Objective To investigate the effect of extracorporeal diaphragmatic pacing(EDP)on wea-ning patients undergoing mechanical ventilation after acute Stanford type A aortic dissection(ATAAD)sur-gery.Methods A total of 80 patients who underwent ATAAD surgery and required mechanical ventilation in the cardiac intensive care unit(CCU)of our hospital from October 2023 to October 2024 were selected as the study subjects.They were randomly divided into a control group and an intervention group using a random number table method,with 40 patients in each group.Both groups of patients received conventional clinical drug therapy,mechanical ventilation support,and rehabilitation exercises after surgery.The intervention group additionally underwent EDP therapy on this basis.The clinical data,mechanical ventilation time,weaning out-comes,oxygenation index,tidal volume,and changes in diaphragm function parameters were compared be-tween two groups of patients.Results Compared with the control group,the intervention group had a shorter mechanical ventilation time[77.00(59.00,133.63)h]vs.54.50(49.00,105.25)h],offline success rate(72.5％vs.90.0％),oxygenation index[202.90(178.63,240.05)mmHg vs.236.50(196.00,293.75)mm-Hg],higher tidal volume[(496.00±111.95)mL vs.(563.23±133.98)mL],with a statistically significant difference(P＜0.05).Compared with the control group,diaphragmatic excursion(DE)of both sides[11.90(8.50,16.50)mm vs.15.30(12.20,19.80)mm;12.60(10.80,14.90)mm vs.14.70(11.43,19.20)mm]and diaphragmatic thickening fraction(DTF)of left and right side[21.75％(17.53％,27.13％)vs.26.30％(21.10％,32.40％);24.00％(17.68％,29.35％)vs.28.30％(22.43％,33.40％)]of the intervention group were higher,and the differences were statistically significant(P＜0.05).Conclusion EDP can enhance the function of the diaphragm in patients,shorten the duration of mechanical ventilation,improve the success rate of wea-ning,and improve the weaning outcomes of mechanically ventilated patients after ATAAD surgery.

Objective To explore the regulatory mechanisms underlying the increased proportion of CD4+Foxp3+regulatory T(Treg)cells in late-stage diabetes mellitus(DM)with poorly-controlled blood glucose,and to identify new approaches and therapeutic targets for the prevention and treatment of secondary infections in the late stage of DM.Methods Wild-type C57BL/6 mice aged 6 to 8 weeks were randomly assigned to two groups,the experimental and the control groups(n=5 per group).Mice in the experimental group were injected with streptozotocin(STZ)to induce the mouse model of type 1 diabetes mellitus(T1D),while those in the control group received injection of an an equal volume of 0.1 mol/L citrate buffer.In addition,wild-type C57BL/6 mice aged 6 to 8 weeks were fed with high-fat diet for 2 months and subsequently randomly assigned to two groups,the experimental and the control groups(n=3 per group).Mice in the experimental group were injected with low-dose STZ for multiple times to induce the mouse model of type 2 diabetes mellitus(T2D),while those in the control group received an equal volume of 0.1 mol/L citrate buffer.The spleen and peripheral lymph nodes of the mice were collected 2 weeks after the stable onset of diabetes,and T cell immune responses were examined by flow cytometry.Naive T cells isolated by immunomagnetic beads were cultured to investigate the mechanisms by which high glucose regulates T cell differentiation and function.The frequency of Treg cells and effector T(Teff)cells,the expression levels of Ki67,a cell proliferation marker,cell apoptosis rate,and intracellular reactive oxygen species(ROS)levels in the mouse tissue single cell suspension and T cell culture samples were assessed by multicolor flow cytometry.Results Late-stage T1D and T2D mice with poorly-managed blood glucose exhibited increased peripheral CD4+Foxp3+Treg frequencies(P<0.05).In these diabetic mice with poorly-managed blood glucose,the expression of Ki67 in Treg cells was significantly upregulated(P<0.05),while the apoptosis of non-Treg cells(Foxp3-non-Treg cells)increased markedly(P<0.05).Under high-glucose treatment conditions,the ROS levels in Teff cells increased significantly,and the cell apoptosis also increased significantly.High-glucose treatment induced the activation of transforming growth factor-β(TGF-β)and promoted the differentiation of Treg cells,whereas blocking the TGF-β signaling pathway or neutralizing ROS completely inhibited high glucose-induced Treg differentiation(P<0.01).Conclusion Sustained hyperglycemic internal environment in poorly-controlled diabetic mice causes high level of ROS production in Teff cells by inducing oxidative stress,which leads to increased apoptosis of Teff cells,promotes the differentiation of Treg cells by activating TGF-β,and ultimately leads to exacerbated immunosuppressive environment in the late stages of DM.Inhibiting the high level of ROS in late-stage diabetic patients may be conducive to mitigating Teff apoptosis and increasing the frequencies of Treg cells,and may offer new perspectives for improving hyperglycemia-induced immunosuppression and secondary infections in the late stage of DM.

