Chronic heart failure （CHF） is a complex clinical syndrome caused by ventricular dysfunction， with mitochondrial energy metabolism disorder being a critical factor in disease progression. Heart-Yang deficiency syndrome， as the core pathogenesis of CHF， persists throughout the disease course. Insufficiency of heart-Yang leads to weakened warming and propelling functions， resulting in the accumulation of phlegm-fluid， blood stasis， and dampness. This eventually causes Qi stagnation with phlegm obstruction and blood stasis with water retention， forming a vicious cycle that exacerbates disease progression. According to the theory of reinforcing Yang， the clinical experience of the traditional Chinese medicine （TCM） master Tang Zuxuan in treating CHF with heart-Yang deficiency syndrome， and achievements from molecular biological studies， this study innovatively proposes an integrated research framework of "TCM syndrome differentiation and staging-mitochondrial metabolism mechanisms-intervention with Yang-reinforcing prescriptions" which is characterized by the integration of traditional Chinese and Western medicine. Heart-Yang deficiency syndrome is classified into mild （Stage Ⅰ-Ⅱ）， severe （Stage Ⅲ）， and critical （Stage Ⅳ） stages. The study elucidates the precise correlations between the pathogenesis of each stage and mitochondrial metabolism disorders from theoretical， pathophysiological， and therapeutic perspectives. The mild stage is characterized by impaired biogenesis and substrate-utilization imbalance， corresponding to heart-Yang deficiency and phlegm-fluid aggregation. Linggui Zhugantang and similar prescriptions can significantly improve the expression of peroxisome proliferator-activated receptor gamma co-activator-1α（PGC-1α）/silent information regulator 2 homolog 1 （SIRT1） and ATPase activity. The severe stage centers on oxidative stress and structural damage， reflecting Yang deficiency with water overflow and phlegm-blood stasis intermingling. At this stage， Zhenwu Tang and Qiangxin Tang can effectively mitigate oxidative stress damage， increase adenosine triphosphate （ATP） content， and repair mitochondrial structure. The critical stage arises from calcium overload and mitochondrial disintegration， leading to the collapse of Yin-Yang equilibrium. At this stage， Yang-restoring and crisis-resolving prescriptions such as Fuling Sini Tang and Qili Qiangxin capsules can inhibit abnormal opening of the mitochondrial permeability transition pore （MPTP）， reduce cardiomyocyte apoptosis rate， and protect mitochondrial function. By summarizing the characteristics of mitochondrial energy metabolism disorders at different stages of CHF， this study explores the application of the theory of reinforcing Yang in treating heart-Yang deficiency syndrome and provides new insights for the clinical diagnosis and treatment of CHF.

Objective To explore the safety and feasibility of posterior quadratus lumborum block(PQLB)in patients undergoing laparoscopic myomectomy.Methods A retrospective analysis was conducted on clinical data of 62 gynecological patients who underwent laparoscopic myomectomy from July 2021 to July 2024.The patients were divided into two groups based on the preoperative blocking method:the PQLB group and the transversus abdominis plane block(TAP)group,with 31 patients in each group.In the PQLB group,bilateral PQLB was performed under ultrasound guidance with 20 ml of 0.35％ropivacaine on each side.In the TAP group,bilateral transversus abdominis plane blocks were performed under ultrasound guidance with 20 ml of 0.4％or 0.5％ropivacaine on each side.The mean arterial pressure and heart rate were recorded before anesthesia(T0),at the time of the block(T1),at skin incision(T2),and during the recovery period(T3).The local anesthetic toxicity,nerve injury,intraoperative opioid consumption,postoperative remedial analgesic usage and dosage,as well as the incidence of nausea and vomiting,were monitored.Results The operations were successfully completed in all the 62 patients.No significant differences were observed between the two groups in mean arterial pressure(F=0.323,P=0.572)and heart rate(F=0.195,P=0.660)at 4 different time points.There were no significant differences in the dosage of anesthetic analgesics during surgery(Z=-0.458,P=0.647)and length of hospital stay(Z=-1.652,P=0.099)between the two groups.The postoperative remedial analgesic usage rate in the PQLB group was significantly lower than that in the TAP group(32.3％vs.74.2％,x2=10.949,P=0.000).Within 48 h after operation,the use of non-steroidal anti-inflammatory drugs(NSAIDs)dosage in the PQLB group was significantly lower than that in the TAP group[0(0,0)mg vs.400(0,1600)mg,Z=-4.849,P=0.000],and no significant difference was observed between the two groups in the use of opioid(tramadol)dosage(Z=-0.045,P=0.964).There was no significant difference in the incidence of postoperative nausea and vomiting(P＞0.05).The scores of numeric rating scale for abdomial wall pain and visceral pain in the PQLB group at 12 and 24 h after surgery did not exceed 3 points.No local anesthetic toxicity or nerve injury was observed.Conclusion PQLB provides effective analgesia for patients undergoing laparoscopic myomectomy,offering better control of visceral pain,helping reduce intraoperative opioid consumption,and lowering the risk of postoperative adverse reactions.

