OBJECTIVE To analyze the influencing factors for achieving target plasma drug concentration （trough） （abbreviated as “PDC”） of vancomycin in patients from high-altitude regions and establish a predictive model for PDC using single- center data， providing references for rational clinical drug use. METHODS Inpatients with vancomycin （1 g， q12 h） administered intravenously in our hospital from January 2021 to June 2024 were retrospectively included. Demographic data， liver and kidney function and hematological indexes were collected. Spearman correlation analysis was used to evaluate the correlation between vancomycin PDC and each detection index. Univariate analysis was used to evaluate the differences of each index in patients with different PDC， and the effects of different gender， body mass index， age and underlying diseases （hypertension/diabetes） on vancomycin PDC. Based on the results of correlation analysis and univariate analysis， multiple linear stepwise regression analysis was used to obtain the independent predictors of vancomycin PDC and construct the prediction model. RESULTS A total of 141 patients were included， with an overall attainment rate of 46.81% for the target PDC of vancomycin. Correlation analysis showed that the vancomycin PDC was positively correlated with age， blood urea nitrogen， uric acid （UA）， serum creatinine （CRE） and β2- microglobulin （β2-MG）， and negatively correlated with height， weight， creatinine clearance rate （CCR）， glomerular filtration rate （GFR）， alanine transaminase （ALT）， hemoglobin （HGB）， white blood cell count and neutrophils （P＜0.05）. There were significant differences in age， CRE and other 14 indexes among different PDC groups （P＜0.05 or P＜0.01）. Age and underlying diseases had significant effects on vancomycin PDC （P＜0.05 or P＜0.01）. CCR， direct bilirubin （DBil）， β2-MG， UA， HGB and height （standardized coefficients were －0.371， 0.367， 0.169， 0.232， －0.140， －0.132； P＜0.05） were independent predictors of vancomycin PDC. The F value of the regression equation was 34.858 （P＜0.05）， the R2 was 0.610， and the adjusted R2 was 0.592. CONCLUSIONS The vancomycin PDC of patients in high-altitude regions is affected by multiple factors such as renal function， liver function and hematological indexes. CCR， HGB and height could be used to predict vancomycin PDC negatively， while DBil， β2-MG and UA could be used to predict vancomycin PDC positively. The variables of the established prediction model could explain 59.2% of the variation of vancomycin PDC.

Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.

Objective:To study the feasibility of detecting vertical semicircular canal function and to analyze the three-dimensional(3D)characteristics and normal reference value in healthy young people.Methods:This was a cross-sectional study conducted from January to June 2024. A three-axis rotating chair was used to perform vertical sinusoidal rotation on 52 healthy young adults (26 males and 26 females, aged 18-40 years) in the left anterior-right posterior (LARP) and right anterior-left posterior (RALP) semicircular canal planes. For each plane, nystagmus was induced with six combinations of different angles and velocity front and back rotation angles of ±30°,±60°,±90°, and velocities of 40°/s and 80°/s, the slow phase velocity (SPV) and their symmetry of 3D nystagmus were analyzed. SPSS 20.0 was used to compare the statistical differences in these two parameters across different stimulation protocols.Results:There were no spontaneous nystagmus in the 52 subjects, and all tests were finished. Except the combinations of (±30°-40°/s), three components of nystagmus were induced stably in the rest of the stimulations. The SPVs of vertical components were no statistically insignificant ( P>0.05), and some horizontal or torsion components were statistically significant ( P<0.05). The 95% reference range of the symmetry was≤25% in the vertical and≤30% in the torsional component of the nystagmus except for (±30°-80°/s), the symmetry was 32.2% and 49.2% respectively. The trend changes of the three components were consistent, among which the vertical and torsional components induced by (±60°-80°/s) and (±90°-80°/s) were the best, the SPV value of the vertical components was higher in the latter group than the former apart from the front RALP, while no significant difference was found in the torsional components ( P>0.05). Conclusion:The (±90°-80°/s) combination is the optimal method to detect the function of vertical semicircular canal in 3D chair test. When observing torsional component, the combining scheme of (±60°-80°/s) and (±90°-80°/s) is better. Considering tolerance, the (±60°-80°/s) combination is recommended.