The corneal epithelium, an essential refractive interface, plays an integral role in the corneal healing after corneal refractive surgery. All existing corneal refractive surgeries entail a degree of corneal epithelial remodeling; however, excessive epithelial remodeling precipitates adverse outcomes on the refractive correction efficacy of such surgeries. This review summarizes the application of corneal epithelial remodeling in the corneal refractive surgery, and more comprehensively investigates the influencing factors of perioperative epithelial remodeling after corneal refractive surgery, with a view to augmenting the safety, efficacy, predictability, and stability of corneal refractive surgical outcomes.

Objective: To investigate the effect of Guangdong Shenqu (GSQ) on intestinal flora structure in mice with food stagnation through 16S rDNA sequencing. Methods: Mice were randomly assigned to control, model, GSQ low-dose (GSQL), GSQ medium-dose (GSQM), GSQ high-dose (GSQH), and lacidophilin tablets (LAB) groups, with each group containing 10 mice. A food stagnation and internal heat mouse model was established through intragastric administration of a mixture of beeswax and olive oil (1:15). The control group was administered normal saline, and the model group was administered beeswax and olive oil to maintain a state. The GSQL (2 g/kg), GSQM (4 g/kg), GSQH (8 g/kg), and LAB groups (0.625 g/kg) were administered corresponding drugs for 5 d. After administration, 16S rDNA sequencing was performed to assess gut microbiota in mouse fecal samples. Results: The model group exhibited significant intestinal flora changes. Following GSQ administration, the abundance and diversity index of the intestinal flora increased significantly, the number of bacterial species was regulated, and α and β diversity were improved. GSQ administration increased the abundance of probiotics, including Clostridia, Lachnospirales, and Lactobacillus, whereas the abundance of conditional pathogenic bacteria, such as Allobaculum, Erysipelotrichaceae, and Bacteroides decreased. Functional prediction analysis indicated that the pathogenesis of food stagnation and GSQ intervention were primarily associated with carbohydrate, lipid, and amino acid metabolism, among other metabolic pathways. Conclusion The digestive mechanism of GSQ may be attributed to its role in restoring diversity and abundance within the intestinal flora, thereby improving the composition and structure of the intestinal flora in mice and subsequently influencing the regulation of metabolic pathways.

