ObjectiveTo examine the influences of Shenfu injection on the endogenous metabolic byproducts in the myocardium of the rat model exhibiting chronic heart failure， thus deciphering the therapeutic mechanism of the Qi-reinforcing and Yang-warming method. MethodsSD rats were randomly allocated into a control group and a modeling group. Chronic heart failure with heart-Yang deficiency syndrome in rats was modeled by multi-point subcutaneous injection of isoproterenol， and the rats were fed for 14 days after modeling. The successfully modeled rats were randomized into model， Shenfu injection （6.0 mL·kg^-1）， and trimetazidine （10 mg·kg^-1） groups and treated with corresponding agents for 15 days. The control group and the model group were injected with equal doses of normal saline， and the samples were collected after the intervention was completed. Cardiac color ultrasound was performed. Hematoxylin-eosin （HE） staining was used to observe histopathological morphology， and the serum level of N-terminal pro-brain natriuretic peptide （NT-proBNP） was assessed by enzyme-linked immunosorbent assay （ELISA）. The mitochondrial morphological and structural changes of cardiomyocytes were observed by transmission electron microscopy， and the metabolic profiling was carried out by ultra high performance liquid chromatography-quantitative exactive-mass spectrometry （UHPLC-QE-MS）. Differential metabolites were screened and identified by orthogonal partial least squares-discriminant analysis （OPLS-DA） and other methods， and then the MetaboAnalyst database was used for further screening. The relevant biological pathways were obtained through pathway enrichment analysis. The receiver operating characteristic （ROC） curve was established to evaluate the diagnostic value of each potential biomarker for myocardial injury and the evaluation value for drug efficacy. ResultsThe results of color ultrasound showed that Shenfu Injection improved the cardiac function indexes of model rats （P<0.05）. The results of HE staining showed that Shenfu injection effectively alleviated the pathological phenomena such as myocardial tissue structure disorder and inflammatory cell infiltration in model rats. The results of ELISA showed that Shenfu injection effectively regulated the serum NT-proBNP level in the model rats. Transmission electron microscopy （TEM） showed that Shenfu injection effectively restored the mitochondrial morphological structure. The results of metabolomics showed that the metabolic phenotypes of myocardial samples presented markedly differences between groups. Nine differential metabolites could be significantly reversed in the Shenfu injection group， involving three metabolic pathways： pyruvate metabolism， histidine metabolism， and citric acid cycle （TCA cycle）. The results of ROC analysis showed that the area under the curve （AUC） values of all metabolites were between 0.75 and 1.0， indicating that the differential metabolites had high diagnostic accuracy for myocardial injury， and the changes in their expression levels could be used as potential markers for efficacy evaluation. ConclusionShenfu injection significantly alleviated the damage of cardiac function， myocardium， and mitochondrial structure in the rat model of chronic heart failure with heart-Yang deficiency syndrome by ameliorating energy metabolism remodeling. Reinforcing Qi and warming Yang is a key method for treating chronic heart failure with heart-Yang deficiency syndrome.

Objective : To explore the effect of Wilms′ tumor 1-associated protein(WTAP) on tissue collagen deposition in pulmonary fibrosis caused by bleomycin. Methods : 60 mice were randomly divided into four groups: control group(Control group), Bleomycin-induced pulmonary fibrosis group(BLM group), pulmonary fibrosis lentivirus empty vector control group(BLM+LV-NC group), pulmonary fibrosis WTAP lentivirus group virus group(BLM+LV-WTAP group). Experimental pulmonary fibrosis mouse model was established by subcutaneous injection of bleomycin(35 mg/kg) into the abdomen, twice a week for a total of 8 times. After modeling, Western Blot was used to detect the protein expression of fibrosis-related markers α-smooth muscle actin(α-SMA), type I collagen(Collagen Ⅰ), fibronectin(Fibronectin), and WTAP protein. Masson staining and Sirius Red staining were used to detect collagen deposition. RT-qPCR was used to detect WTAP mRNA expression, WTAP lentivirus infection effect, and Collagen Ⅰ mRNA expression. Results: Compared with the Control group, the expression of pulmonary fibrosis markers α-SMA(P<0.001), Collagen Ⅰ(P<0.001), and Fibronectin(P<0.01) protein in the BLM group all increased. Masson staining(P<0.001) and Sirius Red staining(P<0.001) confirmed that significant collagen deposition occurred in the lung tissue of the BLM group. In addition, the expression of WTAP protein in the lung tissue of the BLM group increased(P<0.01). Compared with the Control group, the expression of WTAP mRNA in the BLM group increased(P<0.001). Compared with the BLM+LV-NC group, the expression of WTAP mRNA in the tissues of the BLM+LV-WTAP group decreased(P<0.001), proving that virus infection is effective. After infection with WTAP lentivirus, collagen fiber deposition decreased(P<0.001), Collagen Ⅰ mRNA(P<0.001) level decreased, and protein(P<0.001) expression decreased in the BLM+LV-WTAP group. Conclusion Knocking down of WTAP can reduce collagen deposition in bleomycin-induced pulmonary fibrosis tissue in mice and improve experimental pulmonary fibrosis.

