This paper summarizes professor LI Guolie's clinical experience in treating orthostatic hypotension （OH） based on the theory of "raising the clear and directing the turbid downward". It is considered that the core pathogenesis of OH lies in the body's transition from a supine to an upright position， during which dysfunction of the middle jiao （焦） transformation and transportation， along with impaired pivot function， hinders the ascending of clear yang and the descending of turbid yin. Treatment should follow the general principle of "ascending the clear and directing the turbid downward"， placing emphasis on distinguishing the primary and secondary aspects. For cases where the clear yang fails to ascend， the self-formulated Li's Shengqing Jiangzhuo Decoction （李氏升清降浊汤）is used to supplement qi， raise the clear， and strengthen the middle jiao. For cases where the turbid yin fails to descend， the self-formulated Wuxiang Qingzhuo Beverage（五香清浊饮）with modifications is applied to resolve phlegm， eliminate stasis， harmonize the middle， and descend the turbid.

This paper summarizes professor LI Guolie's clinical experience in treating orthostatic hypotension （OH） based on the theory of "raising the clear and directing the turbid downward". It is considered that the core pathogenesis of OH lies in the body's transition from a supine to an upright position， during which dysfunction of the middle jiao （焦） transformation and transportation， along with impaired pivot function， hinders the ascending of clear yang and the descending of turbid yin. Treatment should follow the general principle of "ascending the clear and directing the turbid downward"， placing emphasis on distinguishing the primary and secondary aspects. For cases where the clear yang fails to ascend， the self-formulated Li's Shengqing Jiangzhuo Decoction （李氏升清降浊汤）is used to supplement qi， raise the clear， and strengthen the middle jiao. For cases where the turbid yin fails to descend， the self-formulated Wuxiang Qingzhuo Beverage（五香清浊饮）with modifications is applied to resolve phlegm， eliminate stasis， harmonize the middle， and descend the turbid.

Residual inflammatory risk （RIR） is a key issue to be urgently addressed in the secondary prevention of atherosclerotic cardiovascular disease （ASCVD）. Targeted intervention of RIR has become a novel target for drug development and clinical management. A series of high-quality randomized controlled trials （RCTs）， including COLCOT， LoDoCo2 and CLEAR SYNERGY， provided high-level evidence and confirmed that low-dose colchicine （0.5 mg/d） significantly reduced the risk of cardiovascular events in ASCVD patients at stable stage or after the acute phase， while its efficacy varied in different clinical scenarios. International authoritative guidelines from the European Society of Cardiology and the American Heart Association/American College of Cardiology include low-dose colchicine in the recommendations for ASCVD secondary prevention. Two domestic guidelines released in 2024， namely the Guideline for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndrome （ 2024 ） and the Guideline for the Diagnosis and Management of Chronic Coronary Syndrome in China ， have also added relevant recommendations. Nevertheless， due to potential racial differences， safety concerns regarding drug-drug interactions， and the relative lack of clinical evidence in China， especially the absence of prospective RCTs using low-dose colchicine for secondary prevention of ASCVD patients， current clinical recommendations still mainly based on international evidence and guidelines， and should not be simply extrapolated.

