OBJECTIVE: To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). METHODS: A prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups ( n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups ( P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. RESULTS: In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels ( P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group ( P>0.05), there were significant differences at other time points of two groups compared to preoperative score ( P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours ( P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points ( P<0.05). No significant difference was found in Bromage motor block scores between the groups ( P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference ( P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups ( P>0.05). CONCLUSION Ultrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Nerve Block/methods* ; Male ; Female ; Pain, Postoperative/etiology* ; Tourniquets/adverse effects* ; Prospective Studies ; Middle Aged ; Ropivacaine/administration & dosage* ; Aged ; Ultrasonography, Interventional ; Anesthetics, Local/administration & dosage* ; Pain Measurement ; Fascia ; Osteoarthritis, Knee/surgery* ; Treatment Outcome ; Arthritis, Rheumatoid/surgery*

Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Objective To evaluate the association of different obesity phenotypes and their components with the risk of cognitive impairment in older Chinese adults,and to assess the association between obesity and cognitive impairment in different cognition-related genetic backgrounds.Methods A cross-sectional study based on the West China Health and Aging Cohort was conducted.Logistic regression was applied to estimate the association of obesity phenotypes and components with cognitive impairment in older Chinese adults stratified by APOE gene and polygenic risk scores.Results A total of 7 316 participants were enrolled,of whom 1 820 had cognitive impairment.Weight gains were associated with a reduced risk of cognitive impairment(odds ratio[OR]=0.96,95%CI,0.95-0.97).Being overweight with a normal waist-to-hip ratio was a protective factor for cognition(OR=0.74,95%CI,0.61-0.90),whereas the coexistence of elevated waist-to-hip ratio and overweight did not increase the risk of cognitive impairment.Sarcopenia was associated with an elevated risk of cognitive impairment.This association was found in both overweight(OR=2.03,95%CI,1.71-2.41)and non-overweight older adults(OR=1.86,95%CI,1.58-2.20),and was significant across all polygenic risk score strata.Conclusion Increasing body mass may serve as a key protective factor against cognitive decline in older adults.Having sarcopenia and obesity is associated with an elevated risk of cognitive impairment,independent of genetic susceptibility.

Objective To provide a reference for the selection of frailty assessment tools for stroke patients by conducting a literature review of existing frailty assessment tools for stroke patients. Methods Systematic searches were conducted in PubMed, Web of Science, EMbase, SinoMed, Wanfang, VIP, and China National Knowledge Infrastructure(CNKI) databases from their inception to May 2023. The literature that met the research purpose and question were screened, and the basic information of each article, including the first author, publication year, country of publication, type of research design, name of the assessment tool, dimensions of scale, the number of items, and assessment time, was extracted. Results A total of 1, 729 articles were retrieved in this study. After multiple screenings, 22 articles (including 8 frailty assessment tools) were ultimately included. The analysis results showed that the evaluation indicators, evaluation time, and evaluation methods of the 8 frailty assessment tools were different and had their own advantages and disadvantages. Among them, the frailty index was the most commonly used frailty assessment tool for stroke patients. The selection of effective frailty assessment tools for stroke patients is essential for strengthening prestroke risk stratification and improving poststroke outcomes. Conclusion There are significant differences among different frailty assessment tools, and existing assessment tools have limitations in measuring frailty in stroke patients. Comprehensive assessments should be conducted in combination with clinicians' experience and judgment. New frailty assessment tools are needed in future research to better guide the rehabilitation treatment and management of stroke patients.

