Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)versus non-invasive positive pressure ventilation(NPPV)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied by mild to moderate hypercapnia.Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021,to October 2023,with 49 in the NPPV group and 43 in the HFNC group.The two groups were compared in terms of 28-day intubation rate,90-day mortality,and arterial blood gases.Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group(28.57％vs.11.63％,P<0.05),but no significant differences in the 90-day mortality rate(36.73％vs.23.26％,P>0.05).The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group(Log-Rank test:χ2=4.257,P=0.039),but no significant difference in 90-day mortality rate(Log-Rank test:χ2=2.596,P=0.107).A Cox proportional hazards model,which incorporated APACHE Ⅱ score and baseline PaCO2,demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69％as compared to the NPPV group(HR=0.31,95％CI:0.10～0.93,P=0.037),but the risk of 90-day mortality did not show a significant decrease(HR=0.61,95％CI:0.27～1.37,P=0.232).PaCO2 in both groups decreased gradually and pH increased simultaneously.PaCO2,pH,and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups(P>0.05).Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia,HFNC reduces intubation rates compared to NPPV,without increasing mortality,and shows similar improvements in arterial blood gas indicators,making it a suitable respiratory support option.

Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)versus non-invasive positive pressure ventilation(NPPV)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied by mild to moderate hypercapnia.Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021,to October 2023,with 49 in the NPPV group and 43 in the HFNC group.The two groups were compared in terms of 28-day intubation rate,90-day mortality,and arterial blood gases.Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group(28.57％vs.11.63％,P<0.05),but no significant differences in the 90-day mortality rate(36.73％vs.23.26％,P>0.05).The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group(Log-Rank test:χ2=4.257,P=0.039),but no significant difference in 90-day mortality rate(Log-Rank test:χ2=2.596,P=0.107).A Cox proportional hazards model,which incorporated APACHE Ⅱ score and baseline PaCO2,demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69％as compared to the NPPV group(HR=0.31,95％CI:0.10～0.93,P=0.037),but the risk of 90-day mortality did not show a significant decrease(HR=0.61,95％CI:0.27～1.37,P=0.232).PaCO2 in both groups decreased gradually and pH increased simultaneously.PaCO2,pH,and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups(P>0.05).Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia,HFNC reduces intubation rates compared to NPPV,without increasing mortality,and shows similar improvements in arterial blood gas indicators,making it a suitable respiratory support option.

Objective To investigate the clinical value of thromboelastography (TEG) in monitoring the coagulation function change after plasma supplementation in the patients with severe liver cirrhosis diges-tive tract hemorrhage.Methods A total of 48 patients with high risk and extreme high risk liver cirrhosis a-cute upper digestive hemorrhage receiving the treatment in ICU of this hospital from February 2020 to March 2023 were selected as the study subjects.After plasma infusion with the dose of 10 mL/kg,the coagulation function status was detected.The patients were divided into the TEG group (n=20) and the control group (n=28) according to different detection modes of coagulation function.The TEG group simultaneously detec-ted TEG and traditional coagulation function detection,while the control group only conducted the traditional coagulation detection.TEG and coagulation function detection indicators after the infusion of plasma were compared between the two groups.The plasma infusion amounts at 24 h after admitting in ICU were recorded and the control status of digestive tract hemorrhage was evaluated.Results The R value in the TEG group was (8.02±6.09)min,the K vale was 2.5(1.3,5.0)min,the coagulation comprehensive index (CI) was-4.70±6.29,the maximal shear stress coefficient (MA) was 50.35±18.84,LY30 was 0.The Pearson corre-lation analysis showed that MA was positively correlated with FIB and PLT (r=0.470,0.526,P<0.05),and the other indexes had no correlation.Compared with the control group,the plasma infusion amounts in the TEG group was more[(419.00±143.18)mL vs. (400.00±137.54)mL],the digestive tract hemorrhage con-trol rate was higher[75.00％(15/20) vs. 53.57％(15/28)],but the differences were not statistically signifi-cant (P>0.05).The multiple linear regression was MA=-3.427+11.200×Ln(PLT)+10.230×Ln(FIB).Con-clusion In the patients with severe lever cirrhosis acute upper gastrointestinal bleeding,TEG could earlier find the co-agulation function improvement situation after plasma supplementation than the traditional coagulation detection.

