Objective:To explore the influencing factors for low back pain after decompression and fusion in patients with lumbar spinal stenosis and to construct a Nomogram prediction model.Methods:A retrospective study was conducted to analyze the 132 patients with lumbar spinal stenosis who had been treated at Department of Orthopedics, Nanyang Central Hospital from May 2021 to March 2022. The patients were divided into 2 groups according to their visual analog scale (VAS) pain score: a back pain-free group (104 cases with VAS ≤ 2) and a back pain group (28 cases with VAS > 2). Univariate and multiple logistic regression analyses were employed to identify the influencing factors for occurrence of lower back pain and a Nomogram prediction model for the risk of lower back pain was constructed in patients with lumbar spinal stenosis after decompression and fusion. The accuracy of the model was assessed using the receiver operating characteristic (ROC) curve. Furthermore, the model accuracy was pre-tested using an external validation model which included 66 illegible patients with lumbar spinal stenosis treated at Department of Orthopedics, Nanyang Central Hospital from May 2022 to March 2023. A comparison was made between the outcomes predicted by the model and the actual outcomes observed. The fit of the model was evaluated through the Hosmer-Lemeshow test.Results:The results of the multifactorial analysis indicated that interleukin (IL-1 β), postoperative aseptic inflammation in the vertebral canal, and intraoperative blood loss were independent influencing factors for the occurrence of lower back pain (all P < 0.05). A risk Nomogram prediction model was thus established based on these factors. The area under the curve (AUC) was 0.975, the sensitivity 92.90%, the specificity 91.30%, and the Youden index 0.842. External validation of the model showed an overall accuracy of 99.80%. The Hosmer-Lemeshow test demonstrated good model fit ( χ2=3.512, P=0.898). Conclusions:IL-1 β, postoperative aseptic inflammation in the vertebral canal, and intraoperative blood loss may be the primary influencing factors for the occurrence of lower back pain in patients with lumbar spinal stenosis after decompression fusion surgery. The Nomogram prediction model based on these influencing factors demonstrates excellent predictive efficacy for lower back pain.

Objective To explore the diagnostic efficiency of inflammatory cytokines in chronic obstruc-tive pulmonary disease(COPD)complicating pneumonia.Methods A total of 215 patients with COPD admit-ted and treated in the First Affiliated Hospital of Nanjing Medical University from July 2021 to August 2023 were selected as the study subjects.According to whether or not complicating pneumonia,the patients with complicating pneumonia were included in the observation group(n=87)and those with simple COPD were included in the control group(n=128).The changes of inflammation cytokines[procalcitonin(PCT),tumor necrosis factor-α(TNF-α),C reactive protein(CRP),interleukin-6(IL-6),WBC]and lung function indicators[peak expiratory flow rate(PEF),breathing volume in the first second(FEV1),forced vital capacity(FVC)]were compared between the two groups.The diagnostic efficiency of inflammatory cell factors in COPD com-plicating pneumonia as well as the correlation between the inflammatory cytokines and the lung function in the patients with COPD complicating pneumonia were analyzed.Results The levels of PCT,CRP,IL-6,TNF-αand white blood cell count(WBC)in the observation group were significantly higher than those in the control group(P＜0.05),and FEV1,FVC and PEF in the observation group were significantly lower than those in the control group(P＜0.05).The diagnostic efficiency of joint detection of PCT,CRP,IL-6,TNF-α and WBC in diagnosing COPD complicating pneumonia was better,the sensitivity was 90.80％,the specificity was 90.62％,the area under the curve(AUC)was 0.967.The correlation analysis revealed that the PCT,CRP,IL-6,TNF-α and WBC levels in the patients with COPD complicating pneumonia were negatively correlated with FEV1,FVC and PEF levels(P＜0.05).Conclusion The patients with COPD complicating pneumonia exhibit the typical inflammatory responses and deterioration of lung function.The combined detection of relevant in-flammatory indicators has the good diagnostic efficiency for it.

