Minimally conscious state （MCS） is at the edge between closed and open consciousness， but it still belongs to the category of "wind-strike block" syndrome. The basic pathogenesis of MCS is the obstruction of pathogenic qi， orifices closed and spirit hidden， with pathological factors including phlegm， fire， and blood stasis. Wind movement and water retention may also be present， and often leading to deficiency syndrome due to the exhaustion of qi， blood， yin， and yang at later stages. Treatment chooses Shexiang （Moschus） as the chief medicinal， emphasizing combination of medicinals and urgency of medication administration； the key therapeutic method is to open the orifices， with focuses on expelling pathogens and reinforcing healthy qi. For patients with severe phlegm or fire， use Xiaochengqi Decoction （小承气汤） to open the lower orifices， discharge heat and unblock the bowels， combined with Shexiang （Moschus） and Niuhuang （Bovis Calculus） to open the upper orifices， awaken the spirit and guide qi. For patients with turbid phlegm as the predominant， temporarily replace Shexiang （Moschus） with Baizhi （Angelicae dahuricae radix）， using Ditan Decoction （涤痰汤） to eliminate phlegm to open the orifices， when turbid phlegm gradually subsided， Shexiang （Moschus） could be added. For patients with blood stasis as the predominant， Tongqiao Huoxue Decoction （通窍活血汤） will be used to activate blood and open orifice， if the blood circulates， the endogenous wind will be calmed， the water will be induced， the orifices will open and the consciousness will restore. For patients with closed orifices and body deficiency， the treatment should open the orifices and reinforce healthy qi， and consider the root and branch simultaneously； qi deficiency syndrome can be addressed with Buyang Huanwu Decoction （补阳还五汤） to boost qi and reinforce healthy qi； yin deficiency syndrome can be treated with Shaoyao Gancao Decoction （芍药甘草汤） combined with Fengsui Pill （封髓丹） to nourish yin， soften sinews， and secure kidney essence； yang deficiency can be managed by using Dihuang Yinzi Decoction （地黄饮子） to enrich yin， supplement yang， and open the orifices.

Objective To explore the regulatory effect and mechanism of Zhongfeng Xinglou Tongfu Capsule on the brain inflammatory response of mice with cerebral hemorrhage through cholecystokinin octapeptide(CCK-8)mediated the interleukin 10(IL-10)/signal transduction and transcriptional activator 3(STAT3)signaling pathway.Methods A total of 110 C57BL/6 mice were divided into sham operation group,cerebral hemorrhage group,Zhongfeng Xinglou Tongfu Capsule low-,medium-,and high-dose groups according to the random number table method,with 22 mice in each group.The intracerebral hemorrhage model was established by collagenase method.At 2 hours after the establishment of the model,Zhongfeng Xinglou Tongfu Capsule suspension was intragastrically administered at a dose of 10 mL·kg-1.The sham operation group and the cerebral hemorrhage group were intragastrically administered with the same dose of normal saline.The neurofunctional score and left-turn rate of the mice were recorded.The dry and wet weight method was used to detect brain water content on the 72 h after surgery,and the Western Blot method was used to detect tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β),interleukin 6(IL-6),interleukin 10(IL-10),and the relative expression levels of JAK-1,STAT3,and p-STAT3 pathway proteins around the hematoma of mice at 72 h after surgery.On the 3rd and 5th day after surgery,Elisa method was used to detect the relative expression level of CCK-8,qPCR method was used to detect the expression levels of IL-10 and STAT3 mRNA.Results Compared with the cerebral hemorrhage group,the NDS scores of mice in the low-,medium-,and high-dose groups of Zhongfeng Xinglou Tongfu Capsules were significantly reduced on the 3rd and 5th days after intervention treatment(P＜0.01).And the left-turn rate in the low-dose group on the 3rd and 5th days after intervention treatment was reduced(P＜0.05),the left-turn rate in the medium-dose group was reduced on the 3rd day(P＜0.05)and the 5th day(P＜0.01).Furthermore,the left-turn rate was obviously reduced on the 3rd and 5th day in the high-dose group(P＜0.01).The brain water content of mice in the low-dose group was reduced(P＜0.05),and the brain water content of mice in the medium-and high-dose groups was significantly reduced(P＜0.01).In the low-dose group,the expressions of pro-inflammatory factors TNF-α,IL-6 and JAK-1,STAT3,and p-STAT3 pathway proteins were significantly reduced(P＜0.01),while the expression of IL-1β was reduced(P＜0.05),the expression of IL-10 increased significantly(P＜0.01).The expression of pro-inflammatory factors TNF-α,IL-1β,IL-6,as well as JAK-1,STAT3,and p-STAT3 pathway proteins in the medium-and high-dose groups was significantly reduced(P＜0.01),the expression of anti-inflammatory factor IL-10 increased significantly(P＜0.01).The content of CCK-8 in the low-dose group was increased on the 3rd day after treatment(P＜0.05),and the content increased significantly on the 5th day(P＜0.01).The content of CCK-8 in the medium-and high-dose groups obviously increased on the 3rd and the 5th day after treatment(P＜0.01).The relative expression level of IL-10 mRNA was significantly increased after treatment(P＜0.01),but the relative expression level of STAT3 mRNA was significantly decreased after treatment(P＜0.01).Conclusion Zhongfeng Xinglou Tongfu Capsule can target the content of brain-gut peptide CCK-8 and regulate the IL-10/STAT3 signaling pathway to reduce the secondary inflammatory reaction and cytotoxic brain edema after cerebral hemorrhage.

