Objective To evaluate the clinical efficacy of Shanghai-style pediatric tuina combined with visceral acupoint manipulation in children with adenoid hypertrophy(AH)of lung-spleen qi deficiency type.Methods Sixty-six AH children with lung-spleen qi deficiency treated at Foshan Hospital of Traditional Chinese Medicine from December 2023 to December 2024 were randomized into trial group(n=33,receiving Shanghai-style tuina+visceral acupoint manipulation)and control group(n=33,receiving conventional tuina)for 2 weeks.Traditional Chinese medicine(TCM)syndrome scores(primary/secondary symptoms),Disease-Specific Quality of Life for Children with Obstructive Sleep Apnea 18-item Survey(OSA-18)scores,and endoscopic adenoid obstruction scores were observed before and after treatment,and the clinical efficacy and safety were evaluated.Results(1)After two weeks of treatment,the total effective rate was 93.94％(31/33)in the trial group versus 72.73％(24/33)in the control group.The intergroup comparison(by chi-square test)showed that the efficacy in the trial group was superior to that in the control group(P＜0.05).(2)After treatment,both groups showed reduction in the primary TCM symptom score and secondary TCM symptom score(P＜0.01),with greater reductions in the trial group(P＜0.05 or P＜0.01).(3)After treatment,OSA-18 scores were decreased in both groups(P＜0.01),with greater reductions in the trial group(P＜0.01).(4)After treatment,adenoid obstruction scores were improved in both groups(P＜0.01),with superior outcomes in the trial group(P＜0.05).(5)No adverse events(e.g.,myalgia,pruritus,allergy)were reported in either group.Conclusion Shanghai-style tuina combined with visceral acupoint manipulation effectively improves clinical symptoms and quality of life in AH children with lung-spleen qi deficiency syndrome,demonstrating high safety.

Objective To analyze the current application status,research hotspots and develop-ment trends of sedation strategies from both domestic and international perspectives in mechanically ventilated patients in the intensive care unit(ICU).Methods Relevant literature on the application of sedation strategies in mechanically ventilated patients from 2014 to 2024 was retrieved from data-bases including China National Knowledge Infrastructure(CNKI),Wanfang and Web of Science.Visual analysis of publication volume and keywords was conducted using CiteSpace 6.2.R3 software.Results A total of 475 Chinese-language articles and 405 English-language articles were included.Significant differences were observed in publication volume between domestic and international re-search,with early domestic activity followed by a decline,while international research had demonstra-ted robust and sustained growth over the past five years.International studies primarily emphasized protocol-driven sedation processes and standardized strategies,whereas domestic research focused on optimizing the concept of comfort-oriented sedation management and exploring postoperative sedation strategies.Analysis of research hotspots revealed that precise pharmacological regulation,the development of disease-specific sedation strategies,and the establishment of multidisciplinary collaborative protocols were key areas of focus in sedation strategies for ICU mechanically ventilated patients.Conclusion Future research should prioritize shortening the update cycle of clinical guidelines,enhancing the transla-tion of evidence-based practices into clinical settings,establishing clear application standards for disease-specific sedation strategies,improving multicenter collaborative research capabilities,and developing artificial intelligence-based sedation monitoring technologies.