Objective: To investigate the effect of sirtuin 2(SIRT2) on the proliferation and migration of cardiac fibroblasts(CFs)in C57BL/6 mice under angiotensin II(Ang Ⅱ) stimulation. Methods : The hearts were taken from 1 to 2 days C57BL/6 milk mice. After cutting and digesting, CFs were extracted by different adhesion centrifugation. After CFs attachment, the cells were cultured under control medium and Ang Ⅱ(100 nmol/L) medium and treated using OE-SIRT2 plasmid to overexpression the SIRT2 gene. RT-qPCR was used to detect mRNA expression of SIRT2 proliferating cell nuclear antigen(PCNA), periostin(POSTN)and type Ⅰ collagen procollagen A1(Col1A1), Western blot assay was used to measure the protein expression levels of SIRT2, PCNA, POSTN and Col1A1, CCK-8 assay and EdU assay were used to evaluate CFs proliferation rate, Transwell experiment was used to assess CFs migration activity. Results: Compared with control group, Ang Ⅱ stimulation led to down-regulation of SIRT2 expression in CFs, increased collagen expression, and promoted CFs proliferation and migration. The expression of SIRT2 was up regulated in CFs treated with OE-SIRT2 plasmid under Ang Ⅱ stimulation, Col1A1, POSTN and PCNA expression was down regulated, and CFs proliferation and migration ability decreased. Conclusion Overexpression of SIRT2 can inhibit the proliferation and migration of CFs under Ang Ⅱ stimulation, indicating that SIRT2 may be a key regulatory point in the onset and progression of cardiac fibrosis.

Von Hippel-Lindau syndrome is a type of neoplastic disease that can involve multiple organs and systems, and it can be manifested as pheochromocytoma in the adrenal gland. We recently admitted a patient with a complicated bilateral adrenal pheochromocytomas associated with VHL in a child. After multidisciplinary diagnosis and treatment, detailed perioperative treatment and monitoring, the patient recovered well after surgery. This article aims to increase the experience of diagnosis and treatment of VHL-pheochromocytoma in children by sharing this rare case.

The aim of this study is to determine the effects of Inonotus obliquus polysaccharides on the main organs and hormones of male mice infected with Neosporidium.The animal model of neosporidiosis in BALB/c mice was established.After intragastric administration,the pathological changes of brain,liver and spleen were observed by histopathology,the worm load in brain,liver and spleen was detected by qPCR,and the levels of FSH,LH and T4 in serum of male mice were detected by ELISA.The results showed that compared with the blank control group,granular spherical lesions could be seen in the brain tissue of mice in the model group,with patchy necrosis of hepatocytes,splenic hemorrhage,red pulp hyperemia and a large number of red blood cell infil-tration.Inonotus obliquus polysaccharides can improve the injury of brain,liver,spleen and other organs and tissues.The worm load in the brain of the Inonotus obliquus polysaccharide group was significantly lower than that of the model group on the 14th day and 21st day(P＜0.01),and that of the liver and spleen on the 21st day was significantly lower than that of the model group(P＜0.01).The level of FSH in the model group and Inonotus obliquus polysaccharide group was signif-icantly lower than that in the blank control group(P＜0.05 or P＜0.01),while that in the Inono-tus obliquus polysaccharide group was significantly higher than that in the model group(P＜0.05 or P＜0.01).The level of LH in the model group was significantly higher than that in the blank control group(P＜0.01),while that in the Inonotus obliquus polysaccharide group was significant-ly higher than that in the blank control group on the 7th day and 42nd day(P＜0.05).There was significant difference in T4 level between the model group and the blank group(P＜0.05 or P＜0.01),while the Inonotus obliquus polysaccharide group was similar to the blank control group on the 21st and 35th day(P＞0.05).Inonotus obliquus polysaccharides can improve the damage of Neosporidium on brain,liver and spleen of male rats,reduce the insect load in brain,liver and spleen,regulate the levels of FSH,LH and T4 hormones,and maintain the stability of reproductive system.

