Objective To study the relationship of serum 25-hydroxyvitamin D3[25-(OH)D3],myostatin(MSTN),limb skeletal muscle index(ASMI)with osteopenia(OP)in patients with rheumatoid arthritis(RA)complicated with sarcopenia(SA).Methods A total of 244 RA patients selected as case group,and 123 healthy people who underwent physical examination in our hospital during the same period were selected as control group.The general data,serum levels of 25-(OH)D3,MSTN,ASMI and peripheral blood immune cells were compared among the two groups.The diagnostic value of serum 25-(OH)D3,MSTN and ASMI in RA patients with SA complicated with OP and the correlation between serum 25-(OH)D3,MSTN,ASMI and peripheral blood immune cells were analyzed.Results The levels of serum 25-(OH)D3,peripheral blood regulatory T lymphocyte(Treg)cells and ASMI in the case group were lower than those in the control group,while the levels of serum MSTN,peripheral blood helper T lymphocyte 17(Th17)cells and Th17/Treg were higher than those in the control group(P＜0.05).Among the 244 RA patients,171 had no SA,73 had SA,and the incidence of SA was 29.92％.The levels of serum 25-(OH)D3,peripheral blood Treg cells and ASMI in the SA group were lower than those in the non-SA group,and the levels of serum MSTN,peripheral blood Th17 cells and Th17/Treg were higher than those in the non-SA group(P＜0.05).The levels of serum 25-(OH)D3,peripheral blood Treg cells and ASMI in the OP group were lower than those in the non-OP group,while the levels of serum MSTN,peripheral blood Th17 cells and Th17/Treg were higher than those in the non-OP group(P＜0.05).The area under the curve(AUC)of combined detection of serum 25-(OH)D3,MSTN and ASMI for the diagnosis of OP in RA patients with SA was higher than that of the three alone(P＜0.05).Serum 25-(OH)D3 and ASMI in RA patients with SA complicated with or without OP were negatively correlated with peripheral blood Th17 cell level and Th17/Treg(P＜0.05),and positively correlated with peripheral blood Treg cell level(P＜0.05).The level of serum MSTN was positively correlated with the level of Th17 cells and Th17/Treg in peripheral blood(P＜0.05),and negatively correlated with the level of Treg cells in peripheral blood(P＜0.05).Conclusion The incidence of OP in RA patients with SA is high.At the same time,the occurrence of SA and OP can lead to the decrease of serum 25-(OH)D3,peripheral blood Th17 cell,Th17/Treg and ASMI,and the increase of serum MSTN and peripheral blood Treg cell.The combination detection of 25-(OH)D3,MSTN and ASMI can effectively improve the diagnosis of OP in RA patients with SA,and the levels of the three are significantly correlated with peripheral blood Th17 cells,Treg cells and Th17/Treg.

Objective:To explore the impact of a staged trauma integrated treatment model based on information network platforms on the emergency treatment outcomes of patients with severe cranial injury.Methods:A convenience sampling method was used to select 80 patients with severe cranial injury treated at Yiwu Central Hospital from June 2023 to June 2024. Patients admitted from June to December 2023 were assigned to the control group ( n=37), while patients admitted from January to June 2024 were assigned to the intervention group ( n=43). The control group received conventional emergency treatment for cranial injury, while the intervention group received the staged trauma integrated treatment model based on an information network platform. The emergency response time (response time, triage time, emergency room treatment time, and handover time to the ward), National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, incidence of complications, and family satisfaction were compared between the two groups. Results:After intervention, the intervention group had shorter emergency response time, triage time, emergency room treatment time, and handover time to the ward compared to the control group, with statistically significant differences ( P<0.01). The NIHSS score in the intervention group was lower, and the GCS score was higher, with statistically significant differences ( P<0.05). The incidence of complications in the intervention group was lower, and family satisfaction was higher compared to the control group, with statistically significant differences ( P<0.05) . Conclusions:The staged trauma integrated treatment model based on an information network platform can optimize the emergency treatment process for severe cranial injury, shorten treatment times, improve hospital-to-hospital and interdepartmental coordination, reduce neurological damage and complication rates, and increase family satisfaction. It is worth promoting for clinical use.

