ObjectiveTo investigate the effects and mechanisms of Fangji Fulingtang （FFD） on mitochondrial function in the mouse model of myocardial fibrosis （MF）. MethodsSixty SPF-grade male C57BL/6J mice were randomly allocated into six groups （n=10 per group）： control， model， low-dose， medium-dose， and high-dose （3.315， 6.63， and 13.26 g·kg^-1， respectively） FFD， and captopril （20 mg·kg^-1）. MF was induced by subcutaneous injection of isoproterenol （10 mg·kg^-1·d^-1） in other groups except the control group for 14 consecutive days， with simultaneous gavage of corresponding drugs. Left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） were measured by echocardiography. Serum levels of creatine kinase-MB （CK-MB）， cardiac troponin I （cTnI）， N-terminal pro-brain natriuretic peptide （NT-pro BNP）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6） were determined by enzyme-linked immunosorbent assay （ELISA）. Malondialdehyde （MDA）， superoxide dismutase （SOD）， and glutathione （GSH） levels were measured by biochemical assays. Reactive oxygen species （ROS） were detected by dihydroethidium （DHE） fluorescence staining. Hematoxylin-eosin （HE）， Masson's trichrome， and wheat germ agglutinin （WGA） staining were performed to evaluate myocardial structure and fibrosis. Mitochondrial ultrastructure and function were assessed by transmission electron microscopy， adenosine triphosphate （ATP） colorimetric assay， and JC-1 fluorescence staining. The protein levels of phosphorylated adenosine monophosphate-activated protein kinase α subunit （p-AMPKα）， AMPKα， peroxisome proliferator-activated receptor gamma coactivator-1α （PGC-1α）， mitofusin 2 （MFN2）， pyruvate kinase M2 isoform （PKM2）， lactate dehydrogenase A （LDHA）， and hypoxia-inducible factor 1 alpha （HIF-1α） were analyzed by Western blot. ResultsCompared with the control group， the model group exhibited decreased LVEF and LVFS， increased heart weight index and heart weight-to-tibia length ratio （P<0.01）， elevated levels of myocardial injury markers （CK-MB， cTnI， and NT-pro BNP）， inflammatory cytokines （TNF-α， IL-1β， and IL-6）， and MDA， along with reduced SOD and GSH levels （P<0.01）. Enhanced interstitial collagen deposition and cardiomyocyte hypertrophy were observed in the model group （P<0.01）. Transmission electron microscopy and JC-1 staining revealed mitochondrial swelling， crista disruption， decreased ATP content， and reduced red/green fluorescence ratio in the model group （P<0.01）. Western blot analysis demonstrated downregulation of p-AMPKα， PGC-1α， and MFN2 and upregulation of PKM2， LDHA， and HIF-1α in the model group （P<0.01）. Compared with the model group， treatment with FFD or captopril improved LVEF and LVFS， reduced heart weight index and heart weight-to-tibia length ratio （P<0.05， P<0.01）， lowered the serum levels of CK-MB， cTnI， NT-pro BNP， TNF-α， IL-1β， IL-6， and MDA， increased the SOD and GSH levels （P<0.05， P<0.01）， attenuated the myocardial fibrosis and cardiomyocyte hypertrophy （P<0.01）， and restored the mitochondrial ultrastructure. The medium and high-dose FFD groups as well as the captopril group showed increased ATP production and red/green fluorescence ratio （P<0.05， P<0.01）. Furthermore， FFD upregulated the expression of p-AMPKα and PGC-1α while downregulating the expression of LDHA and HIF-1α （P<0.05， P<0.01）. ConclusionFFD activates the AMPK/PGC-1α/MFN2 signaling pathway and inhibits the PKM2/LDHA/HIF-1α axis to restore mitochondrial function and energy metabolic homeostasis， thereby attenuating isoproterenol-induced myocardial fibrosis.