Objective To evaluate the efficacy and safety of Qixian Tongluo Formula in the treatment of post-cerebral infarction paralysis with kidney deficiency and blood stasis syndrome,and to preliminarily explore the molecular mechanism of Qixian Tongluo Formula in improving impaired motor function from the perspective of cross-kingdom regulation of Chinese medicine microRNA(miRNA).Methods A pragmatic randomized controlled trial was conducted with 102 patients in the recovery period of post-cerebral infarction paralysis with kidney deficiency and blood stasis syndrome in our hospital.Patients were randomly divided into trial group and control group,with 51 cases in each group.The control group received standard Western medicine standard treatment,while the trial group received Qixian Tongluo Formula in addition to the standard treatment,with one dose per day,boiled in water,and taken warm after breakfast and dinner for a course of 2 months.The disability rate was used as the main efficacy indicator,and the incidence of adverse reactions was used as a safety indicator.miRNA from patient serum and Qixian Tongluo decoction were extracted respectively,and high-throughput sequencing was performed.The two sequences were compared to screen out the cross-kingdom gene transfer of Chinese medicine miRNA.Finally,its target genes of miRNA were predicted,and GO function and KEGG pathway enrichment analysis were carried out.Results A total of 67 patients completed the clinical trial,including 36 cases in the trial group and 31 cases in the control group;The disability rate in the trial group(13.9%)was lower than that in the control group(35.5%)(P<0.05);The incidence of adverse reactions was similar between the trial group(7.69%)and the control group(6.06%)(P>0.05);A total of 9530 Qixian Tongluo decoction miRNA sequences were screened,with 150 potentially involved in cross-kingdom gene transfer,including families such as miR-15 and miR-17;According to the target gene prediction of the top 10 miRNAs in cross-kingdom gene transfer of Chinese medicine,345 overlapping target genes were obtained;GO functional enrichment analysis revealed 16 biological processes,7 cellular components,and 2 molecular functions among the top 25 enriched functions,while KEGG pathway analysis mainly focused on the transforming growth factor-βsignaling pathway,neurotrophin signaling pathway,which are closely related to neural repair and functional recovery processes such as glial scar formation and synaptic plasticity after cerebral ischemia.Conclusion Qixian Tongluo Formula can significantly improve the functional independence level of patients with kidney deficiency and blood stasis syndrome in the recovery period of paralysis after cerebral infarction,offering a safe and effective treatment option for these patients;There were a large number of miRNAs in Qixian Tongluo decoction,some of which could cross-kingdom transferred into the human blood circulation,and promote the recovery of motor function in patients with cerebral infarction through multi-target,multi link and multi pathway gene network regulation.This study provides a new idea for subsequent clinical and basic research.

Objective:To explore the factors influencing the incidence and duration of delirium in ICU patients, so as to provide a reference for early identification and prevention of delirium in these patients.Methods:A retrospective analysis was conducted on the medical records of 1, 500 patients admitted to the ICU of the Affiliated Jiangning Hospital of Nanjing Medical University from January 2020 to December 2024. The data collected included gender, age, anesthesia method, surgical duration, infection duration, extubation time, duration of mechanical ventilation and hypoxia, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, duration of sedative medication, and ICU length of stay. Binary Logistic regression and multiple linear regression analysis were employed to investigate the factors influencing the incidence and duration of delirium in ICU patients.Results:The incidence of delirium among 1 500 ICU patients was 38.4% (576/1 500), with a duration of 1.10 (1.00, 3.20) d. Binary Logistic regression analysis revealed that infection duration, APACHEⅡ score, mechanical ventilation duration, and sedative medication duration were statistically significant factors influencing delirium incidence in ICU patients ( P<0.05). Multiple linear regression analysis revealed that delirium type, duration of hypoxia, use of sedative medications, and length of ICU stay were statistically significant factors influencing the duration of delirium in ICU patients ( P<0.05) . Conclusions:ICU patients have a relatively high incidence of delirium, and numerous factors influence the incidence and duration of delirium. Clinical nursing professionals should identify risk factors early and develop corresponding intervention measures to reduce the incidence of delirium in ICU patients and promote their recovery.

Objective:To explore the factors influencing the incidence and duration of delirium in ICU patients, so as to provide a reference for early identification and prevention of delirium in these patients.Methods:A retrospective analysis was conducted on the medical records of 1, 500 patients admitted to the ICU of the Affiliated Jiangning Hospital of Nanjing Medical University from January 2020 to December 2024. The data collected included gender, age, anesthesia method, surgical duration, infection duration, extubation time, duration of mechanical ventilation and hypoxia, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, duration of sedative medication, and ICU length of stay. Binary Logistic regression and multiple linear regression analysis were employed to investigate the factors influencing the incidence and duration of delirium in ICU patients.Results:The incidence of delirium among 1 500 ICU patients was 38.4% (576/1 500), with a duration of 1.10 (1.00, 3.20) d. Binary Logistic regression analysis revealed that infection duration, APACHEⅡ score, mechanical ventilation duration, and sedative medication duration were statistically significant factors influencing delirium incidence in ICU patients ( P<0.05). Multiple linear regression analysis revealed that delirium type, duration of hypoxia, use of sedative medications, and length of ICU stay were statistically significant factors influencing the duration of delirium in ICU patients ( P<0.05) . Conclusions:ICU patients have a relatively high incidence of delirium, and numerous factors influence the incidence and duration of delirium. Clinical nursing professionals should identify risk factors early and develop corresponding intervention measures to reduce the incidence of delirium in ICU patients and promote their recovery.

