Objective To observe the clinical efficacy of Shengdi Xiexin Decoction combined with proton pump inhibitors(PPIs)in the treatment of acute non-variceal upper gastrointestinal bleeding(ANVUGIB)with stomach-heat congestion syndrome.Methods Sixty-two patients with ANVUGIB of stomach-heat congestion syndrome admitted to Dongguan Hospital of Guangzhou University of Chinese Medicine between January and December 2024 were randomly divided into a treatment group(n=31)and a control group(n=31)using a random number table.The control group received conventional western therapy(e.g.,Omeprazole Sodium),while the treatment group additionally received Shengdi Xiexin Decoction.Both groups were treated for 7 days,followed by 8 weeks of follow-up.The changes in traditional Chinese medicine(TCM)syndrome scores,hematological parameters[hemoglobin(Hb),red blood cells(RBC),hematocrit(Hct),albumin(ALB)],tissue perfusion and metabolic markers[blood urea nitrogen/creatinine ratio(BUN/Cr),lactate(Lac)levels],hemostasis time,time to resume oral diet,hospital stay duration,hospitalization costs,and rebleeding rates were observed to evaluate the clinical efficacy and drug safety.Results(1)After 7 days of treatment,the total effective rate was significantly higher in the treatment group(90.32％,28/31)than that in the control group(74.19％,23/31).The intergroup comparison(by chi-square test)showed that the treatment group,efficacy was superior to that of the control group(P＜0.05).(2)The treatment group showed significantly short hemostasis time,time to resume oral diet,and hospital stay duration(P＜0.05),as well as significantly low hospitalization costs(P＜0.05)compared to the control group.(3)Both groups exhibited significant reductions in the scores of epigastric burning pain,abdominal distension,acid regurgitation,restlessness,excessive thirst,scanty dark uring and dry stools,and total TCM syndrome scores(P＜0.05).The treatment group demonstrated significantly greater improvements in the scores of abdominal distension,acid regurgitation,restlessness,dark uring and dry stools,and total TCM syndrome scores(P＜0.05),while no significant differences were observed in epigastric burning pain and excessive thirst(P＞0.05).(4)Hb and Hct levels increased significantly in both groups(P＜0.05),with a greater increase in the treatment group(P＜0.05).Although RBC and ALB levels showed an upward trend,no significant differences were observed between groups(P＞0.05).Following treatment,intergroup comparisons revealed that the treatment group demonstrated significantly greater increases in Hb and Hct levels than the control group(P＜0.05).In contrast,the two groups showed comparable effects in elevating RBC and ALB levels,with no statistically significant differences(P＞0.05).(5)BUN/Cr ratio and Lac levels decreased significantly in both groups(P＜0.05),with a more pronounced reduction in the treatment group(P＜0.05).(6)No significant differences were found in early or delayed rebleeding rates between groups(P＞0.05).(7)Neither group experienced significant adverse events.Conclusion Shengdi Xiexin Decoction combined with PPIs significantly improves clinical outcomes in ANVUGIB patients with stomach-heat congestion syndrome.It is effective on enhancing hematological parameters,correcting tissue hypoperfusion,alleviating symptoms,shortening hemostasis time and hospitalization durations,and reducing medical costs,demonstrating excellent safety.