ObjectiveTo investigate the effects and mechanisms of Fangji Fulingtang （FFD） on mitochondrial function in the mouse model of myocardial fibrosis （MF）. MethodsSixty SPF-grade male C57BL/6J mice were randomly allocated into six groups （n=10 per group）： control， model， low-dose， medium-dose， and high-dose （3.315， 6.63， and 13.26 g·kg^-1， respectively） FFD， and captopril （20 mg·kg^-1）. MF was induced by subcutaneous injection of isoproterenol （10 mg·kg^-1·d^-1） in other groups except the control group for 14 consecutive days， with simultaneous gavage of corresponding drugs. Left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） were measured by echocardiography. Serum levels of creatine kinase-MB （CK-MB）， cardiac troponin I （cTnI）， N-terminal pro-brain natriuretic peptide （NT-pro BNP）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6） were determined by enzyme-linked immunosorbent assay （ELISA）. Malondialdehyde （MDA）， superoxide dismutase （SOD）， and glutathione （GSH） levels were measured by biochemical assays. Reactive oxygen species （ROS） were detected by dihydroethidium （DHE） fluorescence staining. Hematoxylin-eosin （HE）， Masson's trichrome， and wheat germ agglutinin （WGA） staining were performed to evaluate myocardial structure and fibrosis. Mitochondrial ultrastructure and function were assessed by transmission electron microscopy， adenosine triphosphate （ATP） colorimetric assay， and JC-1 fluorescence staining. The protein levels of phosphorylated adenosine monophosphate-activated protein kinase α subunit （p-AMPKα）， AMPKα， peroxisome proliferator-activated receptor gamma coactivator-1α （PGC-1α）， mitofusin 2 （MFN2）， pyruvate kinase M2 isoform （PKM2）， lactate dehydrogenase A （LDHA）， and hypoxia-inducible factor 1 alpha （HIF-1α） were analyzed by Western blot. ResultsCompared with the control group， the model group exhibited decreased LVEF and LVFS， increased heart weight index and heart weight-to-tibia length ratio （P<0.01）， elevated levels of myocardial injury markers （CK-MB， cTnI， and NT-pro BNP）， inflammatory cytokines （TNF-α， IL-1β， and IL-6）， and MDA， along with reduced SOD and GSH levels （P<0.01）. Enhanced interstitial collagen deposition and cardiomyocyte hypertrophy were observed in the model group （P<0.01）. Transmission electron microscopy and JC-1 staining revealed mitochondrial swelling， crista disruption， decreased ATP content， and reduced red/green fluorescence ratio in the model group （P<0.01）. Western blot analysis demonstrated downregulation of p-AMPKα， PGC-1α， and MFN2 and upregulation of PKM2， LDHA， and HIF-1α in the model group （P<0.01）. Compared with the model group， treatment with FFD or captopril improved LVEF and LVFS， reduced heart weight index and heart weight-to-tibia length ratio （P<0.05， P<0.01）， lowered the serum levels of CK-MB， cTnI， NT-pro BNP， TNF-α， IL-1β， IL-6， and MDA， increased the SOD and GSH levels （P<0.05， P<0.01）， attenuated the myocardial fibrosis and cardiomyocyte hypertrophy （P<0.01）， and restored the mitochondrial ultrastructure. The medium and high-dose FFD groups as well as the captopril group showed increased ATP production and red/green fluorescence ratio （P<0.05， P<0.01）. Furthermore， FFD upregulated the expression of p-AMPKα and PGC-1α while downregulating the expression of LDHA and HIF-1α （P<0.05， P<0.01）. ConclusionFFD activates the AMPK/PGC-1α/MFN2 signaling pathway and inhibits the PKM2/LDHA/HIF-1α axis to restore mitochondrial function and energy metabolic homeostasis， thereby attenuating isoproterenol-induced myocardial fibrosis.

