Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Echinocandin B (ECB) is a key precursor of the antifungal drug anidulafungin. It is a secondary metabolite of Aspergillus nidulans, and its titer in fermentation is significantly affected by the ECB synthesis pathway and cell morphology. In this study, the key genes related to the transcription activation, hydroxylation, and cell morphology during ECB biosynthesis were investigated to increase the fermentation titer of ECB and to change the cell morphology of Aspergillus nidulans to reduce the viscosity of the fermentation broth. The results indicated that after overexpression of ecdB and ecdK, the ECB titer increased by 25.8% and 23.7%, respectively, compared with that of the wild-type strain, reaching (2 030.5±99.2) mg/L and (1 996.4±151.4) mg/L. However, the deletion of fksA associated with cell wall synthesis resulted in damage to the cell wall, affecting strain growth and product synthesis. The engineered strain overexpressing ecdB was fermented in a 50-L bioreactor, in which the ECB titer reached 2 234.5 mg/L. The findings laid a research foundation for the subsequent metabolic engineering of this strain.
Fermentation ; Aspergillus nidulans/genetics* ; Echinocandins/genetics* ; Bioreactors/microbiology* ; Fungal Proteins/biosynthesis* ; Metabolic Engineering

Objective A comprehensive evaluation of three kinds of closed triple therapy(fluticasone furoate,umeclidinium bromide and vilanterol trifenatate powder for inhalation,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol,beclometasone dipropionate,formoterol fumarate and glycopyrrolate inhalation aerosol)for stable maintenance treatment of chronic obstructive pulmonary disease(COPD)is conducted to provide reference for drug selection and rational clinical use in medical institutions.Methods Based on the Quick Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions(Second Edition),this study collected drug instructions,clinical guidelines,and relevant literature from databases such as China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database for Chinese Technical Periodicals(VIP),PubMed,Embase and Cochrane Library.Quantitative indicators were established to evaluate three inhalations that closed triple therapy formulations from five dimensions:effectiveness,pharmacological characteristics,safety,economy,and other attributes.Results The comprehensive scores of the formulations included in the evaluation are all above 80 points,among which the comprehensive score of fluticasone furoate,umeclidinium bromide and vilanterol trifenatate powder for inhalation is the highest at 89.2 points,followed by budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol at 87.6 points,and the lowest score of beclometasone dipropionate,formoterol fumarate and glycopyrrolate inhalation aerosol at 82.9 points.Conclusions All three formulations have shown good clinical efficacy,and different triple formulations have different advantages in clinical treatment.Through the comprehensive evaluation of three types of inhalation triple preparations,it can provide a reference for drug selection in medical institutions,and provide a basis for clinical scientific,rational,safe,and personalized medication.

Objective To analyze the value of abnormal expression of platelet membrane P-selectin(CD62p)and zonula occluden-1 in predicting the instability of carotid atherosclerotic plaques in elderly patients with cerebral infarction.Methods A total of 203 elderly patients with cerebral in-farction admitted to our department from March 2021 to July 2023 were enrolled,and based on their status of carotid plaques,they were divided into a unstable plaque group(45 cases),a stable plaque group(89 cases),a no-plaque group(69 cases).General information was collected,and the serum levels of CD62p and zonula occluden-1 were measured.The risk factors for carotid athero-sclerotic plaque instability and their predictive value were analyzed.Results Statistical differences were observed in the levels of low-density lipoprotein,homocysteine(Hcy),C-reactive protein,IL-6,fibrinogen,and intercellular adhesion molecule-1(ICAM-1)among the three groups(P＜0.05,P＜0.01),so were in the serum levels of CD62p and zonula occluden-1(P＜0.05).In the un-stable plaque group,the serum levels of CD62p and zonula occluden-1 were positively correlated with the levels of low-density lipoprotein,Hcy,C-reactive protein,IL-6,fibrinogen,and ICAM-1(P＜0.05,P＜0.01).In the stable plaque group,the serum levels of CD62p and zonula occluden-1 were positively correlated with the levels of low-density lipoprotein,Hcy,C-reactive protein,IL-6 and ICAM-1(P＜0.05,P＜0.01).Logistic regress analysis showed that the serum levels of low-density lipoprotein,Hey,C-reactive protein,IL-6,fibrinogen,ICAM-1,CD62p and zonula occlu-den-1 were risk factors for plaque instability(P＜0.01).ROC curve analysis indicated that the AUC value of CD62p and zonula occluden-1 in predicting plaque instability was 0.850 and 0.838,respectively(P＜0.01).Conclusion Abnormal expression of serum CD62p and zonula occluden-1 can effectively predict the instability of carotid atherosclerotic plaques in elderly patients with cer-ebral infarction.

Objective A comprehensive evaluation of three kinds of closed triple therapy(fluticasone furoate,umeclidinium bromide and vilanterol trifenatate powder for inhalation,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol,beclometasone dipropionate,formoterol fumarate and glycopyrrolate inhalation aerosol)for stable maintenance treatment of chronic obstructive pulmonary disease(COPD)is conducted to provide reference for drug selection and rational clinical use in medical institutions.Methods Based on the Quick Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions(Second Edition),this study collected drug instructions,clinical guidelines,and relevant literature from databases such as China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database for Chinese Technical Periodicals(VIP),PubMed,Embase and Cochrane Library.Quantitative indicators were established to evaluate three inhalations that closed triple therapy formulations from five dimensions:effectiveness,pharmacological characteristics,safety,economy,and other attributes.Results The comprehensive scores of the formulations included in the evaluation are all above 80 points,among which the comprehensive score of fluticasone furoate,umeclidinium bromide and vilanterol trifenatate powder for inhalation is the highest at 89.2 points,followed by budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol at 87.6 points,and the lowest score of beclometasone dipropionate,formoterol fumarate and glycopyrrolate inhalation aerosol at 82.9 points.Conclusions All three formulations have shown good clinical efficacy,and different triple formulations have different advantages in clinical treatment.Through the comprehensive evaluation of three types of inhalation triple preparations,it can provide a reference for drug selection in medical institutions,and provide a basis for clinical scientific,rational,safe,and personalized medication.