Objective To investigate the protective and treatment role of ulinastatin(UTI)on con-trast-induced acute kidney injury(CIAKI)in the elderly with coronary heart disease(CHD)and chronic kidney diseases(CKD).Methods A total of 321 elderly CHD inpatients complicated with CKD undergoing coronary angiography admitted in the First Medical Center of Chinese PLA Gen-eral Hospital from November 2021 to November 2022 were enrolled consecutively and then divid-ed into UTI group(n=161)and hydration group(n=160).Their cardiac and renal function pa-rameters were collected and analyzed before and 2 d after intervention.The changes in above pa-rameters and incidence of CIAK were observed and compared between the two groups.Results In 2 d after intervention,the UTI group had significantly lower Scr,urea,CysC,homocysteine and NT-proBNP,but higher eGFR than the hydration group(P＜0.01).There were 62 patients(62/321,19.3％)developing CIAKI,including 17 from the UTI group and 45 from the hydration group,and statistical difference was observed in the incidence(10.6％vs 28.1％,P＜0.01).For the patients with comorbidities of hypertension,diabetes,hyperlipidemia and hyperuricemia,the incidence of CIAKI was obviously lower in the UTI group than the hydration group(P＜0.01).Multivariate logistic regression analysis showed that UTI was an independent protective factor for occurrence of CIAKI(OR=0.348,95％CI:0.180-0.673,P=0.001).Conclusion UTI can im-prove renal function and reduce the risk of CIAKI in elderly CHD patients with CKD.

ObjectiveTo study the effect and mechanism of Linggui Zhugantang in treating chronic bronchitis （CB） induced by exposure to cigarette smoke combined with tracheal instillation of lipopolysaccharide （LPS）. MethodSixty SPF-grade SD rats were randomly divided into normal， model， dexamethasone （1 mg·kg^-1）， and high-， medium-， and low-dose （30.06， 15.03， 7.515 g·kg^-1， respectively） Linggui Zhugantang groups by the body weight stratification method， with 10 rats in each group. Each group was administrated with 200 μL LPS （1 g·L^-1） by tracheal instillation on days 1 and 14， respectively， while the normal group was administrated with an equal volume of normal saline. Except the normal group， the other groups were exposed to cigarette smoke on days 2-13 and 15-30 （10 cigarettes/time/30 min， twice/day） for the modeling of CB. The rats were administrated with corresponding drugs by gavage for 30 consecutive days from day 2 of modeling， and the mental status， behavior， and body weights of the rats were observed and measured. The wet/dry mass ratio （W/D） of the left lung was measured 30 days after modeling. Hematoxylin-eosin staining was employed to observe the pathological changes in the lung and bronchial tissues. The bronchial mucus secretion and goblet cell proliferation were observed by Alcian blue-periodic acid Schiff （AB-PAS） staining. The levels of mucin 5AC （MUC5AC）， interleukin （IL）-13， IL-6， and tumor necrosis factor （TNF）-α in the serum were determined by enzyme-linked immunosorbent assay. The expression of phospholipase A2 （PLA2）， transient receptor potential vanilloid receptor 1 （TRPV1）， and transient receptor potential ankyrin 1 （TRPA1） in the lung tissue was quantitatively analyzed by immunohistochemistry and Western blot. ResultCompared with the normal group， the model group showcased abnormal mental status and behaviors， bloody secretion in the nose and mouth， the mortality rate of 40%， decreased body weight， severe lung bronchial structure damage， a large number of inflammatory mediators and inflammatory cell infiltration in the tube wall， hyperemia， edema， and fibroplasia， massive proliferation of goblet cells， excessive secretion and accumulation of mucus， stenosis and deformation of the lumen， and aggravation of pulmonary edema （P<0.01）. In addition， the model group had higher levels of MUC5AC， IL-13， IL-6， and TNF-α in the serum and higher expression of PLA2 in the lung tissue than the normal group （P<0.01）. Compared with the model group， the medication groups showed normal mental status and behaviors， reduced mortality rate， stable weight gain， reduced lung and bronchial injuries， decreased goblet cell proliferation and mucus secretion， and alleviated pulmonary edema （P<0.01）. Furthermore， Linggui Zhugantang lowered the levels of MUC5AC， IL-13， IL-6， and TNF-α in the serum and down-regulated the protein levels of PLA2， TRPV1， and TRPA1 in the lung tissue （P<0.01）. ConclusionLinggui Zhugantang can reduce the pulmonary inflammation and airway mucus hypersecretion in the rat model of chronic bronchitis. It may exert the effects of reducing inflammation and resolving phlegm by regulating the PLA2-TRPV1/TRPA1 pathway.