Objective To investigate the prognostic value of neutrophil-to-lymphocyte ratio(NLR)and glycemic variability(GV)in patients with sepsis.Methods A total of 121 sepsis patients hospitalized in Jinhua Central Hospital from January 2023 to January 2024 were selected and divided into survival group(n=68)and death group(n=53)according to whether they died within 28d of confirmed sepsis.Blood glucose levels on the first 1-3 days after the diagnosis of sepsis were collected,and GV was calculated.The risk factors impacting the prognosis of patients with sepsis were analyzed through binary Logistic regression.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of relevant indicators.Results Compared with survival group,the levels of neutrophil count,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),procalcitonin,NLR and GV levels in death group were significantly increased(P＜0.05),while lymphocyte was decreased(P＜0.05).Logistic regression analysis indicated that NLR and GV might be independent risk factors affecting the prognosis of sepsis patients(P＜0.05).ROC curve showed area under the curve(AUC)of NLR was 0.814 and GV AUC was 0.805.Conclusion NLR and GV could potentially be independent risk factors affecting the prognosis of sepsis patients,and they hold a certain degree of predictive worth for the prognosis of sepsis patients.

Objective To investigate the effects of ischemia time and storage periods on RNA quality in fresh-frozen breast cancer(BC)and esophageal cancer(EC)tissue samples in order to establish evidence-based protocols for biobank sample management.Methods The tumor(T)and paired normal(N)tissue samples from 6 cases of BC and 6 cases of EC were collected and cryopreserved in Biobank,Shantou Central Hospital.Mirror paraffin-embedded tissues were simultaneously prepared into sections for morphological analysis.The samples were divided into two groups of<15 min and 15-30 min according to ischemia time,and RNA quality was analyzed at 4 storage periods of 8-10 months(T1),14-16 months(T2),26-28 months(T3)and 38-40 months(T4).Results In 96 analyzed samples,93.8%(90/96)exhibited high quality(RIN≥6),with 89.6%(43/48)in BC and 97.9%(47/48)in EC.Significant differences in RIN were observed between BC group and EC group(8.050 vs.8.600,P=0.009).In EC group,RIN value was significantly negatively correlated with RNA yield(P<0.001).Moreover,RIN values of tumor-normal pairs exhibited markedly significant differences(7.550 vs.9.000,P<0.001).In contrast,no significant difference was detected in BC group(8.200 vs.7.700,P=0.348).Statistical analysis showed that RIN value was positively correlated with 28S/18S(P<0.001),but had no correlation with tumor content(P=0.676)and necrotic content(P=0.055).Neither ischemia time(<15 min vs.15-30 min:8.200 vs.8.300,P=0.932)nor storage periods(T1-T4:8.400,7.700,8.450,8.600,P=0.163)compromised RNA quality.Conclusion Organ origin and tissue type could influence RNA quality of fresh-frozen tissue samples.However,limited ischemia time(≤30 min)and long-term storage period(38-40 months)do not adversely affect RNA quality in fresh-frozen breast cancer and esophageal cancer tissue samples.

Objective:To observe the safety and short-term efficacy of using an autologous fascia lata sling (AFLS) for tension-free mid-urethral sling (MUS) in the treatment of stress urinary incontinence (SUI).Methods:Between February 2022 and December 2023, 11 patients with SUI underwent AFLS-MUS. Preoperative data were recorded, including basic patient information and completion of urinary distress inventory 6 (UDI-6). During surgery, AFLS was harvested through a small incision using a tendon extractor, and used as a sling for transobturator or retropubic MUS. Perioperative indicators were recorded, including surgical approach, operation time, intraoperative blood loss, postoperative hospital stay, duration of catheterization, perioperative complications (Clavien-Dindo classification), and surgical costs. Follow-ups included outpatient physical examination at 2 months postoperatively, and telephone follow-up at 6 months, 1 year, and annually thereafter. Follow-up content included the presence or absence of urinary leakage symptoms, UDI-6, satisfaction, patient global impression of improvement (PGI-I), and complications.Results:The age of the 11 patients was (54.8±10.9) years (range: 41-72 years), with body mass index of (23.9±1.8) kg/m2 (range: 21.4-27.3 kg/m2). All patients experienced urinary leakage after coughing, sneezing and physical activity, with positive SUI provocation tests. The preoperative UDI-6 was 50.0±21.6 (range: 16.7-79.2), the result of 1-hour pad test was (18.9±12.0) g (range: 2.5-71.2 g). Four cases underwent MUS only, with operation time of (98.0±13.3) minutes (range: 86-117 minutes), and intraoperative blood loss of (17.5±5.0) ml (range: 10-20 ml); 7 cases also underwent pelvic floor repair simultaneously. The postoperative hospital stay was (3.5±2.0) days (range: 2-9 days). The duration of catheterization was (4.5±3.8) days (range: 2-11 days), with postoperative urinary retention in three cases, one of which underwent sling release surgery due to severe postoperative voiding difficulty 1 week after MUS, with no other complications of Clavien-Dindo grade 2 or above. The cost of AFLS harvest plus MUS was (2 762±293) yuan. At the 2-month outpatient follow-up, all patients were free of urinary leakage symptoms, with UDI-6 of 2.3±1.9 (range: 0-8.3); satisfaction was "very satisfied" in 10 cases and "fairly satisfied" in 1 case, with PGI-I all being "much better", and pelvic examinations were normal. Telephone follow-up showed one case lost to follow-up, and the remaining 10 cases had follow-up time of (18.6±4.9) months (range: 7-26 months), all without urinary leakage, with UDI-6 of 2.7±2.6, satisfaction rated as "very satisfied", and PGI-I all "much better".Conclusion:This modified AFLS-MUS for the treatment of SUI shows good short-term efficacy and high safety in harvest site, with the need for more data accumulation and long-term follow-up.