OBJECTIVE: To develop and validate a predictive model for the risk of bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). METHODS: A literature search was conducted in PubMed, Cochrane Library, and Embase databases from inception to July 2022 to identify studies reporting statistically significant risk factors for CRKP-BSI. Relative risks (RR) were extracted and pooled. Based on factor weights, a risk-scoring model was established. For external validation, hospitalized CRKP-infected patients from January 2016 to January 2022 at Shanghai First People's Hospital were included. Clinical data were used to calculate individual risk scores. The predictive accuracy was assessed using receiver operator characteristic curve (ROC curve). Patients were stratified into low-to-intermediate-risk and high-risk groups based on the optimal cut-off, and CRKP BSI incidence was compared between groups. RESULTS: The literatures related to the risk factors of CRKP-BSI published from database inception to July 2022 was retrieved and screened from PubMed, Cochrane Library, and Embase. Fourteen risk factors were included in the scoring model: cardiovascular disease, severe neutropenia or immunosuppression, intensive care unit (ICU) stay history, prior hospitalization, carbapenem exposure, aminoglycoside exposure, antifungal exposure, endotracheal intubation or tracheostomy, mechanical ventilation, hemodialysis, central venous catheter, indwelling urinary catheter, CRKP colonization, and Klebsiella pneumoniae positivity at non infection sites. The total score ranged from 0 to 173.5 points. In the validation cohort of 230 CRKP-infected patients, 41 developed CRKP BSI. The model yielded an area under the curve (AUC) of 0.783 (95%CI was 0.689-0.876). The optimal cut off was 81.25 points, with sensitivity of 75.6% and specificity of 81.0%. Based on this cut off, 163 patients were categorized as low-to-intermediate risk and 67 patients as high risk. The incidence of CRKP BSI in the high-risk group was significantly higher than in the low-to-intermediate-risk group [64.2% (43/67) vs. 4.9% (8/163); RR = 13.175 (95%CI was 5.920-29.319), P < 0.001]. CONCLUSIONS The model, based on 14 routinely available clinical parameters, demonstrated good performance in predicting CRKP BSI risk and may assist clinicians in early identification of high risk patients.
Humans ; Klebsiella pneumoniae/drug effects* ; Klebsiella Infections/microbiology* ; Carbapenems/pharmacology* ; Risk Factors ; Bacteremia/microbiology* ; ROC Curve ; Carbapenem-Resistant Enterobacteriaceae

This study aims to investigate the potential of oncolytic nanoparticles encapsulating Coxsackievirus A21 (CVA21) full-genome mRNA (CVA21@ONP) to resurrect CVA21 and induce apoptosis in host cells, as well as the antitumor immune effects of CVA21@ONP in immunocompetent tumor-bearing BALB/c mice. We used lipid nanoparticles (LNPs) to encapsulate CVA21 full-genome mRNA, thus preparing CVA21@ONP. The killing efficacy of CVA21@ONP was determined by the plaque assay and cell counting kit-8 (CCK-8), and the apoptosis in HT29 and CT26-iRFP cells was evaluated by flow cytometry. Mice were administrated with CVA21@ONP at high and low doses intratumorally, and the growth of tumors expressing infra-red fluorescent protein (iRFP) was monitored. Additionally, the types and changes of immune cells in the spleen were analyzed by flow cytometry. The results demonstrated that CVA21@ONP successfully resurrected CVA21 in both HT29 and U87MG cells. The plaque assay revealed robust killing effects of CVA21@ONP against both human and murine cell lines, and flow cytometry results showed increased early and late apoptotic cells. Notably, intratumoral detection revealed significantly down-regulated expression of iRFP in both high- and low-dose CVA21@ONP groups. Flow cytometry results further indicated that CVA21@ONP treatment effectively reduced the levels of immunosuppressive cells, including myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs), in the spleen, while enhancing T cell-dependent antitumor immune responses. These findings suggest that CVA21@ONP can replicate and survive extensively both in vitro and in vivo, activating the immune system of mice administrated with CVA21@ONP to target cells at the tumor site, thereby remodeling the tumor immune microenvironment and accelerating the suppression or even complete regression of tumors. The oncolytic performance of CVA21@ONP has been verified through intratumoral injection administration in this study, aimed at further exploring its therapeutic potential and promoting the development of the field of tumor treatment.
Animals ; Nanoparticles/chemistry* ; Mice ; Mice, Inbred BALB C ; Humans ; Apoptosis ; Oncolytic Viruses/genetics* ; Oncolytic Virotherapy/methods* ; Cell Line, Tumor ; RNA, Messenger/genetics* ; HT29 Cells

Metabolic dysfunction-associated fatty liver disease （MAFLD） has become one of the critical chronic liver diseases requiring global attention， and the degree of hepatic fibrosis in these patients is closely associated with their prognosis. Therefore， control or even reversal of hepatic fibrosis is an indispensable part of the long-term management of MAFLD patients. A large number of studies have shown that the Wnt signaling pathway is involved in the development and progression of MAFLD. This article systematically describes the Wnt signaling pathway and elaborates on its mechanism of action in MAFLD-associated hepatic fibrosis， in order to provide a reference for the treatment of hepatic fibrosis in patients with MAFLD.