Objective To investigate the effect of lidocaine on the chemotherapy sensitivity of gastric cancer cells by regulating the Wnt/β-catenin axis. Methods Human gastric cancer cells SGC-7901 in logarithmic growth phase were inoculated into 96-well plates and treated with different concentrations of lidocaine (0, 10, 50, 100, 150, 200 μmol/L) for 24 h. The cell viability at different concentrations was compared. The SGC-7901 cells in logarithmic growth phase were divided into control group, cisplatin group, low concentration lidocaine group (Lido-L group), medium concentration lidocaine group (Lido-M group), high concentration lidocaine group (Lido-H group), high concentration lidocaine + Wnt/β-catenin signal pathway activator SKL2001 group (Lido-H+SKL2001 group). The cell proliferation, invasion, and migration abilities of each group were compared by 5-acetylidene-2'deoxyuracil nucleoside (EdU) cell proliferation detection, Transwell assay, and scratch healing experiment. The apoptosis of each group was detected by TUNEL assay. The expressions of apoptosis, epithelial-mesenchymal transition, and Wnt/β-catenin pathway-related proteins in each group were detected. Results Compared with 0 μmol/L lidocaine, the cell viability of SGC-7901 cells treated with 50, 100, 150, and 200 μmol/L lidocaine was reduced (P < 0.05). Compared with the control group, the EdU positive rate, the number of cell invasion, scratch healing rate, and expressions of vimentin, N-cadherin, B-cell lymphoma-associated protein-2 (Bcl-2), cyclin D1, scattered protein 2 (DVL2), Wnt family member 3a (Wnt3a), β-catenin (β-catenin) were reduced in the cisplatin group, while the cell apoptosis rate was increased, the expressions of E-cadherin, B-cell lymphoma-2-associated X protein (Bax), Cleaved-caspase-3 were increased, and the differences were statistically significant (P < 0.05). Compared with the cisplatin group, the EdU positive rate, the number of cell invasion, scratch healing rate, and expressions of vimentin, N-cadherin, Bcl-2, cyclin Dl, DVL2, Wnt3a, β-catenin were gradually reduced in the Lido-L group, Lido-M group, and Lido-H group, while the cell apoptosis rate, the expressions of E-cadherin, B-cell lymphoma-2-associated X protein (Bax), Cleaved-caspase-3 were increased (P < 0.05). Compared with the Lido-H group, the EdU positive rate, the number of cell invasion, scratch healing rate, and expressions of vimentin, N-cadherin, Bcl-2, cyclin Dl, DVL2, Wnt3a, β-catenin were increased in the Lido-H+SKL2001 group, while the cell apoptosis rate and expressions of E-cadherin, Bax, Cleaved-caspase-3 were reduced, the differences were statistically significant (P < 0.05). Conclusion Lidocaine may enhance the chemotherapy sensitivity of gastric cancer cells by inhibiting the activation of the Wnt/β-catenin axis.