Objective:To evaluate the long-term efficacy of liposuction combined with lymphaticovenous anastomosis (LVA) in the treatment of secondary lymphedema in lower extremity and analyse the factors that affect therapeutic outcomes.Methods:A retrospective analysis was conducted on the clinical data of 172 patients who were treated in the Department of Lymphatic Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital for secondary lymphedema in lower extremity, between January 2019 and December 2021. The cohort comprised 170 females and 2 males, with a median age of 55 years. The primary diseases were: 99 patients with cervical cancer, 47 with endometrial cancer, 1 with penile cacer and 25 with other malignant tumours. All patients received liposuction to aspirate subcutaneous adipose tissue and LVA anastomosis of the inguinal lymphatic vessels with the great saphenous vein and its branches. Postoperative follow-ups were performed at outpatient clinic, telephone interview and questionnaire survey to acquire immediate status of the patients at the time. Following variables were included the follow-up: gender, age, body mass index (BMI), duration, hypertension, diabetes, the type of primary disease, history of surgery, history of lymph node dissection, history of radiotherapy or chemotherapy, extracellular water ratio (ECW%) in the affected limb, preoperative history of erysipelas, preoperative percentage difference in circumference of bilateral proximal toes, dorsal feet, ankles, distal third of legs, middle legs, proximal third of legs, knees, distal third of thighs, mid thighs, proximal third of thighs and groins. Additional parameters included duration of liposuction, intraoperative blood loss, adipose tissue content, number of lymphatic vessels anastomosed in LVA, postoperative daily standing time, postoperative history of erysipelas, and usage of compression garment. Univariate and multivariate analyses were performed using SPSS 26.0 software, with P <0.05 considered statistically significant. Results:A complete remission was defined as less than 10.0% in the percentage of bilateral limb volume difference during follow-up. There were 112 patients with complete remission. After excluded confounding factors through univariate analysis, multivariate analysis had revealed following independent risk factors: ECW% of affected limb ( P<0.01), postoperative standing duration >6 hours/day ( P=0.021), postoperative history of erysipelas ( P=0.016), regular use of compression garment ( P=0.013), and percentage difference of circumference at bilateral proximal toes ( P=0.038). Among the remaining 60 patients, 32 patients achieved effective remission which was defined as less than 20.0% in the swelling volume expansion ratio. Conclusion:Liposuction combined with LVA can relieve secondary lymphedema of lower extremity for majority of patients. ECW% of affected limb, postoperative standing duration >6 hours/day, postoperative history of erysipelas, irregular use of elastic socks, and percentage difference in circumference at bilateral proximal toes are the independent risk factors that affect the prognosis.

