Objective:To evaluate potentially inappropriate medication (PIM) in hospitalized elderly patients with bacterial pneumonia, and explore its influencing factors.Methods:It was a single-center cross-sectional study. The study focused on elderly patients with bacterial pneumonia who were admitted to Xuanwu Hospital, Capital Medical University from January 2018 to November 2022. Patients′ gender, age, weight, length of hospital stay, diagnosis at admission, physical examination, diagnosis at discharge, comorbidities, medications, and laboratory test results were extracted from hospital information system and electronic medical records. Medication use of patients included in the analysis during their hospitalization were evaluated according to the classification of PIMs in the 5 lists of the Beer′s criteria of American Geriatrics Society. Based on whether PIM occurred, the patients were divided into with PIM group and without PIM group. The clinical features between the 2 groups were compared and the influencing factors of PIM were analyzed using multivariable logistic regression.Results:A total of 2 720 patients were included, in which 1 734 (63.75%) were male. The median age was 78 (70, 85) years and their ages ranged from 65 to 103 years. The number of drugs used per patient was 14 (10, 18) kinds, ranging from 1 to 57 kinds. The length of hospital stay was 12 (9, 17) days, ranging from 1 to 162 days. Charlson comorbidity index (CCI) was 6 (5, 8) points. Among the 2 720 patients, 1 894 (69.63%) experienced PIM, with a total of 6 166 cases of PIM. The top 3 drugs ranked by the number of PIM occurrence were antiplatelet agents (1 357 cases), benzodiazapine receptor agonists (956 cases), and antipsychotics (884 cases). The comparison of clinical characteristics between the 2 groups showed that differences in age, CCI, length of hospital stay, and number of medications between with PIM and without PIM patients were statistically significant (all P<0.001). Multivariable logistic regression results showed that CCI, length of hospital stay, and number of medications were independent influencing factors for PIM. The risk increased by 8% and 1% with one point increase in CCI and one day extension in length of hospital stay [odds ratio ( OR)=1.08, 95% confidence interval ( CI): 1.04-1.13, P<0.001; OR=1.01, 95% CI: 1.00-1.03, P=0.03]. PIM risk of patients with more than 15 concurrent medications had a 22.16 times higher PIM risk than those with less than 5 concurrent medications ( OR=22.16, 95% CI: 14.15-34.72, P<0.001). Conclusions:Hospitalized eldery patients with bacterial pneumonia who have more severe comorbidities, longer hospital stay, and multiple concomitant medications are at a higher risk of PIM occurrence. Rational medication use among these patients should be paid attention to in clinical practice.

Hydrogen-rich water (HRW) shows excellent antibacterial, anti-inflammatory, antioxidant, and wound-healing properties and plays a positive role in the treatment of various diseases, such as brain injury, kidney injury, and periodontitis. Current studies found that HRW can inhibit periodontopathogenic biofilm formation, inhibit oral connective tissue and bone tissue destruction, and show anti-inflammatory and antioxidant properties in periodontitis. Additionally, HRW can alleviate periodontal tissue damage by inhibiting oxidative stress and up-regulating the expression of antioxidant enzymes, such as glutathione peroxidase and superoxide dismutase. HRW exerts anti-inflammatory effects by regulating the nuclear factor erythroid 2-related factor 2 and mitogen-activated protein kinase pathways, which are closely associated with inflammation. Additionally, HRW inhibits the expression of inflammatory cytokines, such as interleukins, inhibits the growth and proliferation of bacterial plaque biofilms, and down-regulates glycosyltransferases and glucan-binding proteins to prevent bacterial adhesion and subsequent development of periodontitis. Furthermore, HRW has a positive effect on the expression of various cell growth factors, α-smooth muscle actin, and type I collagen, which promotes wound healing. Current clinical studies have demonstrated the biological safety of HRW (to a certain extent) and reported no adverse reactions. However, most studies on HRW in oral diseases are preclinical in vivo and in vitro studies. Therefore, further clinical studies are required to validate the therapeutic significance and optimal therapeutic regimen of HRW in human periodontitis. This article aims to review the therapeutic role and the underlying mechanisms of HRW in periodontitis.