Objective To investigate the evaluation value of serum microRNA-19b-3p (miR-19b-3p) and microRNA-933 (miR-933) levels on cardiac function and prognosis in elderly patients with chronic heart failure. Methods A total of 108 elderly patients with chronic heart failure were selected as study group. According to the New York Heart Society (NYHA) classification, 35 patients of the study group were classified into grade Ⅱ, 40 patients were classified into grade Ⅲ, and 33 patients were classified into grade Ⅳ. A total of 90 healthy people who underwent physical examination during the same period were selected as control group. Serum miR-19b-3p and miR-933 levels were detected after admission. Cardiac function parameters [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)] were measured by echocardiography. The relationship between serum miR-19b-3p, miR-933 and cardiac function was analyzed by Pearson correlation method. Elderly patients with chronic heart failure were divided into occurrence group (n=34) and non-occurrence group (n=74) according to whether endpoint events occurred within one year of admission. The predictive value of serum miR-19b-3p and miR-933 in elderly patients with chronic heart failure was evaluated by receiver operating characteristic (ROC) curve. Multivariate Cox regression analysis was used to analyze the prognostic factors of elderly patients with chronic heart failure. Results Serum levels of miR-19b-3p and miR-933 in the study group were significantly lower than those in the control group (P < 0.05). The levels of serum miR-19b-3p, miR-933 and LVEF in patients with cardiac function grade Ⅳ were significantly lower than those in patients with cardiac function grade Ⅲ, grade Ⅱ and healthy population, and LVEDD was larger than that in patients with cardiac function grade Ⅲ, patients with cardiac function grade Ⅱ and healthy population (P < 0.05). Serum miR-19b-3p level was positively correlated with LVEF and negatively correlated with LVEDD in elderly patients with chronic heart failure (r =0.554, -0.368, P < 0.001). Serum miR-933 level was positively correlated with LVEF and negatively correlated with LVEDD (r=0.505, -0.410, P < 0.001). The levels of serum miR-19b-3p and miR-933 in the occurrence group were significantly lower than those in the non-occurrence group (P < 0.05). The area under the curve (AUC) of serum miR-19b-3p and miR-933 to predict the prognosis of chronic heart failure in elderly patients were 0.835 (95%CI, 0.785 to 0.885) and 0.843 (95%CI, 0.790 to 0.890), and the AUC of the combined prediction was 0.901 (95%CI, 0.851 to 0.951). Serum miR-19b-3p (HR=3.762, 95%CI, 1.854 to 7.634), miR-933 (HR=3.480, 95%CI, 1.903 to 6.364) and National Institutes of Health Stroke Scale (NIHSS) score (HR=3.047, 95%CI, 1.837 to 5.051) were the prognostic factors of chronic heart failure in the elderly (P < 0.05). Conclusion Serum miR-19b-3p and miR-933 levels are low in elderly patients with chronic heart failure. The changes of miR-19b-3p and miR-933 levels are closely related to cardiac function and prognosis, which can be used as effective indicators to predict poor prognosis in elderly patients with chronic heart failure.

Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.
Blood Loss, Surgical ; Debridement ; Female ; Humans ; Male ; Muscles/surgery* ; Osteomyelitis/surgery* ; Perforator Flap ; Pressure Ulcer/surgery* ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Tea green leafhopper(TGL),Empoasca onukii,is of biological and economic interest.Despite numerous studies,the mechanisms underlying its adaptation and evolution remain enig-matic.Here,we use previously untapped genome and population genetics approaches to examine how the pest adapted to different environmental variables and thus has expanded geographically.We complete a chromosome-level assembly and annotation of the E.onukii genome,showing nota-ble expansions of gene families associated with adaptation to chemoreception and detoxification.Genomic signals indicating balancing selection highlight metabolic pathways involved in adaptation to a wide range of tea varieties grown across ecologically diverse regions.Patterns of genetic vari-ations among 54 E.onukii samples unveil the population structure and evolutionary history across different tea-growing regions in China.Our results demonstrate that the genomic changes in key pathways,including those linked to metabolism,circadian rhythms,and immune system functions,may underlie the successful spread and adaptation of E.onukii.This work highlights the genetic and molecular basis underlying the evolutionary success of a species with broad economic impacts,and provides insights into insect adaptation to host plants,which will ultimately facilitate more sustain-able pest management.

Objective:To analyze research status and development trends in the field of health management in China from 2011 to 2020.Methods:“CNKI” was chosen as the data source, and “health management（precise）” was used as the search term, and a total of 13, 686 valid data were finally obtained. Frequency counts were used to tabulate the number of articles published in the field of health management from 2011 to 2020. CiteSpace software was used to analyze the cooperation of institutions, and to explore the research hotspots and development trends in the field of health management by institutions co-occurrence, keyword co-occurrence and clustering timeline map. Bicomb software and SPSS 26.0 software were used for multi-dimensional scale analysis of keywords to comprehensively reflect the core degree and maturity of research topics.Results:The amount of domestic health management research literature had shown an increasing trend from 2011 (804) to 2020 (2 044). The top 5 keywords in terms of frequency were “hypertension（611）” “diabetes（577）” “health education（485）” “community（460）” and “chronic diseases（457）”. “Elderly” “Traditional Chinese Medicine（TCM health management）” and “Health management model” were the hot keywords and research trends of health management. There were 7 themes in the field of health management, namely “Construction and application of chronic diseases health management model” “Community health service and health management” “Health management in essential public health service” “Health management of the elderly” “Health management of Traditional Chinese Medicine” “Health examination and health management organization” “Health management based on big data and modern information technology”.Conclusions:A relatively close network of cooperation has been formed in the field of health management research and the number of articles has increased. The elderly, chronic disease and Traditional Chinese Medicine health management are the research trend. The construction and implementation of health management models, the integration of artificial intelligence and health management are the development trends in this field.

