Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Cardiac Rehabilitation ; Exercise Therapy ; Heart Failure/surgery* ; Heart Transplantation ; Humans

Applying Chinese medicine (CM) is an important strategy for malignant tumor treatment in China. One of the significant characteristics of CM is to treat diseases based on syndrome differentiation. For Western medicine, it is of important clinical significance to formulate guidelines for the diagnosis and treatment of cancer patients based on the characteristics of disease differentiation. In Chinese clinical practice, the combination of disease differentiation and syndrome differentiation is an important feature for cancer treatment in the past. Currently, molecular profiling and genomic analysis-based precision medicine optimizes the anticancer drug design and holds the greatest success in treating cancer patients. Therefore, we want to know which populations of cancer patients can benefit more from CM treatment if the theory of precision medicine is applied to CM clinical practice. So, we developed a novel diagnostic and therapeutic strategy "disease-syndrome differentiation-genomic profiling-prescriptions" for cancer patients by CM syndrome differentiation and precision medicine. As a result, this strategy has greatly enhanced the anti-tumor efficacy of CM and improved clinical outcomes for cancer patients with some gene mutations. Our idea will hopefully establish a novel approach for the inheritance and innovation of CM.
Antineoplastic Agents ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Medicine, Chinese Traditional ; Neoplasms/therapy* ; Precision Medicine ; Syndrome

Adult ; Cesarean Section/statistics & numerical data* ; China/epidemiology* ; Female ; Humans ; Pregnancy ; Pregnancy Outcome/epidemiology* ; Risk Factors ; Trial of Labor ; Young Adult

OBJECTIVETo investigate the effect of direct moxibustion at Ganshu (BL18) on the serum concentrations of tumor specific growth factor (TSGF) and tumor necrosis factor α (TNF-α) in a rat model with precancerous lesion of primary hepatocellular carcinoma (HCC), so as to explore the mechanism of moxibustion underlying improvement of HCC.

METHODSSixty male Wistar rats were randomly divided into control group (n=10), model group (n=20), prevention group 1 (n=15) and prevention group 2 (n=15). The normal rats were injected with physiological saline as blank control. At the same time, the rats of other three groups were injected with diethylnitrosamine to establish the HCC model. Direct moxibustion with grain-sized moxa was applied to bilateral Ganshu acupoint of the rats in the prevention group 1 (1 treatment course, 20 days) and prevention group 2 (2 treatment courses, 40 days), 5 doses for each acupoint, 0.5 mg/dose, once every other day. At each time point (before model establishment, the end of 1st course prevention, the end of 2nd course prevention and the end of model establishment), serum levels of TSGF and TNF-α were detected using enzyme-linked immunosorbent assay.

RESULTSCompared with the control group, there was a remarkably increase of serum TSGF and TNF-α contents in the model group at the end of the experiment (P<0.05). At the end of the 1st course of direct moxibustion, the contents of serum TSGF and TNF-α of rats in the prevention group 1 were significantly increased compared with that of the model group (P<0.05). At the end of the 2nd course of direct moxibustion, serum TSGF and TNF-α levels of rats in the model group were higher than the normal group with significantly difference (P<0.05), and the levels of TSGF and TNF-α in the prevention group 2 were significantly reduced in comparison with the model group (P<0.05).

CONCLUSIONIt was possible that direct moxibustion could inhibit precancerous lesion and postpone hepatocarcinogenesis, and the therapeutic effect of two courses were better than one course.

Acupuncture Points ; Animals ; Carcinoma, Hepatocellular ; blood ; Liver Neoplasms ; blood ; Male ; Moxibustion ; Neoplasm Proteins ; blood ; Precancerous Conditions ; blood ; Rats, Wistar ; Tumor Necrosis Factor-alpha ; blood