Objective:To discuss the relationship between three proinflammatory factors and muscle mass(MM)in the elderly patients with sarcopenic obesity and diabetes,and to provide theoretical basis for the development of clinical treatment protocols in the elderly patients with sarcopenic obesity and diabetes.Methods:The elderly patients with diabetes who visited our hospital from January 2021 to May 2023 were selected,including 41 patients with obesity and diabetes(OD group)and 46 patients with sarcopenic obesity and diabetes(SOD group);80 healthy subjects(control group)and 62 subjects with simple obesity(SO group)who underwent physical examination in our hospital during the same period were included.The clinical data of the subjects in four groups were compared,and the correlations between proinflammatory factors and MM and fat mass(FM)were analyzed.All the subjects were divided into sarcopenia group and normal group based on the presence of sarcopenia.Logistic regression model was used to analyze the independent influencing factors of sarcopenia;receiver operating characteristic(ROC)curve was drawn to determine the predictive value of the above factors for sarcopenia.Results:Compared with control group,the body mass index(BMI),FM and body fat percentage(BFP)of the subjects in SOD,OD and SO groups were significantly increased(P＜0.05);compared with control group,OD group and SO group,the appendicular skeletal muscle mass(ASM),appendicular skeletal muscle mass index(ASMI)and grip strength(GS)of the subjects in SOD group were significantly decreased(P＜0.05),and the levels of serum interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)were significantly increased(P＜0.05).In all the subjects,the IL-6,CRP and TNF-α were negatively correlated with ASMI(r=-0.589,r=-0.621,r=-0.620;P＜0.05),and positively correlated with BFP(r=0.252,r=0.221,r=0.147;P＜0.05).Compared with normal group,the ASM,ASMI and GS of the subjects in sarcopenia group were significantly decreased(P＜0.05),and the levels of serum proinflammatory factors IL-6,CRP and TNF-α were significantly increased(P＜0.05).The univariate Logistic regression analysis results showed that IL-6,CRP and TNF-α were the influencing factors of sarcopenia(P＜0.05).The multivariate Logistic regression analysis results showed that the increased levels of IL-6 and TNF-α were the independent risk factors for sarcopenia(OR＞1,P＜0.05).The ROC curve results showed that the area under the curve(AUC)values of IL-6,CRP and TNF-α were all＞0.700,indicating that the above indicators had good predictive value for sarcopenia.Conclusion:The increased levels of proinflammatory factors IL-6,CRP and TNF-α are associated with the decrease of MM in the elderly patients with sarcopenic obesity and diabetes,and IL-6 and TNF-α are the independent risk factors for the sarcopenia.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To investigate the clinical effect of local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser in the treatment of hypertrophic scars in children. Methods:A randomized controlled study method was used. According to the inclusion and exclusion criteria, the subjects were selected from children with hypertrophic scars admitted to the Children’s Hospital Affiliated to Shandong University from January 2022 to September 2023, and were divided into control group and experimental group using random number table method. The control group was treated with ultra-pulsed CO 2 fractional laser. The experimental group was injected with triamcinolone acetonide acetate injection at multiple points into the scar (the ratio of triamcinolone acetonide acetate injection to 2% lidocoin hydrochloride injection was 1∶1), with a distance between the points as 1 cm, and the injection dose was about 0.1 to 0.2 ml/cm 2 according to the degree of scar protrusion. The maximum dose each time was ≤40 mg. CO 2 fractional laser treatment was performed after 10 minutes of cold compress with ice bag. Scars in both groups were treated 3 times, with an interval of 2 to 3 months. Before the treatment and 6 months after the last treatment, the Vancouver scar scale (VSS) was performed on both groups of scars score, the total score was 0 - 15. The higher the score, the more serious the scar hyperplasia was. Six months after the last treatment, the scar treatment effects of the two groups were comprehensively evaluated and divided into 3 levels: markedly effective, effective and ineffective. The total effective rate =(markedly effective + effective) number of cases/total number of cases ×100%. Patient satisfaction was investigated 6 months after the last treatment and divided into 5 levels: very satisfied, satisfied, average, dissatisfied, and very dissatisfied. Satisfaction rate =(very satisfied + satisfied) number of cases/total number of cases ×100%. The occurrence of adverse reactions was recorded throughout the treatment process. Analysis was performed