BACKGROUND:Erythropoietin has anti-inflammatory,anti-apoptotic,and pro-bone defect repair effects.To date,fewer studies have been conducted on its effects and molecular mechanism underlying restorative dentin formation after pulp injury. OBJECTIVE:To explore the effect of erythropoietin on restorative dentin formation after pulp injury. METHODS:(1)Animal experiment:Thirty-two rats were randomly divided into control group(n=16)and experimental group(n=16).In the experimental group,collagen sponges containing erythropoietin were used to directly cap the pulp at the pulp injury,and in the control group,collagen sponges containing PBS were used to directly cap the pulp at the exposed pulp injury.The cavity was then closed with glass ionomer adhesive.After 2 and 4 weeks of treatment,the maxillary bones of the two groups were collected,and the expression of nestin in dentin was detected by immunohistochemistry,and the reparative dentin production was observed by hematoxylin-eosin staining.The maxillae of four Sprague-Dawley rats were taken for immunohistochemical detection of erythropoietin expression in molar and incisor teeth.(2)Cell experiment:Human dental pulp cells,human periodontal ligament cells and human gingival fibroblasts were obtained from human dental tissue,periodontal ligament,and gingival tissue.Real-time reverse transcription PCR(RT-PCR)was used to detect the mRNA expression of erythropoietin.Erythropoietin,dentin sialophosphoprotein,dentin matrix protein 1,and nestin mRNA levels in human pulp cells were detected by RT-PCR under induced or uninduced odontoblastic differentiation.After down-regulation of erythropoietin expression or exogenous administration of erythropoietin intervention under induced or uninduced differentiation odontoblastic differentiation,the relative mRNA expression of dentin sialophosphoprotein and dentin matrix protein 1 in human pulp cells was detected by RT-PCR,and the formation of mineralized nodules was detected by alizarin red S staining,and mRNA and protein expressions of bone morphogenetic protein 2 were detected by RT-PCR and western blot,respectively. RESULTS AND CONCLUSION:(1)Animal experiment:Compared with the control group,the restorative dentin production and nestin expression were higher in the experimental group after 2 and 4 weeks of treatment.The expression of erythropoietin was weakly positive in pulp,odontoblastic cell layer and periodontal membrane of the rat's first maxillary molar,and strongly positive in odontoblasts.(2)Cell experiment:The mRNA expression of erythropoietin was higher in human dental pulp cells than in the other two types of cells.The mRNA expressions of dentin sialophosphorin,dentin matrix protein 1,nestin,erythropoietin and bone morphogenetic protein 2 in human pulp cells increased and the formation of mineralized nodules during odontoblastic differentiation under induction compared with non-induction conditions.The mRNA expression of dentin sialophosphoprotein,dentin matrix protein 1,nestin,bone morphogenetic protein 2 and the formation of mineralized nodules were decreased in human pulp cells after downregulation of erythropoietin under induced odontoblastic differentiation,and the protein expression of bone morphogenetic protein 2 was also decreased.After exogenous erythropoietin intervention,the expression of the above indexes in human dental pulp cells increased.To conclude,erythropoietin can promote the formation of dentin to some extent.

Dysregulation of immune response is currently recognized as one of the important pathological factors in ulcerative colitis (UC). Based on the confirmation that the Sini San (SNS) can significantly improve the colon inflammation induced by dextran sulfate sodium sulfate (DSS) in mice, the present work systematically studied the xenobiotics in the colon and mesenteric lymph nodes, spleen, and thymus of UC mice after administration of SNS by high-performance liquid chromatography-ion trap time-of-flight mass spectrometry (HPLC-IT-TOF-MS). The results showed that, in addition to the colon, some components and their metabolites in SNS could be distributed in immune tissues, and it was found that the quality of relatively low-abundance and weakly responsive components such as saikosaponin a, paeoniflorin, and glycyrrhizic acid had the characteristics of efficient transmission to the colon and lymphoid organs. These components were very likely to be the source of pharmacodynamic substances of SNS. The findings of this study lay a foundation for the study of the efficacy and molecular mechanism of the components against ulcerative colitis, and also provide a scientific basis for the rational clinical application of SNS, which is expected to promote the secondary development of its preparations.