AIM To investigate the impact of varying dosages of Supplemented Wendan Decoction on the PI3K/Akt/FOXO1 glycolipid metabolic pathway in 3T3-L1 adipocytes.METHODS The CCK-8 assay was used to determine the concentration of Supplemented Wendan Decoction-medicated serum.The mature adipocytes differentiated from 3T3-L1 preadipocytes after induction were further divided into the blank control group,the model group,the rosiglitazone group(10 mg/L),and the Supplemented Wendan Decoction groups(5％,10％,and 20％),followed by the sample collections after 48 hours of treatment.Oil red O staining quantified lipid accumulation in 3T3-L1 adipocytes;extracellular glucose levels were measured using glucose oxidase(GOD)assay;RT-qPCR analyzed mRNA expressions of IRS-1,PI3K,Akt,GLUT4,IL-6,TNF-α and IL-1β;Western blot assessed protein expressions of INSR,IRS-1,PI3K-p85,Akt,FOXO1 and GLUT4.RESULTS No significant changes in cell viability(P＞0.05)were observed in 3T3-L1 preadipocytes exposed to serum containing supplemented Wendan Decoction at different concentrations for 24,48,or 72 hours.The 3T3-L1 preadipocytes held the capacity to differentiate into mature adipocytes within a 14-day induction period.Compared to the model group,all supplemented Wendan Decoction groups exhibited reduced lipid accumulation in adipocytes and downregulated mRNA expression of IRS-1,IL-6,TNF-α and IL-1β(P＜0.01);the low-dose group demonstrated increased mRNA expressions of PI3K and GLUT4(P＜0.05,P＜0.01),alongside elevated protein expressions of INSR,IRS-1,PI3K-p85,Akt and GLUT4(P＜0.05,P＜0.01);the medium-dose group showed enhanced GLUT4 mRNA expression,and upregulated protein expressions of INSR and FOXO1(P＜0.01).After 24 hours intervention,the high-dose Supplemented Wendan Decoction group exhibited increased glucose consumption in adipocytes(P＜0.01),and elevated protein expression of INSR,Akt and FOXO1(P＜0.05,P＜0.01).CONCLUSION Supplemented Wendan Decoction reduces lipid accumulation in adipocytes,regulates glucose and lipid metabolism,and promotes metabolic homeostasis through PI3K/Akt/FOXO1 signaling pathway.

Healthcare-associated infections(HAIs)represent one of the critical issues affecting the public health security and the quality of medical services.Monitoring,early warning,intervention and feedback for HAIs re-main the cornerstone of infection prevention and control.To systematically understand the progress of surveillance of HAIs in domestic and international regions and summarize the characteristics and variations,this paper compre-hensively reviews the surveillance systems of HAIs from different regions around the globe,their construction and development as well as the diversity,covering the type of surveillance,surveillance idea and standards,the essen-tial characteristics and advancements of the key technologies for HAIs surveillance and application systems were also compared among the regions.The review aims to summarize the general situation of development of HAIs surveillance in different regions around the globe and to provide new ideas for construction and development of HAIs surveillance system.

The primary role of transfer RNA(tRNA)is to connect a specific amino acid to its 3' end, use its anticodon to match the codon on messenger RNA(mRNA), and deliver the corresponding amino acid to the ribosome for protein synthesis.tRNA exists in two forms: precursor tRNA and mature tRNA.When acted upon by enzymes like Dicer, elaC ribonuclease Z 2(ELAC2), angiopoietin(ANG), and other ribonucleases, tRNA is broken down into tRNA-derived stress-induced RNA(tiRNA)and tRNA-derived fragments(tRF).Recent advancements in RNA sequencing technology have led to increased interest in tiRNA and tRF, shedding light on their roles in various physiological and pathological processes.tRNA-derived small molecules(tsRNA)function similarly to microRNA(miRNA), influencing gene expression and protein synthesis.They show promise as diagnostic markers and potential therapeutic targets for age-related diseases.This review offers a comprehensive analysis of tsRNA classification, biological functions, research advancements, and clinical applications in age-related conditions.

Objective To investigate the dosimetric differences in preoperative short-course volumetric modulated arc therapy(VMAT)for rectal cancer using different fluence smoothing(FS)levels in the Monaco Treatment Planning System(Monaco TPS).Methods Twenty rectal cancer patients who received preoperative neoadjuvant short-course VMAT at some hospital from September 2021 to December 2022 were retrospectively selected.Four groups of radiotherapy plans were formulated using the Monaco TPS for each case,which were classified into an off group,a low group,a medium group and a high group based on the FS levels.Then the four groups were compared in terms of the dosimetric parameters,monitor unit and number of the segments in the planning target volume(PTV)and organ at risk(OAR).Statistical analysis was performed using SPSS 27.0 software.Results All the four groups had the doses to the target volume meeting clinical requirements,which had no significant differences in the doses to 5％(D5％)and 95％(D95％)to the target volume and the maximum dose(Dmax),minimum dose(Dmin),mean dose(Dmean)and conformity index(all P＞0.05).Statistical differences were found between the homogeneity indexes of the four groups(P＜0.05),with the medium group behaving the best.The number of the segments rose while the mornitor units decreased siginificantly with the increase of FS levels,with the differences being statistically significant(P＜0.05).There were no significant differences between the V25,V20,V15 and V10 of the small intestine,the V25 and V20 of the bladder and the V15 and V10 of the left and right femur(all P＞0.05).Conclusion In preoperative short-course VMAT for rectal cancer,clinical requirements can be met with different FS levels in the Monaco TPS,and medium-level FS results in optimal overall dose distribution in terms of treatment planning.[Chinese Medical Equipment Journal,2025,46(5):48-53]