Objective To investigate the effects of Xiaoyukang capsule on neuroinflammation and neuronal apoptosis after Intracerebral hemorrhage(ICH)in rats by regulating JNK/c-JUN signaling pathway.Methods Adult male SD rats were intrastriatally injected with bacterial collagenase Ⅶ to induce an ICH model and they were randomly divided into blank control group,model control group,Xiaoyukang capsule small dose group,medium dose group,and large dose group.Neurobehavioral tests,body mass measurements,hematoma volume statistics,hematoxylin-eosin(HE)staining,immunofluorescence,deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)staining,enzyme-linked immunosorbent assay(ELISA)and Western Blotting were performed after 3 and 5 days,respectively.Results Compared with the blank control group,the rats in the model control group had severe neurobehavioral defects and weight loss(P＜0.05).The arrangement of neurons in brain tissue was disordered,and there was microglia/macrophages activation,neutrophil infiltration,neuronal apoptosis(P＜0.05).The levels of pro-inflammatory factors TNF-α,IL-1β and the expression of p-JNK,p-c-JUN,Bax,Caspase-3 and Cleaved Caspase-3 protein around hematoma were significantly increased(P＜0.05),while the anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2 were decreased(P＜0.05).Compared with the model control group,Xiaoyukang capsule large dose group significantly improved the neurobehavioral function of rats,promoted weight recovery and hematoma absorption(P＜0.05).Reduce the pathological injury of brain tissue,inhibition of microglia/macrophages activation,neutrophil infiltration and neuronal apoptosis(P＜0.05).In addition,the levels of pro-inflammatory factors TNF-α,IL-1β and the expression of p-JNK,p-c-JUN,Bax,Caspase-3,Cleaved Caspase-3 protein around hematoma were significantly decreased(P＜0.05),and the anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2 were increased(P＜0.05).Conclusion Xiaoyukang capsule can improve neurobehavioral defects in ICH rats,promote body mass recovery and hematoma absorption,reduce pathological damage of brain tissue,inhibit microglia/macrophage activation and neutrophil infiltration,its mechanism may be achieved by inhibiting JNK/c-JUN-mediated neuroinflammation and neuronal apoptosis.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Purpose To investigate the value of two-dimensional speckle tracking in evaluating right ventricular function in cardiac amyloidosis(CA).Materials and Methods A total of 25 patients with CA,30 patients with hypertrophic cardiomyopathy(HCM)and 30 healthy controls were retrospectively selected from July 2021 to October 2023 in Wuhan Asia Heart Hospital.The regional difference was represented by the formula apical ratio.The parameters of conventional echocardiography,two-dimensional strain and apical ratio of the three groups were analyzed and compared.Results Only segmental strain was different in right ventricular structure and function between CA group and HCM group,and the differences were statistically significant(all P<0.05).In the CA group,the strain gradient of the right ventricle from the apex of the heart to the base was the same as that of the left ventricle,that was,the"apex preservation"pattern,which was not seen in the HCM group and the control group.Comparison of the right ventricular free wall longitudinal strain-apical ratio,right ventricle four-chamber longitudinal strain-apical ratio,left ventride global longitudinal strain-apical ratio among the three groups,it was found that the levels of CA group were higher than HCM group and control group,and the differences were statistically significant(H=40.40,43.18,55.43,all P<0.05).The right ventricular free wall longitudinal strain-apical ratio had the highest CA recognition value,the area under the curve was 0.935,sensitivity was 96%and specificity was 83%.Conclusion Two-dimensional speckle tracking can accurately evaluate the right ventricular function impairment in CA patients and provide a new choice for clinical evaluation and identification of CA patients.

