Septic shock, a prevalent critical condition in intensive care units (ICU) and a major cause of patient mortality, is fundamentally attributed to microcirculatory dysfunction. Traditional macrocirculatory parameters are often insufficiently sensitive to reflect microcirculatory status. Consequently monitoring peripheral microcirculatory function holds crucial significance for assessing disease progression and evaluating therapeutic efficacy in septic shock. The peripheral perfusion index (PPI), obtained from a standard pulse oximeter, is based on photoplethysmography (PPG). It calculates the differential absorption of red and infrared light emitted by the sensor between pulsatile arterial blood and non-pulsatile tissue, enabling real-time reflection of peripheral perfusion and thus providing non-invasive, continuous monitoring of microcirculatory function. Although often overlooked compared to other ICU monitoring parameters, PPI has demonstrated notable clinical advances in septic shock management. Specifically, in early identification, PPI combined with sequential organ failure assessment (SOFA) predicts disease progression, with its dynamic changes further aiding prognosis assessment. During fluid resuscitation, it guides fluid responsiveness evaluation and serves as a therapeutic target to optimize strategies. In circulatory support, it assists in determining vasoactive drug initiation timing and dosage titration. Additionally, PPI aids mechanical ventilation weaning and organ dysfunction evaluation. This article reviews the principles, influencing factors, and clinical application advances of PPI in septic shock, aiming to provide clinicians with a basis for individualized intervention, improved patient outcomes, and the advancement of precision medicine in septic shock management.
Humans ; Shock, Septic/therapy* ; Microcirculation ; Perfusion Index ; Prognosis ; Photoplethysmography

Objective To analyze the clinical efficacy and safety of Huoxue Xiaoyi decoction combined with exercise in the treatment of ovarian endometriosis.Methods 36 patients with ovarian endometriosis treated in Guang'anmen Hospital,China Academy of Chinese Medical Sciences from May 2022 to November 2022 were selected and treated with Huoxue Xiaoyi decoction combined with exercise for 3 months.The size of ovarian ectopic cyst,dysmenorrhea VAS score,PBAC score,female hormones,serum CA125 and CA199,catecholamines and cytokines levels were observed to evaluate the clinical efficacy and safety.Results After treatment,the maximum diameter of ovarian ectopic cyst,dysmenorrhea VAS score,PBAC score,cytokines(serum IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10)levels were significantly lower than those before treatment(P<0.05).The levels of SHBG and adrenaline were significantly higher than those before treatment(P<0.05).During the treatment,the patient had no adverse drug reactions,vital signs,liver,and kidney function indexes were normal.Conclusion Huoxue Xiaoyi decoction combined with exercise therapy can reduce the size of ovarian ectopic cyst,relieve dysmenorrhea,regulate menstrual volume,increase the level of adrenaline,increase the level of sex hormone binding globulin,reduce the level of cytokines,and has fewer adverse reactions and good safety.

Objective To comprehensively evaluate the prevalence of and influencing factors for low-level viraemia(LLV)in Chinese patients receiving antiviral therapy for human immunodeficiency virus(HIV)infection through systematic review and Meta-analysis.Methods Cochrane Library,Web of Science,Embase,PubMed,China Bio-medicine(CBM),VIP,China National Knowledge Infrastructure(CNKI),and Wanfang Data were systematically retrieved.Retrieval time was from the establishment of the database to February 2024.Literatures related to the prevalence of LLV in patients receiving antiviral therapy for HIV infection were retrieved using combination of key-words and free words.Stata 16.0 software was used for Meta-analysis.Random effects model was adopted to calcu-late the combined prevalence and its 95％confidence interval.Results A total of 15 papers were included in analy-sis,involving 191 212 specimens.Meta-analysis random effects model showed that the prevalence of LLV in Chinese patients receiving antiviral therapy for HIV infection was 13.00％(95％CI:7.82％-19.24％).Subgroup analysis showed that cross-sectional studies,northern regions,males,age ≥50 years,heterosexual transmission routes,baseline CD4+T lymphocyte count＜200 cells/μL,and patients who had ever changed therapy regimens had higher LLV prevalence.Conclusion The prevalence of LLV in patients receiving antiviral therapy for HIV infection is re-latively higher.Attention should be paid to such high-risk population,and appropriate antiviral therapy schemes should be selected as early as possible.Timely intervention is necessary when LLV occurs.