Objective: To evaluate the accuracy and feasibility of coronary artery calcium score ( CACS) on virtual non-contrast scan ( VNC) images obtained from coronary artery CT angiography ( CCTA) scan with dual －layer spectral detector CT (SDCT) ． Methods : The data of 197 patients who underwent CCTA scan in hospital were analyzed retrospectively，and 88 patients with CACS ＞0 were further analyzed． Linear regression analysis of CACS and coronary artery calcium volume ( CACV) of true non-contrast (TNC) images and VNC images ( CACS-TNC， CACS-VNC，CACV-TNC，CACV-VNC) was performed to obtain linear regression equation and correction coefficients λ 1AVG and λ2AVG ．CACS-VNC and CACV-VNC were corrected by the corresponding regression equation and recorded as CCACS-VNC and CCACV-VNC，respectively．Spearman correlation coefficient was used for correlation analysis and Bland-Altman plot was used for consistency test．Mann-Whitney U test was used to compare the difference between the two groups. Results : For the total coronary artery，there was a strong correlation between CACS- TNC and CACS-VNC (rs = 0. 952，P ＜0. 001 ，λ 1AVG = 2. 19 ) ，CACV-TNC and CACV-VNC ( rs = 0. 954，P < 0. 001，λ2AVG = 1. 93) ．The results of Mann-Whitney U test showed that there was no significant difference between CACS-TNC and CCACS-VNC or between CACV-TNC and CCACV-VNC，and the Bland-Altman plot showed good consistency between CACS-TNC and CCACS-VNC ，CACV-TNC and CCACV-VNC． Conclusion VNC images based on SDCT can accurately measure CACS and be used for cardiovascular risk classification，which is expected to replace TNC scan and reduce the radiation dose of patients.

Liver fibrosis occurs due to damages caused by liver diseases of various etiologies and activation of hepatic stellate cells, leading to the repairing and damaging cycle by secreting a large amount of extracellular matrix and formation of fibrosis tissues in the liver. Early reversal of this process could prevent further development and progression of the disease, which may reduce incidence of the end-stage liver disease and even liver cancer. This review summarized and discussed recent advancements and mechanisms of liver sinusoidal endothelial cells, Notch signaling pathway, YAP/TAZ signaling pathway, and autophagy in regulation of liver fibrosis and then enumerated the Traditional Chinese Medicine in reversal of liver fibrosis process and the underlying molecular mechanisms. It expects to provide novel approaches and research ideas for future control of liver fibrosis using Traditional Chinese Medicine.

Objective:To observe the effects of alprostadil at different doses on C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in patients with angina pectoris.Methods:From August 2017 to April 2018, 120 patients with angina pectoris admitted to China Coast Guard Hospital of the People's Armed Police Force were selected and divided into control group (60 cases) and observation group (60 cases) by random number table method.Both two groups received routine anti-angina treatment, while the control group received 10 μg alprostadil, the observation group received 20 μg alprostadil for 2 weeks.The changes of CRP, TNF-α, IL-6 and hemorheological indicators before and after treatment were compared between the two groups.Results:Before treatment, there were no statistically significant differences in the CRP, TNF-α and IL-6 between the two groups (all P>0.05). After treatment, the CRP, TNF-α and IL-6 levels in the observation group were (4.63±0.62)mg/L, (0.46±0.08)μg/L, (46.59±4.72)ng/L, respectively, which were significantly lower than those in the control group [(6.18±0.74)mg/L, (1.19±0.28)μg/L, (58.62±5.07)ng/L]( t=12.437, 19.418, 13.452, all P<0.05). The high shear viscosity, low shear viscosity, plasma viscosity and platelet aggregation rates in the observation group were (4.27±0.46)mPa/s, (8.07±0.18)mPa/s, (1.03±0.25)mPa/s, (37.42±1.05)%, respectively, which were lower than those in the control group [(5.14±0.588)mPa/s, (10.43±0.42)mPa/s, (2.01±0.46)mPa/s, (40.19±1.86)%] ( t=9.103, 40.006, 14.499, 10.046, all P<0.05). Conclusion:The conventional dose of alprostadil (20 μg) is effective in the treatment of angina pectoris.It can improve CRP, TNF-α, IL-6 and hemorheological parameters of patients.