Objective To analyze the value of abnormal expression of platelet membrane P-selectin(CD62p)and zonula occluden-1 in predicting the instability of carotid atherosclerotic plaques in elderly patients with cerebral infarction.Methods A total of 203 elderly patients with cerebral in-farction admitted to our department from March 2021 to July 2023 were enrolled,and based on their status of carotid plaques,they were divided into a unstable plaque group(45 cases),a stable plaque group(89 cases),a no-plaque group(69 cases).General information was collected,and the serum levels of CD62p and zonula occluden-1 were measured.The risk factors for carotid athero-sclerotic plaque instability and their predictive value were analyzed.Results Statistical differences were observed in the levels of low-density lipoprotein,homocysteine(Hcy),C-reactive protein,IL-6,fibrinogen,and intercellular adhesion molecule-1(ICAM-1)among the three groups(P＜0.05,P＜0.01),so were in the serum levels of CD62p and zonula occluden-1(P＜0.05).In the un-stable plaque group,the serum levels of CD62p and zonula occluden-1 were positively correlated with the levels of low-density lipoprotein,Hcy,C-reactive protein,IL-6,fibrinogen,and ICAM-1(P＜0.05,P＜0.01).In the stable plaque group,the serum levels of CD62p and zonula occluden-1 were positively correlated with the levels of low-density lipoprotein,Hcy,C-reactive protein,IL-6 and ICAM-1(P＜0.05,P＜0.01).Logistic regress analysis showed that the serum levels of low-density lipoprotein,Hey,C-reactive protein,IL-6,fibrinogen,ICAM-1,CD62p and zonula occlu-den-1 were risk factors for plaque instability(P＜0.01).ROC curve analysis indicated that the AUC value of CD62p and zonula occluden-1 in predicting plaque instability was 0.850 and 0.838,respectively(P＜0.01).Conclusion Abnormal expression of serum CD62p and zonula occluden-1 can effectively predict the instability of carotid atherosclerotic plaques in elderly patients with cer-ebral infarction.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

This paper summarizes the exploration process and academic significance of the academic thought of Zhou Zhongying,a master of traditional Chinese medicine,who took the creation of a new system of TCM pathogenesis theory as the core,and interprets its theoretical connotation.As a pioneer in the construction of higher education textbooks for traditional Chinese medicine,Professor Zhou Zhongying created the outline of TCM internal medicine viscera differentiation,persisted in carrying out innovative research on patho-genesis theory,achieved fruitful academic results,and enriched and developed the academic system of TCM theory.In the clinical di-agnosis and treatment of exogenous febrile diseases and acute and difficult internal injuries,he systematically created new pathogenesis theories such as stasis-heat theory and cancer toxicity theory.Based on this,the legislation of medication can improve the clinical effi-cacy,and it is realized that identifying the pathogenesis is the key link in syndrome differentiation and treatment.In his later years,Professor Zhou Zhongying,guided by the holistic view,proposed the"thirteen pathogenesis"and constructed a new system of TCM pathogenesis differentiation,highlighting the guiding value of complex pathogenesis and the causal chain of pathogenesis elements to complex clinical diseases and syndromes,forming a theory with the idea of"examining syndromes and seeking pathogenesis,activating syndrome differentiation"as its soul.This theory breaks through the rigid thinking of syndrome differentiation and treatment based on a single pathogenesis or fixed syndrome type,reconstructs the theoretical framework of TCM with the idea of holistic view,and is a major academic innovation in modern TCM.

Objective: To explore the association between light intensity physical activity (LPA) and sedentary behavior (SB) with body composition, so as to provide data references for improving adolescent physical health. Methods: From August 2020 to January 2021, general information of 694 students in grade one of a high school in Foshan City was collected, and the 24 hour activity behavior and body composition of the students were measured objectively by triaxial accelerometer and bioelectrical impedance tester. Dual component multivariate regression and dual compositional isotemporal substitution model were used to explore the relationship between LPA and SB and body composition. Results: LPA was associated with lower fat relative dominance (FRD) (male weekends FRD=-21.44%, female weekly FRD=-17.83%, weekdays FRD=-18.27%, P <0.05), and LPA was also associated with higher muscle relative dominance (MRD) and bone relative dominance (BRD) (male weekends MRD=12.78%, BRD= 12.87 %; female weekly MRD=11.64%, BRD=9.01%; female weekdays MRD=12.02%, BRD=9.23%, P <0.05). Replacing sedentary behavior (SB) with 10 minutes of LPA could reduce fat proportion [male:weekly -0.15(-0.26--0.04), weekdays -0.12 (-0.22--0.02); female:weekly -0.18(-0.27--0.08), weekdays -0.16(-0.25--0.07)) and increase muscle proportion (male:weekly 0.14(0.03-0.24), weekdays 0.11(0.02-0.21); female:weekly 0.17(0.07-0.26), weekdays 0.15(0.07-0.24)]. Conclusion Interrupting continuous SB with LPA can serve as an intervention measure to promote physical health and fitness in adolescents. School should encourage students to engage in frequent LPA during breaks and after school activities, while avoiding prolonged SB.