Objective To investigate the prevalence of sarcopenia in the elderly people in a community of Chenghua District of Chengdu city and analyze its relationship with geriatric frailty syndrome. Methods A total of 586 elderly people in a community of Chenghua District of Chengdu city were selected as research objects for comprehensive geriatric assessment, including general data survey, anthropometric measurements (height, weight, grip strength, pace and skeletal muscle), and frailty screening scale survey. Incidence conditions of sarcopenia and geriatric frailty syndrome were evaluated, and the relationship between sarcopenia and geriatric frailty syndrome was analyzed. Results Totally 83 cases were diagnosed as sarcopenia, and the prevalence of sarcopenia was 14.98%. There were no significant differences in gender, education level, smoking, alcohol consumption and basic diseases between the sarcopenia group and the normal group (P>0.05). Compared with the normal group, the sarcopenia group had a significant lower ratio of patients aged 60 to 74 years old, a significant higher ratio of patients aged 75 to 84 years old and ≥85 years old, and a significant higher incidence of geriatric frailty syndrome (P < 0.05). Compared with the normal group, the sarcopenia group had significant lower grip strength, pace, skeletal muscle mass of the four limbs, and appendicular skeletal muscle index (ASMI) (P < 0.05). Multivariate analysis showed that age, body mass index (BMI) and geriatric frailty syndrome were influencing factors for sarcopenia (P < 0.05). Conclusion Prevalence of sarcopenia in the elderly people in a community of Chenghua District of Chengdu city is relatively high, and sarcopenia is closely correlated with the occurrence of geriatric frailty syndrome.

ObjectiveTo investigate the mechanism of Renshen Guben oral liquids（RGOL） in treatment of mice with renal fibrosis based on metabolomics and network pharmacology. MethodC57BL/6 mice were randomly divided into control group， model group and RGOL group， 12 mice in each group. Except for the control group， mice in the other groups were induced into unilateral ureteral obstruction（UUO） model by UUO. After preparation of the model， an aqueous solution of 4.2 g·kg^-1 extract powder was administered by gavage to RGOL group for 14 d， and an equal amount of distilled water was administered by gavage to the control and model groups. After the last administration on the 14^th day， urine was collected and detected by ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry（UPLC-QQQ-MS/MS） with 0.1% formic acid aqueous solution as mobile phase A， and acetonitrile-isopropanol（70∶30） as mobile phase B for gradient elution（0-1 min， 5%B； 1-5 min， 5%-30%B； 5-9 min， 30%-50%B； 9-11 min， 50%-78%B； 11-13.5 min， 78%-95%B； 13.5-14 min， 95%-100%B； 14-16 min， 100%B； 16-16.1 min， 100%-5%B； 16.1-18 min， 5%B）， column temperature of 40 ℃， flow rate of 0.4 mL·min^-1， electrospray ionization（ESI）， collection range of m/z 50-900. Through network pharmacology， the targets of components in RGOL and the targets of renal fibrosis were analyzed interactively， and the key components and key targets were screened by network topology analysis， and DAVID platform was used to predict the signaling pathways of RGOL for the treatment of renal fibrosis. ResultA total of 7 differential metabolites involving 8 metabolic pathways were identified in RGOL for the treatment of renal fibrosis. The network pharmacology revealed that 36 key components in RGOL were related to 7 differential metabolites， mainly ginsenosides， notoginsenosides and nucleotides. Based on the herbs-components-targets-pathways network， a total of 23 key targets related to the treatment of renal fibrosis by RGOL were highlighted， which together with the differential metabolites were involved in linoleic acid metabolism， arginine biosynthesis， tricarboxylic acid cycle（TCA）， arginine and proline metabolism and other pathways. ConclusionBased on metabolomics and network pharmacology， this study preliminarily identified 7 differential metabolites， 36 potential pharmacodynamic components and 23 key targets and 4 key pathways in RGOL for the treatment of renal fibrosis， providing an experimental basis for the clinical application and mechanism study of this preparation.

Existing traditional Chinese medicine (TCM)-related databases are still insufficient in data standardization, integrity and precision, and need to be updated urgently. Herein, an Encyclopedia of Traditional Chinese Medicine version 2.0 (ETCM v2.0, http://www.tcmip.cn/ETCM2/front/#/) was constructed as the latest curated database hosting 48,442 TCM formulas recorded by ancient Chinese medical books, 9872 Chinese patent drugs, 2079 Chinese medicinal materials and 38,298 ingredients. To facilitate the mechanistic research and new drug discovery, we improved the target identification method based on a two-dimensional ligand similarity search module, which provides the confirmed and/or potential targets of each ingredient, as well as their binding activities. Importantly, five TCM formulas/Chinese patent drugs/herbs/ingredients with the highest Jaccard similarity scores to the submitted drugs are offered in ETCM v2.0, which may be of significance to identify prescriptions/herbs/ingredients with similar clinical efficacy, to summarize the rules of prescription use, and to find alternative drugs for endangered Chinese medicinal materials. Moreover, ETCM v2.0 provides an enhanced JavaScript-based network visualization tool for creating, modifying and exploring multi-scale biological networks. ETCM v2.0 may be a major data warehouse for the quality marker identification of TCMs, the TCM-derived drug discovery and repurposing, and the pharmacological mechanism investigation of TCMs against various human diseases.