Objective To study the relationship of serum 25-hydroxyvitamin D3[25-(OH)D3],myostatin(MSTN),limb skeletal muscle index(ASMI)with osteopenia(OP)in patients with rheumatoid arthritis(RA)complicated with sarcopenia(SA).Methods A total of 244 RA patients selected as case group,and 123 healthy people who underwent physical examination in our hospital during the same period were selected as control group.The general data,serum levels of 25-(OH)D3,MSTN,ASMI and peripheral blood immune cells were compared among the two groups.The diagnostic value of serum 25-(OH)D3,MSTN and ASMI in RA patients with SA complicated with OP and the correlation between serum 25-(OH)D3,MSTN,ASMI and peripheral blood immune cells were analyzed.Results The levels of serum 25-(OH)D3,peripheral blood regulatory T lymphocyte(Treg)cells and ASMI in the case group were lower than those in the control group,while the levels of serum MSTN,peripheral blood helper T lymphocyte 17(Th17)cells and Th17/Treg were higher than those in the control group(P＜0.05).Among the 244 RA patients,171 had no SA,73 had SA,and the incidence of SA was 29.92％.The levels of serum 25-(OH)D3,peripheral blood Treg cells and ASMI in the SA group were lower than those in the non-SA group,and the levels of serum MSTN,peripheral blood Th17 cells and Th17/Treg were higher than those in the non-SA group(P＜0.05).The levels of serum 25-(OH)D3,peripheral blood Treg cells and ASMI in the OP group were lower than those in the non-OP group,while the levels of serum MSTN,peripheral blood Th17 cells and Th17/Treg were higher than those in the non-OP group(P＜0.05).The area under the curve(AUC)of combined detection of serum 25-(OH)D3,MSTN and ASMI for the diagnosis of OP in RA patients with SA was higher than that of the three alone(P＜0.05).Serum 25-(OH)D3 and ASMI in RA patients with SA complicated with or without OP were negatively correlated with peripheral blood Th17 cell level and Th17/Treg(P＜0.05),and positively correlated with peripheral blood Treg cell level(P＜0.05).The level of serum MSTN was positively correlated with the level of Th17 cells and Th17/Treg in peripheral blood(P＜0.05),and negatively correlated with the level of Treg cells in peripheral blood(P＜0.05).Conclusion The incidence of OP in RA patients with SA is high.At the same time,the occurrence of SA and OP can lead to the decrease of serum 25-(OH)D3,peripheral blood Th17 cell,Th17/Treg and ASMI,and the increase of serum MSTN and peripheral blood Treg cell.The combination detection of 25-(OH)D3,MSTN and ASMI can effectively improve the diagnosis of OP in RA patients with SA,and the levels of the three are significantly correlated with peripheral blood Th17 cells,Treg cells and Th17/Treg.

Objective:To explore the impact of a staged trauma integrated treatment model based on information network platforms on the emergency treatment outcomes of patients with severe cranial injury.Methods:A convenience sampling method was used to select 80 patients with severe cranial injury treated at Yiwu Central Hospital from June 2023 to June 2024. Patients admitted from June to December 2023 were assigned to the control group ( n=37), while patients admitted from January to June 2024 were assigned to the intervention group ( n=43). The control group received conventional emergency treatment for cranial injury, while the intervention group received the staged trauma integrated treatment model based on an information network platform. The emergency response time (response time, triage time, emergency room treatment time, and handover time to the ward), National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, incidence of complications, and family satisfaction were compared between the two groups. Results:After intervention, the intervention group had shorter emergency response time, triage time, emergency room treatment time, and handover time to the ward compared to the control group, with statistically significant differences ( P<0.01). The NIHSS score in the intervention group was lower, and the GCS score was higher, with statistically significant differences ( P<0.05). The incidence of complications in the intervention group was lower, and family satisfaction was higher compared to the control group, with statistically significant differences ( P<0.05) . Conclusions:The staged trauma integrated treatment model based on an information network platform can optimize the emergency treatment process for severe cranial injury, shorten treatment times, improve hospital-to-hospital and interdepartmental coordination, reduce neurological damage and complication rates, and increase family satisfaction. It is worth promoting for clinical use.