Objective To evaluate the efficacy and safety of Qixian Tongluo Formula in the treatment of post-cerebral infarction paralysis with kidney deficiency and blood stasis syndrome,and to preliminarily explore the molecular mechanism of Qixian Tongluo Formula in improving impaired motor function from the perspective of cross-kingdom regulation of Chinese medicine microRNA(miRNA).Methods A pragmatic randomized controlled trial was conducted with 102 patients in the recovery period of post-cerebral infarction paralysis with kidney deficiency and blood stasis syndrome in our hospital.Patients were randomly divided into trial group and control group,with 51 cases in each group.The control group received standard Western medicine standard treatment,while the trial group received Qixian Tongluo Formula in addition to the standard treatment,with one dose per day,boiled in water,and taken warm after breakfast and dinner for a course of 2 months.The disability rate was used as the main efficacy indicator,and the incidence of adverse reactions was used as a safety indicator.miRNA from patient serum and Qixian Tongluo decoction were extracted respectively,and high-throughput sequencing was performed.The two sequences were compared to screen out the cross-kingdom gene transfer of Chinese medicine miRNA.Finally,its target genes of miRNA were predicted,and GO function and KEGG pathway enrichment analysis were carried out.Results A total of 67 patients completed the clinical trial,including 36 cases in the trial group and 31 cases in the control group;The disability rate in the trial group(13.9%)was lower than that in the control group(35.5%)(P<0.05);The incidence of adverse reactions was similar between the trial group(7.69%)and the control group(6.06%)(P>0.05);A total of 9530 Qixian Tongluo decoction miRNA sequences were screened,with 150 potentially involved in cross-kingdom gene transfer,including families such as miR-15 and miR-17;According to the target gene prediction of the top 10 miRNAs in cross-kingdom gene transfer of Chinese medicine,345 overlapping target genes were obtained;GO functional enrichment analysis revealed 16 biological processes,7 cellular components,and 2 molecular functions among the top 25 enriched functions,while KEGG pathway analysis mainly focused on the transforming growth factor-βsignaling pathway,neurotrophin signaling pathway,which are closely related to neural repair and functional recovery processes such as glial scar formation and synaptic plasticity after cerebral ischemia.Conclusion Qixian Tongluo Formula can significantly improve the functional independence level of patients with kidney deficiency and blood stasis syndrome in the recovery period of paralysis after cerebral infarction,offering a safe and effective treatment option for these patients;There were a large number of miRNAs in Qixian Tongluo decoction,some of which could cross-kingdom transferred into the human blood circulation,and promote the recovery of motor function in patients with cerebral infarction through multi-target,multi link and multi pathway gene network regulation.This study provides a new idea for subsequent clinical and basic research.

Objective To analyze the publication profile and research hotspots of studies at home and abroad on postoperative cognitive dysfunction by bibliometric methods. Methods Literatures related to postoperative cognitive dysfunction published in the China National Knowledge Infrastructure (CNKI) and Web of Science databases from 2013 to 2023 were included, and statistical analysis was conducted by CiteSpace software. Results A total of 2 705 Chinese literatures and 2 412 English core literatures were included. The number of literatures on postoperative cognitive dysfunction showed an annual increase from 2013 to 2023; China was the country with the highest number of publications internationally, with Capital Medical University ranking the top among Chinese institutions; domestically, postoperative cognitive dysfunction researches predominantly focused on clinical studies, while overseas researches emphasized pathological mechanisms and basic investigations. Research hotspot analysis revealed an enhanced interest in the inflammatory mechanisms and anesthetic aspects of postoperative cognitive dysfunction. Conclusion From 2013 to 2023, the overall research at home and abroad interest in postoperative cognitive dysfunction has shown an upward trend, yet its pathophysiological mechanisms need further exploration. The risk factors for postoperative cognitive impairment and their correlations with anesthesia and mortality are being actively explored, and new methods for prevention and treatment such as percutaneous electrical stimulation are gradually emerging.