Objective:To observe the efficacy of meglumine adenosine cyclophosphate (MAC) in the adjuvant treatment of chronic congestive heart failure(CHF) in the elderly, and its effects on cystatin C(Cys-C) and plasma B-type natriuretic peptide(BNP).Methods:From August 2017 to August 2018, 110 elderly patients with chronic CHF admitted to Zhejiang Provincial Armed Police Corps Hospital were selected and randomly divided into control group(55 cases) and observation group(55 cases) by random number table method.The control group was treated with routine treatment, while the observation group was treated with MAC on the basis of routine treatment.Both two groups were treated for 2 weeks.The clinical efficacy, left ventricular ejection fraction (LVEF), cardiac output, Cys-C and plasma BNP were compared between the two groups.Results:The total improvement rate of the observation group was 94.55%(52/55), which was higher than 78.18%(43/55) of the control group, the difference was statistically significant(χ 2=6.253, P<0.05). Before treatment, there were no statistically significant differences in LVEF, cardiac output, BNP and Cys-C between the two groups(all P>0.05). After treatment, the LVEF[(44.16±6.82)%], cardiac output[(8.07±1.45)L/min] of the observation group were significantly higher than those of the control group[(40.71±5.38)%, (6.44±1.37)L/min], and BNP[(1.65±0.24)mg/L], Cys-C[(552.79±10.46)mg/L] of the observation group were significantly lower than those of the control group[(2.31±0.48)mg/L, (681.73±12.71)mg/L], the differences were statistically significant( t=2.945, 6.060, 9.121, 0.551, all P<0.05). Conclusion:MAC has significant effect in the treatment of elderly patients with chronic CHF.It can improve the cardiac function of patients and reduce the plasma concentrations of Cys-C and BNP.

Objective:To clarify the clinical efficacy of Yiqi Huoxue recipe in the treatment of liver fibrosis of chronic viral hepatitis.Methods:An open, positive-drug, parallel-controlled study method was applied. A total of 207 cases of liver fibrosis with chronic hepatitis B and C diagnosed with liver biopsy and transient elastography were selected. According to the principle of syndrome differentiation in traditional Chinese medicine, self-made Yiqi Huoxue recipe ( n = 127) and Fuzheng Huayu capsule ( n = 80) were used for the treatment course of 24-48 weeks. Change score of TCM symptom, liver biochemistry, liver stiffness measurement (LSM), and noninvasive liver fibrosis index [aspartate transaminase to platelet ratio index (APRI), and fibrosis-4 score (FIB-4)] were compared between the two groups to evaluate the therapeutic effect of Yiqi Huoxue recipe on liver fibrosis. Results:Yiqi Huoxue recipe group and Fuzheng Huayu capsule group baseline LSM, APRI and FIB-4 was compared, and there was no statistically significant difference between them ( P > 0.05). Yiqi Huoxue recipe and Fuzheng Huayu capsule received patients had improved symptom scores to a certain extent. Hepatic facies, discomfort over liver area, and soreness and weakness of waist and knees ( P < 0.05) was significantly improved in Yiqi Huoxue recipe than Fuzheng Huayu capsule. Liver biochemical indicators (ALT, AST, GGT, ALP) had gradually relapsed with the extension of treatment duration and the normalization rate between the two groups after 24 to 48 weeks had reached 100% vs. 100%, 100% vs. 93.8%, 96.8% vs. 92.3% and 87.5% vs. 81.8%. After 12 weeks of treatment, APRI values ??of both groups had significantly reduced, and after 48 weeks of treatment, LSM values of both groups had significantly improved. Moreover, Yiqi Huoxue recipe FIB-4 score was significantly improved after 48 weeks of treatment, and the difference was statistically significant compared to Fuzheng Huayu capsule group ( P < 0.05). After treatment, LSM, APRI, and FIB-4 total effectiveness in the two groups were 80.0% vs. 63.6%, P = 0.046; 68.4% vs. 52.0%, P = 0.052; 68.4% vs. 62.0%, P = 0.437, respectively. LSM total effectiveness was significantly higher in Yiqi Huoxue recipe treated group than Fuzheng Huayu capsule group. Conclusion:Traditional Chinese medicine Yiqi Huoxue decoction can be used as an optimal treatment for liver fibrosis of chronic viral hepatitis.