Objective To evaluate the therapeutic effect of Shenfu injection in shock patients by using bedside critical ultrasound.Methods A total of 80 shock patients admitted to First Hospital of Nanchang from January 2022 to May 2024 were selected and divided into Shenfu group(45 cases)and control group(35 cases)according to whether Shenfu injection was applied.Patients in control group were given conventional western medical treatment,while patients in Shenfu group were treated with Shenfu injection in addition to control group.The ultrasound measurement indicators and clinical results were recorded on the 1st,3rd,and 7th days of treatment respectively,and left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),peak velocity of early diastolic flow of mitral valve(E)/peak velocity of early diastolic motion of mitral annulus(E'),tricuspid annular plane systolic excusion(TAPSE),right ventricular fractional area change(RVFAC),inferior vena cava variation rate(IVCV),heart rate(HR),mean arterial pressure(MAP),N-terminal pro-brain natriuretic peptide(NT-proBNP),lactic acid(Lac),sequential organ failure assessment(SOFA)score and 30-day survival status of two groups of patients was compared.Results After 1 day,3 days and 7 days of treatment,LVEDD and E/E'of two groups of patients gradually decreased,while LVEF,TAPSE,RVFAC and IVCV gradually increased significantly(P＜0.05).After 7 days of treatment,the LVEF,TAPSE,RVFAC and IVCV of patients in Shenfu group were significantly higher than those in control group(P＜0.05).After 7 days of treatment,the HR,NT-proBNP,Lac and SOFA scores of two groups of patients were significantly lower than those before treatment in same group,and the MAP was significantly higher than that before treatment in same group(P＜0.05).The HR,NT-proBNP,Lac and SOFA scores of patients in Shenfu group were significantly lower than those in control group,the MAP was significantly higher than that in control group,and the mechanical ventilation time and the length of stay in intensive care unit were significantly shorter than those in control group(P＜0.05).Kaplan-Meier survival analysis showed that 30-day survival rate of patients in Shenfu group was significantly higher than that in control group(82.22％vs.54.28％,P＜0.05).Conclusion Bedside critical ultrasound showed that Shenfu injection could effectively improve ventricular systolic and diastolic function in shock patients,providing a valuable real-time assessment tool for shock treatment.

Aim To investigate the role and mechanism of KLHL21 gene in myocardial infarction(MI)of mice.Methods KLHL21 gene knockout(KO)mice were generated using CRISPR/Cas9 technology,and C57BL/6 wild-type mice were used as controls.Sixty KLHL21 KO mice and 60 wild-type mice were randomly divided into four groups:WT+Sham group(n=30),WT+MI group(n=30),KO+Sham group(n=30)and KO+MI group(n=30).Postoperative is-chemic and infarct areas were assessed using TTC and Evans Blue staining,myocardial injury markers were measured by ELISA,cardiac function was evaluated by ultrasound,and histological changes were examined using HE and Masson stai-ning.Western blot was used to detect proteins related to the nuclear factor-κB(NF-κB)signaling pathway.Results KLHL21 protein expression in the myocardial tissue of KO mice was significantly lower than that in WT mice.The infarct area in KO+MI mice was significantly larger than that in WT+MI group.KO+MI mice showed reduced cardiac function compared with WT+MI mice.HE staining revealed myocardial cell loss,liquefactive necrosis,nuclear fragmentation,and significant neutrophil infiltration,while Masson staining showed aggravated fibrosis in KO+MI group.Serum tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),creatine kinase-MB(CK-MB),and cardiac troponin Ⅰ(cTnⅠ)lev-els were significantly increased in KO+MI mice compared with WT+MI mice.Western blot analysis showed increased lev-els of phosphorylated inhibitor of nuclear factor-κB alpha(p-IKBα),P65,and P50,and decreased nuclear factor-κB al-pha(IKBα)in KO+MI mice.Conclusion KLHL21 gene plays a preventive role in myocardial infarction in mice,possibly through inhibition of NF-κB signaling pathway activation.

Objective To evaluate the therapeutic effect of Shenfu injection in shock patients by using bedside critical ultrasound.Methods A total of 80 shock patients admitted to First Hospital of Nanchang from January 2022 to May 2024 were selected and divided into Shenfu group(45 cases)and control group(35 cases)according to whether Shenfu injection was applied.Patients in control group were given conventional western medical treatment,while patients in Shenfu group were treated with Shenfu injection in addition to control group.The ultrasound measurement indicators and clinical results were recorded on the 1st,3rd,and 7th days of treatment respectively,and left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),peak velocity of early diastolic flow of mitral valve(E)/peak velocity of early diastolic motion of mitral annulus(E'),tricuspid annular plane systolic excusion(TAPSE),right ventricular fractional area change(RVFAC),inferior vena cava variation rate(IVCV),heart rate(HR),mean arterial pressure(MAP),N-terminal pro-brain natriuretic peptide(NT-proBNP),lactic acid(Lac),sequential organ failure assessment(SOFA)score and 30-day survival status of two groups of patients was compared.Results After 1 day,3 days and 7 days of treatment,LVEDD and E/E'of two groups of patients gradually decreased,while LVEF,TAPSE,RVFAC and IVCV gradually increased significantly(P＜0.05).After 7 days of treatment,the LVEF,TAPSE,RVFAC and IVCV of patients in Shenfu group were significantly higher than those in control group(P＜0.05).After 7 days of treatment,the HR,NT-proBNP,Lac and SOFA scores of two groups of patients were significantly lower than those before treatment in same group,and the MAP was significantly higher than that before treatment in same group(P＜0.05).The HR,NT-proBNP,Lac and SOFA scores of patients in Shenfu group were significantly lower than those in control group,the MAP was significantly higher than that in control group,and the mechanical ventilation time and the length of stay in intensive care unit were significantly shorter than those in control group(P＜0.05).Kaplan-Meier survival analysis showed that 30-day survival rate of patients in Shenfu group was significantly higher than that in control group(82.22％vs.54.28％,P＜0.05).Conclusion Bedside critical ultrasound showed that Shenfu injection could effectively improve ventricular systolic and diastolic function in shock patients,providing a valuable real-time assessment tool for shock treatment.

