous elements were taken as the critical quality attributes（CQAs）， and the calcination temperature， calcination time， paving thickness and particle size were determined as the critical process parameters（CPPs）. Differential thermal analysis， X-ray diffraction（XRD） and inductively coupled plasma mass spectrometry（ICP-MS） were used to analyze the correlation between the calcination temperature and CQAs of calcined Pyritum. Then， based on the criteria importance through intercriteria correlation（CRITIC）-entropy weight method， the optimal processing process of calcined Pyritum was optimized by orthogonal test. Powder XRD was used to analyze the phase of calcined Pyritum samples processed according to the best process， and the mean and median maps of calcined Pyritum were established by the superposition of geometric topological figures， and similarity evaluation and cluster analysis were carried out. ResultsThe results of single factor experiments showed that the physical phase of Pyritum changed from FeS₂ to Fe₇S₈ during the process of temperature increase， the color gradually deepened from dark yellow， and the contents of heavy metals and harmful elements decreased. The optimized processing process of calcined Pyritum was as follows：calcination temperature at 750 ℃， calcination time of 2.5 h， paving thickness of 3 cm， particle size of 0.8-1.2 cm， vinegar quenching 1 time［Pyritum-vinegar（10∶3）］. After calcination， the internal structure of Pyritum was honeycomb-shaped， which was conducive to the dissolution of active ingredients. XRD fingerprints of 13 batches of calcined Pyritum characterized by 10 common peaks were established. The similarities of the relative peak intensities of the XRD fingerprints of the analyzed samples were>0.96， and it could effectively distinguish the raw products and unqualified products. ConclusionTemperature is the main factor affecting the quality of calcined Pyritum. After processing， the dissolution of the effective components in Pyritum increases， and the contents of heavy metals and harmful substances decrease， reflecting the function of processing to increase efficiency and reduce toxicity. The optimized processing process is stable and feasible， and the established XRD fingerprint can be used as one of the quality control standards of calcined Pyritum.

ObjectiveBased on the concept of quality by design（QbD）， the processing process of calcined Pyritum was optimized， and its X-ray diffraction（XRD） fingerprint was established. MethodsThe safety， effectiveness and quality controllability of calcined Pyritum were taken as the quality profile（QTPP）， the color， hardness， metallic luster， phase composition， the contents of heavy metals and hazardous elements were taken as the critical quality attributes（CQAs）， and the calcination temperature， calcination time， paving thickness and particle size were determined as the critical process parameters（CPPs）. Differential thermal analysis， X-ray diffraction（XRD） and inductively coupled plasma mass spectrometry（ICP-MS） were used to analyze the correlation between the calcination temperature and CQAs of calcined Pyritum. Then， based on the criteria importance through intercriteria correlation（CRITIC）-entropy weight method， the optimal processing process of calcined Pyritum was optimized by orthogonal test. Powder XRD was used to analyze the phase of calcined Pyritum samples processed according to the best process， and the mean and median maps of calcined Pyritum were established by the superposition of geometric topological figures， and similarity evaluation and cluster analysis were carried out. ResultsThe results of single factor experiments showed that the physical phase of Pyritum changed from FeS₂ to Fe₇S₈ during the process of temperature increase， the color gradually deepened from dark yellow， and the contents of heavy metals and harmful elements decreased. The optimized processing process of calcined Pyritum was as follows：calcination temperature at 750 ℃， calcination time of 2.5 h， paving thickness of 3 cm， particle size of 0.8-1.2 cm， vinegar quenching 1 time［Pyritum-vinegar（10∶3）］. After calcination， the internal structure of Pyritum was honeycomb-shaped， which was conducive to the dissolution of active ingredients. XRD fingerprints of 13 batches of calcined Pyritum characterized by 10 common peaks were established. The similarities of the relative peak intensities of the XRD fingerprints of the analyzed samples were>0.96， and it could effectively distinguish the raw products and unqualified products. ConclusionTemperature is the main factor affecting the quality of calcined Pyritum. After processing， the dissolution of the effective components in Pyritum increases， and the contents of heavy metals and harmful substances decrease， reflecting the function of processing to increase efficiency and reduce toxicity. The optimized processing process is stable and feasible， and the established XRD fingerprint can be used as one of the quality control standards of calcined Pyritum.