Objective To observe the effect of Qixian Tongluo Formula on contralateral corticospinal tract(CST)remodeling and motor functional recovery in rats with cerebral infarction,and to explore its potential molecular mechanism from the perspective of regulating factors related to never remodeling.Methods The rat middle cerebral artery occlusion(MCAO)model was established by silk thread ligation.Fifty model rats were randomly divided into model group,citicoline group(0.054 g·kg-1),Qixian Tongluo Formula low-,medium-and high-dose(7.83,15.66,31.32 g·kg-1)groups,and sham operation group,with 10 rats in each group.The intervention administration was started on the 3rd day after operation once a day for 26 consecutive days.On the 3rd,14th and 28th day after operation,the gross motor function was evaluated by Longa score,and the fine motor function was evaluated by beam-walking test(BWT)score.The contralateral motor cortex was injected with the nerve tracer biotin dextran amine(BDA)on the 14 th day after operation to anterogradely trace the CST.On the 28th day after operation,the expression of axonal growth associated protein-43(GAP-43)and BDA positive fibers in the contralateral motor cortex and cervical spinal cord were detected by immunohistochemistry.The co-localization areas of BDA positive fibers and presynaptic marker protein vesicular glutamate transporter 1(VGLUT1)in the cervical spinal cord gray matter were detected by immunofluorescence.The expressions of brain-derived neurotrophic factor(BDNF),glial cell-derived neurotrophic factor(GDNF),nerve growth factor(NGF)and nerve remodeling-associated inhibitory factor[Nogo-A,oligodendrocyte myelin glycoprotein(OMgp)and myelin-associated glycoprotein(MAG)]in the contralateral motor cortex were detected by Western Blot.Pearson correlation analysis was used to analyze the correlation between Longa score or BWT score and BDA/VGLUT1 co-localization area,respectively.Results Compared with the sham operation group,rats in the model group had obvious symptoms of motor function deficits,and the Longa scores were significantly increased(P＜0.01)and the BWT scores were significantly decreased(P＜0.05,P＜0.01)at each time point.The expression of GAP-43 in the contralateral motor cortex and cervical spinal cord was up-regulated(P＜0.05),the number of edge-crossing fibers from the posterior funiculus in cervical cord was increased(P＜0.05),the co-localization area of BDA/VGLUT1 in the gray matter of the cervical spinal cord was increased(P＜0.05),the expressions of BDNF,GDNF and NGF in the contralateral motor cortex were up-regulated(P＜0.05),while the expressions of Nogo-A,OMgp and MAG were down-regulated(P＜0.05).Compared with the model group,the Longa scores in each administration group on the 14th and 28th day after MCAO operation were significantly decreased(P＜0.01),the BWT scores were significantly increased(P＜0.01),the expression of GAP-43 in the contralateral motor cortex and cervical spinal cord was significantly up-regulated(P＜0.01).The number of edge-crossing fibers from the posterior funiculus in cervical cord was significantly increased(P＜0.01),the co-localization area of BDA/VGLUT1 in the gray matter of the cervical spinal cord was significantly increased(P＜0.01).The expressions of BDNF,GDNF and NGF in the contralateral motor cortex were significantly up-regulated(P＜0.01,P＜0.05),while the expressions of Nogo-A,OMgp and MAG were significantly down-regulated(P＜0.05),and the most significant effect was observed in the high dose group.The Longa score was negatively correlated with the co-localization area of BDA/VGLUT1(r=-0.89,P＜0.01),and the BWT score was positively correlated with the co-localization area of BDA/VGLUT1(r=0.84,P＜0.01).Conclusion Qixian Tongluo Formula can improve motor function through promoting contralateral CST remodeling in MCAO rats after cerebral infarction,and the molecular mechanism may be related to the regulation of the expression of nerve remodeling-associated factor in the contralateral motor cortex.