ObjectiveThis study aims to explore the mechanism and targets of Shenfu Injection in regulating glycolysis to intervene in myocardial fibrosis in chronic heart failure based on the hypoxia-inducible factor-1α （HIF-1α）/ 6-phosphofructo-2-kinase/fructose-2，6-bisphosphatase 3 （PFKFB3） signaling pathway. MethodsA rat model of chronic heart failure was established by subcutaneous injection of isoproterenol （ISO）. After successful modeling， the rats were randomly divided into the Sham group， Model group， Shenfu injection （SFI， 6 mL·kg^-1） group， and inhibitor （3PO， 35 mg·kg^-1） group， according to a random number table， and they were treated for 15 days. Cardiac function was evaluated by echocardiography， and serum N-terminal pro-brain natriuretic peptide （NT-proBNP） levels were detected by enzyme-linked immunosorbent assay （ELISA）. Fasting body weight and heart weight were measured， and the heart index （HI） was calculated. Pathological changes in myocardial tissue were observed by hematoxylin-eosin （HE） and Masson staining， and the fibrosis rate was calculated. Biochemical assays were used to determine serum levels of glucose （GLU）， lactic acid （LA）， and pyruvic acid （PA）. Western blot was used to analyze the expression of proteins related to the HIF-1α/PFKFB3 signaling pathway （HIF-1α and PFKFB3）， glycolysis-related proteins （HK1， HK2， PKM2， and LDHA）， and fibrosis-related proteins ［transforming growth factor （TGF）-β₁， α-smooth muscle actin （α-SMA）， and Collagen type Ⅰ α1 （ColⅠA1）］. Real-time PCR was used to detect the mRNA expression of HIF-1α and PFKFB3 in myocardial tissue. ResultsCompared with the Sham group， the Model group showed significantly decreased left ventricular ejection fraction （LVEF）， left ventricular shortening fraction （LVFS）， interventricular septal thickness （IVSd）， and interventricular septal strain （IVSs） （P<0.05）， while left ventricular internal dimension at end-diastole （LVDd） and end-systole （LVIDs） were increased （P<0.05）. Serum NT-proBNP levels were significantly increased （P<0.01）， and body weight was decreased. Heart weight was increased， and the HIT index was increased （P<0.05）. Myocardial tissue exhibited inflammatory cell infiltration and collagen fiber deposition， and the fibrosis rate was significantly increased （P<0.05）. Serum GLU was decreased （P<0.05）， while LA and PA levels were increased （P<0.05）. Protein expressions of HIF-1α， PFKFB3， HK1， HK2， PKM2， LDHA， TGF-β₁， α-SMA， and ColⅠA1， as well as the mRNA expression of HIF-1α and PFKFB3 were increased （P<0.05）. Compared with the Model group， both the SFI group and 3PO groups showed significant improvements in LVEF， LVFS， IVSd， and IVSs （P<0.05） and decreases in LVDd， LVIDs， and NT-proBNP levels （P<0.05）. Body weight was significantly increased. Heart weight was significantly decreased， and the HIT index was significantly decreased （P<0.05）. Inflammatory cell infiltration， collagen fiber deposition， and the fibrosis rate were significantly decreased （P<0.05）. Serum GLU levels were significantly increased （P<0.05）， while LA and PA levels were decreased （P<0.05）. Expressions of glycolysis-related proteins， fibrosis-related proteins， and HIF-1α/PFKFB3 pathway-related proteins and mRNAs were significantly suppressed （P<0.05）. ConclusionSFI improves cardiac function in chronic heart failure by downregulating the expression of HIF-1α/PFKFB3 signaling pathway-related proteins， regulating glycolysis， and inhibiting myocardial fibrosis.