Objective To establish a test of autoantibody-panel for the diagnosis of autoimmune cerebellitis (AC) and determine the prevalence of AC in patients with cerebellar ataxia of unknown etiology.Methods Autoantibody screening tests with indirect immunofluorescence were performed in serum and cerebrospinal fluid (CSF) samples of 400 previously'idiopathic'Chinese patients with cerebral ataxia (inpatients and outpatients in Peking Union Medical College Hospital or referred from hospitals of Beijing Encephalitis Group from 2016 to 2018).Immunotherapy was given to autoantibody positive patients and the effectiveness of immunotherapy was assessed.Detailed AC autoantibodies panel included anti-glutamate decarboxylase 65 (GAD65) antibody,anti-Tr (delta notch-like epidermal growth factor-related receptor (DNER)) antibody,anti-zinc finger protein 4 (ZIC4) antibody,anti-inositol 1,4,5-trisphosphate receptor 1 (ITPR1) antibody,anti-homer protein homolog 3 (Homer 3) antibody,anti-neurochondrin (NCDN) antibody,anti-carbonic anhydrase-related protein (CARP) antibody and anti-Purkinje cell antibody 2 (PCA2) antibody.Results Eight out of 400 (2％) ataxia patients were positive for this AC panel tests,of whom two were positive for anti-GAD65 antibody,two for anti-Tr antibody,one for anti-PCA2 antibody,one for anti-Homer 3 antibody and two were positive for serum anti-NCDN antibody.Autoantibodies against ZIC4,ITPR1 and CARP were not detected in this cohort.Two of the eight ataxia patients also presented with limbic encephalitis,and only one anti-GAD antibody patient was screened with underlying small cell lung carcinoma (SCLC).All the eight patients received immunotherapy and four experienced partial response.Conclusions Autoimmune cerebellitis is the cause of acquired cerebellar ataxia.Tests of autoantibodies associated with AC have diagnostic value for paraneoplastic and non-paraneoplastic cerebellar ataxia.Immunotherapy may yield partial response in patients with AC.

OBJECTIVE： To prepare Capsaicin solid dispersion， to optimize its formulation and characterize the dispersion. METHODS： Capsaicin solid dispersion was prepared by melting method using P188 or PEG4000 as carrier. Using 60 min accumulative dissolution rate in vitro as index， orthogonal test was used to optimize type of carrier， drug ratio and stirring time. Validation test was conducted. The stability of Capsaicin solid dispersion within 0， 30， 180 d was investigated at 40 ℃ under the relative humidity of 75％， and X-ray diffraction （XRD） was used to analyze whether there were peaks. Capsaicin solid dispersion was characterized by differential scanning calorimetry （DSC） and XRD. RESULTS： The optimized formula included P188-PEG4000 as carrier， capsaicin-P188-PEG 4000 mass ratio of 1 ∶ 5 ∶ 3， stirring for 20 min. Accumulative dissolution rate in vitro of Capsaicin solid dispersion was 84.6％ within 60 min （n＝3）， and the preparation kept stable within 180 d [RSD of content was 3％ （n＝3）； XRD showed that there was no peak]. The phase characteristics showed that capsaicin was highly dispersed in the amorphous or molecular state in carrier. CONCLUSIONS： The optimized technology can be used to prepare Capsaicin solid dispersion， and improves more than 80％ dissolution rate in vitro at 60 min. It is stable， simple and feasible.