[Objective]To explore the disease diagnosis and treatment philosophy embedded in Zhiyi's Mohe Zhiguan(Great Calm and Insight).[Methods]Using a literary research methodology,this study interprets the medical content of Mohe Zhiguan based on classical theories of traditional Chinese medicine(TCM)and traditional Chinese cultural frameworks.A descriptive analysis without subjective interpretation was adopted to examine the diagnostic and therapeutic characteristics in the text,analyze the value and contributions of Zhiyi's medical philosophy,elucidate his unique cognitive model of medicine,and compare it with modern psychosomatic medicine to uncover its contemporary relevance.[Results]Although Mohe Zhiguan primarily serves as a guide to meditative practice,it contains rich insights into medical diagnosis and treatment.These include an emphasis on medical ethics,distinctive perspectives on life,etiology and therapeutic approaches.While some of these concepts may differ from modern understandings of disease pathology and treatment principles,they offer valuable insights for addressing psychosomatic disorders prevalent in contemporary society when viewed through the lens of holistic and mind-body medicine.[Conclusion]Zhiyi,a master of Buddhist classics,integrated TCM and Indian medical traditions to develop a unique medical paradigm.When critically examined as part of China's cultural heritage,his work can complement and enrich research in TCM.Further in-depth exploration and dissemination of his ideas are warranted to advance the study of traditional medical systems.

[Objective]To explore the disease diagnosis and treatment philosophy embedded in Zhiyi's Mohe Zhiguan(Great Calm and Insight).[Methods]Using a literary research methodology,this study interprets the medical content of Mohe Zhiguan based on classical theories of traditional Chinese medicine(TCM)and traditional Chinese cultural frameworks.A descriptive analysis without subjective interpretation was adopted to examine the diagnostic and therapeutic characteristics in the text,analyze the value and contributions of Zhiyi's medical philosophy,elucidate his unique cognitive model of medicine,and compare it with modern psychosomatic medicine to uncover its contemporary relevance.[Results]Although Mohe Zhiguan primarily serves as a guide to meditative practice,it contains rich insights into medical diagnosis and treatment.These include an emphasis on medical ethics,distinctive perspectives on life,etiology and therapeutic approaches.While some of these concepts may differ from modern understandings of disease pathology and treatment principles,they offer valuable insights for addressing psychosomatic disorders prevalent in contemporary society when viewed through the lens of holistic and mind-body medicine.[Conclusion]Zhiyi,a master of Buddhist classics,integrated TCM and Indian medical traditions to develop a unique medical paradigm.When critically examined as part of China's cultural heritage,his work can complement and enrich research in TCM.Further in-depth exploration and dissemination of his ideas are warranted to advance the study of traditional medical systems.

Objective:To evaluate potentially inappropriate medication (PIM) in hospitalized elderly patients with bacterial pneumonia, and explore its influencing factors.Methods:It was a single-center cross-sectional study. The study focused on elderly patients with bacterial pneumonia who were admitted to Xuanwu Hospital, Capital Medical University from January 2018 to November 2022. Patients′ gender, age, weight, length of hospital stay, diagnosis at admission, physical examination, diagnosis at discharge, comorbidities, medications, and laboratory test results were extracted from hospital information system and electronic medical records. Medication use of patients included in the analysis during their hospitalization were evaluated according to the classification of PIMs in the 5 lists of the Beer′s criteria of American Geriatrics Society. Based on whether PIM occurred, the patients were divided into with PIM group and without PIM group. The clinical features between the 2 groups were compared and the influencing factors of PIM were analyzed using multivariable logistic regression.Results:A total of 2 720 patients were included, in which 1 734 (63.75%) were male. The median age was 78 (70, 85) years and their ages ranged from 65 to 103 years. The number of drugs used per patient was 14 (10, 18) kinds, ranging from 1 to 57 kinds. The length of hospital stay was 12 (9, 17) days, ranging from 1 to 162 days. Charlson comorbidity index (CCI) was 6 (5, 8) points. Among the 2 720 patients, 1 894 (69.63%) experienced PIM, with a total of 6 166 cases of PIM. The top 3 drugs ranked by the number of PIM occurrence were antiplatelet agents (1 357 cases), benzodiazapine receptor agonists (956 cases), and antipsychotics (884 cases). The comparison of clinical characteristics between the 2 groups showed that differences in age, CCI, length of hospital stay, and number of medications between with PIM and without PIM patients were statistically significant (all P<0.001). Multivariable logistic regression results showed that CCI, length of hospital stay, and number of medications were independent influencing factors for PIM. The risk increased by 8% and 1% with one point increase in CCI and one day extension in length of hospital stay [odds ratio ( OR)=1.08, 95% confidence interval ( CI): 1.04-1.13, P<0.001; OR=1.01, 95% CI: 1.00-1.03, P=0.03]. PIM risk of patients with more than 15 concurrent medications had a 22.16 times higher PIM risk than those with less than 5 concurrent medications ( OR=22.16, 95% CI: 14.15-34.72, P<0.001). Conclusions:Hospitalized eldery patients with bacterial pneumonia who have more severe comorbidities, longer hospital stay, and multiple concomitant medications are at a higher risk of PIM occurrence. Rational medication use among these patients should be paid attention to in clinical practice.