OBJECTIVE To evaluate the quality of Zhachong-13 pills.METHODS The contents of agarotetrol， costunolide， hypaconitine， dehydrocostus lactone， mesaconitine， aconitine， liquiritigenin， glycyrrhizic acid， ellagic acid， liquiritin， corilagin， and gallic acid in 18 batches of samples were determined by high-performance liquid chromatography-tandem triple quadrupole mass spectrometry （HPLC-MS/MS） method. Cluster analysis （CA） was performed using the Microbioinformatics online analysis platform. Principal component analysis （PCA） and orthogonal partial least squares discriminant analysis （OPLS-DA） were performed using SIMCA 14.1 software. Random forest， extremely randomized trees， and extreme gradient boosting machine learning models were constructed using the SPSSAU online analysis platform. The comprehensive quality of the samples was evaluated by the entropy weight-technique for order preference by similarity to ideal solution （TOPSIS） method.RESULTS The contents of the above 12 components were 104.331-694.382， 652.217-1 085.075， 6.051-130.980， 612.174-1 417.179， 1.018-32.239， 0.953-24.967， 65.552-652.239， 2 019.412-5 385.807， 52.867-4 990.450， 156.307-883.180， 10.142-475.722， and 1 102.863-4 826.396 μg/g， respectively. The results of CA and PCA showed that the 18 batches of samples were divided into two categories： S1-S6， S10-S15 were grouped into one category， while S7-S9 and S16-S18 were grouped into another category. The OPLS-DA results showed that the variable importance in projection values of mesaconitine， glycyrrhizic acid， liquiritin， ellagic acid， hypaconitine， liquiritigenin， agarotetrol， gallic acid， and dehydrocostus lactone were greater than 1. The results of the three machine learning models showed that ellagic acid and hypaconitine had relatively large differential contributions. The entropy weight-TOPSIS results showed that the overall quality of samples from manufacturer B was superior to that of the other four manufacturers.CONCLUSIONS The established method is stable and feasible， and can be used to evaluate the quality of Zhachong-13 pills， in combination with multivariate statistical analysis. Ellagic acid and hypaconitine are differential markers that affect its quality.

After the full implementation of Diagnosis-Intervention Packet(DIP)payment,driven by the dual mode of public welfare and economy,disease cost accounting,as a key link,promotes the transformation of hospitals from extensive income-driven development mode to refined operation management.Through literature analysis,it compares the characteristics,advantages and limitations of various methods of disease cost accounting.Combined with the current situation of case hospital cost accounting and the dilemma of disease cost accounting,the parameter distribution method combined with the service unit superposition method is used to realize the medical business cost and medical total cost accounting of the DIP disease in the case hospital.In addition,how to better implement DIP disease cost accounting in county-level public hospitals is discussed and suggested,in order to further improve the same type of hospitals and speed up the application of disease cost accounting results.

After the full implementation of Diagnosis-Intervention Packet(DIP)payment,driven by the dual mode of public welfare and economy,disease cost accounting,as a key link,promotes the transformation of hospitals from extensive income-driven development mode to refined operation management.Through literature analysis,it compares the characteristics,advantages and limitations of various methods of disease cost accounting.Combined with the current situation of case hospital cost accounting and the dilemma of disease cost accounting,the parameter distribution method combined with the service unit superposition method is used to realize the medical business cost and medical total cost accounting of the DIP disease in the case hospital.In addition,how to better implement DIP disease cost accounting in county-level public hospitals is discussed and suggested,in order to further improve the same type of hospitals and speed up the application of disease cost accounting results.

Objective To construct a critical care humanistic nursing curriculum under the perspective"great ideological and political education",and evaluate its effects in the training of intensive care unit(ICU)standardized training nurses.Methods A research team was established and organized by department of nursing of Zhongshan Hospital,Fudan University,which consisting of 6 critical care nursing managers and specialists,including 1 chief nurse,3 head nurses,1 master's graduate,and 1 doctoral graduate.The team was responsible for literature review,questionnaire design,expert recruitment,survey distribution and collection,data integration,and analysis.A preliminary questionnaire was developed through literature reviews on critical care humanistic nursing,brainstorming sessions,and clinical surveys.A two-round Delphi method was conducted to finalize the humanistic nursing training curriculum.Ideological and political elements,such as political identity,patriotism,moral cultivation,legal awareness,scientific spirit and professional quality were integrated into the program.From July 2023 to June 2024,newly enrolled ICU standardized training nurses at Zhongshan Hospital,Fudan University participated in the training.Training outcomes were assessed via theoretical examinations and pre-and post-training evaluations of humanistic competency.Results A total of 10 experts participated in the consultation,resulting in a training course consisting of two primaryl indicators and 11 secondary indicators.A total of 60 nurses participated in the training,achieving an average post-training theoretical score of 84.92±7.73.Significant improvements were observed across all dimensions of humanistic competency post-training compared to pre-training(humanistic care practice competency:33.95±4.50 vs.30.82±4.10,communication skills:20.27±2.68 vs.18.98±2.98,self-management:10.07±1.91 vs.9.20±2.02,ethical and legal competence:10.38±1.61 vs.9.68±2.02,psychological adaptability:14.20±2.31 vs.13.03±2.19,and total humanistic practice competency score:88.87±7.65 vs.81.71±8.55),with all differences statistically significant(all P<0.05).Conclusion The critical care humanistic nursing curriculum under the perspective of"great ideological and political education"can effectively improve the humanistic quality of nurses and enhance their ICU practical skills,so as to provide reference for the training of nurses in intensive care.