Although NPM1 mutations are frequently found in acute myeloid leukemia patients, therapeutic strategies are scarce and unsuitable for those who cannot tolerate intensive chemotherapy. Here we demonstrated that heliangin, a natural sesquiterpene lactone, exerts favorable therapeutic responses in NPM1 mutant acute myeloid leukemia cells, with no apparent toxicity to normal hematogenous cells, by inhibiting their proliferation, inducing apoptosis, causing cell cycle arrest, and promoting differentiation. In-depth studies on its mode of action using quantitative thiol reactivity platform screening and subsequent molecular biology validation showed that the ribosomal protein S2 (RPS2) is the main target of heliangin in treating NPM1 mutant AML. Upon covalent binding to the C222 site of RPS2, the electrophilic moieties of heliangin disrupt pre-rRNA metabolic processes, leading to nucleolar stress, which in turn regulates the ribosomal proteins-MDM2-p53 pathway and stabilizes p53. Clinical data shows that the pre-rRNA metabolic pathway is dysregulated in acute myeloid leukemia patients with the NPM1 mutation, leading to a poor prognosis. We found that RPS2 plays a critical role in regulating this pathway and may be a novel treatment target. Our findings suggest a novel treatment strategy and lead compound for acute myeloid leukemia patients, especially those with NPM1 mutations.

Objective:To analyze and interpret the literature on intestinal preparation during colonoscopy in the elderly in China, and explore the research hotspots and development frontiers in this field, so as to provide theoretical reference for relevant institutions and researchers.Methods:Bibliometrics CiteSpace Ⅴ software was used to search CNKI, Wanfang Database, VIP, Chinese biomedical journal database, Chinese biomedical literature database from January 1, 2000 to April 30, 2022, and then statistical analysis was made on the number of published papers, distribution of institutions and regions, authors, journals, funding, and the maps of high-frequency keywords, clustering, and cooperation of authors, institutions and burst words were drawn.Results:A total of 281 literatures were included, and the characteristics of intestinal preparation, the effect of intestinal preparation for colonoscopy and nursing intervention of intestinal preparation for colonoscopy in the elderly were extracted as the research focus.Conclusions:The visualization analysis showed the research hotspots and trend of intestinal preparation during colonoscopy in the elderly. Intestinal preparation and comprehensive nursing intervention are still the focus of future research, and the cooperation among researchers and quality of published literature should be improved based on the research hotspots in the future.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Dermatomyositis, a common autoimmune disease in clinical practice, often involves muscles and lungs, and can be complicated by malignant tumors, and the lung involvement can be fatal. Therefore, early diagnosis and treatment of dermatomyositis is of great benefit for the reduction of muscle and lung injury, early recognition and management of malignant tumors, and improvement of prognosis and survival rate of patients. However, the heterogeneity and various clinical manifestations of dermatomyositis pose challenges to early diagnosis. This article describes risk factors for dermatomyositis complicated by rapidly progressive pulmonary interstitial fibrosis, dysphagia or malignant tumors, and proposes a mode of "rashes + nailfold capillary abnormalities + myositis antibodies" for the early diagnosis of dermatomyositis, early recognition of important visceral injury and tumors, and early management, in order to improve overall survival rate of patients.