ObjectiveChronic heart failure （CHF） is the terminal stage of cardiovascular disease. The adverse cardiovascular events of CHF patients with weakness have increased significantly. Traditional Chinese medicine （TCM） has a good effect on CHF. However，there are few reports on the clinical observation of the treatment of CHF with weakness in elderly patients by TCM combined with conventional health-preserving exercises. This study aimed to explore the clinical efficacy of Qiangxin decoction combined with Baduanjin in the treatment of elderly patients with CHF and weakness. MethodSixty CHF patients with Qi deficiency，blood stasis，and water retention syndrome admitted to the Cardiovascular Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2020 to December 2021 were enrolled. The patients in the control group were treated with conventional western medicine according to the guidelines，while those in the treatment group received additional Qiangxin decoction and Baduanjin exercise based on the therapeutic protocol of the control group. The levels of serum N-terminal B-type brain natriuretic peptide precursor （NT-proBNP），creatine kinase （CK），lactate dehydrogenase （LDH），free fatty acid （FFA），left ventricular ejection fraction （LVEF），left ventricular end-diastolic dimension （LEVDD），6-minute walk distance （6MWD），Minnesota Living with Heart Failure Questionnaire （MLHFQ）， and Tilburg Frailty Indicator （TFI） scores of the two groups were observed before and one month after treatment. At the same time，the re-admission within three months was compared between the two groups. ResultThere was no significant difference between the two groups in terms of the general data and the therapeutic indexes before treatment. After treatment，the NT-proBNP，CK，LDH，FFA，LVEDD，MLHFQ， and TFI scores of the two groups were lower than those before treatment（P<0.05，P<0.01）， and the LVEF and 6MWD were higher（P<0.05，P<0.01）. The efficacy of the treatment group was superior to that of the control group after treatment （P<0.05，P<0.01）. The re-admission rate within three months in the treatment group was 7.1% （2/28）， lower than 30.8% （8/26） in the control group （χ²=4.897，P<0.05）. ConclusionQiangxin decoction combined with Baduanjin is helpful to improve the body energy metabolism，heart function，quality of life，and weakness level of elderly CHF patients with weakness， and reduce the rate of re-admission.

Objective:To investigate the clinical efficacy of modified Guipi Decoction combined with omeprazole in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB) with failure of the spleen to control blood vessels syndrome.Methods:Prospective cohort study. A total of 120 patients from January 2018 to December 2021 Taihe County Hospital of Traditional Chinese Medicine with ANVUGIB of failure of the spleen to control blood vessels syndrome were selected, and the patients were divided into observation group and control group according to the random number table method, with 60 cases in each group. The control group was treated with a large dosage of proton pump inhibitor (omeprazole injection was injected intravenously first, and then omeprazole enteric coated tablets were taken); the observation group took Guipi Decoction on the basis of the control group, and both groups were treated for 7 days. TCM syndrome score, Hemoglobin (Hb) and hematocrit (HCT) levels were measured by colorimetry before and after the treatment. BUN was detected by urease glutamate dehydrogenase method. Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) levels were detected by immunoturbidimetry. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results:Two patients in the observation group and two patients in the control group dropped out of the study. After treatment, the scores of main symptoms, secondary symptoms and total scores in the observation group were lower than those in the control group ( t values were respectively 10.73, 4.45, 7.98, P<0.05). After treatment, the levels of HCT [(41.25 ± 5.03)% vs. (38.19 ± 5.26)%, t=2.95], Hb [(81.09 ± 5.23) g/L vs. (78.39 ± 5.37) g/L, t=2.74] in the observation group were higher than those in the control group ( P<0.01), and BUN [(4.38±0.96) mmol/L vs. (5.39 ± 1.13) mmol/L, t=5.19] was lower than that in the control group ( P<0.01); PT [(12.48 ± 0.67) s vs. (13.22 ± 0.73) s, t=5.69], APTT [(24.66 ± 2.29) s vs. (27.78 ± 2.04) s, t=7.75] were lower than those in the control group ( P<0.01), and FIB [(3.68 ± 0.62) g/L vs. (3.41 ± 0.74) g/L, t=2.13] level was higher than that in the control group ( P<0.05). The total effective rate of the observation group was 93.1% (54/58), and that of the control group was 79.3% (46/58), with statistical significance ( χ2=4.64, P=0.031). During the treatment, the incidence of adverse reactions in the control group was 3.4% (2/58), while that in the observation group was 1.7% (1/58), without statistical significance ( χ2=0.34, P=0.559). Conclusion:High-dosage omeprazole treatment with the addition of internal administration of Guipi Decoction can significantly improve coagulation function, correct the signs and symptoms associated with insufficient blood volume in the body circulation, improve hemostatic efficiency, and reduce the risk of bleeding in patients with ANVUGIB, without increasing the risk of patient safety with the drug.