Aim To explore the predictive value of serum free triiodothyronine(FT3)on the long-term prognosis of patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods All the subjects were from a prospective cohort study(PRACTICE study).In this study,15 250 patients with coronary heart disease after PCI in the First Affiliated Hospital of Xinjiang Medical University were selected,and the clinical data,FT3 and creatinine were collected.All the subjects were followed up regularly,and the primary follow-up endpoints were all-cause mortality and cardiogenic mortality,the secondary endpoints were major adverse cardiovascular events(MACE)and major adverse cardiovascular and cerebrovascular events(MACCE).According to the admission criteria,3 109 patients were finally in-cluded in this study.According to the baseline value of FT3,patients were divided into normal FT3 group(FT3:3.65～6.8 pmol/L,1 446 cases)and low FT3 group(FT3＜3.65 pmol/L,1 663 cases).Kaplan-Meier analysis was used for survival analysis,and Log-rank test was used for survival comparison.Multivariate Cox regression analysis was used to e-valuate the risk factors of the follow-up results of the two groups.Results Compared with the normal FT3 group,all-cause mortality and cardiogenic mortality in the low FT3 group increased significantly(P＜0.05).Kaplan-Meier analysis showed that the cumulative risk of all-cause mortality and cardiogenic mortality increased in the low FT3 group(P＜0.05).Multivariate Cox regression analysis indicated that the risk of all-cause mortality increased by 1.639 folds in the low FT3 group(HR=2.639,95％CI:1.385～5.348,P=0.007),while no statistical difference was found in cardiogenic mortality after adjusting for multiple factors(P=0.125).Conclusion The decrease in serum FT3 levels has important predictive value for all-cause mortality after PCI in patients with coronary heart disease.

Objective To explore the clinical efficacy of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision in the treatment of primary palmar hyperhidrosis(PPH).Methods 84 patients with PPH from January 2018 to January 2022,were divided into the observed group[(inframammary approach,IMA)group,n=42]and control group[axillary approach(AA)group,n=42].The observed group was treated with ultra-micro 8.0 mm IMA single-port endoscopic thoracic sympathectomy(ETS),the control group used the traditional AA single-port ETS.The visual analogue scale(VAS)score,serum C-reactive protein(CRP),cortisol(Cor),interleukin-6(IL-6)levels,the postoperative cosmetic effect and compensatory hyperhidrosis of the two groups were compared.Results The VAS scores of 2,12 and 24 h after surgery in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);At 12 and 24 h postoperation,the levels of CPR,Cor,and IL-6 levels in both groups of patients were significantly higher than preoperation,but those in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);The total satisfaction rate of postoperative incision in the observation group was significantly higher than that of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference of the incidence of compensatory hyperhidrosis between the two groups(P>0.05).Conclusion The clinical efficacy of ultra-micro 8.0 mm IMA single-port ETS through areola incision in the treatment of PPH is good.Compared with the traditional axillary single-port thoracoscopic method,it has the advantages of small trauma,less bleeding,less patient pain,high safety and high patient satisfaction.It is worthy of clinical promotion and application.