Objective To explore the possibility of rhabdomyolysis and related organ damage in new recruits training in high temperature and high humidity environment by comparing the effects of different training environments on the laboratory indicators and electrocardiogram.Methods A total of 250 new recruits from a unit in Beijing and another 250 ones from a unit in Hainan were recruited and assigned into conventional environment group and high temperature and high humidity environment group,respectively.All of them were male,with an average age of 21.36±2.59 years.Before and in 4 weeks after training in the same subjects,their general information,blood and urine indicators,and electrocardiogram were collected.All data were statistically analyzed.Results The incidences of inflammatory reaction,myocardial injury,muscle injury,liver injury,and kidney injury were 45.76％,3.39％,12.71％,25.42％,and 12.71％,respectively,in the high temperature and high humidity environment group,which were all significantly higher than those in the conventional environment group(P＜0.05).The former group had an incidence rate of 6.78％,5.93％,8.47％,6.78％,and 2.54％,respectively,in sinus bradycardia,atrial premature beats,unspecific ST-T changes,left ventricular hypertension and short PR interval,and all of the rates were higher than those of the conventional environment group(P＜0.05).Conclusion The incidences of inflammatory reaction,myocardial injury,muscle injury,liver injury,kidney injury,and ECG abnormalities are more common in new recruits after military training in high temperature and high humidity environment.

Objective:To evaluate the safety and effectiveness of pecto-intercostal fascial plane (PIFP) block and erector spinae plane (ESP) block for postoperative analgesia in median open heart surgery.Methods:A total of 158 patients who underwent elective midline open heart surgery at the Nanjing First Hospital, Nanjing Medical University from October 2022 to October 2023 were randomly divided into a PIFP block group (P group) and ESP block group (E group) using a random number table method, with 79 patients in each group. Before anesthesia surgery, the group P underwent ultrasound-guided bilateral PIFP block, while the group E underwent ultrasound-guided bilateral ESP block. Both groups received sufentanil intravenous patient-controlled analgesia after surgery. The resting and activity Visual Analog Scale (VAS) scores of two groups of patients at 6, 12, 18, and 24 hours after surgery were recorded; The first press time of the patient′s postoperative patient-controlled analgesia pump, the cumulative dose of sufentanil within 24 hours, the number of effective presses, and the rate of salvage analgesia were recorded; and extubation time, intensive care unit (ICU) stay, and adverse reactions; the time of nerve block operation, clarity score of puncture needle imaging under ultrasound, and patient satisfaction with nerve block were also recorded.Results:There was no statistically significant difference in resting VAS scores and activity VAS scores between the two groups at 6, 12, 18, and 24 hours after surgery (all P>0.05). The activity VAS scores of the group P were lower than those of the group E at 6 and 12 hours after surgery (all P<0.05); Compared with the group E, patients in the group P had significantly longer first press time of postoperative analgesia pump (all P<0.05), lower salvage analgesia rate, cumulative dose of sufentanil 24 hours after surgery, and fewer effective presses of analgesia pump (all P<0.05); There was no statistically significant difference in extubation time, ICU stay, and incidence rate of nausea between the two groups of patients (all P>0.05); Compared with the group E, the group P had shorter nerve block operation time, higher clarity score of puncture needle imaging under ultrasound, and higher patient satisfaction (all P<0.05). Conclusions:Compared with ESP block, PIFP block can provide better perioperative analgesia for cardiac surgery patients, reduce the use of opioid drugs, and the operation of PIFP block is simpler, with good safety and effectiveness.