OBJECTIVE To explore the neuroprotective effect and possible mechanism of celastrol （Cel） and its derivatives （Cel-1， Cel-2） in terms of neuroinflammation and oxidative damage. METHODS Neuroinflammation model of microglial BV2 cells was induced by 1 μg/mL lipopolysaccharide （LPS）； oxidative damage model of human neuroblastoma SH-SY5Y cells was induced by 200 μmol/L hydrogen peroxide （H2O2）. The toxicity of different concentrations of Cel， Cel-1 and Cel-2 （0.625-20 μmol/L） to the two types of cells was investigated. The levels of nitric oxide （NO）， tumor necrosis factor α （TNF-α）， interleukin 1β （IL-1β）， and IL-6 in BV2 cells induced by LPS at safe concentrations （0.039-0.625 μmol/L） were all detected. The survival rate of SH-SY5Y cells induced by H2O2 was also determined. The expression levels of phosphoinositide 3-kinase （PI3K）， p-PI3K， protein kinase B （Akt）， p-Akt， cystatinase 3 （caspase-3）， B-cell lymphoma 2 （Bcl-2） and Bcl-2-related X protein （Bax） in SH- SY5Y cells induced by H2O2 at 0.156， 0.313， 0.625 μmol/L of active compound 2 were all detected. RESULTS In the concentration gradient range between 0.039 and 0.625 μmol/L， the results of neuroinflammation model experiments showed that Cel， Cel-1 and Cel-2 could reduce the contents of NO， TNF-α， IL-1β， and IL-6 in culture medium of BV2 cells （P＜0.05 or P＜ 0.01）； their IC50 values for neuroinflammation were （0.25±0.04）， （0.61±0.14） and （0.11±0.02） μmol/L respectively. Meanwhile， all of them could reverse the phenomenon of decreased cell survival rate after H2O2 treatment in the oxidative damage experiments at a certain concentration （P＜ 0.05 or P＜0.01）， with neuroprotective EC50 values of （0.43± XJC2023009） 0.08）， （0.45±0.04） and （0.28±0.03） μmol/L， respectively.Induced by H2O2， the phosphorylation of PI3K and Akt protein， protein expressions of Bcl-2 and Bcl-2/Bax ratio were all increased significantly （P＜0.05 or P＜0.01）， while the protein expressions of caspase-3 and Bax were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS Cel， Cel-1， and Cel-2 all have significant neuroprotective activities at certain concentrations， and Cel-2 shows the most significant protective effect. The mechanism of action of Cel-2 may be related to regulating the PI3K/Akt and caspase-3/Bcl-2/Bax signaling pathways， reducing the inflammatory response， oxidative stress damage and inhibiting neuronal apoptosis.

Coronary restenosis is an important cause of poor long-term prognosis in patients with coronary heart disease. Here, we show that lysine methyltransferase SMYD2 expression in the nucleus is significantly elevated in serum- and PDGF-BB-induced vascular smooth muscle cells (VSMCs), and in tissues of carotid artery injury-induced neointimal hyperplasia. Smyd2 overexpression in VSMCs (Smyd2-vTg) facilitates, but treatment with its specific inhibitor LLY-507 or SMYD2 knockdown significantly inhibits VSMC phenotypic switching and carotid artery injury-induced neointima formation in mice. Transcriptome sequencing revealed that SMYD2 knockdown represses the expression of serum response factor (SRF) target genes and that SRF overexpression largely reverses the inhibitory effect of SMYD2 knockdown on VSMC proliferation. HDAC3 directly interacts with and deacetylates SRF, which enhances SRF transcriptional activity in VSMCs. Moreover, SMYD2 promotes HDAC3 expression via tri-methylation of H3K36 at its promoter. RGFP966, a specific inhibitor of HDAC3, not only counteracts the pro-proliferation effect of SMYD2 overexpression on VSMCs, but also inhibits carotid artery injury-induced neointima formation in mice. HDAC3 partially abolishes the inhibitory effect of SMYD2 knockdown on VSMC proliferation in a deacetylase activity-dependent manner. Our results reveal that the SMYD2-HDAC3-SRF axis constitutes a novel and critical epigenetic mechanism that regulates VSMC phenotypic switching and neointimal hyperplasia.