Responses to sedatives, analgesics and muscle relaxants vary among patients under general anesthesia, which could be ascribed to the disparities of clinical characteristics and genetic factors of individuals. Accumulating researches have indicated that gene polymorphisms of the receptors, transporters and metabolizing enzymes associated with anesthetics play a considerable role in their efficacy. However, a systematically summarized study on the mechanisms of gene polymorphisms on pharmacodynamics and pharmacokinetics of anesthetics is still lacking. In this paper, the recent researches on pharmacogenomics of sedatives, analgesics and muscle relaxants are comprehensively reviewed, and the contributions and mechanisms of polymorphisms to the differences of individual efficacy of these drugs are discussed, so as to provide guidance for the formulation of a rational anesthesia regimen for patients with various genotypes.

With the rapid development and adaptation of high-throughput sequencing in clinical settings, application of exome sequencing (ES) has been gradually expanded from pediatric to prenatal diagnosis in recent years. There is an urgent need to establish criteria for clinical grade ES in order to facilitate such a complex testing. The standardization of pre- and post-test consultation, quality control for sample processing process and validation of bioinformatics data analysis, and more importantly data interpretation and reporting, as well as appropriate reporting scope, is of great importance for health care stakeholders. To achieve this, a committee composed of a wide range of healthcare professionals has proposed an ES standard for prenatal diagnosis. This has provided expert opinion on the genetic counseling and reporting standards of prenatal ES for the purpose of applying ES technology in prenatal setting.

Objective To introduce the laparoscope_assisted modified Swenson transanal pull_through pro_cedure and analyze its clinical outcome for Hirschsprungˊs allied disease(HAD). Methods Thirty_six patients with HAD underwent this new procedure at the Pirst Affiliated Hospital of Harbin Medical University during October 2009 to March 2016. During laparoscope exam,biopsies were taken from rectum,sigmoid and descending colon for rapid frozen pathological biopsy slices. Then the affected colons were dissected to the left hemicolon. Subsequently,a sponge forcep was inserted into anus and the colon was pulled through the right below the peritoneal reflection. In order to prevent re_traction and mark the resection line,sutures were performed circumferentially both at the proximal and distal bowel wall. Between the circles,a full_thickness,circumferential incision of rectum was made. The proximal bowel was mobi_lized out through the anus to the laparoscope part. The distal end was dissected anteriorly 2. 5_3. 0 cm above the den_tate line. The posterior rectal wall was split medium longitudinally and dissected to 0_0. 5 cm above the dentate line, so as to make a full _thickness ＂V＂ _shaped anastomosis. Results Dostoperative anal function scores:33 cases (91. 7%)were excellent,3 cases(8. 3%)were good,and no grades were scored. Compared with preoperative,the anal canal rest pressure[(12. 93 ± 3. 17)kDa,(11. 19 ± 6. 50)kDa vs.(22. 03 ± 6. 23)kDa],length of anal canal high pressure area[(25. 46 ± 5. 56)mm,(21. 61 ± 5. 10)mm vs.(35. 26 ± 5. 05)mm],and rectal resting pressure [(0. 79 ± 0. 29)kDa,(0. 64 ± 0. 23)kDa vs.(1. 22 ± 1. 02)kDa]decreased significantly after 6 month∕1 year follow_up,and the differences were significant(all P〈0. 05). The length of anal canal high pressure area was different be_tween 6 months and 1 year follow_up(P〈0. 05). However,the static pressure of the anal canal and the rectum did not differ significantly(all P〉0. 05). All the patients were diagnosed as HAD on the basis of intraoperative frozen lice ex_amination and postoperative pathologic examination. Thirty_six patients were followed up,and the reported complica_tions included soiling in 1 case(2. 8%),enterocolitis in 2 cases(5. 6%),without complications. During mean follow_up time(3. 3 years),none of the patients relapsed. Conclusions Laparoscope_assisted modified Swenson procedure for HAD is a minimally invasive approach with satisfactory results.