OBJECTIVE: To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting. METHODS: A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively. RESULTS: In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane. CONCLUSION In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.
Adult ; Humans ; Shoulder ; Rotator Cuff/surgery* ; Arthroscopy/methods* ; Scapula/surgery* ; Shoulder Joint/surgery* ; Cadaver ; Joint Instability/surgery*

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

Objective:To investigate the effectiveness and safety of the VA regimen, which combines venetoclax with azacitidine in the treatment of patients with newly diagnosed acute myeloid leukemia (AML) who are not suitable candidates for conventional chemotherapy.Methods:In the Department of Hematology at the Second Hospital of Hebei Medical University, 66 AML patients who received venetoclax and azacitidine treatment from May 2020 to March 2022 were the subject of a retrospective study. The complete remission (CR) rate, cCR rate, ORR rate, MRD negative rate, the incidence of adverse events,1-year EFS, and OS were retrospectively analyzed. Patients subgroups with varying ages, ECOG scores, primary and secondary, risk stratifications, and gene mutation were compared for differences in efficacy and survival.Results:The median follow-up was 4.25 (0.9-19.9) months, and the median number of treatment courses was 2 (1–8) cycles. After the first cycle, the cCR rate was 78.8% , and the MRD negative rate was 51.9% . After prolonged treatment, the cCR rate was 81.8% and MRD negative rate was 66.7% . The median EFS and OS, respectively, were13.2 and 15.3 months. Secondary AML showed inferior efficacy and prognosis. IDH1/2 or NPM1 mutation groups had a significantly higher rate of CR than the control group ( P<0.05) . The CR rate and MRD negative rate of patients with rebound thrombocytosis were significantly higher than those without rebound thrombocytosis ( P<0.05) . Those who had epigenetic modification mutations (DNMT3, ASXL1, TET2) were more likely to benefit from ongoing therapy. The most common grade 3 and 4 adverse reactions were neutropenia, thrombocytopenia, and anemia. Conclusions:In real-world patients with newly diagnosed AML who are not candidates for standard chemotherapy, the VA regimen produces rapid deep remission. Primary AML patients, rebound thrombocytosis, IDH1/2, and NPM1 gene mutations are favorable factors for treatment benefit, and adverse reactions were tolerable.

Objective:To explore the research hotspots and trends of the second victim in China in recent years, so as to provide a reference for domestic researchers and institutions.Methods:CiteSpaceⅤ bibliometrics software was applied to retrieve literature on the second victim in China National Knowledge Infrastructure, WanFang Data, VIP Data, and China Biomedical Literature Database. The retrieval time limit was from January 1, 2015 to October 26, 2021. This article drew the knowledge map of the authors, institutions, and high-frequency keywords and conducted statistical analysis.Results:A total of 55 articles were included. After integrating high-frequency keywords, it was concluded that the research hotspots focused on nurses' experience as second victims, patient safety culture, and second victim support.Conclusions:The number of published articles on the second victim in China is small, and there is a lack of cooperation between authors and institutions, and there is a certain gap with foreign research. Further research can be carried out around the research hotspots of the second victim.