The Department of Thoracic Surgery of Shanghai Chest Hospital has performed esophageal function testing for over 30 years, being the only department of its kind in China with this capability. The pressure testing and 24-hour pH/impedance monitoring of the esophagus is of great help to assist in the diagnosis and treatment of benign and malignant esophageal diseases related to it. Thanks to the esophageal function test, in addition to the routine various endoscopic anti-reflux procedures, our hospital has taken the lead in China in recent years to carry out a series of clinical and research work for benign esophageal diseases, such as the development of magnetic ring, double nedoscopic combination and new anti-reflux endoscopic techniques. In recent years, we have carried out high-resolution esophageal manometry and 24-hour pH/impedance monitoring for patients with interstitial pneumonia and pulmonary fibrosis suspected to be caused by gastroesophageal acid reflux. We can better assess the correlation between gastroesophageal reflux and pulmonary fibrosis, and to provide the different clinical treatments and even surgical interventions. The Bravo capsule is used more often in the United States, and it has obvious advantages over traditional approach for acid measurement. We strongly call for the collaboration between industry and academic institutions in this field, and the development of our own related products with independent intellectual property rights.

OBJECTIVE To promote the application of drones in emergency rescue and related fields， expand “low-altitude+ medical” rescue services， and advance the standardization of “low-altitude+medical” distribution services. METHODS The Consensus on Low-altitude Transport and Delivery Services for Emergency Medicines via Drones （2025 Edition） （hereinafter referred to as the Consensus） was jointly initiated by the Division of Therapeutic Drug Monitoring， Chinese Pharmacological Society and the Expert Committee on Precision Medication of the Guangdong Pharmaceutical Association. Guangzhou Red Cross Hospital served as the leading unit， organizing 53 multidisciplinary experts nationwide to participate in drafting and reviewing. A nominal group technique was employed to discuss and finalize the consensus outline， resulting in a preliminary draft. Delphi method was employed， and 11 external review experts were invited to conduct the evaluation. After the experts’ opinions were analyzed and integrated， the Consensus was finalized. RESULTS & CONCLUSIONS The finalized Consensus includes its purpose， principles， and applicable scenarios， basic requirements， and operational procedures for low-altitude transport and delivery of emergency medications； distribution requirements and precautions for controlled substances， fragile medications， and temperature-sensitive medications； and recommendations for emergency medications supplies suitable for the low-altitude transportation and distribution. The release of this Consensus is expected to provide guidance and support for the standardization of “low-altitude+medical” distribution services and the application of low-altitude economy in the healthcare sector.

Objective:To correlate rs6677604 single nucleotide polymorphism (SNP) with mesangial C3 deposition and prognosis among patients with IgA nephropathy.Methods:A retrospective nested case-control study was conducted among 380 patients with IgA nephropathy who received treatment at Taizhou Central Hospital from July 2018 to July 2021. All patients were tested for rs6677604 SNP. Among them, 36 AG genotypes and 72 GG genotypes were selected. The clinical data (IgA, C4, C3 deposit scores, percutaneous kidney biopsy, interstitial fibrosis/glomerular atrophy, mesangial C3 deposition), tissue and circulating complement levels, and CFHR gene copy numbers were compared between two genotypes. Regular follow-ups were conducted for 2 years to analyze the prognosis of patients with different rs6677604 genotypes. Results:Patients with the rs6677604-AG genotype had scores of (1.34 ± 0.50) points for IgA, (1.47 ± 0.31) points for C4 deposit, and (2.65 ± 0.36) points for C3 deposit, all of which were significantly lower than those in patients with rs6677604-GG genotype [(1.77 ± 0.73) points, (2.17 ± 0.33) points, (3.00 ± 0.48) points, t = -3.17, -10.59, -3.86, all P < 0.05]. The deposition intensity of mesangial C3 was predominantly 2+. Circulating levels of C3, C4, and complement factor H were significantly higher in patients with rs6677604-AG genotype compared with patients with rs6677604-GG genotype ( t = 7.90, 9.87, 2.27, all P < 0.05). Circulating levels of IgA and Gd-IgA1 were significantly lower in patients with rs6677604-AG genotype compared with those with rs6677604-GG genotype ( t = -2.98, -2.08, both P < 0.05). All patients with rs6677604-AG genotype had 1 copy of the CFHR3 gene, with 33 cases (91.67%) having 1 copy and 3 cases (8.33%) having 2 copies of the CFHR1 gene. Both CFHR3 and CFHR1 genes in patients with rs6677604-GG genotype were 2 copies. There was no statistically significant difference in composite endpoint between patients with rs6677604-AG and rs6677604-GG genotypes over the 2-year period (χ 2 = 0.19, P = 0.656). Conclusion:RS6677604 SNP is correlated with circulating complement factor H levels and mesangial C3 deposition in patients with IgA nephropathy, and may have a regulatory effect on complement activation in IgA nephropathy.