Objective:To compare the analgesic effect and postoperative recovery between multi-point and single-point ultrasound-guided fascia iliaca compartment block (FCIB) in elderly patients with hip fracture.Methods:From June 2019 to April 2020, 96 patients aged (71.1±5.4) years undergoing elective surgery for hip fracture in Renji Hospital were randomly assigned in multi-point block group or single-point block group, and the multi-point or single-point ultrasound-guided FCIB was performed for the two groups, respectively. The primary outcomes were the success rate for block of femoral nerve, lateral femoral cutaneous nerve and obturator nerve, and the 24 hours postoperative pain visual analog scale (VAS) score at rest and passive movement. The secondary outcomes were the onset time of sensory blocks of the above three nerves, complications of FICB, the satisfaction score of pain control during 48 hours after surgery and postoperative recovery of patients.Results:The success rate for block of lateral femoral cutaneous nerve in multi-point block group was 97.9% (47/48), which was significantly higher than that in single-point block group (83.3%(40/48)) ( P=0.031). The success rate for block of obturator nerve in multi-point block group was 95.8% (46/48), which was significantly higher than that in single-point block group which was 81.3% (39/48) ( P=0.025). The success rate of femoral nerve block in both groups was 97.9% (47/48) ( P=1.000). The 24 hours postoperative VAS scores at rest and passive movement in the multi-point block group were significantly lower than those in the single-point block group ( P<0.05). The onset time for block of lateral femoral cutaneous nerve and obturator nerve in multi-point block group was shorter than that in single-point block group ( P=0.025 and P<0.01). There was no significant difference in the onset time for block of femoral nerve between the two groups ( P=0.343). The satisfaction score of patients at 48 hours after surgery in multipoint block group was higher than that in single point block group ( P=0.024). The length of hospital stay in the multi-point block group was shorter than that in the single-point block group ( P=0.042), the proportion of intravenous analgesic drugs used after surgery was lower than that in the single-point block group ( P=0.041), and the complication rate within 30 days after surgery was also lower than that in the single point block group ( P=0.026). Conclusion:Compared with single-point block, ultrasound-guided multi-point block in iliac fascia space has advantages of increasing analgesic efficacy and promoting postoperative recovery in elderly patients with hip fracture.

Zhishi Xiebai Guizhitang is a classical prescription for the treatment of chest impediment with the method of warming Yang. It is included in the Catalogue of Ancient Classical Prescriptions issued by the National Administration of Traditional Chinese Medicine （First Batch）， with the effect of activating Yang， dissipating mass， moving Qi and resolving phlegm. Its main symptoms include chest fullness and pain， or even chest pain radiating to the back， wheezing， coughing， shortness of breath， and Qi reversal from the hypochondrium. In modern traditional Chinese medicine， Zhishi Xiebai Guizhitang is clinically used in the treatment of cardiovascular system， digestive system， respiratory system and other diseases， among which coronary heart disease， unstable angina pectoris， myocardial infarction， sinus bradycardia and other cardiovascular diseases have particularly significant effects. This paper reviewed the pharmacological studies of Zhishi Xiebai Guizhitang in the past 10 years. The results showed that each single medicine and the whole prescription alleviated the above cardiovascular diseases to a certain extent， with the pharmacological effects of improving intravascular environment， myocardial ischemia， myocardial ischemia-reperfusion injury， and myocardial hypoxia， anti-inflammation， plaque stabilisation， etc.， and the pharmacological mechanism involved the regulation of relevant active substances in vivo as well as related signaling pathways and ion channels， mainly including thromboxane B₂ （TXB₂）， prostacyclin I₂（PGI₂） and phosphatidylinositol 3-kinases/protein kinase B/endothelial nitric oxide synthase （PI3K/Akt/eNOS） signaling pathways， and ATP-sensitive potassium channels. In addition， the relationship between the pharmacological effects of some single medicines and transient receptor potential ankyrin 1 （TRPA1） has been reported that TRPA1 is a key to understanding the mechanism of Zhishi Xiebai Guizhitang in treating cardiovascular diseases， which is worth of further study.