Sepsis is currently a major problem and challenge facing the medical community. With rapid development and progress of modern medicine, researchers have put more and more attention on sepsis; meanwhile, the morbidity and mortality of sepsis remains high despite great efforts from experts in various fields. According to updated guidelines, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Infection is the initial step of sepsis progression, and development from infection to sepsis is a complex pathophysiological process, including pathogen invasion, cytokine release, capillary leakage, microcirculation dysfunction, etc. which finally leads to organ metabolic disorders and functional failure. According to the latest recommended international guidelines of Sepsis 3.0, the presence of infection and SOFA score ≥ 2 are considered as the diagnostic criteria for sepsis, and the 'rescue' measures mainly focus on reversal of organ dysfunction. However, despite nearly two decades of efforts, the 'Save Sepsis Campaign' has not achieved satisfactory results. Emergency medicine is the frontier subject of acute and severe illness which treats patients with acute infections at the earliest. If at this stage, physicians can predict the possibility of sepsis progression from demographic characteristics, localize the pathogen and infection, detect the inflammatory storms by tests of cytokines and evaluate the severity of the infection with more effective clinical scoring system, and then take effective measures to prevent infection from developing into sepsis in high-risk patients, the morbidity and mortality of sepsis in patients with acute infection will be greatly reduced. Based on this situation, Chinese emergency medicine experts proposed the concept of 'preventing and blocking' sepsis, and launched the nationwide 'Preventing Sepsis Campaign in China (PSCC)' nationwide. The main concept is summarized as 'three early and two reduces' which includes early detection, early diagnosis and early intervention during the 'pre-symptomatic' and 'peri-septic' stage in order to reduce the incidence of sepsis and it proposed a new approach for diagnosis and treatment of acute severe infection. This consensus is jointly advocated, discussed and written by four academic associations in the field of emergency medicine and five scholarly publishing organizations. More than 40 experts from fields of emergency medicine, critical care medicine, infectious diseases, pharmacy and laboratory medicine have participated in several rounds of deliberation and finally reached consensus on the criteria of identifying patients with acute infection, taking anti-infective treatments, screening of high-risk patients with sepsis, detection and treatment of inflammatory storm, protection of vascular endothelial cells and the regulation of coagulation function, as well as strategies of liquid support and organ function protection etc. The consensus summarizes the commonly used clinical diagnosis criteria and treatment measures of sepsis both in Western medicine and traditional Chinese medicine for clinicians in order to provide evidence for the diagnosis and treatment of the disease.

Objective To investigate the expressions of CD34, CD123 and CD38 in acute myelogenous leukemia (AML) and their clinical significances. Methods A total of 164 patients with AML in Xiangya Hospital of Central South University from February 2014 to July 2015 were enrolled. Cellular immunophenotyping was performed by flow cytometry. According to the expressions of CD34, CD38 and CD123, 164 patients were divided into positive group and negative group, and the clinical data and immature cells ratio of two groups were compared. Results In 164 patients with AML, 102 cases (62.2 ％) were CD34 positive, 126 cases (76.8％) were CD123 positive, and 144 cases (88.3％) were CD38 positive. There were no significant differences in age and sex between the positive and negative groups (P> 0.05). But there were significant differences in the proportion of immature cells, white blood cell count and hemoglobin between the two groups (all P< 0.05). The expression rates of CD34, CD38 and CD123 were correlated with minimal residual disease and complete remission rate (all P< 0.05). Conclusions CD34, CD123 and CD38 are effective markers for AML detection. The expressions of CD34, CD123 and CD38 can be used as the judgment marker of cell maturity, which is conducive to the determination of the condition and prognosis of AML patients.

Prenatal 2D and 3D ultrasonographic examinations were performed for 67 008 pregnant women in Renmin Hospital of Wuhan University from January 2013 to December 2016.Among 69 013 fetuses,71 cases of congenital vertebral deformities were diagnosed with a detection rate of 0.103%.There were 40 cases of semi-vertebrae,23 cases of butterfly vertebrae,2 cases of coronal vertebral body fissure and 6 cases of vertebral fusion.Half vertebral deformity was the most common vertebral abnormality accounting for 56.3%(40/71),and the coronal vertebral body fissure was the least abnormality.Among 71 abnormal vertebral fetuses,there were 40 cases with other abnormalities,of which 28 fetuses were induced abortion, 12 fetuses were born;there were 31 cases of simple vertebral body anomalies,of which 8 fetuses were born and 23 fetuses were induced abortion.In infants with a single vertebral anomalies had no significant scoliosis,X-ray examination was performed 3-6 months after birth,the results were consistent with prenatal ultrasound diagnosis.Fifty one cases of induced abortion were examined by X-ray,the prenatal diagnosis was consistent with X-ray findings in 48 cases,and the remaining 3 cases were all multiple hemi-vertebrae with missed diagnosis of congenital butterfly vertebral deformity.