Objective:To construct recombinant lentiviral vectors harboring interference RNA ( RNAi ) targetting murine TNF-αgene,so as to lay the foundation on the RNAi gene therapy.Methods: Three small interfering RNA ( siRNA) sequences targeting murine TNF-αgene ( siRNA1,siRNA2,siRNA3) and negative-control siRNA were designed and synthesized.The inhibition effects of siRNAs on TNF-α,IL-1βand IL-6 secretion of LPS-stimulated RAW264.7 macrophages were observed using real-time PCR and ELISA methods.DNA oligo was designed and synthesized according to the most effective siRNA 2 sequence.The recombinant lentiviral shuttle plasmid expressing short hairpin RNA ( shRNA) was constructed and sequenced.The lentiviral shuttle plasmids with packaging plasmids were transfected into 293T cells to produce lentiviral particles.Results: ①The TNF-αmRNA relative expression levels of siRNA1, siRNA2 and siRNA3 were 0.24±0.01,0.16±0.02,0.19±0.01 respectively,significantly lower than that of negative control (0.95± 0.02) (F=531.3,P<0.001).The inhibition rates at mRNA level were 74.26%,83.09%,79.93%,respectively comparing with negative control.No significance was observed in IL-1βor IL-6 mRNA relative expression change after TNF-αsiRNA transfection ( P>0.05).②The TNF-αprotein expression levels of siRNA1,siRNA2 and siRNA3 were (23.95±1.21),(17.27±1.46),(19.07± 1.57)ng/ml respectively,significantly lower than that of negative control (35.37±2.93)ng/ml (F=18.1,P=0.000 6<0.001).The inhibition rates of protein expression were 32.29%, 51.16%, 46.08%, respectively comparing with negative control.③The PCR product electrophoresis showed that recombinant vectors yielded 343 bp fragments,non-constructed vectors yielded 306 bp fragments.DNA sequencing partially showed insertion sequence.④Lentiviral particles were obtained by transfecting 293T cells with recombinant lentiviral shuttle plasmids and lentiviral packaging plasmids.Cells grew well during virus production with strong fluorescence expression.The titer of concentrated virus was 2×106 TU/μl.Conclusion:The lentiviral vector harboring RNAi targeting murine TNF-αgene has been successfully constructed.

OBJECTIVETo explore the pathological mechanisms of Guizhi Decoction () syndrome and the therapeutic molecular mechanisms of the Guizhi Decoction, Mahuang Decoction (), Sangju Decoction ( ) and Yinqiao Powder (), as well as the potentially biological basis that Guizhi Decoction is most effective only for the patients with Guizhi Decoction syndrome in clinical practice.

METHODSWe first got serum samples from the patients suffering from both upper respiratory tract infection and Guizhi Decoction syndrome identified by the doctors of Chinese medicine (CM) in the clinic. Four formulas with therapeutic actions of pungent warmth or pungent coolness for superficial syndromes were chosen and four kinds of rat serum samples each containing one of the above-mentioned herbal formulas were collected, then the effects of Guizhi Decoction syndromes' patient serum as well as the effects of sera containing the formulas after being stimulated by the patient serum samples on both the mRNA expression of certain toll-like receptor (TLR) subtypes and the release of some inflammatory cytokines in RAW264.7 cells were tested and analyzed in vitro.

RESULTSThe expression of TLR-3, TLR-4 and TLR-9 mRNA among the 9 tested TLR subforms were up-regulated in the macrophages stimulated by the sera from untreated upper respiratory infection patients with the Guizhi Decoction syndrome (symptomcomplex). The products such as interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α and interferon (IFN)-β from stimulated macrophages through TLR signaling pathways were also increased correspondingly. Interestingly, the changes induced by the Guizhi Decoction syndrome patients' sera were masked significantly after the macrophages were incubated with the sera from donors treated with Guizhi Decoction. Similarly, the three other exterior-releasing formulas were all effective in reversing the up-regulated changes of certain TLR subforms to different degrees, but both the number of targeted TLRs and efficacy of them seemed to be inferior to that of Guizhi Decoction.

CONCLUSIONEvidence from these experiments might contribute to the scientific explanation of both the pharmacological mechanisms of Guizhi Decoction and also the CM theory that Guizhi Decoction is specifically prescribed for the treatment of Guizhi Decoction syndrome (The gearing formula to the symptom-complex).