Objective:To investigate the effect of lanatoside C on autophagy in hepatocellular carcinoma Huh-7 cells,and the possible mechanism of action.Methods:After Huh-7 cells were treated with gradient concentration of lanatoside C for 24 h,the IC50 value of lanatoside C on Huh-7 cells was detected by CCK-8 assay,and the role of intervention of gradient concentration of lanatoside C in the proliferation and clone formation of Huh-7 cells was analyzed by CCK-8 assay and clone formation assay.Western blotting was used to detect the expression levels of autophagy markers in Huh-7 cells,such as microtubule-associated protein light chain 3(LC3)-II,LC3-Ⅰ,p62,Beclin1,vacuolar protein sorting 34(VPS30),VPS15 and autophagy-related protein 3(ATG3)in Huh-7 cells,and the changes of LC3-II/LC3-Ⅰ ratio were analyzed.The effects of lanatoside C on the formation of autophagic vesicles in Huh-7 cells were observed by laser confocal microscopy,and the effects of lanatoside C on the formation of autophagic vesicles in Huh-7 cells were confirmed by artificial intelligence image analysis.Finally,the effects of lanatoside C on the interaction between Beclin1,VPS34 and VPS15 on the formation of autophagic vesicles in Huh-7 cells were detected by co-immunoprecipitation.Results:The IC50 value of lanatoside C on Huh-7 cells at 24 h was(0.49±0.07)μg/mL.The results of the CCK-8 assay and clone formation assay suggested that lanatoside C had a significant inhibitory effect on the growth of Huh-7 cells in a concentration-dependent manner(both P<0.01).The results of Western blotting assay showed that the LC3-II/LC3-Ⅰ ratio was significantly increased with the increase in the concentration of lanatoside C(P<0.01),while the expression level of Beclin1 protein was up-regulated(P<0.05),and the expression level of p62 protein was significantly down-regulated(P<0.01).The results of laser confocal microscopy showed that lanatoside C could significantly induce autophagic vesicle formation in Huh-7 cells(P<0.01).The results of artificial intelligence image analysis confirmed this effect of lanatoside C(all P<0.01).The results of co-immunoprecipitation confirmed that lanatoside C was able to promote the binding of Beclin1 to VPS34 and VPS15 with each other(both P<0.01).Conclusion:Lanatoside C significantly inhibits the proliferation of Huh-7 cells and and induces Huh-7 cells autophagy,the mechanism of this effect may be related to up-regulating Beclin1 expression and promoting the combination of Beclin1 protein with VPS34 and VPS15 proteins.

Objective To develop and validate a prediction model for extended hospitalisation in patients with ischemic stroke.Methods A total of 318 patients with ischemic stroke hospitalised between November 2021 and May 2023 in a Grade ⅢA hospital in Changzhou were selected as study objects with a convenience sampling method.The modelling group consisted 212 patients and the validation group included 106 patients.The patients in the modelling group were divided into a group of extended hospital stay and a group of normal hospital stay.Binary logistic regression analysis was conducted to develop the prediction model,and data from the 106 patients in the validation group were then incorporated into the developed prediction model.The prediction performance and goodness-of-fit of the model were accessed using the area under the curve(AUC)of the receiver operation characteristic(ROC)curve and the Hosmer-Lemeshow test.Results Multivariate logistic analysis showed that comorbid diabetes,number of complications during hospitalisation,a Braden score less than 18,and a white blood cell count greater than 3.5×109/L or more than 9.5×109/L were the risk factors of extended hospitalisation in patients with cerebral ischemic stroke.Based on the factors,a prediction model was developed with following formula:P=1/[1+exp(-Z)].Hosmer-Lemeshow test for the prediction model yielded χ 2=7.430,P=0.191.AUC of the prediction model was 0.818(95％CI:0.754-0.883,P<0.001)with Jordon index of 0.51 and the optimal cut-off value of 0.268,sensitivity of 78.9％and specificity of 72.3％The results of the validation of independent data model showed a sensitivity of 75.0％,specificity of 74.4％,and accuracy of 74.5％.Conclusion Comorbid diabetes,Braden score at admission,white blood cell count and the number of complications during hospitalisation are the significant factors that affect the length of hospital stay in the patients with ischemic stroke.The prediction model for extended hospitalisation of the patients with ischemic stroke exhibits good predictive value and can provide reference in clinical decision-making.