To explore the development tendency and major influential factors of traditional Korean medicine (TKM) resource and service by statistics analysis. Data are mainly from the Yearbook of Traditional Korean Medicine (2009-2015). Ministry of Health and Welfare Statistical Yearbook 2016, and the Ministry of health and welfare practicing qualification management system. This article analyzed the related indicators, such as the average annual growth rates and the proportion in the national medical system. From 2006 to 2015, the average annual growth rate of the number of TKM hospital and TKM clinics were 7.0％ and 3.2％ separately; the average annual growth rate of TKM doctor and TKM pharmacists were 4.3％ and 10.0％ separately; the average annual growth rate of the number of beds in TKM institutions were 9.3％; and the average annual growth rate of the number of applications for outpatient and inpatient reimbursement for medical insurance of TKM institutions were 12.3％ and 20.5％ separately. From 2006 to 2015, the resources and services of TKM presented an increasing tendency, and the accessibility of TKM resource and service was enhanced. It is suggested that China should use reference from the aspects of strengthening policy, expanding the sources of capital investment, and expanding the coverage of medical insurance.

Objective To grasp the current situation and trend of health personnel development in public TCM hospitals through the analysis of health personnel statistics data of public TCM hospitals in China; To provide decision-making references for management departments. Methods Data were from the National Health and Family Planning Commission Statistical Information Center. This article analyzed staff number, the average speed of development, the average annual growth rate, health staff age, academic qualifications and job titles and other indicators of TCM public hospitals during 2010-2015. Results From 2010 to 2015, there was an annual increasing tendency of the number of TCM health personnel, and the average annual growth rate was 5.9％, but the growth of the percentage of the TCM health personnel to the total health personnel was only 0.3％. In 2015, the proportion of TCM health personnel was less than 50％; the doctor-to-nurse ratio was 1:1.18; the educational level of postgraduate and undergraduate were 14.0％ and 48.0％ respectively, less than the average level of national hospitals. Conclusion From 2010 to 2015, there is an increasing tendency of the TCM health personnel of public TCM hospitals, but the proportion of TCM health personnel is low. The doctor-to-nurse ratio is reasonable gradually, but there is still a gap compared with the average level of the national hospitals. The average age of technical health personnel tends to be younger. The proportion of high educational level health personnel is increasing, but the proportion of senior technical position is reduced. The management departments should take appropriate measures to promote the rational allocation of human resources and development of TCM hospitals.

To further uncover the scientific significance and molecular mechanism of the Chinese herbs with pungent hot or warm natures, endogenous and exogenous expression systems were established by isolation of dorsal root ganglion (DRG) neurons and transfection of HEK293 cells with TRPV1 channel gene separately. On this basis, the regulation action of capsaicin, one main ingredient from chili pepper, on TRPV1 channel was further explored by using confocal microscope. Besides, the three-sites one-unit technique and method were constructed based on the brown adipose tissue (BAT), anal and tail skin temperatures. Then the effect of capsaicin on mouse energy metabolism was evaluated. Both endogenous and exogenous TRPV1 channel could be activated and this action could be specifically blocked by the TRPV1 channel inhibitor capsazepine. Simultaneously, the mice's core body temperature and BAT temperature fall down and then go up, accompanied by the increase of temperature of the mice's tail skin. Promotion of the energy metabolism by activation of TRPV1 channel might be the common way for the pungent-hot (warm) herbs to demonstrate their natures.