OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Trauma can disrupt the body′s internal environment, resulting in organ dysfunction. This may manifest as symptoms such as acute respiratory distress, liver and kidney dysfunction, circulatory disorders and neurological damage. Mitochondrial quality control (MQC), encompassing processes like autophagy, dynamic changes, and biogenesis, plays an essential role in maintaining mitochondrial function. Stress responses following trauma can cause mitochondrial dysfunction and MQC imbalance, thereby exacerbating organ injury. Correcting MQC imbalance can improve organ function. Current researches on MQC in post-traumatic organ dysfunction mainly focuses on imbalance in specific MQC mechanism, lacking a systemic understanding of its incidence and progression. To this end, the authors reviewed the progress in researches on the impact of MQC imbalance on post-traumatic organ dysfunction, aiming to provide insights for clinical treatment.

Acute carbon monoxide poisoning (ACMP) is one of the most common gas poisonings in the emergency department, with tens of thousands of people seeking medical attention for carbon monoxide (CO) poisoning each year. The severity of poisoning is dependent upon environmental and human factors, with hypoxia and oxidative stress being important mechanisms of cardiac toxicity induced by CO. Myocardial involvement is common in moderate to severe ACMP, including myocardial injury, myocardial infarction, arrhythmia, and sudden death, which are associated with a high risk of death. Ferroptosis is a cell death mechanism caused by iron-dependent lipid peroxidation (LPO), although ferroptosis has been shown to play a critical role in various cardiovascular diseases, the potential mechanism by which it contributes to ACMP-induced myocardial injury is unclear. This review discusses the established link between ferroptosis and cardiovascular disease and summarizes the potential role of ferroptosis in ACMP-induced myocardial injury and the detrimental effects of ACMP on the heart. Elucidating these mechanisms could guide the development of novel therapeutic strategies that target ferroptosis to mitigate ACMP-induced myocardial injury. This review aims to provide a theoretical foundation for future research on the potential use of ferroptosis as a therapeutic target for ACMP-induced myocardial injury.
Humans ; Carbon Monoxide Poisoning/complications* ; Ferroptosis ; Lipid Peroxidation ; Myocardium/pathology* ; Oxidative Stress

Objective To develop nanobodies with broad-spectrum reactivity,specificity,and high sensitivity that can be used for detecting multiple subtypes of influenza A virus,and to establish a nanobody-based enzyme-linked immunosorbent assay(ELISA)method.Methods Gene sequences of twelve nanobodies against influenza A virus were retrieved from the National Center for Biotechnology Information(NCBI)and nanobody databases.The nanoantibodies were prepared using molecular biological techniques including gene synthesis and recombinant expression.The binding activity,specificity,sensitivity,and affinity of these nanobodies were determined by ELISA screening and Gator affinity analysis.A double-antibody sandwich ELISA assay was established by combining the selected nanobody with a traditional mouse monoclonal antibody.Results Twelve nanobodies were expressed and purified.Two nanobodies capable of binding to multiple subtypes of influenza virus including H1,H3,H5,H7,and H9 were obtained and designated as VHH54 and KV108.Both nanobodies showed no cross-reactivity with other respiratory virus antigens.Furthermore,the KV108 nanobody exhibited the highest binding affinity,with a dissociation constant of 5.94×10-9mol/L for the influenza virus nucleoprotein(NP),and the lowest detection concentration for the NP antigen reached 0.00064 μg/mL.The double-antibody sandwich ELISA,using a combination of KV108 and a mouse monoclonal antibody,could sensitively detect the five common subtypes of influenza A virus(H1N1,H3N2,H5N1,H7N9,and H9N2).The lowest detection limit reached 110-403 PFU/mL,which was higher than that of the commercial colloidal gold kitfor influenza virus detection.Conclusion This study has identified a nanobody KV108,which is capable of binding to multiple subtypes of influenza virus,and established a nanobody-based ELISA method that can detect multiple subtypes of influenza A virus.This study can facilitate the development of nanobody-based influenza detection technologies.

Objective To explore the application of bundled nursing care for recurrent obstruc-tive esophageal cancer treated by photodynamic therapy.Methods Thirty patients with recurrent ob-structive esophageal cancer were administered with photosensitizer hematoporphyrin derivative injec-tion.After 24 hours,an optical fiber was introduced under endoscopic guidance,and 630 nm laser was used to irradiate the tumor locally.The degree of relief in dysphagia,improvement in perform-ance status,changes in body mass index,and treatment-related adverse reactions were recorded.Bundled nursing strategies were implemented,including preoperative assessment,education,prepara-tion,postoperative positioning,observation,prevention of complications,and light protection meas-ures.Results After treatment,the median diameter of the narrowest esophageal lesion was increased[(8.92±0.64)mm versus(4.77±0.60)mm],the Karnofsky Performance Status(KPS)score was improved[(77.69±5.99)versus(84.62±6.60)],BMI was increased[(17.17±1.66)kg/m2 ver-sus(18.08±1.60)kg/m2],and the Stooler dysphagia grade was decreased compared with treatment be-fore.The main treatment-related adverse reactions were retrosternal pain and fever.Conclusion Photo-dynamic therapy for recurrent obstructive esophageal cancer has a rapid onset of action and mild ad-verse reactions,and ensures the smooth implementation of PDT and patients'safety.