In the field of rectal cancer treatment, transanal local excision techniques (such as transanal endoscopic microsurgery [TEM] and transanal minimally invasive surgery [TAMIS]) have gradually become an important therapeutic option for patients with rectal cancer at various stages, owing to their minimally invasive characteristics and organ-preserving advantages. For low-risk T1 stage tumors, local excision can achieve radical tumor control while preserving organ function. For some patients with high-risk T1 stage or T2-3 stage rectal cancer, the efficacy of combined chemoradiotherapy and local excision is expected to be comparable to that of radical total mesorectal excision (TME). In patients with advanced rectal cancer who achieve clinical complete response (cCR) after neoadjuvant therapy, local excision can confirm the pathological remission status. However, it is necessary to balance the risk of surgical complications against the potential benefits of organ preservation with the "watch and wait" strategy. Currently, transanal local excision techniques have broad application prospects, and comprehensive assessment of patients' overall condition, implementation of multidisciplinary collaboration, and conduct of long-term follow-up are crucial to ensuring the safety of treatment.

Objective To comprehensively evaluate the prevalence of and influencing factors for low-level viraemia(LLV)in Chinese patients receiving antiviral therapy for human immunodeficiency virus(HIV)infection through systematic review and Meta-analysis.Methods Cochrane Library,Web of Science,Embase,PubMed,China Bio-medicine(CBM),VIP,China National Knowledge Infrastructure(CNKI),and Wanfang Data were systematically retrieved.Retrieval time was from the establishment of the database to February 2024.Literatures related to the prevalence of LLV in patients receiving antiviral therapy for HIV infection were retrieved using combination of key-words and free words.Stata 16.0 software was used for Meta-analysis.Random effects model was adopted to calcu-late the combined prevalence and its 95％confidence interval.Results A total of 15 papers were included in analy-sis,involving 191 212 specimens.Meta-analysis random effects model showed that the prevalence of LLV in Chinese patients receiving antiviral therapy for HIV infection was 13.00％(95％CI:7.82％-19.24％).Subgroup analysis showed that cross-sectional studies,northern regions,males,age ≥50 years,heterosexual transmission routes,baseline CD4+T lymphocyte count＜200 cells/μL,and patients who had ever changed therapy regimens had higher LLV prevalence.Conclusion The prevalence of LLV in patients receiving antiviral therapy for HIV infection is re-latively higher.Attention should be paid to such high-risk population,and appropriate antiviral therapy schemes should be selected as early as possible.Timely intervention is necessary when LLV occurs.

In the field of rectal cancer treatment, transanal local excision techniques (such as transanal endoscopic microsurgery [TEM] and transanal minimally invasive surgery [TAMIS]) have gradually become an important therapeutic option for patients with rectal cancer at various stages, owing to their minimally invasive characteristics and organ-preserving advantages. For low-risk T1 stage tumors, local excision can achieve radical tumor control while preserving organ function. For some patients with high-risk T1 stage or T2-3 stage rectal cancer, the efficacy of combined chemoradiotherapy and local excision is expected to be comparable to that of radical total mesorectal excision (TME). In patients with advanced rectal cancer who achieve clinical complete response (cCR) after neoadjuvant therapy, local excision can confirm the pathological remission status. However, it is necessary to balance the risk of surgical complications against the potential benefits of organ preservation with the "watch and wait" strategy. Currently, transanal local excision techniques have broad application prospects, and comprehensive assessment of patients' overall condition, implementation of multidisciplinary collaboration, and conduct of long-term follow-up are crucial to ensuring the safety of treatment.

Objective To analyze the clinical efficacy and safety of Huoxue Xiaoyi decoction combined with exercise in the treatment of ovarian endometriosis.Methods 36 patients with ovarian endometriosis treated in Guang'anmen Hospital,China Academy of Chinese Medical Sciences from May 2022 to November 2022 were selected and treated with Huoxue Xiaoyi decoction combined with exercise for 3 months.The size of ovarian ectopic cyst,dysmenorrhea VAS score,PBAC score,female hormones,serum CA125 and CA199,catecholamines and cytokines levels were observed to evaluate the clinical efficacy and safety.Results After treatment,the maximum diameter of ovarian ectopic cyst,dysmenorrhea VAS score,PBAC score,cytokines(serum IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10)levels were significantly lower than those before treatment(P<0.05).The levels of SHBG and adrenaline were significantly higher than those before treatment(P<0.05).During the treatment,the patient had no adverse drug reactions,vital signs,liver,and kidney function indexes were normal.Conclusion Huoxue Xiaoyi decoction combined with exercise therapy can reduce the size of ovarian ectopic cyst,relieve dysmenorrhea,regulate menstrual volume,increase the level of adrenaline,increase the level of sex hormone binding globulin,reduce the level of cytokines,and has fewer adverse reactions and good safety.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.