Objective:To summarize the best evidence for exercise intervention in elderly patients with sarcopenia in intensive care unit (ICU) through literature search, and provide a reference for clinical implementation of early exercise intervention in this population through evidence-based practice.Methods:① Summary of best evidence: relevant literature on exercise intervention for elderly patients with sarcopenia in ICU, including guideline, evidence summary, expert consensus, systematic review, and original study [quasi-experiment and randomized controlled trial (RCT)] from UpToDate Clinical Advisor, Ovid database, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, SinoMed, CNKI, Wanfang Database, VIP, and Yimai Tong Guideline Network were systematically searched. The search period covered from the establishment of these databases up to August 24, 2023. The quality of the literature was evaluated by two researchers with methodological expertise in evidence-based medicine, and the evidences were extracted and summarized. ② Evidence-based practice: the elderly patients with high risk of sarcopenia who had been hospitalized in the ICU for more than 7 days from January to April 2024 were enrolled as the research subjects, and they were divided into a control group and an intervention group using convenience sampling method. The control group received routine intensive care nursing. The intervention group implemented exercise intervention based on the actual situation of the patients, the baseline review was conducted before evidence application, and the effectiveness of evidence application at 7 days and 14 days was evaluated.Results:① A total of 19 pieces of literature were included, including 4 guidelines, 1 summary of evidence, 4 expert consensuses, 4 systematic reviews, and 6 original studies (1 quasi-experiment, 5 RCT). After literature quality evaluation, all 19 articles were enrolled. Finally, 31 pieces of best evidence were extracted from eight aspects, including assessment and diagnosis, multidisciplinary cooperation, indication, preparation before intervention, intervention program, safety monitoring, post-intervention evaluation, and special task. ② Finally, a total of 30 patients were enrolled in the intervention group, of which 17 completed 14 days of rehabilitation exercise, and 13 completed 7 days of rehabilitation exercise. Twenty-seven patients were enrolled in the control group, of which 17 completed 14 days of monitoring, and 10 completed 7 days of monitoring. Clinical evidence application results showed that the patients in the intervention group did not experience adverse events such as increased heart rate, extubation, or physical discomfort. The skeletal muscle mass index (SMI) in both groups was gradually decreased with the prolongation of intervention duration, but the 7-day SMI in the intervention group was significantly higher than that in the control group (kg/m 2: 8.61±2.66 vs. 6.65±1.50, P < 0.01). Conclusion:By summarizing the best evidence and evidence-based practice of exercise intervention for elderly patients with sarcopenia in ICU, this study confirmed the feasibility due to safe and effective of implementing early exercise intervention for elderly sarcopenia patients in ICU.

Objective:To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).Methods:A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m 2 for males and less than 5.7 kg/m 2 for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients were evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn. Results:Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio ( OR) = 0.79, 95% confidence interval (95% CI) was 0.67-0.93, P = 0.004], calf circumference ( OR = 0.64, 95% CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation ( OR = 1.06, 95% CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95% CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m 2, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test: χ 2 = 5.619, P = 0.018). Conclusion:Lower BMI, smaller calf circumference, and longer duration of mechanical ventilation are associated with an increased risk of sarcopenia in critically ill elderly patients.

ObjectiveTo investigate the protective effect of total lignans of Arctii Fructus on the retinal tissue in the rat model of type 2 diabetes mellitus. MethodWistar rats were randomized into normal， model， solvent， Shuangdan Mingmu Capsules （618 mg·kg^-1）， and low-， medium-， and high-dose （100， 200， 400 mg·kg^-1， respectively） total lignans of Arctii Fructus groups， with 16 rats in each group. The rat model was established by streptozotocin （STZ） combined with a high-fat diet and administrated with corresponding drugs by gavage once a day for 14 weeks. At the 14^th week， blood was sampled for the collection of serum from the abdominal aorta after anesthesia， and bilateral eyeballs were collected and frozen. Hematoxylin-eosin （HE） staining was used to observe the histopathological changes of the retinal tissue in rats. The pathological changes of retinal vascular network in rats were observed by retinal vascular tissue digestion and mounting The levels of vascular endothelial growth factor （VEGF）， tumor necrosis factor-α （TNF-α）， and intercellular adhesion molecule-1 （ICAM-1） in the serum were determined by the ELISA kit. ResultCompared with the normal group， the solvent group showed pathological changes in the retinal tissue， reduced retinal ganglion cells （P<0.01）， and retinal thinning （P<0.01）， decreased E/P value in retinal blood vessels （P<0.01）， and elevated serum levels of VEGF， TNF-α， and ICAM-1 （P<0.01）. Compared with the model group， the total lignans of Arctii Fructus increased the retinal ganglion cells （P<0.01）， thickened the retina （P<0.01）， and lowered the serum levels of VEGF， TNF-α， and ICAM-1 （P<0.05， P<0.01）. ConclusionTotal lignans of Arctii Fructus may lower the VEGF， TNF-α， and ICAM-1 levels to protect the retina.