Animals ; Cell Survival ; drug effects ; genetics ; Cytokines ; secretion ; Drugs, Chinese Herbal ; pharmacology ; Female ; Gene Expression Regulation ; drug effects ; Healthy Volunteers ; Humans ; Inflammation Mediators ; metabolism ; Inhibitory Concentration 50 ; Macrophages ; drug effects ; metabolism ; Male ; Mice ; Middle Aged ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Syndrome ; Toll-Like Receptors ; genetics ; metabolism

Objective To investigate the correlation between the paired inspiratory and expiratory quantitative CT and pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD).Methods A total of 84 patients with COPD were enrolled.For each patient,CT scan was performed in deep inspiration and expiration.Using automatic post-processing software,a three-dimension quantitative measurement was employed to assess the CT parameters of emphysema and air trapping.The correlation between CT and PFT was evaluated by the Spearman rank correlation test and multivariate linear regression analysis.Results The percent 1 [Perc1,(-984.28 ± 17.93) HU] and percent 15 [Perc15,(-948.35 ± 22.26) HU] from the CT parameters of emphysema were positively correlated with the forced expiratory volume in 1 second predicted (FEV1％,48.69 ± 23,47),the ratio of forced expiratory volume in 1 second over forced vital capacity [FEV1/FVC,(45.89 ± 15.36)％,r =0.454.-0.67,P ＜0.01],was negatively correlated with the ratio of residual volume to total]ung capacity [RV/TLC,(61.32 ±14.48)％].The other CT parameters of emphysema index (EI) and the parameters of air trapping,the change in relative lung volume with attenuation values from-860 to-950 HU [RVC-860--950,(17.66 ±22.36)％],the expiration to inspiration ratio of mean lung density (MLDex/in,0.93 ± 0.06),the expiration to inspiration ratio of lung volume(LVex/in,0.71 ± 0.14) had negative correlations with logFEV1 ％,FEV1/FVC (r=-0.48--0.69,P＜0.01) and positive correlations with RV/TLC (r =0.41-0.66,P ＜0.01).The further univariate linear regressions showed that EI,Perc1,Pere15,RVC-860--950,MLDex/in,LVex/in were correlated with the parameters of PFTs (R square values of the regression equation,ranged from 0.27 to 0.66,P ＜ 0.01).After the pairwise combinations of the parameters of emphysema and air trapping,multivariate stepwise regressions showed better R square values from 0.66 to 0.85.Conclusions CT parameters of emphysema and air trapping can reflect pulmonary function in COPD patients.The combinations of the two types of CT parameters are more correlated with the PFTs parameters.

Objective To evaluate efficacy in detecting lung nodules at low-dose CT(LDCT) by nodule enhanced viewing(NEV).Methods One hundred and twenty seven patients who were referred to undergo low-dose CT (LDCT) for the evaluation of pulmonary metastasis or screening lung cancer were selected randomly.Two radiologists with at least 10 years experience read the images with normal clinical reading speed to find actionable nodules ≤ 2.0 cm in maximum diameter,and their consensus result was referred as Standard.NEV was adopted to detect the pulmonary nodules.Two residents with experience of less than three years read first detected suspicious nodules and recorded reading time,first consensus and mean time were recorded.Then,they made second decisions on the images with the help of NEV and the results and the reading time were recorded and analyzed by using wilcoxon test.The sensitivity and accuracy of NEV,residents and residents with NEV were analyzed.Results Standard,resident,NEV and resident with NEV detected 570,404,768 and 593 lung nodules ≤2.0 cm in maximum diameter,respectively.More than 60％ nodules were less than 0.5 cm in maximum diameter.The performance of NEV in detecting nodules ≤2.0 cm as well as nodules ＜ 0.5 cm in maximum diameter was significantly higher than that of the resident(Z =-6.887,P ＜0.01 and Z =-7.235,P ＜0.01),and the performance of resident with NEV indetecting nodules ≤2.0 cm as well as nodules ＜ 0.5 cm in maximum diameter was significantly higher than that of resident without NEV (Z =-6.606,P ＜ 0.01 and Z =-6.657,P ＜ 0.01).The resident,NEV and the resident with NEV detected nodules ＜ 20 mm in maximum diameter with sensitivities of 61.4％,86.3％ and 95.3％,and with accuracy of 56.1％,58.1％ and 87.6％,respectively.The resident achieved sensitivities of 51.4％,88.1％ and 94.8％,and accuracy of 47.0％,56.9％ and 87.5％ for nodules ＜5 mm in maximum diameter,respectively.The resident,NEV and resident with NEV spent 120-444 s,85-262 s and 131-1512 s per case to read the CT scans,respectively.The reading time of resident with NEV in was significantly higher than that of resident without NEV(Z =-9.781,P ＜ 0.01).The resident spent 23 s per NEV mark.Conclusion NEV considerable improves the resident's performance in lung nodule detection,especially in maximum diameter ＜ 0.5 cm nodule detection.