Objective:To explore the reliability of intraoperative fluoroscopy at lateral 10° and 30° Brodén views in addition to the standard lateral and axial calcaneal views in the lateral decubitus position to assess the quality of articular reduction in calcaneal fractures of Sanders types Ⅱ and Ⅲ.Methods:A retrospective study was conducted to analyze the clinical data of the 74 patients who had been treated at Department of Foot and Ankle Surgery, The People’s Hospital of Linyi for unilateral closed calcaneal fractures of Sanders type Ⅱ or Ⅲ from January 2024, to August 2024. According to the different methods of intraoperative fluoroscopy, the patients were divided into a precision group and a conventional group. In the precision group of 39 cases, intraoperative fluoroscopy was conducted at lateral 10° and 30° Brodén views in the surgery for calcaneal fractures in addition to the standard lateral and axial calcaneal views in the lateral decubitus position; in the conventional group of 35 cases, intraoperative fluoroscopy was conducted only in the standard lateral and axial calcaneal views in the surgery for calcaneal fractures. All patients were treated by traction assisted by external fixation, minimally invasive prying reduction through the tarsal sinus incision, and three-dimensional framework internal fixation. The 2 groups were compared in terms of frequency of intraoperative fluoroscopy; preoperative and postoperative B?hler angles, Gissane angles, and calcaneal varus angles; screw protrusions (more than 2 mm beyond the medial cortex) of the posterior articular surface screw, sustentaculum tali screw, and anterior tuberosity screw; skin irritation symptoms due to the main nail tail (protruding cortex > 1 mm); step-off of the posterior articular surface (more than 2 mm) and wide gap of the posterior articular surface (more than 2 mm).Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). Both groups showed significant postoperative improvements in X-ray B?hler angle, Gissane angle, and calcaneal varus angle compared with the preoperative values ( P<0.05). There were no statistically significant differences in postoperative X-ray B?hler angle, Gissane angle, or calcaneal varus angle between the 2 groups ( P>0.05). There was no statistically significant difference in the frequency of intraoperative fluoroscopy between the 2 groups either ( P>0.05). The precision group had significantly fewer cases of screw protrusion (more than 2 mm beyond the medial cortex) of the posterior articular surface screw, sustentaculum tali screw, and anterior tuberosity screw, skin irritation symptoms due to the main screw tail (protruding cortex>1 mm), step-off of the posterior articular surface (more than 2 mm), and wide gap of the posterior articular surface (more than 2 mm) on the postoperative CT three-dimensional reconstruction compared with the conventional group ( P<0.05). Conclusion:In surgery for calcaneal fractures of Sanders types Ⅱ and Ⅲ, intraoperative fluoroscopy at lateral 10° and 30° Brodén views in addition to the standard lateral and axial calcaneal views in the lateral decubitus position provides stable and reliable intraoperative monitoring of B?hler angle, Gissane angle, calcaneal varus angle, reduction of the posterior articular surface of the calcaneus and the positions and lengths of implants.