Objective To explore the lipid-lowering effect of Qige Decoction before and after compatibility through the combination of pharmacodynamics and liver metabolomics,and to provide new research strategies for exploring the scientific notation of traditional Chinese medicine compatibility.Methods According to the pharmacodynamic strategy,three groups of drug administration were set up as Qige Decoction group,Astragali Radix-Puerariae Radix group,and Pericarpium Citri Tangerinae group.Four indices of blood lipids,serum biochemical indicators,and liver morphology and pathology were used to evaluate the intervention effect of Qige Decoction on hyperlipidemic rats.Liver metabolomics technology was used to analyze the effects of Qige Decoction on metabolites before and after compatibility,and multivariate statistical analysis was used to evaluate the differences between groups in terms of differential metabolites and metabolic pathways.Results Compared with the model group,the callback abilities of four indices of blood lipid in the Qige Decoction group were higher than those in Astragali Radix-Puerariae Radix group and Pericarpium Citri Tangerinae group,among which the total cholesterol(TC)and triglyceride(TG)levels in the Qige Decoction group decreased(P＜0.05).A total of 86 potential biomarkers were identified by liver metabolomics,with 23,13,and 7 metabolites being significantly different in the Qige Decoction group,Astragali Radix-Puerariae Radix group,and Pericarpium Citri Tangerinae group,respectively(P＜0.05).Metabolic pathway analysis of 29 specific biomarkers with significant callback effects showed that they were related to glycerophospholipid metabolism,linoleic acid metabolism,α-linolenic acid metabolism,sphingolipid metabolism,arachidonic acid metabolism,and unsaturated fatty acid biosynthesis.Qige Decoction mainly regulates glycerophospholipid and linoleic acid metabolism,and uniquely acts on sphingolipid metabolism.Conclusion Qige Decoction has more lipid-lowering targets after compatibility,with better lipid-lowering effects than the Astragali Radix-Puerariae Radix group and Pericarpium Citri Tangerinae group.This study provides experimental evidence and research strategies for further revealing the scientific notation of traditional Chinese medicine compatibility.

Objective To investigate the effect of hyperbaric oxygen(HO)combined with ginkgo biloba extract(GBE)in elderly patients with vascular dementia.Methods A total of 132 elderly patients with vascular dementia who visited the Ninth People's Hospital of Zhengzhou from January 2019 to December 2022 were selected as the research subjects,and they were divided into the observation group and control group using a random number table method,with 66 patients in each group.Both groups of patients received routine treatment,while the control group received HO therapy once a day;patients in the observation group were treated with HO combined with GBE once a day;both groups of patients were treated continuously for one month.The cognitive function and activities of daily living of two groups of patients before and after treatment were evaluated using the Montreal Cognitive Assessment(MoCA)scale and Barthel index,and the clinical efficacy of the two groups of patients after treatment was evaluated based on the MoCA score and Barthel Index.Transcranial Doppler ultrasound was used to detect the average blood flow velocity(ABFV)of the anterior cerebral artery(ACA),posterior cerebral artery(PCA),middle cerebral artery(MCA)and vertebral artery(VA)in the two groups of patients before and after treatment.Results There was no statistically significant difference in MoCA score and Barthel index between the two groups of patients before treatment(P＞0.05).After treatment,the MoCA score and Barthel index of both groups of patients were higher than those before treatment(P＜0.05),and the MoCA score and Barthel index in the observation group were higher than those in the control group(P＜0.05).After treatment,the total effective rates of the control group and the observation group were 84.85％(56/66)and 95.45％(63/66),respectively,and the total effective rate of the observation group was significantly higher than that of the control group(x2=4.181,P＜0.05).There was no statistically significant difference in the ABFV of the ACA,PCA,MCA and VA between the two groups of patients before treatment(P＞0.05).After treatment,the ABFV of the ACA,PCA,MCA and VA in the two groups of patients was higher than that before treatment(P＜0.05),and the observation group was higher than the control group(P＜0.05)in terms of the ABFV of the ACA,PCA,MCA and VA.The total incidence of adverse reactions in the control group and observation group during treatment was 16.67％(11/66)and 18.18％(12/66),respectively,and there was no statistically significant difference in the total incidence of adverse reactions between the two groups of patients(x2=0.218,P＞0.05).Conclusion The combination of HO and GBE can significantly improve cerebral blood flow status and cognitive dysfunction in patients with vascular dementia and enhance their activities of daily living with good overall efficacy and high safety.