Objective:To analyze the effect of traditional Chinese medicine emotional nursing combined with scenario-based cognitive function training in patients with cognitive impairment secondary to stroke, providing a practical reference for improving patients′cognitive function, anxiety and depressive mood, ability to live and quality of life.Methods:This study was a quasi experimental study. The 106 patients with post-stroke cognitive impairment (PSCI) admitted to Zhuhai People′s Hospital (Jinan University Affiliated Zhuhai Hospital) between January 2019 and October 2021 were selected by convenience sampling method and randomly divided into the control group and the observation group (53 cases in each group). The control group used conventional cognitive function training and the observation group used traditional Chinese medicine emotional care combined with scenario-based cognitive function training. The Montreal Cognitive Assessment (MoCA) scores, Mini-Mental State Examination(MMSE) scores, Self-rating Depression Scale (SDS) scores, Self-ratingAnxiety Scale (SAS) scores, self-care rate (assessed byActivity of Daily Living scale, ADL), and Generic Quality of Life Inventory-74(GQOLI-74) scores were compared between the two groups before and after the intervention.Results:After the intervention, the MoCA and MMSE scores of the observation group were 24.34 ± 2.18 and 25.98 ± 4.16, which were higher than the 20.41 ± 3.16 and 22.18 ± 4.21 in the control group, the differences were significant ( t = - 7.45, - 4.67, both P<0.05). The SDS and SAS scores of the observation group were 24.46 ± 3.46 and 27.18 ± 3.31, which were lower than the 39.15 ± 4.15 and 39.87 ± 4.70 in the control group, the differences were significant ( t = 16.07, 19.79, both P<0.05). The self-care rate in the observation group was 94.34% (50/53) higher than 81.13% (43/53) in the control group, the difference was significant ( χ2 = 4.30, P<0.05). The quality of life in the four dimensions of physical life, social functioning, psychological functioning, and somatic functioning in the observation group were (85.88 ± 4.14), (71.85 ± 4.10), (82.77 ± 3.44) and (88.51 ± 4.79) points, which were higher than the (73.48 ± 4.11), (66.48 ± 3.57), (75.49 ± 3.80) and (79.54 ± 4.60) points in the control group, the differences were significant ( t values were - 15.48 - - 7.19, all P<0.05). Conclusions:Traditional Chinese medicine emotional nursing combined with scenario-based cognitive function training can improve cognitive function, anxiety and depression in patients with cognitive impairment secondary to stroke, and improve patients′ability to live and quality of life level.

Objective: To explore the application value of protective device in microwave ablation at canine liver risk area, and the role of the device in reducing complications during ablation. Methods: Six healthy mongrel dogs were randomly divided into two groups: group A, used protective devices; group B, unprotected. Conventional gray-scale ultrasound and contrast-enhanced ultrasound (CEUS) were performed before treatment to identify the ablation area (the right lobe of the liver near diaphragm, 1 cm from the surface of the liver). The two groups were treated percutaneous puncture liver microwave ablation under real time ultrasound-guided with the same ablation power (50 W) and equivalent ablation time (600 s). Liver specimens were evaluated histological examination to evaluate the necrotic area of ablation and the degree of diaphragm′s injury. Results: ①There was no significance difference in the ablation range between two groups[ (3.3±0.1)cm vs (3.5±0.1)cm, P=0.184]; ②The tolerance of group A was better than group B during ablation treatment; ③The mean maximum ablation diameter in group A was significantly lower than that in group B [(2.1±0.1)cm vs (5.3±0.2)cm, P=0.001]. Meanwhile the pathological results showed that the damage degree in group A was significantly lower than that in group B. Conclusions This protective device has an obvious protective effect for microwave ablation of the risk area in liver (adjacent diaphragm, hepatic envelope). Our experiment suggests that this protective can reduce the damage of adjacent organ and the complications during the ablation surgery.