Objectives:To observe the effectiveness and safety of recombinant human brain natriuretic peptide(rhBNP)for the treatment of patients with right heart failure caused by pulmonary arterial hypertension(PAH).Methods:A total of 421 patients with right heart failure caused by PAH who were hospitalized in Fuwai Hospital from January 2019 to June 2024 were retrospectively included in this study.All patients were treated with rhBNP on top of conventional therapy.24 h urine volume,body weight,liver and renal function index,electrolyte,uric acid,red blood cell distribution width(RBCDW),cardiac function,blood pressure and heart rate before and after the treatment of rhBNP were compared.Clinical symptoms,signs and the occurrence of adverse events during treatment were also observed.Results:Compared with baseline,after treatment with rhBNP,the 24 h urine volume increased.The levels of body weight,transaminase,total bilirubin,direct bilirubin,uric acid,RBCDW,systolic blood pressure,heart rate,and N-terminal pro-B-type natriuretic peptide significantly decreased(all P<0.05).There were no statistically significant differences in the levels of serum creatinine,and tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio(both P>0.05).Dyspnea and lower limbs edema were improved in 75.2%cases(227/302)and 66.9%cases(281/420)respectively.The incidence of adverse events and severe adverse events during rhBNP treatment were 1.2%(5/421)and 0.5%(2/421)respectively.Conclusions:Adding rhBNP on top of standard medication can effectively increase 24 h urine volume,reduce body weight,improve some prognostic indicators,improve the clinical symptoms and signs of heart failure without negatively affecting the renal function in right heart failure patients caused by PAH.Blood pressure should be closely monitored during the treatment process.

ObjectiveTo investigate the effect and mechanism of polysaccharide in water extract of Cyclocarya paliurus （CPWP） in inhibiting benign prostatic hyperplasia （BPH）. MethodsCPWP was obtained by heating reflux， aqueous extraction， alcohol precipitation， and freeze drying. The chemical composition and structural properties of CPWP were analyzed by high performance liquid chromatography with 1-pheny-3-methyl-5-pyrazolone pre-column derivatization and infrared spectroscopy. Male SD rats were randomly assigned into control， model， finasteride （ig 5 mg·kg^-1）， and low-， medium-， and high-dose （ig 50， 75， 100 mg·kg^-1） CPWP groups， with 8 rats in each group. The BPH model was established by subcutaneously injecting propionate testosterone in castrated rats. The rats in the drug intervention groups were administrated with corresponding drugs， and those in the control group were administrated with an equal volume of normal saline each day. After 30 consecutive days， the rats were sacrificed， and the prostate tissue was separated and weighed. The effects of drug interventions on the body weight， prostate wet weight， and prostate index of rats were examined. The prostate tissue was stained with hematoxylin-eosin （HE） for observation of pathological changes. Enzyme-linked immunosorbent assay was employed to measure the level of dihydrotestosterone （DHT）， and immunohistochemical staining was used to detect the expression of steroid 5 alpha-reductase 2 （SRD5A2） and Ki67 in the prostate tissue. ResultsCPWP was identified as a saccharide， with characteristic absorption peaks of saccharides. CPWP showed the total sugar content of 44.15% and molecular weight within the range of 5.5-78.8 kDa， being composed of mannose， rhamnose， galacturonic acid， glucose， galactose， xylose， and arabinose. Compared with the control group， the model group had significantly increased prostate wet weight and prostate index （P<0.01）， thick and tall prostate epithelial cells， increased internal wrinkles， papillary expansion into the cavity， an elevation in DHT level in the serum， and up-regulated expression of SRD5A2 and Ki67 in the prostate tissue （P<0.05， P<0.01）. Compared with the model group， both the finasteride and CPWP groups showed decreases in prostate wet weight and prostate index （P<0.05， P<0.01）， thinned prostate epithelial cells， with only a small portion of internal wrinkles and papillary expansion into the cavity， shortened papillary protrusions， lowered DHT level in the serum， and down-regulated expression of SRD5A2 and Ki67 in the prostate tissue （P<0.01）. Moreover， CPWP exerted effects in a dose-dependent manner. ConclusionCPWP inhibits BPH by regulating the expression of SRD5A2.