[Objective]To explore the health preservation thoughts contained in Three Essentials of Health Cultivation written by the health practitioner YUAN Huang in Ming Dynasty,providing certain techniques for modern people to cultivate and maintain health.[Methods]By using literature research methods,this paper analyzes the health preservation content of Three Essentials of Health Cultivation and systematically interprets it in conjunction with classic theories of traditional Chinese medicine(TCM)and traditional Chinese culture.By adopting the approach of"passing on the ancient culture without adding anything new to it",the paper delves into the health preservation ideas and methods contained in the book,analyzes the author's contribution to health preservation and the guiding significance of health preservation benefits for people in today's society.[Results]The Three Essentials of Health Cultivation was written by YUAN Huang,who was a native of Jiashan Zhejiang during the Ming Dynasty.This book was extracted by later generations from the YUAN Huang's True Interpretation of Praying for Inheritance.In the book,YUAN Huang elaborated the three major principles of maintaining health:essence,Qi and spirit,namely gathering essence,nourishing Qi and preserving spirit for health preservation.The book contains both the health preservation concepts of TCM and the techniques of Taoism and Buddhism.Its health preservation techniques are friendly and natural which are explained reasonably,making it particularly practical.[Conclusion]The health preservation methods mentioned by YUAN Huang are simple and practical,which are easy to understand and practice for modern people who are obsessed with external factors and have rare leisure time.If one can practice a little while busy,he can achieve the goal of maintaining physical and mental health and promoting a better life.

Objective:To summarize the best evidence for non-pharmacological interventions for postoperative pain in patients undergoing abdominal surgery, so as to provide reference for alleviating postoperative pain in patients.Methods:UpToDate, BMJ Best Practice, PubMed, Embase, Web of Science, Guidelines International Network and other databases and professional association websites were searched for guidelines, clinical decisions, evidence summaries, systematic reviews, expert consensus and randomized controlled trials on non-pharmacological interventions for postoperative pain in patients undergoing abdominal surgery. The search period was from the establishment of the databases to December 30, 2022.Results:A total of 17 articles were included, including three clinical decision-making, four guidelines, six systematic evaluations, two expert consensus, one randomized controlled trial and one quasi-randomized cotrolled trial. A total of 30 pieces of evidence were summarized from six aspects, such as basic principles of non-pharmacological intervention, evaluation and planning, physical intervention, psychological intervention, other forms of intervention, health education and follow-up.Conclusions:The best evidence for non-pharmacological intervention in postoperative pain in patients undergoing abdominal surgery can provide a basis for clinical medical staff to conduct non-pharmacological intervention.

Objective:To explore the behavioral intention of nurses for pain management after abdominal surgery based on the planned behavior theory.Methods:According to the framework of planned behavior theory, an interview outline was developed. Using the purposive sampling method, a total of 11 General Surgical Department nurses from the First Affiliated Hospital of Wenzhou Medical University from July to November 2022 were selected as the interview subjects for semi-structured interviews to understand their behavioral intentions regarding postoperative pain management in abdominal surgery. Colaizzi 7-step analysis was used to analyze the original data. Two researchers repeatedly compared, verified, analyzed and summarized the interview data. When different opinions were generated, the group members discussed and decided together to ultimately determine the code and theme.Results:Based on the three dimensions of behavioral attitude, subjective norms and perceived behavioral control in the theoretical framework of planned behavior, three themes and seven sub-themes were extracted, such as behavioral attitude (positive attitude, negative attitude), pressure sources (group pressure, leadership pressure, patient and family pressure), subjective perception and behavior (imprisonment of comfort zone, insufficient support from external resources) .Conclusions:Most nurses hold a positive attitude towards pain management behavior after abdominal surgery, and the behavioral intention of postoperative pain management is affected by colleagues, leaders, patients and their families. At the same time, there are also obstacles such as insufficient personal ability and insufficient support from external resources.