Objective To exploring the drug rules for treating children's night cough based on the theory of"Shaoyang as the pivot".Methods 189 cases of children with night cough were included,and 224 prescriptions.Used the Traditional Chinese Medicine Inheritance Assistance Platform to analyze the time distribution,syndrome types,and four nature,five flavors,and channel tropism of diseases.Used frequency statistics,association rule analysis,and cluster analysis to extract drug patterns for pediatric night cough.Results Coughing occured most frequently during the Yin period.The syndrome type was mainly Shaoyang syndrome.The high-frequency core drugs were Chaihu,Huangqin,and Banxia,etc..The prescription characteristics were Xiaochaihu decoction without Renshen,Shengjiang,and Dazao,and added Wuweizi,Danggui and Xingren.The drugs were used flexibly according to the syndromes:Maxing Er San decoction was added to the phlegm and drink syndrome,Qumai Er Chen decoction was added to the food stagnation syndrome,Sijunzi decoction was added to the qi deficiency syndrome,Maiwei Dihuang decoction was added to the yin deficiency syndrome,and Weijing decoction was added to the phlegm and heat syndrome.Conclusion Based on the basic principle of harmonizing Shaoyang,and according to the disease mechanism,the classical prescription is flexibly used,forming a night cough treatment system based on the"Shaoyang as the pivot"theory,with distinct clinical characteristics.

Objective:To investigate the efficacy of a predictive model for differentiating benign and malignant renal tumors based on CT radiomic features and clinical features.Methods:A retrospective study was conducted on 1 395 patients with renal tumors admitted to the First Affiliated Hospital of Zhengzhou University from December 2011 to December 2021, including 842 males and 553 females. The median age was 55 (44, 59) years, and the median tumor diameter was 3.6 (2.7, 4.6) cm. All patients underwent contrast-enhanced CT scaning before surgery, and radiomic features were extracted from non-contrast, arterial, and venous phase images. Prediction models for distinguishing benign and malignant renal tumors were constructed using five machine learning algorithms (logistic regression, support vector machine, neural network, random forest, and extreme gradient boosting), and these models were then ensembled to construct a stacking classifier. All patients underwent partial nephrectomy, and they were divided into a training group (941 cases, December 2011 to June 2020) and a validation group (454 cases, July 2020 to December 2021) based on the date of surgery. A clinical-radiomic model was developed by combining the result of stacking classifier, clinical features and CT report results, and its predictive performance was evaluated in the validation group.Results:The radiomic signature based on the combined features and five machine learning algorithms(AUC 0.835-0.844) showed higher accuracy in predicting benign and malignant renal tumors compared to single phases (AUC 0.744-0.831). After integrating the five machine learning algorithms, the AUC of the three-phase combined radiomic model in the validation group improved to 0.847(95% CI 0.802-0.892). The clinical-radiomic model, incorporating radiomic features, clinical features, and CT report results, achieved a significantly higher AUC in the validation group compared to radiologists [0.919(95% CI 0.889-0.950)vs. 0.835(95% CI 0.786-0.883), P<0.01]. Conclusions:The predictive model integrating CT radiomics features, clinical characteristics, and CT report results demonstrates excellent discriminative ability in distinguishing benign and malignant renal tumors.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Objective To discuss the causes of abnormal arterial pressure waveforms occurring during coronary angiography(CAG)and percutaneous coronary intervention(PCI).Methods A total of 760 patients,who received CAG and PCI at Nanjing Municipal First Hospital of China from September 2023 to March 2024,were enrolled in this study.The abnormal arterial pressure waveforms were collected,and their morphological features and causes were analyzed.Results A total of 848 abnormal waveforms were recorded,and based on the morphology these abnormal waveforms were classified into 8 types.Three most commonly-seen abnormal waveforms were nested waveform(22.76％,n=193),atypical waveform(21.11％,n=179)and attenuated waveform(15.57％,n=132).The causes of the abnormal waveforms could be classified into 5 categories.The top three reasons were technical operation factors(n=445,52.49％),vascular factors(n=214,25.23％),and individual factors of the patient(n=101,11.91％).In the specific abnormal reasons,the ostial lesions and spasm of the coronary arteries accounted for the largest proportion(n=183,21.57％).Conclusion Accurate identification of abnormal waveforms is essential for the prevention of complications in performing CAG and PCI procedure.The technical operation factors are the main causes for the occurrence of abnormal waveform.