Objective:To explore the correlation between serum nidogen-2 (NID-2) and thoracic aortic calcification in patients with chronic kidney disease (CKD), and construct a risk prediction model based on NID-2 to evaluate its value in predicting the risk of the severe thoracic aortic calcification and cardiovascular and cerebrovascular events in CKD patients.Methods:It was a prospective cohort study. Patients with CKD at stage 3 to 5D in the Zhongda Hospital Affiliated to Southeast University from January 2022 to January 2023 were enrolled. Syngo.via software was used to evaluate the volume of thoracic aortic calcification, and enzyme-linked immunosorbent assay was employed to determine the level of serum NID-2. According to the volume of thoracic aortic calcification, the patients were divided into three groups: no calcification group, mild calcification group and severe calcification group. The top 25% of the patients were defined as no or mild calcification group, and the latter 75% were defined as severe calcification group. The follow-up period was one year. During the follow-up period, cardiovascular and cerebrovascular events, as well as all-cause death among the enrolled patients were recorded. Logistic regression analysis was used to screen the influencing factors of thoracic aortic calcification. Based on the results of logistic regression analysis, a nomogram prediction model was constructed. The receiver operating characteristic curve (ROC curve), calibration curve, and decision curve were employed to evaluate the discrimination, calibration and clinical practicality of the nomogram model.Results:A total of 132 patients were included, with 91 males (68.94%) and age of (56.51±16.37) years. There were 60 CKD 3-5 stage patients (non-dialysis, 45.45%) and 72 CKD 5D patients (dialysis, 54.55%). Serum ND-2 levels differed significantly among healthy individuals, dialysis patients and non-dialysis patients ( H=70.651, P<0.001). There was no statistically significant difference in serum NID-2 level between the no or mild calcification group and the severe calcification group in dialysis patients ( Z=350.00, P=0.426). The serum NID-2 level in the severe calcification group was significantly higher than that in the no or mild calcification group in non-dialysis patients ( Z=242.00, P=0.019). In non-dialysis patients, there was a statistically significant correlation between serum NID-2 level and volume of thoracic aortic calcification ( r=0.40, P<0.001). In dialysis patients, there was no statistically significant correlation between serum NID-2 level and volume of each segment of thoracic aortic calcification (all P>0.05). The univariate logistic regression analysis showed that, age, hemoglobin, serum albumin, estimated glomerular filtration rate, NID-2, hypertension, type 2 diabetes mellitus and cerebral infarction were correlated factors of thoracic aortic calcification in non-dialysis patients (all P<0.05). Multivariate logistic regression analysis showed that age ( OR=1.22, 95% CI 1.08-1.50, P=0.010) was an independent correlated factor of thoracic aortic calcification in non-dialysis patients. The above related variables of univariate logistic regression analysis were incorporated into a nomogram to construct a predictive model for severe vascular calcification in non-dialysis patients, yielding an AUC of 0.94 (95% CI 0.89-0.99) in ROC curve, with a sensitivity of 83% and a specificity of 95%. A nomogram model based on above variables for predicting cardiovascular and cerebrovascular events in non-dialysis patients demonstrated an AUC of 0.95 (95% CI 0.90-1.00) in ROC curve, with a sensitivity of 95% and a specificity of 87%. Conclusions:In non-dialysis patients, serum NID-2 level in the severe calcification group is significantly higher than that in the no or mild calcification group. The serum NID-2 is a related factor of thoracic aortic calcification and cardiovascular and cerebrovascular events in non-dialysis patients. The nomogram prediction model constructed by combining NID-2 with age, hemoglobin, serum albumin, estimated glomerular filtration rate, hypertension, type 2 diabetes mellitus and cerebral infarction has a high predictive value for the risk of thoracic aortic calcification as well as cardiovascular and cerebrovascular events in non-dialysis patients.