Obesity and related metabolic syndromes have been recognized as important disease risks,in which the role of adipokines cannot be ignored.Adiponectin(ADP)is one of the key adipokines with various beneficial effects,including improving glucose and lipid metabolism,enhancing insulin sensitivity,reducing oxidative stress and inflammation,promoting ceramides degradation,and stimulating adipose tissue vascularity.Based on those,it can serve as a positive regulator in many metabolic syndromes,such as type 2 diabetes(T2D),cardiovascular diseases,non-alcoholic fatty liver disease(NAFLD),sarcopenia,neurodegenerative diseases,and certain cancers.Therefore,a promising therapeutic approach for treating various metabolic diseases may involve elevating ADP levels or activating ADP receptors.The modulation of ADP genes,multimerization,and secretion covers the main processes of ADP generation,providing a comprehensive orientation for the development of more appropriate therapeutic strategies.In order to have a deeper understanding of ADP,this paper will provide an all-encompassing review of ADP.

To improve the effectiveness of bedside localization of nasointestinal tube(NIT)and facilitate the placement of nasointestinal tube into jejunum,we established a procedure and composed a teaching verse for bedside placement of nasointestinal tube based on relevant classical literature and our own practices.Verse content:enteral nutrition means a successful strategy to improve the outcome in critically ill patient management,never hesitate to place nasointestinal tubes when necessary.There are several methods to deal with it,but popularizing it remains a long way off.Half-sitting and swallowing into the esophagus,freely withdrawing signifies the stomach cavity.Passing through the pylorus using light tension on the tube in the right lateral decubitus position.Arriving at the jejunum with low resistance in the left lateral decubitus position.What are the signs of intragastric coiling?Tube return out of nose is the initial observation,Failure of air insufflation indicates tube coiling.Dyeing location surpasses imaging.Vacuum test is the most sensitive,Sequential change from acid to base is specific.Methylene blue test is dramatical for localization.Combining three methods is enough to navigate.Abdominal plain film is the goldan standard and can still be used in ultrasonic era.3-D image establishes overall view.CT reveals the tube route exactly.The teaching verse has become a powerful tool for clinical teaching of manual nasointestinal tube placement in a concise and easy-to-remember form.

Objective To describe the diagnosis,treatment,and clinical course of a patient with severe acute organophosphorus pesticide poisoning(AOPP)complicated by recurrent respiratory failure,intermediate syndrome(IMS),multiple organ dysfunction syndrome(MODS)and sepsis.Methods On May 8,2021,a patient who self-administered the pesticide Dimethoate AOPP was admitted to the department of internal medicine intensive care unit(MICU)of the First People's Hospital of Yunnan Province.After 29 days of treatment,the patient was successfully cured and discharged.The clinical diagnosis and treatment process was introduced.Results The 78-year-old male patient suffered from severe AOPP due to self-ingestion of the pesticide leptophos.Upon admission,he rapidly developed respiratory failure requiring urgent endotracheal intubation and mechanical ventilation support.A series of targeted treatments were administered,including the use of reactivators such as pralidoxime iodide,anticholinergic agents like atropine and scopolamine,as well as antibiotic therapy and management of water-electrolyte balance and acid-base equilibrium.Throughout his treatment,the patient experienced multiple complications,including episodes of sepsis,fluctuating cholinesterase levels,infections from multidrug-resistant bacteria,and recurrent respiratory failures.After 29 days of meticulous care,the patient was successfully weaned off the ventilator,regained normal organ function,and was discharged.Conclusion The analysis of this case highlights the importance of closely monitoring and managing drug dosage adjustments,preventing and treating infections,addressing septic shock,paying attention to the prevention and control of ventilator-associated pneumonia(VAP),conducting timely psychological evaluations,and providing interventions during the treatment process for AOPP.