using SPSS 19.0 software. Measurement data were expressed as Mean±SD, inter-group comparisons were performed using independent samples t-test, intra-group comparisons were performed using paired t-test, counting data were expressed as examples and percentages, and comparisons between the two groups were performed using χ2 test. P<0.05 indicated that the difference was statistically significant. Results:A total of 82 children with hypertrophic scars were included, 33 males and 49 females, aged 1 to 15 years old, with an area of 5 to 45 cm 2. The pathogenic factors were trauma, burns, and surgery. The course of disease was 2 to 30 months. Among them, 41 patients in the control group, 16 males and 25 females; the age was (5.8±1.6) years; 41 patients in the experimental group, 17 males and 24 females, the age was (5.6±1.5) years. There were no significant differences in age, gender, scar area, pathogenic factors and course of disease between the two groups ( P>0.05). There was no significant difference in VSS scores between the experimental group and the control group before the treatment [(9.42±1.35) points vs. (9.06±1.57) points, P>0.05]. Six months after the last treatment, there was a significant difference in VSS scores between the experimental group and the control group [(4.12±0.56) points vs. (5.50±0.75) points, P<0.01]. The VSS scores of children in both groups were significantly lower than those before the treatment ( P<0.01). Six months after the last treatment, the comprehensive evaluation result showed that the total effective rate in the experimental group was higher than that in the control group [92.7%(38/41) vs. 75.6%(31/41), P<0.05]. Six months after the last treatment, the patient satisfaction survey showed that the satisfaction rate in the experimental group was higher than that in the control group [87.8%(36/41) vs. 58.5%(24/41), P<0.01]. The main adverse reactions during treatment included edema erythema, skin ruptures, skin atrophy, and vigorous hair growth. There was no significant difference in the incidence of adverse reactions between the experimental group and the control group [12.2%(5/41) vs. 7.3%(3/41), P>0.05]. Conclusion:Local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser is more effective in treating children’s hypertrophic scars. It can significantly improve the appearance of scars, reduce clinical symptoms, with fewer adverse reactions, and high patient satisfaction.

Objective:To investigate the influence of prolonged post-cesarean skin-to-skin contact (SSC) on breastfeeding outcomes.Methods:A quasi-experimental study was conducted, employing convenience sampling to recruit mother-infant dyads (intervention group: 82 dyads; control group: 85 dyads) from term cesarean deliveries at Northwest Women's and Children's Hospital from December 2021 to May 2022. The control group received routine care, while in the intervention group, SSC was immediately initiated for 90 min upon returning to the ward after cesarean delivery, followed by daily SSC for≥2 h until 42 d postpartum. Propensity score matching was used for 1∶1 matching to control for confounders, resulting in 82 dyads per group. Two independent samples t-test, Mann-Whitney U test, Chi-square test and repeated-measures analysis of variance were used to compare the data between the two groups, including first breastfeeding scores and success rates, the initiation time of lactation, the incidence of delayed lactation, exclusive breastfeeding rates, breastfeeding self-efficacy, and breastfeeding duration. Results:Compared with the control group, the intervention group showed higher first breastfeeding score [11 (11-11) vs. 10 (8-11) scores, Z=30.43] and success rate [82.9% (68/82) vs. 69.5% (57/82), χ2=4.07], shorter initiation time of lactation [45 (35-48) vs. 48 (40-72) h, Z=12.60], and lower incidence of delayed lactation [17.1% (14/82) vs. 32.9% (27/82), χ2=4.68] (all P<0.05). The exclusive breastfeeding rates at 3 d, 42 d, and 3 months after birth were significantly higher in the intervention group than in the control group [76.8% (63/82) vs. 58.5% (48/82), 81.7% (67/82) vs. 67.1% (55/82), 80.5% (66/82) vs. 64.6% (53/82); χ2=5.46, 3.87, 4.41; all P<0.05]. The breastfeeding self-　efficacy scores at 3 d, 42 d, 3 months, and 6 months after birth were also higher in the intervention group [(54.7±6.0) vs. (51.3±9.0) scores, (57.9±5.7) vs. (53.3±8.4) scores, (58.5±7.0) vs. (54.3±7.9) scores, (56.5±8.0) vs. (52.4±11.6) scores; t=－2.81,－4.12,－3.63,－2.63; all P<0.05]. Repeated-measures analysis of variance revealed significant time, group, and interaction effects on self-efficacy ( F=24.29, 13.02, 3.28; all P<0.05). Conclusion:Prolonged SSC after cesarean section promotes the success of early breastfeeding during hospitalization, improves maternal breastfeeding self-efficacy, and increases the exclusive breastfeeding rate within the first 3 months after delivery.