Objective:To analyze the diagnostic value of bedside capsule endoscopy in patients with acute or severe gastrointestinal bleeding.Methods:Clinical data from patients who underwent bedside capsule endoscopy due to acute or severe suspected gastrointestinal bleeding in Nanfang Hospital, Southern Medical University from June 2018 to September 2021 were analyzed retrospectively. The efficacy of capsule endoscopy in detecting upper gastrointestinal tract and small intestinal bleeding was evaluated.Results:A total of 74 patients underwent bedside capsule endoscopy for suspected acute or severe gastrointestinal bleeding. Five patients were excluded due to failure of examination due to retention of capsule endoscope in the gastric lumen, and 69 were included in the study, of whom 54 patients with a definitive diagnosis of gastrointestinal hemorrhage. The positive detection rate of the capsule endoscopy was 83.33% (45/54), including 17 cases of ulcer, 5 cases of erosion, 5 cases of vascular malformation, 4 protrusion mass, 4 diverticulum, 5 obscure gastrointestinal bleeding, 1 stenosis , 1 active mucosal blood exudation, 1 gastric retention, 1 mucosal swelling, and 1 mucosal wrinkle change. The sensitivity and specificity of capsule endoscopy in the diagnosis of upper gastrointestinal bleeding were 92.31% (12/13) and 75.00% (3/4) respectively. The sensitivity and specificity of capsule endoscopy for diagnosing small intestinal bleeding were 80.49% (33/41) and 90.91% (10/11) respectively.Conclusion:Bedside capsule endoscopy demonstrates high sensitivity and specificity in the diagnosis of gastrointestinal bleeding, showing potential advantages in bedside applications for acute and severe gastrointestinal bleeding.

Objective:To evaluate the clinical efficacy of individualized postural management guided by lung ultrasound (LUS) in neonates with grade Ⅲ bronchopulmonary dysplasia (BPD).Methods:This prospective randomized controlled trial enrolled neonates diagnosed with grade Ⅲ BPD at Guangdong Second People's Hospital Affiliated to Jinan University from July 2022 to December 2024, who were randomly assigned to control or intervention groups. The control group received conventional postural management (head elevation 15°-30°, supine-left lateral-right lateral-prone positioning with 2-hour rotations), while the intervention group underwent additional LUS examinations every 12 hours for dynamic posture adjustment based on pulmonary findings. Outcomes included LUS signs (pleural line abnormalities, A-line disappearance, B-line increases, cystic hyperaeration, alveolar-interstitial syndrome, consolidation) and primary endpoints (post-diagnosis oxygen therapy duration, invasive mechanical ventilation duration, and hospital stay). Secondary outcomes comprised new complications (pulmonary hemorrhage, necrotizing enterocolitis, BPD-associated pulmonary hypertension, grade Ⅲ-Ⅳ intracranial hemorrhage, retinopathy of prematurity). Intergroup comparisons used two independent samples t-tests and Chi square tests. Results:Among 49 eligible neonates, 47 were randomized (intervention group=24; control group=23), with 40 completing the study (20 per group after exclusions). At day 7, the intervention group showed significantly lower rates of pleural line abnormalities [55% (11/20) vs. 90% (18/20), χ2=6.14, P=0.013], A-line disappearance [50% (10/20) vs. 80% (16/20), χ2=3.95, P=0.046], B-line increases [50% (10/20) vs. 85% (17/20), χ2=5.58, P=0.018], alveolar-interstitial syndrome [65% (13/20) vs. 95% (19/20), χ2=5.62, P=0.017], and consolidation [50% (10/20) vs. 80% (16/20), χ2=3.95, P=0.046]. The intervention group also demonstrated shorter invasive ventilation [(9.5±2.3) vs. (11.6±3.5) days, t=2.18, P=0.035] and hospital stay [(58.9±4.9) vs. (63.2±6.4) days, t=2.33, P=0.025] post-diagnosis, with no significant differences in new complication rates (all P>0.05). Conclusion:LUS-guided postural management improves pulmonary pathology, reduces respiratory support duration and hospitalization, without increasing complications in grade Ⅲ BPD neonates.

Energy metabolism reconstruction is the new target of the treatment of heart failure. By combing the researches of Chinese medicinals for energy metabolism reconstruction of heart failure， it was found that Chinese medicinal compound formula and single Chinese medicinal have a certain role in regulating energy metabolism， mainly through three aspects， including the optimization of substrate utilization， improvement of mitochondrial structure， function， and homeostasis， and improvement of mitochondrial energy transport， so as to make the energy metabolism of the cardiomyocyte adjusted in the direction of beneficial to the organism， increasing the supply of energy， and improving the cardiac function.