Objective To investigate the target blood pressure level of restrictive fluid resuscitation in patients with traumatic hemorrhagic shock. Methods Sixty patients with traumatic hemorrhagic shock admitted to the First Affiliated Hospital of Bengbu Medical College from January 2016 to December 2018 were enrolled. All patients were resuscitated with sodium acetate ringer solution after admission. According to the difference of mean arterial pressure (MAP) target, the patients were divided into low MAP (60 mmHg ≤ MAP < 65 mmHg, 1 mmHg = 0.133 kPa), middle MAP (65 mmHg ≤ MAP < 70 mmHg) and high MAP (70 mmHg ≤ MAP < 75 mmHg) groups by random number table using the admission order with 20 patients in each group. Those who failed to reach the target MAP after 30-minute resuscitation were excluded and supplementary cases were deferred. The restrictive fluid resuscitation phase was divided into three phases: before fluid resuscitation, liquid resuscitation for 30 minutes and 60 minutes. The most suitable resuscitation blood pressure level was further speculated by monitoring the inflammatory markers and hemodynamics in different periods in each group of patients. Pearson correlation analysis was used to detect the correlation of variables. Results Before fluid resuscitation, there was no significant difference in hemodynamics or expressions of serum cytokines among the three groups. Three groups of patients were resuscitated for 30 minutes to achieve the target blood pressure level and maintain 30 minutes. With the prolongation of fluid resuscitation time, the central venous pressure (CVP), cardiac output (CO) and cardiac index (CI) were increased slowly in the three groups, and reached a steady state at about 30 minutes after resuscitation, especially in the high MAP group and the middle MAP group. The expressions of serum inflammatory factors in the three groups were gradually increased with the prolongation of fluid resuscitation time. Compared with the low MAP group and the high MAP group, after 30 minutes of resuscitation the middle MAP group was superior to the other two groups in inhibiting the expressions of pro-inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and promoting anti-inflammatory factors IL-10 [TNF-α mRNA (2-ΔΔCt):0.21±0.13 vs. 0.69±0.34, 0.57±0.35; IL-6 mRNA (2-ΔΔCt): 0.35±0.31 vs. 0.72±0.39, 0.59±0.42; IL-10 mRNA (2-ΔΔCt): 1.25±0.81 vs. 0.61±0.46, 0.82±0.53; all P < 0.05], but there was no significant difference in promoting the expression of IL-4 mRNA among three groups. At 60 minutes of resuscitation, compared with the low MAP group and the high MAP group, the middle MAP group could significantly inhibit the expressions of TNF-α, IL-6 and promote IL-10 [TNF-α mRNA (2-ΔΔCt): 0.72±0.35 vs. 1.05±0.54, 1.03±0.49; IL-6 mRNA (2-ΔΔCt): 0.57±0.50 vs. 1.27±0.72, 1.01±0.64; IL-10 mRNA (2-ΔΔCt): 1.41±0.90 vs. 0.81±0.48, 0.94±0.61; all P < 0.05]. Compared with the high MAP group, the middle MAP group had significant differences in promoting the expression of IL-4 mRNA (2-ΔΔCt: 1.32±0.62 vs. 0.91±0.60, P < 0.05). There was no significant difference in serum cytokine expressions at different time points of resuscitation between the low MAP group and the high MAP group (all P > 0.05). Correlation analysis showed that there was a strong linear correlation between MAP and mRNA expressions of TNF-α, IL-6, IL-10 in the middle MAP group (r value was 0.766, 0.719, 0.692, respectively, all P < 0.01), but had no correlation with IL-4 (r = 0.361, P = 0.059). Fitting linear regression analysis showed an increase in 1 mmHg per MAP, the expression of TNF-α mRNA increased by 0.027 [95% confidence interval (95%CI) = 0.023-0.031, P < 0.001], IL-6 mRNA increased by 0.021 (95%CI = 0.017-0.024, P < 0.001), and IL-10 mRNA increased by 0.049 (95%CI = 0.041-0.058, P < 0.001). Conclusions When patients with traumatic hemorrhagic shock received restrict fluid resuscitation at MAP of 65-70 mmHg, the effect of reducing systemic inflammatory response and improving hemodynamics is better than the target MAP at 60-65 mmHg or 70-75 mmHg. It is suggested that 65-70 mmHg may be an ideal target MAP level for restrictive fluid resuscitation.