Objective To establish a new T staging system for nasopharyngeal carcinoma ( NPC) based on magnetic resonances imaging ( MRI) and intensity?modulated radiotherapy ( IMRT) . Methods A retrospective analysis was performed on the clinical data of 608 patients who were newly diagnosed with non?metastatic NPC by MRI and treated with IMRT in our hospital from 2008 to 2010. All patients were staged according to the 7th edition of the UICC/AJCC staging system for NPC. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox regression model was used for multivariate analyses. To deal with the deficiency in the current UICC/AJCC staging system, a new T staging system for NPC was established and systematically evaluated. Results The 5?year follow?up rate was 94?5%. The 5?year overall survival (OS), disease?free survival, local relapse?free survival (LRFS), and distant metastasis?free survival rates were 81?5%, 80?1%, 86?0%, and 81?1%, respectively. The univariate and multivariate analyses showed that the anatomic structures of nasopharynx, parapharyngeal space, and skull base were influencing factors for the OS rate (P=0?000?0?045). New T staging criteria were proposed based on the risk differences and survival curves:stage T1:invasion of the nasopharynx, parapharyngeal space, oropharynx, nasal cavity, skull base, and internal pterygoid muscle;stage T2:invasion of the external pterygoid muscle, paranasal sinus, intracalvarium, infratemporal fossa, and cranial nerves. The proposed T staging system achieved a good separation in both OS and LRFS curves. Conclusions The proposed new T staging system gives an objective prognostic prediction in patients with NPC, which provides an exploratory attempt toward a new clinical staging system for NPC.

Objective To study the effect of Sarcandra Glabra on the expression of signal transduction molecules of TGF-β1/Smads signaling pathway in miniature pig of radiation-induced lung injury.Methods 75 miniature pigs were divided into control group,radiation group and radiation plus medication group randomly.At 1 week before exposure of right lung with 15 Gy γ-rays,the miniature pigs in radiation plus medication group were given Sarcandra glabra,while those in the other groups received an equal amount of saline.Right lung were taken at weeks 2,4,8,12 and 24 after irradiation,the pathological changes in the lung tissue were observed by HE staining,and the expression of mRNA and protein of TGF-β1,Smad2,Smad3,and Smad7 were detected by real-time PCR and western blotting,respectively.Results Sarcandra glabra reduced the inflammation and fibrosis of the lung tissue in miniature pig after irradiation.Compared with control group,the expressions of TGF-β1 and Smad3 were significantly increased at 2 weeks after irradiation(P ＜ 0.05),Smad2 and Smad7 were increased at 8 and 12 weeks after irradiation(P ＜ 0.05),respectively,in the radiation group.Compared with the radiation group,the expressions of TGF-β1 and Smad2 were significantly decreased(P ＜ 0.05) from the fourth and eighth week,respectively,Smad3 had no obvious change while Smad7 was significantly increased from the second week in the radiation plus medication group (P ＜ 0.05).Conclusions Sarcandra Glabra plays protective effect on radiation-induced lung injury in miniature pig by regulating TGF-β1,Smad2 and Smad7 expressions in the TGF-β1/Smads signaling pathway.

As a kind of mineral medicine containing mercury, the toxicity of Cinnabaris has always been controversial. In recent years, along with the increasing reports and studies on Cinnabaris, it has been found that although the toxicity of Cinnabaris has effects on multi-systems, the main effect is on nervous system. In order to clarify Cinnabaris neurotoxicity and reduce its damage for nervous lesion caused in clinical application, this article made a thorough analysis on symptom expression and mechanism of Cinnabaris neurotoxicity and put forward corresponding countermeasures.