Non-alcoholic fatty liver disease(NAFLD)is a progressive liver disease caused by factors other than alcohol caused by heterotopic fat accumulation in the liver.In recent years,the incidence rate has been increasing,and there is no specific clinical drug.Studies have found that nuclear transcription factor κB(NF-κB)can activate inflammation and oxidative stress,which plays an important role in the pathogenesis of NAFLD.Traditional Chinese medicine is convenient to obtain and cheap.It can treat NAFLD through multiple channels with good clinical efficacy,and no obvious side effects have been found till now.Many studies have shown that traditional Chinese medicine can inhibit the occurrence and development of NAFLD by inhibiting the NF-κB signaling pathway.This article summarizes the research results of traditional Chinese medicine in treating NAFLD based on the NF-κB signaling pathway since 2021,for several traditional Chinese medicine extracts(flavonoids,terpenoids,polysaccharides,glycosides,alkaloids and phenolic compounds)and traditional Chinese medicine compound(Shugan Jianpi Fang,Erhuang Quzhi Granules,Fuzi Lizhong Decoction,Huangqin Decoction,Qinlian Hongqu Decoction,Jiangzhi Granules),which can inhibit the further development of NAFLD by improving liver inflammatory response,oxidative stress response,fibrosis,apoptosis,autophagy and pyroptosis through the NF-κB signaling pathway,in order to provide new ideas for future new drug development and clinical medication.

Objective:To analyze the influence of Internet + health coach technology (E-Coach) management mode on anticoagulant management and negative mood in patients with atrial fibrillation, and to provide intervention measures for improving anticoagulant management and alleviating negative mood in patients with atrial fibrillation.Methods:Using single-center randomized control study, 78 patients with atrial fibrillation from June 2022 to June 2023 in the Second Hospital, Jiaxing City by convenience sampling method was divided into intervention group (E-Coach management mode based on routine management) and control group (routine management) by random digits table method, 39 cases in each group. The intervention time was 6 months. The anticoagulant knowledge mastery situation, medication compliance, anxiety and depression scores were evaluated before and after the intervention in the two groups. The number of international normalized ratio (INR) full monitoring, days required for INR to reach the first standard (2.0-3.0), the rate of effective anticoagulation, the number of monitoring after INR≤3, bleeding and thrombosis were compared between the two groups.Results:One case was lost to follow-up in the intervention group, and three cases were lost to follow-up in the control group. The final trial intervention group consisted of 38 cases, while the control group consisted of 36 cases. There were 10 males and 26 females in the control group, aged (57.78 ± 10.50) years old, and 12 males and 26 females in the intervention group, aged (60.16 ± 9.86) years old. There were no significant differences in the anticoagulation knowledge mastery situation, medication compliance, anxiety and depression scores (all P>0.05). After the intervention, the scores of anticoagulation knowledge mastery and medication compliance were (13.68 ± 2.11), (7.39 ± 0.42) points in the intervention group, and (9.08 ± 1.93), (5.91 ± 0.85) points in the control group. There were significant differences between the two groups ( t=-9.77, -9.58, both P<0.01). The depression and anxiety scores were (48.74 ± 7.68), (50.61 ± 6.15) points in the intervention group, and (62.97 ± 9.66), (56.42 ± 7.13) points in the control group. There were significant difference between the two groups ( t=7.04, 3.76, both P<0.01). The number of INR full monitoring, days required for INR to reach the first standard, the rate of effective anticoagulation, and the number of monitoring after INR≤ 3 were (10.42 ± 2.04) times, (6.66 ± 1.70) times, 58.1%(25/38), 2.6%(1/38) in the intervention group, and (7.94 ± 1.76) times, (12.72 ± 2.45) times, 33.3%(12/36), 25.0%(9/36) in the control group. There were significant difference between the two groups ( t= -5.59, 12.45, χ2=4.84, 6.12, all P<0.05). Conclusions:E-Coach management mode effectively improves the anticoagulant management ability of patients with atrial fibrillation and reduces their negative emotions.