Objective To explore the action mechanism of dehydrocostus lactone(DHL)on renal interstitial fibrosis(RIF)in rats with unilateral ureteral obstruction(UUO).Methods Forty-four male SD rats were randomly divided into four groups:the sham surgery group(Sham group),the pure drug intervention group(Sham+DHL group),the experimental group(UUO+Vehicle group)and the DHL treatment group(UUO+DHL group),with 11 rats in each group.The rats underwent sham surgery,sham surgery+DHL[10 mg/(kg·d)],UUO modeling+the same volume of solvent and UUO modeling+DHL[10 mg/(kg·d)],respectively.After surgery,DHL or the same volume of solvent was administered by gavage for 14 days starting from day 2 post-surgery.Hematoxylin-eosin(HE)and Masson staining were used to observe the pathological changes in renal tissue.Immunohistochemical staining was performed to detect the expression levels of collagen I,collagen III and α-smooth muscle actin(α-SMA).Western blotting was used to detect the protein levels of the transforming growth factor(TGF)-β1/Smad2/3 pathway.Results Compared with the UUO+Vehicle group,DHL treatment alleviated renal interstitial pathological damage,reduced collagen fiber deposition,and decreased the expression of collagen I,collagen III and α-SMA.It also inhibited the expression of TGF-β1 and Smad2/3 proteins.Conclusions DHL mitigates RIF in rats by inhibiting the TGF-β1/Smad2/3 pathway,providing a new strategy for the treatment of chronic kidney disease.

Objective To explore the predictive value of systemic immune-inflammation index(SII)and control of nutritional status(CONUT)score for the efficacy of immune combined chemotherapy in patients with advanced or recurrent gastric cancer.Methods A retrospective analysis was conducted on the clinical data of 143 patients with advanced or recurrent gastric cancer who underwent immune combined chemotherapy as a treatment regimen at Huangshan People's Hospital from January 2020 to December 2023.The patients were divided into a disease control group(n=105)and a disease non-control group(n=38)according to the response evaluation criteria in solid tumor(RECIST).The CONUT score and SII levels between the two groups were compared.Multivariate Logistic regression analysis was used to identify the factors influencing the efficacy of immune combined chemotherapy in patients with advanced or recurrent gastric cancer.Receiver operating characteristic(ROC)curves were employed to predict the value of pre-treatment CONUT score,SII,and their combination in predicting the efficacy of immune-combined chemotherapy for advanced or recurrent gastric cancer.Results The CONUT score(2.8±0.5)and SII level(1 073.64±141.26)in the disease control group under than those in the disease non-control group(3.3±0.7,1 183.27±186.34),and the differences were statistically significant(t=4.721,3.751,all P<0.05).Multivariate Logistic regression analysis revealed that age,degree of differentiation,maximum diameter of measurable lesions,CONUT score,and SII were all factors influencing the treatment outcome in patients with advanced or recurrent gastric cancer(Wald χ2=5.161～22.758,all P<0.05).The ROC curve results showed that the AUC(95%CI)for pre-treatment CONUT score,SII,and their combination in predicting the efficacy of immuno chemotherapy in patients with advanced or recurrent gastric cancer were 0.746(0.667～0.815),0.839(0.768～0.895)and 0.875(0.809～0.924),respectively,with sensitivities of 73.11%,76.32%and 79.68%,and specificities of 91.43%,82.86%and 84.75%,respectively.Conclusion CONUT score and SII are influencing factors for the efficacy of immuno-combined chemotherapy in patients with advanced or recurrent gastric cancer,and their combination demonstrates good predictive value for the treatment outcome.

Objective:To establish a qualitative analysis of Rhodiola crenulata for determing six components inclu-ding gallic acid,salidroside,tyrosol,1,2,3,4,6-O-gallic glucose,rhodiosin,oxorlin-7-O-rhamnoside by HPLC,and to find out the feasibility of the method of linear calibration using two reference substances in qualitative analysis of chromatographic peaks.Methods:The real retention time of 6 components in Rhodiola crenulata on 19 chromatographic columns were determined.Gallic acid and rhodiosin were selected as the reference substances,and the method of linear calibration using these 2 substances was used to predict the retention time.Tyrosol was also chosen as the reference to predict the retention time with the relative retention time method(RRT method).Comparing the accuracy of these two methods.Results:Compared to the RRT method,the method of linear calibration with two reference substances was more accurate for predicting the retention time and more adapatable for many kinds of chromatographic columns.Conclusion:As a new alternative reference substance method,the method of linear calibration using two reference substances can assist chromatographic peak determination better and has broad application prospects.

Objective:To establish a linear calibration method using two reference substances for seven characteristic peaks of Cassiae Semen under complicated chromatographic condition,and to optimize the method.Methods:Using 15 different types of screened chromatographic columns and 2 components as reference compounds pair,the linear calibration method with 2 reference substances was established to predict the retention time of the other 5 components,and the method was verified by unknown chromatographic columns and unknown samples.Combined with column confirmation number and average coincidence rate of target peaks,the location results were compared comprehen-sively,and the method was optimized according to the defect under the influence of complicated chromatographic condition.Results:The average conformity rate of the target peak of the method before optimization was 73.3％,and the average conformity rate of the target peak of the optimized method was 98.7％.The optimized method has a high-er average peak coincidence rate and a wider range of applicability for the chromatographic column.Conclusion:The optimized linear calibration method using two reference substances can assist the localization analysis of chromato-graphic peaks in the characteristic chromatogram under complicated chromatographic condition.