Objective To form an expert consensus on nasogastric tube and intestinal tube placement in children(hereinafter referred to as the"consensus"),and provide a reference for pediatric medical workers regarding the operation of gastrointestinal tube placement in children.Methods A"consensus"formulation group was established.The"5.0"EBHC Pyramid Model was employed to systematically search,evaluate,summarize and extract relevant evidence to form the initial draft of the"consensus".The RAND-UCLA expert consensus method was utilized.Through a round of expert inquiries by correspondence and a round of face-to-face expert discussions,the data were collated,analyzed,refined,and modified to form the final version of the"consensus".Results The effective recovery rate of the expert inquiry questionnaire was 100％.The coefficient of expert authority(Cr)was 0.891.The Kendall's concordance coefficient of the inquiries was 0.692(P＜0.01),which was statistically significant.The median of the"RAND-UCLA"suitability score were 7-9 points,and the disagreement index(DI)value was＜1.00.The final"consensus"encompasses 9 aspects,including qualification requirements for the tube placement personnel,indications and contraindications,preoperative assessment,preoperative preparation,measurement of tube length,key points of tube placement,methods for confirming the position,tube flushing,fixation,and recording,with 47 recommendations.Conclusion This"consensus"is scientific,rigorous,and practical,covering all links of the gastrointestinal tube placement process in children,providing reference and guidance for the safe and standardized implementation of gastrointestinal tube placement in children.

Objective:To investigate the magnetic resonance imaging (MRI) features of pediatric and adolescent mediastinal T-lymphoblastic lymphoma (T-LBL) and to evaluate their predictive value for early treatment response.Methods:A retrospective, multicenter case series study was conducted on 49 pediatric and adolescent patients diagnosed with mediastinal T-LBL between September 2020 and May 2024 at the Fifth Affiliated Hospital of Zhengzhou University, Beijing Gaobo Boren Hospital, and Henan Cancer Hospital.All patients underwent chest MRI, including conventional MRI sequences and diffusion-weighted imaging.Tumor imaging characteristics were analyzed, and quantitative parameters such as minimum apparent diffusion coefficient (ADCmin), maximum ADC (ADCmax), and mean ADC (ADCmean) were measured.Treatment response was evaluated 15 days post-treatment.The patients were divided into a response group (complete or partial response, 26 cases) and a non-response group (progressive disease or minor response, 23 cases).The relationship between MRI features and treatment response was analyzed.The intraclass correlation coefficient was used to assess inter-reader agreement, and independent sample t-tests and chi-square tests were employed to compare differences between groups.Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive performance of imaging parameters. Results:Significant differences were observed between the response and non-response groups in ADC values [ADCmin (0.80±0.41)×10 -3 mm 2/s vs.(1.23±0.70)×10 -3 mm 2/s, ADCmax (1.14±0.48)×10 -3 mm 2/s vs.(1.92±0.77)×10 -3 mm 2/s, ADCmean (0.98±0.42)×10 -3 mm 2/s vs.(1.56±0.74)×10 -3 mm 2/s] and the maximum tumor diameter was [(11.92±3.61) cm vs.(8.17±2.46) cm] (all P<0.05).ROC curve analysis showed that ADCmax had the highest predictive efficiency for treatment response, with an area under the curve (AUC) of 0.853 (95% CI: 0.790-0.910), sensitivity of 92.3%, and specificity of 65.2%.The AUC for the maximum tumor diameter was 0.814, demonstrating its excellent predictive performance. Conclusions:MRI features, particularly ADC values and the maximum tumor diameter, can effectively predict treatment response in pediatric and adolescent mediastinal T-LBL.

This paper reviews the overview of virtual reality technology and its application effect in diabetic patients, and analyzes the shortcomings of relevant research and application at this stage, so as to provide reference for promoting the application of virtual reality technology in diabetic patients.